January 31, 2009

Fifteen


I didn't document this part too well last time and in preparation this time around I wished I had. So this may be a bit boring, but here are the key things I recall in my post-anesthesia stupor...

For starters, the IM hcg wasnt bad at all. The anticipation was brutal; I had a few smallish tantrums each time I tried to get into position, but by the time I yelled at my husband "just get it over worth already for fuck's sake!" he rolled his eyes and told me it was already done. There was a dull ache later but the next day I was fine. I know the cumulative effect of PIO will eventually be torture but at least I'm ready to be brave for the first few days anyway.

Earlier in the week my nurse asked if I felt like I had a bag of rocks where my ovaries should be and that was EXACTLY how it felt. By yesterday it was more like a smallish cannonball hanging off each fallopian tube. I'm wishing I had more than two pairs of reasonably presentable sweat pants.

In 2007, I was very nervous about the anesthesia since I'd never been under before. This time my big fear was that I was going to shit on the operating table. Piper has had some diarrhea the past day or so, but probably just from teething and all the extra drool. Still. Sometimes the gravity of a very remote possibility outweighs the unlikelihood of it happening and renders it very much worth worrying about.

But really, like last time, my biggest fear of course was that they wouldn't get anything. In 2007 I harbored a secret fear that after all the failed IUIs my follicles had actually been empty all along. Again it didn't matter much to me that this was not a very well-founded fear. This time around since I stimmed for so much longer (12 days versus 9) and had an extra dose of hcg (15k versus 10), I was afraid of the also unlikely possibility of ovulating before retreival.

Our timing was just fine, AND I didn't shit on the table. So a very good result so far. ICSI will happen this afternoon and of course we'll know more in the morning. I feel a bit different about those 15 tiny little potentials after having followed the journey of one from embryo to walking, talking little person. The news tomorrow may be a bit more emotional this time around. Please let it be good news!

I was pretty uncomfortable when I woke up this time. At first I told them I was a 7 on the 1-10 scale but when I started climbing toward 8 and then 9 they gave me some extra IV pain drugs and a vicadin to take home which I haven't taken yet. At the moment I'm doing okay and intend to try to sleep it off, but very willing to ammend that plan as necessary. The IV pain drug was AWESOME though! It was that floating away feeling I recall from the rare occassions when my husband and I have shared a pitcher of strong margaritas, times 10. The picture above is of the throws of my drug induced ecstasy... CHEERS!! The nurse joked "What's going on in here?" when she came in and my gown had fallen from my shoulders unbeknownst to me. I said, "We're trying to make a baby, what does it look like?!!" and Jay pretended to zip up his pants. Future offspring, should we be so lucky, will no doubt be horrified. Which is as it should be.

January 29, 2009

Trigger


Today they measured five follicles per side from 14-24 mm, mostly around 18-20. I'm still waiting for the call and E2 levels but I'm almost certain they will have me trigger tonight. My RE expects to give me a bigger shot of hcg (joy) so I had to go ahead and buy extra but may not use it. I kindda like having extra around for next time; using everything up feels like a jinx.

Thanks for all the input on IM versus subQ hcg. As I mentioned, my clinic always gave me Ovidrel (subQ) for IUI's but prescribed Novarel (IM) for IVF. For my last cycle I asked for subQ and my nurse told me they were moving away from IM anyway so I got it. When I asked again this time I found out that in the two years since, they did a study of patients who had IM versus subQ and found a statistically significant difference in outcomes between the two. I know subQ worked for me before, but if I argued for it this time and the cycle was a bust I wouldn't be able to let go of feeling my own choice may have done me in. One more shot in the ass is not going to kill me. If I'm lucky enough to make it to transfer, tell me that again in a week or so! I remember the PIO being just tolerably uncomfortable for the first week or so but after too many pokes back there I was crying out and almost unable to let my husband give me the shot. All he had to do was say "fine, if you don't want this to work" and I would eventually give in, but it really was that bad. Even with ice and a heating pad.

So ER will be Saturday. It will be nice to have the weekend to chill out. Now I just have to figure out what to do with Piper for the retrieval. I didn't want to tell my family about this cycle. For various reasons I don't feel like having to discuss it or especially having to discuss a potential negative outcome, and I also thought I might like to make the old fashioned "guess what" announcement this time around without everyone having followed every plunge of the syringe. Either I devise some elaborate cover story or I find a babysitter who's available at 6am on a Saturday morning?

PS - E2 was 1379. Triggering tonight at midnight.

January 25, 2009

Happy Lunar New Year!


Wow, you guys are great! Thanks so much for all the encouraging words! Things do look a little better today. E2 has taken a tiny jump up to 322. Nowhere near the ideal 150-200 per follicle, but then we're still growing those suckers. Today they measured five per side, ranging from 8-15mm but mostly around 10-12mm. I do seem to have slow and steady working for me, and it's a HUGE relief not to have to worry about the potential work conflict anymore since I will certainly not trigger before Tuesday night and probably after.

I do see the positives, but it still sucks to hear the nurse say she's not surprised my response is so much lower than last time given that my eggs are two years older. I liked last time. I want another last time. Can someone please stop the clock from ticking? Meanwhile another milestone passes as we ring in the Lunar New Year.

So I'm off to a day of meetings tomorrow and I'll be wearing my super comfy maternity pants since I'm still not back into my old suits. Hope it's not a jinx! Best luck to all in the year of the ox.

January 23, 2009

Ready to call it

I know. I shouldn't. But I'm ready to place my bet on this cycle. I'd put money on a bfn right now. On day 6 my E2 is still only 129 and they measured only 7 tiny follicles. I should feel good about the seven, they're all pretty close in size around 9-11mm. Maybe this is the slow and steady we we're hoping for, but after kicking up the meds two days ago and dropping the Lupron it just doesn't seem like anything has happened.

We're bumping the meds up again to 375iu Gonal-F and 150iu Menopur. I've got to order more drugs but I almost feel like it's a waste. I will get to use the leftover Follistim that's been in my fridge for 2 years and expires in April. No doubt I will spend quite some time in the bathroom tonight trying to figure out how much of this and that adds up to the right number and trying not to completely screw things up between the pen and the syringes and the Qcap.... It's a recipe for disaster.

And yes, I know. I'll wait to see what Sunday's recheck brings before I give up completely, but let's just say I'm not particularly optimistic.

January 21, 2009

Kickin it up a notch

At this morning's monitoring appointment the sonographer saw at least four follicles per side with the largest measuring under 10. She said there were definitely more little ones hiding so I wasn't too concerned. Ignoring previous nurse's advice, obviously I was going to compare this to last cycle, when there were five per side all under 10 at the day 4 scan. So this didn't seem too far off to me, but they just called with E2 levels less than a third of what they were in 2007 at 58.3 (182 in 2007). I see now why the scan is not enough info and blood work is so important.

So we're increasing Gonal-F and Menopur and dropping the 5iu Lupron. In 2007 I was borderline for hyperstimulation. I didn't need to be hospitalized but I had some trouble breathing and other symptoms and went on a strict peanut butter, tuna fish and gatorade diet for three days. That combined with the fact that I had 16 eggs after 9 days of stims convinced my RE we could back it off a little this time and aim for a slower but steady pace, understanding that if monitoring revealed less than ideal progress, we would ramp it up a bit. And here we are. Increasing Gonal F from 225iu/day to 300, and Menopur from 75iu/day to 150. (This is now higher actually than my 2007 doses although I'm not sure how closely Gonal-F compares with the Follistim I used then.)

This further strengthens my belief that all those failed IUIs back in 2005 weren't just a waste of time afterall. I could have passed on the 3 Clomid cycles and three ensuing cycles cancelled due to cycsts (due to Clomid), but I really believe we got the meds just right on IVF #1 because we'd already learned a lot about my response on the IUI/injectable cycles. It turned out we needed ICSI to fertilize, but having the right response from the start certainly helped a lot. If we hadn't had such a great follicle response we might not have had enough eggs for the rescue ICSI to have saved the cycle.

I'm fairly confident that increasing the meds will do the trick, especially since she definitely saw more than four per side already. Now I'm just hoping we don't go too fast because I don't want another brush with hyperstimulation. Also, I'm still very much hoping not to have ER before a major work commitment on Tuesday, so let's take it slow and steady in there okay guys?

January 18, 2009

American Association of Reproductive Problems?


I can live with the penis enlargement spam. Clearly, it's not personal. But just how did the AARP know my reproductive functioning rivals that of a 55 year old? You've got to admire their data mining, but do you really think they'll let me get away with the restaurant discounts for the next 20 years?

Baseline looked good this morning. Stims start tonight. The nurse said "Now try not to compare this cycle to your last one too much, because your last one was quite good. It can be hard to get your hopes up." Uh huh. Got that particular worry covered, thanks.

I think I know what I'm doing tonight. I see they have improved Gonal-F (put the diluent in a syringe, brilliant!). Very annoyed though to see I have an IM hcg shot. At the suggestion of the internets, I complained about the IM shot in '07 and my nurse switched me to subQ saying the clinic was moving toward subQ hcg anyway. My new nurse is much less available for whining about such things so I may be stuck with it. I know it's just one but dammit those PIO shots are so gawdawful one less is a big deal. Just curious, how many of you cycling now have IM versus subQ hcg?

January 14, 2009

"When I Was Big..."

When my sister and I were about 8 and 10 years old and we talked about all the "cool" big kid stuff going on in our lives, our little cousin who was about 3 would say: "When I was big, I did such and such too..." Charming in a 3 year old. Not so at 30-whatever.

I was out with girlfriends and a conversation about pregnancies arose. Even still the topic is usually avoided, either because friends have been scarred by the years of it being too raw and difficult or because they just don't want to invite my latest ramblings about IVF and other circumstances they'd rather not have to think about (and who can blame them?). But tonight was different. The topic came up, and as if it were the most natural thing in the world I said: "When I was pregnant with Piper..."

My words rang in my head later that night in the bath. I kept looking down at my toes (in severe need of a pedi) poking up out of the water. I knew it was me but it felt like I must have been invaded by some other person's consciousness. Me? Pregnant? My fertile friends might say the better question is why is it so hard to imagine? I gave birth for the lord's sake! Has it been too long? Has mamahood killed those brain cells? Or is it because the before part, the infertile years, were so much longer? Pregnancy flies by in the blink of an eye, so maybe even fertile types feel this disassociation with it. But tonight I talked about it as if it were the most normal ho-hum, it could happen to anyone sort of event. Friends and family would rejoice to think I'm finally letting go of all that infertile crap, but now on the eve of this next cycle is not the time!

I guess what this comes down to is that it's a little odd being a mom and an infertile at the same time. It happens that way for lots of people but from the vantage point I held for several years those two things were always worlds apart. All my defenses against the most grueling parts of cycling are built around my non-mom status. Piper has opened my heart back up and I don't want it to be broken again.

Better start building my new fortress now. The bitch showed up today. Lupron check on Sunday and if all's clear I'll start stims Sunday or Monday.

January 13, 2009

Like riding a bike


Any concerns I had about the drugs making their way through all the excess belly fat this time around are assuaged by the grueling Lupron headaches. Grrr. But that's about the only familiar part. Well except the shooting up; that came right back to me. Like riding a...you know.

This is so different the second time around. I'm at the same point today that I was when I posted this almost two years ago: Lupron day four, took my last BCP last night. Just waiting for CD 1, which would be Thursday if it goes the same way as before. In 2007 I was going crazy ready to get started, thinking of hardly anything else. This time around I'm much more consumed by nap schedules and diaper runs to Target and having dinner ready before a meltdown. Oh yeah and that job thing that used to rule my life, before I quit daycare suddenly (last Monday) and started keeping Piper at home. If I have a spare moment I'm trying to catch back up with business and maybe shower every few days.

Also, when I do allow myself some worry time, I tend to think about how Piper will feel about having a sibling, will she feel displaced, should we start working now on not calling her "the baby" anymore, etc. Can you imagine the gall? My 2007 self would never have dared to imagine such end-game scenarios. I may be in for a big fall if things don't work out according to my neat little plan. Is it just me or do most biking accidents happen once you think you've got it down?

Post Script - just realized I completely forgot to start children's aspirin. I'm sure it's not a huge deal to start it a week late, but let's have this be the last of my sophomoric cycling accidents anyway!

January 9, 2009

Playing Doctor

I was supposed to start Lupron yesterday but I've decided to hold off for a couple of days. I have a really important work meeting - a pitch for new business we really really need - scheduled for right around my estimated ER date. I feel pretty confident messing around with the schedule because I sort of unintentionally screwed it up to begin with. I called my nurse and told I was on CD1 and she prepared the protocol based on that day, but it turned out to be a false alarm, just a bit of spotting, and CD1 was two days later. When I told her that she said it didn't matter much and rather than redo the whole protocol she wanted me to just stick with the original one. I'll go ahead and take the not-really-extra two BCPs, which I happen to have because it took me a week to get around to picking them up so I started them late anyway (how cavalier we get after a successful cycle!). That should put the next CD1 back two days, so it makes sense to me that I'd start Lupron two days later right? Of course with all the variables in there (how long until CD1, how long I need to stim) I'm not really in charge of anything but I'm going to pretend I am and hope for the best with this meeting! Lupron starts tomorrow - oh joy!

January 1, 2009

Here we go...again


In the big box:
5 vials 450iu Gonal F..........$1792.50
10 vials 75iu Menopur........$ 659.00
Lupron 2 week kit...............$ 199.00
10,000iu IM HCG...............$ 39.90
20 50MG PIO (ugh!)...........$ 57.75*
60 tablets 2MG Estradiol....$ 15.75*
2 500 MG Azithromycin......$ 16.99*
Grand total........................$2780.89

See what I paid in 2007 here. I did slightly better then with no insurance and taking advantage of discount programs than I did this time around with prescription benefits, paying over $200 less for the Follistim I used in place of the Gonal F. Only the drugs marked with an asterisk were covered (which actually may have been the case in 2007 too).

Protocol:
On BCPs through 1/10
20iu Lupron each morning from 1/8 through CD 2 or 3 (around 1/16)
After CD2-3 Lupron evaluation, drop to 5iu Lupron each morning plus 225iu Gonal F and 75iu Menopur each evening.
ER estimated around 1/27, ET around 1/30-2/1

We've got to show up and sign consents in person in the next week or two and then we're ready to start bruisin the belly. This is going to be super attractive on top of the stretch marks.

Happy New Year everyone!!!