What next?

I overanalyze everything. So when this cycle came to a rather abrupt and unexpected end (how rude!) at first I had a day to deny that this was the end. I was holding out for whatever hope I could. Then, I was overwhelmed with grief. The next day - furious that if it had worked, the embryo wouldn't have had time to implant before it's enviornment started dissolving around it. Anger seethed from every pore in my body.

Now, I'm just sort of here. And I will be for some time as I won't be cycling this month due to the hyperstimulation.

So, while I realize that every woman is different, and that every cycle can be different - I have questions. I want to know what it is that I should be asking the doctor when I go back. (That's your cue). I was supposed to be baking pies last night - and I made two burboun pecan pies and key lime bars before I burned my hand on the oven and decided to say screw it and delve into the wild world of medical journals.

During the last cycle, I started Follistim on day 3, and took 150 iu each day through day 10 (that's 8 days). The HCG trigger shot (day 11) was followed by an IUI 36 hours later (day 13) we had sex again on the next day (day 14) and there were around four- five follicles or so released at ovulation. I started the prometrium (200 mg. in the morning, 200 mg. at bedtime) on day 14 and kept using it until I started bleeding heavily on day 23. On day 23, 8 days post ovulation, my serum progesterone levels were 33.9. Now, that should be high enough to sustain a pregnancy - but for some reason I started spotting that same afternoon.

I knew I had a progesterone deficiency before we started this cycle, and I had begged and pleaded with doctors to put me on progesterone supplementation for over a year. They pooh-poohed my concern, saying that it's just normal to spot before your period. I showed them charts - that I was routinely spotting 3-5 days before my period started, and I generally have an 11-12 day luteal phase while unmedicated. My current R.E. agreed that I obviously have a luteal phase defect and said that he would put me on progesterone supplementation - and he did, in the normal dosage (or even a little higher) for someone undergoing IUI.

For his IVF patients, however, he prescribes PIO. Why? Based on the reading I've done - instead of merely raising serum levels of P4, it is more swiftly absorbed into the uterus, where it's needed (as is crinone as well). With high levels of E2 prior to ovulation, as is often the case in IVF, where the patient is intentionally overstimulated - or in cases where a patient has mild OHSS, as I did - higher levels of progesterone are needed to counterbalance the artificially elevated E2 levels.

Other studies that I have read indicate that if you have had OHSS in the past you are at a much higher likelihood of having it recur with subsequent cycles (check). Being young (check), PCOS (news to me - but check), also greatly increases your risk of OHSS in a cycle.

So, while I can hope it will not be the case, the likelihood is that I will probably overstim again on my next cycle. Which seems to me that merely being on the oral progesterone is not going to be enough again.

The nurse said she's never heard of someone starting already after only 8 days on the progesterone. My question is - why do they use this to help potentially sustain a pregnancy if they also use it for anovulatory women to bring on a period?

So, am I overanalyzing here? What other questions would you ask the doctor?