Friday, 10 January 2014
Since December 19th, I've been trying to figure out if I've ovulated, or if I'm in my luteal phase. And yep, it's January 10th.
I know, it seems kind of basic, right? Something that should be simple. Something that a top notch fertility clinic could figure out?
At CCRM, a regular donor cycle would normally start out with some birth control pills and in the luteal phase, Lupron would be added to quiet my hormones to prepare for the next month's transfer.
Except, I can't use birth control pills because of my family history with stroke.
So, the nurse suggested to use ovulation predictor kits (she suggested the clear blue easy kind with the happy face). I told her that I was worried that it wouldn't work for me. I've never had luck with the OPKs in the past. Not that I've used them that much anyways, because when I found out I had ovarian issues, I also learned at the same time that they were so severe that an ovulation kit was really not going to help my cause. With D's low sperm count, trying to use those kits every month seemed futile and emotionally exhausting. Not to mention a waste of money. So I never used them more than a few times, back when I didn't know how messed up my body was.
I asked my nurse if it would be worth the risk to just take a low dose birth control pill for the one month instead? After all, I was on the pill for 10 years before and didn't have any side effects. The nurse agreed that this sounded reasonable and checked in the doctor. He said that he didn't feel comfortable with me taking the pill.
So we trekked onwards with our OPK plan. As a back up, the nurse said she would send be for blood work if we got past a certain part of my cycle and I had not picked up a surge yet.
I monitored all of the way through the Christmas holidays, consistently and properly, but I did not get a surge. So, on the 30th of December, I cut my Christmas plans short and traveled back home to get my blood work done and have an ultrasound to check my lining. My lining was homogeneous and there was a 21mm follicle.
Later that day, my nurse called to say that my local clinic didn't draw LH and they got an FSH result instead. She said not to worry though because my other levels (estrogen and progesterone) were still low, so they didn't think anything had happened. She told me she thought that I was about to ovulate on my own because of the 21mm follicle. Because of the error, I had them re-run my results form the 30th for LH. The LH came back low (in the 8's).
Due to the New Years Eve holidays at my local clinic, I went back on Monday January 2nd to repeat blood work and ultrasound. Cue horrible snow storm. School buses were canceled due to the snow and very low temperatures. People weren't able to dig out their cars out to go to work.
The roads were ok for the first 30 minutes of my drive but then turned wretched. There were so many cars in the ditch. I battled the roads, and drove white knuckled to my clinic. The one hour drive took me close to an hour an a half. When I got there, all of the lights were off because they had closed the office due to the storm!
Luckily, there was one nurse there who was able to draw my blood. Phew!
I was concerned because my requisition was only to have LH drawn this day. I was cycle day 27 for crying out loud. I called the emergency line for the CCRM nurses and discussed my concerns. Wouldn't they want estrogen and progesterone too? Or how about an ultrasound? My CCRM nurse wasn't in, but after some debate amongst the on call nurses, they told me that the estrogen and progesterone results wouldn't have changed that much, and I didn't need them.
I felt better hearing that.
Until the afternoon when the CCRM nurse called. She wasn't my regular nurse, because mine was off for the holidays. She said to me, "I don't really know how to interpret your results. They only sent in your LH, which hasn't risen much from your last draw. I don't know what to tell you. I think we should wait until your nurse is back tomorrow".
In my head, I said every swear word I could think of. "What do you mean?" I said. "I called for the emergency line this morning asking if I should have these exact tests!" I was fuming mad. I drove all of that way through the ice and snow and didn't even get what I needed to have done. I could have melted all of the ice in town with the heat steaming out of my ears.
The nurse asked me to have them re-run my results. But I'm not able to do so because there was no one working at the clinic due to the storm.
She says, "Don't worry. I'll have your regular nurse call you first thing in the morning".
When I don't hear from my nurse in the morning, I called her. She phones me back at 6pm my time and says "Sorry I was waiting to get the blood results back from your local clinic, but they never showed up".
I explain to her politely what has happened. We decide that I will call my local clinic when they reopen in the morning and have the results re-run.
I anxiously await her call on the next day with an interpretation of what is going on.
However, when she calls, she doesn't have much to tell me. Except they aren't sure if they missed my ovulation (uummmm, ya!) and she inquires about whether I've been doing the did the OPK correctly and if I bought the brand she suggested. I'm so infuriated! This is why I didn't want to use an OPK to begin with. She told me she had reviewed my case with other nurses and a supervisor. I asked "did you check with the doctor?". She said no, that he's only returning from vacation today. I didn't bother to ask why she didn't consult another doctor there, but should have.
I asked her to please review this with the doctor and call me back. She said she would. I told her that we have a lot invested in this, emotionally and financially. I wanted to know what is going on? Should we consider scrapping this cycle and opt for a different one? I don't want to start this with huge doubts about if my medications were even started at the right times.
Late the next afternoon, I phoned the nurse in the later afternoon to see what the doctor had said. 3 hours later, I got a call back. She said the doctor had not looked at it yet. She told me that she once again reviewed this case with her supervisor and she said there are two likely options.
1. We don't use Lupron this cycle. My progesterone has been consistently low. They will control my progesterone exposure to get me a period (I've never had a problem getting my period in the past, it's been late many times but has always shown up).
2. They use the Lupron and coordinate it with Prometirum for 10 days. In approximately 3-4 days after that I will get a period. They will time the Lupron in the last 5 days of my Prometirum.
I'll admit that I don't totally understand the ramifications of these two options yet. This is all new to me.
She wanted me to go in for more blood work and an ultrasound again today. This will tell them what happened to my lining and that follicle.
To make things just a tad bit more annoying, CCRM didn't give me a requisition for today's blood and ultrasound, and I forgot my phone at home. My nurse didn't want to do the ultrasound or have blood drawn without the requisitions saying it was "bad medical practice" for her to do so. I think my sweet little local nurse had a point, but she also had a little tone in her voice letting me know that she was throwing a dig CCRM's way. Not necessary Ms. Nurse. Just ask me to get the freaking requisition.
By the time everything got straightened out, I'd spent an hour in the waiting room. There were kids everywhere. Seriously. When I left the clinic two women walked in with FOUR children. What the hell? There were kids at every row of seating. I chose to sit near a couple and her 3 year old son. Both parents were barely paying attention to the kid. I cringed inside.
I watched a nurse come out with a cute chubby cheeked baby and bring her to the receptionists to oogle over. I was assuming she was the result of one of the clinic's treatments. I continued to watch the 3 year old beside me try to get his parents attention. The nurse came out to talk to the mother of the 3 year old. She let her know that her appointment will be another 30 minutes yet. She says "He's going to do her ultrasound today because of what's going on". The patient says she just needs to know, "Can you do my ultrasound right now she says?" From their muted conversations, I gather that she must be pregnant and bleeding. I start to feel really bad for assuming things about her, and her parenting. I realize why she and her husband aren't being responsive to their 3 year old. It's because they are waiting to find out if she's miscarrying.
I finally got called into the ultrasound room. I stop to talk with the nurse at the desk and I see the woman's ultrasound pictures on the desk. They are requesting more blood work for her. I see two small but empty looking sacs on the pictures. It reminds me so vividly of where we were two years ago getting that exact news. My heart breaks for them. And it breaks for me and D all over again. I realize why my sweet nurse had a little bit of attitude this morning. She's feeling emotional for them too.
My lining appears homogenius again, and that the follicle appears to have collapsed. There are 3 smaller 3mm follicles forming.
I'm hoping this will all make more sense when my blood work comes in. And that my nurse can give me a good explanation of everything and that I will be able to assertively ask the proper questions of her.