Infertility.

I find that patients often approach it in 1 of 2 ways.

A. Denial: “We haven’t used protection since we got married 10 years ago, but we haven’t really been ‘trying’ either. We may start ‘trying’ sometime next year.”

B. Obsession: “We’ve been off protection for 3 months. Here’s my excel spread sheet of my basal body temperatures. The slope of the curve on month two is not quite what it should be. Also here’s a cell phone picture of my cervical mucous. Is it the right consistency? I’ve read on line about natural progesterone. Do I have a luteal phase defect? I want my Clomid…. NOW!”

This is an exaggeration, of course , but I thought I would touch on the medical definition of infertility since we have have several posts about it recently. Infertility is defined as unprotected intercourse for one year without conception. If you have not conceived after one year of ‘trying’ then you should see a gynecologist. Now this applies to healthy women, with regular monthly cycles, under the age 37. If you are greater than 37 then it is recommended you seek treatment after 6 months if you have not conceived. Also if your cycles are irregular and infrequent its most likely that you aren’t ovulating so you would also need to seek treatment sooner. By irregular cycles, I mean cycles every 2 to 6 months, that really have no pattern to them.

As a doctor, when a patient comes to me for infertility, it’s usually a relief to find out that they aren’t ovulating. Ovulation is something that can be ‘fixed.’ Unexplained infertility, when everything is normal, is the most challenging because then there is nothing to ‘fix.’

Medically speaking, clomid is a miracle drug. It takes women whose ovaries are stalled out, whips them into shape and helps them ovulate. 80% of women who don’t ovulate, will do so with clomid. Lack of ovulation is most commonly due to a miss communication between the brain and the ovaries. What clomid does is trick the brain into thinking that there isn’t any estrogen in your system, the brain responds by causing an estrogen surge which then results in ovulation in most women. Now, clomid won’t work if your brain has stopped ovulating due to stress, exercise or weightloss. Sometimes in addition to clomid the fertility specialist will inject the sperm into the uterus at the time of ovulation, in order to get the egg(s) and sperm closer together and bypass any issues that may be going on with cervical mucous.

I wanted to clarify from Jessica’s previous post that clomid doesn’t increase the risk of miscarriage. In Jessica’s situation, because of her multiple losses, it is going to be more helpful to monitor her ovaries with ultrasound and get her timing perfect with the HCG shot. She has already passed the simpler treatments.

Clomid is one of the few drugs that people ask for quite regularly. It is inexpensive* and taken as an easy to use pill, so I think sometimes people aren’t aware that it does have risks. The main risk is twins, up to 8% risk. That may not seem like a lot, but the normal rate of twins is less than 1%. Other risks include hot flashes, moodiness and blood clots. Twin pregnancies have an increased rate of preterm labor and several other complication, so clomid, like all medications should be taken only when indicated.

To all those out there ‘trying’ and even those in the ‘practicing’ stage, my hope is that you never need to read this post, and that all your conception will go smoothly and quickly.

*Clomid costs about $20 a month. If you can’t afford clomid…. You can’t afford a baby.

Dr. Rupe may be horrified that I am attempting to address something medical in a post. I’m writing about ultrasounds and since I’ve been on the receiving end of about 100 of them, I think my point of view is valuable. She can always pipe up if I need correcting.

I’ve completed my round of Clomid so this week I will begin monitoring at the fertility clinic. They do this by performing follicular ultrasounds. Since ovulation usually occurs around day 14, I will first visit the clinic for the ultrasound on day 13 of my cycle. Through transvaginal ultrasound (yes, it’s exactly what it sounds like it is) they will take a look at my ovaries and the follicles that are developing.

Wikipedia defines a follicle in this way. . .(if she wasn’t before, Dr. Rupe is now officially horrified that I am taking my medical definitions from an online mega-dictionary). . .

Ovarian follicles are the basic units of female reproductive biology, each of which is composed of roughly spherical aggregations of cells found in the ovary. They contain a single oocyte (aka ovum or egg). These structures are periodically initiated to grow and develop, culminating in ovulation of usually a single competent oocyte in humans. These eggs/ova are only developed once every menstrual cycle (e.g. once a month in humans).

So basically the eggs grow in the follicles and once they are mature, they are released. My problem? The eggs that are released are no good. I have bad eggs. Probably not mature enough before they are released (something I used to say a lot about boys in high school). This is why I have recurrent miscarriage. By doing the follicular ultrasounds, my fertility specialist can see how the follicles are developing. When we see follicles that are nearing maturation, I will be given an HCG shot to administer at home which will stimulate ovulation. The way my fertility specialist explained it to me, it sounds like the HCG also ensures that the egg that is released is fully mature and thus a viable egg. Our daughter, Hope was conceived this way so I am hopeful that it will work!

You may be wondering why I mention a health care provider other than Dr. Rupe. Unfortunately, Obstetricians do not typically administer this type of monitoring or the HCG shot. After knowing exactly what we needed, I asked Dr. Rupe if she could do the follicular ultrasounds and HCG shot this time around. She cannot and so I will try to make do seeing a less than awesome doctor until I can return to her care. Once I do conceive and make it past 9 weeks, I get to return home to Dr. Rupe. I pray that will be very soon.

If you or someone you know is struggling to conceive, talk to your doctor about whether or not it is time to see a specialist. Your OB/GYN probably knows everything they need to know to help you conceive however their office may be limited in the measures they can take. I never dreamed something as simple as a hormone shot could mean the difference between miscarriage and the life of my daughter, but it did.

It’s funny to me how women don’t like to make eye contact at the fertility clinic. We’re all in the same boat! Hello, it’s alright for other women to see you there because, ahem, they are there too. But still, women do not acknowledge each other. It’s as if they are so ashamed of their plight of infertility they do not even want to connect with others going through the same ordeal. And yet, women flock to blogs and infertility chat rooms. Perhaps they would rather remain a nameless, faceless case of infertility.

Not me. Misery loves company, that’s what I always say. So this morning at the clinic, I made it a point to connect with the other women. After all, we could actually be having babies around the same time next year {God I pray this for all of the women there today}. I asked one why the clinic always seems to put a different doctor’s name on the form. I thought I saw Dr. Hill but Dr. Eblen was noted this morning. And then I chucked with another about how I can’t seem to remember what floor to choose in the elevator for the parking garage. After the countless times I’ve been to the clinic, you’d think I could recall this simple detail. I wanted her to know I’d been there many times before. . .that I was like her. She laughed and commented how many times she’d been there lately and she should remember as well. There. A connection. Hopefully now she knows she’s not alone on her long and exhausting journey.

I feel a strong conviction to drop my guard and do this as much as possible while I visit the clinic over the next couple of months. I’m sure I won’t be changing the world by being cordial but perhaps I can help someone feel less alone as they walk this road.

I was cleared this morning to begin another round of Clomid. I’ll start the drugs today {please pray they don’t make me crazy} and then I’ll do a follicular ultrasound next week to make sure I have mature eggs. Too much information?! Sorry, when you’ve had one of your close friends all up in your fertility you kinda drop your pride when it comes to these things. I appreciate your interest and your prayers. Please believe with me that my lone left ovary will produce the egg I need to conceive this month.

What’s your infertility story? Don’t be like those women at the clinic. Make eye contact. Post a comment and share your story so others can be encouraged.

Hopeful,

We all seem to complain that time seems to fly. Perhaps we should all just try to get pregnant, that pretty much makes it crawl at a snail’s pace. It may be helpful to remember that “normal” fertile couples conceive at a rate of 30% per month. So the average couple takes 3-6 months to to get pregnant. Hmmm. No, that’s probably not what you wanted to hear, but I wanted to reassure Jess, and those out there trying, that they are not alone in their frustration with time.
The goal of clomid is make you ovulate, which then puts you on even ground with everyone else. With IVF, 30% is considered a good success rate (depending on many factors). So even when you carefully put the embryo in the uterus, the rate is still about the same.
So hang in there, as you try again next month. Hey, maybe this slowing of time will help us meet our deadline! I know, wishful thinking

My boss has this recording on his phone that he picked up from the Webkins website of all places. Apparently it is what young children hear when they don’t win the game. . .or something like that. The recording is of a man who sounds like he must be sporting a cowboy hat and chaps along with his raspy voice. He simply says , “No deal, huh? OK.”

His voice has been playing over and over in my head since Dr. Rupe called the other night to tell me my progesterone level did not indicate ovulation. I wanted to say to her on the phone, “No deal, huh? OK.” {I totally wish you could hear this recording.}

So we believe this month’s verdict is no once again. I will take a pregnancy test if I do not start my cycle in a couple of days. The painful irony of my situation is that I don’t ever start on time so my heart thinks there’s still a chance. My next step is to take a drug called Provera which basically jump starts your cycle and then begin a higher dose of Clomid. Before I start that regimen, I have to know that I know that there’s no baby in there. At this point, I actually hope I am not pregnant since I partook of several adult beverages this weekend as I wallowed in my plight as a woman with PCOS. Please don’t judge me unless you’ve walked through infertility. : )

I have to admit that sorrow is knocking at my door. I keep telling him {I’m pretty sure sorrow is a dude} that he should go away and try again next month. . .although next month I’m not planning to need him.

God has been so faithful to remind me of His goodness. I see it every day in Hope’s sweet face. Our journey to her was long and rocky but it was so worth it. I have to be willing to walk that road again if I believe my family has growing to do.

I pray that whatever it is you are waiting for feels well worth the wait. Even on those days when you are not sure you can do it, cling to the hope that you have in Him for He is faithful!

Nothing much to report this week except that my initial progesterone check did not indicate ovulation. I am not disappointed yet because as I mentioned before, I suspect I ovulate later than most (if I ovulate at all). I will return to Dr. Rupe’s wonderful office at the Women’s Group of Franklin on Tuesday to try again.

In the meantime, we are enjoying some beautiful snow here in Nashville. It’s like a winter wonderland outside. This is something we don’t get to experience often. We are basically cooped up in our homes for a few days which I don’t mind at all. Perhaps I’ll get some of this book written.

Speaking of the book, we’d love to hear from you girls out there what you would like to see covered in a faith-based pregnancy book. Please leave us a comment with your thoughts and ideas. Obviously we’ll be covering the basics but if there is something you’d like us to address in more detail and from a Christian perspective, let us know!

I’m off to grab a cup of hot chocolate and then dive into this manuscript.
Stay Warm!

Nothing much to report this week. Just hoping the ovulation fairy visits me this time around. I will visit Dr. Rupe’s office on day 21 to get my progesterone levels checked and that will let us know if the fairy stopped by my reproductive system this month.

Did you know that not all women ovulate by the book? I’m one of the exceptions due to PCOS but there are other reasons women don’t ovulate right in the middle of their cycle. Some might ovulate a little earlier than normal, some later. Sometimes it can depend on environmental factors such as stress and sometimes it’s just the way it is. I probably shouldn’t be giving out information since I’m not a qualified source. But maybe my attempt will ensure that Dr. Rupe chimes in share more on this subject.

The bottom line is (and I think I’m qualified to state this fact) – all women are different. So if you suspect you are not a textbook case then speak to your doctor about it. If you have a doctor as great as Dr. Rupe they’ll be able to help you navigate what’s going on in order to find out what’s right for YOU.

I’d better wrap this up. I need to go find a condom I can leave under my pillow tonight in case the fairy drops by. I have to leave her something!

Today begins week 2 of round 2. I finished up the Clomid yesterday and I am happy to report it did not make me crazy this time around. Hold on while I ask Dave to confirm that. . .He says he hasn’t noticed a change in my mood. I think that means he agrees.

I started peeing on those awesome sticks yesterday and I’m sorry to say the whole ordeal is a bit messy. But I can’t complain. If it takes a little mess to ensure we conceive a child, I guess it’s worth it.

We have a lot going on in our lives right now so I keep coming back to thoughts of peace. I just want His peace to be so present in our hearts and minds that although this is an intense process, we don’t even realize it.

Heather and I completed another chapter this week. We’re making progress and I know we’ll have this baby done in no time. Thank you for your prayers and support as we take this crazy ride.

Praying for peace in your hearts and minds no matter what you are facing this week.

My prayers have been answered! Woo hoo! I’ve never been so excited to be a woman! How sad.

So this is Week 1 of Take 2. And today I started Clomid. Dr. Rupe had planned on posting this weekend to tell you more about Clomid but she got stuck at the hospital all weekend delivery babies. Why do babies always decide to come in the middle of the night and on the weekends? Don’t they understand the 40 hour work week?! I promise she’ll join us soon to set the record straight on anything I’ve misrepresented.

So Clomid. . .it’s simple really. I take 5 pills, one a day from days 3-7 of my cycle and it makes me ovulate. It also makes me really moody so say a little prayer that Dave will be gracious this month! He usually is. The hardest part of the Clomid cycle is knowing when I ovulate. A woman typically ovulates 14 days before the start of her next cycle (or right in the middle if you have a normal 28 day cycle) but I tend to ovulate a bit later. If a woman assumes she ovulates by the book, she may miss her chance to conceive. That is why they make those handy, dandy ovulation tests that I mentioned last month. I went ahead and made an investment is the super, duper pack this time. You get 20 tests instead of just 7. The 7 test packs are for girls that are pretty sure they ovulate within the normal window. For me, with only 7 tests, odds are I’d miss it. So for a mere $35 I’ve got the best chance of knowing exactly when I can conceive. Dave was hesitant to drop that much cash on a bunch of sticks I will pee on. I explained that $35 was a lot less of an investment then the $1500+ we’d have to spend at the fertility doctor if we didn’t make this work. He agreed.

I have a renewed sense of faith going into this month. I’ve been reading in Genesis this week about Abraham and Sarah. I love that story because even though they did not walk through their journey perfectly, God still blessed them with a son. Sure, they had consequences for their actions but His promise still prevailed. You would think after believing and later receiving from God in the past, it would be that much easier for me to do it this time around. Truth is every different thing we trust God for comes with a different process. The goal is for your faith to be strengthened with each one.

So here I go again. Thanks for your prayers.