to scratch or not to scratch?

That is the question.

I'd never even heard of the endo scratch until the ladies in my super-secret Facebook group all were talking about theirs. (To be fair, I didn't know what it meant to have a triple-stripe lining, either. So apparently I'm not as up on the world of IF as I thought I was.)

When I went for my ovulation check almost three weeks ago, I asked my Favorite Nurse about getting an endo scratch, which (if you didn't click through the link above) is basically where they insert a catheter into your uterus and gently scratch all four quadrants. The purpose for this is twofold. From www.createhealth.org:

Increase of endometrial white blood cells. It appears that endometrial injury increases the production of white blood cells which secrete so called growth factors which in turn control embryo implantation.

Gene switching within the endometrium. Scientists speculate that sometimes embryos fail to implant due to genetic switching related to endometrial receptivity. That is, genes responsible for implantation of embryos are not switched on during the time when embryos are supposed to implant. Endometrial scratching may increase expression of genes (switching of genes) thought to be responsible for preparation of endometrium for implantation. 

Anyway, I didn't hear back. So I asked again when I went in for a second ovulation check the following week.

Still didn't hear back.

On Monday, I called and asked to switch out generic hcG for Ovidrel, because I found out that the Ovidrel comes premixed and I have such a bitch of a time mixing the generic stuff. The nurse I spoke with said that was fine, but she'd have to run some other med changes I asked about by the doctor (which I'd figured). Lastly, I asked about the endo scratch for the third time.

No response.

Wednesday morning, I left another message about how I needed these answers sooner rather than later, since at that point I was on CD 21, and I was under the impression that I'd be doing the endo scratch during the priming cycle. Also, my cycles can run short; last month, I got my period on CD 23. So I wanted to get my meds ordered ASAP.

Finally heard back from Dr. Smiles on Wednesday night. He'd left a long-ass voice mail message while I was at work, the gist of which was this:

He doesn't think the endo scratch will help, but it won't hurt, either. So, if I want to do it, we can do it. Ditto RE: my med change questions.

Basically, he bounced the ball right back into my court.

So, I asked the women of my super-secret Facebook group. Of the ones who responded, three said that they'd had success during cycles in which they did the endo scratch, vs. lack of success during cycles in which they did not. One said her RE was in the same camp as Dr. Smiles (skeptical of the research) and another said she had an adverse reaction.

I turned to Google for additional information/anecdotal evidence.

Of all of the various communities I dropped into, the majority of the women were in favor of the procedure. Many of them claimed success after having the procedure done. Was it the placebo effect? A combination of factors outside of the scratch? Who knows?

Yesterday, I called to schedule the procedure. I felt confident in this decision. Then the scheduling nurse told me that Dr. Smiles prefers to do them on CD3 of the transfer cycle. Not what I'd been expecting, obviously. I'm supposed to call back on CD1 to schedule.

I turned to Google again.

Now I'm even more confused than ever. It seems that the studies where the scratch proved helpful concerned women equal to or under the age of 37, who were considered good responders with high-quality embryos, yet still have two or more failed IVF cycles. I'm outside of that age range (not by much, but still), a very poor responder, with likely crappy embryo quality (Dr. Smiles did both my transfers on Day 2, one with a 3-cell and one with a 4-cell).

I've also read that if the scratch is done too close to transfer, it can actually lower implantation rates, not boost them.

I'm at least a day or two away from my period, so I have a wee bit of time to decide. And I'm thinking about calling Posh Clinic today and asking why Dr. Smiles does the procedure on CD3 instead of during the previous cycle. I just don't know if I'll get an answer in time.

Thoughts? Advice? I'm floundering here.

• 
  

priming cycle, advance!

Mr. Hope and I headed up to Posh Clinic yesterday, him for a sperm analysis and me for blood work and another transvag scan. Lining was 8.6, and there were three waning follicles all tracking around the same size (8, 7, 7). And yes, there was evidence of ovulation, confirmed by blood work. 

Due to the timing of Mr. Hope's sperm analysis, and his need to abstain for a certain number of days prior, plus the approximate timing of my ovulation, there's about a 0.0% chance of us having some kind of miracle natural conception. Meaning: no pressure, no symptom-spotting, no magical "what if" scenarios playing in my head. So this is good.

Also good: I've started to drop my pre-O water weight. It's so gratifying to see the scale start to go down, especially after how hard I've been working. 

Of course, now that ovulation has been confirmed, I start my estrogen supps tomorrow, to help prime for the fresh IVF. Twice a day until I get my period. Me on estrogen = near-instantaneous weight gain. So I think I better enjoy my small-but-significant weight loss today, because that's likely to stop.

I need to keep reminding myself that although weight loss would be nice, really I'm doing all of this in hopes of a successful cycle/implantation. I'm 38 years old and I have never seen a real positive pregnancy test, just a few faint positives that were the result of the trigger shot not leaving my system as quickly as I thought it would. 

On a completely different note: allow me to pat myself on the back for a sec. Yesterday was Halloween and I didn't have a single piece of candy. Not even a single BITE of a single piece of candy, though Mr. Hope and his offspring kept offering them to me even after I reiterated that I was off the sugar.

Apparently, I have willpower of steel.

the mind fuck that is my body.

Went to Posh Clinic today for blood work and scan (a.k.a. the transvag probe we infertiles get to know so so well). I think I've mentioned before that the clinic is a good 45-minute drive without traffic, so I usually book my appointments for about 10 a.m. That way, I'm driving up after the morning rush hour but will be on my way home before the afternoon one. Even so, every time I go up for a blood draw and probe, it's roughly a 2.5- to 3-hour time commitment.

One of my favorite nurses was the one doing the scan. At Posh Clinic, the nurse hands you a piece of paper and a pen has you write the numbers down. First thing she says is, "You've got a lot going on here." I have no response for that, beyond basic curiosity.

She tells me my lining is at 6, which seems thin for CD8, but maybe I'm wrong? Then she starts reading off the numbers of the follicles:

14
13
11
12
12

Come again?

I say, "Uh, that's better than when I stim."

She says, "I was thinking the same thing."

But we have to wait for blood work, of course, because they could be leftover follies, or empty ones. So I drive the 45 minutes home and wait for the phone to ring.

And wait.

And wait.

And wait some more.

Finally, at 3:15, I get the call. My estrogen is elevated, but not enough to support the five follies. My LH is low, so it's not like I'm about to ovulate. Results = inconclusive. Dr. Smiles wants me back in a week to repeat the bloods and scan.

I start doing the math in my head. If I ovulate between now and next Friday, then I can start my estrogen priming ASAP. That would put me at baseline around November 21st, stimming until roughly December 5th, and doing the retrieval and then transfer shortly after. Meaning, I'd squeak in just before Christmas.

But if I don't ovulate between now and next Friday, or I have unresolved follies, I'll most likely go on hiatus until after Christmas.

I DO NOT WANT TO GO ON HIATUS. I HAVE BEEN ON HIATUS SINCE MARCH.

I just want to get going already.

Haven't I waited long enough?

and so it begins (I hope).

When I stepped on the scale this morning, I was bummed to see I'd only shed another .6 lbs. Which is better than yesterday, when I was actually up .2 lbs. That's just under 5 lbs. in four days, which is nothing to sneeze at, but the BFF has dropped EIGHT. (Yes, I am jealous. No, I won't apologize for that.)

Anyway, I've been following the EZ Diet pretty strictly, with precious few exceptions. Like, I had pumpkin polenta with dinner on Wednesday night, but couldn't figure out if course cornmeal was on the So-So List or the Bad List. Since polenta has a low glycemic load I'm thinking it's So-So, which I am allowed to have one to two times a week. Then yesterday I was at a work thing and got served a salad that was fine but dressing that had some sugar in it. I did the dipped-fork thing to limit how much I had - maybe a tablespoon of dressing total? - but you know, it's still got traces of sugar, which is definitely on the Bad List.

And I've been exercising at least five times a week, the kind that leaves me with sore muscles and, like today, dripping with sweat and red-faced for 30+ minutes afterward. I've also been getting enough sleep and drinking boatloads of water, so I was really, really hoping the slow-down was the result of an impending period. If I counted the thing that Dr. Smiles said wasn't a true period as my last one, I'd be due on Sunday.

Then something happened with work this morning that almost reduced me to tears, which was an odd (and oddly disproportionate) reaction. Was this PMS? Again, I was hoping.

Finally, about fifteen minutes ago, I went to the bathroom and saw it. Bright red spotting. The kind that says HELLO, YOUR PERIOD IS ABOUT TO ARRIVE.

So yay for that, and yay for getting blood work done this weekend, and for meeting with the infertility counselor on Monday, and getting this mo fo show on the road.

EDITED TO ADD: In less than an hour, the spotting turned to full-on flow. So, I'm officially in my priming cycle!