The scoop.

March 31, 2008 at 10:56 am (Uncategorized)

Alrighty. The nurse saw my lining and immediately said, “Okay, now something’s going on.” It measured 7.1 mm today, up from 4.6 mm last Thursday. “Nice and fluffy,” she said. (She better not take that back like she did last time.)

As for the follicles, a couple (unclear exactly how many) are finally over the 10 mm mark. At least one measured 11 mm, and one measured 12 mm. This is all code for: something’s happening!! Yay! The nurse told me at one point that once they hit 12 mm, they grow 2 mm per day, so I’m going back in on Wednesday. We’ll continue with the hoping, as per the norm.

“But what will you worry about now, talkingaboutmyself?” you may be wondering. Would I let you down? Never fear, I’ve got that covered. Now I can spend my time worrying that too many follicles will grow up all big, and we’ll have to cancel the cycle. And, in case that worry drops off for some inexplicable reason, I’ve got a backup, a new one this time–I’m now worried that the diagnosis of having PCOS and being “insulin resistant,” given by my hippy dippy homeopathic gyno of days of yore, when she told me to cut out “all white food” from my diet (and I lost like 12 lbs in 3 weeks, bringing me to a bmi of under 19), was actually correct and I should stop eating sugar and carbs.

Actually, this brings me to a question I have for you PCOS people–it’s still not entirely clear whether I have PCOS or not. I don’t have high testosterone, any kind of obesity, acne, or hirsutism, so my current RE didn’t seem to think I have it. But just in case I *do* have it, should I be laying off the sugar and carbs? Last night I went to a get-together and had some pizza and brownies (I’m still in it’s-okay-and-probably-even-good-to-gain-weight mode), and I felt kind of shaky later, but not in a weak, low blood sugar kind of way, but rather just a shaky, I ate too much kind of way. I’ve tried googling this but shakiness usually seems to come from having too-low blood sugar, which I doubt was my problem after a night of pizza and brownies. Does this sound like I might be insulin resistant? Keep in mind that I don’t really know what the hell I’m talking about, like, at all. Any help?

So I am to continue on the Menopur at 1 vial a day for now. I had an interaction at the doctor’s office that made me feel good–the nurse was going to look for some Menopur samples to give me, but she forgot and went into a room with a patient. When the nurse came out, I reminded her, in front of the patient, that she was going to see if she had any Menopur. After she left to look for it, the patient said, “If she doesn’t have any, I’ve got a ton at home.” And I said, “Oh man, that would be great, I’ll take anything you don’t need.” (For the record, I was kidding and did not actually expect her to go home and bring me some of her left over Menopur, which she understood.) That was it for that conversation, but before she left, she just said to me, “Good luck,” and I said, “You too!” And it was the first time I’d ever had a face-to-face interaction with someone who is going through what I’m going through, and it felt so good that I wanted to grab her and become her best friend and get her phone number and call her all the time and make dinner dates with her. Because the thing is, no matter how sweet and completely understanding my friends are to me when I talk to them about this, I can’t help but feel like a bit of a freak. Even if they don’t respond with, “Oh, really?” when I say I haven’t gotten a period on my own in 9 years, or when I tell them I’m giving myself shots every morning, or when I explain that I went to get another ultrasound this morning, I still know they kind of have to be thinking that. And also, “Wow, am I glad I don’t have to worry about this.” So it is really nice to just look someone in the face who knows just what it’s like.

So, ultrasound #5 bright and early on Wednesday morning, cycle day 21, Menopur day 19.

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Oh, I don’t know.

March 30, 2008 at 12:02 pm (Uncategorized)

I’ve realized part of the reason I feel so sure we’re not going to see anything tomorrow. Okay, this is going to sound so stupid, but…I can’t really imagine that ultrasound looking any different than it has the past three times to even the most trained eye. What I mean is, I can barely see anything when she shows me the ultrasound screen, and there’s this small but highly skeptical, totally irrational, batshit insane part of me that doesn’t believe the nurse can see anything either. (See, I told you this was going to sound stupid.) Last time I felt like she looked at the two black blobs that are my ovaries for approximately 1 second each and “was able to tell” that the follicles hadn’t grown. How? I mean, I could sort of see the smaller blobs (follicles?!) that made up the larger blob (ovary?!) and *I* thought some of them looked a little bigger. How could she tell so fast that they didn’t? Maybe she hates me and wants me to suffer. Maybe the powder they put in those Menopur vials is actually baking soda. I think I’m onto something.

For the record, yes, I realize she has undergone years of education and I haven’t. I know she has tons of experience and I don’t. And yes, I get that she was trained to see follicles and I wasn’t. But conspiracies are conspiracies, is all I’m saying. Aaaand now I feel the need to explain that yes, I’m kidding.

Ultrasound tomorrow (cycle day 19, day 17 of injections) and I’m still not optimistic because, like everyone else, I actually don’t know anything but I want to protect myself.

Thanks for the comments, everyone. I still can’t believe people are actually reading this. You all sound so smart and rational and wise.

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Quick Update (or, It’s Better That I Waited a Day to Write This)

March 28, 2008 at 1:25 pm (Uncategorized)

I had a tough day yesterday, and my discouraging ultrasound results were only a part of that. I got completely slammed at work and am still in that mode, so I can’t take long to write this, but I want to keep this blog current.

So they still didn’t see any follicle growth. Worse, the lining now appeared to be back to the 4.8mm-ish zone, and the nurse was no longer considering the thickness an indicator that I was responding to the Menopur. So they increased my dose to 1 vial (75 IU) a day, which is fine. My next ultrasound is Monday. By then I will have had five days at one vial a day (last night I gave myself the second half of the vial I started yesterday morning, and this morning 1 full vial, same tomorrow, etc.)

The situation with the doctor and the nurse and all this other stuff was dramatic and I probably should have had the one small cup of coffee I am now allowing myself per day before going in for the ultrasound. The basic gist is that the nurse decided to up my dose and of course now I didn’t entirely trust that she had confirmed this with the RE, so I called after I left to say I wanted to talk to the RE, whom I knew was leaving for a two week vacation starting next week. I got a call back saying she was out of the office as of yesterday, and I flipped out and cried on the phone to the office, which made them feel sorry for me and, when I got the right person on the phone, made them promise me they would have her call me. She did and confirmed that she had told the nurse to up my dose if the ultrasound results were as we found them to be yesterday, and she also told me they had done this a million times and that during the two weeks while she was gone I could trust the nurse to make the right decisions. She said that we’re in a trial and error period during which we’re just figuring out how my body responds.

She said on Monday three things might happen:

1. We will see one or two follicles growing and, depending on the size, we can schedule the next ultrasound and start thinking about when the trigger shot will be, or schedule the trigger shot itself.

2. We will see way too many follicles growing and have to cancel the cycle, but we will have learned something for next time.

3. Still nothing will be growing and we will have to keep going or possibly up my dosage again (whatever the nurse says, goes).

I have quite suddenly grown very pessimistic, and I am completely expecting #3. Although, to be honest, I realize #2 would be way worse than #3, so I guess I’m not THAT pessimistic. I also realize a lot of people are on the maximum 8 vials a day, and I have a long way to go before I’m doing that much, so it wouldn’t be shocking if I still weren’t responding. Still, of course, I am impatient and a brat, and I want this to start happening. And of course, until we start seeing a response, I won’t know if I’m one of those people who just doesn’t respond.

So, more waiting. No surprise there. The nice thing was that the nurse said to me, “How old are you?” I’m 28. “Oh, you’re going to get pregnant.” So that felt good.

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Sweet news: I just thought of something else to worry about.

March 26, 2008 at 11:03 am (Uncategorized)

First of all, thanks all you guys for your great and helpful comments. I cannot describe (though I’m sure many of you know) how great it feels to know there are people reading this who can help me. I’m going to try to ask the nurse a few things when I see her tomorrow.

So here’s the latest worry that’s keeping me from getting my work done: I’m small and thin. I’ve made a point of being this way, because I prefer it, feel better about myself, and all the other reasons anyone tries to stay thin. However, I am also naturally pretty thin–we are all pretty small in my family, and it is not an enormous effort for me or particularly unnatural. There was some notion that I may have been experiencing amenorrhea because of my low weight (for awhile I had a bmi of about 19 and at times even a little lower). I have made a point of gaining some weight when I decided to start trying to get pregnant, so now my bmi is around 20. My RE also told me not to go below a certain weight, and I haven’t.

I also asked her at a later appointment if there’s anything I should be doing in terms of diet and nutrition, and she recommended a nutritionist for me. I haven’t seen the nutritionist yet. Maybe this is stupid, but I have my reasons. First of all, with having to go get ultrasounds every couple of days, it is really hard for me to think about missing more work for an appointment the importance of which is just not entirely clear to me. I mean, the RE didn’t even mention the nutritionist until I asked her, nor has she brought it up since, nor did she emphasize it the one time she did mention it. There’s also a part of me that’s like, women get pregnant all the time without thinking about what they are eating. I have been careful to decrease my alcohol and caffeine intake, but other than that, how worried do I need to be? I eat a very balanced, healthy diet. I love sweets but try not to eat too much because I know sugar isn’t great for me. But my one real concern is that I should just be heavier. I’m worried I won’t get pregnant because I don’t have enough body fat, but I want someone to tell me this. I don’t want to gain a bunch of weight if it’s not necessary.

This is something else I plan to ask the nurse about at my ultrasound tomorrow. I don’t even know if she’ll have an answer, but I guess it can’t hurt.

Grr. I know I should probably just see the nutritionist. But does anyone out there have any thoughts about how important this is?

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Just another day, during which I must force myself to think about other stuff, when I really only want to think about this.

March 25, 2008 at 1:03 pm (Uncategorized)

1. I spoke to the office yesterday. I am to stay on the same tiny dose (1/2 vial) of Menopur for now, RE’s orders.

2. I can exercise since all my follicles are “still little.”

3. They don’t take my estradiol at these ultrasounds. At the first one, the nurse said “we can tell your estrogen is increasing because your lining is increasing.” Other than that, there has been no mention of estrogen or estradiol. Is that strange?

4. They haven’t done an HSG on me. I just looked up what that is, so now I have not only read about other people having it done, but I actually know what HSG stands for (hysterosalpingography) and what it involves. Anyway, is this problematic? I get the sense this is the sort of thing they’ll try if a few cycles of injectables and timed intercourse don’t work, but at this moment they don’t seem to feel there is any reason it won’t, other than bad luck or something.

5. I’m nervous about my own optimism. I’ve mentioned this before. This morning I had the realization that even if everything goes the way it’s supposed to as far as we can tell, chances are I still won’t get pregnant this time around. I think that’s right, right? Like, aren’t the odds against even a completely fertile couple on any individual try? I wish I knew more about this. Can someone direct me towards something that will give me the goods I’m looking for? Namely, what are my chances? And how come no amount of Googling has led me to the answer as of yet?

I forgot to mention–next ultrasound is Thursday. In the mean time I have to try and focus on my work, which is really hard.

P.S. I still have no symptoms but I don’t feel too bad about it since the nurse said I would probably not feel it when I’m just trying to grow one or two follicles.

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Not much, but that’s okay.

March 24, 2008 at 11:46 am (Uncategorized)

Ultrasound #2 today.  Sort of confusing.  I still have “lots of little follicles deciding who is going to be up.”  One measured 10 mm today, whereas last Thursday the nurse said they were all under 10 mm, though she didn’t actually measure any last time.  I tried to get her to say that the 10 mm one had grown since Thursday (it sounds like it, right?), but she wouldn’t cave.   She said it might have been that big last time, as they all probably sit in there under or at about 10 mm. But again, she didn’t seem concerned, what with the low dose and the fact that this is my first time doing this, etc.

Anyway, though, there is some good news–my lining thickened even further to 6.2 mm (from 4.6 last Thursday–I sneaked a peek at my chart). She essentially said this proves I am responding to the Menopur and that it *will* happen eventually. And that we have to keep going slowly because “we don’t want a football team.” Last time we didn’t want a baseball team. I’d probably be okay with maybe like a tennis team, as long as the equipment doesn’t come with. Actually, scratch that–I was on the tennis team in the 7th grade, and they let pretty much anyone with a skirt with built-in underwear play (thus explaining how I got on).

Then she said she was going to increase my dose to one vial a day. And I said, as politely as I could, “Well, the thing is, I thought Dr. RE said she would keep me on this dose for as long as 20 days.” And you know, it’s not that I want to stay at this dose, but I want to do what’s best and I want to see that they are communicating. I was hoping she’d say, “Oh, I know, but I told her all about your ultrasound last Thursday, and she said if they’re all still at or under 10 mm by Monday, that we should increase you to one vial.” Instead, she said, “Oh, really? Okay. I’ll ask her then. You should stay at the same dose unless you hear from me.

Hmm. So I can’t trust you to check with the RE before increasing my dose, but I can trust you to talk to her now and call me if she says you should increase it?

My appointment was three hours ago and I really want to call and make sure they spoke and that I should stay at the same dose. I probably will, because, after all, I am fucking paying for it.

Although, I forgot about the wonderful thing that happened after the ultrasound. Since I have now run out of my original stock of Menopur, the nurse gave me two vials. Two whole vials! That practically made up for the cost of that ultrasound. Actually, it didn’t, but maybe that’s how they figure it’s okay to just go handing this stuff out. It’s like, they obviously made me come in for at least one ultrasound I didn’t technically need, so to pay me back they’ll give me some free outrageously expensive hormones. It just occurred to me that those little vials of Menopur are kind of like those little jars of saffron, where you can’t believe how expensive some crappy little pistils are. Don’t you remember learning that saffron was worth more than it’s weight in gold? I probably learned that on Mr. Rogers and it’s probably totally wrong, but anyway, the point is, I’m seeing parallels here. I’m not sure they’re that interesting, however, so I’ll move on now.

It does disturb me a bit that I had to tell the nurse that the RE did not intend to increase my dose this early. It’s a yucky feeling when you’re not convinced they’re being careful to look out for your best interests. I know they say you have to be your own advocate with your doctor, but it’s scary when you know you know so much less than they do about what’s going on, and you’re not sure they’re paying attention.

While I was waiting to pay, I overheard a couple in an exam room talking to a nurse practitioner, and the NP was saying, “You know, if you want to enjoy your pregnancy, don’t read the internet. I swear, how do you think we got through our pregnancies before there was the internet? We somehow made it!” And the husband guffawed and said, “Yes, the human race has survived until now without the internet!” And the wife laughed timidly. And I know she was thinking, “There is no fucking way I am going to stop reading the internet about my pregnancy.” Look, dudes. Of course most pregnancies would be fine without the internet, but I think it seems obvious that our increased access to information has provided a net positive effect, at least with regard to health. Sure, sometimes you’re going to imagine aches and pains and problems where there aren’t any because someone’s blog or whatever put it into your head. But I, for one, know so much more about this process that *I* am going through from reading the internet, than I would if I were just talking to the people at my doctor’s office. At the very least, the internet gives me the questions to ask. Furthermore, I have read a number of stories of people who became aware of problems they would otherwise not have noticed, thanks to the internet. So anyway, I don’t know why I’m going off on this, since I’m guessing most people would probably agree, and the NP was mostly making a throwaway comment anyway. But I’m just saying. Well, I guess I’m saying that I like the internet. Anyone want to argue with that? Thought so.

I amaze myself with how much I can write when it’s about me. See? The title is fitting.

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I’m frustrated.

March 23, 2008 at 10:38 am (Uncategorized)

I still don’t feel anything.  Why?  Is it a bad sign that I felt something for the first week and now there’s nothing?  And another thing–are the stims I’m putting in my body at this point just going to waste?  Or is there some sense there’s a buildup and that each dose is helping?  I’m going back for an ultrasound tomorrow and I know there’s going to be no change with my follicles.  I am a little worried that my lining will have increased, though that’s kind of a stupid thing to worry about since I’m not even sure whether that’s a good thing or a bad thing.  I guess what I’m afraid of is that the lining will outpace the follicles, and that will throw everything off.

Also, as of tomorrow I’m going to be out of Menopur.  The doctor better have some there for me.  I love how they just assume I can spend all the time in the world running off to their appointments and picking up their meds.  I realize that I’m doing this for me, not them, but man, aren’t I paying enough money that they can at least try to accommodate me?  No.  No.  I know.  They know I will do whatever it takes.  They have me by the balls. 

Can someone answer this for me: after I started the injectables, I called the nurse to ask her something and she said I should avoid strenuous exercise (but only after I brought up the fact that I had gone for a run).  Is this true?  I know I should do so during the two week wait, but do I have to refrain from exercising even now?  What have your guys’ doctors and/or nurses told you?

I’m bored with this.  I’m ready to be at the next step.  I command it to be so.

There.  That should do it. 

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Yipes.

March 21, 2008 at 6:52 pm (Uncategorized)

I was just re-reading this (I happen to have a lot of time on my hands in front of the computer at this particular moment), and you know, I’m uncomfortable with my use of exclamation points.  I think I might stop using them altogether.  Whenever I read something I’ve written that includes exclamation points, I cringe.  It seems like I’m trying too hard, and it is entirely not me.  If you ever talked to me, you’d know what I mean.  When I’m really trying to be honest, rather than trying to act the way girls are supposed to act around other girls (but that’s a discussion for another time…maybe), I don’t use exclamation points.  And I’m trying to be honest here–that’s the point–so I hereby take back the exclamation points I put in my earlier posts.

I realize I could edit them out, but for the sake of honesty, I’m not going to.

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I don’t feel anything.

March 21, 2008 at 5:03 pm (Uncategorized)

Damn it, I can tell nothing is happening in there today.

When I had my ultrasound yesterday, the NP said “once they start growing, they grow 2 mm a day, so we’ll be okay if we wait until Monday.”  Meaning, “they won’t have gotten too big by then.”  I have a feeling we’d be okay if we waited weeks (except I’d run out of Menopur).  I’ve felt sore in the general abdominal area since I started the injections, but apparently I wasn’t feeling anything significant, because all my follicles were under 10 mm yesterday.  Now I’m not feeling anything, so what–are they shrinking?

Look, I realize I’m just being a baby.  Both the RE and the NP told me it usually takes a very long time to “wake up” the ovaries the first time around when they’re not used to ovulating (which mine most definitely aren’t–as I said, it’s probably been almost 10 years since they did it).  And they want to keep the dose low since we only want one, possibly two eggs to fully mature, since we’re doing timed intercourse at this point.  I guess it’s with IVF where you want as many eggs as you can get.

Wow, I just had an epiphany.  I now realize why some bloggers complain about their enormous, bloated, cramping ovaries, which they are on some confusing level trying to achieve, and some don’t and aren’t.  I guess the ones who want all the eggs are doing IVF.  Am I figuring it out?  Gold star?

We will eventually move on to IVF if this doesn’t work after a few tries.  Actually, we will reevaluate our situation if this doesn’t work after a few tries.  It’s kind of awful–my RE told me she was “very optimistic” about my chances, which of course is great (and please forgive me, fellow infertile women and men–I realize it’s not always fun to read this when your outlook is less sunny, and I also realize that I don’t know the half of it).  Oh but wait, I didn’t get to the awful part.  The awful part is how optimistic I am.  I mean, I am cautiously optimistic.  That is, when I’m talking to people.  But in my own mind I’m like, “Why shouldn’t this work even the very first time around?  We have no reason to believe there’s anything getting in our way…the only problem was anovulation and we’re taking care of that.”

Oh wait.  Except for the FSH of 10.  I keep forgetting about that.

Along those lines, I can’t figure out if that’s really high or not.  Some stuff I read suggests it’s not that bad–just borderline bad, or maybe even at the top of the “acceptable” range.  Other stuff I read suggests some clinics won’t even treat women with FSH levels this high.  Really?  My RE made it seem like it wasn’t that big a deal.  What’s the story with this?

Also, of course, there is always the possibility that we will discover other problems.  “Hmm, we’ve spent $5,000 on drugs and ultrasounds.  Should we check the fallopian tubes?  Oh look, there aren’t any.”  I will say this–I have no idea what an HSG is, but I hope I never have to find out.  I have not read a single positive review.

So anyway, I keep thinking I might be pregnant in a couple of weeks.  This scares me for many reasons.  The main one is that I will probably get my hopes dashed (even normal fertile people don’t usually get pregnant on their first try).  The second is that it’s scary to imagine being pregnant.  I actually have a really hard time imagining myself pregnant.  So in that sense, I almost don’t see it happening.  But I really, really want it to.  And I’m also really scared it will.  And even though I have become comfortable with the idea of leaving behind all the “young people” stuff you can do when you don’t have kids, I have, after all, only recently become comfortable with that.  And sometimes I think, “Oh wow, if I get pregnant, I’ll be…pregnant.”

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I’m trying to get pregnant.

March 20, 2008 at 10:31 pm (Uncategorized)

And not in the natural, free way, but rather in the physician-assisted, really expensive (but okay, not the *most* expensive–yet) way. I’ve never even tried to get pregnant naturally, but that’s because I was pretty sure it wasn’t going to work, and I didn’t want to waste the time.  I’m in my late twenties and I haven’t gotten a period on my own in about a decade.  A hippy dippy homeopathic gynecologist diagnosed me with PCOS about seven years ago, but since then the doctors I’ve seen have been doubtful about that diagnosis, for various reasons.  Now that I have a steady job after years of school and general immaturity (from which I am happy to say I have completely recovered!), I’ve found an RE who says I’ll probably be able to get pregnant, but I’ll probably need her help.  On top of that, she says, the sooner the better (I should probably mention that I had an FSH level of 10, which she said was “a little high”).  So it’s “sooner” now, and we’re doing it.  We’re starting with the easy stuff, to move on to the hard stuff if and when it becomes necessary.

The protocol is as follows:

  • Birth control pill for three weeks
  • 37.5 IU Menopur per day (smallest dose I’ve ever heard of) starting on cycle day 3 (day 3 of my period) for “as long as it takes” “because it can take awhile” “like up to 20 days” “I once saw a woman who took 45 days” (or until they increase my dosage?)
  • When there are a couple of follicles that are about 18 mm (I guess?), we trigger ovulation and are instructed to have sex during something like the next three days (constantly!  you may quote me)
Today is cycle day 8 (day 6 of the Menopur), and I had my first ultrasound.  The NP said I have lots of potential follicles, but they are all still under 10 mm, and they don’t trigger ovulation until there are a couple that are at about 18 mm.  She also said my lining is about 4 mm, which is good because it shows I’m responding to the Menopur.  I go back in on Monday (cycle day 12, day 10 of Menopur) to check my progress.

One reason I’m keeping this blog is so I can keep track of all my symptoms, ovarian twinges, etc.  And one thing I will say is that I have been feeling stuff going on in my ovaries from the first day I started the Menopur.  So it sort of surprised me that I didn’t have any follicles over 10 mm…what’s it going to feel like when they actually start to grow?  I am a little freaked out.  But in general, I’m excited to be doing something.  I sort of look forward to the shots each morning because I know I’m moving towards getting pregnant in some small way.  Furthermore, friends are shocked and amazed when you tell them you give yourself shots.  (Except diabetics.  Sorry diabetics.)

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