I Am Insane

I can't remember the last time I was this ridicuously emotional with my period. Granted, I'm going through extenuating circumstances right now (IF, looming unemployment) but this is getting out of hand.

Yesterday I errupted in tears after bursting out at Justin that I am so unhappy and why can't something just go right? I had just gotten off the phone with my mom and I was so mad about our conversation. Justin kept asking why, but I really didn't have a good reason. It was something about being pissed off at people who think they know what they're talking about and actually have no idea... my thoughts were incoherent.

Then today when I tried to leave work, my car wasn't there. My dad had picked it up to get it smog tested (without telling me), which is supposed to be a favour. But I was FURIOUS that it was my birthday, I was done work, and my car wasn't there. I had errands to run (I had to cash my paycheque and get gas) before driving the 25 minutes out to my house. My dad didn't show up for half an hour. By that time I was stuck in way heavier traffic on my way home. I was LIVID. I sobbed furiously as I was driving around to do my errands, cursing every person who turned in front of me or was driving too slow. I swear I had to restrain myself from driving my car right into someone else's purely out of rage.

I cancelled my parents coming over tonight. I am not good company. In fact, I am completely insane.

It's gotta be the Marvelon.

Birthday Arrival

In honour of my birthday today my period arrived right after I got to work. Thank goodness.

I feel like crap. I'm extremely crampy and tired, and my boobs hurt. But I'm so glad my period is here that I'm not even mad that I feel so yucky on my birthday.

This IUI cycle I am doing the following:

7.5 mg of Femara on CD 3
50 mg of Clomid on CD 3-7
75 IU of Bravelle (injectables) on CD 6, 8, and 10.

I'm redoing my Day 3 bloodwork this month, and my RE added a fasting insulin test. I'll actually get it done on Day 3 this time, which is on Wendesday.

My first cycle monitoring bloodwork and ultrasound will be on Thursday, April 9 (CD11). I'm hoping that my high LH won't interfere with my medications. I had positive OPKs again on Saturday and Sunday, despite the fact that the Marvelon was supposed to zero out my hormones. I'm really praying that I'll develop several mature follicles. The goal of my treatment protocol is to produce 3-5 mature eggs, so I'm really really hoping for at least 3. Actually, to be honest, I'm hoping for at least ONE so that this cycle won't be a complete waste. 3-5 would be AMAZING, but if I don't even have one then I'll be really disappointed.

Now it's time to distract myself from the waiting game. Any suggestions?

Goodbye Marvelon!

Today is my last day of Marvelon. I woke up at 2:30am to go to the bathroom and I took it then, 4 hours early. (Oops, I wasn't planning on telling you that, Justin:) I just wanted to have that 4 hour jump start to having the BCPs out of my system.

My husband was very against me fooling around with the timing of it. I tried to explain to him that the timing only really matters if you trying to NOT get pregnant. Obviously that is not our intention here, so being off by several hours isn't a big deal.

So my next step is getting my period and redoing my Day 3 bloodwork. My RE just wants to see what it'll look like after the Marvelon, since Marvelon is supposed to really zero out my hormones.

Speaking of which, I finally got a negative OPK last night!!!!

I know it sounds ridiculous to be excited about a negative OPK, but I just ALWAYS have positive ones because of my massive LH levels. I'm glad my LH is back down to a normal level. The test line was sooo faint. I was so pumped.

L-Carnitine or Crack...

I went to buy Justin's L-Carnitine because he ran out of it at the end of last week. I found out that it is incredibly illegal here in Canada, so my health and nutrition store isn't getting any more in stock. And the girl told me that if I went to the states to buy it and brought it over the border I would go to jail for longer than if I had been smuggling crack.

WTF!

I bought up their last two bottles, but each of those only has a one month supply!

Here's hoping I get knocked up by then.

Lame Limbo?

I'm on day 4 of 10 days of Marvelon (birth control pills, also known as BCP). My feelings keep waffling back and forth between feeling like we're doing something and feeling like we're doing nothing.

On one hand, I'm frustrated that I'm just waiting for my next cycle. I want to be on the fertility drugs now, because then I feel like I'm actually doing something that's working towards getting pregnant. Being on BCP seems so ridiculous sometimes - my body is doing ABSOLUTELY NOTHING right now!!

I don't like putting hormones into my body to get it to do something that it already does naturally. My RE said that I was only ovulating in a third of my cycles, tops. But I still always got a period! So why shouldn't I just wait for my period to come naturally instead of taking BCPs in order to get it to come?

(Side note: this would be the time that my period suddenly decided to take 60 days to get here, and then I'd be kicking myself that I didn't listen to my RE.)

On the other hand, I keep telling myself that we're not just doing nothing. I looked into the whole concept of going on Marvelon (not just Provera or any BCP) or waiting for my period to just come naturally.

I learned that Marvelon is what my clinic gives to IVF patients before they go on GnRH agonists and antagonists. There's evidence that ovulation and the normal luteal phase of a cycle does something to prepare the body to select just one egg for ovulation in the next cycle. So if the objective is to stimulate the production of many eggs, it may be beneficial to not allow this pre-selection to occur.

So as opposed to Provera, which is just to bring on bleeding, Marvelon is used to zero out your hormones more thoroughly, so you're totally starting from scratch in your new cycle.

After learning this I keep telling myself that I am already starting the fertility treatments now. I'm not just trying to bring on a period; I'm trying to supress my body's natural tendency to select just one egg to mature in order to allow my vast array of fertility drugs can do their job. Our goal is 3-5 mature follicles. If the Marvelon helps us get those (even though it seems incredibly ironic that birth control pills could help your fertility treatments), then I'm happy to be on the Marvelon.

I'm going to keep telling myself that.

RE Appointment

Here's a bloodwork and ultrasound update first:

My E2 dropped between March 11 and 14, and my LH jumped back up to 17.1 from 14.2 (it was 17.0 on March 8 as well... stupid LH). I have one follicle at 10mm, but I'm on CD20 and my bloodwork shows that it's not going to go anywhere. My lining was 8.5 on March 8, 8.5 on March 11, dropped down to 6 on March 14 (I had been lightly spotting) and was all the way up to 10 today! Although I'm spotting a bit again now. It's weird, I never spot mid cycle.

Regardless, even though I have no eggs to implant, I'm happy to know my lining is at 10. That's a great lining. I need to be happy about the little victories, right?

Anyway, my RE appointment this morning! It was EXCELLENT!! It was with the RE that owns the practice (which is nice, because he doesn't feel like there's anyone looking over his shoulder and he can just do what he wants). I do not have premature ovarian failure. Thank goodness!!

He wasn't too concerned with coming up with an exact diagnosis. We know what it's not: it's not ovarian failure and it's not pituitary failure. He doesn't really like the PCOS category because it is incredibly broad. So I have unexplained ovarian dysfunction or something like that. He thinks I was probably only ovulating in maybe 1/3 of my cycles. He admits he's confused by the high LH though, because my LH wasn't that high on Day 3.

Anyway, he came up with a plan of action. I asked him to be as aggressive as possible at this stage. Here it is:

I'm on Marvelon for 10 days (a BCP that studies have shown helps your hormone levels to bottom out better than Provera, so that when my period starts I really will be starting from scratch). I'll get my period soon afterwards... or I should. Here's hoping.

On CD 3 I'll do bloodwork again and then take 7.5 mg of Femara, because it helps to sensitize your body to Clomid.

Then I'll take 50mg of Clomid from CD 3-7.

Then I'll do injectables on CD 6, 8, and 10 (75 IU of Bravelle).

This is considered a medium stimulation protocol. And it's what I wanted, because I just have this feeling that I need injectables.

So that's it. Marvelon, then Femara, Clomid, and Injectables.

I'm beyond pumped to get AF and start my next cycle. And I am beyond thankful that my new RE listened to me and did what I wanted. My last RE did the exact opposite of what I wanted and what I told her I thought I needed.

Look who's laughing now, Dr. Muise.

Day 3 Bloodwork Update

(Warning, this post may contain medical talk, jargon, and acronyms that are not easily decodable by one who does not suffer from infertility.)

I called my clinic this morning to find out my Day 3 results. They don't seem terrible.

Estradiol - <73
(should be between 25-75. Lower levels are better for stimulating, and higher levels could indicate either a functional cyst or diminished ovarian reserve. If I'm around 73 that seems a little high to me)

Prolactin - 8.1
(should be <24)

LH - 7
(should be <7, but I'm surprised that it was only 7, considering my enormous levels during the rest of my cycle)

And finally,

FSH - 7
(FSH is used as a gauge of ovarian reserve. In general, under 6 is excellent, 6-9 is good, 9-10 fair, 10-13 diminished reserve, 13+ very hard to stimulate)

I fall into the "good" range for FSH!! But my estrogen is kind of high for Day 3, so it could still mean I have diminished ovarian reserve. Either that or I did have that cyst I was thinking I got from the Clomid last cycle.

We know I have a problem, but nothing in my bloodwork jumps right out at me to tell me what my problem is. If I was ovulating, my bloodwork would probably appear completely normal. However, when I pair my Day 3 results with what we've been seeing during my monitored spontaneous cycle I still wonder if I have PCOS.

I know I have semi-regular cycles (28-38 days), and often people with PCOS have cycles as long as 120 days. BUT my ultrasounds are showing that I'm not developing any mature follicles (their growth appears to have stunted at "small"). So obviously I'm not ovulating.

My next clue comes from my clinic itself. They have an information sheet on Decreased Ovulation and the possible causes (pituitary failure, ovarian failure, and PCOS). It all starts with knowing that you're not ovulating. If you are ovulating, then obviously the following information doesn't apply to you.

If your FSH and LH are <2, then pituitary failure is present.

If your FSH and LH are >10, then ovarian failure is present.

If your FSH and LH are in the intermediate range, >2 and <10, then PCOS is likely present.

Notice they say likely... PCOS is a bitch to diagnose.

Regardless of my extensive detective work and my immense base of infertility knowledge (lol) I am still not a Reproductive Endocrinologist. So obviously I need my appointment with my RE tomorrow to tell me what the heck is going on.

But at least I can spend my day not feeling like I'm going to throw up. I'm telling myself that it's just PCOS.

*sigh of relief*

Uh Oh.

Well, somehow my clinic got my bloodwork from the hospital yesterday and while I was out today they called and left a message. They didn't tell me the results of the bloodwork, but they told me that Dr. Martin (the RE who owns the practice) wants to see me on Tuesday.

Now, just to put this in perspective, I had originally seen a different doctor who I didn't like. And yesterday, after I found out about my possibly horrible situation, I asked if I could please see Dr. Martin sometime this week. Or for that matter, could I please see ANY of the doctors this week. The receptionist looked in the computer and said she had no appointments with any of the doctors for this week, but if I wanted to see Dr. Martin I can see him on May 13. Two months from now.

Then they saw my bloodwork, and suddenly I can see him in 2 days.

To me, that sounds like something a whole lot worse than PCOS. It sounds like they saw my bloodwork and went "Holy crap! High FSH! She's running out of time! She better get in to see Dr. Martin right away!"

I should probably also mention that the person on the phone sounded like she felt really sorry for me.

I'm scared to death. Hopefully I can find out my levels tomorrow, so I'm not feeling bowled over on Tuesday at my appointment.

Is this seriously happening??

And It Keeps Getting Better... Not

I just got back from my ultrasound. I'm on CD 17. Once again, I have absolutely no follicle growth. And my lining dropped from 8.5 to 6 (I'm been really lightly spotting for the past few days... bizarrely, because I never spot mid cycle).

But wait, it gets better.

I looked at my monitoring sheet. My E2 should be in the 500's at this point in my cycle, but it's not. It's in the 100's still. Which didn't surprise me, because my follicles aren't growing.

But it gets even better.

My LH, which should be below 7, was at 17.0 on CD11 and 14.2 on CD14. (This explains why I always have almost positive OPK's).

So I say to the nurse who's taking my blood "Um, that's not normal. My LH shouldn't be that high. Especially when my estradiol is so low." And she said "You're right, that's not normal." So she goes looking for my Day 3 bloodwork, which, TA DA, isn't in my chart. Apparently the hospital didn't send it to them.

I asked the nurse what could be going on and she said "What we will probably see from your Day 3 bloodwork is an elevated FSH."

WHAT?!

I am 24 years old! How could I possibly have high FSH? How could I possibly have a decreased ovarian reserve? Or poor egg quality???

I am terrified. I'm calling my OBGYN on Monday to find out my Day 3 levels and to get them to send them to my clinic. What I'm hoping is that I'll have normal FSH with high LH, which could mean that I just have PCOS. (Keep in mind, this potential diagnosis was done solely through the help of the internet. The nurse did not mention PCOS as one of the diagnosis options. So I don't know how likely it will be.)

I really really hope all it is is PCOS. Because if I have high FSH, that's it. We can't afford IVF, much less IVF with donor eggs!

The nurse said that next month we'll probably do a clomiphene challenge test. It's a test that gives an indication of your ovarian reserve... a test that is normally only done on women in their 40's!!! I can't believe this.

(Oh, and I love how nobody told me that they didn't have my Day 3 bloodwork, and that my hormone levels are COMPLETELY out of whack. I had to look at my own flippin chart and make her tell me something. Don't you think maybe this is worth a frickin PHONE CALL?!?!?!)

Waste of Time

This morning I woke up at 4:30am, got ready, and drove an hour away to my clinic. All to find out that I still have no follicle growth.

The "ultrasounder" (I still don't know if she's a tech or a nurse or what) seemed puzzled. She asked me in a confused voice "You said you have regular periods?" And replied that yes, my cycles are 28-36 days long - if you consider that regular.

She told me "I don't want to give up yet. I've seen ovulation as late as Day 26. So come back on Saturday."

What do you want to bet there still won't be any follicle growth on Saturday?

I'm convinced I'm some freak of nature that gets an LH surge, PMS, and a period every month, but I don't actually produce an egg.

I'm so pissed off.