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.

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.