The fourth IVF cycle has begun with a fucking bang. On Valentine’s Day. Which Husband and I don’t celebrate so there’s really no significance there.

Lupron sucks.

This round is an Microdose Lupron (MDL) protocol which I’ve never done before.  When I asked the Kligster why we were doing this protocol, he said, “because we haven’t tried this one yet.”  Works for me.

Initially, I did my regular research only to find out that depending on who you talked to it was either great for poor responders or it was awful for poor responders(pdf).  Which is it then good or bad? You don’t know, huh?  Looks like Cornell is doing a study on this very question.  The results of which everyone who doesn’t agree with will question.

Then in the spirit I entered into in November I decided I didn’t give a damn and I’d just do what they said to do.

So I began the shots.

And then the craziness began.

Mind you my life is pretty depressing right now, even for me.  I have absolutely no self-confidence, feel like I’ve done nothing with my life of significance, I’m low, I’m down, I’m not at the bottom but only because I can’t drink myself into a stupor every night.  That’s how amazingly shitty I feel about myself.

And Husband and I are continuing to have some conflicts over general marital communication and what constitutes proper social behavior when entering back into a social scene and making new friends of the same and opposite sex.  The social rules are different when you are in a marriage/relationship and I’ve had to kowtow to them in the past and respect his feelings.  While I understand that in his profession it is important to “get out there” it would seem to me that the most important person in his life should be me but I have been feeling like the bottom rung of the ladder for awhile now. I’m feel like I’m not the one with whom things are discussed, I seem to be the last one to know. (update: we have had some more discussion about this and I *think* we are on the same page now, but it was happening when I started the post so I will leave it)

Then add to that mix Lupron…and you have emotional bedlam.

Here’s how the MDL protocol works (via http://www.advancedfertility.com/ivf-low-response.htm)

Flare Protocol, or Microflare for Poor Response Cases (also called Microdose flare, short Lupron, or short protocol)

In this type of stimulation, the Lupron (or other GnRH agonist) is started on cycle day 2 in the same menstrual cycle that we will retrieve the eggs - instead of starting it a week prior to the start of menses.

We are trying to take advantage of an initial “flare-up” response of FSH and LH release from the woman’s own pituitary gland that usually occurs in the first 3 days of Lupron administration. Continuing Lupron for more than 3 days temporarily suppresses the pituitary gland so that it has a low output of FSH and LH.

The FSH product (e.g. Follistim, Gonal-F) is started on the following day (day 3). The idea is that the Lupron will stimulate release of a large amount of FSH (and LH) that will jump-start (flare-up) the follicles so that we might have a better ovarian stimulation with more mature follicles and more eggs for IVF.

Birth control pills are usually given for the month before the flare so that there will not be a leftover cyst (corpus luteum) that could become reactivated by the high LH levels at the onset of the flare stimulation.

So your estrogen is being artificially lowered by the Lupron and you end up with some bitchin’ PMS symptoms.  For days. And days.  Weeping. Emotional (even if the events causing the emotions are valid problems). Anger. You name it, you get it.  But my RE, the Kligster, said that once the estrogen levels begin rising then you begin to feel more normal again.

Which brings me to my estrogen levels.  I’m updating chart four - IVF #4 Details and you will see on there that my estrogen was good and low at E2 of 25 on CD 1.  This is the value they are looking for.  Something in the range of 20-25 BUT you will note that after two days of stims (including 4 days of Lupron) my E2 went DOWN.  Yes, down.  And a decreasing E2 is never a good thing in the world of infertility.

So I emailed the Kligster who basically implied that I should chill the fuck out and that MDL is a longer protocol.  So, I did just that. Chilled.

Tomorrow morning we will see what’s going on with the ovaries.