Wednesday, April 24, 2013

The Easter Cycle Failed

My first IUI cycle ended in a negative.  Having an Easter IUI seemed too good to be true.  I ended up getting my period on day 32, which is earlier than past cycles, but the weird thing was that I didn't have the bloated, cramping, or soreness that I sometimes have right before my period begins.  Maybe this means my estrogen was off?  In the past I've had very sore breasts and could tell when my period was coming.  This cycle, the only way I knew was from the temperature dipping.

I am on day 10 of my new cycle and the plan is mostly the same: clomid + follostim + ovidrell + IUI.  Except my husband is wondering if we should try natural timing instead of IUI.  We have our check in ultrasound on Saturday, day 13 and I'll ask the doctor what he thinks.  It makes sense to me to try this cycle without an IUI.  If it doesn't work I'll move on to an IUI + crinone (even thought research has shown that crinone makes no difference it's worth a try, right?).

I went in for an ultrasound on day 5 (it was supposed to be day 2 or 3, but I asked if I could come in on day 4....but then I messed up the timing so it ended up being day 5!) to check for cysts because I responded so well last cycle.  Everything was normal and looked good.   $250 for a quick 1 minute ultrasound.  Ouch.

I've been trying to conceive for over 5 years.  And for 3 of those years I've been doing basal body temperature charting.  So you would think I should have the basics down!  But for some reason I got confused with "day 1" and thought that day 1 was 24 hours after my period.  Oops.  Which means I started my medication late.  I should have done clomid on days 3-7 and follostim on days 5-9 but that all got pushed back by one day.  So today (day 10) was my last shot of follostim.  Now we wait until Saturday to see if I have some follicles!

I do feel it working, with little twinges in my abdomen, but it's definitely not as strong as last cycle.  Last cycle immediately after I took the follostim I could feel its effects.  This cycle took a couple days for me to feel anything, and I don't feel as full.  Which worries me, but it's also a good thing because I am not uncomfortable when I run or ride my bike like before.

I have to say, it was really saddened and overwhelmed when I realized my first IUI hadn't worked.  It seemed like everything was falling into place and working right!  But no.  If it didn't work last time, why should it work now?  My hope is not as high as it used to be.  But still, it's worth continuing to try.

Wednesday, April 3, 2013

First IUI

My IUI on Sunday went well!  It did hurt a little, but definitely not as much as the HSG.  My guess is that I ovulated Sunday evening, because on Monday I felt much less pressure in my abdomen.  The average time to ovulation after taking the ovidrell is 38 hours.

We had 87.7 million total motile sperm with 85% motility after the wash, which is great!  I was so happy to hear that.

Now it's just a long waiting game.  The directions I was given says to wait 17 days after taking the ovidrell in order to confirm pregnancy.  A positive before then may be false.

I keep telling my husband that we're going to have twins.  For some reason I think this cycle will either be negative, or positive with twins.  Fingers crossed for a positive.

In the meantime I've been having some hurtful cramping.  It happens for an hour or so each day at different times - I've never experienced this before.  Because I'm only 3 days post IUI I'm not sure what would be causing it.  Maybe it's the eggs settling in for good (although I realize it's too early for implantation)?

Saturday, March 30, 2013

Ovidrell Shot

I took my ovidrell shot at 7:25pm last night.  I was told to take it between 5-8pm, but that happened to be while I had plans out of the house, so I had to bring the shot with me and lock myself in the bathroom to administer it.

Today I'm still sore and "full" but not as much as yesterday.  I had egg white cervical mucus today, so that's another good sign.  I'm looking forward to the IUI tomorrow!  Hopefully 36 hours after the shot is the best timing and we conceive tomorrow!

My husband was told to abstain for 2-5 days before the IUI.  This makes sense so he can have the best sample, but it's also very frustrating.  With egg white cervical mucus and knowing that I'm ovulating soon it would be nice to be able to try on our own along with the IUI tomorrow.  I'm worried I may ovulate early (maybe I did this morning or overnight?) and the IUI will be too late.  I need to stop worrying though and have faith that it will all work out.

Wednesday, March 27, 2013

A Good Omen?

My IUI is scheduled for 9:30am Sunday - Easter Sunday.  Hopefully the Ishtar fertility connection is a good omen!

Tuesday, March 26, 2013

Multiple Follicles!

Today, Tuesday, I went back this morning for my follow-up ultrasound a bit nervous, considering my left ovary seemed to be hiding behind a black shadow during my last one.  They had me undress from the waist down and get on the exam table to wait with a sheet draped over me, like normal.  Usually the doctor or nurse practitioner comes in right away, which is a nice thing, but this time I waited for 10 minutes and started wondering who would come (since I've had the nurse practitioner and both doctors perform ultrasounds in the past) and when.

The doctor walked in the door very cheerful and said hello.  She said something to the effect of: "They sent me in!  They weren't sure they could find your left ovary since they'd failed in the past, so I am going to try.  Sometimes I can be an ovary whisperer - when others can't find it, I find it easily."  This made me laugh because I imagined them having a little meeting during my 10 minute wait, with the nurse practitioner and one doctor voicing concerns and begging the other doctor to go in their place because they were scared.

After telling me the possible scenarios for the black shadow and missing left ovary (which included: endometriosis, tube scarring, how I may potentially need a laproscopy and other scary stuff) we were ready to proceed.  She inserted the wand and immediately found my left ovary with ease.  And, it was filled with follicles!  Amazing!  There was no black shadow, although it was slightly off to the side compared to my right ovary.  My left ovary follicles measured at 14.4mm, 13.2mm, 13.0mm, and 12.2mm.

My right ovary also had multiple follicles, with one large contender!  They measured 18.4mm, 16.6mm, 12.7mm, 12.3mm, and 12.1mm.  There was also 3-4 follicles in each ovary that measured under 10mm.  She then took out the wand and I immediately asked about how my lining looked.  She said it looked good, but then realized that she hadn't taken a measurement.  So she has to prepare the wand again (because she had already cleaned up) and in it went for a second time.  My lining looked beautiful!  It had a very distinct triple thickness and was a good thickness (I think 9mm?  I can't remember).

We were all pleased!  She felt that the clomid + follostim cycle was a success!  I was so glad to hear this because I desperately do not want to try letrozole again.  I had such a bad experience with it the only time I've taken it.  She thinks the lining responded well to the follostim, and it counteracted the clomid, which is a very good thing because clomid can really deplete the lining and sticks around in the body for up to 6 weeks.
But all looked good!

The discussion turned to next steps.  She asked how aggressive we wanted to be and suggested waiting a few days to trigger so that the leading follicles could develop until they're mature enough to have 3 release.  She asked if we were OK with having a 6% chance of twins, and a low chance of triplets and we were on board with having twins, although triplets would be OK although not ideal.  She also said that she would recommend an IUI since this increases the chance of pregnancy by 5% and increases the number of sperm that make it through the cervix from 20% to much higher.  This would counteract having low amounts of cervical mucus because it would bypass the uterus.

Today is Tuesday and she recommended testing with LH strips twice a day - in the morning and before 4pm - to see if I would ovulate on my own.  If I didn't have a surge by Friday I could take the ovidrell shot and have the IUI Sunday morning.  Easter Sunday.  Originally when this plan was made I told her we'd need to wait until next cycle to start with the IUI because I couldn't miss Easter morning.  We received instructions on when the take the ovidrell if I didn't get a surge and when to have timed intercourse.  But after our appointment my husband asked why were weren't doing the IUI.  Shouldn't this be our first priority?  All Easter plans and obligations can wait.  As soon as he said this, this made sense to me.  Obviously, we should proceed with the IUI - especially if we'll have three great follicles to work with!  I'd be sad if we missed an IUI this cycle and then following cycles showed poor results.  We can't miss this chance.

My husband will give his sample at 8:30am Sunday and then it takes an hour for it to be washed and prepared before my IUI at 9:30am.  After a short wait after insemination we should be on our way by 10am.  I hope it works!  I can definitely feel the fullness inside of me, it is very apparent even as I sit and write this.  Grow, follicles grow!

Plus the other benefit is that I read that the rates of pregnancy are increased after HSGs are performed (at least for a few months).  I hope this still holds true for the bubble HSG that I had last Friday.  I'm ready for all good things to align and that this will be our cycle!  5+ years of trying to conceive and we're so so ready.


My Hiding Left Ovary

Immediately after the HSG we performed an ultrasound to check my ovaries and lining.  My lining looked good, although I can't remember the number - maybe it was 6mm?  - it was a good number for being so early in the cycle.  He found my right ovary right away and one follicle measuring 10.5mm.

My left ovary was a mystery.  He couldn't find it no matter how much he moved around the ultrasound wand and pressed on my stomach (and this from a doctor who has performed thousands of ultrasounds over a few decades!).  Usually ultrasounds take only 1-2 minutes, but in the search for my left ovary it was at least 10 minutes of prodding and searching.  With no luck with the internal ultrasound he tried an abdominal ultrasound instead.  Also no luck.  Back to the internal ultrasound.  He found where he thought my left ovary should be but there was a black shadow, which he said could be a number of things, possibly the colon. Previously at my last ultrasound, the nurse practitioner had also had trouble finding my left ovary, so this was concerning to me.

The verdict was to come back on Monday or Tuesday (3-4 days later) for another ultrasound.  I left feeling relieved that I had at least had one follicle developing, but sad that there wasn't more, since my abdomen felt "full" and it seemed like the follostim had really been working.  One follicle is the same result as my only-clomid cycles, so it was a bit depressing that the injectables didn't seem to be working as well as we expected, especially when they're so costly.  I was also nervous that we'd have trouble with my left ovary again on Tuesday for my next ultrasound.

HSG

After taking the clomid and follostim I was scheduled for an ultrasound on Day 9, which was a Friday.  But I switched this appointment into an hysterosalpingogram (HSG) test.  I was killing two birds with one stone.  I knew I needed to take this test at some point, and the best time for it is in the beginning of your cycle when the uterine lining is thinnest.  So instead of paying $250 for an ultrasound and $1100 for the HSG, I only had to pay for the HSG and still got the ultrasound results.  It was a little painful parting with so much money just for one short test, but I knew it was necessary.  After so many years of trying it would be nice to know if my fallopian tubes are open and look normal.  But I was definitely nervous - about the pain I might experience during the test and also the results I may get.  Would they find endometriosis?  Would one or both tubes have a blockage?  Or something worse?

I took some over the counter pain medication 30 minutes before the HSG, but it was still painful, although not unbearable.  They first did a pregnancy test, which of course came out negative.  Then they inserted a speculum and swabbed my cervix with a long q-tip dipped in some kind of dark liquid (iodine?  I'm not sure.).  The felt so so weird.  It didn't hurt, but it was a strange sensation.  Next, the doctor inserted a catheter through my cervix and filled a small balloon to hold it in place.  The speculum was taken out.  Then, a medical assistant slowly squirted a clear liquid into the catheter.  This is when the pain began.  I gasped a bit and put my hands over my abdomen, but it wasn't the worst pain I've ever had.

When I had read about HSGs on blogs, via google, or on IVF clinic websites they all referred to a dye-based HSG where an xray was taken.  But my clinic said that they never use dye and instead use a newer technique which uses ultrasound to see air bubbles moving through the clear liquid they inject.  I can't find information online about this new procedure - has anyone else had this, or heard of it?

As soon as the bubbles started flowing you could immediately see them moving through my right fallopian tube and out the top.  There was definitely no blockages there!  But I became concerned that I couldn't see any bubbles moving through my left tube at all.  I asked the doctor and he said that sometimes the balloon blocks one tube and that because the bubbles move with the path of least resistance they may all be diverting into the right tube.  So I held my breath while he deflated the balloon a bit.  It was probably only one second, but it felt like a long time before we could see bubbles moving through the left tube and out the top.  Success!  Both fallopian tubes were open and looked good.  Later, the doctor told me he had been worried about my left tube too, but we were both pleasantly surprised when it really was just the placement of the balloon acting as the problem.  At this point I was super happy - because I had functioning tubes and also that the HSG was over!


First Time with Follostim

After a negative pregnancy test after last cycle we decided to move on to a hybrid clomid + low dose injectible cycle.  I took 250mg of clomid days 3-7, and 75iu of follostim days 5-8.

My clinic suggested ordering the follostim and an ovidrell shot from Alexander's Twin Pharmacy.  Their prices were much cheaper than any of my local pharmacies, including Costco.  My prescription was sent to them on a Friday morning and by Friday night they had mailed out my package (I needed to start the follostim on Monday morning).  I received it on Saturday via Fedex (making sure someone was home to sign for it) and it arrived in a little styrofoam cooler.  There was a little ice pack inside to keep everything cool, a box of ovidrell, a box containing a 300iu vial of follostim, a small sharps container, and a follostim pen kit.

The follostim pen kit is actually cute looking!  I wasn't expecting a small inconspicuous lime green zippered case to conveniently store the follostim, directions, and needle tips.  Actually, I wasn't sure what I was expecting at all.  I assumed the follostim would be similar to the ovidrell, which is a prefilled needle all ready to go.  I knew I had ordered a pen, but I wasn't sure what that meant.  It turns out it is a pretty neat little device for administrating medication.  It really does look like a pen with an end cap that gets taken off, and a trigger where the clicker would be.  Each time you administer a dose you use a new needle tip   It seemed like a complicated procedure to get the needle tip on and off the pen, but it only was the first time.  I had watched an informational video twice (and had my husband watch it) before slowly following the steps to load the follostim vial into the pen and attaching the needle tip.  The first time I attached the needle it was hard.  I couldn't get it on correctly, even though it really is simple.  And once I had the outer needle cover off I grabbed the inner cover and pulled it off with an inelegant motion.  I accidentally stabbed myself in the finger with the needle tip.  It took 3 clicks for a droplet to form on the end of the needle.  I then dialed the pen to set it to 75iu and administered the dose near my bellybutton.  It was pretty easy and painless to insert the needle since it's so thin.  Then the hard part came - taking the needle tip off of the pen to discard.  Later, I realized that this step is easy: place the outer needle cover over the needle and then twist it all off, but my first time doing it I thought you had to pull it straight off.  I couldn't get it after trying a few times, so I had my husband help.  Luckily he figured it out very easily.  The following three days the follostim administration was a piece of cake and I did the whole process myself with ease.

I took the first dose of follostim at 9am on a Monday and by noon I could feel my abdomen being "full".  The follostim seemed to be working!  The following three afternoons I experienced this feeling after giving myself a dose in the morning, and it made me happy.

Sunday, February 24, 2013

One follicle!

I had my day 17 ultrasound yesterday.  It felt so strange to go to the doctor's on a Saturday!  I saw the nurse practitioner at my clinic, who happens to have the same first name as me.  I really like her.

She started out by looking at my uterine lining, which was 6 point something millimeters and developing the triple thickness they like to see.  The goal is at least 7mm, so I should be OK with one more day of estradiol to pump up my lining. Next she went to my right ovary, where she found one 18mm follicle.  I was so happy!  There was also one medium follicle and some other small ones.

She couldn't find my left ovary, which was strange.  I've never had a problem finding it before.  She looked for a while using various pressures and didn't see anything, which she took to mean that no follicles had developed on my left side.

Considering I took ten days of 250mg of clomid, only one mature follicle is not ideal.  But, at least I have one!  This is much better than last cycle with nothing, nothing, and more nothing.

She advised me to take an ovidrel trigger shot today to induce ovulation.  I am going to take it this evening, which means we'll try to conceive Monday morning and Tuesday morning.  I am trying to stay positive, I am so so ready for this cycle to be our lucky one.

If we get a negative pregnancy test this cycle we'll start low dose injectibles on top of clomid for the next one.  Usually they do the injectibles with letrozole (femara), but since I had such a bad reaction to it the one time I've taken it in the past, they will go to clomid.  The nurse practitioner was going to talk to the RE and get back to me sometime this week for our plan of action.

Sunday, February 17, 2013

Last clomid cycle?

I'm currently on day 11, and tomorrow will be my last day of clomid (possibly forever).  I've been taking 250mg of clomid days 3-12, but because I dropped one pill down the drain - oops -  I'll only take 200mg tomorrow.  I am crossing my fingers that my ultrasound on day 17 will show some large follicles, but I'm a bit pessimistic because of the poor results last cycle.

So, last cycle.  It was 51 days long!  It felt like it would never end. After the two rounds of clomid and ultrasounds I figured I'd get my period like normal on day 35 or 36.  I didn't want to waste time by taking 10 days of medroxyprogesterone, but I should have.

We'll see how the 10 days of 250mg of clomid goes.  If it doesn't work, this will likely be my last cycle with clomid.  Instead, we'll switch to low dose injectables.

Wednesday, January 16, 2013

Belated Update

So I did end up growing some nice follicles after taking 250mg clomid/day in November.  My second ultrasound showed one larger follicale and two smaller ones in the right size (over 20mm) and I took an ovidrel shot to induce ovulation.  I was a little intimidated by giving myself a shot with a syringe since I had never done that before but it turned out to be a piece of cake.  It didn't hurt much at all and was pretty fast.  Luckily, the needle was very small.

We planned intercourse according to the doctor's schedule and I was super optimistic that this month it would all come together and work!  But of course....no.  I'm not pregnant.  Not even close.

This cycle I took 250mg clomid days 3-8 and then estrace until day 16.  On day 16 I had an ultrasound which showed only one follicale at 5mm, meaning that the clomid did not do it's job.  I then took 250mg of clomid for 5 more days (16-20) and had an ultrasound on day 23.  My uterine lining was at 5mm and I had a small follical at 7mm.  Sad news.  This cycle was a bust.

I chose to just ride out the rest of the cycle (as opposed to taking even more clomid) and start fresh for the next one.  Next cycle I will take 250mg clomid/day for ten days (days 3-12) and hope it works.  But if the clomid is a bust again we'll ditch it and try low dose injectibles.

I've been feeling really down.  I don't have the optimism that I had in November.  It might be that January 2013 marks 5 years of trying and that just seems so depressing to me.  Things are looking grim on the fertility front, but in the meantime I am trying to save pennies in case it comes down to IVF as a last resort.  I'm still not sure how I feel about IVF for myself.  I'm not opposed to it, but with such high costs with no definite outcome it seems scary.

Costs this cycle: $250/ultrasound (x2), plus $55 for medication = $555.