Big Fat Negative

I spent most of the last week trying to figure out if everything I was feeling was a symptom of pregnancy or PMS. Sore breasts, mild cramps, moodiness--I had it all, I just didn't know what it meant. One minute I was sure I was pregnant, the next I'd be convinced that the IUI hadn't worked. It was maddening.

I was scheduled to get an HCG blood test on Friday, two weeks after the IUI. That meant I would get the news about the test later that day, while I was at work. I was worried that if it was negative, I would be a sobbing mess at work, so I took a pregnancy test Thursday night to prepare myself. I told my husband beforehand that even if the home test was negative, it might not be definitive, since my HCG levels might just not be high enough yet to trigger a positive test. I had read about women having negative or partial positive tests at home, only to find out that their blood test was positive.

So I took the test. And it was negative. I'm not even going to use the cute BFN acronym, I want to spell it out, and shout it out loud: BIG FAT NEGATIVE! There was no faint positive line, it was absolutely negative. All the words I had said before I took the test just washed away, and I knew in my heart that the IUI hadn't worked. As expected, I spent the rest of the night crying, and being mad at my husband for not being as upset as I was. Even though I was more prepared for it this time, I was still really disappointed. Everything had gone according to plan this cycle, and it still failed.

I went for my blood test the next morning, but due to a mix-up at the lab, I didn't get the result until Saturday (making me even more glad that I had taken the home test on Thursday, or I would have been going out of my mind). Unsurprisingly, it was negative.

I talked to my doctor, and expressed my concern that I only had one mature follicle when we triggered. She wasn't concerned about that at all, and pointed out that I had two 13-14 mm follicles that could have also matured after the last ultrasound. She said that we could increase the Follistim dosage to 75 IU for 3 days, and then go down to 50 IU to try to increase the number of mature follicles next time. In general, she was very pleased at how this last cycle progressed (other than the fact that I'm not pregnant). She pointed out that I've probably only ovulated a handful of times in my entire life, so we can't expect everything to work perfectly the first time out.

The progesterone suppositories did their job, and kept my period at bay, so now I'm just waiting for Day 1, so we can start all over again.

In Between Days

IUI day was stressful, but ultimately went well. We had to be at the RE's office at 7:30 AM, prefaced by a 30 minute drive in the rain. My husband did his thing, and we were sent away for a couple of hours. We didn't really have enough time to go home, and didn't really know where to go, so we basically drove around being crabby with each other for 2 hours. I think the combination of lack of sleep, rain, and boredom got the better of us. But we slogged through, and made it back to the doctor at 9:30.

There we got the best news of the day: my husband's sperm count was 85 million. At our first IUI, the count was lower (though I don't remember the exact number), and there was some agglutination, which concerned my RE. Obviously that IUI was not successful, so we were already off to a better start.

My regular RE was in surgery that morning, so another doctor filled in for her. The replacement RE was very nice, and instantly put us both at ease. She had a little trouble getting the speculum at the correct angle (ow!), but once it was in place the IUI went off without a hitch. Once again, they left us alone for 10-15 minutes to relax, and then we went home. The night after the IUI, I started taking 200 mg of natural progesterone, to help build up my uterine lining (we didn't do this after our first IUI, and now I'm wondering why).

My husband tells me he has a good feeling about this one, and has raised his personal odds of success to 42%. I am hopeful, but I'm more cautiously optimistic than I was last time. When I got my period after the first IUI, I was crushed. It had taken us so long to get to that point, I thought that it was finally our time, and all the waiting would be over. I knew the odds of success, but figured that we would buck the odds, and find success on our first try. Now I feel like I'm a little more seasoned, and have seen how quickly things can fall apart just when you thought they were working.

So now we're waiting. It's been just over a week, and I've spent a lot of time overanalyzing every twinge my body makes, wondering if it's a symptom of pregnancy. If I don't get a period, I will take a blood test on Friday to test my HCG levels. Last time, I started my period the day before I was to take the blood test, so I'm sure Thursday will be an anxious day (though I just had a thought--regardless of whether or not I'm pregnant, I probably won't get a period since I'm taking progesterone). This two week wait is such a strange time--you've spent the weeks before in a big rush, doing all the injections, getting multiple ultrasounds, and (hopefully) making it to the IUI. Then it all stops abruptly, and all there is to do is wait.

Two

Just for kicks, I took an OPK test this morning, since I triggered with my Ovidrel shot last night. Hey, look at that--two lines! I've done so many of these, and this is only the second positive I've ever had. Woo hoo! Tomorrow we head to the RE's office at the crack of dawn for IUI #2.

OMG! HCG!

After four days of Follistim injections, I had my follicles checked yesterday. There were 22 follicles, though most were less than 10 mm. There were two follicles on my right ovary that measured 13 mm and 14 mm, and my left ovary had one 17 mm follicle. After checking my estrogen levels, I was instructed to increase my Follistim dosage to 75 IU, and return for another ultrasound today.

This morning, the 17 mm follicle had grown to 18 mm, but there wasn't much change in the others. It was unclear whether they would trigger me today or have me continue the Follistim for one more day. By the afternoon, my estrogen test had returned, and I was told to go ahead with the HCG trigger tonight.

This is further than we got in the last cycle, so I'm pretty excited. The pessimist in me is bothered by the fact that I only have one mature follicle. I've heard of women having success with IUI with only one follicle, so I know it's possible, but it's hard not to think that the odds are not in our favor.

I was finally able to use the Ovidrel shot that I bought last month for our failed cycle, and the injection went smoothly. We're scheduled to do the IUI on Friday morning, 36 hours after the HCG trigger. Here we go!

Expect the worst while hoping for the best

I'm headed back to my RE tomorrow morning to see if my follicles are growing. My feelings are pretty well summed up by the following passage from Alice Domar's "Conquering Infertility":

As a woman being treated for infertility, you somehow have to “expect the worst while hoping for the best.” And that can be incredibly difficult. When you undergo infertility treatment, you have to psyche yourself up so much to endure the medications, to live with the side effects of hormone treatment, to bear the constant blood tests and ultrasounds and injections. You have to get excited about it, because that’s the only way you can push yourself to slog through the process. The problem is, when you psyche yourself up like that, when you put so much time and energy into doing a high-tech cycle, you also set yourself up for a huge crash if it fails.

Follistim Cycle 2: Electric Boogaloo

After my last Follistim cycle failed, my doctor prescribed me Prometrium to induce my period so we could start all over again. She specifically gave me Prometrium in case I had ovulated on my own (ha!) and might be pregnant (double ha!). Prometrium is a natural progesterone, so it wouldn't block the action of any progesterone I might be making if I had ovulated (again--ha!).

I took the Prometrium twice a day for 10 days. I've been lucky enough to not have had side effects with most of the medication I've been taking; but Prometrium knocks me on my ass. About 30 minutes after I take a pill, I start to feel like I'm drunk, and it lasts for 1-2 hours.

I also had some heavy spotting when I first started taking the Prometrium this time. I reasoned that this was due to the drop in my estrogen levels after I stopped taking the Follistim. It stopped after a few days, and I finished out the Prometrium, expecting to get a full period about 3 days later. I had a couple of days of light spotting, but no period.

Just to ward off the inevitable question from my RE, I took a pregnancy test. Unsurprisingly, it was negative. Still, my doctor requested that I get a blood test to check my HSG and progesterone levels. They checked out fine, and so I went in yesterday for an ultrasound to check my uterine lining, and see if I had developed any ovarian cysts.

I got the all clear signal yesterday afternoon, so I started my second Follistim cycle last night. This time around, we're going with 50 IU, and I'll get another ultrasound after 4 days of dosing to check on my follicles. I'm recycling the drugs from my last cycle, since I had a nearly full vial of Follistim, and didn't touch my Ovidrel or progesterone tablets.

I'm excited that we're finally able to try again. I am hopeful that this cycle will go better, but the sting from the last failure is fresh in my mind, so I'm more cautiously hopeful this time. Keep your fingers crossed for us.

Can't shake this feeling

I left the house early this morning, and arrived at my local phlebotomy lab a little after 7:30. My RE's office had faxed in an order for my blood work yesterday. I signed in at the lab, and waited for my turn. Mornings are typically busy there with the waiting area filled with people that have been fasting for their glucose tests, and are therefore pretty cranky. I was cranky, but not because I had been fasting.

After waiting for about 30 minutes, the woman behind the front desk called my name. I told her that my order had been faxed in, and she searched for it in the pile of papers on the fax machine. "It's not here, they must not have faxed it over." Sigh. This isn't the first time this has happened. My RE's office was just opening, so it took me a few minutes to get someone on the phone. I eventually talked to my nurse, and she re-faxed the order in to the lab. I finally got my blood drawn nearly an hour after I'd arrived, and I was off to work.

A co-worker of mine had a baby a couple of weeks ago, and she & her husband brought the baby in today. I am genuinely happy for them, as she is one of the sweetest people I know, and they're going to be great parents. It was a slow day, so I got to spend about an hour talking with them and holding their son. Several other women in the office did the same, and soon a crowd gathered around, including two other women who are also married with no children.

As we oohed and aahed over the baby, a few people sat off to the side talking. At one point, I realized they were all pointing at us, and having a conversation about which one of us would be the next to get pregnant. Later on, a couple of people gave me the "So are you next?" line of inquisition.

I get really anxious when situations like this arise. I haven't told a lot of people at work about our struggles with infertility. I'm a pretty private person, and don't really want everyone knowing my business. I've been pretty discreet about my doctor's visits, usually scheduling them early enough that I can go before work. I've had to take a couple of days off on short notice (one for my IUI, one for my HSG), but my boss is very cool, and didn't question it.

I just don't know how to respond to questions about when we're going to have kids. Today, I just sort of ignored it, and didn't respond at all. I was afraid I might snap at someone, and didn't want to say something I'd regret later.

Today was just one of those days where infertility was constantly on my mind. I was anxious about the bloodwork since the results will affect how we proceed with our next cycle, and I felt awkward being the subject of office pregnancy speculation. When I'm engrossed in my work, I can at least forget about our situation for a little while, but I couldn't seem to do it today.

Follystim

My first experience with injectable fertility drugs was nothing like I had imagined. I think I was expecting the bad TV movie version, with the old-school syringes, 2 inch long needles, and crazy mood swings.

My RE prescribed 75 IU of Follistim, to be injected on days 3-7 of my cycle. Whereas Clomid indirectly promotes follicle stimulating hormone (FSH) production by inhibiting estrogen, Follistim is straight recombinant FSH (so it’s not extracted from the urine of postmenopausal women like some of the more old-school FSH drugs). When I started taking it, I went online to try to find other women’s experience with Follistim, and I wasn’t able to find much. It seems many more women are given Gonal-F, a similar drug. They are both recombinant FSH, and I’m not sure why one is prescribed more than the other.

Follistim comes with this nifty pen that you use to dial up your dose for the injection. I had a 5 minute training session with my nurse to learn how to do use it. It’s pretty easy, and the cool design definitely made me feel less anxious about injecting myself with massive amounts of hormones. The injection itself is pretty simple:

· Pick a spot on your abdomen, and swab it with an alcohol wipe
· Dial up the Follistim pen and insert the needle, making sure a small drop of the drug appears at the end of the needle (this part was a little tricky—more on that later)
· Pinch your belly at the chosen injection site, insert the needle, inject, wait 5 seconds
· Remove the needle, and dispose of it in the cute little Sharps container that came with the drugs.

The first injection went off without a hitch. The second time, I had a major panic, when I couldn’t figure out whether any drug had been injected. I hadn’t seen any liquid at the tip of the needle and it didn’t seem like the level of drug had gone down in the vial. I finally just reloaded the pen, and was able to watch the liquid go down as I injected it. I hadn’t realized that could happen, so I was very careful with each subsequent injection. I switched sides with each injection, but a couple of nights I bled a little bit and developed a bruise at the injection site.

I had heard that the drugs could cause mood swings, but I didn’t really experience that at all. In fact, the lack of side effects initially convinced me that they weren’t working.

I went to the RE for an ultrasound on day 8, and the technician counted 17 follicles, divided pretty evenly between my ovaries. The follicles on the right side were much bigger, and I had two that she measured at 15 mm. I knew that the follicles had to get to 18-20 mm before they would trigger ovulation, but I was encouraged that there was something there. I was a little concerned about the number of follicles, but the technician assured me that wasn’t unusual for someone with PCOS. They instructed me to do another injection that night, but to reduce the dose to 25 IU. This would help along the bigger follicles, while preventing too many of them from progressing.

I returned the next day, excited to see the progress of my follicles. They pretty much looked the same as they had on day 8. They told me to do another injection of 50 IU that night.

When I came back on day 10, it was clear that the follicles weren’t progressing. When the ultrasound machine is out of paper, the technician will hand me a notepad, and have me write down the sizes of the follicles. She had me do it this day, and as she rattled off numbers, I could feel the tears forming in my eyes. I knew then that the cycle was a failure, and we weren’t going to move on to IUI this month.

I talked to my doctor later that day, and she confirmed what I had suspected. I had read that the first injectable cycle is more or less trial and error. It gives your doctor a chance to see how your body is going to respond to the drug, and to determine the optimal dosage.

Knowing that, my heart still broke when I learned that the cycle had failed. I had convinced myself that it was going to work this time. I had wondered how I would explain why I wasn’t having beer at our weekly happy hour at work, or why I didn’t want to go out for sushi. Talking with my family about a potential trip next summer, I wondered if I would be too pregnant to travel. I was angry with myself for getting my hopes up; but without hope, how would you ever have the will to do this month after month?

My RE said we could try again, lowering the initial dose to 50 IU, to try to get fewer follicles so we won’t have to lower the dose mid-cycle. She mentioned again that we could go straight to IVF, but backed off when she saw how upset I was. So we’re going to try the Follistim again, hopefully making it through to the IUI.