Plan B Update 4

Monday and Tuesday were brutally uncomfortable. I pretty much laid in bed on Monday evening and cried. Tuesday wasn't much better. We did the "trigger shot" on Tuesday evening. For this one, we had to mix the dilutant with the powdered HCG. Thankfully, S. was paying attention when the nurse showed us how to do it, because I was feeling so miserable it was hard to concentrate. S. did geat, the injection burned a little when it went in, and I also started feeling very sore where the injection went in. The nurse said I might get a big welt or bruise, but I kept checking all night and that never happened (but it was very sore).

Wednesday, I seemed to rally and felt much better, just felt like someone had punched me around on the insides. And the injection site was very sore, like I had a burn there or something. Also, my breasts were starting to be really sore.

So, this morning, I wasn't feeling great again. S. went in at 7:30am, I went in at 9:00am. I wanted him to go with me, but he was hemming and hawing and I wasn't feeling well, so I just left and went on my own.

When I got in, the nurse told me they wanted me to do supplemental HCG shots, but 1/4 of the dose of what we did on Tuesday evening. The supplemental HCG is to support the lining of the uterus and prepare for implantation and also support the ovaries as they recover from the stimulation (enhancing the ovary's progesterone production).

Then I stripped from the waist down and got on the table. She didn't pull the stirrups out all the way, so trying to get my ass to the edge of the table was quite a feat since my legs only bend so far. She eventually pulled the stirrups out further, that was a relief!

Next was the speculum fun. I HATE speculums, I think they are absolute torture. Did you know the first gynecological speculum dates back to around 400 BC Greece? In all that time, no one has come up with something more comfortable??

Anyway, she kept readjusting it because she had trouble getting good access to my cervix (possibly because it was higher in my body because hopefully I'm ovulating). It was pretty uncomfortable. Then she tried to put the catheter in, but it kept curling back when she tried to get it in, so she threaded and rethreaded it (while I was cramping) and readjusted the speculum, I'm just trying to breathe.

Finally, she got it in and pushed the semen in. Then I got to lay there for 10 minutes or so, which was good because I was pretty uncomfortable and crampy.

Then I got up and got dressed. They are so kind - they give you panty liners in case you have spotting or discharge. Last time, I was commenting to S. how these are the smallest panty liners ever, I refer to them as "Barbie pantyliners" that barely do the job for my apparently "extra wide" vicinity. I should also point out that, in honor of the special insemination day, I wore "Lucky Panties #1."

On my way to work, I felt kind of queasy, a bit dizzy, and pretty crampy. That has come and gone throughout the day, but I think overall I'm feeling OK. Besides, I'm told feeling sick is a good sign that things are working!

Before the nurse did the insemination, she said that all the nurses think we should name our baby "Hunky Dory." Maybe that's a good sign if they are naming the baby already!

Thanks all for your kind thoughts and shiny, happy, uterine wishes!

Plan B Update 3

Back to the doctor this morning for the 4th follicle/hormone check. Saturday, Sunday and today, I've been feeling very nauseated and headachey. Guess I angered the side-effect gods by saying things were going well and I didn't have a lot of side effects.

I think the people at the doctor's office are really pulling for me. The lady who draws the blood is always nice and I always say that the weather is always beautiful on days when I see her (which it is) and that we should play hookie. The lady who does the ultrasounds now calls me "Marce" and explains everything to me as I watch the ultrasound. At my last appointment, she and I even talked about mission work, since she said she would like to do health work in another country after she retires. The nurse who goes over the results with me and tells me how to do the shots is kind of old and crotchety, but she's been warming up to me and now smiles and says good luck. Sure, maybe they are like this with everyone, but I watch them call other people back to the exam rooms, and they aren't as nice as they are with me - they just call the names and seem to be all business.

So, with the ultrasound, she saw 11 follicles! 5 looked just about ripe, and those were all on my left ovary, which is strange because my right ovary was the one that seemed to be blossoming the most in the beginning, but now it's being a slacker. She said that happens sometimes. She also said my uterine lining looks exactly the way they want it to look.

After seeing the ripened follicle report, the nurse reminded me of the possibilities of multiple embryos and made sure I had signed the form stating that I understand the possibilities and would be willing to selectively reduce if needed. Having so many ripe follicles makes this more likely.

I went to work after dropping S. off (who accompanied me to this appointment which was nice). I spent the drive to work thinking about how I might feel if we did get many embryos and had to make those difficult decisions. It's heartbreaking to think that after all this trying, we might have to let go of some successful embryos. But I know it's what we might need to do to have a chance at a healthy, full-term baby. I wondered if they could take and freeze the embryos, or maybe donate them. But, as Depressionista pointed out, they will probably want to wait to see which embryos are developing best before they reduced any, and by that point they'd be too far along to freeze or donate.

The nurse called me later to tell me that I'm to do Follistim again tonight, then the HcG shot to trigger the release of the egg(s), and then we'd go in for insemination on Thursday morning. So, that's the plan.

I left work early and came home and slept for a couple of hours. My headache just wouldn't go away and I felt like I might puke pretty much all the time. After I woke up this evening, the headache has subsided, but now I'm having aches and pains in my abdomen and my breasts are very sore. I'm feeling extremely bloated. I feel like if anyone pokes me or if I sneeze too hard my ovaries will explode. So, I'm trying to take it easy, and hopefully things will feel better soon. I've been vacillating between feeling sort of OK and feeling like I'm dying.

Plan B Update 2

The shots have actually not been too bad - and I gave 2 to myself! Somehow, when S. does it, you can hardly tell, but when I did it, I made myself bleed. I think I was twisting it around too much or something. In addition, I've experienced very few side effects. I feel pretty nauseated for a couple of hours after the shot, but that's about it. I've had a few really strange dreams where I'm inconsolably emotional - angry, sad, depressed, worried - so maybe the emotional-ness is working itself out in my dreams.

After Monday's blood work came back, they had me continue the Follistim injections. On Thursday, I went back for the next egg/hormone check. We had hoped that we'd be able to do the insemination this weekend, but the eggs seem to not be "ripening" quite as fast as they did in the beginning (but thankfully they are still developing) so we are to continue the shots until Monday morning, when I go in for another check. I decided it was because S. wasn't giving me the shots that they slowed down, so I'm making him give me the shots again when he's around.

I was a little worried because we just had to pay our taxes and other bills, and the medications are SO expensive, I was hoping I'd be done with the injections by now. I'm taking 150 IU a day, and a 600 IU vial costs about $500 (about $120 a day). By my appointment on Thursday, I'd already gone through a 600 IU vial that I paid for and a 300 IU vial that they gave me free at the doctor's office (a "sampler" vial). When the doctor said I'd probably need to continue the shots, she said she'd check if there were more "samplers." She came back with a 600 IU vial! She said that sometimes when people don't need the vials they paid for, they donate them back to the fertility clinic. I thought that was such a nice thing! Someone else's generosity saved me $500.

So, now we continue with the shots and go back Monday morning for yet another check and hopefully this time we'll be able to move to the next step.

Tomorrow is our 12th anniversary. We've been trying for a baby for 9 years. Sometimes it's hard to believe that it's been such a long and difficult journey.

Plan B Update!

After some significant anxiety, the first shot went well - my husband gave me the first shot, and he did great. I was more worried about the side effects and being emotional. The only thing I've experienced is the hot flashes, which is nothing new for me during this fertility roller coaster. We started the shots on Friday evening, so we've done three so far.

This morning, S. and I went back to the fertility center to be checked. They drew blood, but I won't know the levels on that until later. They also did an ultrasound of my uterus and ovaries. My left ovary had one follicle, but that was probably the same one that they saw at the first ultrasound, which is likely residual from last month. But the good news is that the right ovary had 5 follicles! (Eggs grow on the ovaries in capsules of fluid called follicles - I explained to S. that it's kind of like a zit - and when it "pops" the egg is released).

Follicles are monitored by ultrasound to determine the number and size of the follicles developing. Probably not all of them will mature or release, but it's good news that I'm responding to the medications and we're on track for possibly doing the next insemination in the next 5 days or so. (Above is an ultrasound of several follicles - the "mature" follicle has the reddish dots around it. This is not my ovary, just an example)

So we keep hoping!

Plan B

Well, the Easter bunny's eggs didn't take. Luckily we have a Plan B (and C and D and E...).

The first 3 tries at intrauterine insemination, we did a cycle with ovulation induced by Clomid. Then I did ovulation predictors, and when it indicated ovulation, we scheduled insemination for the next day.

Plan B is different because now we are adding injectible hormones. So, days 5-9 of my cycle, I take the Clomid. Then, starting day 7, I begin injecting myself with follicle stimulating hormone (FSH) gonadotropins. This helps me produce several eggs and to control when they are produced.

After several days of the FSH shots, I will inject myself with human chorionic gonadotropin (hCG), which tells my ovaries to release the mature eggs into my fallopian tubes. If one of those ripe eggs meets up with a healthy sperm on its way to my uterus, we just might conceive.

When I went for my appointment on Tuesday, I had no idea what to expect. First, they took some blood to get a "baseline" of my hormonal status. Next, they did a trans-vaginal ultrasound (always fun when you're having your period) so they can get a good look at my ovaries as a baseline, too. Basically, they want to see what everything looks like now, before I start the hormone injections so that they can see any differences as they monitor my cycle.

Finally, a nurse sat down with me and showed my how to give myself the shots. I got a little kit with a Follistim (the brand of the medication) "pen." They really make this easy - you load the vial of medication into the pen, close the pen, screw on a needle, dial a dose, and then inject it into your fatty tissue (luckily I have plenty!).

The nurse ordered the hormones from a pharmacy, and I had to give my credit card. The hormone vials were delivered to my work because they needed to be refrigerated and I would be at work later. So, almost $700 later, my well-packaged little hormone vials were in a brown paper bag in my work refrigerator.

After 3 days on the FSH injections, I will go back to the doctor to be monitored with a trans-vaginal ultrasound and blood tests. I will continue to be monitored until the tests indicate that my eggs are mature. Then I'll give myself an hCG injection, which will hopefully cause me to ovulate 24-36 hours later. I will then be scheduled for intrauterine insemination in the next 24-36 hours.

Once again, we will give this process 3 tries before moving on to the next "plan" which would probably be in-vitro fertilization - which is something we'll really have to think about before we go there.

There is a 10-40% chance of my conceiving twins or more with these fertility drugs. While this would normally be an exciting blessing, multiple pregnancies for me would not be a good thing since I have incompetent cervix and I am at risk for miscarriage, premature birth, and other complications with even one baby, let alone more than one. I had to sign a waiver that I would consider selective reduction of the pregnancies if it becomes necessary for my health or the health of the baby(ies).

Success rates are between 20 and 60 percent. This is good since the cost for the whole process, with drugs, tests, and office visits is between $2,000 and $5,000 per cycle. Of course, none of this is covered by insurance.

I start the injections tomorrow, and since I'm currently involved in our board meetings, it should be an exciting emotional roller-coaster of a weekend!