For those of you who follow me on twitter, you’ve likely heard the news already. I had a baseline ultrasound and bloodwork this morning. It’s CD4 of an induced cycle – meaning I didn’t ovulate last month so I had to take progesterone to induce a period.

Results?

The Good: I have NINE antral follicles. When I was first diagnosed with POF (Premature Ovarian Failure)/DOR (Diminished Ovarian Reserve) I had TWO. So this is definitely good news. My personal best, that I know of, is thirteen (although I think it went higher I never got specific counts). But I’ll take nine.

The Bad: Six of those nine are on the ovary with no tube. Leaving only three on the ovary with a tube.

I would prefer the opposite. But I’m still thrilled with nine. Based on my last AMH of 0.34 I was hoping for six (but not really confident I’d make it). In the past, although my AMH bounces around like it’s not supposed to, it always seems to correlate to my current AFC (antral follicle count) – When my AMH was 0.1 my AFC was 2 so I kind of just multiplied by three. Very scientific. 😉

The Weird: One of the six follies on the non-tubed ovary measured 12mm. And my lining was triple-stripe. Despite the fact that it is CD4 and I am still bleeding (although it’s been super light as usual) it looks as if I’m set to ovulate soon. The doc is not overly concerned about that, however. As your reserve dimishes, your cycles become wonky (don’t I know it!) and weird things happen. Although I have NEVER ovulated early, there’s always a first time for everything.

So I’m concentrating on the fact that I have nine follicles total.

There are still some eggs in my basket. Amazingly.

[Again, I wonder about changing my twitter handle.]

Assuming my HSG looks OK, I think the RE will approve this crazy IUI plan for next cycle. Which apparently may come earlier than expected. Although, knowing my body, and more importantly my ovaries, I’m not holding my breath waiting for early ovulation.

This will be my third HSG. I hate them but I guess it’s necessary. Depsite being suspected of having some tubal disease because of the 2nd ectopic pregnancy, I fully expect my remaining tube to be open and clear. Oddly, I trust it more than I do a Day 3 transfer.

Or maybe not “oddly” given past experience. And the fact that it makes no logical sense to me to suspect my tubes of being diseased just because my last embryo happened to wander up in to one. The docs put more stock in where the embryo journeyed to than where it was coming (running?) from. Personally, I suspect my uterus is just some really horrible inhospitable place and that’s why my embabies run screaming from it to anywhere else that might be more inviting.

Or maybe they really are just directionally challenged.

[Again, I ask for someone to create EmBabyGPS – the tiniest GPS known to man, so easy to use a not-yet baby can do it, and it comes preprogrammed with a map of the uterus.]

Regardless of what may or may not be going on with my embabies and girly parts…

…if you want different results – try something different.

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So… I haven’t posted in awhile. I think I start every post these days with an apology for being a bad blogger/tweep. Such is life. I’m busy. As in BUSY. Working full time, packing, planning a move that I won’t be able to make with Right Guy, taking care of Pops… I hate not being able to plan anything. Right Guy will be moving (as will our stuff) next month. I will likely move in with Pops. At present it seems like he may hang on for awhile. Which is good and bad. It’s great to still have him around but I can’t start my new life in Seattle until he’s gone. Bittersweet whirlwind of emotions. But that’s not what I want to write about today. Today I’m back to all things infertile and medical.

As I mentioned in my last post my last MRI showed that my uterus appears to be healing itself. Slowly. So I probably won’t need surgery. But I’m still benched from TTC/FET. However, that MRI also revealed lots of antral follicles. More than I’ve ever had according to my RE. I didn’t ask for an exact count. So she retested my AMH. My AMH was 0.1. Now it is 0.9. That is not supposed to be possible. Under other circumstances perhaps you would assume that one of the results was incorrect. Except that all other indications agreed with the results at the time. When my AMH was 0.1 I had 2 antral follicles, an FSH of 16 and severe hot flashes/night sweats. Now that’s 0.9 I have (presumably) >13 antral follicles and I’ve now been off my estrogen patches for 10 days. That’s the grand experiment. Will the hot flashes return without the estrogen? I’ve been more or less OK until today. There have been a few moments that may have been hot flashes or may just have been the 90 degree weather or the fact that Pops keeps his house at 80+ degrees. But this morning… no denying it: hot flash. But no night sweats. So that’s good. Those are the worst. I think I will try to stay off the estrogen for this cycle (assuming I HAVE a cycle) and then have my FSH tested on CD3 next month.

In conclusion [I feel like I’m writing a 3rd grade essay but I’m really only now getting to my point], in the grand scheme of things I’ve been getting lots of GOOD news lately. And I recognize that. So please don’t think I’m too whiny. All this good news is somewhat disconcerting because it defies logic. AMH is not supposed to go up. Pops is supposed to be getting worse, not better. Even when it’s good news it can throw you for a loop. It changes your reality. It was easier to plan next steps with the bad news. Now it’s impossible to plan anything. It’s like an interminable two week wait. You have no idea whether you’ll be able to attend that “kegger” because you might be preggo. 😉 Well, I have no idea where I’m going to be living or working in 2 months. Or whether I’ll have health insurance. I have no idea whether Pops will still be alive next week let alone 2 months from now. So I can’t plan a trip or even commit to an event more than a week in advance.

Oy. I just want to plan SOMETHING. So I plan to POAS for the first time in a long time. I guess I’ll start today. If I am going to have a normal cycle my LH should surge soon. Not that I can do anything about it.

This was my first injectibles cycle. I had put my estrogen patch on around CD21 of my previous cycle so that I would be “primed” for the next cycle if that one didn’t work. And it’s a good thing I did! On CD2 I had an antral follicle count (AFC) of 13. A personal best. This is the first time I’ve been in double digits so that’s really exciting for me! I fully credit the estrogen primer. And perhaps also the diet – maybe even more so the diet. Or it could just be that all these meds have “jump started” my system. Who knows? All I know is that each month my AFC seems to climb.

CD2
On CD2 I had a date with wandy and got the go ahead to start the shots: 150iu of Bravelle mixed with 75iu of Menopur/day.

CD3
First acupuncture appointment ever. It went OK. Not sure what I really think of it yet.

CD6
After four of those shots (CD 6/Med Day 5) I had another ultrasound. I still had 13 follies – but none dominant yet. My estradiol was 84 so they debated upping my dosage but decided to leave it alone.

CD9
On CD 9/Med Day 8 I had another ultrasound. Uterine lining was good at 7.4. I still had 13 follies (although I apparently lost one on one side and gained one on the other) and I had 6 follies over 10mm in the running(!). The six were all very uniform in shape and size (all ~ 11mm) so there was some worry about having too many follicles – especially with estradiol =333. This is an entirely new and unexpected problem for me to have. My dose is reduced to Bravelle 75iu + Menopur 75iu.

CD10
Second acupuncture appointment. Definitely relaxing. But I’m still not sure it’s any more relaxing or helpful than a massage. Or taking a nap. But I’m still keeping an open mind since I think I have been sleeping better at night.

CD11
CD11/Med Day 10: another ultrasound. I now have 7 follies in the running ranging from 11.9-14.6. Uterine lining is at 7.3. Estradiol ~600. This was a crazy day. The fellow who did my ultrasound really wasn’t sure what to do. So I had to wait on a call from my RE. Then things exploded. You can read about it here: Take A Walk on the Boardwalk.

chance card

I feel like I’m playing monopoly. I’m on Connecticut Ave (just before Jail) and somehow I pull a Chance card that says “Take a walk on the Boardwalk” and I whiz all the way around the board. I skip IUI entirely and GO STRAIGHT TO IVF. Um… wait. What?!

boardwalk cardIt was a HUGE decision to make and I had to make it in about an hour. But we’re going for it. It just makes sense. I’ve had an amazing response on my first injectibles cycle. Even before I started the shots I had a high (for me) AFC (antral follicle count) of 13. This morning I had 7 follies 12-15mm. (well one of them was 11.9). Here are the choices my RE gave me:

1a) Cancel this cycle. She considered the risk of high order multiples too great.

1b) Right Guy and I discussed moving forward anyway and just relying on selective reduction if we needed it. I already have the Ovidrel and the plan was for intercourse at home anyway. This choice was not sanctioned by my RE but we felt it was worth considering.

2) Try some shots of pure LH to see if that would stop the smaller ones from growing more while maturing the larger ones. I would have to drive to another city (20-30 mi) to acquire this medication and there’s no guarantee that this strategy would work so I’d still potentially end up back at option #1.

3) Convert to IVF. Gulp.

We have chosen option #3. And after making this decision, my RE says she thinks it’s the best option. She never thought she’d be having the IVF discussion with me. She’s completely mystified. She described my ovaries as “an anomoly.” She’s hopeful that this will work but says if I don’t get pregnant on this IVF cycle she will want to retest some of my levels (specifically AMH). This is not supposed to happen with numbers like mine (AMH=0.1 & FSH =16). So now she’s questioning the numbers. Although, if the numbers are correct, this is likely my only/best shot. So I’m taking it.

Double gulp.

But it looks like it’s going to happen. And soon. Egg retrieval will probably be this Sunday or Monday.

If anyone is curious about the exact protocol I’ve been one that has worked so well I’ll post it soon and then update here to link back to it.
UPDATE::
Here’s a link to the protocol specifics and results before IVF conversion: Bravelle + Menopur.

Good News & Bad News

August 9, 2010

So the good news is that I’m responding REALLY well to my shots.

The bad news is that I’m responding REALLY well to my shots.

I never ever dreamed I’d be in this predicament. I currently have too many follies. This morning the doc (not my actual doc but the fellow) didn’t seem too worried about it. He made it sound like a few would drop out of the running – no problem. So I took it as good news that I have 6 follies all measuring around 11mm. I never dreamed I’d get so many. But when he called me with the results of my estradiol he didn’t sound as confident. I’m not sure how much of that is due to the estradiol level and how much is due to what my doc had to say about it. But there’s definitely a chance that this whole thing gets called off because I have too many follicles. Apparently having my estradiol go up from 84 to 333 over the weekend is a bad thing.

And all 6 follies are really close in size – between 10.9 and 11.4. All uniform in size and shape. Which would be a good thing if there were a few less. I just can’t wrap my head around the possibility that this cycle might get cancelled because I have TOO MANY follicles. That’s not supposed to happen. That’s not supposed to even be possible. And to think last night I was nervous that it wasn’t working…

They’ve reduced my dosage. And I go back in two days to see how it’s going. Hopefully a couple of those perfect follies will just take themselves out of the running. Fingers crossed.

It seems I regularly get a handful full of visitors who find my blog by searching on “clomid + ovidrel timed intercourse” so I thought I’d post the results of my last clomid cycle.

Originally Cycle 3 was supposed to have been converted from a clomid cycle to an injectibles cycle because Cycle 2 was not a success. But I had a lot of other stress in my life (my father was hospitalized for pneumonia) so I didn’t want to spend the money on the shots when I knew I was already too stressed out to expect results. So I decided to give the clomid one last try. This time with an estrogen primer. The estrogen primer is crucial for me but is probably not necessary for most women. And just because I haven’t gotten pregnant with clomid doesn’t mean you won’t. It HAS made me ovulate which is something I don’t do on my own. So it’s definitely worth a try.

I definitely got a better response with the estrogen primer. Before I even started the clomid I had 9 antral follicles – my best number yet (at the time – my current cycle has even more). However, on CD12 none were mature. But they didn’t have too far to go. I had one follie at 14.5 and one at 15.4 on my right ovary with a small 10.5 follie hanging out in my left ovary. I waited several days to trigger so I don’t know exactly how large they got before the ovidrel. I could have ovulated 1 egg, 2 eggs, or potentially even 3. At least one of them *should* have been mature. But I can’t know for sure since my ovaries are like an Easy Bake Oven and seem to cook a little more slowly than most.

In any case, I DID ovulate and we had sex 3 days in a row. On two of those days I used a Soft Cup. This was the first time I used them. I can’t say whether they help or not but it definitely made me worry less about staying horizontal to make sure the sperm stay in there. And anything that makes me worry/stress LESS is a good thing. So I think I’ll use them again.

Again it was a BFN. Despite the stress of my father’s illness (which required a lot of my time) I was very hopeful for Cycle 3. It was the first time I had multiple mature follicles (or the potential for them anyway). I figured the odds of one of them being of good or decent quality were increased. So I was pretty crushed when I got another BFN.

I’m now doing an injectibles cycle with Bravelle & Menopur + Ovidrel. And again I’m hopeful since this time I have 13 follies baking in there. But again, the Easy Bake Oven is at play – they’re on slow bake. But I think they’ll get there. In their own time. I’m being monitored much more closely this time so hopefully I’ll have a clearer idea of how many are mature at trigger. At the advice of my RE, we’re still doing timed intercourse at home. I think I’ll push for an IUI next time if this cycle doesn’t work.

The Good: My Antral Follicle Count=13! Considering my AFC was 2 back in December this is really quite an improvement. 🙂 Also, I’m starting acupuncture tomorrow.

The Bad: I know what my AFC is because I’m not pregnant. Another BFN. 😦

The Ugly: I misunderstood the protocol so this cycle is going to cost me more than I realized. :-/

the good the bad and the ugly

Many thanks to all my supportive tweeps for the comments earlier today. My apologies for being AWOL from twitter. But I just need to hide out in my cave for a bit.