My Stork Got Lost

Sooo… I’ve done two nights of the 150 IU FSH.  I’ve noticed a couple things.

First of all, when the instructions say to take it out of your fridge and let it warm up on the counter for 30 minutes before injection – DO IT.  We were late getting home the first night and I took it right out of the cold pack I carried it home in, popped the cap, adjusted the dose and shoved it in.

And pretty much wanted to die.

Remember when you were a kid and fell off your bike and roughed up your knees?  Remember how your mom or dad cleaned all the dirt and grass out of the wound, and then said something ridiculously anti-hyperbolic like, “this may sting a bit!” and poured rubbing alcohol all over everything??

Yeah.  It’s like that.  Only ON THE INSIDE.  And there’s no one there to blow away the icy cold burning hot lava…just a husband with a smirky little Vulcan eyebrow thing going on.  Sexy as hell…but super annoying when you’re standing there with a needle in your stomach and a cold fire burning behind your navel.

So, yeah.  Avoid this at all costs.  You’ll thank me later.

Also maybe avoid punching your husband. He will thank you right then and there.

Secondly, you know when you take a shot of tequila and you’re still standing, then you have another and wake up in a strange city with a new tattoo?

FSH is kind of like that.

Last month I was on the 100 IU dose for three days, then 75 IU the 4^th day.  This month, we upped it to 150 IU for 5 days, to start.  I’ll know more after the CD7 ultrasound.

Last month, I injected the FSH and didn’t feel a thing.  Nothing.  Nada.  Zilch. No side effects, no weirdness around the injection site, nothing.  This time…going up just 50 IU… whoa.  I got DIZZY.

I guess technically it’s 50% more, but still, I wasn’t expecting the head rush.  With that, combined with the icy cold burning hot lava sensation, I staggered to my couch like a drunk and watched the ceiling fan spin.  It wasn’t turned on.

So, yeah, stronger dose = actual, legit side effects.  The wooziness wore off after about 15 minutes, and trust me, I’ll take 15 minutes of wooziness over three days of horrible Letrozole headache. It took me by surprise, that’s all.

I’m doing better today.  Here’s a little advice to all the moms-in-waiting out there who are going through this:

Reach out to your friends.

Seriously.

Resist the urge to keep it all inside.  Resist the urge to crawl into a hole and disappear.  Don’t think for one second you are alone in your pain.  You’re not. Trust me.

No, not all of your friends struggle with infertility.  Not all of your friends will have miscarriages or know how this roller coaster feels.  They don’t know exactly how you feel on the inside.  No one can, unless they’ve gone through it personally. But that doesn’t mean that they can’t weep with you, listen to your stories, and just be there when you need a shoulder to cry on.  I’m learning this.

I called my best friend Allie last night.  To be honest, I didn’t want to talk to anyone, and I very nearly shut myself up in my office at work to avoid any kind of communication at all.  I came dangerously close to crawling into that deep dark pit again. But I remembered the last time this happened, last October.  I remembered that keeping everything inside nearly broke me, and I needed to avoid that at all costs.  I remembered how much better I felt just letting it all out.  So I picked up the phone. I texted my sister first, but she was busy with some parent-teacher thing. I texted another friend; she wasn’t off work yet.  So I called Allie. And we talked.

Or, more accurately, I cried and blubbered incoherently for several minutes.  Allie talked.  It helped, a lot.

Allie, if you’re reading this, thank you.  A thousand times, thank you. I started the conversation crying, but ended it laughing.  It was better than Godiva chocolate cheesecake, and much better on my waistline.

So, now I owe you guys an update from my baseline ultrasound yesterday.  I meant to get to it, but I guess I wasn’t in a good enough place to move forward. So, here goes.

Baseline ultrasound for the umpteenth time…with a little good news.  It seems that the DHEA is finally starting to kick in, because for the first time in forever – I have 5 follicles on the left and 3 on the right.  8 is a record, and even though some are super tiny, I’m allowing another tendril of hope to start threading its way through me.  Still about 12 fewer than a normal 34yo, but I’ve never had so many before.  Back in March, when I started the DHEA, Dr. Landay did tell me that it would probably take about 3 months to see any affects.  She also told me to be prepared for a little weight gain, acne, bloating, etc, which she was also right about.  But I’ll take a couple extra pounds and a zit or two if it works, right?

So, 8 follicles ranging from itty-bitty to about 9mm, and we’re officially switching to purely injectable hormones. No more Clomid or Letrozole, which is a small blessing.  No more crying over Homer Simpson or jamming bat’leths into my skull.

The injectable hormone is called Gonal-F, or, if you want to sound smart with your friends, follitropin alfa.  The difference between the oral medication and the injectable is that it’s a straight shot of FSH.

Clomid and Letrozole are estrogen inhibitors. These drugs trick your brain into thinking you’re not releasing estrogen, so it starts a chain reaction that creates a ton of FSH and, in turn, a ton of LH.  Like a domino effect.

Gonal-F just says “screw all that, here’s some FSH!!” It’s a lot stronger than Clomid or Letrozole, and we’re switching to a full cycle instead of a combo of oral/injectables because Dr. Landay is tired of only getting 2 mature follicles.  So am I. Stupid useless ovaries.

She put me on a 150 IU dose – she wants at least 3, preferably 5, mature follicles.  Last month I got one big mature follicle on Letrozole CD 3-7, and then a 100 IU dose for CD 8-10, 75 IU on CD11.

This month is no oral drugs, just 150 IU Gonal-f CD 3-6, and then I have an ultrasound Sunday to see how everything is progressing.  I’ll update then when I know the rest of the game plan.

She’s also calling in the prescription for the pack of stuff I have to mix myself.   It’s a lot cheaper than the Redi-ject pen that comes pre-mixed and all I have to do is turn the dial and cram it into my gut, all hara-kiri style.  This one I mix by myself, draw into a syringe, and cram it in all heroin-addict style.  Good thing I watched all those episodes of The Wire.

Yay saving money.

(Seriously, this stuff isn’t cheap.)

Oh, and I’m also supposed to take a baby aspirin (the 81mg aspirin that tastes like Smarties candy).  From what I understand, the low dose aspirin helps ward off miscarriages. We shall see.

I had another baseline ultrasound this morning with Dr Landay.  Several things happened.

First, she confirmed that the nonsense over the weekend with my HCG being 5…then 1.5…was, in fact, miscarriage.  All of the leftover trigger shot HCG should have been long gone from my system.

Chemical pregnancy, spontaneous abortion, miscarriage, whatever you want to call it, it happened.

It sucks.

I thought I was okay. I mean, I knew what it was; the confirmation from Dr Landay didn’t really change anything except prove that we really, really did get close this time, which is something to celebrate. I understand this, so intellectually, I thought I’d be okay.  This kind of thing happens, more often than people realize.  1 in 3 pregnancies end in miscarriage, and most of those are chemical pregnancies, happening before the mom realizes what’s going on.  I know that, in my head.  I accepted this Saturday, had a good cry right there in the Cheesecake Factory, and drowned my sorrows in an entire slice of Godiva chocolate cheesecake. Calories be damned. It was medically necessary.

But that was Saturday.  This is Wednesday.

I was okay Sunday.  Then I got my period Monday.  No cramping, no spotting first, just walking into work and hello, Aunt Flo.  I’ve been here before.  I knew what it was.

But it turns out that reaching a conclusion in your head and then having a doctor confirm your suspicions are actually two separate things.  I’m not doing very well today.  My heart is aching for another child that will never be, and I’m at the very lowest valley in my roller coaster.  I’m a wreck.

I want to go home.  I want to close myself in my office and just cry for days. I’m smarter than this; I know these things are common, but knowing how common they are doesn’t take the sting away.  That’s the one thing that always gets me when friends talk about miscarriages.

“Oh, honey, I’m so sorry, but you know this is actually really common.”

You know what?  Car accidents are common.  Cancer is pretty common.  That doesn’t diminish the pain that comes with loss of a loved one when they’re in a fatal crash or lose their battle with cancer.  It still freaking hurts.

Please stop telling us that they’re common.  We know this.  Does that mean we’re not allowed to feel the loss that comes with this “common” occurrence?  Of course not.

Sorry.  I told you I wasn’t doing well today.  This was way worse than last month.  And the month before that.  Two months ago, I had no hope.  I never got a positive home test, I never had any inkling I may have been pregnant.  Then last month, I had the beta test at the doctor’s office and it was a big fat zero.  No hope at all.  It still stung a bit when I got my period a few days later, but I was expecting it.

This month I had hope.  I was super tired, but I thought that was all the progesterone I was on.  I was battling a runny nose and sore throat the entire week, but I figured that was just my allergies acting up from all the wild fires in the area.  I felt off, but with all the hormones, I have no idea what my normal is any longer.

And then Dr Landay called me last Thursday with a technically positive beta test…I was allowed to hope.  5 is low – it’s the lowest possible level they’ll consider pregnant, but it wasn’t a negative. Those were her exact words.  It’s not a negative.

And now this.

I would have much rather had no hope and get on with my life than to go through these last few days.  Today is an exceptionally bad day. When hope is there, and that hope is gone, it’s worse than having none to start with.  I would rather have no expectations than to have my expectations crushed.  But maybe that’s just me.

So, anyway.  That happened.

So. I did the combination Letrozole and injectable FSH this cycle, got one big follicle and one “okay” follicle. She was hoping for 3-5 big ones. My ovaries suck.

I did the the trigger shot on July 13th, had an IUI July 14th, and on the 17th I went on progesterone.

I went in July 28th for my blood test since home kits wouldn’t be accurate due to the left over hCG from the trigger shot.

Here’s where things get interesting.

HCG has a half life of 24 hours, so it takes one day to leave your system. I got 10,000 units, so, on the 10th day, all remnants of the trigger shot should be gone from your system. I tested out and even though it was pale…the line never completely disappeared.

So, at my blood test July 28th…my hCG level was 5.

15 days after the trigger shot.

Which means pregnant.

It’d been 15 days since my trigger shot, so everything should have been out of my system.
Dr Landay said a beta of 5 was low – the lowest number they consider pregnant – but it wasn’t a negative. Those were her words.  It wasn’t a negative.

So.. hope.

I went in today for another test. If my hCG level had at least doubled, it was a confirmation I was actually pregnant.  While she ran the test, Q and I went out to lunch. If it had doubled, she wanted to call in more progesterone from the pharmacy, so we had to stay close by and wait for her call.

It was 1.5. That’s a negative.

What’s worse…this was my third cycle. Five IUIs on Clomid and Letrozole, with half a cycle on injectable FSH. No babies.

Lifetime chance success after three failed cycles: Less than 1%.

It just seems like this dream of a baby is getting further and further away.  We’ll switch to straight hormone injections next time, but right now…I’m inside a deep valley and can’t even see the sun shining.

07/25/2016

I had the absolute best week imaginable with my sister and niece out here.  I didn’t realize how much I needed the break.  We took my niece to all the touristy LA hot spots – the Hollywood Walk of Fame, the Santa Monica pier, Zuma beach, Six Flags, Universal Studios and City Walk.  They both had a blast, and I had a great time putting all this fertility stuff out of my mind for awhile.

We’re approaching the end of my two week wait.  It’s been interesting, that’s for sure.  Since I did the hCG trigger shot this time around, I can’t rely on a home pregnancy test, because it’ll show up as positive until all the hCG is gone from my system.

The “trigger shot” is a huge dose of hCG, the human chorionic gonadotropin hormone, which is responsible for pregnancy. It triggers ovulation by forcing the egg to release.  My trigger shot was 10,000 IU of hCG.

Chemically speaking, hCG has a half life of 24 hours. So it takes about one day to get out of your system. I got 10,000 units, so on the 10th day, all remnants of the trigger shot should be gone from my system.

I have been testing out the trigger – which basically means every day, I’ve been taking a pregnancy test anyway.  Not to see whether or not I’m pregnant, but to compare the second little pink line with the previous day’s test.  As the hCG leaves your system, the line should get lighter and lighter.  If you’re pregnant, it’ll get lighter to a point and then start getting darker – or it’ll get lighter and go away and then start coming back.

My line is still there.  It doesn’t seem to be getting any lighter or darker…but it’s definitely still there.  It’s faint, but it’s not really changing one way or the other.

So…who knows.  It may not tell me anything at all, but at least I feel like I’m being proactive and keeping my mind occupied during this two week wait. I go in the 28th for a beta test, so I guess we’ll know something one way or the other then.

07/14/2016

First of all – MY SISTER IS HERE!!!  You guys have no idea how badly I need this.  We have a long, long list of activities scheduled, so posts for the next week will be short!

She came with me this morning to my IUI, too 😀

Here’s what happened:

Two follies this time around. One 25mm (biggest yet!!) and one 22.4mm. Kinda sucks on hormone injections, but two is better than none. Did the trigger shot yesterday, ovulated this morning, just finished the IUI.

It went great!! Super swimmers again, and my uterine lining was 10.5mm. There was fluid in there too, so I literally JUST ovulated. Perfect timing. We don’t need another IUI tomorrow!

Holy saving $600, Batman!!

Now we just enter the two week wait. I start progesterone supplements Sunday, get my beta test July 28.

About those progesterone pills. I don’t ingest them. Omg.

They’re suppositories. You can guess where I have to shove them. OMG. Dr Landay said you can’t shove them up there too far, so go to town.  And she warned me it’ll get…messy.

Holy pantyliner party, Batman!!

07/08/2016

I cannot function with this headache.  It’s insane.

When Dr Koopersmith prescribed the Letrozole (Femara) for me, she warned that some women experience a slight headache.

This isn’t slight.  This is horrible.  Worst part about it – NSAIDs can interfere with follicle growth, so the only thing I can take is Tylenol. Ha.

Which is like slicing off your arm and putting a Band-Aid on the bloody stump.

I closed myself up in my office today, turned out all the lights, switched off my computers, and laid down on my couch for an hour. This did absolutely nothing but waste a perfectly good lunch hour.  I’ve taken to just sitting with my head in my hands and trying not to breathe too heavily.  Seriously, even breathing hurts. I wish I were exaggerating.

I know that this will all be worth it if I get pregnant, but this is the worst pain I’ve been experienced in a long time.  I had meningitis in high school, and that headache was b-a-d.  My doctor suggested putting me in the hospital on morphine but my parents couldn’t afford it, so I stayed home from school several days with an ice pack and a ton of Darvocet (which had little to no effect).

This headache is worse. Thank God I’m only on these pills for 5 days.

 

 

07/05/2016

Shout out to all fertility doctors out there.

So, for starters, I’m in a better place than I was last week.  Partially due to the cider I had Sunday afternoon (Angry Orchard Summer Honey = AMAZING).  Mostly, though, due to the doctor visit I had yesterday.  Yes, yesterday.  On the 4^th of July.  They really don’t take days off in fertility clinics.

Okay, so last we spoke (typed) I had just received news that my 4^th IUI was another fail.  Technically, it was only the second cycle attempting artificial insemination, but I’ve been inseminated 4 times.  They do it the day you ovulate and the day after, just to make sure sperm is in place to meet the egg.  So yeah.  4 times.  4 fails.

Anyway, Dr Landay asked me what I wanted to do, because the IUIs aren’t working.  She mentioned IVF, which is a HUGE DOLLAR SIGN to me – $13-15,000.  She did say that a large part of that was the medicine, and I could apply for a discount on the drugs, but it would still be pricey. Insert panic attack here.

So, I got my period Saturday.  Even though we’d done the HCG blood test, it still sucked when I started.  I was still holding out that it could be wrong. Anyway.  Called my doctor, u/s scheduled for Monday (yesterday), Day 3 baseline ultrasound.

I have 6 follicles.  Three on either side.

Dr Koopersmith (Landay was out of town, they switch off weekends and holidays) said three were a decent size, but three were really small.  Like, they would probably never mature.

So, really only about 3. I’m supposed to have more than 10 good sized follicles on each ovary.  I’m used to this bad news, it was just a little worse than before.

So, we talked injectables, because the Clomid isn’t working.  I’m on the highest dose they prescribe and I’m only getting 1-2 mature follicles.  Most women on Clomid, taking half my dose, get 3-5 each cycle.  Friday and Saturday I was panicking because when I went to pick up my DHEA at the pharmacy, there was a woman there picking up her meds to prep for IVF and we spoke.  She also doesn’t have infertility coverage on her insurance.  Her bill?  $4300.  On just the medication (if anyone follows my facebook, this was the woman with the absolutely incredible albeit man-made chest.  I’m STILL jealous!!).

Anyway, I was also panicking because Dr Landay mentioned injectables when she gave me the not pregnant news, and again when we scheduled the u/s, and she said they’re a little more effective, but a lot more expensive than the Clomid.  Like, one month of injectables is $1000.  My Clomid is $35.  So, yeah.  More pricey.  Also, there’s a “significantly higher risk” of multiples on injectables.  I really, really don’t want multiples.

So, I went to my u/s yesterday with all this bouncing around in my head.  Dr Koopersmith asked how many IUIs we’d done, and what my AMH level was.  AMH is the hormone that tells you how many quality eggs you have left.  My AMH is 2.25, which is really, really good.  So even though I’m not producing follicles, I have a really good quantity of eggs left, so I’m a good candidate for injectables/IVF (you burn through a LOT of eggs on hormone medication, like dozens and dozens and dozens each cycle).

She suggested a combination of pills AND injectables.  She switched me from Clomid to Femara, which is actually a breast cancer drug.  It treats breast cancer because it’s an estrogen inhibitor; apparently estrogen fuels breast cancer.  Didn’t know that.  Anyway, she warned me that if I read up on Femara, it’d talk about nothing but treating breast cancer, but to ignore it.  She suggested 5 days of Femara, followed by only 4 days of injectable hormones.

This is good for a variety of reasons.  First, there’s a higher rate of success using BOTH oral and injectable hormones.  So, that’s one.  Also, even though the Femara was 3x more expensive than the Clomid, ($100 for 10 pills!!!), she said some people respond better to it than with Clomid.  Next, the $1000 that Dr Landay quoted me for the hormone injections was based on ONLY injectables.  Using a combo of oral/injectables, I’d only need 4 days of injectables, not 12.  So, the price tag dropped to around $300.  Still waiting on a call back from the office for an exact price, but she quoted me $100 on Femara, and it was literally $94.99, so I’m not too concerned it’ll be any higher than $300.  WAAY better than a thousand dollars.

ALSO, using injectable hormones, they do an ultrasound the day you complete the shots (next Wednesday for me), and depending on the number and size of your follicles, they actually trigger your ovulation with another shot of hormones, and can time the IUI precisely.  They inseminate 36 hours after the trigger shot.

This is good for a couple reasons – but the main one is IUIs are $600 each.  We’ve been doing 2 each cycle…or $1200/month on JUST the IUI.  So by only doing 1, I’m already saving $600 right off the bat.

Now, there is a small chance that on the Femara and FSH shots, I’ll produce a ton of maturing follicles.  They don’t inseminate with more than 6, it’s too risky and they don’t want people to get pregnant with litters of kids (insert how badly I DON’T WANT MULTIPLES here). However, the chance of me – with only three decent follicles right now – making more than 6 mature eggs is really, really slim.  She says with women with fewer than 10 follicles, she expects 2-4 mature ones.  BUT – if by some small chance I make 6-10 follicles, she says we then have the option of moving directly to IVF.  The eggs are already there for retrieval.

And it’ll mean that I would have only spent $300 on the drugs, as opposed to $4300.  So, IF I create too many follicles, there’s a pretty good chance we’ll go ahead with IVF this cycle. Which has a 43% success rate.

So that’s where we stand.  Please continue to pray for me and Quincy.  As much as I don’t want triplets, twins would be….okay.  But please pray that we get pregnant this cycle, and with only a singleton.

Also, on a happier note, I have realized that on all these hormones, I’m sporting a pretty amazing rack myself right now.  Silver linings!!

06/29/2016

I had to go in for my first official beta test today.  You know, the thing I was supposed to go in for last month, instead of waiting around like a goober?

A beta test is a quantitative hCG blood test.  It measures the amount of hCG in your system.  Unlike a home pregnancy test – the kind you pee on – this one can actually detect the exact amount, down to 1 mIU/ml.  Most home tests can only detect down to about 20-25 mIU/mL…unless you get the First Response ones. And even then it’s just binary – yes or no – whereas the beta test will tell you not only if there’sany hCG in your blood stream, but also how much. Pretty cool.

A “positive” beta test is as little as 2 mIU/ml, but most doctors don’t really consider you pregnant unless it’s 5 or higher.  Some wait until it’s over 20.

Anyway, none of that matters because mine was a big fat zero.

Yay for failed IUIs.

It’s okay.  At least I’m not waiting around on AF and wondering like last month.

In other news…my sister called!  She misses me…and so she and my niece are coming out to visit me July 12-19th!! I am over the moon excited!

This is exactly what I need.  Maybe taking a break from all the stress and hanging out with my sister for a few days will put me in a better place.  Bradley (my neice) has been out here before, but she’s never really done the touristy stuff.  She came when she was a baby for my college graduation (and doesn’t even remember it), she came out for our wedding, but she was a bridesmaid and helped prep wedding stuff and didn’t get to go too many places…and she came out here a couple Christmases ago, but we just hung out and did holiday-type stuff.  This will be her first huge LA trip, and I’m taking her EVERYWHERE!

I’ve warned them…we’re not stopping treatment while they’re here.  There’s a huge chance we will have to spend part of our time at Dr Landay’s office, getting me prepped for another IUI, and then more time actually getting the IUI, but Genia’s pretty excited about that, too.

Oh, and it’s also my best friend Sandy’s birthday that week, so we’re supposed to be going to Universal Studios/Harry Potter World that week, too.  I’ve warned her that we’re plowing ahead, so I may be late to her party.

But – this is going to be an amazing month.  I feel it!

 

First of all, still no more problems with anyone’s naval fleet.  It must have just been nerves or stress or Lord only knows what, but it seems to be behind us.

Anyway, this one HURT today.  I don’t know what the problem was, but it wasn’t like the last three.

After the insemination, you’re supposed to lay there for 10-15 minutes on your back, hips elevated.  The procedure itself was relatively pain free, but once she lifted the table to prop my hips up and left the room for me to stew, I started cramping.  And I mean cramping.

Here’s the thing.  These days, I have varying degrees of “cramping”.  It goes something like this:

• Stage One – Menstrual Cramps.  LOL.  What was that? Yawn.
• Stage Two – Miscarriage Cramps. These are the, “Man, I need to stay still for a second and try to breathe” cramps. Maybe take four advil and curl into a ball on the couch.
• Stage Three – Ruptured Cyst Cramps.  OMG I WANNA DIE. Fall-off-the-treadmill, blank out for a bit, start sweating and vomiting.  These are horrible.
• Stage Four – HSG Cramps. OMG I’M DEAD.  Figuratively. Vasovagal reaction, paralysed from pain, can’t breathe or speak.  Blood pressure plummets. Skin turns grey.  Ya know.  Those.

These cramps need a new category, I guess.  They’re somewhere between Stage 2 and Stage 3, where you are in a lot of pain but are still in control of yourself, barely.  Good thing they only last about 20 minutes. Like, maybe when a faery gets stuck with cold iron.  Pull the nail out and they’re fine. That kind of pain.

What?  I like sci fi and fantasy. It’s a good analogy!!

Anyway, it hurt.  They subsided in time for Natasha to come back and tell me I could get dressed, but had they continued any longer, I would have gotten worried.  I had heard that you can cramp during an IUI, but I had never experienced it before.

I guess there’s a first time for everything.

Anyway, two week wait again.  I don’t know what to think after last month.  I do know that I have a beta test scheduled already for June 29th.  I’ll actually, ya know, GO to this one.  Who knows, maybe the cramping was a good sign!!