Saturday, June 25, 2011

The Treatment Diaries: The Clomid Capers continue, and the Big 4-0, December 2000 - February 2001

New year, new cycle. My period arrived on Jan. 7th, 2001. Jan. 9th found me back at the clinic for day 3 ultrasound & bloodwork.

As I wrote previously, as of Dec. 1st, Dr. RE had moved to new digs, another three subway stops further north of his previous quarters. He had switched ultrasound providers too, making arrangements with a facility a short walk away from his office. The building was very old and change room cubicles quite tiny. On the bright side, there were chairs in the waiting area where we could wait for our ultrasounds, instead of standing in line. The technician was very friendly and talkative but, as the other girls noted, very slow.

Dr. RE wasn't in, but the office manager provided me with Clomid, Puregon and some syringes, and told me to wait for instructions later that afternoon, after my bloodwork results had come in. The instructions were to start the Clomid, and then return on Saturday (day 7).

This time (my fourth cycle using Clomid, alone or in combination with injectables), I noticed some definite side effects: dry mouth & light sensitivity (especially in the morning), sore breasts, a jittery feeling, and extreme fatigue. But I felt better on Friday, January 12th -- a good thing, since it was my 40th birthday! I wasn't especially happy about being 40 and childless, but since there wasn't much I could do about it, I decided I might as well use the day as an excuse to enjoy myself. ; ) I took the day off work & spent the day getting pampered at the spa -- facial, massage, manicure & pedicure, including lunch. I loved it! Dh & I went out for dinner later that night.

The next day, Saturday the 13th, I got up at 5, and took the 7 a.m. train into the city. Dh didn't come with me this time, although I don't remember why, but I had company -- Cousin/Neighbour's neighbour, whom we saw occasionally, both at Cousin/Neighbour's house & on the train from time to time. I told him I had an appointment in the city, and thankfully, he didn't probe. I went to the clinic for bloodwork first, and then for my ultrasound. I wound up waiting an HOUR before I saw the technician. There was a lot of grumbling in the waiting room.

Also in the waiting room, one of the girls was chatting to another, & handed over her business card. I couldn't help but see the logo on it: it turned out she worked for the same company I did, in the same downtown location, in fact. We also exchanged business cards & had coffee together once to chat, but I rarely saw her after that.

I had about five small follicles on each side, each under about 5 mm. By about 10 a.m., I was back on the train, and home again around 11.

Later that afternoon, I had a message from Dr. RE. He bluntly told me this cycle wasn't looking very promising, and that the clomid had obviously not had a significant impact. My E2 levels were essentially the same as they had been on day 3, when he expected it to be up at least 100%. "I can't tell you how successful this cycle will be," he said, according to my journal notes. "If you want to go ahead with the injectables, I would have to increase your dosage substantially, to 300 or 400 IUs. Those are very high doses... You may choose not to go ahead this month, and discuss further treatment." He ended by asking me to have him paged.

When I finally got hold of him, Dr. RE went over the numbers with me again. "Your response was much poorer than I would have expected from a woman your age, given the dosage," he said. He told me I had two options: (1) forget this cycle (beyond the clomid I had already taken) and wait for a better one to try the Puregon again. "We can still monitor you, if you like," he said, "but I'd be very surprised if this cycle took off." This, he said, was his recommendation.

Or, (2) go ahead with the Puregon, but instead of the 200 IUs he was going to recommend, push my ovaries with 300 or 400 IUs daily. "If you don't respond to that, you really should consider your options," he said. "At some point, we have to talk long-term plans -- including, maybe, stopping." I reminded him that we had agreed to three IUI cycles using injectables.

The last cycle, he said, "was adequate -- but I want more than adequate." (What?? Hadn't he said at the IUI that it had turned out to be a good cycle after all??)

I agreed that, since the prognosis was not good, we should save our money for a better cycle, but continue to be monitored. He told me to come in next Friday to see what was happening.

*** *** ***

With this as a backdrop, I moved on to my next immediate challenge (wait for it...!): surviving a baby shower. My FIRST baby shower since Katie's stillbirth, more than two years ago now.

Back on Dec. 1st, on something like day 52 of my neverending cycle, we had arrived home, I opened the mailbox, and pulled out a small square envelope. Without even looking at the return address, I said to dh (a la Johnny Carson's Karnac the Magnificent), "This is an invitation to your cousin's baby shower -- and it's going to be the weekend of my 40th birthday." Nobody had told me. I just KNEW. His cousin was pregnant; I knew her due date was mid-February; logic dictated that her shower would probably be held about a month before that, and my birthday just happens to be in mid-January. But beyond logic, I KNEW in my bones. Of COURSE I would have to spend my 40th birthday weekend at a baby shower. That was just the the way my life seemed to be going these days.

I opened the envelope -- and of course, that's exactly what it was. My birthday was on Friday, the shower was on Sunday. I cried for well over an hour. Bad enough to be turning 40, crossing the rubicon, as it were, without a baby in my arms, while suffering through the indignities of infertility treatment -- but to have to spend that weekend at a BABY SHOWER added the ultimate insult to injury.

I didn't see an easy way out, so I RSVPd yes. The shower was near where BIL lived, so dh drove us there, and SIL & I went together. I don't remember a lot about it, except that it was (thankfully) a smaller shower than some I had attended, perhaps about 40 ladies in all, at an Italian restaurant. I sat at a table with SIL & some of dh's cousins, & (also thankfully), the conversation didn't entirely revolve around babies.

A couple of days later, on Wednesday, Jan. 16th, I noticed a funny rash that had broken out on my neck, just below my right ear. It tingled/burned, and was also itchy.

Dh happened to have an appointment the next day with our family dr and, on an impulse, I tagged along, hoping he would be able to have a quick look.

Family Dr took one look at the strange patch on my neck and immediately said, "That looks like shingles."


Family Dr gave me a prescription, saying that, since it seemed to be in an early stage, it might help to minimize the discomfort as well as prevent the shingles from spreading. And it did, although it took awhile to disappear completely. Thank goodness I decided to go with dh when I did. I used aloe vera gel to soothe the itching & burning.

When I got to work, I immediately started consulting Dr. Google to learn more about shingles. What I learned was that the chicken pox virus I (and probably you) had when I was a kid (pre-chicken pox vaccinations) never really left my system. It went underground, dormant and, most of the time, never resurfaces. But in some adults, for reasons that aren't entirely clear, the virus suddenly resurfaces in the form of shingles. I did read with interest, however, that one suspected cause of shingles is stress. Hmmm....

Shingles cannot be spread to anyone who has also had the chicken pox virus. However, if you haven't had chicken pox but get exposed to shingles, you could get shingles or the chicken pox.

Chicken pox can be harmful to pregnant women -- and the babies they are carrying. Reading this made me feel sick to my stomach. I called Family Dr back to ask him about it. He reassured me that it was highly unlikely, and reminded me that most adult women had been exposed to the chicken pox virus. But we should find out whether dh's pregnant cousin had.

I couldn't talk to her myself. I just couldn't. Dh made the call for me. Cousin hastened to assure me it was all right, she'd already been through this when her nephew came down with the chicken pox, and yes, she was immune. Talk about relief!!

*** *** ***

Friday, Jan. 19th
, day 13, I was back at the clinic. Sitting in the waiting room at the ultrasound clinic, I struck up a conversation with a woman who had a little girl in a stroller with her. The little girl was about 3, her mom had a British accent. There was something vaguely familiar about her, so I checked the sign-in sheet on my way out from my ultrasound for her name, and I realized that, hey! I know this woman. Again, we both worked for the same company in the same location, & had belonged to the same lunchtime group awhile back.

I went back into the waiting room, called her by name and re-introduced myself. We laughed, and she said, "I won't tell if you won't!" She told me her daughter had been conceived through fertility monitoring; she and her husband were now trying for a brother or sister. I suggested lunch some day; she told me she never took a lunch hour: she worked through her lunch and breaks so she could shorten her work day & pick up her daughter from daycare. Daycare issues were also why she had to bring her daughter with her to the clinic in the morning. I marvelled once again at the lengths we go to in order to try to have a child.

Later that day, K., the office manager, called with the disappointing news that both my bloodwork & ultrasound were essentially at baseline. "We'd like you to come in to discuss what's next," she said. I told her about my shingles diagnosis and asked whether that might be having an impact on the cycle; she said it was possible but she didn't know for sure.

We returned to see Dr. RE a week later, on Friday, Jan. 26th (cd #20). He asked us what our plans were. I said we'd committed to three IUI cycles with injectables at the outset, and we'd still like to complete three cycles. "Obviously, if it's six months down the road, and the results have been such that we still haven't completed those cycles, we'd have to rethink our options," I said.

Surprisingly, Dr. RE said he thought that was a good plan, that "you probably should try three or four cycles of any particular treatment." (I guess it was a glass half full day.) He said I responded well to the previous cycle, and my initial FSH results this cycle had been encouraging. But he added, "If, after three or four cycles, you still aren't pregnant, I'd recommend you go on to IVF, or stop... you have better things to do with your life."

We chatted a bit about IVF & the dosages required. I reminded him he hadsaid the placement of my left ovary would make retrieval difficult, and he said, "Well, I haven't abandoned a patient yet!" (This sort of flipflop drove me crazy.) He asked me where I was in my cycle: I said day 20, & I'd noticed some nice quality cervical mucus over the last day or two. "Let's take your blood & see where you're at," he said. I noted in my journal, "Left feeling reassured & satisfied."

K. called later that afternoon: sex every two days for the next week, back on Friday, Feb. 2nd (cd #27) for bloodwork. I noted that my temperature still hadn't gone up. K. called me later with my bloodwork results: my E2 levels had dropped, although my LH was high and progesterone was up. "At this point, there's not much we can do, except wait for day 1," she said.

My period finally arrived on Friday, Feb. 16th, day 41 of my cycle. On to the next...!

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