Obligatory Medication Photo

I swear that the collection of meds (and especially the number of needles and syringes) looked even more impressive in person. S was literally shocked to see this pile! Personally, I like the fact that I have my very own sharps container. Just what I always wanted!! :)

My first doses of Menopur (75 IU this morning, along with Lupron 5 units) and Follistim (100 IU this evening) went fine. Menopur was a little tricky because they included a lot of instructions about using a needleless system for drawing up the saline and transferring into the vial with the powder. However, this seemed more confusing than just using a needle, so I did it the old-fashioned way. I was also confused about the fact that the saline vial contained 2 cc of normal saline, but it seems that you are only supposed to use 1 cc to dilute the Menopur powder, and you can presumably discard the rest. Not to mention that I was chatting on the phone (hi K!) and trying to get ready for work as I was doing this, so it was a little bit overwhelming. I took my time and gave my full concentration to using the Follistim pen this evening, so that one went smoothly. I have no symptoms of any kind yet, except for the fact that my period is coming to a rapid halt. I'm somehow afraid that I'm going to forget a dose of something at some point. Yikes!

Since I'm always complaining about the cost of IVF, I'll take this moment to complain about the cost of something else -- gas! I set a new record today: I have now paid over $40 to fill up the tank on my little Honda Civic!! It used to cost me about $13 for a fillup, but at this point it was 10+ gallons, and $3.82 per gallon for the cheapest available gas. Luckily, I get pretty good mileage and don't drive more than 10-15 miles per day, so it should last me for a couple of weeks. However, I fail to see how suspending the gasoline tax over the summer (McCain's proposal) will really help the economy. I don't think that saving a couple of cents or a dollar here and there will affect the budget of the majority of people, but decreasing gas taxes (which generally fund transportation projects, as far as I understand) may just make road maintenance and new road construction come to a halt.

OK, I'm starting to fall asleep sitting here (I guess I'm even boring myself by talking politics for a minute), so I'm probably better off going to bed now. Good night, everybody!

Suppressed!

My E2 is indeed < 20 today. Suppressed as planned. Yippeee!

Of course, after writing the post earlier today, I started googling "high antral follicle count" etc and managed to freak myself out. Higher counts can be associated with poor quality eggs. And I found the scary IVF tale of a woman with 66 antral follicles who like me, googled high antral follicle count, suspected that she was going to develop severe OHSS, and then did just that. She has twins now, but the original IVF cycle was cancelled due to the OHSS, and then she had a miscarriage after her FET, and then she finally got pg with her second IVF. Yikes!

I just need to trust that my RE knows what he is doing. He always projects himself as so calm and confident. I sometimes want him to commisserate and admit that my case is difficult and that these decisions are tricky, etc, but he never does. They tend to just rush out of the ultrasound room as quickly as possible so that I can't quite voice all my anxieties to them. Maybe that's a good thing.

Ultrasound Report

Today I had my suppression ultrasound and bloodwork. I'll have to wait until this afternoon for the E2 result, but if it's less than 20 (indicating "suppression"), I'll be good to go. Dr. G did my ultrasound this morning. As Ms. Polycystic Ovaries (without full-blown PCOS), I had a whopping 26 follicles on the R side, and 17 on the left. Yes, that is 43 antral follicles. It's really an approximation because he was counting them really quickly. He could see that there were plenty.

So, my initial doses -- starting tomorrow -- will be 5 units Lupron and 75 IU Menopur every AM, and 100 IU Follistim every PM. I get the sense that the Follistim dose is really small, probably because they don't want to overstimulate my ovaries. At the same time, I am a bit concerned because they kept me on a small dose of Clomid (50 mg x 5 days) through 3 IUI's and I only got 1-2 follicles each time. I'm worried that I'm less easy to stimulate than they seem to think.

I expressed these concerns to the nurse, C. (Dr G was in and out of the room so fast that I really didn't have a chance to ask my questions. Grrr.) She tried to reassure me that this is the reason that I will have bloodwork literally EVERY DAY starting on Sunday (4/20/08), and ultrasounds almost EVERY DAY starting on Wednesday (4/23/08). They will adjust the dose every day to try to get a good result. She then taught me about reconstituting the Menopur from it's powder, and how to use the Follistim pen, etc.

My bill at the pharmacy today was $1450.66. My insurance covered part of the doxycycline, Medrol, and Vivelle patches. I had to pay full price for the Follistim ($$$), Menopur ($$$), HCG ($), and progesterone ($). This is a small (non-chain) pharmacy on the first floor of my RE's medical office building, and they are very used to dealing with my RE's patients, so that part is good. There was an older man in the line next to me who gasped when my total bill was announced. His cashier said to him, "See, doesn't that make you feel better about yours?" I smiled over at him and thought about telling him that it was for IVF (since I am sure that he was curious!), but I decided against it. I may need to buy more Follistim later, depending on whether my dose goes up. So far, I have a 900 IU cartridge.

Overall, I'm feeling cautiously optimistic...

Hurry UP Period!!

I took my last birth control pill on Saturday, and now I'm waiting for my period to arrive. I had some promising cramps on my jog this morning, but I'm not feeling anything now. I don't think I've ever been so eager for my period to start. It's bizarre how I took the pill for several years, most recently in November 2006, and yet I cannot remember how long it generally took between stopping the pill and starting the flow! Weird, huh? Anyway, if my period does not start by tomorrow, I will not have my suppression bloodwork and ultrasound on Thursday, and then everything will be delayed. I asked about it, and it sounds like it only delays things by a day or two (until Aunt Flo appears), but it's making me a bit antsy.

I now have two ugly bruises on my abdomen. I don't know why 2 of my 8 injections (the two most recent) have resulted in bruises. I think I was sort of injecting as I was withdrawing the needle, instead of injecting all of the solution while the needle was completely buried. Maybe it also has something to do with the fact that I've been on aspirin for a couple of weeks now. Well, I guess there is plenty of more time for self-experimentation. I never thought that I would look forward to starting 3 injections per day, but I am really eager to get to that part.

Sorry for the utter boringness of this update. I hope you all are doing OK!

Edit to add: My period finally arrived a few hours after I posted this. Onward ho!

Gorgeous Weekend

I have been pretty surprised by the utter lack of side effects with Lupron. I guess I might have had a tiny bit of night sweats last night (dampness on my chest), but it was less than I have experienced previously with either Clomid or with the end of every cycle when my temperature drops.

I took my last birth control pill yesterday, so now I'm just waiting for a withdrawal bleed in the next couple of days. Assuming that that happens, I'm supposed to have another ultrasound with the dildo-cam and an estrogen level on Thursday. Then, on Friday, I'm supposed to start the Big Guns (Follistim and Menopur). Lupron will continue, too, although the dose drops to 5 units at that point.

It has been kinda relaxing, these several weeks of TTC without having to monitor anything, have sex on demand, or worry about symptoms or lack thereof. However, I'm eager to move onto the next phase of this process.

I'm really excited to report that S and I are going to take a 10 day trip to France in mid/late May. The ironic thing is, assuming that everything goes well, we are leaving on the day of what is supposed to be my pregnancy test! (I didn't realize that IVF would take over 6 weeks when we scheduled the trip back in early March!) Of course, I am going to need to have them move the test up by a couple of days. Waiting til 16DPER seems ridiculous, anyway. I guess that if I am lucky enough to be pregnant, I would miss some of that fun stuff like seeing if my beta numbers double, etc... but in a way I think it will be good to get away. I hope that a negative won't ruin the whole thing, though.

We had a good weekend, overall. I did work overnight at my moonlighting job on Friday night. I make these shifts more palatable by thinking that they pay for the extras in life, like IVF and our trip to France. That was my 3rd Friday in a row (ugh!), and my 2nd to last shift ever (probably), so I am thrilled to have it behind me. After I slept away half the day Saturday, I woke up to one of the most beautiful weekends (weather-wise) in recent memory. S and I went to Home Depot and picked up a bunch of plants to plant in our new planter boxes in the back yard. Hopefully in a few months we will have a crop of 6 different types of tomatoes, bell peppers (yellow and green), jalapenos, and maybe even some basil, cilantro, and a giant watermelon. We also got a bunch of new impatiens and coleus for our front entryway along with several other plants for various spots. We had a lot of fun planting it all.

Afterwards, we went for a "date night" to our local barbeque joint (yum!) and then saw the new movie "Sm.art People." Thumbs up! I did cry a little... somewhere in the middle and then at the end. If you see it, you'll understand why. You must stay and watch the credits, by the way. I'm picky, so I did notice a few gaffs, though. For one, we see a paper that Sar.ah Jess.ica Par.ker wrote for her college freshman English class. It was dated 1992. Well, I was a college freshman in 1993-94, and SJP is quite a bit more than 1 year older than I am. There were also a few medical professional things that didn't ring true. SJP is an emergency medicine physician, and she 1) administered a tetanus shot (sorry, but I have never yet given a shot... nurses do that!), and 2) gave the shot to the guy in his butt (as a patient, I've always had tetanus shots in my arm), and 3) took call (I have NEVER heard of an ER doctor being on call). Also, a neurologist did a slit lamp exam, which is usually the domain of the ophthalmologists and wasn't really indicated for a patient who was being seen to follow up a seizure. Since these things bother me, you can probably see why I haven't watched the TV show ER since my intern year (2001-2002). But besides all these nitpicky details, it was a good movie. But ANYWAY...since SJP was in "Smart People", they had a preview for the Sex and the City movie. It looks really cute and I've now started taping Sex and the City so that I can refresh my memory and be ready for it.

Today, we drove up to Laguna Beach just to do something a little different. It's about a 1.5 hour drive. We went on a 5.5 mile hike in Crystal Cove State Park (beautiful, but hot!), and then had a nice lunch on a shady patio, and then went shopping and people watching for a while. Came home and drank a margarita on the patio. Summertime... and the living is easy...

First Shot

I asked S to be with me for "moral support" during my first Lupron shot. While pulling (too hard) to remove the cap from the needle, it recoiled and I managed to stab myself in the palm. OWW! I swear, I think it is a miracle sometimes that I have only had one occupational needlestick, and that was a clean needle that I hadn't yet used during a bone marrow biopsy. Lucky lucky...knock on wood...fingers crossed.

Anyway, I finally managed to draw up the 10 units, cleaned and pinched an inch on the side of my belly, and then I just took a deep breath and stabbed myself with the needle. I have to admit, the shot itself actually hurt less than I expected. I think I'll be able to do this entire part without much problem, even when it increases to 3 shots per day next week. So now I'll just have to start worrying about the trigger shot and the PIO shots. I have to admit that those DO scare me. I've seen those needles. Yikes.

This reminds me... last week, when I was at the RE's office for my trial transfer, there was a woman there who was having an absolute fit while her blood was being drawn. I mean, both her husband and the nurse were literally holding her down to restrain her arm while she flailed her entire body and was screaming and moaning really loudly. Certainly all of her movement couldn't have made it any easier to find a vein. The whole situation was pretty unbelievable and it was hard not to stare at them. I'm assuming that she is an IVF patient and I really hope that she is almost finished with the daily blood draw part of the cycle.

9 Pills Per Day

After months of searching, I finally found a stock market graph that looks exactly like a normal temperature curve in an ovulatory (non-pregnant) cycle! Tee hee hee. Too bad I'm on the pill (pre-IVF) and that I'm no longer tracking my temp. Well, anyway, that's kinda what it usually looks like.

One day after my last entry (Wednesday, 3/26/08), I went to my RE's office. They did an ultrasound to confirm no cysts (and none were seen), and then they drew Cycle 3 blood work. I got the results a few days later, and got a bit paranoid about the fact that my FSH was up to 6.7 with an estradiol of 42. Both of these are normal (they want the FSH < 10 and estradiol < 50), but both are higher than before. In June 2007, my FSH was 5.2 with an estradiol which was actually below the normal range at 18. The RE's nurse told me that "normal is normal" and that I shouldn't worry about the exact numbers. So I am trying to do that. I have also read that FSH can be higher after Clomid, but I tend to doubt that the effect would last for 2 months. As for the estradiol, I can perhaps speculate that the metformin has changed the ratio of my sex hormones? My weight is stable at 130-132 lbs, but it is possible that I have a bit more fat and less muscle than last June... who knows?

Also, my DHEA-S was measured at 142, with normal being less than 200. This is apparently a measure of my adrenal androgens. I have never had any other androgen testing, and I'm wondering what it would have been pre-metformin.

Last Friday (3/25), I started birth control pills (Ortho-Evra, I think). Ugh, since dealing with IF, I never thought I'd need to take the pill again in my entire life. Oh well, at least insurance is paying for that one. They are also paying for doxycycline, which S and I are both taking. Neither one of us have any active infections. It's voodoo, I swear. I feel that way about the aspirin, too. Of course, I'm completing willing to do any voodoo that they recommend at this point.

A couple of days ago, I was shocked to realize that I am currently swallowing 9 pills per day. 1 prenatal vitamin, 4 metformin, 2 doxycyline, 1 baby aspirin, and 1 birth control pill.)

I also went for a "trial transfer" a few days ago (on Tuesday, 4/1). As usual, I forgot to come with a full bladder, so their transabdominal view of my uterus wasn't that great, but hopefully that won't interfere with the results. Anyway, the trial transfer was exactly like an IUI, except that they made note of the fact that they used a small speculum (I could have told them that!), and they said, "6 at 6 o'clock" which is some sort of mysterious measurement that they will use during the upcoming embryo transfer.

On the trial transfer day, I had to pay the $10,525 (gulp!) IVF fee. This does not include meds. Please GOD let it work! I am starting to get more an more comfortable with the idea of transferring two embryos. (Oh, please please PLEASE let me have good embryos to transfer).

I start Lupron 10 units per day on Tuesday, 4/8/08. I take both Lupron and the pill for 5 days, then I stop the pill and wait for a bleed. Soon thereafter, I have another ultrasound and start injectibles (Lupron 5 units, Follistim, and Menopur)...

The only other related events have been:
1) finding out that one of my co-workers' wives is pregnant, and
2) while I was at the drugstore pondering why aspirin 81 mg is more expensive than 325 mg, I had to listen to a loud one-sided conversation (a young woman chatting on her cell phone) about her OOPS! pregnancy, just confirmed by blood test, with the father who she almost just broke up with just last month, and how all of their fighting made her lose track of the days of her cycle (OOPS!), and how she was about to go and apply for WIC, and how her neighbor already gave her "What to Expect when You're Expecting," and how something must be in the water because EVERYONE is getting pregnant. The only good thing about hearing this conversation was that the woman did at least seem happy to be pregnant.

Oh, wow. I promise I'm really not as bitter as I sound right there. But if this doesn't work, I probably will be. :)