End of the ride

We are officially cancelled.  The risk of higher order multiples and OHSS was just too high.  I have an appointment with my RE Aug 14 to sign consents for IVF.  We will take next month off to give my over stimulated ovaries a rest and start bcp for IVF in September/October.

That just seems so far away...

UP, DOWN, UP, DOWN

I'm getting dizzy!

So as of this morning IUI could be back on on Monday... It will depend on my E2 levels today, and how many follicles mature for tomorrow. I guess they had some trouble seeing my ovaries yesterday (or maybe my body just went crazy last night) but yesterday on the L there was 12, 10, today there were: 16, 14, 13, 13, 11, 10, 10!!! Add to that on the R there is: 19, 15, 15, 14, 14, 13, 13, 11...

The nurse this morning looked like she was going to hyperventilate when she saw all of those. When I told her that my R tube was blocked she calmed down some, but the possibility of 4 mature on my good side still makes them nervous.

They weren't sure if I should coast for another day or if I should take another 25IU of Puregon tonight. The concern with coasting is that my E2 levels could start to drop and nothing would mature further, but taking more drugs could cause all 4 to mature and that would be too many... In the end they decided to have me do more drugs tonight and we will see what happens tomorrow morning.  We are hoping to see that on the left, the 16 and 14 have grown, but the rest have stayed around the same.  If both of those 13's grow I will likely still be cancelled.  The risk of quads is just too great and I don't want to be the next Kate...

One option they gave me was to convert this cycle from IUI to IVF.  Since I have so many follicles, I would be a good cantidate.  But the success rates aren't as good as regular IVF.  It is less $ than regular IVF because it's considered a treatment for a complication from IUI but it's still expensive and in my opinion not worth it if the chances of success are lowered. 

With IVF, the ovaries are suppressed so that all of the follicles start growing at the same rate and theoretically they would all be around the same size and the same maturity at retrieval.  Since I do have one lead follicle on the R (that 19 one) it is possible that the others wouldn't be fully mature.  If they did the retrieval for IVF, I would have less mature eggs to choose from than if I started IVF from the beginning.  Therefore less chance for success.

I'm taking this day by day and will see what tomorrow brings...

IUI #1 Take 3??

Left side shrunk, right side grew... dammit!! Cancelled again :(

I am still going to continue with the injections and go back to the clinic tomorrow morning because I'm still going to trigger this cycle to release the eggs... I didn't last month and ended up with 3cm cysts because of it, I don't want 5 of those, that sounds painful!

We have to make a decision about what to do next cycle. We could do IVF, but if DH looses his job in Spetember, we would have no savings to get us through until he finds a new one... Or we could attempt another IUI, but really what's the point?? Or we could do nothing...

The really craptastic thing about this is that because of the timing, I will likely have to cut my vacation in half if I want to cycle again. I leave on Aug 4 for the cottage for a week and that will likely be CD3 or 4... This happened last year too.

Fuck.

Update

CD11

I started going into the clinic for monitoring on Monday morning.  They take some blood to check my hormone levels and do an internal ultrasound to see how many and how big my follicles are growing.

On Monday, my cysts from last cycle appeared to have shrunk some, I don't know how big they are, she just said "smaller". The bad news was that I only had growth on my right (blocked) side, there is one at 10mm and one 11mm. Nothing on the left. It was still early, but I had a feeling that I'll be cancelled by the end of the week.

Yesterday morning went in again and I started to have growth on the LEFT! There is more on the right, but there were 3 on the left and  1 of them was dominant, so that is good! They called me yesterday afternoon because my E2 levels were really high and they wanted me come back today instead of tomorrow.

This morning I had 5 follies on the R (15, 13, 13, 11, 10) and 2 on the L (14, 13)... Mature is 20. They asked if I wanted to consider converting the cycle to IVF since I have so many. But we just don't have the $ for that right now. Yes, 7 follies is a little scary for IUI, but we can ignore the 5 on the R due to the surgically blocked tube, so really it's only 2.

My injection dose has been decreased from 100IU to 50IU and I go back on Friday for more monitoring.

I'm trying not to get my hopes up, but it's hard, this may be the first time we've had a real chance in 2.5 years...

Roller Coaster Day

CD3

I had a bit of a roller coaster ride this morning... I went in for my CD3 BW&US and they found two cysts on my R ovary. Those are the 2 follicles that I had from last cycle, only now they were 3cm each! The nurse said it might cause this cycle to be cancelled as well, but it would depend on what my blood work came back at and they would call me and let me know later today.

I was so bummed when I left the office this morning thinking I'd have to wait another full cycle to see if they resolved themselves. But then around 1pm I got a call from the nurse and my levels are low so I am good to go! I start stimming tonight at 100IU Puregon. Yay!

When I got back to the office, I was at one of the buildings when I got the call from the clinic, the roller coaster ride continued.  I found out that my friend M started spotting this morning.  She is 8 weeks pregnant.  Within the hour, the spotting turned to bleeding.  It looks like she is going to loose the baby :( 

I'm devastated for her.

If I could be happy for her and sad for myself when I found out she was pregnant, I can also be sad for her and happy for me that my cycle is continuing while her pregnancy is not.

I'm so happy/sad/happy/sad/sad/confused....

That was Quick

CD19 CD1

When my cycle was cancelled last weekend I looked to the internets to find information on what would happen now.  I didn't know anyone else who had stopped taking the drugs before O.  How would my body react to that?  Dr. F said that sometimes any follicles that were created with drugs that weren't released, would just shrink away and I likely wouldn't O. 

OK. 

That's fine, since they were on the blocked side anyway it didn't matter if I O'd or not.  But what would happen then?  My biggest fear was that after they shrunk, my body would still look to O naturally and I would have a super long cycle while my hormones sorted themselves out.  If I had a super long cycle, or even if it was just a couple days later than normal, that would result in having to go to the clinic for all of my appointments during my vacation! 

Crappy!!!  I wouldn't be able to go to the cottage and I REALLY need that!

Luckily, that's not what happened at all!  I had a pleasant (?????) surprise this morning when I went to the bathroom first thing and there was AF!  It's only been 1 week since I stopped the drugs and it's only CD19... Well I guess it's CD1 now...

Normally I hate seeing the wicked witch, but having her come sooner this time means  I can get started again sooner!  And I will be done with all appointments by my vacation!

In fact, (If I actually get to do the IUI this time) I will be at the cottage for the last week of the TWW. Which will hopefully be a good distraction.

I am still considering this IUI#1 since I didn't even get to the IUI stage last time. 

I guess this is IUI#1, Take 2.

Cancelled

CD12

We are officially cancelled.  Still no growth this morning on the L side and they aren't sure that what was on the R was actually a follicle, it could have been a cyst.  So... not even halfway through the cycle and it's failed.

I will start the next cycle at 100iu and hope for at least 1 on the L.

Now I just have to wait forever for my period to start again.  This is going to be a long 20 days...

Bust

CD 10

This morning I went in to have a look at what's growing.  The good news is that I have have one follicle at 12mm.  The bad news is that it's on the R side.  Once a follicle takes the lead, it asorbs all of hte hormones and the others stop growing. (That's why 26 on CD3 was not a concern...)

What does that mean?

It means that I will release a mature egg from my R side.  That's the side where I just had hte tube removed.  With no tube, there is no way for the egg to reach my uterus and become fertilized.  Yes, there are miracle stories about the tube from the opposite side picking up the egg, but the fact in with my endo, that just won't happen.

Isn't there anything we can do?

I met with Dr. F this morning and she is increasing my dose from 66 to 100 in a last ditch effort to save this cycle but she doesn't hold much hope that it will work.  I go back on Sunday to see if makes a difference and after that, we wait until next month.

CD8

CD8

This morning I wend for bloodwork and ultrasound to see how my little follies are growing.  As far as appointment go, it was pretty uneventful.  Last week when they took blood I bruised so this week when they did again, it hurt like hell! But that was all the excitement. 

There is no growth yet. 

They only start measuring and counting once the follicles are at least 10mm.  The only thing they could tell me was that at least 1 measured 10mm on the R and all on the L were under 10mm.  I have to continue with 66IU of Puregon for now and go back on Friday for another look. 

Hopefully I will see some growth then.

See Spot Run

CD7

TMI WARNING!!

For about the past 20 years my period has gone a little something like this:

2-5 days of light to dark spotting
2-3 days of heavy flow
1-2 days of light flow
2-5 days of dark to light spotting

Yes, on average my period would last from 7 to 15 days! Usually about 10 days most months. Some months it seems that I had my period for longer than I didn't!

And then I had my first LAP surgery in December...

And nothing changed.

Then I had my second LAP surgery in May...

And the spotting stopped!

This was my 2nd AF since the surgery.  The first one would have still been affected by the trauma of the surgery so that one was closer to my old 'normal'.  But this one!  This one went a little something like this:

1 day of extremely light brown spotting in the morning turning to pink by bedtime
3 days of heavy flow
1 day of light
1 day of extremely light brown spotting
1 day of nothing

That's right nothing!  No spotting today at all whatsoever!  I'm not sure, maybe it's the puregon injections or maybe it's the surgery, I don't know... I'm hoping it's the surgery so maybe this will continue.

Ouch!!

CD3

This morning I had my first monitoring appointment with my new clinic.  After telling the receptionist know I was there I went and sat in the little waiting room.  The blood nurse called my name and I had one vial of blood taken.  I miss the blood nurse from my old clinic... she never hurt or bruised me.  Not that this one particularly hurt, and my bruise is not very big, but it's tender.

After that I went back to the little waiting room until it was my turn for an ultrasound.  First they did the regular abdominal ultrasound and then they did the trans-vaginal aka cooter cam.  This was the first time it was almost painful.  I'm not sure why that was, but I hope it was a 1 time thing.

Today they were looking for what's called Antral Follicle Count (AFC).  This is the number of follicles present at the beginning of a cycle.  These follicles are all very small and in a normal cycle, only one will grow to maturity and the others will disappear. 

In an IVF cycle they try to get as many of those Antral Follicle to grow as possible aiming for between 10-15.  Too many can lead to complications too.  In an IUI cycle, like we are doing now, they want less than that but still more than one.  In my case, they want to make sure that at least 1 or 2 of those are on the L because my R tube is gone.

I had 11 on my L and 15 on my R.  Those are good numbers.  Like I said, only a few of those will mature.

After my ultrasound, I met with a nurse and one of the other RE's at my clinic.  He was super nice and funny.  Dr.F had left instructions on my file regarding the dose of Puregon I should be on (66 mg)  but he didn't agree with her at first.  He said that I have a high AFC and that using that dose may result in too many mature follicles and I should only take 50 mg.  Then he read my chart further and discovered that I only have one tube and decided on 58 mg.

The nurse then showed me how to work the puregon pen.  Partway through the instruction, the RE popped his head in the room again and changed my dose to 66.  He said he didn't want risk not developing any of the follicles on my L side and have to cancel the cycle as a result.

I then went to the in-clinic pharmacy and picked up my puregon.  It comes with a little pouch to carry all the supplies in and another pouch to keep the used sharps.

I have to take the shot at the same time every day.  I chose 9:00pm just in case we go out for dinner or something one night, that way I don't have to worry about bringing it with me and injecting myself in a public washroom...  I was so apprehensive about sticking my self tonight that I ended up pricking my self twice because I chickened out a little too late once before finally going through with it. 

No side effects so far, fingers crossed it stays that way.

A Fresh Start

CD1

Today I was finally able to call into the clinic to start my very first IUI cycle!  I haven't been so happy to see AF in a really long time.  It means we get to start trying something!  I'm still nervous about the injectables, but I know I can do it.

I will do anything for this.

I am not looking forward to the next 8 months at work... or in general.  A co-worker has announced her pregnancy.  I don't work real closely with her, but she is part of the group that I go scrapbooking with.  I would go scrapbooking to avoid doing things with pregnant people, and now I've lost that escape :(  Also, my friend and co-worker M just found out she is expecting.  She is filling in for T while T is on mat leave.  There must be something about that office... the one right outside mine... where I can hear everyone drop by and say congratulations every 5 min...  She hasn't announced yet, she's only 5 weeks along, so I have another 2 months before that starts again, but I feel like it finally just stopped when T left.

Another one bites the dust.

M was also struggling to conceive.  They started trying around the same time as we did, but they took a couple of breaks because they weren't sure they really wanted it.  They started seeing Dr. M after we did and I felt really bad when I left the clinic after referring her there.  They decided to try a couple of cycles with the same drug that I used, and were successful on their 2nd month.

I am the only one left. 

My entire circle of friends in Guelph (not that it is very big) is either pregnant or has kids except me.

It still amazes me how quickly some people forget their struggles. Every day for lunch M and I would get the same thing, a turkey sandwich with a side salad.  Well, now that she's pregnant she can't eat lunch meat and has had to find something else to eat.  And more than once she has commented that she is jealous that I can still eat our lunch.  Really?? I finally said to her on Monday "I hope you'll forgive me if I don't feel sorry for you..."  I tried to say it really nicely, but I hope I made my point.  We haven't had lunch together since so it remains to be seen.

Surgery or no surgery?

This past two weeks have been a bit of a roller coaster with good news and bad news and confusion all around!

Last Tuesday I had my pre-op appointment with Dr. F to sign the consent for surgert and go over the risks etc.  With Dr. M, he tested my tubes last May and it showed they were open, then during the surgery he declared them both closed, but he did not perform another test. Dr. F is not really comfortable taking the word of Dr. M when his reports are conflicting so she ordered another test; a more accurate one than the one I did last May.  It's called a hysterosalpingogram (HSG).

During the HSG, a contrast dye is inserted into my uterus and forced through my tubes while images are recorded on an x-ray. As it turns out, my left fallopian tube is open! But my right is still blocked with nice fat hydro. The image below is NOT mine but it shows kinda what mine looked like.

Notice on the left side that the dye looks like smoke, but on the right it is more solid? That is because on the right the dry is being trapped and contained rather than being released into the abdomen. There was a slight anomalie with mine. At the base of the right one there was a small area that also looked like smoke. This meant that my right tube, while diseased, might possibly be open too. If both tubes are open, then I wouldn't need surgery!

Because the test on my right tube was ambiguous, Dr. F got a second opinion from one of the other RE's at the clinic. They agreed that the tube should be treated as closed because the area of 'smoke' was so small.

What does this mean?

Basically, since I have one open tube, I actually have a chance at a successful Intrauterine Insemination (IUI) which is much much cheaper and less invasive than IVF. If I choose to do IUI, then I don't need to do surgery.

With the blocked tube, there are studies that show IVF is more successfull if the tube is removed. However, there are no studies on IUI and blocked hydro tubes, so she can not say that removing the tube would be beneficial.

If we are going to do IVF, I should have the surgery. But if we would rather do IUI, then I would't need to have the surgery. However, if we try IUI and it doesn't work and we want to persue IVF, I would need to have the tube removed at that point. So, we need to make a decision.

IUI has only a 10-12% chance of success and a 5-10% chance of ectopic (pregnancy in the fallopian tube) whereas IVF has a 60-70% chance of success. And we can only do IUI on the months that I ovulate on the left side since that's the only tube that's open. And those percentages were before I asked her about D's SA results. OF course, he was out walking the dog when I was talking to her so she couldn't give me the numbers, but his count is low so our chances are probably a little lower than 10%. We figure we will likely end up doing IVF eventually, but it's really hard ignore the fact that IUI will cost $350, while IVF will cost $10,000.

I have decided to go ahead and do the surgery on May 9 as planned and we will have to think about whether we want to do an IUI or two before IVF. A successful IUI would be like winning the lottery, and you can't win if you don't play. We are thinking about buying one 'lottery ticket' before going all in with IVF. I keep second guessing that choice though.

Technically we have some time, I'm turning 32 next month and D is the same age. The only thing that puts us into a time crunch is that D is supposed to be on a drug to supress his immune system a little so that he doesn't develop a resistance to Remicade (the drug to treat his Crohn's Disease) but he's not taking it while we TTC. His GI says it's safe, but everything I've read says there is a risk of major birth defects if the male partner is taking it and both RE's that we've had say it's not safe. So he has not been taking it for 2.5 years now and I'm constantly worried that he will build up a resistance to his miracle drug. (You should have seen him before he got on this, he was sooo sick and in sooo much pain all the time I can't watch him go through that because my body is screwed up and can't have babies).

But really, what's another few months for a chance to "win the lottery"?