Round 3: Step 4 (Choices Pt. 2)

Yesterday was CD21 and I had yet another ultrasound. I am beginning to think we should have bought a place next to the hospital at this rate! Anyhow, I was able to see my doctor for the consultation afterwards so that was good. Usually you get the doctor on call but because of the situation I am in he said to see him after the last visit for a follow-up.

Once again there were no real changes No dominant follicle, lots of mediu, sized ones, etc... and once again he gave me choices but there were three this time.

1) Stop treatment and try again. I asked him if he would recommend this. Did he still think there was hope? He said yes. He said that some people do not respond for a month on their first round with Gonal-F because they do not know what dose works best for you. So, based on this I decided not to stop.

2) We could try In-Vitro Maturation (IVM). What this means is that immature eggs are collected (like the ones that I have now) and are matured in the lab for 24-48 hours. Once these eggs are mature they would be fertilized and transferred back into the uterus similar to IVF. You can read more about this and even see some pictures here. While this sounds great because it would mean I could stop the injections and speed things up it is not possible at the moment. This process alone costs about 4500$ not including the necessary medications. I realize we are already spending a lot of money but it is still far less than this. Even the doctor agreed that I am a bit to early in treatment to be considering this. But, it is an option if regular treatment fails for sure!

3) Last but not least, and the option I chose, was to up my dose yet again and see what happens. I am now taking 150 IU until Monday. If something happens (anything at all) I will either continue this dose or increase again for another few days. If nothing happens... we have some decisions to make I guess... I don't really know at this point.

I took my first 150 IU injection last night and that went well in itself. However, about 12 hours later to the minute I was hit with yet another splitting headache. This seems to be a pattern and the headaches are worse and worse with each increase in dose. It is for this reason that I have finally given in and I am now taking Advil as well. For the last month I have avoided any and all medications other than those for treatment but I couldn't do it anymore. The doctor said it was fine in moderation so I only take one each time but it has been working wonders so that's good! Also, I was given a syringe to extract the remaining drops out of each pen in order not to throw money away and on one hand I am happy that we can do this (I should be able to extract about 300 IU at the moment) but tonight I used that syringe for my injection and it hurts! It looks like the same needle as the pen but it is probably three times thicker. Now, I know that still isn't thick but when you are used to a "mosquito bite" it's a shocker! Unfortunately, I will probably have 2 more of those ones to come... Oh well... "no pain no gain" yet again.

Fingers and toes crossed everyone!

Squirrel Rescue

Today, I went into the kitchen to make lunch and saw something swimming in the pool. I realized it was a squirrel and went outside to find him struggling to get out of the pool. I got the pool net and managed to get him out (he swam right into the net and held on like he knew I was only trying to help) but he was exhausted. I put him in the shade next to the pool but then the birds started attacking him because he was whining so I put him in a box with shade, peanuts, and water to drink.

Then I called the SPCA, Animal Control, Shelters and NO ONE wanted to help the little guy. I was on the phone for over an hour and they all offered to euthanize him!!! I didn't save him to kill him!

So, once he got his strength back up I put the box near the hedge and he scampered away into the bushes.  I hope he will be OK!!! And NO MORE SWIMMING!!! I know it's really hot outside but pools are for people!

Round 3: Step 4 (Choices)

Yesterday was CD 18 and I had yet another ultrasound. I am beginning to lose count! On Saturday I had 1 follicle measuring at about 8mm on the right surrounded by a bunch of smaller ones and a "pomeganate" on the left so that side is being useless this cycle. Well, yesterday the one that was 8mm was now about 9mm. Normally speaking, follicles grow 1-2mm a day... even WITH injections, mine are growing about 1mm a week. This is due, in part, to being polycystic. The hormones I take are split across dozens of follicles rather than targetting 1 or 2.

I was able to see my doctor afterwords and he gave me 2 options. I could either stop treatment now and start again next cycle (or most likely the one after that, so July some time) or I could stay at the 75 IU dose until Friday and see if that does anything promising. I am still a higher risk for hyperstimulation so I have to be careful but I chose to continue at least until Friday and see what happens. I still have enough Gonal-F to get me there so why not? Another problem is that, as I keep being told, my uterine lining is responding really well to the Gonal-F and what happens when your lining gets too thick? AF arrives! Go figure, never getting AF used to upset me because it was a reminder that I wasn't "normal" and now that I don't want it, it's around the corner....

Now, why am I at home? The 75 IU makes me very nauseous in the morning and it also seems to give me headaches at night (although, none yesterday) and between the ultrasounds poking around and the pomegranate inside me I have cramps randomly throughout the day. Emotionally this is also taking a toll on me. I knew things were not going well but I didn't think I would have to make a choice to stop or not. Overall, I just need to take a break. I will be home until Friday and then I go back to the hospital to see what's changed, if anything, and then make more decisions. It's not easy... but (my) life never is!

On sick leave...

Hi everyone,

I will post more tomorrow because I do not feel up to it now... but for this week (at least) I am on sick leave. Nothing major, no need to worry. I had some difficult decisions to make today and I took the harder route. I will be at home because I am already drained physically and mentally and the next few days will be rough.

I am just going to spend a quiet night at home with DH and relax. Nothing more I can do right now...

Round 3: Step 4 (Damn oyster continued...)

Yesterday was CD15 and my third ultrasound this round after taking alternating doses of 37.5 IU and 75 IU since the last ultrasound. The hope continues to be that one of the 7mm follicles would have continued to grow and the others would have stayed the same or grown only a little but that there would be a larger dominant one. Well, no such luck yet again. On the right side, there was one at about 8mm and a whole bunch at 6-7mm. On the left side, she just said I was full of smaller follicles (picture the inside of a pomegranate - best analogy I have found to date). The only thing that seems to be responding well yet again is my uterine lining which I have heard each time, but what good does that do if the follicles don't respond? Nothing. Nada. Zip. Bupkus.

I have to continue alternating doses again until CD18 and then go back for another ultrasound. I also had to buy my third Gonal-F pen but this time I got one with 450 IU instead of 300 IU so that I should have enough for a whole week if this continues.

Some of you have asked me how much this has all cost so far so I ran the number yesterday out of my own curiosity as well. Oh, and none of this includes the daily Metformin for the insulin resistance, the Synthroid for my thyroid problem, or the pre-natal vitamins.Here is how it breaks down:

Round 1: 51$ for Provera and Clomid 50mg
Round 2: 85$ for Provera and Clomid 100mg
Round 3: 1203$ and counting for 3 Gonal-F pens (1050 IU) and my Ovidrel injection (yet to be used)

Thankfully, my insurance cover 80% of these medications so we have spent less than 300$ on this. However, they only cover me up to 5000$ in a lifetime so this won't last forever (and if we have to do this again for another baby there probably won't be much left by then). DH will be adding me to his insurance soon as well so we can offset more of the balance but they will only cover up to 2400$ in a lifetime so that one will run out eventually as well. They will also be getting a shock! DH has had this insurance for over 3 years and never made a claim... just wait until they see my bills!

That's it for now... at least the weather is good and we have a long weekend. We are finally getting some much needed work done in the yard which I should probably get back to... hopefully cutting down bushes will take my mind off things for a bit!

Round 3: Step 4 (Damn oyster…)

I mentioned the other day that I was a little discouraged and this has now multiplied exponentially. Normally I am not at the hospital much more than an hour or an hour and a half, but yesterday ended up being nearly 3 hours long and I spent most of it sitting and waiting because things were misplaced, other people had problems and I had to wait my turn, etc… not to mention that the ONE person I don’t feel comfortable with there is the one who ended up doing my scan and that just made me feel even worse. Honestly… when I heard this guy was a DOCTOR I nearly fell off my chair. He reminds me of a garbage man or an orderly at best… not a doctor! Very unprofessional looking and with the type of ultrasounds I have (internal and yes, vaginal) he is just too sleazy for my tastes!!! I felt like I needed a good shower and scrub afterwards!

Anyhow, yesterday was CD11 and my second ultrasound after taking 4 more injections at 37.5 IU (so 8 total now, or 300 IU). The hope was that the 7mm follicle would have continued to grow and the others would have stayed the same or grown only a little but that there would still be the larger dominant one. Well, no such luck. Welcome to the world of PCOS. I now have about a dozen follicles that are all about 6-7mm and no dominant (larger) follicle.

Initially, this sounds great; but, it’s not. I have been put on a new dose of medication for 4 days (and had to buy another pen for 300$); 75 IU one day, 37.5 the next, 75, 37.5… and then I have another ultrasound Saturday morning (CD15). The hope is that no more than 4 follicles will continue to grow because if I have more than that they will not be able to continue with IUI due to the risks and, due to PCOS, ovarian hyper stimulation is a definite concern right now. As I have mentioned before, I could always extract some of the eggs to freeze for future use with in-vitro fertilization (IVF) in order to decrease the amount used for IUI or just switch over to IVF all together but those are some very expensive options and I don’t have the mental energy to think about them right now.

And to add to all of this, my body seems to detest the 75 IU dose so far. I had a splitting headache less than an hour after taking it last night. I took some Advil and I managed to sleep from about 8:30 last night until my alarm this morning. And then as I was running around getting ready this morning I was hit with massive nausea momentarily until I threw up and then it was gone. Or so I thought… I have now been nauseous all morning and have cramps on my left side. Thankfully, I take a lower dose tonight!

So, to everyone who keeps asking me how I have remained so strong through all of this… I can honestly say that yesterday was the first time that I have truly felt as though I couldn’t handle this much longer. Every time I talk about the situation I can feel tears stinging at my eyes. Of course, I am sticking with it and looking ahead to the greater picture but right now I feel horrible and drained both mentally and physically. I just need a couple of days to get my strength back up so that I will be ready for the next appointment. And, while I have a huge support system surrounding me I realize that I am also a “pillar of strength” for others but I just don’t have the energy to deal with everything right now because I barely have enough strength for myself and my own problems at the moment. I am sorry that I cannot be there for everyone at once, but I know that you all understand and I am thankful for that. I will get back to those who have e-mailed me or left me messages as soon as I can.

The saga continues…

Round 3: Step 4 (Like an oyster cultivating pearls...)

So, I went for my ultrasound yesterday morning. No bad news, but no good news either. The only follicle I had was around 7mm in diameter, despite the injections. Now, seeing as I was only CD8 this isn't horrible as it is still early. So, I have to take the remaining 3 injections in my pen and go back for another ultrasound on Tuesday which will be CD11. The doctor did say that my lining was getting thicker so that indicates that something IS happening... we just aren't sure what at this point.

Now, I did learn something though. The reason I am on such a low dose (the lowest possible actually) is because there is a very small threshold for women with PCOS between having 1 follicle and too many follicles that grow to the correct size. I have 1 at 7mm right now but a whole bunch of tiny ones so they don't want to risk all of them responding at once. When I go back on Tuesday they will see if the remaining injections did anything and if not, my dose will be doubled to 75 IU for a short period. Apparently I don't have to wait another month to try again; they just keep increasing the dose for now.

I am not upset, but I am a little discouraged. I never thought that the PCOS would make things so complicated. Hopefully some progress will be made by Tuesday!

Keep those fingers crossed!

Round 3: Step 4 (tomorrow)

I just took my last injection and I will be going in for a follow-up ultrasound tomorrow, on a Saturday! I love that they are open on Saturday's. Anyhow, I have no idea what I did wrong the other day but none of the injections since have hurt at all. Maybe I was too close to a nerve or something. Whatever the reason, I am glad I made it through! Sure, there may be more injections to come but I can handle it.

So, what can happen tomorrow? Well... a lot of things. They could tell me that everything went really well and that I am ready for the hCG shot and IUI on Monday. They could tell me that things are progressing but that I am not quite there yet and have me do more injections. They could tell me it didn't work at all and I will have to try again next month with a higher dose. They could tell me a lot of things I am not even aware of! But, whatever they tell me, I am ready. This week went really well and while I hope they tell me I can move on the the hCG/IUI round, I am really just hoping they see SOME response to these injections... more so than with the Clomid. Even a small response is better at this point than nothing.

FIngers and toes crossed everyone! I will update tomorrow.

No Pain, No Gain... Right?

As I mentioned on Monday, a bunch of new tests were thrown at us at the last miunte. Thankfully, we got all of those taken care of yesterday morning and all of the results should be in by Friday so there is nothing to worry about. I have to say though, watching DH do a blood test was amusing. He is really not a fan of needles so he was all squirmy about it. He even had shivers down his back when we left the room LOL. Actually last night he was even saying his arm hurt. Geez! They only took 1 vile from him! The last time I had blood tests done (before this) they took about 7 viles! I would love to watch him go through that! Mean, I know : )

Also, I did my second injection last night. It didn't hurt at all on Monday but yesterday was a different story. I changed legs (as you are supposed to alternate) and was doing it at home on my own (without a nurse) so maybe that had something to do with it. But, no pain... no gain... so it is worth it!

Off to the notary tonight to finalize our wills and then on to injection 3...

Round 3: Step 2 and Step 3!!!

Would you believe I actually managed to find and buy a new purse all before 8am LOL. That was a good start to the day and it went mostly well from there.

The pharmacy called me around 1:30 to let me know that my injections had arrived. This was great timing because I had to leave for the hospital at 2:30. I picked up the injection and then went up to the hospital all on time. I checked in and said hello to everyone (I am beginning to be on a first name basis already) and went to sit in the waiting room. About 5 minutes later the technician called me up for my CD3 ultrasound!

My ultrasound was all clear, no cysts getting in the way! Then I met with the on-call doctor and he said that I should start the injections right away and, contrary to what my doctor wanted, he also said that DH would not need to do a semen analysis before the IUI.

Happy with the news, I went over to the nurses station expecting them to only teach me how to do the injection. Wrong.  First, we did an injection. I was scared in the beginning but honestly, I have been pricked harder by a rose thorn or stung harder by a bug! It was nothing. Then she told me that all of our blood work was out of date and needed to be done in the next 24 hours. Apparently they will NOT do an IUI if your blood work is not recent and since my IUI could be as early as Monday (in theory) we need to have it done. We are going to go first thing tomorrow morning. And, last but not least, DH DOES need to do his semen analysis... sort of. We could risk not doing it, save the 100$, and still spend the 400$ on the IUI. But, if it doesn't work we will not know if it was me or him and then he will have to go and do it anyway. So, I managed to find a private clinic that will do it between 8am and 8pm and only has a 2 day processing time so he will go and do that in the next couple of days as well.

I had no idea today's appointment was going to bring about so many other appointments but it's nothing we can't handle. DH is being a bit crabby about it... but compared to everything I go through he shouldn't really have anything to complain about. And, thankfully, my next ultrasound will be on Saturday so I won't have to miss work for it. If all goes well, my IUI could be in exactly 1 week!!!

So, that's that! I just finished dinner and I am exhausted so I think it will be an early night.

Happy Mother's Day

Happy Mother's day to all of the mommies out there. I am hoping to be one of you soon!

And to all of you who are like me, hoping, stay strong today!

Round 3: Step 1 (Naturally)

The other day I mentioned that AF had arrived... but, she didn't stay long. I went to buy the Provera on Thursday to kick start things and what do you know? I Haven't even started it yet and AF returned! And this time I think it is for good! So, I made my appointment for the ultrasound on Monday (CD3) and now I am just trying to find out if I can get the Gonal-F Pen in time.

Things are moving faster than I had expected...

New Treatments!

When it rains, look for the rainbow? I don’t know why, but for years now it has either rained or snowed every single time I have had an appointment regarding PCOS and today was no exception. There was only one time that it was sunny and that was the day that both of my doctors agreed to give me clearance to begin Clomid. Ironic, isn’t it? (Yes, I now have Alanis Morissette in my head!)

Now… things are changing gears a bit… ok, a lot. In the past, if you recall, I did Provera for a week, followed by Clomid for a week, had some ultrasounds, and was supposed to have an injection of Human Chorionic Gonadotropin (hCG) had that whole process been successful (which it was not – twice). Now, some steps will remain the same but others are completely different, somewhat scary, and others are just not what I was expecting!

Step 1: Since I still do not have a regular cycle, I need to continue taking Provera to begin AF.

Step 2: Once AF and CD1 arrive, I need to schedule an ultrasound right away. If the ultrasound shows a cyst remaining that is 15mm in diameter or more, I cannot continue with this cycle and treatment will be postponed. However, if there is no cyst I can continue on to the next step.

Step 3: Self-injections… FUN! I will be using the Gonal-F Pen which is a Follicle-Stimulating Hormone (FSH). The pen is preloaded with medication and ready to use. Dosing adjusts with a turn of the dial, making it precise for every injection. You can find an image or the pen here and there are also videos around the internet on how to use it properly if you are really interested. I will be starting on 37.5 IU and the pen holds 8 doses (300 IU). I will be taking 5 doses initially; once daily. Oh yeah, and this pen costs 300-350$! Actually, the pharmacy won’t even order it for me until I pay!

Step 4: On CD9 (or after the injections are done) I have to go back for another ultrasound. This is when they will assess the growth of follicles, see how many I have, and adjust my medication if necessary. I will keep going back for ultrasounds until I have at least one follicle that measures 18mm or more. And yes, this could be a daily trip to the hospital since we do not yet know how I respond! Once I have one (or more) follicles that are the proper size I will receive the injection of Human Chorionic Gonadotropin (hCG) which should make me ovulate in 48 hours or so. At this time, DH also has to “get to work”. He will need to produce a “sample” to be tested in the lab to make sure things are still ok on his end. This test will cost us another 400$ but for once, his name will be on the bill!

Step 5: We return to the hospital 48 hours or so after receiving the hCG injection. At this point, DH will have to produce another “sample” only this time… I will be having Intrauterine Insemination (IUI), otherwise known as Artificial Insemination. I had no idea when I went in this morning that I would be getting ready for this! A plastic catheter will be used to inject DH’s “sample” directly inside my uterus, bypassing the cervix and bringing the sperm closer to the fallopian tubes (where fertilization occurs). This increases the chance of pregnancy but we should also BD to increase our chances… and maybe add some romance to the otherwise un-romantic procedure.

Step 6: I have to have a blood test 16 days later to see if I am pregnant. If positive, I will have to have another ultrasound 2 weeks later to see if the pregnancy is viable.

Yes, there are a number of things that can go very right and/or very wrong in this whole process but it’s the next logical step to take. I am still trying to wrap my head around everything, figure out how to plan for the unexpected, organize schedules, etc… but it will come to me at some point, no need to hurry just yet!

Go figure...

So, I am seeing my doctor tomorrow about starting injections and what do you know? AF arrived on her own late last night!!! I guess this is a good thing. I was hoping to start Provera after seeing my doctor to give myself another week or so to ease into the injection idea but I guess mother nature had other plans. Well, if it is not a false start that is... we will see!

DH will not be coming with me tomorrow so if they have to teach me how to do the injections right away I will be on my own. Hopefully the CLSC can teach us again later so that HE can do them for me... still really nervous about injecting myself!