What's this? I started my period! :)

Most women, especially those trying to conceive, wouldn't be excited about this, but I definitely am. I started my cycle today - ON MY OWN!! This is huge for me. I think this is only my second cycle on my own since stopping birth control in April of 2008. During that particular cycle, it took me 67 days to start on my own, and I'm not even sure if I ovulated. It's hard to say though. I was still new to the whole charting thing (it was my first cycle ever charted when we started TTC), however, I certainly didn't write down any "symptoms" around the time that I would have ovulated, so that's why I'm so doubtful.

In my little corner of the world, this is very exciting! It's nice to see that my body WILL work, if nothing else just some of the time. Can you believe this makes for only my 2nd cycle where we've actually had the *chance* to have a baby (ie. I ovulated) in what will be almost a year of trying to conceive?!! Since I didn't know for sure I had at the time, it was the easiest 2ww ever! :-)

I'm excited, but I definitely realize that even when I DO ovulate, the likelihood of my remaining tube being able to function properly and pick up an eggie is pretty slim with all of the existing scar tissue that has formed due to my surgery years ago. Even still, I have HOPE!! For the next week, I will be reminded that I am indeed a woman - roooarrrr! :P And I will love every minute of it!!



For your viewing pleasure, here is my complete 93 day long cycle. Above is a snapshot of the very end, around ovulation . Our first cycle where we weren't actively trying, I guess you could say. That basically means, we weren't BDing every few days, I wasn't taking my basal body temps, doing any of those lousy OPKs or drugs or anything. In fact, you can see that in late December (when this cycle started), I stopped taking my metformin and, and yes I probably shouldn't have cut this one, but I also stopped taking my prenatal pills. Those things totally suck and I just needed a break.

The above chart snapshot indicates the days when I was having certain ovulation-like symptoms - starting with headaches off and on, very sensitive nipples and my ovary was sore, as in I when I barely pushed on my stomach it hurt, and then on Day 81 I just happened to check my cervix and it was open. Based on all of this, I *believe* I probably ovulated on either CD 81 or 82, but it could have been anywhere in the green outlined area I suppose. As you can see we did BD a several days prior to that, and one day right in that key time frame. Even though BD timing wasn't "perfect", it wasn't awful either. I'd give it a 3.5 out of 5 maybe. Just good to note. It's always nice to test my body out and give it a chance to shape up on it's own, but I'm not holding my breath. I know God can work miracles, so I just continue to pray!!

Our First FREE Appt with an RE!

I should really learn to update this more often so that I don't have to write a book every time! I have an excuse this time I suppose - Christmas!

As you know, we went to our first RE appointment this past week. Prior to doing so, I had a couple questions in regards to insurance and decided to call Fertility Lifelines (see sidebar) back, since they were so helpful the first time. I spoke with Barb again, the same person I worked with before, who helped me understand a little more about infertility states and how the coverage works. She confirmed the point about if a company is self-insured they don't have to offer infertility coverage. She also told me that it is possible that a company would be located in an infertility state, not self-insure, but still not have coverage simply because the state they purchased the policy from was somewhere other than that state (and they probably aren't an infertility state). As you can see, it seems there are several loop holes that companies might be taking advantage of. If we were to consider moving, the only way we would know for certain if a new employer offered coverage was to ask for a policy book during or after the interview. I also asked Barb if we went to an RE now, and tried to switch insurances in the next year (or after), would we likely be turned down or have our infertility issues labeled as "pre-existing". She said that as long as my doctors are continuing to bill my care as something other than an infertility diagnosis, I wouldn't. However, once that changes (also when our current insurance won't cover any procedures), we would be at the mercy of any stipulations. She said they (new insurance companies) typically don't refuse you, but you would be held to any pre-existing clause that exists, which is usually a timeframe of anywhere from six months to a year from the coverage start date. That I pretty much expected.

Because Fertility Lifelines is a subset of the Gonal-F injectable medications, she also updated me on the two savings plans they have going right now. One is their FertilityAssist2, where you can save up to $500 on your second round of Gonal-F shots, and the other is a word-of-mouth program called Compassionate Care that is income based and you can only apply once in your lifetime. However, if you are accepted into the program, you get 1 free cycle of shots (Both Gonal-F and Ovidrel which are needed to stimulate follicles - more info here) for use in either an IUI or IVF cycle and you must have a start date for these cycles from your doctor at the time of applying. To apply, they need a 1040, last two pay stubs and a copy of the front of your insurance card. She said it typically takes about 2 weeks to know if you are accepted (faster if you have a private fax to correspond with). I think I got most of that correct from talking with her, but if you're interested you'd want to call them yourself for full details.

Ok, so with that information, we headed to our first appointment with the Reproductive Endocrinologist (RE), Dr. Peter Ahlering (pictured at left) with the SHER Institutes for Reproductive Medicine, about 25 minutes from home. Our appointment was at 9am and I woke up with a pretty decent head cold. I had taken Nyquil before bed and was still loopy when I woke, so that whole morning was a bit of a haze. The good thing is that it probably kept me from being so nervous!

Anyway, I filled out the patient questionnaire on the way. When we arrived the staff was very pleasant and check-in was a breeze. We waited only about 8 minutes or so and was taken to Dr. Ahlering's office for about an hour long discussion. He was very nice and took the time to not only read through the questionnaire we'd filled out, but also asked a good deal about what we'd done thus far in TTC and made sure to educate us a little on how an ideal cycle would work. While I new most of that, it was good that he didn't want to assume we new everything. The two things he spent the most time talking about with regards to our situation was the fact that I'm not ovulating and that he was concerned my remaining tube might be damaged from my past surgery. He said the ovulation issue is pretty easy to overcome - I'm still young and with the right does of stimulation (shots), he is confident he can get me to ovulate. The tube issue, however, is something that could really be a determining factor as to what we do going forward. He said he will more than likely want to do a laparoscopy, which will allow him to get a good look at how the tube might be functioning. I honestly wasn't expecting him to say that - I was thinking he'd want to do an HSG, however, since that would only tell us if it's open (not if it's damaged), this totally makes sense. He said they usually do the surgery on a Friday and generally people are back up and running by the following Monday, so hopefully it wouldn't be too bad. I'm expecting that the surgery will be sometime the first, second or third week in January.

Last week, on Christmas Eve actually, I went in for new CD3 bloodwork - and LOTS of it... almost a pint! Let's just say I almost passed out and threw up they took so much blood! At least it's over with and I should get my results back this next week. Also this next week, (either Tues or Wed afternoon), we go in for a semen analysis (MSA & SDI - DNA testing), my fluid ultrasound (FUS) which is also known as a Sonohysterogram, my antral (AFC) follicle count via transvaginal ultrasound and for a financial consultation. They think that my lap will be covered by insurance, but we need to look into this more. IF the SA comes out normal and my lap looks good, he said we have a good shot at being successful with doing shots and IUI, especially since we're still young. IF there is a major problem with either the SA or my tube is damaged, our only real chance at pregnancy will be to do IVF. Generally speaking, he said that it would be $1,500 to $1,700 to do shots and IUI and $9,000 to 10,000 to do IVF - each of those is per cycle and the general rule of thumb is to expect to be in either one of those for 3-4 rounds before knowing if it will work or not.

We still have a lot of questions (many of which will hopefully be answered next week), but I can't begin to tell you how much of a sense of relief I feel after talking with him. It was so refreshing to, for once, feel like we're in good hands and that the person helping you actually knows more than you do (what a concept!). I think we probably went at a good time too - we've done just enough for him to know that clomid isn't working for us (he said the signs are pointing to me not reacting to the drug in a positive manor) and are ready to move onto bigger fish. I pray that we can find a way to make this work financially and that mentally I will be able to just turn it over and let God do the rest. Oh yeah, and that my body reacts well to all the poking and examining. I am already a little anxious about giving myself shots in the tummy, but if it helps us get pregnant, I am trusting God will get me through it!

Oh and needless to say, we're not doing another round of clomid - essentially this will pretty much be a cycle off while we do all the tests. And I'm totally fine with that - finally we'll have answers to so many questions and will know where to go from here.

Well, that certainly doesn't cover everything, but it's a start. I'll have to update later about how our holiday went. For now it's off to get showered and then we're headed to one last get-together!

New Doctors. Lots of Appts. Full Steam Ahead!

Boy do I have a lot to talk about this time around!

Meeting the new OBGYN
So, as you may remember, my last OB left the St. Louis area and left me high and dry. I had only been going to her for a little over a month. At first I was really bummed because I thought she was "the one" - she too only had one ovary and one fallopian tube, and she was able to get pregnant without too much trouble. However, at my last appointment with her, I realized she might not really know all of what she's talking about. She said she doesn't do mid-cycle monitoring while on clomid, so we had no way of knowing if my follicules were maturing properly the on the first round. She would also talk down to me a bit... more like giving me the look of "you silly girl"... which got old quick.

This idea of going to a new OB wasn't the worst thing ever as a result. I was hopefully she would know more about infertility - she was older so one would think that would mean more knowledgeable. I was wrong - again.

Maybe it's too much for me to be judging her too much too early, but in this type of situation it's half gut feeling and half what plan or advice she recommends. I didn't get a warm fuzzy on either of those. My gut told me "this isn't the one"... it was pretty obvious too because my husband said afterwards "I thought that if she told you to calm down one more time you were going to scream". I guess my body language is pretty outspoken.

I DID like the fact that she asked more about my female history than any other doctor ever has. It's amazing how reassuring that alone can feel. When she took a look at my chart and saw that this second round of clomid was, at the time, 52 days long, she said "that is unacceptable". She was baffeled as to why the clomid didn't work and asked why the last OB upped my dosage. (Remember that was done with the intention of it upping my ovulation date). I honestly think she thought I might have hyperstimulated and asked that we do an internal ultrasound that day. In the ultrasound room she took the time to show my husband what we were seeing - again my uterus looked good and I think she said my lining was at 5mm (not sure what this means for CD52 and she didn't really say much either).

Then she asked what ovary I still had intact. I am embarassed to say I can NEVER remember the answer to this question. I mean really - it's not like I dress it every day! For the record, if you must know, I have my left ovary (and apparently a little of my right still). I believe that she said I had around 5 or so follicules, but I don't remember for certain. I do know that she said there were several follicules that were not ovulatory follicules (were too small I think) and that there was one larger one, but it was oddly shaped. She said she thought this was because it was on the verge of being absorbed and there was nothing to worry about. She did confirm that there was no PCOS "string of pearl" style cysts present and thought that meant that the clomid was doing something, just not enough. She didn't know why this cycle was so wacky.

I asked about doing an HSG because I was concerned about my only tube being blocked (have read scar tissue from past surgery causing this). She said we shouldn't be looking into this right now because I'm not even ovulating or having a normal cycle. That we should first solve the ovulation issue and go from there. I didn't wholy agree with her - what if it IS blocked and all these months and clomid cycles are for nothing?

I also asked about whether we should have a post-coidal test done, since my cervical mucus was slim to none this time around (wasn't super great the first time either). She again stressed that we shouldn't do this now - it would be too premature because we don't even know if I'll actually ovulate and we would need to time the test around when we think I'm ovulating. I also didn't completely agree with her on this one either. My question is, isn't there another way to still do the test... like have me do the OPK testing and when I get a positive, schedule the post-coidal? Or, since OPKs detect an LH surge, wouldn't it make sense that if I get a positive OPK, I could come in to have bloodwork done to see if my LH is actually high and, if so, do the post-coidal then??

Of course that's assuming that we have Day3 bloodwork to measure from. Which we don't. In all fairness to her, I never mentioned this when she asked if I have had any bloodwork done. I just whipped out the results from the one test I had ((FSH 4.8, LH 18.3, TSH 1.58) which was actually done on CD13 by my OBGYN (3 OBs ago... can you believe I've been to some many different ones in the past 8 months!). That OB said "you can get it done any day", so I did. Honestly, at the time, I think she was simply looking for the FSH to LH ratio to determine if I had PCOS. As you can see it my LH levels are clearly more than 3x what my FSH is. I still think I should have these done again on the correct day - CD3.

She did, however, want to check my prolactin (which could help tell us if I have a pituitary abnormality) and estrodial levels (produced by the ovaries and the brain and will help tell us the baseline of estrogen in my body). The estrodial level is important in part because I have amenorrhea (lack of menses). Apparently estrogen monitoring during fertility therapy is also helpful to assess follicular growth. Seeing as how right now we have no way of knowing if the clomid is actually doing anything, that might be something to check out, though she certainly didn't suggest that. While I'm greatful she mentioned wanting these levels checked, she said I could get the blood work done anytime in the cycle - however, that simply isn't the case. Pretty much any infertility clinic website you read states clearly that estradiol (and others like FSH and LH) must be drawn on CD3. Prolactin can be any day of the cycle. The fact that she said any day makes me really doubt her expertise.

Oh, and I didn't mention that since my cycles are so unpredictable, and therefore my ovulation date is as well, she doesn't want to monitor follicule growth mid-cycle like she normally does. She said it would be "too difficult" and said to just wait it out to see what happens and to call her if it's day 40 and my period hadn't shown. I also don't agree with this decision. I don't really want to keep going with clomid if I have no measurable data with which to make a decision on what to do next cycle. Given the fact that doctors don't like to do clomid for more than 6 cycles (she also practices with this rule), this would mean I am getting ready to embark on my 3rd cycle and come out of it with very little new valuable data. That just doesn't sit right with me.

After talking it over with my very patient, and I do mean patient because I over-talk things, husband, he too agrees it would be silly to continue on the same path with no new info. We came up with few scenerios about what to do (since I'm now on my 4th progesterone pill and will start my period soon, which means that IF we want to immediately do another round of clomid, we'd be starting that on Dec 23, CD3). In the end, we decided I would call around this week to try and find another OBGYN who is more compassionate (I don't think me and this last lady would get along, let alone the fact that I don't think she's very knowledgable in infertility) and has more expertise in infertility. We also wanted to begin calling around to see how long it would take to get in to see a reproductive endocrinologist (RE) and how much an initial consultation would cost.

I had some extra time on my lunch today and was able to get a lot accomplished... drum roll please.... :)

New, new :) OBGYN Appointment Made - He does IUI's!
Dec 30 at 2:30 pm - I came across a local St. Louis baby forum with some OB recommendations and saw the name of a doctor located in O'Fallon, Missouri near Progress West Health Center. The poster said "he does IUI's". I was floored and thought there was no way! So I called and, yes, all three doctors in their practice do them. Not that that's what we will end up doing, but it does make me think that if they do a more advanced procedure like that, surely they know more than your average OBGYN. I have to admit - the only thing that bugs me is that he's a dude. I've never gone to an OB of the opposite sex, but, if he knows his stuff, then I guess it will be worth it. At least my husband will be there with me on the first appointment!

For your reference, the name of the doctor I'm referring to is:

Allied Associates OBGYN
830 Waterbury Fall Dr. O’Fallon, MO 63368 (near Progress West Hospital) (314) 569-2751
Dr. Craig Boyd - 21 yrs experience; board certified OBGYN; can do IUIs!


Appoinment Made with a Reproductive Endocrinologist!
Get this - Dec 23 at 9 am. I am so amazed that he could fit me in so soon! And, hold on to your pants, the consultation cost is: F-R-E-E!!!! Whoo hooo!!!!!!!!! I actually had to ask her to repeat herself and then, when I called back to make the appt, I asked the other girl who answered to confirm that. I just couldn't believe it. Especially since I had just got off the phone with another Infertility Clinic in the area who couldn't get me in until the end of January and who's initial appt cost would have been $300-400. Believe me, I'm still asking myself what the catch is with this other one I found. What's even cooler is that this is the same doctor that I listen to quite frequently on Haveababy.com Life's Online Infertility Talk Radio show. I always make note of who the guest was on the show when I take my own personal notes, in case you're curious what he has to say. It has been a great way to sort of get to know how he probably talks with his patients at the clinic and makes me feel much more at ease. Thus far, he seems to be very kind and knowledgeable.

Here is his information:

SHER Institute, St. Louis
456 N. New Ballas, Suite 101, Creve Coeur, MO 63141

Dr. Peter Ahlering
Obstetrics & Gynecology - 16 yrs experience

Sub-specialty: Reproductive Endocrinology

So... where does that leave us? Well, our tenative plan is to play some massive doctor toss-up. Meaning, on Dec 23 at 9 am I will go see the RE. We will probably talk about my history and he will recommend a battery of tests he'd want done before laying out a game plan. I am going to mention where we're at with our OB currently (getting ready to start a new round of clomid) and see if he has any opposition to that. If not, I will go the appointment that afternoon at 1pm with my current OB to have my CD3 ultrasound done prior to starting clomid that night. Then, on Dec 30 at 2:30 pm, CD10, I will go to the new OBGYN. We wanted to get in to see him before the time when I should hypothetically be ovulating so that if he wanted to do mid-cycle monitoring, we would still have time to do that. Though it just dawned on me that we'll be in Chicago at that time!! I can't believe I didn't think of that until now. Looks like we have something new to talk and think about. Oh well, not going to let it ruin my day. I am on cloud nine with the free consultation and the new OB am just going to trust that it will all work out. If we don't immediately do another round of clomid, then that might be ok, depending on what the new doctors think.

Ok, off to do some last minute Christmas shopping and grocery shopping for holiday parties. Should be fun :P

What Infertility Tests are REALLY Necessary?

Ok, I can't get enough! That radio show was so informative that I had to listen to another one this afternoon. This one is also VERY relavent because we are trying to decide next steps. My first thought was that we try and figure out what test are critical and get them done with our OB now, before moving on to an RE. After listening to the show and what the doctor had to say, I definitely am thinking of things a little differently. Please note that the notes below that I've taken are my (hopefully close) interprutation of the thoughts expressed by Dr. Dlugi and should not be taken verbadem. Please refer to the show to draw your own conclusions on what he has to say. The show can be found here.

Avoiding Unnecessary Testing and Treatments, Hosted by Kim Hahn talks to Alexander Dlugi, M.D., SIRM New Jersey. Dated 3/27/08. (located in the scrollable column on the left-hand side).

Which diagnostic tests are necessary before beginning advanced infertility treatments?

Male Tests
Semen analysis (key because 40% of infertility are male related, 10% combined factor). DNA testing of semen doesn't matter all that much, but costs a lot. FWIW, we don't know a lot about sperm because most types of testing kills the sperm. Infertility centers are probably doing it the same way (rather than a one-off lab), and is of good quality and understands results well. One-off labs are more unreliable. Can a semen analysis change with time? Depends on the situation. Results will fluxuate for sure, but if you find signifigant abnormalities, it will probably still be present. Retesting is sometimes encouraged.

Female Tests - "Old-Fashioned" (thru 80s to early 90s) Standard Testing...

1) HSG (hystosalopingogram - used to look at uterus and tubes).
2) post coidal test (cervical mucus, are sperm getting there)
3) endo bioposy (uterine lining changes) not done much anymore
4) laporsocopy (look inside pelvis and perform surgery if needed). Everyone got testing and then tailored treatment according to results.
5) Basal Body Temps (BBT) - To track ovulation.

Of these, it depends on couples history and what they are willing to consider (IVF, etc). If they're not willing or want to do IVF, then yes, it makes sense to do some of the below.

Thoughts about Diagnostic Testing and What is Actually Helpful

1) HSG: Hystosalopingogram - Used to look at uterus and tubes. Make sense to do.

However, if there is a problem found with an HSG, here are the senerios:
a) Uterus (polip, fibroid, etc) - fix is surgical
b) Tubes - surgery to fix tubes or IVF

10 years ago, recommendation would have been to operate, but because IVF rates are so high these days, that is the way to go. With the surgery, there is recovery time and it takes 1-2 years after surgery to be able to get pregnant, typically, and these problems also will come back. Therefore, surgery doesn't make much sense unless there is a mass or there is pain. Then it's totally different. If for fertility, there isn't much point.

2) Post Coidal Test: Checking cervical mucus to see if are sperm getting to uterus. Not done much anymore.

Problem with this one - you don't really know what the definition of "normal" is. Is a role where a couple uses clomid because it could dimish CM and make it hard to get pregnant. It's good to get one of these done at least to see what findings are. If test is abnormal, you do IVF with clomid, or something else. You will see treatment options come down to trying IUI with fertility meds or move to IVF. So, if you are going to do this anyway, why bother doing the tests if you're going to do the same treatments anyway. If there is a tubal issue, go directly to IVF.

3) Endometrial Bioposy (uterine lining changes) Not done much anymore.

4) Laprosocopy (look inside pelvis and perform surgery if needed). Case by case, but usually not useful.

To check for endo and tubal disease. A lot of people do this before going into something else, but why put people through surgery unless they're having pain. Again, it can take around 2 years before you know if it worked or not. If you're going to turn to IVF anyway, then why mess with it. Probably more successful for people who didn't have much going on, but for people with a lot going on, it's probably not extremely effective.

5) Basal Body Temperature chart and OPK kits - Recommendation to not bother doing those because they are useful for 1-2 cycles, but if you are having regular cycles and you check a chart a couple cycles and if LH surge is fairly consistant, you don't really need to do it. If you do this, you can fall into a trap every month and be more stressed. I'm not sure what his comment would be if you are NOT regular. My feeling is that it can't hurt really to go ahead and do it!

Blood Tests - Used when clinically relevant.

If finding dictates a change in course. A lot of places run the tests purely to get money. Clinically they don't make sense. Where are most blood test applicable? Knowing FSH, Thyroid, Prolactin are important.

Immunological issues should be screened if you have multiple miscarriages or if you've done 2-3 IVF cycles with no success then you should ask is there something else going on when embryo arrives in the uterus and it is being rejected, this is where immunological test are key. This is very
controversial. This doctor wasn't in agreement when he first started working with the SHER Institute. If you are going with IVF, you might want to rule this out and have this test. But, is it cost effective - how many people do you need to screen to rule things out. $1,000 for
screening usually.


New Procedures - Genetic Testing
Genetic testing of egg and embryos. If there are no sperm issues, the egg is doing most of the work. Now you can biopsy the polar body which is a mirror image of the egg, in terms of the genetic. You can see if the egg has all of its chromosomes. Good for fertility preservation and egg donors - you can go to egg repository and pick out the good ones.

The success rates of IVF depend on
if the 1) embryo is normal 2) is uterus receptive and able to accept an embryo and propagate a pregnancy. So it's basically, do we have a normal embroy. One of the reason why miscarriage happens is that the embryo isn't good.

More on Advantages of Skipping Some Tests
Will now get results quicker because these test might not be necessary. When they do test, they might have a mild male factor. Maybe try a few IUI's and then go to IVF. If you don't ovulate regular, yes then try infertility drugs. But, if you haven't found anything, most people would say to look towards clomid and injectables because it's easy to do and doesn't hurt and some get pregnant. The problem is that we dont' know what that really accomplishes. If you ovulate and have normal sperm, then drugs and IUI don't do much that you aren't already doing. The pregnancy rates for unexplained infertility with clomid IUI is only about 7% or up to 10% with injectables. People do it because they have been told to do so, or are afraid of IVF. A lot of patients ask for it, so it is often done. If IUI and drug induced cycles are done for 3-4 cycles and it hasn't worked, it's probably not going to work so you should move on. For most who choose this route, by the 3rd cycle people are fed up and end up moving to IVF.

For people who don't have mandated coverage for IVF, what do you do then? He would say that then it makes even more sense to go to IVF because if you add up all the potential costs throughout each of the procedures, it easily amounts to $1,500 to 2,000 per cycle if you divide by 7% success rate you get a high number - and then 6-7 K later and still not pregnant, you've already paid a lot and haven't tried IVF yet which yields a MUCH higher success rate of 70% or more.

Increase in pregnancy rates from clomid to clomid with injectables is small. Skip injectables move to IVF is becoming more of the rule.

In Summary
Endless months and money spent doing tons of treatments which might not work and will probably end with IVF anyway is a route that some are beginning to take. In my opinion, this doctor is leaning towards doing less tests and moving to IVF sooner.

Free Infertility Radio Show - PCOS and Infertility Treatments

Frustrated with my current cycle (I think it's a total bust, but I'll post more about that later), I have been surfing the net to try and find some answers. Answers for what to do next, what various tests and procedures cost, etc. I came across Haveababy.com's live one-hour online radio show, which I hadn't heard about before. It seems like they do a lot of interviews with reproductive endocrinologists, so it seems like a good opportunity to get some reputable info.

Their shows broadcast every Thursday at 10:00am PT/1:00pm ET. They also keep a database of past shows, so you can listen to the topics that are of real interest to you. I came across the following topic, which really hit home for me, and took a few notes while I was listening... sorry for the incomplete sentences and/or misspellings. :)

Goodbye PCOS, Hello Fertility Treatment, hosted Kim Hahn and Dr. Drew Tortoriello, Medical Director of SIRM-NY. Dated 10/30/08 (archived in the scrollable column on the left).

In PCOS patients, excess androgen test worthwile. Remember, just because you have a period, doesn't mean you ovulated. Even if women do ovulate, they might be at an increase for abnormal oocytes. Excess androgen causes problems with eggs. So, even with women who get pregnant with IVF, their risk for miscarriage is 2x more, due to the androgen excess their eggs are under.

Are OPK tests or OV Watch good for PCOS patients? Yes still good to use. LH elevation in pcos patients cause false positive in opks though, so it just depends on that particular person.

Mid-cycle Follicule Check via Ultrasound while on Clomid
Recommend starting with monitoring with ultrasound to find out when a follicule is developing to give better guidance. Rather than only do ultrasounds, start on clomid. Are people monitored a lot on clomid? Always recommend both scanning and clomid because you don't want to waste time if you don't have response to the clomid and you won't know unless you get your period or if it doesn't come, you then have to figure out what to do next. If clomid is working within 10 days of last pill you should see evidence of this by an enlarged follicule through an ultrasound. If it's not enlarged, then start new dose (higher) the next cycle.

If your partner has normal sperm, it's ok to not to IUI as the first option because the problem is due to anovulation in the woman. But, IUI's are good if you have unexplained infertility because clomid by itself and insemination by itself really didn't do much, but the two together have shown better results. IUI's are fairly inexpensive, easy to do, and invasive, so these combined treatments can be very benefitial.

Things that Mimic PCOS
1st thing - rule out other things that might mimic PCOS, like congenitial adrenial hypoplasia (when adrenial gland pump out excess androgens), cushings syndrome (too much cortosol), insulin resistance b/c 40-50% can be insulin resistance (not necessairly diabetic, but their body pumps out too much insulin to fight off the diabetis; an insulin problem might cause an ovulation problem.

PCOS and Metformin
With PCOS, should metformin be used together? Open for debate. Connection between the two was discovered by a guy named Nesslin. High androgen levels can be due to not ovulating. Metformin can bring androgen levels down. However, it shouldn't be exepected to work alone (without an ovulation inducing drug).

Clomid vs. Injectables
Why is clomid the best? Why aren't injectables even better than clomid? Related to heirarchy of treatments. Injectables are an option, but most people would start with clomid first because it's easier, shorter duration, cheaper and it works for about 70% of women. Clomid is also pretty gentle - as in you don't have to cancel a cycle most of the time because they don't produce too many follicules. 25-30% of each follicule turning into a baby.

Injectables cost more, and could cause a much more troublesome response, even with low dose because the produce too many follicules. It's an option for sure if clomid has failed. Also, sometimes if you do injectables you should strongly consider IVF because you control how many embroys go into the uterus. If you can just get a PCOS patient to ovulate you don't have too many other issues getting pregnant.

Increase in Miscarriage due to Excess Androgens Present
However, there may be an increased risk in miscarriage regardless of IVF, clomid, IUI.. because oocyctes have grown up with excess androgen, which does bad things to egg quality. If you're going to to injectables you should consider doing birth control or lupron injectables to bring down androgen levels for a month or so, so that you can have eggs that grow up in an environment without all the excess androgen. Lupron PCOS users have shown a reduced rate in miscarriage (though, I've read there can be bad side effects with Lupron).

Next Steps after Ovulating on Clomid, but no BFP
If you do about 4 cycles with clomid and are ovulating but don't get pregnant, then you should consider injectables with IUI, or move straight to injectables and IVF. Most people feel comfortable with that because there's not much difference between clomid and injectables (just ovulate in a different way).

Hyperstimulation Risks
Are these people at risk of hyperstimulating? It's rare with clomid only patients, but people using injectables DO have a higher risk. In IVF you usually are at a bit higher risk because you are trying to encourage as many eggs as possible because you can control how many go back in.

Excess Testosterone?
Having more testosterone - Does your body just create this or do you get it more for hormones or steroids (possibly in food). Likely no, it's just your body. Some studies do show DHEA supplements (a weak androgen which has quality of life benefits) encourage androgens, so you should avoid this if you have PCOS. Mostly genetic that we don't completely understand. Not many meds to bring those levels down except for things like Lupron and Birth Control, which only brings it down for a short time (while on the meds and shortly after).

Looks like I might ovulate after all :)

So, the newest series of events in the clomid round two saga is that the temperature rise (which made it look like it dipped) must have been a fluke due to my cold and I actually haven't ovulated, yet anyway. I had been going back and forth in my mind, really wishing and hoping it wasn't true and that I had ovulated, and figured it would be a good idea to just run my chart past my new doctor and see if she wanted to do a progesterone test. I did end up having it done and my results were that of an anovulatory cycle - 1.2.

But... Today is CD30 and I think I will ovulate any day now. I had my first positive OPK on Saturday and have had a positive every day since (3 days, not counting today, which I won't know until this afternoon). They say you could ovulate anywhere within 12-36 hours from either the beginning or end of your LH surge. So, again - we wait.

In the past week or so, I have continued to have side effects from the clomid. I had hot flashes about 4 or 5 days in a row, mostly in the evening. And then, the previous two days, I had been nauseous in the AM and in the PM. Yesterday I came home with a headache and sat down to eat supper, thinking that would get rid of it. As I was finishing my last bite, I was thinking "I feel like I'm going to barf if I eat this". I did some googling and it seems that some women experience nausea around ovulation time. Weird. Maybe it's not due to the clomid after all.

As with every cycle, you can't help but wonder what the next step will be if the current cycle doesn't bring a BFP. With this cycle, even though I haven't even met my new doctor, if we don't get pregnant, I believe she will want me to do at least a month of birth control to try and suppress the cysts that are present. I believe the idea is that we might be more successful if we can just get them to go away and try the clomid without all of that present. Someone did bring up the question - is there another TTC friendly way of doing that same thing, instead of doing BCP, where you have no chances of getting pregnant that cycle. Good point. It had crossed my mind once, but I forgot to look into it.... my initial thought was is there some regimen of hormones (customized based on your personal, current levels) that would get rid of them. I still need to google and ask my doctor about this, if we end up needing to go that route. If I do have to go with BCP, I wonder which particular one will be right for me in my circumstances (for example, one that is better about clearing your system so that we can TTC the next cycle).

I decided while I am writing this that I would look into the suppression alternatives now - why wait :) I came across a site that tates "The oral contraceptives suppress gonadotropins which support "functional cysts". So, if the idea is to suppress gonadotrophins, and that is the only way to get rid of cysts, then I don't think that it's possible to get pregnant. I think you need gonadotrophins to be released for the rest of the key hormones that encourage ovualtion to work. So, I'm betting that a BCP alternative is out of the question, but I will definately still ask. The worst that could happen is that I get a weird look from the doctor, and I'm used to that by now!

I also came across this, though, and now I'm wondering if BCP would even work. When asked if BCP or injectable progestins (DepoProvera) prevent the formation of ovarian cysts, Dr. Frederick R. Jelovsek replied "Oral contraceptives are known to block ovulation in women with polycystic ovarian syndrome as well as lower the circulating androgens which can cause excessive hair growth. They are also used as pretreatment to decrease cyst formation when giving LHRF for in vitro fertilization. Thus they can be used to lessen the risk of new ovarian cyst formation even though they will not suppress any currently existing cysts. Neither oral contraceptives nor injectable progestins totally suppress all follicle development but they do suppress large follicles in the range of 3.0cm." I'm so confused. I know you can't believe everything you read, on the internet especially, but I am very curious now.

Anyway, I need to stop and focus on the here and now. Please be praying that I ovulate soon!! :)

Waiting to Ovulate!

So far so good I suppose. I'm currently on CD12 and my temps, while high, have been consistent and very "regular", compare to all my other cycles thus far. So, that is good. Now - bring on the O!!

Clomid Side Effects
This time around, doing 100mg of clomid, I had my first real side effects. They didn't show themselves until the end of day 3 while taking the pills and they were vision issues, fatigue and on the last day I was nauseous. The vision thing is the only one that was a little concerning because I wasn't "dizzy" really... I saw blurred streams of light when blinking or moving my eyes quickly and it was more prevalent at night. Thankfully all symptoms stopped when I stopped taking the pills.

Other than that, noting new to report really. I am anxious to see if I actually ovulate sooner this month. I really suspect that if I do, it won't be during the typical window of time. It would be great if it was sooner, but I'm not counting on it. We are, however, making sure we are covered so that if it does happen sooner or later, we are 100% ready this cycle. I was bummed that last cycle when I ovulated late we really didn't do as well as we had earlier in the month. Anyway, you live you learn!

I hate taking pills!
Oh, wait, there is more! I started taking Mucinex this month after I finished taking clomid. So far I'm not really sure how much it's helped... hasn't seemed to hurt really, so I will probably keep taking it. It is grose though - let me tell you. It's an immediate release medication so that means there is no exterior coating to keep the "flavor" inside. I can't swallow it fast enough!! I am so bad about taking pills that I pretty much gag every time I have to swallow one. Just the thought or smell of medication makes me get queezy. I did, however, start molding something soft, like a piece of bread or snack cake, around the pill to try and create my own magic coating... it has worked somewhat, but it just increases the size of the pill which is another thing that makes them hard to swallow. Ugh! I will be very glad when I'm not popping a gillion pills a day.

A Spooktacular Weekend!
And that, I do believe, is all I have for now :) I am very glad today is Friday and am looking forward to spending some quality time with my husband. The weather is supposed to be wonderful, so hopefully we'll spend some time outdoors, and we're going to our first Halloween party on Saturday, so that should be fun. We couldn't decide what we were going to be at first - but then it occurred to me that I still have my dress from "The Twelve Dancing Princesses" play I was in during the 8th grade. Low and behold it STILL FITS perfectly!! How pathetic is that! That means that I haven't grown since then. Yikes! Oh well, I guess it could be the other way around, right? Anyway, my date is going as my Knight in Shining Armor!! Now if only he'll rescue me from this infertility stuff, we'll be all set!

Technorati Tags: clomid side effects, mucinex, ovulate

I started my second cycle of clomid this week!!

Well, I saw my OB on Wednesday. We did actually - that's right, me and my husband! I was so happy about that... it made me feel so much more collected mentally when I was there and it was just nice to have him move involved.

She agreed that I did ovulate last month and I had a perfect temperature rise, which is great news. The not so great part is that I ovulated late on clomid (50mg), which isn't ideal, however I have read mixed reviews on this...

This RE thinks that only short cycles are a cause for concern, and that long cycles usually indicate excess ovarian reserve, which is a good thing.

Whereas, this ART company's site states that "too late" could be anything after CD20 which simply means that there are fewer cycles in a given time period to try for a baby, and that you may be releasing eggs that haven't properly matured, or that the other parts of the reproductive system aren't in sync with the egg. You can conceive late, but your chances are just reduced.

With that in mind, she wasn't sure what to do next really. We asked her if I ovulated late because of PCOS and excess cysts, and she said it's really hard to say why. She said we DO know that the Clomid did "something" because I ovulated and my temps looked good. That's when she started debating on whether or not to do another round of clomid or do supression with birth control. She ended up doing another transvaginal ultrasound to see what my ovaries looked like, and I still had cysts - no more or less than last cycle really, which she said was fine - and the good thing is there were no big cysts. She ended up polling the other OBs in her office to see if I should stay at 50mg or up the dosage to 100mg (the vote was split), and she ended up deciding to up it and move my start date to CD3 - both in hopes that I will ovulate sooner. From what I've read it's hit and miss. I am concerned that the larger dosage might do two things - cause large cysts to develop (which I want to look into more, and to see if metformin actually descreases this chance) and that it might dry up my cervical mucus, which you need so that the sperm can travel through your vagina and into your cervix to wait until the egg pops.


Taking Robitussin to Increase Cervical Mucus
To address the last problem, I am going to give Robitussin a shot. I didn't have but one day with egg white cm last month on the lower dosage of clomid and don't want to chance it being worse.

I did a little research and BabyHopes.com states that you should take two teaspoons (200mg), three times per day. When taking it during a clomid cycle, you should begin the day after your last clomid pill is taken. The site also suggests to take each dosage with a full glass of water. An alternative to liquid that I might explore (if I can't stand to swallow that stuff) is Mucinex, as it comes in a pill form. IMPORTANT: No matter which one you choose to take, the key is that the one and only ingredient it can have in it is Guaifenesin. If it has anything else in addition to this, it could have an adverse affect on your cm. And, yes, you can get the generic form of these drugs - you just have make sure it only has the one key ingredient.

You can tell by the sign on my coffee cup.

At least that's how I feel anyway. Nothing like a big cup of caffeinated brew on my desk to announce that AF is here and that screams "I'm not pregnant" like nobody's business. Fantastic. My temp plumeted on Sunday and again today... so it's official that cycle one of clomid was bust. I'm really trying to focus on the fact that I did ovulate and had a great 12 day luteal phase, but it's a little hard to swallow on the first day of AF. Little did I know that would only scratch the surface on what my Monday would hold.

When I got to work, I started my day at work by logging into facebook to wish my baby brother a happy birthday (20 if you can believe that!!) and learned that a long-lost, long-distance, but very dear friend and her husband are pregnant. Don't get me wrong, I am so very happy for them. They have been through so much in TTC and she is just about one of the nicest, most God-loving women that I'll ever meet. It's just - did I have to learn about it today, of all days! Ugh. And I hate myself for not feeling anything by extreme happiness for them. I am praying that God lifts her up in my mind and shows me hope!

Ok, so my day... as always, it gets better. I put a call into my doctor's office this morning... we wanted to set up a face to face to discuss next steps for the new cycle. There are just too many unanswered questions at this point to feel good about making a rash decision to take a month off and do birth control (to get rid of cysts) or give the green light on the second round of clomid (without having another transvaginal ultrasound to know if there are too many cysts to move forward). Ok, so pretty standard, right? Wrong. The nurse is like "ok, so who's the appointment with - Dr. Kiesler?... you do know that she's leaving right?" ummm... no. Leaving how - like leaving SSM or what? No, like leaving the St. Louis area.

This isn't happening to me. Really, I mean come on! The good thing is that they were able to get us in on Wednesday - which is also good because she'll only be here through next week. Hopefully I can at least get a good referral from her. Who knows!

If ALL of that wasn't quite enough... I officially have a creepy stalker at work. Like legit. I was hoping I was overthinking it last week, but today put the nail in the coffin. People - and I can't stress this enough - today is not the day to screw with me. I will tell you like it is and it WON'T be pretty. Leave me the freak alone!!!

Knowing that, picture me returning to work from lunch to see a big vase of flowers. I immediately am like "shut up" there is no freakin way! But to my pleasant suprise, it was from my super adorable loving husband who knew what a crapola day I am having. Big sigh of relief!

Man, it's gotta get better, right?!?! I don't know how much more I can handle.

My first offical 2ww!

It's Monday! And this week, that's ok because I had a great weekend with my husband and am so very thankful for that. We did lots and lots of eating - I'm talkin Mexican food, Ben & Jerry's ice cream, a yummy husband-grilled steak dinner, some IHOP... yeah, it was great! No, we don't normally partake in THAT much bad stuff, but it was oh so good. We watched a Baby Mamma (cute) and went to the Butterfly House in Faust Park (very nice, hadn't been there in awhile) and we got some great, colorful pics that day - the weather was almost too nice for fall weather.

To make it even better, I'm in the official two week wait - Day 7 to be exact! It's so hard not to get too, too excited. Even my own husband confessed to me that he's having a hard time with that as well. I've already started turning up the sensor on my five senses so as to detect the "baby" signs. Not many to report, but then again, I hear so many women say they go quite awhile before they notice something. In any case, it's been pretty darn fun thinking that some serious baby making action is hopefully happening in there :) I'm totally fascinated with the whole thing, to the point that I wish I had a little camera to watch it all unfold. How cool would that be! Then again, I suppose it could turn out not soo good if... well we won't even talk about that now will we!

For now, let's just concentrate on the fact that I ovulated and my temps look pretty darn good, possibly even triphastic as of yesterday, and that's all I can hope for. If it keeps up I just might test sooner than later just for fun :) Thank you cheap HPTs!

Technorati Tags: two week wait, pregnancy test

Praise God! Look at those temps!

I am so grateful today. Grateful for this beautiful fall weather, grateful for a warm inviting home, for a husband who would do anything for me. More than anything, I'm grateful for a loving God who never leaves my side.

It's days like today when I feel guilty for not publicly praising him more when I'm having a not-so-great-day; even still, I can't hold back today! Being realistic, I know this cycle may not be "the" cycle, but I'm ok with that. As much as I want us to get pregnant more than anything right now, I am simply high on the idea that I am almost 90% sure I ovulated over the weekend. Two days with a positive OPK, some decent low cramping on those same days and a significant temperature shift!!! PRAISE GOD!! He is hearing our prayers I just know it. I am so very grateful that he loves me so much that he heres my cry, even when there are lots of other super important things going on in this world right now - our economy, the election, the Iraq war... I could go on and on. I know it might sound stange to think of it like that, but when I put it into perspective like that, it truely is even more amazing!

Oh, and I neglected to mention that on Day 21 I went in for a progesterone blood test to see if I had ovulated on this first cycle of clomid. My level was 1.1, which is very low, as my doctor put it. I believe I've read that with an induced cycle, it should be 15 or greater... definitely no lower than 10. Obviously, this was BEFORE the weekend began, and the weekend is when I am almost certain I ovulated. Again, only time will tell! I'm waiting to hear back from my doctor as to her recommended next step, but I'm thinking she will say to keep an eye on my temps and go from there.

Oh, and tonight my St. Charles IES infertility group meets for the third time! I'm am still loving this group so very much and am thankful for each and every friend I've made there. Today's topic (I guess you could call it) is "show-and-tell"! It should be fun and interesting to see what others bring in to share with the group. Last meeting I brought in my ovulation microscope and was surprised to find that none of the other ladies have ever used one. I was pretty happy to be able to at least give them an idea of what it was and how it worked in case it could be helpful in their TTC journey. I'm still not entirely sure what I'll bring tonight, but I've got my thinking cap on!

My body is crazy!

So, a few days ago I thought I might have ovulated. Thanks to a few good ttc friends, I realized I hadn't. While this bummed me out for sure, I was attempting to take things in stride. Yesterday we were too pooped and full from dinner (yes that happens with us married couples!) to do any BDing. Figuring it probably didn't matter all that much, we weren't super concerned, though in the back of my mind I knew we probably should soon just to be safe. Which, brings me to today. Another day of taking things in strides. I had a very productive and therapeutic Saturday cleaning house - yes, I even did windows! And later in the evening, I did some late-night shopping by myself, which was again, very good. When I got home, the house was empty and I had this overwhelming feeling of "how I wish I was a mommy right now".

In the midst of it all, I decided to make some fudge espresso brownies (yum!), which I bought at the store in haste after thinking this month was a flop. It occurred to me just then that the pains in my lower abdomen I had been feeling in the afternoon were still there and more strong even. The weird thing is that they're not "cramps" and they don't feel like they're coming from my ovaries... rather it's a low, central dull pain - the same heavy feeling when I am about to get my period. Ok, so again - weird, however, my husband reminded me that the doc mentioned something one of my ovaries being more in the center? Anyway... earlier in the day I took a pregnancy test - knowing it would be false, but I just figured what the heck. So, tonight, when the pain was getting stronger, I realized I hadn't done an OPK in the last couple of days. So... off to the bathroom I go and what to my wondering eyes should appear but a POSITIVE - a bright red positive OPK!! Holy bleep :) At this point I have no idea what my body is doing, but I can tell you that we don't have to be told what we need to be doing tonight. TMI, I know, but hey. Who's modest these days!:P

Baby dust, baby dust, baby dust!

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.)