Making PIO My Bitch

I am happy to report that the PIO shots continue to go smoothly and (very nearly) painlessly. They hurt about as much as the old GonalF injections, which is to say, not much to speak of. I can honestly say I'd take the PIO shot instead of a flu shot any day! I also tend to bruise if you look at me too hard, but my backside remains unmarked.

Since this is notably unusual, I thought I would share our technique as best I can. Keep in mind, neither of us is a medical professional and your doctor may have different instructions for you. Below are the instructions our doctor gave us.

1. Warm the PIO to body temperature by tucking the vial into my bra for about 30 minutes pre-shot.
2. Swab the top of the vial and then the injection site with alcohol.
3. Using the larger needle, pull out the syringe plunger to 1cc (my dose) and insert into the vial.
4. Push plunger in completely and then draw the dose into the syringe, taking care to eliminate any bubbles.
5. Switch to the smaller (injecting) needle and push the plunger carefully until a bead of oil appears at the end of the needle.
6. I bend over the back of a chair, resting my ribcage on the chair back and my elbows on the table, putting all my weight on my left leg for a right-side injection (or my right leg for a left-side injection).
7. Prof uses one hand to pinch up the flesh in the target area and the other hand to work the syringe.
8. Needle goes in all the way, and quickly.
9. Prof maintains the "pinch" with one hand and shifts his grip on the syringe to be more stable/steady.
10. Pull back on the plunger. If blood appears in the syringe, pull the needle out and reinsert in a different spot. If the plunger resists and there is no blood, proceed with the injection (maintaining the "pinch" at all times).
11. When the full dose has been injected, remove the needle and apply pressure with a sterile gauze pad.
12. Massage gently, stroking outward from the injection site to disperse the oil.
13. Apply a band-aid (just in case). The band-aid also helps me remember which side was done last.

PSA - Never reuse needles and always dispose of them in an approved sharps container.

In discussing this with Prof, we've decided that confidence on the part of the person wielding the needle goes a long way to minimizing pain.* Don't hesitate! Get the needle all the way in quickly, in one stroke, then keep the syringe steady (no wiggling). While injecting, push the plunger in slowly and evenly. Prof takes nearly 10 seconds the push through the 1cc dose.

*If the person doing the injecting needs some practice to build their confidence, an orange makes a good target (just use water in the syringe). This will provide an opportunity to work on quick insertion and maintaining a steady hand while managing the syringe one-handed.

To Pee or Not To Pee (UPDATED)

The age old question of the Infertile in a treatment cycle. Oh hell, let's be honest. There doesn't have to have been any actual treatment. Just the possibility of an egg and the hint of a sperm together in the same room at around the right cycle day, and it's time to break out the HPTs!

So for IVF, when every little thing is so documented and "known" and there is so much riding on the cycle, the temptation to POAS is nearly unbearable. For months now, I have been debating the idea of buying a stock of internet cheapie sticks and "testing out the trigger". Right up until beta day.

But.

My Mom and my MIL will both be arriving for a visit just a few days before beta (give or take depending on retrieval date). I know, I know... what was I thinking approving that itinerary? It's going to be hard enough to keep those PIO shots under wraps, much less find a way to store and dispose of countless HPT strips.

But.

I seriously want to do this. I want to know if there is even a glimmer of a pregnancy. I need to know.

Also.

Any suggestions for hiding the PIO ritual from the Moms in a house with only one bathroom?

UPDATED: The internet cheapie sticks have been ordered! Here's hoping they get here before transfer. More importantly, I wanted to say a huge thank you for all the thoughtful comments over the last week. You guys are the best!

All Quiet on the Uterine Front

The final IUI is done and I am in the two week wait. Everything went well. There is no obvious reason for it not to have worked. But then, there has been no obvious reason for any of the treatments failing over the past year plus. We did what we could and now we wait.

I am slightly less hopeful with each failed cycle, but not running on empty just yet. I'm still in a pretty peaceful place and I hope I get to stay there if this cycle doesn't pan out.

Funny story: The morning of the IUI, I went in with Professor to help him out in the collection room. As I always do. Keep in mind, nobody ever offered this as an option and I never asked permission. I've always just followed him in. So this time, we get into the room and he's kinda giggling. I asked him why and he tells me the new lady at the desk gave me quite the funny look when I followed him in this time. Guess I took her by surprise. Heh. God I really hope we're the talk of the staff meetings....

Happy Birthday to Me! (UPDATED)

For those of you who don't follow me on Twitter:

• Today is my 38th birthday
• Today is 9 days past IUI
• Today is CD1

I didn't even get within spitting distance of my beta. My RE has some serious explaining to do.

UPDATED: Thank you all for your comments and commiserations, they have been heartwarming indeed. I have a CD4 baseline scheduled on Monday morning. It's later than they like to see me, but that's the soonest I could get there. It may be too late and the cycle may get canceled. We'll see.

A Familiar Stretch of Road

So yeah.

At 14dpo I had no signs of an impending period, so I consulted the Oracle of the Almighty Stick, and the Stick said NO. At 15dpo with no change, I went in for my beta. An hour or so after the nurse called to confirm the negative, my period arrived full on. No spotting, just a little cramping and BAM!

Looks like the acupuncture got my cycle fixed up right.

When the Crazies hit me before this last IUI, I told myself that if it didn't take this time, I was giving my body a month off the meds and another month of acupuncture treatments to tweak my cycles and provide some stress relief. When the nurse called with the BFN, I told her this and let her know that I had some questions for the doctor. She suggested a follow-up consult with the RE in 2 weeks. So we're all set to get back to basics this cycle, and I hope to have a better idea of the Plan Going Forward after this next appointment.

It has indeed been a rough week. Big thanks to my tweeps and the folks who dropped by from LFCA to show their support. I encourage you all to drop by there and see who else needs a little love today.

Best Laid Plans

So for anyone who doesn't follow me on Twitter (and why aren't you following me on Twitter!?!), a brief recap of the "revisions" to the Plan for this cycle:

Plan went overboard with much mad flailing in the waters. Acupuncturist threw out a life vest, and RE rescue boat pulled it out of the water.

So the Plan WAS Clomid with monitoring on CD12 to set Hcg trigger time followed by IUI, with acupuncture before ovulation (CD11) and again after IUI for good measure. I was really nervous about the Hcg trigger shot, in spite of the many reassurances of my fabulous tweeps. But I am a Big Girl, and I will do what needs to be done (or at least let the Professor do it to me).

Now, I know that I tend to get a positive OPK a little earlier than might be expected (CD12) given that the CrazyPills should push ovulation out a bit. So I have gotten in the habit of starting the OPKs on CD10. This cycle, I wasn't going to use the OPK since we were going to use the trigger shot, but SOMETHING made me grab a stick on my way out the door to work on CD11. I told myself that I had two OPKs in the cabinet, and with houseguests impending, I needed to get rid of them.

Good thing, too. It was positive. Well that explains the achy ovaries...

Crap.

Suddenly, the entire Plan was in disarray. Frantic call to RE to see what they wanted to do, and we scheduled in for an IUI Friday morning. All I could think was "I didn't test yesterday, what if it would have shown the surge YESTERDAY? It's too early, why is it so early? What if we've missed it?" All of this followed by a recurring string of profanity, from which I will preserve your delicate eyes/ears.

I left work early to go to my CD11 "pre-ovulation" acupuncture session in quite a state of anxiety.  The only ray of hope I could see was that the Professor and I seem to have seriously superior instincts about these things, and we had indulged those instincts the day before. Right on time. My acupuncturist felt like all of this was no big deal, we had done what needed to be done and she adjusted the treatment to be a post-insemination treatment. The IUI would just be back-up. She must have added something else in to the mix, because I slept through almost the whole hour and a half treatment and woke up feeling calm and reasonable again.

Friday morning IUI went smoothly, administered by our favorite nurse, Nurse FunnyBone. I had her once before and really love her sense of humor, sensitivity and down-to-earth confidence. She had them add in E2 and LH blood work to verify that the OPK positive was accurate. I don't know how they did it so fast, but they called with the results two hours later. Ovulation confirmed.

At least I've already got the progesterone supp's in the fridge!

Here we go...

Back in Limbo (UPDATED)

So I knew where I was. I thought... well, I thought wrong. Where I am is in limbo.

My beta was scheduled for Saturday (two days ago), but since we were leaving town Friday, I used an HPT that morning. Negative, followed by heavy spotting. Ah well. That's what I was expecting... nothing to see here folks... move along!

I called my RE's nurse line and talked to them about this situation, explained about our travel plans and asked for guidance. The nurse told me to continue to take the progesterone until I saw full flow, which was a bummer since we were going to be staying with family and they don't know we are dealing with infertility. What's that in the cooler case you just stuck in our fridge? Errr... ummmm... nothing to see here folks! Move along! With the spotting came a killer headache, so I assumed my period would appear any moment and took a prescription painkiller. Sweet relief!

I decided that I would indulge myself a bit on our little vacation (see my last post about resentment), so Saturday morning I drank a cup of coffee. Spotting continued, but still no full flow and Saturday evening I had a glass of wine after dinner. I will admit that I was a little surprised to still be spotting, but... *shrug*. Come the end of Sunday, the spotting had all but stopped with never a drop of red blood, but the headache was back. Still no change this morning, and I'm debating calling my RE but I KNOW what they'll say. Go for the beta. But I'm still out of town. POAS? But I'm not comfortable doing that in this house. So I won't call. If I still don't have my period when we get home, I'll go for the beta Wednesday morning. But I don't really think this is a good thing. I have no symptoms, other than headaches, light spotting and period-like cramping.

I was sitting here with a frown on my face and sighing, while contemplating the What If elephant in the room. The Professor asked me if I was sad, and I said, "Not really, my uterus is just clearly confused". His reply?

It's a confuterus?

Oh, how I love him.

UPDATED: A mere matter of hours later, and I've got full flow. I'll call the RE in the morning and schedule the baseline.

Once More, With Feeling

Present Day - Cycle #17

Which basically brings my story up to date. Once again, baseline ultrasound clear and non-pregnant status confirmed, we are rolling with the Clomid/IUI and home OPK testing. This time for good measure, they threw in a mid-cycle ultrasound with blood work and added progesterone suppositories to the treatment plan. I'm throwing acupuncture back into the mix as well.

I had been getting acupuncture for a couple of months before the pregnancy/miscarriage. It has been shown to be beneficial in complimenting fertility treatments and it certainly made me feel better. But with my boss out on maternity leave during our busy season, I couldn't justify the added time out of the office.

I still haven't told my coworkers about my infertility and treatments. Sometimes I want to, not just as a way to explain my many doctor appointments but also to explain my mood swings, exhaustion and the other physical symptoms the raging hormones inflict (headaches, nausea and mush-brain to name a few). But still I hesitate. We are a very small group, only five people including me. I know that one person would feel sorry me and one would question why I even wanted kids, my boss would be cool about it but I have no idea what our director's reaction would be. I THINK he'd be cool, but I don't KNOW. So I'm not telling.

The mid-cycle ultrasound showed five follicles on the left ovary, only two of which were mature, and one immature follicle on the right ovary. This was a bit of a revelation for me. I only ever feel ovulation on the right side, so I had developed a theory that Leftie was the slacker. What if, maybe, it's Rightie that has issues and that's why I only feel ovulation on that side. What if Leftie is just fine, thank you very much, and Rightie hurts because there's something wrong there? Just an interesting thought.

The blood work came back normal, estrogen just where it should be but no LH surge. I was told to use the home OPK and expect a surge any day. And next day, right on schedule, positive OPK. I called and scheduled the IUI for the following morning and the nurse called in the prescription for the progesterone. I never felt the ovulation (go Leftie!).

So now, here we sit, in the middle of the two week wait. Still hoping that we can make this work.

2WW Routine

The Infertility Doula wrote a post about how she handles the Two Week Wait, and asked the question - How do you cope with the 2WW? It's an excellent question, and is the experience that binds so many of us together no matter what path we take to reach that point. So here's how I cope (or not, as it often goes).

I've actually just started my 2WW and if it goes the way of the others, I will be cautiously optimistic for the first week and then get progressively more scatter-brained through the second.

My PMS symptoms are identical to pregnancy symptoms (sore boobs and nausea) with one exception... we'll call it intestinal regularity. My one pregnant 2WW I was unbearably constipated, whereas usually I go to the other extreme about 5 days before my period. TMI - I know, but that's the symptom I watch for, and that's the thing that sends hope spiraling every month. I also get what I call hamster-brain, where I can't stop my thoughts racing and spinning.

So yeah, about 5 days out, I lose hope and sink into a mental hole at which point I am certain that I am irreparably broken and this will never work. This makes the Professor so mad - to hear me talk about myself this way. He gets very stern with me and then very sweet and reminds me that it's US that matters. Two days out, I cave and use an HPT, which inevitably comes up negative. We have a phrase in our house, "Stick says NO".

Sometimes I get so far down, that when my period does turn up, I can't even face going to work. I lose all ability to focus, and spend way too much time staring into space. Brooding. I feel defeated, but determined, so I head back to the clinic. Then Hope, that bloody little beast, shakes itself off and hops back up on the twig.