Um yeah.  Please do.  

Given that Dr. Bigshot misdiagnosed the “adenomyosis”, totally missed the lurking embryo-as-cause-of-post-miscarriage-bleeding, has the bedside manner of a 3-year-old who’d rather be anywhere else, dislikes me almost as much as I dislike him, etc.  I really don’t trust him to a) do right by me by being as careful as he can possibly be. or b) remember how to operate the US wand + the needle at the same time.  

Big needle + Dr. Bigshot = panicky patient.  Oi.  

More after the retrieval at 10am.

And he was.  By, like, an hour.

Argh.

Good news is that even though my ovaries feel like they’re going to explode messily, I’m going to be ok til retrieval on Tuesday.  Although I do have to take an early antagon shot this afternoon.  Trigger shot is at midnight tonight, with new oral meds tomorrow (and an early morning blood draw to double check that the HCG injection worked.)  Then nothing til Tuesday am, bright and early – I will take off the whole day, and I’m already looking forward to it!  Transfer will be Friday, so I’ll miss the NY ComiCon, which is a shame, but I’m thinking that I really won’t feel up to hauling around all the freebies that vendors tend to load librarians down with on the pro day.  

Really good news is that he measured 8 follicles between 19 & 21 mm, and it looked to me like there were a ton he simply didn’t bother measuring.  This is still looking like a good cycle, despite my paranoid fears that my sore-to-the-touch breasts were heralding an early ovulation that was going to put the kibosh on this cycle.

(Sprogblogger breathes a giant sigh of relief.)

Now I get to start gearing up for big needles again.  Here’s to having to take 12 weeks of big needles, eh?

I just got a call from the tech telling me that they want me to stay on the 6 vials of Bravelle and the 1/2 dose of Antagon, but they want to up my dose of Menopur to 3 vials.  Which tells me that perhaps even the half-dose of Antagon slowed things down a bit more than they’d thought it would.  Ok, fine, glad they’re on top of it, etc.  Only thing is, Dr. Bigshot doesn’t want to see me until Sunday.  (And it will be Dr. Bigshot, she warned me.)

So tomorrow, I’m flying blind and hoping that this cycle doesn’t get entirely cocked up because he’s too bloody arrogant to deal with one more Saturday appointment.  Nevermind that I haven’t responded the way they’ve thought to ANY of the meds.  Nevermind that my doc has been watching me like a bloody hawk because of this, keeping me on an every-day-schedule since Tuesday.  No, Dr. Bigshot is going to skip a day – on the day he changes my meds.

I swear to dog, if this cycle goes overboard because of him I’m going to raise a stink you should be able to smell all the way across the country.  

Only good thing is that even if my retrieval happens on Tuesday, which is my doc’s day off, he’ll still be in the building and the nurse was pretty positive he’d still be doing my retrieval.  

Assuming I get to have a retrieval.  Assuming everything didn’t just take a turn for the rotten.

Nah, that’s not true – I felt badly for myself, too.  He’s rough with that damned wand, and he keeps my heels hiked up to my ass, and he doesn’t even turn the US screen so I can see.  He did grudgingly admit that I’m responding well to the stims, though, and said I’d be HCG’ing on Sunday or Monday for a Tuesday or Wednesday retrieval.  So that’s good.  I probably won’t even have to buy a few make-up doses of Bravelle.  

But, every time I go to the clinic, now, Dr. Bigshot is yelling at someone, or the receptionists are rolling their eyes and whispering about how Dr. Bigshot didn’t like their coffee mugs, for heavens’ sake.  

Now.  I’ve noticed that I’ve had the place all to myself recently.  When I asked, I was told that January is always a slow month at clinics, since people are recovering from the holidays, etc.  I wonder, though, if the economic downturn is more to blame.  I wonder if Dr. Bigshot is feeling a bit of economic stress – either personal or professional – and is taking it out on his staff (and on those of us patients who are not enamored of his reputation).  Whatever it is, I wish he’d get off it & go into his office and hide out for a while until he can be civil and calm.  Daily dildo-camming appointments suck hard enough that I’d rather not have to deal with a doctor’s angst on top of my own.  Not to mention the fact that all of my veins are now giving up the ghost and bruising when a tech so much as looks at them.  Ouch.  

My jeans are tight, despite having walked nearly 6 miles yesterday, and I’m bloating something terrible.  Not only that, but since we’ll be going to stepdaughter’s dance performance tonight, I’ll be administering my injection & a half in a public-restroom again.  Joy.  Maybe one of her classmates can glimpse me shooting up in the school potty & report back to her.  Oh blech.  

However, I’m feeling really good about this cycle.  I don’t want to have to deal with frozen embryos, but I really really want a chance to go to a 5 day transfer.  So, of course, I spent yesterday’s google-waste-of-time looking up success rate comparisons between 3 & 5 day transfers.  I’ve done the 8-celled embryo transfer – Baby, I want a blastocyst!  (Or two.  Or three.)

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.

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.

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.

I’ve got an appointment to speak with my doctor by phone this afternoon.  So maybe I can at least get some straight talking, and some goddamned answers.

Having to deal with Dr. Bigshot was bad enough, but the really bad news is that he only found 3 or 4 follicles during the US. Granted, he doesn’t seem to be the best “wander” in the world, but since I’ve been on the strongest stim dosages possible for 5 days, if there were more follicles to be seen, I think he’d've glimpsed them.  I asked if they were going to cancel this cycle, and he said that they don’t cancel cycles where the patient is already on maximum meds.  

So I’m trying to steel myself for the disappointment of this being a complete bummer of a cycle.  ie: not enough good eggs retrieved, or nothing that survives fertilization or culturing in vitro, or nothing that makes it to implantation.

Feeling very very hopeless and alone today.  The boy cares that I am upset, of course, but he really doesn’t understand.  He already has children – and a life he loves, doing what he loves, in the place that he loves.  I’m lucky to have him in my life, I adore him.  But the difference between us is that I’ve gambled everything in my professional and personal life in order to come to this horrid city, to work a job I never wanted, in order to try to have a family with him, and it’s just not happening for me.  Too bad, I lose.  And it feels like the ongoing disappointment is destroying the best part of me.  There are days when the weight of all of this fucking useless grief and misery just seems unbearable, and I look around me and wonder how many other people are carrying this sort of despair around.  I’m not sure I can do it.  I don’t think I’m strong enough.  

It’s my birthday this week, I’m turning 39.  6 months ago, on a lower dose of stims, I was able to produce 12 eggs pretty handily.  More than half fertilized, and four made it to implantation.  One pregnancy, one miscarriage, and one D&C later, my body can only produce 4 eggs.  At this rate, I might get one embryo to transfer, but it’s pretty crappy chances, since only one of the four transfered last time made it to a positive beta test.  

I need to start thinking in terms of donor eggs, and all of the advantages therein.  I could choose a donor with curly hair!  I could choose a donor in her early twenties so that we could make lots & lots of embryos to freeze in case the next time doesn’t work!  Maybe we could find a donor who is prettier than I am and smarter too!  All the genetic advantages for my sprog, and damn the cost!  I really wanted to make my own baby, though.  I wished to be able to see myself and my parents and grandparents and my brother and cousins in my child, selfish though I know that wish to be.  I wanted to pass on some of my physical and genetic self as well as whatever of my beliefs and ways of dealing with the world that a child of mine is going to absorb.  And it’s not the end of the world that it looks like that simply cannot happen for me, but I think I need a little bit of time to mourn this loss, on top of so many others.  

Crappy day, and now I get to go in to work until 8.  

Goddamnit, I miss my unadulterated DHEA high.  I could use a boost of artificial happiness right now.

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!

Not in so many words, but my doctor just basically said to me that Dr. Bigshot’s full of shit.

Ok, so not really, I’m reading between the lines here, but he did express professional disagreement with Bigshot’s insta-diagnosis of “worst case of Adenomyosis I’ve ever seen.” My doctor thinks this bleeding is just the result of my poor, over-abused hormonal system trying to figure out which end is up, and that we’re still just seeing varicosities on the ultrasound, because of their position relative to the endometrium & uterine walls, because I’ve had really no pain to speak of since the miscarriage, during my normal (hah) periods, etc. He also made the point rather strongly that a diagnosis like this should never be made on the basis of one ultrasound, at least not where the patient can hear you. He seems pretty confident that if I had a case of AM that was as bad as all this, I wouldn’t be functional for 3 weeks out of the month.

But, since my doc. also realizes that hearing two completely different things from professional colleagues is disconcerting, to say the least, and since this is something that can be definitively ruled out with an MRI, he suggested I get myself to an MRI center &, um, rule it out. A peace of mind third opinion to be the tie-breaker. So I’ll make the appointment, and have it done, but he seemed pretty satisfied that we were still looking at weirdo veins, but nothing new, nothing scary, nothing that would make it impossible for me to carry a pregnancy to term.

Especially since a good solid implantation was not a problem. At all.

Have I mentioned that I really like my doctor, and that Dr. Bigshot just pisses me off every time I have to deal with him? I think next time I have to have an ultrasound with anyone other than my doc, I’ll just pass & come back the next day. Because, really, my reproductive life’s too short for this kind of stressful shit.

If the big black holes currently taking up space in the wall of my uterus do turn out to be a wicked case of Adenomyosis, my doctor did allow that he would recommend against ever trying IVF again. He also seems pretty sensitive to how hard losing this baby hit me, and seemed to be recommending DE pretty seriously – I think simply because it has such a better live birth rate than using 38 year old eggs.

After talking it over with the boy, we decided that while I am not averse to using DE, I do want one shot of using my own eggs on DHEA. (Eggs on Drugs! Boy said it sounded like a particularly scary band, and I had to agree.) However, if we strike out, or if I miscarry again (and I would opt for a D&C with genetic testing), then we’ll probably go that route and not look back since we’re such a bad match for adoption.

And my doc gave me a prescription for DHEA, and told me to start taking it at any time. Supposedly, it’s going to make me feel like a teenager again. No, not in a good way. Pimples, greasy hair, crazy moodswings. However, I’ve always had blah skin, oily hair, and, er, crazy moodswings, so I suppose I could be one of the lucky ones that it just levels everything out, just like when I was pregnant. That would be nice.

Oh, and my HCG levels are down under 10. I’m officially not-pregnant. That’s nice too.

And, assuming I get a real period one of these days/weeks/months, we might be ready to start trying for a sprog of our own again in a month and a half or so. Which is good because I’m missing the needles, let me tell you. Actually, I’m just feeling old and used-up. I’ll turn 39 in a few months, and that’s just scaring me to death. Stupid prematurely aging ovaries.

So I guess, on a whacked out level, today is the first day of prep for my next IVF cycle.

Assuming I get another cycle, which I’m going to try very hard to keep assuming. Optimism. Yeah. I vaguely remember that feeling. Shall make the MRI appointment on Monday, since there’s no real rush, other than a need to know, at this point. And then I can settle into a nice long stretch of anticipation & crazy-making hormone manipulation.

Not that I know what that’s like or anything…