Dry eyed

Thanks for the comments and the love.

I haven't cried. I've been walking around in a sad fog, going through the motions with all the family and social obligations we've had the past few days. It is surely a sign of how much I have grown as a person that on the day of my negative HPT, we spent time with not one, but two different friends, each of whom has a gorgeous new(ish) second child in that adorable 6-12 month age range, and I did not at any point want to scream, vomit, or poke my own eyes out with a sharp stick. (But it did hurt when my husband admitted to me later how much he loved holding those babies.)

I've been eating a lot of junk food (because really, why not?) and skipping my prenatal vitamins (because really, why fucking bother?) and staying up late watching TV because I don't want to be alone with my thoughts when I lie down. It's hard knowing that there's a good chance this may be our last assisted cycle. But one thing I do know--I don't regret that we decided to change our insurance next month, even though that means we can't get in one more cycle. Diving into another cycle right now is just unthinkable--I couldn't possibly handle it.

As a feeling-crappy-about-myself bonus, I have had very little patience lately for Bat Girl's totally normal almost-3-ish-ness--the whining, the slow-as-molasses shoe-putting-on, the milk spilling. You'd think that, being denied a second child, I would appreciate the one I have a little more, instead of losing my shit when she deliberately throws rice on the floor. But when my back is aching and the cramps are coming on and all I want to do is be by myself in a dark room for a day or two, and instead we're seeing endless relatives and I've got my kid attached to me 24/7...it's hard.

And when I do take a moment to hug her extra tight, or when she spontaneously breaks into song ("Monster Boogie") when I'm putting her to bed, there's the sudden knowledge that she's not a baby anymore, and that it's possible--not guaranteed, but possible--that I will never experience the baby days again.

*****

We just got back home yesterday, and tomorrow we're turning around and getting on a plane for another week out of town--I didn't even bother unpacking our suitcase, just shoved in a couple extra sweaters and rezipped the whole thing, dirty laundry and all. We'll be at my parents' house, which means no blogging for me, but I'll catch up with you all next weekend. Have happy Thanksgivings, everyone. I'll be working on remembering just how much I do have to be thankful for.

Nope

Yesterday morning (10dpiui) I woke up feeling distinctly Not Pregnant. A little boob tenderness, but all the other symptoms I've had were basically gone.

Yesterday evening I started spotting, just a little bit.

This morning, even though I knew what the result would be, I took a pregnancy test. The control line came up right away, but I waited the full 3 minutes and did all the things we do, holding the test up to the light, scrutinizing it from every angle, wondering if I saw a shadow of second line.

But the light in my sister-in-law's bathroom is much better than in my own. There was no doubt. Negative.

I expect I'll get my period sometime today or tomorrow.

Wow, this really sucks.

Always prepared

As of this morning, the trigger shot hCG is officially no longer registering on a pee stick. Anything that shows up from here on out is definitely homegrown.

We're going away for the week. I'm packing mostly yoga pants because I'm bloated and uncomfortable. My uterus aches and I'm zitty and cranky and ridiculously exhausted. And have caught a cold from Bat Girl (thanks, daycare!) but can't take any good drugs while in the 2ww. If I turn out not to be pregnant, I will be PISSED.

Since we will be away through Saturday (13dpiui), I'm packing a box of pregnancy tests...and a travel pouch of tampons. You never know.

My body is messing with me

SymptomWatch: After the requisite day or two of minor bloating, things have mostly settled down. My nipples/boobs still hurt, but that's been subsiding as the trigger shot hCG leaves my system. (I peed on a stick today just to check that it's almost gone--and also just for the fun of seeing the second line, let's be honest. I wouldn't ordinarily waste hpts that way but I've got a bunch of coupons and rebates so I figured I'd splurge.)

My uterus (and I know it's my uterus, thanks to the off-center location) is super sore and achy and I've been having all sorts of rumblings and pullings and achiness in my lower abdomen today, but that might just be because of the, er, digestive difficulties I've had lately. And how's this for weird: An hour ago I stood up from the kitchen table and got a shot of searing pubis symphysis pain that won't go away. I know that's not a real symptom, since most women who have it get it late in pregnancy, but I thought that was funny. Also funny (but totally not): I got a mailing from Pampers with info on prenatal nutrition and a sample of newborn diapers. I guess they do this to people whose kids are Bat Girl's age because they figure you're probably working on #2 by now--this actually isn't the first such mailing I've gotten. But I find it kind of presumptuous--and talk about a kick in the ovaries for those of us dealing with secondary IF.

Nothing else to say on this front. Dealing with all kinds of insurance/work/life stress, and I actually had a big stress meltdown on Tuesday. So if I do get pregnant, that's a big in your face to all the "just relax" folks. I'm going to test on Friday, which will be 2 weeks from trigger. We'll be traveling and staying with friends and relatives all week, so I won't be tempted to test sooner.

We are definitely switching insurance as of December 1, which means no more IF coverage. Which means this will be our last try for a while, and possibly forever. I'm too worn out from the last 6 months to feel bad about that right now--and no matter what, we would have lost our IF coverage at the end of the year, so at most we would have gained one more cycle. And we don't want to do another cycle right away just for the insurance, not when I'm so burned out and having more and more trouble with the injections every day as it is. But ask me how I feel in 6 months.

Fingers crossed

If I were superstitious, I would consider it a good sign that today was another gorgeous, warm, sunny, perfect Sunday, just like the day of the IUI that resulted in Bat Girl 3.5 years ago (albeit in November instead of May). I would also consider it a good sign that today's IUI was performed by the same doctor who did that successful 2006 IUI. If I were superstitious, that is. Not that I am.

IUI itself was uneventful. Doctor declared it a "good sample," 26 million or so, and was in and out in a flash.

I can definitely feel my ovaries, though most of the tenderness is on the left, which concerns me a bit considering both of the leading follicles were on the right. But I feel pretty good otherwise, besides the requisite ridiculous nipples that the hcG shot always seems to produce in me. We'll see what happens.

If this doesn't work, I think we may take a break after this one. The prospect of diving into another injectibles cycle fills me with dread, and I just feel worn down by the whole process. My husband is also in favor of taking a break for a few months. There are some other boring insurance complications factoring into all of this, which I won't take up your time with, other than to say we may be switching plans 12/1/09 instead of 1/1/10 which will save us a lot of money but will also end our IF coverage. Either way, I will probably stock up on a couple of Gonal-F pens before our insurance coverage for IF runs out. They only cost me $25 each (I know!!!), so if we do end up cycling again next year I can save a few thousand bucks that way, and if not I can give them away.

But hopefully this cycle will work. Please, please, please let it work.

Three...two...one...

So here we are again, in a familiar place.

This morning the two follicles on my right ovary were at around 17.5 and 16-ish mm, while the two on the left were around 15 mm. At first Dr. SF said that we'd drop down my dose tonight (exact dose to be determined based on today's bloodwork), trigger tomorrow, IUI Monday. Then he amended that to say that if my E2 was much over 1000 we might trigger tonight and do IUI Sunday, to bring down the chance of multiples. I reminded him that I have no tube on the left, so those follicles on the left are much less likely to come to the party, but he's also concerned about excessive fluid and bloating if those follicles get too huge.

Then he stopped and said, "Wait, let's really talk about this." He put down the stack of printouts and u/s pictures and looked at me. Ordinarily, he said, he would push it one more day, to get that lead follicle over 18 mm before trigger and maximize the chances of pregnancy. However, doing so will also increase the chance of multiples. Generally speaking, he does this knowing that selective reduction is there as a "safety valve," in his words. "But if a triplet pregnancy would be a complete disaster for you and you don't want to consider reduction, then it might be better to take the conservative route and do the Ovidrel tonight," he told me.

Well, yes, a triplet pregnancy would be a disaster for me. A twin pregnancy would be a disaster for me, frankly. But I also want this to work. And what it comes down to is the choice that all of us undergoing IF treatment make in some form or another: Minimize the chance of multiples, or maximize the chance of pregnancy?

I told Dr. SF I was leaning toward being more conservative, but I would have to talk to my husband. He agreed and added, "This [gesturing toward the ultrasound screen] is about as good as we're going to get," in terms of having a good chance at pregnancy without scary chance of multiples, though he also pointed out that what doctors see on the u/s screen isn't a perfect predictor of what's going to happen once you trigger, as I know Jody can attest to. He finished by saying that if this cycle doesn't work, he will probably push us to reconsider IVF.

I went ahead and scheduled the IUI for Sunday, then the whole way home I thought and thought. I thought about how upset I would be if I didn't get pregnant, and how sick and tired I am of the shots and the early morning appointments and the endless disappointment. And I thought about how devastated I would be if I saw three or even two sacs on the ultrasound screen a few weeks from now, and how even though a twin pregnancy in me is probably roughly equivalent to a triplet pregnancy in a woman with a normal uterus, and a triplet pregnancy is probably equivalent to quads or quints, I don't know if I would have it in me to reduce. And I talked it over with my husband, and the answer was pretty clear: Trigger tonight. Reduce the chances of multiples, even if that means reducing the chance of pregnancy.

I feel pretty confident in the decision. I was even getting nervous thinking about how even with two less-than-optimal-size follicles on my good side, there is a very real chance of multiples, but I reread this (an old study, but I don't feel like digging to find something more recent, though this one also looks interesting) and it looks like the chance of HOM starts to drop off after age 35, which is good news for me and my aging ovaries. (I know that we are still playing with fire here, but I need to tell myself whatever it takes to be able to sleep at night, OK?)

Nurse called to confirm my Sunday IUI and apparently my E2 this morning was 1009. Not scary high (it is, in fact, about what I had the cycle I got pregnant, so I'll probably have a good bit of bloating next week), but enough that I feel even more confident that we're doing the right thing. As much as any of us can have confidence in any of this, anyway. I swear, sometimes I feel like reproductive medicine is equal parts science and voodoo.

The long slog continues

After two more days of more juice (112.5 IU), I now have 2 leading follicles on the right (14-15 mm range) and two on the left (about the same, but we care less about those). Dr. SF was debating this morning whether to continue to push or to drop down the dose; in his words, "Stimulating ovaries like yours is like walking a gangplank." Based on my E2 results (I forgot to ask the nurse for the number when she called), he decided to keep the dose at 112.5 for tonight but wants to see me back for monitoring again tomorrow, to make sure we're not overdoing it. Right now we're probably looking at Saturday night trigger, Monday morning IUI, if all continues well.

I'm nervous about all those follicles but am willing to wait and see. The ones on the left (no tube) wouldn't concern me if it weren't for the fact that there are also two on the right. I'm hoping one of the follicles on the right takes the lead--two equal follicles on my good side feels a little risky from an avoiding-multiples standpoint, even though it's close to what I had when I got pregnant last time.

Most of all, I am SO OVER this cycle and ready to be done. Over the last week or so, the shots have gotten more and more painful and difficult to do--I've had more bleeding and bruising, it's harder to push the needle in, and it just plain HURTS more, even though I faithfully ice my belly before every shot. I don't know if there's a psychological component to it, or if after 40-odd injections over the last 3 months, my belly skin and fat is starting to put up some resistance. Have any of you experienced this?

So assuming a Monday IUI, the 2ww will be over just as we're leaving to visit my parents for a week for Thanksgiving. I was worried about the logistics of starting another cycle, but I explained to Dr. SF that we would be out of town, but I wanted to squeeze in another cycle before the end of the year when I lose my IF insurance coverage, and he said it was no problem, that I could start stimming at any point after I get my period, whether day 3 or day 10 or whatever. "That's the one good thing about not ovulating on your own," he said.

Assuming this doesn't work, that is. Which I really really hope it does, not least because I'm not sure how much more I can take.

Oh, one good thing I forgot to mention--at Sunday morning monitoring I ran into an old coworker of mine, to whom I'd recommended my clinic earlier this year but hadn't heard from since. She was getting ready to start her second round of IVF. Since we are definitely not going to do IVF, I was able to give her my unused Lupron, Medrol, and antibiotics, and was so happy to see them going to someone I knew. Unfortunately, I didn't realize until I looked that the PIO I have is only good until the end of the month, so she couldn't use it, but I donated it to my clinic, to go to another patient in need.

Um, I don't have a good ending for this, so I'll just sign off. But I'm sure you'll hear from me again very soon.

An open letter to my ovaries

Listen up, ladies. I know that historically speaking, we have not always been on the best of terms, you and I. But seriously--flaunting two 14-15 mm follicles on Sunday, only to have nothing bigger than 12 mm to show today? Are you kidding me with this?

I guess I shouldn't have been surprised--apparently you went on an estrogen-producing strike over the weekend, making my E2 plunge from 250-something on Friday to 80 on Sunday (according to the doctor this morning). But that's why we upped my dosage, so you would get more delicious gonadotropins to snack on. I just never realized that follicles would actually shrink this late in a cycle.

I'm interpreting your renewed interest in producing estrogen (E2=279 this morning) as a peace offering. In return, I promise to continue delivering sweet gonadotropins for at least two more days, but I expect a little more motivation on your part.

In closing: WTF? And also: Get your act together. Thank you.

Your friend,
electriclady

Slackers

Yesterday, as I headed across town to my clinic in the early morning light, I walked along one of the final legs of the marathon. As I dodged gaggles of cops and watched volunteers setting up the barriers and viewing stands for the crowds that would be arriving in a few hours, I thought about the long slow slog that is infertility, and wondered if I would ever make it to the finish line this time around.

I've been feeling pretty discouraged lately, and I know part of that is because of how long this is taking compared to how (relatively) easy it was the first time around--we messed around in treatment for a long time, but once we finally sorted out what my ovaries actually needed, I got pregnant on my first injectible cycle, which was the first cycle where we actually made it to IUI without getting canceled. I've started second-guessing myself and wondering if I should be doing things differently. Should I be eating better? Taking different supplements? Drinking more milk or eating less meat? Doing more yoga? And I keep thinking back to when I got pregnant with Bat Girl, and trying to figure out what was the X factor. Unfortunately, a lot of that is difficult to replicate now that I have a kid--I was in the best shape of my life, ate incredibly well, practiced yoga 3 to 6 hours a week and ran once a week, slept tons, etc.

And then I remind myself that the real differences between then and now are that (a) I stimmed too quickly last time and had 3 follicles going, with a side of mild OHSS, neither of which I want to repeat, and (b) I'm 3 years older now, and so are my ovaries, and I can't do anything about that.

As much as I don't want to duplicate that 2006 cycle (besides the positive results), it's hard not to feel anxious at how relatively slowly this current cycle is going. Back then, I triggered on day 9. Yesterday, on day 12, I had two follicles on the left (ARGH!) side in the 14-15 mm range, and one or two in the 11-12 mm range on the right, which means they probably won't go anywhere. I was instructed to up my dosage from 75 IU to 112.5 IU last night and tonight, which probably means that my E2 is lagging despite the decent-sized follicles.

I'm hoping everything will look better on Tuesday and I'll get to trigger that night--a Thursday IUI is manageable, but the logistics of a Friday or Saturday IUI are trickier. I'm also hoping for a little more action on the right ovary. I'm willing to trigger with two follicles on the left and even with two on the left and one on the right, since the chances of the right tube picking up an egg on the left are so small. This might be our last shot--if this cycle doesn't work, we won't be able to cycle again right away because we'll be traveling over Thanksgiving, and I'm not sure we'll be able to squeeze in one more cycle before Christmas. And then we lose our good insurance and have to start making some tough decisions.

In summary: Wake up, ovaries!