Wham Bam - Thank you CCRM

It's no secret that I've been completely unimpressed by my Coordinator at CCRM and as time has gone by her mistakes and carelessness has almost been a running gag between Jillian, Anthony and I.

First was her lack of compassion when trying to schedule the original transfer date (January 20th). Her cold "sorry..." still burns me. Yeah - I can really feel your deep remorse.

Then it was the constant need for me to clarify instructions with her. I was fully prepared not to micro-manage my own cycle going into this. I wanted to do exactly what I was told - no matter how different the protocol or schedule was compared to our clinic. However, I felt myself having to take the bull by the horns several times throughout this whole process.

When I was originally given my calendar for transfer - I was immediately hypersensitive to the projected progesterone protocol. My calendar wanted me to administer 0.5 ml of progesterone every other day leading up to the transfer and continue until my first positive HCG test. Then it would bump up to 1ml every other day and continue until otherwise instructed. Endometrin (which is a vaginal insert) is also a form of progesterone - however it is more of a local support than the PIO (which is absorbed from the muscular tissue into the blood stream). This was scheduled for twice a day until my positive HCG then would increase to three times a day. My biggest concern was how different this was from our FET protocol. NCRM has their patients do 1 full ml of PIO daily and we use a vaginal insert at nighttime only. That way patients aren't running around with progesterone residue in their chonies.

If anyone is familiar with vaginal progesterone -- they can tell you that the discharge is not only awkward but borderline foul. There are several moments that I can feel it pooling out of me and sometimes running down my leg or just collecting in my underwear. (Yes even with panty liners).

**Note...obviously not actual picture of Endometrin run-off....but pretty darn close in color and consistency. Hope you have a nice understanding of what is going on *down below*

Anyway...back to the calendar. So as you can see from the calendar it is completely different than what I'm used to from our clinic. And the fear of my progesterone coming back low was constantly scratching at my brain.

The day before my scheduled transfer (Feb 23rd) - I received a confirmation email from Candace stating that I would "take my mid-day Endometrin when I got home after transfer).

Wait...what? MId-day progesterone? Am I missing something? I frantically combed through my calendar and dosing schedule and it was very clear that progesterone was to be administered morning and nighttime only.

I wrote back with some concerns regarding the clarification of my instructions - I even used nurse-speak to remind her who she was dealing with:

And surprise, surprise....someone else had to clarify in her stead:

I was extremely put-off at this point.

Now - look back on the FET confirmation email above and note that the Pre- and Post-Transfer acupuncture is clearly marked with an emphatic "No." I've been super clear regarding my dislike for acupuncture. I've had it twice - and was completely underwhelmed both times. I know some people swear by it -- and I even have recommended it to patients that have shown interest. But it's just not my thing. But apparently it's a HUGE thing at CCRM - it felt almost like blasphemy to refuse.

The afternoon of my transfer I was handed acupuncture consent forms to fill out prior to transfer. I handed it back with a huge "DECLINED" written across the pages. As I was getting set up in my transfer room the medical assistant says "Ok the acupuncturist will be in shortly to get you started." Both Jillian and I say simultaneously -- "We don't want acupuncture!" "Oh..." she responds "Your nurse marked you down for it." Jillian and I exchanged aggravated glances.

My progesterone was drawn that morning and resulted at 16.2. CCRM wanted it >15 and NCRM likes it above 20. So this was making me a little nervous how borderline low it was. But I relented to continue my instructions and follow my calendar.

So days went by - and as anyone who read the last post knows that it was not an easy wait - and I got my progesterone checked with my HCG. It had plummeted to 9.3. And this is the response I received from my diligent nurse:

Ok - so let me get this straight -- my progesterone is almost half of where you want it to be and you're going to have me follow my proposed calendar with an increase that was going to happen anyway - even if I had a normal level? You've got to be kidding me. It was at this point I realized that I needed to be my own advocate -- because sadly I had no one at CCRM that seemed to care.

Now - for those of you that aren't aware of the importance of progesterone - it supports the pregnancy by providing nutrients to the endometrium (uterine lining). In a typical menstrual cycle - the ovary that ovulated produces progesterone in hopes of a fertilized egg that will make it's way down for implantation. If your body senses a decline in progesterone - it sends a signal that there was no fertilization/implantation and the body will shed the uterine lining (aka... get a period). Since my body was not participating in ovulating and my own endogenous progesterone production - this pregnancy is solely relying on my exogenous progesterone sources (PIO and endometrin). If you look at my proposed calendar - you'll notice that I already took 1ml of PIO that morning and my next dose wouldn't be until Wednesday morning. Candace ordered another progesterone for Wednesday's blood draw. You're expecting me to think that my progesterone is going to jump over 6 points with just one more injection?

Can you start to see why alarms are going off wildly??

So what do you think I did about it? Did I ask Candace to clarify my dosing? Hell no...that bitch is fired. I took matters into my own hands and converted to our clinic protocol of 1 ml every day. It means more shots -- but totally worth it considering what's at stake. The beautiful thing about progesterone is that you can't overdose yourself.

My progesterone was redrawn two days later... and it was 30.

The nail on the coffin was receiving my final pregnancy letter outlining what the next few weeks will look like as far as blood draws and ultrasounds (yay!)

NCRM keeps patients under their wing until the 2nd OB ultrasound which occurs at 9 weeks gestation. This is to rule out any growth abnormalities between the 7th week and 9th week ultrasounds. As awesome as it is to carry someone all the way through their final happy ultrasound -- we see a lot of sadness at our clinic. We manage patients that have ectopic pregnancies, spontaneous miscarriages, or retained products of conception that will need a D&C. The weeks in between that positive HCG phone call and the final ultrasound are some of the most tumultuous weeks and we get a tremendous amount of panicked phone calls reporting bleeding, cramping, and other worrisome signs.

I received this letter -- pay special attention to item #6.

Or in other words....Thanks for increasing our pregnancy rates -- but you're on your own if shit goes south.

I showed Dr. Whitten this letter and he was just as appalled: "So...they knock you up and then leave you high and dry?"

Yep...kind of like my first pregnancy.

On the bright side.... I'm two blood draws away from being completely Candace-free! Let's celebrate the separation from that numbskull biddy as if we were getting a giant grotesque mole removed. Ahh... doesn't that feel nice? The purpose of this post was not only to let out a little steam about my treatment (or lack of treatment rather) - but to show that you should always be your own advocate...especially when stakes are high. As much as I see myself of having my patient's best interest at heart - this whole experience has shown me that not all nurses feel the same. Even though that is the code we are supposed to live by. It makes me fear how many unknowledgeable patients have been given the run-around by her complacent behavior and lack of initiative and follow-through.

But enough about me! Let's talk about the baby!

Gestational Age: 5 weeks 0 days

Size: Sesame seed

Development: endoderm, mesoderm, ectoderm - basic layers that will develop into organs, tissues, skin, nails, hair, etc. But for now just tadpole status.

Stork Sensations: Nothing new. Still bloated and experiencing breast tenderness. No nausea, no cravings, no probs. If these people wouldn't keep telling me I was pregnant -- I wouldn't know any better. And it's kind of nice to know what is going on but not being physically affected yet. It makes it a little more magical that way.