Monday, June 27, 2011

The Treatment Diaries: IUI #3, May-June 2001

We embarked on our third IUI cycle -- my 27th cycle since losing Katie,and the final IUI cycle we had agreed to do -- on Friday, May 4, 2001. On Sunday (day 3), we were back downtown for the usual ultrasound & bloodwork.

Ultrasounds were now being done again at the clinic where we had first gone when we started treatment. However, since Dr. RE had moved his office in the meantime, this meant that clinic days now went something like this: (1) arrive at the train station & take the subway three stops, walk the short distance to the building where the ultrasound clinic was & get my u/s done. (2) Hop back on the subway & travel another three subway stops to Dr. RE's office for bloodwork, drugs, etc. (3) Hop back on the subway & ride 7 stops to the office. More subway tokens, more running around, more time. :p On weekends, we would generally go to Dr. RE's office first, then for the ultrasound.

Because it was Sunday, we decided to drive downtown instead of taking the train & subway. Perhaps not the wisest choice, since many of the downtown streets were blocked, either for a charity run/walk, or with construction (which made dh REALLY happy...!). Dr's office came first: then off to the u/s clinic. When we got there, the usual entrance was closed. We walked around to the other side of the building & had to be escorted in by the security guard. The clinic was already open and there were six people ahead of me in line.

Later that afternoon, Dr. RE called, said my baseline results looked good, & I could either (a) start taking Clomid & return to the clinic on day 7 for monitoring, or (b) skip the Clomid & go straight to the Gonal-F. I told him I didn't HAVE any Gonal-F; the girls at his office had only provided me with Clomid. So, Clomid it was (my 6th cycle using Clomid). He said I really should start straight with the injectables, though, that the Clomid really wasn't boosting my results that much and he acknowledged the side effects were nasty. He also said he wanted to do an ultrasound himself to determine whether my uterus was a true bicornuate uterus, or just a septum. He said he would have one of the girls at the office call to set this up.

I asked him about the Gonal-F dosage this time around. The possibility of OHSS the last cycle had scared the crap out of me, & dh too. He said we'd wait & see the day 7 results -- he didn't think he'd lower the dosage, but didn't think it would be necessary to increase it either. He did actually increase it, to 4 amps or 300 IUs nightly.

Thursday, May 10th (day 7): I'd been having all-day, dull headaches and eye strain the past several days, no doubt a side effect of the Clomid. I went to the office in the morning for bloodwork, left work slightly early that afternoon & returned to the office, where Dr. RE performed an ultrasound. While he wasn't able to see anything on my left side, he was flabbergasted to find that I already had 12 -- 12!! -- follicles on the right side. They were small, but they were there. "I didn't expect to see that," he said.

As for my uterus, he said there were definitely two horns there -- but the tissue in between looked fibrous & could probably be removed. He estimated that I had a 70% chance of pregnancy loss because of my uterus, and said this likely contributed to Katie's stilbirth. While there were no guarantees, of course, he felt that surgery could help improve those odds. "Your odds are already low -- your age, and you don't ovulate well," he pointed out (gee, thanks...). He explained what the surgery would involve, and said we would have to postpone ttc for several months while my uterus healed. When you're over 40, of course, every month counts, & the thought of having surgery and then losing more precious months in recovery time was not a happy prospect for me.

I left with my head swimming around 5:45, & raced to the train station to meet dh. He was in a bad mood already after a long day at work, and as I told him about what Dr. RE had said about the surgery, he snapped, "What's the point?" I was a little ticked myself that Dr. RE had waited this long to figure this out & dangle the carrot of surgery in front us. Shouldn't he have checked it out & recommended it right up front before we'd started treatment?? I felt we should get a second (Dr. Ob-gyn?) & possibly third opinion before going ahead with surgery. And of course, first, we needed to get this cycle over with.

I noted in my journal that I was feeling LOUSY -- stressed, flushed on my face & neck (even Dr. RE had noticed) and a constant headache. I was exhausted. But that night, before going to bed, I injected myself with the first three amps of Gonal-F. I woke up the next morning feeling much better.

Sunday, May 13th was Mother's Day. :(

Monday, May 14th (day 11) was a clinic day. K. called me that afternoon & told me to come back Friday; however, I only had enough Gonal-F to last me until Thursday, so I spent my lunch hour making a hasty round trip to & from Dr. RE's office to get more drugs. By Wednesday, I was beginning to feel uncomfortably bloated. My Friday visit showed some follicles developing, but not as many or as big as might have been expected.

I went back in for more u/s & bloodwork on Saturday. I was told that now Dr. RE wanted to see the film of my HSG from November 1999. I had to request a copy and spend another lunch hour that week trekking up to the hospital to retrieve the CD, take it up to Dr. RE's office & return to work.

"I just don't get it," Dr. RE said later Saturday afternoon when I spoke to him on the phone. "Your E2 levels are astounding -- 8700 -- I've never seen them so high. Yet there's only one or two follicles that I would call mature. There's a disconnect there. I don't understand where all the E2 is coming from. It's not very encouraging that your response is so unpredictable... You are a bit of a challenge and a mystery." Oh, just lovely.

I asked him whether such high E2 levels posed any risks. He mentioned OHSS again & then threw out another thing to worry about -- blood clots. But he, added, "your levels are high, and high for you, but not exceedingly so."

Monday, May 21st (day 18) was our Victoria Day holiday -- but it was no holiday for us. :p We were up at 5:30, at Dr. RE's for bloodwork by 7:30 and the ultrasound clinic at 8, where (once again) the tech had difficulty seeing my left ovary. Nevertheless, I now had at least three good-sized follicles (although Dr. RE said my E2 levels suggested I should have 13 or 14?!). "We could push you for another day & do IVF, although I don't know how good the quality of the eggs would be," he said. (Nevermind that we didn't want to do IVF -- unless he was willing to do it for the cost of an IUI cycle!)

We agreed: Profasi shot tonight, sample around 8:30 & IUI around 10:30 on Wednesday morning.

Wednesday, May 23rd (day 20) was my third (& final) IUI. We arrived at Dr. RE's office at 7:30 a.m., where dh produced his sample -- went to work (!) -- & then returned for the IUI at 9:30. I was feeling rather crampy, before & after, but barely felt a thing during the IUI itself. Dh's count this time was lower than the two previous IUIs, just under 8.2 million. "It's been a strange cycle -- I really can't give you the odds," Dr. RE said.

En route out, we received our bill:

10 Clomid pills = $62.40
44 amps of Gonal F = just under $3,000
1 Profasi shot = $65
Sperm wash = $350

Total for this cycle: just under $3,500

Later that afternoon, I was feeling extremely bloated & uncomfortable, & called the office. "You could be ovulating," K., the office manager said. She told me I could take a couple of Tylenol, but added I should weigh myself daily for the next few days and watch for anything unusual. A friend at work, who was also going through infertility treatments, said her RE had told her to drink Gatorade or Powerade, so I found a bottle at the newsstand downstairs & sipped on that. I found it very difficult to get comfortable in bed that night, and had an extremely restless sleep.

The next morning, I felt much less bloated, but I felt sore all over -- under my ribs and shoulder blades, through my back & shoulders -- "like I was hit by a truck," I wrote. I decided to call in sick, using the excuse that I'd had an upset stomach all night long. By Friday, I was feeling slightly better.

Saturday, May 26th, I was back at the office at 8 a.m. for bloodwork. Sunday (day 24), I felt crampy all day. Around 8:30 p.m., I noticed I was spotting. I immediately paged Dr. RE & he called me back within 20 minutes. He agreed with me that it was awfully early for my period, but added, "It may not be a bad thing -- it could be implantation spotting... It's unlikely to be anythign serious, so long as you're not bleeding or cramping heavily." To be on the safe side, he suggested I come into the office the next morning to have my bloodwork checked. In my journal, in capital letters, I wrote, "I AM TERRIFIED!"

Monday's bloodwork showed nothing amiss and although I was still feeling crampy, I was not spotting. I was told to come back the following Tuesday for my beta.

Friday, June 1st (cd #29, 9 days past IUI) I woke up at 4 a.m. to go to the bathroom. I felt woozy and nauseous, and staggered back to bed. I woke up an hour later & took my temperature. It had dropped almost four degrees.

Every time I opened my eyes, the room started to spin around me. Eventually, I threw up. Twice. I did start feeling a little less nauseous after that. Even though my temps had dropped, I felt deliriously happy (emphasis on the delirious, I think...!). I must be pregnant!! Why else I would I feel so crappy?? (In recent years, thinking about my symptoms, I have wondered: did I have some kind of a mini-stroke?? Was it some weird hormonal thing going on? Or was it a manifestation of the stress and anxiety I was feeling?) Dh fed me crackers & water and even made a trip to the nearby 24 hour supermarket to get me some apple juice.

I had already missed a lot of work recently. I didn't want to call in sick, so I called my boss & left a message saying we'd had a late start & would be in later. (I told you I was delirious...) I decided not to call Dr. RE, because I knew he would tell me to come into the office later that morning or the next, and I just didn't think I could haul myself in to work AND up to his office feeling the way I did.

Somehow, by shortly after 7, I managed to drag myself out of bed and into the shower. Thankfully, it was casual Friday at work. I put on a pair of drawstring capris and one of dh's polo shirts but didn't put in my contacts or apply any makeup. We made the 9 a.m. train into the city, and I arrived at the office around 10 a.m. By the end of the day, I was exhausted, albeit tired & with a dull headache.

Saturday morning, I felt much better.
Later that night, though, I started spotting again. It continued the next morning, and by the afternoon, it was in full flow.
I called the office and was told to come in the next morning for bloodwork & ultrasound.
I crawled into bed that night, turned out the lights, & proceeded to bawl my eyes out.

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