The Bright Side

A comment today on this post reminded me that there's a bright side to being at the last resort after all. I mean, the last resort is Ganirelix. Which means? No Lupron.

Admittedly, I don't know a lot of women who've done an antagonist protocol, and even fewer women who have done a Lupron protocol followed by an antagonist protocol (most women I know who've done ganirelix have simply started out there), so truthfully, I don't really know how the side effects are going to compare. Maybe they'll still suck. But I'm guessing that I'm not going to be describing headaches that slice through my head like a piece of broken glass. I mean, that was pretty graphic and gruesome, wasn't it? Ick!

It's bound to be better than that, right?

Admittedly, starting the Ganirelix protocol requires me getting my period at some point. And my dear, sweet period is still MIA, which, I must say, is definitely not amusing.

Honestly, there simply *must* be something interesting to say about waiting, but there just... isn't.

Hey, so, have any of you out there used Ganirelix? More importantly, have any of you who have used Ganirelix also used Lupron in the past? How do they compare (specifically with regards to side effects)? I'm thinking of posting this question to the LFCA in my copious spare time, but, um, you all know about me and my copious spare time. I've got so little copious spare time that I haven't even managed to put one of those handy dandy little buttons in my sidebar that says "post my news in the LFCA" which would make it super easy to just go and do it now, wouldn't it? And in the space of time it took me to type this little paragraph about how I don't have time to go post this in the LFCA, I could have popped it into Mel's google spreadsheet. Or picked up the phone and called Mel and told her I'm too lazy to post it in the LFCA and could she please do it for me? But no. I'm not as industrious as Mel. I, as they say, am lazy.

Not *quite* Cancelled... Yet.

Well, my E2 level didn't go up as expected, which probably means those two gorgeous follicles aren't as gorgeous as they look. Typical for me. Whatever.

My E2 level was 98.3 (down 0.7 from Tuesday, but essentially that means it's stabilized, not that it's gone anywhere). My P4 level was 0.75. So I'm not gearing to ovulate any second as SuperDoc had feared, and I get to stay on the Lupron through the weekend and return on Monday (Lucky Me!!). The likelihood is still that I will ultimately end up cancelling this cycle, but I guess we have to give it the old college try, right?

Of course, right.

Anonymous asked if I could try the old fashioned way since I've got those two follicles hanging out - there are a couple answers to that question:

1. The first is, the two follicles are both on the left side, which was the tube that was blocked in my last HSG. Assuming that wasn't a fluke - that would preclude them being useful.
2. Assuming the blocked tube WAS a fluke, I'm not doing anything at this point that involves two follicles on purpose. If you think I'm being extreme, that's fine, but I'm dead serious. I am petrified of ending up with twins - my perinatologist scared the crap out of me in December when I saw him and he made it clear that a twin pregnancy is not an option for me.

Tagging along with that question, Anonymous asked if, in light of this development, whether it would make sense for me to try on my own for the next cycle and see if I ovulate all on my lonesome. A few thoughts:

1. If anovulation alone were my sole problem, sure, maybe. But it's not.
2. If I were uninsured and needed time to pull together money for a cycle, sure. But this cycle is already paid for. My portion of this cycle has already been paid for, it's just being deferred until whenever we DO get started, so the money has already been set aside.
3. I ovulated every single month from the time my HOMs were 6 weeks old until they were about a year old. Then I started spreading out to about every 6 weeks. I used no birth control. I even did my best to, um, make the best of our... timing. I did not get pregnant in that entire time.
4. If there were something inherently healthier about getting pregnant spontaneously vs. via IVF, then sure, maybe there would be some advantage to waiting another month just to see. But aside from slightly lower birth weights in IVF babies (even singletons), there doesn't appear to be any inherent health differences in IVF babies vs. spontaneously conceived babies. So why wait?
5. If I *am* ovulating on my own, I can just as easily TTC spontaneously later, after I don't have insurance covering my cycles, as I can right now. So what's the difference?
6. What SuperDoc implied to me was that it is, oddly enough, the Lupron itself responsible for my response so far. His words were that sometimes in women you get the opposite reaction to the Lupron than what you're hoping to achieve. Note, I'm not so sure about this one, because, honestly? I sort of started tuning him out right around the time that he started making fun of me for always being opposite girl.

Anywhozit, it's just more fun for me. A girl's gotta get her Lupron fix somehow, right?

Exhaustion

Wait, does Lupron make you beyond exhausted?

really?

Thumb Twiddling

Not much to report on the fertility front. My head is pounding AND I have a toothache. This is not making me very happy. I am not thrilled about this development. But the toothache, I'm sure, has nothing to do with my fertility (or lack thereof). Though it might have to do with the fact that I'm constantly clenching my teeth from the throbbing in my head. Sigh.

Still hate Lupron. Shocker.

Received a good response from RESOLVE after I wrote to them asking if they knew anything about the Maryland Personhood Amendment:

---
RESOLVE has a policy statement on Personhood bills and amendments, and can be found here:http://www.resolve.org/site/PageServer?pagename=ta_pap_personhood

There are actually about 13 states that have some level of Personhood legislation in the works. To be honest, we have heard from a number of sources in Maryland that this bill will not go anywhere, however, we really should update our website and let folks know what is going on. We have a very small staff and with so many states taking action on a variety of issues we have had to pick and choose how we spend our time. We have been working on 2 other bills in Maryland that improve the current insurance mandate, as well as other bills in GA and MO that are directly affecting infertility treatment. If we get information that a bill is not going to go anywhere, we know we can put it aside and the outcome will still be favorable. I realize that is not going to please everyone, but all of our advocacy work is done by me and a handful of volunteers scattered around the country (about 3-4 people). I don't have any designated staff person on advocacy, and I try and do the best I can while running the organization as well. The legislative session can be a very busy time for us - especially this year with so much outrage regarding the Octuplets and now the personhood issue popping up in more states.

Thanks again for contacting RESOLVE. If I find out any further information about this bill I will let you know.
-----

Other than that, not much going on here in boring Perky-land.

Ninety Nine (edited, twice)

What? No, really, WHAT?

99?

That's my estrogen level. Seriously, when I'm not on Lupron and I have actively growing follicles, I barely have estrogen that high.

Now I have the most boring looking ovaries I've ever seen, I'm on 20 units of Lupron a day, and... what? My estrogen is double what it needs to be?

Stupid body.

No Follistim or Luveris tonight. No dropping the Lupron dose in the morning. Status Quo for now. Return for re-check on Friday. Yeah. I can't believe I failed the Lupron Eval. Man.

Edited to Add: Shit, wait, you don't think it was the Nectar of the Gods, do you? Seriously, I really only had one a day. Once I had two in one day. But seriously? One 12 ounce can a day can't have done me in. Could it?

Edited, Again: Yes, it could potentially have been the increase in caffeine level that affected my estrogen level. I will note, however, that I drank probably 4-7 cans of coke per day while doing my six IUIs and never had any affect on my estrogen level. Admittedly, back then I simply had a constant blood level in my caffeine stream. Perhaps I am more sensitive to caffeine now than I was then, since I nearly never drink caffeine anymore (I don't ever drink coffee or tea and I hadn't had a coke in months before the last couple weeks). Should I ask my doctor about it? Meh. Possibly, but I'm simply going to cut out the Coke and suffer through the headaches until Friday.

As for whether I need another re-check before Friday - not really. He's leaving it until Friday to give the Lupron more time to work. The only reason to get a recheck before Friday would be if there were serious concern about over-suppressing me between now and then, and there is not that concern. It's just a few more days lost on my schedule, is all. But all that means is that my beta isn't going to fall on Pesach - which it was going to do before - so now at least I won't have to push that off. Right? See? Silver linings all around.

Lupron Eval and Fudge Delivery

Okay, so? How many of you thought I was wrong and there would be a mobile in Room 1 today? How many of you had more faith in Dr. S. than I did? Admit it! Well, you would all be wrong. Wrong, I say! He's off on a cushy vacation on some tropical paradise while his patients lie bored on a table staring at... a blank ceiling. Seriously.

What. Is up. With that?

Dude. Seriously? There are going to be serious consequences for this - and I don't just mean that he didn't get fudge today. I have on good authority that my fudge was pretty damn awesome, though I admit I wouldn't know myself. But no fudge for him!

Now to think up some appropriate consequences for him.

And now on to the fun stuff. My lining is nice and thin (5mm)- I'm told this is a good thing. Truthfully, I'm a sucker for data, and as much as I hoard it, this is one piece of information I've never paid much attention to - the starting lining thickness. I've never really much cared about it. Mine's always been fine and I've never much fretted about it (though I remember once or twice it was alarmingly thick... but whatever... it thinned out soon enough, so it was all good). Somehow very little about the whole fertility/IVF process feels intrusive to me anymore. But there's something about this doctor telling me the thickness of my endometrial lining that feels awfully... up close and personal. I know that sounds ridiculous. There I am with my legs up in stirrups, chatting away about mobiles and whatever. I've appeared on the local news, and spoken with a reporter for a national newspaper about my fertility issues. I write a blog about my daily cycle details for crying out loud. And yet, the thing that feels up close and personal is the thickness of my endometrial lining?

Go figure.

Anyway, whatever. My lining is good, my ovaries, they are quieter than I've ever seen them. Not so perky.

Much fudge was delivered. And I even delivered an adorable gift to my nurse. No, really!







Does it get cuter than this??






My nurse was already having a really tough day, even that early in the morning so, it turns out, I made her day. Go me. And the fudge was just a bonus.

"Admit it," I said, "You don't have any patients as cool as me."
"No way!"
"Aw, you're not just saying that are you?"
"Definitely not!"

Anyway, unless I hear otherwise from her, I'm to start Follistim 166IUs, and Luveris 50 units tonight. And tomorrow! Tomorrow! (I love ya, tomorrow!) I drop the Lupron to 10units! (You're only a Day! A!Way!)

(cue orchestra)

Ahem.

On a more serious note, Maryland sucks. Stay tuned for why.

Nectar of the Gods

It's possible that some of you have been reading various iterations of my blog long enough to know that there was a time that I had quite the affinity for Coca Cola - herafter referred to as the Nectar of the Gods (or, simply, The Nectar). In fact, I was quite offended to discover during my pregnancy that it tasted disgusting to me, and a few of you found out the full extent of my loyalty to The Nectar when you foolishly suggested that That OTHER INFERIOR so-called-Cola product *cough*pepsi*cough* might be a reasonable substitute.

Well, since then I really haven't had much Coke in my life. Though I could say in all honesty that I was a full-blown Coke addict (not THAT kind of coke, silly! The yummy caffeinated cola kind!), I really don't touch the stuff all that often anymore. Now, it is simply a special treat now and again.

But here's the thing!

I have discovered a very important use for The Nectar. It turns out that caffeine actually is the one thing that actually helps these stupid Lupron headaches. Um, well, a little bit, anyway. Look, I'll take ANY little tiny bit of relief I can get, okay? Mel was actually the one who told me that caffeine would help Lupron headaches. "But," she cautioned, "only if you have enough caffeine that it raises your estrogen so much that it sort of defeats the purpose of the Lupron." So not really a good solution.

Obviously caffeine wasn't a good option. This cycle, I happened to have a Nectar one day when I was in the middle of a terrible Lupron-induced stupor/headache and while the headache was still horrifically bad, it DID take the throbbing out of my eyeball, so it no longer felt like I had a jackhammer slicing through my right eye. Definitely an improvement. I have, therefore, felt absolutely no inhibition about drinking a coke or three per day since then. Go me. (I'm kidding about the three)

That being said, yesterday I found a far more effective way of avoiding the Lupron headache. Yep. I forgot to take my Lupron until mid-afternoon. By the time I took it, I'd already had a Nectar, so I didn't get a headache right away. The headache hit me in full force at about 3am. Getting out of bed this morning was nearly impossible. Today's headache was far worse than usual and no amount of caffeine was going to help it. My Nectar had failed me.

There is, however, light at the end of the tunnel. Tomorrow should be my last day on 20 units per day. I have my CD2 monitoring appt. and I should start Follistim and Luveris tomorrow night and then drop to 10 units of Lupron Wed. morning. Plus, with higher starting doses on the stims, my estrogen level should go up faster, so the Lupron headaches should subside faster regardless of the drop in dose. So it's all good. Right?

Last order of business - who wants to place bets on whether Dr. S. has gotten a mobile up in Room 1 yet? I'm betting on a Negatory.

No fudge for him if he hasn't gotten it up yet. I made fudge for everyone else though. With nuts.

Good News

So the good news is that I confirmed with my doctor that I am doing a 20-10 decrease on the Lupron once I start the stim protocol. My poor nurse. I made her check with him about 6 times. "But you're sure he knows that last time I did 20-20, right?" "No, I mean, really sure because I think he thinks I did 20-5." "Okay, but you're absolutely certain that my record reflects 20-20, right?" "I mean, definitely he knows I did 20-20, and even though he said increase on the phone, he actually meant decrease, right? He *does* know what he's doing, right? RIGHT?"

Um.

Not like I didn't think SuperDoc knew what he was doing or anything.

I, um. I mean. Of course SuperDoc knows what he's doing!

Um.

Ohmygod whatthehelliswrongwithme? When did I turn into *that* patient? I must be stopped. Hopefully they just think it's the Lupron talking? Maybe they just think I'm a little knackered? A lot? Surely they *must* know these drugs make their patients crazy, we don't all start out this way. Right?

The bad news is my head hurts. Shocker. Maybe when I decrease to 10units, life will be dandy again. I can dream, right?

Like a sword

The pain ripping through my head is like a sword stuck into my head. Through my eyeball, perhaps. The pain is palpable.

I forgot this was what it would be like. My head hurt so much and I couldn't figure out why. Not my normal migraine. And then, then I remembered what I did this morning.


The news I've been trying not to say out loud, in case SuperDoc rips it away from me next week, is that it appears I'll have a reprieve this cycle. Last cycle I took 20 units prior to stims and stayed on 20 units after starting stims. But despite his original statement to me that this cycle we'd increase or stay the same on Lupron... it appears that this cycle I'm decreasing the Lupron dose to 10 units once I start stims.



That.... that would be lovely. If it happens. I hope it happens. I'm afraid it won't.

L - 1

Lupron starts tomorrow.

You have been warned.

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.

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.

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.