Tag / femera

by adena

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.

by adena

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.