Low ovarian reserve at 35?

The rest of the appointment was pretty shitty.  Even though the doctor looked me in the eye and said "everything is where we expect it to be", when it came to the appointment with the nurse she read what the doctor had written and told me it didn't look good.  The cyst is there, and bigger than it was in April.  We didn't have the bloods back yet so didn't know if it was a "functional cyst" or not but it WAS in April.  My estradiol was 550 in April and apparently it is supposed to be under 200.  Although, when google Day 3 bloods most sites say less than 100 is normal for estradiol.
Today's blood work was estradiol 200 and FSH 11.  Both these numbers show that I may have a low ovarian reserve or that there is a functional cyst.  I'd like to think it's the cyst.  The clinic wants to act like it's the cyst and go ahead with the meds for this week.  Apparently since I'm "only 35" my ovaries might still perk up.  On Friday (Day 7) we'll see where everything is and whether the cycle can continue.
I asked what can be done about the cyst.  The nurse this morning said we can wait until next cycle (yeah, like it will all of a sudden be gone after 6 months) or we could have it drained.  I'd have to discuss this with the doctor.  I don't see my doctor until November now so this doc who does the ultrasounds better talk with me on Friday.  She obviously was "so busy" she gave me a generic comment this morning and sent me to the nurse to deal with the issue.  How insulting.  I know they're busy but did she have to lie to me?  This doctor was a bitch the last time I had a cyst too, very quick to say "I'm not your doctor so you'll have to speak with her".  BUT you can't speak with your own doctor for months.  Only to the nurses, who speak to the doctor, then call you back 4 hours later with an inadequate answer.
I asked the nurse this afternoon if I was going to spend the whole cycle worrying that it could be cancelled any day and she said we'll know if it has to be cancelled on Friday.

So today sucked.

On a positive note, we were sent to a pharmacy where the owner sells all the fertility meds at a 2% markup and no dispensing fee.  Apparently she had gone through fertility treatment and therefore wants to help US out.  Isn't that awesome?
And I took me first shot (300 ui of Puregon) and it didn't hurt.  Great.

At the clinic

So I have a cyst on my right ovary but it didn't phase anyone. Apparently "everything is what we expect". So not standing out and not falling behind. I'll take that.
I met a nice woman while waiting who is back for her second round after being successful 5 years ago. That's always great to hear.
Just waiting for injection teaching now and then it REALLY begins.

CD 1

So Monday is my first day of B/W and u/s for IVF #1. I am SO hopeful and excited. Could we finally be pregnant in just 28 days? I'm feeling very good about this.

Continuing to stare at the calender

I'm changing my guess to CD1 tomorrow and CD3 as Monday, which means I have several clients to reschedule.  This is not going to stress me out though.  I have been excited about this, knowing I will have several days that I have to cancel my clients.  Sunday just sounded like a nice alternative to that.  I guess I still have a few hours for Sunday to be a possibility...

Cramps

Left sided cramps have started.  Any other cycle, I would be:

• trying to convince myself that they aren't actually cramps
• going on FF to see how many people had cramps 9dpo and got a BFP
• checking for spotting every hour
• trying to visualize a healthy implantation

This cycle, my neurotic tendency is to look at my calender, guess my CD1, count to CD3 and think about how I will have to change my schedule that day.  So today's guess is that CD1 is tomorrow, making CD3 BW and U/S start on Sunday.  Perfect!

The Terrible Thoughts

Tonight my mom told me that my sister was going to "try to get pregnant".  My sister is 2 years older than me, so I knew she would soon.
I just hate my thoughts as I drove home.  I'm so jealous of everyone who gets pregnant now.  I stopped going to baby showers at least a year ago b/c it makes me sad and jealous and I don't like being that person.  But, I really don't want my sister to get pregnant before me.  I can't imagine how jealous I'd be, and angry for my own fertility problems.
My self talk is that "no one should have to go through infertility".   No one should have to experience the highs and lows of living month to month.  So I do hope it's fast and easy for her.
I just hope IVF will get me there too.  So I'm only happy for us both and not jealous.

Mondays

Busy days at work help me to stop thinking about next week's IVF and anything that could go wrong to cancel the cycle. Who knew that I could like Mondays?

I am a worrier.

I try not to, but the more time I have on my hands, the more I worry.  Basically, it's better that I keep busy.  I'm usually busy during the week but on the weekends I either need a good book, to be busy with work, or  something planned socially.  I just finished my book so I've started "thinking".
(BTW I just finished "The curious incident of the dog in the night-time" by Mark Haddon - unique book, easy read, I liked it).
Usually I read fertility blogs/infertility blogs and even browse through charts on FF.  Today I've been reading over all of my IVF information given to us at our education session a few months ago.
My Dr. did not put me on the BCP because I get migraines.  The hormone drop when stopping the BCP commonly causes migraines so she told me we'll just start the IVF cycle from a natural cycle.  I've been fine with this decision up until 4 days ago when I ovulated.  I had significant right sided pain, which has happened before.  Once, it was a burst ovarian cyst.  The next time, I am sure it was a cyst since on my next Day 3 u/s I had a functional cyst which cancelled one of our IUI cycles.
The point to BCP before IVF cycle is supposed to be to "give the ovaries a break", "establish schedules", and "decrease the risk of cysts".  So right now I'm worried that my IVF cycle, which should start in 7-9 days, could be cancelled b/c of cyst issues.  I'm SO excited and hopeful about IVF.  I have days off work somewhat figured out (we live 2 hours from our fertility centre so basically every second day I'm off work for 2 weeks).  I REALLY hope that there isn't a cyst in there preparing to delay IVF.
In the meantime, back to reading the internet...

1 or 2 Blastocysts?

As I await the start of my first IVF cycle (8 -10 days), I have one decision to make.  IF enough eggs are retrieved, IF enough eggs are fertilized, and then IF enough fertilized eggs make to to the blastocyst stage, we have to decide on 1 or 2 for transfer.  I was told there is an increased risk of birth defects with twins.  My fertility centre is not able to tell me how much of an increase in risk, just that "there is an increased risk and you have to decide if you want to risk it".  Thanks for that scientific answer.

I like to see stats.  I like to see the research.  I like to see opinions.  And I don't mind spending time trying to compile this information.  So, I used a medical search data base, google, and several blog sites to help me (us) with our decision.

Although the stats vary slightly, it seems to be that 50% of all twins will be born premature (and low birth weight)  and 9% will be very premature (and very low birth rate).  In comparison, singletons will be premature 7% very premature 4% of the time.
Infant mortality rate for twins is around 3% compared to 0.3% for singletons.
Many twins are delivered healthy.
Monozygotic twins have a higher rate of congenital anomalies than dizygotic twins.
There is an increased maternal risk for obstetric complications with twins.
Beyond increased risk of prematurity and mortality, the increased risk of complications for twins includes respiratory distress syndrome, necrotizing enterocolitis, sepsis, intracranial hemorrhage, congenital malformations, cerebral palsy and other long-term neurological complications.  Finding the specific increased risk for each of these complications was nearly impossible.  I did find the cerebral palsy risk among one or both of the twins at about 7% compared to 1.6% for singletons.

A few interesting papers discussed single embryo transfer (SET) with IVF/ICSI.  Basically, with double embryo transfer (DET) the percentage of pregnancy (this includes miscarriages) is 50% with 30% of these pregnancies being twins.  With SET the pregnancy rate is 30-35% with only 2% twins (obviously).    In theory, if you choose SET, the other "best" embryos can be frozen and used in the next cycle if pregnancy isn't achieved.  SO, these researchers are suggesting physicians encourage SET instead of DET to decrease the risks associated with twins.  The researches talk about the expense of IVF and that  most people will choose DET, even if it's not the "best" choice.
Not one paper that I read pointed out how depressing it is to get negative results cycle after cycle and by the time someone gets to IVF they have had so many negative cycles that they are desperate for a positive.

All of my hope is in IVF now.  I am hopeful and excited for the first time in 10 months.  I really need a positive result.  50% and 35% is a HUGE difference.  And I know that the embryo isn't wasted but it may not make it through freezing or thawing.  Even with a positive pregnancy, only 30% of those are twins.  I would, however, feel terrible if either twin had a disability because I couldn't wait another cycle or two.
As of today, with the above information, I'm leaning toward transferring 2.  In the end, we may not even have this decision, but I feel better being prepared for the decision.  Plus, it keeps me busy instead of reading all the TWW sites.