DH and I had asparagus for lunch, and now my urine smells funny. If my egg fertilized today after ovulation, do you think our embryos smell funny, too?
Deep thoughts for a Tuesday afternoon. :)
Tuesday, July 31, 2018
Monday, July 30, 2018
Stolen Bases
I'm trying to process through everything related to the frag results. I think the best way I can explain it is via a really lousy sports analogy.
For a long time now, I've been 'taking one for the team.' I've taken one for the good of the team by doing dozens of injections, and blood draws, and enduring far too many transvaginal ultrasounds. I've shoved pills and suppositories into my vagina for months at a time and lived with the raw, swollen state they create. Despite that raw and swollen condition, I've dutifully done my part when our RE tells us to have intercourse repeatedly. I've taken one for the team with all the medication side effects (doxy nausea, prednisone weight gain, estrogen and progesterone mood swings). I've taken one for the team by completely changing my diet - it is July and I have not had one single scoop of ice cream this year. I love ice-cream. Ice-cream brings me joy. I haven't touched it. I haven't touched pretty much anything else that might be inflammatory/high carb/enjoyable/not optimal for fertility. I've gone to acupuncture, which I loathe. I've cut back on my own exercise habits and made time for meditation and fertility yoga. I've risked my career progress by stepping out for dozens of medical appointments. I have done all of this because I wanted our team to be able to win, together.
Now I find out that my team-mate, who I thought was on my side, has actually been helping the other guys steal bases and telling them the pitches we're going to throw. And he hasn't done that by accident, he's done that because it's felt good to him, so it's a conscious choice. Suddenly I feel completely alone, my entire sense of being a team is gone. Added to that, this season is my last shot at winning the pennant, or the title, or whatever the appropriate award is for this stupid analogy. It's my last shot because my body can't handle any more seasons, no matter how hard I train. But my team mate? He's young and zippy, and with a few months of training he can join a different team with great odds of winning that pennant. And worst of all, I'll still be stuck laundering that team's stinky uniforms and otherwise taking care of the team behind the scenes because they still can't do it without me. I'll still have to take one for the team, if we do DE IVF, even though I'm not a member of the team any longer.
That pretty solidly sums it up, although I extend my apologies to any sports fans. I have an appointment with a new therapist today. I think that's good and needed. So much complexity, so much hurt. One of the few silver linings of the last few years to me has been the feeling that DH and I were a better team than we've ever been. It made me feel good about the decision to have kids together. I don't want to be a single mom, in name or in practice, so operating as a team was critical to my desire for kids. All of a sudden, I'm questioning if we really are a team when things are at their hardest - when personal sacrifices have to be made. That hurts so badly.
While we haven't talked about it, because I don't think doing so right at this moment would be great for our marriage, I suspect DH is dealing with many emotions, too. Or maybe not. He doesn't read the research, he only listens to me with one ear when I mention it, so maybe he really doesn't understand what a big deal this is. I almost hope that's true. That would be nice.
For a long time now, I've been 'taking one for the team.' I've taken one for the good of the team by doing dozens of injections, and blood draws, and enduring far too many transvaginal ultrasounds. I've shoved pills and suppositories into my vagina for months at a time and lived with the raw, swollen state they create. Despite that raw and swollen condition, I've dutifully done my part when our RE tells us to have intercourse repeatedly. I've taken one for the team with all the medication side effects (doxy nausea, prednisone weight gain, estrogen and progesterone mood swings). I've taken one for the team by completely changing my diet - it is July and I have not had one single scoop of ice cream this year. I love ice-cream. Ice-cream brings me joy. I haven't touched it. I haven't touched pretty much anything else that might be inflammatory/high carb/enjoyable/not optimal for fertility. I've gone to acupuncture, which I loathe. I've cut back on my own exercise habits and made time for meditation and fertility yoga. I've risked my career progress by stepping out for dozens of medical appointments. I have done all of this because I wanted our team to be able to win, together.
Now I find out that my team-mate, who I thought was on my side, has actually been helping the other guys steal bases and telling them the pitches we're going to throw. And he hasn't done that by accident, he's done that because it's felt good to him, so it's a conscious choice. Suddenly I feel completely alone, my entire sense of being a team is gone. Added to that, this season is my last shot at winning the pennant, or the title, or whatever the appropriate award is for this stupid analogy. It's my last shot because my body can't handle any more seasons, no matter how hard I train. But my team mate? He's young and zippy, and with a few months of training he can join a different team with great odds of winning that pennant. And worst of all, I'll still be stuck laundering that team's stinky uniforms and otherwise taking care of the team behind the scenes because they still can't do it without me. I'll still have to take one for the team, if we do DE IVF, even though I'm not a member of the team any longer.
That pretty solidly sums it up, although I extend my apologies to any sports fans. I have an appointment with a new therapist today. I think that's good and needed. So much complexity, so much hurt. One of the few silver linings of the last few years to me has been the feeling that DH and I were a better team than we've ever been. It made me feel good about the decision to have kids together. I don't want to be a single mom, in name or in practice, so operating as a team was critical to my desire for kids. All of a sudden, I'm questioning if we really are a team when things are at their hardest - when personal sacrifices have to be made. That hurts so badly.
While we haven't talked about it, because I don't think doing so right at this moment would be great for our marriage, I suspect DH is dealing with many emotions, too. Or maybe not. He doesn't read the research, he only listens to me with one ear when I mention it, so maybe he really doesn't understand what a big deal this is. I almost hope that's true. That would be nice.
Sunday, July 29, 2018
Monitoring #: Too Many
I had my fourth consecutive monitoring appointment today. Several interesting things came out of it.
First, Amy the u/s tech is a lovely lady, but I will specifically request not to be seen by her in the future. It was another extremely painful u/s, which was bad. Worse, when I was done and asked about numbers, she said my lining was "almost to a 6". I told her I was disappointed that I'd regressed since yesterday's 6.18. At that point, she said, 'oh there were other measurements. One was 6.55, that was better, so we'll use that one.' And then she deleted the 5.85 she had and replaced it with the 6.55.
What. The. Fuck.
When DH and I called her on it, she said it was actually the better of the images she'd taken, so it was good. She also said "your lining can't get thinner, so it must be right."
Given that my estrogen dropped since yesterday, I have proof positive that she's wrong, but not much I can do now. I did have a long conversation giving feedback about this with the nurse when she called me with instructions later. I don't know if it will help, but I was not going to let that pass by.
Next, I got the final ultrasound report from yesterday. Turns out that unlike Amy, who told us I was at 22 and 19 for follicles, the report showed 20.5 and 17. Which completely explains why they didn't trigger me. My irritation level is high.
So, the outcome is that I trigger tonight. Estrogen is dropping, lining probably is too. I may or may not have mature follicles (I really don't trust Amy's measurements).
For comparison, here was the twins' cycle two years ago this month. The difference in response is almost unbelievable.
First, Amy the u/s tech is a lovely lady, but I will specifically request not to be seen by her in the future. It was another extremely painful u/s, which was bad. Worse, when I was done and asked about numbers, she said my lining was "almost to a 6". I told her I was disappointed that I'd regressed since yesterday's 6.18. At that point, she said, 'oh there were other measurements. One was 6.55, that was better, so we'll use that one.' And then she deleted the 5.85 she had and replaced it with the 6.55.
What. The. Fuck.
When DH and I called her on it, she said it was actually the better of the images she'd taken, so it was good. She also said "your lining can't get thinner, so it must be right."
Given that my estrogen dropped since yesterday, I have proof positive that she's wrong, but not much I can do now. I did have a long conversation giving feedback about this with the nurse when she called me with instructions later. I don't know if it will help, but I was not going to let that pass by.
Next, I got the final ultrasound report from yesterday. Turns out that unlike Amy, who told us I was at 22 and 19 for follicles, the report showed 20.5 and 17. Which completely explains why they didn't trigger me. My irritation level is high.
So, the outcome is that I trigger tonight. Estrogen is dropping, lining probably is too. I may or may not have mature follicles (I really don't trust Amy's measurements).
|
18-Jul
|
AFC
|
9
|
||||
|
Day
|
4
|
7
|
8
|
9
|
10
|
|
|
L follies
|
9.5, 8.5
|
15, 13.5
|
16, 14.5
|
17, 16, 10, 8
|
20, 18, 9, 9
|
|
|
R follies
|
11
|
16
|
19
|
20.5
|
23
|
|
|
E2
|
691
|
739
|
1232
|
1726
|
1634
|
|
|
P4
|
0.1
|
0.1
|
0.21
|
0.36
|
0.55
|
|
|
LH
|
1.58
|
3.03
|
6.2
|
11.54
|
11.25
|
|
|
Lining
|
5.2 triple
|
5.6 triple
|
5.7 triple
|
6.18 triple
|
6.55/5.85 triple
|
|
|
FSH
|
1000
|
1575
|
1850
|
2125
|
2350
|
|
|
Menopur
|
300
|
600
|
675
|
750
|
825
|
|
16-Jul
|
AFC
|
9
|
||
|
Day
|
4
|
7
|
8
|
|
|
L follies
|
12.5, 8, 8
|
19.5, 13.6, 7
|
22, 18, 7, 4
|
|
|
R follies
|
11, 9, 8.5
|
16.5, 15, 10, 8
|
18, 16, 10, 8
|
|
|
E2
|
803
|
1294
|
1690
|
|
|
P4
|
2.68
|
1.66
|
2.59
|
|
|
LH
|
8.24 miu
|
1.03
|
0.76
|
|
|
Lining
|
6.9 triple
|
6.9 triple
|
7.3 triple, cystic
patches
|
|
|
FSH
|
600
|
1050
|
1200
|
|
|
Menopur
|
|
0
|
0
|
Saturday, July 28, 2018
The ART Coaster, Again
The roller coaster lives on.
I had a monitoring appointment today, my fourth this cycle (plus baseline). I was thrilled with the outcome: follicles at 22, 19, and 17. Lining at 6.18 and trilaminar! It's not going to get any better than that for me, so I'm happy. I assumed we'd trigger tonight, especially since my LH appears to be climbing.
Then the call came in: stim for one more day, return for monitoring tomorrow.
Really?
By tomorrow, that 22 will be at least 24. Larger follicle sizes on older patients are not typically good quality eggs.
If past experience holds, my lining will only get worse by tomorrow. It might be thicker, but it won't be trilaminar. In other words, given all past cycles, waiting a day will make things worse. I develop cystic patches each time they try.
Then there's the extra monitoring. At $575 an appointment, with 6 appointments, we've spent an insane amount on this cycle. This will mean monitoring on days 7, 8, 9 and 10. WTF?
The last hit: we're going to the boundary waters for our anniversary and to scatter Quinn's ashes. Pushing trigger until tomorrow means that if this cycle results in a positive home test, I'll either have to cancel the trip, or wait nearly a week for betas. That wouldn't matter at all if I thought that waiting a day would improve our shot, but given the first two points above, I definitely don't.
Also, new sonographer today. Hands down most painful t/v ultrasound I've ever had. Partly because she managed to drop the gel off the transducer onto the table, meaning there was no gel on the probe when she put it in. Partly because she couldn't find my ovary, decided my bowel was in the way, and started mashing my abdomen with her hand to 'move your bowel'. Spoiler: ovary was not hiding behind my bowel. Partly because, when mashing my stomach didn't reveal the ovary, she must have decided it was down toward my spine, so she angled the transducer such that she was pressing hard on my urethra. Did I mention I have a UTI? I do. It was the longest ultrasound I've ever had and I came close to telling her that we needed to be done. Lots of yoga breathing. New sonographer? She's on again tomorrow.
Only on the ART roller coaster can you go from so thrilled about the results to so down in an hour or less.
I had a monitoring appointment today, my fourth this cycle (plus baseline). I was thrilled with the outcome: follicles at 22, 19, and 17. Lining at 6.18 and trilaminar! It's not going to get any better than that for me, so I'm happy. I assumed we'd trigger tonight, especially since my LH appears to be climbing.
Then the call came in: stim for one more day, return for monitoring tomorrow.
Really?
By tomorrow, that 22 will be at least 24. Larger follicle sizes on older patients are not typically good quality eggs.
If past experience holds, my lining will only get worse by tomorrow. It might be thicker, but it won't be trilaminar. In other words, given all past cycles, waiting a day will make things worse. I develop cystic patches each time they try.
Then there's the extra monitoring. At $575 an appointment, with 6 appointments, we've spent an insane amount on this cycle. This will mean monitoring on days 7, 8, 9 and 10. WTF?
The last hit: we're going to the boundary waters for our anniversary and to scatter Quinn's ashes. Pushing trigger until tomorrow means that if this cycle results in a positive home test, I'll either have to cancel the trip, or wait nearly a week for betas. That wouldn't matter at all if I thought that waiting a day would improve our shot, but given the first two points above, I definitely don't.
Also, new sonographer today. Hands down most painful t/v ultrasound I've ever had. Partly because she managed to drop the gel off the transducer onto the table, meaning there was no gel on the probe when she put it in. Partly because she couldn't find my ovary, decided my bowel was in the way, and started mashing my abdomen with her hand to 'move your bowel'. Spoiler: ovary was not hiding behind my bowel. Partly because, when mashing my stomach didn't reveal the ovary, she must have decided it was down toward my spine, so she angled the transducer such that she was pressing hard on my urethra. Did I mention I have a UTI? I do. It was the longest ultrasound I've ever had and I came close to telling her that we needed to be done. Lots of yoga breathing. New sonographer? She's on again tomorrow.
Only on the ART roller coaster can you go from so thrilled about the results to so down in an hour or less.
How Big Is It?
Let's face it: size matters.
That is, follicle size matters for maturity. As of yesterday, I had three follicles: one at 19, one at 16, and one at 14.5. I have seen good research on follicle maturity by size in IVF conditions, where the oocytes will be retrieved, but I wondered: what's likely to be mature in IUI cycles with gonadatropins?
The first distinction is just that: size for gonadatropin injection cycles. Clomid cycles are a different ball game, and better outcomes are seen with larger follicle sizes. For injections, though, the best study I found is a fantastic 2005 article in Human Reproduction, looking at pregnancies attributable to different follicle sizes. Their focus was on preventing multiple gestations, but in evaluating that, they examined pregnancies attributable to specific follicle sizes on day of hcg trigger.
Human Reproduction, Volume 20, Issue 3, 1 March 2005, Pages 756–760,https://doi.org/10.1093/humrep/deh677
Fundamentally they found that pregnancies could be attributed to follicles 14 and up. Very few pregnancies were attributed to follicles of 14 and 15 mm. The majority were from follicles >16. This is a lower size than I'd have expected, so I find it quite interesting. That said, I know that on Quinn's cycle, I had two follicles, with the smaller one at 14, and both matured, based upon the presence of corpus luteum cysts later. On the twins' cycle, I had follicles at 22, 18, and 16, and the 16 did not mature, based on CL cysts.
A 2010 article in Fertility and Sterility found the highest pregnancy rates in cycles when 3 or more follicles were greater than 16 mm on the day of trigger, but this study didn't report on anything related to smaller follicles.
I'm still hoping we can get 3 mature this time, to maximize our chances.
That is, follicle size matters for maturity. As of yesterday, I had three follicles: one at 19, one at 16, and one at 14.5. I have seen good research on follicle maturity by size in IVF conditions, where the oocytes will be retrieved, but I wondered: what's likely to be mature in IUI cycles with gonadatropins?
The first distinction is just that: size for gonadatropin injection cycles. Clomid cycles are a different ball game, and better outcomes are seen with larger follicle sizes. For injections, though, the best study I found is a fantastic 2005 article in Human Reproduction, looking at pregnancies attributable to different follicle sizes. Their focus was on preventing multiple gestations, but in evaluating that, they examined pregnancies attributable to specific follicle sizes on day of hcg trigger.
Human Reproduction, Volume 20, Issue 3, 1 March 2005, Pages 756–760,https://doi.org/10.1093/humrep/deh677
Fundamentally they found that pregnancies could be attributed to follicles 14 and up. Very few pregnancies were attributed to follicles of 14 and 15 mm. The majority were from follicles >16. This is a lower size than I'd have expected, so I find it quite interesting. That said, I know that on Quinn's cycle, I had two follicles, with the smaller one at 14, and both matured, based upon the presence of corpus luteum cysts later. On the twins' cycle, I had follicles at 22, 18, and 16, and the 16 did not mature, based on CL cysts.
A 2010 article in Fertility and Sterility found the highest pregnancy rates in cycles when 3 or more follicles were greater than 16 mm on the day of trigger, but this study didn't report on anything related to smaller follicles.
I'm still hoping we can get 3 mature this time, to maximize our chances.
Thursday, July 26, 2018
And the Hits Keep Coming
Today's monitoring was good! All three follicles are still growing, lining is up to 5.6 and trilaminar!
There's hope! There's hope for 3 mature and lining over 7! I up my estrace to 2x/day, and I go back again for more monitoring tomorrow, although that seems early to me. My utterly anal chart is below.
Unfortunately, that was the end of the good news. DH's sperm frag test came back.
Research shows that fragmentation above 27% is correlated to recurrent miscarriage. DH is at 30%.
Fuck.
Fuck, fuck, fuck, fucking fuck.
So many thoughts. So many emotions. Resignation. Anger. Sadness. Fresh loss.
Now is not the moment I'm going to process it all. Now is the moment I'm going to go inject more FSH, shove a few more pills in uncomfortable places, and keep going. Now is the moment I'm going to grieve silently. Once this cycle is done, we'll figure out what comes next.
Thank you to everyone who has sent encouraging words and who has been cheering us on. At this moment, it means more than you can know.
There's hope! There's hope for 3 mature and lining over 7! I up my estrace to 2x/day, and I go back again for more monitoring tomorrow, although that seems early to me. My utterly anal chart is below.
Unfortunately, that was the end of the good news. DH's sperm frag test came back.
Research shows that fragmentation above 27% is correlated to recurrent miscarriage. DH is at 30%.
Fuck.
Fuck, fuck, fuck, fucking fuck.
So many thoughts. So many emotions. Resignation. Anger. Sadness. Fresh loss.
Now is not the moment I'm going to process it all. Now is the moment I'm going to go inject more FSH, shove a few more pills in uncomfortable places, and keep going. Now is the moment I'm going to grieve silently. Once this cycle is done, we'll figure out what comes next.
Thank you to everyone who has sent encouraging words and who has been cheering us on. At this moment, it means more than you can know.
|
Stim Day
|
|
7/16
|
2/17
|
12/17
|
2/18
|
18-May
|
7/18
|
|
|
AFC
|
9
R=6; L=3 |
4
L = 2; R = 2 |
7
|
5
L=3;R=2 |
6
L=3; R=3 |
9
L=5; R=4 |
|
0
|
E2
|
49.1
|
18
|
|
|
|
|
|
P4
|
1.81
|
0.31
|
|
|
|
|
|
|
4
|
L follies
|
12.5, 8, 8
|
6.5
|
12, 10.5
|
14, 11, 8.5
|
5, 4.5, 3
|
9.5, 8.5
|
|
R follies
|
11, 9, 8.5
|
9.8
|
5, 3.5
|
7,4
|
5.5, 5, 4.5, 4
|
11, 5.5
|
|
|
E2
|
803
|
585.5
|
188
|
622
|
725
|
691
|
|
|
P4
|
2.68
|
0.07
|
<.05
|
0.07
|
<.05
|
0.1
|
|
|
LH
|
8.24 miu
|
2.73
|
3.38
|
2.12
|
1.32
|
1.58
|
|
|
Lining
|
6.9 triple
|
5.7, fluid
|
4 uniform
|
5.7 triple
|
4.97 triple
|
5.2 triple
|
|
|
FSH
|
600
|
600
|
900
|
1100
|
1100
|
900
|
|
|
Menopur
|
|
0
|
300
|
300
|
300
|
300
|
|
|
|
Day
|
7
|
7
|
7
|
6
|
8
|
7
|
|
6 - 7
|
L follies
|
19.5, 13.6, 7
|
5
|
17.5, 16
|
16, 13.5, 9.5
|
3
|
15, 13.5
|
|
R follies
|
16.5, 15, 10, 8
|
14, 9.5
|
6
|
9
|
9.5, 9.5
|
16
|
|
|
E2
|
1294
|
432
|
718
|
1023
|
252
|
739
|
|
|
P4
|
1.66
|
<.05
|
0.07
|
0.08
|
<.05
|
0.1
|
|
|
LH
|
1.03
|
1.15
|
2.8
|
1.61
|
0.51
|
3.03
|
|
|
|
6.9 triple
|
6.7
|
6 triple
|
7.77 mixed
|
5.2 triple
|
5.6 triple
|
|
|
FSH
|
1050
|
1275
|
1575
|
1350
|
2300
|
1575
|
|
|
Menopur
|
|
0
|
525
|
450
|
600
|
600
|
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