First RE Appointment!

I was SO NERVOUS this morning before my RE appointment. It wasn't so much about meeting him as it was nervousness about actually liking him, whether I'd trust him to help us conceive, etc.

I got there 15 minutes early, then went in to have my vitals taken. I then waited for about 20 minutes or so after my appointment time and we were taken back to Dr. A. I explained by history to him, showed him my records, and waited to hear what he had to say. I actually learned a lot from him!

First, the doc put me at ease by looking at the image of my HSG from November. He showed me my uterus and said it was a "textbook" uterus, then said "It could be on the cover of a uterus magazine!" From that point, I cracked up and knew that I felt very comfortable with him.

In terms of potential issues, he noted that my FSH was high. Although it's well within the normal ranges that doctors recommend, while TTC, it should be below 2.5. My test showed a 2.75. This was about a year ago though, so I went for another test. We'll see what happens with that. We also discussed my past Clomid cycles and my current Clomid cycle. He is willing to start working with me now, so I get to wake up super early tomorrow to get a follicle scan ultrasound. We will see how well they are developing.

If this cycle doesn't work, my next step is to get another CD 3 test done. Well, I should say, get it done for the first time. When I was in the middle of an anovulatory cycle last year, the doctor had me do a panel that included the traditional CD 3 tests like estradiol and FSH. It's slightly annoying because after my first BFN cycle of Clomid, I asked my doctor if I should do a real set of CD 3 tests, since the last ones weren't technically on the right date. He pooh-poohed it and said it wasn't necessary. Dr. A disagrees. He did also mention that he didn't like using more than three rounds of Clomid, so because this is my third, my options are a bit more limited. He did say that we could try and use injects+IUI next cycle which would be fine with me, but my infertility coverage SUCKS. I only get a $5,000 yearly benefit which is definitely more than some people get, but sadly, it doesn't seem to be enough. Dr. A said that the IUI costs about $1000 with everything but meds included. However, when I include injects, he said the cost of those is like, $3,000. That seemed SUPER high to me, but I am not the professional! (Though, I did do some research with online pharmacies and the cost seems to be much lower than he anticipated, based on the number of days/amount of injects I'd need). If I can get the drugs for substantially cheaper, we could probably squeeze in two IUI cycles with injects, even if I had to pay a bit out of pocket. When I asked about the possibility of doing IUI+Femara, he said he doesn't like to use Femara because it doesn't have necessarily better results than Clomid, and he prefers to go straight to the needles.

All in all, I am happy with him. He seems like a great doctor and was awesome in answering my questions and making me feel at ease. I think that he could actually help us get pregnant, which is an amazing feeling to have. I am so hopeful for our reproductive future!

Open Letter to Dr. Girard

Dear Dr. Girard,

I thank you so much for taking the time to see me around March 2011. I know you're busy, so fitting me in 30-45 minutes after my appointment time was quite generous of you. And the fact that you spent a whole 7 minutes in the room with me felt very luxurious--I'm so spoiled!

I am writing now because I wanted to let you know how delighted I was to be reviewing my medical records the other day and learn that you think I have PCOS, especially since you never mentioned that to me. Since I am on unmedicated Clomid cycles, other doctors might be worried that the patient would develop cysts instead of follicles. Clearly those doctors just don't have confidence in their patient's ovaries like you have in mine! Surely I have nothing to worry about! And really, a disorder affecting one's ovaries isn't important to discuss when one goes to visit the doctor about issues regarding TTC, so I'm glad you didn't clutter my tiny non-doctor brain with all that information.

Hugs and kisses,
Trisha

Taking Charge of My Fertility

I took charge of my fertility and great things are happening for me in the past few days.

First, I called my current OBGYN on Monday morning to let him know I had started my period and to check in to see what dose of Clomid I should be taking. I strongly believed that I should be on 100mg even though the doc insisted that I had ovulated with 50mg. A low progesterone number like I've had the past two cycles (7.2 and 8.0, respectively) doesn't seem to jibe with ovulation or at least a strong ovulation. The OBGYN nurse told me he was on vacation and hadn't left any orders about possibly upping my dosage. LULZ. Seriously, dude? You just went on vacation and didn't bother thinking about the patient who you are pumping full of hormones? Luckily the OBGYN nurse is very sweet and had another doc review my file. Boom, 100 mg of Clomid obtained on Tuesday.

The Chief of Medicine at the student health clinic reviewed my file on Tuesday morning and agreed I should visit a RE. Since I thought that's what they would say, I had already scheduled a RE appointment for next Friday (the first one available for a new patient).

My husband had a urology appointment yesterday to review his SA and ultrasound. The first appointment, we waited for more than an hour past his appointment time. This time, I had to get to class at 5pm (his appointment was at 3:45 and the hospital is a 5 minute drive from school). We walk in to find a packed waiting room and were told he wouldn't be seen until 5:30 or so. Thanks for the phone call heads up. I went OFF on the person . . . and I can't even blame it on the Clomid Crazies, just total frustration with an inefficient office. I think my pissy mood made them just give me a copy of the SA results so I can take those to the RE and hubby can go back and meet with the doc on a different date.

(As a random aside, I hate to be all TMI, but I was really impressed with hubby's SA. Very good volume and numbers. But holy crap, FANTASTIC motility. It was over 80%! I was impressed by that. The only think we have to work on is the morphology since that was about 33%. Given the high number of actual sperm and the ridiculously high motility, I'm sure the doc isn't worried about the morph. But I personally would like to see it higher)

So, 9 days until my RE appointment and I don't know all the questions I should ask. For those who have visited with an RE before, what are the kinds of things you wish you knew or the questions that you're glad you asked?

I spoke to the RE nurse this morning

Negative

Another cycle; another disappointment.

No energy to really talk about it. I spent a lot of time crying about it already. I guess I should just be thankful that I get to take Aleve and a muscle relaxer to relieve the cramping.

But I also feel a weird sort of bloat on my right side and I'm a little concerned about what it could be. I plan to call my doctor this afternoon to see what he says about it, but I'm worried it is OHSS (a potential side effect of Clomid) and it's just my ovary being really heavy and large.

Infertility really sucks.

Patience is a Virtue

I'm linking up with Kelly's Korner today for Show Us Your Life - Suffering with Infertility.  To new readers: welcome! This will be a quick recap of our TTC journey thus far.

My husband Spyro and I have been together for nearly ten years and married for nearly five. I knew I always wanted two kids and my grand life plan when I was a kid was to get married by 26 years old, have my first child at 29, and my second child at 32. Well, I hit the marriage age perfectly, so I thought it would be easy to hit the kid targets too. Plus, my sister only seems to need to look at her boyfriend and she gets pregnant, so I thought I'd have no problem getting there too.

We started trying to conceive by not trying at all. I stopped taking birth control and we didn't prevent at all. We thought that it would just happen easily and naturally. After several years of casually trying, I stopped ovulating. I thought that it was related to life stresses at the time because I had had regular cycles previously--although I had been taking birth control for six years.

Just before my 30th birthday, I went to an OBGYN who said that everything was otherwise fine with me--and then prescribed me Provera to induce menstruation--I thought that I would just start ovulating again. That didn't happen. In August 2011, my husband and I went on vacation to Greece. While there, I had my first spontaneous period in a year. I thought that meant I was fully regulated and ready. We kept trying, but after two months of spontaneous periods, I stopped ovulating again and stopped menstruating.

In November 2011, I had an HSG which, contrary to other claims I've read online, was one of the worst experiences of my life! Perhaps it was because I felt exposed and vulnerable? The HSG showed that my tubes were clear and my uterus was "beautiful" (according to the doctor). No cysts on my ovaries. Nothing that should stop me from ovulating or getting pregnant. My doctor then prescribed Clomid to induce ovulation.

After two months of taking Clomid (unmonitored), we have yet to get a BFP. I know I have other issues, but the doctor insists on only treating me with Clomid without looking at other potential causes like hypothyroidism or anything else. I'm now fighting to try to get a referral to a reproductive endocrinologist and at least get in a few cycles of treatment with a specialist before my insurance coverage ends at the end of July and I face an infertility treatment gap until I start working for my law firm.

I often question why a couple like us who has so much love to give has struggled with infertility. It brings tears to my eyes quite often because I feel as if I am letting my husband down. All I can think is that I am learning a very valuable lesson in patience. Granted, I still want to get pregnant quickly, but this process has taught me to slow down, to prepare myself better, to look at the smaller things and be grateful for those things, and hopefully that means that I will one day be an even better mother! I wish you all the very best of luck on your TTC journey and pray that you are blessed with the child(ren) you desire.

Happy (?) Birthday to Me!

Today is my 31st birthday. Even though I knew I'd have a BFN today at 10 DPO (since I may or may not have been testing since 7DPO), I tested anyway. Sure enough, BFN. It was also unsurprising because I got the results of my 7DPO progesterone test. It was an 8. Given that the progesterone level should be 15+, last month's 7.2 and this month's 8 are a cause for concern for me. Although the number is consistent with ovulation, it is not what it should be for a healthy pregnancy. When I brought this up to my OB/GYN last cycle, he dismissed me and dismissed the fact that I had consulted sources through Dr. Google. He also refused to give me progesterone supplements. Obviously not the ideal relationship to have with your OB/GYN, but this is what happens when you are stuck with student health centers while in grad school.

This cycle's BFN after promising symptoms earlier this week (a cold starting 2DPO that I thought was a sign of Early Pregnancy Factor, bizarre breast and nipple pain that lasted for almost a whole day, high temps, etc), hit me like a ton of bricks. And I realized that who knows--maybe I could have had a fertilized egg that just didn't implant because of my shitty progesterone level? This, combined with my frustration with the process led me to take action to advocate on my own behalf.

Yesterday, I called to schedule an appointment with the Patient Advocate at the health center. During my appointment with her this morning, I discussed the problems I have with the treatment I've been given. First and foremost, I am being given Clomid unmonitored: no ultrasounds, no real bloodwork other than the progesterone tests (which I had to push for), etc. We have no idea how many follicles I am producing, what the quality of those follicles is, what my lining looks like (particularly because Clomid messes with your uterine lining), or any other important information. Given that the number of Clomid cycles one can take is limited, it is frustrating that this doctor is forcing me to do three Clomid cycles with him before he will give me a referral. The Patient Advocate listened, then said she would refer my file to the Chief of Medicine to see about getting me a referral. But importantly, she also mentioned benefits that I did not know I had. Namely, I could have already self-referred to a reproductive endocrinologist because I am allowed three visits without a referral. So, I could already go, but a referral would make things much easier (and not limit the number of visits). Second, the infertility benefit for our insurance is $5000. I couldn't do IVF with that benefit (if it comes to that), but certainly we could do an IUI or even just get me the fucking progesterone supplements that I want. Or a doctor who knows what hormonal testing to do and what to look for.

So, after spending basically all day yesterday crying and being depressed, today brings a little more hope for the future. That perhaps by my next birthday, I will be holding a precious baby in my arms. I prayed yesterday several times. First, I had to apologize for only asking for things all the time! But I prayed that even if I could not be pregnant this cycle, that He would help me have clarity in finding out what I need to do to be ready to be a mother. And it seems my prayers were answered today with the Patient Advocate.

Cycle 13, 8DPO

I love my friends with all my heart.  Truly, I do.  I have some of the greatest, most wonderful people in my life.  The hard part is that a good number of them are either pregnant or have recently given birth.  This means that my Facebook feed is flooded by my beautiful girl friends and their little baby bumps or pictures of their sweet faced newborns.  Even harder still is that one of my pregnant friends just got married in September, so this is a honeymoon baby.  While I am excited for all of them and their families for the pregnancies and newborns, it is so hard to see all these pictures and not feel sad or disappointed.  I feel like I have failed myself, my family, and my husband by not yet getting pregnant.  Part of me wonders if I will ever get pregnant.  I try to keep a positive outlook publicly and with my husband, but the insecurities and fears weigh heavy on my mind.  To paraphrase the immortal basketball coach Steve Lavin, I want to be better, not bitter.  But the best I can do right now is just to scroll past the pictures without commenting because the pictures just remind me of the disappointment I feel every month.

What makes this harder is that I am impatient.  I like to know how things end.  I am used to being successful.  I'm the kind of person who starts reading a mystery novel, then flips to the end to see what happens because I can't stand the suspense of waiting.  I even started Googling yesterday for reputable Boston-area psychics.  It's the personal version of flipping through the book (of life), I guess!

In other news, Friday is my birthday.  Hoping I have a wonderful present to share!

Dream a Little Dream

I've been having the most peculiar dreams this cycle.  Two that I remember involve babies, which is something I have never dreamed about before.

Towards the beginning of the cycle, I had a dream that the song "Stacey's Mom" was playing.  I woke up practically singing the song.  No big deal to most people, but S and I have decided on baby names already and the nickname for one of them would be Stacey.

This morning at 3DPO, I woke up with a bit of a sore throat and a stuffy nose.  Since I had the day off, I decided to go back to bed and get more rest and hopefully sleep off the start of a cold.  I fell asleep with my hand resting on my stomach.  In my dream--which felt like I was awake--I felt a baby kick under my hand. It was so vivid and so real to me that I woke up immediately and laid awake confused for a minute or two, wondering if I had actually felt a kick or if I was just dreaming.  It was the most bizarre thing I've ever experienced.  It happened again when I went back to sleep a few minutes later, too!

If I told my MIL about this, she would say that it's my subconscious trying to tell me that I'm already pregnant.  I don't know if I believe that, but I do wish that to be true!

Eggsplain Yo'self!

So, our first Clomid cycle was a failure.  The only positive point I could find was that I went from not ovulating to ovulating.  OK, that's actually a huge positive point.  I should be happy.  But I was upset that our cycle didn't work.  It's really hard when someone is an overachiever in every other part of life except the point where it comes time to make babies.  The doctor kept me on 50 mg of Clomid since I responded the first time.  His idea was that I should take the least amount of medication possible and I suppose that's about right.

After our first failed Clomid cycle, I assumed that I would just keep doing the same thing I did during the previous cycle and everything would repeat--of course, with the hope that we'd catch the egg this time!  Everything was fine for me until CD 15 hit and my OPK showed stark white negative, I started to internally freak out.  Between CD 15-18, I was increasingly worried.  In retrospect, it's only a span of 5 days, but it felt like much longer!  I thought that my doctor messed up in repeating the 50 mg dosage of Clomid.  I started worrying that all my positive thinking, my giving up caffeine/soda for Lent, my taking vitamins and drinking more water was all for nothing.

You see where this is going, right?  After all my freaking out and pouting and crying, I finally got a positive OPK this morning.  Should ovulate today or tomorrow and then the 2WW awaits.  Hoping that March is our month and we are blessed with a little shamrock.  What a beautiful birthday present that would be for me!