Pulling the trigger

Well, there's no going back now. DH just shot two vials of HCG into my ass to trigger all those eggs to mature and be ready for Friday morning's ER.

I had my third follie check this morning and she measured 19 follicles (14R and 5L). I met with one of the office nurses (not the IVF team) and she was so wonderful. I vented to her about the lack of communication from the office about timing, about my embies last cycle, about the FET, etc. Basically, she just got to be the lucky recipient of my hormonal mess this morning. She was so sweet, though. I'm sure she's used to hormonal infertile women crying in the office all the time, but she was really good to me. She said she would make sure to address the communication issues with the embryology lab since it is their policy to give more updates than I got last time. She said that the IVF team has had a few communication complaints lately, so she will talk about it with them too. Then, of course, I shared my lack of hope and my desire to call the whole stupid thing off. Again, she was very understanding and reassured me that it was just the hormones talking and that I didn't want to have injected $5k of meds into my butt for nothing.

I came home from the appointment with every intention of getting stuff done around the house but none of it ever happened. I sat my ass in front of the computer and goofed off all afternoon. I even forgot to make myself something for lunch--I just munched on peanut-butter pretzels while I surfed the net. When I got bored with the computer, I played ball with the dogs and they really helped with my mood. They are just a couple of goofballs and they make me laugh. It was a beautiful afternoon and I really should have taken them for a walk, but we were having fun playing ball instead. It's amazing how much better I felt after about 30 minutes of playing (which is about all the energy my old dog has anymore).

Then the IVF nurse called to let me know that we were definitely triggering tonight for ER on Friday morning. She did want me to do another shot of Gonal-F and Ganirelix tonight, too, which is a change from the first time. I guess there were still some small follies that could come into play, while the bigger ones weren't over-ripe yet so they could handle a bit more meds. She let me know that my E2 was rising nicely (though I couldn't hear the number--stupid cell phones!). The morning nurse was guessing 10 mature eggs, but the IVF nurse said "at least 10 or so". I sure hope that however many we get are healthy ones!

Second Follie check

After a long night at work and a morning meeting that got out early, I called the RE office and managed to get in earlier than my scheduled appointment. I warned them if I had to wait until my scheduled time, I would likely be snoring and drooling in the waiting room. Funny how a time slot seemed to open right up!

I got my blood drawn and then headed into the u/s room. Luckily I didn't have to wait long as even that table might have been just the spot for a quick nap. My scan was much better this morning--she measured 11 follies on the right ovary, and 5 on the left. It looks like the increase in meds worked!

The only problem was that the increased menopur dose meant that I didn't have enough at home to finish the cycle. In fact, I only had one vial left after my injection this morning. Of course, I didn't figure this out until I did my shot on Saturday, which was too late to get any meds delivered before tomorrow morning's dose. I explained all this to the nurse and she said she would call in the order right away so that it gets delivered tomorrow. She gave me 3 vials to use for the morning dose since FedEx won't be here before 7am. When I get my shipment tomorrow, I will just return 3 of the vials to the office to replace what I "borrowed". I'm so relieved that the office was able to help with what could have been a pretty bad situation.

My E2 level was 450 today. I'm not sure how that compares to my first IVF cycle because I refuse to pull out my records to check. I remember things like follie counts, but not sizes or lab levels. I have tried really hard to fight my control freak/OCD tendencies this cycle and just go with the flow. I really obsessed over every number last time and it added so much to my stress level. Heck, last time I even stressed about doing the C + B meditations right! (yes, I did end up giving up on them when they were adding to my stress and not relieving it)

Next follie check is Wednesday morning. At this point, they are guessing that I will trigger on Wednesday night for a retrieval on Friday morning. While it's not the St. Patrick's Day retrieval I was hoping for, a Friday retrieval means that I can still work next weekend and not jeopardize my work contract. So, maybe it's good luck after all!

First follie check

So I got up nice and early this morning for my date with the dildo-cam. I just think it's rude that I have to get up before dawn to get a camera shoved up my hoo-hah and they don't even buy me breakfast first. It didn't help matters that I had a very restless night with lots of coughing, which meant gushing blood with every cough or turn since a nasty AF arrived yesterday. How unfair that I have to shoot up with meds morning and night, deal with swelling ovaries, and still have cramps and heavy bleeding!

I do love the staff at my RE's more northern office though. I walk in and they are so friendly. I get taken back right on time and get my blood drawn right away with no problems. I head over to the u/s room and wait less than 2 minutes for the tech. This morning, she measured 6 follies on my right ovary, but only 1 on my left. She said there were more there but too small to measure this morning. So, I headed out to the consult room to meet with the nurse. She was very nice and listened to my complaints about having to come in again on Sunday morning. I explained that Sunday is the only day of the week that is hard to come in, since I work 12 hour shifts both Saturday and Sunday night. A monitoring appointment at the main office adds at least 1.5 hours to my already 2+ hour round trip commute, which means I either get a hotel room or try to work on very little sleep. I offered to come in again tomorrow morning and then Monday, just to avoid the Sunday monitoring appointment.

The IVF nurse called back this afternoon and let me know that I could just wait until Monday for my next appointment. My E2 level was only 183, so they felt like I could safely increase my menopur dose and wait an extra day for repeat monitoring. I'm also supposed to start my ganirelix on Sunday night to prevent premature ovulation and allow those small follies to catch up. They are still predicting my retrieval date as next Friday, but I'm really hoping to go Thursday--St. Patrick's Day ought to bring some good luck to this Irish girl!

Big Update

Wow! Has it really been almost 3 weeks since I posted? I've been a bit busy with Wrigley as she tends to demand as much attention as I can possibly give her. We started obedience classes and she is doing very well. I think she is very smart, and I'm only a little biased. ;-) She is quickly learning our household rules and routines. She is getting along so well with Rufus--in fact, they are cuddled on the couch sleeping as I write this. She is still quite a challenge though. DH has been gone quite a bit with work, leaving me to deal with all her puppy energy, neediness, and general untrained behavior. I found myself getting very frustrated by the end of the day, so I enrolled her in puppy daycare to get some time to myself on my days off. She loves it there and the staff seem to love her too! In order to keep her well socialized (something we didn't do with Rufus and we truly regret) we are going to take her there once a week or so. It gives Rufus a break from all her puppy zoomies as well!

Last week we took our annual trip to Mexico for our anniversary. It was sunny and beautiful the whole week. We spent most of it at the beach, just reading and relaxing and playing in the water. We did have a bit of a rough patch when we realized that we have spent so much time apart lately that we aren't quite sure how to spend that much time together. We talked about a lot of ways to change that, primarily being our work schedules. So, I might be looking for a new job soon, but I'm not sure yet. DH is going to try to stay home more when it's possible, and I might try to take some trips with him.

I did come back from Mexico with a surprise--well, two surprises really--pneumonia and an E. coli infection. I started wheezing and coughing a bit last weekend while we were there, but didn't really think much of it since we stepped up our exercise a bit (to battle some of the damage from the all-inclusive food and lovely beverages) and I've been known to wheeze after overexertion in the past. When it continued on for the rest of the trip, I figured it would get better when we got home and back to drier air. Then, the day before we were due to come home, I spent the day in bed with what I figured was an upset stomach (diarrhea and nausea, but fortunately no vomiting) from something I ate or drank the night before. I was achy and feverish and slept for most of the day. It continued the next day for the trip home, but at least I could eat again, so I figured it was getting better. When both problems persisted the next morning, I gave in and went to the ER for confirmation of what I had already diagnosed as aspiration pneumonia from sea water and Montezuma's revenge. The chest x-ray showed pneumonia (he wouldn't say whether it was aspiration via the x-ray but admitted the possibility) and he diagnosed my tummy issues as E. coli infection from the water. The good news is that both infections can be treated with the same antibiotic--the bad news is that it's $173 for 5 pills since we haven't met our annual deductible yet. I started the meds on Thursday and I wish I could say I was feeling better, but I'm not there yet. I'm struggling to sleep since any position short of vertical causes coughing fits.

I put a call into the RE office to make sure that this lovely combination of illness and the meds used to treat it wouldn't cause a problem with IVF 2.0, which is due to start next week. The nurse said that the meds won't be an issue, but I need to be healthy for my cycle. I go in for my CD2 baseline labs and u/s on Monday, so I'm hoping that I will feel better by then. I've called in sick to work for the weekend so that I can rest up and give myself the best chance to be healthier by the time I start shots on Tuesday.

All the meds arrived yesterday, after I gave Caremark a large chunk of my money. I thought we had a problem when they sent the Gonal-F pen rather than the multi-dose vial like last time. I'm going to be giving all of my meds IM again and the pen needles just aren't anywhere near long enough for that. So, I'll just have to inject from the pen into another syringe that I can attach a longer needle to for the actual IM injection. Crisis averted!

First day of stims

Well, I survived getting up early to give myself my first injection of this cycle. I didn't even go back to bed right after the shot, either. It means I didn't do my meditation this morning, but I'm thinking that I might be better off doing it before bed anyway. It might help me relax and sleep better too.

I must say that I had to psych myself up a bit for the IM injection in a way I never had to with the SQ shots. It's such a tiny needle (and such a big target!) that I hardly felt it at all, but it was disconcerting nonetheless. I remembered that the Menopur did sting a bit the last time I used it, so I wasn't sure what to expect with doing it IM. It really wasn't bad at all--in fact I think the stinging was less than what I remember from doing them in my belly last time. I'm just hopeful that the protocol change to doing everything IM will pay off!

I had to do my first semi-public injection tonight, too. I say semi-public because I was teaching a class for other ER nurses on our new computer upgrade. It just so happened that the three nurses in my class are all familiar with stims--1 did an egg donation when she was younger, another is in the midst of an egg donation cycle, and the other has done IVF (though nobody else at work knows about that). I had one of my co-workers give me the Gonal-F shot tonight in my right arm, a place that will be a bit tougher to do by myself. I'm trying to rotate which sites I use so any one particular site doesn't get overused and sore.

So far, I haven't had any side effects from the stims. I think the dexamethasone was interfering with my sleep since I had been taking it at night. I was having trouble sleeping and was having hot flashes during the night. Both of these are common side effects of steroids, so I changed today to taking it after lunch. Hopefully that (and the meditation) will help with the sleep issue.

Meltdown

The IVF nurse called this morning to let me know they are changing me from the microdose Lupron protocol to a protocol with Menopur, Gonal-F, and Ganirelix. The only reason that she would give me is that they want to do all IM meds for me and the Lupron can't be given IM. I understand that because I'm fat that the SQ meds will have inconsistent absorption and the IM meds will be more consistent. They didn't spell that out specifically, but I understand that the circulation to my belly fat can't be as consistent as that to my thigh and hip muscles. I get that, logically, but it was enough to cause a minor meltdown this morning. I'm already on edge here, one change this close to the start date was enough to toss me right on over.

I think a good part of the meltdown came from the fact that I really only have one chance at this, realistically. Our insurance is wonderful, but I will hit (or come very close to hitting) my lifetime max for IF treatment with this IVF cycle. I don't happen to have an extra $15k laying around, nor am I willing to take out a second mortgage on the house to pay for a chance at having a child. Plus, I barely got DH to agree to try this once. There is no way I can convince him to do it again.

The other part of the meltdown is from the fact that we used Ganirelix in a previous cycle (IUI #5) and still only came up with 1 follicle. I only used it once and the purpose was supposed to be to slow down the growth of that dominant follicle in order to allow the smaller ones to catch up. It didn't work. So here I am, getting ready to use it again and deathly afraid of a poor response and a cancelled cycle.

Logically I know that my poor response in the past may have also been due to inconsistent absorption of all of the meds that I injected into my fat tummy. I get it. My brain understands, but I just can't seem to convince my heart to believe that using meds that failed me before will somehow magically work this time because I'm putting them in a different spot. If you look purely at the numbers (FSH of 8; AMH of 1.3; resting follicle count of 20), there's no reason to think I will respond poorly to the meds. But then why have we only once gotten more than one follicle during 5 cycles of IUI?

I have to trust that, since the office has done this more often than I have, they know what they're doing. I have to trust that they are trying at least as hard as I am to make this cycle successful. I have to relax and try to think positively, but so far it isn't working.

Can someone please help pull me back up onto the emotional ledge I was precariously clinging to before this morning?