Cycle #20 mid-cycle u/s

This morning's mid-cycle u/s showed a lead follicle of 30.5 mm and several other, smaller follicles, but no other follicles which are large enough to produce and release a mature egg. So in exchange for five days of Clomid and five injections of Follistim, at a cost of around $300, I got basically the same result I'd get in an unmedicated cycle: one egg.

Needless to say, I am not happy about the result. The doctor who did my u/s this morning (yes, I actually had one of the clinic's doctors and not a NP) agreed that this is not the desired response and that, assuming I am not pregnant after this cycle, I will likely be looking at a change in medication dosage for the next cycle.

I'm doubly irked when I think about the fact that last cycle I produced between two and four mature follicles. Why my RE felt that my dosing schedule should be changed is still a mystery to me, and it's now obvious that I did better on last cycle's protocol. I know that dosing is not an exact science, but I don't appreciate the guesswork involved when it translates to wasted money and time for us.

On the plus side, my endometrium was good: 13 mm. After completing the u/s, the doctor observed that some couples opt to do only timed intercourse rather than IUI when only one follicle is produced. After talking it over with MM, we have elected to do that this cycle. Why throw good money after bad? Our insurance will only cover a portion of six IUIs, lifetime. So I triggered when I got home and will have to do nothing more onerous the rest of the cycle than have sex with my husband the next three nights.

Another negative about my ovaries' response this cycle: because my lead follicle is so large, I will have to go in for a baseline u/s to rule out a cyst before starting the next cycle. Assuming that we need to do a next cycle, of course.

Today is one of those days when I am questioning how much more of this I want to do. I don't love taking days of injections even when they produce the desired effect--who does?--but I find it even less appealing when the time, money and effort spent don't result in an increased chance of conception.

I think back once again to the fact that the one-and-only BFP we have ever seen was during a break cycle. . . . and a cycle where my stress levels were through the roof, I was eating like crap and avoiding the gym, and on top of all that, I was taking high-dose ibuprofen! Just makes me wonder whether all this intervention is pointless for us. And why I am bothering to eat better, reduce my stress, avoid certain drugs, and all the rest when it doesn't seem to make any difference.

All these thoughts lead me to think about something even deeper: why am I not more committed to trying everything and anything in order to conceive? Do I just not want to be a parent as much as other people? I read and hear all the time about couples doing multiple IVF cycles, and borrowing tens of thousands of dollars, for a chance to have a baby, women going through much, much worse than I and for much, much longer and still being willing to keep trying. Yet here am I, annoyed at cycle #20, having done a few cycles of IUI and timed intercourse without the desired result.

It seems that many couples who are at our point in this process begin thinking seriously about moving to IVF. It's logical, especially when the woman is my age. That course of action has been suggested to me/us by more than one person. But I am no more interested in starting down that road than I was in May when I wrote this post about our feelings on IVF. MM's feelings on the subject have not changed either. We do not see IVF as an option that we wish to pursue, for all the reasons I talked about in my May post.

Today is CD 12, and I have had a headache on five days so far this cycle, including today. I don't know that I can definitely attribute any or all of those headaches to medication side effects, but I do know that, though I am prone to headaches, that is a much higher frequency than normal for me. And I know for sure that I have suffered with a lot of side effects from the progesterone gel each cycle I've had to use it: cramping, constipation, fatigue, vaginal dryness, breast tenderness.

I'm tired of (figuratively) beating my head against the wall. I find myself thinking, once again, that perhaps it would be better to just focus on other things and stop taking these drugs that don't seem to be helping and may well be causing my headaches. And don't even get me started on the emotional side effects of the drugs. I've gone from someone who has long been noted by family and friends for her calm stoicism--my sister has joked often that I'm "dead inside"--to someone who can barely make it through a day without crying.

If you've made it this far, thanks for reading. I'm not looking for advice. I realize that only I (and my husband) can decide when it's time to stop and whether we want to do more. There are no "right" answers to the questions in my mind.

I'm just venting my frustrations and thinking out loud.

Gratitude

Be thankful for what you have; you'll end up having more. If you concentrate on what you don't have, you will never, ever have enough.
~Oprah Winfrey

When I was in my late 20s and going through a transitional period in my personal life, I ran across the quote above--in Reader's Digest, of all places--and it inspired me to begin keeping a gratitude journal. The idea of the gratitude journal is that each day you write down five things for which you are grateful. The entries don't have to be detailed, and you should try to pick different things each day.

Having done this fairly consistently for the better part of a year, I can tell you that it is not always easy to find five things in a day for which you are grateful. You quickly exhaust the obvious things, like good health, family, friends, pets. Some days I could not think of anything beyond the very basic and mundane: air conditioning, Advil for a headache, making one more green light than usual on my way to work.

I do believe that keeping this journal helped me to shift my thinking and to view my life--which, at the time, was far from what I had hoped it would be--in a more positive light. I don't do it consistently anymore, but I do pick it up again from time to time. I also maintain a "gratitude list" on my work computer and look at it when I'm having an off day.

With Thanksgiving Day coming up on Thursday of this week (at least for us here in the U.S.), I have been reading many emails and status updates on Fac.ebo.ok this week about things for which the writers are thankful, and they got me thinking about gratitude. It seems to be typical of most people that we tend to focus more on what we don't have or what is bad or negative in our lives than on what we have that is good and positive. I think this is especially true in a goal-oriented society like ours, where we are always striving for the next thing, the better thing.

This tendency to focus on the negative, or the lack, in life has become more pronounced than ever for me since I realized that TTC was going to be harder, and take longer, than I'd thought and that we might never be successful and have a child of our own. Despite the many good things in my life, I have spent most of the past year or more focusing on what I don't have: my own child.

So allow me, for a moment, to briefly mention all the things for which I am grateful. I'm grateful for having been born in a country where many freedoms are my birthright. I'm grateful to have been raised by two parents and a grandmother who loved me, nurtured me, and never abused or neglected me. I'm grateful to have had a close relationship with my grandmother, who had such a different world view from anyone else in my childhood because she had been born and lived in what was practically another time, having been born in 1903 and seeing the invention of the car, the airplane, television, and more.

I'm grateful for having a sister close to my age with whom I grew up and to whom I am still close. I'm grateful for my little nephew, who may be the closest thing I ever have to my own child. I'm grateful to have good adult relationships with each of my parents and to still have them around as I approach middle age.

I am grateful for our public educational system and student loans, for without them I would be uneducated. I am grateful for having been given the intelligence to pursue my interests and the opportunity to change careers when I came to believe that doing so would be for the best. My education and the jobs I have had have brought the majority of my friends into my life, as well as giving me the ability to be self-supporting and giving me a purpose.

I'm grateful for the many friends I have. After having been something of a social misfit through high school, having a lot of friends was something that for years I could only dream about. To this day, I know a make a greater-than-average effort to keep in touch with my far-flung friends, and it is worth it for me.

I am grateful for my golden retrievers, who bring a smile to my face every single day. I'm grateful that I have the time, the money and the ability to help people who need it.

Last, but not least, I am grateful for my husband MM. We will be celebrating our first wedding anniversary this Saturday, and he commemorated the occasion today by sending a beautiful bouquet of flowers to my office a few days early so that I could enjoy them before the holiday. It's strange when I think of how close I came to marrying someone else, only to meet MM mere months after breaking my engagement. Had I married my ex-fiance, I would never have known MM at all. I can't say that that would have been a tragedy, because I would never have known what I'd missed, but I will say that this may well be one of those instances in life where things happened for a reason. I couldn't imagine anyone more suited to me than MM, and I know he feels the same about me. We fit.

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We will leave early Thursday morning to spend a few days at my father's house in New Mexico for the holiday. I hope anyone reading this has a good Thanksgiving Day, surrounded by loved ones.

Starting cycle for IUI #3 today

I heard back from my "favorite" NP at our clinic yesterday around 1:30, and I am doing a slightly different protocol this cycle than last:

Clomid 50 mg CD 3 through CD 7 (11/20 through 11/24)
Follistim 100 units on CD 3 and CD 4, 75 units on CD 6, 8 and 10
OPKs before 11:00 each morning starting CD 8 (11/25)
Follicle check u/s on the morning of CD 12 (11/29). (She had asked for CD 11, as I'd suspected, but agreed to schedule it for CD 12 instead.)
Trigger with Ovidrel when instructed to do so prior to IUI

The NP said that the doctor decided to "tweak" the Follistim dosage a little this cycle, for reasons he did not share with her (and that are not clear to me). My initial dose on CD 3 is a little less (I did 125 units last cycle), but my second dose on CD is a little more (100 units vs. 75 units before).

I remarked "I guess the dosing is not an exact science," and her response was "It sure isn't!" How reassuring. LOL

My only mild concern was that my lining was just over 7 mm last cycle at my mid-cycle u/s. She told that my RE just wants it to be in the 7-12 mm range, and as long as it is, he doesn't worry about it, so he did not perceive it as a problem last cycle.

It should be interesting doing OPKs and injecting myself while I am at my dad's. I'm not usually very good at stealth. ;-)

CD 1 and other stuff

I have been neglecting my blog this week, in part because I have been busy and out of the office, and in part because I haven't really had much to write. This post will be a quick update, bullet style.

• I started spotting Tuesday night, and AF arrived early Wednesday morning.
  
• I placed my cycle day one call to the clinic's nurse line at 8:30 yesterday morning and have yet to hear back. I will call a second time if I don't get a call by noon today.
  
• Because I haven't heard from the clinic, I don't know yet whether they will agree to do my mid-cycle monitoring u/s on CD 12 instead of CD 11. Which means that I don't know yet whether we will be doing treatment this cycle because I am out of town and absolutely unavailable for an u/s on CD 11 (and cannot, at this late date, change my plans).
• If we end up doing treatment, it will be a repeat of last cycle.
  
• I woke up with a migraine on Tuesday morning at 5:30. Nevertheless, I had to drive nearly 200 miles through the open desert to attend two depositions that day.
• The date for these depositions had been set for months, and as they involved multiple parties, some from out of state, could not be changed. No one else could attend because the partner who is the only other lawyer in the firm who knows anything about the case was unavailable. So I had to suck it up and do the best I could. I survived, thanks to regular doses of ibuprofen and Excedrin.
• My RE doesn't like for me to take ibuprofen, but he is even less OK with my taking prescription Imitrex, so I had to "pick my poison," as I needed one or other to function.
  
• By Wednesday morning, my migraine had finally faded to a dull ache. . . . but returned full force yesterday afternoon as I attended yet another deposition.
• I am still headache-y this morning, though slightly improved from yesterday.
• I do not want to be at the office today. Such is life.
• I have hardly seen my husband all week between our respective job responsibilities and my going to bed early due to my migraine(s).
• I get to make a 250-mile round trip tomorrow for my fourth deposition of the week. It's good, though, because I will get to visit M, my CASA case child, briefly while I am in her city.
• I am very much looking forward to next week, when I will only have to work THREE DAYS. Wish every week were like that! ;-)
• I'm also looking forward to seeing my dad. It's been six months since I've seen him, which is probably one of the longest periods ever that we haven't seen one another.
  

Waiting for cycle #20 to start

I spent a good portion of yesterday wallowing in self-pity. On the one hand, I feel a little silly for being disappointed at yesterday's BFN: I've seen so many already, and I know that the odds of success for an IUI with injectables are only about 20% or so at the most. On the other hand, I felt that I wanted to acknowledge my sadness at yet another failure, so I did.

Yesterday's BFN means that MM and I will celebrate our first wedding anniversary on November 28th still childless. This probably doesn't sound like a very big deal to many of you, who perhaps didn't even start TTC-ing until you had been married for some time. But when a couple marries in their late 30s and still wants to have children, it is not at all uncommon, in my experience, for them to start TTC right away. Many even give birth to a first child before their first wedding anniversary. (I can think of several couples of my acquaintance who fall into this category.) Everyone is aware that "time is of the essence" once the woman is over 35.

Our upcoming anniversary also just makes me more aware of the passage of time. In my introductory post, I mentioned the fact that we started TTC just over seven months before our wedding date. (We knew pregnancy could take longer to achieve when the woman is over 35. Little did we know how much longer, in our case.) There was actually a period of months when I was mildly concerned about being visibly pregnant for our wedding. How naive that seems now.

It makes me sad to think that we are nowhere closer to our goal of becoming parents together now, after 19 cycles TTC and nearly a full year as a married couple, than we were a year ago. The only things the past year has brought us in regard to TTC are disappointments, inconvenience, stress and less money in our bank account.

Anyway. It is what it is. I am feeling better today, and I am very grateful for all your supportive comments yesterday. (And by the way, a glass of wine is a great suggestion after a BFN; unfortunately, I gave up alcohol entirely about a year ago due to migraines. Drats! I did throw healthy eating a bit to the wayside, though, and eat foods that weren't "clean.")

Now I am just playing the waiting game. Looking back on the previous two cycles when I used progesterone gel, my period did not arrive for about 5 days after my last dose. Assuming that my body reacts the same way this cycle, I can expect that AF will not arrive for another few days.

I am actually hoping that AF arrives no earlier than Wednesday. . . otherwise my monitoring appointment will fall on a day during our trip to my father's in New Mexico over Thanksgiving weekend. I'm not sure if my RE can/will give me more than a day's leeway for performing my mid-cycle u/s, which is supposed to take place on CD 11. And there is no way I could get the u/s done in the city where my dad lives: even if I could find a place there to have it done, our clinic does not permit that. They will only do my IUI if they do the mid-cycle u/s. (And I wouldn't want to do that anyway, because my dad and stepmom don't know that we are doing intervention, and I intend to keep it that way.)

So we shall see. It's not impossible that AF will arrive earlier and we will have to skip this next cycle. If that happens, so be it. As I've mentioned here before, I have never been 100% sold on the idea that the drugs and IUIs are truly improving our chances, given that the one-and-only BFP I have ever seen was during a break cycle. And I'm not thrilled at the idea of taking Clomid & Follistim while staying at my father's very small house with my nosy stepmother, but I will do it if I have to.

MM and I were talking today about a trip we plan to take in March. MM always takes a week off in March--he has for years--and coincidentally, it is usually the week in which my birthday falls. We had first talked about going to Disneyland and California Adventure, but after a trip to Costco today and looking at their travel brochures, we are also now considering a return trip to Hawaii (though not to Maui, to one of the other islands). It's fun to plan trips and talk about things in the future, but I couldn't help thinking that if I am pregnant by March, the odds of our being able to actually take this trip will likely be close to zero. I didn't mention this to MM, though, because nothing is definite yet--with the trip plans or TTC--and I didn't want to burst his bubble.

Once again during yesterday's wallowing, I thought about how much easier it would be to just give up. We are friends with a couple about the same age as us who married just a couple of months before us. In contrast to us, though, they agreed before they were married that they did not intend to have children. (They have nieces and nephews whom they adore, so it's not that they don't like children, more that they are both very career-focused--both on the police force, one a canine officer and one a detective--and like their freedom.)

I couldn't help thinking how much less stressful their first year of marriage has probably been than ours. Sure, I love MM, and I have no doubt that he loves me. We are happy, in the main. Our relationship is good, solid, and fun. Dealing with disappointment every single month can't help but take a toll on any relationship, though. We are both often angry, sad, frustrated, uncertain, and all the other things that go along with infertility.

On some level, I wish I just didn't have the desire to be a parent. I wish MM didn't have that desire. It would make our lives so much simpler.

Another BFN

On to cycle #20.

Eventually

eventually, -adverb: finally; ultimately; at some later time.

I saw this necklace in someone's etsy boutique a few weeks ago and bought it for myself. (Though the woman who made it is a survivor of IF, I found her blog and etsy boutique in a circuitous way totally unrelated to this blog: she is now an adoptive mother, and a law school classmate of mine who gave up her baby through open adoption had a link to this lady on her blog. Serendipitous.) I've worn it nearly every day since it arrived.

I don't know that it means to me that, in fact, "eventually" we will be parents. I think it's more a reminder that, eventually, our current ordeal will be over, one way or another, and life will still be good, whatever the outcome.

Today is 14dpIUI #2.1 and is technically my test date. I will POAS tomorrow morning and post an update then. (Those reading this who are early testers probably think I'm crazy, but trust me: I would be significantly less productive at work today if I tested, regardless of the result. Better to do my mourning--or celebrating--on Saturday, when I will still be just as pregnant, or not.)