Friday, August 13, 2010

Adapting to Unexpected Changes During Your Cycles

I started this blog because I wanted to help fellow infertiles. I wanted to create a blog that I wished was out there when I was still trying to conceive. You know, some 20/20 hindsight from someone who's been down this road before. I wish I could write every day, but because this blog is more topical, I sometimes struggle to find a subject that would speak to all of you. Perhaps I'm just having a guilt trip for not writing daily. Anyhow... So when my fellow blogger Fox in a Hen House suggested that I talk about dealing with the unexpected, I thought, "Brilliant!" Today, I'm going to make some suggestions about finding ways to deal with the unexpected changes during a cycle. Let me emphasize that I am not talking about situations that finalize a cycle, like a BFN or no embryos can be transferred. I'm solely going to focus on unforeseen changes that can be rectified.

Fox's current situation is a great place to start: she was diagnosed with Premature Ovarian Failure at age 35. After a few Clomid cycles, she started an injectables IUI cycle. Turns out her body is responding amazingly well to the meds and at her first visit, she had 13 follicles! Exploring her options, she has agreed to convert her IUI cycle into an IVF cycle. Now that's pretty unexpected. Usually you hear of IVF cycles being converted into IUIs, but hardly ever the other way around. Fox took things in stride. She adapted. Was she prepared for an IVF cycle? No. But is she going to make the most of it now? For sure.

We probably adapt to a lot of unexpected changes in our daily lives without ever realizing it. But when it comes to IF cycles, it seems we lose all ability to take a step back and accept the new direction our cycle is taking. We have too much vested in the cycle and are too emotionally committed to just go-with-the-flow. I've said this many times before, no cycle is ever text book. Not a single one of mine ever went according to plan. You have to find a way to realize that it's out of your hands. I know that this is incredibly difficult to accept, especially when it seems that most IF patients are Type-A personalities (why is that?!). You must remember that you have put your trust in the hands of a reputable clinic (tell me you did your research!) and that your body is in many ways independent from you. Some days it will surprise you with a wonderful gift and other days, it will disappoint you, like a disobedient child.

So when you have a curve ball thrown at you during your cycle, you need to find a way to adapt. How you ask? Well for one make sure you get a hold of your RE (do not accept playing telephone and having the nurses be your point person). If your RE is any good, he/she will make the time to review your options with you directly. Ask all your questions -- What's happening? What does it mean for the cycle? What are my options? What is your recommendation? You're not the first patient whose cycle hasn't gone according to plan and you're certainly not the last. If, like in the case of Fox, it's actually good news, you need to embrace it. Cycles are lived in short windows of time (even if the 2 week wait feels like an eternity). If you miss out on an opportunity, you will always look back and wonder "what if...." But sometimes, the news isn't good, and in those situations, you must remind yourself that you have come this far and that it's too soon to throw in the towel. A skillful RE/clinic will make lemonade out the lemons you've been handed. They will find a way to optimize the situation; that's their job.

So, let's review a few unexpected issues that may arise and ways to (possibly) resolve them:

  • Making too few or too many follicles --> Adjust the dosage of your meds. If no change occurs by the next visit, consider converting your cycle.
  • You're experiencing OHSS --> The excess fluid may be removed prior to your ET or you may need to complete your cycle with a FET.
  • Lining not thickening fast enough --> Try high doses of vaginal viagra to increase blood flow and go to daily acupuncture.
  • Lining is too thick --> If you've confirmed there's no polyp prior to your cycle, a thicker lining shouldn't be an issue.
  • Premature LH surge (i.e., pending premature ovulation) --> Administer Ganilerix to curb the LH surge until all follicles are ready.
  • DH was unable to provide semen sample --> Either go in there to "help out" or consider freezing the eggs and do a frozen cycle. 
  • DH's sample is less than usual --> If it's an IUI, ask to do another insemination the next morning. For an IVF cycle, you only need a few healthy ones.
  • Your embryos aren't dividing well --> You can opt to transfer them on Day 2 or 3. Your body will give those embryos a better fighting chance than a petri dish.
  • You were expecting a Day 3 ET, now it's a Day5-6 --> This is actually great news and it means that your embryos are doing very well. 

The silver lining here is that most issues that may arise during the cycle have solutions that you can explore. At that moment you may not be able to see those solutions, but your RE is there to guide you in the right direction. You can be proactive and do a little of your own research to ask the right questions; it's the not-kowing that frazzles us. Plus, don't forget that I'm your disposal. I'm happy to answer any questions and even look things up for you to help you make the best decision.


Baby bump bound said...

Great info - thanks for sharing this!! I wrote you an email...

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