Clomid Cycle

We decided to try Clomid as the drug is more cost effective and a lot less intrusive than the shots. I was put on one Clomid pill a day, which I took in the evening. It takes longer to develop the follicles as Clomid is a much less aggressive form of stim than the injectables.

Unfortunately Clomid did not work for me. I only ended up with one follicle and it thinned out my uterine lining. They told me it would be very unlikely that an embryo would be able to attach into my uterus even if it did fertilize. We decided just to try regular intercourse rather than the IUI that month since the outlook wasn’t great.

I asked if this was just a fluke, if I needed a higher dosage or if Clomid was just not right for me. She told me not to waste my time with Clomid.

It was disappointing. I was really hoping that Clomid might give me a chance to pump out multiple eggs for a longer period of time (i.e. more than the three cycles of injectables that we were prepared to do), in hopes that we might catch a good one. But by now, we unfortunately are used to getting disappointing news.

 

Follow Up with the Doctor

We met with our doctor to express our concern about reducing the dosage. First, you spend some time with an intern/fellow. The woman I met with was actually out-of-province and was visiting temporarily. I expressed my concerns with her and also asked about other possible treatment options with her.

She didn’t really have too much to offer with regards to the dosage of my medication. Just like most other medical professionals, she commented that my AMH was really not that low and she had seen those with lower numbers go on to get pregnant.

I did however, ask her about Clomid. I had never tried Clomid before and I thought it might be easier to use long-term since it would be less expensive for us. She said we could definitely try Clomid. She said where she was from (Manitoba), woman are put on Clomid while they await further fertility treatments. It’s the first thing they try out there, some women using it for one year before they move onto more aggressive treatments.

When my doctor entered the room we went over my concerns again. I told her how considering I have never ever fallen pregnant in all the years I have been trying, it would be very unlikely for me to all of sudden get pregnant with all the follicles. She said she agreed and considering my history and my two failed IUIs that she had no problem pushing for more eggs, finally!!

She also agreed to let me try Clomid. We decided to give this a try before we moved onto the third IUI.

I was angry that it took this long for someone to listen to me, but I was also happy that we seemed to be heading in the right direction.

IUI #2

After the failure of the first IUI in December we decided to jump right back in and try a second cycle in January. However, due to the four follicles I produced the month before my doctor decided to decrease my dosage to 50 to prevent over stimulation.

Unfortunately the decrease to my dose meant a huge decrease in follicles. This time I was only producing one strong follicle. We weren’t very happy about this. It’s frustrating because when you are given a 2% chance of conceiving naturally, and only a 15% chance of conceiving with IUI it doesn’t make a lot of sense to me to be conservative. In all the years I have been trying to conceive I have never, ever achieved pregnancy. Not even a chemical pregnancy. So I just can’t understand why they need to be so concerned about multiple pregnancies. It’s so unlikely. My husband was angry about it. He feels that the clinics want to push us throw unsuccessful IUIs so that we will move onto IVF. I would like to think that’s not the case, but it does make you wonder.

After the news that we only had one strong follicle we debated even moving forward with the IUI. To me, it wasn’t worth it. We make one egg every month and have no sperm issues. Why would I pay $500 to have the sperm washed and injected into my uterus when the only point to the IUI was to make more follicles.

I raised my concerns with the nurse who told me that statistics still show a higher success rate with IUI even with one follicle. And since we had already invested in the medications, we ultimately decided to go ahead with the IUI.

When I booked the IUI I told the receptionist that I needed the procedure guided with ultrasound, that the doctor had asked me to request this with the next IUI. She said that was no problem and to come with my full bladder. When we checked in that morning to deposit the sperm I asked again about it. The receptionist told me it was no problem and just to let the nurse know when I came back for the IUI (They collect the sperm first thing in the morning. They take a few hours to wash it, so you come back at a later time for the IUI).

When I was called into the room for the IUI there was no ultrasound machine. I said to the nurse, I was supposed to have this guided. She then rudely told me that I had to book that in advance as they don’t just have techs available. I was dumbfounded. I told her I did book it in advance. So here I am with my bladder bursting and I have to wait even longer for them to find a tech. Thankfully they did and the procedure went very well.

While the doctor was inserting the catheter he said to me “ahh, I see why they had difficulty getting this through last time. You have a bump in your cervix.” Umm pardon? I asked him if that was something I needed to be concerned with (thoughts of cervical cancer started racing through my mind). He told me that no it wasn’t, it was likely something that I was just born with. I then asked if it could be preventing the sperm from getting through, he said no. So it seems like the bump is not important at all. Way to scare the hell out of a girl.

We waited anxiously during the two week wait. We figured the chances weren’t high with our measly single follicle. And we were right. I started spotting 4 days after the IUI and it continued till I got my period 11 days later (yes, 11 days of spotting). This time we decided to take some time off, and have a follow up appointment with the doctor to discuss our concerns.

 

 

IUI #1

Our first IUI was in December. IUIs were new to me. I had never done one before so I was a little unsure of what to expect. The needles would be the same, but the procedure where the sperm is injected into the uterus would be a new one for me.

For this IUI I was put on Puregon with a dose of 58. The dosage starts on Day 3. After the first 6 days of injections I went back to the clinic to see how I was coming along. I had 4 follicles coming along nicely. Unfortunately the nurse told me that they might cancel my cycle because they don’t want to see that many follicles. I told her that the whole point of this was to get a lot of follicles since I have DOR. She said she’d see where my hormone levels were and get back to me. The clinic called in the afternoon and told me that my estrogen was through the roof. Thankfully they didn’t cancel the cycle they just had me reduce the dose to 50 and told me to come back in a couple days. That visit showed that there was a front runner follicle with another coming up behind it. The other 2 were smaller. They decided that I was to take the trigger shot that night and come for the IUI the next day. They didn’t want the other 2 follicles maturing and they didn’t want me to ovulate the big 1 before the IUI procedure. The nurse told me though that I likely would have 2 mature eggs, maybe 3 at the time of the IUI. We were really excited and very hopeful.

The IUI procedure was not fun. I have an anteverted uterus (meaning my uterus leans forward towards my abdomen). The nurse could not get the catheter through my cervix. After trying for what seemed like forever (probably like 5-10 minutes) she went and got another nurse. That nurse also could not get the catheter through. By this time I was very crampy and my cervix was irritated and sore. Tears were starting to well up in my eyes. The whole thing is already so emotional and a little bit scary when you don’t know what to expect. And then when things don’t go smoothly it just makes the whole process so overwhelming.

The nurses eventually gave up and told me that they were going to have to use the ultrasound machine to guide the catheter through my cervix. This meant, I had to get dressed and spend 30 minutes chugging water to get my bladder full enough to use the ultrasound machine. After 30 minutes I was back in the room and the nurse was trying again. It took a lot of fiddling but she finally got it in. After that, she simply squirted the sperm in there, told me to wait 5 minutes and then we left.

After the IUI I was medication free, which was nice. I just had to sit back and wait for the pregnancy test, which was scheduled for 14 days past the IUI.

6 days after the IUI I started spotting. I called the clinic in a panic. They told me it could be implantation bleeding and just to wait it out. After that 1 day, the spotting stopped. It really got our hopes high that it was in fact implantation spotting. Then 10 days past the IUI I had another day of spotting. But just like the first time, it lasted for just that 1 day. We were confused but there was really nothing we could do except wait to see what the pregnancy test said, which was only 4 days away.

Unfortunately I never made it that far. My period ended up coming 3 days before the test. We were so disappointed. We had a good amount of follicles and good sperm. It made me think even more that my egg quality was to blame.

Just a bit of a warning about the post IUI menstrual cycle, the period that followed my IUI was horrendous. My periods had started getting heavier the longer I was off the pill, specifically heavy on the first two days then tapering off after that. But this time, on the fourth day of my period, out of no where I started bleeding extremely heavily. This is pretty graphic, but I am going to tell you anyway. I got out of the shower and put in a regular sized tampon. On day four, that would be more than enough coverage for me. But after 30 minutes I noticed that blood was running down my legs. I panicked. That had never happened to me before. I took the tampon out and clots of blood fell into the toilet. I’m talking huge, toonie sized clots. I never get clots and never bleed that heavy so I started to get very concerned. I put in another tampon which I filled again in 30 minutes. I decided to call the telehealth line that we have here in Ontario. The nurse on the other side recommended that I go to the hospital. It was New Year’s eve and our ERs are always packed. I decided to wait it out. Sure enough after an hour the bleeding all but stopped and my period ended the next day.

When I did a little research it looked like the bleeding could have been caused from the elevated levels of estrogen that I had from the four follicles. I’m not a doctor, obviously, so that is just my guess, but it’s something to keep in mind if you’ve undergone medicated cycles.

Update

It’s  been a few years since I’ve posted here, but I’ve never stopped thinking about it. Never stopped thinking of all the people I connected with via this blog. I have been once again thrown into the chaos that is infertility. This time though, I feel like it is worse.

Since my last post my husband and I did end up separating and then divorcing. It was a very hard decision but we just weren’t the same anymore.

I started seeing a high school friend after the split. We hit it off immediately. I was open and honest about what I had been through. He said he wanted to be with me despite my unknown fertility status. However, knowing what I know about my eggs, we decided to start trying to have a baby sooner rather than later. He, being the old-fashioned type, wanted to be married if we were going to start a family. So we got married this September.  The same month we started fertility testing.

I thought maybe this time was going to be different. I thought that maybe the poor eggs retrieved during my IVF were fluke. Or maybe the doctor was right and the drugs did hurt my eggs. Maybe I was going to be lucky. I was wrong.

A few months after I stopped the pill (one year ago now) I started suffering from pains in my side. This happened to me the first time I went off the pill, so I was pretty sure I knew what it was. I went to my doctor and sure enough I had another large cyst. She wasted no time and sent me back to the fertility clinic. However, this time I chose to go to a different clinic. I figured a fresh start would be good (thankfully though I was able to have my files sent to to the new clinic so that they would know my history).

My husband and I had been trying for 8 cycles when we had our first appointment with the fertility clinic. The diagnostic cycle proved to be consist with my diagnostic cycle all those years ago. Everything was great except my AMH which is now 11 (was 15 before). However, my FSH is at 9, which isn’t bad. This is a good sign. Typically the lower your AMH, the higher the FSH, is but not in my case. The doctor said that these numbers could be either falsely reassuring or falsely discouraging, there is no way to know. From what I have read it’s more likely to be falsely reassuring. But with my husbands normal sperm, it seemed like the prognosis was better than my last one.

I wanted to try longer on our own. I wasn’t sure I was ready for more treatments. The doctor thought that wouldn’t be a problem. That I would be no worse off 6 months from now. He also said that my numbers were low,  but not impossible. That he’d seen others get pregnant naturally with these numbers. I was happy to leave right then and try naturally for a few more months. I actually felt fairly optimistic.

Then the “head” doctor came in. She had a very different perspective. She said that with my low AMH I didn’t have time to waste. She said that someone my age should have double the AMH that I had. She gave me a 2% chance of conceiving naturally. 2%. I felt like my heart just broke in half. That was by far the worst prognosis I had ever received. She said IUI with injections should be our first step. She recommended 2-3 cycles before moving onto IVF. She gave us a 12-15% chance of success with IUI and 60% with IVF.

She also asked about my egg quality with my previous IVF cycle. She said it was unlikely that the drugs caused my eggs to be poor quality. She said the eggs are what the eggs are. But she did say that based on my files, I responded way too quickly to the large dose of meds the first clinic gave me. She said they immediately reduced my dose. Of course I had no idea of this.

She was in and out in a whirlwind. But I went from being so optimistic, to being so defeated.

After she left the room I spoke again with the first doctor. We discussed the costs. $500 for the sperm wash and $500-$1000 in drug costs (my drug plan through work doesn’t cover fertility drugs). These costs are per cycle. Then I have to pay over $200 for admin costs. This is a yearly fee. The numbers just kept adding up in my head. And that 2% just kept coming back to slap me in the face.

I signed the consent papers for IUI and left with the plan to start IUI on the next cycle. When I got into my car I just burst into tears. I called my husband (he couldn’t come with me because his boss wouldn’t allow him the time off work). He too was confused by the conflicting information I received. But 2% was not good odds. He thought it was best to move forward with treatments.

I took all this so hard. I knew there was a chance this was going to be the outcome. I knew there was a chance that my infertility wouldn’t be a mistake or a misdiagnosis. Yet, I let the hope cloud my judgment. Hope is important, it’s what keeps us going. But it can be dangerous. It can turn out to be false hope and create expectations and dreams that may never become a reality. I found myself sadder and more negative than ever. Not exactly how you want to spend the first month of marriage.

I think it’s hard for my husband because I have done this all before. He’s not on my level, my level of grief, of negativity of denial. I have been let down so many times and seen such terrible outcomes when the prognosis was supposed to be good. I know how volatile infertility is. He just hasn’t experienced it yet. I’m ready to give up, and he’s just getting started. This adds a level of complexity to the whole thing. But we are navigating OK, trying to remember that we are coming at this from totally opposite sides of the spectrum.

We decided we would give IUI 3 cycles and then that would be it. We put our names on the waiting list for the government funded IVF (it’s a 3 year wait at my clinic). Unfortunately the government doesn’t cover the cost of the drugs, around $6,000, so we are unsure if we will end up trying IVF or not. With crappy eggs, there doesn’t seem like much point. We are both very open to adoption so if the IUIs don’t end up working out, we will grow our family through CAS or a private adoption agency.

No matter what, we will be parents.

 

Chromosomal Results

Finally my doctor notified me that the results were in. They had to call the lab and track down my report in order to get them, but they got them. The lab missed the stat order and was running behind, apparently.

Just as I had suspected everything was fine. Such a relief. I am glad to have an answer and be able to move on.

That being said, my husband and I have decided to take a break from TTC for a while. Things have been really rough for us and I’m just not ready to jump back in. The time off from TTC gave us a new prospective on our lives. We have some marital issues and personal issues that we need to work through before we can start thinking again about having a child.

Maybe we will back on track in a month or two, maybe not. We’ll see where life takes us. In the meantime I wish everyone out there nothing but the best and am sending all my good vibes to you all.

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Fertility Drugs and Cancer

Infertility Network UK has published the results of a new study which proves that fertility drugs do not have a link to breast, ovarian and uterine cancers.

This was something that I worried about going into IVF so this study offers a lot of reassurance. The link to the post is below.

http://www.infertilitynetworkuk.com/blog/70/Long-term%20study%20finds%20no%20link%20between%20fertility%20drugs%20and%20cancers

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