Retrieval

We got 10 - way more than expected. I'm in a lot more pain than I expected to be, but I've got decent pain drugs on board (they even gave me fentanyl, vicodin, and morphine after I woke up). Apparently, they had to manipulate my ovaries a lot to get to them, which explains the pain.

I'm still pretty out of it, but pretty pleased with today's outcome.

Celebrity Status

I went to Ye Olde Fertility Clinic today for my interview with Local News Station #1 this morning. It went really well and J, the Marketing Supervisor Extraordinaire (MSE), for YOFC said I was awesome and hit all the best points possible. I don't like to brag, but... I rocked.

Seriously, if I get a DVD of it (the MSE at YOFC did promise me he'd do his best to deliver the goods) - I'll see if I can figure out how to upload it.

After the interview, I went down to meet with my nurse to sign papers in advance of tomorrow's retrieval. I disclosed to her the fact that I screwed up my trigger shot this morning... I mean, I didn't screw it up, but I was 15 minutes late (I knew this wasn't a problem, but I figured full disclosure was a good thing, right?). Anyway, she said it was completely inconsequential.

So I signed everything, educated her on the weird ways of Judaism, and as I was wrapping up, another nurse knocked on the door and told me that MSE wanted to know if I could stick around because Local News Agency #2 was on their way over and wanted to talk to me!

Well, golly! I'm in high demand!

I wasn't AS in love with this reporter and this one wasn't quite as, um, smart. But it went well, and I got to have a little more fun on camera. :)

And now I'm home and it's time to get ready for Shabbos.

I feel good about tomorrow. I think it'll be okay. I think we're going to get more eggs than expected. I think this cycle isn't going to be a bust. I hate even saying that. I hate that I'm actually putting optimism into print. I am so pissed off at myself that I'm allowing myself to make it publicly known that I have any hope, but I do.

So there.

Scheduled

Trigger Shot: 5:15am tomorrow morning (1/30/2009)
Nothing to eat after: 10:15am Saturday (1/31/2009)
Nothing to drink after: 1:15pm Saturday
Arrive at Ye Olde Fertility Clinic: 3:45pm Saturday
Retrieval time: 5:15pm Saturday (1/31/2009)

I was getting nervous - I hadn't heard from the clinic with a trigger time by 6:25pm. Their offices close at 5pm. I wasn't sure what to do. Should I wait for their call? Should I page the doctor on call? Should I figure it out by myself? What to do?

I called in reinforcements. I called Mel. I called Leah. I asked advice. Both advised I call the doctor on call, and though I felt ridiculous, I did have him paged. Not one minute after I got off the phone with the answering service, my cell phone rang and it was the OR Scheduler from Ye Olde Fertility Clinic with my trigger information. Crap. Anyway, at least I got all the information, right?

And so 15 minutes later when the doctor called back, he was very nice when I told him I got the information I needed. "Good luck," he said.

Good luck, indeed.

Trigger Time

Today's appointment was quite interesting. First of all, I had my old buddy, Dr. S. in monitoring. Also a medical student (maybe a resident? I'm unclear. Actually, she was introduced as Dr. So and So, so she must be a resident or fellow). I immediately gave him some crap about the lack of a mobile in Room 1 (I was in Room 4 today, but that's not the point). He assured me he's on it, and I told him that I swear if he doesn't take care of it by the end of this cycle, I'm getting one myself, hanging it myself, and sending him the invoice and he said that he had no problem with that. :)

"Hey, do you want to be on television?"
"What? huh?"
"Seriously, do you want to be on television?"
"I hardly think I'm interesting enough to be on television."
"Ohh, I wouldn't say that! You're not giving yourself enough credit here!" M (sonographer extraordinaire) chimed in.
"Seriously, I need someone who is doing an elective Single Embryo Transfer, and all the better if it's someone with HOMs."

So I made him a deal. I'd do his TV gig if he got a damn mobile in Room 1! I think it's a pretty sweet dealio, myself! And he agreed, so we're all set. Tomorrow, I'll be interviewed by a news station. Neat, huh? So much for keeping a low profile, though! I probably will not be disclosing the location of my blog. :)

(Turns out what the deal is ... is that they've been getting a lot of media requests since the octuplets were born to find out their stance on the whole thing. My clinic does a lot of eSETs... as far as I can figure, they do more than any other clinic in the area... and they're really trying to push that angle. My nurse thinks it's great because she's hopeful it will help get insurance companies to cover IVF when they didn't used to, etc. She has more faith than I do...)

Anyway, back to the appointment.

We're focused on:
Right: 25.2 (probably past it's prime), 19.1
Left: 19.3, 18.6

There are some smaller ones, but those are the ones we're counting on. I have in my head an idea of how many we might get above and beyond those 3 or 4 (based on the measurements we saw today), but I don't want to jinx it and I don't want to go all crazy, so we'll just go with 4 for now and be happy with anything above and beyond that. Trigger tonight. I don't yet know what time. Retrieval Saturday. This is a logistical nightmare, but my nurse is trying to find the least painful way around this.

And that's where things stand right now.

Waiting *updated*

Not ready to trigger, apparently. WHATEVER.

SuperDoc is this cute little South African Jewish man. My primary nurse is as Irish Catholic as you get. Me? I'm an Orthodox Jew. So SuperDoc loves to torture my nurse by peppering his notes to me with little Hebrew & Yiddish phrases. She can never pronounce them and certainly has no idea what "meshuga" or "shiksa" means.

So today he tells her that I should stay on the same dose tonight and come back for monitoring tomorrow.

"Are you frickin' kidding me?" I said.
"You're not ready to trigger, darlin'" my nurse replied.
"Oh for crying out loud. This is going to mean a Saturday retrieval."
"Or not. If I had to guess I'd say you're goint to trigger Friday, not Thursday. But that's just a guess."
"Friday? So a Sunday retrieval then. Hrm. I could work with that. But you know it's going to be a Saturday retrieval. He's doing this to me on purpose."
"He said to say something else to you, but you know he's just trying to make me look stupid, because you know I can't pronounce any of this..."
"Okay..."
"It says, 'peekoowa' I dunno... there's that 'ch' thing on the end. Then 'ne-' um. Peekooo. I don't know."
We went on like that for a while before I realized what she was saying.
"Are KIDDING ME? Pikuach Nefesh? Is that what he wrote? REALLY?"
"Yeah! Exactly! I knew you'd know what I was trying to say!"
"You know, that quiet, serene, calm little man is evil. EVIL. Do you know what he just told me?"
"Um, no? I have no idea!"
"He just told me I'm having retrieval on Saturday."
"Er..."
"Oh, he acts all quiet and and soft-spoken and sweet, but underneath it all? He's a little smartass, that one! And don't you forget it!"

(for the record, pikuach nefesh does not apply here, though that doesn't mean that there aren't halachically appropriate ways to be able to go to a retrieval on Shabbos - it's just a logistical nightmare)

Needless to say, this is not going to be fun at all if that's the way it plays out. But hey, maybe another day or two will get us to 8? Meh. We'll just have to see what happens, right? There's really not much we can do about it regardless. It's going to be the way it's going to be and it will either work or it won't.

Update: same dose = same dose as prescribed originally. I did tell my nurse about the accidental double dose. But no harm, no foul, and we'll just see what happens.

and yes, my doctor does have a sense of humor. And he certainly does think I still have a sense of humor. Little does he know.

Probably Six

Here's what I've got:

Right: 20.9, 15.6
Left: 16.9, 15.7, 16.3, 14.6
(Endo, 11.5)

Probably will get 6. Me? My gut says cancel. My husband says go forward. I'm sure, when I hear from him, that's what my doctor will say as well. Whatever. I know many people would be thrilled to pieces with 6. Over the moon. And I know that quality over quanity is what we're looking for, but I have no guarantees of quality right now. And I have no guarantees that if I had quantity right now that the quality would suck. It's not always one or the other.

Yes, I only need one. And yes, I'm only planning on transferring one. But I was NOT hoping to only have one available for transfer. Bah.

Pardon my French

So, um, I'm kind of an idiot.

So last night I was seriously considering taking no meds for two days until tomorrow's appointment and just throwing in the towel on this cycle. I meant it, too. But, as I said last night, I'm not a rebel. I'm a good girl who does what she's told.

Unfortunately, I'm also a tired girl, who's getting terrible headaches and therefore apparently can't keep everything straight.

I just took my Follistim and my Luveris. But. Um. I forgot that I'd taken it at 6pm between getting home from one appointment and rushing off to my evening class. Originally I'd been planning to just wait until after the class because I didn't think I'd have time (I didn't really have time, but I'd managed to squeeze it in, since 6pm is my normal time to take it and I do hate to be off schedule).

I completely forgot I took it at 6pm and stuck to my original plan to take it after class. Um. Whoops?

So my husband's a pharmacist, so I'm sitting there thinking that maybe he can impart some words of wisdom, or at least comfort. Maybe he can tell me that I'm not going to grow an eleventh toe or a third head (wait, um, how many heads do I have?), or turn purple with green spots because of this.

"So I did something really bad."
"Yeah?"
"You saw me take my meds just now?"
"Yeah..."
"I also took them at six."
*stifling a laugh, badly, I might add*
"Wow, your head must hurt like a motherf*cker."
"Yeah, um, thanks hon."

Given that overly empathetic response, and the obvious professional concern he had for my physical well-being, I can only assume that I will not die a gruesome death from this error on my part.

Whoopsie.

Now all I have to figure out is whether to own up to my error to the doc tomorrow...

Meh

Ovaries in pain.
I hate fertility drugs.
Head pounding also.

How's that for an early morning haiku? Technically Haiku starts in the very specific and moves to the very general. Or maybe the opposite. And it usually has to do with nature (hey, this is biology, right? That's nature, sort of) So my form sucks, but at least I've got the whole 5-7-5 thing going (which, by the way, is not a requirement for haiku - haiku simply has 17 or fewer syllables). So, to recap: lousy form, bad writing, but not bad for someone who can't stand even attempting haiku.

It's snowing. I love snow. It was snowing the day I had the IUI that worked. I mean the one that worked that did not result in a miscarriage. There was a big snow/ice storm that morning/previous night. It was Valentine's Day - a huge cliche except I don't celebrate Valentine's Day.

But I digress. I love snow. It's calming - soothing. Which brings me to tomorrow. If they see more than 4 or 5 favorable follicles, I won't cancel. If it's four I'll cancel. If it's 5 - I swear on all that is holy (I know I'm not supposed to do that), I'm flipping a coin.

I'm not feeling all zen about it, but I'm calm. I hate this. I hate every stinking second of this. This wasn't how this was supposed to go. This was supposed to be easy; straightforward. This was supposed to be simple. (not that this is ever easy - but at least this was supposed to be straightforward)

I remember sitting in SuperDoc's office after my 6th IUI. The one that was supposed to fail. I was sitting there for my 2nd IVF consult (I'd had an IVF consult right before my 4th IUI which was also not supposed to work, but did, though it ended in miscarriage). Anyway, I was talking to him and I said that I do realize that compared to many women who have been through this fertility gig I have had it pretty easy and haven't been through all that much. He looked at me earnestly, paused, and said, "Let's just say you've handled your burden with extraordinary grace."

You know what?

I'm tired of handling this with grace.

Rebellion

There was a piece of me that really didn't want to bother taking any of my drugs tonight. Or tomorrow. I seriously considered just coasting until Wednesday. Blowing it all off. Probably guaranteeing a cancelation, but at least eliminating the uncertainty.

But I'm not good at being a rebel, so, good girl that I am, I dutifully took my drugs, as planned. We'll see how things go on Wed.

Change in Plan

Update from SuperDoc - raise Follistim dose to 150IU. Back on Wednesday for monitoring. Wednesday is the worst possible day for me to deal with monitoring. My husband is going to work at 6:30am and I'm on duty at home until 7:30 and then have a myriad of other things to do. Dammit.

My nurse thinks we'll get 7, not 4. I guess we'll just see. I'm inclined to scrap the whole thing, frankly. This just hasn't been going as expected, but I guess - when has it ever?

Frick.

Calling all Assvice

Right: 19.6, 12.1
Left: 14.8, 13.1, 13.9, 13.4, 9.9, 9.8

Basically, my doctor is hoping that 19.6 just floats away and that MAYBE we'll get the others to grow enough by tomorrow to trigger. That would mean retrieval on Thursday, my 33rd birthday. And maybe get four eggs.

Four.

Originally, we were really worried about hyperstimming me. Don't get me wrong - I'm extremely happy that didn't happen. But... Four? Now, if I were forty, I'd take four joyfully. If I had premature ovarian failure, or even unexplained infertility, I'd take four. But I have frickin' PCOS, for crying out loud. Four?

What if we go through all this, retrieve four, at best, and then only 3 actually fertilize, and only one makes it to blast? Or what if none make it? Gah. There are too many "what ifs" involved here. I don't know what to do.

My doctor is inclined to go ahead with just four. But his original prediction of a 40-45% chance of pregnancy with an elective single embryo transfer (their normal rate of pregnancy with elective single embryo transfers is 67%) is now down to 30%. Me? I'm inclined to cancel. It just seems like an awful lot of work, time, money wasted for ... four.

I have three IVF cycles covered per live birth. If we cancel before retrieval, this doesn't count against my three. I get that I'm "only" on my first, but if that fails, I'm down to two. That's 30% down.

Oh, there was another option. We could have triggered today and converted to an IUI. Over my dead body. I would have been risking quadruplets if I'd agreed to that.

SuperDoc had students with him today, and while they were poking around at my ovaries I was being as lighthearted and joking away as I could. As he reviewed my previous cycle with them to see what they would think retrospectively, I mocked him a little "Oh no, this cycle will never work. We'll trigger you early, blow this cycle off - we know you're moving on next cycle anyway. No possibility you'll even get pregnant let alone with HOMs!" He said if I weren't back for more he might pay attention to me. A fair point. I apologized later to one of the students for being such a pain in the ass, but she said it was great comic relief.

SuperDoc was jovial and calming as always, but once I sat up, I got more serious and so did he. I wasn't happy. He was calm and seems comfortable with proceeding, but I feel like I'm being followed by a shadow. He did note that if we cancel and start over, we'll start my Follistim at 220 IUs and we'll be much more likely to see the 15 follicles we expected. Still, like I said, he's comfortable proceeding as is. Me? I'm not so sure.

I waffle. The Lupron sucks so badly I'd hate to think I took it for two weeks just to cancel.

Sigh.

Update: Thanks, Bean, for noting that I should double check my insurance - I did just that on my way out of the clinic this morning... I checked in with the financial counselor to find out what the financial implications of canceling would be and whether it would count against the three, and the long and the short of it is that each of the monitoring appointments would get billed separately to my insurance and I'd have my copayment for those and coinsurance for all the labwork. I had her double check to make sure that the cancelation would not count against the three cycles and it will not.

Another Update: the 19.6 is not the one. By Thursday, it'll be gone. Definitely good points for moving forward, but it's a lot of money I stand to lose.

Sigh *Update*

Not great news this morning. When I was doing IUI I never could get a dominant follicle to grow at the right time. Now I'm doing IVF and I don't want a dominant follicle and guess what I've got? Yep. That sucker is still growing and coming out on top. Lots of good medium ones, though, so maybe they'll just let that one go. I didn't like the looks of it and neither did the sonographer extraordinaire, M. No doctor in monitoring again today. I'm feeling the love, let me tell you.

Probably have to go back tomorrow, but will update more later when I hear from my nurse. But for now, not feeling the warm fuzzies.

Right: 17.0, 10.5, 8.1
Left: 12.5, 12.0, 10.9, 10.0, 7.7, 7.6

Yeah, not looking so hot. Possible they'll just let that 17 go and hope the others take over. But the risk with any dominant follicle is that it'll take over and suppress the others. Doesn't seem to be happening so far, but who knows. I suppose anything goes at this point. I also don't love the fact that I'm still not looking at a lot of follicles - considering my typical antral follicle counts, this is suprising (My typical antral follicle counts are in the thirties). I know it only takes one to work, but seriously, I have to have something to worry about, right?

Meanwhile, headaches still suck (possible sign that my estrogen is still in the crapper - typical for me), and my ovaries feel like they're the size of baseballs, though from the looks of today's monitoring that's probably not the case.

Update: My estrogen level is 226 (not great, but good rise from Thursday when it was 99). Meds stay the same, back tomorrow morning. Unfortunately, the only appointment time they had available meant canceling two meetings. Not good. Sigh.

I am not expecting great news tomorrow. Am hoping a doctor actually shows his or her face in monitoring, at least.

The Best Kind of Support

I had lunch with LJ today and feel a million times better than I did before I saw her. We talked about the evils of Lupron. This pervasive headache. The sleeplessness, but the everpresent exhaustion. The headaches. The moodiness. The headaches. It's torturous, really. "It's not just me, right?" It's totally the Lupron, she assured me. Thank God, I said, because I swear my husband's probably going to divorce me if this is the New Me.

We talked about the suckiness of the suckitude. She empathized. She provided support. She assured me that I would return to being a normal human being with emotional control. A good wife and mother who loves her husband. It would happen, she promised, once I wasn't on these god-forsaken drugs anymore. "But while you're on Lupron? You're a saint, your previously perfect husband can do nothing right. That's the way it is. He's evil, you're perfect. It's not you; it's the Lupron."

And I said, "And the worst part is, I don't get to drop my dose! No sirree. I'm still on 20 units a day! Most people get to drop to 5 when they start stims!"

Her face fell into a state of shock. She reached over and held my arm. "Oh my God!" she gasped. "Oh honey! I don't know how you're standing up! I started out at 10! I'm not exaggerating when I say I would have been entertaining thoughts of suicide on 20 units a day!"

And suddenly, it fell into perspective. The headaches that slice through my head like a piece of glass jutting diagonally through my skull. The bitchiness. The lack of an emotional thermostat. The inability to empathize with my husband. It's not (entirely) me.

I do hate whining about it. I know that I made a choice to do this. I know that I have children already. I know that I consciously decided that my family was not yet complete. I know, therefore, that I am the one choosing to bestow these side effects upon myself. But that doesn't make these piercing headaches any more pleasant. And it probably doesn't make my husband enjoy me any more than he would otherwise. I know I brought this on myself. I know that I could make it all stop by simply - stopping all the drugs, right now. It would all go away. And with it, my dreams would fade as well.

So I'm going to try to stop whining about these damn headaches. And I'm going to TRY to be nicer to my husband. And I'm going to TRY to stop worrying about being so tired. Because it IS true... I did bring this on myself.

But I make no promises.... because my head? really, really, really does hurt.

Monitoring and So-Called-Secondary Infertility

Man, I gotta tell you, I thought I missed those 7am monitoring appointments, but I was wrong. What the frick, man? This was a lot easier before when I could roll out of bed and drive there without any responsibilities at home before walking out the door. Not that I'm complaining, mind you. I most certainly am not. It's just different, this time.

A lot of people talk about the difference between their experiences with primary and secondary infertility. I don't think of it that way for me. For me, this is no different. I still suffer from exactly the same conditions of the primary infertility that sent me down this road the first time; I just happen to have children now. It's different than if I'd had no difficulty conceiving the first time around (i.e. no primary infertility) and then found myself afflicted with infertility in trying to have another child (suddenly found myself with unexpected secondary infertility). But for me, this so-called "secondary" infertility is merely an extension of the same, and I hate the distinction - it belittles the experience; makes it seem less valid in a way, and frankly, it isn't.

If anything, this experience is just as intense as the last one, but for different reasons. This time I pulled out the big guns, so while I may have been able to remain more emotionally detached (after all, if this fails miserably, can't I take some solace in what I do have waiting for me at home?) had I been doing IUIs - the stakes are higher this time. The drugs are more intense, the regimen is stricter, the attention to detail is greater. My emotional response is artificially inflated. My ability to focus on the myriad of details that I need to focus on is understandably reduced. My stress level is increased. It is simply a different experience.

Anyway, I had my monitoring appointment at seven frickin' o'clock this morning. Dracula only had to stab me once this time, though the little bugger dug around in there for a good bit. He reuses the same spot every time, because it's the only spot he can get a vein in. I swear I'm going to have the biggest darned bruise on that arm by the time this cycle is done. Then into an U/S room. Last time M (sonographer extraordinaire) walked in on me before I'd even gotten my skirt off, so I hurried out of my clothes and jumped up on the table, my heart racing and then sat... and sat... fortunately I had a good book with me (The Memory Keeper's Daughter, have you read it? I just started it, but it's captivating) And, in she walked.

Now, I hate to be the complainer and all (sarcasm), but seriously, I've been gone two years now. And in those two years, they still have not hung a mobile in Room 1. Dr. S. (not my doc) brags that he personally hung all of the mobiles in all of the U/S rooms, and good for him, but hello? Room 1 does not have a mobile. And every time I saw him in the two years that I went to Ye Olde Fertility Clinic, I congratulated him on his efforts to give women something pretty to look at in the U/S rooms, and then I gave him hell for not hanging one in Room 1. Now he's had two whole additional years to make this right and has he? NO!

Dr. S. was on call for monitoring today, but he didn't come into my room, so M got to hear my (good natured) rant about it. She told me to give him some crap about it - but I never saw him, unfortunately. Oh, but I'll get my chance! Oh yes I will! With the blogosphere as my witness, if I have to buy a mobile and hang it myself, by the time I'm done with Ye Olde Fertility Clinic, there will be a mobile in Room 1! (I was thinking maybe this one, what do you think?)

Anywhozit, M and I had a lovely conversation whilst she perused my ovaries. I love M - she is what makes Ye Olde Fertility Clinic entirely tolerable. M and my nurse, really. Love them both. We gave one of my follicles a stern talking to because I didn't like the looks of its dominance. So M poked it and told it to cut it out. She also warned the little buggers that they'd better turn into a singleton. And expressed a preference on sex (but I won't state that here lest my child someday find out that I had a preference).

I had four good sized follicles on either side, and a bunch of others that she counted but didn't measure (I lost count, can't remember). I feel like 8 good sized follicles at this stage of the game isn't a lot. It worries me, but it's also early, so we'll just have to see what they decide to do. The follicles are measuring:

Right: 11.5, 8.5, 8.7, and 6.9
Left: 8.1, 8.4, 8.1, and 6.6

I don't know yet what they'll do about my meds or next appointment. They'll either screw up and tell me to come in on Saturday (no can do, doc), or they'll let me wait until Sunday. It's possible that the compromise will be that I have to go back in tomorrow and back in on Sunday. We'll see. I used to be able to very accurately predict what they'd do to my medication doses after each monitoring appointment, but all bets are off on this one - I have absolutely no idea what they're going to do to me. I'm thinking they'll keep me the same? But who knows. For all I know they'll double it. (Kidding)

I hope I don't have to go in tomorrow. My kids have speech therapy at 7:30am. Gah.


P.S. Lupron headaches still suck mightily

Could You Do This Blindfolded?

As veterans of infertility treatment, we do so many injections that it becomes second nature. We can practically do them without thinking about them. We joke that we could probably do them blindfolded. Well, last night, I almost got my chance. I was in the middle of giving myself one of my two injections and... someone snuck up behind me and blindfolded me! No, wait, that's not right. Um... Oh right. I was in the middle of giving myself on of my two injections and... the power went out. And flickered back on. And off. And on. And off. And on... and off. And there it stayed. So I'm standing there with a needle hanging out of me wondering what to do, but what are you gonna do, right? So out it came, I found the cap, disposed of the needle appropriately, put everything away in the fridge and said, "Now what?"

Yeah.

So that brings me to last night's injections. Yes, this post is all backward. The fact that I even had injections to TAKE last night is news, isn't it? So I started stims last night. Because I had my Lupron evaluation yesterday morning. I got to Ye Olde Fertility Clinic in the morning and Dracula called me back for bloodwork. He only had to bite me twice to get any blood, poor thing. I think he was mortified that he missed, but that's not shocking. Eventually I got called in to an ultrasound room. No sooner am I in the room and close the door, but I start to unbutton my skirt and in walk M (sonographer extraordinaire) and SuperDoc.

Oh for crying out loud, M, give a girl a minute! M kicked SuperDoc out and turned her back while I bitched at her for rushing me (jokingly of course). "Well, welcome back, huh?" she said, bemusedly. "Yeah, thanks for the warm welcome! I guess you're the welcoming committee!" Anyway, apparently, my ovaries were sufficiently unperky (7 follicles on the right, 8 on the left... far less than usual), and my lining looked good, and my bloodwork must have looked just fine because I started stims last night - 125 IUs of Follistim and 37.5 IUs of Luveris.

There was a little bit of drama about the Luveris - The Luveris comes in 75 IU unit doses. I'm only taking 37.5 IUs, which is to say ... half a vial each night. So I casually said to my husband the other night, "I wonder if I'm supposed to waste half each night, or if I'm supposed to save the other half and take it the next night." My husband is a pharmacist, so he took a look at the packaging and said, definitively, "You need to waste it each night."

"Really? Are you sure? I'm not sure I'll have enough if I do that..."
"Yes, I'm absolutely positive. If you don't, it could start growing things. There are no preservatives in here. You need to waste it."
"Okay, I guess I'll just refill it if I run out."

So when my nurse called yesterday to tell me to start the Follistim and the Luveris, I confirmed that i was just taking half a vial of Luveris each night. "Yes, so put in 1cc of sterile water and mix the Luveris and then draw out half and put the rest in the fridge for the next night."

"Um, really? Because S said I couldn't do that..."

My nurse said they've been told for years you can do that and said that I'm more than welcome to refill it if that would make him happy or I could check with the pharmacy I filled it at, or whatever worked for us, but that they've never had a problem with it, etc. Oooookay.

Not really keen on getting a skin infection from a random bottle of Luveris, I thought maybe my husband (who works in a hospital and therefore doesn't work with a lot of fertility meds)... ANYWAY, I figured maybe I should call the pharmacist that specializes in this stuff. So I did and I explained that my pharmacist husband was a little jumpy about me reusing the vial, but that my nurse had told me to do so and what did THEY recommend?

"Well, I can't recommend that. You'd run the risk of an infection, and the manufacter doesn't recommend it either. I'm sure your doctor's office has never had a problem with it, which is why they say it's fine, but it's not something I can recommend."

So fine. Then my husband comes back with, "Well, you can put it in the fridge and tomorrow you can just look at it and see if the solution is clear or cloudy. If it's clear, you're good."

"Well, is that a definitive test?"
"No."
"Well, here's the thing, it's a $50 copay to refill it once vs. my personal safety here. $50 isn't cheap. It's an unlikely reaction I could have. $50 isn't cheap, but it's yet another $50 on top of all the other $50 copays we've paid for all the other medications. Sooner or later it adds up to real money. But it's $50 vs. the possibility of an infection..."
"Yeah. Refill the medication."

I mean, I'm not trying to be Ms. DramaRama here, but seriously. How stupid would I feel if I ended up with the creeping crud because of this?

Anywhozit, stims started last night. Still taking Lupron. Headaches still suck mightily. I haven't killed my husband yet, though, which is a positive sign. Back to the clinic on Thursday.

Good News, Bad News

You'll be happy to know my husband and I have kissed and made up, so to speak. We're all good. I no longer think he's the devil, though he probably thinks I am. Meh.

In less happy news, these headaches are killers. They suck. Seriously. LJ's right - Forget torture devices, Lupron should be used to get international spies to break.

Man this sucks.

7:45am appt. for monitoring tomorrow. My so-called "Lupron Evaluation." This time to ensure that, for once, my ovaries are NOT perky. This will be a switch. Fun!

Gah!

Okay, Really? Is all this emotion really necessary? Like the estrogen in the BCPs wasn't bad enough? I cried all day Monday, Tuesday, and most of Wednesday. My nurse pretty much said I could blame that on the estrogren in the pill. Whee! Hopefully, she said, things would be better on Lupron. I started Lupron Wednesday. Now, honestly? I don't feel any different on the Lupron (not so much with the crying, though, which is good). I feel completely normal. But my husband sure can't stop screwing up. And can it seriously ALL be him? (I mean, sure, it COULD be - but since he's a damn near PERFECT husband most of the time, I am going to pretend for ONE second that maybe, JUST maybe this could be the Lupron talking here - okay, now I'm done giving him any slack, yeah, it's all him and he's just a big old poopy head).

Anyway, we've been fighting since Thursday. And I will say, he started it and it was all his fault that we started fighting. But honest to murgatroid, in the six+ years that we've been married we have never had a fight that's lasted this long. Ever. I am quick to anger, but VERY quick to get over it (he's the opposite of me - very, very slow to anger, but takes a while to cool down). Now, he did say something to me that crossed a line, but the fact that I'm still not over it is a little ridiculous. And I'm sitting here telling myself to get the eff over it and yet? Not over it.

And hey, remember how I said I don't feel any different on the Lupron? I totally lied. I've got this ridiculous headache that won't go away. It's not a migraine. Migraines I can handle. It's this dumb sharp pain that ... I don't even know how to describe it. It feels like it's slicing diagonally through my head. I don't like it. Probably that is not helping my mood either.

I do not like being cross.

I do not like being whiny.

I do not like being so damn irritable and irrational.

I do not like that I can't just talk myself out of this one.

For the love of ALL that is holy, when is this going to stop?? Those of you who've been through an IVF cycle before... please clue me in. (Note that when I start stims, my Lupron dose will not be going down... it's staying at 20 units, but I'm not sure for how long... and then, of course, night of egg retrieval, I start estrace, so MORE ESTROGEN YAY!, and oh boy won't those PIO injections be fun??)

Hey, imagine if I'm still screaming at my husband when I have to start trusting him to be jabbing me with a 1 1/2 inch 22 guage needle in the ass? Oh yeah. I think I'd better go make nice with him. NOW.

You've Got Question(s), I've got Answer(s)

Lori asked, Why would you both need to take Doxycycline in the last year? That is just strange. No one ever cared if my husband took an antibiotic during our infertility journey.

Well, Lori, you got me. Now, I understand the reason to take Doxycycline during a cycle in general, but why on earth taking an antibiotic any old time at all in the last year matters is beyond me.

Per the Arizona Reproductive Medicine Specialists, Doxycycline, an antibiotic administered in pill form, is given to the male partner during the wife’s stimulation cycle to further reduce the low levels of bacteria that may be found in the semen and which may compromise the performance of the sperm during an IVF cycle.

Now, personally, I think it's a bunch of crap. I think there's a lot of voodoo in IVF cycles that's done just for the sake of "Well it helps a teeney weeney tiny percentage of patients, and it doesn't hurt any of the other patients, so we may as well make ALL of our patients do it." Like Progesterone in Oil injections, for example. Crap, absolute, complete crap for most patients. My perinatologist told me the literature absolutely does not support the routine use of PIO injections for IVF patients - and yet, virtually all IVF patients in the US are routinely tortured with these thick, awful, painful injections for weeks at a time. For what? For a theory that it can't hurt, and it might help.

Which brings me back to Doxycycline. Sure, there may be a VERY small percentage of patients whose male partners have low levels of bacteria in their semen which are causing issues with sperm performance or with implantation. And yes, it could be that taking Doxycycline during the stim cycle of a woman's IVF cycle helps reduce those low levels of bacteria. However, for most patients, those low levels of bacteria are completely normal and are causing absolutely no issues whatsoever. In this case, of course, what's the harm in taking five days of an antibiotic, just for kicks? Not much, unless you start getting into all the arguments of why one shouldn't needlessly take antibiotics willy-nilly.

So no harm, no foul, but I'm not all broken up about the fact that my nurse isn't making my husband take those darned pills.

And So It Begins

So although I was supposed to start taking my Lupron on Monday (whoops), a couple days isn't the end of the world (even though it DOES mean two more days of the evil BCPs!), so I was given marching orders to start taking it today. Of course, my protocol has me taking Lupron in the morning, and I didn't find out about this until, oh, 2 o'clock-ish.


No problem, because as much as the clinics all like you to *think* that the timing on these meds is super-duper important, the fact of the matter is, there's plenty of room to fudge it. So really, it's all good. Just for good measure, I emailed my nurse to make sure and she said it was fine to take it when I got home today, then take tomorrow's dose around noon, and then Friday's dose on my morning schedule. Fine. No problemo.


Meanwhile, technically speaking, I shouldn't have been allowed to have gotten any of this started, because technically speaking, they don't have my current pap smear on file (I just had that done this week, results aren't in yet), my ID bloodwork isn't back yet (I just had that drawn yesterday, and the labwork from The Hatchery hasn't been faxed over yet), etc. But they trust me. Heh. Oh, and then there's the fact that both of us are supposed to have taken doxycycline within the past year. I took Doxycycline in November before my HSG, so I'm covered. But they'd asked me if my husband had taken any sort of antibiotic in the last year and I'd said, "sure, I think so." He wasn't so sure, so I told my nurse that today and she said, "Yeah, we need to get right on that."

So anyway, I get home to take the Lupron. Bear in mind, I've never taken Lupron before. And we didn't take an injection class, because, seriously? Why would we? So I'm looking over the stuff, and it's a multi-dose vial, with insulin syringes, etc. Easy. Except then I start realizing I'm not sure I understand the unit of dosage. My instructions say 20 units. But what KIND of unit? I call my husband and ask if he's close to home. Fortunately, he's just pulled into the driveway. It is handy having a pharmacist for a husband. So he came down and explained to me like I'm a five year old that "unit" was exactly the word they'd intended to use because some medicines are measured in "units of activity" or some such thing. Whereas I'd thought they were using some nebulous, non-exact unit of measurement, it turned out, they were using the technical term, and if I'd looked at the syringe, I would have seen that the syringe also had things labeled as "units" so my minor panic attack was unwarranted.


He showed me how much to draw up and then stepped far away from the needle I was waving all around (sorry honey!) as I tried to remember how to do all this. Seriously, you'd think this was like riding a bike, right? I mean, one subcutaneous injection is just like any other, RIGHT? But it's been like 2 YEARS, people! And man, the needles on insulin syringes? They're way bigger than I remember. (I mean, they're not big, but they're way bigger than the follistim needles)


Anywhozit, aside from having to shoo my eldest away a few times, it went smoothly and in plenty of time to let my nanny go for the night. Tomorrow will be trickier because I'll have to take it at work since I'm supposed to take it at noontime, which presents two separate problems: first, now that it's been opened, the Lupron has to be refrigerated. We do have a refrigerator at work, but ... sheesh. Secondly, doing this in a cramped bathroom stall? Not my idea of fun. Nevertheless, it's not like I haven't done it before!


And now, the requisite IVF Med shot:


Not pictured is my Follistim Pen, which I forgot to include.

Lupron!

Turns out, my nurse had emailed me a protocol and Lupron start date... oh... Friday and Saturday. And she'd updated it on Monday. Turns out, I was supposed to have started the Lupron on Monday. Whoops.

See, and I hadn't wanted to be a big pest about it, even though on Friday she had said she was going to definitely work on the protocol and email it to me and sure had make it sound like she was going to have it that day. I just figured that she was getting push back from the doctor or the clinic calendar or something. And I feel like I pester her enough, so I hadn't wanted to keep bugging her.

Well, it turned out she'd been spelling my email address wrong, but it hadn't been bouncing back to her, so some other perky chick is getting emails about IVF protocols from some random nurse at Ye Olde Fertility Clinic wondering what the *bleeping bleep* this is all about!

Meanwhile, back at the ranch, I was supposed to have started Lupron on Monday. Um, whoops? That's okay, there was no frickin' way I could have picked up my drugs on Monday anyway. Monday was a cluster-*bleep* of a day, the worst possible of Mondays, and I was a total, blubbering mess, incapable of coping with life. (Hey! It turns out, that's thanks to the estrogen in the pill... isn't it going to be fun when I start taking estrace at egg retrieval time?? Whee!)

So I'm going to take the Lupron as soon as I get home (was supposed to be this morning). Then I'll take it around noon tomorrow. And Friday I'll take it in the AM on schedule. This will get me back on schedule. And Friday will be the last day I have to take this God-forsaken BCP. The thing I'm REALLY bitter about is that if I'd known I was to start Lupron on Monday, TONIGHT would be my last BCP!! Gah.

Dear John

It's not you, it's me.

Heh. Actually, the break up with The Hatchery went better than I thought. The nurse happened to call me to see if I was still planning to start my IVF cycle in a week and a half. I didn't say, "Well, yes, but not with you!" I instead fudged the truth slightly and said that just that week my insurance had taken an odd little twisty turn and now I was on a plan that didn't cover them, and if I went to them it would be out of network, etc. etc.

She was super nice about it and said that it made a LOT more sense for me to go back to Ye Olde Fertility Clinic and told me to get my records (small as they are) sent back over to them and to let her know how things turned out, etc.

Such a lot of stress for nothing.

Meanwhile, BCPs are making me a blubbering mess, AND I'm all crampy and icky and having spotting/breakthrough bleeding, so I'm not even having the benefit of no period! Hello? The whole POINT of back to back pill packs is to avoid all of the PMSy period stuff! Gah. This is completely unfair.

But ... things are moving along. I got all my drugs for the IVF cycle yesterday. My copay for everything was $125. Not too shabby. And I've got refills on everything, which rocks. I still don't know when I'm supposed to start the Lupron. Waiting for that day is agonizing. Hello? When is that going to happen? SIGH.

They're Coming to Take Me Away!

Seriously, if BCP's make me this unstable, imagine how much fun I'll be when I start Lupron! Whee!

Not much of an Update

I talked to my nurse on Friday because there's been a bit of confusion about whether I should roll into a new BCP pack after my last active pill (yesterday) or take a five day break and start a new BCP pack, which would delay things by three weeks. Sigh. Rolling into a new pack would mean that I could get the ball rolling on Lupron as soon as all the ducks are in a row. Any day now, in other words.

It seems SuperDoc is driving my nurse crazy these days, leaving cryptic messages in her email for her, telling her I can start Lupron now, forgetting that she needs to have certain things in place first, etc. She has to have the go ahead on the schedule for a date that I'm allowed to start stims, because if they end up not having room on their schedule for retrieval... well, we're screwed, right? So just starting Lupron at will is not so easy. It's not as simple as him saying, "Yeah, go ahead and start." There's a lot of work on her part in the background.

So anyway, finally she concluded that I should just roll into another BCP pack until we could sort all this out. As soon as she can get me a stim start date, she'll get me a Lupron start date, and she'll call in my drugs to the pharmacy. Since my copay is based on the prescription, not on each vial, she'll make sure she calls in enough for the entire cycle, so that I won't need refills, etc.

Therefore, probably sometime next week you can expect me to start bitching about headaches, hot flashes, fluid retention, and general pissiness. Good luck with that. If I were a good person, I wouldn't bitch about any of that, I would simply be grateful for this opportunity to have another attempt at getting pregnant and bringing a life into this world. But I'm not a good person. I'll probably do plenty of bitching.

Meanwhile, my consents have been notarized. Seth's ID bloodwork has been done. Mine hasn't, but I'll hopefully take care of that on Monday. I haven't gotten my HSG results faxed over to Ye Olde Fertility Clinic from The Hatchery yet, but I'll get that done. I'm not sure exactly why I'm dragging my feet on that. There's no logical explanation for it, other than I'm really swamped in the rest of my life and I haven't gotten to it yet. Seriously, if you had ANY idea what else is going on in my life? You'd know there simply isn't time to breathe, let alone deal with making just one more phone call.

Oh, um, as part of getting my HSG results faxed over from The Hatchery, that would involve letting The Hatchery know that I'm leaving them. My Dear John letter, so to speak. I'm not good at that sort of thing, even though this is ostensibly an insurance decision (except that I technically have BOTH insurances right now, so I could go either place). I feel awkward about the whole deal, because I do like The Hatchery, but something feels right about going back to YOFC (several of you even noted that I sounded content, even giddy, after seeing SuperDoc, and you know? I was!)... so it's the right switch for me. And yet? Making that phone call? I haven't been able to bring myself to do it. (Remember that it's a very small office - one doctor, one nurse coordinator, one secretary... it's not like I can just call and talk to a random admistrative assistant who I won't know me from anyone)

Anywhozit, I know that's not much of an update. After all, I even entitled this post, "Not Much of an Update"... but that's what I've got.

Mock Turtle Soup

I had my mock embryo transfer. I now have a mock embryo on board. I will love him, and hug him, and call him George. I hope he will grow into a perfect little mock fetbryo some day.

But seriously, folks. It turns out, I still have a uterus. Go figure. And ovaries. And hey! My ovaries? They're stiiiiiiill perky! Who knew? And I once again got called meshuga by SuperDoc. He told the nurse who was there that I wanted to put back 5 embryos, but he talked me down to 4. Yeah. Something like that.

Anyway, if I can get my test results transfered over to Ye Olde Fertility Clinic from The Hatchery right quick, I should be able to get this show on the road really quickly. It's incredible how quickly YOFC moves.

I didn't ask SuperDoc about not doing the Lupron protocol - Dr. McB at The Hatchery was planning on using an antagonist protocol instead of a Lupron protocol to avoid OHSS. Dr. McB's belief is that Lupron is partly responsible for OHSS issues in patients with my profile. I thought about mentioning this theory to SuperDoc, but he is confident that he can keep my risk under control, and I am confident in his experience, and I don't feel like playing back-seat-doctor in his office right now. I am all set to start Lupron as soon as the doc gives the go ahead, which will be as soon as I have my pap smear, ID blood work, and HSG report all sent over from The Hatchery. Whoo Hoo.

Oh, and I confirmed financials with the insurance company last night. No preauthorization required. SuperDoc is an authorized in-network doctor, so I can just go ahead and do whatever I want. Copay is ridiculous - $40 per visit, $1500 coinsurance for the IVF, etc. But it could be much, much, much worse. I could have no coverage at all. Drug coverage is $50 per prescription, so my nurse is going to call in a LOT of medication, rather than making me get refills as I go along. I love her. :)

That is all. Love to all, from the perky one.

I had my consult...

...and all I have to show for it is a picture of a plastic uterus:


Okay, so I have a little more to show for it than THAT.

I met with Ye Olde Fertility Clinic this afternoon. SuperDoc called me back with a bit of a smirk on his face. He looked... bemused. I said, "I'll bet you never expected to see me again!" "No, no I most certainly did not!" I told him that if he could see the gorgeous smiles on my babies' faces every morning, he would know why I have to make more babies.

"Well," he said, "I'll tell you for sure, if you're serious, all I have to say is IVF with SINGLE embryo transfers; no discussion."

"You think??" I retorted. "Hello? I begged for IVF the last time around. I swore to you I'd end up with HOMs if I did IUI and from the looks of my ultrasound report from that day, I'm lucky I didn't end up with three or four more!"

He pulled up my charts on the screen and said that it was really out of the realm of possibility - my estrogen level was very low, so low, in fact, that the possibility of HOMs hadn't even been on the radar. This was also why they weren't concerned about me hyperstimming when I triggered - with estrogen that low, it wasn't a factor. This made me feel significantly better about what I'd found in the report, at least with regards to the risk of hyperstimming. I still maintain that if I'd ended up with HOMs, given the follicles that I had, low estrogen or not, I'm lucky I didn't end up with a few more.

Anyway, I told him I'd met with The Hatchery and that they've never done elective single embryo transfers - I'm petrified of that. Ye Olde Fertility Clinic does ~15% SETs in their cycles (and has a 67% pregnancy rate in those elective SETs - but that's because with elective SETs, generally you're dealing with a population of women who have lots of very high quality embryos to choose from. He predicts that my chances of pregnancy in an elective SET cycle are closer to 40%). I do have a 2% chance of having monozygotic twins in an SET. It does happen. But then we'd just know G-d has a sick and twisted sense of humor and that would be the end of that.

I'm doing my mock embryo transfer/sonohystogram tomorrow at 7:45am. I'll be starting on Lupron injections either this week or in a couple weeks, depending on what my nurse tells me in the next couple days. Then 125IUs of Follistim injections and 37.5 of Luveris (I have no experience with Luveris whatsoever - do any of you?). We'll likely be aiming for a 5 day transfer since with SETs they try to go to blast.

I have to send my HSG results from The Hatchery and my ID bloodwork from The Hatchery. My nurse is calling in my drugs to the pharmacy downstairs from their offices ASAP. We'll get everything rolling as soon as we can. My husband and I have a notary public coming over this week to get our consent forms signed (if they're not signed in the office, they have to be notarized. Since my husband and I are never in the office at the same time to sign the consents - a notary it is. Sigh. Big pain in the tushie.

And that's all the interesting news there is. Now I need to go to bed.

Randomosity

I feel really nauseated this morning. Every time I turn, I think I might throw up. My husband said, "Maybe you're pregnant..." He's smart enough to duck after he says such a thing. We've been married long enough and been through this infertility gig long enough for him not to be stupid about it at least...

A friend of mine is pregnant with spontaneous twins. She's a fertile myrtle. These will be her fourth and fifth children, complete surprises. I'm having trouble keeping the green eyed monster out of me. She was horrible to me when I told her about my HOM pregnancy. She laughed and laughed and refused to acknowledge the seriousness of the situation. She said after it was all over - "See, they're healthy, what were you ever worried about?" and refused to ever acknowledge that the fact that I almost lost them several times along the way could have any impact on my feelings about the matter. She refuses to accept the fact that a twin pregnancy for her could mean anything different than her normal completely uneventful singleton pregnancies, and I hope she's right, but she may not be. In her case, she's probably right though, which makes it even harder for me to keep that green eyed monster at bay. I'm trying to simply be happy for her, and I'm failing. I think the scars of infertility have left me simply jaded and bitter toward certain people, even though this happens to actually be one of the nicest people on the planet in all other matters (and she helped me TREMENDOUSLY throughout my pregnancy/bedrest/and early days of having the babies in the NICU with caring for my older son and bringing meals, etc).

I am seeing my old doctor at Ye Olde Fertility Clinic this afternoon. I am nervous, though I have no reason to be. Either I'll like what they say and I'll switch clinics, or I won't like what they say, and I'll move forward with The Hatchery. That is, after all, why I'm on BCPs with the plan to start an IVF cycle Jan 24th at The Hatchery just in case. One way or the other, it will work out.