IUI day

My surge (judged by OPK) was close to full strength by around 7 pm last night, and this morning the line had darkened several shades. I went in for the ultrasound and blood draws this morning just because I want the numbers. The doctor who walked in did not even want to do the ultrasound, but reluctantly complied  on my insisting that it be done. She was so eager to be out of there (overall, I really cannot say good things about the practice I'm with now), I did not want to pepper her for details so I did not ask what the lining was at at, but my follicle grew 2 mm to 19 mm. That made me happy because that is largest follicle I've ever had, they have been at 17 mm the last 2 tries.

Not that it should mean much: I've said this many times, follicle size and quantity can never properly translate to quality, these are very likely to be 2 completely separate entities. The only way to ever measure follicle/ egg quality is to:
a)see how well the eggs fertilize and divide as embryos
b) Study of follicular fluid content: I'd think this is an area that really needs to be explored, to understand infertility better. People harp about genetics being the main cause of early (in the first 14-21 days) losses, but, in my opinion, they are looking at it the wrong way.  The fluid in the egg, which provides all the nutrients for the embryo to survive and proliferate for around nearly 8-10 days on its own, is more of the driving force at this early point. There is no reason for the genetics to come into play, because the embryo is just dividing again and again, with very few genes being expressed. In other words, very early losses, probably upto 2 weeks after fertilization are probably are due to cytoplasmic issues, unless the gene missing or damaged is from the small handful involved in  blastocyst formation, hatching, implantation etc. However: there could be a correlation between the two things (cytoplasm and genetics) though- an egg having a crappy cytoplasm is also likely to have had a crappy genetic division with more chances of aneuploidies.

Anyway, away from scientific speculation and back to me--bloodwork just came in.
-Estrogen has plateaued at 235 pg/ml.
Last time, from right ovary, was 265. Question for anybody in the know: what is the estrogen range at peak per single mature follicle? I found one website which said 200-600 pg/ml which makes me very sad, buts most say 200-300 pg/ml
-LH is a whopping 46.2 pg/ml.
Super strong surge, stronger than the last time (that was 31 pg/ml)

IUI is set for 1 pm.Will be saying many prayers as I head, once more, into this very scary breach.

Part II: All about the hormones (updated at the end)

Again, it does not *look* like a super pretty cycle that I am trying in. Its CD15 today.  I'm coming up to a surge possibly tomorrow. I picked this cycle because my Clear Blue Easy fertility monitor(CBEFM) switched to 'high' fertility a possible 4 days before ovulation, which is not too shabby.  To try to understand what that meant, I read the original studies looking up how the monitor works: There are 3 forms of estrogen: estradiol (strongest), estrone (middle strength) and estriol (weakest). The CBEFM measures the levels of a Estrone metabolite, which correlates very well to blood estradiol levels.  At some point, when the estrone levels increase past a certain threshold, the monitor changes from 'low' to 'high' fertility.

The good news, I've had 'high' fertility for around 3 days now, but the bad news is I have not seen a peep of the egg white CM yet.Apparently, estradiol (the strongest estrogen) drives the cervical mucous production. So when that gets super high, you get all that goopy stuff. It should be straightforward (lots of estradiol = lots of CM), but I have to wonder. Here is a question for you IVF ladies: There are times your estradiol levels must have gone through the roof, given the multiple maturing follicles: Do you always see the fertile CM during this time?


Because I've seen no CM yet, I was hoping  that ovulation would be delayed a day past CD17, but no dice, I've been monitoring my LH for the past 2 days, its on the rise and I think I should be in full surge by tomorrow (CD16). Which means the IUI is dayafter. ULP.

I am going in for hormonal monitoring and a U/S tomorrow. I have a feeling my stats (hormone levels, follicle sizes etc) are going to be very similar to my last cycles, and are considered bang normal by any RE, so my nitpicking and worry, is really for nothing. Something I cannot put my finger on is the problem.

In the last cycle, which was a BFN, I had a lot more 'symptoms' in the luteal phase which could
a) have been the result of a hypersensitive, far too imaginative psyche because absolutely nothing happened
b) been indicative of an embryo that probably bounced around for a few days, produced a smidgeon of HCG, before dying out because it could not implant, either due to uterine issues or because it was itself crappy quality and ran out of steam. Yeah- this covers most bases.

CD16 Testing and monitoring update:
EWCM made its exuberant entrance this morning (It always makes me SO happy to see it, yeah, I'm a little nuts but I blame this process :-))
U/S Monitoring:  The action is all in the left ovary (UGH- I have a hate-hate relationship with the left side of my body, will explain why sometime). Lining = 8.6 mm and 'beautiful'; Follicle = 17 mm (almost exactly the same as the last 2 times, albeit those measurements were on the day of ovulation, not from the day before).
Estrogen = 221 pg/ml-- normal for a single follicle,  I'm hoping it will be up a little tomorrow.

LH test results:
9 am blood work shows LH = 13. ie, looks like the surge is starting, but not there yet. 
2 pm check by OPK: Surge still not underway,  test line lighter than control.
7 pm check by OPK: LH surge is here. Test line now as dark as control.

IUI will be tomorrow. While I can apparently take a lot of shit and keep on going with barely a hitch in my stride, here is hoping the universe hands me something good instead.

Update

I CAN have an IUI today. Its scheduled for 2:30 in the afternoon, I went in this morning to draw blood for E2 and LH, and to take a quick look-see at my uterus. My stats look practically identical to the last time where I TTCed where I 'felt' I'd barely had much of an estrogen  peak- 17 mm dominant follicle, and a "nice, thick" lining of 8.5. I groaned when the doctor told me that, he was completely taken aback-- but it scares me that it looks like the last time. Which is not rational at all.  I got pregnant, with a beautiful-looking, albeit short-lived embryo that just happened to have one chromosome missing. That genetic abnormality cannot be correlated in any which way to the size of the follicle or the thickness of the lining. One could imagine a correlation to the E2 level, but that is ridiculous hand-waving at best. But as we all are well aware, fear and rationality go in completely opposite directions.

I just got a call for my blood work, and its not too illuminating since I have not had serial blood tests, and have no idea how this measures compared to my super-pretty cycles, but feel free to weigh in. From all accounts, I will ovulate at some point today.

Estradiol= 262 pg/ml (I have only one dominant follicle, on my right, so this is in normal range)
LH= 31 (Definitely in the surge. Apparently anything above 9 is considered one)

While trying to understand how this can be used to interpret egg quality, this was the most useful resource- wish I had read this earlier, I would have gone in happily for multiple tests. If I ever do this again, I'm going to monitor myself.

The one piece of good news- I'm ovulating from my right ovary. The last try came from the left. For good reason, I think the left side of my body just has more health issues- I have limb-length discrepancy, my right side is an entire inch longer than my left, which means I need to have correctional shoes (GRR).  When I did facial electrolysis years ago,  the hair on right side never grew back, but that on the left kept coming and is still there. Overall, I think the left side has crappier metabolism and is more prone to PCOS, so I'm happy its not in play here.

I had another acupuncture session. I'm taking wheatgrass pills--based on the aroma, I thank god I got those, not the juice. IUI set for this afternoon.

I've yo-yoed between feeling reassured and irrationally terrified that I'm letting history repeat itself. People keep stressing the importance of doing this with a 'positive' outlook--well screw that. Telling you that is counterproductive- you only get nervous that you are not positive enough, just adding to the stress levels. Babies have been conceived in times in incredible stress and negativity- take rape victims for example. Plus, I'm sure a lot of people at the end of an infertility slog, who are in the cycle that, unknown to them, is going to give them that take-home baby, are anything but positive and non-stressed. So if you are one of those folks, please speak up, I could use the reassurance. Any feedback on the estrogen level would be welcome as well, this is the first time I've done one of these tests.

Randomness

I'm home early today and have nothing to do, so I decided to write a blog post. This stuff is addictive I tell you- soon I'll be one of those poeple who cannot shut up about themselves...ACK!!!!

The reason I'm home is I had a mucocele (trapped salivary gland in my mouth) cut off today. I now  have a lipful of stitches that stick out like whiskers, I look like Angelina Jolie gone wrong and I'm on a-don't-eat-anything-you-need-to-chew diet. So I had a ginormous glass of home-made creamy yogurt for lunch and dessert is going to be this---------->
Yum.

In TTC-related news, I woke up this morning and my temps had not shot up like I was expecting them to. So I panic and fall back on the doctor's plan of going in for an ultrasound today to decide if I need a 2nd insemination.  Turns out I did ovulate yesterday, they could see the start of the corpus luteum.  As soon as the doctor and the nurse see the lining, they say in unison- 'beautiful!', but I  freak out a little when the doctor measures it at 8.5 mm instead of 9.. how could it have shrunk? They then assure paranoid little me that different operators can come up with different numbers (yesterday I had the head honcho and today I had the junior partner). But still, I was concerned that it had not grown between yesterday and today- I'm obsessed with size apparently. I want to be a 12, but I'm only 8.5-9. I wanted my follicle to be a 21, instead its only 17. Boo hoo.

As you could probably tell, I'm angry with myself- why the obsession with numbers and patterns, with all the resultant anxious overanalysing?? Why the wish to be 'perfect', especially when you cannot identify what are the factors that lead to successful creation of a baby in 9 months? This road may be long drawn and twisty, and if i don't just let go and let nature take whatever course its determined to, I'm going to end up in a self-created hell.

Its quite annoying when you can clearly identify all the issues with the way your brain and personality function, but cannot fix any of them. I'm trying though. Every time my idiot brain tries to come up with a new worry-inducing permutation and combination, I've been repeating to myself  'Let go and let god' like a mantra.
Lets hope it works.

And its a green light!

My doctor looked at my insides this morning, and my lining was what he described as 'great' at just over 9 mm. Its also triple stripe. Since I've had a lining of 14 mm at 2 DPO in a similar cycle, I was initially not as enthusiastic, but I'm definitely bowing to his superior judgment. Also I'm not sure if the lining continues to thicken for the next few days- anybody know the answer to this one, holler!

Usually I've gotten the impression that my right ovary produces the dominant follicle. This time, its the left one in play with a 17 mm follicle.  The right had one at 14 mm.  So all of this looks adequate, even if developed under less than stellar conditions (by my usual standards).

The swimmers are thawing as we speak. I could not sleep last night when confronted with the enormity of what I am about to do.  I'm not half as afraid of a BFN as I am of going through another loss, this time because of a 'bad' egg.  As somebody pointed out, it is an utter fool's errand to try to micromanage this process, and waiting for that perfect cycle seems pointless because no matter what, you CANNOT accurately calculate the odds of something even the experts barely understand.

So, although I'm agnostic, I'm praying very hard as we speak!

UPDATE: The deed is done!  Let the egg pillage begin!  I feel so much more relaxed with things now once the die is cast.

Note: Lesson learned from comparing this insemination to the last- make sure your RE rewashed your sperm even if it is already 'IUI-ready'! The last time I was curled up in a fetal position cramping horribly after my IUI , and I suspected that was because the sperm still had trace amounts of semen components such as prostaglandins in them because my lazy ass RE did not bother rewashing. With my new RE, of course it was re-washed and I'm utterly comfortable. What a difference a good RE makes!