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.

Tuesday, January 15, 2008

BFN at 12dpiui ...

... and I'm starting to spot. It's not looking good friends.

I'll take one more test tonight - maybe one more in the morning (just to make sure - given that last time this happened I was pregnant - for like - a minute.) But I'll cover my bases and then I'm calling it a day. I have already grieved. I am very tired and sad. I don't understand why this is so hard for so many of us. Talk about life not being fair.

I am formulating a new plan for my next IUI (#3.) Here's what I'm thinking:

First - I'm going to take a month off. I'll still get acupuncture and we'll try on our own. But I'm not doing a medicated cycle again right away. I am actually of the mind that your body needs a break in between injectable cycles. I know I need one - mentally and physically. I am gross right now - bloated and have zits on my forehead from all the junk I've been either a) injecting or b) shoving up my hoo ha. So I need a break.

During my break - I will contact my RE's assistant (because he's impossible to get in touch with) and will relay this information to her regarding my next cycle:

Basically - I want a chance for more follies and bigger follies (I feel like one at 18mm and one at 16mm is not cutting it. I'm 36 - I'm old with old eggs! I need more targets!)

I want bloodwork OR an ultrasound morning before trigger - so we know I haven't a) already ovulated or b) lost all my follies - which is what I felt like happened this time. Morning of trigger - all my bloat - and "ovaries feel like grapefruits" side effects were suddenly ... gone. It just didn't feel right - at all. But I was seen day before .. not day of trigger (it was New Year's Day - one of the two days of the year they are not open.) That's not typical of my RE's office - the only reason I wasn't seen on trigger day was the holiday. But I'll make sure I am seen for b/w, u/s or both on day of trigger this time.

I'm also thinking I want two IUI's. Why not go for broke, right (literally.) It will be more expensive - but only by a few hundred bucks. I want a 12 hour post trigger IUI and a 36 hour post trigger IUI though ... not a 24 and a 48 (I don't think there's anything still happening with my follies after 48 hours.)

And finally, I want to see if they can slow me down at all - I respond SO fast - too fast, I think. So maybe we can try starting me off with a lower dose and INCREASING as needed rather than decreasing as needed.

This is where I am today. Hopes totally dashed for now. But formulating a "plan" makes me feel hopeful that next time might go better.

We cannot afford IVF. I'm not saying we won't go there ... I'm just saying we can't afford to. And while a failed IUI is bad enough - the thought of a failed IVF takes my breath away - for those (like me) paying out of pocket - the thought of losing all that money. Unthinkable.

But we're not there yet. IUI "worked" for me once, even though it ended badly - I have to continue hoping it will work again. Just not this time, I guess.

Sunday, January 13, 2008

10dpiui ....

The last days of the 2ww. The end is near - and while I desperately want to the know the outcome of this IUI cycle … I really only want to know if it’s POSITIVE. If not, I’d rather stay blissfully ignorant – which is of course impossible – because, well, you can’t stop time. And even if you could – doing so would prevent me from finding out if it worked, right?

I want it to have worked so badly. So badly that just writing this sentence makes my eyes well up. But I don’t know, I just don’t know. And I can’t stop obsessing about how I felt right before my trigger shot .

Basically - I felt fine. After having felt very swollen and sore ovary-wise in the days leading up to trigger shot – on day of trigger shot – I woke up feeling – fine. Which scares the shit out of me. WHY did I feel fine? Why weren’t my ovaries even more sore (I had my last stim dose the night before.) Did I ovulate early? I didn’t feel like I did .. but maybe I did. Did my two nicely maturing follies just crap out? I was on a gradually reducing dose of stims (follistim) but I didn’t coast at all – so I shouldn’t have crashed – but did I?

Or was it just because I drank a lot of water the night before – and that cleared some of the bloat? I really want to think it was as innocent as that – but I am so scared.

And at this point – some of my fear is financially driven. I found out on Friday that due to an insurance issue – any future IUI’s will be a lot more expensive … close to 1600 dollars more expensive. So we’ll be looking at paying upward of 2000 dollars rather than 400 dollars per medicated IUI cycle.

I’d love to think that was a “sign” of sorts – a “you’re done” because now it’s going to get more expensive – but that won’t affect you since you’re done and already pregnant. I said as much to the woman from the billing office who called me to break the news … and she agreed and wished me well. But who knows? People spend so much on infertility treatments – taking out loans, putting it on credit – it’s one of those instances where you regret every asinine financial decision you’ve ever made – and you realize WHY it was a bad idea to rack up all that credit card debt in your 20’s (and, OK, maybe a little more in your early 30’s…)

I’ll test Tuesday morning. If I can hold out until then. I may not make it past Monday morning. But Tuesday will be 12dpiui and I have a better chance of getting an accurate result then.

I feel like it HAS to have worked. But who knows? IUI’s fail all the time – if they didn’t – no one would ever move on to IVF unless they had blocked tubes or something like that.

Ech. I’m giving myself a headache.

A quick hello to my new visitors! I am enjoying your comments and the opportunity to talk with you and share information. Keep hanging out – I really enjoy the company!

In the meantime … good luck and good care to all. In my next post I’ll write about how I recently fired the peri/MFM who told me not to take Lovenox and who described my early losses as a ‘whiff’ of pregnancy. Next time. See you then!

Sunday, January 6, 2008

Oh - and I had another IUI...

Sheesh, what kind of infertility blogger am I? I haven’t even written about IUI #2! So – it went down this past Thursday morning – January 3, 2008. That puts me at 3dpiui today. I was on follistim for 6 nights – 150IU for 2 nights .. 100IU for 2 nights .. and 75IU for 2 nights. Thereabouts. I felt a lot of heaviness and fullness in my ovaries after the first 3 days … and then it sort of … tapered off. Which was very troubling to me. I am worried the increasingly lower dose caused my follies to poop out or something.

Because I triggered on New Year’s Day – one of two days out of the entire year that my RE’s office is closed – I did not have b/w or an u/s on day of trigger – but I was there the day before – New Year’s Eve – and had a nice 16mm and a 14mm that morning along with a respectable E2 level that I can't recall right now. One assumes – since follies grow about 2mm a day – that I had an 18mm and a 16mm at trigger. (Unless of course – all of my follies pooped out. Which is unlikely. But I am still irrationally scared that it happened.)

Anyway – I’m perfectly happy with an 18 and a 16. It was my goal to have an 18 in the lead and hopefully – that WAS the case at time of trigger. I triggered with 10,000 IU of HCG on New Year’s Day – and had one IUI 36 hours later. The IUI itself went without a hitch – was painless and quick. I had J in the room with me … for my first IUI I didn’t … but for this one I figured – he should at least be in the room at the time of possible conception, so he came in and held my hand. It was nice.

I started 50mg progesterone suppositories the morning after the IUI (was supposed to start the night of the day that I had the IUI but oh well. I started the morning after. It won’t make any difference. I’m on one suppository/day.) I started my Lovenox 2dpiui … and I continue to take my daily regimen of: baby aspirin, prenatal, foltex, fish oil, pomegranate capsules and an extra OTC B supplement (because I don’t think my hemo has me on quite enough so I’m supplementing. I’ll pee out what I don’t need so am not worried about it. I’m kind of a rebellious patient actually. Oh well. I can’t help it. I’m smart and I question things and I make some of my own decisions. I am definitely not one of those patients who totally trusts her doctor. Just not in my nature.)

So now … we wait. More waiting. Hey – wasn’t that the theme of this blog’s first couple of posts? Ah, infertility. It’s really all about the wait. Unfortunately – I’m getting impatient… Oh well. Too bad for me. Sigh.

Saturday, January 5, 2008

First Lovenox Injection - Down the Hatch! (So to speak)

Well, I just did my first Lovenox injection. And even though I'm an old pro when it comes to injecting stims .... I was SKEERED to inject the Lovenox after hearing reports of acid like stinging and burning. But I must be acidic too - because I really didn't have much of a reaction.

I put an ice pack on the injection site - just for a minute or so so I was a little numb - and then got impatient so just said screw it - I'm doing it. Popped off the cap - swabbed myself with an alcohol pad - and stuck it in! Needle seems to be a hair thicker than follistim pen - it didn't slide right in like follistim needle does. But it's still a tiny needle so with a little extra shove it was in. And then I EVER SO SLOWLY pushed the plunger (apparently that's key with Lovenox - inject it sloooooowly. So I did.) Finally got it all in there - waited 5 seconds - slowly pulled needle out - swabbed with a little more alcohol and then put the ice pack back on for a few seconds.

And that seems to be that! I barely felt a thing! Gawd, I hope that continues and I turn out to be one of those people who just isn't sensitive to it - it seems like so many people are ... maybe I'm one of the lucky ones!

Glad that's done. Now let's hope it helps my cause - getting, and staying, pregnant!