E2 and Prolactin

Got a call from Dr. Z's office today. My E2 level was just over 900 and my prolactin was at 17. They want to see 100 units of E2 for each follicle. So mine can still rise a bit.

Ultrasound #1 & Our FSH Angel of Mercy

Sunday. J and I drove to Dr. Z's for our first ultrasound since I started the FSH shots. They found 12 follicles when we thought there was only 10. Thank god. Every single extra one helps us just that much more. Their size was closely grouped which was a good thing. Uterine lining close to 9mm, which is the thickness required in order to do the egg retrieval. So it would appear that I'm responding well to the drug. Dr. Z said that a 41 year old woman normally has 6 to 10 follicles. That seems high to me, but I am grateful that I have as many as I do. I only hope that the quality is as good as the quantity. There is always something to worry about with IVF. It just doesn't let up.

They took blood to test my E2 and prolactin levels. Results should be in tomorrow. I'll have to return in two days for another ultrasound, but J will be in Arizona so I'll have to make the drive myself.

So we're not sure yet if I will need more FSH. Holding Pattern was our angel of mercy and offered to sell me her extra Gonal F pens for a very reasonable price. I don't know what we would have done otherwise. Well we would have had to buy extra and the inflated price of $60+ for each 75iu. I figure at Dr. Z's prices that would be something like $360/day for FSH alone. Gulp. So we met Holding Pattern at a Starbucks on the Penninsula and chatted a bit about things. She is adopting a little girl from overseas and is embarking along her new path. She has gone through more than most of us can ever imagine in the realm of IVF so it will be heartwarming to see someone like her attain her goal of motherhood.

Aching Ovaries...

Okay, in my last post I crazily wondered what the hell was up with my not having a single symptom of the FSH. I must have jinxed myself. The very next day I started to have a bit of a twinge in one ovary. Kind of like an ovulation twinge. But that's impossible. The 20iu of lupron I'm shooting up morning and evening is doing the job of making sure that (ie, ovulation) does not occur.

So today I went to acupuncture and while I was laying on the table, Dr. Liu softely pinched my cheek and poked my belly and proclaimed, "You've gained weight! Your cheeks are looking chubbier!" Interestingly enough I haven't felt like I've gained weight, but okay, maybe a pound or two did sneak on. But what really got to me today is the feeling of heaviness, achiness in my ovaries. They literally ACHE today. Gosh. Are those 10 follicles finally filling with fluid? I am anxious to hear what Dr. Z will find when he does the U/S tomorrow morning.

So retrieval is scheduled for sometime between February 1 and 4, and the transfer sometime between February 3 and 7. I'm close to running out of FSH, maybe 2 days plus 4 vials left. So that makes 2.5 days left. One of the crones has some 450iu Gonal F pens left for sale so I'll hit her up for a few of hers. Thank god that she has them. Dr. Z wanted $60+ per vial, or $180 per shot...$360 a day.

Health Net Sucks Ass:
Got a stack of letters from HealthNet today. I opened up the biggest one. HealthNet has denied my appeal that they should pay for the anaesthesia for the surgery I had in October. I don't get it. My doctor was contracted with HealthNet. My surgery center was contracted with HealthNet. But the anaesthesiologist WASN'T? On further investigation, it turns out that HealthNet PPO isn't contracted with ANYONE in our county for anaesthesia services.

Mind you, there are still FOURTEEN other letters to open. If that isn't scary/stressful, I don't know what is. I imagine they're a stack of, "Sorry but we're not going to pay for a single lab test that you've had" letters. I don't know if I should even bother opening a single one of them until I know if this cycle is successful or not. I don't think the stress of fighting an insurance company is good for me. They're a wretched insurance company and I plan on fighting them in arbitration as well as at the state level. Bastards.

Lack of Symptoms is Distressing

So I've been on my FSH since last Saturday...which is kind of hard to imagine. The box still looks so full of vials each time I open it up that I start to wonder, "My god...did I miss a couple shots or what? How can this be?" But I am sure I've been on top of my injections.

I have not had many reactions to the medication though. When I started the medrol, and added in the doxycycline, I had a bit of a tension headache, but that is gone. My appetite is sporadic, sometimes there, sometimes not. Not sleeping too well, but we just moved so that isn't really surprising. But I had read all of these reports of how woman's ovaries become literally LADEN with follicular fluid, that they have weight gain, skin changes, all sorts of things. I haven't had any of this. If anything, I might have lost some weight. How can this be? Are my drugs okay? Did I make a mistake buying my drugs offshore? Maybe I'm not really injecting myself with FSH each day. Kind of distressing that I would feel better if I were experiencing SOME sort of side reaction. But I'm not. I should be appreciative, but I'm not. I'm paranoid.

Adding Urofollitropin to the Mix

So today was my first urofollitropin/FSH shot. I didn't do too well at this one. My water vials were actually glass ampules and my instructions were in French. So Nurse S's injection 1 on 1 training didn't prepare me for that. I tried cracking off the first one and I literally shattered the top. I went back to my instructions, tried to interpret as much as I could in French. It was no use. I wound up calling a friend who speaks pretty good French (he's Canadian). Also, his wife did IVF so he's up on technique. He tried to open an ampule and sliced his right thumb open. Blood everywhere. I felt so bad. Guilty even. But as it turns out, my interpretation of the instructions was as good as his, so we were no better for him showing up. Third time we were able to get the ampule to crack correctly. My god. What an ordeal. But then Nurse S didn't tell me about inverting the mixed solution to draw it up...or about the little area for pulling the needle head into in order to get the last drop.

We lost some of my injection to the kitchen floor and ceiling because, despite injecting some air into the vial, we still wound up with a vacuum. It was a bit of a mess. I can only hope that this won't matter "too much" considering that we only lost part of the first vial, and the other two were fine. I honestly think it's less stress to take 3 FSH shots and forget the whole process of trying to fit three vials into one shot. I had to follow up with an insulin needle...sucking out as much of each of the 3 vials as possible to get every last drop (especially since we lost some to the kitchen!) Egad.

I put in a call to Dr. Z's office about my snafu with the needles at 9:30AM today and didn't hear back from Nurse A til about 3:30 or 4:00. Sure took them a while. So Dr. Z said that since I lost 1/3 of one vial (of three vials total) that at my evening dosage he wanted me to do FIVE (!) vials. So I did. But I told Nurse A that it sounded excessive considering I had only lost a tiny amount. But she said that the first days are really important for "recruitment of follicles" - I didn't know this....interesting. One would assume that the "antral follicle count" is the definitive assessment of how many eggs you have. So does this mean that it's not really that true? Maybe my glitch will mean I'll get a few more eggs in the end? ;-)

One can only hope.

Day 1: Lupron

Morning regime:

Baby Aspirin
7 pills of Wheat Grass Juice
Herbal tea to wash it down with.

And now.....drum roll.....we shall add lupron to the mix.

The first shot was scary. Did I swab enough alcohol on both myself and the vial containing my lupron? Was it 20 or 25 units? I read the instructions at least 5 times. It was 20. Definitely 20. Okay. I could do this. Hell, I gave my precious kitty, Kiki, insulin shots for months before she passed away from diabetes complications. But why was THIS so scary? Really it is such a tiny needle.

John even offered to do it for me. No. That is scarier them me giving myself a shot. I declined. He layed in bed next to me, warm under his blankets, while I pondered the dreaded needle.

I pulled up the skin on my abdomen, near my right hip bone, and made a little flesh tent, like I did with Kiki, so many years ago. I took Julianna's advice and aimed for a little red freckle and I struck near to it. Tiny little burning sensation that didn't get worse. Not bad. I depressed the plunger. No increase in pain. No fluid came spilling out. Amazing. I feared that it would all leak out of me...all that precious lupron, gone. But it went in and I pulled out the insulin needle. Lupron back in the refrigerator, and the needle dropped into the empty red-colored sharps box with all it's biohazards warnings written all over it. I reckon, if the Urofollitropin shots are as easy, this won't be a problem.

That is, at least until we get to the big-assed intramuscular progesterone ones. I'll need a shot of vodka to do those.

Baseline Ultrasound

Today we went to Dr. Z's office for our baseline U/S. I thought he was going to recheck my antral follicles to make sure they were still there, but I guess that is not part of a baseline U/S, but more that they're looking for "quiet ovaries" and that my uterine lining is thin, as it should be at this part of the cycle.

They did two blood draws. One for a CBC and one for an estrogen test. Apparantly after I came off of the BCP's my estrogen should have dropped to less than 20. It did. Amazing. So I'm good to go on my lupron in the AM.

At the end, J and I had our injection training class with Nurse S. The tiny needles look easy enough, but it's those big honking progesterone ones that have me scared. My god. They are huge. And Nurse S said that if I do get pregnant, I'll have daily, yes DAILY, shots of progesterone until I'm through my TENTH week of pregnancy. I count that as 70 shots of progesterone, plus those that I take after ET. So At least 85 of them. I despise IM injections and I don't know how the hell I am going to get through that.

Programmed my new Timex Ironman watch to remind me to do my shots at 9AM and 9PM. Very nifty little thing if only it weren't so bulky and U-G-L-Y. I do wish they made these a little more feminine?

"Immunology Support" My Ass

Okay, so I joined this immunology support group that I found mention of on Fertile Thoughts. I read their files, perused their databases and, okay, I'm really impressed. They've done their homework on the subject of reproductive immunology to the point that they actually direct much of their own care through argument and persuasion.

So I crafted an initial, "Hey I'm new and infertile, too!" email...posted my NK assay scores, which APAs I test positive for, etcetera and I waited. And I waited. And then I waited some more. And I continued to read their posts chock full of "baby dust" and "warm wishes". Now I know what one of the crones meant by "choking on baby dust". I must concede that all this "baby dust" shit IS pretty infantile when you think about it.

But to continue, no one wrote back to me even if to say, "Hey Linda, welcome to the group!" Not a single person. So in my waiting, I pinged a few gals offline and struck up conversations with two of them. Real decent gals - but I wonder if they would have spoken to me at all if I hadn't pinged them offline? Hmmm.... I even posted replies to a few posts by some women, but they went unheeded. And late last night I posted an email with an "Yo Jane!" sort of email header hoping to hear from the reproductive immunology guru herself. But nothing. What the fuck?

So now I am left wondering why the heck these women bother to call themselves an "immunology SUPPORT" group? I just don't understand what it takes to break the ice with these women. It baffles me. But no matter. I'll keep reading their files, postings, etcetera. They obviously don't welcome outsiders and I sure as hell can't count on any support from them.

So much for the SUPPORT part of "Immunology Support."

Stress.....

Today I went to East-West University in Sunnyvale for my acupuncture treatment. I try to go three times a week but here it is Thursday and it's my first visit this week. The New Year holiday really threw me off schedule.

I've been seeing the clinic supervisor "Liu" and two ladies that are studying to be acupuncturists (I-Shen and I forget the name of the other, the latter of the two is graduating and I won't be seeing her much more). They're a wonderful group of ladies and they've really taken my infertility situation to heart. They are trying to ready my body for the IVF procedure in general and today I asked them to try to suppress my immune system (Dr. Z's advice) in order to get my NK levels down. They also treat me for stress and my constant low back pain. Today I had probably 5 needles in my head, I think those are for stress...and there was a trickle of dried blood left in my hair...very Frankensteinish. But after one of these treatments (for stress) I feel so calm and relaxed. It is as if someone slipped a valium, or two, into my mouth while I wasn't looking. If I avoid stressful situations the feeling can last me a few hours. Otherwise, it's gone within an hour max.

I'm not normally a total stress monkey. I do run a bit "high strung". I'm great at multitasking, optimizing, getting a shitload of stuff done quickly and efficiently. This ability to move at high speed is often interpreted by others as me "being stressed out". This isn't stress, to me. But talking or dealing with J can send me over the edge in a nanosecond. He knows how to push my buttons much too efficiently.

Me: "When you speak to me in that tone it sounds like yelling to me. When you yell at me I get stressed out. I'm not used to living with people that YELL."



J : "I'm not yelling! I'm just trying to be ULTRA CLEAR!!!!!"



Me: "Well, tell that to your face, why don't you?" Grr...!"

More stress:
Dr. Z's office, just today, decided to change my calendar without reason or warning. Oh my god. Okayk, so they don't know that we're in the middle of trying to move into a new rental, orchestrate the move of my 88 year old mother up here, and then J's got a gig in Arizona RIGHT at the time my frigging eggs are due to be removed, and they just went and changed the whole schedule by a few days!?!?!? I mean WTF? <<>> Then J's lab tests are all screwed up. He has Kaiser insurance so we took Dr. Z's lab requisition to them and asked them to run the tests. Today, over a week later, we found out that they didn't do the cystic fibrosis test, they ignored the sperm test, and for the sperm culture tests they stuck a rather painful q-tip up his penis to collect who knows what, and it turned out that this was, ahem, the incorrect way of gathering said specimen and now it will need to be redone. But the burning question that I have is this:

What the blazing hell did Kaiser do with my lover's semen??? Don't these idiots have any accountability for the human products that come into their laboratory?

Well, anyone with an IQ of 100 could look at the lab requisition from Dr. Z, look at the results from Kaiser, and infer what is missing from the Kaiser results. But, NoooOooOoooooOo, J won't do the calculation himself. He won't let me do it either. I asked him twice to fax me the results. He refused. He wants to fax the results and the requisition from Kaiser back to Dr. Z and have them tally a new test requisition. Well, we've got that, miraculously, but how long is it going to take him to get anything done.

Maybe DAYS later he'll finally get to doing his tests.

We hope.

All I know is that I've got a refrigerator drawer filling up with drugs and I do NOT want to have to do a 10 day course of doxycillin ONLY because J's semen cultures are missing.

More Stress.....

Today I went to East-West University in Sunnyvale for my acupuncture treatment. I try to go three times a week but here it is Thursday and it's my first visit this week. The New Year holiday really threw me off schedule.

I've been seeing the clinic supervisor "Liu" and two ladies that are studying to be acupuncturists (I-Shen and I forget the name of the other, the latter of the two is graduation and I won't be seeing her much more). They are trying to ready my body for the IVF procedure in general and today I asked them to try to suppress my immune system (Dr. Z's advice) in order to get my NK levels down. They also treat me for stress and my constant low back pain. Today I had probably 5 needles in my head, I think those are for stress...and there was a trickle of dried blood left in my hair...very Frankensteinish. But after one of these treatments (for stress) I feel so calm and relaxed. It is as if someone slipped a valium, or two, into my mouth while I wasn't looking. If I avoid stressful situations the feeling can last me a few hours. Otherwise, it's gone within an hour max.

I'm not normally a total stress monkey. I do run a bit "high strung". I'm great at multitasking, optimizing, getting a shitload of stuff done quickly and efficiently. This ability to move at high speed is often interpreted by others as me "being stressed out". This isn't stress, to me. But talking or dealing with J can send me over the edge in a nanosecond. He knows how to push my buttons much too efficiently.

Me: "When you speak to me in that tone it sounds like yelling to me. When you yell at me I get stressed out. I'm not used to living with people that YELL."



J : "I'm not yelling! I'm just trying to be ULTRA CLEAR!!!!!"



Me: "Well, tell that to your face, why don't you?" Grr...!"

More stress:
Dr. Z's office, just today, decided to change my calendar without reason or warning. Oh my god. Okayk, so they don't know that we're in the middle of trying to move into a new rental, orchestrate the move of my 88 year old mother up here, and then J's got a gig in Arizona RIGHT at the time my frigging eggs are due to be removed, and they just went and changed the whole schedule by a few days!?!?!? I mean WTF? <<>> Then J's lab tests are all screwed up. He has Kaiser insurance so we took Dr. Z's lab requisition to them and asked them to run the tests. Today, over a week later, we found out that they didn't do the cystic fibrosis test, they ignored the sperm test, and for the sperm culture tests they stuck a rather painful q-tip up his penis to collect who knows what, and it turned out that this was, ahem, the incorrect way of gathering said specimen and now it will need to be redone. But the burning question that I have is this:

What the blazing hell did Kaiser do with my lover's semen??? Don't these idiots have any accountability for the human products that come into their laboratory?

Well, anyone with an IQ of 100 could look at the lab requisition from Dr. Z, look at the results from Kaiser, and infer what is missing from the Kaiser results. But, NoooOooOoooooOo, J won't do the calculation himself. He won't let me do it either. I asked him twice to fax me the results. He refused. He wants to fax the results and the requisition from Kaiser back to Dr. Z and have them tally a new test requisition. Well, we've got that, miraculously, but how long is it going to take him to get anything done.

Maybe DAYS later he'll finally get to doing his tests.

We hope.

All I know is that I've got a refrigerator drawer filling up with drugs and I do NOT want to have to do a 10 day course of doxycillin ONLY because J's semen cultures are missing.

Let's Usher in the New Year with some Good Ol' MTHFR

Comcast was down for 4 days prior so today is a day of extreme catching up. Over 250 emails came pouring into my outlook inbox and it took the better part of the day to sort it all out. Oh how I would love a big juicy red to sink my teeth into right about now. But no....we're being "good". For as long as possible.

So my last test results FINALLY came in today. Health Line did the venipuncture for my MTHFR test on 12/16/5...after having botched the first test on 12/6/5 when they didn't draw enough blood and then to top it off, their main lab didn't bother to tell anyone about it. So a week went by and no test showed up. Lucky for me I've got the investigatory gene and the gripe gene and I figured out that something was amiss.

So they agreed to "comp" this test...thank GOD. It would have been something like $650 and I can see Health Net having a major cow over this one. So after about a week of trying to wrangle the test results out of them.

HN: "Oh we faxed you the lab results..."

Me: "But you didn't put any both tests on the page and there's no data for the one that you did send."

HN: "But it's right there where it says Test: MTHFR C677T/1298C Genotypr"

Me: "No that is not the result. That is Specialty Labs telling you what test they are running."

HN: "So you are the patient?"

Me: "Yes."

HN: "Well we can't fax you the test results."

Me: "Then what am I looking at?"

As you can see, we didn't get very far. But they did agree to fax the results to Dr. Z's office (I should have told them my fax number just so I could get a copy of my own test results!). Dr. Z's office emailed about 4pm today to let me know they'd finally arrived. I do test positive for a mutated version of the A1298C allele, but it's not a nasty assed version, or even the dreaded double helping. But it does mean that I'll have to supplement with Folgard...no Lovenox for me. No sirree!!

Oh, also accomplished ordering most of my drugs today, with the exception of the Bravelle and progesterone in oil that will be coming by way of the International Pharmacy in Middlesex, U.K. I wasn't sure if I sure if I should use www.IVFMeds.com or the International Pharmacy, but Modern Millie seemed to have researched the latter to the point that I am going to trust her judgement on this one as she IS the WOman when it comes to this sort of thing.

I will be so relieved when all of my drugs are ordered and in my hands so it will be one less thing to worry about....besides the fact that Kaiser screwed up J's sperm cultures...ggggrr.....