The Treatment Diaries: IUI #1 & beyond: September-December 2000

Warning: LONG POST!

Sept. 18, 2000, found us back at the clinic for the usual routine of day 3 ultrasound, bloodwork and a chat with Dr. RE about how we were going to proceed with this next cycle. "You're going to need a LOT of drugs," he predicted. He proposed a combined regime of both Clomid (100 mg daily) and 100 IUs (2 vials) of Puregon daily for four days & return for monitoring. He explained that the Clomid would tackle the pituitary gland & hopefully make my ovaries work harder, so I wouldn't need quite as many injectable drugs. "Any problems with the injections, just page me," he said, patting my shoulder encouragingly.

Later that night, I wrote:

Survived my first date with the needle, about 9 p.m.... seemed to take forever to get everything set up -- and of course, I stabbed my finger with the mixing needle as soon as I tried to pull the cap off! (& so had to toss it) When I finally had a full syringe in my hand, I had to pause and look at it, wondering, "What the heck am I doing to myself?" I was on the verge of tears -- a tad shaky (oh, great!) -- breathing hard. Finally, I took the plunge, so to speak. (Right side.) It didn't hurt going in, but did a little as I injected and then pulled it out. I just sat there for a few minutes afterward, almost afraid to move. (Luckily, there's plenty of cushioning there!!) I told dh to go upstairs, because I knew he's make me nervous, and I could hear him pacing upstairs, which didn't help matters any...!

When it was all over, I called to him that he could come down. He brought me down a little band-aid (! -- not really necessary, but appreciated) & a hug and told me to tell the girls on my e-mail list how proud of me he was.

I did the injections every night at the kitchen table. I meticulously cleaned it off with Lysol first, laid some paper towels down & then laid out my vials,syringe, sharps, etc., on top of that. Someone had told me the injections didn't hurt as much if you numbed the area with ice first, so I also had some ice cubes at the ready.

The next night, I wrote:

Prep went smoother than last night, but when the time came to do the injection, I realized I hadn't iced the site first. (Left side tonight.) Thought I'd try to do without, but the needle pricked the skin and I chickened out & got the ice. (Hope I didn't contaminate the needle.) It was harder going in tonight. I felt shaky & teary as I was doing it. The first site I scratched started bleeding as I actually did the injection. I hope I did it OK. It bled a little more tonight than last. (I had dh bring the bandaids again!) I find I have to sit quietly for awhile after. Some redness and soreness (perhaps the effects of the ice wearing off, too?).

Wednesday night, Sept. 20 (cd #5, day 3 of the Puregon), I thought I felt some hot flashes. Later that night, I wrote:

I'm getting much better at the mixing... but it still gives me pause when it comes to actually injecting...! The ice helps... a little. Going in isn't actually too painful -- it's the actual injection & aftermath that's painful. I usually sit at the table for a few minutes and then on the couch, quietly.

Friday was a clinic day -- day 7 of my cycle & day 5 of the Puregon. There were just two people ahead of me in the lineup for ultrasounds. However, my glee and anticipation quickly deflated. I wrote down my measurements with this discouraging note: "In other words, no progress, and I LOST a follicle!!" :p I also recorded this conversation with the u/s technician:

Tech: Are you on hormones?
Me: Yes -- I 've been taking shots!
Tech: What does Dr. RE say about this?
Me: He's stumped.
Tech: How old are you?
Me: 39.
Tech: (shrugs) I'm sorry, but this is what I see. I wish I had better news for
you.

I wrote:

I was nearly in tears. This is so frustrating. Shooting up every night... 4 nights x 2 amps = 8 amps @ approx. $75 each = $600 to date... and NOTHING.

Even more frustrating, although we arrived at Dr. RE's office early, around 7:30, and waited an entire HOUR in hopes of discussing my results with him, we eventually were told that he had called in sick that day (!!). I arrived at the office just before 9 a.m.

Later that day, the office manager called: she had discussed my results with Dr. RE over the phone & I was now to bump up my dosage to 3 ampules (150 mgs) a day. I must have expressed some concern, because I noted in my journal "it's not a huge whopping dose." Nevertheless, after duly injecting myself with three amps that night, I wrote in my journal, "Is it supposed to hurt so much afterward? Am I doing this right?"

By Sunday night -- less than a week after starting -- I had injected myself with 17 amps total, or $1,275 worth of Puregon. Before committing to this course of action, I had checked out my coverage with my company's medical benefits plan. Strangely enough, while the IUI itself was not covered by our provincial healthcare plan or my private company plan, the sperm wash was. As for my drug coverage, the benefits people told me there was a lifetime maximum of $1,500 for fertility drugs. I had almost reached lifetime max in less than a WEEK.

Monday, Sept. 25th was a clinic day again. Left ovary: 0 follicles. Right ovary: 0 follicles. "The more drugs I take, the less I get," I wrote sadly in my journal.

Office Manager called me later in the afternoon: my estrogen levels were well over 1,100 -- "that's good -- there must be something there they're not seeing," she said, and told me to come directly to the office for an ultrasound the next morning.

Tuesday, Sept. 26th, cd #11, day 9 of Puregon: Went to the RE's office, where the office manager did the ultrasound for me herself. "Looks like a follicle to me!" she said encouragingly. There were actually two on the left side and four on the right, the largest one measuring at 14.

Next, we saw Dr. RE, whose comments were on the "glass is half full" side that day. He said the results from the u/s clinic the other day were "not acceptable," and that I obviously WAS responding (although he'd like to see more large follicles).
"You need a LOT of drugs," he commented, but added that wasn't unusual for "a woman your age." (Thanks, doc... I think...!)

Thursday, cd #13 (with the bill for my drugs now approaching $2,000), I went to Dr. RE's office for bloodwork and then returned there again in the afternoon for another ultrasound, this time performed by Dr. RE himself. My E2 level had skyrocketed to 2,800 and I had one follicle approaching 18-20mm. "Excellent -- way to go!" he said enthusiastically. One more day with the Puregon (26 amps, bringing my total Puregon costs to $2,175 over 11 days), he told me, bloodwork tomorrow morning, back for another ultrasound in the afternoon (what kind of excuses was I giving my bosses??) and then a hcg/Profasi shot that night, with the IUI likely on Sunday afternoon. (Well, at least I wouldn't have to worry
about missing work for that!)

Friday, Sept. 29th (cd #14): "Wonderful...we finally got a good cycle out of you," Dr. RE pronounced after myafternoon ultrasound. Of course, he deflated my ego with his next observation by saying my left ovary appeared to be tucked behind my uterus, & that "I wouldn't want to do an IVF extraction on you." (Hmmm.)

He provided me with the Profasi & instructed me to inject myself at 10:30 p.m. that night -- then return to the clinic on Sunday for the IUI at 10:30 a.m. However, we'd actually have to be at the clinic with dh's sample by 9-9:30, so that it could be washed & prepped for the IUI. He gave us the option of dh producing a sample onsite, or at home, but with the stipulation that we'd have to deliver it to the clinic within a half hour. At the best of times in good traffic, even on a weekend, that sort of timing would have been a stretch, so we said we'd come in.

Saturday, Sept. 30th journal entry:

Yesterday I didn't feel too bad. Today I feel like I have rocks in my ovaries!! Not really painful, but uncomfortable. A woman on my pg loss e-mail list wrote, "I swear I could feel the buggers pop," and I agree.

It has been a quiet day. Dh is helping his brother do the ceiling in their basement. If he hurts himself somehow, I'm gonna kill him...! So I have spent a lazy day, reading the papers, weeding out my e-mail inbox, watching TV (a repeat of "The Champions" on CBC Newsworld, in honour of Pierre Trudeau). [The former prime minister had just passed away.] I feel very tired and a little emotional. I can hardly believe the day is almost here. Whether it works or not, I'm sure I will be a basket case!! The next two weeks are gonna be hard...!

Sunday, Oct. 1: Dh delivered his sample at 9 a.m. And then we waited. And waited. And waited some more.

Around 11:30, we were ushered into the procedure room. Dr. RE said it had taken him awhile to wash the sample, as it contained a lot of "debris." He also noted the count was low, about 8.4 million. Motility, however, was good at 67%, and I had four good-sized follicles.

The IUI itself was over with fairly quickly. I noted the speculum was probably the most uncomfortable part, & there was a cold rush through the tubes. "You don't have to stand on your head or anything," Dr. RE said, "but take it easy for the rest of the day."

In my journal, I've written down a list of "Problems" that he apparently went over with us: (followed by the note "Why didn't he go over all this with us BEFORE we did this??")

• low estrogen/small/few follicles -- have overcome that to some degree
• low sperm count: wash will help some...
• bicornuate uterus: again he expressed an interest in seeing the actual film of my HSG, and mentioned the possibility of surgery.
• cervix appears to be chronically inflamed. He asked whether I had followed up on my irregular Pap. I said yes, & he said it was very important to keep on top of that.

He told us to come back in a week's time for an ultrasound & bloodwork. The total bill, drugs included, came to more than $2,300.

As I recall, I bawled all the way home from the clinic. It hit me that I had four mature follicles. What if all of them fertilized?? Twins I thought I could deal with, but quadruplets??

Dh talked me down from my momentary panic attack & suggested we go somewhere for brunch. When we got home, I took a nap for three hours. I am not generally a nap-taker, but I was physically & emotionally exhausted.

Saturday, Oct. 7th, we got up at 5 a.m. (!) & took the 7 a.m. train into the city. First to Dr. RE's office for bloodwork, then to the ultrasound clinic, where there was a huge lineup, at least seven women ahead of me in line and three or four behind.

When the technician dictated the measurements to me to write down, she had me note one follicle with an "E." Note in my journal: "I couldn't get her to tell me what it was for!"

Later that morning, there was a message from Dr. RE's office: we were to return in one week for bloodwork only. I knew what that meant: a pregnancy test.

Monday, I left a message on Dr. RE's voice mail, asking what the "E" stood for. His officer manager called me back: she said it meant "echoes," or an echogenic cyst, left over from ovulation. That still didn't tell me why it was noteworthy.

Thursday, Oct. 12th, cd#27, 11 days past IUI, my temperature dropped, and I began spotting. I knew that was the end of it. I called the clinic: what should I do? Consider it the start of a new cycle? Come in Saturday as scheduled? I was told to come in the next morning.

Friday, Oct. 13th (yep, Friday the 13th...!!): I had my bloodwork done in the morning, & got the call later that afternoon. As suspected: negative.

*** *** ***

Did I want to do another cycle? Yes please. : ) Right away? So long as the dr said it was all right. The office manager told me to come in the next morning for an ultrasound & bloodwork to ensure I was back to baseline before they gave me more drugs for another cycle.

So we got up at 5 a.m. on Saturday (again!) & took the 7 a.m. train into the city to be at the ultrasound clinic when it opened at 8. There were still two large follicles on my left side.

At Dr. RE's office, I was given a package of clomid, but told to wait for further instructions before I started taking it. If all went well, they'd give me the Puregon to start injections on day 7.

But all did not go well. :( The office called later that day & told me to hold off on taking any meds: I did have two follicles left -- cysts, & they were filled with fluid. "It's nothing to worry about," I was told, "but they have to clear up before we can begin again... Call us on your next day one."

"I will," I said, "so long as it doesn't conflict with Christmas -- we're going away then." I was told the office would likely be closed for several days over Christmas anyway.

Monday, Oct. 23rd, I was back at Dr. Ob-gyn's for a repeat Pap/colposcopy (which showed no significant changes for better or worse since the last examination). I told him that Dr. RE had described my cervix as "chronically inflamed." Dr. Ob-gyn begged to differ, saying that aside from the very superficial changes he had seen at my last visit, he didn't see anything that concerned him, and he didn't think it would be a deterrent to our efforts to conceive. Who to believe??

Tuesday, Nov. 14th was cd #33 -- normally not a long cycle for me, but my temps were still low and there was no sign of AF. I called Dr. RE's office. Should I be concerned? Wait & see? Could it be the drugs? The cysts? The stress??

K., the office manager, said it sounded to her like I was having an anovulatory cycle. She suggested I wait a few days & then come in for some bloodwork.

Thursday, Nov. 16th, I received a letter from Dr. RE advising that his office was moving, as of Dec. 1st. This would mean travelling a further three subway stops north of his current location. On the brighter side, ultrasounds would now be done at a different office, a short walk away from Dr. RE's office.

Friday, Nov. 17th (cd #36), I duly reported to Dr. RE's office for bloodwork. The conclusion was that my levels were moving back to baseline and that Aunt Flo should be paying me a visit shortly. "Wait another week, and if nothing happens, call us again," K. advised me.

Two days later, I began spotting. I spotted on and off for the next several days. What the heck was going on??

Thursday, Nov. 23rd (cd #42), I called the office again. The next day, I went for an ultrasound & bloodwork. No trace of the cysts remained. Dr. RE wasn't in, but there was a prescription for Provera clipped to my file. K. said it was used to induce a period.

K. called me with the results of my bloodwork that afternoon: my estrogen levels were on the rise. "You're having an ODD cycle!" she said wryly. "You may have hit bottom and are starting to rise again." She told me to take the Provera, all 10 days' worth, even if my period started -- and to call the clinic when it did.