My ovaries have thumbed their noses at nearly everything my treating physicians and I have thrown at them. Clomid? Ha! No follicles. Femara? Pfffft…no follicles. After a while, I started referring to the pair as Lady MacBeth and Bellatrix, after two of my favorite literary villainesses. Lady MacBeth’s declaration of “unsex me here” felt especially appropriate to my (admittedly somewhat dark and sarcastic) sense of humor since I struggled with so many feelings of not being a ‘real’ woman. Yes, I know, in the play Shakespeare is actually referring to the idea that a woman with true feminine sensibilities couldn’t commit such acts of violence and treachery as the ones Lady MacBeth is about to embark on. So yep, I’m taking it a wee bit out of context, but I like the way that part sounds.
Finally, when Arthur and I threw in the towel with the oral fertility treatments and started seeing Dr. D my RE, he put me on Follistim by subcutaneous injection.
Even with the big guns of fertility medications, my ovaries responded grudgingly. After three doses of 50 units and then two doses of 75 units, my ovaries had pushed up a measly three 10 mm set of developing follicles. My E2 level was a paltry 37. After another four days of Follistim at a higher dose of 125 units daily, my ovaries had grudgingly allowed one follicle to grow to around 15 mm and another to around 13 mm. My E2 was 157. I took two more days of Follistim at 125 units, then triggered. I wound up with no pregnancy and two large cysts on my left ovary. My blood work showed that I had ovulated, but all in all, it seemed my ovaries just weren’t planning to give up any eggs without a serious fight.
For this latest IUI cycle, Dr. D put me on a protocol of 100 units of Follistim for five nights. This wasn’t an enormous dose adjustment, particularly taking into account that I had six days of Follistim last cycle at 125 unit doses. I headed into the office on Thursday expecting three or four reasonably good follicles. The ultrasound tech ushered me back and started the scan. Then I saw her furrow her brow slightly and she said “Oh, wow.”
I’ve learned that in health care, unless it’s accompanied by an obvious smile and/or a cheerful tone of voice, “Oh wow,” is the don’t-freak-out-the-patient polite way of saying “Oh sh*t.” Absent of the smile or cheeriness, it is never a good sign. My heart dropped.
It turns out my ovaries are acting like sheltered teenagers tasting freedom for the first time freshman year of college and partying wildly. Go figure.
After cycle upon cycle of underachieving, this time, they decided to go for the gold. The ultrasound tech measured nine follicles at a minimum of 10 mm, with four of those at 12-13 mm. The ultrasound tech and the nurse reassured me that while this was not exactly what they’d hoped for, they wanted to take a look at my blood work before any panicking happened.
My E2 level came out around 400. To put this in perspective, the best possible E2 I achieved last cycle if it doubled, as it’s supposed to do every 48 hours with the medication, it would have maxed out around 315. The 400 on this cycle’s day 5 was sky high compared to last cycle’s day 5 reading of 37.
Okay, now it was time for mild panic. Dr. D instructed me to take only 25 units of Follistim that night and come back in the morning for another scan and more blood work. I called Arthur, told him the results and tried to keep him calm. We were both a little nervous, but Dr. D seemed confident that he might be able to save the cycle if my body could just convince my ovaries to work on developing only a few of the larger follicles.
I headed back to the RE’s office this morning. The ultrasound tech took another look at my ovaries. This time she counted ten total follicles at 10 mm or above. One was still around 12 mm, and three were around 13 mm. In other words, the follicles had more or less stalled out where they were on Thursday. My E2 level had dropped to 325, which the nurse assured me was actually what they were hoping for so that I could continue the cycle.
I knew that PCOS patients tend to have a higher risk for superovulation when using Follistim or other gonadotropins, but you could have knocked me over with a feather when all of a sudden there were nine or ten follicles that appeared promising after months of fighting to just get one or two. It feels as though my ovaries, like their nasty namesakes, don’t want to play nice. If it’s not enough follicles, it’s too many. I go back to the RE’s office on Sunday, and hopefully by then, we’ll have around three lead follicles and a matching E2 level. I just don’t want the cycle to end up cancelled for any reason.