it's on!

HCG at 9:00 tonight, with ER scheduled for 9am Thursday.

Now I can peel myself away from the desk and relieve at least a little of the bloat (I didn't want to miss the call).

waiting again

E2 was 2700+ yesterday. The nurse didn't remember exactly, but she recalled 2700-something. Now I'm waiting for today's call with the next instructions. Will it be adjusted doses and another trip to the office for b/w & u/s, or will I trigger tonight? They usually call between 1:30 and 2:30- I'll be glued to my office during that hour.

I left early for today's appointment and it took half as long to get there as it did yesterday. The u/s tech who took care of me yesterday walked into the waiting room just after I arrived, so I told her I'd followed her advice and there I was, an hour and forty minutes early. She took me right in and I was out of there long before my scheduled appointment should've begun. It was great- so much less stress than riding through full-blown rush-hour, and I made it to work early (which translates into leaving a little early).

I mentioned to the phlebotomist that I couldn't button or zip my pants yesterday. Another nurse overheard and asked me to step on a scale and show her my bloated belly, then informed me that we need to be aware of the potential for hyperstimulation. Apparently, she's not really worried at this point, but she told me to weigh myself when I get home from work, and again tomorrow morning. If I gain 3 pounds in 24 hours or less, call them ASAP. I'm also on the lookout for shortness of breath, actual pain in my abdomen (as opposed to discomfort), and nausea.

Speaking of nausea... I had it in spades last night, but I think it was brought on by the massive headache that developed after work. Dear C ran out to the drugstore for Tylenol (I'd left our only bottle in my office... we're usually an Advil household), and I fell asleep almost as soon as I took it. I feel much better today, and better-rested than I have in nearly a week. I think that's the first I've slept through the night since I started stimming. I'm still mega-bloated, but wearing some seriously oversized drawstring pants and a loose flowy shirt disguises it well and keeps me comfy.

I'll post as soon as I hear today's results.

missed call

I'll try to get my numbers when I go back tomorrow for another u/s and more b/w. I was away from my desk when the nurse called, and the message was limited to new doses and tomorrow's re-visit to the office. No trigger tonight. Instead, I drop my Gonal-F dose a smidge...

CD9-
5u Lupron + 75u Gonal-F- AM
report to the RE at 7:50 for b/w & u/s
37.5u Gonal-F- PM

CD10-
5u Lupron + 75u Gonal-F- AM
report at 8:40 for b/w & u/s

Today's u/s tech suggested I show up mega-early when I have a "later" appointment. I'm not a fan of rush-hour traffic, so I'll heed the tech's advice. We'll see if that works tomorrow, or if I end up sitting in the waiting room for an hour.

Sitting at a desk is becoming increasingly uncomfortable as the day progresses. I may have to wear sweats tomorrow.

if only my arms were longer

I am at work, leaning back in my desk chair as far as I can and still reach the keyboard. Even with my pants barely zipped, and not at all buttoned (held up by the wonderful BeBand), I wish I could lean further. Horizontal would be really nice. I'm so thick in the middle that I just don't fold in half like I did a few days ago. Luckily, it's still un-summery here in New England, so I was able to wear a long-ish fleece shirt to work. It's loose enough and long enough to camouflage my engorged mid-section.

I'm waiting again. Blood was drawn and an u/s done this morning, so I expect to receive new instructions in a couple of hours. One of the nurses (one who was very uninvolved & distant last cycle) took a quick peek at my ultrasound images and expects me to be back for the same tomorrow. This was in response to my guess that I'd be triggering tonight or tomorrow. She agreed that I'm close, though. This was as engaged as I've seen this particular nurse. Maybe they're all warming up to me because I've been there for 6 months?

C's sister-in-law has agreed again to administer my trigger shot (Thank you!). She's a nurse, and took care of my trigger last time- painlessly, I must add. I know I'm lucky to have her nearby, and willing to be woken in the middle of the night to stick a needle in my butt. I'm sure C could do it if we had no other options, but he'd be nervous and I'm sure it would hurt... both of us.

This is the fast-paced, edge-of-my-seat, manic part of IVF. Monitoring every morning means getting out the door by 6:30am. I haven't slept well since Thursday. Days and nights are blurring together, and the anticipation builds with every "this looks good" that I hear from the nurses (I even got one this morning!). I'm completely unfocused at work, although I did manage to pull off a big A on an accounting exam over the weekend (online). I admit, I'm utterly useless at the moment. I gave the nurses my work number to call today so I'm staying in my office at least until the call comes. Then, I think I will need to go home and try to take a nap.

ch-ch-ch-changes

CD7-
5u Lupron + 225u Gonal-F- AM
[E2=814]
187.5u Gonal-F- PM

CD8-
5u Lupron + 150u Gonal-F- AM
report to the RE at 7:30 am for b/w & u/s.
[E2=1757; 12 measurable follies: Left=8 measurable + "many" smaller follies; two biggest are 18x10 & 14x14; Right=4 measurable + "lots" of smaller follies; two biggest are 16x13 & 16x11]
150u Gonal-F- PM

CD9-
5u Lupron + 75u Gonal-F- AM
report to the RE at 7:50 for b/w & u/s

It's happening well and fast. The nurses staffing the office this weekend are on rotation from the affiliated hospital, instead of the usual taciturn nursing staff. The nurse who called this afternoon with my results and new instructions began the conversation with, "Holy canoli!" then gave me my numbers and counts. She was incredibly encouraging and sounded like she genuinely cares how this all plays out. Such a contrast to the feeling I get from the RE's regular staff, who appear to go out of their way to remain detached and uninvolved.

So, another trip to the RE tomorrow. I can't wait to see what has changed in one day, and I'm very eager to find out when to trigger. It won't be too long now. Go follies, go!

order up!

Unsolicited call from one of the RE's nurses today. That essentially never happens, so I was afraid something had gone wrong- but how could it when they haven't seen me, my blood, or my ovaries since giving me the all-clear on Monday? It turned out they wanted to share information. Critical information. Information that might have led to a completely useless cycle had they not decided to share it with me.

I was instructed to order the donor sperm TODAY. For delivery Monday. To the HOSPITAL. Now, they've emphasized again and again that DS needs to be shipped to me because they're not equipped to store it. Presumably, the hospital is equipped, while the satellite clinic is not. Good to know. Also, another nurse told me on Monday that I could have the DS shipped to the hospital, but only if it arrived within 24 hours of the ER. At this point (CD6 or Lupron day 15 for those keeping track), no one is willing even to guess when ER will happen. DS is good in the shipping tank for 5 days. So even though no one has seen me since I started stimming, and no one has any more information than they did on Monday, they suddenly know that ER will happen between Monday and Wednesday? And they still won't "predict" that ER will occur between Monday and Wednesday?

Then again, maybe the hospital has cryo-facilities so shelf-life in a portable tank isn't an issue.

Hopefully, someone will tell me tomorrow to expect ER to be some time between Monday and Wednesday. Otherwise, I will worry.

My other worry- no one gave me the hospital's address, and I forgot to ask for it until I was on the phone with the bank. I pulled it off the hospital's web site, but then called the RE's office to confirm I had the right address- left a voicemail, but no one called me back and they all leave at 3:30. Aaargghh! I was feeling so good, and so calm. Now I have new things to worry about.

feeling good

Bloating, bruising, and headaches aside, I feel really good both emotionally and physically. Maybe the doctors do know a little something about taking a cycle off between IVF attempts. Or maybe I feel invigorated because it's Friday, and the sun is shining (a truly rare event in the northeast this month), and the strawberries are still fruiting (I've made 3 strawberry rhubarb crisps already) and the wild blackberries will ripen soon (pie!). Regardless of where it comes from, it feels good to feel good. I'm still obsessed with TTC and IF, but I've become so comfortable with that obsession that I'm no longer obsessed with obsessing. That may not make any sense, but it's the truth. I guess I could say that I am comfortable with the fact that it has come to this. THIS is how babies are made, in our life, so THIS is what we're doing. THIS is our reality. It's not the best reality, but it's ours and we're doing what we can with it. There's no point wishing it were different- it is what it is. And dear God, I hope THIS works.

Bloodwork tomorrow. I suspect the daily monitoring will commence shortly thereafter.

the joys of injectibles

My Gonal-F pens never prime on the first try, so I consistently waste a second 37.5u dose just getting the air out of the thing. I wasn't really surprised when the pen ran out just 37.5units short of my full morning dose as a result of the double-priming. My solution was easy- pull out one of the leftovers from last cycle and do a second Gonal-F shot. Now, I have a bright purple bruise on my belly, thanks to that one extra shot. No more or less pain than any other injection I've given myself, but for some reason the last one this morning bruised right up. I don't flash my belly at anyone, especially as the IVF-bloat sets in, and it doesn't hurt, so I really don't care. It's just very odd.

Speaking of bloat, I think my left ovary is going to be the big producer again this cycle. I'm beginning to feel it already and find myself leaning to the right when I sit down. I wore some too-big pants today, without a belt, and they're starting to feel a little constricting. I bought a BeBand at Target over the weekend, and tried it out with a pair of normally just-right jeans last night- I LOVE THE BEBAND! Seriously- it was so comfortable, I'm tempted to buy a few more and wear them all the time instead of a belt. If you're struggling to be comfortable in your clothes and don't want to jinx things by wearing maternity pants, do yourself a favor and buy a BeBand (or a Bella Band, or any facsimile thereof). If I hadn't read about it on someone else's blog, I wouldn't have known.

I'm working on a 2-day headache now, but that might be Lupron, it might be Gonal-F, it might be the combination of the two, or it might be pollen (although it rained nearly-non-stop for the last week, so I think all the pollen has been rinsed out of the air). Not a massive, kill-me-now headache. It's a nagging one, like an itch- not enough to stop me from doing anything, but strong enough so I can't ignore it. Again, no big deal. I'm functioning, and this won't last forever.

Please don't think I'm complaining. I'm just documenting the symptoms and side-effects as I feel them. It's good to know the drugs are working. Saturday's a long way off...

the protocol today is...

Starting on the evening of CD2, my new protocol became:

5 units Lupron in the AM
225 units Gonal-F in the AM
225 units Gonal-F in the PM

I'll follow this until at least Saturday morning, when I go in for more bloodwork. I couldn't wrangle any hint of a timeline from the nurse who called me yesterday, although she did say we'd have some idea of how this will progress once they have the results of Saturday's b/w. I scheduled a vacation for the week following the 4th of July, which I expect to coincide with the first half of the TWW. I haven't told my supervisor that I may also need a day off some time next week for the ER. I'm sick of people knowing my business and would like to keep everyone at work (including my mother) ignorant of what's going on.

Speaking of mothers... my nephew is coming to stay with my parents for a few weeks. Knowing that I'm taking a week off, and since I said I wasn't going anywhere and had no "big" plans for the week, my mother has begun campaigning for me to take my nephew for a day or two. Sure, I love the kid. But I'm going to have to invent some "plans" so I can be a recluse during my vacation. Maybe I'll just have to "visit" my old friend and college roomie in NJ. I hate lying- it's simply wrong, and I'm lousy at it. But if I'm cornered, I'll do it.

At least my mother hasn't asked me if I might be pregnant in the last couple of months, even though I did call in sick to work one day with an evil headache and dizziness. No, she doesn't know this blog exists. No, she never will.

waiting for the call, CD2- **UPDATED**

AF made her appearance yesterday afternoon, which turned out to be CD1, not CD30. If anyone out there wonders as I did whether Lupron has an affect on cycle length, the answer would be no. At least in my case, taking Lupron beginning on CD22, at a dosage of 10u every morning, had no impact on cycle length. Good to know.

I headed to the RE's for u/s and b/w this morning. Assuming my hormone levels are in line and there are no unusually large cycts in my ovaries or fibroids on my uetrus, I expect to start taking the Gonal-F tonight or tomorrow. Then we head down the slippery slope of IVF... things start off rather slowly, then get a little out of control with daily monitoring and dosage changes and bloating and lack of sleep and finally the trigger, ER, and ET. Then comes the v e r y s l o w TWW. Time will literally fly between now and ET, which is part of why the TWW feels so darn long. Interminable as it may be, I'm eager to get there. I'm excited to become PUPO again, and hopeful (as always) that this is the time that will work for us.

**
Got the call from the nurse- no cysts, no fibroids, no follies. Lupron did its job and E2 was 19, progesterone was 0.5. I have to take her word for it, since I don't know what all those numbers mean, but she said I have the green light to start Gonal-F tonight, 225 units twice per day, and cut my Lupron dose to 5 units each morning.

Back to the RE's on Saturday for b/w. No guesses yet as to when ER will be, but almost certainly between June 30th and July 4th.

ICLW- welcome

Welcome to ICLW-ers, and anyone else who happens along my blog. Here's a quickie synopsis of what's transpired so far in my IF life to save you from the tedium of slogging through the whole blog.


June 2008- after a year of TTC the "natural" way, we learn that DH (I call him C) has no sperm. By this time, I was 40 years old so we can consider "advanced maternal age" yet another limiting factor. All we need is donor sperm, right?

August 2008- DIUI cycle #1- BFN

September 2008- DIUI cycle #2- BFN

October 2008- DIUI cycle #3, this time with Clomid- BFN

November 2008- DIUI cycle #4, with Clomid- BFN

January 2009- invest in some new insurance that will cover fertility diagnosis and treatment. Everything up to now was out of pocket (what a great tax deduction that was!). Hook up with an actual RE, do the usual b/w, HSG, Clomid challenge, etc. I'm OK- just "old."

DIUI cycle #5, with Clomid (from Clomid challenge)- BFN

February 2009- DIUI cycle #6, with Clomid- BFN

March/April 2009- OI cycle using Gonal-F- planned for IUI, but converted on CD9 to IVF due to "exuberant" response to FSH. 11 eggs retrieved on CD11, 5 mature, three fertilized. Three embryos transferred- BFN

June/July 2009- IVF (on purpose this time)- Long Lupron protocol-

10u Lupron CD22-30 with instructions to call RE's nurses on CD1.

And that's where we are now. It's CD30 and AF's arrival is imminent. In fact, I was so convinced she'd arrived yesterday that I called the nurses at my RE's office and reported that I was on CD1. It was a little embarassing to admit this morning, when they called me back, that I had been mistaken but still expected my period to start "literally any minute now." If it starts today, then I'll have an u/s tomorrow, maybe some b/w, and they'll let me know when to start the Gonal-F. Because of my age (I'm 41 now), assisted hatching will be practiced and the RE wants to transfer up to five embryos. I'm perfectly OK with AH, but five... I know the odds are not in my favor, but what if they ALL stick? That's the only real conundrum this cycle, my only real worry... aside from failing completely.

Donor sperm has not proven to be the magic bullet we had hoped for. We're on our fifth donor now. The first wasn't very impressive, so we switched banks. I absolutely loved the second one, but he retired and stock ran out. The third one retired. The fourth one was fine, but now that we're doing IVF from the get-go, we had to find a donor with ICI vials available. Donor #4 had no ICI vials, so we found donor #5. If anyone's curious, unwashed sperm is preferred for IVF and I was instructed to purchase two vials for this cycle. I have seriously mixed emotions about choosing a donor. On one hand, I would love to match as many chacteristics of C as we can find in a single donor. But, at the same time, I would be happy with a baby of any size, shape or color. Most important are the family medical history and the openness of the donor. We want our child to have the best shot at being healthy, and we want her to at least have the chance to learn more about her bio-dad if she wants to. If the cryobank sends us the wrong donor sperm, we'll use it anyway (I've come a long way since DIUI#5, when I had a bit of a confrontation with the RE's office over my checking the cryotank contents before reporting to the office for an IUI).

B

Lupron day 8

The only side effects I've had include being easily distracted, unfocused, and generally a little out-of-it. And maybe that fit of crying I had at the wedding last week. AF is nowhere in sight. If I were unmedicated, she'd have arrived yesterday or today. I couldn't find any answers regarding the affect of Lupron on cycle length, so I don't know what to expect. The injections themselves are easy, with little to none of the mild burning I felt with the first dose. Only the latest three pinpricks are visible on my belly, and those very faintly. There's been no bruising at all. I alternate sides to decrease the risk of stabbing where I recently stabbed. The right side is for odd days, and the left is even because I probably wouldn't be able to remember where yesterday's shot went in.

I've decided to take the week after the July 4th weekend as a vacation. I haven't taken more than three days off (not counting weekends) at one time in over three years, so this doesn't arouse any suspicion. My supervisor just thinks I am finally taking a real vacation. Too many people at work suspected what was going on when I took two days off for IVF #1's ER/ET. And even for those who had no clue, my refusal to lift anything raised questions. I just hope the timeline works out- C is praying for ER on 7/3, a holiday, with 7/2 as a back-up. He told his boss that he'd need a day off in the first week of July to take me to the doctor. If ET falls on a work day, I'll be on my own, but he'll definitely be with me for the ER. I'd like him to be there for both, but that can't happen if they're both scheduled for working days. My ideal schedule would be ET on 7/2 and ER on 7/5. We'll see.

We selected yet another sperm donor. Since this is a planned IVF, I was told to obtain unwashed, ICI specimens. None of the donors we used previously have any ICI vials available, but we lucked out in that Ca Cryobank is offering free donor information (via rebate on purchase) this month. So I splurged and bought the baby photos along with the long profiles of two of our possibilities. Both our final choices have twins in their families. We didn't look for that on purpose, but it's another similarity between the donor and C- C's father is a twin. Not that our decision was based on looks, but my first choice was a much cuter baby than C's choice. Their family health histories helped cement our decision ... we went with the cuter baby. And, thankfully, he's an open donor. I so wanted to give that to our child.

The whole donor selection process still feels terribly arbitrary and artificial to me. I almost wish they had something akin to the eHarm0ny questionnaire, and wouldn't show me any pictures until we'd already been matched based on values and interests. Instead, it all starts with vital stats- height, weight, hair and eye color. We're planning to be completely open with our child about where he came from, so blood type wasn't a criteria. And, to be completely honest, we don't care about any of those superficial traits. We'd be happy with a baby of any color and size. That realization helped me get over the RE's policy about opening the cryotank to check the contents. If the bank sends a wrong vial, I'll use it any way. C agrees with me on that. We just want a baby. Period.

Cycle-wise, I'm still on 10 units of Lupron every morning and just waiting for AF to arrive. Then, I believe there will be a baseline u/s and b/w, with stims (225IU of Gonal-F, twice daily) to start a few days into the cycle.

is it me or is it lupron?

I thought I was experiencing hot flashes in my sleep on Friday night, after my first dose, but them C told me it was just a really warm stuffy night. It wasn't the lupron, it was the weather.

I've been losing words since Friday. This morning, it was "insecure." I knew there was a word, and it had something to do with confidence, but it wasn't "self esteem." I relaxed my no alcohol habit this weekend, at a wedding on Saturday and again yesterday afternoon when I was hanging out with an old friend. I probably drank more in two days than I have in the last year. So, my vocabulary troubles... it's not the lupron, it's the drain bamage.

I had a breakdown on Saturday, at the wedding reception. I was proud of myself for holding it together when a noticeably pregnant bridesmaid marched up the aisle. We just went to her wedding a year ago, and here she is carrying the couple's first child (I later learned that this is actually #3 and they endured 2 miscarriages before this pregnancy). I had a lump in my throat when the priest repeatedly mentioned the bride and groom's willingness to accept children if they were so-blessed by God. No tears though. Then, at the reception, we were seated beside the dance floor and C's nephew danced with his big sister. He's 7 and she's 25. It was beautiful, but it somehow hit a nerve. I sobbed into C's sleeve. I couldn't stop, but I couldn't explain why I was crying. Was it pent up emotions from holding it together all day, from the accumulated frustration of IF, or was it the lupron? I just don't know.

Anyhow, I've yet to notice any "real" side effects of the lupron. It's only day #4, so the suppressive affect likely hasn't begun yet. Maybe the true side effects come later, when the usual hormones are absent. We'll see. I'm thankful there are no more weddings on our social calendar this summer.

And so it begins

Injecting oneself isn't quite like riding a bicycle, but it only took about 3 minutes of shaking hands and repeated utterings of "You can do this. You really can do this," to get that first dose of lupron into my belly. The needle's a little bigger than the Gonal-F pen (29 gauge instead of 30), so there was some resistance at first in puncturing the skin. The needle itself did not hurt. Injecting the lupron didn't hurt either. But about 15 seconds after withdrawing the needle, I felt a slight burning/stinging sensation at the injection site. Two hours later, it's still there. Faint, but noticeable.

No ultrasound yesterday. I have a terrible memory (that's why I write everything down, which makes people think my memory is remarkable when really I'm just reading my notes), and it'd been three weeks since I had spoken to a nurse, so I just plain forgot what I was there for yesterday. Bloodwork. That's all. The verdict- I definitely ovulated, so the low-dose lupron protocol began this morning. 10units lupron daily, at the same time every morning, then call them on my next CD1.

Does lupron affect cycle length? I'm big on thinking one step ahead. When someone's co-piloting for me, I always want to know what to do next as soon as I've begun the preceding step. Even if the next turn isn't for another 100 miles, I want to know now if it'll be a left or a right. So, I want to have some idea when AF will make her appearance. Normally, I'd expect her next Thursday or Friday. But on lupron, will she keep the same schedule?

I'm cautiously excited. It feels great to be DOING something again.

obligatory photo

There's a lab where I work, complete with lots of staff running around in white coats and safety glasses all day. Sometimes, they receive things by FedEx or UPS that require refrigeration. Those boxes usually have a big red sticker on them announcing that they have special temperature requirements, "Please open Immediately."

I had my drugs delivered to work since no one would be home when the FedEx truck came around and I didn't want umpteen gajillion dollars worth of IVF meds sitting unattended by my front door. The drugs arrived today. At my work. Someone from the lab saw the red sticker and took my box. Luckily, before I even had a chance to look in the mail room for my expected delivery, she brought it to my office and apologized for assuming it belonged to the lab. Luckily, she didn't open the box. I would have had a lot of explaining to do, although with all the insulin needles in there, someone may have just presumed that I was diabetic.

The loot:
1 package Leuprolide, 2-week kit (Lupron)
5 Gonal-F RFF 900IU pens
1 dose HCG
Doxycycline
Methylprednisone
Estradiol
2 boxes 15ct. Crinone 8%
Far too many needles (I lost count at 80)
Alcohol prep wipes

These drugs cost me just under $130. The pharmacy doesn't provide pre-insurance prices on the receipt, but I was curious what this would have cost me without my special extra insurance. Dr. Ask (I like him better than Dr. Google, not sure why) sent me to a web site where I was able to plug in the drug names and my doses to find out the retail price range for each item. I was shocked, and once again incredibly grateful that the wonderful Patient Coordinator at my RE's office had steered me in the right direction. I ended up with several generics instead of brand-name meds, which is OK with me, but these still would have cost over $1300 had I gone out of pocket.
I asked the pharmacy when I placed my order if deducting the leftovers from last cycle would save me any money. Nope- so I went ahead and filled the whole shebang as if there were no crinone or Gonal-F already in my house. When this cycle is over, I will donate whatever I have left to whomever needs it. I know I'm lucky to live in a state that mandates fertility coverage, even if my employer and C's union are exempt from the mandate. And I'm lucky to be able to afford the extra insurance that's alowing us to pursue IVF. If there's any way to share some of that "good" fortune, I'll do it. We all need all the ammunition we can get to beat IF.

swinging naturally

It's O-time. I don't know if that's generally a time for mood swings and hypersensitivity, but that certainly describes me over the past couple of days. I'm not sad or depressed, but feel ready to bawl at the drop of a hat. A couple of comments made by co-workers which, in retrospect, were completely innocuous, had me feeling attacked and ambushed yesterday. I don't recall experiencing this mid-cycle moodiness ever before, in either medicated or natural cycles. This is usually how I feel a week or so before AF arrives, but she's not due for at least 14 more days. I'm practicing the mood swings even before I can blame them on lupron. Maybe scheduling delivery with the pharmacy is all it takes to ignite lupron side effects.

So, here we are. The meds will arrive Tuesday, with the obligatory photo to be posted shortly thereafter. Baseline labs are scheduled for Thursday. That's as far as I'm planning. Once Thursday arrives, I can think ahead to Friday. One step at a time this time.

I do have a question for anyone reading who has been through IVF- what's with the gatorade and protein I've seen mentioned in other blogs? My RE hasn't mentioned anything to me about an anti-bloat diet. Can someone fill me in on the details of a special diet around ER/ET? What's its purpose, and what does it include or avoid?

Wishing all a beautiful, rejuvenating weekend.