This Strange Cycle Continues...

Yesterday morning, I had my one-week-post IUI ultrasound and found some strange results. They were again unable to visualize my left ovary, so I have no idea what is going on with the two smaller follicles over there, but the right had some fun twists and turns in store.

Originally, I had three follicles in the right ovary, one smaller one and two large ones that qualified last week as large enough to trigger. Yesterday, however, the ultrasound showed that one of the big ones is still in the right ovary, despite triggering over a week ago. It is now measuring at 29mm. The smaller follicle is also still in there. WTF?

This whole cycle has been terrifying because I have known that this will most likely be the end of affordable treatment options and that C and I will soon have to make some really tough choices about what to do next. Part of me is finding comfort in how wacky this cycle has been, though. Up to this point, every cycle has been almost identical, down to the number and size of follicles and cycle days. Obviously, a CD14 trigger with 1-2 follicles has been unsuccessful, so I can't help but wonder if it will all be different with five slow-burning follicles that don't seem to respond to trigger.

Still terrifying, however, is that it is more than likely that more than half of my follicles (two for sure) missed the IUI. If these late-bloomer follicles are to be fertilized, it will have to be the old fashioned way.  Adding to the heap of anxiety is that C isn't feeling well and is not exactly up to repeated TI all week just to alleviate my anxiety. 

I got the phone call today from the research coordinator that my beta draw has been scheduled for Sunday, March 4 and that I will also be having my exit interview from the study that day. 

~ ~ ~

For some reason, I am rationally and intellectually stressed about all of this, but my emotions have been pretty calm.  We are literally days away from my co-teacher delivering her second child and leaving me with a very green longterm sub.  I also had a friend from work come through the school last week with her six-week-old twin girls and I held one of them for nearly a half-hour.  I know that as soon as my co-teacher's departure really sinks in, I will be more emotionally affected by it, but again, I am fighting my optimism fueled by this crazy cycle.  Or maybe I am just too afraid to face what comes next...

Do They Make This in a T-Shirt?

A fellow Bumpie posted this graphic to the board, so I just had to steal it.  You would think that after three years (almost exactly, actually) of TTC, the bad advice and questions would end, but they don't.  It is amazing to me that people will offer support and advice about a medical condition that they do not understand, but the comments are pretty constant.

A lot of people assume that since they were able to get pregnant, they must have some knowledge that I don't have that they must share.  Some of them even had difficulty getting pregnant and even had to wait as much as six months (Shock!  Horror!) to conceive.  It seems pretty apparent to me that getting pregnant, or at least the process anyway, is pretty easy.  Heck, sixteen year-olds are doing it everyday!  When it isn't so easy, it certainly is not due to a lack of knowledge. 

And if I hear about stress one more time, I am going to scream.  While stress may delay conception or make it more difficult, that does not mean that it is the be-all and end-all of infertility.  Women in war-torn countries with virtually no food or shelter are getting pregnant, so obviously the stress component is a little over-emphasized.  I find it difficult to believe that a person living in a well-kept home in suburban Philadelphia with summers off and a low-stress job, particularly someone as cool-headed as me, could have so much continuous stress for three years that a vacation will "do the trick."  For the record, I have been on four vacations with C since 2009, and here I am, still childless. 

Back to my previous branch of ranting, I do not understand why people think that if they were able to get pregnant successfully, even if there were setbacks, that it somehow makes them qualified to give medical or lifestyle advice for me.  Suppose I were to find out that a friend of mine has been diagnosed with Type II diabetes.  This diagnosis is related in many ways to lifestyle choices, much more so than infertility.  I have managed to avoid this problem for my whole life.  Does that make me equipped to give them medical or lifestyle advice?  Absolutely not.  Just because my body is able to avoid a medical condition that their body was not does not in any way give me knowledge that they do not have.  Even though they have not yet identified whatever medical problem is causing my infertility, it is still a diagnosis with apparent symptoms (BFNs) that has sustained itself for three years.  How is this different?

Whatsmore, several of the people making these suggestions are otherwise educated and sensitive people who should really know better. When one of my colleagues with five children made a comment about relaxing, I brushed it off because, frankly, she's older and she's an idiot.  But when my own family are wondering if there is anything I have done wrong, or if a vacation would help us "de-stress," I feel simultaneous hurt and anger. Are you suggesting that I am wasting money and an RE's time because I'm not really infertile?  Are you suggesting that I don't know how to count, read a calendar or have sex correctly?  What exactly are you saying?

And please don't give me advice about things to try.  I have been under the care of an RE for over a year-and-a-half.  I am also intelligent and well-informed and have done my own research about what I can do to improve my situation.  Do you really think that you have some information that I or my doctors don't have? 

In the end, I think a lot of people just don't know what to say, so they fill in the silence with blather.  I have heard from people with certain chronic illnesses that people do the same thing to them.  Infertility is particularly difficult because so many people think they know more than they do because so many people have children.  That's why part of me would like to wear this infographic as a t-shirt so that people know that yes, I have tried things, and it really isn't that simple.  

Well, that's weird...

It's been a while since I checked in and quite a few things have happened during this cycle.  After my early baseline, I got the OK to start taking meds on CD3.  As required by the study, I went back on CD10 for my check-in ultrasound and there were two measurable follicles in the right ovary.  Already, this was looking good to me.  In my long asssssss history of IUIs, there have only been two occasions when I developed two follicles.  Every other time, there had only been one. 

These two follies, however, were not big enough yet, as is usually expected for me, so I had to return on CD12 for another ultrasound.  This time, there were not two, but three measurable follicles in the right ovary.  This is officially the biggest response I have ever had to meds.

They had some RE fellow do the scan and she was unable to find my left ovary.  It is usually hiding and I have to press down on my abdomen, but this was totally different.  They had two doctors in there and the fellow digging around with the probe and it was quite painful.  Imagine sharp, sudden cramping pains combined with the feeling of your internal organs moving around.  It was like that.

After ten minutes of digging around with both the vaginal and abdominal probes, they decided to just write "non-visualized" on the chart and leave it at that.  The left ovary didn't have any measurable follicles, just a handful under 10, so it was no cause for alarm. 

Flash forward to yesterday...  I had to go in for a CD14 ultrasound and there are still three sizable follicles in the right, but lo and behold, there are two more in the left.  Now, this is unusual.  I have five measurable follicles, but the largest was stuck at 15.5mm.  Still not large enough for trigger.

This morning, I went back.  (Thank goodness I was off from work today because I don't think they would have been pleased at me strolling in an hour-and-a-half late three days in one week.)  At this CD15 scan, they saw the same five follicles and thankfully, the big 15.5 jumped up to 18 overnight.  It still, however, is not large enough for trigger.  I am heading back in tomorrow morning for yet another ultrasound and we will most likely trigger tomorrow night for an IUI on Monday.

This is our absolute last IUI and could be our last treatment for a while.  I think part of me must be in denial because I don't feel nearly as sad as I have felt previously during this course of treatment.  As always, I have that inner conflict of wanting so badly to let myself be optimistic and positive countered by the need to protect myself from likely disappointment.  Of course, it isn't helping matters that I am having the wonkiest cycle of my life with five freakin' follicles just feeding into the hope and positivity side. 

I know that I post often about our likelihood of pursuing IVF, but it is becoming all the more real lately.  In a few weeks, I will be counseled out of this study, possibly pregnant, but more than likely as a failed trial.  That really doesn't seem to be sinking in yet.  Please, please, please let this be it.  I honestly don't know what comes after this if it fails and I don't know if I can bear everyone around me having children while we remain childless and broke.

Did I Catch a Niner in There?

Did I catch a niner in there?

Yup.  This is IUI #9, the absolute dead last try at the turkey baster method.

It was actually really weird to realize that it was all starting again today.  Normally, you could set a calendar by my cycles and for the past six months or so, I have started a new cycle on a Friday, but typically see the first signs on Thursday night.  Not so this time.  CD1 is still a Friday, but it was a rather sudden revelation this morning. 

Earlier in January, there was quite a situation when they tried to get blood on CD3 and I ended up having to come back on CD4.  At that point, my estradiol had already elevated just a few points past the cut-off for the cycle, so we had to cancel.  This time, the study coordinator wants me to come in on CD2 for the blooddraw and baseline.  This morning, I made the call for the appointment, then promptly forgot about the whole thing.  My break cycles are always weirdly forgetful like that. 

I had to remind myself several times today not to make plans for tomorrow morning because I will most likely be in a crowded waiting room until 11am.  I only took a month off and it was already weird to be cycling again. 

Because this IUI will almost certainly fail, I have been making some calls for IVF options and the picture does not look good.  We seem to never be able to get ahead in our finances no matter how hard we are working and no matter how much we bring home.  It seems to always be either feast or famine in this house, and there has been a lot of famine lately for one reason or another. 

I have contacted several local clinics and each was more expensive than the last.  One very enthusiastic rep from Main Line Fertility made it sound so easy, and yet what she was saying was completely crushing.  First, she told me that I was too fat for all of their study and assisted programs and that C and I make significantly too much money to apply for any kind of discounted rate.  It sure as hell doesn't feel like we make too much money for anything.  Then she kept saying about how I could just take a year off to lose weight, then call back.  Or I could talk to the doctors because they can usually "make it happen."  None of this was helpful, and it was actually quite hurtful.  I don't care how young I am...  Why would you ever tell an infertile woman to "wait a year?"

Clinics in King of Prussia and Bethlehem were even more expensive.  Right now it seems like Cooper Institute in NJ is the only program that is even in the ballpark, and that is a stretch.

I should say that, at the very least, my family understands that waiting is a serious problem.  Maybe it sounds selfish, but my very close cousin and her husband are throwing around the idea of TTC and I think many in my family have realized how much it would hurt me if they were successful before us.  I would even take being PG at the same time, or a few months later, but to watch them go through the whole process while we are hopeless would be crushing.  I think they also realize that my age is an asset, not a reason to keep waiting around.  Even though my family is not in much better shape than we are, my mom has insisted upon giving us some money for IVF. 

She has already written a check for what she feels she can afford and she gave it to us at Christmas with a note that just said, "To use whenever."  Obviously, I had my reservations about accepting something so generous, especially when I think that the first round might not work.  The money would just barely cover one round of treatment at MLF or SIRM, but at Cooper, we might really be able to do more. 

At Cooper, they offer a minimal stimulation IVF that is significantly cheaper and could buy us more chances.  Even their traditional IVF is thousands less than at the other clinics.  This may be our only option.  I would be devastated if I spent all that money on one round and it failed.  We would be out of chances and out of money.  If we got two cycles, or even a fresh cycle and a FET, I would at least feel like we gave it an honest chance. 

This is so hard, just thinking about these massive gambles I am making with my life, C's life and other people's money.  As stagnant and crappy as it was to be on a break, at least it was peaceful...