judecorp | Injectables cycle #2 - aka Uberfrustrating

I have really gone off the deep end. So much so that I called my doctor's secretary and made her have him call me back personally, because I had already pissed off all of the nurses.

Today is CD10. For those of you Not In The Know, that means Cycle Day 10, which means I'm 10 days in. CD1 is always the first real day of menses. Today was my second monitoring appointment, which means ovarian ultrasound and bloodwork.

I went for my first monitoring appointment on Monday, which was CD8, after 5 days of injecting 75iu of Follistim. That's basically injecting FSH (Follicle Stimulating Hormone... think back to 9th grade bio) straight into your gut. (Some background: Follistim works by stimulating the ovaries directly to produce follicles (which contain eggs), rather than Clomid (the drug I did before, it's oral) which tricks your brain into blocking cessation of estrogen production so you might make more eggs. Anyway, the point of shooting yourself up with FSH is supposed to be more eggs (and better quality). An average woman has one mature follicle per cycle. An average Clomid cycle is 2 follicles.) So where was I? CD8. On CD8, I had a bunch of little follicles that were all under 10-12mm... with one on my left ovary taking the lead at 13.5mm. My E2 (estradiol, a beta form of estrogen that is released by maturing follicles) was 82, which is pretty low. General consensus is that a mature follicle has an E2 of 200-600pg. I thought they would raise the amount of FSH I was injecting, but they didn't. They told me to stick to 75iu for the next two days (CD8-9) and come in on CD10. That's today.

I came in this morning and was shocked to find that my 13.5mm little guy had grown to 17mm in two days! But the thing that SUCKED was that NOTHING ELSE GREW. So I had this 17mm and the same bunch that were all 12mm and under. I was so upset by this that I called the nurse's line and said something like, "Hey, I thought that the point of injectables was to have MORE follicles, and I am getting ONE. I want to know if you know why this is, especially when I have a good ovarian reserve." I got a message back from a nurse that said, "Oh, everything looks GREAT, you have a ton that are around 11-12mm and I'm sure the doctor will be pleased." She seemed to miss my entire point that I already had one at 17mm and I didn't have much time.

I got the call about my E2 in the afternoon, and it was, oh my god shoot me now, 131. (Guys, that's low. Not only does it show that my 17mm dude isn't mature yet, it definitely proves that there is nothing else really maturing in the pipes.) And in the same breath, the nurse says that I am to take one more dose of 75iu Follistim tonight and then do Ovidrel tomorrow night (Ovidrel is an injection of straight hCG - human Chorionic Gonadotropin - that forces the follicles to release their eggs in about 24-48 hours.) for inseminations on Friday and Saturday!

!!!

So let me spell this out a little bit. An injectables cycle hopes for 2-4 mature eggs. There is usually an E2 level of 200pg for EACH mature egg. You trigger ovulation with Ovidrel when the eggs are mature. For a little comparison, last cycle I triggered when I had 2 follicles (19mm and 15.5mm) and an E2 of 398. This is WAY lower than that.

I was so upset about the idea of triggering tomorrow and having ONE follicle that I really pissed the nurse off. She was getting really short with me and didn't seem to like the idea that I "knew stuff." When I brought up things about E2 levels and mature follicles and stuff she just started saying, "Well, what the doctor wants..." and then I knew that a) I had more information than she did and b) she was getting irritated. So I told her I was sorry, that she was the messenger, and that I was frustrated.

Later, I was still upset and Jen convinced me to call back and demand to speak to the doctor. I had previously tried to do this and the receptionist said the doctor was with patients and sent me back to the nurse line. So this time I called back and asked for the doctor's secretary... and then I told her that I was VERY concerned about my cycle and I really wanted the doctor to call me back TODAY. And she said she would try. And he did call, at 4:45pm when I was in the middle of staff meeting.

He was nice about me wanting a call and told me I probably didn't piss off the nurses (but I know I did), but really didn't have too much to offer me aside from the "party line" of "Oh, this is going to be fine." (I have learned through this process that "fine" means "the minimum of what might possibly work maybe.") He did agree with me that the E2 was low, and WAY lower than last time (dude, you don't need to be a doctor for that) but kept telling me that it was going to be fine because he was sure it would be MUCH higher by tomorrow. (Keep in mind that it went from 82 on Monday to 131 on Wednesday... how high is it going to be tomorrow?) He also said, and I almost spit out water, that the 12mm follicle on my right ovary was going to be mature by the time of trigger. Remember that the time of trigger is TOMORROW and that mature follicles are a MINIMUM of 15mm. He basically told me I didn't know what I was talking about, and that a good E2 level for a mature follicle is 120pg. Whatever.

So basically I can't say I don't have a chance this month because I /do/ have one mature follicle, BUT I really don't have a heck of a lot of optimism (I've had 2 follicles every other cycle and am certainly not pregnant yet) and I don't really have a lot of faith in my doctor's office if I am getting this sort of result from an aggressively medicated cycle.

My main frustration is that I feel like my doctor is not taking these injectable cycles very seriously and is just thinking of them as a stepping stone to IVF. He is always talking about what goes in on IVF cycles and how that is my next step, and today he went as far as to tell me with some happiness that after my third injectable cycle, my insurance will automatically cover IVF. HELLO, CAN WE LIVE IN THIS CYCLE RIGHT NOW? I seriously think he gets a big stiffy in his office thinking about jumping to IVF and raising his stats.

I was pushy enough that he agreed that if this cycle didn't work, he would be a little more aggressive with the meds next time. I think this occurred because I told him quite forcefully, "Look. I am trying to move away. My wife is taking a job across the state and I will be LIVING HERE BY MYSELF to do these cycles and this is my LAST CHANCE." I'm hoping that by telling him under no uncertain terms that even if I ever pursue IVF it will not be with him will let him realize that he has to actually TRY. Or maybe not. I don't know.

So basically I have given myself track marks in the gut and have a major pizza face (FSH causes skin breakouts) for one ridiculous follicle and the lowest E2 ever. I am ready to punch someone in the face.

~//~

That said, yes, I know that people get pregnant with one follicle. All the time. In fact, most people get pregnant with one follicle. But most people aren't spending a billion dollars and shooting themselves in the gut with hormones with one follicle. I feel like I am paying these people for results and am playing by their rules to a T, and I'm getting the same odds that I would be getting if I wasn't doing anything with them at all! (I do still ovulate, without them, and it's probably one lonely follicle.)

It's times like this when I really REALLY get it when people say, "I am just waiting for this cycle to be over so I can move on to IVF." Because it seems like the doctors only really care about IVF and that's what they spend their efforts on.