new chapter

Before I give today's update, I want to share a quote that I discovered today. Those of you who know me know that I am a quote junkie, and I am always on the lookout for great quotes. This one might be one of my new favorites:

"Listen to the mustn'ts, child. Listen to the don'ts. Listen to the shouldn'ts, the impossibles, the won'ts. Listen to the never haves, then listen close to me ... Anything can happen, child. Anything can be." ~Shel Silverstein

So, anyway ... as I said in my last update, today was the official "take a pregnancy test" day. Of course, I couldn't wait until today and actually took one each day for the last two days. All three were negative. :( I have been having cramps all week, so I am guessing that my period will start anytime now. So, I called the nurse today to talk about the next steps. My doctor has three nurses (who are all so wonderful) who work with his patients. I spoke with a different nurse today than I spoke with on Monday about my progesterone results. The nurse today said that she thinks I most likely didn't ovulate this month, based on my ultrasound a couple weeks ago (if you recall, my follicles were very small and I was a week overdue on ovulating) and based on my progesterone level. She thinks that the 0.7 progesterone level was real. I think I believe her. She said that this means the clomid really isn't working for me anymore, and she thinks it would be a waste of time, money, and risk factors to try the triple dose of clomid this next cycle. I agree. It appears that clomid failure has occured. :(

So, we discussed the injectible medication that I will start on day 3 of my cycle. It is called Follistim (here's the website, if you're interested: Follistim). It is an injectible human recombinant FSH (follicle stimulating hormone) that is used to stimulate maturity of multiple follicles and subsequent ovulation. I don't know all the specifics, but I believe I will start injecting myself (in my abdomen or thigh) on day 3 of my cycle and then give myself an injection every day until about day 10. After that, I will still give myself the HCG injection (Novarel) when my follicles are ready, and 36 hours later I should ovulate. This time things will be a bit more involved and complicated. I have to get a baseline ultrasound on Day 3 of my cycle, another one around day 7, and then the normal one around day 14. I will also have to have several blood draws during those first two weeks of my cycle.

I will also take progesterone supplements closer to ovulation, just to help things along. We are also probably going to do IUI (intrauterine insemination) this cycle. Essentially, on the day I am due to ovulate (based on the day 14 ultrasound and HCG injection timing), Brian and I will go into the office. We will bring a semen specimen with us. The semen will be "washed" and the millions of sperm will be isolated. The doctor will insert a catheter through my cervix and into my uterus, and he will place the "washed" sperm into my uterus. This means that my cervix (and any "hostile" cervical mucus, which can be a cause of infertility alone) will be bypassed in the whole process, and the sperm will be waiting eagerly in my uterus for the follicle(s) to come through the fallopian tube. This creates a significantly higher chance of conception occuring.

Sounds complicated, doesn't it?! I'm a bit freaked out by the potential side effects of the Follistim (specifically, ovarian hyperstimulation syndrome, fluid buildup in the abdomen and lungs, and blood clots in the lungs), and I am trying not to focus on them. The nurse reassured me that while these side effects are possible, they are not common, and they will keep very close track of me during the Follistim injections.

So, now I just have to wait for my period to start, and this new chapter of more advanced fertility treatment will begin ...