0dpiui #1

Well, today was the big day. I went in for IUI #1. It was really fast and painless - about 30 sec.

We had great news as well which has me more optimistic:

1) I did not ovulate yesterday. B\c the Ovidrel was causing the four mature follicles to grow even more, my ovaries are simply enlarged. Any cramping that I am feeling is the final "growth spurt" of the follicles. Plus, my sides and back were really cramping when I woke up this morning, so I think I am ovulating now. You were right, Amy! Thank you for calming me down!


2) Ed did his job superbly. We had 41 million sperm after the wash. Just FYI, the sperm go through a "wash" before an IUI. In a wash, the sperm is put through solutions to "weed out" the weakest sperm (bad motility, bad morphology). For an IUI, they want to see at least 2-3 million sperm, with average being 15-20 million. So, as you can see, Ed's 41 million was superb. They actually gave him a standing ovation. Although it does not necessarily improve our chances, it does mean that there are more sperm that can hopefully meet at least one of the four eggs.

3) Remember how I spoke about the high miscarriage rate in PCOS people? And remember how I said that in PCOS one of the main symptoms is obesity? Well, the P.A. said that the high miscarriage is usually attributed to the obesity factor. As such, she said that my chances of miscarriage are closer to that of a "normal" person - so only 15%. Yay!! That made me feel better too!

Illustration of IUI

So all-in-all it was a great appointment. I'm working from home today - with my legs in the air. Now begins the worst part of this process - the 2ww. And b\c I'm on HCG shots anyway, I have all the symptoms of pregnancy. It's going to be a long 2 weeks. Beta test is scheduled for July 14 @ 7:30 am. Ahhh...

16.5 hours until IUI

So I'm ready to cry. I have been "crampy" all day. Normally for me that is a sign of ovulation (at least when I've been on Clomid). When I was in a conference today, I was really crampy. Now, I feel just slightly crampy.  I'm so scared that it is happening tooo early (or already has happened) and I will have missed it by tomorrow morning at 11:00 am.

And, yes, I know the trigger shot is supposed to make me ovulate, but not before tomorrow morning after 11:00 am. I tried to call the doctor after my conference, but of course they closed at 4:00. I don't want to call the on-call doctor for something so minor.

Please just pray that it is a side effect of the Ovidrel (i.e., preparing me for ovulation) and not ovulation quite yet. I will be pretty devastated if I have four "very good" follicles and missed it b\c of timing. Unfortunately, you're not allowed to have sex for 48 hours before the IUI.

Off to an O's game. Keep us in your thoughts and\or prayers.

Trigger Shot

Here is the trigger shot:

I just gave the shot to myself (hopefully in the right area). Side effects include headache, nausea and vomiting, and fatigue. I'll let you know how it goes.

IUI #1 - Day 14

I have the doctor worried. I have 4 mature follicles ready to go. Today's measurement:

Follicle 1 - 20 mm
Follicle 2 -  18 mm
Follicle 3 - 18 mm
Follicle 4 - 17 mm

It looks like they all caught up to each other. So today he gave me a sheet on "the risk of having multiples." At the end though, being the lawyer that I am, I had him conceding that the chances of four are actually low. He essentially gave me these %:

Chance of pregnancy - ~15-20% [a little lower than normal]

If pregnant:
Chance of Twins - ~50%
Chance of Triplets - 20-30%
Chance of Quads - 15-10%

So just got the call. I take the trigger shot tonight. And IUI #1 occurs on 11:00 am Thursday morning. Unfortunately, my RE is out of town the next 2 weeks. I will have a stranger (I think a P.A.) doing the actual insemination. I'm kind of bummed about that, but I do trust all doctors at Shady Grove. Everyone is so nice and supportive there. We have a mini-celebration everytime we see a follicle grow. Plus, I've met the P.A. and she is really wonderful.

I start progesterone supplements 2 x a day on Friday. Then July 14th I go in for my BETA test to see if it worked.

My main emotions right now are excitement and hope. Unfortunately, ones chances are quite low even with IUI. Therefore, I'm likely just setting myself up for failure YET AGAIN. It's hard not to get excited, but the fall is so much harder when you are on a high. I have to keep my emotions on track and my mind off of it. So keep your fingers crossed.

IUI #1 - Day 13

The follicles continue to grow! Today's numbers:

Follicle 1: 16.8
Follicle 2:  15.6
Follicle 3: 15.2
Follicle 4: 14.8

About 1.8 cm in growth as expected. It does look as though Follicle 4 is dropping off, however, which is not necessarily a bad thing (based on the following).

Estrogen 594
LH 12.7
Progesterone .6

My estrogen level is once again indicating that three follicles have the potential to become mature eggs (~ a "dominant" egg puts out an estrogen level of 150-200). My LH went down which indicates, in conjunction with the progesterone level, that I have not yet ovulated, nor will I likely do so imminently. Dr. M says its probably "just where it wants to be right now." As such, when I surge it will likely near 40. This is a great thing at this point in my cycle!

On a "I got excited, but probably should not get my hopes up" note, Dr. M gave me a talk about the three follicles that are still in the race. He says that it looks as though all three may go to maturity, especially when given the trigger shots. If so, that means I have a greatly increased chance of multiples, especially in an IUI setting. I told him that ideally I would love to have three now and be done. He just shook his head and looked at me like I was crazy...haha!

I go back in tomorrow to see where were are. As we near closer to 20 mm, I will take the trigger shot and then the IUI will occur 36 hours later. I'll update tomorrow!

IUI #1 - Day 12

This is our first clomid\injections intrauterine insemination (IUI) cycle (note: different from IVF).

On cycle day 5-9, they had me take the usual 50 mg of Clomid. Most women seem to have side effects, but thankfully I never do. In fact, I think it makes me happier. It could be that psychologically I start to get hopeful that this month is "the month."

Day 12 was yesterday which means only one thing:  daily monitoring begins! I am to get an ultrasound every morning at 7:30 am until it is determined whether or not I will ovluate and, if so, when.

Day 12's ultrasound\blood work came back as a mixed bag! I had 3-4 eggs that looked as though they were going to win the "race to maturity." On a good note, this means the Clomid is working this round. On another good note, my estrogen numbers indicate that at least three of the follicles may release.The numbers looked like this:

1 follicle - 15 mm
1 follicle - 14.8 mm
1 follicle - 13.9 mm
1 follicle - 12.7 mm

Estrogen - 480
LH - 15.6

On the potentially not so good note, Dr. McClamrock does not know now why my LH is so high at this point. On day 12, it should still be around 2-5. Such a high number usually indicates that ovulation is 24-36 hours away, but my follicles are not big enough yet to be considered "mature." With Clomid, they want to follicles to be 19-21 cm before they begin injections to induce ovulation. Since follicles grow 1-2 cm a day, I should still be realistically 4 days away from ovulating. The only thing to do is to wait until I get Day 13 blood work back to see which way the LH surge is going. Because of this uncertainty, we are holding back on the hormone injections until we know for sure.

The call for today's bloodwork should come at about 3:00 pm.

Pet Peeve of the Day:  Women with PCOS should get discounts on pregnancy tests because we have to take so many. We have to take them at least 4 times before they will give us Provera to start the next cycle. Then you take 100000 during the time that should be the "end." I have spent probably $400 on pregnancy tests (including dollar store tests).

Background

The reason that I am writing this blog is so that many of you who know our struggles can stay informed and take this journey with us. It is also a good outlet for us to get our feelings out (a.k.a. my feelings) without constantly whining to my family and friends. Finally, since 10% of women in the United States are dealing with infertility issues, it is most likely that some of my family and friends are as well. This is a good way we can support each other.

As many of you who may read this already know, Ed and I were married in 2006. In 2007, I began law school and he began working as an engineer. On January 25, 2010, we took our last birth control pill hoping that we could have a baby before I graduated in December 2010 and studying for the bar exam began.

Within 2 months I knew something was wrong, however, when I had yet to start a cycle. I made an appointment with Johns Hopkins Bayview, but being as busy as they are I had to wait 2 weeks. At about day 100 post-BC, I saw the doctors. Their response was two-fold: (1) do not temp, chart, etc. because it will just "stress you out" and (2) the birth control is probably just not out of your system.

So fast forward five months and only 2 very short cycles later, I finally found another doctor. I told her my issues (which looking back describe PCOS to a tee minus the obesity) and she guessed that that I had Polycystic Ovarian Syndrome. The ultrasound and blood test confirmed.

 For those of you that do not know, PCOS is a condition where a woman has too high of testosterone and her LH\FSH hormone ratio is off. As a result, many follicles start devleoping into eggs, but cannot finish the process. When one looks at the ovaries on the ultrasound, it looks as though are tiny cysts all over the ovary (anywhere from 15-50) - hence polycystic ovarian syndrome. In addition, PCOS causes acne, excess hair growth (yay thick hair!), obesity, and type 2 diabetes. Women with PCOS are more likely to die of heart attacks (up to seven times), ovarian cancer (up to two times) and uterine cancer (up to three times) than other women.  Very unfortunately, women with PCOS are much more likely to have a miscarriage (50-65%) than women without (12%).

As soon as I was diagnosed on October 9, 2010, we made a plan of action. My OB\GYN was going to put me on Clomid (50 mg) for three months before sending me to the reproductive endocrinologist (RE). The first month I ovulated, but no successful pregnancy (BFN). We paused for two months so that I could take (and pass!) the bar exam. The second round of Clomid (50 mg) had me ovluating as well, but once again it did not stick (BFN).

In early April, I called my OB\GYN to get another appointment to start the next round. To my dismay, I was informed that she left the practice. I decided to take matters into my own hands and called an RE at Shady Grove Fertility Clinic. I had an appointment with Dr. McClamrock within a week.

We met with Dr. McClamrock and started all the testing all over again (blood work, genetic testing, labs, ultrasounds, etc.). On a good note, we are not at risk for any major genetic disorders. And on a DOUBLY GOOD NOTE, I was diagnosed with a "mild version" of PCOS. Whereas some women have 25-50 on each ovary, I only had 13 on one and 19 on the other. He believes that is why the lowest dose of Clomid works.

Ed was finally tested as well. His results came back very good overall. He was diagnosed, however, with borderline morphology (shape of the sperm). Although there are many "ranges," a morphology of 4% is about at the range where there may not be enough "healthy shaped sperm" to get to the egg. Dr. McClamrock said he is only "mildly worried" about it! As such, we would do two rounds of Clomid\Injections before going to IVF. If we do not get pregnant, however, we may  move straight to IVF to avoid the morphology issue.

So that brings us to today. Enjoy the journey. There is one positive note about all of this - Ed and I have never been closer. We enjoy facing a challenge together and it is only making us stronger as a couple. Plus, I'm having time to mature which, as many of you know, is probably necessary.