How great it feels to have someone as focused on getting us knocked up as we are.
My first RE appointment today went better than I could have ever imagined. Joseph went with me, and we were sitting in the waiting room nervous as could be. When we get nervous we get giggly. We were talking about how long we had been trying to conceive, I asked Joseph how long he thought he said ,”We started trying in January 2013.” ….what? How about June 2012, I know not that much of a difference, but enough. I informed him the correct time and he said ,” Well, I wasn’t an active participant until then.” I died laughing. We giggled. When you aren’t using any method of birth control, or contraceptive, and tracking fertile periods, and having sex as frequently as we are, how can you not be trying…Seriously, I don’t know where he gets this stuff, but it made me giggle and relieved so much anxiety.
Okay to the appointment. She asked the basic questions… how long have you been off birthcontrol, I asked if condoms counted, she said “No, people aren’t as cautious with condoms as they think they are.” So that’s been since February 2011. She asked how frequently we have sex, once a week? I said at least that, then she looked at my BBT charts and said “Or much more frequently.” and I giggled a bit. Asked about my period, painless, not super heavy, not long.
She then asked about my family history. How many time did my parents get pregnant. 7, two miscarriages, one set of spontaneous twins. Asked about my mothers sisters which I told her were unknown. Asked about my medical history, congenital heart defect, which is believed to be genetic (ugh number 1!) other than that, my personal medical history is pretty timid. Family medical history mom has fibroids, sister has endo (ugh number 2!) which turns out, when a first degree family member has endo your chance is like 30%. What I then forgot to mention, and will on the phone tomorrow is mom had a brain tumor(ugh #3!) and epilepsy is prominent on both sides of the family (ugh #4!) Oh yeah, same sister that has endo also has MS (ugh #5!) so at this point we get a comment about crappy genetics… Then it transfers to Joseph. All while this is happening, Joseph is feeling like we are doomed. Our genetics are bad, we should procreate ever. So that’s a story for another post (maybe after this, maybe not though.)
So initially my RE said that we probably fall into the “unexplained” category, but at the mention of sister endo, she began to think that may be it.
We then went over all of the test results, looked at BBT charts, and discussed. my Progesterone of 7.9, she would have preferred to be over 10. My HSG was fine, Joseph’s test was all normal. She put limits on our caffiene which I should start following. J can’t put his laptop on his lap until he gets me pregnant.
I asked her about the late ovulation on clomid this cycle, and she explained it like this, clomid can some time delay your brains signal to ovulate, which causes you to have an over ripe or mature egg, that egg is of poorer quality than one released on time. She actually said she prefers to see her patients ovulate 6 days after their last pill, and will trigger if later than that.
So then we go to ultrasound. She ultrasounds, uterus is fine, now she’s checking out the ovaries. Right ovary, she can see the Corpus Luteum on the right, meaning I ovulated there. She then see follicles, she counts follicles, there are 22. I asked if this could be from the clomid(wondering if this is what they mean by hyperstimulation?) she says no this looks like PCOS. a pearl necklace around the ovary. She checks the left where she finds 14 follicles. I have to say I was a bit confused, because she didn’t call the cysts. She then explained that PCOS is not accurately named, they aren’t cysts, they are in fact follicles. We finished up the ultrasound and went back into her office.
She said there are three criteria for diagnosing PCOS:
1. Irregular cycles.
I am on the brink of irregular, mine vary between 31-37 days, but out of the last 7 I’ve charted, most have been 35. So I don’t “meet” this criteria.
2. Many follicles on ovaries.
Normal women have 5-6. I have 22 on one, 14 on the other. Check!
3. Elevated testosterone,
I hadn’t had my testosterone drawn, so she did a blood draw and will call me tomorrow with the results, but the rest of the appointment and plan we came up with is under the assumption that I have PCOS.
This is all IF I am not pregnant this cycle (which I’ll explain why I think I’m not later.)
I will continue clomid but up the dosage to 100mg and change days from 5-9, to 3-7. Her goal is to get me to ovulate 2-3 eggs every cycle. After my last clomid pill, I will wear an estrogen patch until the ultrasound which will be between cd8-12, one my lining is verified to be thick enough, I can stop the patch. After ovulation I will start vaginal progesterone suppositories. 14 days after I ovulate, I will take a pregnancy test, if negative stop progesterone, if positive, hopefully stay pregnant.
She did say that women with PCOS have a high chance for miscarriage, but I’m not sure what is done about that, if anything can be done.
She also asked about lube. Joseph and I have use preseed, but 20 bucks on lube a cycle is a bit excessive. She agreed and suggest canola oil, so we’ll see about that. And said that a baby aspirin a day has been shown to increase chance of a better outcome in women who have had losses. Also she said she *believes* and is researching further before she tells me to do this that a high dose of folic acid has been shown to reduce the chance of my specific heart defect.
So she did say that it’s a LIFETIME max of 6 cycles on clomid. I had heard varying stories across the internet (super reliable I know!) but is is a lifetime max. So I’ve already use 2 of those cycles. I wish I would have known this sooner because I would have waited this cycle to do with with an RE monitoring. There are some studies that have shown a link between 12 or more cycles on clomid and ovarian cancer. So she said that most RE stay FAR away from 12, and only allow 6. She did say that if in 4 cycles, I’m still not pregnant we can try letrizole/femara, but hopefully that is a nonissue.
She metioned metformin, but I’m not on it, and didn’t discuss it much, but I know it is something that women with PCOS get put on frequently.
ALSO NO MORE BBT FOR ME! Dr.Archer said that with her US and OPKS would provide enough data.
Why I think I’m not pregnant:
1. BFN this morning at 9dpo on a dollar tree test. I know 9dpo is too early to rule myself out, I had a bfn 10 dpo in August, then a BFP at 12, I know too early, but it is a bit demoralizing.
2. Late ovulation. This made me uneasy when I was waiting to ovulate, but to hear Dr.Archer discuss why you don’t want a late ovulation, it made me feel worse about it.
3. 1 egg. I only ovulated 1 egg, now back in August, I only ovulated 1 egg (I know this form the US and corpus luteum) and got pregnant, my 1 egg was over ripe.
4. No symptoms. I mean besides the symptoms I’m forcing myself to write down to earn arbitrary pregnant point from fertility friend.
What I am excited for the most:
1. Having the greatest husband in the world!
2. Having a baby. Duh!
3. Maybe having a diagnosis/explanation for why we haven’t been successful.
4. Having a plan with designed specifically for our situation with monitoring along the way.
5. Sleeping in.