The Slow Road to IVF

Ah, just when I begin to wrap my head around the idea of doing another honest-to-God IVF, we hit a few roadblocks, ironically put up by ourselves. 

It all started with that damn Clomid.

See, I had it all planned out.  We would do the Clom.id challenge in November, I would have my usual and customary 30 day cycle which would oh-so conveniently start at the beginning of the month and end at the end of the month, and so on through December and January. Then, at the beginning of February I would start popping those good old ovary-suppressing BCPs, maybe adding a little Lupron into the mix if Dr. Salsa is feeling particularly saucy.  Then, I would start stimming in March and bob’s your uncle, I would have the retrieval and (hopefully) transfer by the end of March.  Perfect plan!  Mr. X had scheduled work travel around this plan. I had scheduled work travel around this plan. It was a thing of beauty.

Unfortunately, it was all based upon me having 30-day cycles, which is where the aforementioned evil Clomid must take credit for totally derailing the plans.  I popped the Clomid as directed, showed up for my date with the dildocam and then Mr. X and I got to the business at hand.  Two weeks later, I have a very light period, Dr. Salsa does a pregnancy test to rule out an ectopic (negative, thankfully), and I go on my merry charting way.  But, there is something underfoot. My temps are above coverline, when they had not been the entire two weeks after I ovulated.  Sure enough, 20 days in to the new cycle, Big Red shows up with a vengeance.  WTF. 

In addition to causing me a great deal of anxiety, frustration and teeth-knashing (not to mention huffing, puffing and glowering at my nether regions), this also has the extremely annoying side effect of moving my schedule for IVF up by three weeks.  Case in point: today is CD 30, my temp is precipitously flirting with the coverline and I had spotting this morning.  I’m pretty certain Big Red is around the corner, which means that CD 1 when I would start calculating the IVF schedule extraordinaire is now 21 days early!  Why is this a problem, you ask?  That pesky work travel.  From my (amatuer) calculations, I would probably start stimming right around when my travel is supposed to be.  Since I have had my travel on the books for several months now, I cannot in any way under any circumstances get out of it (nor do I want to. It’s a very important trip).   Considering the monitoring required, this is not ideal, but possibly doable. 

But then, there is Mr. X’s work travel. Bless his heart he did exactly as we had discussed.  We had planned that March would be the Big Month when it came to his required assistance because I figured I would be stimming in March, not February (damn you Clomid!). So, he scheduled a week-long business trip in another time zone at the end of February which is – yep, you guessed it – right around where I (again amatuerishly) calculate that we would have egg retrieval and his presence would be required.  Oy gevalt.

We have several choices. I can go on the BCPs now and we can see if the stims and retrieval can hit the appropriate windows when we are both in town.  Or, we can wait another cycle, meaning I wouldn’t start BCPs until mid-February (again, I’m assuimg a 30-day cycle, which I seem to be very capable of having if no extraneous hormones are introduced. We would be stimming from mid-March to the end of March with an egg retrieval around the end of March. 

Personally, I choose to wait another cycle because the stress of getting everything coordinated is so not worth the negative effects that stress would likely have on the entire process.  Of course, this is also dependent upon the schedule of the clinic.  The good news is that Mr. X’s travel schedule appears to be pretty flexible after February and I have no travel scheduled or even on the horizon.

Extra bonuses: another month to try to slip one past the goalie the old fashioned way, no traveling with needles, I can get some extra acupuncture in to help with egg quality and there would be no chance that I could miscarry in March!   

We will get it worked out. Someway, somehow. It will all fall into place. It always does.

image: markymarko

You Gotta Pay to Play

Back in August, on the immediate heels of my spectacularly failed and drama-infused FET, I gave about a milisecond’s thought to doing another IVF in the fall and immediately shivered the full-body shiver of revulsion.  I knew that while my body might be ready, the rest of me certainly was not.  The thought of walking away from Dr. Uterus had already started to germinate, I had fresh memories of a particularly horrific and prolonged go round with the progesterone shots, including one 30 minute hyperventilation session in the bathroom before I was able to do the deed, and I just wanted to be normal again.  I didn’t want to count follicles or fret over sperm counts.  And, I certainly did not want to to go through beta watch and OB scans of doom, because to be perfectly honest, that was exactly what I thought was going to happen. Again.

And, I secretly wanted to test the theory that Mr. X and I could actually get this thing done on our own and achieve the Holy Grail of Infertility: a spontaneous, honest-to-God two-people-only-involved pregnancy.  A baby for free!  No beta watch crap, I could go in for an OB scan when I was ready and even if things didn’t work out, I would know that it would be possible for us to get the job done on our own.  Naive, I know. Just like all of my other notions of this getting and staying pregnant business.

Then my cycle started getting really whacked out, a fact which I attribute to Dr. Uterus’s parting gift of two months of Estrace and progesterone during the mock and real FET cycles (which, while making me lose 5 lbs and dropping a dress size was awesome, was so not worth the rest of it).  The Clomid of November too whacked up my system despite producing some beauties of follicles and it’s just now getting itself worked out.

So, rather than being the fall of procreation, it’s been the fall of “what the f*&% is up with your uterus?” And, I’ve come to the realization, that we will likely have to do another IVF to have a solid chance of being able to utter those magic words: “I’m (so not even in an altnerate universe) pregnant.”

We still have until February before things gear up again and I start taking the birth control pills.  But, given my new whacked-out-ness, who the hell knows if we’ll even have a glimmer of a shot without the high tech solution.  And, I’m back at where I started: the girl with no current discernable problems other than two back-to-back monosomy miscarriages which may or may not be the result of spectacularly bad luck who apparently cannot get pregnant on her own but has no idea what to do differently this time to make it work. 

images: merrick_monroe, ian muttoo

I’m Special

In my visit with Dr. Salsa today to go over the bloodwork that I had for immune testing and the Clo.mid Challenge, I learned that I am truly ‘special’ although not for behavioral issues.  I’m special because I am in the 1% of recurrent miscarriers who have chromosomally abnormal embyros but neither partner has a chromosomal abnormality. 1 percent. I’m shocked that the percentage is so low.  I had really thought it was more prevelant than that.  Can you imagine if I played the lottery with these odds and my luck?  I could be a millionaire several times over. 

On the other side of the statistics, though, I still have a 76% chance of actually having a living, screaming, squalling infant at the end of a nine month tunnel.  As I told Dr. Salsa, it is literally inconceivable to me right now that this would happen.  He knows of what I speak – he and his wife had three miscarriages in a row before number 4 stuck. 

Other good news: no immune issues and a nice, normal FSH.  Smack me, though, for wanting something definitive – preferably curable – as to why I cannot carry a child to term (other than bad luck). 

We’re on track for an IVF in March 2009.  It seems far away, but I know it will be here before I blink. I hope I’m ready by then.

Step Away from Dr. Google. That’s an Order!

Dr. Google and I go way back.  He’s seen me through some pretty tough times – when I found out my tubes were blocked, when I wondered if it was normal for G to hump other Golden – and whenever I have a question that is either too pressing or too embarrassing to ask a real human being (or both), I turn to him. 

When I got my Day 4 FSH and estradiol results today, I of course plugged them in.  Big mistake.

First, I should say that my FSH was 7.1 and my estradiol was 81. The FSH is fine, it’s the estradiol that started me on a panic.  I unwisely clicked on … actual studies involving Day 3 estradiol levels that are over 75.  There were dark discussions of low egg yield for retrieval and no pregnancies.  Not what I needed to read. Mind you, one study is 12 years old.

And, never mind that in my one IVF, I had 12 eggs retrieved, 9 of which fertilized and developed.  Oh, no. All I could focus on was that damn number.  By 3pm, I was in quite a lather.

I turned to Dr. Silber’s book for some well-written guidance on whether or not I should truly freak out.  He didn’t disappoint – not only should I not worry, but I should be more focused on having an antral follicle scan!  I then consoled myself remebering that when I went in for my Day 4 ultrasound, there were lots of little pearls on the girls, so chances are I have a pretty good reserve.

But, I still cannot shake what I read in those damn articles.  I will definitely bring those up with Dr. Salsa when I meet with him in two weeks (!) and will content myself with the knowledge that if it was truly awful, they would have called me before I went in. 

So I am faced with a choice: I can either obsess and panic over this for a long time, likely without reason, or I can let it go and enjoy the fact that I have some beautiful little follies thanks to Clomid and Mr. X and I are taking every opportunity to bombard those beauties with lots of troops. 

Which do you think I’ll choose?

No IVF’ing Way

This title isn’t really indicative of this post, it’s just so damn witty that I really liked it and it will now be the new title. Deal.

But, to sort of justify it, I will actually write something about IVF, namely, I still really don’t feel like doing it yet.  I just don’t feel the hurry that I did before.  I think three years of go-go-go infertility treatment has finally caught up with me.  

This has become more apparent when Mr. X and I have had several discussions over the past few days about scheduling an IVF, which have mostly focused on December/January. 

There are a couple of problems with this plan.

1)  Say I start the BCPs for an IVF cycle in December and then stim in late December through early January leading up to an egg retrieval and embryo transfer in late January.  But – and there is always a but – I am scheduled to go to a conference in early February. I can’t miss this.  However, if I get a BFP, I will probably feel as if it is repeat of last year’s episode while on travel.  Only, this time I will be on business in addition to being away from home.  I do not want to be traveling at that stage.  I will already be stressed and remembering when I was pregnant and going to the airport bathroom every 15 minutes to see if the blood was gone will not be the best way to spend the day. 

2) What about doing the pills in Jaunary and stimming in February? Same problem, except this time I would be travelling during stimming. And, it’s a five day conference.  I seriously doubt that Dr. Salsa will agree to let me shoot up for five days without monitoring. 

3) Even if I do manage to get all of this done, I would get pregnant in February. For the Third Time.  And, then I will miscarry in March. For the Third Time.  I will have a D&C in April. For the Third Time. See a pattern? So do I, which is why I’d like to get pregnant in a month other than February, if I can help it.  It’s purely psychological,  but we all have our little mental quirks.

Of course, there are problems waiting too – Mr. X’s travel schedule gets heavier and we do not want to use frozen specimens on a fresh IVF cycle if we can help it.  Putting it off will also mean waiting for a late 2009 or even 2010 (Space Odyssey) baby. 

I do know that being back in an RE’s office with the dildocam was jarring.  And, I know right now, the last thing I want to be doing is sticking a 1.5 inch needle in my ass. Every night. I like being able to drink wine, have a Diet Coke and take a bath (I can even do all three at the same time!). I like not having to worry about weird bleeding and morbid outcomes.  And, I particularly like being in control of what happens to my body.

All of this could be academic – if my Clomid Challenge comes back showing that my eggs are closer to 50 than I am, then, all bets may be off.  Or, if I find out that my FSH is normal, then I may be inclined to try again.  I just know that right now, I’m content to drink my wine and take my bath.

How Random

Coherent thoughts and sentences are so overrated this morning, so this is what you’re going to get.

• I think the Clomid is making my teeth hurt, specifically the space between my two molars. I vaguely remember this from last time.
• Good news, though, no hot flashes yet!
• I found the most awesomest collection on the web yesterday. The Newseum has a page devoted to the front pages of 742 newspapers from around the country and the world. I checked out the Nov. 4 archived pages, and it was pretty darn cool.
• I have the most beautiful cat lounging right next to me.  I’m fighting the urge to poke him. 

That’s all you’re getting for now. But you know I’ll be back tomorrow.

The Perfect Storm

After I posted my diatribe last night (which, I might add, felt damn good), I drove to the airport in the new non-daylight savings time darkness to pick up Mr. X from his week-long business trip.  I needed the time in the car, away from the house … and the house of Her … to figure out just why I had such a visceral reaction to what should have been a relatively non-event. 

I drove through the familiar streets listening to/singing with my mellow mix CD, perfect for ruminating. Ruminating for me is closer to stewing in my own juices than doing the thinker pose, but that’s another post for another November.  I spent the first 20 minutes basically seething and letting it all out.  I got to the cell phone lot and waited for Mr. X to call when he had retrieved his bags.  My ten minute sojourn in the semi-lit parking lot allowed my anger to begin to deflate and I was able to objectively think about the whole thing. 

I’ve come to understand that the whole situation was a perfect storm of things that trigger my bitter reaction and they all came up at once:

• Little to no warning that she was that pregnant.  I was expecting maybe three months, but no, she was sporting the pooch like it was the prow of a giant sailing ship, parting the seas of the neighborhood.
• Knowing when they started and being able to count.  If they started in March, as I was informed, and she looked to be about 5-6 months along, then happy damn day, they got super lucky the first or second time out of the gate.  And, unlike me, she has a succesful pregnancy.
• Being confronted during what is usually one of the more peaceful parts of my day, namely taking G for a walk.  For the record, these people never walk their dogs in the neighborhood that I’ve ever seen.  So, I must (sheepishly) admit that I felt a little possessive of the 5pm walking hour since they haven’t ever taken that slot before.  My inner cynic wondered if they took the dogs for a walk just to show off the pooch. 
• And, finally, the smug smile.  I know in my post yesterday I wanted to see it, but I really think that it was there.  This in turn led me to the conclusion that she knew about us and was doing it anyway. Whether this is true is open to copious amounts of debate with at least five talking heads on Fox.  But, I know in my heart what it felt like and that’s what matters to me.

There you have it, the anatomy of bitter.  And I got to use ‘prow’ on an infertility blog.  I think I’ve earned a Reese’s. 

On a happier note, today is CD 4 and I went in for the beginning of the Clomid Challenge (which I always say in my head in that BOOMING VOICE OF THE VOICE OVER GUY).  Dr. Salsa was there wearing a tie that I swear looked like it had giant sperms swimming on it.  Mr. X was with me and his first words were, “what was on his tie?”  I was thinking the exact same thing.

The coolest and most definitely weirdest part was he did a baseline ultrasound (lots of tiny little follicles developing) and I got to watch it ON THE CEILING.  I shit you not.  It was the freakiest thing ever watching your innards on a screen on the ceiling.  It’s a fabulous idea and not an option at Dr. Uterus’s but I’m still a little weirded out by the experience.

And, in the Irony of the Day Award category, I start my Clomid tomorrow. Talk about full circle since I started on Clomid like just about every other infertile girl almost three years ago and here I am doing it again.  Except, this time my tubes are open.  I’m not going to begin to think about how ridiculous it would be if I actually got pregnant on Clomid.  After IVF. 

As Emperor Joseph said in Amadeus, “Well, there it is!”