Monitoring #1, February

Today's monitoring was ok. Not my best, but my lining is better than last time. I'll try to stay hopeful. My numbers-loving self added to my chart below.

They want me to come back again Friday. I've always done appointments after 4 full stim days, and then 7 full stim days, so I was hoping for/expecting a Saturday appointment. Instead it will be Friday and force me to miss a meeting. I am so grateful my job has some flexibility, and I have so much respect for people that juggle IF treatment without this type of flexibility.

Stim Day		Jul -16	Feb-17	Dec - 17	Feb-18
	AFC	9	4	7	5
4	L follies	12.5, 8, 8	9.8	3.5, 4	14, 11, 8.5
	R follies	11, 9, 8.5	6.5	12, 10.5	7,4
	E2	803	?	188	622
	P4	2.68	<.05	<.05	0.07
	LH	8.24 miu		3.38	2.12
	Lining	6.9 triple	5.9 triple	4 uniform	5.7 triple
	FSH dose	600	600	900	1100
	Menopur dose		0	300	300

Also, totally random, but I live in MN, where the population is a whole lot whiter than it was back in SoCal. There is one place I go that's the exception to this: my RE's office. I see more diversity in the waiting room at the RE than anywhere else I've been in MN. At least 50% of the other waiting patients aren't Caucasian, usually more. I don't know why, and I wish no one needed an RE, but it's nice to see that diversity exists somewhere in the Twin Cities!

Microblog Mondays: New Day, Same Old BS

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Last week CVS Caremark assured me that I wouldn't get any more auto dialed calls. They warned me that it had been disabled in the system, so even if they were needed calls, like refill reminders, I wouldn't get them.

Guess who left not just one, but TWO messages for me today?

How can any organization be this incompetent and not go bankrupt?

I ought to find another pharmacy, but thanks to another screw-up, this one in my favor, if I buy through them, I pay everything, but it counts toward my OOP max. For Pregnyl, the cost is the same as most other US pharmacies. Gonal-F is now also about the same as most other pharmacies. Menopur, though? If I re-order my Menopur through them, it will cost about $3,500 for 20 vials. That compares to roughly $1,750 everywhere else. So not only are they incompetent, but they're double the price of everyone else (and were double the price on Follistim last year, too). Why does my employer stick with them as our only Rx choice?

Baseline

Had my baseline monitoring yesterday. The good news is that I was cleared to start meds. The less good news is that my AFC was only 4 or 5. There were 3 clear follicles on my left, and either 1 or two on my right ovary. So much for my hope of recruiting an extra follicle or two to bump up my estrogen.

I'm now on doxycycline, estrace, menopur, and follistim. First monitoring appointment is on Wednesday. Come on, body!

CVS Caremark, You Never Change. Please Reconsider!

New cycle, new meds order. Thanks to a bit of a meds debacle at year end, I have everything except Pregnyl. I had asked my clinic to refill all my current meds, but with a full-cycle dosage, instead of half-cycle. Knowing how hard it is to get meds, there's no point in only ordering a half cycle's worth, the other half wouldn't arrive in time and I'd be screwed.

I asked my clinic to send ME the prescriptions so that I could fax them to the pharmacy and manage things. Instead, I got a phone call from a pharmacy that I don't use, telling me they had questions about my prescriptions. After calling the clinic and asking that things be faxed to me, again, the prescriptions showed up. I could understand why the pharmacy had questions, since there were two different prescriptions for Follistim (at different dosages), and the Estrace that said to take both two and three times a day.

Aside from those problems, the stack of prescriptions also included Ovidrel. My last two cycles, Pregnyl was ordered for me. My first cycle, Ovidrel was ordered, then I was told to use Pregnyl on the day of trigger. So, I pushed back. Said I thought I should be on Pregnyl, not Ovidrel. Was told that my order said "Ovidrel." I asked if my order had been changed, since the last two cycles, they ordered Pregnyl for me. Instead of answering that question, they told me "they both do the same thing." That's not what I asked!!!

At my forced regroup appointment, I asked about trigger. Dr. B said it was fine to use Ovidrel since I'm petite, but Pregnyl had clearly worked in the past, so she'd order that if I wanted. I walked away with the order and agreed with the nurse that I'd have the pharmacy call them to request a refill, to avoid any confusion. Hah!

Dearest, darling CVS Caremark called to request the refill and told me they'd call me back when it came through. Apparently it came through on the 27th, but they never called. I called them yesterday, gave them my payment info, confirmed a shipping date and address, and thought I was set.

Around 11:30, my phone rang. It was CVS Caremark auto dialing me because I "needed to verify payment and shipping information for your prescription." Their auto dailer then put me into hold for 10 minutes to wait for a rep. The rep looked at my order, said I had everything, and told me to disregard.

At 11:59, my phone rang again. It was . . . . wait for it. . . CVS Caremark auto dialing me because I "needed to verify payment and shipping information for your prescription." After another 7 minutes on hold, we repeated the conversation, only I told them I expected NOT to get another call.

At 12:15, my phone rang. You'll never guess who! Same bloody message.

At least they're consistent. You always know what you're going to get, even if it's what you don't want!

Body Pep-Talk

AF started a bit after 6:00 pm Thursday. I left a message with my clinic, and they're having me come in for baseline on Saturday. Last cycle I did baseline on CD1 and started stims on CD2. The most reliable nurse told me that CD3 was too late to start stims. Maybe AF in the evening means they count the next day as CD1? Whatever CD it is, hopefully I'll be starting meds tomorrow. Estrace 2mg/BID, doxycycle BID, Menopur 1 vial am, Follistim 300 iU pm.

My period is still super light, so I've been having a conversation with my body all day: Uterus, please, please play along and grow a nice, thick, trilaminar lining. Oh, and ovaries, please do your part and grow a few follicles to get that estrogen level up and help out our friend the uterus. Also, I'd like the eggs in those follicles to be euploid, please! I have faith in you, you've both done it before, you just need to do it again!

Wonder if ovaries and uteruses (uterui? what is the plural of that word?) speak English? Might have to rethink my pep-talk strategy!

Knowedge v. Experience v. Humility

While I was in the hospital with Quinn, we saw multiple different MFMs, as they changed rotation once a week. There was Dr. Hart, Dr. Jacbos (same MFM I saw when we lost the twins), Dr. Contag, and Dr. Yamamura. Yamamura was amazing, and kind, and the only one who didn’t try to de-personalize Quinn. Contag was the second to last we saw. He was the one who wanted to send me home, despite the heavy ongoing bleeding, and the fact that I was dilated with prolapsed membranes. DH and I had to advocate, HARD, to stay in-patient, rather than go home and travel in twice a week for monitoring. Given my situation, we should not have needed to do that.

Contag also told us that “next time” we should get a prophylactic transvaginal cerclage (TVC). I asked him why I wouldn’t get a TAC, and he was completely dismissive of me. He wouldn’t acknowledge the difference in success rates. He wouldn’t acknowledge that a TVC is so much riskier to the baby. He wouldn’t even discuss TAC as an option, he just shut me down. Because I hadn’t yet given up on Quinn enough to think about ‘next time,’ I mentally placed him in the category of: doctors who are so enamored with their opinions that they won’t even discuss other reasonable options.

I am a member of a group called Abbyloopers. It’s for women who are considering/have TACs. Most women have suffered multiple losses, many have losses after failed TVC. Abbyloopers collects data from members on post-TAC pregnancies. They post it, for other members to see. It’s been a great source of comfort to me, seeing how high the live birth rates are for my TAC surgeon. The other day I was looking at the records from true failed TACs. There aren’t too many of those records, and most are from laproscopic TAC. There was one record where the TAC failed at 17 weeks and the baby was lost. I happened to glance at the doctor’s name. Contag. The spreadsheet also listed state, though, and the state was MD (year was 2009). I’m not in MD, so I assumed it wasn’t him. But that’s an unusual name, so I checked his bio. He was practicing in MD in 2009.

I guess I know why he was so dismissive of TAC: at least one that he performed failed. Rather than acknowledge the stacks of research on the topic, showing TAC is more successful, he decided to cut off that option.

I rely on my doctors to use their expertise, expertise built of knowledge and experience, to guide me. I also rely on them to have the humility to acknowledge their limitations. I don’t think Dr. Contag did that, and it’s highly disappointing. This is just one more reminder that I need to be my own advocate, and not simply rely upon the professionals that are supposed to be the experts, as their judgment may be just as biased as mine!

Chugging Up the Incline

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There is no description of infertility more apt, to me, than that of the roller coaster. From one moment to the next, emotions, hopes, fears, possible outcomes can change. All it takes is one ultrasound, one phone call, one blood test, one hpt to instantly change your state of mind and your hopes for the outcome. Heck, sometimes it doesn't even take any one of those things; simply living from one moment to the next can cause the change! To be fair, I could describe each of my pregnancies the same way.


If my normal luteal phase applies, I'm less than a week out from CD1. The coaster is here, and I'm on it. We're chugging up the first hill before zipping away to the unknown. I know there will be highs and lows, but hopefully this time I can hang on long enough to get off the ride, grateful for the experience. .  .although I don't see myself as that rollercoaster rider who immediately begs to go again!