Kindred spirit

Yesterday, a colleague who had been off on maternity leave returned to work at our office.  I'll call her Jill.  While Jill and I never worked together directly in the past, she'd been in the same department with a few of my closer friends.  As a result, we ended up socializing a little before she had her baby.  She was one of those people that, because she was friends with my friends, I felt like I should have been closer with her, but we just never spent any one-on-one time together so it never happened.

When I learned that Jill would be coming to work in my department upon her return, I had mixed feelings about it.  I looked forward to the opportunity to work with her and get to know her better.  But I also feared that I'd find it hard to be around her.  After all, she's a new mom who would undoubtedly be plastering her desk (mere feet from mine) with pictures of her year-old daughter and talking incessantly about how hard it was to be coming back to work and leaving her baby behind.  I really wasn't looking forward to this added reminder of my infertility in the same office with me, all day, every day.

When she arrived yesterday I spent some time showing her around, and talk inevitably turned to her daughter.   In an attempt to be polite I asked whether they'd had a hard time finding child care, since I'd heard that you have to put your child's name on a wait list practically as soon as you see that second line on the pee stick around here.  She agreed and talked about how expensive child care is, saying that she and her husband probably couldn't afford to have another child even if they wanted to.  Which, she said, they didn't.  They'd had a hard time getting pregnant, she said.  They'd had to do IVF.

My jaw dropped.  I immediately blurted out that M and I were doing IVF too, and that I'd had an egg retrieval just last Monday.  I couldn't believe that none of our common friends had said anything about this to me, even knowing what I was going through.  Jill said that they'd kept things very private and didn't really tell anyone at work. 

I know that the statistics of infertility are something like 1 in 7 or 1 in 8 couples.  But I've never personally known anyone else who has gone through it...or if they have, I didn't know about it.  And now, an IF success story is sitting not ten feet from me in my office.  And not just any IVF success story.

She had ten eggs retrieved.  Three fertilized.  By day 3 they had one embryo left to transfer.  ONE.

Our male co-workers were on their way back into the office so I didn't get the full story.  We ended up having this crazy hurried disjointed half-whispered conversation, the jist of which was that it's so hard and no one understands and we have to go for coffee and talk about it and I only have one embryo too and don't give up it can work with just one embryo and OMG we have to go for coffee and talk about it!

Now, I'm not one of those people who believes that "everything happens for a reason".  I'm not a religious person and I don't think there's one overarching plan for everyone.  But every once in a while, something happens and you just feel like it's the universe smacking you in the face trying to send you a message.  This was one of those times.  Except the problem is, I can't figure out the message!  I'd love to think it's, "Hey, it happened for Jill in extremely similar circumstances, so don't give up hope!"  But then my pessimistic side takes over and all I can think is that statistically, someone has to succeed and someone has to fail, so what are the chances that two of us in the same office are going to beat the odds?  I know it's totally stupid to think that somehow her success has now doomed me to failure, but there it is.

Either way, I'm incredibly happy to have found someone else in real life that I can talk to about this.  All the fear, the doubt, the sadness, the depression...she gets it.  And I can only hope that her knowing about my infertility will temper a little bit of the baby talk around the office, since she really doesn't seem to have turned into one of those smug former infertiles who is out of the trenches and has totally forgotten the battle.  It's clear that she still feels her scars.

The waiting game sucks. Let's play Hungry Hungry Hippos!

Hopefully some Simpsons fans will pick up on my post title...

Saturday was the Day 5 check-in for our embryos, to see whether any of them made it to be frozen for a future transfer.  All week I had been getting my phone messages from the clinic between 9 and 10am, so I didn't really have too long to wait with a knot of anxiety in my stomach before I got the news and could go back to concentrating on work.

 Saturday?  Those fuckers didn't call until 1pm.

I have this theory (a totally scientific one, don't question my credentials!) that the quality of the news you are about to receive is inversely proportional to the length of time it takes you to receive it.  As in, you'll get good news right away.  But bad news?  The person who has to give it to you will put off delivering it (since it's an unpleasant task), or will find someone else to do it.  In this case, when I hadn't heard from the clinic by noon I was convinced that all of our embryos were dead and that the nurse didn't want to call me herself, so she had passed on a message to our RE to do it.

I tried everything I could to distract myself.  I planned our meals for the week.  I went grocery shopping, sure that M would get a call when I was out (there was no way I was taking my cell phone only to be reduced to a blubbering puddle of tears in the dairy aisle).  He didn't.  I finally decided that I'd better do my workout before I got the news, since I'd be in no mood to do it afterward.  Mid-squat, the phone rang.

We have one blastocyst on ice.

This is the first time in my life that I've cried happy tears.  I don't even cry at weddings, including my own.  But after all that waiting, and believing with almost 100% certainty that they were all gone and we had done this for nothing and we would have to do it all over again...well, having that one measly frozen blastocyst felt like just about the best thing that had ever happened to me in my life.

They cultured the other three embryos until today hoping that we'd get more, but no dice.  This little guy is our only shot for this cycle.

And this is the part where my nasty pessimistic side starts rearing its ugly head.  First, I'm worried that it won't survive the thaw and we'll have just wasted the next two months waiting for an FET that will never happen.  And if it does happen, what are the chances that this one embryo will implant and grow to term?  I mean, my eggs are sufficiently crappy that they only had a 50% fertilization rate and a 25% blastocyst rate.  What are the odds that this lone survivor is really good enough to make it?

I voiced these concerns to M earlier today after we heard that our three other embryos didn't survive.  He responded with, "Well, isn't your blog called It Only Takes One?"  I said, "Yeah, but I kind of picked it ironically because it's the platitude that everyone gives you when you have DOR!"  And yet here we are, with all of our eggs...er, egg...in one basket.  Freezer.  Whatever.

Anyway, there's clearly no point in worrying about this stuff since what will happen is out of my hands.  And don't get me wrong, I'm still overjoyed at the fact that we do have one.  I'm going to spend the next two cycles trying to de-stress from the IVF and get my body as healthy as I can for our FET.  Gotta tidy up.  Important guest coming!

A sales pitch to our Day 3 embryos

So, as of this morning's update message from the clinic, all four of you were still "doing well".  They apparently won't check on you tomorrow so the next I'll hear will be Saturday, to see which (if any) of you has decided to stick around to be frozen and put back in my belly.

It's gotta be tough to be you right now.  It's no mean feat to have popped into existence from a sperm and an egg.  And it only gets tougher from here.  I mean, maybe you're 6 or 8 cells now, but in two days you'll be expected to be 70 to 100 cells.  That's a lot of pressure!

I get it.  I've been there.  And I'm sure it's a lot easier to just kick back, put up your mitochondria and say, "Not worth it.  Have you heard about global warming?  The world's only getting worse.  I'm not signing up for that shit."  But allow me to take a moment and tell you about a couple of the perks that choosing to become a blastocyst has to offer.

First off, you get spectacular accommodation for 9 whole months in the warm, toasty climate of my uterus.  It's essentially the world's best all-inclusive.  It has an all-you-can-eat buffet of delicious nutrients supplied by all the healthy food I'm going to consume, and you get to sleep in all day in a super-soft bed.  You can always try it out there for a while and if you don't like it, you can still get out of your contract at that point, although I really hope you won't.

If you sign on for the lifetime program, that's when the great benefits really kick in. You get your own room in a house that was bought specifically with you in mind, with a nice backyard and across the street from a great school. You'll quite literally be pampered.  You'll be waited on hand-and-foot, with staff to cater to your every need.  And speaking of staff, we've got some really great people.  You'll have not one but two sets of grandparents who can't wait to spoil you rotten.  There's also three uncles who specialize in horsie rides, flying you around like an airplane and other general shenanigans, as well as the coolest aunt in the world.  Oh, and did I mention your big cousin who would love nothing more than to dress you up like a princess (whether you're a boy or a girl)?  She's awesome.

And then there's your dad.  He's the smartest guy I know, so whenever you have important questions like "Where do birds go when it's stormy?" and "Why does poo smell bad?" he's your man.  He gives the best hugs when you're sad, and even though he's not much of an athlete that's never stopped him from trying.  He's also our tech specialist so he's on call 24-7 whenever you have any computer problems.

As for me, I'm kind of your jack-of-all-trades.  I take care of food (we have this amazing stuff called bacon, you're gonna love it!), medical (kissing bumps and bruises, applying fun cartoon bandaids, emptying the puke bucket when you're sick in bed), and general maintenance (don't worry about the at-home haircuts; we'll laugh about those when you're older).  

We've got tons of activities planned.  There's photographing and videotaping you incessantly, being overly interested in your bowel movements, cheering like crazy people when you take your first steps, and making sure you get cake all over your face on your first birthday.  There'll be beach vacations with one set of grandparents, and exciting plane rides to the east coast to see the other set.  Did I mention they have a cabin?  Favourite summertime childhood memories have been made there for generations.

I hope this gives you a good idea of what's in store.  Sure, it won't all be good times, but you'll have our unwavering support for all of those too.  And there's so much good stuff I haven't even mentioned yet!  Like naps and chocolate and snow and dancing and kittens and spaghetti and music and trampolines and...well, hopefully you get the picture.

We're offering total devotion and boundless love.  We can't wait to show you this life.  

We know you can make it.  You just have to grow.

Four

That's it.  That's all that fertilized.

Out of my 9 eggs retrieved, 8 were mature.  Only half fertilized with ICSI.  

ICSI fertilization rates are normally in the 70 to 80% range, so clearly something is seriously wrong with my eggs.  All this time I'd had an illusion in my head that maybe my eggs weren't so bad, and if they could just get M's sperm inside them then things would be fine.

You see, M's male factor has to do with abnormal acrosomes, which is (as my RE explained it) the little drill that the sperm uses to break into the egg and fertilize it.  If that drill malfunctions, the sperm just can't get in and it's game over.  During his fancy shmancy sperm analysis, only 15% of M's sperm had normal acrosomes.  Not that I doubted that my DOR and likely poor egg quality played a role, but I held out hope that maybe the sperm just needed a little help getting in there and ICSI would fix everything.

I'm trying so very, very hard to remember that if I'd only had four eggs retrieved in the first place, I'd think that having four fertilized eggs was the best thing in the world.  And that yes, it only takes one (damn me for picking that blog name!)

But statistically, only 30% of fertilized eggs make it to blastocyst stage (the internets say so here).  Since we can't do a fresh transfer this time around, those embryos need to become blasts so they can be frozen for a future FET.  At 30%, that means we're only likely to have one after all.  If we have any.  At this point, I'm going down a negative thought spiral and while I managed to hold off crying at work, the dam has now burst and I just feel like this whole cycle is doomed to failure.

 It's going to be a very fucking long five days.

Winter is coming

I got my wisdom teeth removed a couple of years ago after much procrastination.  I hate needles, and I hate needles in my face even more, so it wasn't until they started threatening to cause cavities in the surrounding teeth (due to the difficulty of brushing them so far at the back) that I decided to go ahead and do it.  It was one of the best decisions I ever made.

As someone who has smoked weed a grand total of twice in my late teens/early 20s, I was a huge drug virgin.  But let me tell you, the stuff they put me on made me totally understand why people become addicts.  DRUGS ARE AWESOME!  I was awake for the entire procedure which involved a large man using clamps to YANK OUT PARTS OF MY FACE and I just.  Didn't.  Care.  I was so chilled out that when I heard the first telltale clink of a tooth hitting the metal pan, I (through a mouthful of blood and cotton) actually said "Cool, done one side already?  Can I see?"  Of course I'm sure it sounded much more like "Goo, dlarh gah soo yaahaaeey?  Caahhishleeee?"  Once I came down I had a new appreciation for mind-numbing substances and hallucinogens.

So I was reasonably excited to see what they would put me on when I arrived at the clinic this morning for my egg retrieval.  Imagine my disappointment when they told me I would just have a little something to "make me loopy" and another something to "make me comfortable".  This didn't sound like it was going to be an awesome trip at all!  And it really wasn't.

Not to scare anyone off (especially you, clinic sista Vanessa!) but I definitely wasn't knocked out for my retrieval.  Nor, for that matter, did I feel particularly loopy.  Or comfortable.  Yeah, definitely not comfortable.  While I'm sure whatever pain meds they gave me must have numbed things, I did feel quite a bit of pinching as they inserted the needle.  And when they were doing the right ovary (which was supposed to be the easy one based on the smaller number of follicles), it apparently kept "rolling around" on them so they had to apply quite a bit of pressure and poking which was distinctly NOT PLEASANT.  I believe it was at that point that my resolve kind of broke and some tears leaked out and I just wanted it all to be over.

And then it was. 

We got 9 eggs.  We'll find out sometime tomorrow how many were mature and how many fertilized.

The other kick in the ass this morning came from my RE shortly before she began the retrieval procedure.  She informed us that my bloodwork yesterday morning (after my HCG trigger) showed slightly elevated progesterone levels.  While they weren't super high and she assured me that this wouldn't affect the quality of the eggs, she recommended against a fresh embryo transfer since it is likely that my lining will be "out of sync" with the embryos and hence compromise the chances of implantation.  It's called Premature Luteinization and the science is here.  Instead, they want to do a "freeze all" and then a frozen embryo transfer (FET) once my body has had a chance to get back to normal.  So now instead of a two week wait, we have a two month one as I await my period from this cycle, have another full unmedicated cycle (where they will yet again do an endo biopsy), and then start a new cycle where they can do an FET probably in March.  Hence my Game of Thrones-inspired blog title.  Winter IS coming, my little (hopefully soon to be) embryos.  At least I'm in good company, right Daryl?

Have I mentioned that my uterus is an asshole?  Because it is.  An uncooperative asshole.

Anyway, I'm not really complaining.  Well, I am, but kind of good-naturedly because at the end of the day I am very happy that we got 9 eggs out of my equally uncooperative ovaries.  And I'm generally feeling good, despite the discomfort of the retrieval.  No bloating or abdominal pain to speak of right now.  I've eaten a bagel and had some coffee and am suffering no real ill effects except for some nappiness, which will be dealt with shortly enough.

And on the positive side, I have already told M that we are going on some sort of beachy vacation as we wait these cycles out.  No ifs, ands, or buts.  Well, except my white butt gettin' its tan on. 

Uncharted waters

Well my friends, we are officially in uncharted waters.  I triggered last night and am headed to egg retrieval tomorrow!

Before I launch into my usual number roundup, Idiotic Infertility had a couple of interesting posts last week on the topic of sharing stats.  She made the very reasonable point that not everyone appreciates seeing another blogger's numbers.  This is especially true if you're in a bad mental spot, since those numbers could trigger a lot of negative feelings including jealousy and depression.  Ultimately, it all depends on context and understanding how that particular blogger's infertility diagnosis comes into play.

Prior to her posts I'd never even thought twice about sharing my numbers.  For me, as soon as I was diagnosed with Diminished Ovarian Reserve (DOR) I immediately hit the internet for research on what I could expect.  I'm a very analytical person and I really wanted to see what happened to other people with similar hormone levels or antral follicle counts.  Whether their outcomes were good or bad, I wanted to be prepared for every possibility.  And let's face it...no matter what your diagnosis, even if you find 99 stories where people failed, all it takes to keep you going is that one time that somebody like you succeeded.

Anyway, there's obviously more than one way to do things and everyone will have their own opinions and comfort level about how much detail they want to read or share.  I'm going to keep posting numbers because at the end of the day this blog is about helping me to process things.  I hope at the end of it I can be one of those DOR success stories that I was so desperately searching for six months ago, and if not then I hope people can remember that no matter what my numbers say, everyone's body behaves differently and there's also a large component of luck involved.

So without further ado...after 12 full days of stims, I am headed into retrieval with 12 follicles showing on ultrasound.  Four of these are only 10mm and one is 14mm, so the nurse suggested they probably wouldn't be mature enough at retrieval.  But that leaves me with 7 ranging between 16 and 22mm that will hopefully yield some good eggs.  Luckily, lead follicle Fatty McFatterson slowed down enough for the others to catch up, so we won't have to sacrifice him after all.  While 7 mature eggs is certainly a much lower number than I had in mind when I first started IVF treatments last year, over time my expectations have become much more realistic.  As a poor responder with undetectable AMH levels who was worrying as recently as CD10 about being cancelled again, I will be over the moon if they manage to pull mature eggs out of all 7 of those follicles!  My estrogen is currently 8537 (2325 US), for anyone who's counting.

I'm currently flipping back and forth between excitement and oh shit this is really gonna happen nervousness.  I get pretty anxious in the lead-up to any kind of medical procedure, so I really have to try to keep myself busy today and not worry about it too much.  There's some pretty nasty egg retrieval horror stories online, but I've also read a lot of other bloggers who've returned to work the next day with some pretty minimal after-effects, so I'm hoping to fall into the latter category!  I'll try to post something hilarious in my drug-induced stupor tomorrow.

Oh, and I've been nominated for a Liebster Award by not one, not two, but four other awesome bloggers!  As that makes for 44 questions to answer, I'm just going to pick some of the more entertaining/insightful ones and do a post about that next week sometime when I'm (hopefully!) on pins and needles waiting for transfer day.  Thanks for the shout-out, ladies!

I am the Tortoise

After 9 days of stims, I now have three more follicles that have joined the party.  That makes a grand total of 8.  Fatty McFatterson is still leading the pack at 19mm, with the seven dwarves ranging from 10 to 15mm.  Even if we have to sacrifice Fatty, that's still 7 possible eggs.  A hell of a lot better than the three that I started with!  I've been told to keep taking my stims for two more days.

This feels never-ending, but I'm hoping that slow and steady wins the race.

And now, I leave you with a picture of a the happiest baby tortoise ever nomming a strawberry.

 

Slow your roll, Fatty

Well, I've now officially gotten further in this cycle than I did last time we tried IVF.  Last time I was cancelled after 7 days of stims, with one huge dominant follicle and four smaller ones.  This time, after 7 days of stims, I have one huge dominant follicle and four smaller ones.  Sound familiar?  However, this time we're going for two more days of stims before my next check.  I guess it's safe to say that expectations for me have dropped.

I was pretty happy to hear this morning that I had two new follicles in the mix, bringing my grand total up to five.  But the bad news is that there's a monster follicle on the left that's taken a substantial lead at 17mm, with all the rest lagging at 10 or 11mm.  The nurse said that it's likely they'll just continue to stim me and possibly sacrifice the big one by allowing it to overmature so that they can get at the crop of little ones. 

I have mixed feelings about this.  Obviously, IVF is a numbers game and the more follicles at retrieval the higher our chances of success.  But theoretically, Fatty McFatterson (as I'm now calling my 17mm follicle) is my best egg since it's growing the fastest.  It kind of sucks to sacrifice it for the sake of the lesser mini-eggs.  

Mmmm....Cadbury mini eggs....sorry, got distracted there for a bit.

They didn't even bother to give me my E2 level, which is probably good since I would've only researched and obsessed about it all day.  As it is, I feel like I'm on pins and needles all the time.  Every morning before my stim check I wake up with a huge ball of anxiety in my stomach, wondering if we'll be told we're cancelled again.  Then I get to work and try in vain to distract myself before I get my afternoon bloodwork results and drug instructions.  Then the whole cycle repeats itself.  I feel like I'm just scraping through the checks by the skin of my teeth, and I wish just for once that I'd get some kind of results that I can feel confident in.

Now if you'll excuse me, I'm going to go drink some wine and give a rousing pep talk to my remaining follicles.

Hanging in there

Today was my second monitoring appointment after 5 days of stims.  Follicle-wise things are a little better.  I've still got the two on the left (at 13mm and 11mm now), and a lone contender has finally shown up on the right (at 10mm).  The nurse said there's still lots of smaller ones that may join in.  I was actually pretty happy with these results, as the follicle growth looks to be nice and even and there's no dominant follicle taking off way ahead of the others this time around.  Now I just have to hope some other follicles show up to party!

My mood was also boosted when I got my estrogen levels back.  Right now they're sitting at 965 (262 US), which is more than triple what they were two days ago.  I was told they like to see the E2 numbers double, so at least I'm exceeding expectations in one area!  I'm hoping this means that there's lots of follicles waiting in the wings (my clinic doesn't bother to chart them unless they're over 10mm) and that we'll see even more at the next monitoring on Monday.  I also got the go-ahead to start Orgalutron (Ganerelix) today to stop ovulation, since my biggest follicle is over 12mm.

I want to thank all of you guys for your support and thoughtful comments as I slog through this second IVF.  Along with my new approach to infertility, I really think that having this blog is helping a lot.  I get to write out my feelings and thoughts and frustrations instead of keeping them inside and stewing over them, and then I get support and encouragement from a bunch of awesome ladies who know exactly what I'm going through.  While I don't think I'll ever be a full-on optimist, overall I definitely have been feeling a lot less down and negative even though things aren't going exactly as planned. 

M and I haven't talked about the topic of what we want to do if we only get those three follicles to grow.  No one at the clinic has mentioned it yet either, but I suspect they'll offer to convert me to an IUI again if we don't get more follicles.  However, I don't think there's any point in doing that and I'd really like to see what would happen once they retrieve and ICSI my eggs.  I haven't gone into detail about it yet (mostly because I don't really understand it) but M's also got some mild male factor stuff going on so I kind of feel like another IUI would just be wasting our time and all those drugs.  If we only get three eggs, we only get three eggs.  I picked my blog title for a reason!

Deja vu all over again

I was really hoping that this cycle would be different.  That the change in drug protocols would mean a better response to stims.  But so far, it just feels like I hopped into a time machine that's taken me back to our first IVF in October.

Today I went in for my first monitoring appointment after 3 nights of max stims (300iu Gonal F, 150iu old nun pee...er, I mean Menopur).  After my bloodwork and ultrasound, I met with the nurse to get my results and drugs for the next few nights.  It all sounded awfully familiar.   The two lead follicles on my left ovary are still there, at 11mm and 10mm.  Nothing else is growing.  The nurse told me that it's normal for most of the follicles to be small at this point, and we'd have to wait for my bloodwork to come back to see if my estrogen was rising.  When this happened last time, I asked what E2 numbers they like to see at this point and the nurse replied somewhere around 400 (over 100 US).

My estrogen came back at 292.   That's marginally better than last time, when it was only 220 after 3 days of stims, but it's still not where it should be.  Which means that yet again, I'm turning out to be a poor responder.  I know it's early days yet and lots can happen, but the fact is there's no room for them to increase my dosage so I just have to hope that things start happening on their own.  

Then there's those alleged "lead follicles".  On the plus side, neither of them has grown substantially since my baseline ultrasound, so there's still hopefully time for the rest to catch up.  But the fact that they haven't grown and don't seem to be pumping out estrogen makes me wonder if they're follicles at all, instead of just empty cysts.  Which would drop my number of follicles (and therefore potential eggs) down to 11.

The worst part about all of this is that I'm not super busy at work right now, so I have tons of time to spend on the internet Googling all my numbers and obsessing over this.  I'm trying hard to stay positive and not let this get me down, but it honestly feels a little like Groundhog Day and I really don't know if I can handle being cancelled again after 8 days of stims.

At the very least, this whole thing is a good test of my 2013 resolution to not let infertility rule my life.  Last cycle after bad monitoring days I just came home after work, plunked my ass on the couch and sulked my way through the evening with a few chocolate treats.  Tonight I came home, did a workout (even though I really didn't feel like it) and cooked a healthy stir fry for our dinner.  Still waiting for those workout endorphins to kick in, though.

It is what it is, and nothing I can do right now will change what happens.  We'll know soon enough.

Quiz time!

If you're anything like me, you've spent an inordinate amount of time online researching dozens of aspects of fertility.  Hormone levels, antral follicle counts, IVF protocols, you name it, I've Googled it.  But one thing I never really spent a lot of time researching was my fertility meds.  Apart from a quick glance to see what kind of side effects I might experience from Lupron, Gonal F, Cetrotide, or whatever concoction I'm on this month, I never really paid it much heed.  Just took my RE's word for it and poked it in my belly.  

But then I came across a fascinating tidbit that I thought would be interesting to share.  In the interest of entertainment, we'll do this in quiz form!  Oh stop whining, learning is fun.

Question 1:  The follicle stimulating hormone (FSH) contained in ovarian stimulation medication can either be made synthetically or derived naturally.  Which one of the following products contains naturally derived FSH?

a) Gonal F

b) Menopur

c) Follistim

Answer:  B (scroll over to view)

Question 2:  From what is this natural product derived?

a) willow bark

b) salmon skin
c) human urine

Answer:  C

Now, I'll stop here for a second to make sure you've checked your answer to Question 2.  Because again, if you're anything like me, the next thing you will wonder if you've ever used this naturally derived product is this: exactly whose piss is it that I'm injecting into my body???  Let's move on to Question 3.

Question 3:  Exactly whose piss is that that I'm injecting into my body???
a) postmenopausal women
b) old Italian ladies
c) nuns

Answer:  All of the above

That's right, my friends.  It's all right here.  Last night I received my first injection of old nun pee.

All in all it went fine.  It did burn going in, though.  It burned with the fury of hellfire and judgment and the pent-up sexual frustration of 50 years of artificially-imposed celibacy.  Which totally makes sense now.

A whole lotta "meh"

I had my baseline bloods and ultrasound today, and it looks like we're going ahead with this IVF cycle.  But that didn't stop my body from taking yet another opportunity to fuck with me.

The way my clinic works for an IVF cycle is this: first thing in the morning, I get my blood drawn and then have my ultrasound.  Then I meet with a nurse who reviews my ultrasound results and writes a prescription for my drugs for the next few days.  Then I wait for a phone message in the afternoon with the results of my bloodwork and the final instructions for my drug protocol and my next monitoring appointment.

This morning after my ultrasound, the nurse informed me that I had 13 antral follicles, 9 on my left and 4 on my right.  This matches the lowest number I've ever had, and while it's still not terrible it's significantly less than the 23 I had going into my last IVF cycle.  I guess maybe all that CoQ10 and Royal Jelly I've been taking hasn't been having the effect I'd hoped.  But worse than my AFC was the fact that, while most of the follicles were tiny, I had two lead follicles at 11mm and 9mm on the left.  My last IVF was cancelled because a dominant follicle sucked up all my drugs and the others didn't grow...so I figured that this would mean another cancellation or at least a delay until next cycle.  However, the nurse didn't seem overly concerned and said they'd still go ahead with an 11mm follicle already in place as long as my bloodwork came back OK.

Of course I was on pins and needles until about 1pm, when I called our clinic's message line to retrieve my bloodwork results.  Surprisingly, the message said that everything was ok and I was to go ahead and start taking my stims as planned tonight.  At first I wasn't even sure they were going to give me the actual results, but the end of the message went something like this:

"And your bloodwork results are E2 77 (US 21), LH 7, Progesterone 5 and FSH 13.  So go ahead with your Gonal F and Menopur tonight..."

Hold up.  

Rewind.

"...FSH 13..."

What the WHAT?  

Up to now, I've only ever had high E2 on my day 3 labs, never high FSH.  Even when my E2 was within normal range, my FSH didn't seem to be artificially suppressed since it never went above 6.  Now all of a sudden it's 13???  According to Dr. Google, some clinics wouldn't even let me cycle with an FSH this high.  Apparently mine will.  But it still doesn't take the sting out of the fact that my body has now graced me with the full trifecta of DOR shittiness: low AFC, low AMH and high FSH.

Thanks for that.  You shouldn't have.  No, you really shouldn't have.

So now I have a whole host of new questions.  Are those two lead follicles really follicles, or are they just cysts since they clearly aren't producing any estrogen?  Should I even be going ahead with this IVF cycle given my lab results?  I mean, obviously my RE is charging ahead but it's not her money.  Then again, last IVF cycle everything looked perfect at baseline (high AFC, low E2, low FSH) and it turned out terribly, so maybe it really doesn't matter how things start out.

Either way, my enthusiasm for this cycle has just diminished considerably.  It feels like the odds are even more stacked against us than they were before.

My super vagina

Well, here it is a nice sunny Saturday and I have started withdrawal bleeding from my BCP suppression, so that makes today CD1.  I haven't called my clinic yet to report in, but this means I'll be in on Monday (CD3) for my baseline bloods and ultrasound, and hopefully starting stims on Monday night if all looks good!

I'm finding myself both excited and apprehensive about this upcoming cycle, which I guess is normal after a previous cancelled cycle as a poor responder.  I'm super excited that this drug protocol will work better than last time, and yet terrified that it won't and our options will narrow even further.  I'm trying not to focus on the negative, and I'm sticking to my healthy (but balanced) lifestyle which is making me feel good otherwise, so we'll just have to wait and see what happens.

I also had an endometrial biopsy done on Thursday.  For those of you who haven't had one done, I beg of you, please don't Google it!!  You will be terrified reading all of the horror stories from women who for some reason claim that this is the worst pain they have ever felt in their entire lives and wished they had been put out for the procedure.  I'm not sure what their doctors are doing to them, and I know everyone's pain tolerances are different, but I had myself so freaked out last IVF cycle only to discover that there's really nothing to it at all.  

The theory behind the endo biopsy is that, if you irritate the uterine lining at some point in the cycle preceding an IVF cycle, the lining will grow back thicker and somehow stickier.  All the better to implant an embyro with, my dear!  You can read about the actual science here.  It starts off like a normal gyno exam, with the doctor inserting a speculum to get a look at your cervix.  Then they insert a small catheter through the cervix and up into the uterus, where they use a tiny bit of suction through the catheter to pull off little pieces of endometrium.  It's over in about 15 seconds and for me, the worst part of it is actually the catheter insertion.  The catheter is slightly larger than the one used for an IUI, so it's a bit more difficult to insert and both times I felt a quick, sharp stab as it was going in which caused me to kind of jerk involuntarily.  This time around I apparently jerked hard enough to clamp the speculum shut, which wasn't a problem at that point since the catheter was already in.  But my RE did say in a kind of surprised tone: "You're very strong!"

So of course I came home and promptly informed M that I had discovered my superpower.  Super vaginal strength!  All this time my sweet little vajayjay has been Clark Kent-ing us, but now it's taken off its glasses and we know the truth.  I can snap a speculum shut in a single clench...and I don't even do kegels!  Now, I just need to remind myself to use this power for good instead of evil...

Anyway, all this to say that I personally don't find endo biopsies all that bad.  I do find myself a little crampy afterward, but my RE had me take two Advil an hour before the procedure so even that wasn't too intense.  I'm also one of those horribly lucky people who's never really had menstrual cramps to start with (yes, I know, you all hate me now) so maybe it's just something about my physiology.  But I thought I would counter all of the very scary endo biopsy stories out there with something a little more positive.

Until Monday!

Workin' it out

Happy New Year, friends in fetus-making!  

We got 2013 off to a pretty chill start, hosting two other couples for dinner at our place and ringing in the new year with good wine and non-shouted conversation.  I couldn't be happier to say goodbye to the days of paying ridiculous cover charges to overcrowded bars, skittering around icy streets in heels while attempting to flag down the only cab that's passed by in the last half hour.  "$30 cover?  Are you freaking kidding me?  Oh, you mean I get a crappy noisemaker that'll break in ten minutes, plus the joy of being crushed against a bar while waiting forever for a vodka and soda?  Well, why didn't you say so!  Let me in!"  

We're becoming such oldsters.

As my post title suggests, I've also started a new workout regimen.  Given my 8 months of fitness stagnation in 2012, I've decided to ease back into things with some at-home DVD workouts. This will allow me to keep things pretty light while we go through our January IVF cycle, but will also give me a good enough fitness base to ramp it up into some outdoor running this spring if I'm still not pregnant.  I actually have to remind myself not to push too hard, since I tend to have an over-inflated sense of how fit I actually am.  I remember back to when I used to run all the time (5k every day, 10k on the weekends for fun!) and just can't believe I'm not that person anymore.  

But that person also had a very all-or-nothing approach to living healthfully.  Being "on" meant working out every day and following a regimented eating program that included keeping a food diary, weighing and measuring everything I ate, budgeting my 1500 to 1700 calories per day and never going over except on designated cheat days.  Being "off" meant that eating something forbidden or skipping a workout ruined my whole fitness regimen, so I should just not work out at all and eat as much crap as I wanted.  While I never struggled with an actual eating disorder, I definitely had an unhealthy relationship with food and exercise that emphasized perfection and left no room for flexibility or listening to my body's cues.  I've worked a lot on this but I can still fall back into these old habits pretty easily, and the stress of 2012 was definitely a big trigger for me.  I was "off" pretty much all year, and since I wasn't eating terribly well I figured there was no point in working out.  Yep, it's that dumb.

Luckily, it turns out that babymaking is the perfect motivation to pull my head out of my ass!  During an IVF cycle you're supposed to do light exercise and eat healthy (but not diet), which means it's totally counter-productive for me to become fixated on calorie counting or crunching my way to 6-pack abs (yeah, like that's ever happened).   Case in point: yesterday I ate well, worked out, and after dinner ate a leftover cupcake from New Year's Eve.  Today, instead of viewing myself as a complete failure and giving up, I ate well and worked out again.  Revolutionary!!  I mean, I know this is basic logic to a lot of people, but for me it's a pretty big deal.

Anyway, this post became a lot more personal than I originally intended it to be.  It's actually probably good for me to get it out there, since the practice of writing about my all-or-nothing attitude just helps reinforce how ridiculous it is.  And now I'm accountable if I start slipping back into it again.  Although with any luck, the next time I'll need to deal with this issue is when I have 20 to 30 pounds of baby weight to lose!