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CCRM days 3 & 4 (CD 8 & 9)

I can’t quite say how I expected things to turn out here at CCRM but so far it’s been a pretty action-packed few days. Today was my 9th day of stimming and I’m tiring of things. I haven’t been sleeping well (at all!) and however much I try I’m unable to nap through the day. That couple with the constant poking (stims + bloodwork) and prodding (ultrasounds) has left me pretty darn tired. Strangely though, this hasn’t resulted in my shifting into instant bitch-mode; instead I remain fairly calm about things. Even hopeful!

So without further ado, here are the numbers from the past two days:

Day 8

LO: 18.5, 13, 12.2, 9, 7, 6.6, 5

RO: 16.7, 14.6, 12.2, 6.2, 6

E2: 1369

Day 9

LO: 18.2, 14, 14, 11, 10, 9

RO: 18.5, 14.3, 12.2, 9.3, 6, 6

E2: 1928

So, it seems that things are moving along very slowly indeed. The good thing is that the bigger follies are all a similar size but then a couple of them seem to have actually shrunk a teeny bit which, of course, worries me greatly. The nurses at CCRM, while extremely kind, are all reserved in their opinion of how things are progressing and it being a weekend I could not get Dr S’s opinion on the matter.

All I know is that for now, I’ve been told to continue with my stims for tonight and tomorrow morning and then go back to CCRM at 7 am (!!) for another monitoring appointment. As soon as we get done with the u/s and the bloodwork there, we have to rush to Denver to get another dose of cetrotide from a local pharmacy here ’cause I’m out of it. I asked the nurse today if I would need other stims as well but she said we wouldn’t know till my appointment tomorrow. So we reach the pharmacy, get the cetrotide, finish the injections and then drive back (fast!) to CCRM for my IVF physical appointment. Once we’re done with that we need to check out of this hotel and (they did not have rooms available here starting tomorrow for the next few days) and hang out somewhere till its time to check into the other hotel. Oh and, in between, we have to go back to CCRM yet again so that hubby can do his thing for the backup freeze. Whew! It’s going to be a long, long day.

While I am tiring of the shots, I do want to give all my follies the chance to mature and make beautiful eggs for which I welcome the opportunity to stim extra if needed. I’m praying hard and staying hopeful for what lies ahead.

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Oh, the follies!

We are finally in Denver! It’s been a dramatic couple days and I have a lot of updating to do so there will be a flurry of posts over the next day or two. Bear with me!

Tuesday was a hellish day. It was my first monitoring appointment at my OB’s office and it just did not go the way I wanted it to. K drove me over to the clinic and promised to join me after he got some coffee to jumpstart his day. However, before he got there I was undressed and ready for the scan. The doc came in, liberally pumped lubricant on that vile ultrasound wand and started off. He was looking at my right ovary first and he nodded his head as he measured what I assumed (and hoped!) was a follicle.

How many, I asked nervously. I don’t think he heard me for he remained quiet for what seemed like an eternity. 12, he said, looking at me and smiling. Oh really, 12?? That’s simply wonderful, that’s possibly the best– … I cut the sentence off right here as I realized he did not mean the number of follicles but the size instead. Wait, there’s more there right?, I asked. Not really, he replied. There’s got to be some small ones you can’t measure right now, I insisted. He shook his head grimly saying that there was just the one and moved the wand over to point at the left ovary.

My stomach did that uncomfortable sinking thing it does whenever disappointment hits me. It’s a mixture of despair and deep, paralyzing fear I think that makes me head swim and makes me want to run, flee to the comfort of my bed so I can safely hide within the covers and keep all the demons at bay.

This is much better, he said as he scanned leftie. Better, to him, was 4 follies sized at 16, 14, 11 and 10 mm. This made me feel even worse for I knew that the 16mm one seemed too big for this early into the stimming process and I instantly started worrying that I would ovulate before time and my cycle would get canceled. The rest of the scan was a blur as I tried hard to control my lurching stomach and my woozy head. Doc looked back at me as he walked out urging me to have faith and to remember that it only takes one (if only I had a penny for every time someone says that to me!). I could barely look at him for I knew another sympathetic word would have me sobbing my heart out. I hurriedly scrambled into my clothes and walked out the clinic downstairs to get my blood drawn at the lab.

The lab assistant seemed to be having a good week as I found her once again in a rather cheerful mood. She whisked me in and had me out in under two minutes, promising me that she would send the bloods out soonest. I walked out to find K sitting in the lobby waiting for me. One look at my wan face and he knew something was wrong. I told him about my 5 follies, about my worry that I was responding too fast and yet, not enough and then I told him I did not want to talk about it at all. I felt sick to my heart, I wanted to crawl into a black hole and never come out, I wanted K to hold me and tuck me away in some corner of his shirt pocket. I was angry, I was sad, I was frustrated but most of all I was scared. Petrified, really.

The drive back home was a somber affair. I walked inside, ignoring my parents questioning looks. Shook my feet free of their shoe-d confines, drew the drapes tightly shut and crawled into my bed, covering my face with the blanket. I knew everyone was worried. I wanted to tell them I was okay even though I was far from okay. I did not know how to do it. Again and again my mind insisted, how could there be just 5 follies. From an AFC of 13, I get only 5 stinking follies? Even my first IVF I had 9 follies.

What made everything worse was that it was a special day for us–an Indian festival that celebrates marriage and married life. I really like celebrating this day with all its attendant rituals, especially dressing up in traditional clothes. Yet, here I was in my sweatpants and a ratty old sweatshirt, feeling numb and ignoring my rumbling stomach. K called many times to try soothe my fears but with each passing minute I grew more and more anguished. I cried for hours on end, my poor parents trying their best to get me to calm down. At one point I was so exhausted from all the crying and not eating that I dozed off. I woke up to realize it was late afternoon. CCRM still hadn’t called which meant they did not have the results with them yet.

The next couple hours were crazy stressful. CCRM was about to shut for the day and the nurse had called me to let me know she had neither the u/s report nor the labs. I called the doc’s office and had them re-fax the report. The labs seemed to take an eternity but a call to quest revealed they had been faxed early afternoon. I was at the edge of my patience. I was worried that I might ovulate too soon and wanted to start the cetrotide sooner but of course needed the nurse to confirm that with me. Furthermore, I wanted to know if the cycle was at risk of being canceled. Finally at 4.58 pm mountain time, my nurse called and told me they had everything but that Dr S had left so she would have Dr. Schoolcraft look over my reports and advise me on next steps. I waited by the phone and in about 20 minutes she called back to let me know that I had to start the cetrotide the next morning, keep all other doses the same and travel to Denver as planned. To my concern that things were looking bleak, she said it did seem that I was responding fast but then my follicles were of similar size and my estrogen level (at 209) was where they like to see it at this time.

It wasn’t quite the thumping vote of assurance but then, under the circumstances, this was the best that could have happened. At least there was no mention of canceling cycles. Moreover, she told me they preferred doing their own measurements and bloodwork as they did not trust results from other labs. With that in mind, I finally ate and tried to salvage what was left of the day. My adorable husband had already given me a wonderful gift–a beautiful down jacket to keep me warm in Denver–and he now helped me pack and get things in order for out trip the next day.

As I wrestled a nagging headache in bed at night, I prayed hard to God to carry me over this one.

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The suppression check

I had my suppression check yesterday. I think it went well. Thankfully, there were no dominant follicles and no cysts, either of which could have resulted in the cycle being canceled. However, I had very few follicles that showed up in the scan. Just 5 to be precise. 3 on the left side and 2 on the right. The doctor said there were a few small ones he could see on the right ovary but I couldn’t help feeling bummed. I have an AFC of 13 and it’s stayed that way through the past year. Our last IVF I had 9 follicles which had been upsetting enough. How could the number go down by so much? The doc told me not to worry about this; he said this was not an AFC per se and that CCRM also at this stage was not concerned about the no. of follicles (they hadn’t even checked the ‘follicles no.’ box on the lab order they sent). The more important thing was that there were no dominant follies and that things essentially looked good to go. I reasoned with myself that the priming also might have contributed to the low follie count in some way.

I decided to take that info positively and walked down to the Quest lab to get my blood drawn for hormone levels. The lady at the front desk can be pretty moody at times and it was sheer luck that I found her in a great mood. She drew the blood efficiently and sent me packing with the promise that she would courier it out soonest so results could be faxed stat to CCRM.

The rest of the day was a nervous mess as I kept fielding calls from CCRM asking me why my blood-work had not reached them yet. At one point things got pretty stressful as they were about to shut down for the day and Quest had told me that it might take them another couple hours to fax the results out! Thankfully, just 3 minutes before closing I got a call from my nurse and she said they have the report, all looks okay and I am good to go with the stims. In the meantime, I had ample opportunity to get my anxiety levels shooting through the roof as I relentlessly scoured the internet looking for some reassurance that my poor follie count was not an absolute cop-out and there were examples of women having similar numbers yet being successful. All the suppression check posts I found, though, were of women with a thumping 10-20 follies, despite the priming. Thankfully, I had to step out of the house for my acupuncture session which finally put an end to my cyber-stressing! We ended up having a nice evening with my parents and my brothers family joining us for dinner at a restaurant.

I took my first shot of menopur 150IU today in the morning. I know from experience than menopur burns a lot but perhaps because I was expecting it to, it wasn’t all that bad. It’s finally hit me that the cycle is underway and that we are leaving for Denver in 3 days. Hopefully, there will be enough to occupy my mind so that I won’t be going nuts agonizing over each ultrasound and blood-work result. I plan to take my school work with me, go out a lot while we’re there and treat it like a mini-break of sorts. Tomorrow, we are headed to the NorthFace outlet to get some warm gear for our trip.

Keeping fingers crossed!

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Here we go!

Today is day 1 of our treatment cycle at CCRM. Today, K and I started our ten day course of twice-a-day Doxycycline. I got my period late last night and now have to wait for my LH surge to show up. Ten days after I get a positive OPK I start taking Estrace twice a day and from there on the ball starts rolling. My tentative date to start stimming is the 20th (although I think it will probably be the 18th, given my expected date of surge) and I have an estimated retrieval date of Oct 31st! Which means that we expect to fly out to CO sometime around the 22nd-24th of this month.

There’s many things different about this cycle -the estrogen priming, the cetrotide (I used ganirilex last time), the saizen and the dexamethasone. Also the stims are lower to begin with which is something I’m happy about. I am following a strict policy of singular faith in my doctor and no crazy, anxiety-inducing Dr Google searches! If I start thinking of just how many variables are at play here or how long the entire process is likely to be, I know I’ll just implode. So, one day at a time it’s going to be. Right now my focus is to make the most of each day with good food, moderate exercise, meditative visualization exercises and a special treat to just indulge in :).

It’s been a lazy Saturday so far. I woke up to the incessant chatter of rain and a palette of multi-hued green, always a beautiful sight! I’ve not had much by the way of PMS or aches/ pains but I’m taking it easy and generally staying away from household chores etc. Instead, I plan to make best friends with the couch & my favorite throw and get a little caught up on my dissertation related work (which I am lagging SO far behind on!). Hubby’s been an angel, getting me choice delights to tempt my recalcitrant tastebuds with… bless him!

In a way it’s all so fragile. I feel us beginning to hope again – the painfully tender, green & eager stalks of hope trembling their way into the world amidst a sea of concretized disappointment. I want to cover them up with my hands, cradle them, coo and soothe them to suppleness. I want them to ignore their loneliness and their habitat and forge forth towards the sun.

I realize that this could be the beginning of the most beautiful, the most coveted phase of my life or another stepping stone in what has already been a pretty enervative journey! Either way, my goal is to try stay in the moment and stay somewhat neutral especially since disappointment still hovers around in dark shadows and hope, teasingly, skips in and out of view. What matters right now is that I have this wonderful, blessed opportunity and I’m going to relish every bit of it. I’m going to dip into my faith and wrap it around me snug and tight.

Wish me luck!!

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Seductive dalliances with the perennial what-ifs… plus, a calendar!

Last week was emotionally draining. After the consult with Dr S, the realization that we’re about to cycle again hit me and it was all I could do not to get overwhelmed. Distraction intervened in the form of a trip to LA to meet with the dissertation committee. I flew out early morning and got back in around 10. Perhaps it was the physical exhaustion (flight was delayed on the way back), perhaps it the sudden influx of pregnancies in my department or perhaps it was the reinvigorated tussle between dissertation related inertia and enthusiasm -I came back home feeling subdued unlike my characteristic chattery self.

Also weighing on my mind was the big, white elephant in my inbox -CCRM had finally sent the calendar (it looks like the study schedule for a ridiculously competitive exam!) and I have been largely ignoring it, watching it burn a slow hole on my laptop screen. Going with an altered protocol this time means there’s a lot of stuff I’ll be doing which was missing in my previous IVF attempt–adding in estrace, cetrotide, dexamethasone, saizen etc. I swear each time I look at the calendar I can feel my blood pressure escalating at the thought of what lies ahead. I know I should be excited but I’m mostly apprehensive.

Friday, however, brightened my spirits. I went for an early acupuncture session and as always Y managed to relax my frayed nerves. I drove back home feeling significantly better. The rest of the day was a busy blur as I worked on my stuff and K micro managed a Dish TV installation (goodybye pricey Comcast!). I was aghast to walk in on him and the installation guy happily routing a thick, black wire right in the middle of my beautiful living room, smugly announcing that by making sure half of it was submerged under the rug, aesthetics were all taken care of! Men! Friday evening was spent on the couch, watching movies (free HBO for three months!) and guzzling herbal tea.

Saturday, I got to know that my brother (who recently moved to the US and lucky for me, found a place just down the street!) was moving back to the other side of the planet with his family. I am happy for him; this is something he’s wanted for a long time. But it’s hit me hard. Having them here was just so wonderful. They came at a time when we were at our most vulnerable and it felt good having someone to talk to when our first cycle failed. Sis-in-law and I often went out for errands and shopping trips and my nephew is such a delight to be with. It’s going to be tough seeing them go. For the first time ever, we’ve had family here in the US and, that too, living so close to us. It brings me back to the feeling that were my own family complete today, perhaps I would not feel as rudderless and raw all the time. What makes the situation worse is that I work from home and afternoons are really the loneliest times. As I went for my afternoon walk today I passed by my nephew’s school and felt a jab of sadness that soon he won’t be studying in there anymore.

I’m trying hard to stay even-keeled both for the cycle ahead and for the love of my life, my darling husband who patiently supports me through everything even as his eyes tear up often at seeing me sad. One hug from him and the world doesn’t seem such a threatening place anymore. The what-ifs, though, are always around, hanging out in the dark recesses of my mind, waiting to pounce upon me and smother me with their what-if-ness! Just do, don’t think, I keep repeating in my head like a mantra. It’s hard though. I can feel depression creeping in as the fear of another potential failure paralyses my senses. I find it hard to move on yet I only find solace in movement -in walking, in doing the most basic tasks –cleaning, scrubbing, washing dishes, sorting laundry. Sleep teases me, promising a lingering embrace one moment and the very other, deserting me without warning.

I sit on my bedroom floor typing this post. As I look up skywards, I will the clouds to ebb away and for sunshine to become a part of me.

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Cloudy with a chance of tear-falls!

I woke up today feeling craptastic. The weather outside echoed my sentiments. It was cloudy, dull and uninspiring. I willed myself out of bed and got busy reinstating the house to some semblance of order from its nightly state of slipshod-ery (my darling husband has quite the knack for creating chaos!). I set oatmeal to boil for him, ignoring the rumbling protest in my tummy. I should eat, my mind reasoned, it’s important for me to eat on time everyday. Screw that, said my heart. I felt awful, a naked piece of yearning in a slowly careening-out-of-control world. What if this doesn’t work? What if, after another round of injections and monitoring and medication and travel and sleepless nights and hormone-induced emotional hell, I am still sans baby? Still flat-tummied and still bereft? How will I go on? You have a backup plan, persisted the annoyingly sensible voice in my head. Something’s gotta give, sometime. I stuck a mental tongue out at this piss-pot. How do I blame others for always expecting me to be strong when my own frickin’ mind doesn’t allow me the luxury of self-pity?!!

Depositing the steaming hot oatmeal in front of K (buried about ten thousand feet deep in his cyber world of emails, presentations) I walked over to the bedroom and started folding the laundry with energetic enthusiasm, hoping to drown the voices in my head. As I tidied up the room, my eyes fell on the journal I had started earlier this year. Wanting desperately to believe that my baby could listen to me even if he/she hadn’t taken form yet, I had taken to writing letters to my unborn child. Painfully honest, searing letters from a guilt-ridden parent-to-be who feels personally responsible for taking so long to get her baby in this crazy world. I wrote about my hopes and my disappointments. I wrote about baby’s family and how they were all awaiting her arrival. I wrote about my misgivings and my fears. I started by writing everyday but could not keep that up for long. On days I felt particularly down, I could not write. Perhaps because it made me feel like a cheat. How could I tell my baby that I believed in her existence and yet acknowledge being submerged in despair. I continued writing though, sometimes more frequently than others.

And then the IVF started. I wrote with a purpose now. I felt the time was soon that she would come to me. I told her to hang in there. When we were told that we had made only 3 blastocysts which would be biopsied, I begged her to be one of them. I told her I would make her the happiest human being on earth if only she would trust me and let me be her mother.

It did not happen. One email destroyed our carefully constructed world of hope as all three blasts turned out to be abnormal, a heart-rending revelation made all the more painful with the realization that all three were baby girls. My baby girls. Whom I could not give birth to. Because nature likes to screw with me. I cried so much in those days that I thought my body would stop making tears. I wailed and screamed in sheer pain; I ranted against a heartless God who was seeing all this happen and yet not doing a thing about it. I was told that donor eggs were my only option going forward. I lost a part of my heart that day. And, from that day onwards, I could not write to my baby. I could not face her after what happened. Even though I know I could not have done anything to prevent it from happening.

Seeing that journal today brought back lingering painful memories. Perhaps brought back into focus because we are about to start another IVF cycle. About to place our trust in medicine and in science and in God all over again. As I commence, anew, this effort to make my baby, the one person I long for most is my mother. I want to hug her tight and feel her love for me, calming my festering wounds and soothing my fears. And then, I want to let the tears fall.

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Yellow, not green!

We finally had our much anticipated regroup with Dr S today. It went by pretty quick and was sort of anti-climactical. I mean I obviously knew, basis the test results, what he was likely to say but somewhere our last failure has left me so wary I was prepared for the worst.

He started by discussing our test results and I believe he mentioned the word ‘good’ when describing my ovarian reserve even though my FSH is borderline high (10.3) and my AMH is below what they consider normal for my age at about 1.4-1.5 (mine’s 1.3). APA testing revealed only one slight elevation on the IgM (mine was 13, normal’s <11) so he said I did not need any blood thinners (interestingly this is something he told us on our first phone consult itself without any testing!)… phew! Uterine x-ray showed an AFC of 13 and normal blood flow to ovaries all of which is good. DH’s numbers also look good with his motility at 55% even though morphology is low at 2% (he did remind us that they use very strict criteria so, with 4% being the normal, this wasn’t too shabby). His sperm DNA fragmentation results will still take another week or so to come in.

So, he is sticking with his earlier prognosis and his recommended protocol for me is

****drumroll****

EPP–Estrogen Priming Protocol

He also wants to add in a growth hormone (saizen??) and probably an antagonist to prevent premature ovulation. He thinks we should wait on taking a call whether to do embryo banking or not depending on how the ER goes. Anything above 6 eggs and we should not need to bank, according to him.

We asked him a few questions which he patiently answered. He will be using a double trigger for me (HCG/ Lupron) and closely monitoring estrogen levels even though I am unlikely to hyperstimulate. When I asked him how I can improve egg quality he asked me if I was taking the supplements prescribed by them and I said no, I am taking then of my own accord. He told me to ask my nurse for a list and then hung up with the promise that a nurse would contact us soon to discuss scheduling.

So, from the above, it would seem that this went pretty well, right? Well, perhaps its the exhaustion from last evening’s yoga class but truth is, I don’t feel too spirited somehow. Perhaps because I am still, somewhere in the back of my mind, coming from a DE perspective whereas he was pretty clear right from the get go that I should try again with my own eggs. Perhaps because I was anticipating getting rejected by them basis my AMH (which had been much lower at 0.48) and my FSH (which I had never tested before). Or perhaps because I just don’t trust my luck anymore! I kept asking K whether he thought we’re in and he said of course silly girl, this is it; we will be cycling at CCRM.

Really?

All I could think about was one strange comment Dr S made–something about this being a yellow light, as opposed to a red one. Why not green, my mind asked? I categorically asked him if there was any further testing to be done or any issues to resolve before we could start and he said no, it all looks good. Then why yellow? K reasoned with me saying that he is probably meant that about the whole process, especially since we made no chromosomally normal embryos last time. He’s probably right. Perhaps I am just being silly and over-thinking things (surprise surprise!).

The nurse is yet to call. I hope she gets in touch with us soon. I need to see my calendar to believe this is real!