"There's obviously something broken..."

"There's obviously something broken..." Those were the words of the doctor who did my last scan last week. And yes, they hit like a ton of bricks. I mean, clearly, we knew that something was not right. But hearing it so matter-of-factly was a bit startling. But let’s back up…

When last I wrote, I was pretty much in a panic that the cycle was failing. I found out that the doctor had decided to kick back my meds because my follicles were all growing together (2 many mature follicles = risk of too many babies) and my estrogen was increasing very quickly. My understanding is that he thought scaling back my dosage would stop some of the small ones from progressing. Well, what happened was that the dosage ended up being too low and it basically shut everything down. By Sunday’s scan, I had no growth and my estrogen levels had dropped off. Plus, I lost my uterine lining thanks to the lack of estrogen (can you say spontaneous period!?). Dr. Freedman called and explained all this to me on the phone, which was nice. He felt badly that this had happened. He kept saying “I don’t want to overcook ya.” – Nothing like feeling like a Thanksgiving turkey – ugg. He didn’t cancel the cycle but just decided that I would basically be at baseline and starting over. I was 2 weeks into injections and not pleased…

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Pic of the inside of my sharps container! Lots of needles...

 

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I went back for scans the next week and there was minimal growth and my estrogen was SLOWLY creeping up. On Friday, the doctor came in…

As an aside – let me explain the situation with the doctors. When we switched to RMA, there were 4 doctors from the Philly practice that rotated days in Mechanicsburg. Dr. Freedman was there the day of our consult so he became our doctor. We would see whichever doctor was in the office for scans, but Dr. Freedman was handling our care decisions. However, when we were in our first cycle, the Mechanicsburg office got a full time doctor – Dr. Nguyen – and the Philly doctors would no longer be coming to Mechanicsburg. They offered us the option of switching over to the new doctor but we decided at the time to stick with Dr. Freedman because we had talked to him so much and felt so impressed by him. But since August, Dr. Nguyen is who I have been seeing at my scan appointments.

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 Site of our new fertility dr - RMA of Central PA

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So Dr. Nguyen came in and asked me if I was frustrated. She said she had looked over my cycle and even she felt frustrated for me. I told her that we have been at this for so long that we don’t even notice the frustration anymore. She began to talk about IVF and asked if we had thought about it. (She had dropped an IVF comment on me before so I wasn’t overly shocked this time.)

Another aside – IVF is in-vitro fertilization – basically they used injectable meds to grow a whole bunch of eggs, then the eggs are retrieved in a “minor” surgical procedure, they are fertilized with the sperm in a lab, and then the embryo(s) are transplanted back into the uterus to hopefully implant. It’s invasive, time consuming, and expensive (think out-of-pocket without insurance - $10,000-$15,000ish) but offers success rates that are leaps and bounds higher than any other treatments.

I told her that we were pretty resigned to the fact that that is probably where we are headed. I also told her about our stellar insurance coverage…her response: “Oh you should do IVF!” She seemed pretty certain that was the best option based on what she was seeing. I told her that we were okay with moving on to that and we were both just ready for it to be over – baby or no baby. She told me not to think of IVF as the end of the line – that some patients are just better suited for it and she feels that way about me. She said that it’s not like I failed at everything else so now it’s on to IVF. In my head I am thinking – I am pretty sure that’s exactly what it is like!

After my scan she said that things could go on in the cycle to work out but to think about IVF for next time. The nurse also mentioned to me again about switching doctors and I left considering if that would be best (I hate making decisions!). Luckily, the decision was soon made for me. That afternoon the office called – Dr. Freedman was cancelling my current cycle and recommending that I set up an IVF consult with Dr. Nguyen. It was a tough message – it’s like I knew it was coming but to have it actually be right there in front of me was painful. I also felt a little relieved that the doctor switching decision was made and that we were finally moving on to the final level in this long battle.

Our consult is tomorrow. I am anxious to get the scoop on the whole thing. I have read enough – and talked enough to a fellow IVFer – to feel a bit afraid but I am trying to hold out on any true fear or judgment until I get the whole story. We are armed with a list of questions and will see how it goes.

Ironically, I realized that my first treatment cycle – a diddly 50 mg of Chlomid – was in September 2012…one year ago. IVF will be my TENTH round of treatment. We started trying to get pregnant in August 2011…TWO YEARS AGO. The time that has passed blows my mind. In that time I have had friends get pregnant, have their babies, and celebrate their babies’ 1^st birthdays. I just pray that in a year from now we are in a different place in our lives and off this path of sadness and waiting.

 

Let's get caught up!

End of July 2013 –

Well a lot has happened since I last wrote…I finished my Prometrium pills and after a few days – still no period. So Jared and I geared up to go to the beach for a week with my family and figured we’d deal with everything when we got back. A week before we would have left for vacation, Aunt Flow showed up! I was shocked. (I also forgot how painful these dang periods are – I am so out of practice!) So it was back to the doctor for a baseline scan and to see what the game plan was. Scan was perfect – thin lining, no cysts. The NP even said I have “perfect anatomy” – I am thinking, “yeah, so perfect I can’t get pregnant!”

After reviewing my blood work, the doc decided to do Menopur.  We were of course excited to be starting another round. But we were also bummed – because I’d have to be in for scans and blood work every couple days, we would likely miss the beach. Sacrifices!

He initially wanted to start me on 75 units (1 vial) per day but later I emailed him and asked him to reconsider. The doc at Danville had seemed to think that my previous cycle didn’t work because they had started my dosage too low. The last thing I wanted to do was repeat the last cycle (especially if I was going to miss vacation!). He was very understanding and opted to start me at 2 vials (150 units) and that he would back it down to 1 if things started to progress too quickly. After a few days, my hormone levels hadn’t budged so he upped me to 3 vials (225 units). – As an aside, I find it interesting that the new doc looks at all my hormones, whereas Danville only looked at one (Estradiol).

After a week of scans and blood work every other day (it was a crazy week! We managed to drive to the beach between my Mon morning and Wed morning scans!), things slowly progressed. We were at Hershey Park (since the cycle busted our plans to spend the whole week at the beach, we opted for mini day trips instead) when I got the call that I had one follicle at 17 and to take my trigger shot that night and come in for IUI on Sunday. The Good – the HCG trigger they use is a pre-filled syringe (no mixing vials!) and they do IUIs on the weekend to get optimal timing…the Bad – they only do weekend IUIs at the King of Prussia office.  As if we hadn’t done enough driving that week, it was off to Philly!

The IUI itself was easy-peasy – I felt that it was way quicker and less painful than at Danville. I love the sense of calm and happy after an IUI – it’s like everything has been done that can be done. It’s the day or 2 after the IUI that the crazy begins to creep in, haha…if I didn’t get my period before, I was to come in in 2 weeks for a blood test.

Jared & I after the IUI

 

Another new aspect with the new doctor – an awful invention called “Crinone”…this is a progesterone vaginal cream that they recommend you use once a day after IUI. It’s intended to, as it was described to me, “make your uterus nice and sticky”! Really it’s to help thicken the lining in hopes that an embryo will implant. Well, as if using a vaginal cream isn’t in and of itself annoying, it also made me feel excessively tired. I felt like a zombie for days!

Two week wait was murderous as always. I chose not to drink at all which is not fun. Plus, I read the Crinone can delay your period so I didn’t know whether to expect period symptoms or not.  Although it was 2 days later than it would normally arrive, Aunt Flow came knocking the night before I was to go in for my blood test. (As an added bonus, once I stopped the Crinone, I had “withdrawal” symptoms – a headache for 2 days and the inability to stop crying. The fun really doesn’t end.)

End of August 2013 –

So it was back to the doctor for baseline. Jared and I had talked about getting a sit-down with the doctor to try to get an idea of what is happening and where we go from here. But we were trying to be patient too – although this was our 8^th failed cycle, it was only our 1^st with the new doctor. At the baseline, I asked the doctor doing the scan about her thoughts.  Her response still rings in my ears – “At your age, with this many cycles, you should be pregnant by now.” It was haunting – I could just hear Zoma back in February – “You have been with us for such a long time.” I felt hopeless. It was looking more and more like we were on a crash course with IVF. And once that starts, the insurance money is going to run out really quickly – and then it’s the end of the road.

I ended up emailing Dr. Freedman and he called that evening and we got to talk about the cycle. Basically, it was not an ideal cycle. They decided to trigger me because I did have a technically “mature” follicle but it was only 17. He likes to have 19 or 20. But they were concerned that if they let me go any longer, some of the other follicles would catch up and I’d end up with too many mature (ie. too big a risk for multiples).  He didn’t make me feel much better about the likelihood that IVF isn’t the answer, but I felt okay about trying another round of Menopur and IUI.

So that brings us to the present – September 2013. I am on injection day #9. I started out alternating 3 vials, then 2 vials, then back to 3, etc. Two days ago my scan showed 1 follicle with a small lead – a 12 – and then 3 others that were closely behind. He kicked me back to 2 vials. This morning there was minimal growth – if anything the smaller ones are starting to catch up – not good. He is kicking me back to 1 vial. I don’t feel good about this at all. It is my understanding that I should have 1 or 2 follicles that take the lead but all of mine seem to want to grow together. I go back in 2 days and am praying for a miracle.