Clomid Dust

I am beginning to think I see my RE too often. When I enter the city Syracuse in my GPS, it automatically knows where I am going (I use the GPS to get an ETA). Speaking of ETA's when I use my GPS, I get such a sense of accomplishment when I am able to take time off from the projected time. It leads to more speeding, but makes me feel like I accomplished something while driving. I am so sick of rushing my Friday's to get to appointments on time. I don't want to cancel therapy since each session = more money, but it's starting to get to me. I am looking forward to not going there any more (someday). 

My RE had some fantastic quotes from this meeting:

1. "Your chart is starting to take on a life of it's own."

2. "I'm starting to think all I have to do is sprinkle Clomid dust in the room and you will get pregnant."

Well I wish getting pregnant was that easy! Really the appointment was just to talk about the plan for Clomid and IUI and my RE wrote a script for Provera and Clomid. When I took the script to the pharmacy they got a sketchy and then told me you can't write more than one prescription per page. He wrote both on the one page. Not sure if this was a mistake or something that is legal in other states (he moved from Atlanta this past summer). I am constantly amazed by how fantastic my insurance is. The meds were $13.00. 

We will not be adding a gonadotropin this cycle since my RE wants to see how I respond to Clomid. Now, each night I take 500 mg Metformin, a prenatal horse pill, 5000 IU's of Vitamin D, and Provera (tiny little sucker!). My RE did do a pregnancy test and it was negativo. Here's hoping last month was my left ovary's time to shine (if I even ovulated) and this upcoming cycle will get righty psyched to kick some follicle-growing ass. Reminder-no left tube. 

I did get to see my friend the dildo cam (#8) and ultrasound tech. Everything looked fine (according to her) and my file got a little thicker with those images. Does anyone else ever wonder where to put their hands while in those stirrups with a wand inside of them? Gets me every time. 

An answer to my burning question

I got pregnant in January (and miscarried in February). My RE was convinced I ovulated a result of the Lupron I was put on in preparation for an IVF cycle, but the dates never matched (on Feb 4th the embryo measured about 6 weeks). This was something that bothered me because I've been told I don't ovulate on my own.

I have been told by others that doesn't matter how I got pregnant, just that it happened at all. Unfortunately I don't agree. I am the type of person who seeks out answers and wants to completely understand everything I can. I want to know whether my body is functioning properly or not.

Today my RE returned my call and I finally got the opportunity to bring this up. He looked at a pregnancy calendar and determined that from the 6 week ultrasound on Feb 4th, I would have conceived on Jan 7th. I started Lupron on January 5th.

He then went on to say that Lupron may have caused a surge in LH and caused the release of a mature egg. Did you catch that?? Mature egg...

He said that Dec/Jan was probably was an ovulatory cycle for me because there was an egg to release. Lupron didn't help me to grow an egg in two days, it just helped trigger a surge of LH.

I am happy to get some closure on this issue and know that I was growing a follicle that month and that the Lupron didn't cause me to ovulate, it may have just helped. I could have ovulated on my own that month had I not taken the Lupron.

I mentioned that I may have ovulated this month but am not completely sure. He said the OPK's are pretty black and white, but I don't see them that way! He agreed to test my Progesterone this month to see whether I not I ovulated.  He doesn't want to prescribe Provera if there is a chance I did ovulate and could be pregnant (I highly doubt it, but I guess you never know). He said from an academic standpoint, he is always interested in hormone levels as long as I am willing to get stuck with a needle (sign me up, I've done it enough by now). Remember, I'm the one who elected for surgery?

 He also told me I am "not a textbook case"... great. Last time I was there he made a comment about how thick my file at the clinic was... fantastic. Do I get some kind of award for that?

My RE also gave me the news that I am not insulin resistant. My results from the fasting insulin and glucose finally came back and the ratio looked good. It is good news, but doesn't help explain why I have PCOS.

My HCG levels were negative from this past Monday. I have an appointment scheduled with him for Friday at 2:00 where we will discuss my upcoming Clomid/IUI cycle. He briefly mentioned something about gonadotropins in addition to the Clomid, but says he hasn't decided yet. We will see...

PCOS and Vitamin D

So I haven't done a ton of research in this area (maybe I need to go back to school), but I have strong beliefs there is a connection between Vitamin D deficiency and PCOS. A few months ago I got a comment on my blog mentioning the connection, and I had never given it any thought before that time. I've never had my Vitamin D levels tested, but I do live in Syracuse where winters are long and grey. Here is a good description of our winters I found online:


Worst Winter cities

1. SYRACUSE, NEW YORK “Cold,” “clammy,” “snowy” are three great ways to describe Syracuse weather—from October through April. Winter starts very early and lasts late, with plenty of snow and extremely cold temperatures. Winter daytime temperatures average in the lower 30s, with nighttime lows in the teens, but temperatures as low as minus 25°F have been recorded. Snow also makes winter uncomfortable in Syracuse, averaging almost 120 inches per season. During the winter of 2009–2010, Syracuse was again the winner of the prestigious “Golden Snowball Award,” celebrating the city with most snowfall for the winter in upstate New York, beating out such snowy cities as Buffalo, Rochester, Albany, and Binghamton. Syracuse also made our Farmers’ Almanac “10 Worst” list in 2002. Another reason why this city makes the worst winter weather list — December, January, and February are typically gloomy, with Syracuse receiving only onethird of the sunshine possible, because of considerable cloud cover.

So without ever having my levels tested, it is safe to assume I am deficient from this description, at least in the winter months. In late November I starting taking large doses of Vitamin D (5000 IU's) and in December ovulated and got pregnant. My RE thinks I ovulated as an effect of the Lupron, but would you really be able to see anything on ultrasound 2 weeks after ovulation? I think I ovulated by myself before I started the Lupron and partially due to my increased Vitamin D intake. 

My RE doesn't think I ovulate regularly, and I'm not sure what I think about this. In reality, we only "tried" one month and then didn't really try in December and got pregnant. All of the other months since I first starting seeing a RE in August I was on BCP's trying to shrink my cyst. Up until that time we had been preventing pregnancy although I had stopped taking the pill.

 My RE ran a progesterone test on day 21 one cycle, but I was on the pill so I wasn't likely to ovulate. My ovaries appear polycystic on ultrasound and under laparoscopy, which means I have had difficulty ovulating in the past and perhaps present. I have been trying to get ahold of my RE this week to get the progesterone test done again this month, but no luck so far. I can't wait until the regular nurse is back in the office, because I am getting frustrated. 

If you have PCOS and have difficulty ovulating, you may want to look into Vitamin D. I feel like it has helped me and I continue to take it with high hopes (perhaps too high sometimes). 

Here are some articles from PubMed I found: 

Association of hypovitaminosis D with metabolic disturbances in polycystic ovary syndrome.

Serum parathyroid hormone concentrations are increased in women with polycystic ovary syndrome.

Both are just summaries, but you can get the full text by clicking in the upper right corner.

and some less academic links:

Do PCOS Women Have Low Vitamin D Levels?

PCOS and Infertility (Infertility Support Group)

Anyone else take Vitamin D for PCOS or heard anything about the connection?

ICLW numero dos

In sticking with my Dominican Republic Spanish skills, I am impressing you all with the title of this entry. My spanish skills are quite limited (cerveza, bano, and simple things I learned in high school Spanish). I laughed when my hubby got off the plane in Syracuse and said "Adios" to the pilot.

This is my second time doing ICLW and I had a great experience last time. I am hoping to find some new blogs and snag some new followers.

To catch everyone up, my name is Liz and I am married to a great guy, W. We live outside Syracuse, NY and bought our first house in October. If you are interested in our TTC history, check it out: History

 Currently I am waiting for me AF to arrive, although I don't think she is anywhere nearby. I usually have about 35-40 day cycles (thanks PCOS) and am only at day 25 today. I will call my RE on Thursday to report whether or not it has arrived, but I highly doubt it. If not, he is planning to give me Provera. Our plan for this next cycle is to do Clomid and back to back IUI's. The problem is, the main nurse had back surgery and has been out of the office. It is a bit of a disaster trying to get any answers or problems solved at this point. They are hoping she will be back next week and so am I.

Here's where I need your help: I may have ovulated this cycle on my own, but I'm not completely sure. See post Vacation and take a look at my OPK and please share your opinion on whether you think it looks positive. I don't really think it is (since the test line is so thin), but I would love some more feedback.

The next few months are exciting for us since my hubby will FINALLY graduate with his DPT (Doctorate in Physical Therapy) in May and we will have 2 INCOMES!!! Needless to say, I cannot wait!! We plan to celebrate by hosting a graduation/housewarming party in June and then I will ship his butt off to work (jk). The great part about our fields (I am a speech-language pathologist who works in early intervention) is that employment is easy to find. I am hoping for some pregnancy success in the next few months as well, so wish me luck! I am looking forward to getting to know some new people this month and finding some new blogs. Happy ICLW!

Vacation

So we are home and it's Sunday night which means I have to go back to work tomorrow. Don't get me wrong, I love my job, but the end of vacation is always a bummer.

We had a great trip full of lots of sunning, swimming, reading, drinking, eating, relaxing, and enjoying each other. Our room was great and the weather was fantastic. The food and drinks were both consistently great and I had my first bahama mamma (it was absolutely delicious!)

The resort was about an hour and a half away from the airport in Santo Domingo and we had a shuttle arranged. It was interesting to see more of the country and it didn't seem overwhelmingly poor. Unlike Costa Rica there wasn't much wealth either. The biggest thing I noticed was that the street and sides of the streets were covered in garbage. One of the coolest things was that the red lights had a timer to let you know how much time you had left. It seemed like red lights were optional and the driver of our van was very "horny" in that he tapped the horn quite often.

The resort was pretty far back from the road and was very nicely manicured. The beach area was a bit small, but had chairs to sit in. There were a lot of topless women on the beach (not me), and my hubby and I would give out our own award to the best set seen. The waiters even came to the beach to get drink orders and I drank a good amount of frozen alcoholic beverages.

The last day I called MSED (maximum sun exposure day) and am peeling as a result. I got a little burned here and there, but nothing too bad by the last day.

Here are some pictures from the trip:

In other news I started my Metformin last night. I haven't had any extreme side effects, just minor disturbances. I am hoping it stays this way. I had a pretty bad headache all day but so did W, so I'm thinking it was more out of withdrawal from beverages.

Of course I couldn't complete ignore the issue of our trying to start a family on the trip. We had some conversations (less than usual) and I brought ovulation prediction tests with me (of course). I wasn't counting on ovulating this month, but was given the green light to try if I did. I am so confused and frustrated by the test strips since it looks like I got a positive, but in reality I don't think it was. The test strip is darker, but only a portion of the line. When I looked online it said it had to be 50% or more of the line to be positive, so I don't think it counts. What do you think? I'm pretty sure it doesn't count as a positive.

The thing is, even when this test appeared positive, I didn't feel like I was ovulating. I did have some increase in CM the week before but hadn't bought the OPK by then. I really don't think I stood much of a chance ovulating this month, but I may ask my RE to run progesterone levels in order to see since I have to get blood work anyway. 

I am supposed to call me RE this Thursday to tell him whether or not I have gotten my period. It's not that I don't think I would get it if I just waited, but I'm not feeling particularly patient these days. If I haven't gotten it by Thursday (4 weeks post D&C) then he will prescribe Provera to induce it. I don't feel like my period is close as all, but if I did ovulate then I would want to know for sure whether I was pregnant or not before taking it. I'm not feeling like this is very likely, but you never know, right?

 Any experiences with Provera? I've never taken it before. I will probably schedule an appointment for this week to talk about Clomid and I still have to go back for more blood work to check HCG levels and testosterone levels. Ahh, back to reality!

RE appointment 3/11

Today was my follow-up appointment for my D&C and laparoscopy with my RE. I was annoyed because they hadn't gotten my blood work results from the lab, but they were able to call over and get them faxed. The downside was that the insulin levels weren't included. They had the glucose and HCG levels, but no insulin results. My HCG was 10 on Wednesday and my fasting glucose levels were well in the average range (83). My RE checked the incision and everything is healing well. I find it pretty funny I didn't think anything of it or flinch when he moved my underwear down to check the smaller incisions. 

We talked about a timeframe and I am supposed to call the clinic on March 24th (4 weeks post D&C) and tell whether or not I have gotten a period. At first he talked about waiting 6-8 weeks after surgery to see if I got a period, but he changed his tune. If I haven't gotten my period in another 2 weeks he will put me on Provera to induce it. I am hoping it comes before then so that I won't have to use anything, but who knows. He first talked about Clomid alone and using OPK's to monitor, but as soon as I asked about IUI's, he was totally willing and said it wasn't a bad idea. Often times, Clomid changes your cervical mucus, so the IUI would bypass that problem. 

I reminded him of the meds I have from our IVF cycle that never happened, and he then said that we could try two months of Clomid with IUI's and then move on to injectables if we don't get a great response. He reiterated that OHSS is not something I want and is very dangerous. Women with PCOS are very prone to it and that risk would be increased with injectables. I guess you can even get it with Clomid, but it is rare. 

He then wrote me a script for Metformin. I don't have to green light to start taking it until he gets the insulin levels, and he doubted I would demonstrate insulin resistance. I also don't want to start taking it before going on vacation. I signed a waver about using the drug "off label" and will start when we get back. I am supposed to call the clinic when I get back to be sure.  

The pro's of this visit/good news:  

If I were to ovulate this month we can try and don't have to use birth control. I'm not really counting on it, but good to know.  

The full pathology report from the tumor/cyst was fine. Although what I had was rare, it was completely benign. 

Even with one tube it is possible to ovulate from the other ovary and get pregnant. Something about          transmigration (he explained it and I understood, but I can't repeat it). My RE treated a woman who had one ovary on one side and one tube on the other and was able to get pregnant. 

We will do an IUI the first cycle and don't have to just try Clomid. My insurance covers IUI's which is great. Also, we will do 2 IUI's per cycle.

We won't be looking at the same "game plan" as previously and could move on to injectables after 2 months of trying Clomid. 

My RE is as confident as I have seen him about me getting pregnant. He seems to think we will be successful quickly, but never gives percentages or absolutes. 

The cons/bad news:

I will be going on Metformin and am terrified of the side effects and how it will affect me. 

More blood work: HCG repeat (until it is below 5), testosterone, and DHEAS levels. 

IVF is still a possibility in the future. 

Home Improvements

I has been nice to make some improvements/upgrades to our house. I know a big part of this is me being able to have control over something positive in my life with a little hard work and money (unlike my fertility), but who cares, things are looking good!

These are photos of the bathroom before:

   

Notice the beautiful frog border?

Now here are pictures of after:

We also got a new light for the foyer and an antique framed  stained glass that we hung in our window of the stairs.

Foyer before:

 Foyer After:

Here is the stained glass:

Time is dragging

Maybe it is the fact that were are leaving for vacation in a few days, or that fact that our next cycle trying seems so far off, but it just feels like time is going by slowly lately.

We have our next appointment with the RE tomorrow and I am SO nervous. It must be because every time I go there, I seem to get more bad news. I think about my last appointment there, when I found out I had miscarried and had to make decisions about what I wanted to do. It always makes me nervous to go, and I am worried about my blood work results. I never have high blood pressure except when I am at my RE's office.

I went for more blood work on Wednesday morning to check my HCG and fasting insulin and glucose levels. I am so nervous about the results of the insulin and glucose. I did take a pregnancy test this afternoon (2 weeks post D & C) and it was negative! I will be curious to find out what the actual level is tomorrow. When I took a pregnancy test a week ago and it was still positive, it was like a @*$% you, but this week I was a little sad to just see one line. There is no telling when I will see two lines again.

I am planning to go to my appointment armed with questions and a plan. I don't want to do the 3 month (just Clomid), 3 month (Clomid and IUI's), 3 month plan (injectables and IUI's) my RE had suggested. I want to be more aggressive and optimize our chances of getting pregnant. My worst case scenario is that we are looking at IVF 9 months from now (exactly 1 year after our first planned IVF). I don't want to wait forever to end up in the same spot we were this past January. When I read about other people's IUI cycles, they never seem all that successful. Only having one good tube makes me even more nervous about failure since our chances will be reduced.

In other news, we are leaving for the Dominican Republic on Sunday. It is daylight savings and our flight is supposed to leave at 6 AM. This will make is feel more like 5 AM. It is going to be so nice to get away and enjoy some sunshine and warm weather. It will also be great to focus on our relationship and each other without the usual distractions of life.

We had a couple over for dinner on Saturday night. The girl is my co-worker and just entered her third trimester. We have been walking for a few months together at the gym and I really like her. We asked them to bring a salad and as we sat down to eat I looked at her and said, "What kind of soft cheese is in the salad?" She proceeded to tell me it was feta and that she doesn't "always follow all the rules." It's hard to hear this from someone who is so far along is her pregnancy without a hitch. I am forever kicking myself for not following all the rules completely. This whole infertility thing takes the fun out of everything. I have to admit though, I have been loving eating soft cheeses, drinking coffee, eating sushi, and drinking wine. Better live it up while I can. I plan to eat seafood every day on my vacation, perhaps more than once a day!

A little disappointed

So I took another HPT this afternoon (1 week post D&C) hoping it would be negative. I got so excited when a second line didn't appear right away, but within a few minutes it was there. When I took tests previously, the second line appeared almost immediately. The line isn't as dark as other times, but it's still there. It is a weird feeling to wish for a negative test, but I know as long as I still have the HCG in my body, it will take longer for my period to return. Here is a pic of the tests I have taken (the dates are on there). What do you think?

I called my RE's office yesterday and left a message with the nurse asking about the fasting glucose script. She called me back this morning and was surprised my RE wanted that done because he had done my glucose levels previously. I guess I never did fasting ones before. When I talked to her I also asked about HCG levels and getting them tested again. When I went for my pre-op appointment on Monday Feb 21, my levels had risen, but were still low. I really am not sure whether I ovulated when I started taking the Lupron (January 5) or before. I can't figure it out and it doesn't much matter. Either way, my HCG was 4457 10 days ago.

Here are the levels by date:
January 21, 2051
February 8, 3972
Feb 21, 4457

The nurse just returned my call after talking to my RE and said he wants me to do a fasting glucose test. I don't have to do the challenge, just get a fasting level and then he can figure out the difference or something like that. He also wanted me to wait at least a week before getting my HCG levels tested again, and today is exactly 1 week since the procedure. I asked her how long it usually takes to go back down and she said it really depends on the person. Usually, after a D&C is goes down pretty quickly.

I don't really have any pregnancy symptoms anymore, and had lost many of them even before finding out about the miscarriage (only when I look back do I realize this). My hubby looked at me this morning and was like, "Wow, your nipples look so small." I have to admit, I am feeling pretty much back to normal. I was amazed to realize I didn't have to stop to use the bathroom AT ALL during the day today and I drank tea this morning and a decent amount of water. I am glad to not be getting up in the middle of the night to go anymore, and that was incredibly frustrating after I found out the pregnancy was no longer viable.

When I think about it, I think I will probably wait until next Wednesday to do the blood work since that will give the lab enough time to get it to my RE for my appointment, but also allow my HCG levels to come down some more (hopefully). I wish there was something I could do to make them drop!

In other news since I finally uploaded some photos, here are pics of our new bed and the bathroom before (I did take some stuff down before taking the pics, but you can tell how small it is).

Notice our fertility symbol Kokopelli on the wall? I'll take all the help I can get!

The bed is so big it's hard to get all in one frame, but the cat had to be in there! We love having the king size, and I think the cat hogs the most space. 

Here is our downstairs half (closet sized) bathroom. We don't typically keep all of that medicine on that sink, but I took the medicine cabinet down and put them there temporarily. My DH didn't think to move them before taking a picture (oh, the minds of men!) I would love to do something with the sink, but think it will be hard to find a corner sink... nothing else would fit. 

The spots that look strange had the medicine cabinet and another strip of wood with hooks and shelves. I took them down in a craze before I realized it would be good to take pics first. The border had frogs on it, and the color really isn't all that bad in the pictures. It seems brighter in person. 

Digging out

I am feeling much better today. Maybe it was going back to work (I only saw 3 kids, but it felt good to be out of the house and doing something), maybe it's the fact that March started today and it was SUNNY, maybe it was socializing with people other than my hubby (as much as I love him, I need some outside stimulation), maybe it was all the support and love from other bloggers, and maybe it was our trip to Lowe's in order to improve our downstairs half-bathroom. Whatever it is, I'm feeling much better!!

I talked with the Mom of the little boy I see for therapy who knew about our struggles and the miscarriage. She was very positive and had some great advice.

My next appointment with my RE is next Friday, about 10 days away. Is it sad that I am more excited about that than our upcoming vacation? I guess the vacation doesn't seem real at this point, but it will when we are sitting on the beach drinking pina coladas!! I can't wait.

We will be painting our downstairs bathroom, decluttering, adding a new light fixture, and a new toilet paper holder and towel rack. I think this will make a huge difference and I will be sure to post pictures of the before (after taking down some of the stuff) and after. I need to charge my camera battery first. 

I am feeling optimistic about our chances of getting pregnant in my upcoming cycles. It is getting closer to when we will be starting our next round of treatment and time is passing more quickly. I just have to wait until I get another period and then we will start a cycle. I am hoping to talk to my RE about being a little more aggressive than just using Clomid, but we will see. I also have to do a fasting glucose test and am thinking of calling the office and asking for a script ASAP so we can get that show on the road.