I once had a doctor tell me to get pregnant right away or I would never have kids.

I was twenty.

He was old-school and this was way back when they knew NOTHING about endometriosis. Except that it existed.

My endometriosis has never been that bad, fortunately. And I decided not to marry the guy I was with at the time after envisioning our life together. The one where I had kids but was completely miserable because he and I were totally wrong for each other.

I always knew I would have issues getting pregnant. I never understood what, exactly those issues would be, but I knew they’d be there. But I guess I also thought they would be more… defined. More clear cut. As in, you CAN’T have kids so don’t bother trying. Or you CAN but you’ll just have to work at it a bit. Not this seemingly never-ending spiral of you can’t, oh wait you can but you can’t carry, or maybe you can but you have to go about it just so, or maybe you can’t, or maybe we just don’t effing know.

Fast forward. Wrong Guy and I decide to TTC. Within a few months of ditching the birth control pills I’m in horrible pain and end up on Lupron while he’s in Afghanistan. When he comes home we pretend to start TTC again. I say “pretend” because, although I was no longer on Lupron I also wasn’t ovulating. Lupron is the devil. Fertility work-up shows he’s shooting at about 10%. Doc says there’s no chance we’ll get pregnant with a sperm count like that. Then he tells me he’s in love with someone else and asks for a divorce.

Ah, the ups and downs of life. And my prospects for kids. It all really is a roller coaster.

Behemoth roller coaster in Canada

Fast forward again.

Still devastated from the divorce, I work my ass off to get my life back on track. I go to grad school, graduate, get a good job and buy a house. All in preparation for one day adopting on my own. At that point I’d given up on romance/partnership/marriage.

So, of course, that’s exactly when I meet Right Guy. And start to think maybe, just maybe, there’s still time and a chance to do the natural family thing.

Cue hot flashes. I ignored them for far too long. I was too embarrassed to admit them to Right Guy. I remember him commenting how sweaty I was one night. I said it was just the crowded bar we were in. I finally confessed to him after waking up soaking wet in his bed in the middle of the night – I had soaked his sheets. Caused by my night sweats. All I could do was cry and apologize profusely for “wetting” his bed and dirtying his sheets. He just held me.

Later we discussed it. Being a doctor he offered the “I’m sure it’s not menopause” speech. Him being a doctor was partly why it took me so long to tell him. It’s weird (well it WAS weird) to be diagnosed by your partner. Anyway, I made an appointment with my GYN. Who also gave me the “I’m sure it’s not menopause” speech. But ordered bloodwork just to check. And came back with the “It IS menopause and you’ll never have kids” speech.

Then I go see an RE who says that it’s a long shot, but it could happen. I start HRT (hormone replacement therapy) and the hot flashes subside. I start to feel somewhat sane again. But I don’t ovulate on my own. The eggs, they are gone.

We try some Clomid. It makes me ovulate. Sort of. As long as I use an estrogen primer (you can’t be on estrogen while taking Clomid but you can use it just before you take the Clomid). Gradually my eggs begin to reappear. I go from two antral follicles to about eight. Go me!

But I’m still not pregnant so we move on to injectibles. That cycle I think I started with THIRTEEN antral follicles. Which is how I ended up with SIX eggs in play and did a last minute conversion to IVF. And then got a BFP!

Woo hoo! This worked! I am going to have a BABY!!!!

Um no. I’m not. Instead of a baby, I’m going to spend ten days in the hospital and get chemo (methotrexate) and spend a total of five months psuedo-pregnant as we watch my beta HCG fall back to zero and get more chemo whenever it decides to stop falling. And, oh yeah, now I have another fertility hurdle called adenomyosis and this crazy ectopic might happen again. Oy.

Irony of all ironies? I start to ovulate on my own. No more hot flashes. But my uterus is damaged so I’m not allowed to TTC.

Pops dies of his 3rd cancer.

One full year after our surprise IVF I am cleared to TTC and do a FET. I get pregnant AGAIN!!!

Wow. Apparently I get pregnant pretty easily. Well, as long as I do IVF.

Um, no. Not so much. It’s ectopic. AGAIN. But this time it’s a run of the mill ectopic. More or less. The chemo doesn’t work fast enough and I end up in surgery having my tube removed. But I was allowed to go home afterward so no hospital stay at least.

My body returns to regular ovulatory cycles with no hot flashes. But I’m benched for three months.

The very first month we are cleared to TTC what happens? The hot flashes return and ovulation, while still happening, is not occurring regularly.

Sometimes I really want to graph the major events in my life. In 3D. So I can capture not just the highs and lows but all the twists and turns. I bet it would look like the craziest roller coaster EVAR.

roller coaster toy

Well maybe not EVAR. My life has really not been that horrible in the grand scheme of things (I’ve always had a roof over my head, a loving family, etc). There have just been a lot of ups and downs and twists and turns. I love roller coasters. But I always wanted a normal, run of the mill life.

I think what bugs me most is the suddenness and/or the unexpectedness of the ups and downs and twists and turns.

I didn’t see the divorce coming. People usually see it in hind sight. Although I can see a few things now that I didn’t see then, none of them spelled D-I-V-O-R-C-E. I was totally blind sided on that one.

Pops’ cancer? I can’t say that was a total surprise in and of itself. It was more of a surprise that he survived it. Twice. We kept expecting him to die. And he kept not dying. That was… mostly… a good thing. But then you get to a point where you start to think, “Maybe he’s not going to die of cancer.” And that’s when he did.

Same thing with my infertility. My body keeps doing strange things. I don’t know what’s real anymore. Am I really entering menopause in my 30s? I thought so before and my body somehow ‘bounced back.’ So now that it’s tanking again, I have to wonder, “Is this really it? Or will I make another comeback?” There’s really no predicting it. It defies modern medicine.

There is a part of me that just wants it to be done. Get me off this ride. Make it stop.

But I’ve posted that before: Get Me Off This Crazy Ride
Jane, get me off this crazy thing

But that’s silly. This is life. Life is not going to stop being crazy. Something new, and potentially crazy, is just around the corner. It might take you up, it might take you down. Or sideways. Or upside down. Life is like Space Mountain – a roller coaster in the dark. You can’t see where you’re going, you’re just along for the ride.

It seems I regularly get a handful full of visitors who find my blog by searching on “clomid + ovidrel timed intercourse” so I thought I’d post the results of my last clomid cycle.

Originally Cycle 3 was supposed to have been converted from a clomid cycle to an injectibles cycle because Cycle 2 was not a success. But I had a lot of other stress in my life (my father was hospitalized for pneumonia) so I didn’t want to spend the money on the shots when I knew I was already too stressed out to expect results. So I decided to give the clomid one last try. This time with an estrogen primer. The estrogen primer is crucial for me but is probably not necessary for most women. And just because I haven’t gotten pregnant with clomid doesn’t mean you won’t. It HAS made me ovulate which is something I don’t do on my own. So it’s definitely worth a try.

I definitely got a better response with the estrogen primer. Before I even started the clomid I had 9 antral follicles – my best number yet (at the time – my current cycle has even more). However, on CD12 none were mature. But they didn’t have too far to go. I had one follie at 14.5 and one at 15.4 on my right ovary with a small 10.5 follie hanging out in my left ovary. I waited several days to trigger so I don’t know exactly how large they got before the ovidrel. I could have ovulated 1 egg, 2 eggs, or potentially even 3. At least one of them *should* have been mature. But I can’t know for sure since my ovaries are like an Easy Bake Oven and seem to cook a little more slowly than most.

In any case, I DID ovulate and we had sex 3 days in a row. On two of those days I used a Soft Cup. This was the first time I used them. I can’t say whether they help or not but it definitely made me worry less about staying horizontal to make sure the sperm stay in there. And anything that makes me worry/stress LESS is a good thing. So I think I’ll use them again.

Again it was a BFN. Despite the stress of my father’s illness (which required a lot of my time) I was very hopeful for Cycle 3. It was the first time I had multiple mature follicles (or the potential for them anyway). I figured the odds of one of them being of good or decent quality were increased. So I was pretty crushed when I got another BFN.

I’m now doing an injectibles cycle with Bravelle & Menopur + Ovidrel. And again I’m hopeful since this time I have 13 follies baking in there. But again, the Easy Bake Oven is at play – they’re on slow bake. But I think they’ll get there. In their own time. I’m being monitored much more closely this time so hopefully I’ll have a clearer idea of how many are mature at trigger. At the advice of my RE, we’re still doing timed intercourse at home. I think I’ll push for an IUI next time if this cycle doesn’t work.

My ovaries are like an easy bake oven – slow to cook. It’s like trying to bake chocolate chip cookies at 200 F – it takes a little longer.

Easy Bake Oven

I had my CD12 ultrasound yesterday. By the RE’s definition it was CD12. By my definition it was CD13. But whatever. I was ecstatic to learn that I had 9 antral follicles! Nine! That’s the most I’ve ever had at any one time on an ultrasound. Obviously, most of them aren’t anywhere near maturity rendering them irrelevant for this cycle. But I’m just happy to know that there are still a few eggs left in my basket. Or maybe slightly more than a few.

I was also happy to learn that my right ovary is taking lead this month. I’m not sure I’ve ovulated from that side yet so I wanted to give her a chance. <superstition> And that’s Kokopelli’s ovary . </superstition> I think I’ll refer to the right ovary as Koko from now on. Koko has TWO contenders this month. Yesterday I had one follie at 14.5 and another at 15.4. Assuming they continue to grow at the same rate they should release together. That will increase my odds that ONE of them will be good – or make me eat my words about how I won’t have twins. I’d be OK with either outcome.

Lefty had a follie at 10.5 and two other smaller ones. There were also and additional 4 smaller ones on Koko. So it seems I’m improving on quantity. And size. The last Clomid cycle only yielded two follicles, one at 10 and the other at 11 on CD12. One of them eventually released on it’s own but it was considered a failed response. This time it’s not a failure. Just a slow bake. This time they aren’t cancelling the trigger shot – just delaying it a bit. I’ll trigger this weekend for a ~CD17/18 ovulation.

They gave me the option of going back in for another ultrasound tomorrow to confirm that the follies are continuing to mature but I decided to skip that. The doc didn’t really think it would matter much. In retrospect I’m questioning that decision. If I trigger and they’re not mature, the eggs won’t be viable and I won’t get pregnant. If they’re not mature and I wait for them to release on their own maybe they’d be viable. But then I run the risk of ovulating while Right Guy is working nights next week. I can’t say I’m a fan of either option. So I think I’ll just follow the plan and hope for the best.

I wonder if there’s a way to turn up the temp on my Clomid Bake Oven? Actually, I think that’s called injectibles and that will likely happen next month.
hypodermic needle

Ring Of Fire

July 8, 2010

♪ ♫ I fell into a burning ring of fire. ♪ ♫
fireOr rather, I woke up in one. I woke up with one of the worst hot flashes I’ve ever had this morning. Not THE worst but pretty bad. And it surprised me.

I realize that hot flashes are a very common side effect of Clomid. This is the third time I’ve taken Clomid. The last two times I never had any cramping or hot flashes while taking the pills. The cramping started after I finished taking the pills. That was true for Cycle 1 & Cycle 2. In Cycle 2 I had hot flashes after finishing the pills but not during. So that’s why I’m surprised by my current symptoms.

I think I know why. And it gives me hope. Likely I’m grasping at straws and reading too much in to this. And I’ll probably regret posting this optimism for all the world to see. But maybe, just maybe, my theory is correct and I will not only respond this cycle but respond better than I did the first time (hopefully with more than one mature follie).

Let’s see if this makes sense to anyone else…

Cycle 1 with Clomid was preceded by 3 months of HRT (estrogen replacement for all 3 months and 2 months of progesterone). My estrogen had actually gotten quite high. In fact, my RE thought maybe I had a cyst because it was so high. But I didn’t. So she decided that I must just absorb the estrogen from the patch better than most people. In any case, I went in to Cycle 1 with fairly high estrogen levels. Hence the lack of hot flashes. And since I had estrogen, that cycle worked.

Cycle 2 with Clomid was preceded by Cycle 1 + 1 month of BCPs. At the end of the month of BCPs I was already fairly miserable with my normal hot flashes. I get them if I’m not on real estrogen. BCPs do not do the trick. So anyway, I somehow managed to avoid the hot flashes while taking the pills. My guess is that my estrogen was already so low the Clomid didn’t make it go any lower and part of what makes a hot flash is a lack of estrogen but the other part is a drop in estrogen. There was a lack, but not a drop. Cycle 2 produced no mature follicles on CD12. Although my body managed to finish the job and ovulate on its own a week or so later, I really didn’t respond well, if at all, to the Clomid. My RE and I decided that I need that estrogen primer before any treatment.

So now I’m on Clomid Cycle 3 (I was going to move on to injectibles but due to other stressors in my life decided to wait another month on that). This time I’m taking the Clomid after 12 days of estrogen. It was supposed to be at least 14 days but my cycle was all kinds of screwed up last month so it’s only 12. GoldilocksBut I’m wondering if this might do the trick. Silly? Probably. But what if my ovaries are like Goldilocks? They require just the right amount of estrogen – not too much and not too little but just the right amount.

So anyway, for now, I guess I’ll try and make friends with the cramps and the hot flashes in the hopes that they indicate hard working ovaries. Right Guy will just have to put on another sweater while I turn the AC down a little more…

The Bitch Is Back

July 3, 2010

Aunt Flow showed up on my doorstep yesterday quite unexpectedly. With a suitcase full of giant cramps. I thought it was 10-11 DPO. I had thought the spotting the night before was implantation bleeding. I stupidly allowed myself to hope a little more than usual. When will I learn?

Let’s recap Cycle 2:
First of all I can’t believe this is only Cycle 2. It feels like forever. In fact it has been 8 months now since my diagnosis. We waited a few months on HRT to see what my body might do on its own. Right Guy and I were officially “trying” but my my body wasn’t cooperating. So I eventually tried Clomid not thinking I would get much response. POF/POIers don’t typically respond well to Clomid. My response was beautiful for Cycle 1. I got a BFN but I was ecstatic that a $10 drug worked. Until it gave me a cyst. So I had to wait for Cycle 2.

Nothing about Cycle 2 has gone right. When I went in for my CD12 ultrasound I had 2 follicles – neither mature. I was kind of expecting that news since I had been fairly crampy the first time around and this time not. So we canceled the plan for the Ovidrel trigger shot and just waited to see if my body would finish the job on its own. Meanwhile, my morning temperatures were a little erratic. Which was another clue that things weren’t going right. When I started to feel crampy I told Right Guy we should go for it even thought the OPKs were saying no. So we did for a few days. Then I sort of gave up when the OPKs kept coming back negative. My temps were just a wee bit higher but still not high enough to indicate I had ovulated. Or so I thought. Then the OPKs started coming up positive. So we went back to trying. And a couple of days later the temps went up – but again, only slightly. But it was technically up enough to indicate ovulation. I still wasn’t sure so I went in and got my progesterone tested. 14.4. An outstanding progesterone level. I thought things were looking up.

Since the Clomid hadn’t worked as planned, the new plan was to make sure I primed with estrogen before each cycle – no matter what protocol we use (Clomid or injectibles). So I had put my estrogen patch back on as soon as I thought I had probably ovulated. I reasoned that the Estrogen was the reason my temps were low. They never went above 98. This whole cycle my temps were in the 97s (with one dip to 96.9). But I chose to ignore the temps. I was trying to focus on the positive – I had ovulated!
Aunt Flo
So now that Aunt Flo has shown up I’m wondering whether she is indeed early. Or did she show up right on time? Did I ovulate before the + OPKs? If that’s the case my body is screwed up. Or did I ovulate when I think I did and she’s early? In which case my body is screwed up. Why am I surprised that my body would be screwed up? We already knew that. I guess I was just hoping that it was only screwed up in the one way we already know about.

And what’s with Aunt Flo’s suitcase full of cramps? Do I have another cyst? Is it the endometriosis? All I know is that it is not fun. I’m not doubled over in pain just yet. But I don’t feel too far from that point.

So I saw my RE yesterday and we came up with a new plan. I feel better just having a plan. Although, I’m not particularly convinced it’s going to work but… I’ve got to try. But I suppose I also feel better about it not working since Right Guy and I discussed our other options the other night. You can read about that here if you want. I just need to have a plan. I’m fine with plans changing but I need to have one.

I had the option of trying the clomid again (with an estrogen primer) but I chose to be more aggressive. The clock is ticking. Regardless of what protocol I use in the future this failed Clomid cycle proves that I absolutely HAVE to have an estrogen primer. When I’m off the estrogen for too long nothing is going to help: not Clomid, not injectibles. They all work in roughly the same manner: they raise your FSH. My FSH is already high so it doesn’t take a rocket scientist to figure out the problem there. And my reserve is abysmal so all the treatments in the world can’t coax out an egg that doesn’t exist.

So the plan is to use a cocktail of FSH and LH. I have to go take a class to learn how to mix them up. I did go to bartending school once upon a blue moon so I think I can handle mixing my hormones. But this protocol means more shots and more monitoring ultrasounds. Gonna be interesting. I’m not sure what would come after this if it doesn’t work. She just said we could keep going until I’m either pregnant or my body proves it’s definitively not going to cooperate.

I didn’t even ask about IVF. I just don’t see how it’s possible. I know there are some die hard POFers out there who say not to give up on the idea of IVF but if I don’t have the eggs, I don’t have the eggs. The RE did briefly mention Donor Eggs but we’re not there yet and she knows that. I did ask about IUI. Everyone I encounter in this virtual infertility world seems to do them. But it doesn’t appear that I need it. Right Guy’s sperm is good and I don’t have any other issues (that we know about) so she said it wouldn’t really help us any.

So I took my 100 mg of Clomid on cycles days 3-5 as instructed. Today is CD12. And I had my ultrasound this morning. I’ve been a little worried all week that it wasn’t working since I didn’t really have much cramping this time. Geez, I hate being right sometimes! I was hoping I was just being paranoid. But no. It’s official. The Clomid did not work this month. I have 2 follies (one on each ovary) and neither are mature. So no Ovidrel this month. The current plan is to just use OPKs next week to see if I O on my own. As usual, I saw the fellow this morning, so I’m waiting on a call back from my doc to see what the plan is for next month. Even though I knew this was probably coming I’m still kind of… well… almost devastated. I just don’t see how this is ever going to happen for me.

I’m pretty sure I know why it worked last time and didn’t work this time. It’s something I suspected might happen even before I took the Clomid this month. But I was trying to remain positive. Maybe sometimes I shouldn’t do that and I should bring up these concerns with the doc. Since I was freaking right. I could kick myself. I really should have asked her what the chances were of it working without the estrogen primer. Anyway, enough of that here’s the explanation.

My FSH is high because my egg supply is low. When I don’t produce eggs/ovulate my body just produces more and more FSH to try and grow and release a follie. That’s pretty much what Clomid does too. So, given that my body is already unsuccessfully doing essentially the same thing as Clomid I was leary of it to begin with. BUT. The estrogen patch I was on before lowered my FSH. And I think that’s why the Clomid worked before. It’s been 3 months since I’ve been on the estrogen patch so I assume my FSH went back up. And that’s why the Clomid didn’t work this time. I really need that estrogen patch. But I can’t be on it while I’m on fertility drugs. But without it the fertility drugs don’t work. Such a Catch-22.

No babies of my own. Maybe I’ll get lucky but I think my odds of that are on par with winning the lottery. Maybe I should start buying tickets. Maybe I’ll win the lottery and then be able to afford adoption. 😛