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Monday, November 30, 2009

CD7, Future Oc.to.mom

Unexpected results today. Apparently, I'm a good responder to gonal-f. Too good. I had a lot of follicles. 5 on my right and, like, 8 on my left. I have a 15mm, a 14mm, a 13mm, a few 12mm, and then a few smaller than that. The first thing the doctor said to me was that if we did an IUI this cycle I'd have a high risk of multiples.

"How do you feel about that?" she asked.

I laughed.

I had to. I mean, come on. No one wants to be the next octo.mom. To be completely honest, I don't even want twins. If it came down to a choice of never having children ever or twins, I'd take the twins, in a heartbeat, but I would really really prefer just one. For now. And DH agrees, even more strongly than I do. But, then again, I really really want to get pregnant, and there was a part of me (there still is) that was giddy with excitement over so many follicles. Just giddy. Ugh.

So, my options at this point are:
  • Cancel the cycle
  • Go forward with IUI with higher than average risk of multiples
  • Convert to IVF

Yes, convert to IVF. I didn't even know you could do that. But the doctor told me that with the number of follicles I already have, yes, absolutely, I could totally 100% do IVF. She didn't even blink.

Now, confession, I've had a sneaky suspicion for a while that we would end up at IVF eventually. I don't know why. My infertility is currently in the "unexplained" category, but I have a suspicion that endometriosis is my problem (or one of my problems) and my RE told me (although I have not heard this elsewhere) that IUI generally does not work for women with endo, but that IVF does. So, anyway, I'm totally okay with IVF, I have already become comfortable with the idea that that's where we might find ourselves eventually, and, honestly, I like the success rates of IVF when compared with IUI. Sure, they're not 100%, but I'll take 40-50% over 15% any day.

But, I'm covered for IUI, and not for IVF. I only have a ballpark of what IVF would cost me, and it's not cheap: $6500 - $8000, but I'm okay with the expense. (A couple years ago I had to have a bridge replaced by two crowns, which required a tooth extraction, two posts and two caps, with the total bill eventually coming to over $11,000, and I figure if I can spend that much on 2 stupid teeth, I can spend it to get a baby.) And we do have the money.

But, I don't like being put in the position of having to decide mid-cycle. And it just seems like really soon to be already going the IVF route. I have to go back on Wednesday to check my progress, but until then I have a few options. If I want to do IVF, they've suggested that I get ganirelix today in order to make sure I don't ovulate too soon, and continue doing 150iu of gonal-f today and tomorrow. If I don't want to do IVF, I've been advised to cut down the gonal-f to 75iu today and tomorrow, no ganirelix.

Oh, and I called my insurance company to find out if I'm covered for reduction in case of a multiple pregnancy (the doctor advised me to find this out), and I'm not, but they also told me that I'm not covered for IUI, which I am. At least I think I am. My RE says that I am, and I haven't gotten a bill from the last one, but now I'm afraid that I'm actually not covered. I didn't push the issue with my insurance company because now I'm thinking that maybe, technically, I'm not covered, but somehow I've slipped through, but if I make an issue of it then they'll realize that they've been covering me for something that I'm actually not covered for... geez!!

The easiest thing to do would be to just cancel this cycle and hope that an adjustment in the dosage next cycle will prevent this from happening again. But, who wants to ever cancel a cycle?

So, I don't know what I'm going to do.

Friday, November 27, 2009

CD4, A Little... Crazy

IUI#2 is on!

No one had anything negative to say about the state of my ovaries at the RE on Wednesday, so I was given the green light to start the gonal-f. I started my injections yesterday evening, and I've done two 150iu injections so far, and I'll do two more before I go back for monitoring on Monday. Physically, the injections have been fine: not painful or even really that uncomfortable, but, mentally, I am so weirded out by injecting liquid into my stomach. Yuck.

Speaking of mentally: today when I got to work, I, um, had a bit of a... crazy attack. I kind of got really pissed off about what I perceived as a co-worker's extreme incompetence and irresponsibility and almost... almost, told him off about it, when all of a sudden I started feeling really anxious and kind of light headed and that's when I realized that I was way way too mad, and that I should not be practically hyperventilating over what was more of an annoyance than anything, and I realized... gonal-f.

So I decided that I wasn't allowed to talk to anyone or make any big decisions for the rest of the day. And I didn't. And it turned out fine. But now I'm worried about the rest of the weekend. I told DH and he thinks it's... funny. So at least one of us is laughing.

Tuesday, November 24, 2009

13dpo, or, as it's known this cycle, CD1

AF came early. Taking it well because I've known for days - which is the best argument I have for temping during the 2ww - my temps started dropping a few days ago, and it was clear to me what that meant. And I also find getting AF to be so much less disappointing than a beta results call (the one that takes my RE over 6 hours to make).

So on to IUI#2 (hopefully)!

I'm a little worried about how I'll take it if I get a BFN next cycle, though. My reaction to my BFN my first IUI cycle was kind of a meltdown. Because it was the first time we'd tried IUI, and so I was convinced that it was definitely going to work. Everything was timed perfectly, I had 2 mature follicles on each ovary, and then... BFN. DH was out with friends when I got the beta call. I had been pretending that it was no big deal, but when I got the results I immediately called DH. He was at a bar and it was loud and I asked him if he could please come home, and he said "what? I can't hear you," and so I said "can you come home now, please?" and he said "what?" and I... hung up on him.

Right? You're with me on this one, right?

Anyway, he called me back and of course I didn't answer and I guess he quickly put two and two together because he was home within 15 minutes. I had been holding it together until he asked "what?" for the second time and then I lost it. He came home and I didn't speak to him for 2 hours, I just sulked in bed, not even crying but just not talking as he sat next to me and tried to hold my hand, but I wouldn't let him. Yeah, sometimes I don't act my age. (You know how in my last post I said that DH has never been mad at me? Well, it's not like I haven't ever given him a reason...)

I finally spoke after 2 hours. I think the first thing I said was "it's not fair." Because, well, it's not.

So, this will be my first injectable cycle, and my test date will be right before Christmas and during a visit from my parents. And my parents don't know we're TTC or that we're having, um, challenges. But, I'm going to try to be tough, and I'm going to try to keep to my new philosophy: I'm going to stay hopeful, but I'm going to focus my hope on the long term, and not on one particular cycle.

Monday, November 23, 2009

12dpo, Thankful

Temps dropping, still spotting. Not looking good for this cycle. And AF is due on Thanksgiving day (!). Good thing we don't have any big plans for the holiday. I will be cooking a turkey and we might have a couple friends over, but that's it. I love Thanksgiving, but this year I just haven't felt like putting in the effort. But I know I still have a lot to be thankful for:
  • DH - the kindest and most generous man I have ever met. We have been together over 7 years and he has never yelled or even been mad at me. I'm not kidding. He's a keeper.
  • Our families. We both have wonderful, loving, kind and supportive families.
  • Our dog. He brings such joy to both of our lives, and I couldn't imagine life without him.
  • Our jobs. We have them, and they're not that bad (most of the time!). We have several friends who have been laid off and unemployed for months, or, in one case, over a year.
  • Our friends. They constantly surprise me with their thoughtfulness and generosity. I have a lot to learn from them.
  • Finally, the blogosphere. It has been so gratifying to see that there are other women going through the same emotions I'm going through, walking the same difficult road of IF. Your stories inspire me to be more courageous and optimistic; to have an open heart and an open mind; and to not let this IF thing get me down (at least not that much!).

Friday, November 20, 2009

9dpo, Trying Not To Think About It

Had some spotting yesterday. Also started the est.rogen (viv.elle patch). Related? Or implantation spotting? Or the spotting that I usually get a few days before AF? Trying not to think about it.

Wednesday, November 18, 2009

7dpo, Officially Getting My Hopes Up

Sometimes I think that maybe it would be best for me to not continue temping through the 2ww. I had a temperature dip today. Not below my cover line, but significant. Implantation dip?

But I'm trying to stay focused on the long term. I got my meds today for next month's injectable cycle. Almost paid over $800 for them because the pharm.acy told me that I'd reached my "maximum benefit" of $3000. Say what? How could that happen? Well, I called my insurance and was told that it was because of a $2900 prescription in August. The one for the injectables that I never filled because my portion would be $1600 and, well, that's a lot of money for someone who has just started going to the RE. I mean, can we do some lower tier stuff first? Anyway, I had to get that pharm.acy to reverse the claim so that my new pharm.acy could resubmit and then, voila, it was all covered - I just had to pay my co-pays. Phew!

So, I'm on track for an injectable cycle, and I'm focusing on the long term, and I will keep temping this month, because then there's the other part of me that's afraid that my temperature will stay down, and what does that mean? Nothing good, I'm sure.

Monday, November 16, 2009

5dpo, End of the "Magic Time"

I think the days between ovulation and around 5dpo are the "magic time."

I don't like the first 2 weeks of a cycle because I'm so afraid that something will go wrong, especially that somehow we'll "miss the window": that DH won't be able to "do his part," or that I'll ovulate early and the IUI/BD will be too late. And of course all the drugs, bloodwork, ultrasounds, etc., etc. But then, if everything works, you enter the 2ww - and, at first, you can relax. And it seems like I relax for the first 5 days, not thinking about POAS or analyzing my every little symptom, not thinking about the next cycle, or if there will be a next cycle. And then I get to a day when I think "hmmm... I feel a little crampy," and I realize that implantation could have happened by now, and then that magical time when I don't have to think about this cycle and I don't have to think about next cycle is gone and now I'm analyzing everything, I'm wondering what day of the week 14dpo is, I'm thinking about how my next cycle I'm supposed to do injectables for the first time, but that maybe, just maybe, I won't have to...

So, I'm officially now mentally and emotionally in the 2ww. As a reminder, this is a "natural," not assisted cycle for me, so I'm not holding out a lot of hope. And I'm trying to concentrate on the long term outcome, and not the outcome of this particular cycle.

By the way, on other blogs I've been reading about telling friends/family about TTC/IF versus not telling them and I just want to weigh in that I have not told a soul (except my GYN, my RE, and of course my DH). And here is my reason: if we are not successful, I don't want to be known as the couple who could not get pregnant, I would much rather be known as the couple who chose not to have children. My plan is that if we are not successful, this's what I'll tell people: we just didn't really want children. And hopefully no one will ever ask me my reasons for not wanting children...

The only people I plan on telling are my parents, and if we're not successful, I will have to tell them. My brother and his wife has strongly hinted that they don't want (or even like, apparently) children, and I know that my parents, especially my mother, would love grandchildren, so I can't let her think that we also decided we didn't want kids. I will tell them, but not yet.

And that's also a big reason why I'm blogging - I don't really have anyone to talk to about all of this. And I can't talk to DH, and that's just as much my fault as his. From the beginning I've felt uncomfortable talking about any of it to him. Confession: I temp in secret. I know that's really weird. He knows that I temp, in theory, but I do it in secret every day. Oh, and I don't temp in bed. I gave that up long ago - my temperature does not change going from the bed to the bathroom, I've tested this. So, anyway, I temp in the bathroom, when he's in the kitchen making coffee, so he can't hear the thermometer beep. And I don't tell him when I start the OPKs, only when I get a positive. And I don't tell him when I get AF, I just tell him that I have to go back to the doctor (implying it's a new cycle). He does not know that I've ever done a HPT. And he doesn't know I have a blog.

So, what does that mean to our relationship that we don't talk about these things, he doesn't ask about these things, and that I actively hide some of this from him? Well, I think we have a strong relationship, and we love each other, and we get along 95% of the time, and he also wants to have children (although maybe not as much as me).

I don't know what compels me to hide these things from him. I think we are both just very private people. I used to date a guy that was the least private person that maybe I've ever met - he had no problem telling everyone exactly what he thought, whether bad or good. In one way it was very freeing when we were together. He would ask me very personal questions and expect answers, and although I had my limits, for the most part I went along with it. But that's not how I am naturally. So, I'm very private, and I think so is DH. I actually wish he would ask me about this stuff, although admittedly when he has, my responses have been somewhat awkward and terse - probably not very encouraging to him.

Honestly, I often think that he and I could use some counseling. Okay, I said it. But not because we're not getting along, just because I think maybe we'd both be happier in our own lives if we could open up to each other more. Sigh.

Wednesday, November 11, 2009

No Temp Rise, CD13, Not How I Roll

Well, no temp rise today, which is somewhat unexpected for me. So I guess either A) I'm ovulating today and I'll see a temp rise tomorrow, or B) who knows.

No BD for us today, though. DH is not an every day kind of guy. I mean, he's almost 50. He needs time to recharge his batteries. Which is fine. Could that be one of our problems? Sure could.

And, on the subject of husbands/male partners, we all know that they "don't get it." A lot of this we blame on the fact that they don't have to go through what we have to go through - the blood draws, the ultrasounds, the drugs, the temping, the shots, and then the countdown to testing. Oh, and doctor's visits, the waiting rooms, the traveling, etc., etc. We think that if only they could go through some of what we go through then they would understand.

I say, it's a good thing they don't have to go through what we have to go through. Because they wouldn't do it. You really think any guy is going to take his temperature every morning? Go to the doctor every 3 days to have BW and a US? Take drugs that make him crazy? Stick himself with needles? No way. He'd say "you know what, I think we're doing fine on our own. We just need to keep trying."

Why? Because for us ladies it's all about the end result, for guys it's all about the means to that end. Unless we have a baby in our arms, then we feel like failures. For guys, as long as they're still BDing, then they're succeeding.

So, I think it's a good thing the ladies are running the show here. Honestly, I think this is inherent biologically. The ladies want the babies. We think about the babies. We imagine them in our arms, we think about dressing them, feeding them, putting them to bed at night. They are tangible to us, and we want them. This is why you never hear about a man stealing someone's baby. It's always a woman who does it. We want that baby. Men just want to keep doing what they know works to get a baby, BDing. They feel the baby as an abstract concept that will appear at some point as long as they keep doing what nature is telling them to do.

So. That's my theory.

Tuesday, November 10, 2009

A little +OPK, A little BD, CD12, That's How I Roll

Surprise! Last month is was CD16, this month CD12. Like I said before, test early, test often. Most likely I'm ovulating today. That is also how I roll - temp change day after first positive OPK. Things are going smoothly so far this cycle, except for the cancelled IUI. CD12 is a bit early, which I think will somewhat lower my chances (too much time spent on FF comparing pregnancy vs. ovulation charts), but I feel pretty good overall right now. Talk to me in 13 days.

Monday, November 9, 2009

CD 11, Staying Hopeful, Not Getting Hopes Up

3 cycles ago I missed my ovulation. Granted, my cycle was only 17 days long, so little did I know when I started OPKs at day 12 that I only had 5 days left in the cycle (I was not temping that cycle, either). I blame the shortness on coming off of clomid, but the lesson I've learned is test early, test often. And temp every day. It's just that after testing for 12 months and temping (most months) for the last 10, it gets a bit tiresome, doesn't it? Anyway, I started testing on day 10 this cycle, and I'm temping daily, so I won't miss it this time!

I remember when we first started trying I stopped buying the big boxes of tampons and pantyliners, the ones that would last me through several AFs, because, well, I wouldn't need them, right? Ha! I'm back to buying in bulk now. And it's better that way anyway. I put the word "hopeful" in the title of my blog because I'm trying to stay that way, but remaining hopeful and getting one's hopes up are two different things. Staying hopeful is staying positive, not letting IF get you down (too much), and remembering all the good things in life. Getting one's hopes up is betting on one cycle instead of on the long term outcome; it's thinking that TTC is the most important thing instead of one of many important things.

So, I'm trying to stay hopeful.

Wednesday, November 4, 2009

TTC 1 Year Anniversary

Oh, BTW, this month is our 1 year anniversary TTC. We had the "talk" last November, and for some reason I knew we needed to get down to business right away, so we skipped the "let's just throw out the BCP and see what happens" phase and went straight to the POAS phase. I guess I knew it wouldn't be easy for us.

Also, DH turns 50 this month. Not a big deal, really, as it seems that he's not the problem. But it makes me wonder, sometimes, if I'm not pushing too hard for something that's supposed to take some time for us. The fact is neither one of us are that young. I'm 34. With my old eggs and his old sperm, maybe it just takes a little longer for 2 good ones to meet up. And maybe that's what the chemical pregnancy was all about - my body doing the right thing and rejecting an embryo that didn't pass muster. And, anyway, I know that 1 year isn't really that long... and I'm trying to keep that in mind more often.

Monday, November 2, 2009

Scratch That

Well, an interesting turn of events. Lots of info from today, and I'm still processing.

Met with Dr. RE#1 after US and BW. The first thing he wanted to talk about was my lining. Now, AF has been seeming lighter and lighter, and this was happening even before I did any assisted cycles, and so this was something I had mentioned to Dr. RE#1 before and he'd told me last cycle that everything looked good, that my lining was fine. But today he says he's concerned about it, so, okay, well, that's good I guess, because my light AFs have been concerning me. I ask how thick it is and he says 7.8, and that 7 is the minimum. He also says that he's concerned about the lining because I had a chemical pregnancy my first assisted cycle with them.

(Now, here's where it gets complicated and I'm going to fill you in on more messy details. It's never simple, is it? My first cycle with my RE, back in July, I took clomid, did a trigger, but did not do IUI. He asked me to come in for my beta 9dpo. Now, I thought this sounded a bit early, but this was my first cycle with the RE and I just thought that's how they did it. Anyway, the 9dpo beta came back positive, but I was told it was low and I'd have to come back Monday (1st beta was Friday). What a great weekend that was. Luckily, DH and I were out of town at a family wedding and I didn't have too much time to worry about it. On Monday, 12dpo, the beta was negative. He told me the numbers were, I think, 7 or 9 on Friday, and 2 on Monday. The next cycle I did with the RE the NP told me to come in for my beta at 14dpo. If that had been the protocol the first time I never even would have had a positive beta. I wonder if it wasn't just a false positive from the trigger. I mean, testing at 9dpo? WTF? But anyway, my RE now has it down that I've had a chemical pregnancy.)

So, because of this "chemical pregnancy," he is of the opinion that maybe I can get pregnant, but maybe my lining is the problem. And maybe he's right. So, what this means is he wants me to do injectables. So, that's fine. I don't mind injecting myself, actually (at least the trigger has been fine), but I know injectables will be a lot more expensive that what I've been doing so far, so there's that. So, fine, whatever, we'll do injectables.

Next, he says that my follicles look like they're already too big. He's says "they're not that big but they look big." Whatever that means (at least one was 10mm). He explains that he doesn't want to do an assisted cycle because whatever drugs I would take would feed those follicles that are already developing at the expense of other less mature follicles. I gather this to mean that I would end up with one or two mature follicles, very quickly, and nothing else, and he wants me to have more mature follicles than that, but not as quickly. I'm not exactly sure, but what it came out to was that we're not doing any drugs this cycle and then on cycle day 21 he wants me to start estrogen patches to "quiet things down" so we can start with "a clean slate" next month. This is called "estrogen priming" and it's usually done before IVF cycles. I'm not familiar with any of this. I will be googling later.

Finally, at one point in our conversation, as I was asking whether I really needed to move on to expensive injectables instead of staying with affordable non-injectables, and saying that I was thinking about the long term cost (i.e. if we have to eventually move on to IVF and we've already spent thousands of dollars on injectables, we may not have the funds to do more than one IVF), he outlined something for me on a piece of paper. He said that for most women the course of action would be to do 3 IUIs with clomid, then 3 IUIs with injectables, then 3 IVFs, until successful, and that would have a 97% chance of success. He also said that if one were to skip the IUIs and just do 3 IVFs, this would also have a 97% success rate (but he does not recommend this, of course). Really? 97%? Those odds sound... really good. That has actually eased my mind somewhat.

So, I was a bit disappointed overall. I'm itching to get back to it since we were forced to take last month off due to travel and scheduling conflicts. It's very upsetting to think we are going to have to wait another month. He did say that we can try on our own this month, and of course we will, and who knows, right?

So, no IUI#2 for me this cycle. But I will still chart and use the OPKs, and I will update through the month.

Sunday, November 1, 2009

BW and US Tomorrow. IUI #2

So tomorrow is cycle day 4 and I'll go back to the RE. AF started Friday afternoon and I think technically I should have gone in Saturday morning, but it was not a convenient day for me to go, so I called in and asked the receptionist if I could wait until Monday, based on when AF started. She said she thought I could, but that she would have Dr. RE#1 (there are 2 REs at the place I go, Dr. RE#1 is "my" RE, Dr. RE#2 is not, but I end up talking to him just as often) call me to let me know for sure. I then carried on with my day. At about noon I figured that, well, if I haven't heard back by now I probably wouldn't be getting a call back, and indeed, I never did get a call back. Ugh. In a previous post I know I mentioned that it takes about 8 hours for them to call with the beta results, and the last time I went in, to discuss "where to go from here," and I told Dr. RE#2 that AF hadn't shown up yet, he said that I should get another beta "just to make sure," so my blood was drawn, my hopes were slightly lifted, and then... nothing. No phone call with the results. Ever. Of course, I knew it was negative and so I never bothered calling them, but still.

Now, I know that not calling me back did not affect how my cycle turned out in the least, so whatever, but what does concern me is when, last cycle, they screwed up my follicle size. On CD9 (a Wednesday) I had a 14mm and a 16mm, one on either ovary. The NP was nice enough to share this with me unasked. I met with Dr. RE#2 and he told me to come back Friday. Friday, CD 11, I came back, asked the NP the size of the follicle on one of my ovaries, which she said was 18 (did not ask about the other one). Then, in my meeting with Dr. RE#1, as he was looking at his computer screen, he said to come back Monday, because the follicles weren't ready yet, they were at 14 and 16. I told him that couldn't be right, because the NP told me I had at least one that was 18. He then looked at the US printout he had, saw that it was different and commented that his computer must not have updated, and said that they were actually 18 and 21. Now, I'm no RE, but 18 and 21 sound about ready to pop, and when I talked to Dr. RE#2, he had sounded like I would for sure be ready to go by Friday, but now Dr. RE#1 was saying that he would call me when he got the results of the BW to tell me when to trigger. Well, this all seemed rather random to me, and when he called me later to tell me to trigger Sunday night (CD 13) for IUI Tuesday morning (CD 15), I immediately thought that sounded like it would be too late (based on my completely internet-educated and non-professional opinion). So, even though he hadn't told me to use OPKs, I started testing the next morning (Saturday), and got a positive Saturday night. I texted him (he's told me this is the best way to contact him off-hours - is that kind of weird?), and he texted me back that I should trigger Sunday morning ("for a boost"), and come in Monday for the IUI. In my experience in my un-medicated charted cycles, I ovulate within 24 hours of a positive OPK, so I was of course worried that Monday was still going to be too late. DH and I BDed Sunday morning, just to be safe (of course, as you know, we still ended up with a BFN). Anyway, the kicker here is that when I had the final meeting with Dr. RE#2 (the one where he told me to get another beta "just to make sure"), as he was reviewing my last cycle I mentioned that we had had a timing issue and that I had a positive OPK before the trigger, and he said something like "well, your follicles on Friday were only 14 and 16, so it wouldn't have made sense to do the trigger any earlier." I explained to him that those numbers were wrong and that the computer hadn't updated and he totally brushed me off like I had no idea what I was talking about!

So... the moral to my long story is this: you must be your own advocate. In IF treatment or any other medical treatment. From now on I will ask the NP every time to tell me exactly how many and how big each of the follicles are so that I know for sure that the REs are making decisions based on the correct information.

Ok. On the IUI #2.