Forgot to post on Friday :)

I guess my follicle just needed a day off because Friday it had grown to 18.0 mm and we triggered that evening.... so all done with shots for this month! (And hopefully for a long time, if I conceived!)

It seems like the conditions were perfect for conception, so it is up to God to decide whether I am going to conceive this month or not. Isn't it wonderful that although we don't know our future, we can trust in the One who does? Whether I am pregnant or not, praise to Him for an easy month of fertility treatments.

"For men are not cast off by the Lord forever. Though He brings grief, He will show compassion, so great is His unfailing love. For He does not willingly bring affliction or grief to the children of men."
-Lamentations 3:31-33

Taking a break?

Today I needed to sleep post-appointment so that I could get back to myself...

...but here's the update: my uterine lining looked perfect - "triple stripes," which apparently is what you want a baby to implant into.

Oddly, neither follicle had grown since yesterday - still 15.8 and 12.4mm. So, I'm praying that that just meant the eggs inside were maturing rather than wasting energy on simply growing. Or maybe they just took a break because of the yucky weather yesterday and didn't want to work so much.

I appreciate all of your prayers. I know God is hearing them and letting us give this whole pregnancy thing the best chance it's got!

And again!

Everything looked great today - oddly (for me), I am very close to ovulating, and only on CD8! I have one egg that is 15.8mm and one that is 12.4mm. (18mm or greater will usually ovulate...) I may be ready to ovulate tomorrow, so they are probably going to want me back in again then. If I'm not ready tomorrow, then I will most certainly be ready by Friday. I think I would prefer not being ready until Friday because I want those eggs to have another day to mature! (Just because a follicle is large enough to ovulate doesn't necessarily mean that the egg inside is mature.) Plus, I'd love to have two eggs ovulating and not just one... increase my chances of pregnancy and maybe twins. Which would be great since we don't know where my fertility will be a year from now!

I'm feeling very upbeat today - I am so thankful for your prayers and for knowing that my joy is not based on a happy report (although that is always a nice blessing!), but on the salvation that I have in Jesus Christ.

I Will Rise by Chris Tomlin

There's a peace I've come to know
Though my heart and flesh may fail
There's an anchor for my soul
I can say, "It is well"

Jesus has overcome
And the grave is overwhelmed
The victory is won
He is risen from the dead

And I will rise when He calls my name
No more sorrow, no more pain
I will rise on eagles' wings
Before my God fall on my knees
And rise
I will rise

There's a day that's drawing near
When this darkness breaks to light
And the shadows disappear
And my faith shall be my eyes

Jesus has overcome
And the grave is overwhelmed
The victory is won
He is risen from the dead

And I will rise when He calls my name
No more sorrow, no more pain
I will rise on eagles' wings
Before my God fall on my knees
And rise
I will rise

And I hear the voice of many angels sing,
"Worthy is the Lamb"
And I hear the cry of every longing heart,
"Worthy is the Lamb"

And I will rise when He calls my name
No more sorrow, no more pain
I will rise on eagles' wings
Before my God fall on my knees
And rise
I will rise

Perfect? Moi?

I heard a word from my RE today that I have never heard him say before: perfect. As in, "Everything looks perfect."

Hooray!

I haven't heard back from the nurse yet about my E2 (estradiol) levels, but I currently have two or three follicles that are growing (I guess the two were a little more advanced than the third, but it might catch up) and my lining is already at 5.6 mm on day 6 (compared to two months ago when it was only 5 mm on day 9!).

Perfect!

Three self-administered shots down, two more before my next appointment.

"When times are good, be happy; but when times are bad, consider: God has made the one as well as the other." Ecclesiastes 7:10

(I wanted to end this post the same way as the last because, well, it just fits.)

Good and Bad

So, there's good news and bad news. (I am really forcing myself to look on the bright side. Right now, it just seems like bad news to me. I have to keep telling myself that it could be worse.)

Good news: I had 4 follicles on my right ovary and 2 on my left today. I am starting Bravelle this evening.
Bad news: with so few follicles, I am very unlikely to respond well to the drugs that I am taking (and paying $50 per dose for).

More good news: at least we are only aiming for 1-2 mature follicles (unlike IVF, where you really want a lot). I seem to still be getting one every month.
More bad news: We won't be doing IVF ever (with my eggs), it looks like. If I am a bad candidate now, I can't imagine what I would be a year from now, once we were actually able to save up our money!

"When times are good, be happy; but when times are bad, consider: God has made the one as well as the other." Ecclesiastes 7:10

Financial update

A really quick update: we got 20% off of our future treatments that are not covered by insurance (so IVF and IUI). Praise God!!!

No more Clomid headaches!

Sadly, it looks like the Clomid this month was too much for my body. I have one follicle that is ready to ovulate, but my lining is only 5 mm this time (as opposed to 7.5 mm last month, which was already thin). We are going to try estrogen still, but it is likely that I will ovulate on my own very soon and the lining probably won't thicken after I ovulate. The doctor said he has only seen a few pregnancies acheived with a lining that thin in his 40 or so years as an RE... So the good news is that I shouldn't be too disappointed at the end of this month, since I'm pretty sure I won't be pregnant. The other good news is that I won't have any more Clomid headaches, since I won't be taking Clomid any more! Woohoo!

Thanks for your prayers. We're most likely going to take a few months off to let my body rest and recuperate, so we probably won't have any updates for a while. Unless I actually start blogging again. :)

Prayer request

I have a very specific prayer request for the next week: please pray that the Clomid does not block the estrogen receptors in my uterus.

(If you're interested in the medical facts: Clomid's job is to block the estrogen receptors in the brain, which it is doing, but it is also blocking them in my uterus, which prevents my endometrium (lining) from getting thick enough to support a pregnancy and also prevents me from having fertile quality cervical mucus. This is why we will have to switch from this medicine to a much more expensive, injectable medicine the next cycle we try.... so we'd rather this cycle work!)

I will be taking extra estrogen after I finish the Clomid to hopefully counteract this, but it may not help if the Clomid is blocking the receptors!

My praise is that I have not had a single headache from the Clomid this cycle!!! That is amazing. :) :) :)

Infertile people have a lot to remember. Good thing we're not pregnant.

It's a good thing I'm not pregnant now, because there is just too much to keep track of. (I don't mean to complain; just thought I'd share a bit of my daily confusion and why I might be a bit off.)

Prescriptions
What I am taking, when I am supposed to start and stop, how many per day, how I take them (orally, injected or, ahem, another method), what strength. And it all changes from month to month. For example, I took Clomid on days 5-9 for the last two months (100 mg the first month, 50 mg the second month), am taking it days 3-7 this month so that I can start Estrace earlier in an attempt to improve my cervical mucus quality (the doctor doubted it would help, though, since my Estrogen is already fairly high and Clomid is an estrogen blocker - greeeeat). And since the Prometrium from last month gave me joint pain, I'm switching to another form of Progesterone with a name I don't remember currently. Good thing I'm not taking it yet. Oh, and I have to remember to pick them up from the pharmacy in the first place!

Appointments
When you are going to see the doctor at least once per week, on different days each week, it's hard to remember which day you are supposed to be scheduling your next appointment for. Last month I went for my second checkup on day 12, but this month it's day 9, which is.... what day, since my period started Monday? Who knows.

Bills
It's a good thing I pay my bills the instant they come through the door because if I didn't, they would never get paid. I can no longer keep track of how much I owe each different place (Shady Grove, Lab Corp, UMMC) and if I've paid them or not. It doesn't help that they don't bill right away; I just got a bill from November. It's March, people! How am I supposed to keep track of four months worth of bills? Do you know how many times I have been to the doctor's office since then? I don't even know!

Keeping a Record for Taxes
Trying to keep a record of all of my medical expenses for taxes is also a pain. How many times have I gone to the doctor's office in Baltimore so far this year? 8? 10? How many times have I gone to the doctor's office in Annapolis? How much was the parking this time? What about last time?

Update: not pregnant

It wasn't good news on my pregnancy test yesterday (negative); in fact, it was even worse news than we thought: the doctor says I am not responding to the Clomid as well as we thought initially and now we are going to need to try stronger treatments (that cost much more). Basically, we are working against a clock that no one can see and he doesn't know how much time we will have and wasting time on Clomid when it is not working that well is not a good idea in the world of infertility.

We're trying one more month of Clomid with some injectibles after the Clomid to try to encourage my body a little more. It would be great financially, emotionally, and in the hopes of having more than one pregnancy (and thus, more than one child) if we could get pregnant this next month. But we'll see. God has opened up the barren woman's womb before; maybe he wants to show his glory by me getting pregnant after the doctors have given up.

Please pray for our marriage especially, we're very stressed about all of this and I'm an emotional mess with my hormones being all over the place from the various medications. Also, the stillbirth of a baby at church has ripped open old wounds that were healing, so that is making things worse, my struggling with depression and grief. Jonathan is such a great guy; he can take my bad (and quickly changing) moods to a certain point, but anyone would break after being pushed too much. :(

Financially, we are going to apply to Shady Grove's Shared Help program, which means for procedures that our insurance doesn't cover, they will waive a certain percentage of fees (from 10 to 50% based on income). Please pray that they will be generous with us and give us the best percentage that they can. Also, please pray that we will find a good solution for the fertility drugs, because we have zero coverage for those and they can get expensive.

Also, this new news has given the devil a chance to put it into my mind that we are somehow working against God in all of this. I don't think that is the case, as we have been blessed in so many ways throughout this, financially in having coverage for so many more things than we should have had, medically, for getting us into Shady Grove Fertility with zero waiting time because my RE was joining their practice. In any case. I think I listen to the deceiver more than I should, so please pray that God will give me the strength to fight him.

I'll leave you with my favorite verses:

I would have lost heart, unless I had believed that I would see the goodness of the LORD in the land of the living.
Wait on the LORD; be of good courage, and He shall strengthen your heart; Wait, I say, on the LORD!
-Psalm 27:13-14

Please pray that I can keep seeing the goodness of the Lord in the land of the living. I am having a hard time waiting especially when I feel as if I am running out of time.

Hopeful

I'm just going to throw this out there and let you all know how my crazy mind works. There is a robot that has been following me around my mind lately. His name is Ovutron, and he says, "Ovulate! Ovulate!" over and over again in his creepy robot voice. He also carries around a syringe to stab me with on cycle day 12. If I could draw, Ovutron would have his picture featured on this blog. :)

I got great news today! There is one egg that is ready to ovulate and two more that are still growing (yeah, I'm feeling that) and will possibly ovulate. So maybe one, two or three babies, but probably no more than that... which is perfect. So tonight I get to inject myself with Ovidrel (an ovulation stimulating drug), which will help the egg(s) finishing growing and make me ovulate sometime on Thursday morning.

The medications for this cycle haven't been too bad cost-wise (especially since our insurance doesn't cover them at all); I think we've spent around $120 for those. We don't know what the monitoring will cost us yet... Our insurance may cover it (except 10%), but if not, it is $590 per monitoring (with us having two days of monitoring) for a grand total of $1300 per cycle... So please pray for us that the insurance will cover the blood tests and ultrasounds! Or that we get pregnant right away!

Speaking of pregnant, I get a blood pregnancy test two weeks from Thursday... so March 4th might be my new favorite day. :) (Although since it brought one of my favorite cousins into the world, it's already an awesome day. Love you, Emily!) Don't you all go calling me on March 4th now!

I don't know the results of my husband's tests... Apparently patient confidentiality prevents them from telling his wife. I'm hoping the doctor will call him today and let him know - and that they will be all clear! Oh, but the great news is that we didn't have to pay for his karyotyping!!! We were very grateful for that, because it could have been several hundred dollars.

Another prayer request is for my headaches... Clomid has been giving me pretty constant bad headaches... and sometimes they make me grumpy. :(

Update at 10:27 PM, approximately 3 hours and 45 minutes post shot:
Yikes, that is a fierce headache. Also, I would be okay NOT feeling my eggs maturing. Really.

Would you do it?

This past Monday I was so sure that I was pregnant. If I had had a million dollars to bet on it, I would have done it. My temperatures in my LP always drop by 10 DPO, 11 at the latest, and at 12 DPO they were continuing to be in the range that has only ever meant pregnancy for me. I also went from being hungry for one or two meals a day to eating three plus snacks in between. My breasts were sore, and I was nauseous and bloated in the evenings. I was feeling dizzy after standing at work for 3-4 hours.

But then I tested on Tuesday (13 DPO) and got a negative. Say what?!?

Well, guess what my (not so) beloved nurse told me later that day... Clomid can change your LP! Thank you for letting me know that when I started taking it, so that I wouldn't get my hopes up! Why wouldn't you tell me that before?

I actually made it to 14 DPO with high temperatures and then my temp finally fell below my coverline on day 15 - yesterday. AF showed up today.

I called my nurse yesterday to start setting up this month's treatment cycle, after I was sure that AF was on her way. Well, really, I just called to ask when I could come in for my Clomid prescription because I wasn't supposed to be coming in for any appointments.... But wait, there's more! They actually want to full on monitor me for these treatment cycles... Which would be fine if my insurance covered it at all. But it doesn't. Therefore, if we go through with this treatment, it will cost us $900 per month for a 25 freaking percent chance (per month) of getting pregnant. And forget my chances of actually carrying that baby to term... I mean, they're slightly improved over my chances without the Clomid, but still.

I was convinced that we were done with medical expenses and our mostly drained savings account hasn't had a chance to be replenished yet. We currently have enough money to do one cycle at that price and probably two more after that with what is coming back from the government in refunds, but I don't like to live life without an emergency fund.

So my question is, would you do it? And what are my chances of finding a doctor who will do an unmonitored Clomid cycle? Is that a reasonable request?

Better News

No, I'm not pregnant yet, but here's the better news:
1. Only three more tests and then we're done! And... only one of them is on me! Woohoo!
2. The MTHFR mutation shouldn't mean that I need blood thinners. Just a possible vitamin problem that is pretty easily taken care of with extra folic acid.
3. No thyroid problem - the first test was just a fluke!

I ovulated on Wednesday and it was painful. Here's to hoping that means I ovulated more than once. Although not too many times... I am a pretty small person after all.

Good News

I got good news today: my ovaries responded quite well to the Clomid - my FSH is at 10.5 (down from 10.7 last week) and my estrogen is 748, which is a great response. What they didn't want to see is for my FSH to shoot up, which it didn't, so we're happy with the results.

No thyroid results back yet; I'll probably get them at my follow up appointment next Thursday and we'll see where to go from there. We also have a genetic counseling appointment tomorrow at 1, where we'll figure out what genetic tests we need in regards to the MTHFR mutation.

Problem #4

I went in this morning for my Day 3 ultrasound and bloodwork. I was really impressed by the efficiency of the Shady Grove office. I got to my appointment about 20 minutes early and got seen almost right away. I was out of the building by 10 minutes after my appointment was supposed to start... Wow!

The good news is that on my own I had 3 follicles in my right ovary and 7 in my left. My LH and estrogen were normal. My FSH was still higher than normal at 10.7 (over 10 is considered "high"). My new medical problem of the visit (and, yes, I have come to expect a new problem at each office visit) was that I had an elevated prolactin and TSH levels, which suggests yet another problem (hypothyroidism), if the results were not just a fluke. We'll be retesting those either later this cycle or maybe next month (the nurse wasn't super clear on when) and if they are still high, I get to go see an endocrinologist to get put on medication, hopefully just temporarily to straighten things out.

We're continuing on with the Clomiphene Citrate Challenge Test this month - prepare ye the way for hot flashes.

Next appointments: January 14 for retesting of the FSH levels, January 15 for genetic counseling for the MTHFR mutations (to discuss next steps).

P.S. I started a part-time job at Ann Taylor Loft today. Hooray for employee discounts!

Updates on medical stuff

It's Day 1 of my new cycle today, which means it's time for the Clomiphene Challenge Test. I called the Shady Grove office today, but their message said they were CLOSED for the holiday... Is today a holiday?

Anyhow, I need to make an appointment for an ultrasound on Thursday or else I have to wait another month for this test! I do NOT like waiting, so I had better not have to wait again... (Although praise God that my cycles are never longer than 29ish days. I don't think I could do the waiting that some women have to do!)

I also made an appointment with the genetic counselor yesterday to discuss the MTHFR mutation and what needs to happen with that. Thankfully even though I think our insurance won't cover that appointment, the maximum price we'll pay is $135. That's doable!

New Year, New Hair, New Look

I think this is the hope inside of me roaring up - maybe if I change my hair, my year will be different than the last? If I'm not pregnant now, it's on to the clomiphene challenge test next week. I'd love to be pregnant right now and not need the (somewhat expensive) medical help, but then again, if the clomid will improve the quality of my eggs, I will take it willingly and gladly.

Here's to hoping we won't be staying awake until midnight next December 31.

If infertility were the lottery, I would be a millionaire.

Let's begin at the beginning. Yesterday was a followup appointment to the second FSH/estradiol/LH reading I had done on Monday. My FSH was actually okay (7.5), but my estradiol was really high at 121 and it artificially lowers the FSH value, so basically you can take that to mean the same thing (my FSH was probably high). So, we're continuing on with the clomiphene citrate challenge test. That was supposed to be the end of the appointment.

But it wasn't. When I had my progesterone tested a few weeks ago (which was fine, thanks for asking), they also ran a few test for some really rare blood clotting disorders that hadn't been tested for yet. I believe the words of my doctor were, you will not have one of these disorders, but just to cover all of our bases, we'll run these tests. He ate those words! I DO have one of those really rare blood clotting disorders, the Methylenetetrahydrofolate reductase (MTHFR) mutation. But wait - there's more! There are two types of mutations for the MTHFR gene and I have.... BOTH! (I only have one copy of each, though. I might have given him a heart attack otherwise.) This RE has never seen that in a patient before. Goooooooooooooooo me!

Lucky for me, this means that if I ever get pregnant I get to inject myself twice a day with Heparin or once a day with Lovenox (blood thinners) every day of a pregnancy. I also may get to take extra Folic acid for the rest of my life, since folic acid works along with the MTHFR enzyme to break down homocysteine (an amino acid). My RE was not super familiar with this problem, so I'm headed back to... my original doctor! Dr. Atkins, the lovely woman who passed me on to Dr. Blanchard for my septum, who passed me on to Dr. McClamrock for my other problems. I bet she'll be super excited to have me back!

Okay, so to summarize the various ways that I should never be a mother, I not only am going to have trouble getting pregnant (good thing we're starting early!) with any baby, much less a baby that has good genes, but once I get pregnant, my babies are very likely to be miscarried or born too early because of both a septate uterus and a blood clotting disorder.

If infertility were the lottery, I would be a millionaire. Since it isn't the lottery and I am not a millionaire, I can't afford to pay for it. Which means that these doctors are going to have to be very surprised when God takes control and helps me deliver a living baby.

Thank you, Lord, for helping the doctors find these problems, and thank you for the children that I should never have, but will have because you care about me and my husband and our desires! I can't wait to see them and tell them their story...

Yet another problem... sheesh.

Okay, the update that everyone has been waiting for. Sorry, this has been a hard week, with Olivia's due date and the anniversary of the worst day of my life (Max's 12 week ultrasound, where we found out there was no baby), and I have been thinking and not wanting to write much.

Last Wednesday was my first appointment with an RE, Dr. McClamrock. In regards to my septum, he told me a very similar story to what Dr. Blanchard had said: it is muscular, possibly/probably not what is causing the miscarriages, and very hard to take out (because it is muscular, not fibrous), so he'd like to leave it in for now, unless I have one or two more miscarriages, in which case we will rethink. He also took a look at all of the other tests I have had run and that is where we come to my second problem.

It turns out that my FSH (follical stimulating hormone) from October was a 10, which is within the normal range (which is why the other doctors overlooked it), but not normal for someone my age... More normal for a 35 or 40 year old. So we are looking at me having poor ovarian reserve, if the October test wasn't a fluke and the blood test I have on Monday confirms that number. Poor ovarian reserve means that my body has to work harder to produce an egg each month, and when it does, the eggs are often of poor quality, which would be another possible explanation for the two miscarriages. After confirming a high FSH number on Monday, I am going to go through the Clomiphene citrate challenge test in my January cycle, which means that they will test my FSH level on day 3 of my cycle, then I will take Clomid for days 5-9, and then they will retest my FSH level on day 10 to see if I am responding to ovarian hyperstimulating drugs. The Clomid may help my body produce an egg (0r hopefully many eggs), which would help me get pregnant, and have another shot at a healthy baby.

The doctor did say "age trumphs FSH," which means that I, as a 24 year old, am more likely to eventually have a child than someone who is 35 with the same FSH levels, but he also did say that one or two or more miscarriages are likely. At least someone is finally telling me the truth, eh?

Interestingly, my new RE was part of the University of Maryland Medical Center group, but is switching over to Shady Grove Fertility Center on Monday. I guess God wanted me at Shady Grove anyway - but just sped up the process a little bit. Thanks, God.

Uterus Update

The MRIs are done, and I got a call last Wednesday about the results. It turns out my septum is largely muscular (not fibrous) and is not the kind that my doctor (or the RE she consulted with) would be inclined to remove.

The dotted line that you can barely see in the picture is where they would need to trim down to to make my uterus normal, but it would also leave a large area of scarred tissue that would be bad for implantation; basically, it could leave me infertile, which they don't want to do. They are also hopeful that because my septum is muscular, it would have proper blood flow for a growing fetus, which is not the case with a fibrous septum.

They can act aggressively and take it out, or they can act conservatively and leave it, which is what they are inclined to do. The only other option is to do a diagnostic D&C and look with a camera, with the possibility of taking anything out that they felt should come out at that time. The problem is, I'm not sure I want to pay them several hundred (or maybe up to a thousand) dollars to just look around and not do anything. I'm not even sure it would give me greater peace of mind.

Dr. Blanchard recommended that I should meet with Dr. McClamrock, the reproductive endocrinologist (infertility doctor) that she consulted with, before making any decisions. I was a bit frustrated by this, as a new patient appointment with an RE can be several months away. God blessed us thoroughly, though, and got me an appointment with Dr. McClamrock this Wednesday (December 2) at 10 am - wow. I am just glad that we (hopefully, barring that D&C or any other tests he wants to do) will not have to wait any longer, and that I got in so quickly to see him. Praise God.

I'll update after that appointment on Wednesday... Maybe next month we'll be trying again!