Why you should never taunt your ovaries

I learned two lessons today:

First, don't taunt your ovaries.  Remember last post when I challenged them to put up or shut up?  Yeah, well, so they've responded.  With a resounding:

You're not the boss of us!

Second (directly related) lesson: never brag on the internet about your antral follicle count of 15 which is oh-so-awesome-despite-your-DOR.  Because the universe will goddamn well come and take it away just when you need it most, which is of course when you're doing an IVF cycle.

Today's AFC?  Grand fucking total of 8.  Lowest.  EVAR.  Oh, and a bonus cyst.

 

I get it, ovaries.  You win.  I lose.  You feel good about that?

I'm trying to make light of it now, but the truth is that we're both pretty devastated.  M came to monitoring with me this morning because we had to pay our cycle fee and sign a bunch of consents (again!  Can't they just keep the ones from last time??).  Even he knew that 8 was bad (for me) without me having to tell him.  We went for breakfast afterwards before heading to work, and I sobbed into my eggs.  How ironic.  We discussed options.  I called my RE to see if she wanted to postpone this cycle and hold out for one of my better months.  She wasn't in the office.  Her receptionist said she'd pass on the message, but when I got my drug instructions later in the afternoon the nurse's message didn't say anything about postponing.

And the cyst?  It's 1.2 cm, which is apparently small enough to proceed.  I'm actually wondering if it isn't my usual lead follicle, due to the early follicle recruitment that is standard with DOR.  Estrogen priming was partially designed to prevent this.  But the priming also makes it impossible to know if it's a cyst or a follicle, since my estrogen is already way up due to the Estrace. If it's a follicle?  It's going to suck up all my meds and leave the others in the dust.

Of course there's a million things going through my head.  That I wasted four months on DHEA only to go into my next cycle with 25% fewer eggs on deck.  That if I see my standard drop-off and fertilization rates, I'm looking at a retrieval of less than six and a fertilization of less than three.  Which means it's over before it even starts, because what are the chances anything will make it to a Day 5 freeze at that point?  And yeah, I know it's all about quality not quantity and blabbity blabbity blah blah, but seriously?  What the fuck?  Why even bother?

Sorry for the tremendously depressing post.  I totally get that those of you with much lower AFCs will think I'm whining over nothing.  And I might agree with you, if I didn't have to do a freeze-all cycle and could do a Day 3 fresh transfer, but that's not on the books for me.  I have to have something to freeze.  And the chances of that with an AFC of 8 are much lower than with an AFC of 15.  That's just basic math.  Although to be honest, I don't even think we'll make it that far.  If I was a betting woman, I'd say we're headed for another cancelled cycle since I've never had all of my antral follicles respond to the stims.

I don't know why I manage to keep being surprised and disappointed every time something else doesn't work out for us.  It's par for the course right now, and yet I keep getting blindsided.  You'd think I'd learn.  You'd think I would have figured it out.

Stims start tonight.  300 units Gonal F, 150 of Menopur, and a shot of Suprefact (which makes this a flare protocol in addition to estrogen priming).  No more Estrace.

Let's just get this over with.

Bring it on

CD1, bitchez.  Time for these ovaries to put up or shut up.

Also, I have decided to tell the story of this cycle through the use of Supernatural gifs.  Because no matter how bad it goes, looking at pictures of Dean, Sam and Castiel will at least make me (and hopefully you) feel a little better.  How can it not?

For today:

Confessions of a needle-phobe

OK, so I've been pretty bad at providing updates lately.  This is only partially because not much has been going on, but is probably more so due to the fact that M and I have been binge-watching Orange is the New Black on Netflix.  We've been plowing through at least two or three episodes per night over the past week.  Usually I'm a multitasker, tapping away on the keyboard or reading blogs while watching TV out of the corner of my eye.  But I've been totally engrossed in OITNB, so much so that I've had to put down my laptop and watch TV the old fashioned way, with both eyes on the screen.  It's probably because of all the lesbians.

Anywho...

In cycle news, I ovulated last weekend and started estrogen priming this past Saturday.  One little blue pill twice a day, mercifully taken orally (so no smurf cooch).  I've been instructed to wait until I "have a bleed" (so I'm assuming not really quite like a full period??) and call in to start my stims.  I was initially a little worried that the timing would mean that I'd be on stims this Thursday, when I'm scheduled to see Cats with a friend.  That now seems less likely, which is good because it means that I'll avoid having to face one of my worst infertility fears: shooting up in a public washroom.  By myself.

I may or may not have mentioned before that I'm very needle-phobic.  As a kid, if I found out that I needed to have a blood test or a vaccination for any reason I'd break down into tears and freak myself out for hours before it actually happened.  I've gotten better, of course, but my mother (who was the one to comfort me through most of these episodes as a kid) finds it pretty ironic that I now voluntarily pay large sums of money for elective medical treatment requiring near daily bloodwork and multiple self-injections.  And a big ass needle up my vag.

Anyway, when I first found out that ovarian stimulation required lots and lots of needles, I was determined to face my fears.  I was gonna do this shit myself, yo.  So I dutifully drew up my first Lupron shot, and subsequently sat in my dining room for about five minutes willing my hand to dart the needle into my stomach.  My heart was pounding the whole time, and my hand started shaking so bad I started to get worried I'd screw it up, but eventually I did it.  And it wasn't so bad.  So of course, having defeated my fear, I should have been able to do the shots myself from then on out, right?

Wrong.

For some reason I still can't comprehend, the next few nights the five minutes of pre-needle heart-pounding and hand-shaking stretched to seven minutes, then to ten.  Finally, the first night I tried to inject myself with Gonal-F (which is probably the least painful needle of them all), my arm just refused to obey me anymore.  It flat out was not listening.  It was like that scene in Evil Dead 2 where Bruce Campbell's arm goes evil and tries to kill him*, except instead of trying to kill me my arm was just steadfastly refusing to obey my brain's command to STICK THE FUCKING NEEDLE IN, DAMMIT!

With that, I was done.  I told M that the anxiety the self-injections were causing me simply wasn't worth it and that from now on, he'd have to do them for me.  Which he has, religiously, even going so far as to cut a night of drinks with the boys short so he could be home in time for the ol' pokey-pokey.  What a guy.  Awwwwwww.

So of course one of my biggest infertility fears is that there'll be a night when he can't be home for some reason, or I'll be out and will have to do the injection myself.  Say, in a theatre bathroom.  While some shrill dance mom pounds on the stall door screaming that I need to hurry up so her eight-year-old daughter in a one-shouldered 80s-style Cats sweatshirt can go pee before intermission is over, but my hands are shaking so bad that I accidentally drop a $450 dollar pen of Gonal-F in the toilet, and I have to fish it out and use it anyway because I don't want to screw up my IVF so now I'm injecting myself with remnants of stranger pee in addition to the old nun pee and oh fuck I still have to mix and inject the Menopur and the bell is ringing and intermission is over and WILL YOU STOP POUNDING ON MY FUCKING DOOR, LADY, AND GO TAKE YOUR BRAT SOMEWHERE ELSE TO PEE???  I'M TRYING TO MAKE A BABY IN HERE!!!

Whew.  So yeah, good that that's not gonna happen.

* If you don't know this classic 80s campy horror movie and/or this scene, we may not be able to be friends anymore.  Sorry.  Unless you go watch it.  Like, right now.

Save me from myself!

I need to have my Google privileges revoked.

I've always been a researcher.  It's something that I liked and was good at in school, and it's become a part of my job.  So it's no surprise that when it comes to infertility, I've Googled the ever-loving shit out of every test, diagnosis, medication, drug protocol, and procedure that came my way, and even some that didn't.  I like being prepared for the unknown, and having as many answers as possible.  Except I've found that in the case of infertility, being prepared generally amounts for crap-all and answers are practically non-existent.  I'm not even sure why I keep looking, but I do.

Lately, I've been searching Google for hope.

It's no secret that I'm going into this IVF without a lot of it.  But I'd actually been starting to feel ever-so-slightly better, reading about all of the supposed benefits of the estrogen priming protocol and DHEA supplementation for women with DOR.  (Although I'd be remiss if I didn't mention this wonderful analysis and counterpoint by The Infertile Chemist that might make you think twice about all the DHEA hype.) 

Then I started over-analyzing my past few cycles, looking for a hint of hope.  Last two cycles slightly longer?  Check.  Less spotting?  Check.  Flow still pretty minimal, but two out of three ain't bad.

What of the Day 3 bloodwork and baseline ultrasound?  15 antral follicles, which is borderline normal and has been my standard, despite my DOR.  Good to know my ovaries haven't totally crapped out in the year or so we've been pursuing treatment.  And my Day 3 FSH was within normal range at 8.3, so the cycle is a go.  Day 3 estrogen is still borderline high though, at 303 (82.5 US), which we all know can artificially lower FSH.  But it's not out of the normal range by much, and it's certainly lower than some of my past results.  Hope started to flicker.

And then I found this study* that says that with Day 3 estrogen over 80 pg/mL, I have only a 15% chance of success.  Back to that damn 15% again.

 

Must.  Stop.  Googling.

*Yes, I am aware this study is 18 years old.  Reaction may have been exaggerated for comedic effect.

Deep thoughts, road trip style

It's been too damn depressing around here of late.  By way of apology, I offer you the following.

It's an 11-ish hour drive from Toronto to Maine, depending on how long you get stuck at the border crossing.  In order to alleviate our boredom, M prepared a playlist of music which included a huge compilation of '90s dance hits.  We rocked out to everything from 2Unlimited to Ace of Base to Technotronic, and were disturbed by the fact that we could remember being old enough to be in nightclubs when some of the songs were popular.

At one point, Young MC's Bust a Move came on.  I white-girl rapped along, tapping on the steering wheel, until I got to this verse:

Your best friend Harry has a brother Larry
In five days from now, he's gonna marry
He's hoping you can make it there if you can
'Cause in the ceremony you'll be the best man

I paused.  It was like I was hearing this lyric for the first time.  Or at least it was the first time that I'd paid any attention to it.  I pondered aloud:

"If Young MC is best friends with Harry, why is he the best man in Larry's wedding?  I mean, doesn't Larry have any other friends?  Or what about Harry?  Why isn't Harry the best man?  He's Larry's brother."

M looked up from his magazine and pondered a moment.  "Maybe Young MC is friends with Larry too."

"Nope,"  I declared.  "Larry should still pick his brother Harry.  Think of all the weddings we've been to.  If the bride or groom had a sister or brother, that person is always the maid of honour or the best man.  That's just how it's done.  So what happened between Harry and Larry that Harry isn't Larry's best man?"

M nodded sagely.  "I bet Harry and Larry had a falling out.  There's probably a good story there.  Too bad Young MC's career fizzled before he had a chance to tell it."  Then he went back to his magazine.

Damn you, Young MC.  You've left us with more questions than answers.

We now return to our regularly scheduled infertility

It was nice while it lasted.

By "it" I mean both our beach vacation and our summer of no infertility treatments while I waited for DHEA to work its magic.  The parallels of this aren't lost on me.  I'm looking forward to being back in the office about as much as I'm looking forward to daily injections, blood draws, and transvaginal ultrasounds.  Which is to say, not at all.  

We had a lovely time in Maine.  M's parents have been taking M and his brother there for annual vacations since they were little, and it's become a trip rich in tradition.  They stay at the same cottage, eat at the same restaurants, visit the same shopping destinations, and even sit in the same spot on the beach year after year.  Far from being boring, it's the ultimate in relaxation and easy to see why they return there every summer.  This was my fourth time joining them, and I'm sure we'll keep going as often as we can manage.  The one thing that makes me sad is that it's becoming increasingly unlikely that we'll be able to contribute grandchildren and thus continue the family tradition for a new generation.

M's parents have a couple of friends whose families also vacation at the same beach at the same time every year.  And it seems that every year there is another child added into the mix.  I have to assume that M's mom has told her friends about our difficulties, since questions about our own plans to have kids are conspicuously absent.  In a way I'm thankful, and in another it feels like everyone's given up hope and hence just doesn't talk about it any more.  Although I did get a whispered "good luck" during a hug goodbye from one of their friends after dinner one night.  Maybe it was just a general comment, but it didn't feel like it.

In case you can't tell from my tone, I don't have a whole lot of hope for this IVF cycle.  While I've never been one of those people who was certain IVF would work, I definitely feel like I went into our first two cycles with much more optimism than I have now.  This time, it feels more like a formality.  Like we have to do this so that we can say we tried.  Like we're waiting for it to fail so we can put another nail in our fertility coffin and move on.  It wasn't always like this.  I was originally looking forward to this cycle with guarded optimism, hoping that four months of DHEA would make a difference to my egg quality.  But after the results of my endometrial function test, I feel like the wind's been taken out of my sails.  Or someone slashed them.  Or stole them entirely.  And there's a hole in the boat and we're just waiting to sink.  Slowly.

If there was one word to sum up how I feel about IVF #3 it would be dread.  I dread the outcome of this cycle because if it's bad, I don't think I'll have it in me to do this anymore.  Which will mean it's all over.

So where are we now?  I had a 27-day cycle last month and AF arrived last Tuesday.  On CD3 we drove into Portland for bloodwork, and yesterday (CD6) I had more bloodwork and an ultrasound upon our return to Toronto.  We still haven't received the results of my Day 3 bloodwork, and if it shows a super-high FSH (which I've never had, but there's a first time for everything) we'll likely be told to give this month a pass and try again in September.  But for now we're planning to move forward.  I'm to go for regular monitoring until we can confirm ovulation, a week after which I start estrogen priming with Estrace.  Not sure of the schedule after that.

Let's just get this over with.