Poignant Paragraph

I picked up a copy of the Winter 2009 Resolve publication for the North East Region. Usually these pamphlets speak on a really top level, noobie level. I don't tend to find much that resonates for me anymore in these materials. I kind of feel like I've "read it all". But, surprisingly, a particular article jumped out at me, "Pregnancy Between Infertility Friends", by Anne F. Malave, PhD, p. 6.

This one paragraph really grabbed me on an emotional level (I hope they don't mind my including a paragraph here):

"The experience of infertility plunges people into contact with the outermost reaches of their humanity. Infertility is a profound crisis that threatens identity, relationships, and continuity. It threatens one's sense of the world, it disturbs beliefs and assumptions, and it belies safety and security. It is an emergency that uses up coping skills, and depletes resources; people start to run on empty as their chronic stress levels move into the area of trauma. Infertility can shut people down emotionally, it necessarily limits and narrows; people are functioning in "emergency mode", a black and white vantage point that oversimplifies for the purpose of survival. This is not the best place to understand the complexities of human interactions, or the perspective of the "other": this is a time to survive, and everything else may feel inessential, a luxury."

I don't think that there is any more clear way of expressing how infertility has made me feel. My beliefs and assumptions about getting pregnant, of being a mother, have been ripped to shreds. There have been times in cycles that NOTHING ELSE MATTERS. My eye is so "on the ball" that I turn totally inward, tunneling into doing everything to cycle.

That article expresses my innards so well. I can't read it without tears.

Aftermath

I'm still not quite right from an emotional standpoint after this cycle. I vacillate between feeling numb, angry, and extremely sad. It took so much out of me to do this cycle. I was on freaking BCPs for 5 weeks before this cycle...I could have cycled within a cycle for how long it took to get to this cycle. And now I have to wait 4 to 6 weeks to heal from my sclerotherapy before I can go onto another cycle? I spend more time waiting than anything else. I just hope that the sclerotherapy took. I'm still having pain in the right ovary, the one that had the three endometriomas. Maybe it's residual pain from the procedure. I'm going to ask for a follow up U/S at 2 weeks post sclero to verify that the cysts are gone. I'm on deproprovera tabs for two weeks so that my AF will come on time. My ovaries should be nice and quiet the next two weeks. If they're not, I'll know that something's amiss.

I emailed Dr. Italian after my dismal retrieval...I asked if we could please test my hCG levels to see if it the levels that remained would be considered normal for how many hours I was past trigger. I just can't understand why this cycle didn't work. At all. The geek scientist in me wants, NEEDS, to know WHY. I want closure.

So I went to the clinic at 11AM today, precisely 3.5 days after trigger and had them draw my blood. There's a normal range for how much hCG is left in your body after trigger given the known half-life of hCG. This excellent article, "Bioavailability of hCG after intramuscular or subcutaneous injection in obese and non-obese women" demonstrates the declining normal ranges over time.

I had my blood drawn at precisely 84 hours after trigger (3.5 days). The value, if normal, should have been around 100. It was 110.

So the quality of the hCG was fine. The injection site (my upper arm) was fine. What I am thinking at this point (and a number of you readers have echoed this point) is that I triggered way too early.

My lead follicle was 18mm the day before I triggered. It should probably have been more like 22mm, which would have given the stragglers more time to catch up. I guess my question now is why he didn't have me take couple days of of Gonal-F and ganirelex and then come in for another U/S?

Grrrr.

At least it makes sense now. I know what to be angry about and that helps tremendously.

Crash and BurnWith Added Paranormal Kids Flava?

Retrieval was today.

4 follicles. 1 immature follicle retrieved.

I have nothing. NOTHING! Nothing to fertilize.

How can this be? I had a 18mm follicle two days ago. There is nothing about that follicle that could remotely be considered "immature".

How could this cycle have gone so wrong? I just don't understand it. The only things that were different were that I took resveratrol/pycnogenol and I took my HCG trigger in the arm (rather than the hip).

That the largest follicle wasn't mature (and three didn't detach from the follicle wall) tells me that there must have been something wrong with the HCG trigger. What else could it be?

Anyone know what sorts of things cause follicles to just not mature?

I'm having a very hard time emotionally with this failure. The last one was bad...but to have nothing is just heartbreaking. At least with my first failures, I had my ex to lean on. A shoulder to cry on.

This time 'round, I'm on my own, despite that I have an uninvolved partner who doesn't want further children beyond the three he already has. Hence, the DS. He's being terribly detached, hasn't checked in on me once to see if I am OK physically or emotionally. Not once. He didn't even ask how it went when he picked me up from the clinic. I'm stunned. Shocked. Hurt.

I can't express how utterly alone I feel right now. I'm going to become dehydrated if I don't stop crying soon.

On the bright side (AS IF there could be one today), the sclerotherapy on my ovaries was a successful procedure. So the anesthesia went to a good use. Dr. Italian removed 3 endometriomas on my right ovary and 1 on my left. He said that the one on my left gave him a bit of trouble and that he had to "break it up" to get it out. Ick, ick, ick. I don't even want to know what that truly means in terms of process.

I've been put on best rest for the rest of the day as my empty endometriomas were pumped full of a tetracycline solution and they'll slowly absorb over the next few days. I'm not to be "jostled" by the kids...so no jumping on me, crashing into me, etc. No small feat for these guys to be THAT well behaved. Seriously.

Dr. Italian wrote me a Rx for DepoProvera tablets that I'll take orally for 14 days then my period will start like clockwork the day after Christmas or the day after that. When that happens we'll do a follicle check on CD3, E2 test, and we'll see if things look good enough to start cycle #6.

I asked him about doing an "agonist antagonist conversion protocol" next cycle and he said that we could do it. I'd need to get a progesterone test on CD21 and if it was high enough I'd start lupron.

Scary thing is that I will probably be in Zurich, Switzerland at that time...so how the hell I'll get a progesterone test done remotely, and in a foreign country, is utterly beyond me. I'm sure I can get a test done, it's just that hopefully the test results are in English and in units that Dr. Italian can convert from.

But back to today...and what happened after we left the clinic.

After he picked me up from the clinic we drove back home across the river and headed out for brunch. My treat since he had to sit in wretched traffic in the tunnel to get to me. I explained to the kids the rule about not crashing into me. Out of the blue, the older kid said aloud, "She had an operation and she's never going to have a baby. She can't have any children EVER!!!" (Paraphrasing). He kept going on and on about how I would never have children. Mind you, he's 5. I'd have backslaped him if he was a teenager. I turned to his father, holding back tears as best I could, and asked, "Did you guys have a conversation about this before you came to get me or what?" and he said "NO!". Talk about hitting me with the lowest blow I could have ever had. Ouch. And where the hell did he get such an idea? They have no idea I am trying to get pregnant whatsoever. It's just not talked about at all when they are around. Their dad finally told the older boy to "shut up", sensing that it had me on the verge of total freakout. What the hell got into him, I have no idea.

Even weirder. The little one (also a boy), who is four and I am completely bonded to, wants to be a girl when he "grows up" (because, in his words, "girls are nice"). He has this alter ego named "Sophie" that he likes to assume. He'll put my curtain drawback cords on his head, for hair, (they're silky rope with long silky tassels) and then morph into Sophie. What's sorta strange is that Sophie is the name I'd give to my daughter if I ever had one (actually Sophia, but Sophie for short). I was almost named Sophie by my mother so it has a soft spot in my heart. I told him one day, "If I ever had a little girl, I'd name her Sophie, too!" Then, just last night, at dinner, he turned to me, out of the blue, and said very matter of factly, "Maybe you'll get to be Sophie's mother."

Eerie.

What's with these kids?

Back to my box of kleenex. :-(

Trigger Day

Yesterday's E2 = 750

Wow, nearly doubled. Lab error or what? Hmm...

There are four follicles. One's ready to go at 18, the other three are all under 15. I forget the values but there's a chance that two MIGHT be big enough at trigger. I sorta doubt the 4th will make it at all.

So 1 for sure. Maybe 2 or 3 if we're lucky. And if we get 4, I'm heading out to buy a lottery ticket.

I had to take the S/O's two kids (4 and 5) to the appointment. Ugh. They behaved horribly...huge mistake. I felt bad for everyone. Whereas the nurses had previously said it was OK to bring them and that they'd watch them while I had my U/S, at some point it was clear that the offer had been revoked and that I'd have to bring them into my exam.

The kids have known me since the day they were born, they walk in on me while I'm going to the bathroom or bathing. They've seen me naked. But having them in there while the blessed dildo cam is out and about was unnerving. Luckily they were positioned behind me in such a way that they could only see the U/S screen. Whew.

All I know is that I'll never do that again. Ever.

Triggering tonight at 11pm with 10,000iu of HCG in the shoulder (oww!!). WTF is up with the shoulder? They said that they've found it absorbs better in the shoulder. Really? Wow.

Sorta feels like a bit of a waste to be moving forward considering how bad it all is, but there's so little time left. Canceling a cycle now, no matter how bad almost feels sacrilegious.

Stim Day 8

Just got yesterday's lab tests:

Prolactin: 11.4 (down from 14 in October)
E2: 397

I don't remember how to calculate E2. This seems low to me though. :(

Did one shot of ganirelex last night and another this AM per instructions. Still feeling laden with my swelling ovaries, but less so than yesterday.

I so bet I am losing my follicles again.

I'm back at the clinic tomorrow for monitoring U/S #2. I have to take the boyfriend's kids with me this time as they were little terrors at his office yesterday. I hope that the other patients don't hate me for bringing them in.

Stim Day 7Cycle Going Bad

Today was my first monitoring U/S with Dr. Italian. The results were dismal.

One large 18mm follicle on the left side, two or three smaller (12mm, 9mm, etc). And NOTHING on the right side save for a few endometriomas.

It's bad. Real bad. It's my fucking age and it's also the endometriomas. But it might also be that I'm on 600iu of Gonal-F which is more than I've ever been on so I might be overstimmed. I get my E2 & prolactin results tomorrow. If we're over 3000 on the E2 then we KNOW that I'm overstimmed. Prolactin was at 14 before I started stims. It'll be interesting to see where it is now. I've got an old bottle of bromocriptine in the armoire that I can pull out if necessary.

So he said that I don't really have time to be choosy about cycles at my age (45) and that we should proceed with the cycle. I agree. If it weren't for the fact that I'm doing a sclerotherapy on my ovary during this retrieval, I'd cancel this cycle and try again in January. But doing the sclerotherapy means that I wouldn't have there wouldn't be enough time for my ovaries to heal between now and the January cohort anyways. I'd be looking at a February cycle date. So it's February for the next cycle no matter how we slice it. No pun intended.

So I'm reluctantly moving forward.

I don't expect a damned thing to be retrieved at this rate but what else can I do at this point?

Next time I'll reduce Gonal-F to 450iu on my own as I know that in my case, "less is more". I hate having to self-medicate but it really pisses me off when our RE's don't listen to us. After 5 actual IVF cycles, and many "tries" (ie, cancelled cycles) I KNOW better than any doctor how I am going to respond to the meds. I'll also be asking for hGH.

Last cycle I lost ALL of the follicles on my right ovary when I started taking the ganirelex. I wouldn't be surprised if it happens again and I lose them all this time.

All I know is that I want to pour myself a huge glass of red wine tonight and chalk it up to a failed cycle. It makes me so sad that a few years ago I was churning out 10 and 15 follicles/eggs a cycle.

Now THIS?

Fuck!!!!!

Stim Day 6

I read a few sources online that say that taking resveratrol and anticoagulants (NSAIDs and maybe things like lovenox, arixtra, etc) can increase the chance for bleeding.

I believe it.

I'm taking 250mg a day of reservatrol and 40mg of lovenox, and unlike previous cycles, I am bruising more than usual.

Tomorrow is my first monitoring ultrasound. I'm quite curious to see how large my follicles are.

Stim Day 5Feeling the Pain

Today's stim day 5 and my ovaries are aching and feeling laden. I'm still not convinced that 600iu of gonal-f a day is going to have me ready to trigger when I go in for my first monitoring u/s on Monday afternoon. I told the doc that 600iu was a lot for me and he didn't seem concerned at all. He ordered me 5 syringes of 250mg ganirelex, which I'm supposed to take at some point to keep from ovulating, but I suspect that I'll get in one shot on Monday evening and MAYBE, just MAYBE, a second shot on Tuesday.

My money is on my being ready to trigger on Monday and retrieving on Wednesday.

We're proceeding with the sclerotherapy on the endometriomas on my right ovary immediately after retrieval. They'll be taking two 250mg sterile vials of pure powdered tetracycline and rehydrating them with sterile saline (or other) ... they'll drain the blood from my endometriomas, refill with tetracycline solution, and then redrain near completely. Hopefully they'll heal while I'm in my 2ww and the two weeks following that.

I'm feeling terribly bloated and tender and I'm already looking forward to retrieval. It's hard doing two IVFs in rapid succession. I didn't get a chance to lose the weight from the last cycle and I'm just so incredibly uncomfortable. Also making me feel a bit icky is that yesterday I did an intralipid infusion at my hematologist's office which pumped 200ml of intralipids and 500ml of saline into me. Hmmm...no wonder I'm feeling a bit, plump?