I am a delinquent blogger, IUI#4 is done!

Thank you so much for all of the well wishes over the past week! I apologize that I haven't been better at updating. We did our IUI on Wednesday morning, though based on the complex logic puzzle that exists only in my head and consists of all types of crazy, I am unsure whether the timing was really okay. If AF arrives 14 days past the date of IUI or better yet, I am pregnant, we will assume that it was okay but if AF comes 10-12 days after my IUI, I'll have my doubts about the timing.

We did have TI the morning before IUI, so perhaps that could help the timing issue, if the timing of IUI was indeed off. Speaking of which, I know it's a little (read: extremely) personal, but our sex life has really been a disaster since I got pregnant in October. When I was pregnant, I never wanted to have sex, and then when I miscarried, not only did I not want to, but I couldn't. Since then, Y gets so stressed out and nervous about it, performance anxiety becomes a problem and then I can't help but feel rejected and "gross" (it doesn't help that IF has already made me feel ugly, untouchable, and angry at my body).

While I only had one mature follicle, we got another excellent count for IUI this cycle. Y gets embarrassed when I talk about his super swimmers, so I will just leave it at that:) I wonder if they'll bump up my Puregon dose next cycle. I am not feeling so hopeful about this cycle but I am kind of at peace with that. In the past, I feel like I have spent so much time actively fighting against my hopefulness so that I wouldn't be disappointed. Not being so hopeful makes me feel much calmer and more at peace - does that make any sense?

a less than enthusiastic monitoring update

Guess how many follicles I have on my first injectables cycle?? One freaking lousy follicle (sorry lone follicle, I don't mean to insult you - I still have great hopes for your future!). I have a bunch of 10s, but my dominant follicle is already at 18mm, so there's no way the little ones are going to catch up at this point.

I know that during FSH cycles they usually like to trigger a little earlier than during Clomid cycles and that 17-18mm can be considered mature, so I was confused and surprised when the nurse told me to take Puregon again tonight and then to trigger tomorrow night (Mon) and come in for IUI on Wed morning. Doesn't that seem really late? I didn't have LH drawn today, just E2 and prog levels, but I did get a neg OPK so I don't think I started to surge on my own. STILL Wed seems really late for IUI given that I am already at 18 today (and lining is 10.5mm). What do you ladies think?

I know that the first time on injectables is often just a crapshoot to see how you respond to a guestimated dose (for me very low to start, since I over-responded easily on Clomid) and it's better that we figure this out now on an IUI cycle than later on an IVF cycle, but I can't help but be totally bummed I only have one follicle (and of course now I am convinced that the IUI will be too late). I know it's really stupid and it doesn't work that way, but I don't know, I sort of hoped since it's my birthday I was going to get news that made me happy. I am trying to still have a little hope for this cycle and also to remember that if it doesn't work out, that's one more cycle closer to fulfilling the health fund requirement for them to fully cover IVF.

On FSH & fellowships

I feel like a huge baby saying this, especially since I am on such a low dose, but the FSH is making me feel kind of miserable (or rather something is making me feel kind of miserable and I am blaming it on the FSH...who knows, maybe I am just fighting a virus). The past few days I have felt exhausted, headache-y and also a little bit dizzy. I find myself counting down the minutes until I think I can appropriately and discreetly slip out from lab and also just being generally unproductive. Ironically, this is not so dissimilar from the way I felt during my brief brush with pregnancy.

With the Clomid I got many of the standard side effects (except for maybe the "Clomid Crazies"), but never to the extent that they affected my ability to function normally. I wonder if I feel this crappy on such a low dose of FSH, how will I manage if we need to up the dose? I was sort of under the vague (but perhaps misguided?) impression that people generally feel fewer side effects with the injectable FSH than with the oral anti-estrogens unless they are in OHSS territory. Also, what's the deal with all of this bruising? With the Ovidrel, which is also subq, I've never bled or bruised, but with the damn Puregon pen I am bleeding at the injection site (and then bruising) every night. Ah, I just need to suck it up.

In the end, we decided to forego the fellowship for now. After many discussions with each other, our families, and our friends, we consulted with a very wise friend who listened to all angles of our situation and helped us to identify the key things that both Y and I need right now. She helped us to realize that this might not be as good an opportunity as it originally seemed and that we will be in a better place in our lives to make such a big move in a year from now. By that time, we will hopefully (G-d willing) be pregnant with a healthy, viable pregnancy. If we are not it will have meant that by that time we've already had several unsuccessful IVF cycles and if that's the case, we will hopefully welcome the opportunity for a break and to re-think our options (adoption, donor eggs, etc.). I am feeling at peace with this decision, but it still sometimes startles me how much IF and our inability vs. desire to start a family has taken over our lives (at least it's for a good cause, right?).

I pray that at this time next year, Y will get a wonderful fellowship opportunity AND we will be with baby(ies) - I know that's asking a lot!

IUI #4 - the plan of attack

I appreciated all of your kind words so, so much after my last BFN. We are still in limbo re: the fellowship (probably more on that soon), but in the mean time, we have decided to move forward with the next cycle. Since I over-responded on Clomid in the past, which is obviously pretty lightweight as far as ovulation induction goes, we were hoping to keep with a low dose of Clomid a bit longer for our IUI cycles and then move to IVF if necessary when we felt ready, skipping IUI with injectables altogether. With IVF the over-response could obviously still be a big issue, but at least we would have control over how many embryos we transfer and if I did develop OHSS, we could always freeze everything and postpone ET. However, our RE suggested that we move on to FSH injectables for IUI #4.

It turns out that my health fund requires 3x FSH injectables/ IUI cycles before IVF for PCOS or unexplained IF. Our RE did say that he is worried about OHSS and HOM in my case with the injectables/IUI and that this is a common issue for lean PCOSers in particular, but that it's important for us to try it, starting at a low dose and with lots of monitoring, and see how it goes. I am a little nervous about producing a zillion follicles on FSH, but hopefully it will improve my egg quality over the Clomid, and it will be awesome if this is what gives us a viable pregnancy. In addition, I appreciate the logic that if what we have been doing so far hasn't been successful, and it's possible that IVF is in our not-distant future, it makes sense to be working towards that goal by fulfilling the health fund requirement of 3x FSH IUIs.

Of course, we really hope that I will get KU this cycle, but we figure if not, if the cycle is a technical success and we make it to IUI, I will continue with the injectables/IUI for 2 additional cycles and if the cycle is a disaster, we will pay OOP to go to IVF before the 3 injectables/IUI cycles are up (and if I am not feeling ready to make the leap to IVF now, I am sure if I make it to IUI #7 I will be MORE than ready). Much of this very hypothetical plan assumes that we stay in Israel and turn down the fellowship, so obviously this could all change completely. If anyone has more thoughts or experiences to share regarding the issue of FSH injectables/IUI vs. IVF among those of us with a tendency to over-respond, I would really love to hear it.

down down down

I have been feeling really down the past few days. IUI #3 didn't work (shocking) and Y was offered an amazing fellowship in his surgical sub-specialty that would take us to the U.S. for two years beginning in June (and therefore, most likely on a 2 year break from fertility treatments). He has been dreaming of this fellowship and planning for it for years. In order to attain a tenured, academic position he needs to do the fellowship.

Two years ago when we sat down to plan out the next few years, we decided to start TTC with the goal of taking a child with us on a fellowship in summer 2011. Of course now, in 2011, said child remains the same figment in our imaginations that it did when we had those initial conversations. It breaks my heart that in order for us to continue to pursue our goal of starting a family, he will have to give up his professional aspirations, at least temporarily. Who knows when an opportunity like this will come up again for him.

Logically, I know it's not my fault but on an emotional level, I am so filled with self-hatred and the feeling that I am in the one who put us in this situation (technically I did, but not because I could help it or choose differently). No resolution has been reached yet - I suppose this could go either way for us. Even as the time of the hypothetical fellowship approached closer and closer, Y. still always believed that we were just one cycle away from our forever baby. Too bad, he was wrong every single time. What's the contigency plan now? I have no idea, but I hate to be in this place. It just sucks. I know things could be a lot worse, but for now I am still so sad.

I Want it Now!

Veruca Salt is a girl after my own heart...

I want two lines

I want an embryo

I want twins and then everyone wins

and ...

Give it to me

Now!

I want the world

I want the whole world

I want a heartbeat

and two squirming little feet.

It's my time to have babies and I really want it

Give it to me

Now!

I want today

I want tomorrow

I want a big and growing tummy,

I really don't see

what exactly is so funny.

I want a carriage and rooms full of laughter

All of my dreams

And everything that I am after

Or I'm going to scream!

I want the works

I want the whole works

Morning sickness and baby kicks and many surprises

Of all shapes and sizes

And now

Don't care how

I want it now

Don't care how

I want it now!

Happy New Years! (and IUI #3)

Oh man, I can't believe how long it's been since I last posted! I fried the motherhood (sorry, motherboard, Freudian slip...but thought I'd keep it:) on my 3-year-old Macbook and am now waiting until my next trip to the states to replace it, so my computer time has been pretty much reduced to whenever I can sneak onto Y's computer or find a free few moments at work. Since it's been over a week, this post is probably going to be somewhat of a smorgasboard.

First, last Wednesday I went in for my CD14 monitoring ultrasound. Since in the past I haven't O'ed on Clomid CDs 5-9 until CD16 or 17, I wasn't particularly concerned that CD14 was too late. I was floored when the ultrasound technician mumbled "That's a little strange" (famous last words at most of monitoring appointments so that part in of itself was not particularly surprising) and then proceeded to tell me that I had two mature follicles at 25 mm and 26 mm already on CD14. The good news is that at least I didn't overrespond with a zillion measurable but not mature follicles this time, but it was still a little unsettling that they were that big at CD14 and also that I hadn't ovulated them naturally already at that size.

I was told to trigger immediately and return in the morning for our IUI. I worried that I would ovulate on my own before the IUI, and sure enough my temp was up almost a full degree the morning of the IUI. Strangely, I had a lot of discomfort and fullness on my right side above my hip bone a few hours after the IUI to the point that I couldn't stand or walk comfortably. Being Debbie Downer, I jumped to the conclusion that maybe one of those huge follicles was actually a functional cyst, but the pain disappeared by the next morning, so who really knows what was going on.

I don't know what the heck to expect this cycle, but as usual, I undulate about 30 times an hour between daydreaming about those two (very robust or very over-ripe?) follicles that are surely developing into healthy twins with a combined IQ of 500 as we speak and feeling sorry for my broken self who in all likelihood will face either another BFN or another miscarriage in the coming weeks. Thinking of all of you wonderful ladies, and hoping that in 2011 all of our wildest dreams will come true!