Monday, November 26, 2007
First, she mentioned her concern that I'm really sensitive to the Follistim--giving me 75 IU gives a big response, and dropping just to 50 IU really slows down the progress of the follicles (and subsequently my estrogen levels).
Next she brought up the increased risk of multiples, and how I might be particularly prone to this, since I had so many follicles last cycle. My RE seems very concerned that with that many follicles, I could conceive triplets or quadruplets, and then face the dilemma over whether to do selective reduction. In the last cycle, I had one follicle that was around 18 mm, and three that were 13-14 mm. From what I've read, this really isn't that many. It sounds like it's pretty common to do IUI with 3-4 mature follicles, to increase the chances of success. Am I wrong about that? Is she just being really conservative?
She once again brought up the option of going straight to IVF. I explained my reasons why I'm not ready to try that yet: that I don't have any IVF coverage, so we would pay for all of it out of pocket, and that I'm not ready to play my last cards yet. She seemed to understand that, and gave me the go-ahead to start another Follistim cycle tonight. We agreed that we would try as many as six Follistim/IUI cycles before moving on to IVF.
We're going to do the same dosage that we did for the last cycle: 75 IU for three days, then dropping to 50 IU. I'll go in for an ultrasound and bloodwork on Friday morning, after four days of dosing.
Saturday, November 24, 2007
The morning of Thanksgiving I started to feel like I was going to get my period. I've never been one of those women who knew their bodies so well that they could just sense when their period was coming. Since I never had regular cycles, it took me a long time to recognize what those feelings were. But there they were on Thursday morning, letting me know that this cycle hadn't worked, a full day before my HCG test.
I went for the test anyway on Friday, even though it meant I had to drive 30 miles out of my way (since my local lab service was closed for the holiday), and had to pay $50 to get my blood drawn. Unsurprisingly, the test was negative.
I'm just sad. I really thought that once we could get me to ovulate that everything would come together and we could get pregnant. I know it's not that simple, but in my scientist's mind, that's how it should work. Now there's no simple answer for why it's not working, and my mind can't make sense of that.
My doctor wants to meet with me next week to go over our plan. I have a feeling she wants us to move into IVF, but I don't know that I'm ready to go there yet. We've only done 3 cycles and 2 IUIs with the injectable drugs, and I'm not ready to give up yet. I'm just so afraid of doing IVF and having it fail. I'm not ready to face the end of the road yet.
Friday, November 9, 2007
One thing my RE did differently this time was that she did an ultrasound to check my follicles before she went ahead with the IUI. She had remembered that I was worried we didn't have enough follicles last time, and wanted to see how many were developing today. I really appreciated that she did this. I hadn't seen them since Wednesday, and it was nice to know that they had continued to grow.
I also showed her the red area that had developed around where I did my Novarel shot. She said that since it's purified HCG (rather than recombinant HCG, like Ovidrel) that sometimes there's a little inflammation around the site of injection. I was glad to hear that wasn't unusual.
My husband's super sperm performed well again today--there were 50 million per mL, so we were cleared to go ahead with the IUI.
It's strange that all of this is starting to feel normal. That the things you never imagined you'd have to do suddenly become routine. The first two IUIs were so stressful, and the highs and lows of those cycles were so extreme. I'm definitely more calm about it all this time.
And now we wait.
Thursday, November 8, 2007
Wednesday, November 7, 2007
Tuesday, November 6, 2007
I'll do another 50 IU of Follistim tonight, to keep them growing. They are guessing that I will trigger tomorrow and IUI on Friday. Fingers crossed!
Thursday, November 1, 2007
I feel very gratified that she was willing to listen, and make a change, even though she thought the last cycle went well. Before starting all of this, I didn't realize how much of IF treatment is just trial and error. It's like my own private biology experiment, and every month we take what we learned and create a new plan. I'm feeling good about this new plan, and am excited to see the results.
Sunday, October 28, 2007
I was scheduled to get an HCG blood test on Friday, two weeks after the IUI. That meant I would get the news about the test later that day, while I was at work. I was worried that if it was negative, I would be a sobbing mess at work, so I took a pregnancy test Thursday night to prepare myself. I told my husband beforehand that even if the home test was negative, it might not be definitive, since my HCG levels might just not be high enough yet to trigger a positive test. I had read about women having negative or partial positive tests at home, only to find out that their blood test was positive.
So I took the test. And it was negative. I'm not even going to use the cute BFN acronym, I want to spell it out, and shout it out loud: BIG FAT NEGATIVE! There was no faint positive line, it was absolutely negative. All the words I had said before I took the test just washed away, and I knew in my heart that the IUI hadn't worked. As expected, I spent the rest of the night crying, and being mad at my husband for not being as upset as I was. Even though I was more prepared for it this time, I was still really disappointed. Everything had gone according to plan this cycle, and it still failed.
I went for my blood test the next morning, but due to a mix-up at the lab, I didn't get the result until Saturday (making me even more glad that I had taken the home test on Thursday, or I would have been going out of my mind). Unsurprisingly, it was negative.
I talked to my doctor, and expressed my concern that I only had one mature follicle when we triggered. She wasn't concerned about that at all, and pointed out that I had two 13-14 mm follicles that could have also matured after the last ultrasound. She said that we could increase the Follistim dosage to 75 IU for 3 days, and then go down to 50 IU to try to increase the number of mature follicles next time. In general, she was very pleased at how this last cycle progressed (other than the fact that I'm not pregnant). She pointed out that I've probably only ovulated a handful of times in my entire life, so we can't expect everything to work perfectly the first time out.
The progesterone suppositories did their job, and kept my period at bay, so now I'm just waiting for Day 1, so we can start all over again.
Saturday, October 20, 2007
There we got the best news of the day: my husband's sperm count was 85 million. At our first IUI, the count was lower (though I don't remember the exact number), and there was some agglutination, which concerned my RE. Obviously that IUI was not successful, so we were already off to a better start.
My regular RE was in surgery that morning, so another doctor filled in for her. The replacement RE was very nice, and instantly put us both at ease. She had a little trouble getting the speculum at the correct angle (ow!), but once it was in place the IUI went off without a hitch. Once again, they left us alone for 10-15 minutes to relax, and then we went home. The night after the IUI, I started taking 200 mg of natural progesterone, to help build up my uterine lining (we didn't do this after our first IUI, and now I'm wondering why).
My husband tells me he has a good feeling about this one, and has raised his personal odds of success to 42%. I am hopeful, but I'm more cautiously optimistic than I was last time. When I got my period after the first IUI, I was crushed. It had taken us so long to get to that point, I thought that it was finally our time, and all the waiting would be over. I knew the odds of success, but figured that we would buck the odds, and find success on our first try. Now I feel like I'm a little more seasoned, and have seen how quickly things can fall apart just when you thought they were working.
So now we're waiting. It's been just over a week, and I've spent a lot of time overanalyzing every twinge my body makes, wondering if it's a symptom of pregnancy. If I don't get a period, I will take a blood test on Friday to test my HCG levels. Last time, I started my period the day before I was to take the blood test, so I'm sure Thursday will be an anxious day (though I just had a thought--regardless of whether or not I'm pregnant, I probably won't get a period since I'm taking progesterone). This two week wait is such a strange time--you've spent the weeks before in a big rush, doing all the injections, getting multiple ultrasounds, and (hopefully) making it to the IUI. Then it all stops abruptly, and all there is to do is wait.
Thursday, October 11, 2007
Wednesday, October 10, 2007
After four days of Follistim injections, I had my follicles checked yesterday. There were 22 follicles, though most were less than 10 mm. There were two follicles on my right ovary that measured 13 mm and 14 mm, and my left ovary had one 17 mm follicle. After checking my estrogen levels, I was instructed to increase my Follistim dosage to 75 IU, and return for another ultrasound today.
This morning, the 17 mm follicle had grown to 18 mm, but there wasn't much change in the others. It was unclear whether they would trigger me today or have me continue the Follistim for one more day. By the afternoon, my estrogen test had returned, and I was told to go ahead with the HCG trigger tonight.
This is further than we got in the last cycle, so I'm pretty excited. The pessimist in me is bothered by the fact that I only have one mature follicle. I've heard of women having success with IUI with only one follicle, so I know it's possible, but it's hard not to think that the odds are not in our favor.
I was finally able to use the Ovidrel shot that I bought last month for our failed cycle, and the injection went smoothly. We're scheduled to do the IUI on Friday morning, 36 hours after the HCG trigger. Here we go!
Monday, October 8, 2007
As a woman being treated for infertility, you somehow have to “expect the worst while hoping for the best.” And that can be incredibly difficult. When you undergo infertility treatment, you have to psyche yourself up so much to endure the medications, to live with the side effects of hormone treatment, to bear the constant blood tests and ultrasounds and injections. You have to get excited about it, because that’s the only way you can push yourself to slog through the process. The problem is, when you psyche yourself up like that, when you put so much time and energy into doing a high-tech cycle, you also set yourself up for a huge crash if it fails.
Saturday, October 6, 2007
I took the Prometrium twice a day for 10 days. I've been lucky enough to not have had side effects with most of the medication I've been taking; but Prometrium knocks me on my ass. About 30 minutes after I take a pill, I start to feel like I'm drunk, and it lasts for 1-2 hours.
I also had some heavy spotting when I first started taking the Prometrium this time. I reasoned that this was due to the drop in my estrogen levels after I stopped taking the Follistim. It stopped after a few days, and I finished out the Prometrium, expecting to get a full period about 3 days later. I had a couple of days of light spotting, but no period.
Just to ward off the inevitable question from my RE, I took a pregnancy test. Unsurprisingly, it was negative. Still, my doctor requested that I get a blood test to check my HSG and progesterone levels. They checked out fine, and so I went in yesterday for an ultrasound to check my uterine lining, and see if I had developed any ovarian cysts.
I got the all clear signal yesterday afternoon, so I started my second Follistim cycle last night. This time around, we're going with 50 IU, and I'll get another ultrasound after 4 days of dosing to check on my follicles. I'm recycling the drugs from my last cycle, since I had a nearly full vial of Follistim, and didn't touch my Ovidrel or progesterone tablets.
I'm excited that we're finally able to try again. I am hopeful that this cycle will go better, but the sting from the last failure is fresh in my mind, so I'm more cautiously hopeful this time. Keep your fingers crossed for us.
Thursday, October 4, 2007
After waiting for about 30 minutes, the woman behind the front desk called my name. I told her that my order had been faxed in, and she searched for it in the pile of papers on the fax machine. "It's not here, they must not have faxed it over." Sigh. This isn't the first time this has happened. My RE's office was just opening, so it took me a few minutes to get someone on the phone. I eventually talked to my nurse, and she re-faxed the order in to the lab. I finally got my blood drawn nearly an hour after I'd arrived, and I was off to work.
A co-worker of mine had a baby a couple of weeks ago, and she & her husband brought the baby in today. I am genuinely happy for them, as she is one of the sweetest people I know, and they're going to be great parents. It was a slow day, so I got to spend about an hour talking with them and holding their son. Several other women in the office did the same, and soon a crowd gathered around, including two other women who are also married with no children.
As we oohed and aahed over the baby, a few people sat off to the side talking. At one point, I realized they were all pointing at us, and having a conversation about which one of us would be the next to get pregnant. Later on, a couple of people gave me the "So are you next?" line of inquisition.
I get really anxious when situations like this arise. I haven't told a lot of people at work about our struggles with infertility. I'm a pretty private person, and don't really want everyone knowing my business. I've been pretty discreet about my doctor's visits, usually scheduling them early enough that I can go before work. I've had to take a couple of days off on short notice (one for my IUI, one for my HSG), but my boss is very cool, and didn't question it.
I just don't know how to respond to questions about when we're going to have kids. Today, I just sort of ignored it, and didn't respond at all. I was afraid I might snap at someone, and didn't want to say something I'd regret later.
Today was just one of those days where infertility was constantly on my mind. I was anxious about the bloodwork since the results will affect how we proceed with our next cycle, and I felt awkward being the subject of office pregnancy speculation. When I'm engrossed in my work, I can at least forget about our situation for a little while, but I couldn't seem to do it today.
Tuesday, October 2, 2007
My RE prescribed 75 IU of Follistim, to be injected on days 3-7 of my cycle. Whereas Clomid indirectly promotes follicle stimulating hormone (FSH) production by inhibiting estrogen, Follistim is straight recombinant FSH (so it’s not extracted from the urine of postmenopausal women like some of the more old-school FSH drugs). When I started taking it, I went online to try to find other women’s experience with Follistim, and I wasn’t able to find much. It seems many more women are given Gonal-F, a similar drug. They are both recombinant FSH, and I’m not sure why one is prescribed more than the other.
Follistim comes with this nifty pen that you use to dial up your dose for the injection. I had a 5 minute training session with my nurse to learn how to do use it. It’s pretty easy, and the cool design definitely made me feel less anxious about injecting myself with massive amounts of hormones. The injection itself is pretty simple:
· Pick a spot on your abdomen, and swab it with an alcohol wipe
· Dial up the Follistim pen and insert the needle, making sure a small drop of the drug appears at the end of the needle (this part was a little tricky—more on that later)
· Pinch your belly at the chosen injection site, insert the needle, inject, wait 5 seconds
· Remove the needle, and dispose of it in the cute little Sharps container that came with the drugs.
The first injection went off without a hitch. The second time, I had a major panic, when I couldn’t figure out whether any drug had been injected. I hadn’t seen any liquid at the tip of the needle and it didn’t seem like the level of drug had gone down in the vial. I finally just reloaded the pen, and was able to watch the liquid go down as I injected it. I hadn’t realized that could happen, so I was very careful with each subsequent injection. I switched sides with each injection, but a couple of nights I bled a little bit and developed a bruise at the injection site.
I had heard that the drugs could cause mood swings, but I didn’t really experience that at all. In fact, the lack of side effects initially convinced me that they weren’t working.
I went to the RE for an ultrasound on day 8, and the technician counted 17 follicles, divided pretty evenly between my ovaries. The follicles on the right side were much bigger, and I had two that she measured at 15 mm. I knew that the follicles had to get to 18-20 mm before they would trigger ovulation, but I was encouraged that there was something there. I was a little concerned about the number of follicles, but the technician assured me that wasn’t unusual for someone with PCOS. They instructed me to do another injection that night, but to reduce the dose to 25 IU. This would help along the bigger follicles, while preventing too many of them from progressing.
I returned the next day, excited to see the progress of my follicles. They pretty much looked the same as they had on day 8. They told me to do another injection of 50 IU that night.
When I came back on day 10, it was clear that the follicles weren’t progressing. When the ultrasound machine is out of paper, the technician will hand me a notepad, and have me write down the sizes of the follicles. She had me do it this day, and as she rattled off numbers, I could feel the tears forming in my eyes. I knew then that the cycle was a failure, and we weren’t going to move on to IUI this month.
I talked to my doctor later that day, and she confirmed what I had suspected. I had read that the first injectable cycle is more or less trial and error. It gives your doctor a chance to see how your body is going to respond to the drug, and to determine the optimal dosage.
Knowing that, my heart still broke when I learned that the cycle had failed. I had convinced myself that it was going to work this time. I had wondered how I would explain why I wasn’t having beer at our weekly happy hour at work, or why I didn’t want to go out for sushi. Talking with my family about a potential trip next summer, I wondered if I would be too pregnant to travel. I was angry with myself for getting my hopes up; but without hope, how would you ever have the will to do this month after month?
My RE said we could try again, lowering the initial dose to 50 IU, to try to get fewer follicles so we won’t have to lower the dose mid-cycle. She mentioned again that we could go straight to IVF, but backed off when she saw how upset I was. So we’re going to try the Follistim again, hopefully making it through to the IUI.
Saturday, September 15, 2007
Since Clomid wasn’t working for us, my RE presented us with two options: move on to injectable drugs in conjunction with IUI, or go straight to IVF. There were a few things for us to consider before deciding which path to take:
1. The Odds. My RE has told me that with IUI, you have a 25% chance of conceiving—the same chance as any couple trying to conceive the usual way. With IVF, the odds go up, and you have a 40% chance of conceiving (though I’ve seen lower statistics online). IVF definitely wins this one. (Score: IVF=1, IUI=0).
2. The Cost. My health insurance only covers diagnostic testing, and not any “procreative management”. Each injectable/IUI cycle costs about $2000 (depending on the dosage, etc), while IVF is at least $10,000/cycle. Since this would be all out of pocket, IUI handily wins this battle. (Score: IVF=1, IUI=1).
3. The Invasiveness Factor. With IVF, you produce lots of eggs, which are then harvested in a pretty invasive procedure which requires anesthesia. With IUI, the dosage of the drug is modulated, so fewer eggs are produced, and there’s no harvest required. Another win for IUI (Score: IVF=1, IUI=2).
4. The Clumping. At our one and only IUI, when they processed my husband’s semen, they saw agglutination, or clumping. My RE worried that this would impede our chances of success with IUI, and we would have to directly move on to IVF. So she sent my husband back for another semen analysis, where they would process the sample as they would for IUI and see if the agglutination returned. His sperm didn’t clump, so we were cleared to go ahead with the IUI. (Score: IVF=1, IUI=3).
It’s IUI for the win!
My general fear of IVF also played into this decision. In my mind, IVF is our last resort, and if it fails, then we’ve reached the end of the line. I know that we’re getting closer and closer to that line, but I’m still trying to keep it at bay.
Sunday, September 2, 2007
I was hesitant to rush right into Clomid. I felt like it was a quick fix (ha!) that didn’t actually address the issue that I didn’t have regular cycles. I had read a little bit about how Metformin helped regulate the cycles of women with PCOS and asked my doctor if we could try that first. I wasn’t glucose intolerant, so she wouldn’t give me Metformin. It was Clomid or nothing.
In hindsight, I should have either sucked it up and taken the Clomid, or looked for another doctor. But there was a lot going on in our lives at that time. I had been looking for a job for nearly a year, and we were contemplating picking up and moving across the country (which we did 6 months later). I wasn’t ready for Clomid yet. I remember thinking, “What if she’s wrong? What if it doesn’t work? Then what?”
I finally succumbed to the allure of Clomid in the summer of 2006. My new OB/GYN had let me test drive the Metformin for a few months, and it didn’t take, so I decided it was time to give Clomid a spin. We did four Clomid cycles—I ovulated (but didn’t conceive) the first time out, and then never again. She kindly let me know that I needed the help of a reproductive endocrinologist.
My RE decided we should do a high dose of Clomid, with monitoring of my follicles by ultrasound. Again, I ovulated on our first try and again didn’t conceive, even with IUI. My subsequent Clomid cycles resulted in follicles that never got big enough to trigger ovulation. After three tries, my RE recommended that we move on to injectables.
Do I regret not going on Clomid earlier? A little. Maybe we would have figured out that it wasn’t going to work, and we’d have found success with another protocol sooner. But as I said, I just wasn’t ready yet. I was grateful to find a doctor that was willing to try the Metformin before moving on to Clomid. I think that being part of that decision made me feel a little more in control of the situation. I may have delayed the inevitable, but at least it was my choice.
Saturday, August 18, 2007
So I made the appointment at a local hospital. I was surprised to find out that my insurance would cover the HSG. My HMO covers all diagnostic testing, but no “procreative management” procedures (i.e. IUI, IVF, etc).
I received a call the day before the exam, and the woman on the line asked if I wanted to pre-register for the procedure. She explained that it would save time the morning of the exam, so I played along. She asked me the basics (SSN, birth date, contact info) and then asked me a bunch of ridiculous questions (my race and religious background—WTF?).
So my husband and I walk into the clinic in the morning, about 15 minutes before my appointment. We check in at the radiology desk, and the woman at the desk asks me my name and date of birth. Upon hearing my reply, she said, “Uh oh”—never a good sign. Turns out the woman who did my pre-registration was new, and she screwed up my date of birth. I’ve been around enough hospitals to know that your SSN and your birth date are the most important numbers they need. She had my birth date completely wrong, making me 11 years older than I am. As a result, I had to make my way over to the admissions desk and re-register.
Walking over to the admissions desk, I looked at my file. At the top of the page, it said:
It’s jarring to see it spelled out like that. Diagnosis: Infertility. It kinda sounds like the name of a television show that would air on Lifetime Television for Women. It might be a C.S.I. spinoff, like C.S.I.: Uterus.
After the registration fiasco, we waited a while, and were finally led into the exam room by a very sweet nurse. She instructed me to undress below the waist and put on a gown that opened in the back. Both the nurse and the radiologist were very nice, and explained every step of the procedure both beforehand and during the exam.
The doctor inserted a catheter into my uterus, and then up into one of my fallopian tubes. He admitted that he went a little too far, and it was evident by the massive cramping I started to feel. As he injected the dye, the pain worsened, and my husband and the nurse held my hands to get me through it. I was surprised at how much it hurt—I had heard that some women feel some discomfort, but what I felt was beyond discomfort. I felt like a big pussy, but I was in a lot of pain.
The doctor moved the monitor over near my head so I could see the dye move through my tubes as he performed the exam. I didn’t realize I’d get to see the results live, and I really appreciated being told what was going on. After we finished, we got copies of the pictures from the nurse (I don’t think they’re supposed to do this, which made me like my nurse even more).
As expected, my tubes were clear. This clears me for moving on into the world of injectable fertility drugs.
Wednesday, August 15, 2007
I was on The Pill for half my life, from ages 16 to 32. I stopped taking it 3 years ago, when we decided to get pregnant. We’re still waiting for that to happen, thus the reproductive endocrinologist. Who put me on The Pill.
We are starting injectable drugs this time around, so The Pill will help to keep my cycle in sync with the master plan. I have my long-delayed HSG test this week, so if I pass that, we are good to go. Birth control, indeed.
Sunday, August 12, 2007
I am infertile.
It’s taken me nearly 20 years to say those words. I. Am. Infertile. You see, saying it makes it real, and I didn’t want it to be true, so I said other words. I have irregular periods. I have to be on The Pill to regulate my cycle. I don’t ovulate regularly. All code words for I Am Infertile.
After 16 years of irregular periods, I was officially diagnosed with PCOS in 2004, about 3 months after I went off The Pill to try to get pregnant. I always knew that I would have problems conceiving, but I never really understood how painful infertility can be.
So here we are 3 years later, still fighting the good fight. Here’s hoping that it ends well.