Unmedicated FET Cycle Begins — Or Doesn’t…

I had my FET baseline ultrasound yesterday. Or, not quite. Read on…

A Quick Recap

August / September

I was supposed to do an unmedicated FET in August, but a communication SNAFU at my clinic means transfer won’t happen until September. (I was told to call on CD1 in July but they should have told me to call in June, because they wanted my SHG to happen the cycle after my mock cycle). Not happy about this, because a September transfer means my fabulous MIL is probably out of town around the time I will need help with V while on bed rest… Not to mention, we made other plans (like moving house — and paid double rent for a month) based on an August transfer.

Unmedicated FET

I requested an unmedicated FET mainly because I am still breastfeeding, but also because my main infertility issue has nothing to do with my actual reproductive organs. (More about my stellar ovulation in a moment…) And if I don’t have to inject myself and be injected and then use progesterone pessaries for (fingers crossed, you know) the first trimester, then why subject myself to that? (Not to mention, it saves ~$1,500.)

Mock Cycle

Back in March, my prolactin levels were 5 (normal range for a non-breastfeeding woman range from 4-29) so I am cruising along very efficiently on a very low amount. Because all of my hormone levels are normal, and because my lining went from 0 to 7mm in two days, I passed my mock unmedicated cycle with flying colours.

SHG

I was put on birth control pills (mini-pill, which is progesterone only) to keep the lining of my uterus thin for the saline sonohysterogram (SHG). This is where your uterus is filled with saline so that any uterine abnormalities (like fibroids or something structural) can be detected via trans-vaginal ultrasound. It’s routine, but in my case they wanted to make sure there were no adhesions from the placenta accreta. Again, I aced the test, so I stopped the birth control after 14 days, the minimum amount of time I had to be on them. I figured, why be on medication for longer than necessary? Also, given the extra month’s delay, I could save a week which would mean my fabulous MIL would be in town to lend a hand after all.

But to everyone’s surprise, despite being on birth control, there was a large follicle on my right ovary. I joked to the nurse practitioners that in a parallel universe, I’m the egg donor. Apparently, my reproductive system works just fine. It’s just my DNA (specifically, chromosome 8) that’s the problem.

The Surprise Phone Call

I had a call on Friday to ask me to come in Monday for my baseline. “Even though my period hasn’t started and probably won’t by then?” I asked. “Yes, that’s right,” said the nurse.

“Oh, one more thing,” she added. “Have you heard that your RE, Dr. H, is retiring, effective immediately? You’ll need to pick a new RE, or we can assign you to someone.”

I answered — perhaps with a touch of snark — that I’d only met Dr. H twice and he didn’t even do my transfer that resulted in V, so I didn’t exactly have a relationship with him. I don’t mind choosing another RE, but I am pissed off on principal: What about the people who are in the middle of an IVF cycle and appreciate continuity of care? Ditching them mid cycle just seems wrong to me.

The nurse emailed me a calendar of when to schedule my post-baseline follow-up ultrasounds for and the estimated transfer date of September 5-9. Also included was a list of supplements to take:

Baby Aspirin (81 mg)

Prenatal vitamin (check — have been taking for 3+ months now)

Folic Acid (a whopping 4 mg — that’s five times the amount in most prenatals)

(I added a fish oil (EPA / DHA) for good measure.)

Baseline Ultrasound

In went the dildocam and, almost immediately, a large black circle swam into view.

“What the hell is that?” I asked Hilary, my lovely nurse practitioner who has performed all five of hot dates with a dildocam (including the SHG) this year. I’d never seen anything like it on any of my (many) ultrasounds.

Hilary frowned. “It’s a cyst.”

“It looks big.”

“Yes it does. Hang on, I’m going to measure it.”

I watched Hilary plot two points from one side of the black circle to the other. It seemed like there were more green dashes of the measurement path than normal. The cyst measures 4 x 4.5 cm, the size of a golf ball. Hilary couldn’t believe I’m not doubled over in pain.

“How much of a delay is this going to cause?” I already knew it was a question of how much, not if.

Cysts aren’t uncommon, but they can interfere with hormone levels. Maybe I’d need to go back on birth control for a week (you know, finish the pack…) or maybe we’d proceed with the FET anyway (if my hormone levels were normal). Often the only thing to do is nothing, they resolve on their own. My blood work would give us more information.

I did feel like my body was confused. No wonder! Starting birth control during my period means my body bypassed the estrogen and LH of the follicular (pre-ovulation) phase of my cycle. In other words, it went from menstruation to post-ovulation overnight.

I left the clinic disappointed but in good spirits.

A New Calendar

That afternoon, Hilary emailed me to say I did ovulate despite being on birth control, so the course of action is to wait until my period arrives.

Record Scratch. Can we just take a minute to laugh-cry at the fact that I’m the infertile freak who ovulates even on birth control? Clearly, I have a very robust (nay, feisty and fiercely independent) reproductive system. How I wish I could bestow my superpower on someone who could actually use it — like my friends with PCOS who don’t ovulate regularly.  

Yesterday’s appointment was the baseline that never was. I’m treading water until I get my period, which should reboot my system. I’m on CD20 today, and Hilary agrees that it’s reasonable for me to expect Aunt Flo to arrive next week. Whenever it happens, I’ll schedule a new baseline appointment and we’ll take it from there.

It could mean a week-long delay, possibly longer. Who knows? I know the cyst could burst (if it does, it’s excruciatingly painful, so I hope that doesn’t happen while I’m driving on the freeway!) and I am prepared for the possibility of it taking two cycles to resolve (maybe my next period will be mere spotting, due to the lining of my uterus being so thin).

Strangely, I’m not upset. It’s a setback, but not life-changingly so. And if this is the only hitch, I’m okay with that. I’m choosing to view this as an opportunity to enjoy coffee and cocktails for a little while longer, increase my folic acid and EPA/DHA stores, and finish editing the first draft of my book. And, frankly, with the Zika virus, I’m hoping the impending cooler weather will mean goodbye to the mosquitoes that have plagued me this summer.

I don’t believe that things happen for a reason, but I do trust my body will do its thing when the time comes, and because of that, I have to trust the process.

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