Warning: A Movie to Avoid if You're Feeling Fragile

R and I decided to have some fun this afternoon (and procrastinate on work) by going to see a movie. We figured that in keeping with the spirit of holiday cheer, we would go see "Four Christmases."

I'm a fan of Reese Witherspoon, and it was a cute movie, but a word to the wise: If you are feeling fragile about infertility and the holidays make it even worse, this is NOT the movie for you.

There was NOTHING in the movie previews that hinted at the subplot of this movie, and none of the reviews I found online mentioned it at all, either. I won't spoil it for those of you who are in a happy place and are planning to see the movie, but suffice to say this movie did not end up at all where we expected it to.

Fortunately I was in an okay place, so it didn't leave me in tears, but R has been struggling a bit lately, and he was pretty bummed by the end of the movie.

On a different note, I had an appointment with the regular endocrinologist on Tuesday. It did not go well. He basically told me that my TSH levels are abnormal but not abnormal enough to cause symptoms. (Never mind the rapid heartbeat, high blood pressure, tremors and dry eyes at the time of the hyperthyroid results, or the fact that I can't seem to stay awake for more than 8 hours at a stretch now that I am on the hypo side of things.)

The only thing he is willing to do at this point is have me keep coming in every month to get blood drawn. (Which, of course, he requires be done through his private lab, rather than any of the labs my insurance is contracted with.) So basically, I'm paying big bucks every month to pad his bank account while he sits there and tells me that nothing is really that wrong with me.

I pointed out that doing nothing about this isn't really an option, since we have 10 embryos on ice right now. His response was that even if he does something to address the TSH, that's a moot point because I have anti-thyroid antibodies since my issue is being caused by autoimmune thyroid disease. So he said that, combined with my history of miscarriages, means that in his opinion there is no way I will ever carry a successful pregnancy. Nice timing, now that we've already created the embryos.

My Non-IF Hobby

When I'm not poking myself with needles, obsessively researching treatment options or tending to my day job (whish provides the funds for the needle poking and treatment options), my other hobby is baking.

When I have a chance to bake, which isn't often, I tend to go, um, how shall I say this? A wee bit overboard.

Take yesterday, for example. I was in charge of the Thanksgiving pies. I baked four - for eight people.



Yes, I know, one would have sufficed. But FIL loves pecan pie (lower right - it's not burned, though it looks like it in the photo), so I always make one for him. And BIL's favorite is cherry; this year I decided to fancy it up a bit and make a lattice top crust.

I've never made an apple pie, and this year I was determined to do it. I use store-bought crusts, because I'm not that into making dough, but I made the filling from scratch, with three different kinds of apples. (I read a tip in a magazine that using a variety of apples gives it more flavor.) I tried to press a design into the top crust, and that didn't turn out so well. Next year, I want to copy a pie crust I saw in a magazine that used cookie cutters to cut apples and leaves from dough and then added those to the top crust; first, I have to find apple and leaf cookie cutters.

And then of course it wouldn't be Thanksgiving without a pumpkin pie (in this case with a pecan strudel on top), so that made a total of four.

But the good thing is, we left about 90 percent of them over at my in-laws, so the pies will stick to their waistlines more than ours!

Day 6 Was Less Exciting

The lab was hoping 7 to 9 more would make it, but we wound up with 4, so we have a total of 10.

That's a good number, I know, but ultimately it doesn't mean anything until we get the CGH results back and find out if we have any normal ones to transfer.

And speaking of transfer, I got a phone call from RE's nurse today. In an e-mail I had sent her last week, I mentioned being afraid to transfer them back to me and that we might at some point decide to go the gestational surrogate route instead. So she called to let me know that there are additional FDA rules requiring more bloodwork for R and me for GS, and she didn't know if we would be able to meet those rules at this late date.

It turns out we are, but only because R left work unexpectedly for an heroic and frantic sprint to two different labs so that his blood could be drawn before they closed this afternoon. All of that panic was because it turns out the male partner has to be tested for communicable diseases within 7 days of egg retrieval, and today was the 7th day. (Two labs were because the blood could only be drawn here, then has to be shipped to the clinic for testing, and the first lab he went to - the one closest to his office - does not do blood draws if they are not also going to be running the test.)

I also have to do the tests, but for some reason the FDA grants the female partner 30 days instead of just 7.

Maybe I'm just in a mood to be extremely irritated by every little thing, but it really ticks me off that no one at the clinic mentioned it to us before now. It would have been so much simpler to have the blood drawn while we were there the day of my retrieval. I'm particularly nervous about it having to be shipped, because I had to do that for the one-day workup, and the lab that drew it (the same one R wound up at today) stuck it in the back of a freezer, where it sat for a week while they insisted that they had mailed it and that the receiving lab had lost it. That little escapade took four hours of my life over the course of three days before I could finally get someone to locate it in their freezer and actually put it in the mail to be shipped.

So I'm not looking forward to having to keep track of shipping again, particularly because if they lose these vials, it's not just a matter of re-drawing it; it would mean we couldn't use the embryos from this cycle for GS at all.

And it's so totally ridiculous that we have to go through all this hoopla in the first place. If we had never done IVF before and had never had any miscarriages, I could see why no one at the clinic would bring up additional testing for the possibility of GS.

But the two VERY. FIRST. THINGS. out of REs mouth during our initial phone consult this spring were 1) donor egg and 2) gestational surrogate. So it's not like the subject hadn't come up. And with 6 miscarriages, it's something they could have at least said "ya might want to consider this, just to cover all your bases."

I know that ultimately, we cycled where we did for the lab. Although honestly, we had 10 blasts that were frozen during our first IVF too, so right now to me everything feels exactly the same, and I don't know that we're getting a whole bunch of benefit from the revered lab.

Next up: Six to eight weeks of waiting for the CGH results, and tackling the thyroid issue, beginning with another appointment with Regular Endo tomorrow.

The Day 5 Report That Almost Wasn't

I swear I'm not usually a **tch, but my guess is the staff at the clinic probably stands in a back room somewhere and draws straws to find out which of them is going to be the unlucky one who has to deal with me.

I started getting nervous late this morning when I didn't get the call with our Day 5 report, because we got our Day 1 and Day 3 reports before 10 a.m. Then 11:30 a.m. turned into 1 p.m., which turned into 2 p.m., and finally at about 3:45 p.m. I couldn't stand it anymore, so I called the on-call nurse to find out what was going on with our embryos and whether they had forgotten about them or dropped the whole lot of them on the lab floor or something.

You'd think they would understand that a patient wants their Day 5 report on, well, Day 5. But she informed me all the embryologists had gone home for the day, and if I wanted my Day 5 report, I would have to call back on the morning of Day 6.

Seriously, when has that kind of a response ever gone over well with a still-hormonally-ramped-up infertility patient?

So I threw a hissy fit and informed her that that was a totally unacceptable answer and that someone needed to either a) call me from home with my report or b) get back in their car, drive back to the clinic, look the da** report up on the computer and give me a call.

About 20 minutes later, I finally had numbers: they biopsied and vitrified 6 of the 18 today. That sounded like a woefully low number to me, but the embryologist said a rate of 30% or higher on Day 5 is great. She said they're still growing the other 12, and it looks like 7 to 9 of those might be able to be biopsied tomorrow. She promised me someone would call me tomorrow without me having to make another ticked off/hysterical plea.

I asked how many she thought might wind up being normal, but she said there's just no way to tell, and pointed out that if they could determine which ones were good based on the way they look, there wouldn't be a need for chromosomal testing to begin with. Fair point, but ya can't blame a girl for tryin'.

I also asked about R's sperm. He had 65 million per ml on the day of retrieval. Way to go, R! Numbers like that are still so amazing to us, given that at the beginning of this process nearly 6 years ago, he had 5 to 10 (not million, just 5 to 10) normal in each sample. I think that numer alone made his day.

Tomorrow, I will try to sit and wait for the call patiently. We're going to a Christmas concert matinee with R's family, so I won't be able to post until late again tomorrow.

Day 3 Report From Home Sweet Home

We finally made it back. On the one hand, I was thrilled to see our furbabies, and it's very nice to sleep in our own bed.

On the other hand, it's still 80-friggin'-something hot here! Next week is Thanksgiving, for Pete's sake. I shouldn't be having to turn on the ceiling fan in the bathroom while I'm getting ready in the morning, nor should I be sweating (even with the A/C on) while I'm driving in to work.

Clearly the desert has not received the memo re November = autumn temperatures. I tend to hold pretty conservative views, but if you don't believe in the greenhouse effect, come spend Thanksgiving week in a place where the temperatures make a tank top feel like overdressing and the pumpkins wilt, and then decide for yourself.

Ok, on to more fun stuff. Today's Day 3 report: 15 of the 18 are the "ideal" 6-10 cells, 1 is 5 cells but may still catch up, 1 is 11 cells and 1 is 13 cells. In terms of fragmentation (ideal is 20% or less), 2 are at 20%, 2 or 3 have no fragmentation at all, and the rest are at 10% or less.

The embryologist was quite happy. Possibly almost happy enough for both of us. Which is good, because this report has elicited a rather unexpected response from me.

We signed up for the cycle aware of RE's prediction that we would only have 0-2 normal embryos. Not a happy thought, but if that turns out to be the case, at least it would give us an answer. And, I wouldn't necessarily be able to blame myself, because maybe it could be me, but maybe it's R (given his sperm issues, that's not out of the realm of possibility), or maybe it's just our genetic material combined that doesn't work. We would have no way of knowing, and I think I could be okay with accepting that. (Not to say we wouldn't necessarily try and try again, but just that we would have some answer.)

And, it could still turn out that we have 0-2 normal when the CGH is said and done. (I didn't ask the embryologist today what she thought the chance of that was. Maybe I'll ask during the blast report on Saturday.)

But now this report, and the embryologist's enthusiasm, has kind of raised my hopes that maybe we'll have more than 0-2 normal. And while that would be great for obvious reasons, the main reaction I'm having is fear.

If we have several normal ones, I may be too afraid to put them back in me. Because then, if they go back in me and it still doesn't work, it will be my fault. Or, at least, my body's fault. But since I'm in my body, ultimately it will be my fault.

Even if my thyroid issues get resolved, I don't know if I can do this. (Apparently I've begun using the term "if" with all medical issues, infertility or not.)

I'm not quite sure where that would leave us. I don't know my sisters, so I couldn't ask them to be a gestational surrogate for us. We're closer to R's sister, but she's not necessarily in a situation to do that, either. One of my best friends would have been totally willing, but she had a uterine cauterization procedure done a few years ago, so that's not an option. (She's so sweet - she said if she had known then that I might need her uterus, she wouldn't have done that procedure.) I don't know that I want to find an unknown surrogate, because to me that feels like it has too much potential to go the route of all of our adoption situations and fall apart.

But I also just don't know if I can attempt another pregnancy. I suppose this is something I should have thought of before we created all these embryos. I didn't expect to feel this way.

Fertilization Report

We got the call from the embryologist this morning. Of the 30 eggs retrieved, 24 were mature, and 18 fertilized normally. So far, it sounds almost identical to our first cycle. I'm curious to see if all 18 make it to day 3, like all 17 did last time.

Surprisingly, I'm not in nearly as much post-retrieval pain this time around. I spent yesterday liberally popping Extra Strength Tylenol, and it hurt quite a bit when R made me laugh last night, but I stopped the Tylenol after this morning because it seemed like overkill.

Last time, the day after retrieval I could barely get in and out of the car because it hurt so much to bend down or bend over just a little bit. (I had a small car at the time, and it was pretty low to the ground.) So I'm thankful that isn't the case this time, because I was a little nervous about whether I'd be in pain sitting on a plane for a couple of hours, but I think I'll be fine.

Which brings me to my next bit of happy news: We get to go HOME!! We're flying out tomorrow night. I was actually tempted to try to leave tonight, but I didn't come up with that bright idea until about 7 p.m., which gave us exactly 2 hours and 40 minutes to pack up (we hadn't even started packing), notify the hotel and car rental company that we were leaving a day early, drop the car off at the airport, catch the shuttle to the main terminal, get through security (with two laptops and R being hand-searched), get to our gate and get our butts in the seats before they closed the door behind us. Not to mention, call my in-laws sometime during all of that and convince them to pick us up at the airport at 11:30 p.m.

Needless to say, R nixed that crazy scheme pretty quickly. Oh, well, it's been 15 days, so at this point what's one more day, right? I will be so glad to see our furbabies though!

Retrieval is Done

I'm back at the hotel and resting. So far, there's minimal pain, but that's probably just because the anesthesia and pain meds haven't fully worn off yet. I'll be popping Extra Strength Tylenol like crazy for the next few days, I'm sure.

RE retrieved 30 eggs. I know, that sounds like a great number, particularly if you struggled to get even just 4 or 5. But keep in mind that last time we did this, we got 32 eggs, 20 were mature, 17 fertilized, 16 of the 17 had 8-10 cells on day 3 (the 17th had 7 cells), all had fantabulous GES scores, 2 were transferred at day 3, 10 of the remaining 15 made it to blast, 8 of those 10 survived thawing and were transferred during three FETs, and out of all of that we wound up with two pregnancies, 3 miscarried babies and 0 live kiddos.

One of my best IRL friends, on the other hand, cycled a few months before I did IVF #1, with the same RE that I did that cycle with. (Different clinic than current clinic, but still a top-notch clinic.) She wound up with 3 embryos, none looked fantastic, none to freeze, and she has an almost-2-year-old to show for it. She went back to said RE and cycled again two months ago, 4 embryos, only 1 looked decent, two were only 4 cells on day 3, they stuck all four back, and she's 10 weeks pg.

So, to me, 30 eggs means nothing. Except for the fact that I will probably be in a lot of pain for the next few days.

We'll get the fert report tomorrow, the day 3 report on Thursday, and the blast report(s) on Saturday/Sunday. The CGH report won't come until early January. If that shows a bunch of normal embryos, then maybe, just maybe, I'll be a tiny little bit excited and think that perhaps we really can chalk some of the past losses up to my thyroid issues.

Oh, and lest you read my previous post and think "What the heck is she talking about with regard to the title and description going next to the photo??" - I gave up and took the photo off the title bar and stuck it in the About Me bar. Not ideal, but better than what it looked like before.

A New Look...Sort Of

As you can tell, I decided to update my blog. After four years, it was way overdue.

However, as you can see in the title line, Blogger does not seem to be entirely cooperative. I'd like the title of the blog to go on one line to the right of the photo, and the description to go under the title. After I gave up on it, R spent 2 hours working in the html trying to get it to work, and he didn't have any luck either.

If any of you knows how I can get that to happen, by all means, please share.

Triggered!

Thank God. I've never been so happy to do an IM injection in my life.

I mostly coasted yesterday, with 37.5 units of Menopur in the morning and 37.5 units of Follistim in the evening, because my estrogen level shot up quickly. It was only 1,100 on Wednesday, but on Thursday it doubled to 2,200, and by yesterday it reached 3,700.

The coasting seemed to help, because it was back down to 2,700 today. Retrieval will be Monday morning. We're going to stick around for at least two days after retrieval, because the clinic wants me nearby to monitor for OHSS.

On a much more fun note, I slept in until 11:15 today. Well, technically, I dragged myself out of bed at 6:45 to be at the clinic by 7:15, but as soon as I was done there, I came back to the hotel room and went straight back to bed. It's been a long time since I've slept that long!

Once I finally got up for good, we went to Vail. We've never been there, so it was fun to see. It was absolutely beautiful! We walked around Vail Village, which features a very picturesque creek running through it. (Being from the Southwest desert, we're easily excited by any scenery that includes water, or trees for that matter. And trees ever-so-lightly dusted with real snow - it's almost beyond imagination! :-) )

On top of all the gorgeous scenery, we also got our pooch fix. We're missing our furbabies; we've never been away from them for this long. In Vail Village, there was a couple walking around with a pair of Bernese Mountain Dogs, and another person also had a BMD.

I love big dogs, and I've wanted a BMD for a while now. The gentleman who was part of the couple with the BMDs told us that they rescued theirs from a breeder. They said some of the top breeders destroy BMD puppies that aren't show quality, because they don't want them to wind up in the gene pool for future breeding if they aren't top quality. He said some of those breeders will let you rescue a puppy for a fraction of what their show pups cost, as long as you sign a contract agreeing not to breed the pup.

I was horrified. I worked for a while at our local animal shelter, and our entire zoo is comprised of rescues. Two of them are purebred Australian Cattle Dogs, and I belong to a couple of e-mail lists for that breed and another. Most of the breeders on those lists have the motto "if you don't rescue, don't breed." I've never heard of breeders destroying puppies that aren't show quality.

I think we'll consider a BMD at some point, as long as we can find one via rescue. But right now probably isn't the best time for that; as much as it pains me to think of any of our babies passing away, right now our furbrood is big enough, so we don't need to be adding to it.

My Brain on Drugs

During my blood draw today, the phlebotomist told me a story of how a patient completely forgot to come in for a blood draw one day in the middle of her cycle. The patient was three hours away, in the mountains, when she realized and called in a panic.

The phlebotomist said she could understand how a patient might forget something like that at the beginning of a cycle, but she didn't know how it could happen in the middle of a cycle, when you have to go in every day.

I have the answer for her: that's what happens to your brain when you're on all these drugs.

Immediately after that conversation with the phlebotomist, I left the draw room, went up to the receptionist and inquired about getting claim forms to submit for insurance purposes. Then I walked out the front door.

And about 9 hours later, while sitting at dinner in a restaurant and mentally running through tomorrow's schedule in my head, I let out a lound gasp that made R jump. Because I realized that I had forgotten to make an appointment for tomorrow's ultrasound and blood draw. Immediately after hearing a story about someone else who forgot to show up for an appointment.

I blame it on the drugs. At least the phlebotomist will get a laugh out of it the next time I see her. (Assuming, of course, that unlike the appointment, I can actually remember to tell her about this.)

So I guess I'm going to have to call first thing tomorrow morning and find out when they can fit me in. I don't think they're going to let me skip a day, because my estrogen doubled in the course of 24 hours, from 1,100 yesterday to 2,200 today. So at least for the next 24 hours, I am on almost zero stims - they've eliminated tonight's Follistim dose (150 units) and cut tomorrow's Menopur dose from 75 to 37.5 units.

To try to prevent OHSS, they've also told me to eat lots of salty foods to try to keep fluids in my veins rather than filling all the empty follicles I'll have after retrieval. The only thing is, high levels of salt cause hypertension. And my thyroid issues are already causing hypertension, so I'm on beta blockers to keep my heart rate and blood pressure down. So eating lots of salt probably isn't the best idea for me at the moment. Let's hope it doesn't cause my pressure to spike and wind up getting me canceled on retrieval day, because they said my pressure has to be normal for them to do the anesthesia.

The nurse is also now saying that my retrieval will probably be Sunday or Monday. It was originally supposed to be yesterday, but every day I go in, it gets moved one day further out, even though my eggs do seem to be growing. (At least, they look a heck of a lot bigger on the screen now than they did a few days ago. And I've done upwards of 50 ultrasounds, so I've gotten pretty good at reading them.)

I sent my mother (who lives with us) an e-mail tonight that said, "You might as well start packing up the house and plan to move up here, because I don't think we're ever going to get to go home..." I didn't think I'd get to see MamaSoon when she arrives for her cycle at Thanksgiving, but at this rate, I just may!

Did I Jinx Myself?

I may have spoken too soon.

My right side didn't seem to really grow today when compared with yesterday. My left side grew a little bit, but it looks like retrieval will be pushed out at least one more day to this weekend, rather than the end of this week.

Oddly enough, despite my follicles rather anemic growth, my dosage isn't being increased. I think they're still hoping that the slow growth will ultimately mean a few follicles will not continue to grow, and I'll get down closer to 20 follicles. But considering I've got 15 on one side and 15-20 on the other, I'm not necessarily optimistic about that.

I've been working remotely for 6 work days now. My boss is beginning to wonder if I'm ever going to come back. Thank God he's been very understanding and supportive, particularly given that I've been with the company for less than 8 months.

Finally, My Follicles Have Kicked Into Gear

This morning was the second day in a row that my follicles showed good growth - yea!

The down side is that it looks like there are 20-25 that may be growing. I know, I know, for most IVFers, that sounds like a great problem to have. And if only quantity equalled quality, I'd be thrilled. But during IVF #1, we got 32 eggs and still have no baby to show for it. So I'd much rather have a lower number of eggs and actually wind up with a kiddo out of this.

RE was hoping to keep it down to 20 eggs retrieved. We'll see if a few of them stop growing during the next couple of days, but my guess is we'll wind up closer to 30 than 20 in the end.

Stimming for this long (9 days so far, with probably at least 3 more to go) is a new experience for me. Not that I have a lot of experience to draw on, since we've only done one other IVF prior to this. But that time, I only stimmed for 9 days total. What I gather from the nurses is that it's common for PCOS patients to stim much longer here, and in a way I'm glad about that - it gives me a little bit of hope that maybe the outcome will be better this time.

The only things I'm not liking about the long stim are all the needles and ultrasounds involved. The ultrasounds usually don't bother me at all, but I was wincing a lot today - those parts of me don't see action on a daily basis, well, ever! :-) So I'm starting to get sore.

And the needles - ugh. I didn't have a lot of good veins for blood draws to begin with when we started this process 6 years ago. Now, between the scar tissue that has formed over some of the veins and others that have just plain worn out, phlebotomists have even fewer options. After drawing me today, the phlebotomist gave me a baby heel warmer and told me to activate it as soon as I'm done with tomorrow's ultrasound and stick it on whatever spot I want her to try for. (The heat brings the veins closer to the surface of the skin.)

I also don't remember my last clinic having me on Lupron this long. I think they had me stop the Lupron soon after I started the shots, although I could be wrong about that. Between that, the Follistim, the Menopur and the Lovenox, I'm doing four injections a day. I have a big stomach, so lots of surface area to work with, and I'm still running out of room! (This is the only, and I do mean only time I have ever looked at my stomach and been even just a teeny (very, very teeny), tiny, little bit glad that it's not totally flat, because if it was, I don't know where I'd stick all these needles!) If someone who didn't know me saw my stomach, they'd think I'm a drug addict for all the track marks I have. :-)

My Eggs Are Growing...Slooowly

We managed to get ourselves (and the meds) packed, on the plane and to the clinic relatively unscathed.

Thanks to the advice some of you gave in the comments, we used a regular lunchbag with some cold packs to take the meds with us. I put R in charge of that, which worked out in the end, although I did have a few moments of panic about three hours before we left when I asked him if the cold packs were in the fridge and he said, "Um, I think we have some, somewhere in the garage - I haven't gone to dig them out yet..." Nothing like leaving that to the last minute. I have no idea what he would have done if he hadn't been able to find them.

We were quite the sight going through security at the airport. The terminal we were in has four different security checkpoints. We opted for a lesser used one, even though it meant we had to walk farther, because there was absolutely no line whatsoever.

In addition to the lunchbox with the meds and a plastic grocery bag with all the needles and syringes, we had two laptops and a portable printer, and R has to be hand-searched now because of his defibrillator. I think at one point there were four TSA staffers working to get us and all of our stuff through security. They were very kind about it, even packing one of the laptops and the printer back into a bag for me while I tried to gather the rest of our stuff and R was still getting patted down.

We've been at the clinic for 5 days now, and there's not much to report on yet. I've decided that this part of the process is the medical equivalent of watching paint dry.

I had 45 antral follicles (gotta love those PCOS ovaries!), so the challenge is to get less than half of them to grow. RE started me on a very low dose of stims (75 units twice a day), and has only upped it by 75 more per day so far.

Today was the first day the follicles looked like they've really started to respond, so retrieval probably won't be for 4 or 5 more days.

In other news, I finally got a call from the regular endocrinologist's nurse on Thursday. (I was supposed to get my results from them on 10/30.) It turns out that the bloodwork they ordered on 10/28 showed my TSH level to be high rather than low, like it was a month ago. So the endo thinks I have thyroiditis, which means eventually my thyroid will burn out and I will become hypothyroid.

"Eventually" being the key word. I asked the nurse what the next step is, and she said, "Oh, we just have to wait for your thyroid to stop swinging wildly from one extreme to the other and settle down. Then we'll take it from there."

I said, "Do you have any idea when that might be? Because apparently it's been swinging for about 7 years now, and I don't have another 7 years to wait for it to make up its mind..."

I swear, the thyroid thing explains so much of my life for the past several years. Like, for instance, why when I work really hard on dieting and exercising, even though R and I eat the same things but I eat less of it, and I exercise and he doesn't, weight falls off of him without any effort (except for eating the healthier stuff we cook), and at the same time I gain weight!

My next appointment with the endo is two days before Thanksgiving, so hopefully we'll finalize a plan at that point. (And believe me, waiting for my thyroid to make up its mind on its own is not going to be part of the plan.)

Help - A Medication/Packing Question

For once, my body has cooperated. I finished the Provera last Friday, and CD1 showed up yesterday. That means we purchased plane tickets last night, stims start on Sunday, and we're jetting off to the clinic on Tuesday night (Election night) so that we'll be there for the first stim u/s on Wednesday.

Now, for a stupid question: How do I transport the stim drugs, which require refrigeration? I don't want to send them ahead, because I would be nervous about something happening to them. But how do I keep them refrigerated for 2 hours at the airport, a 2-hour flight and then the 2 or 3 hours while we collect our luggage, get our rental car and get to the hotel?

When the meds were shipped, they came in cold packs, but I don't know if those are reusable. (And, come to think of it, I don't know if R kept them or tossed them in the trash.) Last time we did this, we drove to the other clinic, because it was much closer. Because of that, we were able to just stick them in a cooler in the trunk of the car.

There's probably an easy answer staring me in the face, but frankly, I'm too tired to see it.

Poking Along, Literally

Ok, so that title is bad attempt at being punny...sorry to make you endure it, but it's the best I could come up with.

The Lupron shots are going fine; stim shots start next weekend.

So far the side effects are the most challenging thing. In the past, I've never had an issue with Lupron, but this time around I'm getting headaches. I'm also on an anti-depressant that makes me very, very sleepy, to the degree that if I know I'm not going to be able to get at least 7 hours of sleep, I skip the dose that night because it wouldn't be safe for me to drive the next morning if I took it. But the dexamethasone is giving me insomnia. So now I lay in bed, so sleepy that I can barely even open my eyes, yet every 10 minutes or so I wake up, toss and turn, then fall back asleep for a few more minutes. Somehow, R is managing to sleep through all of that. Oh, well, one of us getting a decent night's sleep is better than nothing...

Now I'm heading upstairs to start planning how to pack for this upcoming cycle. Because this time around is a different clinic and we are not driving, I'm not going to be able to pack everything like I did last time. (Imagine your parents' station wagon, crammed to the top of the windows and with luggage roped to the roof, for a week-long road trip with 5 kids - that's what our car looked like.)

Unless I plan to take up the overhead bin space for me and 9 of my closest seat mates on the flight, I'm going to have to pare down the list a bit...

Breathing In, Breathing Out, Beginning Injections

I know my last post was one big, long, hysterical shriek. You'll be glad to know I've calmed down quite a bit, and we're moving forward with our cycle.

I was able to talk with RE last week. He explained that he tested for something called anti-Mullerian hormone, and my level was lower than expected, so he thought it would be okay to skip the birth control pills. (He believes there's still an increased risk of blood clots even if I'm taking Lovenox, though other doctors seem to disagree. But then again, when does anyone in the medical community agree about anything? But I digress...)

I've never heard of AMH before, but apparently it gives an indication of how severe one's case of PCOS is. And if RE's nurse had explained that to me a month ago when I first raised my concerns, I probably would have been (at least slightly) less hysterical about all of this.

RE made it clear that he was not happy being questioned, but I'm not the type to move forward without being comfortable with something, so I guess we're both going to have to learn to give and take a bit.

Speaking of not being comfortable moving forward, I've decided that I'm not on board with the radioactive iodine that is involved in the thyroid scan and uptake test. Apparently radioactive iodine (RI) has a half life of 11 days. I spoke with a radiologist today who said it would be fine to do a transfer three months after the test, but if the test causes them to recommend that I take the full dose of RI to kill off my thyroid, I'd have to wait an entire year before trying to get pregnant. And my family physician and RE both said they've had patients who have required 2 or 3 doses of the full RI treatment before it worked.

R and I talked about it tonight, and I just don't feel okay with the idea of putting any sort of radioactivity in my body. We've gone through hell these last 6 years, and now that we've found a possible answer to some of our losses, I don't want to take the risk of causing damage by ingesting the RI. So I'm going to call my family physician tomorrow and set up an appointment to talk with her about skipping the scan and whether she would be willing to take the approach of just treating it with medication (which may require some trial and error to get the dosage right) or having surgery to remove the thyroid and then start Synthroid for hypothyrodisim (which is a lot easier to control with medication than hyperthyroidism is.)

Someday, I keep telling myself, all of this medical drama will end. But in the meantime, I'm off to give myself the first injection (Lupron) of this cycle - here's hoping R and I don't get the dosage wrong, which has happened before.

One last thing: Thank you to those of you who commented - I appreciate the honesty and support. I will be catching up with all of you soon, hopefully within the next few days. (I want to get the shot done and get to bed before midnight tonight, so I'd better get offline now...)

WTF?? Or am I Just a Complete Idiot?

Alright, folks, I need your honest opinion. I'm six years into this mess, I'm tired, I'm BEYOND furious, and I'm not sure if I've just lost all perspective, or if this is typically how an IVF cycle goes and I was just incredibly lucky to have a smooth cycle the first time we did this two years ago.

So I need you to tell me if I should be shrieking hysterically at my IVF nurse or if I should sit down, shut up and just do as I'm told. Which, apparently, may involve me getting poked with a needle every few days from now until 2025 or until one of my ovaries decides to hack up an egg, whichever comes first.

The original plan for this cycle was a month of birth control pills, lupron, and low-dose stims. Because I have Factor V Leiden, the RE wanted me on Lovenox while starting with the BCPs to reduce the risk of a stroke. However, he wanted a hematologist to prescribe it rather than him since I'm out of state and he doesn't frequently use it in his patients.

Unfortunately, Hematologist was less than cooperative in returning phone calls, etc. So after two weeks of RE's Nurse trying to reach Hematologist to discuss this, it escalated from "we still have plenty of time" to "CD 1 is going to show up any moment now and I still don't know who in the hell is prescribing the Lovenox."

RE's Nurse went to RE and said, "What do you want to do if we can't get Hematologist on the phone?" RE responded by looking at my chart and proclaiming that we could do the cycle without the BCPs.

So RE's Nurse sends me an e-mail that very noncholantly mentions "and, oh, by the way, we've decided to skip the BCPs, so don't worry - we still have three weeks to work out this Lovenox issue."

I don't respond well to my protocol being noncholantly revised without any warning or explanation as to why. So I had a very nice heart to heart with RE's Nurse trying to understand why, suddenly, the BCPs were unnecessary and why, if the BCPs are unnecessary, they were included in my protocol in the first place. (They were also used during my first cycle two years ago with a different RE, so this is the protocol I'm used to.)

I explained that I was concerned that eliminating the BCPs would make it difficult to know the timing of this cycle, and that without knowing the timing of this cycle it would be difficult to handle little details like, oh, I don't know, plane reservations, hotel reservations, arranging time off work.

She assured me that that would not be the case. ASSURED me. Told me that all we needed was for CD1 to show up, and then she would be able to put together my calendar, and we would be off and running. We would have a plan.

I like plans. Plans are important to me. Granted, things never actually work out exactly the way they're planned. But still, I function best with a plan.

So CD1 shows up a few days after that reassuring conversation with her. (That was three weeks ago.) On CD4, I receive my calendar from her. On the Oct. 15 and 16 dates, there are the words "expect period" written across them. What the hell? RE and RE's Nurse know that I have PCOS. They know that I don't have regular cycles. So I sent a very noncholant, very sweet note that said (and I quote) "What on EARTH makes RE think that I'm going to have CD1 on 10/15 or 10/16 when my cycles range anywhere from 2 weeks to 10 weeks?" And "My understanding from our conversation on the phone was that I just needed to have CD1 show up (which it did four days ago) and then we would be able to lock in dates, so that I could lock in flight reservations, hotel reservations, etc. So exactly how confident are you in these dates, because I'm planning to make flight reservations tonight."

I got back an e-mail that said, "Oh, I'm so sorry, I must not have been very clear. Those dates are only estimates, assuming a 28-day cycle. If CD1 shows up much earlier or much later than 10/15, we'll have to completely redo the calendar, so don't make any reservations until your next CD1."

Pardon me, because I rarely curse in front of other people, but WHAT THE FUCK? She specifically told me that all I needed was CD1, and then I would have a calendar. And now that I got CD1, and I have a calendar, it's basically useless and I need to wait until the NEXT CD1??

Ok, that was problem #1. Problem #2 came up today.

Today, my calendar was marked for me to get a P4 level drawn and then start Lupron tonight, assuming the P4 results were okay. Now, I thought it was a bit bizarre that I was doing a P4 draw on CD21 when we're basing this entire calendar on some sort of assumed, fictituous 28-day cycle that my ovaries are not prone to follow, and what the heck happens if I start Lupron now but CD1 doesn't show up next week on the date that RE pulled out of his ass?

But being the good little patient that I am, I drag myself out of bed even earlier than usual this morning and head down to the lab to get poked.

A nurse (not my assigned RE Nurse) calls me almost at the end of the day to inquire about what time I got the labs drawn, because they still hadn't received results. Then she spent 5 minutes ranting about how the labs never send the results STAT like they're supposed to, and how it's a pain to have to track them down all the time, etc. Pardon me for having the audacity to live out of state, where it's not convenient for me to just pop into their office so they can run the labs onsite.

Then, still in her annoyed tone, she proceeds to tell me that she was still waiting for the lab results to be faxed, but the lab had told her the result was 0.6. "Don't worry," she said, "I'm sure it's a mistake." (Apparently the result is supposed to be over 5.) I said, "No, that sounds about right. Why would you expect it to be over 5?"

"If you've ovulated, it should be over 5," she explained in a tone that implied a 5-year-old should know this. And I do, but given that I. RARELY. OVULATE. ON. MY. OWN, why the hell would we expect that this time my ovaries would decide to just fall into line and start spewing eggs like crazy on CD 14?

When I pointed that out to her, she said, "Well, how long are your cycles normally?" Gee, thanks for taking a moment to look at my file before picking up the phone.

"Um, anywhere from 2 weeks to 10 weeks." A long pause, and then she says, "Oh. This could be a problem."

YA THINK? I mean, SERIOUSLY?? SERIOUSLY???

So apparently I needed not only CD1 to show up again, but I needed to actually ovulate. I'm not exactly sure why, because last time I was on BCPs, so I didn't have to deal with this.

She had no answer for me as to what the hell we do next, other than go back in a couple of days to draw it again. "Hopefully your P4 will be rising by then," she said. HA. Don't hold your breath.

I was so angry, I was crying as I was talking to her. I have a radioactive iodine thyroid test scheduled for Nov. 10 and 11. I told her I want a phone call tomorrow with VERY. SPECIFIC. ANSWERS. to two questions:

1) What EXACTLY is going to be done so that I can cycle and have a retrieval before Nov. 10?
2) What date EXACTLY should I buy plane tickets to arrive at the clinic for the cycle?

I've calmed down some, which translates into now I'm not crying as I'm writing this, but my poor innocent little laptop keyboard is still getting a pounding.

Ok, so for the one or two of you who manage to make it through what is possibly the world's longest furiously hysterical venting rant:

Is this normally how an IVF cycle begins?

And, am I out of my mind for wanting to have an actual, real date I can circle on the calendar and write in the words "IVF cycle starts today"??

Turns Out, I Can Blame the Hyperthyroidism

This week, my doctor's office hooked me up to a bunch of wires and then took my blood pressure again to determine what's causing it. It's a test called ICG.

I didn't even know a test existed that could tell you what is causing high blood pressure, but I love the ICG test - my results were "stellar" (to borrow a word from the physician assistant), which means that I don't have any of the conditions that cause primary hypertension. In other words, my doctor is confident that my high blood pressure is 100% caused by my hyperthyroidism, and that when we get that under control, the high blood pressure will go away.

So, yea! I may have issues - lots of issues - but at least the high blood pressure isn't really one of them.

It took a little while for that to sink in before it dawned on me what this means. I assumed the hyperthyroidism was something new, but the high blood pressure isn't. And if the high blood pressure truly is being caused by the hyperthyroidism, that means the hyperthyroidism isn't new, either.

I've had high blood pressure for a few years, but my family physician and my ob have always dismissed it with comments of "oh, you're just stressed," or "you probably walked back to the exam room too quickly from the waiting room" or "I know you're concerned about miscarriage, but you really need to try to calm down."

Okay, yes, I KNOW how insane all of those excuses sound. But I didn't want to believe I had high blood pressure, and they didn't seem to think it was a major concern, so I just chose to ignore it. I don't know exactly when it started, but it's been at least two years, probably more like three.

Hyperthyroidism can cause miscarriage. If my blood pressure has been high for three years, if I've had hyperthyroidism that whole time, I've had it for at least 4 of the 5 pregnancies that ended in miscarriage.

So when I got home from the doctor's appointment, I decided to look through my lab work from my old family physician. It turns out I've had low TSH readings (one of the classic signs of hyperthyroidism) since as far back as 2001. 7 years! Granted, there have been times since then when my TSH has tested normal - it was about 50/50 normal readings and abnormally low readings.

My guess is he assumed since my T3 and T4 levels were normal, that I didn't have it. But my mom had hyperthyroidism when she was 21, and he's been her doctor for the last 25 years as well as mine, so I would have thought that he'd say, "Gee, she has a family history of her mom having it when she was in her 20s, now she's showing signs of it in her 20s, maybe we should watch this closely." Even now, my T3 and T4 readings are still normal, but my doctor is confident in the diagnosis.

For whatever reason, I never closely examined those records. I can't believe I overlooked them. I mean, given all the time I've spent poring over web sites, dealing with all the infertility diagnoses, how could I miss something as basic as this? For 7 years?? But then again, maybe it's exactly because I've been dealing with all the infertility stuff that I didn't have the time or energy to pay much attention to non-infertility (or so I thought) test results.

I've checked with a few docs, and they all seem to think it's okay to do the retrieval now, but I definitely have to have the hyperthyroidism under control before we do a transfer. So we're going to go forward with the cycle this month, and then I'll do the nuclear medicine study next month and we'll figure out how to tackle the hyperthyroidism from there.

So in a very unexpected, bizarre way, I actually have more hope for this coming cycle now, because maybe the hyperthyroidism is part of the answer. It just would have been nice if we had gotten this answer several years ago.

'My Lemon of a Body'

I promise, my goal is to someday write a happy, positive, cheery post again. I used to be an optimist, I swear.

Today is not one of my optimistic days, though.

I had my follow-up to the Bad Blood Pressure appointment today. It was still high (144 over I-have-no-idea), but not as bad as before (150-something over 100-something). So at least I'm moving in the right direction, but obviously still a long ways to go.

And now there are other issues. One, my fasting glucose was in the pre-diabetic range at 110, even though I'm on Metformin. Another bad sign, and another huge motivation to exercise and eat better.

But the bigger news was that my TSH level came back at a measly 0.092. Apparently, I have hyperthyroidism. Hyperthyroidism can cause high blood pressure. (Although I probably can't blame all of my blood pressue on that, as much as I would like to.) And it can cause miscarriage. (Again, can't blame it for all of my m/c's - I've had my TSH tested a few times during the past 5 years, and it's never been this low before.)

So it needs to be addressed, which may mean postponing the cycle we were planning to do in October. Since we're only planning the retrieval for October (a transfer would probably be February at the earliest, assuming there is anything to transfer), maybe there's still a chance we can do that - I'm waiting to hear back from the RE.

I also have a list of appointments to go to now, starting with a thyroid ultrasound next week. (I'm so used to trans-vag ultrasounds, let's hope I remember to keep my pants on for that one. Imagine the ultrasound tech's shock if I suddenly start to undress...) And then there's a lovely 3-part nuclear medicine "uptake" test and scan of some sort that involves me swallowing a radioactive substance while the tech who gave it to me flees the room. (It's never a good sign when the FAQs include "Why Do Medical Personnel Run For the Door After They Give Me RAI?")

And because I haven't whined enough, let me add that on top of all of this lovely news, one of my best friends confided to me this afternoon that she is pregnant again. Of course I'm happy for her, and she's the most supportive IRL friend I have because her first child and this baby are both IVF babies, so she knows what it's like. But still, it hurts a bit to think that she is now well on her way to having her second child, and here I am probably postponing a cycle for at least a few months and don't even have a first kid.

One more thing I feel compelled to whine about: Everything I read says hyperthyroidism causes weight loss. If I'm going to have to deal with this darn problem, the least I could have is that symptom! I mean, really, is it so much to ask for? Fat cells, fleeing my body. Running far, far away. With everything else I have to deal with, I at least deserve that! But noooo, they're all still here, stubbornly clinging to me, mostly in places that make me look like I'm pregnant when really I'm not. When I pointed this out to the physician assistant who was delivering the news to me this morning, ("What do you mean, hyPERthyroidism? Have you SEEN the number written down for my weight on that chart?") she said no such luck. Apparently, it's actually a rather rare symptom. It would figure that would be one of the few things where I actually didn't fall on the rare side of the odds.

All of this reminds me of a conversation I had with a friend of mine when we went to go see a movie earlier this month. She has had several health problems, including infertility, MS, and ironically enough, a thyroid issue. Now she's facing knee replacement (at age 36) for an old knee injury. During our conversation, she said, "I'm doing okay, but some days I wish I could trade in my lemon of a body for a different one!" I know how she feels.

On the bright side (see, this is me working to try to dig up at least a little bit of my formerly sunny, optimistic self), my cholesterol was shockingly normal at 181. It's been in the 210-230 range for the past couple of years, so this was a very nice surprise. I have no idea what improved it, but I'll just be glad about it. And try very hard to resist the urge to go out and have a steak for dinner to celebrate it.

The Moment of Truth

There are rare moments in life when something happens, when something you've known all along but have chosen to shove aside and ignore in hopes that it will go away, can no longer be ignored. Instead, in that moment - the moment of truth - the whole ugly reality is suddenly so in-your-face that it's impossible to not change.

My moment came at about 11:30 a.m. this morning.

I was in my family physician's office, because I've been suffering from a cold all week. I figured there's not much they can give me since it seemed like a cold, but today I was miserable enough to make an appointment anyway.

The nurse's assistant weighed me, took my blood pressure and clipped a device to my finger to check my blood oxygen level. Then she escorted me to an exam room, where I sat clutching the Kleenex box and coughing loudly.

It wasn't long before the physician assistant who I was scheduled to see walked in. She shut the door very deliberately, stood in front of it with her feet braced apart as if I was likely to rush the door in a tackle, looked at me as directly as any person ever has in my entire life and said, "YOU have high blood pressure."

I'm sure it sounds like I'm overdramatizing this, but it is a seismic moment for me.

I know I've gained weight (55 pounds since we started infertility stuff 5 1/2 years ago), I know my blood pressure isn't great. But I kept telling myself that it was just temporary, that eventually I would bring it back under control.

But the reality is that I'm 5'7" tall and I weigh 220 pounds. I'm 15 pounds heavier than my husband, who is 4 inches taller than me. Until this year, I've never been heavier than him. Yes, a lot of that is due to infertility and a lot of that is due to an anti-depressant I take that has weight gain as a side effect. And it's also due to genes - both of my parents are obese, have high blood pressure, high cholesterol, etc. And I have metabolic syndrome, which includes all of those things. But the truth is that it has much, much more to do with the fact that I don't exercise, we rarely cook, and I eat a ton of junk.

As a result, I'm 34 and at significant risk for a stroke. And, it's rather difficult to carry a pregnancy to term if your blood pressure is through the roof. My blood pressure has been on the high side for a couple of years now, but I've just chosen to pretend it wasn't an issue. But I'm new to this doctor, and she (and apparently her physician assistant) isn't the kind of person to take any crap.

I kept telling myself that "tomorrow" I would stop drinking soda, stop eating so much ice cream, start sticking to a diet. But of course "tomorrow" never comes.

That moment when the physician assistant looked at me and uttered those words was a turning point. I have a long way to go to get to where I need to be, but I have to do it. Reality is now too much in my face for me to be able to ignore it. Plus, I have to go back in two weeks to get it checked again.

I don't yet know what this will mean for our upcoming IVF cycle. But around here it means a major lifestyle change not only for R and I, but also for my mom, since she lives with us. She grew up immediately after the Great Depression, and that has profoundly impacted her life. She is a food hoarder - we have two refrigerators in our house and a large walk-in pantry, and one entire refrigerator is hers, and she also takes up half of the other one. The pantry is about 90 percent her food.

She buys three half gallons of ice cream at a time. There are four or five pie crusts in the refrigerator, a dozen boxes of cake mix and eight boxes of lemon bar mix in the pantry. There is an entire drawer of chocolate in one of the refrigerators - chocolate bars, chocolate bark, chocolate chips, a chocolate Easter bunny, Reese's peanut butter cups, etc.

I sat down and talked with her today. She is willing to stop buying the ice cream, but she's not willing to toss out or stop buying the cake mixes and other stuff. She says she will relocate them to a place where I won't have to see them. (I'm guessing that will mean in her closet.) I'm not sure what she plans to do with the stuff when she makes it, but I will need it to be out of sight.

Right now I don't feel well from the cold, which has turned into a sinus infection, and from a migraine that was triggered by some of the medications I got today. So it was pretty easy to eat healthy - or really, not eat much at all - today. But once I start feeling better, I know this is going to get a whole lot harder.