As frightened as I am that IVF#2 will also be a waste of time and resources, I'm pleased that we can start right away. While we were navigating the potential scheduling conflicts, I feared that we would need to wait for a cycle and then proceed during the luteal phase of the subsequent cycle, which could push my stimming and retrieval into the middle of summer. I was supposed to allow my uterus to have one 'normal' cycle after my D+C and then we would coordinate my first FET with the next cycle, but as it took over seven weeks for AF to arrive, my RE felt that enough time had passed and graciously let me start my prep with that cycle. Especially as my 38th birthday is lurking, I'm really keen to start sooner rather than later.
I took an inventory of my leftover meds and called New Girl the next day to review my protocol for this cycle. I pretty much already knew what he was going to use, so I would have been happy if she just gave me a verbal confirmation. She could have also mailed a copy of the list, since I have enough time to gather my supplies. Rather she offered, "I can just take a picture and text it to you." Seriously? "Although you know this is not a HIPPA secured transaction...Wait, I'll fold the corner, now we can't see your name." She is so bad-ass! I love it! I really can't believe that both she and my RE have granted me access to their personal phones, as they must really trust that I won't abuse it (again). I was already so thankful for her helpfulness, but she took it one step further and tried to figure out how much I'll need of each drug. As she looked through the doses from my last cycle, she commented "Wow, you got that many eggs with barely any meds!"
I replied that it really didn't seem like it was that many. In fact, it felt as if my yield was just a touch more than a DOR patient. "Jane, someone with DOR would need three to four times the amount of stimulation to achieve the same number you did." I already knew that, but it was still reassuring to hear her say it. In return, I expressed that it seems like my protocol is sacrificial, why not turn up the heat and see what these girls can do? "Jane, sometimes less is more." she replied. My RE has commented that higher retrieval rates do not necessarily translate into higher pregnancy rates, but it seems so counterintuitive. If every egg represents the possibility for pregnancy, why would you not maximise that potential? I did recall an example from my retrieval. While we were waiting to go back to the surgical suite, we could hear the nurse checking in on the patient next to me. "I got thirty-two eggs this time. I had thirty last time." she announced to the nurse. As I was starting to feel inadequate about my mere dozen, Husband (seemingly unaware that if we could hear her through the thin diving curtain, then she could hear him) asked out loud "What are you doing back here if you had thirty eggs last time?" Ah, tact is not his forte. New Girl laughed, "Let's just hope she was a donor..."
Anyway, that night I started to calculate the costs based on New Girl's projections of what we would need. Just like when we were ordering any building supplies, I added an extra 10% to cover the unexpected. I was able to secure someone's unused Menopur for a steal of a deal. I still had a 14 day Lupron course from my last cycle, as my RE was considering employing Lupron for my trigger. As my instructions for this cycle are to start the Lupron in the middle of my luteal phase and to continue until my trigger, I figured I'd need at least 21-28 days worth. Then I looked closely at the dose. I had a 2.8 ml vial of 14 mg of Lupron, which works out to be 1 mg per 0.2 ml, but my daily dose is only 0.1 ml. I later had both New Girl and Misery check my maths, but apparently I have enough Lupron on hand. I only need to obtain the Gonal-F and Novarel, which I am hoping I can order from my fellow infertile pharmacist friend. Last time we charged over $3,000 to Freedom Pharmacy, which didn't include all my progesterone supplements, which were probably an extra $250. I think I have enough P4 to get me through to my beta test, so we'll only have to purchase more if I actually become pregnant. It's looking like we may have cut the cost of our meds in half, although I did spend $50 on GNC supplements, as I'm going for broke to try to improve my egg quality. Husband's eyes started to light up..."Your ovaries are a cheap date!"
Suddenly, the 'less is more' principle made sense to me. I recalled how a girl with low alcohol tolerance would often refer to herself as a cheap date. My ovaries are the debutante who becomes incessantly giggly after her first few sips of champagne. Or to use a more modern example, they're the sorority girl who becomes totally wasted after a few swigs of Natural Light. The gentleman suitor must know when to curtail her consumption, otherwise he'll be holding her hair back later that evening...and not in the way that he intended. At the same time, my ovaries need to learn the value of being virtuous. They can't let the intoxicating elixir of nun urine and recombinant gonadotrophins go to their head so quickly that they give up a dominant follicle too early. They must save all their presents and wait to open them on Christmas morning.
Husband and I enjoyed a good laugh, as we acknowledged that this is the first bit of encouraging news since learning we'll have to double our investment for an even more improbable return. I even went as far as to suggest that my ovaries may be offering us a favour. "Well, not really." Husband countered "They're the reason why we're going though this again." Yes, but if your boys would get up at 5:30 and go to swim practice with me, maybe we wouldn't be here... I thought to myself, but didn't say out loud.