Sunday, September 03, 2006

Pay No Attention To The Man Behind The Curtain

I realize when I started this thing that I was a bit bummed at how few men there were blogging about the crapheap that is fertility treatments. Now, I want them all to stay away, because I am truly loving the attention from all of you and I want no competition. So, guys, if you are reading this, there's nothing to see here. Move on. These blogs are lame anyway. Chick stuff. Plus, there's a game on.

Ok good. So I was wondering why our Doctor, Dr. ButtMunch, never tells us what's going on. As I mentioned before, my wife and I met with him during our initial consult, and we have NEVER seen or heard from him since, save a lame message on our machine telling us how "sorry" he was about our last BFN.

So in our last IUI cycle, they started M off with like 150 milligrams, or units, or whatever the fuck they are, in that follistim pen. On her FIRST ultrasound, they said they saw 4 decent follicles, and then cranked us up to 225. At the next ultrasound, she had eleven follicles. They kept her at 225. Next ultrasound, they saw 16 follicles. The ultrasound technician said "I'm sure they've already discussed with you the conversion to IVF". NO. What the hell are you talking about? The technician was like "well, they can't give you an IUI now, or we'll all end up on the cover of People Magazine". So, later that day, we were told we were moving straight to IVF because of M's "overstimulation", even though they cranked her UP after the first appt.

So that IVF was negative, and that's all background. We are now back to IUI, as mandated by our insurance coverage. We are in our next cycle, but they have started her off at 75 kilowatts or whatever on the follistim pen. So we go in after a few days for the the first ultrasound, and guess how many follicles they see? NONE. The trusty technical told her that was low, but not totally uncommon. But it makes us worry a bit.

So we get a call that day (Saturday). "Ok, keep going at 75, come in on Monday, gotta go see you then bye"

Why the F would they crank her ass up the first time, and not the second time, when she is producing below average follicles? I just want to believe that there is some guy in that office, hopefully Dr. ButtMunch, who is watching all of this, reading all the data, and has a brilliant master plan from behind his curtain. I guess we'll see. If any of you lovely ladies with your advanced degrees in fertilities have any clue, I'd sure appreciate hearing it.

By the way, some of you asked if my wife reads my blog. Yes, she does. Sometimes she gets pissed at how much I reveal. She's afraid some of you are our next door neighbors.


One Mother's Journey said...

We may have to hate you if you tell us that you actually have insurance that covers any of this... just kidding but if you do, there are a ton of us out there with complete and utter coverage envy. (And I try to reserve my envy for the important things - like positive pee sticks and astronomical sperm counts.)

My guess is that they kept her on the same amount this cycle because they hyperstimulated her on your last cycle and they are trying to avoid that this time. They are probably just hoping that on her next ultrasound she'll have a more workable number of follies for an IUI.

kilowatts... LOL. Nice.

Krista said...

My last IVF I went in on day 5 and had only 3 follicles, they cranked up the dose and when I went back 3 days later I had 13,put dose back down but 2 days later I had 22 and ultimately I ended up with 32 follicles. This round my doctor says we are staring on a lower dose and staying on it even if we don't see anything the first couple of scans. What she is counting on is that those other follicles are going to develop, maybe more slowing but it is better to have a few more slowly than explode with such a high number.

I'm not sure about your clinic but at mine if you have more than 4-5 follicles your IUI is automatically converted to IVF.

Thalia said...

Only a US clinic would have pushed up your dose on that first cycle having seen 4 follicles. 4 follicles (at the right size) is one too many for IUI in a UK clinic! I can't understand why they didn't just start you on 150 again this cycle.

Having started on 75, I'd hang tight wit this dosage. You might find that more follicles appear as you go on - they did last time and not necessarily just because they put the dose up.

theoneliner said...

You and M are further along in this process than my husband and I...I do not know about IVF,IUI, etc...

But I have learned that you have to advocate for you. Dr BM is probably not thinking about anything...other than his summer house. Maybe you're clinic is better than mine..but that's been my experience.

Call them. Kindly demand answers. They are getting paid $$$ (one way or another) tooo much for you to be this much in the dark.

What bugs me the is it that you two have no say in how much whatever drug she is taking. How much overstimulation you're willing to, at least in part, up to you both.

Call. Or, if you can, go in person.

I hope you get answers soon.

Lyrehca said...

I think we may go to the same (MA-based clinic). I am the biggest PITA when it comes to getting results/answers from them. Not sure if we see the same doc, but I'd insist on at least a phone consult with him/her to ask exactly what is going on, exactly what the next step is, and exactly WTF. During IUI/IVF cycles, I was on the phone with (at least) a nurse regularly, and have had one or two phone consults with the doc and Mister Lyrehca so we all knew what was happening when. Type A and anal? Yes. But we always knew what was going on.

Lyrehca said...

I think we may go to the same (MA-based clinic). I am the biggest PITA when it comes to getting results/answers from them. Not sure if we see the same doc, but I'd insist on at least a phone consult with him/her to ask exactly what is going on, exactly what the next step is, and exactly WTF. During IUI/IVF cycles, I was on the phone with (at least) a nurse regularly, and have had one or two phone consults with the doc and Mister Lyrehca so we all knew what was happening when. Type A and anal? Yes. But we always knew what was going on.

NikkiNix said...

First things first - any looooser neighbour who's found you KNOWS you're going through ART... secondly anyone who's sick enough to continue readin is jus a ButtMunch... speaking of which I looove the MD behind the curtain because again,I', scheduled for IVF/ICSI and our retrieval i sin 10 days and other than the first consult I've been chauffered by nurses as well - for gosh sakes!

Now this pen... is the FSH drug, which I started yesterday at age 32 with 250 megawatts (as I love that you call them that) so what the hell are these people doing ??

C'mon smarshy - get someone in that clinic to have a sit down, you've got some valid questions, and logic... and deserve some answers. My own GP is fantastic about teamin with me in anything medical, so I agree with you that this "behind a curtain" approach leaves me feeling quite dis-empowered.

Keep in touch.

spark said...

It's still early and given her history they're probably just being conservative now... Give it a few more days to see what happens.

My RE keeps dosage low in the beginning to recruit a reasonable # of follicles (not too many) and then cranks up a bit more later.

My Reality said...

I don't know why doctors do what they do. I also don't know why drug response from cycle to cyle can be so different. I do know that if I want answers about things, I have to get kind of pushy and demand them. I do know that if we don't speak up, we can sometimes get lost in the crowd, especially at a big clinic.

If your insurance covers IUI, do they also cover the conversion to IVF in the case of over response?

What cycle day is your wife? It does sound like there is still time for things to grow, either by upping the meds or giving it time.

fisher queen said...

Unfortunately, you have to tie yourself to the phone to get any answers out of these people. Non-responsive doctors/nurses are one of the worst things about this whole process. If you continue to get service like this, I might shop around for a new clinic. I'm serious.

To me, that first protocol seemed awfully aggressive. That was dosage I took for an IVF- I'm honestly wondering if they screwed up, thinking that was what your wife was doing. The 75 IU is what I did for an IUI. I wouldn't worry about response just yet- it takes a few days, and sometimes they continue to grow even without upping the dose. During my IUI with stims I had 4 follicles, and everyone seemed very pleased with that. It's not enough for an IVF, but it is a good response for IUI. Don't worry yet!

Heather said...

I'd have to agree with most of the other comments. It sounds like they found out how well your wife responded last time and toned it down quite a bit to allow IUI to happen.

During my follistim/IUI cycle I started out mid-range high (I think around 100iu's), then based on my u/s and b/w the modified the dosages.

In the end I had one good follicle and one so-so. Which in IUI land I guess is considered "perfect".

ellie said...

It's more of an art form than a science-- while it would be nice if we all responded to the stims the same way- just like the side effects- all different for all of us. Since you got a few too many follies the first time they are sticking low thinking that perhaps your wife will respond but not on the first u/s. I have had 2 follies for the last 2 ultrasounds I did and got bumped from an IVF to an IUI-- this morning- on my ultrasound I have 6. They reduced my meds down 2 days ago. Seems like with less stims that I would have less growth and not more.
Whatever- I figure we put the meds in our bodies and then it takes awhile to work- a delayed reaction in some of us. It's sad to say but each time you go through the meds process they learn alittle more about how you respond and to what....nothing really scientific about this process other than the doctors are involved.

susan said...

I gotta tell ya, from what you've described I would never step foot back at that clinic. The place I go is all fancy-pants too, right outside of NYC and from our first meeting, my RE (Harvard) has done each and every scan, reviewed all results with me in person and has been by our side throughout. It sounds like you have an absentee doc which is evidenced by the bullshit dosages you are getting. It isn't being closely monitored enough.

Stuff like this frosts me and it sounds like it has nearly killed your wife. If you find someplace really responsive it will relieve a bit of the stress for her (and ultimately you) because she won't feel like she needs to control it, or run the show. I'm a control freak myself and have totally abdicated to my RE because he is SO THERE. He says jump, I say how high... I know he is very tuned in and therefore I don't have to be....

What a clusterfuck all of this is...IF in general, and incompetent medical people. I'd love to know the rationale for the insurance assholes to require going back to IUIs...that is incomprehensible to me...