16 Weeks - Little Cutie

After several more unsuccessful house hunting ventures, I finally had my 16 week OB appointment yesterday. Although it's not usually an ultrasound appointment, I got to have a little peak at our baby anyway. They were so darn cute, kicking their legs and waving their arms.

Such a cutie already!

This was my first appointment with my awesome midwife S who I haven't seen in a few weeks since I stopped acupuncture. Although she prefers to use her hands and the doppler to check on baby, she hadn't seen our bean yet in person and knew I wanted to check on them so she obliged me with the ultrasound. I'm so glad she did, seeing their heart beating and legs kicking always makes me feel better. Overall I'm doing pretty well with the pregnancy too, no more morning sickness and I've come to accept that heartburn is clearly my new way of life. Considering that I'm a couple weeks into the second trimester now, I thought I would have gained a few pounds too but it looks like I'm still at 0. It's not a problem since I started off so chubby to begin with, thanks FXPOI and IVF, but I'm sure that will change over the next few weeks. 

That morning the traffic had been absolutely horrible, apparently Vice President Biden was in town blocking roads, so I'd ended up getting to my appointment at least 20 minutes late. S had been planning on putting in some needles for me but now we didn't have the time, which was a bummer. I think I'm going to schedule a regular acupuncture session at the center instead, certain points in my foot and on the inside of my knee are feeling kind of sore. Plus, I always feel better in general when I'm doing acupuncture. 

I also had a little bit of an upset tummy yesterday, something I ate the day before didn't agree with me. That coupled with skipping breakfast since I had to leave so early meant that I was super dehydrated by the time I got to Kaiser. I couldn't pee for them for over an hour, even chugging down water, and once I finally did, they weren't thrilled that my urine sample had some protein in it. I gave them a second one that looked much better that they had tested in the lab and thankfully it came back totally clear. No bladder infection, no protein, no sugar, nothing to suggest anything out of the ordinary. Basically, I have to be more careful about drinking even more water in this heat. Otherwise, everything looks nice and normal with little bean and I won't get to see them again until our anatomy scan at almost 20 weeks.  

So ready for our frostie baby

This time tomorrow, I will be Officially Pregnant (until proven otherwise). There will be an actual, live embryo getting cozy in my uterus, settling in for the next 40ish weeks. After almost three years of trying, I am so excited and so ready that I feel like I might burst.

My pre-transfer protocol began this morning with the last of my Z-Pack, my estrace, aspirin and vitamins. I ran the last of the errands I'm going to be allowed to run for the next 4 days and then had a wonderful, relaxing acupuncture session to increase the blood flow to my uterus. Although she forgot to tell me the day before, my acupuncturist S also recommends a massage the day before transfer to completely relax the muscles. This sounded wonderful of course, who doesn't love a massage, but they usually require a bit more advanced notice than 20 minutes to book.

So, after leaving acupuncture, I called my mother in law to see if she could get me in for a massage at her regular place. Most of the places near me require at least a days notice but her place is unusually  flexible. To my great delight, they were able to squeeze us both in at a moments notice and I spent a glorious hour getting rubbed and stroked by a deceptively strong little woman. I hadn't realized I was in need of a massage until she dug her elbows into my shoulders and pressed the small of my back. Holy Ow. After being waved out of the massage clinic, hair all over the place and a tiny Thai woman telling me something about my face (perhaps that I needed water?) we capped off the evening with some delicious Italian food.

The next step begins tomorrow at 8am when I take the first of two Naproxen, along with my usual estrace and aspirin. I skip the Endometrin until after the transfer, so I'll probably bring that to the appointment with me. I follow that up with breakfast and at least a liter of water between 9 and 9:30am to ensure that I have a super full bladder for the transfer. The fuller my bladder is, the more it presses my uterus into an optimal position. Finally, we check in at 10am for our 10:30 transfer and I get to bring our little embryo home.

Everything is lining up perfectly. E and I are so ready for this frostie to be our baby. This IS going to be our baby.

Endometrin Again

Today's appointment was a quick one, just a single vial blood draw to check out my progesterone levels. Unfortunately, it looks like my numbers are just a tad low, they like to see a level around 2.0 and mine was only 1.5. This isn't a setback though, it just means it's time to start my Estrace and Endometrin as scheduled to boost it up a bit. It is rising as it's supposed to, it went from 0.7 to 1.5 with ovulation and since I haven't taken any hormones until now, that was entirely on my own steam.

 Still, it's time for a little extra support so as soon as I hung up the phone with the nurse, I swallowed my Estrace and popped in an Endometrin tablet and snapped on cloth panty liner. Then I rushed off to acupuncture for my weekly needles and nap session. I'm gearing up for the transfer with S as well, I did my last regular heat clearing and energy moving session today and will see her again Monday where she'll prep me for the embryo by improving blood flow to my uterus.  I'll be seeing her or her associate D on Tuesday after the transfer as well to help our little frostie stick.

Please don't kill my panty liners Endometrin...

Since this little babe IS going to stick and I'm going to be taking Endometrin for the next 10-12 weeks, I'm curious to see how my liners hold up to the assault. I'm trying out an all cotton flannel liner today and I'm thinking I might strip it with dish soap or something similarly grease cutting afterward, just to prevent any of the medication medium from affecting the absorbancy of the fabric.

My next check in is tomorrow to see how much my progesterone has gone up in 24 hours. My poor little arm, the tech can still only draw from one vein so it's taking a lot of abuse. This brings the FET calendar to two more days of Medrol, three more days of the Z-Pack and aspirin, and hopefully 10-12 more weeks of the Endometrin and Estrace to look forward to.

Magical Chinese Cure All?

I wrote here about the rash that cropped up practically the second I started this cycles birth control regimen. It was itching like crazy and I still have no idea what caused it - hormones? All the medications? Detergent in my sheets? something I touched? A yeast skin rash from the birth control? A combination of the above?

I asked my acupuncturist about it and she said that from a Chinese Medicine stand point, rashes like that are the result of damp heat or "wind" in the skin. She used several points to help clear out heat and dampness in my acupuncture session and gave me this herbal wash that she usually gives to her post postpartum patients to help with healing tears, hemorrhoids, yeast infections and a whole host of other things.

Yin Care

I've been using this stuff for two days and I have to say it's friggin' magical. It's like there's nothing this stuff can't treat.  The ingredient list is full of herbs and extracts, some I recognize and others I'm totally unfamiliar with: 

Extracts & Essential Oils of:

• Di Fu Zi - Kochia
• Yin Chen Hao - Artemisia
• Du Huo - Angelica
• She Chuang Zi - Cnidium
• Shi Chang Pu - Acorus
• Ai Ye - Artemisia
• Bo He - Mentha
• Jin Yin Hua - Lonicera
• Zhi Zi - Gardenia
• Huang Bai - Phellodendron
• Huang Qin - Scutellaria
• Ku Shen - Sophora
• Cang Zhu - Atractylodes
• Tu Jing Pi - Pseudolarix

The list of things this stuff successfully treats is unbelievable. You can use it as a compress, rub, rinse, douche, soak, spray, mix it with a compounding cream and even soak tampons in it. Depending on the ailment you're treating, you dilute it with different amounts of water but you can also use it at full strength.

Topically, Yin care treats:

• Acne, Eczema, Psoriasis, Rashes, Rosacea, Hemorrhoids
• Shingles, Cold Sores, Sty, Athletes Foot, Poison Oak, Poison Ivy 
• Fungal Infections in the nail, toe or skin, Insect Bites and Staph Infections 

 For Gynecological issues, Yin care treats:

• Yeast, Bacterial, Fungal, and Trichomonia Infections 
• Vulvitis, STD
• Cervical Dysplasia, Cervicitis

A herbal solution that treats everything from acne and hemorrhoids to poison ivy and yeast infections? How does this even exist? I can even use it on Milou's flea bite/lick granulomas. This stuff is insane, it's already helping to clear up some acne and a small rash E had.

OMG. Just this very moment I think I figured out what caused the rash on my groin. I'm fairly sure that the day I started birth control I also shaved my bikini line. With E's man scented shave cream. That I am obviously allergic to. Whoops.

I still don't know what caused the one on my stomach but that one is basically gone, so major points to Yin-care.  

Those little dots are the last remnants of the belly rash. Bye bye!

Where NOT To Inject

When I added Cetrotide to my IVF regimen, I was running out of usable belly space to inject. I made the rookie mistake of starting with one morning injection and two evening injections when my morning appointments take place After my morning injection is done.

This means that any changes, including additions, would need to be made to the evening injections, leaving my meds unbalanced. It wasn't the end of the world doing three injections at once but I did end up picking an injection site you should never touch because I was out of space.

Do NOT inject below the belly button!

I know there are acupuncture points all over the belly but somehow I didn't make the connection between those points and my injection sites. Duh. The second I put the Cetrotide needle in below my belly button, I felt a zing, saw stars and knew it was the wrong place to inject. Ouchie.

I asked the acupuncturist about it the next time I saw her and she told me there's a point you should never touch in women about 2.5 - 3 fingers below the belly button. The location is measured with your individual fingers since everyone's fingers are different sizes.

Fertility Points, I'm not sure if the "Don't Touch" point is one of these

My Menopur sites were good, they fall between the Zigong points and Ren 6 point so they're okay to inject. My Omnitrope points were okay too, they were outside the Ki 16 points so also in the clear. The Cetrotide injection might have been okay if I'd done it a little lower but there's a meridian line that runs straight down those points and I should have just avoided the whole area entirely. I somehow managed to hit a point twice and it hurt each time, definitely not worth it. 

For next cycle. I'll take my Omnitrope in the morning with my first Menopur injection so I can use the other Omnitrope site for the Cetrotide when it comes time to add it. This should keep things more balanced so I won't have to do so many injections at once and I shouldn't run out of injection sites.

Day 4: Acupuncture and Patience

Today, I'm finding it difficult to be patient. We don't get an update on our embryos and I know they're in the most difficult phase of growth where many embryos are often lost. Last we heard, four were doing very well with 7-8 nice, even blastomeres (cells) and two were growing nicely but a little slower with only 6 nice, even blastomeres.

On day 4, we need those embryos to be in the Morula stage, the last phase before they grow into blastocysts, form the blastocoel (fluid filled cavity) and start differentiating cells. Today, and possibly tomorrow if they're slow growers, they should have between 10 and 30 cells.  They might even have begun compacting like the embryo below, which is where the cells start squishing together like the embryo below.

Nice quality Morula

Hopefully they'll make it through the morula stage and grow into nice blastocysts tomorrow. If they're not quite there yet it's still okay as long as they're progressing. They'll be allowed to grow to day 6 when plenty of embryos are frozen and I probably won't sleep until we get the call. As blastocysts, they should be dividing into the inner cell mass (ICM), the Trophectoderm (TE) and the blastocoel (fluid cavity), which gets bigger as the embryo expands.

Nice Blastocyst

We need good cell differentiation to get a clean biopsy of the embryos for PGD. They need to sneak some cells out of the TE on the side there, the cells that will become the placenta, so we can test the fetal DNA for abnormalities.

Since there's nothing I can do to help my embryos grow, my distraction for today was a much needed acupuncture appointment. I haven't been since my retrieval and it's supposed to really help with recovery and the symptoms of OHSS. I laid down on the table, S took one look at my belly and said "Oh boy, you're definitely hyper stimulated". Clearly other people think I look 6 months pregnant too.

I already knew that I probably had OHSS but it's still a bummer to have it confirmed by a nurse. I also woke up sore this morning, my hamstrings and back felt like I'd worked out, and S said it's because of all the fluid I'm retaining. The fluid is responsible for my bloat, my repeated peeing, the heart burn and now the muscle soreness. Oh the joys of IVF.

Dr. D's nurse also called today to ask us about aCGH testing for our embryos and to see how I'm doing. I told her we'd probably base our decision for chromosome testing on the number of embryos we get, our lab doesn't really need an answer until they have all of our biopsy samples but as long as we get a good amount from each cycle I think we'll probably go ahead and add it on. If we only end up with a couple of embryos from each cycle, I'm not sure if it's worth doing, but if we get six lovely frosties each time I'd say it's worth the extra $2500.

As for next cycle and the crazy bloating, she said Dr. D usually takes a "flush" cycle in between IVF cycles to allow all the hormones to flush out of your system. It would also give me a good amount of time to order my meds from IVFMeds.com so I wouldn't be doing things so last minute. She made a note for Dr. D to chat with me about it tomorrow when he calls with our embryo update, so I'll probably be holding my breath until the phone rings tomorrow morning. I so, so hope our six embryos are doing well, I worked so hard for them and I won't be able to relax until they're safely biopsied and frozen.

TWW: IUI #2 Protocol

This cycle we went with the "Nuclear Option" and bombarded my ovaries with the maximum dose of Menopur. It was a big, somewhat expensive, gamble but it paid off and I ended up recruiting an unprecedented 7 follicles! I really think this is going to be our lucky cycle. If not, I think we'd definitely follow this protocol or a similar one again since it produced such good results.

Here's the protocol we followed this cycle:

CD 1:                   No Meds
CD 2:                   Base Ultrasound, 6 antral follicles visible (Acupuncture)
CD 2 - CD 11:     Birth Control Pills
CD 12 - CD 14:   No Meds
CD 15 - CD 18:   8 vials Menopur, 600ul, divided into 2 doses daily (Acupuncture)
CD 19:                 E2 220 and Ultrasound, 5 small follicles visible 
CD 19 - CD 20:   8 vials Menopur, 600ul, divided into 2 doses daily
CD 21:                 E2 538 and Ultrasound, 7 maturing follicles visible, 10-14mm
CD 21 - CD 23:   6 vials of Menopur, 450ul
CD 23:                 E2 926 and Ultrasound, 7 maturing follicles visible, 13-15mm (Acupuncture)
CD 24:                 E2 1476 and Ultrasound, 7 maturing follicles visible, dominant follies 17-19mm
CD 24:                 Ovidrel Trigger Shot
CD 25:                 No Meds
CD 26:                 IUI #2, count 148 million with 70% motility (Acupuncture)
CD 27:                 Acupuncture
CD 28 - CD 38:   Endometrin twice daily (Progesterone Suppositories)
CD 30:                 Acupuncture
CD 37:                 Acupuncture
CD 39:                 Pregnancy Test


I had another acupuncture appointment today, CD 27, with a different acupuncturist since S was unavailable. I've seen her once before and she's also really good, with a little more emphasis on the Chinese MEDICINE aspect and a little less on the mind-body-spirit thing. It might be because I told her about my background in Science and she is tailoring her approach to my needs. Either way, I appreciate it! Her needles always hurt a little more because she places each one very precisely, but I can tell she's hitting the points when I have a reflexive twitch or feel increased blood flow to the area. This time there were 5 needles in my ear, which is apparently a point for the uterus. Crazy cool stuff.

Looking at the schedule all laid out, there's no way I'm going to be waiting the whole two weeks to test.  I'm thinking I'll test for the trigger in a day or two to make sure it's flushing out and then test for a positive at around 11 days, July 4th. A positive would be such a nice Independence Day surprise! 

Go, Baby, Go!

IUI number 2 is complete and I feel super psyched and so hopeful about this cycle! It's been a long day for E and I, we had to be up early to meet the nurse at 8:30am to deliver our cryotank. She took my vitals, had me sign the consent form and then gave us about two hours to kill. Since we didn't want to sit around in the waiting room, we drove to the nearby coffee bean and had some breakfast. I'm absolutely in love with their chai latte with almond coconut milk, it's delicious :)

After breakfast it was back to the waiting room to wait some more. They were running really behind today and had a ton of patients to see. We finally went back to a room and Nurse C joined us with her  trainee nurse, Nurse M, who will be replacing Nurse C when she retires.  She's really nice and I enjoy her bedside manner a lot, but she's not quite as good as Nurse C. Nurse M put my speculum in wrong, OW, and Nurse C had to reposition it and take over the IUI later when Nurse M couldn't get the catheter in.

Before we got down to business, Nurse C asked us to confirm our donor number and make sure everything was labeled correctly. Our count this time was phenomenal, 148 million with 70% motility post thaw! Last cycle was only 50 million with 50% motility so I'm feeling much more confident about our swimmers this time. Come on boys (and girls!), you can do it!

Our tiny vial, this thing cost $850

Nurse M tried to insert the flexible catheter but seemed to have difficulty with the internal portion of my cervix. It was pretty uncomfortable, though not painful, to have her poking around and I was relieved and felt much better about Nurse C taking over. Nurse M had the speculum jammed straight in, instead of following the natural curve of your body, and I didn't realize how poorly it was positioned until Nurse C adjusted it down and my legs dropped like 6 inches. She swapped the catheter out for a stiffer one, popped it right in on the first go and said

"Here we go! There go your little guys, and gals!"

This time, we chose to inspire our swimmers with the classic 80's movie soundtrack of Look Who's Talking while I laid with me knees up for 30 minutes:

I hope they were inspired by the Beach Boys to follow the trail leading them towards all those eggs. I was a little worried about when I would ovulate and whether it had happened or not, I know many women say they can feel ovulation when they are releasing multiple eggs and I hadn't felt anything. Nurse C told me not to worry about it and she was right, as I'm typing this now at 6:30 I can feel definite uncomfortable cramping on the side where I have 5 eggs. It's starting to hurt so I'm hoping those follies are all rupturing and releasing their eggs!

After the IUI, E and I went and stuffed ourselves at The Smoke House. It's a decent steakhouse, not super high end, but full of that old school-red-booth-dim-lighting steakhouse charm. I had a little fillet with mashed potatoes, spinach and insanely delicious garlic bread while E had BBQ ribs and chicken with mashed potatoes and corn on the cob. It was indulgent celebration lunch, a little off diet, and it filled the time gap between our IUI and my acupuncture appointment. We used to go all the time for celebrations when we lived in The Valley and now I drive past it on my way to acupuncture and long to stop and order that garlic bread. I was so glad I got my fix at last :)

With my tummy full to bursting and my eyes heavy, acupuncture was wonderful as usual and I slept from 2:00pm-3:30pm. S is feeling really good about this cycle too and told me that Dr. K called and asked her what on earth she was giving me to grow so many follicles so big! I love that my whole team is so supportive, it makes me feel well taken care of. While I was asleep with my needles in, E went down the street and treated himself to an ass kicking 60 minute massage where they bent and twisted him like a pretzel until he felt amazing. I'm going to have to go and try this place myself at some point, he gave it a glowing two thumbs up. 

I start my most hated Endometrin on Thursday and thus begins the dreaded two week wait. My blood test is scheduled for Sunday July 6th and I can already tell I won't be able to wait to test this time. I have acupuncture again tomorrow to help the egg and sperm find each other and then another session on Friday to help encourage implantation. I'm trying to focus on work to keep myself busy while also being careful not to stress or overexert myself. The gym is off limits, I'm not supposed to lift heavy things and I've already been tested today when I went to move a piece of furniture and realized it fell under the category of "things I shouldn't be doing" ugh. 

It's going to be a long two weeks to find out that this cycle was a success. I really think we did it this time!

Cycle Acceleration!

While on my way to acupuncture this afternoon, I got a phone call from one of the nurses in the Kaiser infertility office. She had my marching orders for the next couple days and wanted to give me my instructions. I was driving so I had her on speaker and was listening for confirmation of Nurse C's instructions when this phone nurse said something completely different.

To Recap, Nurse C's Instructions:
During my appointment, Nurse C said I would require at least a couple more days of stimulation and had me order 10 more vials of Menopur. She guessed that we would be doing my IUI on Tuesday or Wednesday, and that I would be triggering on Sunday or Monday, with another appointment to check growth on Saturday. I would be continuing with my 6 vials of Menopur.

Phone Nurse's Instructions: 
Take the usual 6 vials of Menopur today and trigger on Saturday, with an IUI schedule for Monday. There would be no need to come in on Saturday.

This information did not at all jive with what Nurse C said. My E2 was good, yes, but with 7 follicles it was not the 200+ per 18mm follicle that we're looking for. It did not seem like a good idea to skip Saturday's ultrasound, this cycle and those follicles are too important to screw up. This also meant that we needed to have our donor vial on hand stat so I called the bank and placed our order over the phone. I'm so glad they store purchase history and credit card info, I never would have been able to place the order if the customer service rep didn't already have all my info in front of him.

When I got to acupuncture, I shared my concerns with my Acupuncturist S. Since she's a Certified Nurse Midwife at Kaiser, who has been there so long that she taught most of the OB/GYNs how to deliver babies (including my OB/GYN who is now the head of the department), she has an excellent relationship with most of the doctors, including Dr. K, and also happens to have her personal number. While I was on the table, having a treatment on my back this time, she gave Dr. K a call and talked over my procedure with her. I'm not sure if Dr. K had missed some notes or if she wasn't completely aware of the instructions given by Phone Nurse, but she agreed with me and S that I should be monitored on Saturday. At the very least, this would give us confirmation of the correct time to trigger so as not to leave viable eggs behind. I am incredibly grateful to have S on my team and feel much better about moving up the timeline as long as we check and make sure my eggs are mature first.

The new plan is to take 6 vials today, which I just did, and go in for another E2 draw and ultrasound at 7am tomorrow. I'm really not going to enjoy leaving the house before 6:30am but it's worth it to me to make sure these follicles are mature. If everything checks out, I have my trigger ready to go for Saturday and E has a rare day off on Monday. If they're still looking a little runty, I have more Menopur ready to go to give them a boost. Our vial will be picked up tomorrow and will be good and frosty for 5 days which gives us plenty of time. Whatever happens, we're prepared.

Stanley Cup Champions!

I don't often post about sports but there's no way I could let today pass without saying something. For the second time in 3 years, the Los Angeles Kings have won the Stanley Cup! Congratulations boys, you did it! The Cup is coming back home!

Stanley Cup Champions!!

During the regular season, E works all of the Los Angeles Kings hockey games. He was there when they won The Cup in 2012 and got to celebrate with the team afterwards in what was an unbelievably memorable night. We've got pictures of him with The Cup and they're definitely some of my favorite "work" shots.

Unfortunately, this year was a little bit different. E worked all the regular season games, but since the post season games aren't crewed until we know they're happening, he was already booked by other teams by the time the post season came around. He was only able to work a couple of the Kings post season games, and was working the LA Dodger game when the Kings won The Cup tonight.  He'll have to wait until next season to celebrate with our boys in black but that doesn't make the victory any less sweet. I'm pretty sure we'll be at their celebration parade on Monday, if my E2 ultrasound finishes in time.

Aside from the Kings killer victory, today was my second day of double injections and they seem to be going well. Still no weird side effects to speak of, and my skin isn't too irritated yet. Covered in little pin marks yes, but no bruising or redness. My only complaint is that it's a little crazy to go through this many vials of Menopur a day. I feel a bit like a walking pharmacy (Hey, wanna score a vial? I've got 8!) and although this cycle IS GOING TO WORK, positive thoughts!, if we have to do this again I'd definitely like to try Letrozole and Gonal F or Follistim. 

I also got to enjoy some double relaxation in the form of acupuncture AND a massage. My acupuncture appointment was first and went off like usual, a weekly nap. Needles go in, I go out. I think I'm actually starting to get drowsy on the way to acupuncture, like I'm anticipating the coming nap. Instead of fighting traffic and heading home afterwards, I met up with my mother-in-law to do a little work and we ended up going for massages and dinner. She goes to the best Thai massage place I've ever been to and I had the pleasure of the strongest masseuse working on me today. It was incredibly painful to have her repeatedly digging her elbow into my shoulder blade, so much so that she had to brace me on the table at one point because I was arching off, but I know I'll feel so, so much better tomorrow.  It felt almost like a battle of wills, can I take the pain or should I ask her to lighten up? Is she pressing harder because I'm not asking her to lighten up? Is this a test?

I survived my massage, just barely, and we capped off the evening with some delicious Italian food. I was well behaved and got my entree with whole wheat pasta, but I was sorely tempted by the deliciousness on the menu. I wonder if that's a symptom of the Menopur, the desire to hoover all food within reach? Soon, Italian goodies, once I'm pregnant I will eat you all.

Busy Boy

Yesterdays acupuncture appointment went very well, as usual. S complimented me on my "positive spirit" and after about 5-10 minutes relaxation, I dropped off into a deep sleep. This time I slept so hard I didn't wake up until S had opened the door and walked in. It felt like I had only closed my eyes for a second but somehow an hour had passed. I got a new herbal formula to try out as well, it's less bitter than my batch which is a nice change. It almost feels like I'm paying for a weekly nap, but I'm up for anything that helps.

As planed, I dropped E off at the airport early this morning. He got home super late last night, near 1am, and I have no idea how he's going to get through the weekend :(

Let's go E!

He has to land, pick up his rental car, drive to the track meet, work the track meet which should go till 9 or 10pm, check into his hotel, build graphics and prepare for the game on Sunday, sleep at some point, check out of the hotel, drop off the rental car, hop on a plane, get picked up, get his car, and go straight to the next game, arriving about 4 hours after his call time. It's gonna be a busy weekend for him and I'm already looking forward to picking him up tomorrow. 

I have a much simpler weekend planned, with a lot less running around. Milou has her Agility class today, I'll probably work and run some errands, but on the whole will be able to chill out a bit.

Tomorrow I get to pick up E bright and early, and it's also my last day of birth control, yay! I get three days off while the hormones leave my system and then it's on to the big guns. I don't expect two injections a day to be very much fun, but the prospect of recruiting lots of eggs is a really exciting one. The more targets we have, the better chance we have of getting pregnant with a healthy baby.

Sunday is also a big day for my bestie M and her insanely adorable son Dean. Deano, who is quite possibly the cutest baby on two legs, turns 1 today and we'll be celebrating his birthday tomorrow :) Like his big sister, Deano practically radiates sunshine and exudes happiness out of his pores. He's an absolute joy to be around and I can only hope that E and I have kiddos have as awesome.  

TWW: IUI Protocol

Now that I'm in the TWW (two week wait), I'm looking for all sorts of ways to distract myself. J and C's wedding was a happy and time consuming distraction but now that it's over, my mind is free to wander. I'm also under strict orders from my acupuncturist to take it easy for the next week, so no gym, no stress, basically no diverting energy from my uterus where there's hopefully a healthy little embryo getting comfortable.

Although I'm a little unsure about the upcoming acupuncture dates since I'm only 4DPIUI, I think this is the jist of my IUI protocol for this cycle. I'm feeling really good about this cycle so I'm telling myself we won't need to do this again until we want another healthy baby, but if we do my RE wants us to go balls to the wall. This cycle I had a bunch of little follies that didn't grow in time to be ovulated with my dominant follicle. If we need to do this again, the RE wants us to do IVF, starting with birth control (to even the starting line for all the follicles) and then 8 vials of Menopur a day to generate as many as possible. Dr. K doesn't think it's worth harvesting less than 3 eggs which I'm mixed about but see the merit in.

Here's the protocol we followed for this cycle, that will hopefully result in a healthy BFP:

CD 1 - Base ultrasound, 300 IU Menopur
CD 2 - 300 IU Menopur
CD 3 - 300 IU Menopur
CD 4 - 300 IU Menopur
CD 5 - E2 Labs & Ultrasound, 2 good follies one ~11mm, one ~8mm, 1 little cyst ~12mm, 4 tiny follies, Estrogen 68, 375 IU Menopur, Acupuncture
CD 6 - 375 IU Menopur
CD 7 - 375 IU Menopur
CD 8 - E2 labs & Ultrasound,1 good follie 15mm, 1 little cyst ~12mm, Estrogen 186, 375 IU Menopur, Acupuncture
CD 9 - E2 labs & Ultrasound, Ovidrel Trigger, 1 good follie 20mm, one small follie 13mm, 1 little cyst ~12mm, Estrogen 286
CD 10 - Positive thoughts
CD 11 - IUI! Go little swimmers, go!
1   DPIUI - Acupuncture
2   DPIUI - Positive thoughts
3   DPIUI - Endometrin twice daily
4   DPIUI - Endometrin twice daily, Acupuncture
5   DPIUI - Endometrin twice daily
6   DPIUI - Endometrin twice daily
7   DPIUI - Endometrin twice daily, Acupuncture
8   DPIUI - Endometrin twice daily
9   DPIUI - Endometrin twice daily
10 DPIUI - Endometrin twice daily
11 DPIUI - Endometrin twice daily
12 DPIUI - Endometrin twice daily
13 DPIUI - Endometrin twice daily, TEST!!

I'm on my second day of Endometrin now and it's an unfortunately messy medication. They come as these little white pills that you insert like a tampon to help support the pregnancy. The downside of course is that pills dissolve, so it looks like I'm stuck wearing a panty liner for (hopefully!) the next 10 weeks. It's a bit of a mood killer, but anything that helps keep a baby safe and healthy, until we can find out of they're healthy around 14-15 weeks, is okay in our book.

Over the next two weeks I also need to decide if I should test at home before my Beta blood test. On one hand, I don't want to see another negative test, but I also feel like I need to go into the blood test with some idea of what to expect. Some people get negative HPTs right up until their blood test but others get positives pretty quickly. I've never had a positive test before so I don't know how my body will react but hopefully I'll know soon.

Jinx

At my ultrasound appointment yesterday, the nurse asked me if I was having any side effects from the Menopur I've been taking. Apparently it can cause cramping and a whole lot of other unpleasant side effects in many people. I was happy to report back that I felt just fine, no cramping, and the injections *didn't even hurt OMG yay!* as long as I did them slowly! I felt like I could ride off into the sunset on a rainbow shitting unicorn on because I felt great! *insert some rainbows, sunshine and glitter shit here*

Ha Ha. Not.

Yeah. Because that's not painting a big huge target on my back for fate.

So, naturally, the second I left the doctor's office I started to feel sick. Then I remembered that I had had some digestive upset when I woke up that morning, but I'd attributed it to nerves. I sucked it up, blamed nerves again, and went to my acupuncture appointment. I told my acupuncturist, S, all about the insurance woes and my low estrogen and she told me she'd already received a call from my RE, Dr. K, that morning.

Dr. K actually called S, personally, because she believes in what she does. Even though S sees Dr. K's patients and is a Nurse Midwife at Kaiser, S said she's never had a doctor personally call about a patient before. Dr. K asked her to please do whatever she could to help me, to try and get as much blood flow to my ovaries as possible because we have to help my follies develop and get my estrogen up or this wasn't going to work. This really choked me up, I don't know how my chances are looking for this cycle but I really love my infertility team. I couldn't ask for better, more supportive doctors.

With specific marching orders in hand, S began my treatment to clear out the cold and phlegm and get my blood flowing. I also told her about my weird stomach pain so she added on a stomach treatment for that. And for the first time ever, those needles hurt. She put the first one in my foot and my leg nearly jumped off the table. "I'm sorry," she said, "you're much more sensitive today. The Menopur can do that, make your skin much more sensitive". Ow.

This was the 4th time I've done acupuncture and the first time it's ever been uncomfortable. Each needle hurt a bit going in and was sore during my hour, although I was able to ignore it and focus on visualizing all my energy going to my ovaries. S strongly believes that you need to put positive energy out there so I'm sending every positive thought I've got down to those follies. Afterwards, the points in my left wrist and left foot were actually too sore for me to put my watch or sandals back on, another first. I usually feel relaxed and refreshed after a session, not sore.

Before I left S also told me that she had a patient who might have some extra Menopur. She had been planning to donate it to another woman who ended up not needing it so it might be available for me! This would be so, so wonderful, with the increase to 5 vials a day, I don't think the stash I just bought is going to get me through this entire cycle. I might also be one of those people who are slow to stimulate and require a couple extra days of injections, which would mean I'd definitely be short.  I should know on Monday if she still has the Menopur available.

As for the side effects, they continued for most of the day. S's stomach treatment worked for a couple of hours, but the general stomach pain eventually came back. I didn't feel nauseous, crampy, and I didn't have ovarian pain, my stomach just hurt. The injection was also much more painful last night, the needle itself was really uncomfortable for the first time and it took me a good 5 minutes to inject all the liquid. Even though the acupuncture hurt, I somehow wasn't expecting my injection to hurt and was completely surprised when I stuck the needle in and my skin went OWWWW. I hope this is a temporary side effect because I have at least 5 more injections to go.

IUI: The Disasterous Beginning

So after years of trying, we're finally starting a process that just might work. Today I went in for my baseline ultrasound that gives the RE a starting point for my IUI. This was the hopefully beginning of the post that I wrote this morning before I went to my appointment. It's not the opening I would have chosen afterwards. That would probably go more like:

I went to my first IUI appointment today. The ultrasound went great but the latter half the day was a complete and utter disaster.

I got to the hospital on time, with the 15 minutes to check in I always seem to miss, and after circling a couple times I lucked into the best parking spot. 2 hours of free parking? Yes please! I thought this was a sign our IUI was off to a great start and gave myself a mental fist bump. 

I met a new OB/Gyn and some really sweet nurses who were great company while they checked me in. I couldn't pee right away for the pregnancy test we all knew would be negative, even though I'd guzzled water, so the nurse let me proceed and said I could pee later. The ultrasound itself was a little uncomfy (as if a wand going up your girly bits could ever be anything but uncomfortable) and I had 9 antral follicles! That is AMAZING for me,  I've never had more than 7 follies. I would have danced on the table but the OB still had the wand so I settled for telling her how pleased I was with my body and how acupuncture seems to be working. 2 extra antral follies after only 3 acupuncture sessions and a week and change of herbs? I'm sold.

(I love your comics Phoebe Potts)

The nurses have the routine down, so after my ultrasound I went over my treatment with the OB and discussed the massive amount of meds I'm going to be taking. She was nice, was familiar with my file and we joked about the insane prices of donor sperm. There is always a long line at the pharmacy, so the nurse had me go down and put in my prescriptions before getting my injection training. I went back up, watched the nurse mix pretend Menopur, she told me how easy it would be to inject myself and then sent me on my way to go pick up my meds. I still hadn't peed yet.

As predicted, that pharmacy line was LONG. It took me about 30 minutes to get through, standing behind a high school student hiding a pregnancy test against her leg and hoping no one would notice. I felt badly for her and hope she got the negative she wanted, she was clearly terrified and wishing to be anywhere else.  It's nice to know I'm not so dead inside that I would resent the fertility of a scared teenager, though I did resent the lazy father telling his 2 year old he was going to tie her up (stroller) if she didn't sit still and be quiet. She's 2 asshole. 2 year olds aren't designed to sit still and be quiet, with no entertainment, for 30 minutes.

Finally I get to the front of the line and the pharmacy assistant starts pulling out box after box of drugs. There's a crap ton of menopur, my ovidrel trigger shot, progesterone, needles, and syringes. She starts ringing them up:

Her: Wow, this is over 1000 just for this? 
Me: Yeah, fertility treatments are expensive :/
Her: This is expensive, over 2000!
Me: You mean before insurance? Cause we should have 100% coverage
Her: Uh, no...you pay 100% All of it. $2000 please.

SCREEEEEEEEEEEEEEEEEEEECCCCCHHHHHHHHH

We are NOT supposed to pay 100% out of pocket! The whole reason we switched around insurances and paid a fortune to the union was so we would have infertility coverage! It's been confirmed numerous times by different people and now they're telling me to fork over $2,000 for a weeks worth of meds?????? I explain all this to the assistant, she enlists another assistant and freaking out, I head back upstairs to go pee in my cup and panic. 

I explained the whole thing to my nurse, and then to my doctor, who also insisted we should have coverage. When my nurse called for help, the pharmacy services insisted we had no coverage and hung up on her! I couldn't believe it and I kept trying to get ahold of E to ask if I should go back down and spend $2000 on the meds since we can't not have them. While I was doing that, the nurses were angels and scoured the office looking for donated Menopur for me. I was so thankful I almost cried, they found 4 boxes, which is 5 days for me, and told me to call back in the morning to see if we can fix things. If not, my doctor said she'd put in a prescription at a cheaper pharmacy for me and we'd just have to pay out of pocket. The nurses kept saying they hoped the donation would pay off with a baby, and I didn't have the heart to remind them there's a 50% chance I might have to terminate if it works. I almost cried again.

With donated Menopur in hand, I went back to the pharmacy and paid for my needles and syringes. They were really apologetic but I had to leave without the rest of my meds. I drove home somewhat shell shocked, where I met my mother who wanted to talk to me about my premutation. Apparently, although it's insanely rare, my premutation was passed down by my father, not my mother. She wanted to talk, discuss options, make me an appointment at UCLA and offer us money we're not sure we're comfortable taking. I wanted to scream that I've been over the options and back over them a million times, but it's not something we feel comfortable discussing with her. My defenses were low and I explained more than I wanted to, when I really just wanted to go cry in a corner.

Why are you so expensive???

I really hope we can get this prescription problem sorted out. I need enough Menopur to stimulate a large horse and it will be insanely expensive out of pocket.

Infertility Acupuncture

In addition to our infertility treatment, E and I decided that I should give acupuncture a try. I'd never had acupuncture treatment before, but I had read several good things about it online and many people seem to have excellent success with it improving fertility.

Super Skinny Needles

I'm not sure how much it can help with my FXPOI, but there is scientific proof of increased blood flow to the uterus and ovaries, improved ovarian environment, lower FSH, more balanced hormones etc. I need to get my estradiol and AMH up, my FSH down and help convincing my body it has eggs and isn't 40. So, I put the question to my RE and was pleasantly surprised with her response.

Since many infertility patients are interested in pursuing acupuncture, my RE refers her patients to a wonderful acupuncturist. She is a Certified Nurse Midwife with a degree in nursing, a masters in Acupuncture and Chinese Medicine, and something like 6 years of Acupuncture training. Because she understands fertility from both an Eastern and Western perspective, my RE is okay with me taking herbal supplements throughout my infertility treatment.  If you have any experience with infertility treatment, you will know what a high endorsement that is.

Fertility Points

I started acupuncture once a week and have had three sessions thus far. I generally feel more relaxed after after each session, and I can feel all sorts of tingly things happening during a session but I can't pinpoint what it's doing without testing. The needles are so thin you can barely feel them, and often times it's the tap of her fingers that lets me know she's put a needle in.  The other day she accidentally poked my foot with the plastic packaging the needle comes in and I was struck by how the plastic package hurt way more than the needles.  There are a couple points that twinge or ache a little when she puts the needle in, but the ache means the needle is placed correctly.

I also just finished my first week of herbal supplementation, the acupuncturists prenatals, and the acupuncture diet, and from that, I can Definitely feel the difference. It only took about 24 hours of the powdered herbal tea twice a day for me to be insanely hungry. I used to be able to go all day without eating and not notice it, but the past week I've been ravenous. I wake up hungry, I'm hungry in between being hungry, and I go to bed hungry. Basically, I've felt like shoving food into my face at all times, with both hands, and a side of more food.

As to what I'm allowed to eat, that gets a little tricky. My rules are:

• No cold food, ice, ice water, cold anything 
• No dairy 
• No cheese - this gets it's own category. I loooove cheese :(
• No raw vegetables 
• No white flour, bread, pasta, etc 
• No sugar or artificial sugar 
• No juice 
• No caffeine

This leaves me with whole wheaty options, cooked veggies, lean protein, fresh fruit, beans, and a whole lot of soup. Basically, I've been eating soup, eggs or oatmeal for breakfast, soup for lunch, and some sort of protein, veggie, and brown rice/some carby thing for dinner. Even my corn chex with almond milk are considered cold food, so while I've been pretty limited, I haven't let it stop me from shoveling food in my face.

Breakfast

When I told my acupuncturist about my need to be eating at all times, she was thrilled. Apparently my metabolism has been functionally shut down due to my lack of hormones, and the fact that I'm crazy hungry means it's turning back on. I've also been back at the gym 6 days a week, so it's a double whammy.

In addition to my weekly appointments, I have to go in more frequently around my IUI. We'll probably do the procedure around the middle of May, and I'll have to go in a day or two before, the day of, and the day after. Between the Menopur injections, the trigger shot and the acupuncture needles, I'm essentially a human pincushion.

The only downside to Acupuncture is the cost. Without counting the special appointments around my IUI, acupuncture is essentially like a car payment every month. I'm hoping that it will improve my fertility and our chances of having a healthy baby enough that we won't need to do IVF, which will should save us money in the long run. It should also make me healthier, which is always good, and which will hopefully contribute towards some weight loss, balanced hormones, and a healthy pregnancy.