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.

Why Can't Biologists Just Bow Down and Worship IUPAC?

My LH surge came a few days ago and the folks at the clinic have calculated that I'll start my oral estrace on the 11th. So two days until it begins. The financial lady at the clinic called today, no doubt to ask where our money was. We haven't sent it in yet. A bit of procrastination mixed with a lot of hesitation makes for a non-payment of our IVF fees. Back to estrace though, as that's my rant for today.

At first I was happy that I wouldn't be subjected to the birth control pills, aka: ethinylestradiol. But I just went and looked up the chemical formula of estrace and we're looking at micronized 17 beta-estradiol. Hmmm....ethinylestradiol? 17 beta-estradiol?

I dug further. Biologists have come up with a cornucopia of terms to refer to estrace:

1,3,5(10)-Estratriene-3,17b-diol
(17b)-Estra-1,3,5(10)-triene-3,17-diol
cis-estradiol
3,17-epidihydroxyestratriene
dihydrofollicular hormone
dihydrofolliculin
dihydroxyestrin
dihydrotheelin

None of them tell you much about what the hell estrace really is.

All I can say is "leave it to the biologists to f*ck up chemical nomenclature". IUPAC created a sensible process whereby one names a chemical according to how things are "stuck" onto it, or in which order they're stuck on. Biologists, on the other hand, create odd names like toluene that us chemists would call methyl benzene. How much more simple can that be? Methyl benzene: a benzene ring with a methyl group stuck anywhere you wish on it. Remove one H- on each the benzene and the methyl, stick together, and viola! Methyl benzene! Damned easy. But toluene? Unless you have the name memorized, you will have no idea what you're looking at. (Yeah, I've got that one memorized thanks to the biologists). [Note: Biologists might not be responsible for the toluene naming convention, but it's just to illustrate an example, one of MANY, that I found in my pre-med college years].

So why am I all pissy about biologists and their bastardized naming conventions? For instance, the biologists call the substance in birth control pills "ethinyl estradiol".

The chemists? 17-ethynyl-13-methyl- 7,8,9,11,12,13,14,15,16,17- decahydro-6H-cyclopenta[a] phenanthrene-3,17-diol.

Scary? Yes. But this is what it IS. You could build the damned molecule based using the IUPAC name. But what does the name "ethinylestradiol" tell you?

Not a damned thing except that you have an ethinyl stuck onto an estradiol, a diol meaning a "di alcohol" (or two -OH groups on it). But "ethinylestradiol" is shorthand. Who on earth wants to memorize the sequence of carbon and hydrogen atoms in the example above? Not me. So I do see the need for a shorthand version whereby we can all say that "ethinylestradiol" is the same as the huge assed molecule above.

Liken it, if you will, to hieroglyphic versus alphabetized languages. With an alphabet you can break down a word to it's fundamental elements (ie sounds and syllables). With a hieroglyph, there may be nothing that tells you that you are looking at a 3 syllable word that starts with "z". Instead, you have to memorize all 65,000 symbols, or how many the language contains, in order to communicate. With an alphabet, you need only memorize 26 or so, give or take a few depending on which alphabet you're working with. You memorize the sounds to the letter clusters and you're at least phonetically saying something, even if you don't know what the hell you're saying.

So it's twice the work to memorize both the IUPAC version and the biologists' I-want-to-be-a-chemist version. But why the hell do the biologists need to go out and create 8 other names which state the same thing?

That just drives me batty.