Advise me, please

Okay, folks, help me out here. I've got a consult with Dr. Gorgeous tomorrow and I'm not quite sure exactly what I'm going to say. I mean, I think I want to talk about this nightmare of a Menopur cycle. And possibly my luteal estrace dose/protocol. And whether an antagonist IVF protocol w/ ONLY follistim might be worth doing before moving on to donor egg. Which, really, I don't want to do. Hard as these two years have been, I'm not ready to quit on my body. And if I'm already going to do a Follistim cycle, why not try for IVF and then if I don't get 5+ follicles just do IUI. And then I wonder if I should just bail on Dr. G, whom I really do adore, and go to some Mega Clinic for either IVF or donor cycle. Or maybe just go back to unstimulated IUIs because nothing seems to be working. Really I'm at a loss. And tired of looking like a junkie (you should see my arms!). I'll take whatever suggestions/advice/observations you have. I have a feeling Dr. G will let me do WHATEVER I want as long as it's not completely medically unadvised.

Now I'm going to get the last of my manuscripts in the mail, go get a massage, enjoy the evening with LG, and take my Ovidrel for Friday's IUI.

Unrelated Bits of Anxiety and Dread

1. I just turned in my tenure portfolio. My department chair was pretty blase about the whole thing. I'm glad it's done, but the finality of it has filled me with a sense of dread. I mean, I won't find out officially if I actually GET tenure for another full year. And now it's totally out of my hands. And if you read this blog you know that I am a control freak. I am skeered, people.

2. When the medical assistant called me to give me instructions today I was told to stay at my same dose of Menopur and add Ganirelix for two days, come back on Thursday for monitoring, for IUI on Saturday. Have I mentioned that I have a single follicle at 16+ (and an E2 level of over 300) and no chance in hell of anything else developing? Thus began phone calls back and forth so I could actually find out what this plan was all about. Turns out Dr. G was trying to save me from driving back there every freaking day this week. Sounds good to me. But then I started thinking, if there's no actual *medical* reason for waiting, and I'm already concerned that this poor follicle has been way overexposed to LH, why the fuck would I want to take Menopur for an extra day? And why not get this cycle over with as soon as possible? So I left a message that may or may not be returned today, and I'll take Ganirelix + Menopur tonight regardless, but methinks I won't be waiting until Thursday to trigger. Argh. Argh. Argh.

In Which I Denounce Rhetorical Questions

Remember when I wrote this?

"Thankfully, Dr. Gorgeous has been willing to entertain my next cycle questions even though beta isn't until tomorrow. It appears we've entered a new phase of our relationship, which is that she asks me what I want to do, I tell her I can't make decisions anymore so please make them for me, and then I actually listen. In this case, that would be doing a straight Menopur cycle, which was the thing I thought I never wanted to do. But the situation can't really get any worse, can it? (Don't answer that!)."

Well, the answer is obviously yes. First time I've had a lone follicle on a medicated cycle since March 2009, which was the first cycle I did with Dr. G. Looking at IUI #14 Thursday (likely) or Friday. If it's Thursday maybe Dr. Gorgeous will do the damn thing herself before/after/during our consult, in which I tell her I am never going near Menopur again. Gee, anyone think that might be why I didn't stim so well during IVF? I'm sad that this cycle is likely to be a bust. But I don't regret listening to Dr. G on this one; even if it's not the outcome we both desired, this is information we really needed. This whole thing just sucks, you know?

The Ultimate Vacation

I just booked hotel reservations for what I think will be the ultimate vacation. It's not NY (sorry, Sprogblogger) but otherwise meets all my quirky needs. We're going for 3 nights, which is about as much as I can handle being away from home. It's a roughly four hour drive, which is about how much I can handle being in a car for one stretch. It's a location with all the beachy charm I want and enough of the touristy/waterparky attractions that a six-year-old needs. And, barring the unforseen, we should be back soon enough for me to get a beta, even if it's not exactly at 12dpo. One more item to cross off my to do list.

We're both really stoked.

Small Good Things

(while I wait for LG who is listening to 80s pop tunes instead of getting dressed like I asked her to about an hour ago...)

1. LG's "retro" fascination means that if she keeps the radio on for much of the day (which I encourage because it cuts down on the made-up songs that she uses to produce noise otherwise) I get to hear Culture Club and Pat Benatar and all kinds of things I haven't listened to (at least not deliberately) since high school. That's pretty fun.
2. I've decided that instead of waiting until 10dpo, I'll just give up on this cycle now. That means things can only get better. This Menopur mess will be over with in 3 weeks, tops. And either I will be pregnant (yeah, right) or I will be moving on to another plan. Either way, the future seems brighter than the present. Expect a blogotherapy post in the next few days, before my consult with Dr. G. I need a better plan, people.
3. Reconnecting with a friend from high school. It's unfortunate that our source of bonding is now IF/RPL and not Sylvia Plath and high school theater productions, but rejuvenating friendships is always a good thing.
4. I have plans for a long overdue stealth hangout operation tonight. A friend's coming over after LG goes to bed and we can relax on the porch and she can drink my share of the vodka. In the meantime, I need to figure out what might be good to eat that doesn't have caffeine, sugar, alcohol, wheat, dairy, or soy. I'm stumped, other than chips and salsa...
5. Night yoga seems to be helping with insomnia. I slept from about 10:30 to 7:00 straight through, and then fell back to sleep for 1.5 hrs after LG went downstairs to watch TV. Bliss.

Fuck Menopur/Menopur Funk

Dr. Gorgeous's Menopur plan? Not working out so great.

After 5 days of hard core stims, I've got one at 11. I didn't bother asking about my E2 level, though I will on Monday.

I know there's a chance that something else will pop up in the next couple days, but I highly doubt it. I'm glad I have a consult later this week because if this goes the way it looks like it's going, I will never touch Menopur again. I'm really tempted to crack out the Gonal-F leftovers from last July's IVF debacle but I think I'd rather know for sure that Menopur is a bust.

It just feels like the harder we hit my body the more it shuts down. It seems pretty clear to me that what I need, physically, is a break. But logistically and emotionally it makes sense to wait until fall.

I'm sad and angry, and I don't know what to do anymore. I guess I'll see what Dr. G says on Thursday.

In Which My Brain Is Spinning

• Just when you think you're done with something, turns out you're not. I got feedback from another colleague on my statement, and contrary to previous opinion, it needs work. I mean, I thought it needed work, but when my department chair said it was "great" and "well-written" and gave no suggestions for improvement whatsoever, I kinda stopped working on it. So now I'm back to spinning my wheels; it's really hard to develop ideas when you've already hit the upper page limit. So more mint tea and coffee shop for me this afternoon.
• Context: a long time ago when I was part of an online group for SMCs, it used to drive me bat-shit crazy that some people would proclaim that they'd had an early miscarriage based on no evidence (no positive HPT or beta) whatsoever. It was like it was easier to conceptualize the experience as a loss than as something that never happened in the first place. Now I find myself wondering if that May cycle, when I really thought I was pregnant around 11-12dpo, if I actually was very briefly. (This might be the problem with having betas at 12dpo.) Why am I thinking this? Because my period was late despite stopping progesterone early, my AFC was wicked low (5, when it's usually 11-12), my lining was very thick at baseline, and it took me forever to respond to stims. That would also be true of the last cycle I did immediately post m/c. It's totally unproductive thinking, so I should stop doing it, but, like I said, my brain is spinning.
• I am vacillating between thinking my CV is quite respectable (Yes, InB, I am the shit) and thinking I've done very little and there's no way I should get tenure. Also, unproductive. I've just got to get this turned in, take a real break, and then come back ready to get some shit done this summer.
• My ovaries hurt, and I am wearing what I think of as my summer "maternity" dress, which is a loose white thing that I bought last summer and did indeed wear during early pregnancy.
• So far 50mg of DHEA seems okay. I'm not sure if I'm going to go up to 75mg, which is what I was actually prescribed.
• LG said she rowed a canoe yesterday. And did mini golf. And archery. I'm glad she likes camp. I loathed it as a child (but, of course, my mother also dosed me with benadryl because I'd puff up from bug bites, so my experience might be a bit foggy).
• Great, a very pregnant woman just sat down at the table beside me. I really don't need that today.
• Despite these grumblings, I'm really okay at the moment. Now back to work.

Small Good Things

1. I'm making headway on my list of things to do without much difficulty. Books are ordered. Photocopies are about 80% done. CV looks good. Statement looks good. Figuring out what to do with all those manuscripts...
2. I killed The Headache with Fioricet and it hasn't returned. Maybe it wasn't the DHEA alone, as I generally get a headache around this time in my cycle, with estrogen levels going down and up.
3. I'm feeling pretty good. Not stressing (at the moment) about either the reproductive stuff or the tenure stuff. Just taking my Menopur and doing my work.
4. After three/four days of boo-hoo baby, LG seems to have settled into her camp routine. It's always rough when Gram visits and leaves, and she's overtired and not eating and drinking enough during the day (at the moment, I think she's taking 75% of her calories between the hours of 4-7 pm). But last night was good. This morning was good. Things are looking up.
5. It's just a lovely, lovely day, and I'm sitting in a coffee shop drinking mint tea (without sugar) and doing some work. I really need to get tenure, people, because a sabbatical is long overdue.

Courtesy of FedEx

I took my first DHEA pill about 3 hours ago. About 1 hour ago The Headache returned with a vengeance. Coincidence? I hope so, or that's $90 worth of pills I won't be taking because I can live with many side effects but The Headache is not one of them.

But LG was fascinated by the idea of getting pills in the mail. Particularly blue ones. Great.

On Being Zen

It was just about a year ago that Dr. Gorgeous told me I needed to be zen. I'm entering what should be one of the most crazy-making weeks of my career. Last night I decided that the most important thing I can do is stay calm and just get this stuff done (the stuff being both reproductive and professional). Here's the reproductive plan, to keep me focused and healthy for the next few cycles:

• walk daily
• do yoga daily
• stop eating all dairy, with the exception of cream in coffee, which is my one dietary luxury
• go back to eating walnuts, olives, and other combatants of NK cells
• start taking DHEA

By NOON of June 30, I will do the following:

• complete my statement of professional activities [in pretty good shape now]
• fill in missing page numbers and such on my CV [also, minimal work]
• photocopy everything I've published since grad school [ugh!]
• order books for my fall class
• send out a minimum of 3 more manuscripts and, ideally, 6
• meet with my writing group about a current project
• drive to Dr. Gorgeous's office probably 3-4 times

On June 30 at 1:00 I have scheduled myself for a massage, after which time I will do nothing resembling work for two weeks, go somewhere with LG [need to get on that], and, hopefully, hopefully, hopefully, get knocked up with a keeper. A girl can dream, can't she?

The Year of Injectable Drugs

I just took my first Menopur injection for the cycle. While I'd like to say I'm going into this cycle with no expectations, of course that's not true. I suspect it's going to go either (a) swimmingly well, resulting in 3-4 follicles or (b) abysmally, resulting in 1 follicle developed way too quickly. I'd be very suprised if I get a run-of-the-mill 2 out of this. Of course, I've been surprised by just about everything that's happened in the past year, since I started on the road to IVF and gonadotropin IUIs. I'm anything but optimistic, but I'm hopeful that this might just be the change my ovaries need.

The Big Box of Bad

So this morning I brought up a box from the basement. My mom, who is visiting, said, "What's in that?"

I replied, "That's the big box of bad."

"Huh?"

Then she got a real treat, watching me sort and count needles and syringes. Follistim is so easy, I'd forgotten all the nonsense with Menopur. I have a million and one containers of diluent; what the hell do you do with all that leftover stuff?

Anyhoo... the nurse has now ordered me 36 vials of Menopur, 12 days worth of needles, 60 Prometrium pills, 90 DHEA pills, and why not throw that Ovidrel in for good measure. The ridiculous thing is the most I'll pay for is the DHEA, which I could get over the counter for like $5, but Dr. Gorgeous won't let me touch that stuff.* And I guess given how much hormonal tinkering I've done over the past two years, I should probably listen.

Next Monday I'll call and get another vial of Cheap and Hardy Gametes. This is the part I like, when a cycle is shiny and new and anything is possible (of course, it's not even technically cd 1 yet). It's all down hill from baseline...


* So after a million rounds of phone tag the nurse told me that not only did Dr. G approve of the DHEA plan, she thought it was a good one. Really, if I don't get tenure, maybe I should become an RE.

Small Good Things (Beta Day Edition)

1. After the night of insomnia and Fioricet (Tues), I slept for 9 hours last night and easily could have kept going if it weren't for the blood draw and the business of the day. The only reason I woke up (no alarm) was somehow the cat ended up replacing my pillow with her body, which was not pleasant. Sleep is good.
2. Lunch with Best Professor Friend today. Haven't seen her in a few months, so it will be good to catch up.
3. Long talk with A last night, who has been out of town, about Menopur and DHEA and red sandals and blue toenails and crazy sisters, among many other things. She promised me when she comes back she's going to have a Universe Sucks party and keep me company while I drink the vodka. (Of course, I only drink vodka once a month, and tonight's the night, so it might be a vodka-less vodka night. Of course, my mother being here sort of puts a damper on vodka night, so we'll see.)
4. Two weeks until the tenure file goes in. I'm trying to turn this into a good thing. That my part will, essentially, be done, and I can concentrate on the rest of my life. And take LG to a beach somewhere (of course I need a bathing suit that doesn't showcase my lovenox/menopur belly).
5. My girl is coming home today. I expect a lot of bad behavior in the next few days (it's the consequence for being away from me) but a nice big hug. I'm trying so hard to become a mother that it's often difficult to enjoy just being one.

Random Bullets of Updates

• You might notice some redecorating. It was depressing the hell out of me to see IUI #14 in my timeline so I decided to delete the whole damn thing.
• I spent yesterday alternating between writing and crying and watching TV. Then I went in the shower and screamed, dosed myself with Fioricet and went to bed. Yesterday was a very very bad day. The good thing about very very bad days is I can't sustain that kind of negativity for more than 24 hrs and woke up in a fine mood.
• Thankfully, Dr. Gorgeous has been willing to entertain my next cycle questions even though beta isn't until tomorrow. It appears we've entered a new phase of our relationship, which is that she asks me what I want to do, I tell her I can't make decisions anymore so please make them for me, and then I actually listen. In this case, that would be doing a straight Menopur cycle, which was the thing I thought I never wanted to do. But the situation can't really get any worse, can it? (Don't answer that!).
• Another question into the nurses about DHEA supplementation. Experiences or opinions, anyone?
• Without LG I'm eating very erratically. Tonight I'm making a chicken salad, which is a little new and different. I'm tempted to crack out the vodka to go with the limeade, but I'll hold off for another 24 hrs. Maybe.
• LG comes home tomorrow. She left me a message on the voicemail last night which was the sweetest thing ever. I could play it all day. But I have to confess I could really use another day or maybe two to get myself together.
• Tonight: more writing, more reading, and maybe a trip to a coffee shop. It's nice to be able to leave the house after 6:00 without needing a babysitter.

Timing

The first available consult with Dr. Gorgeous is the same day I turn in my tenure portfolio.

Great.

Welcome to the Bad Place (Redux)

1. Despite the breasts and the wicked high temps, negative HPT (10dpo).
2. My AMH level came back low. The nurse told me "low/normal," but it's .5, and that's pretty fucking bad. Of course, this is the same nurse that told me my hcg level was "a little low" last year when it was less than half what it should have been.

The more necessary donor egg seems the less I want to do it. Fuck.

Small Good Things (Grammy Camp Edition)

1. Instead of making dinner, I took a walk last night at 5:30. And then I made chicken tikka masala, while listening to NPR. Dinner wasn't until 6:45, which is usually when LG and I are making our way upstairs for protracted bedtime rituals.
2. The kitty slept with me all night. No one woke me up in the middle of the night to find lost things or because nightlight went out. (It's too bad I couldn't fall asleep easily, or I might actually feel rested.)
3. Getting an earlier-than-usual start to the day, despite "sleeping in." Not making lunch and rushing to the bus stop is a really nice thing!
4. Indulging in the 2ww insanity without LG's running commentary. (For the record, the HPT I took yesterday, at 9dpo, says no way, so I'm trying not to get my hopes up.)
5. An acupuncture session this afternoon without needing to run to the bus stop afterward. The plan is to work like a fiend until then and then relax.

Of course I miss her. But Grammy Camp couldn't have happened at a better time.

Let's file this under new and different

My breasts have gone up a cup size (or more?) in the past two days.

Now before you all jump on the pregnant bandwagon, I'll remind you (okay, me, I'm reminding me) that this occurrence has never happened to me during the 2ww, including my 3 (or more?) conception cycles. WTF?

In about an hour I'll be leaving LG with her grandmother for Grammy Camp and driving home alone. And then, I think I have a date with a plastic cup and a pee stick. Or maybe I'll just enjoy this novelty and wait a couple days. You'd think this would get easier after 24 cycles, but apparently no.

Progesteroney

When I went to have my blood drawn this morning, the phlebotomist commented that I looked tired. Granted, I didn't have any makeup on, but I did indeed feel tired. Exhausted. Annihilated. I've been fighting myself all day to stay awake and get just a little bit of something written. Yesterday I felt woozy in a way that I only associate with high progesterone/early pregnancy.

Still, I was, well, stunned to hear my progesterone level:

50.12 [but when I called back to make sure I didn't mishear fifteen, I was told 55. hmmm.]

Usually, on my current level of supplementation, it runs about 30.

I'm not dumb enough to think that high progesterone level in any way indicates pregnancy, but this is interesting, isn't it?

Now I just have to keep myself awake for another hour before LG's kindergarten class party.

Small Good Things

1. Last night, after I had tucked her in and left her room, LG called me back. "Mom," she said, "you forgot to ask me for my three good things." The sweetest moment I can recall in a long time.
2. Reading. Reading. Reading.
3. Opening a new bag of coffee and hoping it's the last one for a while.
4. Dear friends, online and off, who are willing to listen to me cry and bemoan the state of my infertile existence.
5. The first lilies of the season in our yard.

So Much for The Year of Grace

I've lost the zen. I wouldn't say I'm a nervous wreck, but I'm definitely off-kilter. Tenure anxiety. Reproductive anxiety. I'm only two days into this wait, and already I'm coming up with plans for Dr. Gorgeous (up my estrogen dose? halve my follistim dose?).

I'm waiting. I'm tired of waiting. This baby project has dragged on already a year longer than my worst case scenario. The tenure thing? Well, if I'd stayed at my other job I would have had it a few years ago. Now not only do I not have it, I'm not sure I'm going to get it.

I'm waiting. Where the hell is my good thing?

IUI #13

Well, it's done. For all the drama of this past week, the actual deed was very anti-climactic, I must say.

I've renounced all superstition and magical thinking. Didn't bring the baby socks, didn't wear the tie-dyed socks. Didn't bake for the nurse. Didn't read Barth's sp*rm story. Didn't have Indian food or a glass of wine with friends. I won't be taking my temperature every 30 seconds for the next two weeks (that's only a slight exaggeration). I won't be peeing on sticks. I won't be eating pineapple or walnuts or olives as if my life depended on it, except when it suits my fancy.

I'm just going to put a tiny smidgen of faith in those 1-3 eggs (2, probably 2), a darn good specimen from the new bank (their advertisement should be twice the sp*rm for half the price!), a fabulously timed IUI, and good wishes from the nurse.

Well, that plus gobwads of Prometrium and Lovenox.

Here's hoping my life is radically changed in 12 days.

Small Good Things

1. Apparently Dr. Gorgeous was quite pleased, yesterday, with the new follicular development. I'm not over-the-moon excited but I, too, am pleased with how things went today. RO: 20, 14; LO: 13.5, 10; Endo: 10. What this adds up to is the tech I saw yesterday mismeasured things (which I suspected), as I highly doubt both my uterine lining and a brand new follicle shrunk in the past day. Bottom line: I've got two in the mature range (though I wish that 14 was a bit bigger) and that 13.5 is still in the running for extra growth by tonight. I should start hiring myself out as a fake RE because it seems this crazy Ganirelix plan worked.
2. First cherries of the season at the market today. Yum!
3. Reading fiction (mostly) unrelated to my work. It's how I made it through last summer, and it's helping again (much more so than meditation ever could).
4. In two weeks, I will be alone in my house for three days (not counting the feline, of course). LG is headed to her grandmother's and, while I will miss her, I've needed this to happen for a while. That it will occur during the most insane part of the 2ww is even more welcome.
5. Not teaching this summer. I'm being pretty productive, these drives to the clinic aside, and enjoying being able to think and work without the added time and pressure of class prep. And if everything goes as I'd like (ha!!), I could have a post-tenure sabbatical on the heels of maternity leave.

June 2, cd 11

Exactly one year ago, I spent the morning sobbing in Dr. Gorgeous's office, not having my six week ultrasound, but instead having my blood drawn for repeat RPL testing. I spent the evening getting very very drunk and waiting to bleed. I've had many bad days since then, but I think that was probably the lowest I've been.

I put off thinking about this pregnancy loss a couple weeks ago, because I knew I couldn't handle it on top of a negative beta. I tried to tell myself that stims for this cycle would go so stunningly well that I could bask in hope. I mean, Dr. Gorgeous has been more encouraging than ever; she actually used the word optimistic about my chances of (eventual) success.

Since yesterday, when I saw that lone follicle on the ultrasound I've been, frankly, a wreck. To say that I was disappointed would be a radical understatement. (To be fair, I'm sure the elevated estrogen/Ganirelix combo isn't helping matters.) I woke up this morning at 4:20 and never fell back to sleep. I'd like to think that's when my ovaries woke up, too.

I'm not yet hopeful, but I am more optimistic for this cycle now than I was two hours ago:

Endo: 13
RO: 12.5, 18
LO: 13.5, 12

For now, let's just hope that Dr. Gorgeous and Ganirelix buy me another day. Later, I'll talk to her about this, err, belated response to stims.

Strike One

I'm Ganirelix-ed again, in the desperate attempt to get two follicles in the mature range. Today I had one at 16 (on the *right* of all places) and one at 10; Dr. Gorgeous is trying to buy two more days, for IUI on Sat. June-fucking-fifth.

Will someone please explain how it is that on a mostly unstimulated cycle I came this close to having three, and on a completely jacked-up Estrace/Femara/Follistim combo I will in all likelihood have one. Have I mentioned that I can do that completely on my own?

Why is it that my ovaries seem to listen to every bad possibility Dr. Gorgeous mentions? It's like the speech act theory of reproductive endocrinology. She pronounces, and it is so.

I'm crushed. Sigh.