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.

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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.

Updates

There’s a few things I’ve been wanting to update all my bloggie friends on. Let’s do it with bullet points:

• Metformin: I’m still on it, 1000mg/day, and I’m happy to report I have felt no side effects whatsoever. Like, absolutely none. I also do not know that I have seen any improvements in my menstrual cycles, but I will continue with it (possibly increasing the dosage) for a few more months in hopes that it just may take a while to really go to work.
• My BBT: Ever since determining that it was stress causing such erratic shifts in my temp, I have implemented down-time (10-30 minutes) into my daily schedule, morning, afternoon, and right before bed. And it seems to be helping! While still not completely stable, my temp is no longer having the low dives and high spikes every damn day. I haven’t seen it go above 97.6 in over a week! And maybe it’s just a coincidence, but I like to think this is actually something over which I had a teensy tiny bit of control.
• My sis: Yesterday, I logged onto Facebook after breakfast to see a pregnancy announcement from my sister, her husband, AND her mom. Oh joy. I was ill-prepared and it made me cranky and weepy all morning. I had really thought my sis might warn me before she did that. I was wrong.
• My cycle:  I had thought I might get a positive OPK today, but I was wrong about that too. It’s CD20 and I’m still waiting and growing increasingly impatient and anxious. The second OPK line does seem to be getting darker and I am now seeing EWCM and feeling the pressure and tenderness in my lower abdomen (completely normal for me) that indicates ovulation, so I think we’re close. I hope. But I’m also afraid of hope, so I’m trying to prepare myself for the possibility that it might not happen at all. And I’m simultaneously fearing that it will happen and it’s so late in my cycle, I’ll inevitably miscarry again. It’s kind of a catch-22 at this point. Why couldn’t I just have ovulated on day 14 like last time?! (But, of course, we know how well that cycle ended.)

So that’s what’s new (or not) with me in TTC-land. I’m hoping I have some actual news to report soon! And I’m not talking about a BFP. All I really want in this very moment is a positive test of a different kind. But I’m no good at waiting. No good at all.

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.

Sigh.

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.

CD1?????

I’m so confused.

Five days ago, I took my last progesterone pill. I have been waiting for my period to arrive ever since. And today it did. Maybe.

I’m spotting. I guess for some women that’s normal for a period to start like that. Not for me. My period always starts like a wildfire and simmers to a campfire three, four, or five days later. It starts quickly, forcefully. It starts painfully, with a blood bath. Gross, but true. And so this slow start has me concerned for two reasons:

• I don’t know if I’m to consider this cycle day 1 or not. I think technically it is, but maybe it’s not until my period starts in earnest? Normally (for a normal, reproductively-healthy woman), it wouldn’t really matter much, but I need to know so I can know when to start my Clomid.
• And then I worry, what if this is it? What if this is the heaviest my period will be this time? And what does that say for my reproductive health and the thickness of my endometrial lining?

I’m probably worked up over this for no reason. Tomorrow, it will be a blazing forest fire “down there” and I’ll breathe a sigh of relief…while popping lots of ibuprofen! And I’ll call the nurse and she’ll advise me when to start the Clomid and it will be no big deal. But right now, I’m just overwhelmed and scared and sad that, of all things, it’s my period I have to worry about.

And then there’s a completely separate issue…

After some careful thought, I decided to ask my OB/GYN for a prescription for Metformin. I talked to him today and he agreed…he’s great like that. Always willing to comply. But now I can’t decide if I actually want to take it.  I consulted Dr. Google for the possible side effects and they worry me. Diarrhea? Vomiting? It makes me ill just thinking about it. But I’ll be honest…the thing that is making me question this the most is that all of those gastrointestinal problems can be exacerbated by fatty and sugary foods. And while I try to eat healthy, I don’t always succeed. I do have a sweet tooth as wide and deep as the Pacific and as ongoing as the Energizer bunny. Really. And I have a road trip and my birthday just around the corner — I don’t much want to feel sick when I decide to indulge in something yummy. Especially when I don’t even know if I need Metformin, considering I’m not insulin resistant and I’ve never been diagnosed with PCOS.

So what do I do? Do I take the Metformin? Do I not? Do I wait until my life has slowed down a little bit (in mid-August)? But then will it be too late to have any effect on this cycle? Should I just wait until next cycle? Should I start taking it, maybe, if I conceive this time to help with the miscarriage risk, or will it be too late by then too? Should I just not even bother, given that we don’t know if I need it?

These are all the things going through my head right now. But to those of you who read this and have tried Metformin, will you, please, please be so kind as to tell me about your experience with this drug? How long did it take before it started working for you? Or did it not? Did you suffer any of those side effects I dread? How long until they went away? Was it all worth it for you??? I know none of you can make this decision for me, but I desperately need input.

Sigh. I hate feeling like things are out of my control, but sometimes I do think it’s easier. Because I’m, like, the most indecisive person ever. And when I do have control over something (like whether or not to take Metformin)…how do I ever decide what the right answer is, for me?