Wednesday, December 23, 2015

Deciding Our Next Step: Meeting with our RE

I was lucky to get an appointment with not too much of a wait - RE's offices are typically so busy with the day to day monitoring of patients actively cycling, there are a limited number of slots available to just talk. Our RE is an extremely nice guy and really spends time with you during your appointment. During this visit, we spent about an hour with him. 

We discussed all of our options. We could continue to do Clomid, since I haven't had any negative side effects and responded very well to the 100 mg dosage. We could do injectable IUI cycles. Or we could to IVF. Since we got pregnant once through IUI, he thought that was our best option. He mentioned that while injectable IUIs have higher pregnancy rates, they are much more expensive. In my case, he said I would need very little medication and would only need to buy one Follistim pen, so that wouldn't be too bad. But with all the monitoring ultrasounds and bloodwork, that quickly raises the price to roughly $4,000. For comparison, our IUIs with Clomid and limited monitoring only cost us $550. The base price for an IVF cycle (no meds included) is $8,800. So his reasoning was that if we wanted to do injectables, it would be better if we just did IVF because the chance of pregnancy is drastically higher than the IUI. We totally agreed with this!

Together we ended up deciding on three more cycles with Clomid at 100 mg and IUIs with limited monitoring. If we are not successful after three cycles, we will revisit the plan. Our RE also mentioned that my AMH level, which is 3.7, was excellent and indicated I would respond very well to injectable medications. But it also meant there was no rush to be pregnant immediately - I have plenty of time. So if we don't feel comfortable moving past IUIs, he wouldn't have an issue with us doing three additional IUI cycles, but just switching to Femara instead of Clomid. 

We also discussed IVF a bit. He felt that if we chose to do IVF, which he was very clear to say he didn't think we needed it at this point, that he predicts that I will produce many high quality eggs and have a very good chance of having enough eggs left over for freezing that I will never have to worry about fertility again. I have to say, that is such a nice thought! 

It also feels great to have options. Our doctor really let us decide what path we wanted to take. He gave his recommendations and listened to what we wanted, giving the positives and negatives of each approach. We had our heart set on doing more IUIs, so this is exactly what we were hoping to hear!

I'm cleared to start our next cycle on Clomid as soon as my period arrives. Unfortunately, my cycle is a bit off still after the early miscarriage. This looks like the longest cycle I will ever have! Yikes! Just can't wait for this cycle to be over with so we can move on and try again.

Wish us luck!

Monday, December 7, 2015

Not Our Happy Ending...

I wish I had a better update to share. We aren't at our happy ending just yet. It looks like we're just getting started...

In my last post, we were ecstatic that we had just found out we were pregnant! After so long and so many months of it never being "the month".. we were in disbelief. I felt very cautious about the whole thing. But my first clue that something was wrong came even before the pregnancy test. A few days prior, I started feeling a little odd. Some very strange pains in my stomach, although I hadn't eaten anything recently, and I was even woken up in the middle of the night with strange tummy aches. I assume it was some sort of indigestion and took Tums.

But it wasn't just a tummy ache.

It was the worst illness I'd ever had in my life.

But I didn't know that just yet! I happily called our RE's office and spoke to my nurse, who was so happy to hear the news. I was scheduled for a blood test in a few days. But then I started really feeling sick. A strong feeling of nausea. Could this be morning sickness so soon? Googling led to the answer of "possibly since everyone is different, but it's unlikely to start so soon". Within a few hours I couldn't keep anything down. And nothing stayed down for a whole week. I was seriously sick.

By the time I was scheduled for my blood work, I already thought I was in the process of dying. I went into the office, but had to wear a mask and have my blood taken in the back room. I was very careful to not touch a thing or even stand near anyone. I was surrounded by other women getting bloodwork for their IUIs and IVFs.. I would never want to even have a chance of getting them sick.

The bloodwork came back at the end of the day... it was positive. But my progesterone had dropped down to a 2. At that point, I knew it was over. I started progesterone supplements, but I knew my HCG had already begun dropping. My tests had gotten quite dark,.. but then my blood results said only 11. That was very low.

That night, I was so weak and extremely dehydrated from vomiting and ended up in the ER. Over the next week I was pumped full of anti nausea medications - none of which seemed to do much, if anything. At the hospital, they ran my HCG again. It was a 6. It needs to be above 5 to be considered pregnant. By the next morning, I was bleeding and I called my nurse for permission to stop the progesterone.

I was very ill and wasn't able to make it in for my final blood work for quite a while, and I was well into my next cycle. But my HCG was at zero, as expected.

So where does this leave us? In limbo, really. We need to wait to meet with our RE, to discuss our next steps. This current cycle will be med-free and hopefully my body will get back on track quickly.

I'm not sure if I've processed that I was pregnant, then suddenly I wasn't anymore. It's hard for me to understand why this happened. Why give us such a hard road, and then once we finally get there, take it away? But I think the real answer is that life just isn't fair most of the time. It certainly sucks, but that's just how it happens sometimes.

I know our happy ending is still out there.. and hopefully we'll be there before we know it.

Wednesday, November 18, 2015

Our Third IUI, with Clomid!

After having only one follicle for each of our first two IUIs, my RE decided to increase my Clomid dosage to try to help us get another follicle or two. My previous dosage was 50 mg and my RE increased it to 100 mg, still on CD 3-7. Starting out with this cycle, I was sure there was no chance it could work. I was glad to have an increase in my medication, hopeful that could give us a boost. So I started taking my Clomid as scheduled, and I didn't notice too much difference between the dosages. Although I think I may have had a few hot flashes? There were a few occasions that I felt hot, but it wasn't severe in any way.

Same as the last two cycles, I got my positive OPK on CD 12, and our IUI was scheduled for CD 13. We did the same routine as previous months.. dropped off the sample, got breakfast, went home, and then went back. When it was time for my ultrasound, my lining was good at 9.1 mm and I had TWO follicles! A 26 mm follicle on the right ovary and a 21 mm on the left. I was also really happy that there was one on each side, which I felt helped our chances a little more. I had two smaller follicles that didn't quite look big enough to be mature. The post wash count was really good this time too! It was 44 million with 76% motility! They want the post wash count to be 1 million at minimum and feel you have a better chance if you have 5 million +. So we were extremely happy with that number! The IUI went perfectly, no cramping at all.

I felt a lot of pressure during the TWW. I was questioning what was next, what would happen, etc. I had an appointment already scheduled with our RE to discuss our next steps. I did take a few pregnancy tests, but stopped when I got a negative on 10 dpo. I figured I was out. But then on the evening of 10 dpo, I felt some odd pulling in my uterus area. It was a very strange feeling I'd never had before. So I took a pregnancy test the next morning...

First I just used an internet cheapie test (the little pink strip in the photo). I couldn't believe it that suddenly there was a line! But I was wary, I didn't want to get excited over an evap line. So I took a Sure Predict test, which is the bottom strip. And that was positive too!! I confirmed it with an OSOM test, which showed a very clear positive.

We just couldn't believe it! We were SO happy. I was so sure we'd need to do IVF and I was so ready to see those two lines!

Want to hear about our other IUIs? 

Friday, October 30, 2015

How to Read Your OPKs

One of the first suggestions doctors make to any couple that is trying to conceive is to use ovulation predictor kits, commonly called OPKs. These inexpensive tests are used in the same way as a pregnancy test. They are dipped in urine for a short amount of time, usually about 5-10 seconds, and the result is ready in roughly 10 minutes. But the results of these tests are interpreted in a totally different way than a pregnancy test, which often creates some confusion!

To better understand how these tests work, I'll explain what they are actually detecting in your urine. OPKs pick up the Luteinizing Hormone, or LH, that is always present in your urine in varying amounts. The amount circulating in your body changes throughout your cycle, but you will almost always have at least a very faint line on OPKs. This is where the confusion comes in. With pregnancy tests, any line within the time limit means a positive result. But since you always have LH in your system, you will always have a line on your OPK tests.

As ovulation approaches, your body begins to "surge" and suddenly releases large amounts of LH. This is a signal to your body that it's time to ovulate! Usually you will ovulate between 12 and 48 hours after you get a positive test, with most people ovulating the day after they get a positive result. If you are temping and charting, you should see your temperature rise the day after ovulation.

A positive OPK does not mean you have already ovulated, and it also does not guarantee that you will ovulate. Your LH surge occurs prior to ovulation and the only way to be sure ovulation occurred is to chart your temperatures, have a progesterone blood test, or confirm ovulation with an ultrasound (for those of us who have our cycles monitored). It's possible to have an LH surge and positive OPK, but not ovulate. This can commonly happen to women who have PCOS.

With an OPK, the test line has to be equal in darkness to the control line. You may have your test line darken gradually until you get a positive, or you might surge suddenly and go from a faint line to a dark line in no time. Everyone has a different pattern and it may take a couple of months to figure yours out.

The photo below shows a negative OPK on top, and a positive result on the bottom. If your test line is not as dark or darker than the control line, the OPK is considered negative.

My two favorite brands are Wondfo and Babi. Both are reliable and inexpensive! I usually buy them in packs of 50, which last me for awhile. Click the photos below for more information and to check out the reviews from others who have used them.

If interpretting lines isn't your thing, some of the digital tests might be a better fit for you. They give you a clear yes or no answer each time, which is really nice! But the only downside is they are significantly more expensive than the strip tests. I have found that both my strip OPK tests and digital OPKs are positive at the same time, so I prefer the cheaper tests. The most reliable digital test is made by ClearBlue and comes with multiple test sticks.

OPKs are a really helpful tool that can help to ensure you time intercourse properly to give yourself the best chance of conception. If you haven't tried using them yet, I highly recommend them! The cheaper tests work just as well as the expensive ones, so there truly is no need to break the bank.

Do you use OPKs? What is your "go to" brand?

Thursday, October 22, 2015

IUI #2 with Clomid!

My hopes were pretty high for the first IUI, but even higher for our second IUI. I was so excited to get started with the process and have our first IUI, but once the first one was unsuccessful, that excitement had worn off. I had really been hoping for 2 follicles originally, so I was disappointed when I only had 1. Having 2 follicles can increase your chances of success greatly, so I really wanted that extra boost. I was so hopeful that I'd get 2 follicles for the second IUI, because I had one large one and one just too small to be mature the first time. I thought that the next time for sure I'd get 2! Our RE kept me on 50 mg of Clomid on CD 3-7, which I did well with again.

Right on time, I got positive OPK on CD 12! I called to schedule us in for the next morning. I was less nervous this time since we had already done this before. So we headed in first thing in the morning with my husband's sample to drop it off with the andrology lab, then stopped to pick up some breakfast. A couple of hours later, we went back for our appointment. We paid for the IUI and then went right in! 

I had my ultrasound to check my lining and follicles. My lining was not as thick as last time, but it was 7.8 mm, so it was thick enough! The doctor explained to me that there is a natural variation from cycle to cycle, so it's not a concern, especially since it was above 7 mm. I had one very large follicle, 30 mm, on my right ovary. On my left I had two follicles, 10 mm & 12 mm, which were unfortunately too small to contain mature eggs. So again, only one mature follicle. Definitely disappointed! Our post wash sperm count was similar to the first time: 13.5 million with 53% motility. This IUI was a lot more uncomfortable than my last one for some reason. I started cramping quite badly as soon as the catheter was inserted, and I had to really work to calm myself down. The nurse performing my IUI waited until the cramping had stopped to proceed. I was really happy when it was over with! I kept having dull cramps while I laid on the table for 15 minutes, and continued to be crampy and uncomfortable for the rest of the day. I had a little spotting as well, but that is completely normal. 

This TWW unfortunately felt much longer than usual. But then my temperature dropped at 12 dpo, and stayed down until 14 dpo, when my period showed up. 

When this IUI was unsuccessful, I was pretty upset. I felt we had only one "chance" left to get pregnant through IUI, and was mentally preparing myself for IVF. I looked into the pricing, the different plans, the success rates, etc. I was ready to move forward with that. I wasn't happy about it, but I figured if that's what we need to do. Still in my back of my mind was the hope that the third IUI would be the one and we'd get a positive pregnancy test! On to the next cycle...

Want to hear about our other IUIs? 

Saturday, September 26, 2015

Our First IUI!

When we had our first RE appointment, my period was due in just a short time. My RE wanted me to complete all my bloodwork before then, and as long as everything was as expected, I was to call them on CD 1 to schedule both my HSG and have them put me on the schedule for an IUI. My RE said I could do the HSG and IUI in the same cycle, and we were eager to get started so we jumped at the chance! My HSG was scheduled for CD 11, which made me a little nervous. I was afraid the clomid would change my ovulation date and I would ovulate too soon, but thankfully that didn't happen!

I started taking 50 mg Clomid on CD 3. I was pretty nervous! I had no idea what to expect. I've heard some women say they have horrible side effects on Clomid, while others don't notice a difference. I'm quite happy to say that I don't have any side effects while on Clomid! But I was so nervous to take the first pill. 

I'd done a lot of research about Clomid, and I read that drinking pomegranate juice, red raspberry leaf tea, and taking vitamin E can help to ensure your lining develops nicely. In some women, Clomid causes their linings to not grow thick enough prior to ovulation. I wanted to do everything I could to make sure that didn't happen! I also took probiotics for most of the cycle, because of the antibiotics I had taken for the HSG.

The day after our HSG, I had a positive OPK! It was CD 12, so our IUI would be on CD 13. I called and got us scheduled for the next morning. I was already starting to feel a bit crampy prior to ovulating. By the next morning, I was feeling lots of cramping and pressure. I was sure I had multiple eggs! We dropped off my husband's sample, then went out for breakfast. We needed to wait for the sperm to be washed and prepared first before our IUI. A couple of hours later, we went back. 

The first thing the doctor did was an ultrasound to check my lining and follicles. My lining was great at 10.2 mm! They like it to be over 7, with over 8 being ideal. I was a little disappointed to find out I had only one follicle, but it was a big one at 28 mm, so that explains the pressure I was feeling. I was actually in the process of ovulating right as they were doing the ultrasound - so fascinating! We had to sign off on the sperm sample before proceeding. The numbers were a bit lower than we were expecting, with the post wash count being 16.5 million and 42% motility. But the doctor said the numbers were above what they want to see, so they were happy with them. 

Once we got started with the actual IUI, I got a little nervous. But I figured it would be similar to the HSG, and it was. It was really quick and over before I knew it. All that was left to do was have the table put on an incline (to help the swimmers!) and just lay there for 15 minutes. Then to go home and start the TWW!

I had my hopes SO high for this cycle. I was sure that we just needed a little boost to get there. Unfortunately, my period came right on time and it was time to move onto the next cycle. I was disappointed, but I knew that it often takes a few tries to be successful.

Want to hear about our other IUIs? 

Friday, September 11, 2015

HSG Test

If you're a woman out there who might need an HSG, my biggest advice is to stop reading all the horror stories online. Every woman I've actually spoken to has had no problem with the HSG. There is a chance of cramping during the procedure, but it's nothing to be concerned about. A very small percentage of women have a painful experience, but so many more have no issue at all. Don't stress out over something you have no control over. The entire test takes about 30 seconds.. that's it!

If you aren't familiar with what an HSG is, it stand for hysterosalpingogram, also known as a dye test. This is how a doctor or radiologist checks to make sure that your fallopian tubes are open and functioning properly, as well as get a good view of the shape of the uterus. It's performed by inserting a catheter through the cervix and into the uterus, then a harmless dye. Meanwhile, you will be having an x-ray taken throughout the procedure to view what's going on inside the body.

I read all the horror stories. I heard how horrible it supposedly was. But when a friend of mine had an HSG a couple of months before mine, she said it was truly no big deal. I was still nervous, which I think is normal. My RE likes to perform vaginal cultures and have you take an antibiotic prior to the HSG to really cut down the risk of infection. They advised me to take Ibuprofen or Naproxen prior to the appointment, since it can help to eliminate cramping. I chose to take Naproxen.

When we were led back by the nurse, she first went over the whole procedure with us. But then it was time for me to do the test alone. Due to the xray machine, my husband couldn't come in with me. They first had me take a pregnancy test, which is ironic, since we all knew there was no pregnancy since I hadn't even ovulated yet. But they need to be sure. My RE came in to reassure me and ask my permission for a student doctor to observe, which I had no problem with. Everyone was really light hearted which definitely helped! I got set up on the table and they put in the speculuum first, then cleaned the area with some iodine, then the catheter. I felt the balloon inflate (which blocks the opening to the cervix) and had a little cramping. Everyone in the room was telling me everything was fine, so I relaxed and the cramping stopped. Next it was time for the dye to be injected. I admit I started freaking out a little at this point. I was really concerned if they could see if everything was alright! But they reminded me the screen was next to me and I could actually watch the dye myself. It was amazing! I watched as the dye filled up the uterus first, then the tiny little tubes, and then how it spilled out the ends. Instant relief knowing there was nothing wrong!

The catheter and speculuum were removed before I knew it. They had me get changed, and then the doctor came back in to explain the images further. He explained what it would look like if there was an issue, and why mine looked great! To say I was relieved was an understatement. I was cleared to do my IUI in just a few days!! Now all I needed was a positive OPK!

Sunday, August 30, 2015

Our First RE Visit

The week leading up to our first RE visit, I was a mess. I was so nervous. I knew in general what to expect, as I had read a lot of other women's experiences. But I just couldn't believe it was us, walking into a fertility center. When we got there, we had a wait for only a short time before being brought in by a nurse. She took my blood pressure, weight and height, and explained what we'd be doing at that visit.

First, we met with a resident, who went over our entire patient intake packet. It was about 20 pages long and was really extensive. She reviewed our labs and did a family history on both sides. Once we were done, it was time for me to change and get ready to meet our doctor and do our exam and ultrasound. Our doctor is such a warm, kind person and you can notice this immediately when you meet him. We did an ultrasound to check my ovaries, uterine lining, and follicles. Everything looked great! We also did some vaginal cultures (similar to a pap). Once all that was done, I got dressed and we went to talk with the doctor in his office.

We got to ask plenty of questions, developed a treatment plan and had a couple more tests ordered. Just a few more blood tests, all standard prenatal things. And I needed to do an HSG. Once our testing was completed, we were cleared to get started with our clomid & IUIs!  Our doctor was very positive about our chances and decided to start me on 50mg of clomid CD 3-7. After reviewing my charts, he decided I didn't need any extra monitoring, since my cycles were very regular. He was really happy I had been charting so long. It's so nice to have doctors that see the value in charting! So to start my first treatment cycle, all I had to do was take my clomid and do my OPKs as usual. Once I got a positive OPK, I needed to give them a call to schedule my IUI for the next day. Really simple actually! Since we have no infertility coverage on our insurance, we qualified for a special cash price for our cycles. But first, we needed to do that HSG...

 Image Credit

Wednesday, August 26, 2015

The beginning...

Hello out there! While dealing with all the difficult feelings one goes through during infertility, I found so much help in other online blogs. It was such a comfort to me to simply read other couple's journeys as they met disappointment after disappointment, but finally in the end they are blessed with their little one. I even found a blog from someone from my very own RE's office! This really helped me to get some insight into what I would be going through. Knowing that other people were successful before you certainly boosts your hopes!

First a little about us. We're high school sweet hearts, have been together for over 10 years and married for 3 of them. We are both in our mid twenties. We love animals, growing our own food, and spending lots of time outside. We have always wanted to have children, but never thought it would be so difficult to have them!

For now, we will be keeping this blog anonymous. We have only shared our infertility struggles with our immediate family and just aren't ready to go public quite yet. I know everyone has a different comfort level when it comes to sharing, and we really feel it will help keep the pressure off if we keep things more private. Thanks so much for understanding!

I'll give a quick summary of how we ended up here. After our wedding, we did not use any birth control other than natural family planning and charting. I always found charting to be interesting, so I had picked up the habit of always charting my cycles. I figured this would also be helpful once we tried for a baby. Once we decided to try, I expected we'd get pregnant rather quickly. I had always had perfect cycles, beautiful charts, positive opks followed by a big temperature spike.. but I didn't get pregnant right away. I read a lot of statistics. About how most couples get pregnant within 3 months, the majority of those who don't will get pregnant by the 6 month mark, and the rest of the stragglers follow suit in the last 6 months, except for those that don't. When we hit 6 months, I really in my heart knew something was wrong. I can't explain it, but I knew there was.

We still had to wait to visit the doctor. You need to be trying for a full 12 months before most doctors are willing to do an infertility work up. Once we were at 12 months, I made an appointment with my gynecologist, who is a wonderful doctor. Both myself and my husband went to the appointment. I brought all my charts as well, which my doctor was really happy to see. Based on my charts and my CD 3 labs, everything looked good. But she was concerned. She ordered a 7 dpo progesterone check and a semen analysis for my husband. The results of both came back on the same day and my doctor gave me a call. There was a problem. The progesterone test came back great! But the semen analysis didn't. The results were actually not terribly bad. The count was within normal limits, but on the lower end. Still, that's not a problem on it's own. But then the motility (how many are swimming quickly), was less than half of where they wanted it to be. And the morphology was low.

My doctor recommended two things: a urology exam for my husband and getting started with a reproductive endocrinologist , also called an RE. We did the urology exam first, which gave us the reason for the problem. At some point, my husband had an injury. The urologist explained that an injury can sometimes cause the testicles to function at a lower level than they normally would. But the good news was there was nothing else wrong! No tumors, no blockages, nothing serious.

Our next step was the RE. There are quite a few doctors at the center we were planning to use, and I had no idea who to pick. I couldn't find a single bad word about any of them online, only wonderful things and happy patients. I let fate decide and told them I just wanted who had the next available appointment. As soon as we met our RE, I knew we had the right one and we were ready to get started!

If you've stumbled across our blog and are dealing with infertility yourself, please don't hesitate to leave a comment with a question or to share your story. I'd love to hear from you!