Trigger Happy

IMG_4622This morning’s appointment brought the welcome news that we are ready to trigger for our egg retrieval!  I’ve been really uncomfortable and nauseous the past few days and no wonder – today’s ultrasound revealed at least 20 follicles just on my right ovary.  The nurse actually stopped counting once she hit 12 on each side.  While I am pleased that my body has responded so well to the stimulating hormones, I do realize that it is quality over quantity, so I am really hoping that we are able to retrieve viable, healthy eggs that fertilize.  And, let’s be honest, I’m looking forward to not feeling like a Macy’s Thanksgiving Day Parade float.

I just had an opportunity to look at my lab results and, to my untrained eye, my estrogen levels look really high: slightly over 9,000 pg/mL.  As I understand it, each follicle will release between 150-200 pg/mL, so I get why my level is sky high but I worry that this could develop into ovarian hyperstimulation syndrome (OHSS) after egg retrieval and/or they will cancel this cycle.  I haven’t heard from my doctor’s office and they are usually really good about calling if there are any issues with my lab results.  Anxious, much?

Tonight I am scheduled to take my first trigger of Lupron.  Due to timing, I will have to give myself a Lupron shot at work tomorrow morning as well, which should be interesting to say the very least. Making IVF viable while I work has been a challenge, but thankfully I have a job with some flexibility and that is accommodating to the many doctor’s appointments that I’ve so far had.

Wednesday, first thing, Daddy Graham and I will head into the Fertility Clinic to have the eggs retrieved and for Daddy Graham to deliver some swimmers.  Fingers crossed that everything goes smoothly and that we are one step closer to Baby Graham!

Bunches o’ Grapes

The follicles are growing!! Today was the first ultrasound since beginning the follistim and menopur and it appears that my ovaries are responding well to the stim meds – so far there are at least four follicles growing on each side (the nurse couldn’t give me a definitive number of follicles because they were “on top of one another”).  I return for another ultrasound and blood work on Friday… here’s hoping for continued growth! 

It’s really the only time I’m hoping that my ovaries are like bunches of grapes. 

Stims in the Woods

The view from our family cabin on Lake George, NY


My family’s annual 4th of July holiday reunion landed smack in the middle of our IVF injections schedule and I’m here to report that, while maybe a little awkward that Daddy Graham and I would disappear at 6 pm on the dot to go through our routine with MUCH STERILIZATION, it was completely doable.  

In fact, being able to enjoy family and do our normal things (go to the beach, laze about a campfire, eat picnic food with abandon) was imperative – resuming our life as usual instead of obsessing over our ever-present conception journey was a lovely and important reminder of the necessity of balance. 

So far, I’ve had no noticeable side effects from the menopur and follistim. I’ve actually been feeling great – fingers crossed that this continues! My next appointment for an ultrasound and blood work to see how the follicles are progressing is tomorrow morning.  I’m feeling confident and positive that we will be successful with IVF and that at next year’s family reunion, Baby Graham will be there with us! 

IVF Day 1

Yesterday’s appointment brought another ultrasound and baseline blood work panel. I got the go ahead to start my IVF injections – a combination of menopur and follistim – to begin stimulating my ovaries.

Coming off of the progesterone from our last round of letrozole and timed intercourse has left me feeling emotionally fragile. I’m hoping that these new hormones won’t throw me too off-kilter. I feel extremely thankful and lucky to have such a patient and understanding partner in Daddy Graham.  

 The process of mixing the two drugs together for injection was a little daunting at first, but once Daddy Graham and I watched a video we found, we felt pretty confident. Once again, the injection wasn’t bad, but the amount of liquid that the needle contained was much more than the trigger shot I had done the first go around, so the tenderness factor at the belly injection site was upped. 

Another needle in the sharps bin, another needle closer to Baby Graham. 

TTC, WTF?

IMG_4565New to the whole world of trying to conceive, I was utterly confused at first by the language that kept cropping up in online forums and message boards.  I work in a field that is acronym heavy (educational policy at the state level), but it was still a challenge decoding some of the terminology as some of the acronyms have other, more commonly used meanings (see AF, below). I found myself Googling quite a bit, and wondering at times why we should need a glossary to describe one of the most fundamental aspects of biology or why we can’t just write what we want to say instead of abbreviating.  It should come as no surprise that I am the kind of texter that writes in long form.

At any rate, I thought I’d share some of the common acronyms floating about:

2WW/TWW The two week wait (otherwise known as the luteal phase or ~14 days after ovulation).
AF “Aunt Flo”.  I hadn’t heard this term since junior high.  Also not to be confused with its more common usage “as f*ck”, as in “I’m tired AF right now”.  Why can’t we just say period, ladies?
Baby Dust What well-meaning fellow message board-ers will offer to sprinkle on you for good luck.
BD Baby dance (sex).  Is this cutesy acronym in play so that message board content doesn’t get flagged as inappropriate?
BFN Big Fat Negative

Big Fat Positive

The pregnancy test results.  You’ll see these a lot.
BFP
CD Cycle Day … usually followed by a number
DB Darling boyfriend

Darling daughter

Darling fiancé

Darling husband

Darling son

The darling monikers.  I’ve seen the “D” also stand for ‘dear’.
DD
DF
DH
DS
DPO Days past ovulation
FRER First Response, Early Response pregnancy test.
FX Fingers crossed.  Usually used in conjunction with baby dust.  The best part of the message boards is the common rally call and support you receive.  Everyone is rooting for you!
HPT Home pregnancy test
IUI Intrauterine insemination
IVF In vitro fertilization
LH Luteinizing hormone (detected in ovulation predictor kits)
OPK Ovulation prediction kit
POAS Pee on a stick (Home pregnancy test). No DYSIP, though (dip your stick in pee) … yet.
SA Semen analysis
TTC Trying to conceive
VFL Very faint line – with regard to pregnancy tests.  Chances are you’ll also see VVVVFL, as well as other iterations that vary the frequency of the ‘v’.

Any others that I’ve left off?

 

The BFN

IMG_4571Negative.

I won’t lie and say both Daddy Graham and I are not disappointed.  We are and it stings like we thought it would when we began this process.  It was too easy to get carried away – pinning baby items on a secret baby board and continually adding names we like on a list on my phone.

Both Daddy Graham and I are undeterred, however.  We knew this wouldn’t be easy.

The nurse I spoke with was sweet and gentle … and told me we could begin again as soon as my period starts.  Which should be just a few days from now, as I’ll no longer be taking progesterone.  I was surprised to hear that we could/would/should start anew in three days – it almost doesn’t feel like enough of a mental break.  Unfortunately, we don’t have the luxury of time.

I called my insurance company and got my prior authorization codes for IVF – I am beyond lucky that my medical insurance through work covers IVF up to $50,000.  Now Daddy Graham and I need to figure out when to begin IVF, if we want to try another cycle of timed intercourse or if IUI should be considered as a next step.

The Wait

 

the wait

I keep refreshing my browser, thinking that the lab results will miraculously appear… even though I know that the office will call in roughly an hour.  I’m impatient and the pendulum keeps swinging between optimism and trying to temper my expectations so as to not be too disappointed should we find out that this round didn’t result in a pregnancy.

Here is a snippet of my mind’s conversation:

“I don’t feel pregnant.”

“How would you know what pregnancy feels like?  You’ve never been pregnant!”

“What if I’m not pregnant …”

“What IF YOU ARE?”

“Why am I craving donut holes?”

Etc.

Schrödinger’s Uterus

Ok, so not exactly.  Copenhagen Interpretation Uterus doesn’t have the same ring to it.  For those of you who are asking, “what in the world is she talking about?”, let me (briefly) explain…

Schrödinger was a physicist who created a thought experiment involving a cat placed in a box.  The Copenhagen Interpretation of quantum mechanics would say that, until someone opens the box and observes what actually happened to the cat, it is impossible to predict what happened to the cat… that is, the cat could be in all possible states simultaneously.   (Schrödinger actually thought this was nonsense, and had created the thought experiment to show exactly that).

Anywhooo, what does this have to do with my uterus, you might wonder and why is she talking about physics so early in the morning?

IMG_4244Well, I’m currently in the state of limbo where I could be pregnant, I could not be pregnant, and both are equally possible.  I won’t know definitively until Monday’s blood test (or the arrival of an unwelcome period), and until then I’m … both.  I was telling Daddy Graham last night that a teeny party of me does not want to find out on Monday because it bursts the hazy state where all things are possible.

The 2WW

I’m currently in the last week of the dreaded two week wait (or 2WW, according to the blogs) – the wait between ovulation and being able to find out if everything you’ve done up to this point has worked …

After my last ultrasound showed a nearly-mature follicle in the left ovary (it was 17.5 mm), the RN instructed me to administer the trigger shot the following morning (a Friday).  For those worried about the trigger shot, and having to administer a shot to yourself, rest assured.  It wasn’t bad at all. In fact, I had to give it myself twice, as I realized after the first round that I hadn’t sucked up all of the HSG.

And thus commenced the timing part of our timed intercourse cycle – we were given explicit instructions as to which days we needed to get it on (24, 48, and 72 hours post trigger shot).  I’d like to say that we did exactly that, but we, ahem, made a 12, 24, and 36 hour tour of the bedroom instead.  While I normally do not buck any medical advice, especially when it comes to this process, one of the sessions was to occur after I started the endometrin suppositories and, well, who wants to have sex when you are dealing with a vaginal suppository?  Not me.  I’m pretty sure Daddy Graham would say the same.

During these two weeks, I’ve felt every symptom imaginable – nausea, dizziness, mood swings, tender breasts, cramps, even light spotting on what could have been implantation day (~6 days post-ovulation).  I’ve had dreams where I am pregnant, dreams where I am definitively not.  Listening to my body is difficult when it is currently an unreliable narrator. Only time will tell.

PICT0043

My mom, c. 1981 – pregnant with my younger brother

Our Journey So Far (Part 1)

IMG_4504Daddy Graham and I first began talking about having a child when we made the decision to go off birth control in August of 2016.  I had been on birth control intermittently throughout my 20s and 30s as a means to control an irregular and often errant period.   I was diagnosed with PCOS (Polycystic Ovarian Syndrome) pretty late in the game which means that I rarely ovulate on my own, and so we knew that it wouldn’t necessarily be an easy path to pregnancy.

 

Understanding that both Daddy Graham and I were staring down the barrel of 40, I went to my OB/GYN for my annual checkup right after I went off birth control to discuss the odds and practicalities of beginning to start a family.  She suggested we try for a year before we pursued any sort of official fertility interventions.  It felt like too long to me – if we were in our early 30s and without PCOS, no big deal.  So, we compromised with six months of trying to conceive.  And try we did.

To no avail.  But man, we did have fun trying.

I proceeded to get a referral to a local fertility clinic that blends both eastern and western philosophies – treating body and mind simultaneously, which felt (and feels) right to us.  The facility also may be the nicest doctor’s office I’ve ever been in – a fireplace, plush leather couches and chairs, even chair massages when the masseuse was in the building.  I went in for my initial consultation in late January of 2017, where all the different options available to us were described (and drawn) in great detail – timed intercourse, intrauterine insemination (IUI), in vitro fertilization (IVF), etc. Daddy Graham and I decided that we wanted to first try timed intercourse with the aid of a drug to stimulate ovulation – letrozole.

Before I go into some details, a warning: fertility is not for the faint of heart nor the squeamish. Nor the modest, but that’s for another time.

I had the first of several diagnostic tests in beginning in February of 2017 – a full blood panel, a vaginal ultrasound, as well as an HSG (hysterosalpingogram) to check my fallopian tubes and uterus.  Having blood taken has never been easy for me – it’s not a fear of needles, or an aversion to the sight of blood. I have tiny veins and the process of finding the vein, the pushing on the tender crook of the arm repeatedly to check for vein bounce back, can send me over the edge.   Six vials of blood later, I had one nasty bruise. The vaginal ultrasound isn’t exactly, well, pleasant, but I was fascinated by being able to see my ovaries and uterus not to mention completely baffled by how the RN could determine follicles from, say, other black dots on the screen.  It all looked the same to me. Lots of follicles on this initial ultrasound, so lots of potential for mature eggs.  The HSG was probably the most uncomfortable physically, as a small catheter had to be inserted into my cervix to release the dye that would enable the doctor to see my tubes and uterus.  In order to get the best picture of this, I had to lift my pelvis off of the table for what felt like forever, nearly kicking the doctor in the face as I struggled through a charley horse. But I did get to see my fallopian tubes light up on the screen, and was happy to hear that there were no blockages and that all looked well.  All in the name of good things, I am always quick to remind myself when uncomfortable.

Daddy Graham also went in for his testing to make sure that he was ready to go.  I’m not sure I can do his story justice, as he does a much funnier job of relaying having to race to the doctor’s office which a sample cup between his knees to keep it warm.  The long story short is that he had to be tested twice – the first time his sample came back with low motility (16.5% on average)   The second time everything checked out fine – apparently it all depends on the day – with a motility of 49.5% on average.

All in all, we were good to go – the doctors explained that I had a suitable ovarian reserve and that all of my hormone levels, while indicative of PCOS, didn’t preclude me from getting pregnant.  Daddy Graham’s swimmers were given the thumbs up. We were given a prescription for the letrozole, a trigger shot, as well as endometrium, which is a progesterone suppository.  More on that later.

Daddy Graham and I talked about optimal timing for when to start – given that Daddy Graham’s work schedule is such that he is in another state for most of the week during the academic college year.  And so, we chose to begin in May of 2017.

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