IVF#2: After 10 Days of Stims

Goodness! It’s been 10 days already, and we’re still not trigger-ready.

Today has been an exciting day however. At 6am, I awoke to my wife’s ecstatic giggles, as she exclaimed “It’s a SNOW day!!” Our school board cancelled all buses and closed all schools for the day, due to the terrible weather.

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As teachers, this means we do not have to come into work. It’s a safety thing really. Last year, an Ontario school board kept schools open during one of the worst snow storms, and a teacher had a fatal accident while commuting to school due to the terrible road conditions. School boards rarely call a snow day unless it’s projected to be really necessary, as they have to pay back the government for the lost teaching day.

But we woke up to our front door being snowed in. I had to go out the side door, and shovel and brush it clear to walk through. The snow was also at least three times as tall as Clementine (the dog), so DW had to shovel a path for her from the side door to an appropriate “bathroom spot” in the yard. Juno (the big dog) just loves this weather. She sat on a mound of snow in our front yard, while DW and I brushed off the cars and shovelled our driveway. We wouldn’t have been able to get to my monitoring appointment without doing so. I love shovelling. I like the physicality of doing it. But today, I got some sharp pains in my left ovary after tossing numerous shovels of snow. I guess when your ovaries are the size of oranges, you shouldn’t be twisting like that. DW made me stop, and finished off the driveway on her own.

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By the time we were done, it was time to leave for my monitoring appointment. I was hoping that my follicles would be ready to trigger today, as my beta (if we do a five-day transfer) would land on DW’s birthday, but alas, it seems we may have to wait one or two more days. I don’t know why my follicles take so long to grow. I have so many of them, but they just take their sweet ass time. I’m already half-way through my third 900IU Gonal-F pen, which costs about the same as one of my paychecks!

Anyways enough of my complaining. Here are today’s stats:

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So, we’re getting there… One or two more days until trigger.

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.

Happiness Cycle Day 14: Downtown

DW took the day off work today, as we had a day of medical appointments, in town and out of town. She has also been so busy and overworked so far this semester that she really needed a “mental health” day as well.

I must mention that I finally had a good sleep last night, after almost a week of terrible anxiety-induced insomnia.

This morning DW made me a decaf coffee (such a nice treat to be served coffee in the morning), we gave the dogs got some consolation pats on the head, and we were on our way.

Our first stop was the fertility clinic’s satellite clinic, which is in our city. I needed to have my blood work and ultrasound monitoring again. Things are on track, with my uterine lining measuring 9.4 today, up from 8.7 of two days ago. I also got a “present” from one of the receptionists, who wasn’t working today, but had mentioned last time I was in that “she’d give me a troll to put down my pants”. I wasn’t sure what she meant by that, but she meant Treasure Trolls, those dolls from the 80’s, for good luck. We joked about for a bit- especially the part about putting one down my pants. Anyway, today, the phlebotomist nurse gave me this on behalf of the receptionist:

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So thoughtful and sweet!

After that, we headed downtown, to see my family doctor. I was really nervous and stressed about this appointment, not knowing how to describe and explain the overwhelming emotions and feelings that I have been experiencing since the miscarriage. When we got there, my family doctor was super attentive, gave me room to talk, listened patiently and compassionately, and gave some good advice. I shared with her how depressed and anxious I have been feeling, how it has continued to affect my sleep and made me weary of socializing with friends who aren’t aware of our situation. She had me complete some forms: a depression questionnaire, an anxiety questionnaire, and a survey on the impact of my feelings on my activities of daily living. It was the first time that I had taken inventory of various aspects of my depression and anxiety, and how it has been affecting me beyond just my feelings and sense of hope for the future. This whole time I’ve been so consumed and obsessed with our miscarriage(s) and getting back to making babies that I completely lost sight of how I have been doing as a person. I mean, I knew that I was depressed, and I knew that I had an anxiety problem, but I had always placed them under the context of the miscarriage, and not really that they themselves are focal points that need to be addressed.

I have battled depression before, and had reached a nice homeostasis with Wellbutrin for years. When I first met DW, I had already been on it for many years, but like most people with mental health issues, because I felt better, I thought “why not, let’s try life anti-depressant free!”. That was a couple of years ago, and for the entire time, I have been fine. However, with the fertility challenges and heartbreak of three miscarriages, I think my dear friend depression has snuck back into my life, and has brought his asshole friend anxiety along as back-up.

I have mentioned my emotional struggles on my blog many times, but didn’t realize how bad it has gotten until I answered those questionnaires, and saw and felt the true concern in DW’s and my family doctor’s feedback on how I seem, and have been behaving. I guess this is sort of what an intervention feels like. I’ve been so caught up in my own head, and needed to hear what other people are observing. My depression and anxiety are a big concern right now, and my family doctor is concerned enough about it to suggest that I start some medications right away. She suggested Cipralex, which is an SSRI, and is effective for both depression and anxiety. I would love feedback from anyone who has taken it before. She says that it is safe before, during, and after pregnancy, even though Dr. Google claims otherwise. But I am convinced that you can search anything and find support for it in the form of a online support forum. This I have learned from the all-consuming world of TTC.

She wants me to double check with the RE that he Cipralex won’t interfere/interact with all of the other stuff that I will be on: estrace, prometrium/endometrin, aspirin, fragmin, prednisone, intralipids. I’ve emailed the RE’s nurse, so hopefully I will hear back soon.

I have mixed feelings about taking the Cipralex. On one hand I think that it would be better for me to just tough it out, that it’s normal to have feelings of sadness and despair, or constant worry, given what I’ve been through. On the other hand, it is becoming more and more apparent to me that my depression and anxiety levels are abnormally high, and the culmination of evidence is that that can negatively impact our potential pregnancy even more than the small risk of cardiovascular defects and autism that have been reported but not confirmed. I look at DW, and some of you who seem “recovered” from your miscarriages, and wonder why I’m still stuck in this destructive loop of depression and anxiety. I realize now that it’s because I am struggling with an extra layer of mental illness.

Work has been harassing me again as well. In the past seven days, the person in charge of leaves has called me three times and emailed me once. This is after talking to her already the first time. She didn’t have anything new to discuss the subsequent times, but rather has been very negative and pushy in her tone. DW says that if she calls me again, that we should complain to the union. The last thing you want to do when you have an employee suffering from a mental health challenge is harass them.

Anyway, after my doctor’s appointment we went out for lunch at our favourite Vietnamese place.

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Then grabbed some baked treats down the street at this great little bakery we found by accident one day the last time we were here. I got a gluten-free chèvre cheesecake, and DW got “the best butter tart ever”, as well as a pear almond tort-like thing that has a fancy French name that I don’t remember.

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We then went shopping at our favourite outdoor store: Mountain Equipment Co-op, where we caught up on some much needed shopping, and bought a couple of early Christmas presents (me mostly).

We also got a call from our primary nurse today. I am supposed to start my long list of meds on Saturday, in preparation for our embryo transfer on Wednesday morning!

I hope that time moves fast, as I’m anxious for our last embryo to come home, but I also feel like I need some time to process everything that has happened today. The good, and the bad new.