Tuesday, October 23, 2012

On 2nd Opinions

I had an appointment for my beta test after the 2nd IUI on the same day as my "next steps" appointment with the head of the practice, Dr. S. While I was at this appointment, he broke the news to me that I had already known from my obsessive POAS - that I wasn't pregnant. He then went on to tell me that the oral medications had thinned my lining too much (duh, I was the one who brought that up before), and that I NEEDED to move to injectible medications in order to get pregnant. He suggested a "break cycle" and then moving directly to them.

This information shocked me - when did things get so dire? I was always under the impression that I may be able to get pregnant on my own, but that due to my own desire to "be aggressive", that's why we took the medication route. Now he's telling me that I need the injects to get pregnant? This news was beyond devastating for me. I consoled myself with a pizza, a bottle of wine, and my jacuzzi tub that night. I literally cried through the night, and when DH came home from work, I was still sobbing in bed.

The next day, I started some online research and chatting with a friend who I knew had suffered from infertility before (but now had 2 healthy children). She told me of her similar experience at the RE practice, and convinced me to make a "2nd opinion appointment" at another RE practice about an hour away. I called and made the appointment, which was about 3 weeks away.

I went and got a copy of my chart from the old RE's office, and much to my surprise, throughout the chart, there were things indicating that "patient may be able to get pregnant on her own", which was certainly different from what was portrayed to me in that last appointment. Was it possible they were only recommending this treatment because they knew my insurance would cover it?

During this time, I had a "break cycle" with no temping, no OPKs, nothing. This cycle, I'm assuming due to the oral meds still in my body, lasted only 18 days. That frightened me. Had I done irrepairable damage to my body?

I ignored the calls from the fertility pharmacy and the old RE's office about starting injectibles, I needed some sort of indication from an outside source that my situation WAS that dire and I anxiously awaited my appointment with the new RE.

From the moment I met the new RE (Dr. C), I knew things would be different. First of all, the appointment lasted over 3 hours. He spends the majority of that time talking to you (a foreign concept this day and age, it seems), and telling you about research & studies he's done, and papers he's published, relating to your certain issue. He goes over everything, including his recommended "next steps". For me, he said he wanted to give DH a more comprehensive semen analysis to check for antibodies. He also wanted to do an ultrasound and bloodwork that day, and have me come back in a week. His suggestion was to just monitor my cycle, add progesterone after ovulation, and possibly use Menopur to "boost" my follicles if the monitoring showed they weren't maturing fast enough on their own (a common issue for women with luteal phase defect, apparently). He also wants to do a post-coital test (to make sure DH's sperm are able to thrive in my cervical mucus), and then IUI, if I want. He said he doesn't see a need for oral ovulation medications or injectible medications to stimulate my ovaries - exact opposite of what the other doctor said.

I left that office feeling so confident. Not only did he have expertise in my problem (luteal phase defect) but his treatment plans were based upon research and studies that HE conducted. Absolutely amazing.

Thursday, October 18, 2012

On My 2nd Medicated Cycle - Tamoxifen/Ovidrel/IUI/Progesterone

My 2nd Medicated Cycle was to be 20mg Tamoxifen CD3-CD7, an ultrasound and bloodwork on CD12, and an Ovidrel trigger to spur ovulation 36 hours prior to IUI, and then IUI.


Tamoxifen, compared to Clomid, was a breeze. I still felt a little moody, but not nearly as bad as when I was on the Clomid.

When I went for my CD12 ultrasound and bloodwork, Dr. VD saw 4mm lining, and a 20mm follice on right. Not exactly a stellar response, and the thin lining was still an issue. He mentioned that next cycle, I should take estrogen after the Tamoxifen to try to thicken up my lining, but again, didn't seem very concerned. I mentioned that I may want to switch to injects if this doesn't work, and he suggested I set up another consult appointment for it.

I got a call from the RE's office later that day stating that my bloodwork showed I was surging on my own, so I needed to do my trigger shot ASAP and come in for IUI the following day. This "shake up" of events really startled me. I was very concerned about timing and about my lining and the follicle size. Neither my lining nor the follicle would have any time to grow before IUI. We went ahead with it, but I did not feel confident at all. However, in looking at my chart after IUI, I thought I was for sure pregnant. Of course, I wasn't.

On My 1st Medicated Cycle - Clomid/Ovidrel/IUI/Progesterone

My 1st Medicated Cycle was to be 50mg Clomid CD3-CD7, an ultrasound and bloodwork on CD12, and an Ovidrel trigger to spur ovulation 36 hours prior to IUI, and then IUI.


Clomid, in and of itself, only added to my crazy lady behavior. I am, by nature, a very passionate and emotional person. If you want an opinion on something, ask me, because I'll always be honest. It may not be what you exactly want to hear, but I'll try to watch my delivery but still give you the truth. Now, take that personality, multiply it by 10, add in headaches and fatigue, and general crankiness and you get me on Clomid. It was a rough few days, and I stand by my statement that R is a saint for dealing with me.

On CD12, I went in for my bloodwork and ultrasound. Dr. VD saw 4mm lining, a 23mm follice on the right ovary, and 14mm & 15mm follicles on left. He said the 2 on the left may not be big enough by IUI, but you never know. I was given instructions to trigger that night at 9:30pm, and then come in for IUI 2 days later. R would drop his sample off at 8:30am and I'd come in at 9:30am.

I was beyond excited that night. We were also told to BD, and I was definitely into it. ;) A friend of mine gave me the trigger because I was scared to do it myself, but it wasn't bad at all.

2 days later, I went in for my IUI. R couldn't come because he had to work. All in all, it was a very simple process. I had to sign a piece of paper that told me all about R's little guys, and confirming I was receiving his sperm. Thank the lord I was the only IUI that day, so there was no real concern, but still, lol. The process felt much less uncomfortable than a Pap, and I had to lay there for 20 minutes afterwards. I tried to practice visualization of the sperm meeting the egg and singing a little song that some friends and I had made up (the sperm will find the egg, the sperm will find the egg, hi ho the dairy-o, the sperm will find the egg).

Something that had concerned me was how thin my lining was at the ultrasound. I brought this up to the doctor who performed my IUI (Dr. S, the head of the practice), and he had me start progesterone vaginal suppositories 3DPIUI. He didn't seem super concerned about my lining and neither did the nurse. I had asked if I could switch to something other than Clomid for my next cycle, if it was unsuccessful, to try to alleviate the lining issue - the doctor agreed.

Now, to wait. I had to wait a week and come back for progesterone bloodwork... and then wait another week to come in for my beta. As you can tell by my chart, I started testing on my own at home, so I wasn't totally shocked when my beta came back negative. It was, by far, the hardest cycle for me when AF came. I had a friend who had similar issues to mine and went this treatment route and got pregnant on her first try with it, so it was devastating to me that I didn't. I also had a baby shower for that same friend that weekend, which only added to my personal pity party.

Something that TTC/infertility constantly brings up for me is this feeling of being happy for someone when they get pregnant, but also incredibly jealous and feeling betrayed by my body.

On Visiting the RE

I made an appointment with a local practice of Reproductive Endocrinologists (REs) aka fertility specialists.

About 3 years prior to our wedding (and actually before I was even dating R), I had a bout of unexplained lower abdominal pain. I had a colonoscopy done and nothing was found. I had gone to several doctors and no one could figure out what the issue was. I had my yearly appointment with my ob/gyn and she said "well, let's explore this". I ended up having a transvaginal ultrasound done, and during the exam, they noted that I may have a bicornuate uterus. (The reason behind the abdominal pain was never discovered.) My ob/gyn recommended I see a fertility specialist, so I ended up at my RE's office.

I had an appointment with Dr. VD, who I loved from the moment I met him. He explained the issues associated with having a bicornuate or septate uterus, and basically said that there is a procedure done to diagnosis it, and then if I did have it, I could have a surgical procedure done to correct it. He said it was up to me if I wanted to explore it now, explore it once I'm ready to have kids, or explore it if I have recurrent miscarriages. I decided to just wait overall.

About a year out from our wedding, R & I went back to Dr. VD  to explore the issues with my uterus. After performing the hysteroscopy, he noted that I did not have a septate or bicornuate uterus, which was of huge relief to me.

So, when I needed to return to the RE to explore my luteal phase issues, I knew I wanted to see Dr. VD. Initially, we met with another doctor in the practice for our consult. I brought in all of my charts from Fertility Friend, and we spent about 20 minutes with the doctor. She explained that my luteal phases were definitely short but that I was definitely ovulating, so she suggested we run through the fertility testing to see what we came up with, and then have another consult.

Through all of the testing of both of us, we were found to both be pretty normal. I had slightly low progesterone after ovulation, but really, that was the only issue they could find. Dr. VD then discussed treatment options with me. He said if we wanted to be really aggressive, I could start Clomid, with a trigger shot, and then if we really wanted to "up our chances" we could do IUI. He felt taking the Clomid would bring my ovulation date up, and naturally lengthen my luteal phase. I agreed that this treatment plan seemed like the best option. Dr. VD assured me that most women in my scenario would get pregnant within 3 cycles of this regimen.

On Charting

R & I started discussing babies almost as soon as we started discussing marriage - which was about 2 weeks into our relationship, lol. We had been friends for years and years, and had been teetering on the edge of a relationship for months, so really, this was a natural progression for us.

I knew that I wanted to start trying for a family soon after marriage. My initial concern was our housing situation, but we signed a contract to build our house a few months before our wedding - it would be completed 2 months after we were married. We both have great jobs, an awesome support system, we would have a beautiful home to fill with children, and most importantly - we both wanted to be parents more than we could describe.

So, in the plan I drew up in my head, I'd go off my birth control pills (which I had been taking for the better part of my life since I had turned 18), and then I'd get pregnant. I had even thought that I may end up pregnant for our wedding, a risk I was willing to take. Haha, what a fun little plan that was!

In reading online on some of my favorite message boards, I heard about a book called Taking Charge of Your Fertility. I bought the book and began reading - I think I finished it in the better part of a day, lol. I learned all about charting and ordered my basal body temperature thermometer.

I started charting the month I went off birth control. I use Fertility Friend's VIP service to do all of my charting, and really, it was a no-brainer. I even went ahead and ordered some OPK's and sperm-safe lube for our honeymoon.

I was surprised, although not shocked or concerned, when I wasn't pregnant for our wedding. My charts showed obvious ovulation, albeit a bit late, every cycle on CD18. I was definitely shocked when I wasn't pregnant after our honeymoon - we did everything "right", which you'll learn in TTC world doesn't always mean a thing.

After analyzing my charts after our honeymoon, I noticed a pattern - I only had a luteal phase of 10 days or less, and this was often accompanied by spotting after ovulation and spotting after AF. After reading about the importance of the length of the luteal phase, I made an appointment with an RE (Reproductive Endocrinologist).

On Being a Mother

I was never one of those girls who always wanted to be a mother. Up until about age 25, I wasn't completely sure it was for me. In fact, up until I started dating my husband, I wasn't completely convinced marriage was for me. (Not that you need to be married to have children, but for me, the two went hand in hand.) As soon as I started dating my husband, I knew I wanted to marry him and I also knew, for sure, that I wanted to have kids.

The funny thing about that is, you always believe that when you want to have kids, you'll just go off birth control and suddenly it'll happen. No complications, no issues, just stop taking the birth control. It still boggles my mind that after spending 10+ years trying to avoid being pregnant, now that I want to be pregnant, it's not happening.

Dealing with infertility makes you question every decision you made about your life. Should I have not taken birth control? Did that glass of wine last week ruin everything? Should I have been trying to lose more weight this whole time? Is sitting my cell phone on my lap dangerous?

The biggest one for me is - did I wait too long to try? I'm only 30, but we all know fertility drops off for women after their 20s, so this plagues me often. I'm glad my life fell into place the way it did - R is my soulmate and the man of my dreams, but did my quest in taking so long to find this man lead me to where I am now with trying to conceive?

Something else that plagues me is that R was married before. His ex-wife is now pregnant with her new husband. I'm so happy for her (we are not friends by any stretch, but I know she longed to be a mother), but in the same token, I feel awful for R in the sense that, if he had stayed married to her, maybe he'd be a father already. Their marriage was not meant to be, but I feel such overwhelming guilt that he is not a father yet due to issues with my body.