Lucky Number 7 [continued]

Lucky cycle number 7 is on the verge of being cancelled, so as it turns out, the Agonist/Antagonist Conversion Protocol recommended by Dr. Sher didn’t work for me. This is SD 8 (stimulation day 8 – in other words, my 8th day of taking drugs to stimulate follicle growth in my ovaries). We went in for our monitoring appointment, knowing that we had three small follicles and one possible cyst three days ago. The nurse waved the ultrasound wand around inside my pelvis for all of two minutes, which was a record-short ultrasound for me. I didn’t even see her measure the follicles on my left ovary. But somehow she concluded that there was no growth since my last scan three days ago. And my labs also showed no increase in estrogen, which Dr. Sher did say could happen with the A/ACP. However, without a change in estrogen or follicle size, CNY saw no justifiable reason to continue.

I’m not surprised, but I am disappointed. In spite of my attempts to avoid getting attached to the outcome of this cycle, I am upset. I put a great deal of planning and resources into cycle number 7. We have been staying with my in-laws in Rochester, NY in order to be monitored locally by CNY Fertility. Typically we are travel patients. Many things needed to fall into place in order for this to be possible. I gathered up the courage to ask permission to work remotely. I chose a month when I knew my meeting schedule would be light. My ex husband was available to take care of one of our dogs, Chance, who I adopted during my first marriage. My consultation with Dr. Sher was in October, 2019 – nearly three months ago. I waited and waited after a letrozole-induced 60 day cycle, so that I could start priming with birth control and lupron, the first phase of the protocol. And finally, on January 3rd, my period came. We left for New York that weekend.

I got the call from the same nurse at CNY that I saw this morning for my record-fast, and apparently unremarkable ultrasound. I think it’s interesting when people delivering bad news tend to ask, “how are you?” beforehand. I imagine that it’s how they have learned to warm up to the person on the other line, and perhaps buffer the blow. I stopped disingenuously answering “good, how are you?” as I expected they wanted to hear, and started meekly responding with “I’m okay” at some point in this process. She said that she had talked with the other nurses in the office, and since there had been no measurable growth, and they were unfamiliar with the protocol recommended by Dr. Sher, they could not advise me to continue. She told me that the addition of Cetrotide on SD 1 was something that CNY would not recommend, because Cetrotide can stunt follicle growth. She gave me several options, including continuing for a couple more days and keeping my appointment two days from now to see if anything had changed. She advised me to call Dr. Sher, which I had already planned to do.

I called Dr. Sher, being mindful not to contact him too early, since he is in Los Angeles, 3 hours behind me. I explained that I was in the middle of a stimulation cycle using his protocol, with little to no follicle growth on SD 8. I asked for his recommendation. He said that it was clear the protocol wasn’t working for me, and then proceeded to recommend estrogen priming, but not just any estrogen priming. HIS estrogen priming protocol, which he would disclose to me should I decide to cycle with him in L.A. (which we cannot afford to do). He also opened up my records, and noted that I have “EXTREMELY low AMH and VERY high FSH.” He added that my AMH is probably much lower now, than the last time it was measured. He finally recommended that I continue stimming for 4 days using the same meds, and if nothing changes, the obvious choice would be to cancel this cycle, schedule a cycle with him to try estrogen priming, or move onto donor eggs. To Dr. Sher’s credit, he has answered his cell phone both times I have called him, and has answered my questions, for the most part.

I had to take a few breaths and fight back the tears after these phone calls. Reality set in. I talked to my husband about our options, and we decided that we would continue meds and keep my next monitoring appointment, if nothing else, to use the time to discuss a new plan. Perhaps estrogen priming? Ironically, I had discussed estrogen priming with CNY after my last cancelled cycle, but while researching it, I came across Dr. Sher’s agonist/antagonist conversion protocol, became intrigued, and set up a phone consultation.

It seemed pointless to continue the same amount of meds – Gonal-F, Menopur, and a full dose of Cetrotide – as I had for the previous 7 days with no measurable progress, so we decided to try removing Cetrotide. Two days with stimulation meds and no Cetrotide may at least tell us whether or not Cetrotide was impeding follicle growth. We don’t have much to lose (except valuable stimulation meds), because this cycle appears to be a bust either way.

I’m tired. My body hurts. I am feeling anxious about being away from home. I began experiencing physical side effects from stimulation drugs during my last cycle that was cancelled in October, 2019 after nearly two weeks of stims.
My joints began to ache.
My knees would throb. They hurt when I was sitting. They hurt while I lay in bed.
Then my back began hurting.
Then I started spotting.
I felt pretty good this time, until few days into my current cycle, when I started having intense cramps. [TMI] I started spotting and passing pink tissue. But other than that, I felt fine. Then the joint pain set in around day 7 of stims.
I have had more cancelled cycles than egg retrievals at this point.
I often wonder how many more times I should put my body through this.

• 

It is hard for me not to feel like I am now another step further away from having a baby, instead of another step closer. When I spoke with the CNY nurse today, she looked back at my previous cycles, noted that I had my best cycle yet on letrozole, and expressed that for women like me, sometimes IVF is trial and error. But time marches on, and while I always attempt to find the lesson in what didn’t work, I think about the amount of months and years that have already passed. When I felt like crying today, it wasn’t because my cycle was getting cancelled. Instead, I caught myself thinking of the pregnancy we lost in 2018. She would be 15 months old now. We would have our baby – if only I could have kept her alive. We wouldn’t have been presented with the option to venture down this path of seemingly never-ending treatments, appointments, procedures, and medicine that fucks with my body and my emotional state.

In an effort to document my cycles for my own reference, as well as possible benefit to others, I have outlined my protocol below. I also plan to share protocol outlines from my past stimulation cycles in upcoming posts.

ETA: This cycle was cancelled, as we suspected it would be. After dropping the Cetrotide for two days, there was still no measurable follicle growth. We sat down with the PA at CNY Rochester, and she theorized that Dr. Sher’s protocol had suppressed my ovaries too much. She came up with a couple of options for our next stimulation cycle, and set an appointment for me to talk to Dr. Kiltz on the phone this coming Monday.