h-C-Gee-whiz!

That thing stings every time.

My Day 12 follicles met triggering criteria this morning — so trigger I did, at 8:00 pm on the dot.

For those who want numbers — I'm talking to YOU, current and future IVF-ers scouring the Web to obsess about how your follicles compare to others' — here's my size breakdown:

The Presumptive Leaders
3 follicles at 18–21 mm

The Still-in-the-Running Hopeful
1 follicle at 16.5 mm

The Scrappy, Ready-to-Come-from-Behind Underdog
1 follicle at 15.5 mm

The Also-Rans
3 follicles at 9.5–12.5 mm

The "Less Thans" (actual clinic-speak)
3 follicles at less than 7 mm

My E2 today was at 1,600, only slightly higher than my trigger-day E2 during IVF #2. But it's a better number (I think) because I have many fewer mature-looking follicles, which are the ones that give off the measurable E2 reading. So, relative to the last cycle, the reading is higher in a potentially desirable way. I think.

In any case, this is the thought process that's allowing me to feel not so glum about having less than half the seemingly mature follies I did last time. It's also keeping me from letting my mind revisit the time where we thought we had 4 follicles at retrieval but got nothing. These 4 follicles are different from those 4 follicles.

Please, please, please, please don't let these 4 follicles be empty. Please.

My personal best-case prediction is that we can possibly get 5 eggs with 3 acting mature.

ER is Friday morning at 7:30.

Breakout

I woke up singing this song today. I mean that literally. My foot hit the floor, and I sang at my wagging pup's face, "Lay down the law, shout out for more, breakout and shout day in/day out, BREAKOUT!"

I don't know when I heard it last, and I didn't realize that I knew any lyrics. I do know that last night I said "Swing out, sister" to the dog (I'm alone, 'member?). She was twirling around the room in joyful anticipation of a beefy dental bone, and it just seemed to fit. I also know that as I drifted off last night, I thought back to the first time I was told that a hysterectomy was in my best interest. That was in 1987. The same year the song came out in the U.S., I see! FREAKY, no?

I almost took that uterus-removal advice. Obviously, though, I didn't, and all that is a story I'm not telling today. What I AM telling is that I went to bed thinking I wouldn't change the past. And today I woke up to a new attitude and a new cycle. (Howdy, Auntie F!) Where yesterday I was wallow-y, today I am ready to go.

I called my assigned nurse this a.m. and asked for more deets about the antagonist protocol Dr. K recommended. IFFY we try IVF again, this is my sketchy understanding of what we'll do (I didn't take notes or search the protocol, so I may be missing something):

I'd monitor for ovulation this cycle, go in for a 7 dpo progesterone test, and then take an antagonist shot at some appropriate time after that to suppress ovulation for the next cycle. No BCPs (it's part of their SOP, but she let me say no to it w/no fuss) and no Lupron. Minimal suppression all around. A week after the shot, I would start Follistim and Menopur (not sure about dosages). Once the follicles grew to 11–12 mm, I'd do another antagonist shot to prevent a natural O. Trigger to follow when things look ready. If all went okay, we'd hope to at least get as far as finding an egg or two at retrieval.

Just to be clear, DH and I have not made a decision. But I can tell you that as of today, I want to try again. The thing I keep coming back to is that had we canceled at anytime prior to the attempted retrieval, our plan was to eat the costs of the first part of the cycle and try again. IVF is supposed to be our best-possible shot at conceiving. Statistically speaking, it's supposed to be our only shot. So how can we say we tried if we don't go through a full cycle? If we come up empty at ER again or we get eggs but no fertilization and thus no transfer, well, that's another ball of wax. I wouldn't feel compelled to do another trial. But those are MY feelings. Today.

DH gets a say, for sure. I know he knows I know what I want to do. I know this because I described the basic protocol the other day and saw his knowing "I know you know what you want to do" look.

All he said then was, "When does Finance tell us what portion of the cycle fee we're getting back?"

"As soon as I ask them," I replied. Now would be a good time to do that.

******
Other things that inspired me this morning —

Quote of the day from my planner:

"There's as much risk in doing nothing as in doing something." —Trammell Crow

Today's literary quote on my home page:

"Gardens are not made by singing, 'Oh, how beautiful,' and sitting in the shade." —Rudyard Kipling

Processing, second-guessing, waiting, fuming, aching, coping

The good news about yesterday, as Doctor would no doubt concur, is that nobody needed anything tangible from me. I floated through the workday, focusing on the simplest of tasks (filing, invoicing, outlining, staring at a boxelder bug for an hour) and saving any important client communications I felt like initiating for another day. I also managed to cancel the Darvocet Rx we never picked up and ask the clinic (using their online contact form) to be sure to tell the acupuncturist that the transfer was off.

During the day I avoided the guest bathroom, where my Injection Station still exists (cycle meds, syringes, alcohol prep pads, extra needles, biohazardous waste receptacle, injection instructions) and my now-absurd-seeming TCM foot-soaking ritual took place. I also turned a blind eye to the stack of IVF-related propaganda on the coffee table and shoved my detailed cycle calendar into the recycling bin. It was a good grab-and-shove. Barely had to look.

I took no vitamins. Not even a PNV. Nor did I consider the fertility- or cycle-supporting value of any foods I took in.

During an after-work Costco date, I winced at the sight of the fresh pineapple I'd planned to pick up on transfer day. Longtime TTC'ers, you know why. We veered left and snagged an inexpensive bottle of shiraz-cabernet instead. For another time.

I fell asleep at around 8:30 watching Paris When It Sizzles. Haven't heard of it? I know why. (Even so, a bad Audrey Hepburn–William Holden film is still not terrible.)

Now it is midafternoon on Tuesday. Two days after the failed retrieval. No word from my RE. If that trend continues, I will call her (to leave a message to call me, what else?) tomorrow. In the meantime, I am free to continue speculating about what may or may not have happened. Although on-call Doctor was unable (or unwilling?) to even suggest possible reasons ZERO eggs were found, I have had no trouble assembling a fairly straightforward list of my own.

Let me preface my info rundown info with an anecdote from the wee hours of Sunday.

******

At 4:30 I woke up feeling a subtle chemical shift in my body. Something changed, I don't know what. But I know that I feel certain shifts at predictable times during a natural cycle (just before O time, at mid LP, just before AF, etc.). With no previous IVFs or medicated cycles to compare it to, I hoped what I'd felt had to do with the HCG doing its thing and/or my body adjusting to not getting its Follistim/Menopur/Lupron fix.

When the alarm went off at 5:15, I sat straight up and said, "I have a sick feeling that I've ovulated. What if that was the biggest/best follicle releasing its egg?"

"Can that happen?" DH said. "I think so," I said. "But it didn't," we said.

I honestly put that out of my mind — completely — until the car ride home. Can't stop thinking about it now.

*****

Below are up-for-debate tidbits I found about what some call Empty Follicle Syndrome. I gleaned it from sources such as INCIID, "name" clinics, and RE blogs/forums.

• Some REs say that all mature follicles contain eggs. In other words, there is no such thing as an empty follicle or Empty Follicle Syndrome. Eggs may not be good, but they are there and either not ready to come out (immature) or too sticky (damaged) to come out.

• Two common explanations: old eggs; unexplained.

• User error when administering the trigger shot can cause a problem. If you don't do it correctly (wrong time; SubQ instead of IM, maybe?), the eggs might not reach maturity.

• Problem with the drug itself. Some REs have patients take two HCG triggers from different batches at the same time to allow for the possibility of a random bad batch.

• Some women have problems metabolizing certain brands of HCG formulations. Some REs do bloodwork to test for beta HCG before the procedure. If there's a problem, they send you home with a different formulation and schedule the retrieval for 24 hours later.

• Some women ovulate slightly before the scheduled procedure. This, of course, would be next to impossible to detect. To account for this possibility (or, often, during a subsequent attempt), some RE's retrieve at 34 hours instead of 36.
  

• Some REs think that a high-stims protocol damages eggs, particularly in women over 40. This could cause the stickiness problem.

• Some think that the high-stims protocol can recruit follicles that would have been in line for the next natural cycle. In other words, this was not their time but they were hustled to the front. The eggs have been rushed and are of poor quality and/or just aren't ready for any type of action.

No logical post ending. It's just back to work and waiting for I-don't-know-what.