Tuesday, June 28, 2011

One is the loneliest number

Last weekend it was time once again for my monitoring ultra sound.  If nothing else at least it feels like this cycle is passing quickly.  As usual, I started to feel nervous in the hours leading up to the scan.  I won't drag it out and leave you in suspense, the results were nothing new.  One single 19mm follicle on the left ovary and good uterine lining.  I think we have successfully established that this 50mg dose of Cl.omid just gets me up to operating at a "normal" level of one follicle with alternating ovaries.  Normal is great...if you haven't been working at this for over a year already and had hoped to be pregnant several cycles ago.  I think we've finally established that if we aren't successful this round that we'll be doing something different next cycle, though I'm not counting us out this time around.

I did have a brief infertile panic attack before my appointment.  My doctor's office calls my trigger shot and progesterone supplements into a small specialty pharmacy that has a location right above their office.  I don't typically use this pharmacy for other medications and I usually only stop by when I have an appointment at my RE's.  Since my Saturday monitoring appointment was the first time I was going to be at the office this cycle I figured I would make one stop and show up a few minutes early to pick up my prescription before my appointment.  So imagine my surprise when I walked up to the pharmacy to find the door locked, the lights turned off and a sign that read they were open Monday through Friday.  My heart started to race as fears that I had just ruined the cycle filled my head.  I sent an urgent text message to my father, a pharmacy manager at one of the big pharmacy chains, to see if they happened to regularly stock the meds...they don't.  It was an IF nightmare, following my protocol to a T and putting myself through 2 weeks of hormones only to drop the ball at the goal line.  Luckily my nurse saved the day as she remembered that the specialty pharmacy had a location a half hour away that was open until 12:30 on Saturdays.   With the clock ticking away, once my appointment was done I hustled to get across town before they closed.  I made it just in time and breathed a sigh of relief that I hadn't screwed up the rest of our cycle.  I guess I will be making a point to get to the pharmacy sooner the next time around...if there is a next time around.

In addition to my panic attack I did get a nice little surprise while sitting in the waiting room.  Dr Love was on call that day so I went to the appointment by myself, which wasn't anything new as I've attended most of the appointments alone.  In the midst of trying to solve my shot dilemma I received a text from Dr Love that he was on his way.  The senior residents were kind enough to cover the floor for a hour in order for Dr Love to be able to come.  Even though it was only for a short period of time I know we both appreciated the fact that he was able to be there.  He wants to be involved but like a lot of husbands whose wives are having fertility treatments, he struggles with feeling out of control of the situation.  He's not the one taking the medications, dealing with the side-effects, or having regular dates with Wanda (the vag cam).  The only thing he can do is be supportive and one of the ways he can do that is to come to my appointments but his schedule has made it difficult to do that.  He definitely paid for that hour off the rest of the day and evening as there was a never ending stream of patients/admits at the hospital once he returned.  Regardless I think he'd say it was worth it to be there with me.

Now we wait to see if we finally got that winning follicle.  At the very least I find comfort that if we don't, we will have a more aggressive approach next round.  Fingers crossed.  

Friday, June 24, 2011

They're Heerrree

The interns are here, the interns are here!  The welcoming activities are officially in full swing and I'm interested to see how everything all turns out. 

We kicked things off with a resident sponsored welcome dinner last Thursday that we almost didn't make it to.  In typical expect-the-unexpected medical fashion, Dr Love got pounded with a stream of hospital admits that afternoon which had him running all over the place in addition to his regular floor work and was thus 2 hours late leaving the hospital.  As a result he came home tired, a bit grumpy, we were both hungry and 2 hours late for the welcome dinner.  We pondered if it was really worth going to at that point (would anyone still be there?) and I made the point that if anyone would understand the impact a bad day at the hospital can have on your previously laid plans it would be this group.  Despite all my logic of why we should cut our losses and stay home, Dr Love's team player attitude won and we made the drive over to the resident's house hoping there would be food and people still there.  Considering only 2 of the interns RSVP'd that they were going to attend the dinner, I was pleasantly surprised to see that 6 out of the 9 came and were still there several hours in.  Hooray we didn't scare them off!  Though really only 1/3 of them RSVP'd?  Come on folks maybe I'm old fashion but I've always thought work related events warranted higher levels of etiquette.  Rant aside we did have a nice time chowing down on carb-a-licious food and chatting with everyone.  A number of the incoming interns had that deer in the headlights look that I remember well from last year as you're the new kid on the block surrounded by people you don't know (though you will soon see them more than your own family) and you're about to embark on a huge journey.

Saturday was a bitter sweet day as we attended the graduation ceremony for the current 3rd year residents (even though they are here through the end of the month).  I'm sad to see several of them go.  This group played a big role in recruiting us to come here.  They were the first ones we socialized with and came to know.  They're strong doctors and good leaders.  They've been a valuable asset to the program and I'm sad to see them go. 

With this changing of the guard comes LOTS of other changes as well.  During graduation one of the attendings noted that Dr Love's class will go down in history as the last "true" intern year.  As some of you know the restrictions on interns have undergone a major overhaul.  Recently the AC.GME (THE grand poobas of ALL the residency programs in the US) decided that interns are now limited to 16 hour shifts, which is down from the 30 hour limit that was previously in place.  I can only imagine how prospective interns across the country breathed a sigh of relief since 30 hour shifts are not fun but this change has further reaching implications, particularly the necessity for a night float system.  Since what previously was one shift has now been split into two, the rotations had to be reworked in order to implement a night shift (aka night float).  I already hate call nights where I have to spend the evening alone, now there's going to be a whole month where I won't see him in the evenings (or possible at all) 5 days a week.  SIDENOTE: I really hope we're either pregnant by the time night float comes, though I guess it could make scheduling an IUI easier since he'd be free during the day.  Ah the joys of trying to work life around the demands of medicine. END SIDENOTE.

In addition to the change in work hours, the AC.GME also decided that interns need "close supervision."  No big deal right, except that the powers that be with the family medicine association interpreted "close supervision" as recommended in room supervision for a time period to be decided by the residency programs.  This means that for a certain period of time an intern can not see a patient, do a simple history and physical, anything, without a senior resident or attending present.  In essence they need a babysitter.

The current residents joke about giving the interns backpack leashes or creating intern-bjorns and just carrying them around everywhere.  The administration has assured everyone that they are working on a solution to make this babysitting time as short as possible but so far there's been no word on how they plan to do that. 

So we have smashed 2 residents into 1 and split what used to be 1 shift into 2 which equals (if my math is correct) more work for everyone.  Buckle in cause this ride just got more interesting.  In the end I'm sure it will turn out fine (if it's not fine it's not the end) but in the mean time I fear things are going to be a bit messy. 

Monday, June 13, 2011

Strike 3

Cl.omid cycle  #3 and mega follie were not the one.  As usual Saturday's test was negative with one lonely line and Sunday AF made it official by storming in.  I wish I could say I handled it like a champ and that I have a cheery / hopeful outlook for what lies ahead.  I wish I could say that but right now I can't.

In preparation for the possibility that Saturday could be a bad day, Dr Love brainstormed a list of things we could do to get our minds off of the BFN and lift our spirits.  First up was a nice 11.5 mile bike ride.  We hit the pavement only to find that our path took us head first into the wind.  I don't know if you've ever rode into the wind but even a slight wind can make things difficult and a strong wind makes it feel like you're peddling through quicksand.  Maybe it was just the frame of mind I was in but as we rode I felt like it was metaphorical of what we are going through.  I wanted to move forward but the forces ahead were working against us.  We paused at the crossroads waiting for the road to clear and then I threw everything I had into moving forward.  My legs and chest burned and ached but I didn't want to stop.  I didn't want to give up and give in to the forces that were making the journey difficult to reach the end.  We reached what I had remembered being the last stretch and I was relieved to be near the end but as we continued down the stretch it didn't look like the end.  I felt the tears start to well up at the thought of having to go further; my body was exhausted and I didn't think I'd be able to go further if we had to.  Just then I saw the end of the path, we were there, we had made it.

Obviously we haven't hit the final stretch on this ride yet.  So far it seems we've only come up to a number of crossroads waiting to move forward and throw all we have physically and emotionally into making it through the wind beating against us and down the path hoping this will be the last stretch.  Currently I don't see the end in sight but I don't know how much more I have to give.

In light of the recent emotional struggles we've had, Dr Love and I decided that we need to utilize our support resources more.  "I see my wife holding on by a thin thread and circling closer to being clinically depressed," Dr Love said.  Even though I knew this, it was hard to hear him say it out loud.  As such we decided to let Dr. Love's family know about our IF struggle and treatment.  It's a relief to know we no longer have to hide from them and that they are in our corner to support us.  Since they have gone through this before with my sister in law they understand the pain, heartache, and discouragement that we're going through.

Today I spoke with my nurse to get the plan for the next round.  Since we have told them that we would not consider selective reduction in the case of 4 or more embryos, and given my "optimal response" there is no change in my medications or dosages, they think we just need more time.  I trust their opinion and I know they want to get us to our end goal of a healthy pregnancy but the prospect of "more time" brought tears to my eyes.

I know I will rediscover my faith and hope in this process but for now I'm just going through the motions, hanging by a thread, and peddling as hard as I can muster the strength to do so.

Friday, June 10, 2011

Blue

I'm apologize for being such a bad blogger lately.  Hopefully there are a few of you still around and not all my readers have left.  Truth be told I've felt a little like this recently....

Sad, down, blue, depressed.  I'd like to say it's due to the hormones but I think that would be a bit of a cop out as I've had these feelings, albeit in fluctuating levels, for some time now though they've recently hit a high (or perhaps more appropriately a low) point.  As such I've had a difficult time thinking of anything to write lately. 

Now some may say that it is understandable and even a bit expected to feel depressed from time to time when dealing with infertility but the root of it is more than just our infertility.  Sure that is part of it but that is not where my frustrations with my body end.  Like most women I have struggled with my weight since getting married and my condition plus the medications make the struggle increasingly difficult.  I eat well...most of the time, and I've made an effort to add regular exercise into my weeks which is where my body thwarts my worthy intentions yet again mainly in the form of persistent and unrelenting shins splints despite stretches and new shoes.  I have so many good things I want to do but my body just keeps saying no. 

In addition to my frustrations with my body I've grown increasingly dissatisfied with my job.  The subject matter in itself is steadily losing interest to me and the environment feels cold and detached which I find odd when there are only five of us.  This is my first time working for a small office and everything I had heard lead me to believe it would a tight cohesive environment full of teamwork where everyone looked out for each other.  After being here for almost 18 months I realize it is not, it's actually quite the opposite and feels very individualistic and impersonal.  I work hard but I feel as though most days it wouldn't matter if I showed up and thus it's getting harder to convince myself to do so.  The obvious answer here is to find something else but fact of the matter is I don't know what I would like to do which is probably due in part to the last aspect of my blue mood.

Aside from my marriage (which is still healthy and strong), I feel like I've lost sight of what makes me happy.  I haven't been inspired to do much cooking, photography, crafty projects or write.  The general joie de vivre has dimmed and I don't know how to get it back but I know that I do want it back.  I do want to be happy with myself and have my passions back in my life but I'm struggling to know how to light that spark again.

Lastly I'm a bit afraid of what the results of this last treatment cycle will bring as I'm not sure how I would take another BFN in my current emotional state.  I know I have to test to find out but I'm dreading it.  I'm dreading those long minutes where you wait to find out if the weeks of medications and appointments have been worth it.

So that's it.  That's where I'm at.  I wanted to let anyone still reading out there know I hadn't abandoned the blog and give some reason for the radio silence.  Let's face it blogging can be a cheap form of therapy too.

I'm crossing my fingers that I'll have much better news to share in a couple days.

Thursday, May 26, 2011

Hey there big fella

Not long after I finished my Cl.omid pills last week, I started to feel something.  Twinges, pressure and discomfort emanating from the area of my right ovary.  The feeling is like an annoying eye twitch, always there and driving you crazy but you know if you could just stop thinking about it, it wouldn't bother you as much.  I hoped it was a sign that the meds were working, that something was cooking and all I could do was cross my fingers that it wasn't another cyst.  Today I got a peak inside to see what we are working with. 

Lefty who has previously been my follicle producing champ showing up each round has decided to take a breather this month and let Righty take care of thing.  And what did Righty decide to do when the ball was passed off to her?  She gave us one follicle, but oh what a follicle it is.  Big, bright and ready to burst at 27mm.  For comparison, previous cycles yielded nothing over 20mm at this same point.  It's no wonder my right ovary has felt uncomfortable for several days now, she's been hard at work and hopefully giving us something great to work with. 

Like last cycle it's only one but I'm not as bothered by it this time.  First off it's a big sucker and my nurse was thrilled with it.  Secondly with each medicated cycle they've grown bigger quicker.  Lastly I take a bit of comfort in knowing that this low dose of meds is getting my body to respond like a natural cycle, one mature follicle from alternating ovaries so I won't burn out on eggs. 

So tonight we give mega follie its eviction notice to push it out the door where millions of potential suitors are hoping to be selected for the cellular mambo.  I'm feeling good about our chances and can't wait to get this load of my ovary, she's been working hard and I think we both could use a break from the pressure.  Two week wait here we come.

Friday, May 20, 2011

Welcome May ICLW


It is that time again, time for the round robin of comments, conversation and virtual hugs we like to call IComLeavWe.  I can't believe how fast time flies and that it's already here again.  This is my second time participating and I'm looking forward to find some new blog friends.

If you are new to these parts there is a complete synopsis of our journey so far under the tab "How did we get here?"  Currently we are in the midst of our third round of Cl.omid treatment in the hopes that we can overcome my PCOS and get my ovaries to cooperate with our desire to add our first child to our little family.  As if any cycle didn't have some element of pressure, I'm feeling an added measure of pressure this time as my heart and head are telling me that we are running out of opportunities to do this on our own with out additional medical assistance and I am clinging to the desire to do this on our own out of the stirrups. 

My partner in crime on this journey is Dr. Love, a family medicine resident on the verge of finishing up his intern year.  We have been married for almost 2.5 years and I can't imagine anyone else I'd rather have at my side. 

Thanks for coming by, I hope to see you around here again.

Thursday, May 19, 2011

Wash, Rinse, Repeat

I admit I meant to write this post days ago but you know how it goes; life gets busy, you keep popping pills and then holy cow they're almost gone. I'm unsure if I like how routine this is starting to feel. There have been a few panic moments where I have to stop and think "did I take my pills today?" and I always have but since this is our 3rd round it's so routine now that I'm not thinking about it as much and it worries me I'm going to screw things up.

Our treatment for this cycle is the exact same as last time.
-5 tablets of 50mg clomid on CD 3-7
-14 tablets of .5 mg dexamethasone on CD 1-14
-1 shot of Pregnyl to trigger
-50 mg of progesterone suppositories after ovulation

Since I only grew 1 lonely follicle last time I was a bit surprised and disappointed that they didn't bump up the clomid dose but I can understand why.
A)RE's are not in the business to purposefully create multiples. Their main objective is to get us on our way to a healthy pregnancy and in the process of doing that multiples do happen but that's not what they're shooting for.

B)I appreciate their effort to mitigate the risk of cysts that could come with higher doses given how I initially responded and I don't want a repeat of the frustration/pain/downtime that came with that.

C) They apparently we really happy with that 1 follie, the nurse even emphatically called it a "beautiful follicle" when I talked to her for my instructions on cycle day 1.

In the end I have to trust that they know what is best even if it's not quite what I expected. They're the specialists who see it all day, every day, and they know better than I do what could happen. Who knows maybe righty just needed extra time to heal from the 2 cysts and will be ready to rejoin lefty in some quality follicle making fun this go around. All I can do now is wait until my ultrasound on May 26th to if anything is cooking or if we're in a situation of diminishing returns at this dose. I do take comfort in knowing that if my monitoring ultrasound shows no mature follicles, Dr M. has been known to go straight into another round of drugs (if everything else looks good) without waiting for a cycle. As with everything else, only time will tell...I feel like this is becoming my new motto.

Friday, May 13, 2011

Swing and a Miss

I was wrong about the last box.
I was wrong about my Easter monitoring appointment resurrecting my fertility.

I was right in not feeling confident about our chances of success these last couple weeks.  Of the things I've been wrong about I wished I had been wrong about that. 

Even though I expected to see a big ole fat negative it still crushed me in the early morning to see that one little pink line staring up at me without even a glimmer of a partner.  I crawled back into bed trying not to wake Dr Love sleeping beside me.  45 minutes later when he woke I rolled over into the nook of his arm and cried as he held me. 

The night before as we settled into bed I confessed to him how I was nervous about testing.  "I know," he said, "but I'm still optimistic."  The next morning as I sniffled and cried into his shoulder it broke my heart to hear how his tune had changed.  "This process is so frustrating.  I really try to balance things out and be positive for for the both of us but it just keeps getting thrown back in my face."

I think this failed cycle has shaken both of our hope and confidence.  I always thought I needed just a little cl.omid, get me to ovulate and we would be on our way to 9 months of pregnant bliss.  Now that we're heading into our third medicated cycle I'm left wondering what it is going to take, how far are we going to be pushed, and how much are we going to have to endure to become parents.  I feel like the number of chances to do this on our own, out of the stirrups, is running out...and apparently Dr. Love feels similar.  During a recent heart-to-heart talk about where we are at and what we think lies ahead.  We contemplated how many chances we have left and the possibility of having to move on to IUI, to which Dr. Love commented, "I'm wondering if we got to that point, since you're putting the time and effort into it, why not go all in and go straight to IVF."  Unexpectedly, my eyes welled up with tears at the prospect of moving on to IVF at some point.  Right now I am not ready to put myself through the physical and emotional strain of IVF.  I sincerely hope and pray that I don't have to get to the point where I need to be ready. 

Right now I wait for my friend Aunt Flo so that I can find out what the next step is.  Given my response of one follicle this second cycle I expect my dose of meds will be increased which makes me nervous about cysts coming back again.  I worry about getting in a pattern of increased dose-cyst-forced break-no response.  I deeply want to feel positive about this process and I feel bad that Dr. Love has to be positive for the both of us, however, it's hard to be positive when all I see/hear is NO.  Whether it is OPK tests or pregnancy tests all I've ever seen are negatives...will I even recognize a positive when it comes around? 

In the coming days, hopefully our feelings of hope will spring back and we'll have a more positive outlook on everything. 

Dang it Blogger!

For those that don't know, Blogger had a hiccup Wednesday night during some scheduled maintenance. Somehow I was able to publish a post yesterday morning bragging about Dr. Love's stellar job on my birthday, but then the Blogger Gods reverted the service back to a pre-hiccup time of Wednesday morning thereby sending yesterday's post (along with its lovely comments) and a draft I had planned to publish today into some mysterious black hole. The Blogger Gods reportedly have access to this black hole and are in the process of restoring posts, comments, and drafts to their appropriate place in the blog space/time continuum.

Soooo in the mean time I'm waiting not so patiently for things to be restored. I'm not trying to be dramatic and keep anyone in suspense, I just don't think I can effectively re-create today's post with the same emotion. Then there's the point that it would be just my luck to go through the steps of re-creating said posts only to then have the originals come back right as I published their poor replacements. It's like when there's a power outage and right at the moment you find the flashlights after fumbling around in the dark, risking bodily injury from chairs/tables/cupboards shrouded in darkness...the power comes back on.

Hopefully we're back to our regularly scheduled posting soon....possibly after the bad luck of Friday the 13th leaves. Coincidence? I wonder.....

Wednesday, May 11, 2011

Happy Birthday To Me

I appologize for going underground, M.I.A., AWOL for the past week. I wish I could say I've been off galavanting around the country or something else really exciting but I haven't. In all honesty the hormones have played a messy game with my emotions the last few days. Bummed, frustrated, cranky, it's been a revolving door of feelings not entirely of the uplifting sort that have made it difficult to be inspired to write anything. So while I'm still not back to my usual self I figured the least I could do is write about my birthday.

Last week I turned 29 and entered the last year of my twenties. I had to work on my birthday and historically Dr Love has a good track record of sending me flowers. I waited and waited but no delivery came. As I drove home I told myself I shouldn't have expected him to send me flowers and that it didn't mean he'd forgotten me. Imagine my surprise when I walked into the house to find not 1, not 2, but 3 bouquets of flowers around the house for me.





"I thought you deserved a house full of flowers," Dr Love said.

In addition to a house full of flowers, he gave me an accessory for my camera, and he made my nickname official with this....



a fleece jacket from our residency program with my name all over it. One of the billing administrators embroidered them for everyone and apparently Dr Love's request for mine got some mixed reactions; some thought it was a funny, a couple thought it was sad. Regardless the jacket is warm and I think my status as residency widow has been officially spread among the program.



Now after multiple nights of dinners with family and friends, and far too much cake, the birthday festivities are over. I'm looking forward at the next year, my 29th year, and the things I hope to accomplish in the next year, the dreams I hope come true, and where I hope to be when 30 rolls around. Here's hoping 29 is a great year and that they each get better than the last.