There are key dates for every one of these procedures, the first is the beginning of my menstrual cycle. Each date is carefully calculated from this date and future data that are collected at each one of the dollar dropping visits. So period on March 22, call the doc, schedule 11th day transvaginal ultrasound to look at follicular development (this is truly amazing, they can see developing follicles in the ovary, really clearly I might add, and measure them and everything – more when we get to April 1 later in this post).
letrozole or clomid – as if there were not enough decisions to make already, the doc said there are 2 drugs used to help develop follicles. Now the female body and the cycle of hormones is one of the most amazing things ever! Sheer beauty in terms of coordinated steps that feedback onto one another (except for the menstruation part). But in order to not completely bore you here is a very simplified version:
- Developing follicles make estrogen
- Estrogen from the maturing follicle(s) tells the brain that a follicle is developing and not to encourage more
- When estrogen spikes (because the follicle is ready to ovulate), a brain hormone, LH, spikes in response to make that ovulation happen (this is pretty much getting approval from the brain!).
- The leftover cells in the ovary continue to produce estrogen but also make progesterone – it is this combination that tells the uterine lining to stay nutrient rich because an egg is on the way
- The leftover ovary cells however die if they don’t hear back and then the uterine lining does the whole slough off thing and we get our period – UGH! (unless you get pregnant, then step 5 is different)
and the blood test being under that OTHER name. So start letrozole Sunday night, get blood drawn Monday morning. Feel COMPLETELY EXHAUSTED Monday. Wow, I know it was a fairly big ride (63miles Saturday and 67 mile on Sunday) and had some big climbs, but really… and I didn’t really get up any earlier for the blood draw…I’m talking tired like I haven’t slept in a few days and barely able to stay focused tired. Hmmm letrozole. Actually I was really tired the night before, took that darn pill at 7pm and couldn’t hold my head up any more by 11:30 or so (and I usually have to force myself to bed). Interestingly enough I talked to a friend of mine a few days later who happens to be on letrozole for 5YEARS – not 5 days and probably more than my pathetic little 5ug dose, and she said it makes her completely exhausted too and that it even makes her “bones hurt,” achey joints and pain think what it would feel like to be really old. So yep, now I think it’s the letrozole and it did get better after stopping that drug (which should be cleared from your system within 2 days of taking the last pill unlike Clomid which stays in your system much longer and causes moodiness – I still think I picked the right drug). So everything is ready to go, the following weekend is Easter weekend and my friends have a fabulous Easter party and we joke infinitely about EGGS the day before I go for my ultrasound. We even have a fertility dance (drums and people dancing out in the beautiful Tucson weather), calling for good luck, a healthy egg and healthy swimmers. Like I said, I have great friends and way more people are incredibly supportive than I ever imagined would be. It’s just an open part of conversation on our bike rides (although some joke they aren’t old enough for the conversation – silly). Again, I’m so lucky, so grateful. But I had to start talking to people to find out I had this incredible support group. If there is anyone reading this that is thinking about doing this path, tell your friends, let them be there for you.April 1 (yes, I got my ultrasound on April fools day), but there was no fooling. There was one spectacularly beautiful follicle in the right ovary. Doc looked at my uterus first - also wonderful (I have undergone a bit of surgery to get rid of fibroids and extra thick lining and endometriosis outside of that, but that wasn’t 2013. This year I have a beautiful, healthy, happy, ready to receive uterus – and Dr Hutchison was sure to show me on the monitor and tell me just how perfect it looked this time around). Left ovary, no maturing follicles, Right ovary, just one – THE ONE as the doctor pointed out. Click click, zoom, move around a little and then he says, “yeah that’s the one and she’s ready to go.” So after he removes the magic wand that showed all my insides at high power, he has a script called in for me to the pharmacy – next door - for hCG. I walk over, get the prescription and bring it back so they can inject it, just like that. EXCEPT, hCG is human Chorionic Gonadotropin, my brain is spinning, so if you remember from the hormone talk outlined above, I told you in step 5 if the “leftover cells” don’t get a signal back, then they die and you get your period. Well the signal that can keep them alive is hCG, cells that help implant the embryo into the uterine wall secrete this hormone to tell the ovary cells to stay alive and keep producing estrogen and progesterone. SO WHY hCG when I want the follicle to ovulate? Wouldn’t hCG prevent ovulation? Well, a bit more research and we are once again overwhelmed with the awesomeness that is our body (ok well I am at least and I tell as many people as will listen). hCG and LH actually have a common subunit (part that is the same) and so an injection of hCG at this part of the cycle will mimic the LH and force the ovulation – quite effectively between 32 and 38 hours – WOW, now we’re in control. Oh and the research said this should be done when the follicle is larger than 18mm. Mine was 23mm (although it looked HUGE on the screen and took up half the ovary). So poke me in the belly with some hCG and schedule me for IUI tomorrow morning.
April 2, IUI appointment at 10am (Intrauterine insemination). Can I tell you that I teach students with dramatic emphasis that a man makes millions of sperm each day, I know this and I know that each ejaculate has possibly hundreds of millions of sperm (reference range on a sperm count is 15-480 million sperm, in 1.5-5mls average ejaculate volume. So can I just tell you even knowing all of that, it is completely depressing to see the doctor come in with your pathetic little 1ml sample all resuspended in a beautiful pink pH indicator solution. I mean 1ml may have 15million sperm in it (10million guaranteed by the sperm company), but geez, is that really all I get?! Then he draws it up into the catheter and there isn’t even enough to get back to the syringe, just drawn into the catheter which takes all of 10 seconds to put into the uterus (yep they open you up like a regular visit and then insert the catheter through the cervix, dim the lights and tell you to just lay there for 15 minutes - which I couldn’t do because I had to pee sooooo bad. The doctor had told me to have a full bladder so that the bladder would push the uterus back – prop it up basically, to make it easier to insert the catheter, but I overdid it and had a nearly explosive bladder by the time they did the insemination. So I ran down the hall to the bathroom with the sheet wrapped around me – what a dork! Then I went back in the room and laid down and thought happy pregnancy thoughts – oh wait, no I didn’t, I texted people “you’ll never guess where I am right now.”
WAITING, yeah, the problem with telling all of your friends what you are doing is that they actually care – a LOT, but have no idea what 2 weeks is. ”The sperm go in Tuesday and then I won’t know anything for at least 2 weeks.” And I mean I really won’t know anything, there are very few signs that show up before the missed period, heck there aren’t any changes to the mother-to-be’s body for the first 7days, not even hormones. If one of those sperm gets lucky and penetrates the egg the whole things seals off and spends the next few days floating down the fallopian tube dividing inside the protective shell. So not even hormone changes for most of the first of those 2 weeks. But everyone asks, “so do you feel any different?” And it is ok, because I love all of you for caring so much and being so interested, but I really wanted to be able to tell you something and there wasn’t anything to tell.
Waiting
Waiting
Waiting waiting waiting
Waiting waiting waiting waiting waiting
Waiting waiting waiting waiting waiting – wow (each 'waiting' was a whole day in real life)! So the luteal phase (the time from ovulation until you should get your period if you do NOT get pregnant) is pretty consistently 14 days – those who have shorter or longer regular cycles it is usually variable in the other phase of the cycle (the follicular phase). So is there anything different? Well, I might have been looking really hard, and there may have been some differences because of the letrozole and the hCG (very possible), or more likely, the sperm did get to the egg, one of them fertilized it, but something was critically wrong and the blastocyst/embryo didn’t develop, couldn’t divide, couldn’t implant, or couldn’t properly produce the germ layers necessary to make a baby (this is really common and most often of these are caused by aneuploidy. Again, aneuploidy increases with age, but is even high in young women which is one really big reason people don’t always get pregnant the first time they try). Anyway, I did have some digestive system changes toward the end of the week (increased progesterone can lead to constipation, and if you do have success, progesterone continues to rise steadily the entire pregnancy). I had a little nausea Sunday late afternoon, but then I started spotting (small amounts of bleeding) on Sunday night (Monday was the period due date). In denial I made it through most of Monday with only light spotting. I couldn’t wait so I took a pregnancy test (still had some in the house from last year, and went and bought more – YAY Dollar Tree $1 pregnancy tests), it was negative, and negative again on Tuesday morning, shortly followed by my period. So I was bummed, but not too bad, I had ordered 2 vials of sperm because it isn’t really likely that it will just work the first time, even with all the planets aligned (or whatever you want to call the magic of controlled hormones and medical intervention). But another hard part was that I hadn’t really thought about how to tell people if it DID NOT work, I had created all kinds of fun things to say if it did work, but now I was stuck with trying to send a message out to all of my friends that says “Hey, it's April 16th, I got my period today!” I really was ok with it, I called the doc’s office, said I got my period again and scheduled the next round of letrozole and ultrasound, that way I could just let everyone know what the next set of dates were and expect that they would understand I wouldn’t know anything for 4weeks from this point. Yeah, 4 weeks! On with life in the meantime, I have a plan, dates in the calendar, this is forward progress. It is a good thing I ordered 2 vials (although I was already starting to think about whether or not to order the same sperm for the next round if I needed more – you see the cryobank keeps sending you new profiles as they get new donors, and maybe I should have picked that other guy that was almost too perfect – yeah, I eliminated one for that……..long story, maybe I’ll tell you sometime. Oh how I want a brain off switch! And I hope my kid has a brain off switch, that was part of the reason, I digress). So where am I now? Well I still have a vial, and now I have an appointment. Round 2 here we go!
Great information that is beautifully presented. The personal voice adds to the telling. You give hard science a human face and emotional weight.
ReplyDeleteNice work, Mischala (whoever you are...) : )