Folli-optimism

 My husband and I were really freaked out by all of the needles involved in Follistim, but it really hasn't been so bad- especially because we are finally, finally seeing some changes so it all feels worth it. Side effects have been minimal (follistim farts and gas pains, :) and are a piece of cake compared to Clomid and Femara. I wish we could have just started here to begin this journey.

Fun, follistim freebies: 

a. The nurse mentioned that there might be some extra meds in the 300iu pen and turns out this is quite common! It has given me two free days! Woo hoo! I love free when it comes to this pricey adventure! Well, I love free when it comes to anything! (Hotel shampoos and Starbucks Splendas anyone?)

b. The cool red container for the needles from the pharmacy below the fertility clinic. You can get fined if you discard the needles inappropriately so you bring this container back to the doc to empty it there. Multiple times this weekend, I have wanted to use it as a vase. Maybe I will when I can celebrate the end of this process!

c. Rubbing alcohol wipes. When the nurse taught us how to use the follipen, she asked if we had alcohol in the house to prep the injection site. Dead serious, my husband responded intently and matter-of-factly, "Oh yes, vodka. Got it." HA! I almost died on the spot! She was very gracious and corrected him. We had to get some from the pharmacy and when the woman at the pharmacy saw us looking for it on the shelf, she gave us a huge stack of single wipes for free!

 

Follistim Day 6 Monitoring (Saturday)

-Bloodwork showed my Estrogen increased to 74 from the 20s!

-3 follicles growing larger (2 on the right, 1 on the left) and lots of little ones, largest at about 12 mmm
-My husband and I were so excited that two follicles were growing on the right so even though you are supposed to switch injection sides each night, we excitedly decided to inject only on the right to be closest to our potential little gifts. Silly, I know, but everyone needs something to keep their hopes up!
-Severe gas pains have subsided, not sure if it's from the interaction between the metformin and the follistim or what. Thank goodness ! 
-Continue with 50iu injects nightly

Follistim Day 8 Monitoring (Monday)

- Bloodwork showed increase in Estrogen to 102!

-6 larger follicles now, largest at 14.5mm! (Getting closer to the 18mm needed to trigger!) Hilarious that the largest ones were now on the left and 1 large on on the right. I guess it doesn't matter where you inject! Felt amazing to see such a large follicle today. I could really tell the difference and my ultrasound technician was so excited for me. We were both celebrating! Hoping that I got the first glimpse of our future little one this morning!

-Filled with so much hope! Just hoping and praying that only 1-3 will get big enough.

-Going back in two days to see if anything changes!
-Continue with 50iu injects nightly

Follistim Day 10 Monitoring (Wednesday) 

 Went in again for monitoring- good news!

-three follicles measured 19.0, 16.6, 10.7

-estrogen level is 248. 

-trigger this evening with the Ovidrel injection and get busy

-start prometrium on Saturday

-schedule for pregnancy test two weeks later

Good-bye Clomid, Hello Femara

 

Since I never responded to Clomid, my fertility doc moved me to Femara 2.5mg. On Day 20 of my Clomid cycle, I went in for an t/v ultrasound and blood work to confirm that I had not grown any follicles.  My husband and I also had to sign a release form to take Femara, which is commonly used as a breast cancer drug and is illegal in several countries. Again, I had lots of follicles and they were all too small, proving that Clomid and I were due for a break-up. 

I got a call later that day from my nurse instructing me to start my five days of Femara that evening, treating my actual day 20 as day 3 since my uterine lining was set to go. I was concerned that the dosage of Femara was so low that I wouldn't respond and wondered why I didn't start with what seems like the common 5.0 or 7.5 mg. They explained that it was due to me already being somewhat stimulated by the Clomid this cycle so they did not want to send me into hyper-stimulation which makes sense. Now, I just wait until my next t/v ultrasound and blood work to see if I can use that trigger shot that is just waiting for me in my fridge.

Several friends have announced their pregnancies in the past week or so. We're hoping that we are one step closer to our own gifted little one. 

Stay tuned for my play-by-play on my Femara experience.

Failed Follies

Went yesterday (Sunday, day 11) to get my ultrasound and blood work done. I didn't respond to my third round of Clomid. I had one follicle measuring 7.4 mm and bunch of little follicles. (You need to find follicles around 20mm to do the trigger shot.)

One of the most depressing things about Sunday monitoring were all of the hopeful couples waiting in the lounge area. They were overflowing with patients but the waiting room was very quiet. Patients and their partners were whisked in and out of the blood work room, the ultrasound rooms and the check-out area. While they were very efficient, cheery and positive, my husband and I both felt a bit sad to see so many struggling people all around us.

One of the good things was that my husband was finally able to see what my PCOS ovaries look like via ultrasound. The radiologist told him that I have a beautiful uterus (um, thanks?) and explained to him that that chocolate chip cookie looking thing was my right ovary (and there is an ovary on each side.)

When the doctor on call came in, he told me to schedule again for Thursday (cd 15) to check again but that I most likely will be advised to try another route since I did not respond to the maximum dose of Clomid they use at the clinic. Still have the trigger shot chilling in the fridge and the progesterone supplements waiting in the drawer in case something changes, but it's not likely. While I didn't expect the Clomid to work this time due to my lack of response before, it still hurts to have gone through all of the yuckiness just to have to undergo more yuckiness and uncertainty...

HSG Test and Aftermath

From my perspective and experience, here's what they do when you have to get a dreaded HSG test to check to see if your tubes are blocked or if there are any other problems that could be inhibiting fertility. First off, this goes into the TMI category but in the spirit of full disclosure of my experiences, I guess this whole blog is TMI...

HSG Test

1. Arrive with a full bladder, they will make you pee in a cup (not sure why??). Doesn't help to wait while nervous with a full bladder... Read the waiver form in the waiting room. Freak out because it says something about seafood allergies and the iodine being a risk. (Of course, I'm allergic to seafood...)

2. Meet the nurse and pee in a cup. (Nice to meet you!) Pass the test. :) Nurse tells me that I'll be fine with the iodine and that it's an outdated form but she'll let the technician know and she might use a different rinse. Nurse took my height, weight and blood pressure and explained the test procedure. Hands me a Kleenex as I get teary eyed from my nerves listening to the procedure and the googling I did earlier in the week... (The nurse was super friendly, especially for a 7am appointment, and you can really tell she has experience calming the nerves of many, many patients! She is so good at her job.)

3. Go into the xray room and go into the changing room to put on a gown over your sweater and booties on your feet. Recline on "bed."

4. Insert speculum and catheter and then slowly inject dye. Small, round x-ray machine is floating above your abdomen and captures the image in real time as the fluid goes up one tube, into the ovary and then out into the abdomen. Repeat towards the other side. Feels like uncomfortable pressure and general ickiness but not sharp pain at all if they do it correctly (which they did). I heard that it lasts 2-3 minutes but I think they were way faster than that.

HSG results (not mine)

5. Immediate results= all clear! You own doctor/nurse team will follow up with you later in the day.

6. Go to Panera next door to make it all feel better. Go home to stretch and do some yoga before work.

7. Wear a pad, no tampons allowed, as the brownish/orange dye will leak out and you may experience spotting and cramping (I did).

 

Aftermath

I went on the birth control pills after passing my day 3 ultrasound and before the hsg test. The original plan was to discontinue the pills after getting the hsg all clear. Because of my husband's need to get more blood work done (to prove he doesn't have hiv, etc), our timeline got put on hold again. With vacations and wedding festivities for friends, we have to delay further because I need to be in town for monitoring. It just feels sometimes like the roadblocks keep on coming but at the same time, we are so lucky to be living such full lives.

I kept cramping/spotting for almost two weeks after the hsg test which is abnormal. Not only was it uncomfortable for a long period of time, it was also incredibly inconvenient because I was on vacation at the beach. Horrible time to not feel well and not be able to use a tampon...

After a week of bleeding, I contacted my nurse from my vacation spot and after exchanging emails, she recommended that I go to the emergency room to get an ultrasound. I decided not to go because we were out of the country and would be returning to the US in a few days.

Upon returning home, the spotting ceased with just 3 birth control pills left before I will get a period again... but hopefully this time it will lead to something more positive and less stressful.

Ultrasound- Follicles Galore!

I got my period yesterday after taking progesterone (provera). So, I called my nurse and she scheduled my monitoring baseline ultrasound for first thing this morning. (You have to do it between day 2-5.) I got there 30 min before my appointment when the office opened with hopes that I could get in early so I wouldn't be late for work and sure enough, they got me in lickity-split!  Again, everyone at the fertility clinic was so friendly and happy (even though it was really early in the morning) which really put me at ease.

http://weheartit.com/entry/36681830

The tech administered the t/v ultrasound while another doc from the practice sat in to interpret the results on the spot. She said my uterine lining looked good and then when she saw the "pearl necklace" lining the outside of my first ovary, she grew quiet and looked a bit nervous. I said, "I already know I have pcos." To which she sighed in relief saying something about how they look like typical pcos but in a way that made me feel positive about them looking so normally abnormal. (See, everyone is so friendly they make everything sound okay. Talk about rose colored glasses!)

She said to go forward with my plans to get the HSG test on Monday and that they saw nothing there that would hold me up further. ::Sigh of relief::

After about 2 minutes of the ultrasound, I was on my way to pay my 50% and even had enough time to grab a small cup of decaf coffee as a treat for myself during my drive to work!

Fast forward to the end and highlight of my day- Acupuncture Tuesday! I had another great, relaxing, centering session and walked around outside for awhile feeling refreshed and renewed.

After returning home, I found my lost phone and saw that I had a long voice-mail from my nurse. She informed me that they were looking for me to have at most 10 follicles when I, in fact, have 90. Yes, I'm an overachiever... 40 on one side, 50 on the other.  She said they "looked good, really good" with a laugh, so I suppose this is good. I'm patting myself on the back for not googling this... yet.

Lots of long walks planned for this week, start b.c. tomorrow leading up the HSG test Monday and an acupuncture reward on Tuesday!

Our Fertility Journey

It's been a long one so far with a lot of highs and lows. We are still hoping and wishing for our own little one.

A little about myself: I am now 29 years old, happy and healthy but after about 100 days of amenorrhea (lack of period) following birth control last year, I was diagnosed with PCOS via ultrasound and was put on progesterone to start my period. I switched from my general women's health doctor to a specialized ob/gyn who also confirmed the PCOS through another transvaginal ultrasound. My husband's sperm was tested and he has no diagnosed issues. She started me on progesterone again after a long cycle and I tried one round of Clomid 50mg on which I did not ovulate. I began another round of progesterone and got my period after 50 days. I completed a second round of Clomid at 100mg but again, failed to respond and ovulate. Following the second round's failure, my doctor broke up with me and referred me to a fertility clinic.
 


Feb/March 2013- Preconception Meeting with women's health doctor, given the green light. Began taking prenatal vitamins

May 21, 2013- Take out last NuvaRing

May 24, 2013- NuvaRing induced period

July 29, 2013- Start officially tracking CM on fertility friend

August 17, 2013- CD 86, Start officially temping

August 26, 2013- CD 95 Start Metformin 1000mg, t/v Ultrasound. Blood work (PCOS diagnosis)

August 29, 2013- Metformin 1500mg

August 30, 2013- Bloodwork done

Sept 4, 2013 Horribly sick, stomach pains

Sept 5, 2013 Back down to 1000mg Met for a week, then back to 1500mg

Sept 26, 2013 Switched Drs to specialist, t/v ultrasound confirms pcos, prescribed Provera for 10 days to induce a period.

Oct 5, 2013 Last Provera pill CD 136

Oct 7, 2013 Provera Period #1! (Light, no major cramps or symptoms)

Oct 9- blood test, fsh, progesterone, wbc- not ovulating

Nov 2- Hubby SA- all clear! (rushed to get done because we thought I'd start provera/clomid but dr said to wait two more weeks to see if my period would come first...)

Nov 19- No luck, Provera round 2 (cd 44)

Dec 2- Provera Period #2! (after 56 days, more substantial and longer flow than p#1)

Dec 6- Begin Clomid Round 1 (cd 5-9)
Dec/Jan Test with OPKs and temping, did not detect ovulation. Blood work confirmed this.

Jan 21- Provera Period #3 began after 10 days of Provera round 3. (50 Days...)

Jan 25-29 Clomid increased to 100mg Round 2 (Taken days 5-9)

Feb 4- Begin Acupunture! :)

Feb- More bloodwork confirms that I did not respond to Clomid

March 7- Ob/Gyn breaks up with me, telling me I'm infertile and she can't help me any more, refers me to fertility center and asks if I have considered adoption... obviously devastated

March 17- Was scheduled for a 4/21 appt, but got a new patient appointment at fertility center because of a snow day cancellation and a lot of Irish luck! Dr. Hope says he feels confident he can help us get pregnant! Start Provera round 4!

March 26- Genetic testing is in- I'm a carrier for SMA.:(  DH needs to be tested to see if he's a carrier too. If so, it will reset our plan again. 2ww for results.

March/April ??-Provera Period #4
April 26- Start Clomid (days 3-7), plan to take trigger shot and progesterone if all goes well
May 4th- Day 11 ultrasound and blood work, one follicle at 7.4mm (too small), others tiny, no trigger shot necessary
May 8th- Another u/s and more blood work... failed again
May 13- Day 20, Another u/s and more blood work... failed again, no Clomid response, begin Femara 2.5mg
May 26- Femara failed, began Follistim at 50iu and continue Metformin/Acupunture (estrogen dropped to 25, yikes!)
June 6- Estrogen jumped  to 102 -6 larger follicles, largest at 14.5mm
June/July- Failed injection cycles
August- Successful with follistim and ovidril but ended in chemical pregnancy
September- Again successful, but same result 
October 2014- Started with follistim and converted to IVF
Oct 8- Egg Retrieval- 28 eggs, 22 mature, 18 fertilized!