IUI - Cycle # 3 Progress

IUI # 3 insemination 1 & 2 happens this weekend. I was on 75, 75, 75, 100, 100, 100, 125, 125, 125, 125 IU of Follistim for the last 10 days. I will be taking Ovidril tonight and going to the other clinic location which operates on the weekend (different and farther off from my regular one) tomorrow. During today's u/s, I had 2 follicles in my right ovary (18 & 13 mm) and a couple of 11-12 mm in the left ovary. My RE prefers going low and slow on the dose because of (my) PCOS. However, that resulted in to just 1 follcile during second IUI. I guess, technically you just need 1 "good" egg to do the trick, but it sucks when you have already had 2 failed IUIs. So I ended up speaking with my RE to see if we could be a little bit more (of course reasonably) aggressive this time... last time I took 75 IU of Follistim every single day except for the last 2 days, when I took 125 IU! The increased dose for IUI # 3 did not really shorten the cycle (I have been on Follistim for 10 days starting at CD3 the last 2 cycles as well), it seems to have slightly increased the number of potential babies. My Estrogen was 787.

The u/s was performed by a different RE (from group of docs at the clinic)... he is one of the founding members of the practice and I had never really interacted with him before. So, I was a little curious to see how things went.... He entered w/o knocking the door (I could hear him outside and of course I was ready... so I wasn't really startled!)... exchanged a few pleasantries and then swiftly moved my cover/paper blanket (or whatever it is called) up (I was a little startled then), the probe went in equally fast as well! With his quick actions... I actually lost track of the follicles (hence the "couple" of follicles in left ovary (mentioned above)). He started asking me as to why I am not going for an IVF. During our conversation he also went on to say that with the number of potential follicles I have, there is a great risk of multiples with IUI, and as much less "torture" (yes, he used that word to imply IVF) as they would want me to go through, I would probably produce a lot of eggs for IVF (which has approximately 80% chances of success at my age at this clinic (assuming other things are okay besides PCOS) as compared to 20% with IUI). He also mentioned that at my age probably 50% of the eggs are probably already bad... which adds up to the BFNs for IUI!!! I mentioned to him that I have an appointment with my RE to discuss IVF and that is probably going to be our next option if this IUI doesn't work!

I was not very pleased with his bed side manners, however I was very impressed with the amount of time he spent with me and the way he answered my questions! Gives me lots of hope for IVF! :) So for now... IUI # 3... here we come! Will this be the lucky cycle!?!

New symptoms/side effects every cycle…

I have gotten used to getting new symptoms/side effects every cycle. I have been on mental over drives of (over) analyzing each symptom/side effect, and figuring out what it means and how it could impact my success rate that cycle, several times thus far… and I think I am now reaching a point where I seem to be kind of ignoring them and just doing my usual stuff. However, some of the occurrences are absolutely unexpected and new.

The other day, I got up in the middle of the night to pee (Sorry if TMI)… and I felt very uncomfortable. Within a few seconds I felt dizzy and weak, and then felt flushed… I guess I experienced a hot flash! I felt extremely hot and started sweating. In a matter of minute or so, that turned into extreme chill (I guess sweat is supposed to cool you down)… this feeling passed away in a few minutes. I got in to the bed and drank a ton of water (I had to send DH to the kitchen to get me some more). This has never happened to me before. It seems that this is a side effect of Follistim.

The day following the night sweat, I had muscle spasm in my left hip. It continued for 2-3 hours and then disappeared, again to reappear the next day in my left hip, back of the left thigh and close to my left big toe. This continued for some time and again disappeared! I have never had such repetitive and long muscle spasms before. I mentioned this to my Acupuncturist. She added a few points to the routine to help ease that and asked me to let her know if this repeats. I did feel a few spasms in both my legs during the acupuncture session, but I was too dazed to really register it well.

I wonder what lies ahead!

Weight Gain/Loss during IUI Cycles

I had gained almost 4-5 lbs during IUI # 1. I was afraid that I was going to be like 100 lbs heavier by the time I finished all my cycles/got pregnant. But to my surprise, I lost that gained weight and I lost additional 4 lbs during the rest cycle (total -8 lbs). I looked slimmer too! :) May be it’s the medication (Follistim, Ovidrel), may be it’s my insulin/sugar in control (due to Metformin), may be it’s the Acupuncture… or may be its just me! :)

With IUI # 2, I was afraid that I was going to gain weight again… though till now, I might have gained 2-3 lbs… in spite of me getting hungry every now and then and hogging so much! Though, I do feel heavier and bloated. Only time will tell the final outcome!

IUI – Cycle # 2

…And so, day 35 came (of the break cycle) and I decided to go to the RE’s office and get my bw & us done to see what’s going on! Guess what, just like January end/February beginning, my lining was thin and hormones were low enough for it to be considered day 3 (without AF). So here we go… IUI # 2! I was still afraid that my cyst would pop up again and we would have to cancel the cycle. I wasn’t at peace till my day 7 us (which is when they found the big cyst during the previous cancelled cycle). Day 7 arrived and things looked okay. In fact, one of my follicles had already started growing in my right ovary (by day 7 us) and was 12 mm and estrogen was 63 units. That was a quickie as compared to the first IUI cycle! It had taken me almost over 8 days to respond last time. During this cycle, I took 75 IU Follistim for 8 days followed by 150 IU for the next 2 days. I triggered on day 13 (of the so called non AF cycle) using Ovidrel. The “big follicle” kept growing up to 18 mm before I triggered. Only 2 more follicles in my right ovary were around 12 mm before I triggered (none >10 mm in left ovary). I forgot to ask about estrogen on the day of the trigger. I know things can be very different every cycle, but I still asked my RE as to why I had such less follicles… he mentioned that this is normally what they expect (& not the "n" number follicles I had last time). I was ready to deal with all the side effect of Ovidrel (with last IUI cycle experience). But fortunately (?) things were much better this time. Slight tiredness, slight cramping and the rest was smooth sailing. I had mentioned to my nurse about my OHSS like symptoms from last time and had asked if I could take an Ovidrel alternative for my progesterone boost if required. I was told that I could take Prometrium (http://www.drugs.com/pdr/prometrium.html) vaginally if the progesterone was not as per the standard requirement (of 9 units or higher).

IUI (insemination 1 & 2) went well. Sperm count was great and it looked like I had one healthy egg (for sure)! With the (minor?) aches and pains that keep coming with all the medication, I wasn’t very successful in telling if I had ovulated (couldn’t identify ovulation symptoms). 5 Days past first insemination, I went in for my progesterone check… level was 6 units (just like IUI # 1). I was prescribed Prometrium vaginally 4 times a day till my next bw (pregnancy test). So, currently I am at the 2WW!

This progesterone suppositories– Prometrium is supposed to help with implantation (progesterone > 9 units for implantation). It’s very easy! Just that it can be messy. Progesterone from the pill is supposed to be absorbed by the vagina/uterus, though some of the ingredients leak out. (Sorry, if it’s TMI!) A panty liner is a must.

I am hopeful, yet even more cautious this time. I am trying hard to not look up every symptom online… trying harder to not look at online (baby) shopping websites… and trying even harder to not be disappointed, frustrated and bitchy! My ovaries have not cramped much this time, though I have felt some twinges once in a while around my uterine area. I feel a little something in my chest/throat… may be heart burn… I am too scared to call it nausea. My inner thigh (mainly right) feels strained. I am hungry a lot and get tired very easily. Approx 7 days past ovulation (DPO), my cervix is soft & low, and my body feels warm. I think my brain is on an overdrive... it’s probably all the medication! May be the next time I will learn to ignore these new symptoms as well (though I truly hope that this is the lucky cycle)!

My Acupuncture routine is the same as IUI cycle # 1. Twice a week while on Follistim; followed by day before and of the insemination; and once a week during 2ww.

IUI – Almost Cycle # 2

I went in for day 3 b/w and u/s for this new cycle (early February 2009). I was positive and hopeful! There was 1 cyst on my left ovary. The doctor mentioned that if the cyst is not secreting any hormone (which would be detected in the b/w), we should be okay with starting a new cycle. The b/w was good; we could start the 2nd IUI cycle!!!

I started off with 75 IU of Follistim again (for the next 4 days). I had started to feel a little discomfort during these 4 days. I went in for day 7 b/w and u/s. I had more than 5 cysts each greater than 50 mm in my right ovary and a few small ones in my left ovary! My ovaries were almost double the size. The cycle had to be cancelled! I was disheartened!

Currently, I am towards the end of this “waiting” cycle. My ovaries have cramped once in a while and I have been tired at times… no other pains in this month! I am going for acupuncture once a week and have not really done any yoga this month (I am too afraid that my ovaries are the size of a football). Hopefully, I will get my AF naturally and the ovaries will be fine.

IUI – Cycle # 1

I started my IUI cycle towards the end of January 2009. The cycle medication normally starts with b/w and u/s on day 3. I was towards the end of my menstrual cycle and was hoping that my AF would start soon (so that I could start my IUI cycle)… though nothing seemed to happen till day 35! So I went in for u/s and b/w to see if I could be induced. Surprisingly, I had not developed any lining on my uterus (to shed during a period), so even if I had been induced, it would not work. The b/w it seems turned out such that… my hormones were at a level that one would have during day 3 of a new cycle. So my RE decided to start my medication.

I administered Follistim (http://www.follistim.com) every night (75 IU for 4 days, 100 IU for 4 days and 150 IU for 2 days) at home starting on day 3 of the cycle. I was scared big time to poke myself in the belly the first night, but honestly it wasn’t bad at all. Though I did realize that I had different sensation every night (from no pain to sharp pain to tingling sensation)! I guess things changed as my body hormone level went up/down. Follistim made me bloated, tired, my boobs were sore, nipples were extremely sore, I was a lot more thirsty, had an increased appetite. My follicles went from too small (less than 10 mm) to 15 mm + as soon as I up’ed my dose to 150. With PCOS (excessive follicles in the ovaries), the doctors do not want to stimulate you to quick, because it could cause a severe hyperstimulation (OHSS: http://en.wikipedia.org/wiki/OHSS). I was monitored (b/w and vaginal u/s) on day 3, 7, 9, 11 and 13. On the 13th day of the cycle (3 follicles > 18mm @ right ovary and 1 follicle > 15 mm @ left ovary), I administered myself the prefilled syringe of Ovidrel (http://www.drugs.com/mtm/ovidrel-injectable.html)! We were supposed to go to the RE on day 14 for the 1st insemination and day 15 for the 2nd insemination (My RE does 2 insemination to increase the chances of catching the ovulation post induction).

Insemination went well! Husbands sperms were collected (both days – good count) and were washed (Sperm Washing: http://en.wikipedia.org/wiki/Sperm_washing). The insemination procedure did not take very long (approx 10 mins) and there was no pain or cramping or bleeding involved. I rested both the days after IUI. The Ovidrel did make me bloated and soar. My ovaries cramped, my feet hurt bad, caused headaches and I was very thirsty… it was manageable and it all subsided within 3-4 days. I went in for progesterone check 4 days past first insemination. Progesterone level was 6.4 units, the doctor recommended taking an Ovidrel shot to up the levels (10 or above is required for implantation to occur). I had similar symptoms to my first Ovidrel shot, though the intensity of all the pain was higher! My ovaries were cramping badly and I couldn’t move much, had some chest pain and had difficulty urinating! I was afraid it was OHSS! I ended up calling the emergency line at the RE’s office and spoke to a nurse. According to her, as long as I had not stopped passing fluids (urinating), I should be okay. She scheduled an u/s and b/w appointment for the following morning. The u/s revealed a few cysts in the right ovary (not very big). Cysts normally subside by the end of the cycle. Sometimes they can persist through pregnancy. If they don’t subside a cycle might have to be skipped (if not pregnant)! My RE mentioned that bloating and pain normally increases towards the end of the day (because of physical activity throughout the day). He also mentioned that since the Progesterone levels were above 3 units (during the progesterone check 4 days past insemination), ovulation had occurred and these cysts were not just left over eggs.

My OHSS symptoms subsided in the next week or so. I was perfectly fine initially during the 2 weeks waiting (2ww). With all the medication I had had thus far, it was hard to tell if all the changes/symptoms were pregnancy symptoms or medication. My August 2008 experience had taught me not to read too much into these symptoms. Though it did not stop me from looking up information online… it just made me a little cautious and less anxious! However as the 2ww almost came to an end, I couldn’t stop myself from trying an EPT! I used the Walgreens brand (I had spent enough $$ last yr to realize that the brand name didn’t make much of a difference) 2 days prior to going to the RE’s office for b/w! It was slightly positive, though it could have been the Ovidrel (HCG)! I tested again the day before (b/w) and the line was much lighter than the previous day! I was kind of mentally prepared for a BFN at the RE’s!

Never ever has this treatment not surprised me (till date)! My b/w results were indeterminate. My HCG level (pregnancy hormone) was 3’ish. If one is not pregnant, the levels are below 2 units. Progesterone levels were 6’ish (not suggesting pregnancy). I was asked to come again 2 days later for another round of b/w. Even though I had anticipated this (after my EPT), I was frustrated and angry! Why me!?! I cried a lot that day, didn’t want to speak with anyone. Though I calmed down after speaking with my husband at night and I was pretty normal from the next day. The second round of b/w was definitely a very BFN for sure! My AF started the following day. I cramped like never before… I could hardly move during the first half of the first day!