Cautious First Steps

T and I met today with our fertility doctor to get information about IVF. We're still not certain about taking that next step -- or, rather, I am not certain; T seems to have few qualms.

Even though I consider myself somewhat knowledgeable about the IVF procedure, the hour was a deluge of information, too much to digest.

This is the process, as described to me, and assuming my recollection & notes are accurate:

-Take birth control pills for 3 weeks
-Subcutaneous injections of Lupron for 10 days
-Subcutaneous injections of follicle stimulating hormone, multiple times per day, not sure how long, with monitoring ultrasounds every 2-4 days
-Subcutaneous injection of "trigger shot," timed exactly 36 hours before egg retrieval
-Surgical egg retrieval, requiring anesthesia
-Beginning on the retrieval day, intramuscular shots of progesterone, continuing for up to 12 weeks if pregnancy results
-Fertilization at the lab after retrieval
-Wait 3-5 days after retrieval for embryo development
-Transfer of embryos into uterus
-Wait, hope

After this, a 40-50% chance of a viable birth.

There are also ethical issues to be addressed: How many embryos will we transfer? What should be done with unused frozen embryos -- discarded, donated to science, donated to another couple, preserved? What should be done with those frozen embryos if one of us dies, or we divorce?

It is a lot to take in. My head is spinning. But we won't make the decision just yet.

Yet Again

Yet again, I'd gotten my hopes up high, even as I told myself not to. That internal monologue is hard to silence, that glimmer of hope impossible to extinguish. 'Am I feeling nauseated? More so than I normally do at this stage of my cycle? No, this is typical. But what if it's not?'

Yet again, this time over a lovely outdoor breakfast with my family, on a weekend trip away, just before a hike, the cramps started. Another failed cycle.

My doctor now doubled my Clomid dosage from 50 mg to 100 mg, and I don't know why. I'm nervous about increasing the Clomid after it caused a cyst on an ovary not too long ago. I'm also nervous that it will, as usual, make me ovulate crazy-early, and specifically while T is out of town. But here I go, another try, yet again.

Back in the Stirrups Again

There's that old saying about doing the same thing, over and over, and expecting different results this time as a sign of insanity.... I found myself with my feet up in the stirrups over the past two days for yet another IUI, hoping again that I'll defy the 3% success rate odds.

In June, my entire treatment cycle was canceled because the Clomid caused me to develop ovarian cysts. I couldn't start Clomid in July, though, because I was traveling when I needed to visit the clinic for a diagnostic ultrasound. Clomid would have doubled my success rate odds to a whopping 6%. Alas.

I like to describe an IUI (intrauterine insemination) as the "medical equivalent of using a turkey baster." The clinic processes a semen sample, washing it to select only the best and brightest sperm, and somehow "waking up" the sluggish ones. Then, my feet up in the stirrups, my ass all but hanging off the end of the table, naked from the waist down, the technician inserts a catheter into my cervix. Through the catheter, the sperm are deposited directly into the uterus, apparently so that they have less of a chance to get lost and don't have as far to swim. Wait. I thought these were the best and brightest. Apparently, lazy, too.

In my experience, the pain can fall anywhere in the range from, "Wait, you're done? I didn't know you started," to, "F@s#$, I'm going to kick you in the face!" Yesterday's IUI fell squarely on the painful end of that spectrum. Normally, when there's pain, it's more like menstrual cramping, but only when the catheter is inserted. Yesterday, the pain got increasingly worse as the technician worked - and it did not end when she took everything out. I lay on the table, with one hand over my eyes and the other gripping my husband's hand, white with pain. Even after 20 minutes, I was scared to get up because I thought I might pass out or vomit. When I did get off the table and went into the bathroom, I saw that my face was pale as a sheet.

The next morning, of course, I was fearful, knowing I'd have the same technician. The wait seemed eternal; as compared to 1 1/2 hours from start to finish yesterday, the whole process today took 3 1/2 hours. There was no apparent reason for the delay. Luckily, today's procedure went a million times more smoothly. Only some slight cramping when the catheter was inserted, and it stopped within a minute.

So here I am, in another two week wait. Hoping that this time, the outcome will be different.