My Hormones are Crazier Than I Originally Thought

The craziness of my hormonal mess did not end when AF showed up ten days ago.  Let me tell you what has been going on.

My basal body temperature was at 97.1 when AF arrived on cycle day one.  I had regular flow for three days.  On cycle day four, I was spotting.  I thought that I could start tracking my basal body temperature to more easily pinpoint ovulation this month so I have some semblance of *control* or maybe just knowledge of when my next cycle would be.  I was shocked that morning when the little window on my thermometer showed 98.0 in the dark at 5:30 am.  My usual cover line for charting is about 97.3 and 97.4.  The high temperature usually means post ovulation temperature shift.  Remember it was cycle day four only.  So what does that mean?  I of course would need more data since this could be a one time fluke.  But my suspicion was that I had ovulated from those follicles that I grew in the last luteal phase.  At that point, I was still spotting.  It was quite weird to think that I was bleeding and ovulated at the same time.

The temperature the next two days confirmed that I indeed ovulated as they were at 98.0 and 98.1.  I continued spotting for two more days.  I thought that the temperature would maintain high for another ten days or so like a regular luteal phase.  But nope.  It started dropping and I had light flow on cycle day 7 and full flow on cycle day 8.  I had my second full flow within eight days of my cycle.  Let me show you my chart so you know what I am talking about.

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I didn’t know that your body can bleed, ovulate on cycle day 3 or 4, then have a mini luteal phase, then full flow again.

Isn’t that messed up?  I feel like my body is screaming for me to stop taking any hormones and just rest and rest and rest.  Because of this strong sense I got, I actually did something that I had never done before.  I usually would go with the flow when my RE suggests a scan, or going forward with a cycle.  But this time, Bob and I made a decision for the next steps.  Let me explain.

I had emailed my nurse earlier this week to ask if my RE had any explanation for my crazy hormones, or maybe he had seen it before and could tell us what the next steps should be.  I really don’t want to recruit follicles so early in the luteal phase so I wondered what he would suggest doing.  I also had a question about whether or not my intramural or submucosal fibroids would interfere with implantation or impede the growth of a fetus.  I had an abdominal myomectomy in October 2011 to remove many tiny fibroids but they had already grown back the next year.  Every time I go in for a scan, a new doctor would comment on the fibroids.  I know that they exist but Dr. No Nonsense never said anything about them being detrimental to a pregnancy.  I wasn’t thinking much about them until my research on the donor egg Success Guarantee Program at San Dieg.o Fertility Center showed that they wouldn’t accept a patient into the program unless the intended mother does not have any submucosal fibroids or have surgically remove them.  I know that as long as my fibroids are not in the cavity, they don’t affect implantation.  But I just don’t know how these newer fibroids would affect my chance of keeping a pregnancy.  I emailed my nurse again and asked that.

My nurse didn’t get back to me until Thursday late afternoon.  She said Dr. No Nonsense wanted to see where I was at during my cycle.  I informed her that my basal body temperature dropped and I started having full flow again.  So in a sense, it was kind of like cycle day one all over again.  She then said Dr. NN wanted to have me go in for an ultrasound the next day, just to see where my ovaries are at.  (To that, my dear friend M answered, “Inside your body.”) And we could also measure the fibroids during the scan to see what state they are at.  I asked if it would make sense to take a break this cycle rather than moving forward with it.  She said that this is a discussion between me and Dr. NN.  So I scheduled the appointment and hung up.

However, all night long, I felt this nudge telling me to cancel the appointment.  I remember last cycle how I was kind of pushed into growing those follicles in the luteal phase and pumped myself with extra hormones from the Meno.pur and Gan.irelix.  I mean, no one forced us but my first instinct was to not push forward with follicles that were growing in the wrong phase of the cycle.  I don’t want to go into another scan being told to start meds and see what happens.  I truly want to give my body a rest.  I know I am 40 1/2 and approaching 41.  I know that I don’t have a lot of time to waste.  However, at the same time, I don’t want to push forward when I know that my body has been giving me warning signals to just rest and rest and rest.  So I was debating with myself to see if I could justify the need for a scan just to check on my fibroids.  After a discussion and understanding the situation, Bob voted for canceling the appointment.  I prayed and prayed for it.  I had peace in my heart, feeling that God’s will was for us to take a break regardless of what the scan would show.

My appointment was set at 2:15pm.  I emailed my nurse at 9:30 am:

“Please ask Dr. No Nonsense if I should still come for the scan today if I plan on taking a break this cycle to let my body rest?  Or if it’s still beneficial to check on the fibroids today to see if they will interfere with transfer next month?”

I didn’t know that Dr. NN would call me.  I felt lucky that I had my phone with me when I went to heat up my lunch.  I stuck it in my back pocket and it rang when I was in the kitchen.  We had a good discussion about my situation.  He asked me why all of a sudden I was concerned about my fibroids.  I didn’t go into the whole success guarantee program in another clinic.  I said I was just wondering about them.  He said that he wouldn’t have said to move forward with a transfer cycle if he thought that the fibroids were a problem.  My previous hysteroscopy and saline sonogram all indicated that my cavity was free of any polyps or fibroids.  Intramural or submucosal fibroids are fine for getting pregnant.  No one knows what they would do in a pregnancy until one gets pregnant. He said that removal of these fibroids doesn’t really help with pregnancy.  As long as I don’t have fibroids in the cavity, I am good to go.  However, if I am really concerned, I could do a saline sonogram again to make sure nothing is wrong.  He asked me how I wanted to proceed.  It comes down to the cost.  I would have to pay out of pocket if I did it at my current clinic.  Or I could ask my OB/GYN to do it and let the cost be part of my deductible for my health insurance.  I told him I would think about it.

As for my current cycle, I told him that I would like to take a break.  I didn’t ask him why my hormones are so messed up.  He agreed with me that my hormones are messed up and a break is a good thing.  So if we decide to put the cycle on hold, then I could just cancel the appointment in the afternoon that day, since the scan wouldn’t really tell me much about my fibroids.

I am grateful for this phone call with him instead of passing messages back and forth via my nurse.  After consulting with Bob, I called the clinic and canceled the ultrasound appointment.  I hung up and felt good that I am listening to my body this time.  I really didn’t want to go into an appointment, seeing some follicle growth, and be swayed into thinking that it would be a good idea to cycle again just because I would be scared of delaying yet another month.  I want my body to be in the most tiptop shape that I can be (whatever that means) before we try for one last time to make some embryos.

I hope that my body can feel my love and decide to cooperate again.  For those who pray, could you please pray for my body to return to hormonal balance?  Thank you so much.  It’s about time our embryos return home, a nice a cushy one that is ready for them.

What A Crazy Ride

I don’t even know where to begin.

This has gotta be the craziest, weirdest, most unpredictable, and shortest cycle ever.  So what happened?

Well, after last Saturday’s scan with the three follicles and my high progesterone which indicated post ovulation, we returned on Monday for another scan.  My appointment was at 8:15 and Bob got me there miraculously at 8:16.  Unfortunately, that didn’t translate to us being seen on time.  I had a 9am client and couldn’t leave the clinic until 9:05am.  Fortunately the client’s mom is usually very understanding and was okay with me being late.  Anyways, I was seen by Dr. Italian again.  The lining went back up to 10.4mm, but definitely not trilaminar as it was already in the luteal phase.  There were two follicles on the left ovary: 13mm and 11mm.  The right ovary had a little one at 8mm.  I was very confused about this and wondered about what this all meant.  Do I get to transfer if I get some embryos?  Dr. Italian made sure that he would tell Dr. No Nonsense to call me so we could personally connect on the phone to discuss about the cycle.  He did tell me to schedule an appointment for Wednesday to check on the follicles again.  He explained to me that sometimes they try to retrieve in the luteal phase.  It’s unusual, but it happens.

Since I was so rushed in the morning and had a full morning of appointments, I didn’t even check on my phone.  I had it on mute when I was in the clinic and totally forgot to turn the ringer back on.  I would usually have my phone with me in the lunch room but I was avoiding my pregnant coworker so I sat in my office having lunch and being on the computer.  I was oblivious to the fact that the phone was ringing in my purse at 12:51 and Dr. No Nonsense was trying to reach me.  By the time I discovered the phone call and voicemail, it was already 3pm.  All he said was that he wanted to push through the cycle to see if those follicles would grow.  He instructed me to inject 150IU of Meno.pur and one dose of Gani.relix.  After I listened to the message, I was saying to myself, “Huh?”

The thing is… I had ten thousand questions for him.  First of all, how good are the follicles that are made in the luteal phase?  If we move forward with a retrieval, would the follicles yield real eggs?  Eggs that are normal?  Secondly, this is supposed to be a fresh cycle where we would grow eggs, make some fresh embryos, thaw some frozen embryos, and transfer.  If we move forward with the follicles in the luteal phase, it would be a freeze all cycle again without a transfer because the uterine lining would not be the right phase, pattern, and thickness.  I needed to confirm with Dr. NN that this is in fact the case.  A freeze all cycle is only $600 cheaper than a fresh, thaw, and transfer cycle.  If we do a freeze all, the majority of the money that we had paid for this cycle would be gone, and we’ll have to shell out another few thousand for a frozen embryo transfer next cycle or even more money for another fresh cycle.  So this IS about money.  Anyhow, in the voicemail, he said that he would have a nurse call me with the instructions for the injections.

So I called the nurses station and got a hold of somebody.  I discussed with her about the plan.  I said I missed Dr. NN’s phone call and would really love to talk to him about the plan he had in mind.  She explained to me that the plan was to do the injections like what Dr. NN told me on the phone.  I re-emphasize my need to speak to Dr. NN, which she noted and said she would email him and let him know.

I went ahead that night with what I had to do.  I turned off my ringer at around 6:35pm for my bible study.  Dr. NN called at 6:41!  You know, I had bragged to Bob during the holidays that I had never missed one single phone call from Dr. NN in those past few months whenever he called out of the blue.  I couldn’t believe that I missed his phone calls twice in one day!  All he said in the second voicemail was that he agreed with the plan and just moved ahead with it.  Ugh.

I emailed my nurse the next day my availability so Dr. NN could call me again. She forwarded the times to him but told me that he just flew to Arizona and was probably very busy.  Since the two missed calls, I literally had my cell phone stuck on my butt (well, back pocket) all day long.  I called the nurses station again and spoke to the same nurse.  I asked if I was supposed to do the Meno.pur and Gani.relix again.  The nurse confirmed the plan and told me that she spoke to Dr. NN briefly who just told her to tell me to continue with the meds.  I re-emphasized that this is about money as well, since it’d cost us more to do a transfer next cycle.  I just really wanted to talk to him.  She said she would email him again with my concerns.  I didn’t hear from him at all on Tuesday.

Wednesday’s scan showed a 15mm follicle on the left, but the 13mm one was gone.  Instead, there was a 13mm follicle and an 8mm follicle on the right?  What the heck?  Where did that come from?  I was so confused.  The lining had grown to 12mm.  However, I had continued to spot and had been doing so for a few days.  I didn’t know if the mid-cycle spotting had any indication in how good or bad the cycle was going.  Dr. Italian said that the lining had no blood on it.  I told him that I still hadn’t talked to Dr. NN.  He looked at the progress of my follicles.  They had been growing quite slowly.  Just one millimeter or so a day even with injectables.  He was staring at the chart of my follicle growth on the screen and said that maybe we could do better next time.  To me that means that he would cancel this cycle if he were my RE.  But he emphasized that I should discuss this with Dr. NN and come to an agreement with him.

I called the nurses station yet again and spoke to the same nurse.  She said that they do luteal phase retrieval with cancer patients all the time.  I asked her about transfer during the luteal phase.  According to her, it could still be done with the right lining and low progesterone level.  I was listening and not believing what she said.  I don’t think that a transfer in the luteal phase would be optimal, especially for someone like me who has so few embryos to spare.

My phone continued to be with me all day long.  And Dr. NN did not call me until I was lying on the table at acupuncture with needles all over my body.  We both exhaled a sigh of relief that we finally connected.  He kept apologizing for being so busy.  Right off the bat, he told me that if we wanted to do a fresh cycle with a transfer, we’d have to cancel this cycle because we can’t possibly transfer with this lining.  If we wanted to gamble and see if we would get some eggs, then we should proceed and continue with the injections.  He said that there is no way of knowing if there would be any eggs in the follicles or if the egg quality would be different/worse in the luteal phase.  He said that in the cases that they had seen, it didn’t really quite make a difference in the quality.  And to him, my mid-cycle bleeding was irrelevant to the decision.  So basically, what he said was, it was up to me and Bob to make that decision.  If we decide to cancel, then just call the clinic and cancel the ultrasound.

I thanked him and lay on the table with all these needles on me.  I didn’t fall asleep like usual and my mind was going 100 miles per hour.  I was wavering between moving forward with a chance to make an embryo or two and stopping the cycle so that we didn’t have to waste more money.  I was doing math in my head.  I was thinking and worrying about the quality of the eggs.  I was just not at peace.  I didn’t know how we should proceed.  I finally prayed and asked God for clarity, direction, and peace.

Bob came to meet me at acupuncture.  On our way home, we discussed all the various factors into making our decision.  We got home at 7pm.  We had about two hours before we had to do the injections again.  I continued to waver.  Bob said to wait until the next cycle, but said he would be okay with moving forward with this one.  He told me not to worry about the money part because we do have some money to spare.  Do we want to risk having eggs that don’t fertilize, or not even having any eggs at retrieval?  I honestly could not answer that question.  But then I also didn’t want to give up the chance to potentially make an embryo or two.  I was so torn.  At 8:30, I emailed Elisha and asked her to pray for this decision.  (I love you girl.  You came through quickly with a great prayer.  Thank you so much.)  At 9pm, we decided to move forward with the cycle so we did the injections.  Honestly, I was okay with the decision but had a tiny hesitation in the back of my head questioning whether this was the wisest thing to do.  I still wondered about the money.

Well, God made the decision for us.  Last night, my so-called “mid-cycle spotting” got heavier and heavier.  It almost felt like a precursor of my period.  This morning, my basal body temperature dropped to 97.1, which is below cover line.  My bleeding had gotten heavier.  Cycle day 16 had become cycle day one again.  My luteal phase was only seven days long.  This has got to be the shortest luteal phase for me ever.  My cycle was only 15 days, with a 8-day follicular phase.  How messed up is that?  This is the first time that it has ever happened to me.  And this happens to be the cycle we’re supposed to transfer.  So I was wondering if we could still do a retrieval during AF?  I was still hoping that those follicles would grow.  Well, they didn’t.  Today’s scan showed that the 15mm on the left had shrunk to 13mm.  The 13mm and 8mm on the right were 8mm and 8mm.  So the follicles failed to continue to grow.  The lining had gone down to 10mm again.  Dr. Italian and I discussed about maybe taking a break from any meds for one cycle and resume in mid-February.  I thought it was a good idea.  He wrote a note to Dr. NN about today’s scan.

When I left, I was feeling relieved and at peace.  God made a decision for me and I actually feel that a weight has been lifted off my shoulder.  The unknown of the quality of the eggs, if any, would continue to haunt me if the follicles continued to grow.  If we retrieved but didn’t get any eggs, that would have been another blow to our journey and we might regret and question our choice.  I was feeling very good all day long.  I hadn’t felt this good since the beginning of the cycle.  It had not been a good cycle:  humungous cyst, cancelled cycle, resuming the cycle, taking Fem.ara, no follicle growth, high progesterone and temperature indicating extra early ovulation, follicle growth in the luteal phase, having difficulty reaching Dr. NN, doing injections in the luteal phase, mid-cycle spotting, and worrying about the money and quality of the eggs.  All of these made the cycle a bit stressful with all the unknowns and my inability to reach my own RE.  I was mostly zen throughout this whole thing until last night.  God came through and quickly showed us that this is not the right way to go.

I did waste 3 doses of Ganir.elix.  We have three more at home.  It would be a bummer if we need some but don’t have enough next time.  But it’s okay.  We have given our everything for this cycle.  We don’t have regrets that it didn’t move forward.

I am ready for my hormones to go back to normal.  I yearn for a regular cycle where I have a couple of follicles growing, we make some embryos, and have a nice lining to transfer.  I believe that a cycle off would be the right choice.  I am still waiting for Dr. NN to give his opinion, but I doubt that he would suggest doing a cycle immediately because my ovaries still have those follicles that are still shrinking.  I hope that in a month we’ll be back on track so we can just transfer those precious frozen embryos.  I am so ready for this stage to be over, regardless of the outcome.

Well, of course I want a good outcome.  There is still hope.

Thank you all for reading this extremely long post!