Investigation into the Case of the Missing AF

Well folks, it has been quite the day!
DW and I both seem to have some kind of mild flu. I never get the flu. And this year, I actually got the flu shot!! Wtf? The last time I can remember having it was sometime in 2005, and it was complete with bedsheet-soaking fever and chills, loss of appetite, and diarrhea. It lasted about 3 days, and cost me about 7lbs of my already emaciated frame. Luckily, I am no longer this skinny, and this round has not come close to being that bad. For me, it’s still a mild fever and chills, body aches, and my favourite: the runs. Seriously, I tore into a new package of toilet paper recently, and stocked the bathroom with two extra rolls. Just in case.

Now, feeling like shit would be a whole lot nicer if I knew where the fuck AF has been hiding out. Yes, it has come to this. I know I’m starting to sound like a broken record, or like your significant other nagging you about why it’s necessary to keep 13 bottles of supplements on the kitchen counter permanently, but I am seriously frustrated.

Let me put this into perspective for you.

This is what the Long Lupron Protocol for IVF is supposed to look like:
Day 21 Precycle: start Lupron and stay on it until near the end of IVF stims
Day 28 Precycle: get period –> this becomes Day 1 of Treatment Cycle
Day 3 Treatment Cycle: start stims (Gonal-F for me), lower Lupron dose
Day 13-15: HCG trigger
Day 15-17: egg retrieval

This is what it looks like so far for me:
Day 21 Precycle: start Lupron (and Provera because not yet ovulated)
Day 28: no period
Day 29: still no period
Day 30: still no period
Day 31: still no period
Day 32: still no period
Day 33: still no period
Day 34: still no period
Day 35: still no period
Day 36 (today): STILL NO PERIOD!!!

Notice how in an ideal cycle, you’re on the high dose Lupron for 7 days before your period, but I‘ve been on Lupron for over 15 days now. Lupron causes weight gain, headaches, and major irritability. So yeah. I’m kind of losing my mind.

Early this morning, I went to the fertility clinic for bloodwork, a full bladder pelvic ultrasound, and a transvaginal ultrasound to figure out what the hell is going on. This appointment went well.

The ultrasounds revealed that:
– my endometrial lining is 8.4mm thick
– I have no cysts (hallelujah! I was so worried about this)
– I have 14 antral follicles (6 on the R, 8 on the L) just chillin’, waiting to be stimmed

Last year, during our baseline for IVF#1, I had 16 antral follicles, so time does seem to be showing an influence here. I was reading a research paper on antral follicle numbers, and apparently they are grouped into three ranges: less than 3 (poor ovarian reserve) , less than 6 (average ovarian reserve), greater than 9 (high ovarian reserve). So with 14, I’m still looking really good.

I still had to wait for the bloodwork results, which would be available this afternoon.

By the early afternoon, I got a call from the head nurse.
Apparently, my blood results were in, and they were abnormal:
Estrogen 360 (way too high, should be less than 250)
Progesterone close to zero
She wanted me to keep on the 10 units of Lupron for another week, and then we would recheck my levels.

I thought this was really weird. It didn’t make sense because I was definitely feeling my classic progesterone signs- sore breasts, back ache, dairy cravings. So before she could hang up, I asked more questions, really nit-picking about the values, which required her to go back to her computer and consult my bloodwork results.

There was a pause. An extended silence.

And then she spoke.

She had planned my next steps based on the WRONG results!! Those results were from my pre-Lupron scan, not today!! My results from today had not yet be logged, so more waiting…

I took the dogs shopping, as Clementine needed a new winter coat. Then I took the dogs to the conservation lands for a hike. The paths were all iced over, and I was glad to have my grippy strap-ons (for my boots). When we got back to the car, I noticed that I had a voicemail from the fertility nurse (no missed call- she sent it straight to voicemail):

My levels for today were actually:
Estrogen 74 (nice and low- they want it to be less than 250 to be cleared to start)
Progesterone 1.71 (nice and low- period should be here soon)
My period looks to be due any day now, with my progesterone being so low, so they want me to just call when my period shows up, and then I guess I go in again for my baseline (I actually hope I don’t have to, since everything looks good today).

I found this online, and really liked how it presents estrogen and progesterone levels throughout a typical cycle:

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Also, my BBT temp went down a bit today:

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So all signs- blood, temperature, and ultrasound- point to AF coming soon. But I’m checking every chance I get, and soon can’t seem to come soon enough.

Provera, Diarrhea, and Waiting for AF

What a title eh?

Well, I finished my last dose of Provera on Saturday night. I was on a 10mg daily dose for 7 days, overlapping with Lupron. The Provera didn’t make me sleepy like the oral Prometrium usually does, which was disappointing (especially for the insomnia).

Some side effects that I did notice from the Provera were:
– constant back ache
– sore breasts toward the latter end of the week
– cramps roughly 12 hours after each dose, with the worst cramps from days 3-5, lasting 1-2 hours
– frequent urination at night- 3-4 times a night
– major constipation!

It’s hard to tease out what side effects were from the Lupron, but after consulting with the information sheet that came with my medication, as well as some IVF blogs, I think the following side effects are care of Lupron:
– super hungry (increases cell uptake of blood sugar and causes hypoglycaemia)
– insomnia
– mild headaches

For two days now, I’ve only been on the Lupron, and I’ve had the headaches. They aren’t bad, but have me retreating into the depths of a dark bedroom for a while.

As the Provera wears off, so has the constipation. Today, I have had frequent episodes of the runs. Fun times. Notice that I didn’t give you a TMI warning? (People who want babies should become desensitized to poop issues.) Diarrhea is a good thing though, as I would like my meals from three days ago to finally vacate my body. Diarrhea also means that my period is coming… Soon! *Fingers crossed* I can’t wait for CD1 and to start my stimulation drugs!

I have been tracking my BBT the past two days, so that I can get an idea of when to expect AF. Many women report not getting their period for up to two weeks after stopping Provera, so I’m a bit anxious about it. I’m super OCD about scheduling, so waiting for AF is pure torture for me. But my BBT has been hopeful, as this morning, my temperature dropped almost to half of the overall spike temperature. So I might start to bleed any day now. My withdrawal bleeds after Endometrin came three days later, so if I am consistent with that, I should get my period late tonight, or tomorrow.

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For now, we wait.

FET#4 CD1

I was expecting my period at the end of the week, but was pleased to see it arrive this morning. Darn you short luteal phase (this cycle 10 days), but thank you for appealing to my impatience.

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Today, I start my Chinese herbals again, which dispels blood stasis from my womb, flushing it out with the natural shedding that is happening.

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Previous to TTC-ing, I rarely had painful periods. Even during my IUIs, I had only minimal cramps. When our RE started us on Marvelon (oral contraceptive) back in September of 2013 to sync our cycles in preparation for our reciprocal IVF, I have had painful periods ever since. Like screaming in agony painful. However, last cycle, I took this Chinese herb mixture, and had absolutely no pain during menstruation again. It was wonderful, and a good sign of uterine health.

This herb mixture is actually in concentrated granule form that has been extracted from the cooked raw herbs. I just add 5 scoops and two ounces of boiling water into a mug, stir it up, and voila! An earthy tasting tea! I do this 3 times a day, on an empty stomach, or before food.

Today, my first blood was a bright red blood, which is also really good. Old brown clots are a sign of stasis. It means that there may be some congestion in the uterus, which can be inhibiting good circulation.

So far, we’re off to a good start!

I’m in a bit of a mad rush, trying to get some appointments in before the embryo takes up residence. I need to replace a root canal filling that is cracking with a crown, and my insurance is being picky with my dentist, requiring more x-Rays etc. The whole process could take weeks, and since they will have to use local anaesthetic on me, I’d rather have it done before the transfer. Fingers crossed that it works out. I also need to get my eyes checked again, since my vision changed significantly from the pregnancy. They use medicated eye drops to dilate your pupils, which is also contraindicated during pregnancy, so I’m getting it done today, with a dear friend of mine who is the world’s most thorough optometrist. DW and I love him so much that we always comment (to each other) about how it’s too bad that he has so much cancer in his family (two siblings and his father), because we would’ve loved him as a donor. He has the kindest spirit, is very thoughtful and intelligent, and has amazing dimples!

Anyway, yesterday was a beautiful sunny and warm day, feeling like 20 degrees Celsius, and today is dark, windy, and super cold (feels like 0 degrees Celsius). It’s supposed to be like this for the rest of the winter. DW and I are planning on “winter camping” at our cottage this weekend. By “winter camping” I mean, staying in the cottage, which is not winterized, so the well has been turned off. This means no running water (we’ll bring some), and using the outhouse (which kind of terrifies me, as a non-camping city girl). It’s a very underused outhouse, and is super clean and odourless. I am always just so scared of falling in. I also hate how cold the seat is- can’t we just plug in a seat warmer? Or does that defeat the point of the great outdoors?

Waiting to Bleed

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10 am: Today will be the 10th day of my luteal phase. In all of my previous non-medicated cycles, I have started shedding my uterine lining on or before this day. The wife too, feels a bleed coming on soon. I hope that we are right. We had been very patient during this in-between time. I think that the numerous agonizing two-week-waits have served as some sort of training.

In the meantime we’ve been busy with work, doing summer-closing chores around the house and in the garden, cooking up heaps of homemade lunches for the week, and getting our sleep schedule back on track.

11 am: I found this beautiful art painted in menstrual blood:
http://www.vanessatiegs.com/creations/menstrala/

12 pm: Wife starts bleeding, then cramps begin.

9 pm: I feel cramps, then start spotting.

Within 12 hours? I’d say we’ve synced!

This is a first for us!! I’m hoping it’s a good sign.

A Fresh Start or a Quick Finish?

Many things to update you on as I spin away on my stationary bike:

1. Aunt Flo arrived on Sunday, so we were not successful this past IUI.
2. We had our long-awaited appointment with the RE last Wednesday, and he recommended that we try a course of Femara to help accelerate egg development in my follicular phase. He treated me a bit like there was something wrong with my long follicular phase, which irked me. I informed him that research suggests that Asian women genetically tend to have cycles that are longer than Caucasian women. He seemed to not be familiar with this research but agrees that there would likely be some genetic component to it (duh).
3. So I started the Femara on Wednesday, and so far the only side effect I’ve experienced is mild hot flashes in the middle of the night. It doesn’t help that we are in the middle of a heat wave here in the GTA.

Today is day 10 of my cycle, and I went in for blood work and ultrasound early this morning. The results were a bit disappointing. So far, despite the Femara, my follicles are only 12mm. If they don’t get up to about 18mm+ by Monday, they will likely cancel the IUI. I’m really bummed about this, because I know that normally, follies usually grow about 1mm per day, and mine grow even slower than this. The nurse said that they will likely need to increase the dose for next cycle. Hrmph. She’s talking about this one like it’s already failed.

I’m upset, and have been trying to keep my mind off of it, but I just can’t help but wonder if in fact, I am infertile with this stupidly long cycle. I mean really, why is it taking so long for my follicles to develop? Why do they need 12 days more than the average woman’s? And why aren’t they responding to these meds?

We’ll see on Thursday morning if anything has changed. Fingers crossed that these follies grow grow grow!