Brighter Days

            On Monday of this week we had our first visit to our new doctor! If you are regular reader of this blog, you know that we have not had the best luck with our last fertility specialist. He is a very unpleasant man, with a serious lack of bedside manner. After he told us we were wasting our money seeing him, I booked an appointment at a new clinic. The clinic is called CORM, and is so close to our house that I cannot believe we were driving on the other side of Houston before. Anyway, one of the best parts about this new clinic is that our specialist is a female. Don’t get me wrong, I don’t necessarily think women make better doctors, but when it comes to dealing with my most intimate regions, I would prefer a woman to a man.

            Dr. Schnell is one of two doctors in the practice, and she really is very sweet. Although, we waited in her office a long time to see her, when we were with her she was thorough, professional, and very good at answering all of our questions. She did a physical exam and ultrasound on me, and talked to my husband and me at length about our treatment options. During the ultrasound, she confirmed that I did, in fact, ovulate this last cycle. But, I was not pregnant, a fact I knew because I had just finished my period. I told her about the pain I had during my last cycle, and she agreed that it was most likely due to overstimulation from having two cycles of Clomid back to back without a period in between.

            We learned a lot from this visit. I knew that PCOS made up the majority of female related infertility, but I had no idea that 40% of infertility patients are due to male infertility, caused from slow swimmers to low sperm count and everything in between. My husband has not had a semen analysis done yet, but he will be having one soon. We don’t really have a reason to believe he has issues with his sperm, but you never know. Incidentally, he’s not really looking forward to this test, because, as you can imagine, it is awkward to produce a sperm sample in a doctor’s office.

After my exam, Dr. Schnell spoke with us again about another test she wanted to conduct on me. The test is called a Hysterosalpingogram (HSG). Basically, an HSG is an x-ray conducted after dye is injected into the uterus through a catheter to check if the fallopian tubes are open. This test is usually a test given early in treatment between days 5-10 of a cycle. I had asked for this test repeatedly when we were seeing Dr. Smith. And, although it is normally one of the first and most basic tests, he told me that I did not need it. After seeing Dr. Schnell one time, she ordered the test, and I had it done yesterday. Amazing how much faster things work when you know what you’re doing! I was given a Valium for the test in order to relax the uterus and lessen some of the pain. The test isn’t painful, but it’s uncomfortable. A catheter is thread past the cervix into the uterus where a small balloon is inflated to prevent the dye from leaking out. The balloon is the most uncomfortable part of all of it. The pain is like a normal menstrual cramp. I actually got to watch the dye fill my uterus and flow through both fallopian tubes on the screen. The entire procedure probably took 10 mins, at most. And, the results… ALL CLEAR! This means that when I ovulate, the egg has a clear path to the uterus.

But, the successful HSG isn’t even the most exciting thing to come out of our visit with our new doctor. The best thing is that SHE HAS A PLAN! Every time we saw Dr. Smith, the plan was always to wait and see. There was no clear path. But, Dr. Schnell has a 31 day pregnancy plan. We will go back to see her on May 8^th to start a new cycle. First, I will take a medicine to induce a period (not Provera, which I hate). Then, on day three of my cycle I will start Clomid. She is increasing my dose to four pills instead of three, and I am starting the pills two days before Dr. Smith had me start them. On day 11, I will have an ultrasound, begin taking an estrogen supplement, and receive an HCG trigger shot. Over days 13-15, my husband and I are to have sex, or if his semen analysis is not so great we can opt to do IUI (artificial insemination) with his sample. (The IUI is more effective because it forgoes the sperm traveling through the cervix in order to reach the egg.) Here’s where things get really tricky, I will have another ultrasound, another oral estrogen pill, and two more HSG shots between days 18-31. The extra two trigger shots are smaller doses than the one that forces ovulation. They are used to maintain the egg growth, so that I have a greater chance of not miscarrying early in the pregnancy. HSG is the pregnancy hormone; it is what causes the home tests to give you a positive, so it is not harmful to the baby. After this entire process has concluded, if we are still not pregnant, we will revise the plan and try a more aggressive treatment.

I am happy to report that Dr. Schnell only took me off one medication Dr. Smith had me on, the estrogen supplement. According to Dr. Schnell, if you take this pill daily, it makes it more difficult to get pregnant. It is best to take a higher dose for a few days during the cycle. Since the estrogen I was taking was only available from a pharmacy that did not take my insurance, my husband and I were both pleased to not need it anymore.

In general, things are looking up. I really have a good feeling that we will get pregnant before the end of this year. This new clinic is professional, friendly, and technologically advanced. (They use computers- a concept that Dr. Smith never got.) I’m looking forward to our next visit with Dr. Schnell, and if the worst part is the long wait times in her waiting room, then I would still say she is worth it.

Ice Cream Is Essential When You're Wasting Money

     Since my last post, a lot has happened, but it was really difficult for me to find the words to express how I was truly feeling, so I let my blog rest on a cliffhanger. Let me begin with three weeks ago.
     We went back to our doctor to follow-up on my egg situation. The hCG shot was supposed to force ovulation, so there was a chance I was pregnant. I took a home pregnancy test before scheduling my appointment, and it was negative, so I didn't really have high hopes that I was pregnant. However, I had every symptom you can imagine, literally. I woke up with a sore throat one day, a symptom I didn't even know existed. I also had an egg white discharge, which kind of freaked me out at first, because I didn't realize that was also a normal symptom. The problem is that despite all these symptoms, I wasn't pregnant. The trigger shot made my body behave pregnant, and my heart was just along for the bumpy ride. At our doctor's visit, I assumed our doctor would do blood work, because he ALWAYS does blood work. But, he didn't. He told me that I was unlikely pregnant, and that my testosterone levels had gone back up in the blood work he had taken last time. He also said that while it was possible that the presence of follicles at the last visit could have caused the hormone change he doubted it. But, he didn't do ANY blood work to confirm, even after I asked/ told him he should. The whole situation really pissed me off! My husband and I live about an hour away from his office and we waited 30 mins to see him, and HE DID NOTHING!
     I haven't really trusted Dr. Smith since he said I was closer to a daddy than a mommy, but this visit was the last straw. In fact, his new treatment plan seemed so poorly thought out, I was a little embarrassed to tell people for fear they would judge me for sticking with a bad doctor. His plan was to wait a few days, take another home test, and start another round of Clomid (with an increased dosage) without having a period. I knew from the ultrasound the last time that I had a uterine lining build up, which needed to be cleared out for my own safety, but the doc told me, "Your body doesn't follow the normal rules, so it will be fine". I was pissed.
     My husband and I really don't fight a lot. We disagree, discuss, move on, but fight... we just don't. But, that day, it was brutal. I told my husband that I didn't want to continue with our doctor, because I didn't trust him, and I was scared for my body to build up this lining and not shed it, because it can be toxic. My husband is normally fully on my side, but this time he wasn't. He thought I was trying to change doctors so that I could move to a more aggressive treatment too soon, which he didn't think was a good plan at all. I agree that moving faster than normal through procedures was a bad plan, but that was not what I was doing. After, literally three hours discussing it, my husband agreed that a second opinion wasn't a bad idea, especially since I was actually willing to postpone treatments altogether to ensure that what our doctor was prescribing was the best. We agreed to look at another clinic in April if round two of Clomid failed.
     Fast forward to this week... After five days on Clomid, and 14 days of waiting, we had another follow-up. While on Clomid this time, I had the same side effects as the first time, light cramping and mood swings. But, this time, I had a significant temperature drop (the first sign of ovulation) right on schedule! A few days later (Tuesday of this week), I had the same white discharge, which can also signify ovulation is starting. Then, on Wednesday I was sitting at my desk at work, when out of nowhere, a blinding pain hit both sides of my ovaries. It hurt so bad I thought I would throw up. And, the pain did not dissipate for over two hours. After the first hour, I called the doctor. I didn't hear back until much, much later, after the pain had subsided to a dull ache. His nurse said to take some Aleve, but since our appointment was the next day there really wasn't much else to do.
     At our appointment yesterday, Dr. Smith looked at my temperature chart, which featured another significant drop from that very morning, and said he didn't think we needed to do an ultrasound, because he didn't think there was anything going on. I sort of insisted that we do the ultrasound, since that was really the only way to be sure, and since I was still in a little pain it would be nice to know why. The ultrasound revealed that I had a lot of small follicles, and two large ones (one on each side), but it also revealed that the large one on the left had ruptured, and was caving in on itself. This was the pain I felt. There is no real way to tell if the ruptured follicle contained an ovum/ egg, or if it was just filled with liquid, but there was liquid present, which was a good sign that something was actually happening in my ovaries. The follicle on the right side, may or may not rupture to leak the ovum or liquid out this weekend. There's really no telling. So, he ordered some blood work to check my estrogen and progesterone levels, which would be a clearer view of ovulation. I won't have those results until Monday, but the doctor had some advice for us. He feels as though Clomid may not work for us, because there is a chance that my ovaries have a thick "shell" built up on them, which is common with PCOS. He also feels that the best way to treat it is to drill holes in my ovaries to make a path for the eggs to escape from. The procedure has had poor results, and he doesn't know a doctor in all of Houston that does it. So, this was less than helpful, to say the least. Our other options could be to move to IVF, but he doesn't think my body will produce viable eggs, despite the fact that Clomid is producing follicles that are the right size and shape. He concluded his recommendation by saying, "I feel like I'm wasting your money". And, in that moment, my world shattered. HE HAS GIVEN UP! I am grasping at straws of tiny successes, and he is throwing in the towel. It was all too much to handle, so this time I did cry in his office. And, I didn't stop crying for nearly the whole hour drive home.
     As is our routine, my husband and I discussed the visit on the way home. He said he doesn't think Dr. Smith is right, and he wants the second opinion. While I was hurt, my husband was angry. He couldn't believe our doctor would give up when there was literally proof that my body was responding to treatment even in the slightest. When I suggested maybe we should explore adoption, something we have not done, because we weren't ready to quit trying yet, my husband said we could look into it, but he still wasn't ready to give up. We are so early in the process that it doesn't make sense. Plus, there is a chance I am ovulating right this very moment. My husband was right. It isn't time to give up. I told him that I do not want to have my ovaries drilled, but, if we have to move to IVF, then we should start saving.
     Today, I feel awful. I have dull, achy cramps on both ovaries that feel sort of like someone poked them repeatedly with a stick, which is pretty accurate, I guess. I'm writing this while drugged up on Aleve and resting on a heating pad. But, the second I hit "Publish Post", I am calling the fertility clinic we chose for a second opinion.