Getting Pregnant with PCOS: The First Attempt

I’ve known since I was 15 that getting pregnant would be a challenge, but I didn’t think much of the said challenge then – I was worried about college and getting life started, not having kids with my “haven’t-met-him-yet” husband. Fast forward 18 years and I’m now married with a great partner, and we’re ready to have our first kid… however, it still won’t be easy.

I have Polycystic Ovary Syndrome (PCOS, for short) which is fairly common among women and causes a whole host of issues and health risks, with the most relevant to this blog post being that it often causes infertility. Women with PCOS (usually) do not ovulate regularly, or at all, which means it is not possible to get pregnant. Luckily for us ladies with PCOS, there are medical interventions which have been proven to increase the chances of getting pregnant, even though they can be expensive and there are no guarantees.

In most states, medical interventions for infertility are not covered by insurance. My insurance does not cover these costs, so I’ll also be documenting how much is spend on this journey here. We really want to have kids (two, ideally, though starting with one) so we’re currently of the mindset that we’ll do whatever it takes… but eventually the financial and mental toll could add up to too much, and we’ll have to either adopt or accept that we’re not meant to be parents.

I’m not ready to throw in the towel yet – since we’re just getting started. In order to begin treatment, the infertility specialist / clinic required that I have an ultrasound (to determine the quality of my ovaries and follicles), a bunch of blood work, including costly genetic testing, and my husband also needed some tests done as well (he’s perfectly healthy.) Once this was completed, the doctor told me I can start my first “Cycle,” i.e. first course of treatment starting the day you get your period and up until your next period.

Given that these appointments are costly and most places with good reputation are booked months, if not years in advance, I’ve opted not to get multiple opinions on these issues (yet.) I’m trusting this well-reviewed establishment will do the right things in order to increase my chances of getting pregnant, instead of wasting time shopping around.

During the ultrasound, the doctor said the good news is that I have a lot of follicles — the not-so-good news is that they aren’t maturing. Every month, one follicle from either right or left ovary is supposed to get bigger and eventually be released. If it isn’t fertilized, then you get a period. But, it’s also possible to get a period without ovulating at all, as the body can do weird things due to hormones and such.

The other thing I learned this year – opposed to what was taught in high school sex ed – there are actually only a few days per month a woman can get pregnant. The reality is that you can’t know what days those are exactly and cycles can get off, so you may be ovulating early or late, and since you can’t know then you could get pregnant at any time of your cycle. But – chances are you’re going to ovulate somewhere in the middle of the cycle, around day 14-18 if you’re ovulating regularly each month. This makes it easy to time intercourse with a reasonably high chance of getting pregnant if you do this for a few months in a row. However, with PCOS and irregular periods, you have no idea when you’re ovulating – so unless you have sex every day for a year and you happen to ovulate occasionally, your odds of getting pregnant are very low.

I’m not going to get pregnant “naturally,” so the doctor decided to start me on Femera (Letrozole), which is a drug that was originally intended to treat breast cancer, but is now used to help women ovulate. The better-known infertility drug is Clomid, which is another option should this not work, but he prefers to start with Femera because there are less side effects and less chance of multiples (I wouldn’t mind twins, esp given my age and goal to have at least two kids, but any more than that and I don’t know what we’d do.)

Although I’ve read online that most women are told to take Femera on CD (cycle day) 5-9 or 3-7, my doctor told me to take it on CD 1-5. I go in for an ultrasound on CD 9, and he will see if any of my follicles have matured. He mentioned that one of my problems (if not the only problem in this case) is that the “signal” from my brain to my ovaries is not sending straight, so the medicine can make that signal a lot stronger and make me ovulate. If the ultrasound shows that I am indeed en route to ovulation, then this is a very good sign. Even if it does work, there’s only a 20% (1-in-5) chance that we’ll get pregnant in any give cycle and the added challenge that women with PCOS are more likely to miscarry. Overall, I’m trying not to get my hopes up — not until I deliver a healthy child.

I don’t exactly feel ready to be a mother, but if not now than it will never happen. I’ll be 34 in November, and I’d like to have my first child before 35 if possible, with my second before I turn 37 or 38 at the latest – which already makes me an older parent. Side note, it’s incredibly strange now being a (potential) older mom, when I don’t feel so old at all. There really needs to be an extra decade of life between one’s 20s and 30s. I’m avoiding thinking about the fact that in 6.5 years I’ll be 40. Life goes too fast, hence the name of this blog… I’ve always loved the saying “life is what happens when making other plans.” Thus, this blog today is about planning for having a kid, but it may end up being about not being able to have a child – or, it may be about having children and striving to be the best mother I can be. For now, I’ll document my infertility journey and share any learnings along the way. Hopefully, in the next 24 months, there will a picture of my  beautiful son or daughter that I can share, along with a huge smile on my face. I genuinely look forward to meeting my future child. I hope I will be able to, one day.

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