Wednesday, January 23, 2008

Note to my RE ...

So here is a copy of the e-mail I sent to my RE's assistant. She is a physician's assistant - meaning she has prescription writing power. She also does some in-office procedures - she did my S-HSG (saline uterine ultrasound) and did a great job (at least, I thought she did. It was painless. So to me that equals great job!) Recently - after I called and left a message letting her know I had a few things I wanted to communicate to her and to my RE - she gave me her e-mail address. So -- this is what I sent off to her in regard to my next IUI cycle:

Hi A - thanks for getting back to me!

So - I am taking a short break from meds right now, and we're trying on our own. If nothing exciting happens - I will be ready to begin another IUI cycle in about 3 weeks. For that IUI cycle - here's what I'd like to run by you and Dr. W:

I'd like to try and get to trigger day with 3 or even 4 mature follicles. I understand the risks - but at age 36 (soon to be 37) and with so many failures behind me - I think we need a few more targets to try to achieve success. I'd also like to try to get to a point where one or more of my mature follicles is around 19mm on trigger day. Also - it seems I respond pretty darn fast to stims. Would starting me off on a lower dose of follistim - and then increasing as needed - be something worth trying? Rather than starting off higher and decreasing? I will of course let you guys guide me on that! Just throwing it out there.

Another concern I want to bring up - as I was stimming for my most recent IUI - I felt the effects rather quickly (bloating - and ovaries feeling quite swollen.) However - I woke up on the day of trigger and felt - nothing. No bloating - ovaries no longer felt swollen - nada! Now, that was New Year's Day so I had no bloodwork or ultrasound day of trigger. But I had some concern that I either a) ovulated early or b) my follicles just pooped out. Now - it may not have been anything - but I just wanted to make you guys aware that had happened.

Finally - I would like to try back to back IUI's this time - rather than just one at 36 hours post trigger. I'd like to do those back to back IUI's at 12 hours post trigger - and 36 hours post trigger. I understand that back to backs are sometimes done at 24 and 48 hours past trigger - but I'd rather try the 12 and 36 approach if Dr. W. is open to that.

Again ... I won't be back in action for about 3 weeks. Just let me know once you've had a chance to talk over my thoughts with Dr. W. - and we can go from there. MUCH appreciated!!


Haven't heard back yet ... but didn't really expect to. I'm assuming she'll talk my issues over with my doctor at some point in the next week or so (especially since I indicated we have a three week lag time before next IUI cycle begins..) - and hopefully she'll get back to me with some good news. We'll see...

Oh. It just struck me that there is one more thing I wanted to mention to them. The fact that the last three times I've been on injectables - I've started spotting at exactly 2 weeks after my trigger shot. Hm. I think I'll dash off another brief e-mail. What the heck, might as well lay it all out there.

God, it would be great if I ended up pregnant on my own this cycle. Beyond great.

I'm tired of all of this crap. But I'm not ready to let it go - not by a long shot. The thought of never being pregnant (successfully, healthfully pregnant) strikes more fear and anxiety into my heart than almost anything else I can think of. That would be really, really horrible.


Jen & Jeff said...

Hey there,
Just wanted to thank you for your sweet comment on my blog. I hate that anyone ever feels like I do sometimes. ugh.. I hope you don't mind that I linked to your blog!


Melisha said...

One Out of Six,
What a weekened! I couldn't quite wait till Sunday to test, I held out until Saturday. The test had a very faint line to indicate a positive. So, I tested Sunday with the first morning urine and the line was still faint but a tinge darker than on Saturday. I tested again this morning, the line is still faint but a bit darker than Sunday. I hate me, why can't I just get a real positive? Why do I always get these faint positives? Well I called my RE's nurse she had me get a BETA HCG done. She told me she would like my number to be 50 and that they would follow the level up to some high number that I never, ever reach. I told this nurse my number would not be 50. She said lets just wait and see. I asked her what do we do if it isn't 50? She said we would check it in 48 hours to see if it doubles. Which it never does, did I mention how much I hate my body? So I got my level checked and it was only 17.8. Of course that is no where near 50, what is wrong with me? I of course can barely hold back the tears as she is printing off my lab results. Of course as soon as I leave the tears start rolling. I just wish my body would work right. Why is it so messed up, could someone just explain that one to me? I just heard back from the nurse and she said I am having another chemical pregnancy. She said most likely the attachment was bad, just like in the past. I have to get my number tested again on Wed. and then maybe I can stop all this medicine and let the miscarriage/period start. I am so sad! I am really going to push for a uterine lining biopsy, something is wrong with this lining and I want to know what it is and if it is fixable?


ONE OUT OF SIX said...

Oh Melisha - I am so, so sorry to hear this. Remind me - do you take pre-conception lovenox and/or baby aspirin - or does your doc prefer you wait for a positive test?

Again - I am so sorry. No one should have to go through this.

Melisha said...

I have been on Lovenox for about two months now. The Hematologist I went to isn't the brightest and failed to inform me I only need to take it the day after ovulation till pregnancy or period starts. I have been taking a baby aspirin since the day after ovulation. This is my fourth chemical pregnancy. There is something happening during implantation and until we can figure that out I am going to continue having chemical pregnancies. I want a hysteroscope, uterine biopsy, and immunologic testing done. I am not sure how far I will get with my requests? I have spoken with the nurses and told them I want as much testing done as possible before we try again, something is wrong and it has to be fixed. Even if it can't be fixed at least we would know and we could look at other options. This whole process is so draining but I can't make myself step away from it. I will have another Beta HCG and progesterone level drawn tommorrow. Hopefully the RE's office will call with further instructions. My hope is for more testing! Have you heard back from the PA yet?


ONE OUT OF SIX said...

No word from the PA yet .. wait, that's not entirely true - she did e-mail back to say she got my e-mail and would be talking it over with my RE on Friday or Monday. So if I don't hear anything from her by Thursday I'll check back in with her. I'm only on CD 14 so plenty of time before we'd be headed into another IUI cycle.

I think a hysteroscopy and an endometrial biopsy are a very good idea for you - and I hope you get answers. I'm so sorry you are going through all of this. Also - for what it's worth - I take baby aspirin everyday regardless of where I am in my cycle - I start lovenox after ovulation. Some people do start the lovenox as early as CD 6 though.

Keep me posted on what happens with your next beta and progesterone check. Hang in there!!!

Melisha said...

My beta went up to 50.8. However, my progesterone has fallen to 9.89. My last progesterone at mid luteal phase was 26.7. The RE has no idea why it has fallen and has no recommmendations but to keep me on the prometrium 100mg vaginally twice daily that I have been on since the day after ovulation. I will have labs drawn on Friday to re-check both the beta and the progesterone levels. The vibe I get is that he thinks I will miscarry due to the lack of progesterone. I have had just a little bleeding during the day for the past three days but it seems to quit after inserting the Prometrium in the evening and early morning. I was wondering if maybe more Prometrium would help the level. But he said no, 100mg twice daily is it. I think my biggest fear in this whole thing is that he has no idea how to keep my progesterone level high enough to sustain a pregnancy. What does the future hold for me, if he has no idea how to help me!


ONE OUT OF SIX said...

Melisha - things sound more hopeful for you!!

I'm not sure why he won't budge on the progesterone - I know some people are on much higher doses.

My RE only puts me on a low dose as well - 50 mg once/day, although at my request - we upped it to 50 mg twice/day last time - but I was not pregnant so it didn't matter.

The fact that your beta is going up is great. Slow rising betas, at least in the early days, are not uncommon. Fingers crossed for you - hang in there!!!

Lynn said...

Melisha -

If I understand correctly, I also think the betas can be very low in the beginning. Try not to worry (yeah - MUCH easier said than done). I hope and pray everything works out well!

Melisha said...

One out of six and Lynn,

I started to miscarry on Friday. My HCG was back down to 27 on Saturday. I have to get tested again on Tuesday. My next appointment with the RE is February 21. I am not sure what testing if any will be done this month. His nurse told me he does not like to do a HSG in the month you have a positive pregnancy test. More waiting, that seems to be all I get done doing! Hope things are going well for you both!


lynn said...

I'm sorry and my thoughts are with you. I can imagine how mentally and physically drained you probably feel right now.

I think you are spot on with looking to have a uterine/ endometrial biopsy performed. Maybe they can do this particular test this month?

I had an HSG done a couple of days ago. Good news - it probably took less than 5 minutes and it wasn't painful (just some cramping while they were doing it). I guess it can be more painful if your tubes are blocked (this doesn't seem to be your case).

I know they like to do this test between days 6-10 of your cycle, as to ensure there isn't a pregnancy. Maybe they don't want to do this test right after a loss because of higher infection risk? I had to go to the hospital for this test and, at least where I live, it can be a few weeks until you can get an appointment. So, maybe you can at least schedule?

Take care and make sure to do something nice for yourself today!

Melisha said...

Thanks for your kind words! Yes I am exhausted. My doctor will not do the HSG in the month you have a positive pregnancy test. I am not sure what he will have in store for me? My next appointment is in a couple weeks. Seems like so far away, my patience has gotten the best of me...Melisha

ONE OUT OF SIX said...

Oh Melisha. I am so, so sorry. That is awful news. My thoughts are with you and I feel so sad for you right now. This is all so hard. Thinking of you.