Life After Clomid

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.

Clomid Resistance

When I first saw an OB/GYN to discuss why I wasn’t ovulating, she immediately suggested that I go on Clomid. She herself had taken Clomid to get pregnant, and she was sure it would work for me. This was in October 2004, and we had been trying to get pregnant for about 4 months.

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.

Diagnosis: Infertility

I had my hysterosalpingogram (HSG)—finally. I had been putting it off since I started seeing my reproductive endrocinologist in February. Since I have PCOS, my problem has always been that I don’t ovulate. I figured I wanted to conquer that problem, before thinking about whether my tubes were blocked. I made it all the way through several failed Clomid cycles, before she told me we couldn’t go on until I had the test.

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:

Diagnosis: Infertility

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.

Irony

Last weekend I started taking birth control pills, prescribed by my reproductive endocrinologist. I find this hilarious.

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.

Denial

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.