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!

The Most Peculiar Cycle

When it comes to IVF cycles, I am convinced that it’s best to know your body and to be vocal.  Let me tell you why.

After all the crying and then being told to proceed with the cycle, I took 5mg of Letro.zole from cycle day three to cycle day seven.  AF was very short this time.  I only bled for three days.  We baby danced on Sunday.  Then I started spotting again on Tuesday which actually matched my experience with my previous cycles with cysts, that I would usually spot mid-cycle.  I have been doing castor oil pack nightly to help reduce the size of Muriel the Cyst.  When I saw the spotting, I knew that the castor oil pack was doing its thing.

We went back to the clinic for a scan on Wednesday.  Dr. Dry Humor, who did my second retrieval at the current clinic, was the one who was present for my scan.  My lining was 9.5mm and the size of my cyst had reduced from 25mm to 16mm.  Way to go Muriel and castor oil pack!   He didn’t see much follicle growth on either ovaries and told me to return in a few days for another scan.  I didn’t have an expectation of the scan so I didn’t have much feeling or thought about the outcome. I was just glad that the devilish cyst decided to pack her bag and begin her departure.

Out of curiosity, I took my basal body temperature the next morning, which was cycle day 10 according to my own cycle and cycle day 9 according to the clinic.  It was the first time I had temped during this cycle, so I had no way of knowing what my BBT was from cycle day 1 to cycle day 8.  But I was shocked when I saw that it was 98.  98 may not mean anything to others but it often means that I am either sick or I have ovulated.  My cover line is usually around 97.3 and 97.4.  Anything above that usually means ovulation.  Period.  I thought it was a fluke so I asked around.  Some ladies who have experience with Clom.id or Fe.mara told me that sometimes their BBT goes up during and a couple of days after they took the meds.  The next morning, my BBT was 97.6.  Still above my usual cover line.  BBT this morning was 97.7 and was taken an hour before my usual time, so it could have been even higher had I taken the temperature at my regular time.  I was determined to get to the bottom of it.  So I decided to ask for my progesterone level to be checked.

Today is CD 11 (according to the clinic calendar) or CD12 (based on my natural cycle).  Dr. Italian did my scan.  Lining has gone down to 8mm.  The cyst seemed small, although it wasn’t measured.  Then the strangest thing happened.  My right ovary had a 10mm follicle and my left one had a 12mm and a 10mm.  I didn’t expect any follicles because there were none three days ago.  I told the doctor about my elevated basal body temperature and he agreed to check my estradiol level and my progesterone level.  I also reported to him that I had been spotting and was still spotting.  I was instructed to return on Monday to check on the progress of the follicle.  We got my blood work done and left.

The phone call this afternoon confirmed to me that yes, as a patient, we have to be on top of things and know our body.  The progesterone level is 17.1.  Based on this level, it means that I did indeed ovulate.  It’s actually a good progesterone level.  I’m so glad that I checked my basal body temperature and trusted my instinct.  But I don’t know what this all means.  Isn’t it odd for my body to be producing multiple follicles during the luteal phase?  What does that mean for the timing of retrieval (if indeed the follicles continue to grow bigger and bigger for retrieval to happen)?  Or maybe Muriel the Cyst was actually a follicle that began to grow in my last luteal phase and matured in the follicular phase of this cycle, hence the size of 25mm on cycle day 2 (or cycle day 3).   It’s all very puzzling to me.

I asked the nurse who phoned me what this all means.  She did not have an answer for me.  She told me to ask the nurse practitioner that I usually see for my monitoring scan on Monday.  I am so curious to see what Dr. No Nonsense will say about this.  I have heard of women with high FSH who would start to recruit follicles during the luteal phase when the ovaries are supposed to be quiet.  The end result is an early ovulation the following cycle.  I don’t really know how healthy the follicles/eggs may be if they were recruited out of phase.  Do I take birth control pills to sync up my follicular growth with the right phase of my cycle?  This is all so puzzling.

I don’t know how to feel about this.  I guess I will hold off my opinions, feelings, and thoughts until our scan on Monday.  This is the strangest place of unknown I have ever been.  When do I get my period next if I had ovulated early?  When should we do a transfer next?  Will I still get my period fourteen days after ovulation even with follicular growth in the luteal phase?  This is an uncharted territory and I feel like I am lost.

Pray that God will give us clarity and wisdom for directions in the upcoming days and weeks.  It’s hard to wait for God’s timing without being able to predict approximately when things will happen.  This journey requires us to exercise patience and trust.  I am definitely experiencing that right now.