Thursday, December 1, 2011

Thought Vomit Thursday! Get It While It's Hot!

Hello friends.  Sorry it has been a week since I've posted anything.  It's not even that it's been a busy week, I've just been super lazy.  I'll do better, I promise.  This is going to be a Thought Vomit Thursday of EPIC proportions....mainly because it's a long post.  If you're not interested or in the mood for a long read, I understand, but keep reading anyway.

I have literally felt so uneducated this last week.  I don't mean like the "I didn't get the proper education" uneducated, but more like the "I don't know enough about my "situation" to know if I'm on the right track, the wrong track or no track at all" uneducated.  I read your blogs, I see your stats and your measurements and your test results and I can't help but wonder why I don't know all of mine off the top of my gourd and does that mean I am not serious about this infertility business?  I feel like I'm serious business.  I also have no clue what 90% of the hormones the doctor is testing me for are supposed to do and if mine are at normal or abnormal levels?  I will say though, I have come a long way in the past year or two.

Before last year, I had no idea where my cervix was or what it did, where my uterus was hanging out in there and where it all was in relation to my fallopian tubes and ovaries (which I was semi-familar with).  Up until one year ago, I had NO idea that your cervix was a little tubish shaped thing with a hole at the end.  I kind of thought...never mind.  You get the point.  Sure, I have seen the diagrams but they are usually a frontal view and I needed a more accurate and lifelike illustration to help my visual-learning self come to grips with what the doc was seeing when I was on the table being fileted during my once a year appointment.  Thanks to a lovely book my friend gave me, I now get it and understand and can pretend to be knowledgeable during my procedures that involve discussion about such things.

What I do NOT get is how medications work, how they effect my body, why we use them, what my hormones should be doing, which tests do I need, which tests have I had and ultimately, why is nothing we're doing working and by working I mean getting pregnant?

Tuesday, I had my 12 day scan.  I had done what Dr. S asked of me and taken the crappy anastrazole for the alloted time and so there I sat, with bated breath, while we waited for the ax to drop.  As you'll recall, last month, the anastrazole did nothing more for me than my body was naturally doing.  I produced ONE follicle, released one egg and didn't get pregnant.  What happened, was not at all what we expected.  Who happily gobbled up an entire humble pie and asked for seconds?  This girl.

We had three follicles.  They measured in at a lofty 10, 12 & 14 mm's.  All on the right side which is usually my "quiet" side.  The left was completely silent this month.  A ghost-town if you prefer.  Dr. S was pleased and said my endometrium was nice and fluffy, triple-striped and measuring 9 mm I think it was.  She told us to go home, continue the OPK's and when we had an LH surge to call and report it but if we didn't have one by Thurs or Friday morning to let them know and we'd do a trigger shot Friday with an IUI Saturday.  Easy as humble pie.

While we were there, Rik asked if we needed to sign up for the class on the injectable meds and go ahea and have those ordered so they'd be here for next month just in case this month was another failure.  Dr. S basically said that she didn't think injectable meds would be a good benefit for us because it would only increase our chances about 1-2% because we have already had so many failed attempts w/ IUI's after good responses from Clomid & now Anastrazole.  She said there gets to be a point when you have to start questioning the fertilization process, egg quality and other more serious problems.  It wasn't easy to hear at all.  I have to tell you at one point I thought I was going to fall over.  She said those problems were confirmed and worked around by IVF.  The three letters I never wanted to hear.  She said she would recommend continuing with the oral medication and IUI's until we couldn't do it anymore emotionally and then move on to IVF if we still weren't successful.

We left with our results both happy and sad.  Overall, I felt pretty good because that little light of hope was already starting to shine through the clouds and lift my spirits.  Three follicles this month!  Then my mind started working and thinking and wondering about things that maybe it shouldn't, but usually does and I end up emotional, frustrated and cranky.  By the end of the day, I was all of those things.

Total sidenote here: At the old clinic, they did lots of things to/for me like prescriptions, scans, bloodwork, trigger shots and tests during a cycle (albeit with wretched service) .  It sounds like the same happens for all of you ladies as well.  I got accustomed to that level of pampering (not that being stuck and jabbed and poked with the DC is pampering, but in this twisted IF world we live in, you get my drift) and at this clinic, it's more hands-off, let your body do the work if it's working and we'll do our part when it decides to cooperate.  My body cooperates and they do their thing and viola!  No baby.

So my thoughts were centered around why they were letting me ovulate on my own instead of using the trigger shot to release more eggs, does my body only release one egg naturally, and if so, why the heck are we trying to create more follicles with medicine when we are only taking a stab at one per month anyway?  So I started trying to figure out if the hcg shot causes more than one egg to release (I had no idea!) and it seemed like that was a true statement.  Then I started researching ovulation and it seemed like what I read stated that the most mature egg would release during ovulation.  Naturally, I was confused.  I felt like we should be getting two or three follicles to release each month so that we had more than one shot to get pregnant.  Again, I've already admitted I'm uneducated about this girls so don't beat me over the head if you already see where this is going!  :)  Ultimately, I just needed to know one thing, "What's the point?"

I received a positive LH surge yesterday morning and called it in.  They scheduled our IUI for this morning.  While I had the nurse on the line, I asked her the above questions and she stumbled around a bit and ended up sort of confirming what I was thinking and then also saying I should ask Dr. S.  So, Rik and I discussed everything last night and I typed out a few questions this morning that I wanted answers to.  I always get nervous or anxious in the room and all of my well planned questions and coherent thoughts take a vacation the second the doc asks if we have any questions for her!  She surprised me when I pulled out my sheet of paper today (with about 9 questions on it) by pulling up her stool and reading them all one by one, taking time to thoughtfully explain each and every one of them for us.  I had to fight back tears the whole time and ended up covered in hives by the time it was all said and done, which also happens when I am nervous or anxious or both.  The IUI didn't help things either because it had actually been the most painful one I've had to date.  Stupid tilted thing-a-ma-jig aka uterus.

Here were my questions and her answers and hopefully, this will help someone else that might be uneducated and confrused about what the heck is going on down there and why we are doing what we're told to do in the first place.

1.) Does ovulating naturally (without a trigger shot) release only one egg? Dr. S = Not necessarily.  If you have two that are mature, two can release naturally and the same goes with three.  That is why we have you take the oral medicine so that you have as many mature follicles as possible by the time you have an LH surge or we give you an hcg injection.
2.) Does HCG cause more eggs to be released if there are several mature follicles?  Dr. S = Yes and no.  It causes you to ovulate when you're body doesn't naturally.  The reason we let you ovulate on your own is because at times the risk outweighs the rewards in that hcg can cause your eggs to die if they aren't mature enough when released.  When you're not ovulating on your own, obviously that risk is worth taking because the benefits are that you will then ovulate and hopefully one or two will survive.  (this one, i got a little fuzzy on because I thought about it too much so this may not have been her exact response but it's close)
3.) What is actually considered a mature follicle?  I think she said anything over 13 or 14 mm's.
4.) If ovulating naturally releases only the most mature follicle/egg why are we taking medicine to produce more follicles and then being allowed to ovulate naturally, releasing only one egg anyway? ((See above so she didn't really have to answer this one.))
5.) What benefits are there to taking medicine if this is the case (above)?  Dr. S = The goal is to get several mature follicles by the time you ovulate so that you do have a couple of eggs that are released.  
6.) Can we be more aggressive without moving on to IVF? Or is this our next best option?  Dr. S = Not in our case.  Basically, we fall into a grey area in that we are partially unexplained infertility, partially explained by endometriosis.  The possibility of getting pregnant doubles for people with endometriosis during the six months after having the surgery and getting it all cleaned up.  With us, however, it's not really that cut and dry because I didn't have any of the closed off fallopian tubes, seriously effected ovaries or misshaped/deformed uterus that was corrected in surgery.  At this point, it's a waiting game and if it doesn't work in six months or so with what we're doing, we'll have to decide if we want to move forward with IVF to check egg quality and fertilization issues.  My body responds so well to oral meds and I ovulate like clock-work it seems so it really doesn't make a ton of sense why this isn't working.
7.) Why were injectable meds mentioned at our last IUI if not it's not something that would really increase our chances of conception?  (I had gotten excited thinking we were heading in a new/agressive direction and now I feel really let down and like we have hit a dead-end.)  Dr. S = At the time of the last IUI, we hadn't gotten any response out of the Anastrazole.  If we hadn't gotten the response we needed from it this month, she was going to pair it with something to stimulate my ovaries and just let the Anastrazole do it's thing with my lining.  Since we did get the response we needed this time, there is no use in using injectables because getting five or six or more follies is not something they want to see (and I don't either). I just had NO idea that's why she recommended it or why it was no longer something that could benefit us.  I am happy with this answer, most of all.
8.) Do we have any idea why this isn't working or what our problem might be?  Dr. S = Nope.  Hopefully, it's just a matter of time and we do something right and get a positive result.  I have to keep reminding myself we have had one IUI since surgery (even if only slightly increased our chances) and it was working with ONE follicle.  Patience.
9.) Are there any other tests that can be done? Dr. S = You've had them.  Other than retrieving eggs and testing them in the lab/doing IVF, there aren't any other tests to do.  

So, I'm still a mystery....but a smarter one now.  I'm still frustrated but more so at my body than anything else.  I'm still cranky, but mostly just because I'm tired of all of this, depressed that I've gained an extra 10-15 lbs, exhausted from the emotional mess I stay these days and annoyed that I haven't done more Q&A in the past.  I could have saved myself a lot of trouble if I had thought to ask all of this information on the front end or at least during the past year.

Anyway, she sent us on our merry way today by telling us to take a home pregnancy test in two weeks and let them know the results.  Sure, I still wish I could go to the office and have them draw my blood and then let me know, but I'll do it the ol' fashioned way and POAS like the rest of the TTC community.  She also recommended that I start taking a different Progesterone supplement, one that doesn't cause me to look like Sponge Bob Square Pants.

And to round out this post which has turned into a seriously long novel that could have been delivered in a Trilogy (a la Matrix or Lord of the Rings), I give you (insert dramatic drumroll) my stats, measurements and a few test results.  Yep, I asked for a printout!  I'm such a big girl these days (and I don't mean because I'm chubby now)!

Baseline Ultrasound (I HAD NO IDEA THIS WAS MEASURED!!!!!):  Antral Follicle Count 10-20 (read somewhere that this is "normal")

IUI Cycle #1:
Clomid 50 mg x 5 days starting CD 5
3 follicles greater than 16 mm (one was 30)
Endometrium 9mm
10k hcg given
TMC (what's this stand for exactly, I know it's the specimen that was used for insemination) 13 million
Provera 10mg started for 10 days   (this is NOT true - I didn't take Provera, ever....Thanks old clinic!)

IUI Cycle #2:

Clomid 50 mg x 5 days starting CD 3
3 follicles greater than 16 mm
Endometrium 9 mm
TMC 11 million
hcg 10k given at home by hubby
E2 = 254 pg/ml (Estradiol is at a normal level)
THIS is when I started taking Prometrium 3 x's a day on CD 14 but it's not mentioned in my chart.  Thanks again old clinic!

IUI Cycle # 3:

Clomid 50 mg x 5 days starting CD 5 - I still think I was at CD 7 at this point but devil nurse insisted
3 follicles greater than 15 mm (I had already ovulated at this point though - Thank you old clinic!)
Endometrium 12 mm
hcg 10k after natural ovulation
Progesterone was 8.9 when tested (no clue what cycle day this was though)
Prometrium 3 x per day for 12 days starting CD 14
NO IUI performed, just timed intercourse (the name of which makes me think you're supposed to use a stop watch or something - makes me giggle)

Anastrazole 2 mg x 5 days starting CD 3
Endometrium 9 mm
1 follicle @ 16 mm on CD 12
No hcg given
Motile Sperm Count 39 million
Prometrium 1 x per day for 7 days before eye-bulging incident and discontinued :)

IUI Cycle # 5:
Anastrazole 2 mg x 5 days starting CD 3
Endometrium 9 mm
3 follicles - 10, 12, 14 mm on CD 12
NO hcg given
Motile Sperm Count 32 million
Progesterone supplement to be started on CD 16
results: TBD

If you hung around this long, thank you and I love you.


  1. We love you too. haha. I'm sorry you've been so down and frustrated with everything. Ya know, I never felt like I knew everything I should know. I would read other girls blogs and be like "Whattttt does that meannnn?" I kind of felt like I was in the 5th grade at infertility school and everyone else was in high school or something. Good for you though writing down your questions. I used to feel bad doing that like I was taking up too much time. But then I was like F that and ending up bringing a list of like 20 questions to our first OB appt. Well I am going to pray for you that this IUI brings you everything you've been dreaming of :)

  2. All of this can be oh so much to take in, handle, and learn. I think I dove in from day one bc 1. it's my natures 2. I'm a nurse and neeeeeed to understand the physiological and medicinal aspect of it all. Control? Yup, probably!!
    I am thrilled the MD pulled up her stool and answered your questions, even if they weren't the answers we want to hear. I have the endo surgery and 11 months later we got pregs (mc to follow). They told me the same thing, 6 months from surgery was the best chances. It sucks being the in the 'unexplained' bucket. Basically tell me, well we don't know why you are so broken...shitty luck lady! Thats me!
    Hoping one of the three lil eggs give you your dream :) xo

  3. This was such a great post, Shannon! I'm so glad that Dr. S sat down with you and took the time to explain everything. And THREE big follies - you go girl! Who knows, you might get an extra special Christmas present this year. I'm so curious to know which clinic you refer to as the devil clinic (just want to make sure it's not the one I'm at!) :)

    Oh and TMC, I believe stands for total movement count.

    Keeping my fingers crossed for you!

  4. I'm glad you wrote down your questions. Don't forget you can always reach out to us too in between RE appointments if you have questions like that!

    During our IUI cycle, my body suddenly surged on its own, so we skipped the HCG shot because that would have been overkill and needless. If your body surges on its own, cool, if not, at least you have options to help it along. The fact that you cycle pretty normally is HUGE.

    Makes total sense that your RE doesn't want to be more aggressive with injectibles if you got 3 follies from your current protocol. It'd be way more expensive and probably result in a cancelled cycle b/c of TOO high of a response if you did that.

    I found this online, and it pretty much directly matches what my RE told me. Good information....
    Q: At what size are follicles considered mature?

    A: Many doctors monitor follicle development during IUI cycles. Most trigger when the dominant follicle is within a certain size range. While there is always some difference in doctor preference, the norms are unmedicated 20-24mm, clomiphene citrate 20-24mm, FSH-only meds 17 or 18mm minimum, and FSH+LH would be 16 or 17mm minimum. It is possible for slightly smaller follicles, 14-15mm, to contain a viable egg. Also, follicles continue to grow until they release, usually at a rate of about 1-2 mm per day. A woman may ovulate more than one follicle in a cycle, but the releases will occur within 24 hours. When hCG is not used, only follicles close in size are likely to release. The use of hCG induces ovulation in about 95 percent of women, and will get most mature follicles to rupture.

    Q: What should estradiol (E2) level be at time of hCG trigger?

    A: The E2 level should be 200-600pg/ml per 18mm follicle. Some doctors are content with a minimum level of 150, but higher tends to be better.

  5. This is all very official. You are now a IF smarty pants in my book. I have to google pretty much everything everyone talks about because I didn't go the medical route. So the first time I saw HCG I was like 'wtf is that?'. I am glad you got your questions answered and i hope this is it! Bring on the TWW!

  6. When I was going through IUI's and IVF I had to google the shit out of everything! There are so many numbers and confusing. It looks like you have a great grasp on it!

  7. I'm glad you got your questions answered. I know how hard it is to try and make big life decisions when you feel like you are standing in the dark. I hope you get more good news this month!! :)

  8. Holy hell, this post was so long and I was RIVETED! :) So much good information, thank you for sharing what your RE said. Um...I still don't understand about how many eggs we ovulate, isn't that crazy? Still unclear...

    Oh, Shannon, I hope this is it for you! I hope THIS is your IUI!. I feel like we are similiar in that my RE told me that IVF was the ultimate "test" that would help us really discover what was going on. I still didn't get all the questions answered that I wanted, but I'm so glad I did it. I, like you, never thought that was something I'd be okay doing, but it gets easier.

    If you ever have any questions, send them my way! We'll swap info. If you do IVF, you will for sure get the monitoring and attention that you crave. I always felt I wasn't getting enough attention with my IUI's. With my IVF I was texting my RE at 10 pm at night and she called me back. :)

    Anyway, I gave you a blogger award today on my page!