Tomorrow is another big day!

Our newest set of instructions came in today around noon.

Tonight
Stim again - this time Follistim 50 IU

Tomorrow
Lupron in the AM
Oral Meds
Another E2 blood draw before 8 am
US appt at 1 pm

At this rate, I’d say that we’ll, more than likely, have a Saturday egg retrieval (ER), since they’re still having me stim tonight, but maybe that’s too much to assume. Either way, it makes no difference to me. Any day is a good day for ER!!

I did ask how my E2 numbers came out and was told they look good: "we just want to bump up the follicles a bit more". She gave the numbers to me - 3,230 and 3,124 - but I’m not sure which one she said was Monday and which was today (sheesh). I am reading online and it sounds like it’s plausible the lower number is today and that it’s ok that it’s lower because they are controlling it by the level of stims they’re giving me (stims went down slightly and so didn’t the E2, is the idea). If the E2 goes down on its own though at this stage, it sounds like that’s not a good thing, but I don’t think that’s what’s happening here. Here is the reference I used to come to this conclusion. Surprisingly, there's not a whole lot of info on estradiol numbers as it relates to IVF circulating out on the net. What I got from SIRM regarding my estradiol was, when I asked her if the numbers are on track, and she said, yes, the numbers look good. So there you have it. I'm not really going to think to hard about it and just trust they know what they're doing. My, my how I am changing. :)

In other related news, it officially hurts to walk too fast. I knew that day would come soon. And I have been visiting the ladies room WAY more than I'd care to, but darn it if all that extra pressure just adds to the discomfort, so in I go, and back again I return about 30-40 minutes later. You'd think I would have stopped or lowered my liquid intake by now, but I've heard that extra fluid is good for growing follicles. Maybe it's an old infertile wives tale, but it seems like it would make good sense, so I've been downing as much as I can.

Ok, and yes, I know this is TMI, but gosh darn it, who cares. This is my blog! You know how they say you're supposed to get EWCM during your most fertile phase (i.e. right around ovulation). Well my silly little body must think I am getting ready to have the ovulation of a lifetime (which I guess is actually correct!) because ever since Saturday, I have had more EWCM than I've ever had in any cycle in my life. Hahaa! I'm going to chalk that up as a good thing. That maybe these hormones aren't too drastically different from what my own body would produce, if it was, say "normal". :)

Ok, I've had a good laugh, at my own expense, and my belly is poking out like I'm about 3 months along (from what I've heard anyway), so I'm going to think about retiring early for the night. You know... a little extra beauty sleep for these super fantastic eggs that are cooking, just waiting to break out and join their other half in a few short days.

Will update again tomorrow, and this time, will hopefully have a date/time for trigger & ER!

It might be boring, but still, it's progress!

Now, let me put you to sleep with the details... I finished my last Provera pill (10 of 10) on Sunday. In the past when I've taken this to induce a cycle, I only take 5 and then 2 or 3 days following AF will arrive. I expected the wait to be the same in this case, but it wasn't at all; instead it showed up the middle of the next day. Surprise! As instructed, I contacted my clinic to let them know it was CD1. They called in a BCP prescription (for Aviane to be exact, which contains ethinyl estradiol

and levonorgestrel, two forms of the female hormones estrogen and progesterone) and I was told to start my first pill no later than CD5. I have read before about CD3 being a common day women begin the regime, so I decided I would too and popped it late last night.

Everyone always talks about how funny it is that you're TTC and you are on BCP. :-) To me, if it seems weird or crazy, it pretty much fits right in with IF. hahaa! Actually, what I hate about the BCP, which I completely forgot about until right when I opened the pack, is that I feel nauseous from the stupid things. Years and years ago when I was on the pill, I dealt with this constantly. It would always take a good 4 days or so for my body to get used to the low-dose hormones. Even if I take them with food or at night, my stomach will hurt pretty much the entire next day. Ultimately, this is why I stopped taking them and switched to the Nuva Ring. Anyway, is it annoying - yes. Will it be worth it - yes indeed! This is mild to what these next couple months will throw at me, I'm sure, so I best get used to it now. *grin*

Why do most people take BCP during an IVF cycle?
Most of the time, and I fit right into this personally and because I'm cycling at SIRM, women with unpredictable cycles are put on the BCP to sync their body with the rest of the women who are cycling that same month. I believe that sometimes even women with regular cycles will be put on this because they want the ability to do ER & ET around the same days for scheduling purposes. Also, in women who are known to be classified as "high responders" (where they will recruit lots and lots of eggs), the pill is thought to lessen the risk of dangerous OHSS. Since I am PCOS, I fit into this category as well.

A little clarification from my last IVF update...
I spoke with Mary again. Based on her previous note, she cleared up for me that the ER will fall on 8/5 or after (not 8/3). Beginning around 8/3, I'll be in their office sometimes daily for monitoring to see how the follicles are doing. I’ll then have approximately a 2-day break between the HCG and ER and then a 3-6 day break between ER and ET. So, knowing this, I am able to get a better idea that the first two weeks in August will be when I'll be taking quite a bit of time off work for appts, procedures and bed rest.

Things you never thought you'd tell your boss :P
I am fortunate enough to work for a wonderful company. We're a fairly small group (just 13 of us) and the owner/my boss is a young guy himself. I have always been able to be extremely open about family priorities, career goals, etc. and everything as always been very well received. I'm happy to report our upcoming IVF is no exception. I filled him in on the general idea of how things will work, which tells the story of when I'll need to be out of the office and sometimes the very short notice of when I'll need time off (take those two weeks in Aug for example). He was fine with everything and was more interested to say things like "Are you ready for this?" and "I'll be crossing my fingers for you." With IVF, I feel like we have to put our best foot forward and the last thing I need to do is stress about about my job too. It's such a relief to know that isn't a concern - I consider it a blessing from God!

What's next?
I'm waiting to get a call from my IVF cycle coordinator, Peggy, who will then set up our IVF calendar review. I was told on Monday she would be contacting me within a week or so and to mention it to them if I hadn't heard anything. So, I wait. If nothing by, say Tuesday of next week, I call. I think that's fair, don't you ;-)

Oh and - let the countdown to shots begin!
It was also confirmed that down-regulation (also known as ovarian supression) with Lupron will begin on or around July 15 (like I posted way back when). That's now less than a month away - hooray!

Oh to be a woman!

Before I share my "poor me" pity party I had yesterday, let's have a little laugh. This has to be one of my favorite videos. It's on a related subject of a bad case of the darn rampant, womanly hormones. (Yes, Mom, this is the video I was telling you about!)

God help me when I actually start on IVF meds, I just might be one of those ladies!!

As for yesterday, ah, yes... onto the pity party. Yesterday I had a small case of the blues. You know... popping a tear at the little things. It was silly really. Every now and again you sit back and look at the big picture and wonder what you're life will look like in a few years... just hoping and crossing every finger that it will include us with baby in tow. Anyways, it was one of those days. Every time I turned around there was something that moved me.

Like the story of a young couple who tried and tried to get pregnant and finally - after doing IVF - they got pregnant, only to loose their baby after it was born very prematurely because the mother developed severe, life-threatening preeclampsia. They watched him fight and fight for life for several weeks, only to have him pass away in their arms. Wow. What a life-altering experience. One that I can't even, and am completely and totally scared to, imagine. My heart aches for them.

Or the fact that my good friend Meghan's first IUI was looking like it wasn't going to pan out for her. They deserve this, darn it!

And then I check FertilityFriend to see where I am in my current cycle and think "ok, so I'm on CD 35... I had fertile-like signs around day..." - wait, who am I kidding. It's silly for me to even think that I'd have a chance at anything, but my heart always tells me that God can work miracles. So the glimmer of hope remains, as silly as it is with as crazy as my body is.

Did I mention my husband turned 31 on Sunday. That made me sad yesterday too. Not because I'm married to a guy in his 30s, but because "that" 31-year-old guy, who happens to be MY husband, isn't a father yet. I want us to be young parents, if I haven't mentioned that before.

And, last but not least, this darn song that I keep hearing on the radio. I've heard it enough now, and sang it enough while shuffling around the house, that I felt the need to share a few lines. There is a reason that I heard this song while coming into work yesterday AND going home (my drive time each way is all of 3 minutes). It was a nice way to end a day and helps me to stay focused on what's ahead.

There is hope for me yet
Because God won't forget
All the plans he's made for me
I have to wait and see
He's not finished with me yet

Still wondering why I'm here
Still wrestling with my fear
But oh, He's up to something
And the farther on I go
I've seen enough to know
That I'm, not here for nothing

He's up to something

2009: A year of faith and happiness

It's time to take a deep breathe - '08 is now complete and I am mustering up the strength and faith to face 2009 head on.

In celebration of my Dad returning from a tour in Iraq, me and my husband, my Mom, Dad and brother all went to Chicago for a short vacation. It was the first time I had been on a train since I was a little girl, and the first time I really had the chance to explore the city somewhat in depth. All in all it was fun to spend time with the family, do touristy things and have a chance to girl-talk with my Mom - everyone needs a good dose of that from time to time.

The unfortunate part of the trip was that hormones must have been getting the best of me. I was a real bear, let me tell you. I was frustrated over the littlest of things and have never wanted to curse or throw something through a window more than on that little vacation! By the last day I was really trying to be more aware of what would set me off and just retreat to my "happy place", hoping the moment would pass.

Ok, so maybe hormones weren't the only thing to blame. Some of my other issues I will let rest, as it's just not worth bringing up. I will say that I think things from the past few months have really just come down on me harder than ever before. While we seem to be getting closer to a path, or infertility diagnosis, I now feel the weight of life bearing down on my shoulders. How are we going to pay for this? Are we selling our house - if so, what needs to be done first? How am I going to make it through repeated self-injected shots? I could go on and on.

For some strange reason I felt this overwhelming sense of failure surrounding a lot of things in my life. Now don't get me wrong - I know I am quite blessed and have accomplished a good deal in my still seemlingly short life. In fact, I struggle with allowing myself to vent like this because I know so many people have far worse things to deal with. I feel so selfish sometimes. What is certain is that I can't continue to stress and overplan. Infertility is teaching me to take each moment as it comes. Some days this is easier than others though - this past weekend it wasn't easy. I felt a strong urge to invision, plan and make certain my life is going in the direction I so badly want it to go in.

I say all of this to admit that I need to resolve to have faith that everything is like it is for a reason and that God is in control of every situation. I need to believe and let go - allow myself to take one day at a time and learn to take care of my mental, as well as physical self.

I guess you could say that's my resolution for this year - to simply let go and be happy. I think I'll begin that by enjoying my 8 year anniversary with my husband tonight... a little birdie tells me he's planning a relaxing evening at home. A welcomed, much needed treat!

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!! :)

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! :)

I LOVE IT when doctors listen!

I haven't written lately, but a lot has happened. The last week was primarily filled with a lot of late nights and uneasy, unproductive research for my first appointment with my OBGYN. Well, not "first" appointment ever with her... I have had the same doctor for about 3 1/2 years now, but have never been TTC and have never really went into an appointment with a true agenda.

I was so nervous because I feared that I wouldn't know what to say or what to try and demand. It's tough getting appointments with her sometimes and I just didn't want to waste any more time. After a long night of reading and studying (it felt like preparing for a college final all over again), I headed into the doctor's office that day with a binder full of key information and an outline of what I wanted to ask and insist on.

In the end, it didn't really come down to insisting. My doctor was actually very in tune and seemed aggressive about wanting to get me on track. The conversation went a bit like this: So, you've been trying to get pregnant since April. Yes. And when was your last period? 2 weeks ago - I have been charting, if that's helpful to see. Oh, you're on the ball. Yes, let's have a look at that. Ah, so you're last cycle was 67 days long - that's too long. And... let's see... you've definitely not been ovulating. If you were, you'd see an obvious shift... your temps aren't showing any sign of matching this shift. Let's get you started on metformin. This will help to regulate your cycles and encourage ovulation. If we need to go with clomid at some point, we might do so, but let's see how this does. Sound good? Sure does. Do you think we should do bloodwork again? Well, it has been almost two years since we did it last... let's go ahead and have it done. You can schedule it today in our office, if you'd like.

Long story short, they took my blood and checked for FSH, LSH, and something else... can't remember right now. The two tell-tell levels were very out of balance. I think my LSH was 3 x the FSH level, but I'll have to double check that.

I started metformin and so far so good I guess. I'm hoping my temps level out and I start seeing something normal. Wish me luck!