Calendar Girl

Yesterday, I sat down at my desk and turned the page in my monthly calendar to start June.  I love turning the page to see the clean pages that haven’t had drinks spilled on them or scribblings filling up the days. 

This June, however, has grown a page: my IVF calendar. I stuck it in the folds of June so that I wouldn’t lose it but I also wouldn’t constantly be reminded in May of what was coming up.

June is now upon us and the IVF calendar is looking hopeful that it won’t have to be stuck in the dark for 30 more days.  It’s been saying to me, “Time to gear up for IVF! Aren’t you excited?! I’m excited! I even say, ‘Think positive!’ Isn’t that awesome!?”

I’m saying to it, “Chill, buddy. Keep your caps on for a little while longer.  You don’t even begin until next week so why don’t you just go hang out with the other important documents in my filing cabinet where you can continue to stay clean and dry?”

Truth be told, I’ve reached that point in my infertility treatment journey that the beginning of a new IVF is neither exciting nor terrifying. It just is.  I try not to think about the enormity of the entire thing, but compartmentalize it into the various sections: suppression, stimulation, retrieval and beyond.  It’s like eating a steak – you start at one end and bite by bite you make a dent.  I also take it like recovery – one day at a time.  If I start thinking down the road, the thoughts snowball into a giant ball of expectations that starts to chase me like Indiana Jones after he steals the gold idol.  Unlike him, I tend to get flattened most everytime.  I finally learned to turn off the thoughts of After This IVF and channel them into more immediate, and usually frivolous pursuits, such as contemplating what I am going to wear the next day.  It’s more a manfiestation of my need to plan (which is code for need to be a control freak) than a desire to really day dream about this time maybe it actually working.  I’d much rather expend that time and effort into something that I can control and still makes me happy. 

For now, the birth control pills are still winding down, the medicine is chilling like a fine wine in the fridge and I’ve set my baseline appointment for some not too soon, but not to far away date. And, for now, I’m very content to know that neither tomorrow nor even the next day will see me taking out that IVF calendar.  Sorry, buddy. You are going to have to be in the dark a little while longer.

Swimmingly

Last Friday, I informed Dr. Salsa that I wanted to get started on a new IVF cycle.  And, just like that, my anxiety and indecision vanished.  I couldn’t remember what I was so undecided about.  It seemed like the most natural decision.

felipe-skroski

Four days later, two birth control pills down, the water still feels really good. 

I pick up my schedule on Thursday. 

image: Felipe Skroski

Vidi, Vici, Venipuncture*

*I saw, I conquered, I got poked for blood. Again.

Yesterday, I took my first solid step into the land of IVF Number 2.  I plunked down the Mastercard, attended the IVF Class, gave up the first of many vials of blood and, (bonus!) got an SHG to start things off with cramps a bang.  I was out of there in an hour and a half.

First things first. We made the payment for the entire cycle on the plastic and I had a very inappropriate laugh with the financial coordinator about how many points I was earning on the conception of my hopefully future child.  It was then that she just had to share with me that she had IVF in December and was pregnant.  Talk about a double sucker punch – pay five figures AND get a pregnancy announcement. 

Now, if you’ll excuse me for one second while I say something very rude: “WHY ON EARTH WOULD YOU SHARE THIS WITH ME, ME WHO YOU CAN EASILY SEE FROM THE CHART IN FRONT OF YOU HAS HAD TWO MISCARRIAGES, BOTH AROUND THE GESTATION THAT YOU ARE AT NOW? WHY WOULD YOU DO THAT, WITH THAT STUPID GRIN ON YOUR FACE AND VERY ANNOYING ASSUMPTION THAT I MUST BE HAPPY FOR YOU? RULE NUNMBER 1 OF WORKING AT AN INFERTILITY CLINIC, HONEY: NEVER, EVER SHARE YOUR REPRODUCTIVE HISTORY OR STATUS WITH PATIENTS, OR MORE PARTICULARLY, WITH ME. IT’S BAD ENOUGH THAT I’M GOING TO HAVE TO WATCH YOUR BELLY EXPAND.  I WISH YOU WOULD HAVE NOT TOLD ME AND JUST LET ME DECEIVE MYSELF THAT YOU WERE GETTING FAT.”

Ah, I feel better. 

I didn’t have much time to collect myself before I was called back and told to pee in a cup and whip off everything below the waist.  I stood there for a minute, looking very stupid, and said, “but I thought I was here for the IVF class?”  Apparently, it was decided without my knowledge that yesterday was also SHG time!  At least this gave me very little time to ponder what a terrible experience with an SHG I had had before.  So, I went and peed in a cup, knowing that it was likely for a pregnancy test which I could have told them would be as white as snow (“UPT was negative,” the nurse chirped).  I delivered the precious cargo to the nurse and went in to the exam room to do my favorite strip tease.  Flat on the exam table, I waited for Dr. Salsa to appear and amused myself by looking at the screen on the ceiling to see what the dildocam looks like when it is not dildocaming (pretty much as incomprehensible as it does when it is dildocaming). 

Dr. Salsa promptly arrived and looked like…. Ted Kacz.ynski?  Apparently, he has decided to start growing a beard.  I looked at him with furrowed brows and successfully fought the urge to point out the similarity.  I also subtly shook my head at the coincidence: when I first started seeing Dr. Uterus, he too had the Mountain Man beard thing going on.  He shaved it off about half way through our relationship.  Now Dr. Salsa has begun to grow the Mountain Man beard.  What is it with my REs and beards?

Dr. Salsa was damned efficient.  He had that catheter in before I could say “hey, where are you sticking that?!” and then it was time for the dildocam and saline action.  Everytime he would push in saline, he would say, “and now, some cramping” and he was so not kidding, and I would yelp.  We did this twice and then, thankfully, he stopped squirting water into my lady parts and merely took a perfunctory looks at my ovaries which he pronounced, “photogenic.”  I would think that he was trying to pick me up except that he already had me on my back. I’m easy that way.

With the SHG (or “mapquesting of my uterus” as the nurse called it) finished, I headed over to the patient education room waiting to learn all that the IVF masters had to teach me.  Pretty quickly I realized that it was as I had thought. It was IVF 101, or what I would have loved to have heard the first time around but is no longer information that I didn’t know.  Some highlights though – they do a lot more monitoring than Dr. Uterus did and they will work with the schedule so that all procedures will be done when Mr. X is in town.  I also learned how to use the Follistim pen and that they will allow a subcutaneous HCG injection, rather than the intramuscular that Dr. Uterus swore was the only thing that would work. 

I then gave up the vial of blood to test for exotic diseases and I was released. 

So, I’m feeling ok about getting started again.  There is enough that is done differently – different protocol, different medicine, different doctor, different procedures – that mentally I don’t feel as if this is just a repeat of our last IVF and may not automatically be a repeat of how it ended.  Right now, that’s about all I can ask for.   Well, that, and for the lady at the office to NOT share her news with any other patients.

Will There Be a Quiz?

Well, I don’t have a schedule* yet, but I do have a plan.

Monday was CD 1 and I was so thankful for having a genuinely normal 30-day cycle, complete with 13 day luteal phase that I wasn’t even that upset that Big Red showed up.  I called Dr. Salsa’s office and had The Talk with the IVF coordinator about timing. 

And, once again, Mrs. X learned that ever important lesson: jumping to conclusions does no one an iota of good.  Apparently, under their schedule I would start BCPs next Sunday and wouldn’t start stimming until the end of February which means that all of the important stuff that Mr. X needs to be around for happens in mid-March – precisely when we want it to.  I don’t have specifics yet, but she assured me that his scheduled travel at the end of February will not cause any problems. Cautionary whew.

buster-mcleodPart of the reason I don’t have any specifics, though, is that Dr. Salsa’s office is kinda sorta holding them hostage.  The ransom? I have to attend their IVF class and do my upfront payment for the entire cycle.  Some would call this extortion.  I’m so far into IF treatment that I call it the cost of doing business.  I choose to believe that they have legitimate reasons for doing it this way (getting their money to avoid nasty money battles later) and are not doing it just to cause angst and further stress on the part of already frayed nerves.  I also choose not to extol on the breathtaking unfairness that I have to pay exorbitant amounts of money to get knocked up.** 

So, guess what I’m doing Friday morning? I’m attending IVF class, because it was either Friday morning or wait until February to take the class and, duh, get my schedule. That was a no-brainer for me. 

I am decidedly curious about this class. Dr. Uterus had no such protocol.  During my tenure under his care, my only ‘class’ , if you could call it that, was a 5 minute lecture before my first injectible IUI cycle from Nurse to a T on how to fill a syringe and where to do the deed.  Seriously.  So, it will be very entertaining to see what they will attempt to educate me on that I haven’t already done.  I’ve been through 6 injectibles cycles, 1 IVF and 1 FET with a bonus mock cycle.  I have mixed my own medicine (no pre-filled syringes here, I’m afraid), I’ve given myself all of my own shots – PIO injections, HCG triggers, Lupron, Menopur, oh my! -, I’ve shot up in airport bathrooms, hotel rooms and relatives’ homes in at least three states, I can take medicine on a schedule (hello, phone alarm!), and I can follow directions.  IVF is not a walk in the park, but what requires a 2 hour class to explain

And good student that I am, I will bring along something with which to take copious notes and will raise my hand before asking a question. So far, my only question is “will there be a quiz?”

* Do any other Americans out there have a lovely chirpy British lady’s voice in their head who says ‘shedule’ whenever they read this word?

** Check back later, though. I may change my mind on that one.

image: Buster McLeod

The Slow Road to IVF

markymarkoAh, 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