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.

#$^&^%$

Warning: it's Self-Pity Wednesday

It is now day twenty fucking five of this cycle and no sign of ovulation.

CD5: E2 33
CD18: E2 48 (LH 4.6)
CD24: E2 36 (LH 8.2)

That's right. It went DOWN. I'm waiting for it hit 100 before we can be reasonably sure that I'm on the path to ovulation. I had been encouraged by the fact that it rose a little between CD 5-18. But now it's practically down to the start. Those E2 levels are right about normal day 3 values. This means we are weeks and weeks from any action.

I just want to get started again. I just want to move on. I am unreasonably furious. I hate this. June, July, August. The world is speeding along and I'm waiting and waiting just to get another chance. Time moves differently for those who are pregnant, for those who have children. Time is not my friend.

I'm tired, I'm bored, I'm sad, I'm so, so angry. I guess the anger should be a clue that on some level I feel entitled, that I deserve this. Really I know that I don't, any more than I deserve my good health or ludicrous wealth. All the grazillions of people who conceived since I started trying, they don't deserve it, but neither do I. There is no desert, just dumb, dumb luck. Fertility rains on the just and unjust. I've been on the right side of dumb luck for health and wealth, so naturally I feel entitled to be on the right side of luck for this too.

Huh. I just looked up the "just and unjust" quote. It's originally from the Book of Matthew in the New Testament, to wit:

...He maketh his sun to rise on the evil and on the good, and sendeth rain on the just and on the unjust.

I'm not Christian (nor well-read in such matters), so I wasn't familiar with the original source -- I knew it only from the Victorian jingle

The rain it raineth every day
Upon the just and unjust fella,
But more upon the just because
The unjust hath the just's umbrella.
(somewhat uncertainly attribute to Lord Bowen)

I'm pretty sure that the rain in the New Testament quote is meant to be a good thing, in a agricultural sort of way, whereas by Bowen's time it's clearly an urban annoyance.

There's some philosophical nutmeat there but durned if I can be bothered to pick it out.

In conclusion, I still don't like Wednesdays.

I don't like Wednesdays.

Reasons:

1) Wednesdays are what's referred to in my organization as "core day". That means you don't schedule any meetings outside the building, which guarantees that your day will be studded with meetings inside the building. Today I had meetings from 8:30-10, 10-11:15, 12:30-2 and 2-3:30.

2) Because I have a short attention span and most of these meetings are very, very boring, traditionally this has been the time during which I jot tiny calendars in the margins of my agendas, with arrows and circles to indicate ovulation, etc. This has not been particularly uplifting as of late. I don't know when I'm going to ovulate again, so there's isn't much for me to do except sit there and think about

3) the fact that Wednesday is my egg-retrieval-versary, and thus was my pregnantversary. Today should have been 9 weeks. I know I'll stop counting the Wednesday eventually, but eventually is apparently not today. It is also my unpregnant-versary, as it was six weeks to the day when I had that grim doctor's appointment.

Last Wednesday was pretty good, though. I escaped from meetings long enough to go for an ultrasound. I have two large (>21mm) cysts on my right ovary, but they're "inactive" -- not pumping out estrogen -- and thus shouldn't interfere with the next cycle too much. My left ovary was meek and quiet. My beta from the previous Friday was down to zero, a piece of information I was personally unable to extract from Bitchy Office Assistant. Thankfully, my doctor had better luck. Uterus looked empty, lining thin. Estrogen was low, progesterone was low. Peace reigned in the pelvic girdle.

He suggested that once I got my period in 4-5-6 weeks, I call the office and we'd make plans for the next cycle. We told him that we didn't want to wait and that we wanted to do an IUI this cycle. He was non-nonplussed and suggested that I come back for bloodwork in a week to check my estrogen and see if my ovaries are coming back online. He also used the word "miscarriage" several times, which I found oddly comforting. More than once I've felt like this whole crazy thing was in my head, how absurd to think that I ever was pregnant.

And my ovaries, they are coming back. I can tell, with my mysterious mucus-scrying ways. I've started peeing on sticks and I feel pretty sure that I'll be ovulating again before too terribly long. I'm so eager to start again, although the eagerness is no longer nearly as desperate as it was.

Right after the miscarriage I felt a tortured craving to be pregnant again, right this second. It was horrible, like I needed a drug that no one could sell me. I would have done anything.

That sensation has steadily ebbed, not coincidentally as my hormone levels have approached normal. Now I want to be pregnant again, soon, but there are things I wouldn't do to make that happen.

But you know what I would do? Stick a catheter up my hooha, that's what I'd do. Especially now that I've already maxed out my deductible, which makes all medical treatment FREE, that's right, FREE, I can go and get my ovaries scanned and it will cost my hapless insurance company but not me personally. So laissez les bon temps roulez!

Today

Along with thoughts of my own much-loved mother, Mother's Day makes me think of all those who are sore and tender today: the motherless daughters, the might-as-well-be-motherless daughters, and of course the childless mothers.

So here's a special dose of love for all of those who had to learn to do without their birthright of mothering. And another again for those who are still standing in the aisle with itchy feet and fading smiles waiting to be mothers, whether they are waiting for the grand biological conjunction or some bureaucratic unraveling.

As for me -- well, I'm a lot happier than I was last week at this time. Last Sunday was physically my most miserable time, and I wish I could go back and tell myself that in a week I'd feel so, so much better.

The week was pretty good, distractingly busy, although Friday was a bad day. I finally went for the followup bloodwork I'd been putting off, to check that my beta has gone down to zero*. I was supposed to come in on Tuesday but whatever, I didn't want to get a beta of 11 and have to come back two days later. I had >10 blood draws last month. The crook of my arm is finally starting to heal up and all that jabbing isn't half as much fun when it's to verify only how pregnant you aren't.

Anyway, I've been reasonably chipper, but going back to that hospital was damn depressing. It's taken me most of the weekend to get my balance back.

Got an appointment for Wednesday. I just want to know what's going on in there. I want to know if my hugely swollen ovaries have slimmed down and migrated back to where they're supposed to be. I want to know if my uterus managed to expel everything it was meant to expel. Mostly, I want to know whether I can count today as CD8. I want to know how long till I can try again.

*I still don't know the results of the bloodwork due to my doctor's ever-bitchy office assistant. I'm thinking of scheduling a consult with another practice just so I don't ever have to talk to her again. I like my doctor a lot, but his staff is abominable.