Tuesday, February 26, 2008

A Thin Ray of Hope (updated)

I haven't posted for a few days, mostly because all I'd have been able to do was wring my hands and worry, and I've been doing that plenty without writing about it.

I had another doctor's appointment this morning, and it was at once comforting, encouraging and quite scary. The good news: my cyst seems to have disappeared, and the doctor is cautiously optimistic that my estrogen could be low enough to allow me to start my cycle this weekend (I'll know this afternoon). Plus, we have at least an idea of what to do next if my estrogen is still elevated -- I go on Lupron, which most IVFers use, anyway (my clinic doesn't usually do Lupron cycles; the prefer Antagon). The doctor says that Lupron will definitely bring my E2 levels down, but may also interfere with my response to the follistsim.

Which brings us to the bad news: The doctor is clearly no longer of the opinion that I'm a good IVF candidate. If we do get to start our cycle, she's upped my planned dose of Follistim to 450, which is apparently the maximum dosage. She warned me that if I don't respond well, they will not continue to retrieval, and that there would be little point in trying a second time. She mentioned at least twice how lucky I am that I had my daughter when I did, and mentioned that I should imagine what it would be like if I were just trying for the first time now (I think that, in saying these things, she meant to be comforting. I'll admit, however, that I found the comments pretty insensitive. Does she really think that the fact that I have one child makes any of this easier to take?) I did get her to tell me exactly what I need to keep my cycle going -- a minimum of five follicles. So after my E2 results (assuming they're good), the next number that I'll be keeping in mind is 5.

I also finally got a straight answer on the question that's been haunting me since the ectopic -- could all of these bad things that have been happening to me be a symptom of a larger underlying problem? Apparently, absolutely not. Life just sucks sometimes. She did say that she's noticed that people who have ectopics generally also have low AMH numbers, but she doesn't seem to think there's much significance to the connection.

So overall, a strange morning. I'm half-expecting that we'll start this week (but I don't want to get my hopes up too high), but I'm also well aware that if we do, we've really only cleared the first hurdle. The mere fact that we can start an IVF cycle doesn't mean we'll be able to complete one. Most of all, I find myself thinking "how the fuck did I get here?" Last year at this time, the idea that I could ever be infertile wasn't even on my radar screen, but now it appears that I could be so infertile that I'm beyond even the help of the most extreme of reproductive technologies. It's a pretty tough fact around which to wrap one's mind.

Update, 4:15 pm

Ok, now I'm more confused than ever. The clinic finally called a few minutes ago. I knew the news wouldn't be good, because they tend to leave tougher calls until later, and I was kind of right. My E2 level is still elevated, and in fact only dropped 2 (thingies? I have no idea of what unit of measure they use) from my last draw two weeks ago. But my regular doctor's (hereafter, Dr. Good) notes said I should start my cycle Saturday anyway. However, the doctor who called wasn't Dr. Good, it was Dr. "Good lord, who gave this guy a medical degree?" He thinks that instead of starting my cycle as-is or waiting another two weeks while we obtain and take Lupron like we'd discussed with Dr. Good this morning, I should start giving myself Antagon injections tonight to try to force my estrogen level down. He says I'd take the Antagon tonight, tomorrow and Thursday, then come in on Friday for another blood draw.

I'm a little bit consternated here (I don't know if consternated is a word, and I don't care.) On the one hand, my inbred "listen to the doctor" training is telling me I should do as Dr. Untrustworthy says and start my Antagon tonight. On the other hand, I don't really trust this guy, and I hesitate to deviate from the plan Dr. Good set out. I asked Dr. U if he could check with Dr. G before I went ahead, and he said he wouldn't be able to contact her tonight, but that she's used this protocol before on poor responders (look! I have a fun new diagnosis!) and that he'd leave a note in my file for her telling her what he'd told me.

Anyway, I guess we're starting tonight, so that's something. The next few weeks may suck big fat hairy monkey balls, but at least we're not in a holding pattern anymore. And at least I'm not a quaking mess anymore, like I have been for the last few days. I actually feel almost calm.

Calm for someone who's about to stick a needle in her stomach fat, that is.


FiestyKel said...

Scary how we have to trust these guys eh? Hopefully, if it is a bad decision, Dr G will discover it and stop you before you get too far. Not that that is good news. Not that I am vaguely helpful. Shutting up now and simply wishing you well!!!!

shinejil said...

I hate getting contradictory info from doctors, especially when so much is at stake for you. Any chance you can reach Dr. Good on the phone to confirm the tx plan?

Regardless, I'm glad you're moving forward. I hope the plan works perfectly.

Mrs.X said...

I'm so sorry you are getting alternating stories. I never realized how fortunate I was to have Dr. Uterus with his sole practice until I started hearing horror stories like this!

Forward momentum is always good. I did Lupron and it basically shuts down the ovaries. I still did it while I was stimming (although a much lower dose) to make sure that the follicles that were developing were uniform and one wasn't doing the domination thing.

Best of luck - this is so hard and to hear that you may no longer be a good candidate for IVF is just devastating news. All my best coming your way.