No good news

So yes, the endometrioma is back, possibly gotten a push from Letrozole, and is just slightly smaller than it was before the surgery in February. Not only that, but my CA-125 is higher than it was before the surgery. I am not back to square one, I am back to ground zero. I just cannot win. Such a neat double whammy: no pregnancy, but a bunch of potentially dangerous cysts, that threaten the whole possibility of me ever getting pregnant again.

I realize that all this time, I've been waiting for a miracle. Like you know, deus ex machina, light saving the darkest hour, this kind of thing. But apparently the miracles do not apply to us anymore. We had our miracle 6 years ago, only we did not understand just how great and singular it was.

And of course I am angry. At the surgeon - did she do her job well? At Dr who prescribed Letrozole - how could he not take into account my history, being told about it repeatedly? He said "you're in a good place right now", and then proceeded to put me in a much shittier place. At myself - if I wasn't so impatient, I would not have taken Letrozole, and maybe I'd have had another shot at miracle. At my body, which is failing me again and again.

CD14

Today, I feel so down and dispirited. What did this round of treatment done to me? Not much, given that I don't even know the size of these two follicles I did have, and I don't know the lining thickness. But I potentially have a cyst, which might prevent me from pursuing whatever other treatment options there are for a while. And I had spotting through CD12. Now, I have ovulation-like cramps on CD14, and, just you wait - a negative OPK. I know this attention to mundane details is useless and potentially damaging, but I cannot help but feel that Letrozole screwed up my body and my cycle, and for what?

Trigger shot dilemma

I am sick and tired of dealing with doctors. They basically run a conveyor belt system, where they hand you a protocol and expect you to get on with it. I cannot operate like that. I have questions, and I need answers, and I get frustrated not getting any. I cannot do things without getting an explanation, especially when my health is concerned.
Take this trigger shot situation. I emailed the Dr, twice, asking whatever brought this change of plan - were the follicles too small, or their amount too insufficient, and does he really think I need it? There was no reply, and we mulled it over on our own.
I was thinking about how, to get the shot, I need to get to the office and back in time to pick up the kid from the preschool. It's a half-day tomorrow, so it leaves a very small window to operate - the office is out of town. My husband would be out of town until Thursday and would not be able to drive me/pick up the kid. So logistically, it's a challenge. There are ways around it, but we need to plan these things in advance.
And then, of course, I've read about OHHS. I realize it's highly unlikely to get this particular complication with oral medication and two measly follicles. However, being a sole adult at home for a day and having even a slight possibility that things could go wrong... this is too scary.
So after some more Googling and seeing that many people don't do the trigger shot - and especially people who have no problems ovulating on their own, like me - we decided to skip it, at least for this cycle. I fully realize that we might not get to even discuss it the next cycle - if the cyst doesn't disappear, I wouldn't be doing any Letrozole.
I feel depressed by how things turned out. To get the answers, I have to ask the right questions at the right time, i.e. during appointment. But during appointment I usually don't know half of it - they arise later, after I receive the information, think it over, and do some Googling - and then nobody ever cares to answer them properly. I feel like I am playing catch up with the doctors, and failing again and again.
And yes, I received the Dr's answer around 9 pm. It was short: yes, he agrees with Dr who did an ultrasound, and he thinks the shot is a good idea. Nothing re: why. Nothing re: follicle size.
It's midnight now, and too late to change my mind anyway.
On a different note, somehow my parents got wind of us having been to a doctor's appointment. How? I have no idea, not me nor my husband told them. Anyway, my mom asked me what it was for, and I gave her the highly edited version of our visit to my RE. I've got sympathy and the requisite "be happy with what you have" spiel, and then I was fighting tears for the rest of the day. There was a reason I did not want to share my journey with her - it's too hard to look at it as it is, in all its hopeless glory.

Letrozole scan

Went for Letrozole scan. The Dr. on call who performed it gave me the impression of being quite pissed off because she had to be at the office on Sunday, and on Mother's Day, no less. She was professional, but brisk and unfriendly (and she refused to look for semen analysis kit, so my husband would have to drive there again to pick it up). She did not tell me the size of follicles, and I did not do my homework - so I did not ask. My impression was, they are not quite as big as she would want them to be, and there are only two of them. She outlined the protocol: few more days of Letrozole, trigger shot on Wednesday, BD on Thursday, estrogen and progesterone few days afterwards. I flat out refused estrogen. I questioned the idea of more Letrozole. I basically got very confused, since none of this was discussed as a possibility at my last week appointment, and decided I will have to think it over and talk to my Dr about all of it. As for my continuing spotting - she dismissed since my lining "looks good". 

Also, she told me there's a possible small cyst on my right ovary - the one that I had a surgery on. "Or maybe it's just the way your ovary looks after the surgery," she said, but I am so not convinced. She doesn't think this cyst appeared during the last 10 days. Does this mean they missed it while doing an ultrasound to rule out any cysts before starting me on Letrozole? Or is it a Letrozole sife effect? Too many questions, and no answers. 

There was a poignant moment today, while we were waiting for the Dr. to come and for the office to open. All three of us had to come to the appointment - the kid had a birthday party nearby to attend later, and we were going there as soon as the ultrasound was over. Another woman came to the door to wait. She was alone. She complimented my kid, we exchanged some platitudes about bilingual childhood. She mentioned that her husband was of different ethnicity. She mentioned her nephew. I just knew she was there for the same reason as me, but she had it much worse. And my heart was breaking for her, too.

It was also breaking for us. Two years. Two years, and we are visiting the same parties, same shows, same places. And I am still checking my freaking pantiliners and pads, peeing on sticks, and having nothing to show for it but few gray hairs. 

Letrozole, rainbow & unicorns

So, I am on my 4th day on Letrozole. On Friday, I had my scan, got a timeline of pills, intercourse, and my next scan, and then I was on my own. Well, me and the mighty Internet, where I googled all kinds of things, starting with "Letrozole side effects". I got myself so thoroughly scared, that I couldn't even look at the pill bottle. I used to be a reasonably healthy person, and I don't have any experience with medications that are so serious and strong. Still, I took my four pills, and the next day I took another four... and tomorrow would be my last day on them for this cycle. I haven't had any adverse reaction so far, except for feeling out of sorts in the mornings, but this sensation goes away.
Today I went to see the Dr who prescribed it, the optimistic one, the one of the unicorns and rainbows. Last time when I've seen him, he was somewhat cavalier about my numbers and my age. "Your eggs are not THAT old," he told me. Since then, I turned 39. My big 4-0 is just 6 month away. I have high FSH, low AMH, and low AFC. He cannot ignore this anymore, not really. Yes, there is an age factor, he said. But considering what the surgery found - or did not find - you are in a good place, you are doing the right thing with Letrozole, let's try that for 3 months and see how it goes. If it doesn't work, let's add injectables; the next step is IUI. Of course, even after achieving the pregnancy, there's a matter of keeping it; Intralipids and Lovenox are his choice for that, as he said previously.
So there's that.
Wednesday would be the day of doom and gloom Dr, my RE.