Barren Mare

Baker's dozen

Day Ten of Stims

You'll notice I am posting, which means I am home. Turns out I may have jumped the gun a little in terms of when to expect the trigger shot. Oh, how I love these little Human Chorionic Gonadotropin puns, ha ha ha.

I'll get on to all that in a minute, but first! At the risk of attracting all the internet weirdos, I must mention what I can only assume is a somewhat unexpected side effects of all the drugs- my incredible shrinking bosoms. Even E. noticed, even though he is generally more of an ass man, and does not tend to concern himself overly with the state of my rack. He tactfully waited until I brought it up at dinner the other night, but then immediately agreed there was something of a decrease. Actually, the way he put it was more like, "Yes, sweetie, I was wondering where have your tits have gone," before adding an extra helping of potatoes to my plate- as if that might help restore them to their former glory.

Anyway, deflated breasts aside- I toodled in for my next meeting with the πίθηκος ράβδων*. I had a few spare minutes alone in the wanding chamber, and made sure to wheak the stirrups inward ever so slightly to prevent a repeat of the Svetlana incident. There were more nurses around, which meant I was spared having to endure clipboard duty again. Also Nurse Fraulein was also absent. So all in all, the wanding was a considerably happier experience this time, in those respects.

The good news is that my lining is now a much plushier 8.4. However, there were only thirteen follicles, only one more than last time. A baker's dozen. I confess I found this disappointing, as I was sort of hoping for more at this point. Measurement wise, there was:

Right side: 18, 12, 12, 11, 10, 10, 8
Left: 17, 15, 14, 13, 12, 12.

Musn't grumble, I suppose, as the ones that are there seem to be coming along decently enough. But I worry they might suddenly change their minds, and stop growing- or worse, fuck off altogether to a more exotic locale, perhaps meeting up with my missing boobs on the way. Oh well. At the risk of sounding all negative, I'm not exactly expecting a particularly dazzling yield at this rate. Which leaves me feeling sort of mediocre and, well...bleh. Just all over bleh.

I find out the E2 number later as usual, but we're looking at trigger shot Wednesday night, with retrieval on Friday. I really do expect to be pretty much disappearing as of tomorrow night for the OC, since the back and forthing is now becoming decidely tiresome, but you know the drill- I will update you when I can, I promise.

*Greek for "wand monkey"

Update: E2 is at about 9,000 UK (translation= approx 2,450 American. I think.). The nurse said I was "doing well", and seemed surprised when I asked for confirmation as to the dosage.

"Did someone say to change it?" she asked

What I wanted to say was that NO, no one has said fuck all about the dosage, one way or another, ever. Not to mention I have not even had a whiff of Dr Billy Flynn, he of the Jazz Hands, since this all began. I can only assume (!) he has some idea what is going on, but I mean- who knows? All I ask is that they throw me a frickin' bone here! Answer: yes, stay on 225 ius of the delicious, delectable Gonal-F. OK then.

I love the smell of follitropin alfa in the morning

Day Nine of Stims

OK! Let's get down to the nitty gritty. I got the numbers from the nurse the other night when I finally got through (again with the phone line seemingly permanently engaged). Definitely 12 follicles- a twelve, two nines, and two eights on the right, and an eleven, a ten, two nine, two eights and a seven on the left. That may be more excruciatingly detailed information than you really wanted, but I am multi-tasking in using this blog as my clinic notes. She said the E2 number was "fine" at "around 2,500" which converts to something like 681 American (divide UK number by 3.67. Or so I gather.) At least I am assuming I should convert it, since otherwise I get the impression from Messrs Google that I am in deep shit. So my orders were to continue on for the time being at the same dose of Gonal-F, that being 225 iu.

What fun. And, after an afternoon of Google-gorging, I've decided to now relax for the moment. When I started this cycle, one of my worries was that I would over-respond to the drugs. I should stress that this fear was not based on arrogant assumptions about my ovarian excellence, but more to do with the fact that my clinic operate on what seems to be a relatively conservative approach in terms of hyperstimulation. An approach which could result in cancellation of fresh embryo transfer and conversion to FET. I'm less concerned about that now. But I hadn't really appreciated before what a mind-fuck the numbers game can be, and all the more so because everyone else's cycle will be different. So whilst reading message boards and other blogs has been useful to get some sense of how I might be doing in the big scheme, I also realise that comparing myself to the anecedotal evidence of others is not necessarily an altogether healthy exercise. So I am trying to take it all with a pinch of...Gonal-F. But thank you muchly for all your encouraging comments and soothing words.

The shots also continue to be absolutely fine, although I gave myself a bruise the other day. This annoyed me, not because it was sore, but because I now take considerable pride in my needle work and it messed up the clean lines of tiny pinprick holes in my tummy. Like doing a cross stitch sampler. I think the problem was that on that occasion, I forgot to pinch, and also I may have gone in a little too fast. A dart-like motion, yes- a headlong stabbing rush, no. It's a fine balance.

Also, drinking all this water (at present I am guzzling at least 2.5 litres a day) may be good for the follicles and prevention of OHSS, but I am getting a little bored of constantly having to pee like a racehorse. Still, I am reminded of a former lacrosse coach who used to yell at us to drink more after games during the hot weather. "Copious and Clear, laydeeze! We want pee that is Copious and Clear!" I keep waiting for my skin to transform into glowing radiance, like all those supermodels who swear their flawless complexions are simply due to drinking lots of water. So far, not so much.

I'm off to the OC tonight for a Monday morning appointment, and will update when I can. I should point out, if I haven't already, that there is no internet access at the OC flat (I know! the horror!), so for the immediate future, I am making the trudge back and forth as best I can. I'm just saying in case there comes a point where I have to stay there for some reason, and it goes correspondingly quiet here.

It's 3am- do you know where your ovaries are?

Day Seven of Stims

Is it written somewhere in the IVF manual that at some point during the process, one must have at least one "wide awake at 3 am" moment? Actually, wide awake would be stretching things- a fretful, bleary-eyed awake is more like it. Last night was extremely unsettled- in the wee small hours, not long before I had to be up to make the drive with E. to the OC for my appointment, I found myself sitting at the computer, staring into cyberspace.

I suppose it would be fair to say that I have a lot on my mind. And it would also be accurate to say that not all of it concerns the pursuit of delicious embryos. Because, you see, in this house, one major life stressor isn't enough to keep us occupied, oh no. Now, in addition to the upheaval of E. selling his flat in the OC (a story which I haven't quite gotten around to telling you about, because in the larger scheme of things, it has thus far been relatively uneventful), we are also thrashing out certain major career decisions. Or rather, I should say he is thrashing them out. My involvement is more akin to a theater-goer, sitting in the darkened audience, witness to a series of interminably strung out encores, wondering when it's finally time to applaud or at least nip to the loo. I can't really say any more about it, and I am sure it will all work out just dandy. But honestly, I could do without the additional stress right at this particular moment in time!

Anyway. This morning, I went for my first ultrasound and bloodwork since starting stims. My usual nurse was off, and so I got stuck with a surly ist Affe schwächer geworden*. Och. You know, I don't expect the clinic staff to be my best friends, but neither do I wish to be treated with barely concealed ill humour. Then, for some reason, the stirrups in the wanding chair were set at a peculiar angle- that is, extra wide- and she made no move to readjust them. Plus, the chair itself was tilted really far back. Accordingly, upon assuming the position, I found myself slightly more flang-dang than was strictly comfortable, or indeed dignified. I mean, good grief, there's spreading your legs in the name of your ART, and then there's emulating Svetlana Khorkina.

To make matters worse, she then handed me a clipboard on which to record the follicular findings. I grasped the pen, sending up a silent thanks to the Land of the Hippogriff for warning me that such absurdities were possible. Nurse Fraulein commenced with the scan, barking out instructions to make a check in the appropriate column (i.e. left or right ovary) next to the number on the grid corresponding with the follicular measurement. Well, oooookay. Besides the fact my heart was beating like a frightened rabbit with anticipation, I confess I found it rather a lot to take in, what with my odd angle of repose, the dim lighting and the hunting of ovarian shadows on the screen.

The upshot: lining 5.4 (she said this was "OK", and while I probably should fret, I can't be bothered right now). Follicles: some. I actually lost track of how many checks I had made in the columns and she rudely wheaked the clipboard away before I had a chance to do a final recount. I think it was about 12 or 13, roughly even on each side. I'll confirm later when I call for my E2 number. I do recall that sizewise, on average, they were mostly 8mm, with one at 10 and one at 12mm. I had absolutely zero feedback or information whatsoever from the pissy clinic staff to indicate how they think I am doing. After a quick but ouchy bloodletting, I was dispatched with a perfunctory grunt of farewell, and the next appoinment set for Monday. Huh.

For now- Google, come here, I need you!

*German for "wand monkey".

The sound of follicles growing

Day Five of stims.

Life, it would seem, has been reduced to a simple equation. Wake up, snort Synarel, go to work, come home, inject self with genetically modified Chinese Hamster ovary cells, eat dinner, snort more Synarel, go to bed. Occasionally, for a change of pace I wander out to the terrace to give the dying bay tree another pep talk, but the response is always the same- wilting silence. The new rose bush, on the other hand, is overcompensating for her withered neighbour, thrusting her saucy blooms eveywhere. The other wallflowers are sulking.

I don't go back to the OC for a scan and bloodwork until Friday morning, and the week is dragging. I'm a little nervous about what we'll find. Sometimes, I lie in bed and listen out for the sound of follicles growing quietly, as if my ovaries were a cornfield in Iowa. Other times I find myself tapping my fingers gently across my lower abdomen, calling, "Hellloooo? What's going on in there? Anybody awake?"

But really, I don't feel much of anything except a vague rustling in the tall grass and a slight pooch around the lower belly region. It's hard to tell, since- grasping at any straw to justify my wearing my fat pants to work- I'm already in low slung slouchy trouser mode. I remembered reading in Vogue that slouchy tailored trousers are/were/will be all the rage, er, sometime during the whirligig of the fashion seasons. And I was consoling myself with how well I was carrying off that particular look with a rather insouciant air ala Katherine Hepburn, slouchy trousers offset by crisp white shirt and bright red lipstick.

Then someone commented upon my "very casual attire". To which I was sorely tempted to reply by way of a swift kick to the shin with one of my high heeled Prada sandals. Comments like that are right up there with saying, "Oh, you look tired today." I mean, why not just come out with it- what they really mean is, "You look like shit. You look like nine miles of bad old road. You look like something the Chinese Hamster dragged in."

And here I am, too addled with gonodotrophins to think of a suitably witty riposte, damnit.

The Wizard Revealed

"Pay no attention to that man behind the curtain"

-The Wizard of Oz

Antral follicles! Aha! Thank you, Amanda for that tip. I believe now that the little follicles seen on the last ultrasound were indeed antral follicles. Though now I know what they are, I am worried that we didn't see more. I am comforting myself with the thought that La Nurse didn't really spend a lot of time focusing on what was there. Perhaps she is not too up on all things antral, and may not have counted properly.

Meanwhile, it's Day 3 of stims! Stimmity stims with the jaunty pen!

Perhaps the best way I can describe my current feelings on the whole injection thing is to say that Oz the Great and Terrible has proved less than great and less than terrible after all. After two years of tripping down the Yellow Brick road, fearing and dreading my arrival in the ART City, knowing that the day would come when I would have to give myself a shot, it's something of a revelation to pull the curtain aside to discover that what scared me the most was the idea of Oz.

OK, I do confess the first one was a wee bit fraught. But in part that may have been due to the fact that E. took it upon himself right at that particular juncture to form a keen interest in all things IVF. I was cleaning the bathroom and unpacking the pen kit in preparation when he wandered in.

"Want help?" he chirped.

"No, not right now, thanks," I said, washing my hands.

He leaned against the bathroom door, arms crossed

"But I want to participate! I want to know what is going on. I want to be part of the proooooocesss!" he said.

Huh. This was all news to me, considering he has thus far attended almost none of the appointments, has no idea of what drugs I am taking, and wouldn't know his ass from an antral. But I decided to humor him. Because I am nice that way.

"Let's read the instructions to-gether!" he said gaily.

Oh, you mean the instructions that I have already read about eight thousand times, to the point where the words are practically tattooed on my retinas? Sure thing, chicken wing.

"Photo A," he recited, "Remove. The. Pen. Cap."

"Yup, done, moving right along."

"Photo B, take the needle and remove the peel tab from the outer needle cap," he intoned.

"Yes, already done. Let's move it along."

And so it went. By the time he had reached Photo D, I had already primed the pen, dialed the dose and iced my stomach. All I wanted to do was get on with the injecting before I completely lost my nerve.

"Photo E," he droned.

"Sweetie," I interrupted. "I need to do this RIGHT NOW before I freak out completely. Go away. I will call you when it is done."

So he went and waited outside. I looked at the needle, whimpered, and paused.

"Do you want me to do it?" he shouted through the door.

"No," I called, "I have to do this now or I will never be able to do it."

And with that, I stuck the needle in. Hey presto. Like a knife into blubber. No pain, no bruising, no problemo! I only have to do it once a day, which relatively speaking is a plus, but even so- what a revelation!

I am sure the Wanded- er, I mean Winged- Monkeys would be very proud.

Assisted Conception and Deli Counter

The Day 3 appointment went just dandy, though not without the obligatory moment of minor suspense.

First things first- off with the knickers and into the stirrups. During the rummaging around my innards, the обезьяна палочки* pointed out that I had what looked like two smallish follicles in the right ovary and four little ones in the left.

"Mmmm," she said, "Interesting."

"What are they doing there?" I asked. "I haven't even sent out the invitations yet!"

"Well," she mused, executing a sharp right jab with the wand, "it might be that they are always there, just sort of hanging out...but not doing anything. We'll be taking some blood to check your estrogen levels to make sure you are properly suppressed before you start the stimming injections. But it might mean that you'll be a good responder."

"Um, what happens if the estrogen levels aren't down?" I asked.

"Oh, you'll have to wait to start stims, carry on snorting the Synarel for another five days, dangling perilously over the abyss of insanity and then come back in for another baseline scan and repeat blood test."

Ah, super.

By the time we finished with the wanding action, we had lost our space in the consultation room and I was sent back out to the waiting area. It was so busy there were no seats left, so I stood leaning against the wall avoiding eye contact with the other patients. Two minutes later I was summoned back in, and sent back down to the scan room for the blood draw.

"It seems quite busy," I commented, as I plunked myself down in the seat and stuck out my arm.

"Here, hold this," the nurse said, wrapping the tourniquet around my limb and giving me an end to hold while she readied the needle. "Yes, it's very busy," she went on to say, "Sometimes I think we should have one of those ticket machines, where you take a little number. You know, like at the deli counter."

Now, there's an image for you. Yes, I'd like a quarter pound of smoked gouda, three packs of Gonal-f pens, a half pound of embryos, and oh what the heck, throw in some of those spare ribs while you are it.

The bloodletting concluded, we had a brief tutorial in how best to ram the Gonal-f needle into my flesh, before I was dispatched home with an extremely expensive bag of drugs.

"You didn't by chance bring a cool bag with you?" the nurse asked as she loaded the goods into a plastic carrier bag. "Because the pens should stay refrigerated until you start using them."

No. No, I did not bring the fucking cool bag (even though I have one, as you know) because nobody told me to and I forgot. No matter, nothing like a frantic sprint back to the flat in the ongoing heat to get the blood moving.

"Call in about five hours and we'll tell you the results of the E2 test and whether you can start the injections," the nurse said on my way out.

So I spent a very uneasy afternoon worrying that somehow the suppression via the nasal spray simply was not working- to the point where my ovaries were staging an impromptu uprising, creating armies of small follicles in protest, shouting "Viva la Revolution! Up with Estrogen!"

But no. Everything was "fine", or so they said. Like a dumbass, I forgot to ask the E2 number, which no doubt is going to put a crimp in this afternoon's Googling. Oh well, roll on stims. Yay. I'm doing the first shot in a couple of hours, a thought filling me with sweaty palmed anticipation.

*Russian for "wand monkey"

File trials

My period having arrived, right on time like a punctual relative, I phoned the clinic to make an appointment for my Day 3 scan and bloodwork. This is all that stands between me and my jaunty Gonal F pen.

When I finally got through after about twenty tries (do they only have ONE line? why is it always engaged?), there was a long pause after my request.

"Hold on," the nurse said, "We'll just need to get your file."

And then she put me on hold for a seeming eternity. I waited, and waited, observing the polar caps and glaciers melting and freezing over the passage of several ice ages.

The nurse finally came back.

"Mare," she said. "We can't seem to find your file."

I took a deep breath.

We managed to quickly establish that the file had reappeared after its last trip into the void. But then they immediately managed to lose it again.

"Nurse," I said, chuckling mildly but with a dangerous edge, "You are not exactly filling me with confidence here."

Point taken. She promised to search to the ends of the earth for my file, and meanwhile she would fax through my order to the drug company, who were to phone for me directly for payment. And lo, ten minutes later she called back to say the file had MIRACULOUSLY reappeared from the car wash where they had sent it for a wax & polish. Hurrah. And lo, indeed the drug company did phone me straight afterwards with kind but ruthless efficiency, extracting my credit card number, a large sum of money, and a small slice of my soul. They did, however, promise to deliver the drugs direct to the clinic so I can just collect them when I go in.

So, I have another dalliance with the scimmia di bacchetta* to look forward to tomorrow afternoon, not to mention the arrival of my jaunty stim pen. I am pleased. Because really, aren't these small treats what makes life worth living?

*Italian for wand monkey

Here the whole time

I have several fond memories of my grandfather (apart from, you know, the $100 bill thing). One such memory is how, in his latter years, he used to wander around the grandparently house, picking up little knicknacks and other objet. He would stand there, a puzzled look on his face, squinting at the thing in his gnarled old hand. Then he would demand, loudly, of whoever who happened to be standing by, "Where the hell did this china shepherdess/wooden elephant/tiny vase come from?"

He would repeat the question- until my long suffering grandmother heard him, and until she replied,

"Dear, we've had that crystal rose/jade box/lamp shaped like a baboon for the last twenty years! It's been here the whole time".

And my grandfather would put it down, looking befuddled and slightly disgruntled, until he found the next thing an hour later and started the process again.

Worryingly, my father seemed for a time to be developing the same habit, but my mother kept clouting him over the head with the whatever- it- was, which happily seemed to knock the impulse out of him.

This Synarel sniffing business, my accompanying moods and my response remind a little bit of my grandfather's habit. You see, today I was sure that I was really quite down, quite fragile- dare I say, a bit vulnerable. I nearly burst into tears for no apparent reason on the way to a meeting. Later, I shot dark and violent mental arrows at the person talking too loudly on the phone across the room. And later, I had a pensive moment contemplating my dying bay tree (nothing I do for it seems to make it revive), thinking melancholy yet rather beautiful thoughts of the cycle of life, how all things fade in time.

Good God, I told myself at each point during these moments, pull yourself together! It's the drugs talking! The drugs! It's Day 7 of Synarel sniffing- by now it must be working its slow and pernicious effect.

But you know, I'm not so sure. If I am honest, I think I am usually a moody little thing, prone to odd flights of fancy and the occasional trembling of the spirit, even when not inhaling hormone altering medication twice a day. So I find myself picking these emotional moments, these cluttered mental knicknacks- holding them up to the light, and nodding in recognition.

Saying to myself, "Dear, it's been here the whole time."

Prix Fixe

Holding steady at Day 5 of the sniffing. Nary a storm cloud on the horizon- there was one small squall last night with a mild headache, but I get headaches all the time, and so cannot necessarily put it down to the Synarel.

It occured to me that perhaps you are all wondering about my pick from the delicious Stim Menu (and thank you for all your helpful comments- much appreciated). Well, the short answer is that when I sat down at the table, the waitress announced that most of the daily specials were, in fact not, available- and I could choose between pickled herring or beef. Basically, Menogen (old lady wee, IM injections) or Gonal F in the jaunty pen.

I think La Nurse was probably talking out of her ass, since when she opened the drug cabinet, I could see a big box labeled MENOPUR and a pack of auto-injectors. But luckily, I had basically decided on the pen beforehand anyway, and decided not to worry about it.

"So, I'll go ahead and get the form ready for you, and we'll order that up for you later," she said.

Now, the thing is, the Stim Menu makes clear that ordering direct from the drug company is an option, but gives absolutely no information as to how to go about this. However, I had heard via other message boards that the savings from ordering from the drug manufacturer could be substanital. So like any good little frugal Googler, I had already ferreted out the number to call for a quote, but hadn't gotten round to doing it. My question for La Nurse was whether it was cheaper to order direct.

"Oh no," she assured me, "the prices are the same from us as you would get from them, and you don't have to pay the home delivery charge. We're actually very reasonably priced."

That may indeed be true. But what a little more investigative googlage revealed was this article, which confirms what I had heard elsewhere. Even if you order direct from the drug company, the price of the medication for IVF treatment can vary hugely, since the price they quote you will depend on which clinic you go to. But even more confusingly, there is a huge variation even if you opt for a big chain pharmacy to supply the drugs- in some cases, a difference of nearly £1000.

The only way to be sure that you are getting the best deal is to phone around. For me, doing that entails a weighing up of what my mother would call "the hassle factor". Making numerous phone calls to pharmacies during the day in my open-plan office is pretty much out of the question. Delivery of the stuff is an additional complication. Not to mention that in the absence of my missing file, the O.C. has been unable to confirm exactly the dosage I will be on..

None of this is insurmountable, of course. But I do have a rough idea from the Stim Menu price list as to how much I will be paying, and it does not seem such an unreasonable sum as to make me go "eeeeeee" and spend hours and hours shopping around. So all things combined, I am filled with foolish inertia, which no doubt is exactly what the drug companies, clinics, and pharmacies hope will happen.

I'm trying not to think about how, if there's a next time, I'll be incentivised to haggle for the best deals- older, wiser and poorer.

Thar she blows

Thank you all so much for your gratifying interest in my cool bag. As it happens I did stash the drugs in there with a cold bottle of water, because despite what La Nurse said, I couldn't quite see that it was a good idea to have medication baking in the heat. And I may yet have some use for the bag, especially when I start stimming- since there will no doubt be some back and forthing beween home and the flat in the OC.

I confess the first place I went to, I asked for a cooler bag, since that was what I would have called it, had I been in my native land. But the first befuddled look of the day reminded me that in fact, things are ever so slightly different here.

"Oh," she said, "you mean a cooool bag."

You see? It's all in the inflection. Had I wanted a pretty purse, I would have gone searching for a cool baaaaaag. You say tomato, I say tomahto.

But enough of that. Let's talk about Synarel, my delightful new nasal spray. I take this at 8am and 8pm, one snort in each nostril. First step, take off the little safety clip which keeps it from spraying everywhere accidentally. Second step, take off the cap. I should point out that it really, really helps to take the cap off before spraying- not too effective otherwise. As I discovered this morning when I, er, forgot. Ironic, given that I am notorious for forgetting to put the cap back on things, much to E.'s considerable chagrin.

Engage in some vigorous nostril snuffling to clear the airways. It is good that E. has not here to witness this, because my nasal activities (sneezing, blowing nose) annoy him at the best of times.

Tilt head down. Stick the tip of the bottle in nose- to the side and back is best, apparently. Block off opposite nostril with firm finger to the side of the nose. Pump the spray with thumb and forefingers while inhaling.

I worried the first time I did it that in the excitement of pumping, I would accidentally blow out instead of in. Because I am a goober like that. So my new little ritual goes like this- insert tip, block, breathe in, out, and IN/PUMPSPRAY. It works a treat, and makes me feel rather Zen to boot.

Then I tilt my head back for about 20 seconds to keep everything from dribbling out. It's a little disconcerting if you don't immediately "feel" anything. The first time I did it, I had an almost immediate burning acrid sensation at the back of my throat. But tonight, nothing- at least not right away. I worried initially that I had not administered a proper spray somehow. I gave it a minute, and pretty soon that nasty reassuring aftertaste filled my mouth and throat. Yummy.

So far, so good. Moodwise, I am curiously upbeat at the moment. It feels like a tremendous relief to be doing something at last, after the interminable waiting. But something tells me it won't last, if nothing else because I have been warned that Synarel may cause "mood swings". Why do I suspect that to be a big understatement? E and I spend a lot of time surfing the tide of my moods at the best of times, so we're both a little wary of what lies ahead.

And there are certain other events conspiring to wreak chaos and havoc. For example, would you say that in the middle of an IVF cycle is a good time to be selling the flat in the OC and moving house? Any sane person would surely be shaking their head and saying, "Fuck, no! Are you out of your tiny minds?". Well, one of us is (not me, did you guess?) because that is precisely what is happening.

More on that development later. For now, I am humming a little happy tune, while scanning the horizon for the brewing storm.