Well here is the post that starts to get interesting (maybe only to me...I am kind of a geek like that.) Anyway, our first appointment with Dr. H he gave us several different treatment options to consider. Each option becomes a little more involved and costs more...imagine that!
Option 1: Oral follicle inducing medication (Clomid) and IUI (intrauterine insemination) This option is the least invasive and least expensive. I would take Clomid for 5 days, have ultrasounds to monitor the follicle growth, take a "trigger" shot to force ovulation when he felt my follicles were mature, and then go in for the insemination.
Option 2: Injectable follicle stimulating medications and IUI. This option is a little more involved than option 1, because there are more ultrasounds involved to monitor follicle growth, and I'd be giving myself a shot everyday for a week or so. It would also include the trigger shot and insemination. There is also a higher risk of multiple embryos with injectable meds, particularly among PCOS patients.
PCOS causes the woman to produce many follicles each month, but there are so many that they never grow to maturity and are therefore never released. Ultrasound monitoring is essential when using injectable meds but particularly for PCOS patients, to ensure we're not over producing follicles.
Option 3: IVF (In Vitro Fertilization) IVF is much more involved than I'm sure you care to know about at this point, but in a nut shell, it would include many more injectable medications forcing my body to produce as many follicles and mature eggs as possible, the eggs would be removed and fertilized in the lab, and any viable embryos left after about 5 days would be transferred back to me to hopefully implant. 1-2 embryos is all I would have transferred, even if more were still viable. Any more than that and the risk for higher-order multiples is too great. The remaining embryos have several options as well.
So after discussing with him our options we decide to start with option 1, Clomid and IUI.
We are INCREDIBLY blessed to have unbelievable insurance coverage for fertility. I have sworn to NEVER complain about health insurance or the state of Illinois again. Illinois is one of 15 states that have a fertility mandate, requiring all insurance companies to offer coverage for fertility treatments. I'm even more grateful to my employer for choosing to pick up the fertility coverage in our benefit package. Without the insurance we would not be able to afford all the things we're doing. My insurance covers practically everything. We even have several rounds of IVF covered which almost never happens. We are unbelievably lucky and give thanks all the time for the coverage we have.
Thursday, December 30, 2010
Wednesday, December 29, 2010
Not a patient patient
Well, if you've made it this far in the blog posts, congratulations and THANK YOU! I'm impressed that you're still reading and haven't decided that you could be spending better time elsewhere :o)
Through the months of September and October I was taking my Metformin, taking my temp each morning and using ovulation predictors and we still were not having any luck. I still wasn't ovulating and if I did, it wasn't until VERY late in my cycle which isn't good either. Late ovulation usually results in a poor quality egg that either cannot be fertilized or isn't viable once it is...either way probably not going to result in a healthy pregnancy. As more time went on, the less patient I was becoming. The Metformin wasn't working the way I had hoped it would and I wasn't being very patient. I knew that there was no point in calling my OB/GYN back because I already had an appointment scheduled for December, so that would go nowhere in October. The more information I found on PCOS the more apparent it became that we needed more help than my OB/GYN could give us. After much deliberation and insurance policy research, I decided to jump in with two feet and schedule a consultation with a Reproductive Endocrinologist (RE). Needless to say I wasn't patiently waiting to see whether or not the meds would do what Dr. T thought they might.
REs are what are most commonly referred to as "fertility doctors." Matthew and I discussed whether or not we needed to take that next step and the more we talked about it the more it became clear that we did need to get some additional help. So at the end of October we had our appointment with Dr. H for the first time.
Our first appointment with him consisted of A LOT of health history questions. We spent a good 45 minutes talking with him about both of our health histories, family histories, etc. After all the questions were finished I had an ultrasound (the first of MANY I would soon discover.) After the ultrasound we discussed PCOS and his take on it. He instructed me to increase my Metformin dosage every day and then began to discuss various treatment options.
Since this post is starting to get long (like all of the others...again sorry!) I'll save the treatment options for a later date!
If you've made it this far you can see that it hasn't been an easy process. Just when it feels like we might be making a little progress there is another hoop thrown at us to jump through. As a friend explained it to me one day, trying to conceive with fertility problems is a marathon. I have to completely agree. It's definitely not for the faint at heart and you really have to pace yourself while embarking on this journey. If not, no one would make it to the finish line and finally have baby that they're so desperately trying for.
Through the months of September and October I was taking my Metformin, taking my temp each morning and using ovulation predictors and we still were not having any luck. I still wasn't ovulating and if I did, it wasn't until VERY late in my cycle which isn't good either. Late ovulation usually results in a poor quality egg that either cannot be fertilized or isn't viable once it is...either way probably not going to result in a healthy pregnancy. As more time went on, the less patient I was becoming. The Metformin wasn't working the way I had hoped it would and I wasn't being very patient. I knew that there was no point in calling my OB/GYN back because I already had an appointment scheduled for December, so that would go nowhere in October. The more information I found on PCOS the more apparent it became that we needed more help than my OB/GYN could give us. After much deliberation and insurance policy research, I decided to jump in with two feet and schedule a consultation with a Reproductive Endocrinologist (RE). Needless to say I wasn't patiently waiting to see whether or not the meds would do what Dr. T thought they might.
REs are what are most commonly referred to as "fertility doctors." Matthew and I discussed whether or not we needed to take that next step and the more we talked about it the more it became clear that we did need to get some additional help. So at the end of October we had our appointment with Dr. H for the first time.
Our first appointment with him consisted of A LOT of health history questions. We spent a good 45 minutes talking with him about both of our health histories, family histories, etc. After all the questions were finished I had an ultrasound (the first of MANY I would soon discover.) After the ultrasound we discussed PCOS and his take on it. He instructed me to increase my Metformin dosage every day and then began to discuss various treatment options.
Since this post is starting to get long (like all of the others...again sorry!) I'll save the treatment options for a later date!
If you've made it this far you can see that it hasn't been an easy process. Just when it feels like we might be making a little progress there is another hoop thrown at us to jump through. As a friend explained it to me one day, trying to conceive with fertility problems is a marathon. I have to completely agree. It's definitely not for the faint at heart and you really have to pace yourself while embarking on this journey. If not, no one would make it to the finish line and finally have baby that they're so desperately trying for.
Tuesday, December 28, 2010
The diagnosis is...
Now that you're way more familiar with my inner-workings than you ever needed or wanted to be, I guess we'll continue the story. :o) A week after I'd started back to work I had my appointment with the OB/GYN to figure out what was wrong. While I was glad to finally be getting somewhere I was really afraid of what she was going to tell me, or worse yet, tell me there was nothing wrong and to just keep trying. The more info I give the nurse about my medical history, she makes notes, and then decides to go check with Dr. T about whether or not to do an ultrasound to check my ovaries. The symptoms I had described were along the lines for a specific fertility disorder that can be identified through bloodwork and ultrasound. It didn't take more than a couple of minutes before she came back and said to follow her to the US room because the doctor definitely wanted to see what was going on.
The US was pretty quick and painless, and it was sort of interesting to see everything up on the screen. The US tech was showing me the other various organs that are visible when doing one, and I was sort of intrigued by everything there. As she's pointing out each ovary and my uterus I began to notice things on each of my ovaries. Now before I go any further, I have to tell you that even before I had the appointment to meet with Dr. T I had spent many hours on my own researching potential fertility problems, their symptoms, treatments, etc in hopes of self-diagnosing. After my US I pretty much knew what Dr. T would come in to tell me, and my suspicions were right on target.
The US was over, and I went back to my exam room to wait for Dr. T. When she arrived she told me exactly what I was expecting to hear. I had PCOS or Polycystic Ovarian Syndrome. PCOS is one of the most common fertility problems in women. What's even more surprising about it though, is there are probably many more cases that go undiagnosed than actually diagnosed each year. PCOS has a whole list of symptoms that can be related to any other number of health problems. Each of the symptoms associated with PCOS could be treated individually by different specialists. It isn't until a woman has trouble conceiving that the diagnosis of PCOS is actually considered and finally made. She told me that I don't look like the textbook PCOS patient, but my ovaries tell an entirely different story. Each one was covered in over half a dozen small follicular cysts and my ovaries were enlarged as well. Both are tell-tale signs of PCOS. She gave me the news, and I think was surprised that I wasn't more upset by the diagnosis. When I told her that was my suspicion all along, and that I saw the cysts on the US screen and pretty much self-diagnosed then and there she laughed and told me that she was impressed. Maybe I went into the wrong field...hmmm..anyway. We talked at length about what PCOS is, why it causes fertility problems, and ways to treat it. We were going to start out with a diabetic medication called Metformin to help regulate my insulin levels. Many PCOS patients have insulin resistance problems which then cause the rest of the hormones to produce incorrectly, thus throwing off ovulation and the monthly cycle. I was to take my Metformin for 4 months and then go back to see her in December. She said it was entirely possible for the Metformin to work on its own and restore my cycles. There was even potential that it would work well enough that I could be pregnant by the time I went back to see her in Dec.
I left the appointment extremely glad I pushed to see her. The problem with PCOS is that it's very very difficult for a patient to get pregnant without some sort of medical intervention. It could be something as simple as Metformin, or it may take a more involved route, as we soon would discover. The other problem with PCOS is if left untreated it can lead to a whole host of other serious medical problems down the road. One of the easiest ways to treat it is for the patient to be on birth control, forcing a monthly cycle and keeping the hormones in check, but since we are trying to have a baby, obviously birth control pills are counterproductive. Metformin is the other typical treatment, specifically if you're trying to get pregnant. If only Metformin had been the miracle drug we were hoping for...
The US was pretty quick and painless, and it was sort of interesting to see everything up on the screen. The US tech was showing me the other various organs that are visible when doing one, and I was sort of intrigued by everything there. As she's pointing out each ovary and my uterus I began to notice things on each of my ovaries. Now before I go any further, I have to tell you that even before I had the appointment to meet with Dr. T I had spent many hours on my own researching potential fertility problems, their symptoms, treatments, etc in hopes of self-diagnosing. After my US I pretty much knew what Dr. T would come in to tell me, and my suspicions were right on target.
The US was over, and I went back to my exam room to wait for Dr. T. When she arrived she told me exactly what I was expecting to hear. I had PCOS or Polycystic Ovarian Syndrome. PCOS is one of the most common fertility problems in women. What's even more surprising about it though, is there are probably many more cases that go undiagnosed than actually diagnosed each year. PCOS has a whole list of symptoms that can be related to any other number of health problems. Each of the symptoms associated with PCOS could be treated individually by different specialists. It isn't until a woman has trouble conceiving that the diagnosis of PCOS is actually considered and finally made. She told me that I don't look like the textbook PCOS patient, but my ovaries tell an entirely different story. Each one was covered in over half a dozen small follicular cysts and my ovaries were enlarged as well. Both are tell-tale signs of PCOS. She gave me the news, and I think was surprised that I wasn't more upset by the diagnosis. When I told her that was my suspicion all along, and that I saw the cysts on the US screen and pretty much self-diagnosed then and there she laughed and told me that she was impressed. Maybe I went into the wrong field...hmmm..anyway. We talked at length about what PCOS is, why it causes fertility problems, and ways to treat it. We were going to start out with a diabetic medication called Metformin to help regulate my insulin levels. Many PCOS patients have insulin resistance problems which then cause the rest of the hormones to produce incorrectly, thus throwing off ovulation and the monthly cycle. I was to take my Metformin for 4 months and then go back to see her in December. She said it was entirely possible for the Metformin to work on its own and restore my cycles. There was even potential that it would work well enough that I could be pregnant by the time I went back to see her in Dec.
I left the appointment extremely glad I pushed to see her. The problem with PCOS is that it's very very difficult for a patient to get pregnant without some sort of medical intervention. It could be something as simple as Metformin, or it may take a more involved route, as we soon would discover. The other problem with PCOS is if left untreated it can lead to a whole host of other serious medical problems down the road. One of the easiest ways to treat it is for the patient to be on birth control, forcing a monthly cycle and keeping the hormones in check, but since we are trying to have a baby, obviously birth control pills are counterproductive. Metformin is the other typical treatment, specifically if you're trying to get pregnant. If only Metformin had been the miracle drug we were hoping for...
Wednesday, December 22, 2010
Not easy...not easy at all
So last December we thought we were big time. Scared but excited to start the journey into parenthood. It's amazing how naive we both were even at 27 and 29 years old. I have definitely decided that "the talk" that is given in middle school is nothing more than a scare tactic. Now don't get me wrong, I'm not saying that middle schoolers need to know the full truth, scaring them is totally fine if it prevents teen pregnancy, however when you're finally an adult ready for this next challenge, it's incredibly frustrating that it doesn't just happen like the teachers/school personnel swore it would. So we tried, and tried, and tried some more. When that wasn't working out, I decided it was time to take it to the next level and start keeping track of some things. As I started doing some reading into ways to improving our chances, I found several things that can increase the odds of conception each month. So I bought various products designed to help pinpoint ovulation and started taking my basal body temperature every morning. Matthew was NOT a fan of the thermometer beeping each morning, and on more than one occasion asked how much longer I was going to be using it. To which I replied "until we get pregnant."
Despite all our best efforts each month a new cycle would start or I'd blow through several pregnancy tests thinking that I was late for a reason! Each time I would allow myself to get my hopes up, they would come crashing down in the form of negative pregnancy tests and the start of a new cycle for me. Now comes the crazy part.
Sorry for all the personal details about my cycles than I'm sure you don't care to know, but it is kind of imperative to the rest of the story, so just hang with me...Up until April everything had been fairly regular. Usually after stopping birth control pills it can take a few months for a woman's body to go back to "normal." So far things hadn't been too bad, more regular than I ever remember before I started taking the pill many years earlier. April rolls around and I'm waiting for a new cycle to begin and nothing. I wait a little longer (mostly because I was already tired of negative pregnancy tests and didn't want to take one) keep waiting, and nothing. May rolls around and still nothing. Pregnancy test after pregnancy test keep coming back negative. Ugh! At one point I almost had myself convinced that I was that one-in-a-million woman who never gets a positive test but is pregnant (crazy I know.) June rolled around and still nothing. At this point I chalked it up to stress. There were many things going on in the month of June that very easily could've caused a kink in my cycle, so I tried to convince myself that was the reason behind it. There couldn't be anything wrong with me...
By the time July came around and I was still having negative pregnancy tests and no cycles I was starting to get nervous and worried. I finally made the decision to call my OB/GYN and see if they could give me some answers. The response I received was NOT what I had hoped to hear. They basically told me to monitor my cycles for the next 3 months and if they were still crazy to call again. Monitor my cycles? I wasn't having cycles! It wouldn't be hard to monitor something that never came! At this point I was convinced that there was a problem and needed confirmation for why my cycles were so screwy. I waited about 3 weeks and called back. This time I was much more firm about what I wanted and actually got my way! They had me come in for a blood test to ensure that I was not pregnant, and then used medication to induce my cycle. I also had an appointment scheduled with one of the doctors in the practice to figure out what was going on...
No where in "the talk" in middle school did they ever tell you that there is a possibility of having fertility problems later in life. I'm not even "old" in terms of reproductive age, but I guess it doesn't really matter. As I've come to find out, not everyone going through fertility treatments is 40 or over the way the media likes to portray.
Despite all our best efforts each month a new cycle would start or I'd blow through several pregnancy tests thinking that I was late for a reason! Each time I would allow myself to get my hopes up, they would come crashing down in the form of negative pregnancy tests and the start of a new cycle for me. Now comes the crazy part.
Sorry for all the personal details about my cycles than I'm sure you don't care to know, but it is kind of imperative to the rest of the story, so just hang with me...Up until April everything had been fairly regular. Usually after stopping birth control pills it can take a few months for a woman's body to go back to "normal." So far things hadn't been too bad, more regular than I ever remember before I started taking the pill many years earlier. April rolls around and I'm waiting for a new cycle to begin and nothing. I wait a little longer (mostly because I was already tired of negative pregnancy tests and didn't want to take one) keep waiting, and nothing. May rolls around and still nothing. Pregnancy test after pregnancy test keep coming back negative. Ugh! At one point I almost had myself convinced that I was that one-in-a-million woman who never gets a positive test but is pregnant (crazy I know.) June rolled around and still nothing. At this point I chalked it up to stress. There were many things going on in the month of June that very easily could've caused a kink in my cycle, so I tried to convince myself that was the reason behind it. There couldn't be anything wrong with me...
By the time July came around and I was still having negative pregnancy tests and no cycles I was starting to get nervous and worried. I finally made the decision to call my OB/GYN and see if they could give me some answers. The response I received was NOT what I had hoped to hear. They basically told me to monitor my cycles for the next 3 months and if they were still crazy to call again. Monitor my cycles? I wasn't having cycles! It wouldn't be hard to monitor something that never came! At this point I was convinced that there was a problem and needed confirmation for why my cycles were so screwy. I waited about 3 weeks and called back. This time I was much more firm about what I wanted and actually got my way! They had me come in for a blood test to ensure that I was not pregnant, and then used medication to induce my cycle. I also had an appointment scheduled with one of the doctors in the practice to figure out what was going on...
No where in "the talk" in middle school did they ever tell you that there is a possibility of having fertility problems later in life. I'm not even "old" in terms of reproductive age, but I guess it doesn't really matter. As I've come to find out, not everyone going through fertility treatments is 40 or over the way the media likes to portray.
A little background info...
Well here is a little background info on us and how we arrived at the point of seeking the help of a fertility specialist in order to get pregnant and have a family.
Just over 5 years ago, Matthew and I were introduced by college friends. We quickly went from getting to know one another to dating. It was definitely the easiest relationship either of us had ever been in, which was a relief but also a little nerve wracking at the same time. We did the long distance thing for almost 2 years. Looking back on it, it amazes me how often we made the drive back and forth. It may be an easy drive, but it is long and so boring! In the end, though, it was all worth it! In June 2007 I was offered a job teaching in Germantown Hills, and I moved in August. Just about a month later Matthew proposed and we spent the next 11 months planning out our perfect wedding. MANY MANY MANY thanks to my parents, Matthew's parents, and everyone who had a part in our special day. We couldn't have asked for anything better!
A few months after the wedding we bought our condo. It's been an interesting purchase to say the least, but it is nice to be homeowners and not throwing money away on rent any longer! There is a reason they say hindsight is 20/20 though. I have a feeling if we knew then what we know about the place now we may have waited to buy it, but had we not bought the condo we wouldn't have Sophie!
Life without Sophie just would not be anywhere near as fun! She has definitely brought a whole new element to our lives. And who would've ever guessed that Mom and Dad enjoy playing and snuggling with her as much as we do! For two people so skeptical about us getting a dog, they sure are hooked on her :o)
So now that we'd hit all major milestones as a couple (wedding, house, dog) it was time to take that next big step - kids. Like most people we figured it wouldn't take long once we started trying to wind up pregnant, boy were we wrong. Now that you're caught up, you get the rest of our trying to conceive story, and my motivation for making this blog. Forgive me if I get frustrated and start to get down on myself. Infertility struggles are some of the most difficult problems to deal with because it's something that's not talked about much. It's an incredibly private struggle, which only adds to the stress and frustration. The next posts are about our journey through the world of infertility and the treatments that we are confident will lead to extending our family!
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