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06/02/2006

A round of penis for all my friends

Thank you, all of you, for your kind words about my cancellation.  Five years ago I would never have predicted I'd be classifying "fuck," "sucks ass," and homey tips on how to prepare testicles as kind words.  Now I know better.  Y'all give good monkey nut, my friends inside the computer.

At my scan on Wednesday, on day 6 of stims, we saw two infinitesimal follicles, period.  I was initially instructed to up my dosage to six amps a day and return two days later, but an hour later I got a call from my doctor suggesting that that would merely be throwing good postmenopausal nun urine after bad.  I agreed immediately. 

Although I'd been resistant to cancelling in the past, this time I felt none of that reluctance.  First, I am seasoned enough to know that a cancellation hurts less than a negative.  I have enough perspective now, too, to believe that "nothing survived to transfer" is significantly worse than "didn't make it to retrieval."  And I've done this enough times to know that on a good cycle for me, which might fairly be considered a crappy cycle for anyone else, my day 6 E2 has always been between 150 and 200.  13 wasn't going to cut it, and even I, ever the sunny, cockeyed optimist — shut up — knew it.

But there's also the fact that the stakes are different this time.  A cancellation no longer holds the possibility that I'll never achieve an ongoing pregnancy.  It might mean that I never will again, but everyone who's contended with infertility, successfully or not, knows what a very big difference that is.  So I'm disappointed, yes, but not devastated.  My hopes are dampened but not shattered.  It's the kind of letdown that makes you drink a big glass of vodka, not a big bottle of rubbing alcohol.

So, you know, everything's okay.

What I don't know is what happens next.  As a noted reproductive endocrinologist with years of clinical experience and impeccable credentials, I have a theory, and it is that 18 days of Lupron before starting stims knocked my ovaries flat on their sorry asses — sorry, am I being too technical? — leaving them too stunned to hang ten on the torrents of elderly nun pee that temporarily flooded my system.  So it's tempting not to abandon the long Lupron protocol, on which I've gotten pregnant three times, but to try it again, only, er, less long.

But I can't ignore the fact that I've never had a great response on that protocol, despite those three pregnancies.  It has always given me pause that on every cycle, I end up with one good embryo, max.  Now, I don't need more than one good embryo, and it is, after all, the getting and staying pregnant that matters, but this is America, where more is better, so of course I'd rather a more enthusiastic response.  In fact, I'm pretty sure our Constitution guarantees it.  So the temptation to try another protocol is stronger.

My doctor has suggested an antagonist protocol, which is commonly prescribed for older women and poor responders.  It differs from the long Lupron regime I described before in that there's no suppression prior to starting stims.  When your period begins, you have a scan to make sure that your endometrium is properly thinning and your ovaries aren't pocked with cysts.  Then, if you're given the all clear, you begin injecting gonadotropins on day 2 of your period.  When your follicles reach a certain size, you begin daily injections of a GnRH-antagonist — see, I told you I was a doctor — to inhibit ovulation so that the eggs can be retrieved surgically.

Here's the catch: Scheduling this is going to be difficult.  Because of lab closings, a heavily scheduled summer, and the fact that I can't take oral contraceptives, I don't know when we'll be able to cycle again.

The nurse called this afternoon and said I could take progesterone to start my period and then start stims June 11.  This puts a theoretical retrieval perilously close to an unbreakable commitment Paul has.  If we don't take the date, the lab closes, my period goes on holiday, and July and August are completely booked. 

There are certainly worse things than taking another couple of months off because we can't fit a cycle in between trips to a beach house — certainly.  It is, as I said above, a disappointment.  But I repeat, it's a big-glass-of-vodka disappointment, not a frosty-cold-dead-penis disappointment.

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