IUIs 6, 7, and… 8?

Super-Secret Post
Concerning cycles 51, 52, and 53 (November and December 2015 and January 2016)

Faced with trying IVF again after only producing a single transferable embryo over two rounds — costing immense amounts of money, time, and pain — I wanted to make sure we had exhausted less-invasive and less-expensive treatment first. After all, we had been pregnant twice on IUIs and zero times on IVF so it seemed to make sense to focus there. We purchased a three-pack (buy 2 get 1 free).

The thing we hadn’t tried yet with IUI was medication to stimulate my ovaries at the beginning of a cycle while they were producing an egg. We’d skipped this medication since I was ovulating already and since this is the kind of treatment most likely to result in a multiples pregnancy (if you ovulate more than one egg, then all are in play for that cycle, unlike IVF where there’s control over how many embryos are placed back even when you make a lot).

But even though eggs are too small to see on ultrasound, the follicles that grow and release them are easily visualized and so with monitoring, couples can mitigate their risk of multiples by deciding if they want to proceed with however many eggs may be in play.

At the same time, we wanted to cross off any genetic reasons for our terrible IVF performance and had our karyotyping done. There are two seats in the blooddraw room, across from each other, and Mr. EAP and I got our draws done at the same time. I said “Wow — for once we are having the exact same thing done at the same time.” He tried to say that him giving me shots was also that but I still disagree. *Exactly* the same thing at *exactly* the same time!

One scary thing happened here around informed consent. The doctor offered us “genetic screening” and talked about the price and that was it. Then we went to sign the consent and there was no information about the test on this page we were signing to accept that we understood all the information about the test. Um, huh? But only the admin assistant was present so our choices were a) blindly sign the consents, or b) turn down the testing until we saw the doctor again in several months. Well fine then, we’ll just sign… until later that day when I wondered if I was going to receive a report with all my DNA laid bare with, say, a risk factor for breast cancer, Alzheimer’s, Parkinson’s, or something else, because I would really rather NOT KNOW stuff like that.

The same day, I started the injections for the first IUI cycle. Since the doctor already knew my reaction to the injectable Follicle Stimulating Hormone we skipped over the usual beginner oral medications Clomid and Femara and I took a small dose of FSH instead. It was also the first time being monitored for an IUI cycle so I had my usual disorientation as I tried to learn a new protocol for the first time, getting into the rhythm of medication timing and making it to appointments every second day. At least I had done monitoring before for IVF so I was used to the appointment routine.

The first monitoring revealed only one follicle growing! Yay! It also set me on a probable timeline for when the IUI would fall, and I got instructions to test at home to make sure I wasn’t going to ovulate earlier than expected.

Injections continued nightly including needing to do one while out and about for dinner-and-a-concert. I didn’t want to use a bathroom so I used my parents’ car’s backseat on a cold November night (luckily parked in an underground lot). Achievement unlocked for weird injection site.

At the next monitoring, the dominant follicle from the time before looked like it would be ready in a day or so, as did my lining. But a follicle on the other ovary (or trollvary amirite?) had started sneaking up. With these scan results usually the doctor would give me one more day before triggering ovulation and scheduling the IUI but that would have given the second follicle time to possibly catch up. Instead, we opted to rush the dominant one in order to leave the second behind. It meant a less than perfect follicle and lining but took out the multiple egg risk, so we ran with that.

It was perfectly possible that this was wasting the IUI (which I could have carried over to the next cycle as a credit) but they are SO much cheaper than IVF that is skews my idea of “affordable”, and because of the Christmas office closure, it was my last chance before January.

It was coming up on American Thanksgiving and one of my online buddies cycling with me called her IUI her “basting” appointment to great amusement. With this rush to trigger ovulation and the IUI it meant my basting fell right on Thanksgiving Day.

I got Dr. Optimism again for my immediate follow up after the nurse finished the IUI. “10 minutes of waiting and then you can go shoe shopping. Or work. Or whatever.” -.- actually my plan today was to continue building a website for my neighbourhood association as a volunteer, but thanks for making me feel simultaneously bad for not being girly and bad for not having a job to go to and filling the rest of the day after the website building with homemaking. That’s talent.

He also tried to second-guess why we were doing such a low dose of FSH while he had one foot out the door, so I’m trying to rushedly explain my aversion to multiples while asking if it’s likely every cycle is going to be such a close call with the second follicle. Bah.

What’s usually termed the “two week wait” between ovulation and time to test is actually 17 days at my clinic. Maybe they do that on purpose to be less likely to catch early miscarriages? It drives me crazy having to wait so long, and there’s a huge amount of emotional baggage around whether or not I should use home tests while waiting (and how sensitive a test it makes sense to use). I formalized with the clinic this cycle that I can’t get in early for those blood tests on weekends which this cycle meant just waiting in out, even though my period arrived on time (although it was not early, a good sign that this protocol had gone better). I felt like an idiot continuing to take medication when it seemed clear I was “out” for the cycle, but that’s how these things go; at least once every couple of months someone online declares themselves out and then it turns out they are pregnant.

The test came back negative and we had to take a cycle off for Christmas. At least my timing was good so that I wouldn’t manage to let the office closure span two cycles.

In the mean time, our karyotyping came back. The only report we got was a phone call from the admin assistant that there was nothing to indicate any problems – yay, no complete genetic workup for me to obsess over.

I saw my family doctor and got a request for bloodwork to check everything to look for any hints on what might be causing issues… maybe my blood sugar would be off enough that I could go on metformin*, or maybe I was severely deficient in something. One can hope.

* metformin is growing a reputation as a bit of a miracle drug for certain causes of subfertility. Women with PCOS sometimes become pregnant on their own after starting metformin, and at too-quick a glance I have some signs which seem like PCOS (until closer examination). If blood sugar levels are related to fertility it would also partially explain why a lower carb, higher protein diet can result in better IVF results.

We started up again in January. Things started feeling really routine, but in the way where I started messing them up because I wasn’t so worried about them anymore. One day I forgot to bring an ice pack to bring my meds home on the bus. Not strictly necessary, but it can get pretty warm if I put my bag down next to a heater. I stopped remembering on my own to take the meds and relied heavily on my app to remind me.

By now I was doing my own shots. I even graduated from needing to freeze my thigh and started giving myself belly injections no problem, no freezing.

Well mostly no problem. I title this photo “No really hon, I’m fine to do the injections myself.”

I must have nicked something. I started with a huge lump and then it faded to this bruise which lasted almost a month. Note to self – pinch more skin to keep subcutaneous shots subcutaneous.

So things were chugging along when I went to the first monitoring appointment in January expecting it to be the first of probably three. But there they were, one follicle juuuust big enough to count as ready and another one sneaking up behind it. I had to decide between triggering ovulation today or risking a second egg again, but so much earlier than last time!

It was a bit of a scramble to have everything ready but we triggered ovulation in time for a regular timeline of trigger, a 36 hour wait, then IUI. Phew.

By this, the seventh IUI, I had forgotten completely to do something cute with my feet to decorate the stirrups. Things were definitely routine by now, down to making sure my phone was handy to snap a picture of that morning’s lab report for reference and give myself something to do while waiting for 10 minutes afterward. The best part of having an online support group is getting digital high fives at 10am on a Sunday while lying pantsless on a gurney.

Partway into the Two Week Wait, I wrote an entire post about how the hormones I was bathing myself in really made it feel possible. I had taken extra of the hormone that makes eggs, taken a shot of “the” pregnancy hormone to make myself ovulate on a schedule, and was taking supplemental amounts of the hormone which supports early pregnancy. It all added up to my body feeling really, really pregnant and me feeling glowing and hopeful all over again.

The long list of pros and cons around home testing might warrant its own entire post, but after talking it out with my therapist, I had allowed myself to test at home again this cycle. I had a whole system: buy the four pack of good quality tests from Costco; test 10 days post-IUI, expecting a negative, to confirm that the hCG trigger had left my body; test again 12, 14, and 16 days post-IUI; and then have the blood test 17DPIUI.

10 days post-IUI I was staring in shock at a +.

If you’ve ever read the instructions for a home pregnancy test you may have noticed they mention that the birth control pill won’t affect results, and neither will the most common kinds of fertility medications, but that some other fertility medications may give you a false positive (namely, you took the hormone that the test is looking for). The brand of tests I was working with also compassionately referred to ectopic pregnancies as giving “misleading results”. Really, aside from the *extremely* rare problem with the test, if you read the test within the time window there’re only two things that show a positive: something that started as a combination of sperm and egg implanted in you long enough to release hCG, or you took a dose of hCG. You know that “trigger” I keep referring to? It’s an injection of the same hormone these tests are looking for.

I had actually been hoping that this test at 10DPIUI would be negative. That would tell me for sure the trigger had been processed and therefore any future positive tests would be real positives, not false positives.

But here was a +. “Fucking trigger!” I posted that day. I had a week until my blood test and I was in the weeds with home tests again.