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.
Saturday, March 30, 2013
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.
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.
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!
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.
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.
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