Breathe in, breathe out

My new acupuncturist told me to do deep breathing exercises every day for 5-10 minutes. And so I tried it last night, just focusing on breathing. I do this with yoga, but I'm also moving around (I'm a vinyasa/ ashtanga yoga person), but just sitting, focusing on nothing but deep breathing is hard. She suggests that it will help improve my somewhat sluggish circulation and get my energy flowing again, so I'm willing to try it. Plus, relaxing can't ever be bad, right?

I think that I will be a bit more able to breathe deeply today because my monitoring appointment was just so. much. better. Not only did I get the really nice RE who always gives me a pep talk, has rational explanations for things, and is willing to say "I don't know" instead of making up some half-assed answer, but I now have 9 (NINE) follicles of at least 10mm (largest is 14mm) and some smaller ones showing up as well.

(Take THAT you mean nasty RE who told me my ovarian reserve was empty and that I might considering cancelling this cycle.)

My husband attributes the good appointment to the fact that I made him come with me at 7.15 this morning. Retrospectively, it was really kind of ridiculous, but I needed a security blanket and a shoulder to weep on if the follicle count still was very low. So he hung out in the waiting room for me and was there to give me a hug as I got on the subway. It seems like a small thing, but it was great, and made me feel like it was all going to be ok, regardless of what happened with the ultrasound. It's weird -- I'm usually not this fragile, but I think this is harder on me than I sometimes admit. And I love my husband for not telling me I'm being silly, but for just getting up and coming with me for no other reason than to hold my hand.

And since I have a bit more perspective (read: I'm not freaking out about hearing the death knell of my fertility) than I did Monday, here's what I know:
- I know that I am lucky that all my numbers are still good and I am still responding so well to the drugs, considering I am almost 40
- I know that I am lucky that there is nothing obviously wrong that needs to be addressed
- I know that I am lucky that I have insurance that covers absolutely everything, including acupuncture
- I know that I am lucky that I live within a stone's throw of some of the best REs in the country
- And in the big picture, lest I forget, I am lucky that I have a wonderful husband who will pick me up and dust me off when I am knocked down, I am lucky to have a family that loves and supports me, I am lucky that we are all healthy, well-educated, and have a lot more resources than many others.

So today I am going to feel relieved, happy, and grateful. Grateful that my life is, on balance, really good, and grateful that doing this ivf cycle is as easy as it is. And to ensure that I hold onto the sense of balance and peace that I am feeling right this very minute, I'm going to try to breathe.

Calmed down

OK. So I overreacted and was a bit hysterical. And I admit that. Because 3 today is still more than zero, and if there is any correlation to last cycle, I just start slow and then ramp up.

And I am responding, so that's good: E2 was 260.

It's just weird -- last time there were many more follicles (9) and E2 was 170. I think I just don't like it because I don't know what to expect, and every time I think I understand something and know what to expect, I get thrown a curveball.

And I, who like to control everything in the world around me, don't hit curveballs all that well. In fact, I'm more likely to end up with a black eye from not even seeing it coming.

I also think I freaked out because of the whole thyroid thing. But my full results came back today (in advance of my appointment with the specialist tomorrow) and everything -- seriously everything -- is really normal, and not even near the edges of the ranges. Free T4, Free T3, antibodies, T3 uptake -- I'm a picture of perfect health in this regard, and I don't have any of the clinical manifestations of hypothyroidism, and I generally feel just fine. So it's only this TSH that's off kilter, and hopefully tomorrow I will hear good news about the effect on my fertility (or lack of effect, actually).

So I've un-freaked out for the last 12 hours or so, and am trying to stay very positive and will think "oh you just stimulate slowly -- there will be more" or "really, you just need one" or "there were 12 antral follicles, you have a lot to work with" or (my current fave) "this RE was new and sucked at finding the follicles and counting." I'm pretty much thinking that all of these are possibly true, so I'm not going to freak out today.

Tomorrow? Totally a different question. I might freak out tomorrow. But today I will not.

More to come tomorrow after monitoring

Running out of time?

Today I went in for my first monitoring appt this cycle. There are 3 follicles, each at about 10mm.

Three.

Three is bad.

Last time after 5 days of stimulation there were 9, and I was anxious that it was so low, but then ended up with a whole bunch at the end (18 were retrieved).

Three is even worse because my RE upped my drugs this time to try to get me "up the curve" faster instead of all at the end. But apparently that is just not working. In fact, it appears to be having the exact opposite effect, which means I am panicking.

My RE is out of town this week, and so I saw another one this morning. Here's her comments:
"Hmm, this is very different than last time"
"This is quite disappointing"
"How old are you, again?"
"Well, your AMH levels look good, but this test is from 6 months ago."

When pressed as to why there would be such a difference, I get: "You know, I've had 2 patients in the last 6 months who were showing great ovarian reserve levels and had good response, and then just a few months later, their ovarian reserve just fell off a cliff, and they really didn't respond to the stimulation drugs anymore. Do you want to check on yours again? That test will be back in 3 weeks."

I told her that wasn't exactly reassuring. She didn't appear to be interested.

So in the absence of reassurance, I'm fucking panicking. I feel as if I've been punched in the chest and I can't catch my breath. I feel as if I am watching everything I wanted just turn to shit in front of my eyes.

And yeah, I know I'm being melodramatic, but I'm scared as hell that I've missed my window to make this work.

If it's not one thing, it's another

Today is day 3 of stim shots (cd4) and I'm wondering if this is all a big fat waste o' time.

Two days ago I went in to get started on this cycle and did the ritual early morning bloodletting. And because it has just been niggling me in the back of my mind that maybe my thyroid is out of whack, I asked them to run a thyroid test on my blood as well. And they did. And my TSH is 4. FOUR. That is still within some definitions of normal, but it's definitively higher than the 0.3-3.0 range that is recommended by many endocrinologists, and some recommend a range of 1-2 if you are trying to get pregnant.

So I freaked out post the RE's call. And made an appointment with the thyroid expert she recommended for this coming Wednesday, and then after work I took a look at previous blood test results. And right there were my results from my primary care provider showing that my TSH was 2.2 in January. And earlier tests from my RE have it at 3.5. So I don't know what to think or what I should do.

I went in for yet another blood draw yesterday and will have those results Monday, and I guess I can't really do anything until I bring those results to the thyroid endocrinologist on Wednesday. Except now I am wondering if this cycle is just a profound waste of time. I can't seem to find much research on this, except that hypothyroidism does cause recurrent miscarriage. So maybe I'm fine making the embryos and just freezing them if there is a thyroid issue? I seriously have no idea. All I know is that I am totally, utterly freaking out.

I don't even know why I asked them to run this test; my sister has severe hypothyroidism and I have had some variability in thyroid function in the past (borderline hyperthyroid in my youth, and borderline hypothyroid a year or so ago). I guess I'm glad I did, but seriously, I wish I knew more about what to do.

Do any of you have experience in this area and have ideas? I just don't know what to do....

Sheer force of will

Amazingly enough, merely by focusing all of my energy on willing my period to arrive, it did yesterday afternoon. And so, unless I hear back from the RE that something was wrong with the bloodwork from this morning, it looks like everything is good to go and I will begin shots tonight.

For those of you interested in the details, I starting with 300 IU Gon.al-F and 75 IU Men.opur. Last time I did 225 IU of the G-F, and it took a while for things to get rolling (ended up with 18 eggs, but had only 5-6 on day 6, and my E2 was lower than expected throughout), so we are going to try a more aggressive start and then coast a bit more at the finish.

I'm irrationally excited to get going. It's so much better than sitting around not doing anything. I'm just trying to eke out whatever sense of control I can over this whole process, and if control means mixing hormones and taking shots, well then so be it.

The one thing I am not excited about is stopping working out and my yoga classes. I know that seems odd, since I do a fair bit of whining about getting to the gym, but it's hard to build a base of cardio fitness and some actual strength only to have to stop all of that when my ovaries swell to the size of grapefruits. Also, the working out keeps me sane -- its just one of the things that I do to focus on something other than not being pregnant.

So since I'm now looking at basically a 3+ week time out, since I'm not supposed to do too much while waiting for the results, I'd love any good suggestions of things you do to keep fit/ keep sane while doing a cycle.

Guess what? I'm waiting.

I feel like trying to have a baby is one huge cosmic effort to teach me patience. It's like some children's fable where the girl who always wants things now Now NOW has to wait in some uncomfortable way to teach her a lesson that what she really wants is better if she patiently waits for it. (Alternatively, if this is an Andersen fairy tale, she gets cooked up and eaten by a witch because she was impatient.)

So yeah, I'm learning to wait, and yeah, I haven't died yet from the waiting, although I swear there have been a couple of times when I thought my head might literally explode. And I repeat things to myself like "it's only another week" or "what difference does a month make" or "in the grand scheme of things, 6 weeks isn't that much time." But really, I am seething under the surface, mentally trying to will this process forward.

Because it's all well and good for me to be a model of patience and forbearance, but it sucks mightily to watch every single other woman on the entire planet just go out and get knocked up exactly when she wants to and then enjoy life with the children she had no trouble creating. Why am I the only one who has to be patient, for fuck's sake? (Sorry, I'm working myself up.) I know I know I'm not the only one, but that is just how it seems to me, and it just feels shitty. And unfair. Really fucking unfair.

What am I waiting for this time? Since I stopped the bcps Thursday, I am now directing all of my energies towards willing my period to arrive. All indications are that it should be here some time real soon, and once it does come, I'm on the express train towards another ER. So please please please body -- hurry along already! I'm seriously going mad waiting for this cycle to get started.

Un-birthday cake

So I haven't been blogging all that much recently, and I think that's generally ok, because frankly there just isn't a whole hell of a lot going on with me, infertility wise.

Today was my lastest bcp and so now I'm waiting for the cycle to start again so that I can begin injectables.... I'm relatively sanguine about this whole thing, because this time we are not going to do a single embryo transfer, and since I've rationalized in my head that was the cause of the failure of my first IVF and FET, well -- this one clearly is going to work. Note to all of you paying attention: 1+1=2. So even if I had put those same two embryos back in at the same time, it's pretty damned likely that it would not have worked that way either. But I'm irrational about this and need to believe that this cycle is just the magic one.

Plus, I can't possibly reach 40 and not be pregnant, right? Please? Seriously, whoever out there is listening, I'm turning 40 at the beginning of May and I'm really worried that I am going to become totally unhinged as the day approaches if this cycle doesn't work.

I mean, I'm already 3/4 of the way to crazy most days -- if this goes bad and I turn 40 all at the same time? I suspect I'll need a padded room.

To ensure that I am fat (as well as crazy and still barren) on my 40th birthday, I have hidden away in my bag a piece of cake that I acquired on the way home from, well, from the gym actually. I'm kind of debating waiting on eating it until tomorrow, but what I'm really thinking is that a piece of cake and a glass of milk would be a perfect accompaniment to the Daily Show in 10 minutes. So cake it is. If only I could eat my way to a positive pregnancy test.

All's well with the nest

I had my very first saline sonogram on Friday to check out my insides. Turns out it isn't the most comfortable I've ever been although my RE did warn me that the saline was going to cause cramping.

Frankly, this was a lot less comfortable than the HSG, although everyone says that one is worse. My view: saline sonogram = bad, HSG = ok.

Initially, for those of you interested, it looked as if my entire uterine cavity was filled with some sort of mass, but with another pain-inducing squirt of saline it was gone and my insides were as clean as a whistle and looking just perfect. I understand that that second squirt saved me some unnecessary surgery, but it certainly didn't feel very good.

So while that's all good, I'm left thinking: if everything is checking out perfectly, then why aren't I pregnant/ a mother yet? I know that "unexplained" IF is often the diagnosis, but part of me really would like to be able to identify (read: blame) some cause or another. The "well, it's kind of a mystery" is really highly unsatisfactory.

So in my search to find a cause for all of this IF crap, I asked my RE about some of the tissue biopsy testing/ clotting issues. While she is certainly willing to run all of the bloodwork now, in her view there is nothing clinically pointing in that direction, as it's not like I am getting pregnant and then repeatedly miscarrying. So I am thinking I should let that rest until after this cycle.

I am, however, going to ask her to run a full thyroid panel, since I have had borderline thyroid function issues in the past. It just makes sense to me to be sure.

I'm really out of ideas of how to answer this "what's behind the IF" question, and am thinking that continuing to try is not really all that helpful. But it really would be more helpful to me than to just have generalized, unexplained IF.

Sigh.

Once more, this time with feeling

Since I am not pregnant, I now have my period. And since I have my period, guess what that means? It means I get to start another stimulation cycle in 2 weeks after I shut my system down with bcps for a while.

So, I guess, yippee?

I guess I'm enthusiastic about this cycle, since it means that there is still forward progress, but it's somehow less exciting the second time around. Maybe it's just that the novelty has worn off. But novelty or not, I have a big box of drugs in my closet, and went in for my day 2 vagicam and bloodwork today. So 2 weeks of bcps start now, and then hopefully I will be able to muster up the appropriate enthusiasm to not mind the shots so much.

I wish I felt something more than "meh" about this process right now. I just feel kind of let down by the magic of ART and my hopes for an insta-solution to our infertility woes have not been really fulfilled. I guess that was never realistic, but it sure would have been nice.

Really great pinot noir

Was had tonight. By me. And DH, but who really cares about that? And I drank a lot and am typing feeling somewhat woozy because guess what? I am not pregnant! Again! Awesome!

I have to say, even though I kept a little eensy glimmer of hope alive, still religiously took my meds, and avoided booze, rigorous exercise and hot tub/ sauna, I never really thought that my meager HCG number from Thursday would turn into anything viable. So I am not crushed, which I guess is good.

I'm actually trying to think about this as a positive trajectory:

- 1st transfer of 1 embryo -- negative

- 2nd transfer of 1 embryo -- low positive

- 3rd transfer of 2 embryos (we are going to keep the last frozen one on ice and do another fresh cycle) -- maybe a real positive?

I'm so doing all I can to keep my spirits up -- just getting ready for the next cycle and waiting for my period. But let's be clear, what I really want to do is to curl up into the fetal position and begin to cry.