These Are Your Tear Ducts on Follistim

OK, I just cried at the finale of “Who Wants to Be a Superhero”. A few minutes after injecting 300 units of Follistim.

Yesterday when I was channel surfing and saw a promo for it, I thought it sounded silly and uninteresting, but somehow today I ended up watching a couple of the repeats they were broadcasting and then catching the finale after poking myself in the abdomen with a couple of needles.

Did I mention cable tv is one of the perks of this whole out-of-town ivf for me? I told Mr. Luo that cable was the real reason I wanted to do a third cycle, but I was thinking of Dr. Who and Stargate and The Daily Show. I’d never even heard of this superhero show. Fortunately I knew a little bit about the esteem in which Stan Lee is held from watching Mallrats, or I wouldn’t have really understood the attitude of the contestants towards him.

Oh, and I blame those bloggers who rave about Project Runway for the fact that I watched many hours of it last night. That and the fact that I was coming off of a cross-country flight and 3 hours of sleep. I was shocked, shocked that someone got kicked off for using linen in a travel outfit, especially since I am quite the jet-setter myself, and approximately 60% of the clothes I brought with me are linen. Wrinkles are good!

P.S. Just so you know my cultural diet has some balance, I spent the morning at the Metropolitan Museum of Art. (My other reason for coming back for this cycle: I got an out-of-towner’s membership at the Met the last time I was here.)

Eastern Daylight Time

I’m here. Took a while to get connected. In the meantime I have had my shortest clinic visit ever this morning-I got called in even as I was signing in. Bloodwork, paperwork, pay, pay, pay, pay, pay, pay. I had no chance to work on the crossword at all.

“Day” “Three”

OK, my brain on lupron thought I had posted this yesterday…now it is late on Tuesday and I have to pack for an early flight tomorrow.

All systems go. 375 Follistim, 0.05 Lupron, and see ya in NYC on Thursday.

All it took was three phone calls from me to the clinic, my local doctor’s office, and the clinic, along with three phone calls from the clinic to my cell, my home, my cell, and it would have been less if I had answered the cell while driving. Compared to past local lab vs. clinic communication fiascos (on beta days of ivf1 and ivf2), this was a cinch.

What Kind of Name is “Luolin” Anyway?

Luo Lin is not my legal name, but it is a real name that I have used in China and Taiwan and in my Chinese classes in the United States. My first Chinese teacher (at a short intensive course I took the summer before I started my job in Old Colony) gave it to me. Most of the people I met in China and Taiwan and many of my classmates knew me only as Luo Lin.

In thinking about this post, I realized that I have had Luo Lin as a name almost half my life.
When I decided to set up a Yahoo account with a pseudonymous screen name to use on the internet, I chose to use my Chinese name. Easy to remember, and I didn’t have to think of something clever. I didn’t realize that a decade later, I would be reading and occasionally commenting on China adoption blogs, where people would recognize luolin as probably a Chinese name. So, I feel like I have to keep explaining that I’m not Chinese, but I use this Chinese name, but I’m not trying to pass as Chinese online and so on.

For a long time, I liked Luo Lin better than my real name: it is more mellifluous and less gender neutral. I like my real name better these days, and don’t get much chance to use Luo Lin outside the computer.

Some details

Luo is the surname; Lin is the given name. Most Chinese have two-syllable given names (like Karen’s daughter Chaoxing etc) but not all. When they are one syllable, like mine, it is common to call the person by the full name, (Luo Lin) rather than just the given name (Lin) in a situation where the given name is used. (That’s not getting into nicknames and diminutives, like Xiao Luo/Little Luo, expecially because I can’t remember if it would be Xiao Luo or Xiao Lin.)
Pronunciation: two second tones Luo2 Lin2.

Meaning: I thought I remembered using “Luoma de Luo” (Luo as in the word for mule) to clarify the character, but I just looked it up and it is not that luo at all. But I am tired, and only looking in the easy pinyin dictionary.

The Lin is “beautiful jade.” The character has the wang (as in king) radical with the lin (as in forest) phonetic.

When I learn how to scan images into the blog, I’ll upload the characters and you can see an example of my babyish writing (in Chinese; in English I have a very mature illegible scrawl).

This is Your Brain on Lupron

I was warned.

In my case, the Lupron seems mainly to affect my ability to take Lupron.
By which I mean, I forgot to inject the Lupron last night, and didn’t realize it till I woke up this morning. I called the nurse-on-call number, got the answering service, and am waiting for a call back. Part of me is convinced they will cancel my cycle. The whole, you-can-do-your-day-3-tests-on-day-5-because the lupron puts-you-in-a-suppressed-holding-pattern idea would seem to break down if you don’t actually take the Lupron. The other part of me say, eh, there will be some solution to this, just like when I (ahem) forgot to take the oral contraceptive one time in my last ivf cycle. Perhaps the fact that I am not crying hysterically about this is due to the fact that I do not have Lupron coursing through my system.

THIS JUST IN: take some Lupron now, and regular dose tonight. Now I am feeling that as a public service I should open up the blog to search engines so as to provide answers to the query, “sh*t, I forgot the lupron shot”. (I tried googling that and got this post of Persephone’s that I read last year and had forgotten.)

The real question is whether this is a newbie mistake, or does it indicate I am blasé enough to be considered post-newbie (on cycle 3, so precocious). This describes me during ivf1 and ivf2 fairly well:

A newbie wouldn’t have forgotten in the first place. She would have her instructions in front of her, reading them carefully, moving her lips reverently, as she went through the nightly ritual. She might even have noted her instructions on her calendar, synching it to her Palm Pilot for daily reminders. (Believe me, I say this with love. I even used to use those alcohol swabs. Cute, huh?)

This time, I still have the ritual (and still use the alcohol swabs), but not longer read the injection instructions every single time. Also, I don’t have a Palm Pilot. For ivf2, however, I wrote down “start lupron” in three separate places (the calendar on my computer, the “week at a glance” format printout of that calendar in my paper organizer, and monthly-format printout that I use to keep track of the ivf cycle (just like the one the clinic gave me for ivf1-I am well trained). One day my Lupron arrived, I gave myself my first injection that night, and then realized it was a day early. See, I get Lupron brain before even taking the Lupron, though I suppose I could blame that incident on the oral contraceptives I had been taking for that cycle.

In ivf 1, all I did was carefully calculate the exact time between 7 and 10 pm that I could inject Lupron consistently, taking into account my schedule (often can’t get home before 9), horror at the thought of trying to do the injection anywhere but home (see above re: rituals), and the fact that I was starting the Lupron in a different time zone than where I would be doing the rest of the cycle. Then I forgot all about injecting the Lupron until 11:15 pm. This is your brain on ivf anxiety.

Or perhaps just ambivalence about doing ivf! The very ambivalence that is making it unsuccessful! I wish I could link to getupgirrl’s rant about that kind of Christ*ane Northr*p stuff, but she is gone, gone, gone. I remember that it began something like “Yes, there is a mind-body connection. Welcome to five thousand years of Chinese medicine” before tearing apart CN’s “findings”.

Enough rambling. We have a seldom-obeyed rule here, which is “no blogging before breakfast”. Time to convince my husband to make some pancakes. (I’m tired of writing “my husband”. He calls himself hubby in comments, but I just can’t call him that, so I’m going to go with Mr. Luo/Mr. L.)

On the Lighter Side

So as not to leave my anxieties on top, and in honor of Karen at Chookooloonks, in Trinidad and Karen at The Naked Ovary, who’s received her Travel Authorization for China, I give you a Trinidadian-Chinese travel story.

When I was working in Old Colony, I had this exchange with a friend and colleague from from Trinidad and Tobago:
Trini Friend: When you go to China, everyone has pictures of you on their walls.

Me: But that’s because your parents are from China, and when you go there you are visiting relatives. When I go to China, nobody has pictures of me on their walls.

Before I moved back to the United States, I took one last short trip to China, with this friend. One day, we went to visit a former student of mine who lived in StoneTiger City. And there was a photo of me on the wall.

Worries at 4:00 am

The Lupron won’t really suppress what it is supposed to suppress, and waiting till day 5 to start will ruin everything. (This is what I was dreaming about before I woke up at 3:45.)

I haven’t suffered enough (no needle phobia, no pelvic exam phobia, no OHSS), so the ivf won’t work.

Because we are trying to cheat Nature and avoid having a child with a fatal, incurable, and possibly juvenile-onset hereditary disease, Nature will give us a child with a different and worse illness.

Because I was too tired to buy tickets to NY yesterday, the prices will have doubled overnight.

No domestic or foreign government agency or expectant mother contemplating a birth plan will ever approve us to adopt a child.

Insomnia is a symptom of depression, so therefore I am having a major depressive episode and don’t deserve to have a child anyway.

Day 1

When my RE said we might do a day 2 start without Lupron, I predicted my day 1 would be yesterday, based on a 25 day cycle which seems to be the current norm. When the plan changed to Lo-dose Lupron (as in previous 2 cycles, but without the oral contraceptives I had in ivf2) and Follistim, I thought maybe day 1 would be tomorrow, since it had come after 8 days of Lupron in the ivf1 and ivf2. Just to remind me not to get confident about my ivf schedule predicting abilities, day 1 came today.

My RE (sorry, no cute pseudonym yet) said that they had enough information about my responses (and, I suppose, those responses were consistent enough) that I could do my day 3 ultrasound and blood tests locally and start testing at Alma Mater clinic on day 6. So I got to make a lot of extra phone calls over the past couple of weeks. Results are: I will do the day “three” tests on Monday at my obgyn’s office (big fancy office with a lab that can do same day Estradiol, FSH, and LH tests, but only on a weekday). If all goes well (lab results actually get faxed to the clinic on time, results are satisfactory, etc), Monday will be my “new day 3,” I’ll start the Follistim, fly to NYC on Wednesday, and show up at the clinic bright and early Thursday morning, crossword puzzles and Sudoku in hand.

At first, I didn’t want to even try the local testing. Aside from the fact that I have had major problems with local labs getting my beta test results done and sent to the clinic for ivf1 and ivf2 (nothing like having to wait an extra twenty-four hours to get a negative result), I sort of liked the way Alma Mater clinic was so snooty about doing all its own tests. Perfectionists, earning those fees, no one else is good enough for our patients, and all that. Also I figured the hotel savings would be balanced by the extra cost of paying for the tests locally. I decided to do the local thing mainly to be able to spend more time with my husband and to be able to help him get all his short term disability paperwork done. Then it occurred to me to call the financial people at the clinic and ask if there was any discount if I didn’t do day 3 tests there. Much to my surprise there was, and it is probably about equal to the amount I’ll be paying here (I’m not sure of the cost of the ultrasound yet).

Here’s hoping day 3 results are fine. I’ve had no problems with them in the past-our hurdle has always come at the transfer-not-implantation phase of the process-but you never know.

Blogger Debts, or Some of the Things I Learned about IVF that Was Not in the Official Clinic Information

I learned that there is a hotel next to my clinic, associated with the hospital, but that if one’s cycle takes longer than you expected, it might be hard to extend one’s stay.

I learned that the clinic is so busy I should expect it to be like an assembly line (the big waiting room was empty when I went for my consultation, so I would have been surprised when I showed up for my cycle), but that that is a good thing in some ways. As Emma Jane at Barely Tenured said a while back:

I admit that I was worried about some of the cattle-call stuff I’d read about. But, when the crowds were big, I remembered that I was there precisely because they’re a huge clinic, and that you always always always want to be treated by people who do nothing but take care of your kind of problem, all day long, every day, for years and years and years.

I learned that it is a good idea to call if something doesn’t seem right, because sometimes they’ve got it wrong, even at the clinics that have so much experience doing these procedure. Too many examples to link to, but I can share my own stories on that later.
I learned that sometimes pgd results are wrong.

Why I Travel

I have done all my ivf cycles far away in a metropolis (let’s call it “New York City”), at a fancy clinic that is associated with a branch of my Ph.D.-granting institution. I got all nostalgic the first time I saw the college logo on their stationery, but that didn’t last long-they’re not even in the same city. While I appreciate the chance to traipse around the city while confirming the ascendance of the B*g*boo stroller amongst those who can afford it, doing the ivf there instead of here adds all kind of inconvenience and expense to the project. In fact, I just figured out that it added 12-24% to the cost of the cycles. Why travel, then?

Well, first we needed a clinic that could do preimplantation genetic diagnosis. (Another post needed to explain why). Secondly, the clinic that is close enough to drive to (let’s call it the Clinic I Hate, CIH) would not work with me because my weight was higher than their limit. “Studies have shown,” they said, that obese patients do not respond well to stims. Strangely enough, that has not been my problem with the first two ivf cycles. Perhaps not so strange, given that my reproductive endocrinologist and his colleagues are the authors of a study on ivf and obesity, yet when I called the clinic the first time and timidly asked if there was a weight limit, the woman who answered didn’t know what I was talking about. “Do you mean the wait?” she asked. In any case the study does not say obese women cannot succeed at ivf, but that they may need higher doses (I don’t) of stims, and that pregnancy rates per transfer are not affected.

When CIH first told me I needed to lose weight before I could cycle there, I figured I couldn’t lose fifteen pounds (approx) in a month in any kind of healthy way, so I gave myself a year. I needed to do the cycles in the summer to work around my teaching schedule. By the next year, I had gained ten pounds. Thank you, CIH (to be fair, the tenure review year may have had something to do with it, but never underestimate my rebellious side). So I called Alma Mater Clinic and cycled with them at the end of the summer (no problems with weight or wait). Thank you to Cecily at Wasted Birth Control and the mental health professionals in my life for encouraging me to be assertive about finding a clinic. Thanks for nothing to CIH for the year I wasted. Of course, if I had not just accepted that I was unsuitable when they told me so, I could have call AM clinic a year earlier. I read enough blogs to know that clinics have different criteria for accepting and rejecting people. But (and this is also why it is scary for me to even mention my weight in a blog with a comments section) because my weight is a big topic for my self criticism, I accepted CIH’s rejection of me as entirely appropriate.

For the record, I am back at the weight I was when I first talked to them. Over the past year and a half, through two ivf cycles, I lost ten pounds. I am contrary that way: when I read in my ivf materials that I was not supposed to engage in strenous exercise once I started stims, I joined started swimming and joined a gym a few weeks before that in addition to the weekly dancing and twice-yoga I was doing. I had some vague idea that “strenous” might be a relative term, so that the higher my activity level before starting, the more would be ok during the cyle. I was wrong. I think it is funny, though, that “walking is ok,” even though a normal amount of walking in NYC would be a lot to people where I live and drive.)

Now, I am off for Lupron injection #6. Next post may be: my brain on Lupron.