After I got my BFN I went back to bed and fell asleep. Apparently my mind wasn’t in a great place, because I ended up having a crappy nightmare, something about hippos and Den’s brother getting eaten by a shark. I always love getting hysterical in dreams, don’t you? Woke up and snuggled close to Den for a while. I usually get to work at around 11 – but due to staying in bed and not having to get up (because Den’s off work today) I’m still home and it’s 12:30. Thank goodness I have a job that doesn’t really care when I come in.

I’m starting to understand why people throw in the towel after a few years of this. It’s taking over my life. At first it was a fun obsession. Now it’s something that I just can’t get away from. All I think about is the next appointment, next test, next AF, next cycle. I’m starting to wonder what the hell clomid is really supposed to do. I mean, if I had 13 eggs before going on clomid, and none of them fertilized/stuck, why would increasing the number of them help? There’s gotta be something more at work here. Endo? Poor egg quality? Hostile endometrium lining? I want to know, and I want them to fix it, instead of rolling the wheel every month.

The way I’m seeing it – this cycle’s due date would have been end of September, our next cycle – our last Clomid/IUI cycle – will put us at end of October. For the two cycles after that I definitely don’t want to do IVF… so whether it’s taking a break or doing just clomid or what, I don’t really know. But then after that I think we’ll be looking to IVF for a 2008 baby. To me this gives me enough time to come to grips with the idea, gives the clomid a fighting chance of working, and by then I’ll be ready to take the plunge. IVF scares the crap out of me, just so you know. But damnit… two cycles of clomid down and I’m already getting fed up with it and ready to move on.

By the time night rolled around and Den finally came to bed I wasn’t tired anymore. I’d started to get a grip on myself again, and unfortunately that means thinking. So I got up and opened up my infertility books and read the chapters on ART (Assisted Reproductive Technology). I’d never read them before – because, I guess, at the time it didn’t apply to me… and I really never expected to have to deal with it. There was a lot I didn’t know.

A part of me, I’ll say now, thinks that it’s too soon to be reading up on IVF and planning that far ahead. Then the other (more logical, IMO) side of me points out that we have only one more insurance-paid cycle. We have an RE appointment coming up on February 1, which is only 2 weeks away – and that’s when I need to go over all our future plans with her. With infertility planning ahead can definitely save you months of wasted time. So yes… strange as it sounds, this is the time to start planning for IVF.

Here’s the basics I got out of it:
* IVF will require 2-3 weeks of birth control pills before starting. Sounds counter-productive, doesn’t it? :)
* Lots of shots. That DH will have to give me. Not looking forward to that.
* Egg Retrieval involves sticking a needle into my vagina, through my vaginal wall, and into my ovary. For some reason I always assumed they got to the ovary through my stomach, not through my vagina. So this is a bit freaky to me.
* Then you wait and let the people at the lab do their thing with your eggs and his sperm. They let the eggs fertilize and become multi-celled embryos. They grade the embryos and select the best candidates.
* For egg transfer, they show you photos and give you the numbers and you decide how many to put back in. For us 2 is the max – because of both the insurance’s limits (2 max) and our own feelings about multiples (twins max). 2 is a good number.
* For the transfer the embryos are put in a syringe and inserted into the uterus through a catheter, same as with the IUI.
* But then, some clinics will put you on strict bed rest for 2-3 days. I didn’t know this. Taking time off from my work might require a little bit of changing things around and prep work, but I know it will never be a problem asking for time off. (It’s just hard because I’m the only one who does what I do, so it’s kind of hard to find someone to do it. I don’t like putting extra work on anyone else.) I might need Den around as well, because of the dogs. Although if i stayed quiet all day it might be okay, long as Zoe didn’t suddenly decide her bladder was going to burst.

That last point made me think and worry. If their concern is the embryo sticking… is maybe my work and/or activity level the reason we haven’t conceived yet? IUI or IVF, it’s still implantation that’s at issue. I mean, I’ve seen nothing saying that you can mess up implantation from daily activity. But if that were the case, why would the IVF clinics put you on bedrest? Questions, questions.

Oh yeah, our appointment with the RE on Feb 1? Kind of ironic…. because my period, if it follows the same LP length as last cycle, will arrive on Saturday. Which will place our IUI? On Feb 1. Guess I’ll be spending a lot of time at the hospital that day.

The book I just read mentioned the statistic that 40% of infertile women (I can’t remember if this statistic applied specifically to unexplained infertility or not) get pregnant on clomid. That’s kind of a crappy number.

I’ve got some spotting this afternoon. I checked out my chart for last cycle – exactly the same. Spotting on 13dpo, then 16dpo, then AF on 17dpo. I even have the sensitive nipples to go along with it.

No…. there’s not going to be any miracle this month.

I’m making myself sick worrying and wondering what the hell to do next cycle. I’ve heard from so many people that injectibles can give you a better chance. And I’m still ticked that the RE never thought to plan for the fact that we only had 3 IUIs – and never scheduled a follow-up consultation to discuss where we were going AND when I went to do so I couldn’t get one until halfway through IUI#3 when it’s far too late. Gah.

So tomorrow I’m planning to test again just to confirm the negative so I can call the nurses and ask them again if injects is something we should be concerned about.

Am I making any sense? I have no idea.

Today I was really snippy with Den when he came home from work. Not feeling upset or mad or anything, I just felt very detached and a little bit snarky. He finally pulled me aside and told me to take a deep breath and take it down a few notches. He gave me a hug and I just started crying. Guess I’d been holding in more than I thought. I’m just so frustrated. When we started the clomid I was so hopeful again. Now I’m right back where I started. :(

This study (quoted on this FAQ) reflects what I’ve been thinking. I’ve highlighted the parts that stood out to me.

Basically, ovulation induction as a means of infertility treatment doesn’t work half as good for those with unexplained than those who have some form of anovulation disfunction. Which is completely logical – in most cases with those who are anovulatory your main battle is going to be ovulation, and it appears most of the time that’s all you need. But for those of us for whom that is not a problem, ovulating “more” or “better” isn’t going to make a huge difference in the end result.

This only strengthens my opinion that we should move to IVF sooner rather than later. Sigh.

Guess who showed up today? AF! I was caught off-guard, yes. Last month on clomid my LP was extended to 16 days. This month? 13. Same as my usual without clomid LP. Uhhh? I’m confused. I’m also feeling extremely nauseated. But I’m refusing to take a midol.

Good thing I’d waited to call the nurses this morning… I’d have had to call them again to say “CD1 today.” So I called and left a message trying to be very succinct: only 3 covered IUIs, done 2 on clomid, should I do injects for last one? So a nurse called back while I was at work and she had answers for me!! She says that the RE WILL probably want me to do injects for my last IUI cycle. Which is what I’d anticipated. And I know just a few weeks ago I was very anti-injectables, but at this point I really don’t feel like doing another clomid/IUI cycle, I just don’t see a point to it. And I’ve heard that injects gives better quality eggs. So 1 cycle of injects is free with insurance, SURE let’s try it.

But of course it’s too late to do it for this cycle. Which is fine with me, actually – I was kind of surprized at how fine I was. We scheduled an injectables class (required before you do a cycle on injects) for February 8th at 1:30pm. They only offer the classes wednesday and thursday, and only at that time. With me working wednesday I chose the thursday so I wouldn’t have to worry about anything. Den is going to take that time off to come with me, she said they prefer the partner to come to the class as well, and he’s probably going to be the one giving me the injections. We still have an appointment with the RE for Feb 1, at which point we’ll go over the protocol I’ll be following for that cycle.

As for this cycle… I asked the nurse about us doing just clomid. She said sure, we could do that if we wanted to. We know it’s not going to give us the best chance at pregnancy, but it’s better than doing nothing this cycle. With clomid only doing like $10 more than we were paying in co-pays for the meds it’s an easy decision. 4 eggs instead of 1. Makes us at least feel like we have some chance this month.

I did ask about a possible ultrasound this month with the clomid – you know me, I want to know how many follicles are there, how big, etc. She unfortunatey didn’t know. So I’m going to call the insurance coordinator to ask if insurance would cover an ultrasound coded under “ovulation induction” (since we get 4 of those under our plans – but I don’t know if they apply only to those who don’t ovulate on their own). If it’s not covered the cost would be between $100 and $125, said the nurse, and unfortunately that’s probably not worth it. It doesn’t really give us any better chance than just using OPKs and having sex every other day… it just gives us more information (which is good in my book – but definitely not necessary in the grand scheme of things). So short form: if insurance will pay we’ll do that and trigger then just have sex like bunnies; if not, then we just have sex like bunnies and chart. Yes, charting again – blah, I have to go back to setting my alarm every morning. Booo. ;)

So there you go. One month of clomid, then one month of injectables and IUI. Then a break in March to avoid a Christmas baby. Then, if we make it that far… IVF. Which wouldn’t be starting until April. Gives me lots of time to absorb information and prepare myself.

Oh and somewhere in there probably a lap. At that appointment with the RE I’m going to ask her about that and probably schedule one. Just out of curiousity’s sake I didn’t take a midol or any pain meds when my period hit and I started cramping. I wanted to evaluate how bad the pain was. (You know, in an attempt to decide if it was endo or not.) I made it to 5:30pm. It sucks, man. Not just pain in a sharp “ow” kind of way… but major stomach upheavals and twisting and a squishy kind of “ugghhhh” pain. And the pain was getting worse. Was it so bad I wanted to die? Well no. (Not yet, anyways.) If it was, say, labor pains I’d be fine and dandy, because it would mean a baby was on the way. I could stick it out, no problems. But when it serves no purpose but to remind me how miserable I feel? Screw it. I took two midol and went to bed (where I am now).

Oh and PS? It’s great having a hubby who is getting mildly annoying and yet is attempting very hard to cheer you up and make you laugh; and having a cat who LOVES cuddles. Soon as Merlin came in here he ran over to me and layed on my chest purring. Kitty cuddles make everything seem better, don’t they. (Now he’s playing with my dog, who was very whiny and looking bored and full of energy. Built-in exerciser.)

I just found out two things about a lap. Well, three but I’d already read one of them somewhere else: That I will be under general anethesia for the proceedure (yay – I really don’t want to be aware of anything… period). That you have to have a breathing tube put in during the proceedure (AGGGH! At least they do it while you’re asleep. Whew.). And that after the proceedure you are not to lift more than 20lbs for two weeks. That should make my life interesting. (I do heavy lifting every day at work.)

Oh, plus you need to get an IV for the lap. I just saw an IV on TV for a birth, for all of 2 seconds. Freaked me the fuck out. That may be the worst part for me. (I can handle injections and drawing blood okay – but I have to look away and distract myself while the needle is in. It just really freaks me out to see a needle in my skin. And an IV goes in and stays in. And that. Is not. Cool.)

The RE’s insurance coordinator called me today to keep me up to date. Basically she said she’s been trying to nail down specifics over exactly what is covered under what (like is my clomid counted as an ovulation induction? Or is it a part of the IUI coverage?) and she’s waiting to hear back from them. She’ll let me know.

She also said that this past cycle she did not get prior authorization for the IUI because she had been TOLD by someone at my insurance that I didn’t NEED it. (During that snaffoo.) Billing hasn’t gone through/been approved for that cycle either, because they always take a few weeks to do it. So she told the insurance company that I should NOT be punished because THEY screwed up and she’s trying to get this sorted out. I’m glad she’s on my side and being my advocate, but I’m still worried that billing will find some way to stick it to us.

So I’m glad I’m doing a break this month to get this all sorted out. Unfortunately she did mention something that makes me think they’re expecting us to do IUI this cycle out of our own pocket… which we have no intention of doing. I wonder if they’ll be upset if we don’t do it. Oh well. I’m still doing the clomid.

So yeah, the more I think about it, the more I think I have endo. I asked my friends and my journal buddies about what they deal with during AF to sort of guage if I’m just a huge sissy or not. Turns out – no. I know my best friend in high school had HUGELY bad AFs, but it turned out she has PCOS. So maybe I just grew up thinking what I had was fine. And actually I remember a time in high school when it didn’t bother me at all. And I remember when it started getting worse. I would cry during AF, curl up in the fetal position and just cry. Then I went on the pill for a few years and I really don’t remember how bad it was…. but I also started using Midol when it did get bad. But when I don’t use midol… definitely very, very bad.

So in any case I’m definitely looking to have a lap done. I just hope the RE agrees with me. I know Den’s getting a little worried about all the time he’s having to take off for IUIs and doctor’s appointments, but the lap is one he really needs to be there for because I won’t be able to drive afterwards… and I need him to write down what the doctor says afterwards, since from what I’ve read I’ll probably be pretty out of it.

Shoot I need to pick up my clomid today. I’ll do that on my way to work.

I got my clomid! I did have to wait a little bit because when I went to pick it up they only charged me $15 and I had to tell them I wanted to pay cash in full. But they changed it no problems. :) Only $45 total. Not too bad. Tonight I’ll take my first one. (Since taking them at night worked so well for me the last two cycles – and didn’t affect it’s effectiveness – I’m going to keep doing it that way and not mess it up!)

Still haven’t heard back from the insurance coordinator about the situation with our insurance. When I find that out we’ll change our plans if necessary (regarding the IUI and U/S) – though I really doubt anything will really change – and then call the nurses to let them know what my plan is (ie, to inform them that I will not be doing an IUI this cycle). They may think that’s a little silly – but that’s okay. It’s not like really expect a miracle this month or anything. But with insurance limiting us to 3 IUIs this is what works best for us.

My period is completely annoying today. Somehow, for some god-unknown reason, this morning I was so distracted I forgot to put a pad on. Got to work, puttered around, went to the bathroom…. WTF?! Yeah. I think that underwear is trashed. Sigh.