450 + 20 = headache

Also equals crying. Right. Fake hormones do this to me. I’d forgotten.

Since Saturday night (between 6 and 9, though honestly closer to 9), I’ve been shooting up 450 IU of gonal-f and 20 IU of low dose HCH. (Do I need to say low dose when I am putting down the actual dosage? Idk.) The mixy-mixy part is pretty fun: take the bariostatic water and inject it from it’s glass-looking hypodermic needle into the little vial of gonal-f powder and – presto! chango! – its 600 IU of ovary amping liquid! Then get 20 IU of HCG from it’s nice little vial, which you’ve been warming to something above fridge temp in your bra or armpit, as the case may be. Then! Combine those two syringes of medications into one other and slightly larger syringe and then with some fancy needle switching foot work and buy yourself a headache that lasts more than 24 hours! And a lot of trash. What I’d really forgotten is how much medical waste there is in This Journey.

Ok, for real, it’s not so bad. The headache could be something else. I am prone to them.

But the crying. Bah. I went for monitoring today and didn’t see Dr. Hot, which is fine. The other guy is fine. And they got me in and out of there really fast, which was good because I was racing the children to camp. But. But it was really fast. And I didn’t get it together to talk about the headache or to check in at all really. There was a resident, to whom I was introduced, and whose presence was cleared with me, sort of – it was so quick, I’m not sure how it would have gone down if I’d said it wasn’t ok for her to be there.  And the wanding was honestly one of the more comfortable I’ve had. And the Other Doc (this is really the cheater RE, the one who left my old and dear RE at the other hospital to start this private practice) kept the screen tilted so I could see and narrated what he saw and laughed a my (one) joke. But he didn’t count noses, as my old and dear RE used to say when counting follicles. He didn’t look at my lining, which obviously isn’t the issue at this exact moment, but I’d still like to know what it’s doing.  He just said that things looked good. I want details. And the nice IVF nurse was nice and combined my partial vials of gonal-f into one vial so I have an extra day of meds for (sort of free), but she didn’t do my blood draw and the nurse who did wasn’t so nice – not mean, but barely made eye contact. (Y’all, I get it. It’s also my job to make nice to people all day and sometimes it doesn’t happen, and she was perfectly civil and it didn’t hurt… but I just wanted… well, I wanted my old lab people. That’s the long and the short of it. I miss my old lab people.) And it was all so damn fast. Which was great for getting to work, but also, it sucked.

And so I cried a little in the elevator leaving. For all that I was one person inside the huge system of the big public teaching hospital before, I never felt like I was anything other than the only and most important patient of whoever (intake nurse, RE, lab tech, receptionist even) was taking care of me. And here I am at the fancy private clinic and the appointment is all moving so quickly I can’t catch my breath to think if I have any questions. I mean, I’ll be better prepared Thursday, but yuck. I guess I was spoiled. Which is sort of bullshit, because people should be treated like I was treated anytime they go for medical care.

For the record, Dr. Hot has so far always given me her full attention at appointments and I wonder if it would have been different with her? I wonder if part of it was that I dislike the round-robin of doctors model? (Am I using that sports-related term right? Even google can’t tell me.)

Anyway! I have 4 days worth of 450 IU of gonal-f in my system! That’s… maths… 1800 IU. Another wanding on Thursday morning!

Damn that’s a lot of exclamation points.


and now we are

Done with birth control. And done with the antibiotics for various orifices. Whew. None of those were fun. I know they are nothing, so far as “fun” is concerned as compared to the injections I am about to undertake, but all the same, I’m glad they are over.

So yesterday I went for a “practice transfer” and a baseline wanding and some blood work and a little meds tutorial. This was supposed to be a “full bladder” appointment, but I forgot that part in my scramble to be sure I had all the Sperm Related Paperwork* in order. So I spent the 10 minutes or so in the fancy waiting room drinking cup after 4 ounce cup of water while texting my friend Melissa and uberbutch. (F y’all’s I, this does not work – they knew I didn’t come in with a full bladder.) Despite the lack of retained urine, everything went swimmingly, as it does, and now there is a “map” of my vaginal canal, cervix and uterus for whichever RE ends up doing my transfer (please, baby Jesus, let it be Dr. Hot, please).

It’s interesting to me how every RE has a different way of doing things. E.G. in terms of cervical navigation, my dear old RE wanted me to remember the direction northeast and tell that to him anytime he had to put something up and into my cervix. The Richmond RE made a thoughtful face when I told him this and then allowed has to how that made some sense, but he never referred to any of the cardinal directions when threading my cervix. Dr. Hot, meanwhile, looked at me like I was a little crazy (but she laughs at my jokes and is, well, hot, so that’s ok) when I said to her that my cervix was of the NE variety when she did my SIS, but then she turned into a cartographer while doing my practice transfer.

I know your real interest is in the numbers, though, so I’ll give them to you. In a list, because I care:

  • 10 antral follicles, 5 on each side
  • 3mm-ish lining
  • e2 at 20

So I have, as I said, quit the BC pills and now I wait for my highly overpriced meds to be shipped to my house and then I start injecting them into my belly on Saturday evening. These meds are all Science-y! I get to mix powders and salines and then use various sizes of needles and alcohol wipes and terms like “sub-q” and “IM”, if only to myself, and it’s like I am a scientist all in my own house! Whee!

Any damn way, injections Saturday, initial monitoring wanding on Tuesday and then everyday/every other day after that until things are settled where they should be and then retrieval and then transfer.  Ok.

Of note, I signed off on assisted hatching if we do a three day transfer. Thoughts?

*Oh, the Sperm Related Paperwork… it is a post all it’s own. But it is done to the best of my ability and said sperm should be arriving chez Dr. Hot tomorrow, via Cryoport, who should be your go-to for all shipping because they win.

and doubt not, the earth that has grown old in sorrow/ shall grow young again in the light of that morrow

Check out this handy list I made, back in the day:

https://starrhillgirl.wordpress.com/2010/07/17/stats/

Whoa. I’d sort of forgotten a lot of that.

And whoa, am I ever doing a different protocol this time. Dr. Hot thinks that since I did a lupron cycle last time, why not “mix it up” as a co-worker of mine used to say, and go for antangonist this time? I certainly can’t think of a reason.

So I’ve picked up the meds that I can get at my favorite pharmacy/soda fountain, which not only has delicious sandwiches and limeade, but also the friendliest ever clerk at the pharmacy counter who refers to me as “lady” in that way hip young people do, which makes me feel hip *and* young, ahem. Those meds are :

  • birth control (oh, days of yore when I’d read other blogs and be confused by people taking birth control to get pregnant… such youthful ignorance!)
  • cipro
  • some vaginal “cream” version of antibiotics (haven’t started those yet, but for the record, I am not a fan of such things, just F everyone’s I)
  • valium (for the eventual transfer, although not as many as I used to get from the dear Richmond RE, however the new cheater RE wants me to take three at once? Fun! But none to horde… boo.)

I started the birth control (did you know it comes with these little stickers so you can change the day of the week?! It’s like controlling time! So fun!) and the cipro yesterday and my stomach seems to already be a little unhappy. It is handy to have a friend who is a nurse to text at such times. She suggested probiotics. My pre-school-strengthened immune system has afforded me years of no antibiotics so I was all  “whaaa?” when I struggled to eat more than a few pieces of roasted kale.

The plan, as it stands now is a mock-transfer and baseline u/s and bloodwork on the 25th, start injections on the 29th and then see what happens from there, the general hope being, aside from a live baby, home from the hospital as they say, retrieval sometime the week of the 7th and transfer 3 or 5 days after that. There are a mess of commas up in here. Probably, I don’t need them all.

For the record, the final outlying test – kerotyping (still no idea if that is the correct form or use of that term) – came back normal, so no PGD, which I wasn’t really up for anyway, so yay. I also said no to ICSI, which this lab likes to do with all sperm bank sperm, because it seems, they got burned once and are traumatized. But my “gifted” sperm (that’s for you, LB) seemed to have no trouble fertilizing  a mess of eggs sans ICSI and my personal eggs seemed to have no trouble being fertilized by other sperm bank sperm, so I’m not going to worry myself over that one.

There are plenty of other things to worry about! But, oddly, I find myself rather, um, un-worried. Weird, huh? I just pretty much feel ok – cheerful, even. Not desperate. Sanguine, almost? This isn’t one of those “I’m so blissed out and and relaxed, I’m sure to get knocked up right away!” things, mostly because I’d never use the term “blissed out”. It’s really just this thing I’ve noticed that’s, honestly, a relief. This will work or not work and that’s how it is. My freaking out or “relaxing” won’t make anything more real, so I just feel… ok. Good, mostly. It’s like they’ve added the bonus valium that didn’t come with my prescription to my water. Valium certainly is a fun drug.

So. Onward Christian soldiers! Keep your hands and arms inside the ride! Forward ho, lovers of truth and good*!

*stolen, shamelessly, like the title of this post, and then adulterated.


one down

One decision that is.

As some folks here and lots in other places noted, I’m clearly not ready to give up on this pregnancy/baby lark.

I had some New Age Time with my chiro (rolling my eyes at myself), after which I realized my fear about trying again stems from how terrible I felt for, really, two years after my last failed IVF.  Hence, in hindsight, my friend’s order to examine how I’d feel if I tried and failed again.  Which is, obviously, within the realm of possibility.

Here is the deal. Things were bad there, for a while, y’all. Not like thoughts of suicide, but generally just not good.  But then, last summer I started to feel better and now, as evidence by several things (my energy level for cooking and gardening most prominent among them), I feel, well, like my normal self. No longer broken! Fixed! It’s nice.

Even if I fail miserably at this, even if that failure makes me miserable, it looks pretty clear that I’d be able to, given time, come out the other side and feel ok. It might take a while. It might be really hard. I might alienate *all* my friends this time. (That’s a joke.) But I’ve done it before – with complicating factors – and so I trust I could do it again.

Done and done. That part at least.


clever metaphor of your choice for “decision making” here

Oh, hi.

So I had a Saline Sonogram on Friday. I took the entire day off for it, which was a great plan, not because the procedure was bad, but because – woo! – day off! Dr. Hot wanted to get a look-see at my ute to be sure everything looked normal post the miscarriages.

She was as cute as ever and it was easy and everything looked normal. Yay, right?  And all my new and re-done bloodwork looked normal, too! Yay! Right?

Sort of. Everything normal means that there is still no known reason for my infertility. No easy fix to something that got overlooked before. No clear “you will never carry a pregnancy past 10 weeks, so don’t even try”. Honestly, I was really hoping for one or the other.

There is one test for which I have not yet received results. Dr. Hot seems as into genetics as Dr. E (nice old RE) was into auto-immune. She ordered a karotype test that will be back in a few weeks and will, to quote the paper for from the cheater RE’s, be “expensive”. Oh, yay. There is a 5% incidence of chromosomal abnormalities in cases where there have been at least two miscarriages. Heck, I hit that number three summers ago! Anyway, Dr. Hot is interested in my genetics, it seems. If I do IVF again, and, wow, is that ever a big if, she strongly recommends PGD (yes, that’s a wikipedia link – it looks legit). She even gave me the name of a guy in New Jersey so I could look him up – which I should do, at some point – because he is at the forefront of genetic testing. Which sort of gives me hives, because that sort of thing is a slippery slope, I fear. But. But.

But it’s so highly unlikely that I’d do IVF again. It’s just so damn expensive. And I am barely holding my financial head above water from the transfers I did, all willy-nilly, over the past two three (Jesus.) years.

Let’s break it down:

  • basic IVF package price is $8,400 – that’s $5000 for the clinic portion and $3400 for the  Laboratory
  • the average cost of meds is $2,500 – ouch. Last time I got these for free from the ever generous IVP
  • cryopreservation of bonus embryos is $470 and then storage is $150/quarter and $470/year. If memory serves, storage at the Richmond RE was cheaper, but maybe prices have gone up everywhere.

You do the math. Don’t forget to add something huge for PGD.  Although, wow, I feel sketchy about that. And not just because of the (unknown amount of) money.

If I had a million dollars, I’d do it in a minute. I respond well to the meds; I make a shit ton of eggs; it was unpleasant but not terribly so (and it might be better if I wasn’t unknowingly at the beginning of the end of a relationship). But I don’t have a million dollars. The cheater RE has some sort of payment plan (pay some amount at the time and then pay monthly for a year), so I guess I will call to see the ins and outs of that.

Then there’s the option of making this the summer of IUIs. Dr. Hot wants, if I do any more IUIs, to throw my old friend femara as well as gonadatropins (with whom I has a short fling back in 2009, thanks again to the ever generous IVP) into the mix. More targets, as Dr. E, the nice old RE, would say.  I can’t find the price list for any of that, but let’s guess around $600 with the meds? Damn. I wish I could find that page on the cheater RE’s website. I swear it was there.

ANYway.

Then there’s buying sperm.  So factor that in. Let’s call that – wait, I can look that one up – let’s average it and call that $700. That’s without shipping.

Then there’s throwing the towel in.

I’ve decided on one option or the other about 50 bathousand times in the past two days. Heck, I’ve decided on one option and then another forty-eleven times writing this. Each ones seems equally valid and perfect and equally wrong. Ugh.

My wise friend Susie said to think about how I would feel if I tried and failed. Which is good to remember. And why it’s so hard to decide. If trying again was a sure thing, then that would be the obvious answer.

I’d love to farm this decision out. Can’t somebody decide for me? Dr. Hot has refused, for the record.


public v private

Y’all, the cheater RE is a private hospital. My old RE was in an endocrinology clinic in the public hospital. I knew all this. I’d compared and contrasted public and private medical establishments when I went to the Richmond RE for IVF. It was fancy pants. The button to call the elevator was normal elevator-call-button sized, but the marble (!) inset around it was bigger than my head. The elevator call button at my nice old RE’s sometimes had a piece of paper with an up arrow drawn on with ballpoint pen. (For years – yes, I was there for years – it was forbidden to take said elevator to the 3rd and final floor there. So it was mysterious! One of the nurses told me it was just full of old chairs, but it was still full of mystery to me.)

I went for lab work Friday. So, yay me, right? Right. But, wow, did it make me miss my old lab people.

At the old RE’s, the lab was clearly a Lab. Not just because Amir and Michelle and the other nice lady whose name I wish I could remember wore white coats. But because there were Science Things in there. Not just a red bio-hazard sharps container and boxes of gloves, either. There were those racks where you stick everybody’s blood vials, and important looking notes stuck to the walls, and millions of drawers that were filled with More Science Stuff, and stacks of papers around the computer where they sent out orders for pick up and processing like “STAT”. (For real.  Remember that? No. Because everybody who read my blog then is dead because I’ve been doing this for so damn long.) There was something of a partition so two people could get stuck at once, and there was a random hard chair by the door in addition to the chairs with the giant funny arms for the stick-ees to rest their arms on. Sometimes you’d even get to see the courier people come in to pick up all the bloods! So exciting! It was all Science! and Medicine! and Lab! But also they were so nice there, Amir and Michelle and that other nice lady. They always remembered me, even when it had been over a year since I’d seen them. And Amir once sat me down and gave me a very serious pep talk, drawing parallels between football and ttc, saying things like “you just have to stay in the game” and “you might be tired and feel like you are loosing, but keep playing – stay in the game.” Those are not direct quote, but you get the idea. Anyway. My lab people. Winners.

Now, if you’ll consult back to the top of this (already rather long) post, you’ll see that the new cheater RE is at a private hospital. This was pretty apparent at my first visit with Dr. Hot (whom I saw two weekends ago at the farmer’s market with her husband, whom I mistook for an adorable, tiny butch lesbian at first): fancy water cooler, matchy-matchy upholstered chairs, etc, etc.  But it was this recent trip for blood work that really hammered the difference home. Y’all, the walls in the little “room” where I actually got stuck (by a nice blonde 12 year old – really, she was 12) were painted not one but two colors and the upholstered chair in the corner matched both of those colors. All the Science was hidden away somewhere else, but there was a chair that matched the walls. Who was supposed to sit in that matchy chair, I don’t know.  I certainly didn’t get stuck in it – no blood on the goods! As we used to say in the costume shop. Maybe it’s for if you bring company into the lab? But it’s too far away from the chair where the business gets done for any hand-holding to take place, if you were the sort who needs hand-holding. Weird. And matchy. For all the (obvious?) care taken in the decoration of the little “room” it was strangely devoid of feeling. Or, rather, it’s feeling was empty. There were other little “rooms” off of the tastefully painted hallway from the (second) waiting room, so I guess the idea was confidentiality and comfort? But it was really not very comforting in there. And I could hear the chatty lady in the next “room” perfectly well.  So really, I don’t know what they were trying to achieve.

It was fine, of course. I’m a bloodwork rockstar. The 12 year old who stuck me laughed at my jokes.  She was good – it didn’t hurt at all. I got paper tape and gauze rather than a big itchy wrap bandage. But, wow, I missed my old lab people a lot.


incipiencey

CD 1.  I wasn’t sure I’d ever write that in relation to myself, but I am.  Bloodwork within the next couple days.  I hear the lab guy at the cheater RE is nice.  But I did love my old lab people so much. I wonder if this new guy will be willing to give me gauze and paper tape rather than a big stupid wrap?