One Small Step

A week ago, I stepped into my OB/GYN’s office for the first time in over a year. A half hour later, I left with a new prescription for Clomid, Provera, and Metformin. It all felt so familiar, it was as though I was living my life of two, or five, years ago.

Except I came home to a house full of children, screaming and fighting, and a floor that was unseeable because of the massive field mine of toys that stretched from the front door to every corner of every bedroom, and I had to ask myself, can I even handle another child? Can I handle the constant stress and mess and lack of rest? Because some days it feels as though I am seriously failing. Some days, it feels as though my head might explode if one more child whines about what is on her dinner plate or about how itchy her shirt is or about having to pick up her toys before bedtime. There are days when the monotony of parenthood — the barage of reminders I have to give Cupcake in the morning so that she will be ready for school on time, the taking of Skittle’s hand numerous times a day to lead her to the potty, the gentle (but infinite) guidance I have to give Poppy to keep him from unplugging every lamp in the house, the meal planning, the drawn-out bedtime routines, the toy pick-up over and over and over — seems overwhelming and exhausting. And so often, the worry that ebbs and flows over my children’s health — worry about everything from allergies (yes, lots of them) to asthma (probably not) to mysterious fevers, strep, UTIs, and yeast infections (the last four of which have all made an appearance at our house within the last three months) — just feels like so. damn. much. TOO much for one person, or for at least this one person, to handle with any sort of grace or dignity. And to think of doing it for one second longer than I have to seems foolish.

And then there are the other days. Days like yesterday, when I take just Cupcake out for hot cocoa and we talk about wonderful things while we sip from our cup and she is a delight to be around and declares it “the best day ever.” Days when Poppy takes a few steps on his own and then collapses onto the ground in a fit of belly laughs because he is so proud of himself, or  when wide-eyed Skittle crawls into my bed and whispers into the darkness of the room, “I love you, Mommy.” There are days when the kids are happy and loving from sunrise to sunset, and thank me sweetly for the cookie on their plate at lunchtime, and play nicely together all day long. Or maybe they don’t — maybe they fight or argue about who-knows-what and yell and snatch toys away, but then they say “sorry” unprompted and give each other an affectionate, genuine hug and all is well again. And there are days when we go on adventures as a family, near or far, and nothing on our list of daily tasks to do weighs on us. And there are days when we spend a relaxing morning at home, us adults sipping coffee with our littles snuggled next to us on the couch while we watch home movies, and I am suddenly reminded how quickly the years go by and that they will be all grown up in a flash. Those are the days when my heart explodes and I wish I could do this a million times more.

Though we are not taking any preventative measures — and haven’t in nearly eight years — we are not yet officially “trying” for our fourth take-home baby. But we are putting a plan in place. I have significantly cut back on sugar and caffeine. I will wean Poppy over the course of five weeks starting in April. I will order my regime of vitamins at some point in the future if necessary. And now I have my prescriptions, for better or worse. And perhaps I won’t even need them. Perhaps lightning will strike twice and I will fall pregnant with my one lucky, post-weaning ovulation as I did with Poppy. But that seems like a little too much to hope for and so I am preparing for a harder journey.

I don’t know what will happen in the months to come. I am hopeful and excited. I am apprehensive, scared, and even a little sad. This very well may be our last baby. It’s a relief to be at this point, but it’s bittersweet as well. It hurts to think that this could be the very last time I do any of this. Even more, it hurts to think that I may not get to do it at all. I mean, let’s get real, you guys. My ovaries don’t work as they should. None of this is a given. And so I’m fearful of what is to come. What I will have to endure. What I will put my family through in doing it.

It’s a difficult thing to go forward, knowing that the path ahead could be nothing but a journey towards failure, disappointment, heartache, and loss while also knowing that it’s probably possible to be perfectly happy with what I have right this minute. My children are incredible. My life feels full. It’s hard to imagine being much happier than this. And yet, without this fourth baby, I know that it will forever feel as if someone is missing around here. Our family is not complete and missing someone who could have been here, if only I had tried, is not really the way I want to live the rest of my life. I have never let fear or doubt stop me when it comes to going after something I really want. And this — this big family — is something that I want so much. I have longed for it since childhood, long before I met my husband or ever heard the term “infertile.” Even when we were celebrating just having one, so grateful for the opportunity to be parents at all, my heart always yearned for more. And it feels so, so close.

So we will try. Come what may, we will try to achieve what always feels impossible. A miracle.

Waffling & Worrying

It’s hard to describe the place I’m in right now, but it’s not good. The beginning of this new year has really thrown me for a loop. I waffle between despair and limited hope on a minute-to-minute basis. On New Year’s Day, it occurred to me that I have little to look forward to in 2013 at this point, only a whole long list of things to dread: my sister’s baby shower, the birth of my niece or nephew, the birth of my cousin’s little guy, endless months of fertility treatments and BFNs. So many people I know have so much to be excited about this year, but not me. Realizing that sent me sobbing into my husband’s chest as he was trying to sleep until I finally fell asleep myself. I’ve been feeling emotional and heavy-hearted ever since. 2013 terrifies me because it feels like a make-or-break kind of year. By the next New Year’s Eve, we will either have a baby, be expecting one, or be quitting fertility treatments. I don’t want to face that.

In other news, we now have a plan for my next cycle. If I haven’t ovulated by CD35 (it’s CD27 today), I am to call the nurse to let her know and then begin Provera (well — my cheapie generic kind of progesterone) to induce a period. I really want to start this tomorrow because I don’t think I’ll be ovulating any time soon and I just want to move forward, so I may just do that. And in two weeks, when my period comes, I’ll then call and not bother to mention that I took the Provera before I was supposed to.

My RE is willing to switch me to Femara for my next cycle and try that for two cycles before adding injectables, but I have spent the last week (as I waited for a damn callback from the medical assistant) thinking all of this over. As I struggle with the concept that this year will really be the beginning or the end for us, I feel a strong urge to take action. I’m tired of standing still, or of doing the same thing over and over, expecting different results. I have pondered it, and prayed over it, intensely and I feel like the right answer is to move full-steam ahead, at least for now. We know that my body can and often does respond to Clomid. We don’t know how it will respond to Femara, and I don’t want to waste time trying to figure it out. Not now. So with that being said, we’ll try Clomid (I’m unsure if it will be 100 or 150mg) again (days 3-7), followed by Follistim injections until my body responds.

I feel like this is the best option for me, but there are three things causing me rather grave concerns in regards to this (three things that, once again, had me crying when I hung up from talking to the medical assistant):

  1. I learned that, with injectables, I will be required to do a baseline u/s on CD2 or 3…something I haven’t had to do thus far. I cannot tell you how hard it is for me to get into the city for these frequent ultrasounds. With driving time, it takes a total of four hours for a 15-minute appointment. On top of that, I have to drag my husband along with me because there is no way I can keep Cupcake quiet and occupied for 15-30 minutes while my feet are up in the stirrups (yes, it has taken 30 minutes in the past for a monitoring u/s because of stupid Lefty who likes to play hide-and-seek). I can forfeit my time, but I worry about the impact on Honey’s job and the extra $200 that yet another u/s will cost me.
  2. Follistim is not cheap, nor are the ultrasounds and, because I don’t often respond immediately to the Clomid (maybe Follistim will be different?), I often need several ultrasounds. Furthermore, I can’t really prepare for the costs because I don’t know how long I’ll have to take the Follistim for each cycle and I don’t yet know if my insurance will be covering the ultrasounds…but I’m expecting it won’t. So I’m freaking out about the expense and, even with some financial support from my mom, I am afraid we’ll get in over our heads…but what other choice do we have? Stop trying before we’re ready? I can’t let money be the be all and end all, but the thought of a huge bill at the end of each month is causing a great deal of panic.
  3. This is the least of my worries, and rather vain and petty, but I have heard the horror stories of the weight gain injectables can cause. I have struggled with weight and body image my whole life. I grew up thin and tall for my age, but gained fifty pounds in my early adolescence and it forever changed the way I look at myself. I lost that weight in college and have maintained a healthy weight ever since (ten years now!), but I still live in fear of regaining those pounds. I don’t want to be fat again.

So that’s all I know right now. I’ll be starting progesterone to bring on yet another CD1 sometime in the next week. I’m ready to take a more aggressive approach because I’m losing patience with all of this crap, but I’m terrified of the consequences of said approach. And I’m tired. I’m tired of feeling this way. I just want to have the same hope and optimism that I had when we rang in 2012. But I feel like that girl is long, long gone.

A La Dr. Young

I had a successful appointment with my RE this afternoon. I went there feeling jittery with nerves. I was expecting to leave feeling discouraged, after hearing nothing but gloom and doom and being told that our only hopes of conception are IUI or, worse, IVF. I got none of that.

We came up with a plan going forward, which I’ll get to in a minute, but first, we talked about plenty of other things. A *quick* summary:

  • Dr. Young thinks it’s probably wise to quit taking all the vitamins that we are on as they aren’t well regulated and there is not solid research proving that they are beneficial for reproduction. She thinks the only ones to continue with are the prenatal, omegas, and vitamin D (because of the climate we live in).
  • She would advise me to discontinue baby aspirin until after my BFP. I am young and healthy, so it is unlikely that I’ll develop an ulcer or bleeding issues from the aspirin, but it’s still possible and she always likes to error on the side of caution.
  • She will gladly prescribe progesterone suppositories, but she stressed the importance of taking them at the right time in my cycle. If I am being monitored and doing a trigger shot, I can take them three days after ovulation. If I am just predicting date of ovulation by OPKs, she wants me to wait a week just to be on the safe side.
  • She reviewed my 2009 2 hour glucose tolerance test. One value was abnormal and had me worried about possible insulin resistance, but she doesn’t think one abnormality is a concern. She would still recommend stopping the Metformin (I have been reluctant to thus far). She says she used to give it out like candy ten years ago, but after a study was done with Metformin and Clomid proving only a very few people benefit from it (by ovulating) in taking only Met, she thinks it’s unnecessary and worries about long-term safety.
  • Dr. Y reviewed my husband’s semen analysis with us and says his motility and count are excellent (which we already knew). The morphology is a concern and some doctors would automatically recommend IVF, but she says she’s not one of them. In a perfect world (where cost and time aren’t a consideration), she would say go with IVF w/ ICSI because it would give us our best chance. I’d probably be pregnant in a month or two, she predicted. But with the amount of money and time that must be invested in an IVF cycle, and with our prior two successes (BFPs), she doesn’t think it’s warranted yet. Nor is IUI. She wants to continue on the same road we have been.
  • She is billing my insurance under “PCOS” and “irregular periods,” but she did warn me that the insurance company can do with that information as they want. They could still deny coverage if they find out I’m taking Clomid. Fingers crossed that they don’t decide to be jerks about this!

Basically, from all of this, I got that my doctor is conservative in the drugs/supplements she encourages and describes, and likes things to be as simple as they can be. I respect that and I respect her. She’s got fantastic bedside manner, is open to all questions, and I appreciate that she seems well-read and well-informed. I truly trust her. However, that does not mean I necessarily agree with every recommendation. At this point, I’m going to continue baby aspirin and Metformin. I’m just too scared to quit right now. But I will re-evaluate the vitamins we’re taking and start with progesterone suppositories — but next cycle. This one, since I don’t have much hope for it and it’s already 9dpo, I’m just going to relax and take things easy.

And now for the plan… When my period comes, we will try 150mg (instead of 100) of Clomid in hopes that it may help my body to respond and ovulate sooner than CD20+. There is a greater chance of side effects, none of which I am particularly concerned about except possibly the elevated risk of cysts (because I’ve had them in the past) and the thinning of my lining. However, my last u/s (on CD16) showed a multi-layered lining of 11.5 (and that was after many months of Clomid), so Dr. Y is very encouraged that it may not affect me too much. And if the 150mg doesn’t work? We’ll do a combo cycle with Clomid (or Femara?) and an FSH shot.

I am pretty comfortable and happy with this plan. We’re moving forward, trying something new, but not doing anything too drastic. I’m slightly freaked out by taking Clomid for so many cycles and about the cost of the FSH and about giving myself an injection (eek!), but one day at a time, right? One step at a time. Breathe in. Breathe out.

Thinking It Over

I’ve done some serious thinking over the last couple days, since getting the results of my husband’s semen analysis, and I know ya’ll are right. I need not make a hasty decision right now. I shouldn’t feel pressured to do anything that I’m not comfortable with. And I must get Honey re-tested.

Which is just what we’ll do. Soon (I hope). I’m not exactly sure how Honey is taking this news of his ill-shaped swimmy friends, but I do know he’s been googling himself into delirium trying to get all the facts. And we all know how *reliable* Dr. Google is. But there are some suggestions for supplements and herbs to consider, which we will, after getting a second SA. And because my husband is a skeptic and suspicious of everybody, we will be retesting at a lab that is not associated with the fertility clinic that is pushing for IUI. Our insurance will allow us to go to a specialist without a referral, so Honey plans to make an appointment to see a urologist (hopefully one specializing in male fertility) and will then get another SA from there, if all goes according to planned (which, you know, it rarely does).

I’m not particularly hopeful that the results will be any different, but I’m also not particularly panicked by it anymore. All of a sudden, I feel sort of indifferent. I don’t know what to think. I keep coming back to the same thing that so many of you reminded me of. I’ve had two pregnancies that happened rather quickly after I started ovulating. That has to mean something, right? Either that…or those babies really were true miracles.

I will say this, though: while not all hope is lost, I have lost my confidence. Confidence that this will happen. Even after my miscarriage, I was certain that that we would have another child, though I wasn’t so arrogant to think that it would happen quickly or easily. But now…I can’t say even that. There is more doubt than there ever has been before (at least since we began TTC #2). More uncertainty. I still hope, but no longer am I sure, that Cupcake will be given a sibling. Instead, this journey is just starting to feel long and endless and sometimes I question the value of it. Is it worth it? Is all this pain, heartache, frustration and fear worth it? The problem is, we don’t really know the answer to this ever-important question until our journey is over — one way or another.

And so I march on. I will not let our fertility clinic talk me into a step that I am not ready to accept or embark on. IUI is our last resort, for there will be no IVF/ICSI for us, and I’m not ready to tap it just yet. For now, we will continue as though my husband’s sperm are the macho men we wish and once believed they were. I will go forward with this monitored cycle. I will do a trigger shot when the time comes. We will get naked together every other night until we know we don’t need to anymore. And next month…we will do it all over again.

Once Upon an RE…

As many of you know, I went to to visit an RE for my very first time on Friday. It was a frantic morning because they had to move my appointment to the 8 a.m. slot at the last minute, which meant waking my daughter an hour before she usually gets up and making an hour-and-a-half commute to get there in rush hour traffic. We had to park a block away and ran to the office (and I did not wear running shoes!). We arrived three minutes late, which I really hated and it left me feeling out of breath…which would probably explain why my blood pressure was 150/88 when the pregnant (of course!) medical assistant took it (it’s usually around 110/70). Ugh.

But the appointment went well, for the most part. My doctor, whom I will call Dr. Young because she is (late 30s? early 40s?), is straight-forward, easy to talk to, and open to questions. Since I’ve only spent an hour with her so far, it’s hard to have a real opinion, but I think I will like her and feel comfortable with her and I certainly do have confidence in her expertise. And surprisingly, she is in agreeance with much of what my OB/GYN, Dr. Smiles, already told me, which was unexpected but reassuring. We talked about a lot in the time that we spent with her, so please forgive me if this isn’t organized well. I think I’ll do it with bullet points (to at least give the illusion of organized thought):

  • PCOS: Yes, she thinks I have it. She says I am not a “classic” PCOS patient in appearance or labs, but she diagnoses PCOS through the process of elimination (every doctor has different criteria, I have found…I’ve seen four different doctors and they’ve all told me something different!). When someone has irregular periods, she rules out thyroid disorders (check!), prolactinemia (check!), and perimenopause (check!). If someone has no signs of those but doesn’t ovulate regularly, then she diagnoses PCOS. And it’s possible that the only sign of PCOS could be irregular cycles. So yeah…I guess that means I join the PCOS Club. Officially. My biggest fear in being diagnosed with PCOS was the high risk of miscarriage, but she assured me (just as my OB did) that there is no connection between the two. The studies that linked them were old and did not take into account diabetes and severe insulin resistance (which can cause miscarriage). If you exclude diabetics from the studies, the miscarriage risk would have been proven to essentially be the same as anyone else. So that was a relief to hear. I know there will be differing opinions on this, as Dr. Young reminded me there always will be, but I’m choosing to believe what she’s telling me. I need to believe for my own peace of mind.
  • Metformin: This is not a drug she prescribes, unless someone is clearly insulin resistant. Recent studies have shown that there is no proven benefit in helping with ovulation and she is hesitant to prescribe any drug that isn’t proven to be useful and has no long-term studies about it’s safety. I asked her if I should stop taking it and she says she thinks I should because, while I am lucky to suffer no GI side effects, there is the potential for liver and kidney problems…they’re rare but possible. And after thinking it over, I think she’s right. I have been taking this drug for three months and haven’t seen one bit of change in my cycles. I’m not insulin resistant, so why take a drug that I probably don’t need? Even the pharmacist told me that I was taking a very high dosage when I picked up my prescription last month. So I think it’s time to quit. I’ll wean myself off of it over the next few weeks and be done. I’m a little nervous about that because I know some do believe that Metformin can lower m/c risk, but Dr. Y doesn’t and I have to keep reminding myself that I didn’t need it while pregnant with Cupcake, so I probably don’t need it now either. Right?
  • Blood work: I successfully completed all the preliminary bloodwork through my OB and my RE doesn’t think any of it needs to be repeated at this time. Yay! This also means there won’t be any delay in starting treatment. Go me for totally being on top of this!
  • Chances of success: She reminded me that, with every cycle, there is only a 25% chance of success. I was very lucky to conceive on my first Clomid ovulation with both Cupcake and Teddy Graham, but I can’t expect it to happen every time, so this process is going to require some patience on my part. While I may be growing tired of Clomid because it’s not “working” (i.e. no BFP), it is doing it’s job and producing an ovulation. Now, it’s just a game of wait and hope.
  • Semen analysis: My husband asked about having one done. Honey had one come back as normal two years ago, but Dr. Y doesn’t think it’s a bad idea to have a recheck and we agree, so we’ll go ahead with that. Last time, my hubs got to do his business at home and take it in afterwards, but this time he’ll be doing it at the lab, which I can tell he is uber-excited about. He’s so fantastic, though, and hasn’t complained for even one second. It will cost us $110, which seems like nothing compared to everything else.
  • Short luteal phase: Dr. Y does not think this is a problem for me. She considers a luteal phase too short if it is less than 9 days. My shortest one has been 10 or 11 days and she doesn’t feel this needs any treatment. I asked why sometimes my LP is so much shorter than it is in other cycles and she said it’s just based on different hormone levels produced for that particular ovulation. Hmmm…
  • Baseline scan: I had a meet ‘n’ greet with the dildo cam at the end of our visit. It was the first time I had ever had that done during my period and can I just say…ew, gross? It was really, really gross and I’m sure much more so for my doc, but she’s used to that, right?  Anyhoo…she did conclude that my ovaries look polycystic (with 10-12 visible follicles on one side and 12-15 on the other, when the most she should see is 10 and that’s in someone much younger than myself). Also — there are no ovarian cysts or visible uterine fibroids. Good news! She also determined that my lining got plenty thick in my last cycle because, when she measured it, it was 11mm…and that was on CD2, after a full day of bleeding. So Clomid isn’t causing problems with that at this point. More good news!
  • Progesterone levels: In September, my P4 was 11.0 at 8dpo. I was less than excited about that number, but the doc doesn’t think I have a reason to worry. She says she only orders a P4 test to see if someone has indeed ovulated (anything over a 3.0) or if she is concerned about a very, very short luteal phase. She never bothers with the actual number and doesn’t monitor it in her patients because she doesn’t think it provides enough information to be worth it. Which means she doesn’t think I need progesterone supplementation of any kind at this point. She did say, though, that a trigger shot will probably help my body to produce more progesterone.  Which leads me to…
  • Treatment: I asked about switching to Femara, but for now, Dr. Y wants to stick with Clomid. She says that “they” say you shouldn’t take it more than twelve times in your lifetime, and this current cycle will be number 12 for me, but she is willing to let me go two more after this one. She really wants to do a monitored cycle and a trigger shot for this round, to see how my body responds. So I’m scheduled for a scan on day 12 (Nov 12) and we’ll go from there.  Hopefully, I’ll be ready to trigger and then we wait. If not, I’ll have to return for another scan and keep doing so until I am ready for the shot. And if this cycle doesn’t end happily, we will do two more rounds of Clomid, of which I will have to decide if I want to do monitoring or not (not recommended, but allowed).  After that, I’m a bit confused about where we go from there. There was talk of Femara, IUI, and IVF, which raised my level of anxiety and panic to unknown heights. I do know there won’t be any injectables (maybe if I beg?) because, when combined with PCOS, the risk of multiples is just too high. I have a follow-up scheduled with Dr. Y for Dec. 4, where we will create a long-term treatment plan. Which scares me to death.

So I feel pretty good about most of this, but there are a few concerns I have:

  • I felt a bit rushed at the end of the appointment and had to speed through my final questions, which was a bit irritating. I know Dr. Y had a procedure to get to (which is why my appointment had to be moved up), but I’m a new patient and have a lot to talk about…don’t I deserve her time and focus while she is with me?
  • I’m not thrilled that I won’t be getting progesterone suppositories. Dr. Y doesn’t think I need them, which is great, but what if she’s wrong? I want a safety net. One thing that will let me breathe a little easier and say, “At least I don’t have to worry about that.” So I may push her on this a bit more down the road.
  • Monitoring and especially the cost of it. One u/s scan on day 12 and a trigger shot? I think we can afford that (definitely can if my insurance picks up any of the cost). But I am fairly confident in saying that I don’t believe I’ll be ready to trigger on day 12. I normally ovulate days 19-23…a whole week (or more) earlier than this seems too optimistic to me. Which means I’ll probably have to return for another scan. And what if I’m still not ready and have to go back for another? The costs will just keep climbing and, while we can do this for one month, I’m not sure it’s something we can do over the span of several. Not to mention the exorbitant time that will be required, especially with the holidays nearly here and with a toddler in tow. It takes at least an hour to get to my RE…and an hour to get home. That’s a lot of time, especially if I have to do it more than once a week.
  • Too much too soon. In other words, taking an approach that becomes too aggressive too quickly. I am willing to stick with Clomid or Femara for a good few months and maybe do monitoring and a trigger for those cycles. But to go straight from Clomid to IUI in just three months? That’s when I start to feel my panic rise. Because I know that IUI is the end of the road. There will be no IVF for us. This is not something I’ve discussed before because I haven’t thought I would need to, and it’s something I will explain more if it comes to that, but I just know that, right now, we have drawn the line there and IUI is the last stop. And so in three months, if Dr. Y wants to move on to IUI, it will be my final and only hope and that is just too scary. I am not ready to arrive there yet.

So over the last couple days, since meeting with Dr. Y, I’ve been feeling overwhelmed. Overwhelmed by the money and time all of this will require. And overwhelmed by the possibility that none of it may work. That the bills will pile up and it won’t be worth it in the end because I won’t have another baby. But as my mom keeps reminding me, I need to take it one step and one cycle at a time. Why worry about IUI in three or six months when this very cycle could be The One? So I’m taking lots of deep breaths, praying, and just trying to balance hope with expectations. Faith with realism. Not worrying about what hasn’t happened yet, and still preparing for the worst case scenario. It’s a very fine line.

And so there you all go…the story of the day I met my RE. Fascinating and heart-warming, isn’t it? So sorry about the neverendingness of it. I do promise you that one day — one day very soon! — I will publish a post that doesn’t take me three hours to write…or you a whole hour to read.


Well, I guess it’s a three-post kind of day. Sorry to fill up your readers with my babble.

But I’m proud to announce that one more thing has been checked off my list. I have found an RE! In the last few weeks, I have searched high and low, researched all five fertility clinics in our area, spoken with two out of my top three, reviewed to see what past and present patients were saying, and come to a decision. And today, I made an appointment with my top choice who I am, so far, very pleased with.

What won me over? you ask. I’ll tell you. It was quite a few things really. Their doctors and their lab are both in-network for my insurance carrier, which means that diagnostic procedures will be covered in full. They got the best patient reviews on Yelp. They were able to schedule me immediately (though I chose to wait a while for my appointment). They responded to my e-mail (one clinic did not). They allow children to come to their clinic (one clinic has a strict “no children” policy). They told me that they don’t often bill under the “infertility” billing code, which might mean that my insurance will cover more than I think. They have several female RE’s to choose from. They are not too small (i.e. expensive) nor too big (i.e. a baby-making factory). They do prescribe Femara and allow unmonitored Clomid and Femara cycles. And the particular doctor that I requested is their clinic expert on ovulatory disorders and pregnancy loss. All of this has led me to believe that I will be in very good hands.

This is a huge step for me as I have never come this far in the process. While it took over a year to conceive my daughter, I never had to see an RE to do it. I just kept taking Clomid until it worked. I could almost pretend that I got pregnant like a normal person. But in going to a fertility clinic, that illusion will be gone with the wind. So I’m scared, but excited as well. Not so excited that it has come to this, but excited that I have a plan and that I have confidence in the clinic I have chosen.

My appointment is scheduled for November 2 at 10am. This should be at the end of my next cycle or at the beginning of the cycle after it. I’ve already completed most of the initial bloodwork through my OB, so I’m hoping we’ll be able to move forward with treatment quickly. Of course, what I’m really hoping is that I’ll get the joy of calling to cancel that appointment thanks to a positive BFP in the next month or two. But if not? I’m ready.

I’m ready, come what may.

A New Way of Thinking

It’s still fairly early in my cycle, day 10, but I think I’m giving up on this one already.

My BBT has just been too erratic: 97.9 one day and 97.2 the  next, then 97.0 and up to 97.7. It’s been all over the place. And I don’t know if that really, truly means anything — after all, it was the same way last month and, miracle of all miracles, I ovulated on day 14! — but I do know that the only two times I have ovulated and conceived, my temps were nothing like that. While they’ve never been super steady for the entire follicular phase, they haven’t been bipolar either. This bipolar BBT is making me nervous…and stealing my confidence that this cycle will be The One.

So I’m trying to adjust my expectations. After a disappointing cycle last month, I’m afraid to let myself hope. I’m afraid to count on anything.  I have always known that you need to ovulate in order to make a baby.  But I have now learned that ovulation does not necessarily equal conception.  That Clomid is not a magical bean that automatically creates something great out of something small. That hoping with all my might, wishing on the shooting stars in a meteor shower, and praying constantly will not always give me what I want.

And so while I move forward with things as I’ve always done them — Clomid, frequent sex, and far too many vitamins — I’m also trying to plan for all of that to fail. This means envisioning our trip abroad in October, Teddy Graham’s due date in December, the holidays, the start of the new year, and my sister’s baby shower, all without my own baby in my own belly. It also means beginning the search for an RE. I’m going to take my time in doing this, but I’ll start looking, start asking questions, start trying to figure out where I go from here.

Which is scary.



But also — it’s freeing.

There is freedom in not believing that this cycle will be the cycle. As I go about every day, I can breathe easier knowing that I don’t have to make a baby right now. I would love to be holding my second child in my arms by my 30th birthday. That means I need to conceive by mid-November. Which gives me another two or three cycles. Okay, I can do that! And I really, really want to have another child by the time our Cupcake turns three, which means conceiving by early March. Surely, something has to happen by then! Of course, I know there really is no “surely” about any of this. No guarantees. March may come and go and there will still be no second line on an HPT. Or I could conceive, at any point, and lose again a month or more down the road. But — but — by extending my own personal deadlines, by looking at the bigger picture and preparing for a few “worst case scenarios,” it takes a little of the stress off of my shoulders right now. It removes the pressure from this very cycle, right here and now.

Of course, that does not mean I completely lack hope. There will always be that, no matter how dire the circumstances or how low the odds. Maybe I am just telling myself all of this so that I don’t feel so let down when CD1 is upon me again. Maybe I am hoping that by relaxing my own expectations, the old, overused adage “maybe if you just relax…” will prove to be true. And I know if I do see my period again in three or four weeks, there will still be disappointment. Sadness. Heartache. But I’m hoping that, with this new way of thinking (which is still a work in progress, if I’m being honest), my heart, soul, and faith won’t be pulverized at the first sight of blood.

I’m hoping. But we shall see if any of this really holds up a few weeks down the road. We shall see.

Doctor Appointment

Well, it was not a fun weekend. I spent it crampy, cranky, and crying over everything. But I allowed myself to nurse my wounds with a few indulgences which I rarely get to enjoy — soda, coffee, doughnuts, bagels, chocolate, old episodes of Dawson’s Creek, and some retail therapy — and that did help as much as it could.

Today, I met with my OB. We’ll call him Dr. Smiles since that’s always the first thing I see when he walks into the room. A smile. I had scheduled this appointment before I ever got my period so that I could renew my Clomid prescription, but the opportunity allowed me to ask a LOT of questions. Thanks to everyone for the suggestions, guidance, tips, and encouragement that enabled me to ask what I needed to.

Here’s what we discussed today:

  • Clomid: We’ll be sticking with 100mg for now as it worked well last month. Dr. S reminded me that I can’t expect to get pregnant on the first ovulation every time. He doesn’t do any sort of monitoring and advised, if that is something I am attached to (I’m not), then I’d need to see an RE.
  • Femara: My doc has no experience with this and thinks it’s wise to stick with Clomid for now as we know that has worked in the past. However, if Clomid fails or causes problems in the future, he’d be willing to look into this to see if it might be an option for me.
  • Supplemental Progesterone: Dr. Smiles does not prescribe vaginal progesterone suppositories to be used after ovulation. If this is something I want, I’ll have to see an RE. However, once I get a positive pregnancy test, I can then request them and he will gladly write me a prescription. This is perhaps the answer I was most disappointed in, simply because I’m concerned about my rather short cycle this month and would like to have one less thing to worry about. My doc doesn’t think my short cycle is cause for concern as it’s only happened once that we know of and, in the past, my luteal phase has been long enough to allow for implantation of two pregnancies. I will, however, follow everyone’s advice by adding B and D vitamins to the mix and cross my fingers that will be enough to get me through to a BFP.
  • Ovarian cyst: This was a new development over the weekend, something that caused me a fair amount of discomfort on Saturday and Sunday. I’ve had them before while using Clomid (including during the cycle that gave me my last pregnancy), so I knew what it was. It has since gotten better and the doc doesn’t see any reason to worry, unless it swells up again. It should not prevent me from getting pregnant this cycle (which I do believe, because of my last cyst and the ovulation and pregnancy that still resulted three weeks later).
  • My short period: I was concerned because my period only lasted 3-4 days this cycle (normal for me is 5-7), though one day was very heavy. Dr. S thinks this isn’t a problem and is no indication of the thickness of my endometrial lining.
  • More lab tests: While Dr. Smiles does not think I need a “re-do,” he agreed anyways to order my lab tests to be redone so that we can really know if I fall into the PCOS category, at least hormonally. Past tests have been completely normal but were taken on the wrong day of my cycle. I want a definitive answer for peace of mind, so that I can give it all a rest. With that being said, today I had my blood drawn to check for the following levels: LH, FSH, prolactin, testosterone, DHEAS, estrogen, iron, and TSH. Results should be in by the end of the week. He also ordered a P4 test to check my progesterone level after my next ovulation.
  • When to see an RE: This really deserves a post of its own, because I already have my own opinion and plan for when this will occur if it comes to that. But Dr. Smiles’ rec is to give Clomid another three to four months as that’s working for us right now. In fact, he said he has every confidence that it will happen for us again. I know that he really cannot make such a guarantee, but it’s nice to hear that we are not the only ones with hope.

So while it was not a perfectly satisfying appointment that gave me everything I wanted (ahem, a prescription for those vaginal suppositories), it did give me a few other things — answers, new hope, reassurance, and peace of mind — and I guess that is enough for one day.

And now, having met with my doctor, I think I am ready to move on. To let go of the  disappointment of a cycle that held so much promise, and to start again. I’m still feeling fairly melancholy on a day-to-day basis, but as Tami recently suggested in one of her comments, it helps to start looking forward, instead of dwelling on what could have been. I’m already on my second day of Clomid. I’m adding extra vitamin D and B vitamins to my long regimen. And I’m still praying. Hard. But also trying to release any expectations. I don’t know what this cycle will hold. I don’t know if I’ll ovulate, or if I’ll conceive if I do. But I do know that if I don’t, there is always next month. I still have plenty of options. My next chance could be right around the corner.

Metformin: a Decision

Well, I finally did it. I took my first dose of Metformin last night with dinner.

I actually made the decision to try it while we were away in Idaho. When I heard my sister’s news, there was a sort of flame of desperation that was fanned inside me. I just knew that I was willing to do whatever it takes to conceive and carry our next baby to term. Metformin offers no guarantees, but it is an easy next step and I’m willing to give it a shot. At least for now. And if I hate it? If it makes me miserable? Well, there’s no one saying that I can’t stop it whenever I want.

At least this is what I’m telling myself as I consider popping some Tums for the GI discomfort that I think I’m already feeling. But maybe it’s all in my head at this point. It is still so early.

So for the next ten days, I will be taking just one dose of 500mg with my evening meal. After that, we will add another dose to have with breakfast. Hopefully, this stair-step approach will help to keep the side effects at a minimum. My OB says he can even add one more dose to have with lunch, but he wants to see how my body responds to just 1000mg/day first. He also prescribed me the Extended-Release version, which can further help reduce side effects, so I’m hopeful that it won’t make me feel too crummy. I still have limited expectations in regards to it actually helping my reproductive parts do their job, but miracles happen I suppose.

And at this point, I really need a miracle. I think we all do.

Some Thoughts on Hurting, Home, and the Things in Between

Today, I hurt.

I hurt today because yesterday I came to the conclusion that my sister is pregnant. She has not confirmed this, but I know. I know that she and her new husband started trying during my short-lived pregnancy in April. I know that she has always had regular periods and will probably have no problems conceiving.  I know that she has dropped hints such as being the designated driver at a bachelorette party, feeling so tired all the time, and in an e-mail yesterday she mentioned that she hasn’t been feeling well for a few weeks but said nothing more. And I know that she is probably afraid to tell me her good news.

I know she is pregnant, and I think I have for a while, though I have tried to convince myself otherwise. Either way, I sent her an e-mail last night to ask if my suspicions are true. Was this out of line? I hope not. I don’t want to make her uncomfortable. But if she is expecting, I want to know so I can accept it and move on. So we don’t have a pink elephant hanging around every time we talk on the phone or send an e-mail.


This, in the aftermath of my loss, is one of the things I have been fearing the most.

As you may remember from a previous post, my sister is no ordinary sister. She is a half-sister whom I learned about just this year. At this point, we are bonded only by blood and quite a few common interests and personality traits. We don’t have a history. Not really. And the history we do have is short and shadowed by the fact that I feel as if she did not support me through my miscarriage as I had expected. This has left me with a bad taste in my mouth and a lot of resentment. I’m trying to forgive, to believe her intentions were always good, to fake it until I make it. I think I have done a good job at that, but it doesn’t mean I want to celebrate her pregnancy with her.

I am happy for her but sad for myself, torn between wanting to hear every detail about every second of this pregnancy and this baby (my niece! my nephew! my very flesh and blood!), but also afraid to experience all of that. Afraid of the jealousy and contempt and pain it will cause me. There have been times that I wished she would have to deal with my same infertility issues (that somehow it was genetic) and, in the last 24 hours, there have been times when I wished that this pregnancy didn’t exist. Not that I would wish her and her unborn child any harm or tragedy. Just that this had not happened for her quite so quickly and not yet, not until there is another life growing inside me too. Maybe then it would hurt a little less.

I just want to stop hurting.

Someone please tell me I’m not a horrible person, or a bad sister. Because I’m new to this sister thing and I don’t know if these feelings and thoughts I have make me the very worst sister-friend to ever exist.

But on to other things…

It’s cycle day 3! Officially. Not long after my last post, the flow started to pick up and blazed throughout yesterday and into this morning. I don’t think I’ve ever been so glad to see that much blood! (TMI?) So of course, I was worried for no reason. Like always. It’s still not as wicked as it has been at times in the past and I’m not nearly as crampy either, but maybe that’s a good sign? I’ve heard extraordinarily heavy and painful periods are not healthy either. And now I’m at a point where I’m hoping for a little mercy and for the flow to slow waaaaaay down by the end of the day. And I took my first 100mg of Clomid with breakfast this morning. It’s always exciting to me, because it gives me new hope, even if that hope wavers. Often.

(And btw…thank you so much to everyone who offered their advice about cycle days, spotting, and Metformin. I needed to hear all of it and, with each new comment, I breathed a sigh of relief.)

As for the Metformin, I am still on the fence. I go back and forth about a hundred times a day. I did fill the prescription and pick it up from the pharmacy, but I’m going to leave it sitting on our bathroom counter for a few days. I want to ponder it and give my decision time. On one hand, I find it deliciously tempting not to take it and not to have one more obligation and worry in TTC-land. Especially when there is no proof that I actually need it. But on the other hand, I want to do everything I can to up my odds and help my body to ovulate and hopefully ovulate earlier than is standard for me. But at any rate, I won’t be taking it until next week (after my birthday and road trip) and I will definitely be taking it if this round of Clomid doesn’t work at all. I think.

And speaking of our road trip…

We leave today!  Going back to Idaho. Back home…or at least to the only home I had ever known until the place that we now call home became our home. (Hey…that was a lot of fun to say!) I’m so excited for this return to our “roots.” There was a time when I hoped I would be returning with a growing belly and, for a short while during my Teddy Graham pregnancy, I really believed I would. In the weeks after my miscarriage, I lamented that this picture I had of myself in a cute sundress attending the wedding of a family friend in Idaho would never come to be. I cried for days over that silly image. But I’m stronger now, and looking forward to going back to a place that is so familiar to us. It will be good to get away for a short while and, when we return, I will already have made it through the first week of this cycle…with only one (but probably two) more weeks until the anticipated ovulation date. I will welcome anything that can make time go faster right now.

And with that being said, I will probably be off the grid for a few days. If there’s time (perhaps in the evening while watching the Olympics!), I will stay caught up on my blog-reading, but I don’t anticipate that I’ll do any of my own posting. Unless, perhaps, I hear back from my sis about her suspected pregnancy. In that case, I might have no choice but to come here to whine and cry over the unfairness of it all.

Just a warning, friends.