Head Case

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I had been freaking out since Thursday when I was supposed to take my orgalutran in the afternoon because my LH had started surging already and they wanted me to suppress it ASAP. Well I was at work, didn’t get the message until later, and didn’t have the orgalutran with me anyways. I took it as soon as I got home, hoping that was enough to prevent me from ovulating early. I had literally been worrying myself sick, my stomach had been churning and upset for the better part of two days (although part of that could be from the meds).

I called the nurses line Thursday evening to leave a message regarding the fact that I was not able to take my meds when they called and told me to do it sooner, hoping that it would be ok. The nurse called me back Friday morning and basically gave me shit for not being more on top of my phone when they called. It was sitting on my desk the entire time, but I didn’t notice the missed calls or the voicemail until the phone lines had closed…at 3:30 pm. I told her as much, and she said well I need to make sure I get their calls as things can change once they get my bloodwork, and it is very important. No shit, I’m not purposely trying to mess things up, life happens, even when IVF is my first priority. I also did not have my meds with me, I was at work, and they were at home, so I don’t know what could have been done even if I had gotten their message. Everything they gave me indicated I was to take the orgalutran in the evening with the menopur and after the fact I was told that it is extremely rare that they see an LH surge before the orgalutran is started, so they didn’t see it coming either. I would have appreciated not being treated like a child, and rather a patient who is complying to the best of my ability, and paying a lot of g-d damn money for this B.S. (I’m starting to get bitter about this whole IVF process, can you tell?…)

So in any case, I had been stressing, googling, and hand wringing waiting for my follow up appointment. I was feeling pretty intense pressure in the right side of my lower abdomen Friday, so I was pretty sure big righty (my 18mm follicle, as of Thursday) was still there, and hadn’t ruptured. This gave me some comfort, but not enough to slake my worries. It seems after each appointment so far there has been some catastrophe that has threatened to derail this cycle, and I’m getting really tired of it. I didn’t expect quite this much stress between appointments, I thought it would be at it’s worst leading up to retrieval and then waiting for the fertilization report. Apparently things can’t be that easy.

Saturday morning I had to go back for another monitoring appointment, and J came with me this time, to see the ultrasound, and for moral support as I was somewhat expecting bad news. Normally my blood work, and my ultrasound are both done at the clinic, but it seems on Saturdays they do not have a phlebotomist on staff. Therefore I had to go to the main hospital building for my blood draw, before my ultrasound. The blood collection lab in the hospital does not open until 9am, but I was advised that people will get there early, so they can get in first. Duly noted, and lesson learned from the ultrasound numbers game, I decided I should show up at 8am. This was a good call as there were already a few people waiting, and some that had submitted their requisition and gone to wait elsewhere (as I found out when there were more people ahead of me than I had even anticipated). I am normally supposed to start work at 9am, but I told them I had a doctors appointment, and no one asked any questions this time.

After my blood work was completed, we had to wind our way back through the hospital to the seperate wing where the clinic is located. Once at the clinic, we checked in (no numbers or waiting for them to open this time). There was one couple who arrived before us for blood work, that was now sitting in the lobby of the clinic. There were a few other couples, presumably for IUI’s or their related monitoring. As we waited, the lobby began to fill with the other couples that had been at the lab and had now made there way over to the clinic. I was extremely glad we got to the hospital as early as we did. Overall we waited maybe 20 minutes before going back for the ultra sound.

While we were waiting for the doctor in the ultra sound room I was telling J what we would see on the ultrasound, and he was getting confused in the terminology, follicle, egg, embryo; he’s still trying to wrap his head around it all. I get it, it’s not his body or his process and it is hard for him to follow, or understand. Yet another case and point as to why I don’t tell people what I am doing. I was telling him that I can feel the follicles in my abdomen, like the pressue of leaning against the counter while doing the dishes…with a full bladder. I managed to give myself a massive bruise, and lump on my right side Friday night as I managed to nick a blood vessel whilst injecting my ganirelix. I am beginning to hate that stuff, the needle is dull so I have to jam it in, then it leaves a red welt (or in this case an ugly painful bruise). J was feeling pretty sorry for me as I have been feeling pretty disgusting. He said he wishes I didn’t have to go through it all, or that they could at least give me oral tablets or something. Sweet notions, but just not the way it works.

It wasn’t my normal doctor that did my ultrasound, which made me a bit leery, as I had never met this doctor before, but she was fantastic. I told her I was worried because of my LH surge, and not taking my meds right away to prevent ovulation. She said it should be fine, as spontaneous ovulation during IVF was exceedingly rare. I asked her what level my LH was the day the clinic called in a panic to have my start my ganirelix, and she told me I was only at 11 IU/L when they did my bloodwork Thursday morning (around 30 IU/L would be peak). I was thankful that she gave me a number, as that helped ease my mind somewhat, although I wasn’t able to take the ganirelix until 12 hours after that level was recorded so who knows what it was by that time.

She inserted the dildo came, and checked my lining (7.6 mm triple strip, woot woot!) and then moved to the right to start measuring. And there they were, my follicles still all hanging about. Now, I suppose this doesn’t absolutely ensure that I hadn’t ovulated…? I think it is possible that a/some follicles could have ruptured, releasing an egg, but because I am still on a FSH it could be artificially keeping the remaining follicles intact and growing. When the doctor gave me my requisition for Monday’s blood work she selected to check my progesterone as well because if that has risen, then it means I did ovulate. Although, since there are follicles still it may not mean a cancelled cycle, per se. But back to my follicles, that fat follie on my right side has grown from 18mm on Thursday to 25mm as of Saturday morning! Holy hell, no wonder I am so uncomfortable on that side, that is literally the size of a small grape. And that’s not the only one hanging around over there. There’s another bigger one at 19mm, two at 15mm, a 14mm, 13mm and 12mm. On the left side things are a little quieter. There is one leading the pack at 17mm, a 13mm, 12mm, 10mm,  two 9mm and one 8mm. It was so nice of the doctor to write them down for me, she was very informative which was really great.

I told her everything with this cycle has been a bit of a schmozzle. She told me it’s usually the cycles that appear to go perfectly that don’t always end in success. She seemed to think I don’t have anything to worry about, lots of follicles, everything is coming along as it should. I am past believing that everything will go smoothly from this point, but it did give me some relief. I am still a bit nervous to hear my progesterone level on Monday, but I have a bit more faith that all will be well. I thought I had my head wrapped around this process but it is such a steep learning curve, one that I hope I don’t have to repeat.

Looking at how this cycle started I’m not entirely surprised at where it has ended up. My estrogen was high because of the birth control, I started stimming late because of the high estrogen. I’m assuming big righty started developing naturally since I didn’t start stims until CD6 instead of CD3. My first monitoring ultra sound and blood work wasn’t until CD10, so of course I was close to an LH surge with an already large follicle and no ovulation supression meds yet. Looking back I can see it, and it makes sense but I can never predict what’s around the next corner and I hate it. All of this has turned me into even more of a head case than I already am.

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Do Not Go Gentle into that Good Night

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I had my first monitoring appointment today, exactly a week after my cycle almost fell apart. Monitoring is normally more frequent by now but because of the confusion with the birth control and my estrogen level, my schedule got bumped by 3 days. To be honest, this is sort of ok with me, as it would put my retrieval over the August long weekend, so I don’t have to miss work, and I have more time to recover (if needed).

I was really nervous going into todays appointment, just because of the almost cancellation of the cycle, and then starting my meds 3 days later. Nothing really got off onto the right foot. I was scared that the cycle might possibly get cancelled because of the problems and delays. Yet again, I had a very early morning, and I wasn’t even first in line this time. Luckily I had to work late tonight so I was able to go into work around noon, well after my appointment finished and I had time to go to the pharmacy, and then home for a bit. I had J come with me because there was a bunch of consent forms that needed to be witnessed, so it was just easier to get the nurses to do it and keep our privacy.

I hate getting there early because then I just have to sit and wait, and stew in my nervousness. It was almost better that J was there, I at least had him to chat with. We went back fairly quickly, even though I was third instead of first this time. I had to wait a bit for my ultrasound as my doctor tends to get backed up on Thursdays as he has “learners” with him in the morning. I could hear him in the next ultrasound room once he finally got going, and he whips in and out of those ultrasounds pretty quick.

I do love my doctor though, he has very good bedside manner, and even though he is in a rush he takes time to be chatty and he loves to joke around about giving me stretch marks. He’s always very lighthearted and I know he tries to make his patients feel comfortable, which I appreciate. He checked my lining and said it looked very good, at 7mm. Then he started listing the follicle sizes out to the nurse to be recorded. The first one on the right side was 18mm! I was surprised there was one that was that big already, but not entirely shocked as I’ve been having some pretty strong, uncomfortable pressure on that side. He counted off the rest of them, on the right I think there were another 4 or 5 that were in the 11mm – 13mm range. The left side only had about 4 I think, again around the same size. I was sort of disappointed that there weren’t more of them, and I expressed this to Dr. M. He told me not to worry, that there would be more soon. He said he doesn’t like the look of the 18mm, it’s too big already so that one might be a bust.

So after that I was feeling pretty good, relieved that everything was on track (besides the 18mm keener). I was told to start my orgalutran (ovulation inhibitor) tonight, and to come back on Saturday for my next monitoring. The nurse who told me to start orgalutran, said come back in two days and that was it. I double checked with the other nurse as I was leaving if there was anything else I needed to do today. She said no, but she did helpfully inform me that apparently the clinic doesn’t do blood work on Saturdays so I have to go to a different part of the hospital, and then back over to the clinic. And the lab for my blood work doesn’t open until 9am. Normally this would be a nice reprieve from the early mornings, but I am supposed to be at work for 9am on Saturday…so I am definitely going to miss a few hours. I am not sure how long the waits are on Saturdays and what the protocol at the clinic is, so that’s another fun unknown.

So, slightly stressed about that, and had to tell my boss that I was going to be at another appointment on Saturday, plus I mentioned to her that I may have others in the coming week. She doesn’t ask me why, which I appreciate and think she knows I don’t want to talk about it. Besides protecting my privacy, and not putting any of my career aspirations in jeopardy, I realized I just don’t want anyone knowing about IVF because I don’t want to have other people waiting with bated breath to hear the results.

I had my cell phone on my desk at work today (like most days), I can’t generally answer it, but I can at least see if I get a message, or a missed call and then go attend to it away from my desk. Today, I did not notice the two missed phone calls until a bit before 5 pm. I checked my messages, both from one of the nurses at the clinic, urging me to take my orgalutran at 1pm as per my doctors orders (the first message from 12:40pm) and the second message reiterating for me to take it as soon as possible if I hadn’t already (this message from around 2pm) and my menopur was fine to take at the same time I normally do in the evening. The phone lines are only open until 3:30pm. I took my meds home after my appointment and had to stay late at work, until around 8pm when I normally take my menopur. So cue freak out (internally, as I was still at work). I am thinking Dr. M wanted to make sure that fat fucker, 18, didn’t rupture early and screw everything up. Something with my blood work must have come back high, to have them call me twice, and with such urgency.

There was nothing I could do. As soon as I got home, around 8:45pm, I did the orgalutran shot. The pharmacist said it might sting a bit, or cause some nausea, as well as redness and swelling around the injection site. Oh great, I thought, because the menopur wasn’t enough. Firstly the syringe is pre-filled, which is handy, secondly, the needles are dull as fuck. They are about the same size and diameter of the menopur needle but with menopur it slides into my skin with ease, like a knife through butter. I pushed the orgalutran needle to my belly, and nothing, it barely dented the skin. So going at it the second time I had to give it a bit more force. Thankfully it went in, and the injection did not sting whatsoever. I then iced my belly for a bit to prep for menopur. Now, backing up a bit the pharmacist did tell me to do menopur, and then orgalutran, but because the clinic seemed to adamant about the orgalutran earlier in the day (and therefore first) I reversed the order and did them about 20 minutes apart.

My belly did get red around the orgalutran shot, and when I went to do the menopur shot, I tried doing it on the same side as the orgalutran. I picked a spot a fair distance away from the orgalutran site, and away from the redness. I barely pierced the skin, and immediately pulled it back out. Oh the pain! Apparently orgalutran and menopur do not play nice together. Take two, I did the menopur on the opposite side, with no major issue (besides the normal burning).

I have been cycling paranoid nightmares through my head that I’ve ovulated or will, that it’s too late. I’ll have to wait until Saturday to find out if I’m safe or not. I called the clinic and left them a message telling them the situation, so I’ll hear back tomorrow morning as to what, if anything, I should do, beside continuing on with my meds. It may just be my imagination, but I feel like I am having less pressure on my right side, where the biggin’ is/was. I may just be projecting my delusions onto my ovaries, but so far I have been very in tune with my body and able to feel what’s been happening. So now I have a really bad feeling.

In my naiveté I thought our IVF cycle would go smoothly. Then after our first hiccup, I was nervous. But everything looked good today, I though we were back on track, and I let myself get hopeful again. I didn’t think I had any naiveté left, after everything that infertility has taken from me. Fool me once, shame on you, fool me twice, shame on me. Please hold on little (big) follicle. I need you to hang on.