I'm not bleeding. I don't think I'm anywhere close to bleeding. Consequently I feel wonderful, which is probably just as stupid as how awful I was feeling the last two days. But I've decided to take my mood swings at face value and let them happen. Of course now I'm going to be even more devastated on Monday if we get bad news, but that's life (if we get that far, of course. Must keep saying that). I think I'd be pretty devastated if it's bad news on Monday anyway, so being in a good mood now won't make that much difference. It's amazing how pessimistic you can feel and still have Hope sitting in a corner of your brain, saying, "It might have worked, you know. Those pains, they were different than anything you've had before!"
Linda asked about why I bled last time at 8dp3dt. Good question. We should start by reminding ourselves of why we have to be given supplemental progesterone. At the beginning of IVF treatment, no one had any idea that this was required. Eventually they figured out that the disruption of the follicles during aspiration means that they do not go on to start their progesterone synthesis a day or so after ovulation in the way that they should. Although many women did get pregnant in those early days without progesterone supplementation, too many did not. Progesterone supplementation became the way to go. There is still much debate about how long it needs to be continued. Most studies show that you can stop after the luteal phase and get the same live birth rate as if the progesterone is continued throughout the first trimester because by then the follicles have recovered, are forming the corpus lutea that they should have become in the first place. Continuing progesterone support through the first trimester results in an increased rate of late miscarriage - i.e., the progesterone support is 'allowing' pregnancies that would otherwise have ended to continue.
Last time I used the progesterone suppositories rather than the PIO. At my clinic the suppositories are the standard treatment as much clinical evidence shows that there is no difference in clinical outcomes between PIO and intravaginal support, and most people prefer the suppositories to sticking themselves in the ass. Although, I have to say, I've read a lot of the papers on this and they are not exactly conclusive - plenty say that IM progesterone is better so I imagine that Dr Candour and team are partly going on published studies and partly on their own experience. They use anal suppositories here, and you do them at night, so you don't get any leakage. No side effects of smooth thighs and messed-up underwear. In addition, it is not true to say that you will not bleed while the progesterone continues. In one study, 67% of women bled before IM progesterone was discontinued (admittedly, at an average of 16.2 days after retrieval, so I am a bit wierd). Actually, recent work says that hcg might be better than progesterone support, but I guess it's too early for them to be switching.
However, since I bled at 8dp3dt on the suppositories, clearly something was wrong. I have a short luteal phase on my regular cycles - anywhere from 10-12 days, but averaging just under 11. That might indicate a progesterone problem, but my progesterone a week after ovulation was a "text book excellent" value of 59 when it was tested 15 months ago. So it's not the absolute level which is the problem. Apparently, though, everyone's body uses progesterone in different ways, probably due to genetic variability in the chemicals which metabolise progesterone, so testing the absolute level doesn't actually give you the answer. Dr Candour decided that PIO was the way to go, just to see if I was the one case in a million where it made a difference. So far he seems to be right.
That's enough science before breakfast. Onwards and upwards.