Happy Birthday to Me?

Well, it’s my 34th birthday. I never expected to be 34 – and any expectation I had of myself being 34 definitely included driving around a gaggle of children in the backseat of a beautifully-fugly minivan. Given I’m now a walking biological clock – and I want at least two kids — I know it’s now or never.

The trigger shot MAY still be in my system. I originally planned to take my first post-trigger pee-on-a-stick test today. I’m using the cheapies right now, so they could also be off. But I’ve tried them plenty of times before and they always show up w/ no line (except the one time I tested two days after trigger, just to confirm they worked at all.) So, the fact that they keep showing lines is promising. The line did get lighter last night and today it’s definitely there but faded. No “BFP” as they say (Big Fat Positive – who comes up with these terms?)

b_nLREIg

Chart is looking good… but temp spike this am could be due to all the eating and drinking at Thanksgiving last night! Tomorrow will be the real test… if I DID ovulate on the 10th of November, today is 14 days post ovulation and AF (Aunt Flo) should come tomorrow. Even though my body has a mind of her own, I seem to be fairly consistent in the 14 day Luteal Phase, and bleeding promptly on day 15. (Without the medicine Femera I apparently ovulate too late, if at all – but if I have the temp spikes I’ll see AF there, shiny her happy red face, 15 days later.)

As far as how good this could look right now… this is looking very good. That doesn’t mean that a) the trigger shot is still in my system (though the line definitely got darker from two tests three days ago so I think that’s unlikely) OR b) it could be a chemical pregnancy (my current concern) which means that it didn’t actually stick properly or 3) it could eventually be a miscarriage, which is so common with women who have PCOS. In short, even though it’s my birthday, I’m still trying not to get my hopes up!

This weekend (and Monday) will tell all. If my period isn’t here by Monday am, I know something’s up. I’m going to take my first blood test at 6:30 on Monday morning. Originally the doctor said I could take my first blood test today BUT they aren’t open today or on the weekend, of course, so I’m waiting until Monday. That makes sense anyway, since by Monday either I have started my period or… I’m probably at least somewhat pregnant.

Happy Birthday to me?

 

CD 21 (11 DPO) – headaches, nausea, cramping, and hope.

Maybe I’m just getting sick or having a severe case of PMS. My temps are still safely up at my post-ovulation levels, but haven’t actually gone up further. I’ve been at 98.1 flat for past two days. Which could mean – anything.

Based on prior Femera cycles, I seem to get AF (“Aunt Flow”) 14 days after ovulating on the dot. My body is a strange beast. I think it wants so desperately to be working properly (I must have my grandmother-who-bore-6-children-before-27’s DNA, huh?) but since I don’t ovulate on my own, it goes into overdrive to prove it can work when I get the meds that make me finally grow and release an egg(s.) Or, so that’s what I tell myself to keep sane and hopeful.

So – either I’ll be getting a visit from AF on my 34th birthday, or I’ll be left to wonder… did something stick this cycle? I’m planning to test Sunday or later. I kind of want to just wait it out until CD 36 as my natural cycles have been ~35 days lately (though some have been much longer), and if AF isn’t here by then it’s worth testing. I don’t think it makes a huge difference if I’m 4 weeks pregnant or 5 weeks when I find out, as long as I avoid alcohol (and, lawd knows all of this “am I pregnant?” stress – plus the holiday season – makes it hard to avoid… but I shall abstain for good measure.)

 

Cycle 2: CD 19 – Should I Be Hopeful?

Trying really hard not to get my hopes up. So far this whole TTC with PCOS thing has been brought to you by believing I probably can’t have kids. But I have a feeling (and a tiny hint of data) that this cycle may be different. And, why wouldn’t it be? I get to take my first pregnancy test on my 34th birthday.

Why do I think I might be pregnant? Well, I haven’t had any implementation bleeding yet, but apparently not all women get that. My BBT chart leads me to think this could be the cycle for BFP. It also could just be my body freaking out after being shot up with HCG a week ago and releasing a bunch of eggs. I’ll find out fairly soon.

I’ve read a bit about triphasic charts when you are pregnant… your temp starts low, it goes up after you ovulate, and then, after implementation it goes up again if you have the right amount of progesterone to stay pregnant. Two days ago, which was 6-7 days post ovulation, I had a dip in my temps (down to 97.3) and then it went back up. That’s either a fluke, or a good sign. It seems a little early to be an implementation dip (I triggered on CD 11, which means I likely didn’t ovulate until CD 13 — but with the trigger shot and what I was feeling I wonder if I released a little early. It’s apparently possible 24 hours after trigger but usually around 36.)

So far, my chart looks like this:

CD 11: trigger (9pm)
CD 12 (0 DPO): slight temp rise and strong ov. feels (97.3)
CD 13 (1 DPO): very strong rise (98.0)
CD 14 (2 DPO): remains strong rise (98.1)
CD 15 (3 DPO): possible corpes luteum dip  (97.4)
CD 16 (4 DPO): up again
CD 17 (5 DPO): slight drop
CD 18 (6 DPO): major drop – too early for implantation??? (97.3)
CD 19 (7 DPO): up again
CD 20 (8 DPO): possible triphasic shift (98.3)
CD 21 (9 DPO): tbd
CD 22 (10 DPO): tbd
CD 23 (11 DPO): tbd
CD 24 (12 DPO): tbd
CD 25 (13 DPO): tbd
CD 26 (14 DPO): — * 34th birthday
CD 27 (15 DPO): tbd
CD 28 (16 DPO): tbd

So – I think the CD6 drop was too early to be an implementation dip. The only thing that I think could have happened is that I somehow ovulated before the trigger shot (my follicles seem to grow really fast on Femera, as the doc told me to trigger the next night when I had one at 19 and one at 17) at my CD10 ultrasound.) There was a slight temp rise (from 97.0 baseline to 97.3) on morning of Trigger shot, then the next day it shot up to 98.0, so ovulation happened somewhere in there.)

Right now, all there is to do is wait. I was a little defeatist the other day when my temp dropped so significantly, but it’s a relief to see it bump back up. I’ve hit 98.3 in prior cycles in post ovulation, so it’s not strange for me, but according to temps this cycle it could be the start of the triphasic shift. Or it could be meaningless.

My BBT test times are a bit all over the place this cycle too — so it’s not 100% accurate. And I had one night of horrible sleep. But I’m hoping there’s something to it.

If we get pregnant this cycle, it would be amazing. It would mean not having to worry about spending $30,000-$100,000 on IVF treatments. So – we could buy that new couch we’ve been wanting…  and a crib. 🙂

 

Cycle 2, CD 12: Day After Trigger Shot

This Femera + Trigger Shot cycle has been similar to the one I did last spring at the other clinic, with the exception of my Trigger Shot being bumped up a day. Last time I triggered on CD 12 and this time my RE told me to trigger on the evening on CD 11.

I understand so little of the logic behind any of this, but I think some clinics are more risk-averse regarding multiples. This clinic certainly is (they only implant one embryo at a time for IVF) so perhaps they wanted to trigger sooner than later, in case other follicles caught up and released. My doctor did clearly state that I have a chance of twins since I had two large-ish follicles.

Interestingly, my body reacted to the cycle almost identically as it did to my last Femera cycle — one fast-growing, large follicle on the left side (that I can definitely feel) and a couple of medium and small sized ones on the right. The one on the left grew from 15 mm to 19mm in between my CD 8 and CD 10 appointment, so I guess it’s safe to assume that it was about 21-23mm when I triggered the night of CD11. Who knows what the others were, if any in the right ovary were ready to release.

Right now I’m massively thirsty and I feel a lot of action in both of my ovaries. They are very sore and bloated. I am looking forward to ovulating so this discomfort can go away… unless, of course, I do get pregnant from this cycle – and there will be more discomfort, but at least it will be for a good reason. 🙂

I’m not getting my hopes up but I know there’s a possibility I will get pregnant this cycle. I’ll find out in a few weeks one way or another. If I am not pregnant, I’ll likely let my body have a natural cycle which will take us through the remainder of the year, and start trying medicated again in January.

For the record, the cost of this cycle was $960 ($800 ultrasounds and bloodwork, $150 trigger shot, $10 femera), bringing the total costs of infertility treatment to date to $3745.50.

First Femera Cycle, Ultrasound CD 9

Throughout this process of infertility, I’m trying to not get my hopes up. I know that even if I do happen to get pregnant in any given cycle, odds of miscarriage due to PCOS are high. However, I know that just getting pregnant will be a miracle, and every step towards that feels just as significant.

Today, I went in for my first ultrasound to track my progress on cycle 1 of Femera (Letrozole.) I’m glad that I’m going to an infertility specialist who understands PCOS, as apparently many women start with infertility treatments (meds only) via their gynecologist, and in that case many start out with Clomid which has more side effects and is less effective for women with PCOS in most cases.

Admittedly, I expected for this first cycle to have no results. When I went in for my mid-cycle ultrasound (non medicated) during my consultation, I was told I have a lot of follicles but they weren’t growing, and follicles have to grow to create eggs. You only need one good egg a month to get pregnant, but with the signal from my brain not making it to my ovaries, no eggs were being released, and pregnancy couldn’t happen.

So I went in to this appointment expecting the worst — if Femera didn’t cause any follicular growth, then I would need to move on to harsher interventions (injections, then IVF, or straight to IVF) — and given I’m already 33.5, time is ticking on peak fertility even if I were a completely healthy woman… I’d like to have my first child before I turn 35, which means I only have nine more months to get pregnant. Honestly, with the hope to have two kids total (three max, but two would be great), I know it’s best to have my second by 36/37, which gives very little time in between one and two even if I can get pregnant right away. I’d rather have more time with #1 (get pregnant sooner) and not feel so rushed into #2. And this isn’t all in my head — my infertility doc told me that as long as I have my second basically right away, whatever method gets me pregnant this time (i.e. Femera alone) should work again. Once I get into my later 30s, things just get a lot harder (i.e. more expensive) for everyone, even the healthiest of women.

I was a ball of emotions and bit my tongue not to cry when the nurse showed one sizable follicle on my left ovary, and another on my right. It’s too early to tell if they’ll be big enough to release an egg in a few days (and I have to go back for another $350 ultrasound on Sunday to find out), but the progress looks good. It clearly looks like the medicine worked in stimulating my ovaries to start doing their job. That alone is an incredible feeling —  maybe I can get pregnant after all with only thousands of dollars of intervention (instead of tens of thousands.)

I asked the nurse a zillion questions at the appointment today because I realized I didn’t understand what was going on — I had met with the doctor for a consultation a little under a year ago now, and at that point I wasn’t really ready to get started and I planned to meet a few other clinics to discuss options… but other clinics all had wait lists or super pricey consultation appointments, and this place had as good of reviews as any of them (and some just did IVF so if this doc wanted to start with basic meds that would be way less expensive, who was I to say I needed to freeze eggs, fertilize them “off site,” and implant them in order to make this work?)… so here I am, at this clinic because… they’ve been the most responsive and they’re working with me on what the minimal intervention needs to be to get my husband and I pregnant, and keep us pregnant (well, for nine months.)

Apparently they want me to have 2-3 healthy, large follicles in my cycle, and they’ll know that via ultrasound (hopefully by Sunday, though based on how everything is going I have a strange feeling they’ll want to give me another ultrasound next week if everything hasn’t grown enough yet by Sunday…) and once they see the follicles looking healthy they have me stab myself with an HCG shot to tell my ovaries to release the egg(s), and then DH and I (Dear Husband and I) have “TI” (timed intercourse) — hey I’m starting to get the hang of these infertility acronyms — and then, we wait…

There are plenty of reasons why, even with healthy follicles and an egg released, we won’t get pregnant, especially on our first try. We still don’t know what my fallopian tubes look like (an HSG test, not to be confused with HCG (Human Growth Hormone), also known as a hysterosalpingogram test, is a special X-ray tests that sees if your tubes (you have two) are blocked in any way, preventing a fertilized egg from making it to your uterus. In reality I could have a problem with this, but having PCOS makes me no more or less likely to have an issue with my tubes than any other healthy woman. Thus, the cost of test doesn’t make sense right now, unless there are other reasons to believe my tubes are broken (there aren’t.) The test can cost anywhere from $800-$3000, and while it may at some point be necessary, I’m trying to avoid unnecessary expenditures and this one seems unnecessary. The doctor said it was my choice — certain bloodwork was not my choice to do before we started any treatment (about $1000 worth of bloodwork) but the HSG test can wait, so it will wait.

Other than my tubes needing to function (at least one of them), I also need to be able to produce a thick enough uterine lining for the egg to stick. They are able to measure this via the ultrasound and right now it’s not thick enough, but the nurse seemed to think it’s en route to the appropriate thickness. I’ll find out Sunday when I see the doctor if there are any issues there. They apparently give you more/other drugs to help with this if it’s an issue. DH seems to be fully functional (his tests came back normal) so right now it’s my body that has to work.

But, it’s kind of crazy to think that this could work. I mean, if Femera makes me ovulate and everything else is normal then there is a 1-in-5 chance that we will get pregnant this cycle. With 2-3 good eggs, we could end up with twins (even triplets), although that’s quite unlikely with Femera (vs Clomid.) This office also doesn’t like multiples (beyond twins) so if you are showing too many eggs they won’t do the HCG shot to release the eggs. So things have to be just right on any given cycle for pregnancy to occur…

Then you wait and hope to not have a miscarriage, since women with PCOS are at very high risk for losing their babies, esp in the first trimester. I’m still hopeful that this will work… just seeing those beautiful follicles on the ultrasound gives me real, and I think rational, hope. I’ll follow up on Sunday to share how my follicles are looking and what our next steps are.

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.