Out with the Old, In with the New

I tested on June 24th and got a BFN.  I called the ARS / RE's office and talked with the nurse.  She said they wanted me to go in for a pregnancy blood test to make sure. So I went in the next day.  She called me later that day with the results.  They were negative.  My progesterone level was good and she said the next time around they are going to start Prometrium 4 days after I ovulate.  She said to call when AF appears in full cycle to schedule appointments for the next cycle.  AF visited for a short visit that night, then went away until Sunday.  I called the office on Monday thinking they were going to have me come in that day, but they said that since AF wasn't a full flow until Sunday they would consider Sunday as CD1, so my appointment (u/s) was scheduled for Tuesday morning.  Tuesday, June 29th, I went in for my CD3 u/s.  I was a little taken aback by the u/s tech's first words to me.  She came in and said "aren't you supposed to be pregnant by now?"  I knew she was just joking and didn't mean anything harmful by it, but it made me a little uncomfortable and stung a bit.  Then she looked at the chart and saw it was only my 2nd month (2nd cycle) with them.  She said that I had some good things going last cycle - good lining, made a follicle big enough and I ovulated.  She started the u/s.  She said that I shed my lining, had no residual fluid and lots of eggs / follicles.  I met with the nurse and she gave me a calendar with the details of the plan for this cycle.  My plan for this cycle: Clomid for 5 days starting on June 29th.  Follistim injection on July 5th.  OPK on the 7th and 8th.  U/s on the 9th.  Ovidrel injection timed with ovulation.  IUI (2 rounds) timed with ovulation.  Start Prometrium 4 days after ovulation / Ovidrel injection.  Progesterone b/w one week after Ovidrel injection. The plan this time is similar in that I had the CD3 u/s, took Clomid for 5 days starting on CD3 and have a Progesterone b/w 1 week after ovulation.  It differs from last time because this time I will get Follistim injection instead of Gonal F and I receive it on CD9 where as I had the Gonal F injection on CD13.  I will also start Prometrium 4 days after ovulation. 

I started Clomid for 5 days that evening.  Instead of Gonal F, I had to purchase Follistim.  I received that injection on the 5th (CD9) in the back of my upper right arm.  Man, that injection stung and burned going in and even afterwards for a bit.  I was glad I went in to have the nurse give me the injection instead of trying to do it myself.  I don't know if I could've done it myself.  I took an OPK on Wednesday and Thursday with negative results for surge.  This morning when I went in for my u/s, I was having terrible pain and pulling below my stomach.  I told the u/s tech and she said something must be happening. I was actually fearful that I had ovarian hyperstimulation syndrome (ohs).  Well thankfully that's not what the pain was.  My lining was 7.6, I had no residual fluid and 4 follicles that she measured in my Left ovary.  They measured 25.5, 19, 16 and 10.5.  In my right ovary, I had 2 follicles that she measured.  They measured 15 and 10.5.  I was very excited about this news.  I can't believe all the follicles that are at a good size.  The tech said they measure any follicle over 10, but that they didn't expect the 10.5 ones to do anything.  She said the follicle that measures 16 (in my left ovary) and the one that measures 15 (in my right ovary) could still get bigger, so we couldn't discount them.  The tech said that is the reason I am having so much pain.  She said that I should just take it easy.  After the u/s, I saw the nurse.  She said that they had to go over my risk for multiples and make sure I wanted to proceed since I have 3 good size follicles in my left ovary.  She also made it clear that just because I have 3 good size follicles, nothing could still happen.  I told her I understood and wanted to go ahead with the plan.  She gave me the Ovidrel injection.  I must just be a wimp because that burned going in, too.  I have an IUI scheduled for tomorrow and Monday.  I start the Prometrium on Tuesday and go for a Progesterone b/w on Friday. 

IUI, Post-Ov Ultrasound and Progesterone Bloodwork

Sorry I haven't posted an update about the IUI.  I guess I have just been trying not to think about it much and trying to focus on other things so I don't drive myself crazy.  June 10th, I went in for the IUI with DH's specimen in a cup tucked inside my clothes so that I could keep it close to my body (that's what they suggested I do).  The IUI was about 10 minutes long.  The nurse brought in the tube with the sperm and said there were lots of sperm in the specimen I brought in.  Yeah!!  She showed me the tube.  It was cloudy looking.  She said that was good and means there are lots of sperm in there.  She brought out a long thin needle thing, which is what she used to inject the sperm in me.  The procedure was fine except for when she hit my uterus.  We were talking and I stopped in mid-sentence.  She asked if I felt discomfort.  I said yes.  She said that she must have hit my uterus and needed me to tell her if I felt any discomfort  because she can't tell how far she has injected it / if she is hitting the uterus.  After the procedure, I layed on the table for about 5 minutes before I left.  I felt some pressure in my vaginal area, but other than that felt OK. 

I was pretty tired.  DD and I took a 3+ hour nap.  It was great! 

I went in the next day (June 11th) for a post ovulation u/s.  The tech said my lining was now at an 11.  Good!  She could also tell that an egg was released because there was fluid.  She said we had done everything we can up to that point.  She said 2 weeks after I had the Ovidrel, I can take a test.  She did warm me about taking it too early though, to avoid getting another BFN.  I am to call when I receive a BFP or if AF visits. 

DH and I drank a bottle of one of our favorite wines (because hopefully soon I won't be drinking any for about 9-10 months) and he toasted "to our growing family."  That was such a sweet toast!  I loved it and I love him.

June 15th I went in for b/w to check my progesterone level.  The nurse called the next day with the results.  She said my level was a little low.  They like it to be at least 20 and mine was at 13 (which was no surprise since my ob/gyn diagnosed me with LPD).  They want me to take 100mg of Prometrium 3 times per day.  She said that I should call the office by the 25th, unless I receive a BFP before that (then I need to call right away).  If I get a BFN and no visit from AF, they are going to do b/w.  I plan on testing today actually (the 24th).

Since then it has just been a waiting game and I have been trying to focus on other things and not think too much about it.

That's Your Baby Maker and Ovidrel Injection

I used the OPK on Sunday and Monday and had no surge, so I called the ARS' office to schedule an u/s.  I was a little (OK, quite) disheartened that I hadn't received a surge.  I went to the u/s yesterday, which was CD16, and got great news!  While the tech was doing the vaginal u/s, she first checked my lining.  She said that it was looking good and was at a 10.  She said they like it to be 8 and above.  She then checked my uterus and checked for any fluid (which could have been left over indicating we missed my ovulation). Thankfully there was no fluid.  She viewed my right ovary and found a lot of small follicles.  Then viewed my left ovary and found the Baby Maker (as she referred to it).  She measured the biggest follicle and it was at 21 1/2!  Anything 18 and above is good.  I was so happy and excited when she told me how big it was.  She said that one is going to be your Baby Maker.  You can get dressed and go up to the front.  As I got off the u/s table and started to get dressed, I got so anxious, excited, happy, emotional, nervous, scared, etc that I started to cry.  I got a hold of myself, but was shaking a little.  I was so scared going into that appointment that things weren't going to progress.  I was feeling something going on inside, but didn't know what.  I guess I was feeling my body getting ready to ovulate!  I saw the nurse and she said that basically now they give me the Ovidrel injection, DH and I should get together that night or the next morning, come in on Wednesday for a post coital test, post ovulation u/s on Friday and progesterone b/w next Tuesday.  She gave me the Ovidrel injection in my right upper arm.  It stung a bit.  Needles are just unpleasant going into the body (at least for me).  I scheduled my appointments and left. 

Later, I was thinking that no matter what happens I thank God for getting me this far.  Knowing that my body (with the help of medication) has gotten to this point is somewhat of a relief to me.  Don't get me wrong, my ultimate joy will be when I hear those beautiful words: "you're pregnant!" and then of course when we hear our beautiful baby make his/her first cries / sounds! 

I am pretty nervous about the post coital test this afternoon.  I hope that everything is good and doing what they are supposed to be doing.  As stupid as this may sound, I just want to know when the ARS / nurse / u/s tech can tell us if we are pregnant.  I am not sure how much longer we have to wait to find out.  Then I think about twins / multiples.  Twins run in both of our families.  In my family both of my parents have twins in their family.  Then the Clomid, Gonal F and Ovidrel run the "risk" of multiples.  So does all of that multiply our chances of having multiples?!?  First I think, well I only have one follicle that is big enough to produce a mature egg, but then I am reminded that the egg can split to form twins, too. 

If you can't tell, I am a very impatient person.  I try to be more patient.  I try to be patient and listen to what God is trying to tell me or teach me during the waiting, but it's hard for me.  I feel like I have been patient long enough.  Yes, I understand that to some people TTC for 8 or 9 months is not very long.  I know that many have been trying for years and years.  I can't imagine that.  I don't know what I would do or will do if that is how long our journey is.  I know that things are in God's hands.  I have to put my trust in Him and know that His plan is what is best for me.

If you have a chance to say a little prayer for me and that the tests in the upcoming days all come up good and we get a positive result soon, I would really appreciate it. 

CD13 Ultrasound and Gonal F Injection

The (mail order) pharmacy that the ARS's office uses is great.  They have called me several times - 1st to confirm the script, date I needed it and get insurance and payment info, 2nd to see if I received the med and 3rd to make sure the order was correct.  And best of all the Ovidrel injection came the day it was supposed to and it was correct.

The OPKs were negative for a surge on the 3rd and 4th (CD11 and CD12).  I went in for my appointment on the 5th.  The u/s showed 2 follicles on my left ovary and 1 on my right ovary.  There was only 1 on my left that measured enough to be able to use.  The tech said it was at a 14 and they like to see it at 18.  She said it would probably get there in a couple of days.  Then I had an appointment with the nurse.  She said for me to continue doing the OPKs the next few days.  If I get a surge I am to inject myself with the Ovidrel.  If I do not show a surge by the 7th, I need to call them to schedule an u/s for the 8th (so they can see what happened).  She gave me an injection of Gonal F, which she said would give me a boost.  She also showed me how to give myself the Ovidrel injection when she was doing the Gonal F injection.  It burned when she was injecting me and even after it was injected.  She said that was normal and hopefully it wasn't / wouldn't be too uncomfortable.  She said if she was a betting woman, she would bet that I would have a surge by Monday.  Here's hoping so!

The OPK for later that day was negative for a surge.  The Gonal F injection site stopped burning, but is a little sore at times. 

I do worry about the medications (Clomid, Gonal F and Ovidrel) and the effect(s) they will have on my body in the long run.  I guess and hope that they are safe and don't / won't cause any kind of problems or disease.  I haven't done much, if any, research on the meds because I don't want to know.  I want another child.  I don't want DD to be an only child.  DD wants a sibling.  So at this point, I want to be ignorant of the side effects, short term and long term.  I trust the ARS and God and that's all I can do at this point.  I don't need any more stress. 

CD3 ARS Appointment

Wednesday the 26th I went to the ARS for an u/s, exam and b/w.  The ultrasound tech did a regular u/s and a vaginal u/s.  She showed me the follicles in my ovaries.  She said that on the screen they looked like a chocolate chip cookie. The ovaries being the cookie and the follicles being the chocolate chips.  Once she said that, it really did!.  After the u/s, I went to an exam room where the nurse had me get undressed and I  waited for her and the ARS to come in.  The ARS said he had good news: my uterus looked good and I have a lot of eggs (which could be because of the PCOS but it is probably more a sign of my fertility). Basically he said we just need to try to control my ovulation or see if we can control it. He did tell me that I have a fibroid.  He said it was very tiny and that they don't typically do anything for ones that tiny.  They will watch it to make sure it doesn't grow / get very big.  Since my period was different this month (much lighter and at that point almost non-existent), he ordered an HCG to make sure that I was not pregnant. he said if I was it would probably not take and we would have to wait for the numbers to drop.  He did an exam, taking samples in case we have to do IVF (and there might have been other reasons that I don't remember).  The nurse gave me a calendar for May and June that showed our plan outlined. Basically I took Clomid CD3-CD7 (5 nights). Then I started using an OPK on the 3rd (which was CD11) and was scheduled to come back to the office for another u/s on the 5th (CD13).  If the OPK showed a surge before my u/s, I was to call the office.  The nurse faxed a prescription for Ovidrel (an injection that I received through the mail).  I was told to bring the Ovidrel with me to my u/s on the 5th, if I had not had a surge before then.  Basically, when I have a surge, I take the Ovidrel.  The nurse said she didn't expect me to have a surge before the 5th, but I needed to test just in case.  She said to plan on coming back into the office for a postcoital test the 7th-9th.  Basically after I get the surge, I do the shot of Ovidrel, then we do the BD and come in to have my CM and the sperm checked. 

The Clomid (still the same dose) this time, seemed to make me very angry and on edge.  I barked and snapped at DH and DD several times.  Actually I don't know if it's the Clomid or the stress from being infertile and not being pregnant yet.  It's easier to blame the Clomid though.

First Visit to the ARS

Sunday I took another test.  Why do I put myself through such trama?  Of course I got a BFN!  Later that evening, I was preparing for my appointment on Monday with the specialist and entering my BBT in my chart at Fertility Friend.  I got another glimmer of hope.  From my chart, it stated that I was only 11 DPO and it was still too early for me to test.  I had several signs that indicated pregnancy.  I gained some hope back, but then lost the hope on Monday morning.  I didn't even have to get out of bed, I knew the feelings - the cramps, the headache, the wetness.  AF roared her ugly head!  So, CD36 turned into CD1, just like last cycle.  At least that has become consistent.  DH, DD and I attended the appointment with the Advanced Reproductive Specialist (ARS).  I was a little worried about taking DD to the appointment because I didn't want to upset other women who might be at the appointment.  I didn't want to seem like I was rubbing her in anyone's face.  I was quickly reassured about her being there by the office staff.  They were all talking about her - how smart, creative, talkative, etc she is.  It really helped to put me at ease.  We first met with a nurse (Janna) in one of the rooms.  She took my BP which was good.  She weighed me (which I had lost a few pounds - yeah).  She went over my paperwork, making sure she understood our situation.  She went over my medication and talked to DH about his health and medication.  She told me that I should stop taking the Valerian Root and Melatonin because herbal supplements can contain hormones and this could affect my fertility.  She gave me a hand-out to read while we were waiting for the ARS.  We didn't wait long before we were told to go into his office.  He first started out asking us what questions we may have.  I talked to him about taking Calcium with Vitamin D supplements.  He said that he would recommend me to not take those, since I take a prenatal vitamin.  He said too much could cause problems with fertility, birth defects, and be toxic to my body.  He said that he felt I was not ovulating or at least not ovulating regularly.  He talked to us about what he recommended in our situation.  He said that since we live close by, it would be best for me to come by on CD3 to have an u/s to check my uterus and tubes.  At that appointment I would also be given a physical exam and have b/w drawn.  At the end of that appointment he said I would get a calendar with written instructions on what was going to happen next.  He said he did not want me to start taking Prometrium on CD14 like I have been because this could be hindering my ovulation.  He said that if my body was about to ovulate, it could stop it and push it back further.  He doesn't want me taking it until I have ovulated.  He also said that we will use Clomid to help with ovulating and that he would not increase the dose.  He likes to keep the dose as low as possible, but would add other drugs if need be to help me ovulate.  He gave us hope that we would be pregnant in 3-4 cycles.  Obviously, he can not promise that and did share the statistics (which aren't that great), but said that since we were able to conceive before and have a healthy child it's like "money in the bank".  He said another thing they will check is my CM.  This is done by a postcoital test.  This test will also help them figure out if DH should go ahead with the sperm analysis.  He was so nice to DD and was talking to the nurses / office staff about her.  They all reassured us that DD was welcome at the appointments and he even said that DD would become great friends with the girls (meaning his nurses and office staff). 

I am excited about this plan.  I think that he is covering all the basis and is willing to change this as we go, according to how my body is responding.  DH and I are very comfortable with the plan and agree with it.  It is also scary, but I am trying not to let myself think about the what ifs or anything negative. 

DH kind of mentioned to my mom that we are seeing a fertility specialist.  We talked about it before he mentioned it to her.  He asked why I haven't told her.  I told him that I just didn't like talking about it.  It's nothing against my mom.  I tell her lots of things, but I just have such a hard time talking about this struggle.  Hence the reason I need this blog.  I know that I need to talk about this struggle.  I can't keep it all in, but it is so hard for me to do that.  I don't know if it is admitting it, or if I am afraid of the reaction, or showing too much emotion, or being too vulnerable.  I'm not sure.  Maybe it is a combination of all of that.  I don't want people feeling sorry for me or pitying me.  I would, however, love to have someone (or many) walk alongside me (us) as we struggle with this.  I know in order for that to happen I need to open up about this, but it's hard.  I pray about it and have opened up a bit.  I sent a prayer request to our church prayer team and asked to be prayed for at the Global Day of Prayer.   

U/S

I started Prometrium on Saturday the 27th (since it was CD14).  I am hoping this cycle will be it.  Another thing I forgot to mention about my appointment with the ob/gyn was we discussed whether I was ovulating.  I was thinking that I probably wasn't.  She said the pains I am having could be ovulation.  I also told her that I have had the cervical mucus (even cycles when I haven't had AF for over 40 days), she said I could very well have ovulated then too.  Apparently you don't have to have AF to ovulate. 

Thursday I had the u/s.  I told the tech that I was still having the pains on my right side, but also my left side has been hurting (even more than the right) and the center of my abdomen has been sensitive / soar.  She did 2 types of u/s.  She showed me my ovaries, cysts, follicles, etc.  She said that it's not common for women with PCOS to have pains (but I am not sure how much she really knows about PCOS because from what I have read, it is very possible).
The ob/gyn's office called with the results later that day.  The u/s confirmed / was consistent with PCOS.  There is no blockage or scar tissue.  My ovaries are functioning, but with PCOS.  Normal treatment for PCOS is to suppress the ovaries, but since we are TTC, we don't want to do that.  She said the pain is just from the PCOS.  She said the u/s showed tons of cysts (almost like an overactivity), but that is PCOS.  The pain is from the PCOS and there isn't much they / I can do about it.  She said to take Tylenol, keep hydrated and to make sure I am not constipated.  She said that Metformin is a good drug to make the ovaries function.  She wants me to keep them posted.  I asked if she could tell from the u/s if I ovulated this month this I was on CD19 and she said that she couldn't tell. U/s isn't a good tool for that. 
So, at least I have no blockages or scar tissue, but I have major pain a lot.  Thankfully the pain doesn't last a long time, but it does happen frequently.

New Game Plan

Last week I attended an appointment with my ob/gyn.  The nurse talked to me about the fact that I have several factors against me in regards to conceiving again - PCOS, hypothyroid, LPD, but that the most promising factor was that my body did it once.  I have a beautiful 3 year old little girl.  The ob/gyn reviewed how things have been going with me.  I told her about my pains, especially on my right side.  She ordered an u/s to rule out blockage and scar tissue.  We talked about TTC and what our next move should be.  Thankfully she understood that we mean business and want to get things rolling with having a baby.  We don't want to play games or twiddle our thumbs.  She laid out all the options - try Clomid (she only does 3 rounds then sends you to a fertility specialist), seek a fertility specialist, keep trying with Metformin and Prometrium.  I asked her opinion because I truly respect it.  She said she thinks we should go ahead and start Clomid, get an appointment with a fertility specialist schedule for the next few months, and of course get the u/s.  She said the Clomid will be hard on me.  It will make me feel like I am going through menopause.  I told her that I already feel that way, as I have major mood swings and was having hot flashes.  I actually asked her if she was just teasing me and I was truly going through menopause.  She reassured me that I wasn't.  She said Clomid will bring on all these symptoms, plus there is an increase in multiples.  She said that she personally has never had anyone have multiples from it, but it is a risk.  We are worried about that risk because twins run on both sides of our family.  DH also asked if something could be wrong with his swimmers and so he is going to be tested.  I thought that was such a great thing for him to ask and kind of took the "heat" off of me.  I just thought that was very supportive.  The nurse was great at reassuring us and DH about the sperm analysis.  She told us her DH had to do that, too.  I really appreciate my ob/gyn and the nurse sharing their experiences with us because it helps me to know I am not alone / we are not alone in the struggle.  If I hadn't said this before, my ob/gyn also has PCOS.  So our game plan is to take Clomid CD6-9, then Prometrium CD14-28, on CD 29 I will take a pregnancy test if AF hasn't visited, if BFN then I will continue the Prometrium until AF visits (or I get a BFP).  We will do that for a few cycles, then if no BFP, we will meet with the specialist.  Oh yeah, and DH will get his swimmers checked and I will get an u/s.