Insight fail, data, and the next steps

April 29, 2013 § 16 Comments

I like to think that I’m pretty insightful. When I start getting salty with the Artsy Engineer for no apparent reason or weepy at commercials, I’ve usually determined the etiology of the distress in no time. But I’ve been avoiding this space for the last few weeks, and, while I knew I was doing it, I couldn’t really put my finger on why.

And then Vanessa nailed it. And I was like, YES. Now I get it.

There was this barrage of good news among us, and I was riding on that wave. Whoohooo! Everything is good and golden and bubbly rainbows and we’ll all be pregnant in no time and isn’t life grand? And then BAM. Several of my favorite bloggy friends miscarried. And there were failed IVFs. And then I think what happened is that I promptly put my fingers in my ears and started singing “LALALALALALALALA” on the inside, as loudly as you can do something like that silently.

It was fairly easy to ignore all of you. (Not that I didn’t read. I still read. I just didn’t have it in me to participate.) I have a big deadline to meet (a first draft of the literature review portion of my dissertation MUST be in to my advisor in 7 days) and a trip to plan (sort of). But now that it’s been a few weeks, my strong desire to avoidavoidavoid and self-protectprotectprotect has lessened. And now I feel like a shitty friend who couldn’t stand the heat.

I hope it was (but maybe it wasn’t) a coincidence that it happened at the same time as Infertility Awareness Week, which is now over. Nothing like learning that you will not get pregnant via intercourse coupled with a string of bad results amongst you, my friends, to seal the nail in the infertility coffin. I belong here. And now I know. And I’m upset with myself for “missing” awareness week, because I debated for the last month about how I was going to participate. And then I just dropped the ball.

So, while I go ahead and sit with that (I was raised Catholic; guilt is a fairly comfortable feeling for me), I’ll give you a small/uneventful update about my ever empty ute.

It’ll be quick.

Status?

Still empty.

That’s all you really need to know, I suppose. But if you want more, here goes. Letrozole cycle number three resulted in a negative beta this past Wednesday. I knew it would. In fact, I stopped the progesterone a day early by myself. It just wasn’t going to happen.

We’re going to move on to IUI now. But, truth be told, I’m feeling pretty hopeless about it. See, I’m a stats woman. When I was a kid, I was terrified for years that someone was going to break into my house and murder everyone in my family except me. No amount of reassurance ever resulted in alleviation of this fear until it finally occurred to my mother than she was dealing with the child of two scientists, here, and that maybe she ought to throw some data at her. So at 8 years old, after being terrified for 4 years that my family would be murdered while I slept (I was never worried about myself, just everyone else), I finally chilled the fuck out after learning how few people are actually murdered, the likelihood that any member of my family would be one of them, and the percentage of those who are murdered that are either drug-related or killed by family members or people close to them. And then I was cool. Because no one in my family was going to kill anyone else. And no one did any drugs. And that was that. My odds of not becoming a child of murdered parents were good.

All of that is to say that when I am faced with scary or overwhelming things, I now go straight to the primary source. I read peer-reviewed research articles, and I make my own mind up about the conclusions. And as a result, I believe that IUI ain’t gonna do a damn thing for me. Is it possible? Sure. But it isn’t likely. That being said, I feel like I need to do a couple of them before I can justify moving on to something more invasive and more expensive.

I don’t want to bother with 3 cycles of regular old letrozole+trigger+IUIs. It just seems like a waste of time. But we’re not quite ready for IVF (although we’re probably close), and I don’t want to pay out the wazoo for injectables if I’m doing something that is about as likely to result in pregnancy as a blow job. While doing my lit review, I came across some recent research on an extended letrozole protocol. There are several recent studies that suggest that an extended protocol (CD1-10) is more effective than the standard CD3-7 protocol. For example, in one study, the extended regimen resulted in an average of three follicles greater than 18mm versus 1.8 in the short regimen. Pregnancy rates were significantly greater in the long regimen, as well (up to 18% for couples with unexplained infertility), and there was no significant difference between groups in thickness of the endometrial lining. Rate of multiples was about what it is with Clomid, so not too high.

I have no idea if this extended regimen has made the jump over from science to practice yet, but I called the RE’s office on Friday afternoon to ask if she was familiar with it. Trusty Dr. H was out for the weekend already, but the nurse sounded interested. She said that it definitely wasn’t anything Dr. H had ever done at the clinic, but she also didn’t shoot it down. She said she would put a note with several of the references I provided on Dr. H’s desk so she would see it first thing Monday morning. It is now Monday morning, and I have my baseline ultrasound at 10, so maybe I can argue my case there, too. It’s obviously too late to do it this cycle, as today is already CD4. But maybe I’ll have a shot at it for the next round.

Go data!

This bit is totally (well, mostly) unrelated to vajeens

March 6, 2013 § 15 Comments

Things are ticking along swimmingly here.

I’m on my second letrozole cycle, and it’s my last day of pill popping. Other than my ovaries being a achy (which is weird and didn’t happen last cycle), nothing all that exciting is going on with my vagina and its related parts. We decided to hold off on the mid-cycle ultrasound and trigger shot this go around. I don’t think I actually needed it last cycle. My body responded well to the drug. I had pretty follicles and thick lining, and I’m pretty sure I actually ovulated the night of the trigger (and would have done so whether The Artsy Engineer had poked me, live on the interwebs, or not).

I haven’t really been thinking much about cycling and babies over the last few days. I tend to get a nice bit of calm during the first week of my cycle during which my obsessive thoughts subside and I can just be Lentil.

Today is one of those days. Today I’m finding myself getting excited for totally frivolous reasons.

Now, I’ve never been the most fashionable individual. I like to look nice, but I’m not good at putting effort into it. I want to look nice without trying. In fact, if that was a style, I’d claim it.

A friend of mine introduced me to this the other day. It’s an online personal styling company. Which, in my opinion, is genius. The idea is this. You fill out a profile about yourself that includes everything from your size to your style to your desire for work versus play clothes to your cleavage (and rear end*) flaunting preferences. You then pay $20, and they will send you a box of clothes based on your profile. If you keep any of the items in the box, that $20 actually goes toward the cost of whatever you decide to keep. The clothes are from small and up-and-coming brands, which this Midwestern girl does not typically have access to. I’d rather give my money to these types of companies than to Ta.rget.

I’m not particularly into fashion, but I think this is nice for two reasons:

1) I’m lazy. I hate shopping. I don’t have the patience for it. And I never look as good in those dressing room mirrors as I think I do in real life, and

2) I work in healthcare and need to look nice. Everyday. That’s a lot to ask! And I have no idea how to do this. I’m afraid I either look unprofessional (I’ve never been anything but a student and very much have ‘grad student style’) or 15 years older than I am.

So, I could use help with this whole dressing myself thing. And I’ll gladly pay someone with good style $20 to pick out clothes for me. I spent $20 on decaf coffee over the last week while working on my dissertation at the coffee shop. It’s worth it. (Decaf coffee, on the other hand, is nothing but filler. Not at all worth it.) And who doesn’t love getting a box of surprise stuff in the mail that someone else has picked out for you? It’s like having an anonymous pen pal. And you get to be lazy about responding.

Anyway, I hope this can provide as nice of a little distraction for someone else as it has for me. Because filling out my style profile took me something like 45 minutes. And that’s 45 fewer minutes that I spent thinking about my empty uterus. 

 

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*Don’t ask me what kinds of clothes might exist that are designed to flaunt your rear end. I have no idea.

Not negative but not positive either

February 25, 2013 § 17 Comments

First of all, I am floored by all of your thoughtful comments on my last post. Truthfully, I didn’t realize how many people both read this and care. You all are amazing.

Yesterday was a bad day. And, ya know, this morning didn’t start out so great either. First, the car in front of me getting onto the ramp headed toward the highway plowed over a bunny who was just sitting tharn in the middle of the road. Right in front of my face. And, don’t say he didn’t see it. He saw the bunny. It was in the middle of the freaking road. And it wasn’t moving. And there were no other cars around. This jackass just chose to not slow down to allow it to get out of the way. Admittedly, this kind of thing probably bothers me more than it should. Forgive me. And then, I somehow just forgot to get off at my exit for the hospital this morning. So, not the best entry into Monday.

But, as the day wore on, my mood improved. The Artsy Engineer called me around 10 to tell me that, whatever the results of this morning’s beta, he is 100% on board with moving forward with treatment. He said that he was having a rough day yesterday, too. He was anxious about money and work. And the prospect of another failed cycle. If I’m allowed to feel shitty and hopeless at the very end of the 2ww, he certainly is, too.

Weird thing. So, a couple of days ago I had really swollen boobs. It lasted for two days. I allowed myself to get a little excited, but I figured it was mostly the progesterone talking. Then, yesterday, the swelling went down. They were still tender, just not as big. I think this is part of what sent me into a tizzy.

But maybe it makes sense.

I went in at 7:45 for the beta, and I got the call back around 11.

In the words of the nurse on the other end of the line (my favorite nurse, by the way), the beta results were not quite negative, but they weren’t positive either. Let me explain. At my clinic, a “negative beta” is below 1. (I’ve always read that the number is 5, but my RE explained to me that their tests are really, really sensitive and can detect trace amounts of hCG that are in the blood stream even before implantation.) My number was a 2. The nurse explained that we clearly achieved fertilization but that it didn’t get much farther than that – it probably never made it’s way out of the tube.

Major bummer.

Of course, we are disappointed.

But, I actually don’t feel nearly as crushed as I thought I would feel. I felt momentarily upset, but then it quickly went away. We achieved conception. Step two may have been a bust, but step one worked. I know the stats. 50% (or up to 70% depending on you who you talk to) of all fertilized eggs end up this way.

I guess this just wasn’t the right combination.

Thanks for all of your support, friends.

On to round 2.

Today everything feels like it sucks

February 24, 2013 § 15 Comments

It’s weird. I had a really good night last night. I attended a fancy work* party with my supervisors and my supervisors’ supervisors. At this work party, I got some pretty good feedback about my performance. People were making comments like, “when we have a student we really like, we try to do everything we can to create positions for them within the department when the time comes for them to get a job.” So, yeah, last night I was feeling pretty good about myself. Last night, things were looking up in the world.

Then for some reason, today everything is wrong. I lie. I know the reason. I have all of these symptoms that I know I can’t pay attention to because I’m on progesterone. My boobs are sore and huge. Or, huge for me, which is still tiny (I like to use the term “perky”). Yesterday afternoon, I took only the second nap I have taken in my entire adult life. My chart is revealing this beautiful triphasic pattern. But. I am 12 dpo on my first medicated cycle. I didn’t test today because I tested yesterday and the day before (at 10 and 11 dpo) and both were negative, and I just didn’t want to see that shit again. Actually, they both had really faint second lines, but that means nothing because of the trigger shot I took less than two weeks ago. And the 11 dpo test was lighter than the 11 dpo test. So, negative.

Oddly enough, despite all of my initial optimism, I wrote this cycle off right after ovulation. I had no good reason to do this, aside from the fact that I am not a person who gets lucky. And I would have to get really lucky to get pregnant on my first medicated cycle. So, in my head, I’ve been looking ahead to the next round of treatment.

And, poor Artsy Engineer. I think this glass-all-the-fucking-way-empty attitude of mine has weighed heavily on him. And now in addition to feeling shitty about not being pregnant, I feel guilty for killing The Artsy Engineer’s hopes. And we’re both really concerned about finances. I make nothing, and The Artsy Engineer works for the state (and so makes just next to nothing). Our insurance does not cover anything related to fertility treatments, including ultrasounds. Just a simple, old cycle with nothing but Femara costs us nearly $500.

The Artsy Engineer and I took the dogs on a walk today. It was really nice out, especially for February in Wisconsin. The sun was out in full force and it actually felt kind of warm when it hit you. But, I was cranky the minute I woke up this morning. Not irritable, really; just pouty. A real Debbie Downer. Sometimes when I get like this, The Artsy Engineer gets pissed at me. Which is understandable. Even from the inside, I can tell that it creates a far from pleasant home environment. Anyway, we were walking. I brought up having to drop another $500 this week for treatments, and The Artsy Engineer pulled a surprising one on me.

It went something like this:

Artsy Engineer: Truthfully, Lentil, I am just not clear on how all of this is helping. We were able to get pregnant on our own back in October. That makes it seem to me that our problem is just a lot of bad luck and poor timing or something. I don’t see the point of these treatments if we did it ourselves once. It would be different if you were not ovulating on your own, but you are.

Me: What. The Hell. Are you saying? I thought we were both excited and hopeful about this next step. Are you hinting at wanting to pull the plug?

Artsy Engineer: Yeah, kind of. Nobody seems able to tell us why exactly this medication is worthwhile in our situation. And I am not one to just trust a doctor because she’s a doctor.

Me: Okay. You’re right. I have no fucking idea why it was recommended. Nobody has said, “Lentil, your eggs will be healthier if they don’t have to wait around in there for an extra week, which will lead to greater likelihood of pregnancy and less likelihood of miscarriages.” It was just recommended. And this is what I assumed. And we both seemed to think it was the right move.

Artsy Engineer: Well, I don’t know if I buy it anymore.

Great. Now look what I did. In all of pessimism, I finally rubbed enough of it off on my always optimistic husband. And, he is absolutely right. I don’t know the justification for this treatment. I don’t know why it was recommended. I feel like I’m just blindly following advice, which is not my style. My RE hasn’t really given me any more than “sometimes it can be helpful, so we will try this first.” Despite a long list of questions that I have in my head, whenever I actually go to the RE and she is finishing up and asking if I have any additional questions, I panic, forget everything, and tell her “no.”

And this also made me realize that he has definitely not come as far as I have in the process of accepting that what we are dealing with here is infertility. To him, it is still some combination of bad luck and sub-par effort or knowledge or something. If we could only figure out what it is we are doing wrong, we can fix it.

My blood hCG test is first thing in the morning, and I am not at all hopeful. I just want to stop putting progesterone into my vagina so I can get on with the next round.

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* I don’t actually have a paying job. That would be too much to ask. I’m taking part in clinical training for my degree, which takes up many, many hours in my week and is unpaid. Yes. It is ridiculous.

My first mid-cycle ultrasound, Grover Clevelands, and nausea

February 11, 2013 § 8 Comments

You know those days when you feel like everything is going beautifully? Well, I haven’t had too many of them in the past several months. I’ve had some, for sure. But, for the most part, I’ve felt unsettled.

I decided today that I think that notion of being unsettled is the result of feeling hopeless. And, I know this because today I felt great nearly all day (except when an old friend announced her pregnancy with number two and I had about of ten minute period of the why is everyone fertile but me‘s).

My mid-cycle ultrasound was at 8 AM this morning. And I think I’m pretty pleased with my response to the Femara. This morning, which is my CD 12, my lining weighed in at a beautiful 9.2 mm. I had three measurable follicles – one at 21.5 mm, one at 13.5 mm, and one at 13 mm. From what I’ve read on the all-knowing Dr. Google, the smaller two will likely do nothing for me.

Overall, I’m really pleased. My body is really weird and finicky. It responds to meds/supplements/substances in a really funky way. Either a) nothing happens or b) I’m extraordinarily sensitive and have every weirdie side effect in the book. For instance, I am super super sensitive to caffeine. I stopped drinking it about 4 months ago, but before that, I had only about 8 oz of coffee a day (almost nothing), which I had to make sure to drink first thing in the morning. If I didn’t have any by 11:00 AM, I’d get a terrible withdrawal headache by 1:00. And if I drank anything at all with caffeine after about noon, I would straight not sleep that night. For the whole night. Which is why I felt like a slave and finally quit cold turkey after a 15 year love affair with coffee.

I digress.

I do kind of wish that one of those other two measurable follies would have been a little bigger. If we’re dropping a Grover Cleveland* on one cycle, I wanted to get my money’s worth with a shot at two mature eggs.

Tonight, we triggered. And I actually took video of it. Because, y’all. The Artsy Engineer was hilarious. He wasn’t at my appointment this morning, so he didn’t get to hear the instructions first hand. He also hates needles. He admitted to me this morning that he has been looking at the package that was so dear to my heart with dread. In fact, when I pulled the materials out tonight, he developed all sorts of different kinds of symptoms. By the time we had everything sterilized and prepped, he was white as a sheet, his hands were shaking, and he’d been telling me for about 45 minutes that he thought he was getting sick**.

But he did it, and he did a great job. I didn’t feel a thing.

I’m now about ready for bed. According to the chart my RE gave me, we have to go have sex now, so cover your eyes. In approximately 36 hours, I will hopefully ovulate. This sucker will be the freshest egg I have ever ovulated (usually they sit around in there for at least another week or two before they decide to make the trip). I know our odds are still not good. But I feel some hope, because I think they’re at least a little better than they have been up to this point. And that little bit of hope went a long way for me today. Me and my healthy, average response to medication. I couldn’t believe it. I felt like a celebrity. Happier than a pig in shit. Like a million bucks.

*Apparently Grover Cleveland, US President #22 and #24 (the only US President to serve two nonconsecutive terms), was on a $1000 bill that was published in the 1934. Who knew.

Image

**It’s now an hour and a half later and (lo and behold!) he’s not sick. He’s playing his guitar with his harmonica strapped around his neck. Full of energy and zest. And health.

I’m in love with the mailman

February 6, 2013 § 10 Comments

Today, I met a new guy. He came right up to my door (ballsy!) and proceeded to try to engage me in small talk about dogs (mine were barking their sweet little noggins off at him) and the weather (it’s sunny and there is snow on the ground; whoohooo) and the superbowl (meh). He was nice enough. And not unattractive. But I kind of ignored his face and his words. Because I could not keep my eyes off the box he was holding in his arms. My eyes were so attracted to it that you would think that it was glowing. Or on fire. Something.

If this very kind Fedex man knew what was in the box I was struggling internally not to yank from his hands, he probably would not have been semi-flirting with me. He might have averted his eyes, as have a few of my male (and female) friends who I have told about my miscarriage and about my infertility. He likely would not have had much to say except an awkward “Uhhh, are you Lentil? Can you sign for this?”

Mr. McFeely's Speedy Delivery!

    Mr. McFeely’s Speedy Delivery!

But he didn’t know. And so he engaged. And I kind of fell a little bit in love with this kind, chatty Fedex guy. Little does he know that he has now played a roll in helping me knocked up.

The flaming box.

  The flaming box. And view #1 of my living room.

Once I finally got the box inside, I ripped it open (after feeling oddly compelled to document it for you all), and emptied the contents onto my kitchen counter. One box of Pregnyl HCG trigger components. Two syringes. Two needles. A prescription bottle of progesterone (The Artsy Engineer, funny guy, already informed me that he keeps the applicator for the these vaginal suppositories in his pants). And a bag of Hershey kisses.

The contents plus the kisses (and view #2 of our living room).

The contents plus the kisses. And view #2 of my living room.

I was so excited to get this package. And y’all. I was tickled to death that they put a bag of Hershey kisses in the package. I have no idea why. I’m no big sweets person. I’d choose a second helping of pasta over dessert any day. And I know this pharmacy in New Jersey that specializes in infertility medication very likely puts Hershey kisses in with their shipments purely for business reasons, to make me feel special and cared for so that I continue to purchase my expensive drugs from them. But, they got this girl. Those kisses made me feel warm and fuzzy inside. And those syringes made me feel hopeful. Not too bad a combination for a Wednesday afternoon.

A new plan

February 3, 2013 § 8 Comments

It’s been a week since I wrote a post in real life, but I feel like I’ve written several. In a sense, I have. It’s just that most (or all) of them have been in my head. A lot has happened in my little infertile world over the past week. And I’d rather see a lot happen than see nothing happen. Things happening means progress. Usually. Maybe I should not be so optimistic. Maybe it just means movement. But with all the waiting I’ve done, movement is lovely.

First, I started spotting 9 days into my two week wait, which is earlier than I’ve ever started spotting in my not so brief history of charting. That was Monday evening. I was pissed. I was devastated. The world was not fair. Cue catastrophizing Lentil.

See, not only did I want this last cycle to be my lucky cycle more so than any other cycle (although I’ve noticed a trend with that one.. there is an strong positive relationship between how long this takes and how much wanting I do), but I also really thought this might be it. October just felt right. I almost knew it. I even felt guilty for starting a blog about infertility on the same cycle that was was most certainly going to get a beautifully positive pregnancy test and leave the infertility world just after officially entering it.

So much for that silly intuitive sense I was so certain about. So so certain.

I spotted for three days before finally getting my period. I don’t know what the hell that means. If anything. I’m trying not to add it to the list of things to worry about that may or may not be wrong with me.

While I was spotting, I made a decision. A big decision. Round two. A new plan.

Back in September, I had just finished all of my initial testing with my RE. She found nothing wrong (hence the unexplained nature of my oh so special blend of infertility). And she recommended that I start treatment with three cycles using Femara. At the time, I thought that if my very good doctor could find nothing wrong, I probably didn’t need the Femara. Perhaps I was just being impatient.

So, I didn’t take the Femara. And then I immediately got a BFP. And then I lost the pregnancy. Now, three cycles later, I’m back at the same decision. And this time, we were so ready. I threw away the vitex and the red raspberry leaf tea, abandoning the herbal supplements I was hoping hoping hoping would be all I needed, and I called the clinic. That was Wednesday. On Friday, my CD 2, I went in for an ultrasound. Everything looked good to go. And I’m now on day two of the Femara. When I look at those little pills, I feel a whole lot of love.

After a whole lot of back and forth, we decided to also do the HCG trigger shot. At first we were thinking we’d hold off, because I typically have a lot of success with ovulation predictor kits accurately telling me when I’m going to ovulate. But then the nurse at my RE’s office said that the Femara could possibly mess with my usually predictable OPKs. And she also said that the trigger would release all mature follicles, which seems like it would up our chances of having one of them meet one of the Artsy Engineer’s swimmers and stick. I guess what I still don’t know, though, is if you release all mature eggs even if you don’t use the trigger. And I also don’t know how likely it is for me to have multiple mature eggs while using the Femara. Timing alone doesn’t seem like a good enough reason to spend the extra $550 for the trigger+ CD 13 ultrasound. But if it might throw another egg into the mix and increase my odds of getting pregnant, then maybe it’s worth it. Plus, I feel like getting a CD 13 ultrasound during my first Femara cycle makes sense (it’s not mandatory at my clinic), because what’s the use of doing three rounds of the thing (for $500 a round), if it may or may not actually be working as it’s supposed to work? I think the CD 13 ultrasound should give us some insight into whether or not this medication is doing its job. And if we’re going to do the CD 13 ultrasound, why not do the trigger? It’s just another $100. What’s $100 when you’re already spending nearly $1000? Holy shit. $1000. For one cycle. And then I saw some awful statistics the other day saying that there was only a 5% chance of conceiving using Femara/Clomid if you’ve been diagnosed with unexplained infertility. Is that true?! If so, how the hell can I justify spending this much money doing this??

Who knows. From that jumbled mess of thoughts I just spit at you all, clearly not me. I feel so new at this. I feel like I just dove into this decision without researching and reading every tiny little thing about it first (my typical modis operandi). It was definitely a reactionary decision. I was still reeling from the failing end of my January cycle that was supposed to be the one. But maybe I needed the reactionary bit to get me going. Otherwise, I would have futzed around, weighing the pros and cons, over and over and over again (also my modis operandi).

And so, here we are. Me and these little orange pills I’ve already fallen in love with, because they’ve given me hope.

Oh, and look forward to upcoming posts on my difficult sister who I love dearly, getting lost in the woods yesterday, and Femara farts (all things that occupied my thoughts/time/ass this weekend).

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