Sunday, April 29, 2007

I'm human again! Oh shit, is that bad??

So I woke up today feeling much better than I have in a week. And I was so thankful and happy to not be in pain! Until about halfway through the day when I remembered that they said IF I were to get pregnant I would probably feel worse before I got better. AAAhhhhhh! Of course a part of me is telling myself this means I probably didn't manage to get knocked up, on this, our one and only legitimate try. But, I'm trying REALLY hard to think positive and will my way into a positive result at the end of this 2WW from hell. I'm banishing all negative thoughts each time they creep into my brain. Which happens about 46 times an hour.

But anyway, let me tell you about my visit to the Scary Radiology Lab with Dr. Doom-n-Gloom on Friday. Dear Lord in Heaven, did this guy scare the crap outta me - cripes!! The ultra high tech ultrasound was actually pretty cool - it not only showed the normal black and white Rorschach images as the ultrasound at the RE's office, but it also could show, via different colors, blood flow, fluid movement, etc. Also the quality of the black and white Rorschach blobs was like the difference between regular and HD TV broadcasts. You could like, see the PORES on my ovaries faces! Har har.

Anyway, so here's the list of observations Dr. Doom rattled off to me after prodding me with the wand for what seemed like HOURS: "Your ovaries are three times their normal size, the lining of your uterus is twice as thick as it should be, you had at least 3 or 4 ovarian cysts which have ruptured within the last 48 hours and are now leaking fluid into your abdominal cavity - likely the reason for most of your acute pain, there is decreased blood flow to both of your ovaries, and many different hemorrhagic cysts remain on your ovaries which contain blood and other debris and they may or may not rupture in the near future. Also, there is no absolute certain way to diagnose ovarian torsion, it's extremely difficult, even with high-res ultrasound. Your ovaries are both symmetrical, so that might indicate that neither have twisted, as it would be highly unlikely for both to have twisted in the exact same way. However, having said that, since they are so enlarged, I would have to say that you are at very high risk for ovarian torsion. I'm going to go call your doctor and he'll have to decide whether or not you need surgery...."

He did call Dr. D, and then patched him thru to me once I was back out in the waiting room, and as soon as I answered the phone Dr. D said, "Well hi there kid, sounds like everything is looking really good!" Um....wha??? I told him the other doctor had scared the shit out of me. He said he figured as much, and that's why he wanted to talk to me directly. He said he thought it was great that I had blood flow to both ovaries, and that DUH, of COURSE it will be decreased if they are that enlarged, which we already knew. As for the rest, he said, well, yeah, we knew you were hyper stimulated, and those are all things we expect to come along with that. He basically said what he's been saying all along, which is that he knows it sucks, but there's nothing really to be done but to grin and bear it and suck down a Percoset every now and again when the going gets really rough.

So, I went home and crawled back into bed. Then on Saturday, I had another pity party when I woke up feeling even more pain that I had on Friday. Then, miraculously, I woke up today feeling almost human again. Back to the way I felt just after the IUI actually, where I felt full and uncomfortable - but only in pain when I walked too quickly or laughed too hard or sneezed or something. Oh LORD, oh Lord, I hope this isn't a bad sign, because, remember they said that IF I got pregnant that I would.......... Oh! Right! I'm not supposed to be thinking that! Nope, no negativity! Only happy shiny sugary sweet thoughts! Happy thoughts! Happy thoughts!! I AM going to be pregnant, I AM going to be pregnant, I think I can (get knocked up), I think I can (get knocked up)...Chooo chooo!!

By the way, this 2WW thing really bites!! 1 week down, 1 to go......

Thursday, April 26, 2007

OHS Sucks.

Well, prepare yourselves, for this will be another in a long line of 'poor me' posts. I feel like dogshit. The OHS has gotten progressively worse and worse since Sunday. Sunday after the IUI and Monday, I pretty much just felt my ovaries - felt how big they were, felt them everytime I walked, felt them when I stood up or sat down, and as aforementioned, when I had to urinate. Tuesday this progressed into feeling like my whole midsection was one big cramp, which I could feel all the way across my belly and through my lower back. It was unrelenting, but bearable. On Wednesday morning I woke up and noticed that after I peed.....I didn't feel any sense of relief. I walked into my kitchen to let the dog out onto the deck, and by the time I got back to the bedroom I was in really bad pain. I discovered that the only thing that made the pain relent, at all, was if I laid on my right side. I was huffing and moaning to beat the band on Wednesday morning, and finally R convinced me to call the RE's office. Dr. D told me to get dressed and come to the office - he'd work me in, between other patients.

It was all I could do to stand up in the shower long enough to get the shampoo out of my hair - I had to take several breaks while getting dressed to come lay down again to let the pain recede a little bit. I rode to the doctor's office with R driving as fast as he could, and me stretched out across the backseat trying to get some relief.

Dr. D showed us my ovaries on ultrasound (from the outside, thankfully, no wanding on this visit) and confirmed that they indeed were both the size of grapefruits. His basic attitude was that he was not at all surprised that I was in pain. He said that he was not concerned about ovarian torsion (where your enlarged ovary can twist on itself, cutting off it's own blood supply), because he said that if that were happening, I wouldn't be able to speak, or sit up, or stand, or do much of anything other than scream in agony. If torsion happened, he said that the only thing to do would be to call an ambulance and meet him at the hospital.

He asked me if I'd been eating and drinking. I said no, I haven't felt like doing either of those things at all. He said I didn't HAVE to eat, but I did have to drink. He said to go get Gatorade on the way home. He also gave me a prescription for Percoset. I honestly don't know how I would have made it this far without it. I've been going through periods every now and then - once around 4am last night, once around 12pm today, where the pain just absolutely would not go away, would not subside no matter what position I contorted myself into. I shudder to think how bad it would have been if the Percoset wasn't at least taking the edge off of it.

So, Dr. D made me promise I'd call him this morning and let him know how I was doing. I left a message basically saying that I wasn't any worse, but neither did I feel any better. I'm nauseous, everytime I stand up and/or drink Gatorade the nausea gets worse. I told him I was scared to death of running out of Percoset, bc I didn't know how I would bear the pain without them. (He didn't give me any refills on the measly 24 pills he prescribed yesterday.)

His nurse called back this afternoon and said that Dr. D had gotten my message, and was OK with my progress report (?) and that he thought maybe I'd feel better if he sent me to get some kind of special, high falutin' ultrasound scan that could rule out ovarian torsion for certain. The nurse proceeded to tell me that she had gotten the radiology lab to 'work me in' even though they had no appointment openings. I should be there by 3:15pm, she said, but be prepared to wait, since they'll be squeezing me in whenever they can. Oh, and I should drink 32 ounces of water 1 hour before the "appointment" time. Are you freakin' kidding me???

The way I feel right now, this sounds like a sentence of torture!! First of all, I've got to get someone to drive me to the damn appointment - someone in front of whom I won't feel like an idiot when I'm moaning and panting in the back seat. (R took off on Wednesday to take care of me, and I really don't want him taking any more time off because of this shit.) Then they expect me to just hang out in the waiting room for God knows how long....with a full bladder?? Not only is it excruciating at this point to have even a moderately full bladder, did I also mention that I can't sit or stand for more than about 2 minutes without feeling acute pain radiating across my right lower abdomen?? There is simply no physical way I can do this. My plan is to march (hobble) in there, tell the receptionist that I'm in major pain, and I simply cannot sit in their waiting room. I'll give her my cell phone number, tell her that I'll be laying in the back seat of the car, and to call me when they are ready to take me. The time it takes to get to the car from the office will be bad enough.

I'm so exhausted from this pain, and so tired of laying, squirming, tossing, turning, in bed. If nothing else, this kind of thing really makes you appreciate having a normal pain-free life. I should count my blessings every single day! I'm so aware right now of things I usually take totally for granted.

I think the worst thought though, that keeps creeping into my mind, is that after all of this, if this doesn't work?....Ugh, what a nightmare it will be to know that we have all of this to look forward to with IUI#2...

Tuesday, April 24, 2007

Is it time to pee on a stick yet??

So, I had my first IUI on Sunday morning! It was quite exciting! Actually, the IUI part was rather anti-climactic, if you ask me. Especially given how much of a pain and a production the follicle reduction was. Apparently, a follicle reduction in an IUI cycle is the exact same thing as an egg retrieval in an IVF cycle - except, in an IVF cycle, they keep the eggs, in a follicle reduction, they don't. Who knew? Not me. I thought the nurse was going a bit overboard when she called in a prescription for me for valium, and told me to take it 15 minutes before my appointment time.

Before I go any further I should probably warn you: if you are a first time IVFer, or are like my good friend Kellie who hates the idea of surgery/procedures, etc., or if you just don't want to hear about painful stuff, (then why are you reading an infertility blog, hardy har har) then you should probably just skip the next paragraph...

Yeah, so I was totally, TOTALLY unprepared for the pain involved in the follicle reduction procedure. When they told me that I would be sedated for the procedure, I thought that meant I'd be out. As in, OUT. Asleep. NOT awake or aware. Um, yeaaaah...not so much. When the nurse had me all prepped in the "procedure room"(not quite an OR, but neither as casual as an exam room), IV inserted, good drugs dripping into my arm making me feel like I'd had 6 vodka tonics on an empty stomach, oxygen mask over my nose, legs akimbo resting on weird bent-knee-holders instead of stirrups, (and I should have been really nervous when she TAPED my legs to the leg holder thingys) and the cast of doctors and nurses gowned and masked and gloved and ready to go.....all of sudden I thought - hey, I'm not asleep! I'm still aware! I feel like I'm completely bombed out of my gourd, but I'm still, you know, present and in control of most of my faculties! So I said to the nurse, "Hey, I think I need more drugs!" And she said, "Why?" And I said, "Because I'm still talking to you!" And she said, "Don't worry, you won't remember a thing!" And I distinctly remember thinking, "Oh SHIT. They have no intention of putting me to sleep!!" So, yeah, the doctor took out (sucked out? aspirated??) 10 follicles. And although I was really, really out of it, I felt the needle each and every time. I think I had my eyes closed the whole time, but I kept crying out, and the nurse kept telling me to shush and try to relax. Yeah right! It just seemed in my drug addled brain that it went on and on forever. Round about number 6, I asked if we could take a break, because I didn't think I could stand it. I'm telling you it hurt like a motherfucker. I heard Dr. G say, "Just hold on K, we're almost there, we're almost there..." Dear GOD.

So, ANYWAY, after all that, I was helped into a wheelchair, and then they took me back to an exam room. They had me lie there for about 40 minutes while the drugs wore off, and I think I slept most of that time. They made me drink some juice, I think, too. Then, when the nurse finally came in to do the actual insemination it took all of about 45 seconds, and I said, "That's IT?" I kept waiting for it to hurt! She was in and out before I even knew what was happening!

Dr. G came in a little while later, and the first thing he asked me was if I remembered anything from the procedure? I looked at him a little incredulously and said, "Um, yes. I remember that it was painful!!!" He sort of laughed conspiratorially and then told me that he had taken out 10 follicles, and left 3. He said that he could tell I was probably going to experience some mild hyperstimulation symptoms. He said my ovaries were very enlarged, but not to the point that he was overly concerned. However, he said that they might get larger over the next two weeks. He also said that if I do end up getting pregnant this cycle, the OHS symptoms will worsen for several weeks before they get better! Conversely, if I don't get pregnant, the symptoms should dissipate pretty quickly. Bummer, huh? Whatever, I'll endure any amount of pain if it brings me closer to bringing home a baby!

So, indeed, the OHS symptoms have worsened since Sunday. This morning I could literally barely walk when I got out of bed. It hurts if I let my bladder get full, and it hurts worse when I sit down to pee (it also hurts me to write that word: pee. My mother taught me that was a vulgar word, and we've always used the euphemism 'tinkle'. However, that seemed a trifle silly, having dropped the F bomb just a couple paragraphs up...) After I empty my bladder there is much relief, but actually emptying it is a Herculean feat. I'm the world's WORST baby when it comes to pain, so I've taken to moaning as I hobble around. I thought I was alone in the bathroom at work yesterday, and indulged myself in some oohs and aahs of pain before settling down and peeing, already. Too late, I realized there was another occupant in the far stall. I can scarcely imagine what she thought I was doing in there. But, I drew up my feet under me lest I should be identified by my shoes, and waited until she left before exiting. HA!

So, I've decided my strategy for enduring the 2WW will be to pee on a stick early and often, so that I will know when the HCG trigger shot is out of my system, and hence I will not be led into false exhilaration at a fake-me-out positive HPT. I tested on Sunday after I got home from the IUI, and of course, got a line. Not a dark one though, which surprised me. I tested again today and didn't get a line. So, I wonder if that means that detectable levels of HCG are out of my system?? It seems rather early - don't they usually say that the trigger stays in your system for 6-10 days? I took it on Friday, so it's only been 4 days? No matter. No amount of self-talk will prevent me from peeing on sticks at every imaginable opportunity. So, I'll do it again tomorrow and see what I get - maybe today was a fluke, and the trigger will turn tomorrow's test positive, you never know. And yes, now that you ask - HPTs DO grow on trees! Why, I have a lovely First Response tree just outside my kitchen window....

Thursday, April 19, 2007

Ovaries in overdrive

I still can't believe this is happening! Went in for monitoring again this morning, and suddenly my wizened old ovaries fancy themselves overachievers of the highest order. Yesterday morning I had one follicle at 21mm. This morning I have NINE over 20 - some up to 23mm. And don't forget the 16 or so hovering in the 17-19mm range. YIKES!

Dr. D called a few minutes ago to confirm that although octuplets might make the record books, we won't be taking the chance. Instead, he'll perform a follicle reduction before insemination, limiting me to only 3 eggs. Even that makes me nervous. I'm definitely NOT one of those people who says, "Oh gee, wouldn't it be nice to have twins and just get all of this pregnancy stuff out of the way with one fell swoop?!" Nuh-uh, not me. I've SEEN people pregnant with twins, I've TRIED to talk to mothers of twin babies when both kids were squalling and demanding attention simultaneously, I've WITNESSED the chaos, and I say, gimme a singleton pregnancy any day of the week and twice on Sunday...that is to say... well, you know what I mean.

Anyway the plan is to trigger at 11:30pm tomorrow night. Then bright and early on Sunday morning R will make his deposit, and they'll put me under for the follicle reduction. The nurse said that they'll go ahead and do the insemination while I'm still out of it. She said this like it was a good thing. Am I to surmise that the insemination procedure is not pleasant? I had the cervical culture and mock-insemination done, way back in the Mesozoic era, before I started this cycle. I didn't find it particularly uncomfortable? But maybe there's something about the real thing that is worse than the run-through??

Ever since yesterday, I have felt like there was a warm ray of light shining down on the top of my head. I cannot express how thankful and grateful I feel right now for this opportunity. This will be, literally, the first and only chance that R and I have had to create a child since we married 2 years and 6 months ago. Isn't that a kick in the pants?

Wednesday, April 18, 2007

Updated: Follicles a go-go

To say that I'm pleasantly surprised is a gross understatement. This morning was my last hurrah with Dr. D. I'm down to the last of my drug supply. If this morning's scan had shown the same old status quo with my unresponsive ovaries, the plan was to cease and desist, rather than continue throwing good money after bad. The next step of the plan wasn't to occur until mid-May, when I have a consultation appointment scheduled for a second opinion with another doctor at a different clinic.

To my utter amazement, this morning's ultrasound revealed that the drugs have finally worked. My follicles have been in the 6-10 mm range for over 60 days, but they've now moved on up to the big time, several clocking in at the 16 through 19 mm range, and even one at 20!!!!!!!!!!!!!!!!

I. Can't. Believe it!

Today, for the first time the wanding was reeeaaallly uncomfortable, and for the first time, my left ovary was hiding behind my uterus. The RE had to really be aggressive to find it, and it was so uncomfortable that I was making little "ooh, ohh" noises from the uncomfortable-ness of it. It was worth it though, because that is where the 20mm chief follicle was hiding. RE said that was the threshold they looked for to indicate readiness to trigger. He also said that we'll have to monitor closely to see if the others try to catch up to Mr. Big. If there's a sudden burst of competition, I'll need to have the follicle reduction procedure to reduce the risk of high order multiples.

Bottom line is that trigger is imminent, and IUI is likely to happen sometime this weekend.

I know that several things could still go wrong from here. What if the trigger shot doesn't work? What if I don't ovulate in a timely fashion? What if my body can't seem to release the egg at all? What if, what if, what if?

You know what? I'm absolutely not worrying about any of that. Won't even let myself go down that path. La, la, la, la.....Right now, I'm giving my full concentration to being joyful and thankful that my ovaries are in fact, NOT completely unresponsive. This means that there is hope to try again after this. This means that this is not the end of the road. This means that my body cooperated and performed properly, and for that I wholeheartedly commend it.

I have been effusively thanking and congratulating my ovaries all morning, lest they should feel unappreciated and go on hiatus again.

The office will call me this afternoon to tell me whether I need to take my last 3 remaining doses of Follistim, and/or when to take the trigger shot. Be assured I shall update you as soon as I hear something!

Update: I have officially set my clinic's record of longest stim, at 65 consecutive days. R thinks I should get some kind of recognition for that, like my name on a plaque in the waiting room or something. The streak ends today, thank the good Lord above. Dr. D has decreed that no needles shall pierce my skin tonight. Drugless for tonight, then back tomorrow morning for one last wanding, to ensure there are still only one or two biggies. If all goes well, I'm back on the needle tomorrow night--- for the trigger! Woo hoo!!!

Friday, April 13, 2007

Black market drugs

Quick question: Has anyone heard of buying fertility meds from strangers via ads on the internet? Is it against the law? Is it a very common practice? I was searching for the best price for Follistim to buy my last fix, and I came across a "craigslist"-ish type website where individuals have posted ads describing all the meds they have leftover from cycles (both for positive and negative reasons, I assume) with prices far lower than you could get from any pharmacy. Although this seems inherently frightening and creepy to me, I must admit that part of me is intrigued- the price for the Follistim I need would be about a third of what I'd pay from the pharmacy. Have any of you heard of this? What are your thoughts?

Thursday, April 12, 2007

Getting a grip

Well, I'm happy to report that I'm slightly less unhinged than I was when I wrote my previous post on Tuesday night. I'm still very sad about the current state of affairs, but I've dragged myself sufficiently far - but not all the way - out of that deep dark hole to be able to string coherent thoughts together again.

My thoughts on adoption over the last few days run along very similar lines to Julie's most recent posts on "A Little Pregnant." (And I've also followed the ensuing flame-fest on Chicagomama's blog incited by Julie's posts...)

I have the same reservations about adoption, at least right now, that were expressed on ALP - to me, right now, it feels like a crappy second choice. It feels like settling for decidedly less than. (I understand that once you actually have an adopted child, you love that child no less, and possibly more, than anyone else loves their biological child. So please don't flame me to a crisp, I'm merely expressing my own personal fucked up FEELINGS here.)

The way I feel at this moment, I can't imagine how to get from there. Because here is bitterness, and anger, poor-me syndrome, and grief. I can't fathom how I will get through these feelings of loss - grieving the inability to have a house full of children with my hair and my husband's eyes and my grandmother's nose, grieving the missed experiences of carrying a child inside of me and feeling it kick for the first time, etc., grieving the missed experiences of saying yes, I'm due in 3 months! and giving birth, and breast feeding, and listening to friends and family argue over whether the baby looks more like me, or R, or Aunt Polly? How do I get from feeling like this shriveled up, bitter, jaded a place where I'm approaching adoption with a positive, excited, this-is-definitely-the-path-for-us attitude?

R is absolutely amazing, that's at least one thing I know for sure. I've endeavored over the last few days to try to concentrate on how colossally blessed I am to spend the rest of my life with this astounding man. When I called him, hiccupping and sobbing after my appointment on Tuesday, the first thing he said, after, "I'm so sorry baby", was something quite positive. He said maybe this is for the best - maybe now we can put the infertility treatment behind us, put all these little accumulating disapointments to rest, and focus on something that has a 100% chance of having a positive outcome. He said that he has prayed over and over again about a positive outcome for our infertility struggle - BUT, that he has never prayed specifically for me to be pregnant. Rather, he said, he's prayed for us to find the path and the way to our family that is meant for us. So, he said, maybe this is finally a nudge onto OUR path?

He seems much less conflicted than I. He said something yesterday that summed up his feelings, very simply: He wants a family, he wants to be a father. We can't get pregnant. Therefore, we will adopt. Simple as that. He's looking forward to the joys of being parents, of having children running around in our house. Having children in our lives is more important to him than the process by which they will come to us.

I feel like I have to get to that same point, to feel that same way, before I can really commit to the adoption process. Right now I have so many fears and doubts. Now - I have absolutely NO doubt that I, we, posess the capacity to love an adopted child as fiercely and passionately as I , we would love a biological child. But, I worry that adopted children would eventually resent that our desire to adopt them was, in itself, borne from a place of grief and loss?

An anonymous poster on ALP wrote,

"Please. Don't. It made my heart sink to read this post. Let someone else adopt the baby you are feeling so ambivilent about. Only children do not die from onlieness. I just can't imagine how gut wrenchingly awful it would be for you to adopt a child and have this child later in life discover these archives. Please. Don't. Step away from the application now." (italics mine)

I get that - even as I write this post I think - we'll never tell our future adopted children the details of this struggle, and I must destroy all evidence of this blog lest they should find it someday and feel they were our second choice! I guess I just don't know how to reconcile that.

Other than emotional ambivalence and lack of moral fortitude where the theory of adoption is other concerns for the immediate time being are that I feel completely emotionally drained and physically exhausted. I've come to the conclusion in the last couple of days that I have to move forward with little shuffling baby steps.

Yesterday I decided that I had to make an appointment for a second opinion with another fertility clinic in this area. If I didn't, I might always look back and wonder, what if? However, I simply couldn't face the visualization of starting over at a new clinic - staring down the months ahead filled with more tests, then more ultrasounds, more shots, more hoping, hoping, hoping, and most of all, more disapointments mounting up and and up and up. So I told myself, all I have to do today is pick up this phone and call to make an appointment. That's all. I don't even have to think about what comes after that point. Just make the appointment, and don't think any further. So, I accomplished that. I have an appointment on May 15 with a well respected doctor at the largest fertility clinic in the metro DC area.

As far as adoption goes, I made phone calls and sent emails yesterday to several former co-workers who have made the journey from failed infertility treatments to the adoption process. I asked them for a quick overview on all things adoption, as well as advice on the emotional component. I asked them if they felt these reservations, and doubts, and like Julie on ALP also asked on her blog - I asked them if those doubts fell away the further they went into the process. I was trying to find out if it's OK to at least start the process feeling this way?

Both of the women I was able to get in touch with yesterday said that they felt exactly the same way. One woman, in particular, said it took a whole year for her to gain the excitement she now feels about her impending adoption of a son from Russia. She now wishes that she hadn't waited so long to begin the copious and time consuming research necessary to even begin the adoption process. She wishes that she hadn't wallowed in self pity and jealously for as long as she allowed herself to do. Like everything else related to infertility, time is never on your side. She warned that if we decide to consider international adoption, many countries have age limits over which they will not allow you to adopt infants. If we want to consider domestic adoption, she cautioned that most agencies will tell you that if you are an older couple, you'll have a lesser chance of having a birth mother pick you, regardless of your financial stability or effervescent personalities.

So, baby steps. I've decided to begin researching the idea. The theory of adopting a child. What information does one need? How does one prepare? What is necessary? In this way, I hope to be able to collect all the information that we'll eventually need in order to consider and commit, but in a sidelong, oblique sort of way that doesn't require commitment up front.

Maybe, as I go along, some of my doubts and reservations will begin to fall away. Maybe one day I'll wake up and feel in my heart that this IS our path.

I'm certainly not naiive enough to believe that I'll be able to work through all the pain of infertility, all the grief, all the loss, all the anger, in some proscribed period of time, and just be a clean, blank slate ready to begin the adoption process. I think like anything else on this protracted journey to parenthood, it will necessarily be a progressive progress. So I think the only way to begin is just to....start. Start learning about it, and see what happens as we go. This approach is very much against my nature, but I think it's the only way I can get through this.

In the meantime, as aforementioned, we've decided to continue the meds at least until the drugs I've already paid for are depleted. At that point, we'll have to decide whether to shell out for more drugs. This worries me, for two reasons: inasmuch as I've told myself over and over again that this is a futile effort, and I should under NO circumstances allow a positive thought to enter my mind.....somewhere deep down I still have a vision in my mind's eye of the impending wanding session on Saturday morning - that Dr. D will break out into a wide grin and say, "Well waddya know about that - some progress at long last!" And I'll call R, crying from the parking lot, but this time crying with relief. I try to banish these thoughts, because it will be soooo much easier on Saturday to hear the familiar refrain of resistant and inactive ovaries, if I've already convinced myself that bad news is the only news I'll get. But, to no avail. Hope continues to creep in, unbidden.

And finally, what about the crack factor? No, no, I'm far too practiced a stirrup jockey to be concerned about the ubiquitous paper sheet and it's inherent coverage-related shortcomings. I'm talking about the impulse that I KNOW I'll have, even after Dr. D looks at me morosely from between the stirrups on Saturday and shakes his head in resignation, to say....OK, how about just one more shipment of drugs? Just one more week? One more week of doses, and then I promise I'll quit these fucking hormone shots. One more hit? Please, Dr. D, can't we go up to 225 IUS a night? That's just a little more than 200ius, but what if that will make the difference? What if my ovaries are holding out for the extra large, super value meal sized dose? Let's just give them one more chance, waddya say? Uuuggghhh... it makes me feel PATHETIC already!!!!!

Tuesday, April 10, 2007

Down in a hole...

I've heard some of you describe it that way, when you've received bad news about another failed cycle, or a canceled course of treatment, or some other setback on this journey. That is a perfect description of how I feel today. Let me endeavor to bring you up to speed:

Last week I ordered another batch of drugs, and when it arrived on my doorstep the invoice indicated my credit card had been charged for more than $700, instead of the $50 co-pay I had expected. Further investigation revealed that I had exceeded the calendar year limit imposed on infertility prescription drug coverage by my insurance provider. I quickly calculated that regular out-of-pocket costs for my current consumption of Follistim and Menopur would cost me almost $1300 per week. That's expensive even for someone with normal functioning ovaries, who might be on the drugs for a week or maybe two. For someone who's now been taking daily injections for 60+ days, it's a bloody fortune, and a luxury I knew I couldn't afford to keep up.

So, I despaired and cried and screamed and generally felt, by turns, immensely sorry for myself, royally pissed off at my insurance company for hiding this calendar year limit in the fine print, outraged with my ovaries for their stupefying laziness, and then sorry for myself again, around and around we go, etc.

I made an appointment for this morning to meet with my RE. I wanted to impress upon him that if my husband and I were going to have to borrow money to finance our treatment, that I wanted to be sure it was the most aggressive form of treatment, the wisest use of our precious funds. I wanted, in my innocence, to announce that I was ready to move on to IVF, please, and don't spare the horses.

In the comfortable leather chair of my RE's office, after delivering the above rehearsed speech, I took a breath, and braced myself for what I thought would be a lecture on the fickle nature of polycystic ovaries. I was expecting admonishments from Dr. D that just as he could not predict how quickly I'd respond to IUI doses of gonadotropins, neither could be predict my response in an IVF protocol, and that I could expect to spend just as much money on drugs in this next, and final, level of treatment. That we could convert this long and laborious IUI cycle to an IVF cycle, but that even with larger doses of drugs, we couldn't expect my ovaries to respond overnight, and that I'd have to continue to be patient.

What I got instead left me breathless, and savagely biting the inside of my bottom lip to keep from breaking down in front of my RE: "K, I'm sorry to have to tell you this, but I really think it might be time for you and R to start considering adoption."

Basically, he thinks that I have unresponsive ovaries. He said he had seen a handful of cases of ovaries as resistant as mine in his 27 years in reproductive endocrinology, but they have been few and far between. Based on past experience, he would be willing to continue attempting ovulation induction with gonadotropin therapy, but he doesn't really have a lot of hope that it will work. It should have worked already, and the longer it doesn't work, the more bleak the probability of eventual success.

Dr. D said that for what it was worth, before I made this appointment, he hadn't been ready to quit just yet. If money weren't an issue, he'd have recommended continuing for at least another 2 or 3 weeks before throwing in the towel - but, it's now up to me and R to decide. We agreed that I'd continue at least until the drugs I've already purchased are depleted. That gives me about another week. At that point, R and I will have to decide whether to spend another $1400 for one more week....or quit.

Needless to say, I have been a complete wreck today. I came home after my appointment this morning, opting to work from home rather than drag my swollen and bloodshot self into my office. There's not a tear left in me right now. Neither is there the energy required to go into all of the labyrinthine thought trails I've been down today in my head - and with my husband - about adoption, mourning the loss of a biological child, the wisdom (and fortitude) to seek a second opinion, etc. etc. etc.

I'll be back tomorrow to get all of that out, and perhaps more. Right now, I feel like I've been run over by a truck. I'm sadder and more devoid of hope than I can ever recall feeling since my father died when I was 17 years old. So, I'm going to bed.

Thursday, April 5, 2007

I'll have a decaf Follistim latte please...the regular kind might make me HYPER.

Good morning girls -

Thanks for the well wishes from Monday's post. Monitoring this morning went as usual: nothing much happening, still.

After the initial wanding confirmed my suspicion of continued inactivity, I asked Dr. G (who was doing the scans this AM instead of Dr. D, my usual doctor), a question: If they can perform a fabulous follicle reduction in the event I produce too many follicles, then why in the name of all that is holy can't we get this show on the road already?? Why can't we just blast my frick frackin' ovaries with hideous amounts of drugs to spur them into some kind of action?????? (OK, no, you're right, I didn't ask the question exactly like that, I was far more controlled and respectful, I assure you.)

Dr. G said that the reasons we can't do that are twofold: with higher doses of FSH, my ovaries are likely to become quite enlarged. The poor fallopian tubes then, end up stretching waaaay out to reach the monster-sized ovaries in order to perform their job as catchers and get ready to grab whatever's going to come out of them. Sometimes this creates a crappy situation for the F-tubes where they basically miss. Obviously, that would make it pretty difficult for the sperm, exquisitely deposited through well placed catheter though it may be, to reach the egg.

The other reason, he said, is that lucky ladies like me who have PCOS, and are receiving higher doses of drugs, are highly prone to ovarian hyperstimulation. Imagine, he said, that I were to produce 18 big ripe follicles. My body would be cranking out estrogen like crazy, and even if they went in and sucked out 15 of those follicles before trigger, it's unlikely my body would be tricked into immediately reducing the full court press of estrogen. Hence, I'd be suffering from ovarian hyperstimulation with no relief in sight, save canceling and popping BCPs till the cows came home.

He also added that in the above described scenario, even if it wasn't a dangerous enough level of hyperstimulation to warrant canceling the whole shabang (which - chances are it would be), that if I somehow, against the odds, became pregnant in that state - that I'd be (gesturing to indicate general humongous-ness) "...out to HERE and absolutely MISERABLE."


SO, they'll call me this afternoon to tell me what to do as far as drugs are concerned. I suspect it will be another four days of Follistim and Menopur. I can't help wondering how long they'll continue this endless low-level stimulation, until they'll throw up their hands in defeat and declare me a non-responder? This can't go on indefinitely, of that I'm certain. It just doesn't seem healthy?

Monday, April 2, 2007

Reduction in Force?

Hey y'all -

It's been a few days...but because my ovaries were up to their usual level of staggering inactivity, I had no progress to post.

Sunday's appointment was slightly more noteworthy, unfortunately not in an overly positive way. Sunday was day 50 of daily stim injections for me, and suffice to say that the RE was none too pleased with my lazy-ass ovaries.

Here, yet another excerpt from our over-the-stirrups conversation:

RE: "K, there's still nothing happening in here, and I'm worried. Your ovaries are just completely loaded with follicles, but none of them are responding to these meds. They are all still around 6-8mm, and that is not a good sign."

Me: "I know. I've been giving them pep talks every night, but they clearly have a problem with authority."

RE: "You have what I call SCARY ovaries. IF you do eventually respond to the meds, and IF ALL of those follicles develop, we'd have a nightmare on our hands. We couldn't risk triggering with that many mature follicles, it would be very irresponsible."

Me: "I understand. So what now?"

RE: "Well, understand K - I'm not saying that you should give up.........yet."

Me: "Ahem! Ffflugh, hughhh! Ahem!" (Yet???!?!?!?!)

RE: "I can give you more drugs, of course, but the risk is that all those follicles will mature simultaneously. If they do, there is a procedure that I can perform before triggering you, which is called a follicle reduction. You'd be sedated for the procedure, and we'd insert a needle into your ovaries and remove all the "extra" follicles, leaving you with a nice, safe, 2 or 3."

Me: slightly less pale now, "OK."

RE: "So, do you have any thoughts about this? What are you thinking you want to do at this point?"

Me: (stifling the urge to scream like a banshee), "Ummm, well, I'd like to PROCEED." What's the alternative doc? Go sit in a corner and RELAX until my ovaries decide to get off their sorry asses and work for a change, all on their own????

RE: "OK then, I'm going to leave you on 150ius of Follistim for the next 4 days, but we're also going to add Menopur to your daily routine. You'll take 75ius of Menopur, in addition to the Follistim, for the next four days."

Me: "OK, so ummm, because I have all these tons of follicles - does this mean that I'm a better IVF candidate than IUI candidate?"

RE: (literally stepping back in his haste to rein in my over zealousness, and holding up a hand palm out, traffic cop style), "Well now, I've never said I thought you were a good candidate for IVF. We're not even ready to talk about that yet. I mean, no eggs, no baby. No eggs, no IVF, you know? We don't even know if you can successfully produce eggs yet, there's no way we can even start talking IVF until we know the answer to that question."

Me: (doubled over with wind knocked out of me), "Oh. OK."

I've been ruminating on this exchange ever since. I feel like Dr. D stole my trump card. I guess I've always felt like IVF was in my back pocket as our Plan B, fall-back, pull out the big guns, save the baddest for last, last resort option - my IF safety blanket, if you will.

I lost a whole lot of optimism at that appointment on Sunday. I had never allowed myself to consider the possibility that maybe my ovaries COULDN'T make eggs. I had just always supposed that it was a matter of the right drugs - albeit possibly the right combination of drugs, and the right timing. Walking out to my car I suddenly had the urge to smack my forehead, V-8 style - How foolish, this foregone supposition of ovarian ability!! Jesus, K, really, you should be so fucking lucky!

Now I'm scared to death that on Thursday at my next monitoring appointment, Dr. D will take one swipe with the wand and declare me a lost cause. "Nope, nothing happening in there, this is a case only St. Jude can help with!"

We're hosting Easter at our house on Sunday, so I'm trying to concentrate on preparing for that this week instead of dwelling on these fears, but, well, y'all know how it is.....

On a lighter note, speaking of Easter, I went bananas this weekend and bought 6 dozen colorful, fillable, plastic know, the kind you use for hiding? I'm planning an Easter Egg Hunt for my nieces and nephews when the family comes over on Sunday. After filling 6 dozen eggs with all manner of miniature chocolate bunnies, jellybeans, marshmallow eggs, and pastel foil covered Hershey Kisses.....I found out that only THREE kids are going to be in attendance on Sunday. Ack! My sisters-in-law are all going to kill me when their kids go home with 24 eggs full of candy, each! Oh well! I also saw on the news this morning that they're expecting it will be around 40 degrees on Easter Sunday, so we'll all be wearing our winter coats to church! Bah!And who wants to hunt for eggs when it's that cold outside? Actually, KIDS, that's who. I suspect it could probably be blizzard-ing, and they'd still be clawing each other and scrambling through the front door to get out there and find that candy!!! I LOVE Easter, and I can't wait for Sunday!