Now What?

I'm getting frustrated. I had my botched IVF follow-up appointment with Dr. Mottla today. They took some blood (to check my E2 and progesterone levels and I asked them to throw in a TSH check, too) and performed an ultrasound. The ultrasound revealed that I still have that damn cyst. I kind of figured it was still there. I'm on CD22 and doubt that I've ovulated yet because my temps haven't gone up, nor have I gotten a peak reading on my fertility monitor. I'm pretty confident that this delayed ovulation is due to either 1) the fertility meds I was on at the beginning of this cycle or 2) the birth control pills caused my body to not know what to do.

Dr. Mottla told me that he's going to wait to see what the bloodwork reveals, but he's probably going to prescribe Provera for me to kick-start AF and then have me return on CD3 for a baseline appointment. If the cyst is still there, he will put me back on BCPs for another month to see if that combats the cyst. However, considering I was on them last cycle when this cyst formed and considering doubling up the dosage of BCPs when they found the cyst didn't do diddly, I don't understand how putting me back on BCPs for another month will get rid of it, but that's a question for another day. When I asked him why he wouldn't want to aspirate it, he told me that they try to be as minimally invasive as possible (sound familiar?), but if it was filled with fluid (and not blood), he would consider doing it. I don't know how they determine a cyst's contents, but that's yet another question for the future. Dr. Mottla told me that he will personally call me back this afternoon with my bloodwork results and probably just tell me to take the Provera and come in on CD3 and we'll go from there depending on what my body chooses to do.

So now what do I do? Should I take the Provera or just let my body do her natural thing for once? If I were to follow Dr. Mottla's plan and go back on the BCPs, I won't be able to start my IVF cycle for about 5 weeks (2 weeks to get AF and 3 weeks of BCPs), which puts me at the end of September or beginning of October (and that's IF the cyst has gone away). I have an initial consult with Dr. Sacks at Columbia Fertility Associates in the beginning of September. Maybe I should just rack up my experience at Shady Grove as a learning experience and move on at this point - especially since I won't be able to get started again until October at the earliest. In the meantime, I can try to just see an acupuncturist and hope that he can get my body in good shape for the next round of infertility treatments - whenever that may be. I'll get it figured out - I always do and things work out just fine.

However, I do have some other possibly concerning news to add to my mix of issues - Yesterday I had my annual mammogram. (I had to start getting them two years ago at the age of 35 because my mom was diagnosed with breast cancer in her early 40s (or was it her late 30s?). She had a complete mastectomy and she's been cancer free ever since). The tech told me that I have very dense breasts. I'm not sure what that meant, other than she had to expose me to more radiation. She also had to take an extra picture of my right side (I had to be called back so they could rescan that one two years ago because they couldn't tell if I had something to be concerned about or just this dense tissue). She told me that the breast doctor will be there tomorrow to review my results, but I didn't like the look on her face when she told me that. I need to stop googling. The first two hits that come up about dense breast tissue are 1) dense breast tissue hikes risk of cancer and 2) Premenopausal women, especially women who have never been pregnant, may have dense breast tissue. I'll just wait for the doctor's call. However, a good number of my Fertile Thoughts High FSH friends have been posting that they, too, have been told that they have dense breasts and are cancer-free. However, this could lend to a link with our probems in TTC. Interesting.

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Just got the bloodwork call from Dr. Mottla: I didn't O. Uh, yeah - I knew that. P4 was .4, E2 was 504 and TSH was .4 (that's on the low side now, but he's satisfied with that since he'd rather have it be lower than higher since it increases during pregnancy). He's calling in a script to the pharmacy for Provera. So I get to join that happy train. I'm supposed to return on CD3 and Dr. Mottla wants to be there personally for that appointment, as well. So, at least I'm getting that personal touch now, which is nice.

A Lesson in Patience - The Cyst Saga Continues

Well my cyst is still there - it actually grew a bit to 35mm. So, I have to wait for my bloodwork results, but it looks like I'll either have to stay on the double dose of BCPs (which is doubtful considering the cyst didn't get any smaller) or will have to have is aspirated. After they do that, I can start stimming right away, so that's actually good news.

What I'm even more thrilled about is that Shady Grove really seems to have stepped up things in the TLC department. It seems as though they've done a complete 180 in providing personalized attention and showing genunine compassion and empathy. Maybe this change is due to the fact that (in my opinion) they weren't monitoring me closely enough along the way and feel bad about that so now they know they need to pay closer attention to me. Whatever the reason, I'm happy with the way things are going now and I will let bygones be bygones. Joyce, the morning nurse on duty, looked as though she wanted to hug me when I came in to meet with her after she found out that my cyst was still there. She told me that she and my nurse Dana had actually been talking about me yesterday and saying how I just couldn't catch a break. After I had checked-out, she actually called me over to her office again and told me that things WILL work out. So that was comforting. Whether they will or not, I appreciated her confidence in my situation.

So, it's back to the waiting game for me for now. If they do decide to aspirate the cyst, Shady Grove might be able to get me in to their Rockville office (the only office that does the aspirations) either tomorrow or Friday. Believe it or not, I'm actually feeling more hopeful about things again because there's a good chance that this cycle may not be a bust, after all.

Possible Good News, Yet Losing Some Hope

I got my TSH re-test/additional test results back last Friday. My TSH was a 1.530!!! Here are my other results:

T4: 11.4 (normal levels are 4.5 - 12.)
Antithyrodlobulin Ab was < 20 (normal levels are 0-40)
Thyroglobulin: 7.7 (normal levels are 0.5 - 55)

My question is this - if my TSH level came down that much after just being on the medication for two weeks, does that mean that I'm now in danger of having HYPERthyrodisim? LOL. If it's not one thing, it's something else. While I'm trying to stay as positive as I can about being able to start the IVF process, considering all of the obstacles I've faced so far, until that day actually comes, it will be hard to believe that I made it there.

Regarding acupuncture, as much as I have truly enjoyed my past two appointments (last Tuesday's appointment was simply heavenly), I think I'm going to postpone any more until after my IVF cycle if it results in a BFN. $95/session is too expensive for us right now and the impression I'm getting from my acupuncturist is that he can help me more if he does acu for me in conjunction w/ herbs (which I won't be able to do while stimming). So, I plan on taking a good three month break IF my IVF cycle doesn't work. During that time, I will go whole hog w/ the acu and herbs and see if I can get a natural BFP while my body is not all whacked out on meds and artificial manipulation.

As for how I'm feeling as I'm gearing up for yet another baseline appointment on Saturday, I'm starting to lose a bit of hope. I'm not really feeling confident that I actually will be able to cycle again. My cycles typically are about 23 days. These birth control pills (BCPs) have artificially put my body on a 28 day cycle and I have a feeling that my body wants to stick to the shorter cycle (I've been experiencing cramps during times that I shouldn't be experiencing them and I feel like I was having PMS symptoms last week meaning that I should get AF this week (but can't because of the BCPs); therefore, my body won't respond to the stims the way that other ladies who experience regular cycles do. Considering I have been on BCPs for two cycles, I also have a nagging feeling that I will be too repressed or I may have even developed cysts. At this point, I really have absolutely no confidence in my RE at all. Why does Shady Grove put everyone on 21 days of birth control pills prior to their assigned protocols? If my cycles are shorter than other women's cycles and my follies probably start to develop even before I get AF, wouldn't being on 21 days of BCPs confuse my body even more? I'll be especially upset if I can't proceed with this next cycle because he didn't do anything to address my high TSH level prior to when I was supposed to start last cycle. I didn't have any cysts and my other blood levels were good to go, so last cycle could have been my successful one. I really have a feeling that my RE has no clue as to what he's doing. Maybe I'm mistaken and judging unfairly, but he has given me no indication that he knows what he's doing. A phone call to alleviate any of my fears and misguided assumptions would be greatly welcomed, but we all know that won't happen since when has my Shady Grove office ever taken the iniative to show that they care or know what they're doing?