Category Archives: Metformin

Plan, wait, J? Are we at J now?

Today, H and I went back to the Riverside Clinic, to see about setting up a Frozen Embryo Transfer for Frosticle.

I felt very calm about this. And sensible. And calm. Right up until I was sitting in the waiting room. All those hopeful people, with their brave blank faces.

(Oh, God, and the woman with the toddler – obviously, there was nowhere else for toddler to be while mama got one with making his sibling. Obviously. No one is so fucking oblivious as to take a toddler to a fertility clinic unless they have to, right? Right. Still. And nevertheless. I actually read The Times therefore. I dislike The Times. I am a raging leftie and I don’t give a TUPPENNY DAMN about celebrity affairs and cellulite. But I read it, because I’d forgotten a book and I didn’t want to look at the toddler).

And then Dr George called us into his office and we discussed the FET at length, while he flicked repeatedly through all the letters from my various haematologists.

Plan, therefore:

  1. Start taking prenatal vitamins with folic acid again. Also, take 75mg of aspirin a day for entire duration of shenanigans, starting about now.
  2. Even though I am on Cerazette, I am having regular, if extremely light (spotting, basically) bleeds, about once a month or so. Satsuma is definitely refusing to be suppressed. Irrepressible ovary. I’d say bless, but there were all the times I wanted her to ovulate and she sodding well wouldn’t for months. Anyway, as soon as the next bleed starts, stop taking Cerazette, and call the clinic to arrange a scan.
  3. Start taking Synarel. (We have a bottle of Buserelin in the fridge, left over. Is this the same thing? Or not? Are the dosages different? Should I just shut up being clever and get a bottle of Synarel?).
  4. Between Days 2 and 4, get first of many many scans.
  5. Start taking Progynova tablets (this is oestrogen, yes? Yes. I’ve checked. It is). THEREFORE AND IMPORTANTLY, also start taking TWO (2. Two. TWO) needlefuls a day of Fragmin, so the extra oestrogen doesn’t promptly turn my blood to porridge.
  6. Steroids again.
  7. When Cute Ute’s lining looks good and plumptious, stop taking oestrogen and start ramming progesterone bullets up my various private orifices instead.
  8. Hang on, when do I stop taking the Synarel? *scrabbles through notes, to no purpose*.
  9. Intralipids.
  10. On day seven of the progesterone, thaw out Frosticle and pop it back in.

You will note no mention of Metformin. Dr George thinks it’s mostly for improving egg quality, really, and not necessary for a FET, and while I know the views on this in the States are vastly different, I personally am pleased, because Metformin makes me feel really disgruntled, and every single time I have taken it I have put weight ON. Yes, ON. I am pretty sure I am one of the minority of people who finds it screws their metabolism up even more, rather than sort it out.

You will also notice we are doing the same old same old protocol – intralipids and steroids and Fragmin – with the addition of aspirin. We are not doing IVIG. We all considered it, but my NK cells, while elevated, are not sky-high, and back in July 2012 while we were being Thoroughly Poked by Dr Expensive, we found that Intralipids alone massively reduced their activity (no idea why H is burbling about IVIG in that post – we didn’t have any results indicating IVIG testing had been done (everything about Dr Expensive’s testing and briefing regarding the tests was confusing and off-pissing, by the way. Everything. Which is why we quit him)).

There are no good theories as to why 6AA died. The higher dose of low molecular weight heparin mentioned above is for me, not Frosticle, and Dr George doesn’t think I could’ve clotted 6AA to death. Though the aspirin is for us both, given The Professor’s recommendation years ago that I take aspirin when pregnant. The steroids and intralipids are definitely all Frosticle’s, as are the cooter-bullets, because ew. We had those bases covered. So, 6AA may have had the right number of chromosomes, and yet still have had DNA of gibberish and codswallop. Maybe all my embryos do. H and I have both been karyotyped and we are both normal (no translocations, balanced or otherwise), but that doesn’t guarantee one or both of us doesn’t have a spontaneous fuck up in the gamete-making process that doesn’t show as a miscount in the chromosomes. And I am 38. My eggs are crappier than those of a 28-year-old and that is Mother Nature for you, the stone-hearted bitch. And it could’ve been just ‘one of those things’. We know so very, very little about conception and early embryonic development. So very, very, very little.

H and I snuck off for coffee before heading back to work, and to have a little think. I had actually started another round of spotting and light bleeding a couple of days ago, but we both decided we did not want to start the sniff-swallow-stab-poke regime today. We’d rather have the extra month. In which I shall take prenatals again and make sure I exercise regularly. And eat my greens. And have a couple more counselling sessions, and warn my boss about the scan regime, and cry and panic and flail about, because this is insane, Gentle Readers. It is nuts. Nuts. How can we possibly put us through this again? And yet, if we don’t, we both know we will regret it. And I can’t face abandoning Frosticle. The poor wee thing will probably die in my uterus, but it will certainly die in a petri dish otherwise. At least Cute Ute’s nice and warm.

P.S. – Cute Ute, the psychotic bitch, decided to make some unintelligible point or other very definite to me, by a sudden outbreak of seriously heavy bleeding with clots this evening. What? Why? I am taking Cerazette, damn it. At least I’m not in pain, she said cheerfully, practically begging Fate to smack her in the teeth for that one.

So what the futility happened?

The WTF appointment with Dr George was over three weeks ago now, since when I have been Refusing To Think About It. You’ll have to excuse me. I had a lot of ‘Holy fuck I nearly died’ to process, which created massive interference with the ‘Shit shit shit shit SHIT I miscarried 6AA’ data stream. Basically, my hard-drive needed serious de-fragging. I think I cobbled together a parallel-processor out of tinfoil and spit – it may burst into flames mid-post – so onwards! Let me see what I can dredge out of the dark backward and abysm of time.

(From semi-educated computer jokes to Shakespeare in one sentence. I rule).

We had emailed Dr George pre-visit, so as not to waste the entire appointment in a ‘previously, on House‘ montage. The first thing he said was ‘I see you’ve been in the wars!’ with a welcoming grin, which instantly dissolved into gloom and he added, solemnly, that actually what we’d been through was horrific, and he was truly sorry. He’s normally a cheerful upbeat sort of chap. I see I defeated him. I felt a complicated cross between vindicated and miserable about that. It’s nice to be taken seriously but not very reassuring to be The One That Makes Doctors Gloomy.

To address the DVT and dramatic pulmonary embolism problem, Dr George agreed that whatever my test results up until now showed (i.e. absolutely bloody nothing that could predispose one to thrombophilia) (apart from a tendency to sodding well clot anyway, so bloody there), I clearly had a severe, pregnancy-related thrombophilia problem. He wanted to wait and see what the Haematologist had to say about it before we did anything else, in case I needed more aggressive treatment than prophylactic doses of Clexane, for my own safety. And in any case, I needed time to recover and make sure there was no lasting heart or lung damage (jolly conversation, this). On the other hand, the Clexane should have been enough to protect 6AA, especially as my troubles began when I stopped taking the Clexane. Which, incidentally, will never ever never happen again – me suddenly stopping anti-coagulants after the end of a pregnancy. Hell no. Dr George was quite firm about that. The thing is, the lack of diagnosed serious causes of thrombophilia had lead everyone, everyone, to believe the clotting was only a threat to my teeny-tiny embryos, and not in the least to me. Hahahahahahah.

And then we turned to the sad demise of 6AA. Who had a perfect set of matched chromosomes, and no business failing to develop at all. Dr George declared that waiting to day 5 and having CGH performed on the survivors had been the right thing to do. To recap, back in July:

  • Thirteen eggs were retrieved during, uh, retrieval. Dr George was pleased about this. It promises well for future IVF, apparently.
  • Nine of those eggs fertilised on being placed in the company of H’s sperm – this is also good, given my age.
  • On day three, we had six embryos that looked worth culturing to day five. So we cultured them to day five.
  • On day five, we had four embryos left to biopsy, one excellent-looking, one reasonable, one a little slow, and one shabby little creature they could only get one cell from to test.
  • Twenty-four hours later, we had the results. Normal 46-chromosomes-in-pairs 6AA and 6BA, one wildly abnormal one (still alive, still growing strongly) which had three trisomies and a monosomy, and the shabby little creature couldn’t yield a result and anyway had conked out overnight. So we transferred 6AA and froze 6BA.
  • Consider, if we’d done a day three transfer as per standard, we’d’ve had a one in three chance of transferring a normal embryo, a one in two chance of transferring a non-implanting dud (and a possible chemical pregnancy, if it’s true embryos do slightly better inside one, as shabby little creature was hatching and looking to implant), and a one in six chance of transferring a badly damaged future miscarriage (best scenario) or stillbirth (horrific worst scenario).
  • Nevertheless, 6AA died anyway.

So why did I miscarry, given the Clexane for clotting and inflammation, the Metformin for wonky blood-sugar, the Prednisolone for my psycho immune system, the Intralipids ditto, the Progesterone pessaries to keep my uterus from shedding? What had prevented a normal embryo from developing normally?

It is possible the clotting issue was the problem, and prevented 6AA from creating a decent placenta. A human embryo spends its first week or so, once it has implanted, house-building rather than developing itself, so the gestational sac and yolk sac grow first, to nourish the embryo while it works on tapping maternal resources via a tiny little proto-placenta, and then and only then gets to work on itself. If placental development had been botched by micro-clots in my uterine capillaries, 6AA would’ve stalled. And in fact, we had a lovely gestational sac and yolk sac and no bloody visible foetal pole.

It is possible my psycho immune system was not sufficiently suppressed after all (I seem to be Queen of borderline or inconclusive test-results and nevertheless violent symptoms) and there were enough NK cells roaming my uterus to attack 6AA’s placental intrusions, with results as above. There’s a further test (expensive, natch) they can do, testing my NK cells against various combinations of Prednisolone, Intralipids and IVIG, to see which mix suppresses the NK cells best, and then use that. We are thinking about that.

A very very unlikely possibility (and Dr George was adamant this was unlikely) was that I simply wasn’t absorbing the progesterone from the pessaries very well. You apparently can’t really test for this as blood levels of progesterone don’t match the uterine levels of progesterone, as the stuff in the pessaries is absorbed by the uterine area primarily. Or should be. My uterus is abnormal, however, what with the adenomyosis. ‘Next time,’ said Dr George, ‘we could use progesterone-in-oil injections instead, just to be sure. They’re a bit of a pain, though.’

And it is possible, if apparently also very unlikely (H and I have both been karyotyped and genetic issues do not seem to run in our typically-non-miscarrying families) 6AA, despite the 46 chromosomes and healthy go-getting attitude, was genetically non-viable on a more subtle level. I don’t know. Nobody knows. There was nothing to test.

We then discussed trying again. Should we ‘bank’ 6BA, our frosticle, and do another fresh cycle to gather up a couple more healthy embryos before I get all perimenopausal? Or transfer the frosticle first and bother with more IVF only if ‘necessary’? H has been rather pro the first option, not least because he always wanted two children, and therefore having a few spare healthy embryos in store and ‘only’ 38 years old, for when I am, oh, 41 say and ‘ready for seconds’, would be sensible. I had been all ‘two kids would be splendid’ up until a couple of years ago, whereupon a combination of ‘I’m too old for this shit’ and ‘I’m too ill for this shit’ and ‘I can’t go through all this that many more times’ put me squarely in ‘one. One would be perfect. One would be a fucking miracle‘ camp. With the proviso that Lord knows how I’d feel about it once I had the Precious One, because I am not stupid.

Dr George was of the opinion that given my clotting issues, we’d want to avoid the oestrogen stimulation of fresh IVF cycles if it wasn’t necessary. He would transfer 6BA first, and then rethink if that ‘doesn’t work out’. This does rather mean H too would have to become more reconciled with the idea of an only child, because if the FET did work, it’d be maybe two years before we’d be up for another IVF, and I’d be 41 and mouldier. Even though the women in my family have late late menopauses and both grandmothers had naturally conceived healthy children in their forties. And would I want to take Cute Ute the Despoiler back into cycling? With a very small child to care for? Remember I call her The Despoiler for more reasons than the recurrent miscarriages.

Anyway, if I am behind any plan, I am behind the FET plan, and see how I feel about a fresh IVF after that. But I am very skeeved about trying again.

Plan, such as it is: Wait and see what Haematologist says. Contingent on her opinion, consider further NK cell testing. Do a FET using recommended anti-coagulants, immuno-suppressants as revealed by test, and progesterone-in-oil rather than pessaries. And see what happens.

To which plans I would only say, why the fuck is everyone being so gung-ho about this? What about me? What about all those miscarriages, including one of a sodding perfect embryo? Why are you all so keen to do this to me again? The hell is wrong with you all, you heartless arseholes?

I’m going back to my bat-cave, and walling myself in.

And now kindly wash your hands (NBHHY)

I am having not such a good day today. Yesterday was excellent, in that I felt quite quite hormonal, and found the commute home to be very much a trial to my overkeen sense of smell and evening nausea (that’s me. Not morning sickness, evening sickness). People of Britain! Washing is neither expensive nor bad for you! Kindly do it daily!

And then I slept badly and woke up slightly feverish, with a sore throat and tummy cramps. Oh, fucking hurrah. And not feeling pregnant at all.

So I went back to bed and pretended to be in a coma for a while.

The cramps were actually being caused by a slight gastro-intestinal disturbance – my bowel is not perfectly happy and is alternating between mild constipation followed by Day of Reckoning Also Several Visits To Privy, and then back to nada for a couple of days. Today was a Day of Reckoning, and I think Cute Ute was not enjoying the pressure, as it were. She is being quite domineering in there. Satsuma is also still achy and twingey and at great pains to let me know she took a giant needle for me. Over a dozen times. After having been inflated to a, oh, I don’t know, she says cantaloupe, but I think she’s milking it.

Having cheered, marginally, up about that, I then decided to weigh myself, because, Gentle Readers, I feel rather larger than I was. And I indeed am piling on weight at a rate of a couple of pounds a week since they popped the embryo back in dear God. I have not changed my diet. If anything I am snacking less because the metal-mouth makes chocolate very unappetising. Fucking hormones. Not that I mind putting weight on and growing serious tummy as such – I am pregnant, damn it – but it feels a bit weird to be gaining so fast and looking so very… tummy… already. I am six weeks. Surely nothing much should be happening, weight-wise, yet? My little passenger is the size of a raisin. Raisins do not weigh 6lbs. So there was that.

Remind me that I’m on Metformin, which has always made me gain half-a-stone or so because I’m weird, and I’m on progesterone, which makes everyone bloated and constipated, and I’m on steroids, and what did I think would happen on steroids?

Naturally, having crushed my indifferent breasts into my ribs repeatedly and having made myself eat mayonnaise to mere mild pleasure rather than unGodly retching, I peed on the remaining (cheap, insensitive (it told me I looked fat, the bastard)) pregnancy test. The test line came up thick and vivid before my pee had even soaked as far as the control line. Last week, the same brand took two minutes to provide a faint, if clear, line. So I am peeing out rather more HCG than I was last week, for what it’s worth. Which isn’t much, when you’re an Olympic-grade worrier like me.

There’s a whole week to go before the scan. I am going to go quite quite mad.

I have put myself back to bed with the ginger ale and a bucket of herbal tea and Agatha Christie. It seems the only thing to do under the circumstances (crapping hell, my throat is sore. A colleague was off sick yesterday after sneezing and coughing all over the place on Wednesday. Do I think…? Yes I do).

Believe in the line

Early morning dialogues chez May & H:

‘H? Don’t you want to look at this?’
‘What am I looking at? Oh. Well, I can’t see anything.’
‘You can’t see… With what eyes are you looking, for fuck’s sake?’
‘Really tired ones. What with the storm last night, I did not exactly sleep.’
‘Neither did I. Just look at it.’
‘OK… Oh. Huh. That’s really quite faint.’
‘Yeah. It came up within three minutes, though.’
‘Five days past six day transfer on a cheap Internet peestick. That claims a sensitivity of 10miu.’

Oh my Gentle Readers, the romance. The adorableness. It’s exactly how we all dream of telling our partners.

‘So you’re going to work this morning?’
‘Yes. I feel fine, and I need to think of Something Else for the rest of the day.’
‘Well, take care. And remember not to freak out if you get cramps. As far as I can tell from twitter, everyone gets cramps.’

Bless the man.

So I went to work, and thought about Something Else for as many chunks of the day as I could muster. Work also had air conditioning. I know we had a massive storm last night (‘It lives! It LIVES!Bwahahahaha!‘), and they’re supposed to clear the air, but this city is still and exactly like sitting in a bowl of nasty hot chicken soup. Complete with unwelcome feet and a greasy film all over everything.

And yes, I have cramps. More infuriatingly, I had a trace of pink spotting. Some gentle investigating with a tissue leaves me completely unsure as to whether it originates from deep within, or from the more outward area of my precious, and said precious is actually feeling a tad sore from all the ghastly waxy glop of dissolving progesterone pessaries, also I am on Clexane. So I freaked out for about ten minutes and then talked myself down off the ledge.

Actually, no, I did not freak out, exactly. I was actually hijacked but completely by Bitter McTwisted, who looked at the trace of pink on the toilet paper and laughed, acidly, because chemical pregnancies are what Mays do best. Who the hell was I to think this one would go any differently? It would never go any differently. This was insane and I was a fool. An utter, utter fool.

And then the Positive Thinking Fairy got her in a headlock and dragged her back to my hind-brain. They’ve been duking it out ever since. Don’t they ever get tired? As I type, the Positive Thinking Fairy is listing everything that is different this time, the progesterone support, the Prednisolone, the Metformin, the bloody Clexane (wanna see my bruises?), and Bitter McTwisted is leaning back, staring at the ceiling, muttering ‘yes, but this is May we’re talking about’ whenever Positive draws breath.

I’m not sure which of them dragged me into a chemist on the way home and held out a box of peestick and some money to the lady at the till. This peestick, an ‘Early Bird’, which the internets later told me had a sensitivity of 50miu, also came up with a faint positive within 3 minutes. Christ, those internet cheapies are cheap pieces of shit, aren’t they?

Parnassus (temporarily)

Item – Hi, H! Thank you for posting yesterday. Hi, Gentle Readers! It’s May, but a rather frazzled May who is so not up to narrative arc. So! Items!

Item – H mentioned the ‘tricky’ egg retrieval yesterday. By ‘tricky’, Dr George assured me, he meant they had to tilt the table with me on it at 45 degrees, and the one of the nurses pushed down hard on my belly with both fists, in an attempt to shove Satsuma just that little bit closer to the ‘probe’ (I think he meant ‘needle’). ‘And we used the extra-long probe, of course,’ he added breezily, ‘You’ll feel a bit bruised tomorrow.’

Item – He’s right, you know. I do.

Item – Itemised list of owie: Bruised back of left hand from bastard awful failed cannula insertion which hurt so much I nearly cried (Anaesthetist very apologetic). Bruised crook of left elbow where I had several blood draws including a messed up one already, but where the cannula had to go in the end anyway so tough. Mysterious scratch on inner wrist, possibly to do with Anaesthetist’s chirpy announcement she likes to do acupuncture on her sleeping patients to hasten their recovery oh my horsey God. Tender area between waist and ribs on right side of abdomen, I think courtesy of Satsuma-wrangling. Tender achy Satsuma, who is clearly feeling hard-done-by (and oh, Lord, but wasn’t she sore when I came round. Thank you tramadol). Attacks of menstrual-ish cramp whenever I pee. And there is no way in aitch-ee-double-hockeysticks that I’m getting into anything with a waistband this week. On the plus side, I am peeing, and I’m not bleeding.

Item – Thirteen eggs! It seems to me that Satsuma, Queen of Passive-Aggression that she is, decided to be as helpful as possible in the most fucking awkward way possible. Yes! I will grow many many eggs, all by myself I might add, and I will take them with me to relax on your lungs because I can’t work in these conditions why won’t you people leave me alone. What do you mean, giant needle through the vagina? I just grew all these! Absolutely fucking not, you can’t have them, I’m leaving, Harold, and taking the babies with me! [Who the hell is Harold? – Ed.]

Item – As of this morning, I am taking two Cyclogest pessaries a day, morning and evening, fore or aft. I am going with ‘fore’ for the moment because [TMI] farting after the insertion of melty waxy substances aft is traumatic. I am instructed to go aft on day of transfer. Joy. I am still on Metformin, and Prednisolone. Tonight, I stuck my poor abused muffin-top with 40mg of Clexane, in a pre-loaded syringe that goes ‘bang’ when it’s done. Have you ever had a stout elastic band snap and ping you? Feels like that. I have ice. And all those, plus the Intralipid infusion yesterday (Golly that was boring. And I had to call for the nurse to unplug the drip-stand from the wall so I could go to the loo. Dignity), are to stop my rabid and unreasonable immune system from savaging the putative embryo when or if we put one back.

Item – Speaking of Putative Embryos, Riverside called this morning to let us know that of the thirteen exhaustingly retrieved eggs, nine had played nice with H’s little gentlefolk and fertilised. Nine! Nine embryos!

Item – They will now spend the weekend in a nice warm incubator, I hope behaving themselves impeccably and dividing neatly and evenly and in a timely fashion. And yes, it does feel surreal and slightly wrong that they’re all the way over there and I’m all the way over here. On Monday at 8am, the embryologists will let us know how they all got on, and we have to decide right there and then whether to do Day 3 CGH, Day 5 CGH, or stick any sorry remainder straight back in without testing. Or if they’re all dead, of course. The attrition rate on this is not for the milky with human kindness. So Transfer could be anywhere between Monday, Wednesday, Thursday, next cycle as FET, or never because life’s a sod like that.

Item – I am cycling rapidly between delight (‘nine! Nine embryos!’), Jewish motherishness (‘And what was wrong with the other eggs? Eh? Eh?’ (my first Jewish Mother joke about me! I’m so proud)), and profound irritable despond, because what’s the point and why would I ever assume it would work, and I’m sad and I’m tired. H being anxious and cranky as well, we had a, uh, frank exchange of unflattering opinions. This sucks.

Item – Nine!

Item – Ow.

Item – Nine!

Better living through chemistry

Hola, Gentle Readers. I had a very nice weekend. We went Out, and had lunch with friends, and went to concerts, and had Sunday Brunch, and the weather was, for once, gleefully sunny (hey! It’s summer! Actual summer!). The point being, not to think about things very much and be cheerfully distracted by sun and music (H and I are both serious classical music nerds) and nice amusing people and bacon. And it worked.

We harshed the mellow a tiny bit this evening because I had my share of HFEA consent forms to fill in, which I had been procrastinating about, because, jeez, what happens to my embryos in the event of my death? Aiieeeeeeeeee.

And of course, there’s the nightly stabbing of self with the Gonal-F pen. It’s a cool pen. The needles are like hairs. I haven’t felt a single stab yet, nor left a mark above a tiny red dot that had entirely vanished by the next morning. It’s almost fun. Apart from the headache. Which could actually be caused by astonishment at the hot weather.

On Monday or Tuesday, depending on the scan and blood work, I start Cetrotide. In which the needles are considerably bigger. So, yes, tomorrow morning I go back to Riverside with my consent forms for a thorough poking.

I am going to talk about my ‘regime’ now (I have a spreadsheet! Riverside gave me one!), if for no other reason than to tidy up the inside of my head a bit.

Buserelin, from day 21 to first day of period. To squash any funny ideas Satsuma may have had about early follicles and random cysts, and to quell the endometriosis a bit. I felt nothing for the first week, and then developed a persistent bitter-sweet taste in the mouth and a very irritating headache that went on and on and relentlessly on. On the plus side, Satsuma looks angelically docile and while my period still sucked hugely, it definitely sucked rather less than the previous few.

Metformin, 1000mg – 500mg pill twice a day, at breakfast and at dinner. I find this dose, as recommended by Dr George, easier to tolerate than 1500mg as per GP’s recommendation. 1000mg makes me burp a lot. 1500mg made me constantly gassy both ends, thirsty, hungry, and tummy-achey, and I put weight on (on, for fuck’s sake. This is not how Metformin is supposed to work). So. The point of Metformin is to improve egg quality, and reduce the chance of miscarriage by keeping blood sugar level, and Dr George said it can help prevent OHSS in women with PCOS (which is me. I still have a moustache, even if Satsuma is behaving so nicely these days).

Daily multivitamin-and-mineral, with the recommended 400mcg of Folic Acid (I also eat green leafy vegetables and brown rice by the shovel).

Daily fish-oil capsule, not cod-liver oil, because vitamin A can be toxic to wee embryos (an early Arctic exploration team all died from eating polar bear liver. They thought it would be nourishing. Polar bears store retinol in vast quantities to survive months on end without food. Oops). Essential fatty acids however are good for fetii and, crucially, are good for people who have ichthyosis vulgaris (hi!) and eczema (me again!).

Gonal-F, 150 units of whatever the hell units they are, subcutaneously. This is the ‘artificial’ Follicle Stimulating Hormone that is now bullying Satsuma into growing a bazillion eggs at once. Daily until collection. Unless Sats explodes and my oestrogen levels go through the roof. Side effects, ‘premenstrual symptoms’. In practice, I am headachy and tetchy. Which could be caused by just about anything.

I do not understand the anything at allness of anything at all

We received an email from Dr George today, saying, basically, ‘as I said in my letter…’. And H called me from work to say ‘WHAT LETTER?’ and that’s the problem right there. Dr George sent us a letter explaining all about the changes in plan and we never got it.

Though his explanation for the buserelin prescription was a little more, well, less. He did it via email while out of the office, apparently. I can only imagine that the nurses pestered him at home about it, and he emailed it in without double-checking who it was for and why, because why the hell would someone want buserelin if it wasn’t needed for something? And ta-dah! Cock-up.

HOWEVER, in our email to him, the ‘what’chu talkin’ ’bout, Willis?’ email, we pointed out that the original reasoning behind the buserelin was to give the endometriosis/adenomyosis a good ol’ squashing, so I don’t start The Cycle Of The IVF puking hysterically (puking hysterically! I kill me!) and will be more available for wanding (personal comfort apparently a factor. Who knew?). So now Dr George is saying ‘oh, what the hell, do two weeks’ buserelin suppression anyway, and then we’ll go on to an antagonist protocol’.

The reason behind the antagonist protocol? My AMH is ‘excellent’. And that plus PCOS equals quite a risk of OHSS. Which we all agree is a Bad Thing. So. This all seems perfectly sane, and would’ve seemed sane from the off if we’d received that bloody letter.

So. Plan. Buserelin, then antagonist protocol, with steroids. After collection, intralipids and clexane (heparin). Meanwhile, the point of being on metformin (oh, yes, I forgot yesterday to mention the actual point) is that it lessens the risk of OHSS in vulnerable patients (hello! That would be me!).

My eyes looked fairly normal this morning. I don’t know what to do about the metformin anymore. Bloaty farty bog-addict I can live with, exploding liver I (natch) can’t. I wonder if H was just being vaguely hysterical (ha! Hahahaha!) about my eyes. I haven’t taken any metformin today while I worry about it and prod myself repeatedly in the solar plexus (nada).

Meanwhile, Satsuma and my bladder had a competition to see who could give me the most grief, and I am in so much pain in that general area I feel vaguely sick, and have gone all morose. It would be just like Satsuma to pop early this cycle, and make me do maths. Silly gonad.

[Enter flock of unicycling pygmy goats playing the famous bit from La Forza del Destino on teeny tiny violins]