All Systems Go

We are a go for transfer on the 23rd.  They wanted 7mm.  I was 7.1.  There's still mucus in there, but they're letting me go.  SO GLAD!  

Quick funny story.  My hair has been curly since Chipmunk was born.  I decided to chop all of my hair off and rock it.  I'm having a good time.  I walked into the clinic today (without tripping)  and the receptionist said, "I love your hair!"  Phlebotomist said, "I love your hair!"  I'm in the stirrups.  Doc comes in and says, "Sorry I took me so long to get you.  We have another Lisa HapaHopes and she's a patient of Dr. Awesome's too.  I thought she was coming so I was confused.  They are so cool.  They won this video contest and got a scholarship for their daughter.  It was from Ferring and..."  I said, "Dr. M, that's me.  I just got a hair cut."  He laughed so loudly.  I'm pretty sure I signed all of my HIPAA rights away with that video about a billion times over.  I'm just glad they think we're cool.

Can't I Just Go Back To Bed and Try Again Tomorrow?

I had my first monitoring visit for our FET last week. My lining wasn't great, but it wasn't horrible either.  She thought I'd be fine by this week.

Not so much.

My day started when I literally tripped into the clinic.  Yes, literally in the real sense of the word,  not the way people butcher it now.  I somehow walked right on out of my shoes and landed flat on the concrete, cutting my knee and scraping my chin.  That should've been my first clue that today was destined to suck.

My lining has actually shrunk.  What was a 6.5 is now a 4.7 and I still have a bunch of mucus in my uterus.  They pushed back my transfer to the 23rd and I'm adding Vivelle dots.  Two of them twice a week.

I cried the whole way to my office.  As much as I've tried to remain cool, I don't think I really tuned into how emotionally ramped up I was about this cycle.  I can't stop crying.  I can't get it together.  I'm all E2ed up and I can't. stop. crying.  I guess all of this estrogen is just going to my emotions and my ass.  Both seem out of control lately.  I hate FETs.  I think I've mentioned that before.  I also think my lining did this before.  Swell.

I went to fill my prescription.  Insurance apparently only pays for one box a month, not two.  So I filled the one box, cried again, and will hope that the angel nurses at the clinic can fix this shit sometime in the next 15 days so I don't run out of patches and can get them filled before I have a new deductible to tackle.

I hate this.  I hate the drama.  I hate watching my body fail again.  I hate worrying about insurance and money.  I hate over analyzing everything I do.  I hate being sad when I should just be enjoying the holidays with my healthy, happy two year old.  I hate it all.  This SUCKS.  It all just sucks.

And my chin hurts.

So an FET is happening...

We were planning on telling no one, but a visit to the RE today reminded me that I need my tribe.  I know this means that a few IRL friends are reading this.  Unless you're "Farrah," please understand that I'm in a weird place and don't really want to talk about it in person.

We have one embryo left.  The fresh cycle for this embryo started at "the clinic which shall not be named."  It was a day three embie from a set of 8 (I think), thawed for our FET, and cultured to day 5. We transferred the two best blasts from that cycle and planned to freeze the rest.  This was the only one that survived and it was a slow grower.  It's a day six 3AB expanded blastocyst from a now twice failed cycle.  We don't have the highest of hopes for it, but we feel very connected to our embies and we want to give it a chance.  Since we're about to hit out deductible, now's the time (because when you can't build your family the old fashioned way, you base your childbearing decisions on deductibles).

Going back to the clinic was unexpectedly strange.  I had a sick feeling in my tummy all morning that J didn't really understand until the visit was over and his feelings mirrored mine.   Since winning the video contest, we have an odd little celebrity there, so it's strange to walk in, be immediately recognized, and everyone from the front desk to the embryologists wants to know what your kid is doing for her birthday in a few weeks.  Unsettling too in a way.  I just kind of wanted to keep my head down and get this over with if that makes any sense. Instead, everyone just assumes the cycle will work and they are "dying to see what 'Chipmunk's' sibling will look like."  Maybe it was bothersome because we walked in being okay with not having much hope.  We both walked away feeling bad that we were okay with not feeling hopeful.  Like we should be more hopeful, excited even.  Perhaps we're just still scarred and reeling.

It is different, though.  If this doesn't work, we're okay with it.  We'll be sad, disappointed, but three years ago, the thought of a failed cycle meant looking at our future completely differently.  Now it doesn't.  It means the future we envisioned will stay the same, because another child would be a bonus.  I know so many women are reading this and thinking I'm nuts.  I didn't envision a one child family, but as conception became more difficult, and we started to see a family of two adults as our reality, Chipmunk became the bonus.  I no longer feel a hole in my heart for a second child to fill. I would welcome one, of course, but there will be no more fresh cycles.  If this FET doesn't stick, the door is closed.

I don't know, maybe I'm still sorting out how I feel.  I just know that I stood at that desk scheduling FET class and words like saline ultrasound, E2, FSH, and PIO were pouring out of my mouth like second nature again and I hated it.  We're heading down the gauntlet one more time and I fucking hate the gauntlet.

Oh For Pete's Sake!

I switched over to Feedly and became a moron.  I would check it on my phone, and couldn't for the life of me figure out why I wasn't getting new posts.  I would click on "all" and it would always be the same posts.  Turns out that "all" is still sorted by topics and it was just that blogs in my "adoption" folder hadn't been updating.  So, I apologize for my lack of commenting - I still have no idea what's going on in your lives.  I will catch up right after I post this nonsense.

Let me begin the nonsense by saying that I do understand how completely blessed we are.  Our little Hapa seems to be doing great.  She always measures right on the dot.  Her heart rate is perfect, and she has all of her parts in the appropriate location and number.  My immune system, on the other hand, sucks at being pregnant.  

Since I hit the second trimester, I have had two UTIs, a colposcopy because of the sudden appearance of high risk HPV, and my asthma has flared up (it had been so long since I'd had an asthma issue that I didn't even have an active inhaler prescription anymore).  Today I was sure I was going in with no issues.  I was happily sitting on the table, telling the OB I had just met that I was feeling so great.  Then, just before she left I remembered that I needed to show her the sore that I had gotten from my sports bra.  That silly over-protective husband of mine wanted me to bring it up. Well, silly over-protective husband is wiser than I thought.  It wasn't a sore.  I FUCKING HAVE SHINGLES!  

Apparently this is rare in pregnancy.  Lucky me.  I have two areas of blister "chunks" and she could see more forming.  I'm on Valtrex so hopefully that will keep new ones from forming.  Chipmunk is fine and it shouldn't affect her at all.  I'm in some pain, but it's tolerable right now - except for a bra.  They are right where my bra strap hits (which it why I thought it was chub rub from my bra and not FUCKING SHINGLES).  I'm going to try to figure out how I can get by without wearing one because I just can't handle it.  I can work, I just can't see the little bitties who haven't been vaccinated yet.

The OB was playfully teasing me about all the random crap that has snuck up on me during pregnancy.  I said, "Well what other dormant viruses can I have pop back up?"  She said, "Shhh!  Don't say that out loud!" Truth is it does scare me.  I had a REALLY bad case of mono in high school.  Epstein Barr would not be a fun thing to see rear it's ugly head right now.

Like I said, I'm all too well aware of the horrible things that could be going on.  I know that we are so super lucky to have a healthy baby thriving and that anything that has happened to me has been benign as far as she's concerned.  But it's like I told J, "Why couldn't I be one of those people who had a happy-go-lucky pregnancy?"  His reply? "Because people who have happy-go-lucky pregnancies don't walk the kind of roads we walk."

Ah, my wise, over-protective husband.  I'm incredibly lucky to have him too.

Visit to the OLD

Sorry I've been MIA, but I've been pretty freakin' sick.  I knew I would whine and moan about it here and that just didn't sit right with me.

*This post is about a prenatal visit.  If you aren't in a good place right now, feel free to pass.  If you're in a great place, read on and check out Chipmunk's updated page.*

Today I went to the OLD.  That's Old Lady Doctor for those of you not in the know.  Okay, some people say it's the perinatology group, but I'm calling it the OLD, because that's why I have to go there.  I'm turning 35 in 12 whole days.  That apparently gets the dreaded AMA stamped on your chart.  Advanced Maternal Age. Oooooh.

First we went to the regular OB for a checkup.  There are 5 OBs in this practice.  I liked the first one and today I liked the second one.  She was very grandmotherly and just lovely.  She commented several times on the rough road we've had.  We got to hear the heartbeat for the first time.  I've seen it a few times now, but I've never had the chance to hear it.  It was quite possibly the most beautiful sound I've ever heard in my life.  She let us listen for a good long while.  She did a regular old exam and told me that because of my small stature and small pelvis (which of course seems gigantic to me!) we're aiming for a 6 lb baby.  No bigger than 7.  Not only would I have a hard time with a vaginal birth with a baby bigger than 7 lbs, but there just isn't a lot of room in there for a "big" baby.  I kinda saw that coming.  So the goal is to keep my weight gain to 1/2-3/4 lb a week for the rest of the pregnancy. Wowzers.  I have to behave, people!  I was only 6 lbs and J was 7 lbs so hopefully things will be just fine.

Then I got some not so good news.  My pap showed atypical cells.  This is a first for me.  So they ran an HPV test and I came back positive for high-risk HPV.  At the time the OB seemed really nonchalant about it, so I really wasn't worried.  She said 80% of women have HPV at some point in their lives, but I still felt like a big ho.  She assured me that it Chipmunk isn't at any sort of risk either.  I was okay at the time.  Then I of course started Googling as soon as I got in the car, and found things that bothered me.  Like how high-risk HPV has an increased chance of turning into cervical cancer, and of women who had to abort their pregnancies because they had malignancies.  Thankfully, these women in my OB's office are really awesome, and she called to check in later.  So I asked her if these sorts of things are usually a big deal.  She told me that I could have had it for years and it just laid dormant until now, when my immunity is down.  Most of the time it's either completely benign or there is some mild-dysplasia.  I'm having a colposcopy on 4/16 and they will hopefully decide that nothing looks concerning and they can postpone a biopsy.  They'll do another pap at 28 weeks to see if anything has changed and then another after I deliver (me... delivering... and not pizza... crazy).  We'll decide from there what to do if it's still there.  She also assured me that if there is a cancer risk it typically takes years to develop, so we should have some time to decide what to do.  That call really put my mind at ease.  I'm seriously tired of the drama, however.  Just for the record.

Then we headed off to the OLD.  First we met with the genetic councilor.  She went over my family history and J's in detail.  Nothing stood out for either of us putting us at a higher risk, so that was good to hear.  Then we had our ultrasound.  You guys, Chipmunk actually looked like a baby.  It was amazing.  S/he was wiggling all around, kicking arms and legs.  She took a nuchal fold measurement since Chipmunk was in a good position.  She measured arms and legs (two of each!) and looked at my uterus, ovaries, and cervix.  She said everything looked good.  Then the maternal fetal medicine specialist came in, declared we had a "very cute fetus" which cracked me up, and took a look at things. She too declared that everything looked great.  I'm measuring right on time.  11 weeks 0 days exactly.  I had my blood drawn for the MaterniT21 testing and we were all done!  I'll get the results in 7-10 days.

It's been a good day.  I'm finally starting to feel like I'm bonding with this little one.  That's been hard to explain to J.  I guess I've just been so scared that it's been hard for me to really fall in love with the Chipmunk, but after hearing that heartbeat and seeing that little wiggle worm today, things are certainly changing.

First OB Visit and First Purchase

We had our first OB visit today and it went pretty much exactly like Liz's.  The office was quite nice.  They called me back first for a urine pregnancy test and blood pressure check and had J wait in the waiting room for that.  I'd filled out my history online ahead of time, so the CNA working with me was quite confused by my LMP date.  I haven't had a period since November 8th and yet I'm only 9 weeks pregnant.  I told her it was an IVF pregnancy and that I had been on Lupron.  She took my blood pressure and everything and then asked how long it had taken us and what we had been through. She was just making conversation and I was totally fine with it.  Then she said, "So you were on Letrozole?"  I said, "Um, a long time ago during my IUIs, but we're you talking about the Lupron?" She said, "Now which is IUI and which is IVF?"  I said, "Uh, IVF is when they take the eggs out of you and IUI is the turkey basting?"  She said, "Okay.  That's what I thought."  Hmmmm.  Alrighty.  Thankfully things went up from there.

The doc came in and went over our history again.  She was so very sympathetic.  She gave us a stack of info on testing, what to eat, how to battle morning sickness, what constitutes an emergency and who to call, meds that are safe (but try not to take any), a to do list.  WHEW!  She did a pap and a breast exam (J's first witnessing of such things, but let's face it - he's seen much worse!).  I fessed up that I have been too pooped to exercise and eating is pretty much whatever stays down.  I felt better when she said that it was okay and that I'd feel better and could get back on track when the first trimester is over.  Then she asked if we had any more questions.  I asked if she had any tips on how to stay calm.  I said, "We've just been through so much and it's hard to be optimistic..." then of course I teared up.  She said that she wants to get me through the first trimester, but that having seen a heartbeat at this stage was a great thing.  She admitted that she didn't have any other advice, but she asked if we wanted to take a peek.  We weren't scheduled for an ultrasound at this stage, but she did one and didn't charge us.  It was so very sweet of her.

So we will be doing MaterniT21 blood testing and she wants us to do a level II ultrasound in the second trimester because I'm old.  I guess the MaterniT21 test makes the NT screening kind of overkill, right?  Any thoughts on that?

I was very happy with our visit and the clinic as a whole.  We go back next week already!  That will be just some blood tests... thyroid and stuff... and a visit with the nurse practitioner.

So just in time for March Madness, we decided to throw caution to the wind and make our first baby purchase.  We can't wait to see our child wear it proudly.

Happy Dance!

Quick update because my in-laws are in town. We have a heartbeat! The chipmunk is measuring 6 weeks 3 days (a day ahead!) And everything looks great! We're so relieved.
I have so much to write about. I'll fill you all in after my weekend of kimchi.
You guys are the best!

Truckin' Along

Today is med day 5 and I’ve got about 17 follies at this point, all around 10 mm.  I’m pleased with that.  Lining is only at 5 mm, but we have time.  I’m strangely uncomfortable physically and usually I don’t feel anything until the morning of retrieval.

My protocol is unique enough that no one entirely knows what to expect, but so far things seem to be going well.  Since I had a Lupron Depot shot, there’s no Lupron and no antagon with my stims.  We’re just letting things grow and planning that the depot shot keeps me appropriately suppressed.  I’m taking more Menopur than Gonal-F and it’s usually the other way around at my clinic.  I’m supplementing estrogen around retrieval time along with the usual antibiotic, steroid, baby aspirin, and progesterone.

It’s strange how at home this all starts to feel.  Joking with your RE and the nurses in the hallway while totally ignoring the giant invasion of privacy you just received.  Calling your husband on the way to the office with the rundown: “There’s about 17, all are around 10, we’re not changing anything.” “Got it!”  Getting to work and just plopping on down and starting the day like nothing has happened.  This is my life.  C’est la vie. 

This cycle is showing us how ready we really are to be done with all of this.  Of course we hope that there are finally two little lines at the end of this cycle, but I think that if there isn’t we will feel at peace that we’ve done everything we could.  We’re emotionally wiped.  Even if the littlest hill is placed in front of us, we are protesting about how tired we are and how sick we are of climbing mountains when others have nothing but plains.  Our whole marriage has been about trying to make a baby and we’re ready to just enjoy each other, baby or no.

Whiskey Tango Foxtrot

We were really anxious about our WTF appointment today. We were so worried that he’d say, “We have no idea why you aren’t pregnant, but if you just keep trying I’m sure it will eventually work. “  That would not be something we were looking forward to hearing.  We want to look towards the end of this roller coaster.  If there’s nothing else to try, we want to know it.  None of this, “just keep trying” hanging over our heads for the rest of our lives.

Dr. Awesome started off by saying that he was really disappointed and that their whole team felt confident that they’d found a solution for us in our FET cycle.  He said he went back over my records to see if there was anything that could have been missed and he couldn’t come up with anything.  I ovulate.  My FSH is a little high, but my AMH and AFC are great and I respond really well.   My tubes are open.  My uterus looks healthy on hysteroscopy.  I don’t have any adhesions or scar tissue in my pelvis.  I’m relatively young in infertility land.

I brought up everything I could think of.  I’m sure I sounded like a babbling idiot.  I mentioned the auto-immune response I had from LASIK.  I brought up the really bad (I mean really bad) mono that resulted in hepatitis when I was 15.  I asked if my well controlled B12 deficiency could be at play.  The nice doctor humored the crazy lady.

The fact of the matter is, the only thing we know I have is endometriosis.

He thinks I’m one of the small subset of women with endo that is affected on a cellular level and my egg quality is suffering from it.  This would explain our poor fertilization and need for ICSI as well.  So what he wants to do is a 3 month Lupron course to put any endo that may be lingering into a dormant state.  We’d then go straight into a fresh IVF cycle.  That way, none of the eggs I would make in the fresh cycle would have ever been exposed to any endo.  Oh, and no “add-back” therapy as long as I can stand it.  My husband has decided that since I will be in “menopause” he should be entitled to a mid-life crisis.  I think not.

We’ll also be adding some LH in with stims as well to see if that helps.

This is where I opened my big mouth.  I asked if there should be any supplements I should be taking or diet changes I should make while we have 3 months to work with.  Time to bring up the elephant in the room!  When we started this road, I was just inside the normal weight range.  After 3 IUIs, 2 IVFs, 1 FET and a lap I am smack in the middle of overweight land.  So Dr. Awesome recommended getting myself back down to a BMI under 25.  Being a man, he thought this should be no problem!

So I have 3 months to lose 17 pounds.  While on Lupron.  During the holidays.  Might as well put me in handcuffs, light me on fire, and charge admission while you’re at it, doc!  But I will do it, dammit.  You know why?  Because this is our last shot and weight is the only thing I can control in this mess.  If this fails, I don’t want to look back and wonder if losing weight would have made the difference.  So I will go back to my nutritionist’s totally depressing eating plan.  I will get my ass on the treadmill.  I will do all the meal prep and planning ahead needed to get though the next three months, including the holidays.

Bring on the salads.

%^$!

My lining has not grown.  It was 5.9 at my first ultrasound and it was 5.6 today (day 13).  Waiting for a call from the doc with my E2 results and what to do next.  I'm so over this I can't even stand it.

Ambivalence In An Elevator

I loved this post from The Infertility Therapist on RE waiting rooms.  I was thinking about it earlier this week when I ran into an uncomfortable situation at my RE's office.

The elevator won't go all the way up to the RE's office until 7:30 am on the dot.  So I was waiting in the lobby the other morning for the clock to strike the magic hour.  A couple came in and also waited.  Then another couple and finally another woman.  We all waited.  And waited.  We sat there for almost 10 minutes and no one said a word.

Everyone had their noses in their phones, texting or playing Fruit Ninja.  I kept thinking about the post from Dr. Rouff.  I was making judgements, but sadly they were judgements that hurt myself more than anything.  I figured that there were 4 women there, and since we were all there at prime monitoring hour, we were likely all IVF patients.  If we were to go with 50/50 IVF odds, two of us would get pregnant and two wouldn't.  Since I perceived them all as prettier, slimmer, and more well put together than me, I figured I would be the one out of this group to miss out on the baby lottery.  Truly, truly ridiculous, but this was honestly what my subconscious was saying to me.

So I started thinking that I should reach out and be friendly.  What a great way to meet local people who are going though the same thing!  But what the hell do you say?  "What are you in for?" "How are your ovaries feeling this morning?"  "What CD are you on?"  Okay, okay, I probably could have gone with something like, "How stupid is this whole elevator thing?" but at the time I could only think about the fact that we were all going upstairs to simultaneously drop trou (in separate rooms, mind you).

Got any interesting waiting room stories to share?

Return of the Jedi: Baseline

Baseline went well.  I'm cleared to start meds on Saturday for our FET.  I met a new Wand today.  All Wands are alike.  Go figure.  The nurse who did the ultrasound really pointed out landmarks and stuff which was nice!  I knew what was my lining and could spot a giant ovary full of follies, but she showed me blood flow and stuff.  I've never had a thorough explanation before, and apparently I have been looking at the damned thing upside down.

They wanted to do a mock transfer, so I had that done today too.  Easy peasy.  BUT whenever I meet a new physician and they ask what I do for a living, a whole conversation ensues.  I'm an audiologist.  I work with cochlear implants and I only see children.  (There, I said it! At least this blog is not googleable.) The minute I answer the "what do you do" question, I see their eyes pop up from between my knees and the questions start.  Doctors have genuinely great questions about implants and I'm really very happy to talk about it.  I love my job and I love talking to others about how awesome implants are.  Here's the deal - I would much rather these conversations started when I was wearing pants!  At least this time she had the decency to let me sit up and put my legs together.

One Foot In Front Of The Other

First, an apology.  I know I have been a piss poor commenter lately.  I haven't even been a great reader lately, I'll admit.  The wind has really been knocked out of my sails, and when I'm feeling hopeless, I work my ass off.  I bury myself in work.  I don't even know where I came up with the pile of work I made for myself this week, but I got a lot of crap done!  It feels good to accomplish something I guess.

But you don't want to hear about that, you want to hear about the new RE!!!  He is yet to be blog-named.  I'm working on it.  The man sat with us for an hour.  AN HOUR, PEOPLE!  That's 60 whole minutes in one sitting.  I don't think Dr. Plethora has spent 60 cumulative minutes with us in the year we've been seeing him... at least not while I was conscious.

The new doc went through my file with us step by step.  He laughed about how great it is to work with infertility patients because you can say, "What was your AMH?" or "What dose did you start your last cycle with?" and we can shout out a number without thinking.  He talked about what he would have done differently in the past and what he would do in the future.  He gave us a number of theories on why this cycle didn't work.  I really appreciated how he talked with us about the possible impacts endometriosis has on infertility and what could have happened in our last cycle.  He made it really easy to understand... well... he made the fact that we don't understand hardly anything about endo easy to understand.  But at any rate, it's obvious that the lap has helped with embryo quality and we want to make hay and keep riding the coat-tails of a recently gutted gut.  Here's what he would have done differently:

• Added LH to my stims.  Apparently there is some research to support this.
• ICSI on round one - even though it didn't look like we needed it.
• Added some HCG to my trigger.
• Cultured to blasts.
• Added some HCG to the culture medium at transfer.  Really cool to learn about.

The most exciting thing about our FET is that they are going to thaw the embies, culture them for two more days, and then transfer.  If any are left, they will refreeze them!  I didn't know you could refreeze!

So we're going to move our little kidsicles to the new clinic and do an FET.  I started BCPs today.  We have to take an FET class (Ugh!  Enough with the classes!  I'm pretty sure I've injected, ingested, and inserted it all!) and then we'll get our calendar.  I can't get in to do the class until the first week of September because of my patient load, but c'est la vie.  I'm tired of feel stressed about rushing to get things in so I'm not going to do it.


When we were leaving the new RE's office, he told us that he doesn't see any reason why I can't be pregnant and fully expects that I will be as long as we keep trying.  That was good to hear.  Then J looked up and noticed that one of his diplomas matches one of mine.  I don't know how I missed that we shared an Alma mater.  I was sold.


We met with the financial person, who was awesome.  She had already called our insurance company to verify benefits and what we had left on our limits.  She handles so much more for us than our old clinic did.  Knowing that I wouldn't have to haggle for pre-auths made me want to cry.  Then she walked us over to embryology to talk frozen embryo transport.  

I emailed the new RE to tell him we were planning to go ahead with the new cycle and he answered me in a matter of minutes.  I about fell over.  I couldn't even leave a message for the old RE directly!  We could only leave a message for the nurse and keep our fingers crossed.  Heck, I called about moving our embies on Wednesday and STILL haven't gotten a call back.  I feel like I'm in high school, trying to break up with a slacker boyfriend, and he won't even call me back so I can end it!

As soon as the old clinic calls me back (!^#*^#@$%$@), we're going to move the embies ourselves.  I'm that type-A.  I wonder if I can make an "Embryos on Board" sign to put on my car.  Maybe a stick figure family with embryos on it?

We're moving forward... one step at a time.

How Infertility Weasels Its Way Into Everything

As treatment for my case of the hormonal crabbies, I was prescribed a task.  "Do something fun this weekend" the PA at the clinic said.  J bought us tickets to see Batman, so I figured we were all set.  A few hours of movie land sounded like a good treatment plan.

First, there were the ultrasound and E2 hurdles to jump though over the weekend.  In general, no biggie. Today I had 36 follies, but there was a catch.  A third of them were measuring mature, another third were just on the cusp, and the final third probably wouldn't make the cutoff.  The new fellow, we'll call him Dr. Newbie, wanted to check my E2 and talk with an Attending before making a call on when to trigger.  So he sent me home with a blank instruction sheet and told me to wait for his call.  I figured that with my luck, he'd call in the middle of the movie.  You all know how that goes.  No way I was letting it go to voicemail.  Especially not on a Sunday.


We got to the movie early so I could have a seat by the door to make a dash to the hallway in case my phone started vibrating.  We sat through Batman, phone on lap, waiting for the call.  And we waited.  Finally, we got the call.  


And I missed the last 7 minutes of the movie.


In light of what happened in Colorado, I feel like a schmo being upset about that, but dammit!  I just wanted to sit through a movie without having IF get it's nose all up in my good time.


Anyway, my E2 was about 3100.  We're going to push it out one more day to let the other third catch up.  Retrieval is scheduled for Wednesday morning.  Looks like we'll be expecting about the same number of eggs as last time.  Sounds like a lot of eggs, but that didn't mean crap during round one.  Still rooting for a better outcome!

Ch-ch-ch-changes

July always brings new medical students and residents to deal with.  I say deal with because, well, in my line of work they can be a pain in my ass. They tend to be overly cocky and see me as a technician rather than a teammate.  For example, I remember being in the OR one July and a resident pointed at me and called me "Hey you."  The surgeon said, "Uh, that's Dr. Hey You to you."  So I understand the breaking in period quite well.  It's fine when it's in terms of my work, but not so much when it comes to my baby making attempts.

My REs office is part of a teaching hospital, which is okay with me.  The fellows do most of the monitoring and they did all of my IUIs.  They do the retrievals with supervision as well.  My favorite fellow just finished his rotation.  That means there's a new one whom I will see on Sunday.  This makes me a little nervous.  The other fellow knows me.  This dude doesn't, and if the fellows I've seen in my work are any indication, he could be a guns-a-blazin' hot shot.  I just want him to tell me I can trigger.  Any other July I could probably tolerate the thought of a new fellow, but friends, there's some crazy shit going down at my clinic and I'm not totally sure what's up.

There's been an odd vibe there lately.  On top of that, my phone calls are taking longer than usual to get returned, to the point that it's unacceptably too long.  Then the staff photo poster that's usually in the lobby was taken down.  Now today, I met a new attending.  I took a peek at the website and sure enough, two of the physicians are gone.  My RE is the only one left.  That makes me uneasy.  The new guy has awesome credentials, but not the most glowing recs online from former patients.  Plus, he's super old.  Not to be ageist, but old makes me nervous.  I don't want shaky hands wielding a a needle tipped ultrasound wand at my vagina.  I also like my doctors to be up on the latest and greatest and in my experience, older physicians have found their grooves and are unwilling to veer from the path.

This clinic has a team strategy for patient management, which I like. My office functions the same way.  They all meet and decide on protocols, etc.  I'd seen all three physicians at some point and they all had a part in my last cycle.  It's important to feel comfortable with everyone there and it's really irksome to have all of these changes, all at once.  So, we're thinking that if this cycle doesn't pan out, we will go elsewhere.  Maybe a private clinic where there aren't fellows and residents.  Hopefully it will all be a moot point. 

So far things are going well with IVF deux.  I don't have as many follicles as I did last time, but I'm all about quality over quantity.  I'll likely trigger Sunday and have a Tuesday retrieval.  Let's hope!

All Clear!

My baseline ultrasound was cyst free and meds start on Saturday!  My insurance decided to ovary-block two of my Ganirelex (Get it?  Ovary-block?  I'm so funny.), so we'll see how that all pans out.

When I was in the waiting room at the clinic this morning, there was a child there.  It always irks me a bit when there's a kid there, but I get over it.  Today was a little different, though.  This was a boy of about 10 or 11.  Seriously.  A fertility clinic is no place for a boy that age.  Ew.

Hooray Hooray For Q&A

We had a really good visit with the RE today.  I actually feel like he answered all of our (current) questions... because I actually bucked up and asked them!  Go figure.

He told us that the endo was the worst on my bladder, surprisingly.  That was that only thing I didn't have symptoms for!  Now that it's removed, I'm hoping that I can have some time sans constant peeing... at least until I get pregnant, right?  One can only hope!  Anyways, he thinks the pain I'm still experiencing will go away with my next period and he's "anxious to see how it goes."  Well isn't that just nifty.  I guess we're all awaiting AF with baited breath.  He guessed that we have a window of about a year before it starts to come back, and that fertility treatment might speed that up a bit.

Gratuitous puppy pile just so I can say, "Look!  A plethora!"
Image Credit

As usual, he gave us the treatment option smorgasbord.  I realize I need to give him a pseudonym.  I think I shall call him, Dr. Plethora because of all of the options he is constantly throwing at us.  There - he's named. We talked about doing a few months with Depot Lupron.  He told us there was some evidence that it could help with an IVF cycle and we could do it if we wanted.  I cornered him on this one.  I was concerned about the symptoms and he said that we could do add-back to avoid some of that.  So I asked if he thought it would really help in our situation.  He FINALLY gave us his actual opinion.  In our situation, it isn't worth the time.  That if I had stage 4 endo he would push for it, but with stage 2, he thinks the help would be marginal.  So we're skipping it and I might revisit it as a pain treatment when we're done with the baby making.  We'll see.

I also asked him about all the endometriosis diet stuff I see, because no fatty wants to limit her eating that much unless the doctor tells her to.  He said that there are things all over our environment that our bodies treat as estrogen (soaps, shampoos, plastics, stuff in the water, all kinds o'crap) and that just limiting certain foods would have such a very minor impact, that it isn't worth it.  There's no way you could avoid things in the world enough to change the estrogenic response in the body.  I was happy to hear that.  What the hell would I eat?  And no wine for the rest of my life?  Shoot me now!

He was very kind and sympathetic and really wanted to make sure we were doing okay emotionally.  He said, "This is not fun stuff to go through by any means and you guys have been through a lot."  It was nice, but I couldn't stop thinking that there are a lot worse things we could have faced at this point.  While never being remotely pregnant makes me sad, I do realize how grateful I am that I haven't suffered a loss.  I see how strong the women in our community are when they experiences losses and I just don't think I could be as strong.  They are the true warriors if you ask me.  Anyway, we're feeling really hopeful right now.  It's good.

As soon as AF rears her head, I'll start BCPs again for IVF #2 - this time WITH ICSI.  We will do another antagonist cycle since I made plenty of mature eggs on it.  He's hopeful that the ICSI will give us more embryos and that cleaning out the endo will give us better quality embryos.  Sounds like a plan to me! And if you're here from ICLW... What up?

The Worst Way to be Popular

I've never considered myself to be popular.

People don't dislike me and when they get to know me they like me just fine, but I'm generally a quiet person.  I'm the girl no one really thinks much about, but if they were to be asked, "Do you know Lisa?" they'd say, "Sure.  She's nice."

My clinic is a busy place.  I don't think I've ever seen the same patient in the waiting room twice.  I've noticed over time that staff has become more comfortable with me.   There are more smiles, more "good lucks" and well wishes after one treatment or another.  When the phone rings, the message just says "Hi Lisa!  It's M."  I no longer hear, "Hello Lisa.  This is M.  I'm one of the nurses at Blah Blah Blah Fertility Clinic."  That much is nice, but now things are... unsettling.

At my lap, there were a billion people there, I swear.  I am in surgeries as part of my job a couple of times a week.  There is a scrub nurse, a circulating nurse, the surgeon, a resident, a me, and a nurse anesthetist or anesthesiologist.  Every once in awhile a med student or another resident will be there, but those are the usual players.  When I went in to the OR, I remember being overwhelmed at the number of people in there.  There was my RE, one of the fellows I always see, a resident I'd never met before, an anesthesiologist (MD count of 4 now), a nurse anesthetist, and about 3 or 4 more random people.  I'm assuming they were nurses and/or residents or med students.  I really wasn't planning on adding that many people to the cooter view count at the time, but so be it. 

When I went to the clinic for a culture yesterday, I walked right in and the receptionist (There are 3.  They are that busy.) didn't even need my name.  She actually just buzzed me right on back and told me to go ahead to the bathroom and put my sample on the counter in the lab.  I could just wander around the clinic with a jar of pee.  When I came out, I heard a nurse talking with the PA.

"Lisa's here.  Were you going to do a UA?"
"Oh yeah.  I'll still send it out, but let me do a dip really quickly."

At the same time, another nurse walked by me from the other hallway and said, "Hey Lisa!  How are you?  Hanging in?  Healing up okay?"

I like that there's a nice comfort level there and I feel like I'm in good hands when they know me so well.  But at the same time... I must be spending way too much time there.

I make it a point to get to know my patients well from day one, but I also know that I need to get that 6 month old to trust me so that I can help him or her the best way possible and that I will likely be spending the next 21 years working with this family (We have a good pension plan, what can I say.). 

When I first started at the fertility clinic, I was just another patient.  One that they thought was a young chippie who would be in and out, getting pregnant with just a little help.  I had to give my name and DOB all the time.  People introduced themselves J, forgetting that they already had... twice.  Now I feel like I'm a vet.  An old timer.  Someone they see on a regular basis and can't help but get to know.  But now that they know me, they have to feel invested, right?  I have to be one of the people they are trying to get the hell out of their office.  I have to be.

Owie

I am very good at getting UTIs.  So when I tried to go before bed last night and it burned and not much came out, I was a tad bit worried.  When it happened again this morning, I called the clinic.  They had me come in for a urinalysis.  Thankfully, it was negative.  Just a little blood in there.  They're sending it for culture, just in case, but it's just part of healing, it seems.  I kind of felt like a hypochondriac, but better safe than sorry, right?  And since I was near J's office, we got to have lunch.  I'm now totally wiped.  I'm still going to try to go to work tomorrow because I am bored out of my gourd.

Aside from being tired, things aren't so bad.   I'm a little sore, it hurts when I first get up, still bleeding some, I'm still bloaty and... round, but overall the belly area is on the mend.  The bad part... I've got a canker sore the size of Texas right next to my uvula.  It hurts to swallow, it hurts to talk, sometimes breathing hurts.  This thing is a bitch.  I'm good at getting canker sores too, so I'm assuming that the anesthesiologist nicked me when he was intubating me, I got an owie and now it' s a canker sore.  Ugh!  I hate mouth owies.

Jiminy Christmas

My RE called last night for an impromptu WTF.  I certainly don't mind the phone call vs office visit scenario.  He's kind of socially awkward and seems to do better on the phone.  Also, I'm down with the lack of copay for these phone calls.

He was so kind.  He genuinely seemed very surprised by our poor fertilization and negative beta.  He said we would definitely do ICSI, but that there was no guarantee that it would fix things for us.  He wants to do an endometrial biopsy, which seems to be pretty standard after a failed IVF, so while I'm certainly  not psyched about it, I will sign up for more cervical suction cups and catheters.

Then he started talking about the endo issue.  About 10 years ago, I had symptoms that led my then Gyno to suspect endometriosis. She put me on the pill and there I sat.  Truth be told, I had symptoms long before that, but I also had an asshat for an Gyno when I was young and naive who said "Yup, periods hurt."  He was a dude.  Surprised?  Anyway, they have never seen any evidence of endo on my ovaries, so they assumed that if it were endo, it couldn't be severe.  He said that there is a chance that I could have severe endo that just isn't on my ovaries, and while it would be rare, it could affect egg quality and fertilization rates.  He didn't come out and say it, but I think the fact that we had a few fertilize, ended up with a couple of embryos, and I didn't get pregnant leads him to think this is an egg issue and not some subtle sperm issue.

So he wants to do one of two things.  Either assume I have endo and put me on Lupron for 2 1/2 months or do a lap.  I was down for the lap right then and there.  For one thing, I need to know.  For another, I ain't takin' something as evil as Lupron without knowing if I really need it or not.  For a third, I have a big history of early onset osteoporosis in my family that includes my mother.  I do NOT need to encourage that shit and I certainly don't need to shrink for the love of all that is good and holy.  No Sally Field meds to be added to my cocktail, thank you very much.

He didn't want me to make any decisions yet.  He wanted us to sit on it for a bit and then come in and talk to him about all the pros and cons.  He's never seemed very psyched about the thought of a lap and hasn't come out and said why.  Before it was just that he thought IVF would circumvent the issue, but he doesn't have that to fall back on anymore.  He said any surgery was a big deal and the Lupron is a big deal too.  I send babies off to surgery on a daily basis so maybe that's why I'm a little desensitized to the whole surgery thing, I don't know.  He kept talking about how emotional this all is and that we just had a big blow.  While I appreciate the sentiment, all I kept thinking was that it was one of a million other nasty blows and we just want to keep chugging along.  He recommended seeing their therapist and I thought that was a good idea.  Lord knows I'm as anxious as all get out these days. 

The RE kept repeating, "The biggest predictor of outcome is age and you have that on your side."  I wanted to yell, "FOR HOW LONG!?"  I turned 34 a month ago.  The magic number will be here before I know it.  Every time we make a decision, another cycle goes by before we can act on it and another month is lost.

I just hate wasting time.  I feel like there will be an end to all of this at some point and I want to get there.  Whether that's end comes with a baby or not... I just want to know what's on the other side.  I want to stop hurting.  I want to see my husband enjoy 24 whole hours of happiness.  I want my life to revolve around something else.

If you've gotten this far, I appreciate it and apologize for your eye strain.  Got any advice?  To Lap or to Lup?