another me

I'm a different person, now that I'm "on a break" from TTC. A co-worker brought some leftover Easter candy to work and offered me a piece of dark chocolate. "Mmmm, thanks!" I indulged. The gym is crowded, with a lot of grunting meatheads after 5 PM. This fact, plus the whole heart rate debacle, led me to visit just twice in the last three months... until this week. At 2:15, the gym is virtually deserted. It's downright delicious. I take a late lunch nearly every day now (it's almost a habit, after just four days) and hit the gym for a little sweat therapy. I enjoyed a beer on my sunny patio Saturday evening (and immediately dozed off... I've become a terrible lightweight). I cleaned the litter boxes (I know you're wondering why I'd rejoice about that... well C doesn't clean them as often as I'd like them cleaned. So, when I clean them, no one can even smell that we have two cats.). I'm going to dinner with some ladies in my neighborhood tonight, and I fully intend to enjoy a nice glass of wine.

Little things. A year ago, I wouldn't have thought they mattered. But I feel refreshed and energized and while I have no pie-in-the-sky thoughts for my next cycle, this new me certainly can't hurt.

layin' low

Well, the staff at the RE's office didn't think an unmedicated IUI cycle was a good idea. Not for medical reasons. Medically-speaking, they were pretty supportive. Getting insurance approval for anything this cycle would negate all previous approvals, and there may not be enough time after a BFN to obtain an approval for whatever we're doing next. So, my choice is between doing an unmedicated IUI this cycle and taking the next one off OR taking this cycle off in preparation for whatever the REs all recommend for my next active effort. Either way, I'd have to endure an inactive cycle. Doing nothing today translates into doing something with a higher success rate sooner than if I do the littlest bit of something now.

And because I am an (unwilling) optimist, I must point out that I think we've moved a month ahead of where I thought we'd be by now. Originally, my insurer announced the requirement of two OI/IUI cycles before progressing to IVF. All of the nurses I've spoken with since my blood draw on Monday (all three of them) have implied that my next cycle will somehow involve IVF. One nurse specifically mentioned that once I'm approved for a procedure, insurance typically will not approve a lesser treatment. So instead of beginning my second OI/IUI, which would have been followed by a month break before moving on to an intentional IVF, I may be skipping the OI/IUI to move straight into IVF. I'm a month ahead of schedule.

The pessimist in me feels the need to point out that if an unmedicated IUI cycle would have resulted in a BFP then I will end up at least a month behind in the grand scheme of things. The sun is shining and the forecast calls for a beautiful warm weekend, so I'm ignoring pessi-me.

As for proceding with an unmedicated cycle without insurance approval- we can't afford it. Sperm costs over $1,000 (including shipping). IUI's with the midwives that I frequented last fall cost $225 apiece, and they're the cheapest around. Plus, because the clandestine IUI might not succeed, I'll still have to shell out $485 for May insurance. C just went to work last week, so we're still recovering from his winter lay-off. We just don't have the extra cash.

So, I wait. And this weekend will be perfect for enjoying a nice cold beer on the patio. [silly optimist]

I wish I knew

I think too much. I am well aware of this, and struggle constantly to balance thought with action. I even have a tattoo to remind me to keep this and other sorts of balance in my life. At the same time, I don't handle "breaks" like this cycle well. I want to DO something. We're not in a situation where we might get pregnant "by accident" while on this break. The only sperm in our lives arrives frozen, and there's no romance involved in introducing it to my insides. I've heard about other people who got knocked up the old fashioned way or even through an unmedicated IUI during a break after a failed IVF. If they can do it, shouldn't I at least give it a shot? After all, my eggs and ovaries aren't getting any younger.

So, I called the RE's office today and left a message. I asked if the RE might authorize, and submit to insurance for approval, an unmedicated IUI cycle while we plan what to do next. If I were an insurance company, I'd cover it. It's a relatively small gamble that might keep them from shelling out $15,000 for a June IVF (if that's our next step). Sure, if it works they will probably get one less monthly payment from me, but they'd still come out ahead. Or at least not so far behind.* I have a history of getting my money's worth out of my health insurance.

I don't know what to expect from this cycle. Just how messed up is my system from the gonal-f, hcg, estrace, and crinone? Will I ovulate normally on my own? I realize it may take a month, or even longer, to return to "normal." But I might resume my usual cycling immediately. Why assume the worst? I'm eager to hear what the RE has to say. If I wait until my 5/7 appointment, I'll miss ovulation by a day or two. I'm hoping she'll see me sooner... maybe next week so I can stop thinking and start acting.

*For anyone who lives in MA and whose employer-sponsored insurance is exempt from the state's mandate to cover IF treatments- Sign on for my kind of health insurance ASAP, before I drive them bankrupt. Just this year, I have given them less than $2,000, and paid my $1,000 deductible. In return, I've received more than $20,000 in services. I don't think they'll be in business long if they keep this up, but I am unspeakably grateful for their help.

the official BFN

I knew it was coming, but it hurts any way. I was so certain, I quit the estrace and crinone as of last night. Still, when I got off the phone with the nurse, I needed a few minutes alone in the bathroom. I should invest in some waterproof mascara.

The second hardest part of this moment is not knowing what comes next. I have no plan. I need something to look forward to- not like a vacation or big event. Just a plan. Some iota of control. Something I can DO.

The doctors and embryologists gather each Wednesday to review BFNs and to map out a plan for each person's next cycle. My file might not make tomorrow's review because my BFN is so recent, but the nurses told me I'm off the bus for this cycle anyhow as my body recovers from the prescriptions and procedures. I have an appointment with the RE on May 7th, but if they review my file either tomorrow or next Wednesday, I'll be rescheduled for an earlier consult.

Meanwhile, I'll resume charting. I can go to the gym again, and maybe lose some of this IF weight.

I'm not OK with this. But I am OK.

who needs a blood test?

Saturday's pee-stick didn't produce a second line either. My body is dropping hints left and right to let me know I am certainly not pregnant. I'm beginning to worry that waiting until tomorrow to get the official word might put the next cycle in jeopardy because we won't be able to get the prescriptions in time. Honestly, it wouldn't surprise me if tomorrow turns out to be CD2. Then again, I came to work prepared for the onslaught of CD1, and we all know AF prefers to surprise us with her arrival. She'll probably lay low until I forget to be prepared.

Before any real panic sets in with respect to starting another cycle, I remember that I still have a few partial pens of gonal-f, plus one full pen in the refrigerator (buried under some cold cuts so no one would stumble across it at Easter). I suspect we'll go back to an OI/IUI plan, but with a smaller dose than last time.

I'm in complete agreement with Melissa about dropping the BBT habit. It has been pure bliss to wake without worry; to go back to sleep unconcerned when I wake inexplicably at 3 am. I haven't even logged onto FF in 5 days. I wasn't sure what to enter for non-BBT days on such a closely monitored cycle. Ovulation was purely intentional and forced, so I didn't even use an OPK. I kind of like these monitored/medicated cycles... as long as I remember to take all the right drugs at the right times, there's no stress at all!

Funny- the RE's office just called to tell me they'd expected me in this morning for a beta. I have it in writing on two different instruction lists from the IVF procedure that I was scheduled for a 4/21 test. I could have had my definitive answer today. And with the holiday, traffic would have been a breeze this morning. Oh, well.

rien, nada, zilch, nothing

I P'dOAS yesterday, at 10Dp3dt. Nothing. C doesn't know I used my last pee stick yesterday and need to buy more. I promised him I'd POAS on Saturday.

I insert the crinone every morning, as instructed. I take my 3 estrace pills every morning and again each night. Notable and common side effects include symptoms similar to early pregnancy. I feel nothing.

I have nothing to say. I want to think of nothing until the beta on Tuesday.

I tried to break the news, or the beginning of the news, to C last night. He's still optimistic, though, which is making this even harder. I'm convinced that when I POAS tomorrow,

I'll see

nothing.

CD22, 8dp3dt

Still nothing. No symptoms, false or otherwise, unless a kink in my neck counts. I have one pee stick left, from when I caved and bought a super-cheap 2-pack last cycle (I hadn't confessed to that yet, had I?). I'm planning to use it on Saturday morning. The official blood test will be Tuesday.

This cycle's drug ensemble:
Gonal-F EFF- 187.5IU CD3-6; 75IU CD7; 37.5IU CD8
HCG- 10,000U CD9

Added to the mix when we converted to IVF:
Doxycycline- CD11-14
Medrol- CD13-15
Crinone- CD13-...
Estrace- CD14-29

ER on CD11.
ET on CD14.

CD17, 3dp3dt

The bloating is pretty much gone now, and I am back to my usual belt notch. I slept straight through each of the last two nights after more than a week of discomfort- and anxiety-induced insomnia. The doxycycline and medrol are gone, so I'm down to just estrace and crinone every day. I feel pretty normal now.

I've had a couple of odd dreams, now that I'm sleeping enough to dream. Last night's was in a bus or train station. Everyone else was running around, late for a ride to NYC. I was barefoot, but unconcerned and early for a trip to Boston. The fare was $1 and the cashier was demanding that at least part of the fare be paid in change, which made absolutely no sense. Rather than argue with her, I smugly handed her two quarters and a dollar bill. Of course, she had to give the quarters back to me. She thanked me for using change, and I laughed to myself at how easy it is to please irrational people. There was more to it, but I don't remember the rest. Mostly, I recall feeling calm, collected and in control amidst a crowd of anxious and panicky people.

The next challenge will be to decide on an appropriate date for a HPT. I'm leaning toward Saturday, 4/18, CD26, 12dp3dt.

ten, seven, and five

We transferred all three embryos (10-, 7-, and 5-cells) today. I'm taking it easy ... watched a little TV, and will take a nap now (to make up for staying up almost all night worrying we'd have nothing to transfer). I'm planning to go to work tomorrow, but will avoid the stairs as much as I can and will basically just sit at my desk all day. No different than if I stayed home, really. I still feel pretty bloated from the ER, and I suspect that some of the medications are responsible for last night's insomnia. Generally, I feel good. We'll have our beta on 4/21, so now I just need to keep on hoping.

more than two; fewer than four

Three eggs fertilized.

When I heard they'd retrieved eleven, I was concerned that they might do the assisted hatching on too many embryos and I'd either be coerced into transferring more than I'd be comfortable with, or some would be wasted because I think you can't freeze an embie that's had a hole cut in it. I coached C on exactly what I wanted to ask the embryologist, or what I wanted him to ask if I weren't home to take the phone call. I needn't have worried. We have three fertilized eggs as a result of this cycle. I'm thankful for those three. There will be nothing to freeze, and that's OK. I just want something to transfer on Monday.

11 on CD11

Retrieval today went without a hitch and 11 eggs are now exposed to sperm. Tomorrow afternoon, they'll let us know how many fertilized. On Sunday, they'll tell us what time we should report for Monday's transfer.

C is incredibly optimistic this cycle, repeatedly saying, "Everything is moving along like clockwork," and things like that. I am optimistic, too. But I have to bite my tongue every time he quips something like that. My instinct is to tell him that everything was like clockwork for each of our failed IUI cycles, too. I have no more and no less hope for this cycle than any other. Except maybe the first one, when I thought our only hurdle was getting our hands on some sperm. I thought sperm was our magic bullet. I think C believes IVF is.

Anyhow, things look good so far. Eleven eggs on a converted OI/IUI cycle is more than I hoped for. The embryologist said the norm is about 70% fertilization, but he's seen everything from 0 to 100. I'm just hoping that we have something to transfer. A couple to freeze would be gravy. But for the moment, my focus on on the transfer.

Recovery-wise, I feel pretty good. A bit sluggish bloated and crampy, but otherwise normal.

Oh, and the hcg shot? Well, I am incredibly grateful that my husband has a sister-in-law who happens to be a nurse and who didn't mind me showing up in her kitchen at 1:15 am.

jump to the head of the line

Holy crap- we're doing IVF. Hcg shot tonight- intramuscular, because now it's an IVF cycle, not an IUI. Eleven follies- 3 on the right and 8 on my left (no wonder my left ovary hurts!). Estrogen is 1181... I don't know what that means. Retrieval will be some time on Friday, 34 hours after the trigger.

I'm not prepared! I've read blogs written by women undergoing IVF, but since I was stuck on IUIs for at least another cycle, I didn't memorize anything. I know the basics as far as what will be done procedurally, but I feel pretty clueless right now. Hopefully, tomorrow's meeting with the RE will answer all my unasked questions (I'm not even sure what to ask).

I'm so nervous/anxious/excited that I am shaking. It's a very good thing C isn't already back to work.

sub-Q

A load was lifted from me this morning. I headed to the RE's office again this morning for another blood draw and ultrasound. I asked the phlebotomist if she could point out where I am supposed to inject the Hcg and she declared that the trigger shot for an IUI is subcutaneous, not intramuscular. Hurray!

There's still a chance that this might turn into an IVF cycle. Seven measurable follicles, all of similar size raises the risk of conceiving high order multiples as a result of an uncontrolled IUI. Then again, insurance may not see this as a "glass half full" scenario and could deny coverage for an IVF at this time. In which case, we're as good as cancelled. We can swing the price of the extra insurance, but not the cost of an IVF. Especially when we know that an insurance-covered IVF is on the horizon, just one more OI/IUI cycle away if we need it.

I don't know when the decision will be made, but I hope it's soon. It's not the prospect of undergoing IVF that has me tense; it's the not knowing what we're doing.