Attempt Numero Tres: Nothing's Charming

I met with Dr. D on the 3rd day of my next cycle.  We discussed that Clomid was not only not working for me, it was working like a really expensive form of birth control.  Dr. D, not wanting us to shell out 10+ grand unless absolutely necessary, wanted to try at least one more round of IUI, but this time using straight follicle stimulating hormone (FSH).  These are the injectable drugs.  The downside of them is that they only improve our chances by 1%, and they cost some major dough.  Four days worth runs about $500.00.  They also increase your chance of multiples dramatically.  We would be going from a 10ish% chance of twins to nearly a 30% chance of twins and 2% chance of triplets.  On the positive side, they don't intefere with your uterine lining.  It was a fair trade-off. 

Let's talk about the multiple situation...I, previous to my personal fertility dilemma but post John & Kate + 8 hoopla, thought, 'Well, clearly they did not need fertility treatments if they had that many babies.' I don't feel that way at all anymore. I think 4, 5, and 6+ babies are ridiculous, and with a good fertility specialist is completely avoidable, but twins and triplets do not a bad doctor make.  Typically these higher order pregnancies are the result of IUI's, not IVF. During IVF, the fertility specialist and you have complete control over how many embryos are transferred back. In my case, I barely ovulate, and as Dr. D says, who even knows if my eggs actually even leave the follicle.  So instead of just having one microcosmic chance of conceiving during a normal month, a medicated cycle with multiple follicles increases my chances, even if only incrementally.  Dammit, I'll take it.  A responsible fertility specialist should look at a quad or higher order pregnancy as a bad thing.  They should know when to cancel a cycle because there are too many mature follicles.  The vast majority of fertility treatments result in 1 baby.   The point is don't scoff at people undergoing fertility treatment for having multiples.  It's kinda an all or nothing game, and the chance of these freakish pregnancies with a blue-million babies should remain less than 1%.  That's my beef...

Dr. D and I also discussed that 8 million-post wash sperm was not so good.  BJ had been taking a multi-vitamin and a vitamin E supplement for a couple of months to help improve sperm quality.  We knew we couldn't get his morphology to improve, but we thought the more sperm, the more normal shaped sperm there would be. We learned that the washed sperm were not necessarily all the correctly shaped ones either. Apparently BJ's dunderheaded sperm can be great swimmers despite their block-heads. Dr. D thought we would see a lot of improvement in this round, because it usually takes 3 months for the vitamins to make their peak impact on sperm count and motility.

After a quick lesson from my favorite nurse, Pat, on how to give myself subcutaneous (sub-q) injections, I was sent off with my Follistim kit and started injections that night.  I am by no means a needle-phobe, luckily.  My poor husband, not so much.  Anyway, giving myself the injections in my tummy was no big thing at all.  Sub-q injections require tiny needles that you can't even feel.  The only time I had any stinging was when I got in a hurry and didn't let the Follistim warm-up to room temperature.  (It has to be kept refrigerated.)  The 55 degree medication did not feel so good when it hit my 98.6 insides.  Every night for the next two weeks I gave myself 150 IUs of Follistim.  The only real side effect I noticed was extreme fatigue, which isn't even one of the side effects listed as common.  I may be blaming the Follistim for my mental and emotional fatigue from the failure of the last cycle, but I swear I could have slept 24 hours and still been tired. 

They monitor you a lot more closely when you use injectables because of the increased chance of developing ovarian hyperstimulation syndrome (OHSS).  That is when your normally almond-sized ovaries blow up to the size of softballs (or bigger) and cause fluid to collect in your abdomen.  It only happens in 2% of women undergoing fertility treatments, but it has the potential to turn deadly.  Besides extreme pain from the swelling and fluid in the abdomen, you can also start collecting fluid in your lungs.  Not a fun way to go, and definitely not something you want to have happen.

Any-some-how, I had four ultrasounds during this cycle.  My lining was much improved and even my right ovary got its lazy butt in gear and started producing follicles. My uterine lining went from 8mm to 11mm.  I had three mature 18mm+ follicles on my right and 2 potential follicles that were a little smaller on my left.  Considering my lack of success, Dr. D was fine with proceeding with an IUI this cycle even though I had a 2% chance of conceiving triplets...if I conceived.  I was instructed to set my alarm for 1:00am so I could give myself my Pregnyl injection.  Tis another bitchy thing about fertility treatments...even when you don't want to be thinking about it, you have to do crap like wake yourself up in the middle of the night to stab yourself with a needle.

At 1:00am Britney Spears, "Toxic" seranaded me as I drowsily got my injection tool-kit out.  Ever the needle-phobe, BJ stayed far, far away saying, "I'm sorry baby, I just can't." Wuss...Thanks to my awesome organic chemistry lab at Ursinus College, I skillfully mixed my medication and loaded the syringe.  Pregnyl is an intramuscular injection (IM) so it has to go in either your butt or your thigh with an 1.5 inch needle.  It can be a bit intimidating especially at 1:00am.  I counted to three and stabbed, but then remembered I didn't check for air bubbles...DAMMIT.  So I pulled out the syringe, changed the needle and swabbed up my other thigh...this time I made sure the medication was loaded into the needle and stabbed myself again. This time it went off without a hitch, and I got to limp back to bed.  If you ever have to inject yourself with anything...it's worth taking the time to find the check-sheet your nurse gives you!

34 hours later BJ, having done his thing, and I showed back up at the fertility clinic.  I was really excited because of my amazing follicles and even had been joking about my triplets with my best friend who had already named them Nicole, Nikki, and Nicolette.  (Her name is Nicole if you haven't figured that out yet...) To top it off with even better news, Pat marched right into the exam room proclaiming that BJ's sperm count had gone from 102 million pre-wash (AWESOME) to 33 million post-wash (EXTRAORDINARY).  The procedure went much the same as the last, with some mild discomfort. 

Since lifting heavy things within 48 hours did not help so much last time, I chose to take it pretty easy.  Not bed rest per say, but nothing strenuous.  I didn't run or even walk briskly for 48 hours.  I also started progesterone supplements immediately after the procedure this time.  When I went in for my progesterone test it was over 40 which is the level you would expect for a woman during her 2nd trimester of pregnancy.  I got really excited.  I thought this has to be it.  Surely my progesterone would not be so high without a reason.

The progesterone level was taken on a Wednesday, and I was having a ton of PMS/early pregnancy symptoms.  My boobs hurt to look at.  BJ even gave me lots of compliments about my enlarged bustline.  I totally found myself wishing I'd doubled up on the sports bras when I used the elliptical or ran. But then, by the weekend it just stopped.  While it's not too uncommon for symptoms to come and go, this just felt different.  By early the next week I was back to where I usually was with cramping and achiness like every other disappointing month.  I knew it hadn't worked, and I was decimated.  I elected to quit taking my Prometrium a day early because I didn't want to have to wait any longer for the next cycle to start, and the Prometrium can delay your period.

I told the nurse with a stiff upper lip my test was going to be negative.  She tried to stay optimistic and say I didn't know for sure until I had the blood test results.  She had me wait while she ran a quick version of the beta HCG test. She came to get me with the results and told me that I had been right, and I, despite my best efforts, broke down anyway.  God bless, Pat.  She rubbed my shoulders and let me cry.  She told me how it took her 13 years to conceive and how she felt so worthless and constantly questioned what she had done to deserve her infertility.  It was great to have someone validate my feelings of worthlessness and not make me feel like an idiot for feeling like that. 

She asked me what I wanted to do.  I told her I did not think I could make it through another round of IUI.  I had the most follicles I had ever had, and BJ had his best sample, and I just knew if it did not work this time, it was not going to work.  I had that same gut feeling I had after three months of trying on my own.  IUI's were just not going to be our ticket.  She told me she would put the bug in Dr. D's ear about pursuing IVF.  Stupidly, I had been a little scared of broaching the subject because I didn't want Dr. D to feel like I didn't believe in him.  When you depend on somebody so much, it's easy to sit back and become a passenger when you still need to be holding the reins.

I was resolved.  I went home and told BJ that I was done with IUI's.  Fiscally it was not worth it anymore.  By the time we tried three rounds of Follistim/IUI's, we would have spent half the cost of IVF.  I'd rather put my money where the odds are much higher.  BJ looked at me and simply said, "lets do it."  He's pretty dang awesome, that one.

And now, we are all caught up...
MK