How many follicles is too many?

I met with my RE today to go over our next move. I was wary of this conversation, since the fact she wanted to meet with me at all suggested she was hesitant about the course we've been taking, but I wanted to hear her out.

First, she mentioned her concern that I'm really sensitive to the Follistim--giving me 75 IU gives a big response, and dropping just to 50 IU really slows down the progress of the follicles (and subsequently my estrogen levels).

Next she brought up the increased risk of multiples, and how I might be particularly prone to this, since I had so many follicles last cycle. My RE seems very concerned that with that many follicles, I could conceive triplets or quadruplets, and then face the dilemma over whether to do selective reduction. In the last cycle, I had one follicle that was around 18 mm, and three that were 13-14 mm. From what I've read, this really isn't that many. It sounds like it's pretty common to do IUI with 3-4 mature follicles, to increase the chances of success. Am I wrong about that? Is she just being really conservative?

She once again brought up the option of going straight to IVF. I explained my reasons why I'm not ready to try that yet: that I don't have any IVF coverage, so we would pay for all of it out of pocket, and that I'm not ready to play my last cards yet. She seemed to understand that, and gave me the go-ahead to start another Follistim cycle tonight. We agreed that we would try as many as six Follistim/IUI cycles before moving on to IVF.

We're going to do the same dosage that we did for the last cycle: 75 IU for three days, then dropping to 50 IU. I'll go in for an ultrasound and bloodwork on Friday morning, after four days of dosing.

Not so much

The 2-week wait was pretty uneventful this time. I tried not to think about it too much, and was pleasantly distracted by work, my birthday, and the release of Rock Band.

The morning of Thanksgiving I started to feel like I was going to get my period. I've never been one of those women who knew their bodies so well that they could just sense when their period was coming. Since I never had regular cycles, it took me a long time to recognize what those feelings were. But there they were on Thursday morning, letting me know that this cycle hadn't worked, a full day before my HCG test.

I went for the test anyway on Friday, even though it meant I had to drive 30 miles out of my way (since my local lab service was closed for the holiday), and had to pay $50 to get my blood drawn. Unsurprisingly, the test was negative.

I'm just sad. I really thought that once we could get me to ovulate that everything would come together and we could get pregnant. I know it's not that simple, but in my scientist's mind, that's how it should work. Now there's no simple answer for why it's not working, and my mind can't make sense of that.

My doctor wants to meet with me next week to go over our plan. I have a feeling she wants us to move into IVF, but I don't know that I'm ready to go there yet. We've only done 3 cycles and 2 IUIs with the injectable drugs, and I'm not ready to give up yet. I'm just so afraid of doing IVF and having it fail. I'm not ready to face the end of the road yet.

Third time's a charm?

Today was IUI day. This is our 3rd time around, so we've gotten used to the protocol.

One thing my RE did differently this time was that she did an ultrasound to check my follicles before she went ahead with the IUI. She had remembered that I was worried we didn't have enough follicles last time, and wanted to see how many were developing today. I really appreciated that she did this. I hadn't seen them since Wednesday, and it was nice to know that they had continued to grow.

I also showed her the red area that had developed around where I did my Novarel shot. She said that since it's purified HCG (rather than recombinant HCG, like Ovidrel) that sometimes there's a little inflammation around the site of injection. I was glad to hear that wasn't unusual.

My husband's super sperm performed well again today--there were 50 million per mL, so we were cleared to go ahead with the IUI.

It's strange that all of this is starting to feel normal. That the things you never imagined you'd have to do suddenly become routine. The first two IUIs were so stressful, and the highs and lows of those cycles were so extreme. I'm definitely more calm about it all this time.

And now we wait.

Sweet apology

My nurse called me this morning and said that she had indeed set aside the Ovidrel, nurse #2 just didn't see it for some reason. She felt REALLY bad for the mixup and apologized profusely. Did I mention that she's great?

Pull the trigger

Before I get into today's saga, let me say a little bit about my nurse that coordinates all my IF treatment. At first, she rubbed me the wrong way, but now I'm grateful to have her on my team. Since I don't have insurance coverage for "procreative management", she has been kind enough to set aside samples they get from the drug reps, so I get some of my drugs for free. I was absolutely stunned the first time she did this--not sure why, I've certainly gotten free samples at the doctor before (oddly enough, for birth control pills). I guess it's just that I know how much these drugs cost, and to get them on the house is really a gift.

When I talked to my nurse yesterday, she mentioned that she would be out of the office today, but would set aside an Ovidrel sample for me. Assuming I would trigger tonight, I could pick up the Ovidrel when I went in for my ultrasound this morning.

After yesterday's good news, I was in a good mood this morning. The day got even better when I saw that my follicles were growing, and the biggest was at 18.5 mm, which meant I could trigger tonight.

When I got to work, I went to put my lunch bag in the refrigerator, and I suddenly realized that I forgot to pick up the Ovidrel (you see, I would have put it in my lunch bag to keep it cold). At that point I swore out loud, and went off to call my RE's office.

The nurse I talked to (not my nurse, mind you) had absolutely no idea what I was talking about, and couldn't find any Ovidrel in the office at all. This is when I really started to panic. I couldn't believe that this cycle would be progressing so well, and it could all be canceled if we couldn't find this Ovidrel. Several minutes into our increasingly aggravating conversation, she realizes that they do have some Novarel on hand, and that I could substitute that for the Ovidrel. She agreed to make up the formulation for me, and I could come back to the office and pick it up.

Normally, it wouldn't be a big deal to have to go back to the doctor, but my RE's office is nowhere near my work or home. It's in the complete opposite direction, and you always have to fight horrible traffic to get there. It can easily take me an hour to get there in morning traffic, whereas it would take me 15-20 minutes if there were no traffic. Having to make one trip a day is bad enough, but today I had to make two. Ugh.

So I headed back to the doctor, picked up my Novarel, and headed back to work. The Novarel is a little more intimidating--it's not a preloaded syringe like Ovidrel, so I was a little more nervous about doing the trigger this time. But I figured it out, and I'm triggered and ready to go for IUI#3 on Friday.

Follicle City

I went in for my follicle check this morning, and the news is good. I have one on my left ovary that is 17 mm, and three others on the right that are 13-14 mm. Of course there are lots of little follicles too, but it's the big guys (girls?) that matter.

I'll do another 50 IU of Follistim tonight, to keep them growing. They are guessing that I will trigger tomorrow and IUI on Friday. Fingers crossed!

Here We Go Again

And we're off...Follistim cycle #3 has begun. My doctor listened to my concerns about having only one viable follicle last cycle, and has agreed to up my Follistim dose. We're going with 75 IU for 3 days, then dropping to 50 IU for 2 days before checking in on the follicles.

I feel very gratified that she was willing to listen, and make a change, even though she thought the last cycle went well. Before starting all of this, I didn't realize how much of IF treatment is just trial and error. It's like my own private biology experiment, and every month we take what we learned and create a new plan. I'm feeling good about this new plan, and am excited to see the results.