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.

~MK~

Attempt Numero 1: I hate Clomid...

As soon as I was done crying over my previous failure (March cycle on 50mg Clomid), I started taking 100mg of Clomid to get ready for my first attempt at intrauterine insemination. I took it on days 3-8 of my cycle. The previous month, besides growing more emotional, I really didn't have too many side effects. By the third night of 100mg of Clomid, I woke up @ 2:00am burning up. I am generally cold-natured...like it was 94 degrees out today and I'm wearing a hoodie kinda cold...so this really threw me off. I woke BJ up and said, "I think I'm hot." His response..."Good for you." It was a bizarre sensation. My thighs felt like I'd done a thousand squats and were really burning from the inside out. It radiated through the rest of my body from the inside. It finally dawned on me that this was a hot flash. I never paid much attention to my mom when she complained of hot flashes.  I had no clue what it was actually like. Well ladies, let me just say we don't have a lot to look forward to. For the next couple of weeks, I would wake up in the middle of the night drenched while being hot and freezing at the same time. Oh, and the emotional side-effects...

True Story:
We were getting ready to move to our new house. I had bought a glass-top coffee table to go in my conceived, ultra-hip contemporary living room we were going to have. One evening after work, I saw my new coffee table and had a meltdown.  I stared at the coffee table and just sobbed for hours. Finally, I called my mother and bawled to her about how I'd never be able to adopt because we'd never pass a home inspection with a glass coffee table. There was no reasoning with me. I was adamant that I had ruined any chance of ever adopting because of this coffee table and there was no sending it back, because I had bought it on sale. My mother, who is a retired social worker, tried to console me by telling me social workers aren't worried about your furniture during a home inspection, but with dogmatic conviction I proceeded to argue with her that yes they did. I could never provide a safe home...At the time it all seemed to be a rational response and made total sense. So ladies on clomid, it's best to refrain from making any important decisions such as paint colors, furniture, or even what to wear without help because of its potential to induce nuclear meltdowns.

I went in for my first ultrasound (US) and bloodwork on the 11th day of this cycle. My right ovary was apparently taking the month off, but my left did have a few follicles.  Unfortunately, they were too small to be very promising. A few hours later (and this is how it goes from here on out) the nurse practitioner calls you and lets you know when you need to come back in again and what you need to do with your medications. Because of my lack of progress on such a large dose, my doctor wanted to try a step protocol, and he had me take 100 mg of Clomid for 8 more miserable, waking up in the middle of the night, behaving like a raving lunatic days.

I had my next set of labs the day of prom. (I'm a faculty advisor for the prom committee.) My right ovary was still on vacation, but my left had 2 large follicles. They measured between 22-25 mm, which is large enough to be considered mature. After a quick lesson on how to give myself my Pregnyl injection (medication to trigger ovulation), she sent me off and told me she would call me shortly with instructions. I drove back to help finish decorating absolutely elated. I was truly happy for the first time since right after my surgery. I felt hopeful.

But alas, the nurse called with not good news. My blood work indicated that I had already ovulated and they would not do the IUI because it would be a waste of my money. (You only have 24 hours after ovulation to fertilize the egg, and they had no way of knowing when exactly I had ovulated.) Dr. D's partner called me a little later to check on me and encouraged me to make a follow-up (a de-briefing would be more descriptive) appointment. So just like that, it was all over, and I had 0% chance of having a baby this month. Talk about emotional whip-lash. There I was with rolls of multi-colored mesh, seashells, and Chinese lanterns bawling my eyes out yet again...

Thanks to some amazing friends who just happen to be co-workers, I was able to pick myself back up and get through prom.  I even managed to not lynch the pregnant student who had sobbed in my office for a half hour because her prom dress no longer fit.  No lie...She even came over to show me how a seamstress used the material from the hem to increase the side seam. Thanks a-lot, MTV...

Having to cover up some red-eye, but blessed to work with these amazing people!

I got home really late that night and had a breakdown.  I was so angry.  I wanted to destroy something. (Mind you, I had taken Clomid that morning.) I threw a tantrum full-out with kicking, screaming and punching that would have made an angry 2 year-old stop and say, "You crazy, lady." I felt like such a loser because I wouldn't get to try to have a baby even with medical intervention.  I hated my body for being so damaged that it didn't even respond to medication correctly.  BJ was there the whole time holding me, soothing me, saying all the right things, and saying nothing at all when I needed him not to.  Even through all the darkness of that moment, it's hard to forget how wonderful it was to have my UH-MAZING husband right there with me.  Oh, the thrill ride of fertility treatments...

Until later,
MK

How I Got Here Part 3: The Follow-Up

After my surgery, Dr. B. had told my husband that I did have endometriosis (endo), but he was able to remove all the lesions.  I did not have any adhesions which is pretty lucky since I've probably had endo since I was 15.  It turns out that being on Depo Provera (birth control shot) had been a good thing because it halts the progress of the endo.  A lot of people with fertility struggles who used depo like to blame it.  While it may take a while for your cycles to restart, I don't know of any legitimate research that says it harms fertility.  So, if you don't want the more drastic medications to slow endo down, and you aren't interested in spawning, it's definitely an option you and your doc could consider.

Anywhoselbees...I was feeling great in the weeks following my surgery.  My follow-up was scheduled for three weeks post-op.  In the meantime, I was free from pain, free to continue to try to spawn, and I was mentally doing better, too.  I had it in my head that Dr. B was going to tell me I was good to go and that my year of trying would start from March now that my endo had been cleaned out.  I really thought I was going to be able to conceive.  For most people with endo, they have an increased chance of getting pregnant in the 6-9 months after their surgery.  Thinking that my mom's fertile genes would kick in now that the obstacle of endo was removed, I really thought it was my time.

Unfortunately at my post-op check-out, I got slapped in the face with reality.  Dr. B. told me that my chromotubation (fallopian tube check) was great.  The dye spilled easily.  My anatomy was all normal, no fibroids, deformities or anything else wrong with my uterus.  He said he was able to remove all the endo I had, which wasn't much.  I am considered to have mild endo.  This sounds great right? Well, apparently it's not.  Dr. B. could see no reason why I had not been able to conceive.  With severe endo, you have tubes all tangled in scar tissue and adhesions that create physical barriers that prevent pregnancy.  When you have mild endo, you can usually still get pregnant, but when you don't, you really don't.  It depends on your fertility specialist's beliefs, but a lot will go ahead and give you an unexplained infertility diagnosis if you have mild endo and have not been able to conceive.

Dr. B told me that he was also concerned with my irregular periods which were now 26-43 days.  He told me he would write a prescription for Clomid for me to use my next cycle, and that it would help me ovulate at a more regular interval. 

Pardon the interruption for a quick physiology lesson!  In a typical functioning female (as in not me), after your period starts, which is the beginning of your cycle, your pituitary gland and hypothalmus tell your ovaries to get busy by releasing follicle stimulating hormone (FSH).  As your ovaries develop many follicles (they are basically cysts, that contain an egg).  When one or two follicles begin to mature, they release estrogen.  The estrogen then tells the hypothalmus to stop releasing FSH.  This is why most humans do not have litters of children naturally.  Luteinizing hormone is then released by the pituitary, and the most dominant follicle will release it's egg.  The other follicles simply dissipate and the eggs that were in them are gone forever.

BUT WAIT!  YOU'RE NOT NORMAL...OK, well here comes Clomid to save the day.  Clomid blocks the estrogen from telling your hypothalmus that the eggs are ready.  So for people who naturally don't have enough time in their cycle to let their eggs mature, Clomid gives them that time.  A side effect of this, is that it allows other follicles to catch up so you may release more than one egg.  Your chances of having twins goes up from less than 3%, to just under 10%.  You have less than a 1% chance of having triplets or more on Clomid.  For lots of people clomid works just great.  If you haven't conceived in about 6 cycles, however, it is probably time to move on to something different.

OK, back to me. It is my blog after all...

My doctor also said that we could go ahead and try intrauterine insemination (IUI).  I was dumbstruck.  This appointment did not go the way I had planned at all. He explained that the procedure was similar to a pap smear.  They use a catheter to place the sperm directly into the uterus so it is that much closer to the egg.  He asked if I wanted to go ahead and try IUI's or try naturally.  Without thinking, I immediately said I'll try naturally.  I was having some serious denial issues.

As I checked out, I noticed that my billing diagnosis said infertility.  I saw a card for a nurse practitioner at a fertility clinic.  I picked it up without really thinking.  I made it to my car with my prescription in hand one hand and the fertility clinic business card in the other, got in the driver's seat, and had a meltdown.  The ax had officially dropped, I was indeed infertile.  I called my wonderful husband, and he had me come to meet him at his office.  He patiently let me sob through the details of my appointment and told me he was willing to do whatever he needed to do.  He encouraged me to email the nurse practitioner at the fertility clinic.  He wanted me to get a second opinion.  Which is not to say either one of us doubted Dr. B at all.  We both just needed to be told by someone else before we could accept it. 

The nurse practitioner responded to my email the next day while I was at work.  She said the next step for us would be to have BJ's swimmers looked at (semen analysis).  Knowing that BJ had said yesterday he was willing to do whatever, I thought, 'OK, I'll just get the logistics of how that will work and what times were available.' I called the clinic and said I was interested in procuring a semen analysis for my husband.  They asked for his information, which I just happened to know, and the receptionist said, "How is 8:30 am Monday?" I responded, "Perfect!"  She asked for his health insurance info which I did not have all the details of, and told me it was fine, she would be emailing him shortly. Uh, oh...

I tried to call BJ to let him know what I had done, but when he answered the phone he immediately said, "Can't talk now, in a meeting," and quickly hung up. Oh, boy, I was gonna be in trouble.  It was not 20 minutes later that I got a "WTF" text message.  To which I responded, "Exactly, but in a cup."  After the initial shock of my guerilla semen analysis approach, BJ quickly resolved himself to go through with it.  So, if you ever wanna play a practical joke on a guy...you can apparently set up an appointment for them to have a semen analysis without their consent.  I guess this makes sense.  How many men would actually take the initiative to have this done and call for an appointment? I gather from my experience that it's not many...

Peace, Love and Spawning,
MK