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!