Roadblock

I'm glad I went for another ultrasound before doing the transfer. Yesterday afternoon I had another ultrasound followed by an appointment with Dr. S. The ultrasound revealed the same amount of fluid plus traces of additional fluid next to it. 

I then met with Dr. S. He pointed out the trace fluid and gave me three options. 1) Go ahead with the transfer despite there being more fluid 2) Cancel the transfer and do an endometrial biopsy, 3) Cancel the transfer and do nothing. 

We talked for a while and I asked for his best recommendation. He said none of those situations are ideal, but since we know a FET is less successful than a fresh transfer, it would be best to eliminate any other variables that may reduce the chances of implantation. He also said he would hate for it to not work and look back and say we should have waited. He looked at the ultrasound and my trial transfer and tried to determine if he could avoid the fluid. It was possible, but not the ideal placement for them. He was planning to place the embryos where the new fluid appeared. He doesn't know why the fluid keeps reappearing since I don't have a hydrosalpinx and there is no possible reason at this time. He recently rechecked my testosterone levels and they were normal (thanks Metformin!)  He's not sure we will be able to avoid this happening in the future, but it is probably best to wait and see what happens in subsequent cycles. It's not a problem I had doing IUI's or on anything ultrasound until last month. 

I opted for choice number 2. He did the biopsy right then and it was not fun. I wasn't able to take anything prior so there was a lot of cramping, but nothing horrible. It felt similar to an IUI but with much more cramping. I saw the tissue he removed and it was a decent amount. 

After the biopsy I went back into his office to get my prescription and paperwork to bring to the receptionist. At first he wrote me a prescription for oral progesterone and told me to take it for a week and then would start the protocol for the FET once I get my period. He then informed me that he is going to be out of town from Sep 1-11. We looked at a calendar and determined that if I took the progesterone and we started another cycle, the next time we would do the transfer would fall during that time he was away. He offered that the other RE in the office could do it, but I've never even met the guy. So, after some discussing with the nurse he decided to put me on birth control pills and keep me on them until he is back. That way he will be there to make any decisions and not have to communicate over the phone with the office during my cycle. 

In a sense I feel relief. I know this is the best decision and gives me the best chances for the future. I'm not sure why this fluid started appearing and has now become a chronic problem. I'm hoping giving my body a break for a month will help and the fluid won't reoccur in the future. 

I had the cyst and surgery and wasn't able to start trying until January. Once January hit we did the IVF that got cancelled because I got pregnant, a miscarriage in Feb followed by a D&C and laparopscopy #2. March was spent waiting for my cycle to start again after the miscarriage, I tried Clomid + IUI in April, injectables + IUI in May, Lupron started for IVF in June, IVF cycle in July was cancelled at the time of the transfer due to fluid, and a cancelled FET cycle in August. I need to step away and take a month off, forced or not. 

At the same time I am disappointed. Disappointed that this has been so difficult, disappointed that my body won't cooperate, and disappointed that I will be in limbo for another month. I need to step back from infertility and distract myself. I need to live life outside of trying to get pregnant and just be. This is going to be hard, but it is something I know I have to do. At this point I don't know how to not focus on TTC. We shall see how the next month pans out. As I left the office my RE apologized that we had to cancel the transfer again. My response, "I'm learning how to be patient." 

If it's not one thing....

I had my appointment on Friday afternoon. W wasn't able to make it since he was working, so I was nervous and anxious the hours leading up to my appointment. I was still bleeding and didn't have high hopes for a green light to start the FET.

 When I got there the ultrasound tech took me down to the room and told me Dr. S wanted to watch. I was shaking at that point. I told her I need Valium for all of my future appointments. Dr. S stood in the room with his arms crossed, looking at the screen. I think he was making us both nervous.

Well, my uterus looked great. It was clear of any fluid. This was such a huge relief.

Then the tech went on to scan my ovaries, and boom, huge cysts on each. I think the right ovary had 2 or 3 cysts and the left had 1. They weren't exactly small either (about 2-3 cm). Since I have had so many ultrasounds I knew the cysts as soon as I saw them. The tech told me to get dressed and meet my RE in his office.

At that point I was grateful the fluid was gone, but nervous as to what the cysts would mean. My RE then wanted to do a literature search about cysts and starting a FET cycle. Since he works in an academic setting and does research himself, he is always consulting the literature prior to making decisions. He even had 3 articles printed relating to PCOS and FET protocols that he had found prior to my appointment. Good thing I took classes about research and statistics so I can better understand when he pulls them and the technical terms out.

When he came back he told me that the cysts weren't going to pose a problem to the FET cycle. In fact, they may help if they are estrogen producing. That seemed odd to me, but I guess I don't need my ovaries to produce eggs this month, so the fact that they have cysts is fine. They typically prescribe estrogen during a FET cycle in hopes that it will build up your lining, so the cysts may help to do the same thing. My lining was at 4.7 on day 5 and he thought it was a little thicker due to the cysts. He prescribed me Vivelle patches and sent me to get my estradiol levels checked.

I have a protocol I will follow where every other day I change the patch. As time goes on, I increase the number of patches I put on until I am up to 4 every other day. I was able to get 8 patches covered by my insurance, but the rest will be OOP since that is a typical month supply. Without insurance the pharmacy quoted me $72 for 8 patches. This is going to get expensive quickly....

 I'm not sure I will get to the 4 patches every other day since we started on day 5 instead of day 1, and I likely have extra estrogen due to the cysts. He wants to wait until my lining is at least 8 before we do the transfer. The tentative date now is August 15 for transfer, but we will see. I have a feeling it will be sooner.

I kept my appointment for the 8th and they will check my lining then. It feels weird to be doing a cycle but not popping any pills or shooting up with any needles (is it possible to me a drug addict to fertility meds?) Estrogen patches are seriously anticlimactic. It doesn't even feel like I am doing anything. At some point I will start progesterone IM shots and will likely also do Medrol. This is a steroid that is given when assisted hatching is done.

My hubby and I have been talking about how amazing it would be if this cycle worked. The financial burden of fertility treatments is huge, and a big weight would be lifted if we didn't have to pay for another round of IVF. We can do it if needed, but I'd love to be able to spend money on things outside of making babies. The chances are better than it won't work, but I am holding some hope out for my little totsicles.

Clomid Dust

I am beginning to think I see my RE too often. When I enter the city Syracuse in my GPS, it automatically knows where I am going (I use the GPS to get an ETA). Speaking of ETA's when I use my GPS, I get such a sense of accomplishment when I am able to take time off from the projected time. It leads to more speeding, but makes me feel like I accomplished something while driving. I am so sick of rushing my Friday's to get to appointments on time. I don't want to cancel therapy since each session = more money, but it's starting to get to me. I am looking forward to not going there any more (someday). 

My RE had some fantastic quotes from this meeting:

1. "Your chart is starting to take on a life of it's own."

2. "I'm starting to think all I have to do is sprinkle Clomid dust in the room and you will get pregnant."

Well I wish getting pregnant was that easy! Really the appointment was just to talk about the plan for Clomid and IUI and my RE wrote a script for Provera and Clomid. When I took the script to the pharmacy they got a sketchy and then told me you can't write more than one prescription per page. He wrote both on the one page. Not sure if this was a mistake or something that is legal in other states (he moved from Atlanta this past summer). I am constantly amazed by how fantastic my insurance is. The meds were $13.00. 

We will not be adding a gonadotropin this cycle since my RE wants to see how I respond to Clomid. Now, each night I take 500 mg Metformin, a prenatal horse pill, 5000 IU's of Vitamin D, and Provera (tiny little sucker!). My RE did do a pregnancy test and it was negativo. Here's hoping last month was my left ovary's time to shine (if I even ovulated) and this upcoming cycle will get righty psyched to kick some follicle-growing ass. Reminder-no left tube. 

I did get to see my friend the dildo cam (#8) and ultrasound tech. Everything looked fine (according to her) and my file got a little thicker with those images. Does anyone else ever wonder where to put their hands while in those stirrups with a wand inside of them? Gets me every time.