Aftermath

I'm still not quite right from an emotional standpoint after this cycle. I vacillate between feeling numb, angry, and extremely sad. It took so much out of me to do this cycle. I was on freaking BCPs for 5 weeks before this cycle...I could have cycled within a cycle for how long it took to get to this cycle. And now I have to wait 4 to 6 weeks to heal from my sclerotherapy before I can go onto another cycle? I spend more time waiting than anything else. I just hope that the sclerotherapy took. I'm still having pain in the right ovary, the one that had the three endometriomas. Maybe it's residual pain from the procedure. I'm going to ask for a follow up U/S at 2 weeks post sclero to verify that the cysts are gone. I'm on deproprovera tabs for two weeks so that my AF will come on time. My ovaries should be nice and quiet the next two weeks. If they're not, I'll know that something's amiss.

I emailed Dr. Italian after my dismal retrieval...I asked if we could please test my hCG levels to see if it the levels that remained would be considered normal for how many hours I was past trigger. I just can't understand why this cycle didn't work. At all. The geek scientist in me wants, NEEDS, to know WHY. I want closure.

So I went to the clinic at 11AM today, precisely 3.5 days after trigger and had them draw my blood. There's a normal range for how much hCG is left in your body after trigger given the known half-life of hCG. This excellent article, "Bioavailability of hCG after intramuscular or subcutaneous injection in obese and non-obese women" demonstrates the declining normal ranges over time.

I had my blood drawn at precisely 84 hours after trigger (3.5 days). The value, if normal, should have been around 100. It was 110.

So the quality of the hCG was fine. The injection site (my upper arm) was fine. What I am thinking at this point (and a number of you readers have echoed this point) is that I triggered way too early.

My lead follicle was 18mm the day before I triggered. It should probably have been more like 22mm, which would have given the stragglers more time to catch up. I guess my question now is why he didn't have me take couple days of of Gonal-F and ganirelex and then come in for another U/S?

Grrrr.

At least it makes sense now. I know what to be angry about and that helps tremendously.

Crash and BurnWith Added Paranormal Kids Flava?

Retrieval was today.

4 follicles. 1 immature follicle retrieved.

I have nothing. NOTHING! Nothing to fertilize.

How can this be? I had a 18mm follicle two days ago. There is nothing about that follicle that could remotely be considered "immature".

How could this cycle have gone so wrong? I just don't understand it. The only things that were different were that I took resveratrol/pycnogenol and I took my HCG trigger in the arm (rather than the hip).

That the largest follicle wasn't mature (and three didn't detach from the follicle wall) tells me that there must have been something wrong with the HCG trigger. What else could it be?

Anyone know what sorts of things cause follicles to just not mature?

I'm having a very hard time emotionally with this failure. The last one was bad...but to have nothing is just heartbreaking. At least with my first failures, I had my ex to lean on. A shoulder to cry on.

This time 'round, I'm on my own, despite that I have an uninvolved partner who doesn't want further children beyond the three he already has. Hence, the DS. He's being terribly detached, hasn't checked in on me once to see if I am OK physically or emotionally. Not once. He didn't even ask how it went when he picked me up from the clinic. I'm stunned. Shocked. Hurt.

I can't express how utterly alone I feel right now. I'm going to become dehydrated if I don't stop crying soon.

On the bright side (AS IF there could be one today), the sclerotherapy on my ovaries was a successful procedure. So the anesthesia went to a good use. Dr. Italian removed 3 endometriomas on my right ovary and 1 on my left. He said that the one on my left gave him a bit of trouble and that he had to "break it up" to get it out. Ick, ick, ick. I don't even want to know what that truly means in terms of process.

I've been put on best rest for the rest of the day as my empty endometriomas were pumped full of a tetracycline solution and they'll slowly absorb over the next few days. I'm not to be "jostled" by the kids...so no jumping on me, crashing into me, etc. No small feat for these guys to be THAT well behaved. Seriously.

Dr. Italian wrote me a Rx for DepoProvera tablets that I'll take orally for 14 days then my period will start like clockwork the day after Christmas or the day after that. When that happens we'll do a follicle check on CD3, E2 test, and we'll see if things look good enough to start cycle #6.

I asked him about doing an "agonist antagonist conversion protocol" next cycle and he said that we could do it. I'd need to get a progesterone test on CD21 and if it was high enough I'd start lupron.

Scary thing is that I will probably be in Zurich, Switzerland at that time...so how the hell I'll get a progesterone test done remotely, and in a foreign country, is utterly beyond me. I'm sure I can get a test done, it's just that hopefully the test results are in English and in units that Dr. Italian can convert from.

But back to today...and what happened after we left the clinic.

After he picked me up from the clinic we drove back home across the river and headed out for brunch. My treat since he had to sit in wretched traffic in the tunnel to get to me. I explained to the kids the rule about not crashing into me. Out of the blue, the older kid said aloud, "She had an operation and she's never going to have a baby. She can't have any children EVER!!!" (Paraphrasing). He kept going on and on about how I would never have children. Mind you, he's 5. I'd have backslaped him if he was a teenager. I turned to his father, holding back tears as best I could, and asked, "Did you guys have a conversation about this before you came to get me or what?" and he said "NO!". Talk about hitting me with the lowest blow I could have ever had. Ouch. And where the hell did he get such an idea? They have no idea I am trying to get pregnant whatsoever. It's just not talked about at all when they are around. Their dad finally told the older boy to "shut up", sensing that it had me on the verge of total freakout. What the hell got into him, I have no idea.

Even weirder. The little one (also a boy), who is four and I am completely bonded to, wants to be a girl when he "grows up" (because, in his words, "girls are nice"). He has this alter ego named "Sophie" that he likes to assume. He'll put my curtain drawback cords on his head, for hair, (they're silky rope with long silky tassels) and then morph into Sophie. What's sorta strange is that Sophie is the name I'd give to my daughter if I ever had one (actually Sophia, but Sophie for short). I was almost named Sophie by my mother so it has a soft spot in my heart. I told him one day, "If I ever had a little girl, I'd name her Sophie, too!" Then, just last night, at dinner, he turned to me, out of the blue, and said very matter of factly, "Maybe you'll get to be Sophie's mother."

Eerie.

What's with these kids?

Back to my box of kleenex. :-(

Trigger Day

Yesterday's E2 = 750

Wow, nearly doubled. Lab error or what? Hmm...

There are four follicles. One's ready to go at 18, the other three are all under 15. I forget the values but there's a chance that two MIGHT be big enough at trigger. I sorta doubt the 4th will make it at all.

So 1 for sure. Maybe 2 or 3 if we're lucky. And if we get 4, I'm heading out to buy a lottery ticket.

I had to take the S/O's two kids (4 and 5) to the appointment. Ugh. They behaved horribly...huge mistake. I felt bad for everyone. Whereas the nurses had previously said it was OK to bring them and that they'd watch them while I had my U/S, at some point it was clear that the offer had been revoked and that I'd have to bring them into my exam.

The kids have known me since the day they were born, they walk in on me while I'm going to the bathroom or bathing. They've seen me naked. But having them in there while the blessed dildo cam is out and about was unnerving. Luckily they were positioned behind me in such a way that they could only see the U/S screen. Whew.

All I know is that I'll never do that again. Ever.

Triggering tonight at 11pm with 10,000iu of HCG in the shoulder (oww!!). WTF is up with the shoulder? They said that they've found it absorbs better in the shoulder. Really? Wow.

Sorta feels like a bit of a waste to be moving forward considering how bad it all is, but there's so little time left. Canceling a cycle now, no matter how bad almost feels sacrilegious.

Stim Day 8

Just got yesterday's lab tests:

Prolactin: 11.4 (down from 14 in October)
E2: 397

I don't remember how to calculate E2. This seems low to me though. :(

Did one shot of ganirelex last night and another this AM per instructions. Still feeling laden with my swelling ovaries, but less so than yesterday.

I so bet I am losing my follicles again.

I'm back at the clinic tomorrow for monitoring U/S #2. I have to take the boyfriend's kids with me this time as they were little terrors at his office yesterday. I hope that the other patients don't hate me for bringing them in.

Stim Day 7Cycle Going Bad

Today was my first monitoring U/S with Dr. Italian. The results were dismal.

One large 18mm follicle on the left side, two or three smaller (12mm, 9mm, etc). And NOTHING on the right side save for a few endometriomas.

It's bad. Real bad. It's my fucking age and it's also the endometriomas. But it might also be that I'm on 600iu of Gonal-F which is more than I've ever been on so I might be overstimmed. I get my E2 & prolactin results tomorrow. If we're over 3000 on the E2 then we KNOW that I'm overstimmed. Prolactin was at 14 before I started stims. It'll be interesting to see where it is now. I've got an old bottle of bromocriptine in the armoire that I can pull out if necessary.

So he said that I don't really have time to be choosy about cycles at my age (45) and that we should proceed with the cycle. I agree. If it weren't for the fact that I'm doing a sclerotherapy on my ovary during this retrieval, I'd cancel this cycle and try again in January. But doing the sclerotherapy means that I wouldn't have there wouldn't be enough time for my ovaries to heal between now and the January cohort anyways. I'd be looking at a February cycle date. So it's February for the next cycle no matter how we slice it. No pun intended.

So I'm reluctantly moving forward.

I don't expect a damned thing to be retrieved at this rate but what else can I do at this point?

Next time I'll reduce Gonal-F to 450iu on my own as I know that in my case, "less is more". I hate having to self-medicate but it really pisses me off when our RE's don't listen to us. After 5 actual IVF cycles, and many "tries" (ie, cancelled cycles) I KNOW better than any doctor how I am going to respond to the meds. I'll also be asking for hGH.

Last cycle I lost ALL of the follicles on my right ovary when I started taking the ganirelex. I wouldn't be surprised if it happens again and I lose them all this time.

All I know is that I want to pour myself a huge glass of red wine tonight and chalk it up to a failed cycle. It makes me so sad that a few years ago I was churning out 10 and 15 follicles/eggs a cycle.

Now THIS?

Fuck!!!!!

Stim Day 6

I read a few sources online that say that taking resveratrol and anticoagulants (NSAIDs and maybe things like lovenox, arixtra, etc) can increase the chance for bleeding.

I believe it.

I'm taking 250mg a day of reservatrol and 40mg of lovenox, and unlike previous cycles, I am bruising more than usual.

Tomorrow is my first monitoring ultrasound. I'm quite curious to see how large my follicles are.

Stim Day 5Feeling the Pain

Today's stim day 5 and my ovaries are aching and feeling laden. I'm still not convinced that 600iu of gonal-f a day is going to have me ready to trigger when I go in for my first monitoring u/s on Monday afternoon. I told the doc that 600iu was a lot for me and he didn't seem concerned at all. He ordered me 5 syringes of 250mg ganirelex, which I'm supposed to take at some point to keep from ovulating, but I suspect that I'll get in one shot on Monday evening and MAYBE, just MAYBE, a second shot on Tuesday.

My money is on my being ready to trigger on Monday and retrieving on Wednesday.

We're proceeding with the sclerotherapy on the endometriomas on my right ovary immediately after retrieval. They'll be taking two 250mg sterile vials of pure powdered tetracycline and rehydrating them with sterile saline (or other) ... they'll drain the blood from my endometriomas, refill with tetracycline solution, and then redrain near completely. Hopefully they'll heal while I'm in my 2ww and the two weeks following that.

I'm feeling terribly bloated and tender and I'm already looking forward to retrieval. It's hard doing two IVFs in rapid succession. I didn't get a chance to lose the weight from the last cycle and I'm just so incredibly uncomfortable. Also making me feel a bit icky is that yesterday I did an intralipid infusion at my hematologist's office which pumped 200ml of intralipids and 500ml of saline into me. Hmmm...no wonder I'm feeling a bit, plump?

Birthday Eve

AF is taking her time showing up in full force and I am quite happy about this. I was worried that Dr. Italian was going to be doing my baseline way too early and he was right: there's enough hormone in my body to trick things for a while.

Today's my last day at 44 - it's sort of an ominous birthday as many clinics will only let you cycle up til your 46th birthday. So I see it as my last year of trying for a child unless I find a clinic that will let me try with my own eggs.

I'm feeling fabulous after my iron infusions - I can't remember the last time I had so much energy, but this is great. If this doesn't help me get knocked up I'm not sure what will!

Ironies and Iron Levels

So I've been on BCPs since my last hysteroscopy, roughly five weeks according to my pill packs. I've bled the entire time without cease...and yesterday was my last BCP. Ironically, I stopped bleeding on the last day of my BCPs...and now I can look forward to....more bleeding as my AF starts.

Oy.

On iron levels, my ferritin values came back today.

461

When the doctor emailed me my values, I did a doubletake when I saw the number. 461? Or 46.1 and he forgot the decimal point. I emailed him and asked for clarification.

Nope. 461. High but not dangerously so and my values would fall over time as the Fe+ in the ferritin converted to hemoglobin in my RBCs. He cautioned that I shouldn't be taking any oral iron supplements. Yikes. I took 65mg of elemental iron each of the last two days, sort of panicked that my levels might be high enough! And 50mg for a few days prior to that.

Wow, I started off at 14. This was a huge spike!

So my irons levels are completely topped up. My last hemoglobin (or was it my hematocrit) was at 36.5 or so, just under the normal mark. With luck, I'll surpass 40 with my next blood test. :-) I am feeling quite perky with high energy levels. I've also noticed that my skin looks rosier, tauter. The bags under my eyes are a wee bit lighter but the upper eyelid skin is remarkably better (it was quite thin and crepey just a few weeks ago). I haven't changed my skincare regime but I have been taking shitloads of pycnogenol and resveratrol since early to mid September. Maybe these antioxidants are finally paying off in ways I hadn't expected? Or maybe the increased iron is helping to get more oxygen to my tissues? Who knows. I just look and feel better.

Well, save for the 10 pounds that slid on in the last month or two due to cycle #4's steroids and gonatropins, then 5 weeks of BCPs. And now I'm just about to start more stims and steroids. God. I hope I can get at least a few pounds off before the end of the year.

Key to the next week:

Yesterday: Last BCP
Tomorrow (Sat): Meds arrive
Sunday: I turn 45. F*ck. My last year of IVF begins.
Monday: Baseline U/S and Bloodwork. Start Stims.
Tuesday-Friday: In California
Friday: Intralipid Infusion

I have no idea when my first monitoring U/S is...oy! Don't you just love cycling by the seat of your pants?

Iron Infusion #4

Fourth iron infusion today. Nothing remarkable happened...just a bit of burning in my right hand where the iron was being dripped into. I'm not feeling hugely energetic or anything. I wonder how long it will be until I can feel some of the side effects of the iron infusion?

I'm still bleeding quite a bit from the BCPs - that hasn't let up and it seems to be getting heavier. I had a call with the RN from my new clinic yesterday to go over my cycle. She said for me to call her when my period starts once I stop taking BCPs on the 27th. I said, "I've been bleeding non stop for 5 weeks. How on earth am I going to know when my period arrives?!" She just didn't get it. So here's the schedule so far:

• 11-26 take last bcp
  
• 11-30 baseline u/s and bloodwork. start meds if all systems go. sperm is supposed to arrive today but I am going to defer delivery until 12-1 just in case the cycle is cancelled.
  
• 12-3 intralipid infusion
  
• 12-9 or 12-10 probable trigger
  
• 12-11 or 12/12 probably retrieval (add in sclerotherapy if I plan on freezing it all
  
• 5 day transfer OR freeze it all

I just wrote to Dr. Italian to find out why they are delaying my baseline til CD4. I think that it's an excessively large amount of time to wait and want to make sure that they realize how they're scheduling things. I don't have huge amounts of confidence in the RN I chatted with...another cycle of managing the managers I guess?

Forgetting CDs

Let's just skip what cycle day I'm on. I'm on BCPs, downregulating, so CDs are sort of a thing that doesn't really apply right now.

I'm supposed to hear from the clinic on Monday whether we'll be doing the sclerotherapy on my right ovary next week. I hope so. I want this to be done with so I can put my eye on the ball of another IVF cycle.

I feel so impatient, like a horse waiting to take off at a race. It's like that, waiting for an IVF cycle to begin. It always feels like time drags so slowly and that it takes forever for everything to fall into place, for the doctor to finally give the go ahead to start stims. I so hate this feeling. This waiting. It's like nothing else matters...time just needs to move faster so that I'm trying again. When I get into this frame of mind, I realize that I am too invested in this...everything else pales in my life. I get hyperfocused.

I dislike that.

I want to be able to go about my life without dwelling on the next cycle, when it starts, what it looks like, and how I get to it.

I think I am probably horrible to live with when I am this hyperfocused. Arrgh.

CD6Day After Surgery: Ranting About The East Coast

The doc wasn't able to do the sclerotherapy procedure on my right ovary as they weren't able to get the medication that they use in time. Apparently, the compounding pharmacy in St. Louis that packages the medication that I needed failed to renew their NY state licensing in time and so they're out of commission for another week to week and a half. Ugh.

All it is is pure tetracycline in a sterile vial - my doc would reconstitute it with sterile saline and use this to flush out my ovary once the blood had been aspirated away.

Amazing that there seems to only be ONE pharmacy in the entire blessed country that can do this. Ya know? I bet there are other pharmacies that can do this. Really. It's got to be an east coast madness thing. More on this later.

So they weren't able to do this procedure.

Upon waking up, the doctor said that they also didn't aspirate the cyst on my left ovary as it had already popped.

So, the last RE clinic (Columbia) had essentially postponed my cycle for NOTHING. NOTHING! I could have easily cycled right away. Damn!!! I have loved the doctors there and they have a top notch embryology lab, but it's just frustrating that they have a cookie cutter approach to IVF. Even my cycle was cookie cutter, using ganirelex on me when I am nearly 45. Ugh.

So he did the hysteroscopy, the only thing he COULD do considering the circumstances. He found some flimsy sorts of adhesions in my uterus, which he removed. I had some good cramping afterward and have bee spotting since then.

Bummer that I have to do another procedure the week of November 9th because of the pharmacy. That just bites.

So I am going to be doing cycle #5 in December unless I am able to get them to cycle me out of the December cohort. I am going to beg for that. Hopefully they'll relent and let me proceed earlier, but they do close for holidays so they wouldn't be able to monitor me during Thanksgiving as no one would be there. Maybe I could at least start my stims then and monitor right after the holiday?

We'll see.

It's so hard to be patient when I have so many damned setbacks like this.

Along the surrogate route, I placed an online ad for a gestational surrogate. Three gals have written so far. Wow. I'm a bit scared to go this route, but I am seriously considering this if I wind up getting the job that I am currently interviewing for. I can't afford a surrogate without a job that pays really well as it'll cost me at least $18K for her fees and, at most, another $6K for the attorney's fees to draw up a contract. Add in her travel fees and any other expenses and it's easy to imagine that a surrogate would cost me $30K. At least.

I would love to find a local surrogate to cut down on fees but also that I would simply want to be close by while she is pregnant - but chances of that are slim as you can't pay a surrogate in the state of New York. It's illegal here. Can you f*cking believe that? I simply don't understand why it's illegal for me to literally "rent" a woman's uterus in order to have a child. Also, why shouldn't she be able to provide this service for others? It's her body for cryin' out loud. Some women love to be pregnant and are thrilled to provide this service for others. It's their right to be able to do this! I don't understand our country's laws. We're so behind. We're in such a dark age when it comes to how we deal with fertility, the LGBT community, etc.

It's not illegal in the state of NY to have a compassionate surrogate (unpaid) so I have a few family members that I will ask to see if they might help. I am not hugely close to either side of my family, so asking one of them to help is very uncomfortable for me. Also, because I have immune issues that might be hereditary in nature, a family member might also have the same issues that would cause her to have repeated implantation failure as well.

Why can't the law realize that there are very good reasons for our need for paid gestational surrogates? We need access to women who are willing to do this for us who have had children of their own, or have been surrogates before - women with a proven ability to bear children. At least California doesn't have such silly laws. Paid surrogates are fine. Having the intended parents' names on the birth certificate is fine too. Sheesh.

I am so frustrated with all things east coast today. No offense to anyone who reads this on the east coast. But even the act of buying a bottle of wine in this blessed state (NJ) means that I have to hit up a "liquor store" in addition to a grocery store when I am out shopping. Same for NY, CT, and other surrounding states. The east coast is so puritanical. Anti anything that is outside of the box. State lobbyists say that allowing liquor sales inside stores will cause mom and pop stores, and wineries(!), to go out of business. Really? I don't think so. Opening up your market to new customers would increase sales. Multi level marketing. It's marketing 101 folks.

I've stopped being mad about this one - well almost. I just order my wine from California now and have it shipped here to NJ. Screw this stupid state and the horse it road in on. My dollars are going back to California where it is SANE.

CD4Day Before Surgery

So surgery is scheduled for tomorrow morning at 11am. I'm due to arrive half an hour early, empty stomach, sans contact lenses, jewelry, etc. The BF will pick me up in the car at some point to be determined.

They're going to aspirate the cyst on the left ovary, asprirate the endometrioma (chocolate cyst) and flush it with a tetracycline wash to assist it in healing, and then they are going to do an HSG to see if the fibroid that we partly dealt with in late July is in fact still behaving.

I'm still sorta stunned that it all came together as fast as it did.

I guess the fibroid is the limiting step. If it's still there, I'll continue with the cycle but I'll freeze everything and then head to SF in November to do the full blown surgery. I'll return and do another course of IVF or two, banking embryos as I go.

When I have enough, I'll do CGH testing to determine which are good and then I'll transfer those.

As a side note, I'm currently interviewing for a dream job in NYC right now and I am thinking that if I get it, it might make sense to go the gestational surrogate route rather than fight my immune system AND the stress of a new job.

I posted an add on one of the surrogate websites to see what I could get. If I could find a gal outside of an agency, willing to carry my embryos for $20K, I think I'd do it in a heartbeat. But NYC has rather inhospitable rules/laws with respect to surrogacy. Surrogate contracts that include compensation are not valid in the state. It seems that you need to look to the state in which the surrogate lives in order to determine which laws come into play. Here in the tri state area it gets confusing as there are many states in distance of each other. I live in NJ, but I will likely be working (and cycling) and delivering in NY. PA and CT are within two hours of me. They have their own rules and regulations. It gets confusing. I'm just now starting to seriously consider this route and it's daunting. Agencies and lawyers all want a cut of the action (ie, money) and that's just so incredibly frustrating when I've already spent a small fortune when I didn't have IVF coverage.

So, I am starting to feel that I might be at a crossroads...I will likely have to decide in the space of a week or so if I am going to get serious about a gestational surrogate.

CD2Busy Day of Busy Work

Got up at the crack of dawn to see Dr. Indian in the Big Apple. Two trains to get there and about a mile of walking. The place was pretty empty, luckily. They took my blood and put me into an exam room. Two of the docs that did my retrieval came in to do the U/S. I told them that I was having pain on the left side and suspected a cyst. They checked, and as I suspected from the nagging pain on my left side, I've got a good sized cyst on my good (left) ovary about 17.8mm large. Endometrioma on the right side.

Fuck.

Canceled again.

Just when I THOUGHT that I had things all planned out.

I decided to spend some time in the city and just wander and think. I treated myself to breakfast at Penelope over in Murray Hill and then spent some time browsing Kalyustan's (the mother of all spice shops) before heading home. My head must have been in the clouds over the U/S findings because I wound up taking the train to Hoboken rather than Jersey City. It was only a delay of 10 minutes or so, but I haven't done that in a long time.

Back at home, I quickly got on the phone and made a bunch of calls.

I followed up with my reproductive immunologist to see which drugs I should continue and which ones I should cease and to beg them to prescribe some hGH for my next cycle. I called the pharmacy and ordered 2 months of lovenox, to arrive on Wednesday. I made an appointment with the current RE to discuss what happened. I called the Persian doc in Palo Alto to see if there were any cancellations this week. (There weren't but my December 2nd surgery might get moved up to November 23rd). And lastly, I fired off an email to Dr. Italian in NYC to see if he would simply drain my cyst and let me cycle.

He replied right away.

YES.

He instructed me to get myself on BCPs ASAP and to call his office in the AM to schedule the procedure.

Thank you universe.

Finally something is going to happen that includes my trying again as soon as possible. I envision that this means my surgery with Dr. Persian will get postponed or, better yet, canceled due to pregnancy. Fingers crossed.

And...while I was out...Dr. Las Vegas telephoned me to tell me her hGH protocol and tell me that she's working on getting a letter to Dr. Persian.

Things are falling into place.

I hope.