A good day so far

November 29, 2008 at 1:14 pm (Uncategorized)

I tried to post from my iPhone on Thursday immediately after I accidentally administered to myself a full vial of Bravelle and a full vial of Menopur when I was supposed to administer myself only a full vial of Bravelle and a HALF vial of Menopur. I was kind of tipsy after the Thanksgiving meal and we were in a hotel room and we had even rented a $10 refrigerator in which to store the half vial of Menopur. And without thinking about it, I just gave myself the same dose I had been giving myself for the past six days. So of course I kind of freaked out and called the on-call nurse (thank god they have one) and she was actually kind of nasty to me, but she got a message to the doctor the next morning and by 8:30 am the following day I knew what to do, and everything was fine.

Went in this morning and everything seems fine, am triggering today with probably two follicles, IUI on Monday. I start estrogen and progesterone on Tuesday.

I am feeling good about this, and optimistic. I love my doctor. He thinks about things Dr. R never bothered with. And he said the extra push of Menopur on Thursday night probably got us to where we are today (which was nice of him to say even if it’s not exactly true or it was not exactly necessary). He also said, “This is what it is supposed to look like. You can now consider yourself normal.” In retrospect, I’m not sure what that even means, but I had already asked enough questions for the day. I got his general gist. He’s still unclear on why I didn’t produce progesterone last time even though he is apparently certain I ovulated. He figures we’re correcting for it, but he was at first uncertain as to whether he should give me Lupron to stimulate an LH surge of my own to cause me to ovulate, or just give me hCG again. He decided on hCG since he felt we had proven it worked before with the ultrasound, but this time we are going back to Ovidrel rather than the Novarel we used last time. Just to try something different? I dunno. I’m tired of asking questions. I don’t care about any of this, if it works.

By the way, assuming I do ovulate, this will be a CD 13 ovulation, the shortest yet. I am pleased with this. For once, it doesn’t seem that long ago that we last did this.

P.S. Thanksgiving was fun this year. It was an entertaining change of pace, because we spent it with my husband’s cousin and his wife and their family (and my husband’s mom and brother) instead of with my side of the family, which always has more established and elaborate Thanksgivings, since I just have a bigger family. It was cool. This has felt like a very luxurious long weekend.

P.P.S. I hope all of you had good Thanksgivings, too!

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please please please please please please please

November 24, 2008 at 4:05 pm (Uncategorized)

this time. please this time.

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Well, so.

November 21, 2008 at 11:55 am (Uncategorized)

I saw the doctor today. And though as I write this I am tormented by superstitious thoughts telling me not to write anything down for fear of jinxing things (before you read any further, don’t get the wrong idea, I AM NOT PREGNANT), I am trying very hard not to entertain those kind of useless thoughts, because I want to share with you. I need to talk about this.

I am feeling optimistic. The doctor came in shaking his head and chuckling to himself. He said, “Well, you are certainly an interesting patient.” He also said, “You definitely seem to have some receptor…”

“Problems?” I suggested helpfully.

“Problems.” He said. I worried.

So here’s the deal: he doesn’t know why the hell I produced so little progesterone after ovulating, but he does not seem to be questioning *whether* I ovulated–he feels he confirmed that with the ultrasound. He really was just shaking his head at the whole progesterone thing. I told him I thought I had had decent progesterone production in at least two previous cycles: one because I had it measured, and the other because I had a temperature rise AND because I got my period before I stopped taking the endometrin, which suggested to me I had my own drop in progesterone that brought on the period. He said those things could have happened even with very little progesterone, so that didn’t tell him much. He did think that perhaps I started producing my own progesterone in this cycle, for two reasons: (1) because the 10.1 level I got after starting the Endometrin was high for Endometrin (as I said before, Endometrin doesn’t tend to raise blood progesterone level by much, which means I must have been doing that on my own), and (2) it took several days for me to get my period after stopping the Endometrin–he said if I had no progesterone of my own my period should have started immediately.

He told me he DOES think that my having had so little progesterone in the first several days after ovulation COULD have caused me not to get pregnant this time. I told him I was unaware that progesterone mattered that much for implantation, that all I figured was necessary was that the lining be there and then you start taking progesterone after a few days to make sure you don’t shed the lining prematurely. He said no, the presence of progesterone, even some right away after ovulation, is involved in the timing of implantation. He said that it’s not that this is not correctable–it is, and they do this sort of progesterone supplementation (like, immediately following ovulation or whenever ovulation would otherwise occur) with frozen embryo transfers and donor egg cycles, where the woman is not ovulating and so needs to have all her progesterone supplemented. He just thinks it’s strange that I didn’t produce progesterone normally; he just doesn’t understand why my luteal response would be so weird. He feels it was necessary that we know that I need this kind of correction. But he thinks that if we start up with the progesterone right away, that should take care of the problem (or help, at least), along with monitoring my progesterone carefully during that period.

He also said that he likes to have two “good” ovulatory cycles and he doesn’t consider the one we just did “good” because of this progesterone problem. So we’ll do this at least twice more.

I also said to him, “Look, I know you said that you’re not sure any of those prior cycles were any good because of how long they were and everything, but I can’t help but feel like I have had six cycles now, and feel discouraged by that number.” He said, “I can’t tell you that you can’t count any of those. I don’t know what happened in those. But I also can’t tell you that they were good cycles either. So we just have to try this a few times.” I appreciated his honesty, and even though I sort of wish he had said, “Those were crap cycles and they don’t count,” I’m sort of glad he didn’t because I wouldn’t have believed him if he did, and I would end up just trusting him less. It’s just common sense–those other cycles MIGHT have been good, we just don’t know.

I will say this: I am so, so glad that we are looking at all these different factors. With the old doctor, Dr. R, I would have just done the same thing thirteen times, or until I couldn’t stand it anymore and threw up my hands and moved on to IVF. She was never going to adjust her plan for my follicular response, for my luteal response, etc. She never would have even looked at my progesterone if I hadn’t bugged her to prove I was ovulating. Or, who knows? Maybe she would have. But five cycles in, she was convinced we were doing everything right and should just keep trying. And maybe it would have worked eventually. And maybe the current Dr. M is on a wild goose chase right now, trying to figure out what kind of random things might be wrong with me and they’re all a bunch of dead ends. Except that it seems pretty clear that there is more going on here than just bad luck. Except that’s kind of what it all comes down to, doesn’t it? Bad luck.

He said, of course, we still don’t know for sure things like whether my tubes are even picking up the eggs I ovulate. And that’s something we won’t know for sure unless I get pregnant without doing IVF. I have never heard of that happening before, the tubes not picking up the eggs, but it certainly seems plausible. I sure hope it’s not true. I also asked him about my eggs, worried they might be of low quality, but he said they are “young” and therefore should be fine. I sure hope that is true. I sure hope I get pregnant this time, or the next. I’m ready, guys. And this progesterone thing sounds promising. I just hope it’s not a wild goose chase.

If it is, it will probably be time to move on to IVF.

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Oh look, it’s

November 19, 2008 at 8:14 pm (Uncategorized)

Cycle Day 1. That’s the thing about cycles. You get to start fresh…over and over and over again.

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It happened.

November 17, 2008 at 2:35 pm (Uncategorized)

A very close friend just announced her three-month-old pregnancy to me over lunch. She is very, very sweet, she did it in a very, very sweet way (she knows we’re trying and have been unsuccessful so far, though I didn’t mention this cycle’s BFN to her today), and I actually am very, very excited for her. No joke. I did not have to fake my excitement when she told me. I also kind of had a feeling she was going to tell me that. I had a few clues.

Needless to say, I am also very, very jealous. It hurts. Why can’t someone fix us or me or this?

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BFN.

November 16, 2008 at 8:24 pm (Uncategorized)

No surprises. Just wanted to let you all know.

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Sad despite my low hopes

November 13, 2008 at 6:32 pm (Uncategorized)

I just started having cramps, just like all the other cycles. I don’t know what it means, technically, but it’s never meant anything good. I feel sad and, for the moment, hopeless.

I hate how the sun goes down so early these days. It makes it harder, somehow.

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Meme?

November 12, 2008 at 12:52 pm (Uncategorized)

Whoa! I just noticed I was tagged as a beloved blog by Blue. THANKS, BLUE!! You are too sweet! I love your blog too. And out of my great flattery, out of my extreme boredom, and in an effort not to be a party pooper, I am totally going to do your meme, right now. You’re supposed to answer with single-word responses. Here goes:

1. Where is your cell phone? Desk
2. Where is your significant other? Office
4. Your mother? Wise
5. Your father? Smart
6. Your favorite thing? Comedy
7. Your dream last night? Rain
8. Your dream/goal? Motherhood
9. The room you’re in? Office
10. Your hobby? Therapy
11. Your fear? Trapped
12. Where do you want to be in six years? Happy
13. Where were you last night? Home
14. What you’re not? Laid-back
15. One of your wish list items? House
16. Where you grew up? Los Angeles
17. The last thing you did? Work
18. What are you wearing? Glasses
19. Your T.V.? Big
20. Your pet? None
21. Your computer? Macbook
22. Your mood? Anxious
23. Missing someone? Nah
24. Your car? Awesome
25. Something you’re not wearing? Socks
26. Favorite store? Banana Republic
27. Your Summer? Skirts
28. Love someone? Yup
29. Your favorite color? Green
30. When is the last time you laughed? Today
31. Last time you cried? Today

I tried to keep it to just one word, but in some cases (Banana Republic, Los Angeles) it’s hard. I know you will all forgive me.

Here are some blogs I love, and if you guys feel like doing it, feel free to join in, but if not, I won’t be offended:

http://bigbellymeli.blogspot.com/

http://maybejust1more.blogspot.com/

http://infertilityrevisited.blogspot.com/

http://probableimpossibilities.blogspot.com/

http://highfshlevel.blogspot.com/

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Tuesday levels

November 11, 2008 at 5:06 pm (Uncategorized)

Thanks for your really, really sweet words, guys. It actually helps a lot to know you’re out there cheering me on.

Today, E2 = 94, Progesterone = 10.1.

The doctor apparently said this was “good.” And the nurse and I agreed that Endometrin tends not to show up in the blood as much because it’s local to the uterus, so we would expect the result to be lower than what it’s actually doing for me.

Or something.

So that’s relatively good nows, but I’m still not expecting much for this cycle. It’s just been too weird. But again, at least we’ll know for next time…

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Low hopes.

November 9, 2008 at 3:54 pm (Uncategorized)

So, Friday I was devastated, and I’ve bounced back from that to some extent, but my hopes are pretty low for this cycle.

What happened was this: on Friday morning I went in to get my estrogen and progesterone levels tested, per the doctor’s request. I was supposed to have ovulated four days earlier, on Monday. As you may recall, I once had this test done at my old doctor’s office, about seven days after I was supposed to have ovulated, and my progesterone was, I believe, 14. Even though the doctor at the the time thought a 14 was okay, she wanted it to be a little higher, so she had me start with one Endometrin (progesterone) suppository a day. I was sort of hoping that my progesterone would be higher this time around. That’s just a little background for you.

Friday afternoon, the nurse calls me. “Okay, let’s see,” she said. “Okay, your estrogen was 54, and your progesterone was .78…”

“Excuse me?” I said. “Did you say ‘POINT SEVEN EIGHT?'”

“Yes, 0.78. And so the doctor wants you to start on progesterone suppositories three times a day…”

“Point seven eight? Isn’t that, like, really low? Like, really really low? Like, really really REALLY low?”

“Yes, it is, it’s low…”

I was crying at this point. “Isn’t that, like, a problem? How could I have even ovulated with that low a progesterone level?”

“Well, he did a scan on Monday and that showed you ovulated…”

I was distraught. The nurse was unable to provide me with any helpful information, the doctor had left for the day, and I had nothing to go on. All I knew was that a 0.78 sounded so, so wrong to me, and I even wondered whether it might be a mistake. What’s more, I totally freaked out the nurse by crying on the phone to her. She had been my buddy, but I could tell now she was totally stiffening and turning cold when I got emotional. It made me feel horrible.

That evening, I called the office and left a message essentially saying that I was upset by some test results I had just gotten and I would really like to talk to the doctor over the weekend if possible, even though it wasn’t an emergency, but if I couldn’t talk to him I would really like someone else to call me. I just couldn’t imagine going through the entire weekend not knowing if it was even possible that I ovulated.

I explained to my mom and to my husband that I needed an explanation along the lines of one of the following:

1. Yes, you’re right, it is simply impossible that your progesterone level could be so low if you ovulated, so it looks like you didn’t ovulate.

2. Yes, you’re right, it is simply impossible that your progesterone level could be so low if you ovulated, but we conclusively saw that you ovulated on the ultrasound, so this blood test must have been wrong.

3. No, it is possible that your progesterone level could be that low even if you ovulated, and we saw that you did ovulate, and we are trying to correct your levels now. This is not unprecedented.

I was very, very pleased when I got a call shortly after 8 am on Saturday morning from a nurse who said the doctor was in and she wanted to clarify my question before getting an answer from him. I explained to her my concerns: is it possible I ovulated with this low progesterone level?, is this normal at all? is there any hope for this cycle, or for me in general? etc., and she got off the phone and then called me back with his response. He said that he was NOT SURPRISED by my low progesterone level, based on my follicles’ weird response to stimulation; basically he thinks they are also responding weirdly to the hCG, that’s all. We’re trying to correct it with the suppositories and we’re going to do another blood test on Tuesday to see if the suppositories corrected the problem. I asked if maybe it was too late, and she said no, of all the doctors in the office, if he believed there was no hope left for this cycle, he’d be the first to tell me to stop everything and wait for my period. She did say that perhaps it would have been better to know this sooner, but there’s no way we could have, so we’re doing the best we can.

Needless to say, the news sucked, but the response from the doctor was not terrible. I was at the very least happy to know that he was thinking about these issues. When I apologized for being a crazy patient, the nurse said my question was good and that she had learned something from it.

Still, I get the sense that this is extremely rare (none of the nurses I spoke to had ever seen anything like it before, obviously), and not a good sign. And this is why I do not have much hope left for this cycle. Something is clearly off–why would I be producing so little progesterone where I produced a basically normal amount in a previous cycle? I am also still not completely convinced that I ovulated. So, I’m carrying on in this 2ww, don’t worry, I won’t start boozing or anything, but I am not expecting much. Everything just seems off. It seems like something is wrong and we’re still not figuring out what it is.

So that’s that. But at least we’ve learned a few things for next time.

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