Tuesday, September 30, 2008

Did I ovulate my first cycle on clomid?

I'm about ready to start begging. Seriously. Please pray for me! My temps have looked so good this month for the first time ever - thank you clomid! - and I am so hopeful for my temp to go up and stay up! I really hate to get my emotions caught up in this cycle, simply because I'm afraid it might not work out, but darn it I want to be excited. I want to feel gitty about the whole thing and in order to do that I have to get emotionally involved in the process. I really have been trying not to do that lately because I know it will only be harder on me, but when things look like their on the up and up, I can't help myself.

So, yesterday I was ecstatic and today I will be too and I'll just have to deal with whatever comes next and live with it! Here's my chart thus far... and my OPKs too, ending with today - CD19 (I'm wondering if the third test from the bottom (CD17) was positive?? Those are the dip in the cup ovulation predictor kit strips I purchased online at early-pregnancy-test.com, so I'm a little weary if they're working like they're supposed to.)

Wednesday, September 24, 2008

A love/hate relationship with hormones

Yesterday was a not-so-good day! For goodness sake I almost cried when my boss was going over a design I had done, over something that was very small and insignificant. This isn't normal people! I only hope this means that the Clomid is working it's magic. The remainder of the day didn't get much better, but I did try to make note of when I was overreacting in a situation and then change my reaction, but boy is that hard. I would say that I totally hate hormones, but I should really learn to love them and the power that they have on the human body. After all, the lack of functional hormones is pretty much what has led me to where I am today.

I'm sure hormones also played a part this past weekend - a situation where I would normally be happy and excited. I attended two parties where there were lots of people my age had young kids... you would think this wouldn't be a big deal, and usually I do just fine, but two days in a row and multiple people like that really got to me. It's tough being "normal" in social situations like that because it's just gets plain awkward, in terms of emotions and conversation.

And then, yesterday, I realized that all I have been doing for the past several months is waiting for the next day - the next cycle - the next month when we get pregnant. No wonder this year has flown by. I can't promise that I won't continue to look forward to another opportunity to have this happen for us, cause that would just be a lie, but I do really want to try and make more of an effort to enjoy life today. Fall, my favorite time of the year, will be here in the next couple of weeks and I really, really want and need to just relax a little and be thankful for everything that I have.

On a more uplifting note, there are other signs that the Clomid might be working, but I just don't want to write it in fear that it might jinx the whole thing. So, for now, I wait and will just have to keep you posted! :)

Friday, September 19, 2008

On my last Clomid pill and hoping for ovulation!

As you can tell, my ultrasound went well and so far so good! I've not had any symptoms of being on Clomid (knock on wood) and feel quite fortunate. My ultrasound went well - again, revealing typical "string of pearl" ovaries - yes, you heard me right - ovaries, as in two! The most revealing part of that test is that she said I actually have part of the ovary that I thought was completely taken out. Of course, it had cysts on it as well, but it has to be good that it's there. If I'm lucky it still contains a few eggs, but I'm not holding my breathe I suppose.

Something else worth mentioning... I took a voice recorder to my appointment so that I could remember everything my doctor had to say and it worked like a charm! I figured no need to make a big deal of it so I left it in my purse and just reviewed it when I got home with my husband. It was nice because it's sorta the in between - he can still hear exactly what her feedback is, without taking time off work. I always had such a hard time remembering exactly what was said and in what order the doc mentioned things in, so this should work out nicely!

Here's what I got out of this appt:
  • Yes, I have lots of cysts, but nothing to large to give clomid a try for one round (at least)
  • My uterus measure an average size and shape
  • The doc wanted to start clomid on days 3-7, but Monday was day 4, so we're doing days 4-8
  • We were told to start having sex no later than day 9 and to NOT have sex each day, but rather every other day.
  • If nothing productive happens this cycle (ovulation or pregnancy), it seems as though my OB is recommending I go back on birth control for a month to see if the cysts will go away, before trying another cycle with the clomid; I'm not sure how hard I'll push for upping the dosage first before doing that. Maybe if I don't ovulate I'll be apt to go that route, but if I DO ovulate but don't get pregnant, I might see if we can try upping the dosage first.
In other news :) after talking with Meghan, a friend I've made connections with through St. Charles IES, she's reopened my eyes to actually trying to get at the root of my PCOS. She recently had a success story where she changed her diet to South Beach and is taking some alternative natural supplements (such as taking soy early on in the cycle, which mimics clomid) and no longer has cysts present, etc. Such great news! While I still want to keep up with the clomid and such, I am definitely curious and want to find out how and what I can incorporate into my diet to try and correct the underlying cause, rather than simply masking the symptoms. For more good stuff, check out her blog.

Also, I came across a few articles that are worth sharing - all of which tie back to the above... I hope to read them more in detail and write about it later when I have more time. In the meantime, here are the links:

Sunday, September 14, 2008

Anxious about my 1st Ultrasound - Clomid or bust :)

I'm preparing for my first ultrasound, a transvaginal ultrasound to be exact - if all is "clear" (no large cysts), I'll start my first pill of five tomorrow as well. Pretty exciting! I'm praying that this is the month!

I am curious though - even though I know my OBGYN is looking for large cysts, what else can you see regarding infertility through one of these tests?

According to medicare.com, a transvaginal ultrasound may be done to:

1) View the external structures of the uterus, fallopian tubes, and ovaries.
2) Monitor the development of follicles in the ovary leading to ovulation. This helps to know when to schedule artificial or intrauterine insemination just before you ovulate.
3) View the uterus and uterine lining.
4) Guide the needle used to remove eggs to be used in assisted reproductive techniques.
5) Count the number of egg follicles in the ovaries, which, along with your age and blood tests, may be used to give an estimate of treatment success.

I am most curious to see if she detects any scar tissue from my past surgery, to find out the overall state of my uterus (just to make sure it's ok), to see if there are any abnormalities with my remaining tube, and to see if there appears to be any problem with the quantity of my egg follicles. And, of course, to see how many cysts I have going on. I hate cysts with a passion!

Friday, September 12, 2008

Clomid, here I come!

Today I put call into my OBGYN office for an ultrasound on Monday. If there are no large cysts, we will move forward with Clomid this next cycle. In these still early stages I often find myself thinking, "God please let this work... I don't know how my mental state will be down the road if this becomes my life."

In times like these I feel powerless if I don't at least half understand what my body is doing or should be doing, so I search - or research rather. Here are some of the questions I have surrounding this issue.

Should you be monitored on Clomid, or not?

While I am getting this ultrasound, I often hear that a lot of women going to their OBGYN don't get monitored. I wondered if this was a valid practice, or just bad practice on some physicians part. I've read a lot that seems to very much stress monitoring, but I came across a blog written by a full-time Southern California Reproductive Endocrinologist that seems to show both sides. It basically says not doing so is cheaper, but the more ways you have to monitor your progress, the better informed you and your doctor will be in making a "next step" decision.

They go on to list several clear advantages of monitoring while on Clomid
1) Ability to avoid cysts 2) Assurance of follicular growth 3) Optimal timing of intercourse and/or insemination 4) Assurance of ovulation

For me, #1 (the ability to avoid cysts) is enough of a reason to do it, given the fact that I am working with only one ovary. I found it interesting that while most doctors check progestone as a way to tell if you've ovulated successfuly or not due to the Clomid, it doesn't sound like that is always a sure-fire way to tell. That some people show all the signs of ovulation (temp change, positive OPKs, pain, rise in progesterone levls), but the follicles don't actually burst, and the egg simply remains trapped inside until it's too late to be fertilized.

The blog points out that an ultrasound will pick this up, if this happens to be the case. The other points liste in detail are also really very helpful, but those are the two that seem to best apply to my situation at this time.

When do you ovulate while on clomid?
I was curious as to when I can expect to ovulate while on Clomid. I found a handy Clomid Ovulation Calculator by babymed.com that told me this:

If you take Clomid for 5 days from 9/15/2008 to 9/19/2008, you would expect to ovulate between 9/24/2008 and 9/29/2008. You can start LH testing for ovulation on 9/22/2008. Optimally you would start making love every 1-2 days starting on 9/22/2008.

I checked out what FertilityFriend had to say about it and they said "In most cases, you can expect ovulation within 5-9 days of your last dose of Clomid, but the doctor who prescribed the medication for you should be able to give you a good indication of when to expect ovulation based on your own situation. He or she can also help you plan when to have intercourse based on when you are expecting ovulation.

You may notice that your temperatures are higher on the days you take the pills, but they should level out enough for ovulation to be detected on your chart when it occurs. Some women also notice that cervical fluid is not as abundant when taking Clomid."

What if I don't ovulate on Clomid the first time - what's next?

I came across one site with replies from Dr. Amos, medical director of the WebMD Fertility Center, who says "... if you start at 50 milligrams and monitor for ovulation with a temperature chart or progesterone. If you do not ovulate the first month then Clomid is increased by 50 milligrams a day until you ovulate. It's not good medical practice to keep you on the same Clomid
dose if you don't ovulate, and to not adequately monitor to see if it induced ovulation. Keeping you for six months on the same dose is wrong."

TheFertilityExperts.com fertility institute had to say this... "If you fail to have a period, but your pregnancy test is negative, you are not pregnant. We will induce a period with medroxyprogesterone acetate. During your next cycle, we will increase the clomid to 100 mg. to be taken days 5-9 of your cycle. We will continue to increase the dose if you do not ovulate when taking the lower dosage."

Monday, September 8, 2008

PCOS Support Group St. Charles IES - First Meeting this Wednesday

I am really looking forward to this Wednesday! It's the first meeting for the newly formed PCOS Support Group in the St. Charles, MO area called St. Charles IES (Infertility and Education Support). Shout out to Meghan for organizing and leading this group :) (Yes, I just did a shout out :P). It will be great to meet other women locally who are going through a similar situation. I can't tell you how tough it's been for me not being able to really talk to very many people about what's going on.

Who you talk to and how you talk to those people can be difficult - I haven't told my parents yet because I really want to be able to surprise them, rather than have this be a stressful or "expected" thing for them. I did tell one of my close girlfriends, but she and her husband just had a baby and I'm not sure that she totally gets what I'm going through. The only person at this point who I've told and who has been super supportive is a good friend I work with. I can't tell you how thankful I am to have her as a friend. Even though she has never been through something like this before, she is always there for me when I need someone to vent to or bounce medical theories off of (ie. maybe "this" is what's wrong with me!). She definitely has never said "just relax and it will happen" and for that I'm very thankful. The whole "relax" thing sounds great and might be true, but you cannot relax when you don't have a plan or any idea about what's going on with your body.

If you live in the St. Charles County, Missouri area and wish to join or learn more about the PCOS Support Group, St. Charles IES, check us out the following ways:

Facebook: http://www.new.facebook.com/group.php?gid=21658117660
MySpace: http://www.new.facebook.com/group.php?gid=21658117660

Thursday, September 4, 2008

My new OBGYN - I think we might have a plan... but can we pay for it?

I'm happy to report that this past appointment with Dr. Lydia W. Keisler out of SSM St. Joseph Health Center went very well. I've been to this facility before and really like not only the relaxed, updated feel of the building, but am also very pleased with every staff member I've ever been helped by.

By the way, if you're looking for a doctor, I recommend cross checking their credentials with Vitals.com. This is a 100% FREE site... unlike some of the sites out there that want to charge you for similar information. Don't fall for it - it's all free here. I love this site because it's easy to find someone in your local area, according to specialty. You can see where they went to school and how long they have been practicing for, as well if they are board certified or not. The site is still fairly new, so there aren't tons of reviews, but I would guess that in the future more and more people will rate their docs on here. I recommend everyone do that, so that as a community we can share our experiences and help others make an informed choice. And no, I am in no way affiliated with this website or company, I just really dig their site.

Anyway, back to my appt...Luckily, I had a 9am, so there wasn't much waiting at all. One of the nurses, Marilyn, called me in from the waiting room, introduced herself, took my weight and showed me to the room. I should also mention that my husband went to this appointment with me as well. We decided that it would be good to get on the same page as far as what our options are and it would be good to hear it from the Dr. herself.

Once in the room, Marilyn, took my pulse and blood pressure and proceded to run down a list of questions regarding things like when my last period was, serious family medical conditions, etc. She and my husband left and the Dr. came in. Overall, she was very pleasant and very to the point. She had a question and I had and answer and usually a follow-up question. The first thing she asked was if I have a history of regular periods. When I said no, she took a look at the bloodwork I had done and the BBT charting I had been doing for the past three cycles and said that we need to get me to ovulate - that is priority #1.

She recommended I take prometrium to induce bleeding and call her on the first day of heavy flow to schedule and ultrasound for day3. She said if the ultrasound reveals a cysts over 2mm, then I will go back on birth control for a month and she will up my metformin slightly - both of which would be used to get rid of the cyst and to prevent new ones from forming (I assume that's the role of the metformin at that point). If my ovary looks good and this isn't the case, she will start me on Clomid on days 3-7. Then we BD and wait to see if I've ovulated. She didn't say how she would determine IF I did in fact ovulate (I'm assuming via bloodwork... possibly by looking at my progesterone levels?), but she did say that she is looking for ovulation specifically. If I did ovulate and I don't get pregnant, she wants my husband to get a sperm analysis. If everything checks out with him, I believe she said we will do one more month of Clomid - either that or she wants me to consider doing a laprascopy or an HSG (I don't remember which one because she mention both at one point.)

If I didn't ovulate, I'm assuming she will up the dosage to see if that works... she didn't really say much about that at this point.

I asked her if we should be concerned about hyperstimulation with the one ovary when we use Clomid. She said yes, it can happen, but in her 15 years of practicing, she has never seen it - only once in residency, and she's not sure of that persons treatment leading up to it. I asked her about Femera and if that is maybe a better option - she seemed to very strongly feel that no, Clomid is the better option, that there is more data to support it and a lot of women have success with it. I'm still not sure if I agree with this 100%, but as long as she is planning on monitoring me with an ultrasound, I figure it is worth starting out with her recommendation.

I should also mention that Dr. Keisler herself had the same experience with a one of her ovaries filling up with blood and ruining an ovary and fallopian tube. How weird is that... that I would pick one doctor out of the blue who is in a similar boat as me?!! She said she was able to get pregnant twice after this happening, so it IS possible. She didn't say whether or not she has PCOS.

Speaking of, she didn't really seem super focused on my PCOS like my last doc. The last doc wanted to start with metformin and see what that could do, and this doc, even though she new I have been on it for about 60 days now, she didn't really talk about it much. She did say that she will sometimes start women out with it, but not always. In the case where they are on it and doing ok, she will leave them on it, but that's it. She mentioned in passing that docs thought at one point "oh metfomin, it's the new cure", but that it isn't really. Sometimes it's helpful, sometimes it's not. In the end, I'm not sure how to perceive her take on metformin. From my perspective, I know I am not ovulating yet and I figure it can't be that bad to give Clomid a try and keep going with the metformin in some capacity, so I won't push too much on this issue. It seems that if it works for women, it takes quite a few months and, even then, it's still pretty iffy.

The one big thing I forgot to focus on was the whole hormone issue and miscarriages. I wanted to ask about maybe having a larger hormone check done (particuraly progesterone, estrogen, and testosterone) to make sure my body isn't totally out of whack in this area - if it is I'm afraid that if I don't address it now, and I DO get pregnant, that I could be at a higher risk for miscarrying. After stressing a little about this post-appt, I've decided that it's probably ok to the prometrium and get the ultrasound done and maybe address this at that time, if I go forward with Clomid. Ultimately, I assume I'm ok to wait until I actually get pregnant to really be concerned about this, but I'm not totally sure.

Dang, I also forgot to ask about Vitex! I hate to take it without talking with her first... I have a feeling like she'll say don't bother, but I still might bring it up. I mean, it's got to be better for me to get my body regulated, regardless of whether or not I am TTC or not.

So, tonight I go to pick up my prescription for prometrium. Let the fun begin!

Tuesday, September 2, 2008

Just as we thought - No Infertility Insurance Coverage

The cold hard facts are in. At least we know for certain now and can begin to come up with a plan.

I do, however, want to give a big thumbs up to Fertility Lifelines for helping me sort through it all. I called them on Friday and they got back to me the next business day (this week that happened to be a Tuesday, with the Labor Day holiday). Bonnie, the same benefits specialist I spoke with on Friday, called me personally and let me know the not so great news in a very kind and sensitive way. I was prepared for the news, so it wasn't tough to hear at this point. She let me know that she will be mailing me out a letter with these same findings, so I would have something for my records.

The next day I received a packet with a letter and a couple informational pieces on the Gonal-F injectables they manufacture. In a seperate mailing I also received general information about infertility and TTC that covers basic information and concerns that someone in this position might have. It didn't necessarily tell me anything I hadn't already heard, but it was still a good piece to scan. For those who haven't really looked into infertility yet, it might be pretty informative.

Go here to sign up and get a packet of your own.

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