Cycle 1 CD11 2nd Ultrasound & Trigger Shot

So far, so good. I went in today for my second ultrasound of the cycle (another $350) and was informed that each ovary has one mature follicle — 17.7mm on my left and 19.4mm on my right. My lining is 9.6mm, which is good I guess (they didn’t tell me anything was abnormal with the lining) and DH and I are set to stab me (ahem, take my first “trigger shot”) tonight and then we’re instructed to have TI twice this week. And then we have our TWW (two week wait) and see if it worked – if not, we repeat the same thing again.

I wasn’t thrilled with my doctor’s bedside manner today – I understand he is much more engaged with patients who require IVF and my current treatment is fairly basic, but I’m paying $350 per appointment, it would be nice if I didn’t feel like I was being a nuisance asking questions. Apparently I should have taken better notes during the consultation (which was almost a year ago because I took some time before I decided to get started) — or I’m asking too many questions in general and should just do what they tell me to and not really know what is going on. I like to understand things, esp. medical-related things happening to my body, so I do ask a lot of questions.

If this cycle works, great. I’ll be freaked out in the way anyone is when they realize they’re about to bring another life into the world and there will be a nine month wait when they blow up like a watermelon leading up to the most painful experience in a normal human’s life (other than, you know, death, or, as my husband reminds me, stepping on a lego) — but also, ecstatic. And odds are still very slim right now… even super healthy women at my age only have a 20% or so chance of getting pregnant each month.

There’s also a slim chance that I’ll get pregnant with twins. I asked the doctor if the trigger should might make both of the mature follicles release eggs and he looked at me like I’m dumb and said “might? It will.” Now, just because two mature eggs release does not mean both (or either) will be fertilized and even if they are there are a host of things that could go wrong which is why it’s unlikely in any given cycle I’ll get pregnant at all. I’m saying this based on Internet research, not based on what my doctor told me, because he didn’t seem interested in explaining much of anything to me.

If it works, it works. I guess the TWW starts on the 13, with testing starting on the 27. That’s all we do at this point… trigger… TI… x2… then wait. It’s basically like normal reproduction with the added help of ensuring mature follicles and knowing when you’re ovulating.

Please send baby dust our way.

Ideal Follicle Size for Ovulation…

As any woman with infertility, I’m learning a lot more about pregnancy and getting pregnant than most people would know in their lifetimes, unless they happen to be gynecologists or reproductive endocrinologists.

I’ve learned in order to ovulate you need follicles large enough to release an egg each month. The ideal follicule size for the “leading follicle” is 23 to 28mm, and you should have one follicle at least 18mm before “triggering” (i.e. stabbing yourself in the stomach/butt with HCG to induce ovulation) — although according to the internet some fertility specialists say the follicle just needs to be 14mm before triggering and you can still get pregnant. Mostly I’m reading it’s 18mm minimum, so I’m not that far off…

I was told by a fertility nurse that follicles should grow at about 2mm per day. At my CD9 appointment, I had 14mm and 9mm follicles on the right and 12mm on the left, so that sounds good, I think? I’ll be going in for my next ultrasound on Sunday, so if the 2mm a day growth projection is right I should have 20mm, 14mm and 18mm follicles ready to go. I’m not sure exactly when they stop growing, but that seems promising.

 

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.