Benched

CD3 ultrasound this morning revealed my ovaries to be absolutely covered with "enormous corpus luteal cysts," in the words of the doctor. So I have to take the month off to let things settle down. I'm going to try to get a better handle on my work stress in the meantime--I'm certainly not of the "just relax!" school but spending the next 8 days after my IUI with my stomach clenched with stress can't be good, right?

I'm also trying to put things into perspective. Looking around the clinic waiting room this morning, I reminded myself that most of the women in there would give just about anything to have what I have--one healthy child.

Nope

I don't know if it's because of the hormones, or because my unmedicated cycles are really not normal at all, but I always find that the first couple days of a period following a failed cycle are much rougher than usual. Bad cramps, aching back, weepiness--I don't get those symptoms on a non-IUI cycle.

See what I did there? That's what you might call burying the lead. Yeah, I got my period today. I took another hpt yesterday morning, 11dpiui, and naturally it was negative. Some instinct told me to put in a pantyliner before I left the house, and sure enough, as I was walking across town I started feeling that telltale ache in my abdomen, and the spotting started soon after.

Emotionally, I don't mind telling you I've been a wreck. I had an orthodontist appointment yesterday morning, of all things, and I seriously started crying right there in the chair when the doctor was over an hour behind schedule. I had to go pick up BG soon, and all I wanted was to go buy myself a goddamn donut to try to drown my sorrows in empty carbs, and I wasn't even going to have time to do that. Yes. I was crying because I couldn't have a donut. Then I started sobbing in earnest as I was walking back to the subway. I made it through the rest of the day, then after I put BG to bed, I cried again to my husband as we talked about what to do next. Then I baked a cake and ate...well, let's just say a lot of it.

I don't know why it keeps getting harder and harder. You'd think I'd be used to it by now.

We're going to try one more IUI. If that doesn't work, we're going to revisit the discussion about IVF.

10dpiui

I took a test this morning. It was negative.

I wasn't surprised. It's still too early, honestly. My post-trigger symptoms have all waned in the last few days--less bloating, less cramping, boobs gone from Ridiculous Nipples (TM) down to normal premenstrual soreness--and having been pregnant before, and knowing how my body responds to hormones, I know that if I'd had enough hCG in my system to get a positive hpt, I would likely have SOME kind of symptoms.

Knowing the test would most likely come out negative didn't make it any less disappointing, though. It didn't prevent me from (once I decided, last night, that I'd test in the morning just to have something to think about) having multiple dreams about POAS (with varying results). It didn't prevent me from sitting in the bathroom watching the control line come up, staring at the white space next to it hoping for another line to appear; even doing that crazy thing we do where we hold it up to the light and tilt it at various angles, trying to decide if there's actually the ghost of another line there, even if just an evap line, or if we're just imagining things, willing it into being through sheer force of insanity.

So I'll continue parsing my symptoms, checking my boobs (is that some soreness in my armpit?), gauging the tightness of my waistband. And I guess I'll keep testing until the hope runs out.

Catching my breath

Brutal week at work this week. Trying not to think too hard about whether the insane amount of stress will affect implantation.

IUI Sunday was fairly routine. The biggest wrinkle was that we couldn't get a sitter for a Sunday morning and due to a long, boring complication of who had to be where when, we had to drag BG 40 minutes downtown on the subway. My husband headed out first, gave his "sample," then BG and I met him near the clinic, I handed her off, and he entertained her for another hour while I went in for the IUI. Doctor doing the IUI was the same one who did the IUI in 2006 when I got pregnant (and also the one in 2009 when I thought I would get pregnant), so while not definitively a good omen, not a bad one either. Good sample, 26 million.

Since then, I've had plenty of symptoms, every single one of them attributable to the trigger shot, the ovary-plumping drugs, or the progesterone spike. Ridiculous Nipples, of course, are my trademark trigger shot side effect. Bloating, stretching, pulling, jostling in the pelvic area, all normal at this point in the process. But it's hard not to hope, all the same.

Eek [UPDATED]

"How do you feel?" asked the doctor on monitoring duty this morning (CD 12).

"Like I'm about to ovulate!" I chirped.

As the dildocam slid home, the doctor said, "Well, you've got a lot of eggs here, so I can definitely see that you'd feel bloated." (Bloated, yes, but there have also been more...um...personal symptoms suggesting imminent ovulation. Fellow veterans of the TTC wars, I trust you know what I mean.)

I watched, squinting at the screen as he clicked and measured...18...15...15...right...left...then it was over and I wasn't sure what had happened, but I had a pretty strong suspicion that there was a LOT going on. I'm used to seeing perhaps two large follicles on an ovary, and there were definitely more than two.

He told me that most likely I would trigger tonight for a Sunday IUI, bloodwork pending. Nurse called a few hours later to confirm that yes, I should take Ovidrel tonight and schedule my Sunday morning IUI. I asked her what my follicle count and E2 were. She told me:

Right side (where I have a tube): 5 @ 15 mm, 3 @ 17 mm, 1 @ 19 mm (and a bunch of littler ones)
Left side (no tube so not so much of a factor): 2 @ 17 mm, 1 @ 19 mm (and a bunch of littler ones)
E2: 1128

Yikes. Even if we assume the left ovary is not really in play (which isn't totally guaranteed), that is DEFINITELY more follicles than I have ever triggered with in the past. (Cycle I got pregnant I had one lead follicle and two close behind; last year I had three cycles and never had more than two over 16 mm a day before trigger.) Granted, I never had this level of detail about the follicle counts before, and I usually had my final ultrasound the day before trigger, not day of, so it's likely that I had some 15 mm guys hanging out at trigger in the past too.

But still. 1 19mm and 3 17mm follicles seems like a lot for someone who really, really does not want to have multiples. And we all know those 15mm follicles could decide to join the party at any minute.

Here's the thing: My doctor isn't actually in the office today. So the call to go ahead was made by one of his partners, who doesn't know me and my history. The nurse said she would email Dr. SF and he would call me back this afternoon so I could talk it over with him. If I was 32 and on my first cycle, I would almost certainly pull the plug and cancel the IUI. Too scary. But I'm 37, which while not ancient is old in fertility terms, and I had 3 unsuccessful IUIs last year with average 2 mature follicles on the right side each. And I once again reread this, which, while 10 years old, had this to say (emphasis mine):

For patients age 35 and older, pregnancy rates in HMG and clomiphene + HMG cycles were doubled when six or more follicles were > or = 12mm without a significant increase in twin or higher order implantations.

and

Conclusions:
Withholding HCG or IUI in clomiphene, HMG, and clomiphene + HMG cycles when six or more follicles are 12 mm or more in diameter may reduce triplet and higher-order implantations by 67% without significantly reducing pregnancy rates for patients under 35 years of age.

For patients age 35 and older, withholding HCG under the same circumstances may decrease pregnancy rates by half without significantly reducing multiple implantations.

Clearly more follicles does improve the chance of pregnancy; considering that I'm 37, and thus far have not been successful with fewer follicles, do we go for it and consider that the risk of multiples is probably less than for someone 10 years younger with the exact same numbers?

On one hand: I'm tired. I hate this shit, the needles and the slog. I don't want to do IVF, and I barely want to do another IUI. I want to just go for it and take home a baby.

On the other hand: THIS IS HOW PEOPLE END UP WITH SEXTUPLETS.

Nurse promised that Dr. SF would call me back later this afternoon. I will of course update then.

UPDATE: Dr. SF called right as I hit "publish" on this post. He talked me down. While of course, he said, we cannot avoid the risk of multiples with IUI, this cycle is actually pretty equivalent to the cycle I got pregnant on, maybe actually safer from an avoiding-multiples standpoitn. Apparently that cycle I had 3 follicles hovering around 17 mm the day before trigger with an E2 of 1074, so I most likely had a much higher E2 the day of trigger, and probably a bunch of 15mm follicles too. He thinks that we're not going to get a cycle much better than this, and recommended going forward.

So we're going forward. And you can all laugh at me when I end up pregnant with sextuplets.

Not a repeat

If we were truly recapturing the magic of the one mythical cycle that worked, I would now be coasting after 5 days of stims, preparing for trigger with a couple of nice fat follicles. Alas, my ovaries did not get the memo about repeating their five-years-ago performance. This morning, CD10, after a rather painful Pap smear (I was overdue for one so they threw it in; it is clear, however, that this is not a fertility clinic's area of expertise), I was wanded by the doctor on duty (not mine), who said that I had "lots of eggs" growing, but nothing in the lead. He measured a couple of them but didn't share the numbers with me. Based on my E2 level (again, no idea...), I'm to do 112 IU tonight, then drop down to 75 IU tomorrow, and come back in for monitoring on Friday.

So. It is what it is. I'm disappointed, but it's hardly surprising that (a) my finicky ovaries would respond totally differently to the same protocol on any given month; and (b) my finicky 37-year-old ovaries would not be as responsive as my 32-year-old ovaries were. I'm hoping we can still pull out maybe a Friday trigger and Sunday IUI, because I have such a hairy week at work next week that the logistics of an IUI next week are reeeeeeeaaaaaally going to stress me out.

Meanwhile, my ovaries are definitely feeling tender, and my boobs are actually kind of sore too, which I don't remember happening on previous cycles (at least not until after trigger). The injections have been hard. The mechanics of them, fine, I remember to do everything properly, I'm psychologically up to them, all that. But actually pushing the needle into my flesh, for some reason, is really difficult this cycle. It hurts, even though I try to numb up with ice. My skin seems to push back on the needle, so I have to push hard to get it in, and when I pull the needle out my flesh resists giving it up, so I feel a pinch and a pull on my skin as I drag the needle out. Oof. Am I just getting old? Too sensitive?

Speaking of sensitive...way back when I was trying for #1, I got sucker-punched by a pregnancy announcement from my friend R. It was one of many, many pregnancy announcements I was dealing with back then, but for some reason this one hit me particularly hard. (I had to excuse myself from dinner and go cry in the bathroom.) This afternoon, what should I get in my inbox but...a pregnancy announcement from R! She's due in July with #2! Isn't that awesome?!?!?!?

Yeah. I was glad it was over email so I could be cranky about it in the privacy of my office. Perhaps, though, some good mojo will come of it. Because 3.5 months after she gave birth to her baby #1, I had my baby #1 too. Maybe I'll get lucky and have a repeat performance after all.

CD8

After three days of 112IU (really more like 100IU, since I've kept the dial a little under the 112.5 mark as directed), my ovaries are "definitely swollen," said Dr. SF (and I'm starting to feel it), but nothing notable yet on ultrasound. Lining good at 8.5 mm. Dr. SF said he'd base the next couple days' dosage on my E2 levels, since that's a better indicator at this point than follicle size. Finally got the call late this afternoon to continue 112IU, come back Wednesday. Onward!

CD5

First injection of the new cycle done. (Almost forgot about it, too, despite programming a reminder into my phone.) I was worried it would be weird or I would forget how or something, but turns out it's just like riding a bike. Or falling off a log. Or something. Anyway, I did it.

CD3

Not fun: making my way to the clinic at 7 am in a horrible ice storm. Sidewalks slick with an inch of sheer ice, pelting frigid rain, really testing one's commitment to getting pregnant. Sort of symbolic of my wintry state of mind as we start off our second round of trying for #2.

Also not fun: bleeding right through the paper onto the exam table. Ick.

However, all systems are go for this cycle. Dr. SF had put a cheat sheet in my chart to remind himself of the details of my one successful cycle (3 days at 100 units Follistim, then drop down to 75 for 2 days). Friday I'll start with 112 units Gonal-F (he advised me to actually dial it between the 75 and 112.5 lines to get a little bit less), back in for monitoring Monday. Normally I would have started tonight, but I didn't want to come in on Saturday (it's BG's birthday! and I have to prepare to have a horde of small children dismantle my apartment!) and since Dr. SF isn't in this weekend he said he'd just as soon have me come in on Monday when he could see me himself.

Wintry metaphors aside, I am trying to have a really positive attitude about this cycle. Being cranky and whiny about it is only going to make it harder to drag myself out of bed before dawn or give myself the injections. Being upbeat isn't necessarily going to make it any easier, but it will help me stay a little saner, perhaps. (I hope--this positivity thing is kind of new for me.)