new cycle and trying to stay hopeful

I saw Dr. Schmidt on Thursday (12/16) for my baseline ultrasound. He could see the old ovulation sites on my ovaries, so I did ovulate last month. He decided to try something a little different this month. Instead of starting the Follistim injections that day, he had me take an oral medication from Thursday through yesterday. The medication is called Femara (http://www.femara.com), and it is in a category of drugs called aromatase inhibitors. The drug is indicated for breast cancer patients, because it reduces the amount of estrogen produced by the body (estrogen actually fuels certain types of breast cancer cells to grow). This drug is also used for infertility because decreased estrogen production causes increased follicle stimulating hormone (FSH) production. So, I took 3 Femara pills each day from Thursday through yesterday, and I started the Follistim injections today. I will go in for an ultrasound and bloodwork (estradiol level) on Thursday, and my Follistim dose will be adjusted based on the bloodwork results. Dr. Schmidt is trying this because he said my cycle was way too long last time (over 3 weeks between my period and ovulation), and he is hoping that the combination of Femara and Follistim will help me produce some big fat follicles by next week. He is aiming to do insemination by the end of next week, and I am hoping that is what will happen.

I know so many people who are pregnant right now (6 people come to mind immediately, and I believe there are a few more, too). I am so happy for them, but also so envious. I desperately want to be pregnant. My life has become completely consumed with getting pregnant. I wish I wasn't like this, but I don't know how not to be. I keep wondering how many more months I can go through this. I can't believe I am going to be 35 in two months. I have never felt as old as I do right now. I really stop and wonder sometimes if my time to get pregnant has come and gone. People keep telling me that we can always adopt. Well, yes, that's true, but adoption is a very complicated process. I have a few friends who adopted, and they had to go through so much to get their babies. Plus, it may sound selfish or unreasonable, but I just want to feel a baby growing inside me. More than anything, I want to feel everything that goes along with a pregnancy ... morning sickness, growing belly, feeling a baby moving around inside me, giving birth, and breastfeeding. I have been dreaming about being pregnant a lot lately. Maybe in 2011, that dream will become a reality.

not pregnant ... AGAIN.

Well, my period started today. I guess I don't have much to say except that I am feeling very sad tonight. I was so hoping this would be the month. I will go in for my baseline ultrasound on Thursday, and I will start the daily Follistim injections that evening. Here's hoping that 2011 will be a better year ...

oh, what a month!

I just realized it has been over a month since I last posted. What a month it has been. Brian and I went on our trip to NYC from 11/5-11/8. It was a very bittersweet trip because I saw my most beloved Aunt for the last time that weekend. Aunt Connie (my Dad's only sibling) and Uncle Ted have lived in New York City forever, and they are the reason that New York City is one of my most favorite places in the world. Aunt Connie battled fallopian tube cancer (pretty much the same as ovarian cancer) for the last two years, and declined pretty rapidly over the last month. I went to see her on the Saturday we were in NYC, and she didn't even know who I was. That shattered my heart in a million pieces. I gave her a bath and a foot massage, and said goodbye to her. It was incredibly painful, but I will always be glad that I had a chance to say goodbye. She passed away the following Wednesday (11/10). Brian and I flew back to NYC the following weekend for the funeral. Twelve days after Aunt Connie passed, Uncle Ted joined her. He had been battling some health problems, but I also believe that he died of a broken heart. They were each other's whole world, and they had spent over half their lives together. I am terribly sad for my cousin, Lauren, who is an only child and had to bury both of her parents within two weeks. My family spent every Thanksgiving (in Ohio) and Christmas (in NYC) for my entire childhood with Aunt Connie, Uncle Ted, and Lauren. Needless to say, this holiday season is very sad for my family and me.

Back to fertility stuff ... my period started on 11/8, and I started my daily Follistim injections on 11/10. Since 11/10, I have gone to Dr. Schmidt's office for 5 ultrasounds (the internal, not-very-fun kind) and blood draws. Each ultrasound showed the progression of my follicles maturing, and the blood work showed my estrogen level. My Follistim dose had to be increased after each ultrasound and blood draw, because my estrogen wasn't high enough and my follicles weren't big enough. The injections weren't too bad ... I have bruises all over my belly and general abdominal soreness, but that's about it. I went in for my last ultrasound this past Friday (11/26). That was also the day of my last Follistim injection. The ultrasound showed one large follicle and a few other smaller ones. Dr. Schmidt told me to take my HCG injection on Saturday night at 9PM, which would have me ovulate this morning at 9AM. I had to work last night, so I met Brian at Dr. Schmidt's office at 7:45 this morning. He went to the lab and provided a sample :), and we were told to be back at the office at 9AM for insemination. When we got back to the office at 9AM, there were about 8 other couples there. Surprisingly, we were still on our way home by 10AM. The insemination was pretty harmless. Dr. Schmidt came into the exam room with a very small vial of "baby making gold". Haha. He said that the lab took Brian's sample and washed away everything but 36 million of the fastest, strongest sperm. It's amazing that they are able to do that. I got on the exam table (yep, stirrups and all!), and he inserted a speculum (just like in an annual GYN exam). Then, he inserted a thin catheter into my cervix, all the way to the top of my uterus, and injected the sperm into my uterus. I had to lay there for 10 minutes, and then we were on our way!

I have to have my progesterone blood draw next Monday (12/6), to confirm that I ovulated. After the blood draw, I will give myself an HCG booster shot (half the dose that I used to induce ovulation). This will help prolong the luteal phase (period of time between ovulation and menstruation), which in turn supports the pregnancy (if it has occurred). Then, I will take a pregnancy test on 12/16. Gosh, that seems like a LONG time away!!! I am trying so hard not to get my hopes up, but I desperately hope that this will work. What a beautiful Christmas present that would be ...

no period, but not pregnant :(

Well, my period never started. Silly me got all excited that I might actually be pregnant, despite knowing deep down that I really didn't ovulate this month. I realize this seems pretty irrational, but I was so hopeful.

I spoke with one of the nurses yesterday, and she wanted to start me on Provera, which is a medicine that induces a period. I asked if I could have a beta hCG (the pregnancy hormone) blood level drawn, just to make sure I'm not pregnant. She agreed this was a good idea. So, I had the blood draw yesterday and got the phone call this morning. The test was negative. As much as I think I knew that was coming, I was still crushed.

So, I started my 10-day course of Provera today, and my period will begin when that is finished (usually a few days later). That means two weeks delay until my next cycle begins. I try to be a patient person in life, but when it comes to this infertility stuff, I am far from patient. Needless to say, I will be anxious for the next two weeks to come and go. Fortunately, Brian and I are going on a trip to New York City at the end of next week, to celebrate our 9-year anniversary (earlier this month) and Brian's 40th birthday (next week). It will be nice to get away and get this infertility nightmare out of my mind for a few days ... who am I kidding ... it will never leave my mind, but at least I will be having fun and distracting myself with other things.

I also confirmed the mail order for the Follistim and Novarel (HCG) today. They will be shipped on ice overnight tomorrow (delivery is free!), and they will be waiting patiently in my refrigerator until I am ready for them in a couple weeks.

So, that's the story. I am feeling sad tonight. I was so hoping this would be the month I got pregnant, but it wasn't meant to be. I continue to be amazed at how consumed I am with trying to get pregnant. It's all I have focused on for several months, and I feel like it's all I think about. I wish there was a way to not be like this, but I don't know how. I would imagine that others who are struggling with infertility go through the same thing. I have thought about joining an online support group, but I am not sure if I want to. When I was diagnosed with cancer in 2008, I joined every online support group I could find. I ended up leaving all of them after a few months because they just left me feeling depressed. I am afraid this would be the same way. We'll see. Time to move on to the next cycle ...

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 ...

oh, the ups and downs (mostly downs) ...

Well, I was supposed to ovulate last Sunday (10/10), after giving myself the HCG injection late on Friday. I had my progesterone blood draw this past Friday, and Dr. Schmidt's nurse called me on Monday morning with the results. She said that my progesterone was 0.7, which means that ovulation did not occur. She is pretty certain it's a lab error, because she said it is pretty unlikely that ovulation did not occur, especially with the HCG shot. Progesterone level needs to be above 2 to indicate ovulation. So, while I can only hope that there was a lab error, I am still sad and worried that maybe that number is real. In any event, I have had cramps since about Saturday, and I just feel like my period is going to start anytime now. If I am not pregnant now, I guess I have 4 options for next cycle:

1. Take a triple dose of clomid (highest dose possible)
2. Take a triple dose of clomid and add progesterone supplements (vaginal suppositories, I assume) at the time of ovulation
3. Be done with clomid and move on to stage 2 of fertility treatment: injectable gonadotropins
4. Take a break from fertility treatments and try to put it out of my mind (yeah right, like that's going to happen), and hope that maybe it will happen when we are least expecting it.

I'm leaning towards 2 and 3 at the moment. To be honest, I don't think 4 is an option I can live with right now. If I was 28 or even 30, I might consider it. But, I am almost 35, and I may not have very many years of potential fertility left (if I even have any potential fertility right now). So, I feel like time is fleeting and I need to do anything I can to get pregnant sooner rather than later.

We'll see if (when) my period starts, and then I will talk with my doctor and get a better feel from him about which option(s) he recommends.

Infertility sucks.

feeling sad

Well, I had my ultrasound today. I only have 2 follicles, and they are very small. :( I'm not supposed to take my HCG injection until sometime on Friday, which will have me ovulate on Saturday night or Sunday morning. Unfortunately, Brian is supposed to go out of town this weekend, so I'm pretty stressed out about how we are going to make this work.

I asked the nurse (who talked to me after the ultrasound) some questions about where we go from here. She was pretty candid with me and said that they usually only have people take clomid for 3-4 months before clomid failure is declared. This is my 3rd month. :( She said that if my post-ovulation progesterone is as low as (or lower than) it was last month, they probably won't even have me take clomid next month. She explained the next step ... injectable gonadotropins which mimic the hormones that my body is supposed to be making. The whole process is pretty complicated, but it sounds like I would be giving myself subcutaneous and intramuscular (ouch) injections several times a day starting on cycle day 3 and going until at least cycle day 8-9. I would also have to get blood draws and several ultrasounds during that time. If you think this sounds expensive, you are correct. She told me that this whole process costs close to $1,000 a month. Yep, that's like a second mortgage payment. My heart sank when she said that. Of course, we will figure out a way to do that, but it's going to be hard with nursing school loans coming due.

I realize that I am getting ahead of myself by worrying about all of this. But, I am a worrier by nature, and I haven't yet figured out how not to be. I guess I just think that I can see the writing on the wall, and I don't feel like the clomid is really working for me anymore.

So, first I have to figure out how this weekend is going to work. Then, I have to hope that my follicles will continue to grow over the next few days and actually be viable. Then, I have to hope that I will actually ovulate. And finally, most of all, I have to hope that I will get pregnant this time.

And that's all I have for now. Please send good thoughts my way. I need them.