Saturday, July 23, 2011

Attempt Numero 2: Clomid Hates Me...

So just like the previous month, I cried a lot.  OK maybe I cried a lot more, it was pretty rough. We did have the debriefing appointment with Dr. D. He was very consoling and told us that sometimes it takes a cycle or two to figure out how my body will respond to medication. He was pleased that I did ovulate despite having such a rough start with barely any follicles. I don't think I appreciated how bad off I was at my first ultrasound during the previous cycle which let me get my hopes pretty high. Dr. D thought Clomid would work for me, but I needed to take it for a few extra days. Most people just take it for 5 days, and I would be taking it for 8.  He reminded me again, how he had no reason to suspect that I could not get pregnant, we were still just trying to figure out how to make it happen.

A long, awful, and still pretty weepy 2 weeks later, I was finally able to start my clomid again...and have hot flashes again...and have sob-fests, again.  They had me come in for my first ultrasound (US) and I was really nervous.  I was so green last month, that I no clue what all could go wrong.  This month, I knew a lot more, and was definitely more anxious about everything. The US showed that once again, my right ovary was hibernating.  My left, however, had a couple of follicles.  The lining of my uterus, however, was only 4mm.  This isn't so good.  They really want it at 10, but 7-8 makes pregnancy plausible.  The nurse explained to us that it may be due to my "small" uterus. Dr. D says that some of his "petite" [insert eye roll] patients don't ever get a thick lining because there is just not enough room.

OK, so a little more about Clomid... As I've said before, for most people with ovulation issues, Clomid works great. For a few of us (and of course I'm included in this group), it may improve ovulation, but it also leaves us with some undesirable side effects, too. If you remember, Clomid works by blocking the estrogen receptors in your brain that tell it when it is time to ovulate. This gives you more time for more follicles to mature and better quality eggs are released. The bad thing for some of us with Clomid, is that the estrogen is what tells our uterus to develop a nice cushy lining. In addition, it can increase the overall "hostility" of your uterus and cervix by making it an unhappy place for sperm to live. Ideally, intrauterine insemination will allow the sperm to bypass these obstacles, but you still need a thick lining for the embryo to snuggle up to and make a home in for 9 more months.

I went in every other day for the next 6 days for my US and bloodwork. Each time my follicles got a little bigger, and my lining incrementally grew. By the third ultrasound, I had two follicles that were 18+mm, which indicates that they are mature and ready to be "triggered" so I ovulate. My lining had made it to 6.5mm, so there was some hope. I couldn't believe this was actually going to happen!!!! The nurse gave me a shot of Pregnyl, which is human chorionic gonadotropin (HCG). This is the same hormone that home pregnancy tests detect when you are pregnant.  After the shot is given, you are expected to ovulate within 36 hours. So they scheduled my IUI for the next afternoon about 34 hours post trigger shot. I still couldn't believe it was actually happening this time, and I kept asking my nurse if they could cancel for any reason. Patiently, she told me over and over it was really going to happen...YAY!!!!

The next afternoon, BJ deposited his sample to the clinic. We also learned that he had to sign an affidavit saying that he knew that our intention was to use his sperm to create a pregnancy in me, his wife. I sure would like to see the lawsuit that made this necessary. So fair warning gentlemen, if a woman ever asks for a sperm sample, you should be suspicious about her intentions.

It takes about an hour for them to prepare the sperm. They spin the sample in a centrifuge and perform what they call a swim-up test. This means only the best and the brightest of the sperm are used for the insemination. Since the sample is going directly into the uterus, it doesn't need to be protected in seminal fluid which contains prostaglandins and would make me cramp like a dehydrated football player. So once they go through 2 or 3 "swim tests" the lab tech gives them a little dose of caffeine and a pep talk. Apparently, sperm are about as smart as UT's offensive line...

So, BJ and I are in the exam room, and they bring in a test tube with pink liquid that is what his sample looks like post wash. They show you the test tube so you can confirm that it has your partner's name on the label. They told us BJ's pre-wash count was 92 million, but the post wash sample was down to 8 million. Dr. D said this was fine, but it is definitely on the low side. Your goal is at least 10 million with 5 being the absolute minimum. What we didn't know at the time is that this took us from a 9-12% chance, to about a 5% chance of conceiving.

Then the fun begins... Two male doctors at this point have told me, "Oh, an IUI is just like a pap smear." Apparently, neither of them have had a pap smear nor an IUI. I think there are a few women that don't have any discomfort, but I apparently am not one of them. Generally speaking, the sensation of something being forced up my cervix is not pleasant.  Dr. D struggled a bit to get the catheter in place. I had quite a bit of cramping during the procedure, but it doesn't take two minutes. After the sperm were deposited within inches of their goal, they raised the table and had me lie with my hips up in the air for 10 minutes. I would go in the next week for a progesterone check, and then the following week for my beta (beta HCG level to check for pregnancy).

Since we were going to be moving that weekend, I tried to take it as easy as I could that evening. I had some mild cramping, but it wasn't too bad. Dr. D. said it was no problem for me to be lifting or doing anything heavy, but my uterus definitely its presence known when I did that weekend. Dr. D later explained that my endometriosis was probably coming back and making my uterus a little more sensitive to all of these procedures, but it shouldn't effect my chance of conceiving. Lucky me...

I cramped on and off for the next week. Every twinge made me wonder if I was having implantation cramping (cramping that can occur when your blastocyst baby settles into the lining of your uterus). It is so easy to let yourself over analyze every little symptom. On message boards people obsess with what may and may not be early pregnancy symptoms. It's tough because you can totally trick your body into having symptoms even if you aren't pregnant. In addition, PMS symptoms are also early pregnancy symptoms so that just heightens the madness. Much more easily said than done, try to not obsess. I also found it better when I had over-scheduled myself and stayed really busy. The time goes by much faster.

It turned out that I did have a progesterone deficiency. It was Dr. D's hope that the Clomid, which did increase the size of my follicles, would help improve my progesterone levels. The remnants of the follicle after you ovulate become the corpus luteum which releases progesterone to help create an ideal environment in your uterus (thicken the lining). Since Clomid had given me two large follicles, you would expect that I would have two corpus lutea (see Daddy, all that Latin in high school is paying off) making plenty of progesterone. I was put on Prometrium, a progesterone supplement, two times a day.

The next week I had my blood pregnancy test. My symptoms at this point were all the same as I was used to having so my gut instinct was that since nothing was different, the IUI had not worked. That did not mean that after the longest hour of my life when I finally got the call from a medical assistant, I was not absolutely devastated when she said it was negative and to stop taking the Prometrium. She also said rather unsympathetically, "If you want to try again, just give us a call when to start your period." As if I had another option? I bawled my eyes out, and, once again, my wonderful husband was right there to hold me and get me through it.

The one good thing (if anything could be good) I thought was that for the first time since I've been trying to conceive I was able to take Ibuprofen before I started my period.  So I hoped that at least I would not be in pain this round.  The endo definitely makes the lack of success worse because in addition to the devastation of not being pregnant I get to look forward to hellacious cramping for a few days. Talk about insult to injury, or maybe injury to insult in this case.  My pain level has also increased over the past 3 months because the Clomid can accelerate the regrowth of lesions. So, I took 800 mg of ibuprofen every four hours around the clock.  Despite the prophylactic ibuprofen, on the night before my birthday, I started having severe cramps at 1:30am.  These were probably the worst I've had since BJ and I started trying to have a baby.  I spent the next couple of hours heaving, sweating and pacing with my trusty old heating pad.  I finally broke down and took some Tylenol #3 at 4:00am left over from some surgery some other time.  It relaxed me enough to at least lie still. It was a rough 24 hours to say the least and not a very happy birthday.


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