What I've become

The great ute reboot is underway.  Last Wednesday I received my first Lupron depot injection.  Right in the butt.  And here I thought that since my RE uses Crinone instead PIO injections that I'd escaped the dreaded butt-shot monster.  Alas, no such luck.  Oh infertility.  You always find a way, don't you?  So far so good, but I'm not even a week in yet.  I think the worst of the side effects (hot flashes, headaches, moodiness, etc) don't kick in for a week or two.  M is currently enjoying the calm before the storm.

(Side note:  If you Google "butt injection" looking for funny pictures of people getting shots in the ass with which to illustrate your point, you will instead find horrific plastic-surgery-gone-wrong photos.  I won't inflict them on you.  No need to thank me.)

October marks the two-year point in our attempt to have children.  After getting married in April 2011, we (foolishly, it now seems) decided to wait six months to start trying.  I had just turned 35, but we wanted a short while to enjoy being newlyweds before we threw kids into the mix.  We also had a friend's wedding in Jamaica in January 2012, so we figured if we waited until September to start trying, I'd only be three or four months along if it happened right away (OH HO HO HA HA HA) so we could still travel.  So in September we ditched the condoms and in October 2011, for the first time ever in my life, I hoped that I wouldn't get a period.

 It seems like a lifetime ago.  

When I started reading infertility blogs, I marveled at how long some of these women had been trying to conceive.  How many cycles they'd been through.  How many tests.  All the diagnoses.  The losses and the heartaches.  And it scared me.  I didn't want to go on this journey.  I didn't know how I'd get through what these other women had experienced.  I wanted to be the person who got unexpectedly pregnant while waiting for her first RE appointment.  Or at the very least, who had a success on her first IVF cycle.  But I was neither of those people.

I know that in the grand scheme of things, I haven't really had too bad a go of it.  Every time I read about another miscarriage, I thank my lucky stars that it hasn't happened to me.  Yet.  I know it's still a possibility, but I've begun to feel more and more like I'm someone who just won't ever know what it's like to be pregnant.  Which is its own kind of torture, really.  To never know that joy of seeing a second line.  To never have that moment, however brief, of imagining your future play out like you planned it.  But never having that means that it never gets taken away, so I guess that's something.

I never thought I'd be here.  I never wanted to be here.  Two years later, two egg retrievals under my belt.  One failed embryo transfer, and an uncertain future.  A TTC timeline growing longer by the day.  I've become one of those women I whose blogs I was reading two years ago.  One of those women that I didn't want to become. 

Bad dreams and bad feelings

Dreams fascinate me.  I know lots of bloggers who have said they're bored hearing about others' dreams, but to me they're an intimate little window into someone's subconscious mind.  I love trying to parse them, figure out where they came from and what they mean, and discover what they say about the dreamer.

Last night I dreamed that I was making hard boiled eggs.  I put a bunch of them into a pot of boiling water and walked away for a little bit, but when I came back it was obvious something had gone wrong.  The shells had broken and the water was filled with bits of cooked egg white, as well as what looked like little blobs of cooked ground chicken.  I quickly realized that something was wrong with the eggs; instead of yolks, there were little dead chicks inside each one.  I pulled the egg carton out of the fridge and used a flashlight to look through the shells to see if I could find any good eggs to use.  But there weren't any.  They were all bad.

I guess it doesn't take a PhD to figure that one out.

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I think I feel like I deserved that bad dream last night.  Have you ever had an opportunity to say the right thing to someone, and for whatever stupid reason you instead choose to say the wrong thing?  Something that maybe isn't hurtful in and of itself, but has just a little bit of sting so that it takes the wind out of someone's sails?  Something that makes it so that everything is about you, when it should be about them?  I did that yesterday and I feel like shit about it.  I tried to make it better afterwards but I think it was too late.  At least I feel bad enough about it that I probably won't ever do it again.  

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I got my period yesterday.  I go in for my first Lupron depot shot on Wednesday.  I'm nervous about how my body is going to react to it.  I already get some night sweats at the start of my cycle when my estrogen and progesterone are really low...what's going to happen to me when my whole system gets shut down?  This worry found its way into my dreams last night too.  I dreamed that I couldn't find a nurse to give me the shot, because they were all scared of what it was going to do to me.

This is all going to be worth it, right?

Right?

Still in the game

When I started my blog almost a year ago, I put a lot of thought into what I was going to name it.  I very nearly went with "Ute Overload", which is a play on one of my all-time favourite time-waster websites, Cute Overload (you're welcome).  But then I figured that a lot of people might not get the reference, so I opted to go with "It Only Takes One".  It seemed to be the phrase that popped up most often on message boards when I was reading about Diminished Ovarian Reserve, so I thought it would be funny and ironic to use it as my blog name.

Little did I know that the universe has the maturity level of Barney Stinson and would view said title as some kind of throwdown.

As you may have guessed by now, we have one frozen blastocyst.  Again.  One embryo arrested on Day 2, one somewhere between Days 4 and 5, and the final one was a morula on Day 5 but hadn't blasted by Day 6 so end of the line.  And if even one of you fuckers says "It only takes one!" in the comments I am going to crawl through my computer screen and bitch-slap you.  (Just kidding.  Kind of.)

Obviously, I'm happy we have one, and upset that we don't have more.  Same as last time.  There's not much sense repeating myself.  What I can say is the following, based on a conversation I had this afternoon with my RE:

1.  She's also disappointed we didn't get more blasts, based on the supposedly vastly improved egg quality this time around.  That said, she is very happy with this one, which is graded 3AA.  They didn't tell me what I had last time around, so I had no ability to Google it to death, but rest assured I will this time.  Preliminary results are encouraging: according to this study, 3AA blasts or better have a pregnancy rate of over 60%.  About time I was on the positive side of some IVF stats!

2.  This will be our last attempt at IVF with my own eggs.  Having tried three different drug protocols and spent significant amounts of time on the two primary recommended supplements for egg quality (CoQ10 and DHEA), we have ended up with the exact same results twice in a row.  And you know what Einstein had to say about that:

3.  With respect to the outstanding lining issue discovered during my Endometrial Function Test, I'll receive my first Lupron shot shortly after my next period starts.  I get another one a month after that, with my period expected to return in 6 to 8 weeks after the second shot.  I asked whether we should repeat the EFT before attempting a transfer  My RE replied that when conducting his research, Dr. Kliman re-tested his subjects post-Lupron and discovered that the injections appeared to clear up any endometrial synchronization problems 90% of the time.  Meaning that we could re-test, if we wanted to waste another $500 and two months, but it's probably not necessary.

So that's pretty much it.  The end of IVF #3, and the start of a long wait before FET #2.  Before we knew the fate of any of our embryos, I commented to M that having nothing to freeze would be like an athlete going to training camp for months, busting his ass in tryouts, and getting all dressed only to find out that he wasn't even going to get to play.  It would suck on so many levels.  Fortunately, at this point we're still in the game.

The more things change...

The more they stay the same.

Seven eggs retrieved.  All seven mature.  Four fertilized.

Bear with me for a sec.  I'm not actually complaining.  I'm just remarking that it kind of feels like I got into a time machine that zapped me back to our January retrieval.

Groundhog IVF!

All things considered, this is actually slightly better than last time.  It gives us an almost 60% fertilization rate, compared to our previous 50%.  Then, my RE called in the afternoon with some additional details.  Our clinic uses a technology called Oosight (also called "Spindle View") to get an image of the inside of the egg so they know how to line things up and perform the ICSI without damaging the interior of the egg.  Every egg has a "spindle" that is responsible for tearing the chromosomes apart and putting them back together during fertilization, and if the spindle is damaged or abnormal then you have a higher chance of chromosome damage and hence a non-viable embryo (read more here).  Last time, only 13% of my eggs had normal spindles.  This time, a whopping 57% were normal.  That's four out of seven, if anyone's counting.  All of which I'm hoping means that these four fertilized eggs have a better chance at making it to blast than our last go-around.

Now, I'm not going overboard with optimism.  That just wouldn't be me.  However, I'm cautiously optimistic that we'll have at least one to freeze, like we did last time.  More than one would be earth-shatteringly amazing.  But I'm also prepared for none.  You know.  Just in case.

One last thing is that I really want to thank all of you guys for putting up with me during the last little while.  The fact that you are all still coming here, and still commenting and offering support when a lot of the time I've been nothing but a little rain-cloud of pessimism, still blows me away.  I read so many blogs where people are able to keep positive and I always wonder how they manage to do it.  I never could.  I've always seen the glass as half empty, and trying to change my frame of mind always just seems fake.  So instead I go down the path of sarcasm and snark and dark humour, which works most of the time but sometimes fails me entirely.  And that's when you guys are there.  You pick me up, smack me around and tell me to snap out of it, or offer virtual hugs if that's what's needed.  You're my sanctuary.  My soft place to land when IF hurtles me off yet another ledge.  And even though I've never met any of you, let me just say it now:  I totally love you guys.  Seriously.  Group hug!

Insert clever retrieval title here

I won't make those of you with busy lives wait until the end of this post.  We got 7 eggs.  My RE is hopeful that 5 of those will be mature.

And I cried on the retrieval table.  Again.

My emotionless resolve started to break somewhere around noon yesterday.  I was at work, and I was bored because I wasn't very busy, and I started getting anxious.  My stomach worked itself into a ball of knots.  Then I got home and had things to do and I felt OK again.  I walked Buddy.  I ran to Target to pick up a gift to mail to my niece for her birthday.  I also got some lightbulbs, the non-energy efficient kind.  Normally I try to be as nice to Mother Earth as possible, but on the weekend I had bought a new lamp for our living room and installed some of those high-efficiency CFL lights and absolutely hated them.  Instead of being warm and homey, the light these bulbs gave off was cold and stark.  It make our living room feel like a lab.  So I decided to swap them out for some normal incandescents, and in taking out the CFL bulbs I accidentally broke one.

M freaked out.  Apparently CFLs contain mercury and there are very specific instructions on how to clean up when you break one, involving scary things like airing the room out for 15 minutes, using rubber gloves, and putting all of the particles in a freezer bag to prevent any more mercury vapour from being released.  None of which I knew anything about, so M's reaction kind of pushed me over the edge.  I felt stupid and terrible and worried.  Like I couldn't do anything right, even change a fucking lightbulb, let alone make a goddamn baby.

By the time we went to bed, I was pretty much feeling ALL THE FEELS that I'd been shunting away all week.  The fear that we'll get yet another shitty crop of eggs.  The guilt for putting us through this.  A heaping dose of self-pity.  And some new unpleasantness: the grief of saying goodbye to my chances of ever having my own biological child.  Because, my friends, I'm pretty sure this is it.  Whatever happens this week, I am as close to certain as I can be right now that this will be our last egg retrieval. While I'd be ecstatic to be proven wrong, I'm pretty sure my eggs (no matter how many of them there are) just aren't going to cut it.

We got up at the ungodly hour of 5:30am to be at the clinic for our 7:00 retrieval.  It was dark and muggy when we got into the car.  There was no traffic and we arrived even before most of the clinic staff, so we sat in the waiting room all alone until a few of the nurses finally arrived to prep me.  Then, a needle-phobe's worst nightmare: the nurse screwed up the IV she was putting into my arm.  She fidgeted.  She poked.  She prodded.  Then she took the fucking thing out and started all over on the other side.  Between my needle phobia and the residual bad feelings of the night before, by the time she was done I was already fighting back tears.

Then, the retrieval.  My RE asked how I'd been doing and I told her honestly that I was disappointed with how few eggs we'd be getting this time.  She was understanding but said that there was no guarantee any other month would be better, so we just had to hope for quality.  Then she asked whether I had been comfortable the first time during retrieval, and I told her no.  They decided to give me more drugs than before.  Which helped a little, but there was still pain.  Damn my right ovary for being uncooperative.  But just like last time, right when it seemed that the pain was getting too much, it was over.

They told us they got seven eggs.  I should have been happy, but all I could think was that they won't all be mature and they won't all fertilize.  I just felt hopeless.

My RE asked if I was ok.  And I wanted to say yes because physically I was but emotionally, I was so very not.  So like a big fucking baby, I started to cry.  And she put her hand on my shoulder and told me it was ok, that she knew how overwhelming it all was.  I just cried harder.

 Honestly, I liked it better the other way.

Trigger

So it looks like I might have been jumping the gun a little bit getting all excited about my mysteriously-appearing new follicles last week.  None of them has really done anything.  Most of them have stayed unmeasurable, while the big new one on my right (which, according to one of the ultrasound techs, was probably there all the time but was obscured by my bowel) has stayed the same size for the past few days.  Everything else has grown, though, so we triggered tonight with 5 follicles between 16 and 21mm and a couple of stragglers.  Looking at my stats from last retrieval, nothing that was under 15mm on trigger night yielded a mature egg, so at this point I think best case scenario is 6 or 7 eggs retrieved, with a maximum of 5 mature ones.  Anyone up for some bets?

I'm not thrilled with this, but I'm not devastated either.  Honestly, I'm not quite sure how I feel about it at all.  Ambivalent?  Resigned?  I find myself curiously emotionless, which feels weird after the roller coaster ride I went on last week.  But at the end of the day, there's nothing more I can do.  We'll get whatever we get on Tuesday, and then it'll do what it's going to do in the lab.  We'll either have an embryo to freeze or we won't.  Maybe the fact that I won't be doing a transfer is part of the reason I'm feeling so detached.  Or maybe it's because, after four months of DHEA and a new drug protocol for this cycle, we're still going into this with fewer potential eggs than we did last time, with no guarantee that the quality is any better either.  All of which isn't doing much to dispel my initial pessimism that this cycle isn't going to work, and it's just something we have to do before we can move on.

Wow.  You guys are still here?  Even after all this whining?

Yeah, we came for the Supernatural gifs.

Anyway, one bit of good news is that, despite all of this emotional up-and-downing, M and I have finally come to some kind of a decision about our next steps.  That's a whole 'nother post, but suffice it to say that no matter what happens in the next few days, we have a plan for moving forward.  And just knowing that there is a plan will hopefully make whatever does happen that much more bearable.

Where the hell did YOU come from?

At every monitoring appointment so far this cycle, the various ultrasound techs have all counted eight follicles.  Four on each ovary.

Today, seemingly out of nowhere, four more follicles showed up.  While most of them are not really measurable, one of them appears to have gone from not existing at all to being 12mm big in the space of two days.  How does that even happen??  I now have seven follicles in the running between 12 to 16mm, with five (FIVE!) on the right and two on the left.

At first I was like:

But then I:

Of course this is the point where the little bird named Hope starts fluttering its wings and trying to take flight, and I'm forced to pluck some of its feathers to stop it from getting off the ground.  Getting seven eggs would be great, yes.  But it's not guaranteed.  And even if it was, we still have that whole 50% fertilization rate hurdle to jump.

Oh, screw it.  Keep dancing, boys.  Two more days of stims, back in on Saturday.

Bring me more wine!

Today's lesson?  That my ovaries like a full-bodied cabernet sauvignon at least as much as they like huge doses of Gonal F and old nun pee.  

After 7 days of stims, we've gone from three contenders to six.  Four follicles on the right between 10 and 12mm, with lazy lefty (strange, because it's usually my powerhouse ovary) contributing a 10mm and a 7mm.  My estrogen is continuing to rise nicely and is now sitting over 1800.

You know what that means, don't you?  It means that ALL THE DOCTORS ARE WRONG and you should TOTALLY BOOZE IT UP while you're stimming.

Or not.  I dunno.  Stop looking at me like that.  I didn't go to med school. 

Next stim check is Thursday morning.  Until then, from my ovaries to yours, cheers!

Stim updates and a welcome distraction

I know you're all dying to know what's been happening with my lady parts.  Don't try to deny it.

Well, so far we're still cycling.  Things are happening, but slowly and not in large numbers.  I went in for my first check on Friday morning after three nights of stims.  I had four small follicles growing, two on one side at 8mm each and a 5mm and a 6mm on the other side.  The nurse who gave me my ultrasound results and meds prescription was kind enough to state, in a somewhat accusing tone, that "they're all really small."  I must have stared at her blankly, because she helpfully clarified, "They need to get a lot bigger."

No fucking shit, Sherlock.  Again, her tone seemed to suggest that somehow I  was responsible for making this happen.  I respectfully declined to tell her that, if I could make things happen by sheer force of will, not only would I have a crop of about 25 eggs growing right now, but she would be bursting into flame.

The biggest piss-off was that I was actually not unhappy with the results.  The estrogen priming protocol is notorious on internet message boards for being a "slow burn" protocol, where you often start out slowly and stim for a bit longer before retrieval.  In doing so, you get more even growth and avoid the runaway lead follicles that are so often a problem with DOR (and have plagued me during both of my previous cycles).  Also in the plus column, my estrogen levels came back nice and high (taking into account that they dropped somewhat from baseline after I stopped taking Estrace) and were over 400 as opposed to previous cycles where they hovered at barely half that.

I was sent away with meds for two more nights and instructed to come back Sunday.  In the interim, on Saturday night M and I headed to the airport to pick up my friend Dee who was coming to town for a wedding and whom I haven't seen in almost two years.  She was a bridesmaid at my wedding but has been living out of country for a few years now, and I've seriously missed being around her.  She is, hands down, one of the most physically beautiful people I've ever met in real life.  If she wasn't so awesomely nice, it would be very easy to hate her as she's also incredibly fit and has even placed in the top five in some CrossFit competitions where's she's living now.  Lucky for her she's also sweet and funny and generally fantastic to be around, so I knew that whatever happened on Sunday morning, we'd have a fun day and I'd get to forget my troubles for a little while.

So on Sunday morning after five days of stims, I have three follicles growing at 10mm each.  I suspect that there are others in the running, but once things get over 10mm some ultrasound techs at my clinic stop measuring the smaller ones.  My estrogen also doubled and is sitting around 850, so I'm really hoping that means others will join the party.  Since my RE decided to proceed with anything over 4 eggs, I'll go out on a crazy limb here and say that chances of cancellation are now pretty slim.  BUT we're also definitely not going to get the 9 eggs we did last time.  At this point I'm hoping for at least 6 with a higher fertilization rate, but of course that's probably totally greedy.  I can't say I'm incredibly stoked about these results, but they're also not terrible so we're just going to have to go with it.

This is my "meh" face.

Other than that, yesterday with Dee was pretty awesome.  We made a gigantic breakfast of homemade waffles topped with fresh strawberries, then headed out to do some shopping and meet another friend for coffee.  There was lots of laughs and sorely-needed girl time, and a good emotional vomit about our infertility situation.  Then we BBQed dinner and sat out on our back deck with a bottle of wine, chatting into the wee hours of the morning.  And yes, for anyone who's counting, I consumed a couple of glasses of wine while stimming.  I know lots of people cut out things like booze and caffeine entirely, but you know what?  Eff that noise.  Humanity would have ended a long time ago if wine and coffee were the cause of infertility.  I'm pretty sure we've scientifically figured out my problem (spoiler: it's old ass eggs) and IVF is brutal enough without taking away all of life's little pleasures.  I don't drink much or often and I only have one coffee a day, so if anyone wants to tell me that's why I don't have a baby then they can go be judge-y somewhere else, thank you very much.

Next stim check is tomorrow morning.  We'll see what my wine-soaked ovaries can come up with.