Permanent Changes

This evening I packed 2 boxes of maternity clothes to give away to some online friends of mine who are expecting babies. I am heading to the post office to mail them tomorrow. I now only have 2 very small shopping bags of maternity clothes. I keep them upstairs in a spare bedroom closet. That is also the room where I keep Elise's baby furniture and baby clothes - the room that I planned to turn into a nursery. I have put a lot of her clothes on consignment and donated most of the rest. The furniture...I think that will be the last thing to go. It's going to be the most expensive to replace if we actually do get pregnant someday. At this point the decision to keep it is more financially based than emotionally based. In many ways I think it would be good for me to have it out of the house. For now I settle for just keeping the door shut.

I think I actually feel okay about giving up all the clothing. I've been saving those maternity clothes for 5 years, and at this point it feels selfish to keep them to myself for some hypothetical pregnancy that may or may not ever happen when others can use them right now. I had been planning to donate them anyway, so when I found out that people I knew could use them, giving them away just felt like the right thing to do.

As I went through the bags to pack them up, I remembered little details about my pregnancy with Elise and when I had worn them. It made me a little bit sad, but it was also kind of a warm feeling to reflect on those memories. It's not something that I allow myself to do all that often. I didn't even cry.

I wonder if this is a step towards accepting that our family is complete? I'm not really sure yet. Some days I don't want to try anymore, and other days I feel like I could keep trying for years. It's a process that is unpredictable for me - I can be doing great and then all of a sudden something can trigger an emotion and this huge flood of sadness just rushes over me. Sometimes it happens at really inopportune times - such as glancing over at a new mom feeding her baby in the stands at a football game. All of a sudden in am in tears and trying my hardest to act normal so no one will notice and think I'm insane for crying at a football game!

I've reached a point now where some permanent changes have taken place. I think there will forever be a part of me now that gets a twinge of jealousy when I hear a story about someone getting pregnant by accident or on the first try. I will always feel a bit of resentment for the fact that things have not come easily to us...even if we do eventually have another child. It's a change in myself that I don't like. Bitterness is not a flattering characteristic. It's not the way that God would want me to behave, and yet it's something that I can't really control. Or I haven't learned how to control yet. I just don't think I'll ever be completely the same again.

Jamie and I talked a few nights ago, and if we aren't pregnant this cycle, I really want to take a break at least for December. I am so tired of going to the doctor every 2 weeks, and the drugs are making me bloated and irritable. I want to enjoy Christmas and worry about all of this in the new year. He agreed, mostly for my sake I think.

The trigger shot

I got really confused about whether or not to give myself the shot, because I was getting positive OPKs yesterday. I know it's possible to get a positive and still not ovulate. I debated back and forth whether I should do the shot anyway, just for extra insurance that I'd ovulate, or if it would actually hurt something if I already was ovulating and then took the shot after the fact.

I posted the question in the Infertility forum on Mommy's Online and got some great, quick advice from other ladies. So, the verdict was that I would go ahead and take the trigger shot today.

That was an interesting experience!

I locked myself in the bathroom to keep Elise from walking in and getting freaked out. I thought if she saw me stabbing myself in the stomach with a needle it might upset her. LOL Of course she was standing outside the door yelling, "Mommy! Mommy! The door is locked!" the entire time.

I read the instructions like 10 times before I made my first attempt. I don't mind needles at all and I'm not afraid of shots in the least. However, it is a bit unnerving to have to administer your own shot. The first time I tried, I guess I didn't push hard enough, because the needle didn't penetrate my skin. So, on the second attempt, I had to apply a bit more pressure. It really wasn't painful - the needle is really small. It just stung a little bit. It is sore now at the injection site, but all in all, I think it went pretty well.

Medicated Cycle #3 Update

Jamie and I went to the doctor this morning for our mid-cycle scan. My lining is back down to 5mm (this seems to be a recurring theme), but I did at least have 2 mature follicles. We saw a different RE today, since Dr. Dunn does not come to the Clear Lake office.

We were told that I need to take the trigger shot on Sunday night, which the doctor thinks will cause me to ovulate sometime around Tuesday morning. She wanted us to be using the OPKs, because she thought I may end up ovulating on my own. Not sure what to make of that, since Dr. Dunn said not to bother because the estrogen would confuse my system and I would need the shot to ovulate.

We will follow up with Dr. Dunn again at the end of the cycle.

Medicated Cycle #3

Unrealted to this post, but just as a side note, November 8th was the one year anniversary of my surgery.

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Jamie and I met (again) with Dr. Dunn last Friday. He went ahead and ordered a scan, just to see if he could tell if I ever did ovulate in spite of my medication mishap. They couldn't tell on the scan, so he ordered bloodwork to check my progesterone level (this would tell him definitively if I ovulated or not). I am not sure what to make of this, but my lining was 11mm during the scan. We left his office with a plan in place.

If I had ovulated, I was to wait for my next cycle to begin.
If I had not ovulated, I was to begin taking Femara again immediately.

As it turned out, I had ovulated. So, I waited. I didn't have to wait long, because a new cycle arrived on Tuesday.

So, here is the protocol:

• 5mg Femara (TWO pills a day - important distinction!) from CD 3-7
• 2.5mg Estradiol from CD 10-12
• Scan on CD 11 (day 13 would have been better, but it falls on a weekend) - at the scan they can see how things are progressing and adjust the Estradiol if necessary. I am guessing the scan will also determine when I will administer the trigger shot to induce ovulation as well.

I don't feel pessimistic about this, but I don't feel particularly optimistic either. I'm just kind of going along. I guess Dr. Dunn still thinks we are on the right track since he hasn't suggested any more potent drugs yet. So, at this point, I am still a willing participant.

As everyone knows by now, I am completely enthralled with the Twilight saga at the moment. It's been a VERY welcome distraction from reality. As strange (or pathetic?) as it is, it's actually made me feel happy. I am starting the fourth (and last) book today. I think I may be onto something. I normally don't make a lot of time for reading, but I think even after I finish this series, I might start doing more reading. It's been strangely therapeutic for me.

Today's scan

I'm not feeling like typing much, so I'm just posting the results.

No mature follicles.
No improvement in the lining.

The nurse said to just skip the trigger shot. There is no point since I'm not producing an egg this cycle. We meet again with Dr. Dunn on November 7 - ironically one day short of being exactly one year post op.

I had to return to work after the scan, and that was pretty tough. Thankfully Lisa was comforting as usual. I don't know if there is much more the doctor can do for us. I don't know if increasing the estrogen and trying injectibles will be an option or not.

I am an idiot

I have been SO SICK over this that I haven't even managed to log on and type it out.

I screwed up my medication. I was supposed to be taking 2 Femara pills from cycle days 3-7. Instead I am a huge screw up and only took one. I didn't realize it until it was too late. As a result, I am not expecting to see multiple follicles at my scan tomorrow.

The Viagra has made me really sick for the past 10 days. Within 30 minutes of taking it, I can feel the blood rushing to all parts of my body, and it's an intense and painful feeling. It's making my gums bleed a lot when I brush my teeth, to the point where I can still taste blood for about an hour after I brush. I've been up all night for the majority of the nights since I began taking it. Oddly enough, since I started the estrogen, I have been sleeping through the night again. I don't know what the deal is, but I am thankful for some relief. I'm really disgusted that I am going through all of this, and it could be for nothing thanks to my Femara mishap.

I called the nurse as soon as I realized I had messed up, and she talked me down from the ledge. She told me that this happens, and we need to just move on and not worry about it. She wanted me to continue all the other meds as planned, and she told me that we'll just see how I respond to a half dose of Femara.

I go for my ultrasound tomorrow, and I'm terrified. If they tell me the lining is not improved, I don't even know where to go from here. Maybe a higher dose of estrogen? Or maybe there is nothing more we can do? My stomach is in knots.

I've beat myself up over and over for messing up. This should be THE most important thing in my life right now. Yet, I am so over-extended with work and other responsibilities that I was careless. I decided that my life is way too disorganized, and as a result, I've spent the entire weekend decluttering my house. I'm hoping this will help me also declutter my mind. How could I do something so stupid? After all that we've been through.

Some information on Viagra

A good synopsis can be found in an article written by a brilliant infertility specialist, Dr. Geoffrey Sher. (Thanks for pointing me in this direction, Amanda!). The article can be read here.

The cyst is gone

I had another scan done with the start of a new cycle on Thursday. It was all clear, so I am back on a medicated cycle. The plan this time:

• Femara - cycle day 3-7
• Viagra - cycle day 3-12
• Estradiol cycle day 10-12
• Ovidrel (shot to trigger ovulation) - cycle day 13

The Ovidrel may move around a bit depending on what my mid-cycle scan shows. I am going on October 27th (cycle day 13) to have that scan performed. If all looks good with mature follicles, I will trigger that evening. I've been reading more information on Viagra for lining issues. It was briefly addressed on an infertility blog that I will now link over on the right side of the page. There is a lot of good information there.

I suppose I should be more enthusiastic about this cycle, trying new medication, etc. The truth is that I've really lost the wind from my sails lately. It seems like there have been more tears than usual, and the beginnings of acceptance are creeping in. I'm talking about the acceptance that this just might not happen for us. We've been trying for a long time now, and I'm still in the game for now. But I need to establish some type of ending point to this, because I feel like my life is on hold. Not in the literal sense, but in my head. I realize now more than ever how important it is to treasure every single moment and every stage of Elise's childhood. This journey with infertility is taking a small piece of that joy away from me, and I don't like that. I need to start living my life to the fullest, and right now I feel like I can't do that because I am constantly waiting for this huge, life changing event to happen. Every month when it doesn't happen, it breaks my heart a little bit. There definitely has to be an end - whether it involves a pregnancy and new baby or an acceptance that it wasn't meant to be. I need one or the other to happen sometime in the relatively near future. Jamie and I talked about it tonight. He agrees, but neither of us are sure when it will be. We talked about the summer, because that would be the 2-year mark since this all began. But nothing is set in stone other than the beginnging of that realization.

First Femara Cycle Failed

And now I have a cyst on my right ovary that is currently preventing us from trying again. Hopefully it will be gone by the start of my next cycle, and we can give it another shot.

Next time we will be doing:

Femara from cycle day 3-7
Viagra from cycle day 3-12
Estrace from cycle day 10-12
Trigger shot on cycle day 13

The Estrace and Viagra are for my lining and the Femara will stimulate the ovaries to produce multiple eggs again (hopefully). The trigger shot will be needed to tell my body to ovulate, because when we add the estrogen, it will confuse my brain into thinking that I am further along in the cycle than I actually am.

We don't know when we'll get to try again now that we have the cyst. I will get a baseline ultrasound at the beginning of each cycle until it's gone. When we get the all-clear, we'll start the protocol above.

This is getting REALLY old.

Mid-cycle scan

Our mid-cycle scan was on September 3rd.

Good news: 2 mature follicles, one on the right measuring 21 and one on the left measuring 20.

Bad news: Lining is only measuring 5mm.

The nurse said she's not happy to see the lining measurement, but it's not impossible to become pregnant. We know this will not work in our favor. I think it's good to at least be able to focus on what is most likely causing the problem. I've been reading a lot about the use of viagra suppositories to treat lining issues. A friend of mine who has done IVF told me that they took her lining from 8mm to 14mm in only 3 days!

I'm guessing that this cycle will probably be a bust, so I am making a list of things for us to ask Dr. Dunn when we go back on the 19th. I'm definitely going to see what he thinks of using viagra. I feel confident that if we can get my lining above 8mm, I can get pregnant. I think.

Baseline Scan

I had my baseline ultrasound on Friday. The nurse said all looked good. I didn't have any "left over follicles" from last cycle, and my lining measured 4mm. She said that was right on track.

I began the Femara this evening, and I will take it through Thursday. I go back for another ultrasound on September 3rd. We are hoping to see several mature follicles and a lining measuring 8-10mm.

I'm praying that Femara will do its job. I asked Jamie if he thought it would work on the first cycle. He said, "Knowing our luck, probably not." I'm glad he said it, because I was thinking it. Still, I am trying to have a positive attitude, because as Jamie loves to remind me - the mind controls the body.

I could use a lot of prayers, because at this point, being positive is not something that comes naturally for me.

Will update on the 3rd after the ultrasound.

Jamie's Test Results and The Plan

We met with Dr. Dunn (again) on Friday to go over Jamie's semen analysis results. His numbers were all really good.

Normal Volume is 1.0 - 6.5 mL per ejaculation.
Normal Count is 20.0 - 150.0 million per mL.
Normal Motility is 60% or higher.
Normal Morphology is 70% or lower.

Jamie's Results:
Volume 1.5mL
Count 216.1 million per mL
Motility 62%
Morphology 76%

The morphology is a little high, but that is more than offset by the count. The dr. was very pleased with the results, and we are now satisfied that my issues are the only obstacles we have to face. That is an enormous relief, because we are hoping my issues can be fixed with minimal interventions and drugs.

Dr. Dunn mentioned endometriosis again at this appointment. He said I had Stage I when he did my surgery, and it was just a few points away from being Stage II. This does statistically decrease the odds of pregnancy in each cycle.

So here's the plan:

Since I face a statistically lower possiblity of pregnancy, we are going to start doing things to increase my odds from another standpoint. I do ovulate on my own with no issues, but our first step is going to be medication that stimulates the ovaries to ovulate, sometimes producing multiple eggs. More possible targets = higher odds of pregnancy. Clomid is one of the more popular medications of this kind, but it is not what I will be taking. One of the side effects of Clomid is a decreasing of the cervical mucus (which is what creates a hospitable environment for sperm) and a slight thinning of the uteran lining. Thinning of the lining is the LAST thing I need, obviously. This is what makes Clomid an unattractive choice for me. I will be trying a cycle on Femara instead. This drug operates a bit differently from Clomid, but gives the same end result.

Clomid aids ovulation by binding to estrogen receptors in cells and tricking the brain into thinking that estrogen levels are low. When this happens, the brain tells the ovaries to work harder, thus creating more eggs and/or stronger ovulation.

Femara aids ovulation by interfering with the conversion of testosterone into estrogen in the body. So, rather than tricking the body into thinking estrogen is low, this drug actually does cause lower estrogen levels. In doing so, the ovaries are stimulated.

I'm a big student of Google University, but I had never read about the differences between Clomid and Femara. I learned something new!

We are instructed to wait out the remainder of this cycle. When the next cycle begins, I am supposed to call the nurse and come in for a baseline scan. I assume they will be checking the lining at that appointment. Then I begin Femara on cycle day 3 and continue to take it through cycle day 7. I will go for another mid-cycle scan around cycle day 13 or 14. At this ultrasound, they will be able to measure the follicles that my ovaries have produced and tell how many eggs I will most likely release. We are supposed to use an ovulation predictor kit and have timed intercourse (oh how romantic). Then we will see what happens. We'll meet with Dr. Dunn again at the end of the cycle to assess how things went, how my body responded to the Femara, etc. What we hope to learn is that my body does just what it should on the Femara - or better yet...that we are pregnant.

In the event that I do not get multiple eggs on the Femara, we may need to try something different. Dr. Dunn said we might even end up trying a Clomid cycle if the Femara is unsuccessful in producing the kind of results we want to see. If both the more "minor" fertility drugs fail, then we may have to resort to injectibles. This is when our odds of multiple births really begin to increase substantially. I have some major worries about multiples, which is a topic for a different post. Needless to say, I really am praying that the Femara will do the trick. Our odds of twins are only 5-10% on that drug.

So we should be off and running in about 2 weeks.