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Posts Tagged ‘clinic’

HCG = 11.7

…which is, of course, bad news.

It is not, however, the worst news.  Doc feels confidant that this is the remains of a chemical pregnancy, NOT an ectopic in process.  He said that if my numbers next week start rising up into the 30s, 4os, 50s, then we might have to reevaluate, but that this level of rise looks more like a few cells sputtering to a halt rather than something strongly taking root where it ought not.

Relief.  Pure, giddy relief.

Yay!  I’m not pregnant anymore!  Woohoo!

Ok, irony aside, it was a very good consultation.  We have a new game plan, and the idea is to put it into place almost immediately.  Like as soon as my period starts we’ll get going on cycle #3.  Like maybe next week.  Whoa.

Doc chastised me gently about my “womb of death” mindset, and said that in his not-so-humble opinion, it was more a case of ‘less-than-stellar embryos making an against-the-odds go inside a fabulous uterus’.  He was willing to come right out and say that he’d rather see a chemical pregnancy than no sign that anything “took”, and that if anything, it would make him more, rather than less, optimistic about giving it another go – either with my own or donor eggs.  Old though I am.

Since my insurance will cover one more go for me but a donor cycle will have to be pretty much out-of-pocket, the Doc recommended giving it one last try with my eggs, as long as I feel that my heart could stand the possibility of another walloping.  (This is why I like this doctor.  He actually thinks about – and voices – such concerns.  Well, that and the fact that he took a call from his wife while we were there, and I heard him call her ‘honeybuns’ & then he told her that he loved her even though we could obviously overhear, which I liked.  He’s a nice guy – a genuinely nice guy, which does make a difference to me.)

He spent almost an hour with us, answering questions, asking questions, offering options and ideas.  He also compared my two cycles and showed me how he was looking at The Plan at this point.

Interestingly, and something I hadn’t realized previously: although he retrieved the contents of 12 follicles in my first cycle, we only got 6 eggs out of it – the same number of eggs in this past cycle.  Which means that there was really no difference at all between the cycles in eggs retrieved & fertilized 6/4 both times.   Because of this, he suggested that this next time we should try a no-Lupron protocol.  It’s riskier, since I could accidentally ovulate OR conversely, the antagon protocol could stop follicular development cold when we have to put it into play.  Still, he thinks I might respond better to it than I have to the Lupron-based microdoses and get us a few more eggs to play with.  I like having something new to try, since simply upping the medicines didn’t do much good.  

And since at this point, some of my anxiety is due to the feeling that my range of options is shrinking, the idea of not yet using up my “initial, insurance-covered IVF” option sounds good to me.  The idea that I will be able to start this new cycle as soon as my period begins sounds even better.  Like, as early as next week.  He recommended getting going right away if I felt up to it – why waste all the hormones still hanging out in my body, seems to be the notion.  Plus, less time spent on evil DHEA this way.  Plus, actually DOING something instead of being placed back in IVF limbo.   Yeah, I feel up to it.  

And tonight I’m having a Guinness, I’m thumbing my nose at my medicine cabinet  while I dance my bruised ass away from all the pointy things, and I’m planning to waylay my husband when he comes home from his poker game.  

And I can start weaning myself off prednisone tonight, which makes me happy since it’s a scary-ass medicine and the less time I spend on it the better, even though I’ll likely start taking it again in earnest just about exactly when I’m just finished my last dose.

But that’s ok.  Going out to eat to celebrate the “no real fear of ectopic” news, (well mostly because we have had damned little to celebrate in the last month or so and we’re both feeling a bit ragged, and some wonderful food washed down with nice wine would be good for both of us.)  

I’m (obviously) feeling better than I have in a while.  I love having a Plan.  

*deep breath*

This isn’t the end, this is another chance, and I’ll take it.  I’ll grab it with both hands and hang on tight.

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So I got to work and immediately started looking for my box of meds that should have been delivered this morning.

Nothing.

I ate lunch, and jumped every time the bell rang but it was never anyone except a bunch of people wanting to come into the library before we’re open.  So I called the pharmacy.  I was pleasant and professional.  I used my librarian voice.  “Just calling to confirm that my meds were shipped out overnight & should be arriving today!” 

Silence on the other end of the line.

Turns out they never received any Rx from my doctor yesterday.   So I called the clinic, insisted on speaking with the nurse right away.  Used the word “emergency”.  She, of course, insisted that she did call in the meds yesterday and said she was going to have a talk with the pharmacy.

Yeah, that’s fine, but meanwhile, I’m without my meds for tonight.  So I made arrangements to go into Manhattan to a fertility pharmacy this afternoon, in between shifts on the reference desk.  Today’s also miserably rainy, and the subways have been on the fritz.  Several co-workers were late, due to subway messes, so it wasn’t going to be a quick trip, regardless.  Sort of a three hour lunch, which I’ll pay for in my check.

Meanwhile, behind the scenes, the nurse apparently did make a pissed-off phone call to the pharmacy, because I got a call almost right away from them saying that they’d located the vials I needed for this evening and tomorrow morning in a Brooklyn pharmacy, and they’d have them delivered to my workplace in Queens this afternoon.  As well as the buttload of stuff that they’d deliver tomorrow for IVF #3.  For insurance reasons it made more sense to just order the shit and worry later if I don’t need to use it.

*sigh*

The above was a sigh of relief – it looks like the meds emergency really has been handled (three cheers for living in NYC where oddball pharmacies stock Bravelle, and where courier-delivery of prescription meds is sort of the norm) – as well as a sigh of sadness.  I would really really like for this to be the last time I have to deal with infertility medications.  It’s feeling less & less likely, but it’s a sincere wish.  I wish I could be thinking of how best to raffle off fertility meds in another 9 months, as I dandle Sprog on one knee and try to clear out my medicine chest for important things like diaper rash cream and bandaids decorated with superheroes.

But in the meantime, I’m going to just concentrate on being grateful that my clinic came through after their(?) screw-up.  I have an appointment in the morning, and I’m desperately hoping we’re a go for triggering tomorrow night.  I’m starting to get very physically uncomfortable.  Here’s hoping for a Sunday retrieval!

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update

Got a call from the clinic to give me my estradiol numbers – 932 – and to tell me not to bother to come in tomorrow morning, but wait til Friday morning.

Shit.  This is not looking good.

Didn’t hear from the stupid mail-order company today, so I don’t know if anything went through.  Don’t know if I’ll be begging to take more time off work to go try to scavenge another few doses of Bravelle.

Going to sleep now.  Very pissy.  Very frustrated.

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…and we’re still holding out at least another day before triggering.

Dr. Bigshot was my doctor.  Again.  And he was 2 hours late.  Again.  Ask me how much I care about his presentation.  Answer: Not even a little tiny bit.

He wouldn’t tell me how many follicles he was looking at, though there were certainly more visible than last time.  By listening to his murmurred words to the nurse as he measured a few of them, I could hear that they weren’t growing quickly.  The largest – I think – was right around 17mm, though there seem to be many more that were smaller.  This doesn’t seem to bode well for my chances of a successful retrieval, and he – of course – couldn’t be bothered to tell me what his thoughts are.  “Is fine, is fine.”  Well, last time Dr. Bigshot assured me that “is fine,” my poor, failing-to-thrive embryo died in utero.  A possibility that I might have been warned about – or at least prepared myself for, had I been given better info on size, heartbeat rate, etc. – beforehand.  If I haven’t made myself clear yet, let me just say that I have no confidence in this doctor. 

And, unforuntately, he seems to be my new doctor at this clinic. 

Goddamnit.

(okay, deep breath.)  What I do know is this:  I’ll be triggering either Thursday night or Friday night, for a Saturday or Sunday retrieval.  If I trigger tomorrow, I’ll be learning to give myself the IM shot on the fly.  Damnit.  Though at least the boy will be around this weekend to pick me up and to do his manly duty in providing a fresh specimin, so we won’t have to rely on the frozen swimmers still in storage.  That’s a good thing.  

I should count my blessings, but this delay is also causing major problems with my insurance coverage for meds.  I will be out of Bravelle tomorrow morning, but my insurance only covers 3 “doses” of IVF meds and this is my second IVF.  So, rather than order the 10 vials or so that would see me through the end of this cycle, I’ll be getting a special rush order of the full 100 or so.  And if we go through a donor next time, I’ll just have to hope she’s prescribed Bravelle, or I’ll be paying for it out of pocket since my doctor didn’t prescribe anything as a backup, in case my low-responderness caused me to respond slowly.  Which it did.

Goddamnit.

I am so frustrated, feeling so out of the loop of this whole reproduction thing.  I work in a library.  With children.  And parents.  And I get so bitter with all these women mindlessly reproducing, having more kids than they’re equipped for, more kids than they want.  And all I want, everything I’m aiming for in my life isn’t enough to bring it about even with all the medical intervention in the world.   I think I’ll always – even if this does, eventually, work – carry around a little seed of bitterness toward all those women who are able to conceive by simply, you know, fucking the man they love.  I am tired of my whole life being contained in a several-inches-thick folder detailing exactly how physically unfit to be a mother I apparently am.  I am tired of being “the lady with the veins” or “ah yes, you are a low responder” or – my favorite – “this is simply a case of prematurely aging ovaries.”

Why thank you, yes, that’s me.  I am my disfunctional reproductive system.

And I’m tired of this clinic treating us all as if our time – all 15-odd women who were waiting for Dr. Bigshot this morning – was not nearly as valuable as his.  I’m tired of explaining to blood-techs that even though the vein in my right elbow looks good, it’s actually scarred and mutilated from the last 6 months of blood draws and will hurt like hell if they insist – no really.  Really!  Ouch!  Goddamnit that hurts!  And it’s going to bruise like a son-of-a-bitch.  Yes, next time I’ll tell you.  Again.  And you’ll ignore me.  Again.

Tired of everything hurting and being so hard.  Tired of all of this.  Just tired. 

Whiny, too. – in case you hadn’t noticed.

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Though it was another appointment with Dr. Bigshot.  Making me happy I stuck to my guns and forced my doctor to deal with my questions last week.  Argh.

Anyway, my pathology report came back from the D&C, and it was as suspected, nothing cancerous, nothing but what he expected to see.  

This morning’s appointment went a bit smoother than they have been going – Dr. Bigshot gave the impression of someone trying to make a better impression, somehow.  I’ve got at least 6 follicles developing, though they’re not growing as quickly as they might, they are growing at a workable rate – the largest were at 12 or 13 mm, up from around 7mm three days ago.  So unless I hear otherwise when I call for results this afternoon, I’ll be going in on Wednesday, and – I suspect – triggering that evening for a Friday retrieval.  

Why do I suspect such a thing?  Because the boy will be out of town on Friday, that’s why.  And the way my timing-luck has gone this cycle, that’s about the only day that retrieval COULD happen and still interfere with something I have no control over.  Argh.  He’ll bring in an emergency sperm sample to be frozen on Tuesday, and that should work out just fine.  I suppose it’s better this way than if I’m trying to give the trigger shot to myself.  Which would be scary.  

Won’t know much else until this afternoon, and even then, I expect the message to be no more than “continue with your meds as you have been and we’ll see you on Wednesday.”  

Off to take the dog for a run.  Fingers crossed and maybe the rest of this cycle will not be such an emotional roller coaster.

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…as it seemed this afternoon.  Ok, apologies for the earlier freak-out.  At about 3 or so, I finally got in touch with my doctor.  My real doctor.  The doctor who actually seems to care whether or not I lose my mind during this process.  Which still might happen.

He does not yet have the pathology report from my surgery.  I asked him to please make some inquiries and get it.  It’s been almost 2 months.  Surely it’s available by now, or a percentage of the surgery center’s biopsy patients would die while waiting for results.  I don’t care if everything looked fine to the naked eye.  If I pay $6000 for a surgery & pathology work-up, I want to get the results from said work-up.  No, I really do. 

Apparently, although Dr. Bigshot claimed that my doctor prescribed the Lovenox, my doctor claims that Dr. Bigshot prescribed it. 

(Sprogblogger throws hands up in the air in frustration.) 

Whatever. 

Regardless of who actually prescribed it, Lovenox is not being prescribed for a clotting disorder, but rather for a suspected immune disorder.  Not too surprising either, given my family history.  Good to know for sure, though.

Finally, and to my relief, my doctor looked into my file (the same file that was in Dr. Bigshot’s hand when I asked the question & received the ambiguous and upsetting answer,) and was able to tell me that at this point in my previous cycle, I only had 5 visible follicles even though he retrieved 12 eggs.  So, with that as evidence, my doctor said, “This is still very early days.  Your estradiol numbers are fine, you’re a low responder, but you’re definitely responding.  Therefore, given your documented history, we’re not worried at this point and you shouldn’t be either.” Which was the right answer to put my mind at ease.  (Instead of Dr. Bigshot’s response which was: “We do not cancel cycles at this clinic when patients are on the maximum allowed meds, like you are.”) Then he walked out of the room.  All the bedside manner of a Cossack, as my husband observed, (with apologies to Cossacks.)

*sigh*

Ok, I think I can safely say that the hormonal craziness has begun.  Don’t know whether it’s related to the mental breakdown or not, but I spent the day sweating through hot-flashes and fighting the urge to alternately weep and scream.  Plus my hands are shaky, which could just be the emotional upheaval.  I do not react well to frustration and fear.  Never have, and these days, it’s like I’m on a hair-trigger for panic-stations. 

I hate feeling so much at the mercy of my body and whatever chemical pool I’m swimming in at the moment.  In fact, I’ll go so far as to say that it’s what I hate the most out of this whole IVF nastiness.  Not the needles, nor the massive inconvenience, nor even the underlying uncertainty.  It’s the day-to-day battle with myself when I can’t be certain if the angst and terror I feel is justified, or if it’s hormonally induced.

I was very proud of myself, last cycle, when I refrained from handing my darling boy a letter (a screed)detailing all the ways I felt so very put upon.  I held onto just barely enough self-restraint to realize that it would be better, perhaps, to wait a few days to make certain I really wanted to say those things.  Turns out that was the right choice.  I really didn’t want to say those things, and I’m really glad I didn’t.  I think I need to apply that lesson to my dealings with people in general until this is all over. 

Deep breath.

Count to three million and thirty-three.

Stay away from Dr. Google.

Deep breath.

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So, I had my appointment this morning with – Dr. Bigshot!  Some of you may remember that he’s the one who failed to find the fetus still hanging around in my bleeding uterus a month after the miscarriage.  You might also remember he’s the fellow who cavalierly diagnosed “the worst case of adenomyosis” he’d ever seen, on the basis of a 2 minute US and told me that the best way to deal with it would be to get pregnant.  Not my favorite guy at the clinic, despite his Bigshot-status.

Today, he once again offered up that diagnosis, DESPITE the words “no MRI evidence of adenomyosis” being on the front page of my chart.  I mean, really, I know it’s an assembly line set-up there, but if the techs and the nurses can manage to remember my name and case, surely the doctor should be willing to read the most recent entry in a chart before letting his mouth run on?  I didn’t want his ridiculous statement to actually be entered in my file, so I set him straight and had the satisfaction of watching the nurse cross out the transcript of his words (which felt better than it should have.)  And gently (no, really!) reminded him that his last US also failed to accurately diagnose the cause of my two-month hemmorhage. 

He couldn’t find pathology results from the genetic testing after the D&C, nor could he tell me why Lovenox was prescribed this time around.  He’s guessing it’s a prophylactic measure, but I’ll wait to talk to my doctor before believing that one.   

What a putz.  But, he found antral follicles on both ovaries, and the DHEA hasn’t yet provoked any weird cysts or fibroids anywhere (at least not that he could find), so unless I hear otherwise in my bloodwork results at 4:00, we’re a go for the start of IVF cycle #2! 

I’ll start Lupron tonight, and then starting on the 2nd, I’ll move up to 2 Bravelle and 1 Menapur + the 2 Lupron each day.  Blech. 

Woohoo.  Needles and blood thinners and steroids, here I come!

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