Attitude is Everything

The title of this post sums up why I think this cycle has been better.  Well, also not being on birth control pills probably helped, too.  But this cycle I really had no expectations.  When my first cycle was cancelled I was torn up.  Going into it I had low expectations of a successful transfer but I thought I’d at least get there.  Not even getting to retrieval was a real blow. 

What did I do wrong?  What did the doctor do wrong?  Honestly, I think it was a combination of both.  For me, I think I read way too much and had a negative attitude going into the cycle.  Since I have such a low AFC I worried every time I’d read that someone with twice as many follicles got only a handful of eggs.  Add to that my fear from before I even started that there was a good chance I would be cancelled.  This was because I had an elevated estradiol level before I started anything.  I read soooo much that my number should have been no more than 50 when I was 191!  I even had my doctor do a pre-baseline scan and bloodwork to see what was going on.  And you know what – the estradiol was even higher – 212!  So I went on BCP for two weeks, which took care of E2 but I also think it really over-suppressed me (this is where I think the doctor messed up).  I also paid way too close attention to the metrics (I’m an analyst IRL).  I made sure to write everything down, ask questions during the ultrasounds, question why I was taking what dose of what. 

So this time around, I was easy peasy.  I didn’t ask a lot of questions.  I “chatted” with my Resolve message board friends more about how they were doing than how I was.  Up until today, my sixth monitoring appointment, I hadn’t even seen a doctor at monitoring.  Just the ultrasound tech and me.  Some are a little tighter with information than others and I decided to go with the flow and not ask detailed questions.  Couple that with monitoring for three days with another nurse calling me, I got very little detail this cycle.

Plus my husband and I met with another RE last week and decided to make the switch to him after this cycle is over.  We really liked him and he had some good ideas of what he’d do differently for my hard case of DOR.  Since I have that backup plan in my back pocket I kind of have the attitude of, if it works, it works.  If not, no big deal.  We go to plan B.

Long Time, No Talk

I used to blog regularly from 2008 to 2012.  After starting to shoot competitively and discovering Instagram, my blog fell by the wayside.  When embarking on this IF and IVF journey I had grand aspirations of regular writing.  As you can see, it's been awhile since my last post. I discovered the Resolve forums and a super supportive IVF Instagram community.  I've spent most of my online IVF time between the two.  Resolve for the super helpful information and support and IG for the camaraderie.  But I've decided that I should get back to this so that I have a journal of this process, should I ever want it.

Where I am...

I started my first cycle, in early May.  In fact, I did my first Lupron shot on Derby Day.  I was on the microdose flare protocol.  According to my RE, this was the most aggressive protocol for DOR.  Before starting this protocol I was on BCP for two weeks to “quiet my ovaries”.  Unforatunatlely I think they were too quiet.  On May 13, 10 days into stimming, my cycle was cancelled.  I had a lead follicle at 14mm and only four others between 7 and 10mm.  The doctor and his colleague said there was very little chance of the other four catching up to the lead so it was best to cancel.  After 41 shots, it stopped.  Just like that.  I was angry, upset, disappointed, sad, and despondent, all rolled into one.  We have good insurance and weren’t worried about the financial aspect of continuing to retrieval but the doctor said no.  I harbored this anger until a week ago.  Slowly, I let it go.  So many people say the first cycle is just a test to see how you respond to the meds.  Well I responded sh**ty!  I wanted to jump right back into the saddle.  Fortunately my doctor was agreeable to this.

I triggered on May 15 so that I’d ovulate and could start right away on a new protocol.  This time around I did the estrogen primed antagonist.  I placed my first Vivelle patch on my belly over Memorial Day weekend.  According to the timeline my doctor gave me, I’d do five or six patches.  Well as I’ve quickly learned with IVF, the timing for this wasn’t right.  AF arrived five days earlier than the doctor thought it would so I only made it to three patches.  I started the injections on May 30.

I’m currently on day 11 of stims and 35 shots in.  This protocol calls for Follistim and Cetrotide in the morning and then Menopur and more Follistim in the evening.  As of yesterday’s monitoring, my E2 is 1,331 and I have nine measurable follicles.  One is 16.2mm and the rest are 10.3-13.7mm.  A much better place than day 10 last month.  I had monitoring again this morning and the follies are still there and growing some.  Yesterday my nurse said that I’ll likely stim until Thursday morning and then trigger that night.

Tomorrow I’ll share why I think I am doing better this time around.

Needles Don't Bother Me

I can't believe I am actually writing that down!  When I was a child, I suffered from migraines.  The pain and vomiting was so bad, my pediatrician taught my mother how to give me shots of the medicine.  This way Mother wouldn't have to rush me to the doctor every time I had an "episode".  Even though the shot brought relief, the medicine stung so badly that it started a small fear of needles.

Fast forward to my mid-20s when I was diagnosed with Hashimoto's.  At the onset, I had blood taken every six weeks for thyroid monitoring.  This went on for about a year.  I got over my fear of needles real quickly.  Living with thyroid disease has caused me to get blood drawn at least six times per year.  So yea, needles don't bother me any longer.

When I found out I would need to do IVF, and four injections a day, I started to panic a little.  While I don't mind injections/blood draws any longer, I've not had to do them to myself!  JDD and I took an injections class with one of the nurses from our clinic.  We practiced mixing Menopur, priming the Gonal F pen, and filling the teeny tiny syringe with Lupron.

So we're ready.  Yet, not ready at the same time.  I know a lot of women have their husbands give the injections but I am pretty sure, when the time comes in about three weeks, that I will do them myself. I like to be in control and know that I'd rather hurt myself than be mad at JDD for hurting me!  And I have already gotten the information for a nursing service you can hire to do the trigger shot.  I'll definitely be engaging them!

TMI

TMI… No, not gory fertility treatment details.  But rather all the information floating out there on the interwebs.  Blogs. Forums. Pharmacy sites. Infertility awareness sites. Even before we found out we were going straight to IVF, I had been reading a few sites, mainly to see what my numbers meant. Well since we got our diagnosis and treatment plan, I spend several hours a day, on and off, online reading reading reading.

I've realized that I need to stop this.  The stories from the girls on the blogs and message boards are moving.  But they are that girl’s story.  Whether it was a successful process or she’s doing IVF for the fifth time.  Even with the successful stories I read, I worry” “oh, they had success but I surely won’t”.  And with the posts about struggles, I feel, “her numbers are so much better than mine and it didn't work for her”.

I've even gotten to the point that I feel with great certainty that the treatments won’t work, that I've compiled a list of REs that specialize in DOR.  Yes, I’m already making a Plan B when I haven’t even started Plan A yet.

A lot of the information I've found is helpful.  Because of the posts, I’ve started acupuncture (more on that later), increased my CoQ10 dosage, and started DHEA.  I also had ~two dozen questions that I asked of my RE last week, much to his dismay (more later on that one). 

I think from this point forward, I am only going to read message board posts that apply to something specific for my situation, and only after I get started.  For example, after I start the stims, if I find that I’m having headaches, etc., I’ll search out advice for what others did.  No more random reading of girls who got 20 follicles or what feelings/symptoms to look for during the 2WW.  The former will never happen to me and the latter will just make me crazy when I get to my own 2WW.

I need to realize that this is MY experience.  It won’t be like anyone else’s.  And that’s okay. 

How to Proceed

JDD, my husband, and I saw Dr. EDL on March 13.  Two appointments with him, both on Friday the 13th. Hopefully a good omen. ;-)  Based on all the tests, both his and hers, my advanced maternal age, and the fact that I hadn't been on the pill for eight years, he recommended we Go. Straight. To IVF. Do not pass Go. Do not collect $200.

To be honest, I wasn't surprised.  I had two weeks to research, read blogs, and countless message board threads, to realize that our chances for Baby D would be optimized with IVF.  Even though I wasn't surprised at the outcome of IVF, I was still a little surprised at the diagnosis, a combination of diminished ovarian reserve (DOR) and unknown factor.

I thought that when I wanted to have a baby, I just would.  JDD has a 19 year old daughter.  My sister has never had trouble getting pregnant and my cousin has three little boys.  But I am older than they are and I have had crazy thyroid problems for almost 12 years.  Looks like we need help from science and a cute doctor. ;-)

I'll be doing the microdose lupron flare protocol.  This will be proceeded by ~ two weeks of birth control pills to "quiet my ovaries" and also help to get rid of the cyst that I likely have.  After that, I'll start the stims.  If all works according to my calendar, I'll do the BCP from April 15-29, the injections May 1-15, ER May 18 and implantation May 23.  If that works I'd be over the moon because May 23 would have been my grandfather's 90th birthday.  Hop and I were besties, partners in crime and soulmates, and if he were still alive I know he'd be the one family member I'd confide in about all of this.

Next week JDD and I have our injection class on Monday and then I'm meeting with our RE on Tuesday for a follow up.  I have a lot of questions after completing the IVF course they wanted us to take and also from reading so much about this.

More after those two meetings...

The Journey Begins

I've spent over half my life trying not to get pregnant. Now that I've been married for 10 years and am staring 40 in the face, I've finally gotten that "ache" to have a baby. Sadly, nature has not be kind so my husband and I found ourselves meeting with a reproductive endocrinologist, Dr. EDL on February 13.

I knew my age would be a factor.  And I've read that Hashimoto's, which I've had for over a decade, would probably contribute to pregnancy difficulties.  But after I got the call with my CD3 (the first set of diagnostic tests you have on the third day of your period) results, I didn't realize how dire my situation was. There were four measurements taken that day - antral follicle count (AFC) and levels of follicle stimulating hormone (FSH), Anti-Mullerian hormone (AMH) luteinizing hormone (LH), and estradiol (E2).  My fantastic nurse, MH, went through the numbers with me and my mood sank lower and lower as she moved through the four data points.  Of course I was panicking since I had previously researched what are the "good" numbers.  

AFC: 6 total b/t both ovaries

FSH: 3.79

AMH: 0.618
E2: 191

My AMH was abysmal (1.0 is what doctors consider low-normal).  My FSH, while a very good test number, is probably artificially low.  Dr. EDL said the low FSH level is likely the result of an ovarian cyst, which is also why my E2 number is high (normal is <50).  And to complete the superfecta (hey, I'm from a horse racing family so betting terms are part of my vernacular) of fertility bad news was the AFC of only six (10 is what doctors like to see).

About a week after these tests, I had the pleasant truly agonizing experience of an HSG on February 28.  The procedure wasn't bad but about four hours later I had a terrible stomach ache.  Not cramping pains, like I had been punched in the lower abdomen about a thousand times. It wasn't any better the next day (Sunday) so I ended going back to SGF for blood work and an ultrasound to see what was going on.  And for the trifecta of transvaginal ultrasounds, Dr. EDL had me come back the day after that, Monday, March 2, for one that he could personally see.  It ended up that I had an allergic reaction to the dye which caused severe inflammation and an infection.  

With that out of the way, it was time for our own version of the two week wait before our follow up with Dr. EDL...