Fingers Crossed

I went in to the RE's office this morning for my mid-cycle bloodwork and ultrasound. This cycle I went in two days earlier than what we normally schedule. This is because the Femara seems to make me ovulate sooner than I do on a non-medicated cycle. The last two cycles I took Femara I had to call the doctor the day before I was scheduled for monitoring. I was already getting a positive OPK and because of this I had to rush to the office to do my bloodwork and ultrasound a day ahead of time. We decided to be proactive this time and start the monitoring a little early.

At the office there are two ultrasound technicians. For my first cycle of monitoring, I had the "good" tech. She talked me through the entire ultrasound, telling me how many follicles she saw andthe size of each follicle. She was great. The next two times I had the "other" tech. She was all business. She didn't chat, didn't tell me what she saw, and I had to wait until the nurse called me later that afternoon before I knew if I had any follicles at all.
This morning I had the good tech again! She talked me through the entire ultrasound, told me that there was a 21mm follicle in my right ovary, along with three other small ones. The three other follicles won't mature and release an egg. My left ovary also had three small follicles which won't release eggs. This may not sound like the greatest news, but I think it is fabulous! This means that I do have a good number of eggs left. This means that my diagnosis of DOR isn't all that horrible. This means that if the Femara doesn't work then I have a really great chance with Bravelle or other injectables.
The good tech also gave me an ultrasound picture of my one fabulous follicle. I took the photo with me and tucked in into my purse.

The nurse called me this afternoon and confirmed what the good tech told me. I have one fabulous follicle in my right ovary and a handful of smaller follicles that aren't large enough to release eggs. My E2 was 97, which seem a little low, but it is earlier than when I usually have the blood draw so I am not concerned. She didn't give me my actual LH level but just said it was still low and that is good. I took an OPK (ovulation test) tonight and it is still negative. So, now I take the Ovidrel shot tomorrow morning and the waiting game begins. Here's to hoping that this cycle works!

Amaze-balls!

National Infertility Week ended May 1st. I ran across this video on many, many websites over the week and wanted to post it here. A project was started on one of the infertility blogs, I think it was on Stirrup Queens, and it was called "What IF". In the online communinity IF stands for infertility. The "What IF" project allowed those struggling with IF to all post a "What IF" comment on the board. It could be a fear, a hope, anything you wanted. The project receive a lot of attention, and one woman made a video of her "What IFs". It really touched me, and I wanted to share it.

What IF? A Portrait of Infertility from Keiko Zoll on Vimeo.

Another One Bites the Dust

Well, just as I suspected this cycle was a bust. Aunt Flow made her appearance this afternoon, exactly on schedule, just like she has for the past 25 cycles. Is this really happening to me, to us? I don't even close my office door any longer when I call the RE, speaking clearly into the voicemail saying:
"This is Corinne. My medical record number is 12345678. I am calling to report the outcome of this cycle. I started my period this afternoon. I will be staring my next round of Femara on cycle day three and I need to make my appointment for my cycle day twelve bloodwork and monitoring. Please call me back, you may leave a message if I don't answer."
Then I hang up and dial the online Fertility Pharmacy and order my Ovidrel. "This is Corinne calling to refill my prescription for Ovidrel." With my door still open, I hang up and call my local pharmacy to refill my Femara, and I cross my fingers when I pick it up that my insurance is still allowing the co-pay and that I don't have to pay the out-of-pocket cost because after all, I am using it for a fertility treatment, which is not supposed to be covered by my insuranse.
The Ovidrel is shipped to me at work in a huge refrigerated Federal Express overnight box. When our warehouse manager delivers it to my office the morning it arrives, I will have to immediately take it out of the package and put it in the refrigerator in our break room. I hope no one is pilfering the fridge later that day, looking for a sweet treat to steal, peeking into my goodie-bag only to find a prescription box with my name on it, containing a syringe filled with my next month of hope.
I am not really sure what I feel tonight. I am a little sad and a lot empty. Is that even possible; to feel a lot empty? I am really beginning to wonder if this is going to work. The more I read about Diminished Ovarian Reserve, the more afraid I become. Reading blogs and other women's experiences telling me to run, do not walk, do not pass go, but run like the wind to the nearest RE and inquire about IVF. Like yesterday.
With each passing cycle, I am afraid that I am coming closer and closer to never being a mother. What if this never happens for us? What if I am only able to watch other people's children grow up? What if it's only Scott and me? I don't think I can handle that possibility.
I've listened to all sorts of advice. Take a break, take this vitamin, take a deep breath, take some time to relax, take some royal bee jelly, take some wheatgrass. Okay, well, I don't know what to say to those things. My whole body aches to see those two pink lines.
So, do I take the Femara or do I take a break? What if I break? I just don't know if I can take any of this anymore.

Just a Little Update

I haven't posted in a while and I thought I would try to recap the past month or so. I was seriously looking into starting acupuncture, I even scheduled an appointment for an initial consult and acupuncture session. I was inspired by the book The Infertility Cure. It discusses Traditional Chinese Medicine as a treatment plan for infertility, which uses acupuncture and Chinese herbs.
The week before the appointment, I got cold feet and canceled the appointment. While it was with a certified TCM practitioner, the practice was through the Oncology Department at a local hospital. I felt that if I was going to see at TCM practitioner, I really want to see someone who specialized in women's health and infertility.

Scott and I also took an entire cycle off. It was freeing for the first two weeks or so, but then I was feeling a little sad that we missed our window for that month. It made me realize that while there can be enormous amount of stress during a cycle, I am willing to endure it for the hopes of a successful cycle. I waited impatiently for my period to start, and when it did, I called the RE's office to let them know that Scott and I were ready to start another medicated cycle.
I filled my prescription for the Femara, and ordered my Ovidrel from the online pharmacy we've been using. It saves us nearly $70 each month. I also scheduled my mid-cycle monitoring for Tuesday the 13th, which consists of blood work and an ultrasound. Monday I took an ovulation test, and it was positive. Well, it really shouldn't be positive until Tuesday or Wednesday, so I called the RE's office when they opened at 9;00. I didn't know if I should wait and go in for my scheduled monitoring the next morning, or if I needed to go in that same day. The nurse called me back at 10:00, asking if I could come down now for my bloodwork and ultrasound. I was hesitant to have to leave work, but after talking to my boss, she said to go ahead and go. I didn't share all of the details with her, but she does know we are going through some type of fertility treatments.
I went to the office for the monitoring, then went back to work; two hours later. Ugh. The nurse called back that afternoon to tell me that I had two mature follicles, one at 25 mm and one at 17 mm. My E2 was 486, so everything looked good. I was told to take my trigger shot that night. For those of you who are not familiar with a trigger shot, it is used to release the mature eggs that my body is producing for better timing. I got home from work, took the trigger shot, ate dinner, and then I got a migraine. Those of you who know about my migraines know that once I get one, I am relegated to the dark and quiet until it passes, which is usually about six hours. Needless to say, there was no baby-making going on that night. Which means that I probably lost another cycle, and any hope for having a 2010 baby.

I was and am pretty upset about it. But, it is not anything I can control. It is frustrating to think that we paid all of that money for the monitoring and medications and then missed our window for this month.

The good news is that I finally decided to go to a peer-led support group hosted by Resolve. They meet once a month, and this month they also had a guest speaker who is certified in Traditional Chinese Medicine. The speaker was interesting, and the group was amazing. It felt good to be surrounded by other women and men who know what this journey is like, who have been there and struggled too. I met a few women, got some email addresses and phone numbers, and will definitely go to the next meeting. It's a 40 minute drive on a Friday night, but it was so worth it.

Taking a Break

Just a short little post to update those of you who are following our Blog. My first cycle on Femara and Ovidrel, which was our 23rd cycle trying to get pregnant, ended this afternoon when I started my period. Scott and I have decided that we are going to take a break for a cycle or two. I need a little break from the charting, monitoring, doctors appointments, and generally the stress. Scott is being wonderfully supportive and agrees that a little break could be good for us.
We will resume the treatments and trying sometime in April or May.

So, How Are You Doing?

This is a question I hear quite frequently from family and friends. When I hear it, I am reminded that others are thinking of Scott and me during this journey. I know that the question comes from curiosity and wonder and care for us. What I don't know is how to answer the question. I usually tell people that things are going well, briefly explain where we are in our process, mention a medication or two that I am taking, and then say how I am really hopeful that this is the month for us.
What I don't say is how hard this really is. How I never in a million years thought that after nearly two years Scott and I would be here as only the two of us. That at times, the grief is nearly unbearable. During this process I have been excited, hopeful, afraid, terrified, angry, hopeless, fearful, jealous, tired, crazy, numb, relieved and disappointed. And thanks to some of the medications, I can feel all of these feelings over the course of one day!

Sometimes I wish I could post a list of the questions and comments that are acceptable to ask me along this journey. The problem is that what is acceptable one day, might set me off the next.

I guess as an outsider, someone who has never struggled with this, some can't quite grasp the daily reminders that I have had to learn to deal with. The friendly co-worker who asks me, as I am leaving work early to see my RE (fertility specialist) for yet another round of blood work, if I am going to the doctor for bloodwork to confirm I'm pregnant, when I never even mentioned the word bloodwork in the first place. I want to say "No, I'm going because after nearly two years I can't get pregnant and we're trying to figure out if I ever can." Or, "No, I am going see my doctor so she can tell me that I have few eggs left, and my chances of ever getting pregnant without serious intervention fall somewhere between slim and none." Or the co-worker I pass on my third trip to the bathroom in the past two hours because I have a case of the stomach flu starting, and they say "Don't worry kiddo, it will get better." I want to respond "It's not morning sickness you asshole, I have diarrhea". And then I realize I need to put my own feelings in check. That people may just be curious and hopeful. They may or may not realize that so much time has passed and I am still not pregnant. (All of these things have actually happened to me!)

I wish there were magic words to say, a finite list of acceptable questions and responses I could provide to family and friends so that people aren't afraid to ask me how I am doing or what is going on. I wish there was a sign I could wear that says "Please don't assume". But, I guess the best I can do is to tell you that it is okay to ask me what is going on and how we are doing. I really don't mind talking about it. My responses might not always be short or pleasant, but it is good for me to share some of what is going on.

RESOLVE Article

When I received my diagnosis of DOR, my doctor handed me a pamphlet about an organization called RESOLVE. It is a national infertility orginaztion providing support and resources to those of us struggling with infertility. It was quite a blow when she handed me the information. I couldn't believe that I was actually diagnosed with infertility let alone that she thought I needed support. It took some time, but eventually I perused the website, reading some articles and finding many useful resources. Today I found an article I wanted to share.
I found that most of the points were really great, and that a few didn't really apply to me and what I am feeling. I realize that when people ask questions or offer advice, they are doing so out of support and curiosity. The intent of this post is to let others know some of the feelings we may have when these questions or advice are offered. I hope that the article will help some to understand some of our struggles and feelings. I also hope it doesn't deter anyone from offering advice or asking questions.
I have felt pretty accepting of my diagnosis lately. And after reading the article, I realize that I am indeed going through the grieving process. I am finally at the point where I have accepted the diagnosis and we are ready to tackle it with whatever we can emotionally and financially endure.
There was a point where I was incredibly angry, and unfortunately that fell right over the holidays. Thanksgiving and Christmas were extremely difficult for me, and for Scott as well. But I think we are in a better place now. I can talk with others about what is going on and share our diagnosis and treatment plans. I can answer questions without tearing up or becoming angry. And I hopeful that very soon I will be able to share good news and joy with our family and friends.
The article really affected me because I was able to see that much of what I am feeling is normal! Finally, I am normal. The blog has helped me to express what we are going through and for me to work through my feelings. I am glad that I finally decided to share it with friends and family, and I hope it helps you to learn as much as you are comfortable with about our diagnosis and treatment.
I will continue to keep the updates as "PG-Rated" as possible, and spare the public from the more personal details.

Trigger Happy

I was scheduled for my first ultrasound for Wednesday, February 17th to measure my follicle development with the Femara this cycle. Over the weekend I started to see and feel some pretty prominent fertile signs. On Monday morning I called the RE's office to see if we could change my appointment to either that afternoon or Tuesday morning. We decided to schedule it for Tuesday.
I went in this morning and completely forgot I would have to have bloodwork too to check my FSH and E2. The nurse did the blood draw and then the ultrasound tech did the ultrasound. It was pretty quick. The nurse called back this afternoon to say that it was a good thing I changed my appointment because it is time to trigger! I had two mature follicles (eggs) in my left ovary, one at 24mm and one at 21mm. My LH was 10.2 and my Estradoil was 323, which the nurse said was great! I took the Ovidrel shot this evening when I got home from work. I was pretty nervous because I was afraid it would hurt. I did it all by myself and it was completely painless! Now the waiting begins!

I also went home this weekend for the baptisms of my two nieces. It was a very nice service. I talked to my mom a little bit, and she told me that she saw on the news that there was a recent study showing that as early as age 30, many women have only 10-14% of their ovarian reserve remaining. She said the report noted that for these women, it just takes longer to achieve a pregnancy than it does for women in their 20's. I am hoping she is right! And it was nice to know that she is thinking of Scott and me through all of this.

AFC Results

I had my ultrasound today to get my antral follicle count. It is an ultrasound where they look at your ovaries early in your cycle, usually around day 3 or 4, to measure how many follicles you have developing. Most of the information I have correlates the AFC to IFV(In-Vitro Fertilization) success rates, and since I am not doing IVF, it is a little difficult to determine what it all means for me. But, from what I can tell, a good AFC count is somewhere between 15-30. If you have DOR (diminished ovarian reserve) like I do, then your count is lower. A count over 30 typically indicated PCOS (Polycystic-Ovarian Syndrome). My count this morning was nine plus one cyst.
I'll take nine! It's not fabulous, but it could be much worse. So, I have nine little follicles ready to mature into one (or two) great eggs to be fertilized!
I am not sure about the cyst. From what I've read, a cyst is fairly common when taking clomid or other ovary stimulating meds. I thought the nurse from my RE's office might call this afternoon to go over the results, but she didn't. So I will call in the morning to see what they say about the cyst.
Now, I just continue with the Femara for the next three days, and I go back for another ultrasound on February 17th to measure follicle/egg growth. If the egg(s) is (are) about ready, then I will take Ovidrel (a trigger shot) to trigger ovulation so that we can better time baby-makin'!

The Last Piece of the Puzzle

Tomorrow I go back to the RE for my antral follicle count. It is the last bit of testing to really know what my diagnosis of DOR means for me.
My RE will take my FSH* (11) my AMH* (0.8) and my AFC* (let's hope for 10! That's a big number, but I am hoping for the best case scenario.) Those numbers together should indicate how I will respond to the Femara and determine if we should move on to injectables like Bravelle.
This cycle I am taking Femara on cycle days 3-7, then go in on CD12 for an ultrasound to check how my egg(s) are developing. When they are nice and mature, I will then take a trigger shot, Ovidrel, to trigger ovulation.
Femara is actually not a fertility drug. It is a drug used in the treatment of breast cancer in menopausal women. I don't know much about the research that lead to the more widespread usage of Famara in treating fertility, but from what I understand, it helps to increase and/or improve egg maturation and egg quality when taken on cycle days 3-7.
Since my diagnosis I have been taking wheatgrass every morning and red raspberry leaf tea each day from the start of my cycle until ovulation.
I will post tomorrow with my results!

*most of the information I have been able to find regarding the DOR diagnosis is based on IVF cycles.