EPP Deja Vu - SD1 (CD2)

I had my CD2 baseline appointment today. The ultrasound showed no cysts (!) and 2 antral follicles on each ovary (!). The bloodwork also looked "terrific." E2 - 184; P4 - .30, LH - 1.10 and FSH - 4.7. Don't get too excited about the low FSH - it's supposed to be lower because I have been estrogen priming for the past eight nights. The only concern I have is this cycle appears to be an exact replica of my last EPP attempt. The CD I got AF would have been CD 18 (same as last time), I didn't have any cysts on baseline, my lining was fine and my E2 was 187. So, we'll see if I respond. Dr. Sacks decided to try a low-stim approach this time, though - he lowered my nightly dose of Follistim from 450 ius to 150 ius and kept my Menopur the same at 150 ius. I continue to take the Estrace two times a day. My first check-up to see if I'm responding will be on Tuesday...after five nights of stims. I must say that I'm feeling good about this cycle, though. I think I must feel that way, though, because I've made the decision this will likely be my last attempt. Stay tuned!

And the Scenario Winner Is...

#2! I went in today for an ovulation check (CD11) and my blookwork shows that I ovulated (E2: 238 / P4: 3.9). The ultrasound revealed two follicles (we can call them follicles and not cysts since I ovulated). They were both large (at least 25 mm), but one was cloudy, which typically indicates rupture. I'm a bit concerned that the second one wasn't cloudy though, because that means it did not release an egg and could turn into a cyst at the beginning of the next cycle. Anyway, since I ovulated, Dr. Sacks decided to put me on the estrogen pills again. I asked my nurse if doing so will result in the same response I had the last time I had taken them (no response to stims). She is going to check with Dr. Sacks to confirm and get back to me. I'm really trying to take this cycle in stride, but I am optimistic that this cycle will yield better results.

A Little Bit of Information Goes a Long Way

Dr. Sacks is back on my good side. After I sent my new favorite nurse, Amy, an email telling her that I was surprised Dr. Sacks didn't want to do anything until the start of my next cycle and asking her if she knew what his plan was for me, he sent me the following email:

"In general, the cysts on your ovary are either from the previous cycle, or new this month because your body is trying to compensate for the reduced ovarian function. In that case, the level of FSH is higher just prior to the menstrual cycle beginning and the “cysts” are really follicles.

It is impossible at this point to distinguish between these two scenarios, but neither one should delay the onset of the next cycle or stop us from moving forward. In addition, they should not need to be aspirated prior to starting a cycle.

I was going to check you in a week to get a better idea which scenario is more likely, and they would make some recommendations.

If it looks like you have already ovulated, then the second scenario is the case and I may start estrogen pills to block the early rise in FSH for the next cycle. If you have not ovulated, then it is the first scenario and I will just await the resolution of the cysts and the onset of the next cycle."

So, all is well again. I'm very happy he emailed me. However, had I not emailed Amy, I would have simply gone in on CD1 and another cycle would have been lost. This all goes to show you...be proactive ladies!

As Suspected...

I had a cyst (well, I actually have TWO large cysts on my left ovary) during today's CD2 baseline appointment. And go figure that I had a few antral follicles on my right, clear ovary. I really wish I had been monitored a bit more closely last cycle (or at least gotten some feedback when I told Dr. Sacks that I tend to ovulate early) because I truly believe that was a rare cycle in which things were coming together so nicely and likely would have produced at least one good egg. It is not a good sign that Dr. Sacks asked me today what my schedule is like. This can only mean that if there's no scheduling timetable, he may take the slow route to get these cysts to shrink and then we just start all over again. Unless Dr. Sacks does shake things up a bit (but I don't know how much shaking he can do when I have two cysts), I bet he puts me on BCPs to shrink these cysts - or we wait until I ovulate and go on the estrace again. There really aren't that many other options at this point.

I just got my bloodwork call. The cysts were producing E2 (344), so Dr. Sacks actually just wants me to sit out for a month and come back on my next CD2. I'm surprised that he's not even going to try anything to shrink these cysts like he (and my former RE) prescribed in the past. I'm starting to feel a bit more deflated now that we missed my ovulation last month when things were looking promising. The kicker for me is that this cycle's FSH was AMAZING - 2.2! Go figure I have such a low FSH on a cycle where I can't do a darn thing about it.

Back to Square One

Yesterday's appointment showed that I indeed did ovulate. So yes - to answer my earlier question - it is possible to ovulate when your follicles are small. So it's back to the drawing board. I will call on Cycle Day 1 to schedule my baseline appointment and we'll start anew. Dr. Sacks is not going to put me on another estrogen priming protocol considering my non-response from the first attempt.

Riding the Roller Coaster of Infertility

My hopes for going to egg retrieval were very short-lived. I got a rather disappointing bloodwork call today telling me that my LH was surging, so it was likely ovulation was imminent (if it hadn't happened already). I should have given myself that Ganirelix shot yesterday! Amy (the nice nurse) told me that even if we had gotten the results back yesterday, it still probably would have been too late (but I'm still doubtful about that). She asked if my husband and I had gotten any action in (my words, not hers) and I had to laugh inwardly knowing it would have been futile even if we had.

Dr. Sacks still wants to see me tomorrow - I guess to see if I've ovulated (doesn't this sound familiar?). And I have a strong suspicion that when I do get AF in about two weeks and go in for a baseline appointment, there will be cysts. These follies were too small to actually ovulate anything and based on my history, all facts point to cysts ahead. Dr. Sacks is going to have to get really creative for my next cycle. I'm a bit peeved about missing a potential egg retrieval this time. I had a lot of faith in these three follies that appeared semi-naturally. I had emailed Dr. Sacks last week telling him that I tend to ovulate early. He never responded to that email, so I assumed that he wasn't too worried about it. My guess is is that he's not going to be too concerned about missing an IVF opportunity this cycle since his intention was probably just to monitor my body and see what it does without any meds. But considering an opportunity arose for a decent egg retrieval, I feel as though he should have monitored me more closely (especially since I armed him with some information about my cycles). So now I'm back to feeling blase about going in for tomorrow's appointment.