Fall from Hope

On December 19th, the first day I started taking BCPs in preparation for my first IVF cycle, I wrote the following:

I know every woman starting an IVF cycle talks about the irony of taking birth control pills in order to get pregnant. I don't think for me that I find it ironic. I'm struck with a profound sense of - change. This feels like a big step toward my new goal. Toward my new hopes of family building.

I fear that the fall from hope will be devastating.

So today I went in for my beta from that very first IVF cycle, knowing full well that my beta would be negative. I brought with me cookies for J (Marketing Supervisor Extraordinaire, who reports that he has not yet even had a chance to eat my delicious snickerdoodles!), SuperNurse, and yes, even SuperDoc. The receptionist at the front desk was tickled pink when I left the box of cookies for SuperDoc, by the way. It was pretty adorable. I almost felt badly that I didn't leave any for her, but hopefully the good doctor will share (though rumor has it that he's quite the cookie monster, so who knows!?).

Two hours later, I got a call from SuperDoc himself.

"I'm sorry to say, I don't deserve the cookies. It wasn't the result I was hoping for; unfortunately, your beta was negative."
"Oh, I know that!"
"Really? How'd you know?"
"Please! You can't trust your patients not to pee on sticks! Plus I'm mighty certain my period is going to start any second now."
"Unfortunately, both of those were correct. I already had a cookie and then saw your results and felt guilty about it."
"Are you kidding me? All the more reason you deserve the cookies!"
"Why's that?"
"Because now you're stuck with me! Seriously, you can't get rid of me now!"
"Wow, when you put it that way, I think I'll have to have another cookie..."

It shouldn't bother me, you know? None of this. I've been there, done that. Why, it feels practically anticlimactic. After all, I would have probably passed out from shock if he'd given me any news other than a negative today. But there's something very, very final about the quantitative blood test. There's no going back from there. It isn't so much a fall from hope as it is the end of this chapter - knowing that there really are only two more chapters left before the conclusion to this part of the story.

And so... what now? What's the plan?

In a word, or three? I don't know.

Originally SuperDoc told me that what he'd do is check my progesterone in three weeks, if I hadn't ovulated (which he doesn't anticipate that I would have, he'd put me on provera for 5-7 days to induce a period, start BCPs, and on day 19 start Lupron, etc. etc.

Gah, I said. That gets us into Pesach. No problem, he said, we'll check your progesterone in 4 weeks, provera, etc, etc, we'll be a week after Pesach.

I hate the timing. Hate it. I told him so. I hate waiting that extra week I hate waiting that long. I am not a patient person. I don't want to wait any longer I don't want to do it. A break isn't a bad thing, he said. Yes it is! I countered. I was petty, I'm sure. Irrational, no doubt. I gave him no logical reason why waiting was not an option. He said he'd give my nurse a few options on timing and I could work out the dates with her and see what worked best with me on timing, but if I really wanted what I can do is start BCPs as soon as I get my period. Take BCPs for four weeks (rather than the usual 3), then start Lupron, etc. He said from an ovarian perspective, he had no issue with that and I hadn't hyperstimmed this cycle so he didn't think it would be problematic in any way. SuperNurse and I can review the calendar together and see what works best for my schedule. [Update: Talked to SuperNurse - I can, in fact, start BCPs on CD2. However, the trick to that is that sometimes it takes a while to get a period, so if it takes a few weeks, we'll just have to push it off until after Passover anyway. Bah. Hopefully all these cramps are a good sign that this won't be an issue regardless.]

Which brings me to the protocol issues.

Lupron. Yeah.

He is going to increase my Follistim (not as much as he'd originally planned - my estrogen rise was appropriate for once, once I got to 150IUs... and the accidental 300IUs that one day...). He's also going to increase my Luveris to 50units (up from 37.5). And... the Lupron. He's going to keep the Lupron at the same horribly high dose. I told him the headaches were absolutely unbearable and he said that they should have gotten better once my estrogen rose (they got somewhat better around day 9 or 10 of stims, that's true), and that on higher doses of follistim/luveris, my estrogen rise should happen earlier in the cycle which should mean that the headaches are alleviated sooner in the cycle. I hope he's right.

His logic is this (or something like this... I was juggling a lot when he was talking, so I wasn't really taking notes): he feels that the best option is to get more follicles growing early on, while avoiding a dominant follicle. He wants to use the high dose of Lupron to heavily suppress in order to avoid the dominant follicle (and also avoid hyperstimming), but more Follistim to greater stimulate the ovaries into producing a greater number of follicles. I did ask about not using Lupron and using an antagonist protocol instead, but he was against it for a number of logical reasons. While he has had success with that protocol with other patients, with patients with MY profile, he has better success with a Lupron protocol.

There's a piece of me that wonders if I'm just tying SuperDoc's hands by forcing the eSET issue. But then I think back to my appointment on Dec. 15th with my perinatologist and his dire warnings about me and a twin pregnancy and I realize that it just isn't a possibility. I simply cannot take that risk, even if it means I don't get pregnant again. And it is that reality - the knowledge that it is my own determination to push forward with eSETs that may be my downfall - that humbles me, reminds me that hope is something I may just have to let go of some day.

And at the same time, I know that I am unendingly lucky, for I have smiles and hugs and snuggles every day from the miracles I already have in my life.