Last day, next step

Yesterday was my last birth control pill. I had an ultrasound on Thursday, and everything looked good, ovaries were "quiet" and endometrium was thin. We're one step closer! I feel a bit like getting ready to launch a space shuttle. I'm not sure where in that analogy is "lift-off", maybe my first FSH injections? Last Thursday was like the "all systems ready" green light, and next up is the clear weather forecast.

I took my basal body temperature periodically through this birth control pill stretch, and it was very "luteal" which tells me my progesterone has been holding steady, so now I'm just waiting for it to crash back down. Should be interesting to temp throughout this cycle, but then I won't know if I'm pregnant because I'll be on supplemental progesterone after retrieval. As the day gets closer, I'm nervous and excited, and very very hopeful!

Countdown!

There are so many milestones along this IVF journey, and today I'm getting excited about the next one - the end of the oral contraceptive down regulation. Bright and early, two days from now, I will have an ultrasound to check and make sure I don't have any cysts. It's the next step to beginning medication injections, which could start in as little as a week! I'm just so excited I want to bounce off the walls! The next few weeks will be like a child counting down to Christmas!

The hormones...

One week into my birth control pill protocol, and I feel horrible. My boobs hurt. I'm really irritable. I'm tired. Yesterday I was nauseated. It's everything of a luteal phase, but without the "yay, maybe this is a pregnancy symptom". I took the pill for about 10 years, and I don't remember any of this. Maybe because I took it so long I don't remember. Maybe because I was pretty young when I started (17-ish?). You know what is ironic? I've had these luteal symptoms for about 4 years. I call it "four years of morning sickness and feeling like I'm pregnant". I didn't remember feeling any of it before I really was pregnant, but maybe I just didn't know what it was. When I was pregnant, I remember thinking, hmmm, this morning sickness is a lot like what I've been calling "migraine" for most of my life because it was a nauseous dizzy headache. Although sometimes it is vertigo too. All very hard to differentiate. Until I started tracking my cycles trying to get pregnant, and lo and behold, it was progesterone! So I went to my doctor for some tests, back before I was actively trying to conceive complaining of these symptoms to my doctor. First off, he didn't believe I wasn't pregnant. Second, and this is why I went when I did, I also had intense pain around one kidney which he was convinced was an ectopic pregnancy. Turns out it was a UTI, even though I didn't have any symptoms. But the progesterone symptoms didn't go away. The doctor suspected it was cyclic (because I said it was) and offered to put me on birth control pills. His reasoning was that it was ovulation related symptoms. Which it was, just not the act of ovulation. Birth control pills work by disrupting the endocrine system and often it's just by tricking your body into thinking it's already pregnant. With progesterone. That is what inhibits ovulation naturally happening again within a given cycle or when you actually are pregnant. So I have to say, I'm not surprised that the symptoms of birth control pills are the same as the sucky feeling of early pregnancy or luteal phase in general. Long story short (too late)… I can't wait for this part of the protocol to end.

I have also answered the question of why birth control pills, and what role they have in an IVF cycle. The goal is to make sure the estradiol level at the beginning of the stimulation cycle is low. There is no consensus on how low it should be, my clinic likes it under 200, and the birth control pills for a few weeks will do that. There seems to be some debate about the importance of a further GnRH antagonist for a few days before FSH shots start, but I need to do more reading on that. The argument is that a further few days of Lupron or something like that to manipulate the pituitary improves ovarian response to the FSH, but that probably depends on the individual. It's not about quantity, it's about quality, and 4-6 good quality eggs is what my clinic wants. I read a study that found outcomes were best if 6-15 were produced, any more or less and the success rate was not as good. I don't remember if the outcome was clinical pregnancy or live birth, I suppose I will have to look it up and post it here.