Thrush. AGAIN.

Can I just say how truly SICK of having thrush I am? This is, I think, the third, maybe fourth, time that I've had it in the five months that I've been breastfeeding. ENOUGH IS ENOUGH. It is quite possibly the most painful, but most definitely the most unpleasant, thing I could possibly ask to experience. It hurts like hell, I'm bleeding, I cry nearly every time I nurse my babies, and pumping isn't any more pleasant than nursing, so it's not like I can just pump and forgo nursing for a bit.

Gah!

It's not enough to make me stop nursing, but ohmygodpleasemakeitstopseriouslyplease!

On Breastfeeding Triplets

You're pregnant with triplets? Well, you're obviously not going to breastfeed them, you're going to spend a fortune on formula!

I heard that a lot when I was pregnant. Over and over, I heard unsolicited opinions from people telling me that there was no way I would ever be able to breastfeed triplets. It's not possible, they would say. I didn't even bother trying with my twins, I would hear. Why would you even think about it? You'll never do anything but feed them all day long if you try! the incredulous voices would cry. They'll be preemies. You can't breastfeed preemies, you know.

I never expected to be the militant type...certainly not about breastfeeding, and certainly not about breastfeeding triplets. But these constant, unsolicited words of discouragement absolutely convinced me that I was going to do everything I could to breastfeed my babies, at least for the first few weeks. My premature babies were going to NEED the benefit of my colostrum and my milk for as long as I could give it to them, and I knew it wouldn't be forever, and even during my pregnancy, I mourned the loss of the ability to just KNOW that I could breastfeed with reckless abandon, but I set a modest goal. I wanted to get 3-4 weeks of exclusive breast milk into them if I could. And if I could do that, well, we'd go for 6 weeks and after that, I would give myself permission to supplement with formula, because it would be a miracle if I made it that far.

The babies did get a little bit of formula in their first few days. My colostrum was mixed with a few cc's of preemie formula to make up for lack of volume, but they DID get my precious drops as well. In their first 3 days they received a couple ounces of formula between the three of them. TOTAL. And then I started producing enough to feed them exclusively my milk. It helped that Abby started out with 2.5 cc feeds and Ellie and Sam started out with 4cc feeds, so the demand wasn't huge from the start. They were still getting the bulk of their nutrition through a TPN at that point while they figured out the whole suck/swallow/breathe thing.

And on Day 4, my husband asked the nurse how long it would be before I could try actually breastfeeding my babies, and she checked with the doctor and got permission for me to breastfeed them. She helped me get set up with Sam and showed me how to hold him and support him, and I fretted about whether he'd be able to latch, but he did! He didn't latch on for very long, but he definitely knew what to do and figured it out pretty quickly. He tired very quickly, so we gave him a feeding through his gavage tube afterward, but it was miraculous. I had no idea how amazing an experience nursing my baby could be until that moment. It felt strange and awkward and perfect and amazing all at the same time. My tiny little three and a half pound baby knew what to do and he nursed like a little champ! How incredible. And then it was time for Ellie's feeding, but she was having a harder time, so we gave her a gavage feeding while she was nursing so that she could associate a full tummy with mommy's breast...a technique we employed a lot with her in the NICU, actually. I was shocked at how exhausted I was after nursing just two tiny babies. Abby was still too small to try to nurse, so when her turn came, I held her skin-to-skin while giving her a gavage feeding, and then I pumped afterward while gazing at my beautiful two and a half pound angel and had the best production I'd ever had before. It was amazing to see that it was all true... being around your babies really DOES improve milk supply. Who knew?

And that was my first day breastfeeding my babies. The next day, believe it or not, I was able to breastfeed all three of them, even Abby, and I breastfed them at least twice a day every day until they left the NICU and I pumped 8-12 times per day, every day. And then, on day 24, they came home. My once champion breastfeeders suddenly would not breastfeed anymore. None of them! I continued to pump 8-10 times per day, fed them expressed milk, attempted to breastfeed them at every feed, and never slept, because of the constant fight to get them to remember how to breastfeed. I thought all was lost. I developed my second clogged duct and was in misery until it resolved. And then... a few days later I woke up with painful, red, tender, swelling in my breast, a high fever, chills, flu-like symptoms... you guessed it, mastitis! The way to get through mastitis, I'm told, is to let your baby nurse as much as possible, but my babies wouldn't help me, so I gave up for a few days and just pumped, pumped, pumped, pumped and pumped some more. And gradually, it got better, and I was able to see the light at the end of the tunnel.

I thought there was no way my babies would ever return to nursing... but on the advice of a nurse, I got some nipple shields, even though lots of people told me that nipple shields would only lead to nipple confusion. Seriously...these babies were drinking from bottles, so how much more confused could they get? And lo and behold... suddenly, Ellie was nursing. Then Sam was nursing. Only Abby remained skeptical. She would latch occasionally, but would usually scream her head off at the mere mention of breastfeeding (er, that might be a SLIGHT exaggeration). And eventually I was able to rid myself of the nipple shields all together and I had two, perfectly normal nursing babies and one baby who would not nurse, but who still received only expressed breast milk.

I called the pump my FOURTH baby, because I spent as much time with her (I named her Maggie) as I did with my three babies, in order to make sure I always had enough milk for Abby. And pump, I did. I was able to reduce to 6-8 times per day without changing the amount I was producing, since I was nursing so much, and I still got lots of snuggle time with my beautiful Abby. Even today I still try to give her the opportunity to nurse occasionally, but she still hates it. She's got a tongue-tie, and has a really hard time latching, so it's not shocking that she won't nurse, but it's a little disappointing.

My babies will be five months old next week and today, for the first time, I'm faced with the need to supplement them with formula. I've finished my stash of milk in the freezer. And I'm pumping like mad. But I'm producing 40-45 ounces of milk per day in addition to whatever they get via nursing directly, and the three babies together are eating 52 ounces of milk per day, so I'm falling a little bit short on the supply. I've tried everything... domperidone, fenugreek, blessed thistle, some weird herbal concoction, reglan, oatmeal, breast compression before and during pumping... but I just can't produce more than I'm producing now, without adding additional pumping sessions in each day. I'm pumping about 6-7 times per day right now, and if I pump any more than that, I'll probably lose my job.

A piece of me feels like a big, giant failure, even though I'm obviously not going to STOP breastfeeding and pumping at this point. I'm not sure when my 6 week breastfeeding goal turned into a 3 month goal, or when that 3 month goal turned into a 6 month goal, or when that 6 month goal turned into a 6-month-adjusted goal, but I know now that I'll breastfeed as long as I can, as much as I can until they're a year old, and then I'll work on weaning them before moving on to my next round of fertility treatments. I'm not getting any younger, but I do want at least one more chance at this pregnancy thing. And I want my children to have lots of siblings. I had only one and he loathes me, so I've been determined my whole life to make sure that my children are surrounded with a big brood. They don't all have to like each other (though that would be nice), but at least the odds are good that they'll each find SOMEONE to love in the family.

But I digress. I do feel like I'm failing my children, though I don't feel that way toward any other woman who feeds their babies formula. I've told countless mothers of multiples that they should not ever beat themselves up over their breastfeeding decisions because it's HARD, and sometimes darned near impossible. And I know I should celebrate my five months of accomplishment, rather than focusing on my failure to continue the same pace, but I just can't get past it. I know very few women who made it through five months of feeding triplets only breast milk... so I should be thrilled, right?

But then this morning, the first morning that I was guaranteed that the babies weren't going to have enough of my own milk for the day, the guilt poured on. I thought it would be wise to try giving Abby a bottle of formula while there was still breastmilk in the fridge, just in case she didn't like it. After all... what would we do if she refused it and there were no other options? So when the nanny arrived this morning, I handed her a bottle of formula (no way was I going to be the one to give her the yucky stuff). Sure enough, Abby screamed her little head off. My poor persnickety Abby wanted NOTHING to do with the formula. NOTHING. I thought maybe she just wasn't hungry, but we gave her a bottle of breastmilk and, sure enough, she gobbled it right up. Sigh. Sam, fortunately, had no problem drinking the formula, little piggy that he is. Next week, I'll try making 50/50 bottles and see what happens with Abby, but oh gosh, my heart was breaking knowing how much she hated the taste of the formula! I was completely failing my child! Thank heavens I tried it out while there were still options!

In a couple months, we'll be starting them with some solids, and eventually their consumption of milk each day will go down slightly, so I may actually be able to return to being able to feed them 100% breast milk. But for now, each of them will probably get 2-4 ounces of formula each day. And I know that's still pretty amazing on my part. And I know there's nothing to be done, and no way for me to get around it.

And once again, I feel like a failure. Once again, I feel like my body is betraying me. It's infertility all over again, even though I know that logically, this is the polar opposite of infertility. Somehow, I simply MUST make myself okay with supplementing, because there's really nothing wrong with it. It won't hurt my babies. They'll still grow and they'll still be healthy. I'll still be able to fortify for the extra calories that Ellie needs. I'll still be able to breast feed any time I'm home and feed them breast milk most of the time. 2-4 ounces per day just isn't the end of the world, so why do I feel like the world's worst mommy?



~~~~~~~~~~~~~~
Also, a quick update on Ellie... at her appointment yesterday she hadn't gained any weight, but on Wednesday we were able to convince her to start taking 120 ml bottles, so we're hoping another week of that will be enough to boost her back toward gaining. Bigger babies need more calories to grow, of course, so hopefully that's all that's going on. For the moment, she is a bit of an enigma, but she's definitely improving. She's more alert, and smiling and cooing almost as much as Abby now. She looks good, but is still far more sleepy than the other two. We'll go back in a week to see how she's improved.

Breaking News! Indocin Works! (Update at Bottom)

So while I was in the hospital I was on Indocin for 24 hours. This isn't a drug that can be taken long-term in pregnancy because it reduces the amount of amniotic fluid, which is bad (and after 31 or 32 weeks causes bigger problems), but for short term use, it works quite well as a tocolytic, as I've discovered a couple of times now. So, while I was in the hospital, my contractions went down to only a few per hour, which is great.

I didn't bother to monitor the night I got home, because I figured I'd been monitored enough all day. And the next morning (Tuesday morning) I had zero contractions. This isn't shocking, considering that I still had some Indocin in my system. (Though, honestly, I can hardly remember another time that I had zero contractions in an hour.)

Tuesday night, however, I had fifteen contractions in an hour. The Indocin, clearly, was no longer in my system. (I had my uber-husband look up the half-life of Indocin, which turns out to be 4.5 hours, so that worked out about right) So I had to give myself a demand dose of terbutaline and remonitor (shock of shocks). And I had 10 contractions. So the nurse said "Well, should I have you remonitor again, or just call the doctor?" Uh, yeah, let's think about this. It was 10:30pm. If I remonitored, by the time I heard back from her it would be close to midnight, by which point if I still had that many contractions, they'd be calling and waking up a doctor. No thank you. So I told her to call the doctor. In an ideal world, frankly, I would have called the doctor, but for whatever reason the after-hours nurses prefer to speak to the doctors directly, so whatever. I suggested that she mention that I do have Indocin at home and ask if I could take that for another 24 hours.

Dr. R. was on call again (she was the doctor on call who admitted me on Sunday), so she knew that my fetal fibronectin on Sunday had been negative, knew what my cervical length was, and knew what the orders in the hospital had been off the top of her head, so she was okay with me taking the Indocin for 24 hours, and was otherwise unconcerned. For the record, I wasn't concerned either. This is just what I do at this point. I contract. A lot. Often. But, admittedly, if it had kept up at that rate, there was no way I was going to get any sleep, because it was making me pretty darned uncomfortable. And so.... I went back on Indocin for 24 hours last night. Easy enough.

And this morning I had 3 contractions. And tonight? One contraction. Gee, do you think this stuff works? I think so. Shame I can't take it continuously.

Edit: Jennifer from Arkansas asked You've posted about the side effects of the terbutaline (sp?) as far as how it makes you feel. What is the indocin like? Any immediate sife effects to speak of? (other than the fact that it ROCKS in taking care of the contractions!!)

Well, all drugs have a side effect profile, of course, but the short answer is that Indocin doesn't really have any negative side effects for me. Indocin (or indomethacin) is a non-steroidal anti-inflammatory drug (NSAID) like Aleve or a variety of other drugs. Normally NSAIDs are contraindicated in pregnancy, but obviously there are controlled exceptions like this one, but I wouldn't recommend taking an NSAID just for fun while pregnant. Anywhozit, the main side effect for me is that it helps my headaches ever so slightly. It can also cause stomach pains or upset, so it's recommended that one take it with food or Tums, which I find is helpful, but rarely remember to do. (I never found that Aleve hurt or upset my stomach, but I do find that the Indocin does a bit... which is funny because I took a LOT of Aleve before I was pregnant and the Indocin isn't any more potent) Anywhozit, that's pretty much it. I don't think there are any other major side effects.

I'm also now taking the Nifedipine every day which has a few side effects itself, most notably it is a beta blocker, so it can lower blood pressure (which isn't a bad thing, since Terbutaline raises blood pressure). The lower blood pressure can also lead to dizziness and whatnot, but that hasn't been a problem for me. Yet.

Home Again

Many thanks to my pinch-hitter husband for posting for me this morning. As he said, I was sent to the hospital for monitoring last night after my 4:30 monitoring session had 15 contractions in an hour. Suffice it to say, it was a fun day all around.

So... off to labor and delivery triage we went. Where we quickly discovered I was still having far too many contractions. The nurses were great, the hospital was boring. My doctor called after a bit to suggest some options. We settled on trying 3 doses of Nifedipine over an hour and half and if I was still over threshold after that, she'd admit me over night for observation, get me on Indocin for 24 hours, and check my cervix in the morning and probably let me go after that.

Three doses of Nifedipine later, and just as many contractions, and there was a room with my name on it. And so, my darling husband went home to get some things for me, including (bless him) a toothbrush/toothpaste which hadn't even occurred to me, but BOY DID I LOVE HAVING THAT! And the fun began. They got me back on the monitors... three fetal monitors and a contraction monitor. Now the ironic thing about that set up is that to keep the fetal monitors in the right place, I had to be laying on my back. But that made the contractions worse. But rolling onto my side disturbed the fetal monitors too much. Finally around midnight, the nurses called my doctor and asked if they could just leave the contraction monitor only on so that I could get more comfortable and hopefully sleep. At 1:30, they came in and took off the three fetal monitors, I rolled onto my side and went to sleep. At 4am I got my second dose of Indocin. At 6am, I woke up and my day started... for the last couple hours I'd only had a couple contractions. Miracle! (Indocin works well for me...it's just that it can't be taken long term)

Anywhozit, around 8 I was brought the world's most disgusting breakfast (kosher hospital food... never a good thing... ick!). and a bit before 9 I was taken down for an ultrasound and to meet with my doctor. My cervix was, at its shortest, 1.7cm... shorter than last week, but not so much shorter than it was 5 weeks ago when this whole bed rest crap started in the first place. She recommended raising the basal rate on my terbutaline pump, adding Nifedipine XR again on top of the terbutaline, and having a fetal fibronectin test done weekly along with the already-scheduled weekly cervical measurements.

She was fully prepared to let me go home and asked if I had any questions. And I said, well, I wasn't trying to be picky or anything... but I was doing the 4x daily finger sticks for blood sugar testing because I couldn't take the three hour test, and since I hadn't had a single blood sugar reading out of the range of completely utterly normal, could I maybe cut back on the number of times I had to test...but I was willing to do whatever she wanted me to. She said I could just do it twice a day if I wanted, but forewarned me that as I got later into the pregnancy, they'd probably still make me return to four times a day anyway. No problem. She went off to type up the ultrasound report and then popped back in and said, "Hey, since you're in-house right now anyway, do you want to just DO the three-hour glucola test?" Uh, YEAH! Except I'd already eaten breakfast. No problem. I had eaten breakfast at 8, so they'd do the test at 4 and I could go home after that, unless I'd feel better staying another night (NO THANK YOU).

And so... I spent the most boring day of my life in the hospital today, internet-less, bored, with limited things to read or do. But on Friday, I should know whether I have to keep finger-sticking myself! And I was home at 8pm tonight. Safe and sound. All is well, the babies are all healthy and fine. The contractions are better for the moment. And life is good because I have my precious internet back. Gawd I'm an addict. Thanks everyone for your kind thoughts. I suspect this won't be the last time I have a visit to the hospital before this is all over, but at least this wasn't a terribly long orientation... :) I'll try to catch up on your blogs tomorrow.

We've hit a new record...(updated twice in middle)

Fifteen contractions this morning. In an hour. I'd say that's impressive, except, uh, that's not exactly how this is supposed to be working...

*shrug* I have to take my BP and pulse in a couple minutes, give myself a demand dose, and then remonitor from 10:30-11:30. Hopefully the extra dose will help calm things down. Otherwise, I imagine this will be an... interesting day.

I wonder if there's an award for hitting the record. Er.... scratch that. I'm pretty sure I don't want to find out. I have a feeling today I will not be moving much. My husband can wait on me hand and foot, right? Excellent.

Update: 8 contractions in my re-monitoring session. Got an auto-dose of terbutaline at 12pm. Remonitoring from 12:30-1:30. Not worried about it. Likely to go down again... that's three doses of terbutaline in a short timeframe. Even if it goes down, I may ask the nurse to call my doctor anyway, because that much terbutaline at once is making it hard for me to breathe comfortably. I think it's time to ask about repeating the Indocin regimen for 48 hours so that I don't have to keep doing this multi-dose stuff for the next few days. I dunno. I'm not feeling very assertive today, so I guess I'll just have to figure it out.

Update #2: Now I'm waiting for a call back from the doctor. Third monitoring session was 12 contractions. ... And while I was typing this the nurse from Matria called back to say she'd heard from the doctor on call (Dr. R.) and what she wants me to do is give *another* demand dose at 4pm, re-monitor at 4:30 and then decide whether I should come in to be checked. SO.... I'll update you later!

In other news.... I absolutely could not fall asleep last night, which is unusual for me. I mean, I usually can't STAY asleep, but most nights, my head hits the pillow and I'm OUT. Not last night. Not sure what the deal was, but I think it was close to 3am before I finally drifted off and I couldn't drag myself out of bed until about 10 'til 8 (normally I wake up around 6, even if I don't get out of bed that early). Anyway, in my supreme irritation at not sleeping, I read a couple blogs I've never read before and then got curious about something and got myself a tape measure...

Now, I've lost about 20-24 pounds this pregnancy (depending on the week... I seem to gain and lose the same 2-4 pounds week to week lately). But what wasn't making sense was that recently, many of my pre-pregnancy clothes have been fitting just fine. My skirts have fit me all along, but I grew out of my blouses pretty quickly after I started showing. (my skirts fit me primarily because I don't like things ON my belly; I prefer that they be under my belly... but recently, I've noticed that even my pre-pregnancy skirts are sometimes falling a little too low if I wear them and I realized I could actually pull them up around the largest part of my belly without any real discomfort other than my normal "I don't like things touching my belly" discomfort)

Anywhozit, I pulled out a tape measure and measured my girth. And sadly? My "waist" measurement (not that you can really call it a waist anymore) is only about an inch larger than it was last summer (the last time I measured my waist). I lost a bunch of weight (maybe 15 pounds in three months?) in my first pregnancy and only gained 3-5 pounds back after the miscarriage (some of which was attributable to the fertility drugs, I think). And I've lost about 20 in this pregnancy... but when you consider that the babies keep gaining weight and I'm not gaining weight... my total loss is probably much higher than 20 pounds. HOLY HECK! I wonder how much I'm going to weigh a few weeks after these babies are born. I mean, seriously, I'm overweight, there's no question. And I had a lot of weight to lose. But sheesh! I was JOKING after my first pregnancy when I said all I have to do to get to my idea weight is get pregnancy 3-4 times, but apparently pregnancy really IS the great weight-loss plan for me. How ridiculously odd.

(to be fair, a lot of this weight loss is probably due to the fact that I've been off of Depakote for a while now... I gained a LOT of weight taking Depakote, but had to get off of it because Depakote = EVIL in early pregnancy. And now I'm taking Topamax, which does have a weight loss side effect for some people... but when I last took it [at a significantly higher dose] I didn't have this kind of a drastic weight loss - not even close. Anywhozit, I think it's fair to say that I'm taking off that 20 pounds per year that the Depakote helped put on me... at a somewhat faster rate than I put it on)

Frustrating

First, I should note that this is my 198th post. I'm pointing this out because of the unlikelihood that I'll notice when it's my 200th post, so there you go. This is fair warning that apparently, I am verbose.

Then there's the fact that I made it to 28 weeks this week. And... I have mixed feeling about this. On the one hand, this is definitely a milestone. Babies born at 28 weeks do much better than babies born at, say, 25 weeks. But it would still be utterly devastating to me if they were born right now. Apparently I'd had my doctor worried over the weekend that he was going to be delivering me at 27+ weeks. That's not good. What is good is that he didn't make me think there was that much reason to worry until it was clear that we didn't need to worry. But anyway, in a lot of ways, I'm very sorry that I ever, ever, ever told anyone that 28 weeks was a milestone. It IS a milestone, but it is NOT the goal. The goal is 34 weeks. The first milestone along the way was 28 weeks, and here we are. But now people (not YOU people... but stupid people) keep thinking it's okay to say stupid shit like, "Well, great, you got to 28 weeks, so it's all good now, the babies can be born any time, right?!?" WRONG. And when I try to explain to these people that I appreciate their optimism and enthusiasm, but 28 weeks would still be horrifying, they tell me to stop being such a pessimist and proceed to tell me all these statistics about babies born at 28 weeks.

Yes... 90ish percent of babies born at 28 weeks survive. And most of them do not have long-term issues. But 10% don't survive. And 28 weeks, need I remind anyone, is twelve weeks early. Twelve. That's too early. If my babies were born right now, they would be about 2 pounds. That's not enough. Not when they should have the opportunity to grow to be close to 4 pounds. If my babies were born today, they would probably do just fine. But that is not what I want. And that is not what is best for them or for me. And I am so sick and tired of people accusing me of being a pessimist for not thinking it would be so great for these babies to be born this week. Case en pointe: My foster-son's grandmother called me on Wednesday (GAWD, why did I EVER acknowledge that Wednesdays are the days that I hit the new-week-milestones? WHY WHY WHY?). I was waiting for my Matria nurse to call me with my morning monitoring numbers and I'd had a terrible night the night before (10 contractions in an hour, two hours in a row), so I was a bit on edge when I picked up the phone.

"Hello?"
"28."
"28?"
"28!" (I'm still trying to figure out who the flying fig is on the other end of the phone)
"What do you mean, 28?"
"You're at 28!"
"That's not possible!" (I knew it wasn't my nurse from Matria, because she always identifies herself, but I was still in that contraction-counting-mode, and I was doing the math and there's no WAY I could have had 28 contractions in an hour)
"What do you think it is?"
"What do you mean 28?"
"28!"
"28??"
"Yes! 28!" (this went on for about two minutes)
"28 what????"
"You're at 28 weeks!!" (I finally at this point figured out who it was who was calling because this is the one person in the world who cannot seem to get the point that I need her to stop harping on the 28 week thing, plus I finally recognized her voice)

I was livid, really. I told her flat out that I don't know any other nice way of telling her that I need her to stop dwelling on this 28 week bullshit. YES, it's a milestone. NO, it's not the goal. YES, babies do very well at 28 weeks (at which point she broke in and said, "I even talked to my sister who's an OB/GYN and she said..."). But NO, it would NOT be good if these babies were born at 28 weeks. They will have so many disadvantages already. We really want to get into the thirties. Thirty-four weeks is absolutely ideal. And please, please, please, I'm begging you, stop acting like it's okay for these babies to come out right now!

I swear, it's like I almost feel like all these people who think it's "okay" now for these babies to come out are almost willing it to happen and it terrifies me. Yes, they really probably would be okay, but I don't want to find out the hard way. I just want these babies to have every chance possible. I don't want them to come out now. I'm not ready. They're not ready. They're too tiny. I'm too scared for them. Please don't come now. Please. I don't know how we'd bear it. I don't. I know we'd just do it, but I don't want to find out. I really don't. I can't.

I haven't been a seriously emotional wreck through this pregnancy. I'm not more snippy than I am when I'm not pregnant (I'm very snippy when I'm not pregnant, so who can tell the difference?). I rarely cry, though I'm crying now just thinking about these babies coming out now. I keep it together. After the first few weeks of the triplet-shock, I've been okay. I've had my moments of "oh my god how are we going to take care of triplets??" but nothing too horrifying since those early weeks. And now, with people continually acting like 28 weeks was such a huge milestone and that everything's okay now... I just feel like ... like they're saying it's okay for all my worst fears from the beginning to come true.

And it's not helping that the contractions really are out of control. I mean, the good news is they're not seriously affecting my cervix. Contracting is, apparently, just what I DO (sort of like how we discovered that bleeding in early pregnancy is just something I DO...). I'm just lucky. Somehow, that doesn't bring any peace of mind, because it makes me worry that if there really IS a problem, we'll miss it. But then again, my doctors have been careful never to assume that my contractions are just "normal for me" when they get up to a certain level. They'll bring me in any time I feel uncomfortable with the pattern or feel like I should be seen. Or if anything's different. So it's not like they're blowing it off, thankfully. And they are awesome. I love my doctors. All of them.

But I'm having so many contractions that they keep changing the terbutaline dose. And I can't keep taking the Indocin (though I suspect I'll be back on it for another 48 hours next week), even though it worked. Unfortunately, I've gotten to a point where the terbutaline side effects may be outweighing the benefits. I was having difficulty breathing, so they've lowered the dose a little, but my contractions are going up even though breathing is a little easier. I can barely keep any food down. My head hurts constantly (and these aren't "just" migraines... this is definitely terbutaline-induced). I'm afraid that we're to the point where even though I haven't topped out pharmacologically on the terbutaline, I may have topped out on how much terbutaline my body can handle.

So we'll see. I'm trying not to be frustrated. I'm trying not to be angry at people for their good intentions. I'm trying not to be too anxious about these babies. I'm trying to remember that I chose my doctors because I trust them and have nothing but faith in the care I receive from them. I'm trying to remember that there are more options after the terbutaline and even if those options require that I go into the hospital temporarily or permanently, it doesn't matter. All that matters is keeping these babies in for another 6 weeks.

Please write "I will not tempt fate" 100 times on the blackboard

You know how I haven't had much nausea in this pregnancy? Yeah. Um. I lied. A lot. I am very much regretting having been worried about my lack of nausea. YUCK.

Seriously? I mean, really?

I keep going back to the comments on my original triplet post. Many comments are checking to see if I'm serious. Wait. Are you serious? Honestly, I'm still not sure I'm serious. I mean, how ridiculous would THAT be? I can't be pregnant with triplets. That's the most assinine thing I've ever heard. But that picture... that scan... that's my uterus in that picture. Surely it can't be? Obviously I will wake up soon, right? RIGHT?

I hate to sound like a broken record, and I expect that several posts to come will all sound the same and for that I apologize, but I still don't know what to think or feel. I didn't even know what to think or feel about there being twins at the first scan. How exactly is triplets supposed to be clear-cut, emotionally?

If I have triplets, I'm guaranteed three seriously premature babies. Best case scenario? I get three, three-pound babies. And that's if all goes perfectly. I cannot begin to tell you how much that terrifies me. That is the best case. I cannot keep out of my head visions of three pound babies. I just can't. I cannot believe that come September, I could be faced with that for real. Yes, September. Because no way are triplets making it to November. (I'm theoretically due the first week of November, hah!)

Mostly, I'm in pain. Physical pain. I know some cramping is normal in pregnancy, and I imagine that cramping with three in there would be, oh, three times worse than a typical pregnancy. But this is really ridiculous. This is doubling-over-in-pain kind of cramping. This is me not being able to load the dishwasher because that would require bending over kind of pain (mighty convenient, that one). My hips, believe it or not, already feel like they are trying to spread out. Everything is all out of whack. Everything hurts. My migraines are unbelievably out of control now, and there's nothing I can really take for them that will help. I had a serious anxiety attack yesterday because my husband's car died and now we have to buy a new one sooner than I'd hoped and I don't know how we're going to pay for it, and the anxiety only made my head pound more, my abdomen cramp more, my back ache more. And you know the best part? You can't take any anxiety medication when you're pregnant. I very rarely have anxiety attacks. I was given Ativan years ago when I had a malfunctioning gallbladder and couldn't sleep through the pain. I was pretty pissed off to be handed anxiety medicine for sleeplessness, but it turned out to really work. Now I'm pretty pissed off that I can't take any Ativan now.

I don't really need a scan tomorrow, but I'm going in for one anyway. I'm going to carefully explain to Margaret that if she even THINKS she sees four, she is not to say a single word about it to me. Maybe I should just wait until Tuesday when Dr. Amazing is back. Actually, it doesn't matter, I'm seeing Dr. Amazing on Tuesday regardless of whether I go in for a scan tomorrow. I may as well get another scan just for fun anyway. If she sees four, I'll die on the spot.

A Fine Question

Anonymous writes:
Is it only the implantation that has been causing the bleeding? Might you have had multiple implantations and losses early on in the other pregnancy? What information are you being given about the bleeding?

This is a great question. And the answer is, I don't know. One theory is that I could be bleeding from implantation , but I gotta say... I don't have a lot of faith in that theory. There's an awful lot of bleeding, in my admittedly uneducated opinion, to blame only on implantation. Beyond that, who knows?

Could I have had multiple implantations and losses early in the other pregnancy? It's doubtful because in my last pregnancy, I literally had ONE mature (16mm) follicle and nothing more. All the others had shrunk away to unmeasurable levels. This pregnancy there was a maybe-leader and a whole lot of close followers (16.4, 15.4, 14.2, 14.2, 14.0). Gosh I feel really stupid now. We should have just cancelled the cycle. In the case of the last pregnancy, multiple implantations and losses definitely doesn't cover it, because I had consistent bleeding for 12 weeks. Had there been other implantations that I was losing, they would have shown up on ultrasound.

But as for what information I'm being given on the bleeding... not much. Not any actually. Just the possibility of implantation bleeding, which doesn't make enough sense to satisfy me. They can't find a reason for the bleeding on ultrasound and they are therefore unconcerned. Easy for them to say. I'm the one dealing with it.

What else? A couple people have asked me how far along I am... I'm at about 6 weeks gestation, with variances depending on who you ask. Another popular question is when is my next scan? I don't have to go back in until Tuesday, but I'm going in on Friday so that I don't spend all weekend assuming that life is all doom and gloom. I don't expect Friday's scan to yield any interesting results. I don't expect fetal poles or heartbeats by then, but I expect there may be something more interesting to see on Tuesday. If not, that's when I'll worry. Not that I'm not worrying now.

My question is... at what point do I mention this little predicament to my OB? And will he be able/willing to see me if this stays triplets? I'd feel stupid calling now only to find out I'm down to one or two by the time I "graduate" from the RE's office. But I wouldn't want to not have a plan in place for my next appointment once I graduate from the RE's office either. Decisions, decisions.

On another note, a small part of me is really irrationally angry with Shady Hell right now. I know that IUI made the most medical sense in terms of avoiding costly, invasive procedures if we could... but if someone had just let me have my way and went straight to IVF after the miscarriage.... the odds of triplets right now would have been infinitessimal. We never would have transferred three embryos and we would have had to have a very, very good reason to transfer even two. This is not Shady Hell's fault. They did do the responsible thing in giving me the guidance that they gave me. But I'm still upset about it.

Drama Queen

Ever the drama queen, I emailed my nurse yesterday to ask about the bleeding. Every time I think it's going away and I was worried for nothing, it gets worse. And every time I start to really worry, it stops suddenly. The bleeding was very heavy Friday, Saturday and Sunday. Yesterday was lighter, but I figured I'd better check in with her anyway. I'd hate to find out later that I ignored something I shouldn't have.

Well, the whiny patient gets seen, so I'm going in this morning for a repeat ultrasound. And right on cue, I'm not bleeding (much) this morning. Of course. So the doctor will probably think I'm a complete hypochondriac, which is fine, since it's not Dr. Amazing this morning.

Hopefully everything is fine and I'm just being a drama queen.

It's like de ja vu all over again...

510.

No, seriously.... five-one-zero.

Holy cow. I'm in shock. My nurse is in shock. Did I mention I'M in shock?

My nurse called and said, "you're still in the game, the numbers look great!" and I replied, "You're kidding...!?"

What a dumbass thing to say. Of course she's not kidding. Why would she lie? I don't think I could say anything dumber. Gah! Actually, it got stupider. I then told her I didn't believe her and she told me the number (510!!). I was stunned so she asked how much I was bleeding. A lot. How much is a lot? I would easily have called yesterday CD1 and it hasn't relented.

So now I'm officially on "restricted" activity. What my nurse isn't saying is that this restricted activity will have no physical effect on the outcome of this pregnancy. What I know that she's hoping is that if I miscarry I don't sit around blaming myself for lifting something too heavy, or overexerting myself, or whatnot. This "restricted activity" is merely meant to keep me mentally stable. Yeah.

Oh, and if I have any severe abdominal cramping, fever or vomitting, I must come in immediately to be seen. Yeah. Or something.

For the moment, I'm just plain grateful. We're going for FOUR months this time! (Just kidding!) And you know, if this doesn't work out, we've got the backup plan.

Off-topic:

Oh, I miscounted. We're having 15 adults and three kids. And I'm supposed to be "taking it easy." Decemberbaby asked what I'm cooking. I did most of my cooking last night: Mushroom Barley Soup, Baked Gefilte Fish, Chicken (just boring marinated chicken), Mushroom Tarts, Cranberry Apple Tart, Roasted New Potatoes, Green Beans with caramelized onions and pignoli, Broccoli Kugel (maybe), and um, I feel like I'm missing something. Dessert came from the bakery, because I'm lazy. And my nurse doesn't want me doing any serving. HAH! 'Cause that's gonna happen.

Confession

I have a confession to make: I keep forgetting that I'm in the two-week wait. I mean, I know I'm waiting for my beta so that I can start birth control pills. But I keep forgetting that what it actually means is that there's the theoretical possibility I could be pregnant. I'm completely serious. So much so that I keep forgetting to use the evil prometrium suppositories.

The cool thing about forgetting to take prometrium is that it means I don't have all the progesterone side effects. Or so I thought!

I have the stabbing, white-hot, poker pain in my breasts, just like I always do during the stupid 2ww because of the prometrium. And I'm queasy, just like I always do with prometrium. And every time I start to feel a little dizzy, I think, "don't worry, that's just the prometrium." Except, um, it isn't.

I'm not trying to sound ungrateful that maybe there's a possibility of anything interesting going on in my nether-regions, but seriously! This is ridiculous! There is no effing way that I'm pregnant and I seriously resent my body's insistence on pretending like there's even the remotest possibility. Worse, I still can't get out of my head that a positive beta would only be an inconvenience at this point... I'm ready to move on. I'm not interested in having another 5 month delay for pregnancy, inevitable miscarriage, D&C, and following betas down. And there isn't even the tiniest part of me that thinks it would be anything but that scenario. So this better just be God messing with me (as per usual), because I'd really like to be pregnant at some point when I can appreciate it and be happy about it, not now when I would only resent it.

I know that is completely screwed up. I know I'm an ingrate. I also know I'm not pregnant, so I don't know what I'm complaining about. I'm a completely messed up person.

Dragging Along Part II

Lest you think that today's E2/LH levels will shed any more light on my peculiar puzzle, I should update you on my call from my nurse this afternoon.

Three more days, two more clicks of the pen. I'm up to 108 IUs for the next three nights. Apparently Dr. Amazing is bored and ready to move on to IVF, which is good, because I'm ready to move on also. I return on Sunday for more ultrasound fun! Whahoo! I asked Mary (my nurse) what my E2/LH levels were and she said she didn't want to tell me because it was only going to irritate me. I promised her I could take it.

E2: 110 (down from 113, but that's really just a plateau)
LH: 2.5 (it went from 2.5 on Sunday, to 2.2 on Tuesday, back to 2.5 today)

Mary is pleased with my LH because she doesn't want it spiking yet because that would mean I was about to ovulate on my own and that would be bad, since apparently my eggs are too immature. They're like teenagers trying to break out into maturity, but still stuck with some rather childish behaviours and development. Curses!

I forgot to tell you all the funniest part of my ultrasound this morning. After Dr. S. left the room I was talking to Margaret, sonographer extraordinaire, and she said (JOKINGLY), "gosh what IS going on with those ovaries of yours? Whatever they tell you to take, you should take double and see what happens." I told her I'd considered it, but that would be wrong. Wrong, I say! Do I sound convincing? I reminded her that doubling my meds was probably the easiest way to land myself with a canceled cycle from overstimulation. "True," she said, "but they can't stop you from having lots of sex!"

Of course, sex has never helped us have a baby before, but if I had four perfectly mature, ripe, beautiful follicles ovulating all at once, you can be damned sure this would be the one time I'd end up pregnant. With quadruplets. And I gotta tell you... I really don't want quadruplets. Not even a little bit. Seriously!

Anywhozit. The point is my ovaries are doing absolutely nothing. I think I ought to have S provide a "sample" for cryopreservation, because I suspect what's going to end up happening is that I'll end up needing an IUI when I'm supposed to be in Florida. At least if we had some swimmers on ice, I'd be able to stay here while S and J go to Florida without me (or maybe just have me catch up with them later or something). And anyway, if I plan for that contingency, I won't end up needing it, and all this worrying will be for nothing, right??

Edited to Add: Anonymous makes a good point in the comments that I could always go for the well-timed intercourse in Florida idea in lieu of the IUI. The IUI itself doesn't really increase our odds, since our whole problem appears to be me not ovulating naturally, so well-timed intercourse COULD do it, except for a couple things:

1. We'll be staying at my dad's ... and well, GAH!
2. Timing has never worked out particularly well for us, but we could still give it a shot.
3. I need to find out whether my RE would count this as one of my 2 last IUI cycles before moving on to IVF if I skipped the IUI part. I suspect he would, but I'm not entirely certain. But I am NOT doing another one of these cycles if I don't have to. It's time to move on. My insurance coverage for IVF runs out in September or October. After that, I start fighting an uphill battle. Bleh.

Still, I haven't entirely ruled out the possibility of just resorting to "the old fashioned way" if necessary
End of Edit

Dragging along

Last March I had the longest IUI cycle in recorded history. Or at least in MY recorded history. And since it was only my second IUI cycle, my recorded history wasn't very extensive. That cycle went on forever. hCG trigger was on CD 31. Thirty One! IUI on CD 33! Dr. S. called me a "two-pager" meaning that in the old days of paper charts, I would have been one of those patients whose cycle notes went on to the second page.

Not to worry, he assured me. Because historically, two pagers had a remarkably high pregnancy rate compared to shorter cycles (you know, the cycles where trigger happens on Day 12 and IUI is on Day 14 like a textbook?). I remember I really appreciated his reassurance (actually, I still do), but the long cycle was slightly problemmatic because I had a one-day trip scheduled to go to Florida (to see my father and a friend from Scotland) when I figured I'd be in the two week wait, but was actually not even close to IUI day. Dr. S. said no problem and let me push off my next monitoring appointment an extra day, figuring it wouldn't be too big a deal. It wasn't, and the cycle dragged on another week or two after I got back before I triggered.

That cycle ended horribly and dramatically while I was away for Passover. It was probably the worst bleeding I'd ever had until that point, and that's saying something. It was unbelievable amounts of pain, componded by the fact that I was away from home, living in a hotel for a week, not able to start a new cycle because I was nowhere near my fertility clinic (a 10 hour drive each way seemed extreme just for CD3 monitoring). I snapped a lot at my husband that week, had very little energy most of the time, suffered from migraines throughout the trip, and cried a lot. (Believe it or not, I still had a tremendously good time on that trip, especially considering the circumstances)

Do I have a point? Not really, actually. But fast forward to today's CD16 monitoring appointment. Last cycle I triggered on Day 14 and had an IUI on Day 16. This cycle I am not anticipating triggering anytime soon. Dr. S. was covering monitoring today, so I needled him about the fact that Room 1 doesn't have a mobile. He said they were waiting for a donation and I said that for what I'm paying this place... he chuckled. On to the ultrasound, the funnest part of the day!

Follicle growth is weird. The follicles on the Right Ovary seem to have stalled, while the follicles on the Left Ovary (previously known as the completely, utterly, evil, underperforming, useless ovary) made a little bit of progress.

Right Ovary: 12.3 (down from 12.6), 9.6, 9.4, 9.0
Left Ovary: 12.0 (up from 10.7), 11.0 (up from 10.0), 9.4
Lining: 11.41 (down from 11.75, should I be worried?)

No word yet on my E2/LH, but Dr. S. was not worried about the lack of growth of my follicles. He said that I had a beautiful jump in E2 on Tuesday (67.5 to 113!) and that we should expect to start seeing some more growth soon, based on that estrogen jump. I trust him, I believe him. I mentioned that I thought this was going to be another two-pager cycle and he laughed that I remembered that, but reminded me that historically two-pagers have relatively high success rates. When I told him that my last two-pager cycle was a resounding disaster he said, "and that's my cue to exit stage left!" (except he was wrong, it was stage right)

Anywhozit, the bottom line is that there is very little progress happening in Ovary-Land, perky or otherwise, so I'm sorry to give you such a boring update. Not to worry, I'm sure I'll have some dramarama for you soon!

(You know, for example, the fact that I have a trip scheduled to go to Florida for three days Feb. 18th-20th...Since I figured this cycle would be similar to last month's I figured this IUI would already be over, at the end of the 2ww, and failing by Feb. 20th. Now I'm wondering if my IUI is going to end up being scheduled right smack in the middle of that trip, meaning I have to cancel either the cycle or the trip. I haven't seen my father in almost a year and my father hasn't seen J in a year and a half so I really, really, really don't want to cancel this trip, but I also don't want to skip this IUI. DRAT, DRAT, DRAT!)

And the Fun Just Keeps On Coming

Another monitoring appointment this morning. I have 3 follicles on the Right Ovary measuring 11.8 and one measuring 11.6. If I end up with four mature follicles at trigger time, my doctor will cancel the cycle. My completely useless Left Ovary has one follicle measuring 8.8. Not impressive, but that's fine since I've got four contenders on the Left.

I'm not too worried about this cycle being cancelled because of over-responding. I've certainly never had that problem, even in the cycles when it looked worrisome at this point. I'm more concerned about my wonky estradiol levels and the fact that these follicles are only at 11.8 on CD12, which is quite a bit smaller than in my last cycle at this point (on the same dosages). It almost seems as if my response has gotten worse with each successive cyle, but it might be me overreacting. In fact, it probably IS me over reacting, since I know they've been fine-tuning my protocol with each cycle, so I wouldn't necessarily have the same response as previous cycles. For example, my 2nd IUI cycle went on FOREVER, in part because of the teeney weeney dosages. But now I'm on slightly higher dosages which means faster, but different response. I get that in theory, it's just frustrating right now. I'm sure I'll feel better once I get my E2 and LH levels back. I'm somewhat annoyed right now.

Actually, the reason I'm annoyed is because I had a sonographer and not a doctor today. It really irritates me that I haven't been getting an actual doctor on the weekends. It's one thing when it's my beloved Margaret running the ultrasound. But no offense to Julie (the person covering today), but she's just not Margaret. She didn't let me look at the ultrasound display at all, so I couldn't see anything for myself. And I also know that when there are different people measuring each time, it's not necessarily great for comparison, since some people measure differently. Plus, I know I could have asked Margaret to send in Dr. O (the doctor theoretically covering monitoring today, even though I never saw her). I really wanted to ask if there was any possibility that my wacky estrogen response this cycle and last could be fallout from the miscarriage. I know it probably isn't related, and it won't make a difference even if it is, but I wanted to ask. It's very rare that I have questions for my doctor because honestly, I'm pretty well-read on this stuff, and I trust the care I'm getting. But it would have been nice to have the option to speak with Dr. O today. I think I'll call Dr. Amazing this week.

I'm to return on Tuesday unless I hear otherwise after my bloodwork comes back. I think it's possible that they'll ask me to return tomorrow, but not necessarily likely. My guess is I'll stay at the same dosage (which was bumped to 83 IUs as of Friday), but I suppose it doesn't much matter. If I go back tomorrow, I won't call Dr. Amazing, since I'll be speaking to my nurse in the afternoon. I love my nurse... she knows me very well, and while we had a bit of a rocky start (she used to have a hard time remembering specifics about me), I've been around long enough at this point that she knows me really well, remembers the important things, and we have an incredibly good relationship. When she called me with my results and protocol on Friday she said that I should increase to 83 IUs and return on Sunday. I said that was fine and that I'd already set up an appointment for Sunday and she said, "I don't know what I'm going to do when you get pregnant! I'm going to have to find another patient who always knows exactly what to do." I told her I was pretty sure I could do this without all the doctors and she agreed. She's been there, done that, and has twins via IVF, so she gets it.

One final note: Thalia mentioned in a comment to my questions post that in the UK I'd be required to take a couple months off between IUI cycles because any kind of ovarian stimulation is regarded as needing a break between cycles. I can understand this to a point, but it still confuses me a bit. I do understand that you don't want to muck too much with your body's natural processes. But on the other hand, is it not reasonable to believe that there's an enormous difference between trying to stimulate ovaries to produce one egg and trying to stimulate ovaries to produce 20 eggs. So while I could see taking a month or two off after every two or three IUI cycles, I find it odd that there would need to be a blanket policy of taking 2-3 months off after EVERY IUI cycle. I would think one would want to look at that on a case by case basis. Probably none of my readers know that I'm a dual citizen of the US and UK and it is my goal to move to the UK eventually, but the timing has never been right. We can't move out of the State we live in, much less the country given the status of our foster son at this point. And beyond that, I'm not certain I would want to move while in the middle of all this fertility stuff, particularly since protocols between the US and UK seem to differ widely. I don't think one protocol is better than the other, but moving to something completely different seems overwhelming, at best. Ah well, I hope it will happen eventually.

UPDATE: Shit! (pardon my language) Not so much with feeling better now that my levels are back. E2: 67.5, LH: 2.5. This means my E2 levels have dropped. In fact, I snuck a look at my record after my monitoring appointment (they left it up on the computer monitor, so I couldn't resist a peak) and my E2: level had actually be 71.8 on Wednesday, not 71.5 as it was on Friday. So it's dropped twice in a row now. DRAT! Why in heaven's name is my body doing this? This is utterly ridiculous. Anywho, increase dosage to 91 IUs tonight and tomorrow night and return on Tuesday. Joy of freaking Joys.END OF UPDATE

Some Answers to Questions

One of the really annoying things about Blogger is that there's no easy way to respond to comments that I receive... It doesn't provide me email addresses for commenters, so I can't just email a response to a comment. And it doesn't do comment threading, so you'd never know if I responded direclty to a comment unless you keep looking at the comments on an individual post. This is, by far, my biggest frustration with Blogger. So I'm going to address some questions here.

1. Someone asked what I would do if I had to have an IUI on Saturday. (I think this was My Reality, but I'm not certain and I'm too lazy to look it up right now)

This is a somewhat complex question. First let me explain the whole Saturday problem in the first place: I'm an Orthodox Jew and there are a number of restrictions that I have on Saturdays (my Sabbath, or "Shabbos"). Shabbos is supposed to be a day set aside from weekday activities. A rest from the mundane. A completely different kind of day from the rest of the week. That being said, I don't drive on Shabbos. I don't write or exchange money on Shabbos. I don't cook, work, affect electricity, or play a musical instrument on Shabbos. I hate describing it this way, because it sounds as if Shabbos is all about all the things you CAN'T do, and that's not how I try to look at it. Shabbos starts at Sundown Friday and ends about an hour after sunset on Saturday. Nearly every Friday night, we have company over for a festive meal (and if we don't have company, which is rare, we still have a nice dinner). Saturday we go to shul (synagogue), take long walks, read, spend time together as a family, have a nice lunch with friends (usually... occasionally it's just us at home, but still a nice meal), take naps (something I never get to do during the week). So although there are a lot of things I can't or don't do on Shabbos... it is an extremely enjoyable day that I look forward to all week.

All that being said, there are a number of problems with me being at the fertility clinic on a Saturday. The first, most obvious, problem is driving. I can't drive to the clinic, so if I had to have an IUI on Saturday, I would have to spend the weekend in a hotel near the clinic. This is completely doable, but not without its drawbacks (primarily dealing with having food). My clinic is situated within walking distance of several hotels, though none are especially convenient. Still, it's doable. There are lots of other little problems, all of which are easily handled: I don't write, so I can't sign in or fill out any forms, but those things can all be taken care of ahead of time. I don't exchange money, but I could pay my copay ahead of time or have them bill me (they have a lot of Orthodox patients, so they've grown accustomed to such things). Those are all doable.

The bigger (and least surmountable) problem for me is that being at the fertility clinic on Saturday is not really in the spirit of Shabbos. It takes me out of the calm beauty that characterizes Shabbos for me. It forces tension into a day that would otherwise be focused on my relationships with God, my family, and myself. Practically speaking, it would also require that I figure out what to do about Julian. If we both had to be at the clinic, we'd have to have someone watching J (though obviously we could take turns being at the clinic since that's usually what happens if I have an IUI during the week anyway. It's rare that S is present for the actual IUI (he's been there 2 out of 5 times), but that's because of practical reasons. We both have jobs. If I have an IUI on a Sunday, we go together. Otherwise, he's only there for his part.

The nice thing about IUI is that it is somewhat more flexible with timing than IVF is. With IUI triggering a day earlier or a day later isn't so much of a problem. With IVF, there's less flexibility with egg retrieval and even less flexibility with transfer, so it's much harder to avoid Shabbos retrievals or transfers. So far, with five IUIs in my portfolio, I've never had to have a Saturday IUI, though I know it could happen. Mostly, my doctors are aware that Saturdays are big problems for me, so they've been able to avoid it. If I had to have an IUI on a Saturday, my rabbi would tell me I could do so, with some restrictions (as noted above), but I'm not sure that I would do it. Given my particular issues, IUI itself doesn't really increase my odds of achieving a pregnancy in a given cycle. What increases my odds significantly is the ovarian stimulation and triggered ovulation (since my problem is primarily anovulation and there's no male factor involved, and so on). However, if I had an IVF procedure fall on a Saturday, which is far less avoidable, I would find a way to make it work. There's an awful lot more at stake with a given IVF cycle than with an IUI cycle, so I feel much more strongly about it in that case. I'm not saying I definitely would not do an IUI on a Saturday, but I think it's unlikely... besides, like I said, I've never really had to consider it.

That was probably far more information than any of you wanted to know.

2. re: my right ovary always being the producer, someone asked if I was cycling every month or every other month (I think this was Kris)

This is a good question. My first IUI was in February, the second was in March. Then I took some time off and the third IUI was in June, fourth in July. Then I was pregnant until October 10th and wasn't able to start a new cycle until the end of December. IUI #5 was in January, and IUI #6 (this current cycle) will be in February. So while I've skipped months, I've generally had 2 back to back cycles. IUI doesn't require rest cycles in the same way IVF does. So I think that it really is true that my left ovary is a complete and total slacker. I wish it would get the memo that it's time to shape up and earn its keep!

3. re: my wonky estradiol levels... someone (Kris, again, I think) asked if I was on estrogen support/supplements

I am not, and I get the impression that this is far more common with IVF cycles than with IUI cycles. I have had notoriously low E2 levels for all of my cycles, but the levels at least have still increased appropriately, even if they are always a bit on the low side. Last cycle and this cycle seem to be the exceptions. This is my last IUI cycle. My next cycle will be an IVF cycle, and will likely include estrogen as part of the protocol. If I were planning another IUI cycle, I'd probably ask if there would be any advantage to me taking estrace or something similar to improve response. I'm theoretically a good responder in general, it's just that my estrogen levels these last two cycles have been puzzling, at best.

4. Finally, Thalia asked (re: my wonky estradiol levels) if I'd considered taking a month or two off in case my body just needs a break.

I might believe that my body just needs a break, except it was forced a break just recently. I had to take several months off after my miscarriage for my hCG levels to go back down and then I had to have a rest cycle before I could go back to an IUI cycle. It was an extremely miserable time, because nothing puts me on edge about this whole infertility thing than not doing anything. Either way, this is my last IUI cycle, and I'll be on birth control pills from the time this IUI fails (anticipating around Feb 20th) until mid-April. I would only take them for three weeks, but that would put retrieval or transfer dangerously close to the first days of Passover, which I absolutely will not allow to happen, so I'll be waiting to start an IVF cycle until right after Passover. So whether my body needs it or not, I'll be taking a bit of a break. I'm not loving staying on birth control pills for that long, because as most of you know I've already got crazy ridiculous migraines and BCPs will only make them worse. I'm not entirely certain how I will function, but I'm sure I'll find a way.

Those are all the questions I can think of, but if you have any others, let me know and I'll post again.

Craptastic!

Let's Review!

Me: 31 years old.
Diagnosis & History: Anovulation due to PCOS; Four (+) year history of infertility. 5 IUIs. 1 pregancy, resulting in 1 miscarriage at 12 weeks. No male factor.
Usual response to Gonadotropins: Super-responder. No problems whatsoever. Go me.
This cycle and last? SERIOUSLY MESSED UP.

Okay, so here's the deal. If you don't remember, last cycle, I had a little plateau problem... my E2 level went up, went back down, went up a little bit, and hung out for a couple days without doing anything interesting prior to IUI. Follicles were all wonky (splitting, disappearing, whatever). It kind of freaked me out a little bit, but it had to be a fluke, right? Yeah...No.

And now we find ourselves caught up to date for everything prior to this cycle. Now just to refresh your memory....

CD8 (Wednesday)
Right Ovary: 9.6 & 10.2. Another 10 follicles smaller than that
Left Ovary (hereafter referred to as the useless ovary: a bunch of small, meaningless, boring, uninteresting ones.
Lining: 9.2
E2: 71.5
LH: Unknown (they didn't tell me)

CD 10 (Today)
Right Ovary: 8.5, 8.9, 9.2, 10.3, 11.9 (and about 7 smaller ones)
Useless Ovary: 7.0, 7.1, 9.0 and 6 smaller ones
Lining: 9.6
E2: 71.5
LH: 1.85

Follicles are expected to grow at a rate of about 1-2 mm per day (I'm nearly always on the low end of the growth chart... averaging a little over 1mm per day... most normal humans are closer to 2mm per day). My biggest follicle on Wednesday was 10.2, so they would have hoped for it to be 12-14 (preferably closer to 14) today. Instead, it was 11.9. Not quite 1mm per day. And did you notice that lovely E2 level? I didn't either. I only see the craptastic one. That is, the craptastic 71.5 that has not changed at all in the two days since the last level was checked. So again, I'm facing a plateau which might possibly mean this is all useless.

Now, the truth is, I never ever put much faith in any individual cycle. I have complete faith that eventually something will work, but I never believe any individual cycle will work. However, I'm not normally so ridiculously negative as to believe any given cycle is a waste of time. I'm beginning to feel that way now.

And by the way, should I be worried that my right ovary (hereafter lovingly referred to as the "Not-As-Bad-As-The-Left Ovary", or NABATLO for short) is always the producer? Is my Useless Ovary really and truly useless? Is it just there for looks? Did God just want me to have a matched set, even if they don't work? Or is it purely coincidental? I get that none of you actually know the real answer to that question, but I'm asking anyway, even if I'm not sure what kind of answers I'm hoping for.

BLEH.

Ruh-Ro!

This morning's monitoring appointment was a little less happy than it could have been. I've got too many follicles trying to peak out all at once. Not so fabulous. I owned up to the fact that I'd accidentally (again) increased my dosage by 8 IUs, but also noted that I'd accidentally done the same thing last month. The doctor didn't think that the 8 IUs were really signficant, particularly in light of the fact that I didn't have the same response last month to the same dosage. I think my second cycle (could have been the third, I can't remember) I had a similar response (super-perky ovaries, that is) with only 33 IUs but I still only ended up with 1 mature follicle at trigger time, so I'm not too worried. But look take a look for yourself:

Right Ovary: 8.5, 8.9, 9.2, 10.3, 11.9 (and about 7 smaller ones)
Left Ovary: 7.0, 7.1, 9.0
Lining: 9.6

Maybe I'll have quintuplets! JUST KIDDING! Seriously!

Even my beloved Margaret (sonographer extraordinaire) asked if I could please tell my ovaries to tone it down. I told her it was all her fault since she's the one who dubbed my ovaries "perky" oh so long ago. She has promised never to refer to my ovaries as perky again. Until, you know, the next time she does. At any rate, I'll be going back on Sunday. No dosage change unless my bloodwork comes back all wonky. It's all good. I mean, after all, why would I want to be anywhere but the clinic at 7am on a Sunday morning?

While I'm disappointed at my ovaries' blatant disregard for my wishes, my biggest disappointment wasn't seeing them rebel most annoyingly... Rather, it was that I was put into Room 1 for my ultrasound (I'm not actually serious). The problem with Room 1 is that it doesn't have a mobile hanging from the ceiling. All the other rooms do. Dr. S. (hereafter known as Dr. Can't-Follow-Through-With-Mobile-Hanging) once told me that he personally hung the mobiles in the exam rooms and I was quite impressed. I mean, really, what else is a girl supposed to look at during an ultrasound? But Room 1 has no mobile, so every time I'm there I harass the staff about the fact that I'm stuck in the boring room. Margaret offered up a Garfield poster, but refused to accept my suggestion of putting comics on the ceiling above the table. "In a fertility clinic? Nah!" Why not? There are bound to be some funny infertility comics, right? Now I must scour the internet for funny infertility comics and I'm asking you, my faithful readers, to help me. I have made it my mission to bring a collection of infertility comics to Margaret before this cycle is done for. So give it your best shot!

Edited to Add: Okay, sure, I COULD be looking at my ovaries during the ultrasound, but really, they're kinda boring after a while. Plus, what about the 2 IUIs I've had in that room? Laying there bored for five minutes afterward with nothing to do but count the ceiling tiles isn't so fun. Fortunately, the other 3 IUIs I've had were in rooms with mobiles! End of Edit

Anywhozit, Dr. Can't-Follow-Through-With-Mobile-Hanging (Dr. CFTWMH) wasn't the doctor covering monitoring today, so I didn't get to harass him directly. Instead, Dr. C. was covering monitoring. He's an extremely good doctor and very well-respected in the Washington Area (named one of Washington's Top Doctors), but he makes me edgy. He's very nice and personable, so that isn't it. It's that I tend to see him when things aren't going QUITE as expected in my cycle and he gets this worried look on his face every time. I mean, he didn't freak out or anything, but he sort of gave this worried sigh-like sound and that worried look flashed across his face briefly. Maybe I'm reading too much into it.

In other news, the Follistim is really getting to me this cycle. I'm moodier than I've ever been on Follistim (though maybe it's just me and I can't blame the drug) and I'm having a tremendous amount of nausea. If I didn't know better, I'd be wondering if I was pregnant. But I do know better, and I'm definitely not pregnant. Last cycle I didn't have nearly as much moodiness, nor nearly as much nausea. But last cycle the Follistim REALLY STUNG every time I used it, and this time I've barely felt the injections, so I guess I should count my blessings.

That's all for now. I'll keep you posted if anything changes (since I know you're all just on the edge of your seats waiting to hear my E2 and LH levels!).

Welcome to Cycle Day 1

It's like deja vu all over again. Goodbye, IUI #5; Hello, IUI #6. Originally, my beta was scheduled for Friday. Now that appointment has been changed to a Day 3 Monitoring (BW/US) appointment.

Shocking, I tell you, simply shocking. Do you think it was my husband's high fever on IUI day? Or my high fever for 7 days after IUI day? Or the terrible fall I took in my laundry room? Yeah, I don't think it was any of those things either. I think it was the fact that IUIs have abysmally low per cycle success rates, which is why I'm ready to be off this IUI train. One more and then I move to IVF.

I can't say I'm particularly thrilled about moving to IVF, except that the per cycle odds are somewhat higher than with IUI and at least it will feel like I'm doing something instead of marking time in my calendar until the next cycle.

Still, I'm quite tired of this whole game.

It's Official

I woke up in the middle of the night throwing up. Hey, maybe this is a pregnancy symptom.... ??

JUST KIDDING!