Old Mother Hubbard

went to the cupboard

and discovered she owned dessicated gonads.

My antenna waved Danger! as soon as I heard the tone of the nurse’s voice down the phone: even over the bustle of the RSC foyer and Harry’s grief-stricken howls (we had just discovered you need to book a timed ticket to go up the tower, and he had been Promised An Immediate Ascent) I could clearly hear that she was projecting enough Cheerful for two; I swiftly deduced that she anticipated I was about to be in deficit. 

(AMH testing is Clever-Shiny-New fertility science, and they’ve recently changed methodology to a 2nd generation assay giving values 40% higher than previously. Keep Calm and multiply by 1.4 if your previous happy AMH level suddenly looks wide of the goal posts.)

Ovarian Fertility Potential                pmol/L  (Not ng/ml, which’d be helluva lot lower.)
High Level                                            > 67.9 
Optimal Fertility                                    40.04 – 67.9       
Satisfactory Fertility                             21.98 – 40.03              
Low Fertility                                          3.08 – 21.97          
Very Low / Undetectable                    0.0 – 3.07       

I scraped a 20. Distinctly and saddeningly sub-optimal, but not quite fully disintegrated into oocytical dust in the coffins of my ovaries, either.

I… wasn’t expecting bad news. Alive to the possibility, yes, but my Autumn 2009 FSH & E2 were – I quote my Consultant – ‘beautiful’, and I felt reassured. Once I’d got my head around the difference between US & UK lab units of measurement, that is. John had been blithely complacent (the man is a congenital optimist, even appertaining to my haphazard reproductive abilities) that I had the ovaries of a nubile teenager, and has had to mentally regroup accordingly.

Ah, well. It’s been a while since I felt really slugged in the stomach. They do say a change is as good as a rest.

Of course, my previous poor response to gonadotrophins now looks completely divorced from the possibility of a still-stunned pituitary after a shitty downreg, and simply looks like common-or-garden Rapidly Emptying Ovaries instead. And the shortened cycle I was crowing over last night might credibly be the dark horseman of the Menopause galloping towards me, waving his scythe, with hot flushes spilling from his saddlebags.

Damn it.

My Consultant has altered my protocol still further on receipt of this glad news and has now prescribed me Gonal F instead of Menopur: I’m not sure why & absolutely can’t be arsed to Google it; the woman knows her business. 300iu for 10 days pro tem, and we’ll see what we get. Another day older and deeper in debt. Sources of Gonal F are, naturellement, more circumscribed than Menopur, although I have managed, after a few phone calls involving Far Too Many Fucking Zeros to get a quote that just squeaks in at under £700, so the cost differential isn’t as Implicationy as I first thought it might be.

If nothing else, this news has made me feel a little more exculpated for already having chosen IVF over IUI – and exonerated altogether for wanting medical reproductive input this time around. 

I know it only takes one egg, but we’ve got to find the bugger first.

Curiouser and Curiouser

I’m getting good at this whole dark-art-menstrual-cycle-prediction thing. With nary a clue, apart from my heart spending 24 hours trying to explode out of my chest like a startled pheasant, I correctly diagnosed ovulation – or, at least, an event involving a strong LH surge. 13 days later, when John peered into the saucepan I was cursing loudly over and pulled a face – ‘It’s a funny-looking texture!’ – and I burst into outraged and mortified tears, I managed to surmise without a great deal of difficulty that my uteri would very shortly be closing for renovations. 

A scientist I am not, but overly analytical I certainly am, and it’s exasperating me mightily that not one, but a confusing two variables have altered this month, in the ongoing crapshoot that is the workings of my reproductive system, and I don’t know which one to credit for improvements. Firstly, I have been taking low-dose aspirin since my last period, and secondly, I started Loestrin combined contraceptive pill on the first day of this period.

Either the co-incidences are piling up, or the low-dose aspirin must step forward for a bow. Fact number 1: my cycle came in at a magnificent 5-and-a-little-bit weeks, which is my shortest natural cycle… ever, I think. Why, how, or even if, aspirin c/should shorten my tediously protracted follicular phase, I really don’t know. *intrinsically Jewish gesture denoting nonplussedness*

My right, Harry-housing uterus, only ever seems to shed road tar, not endometrial lining. The adenomyosis pain that leads me to regularly chew on the furniture is unvaryingly very left-uterus centred these days, with only an occasional bout of snarling from over on the right. Not so this time. Fact number 2: right uterus has done 90% of The Hurting this period. And, for all I know, (I was bleeding far too copiously to even think of attempting to find out) 90% of the bleeding, too. I conclude that the lovely Problem-Uterus May was correct, and that the aspirin has tickled things up in my right uterus no end.

My periods have, the last 18 months or so, become progressively more painful, and rather less heavy. Fact number 3: this period was a proper, days-of-yore, when-I-was-a-lad, don’t-make-’em-like-they-used-to, retrospective, authentic, like-Granny-used-to-make tsunami – characterised by remarkably little pain. Now, allow me to assure you that there was still pain. (So stop that there sympathy of yours in the act of convoying straight out of my blog! *waves clenched fists* Back! Come BACK! *dancing on spot* I’M STILL SPEYSHUL!) It’s just that there wasn’t bloody agony this time, which I’d virtually come to look upon as par for my course(s).

Now, either the aspirin achieved a hat trick for me with most mysterious pain-reshaping and management – or the pill has worked its Old Black Magic in jig time. Because my uteri like the pill. They behave on the pill. I wangled myself onto it at an early age, as my pubescent periods were essentially in danger of flooding the nearest river delta and sending me to an anaemic early tomb (don’t, for the love o’God, start me off on the subject of 1980s sanitary towels. I’m told I start to produce too much spittle.), and stayed on it for 15 years, give or take. It didn’t eliminate period pain, but it consistently delivered (primarily right-sided) low-mid-range pain, entirely treatable with over-the-counter analgesics, of just the type I have just re-experienced. 

Spooky.

Anyway, none of it matters a damn just at present: I started the pill a few days ago and will continue it for 3 weeks. Following a very productive session with the senior nurse last week (appointment was on my 36th birthday, which was a birrova pain, but standard array of bloods taken from both of us, standard swabs taken from me, all consents signed, prescriptions issued), I have a baseline scan booked for the 21st March. Provided neither of us is discovered to have inadvertently collected an STD or one of the Heps lately, then we’re good to go that day. Any lingering hopes I may have had of proving at baseline that my right uterus is a malevolent, clutching, retentive harbourer of substandard lining have now been kicked into touch A) by the Period Massive and B) the fact that I have remembered that the pill buggers about with your lining thicknesses anyway.

In the meantime, to keep me occupied, I have to buy my drugs. Yippee. I have a prescription for everything except the gonadotrophins, which our nurse sensibly said she would issue once they know my AMH result – which, come to think of it, I should really ring them up about tomorrow; it’s been a week. If it is nice and high, I needn’t take out an actual mortgage buying my stims; if it is low, then there will be wailing and gnashing of teeth in the outer darkness of my credit card, etc.

Either way, the New Age of Austerity is biting at Hairy Towers: money is tight, and so, sadly (and ubiquitously), are my waistlines. And one of my bi-annual episodes of reduced co-parenting approaches: John, after a couple of months of comparative agricultural down-time, is due a sharp increase in farming activity: the lambing is about to start in spades.

As it has for us before, lambing will cause a problem if this cycle is successful: ewes carry toxoplasmosis (as do cats, which is why litter trays are a no-no in pregnancy) and I have zilch antibodies. Nary a one. I have handled enough sheep to have justifiably and fairly caught it by now – but no. John has never been tested, but irrespective: his work clothes will have to stay at the farm, his hands, already raw from the washing after constant immersion in amniotic fluid will have to be scrubbed, and the dogs will have to be rather better supervised in re: consumption of afterbirths. Yuk, I know. I’m not sure how we’d either restrain Harry (who has unsurprisingly decided that his life’s desire is to bottle-feed baby lambs) or hose him down sufficiently for peace of mind, but… well.

 
“We cross our bridges when we come to them and burn them behind us, with nothing to show for our progress except a memory of the smell of smoke, and a presumption that once our eyes watered.”
Tom Stoppard, Rosencrantz & Guildenstern are Dead
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