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.

Honestly! Still Waiting for AF!

I consistently have 31-32 day cycles. Today is day 35. I finished a round of Provera about 8/9 days ago, which was supposed to bring on AF last week. My temps remain high, my nipples are super tender, my back hurts, and I’m super emotional.

This needs to end.
AF where are you??

I emailed the nurse on Friday, to ask how long we should be waiting for AF, and she said if I don’t get it by Monday January 19th (today), to call her and we will have to investigate. She also told me that they don’t need AF to show before starting stims. This kind of scared me, and delighted me at the same time. So of course, I scoured Google for examples of this, and sure enough, IVF stim cycles are commonly started with or without preceding periods. Now, since we plan on doing a fresh transfer, wouldn’t this be like sleeping in bedding that hasn’t been washed since last month? Okay, bad analogy, but you know what I mean.

Anyway, I called the nursing line and left a voicemail about not yet having a period, and I’m waiting to hear back from them. What I’m anticipating is that they will have me in for blood work and ultrasound, and then one of the following outcomes will happen:
– my hormones look great, and we go ahead and start stimming
– my hormones look not great, and they make me wait or take Provera again
– ultrasound reveals a functional cyst and they either aspirate it, or cancel the cycle

I certainly feel the effects of progesterone, so my gut feeling is that AF will happen eventually, but that I am just experiencing a very long luteal phase (Lupron can delay AF too). I do worry about being on Lupron for so long, as it can cause oversuppression, and then I’d need higher doses or longer stimulating with the Gonal-F.

Here’s my BBT for those of you who enjoy these types of things (I know I do):

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Anyone have experience with starting stims without a period beforehand? I going nutz over this. Please send sanity vibes. This waiting is seriously killing me. Merci beaucoup!

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.

Ugh.. Where Can I Buy Some Sleep?

It’s 4:44am right now, and I have been trying to fall back asleep since 2. We went to bed at 11:30 tonight last night, and I think I may have finally fallen asleep at midnight.

I have been having problems sleeping on and off ever since July, and it has progressively gotten worse since then. I think that all of these treatments have my hormone balance all out of whack and it is affecting my sleep cycles… Oh and my anxiety levels! I’ve talked about my recent struggles with anxiety here, and how my family doctor encouraged me to take Cipralex (Lexapro), an SSRI. I wavered in my decision several times, got desperate after 13 days without a good sleep and filled the prescription, and then our last FET failed, and the potential of doing another full IVF had me reconsidering starting the Cipralex.

Here’s why:
Cipralex is an SSRI, a serotonin re uptake inhibitor. Normally, when serotonin is released between your neutrons (nerve cells), there is a sort of pump-like mechanism that gobbles it all up (re uptake). The Cipralex turns off this re uptake mechanism (inhibits it) and allows the serotonin to linger a little longer for your body to benefit from it. This happens in many places in your body- of interest to those with mental health issues, there are receptors in the brain. But there are also receptors in the ovaries, which is why I’m hesitant to start it right before an IVF cycle. The IVF stim cycle is such a crapshoot on a good day, and seeing as how my first IVF went so well, I kinda don’t want to add any new factors to the mix.

Last IVF:
On lupron (20IU–>10IU)
On Gonal-F (200IU)

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Part of me feels like once I get pregnant, and I mean safe zone pregnant, the anxiety and sleeplessness will go away. But following some of your journeys, I have come to realize that the worrying doesn’t really stop, and the sleep issues might get worse. Another part of me feels like if things are still super shitty, it wouldn’t be a big deal if I waited out the minor heart defect risk of the first trimester, and started the Cipralex during the second. I am willing to deal with the temporary risk of infant withdrawal symptoms.

So yeah, this is the shit that I am worrying about at what’s now 5:17am! Totally getting ahead of myself, over planning, trying to control shit that is unreasonable for me to control, feeding my anxiety with more anxiety… I suppose this is what my life has become. Sadly, seeing my therapist on a weekly to biweekly basis hasn’t helped much beyond that first visit. I know that therapy is so patient/therapist specific, but I feel like my anxiety is beyond the mending capabilities of talk therapy. I also feel like the only thing other than being pharmaceutically altered that will help me feel better is finally getting pregnant and staying pregnant. I know this is a tall order, and I am still working on not getting super upset that everyone on my Facebook is pregnant or has children already.

Anyway, it is amazing that I have lived 32 sweet years not knowing what anxiety feels like. I have empathy for those who suffer from mental illness. It is a struggle wrought with a lack of understanding or compassion. For many people, there isn’t a “solution” that helps them cope with life or even affords them the simple enjoyment of a day. And while there is a lot of encouragement to “talk about it”, the stigma remains, and people are forced to stay in the closet about it. Being a gay woman, I’ve already spent too much time in the closet.

Now, where does a gal go to buy some sleep at this time of night? (It’s now 5:40am. Faaack!)

Suppression Phase: Lupron and Provera

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So the suppression phase begins! I started my Provera and Lupron today.

Provera:
Technically, my Provera started last night, as it’s supposed to make you feel dizzy (progesterone), but I didn’t seem to feel the dizziness at all, which sucked because I had another sleepless (insomnia) night last night. I did feel cramps (a common side effect) though, which delayed my workout until dinner time.

[An aside: the gym was ridiculously packed today. Lots of people hitting their New Years Resolutions hard I suppose.]

Lupron:
The Lupron injection went in so easily, and the injection itself didn’t hurt at all, in contrast to the Fragmin (which I start in a couple of weeks) which has a much thicker needle and burns like a BYATCH!

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IVF Paid!
We also paid for the remainder of our IVF balance (ouch!). Unless we win the lottery, I don’t think a March Break vacation is in our future. I realize that we are lucky to be able to afford IVF in the first place, but it isn’t without having to really penny pinch in several places over the past two years. A nice side result of this is that we have been forced to tighten up our finances, which is a point of contention for many couples, but has brought us closer. It has actually revealed how similar DW and I are in our priorities, her a little more frugal on herself than I am.

Big Decisions Made Today:
So DW finished her Principal Qualifications (5 components) last month, and I feel that I should give her some props for that because it was HELL working full-time plus staying past 9pm once or twice a week this semester. She has been tapped on the shoulder by a couple of BIG TIME supervisors this past year to apply to become a vice-principal in our school board, but has generally brushed it off because she was not mentally ready for it. There are a few advantages to becoming a vice-principal and many more disadvantages to leaving the teaching profession.

Advantages to Being a VP:
– leadership- be able to affect slightly more change than a teacher
– if you’re into logistics and organizing things, things like timetabling can be fun
– if you’re good with the at-risk kids, you can be an effective disciplinarian and hopefully help those students turn themselves around
– detective work: Classic who-dun-it style- investigating things like theft, fights, drug trafficking in school
– get to see the inner workings of the school board a little deeper (find out secrets)
– get to hire people (pick your team, which makes a HUGE difference)
– a modest pay raise (only about 5000 to 10000 more than an experienced teacher with a department headship)
– no “course preparations” or marking to take home

Disadvantages to Being a VP (and Leaving Teaching):
– no control over your hours: if there’s a fight after school, you may have to be there until all the paperwork, police, and parent issues have been dealt with
– have to be present for more hours than teachers (from 6am to 6pm typically, and later if there is an event- games/arts night/performances)
– generally deal only with the “badly behaved” students- disciplinary role
– deal with unruly parents: I say “unruly” because most issues can be dealt with via the teacher or guidance counsellor, so when it gets to the VP, it’s as a second last resort
– once you leave the teaching union, you can’t go back if you decide that VP isn’t for you

Obviously, there is a lot to consider here, and there’s a big event happening at the end of February, which DW has been invited to attend. It involves all VP candidates being grilled on difficult scenarios, individually in front of superintendents. These scenarios are tough and require on-the-spot decision making skills. The superintendents watch each candidate and decide based on their responses, whose application they are going to support. It is a critical night! I compare it to those reality talent competitions like The Voice.

Anyway, DW decided today that after five years of thinking about it, and almost three years of actively getting her qualifications, she is ready to apply. The application package will probably take almost a year to complete, and she could get placed a year or two after that. So two to three years from now she could be a VP!

This is huge people!

I must also add that doing this allows us to be more mobile in terms of changing boards. We’ve been so unhappy living in the Greater Toronto Area. Too many transport trucks, pollution, ugly commutes, and too expensive to raise kids the way that we want to. We are lucky enough to own our house, but can’t really upgrade to a bigger or nicer home on a two-teacher income, and have absolutely no family nearby to help once we have kids.

So if she goes VP and gets a job in the city where her parents live, I can stay home with our kids for a couple of years, have grandma and grandpa close by, and our cottage a quick drive away. You can’t really put a price on that right?

Fertility Friend Was Right

Yesterday’s blood work confirmed what my BBT suggested- as of yesterday morning (CD18), I had not yet ovulated. I got a phone call this morning from the nurse that I should start Provera on Monday along with the Lupron, and that I will be taking the Provera for 7 days. After a few days of stopping, I should get my period, which will be CD1 of our actual stimulation cycle!

*TMI warning*
Last night, I discovered what must be some kind of cervical mucus plug. It came out while I was showering, and was a huge glob the size of my thumb. I experienced this on my last natural (meaning non-FET) cycle as well, and recorded it in Fertility Friend. Last time, it was followed by three days of copious amounts of EWCM and then ovulation. Fun times.

I haven’t been sleeping well, which also seems to be a recurring symptom that I’m noticing the week before ovulation. I can’t wait for the Provera, as I find that I sleep so much better during my luteal phase (or with lots of progesterone). I have become a progesterone junkie. I just love that shit.

For now, we’ve been keeping busy. DW has been chipping away at school work and marking, as well as taking the dogs on their regular hikes (she doesn’t get to take them as much during the school week, which is when I usually take them). I’ve been working through Jessie Hilgenberg’s Muscle Building Program, which is kicking my ass due to the sheer volume of exercises and reps. I’m used to doing reps in the range of 6-8, and 4 sets of 5-6 exercises, but her program includes a lot more reps (12-20) and more sets (4-5), and 6-7 exercises. It’s forcing me to take longer rest periods, which has me at the gym for almost 90 minutes for just weight lifting (previously, I would lift for 40 minutes and do cardio for 20 minutes). This doesn’t leave much time for cardio, which is fine because she doesn’t include much in this beginning phase of her Muscle Building Program. I’ve also jacked up my protein intake and incorporated more carbs back into my diet, which is different for me as well since I was previously on a low carb, moderate fat, moderate protein diet. I’m fighting against some hard-gaining genetics (and soon-to-be fertility drugs) though, so we will see what happens with all of this. My goal isn’t to lose weight, it is to pack on as much muscle as I can before the embryo transfer. Pregnancy made me so tired last time that I just know I won’t have the energy to do any heavy lifting.