Begin at the Beginning...

From: http://aliceinwonderland.wikia.com/wiki/King_of_Hearts

“Begin at the beginning,” the King said very gravely, “and go on till you come to the end: then stop.” 
~Alice in Wonderland

I feel so behind on blogging about what is going on.  Ok. Let's start at the beginning. Or at least the beginning highlights of IVF cycle #3.

Christmas Day I starting on my Viville-dot .1 estrogen patch. The instructions were to change it out every other day until I started my regular cycle meds. Once I began those, I was to leave the last patch on for 3 days. 

Day after Christmas I started my protocol of injecting Ganirelix 250 mcg for 3 days. 

Friday night (12/28) my period started, and that brought me into the ACRM office on Sunday morning to do our baseline ultrasound check: 11 follicles. 

Monday (12/31) I started my Bravelle (6 vials of 75UI) and Menopur (2 vials of 75UI). You can see my discussion about that process here.

Friday I had my ultrasound and was introduced to my new nurse. Our old nurse/third party coordinator was promoted to Director of Nursing (or some similar title) and I was a little apprehensive of having to start with a new nurse. Even though our old has frustrated me a few times. Both nurses were there on Friday and I was actually pleasantly surprised with our new nurse. My fear was that she was going to be a total noob, but I couldn't have been more wrong. Apparently she was the former Director of Nurses took 6 months off, and was coming back as the new third party coordinator. She instantly made me feel at ease with her knowledge and bedside manner. Brava because I was very irritated with my clinic that day. 

The ultra sound showed 6 follicles growing on my left ovary and 3 on my right. All in the 10mm category. She explained BEFORE the ultrasound (which was really smart in my opinion) that it was very early and the number we were going to see that day could change. Not to worry if we only saw a few. At 9, I was pretty happy. 

After the ultrasound, I requested to meet with the financial coordinator. She was supposed to have called me back on Wednesday after speaking with her manager about a mistake they made, but did not. This meeting ended up with manager joining us and I will save that for another post. Suffice to say, I was not pleased about a mess-up and I let them know. 

The rest of the day saw me at work, running around trying to get required IVF forms notarized, and finalizing the attorney items. A busy day indeed. The mountain of forms you have to go through is staggering. 

Saturday my GC had her ultrasound and mock transfer. All went well, but neither one of us was informed before hand that she would be having this mock transfer. I'm guessing it was a bit of a surprise for her. 

Which brings us to today. (Shew.) Another ultrasound and blood work. Lining (where I have it) is striped and at 7mm. There are 4 follicles on the left that are 10mm or greater, and 3 on the right. Several smaller ones that may still be recruited. We will know more at my ultrasound on Tuesday. Blood results came back this afternoon and estradiol is looking good in the 500s. As long as it was in the 300's that was a good sign. 

That pretty much brings everyone up to speed. Well, everyone that reads this anyway. Not technically "the end" but a good place to stop for tonight. :-) 

Day 1 and 2 with the doc

Some of my meds

Yesterday was my first visit with the doctor. We thought we were going to have to aspirate my cyst, but Dr. P thought we should check my hormone levels first. We would only aspirate if the hormones were off.

 Last cycle I had a 3cm cyst and my estradiol was way off. I only had 3 follicles and we had to aspirate in order to proceed and get my hormones back in line. Once it was aspirated (general anesthesia - ACK!), we saw 14 follicles. Not exactly sure how that works (were they hiding???, why were we able to see more later on the unaffected ovary?), but that made the initial panic of 3 follicles easier to deal with.

This time I knew I had a 5cm cyst walking in. Turns out it had reduced to 2cm, but I only have 5 follicles currently showing. 4 and 1. My hormone levels came back normal, so we opted not to aspirate. Dr. P ordered an AMH test, and I get the results back tomorrow. Truthfully, I am a bit horrified to get the results back from that one. The follicle thing I can not worry about and simply hope more "appear", but a bad AMH right off that bat will crush me.

We are starting off with a stronger course of meds this time, though the Gonal F is at the same range we started last time (we increased it halfway through last time). 4 shots to the belly right now. Here is the breakdown:

gonal f - 375 IU

luveris/lutropin - 75 x .2

lupride/ leuprolide - 1. mil IU

human chorionic gonadotropin (hCG): HOCOG - 1250 IU

I started researching some stuff yesterday and then I just stopped. It was too depressing and I don't think it is doing me any favors right now. Hopefully my AMH has not tanked (it was 1.7 in February) and then I can be cautiously hopeful. Not even sure if cysts can affect AMH, but I'm too afraid to keep looking. 

Today I'm ok. Got shots in the belly and then socialized a bit with some other patients. For some reason, buying dog food to leave for homeless dogs (I especially worry about the lame ones) made me feel better. I don't know why, it just did. Maybe because it gives me a little bit of control or maybe it's because I feel like I can do a little tiny something to help. Right now I need a super simple way to make myself happy and that did it. I'm sure there are plenty of more laudable things I could be doing right now, but that comes with such complications at times and often tons more stress. 

I'll confess that in the last few weeks, I have, on occasion, semi-prayed. Given my atheist/agnostic ideology, this is quite complex to me internally. Not posting this because I want I bunch of comments regarding religion (quite the opposite), I just thought since it is part of my journey that I better fess up. If you are religious and are reading this, feel free to send your prayers, good vibes, or whatever else my way. I need all the help I can get. :-)

That's it for now. 

Special Lady Cocktails

When I first was swept up by the internet infertility tornado, I remember reading forum posts from other hopeful women. Falling on a theme (as I often do), I obsessed over the ridiculousness of women taking all kinds of crazy pills - usually without having a doctor recommend them. OMG! DO YOU JUST TAKE ANYTHING YOU FIND ON THE INTERNET??? Some posts swore by the helpfulness while others confessed that they worried it may have hurt. Once discovered, some doctors gave full-on lectures how it was not appropriate for the poster's situation, only to find out that someone else (usually another doctor) in their clinic had told them to take it. Truthfully, I was personally affronted that such naivety and desperateness could drive women to arbitrarily take anything in an attempt to conceive.

The picture above is from MY house. That's right, Ms. Holier-than-thou is ...well, the same as everyone else.

At first it started small. My first pill was THE PILL, and I was told I would have to take it by my Indian doctor to make sure I was synced properly for my IVF treatment. Fair enough. I called my OB/GYN and promptly got a prescription. Let me mention here that I do not like taking birth control pills (bcp) as not only does it make me gain weight and experience occasional nauseousness, but sometimes I experience additional glum side effects (depending on the brand). Fine - whatever - I set my alarm on my phone to give me a daily reminder; particularly because my history of remembering to take medicine on a daily basis is pretty dismal. Especially BCP. Our local IVF doctor also advised to add a pre-natal vitamin (another item bound to make me nauseous) and I immediately relented as I ran to our local Publix.

Baby aspirin and acupuncture were added to the regime - the latter being something I normally would have scoffed at a year earlier. Doctor semi-recommend it and so I shelled out the cash. My husband gave me the big-eye, but I'm guessing he recognized my fervent look and said nothing. 100 bucks a pop for 6 weeks = not cheap. What can I say except I wanted no regrets.

IVF treatment #1 was dismal. 2 eggs retrieved, only 1 fertilized. Even that 1 took a damn long time to fertilize.

Now I am prepping for treatment #2. In typical fashion, I have been obsessively researching similar cases. Not just blog posts, but academic papers and any type of current research I can lay my grubby little eyes on. A clinic in India recommended 25mg of DHEA for 3 months. I rush to pull up the scientific documentation and realized all of the research is really based on a tiny Tel Aviv study. The study showed a significant difference in live birth rates with women who were poor responders and took 75mg of DHEA for 40 days vs women who did not. A follow-up study had additional encouraging results. Screw the 25mgs -I only had about 40 days till cycle, I was going to go full boat - 75mgs it is! [I would like to make a note here that I was not able to take the full 75mg initially because of side effects. I had to build up and even now I have minor side effects.]

Next I read how melatonin could also help woman with poor ovarian reserve and immediately I was hunting down more articles and recommended amounts. 3mgs seemed to be the magical number, but that amount knocked me on my butt. Still 1-2mg was doable and thus it was added. Combining it with the DHEA means I sleep really well, but I'm groggy as all get-out when I wake up. Heaven help me if I don't get a full 8-9 hours. Oddly enough, my friend says she takes 10mg all the time and it barely helps her sleep. What can I say? I'm a lightweight.

Did I stop there? Heck no! I was on a search that day and after reading some articles (which I can not find at the moment) regarding myo-inositol, my amazon shopping cart increased. Among other things, myo-inositol was suppose to help women with cyst issues and a giant cyst almost caused a no-go last cycle. My OB/GYN found a cyst last year and I began to wonder if some of the pain issues I had felt over the last year were cyst related. GIVE ME MYO-INOSITOL NOW!!!

There were a few other things on the list, but these 3 new items had good scientific data to back them up and they applied to women with similar (if not exact) conditions. The other pills I noticed my fellow women-at-arms were taking were either less scientifically regarded or didn't apply to me. Besides, as I mentioned before, I'm a light weight and I wanted to see how I was going to handle this new concoction.

Which brings me to last week. I'm not quite sure HOW I ended up at the Rainbow (read: hippie) Grocery store - but all of a sudden I found myself at the cashier's stand with CoQ10, some fancy fish oil supplements, and yes even some Royal Jelly that was well hidden in a jar of honey. And some awesome low-sugar dried mango. And a yummy nut mix. And Activated Charcoal that I told myself would be good to have on hand if my dogs ever get into something they shouldn't. Somehow I think my subconscious was trying for an easy excuse to get some for me. You know. Just in case.

"Just a spoon full of sugar..." (or honey) 

First day jitters

Our nice A/C waiting room is for IVF peeps only. We waited only a short time (by universal doctor standards) to have our initial consult and then blood drawn. After which, we grabbed some lunch at The Rama Hotel's Thalis restaurant. Both my husband and myself enjoyed it very much, although it was on the sweeter side of his preference - typical of Gujarati cuisine according to him.

After lunch, we came back to the clinic as directed. After another short wait we were able to see Dr. Patel. She was concerned about a high estradiol level and we went over the dreaded "you're 40 speech". I appreciate the honesty, but that is one "tut-tut" I've grown weary of, regardless the source. We followed up with a scan that gave us more bad news: only 3 follicles and a 2cm cyst. The cyst would have to be aspirated to insure the highest chance of success. Come back at 5:30pm. Eat or drink nothing.

"Ok!!!! Wait what?" We had 3 hours to burn in the heat of Anand (currently at 104 F) and I was instructed not to drink. Fine. We took a rickshaw/tuk-tuk (my first ever!) to the famed Big Bazaar (BB) where even the girls in Bedazzled burkas stared at me. The BB here is like a really tiny Walmart with food items. Even though the drinks were in a refrigerated area, the want to drink was too much and I walked back over to the skin lotion aisle. The Nivea whitening lotion I bought is a testiment on how well marketing works (I've seen the commercial 30+ times now, and it has convinced I'm covered in spots from skin damage, even though I'm not positive that's what the Hindi spoken commercial says.)

After BB, we return to the hotel for an hour, and then back to the clinic. At the clinic, in a not so A/C area, I'm handed a consent form to sign. I ask what it is for and I understand it is for the anesthesia; it's at this point I realize I will be getting GENERAL anesthesia and not local. Ask my husband to confirm this and he does. Crap. I'm not known for doing well under general anesthesia. I prepare myself (and others) for the liklihood of puking.

Fortunately, I did not puke when they woke me up, but my husband was asking me what the class of antibiotics was that I have a problem with. Once we figured that all out, an older lady in a white sari added a yellow liquid filled syringe to my empty IV. They let me rest till I was good and ready to come back downstairs.

Dr. Patel informed us that once the cyst was aspirated, she could see 14 follicles. Yay!!! I had to confer with my husband that I understood correctly. Not because any language barrier, but because I still felt a little loopy. He said yes and I was jubilant, if not completely dexterous.

That pretty much was the end of our first day. We went back to the hotel for me to rest, which really turned into me going to bed for the night. My poor husband missed dinner for the second night in a row.