First Ultrasound Decision

Thank you so much to everyone who weighed in about my question on when to schedule my first ultrasound. It means so much to me to hear everyone's side and be able to make a good decision. Sorry I haven't updated much lately. I've been trying to get back in the habit of writing again. I had originally planned for this month to be all about relaxing and staying low-stress and dealing with the IVF process in the best way I could without adding pressure as far as my career goes. With the amazing news of getting pregnant, I have also realized just how much needs to get done before baby. Most of which takes money. Which brings me back to my writing, haha.

But I do want to keep up with my blog, so here I am, and I'll be better about not skipping days this week. Plus, I wanted to give an update on my decision since so many people were awesome enough to leave suggestions and advice about the ultrasound.

At first, I called and scheduled it for October 26th. I would be 6w4d pregnant at that point. However, after reading your comments and agreeing that it would probably drive me even more crazy to go in and NOT have a definitive answer about the baby's heartbeat, I decided to call and have the u/s pushed back one week. Now, I'll be going in November 2nd, which is 7w4d into my pregnancy. I feel like it's a perfect compromise. Only a few days away from the 8 week mark that my doctor suggested, but still late enough that we should definitely be able to see a heartbeat and know that everything is okay.

This puts me 2 weeks and 2 days away from the ultrasound!! So it's back to another 2 week wait for me, hehe. In the meantime, I am trying to stay positive and know that everything is okay in there. Everything is unfolding exactly the way it's supposed to, for better or worse. And I am going to trust that journey.

Third Beta! And a Question...

I just got the results of my third beta. 519!!! So it more than doubled again and I can breathe easy for a little while, thank goodness. But I have a dilemma about the first ultrasound.

The nurse said I should schedule it for the week of November 6th. Ugh. SHe said they typically like to do the u/s one full month after the positive test. That would make me 8 weeks pregnant already. She said they do it because that way there's no chance you won't see the heart beating and the baby growing if everything is okay. I, of course, am not super happy with this timing. That's almost a month to wait!!

I expressed my unhappiness and she said I could schedule it for sooner, but that we might not be able to see a heartbeat and Dr. Toma would probably want me to come in again before 10 weeks just to make sure everything is okay. So what do you ladies think I should do? I actually called the nurse and scheduled an appointment for October 26th, which is only about 2 weeks away. I would be 6weeks, 4 days pregnant. I mean, almost everything I've read says that most people can see a heartbeat by then

George thinks I should do what the clinic recommends because he is scared that if we go in early and don't see a heartbeat, it will be catastrophic for me and I'll freak out. My worry is that what if there's just a sac and there's not really a baby growing in there? I don't want to happily think I'm pregnant and all is well for the next four weeks when I could have found out in 2. /sigh. Am I overthinking this?

I'm debating whether to call and reschedule back to a later week or just go in for the 6 week one and risk not seeing a heartbeat by then? But they would at least be able to tell if there's a tiny fetus that's growing on schedule, right? I guess mentally and emotionally, I would rather know something is wrong earlier rather than later. Any advice?

CD20 Ultrasound and Progesterone Bloodwork

A few weeks ago, George and I went in to our clinic for our education class. When the nurse gave me my protocol, she mentioned birth control pills. I know they don't typically prescribe bcp, so I asked about it. She said Dr. T was thinking I don't have a true natural ovulation and therefore do not truly shed my lining with each period. In order to get a good start to the IVF cycle, he wanted me on 14 days of bcp to stimulate a good AF.

Instead of just sitting back and letting them tell me things I didn't feel were true, I actually spoke up (which is a big deal for me in a situation like this.) I told the nurse that I thought I was actually ovulating on my own. I asked her if it would make a difference one way or the other and she said she needed to ask Dr. T. When the verdict came back, she said that yes, it would make a difference. If I'm ovulating on my own, the bcp would be a bad idea as it would mess with my natural cycle. So, in compromise, we decided to do a u/s and progesterone check near the time I thought I was ovulating to see if it looked like I was going to ovulate on my own.

Today is CD20. I got a near-positive OPK yesterday and the day before along with some twinges on my left side. I also have EWCM (egg-white cervical mucus), so I was pretty sure I knew what we were going to see today, but I still had my doubts. I kept thinking, what if I haven't even been ovulating the past six months like I thought I was?

I still have to wait for the results of the progesterone test, but there was no doubt what was going on with my ovaries! My right side was quiet, but on my left side, I had a big 22mm follicle. Definitely looks like I'm ovulating on my own! This is such good news for me, because a year ago when they did this, there was absolutely no activity. That's why I went on Clomid in the first place. Now, because of the lifestyle changes I've made with diet and exercise, along with the metformin and vitamins, I'm actually ovulating on my own. I looked at that big follie and thought, "Wow, I did that! I made that happen." It was pretty exciting to see.

Unfortunately, ovulation has not equated to pregnancy. I'm not sure of the reasons behind that. Maybe the outer shell of the egg is too hard, which often happens with PCOS, and the sperm just can't get in there. If that's the issue, the embryologist will bypass that step with ICSI (where they actually inject the sperm into the egg with a tiny needle). I pray it's not an implantation issue or a problem with the overall quality of my eggs. We'll know more once the embryologist gets hold of them next month.

Anyway, I'm going to have to wait until this afternoon to know officially, but I am pretty sure this means no birth control pills for me, which makes me a happy girl. I should be on track for AF to arrive around October 7th, which means my baseline u/s, blood draw and stims will all be starting CD2, October 8th! That's only 15 days away! I'll update later with official word, but it looks like a natural cycle for me this cycle, and I honestly couldn't be happier. It just goes to show that with PCOS, sometimes changing diet and adding exercise really can make a difference. All this hard work has not been in vain.

*UPDATE* - Seems I spoke a little too soon. Carla called me around 2:30 to say that my progesterone levels were nearly 0. Basically, what that means is that even though I have a mature egg that is ready to pop out, my hormones are not giving it the go-ahead. When that happens, the egg ages and deteriorates and in the end, if it does come out, it's not good anymore and my lining doesn't totally shed with AF. BCP would be bad because since I already have a big follie, the bcp wouldn't get rid of it and it would still be there in 2 weeks and I wouldn't be able to start stims, so it's definitely good I went in to have this all checked.


Still, this explains why I'm not getting pregnant naturally. In order to solve the issue, I went back in this afternoon and got an HCG trigger shot. Basically, that forces the egg to ovulate. I don't want to get my hopes up and think that maybe we could end up pregnant on our own, but it is a possibility. They want me to come in for a blood test in about 12 days to make sure I'm not pregnant before I order my meds for IVF! I should still be right on track for AF to arrive on October 7th and stims to begin on the 8th, but man, wouldn't that be amazing if I got pregnant? I know, I know, stop dreaming, right? Haha.

CD 1

AF came this morning. While I was working out, of course, lol. I got home from the gym and it was on. Cramps full force, which only adds insult to injury when you're TTC. It's like, not only do you have to deal with the blow of not being pregnant yet again, you also have to deal with feeling like complete crap and being in excruciating pain. Ugh. I am going to take another tylenol and hope it goes away by this afternoon.

The good news is that I was finally able to schedule my CD 5-9 ultrasound. It's one of those pre-requisites to IVF, so this will be a very good step in our journey. I had one of these done last year, but the clinic requires it to be done within a few months of IVF just to make sure there are no fibroids or tumors in the uterus that would cause IVF to fail. I feel confident that everything will be fine, so this is just going to get us one step closer to the good stuff. Dr. T is going to put some kind of "bubbles" in the saline this time around so we can get a clearer look at the tubes. I realize this seems strange since we're doing IVF and the tubes will be bypassed, but for my own peace of mind, I want to know if my tubes are blocked in any way or not.

So, the saline ultrasound is scheduled for 3:15 PM on August 9th. That's next Tuesday. On the phone, the nurse told me to be sure to take some tylenol or other pain killer about an hour before I come in. Nice. I hadn't been thinking about the pain of it, lol. I've been so focused on the process, I had forgotten to think about how the saline u/s felt. It does kind of suck for a few minutes, but I don't remember it being awful or anything. Hopefully this time will be the same.

I also left a voicemail for the nurse I work with most directly. I'll just call her Nurse C. I asked her to please call me back when she gets a chance so we can discuss my IVF protocol and whether I need to come in for a specific "plan" sort of meeting with her and Dr. T. Today marks the officially 2 month waiting period before we start our IVF cycle on October 1st. I'm very excited and very nervous at the same time.

Oh, and today is my first acupuncture appointment! 6:00 PM tonight. I had to fill out a ton of forms. Think I will print out my charts from FF too and take those with me. We'll see what he has to say tonight, but I'm hoping it will help me relax and also help us conceive. I feel like even though IVF is still 2 months away, we're finally starting to take real steps towards it, and that makes me very happy. On CD1, I usually am feeling depressed and wondering if I will ever feel the joy of seeing those two lines on a home pregnancy test. Now, though, I can truly find hope that I just might see it in 3 months or less!

Our Plan Moving Forward

I thought I would take a post to organize my own thoughts on our current TTC plan. After talking with our doctor at NCCRM in April after several failed IUI's and Clomid cycles, we decided to move forward with IVF. Rather than just rush into it and start right away, we decided to take several months to prepare, save money, and try to get into a better place for IVF. Somewhere in the back of my mind, I kept thinking we might get pregnant on our own before it came to that, but after four cycles without fertility meds, we still are not pregnant, so we are looking on toward the upcoming IVF and setting our sites on success.

At first, we planned to start IVF in August, but as most of you know, I'm a writer. I just released the fourth book in my YA series. There is one final book left in this series and rather than go through the emotional roller coaster of IVF (and possibly morning sickness soon after, hehe) while I'm still writing this series, I thought it would be better for me to write and publish the final book before we begin IVF. I am just starting book 5 now and hope that it can be finished and published by mid-September. (fingers crossed!) In the meantime, we are going to get all our little ducks in a row so that when the book is published, we are 100% ready to move forward.

Here are the major things that we need to do before we can start meds:

• Saline Ultrasound - this has to be done during CD 5-9. I've already had one of these done, but that was back in November and my clinic's policy is to do another one right before IVF to guarantee that there are no tumors or fibroids in my uterus that would prevent an embryo from implanting. Also, I've asked my doctor to check my tubes just to see for sure if they are blocked. Instead of performing a painful HSG, he said he can add bubbles to the saline and see the tubes clearly. I plan to go in for this u/s during this next cycle.
• IVF Labs - George and I both will need to get blood tests done to check for infectious diseases (I think this is a federal requirement for IVF). I'm not sure yet if I will need to also get another check of my FSH and AMH and all that good stuff since I had those tests done less than a year ago, but we'll see.
• Acupuncture Initial Evaluation - I know that acupuncture isn't a necessity when it comes to IVF, but I'd like to go for it and do everything I can to give IVF its best chance for success. Some studies say that acupuncture can increase implantation rates, so I'm going to go for it. We have a couple's evaluation already scheduled for August 1st.
• S/A and Freeze - This is all George, haha. He's had a semen analysis done several times before and everything has been awesome with his results (above average which is great), but the fertility clinic requires him to do another and they also require a sample to be frozen ahead of time just in case there is something that prevents him from giving a sample on the day of retrieval. That way, there's always a backup if anything happens. The freeze is one thing insurance does not cover, so that's $200 out of pocket, but totally worth it.
• Weight Loss - My doctor says that he doesn't believe my current weight will cause any problems with IVF, but he did say that any amount of weight I can lose before the procedure will only help the maturity and quality of the eggs retrieved. I am very disappointed to say that since this time last year, I've gained nearly 20 pounds. Ugh. How does that happen? Well, I know how it happened. I gained nearly all 20 pounds during the clomid rounds and it totally sucks! It scares me about the drugs for IVF and how my body will handle it. Am I going to gain a bunch of weight? I hope not. I definitely need to drop some of this weight. I am working with a personal trainer 3 times a week, going to Zumba classes, Yoga classes, and walking a lot with George. I also have a new diet plan, so I am confident I can drop that 20 pounds before we start meds. However, I am also happy to know that my doctor doesn't think my current weight is going to be an issue.

So that's our list. Once the book is finished and the list is done, we'll start the official process. I don't know all the details of the meds I'll be taking yet, but I do know a few things. Here is a rough outline of what our IVF plan will be:

• Birth control pills for 10 days to restart my cycle.
• Clomid starting cycle day 2.
• Injectables (not sure which ones yet) for 10-12 days.
• U/S every 2 or 3 days throughout injection period and E2 check.
• When follicles are ready, trigger shot.
• 36 hours later - Egg Retrieval (not looking forward to anethesia here, but going to stay calm).
• 3-5 days Later - Embryo Transfer (My doctor plans to transfer two embryos as long as there are two near-perfect ones to transfer. I'm very hopeful we can get at least two great embryos.) Any remaining embryos will be frozen for a possible FET round (Frozen Embryo Transfer) if IVF is not successful. 

Our chance of success is between 50-60% with IVF at this clinic, and I'm feeling really good about it. An FET round has a 30-40% success rate, so as long as we can get at least 4 healthy embryos, we have a really good shot of being pregnant within the next six months. I'm so nervous, but also excited about the future. I'm so glad we have a plan now and are moving forward with IVF. Even though the actual retrieval and transfer are probably still three months away, I know that time is going to fly by and it will be here before we know it.

Second Ultrasound

This morning I had my second follicle check ultrasound for this third medicated cycle. My follicles are definitely maturing. I had one 22mm follicle, which is big enough to trigger. But I also had two others that were at 17 and 16 mm's. The nurse said that there is still a good chance the IUI will work with only one mature follicle, but having more than one does increase the chance of getting pregnant without significantly increasing the chance for multiples. So, I had a decision to make. I could either trigger today with one follie or I could give it a day and allow the other two medium follie's to mature.

The only problem with waiting a day is that there is a possibility I could ovulate on my own tonight or tomorrow with the one mature follicle. If that happens and we don't catch the surge, it's possible the IUI could be too late. I've been taking OPK's every few hours, and there hasn't been a surge yet. I'm hoping the bigger follie will hold on just a little bit longer. Tomorrow, I will go in to the doctor and get my trigger shot. Hopefully, I will then ovulate within the next twenty-four to thirty-six hours.

Our plan is to go in for the actual IUI on Thursday, which should be exactly right. I hope. If I release three good, healthy eggs this cycle and we get the washed sperm into my uterus within 24 hours of the eggs releasing, I should have a really good shot at getting pregnant this cycle.

There is definitely a little bit of fear that we might end up with twins. I think I would be okay with it. Sure, it would be twice as expensive and probably twice as tough, but I think it would still be fine. It's three babies that bothers me, and the chance of that happening is extremely rare. I am so nervous about entering into the 2-week-wait. It's the worst time of the month, because it's so incredibly difficult. And since this is our best chance at having a successful cycle, I have a feeling it's going to be particularly tough.

Even though I'm not technically in the 2-week-wait just yet, I can feel it getting closer. I want to be ready with some ideas on how to stay centered so that I don't go crazy over the next few weeks. I will either get my period or get a positive pregnancy test by February 17th. I hope it's a BFP! How exciting would that be? It would be such a dream come true! I will think about the different ways I can keep stress-free over the next two weeks and hopefully post a new blog about it in the next few days. I will also blog about the IUI and what it was like.

CD 11 Ultrasound - Round 3

This morning was our CD11 ultrasound to check for follicles. I am always so nervous going into it that there will just be zero activity in my ovaries. That's what my ultrasound looked like before I started taking the Clomid - nothing. No follicles at all that seemed active.

This morning, though, there was some decent activity. No mature follicles, but five medium-sized ones. There were three on my left ovary, measuring 12mm, 10mm, and 10mm. Then there were two on my right ovary measuring 10mm and 10mm. The nurse said that follicles tend to grow 1-2mm a day, so I am scheduled to come back in for another ultrasound on CD14, which is Tuesday.

Last cycle, the result was very similar. Medium-sized follicles on day 11, but by day 13, there were two that were big enough to trigger. I am going to go buy some more OPK's and keep testing every 12 hours just to make sure I'm not going to ovulate before I go back in. I figure DH and I better get on some BD'ing too, just in case!

I'm a little bit nervous about doing our first IUI. I've heard there is a lot of cramping afterwards that can be pretty painful. Some women also said they got really bloated and generally didn't feel well for a few days. I'm hoping things go well for me, but since this is the first one, it's hard to know exactly what to expect. From what I've read and from what the doctor said earlier in our treatment, IUI increases the chance of getting pregnant up to 25%. With Clomid alone, the chances are something like 12%. So, Clomid with IUI is twice the chance! Plus, this is our third cycle so the odds are in our favor, statistically. I'm going to do everything I can to stay relaxed and to eat well for the rest of this cycle. I want to make sure to create a good environment for implantation. I will write more as the next ultrasound approaches.

Mature Follicles on Cycle Day 13

I am on my second round of Clomid, Cycle Days 1-5, 100 mg. I went in on CD11 for my first follicle-check ultrasound on Sunday, but there were not any that were big enough. I had a couple of medium-sized ones on the right side, but the nurse looks for 20mm or bigger in order to give a trigger shot.

DH and I went back for a second ultrasound this morning, CD13. They found two mature follicles! One was 23mm and the other was 18mm. I don't know whether the 18 is big enough to release an egg this cycle, but there's definitely going to be one little eggie released this month! I am so excited!

The most I can ask for each month is for a good chance. Without the Clomid, there's pretty much no chance I could get pregnant. I feel so grateful that the medications are working. There are no guarantees that I will get pregnant this month, but we're doing everything we can. Last night after we made love, I propped my butt up on some pillows and envisioned the sperm traveling up through uterus and the fallopian tubes, meeting the egg when she comes out, and snuggling into her. I know it sounds a little bit silly, but I want to stay positive and visualize the process. I'm hoping that by imagining the sperm meeting the egg, it might help my body to make it happen.

With the trigger today, I should ovulate tomorrow, on CD14. I should know if this cycle worked by Wednesday the 19th. My 34th birthday is the following Sunday, Jan. 23rd. Wouldn't a positive pregnancy test be the most amazing birthday present? I am trying to be less obsessive this cycle. Last cycle, the two week wait nearly drove me insane. And then when I found out I wasn't pregnant, I was depressed and upset. I'm going to do better to keep my hope up. And if my period comes, then we just try again. It's a new year, and I feel in my heart that 2011 is the year I finally get pregnant!

Cycle Day 11 Ultrasound - Mature Follicle!

Today we had good news! Our first round of Clomid did its job. We went in this morning to have an ultrasound done to check for follicles. My left ovary was nothing special, only small follicles (11 I think on one was the biggest). But on the right side, there was one really nice mature follicle that measured around 21 mm! She said that anything over a 20 was great, then suggested we go ahead with an HCG trigger shot. We had to run to the Walmart across the street and pick up the shot (not covered my insurance which is crazy since we're supposed to have a $22,000 fertility benefit), which cost $115. After we got the shot, we went back to the nurse and she mixed it and administered it into my left hip. It didn't hurt at all, but she warned me that I might experience some extra ovulation cramping in the next few days.

With the shot, I should ovulate within 12-36 hours! DH and I were planning to do an IUI this cycle, but after discussing it, we'd rather try naturally a few months with timed intercourse. There's just something beautiful about conceiving a child during the act of making love. I think we'd both be more willing to do the IUI if it turns out regular sex isn't doing the job, but we'll give it three or four cycles. I'm glad we came to this decision, and I'm looking forward to some intimate time over the next few days! I told him to be ready to go when he gets home tonight, haha.

So far, everything has gone just like clockwork. For most of my adult life, I have anticipated pregnancy being a tough road, so in a way, I keep expecting a more serious complication. Don't get me wrong, I'm very happy there haven't been any, but what I mean is that I feel like I'm waiting for the bad news to come. I can only pray it never does.

The Clomid was surprisingly side-effect free. I took it from CD1-5 and the only thing I experienced was some extra sleepiness. The Glumetza (Metformin) has been the most difficult part by far. It's been very hard to find food that I can eat without having to run to the bathroom every five minutes or feel like I'm sick all day. The nurse said that after another week or so, I should be well enough adjusted that I won't get that sick feeling as much. I'm keeping my fingers crossed!