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Tuesday, March 31, 2015

What's Been Happening

***The majority of the following was previously written as each appointment took place. I saved it all within my email with the intention of posting it as I went, but obviously, I never posted any of it. I did edit it a bit while going back and reading it all to make it ready to post. I wanted to be able to remember what all we went through so I can be more prepared for future instances when we will probably be facing the same issue again. I also thought it would be nice to share what I have learned with others in hopes that it helps even just one more person. I know I looked ALL over the internet for everything I wanted to know.
 
Did I ever mention my gynecologist referred me to a fertility clinic? (I don't think I did.)
She didn't feel there was anything more she could do for me. Mostly because she didn't think I was ovulating on the Clomid and she didn't feel comfortable upping the dosage level without closer supervision. She explained to me how the fertility clinic would be able to watch my body more in relation to how I react to the medicines better then she can. She told me even if I do another round with her, my outcome was looking like it would be the same and why waste time and money with her when the fertility clinic might be able to help me get pregnant sooner rather than later.
No problem to me. I was happy to get a referral to the fertility clinic. I
hear good things.
 
I made an appointment for the fertility clinic as soon as I could - I had to wait a few weeks and was seen on the day before Thanksgiving.
 
Side story - I haven't gotten my period on my own in MONTHS. I always have to take Provera for it to come. Well, guess what? Monday before my Wednesday appointment, I got my period. On my own with no help from medication. YAY! Granted, it was a 49 day cycle, but at least I got it.
 
Back to the doctor -
My referral was to a doctor within my same hospital network. Literally
downstairs from my gynecologist. This was a bit comforting to me. Why? I don't really know. Maybe because I didn't have to worry about getting lost trying to find the place. Doesn't really matter why though. When I got there, I checked in and handed over all the documents I was told to have filled out prior to my appointment and she made copies of my id and insurance card. While sitting in the waiting room for my turn to go in there, of the ladies who came out, two were pregnant. Lucky them. Gives me hope too though. If they can be helped by this clinic, maybe I can be helped too. Finally it was my turn. I was weighed, had my blood pressure taken, pulse taken, and I think they took my body temperature. I was then taken to a conference room with a big table with six chairs around it to wait for the doctor. This doctor is (so far) wonderful! She was very comforting and very articulate on what she was explaining to me.
Honestly, she had the best 'bedside manner' of any doctor I have ever
encountered in my adult life. She definitely comes across as having the right attitude for this type of job. She didn't seem too much older than me so maybe the job hasn't worn her out yet. If that's the case, I hope it never does.
 
We started off by going over all the paperwork I had filled out prior to my appointment and all the documents my gynecologist had sent over. I was told I am healthy, she's glad I exercise, I did tell her I make poor food choices and am currently working on doing better and was advised to get the flu shot. With the information from my gynecologist, she agrees it doesn't sound like I am ovulating. Boo! However, knowing this, after she has my blood work in hand, she would know more to hopefully treat it.
 
After going over all that, she brought out a piece of paper with the female reproductive parts on it and told me she was going to go over some stuff and make notes on this paper for me to have. I GREATLY appreciated the effort taken to do that for me. It is nice to have something to keep in case I forget something. I made sure I told her this. Of course, I was also secretly recording the whole conversation to write everything down.
 
Here are the highlights:
3 things to get pregnant - Ovulation, sperm and open tubes
When ovulating, best lubricant (if needed) is canola oil. How odd, huh? Sperm have to swim through cervical mucus to get to the egg... the higher the dosage of Clomid, the thicker the mucus is which makes it hard for the sperm to get through. If Matt has bad swimmers, they would do insemination which is when they get the sperm as close to the egg as possible. She is currently not worried about my tubes being blocked and sees no reason to test them with dye right now. My body might be ovulating sometimes, but she is unsure as of now. Because PCOS causes the body's LH level to be high, ovulation test strips might not work. In this case, only an ultrasound will tell when ovulation occurs. She recommends sex daily during ovulation.
 
Because I have had 2 past gynecologists who believe I may have PCOS, we
discussed how it is a diagnosis of exclusion. If you have 2 out of 3 of the following, it is highly likely you have PCOS - no regular menstrual cycle, multiple follicles on ovaries and elevated testosterone (hair and acne). I do not have normal cycles, previous ultrasounds do show multiple follicles and I have lots of hair where hair shouldn't exist on me. *Sigh*
 
She discussed different options for me based on my blood and Matt's seaman
analysis. Once those two results come back, she will create a plan for us.
YAY!
My goal right now is to ovulate. She is willing to do more rounds of Clomid at a dosage of 150 or 200 along with Dextromethorphan or Metformin which is suppose to help the body respond to the Clomid. If that doesn't work, we can try Clomid with an HSG shot which goes in the butt to help release the egg.
 
After speaking with the doctor, I had 6 vials of blood drawn per the doctor's orders to have several different things tested. On the following Monday, Matt had a doctor appointment to have a seaman analysis.
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Matt had his sperm analysis and we learned his sperm is awesome!
I spoke with the doctor over the phone and she went over Matt's results and mine.
 
***Sadly, I am unable to find the notes I wrote down from this conversation so I can't give you the exact numbers. I am mad at myself because I am wanting to document everything I do with the fertility doctor and my body in the event of we have to do this again. I suppose I could ask for the results again, but I would feel like an idiot.
Overall, Matt's sperm are good, strong swimmers.
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Same with my blood work since it was discussed in the same conversation... I do know what was tested at least thanks to the bill.
 
Blood work done:
DHEA-s
RBC AB
RUBELLA
ABO
RH
TESTOSTERONE
25-OH VITAMIN D-3
$898.80
Insurance Discount $835.74
Paid $63.06
 
ANTI MULLERIAN HORMO
$146.06
Insurance Discount $139.40
Paid $6.62
 
HYDROXYPROGEST 17-
$257.42
Insurance Discount $244.19
Paid $13.23
 
$1219.33 Insurance Discount
$82.91 Paid by me
 
I am assuming the Insurance Discount is what my insurance paid and I am also assuming this is going towards my lifetime fertility max insurance amount. Maybe not though. I imagine several of these tests are pretty normal for regular routine matters. Either way, I am going to keep a record of them and count them towards my max. I can always call the insurance company later and see if they do go under my lifetime max. I'm not worried about it right now.
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Had another appointment this week because I FINALLY got my period courtesy of Provera. I start 2 days after being on the medicine. On day 3, I went for my appointment where she did an internal ultrasound.
Results:
No cysts! YAY! Small victory!!!
My uterus looks good and measures at 7.2 cm. However, there is a little angle between my uterus and cervix. She told me this was normal.
My right ovary has 8 follicles and my left one has 7. Meaning I have eggs
available. Just because I have eggs doesn't mean my PCOS will necessarily
allow those eggs to grow and mature. If this happens, it means I didn't
ovulate. If my follicles grow and mature an egg(s), seen in my next internal ultrasound, I will be getting a HCG shot to release the egg(s) and then the fun begins. ;)
If too many eggs grow and mature, no trying this cycle per the doctor - risk of multiples is too high.
No ovulation, she ups the medicine.
 
I'm hoping this round (round 3) works and we can move on. I'm trying not to get my hopes up though. I have ovulation strips which I plan on starting ASAP so maybe this will help pinpoint ovulation along with the help of the ultrasound.
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Went to another infertility doctor appointment to once again check my follicles and lining. (None of my appointments have been processed by insurance yet - not sure why they are taking their sweet time.)
The estrogen patch must be helping some since my lining is a little thicker although she did say it needs to be even thicker. None of my follicles are doing what they are suppose to be doing yet. Going to be checked one more time - on Thursday, CD 20. I am then going to wait for another cycle to try again with round 4. *Sigh*
 
So what's next?
The options given to me were:
1. I can wait till I get another period (probably with the help of Provera) then do 100 mg of Clomid on the same cycle days as last cycle and see if anything happens in regards to me ovulating. However, my second round of Clomid was on this dosage and I didn’t appear to respond to it. My opinion of this route is it might be a waste of my time.
2. I can take 1 additional pill of Clomid 50 mg (now) to see if my body reacts to the additional medicine from the original dose. But she did caution it might stimulate too many follicles which can bring on multiples and if that happens, she doesn’t want us to try to get pregnant this month. (She doesn’t want us to have more then 2 at once AND I agree!)
3. I can wait till I get another period (probably with the help of Provera) then do a round of Letrozol.
She explained - it is not FDA approved for this purpose, but she has had success with it and the risk of multiples is less. She told me some women just react better to it.
 
I think I am going to go with option 3. I spent some time researching the drug and how it affects infertility and it does seem like people are successful with it. I would like to see if my body does anything with it. Might as well look into it now and see if it is something I should continue to pursue. Why do more rounds with Clomid when there is a perfectly good option right in front of me?
  
To help myself even more, I am starting to count my carbohydrates. Easier said than done.
I wish I could completely cut them out because I KNOW I could drop some major pounds if could, but I am an eater through and through. And no matter how many times I have already tried to do this, I always seem to fail. I am gonna try really, really, really hard this time. I promise - I promise myself and Matt!
Stupid gum with its stupid carbs are going to be my downfall. If the taste lasted longer I would probably chew less. And no, I cannot give gum up - at least not now. It really does help me not eat as much. When I get hungry at work (which is always), I am eating clementines and pumpkin seeds. Better then the chips and candy I enjoy from the vending machine which is like 25 steps from my desk.
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January 26th consisted of another appointment with my fertility doctor.
I was told my uterus looked lovely as usual, but had no follicle growth even though I had plenty of follicles available.
Good news was she told me we could try Letrozol right away because she saw no benefit in waiting for another period. Awesome!
I was to take 2 tablets daily for 5 days at the same time of the day. She wanted me to start taking them on Saturday, January 31st (which we were now calling Cycle Day 3). On cycle day 12, I was to have another appointment to see if I ovulated.
 
Monday, February 9th showed my lining looking good and she could finally see something starting/growing on my left ovary. Right ovary wasn't showing anything yet. Although, she did mention it was a bit hard to see with my bowel movements - she knew I was hungry. Crazy!
Evidently follicles grow 2mm per day and I was already at about 17mm. She said I should be fully ovulating by Wednesday so here was our game plan:
HCG shot on Wednesday morning to release the egg followed by timed intercourse each evening starting that night for 3 days. The shot goes into muscle on my hip bone above my butt. She drew a circle where Matt was to give me the shot.
The shot didn’t hurt going in, but I was sore for several days after AND it bruised.
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February 11, 12, 13 was our times intercourse days... We did not on the 13th. After this time, we were to wait 2 weeks before taking a pregnancy test. This was easy to do until the last few days. But I waited until the Saturday after the 2 weeks ended.

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