CD10, Sorta Cycling

A quick update (we've been super busy and will continue to be until after this weekend)!

At u/s on December 23rd RE found 2 or 3 leftover follicles (about 27mm each) from last cycle on left ovary (rightie was all clear). He said this was not uncommon but meant I had 2 choices: 1) skip this cycle, or 2) take BCP for 10 days to see if the follicles would shrink and then we could start the cycle. Although I swear I heard him say the word "choice," he then told me that we would do option 2. Fine by me. So that's where I am now. On BCP until January 4th. Honestly, I'm glad. With the stress of the holidays the last thing I needed was to be giving myself injections and going in for ultrasounds. So the delay is actually good.

One more thing: I "spoke up" about my thin lining (6.5mm last cycle) to my RE, and he spent about 20 minutes looking into it and talking to me about it. He looked at the previous two cycles I've done with them, the first on clomid, the second on femara. He said my lining on one (I forget which) was 6.3, the other was 5.5. He told me that although a thin lining is almost expected with clomid that I shouldn't have a thin lining with gonal-f, and that this was definitely a concern (he said 8mm is minimum) and that we would watch it carefully next cycle. He said that the best way to treat it was with added estrogen, but that if I didn't respond to the estrogen they would have to perform a procedure (name? I forget) to look for adhesions.

I only remembered later that during my previous (November) unmedicated cycle I started an estrogen patch at CD21 and that AF at the end of that cycle was much heavier than what has been normal for me lately, so that seems like a good sign that my lining will respond to estrogen if I need it.

Okay, gotta go for now! Will be back to regular posting and commenting next week!

Happy New Year everyone!

CD2, No News Is Not Good News

I did finally get my beta results on CD1 (yesterday). Tell me something I don't already know, RE.

I had called into the office Saturday morning to try to talk to someone and got their answering service (and they're technically open on Saturdays, too...). My RE did finally call me back Saturday night to tell me that he couldn't find the test results and wouldn't be able to get me any info until Monday. He said the word "sorry" about a half a dozen times, so points for that, but still. He'd asked if I'd taken an HPT and suggested I take another one just to make sure. I said I would but didn't, because, well, for the moment, anyway, I'm still living in reality.

So this week's going to be a crazy week for me, so I won't be posting again until next week. At this point I'm still going to try to cycle again right away, I go in tomorrow for my u/s and b/w. But I don't know what their holiday hours will be next week, so we'll see what happens.

Merry Christmas everyone!

14dpIUI, Beta Results Are... Not In

Guess what time the RE finally called me yesterday with my beta results?

Never!

That's right... 7pm rolled around and I thought, "well, it's getting a little late now, but last time I didn't get a call until 7:15..." Then 8pm rolled around and I began to realize: I'm not going to get a call. And at 8pm, who do I call? The office is long closed by then. Since I took the HPT I wasn't all that anxious to get my beta call, but I could imagine what kind of state I would've been in if I hadn't done the HPT. It pissed me off a little to not get a call, but if I hadn't already done the HPT, I would've been livid.

Oh, and when I went in yesterday for the blood draw I spoke to my RE and told him I'd taken an HPT and that it was negative and guess what he said? "Well, urine pregnancy tests can only detect down to 50 hcg, and you might still be early in the pregnancy and have less than that, so we'll see what the blood test shows." What century is this guy from? It's my understanding that HPTs detect down to 25 hcg, sometimes 20 (for "early result" tests, which are the only kind I ever see at a pharmacy).

We're starting to wonder if this is the right RE for us.

13dpIUI, HPT Results Are In

Starkly and undeniably negative.

12dpIUI, Getting Ready for Beta Day

No new symptoms, except that today my temperature stopped falling. If it had gone down again today I probably would have given up on this cycle. Unfortunately it didn't go back up, but whatever, I'll know one way or another tomorrow so I'm going to try not to over-analyze my chart too much.

So, yeah, tomorrow is beta day. Woo-hoo! I know, I only just recently confessed my love for the 2ww, but that was way back at 8dpIUI. Like, forever ago. I'd forgotten that the last few days of the 2ww are psychological torture. The past 24 hours have been like an endless loop of "Maybe I'm pregnant. Maybe I'm pregnant with multiples! Yeah, right. I'm probably not pregnant. I probably will never be pregnant. But maybe I am pregnant. Maybe I'm..." Wow. Turn it off.

So, I'll be POAS tomorrow morning. As I've posted before, last IUI they didn't call me until 7:15pm with the beta results. What, did the RE have to go out to dinner first or something? I can't wait that long again. And I have thoroughly considered my emotional reactions to each possible outcome of POAS, so I think I'm ready:

• Test is clearly positive. No need to even discuss this one. Celebration ensues. Can't wait to get the exact number from the beta.
• Test is clearly negative. Hopes dashed, waiting over, small glimmer of hope that HPT was defective, but negative beta should be less soul crushing.
• Test has very faint line. Hmmm. This one is the wild card. At 13dpIUI, I would hope that if did I get a line, that it would be fairly dark. A faint line would be the worst option here. But I don't think it would be any worse than not POAS.

I will post results tomorrow morning.

10dpIUI, Symptom Score

I'm 10 days into the 2ww now, and I've started googling early pregnancy symptoms again. Yes, I know them all already. I've googled them about ten thousand times before. But, you know, always good to stay obsessed during the 2ww.

So, here's what I have:

• Cramps like AF is about to start. This started yesterday. I've been having cramps ever since the IUI, but they've been different from AF cramps. AF-like cramps are an early pregnancy symptom, but of course, it's also a non-pregnancy symptom. And I've had AF cramps at 10dpo before, so I don't think this one counts. 0 points.
• BBs are larger than normal, firm and sore. They've been like this since before the IUI and I've had this symptom on previous cycles, so I don't think this one counts either. 0 points.
• My skin is breaking out more than normal, and in weird places: under my chin, on my backside. I have heard this can be an early pregnancy symptom. I have not had this symptom before. I give myself 1 point for this one.
• I feel a little run down. But then, when don't I? So that one doesn't count either. 0 points.

Overall score: 1

8dpIUI, I Love You 2ww

I'm not ready for the 2ww to be over. I still have 4 days (5 if you count beta-day, but I'll probably POAS that morning), but I want more time! Is that weird? I know everyone wants the 2ww to be over with already, but I kind of like it. Ok, I kind of love it. Because when it ends, I'm going to be a lot less pregnant than I am now (which is not very much, I admit). And because sometimes during the 2ww I just have a warm happy feeling of "I could be pregnant. Right. Now..." and then I get all starry eyed and swoony...

Anyway... so, I'd like to take this opportunity to acknowledge my beta buddies. Um, it's not like we've formed an official club or anything... well, at least I haven't asked them yet! But these 3 bloggers have the same beta day as me: Friday, December 18th, and I, for one, am pleased as punch that I am going to have some company that day. And I have to think that at least one of us will get a BFP. 1 out of 4 is pretty likely, right? Of course, I'm hoping 2 or 3 or even all 4 of us will get good news! And I do know that if I get a BFN and at least one (or more!) of these ladies gets a BFP it will make my BFN a lot easier.

• Melissa at Banking On It. This is her 6th IUI. Good luck, Melissa! (I don't know for sure her beta is Friday but her IUI was the same day as mine)
• A at Remember All the Way. This is A's 2nd IUI. Good luck, A!
• Rachel at Our Journey, But Not Our Plan. This is her first FET after her first IVF. Good luck, Rachel!

7dpIUI, Way Too Much of My Medical History

Today is 7dpIUI#2 and my temperature went up a little. Of course, that really means nothing at this point, but now that I'm in week 2 of the 2ww, I'm going to be over-analyzing every little thing from now until beta-day!

I know it's still early for pregnancy related symptoms, but I have had what I assume are non-pregnancy related symptoms. Ever since the IUI I've been having pain, discomfort and cramping all through my lower abdomen. Sometimes on the left or right, as if it's ovary related, but mostly in the middle. Last night it was worse than usual. I was awake at 4am with this feeling like someone had implanted a brick in my lower abdomen - it felt uncomfortably bloated down there, and painful. When I pressed on my abdomen, below my belly button, it hurt. I've had these symptoms before, mostly 1-2 days post-ovulation. I doubt this is any sort of early pregnancy sign or implantation related pain. I think it's probably a sign that something's not working right down there.

I guess now's as good a time as any to relate some of my medical history leading up to our current situation. About 3 years ago I started feeling "full" a lot. The best way to describe it is a feeling like, even when I hadn't eaten recently, my stomach was "bigger than normal," and when I did eat, after just a few bites, even though I was still hungry, my stomach felt so bloated and distended it was like I'd just had thanksgiving dinner. I stopped being able to eat an entire sandwich in one sitting. I could eat maybe half a sandwich, but I'd have to wait an hour or even two before I could eat the other half because I felt so stuffed. At first I thought it was constipation and began various over the counter remedies, none of which had any affect. So, about 6 months after the symptoms began, I saw my GP. He said it was probably Irritable Bowel Syndrome and gave me a list of foods to avoid, but also referred me to a gastroenterologist. I felt the IBS diagnosis was unlikely because A) my symptoms did not come and go based on the foods I ate (even drinking a glass of water caused my symptoms), and B) the foods on his "avoid" list I never touched: they were things like fried and processed foods, and I eat mostly fresh vegetables, fruits and whole grains (I am actually kind of obsessed with eating healthy).

The gastroenterologist did a series of tests. Let's see if I can remember them all: lower bowel series (where you swallow a barium milkshake and then they x-ray your intestines), upper endoscopy with biopsy (tube w/ camera down your throat while sedated), colonoscopy (tube w/ camera up your backside while sedated), capsule test (where you swallow a tiny camera). Those were the invasive ones: also bloodwork, stool analysis, etc.

He found nothing wrong with me.

At my annual gynecological exam, I mentioned my symptoms to my OB/GYN and she almost immediately said that one thing it could be was endometriosis. Sorry to be graphic, but she did a rectal exam that caused me extreme discomfort, and she said that this discomfort also pointed towards endo. She told me that the only way to confirm endo was through laprascopy, and that she was willing to do that whenever I was ready for it. I wanted to think about it and see how my symptoms progressed or didn't progress before making a decision, but then, about 3 months later, I got a letter from her office telling me that she would be no longer accepting my insurance in about a month.

After that, I lived with my symptoms for about a year, until we decided to start ttc back in November of 2008. Something told me that, based on my symptoms; the results of the tests the gastroenterologist had run; and the diagnosis by my OB/GYN, that we would have problems getting pregnant. But the way I figured it was, if I got pregnant easily, then I wouldn't have to worry anymore about my symptoms being reproductive in origin, and if I didn't get pregnant easily, then I'd know my symptoms were probably reproductive in origin, I'd have some tests done, and I'd know what the problem was. I even remember thinking back at the end of 2008 that either I'd get pregnant in 2009, or I'd find out what was causing my symptoms in 2009, and that one way or the other things would be resolved in 2009. Well, so much for that idea, because I'm neither pregnant nor do I know what's wrong with me.

I will say, however, that I'm more aware of how my symptoms relate to my cycles now than I was a year ago. There seems to be a high correlation between my worst symptoms and the week after ovulation, although this doesn't hold true 100% of the time.

So, I'm not surprised at all that, since I had so many follicles this cycle, I have so much pain and discomfort now. I really think endo is my problem, which almost makes me wish we'd gone with the IVF this cycle. I don't think IUIs are going to work for me.

One thing I do take comfort in is that I've read that the severity of endo symptoms often do not correspond with the severity of the disease, i.e. women with advanced endo might have no symptoms, and women with mild endo might have extreme pain and discomfort. And, also, there are a few typical endo symptoms that I don't have: AF is generally light to moderate (actually getting lighter for me, not heavier), and AF has also lately been less painful recently, not more. Whatever that means.

But, at least I feel like we have a plan now, and we're making progress. Even if we get a BFN this cycle, it will be in pursuit of my double goal: getting a diagnosis and, even better, getting a baby.

5dpIUI, Babies, Julia, and Me

I love/hate babies.

I love them in my imagination and I love them in my dreams. I love my friend's baby (and thank goodness I only have one friend with a baby, because I think for now that's enough).

But I hate public babies. What do I mean? Those babies whose parents have decided they are a gift that they have given to the world, and who try to get you to acknowledge their baby's adorableness by theatrically fussing and cooing over them in public. I don't play their game. I'm like the cranky old-maid that walks by with her head held high and says, "Pshaw!"

Oooohhhhh.... I'm a bitter bitter woman.

But, on a related note, I watched Julie and Julia last night, and really appreciated the shout-out to the infertiles. For anyone who hasn't seen it, there's a scene where Julia Child gets a letter from her newly married sister with the announcement that she's pregnant. Julia, her voice catching, says to her husband, "Isn't that just wonderful news?" She then begins to cry and buries her head in his shoulder. "Yes, it is," he says as he strokes her hair. "I'm so happy," she says through tears. "I know," he says, patting her gently, "I know you are."

The most wonderful thing about the movie, of course, is how wonderfully happy and full of life Julia Child is. It's an inspiration, really. She so longed for children, but lived an amazing and accomplished life without them.

And so, she inspires me to throw off my bitterness, and to instead look at all the wonderful things in my life and say, through my tears, "I'm so happy!" Because, as Julia knew, what else can you do but live the life you have to its fullest?

3dpIUI, IFROCGD

The boredom and restlessness of the 2ww have begun. The solution: IFROCGD (Infertility Related Obsessive Compulsive Googling Disorder). Today's search: E2 levels as they relate to follicle size.

(Yes, I'm still obsessed with the size of my follicles.)

I triggered 36 hours after my follicles were at the following sizes (this is CD9) (does not include follicles under 10mm):

1. 10.83
2. 11.35
3. 11.67
4. 12.53
5. 14.01
6. 14.14
7. 14.48
8. 14.66
9. 15.16
10. 15.29
11. 15.58
12. 15.78
13. 15.93

(Phew, that's a lot!)

My E2 level on that day (CD9) was 599 pg/ml.

What I wanted to know: Is that E2 level too low? Because it seems kind of low, for that many follicles.

What I learned: Apparently each mature follicle should contribute 150-200 pg/ml towards the overall level, but all follicles contribute, not just the mature ones, so you can't just divide your total by 150 or 200 to know how many mature follicles you have. So, I'm not sure if it was low or not. But I did read that E2 levels over 1000 are related to a higher incidence of HOM ("High Order Multiples": learned that today, too).

I also learned that follicles grow from 1 to 2mm per 24 hours, and that follicles are considered mature at varying sizes, but 18mm-20mm seems to be about standard. My two largest follicles (15.78 and 15.93) might have just made 18 by the time I triggered 36 hours later. Of course I injected two more shots of gonal-f during that 36 hours, so hopefully they were on the high side of the estimate.

I've also been thinking a lot about IUI/IVF success statistics and what they really mean (to me). Haven't googled it yet. But then, I have 11 more days of the 2ww to go, so I've got plenty of time!

(Somebody stop me.)

1 dpIUI, Hello 2ww!

Dear 2ww,

I've missed you.

Yes, I know, I know: we haven't gotten along very well in the past. But I've been really looking forward to seeing you again. The thing is, when I'm not with you, there's just so much to do, and so many decisions to be made, and all I can think about is getting off that crazy roller coaster and us spending some quality time together!

Having said that, I have to be honest: you're already kind of getting on my nerves. I'm sorry to have to tell you that when we've only been together again since yesterday, but we both know how you've treated me in the past, and I can't help but think our time together for the next two weeks is not going to be much fun. I know it's rude to bring up past transgressions, but your behavior last cycle was so not cool. Remember? I had that textbook temperature dip at 7dpo? And you totally got my hopes up? And then you crushed them 3 days later when my temperature took a nosedive? Yeah, that wasn't funny. It was actually kind of cruel.

Look, okay, maybe the temperature nosedive was your way of breaking the news to me gently. I'm going to try to look at it that way. But that "implantation" dip? How about let's agree that you don't do that again. Unless we're really pregnant. Okay?

But I did miss you.

Your frenemy, Jane

CD11. What. Ever.

I've already gone from being worried about getting too pregnant to now worrying about not getting pregnant enough.

I was so obsessed with those 9 rapidly progressing follicles that it took we a while to realize that I'm being triggered kind of early this cycle. Now, I love to second guess my RE as much as the next infertile lady, so of course I'm thinking about how last IUI cycle the RE told me to trigger 60 hours after I had my u/s that showed a 21mm and an 18mm follicle (granted, I also got a positive OPK the day after that u/s, about 24 hours before I was supposed to do the trigger, so maybe they waited too long...). This time, I was told to trigger 24 hours after my u/s showed only 2 follicles over 16mm. Of course the big difference is that last time I was doing a femara cycle, and this time it's injectables, and I have continued the injectables all the way through last night, so it seems likely that that could speed things up at the end. But, I'm still worried that I triggered too soon and all those follicles are going to end up going to waste.

But you know what? What. Ever. I have to say that I'm sick of this roller coaster. I've even started having thoughts of what it would be like if we just stopped trying. We were happy together for 7 years without much thought of a family, and I feel pretty confident we could go back to that. It's going to be such a relief when we're done with IF, whether through a pregnancy or just giving up.

Also, I had an IF dream last night. I don't have that many, thank goodness, but I thought this one was interesting (although aren't dreams always more interesting to the dreamer than anyone else?).

In my dream, the fertility clinic I had been going to (not the one I go to in real life) had moved, and no one would tell me where they had moved to because at their new location they were going to only be treating women whose infertility was explained, not women with unexplained infertility (like me). The implication was that they knew they could help women with explained infertility, so that was the only women they really saw a point in treating. They told me I had to go to another fertility clinic for women with unexplained infertility, but when I went to try and find it, I couldn't. I kept getting out of the elevator at different floors in the building it was supposed to be in, but it just didn't seem to exist. It made me feel rejected and hopeless. And, yes, if you are reading into this an underlying jealousy of those women who know why they aren't getting pregnant, you're right. Part of me wishes I had a problem that could at least be treated. I know, I know, careful what you wish for...

So, I did the ovidrel and last 150 of the gonal-f last night. I'm glad to be done with the injections. I got a half positive on an OPK this morning (did an OPK yesterday too and it was very negative). IUI is tomorrow at 9am.

CD10, Crazy Infertile Lady Allowed to Go Insane

Here's what happened yesterday.

First, the ultrasound. My lining is on the thin side: 6.5mm, but apparently it is "beautiful" and "homogeneous." On to the follicles: I have 9 follicles measuring over 14mm (two of those are over 16mm), I have 15 follicles total that are over 10mm. As I was still considering IVF at that point, I asked the doctor if I had started out as an IVF cycle, what number of follicles would they have liked to see. She told me that the standard is "5 to 13," so I was well within that. (BTW, the Dr. performing the ultrasound was the same one that I had spoken to at my last visit, the one who had told me that if we went forward with the IUI we would have a higher than normal risk of multiples, and had offered IVF to me as an alternative.)

After the ultrasound and bloodwork, DH and I met her in her office to discuss our plan. DH shocked me by completely taking control of the situation and asking her about a bazillion questions about IVF versus IUI to the point that she said, "You know, I'm not sure I have all the answers you're looking for, maybe it would be better for you to speak with one of the doctors. Hold on." (note: she is an NP, not one of the main 2 REs at the clinic).

We were sent back to the waiting room to wait for RE#1 (my assigned doctor).

It was nice to see him, finally, as he is the doctor that I started with, and the one who knows the most about my progress so far. But as soon as we sat down it was clear he was not on board with IVF. Although he didn't exclude the option, and he answered all of DH's questions, it was clear that he was leaning toward IUI for us. It was also quickly clear that DH was in doctor love.

Basically, the RE's opinion was this: we are not at the point in our infertility treatments where it makes sense to move forward to IVF. He felt that it would be too aggressive. And the only reason not to go forward with IUI would be the increased risk of multiples.

So, really, what it comes down to is our tolerance for the multiples risk. As I said in my earlier post, DH and I would very much prefer a singleton to twins. And anything above that is out of the question. What makes this so hard to wrap my head around is that even with 9-15 follicles, our chances of failure this cycle are still far greater than our chances of success. There is still only a 20% chance of pregnancy. The main difference between this cycle and a "normal" one is that our multiples risk has gone from 10% to 20%, with most of that risk being in the twin category. But another way to look at it is, if our chance at getting pregnant is 20%, and our chance of having twins or more if we get pregnant is 20%, than our overall chance for twins or more this cycle is 4%. So it seems pretty unlikely.

Of course, then I think about the fact that most likely I will have at least 9 mature follicles this cycle and it seems insane to do an IUI. Just insane. I have not heard of anyone else doing IUI with this kind of response. At one point in our meeting with RE#1 he said, "Would doing an IUI under these circumstances be irresponsible? Well, the answer to that is: I do it all the time." (!!!!!)

So, it ends up like this: I am relying on my RE and DH to be my voices of reason. Of course I want to do IUI: the more follicles the better! But I'm a crazy infertile lady hopped up on fertility drugs! I trust them to hold me back if I want to do something nuts, and yet here I am the one leaning toward the more conservative route.

So, I'm putting my trust in them that this is not crazy.

Is this crazy?

CD9, Ugh

Ugh. We're going with IUI. Do I have mixed feelings about this? Yes. Yes I do. But I would have had mixed feelings no matter which decision we made.

I may write a longer post about how we arrived at this decision later. For now, I just don't have the energy.

IUI scheduled for Saturday at 9am.

CD8, What to Do?

Currently, I'm leaning toward converting to IVF. Or cancelling. But not IUI. I don't like the multiples risk. DH doesn't seem to think reduction would be a big deal if we found ourselves facing that, but I kind of think it would be a big deal. It's one of those things that you can think about theoretically and be okay with, but I suspect that if we were actually looking at multiple implanted embryos on a monitor, I would be a complete wreck about having to decide to reduce.

I didn't get the ganirelix last night. A pharmacy was supposed to call me and never did. But I did do the higher dose (150 instead of 75) of gonal-f. The higher dose may end up taking IUI off the table as an option because of my concerns about multiples, but will leave open the IVF option, and, of course, the cancelling option.

I'm working on finding out what happened with the ganirelix prescription now, and will probably pick it up today. Then do another 150 gonal-f tonight, then back to the RE tomorrow.

I called my RE to get pricing for IVF and here's what I found out:

• $8000 + $500 for anesthesia
• $700 if I want to freeze embryos
• Any future FET cycles $3500/each

Also, I would be paying less for this IVF because I started it as an IUI, since I'm covered for all bloodwork and ultrasounds while I'm still in IUI mode. If I do another IVF in the future that starts as an IVF cycle, the cost would be $11,000.

Although we're leaning toward IVF right now, we'll of course wait to see how everything looks tomorrow before making a decision. I think we're also leaning toward only transferring one embryo if we go the IVF route. But there are a few things I'd like to know before we make a decision:

• How many mature follicles are there likely going to be? If we started this as an IVF cycle, would there have been more than that? Is it a reasonable number to go forward with IVF? (I'm afraid we're going to end up falling in some sort of gray area: too many follicles for IUI but too few for IVF)
• If we do IVF and fail, can we go back to IUI, or are we better off going on with IVF?
• What are the chances of twins if we transfer 2 embryos?
• What are the chances of twins/multiples if we do IUI?

I feel like this is all happening so quickly. I really don't even know how IVF works. I mean, I do, but if we knew we were doing IVF going into this, I would have read up on it a lot more.

Are there any other questions that I should ask tomorrow? (If anyone wants to give me advice, I would welcome some!)