CD2

Today's bloodwork
E2: 34
FSH: 7.7

Last cycle, my E2 was 52 and my FSH was 6.5. FSH is the ticking time bomb of fertility, so seeing it go up is never thrilling, but it's still safely under 10. And I believe that E2 pushes down your FSH to some extent, so it's possible that I'm in the same boat I was last time when my FSH was lower but my E2 was higher.

Meds are ordered, and I'm starting birth control pills and metformin tonight.

On my last entry, the lovely & talented Emily asked why I'm going through stimulation and retrieval again when I am, in fact, the proud mother of five tiny frozen Americans.

I'm doing it because my insurance is generous but dumb. My insurance covers 3 IVF cycles but does not distinguish between fresh and frozen cycles. A fresh cycle costs about $10k and has about a 30-40% chance of working. A frozen cycle costs about $3k and has about a 15-20% chance of working. Therefore, it's in my interest to do three fresh cycles and then pay for frozen transfers out-of-pocket, if necessary.

It's kind of messed up, and not the decision I'd make if money weren't an issue at all. But I'm damn grateful to have coverage, however arbitrary.

Plus, at the ill-fated end of my last IVF, I could not imagine jumping back on that train any time soon. Well, my period took not the 4-6 weeks I'd been told to expect, but 8 weeks to find its way home. Apparently 8 weeks is exactly how long it takes me to forget physical unpleasantness. Right now I'm nothing but eager to begin.

56 days later... another openin' of another show!

Man, I am impressed by those Endometrium pills. I admit that I was a bit skeptical that shoving them up my hooha twice a day could actually make a difference the way shoving a 1.5" needle into my ass did, but sure enough, it worked. The proof is in the luteal period; 17 days. I didn't get my period until almost 3 days after stopping the Endometrium. I've never had a luteal period longer than 14 days on my own. That's some good shit.

Yesiree Bob, that's right, I've started bleeding, which makes today CD1. Which makes today the first day of IVF #2. Tomorrow I go for bloods and, if all is well, I start birth control pills in the evening.

Tomorrow I will also start metformin. Doc read my carefully supplicatory-yet-insistent note and agreed that, on the basis of the paper I sent him, I looked like a good candidate for the protocol.
Either that or he glanced at the long paper and long note and thought "the quickest way to make her leave me alone is to write her a prescription for glucophage". Either way works for me.

To do:

1. Stop by SpunkMart and get some sperm. This time I'm going to buy the "ART" vials, which are (even) smaller and (somewhat) cheaper than the standard IUI vials. It's a shame they don't sell the sperm per each. Since we're doing ICSI we only need, like, ten.
   
   
2. Do the math, ask for a few days off around retrieval. Hopefully there'll be fewer eggs and no OHSS and therefore the retrieval won't knock me flat on my ass for five days the way it did last time. In any case, I'm going to try and pass it off as vacation time, not sick time. Everyone's already quite suspicious enough from my two-week bender in April, not to mention my constant needle tracks. Thank goodness I don't bruise.
   
   
3. Order meds from Awesome Online Pharmacy. Last time the doctor's office ordered the meds from a local pharmacy that seems to have a stranglehold on area fertility prescriptions. They'd never heard of my beloved ethyl oleate, and sent (and charged me for) crappy-ass syringes that B disliked so much that she swiped some better ones from her lab. Awesome Online Pharmacy not only overnighted me the P in ethyl oleate for half the price of the only local place that could or would compound it, they also sent, for free, decent syringes, alcohol swabs, and a sharps container. So this time I got the prescriptions myself and I'll be ordered everything from AOP. Actually, why be coy -- it's The Apothecary Shop. The eagle-eyed who know me in real life may be able to spot another random reason for my affection for this particular establishment.

In other ordered lists news, I have some good life distractions.

1. I got a fat promotion at work, which was extremely soothing to my soul -- at least my life is moving ahead in that way. Since the world has been generally failing to conform to my will lately, it meant a lot to me.
   
   
2. Not coincidentally, we're remodeling the kitchen, which has been in desperate need of help for a long time. We took Friday off from work and went to IKEA and just bought the whole freaking kitchen. It was very exciting. And I love shopping, so picking out the sink, faucet and cabinet knobs are all endlessly thrilling tasks. We're having it installed by the IKEA-branded contractor, mainly because I am unsure of my ability to hang the wall cabinets safely on our masonry exterior walls. Also because I would really like this done without lifting a finger, since my honey-do list is both long and neglected.
   

And that's all the list items I've got today.

CD54/ 15dpo

Well, that last IUI didn't work. Had the blood test this morning, got the call this afternoon. It's okay, I knew what the call was going to say -- I've been assiduously peeing on sticks since 10dpo, and each one has been blanker than the last.

It was a long shot, anyway.

It means I get to stop the progesterone, which is good, because progesterone makes me strong with the crazy. I cried hysterically at Move On's latest ad. Guys now is not a good time to be emotionally manipulative mmkay. Particularly not by deploying ads featuring a besotted first time mother dandling her perfect cannon-fodder infant on her knee.

Hey, remember Inappropriate Lab Administrative Assistant? The one who told me I looked 6 months pregnant when I wasn't, and wanted to know what was wrong with me? I forgot to record our dialogue at the last visit:

ILAA: Baby doing good?
Me: Nope.
ILAA: Oh, you lost it?
Me: Yup.
ILAA: Sorry.
Me: Thanks.

The next time she saw me she started chattering about air conditioners, so I am glad to say that there will be no awkwardness between us.

So, back to the reproductive plans: we are embarking on IVF#2. To do list includes:

• Fill prescriptions from mail-order pharmacy
  
  
• Wait a suitable time for the baby aspirin to get out of my system and then have my anticardiolipin antibodies tested. Abnormalities in this area are a fairly common cause of miscarriage, and this testing is part of a recurrent miscarriage workup. Now, no doctor would send me for a recurrent miscarriage workup after one miscarriage, so I'm just ordering the tests on the internets and paying for them myself. It doesn't make sense to me to risk a $10k IVF in order to save $151 on a test. Plus, have I mentioned that I would really rather not go through that again? If I do have antiphospholipid antibody syndrome then it will actually be kind of good news -- it's easily treated with blood thinners. Big thanks to Hope for bringing this possibility to my attention.
  
  
• Persuade doctor to give me some metformin once I start downregging (that's the lupron phase, for the uninitiated). I've sent him an article and a note, which I chewed my pencil over for a long time. I don't want to piss him off. He's my connection to get hooked up with my future children. But metformin shows promise in reducing both rates of OHSS and miscarriage. I'd swallow hedgehogs to prevent OHSS and miscarriage this time around. I hope he is okay with it and prescribes me the met. If he doesn't, I'm sorry to say that I will probably just get some from Mexico. I've satisfied myself that metformin's a safe drug in this context, and have I mentioned that I really, really don't want to have OHSS or miscarry again?
  
  
• Start my period. Hear that, body? Please? I took a progesterone suppository this morning, but obviously won't this evening, and it remains to be seen how long it'll take my body to bleed. I'm a little tickled that I'm responding so neatly to the progesterone. A 15 day luteal period, huh? And not even any spotting. But I hope my body gets the memo right quick and starts bleeding. Once I do we'll really be starting the next cycle.

Cycle Day Nothing/6DPO

Oh, my, it's been more than two weeks. Time moves strangely in the gap between the end of a pregnancy and the start of a new cycle. "Can I consider the day I started bleeding cycle day 1?" I asked the doctor.

"Nah," he replied cheerily, honestly. "You're on cycle day nothing."

So for the past few weeks I've been on cycle day nothing. I went in twice a week for blood tests, all of which showed that my ovaries were doing... nothing. Just lying there sullenly like a pair of kicked dogs lying there sweetly snoozing, dreaming of better days to come.

After the fourth no-action blood test results, the doc began to entertain the possibility that my ovaries might not be coming back on their own. He offered me a ten-day course of Provera, at the end of which I would have a period and begin a new cycle. I liked the certainty, but I didn't like the fact that it would put me probably 4 weeks out from ovulation. I decided to wait until (last) Wednesday and, if no action, start the Provera then.

Well, sure 'nuff, Wednesday's bloodwork revealed that... I should have had bloodwork done on Tuesday. My estrogen was over 300, and my LH was over 100 (45 or so is considered "elevated" and indicative of imminent ovulation).

By the time I was lying on the table we were 24 hours past that blood surge, and there was nothing left but a swinging barn door where the follicle was.

We insemmed anyway. This is probably what's known as "dumb" and also "a colossal waste of $530." Pretty much everyone agrees that the sperm has to be in the fallopian tubes before the egg's released.

I didn't care. I was (apparently) willing to spend $530 to feel like I have a chance and I'm back in the game.

So here I am at 6 DPO. Careful Googling has revealed that some doctors think that slightly post-ovulatory insemination is better for male-factor infertility, and using donor sperm is kind of like having automatic male-factor infertility, because the number of sperm you get are much fewer than in a normal shot. So that's a little hope, right there. And you know, I don't care. I'm waiting for something, I'm no longer just waiting. I needed to be back here.

So yeah.

Assuming I'm not pregnant this cycle, I will be starting birth control pills for my next cycle of IVF in approximately two weeks.

The auguries are depressingly negative. Apparently I don't believe in that stuff strongly enough to change my plan of action, but I do believe in it enough to feel badly about it.

Or maybe it's the Prometrium (progesterone supplements) I'm taking. Estrogen makes me high, progesterone makes me cry. Seriously, guys. I've choked up about twenty times today. I blame the gorgeous wedding pictures that keep popping up.