The Proverbial Square Peg - AKA Monitoring Update #2.4

We started a new medication yesterday. Ganirelix. I'm told that it's job is to prevent my oodles of follicles from releasing eggs too early. In other words, it delays ovulation. See - that's funny. Because I thought it's job was to burn and itch like a son of a bitch, but not until about 20 minutes after it's given. It first lulls you into this false sense of "Hey - this med isn't too bad". Then about 20 minutes later, you're all "son of a motherless goat... what the f is wrong with my freakin' arm?!!?!?!!?"

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As long as it does it's job, right, and keeps those suckers in there until Dr Z is ready to get them out.

So, yesterday, my nurse F did my monitoring u/s and it was great. I was an egg machine - she was finding them everywhere, and I LOVED the way they were measuring. This morning, Dr B (Dr Z's associate) did my u/s, and although I definitely LIKE Dr B, he's no Nurse F or Dr Z. And I definitely like the way Dr Z and Nurse F measure a little better. I don't know if they measure big, or if he measures small - but at least I still had about the same number of follicles today.

Here are my day 9 measurements, on day 2 of ganirelix, for anyone who's keeping count. My lining is 13mm and trilaminar.

Right ovary: 13x12, 12x11, 11x10, 16x14, 13x10, 14x12 and 3 small (less than 10)
Left ovary: 17x12, 14x10, 17x12, 12x9, 15x13, 15x13, 17x13 and a few small

The funny thing was that the 1st follicle on my left ovary looked like a square. I tried to find a good picture of one like it online, but this was the best I could do. It was sort of like the one in the middle on the right. But MUCH more sharply defined. Since it's 17x12, I guess it was more of a rectangle - but it REALLY looked like a perfect square. It was so funny.

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We're pretty sure that perfect square is half of our baby. ;) I like thinking that the funny looking ones can be our kid. We're such weirdos.

Anyway - no call from Dr Z's office this morning, which means they're not making any changes, and we have to be there again by 6:40 in the morning tomorrow. Yesterday, my E2 was 615, up from 480 the day before. Dr B says that's not bad at all. No call today means I don't get to find out today's E2 until tomorrow. Talk about pins and needles. Apparently the Ganirelix can also keep the E2 from rising and sometimes, even drop it a little bit. I hope it doesn't do that to me. I can't afford it. I just want this cycle to stay on the track it's already on. The good track. The working track. The "I have working ovaries" track.

In other news, the short term disability policy is a bust. Apparently, in the state of NJ, if you're infertile, you're all around screwed, regardless of how responsible you're trying to be. So, we're just not going to worry about it. There's nothing we can do about it. We can just hope we get pregnant, with all of the scientific and medical support we have, and do everything in our power to have a healthy perfect pregnancy that will allow me to work as long as possible.

Until then, i'll just be SO crampy. Headachey, nauseous, painful... I'm SO uncomfortable.

I'm so happy.

There, but for the grace of Tampax, go I.

Ah, to be in the house of Dandelion.

I'd love to say that the road to IVF #2 is fraught with blood, sweat and tears - but mostly, it's just blood.

I've been on my favorite devil pills for 6 weeks now. I just started pack number 3 of the desogen. At least I know I only have to take 5 pills from this pack - because my last devil pill will be this friday. Usually, after you stop taking the devil pills, you expect a period. However, i've already been bleeding for almost 3 weeks. Isn't it just fantastic? Usually, the ONLY benefit to BCPs is NOT bleeding. Not in Dandelion land... not this time, anyway. The good news, is that my IVF nurse says I might not bleed like I did last time i came off the devil pills, since i've been bleeding for so long. But I've been through almost 5 boxes of tampons. So, enough is seriously enough already.

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I had my baseline ultrasound this past wednesday. The good news: my antral follicle count is 11. So - that's not great - but it certainly doesn't suck. Our only question is how many of those eggs aren't geriatric. I guess time will tell. I found this chart (below) online... explains a little bit more about AFCs. I think my AFC last time was 14 or 15.

Total number of antral follicles	Expected response to injectable stimulating drugs and chances for IVF success
Less than 4	Extremely low count, very poor (or no) response to stimulation and a cancelled cycle expected. Should consider not attempting IVF at all. Rare pregnancies if IVF attempted.
4-7	Low count, we are concerned about a possible/probable poor response to the stimulation drugs. Likely to need high doses of FSH product to stimulate ovaries adequately. Higher than average rate of IVF cycle cancellation. Lower than average pregnancy rates for those cases that make it to egg retrieval. The reduction in success rates is more pronounced beyond age 35.
8-10	Reduced count. Higher than average rate of IVF cycle cancellation. Slightly reduced chances for pregnancy success as a group.
11-14	Normal (but intermediate) count, the response to drug stimulation is sometimes low, but usually adequate. Slight increased risk for IVF cycle cancellation. Pregnancy rates as a group slightly reduced compared to the "best" group.
15-30	Normal (good) antral count, should have an excellent response to ovarian stimulation. Likely to respond well to low doses of FSH product. Very low risk for IVF cycle cancellation. Some risk for ovarian overstimulation. Best pregnancy rates overall as a group.
Over 30	High count, watch for polycystic ovary type of ovarian response. Likely to have a high response to low doses of FSH product. Higher than average risk for overstimulation. Very good pregnancy rate overall as a group, but some cases in the group may have egg quality issues and somewhat lower chances for pregnancy.

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Okay - so the question on everyone's mind... what the heck is causing the bleeding? .... what about the fibroid? Here are the answers to those questions....

The bleeding, as far as they're concerned is just an unfortunate and messy side effect of the BCPs. They are 100% sure that it is NOT from the fibroid, because the fibroid "has not deviated the uterine cavity". In other words, my lining appears on the ultrasound as a straight line. If the lining were interrupted, because a fibroid had broken through into the uterus, the line would be separated, interrupted or deviated in some way. It is not. So, Dr Z is NOT concerned at all. Therefore, I am not concerned at all. However, there isn't just 1 fibroid anymore. Now there are 3. Nevertheless, as long as they all stay outside of my uterus, where they are now, Dr Z could care less, and isn't even considering taking them out. Totally works for me.

I also discussed another concern with him. It seems that the majority of girls I talk to have an ultrasound guided embryo transfer and all have had a mock embryo transfer prior to their cycle. I hadn't had either - and I was curious as to why. Mr DB told me just to ask, so at my appointment i said, "Dr Z, i'm in a support group (he doesn't like that I go online all the time, so i figured he'd take it better if I told him this all came from a support group), and some of the girls were talking about their transfer experiences. I was wondering why it seems that some doctors do mock transfers and u/s guided transfers, and some don't?" He was SO awesome with his answer. First of all, I DID have a mock transfer... it's just that mine happened during my retrieval while I was unconscious. That works for me! Then we talked about the u/s guided transfers.

Apparently, they did do them for about 4-6 months when they first came in vogue. However, their pregnancy rates dropped by almost 15% during that time. Dr Z said that it is a matter of learning new technique and personal preference. He said that in his experience, you can focus too much on the picture, and even a minor movement can cause you to lose embryos. Furthermore, he felt t he full bladder was very uncomfortable for patients. He said as soon as he stopped doing the u/s guided transfers, his pregnancy rates went right back up, so unless he has a patient with a particularly difficult mock transfer, he prefers to NOT do them.

As his pregnancy rates are already above the national average, without u/s guided transfers, I say, "if it ain't broke, don't fix it".

What 8 grand worth of meds looks like

So, where we are now:

• Last devil pill will be this friday
• Suppression check Friday, March 5th
• Stims start, at max dosages, Friday, March 5th
• 1st monitoring appointment Tuesday, March 9th
• ER/ET will be the week of March 14th

This time it is going to work - POF be damned.