Not that I'm complaining

I've tried to write this post several times, but because I keep checking updates from fellow IF blogs before I start typing, I haven't felt able to go through with it. What do I have to complain about, honestly? It takes about five minutes of clicking around to find heartbreaking, awful stories from women who have lost their babies, whose cycles did not work, who are preparing for life without the children they so desperately want. And then there's me, trucking along just fine on my FET cycle, heading home each night to my healthy son and my loving husband, and I have the gall to start moaning about how terrible things are?

Yup. Brace yourself (or stop reading), because I am totally about to complain. But here's the thing! I don't complain to anyone in real life anymore. I don't talk about this cycle with my husband, my parents, my siblings, my friends, my coworkers. As far as they are concerned, there is no cycle happening, no attempt at another pregnancy, everything is just status quo. (I should clarify: my husband knows that this cycle is happening, but that's all. I do not discuss it with him.) It's my first time really experimenting with denial, and I have to say, it's going much better than I expected. A lack of sympathetic faces in my life means that I don't turn to them when things get tough. And if I don't have the option of getting any sympathy - if it simply doesn't exist - well, I find I don't need it as much as I thought I did. And then at least I can cling to that thought - as bad as it gets, as bad as it has been, at least I haven't burdened my loved ones with my inability to cope.

And what is there to cope with, really? Here's a brief summation of what's happened in the last few weeks:
- Right after my SHG, while I was on the antibiotics they prescribed, I got a yeast infection. I tried OTC remedies unsuccessfully for two days before finally procuring some prescription-only Diflucan (don't ask - let's just say that I managed not to hassle my OB or RE.)
- As the yeast infection was coming to an end, I started bleeding heavily. It lasted for three weeks and was similar to my post-partum bleeding, with clots the size of walnuts. I went through a staggering amount of feminine supplies. Another period? Just more irregular bleeding? Who knows!
- I started Lupron injections and got a headache that never really goes away.
- I had a monitoring ultrasound and bloodwork that looked good enough to move on to the next phase of my FET. The 4-cm cyst had gotten a bit smaller, from what I could tell anyway (the OB's office was under strict instructions not to interpret my results and wait for the RE to weigh in, but then all the RE said was to proceed, so I don't really know what's happening with that.)
- I started taking oral Estradiol and injecting myself with Lovenox, since I'm a clot risk after the DVT in 2012. The Lovenox has given me giant, painful bruises on my belly that I believe I have successfully concealed from everyone besides my husband - and even he didn't see them for the first few days, so artful was my dressing/undressing.

None of this is particularly terrible, but yeah, since we're complaining and everything, I will tell you that I've been doing my usual amount of sobbing behind dark glasses. I feel pretty decent about 90% of the time, it's just occasionally that the self-loathing takes over. I start feeling sorry for myself, and then I hate myself even more for wallowing in self-pity, and usually the cycle continues until something external breaks it. Which is often - I'm crazy busy with work, travel, and life in general. That pace is unlikely to slow down for at least another month, which ordinarily would feel daunting but these days is a very welcome distraction.

Next up: at least one more monitoring ultrasound coordinated through my OB's office, another two weeks on medication, and the transfer itself at my RE's office. I am trying to figure out how to casually bring up the topic of the transfer when my nurse calls me in a few days with next steps... for instance, I don't want to put my legs in the stirrups. Could they do the transfer with my feet flat on the table? And what about my RE himself, is it worth even bringing up whether it's possible to have someone else do it? I get the feeling that his embryo transfer technique is probably the best in the practice, and of course I don't want to have to go through this ever again so I want to do everything I can to achieve a pregnancy on the first try, but I am horrified at having to physically put myself in the same position that I was in for my egg retrieval. I don't know. Sometimes I feel angry and empowered, but sometimes I just feel so defeated - sure, go ahead, do whatever you want to my body, it's not like it's worth anything anyway.

And then... then, in December, I'll find out whether this worked. Either way I will have a whole new set of decisions and obsessions. I'll come back here and complain some more, so get psyched!

Sequel in pre-production

Well, this is happening. IVF 2: Return of the Frozen Embryos is coming soon to a theater near you.

My sonohysterogram wasn't that bad, but then, I didn't remember it being anything to write home about after my first IVF either. If you look carefully you'll see that it doesn't even appear in my writing from that time except as a brief mention in my first post. I mean, there's a little bit of cramping and what I perceived as a deep burn from inside my uterus, but a partial list of things that hurt more than a sonohysterogram would include stubbing my toe, grazing my hand against a hot teakettle, and slicing open my thumb with the blade of an open pair of scissors (all of which I've done this week. Go me.) Yes, I was completely freaking out the whole time, but that's old news.

More interesting was what the test found - my uterus is fine and dandy, but my ovaries are back to making trouble. They were so quiet for so long but it's clear now that when I stopped nursing back in August, the mini-pill alone was not enough to stop me from ovulating, and there was evidence of that on the scan- including a brand new cyst. It's on my right ovary, 4 cm, and in an interesting departure from our usually scheduled programming, may not be an endometrioma. The current theory is that it's a simple ovarian cyst common in women of reproductive age, so it may go away on its own (shrink? rupture? nobody seems to want to discuss that with me...) and the only real risk is that if its a functional cyst then it could mess with my hormones at the end of my upcoming 20 days on lupron.

Wait, what? Lupron? Already? Yes, friends, I will start it later this week. Almost one year to the day after the birth of my beloved first child, I will begin injecting myself again with drugs in an effort to give him a sibling. I thought we had more time before this whole process started again, I really did. Can I really do this again? Can I disrupt my life, my husband's life, and now my child's life by going through the same terrible process as in 2011-12? Getting this diagnosis meant choosing the best of a series of bad options for my body going forward. I hate that, basically, my kids are wrapped up in those choices. There are two separate decisionmaking processes here and in an ideal world we could tackle them separately: first, what should I do to keep my body as healthy as possible for as long as possible? And second, do we want to add another member to our family?

Our decision is to move forward with the FET in early December. It's a compromise in a lot of ways but I hope and pray that it's the beginning of the end of this whole IVF nightmare. A huge amount of questions remain unanswered - will our incredible luck hold, and will I get pregnant again? If this cycle doesn't work, will attempt another one? If this cycle does work, and we still have an embryo or two left in the freezer, will we try for yet another pregnancy? How far am I willing to go to try to reproduce before I give up, hug my child and husband tight, and wait to see what my body does next?

Next Steps and Continued Hormonal Funtimes

Hey, look, we've made it to six weeks! Good job, everybody!

Six weeks means that O is smiling (sometimes), cooing (occasionally), and extremely cute (all of the time.) It also means that I had my six weeks postpartum checkup, which ordinarily would have focused on healing Down There and birth control plans, but was a bit more interesting for me. The endometriosis that got us into this whole IVF mess is a problem that won't go away, so there are a few things we're going to continue to monitor going forward.

First of all, some good news. I passed another milestone this week: I'm off Lovenox! No more enoxaparin sodium for this girl, at least until/unless I get pregnant again. For those of you keeping score at home, this was nearly a full year of daily injections, with a few short breaks here and there. Someday I'll post the total number of needles that it took to get O from theory to reality, but for now I'm content just watching the bruises fade.

Also, the preliminary results suggest that the endometriomas have not recurred (or are pretty small if they did.) The one on the left was 4 cm right before my IVF cycle and we'll see what continued breastfeeding does to keep things quiet. I've seen it described as "natural Lupron," which would be nice since I want to avoid taking that stuff again if at all possible.

Since I had a complicated pregnancy, I also wanted to go over whether I'd have to be concerned about attempting any other pregnancies in the future. Yes, I will likely have to be on Lovenox again, but my risk of placenta previa is only slightly higher than normal and the fact that it resolved this time is a good thing. I also had some weird liver stuff that popped up on my bloodwork at the very end, but that just means they'll be on the lookout for pre-eclampsia as they would for anyone. Overall, I guess I'm not a terribly complicated patient when it comes to another pregnancy, which is nice!

Now for the tricky stuff. The endometriosis which caused my tubes to scar over and my ovaries to grow endometriomas will theoretically get worse every time I have an ovulatory cycle (though how much worse, and how much it will bother me, is kind of a question mark.) Ordinarily I would probably be prescribed a combination estrogen/progesterone birth control pill, but thanks to my DVT, I'm not a good candidate for that. I'm likely headed towards a progestin-only pill or maybe a Mirena IUD - and yes, I really am considering taking the pill despite my earlier protestations about systemic hormones. Why? Well, partially because the side effects are theoretically less problematic than the combined BCP, and partially because I can wrap my head around taking a pill if I know it's only for a short period of time.

All this to say: it's a matter of time before we're back on the IVF train. Don't think I've forgotten about those three embryos on ice, and because of a combination of family and medical factors, we're probably looking at attempting another cycle in a year. Or less. Or maybe a little bit more. There are a lot of moving parts to consider, even though we're committed to giving O a sibling - or at least trying our hardest to do so. We've been so blessed to have him, and I hope and pray that our luck continues!

Stimulation has Begun

You guys! You guys.

I HAVE FINALLY BEGUN TO STIMULATE MY OVARIES.

As of a few moments ago, I am no longer in menopause. (Kind of.) In addition to 5 units of leuprolide acetate, I injected 225 IU of Follistim into my belly. And this comes after a whopping 33 days of downregulation. It's the longest Lupron protocol I can find anywhere on the Interwebs, but it. has. finally. ended.

Welcome back, ovaries! We have a lot of work ahead of us. First order of business: Golden Globes fashion critique. Angelina Jolie: yes or no? I'm leaning towards no, but I still haven't seen a full-length shot of her.

Rose! Hyper on Two!

(If you can name the movie I'm quoting above, you get a gold star.)

Today was my extra-special crazy-lady appointment at my RE's office (with a bonus unscheduled appearance from my RE himself!) to talk with the nurse coordinator about my concerns regarding egg retrieval. I will admit, embarrassingly, that I do feel much better now that I've voiced all my worries to somebody and seen the procedure room and been assured in no uncertain terms that this will not be agony and if it is, they'll stop. Sigh. The Ativan prescription I picked up probably won't hurt either.

The only thing that continues to bother me is that when I related my friend's story about trying to take her feet out of the stirrups but being prevented from doing so by an additional drug being pushed into her IV, the nurse's reaction was immediately that it had never happened or if it did, it didn't happen exactly that way. I mean, it's hard for me to get all indignant about it because it's not my story, but I really don't think my friend is lying and even if she is mistaken about the details - this is what their former patient perceived to be her experience at their clinic, and it was upsetting. Period. If I had a horrific experience at a doctor's office of any kind, I would tell them about it in no uncertain terms, but my friend isn't interested in doing that so I guess the matter will just rest here.

The other new development to come out of today's meeting is that my RE asked if I had 5 minutes free to meet with him to go over the calendar for my cycle - believe it or not, we are pushing back my start date for Follistim AGAIN! This time it's because my RE has to be out of town on what would have been my retrieval date. I can stay on the leuprolide acetate "indefinitely" (it's similar to being on Lupron Depot, which would last for several months, so two more days of the injectable stuff won't actually harm me - it just keeps me in a holding pattern until we're ready to start). Part of me feels like this is a stay of execution but another part of me just wants to get the show on the road already! Anyway, I am now starting Follistim on Sunday 1/15. With any luck sugar cookies will be involved.

Thanks, Menopause!

Not much new to report here, things are still pretty bleak. But after yesterday's depressing post, I wanted to add something that was positive and uplifting. Are you ready?

My skin is the clearest it's been since puberty.

So I have that going for me.

Feeling...

HOT HOT HOT!

The last time I wrote about my leuprolide acetate side effects, I said that I thought I might be having hot flashes. I am no longer wondering if this is the case. Yowza! Bring it on, winter! Seriously, it is mighty cold here today, and I am sitting around in my office wearing a t-shirt waiting for the next wave of self-generated heat to hit me.

What does a hot flash feel like? Well, for me, I'll just be sitting around minding my own business when all of a sudden a hot feeling prickles up from my chest to my face. It's like wearing a ton of layers in wintertime, heading inside but not taking any of them off, and then a few minutes later suddenly realizing how overheated you are. I start sweating all over and the only thing that feels like relief is pulling up my shirt to expose my belly and back to cool air. Of course, if I'm in a meeting or something, I can't exactly do this, but the good news is that the feeling passes in about a minute. Then I get really cold for a few moments, and then my body settles down again for a few hours. It's not like I'm sweating so profusely that I've ruined clothing, and so far nobody has looked at me strangely to ask what's going on. It's mostly just weird. Oh, and my headache continues, although it's more intermittent now.

In a strange way I'm actually kind of grateful that the hot flashes have gained intensity over the past few days, because somehow I managed to convince myself over New Year's that I had been doing the Lupron injections wrong and the entire cycle would be ruined and I would have to start all over and it would be dooooooooooom. (And no, I don't have any real reason for thinking I had done the injections wrong, it was more of a "Wait, was the needle supposed to go in at a 45 or 90 degree angle? And do I need to wait a full ten seconds before taking it out? I've poked a lot of holes in the top of the little vial at this point, does this mean there's air getting in there that will ruin the medication?") The answer appears to be that everything is fine, for now at least.

The question I'm now wondering is - can I stand these symptoms for another week? (And then replace them with different ones?) I was supposed to start Follistim on Jan. 6th but I may need to delay for a just a little bit longer. I'm worried about over-suppression because I've read a few horror stories but my RE will give me the final decision on Friday - he is the expert and we'll have a plan soon.

Lupron Update

The fact that I haven't been posting much about my experience on leuprolide acetate is actually a good thing. Because 'twas endometriosis that got me here in the first place, my RE wanted me on a looooong Lupron protocol - as in, nearly a month of shots before any stimulation will start. Believe me, if I had had a reason to complain, I would have. Because I hate the birth control pill with such a fiery passion, I was expecting to feel the same way about Lupron... but, magically, I don't. No joke, this has been (knock on wood) no big deal.

The biggest thing I have to complain about is a persistent headache. Most of the time it's minor enough that I can ignore it, occasionally it makes me want to lie down and take a nap, but it's really nothing worth writing home about (or, in this case, telling the Internet about.) I have had it since the second day I took Lupron and I really don't think at this point that it's attributable to caffeine withdrawal, but who knows.

I have also had a few strange instances of getting very flushed from my chest to my face and feeling hot without any good reason. Hot flashes? Maybe. There are more than a few post-menopausal women in my life and their experience with hot flashes has been a bit more dramatic, so I don't really feel I can complain - I'm not tearing off my clothing in restaurants while sweat pours down my face. I'm just warmer than usual. And as someone who is chronically cold, a little unexpected warmth in a New England winter is very welcome.

And no, injecting myself hasn't really gotten easier. I haven't resorted to sugar cookies every time (even though, let me tell you, this is the right time of year to find cookies everywhere I look.) It hurts and it's not fun and the only good thing about it is that Harry thinks I'm pretty badass for stabbing myself in the stomach every night. But it's over quickly and it makes me feel like I'm making progress with this whole crazy endeavor, so that's good.

Overall, Lupron? Totally fine. Of course now that I've written this down I'm sure I'll wake up tonight with some sort of bizarre problem like hot dog fingers or spontaneous dental hydroplosion, but so far... so good.

Lupron: One Week

One week into injecting myself with Lupron, I can say: it makes me have a headache. A low-grade, persistent, usually easy to ignore headache. I did break down and have a tiny amount of caffeine yesterday and although I enjoyed the familiar feeling of artificial well-being and energy flowing through my veins, it didn't make the headache budge. Oh well. Maybe I wasn't as addicted as I thought, or maybe both things just give me a headache and I was doubly screwed?

The other symptom that I have, and I mention this only for the benefit of medical posterity, is that my bazooms are a bit sore. My guess is that this is general I'm-about-to-get-my-period stuff, but we'll find out in due time. The really exciting side effects should start 10-14 days after my first dose, so stay tuned!

Confession

Hi, my name is Charlotte, and I am a caffeine addict.

Phew.

That was surprisingly hard to say! When I was diagnosed with a (benign) heart issue as a teenager, I was told that it would be a good rule of thumb to steer clear of caffeinated beverages. I was very proud of my caffeine-free status for a long time, but over the past year, things started to get out of hand. A mug of Earl Grey here, a small iced coffee there... you know how these things go. It really got bad when I read that green tea helps with conception (although, maybe it doesn't?). I started drinking a cup every day, around 11 AM, when I would start to get hungry but lunch still seemed far away. Yes, green tea has less caffeine than black tea or coffee, but even that was enough. On days that I missed my cup of tea, I felt - could it be possible? - a slight headache. Uh-oh. Withdrawal.

When I started going over my IVF protocol with my RE, one question I asked was whether I needed to make any lifestyle changes. He was surprisingly negative on caffeine in any form while TTC (more so than alcohol), so when I circled the date on my calendar to begin my leuprolide shots, I knew that would also be the end of the road for my daily tea habit. I used up all of the green tea I already had and replaced it with decaf and herbal so I could still have a nice mid-morning warm beverage, and crossed my fingers.

Why do I bring this up now? Because for the last two days, my only symptom has been a low-grade but persistent headache. I hoped it might just be from dehydration, so I guzzled a bunch of water, but that didn't help. The other two likely causes are the leuprolide itself - and it totally could be that, it's a known side effect of the drug - but it could just as easily be caffeine withdrawal. I guess if it continues for the entire time I'm on the leuprolide, I'll know which one was the culprit, but for now I'm leaning towards lack of caffeine. So, in other words, I brought this on myself... sigh.

First Lupron Injection in 3, 2, 1...

So tonight, I am live-blogging my first injection of leuprolide acetate. Okay, so it's not really live - this is the Internet, after all, you have no idea when I'm actually typing anything or if it's even happening - but I promise I'm writing in real time. Near real time, anyway.

This is the first shot I am giving myself ever, which I guess isn't too surprising when you consider that injectable meds are rarely considered the first line of defense for common health issues. I just feel like I should be more confident about it. When I had my IVF orientation meeting I was so uncomfortable with the injection demonstration that I was all smiley and jokey with the nurse and said I had no questions just to get it over with. I was much calmer when we were going over paperwork. Paperwork, now there's something I can do.

The thing is that my questions about the injections are not the ones that she could answer. How much will it hurt? Will the side effects be really bad? Why do I have to do this to have a child and other people just enjoy a well-timed orgasm? (Edited to add: not much; still to early to say; nobody knows.)

Anyway. In preparation for this evening, I've been keeping an informal log of the various "side effect" symptoms I've experienced over the last few days of my drug-free existence, in the hope that I would freak out less when I actually had lab-made hormones running around in my system. For instance, on Friday, I had what felt like menstrual cramps (but weren't); they were bad enough that I considered actually taking some ibuprofen, but then they went away with no explanation. On Saturday, my sciatic nerve hurt intermittently. On Sunday, for about 20 minutes I felt nauseous enough that I was discreetly looking for places to throw up in public if necessary. Okay, so that last one was directly attributable to motion sickness, but my point is that life is full of random little ailments. Most are temporary. Many would never even be worth complaining about. They're no big deal. I NEED TO REMEMBER THIS.

But now I'm just stalling. Ready, everybody? Time to inject some leuprolide. My essential self-injection supplies appear below.

...

And we're back.

If you ever find yourself injecting hormones into your body, I cannot overstate the importance of having a frosted sugar cookie on hand. Please, don't take any risks with this.

But seriously, it wasn't that bad. I cut myself while shaving my legs a few days ago and that was ten times worse, pain-wise. I'm just so resentful that I'm doing this in the first place, which is something I didn't feel when I nicked myself in the shower. (Though maybe I should have been resentful that I was shaving my legs at all, in a sort of second-wave-post-feminist-join-the-sisterhood kind of way?) And I'm also driving myself nuts thinking about the giant hormone molecules currently dispersing themselves throughout my body, just dying to start trouble. I'll be keeping a close eye on them. :::shifty eyes:::

These Meds are Worth More than my Car

As we were walking into the hospital for my surgery, I caught a glimpse of a doctor in scrubs and a surgical cap through a window and I thought I was going to pass out. I said out loud to Harry, "This is the worst," and I almost turned around to go back to the car.

Yesterday, I picked up a Chinese-takeout-sized bag full of hormones, syringes, and antibiotics from the pharmacy. I had the same reaction when I laid it all out on the dining table at home. This is the worst the worst the worst the worst. These are the medications for a sick person, right? Look at how many of them there are! Look at all those needles!

Okay, Charlotte, let's calm down a little bit here. Take things one step at a time. What are these, and what will they do?

First up, the leuprolide acetate. Note that this is not brand-name Lupron, which I appreciate since my copay was significantly lower. This quiets down my ovaries to the extent that they tell my body I'm in menopause, so really, I see this one as an exciting little glimpse into the future. Side effects apparently include the following:

Leuprolide will cause an initial flare in testosterone or estrogen levels leading to bone pain, urinary problems including blood in the urine, and tingling in the feet and hands.
Common side effects: irregular menstruation, bone pain, sweating, dizziness, water retention, hot flashes, headache, nausea/vomiting, and pain at injection site.

Awesome. Next up, I think I can figure out what this one is:

Follistim will get my ovaries out of artificial menopause and into overdrive. Eggs? Did somebody say to make eggs? Hey everybody! It's egg-making time! I'm told this is the most expensive of my medications, so I'll try not to inadvertently confuse it with the cheese and butter it's sharing space with in the fridge. (I also probably shouldn't have accidentally dropped the pen and then kicked it partially across the room when I was trying to gather everything up at the pharmacy, but live and learn.) Side effects:

The most common adverse reactions (≥2%) in women undergoing controlled ovarian stimulation as part of an IVF or ICSI cycle are pelvic discomfort, headache, ovarian hyperstimulation syndrome, pelvic pain, nausea and fatigue.

So we have that to look forward to. Next is a single, unassuming little tube... Ovidrel! This one will make my hyperstimulated ovaries get ready to release all those eggs they just made - and it will be perfectly timed so my doctor can get in there 36 hours later with a scary-looking needle and grab them before they all head off for their various adventures. Ovidrel warns me:

The most common side effects in women using Ovidrel® include abdominal pain, injection site reactions, nausea and vomiting.

But after ovulation, the fun isn't over: for two weeks, and longer if I actually do get pregnant, I get to apply a "unique bio-adhesive gel" to my cervix, Crinone. Not going to lie, this is the only medication I am kind of curious about, because A. it probably won't hurt, and B. unique bio-adhesive gel? Sounds super space-age! Also, I understand that this replaces the progesterone in oil shots that other women have complained about, so I was pretty stoked to see it on my list of meds - even if it will be messy and gross. Side effect info:

The most common side effects of CRINONE (progesterone gel) 8% include breast enlargement, constipation, drowsiness, nausea, headache, and pain in the pubic area.

Let's not forget the various antibiotics I'll take for a few days at different points in this process, or the prenatal vitamins and baby aspirin I'll take throughout, or the additional meds I will have to start if I am knocked up. First, one thing at a time. Leuprolide acetate begins on Dec. 12th.