Provera, Period, and Clomid! Oh, My!

This week started off with another disappointment, but today Dr. Smith turned it around. Monday, I called the doctor after unsuccessfully having my period on my own again. I faxed the doc my temperature chart, and he asked me to take a home pregnancy test. Despite the fact that my blood work did not show signs of ovulation four weeks ago, my temperature chart looked like I may have been pregnant. Although it was disappointing to take another negative pregnancy test, it wasn't as heartbreaking as others I've taken. I wasn't letting myself get too excited about anything, because I know my body well enough to know I was not pregnant. Because it was negative, the doctor requested my husband and I come in today for a follow-up. I made my husband promise he would help me be tough and press the issue that enough was enough, and it was time to try an actual treatment. I was prepared to put on my big girl pants and threaten to seek another doctor. But, all of that was unnecessary. Dr. Smith began by saying that, while he had hoped I would ovulate on my own, it wasn't looking like my body would. And, that he wanted me to take Provera (a period-inducing pill) for 10 days to shed the lining in the uterus and have a period. After I actually start my period, I am to fax my temperature chart, and he will tell me when to start Clomid. I think my heart literally skipped a beat when he said the word! Clomid is often the first step in infertility treatment, but Dr. Smith is an advocate for balancing the body's natural hormones before trying any ovulation stimulators. I actually agree with him. He has given my body the best chance at not only conceiving, but staying pregnant, and delivering a healthy baby. The side-effects, besides the possible lack of cervical mucus I mentioned before, are hot flashes and night sweats. Provera makes me crazy hormonal, and I imagine Clomid will as well, so I have pre-apologized to my husband for my possibly crazy, hormonal behavior. Also, Clomid increases the chance of twins. I wouldn't mind twins actually. Since we don't have any kids now, it's not like we'd know the difference in the lack of sleep from one baby versus two babies. Besides, built-in playmates sounds pretty good to me. I think my husband is less sold on the idea of twins, but he is super excited to be taking another step forward toward making a baby. I feel conflicted about starting Clomid. On the one hand, this is exactly what I want. On the other, I worry that I will get crushed if it doesn't work. But, I will NEVER give up. I believe that I will be a mother. I believe I will carry a child. And, this is just step-one in making my body cooperate. There will not be much to report over the next three weeks as I will be taking Provera and having a period. But, I am asking that my readers will keep my husband and I in their prayers for the road ahead. I am guessing we will start Clomid in the middle of November. During that time, the husband and I will be on a strict sex schedule (I doubt he'll complain), and wait to see if it worked. Speaking of the sex schedule, after Dr. Smith once again gave us the best doctors orders of sex every other day, I thought of a very important question: Are there any positions that help with fertility? Dr. Smith said, "don't believe any of that." Fertility is different for each person, and each egg is different each ovulation cycle. But, one thing remains the same, if the sperm can get to the egg, pregnancy will occur. There isn't a position that can help that, just our bodies doing what it does naturally, or in our case with the help of Clomid.

Losing Smoosh

     Saturday evening, my husband and I returned home to discover that our dogs, a beagle named Bella and a pug named Smoosh, had dug their way out under our fence. They were so determined that they actually dug around chicken wire. We searched everywhere for them. It was dark and late. My husband searched until 3:30am. He hung signs and walked until his legs literally hurt. I drove our neighborhood and two others following the creek behind our house until midnight. I finally convinced my husband to get some sleep around 4:30. We woke up to my phone ringing at 8am. A woman had found Bella in her yard howling loudly at 3:30am. She didn't have Smoosh.
     I had a bad feeling about it, because they NEVER go anywhere without each other. The one time Smoosh went on a car ride with daddy without Bella, Bella cried the entire time. When we go to the woman's house, a house so in the country she didn't even have an address, I saw a black animal lying under a tree. I knew it was Smoosh. I got out of the car, and called her, certain she would come running with that big smile on her face. But, she didn't come. She was gone. My husband believes she was hit by a car, but we'll never know for sure. The evil, Texas fire ants had already begun to do significant damage to her body.
     Bella was not hurt at all, at least not physically. She has a few scratches on her tummy that are probably from the chicken wire. But, she is heartbroken. I believe she was howling to try to get Smoosh help. She knew her sister was hurt, but she was unable to communicate it properly. And, since the woman didn’t want to be rude and wake us up in the middle of the night, we couldn’t do anything to save her. So, we wrapped her body in a towel the woman gave us, and took her home. We buried her in our yard in a shoebox from the pair of boots we were busy buying while she was escaping to her death.
     Losing Smoosh is absolutely devastating. She was our baby. We got her from a breeder when she was eight weeks old, four pounds, and didn’t know how to bark yet. She was beautiful. We fell in love with her when we first saw her. We wanted a fawn pug, and we wanted a female. The only fawn left with this breeder was a male. But, it didn’t matter; we fell for Smoosh as if she were ours all along.
     Part of the reason we purchased Smoosh, not a small fee for a purebred, was because I wanted a pug. I love pugs. They’re funny, happy, and loving dogs. The other reason we got Smoosh was to fill the void of my empty womb. We knew at that time that we were going to have difficulty conceiving and this way we would have a baby until we could have one we made. It may sound silly to some of you, but she really was my child. I taught her everything. She went through the same developmental stages a human baby goes through. And though I didn’t carry her and she wasn’t technically human, she was mine. Don’t get me wrong, I know I will love my own child more, if not differently, than Smoosh, but she is the only child I know now.
     I’m heartbroken. I’m angry. I’m hurt. I’m sad. I’m regretful. She did not deserve to die that way. She deserved to grow old, and die peacefully. Not like this. She was the happiest dog I have ever met. She loved life. She loved her sister. She loved us. And, we failed her. We failed to keep her safe. I hate that I cannot stop thinking about other sceneries that end with her sitting in my lap when I get home from work today. We had several people tell us they saw our dogs out, and one even checked their tags. But, no one called us. I suggested we lock them in, but we decided they would be fine roaming our fenced-in yard. If I would have stayed up longer, and driven further. If the woman who found Bella would have called us sooner. None of these things can change, but I can’t stop wishing they could.
     I feel cheated. I have been unable to get pregnant on my own, and now I lose the one child I had. I feel cursed. And, I feel like God hates me. He has many reasons to. I know these are not realistic feelings, but they feel normal right now. Grieving the loss of a pet feels no different than when I was grieving the death of my grandma last December, a loss I still have not been able to fully get over. I feel empty. I am empty. Smoosh was ours. One of the first things that was ours. And, now she’s gone forever. Nothing can replace her. But, I do think we will eventually get a new dog. Maybe another pug, because that’s the breed I prefer. But, no new dog will ever be Smoosh. I miss her more than I knew I could.

When failure repeats

     This week has been depressing. There is no other way to describe the emotional roller coaster of happily anticipating good news only to receive another heartbreaking blow of disappointment. I am not trying to sound as though I am whining, or seeking sympathy; but, I cannot shake this feeling that I am in a major funk.
     Monday, my husband and I went back to the doctor to have him look over my temperature chart, and run some blood work to check for ovulation. A few weeks ago, I had a drop in temperature, which is usually the sign that ovulation has begun. Dr. Smith took one look at my chart and said, "Well, April, I think you've ovulated!" The rest of the appointment went on with discussion of when we would know we were pregnant, and for how long he would monitor me after confirming pregnancy. He had me so excited, anxious, joyful, and scared... everything a first-time mom feels. My husband was also pretty excited, because he has been telling me for a week that I was pregnant based on the "symptoms" I was experiencing (nausea, fatigue, swollen and sore breasts). So, I had my blood drawn, and left awaiting the phone call Tuesday that would confirm that this was the "first chance we truly had at getting pregnant" (Dr. Smith's words).
     Tuesday morning I woke up with a fear of bad news. I couldn't shake the feeling that the temperature drop was a fluke. I was right. In the midst of pure chaos after realizing our dogs had literally broken out of the fence (seriously they broke boards, and the biggest one is only 32 pounds), I got the phone call from  the doc's nurse. The blood work showed that I had not ovulated (again). The doctor's new orders are to call when/ if I get my period. If I do not get it by the time I am due (which is supposed to be 10-2), then I am to call in three weeks. THREE MORE WEEKS!
     I feel like I am fighting with myself. Half of me wants to begin treatment immediately, because I would like to pregnant before the end of the year. The other half of me thinks that we have to start right away, because this is going to take a while. I didn't ovulate this month, so I will not likely have a period. I know that I have to have a period before I can begin Clomid, because of the nature of the medication, so why not just give me a period inducing med (like Provera), and get a jump start on things. Provera usually takes 10 days to induce a period; Clomid induces ovulation in the typical 28-day cycle. So, we are now looking at Thanksgiving before we could even get pregnant.
     My husband told me it is difficult for him to understand my need for a "time table". I want to be pregnant before the end of the year (I turn 30 in December), but not because it is some need to meet some biological clock as much as it is a need to set a goal. Sorry to brag, but I have accomplished a lot in 29 years. The reason is because I have always set goals for myself. I know that fertility treatment is at best a guessing game, which scares me to death. I am not fully able to set a goal in this case. Dr. Smith shared the statistic that, with a couple with no fertility issues, there is only a 1 and 5 chance of conceiving. Now that my hormones are balanced, we have a better chance than what we did, but still not 1 and 5. With Clomid, there is only a 35% of conceiving. Other treatments are even lower. We could be undergoing fertility treatments for years before we conceive, or we could get pregnant in a few weeks. The fear of the unknown is killing me.
     My husband says, that he is not giving up on my bum ovaries. And, he believes that he will be a father, and I will be a mother. I believe that too, but I wonder when. It breaks my heart every time we go to the doctor, and hear that it didn't happen again. It breaks my heart every time I have another month go by without ovulating. It breaks my heart that I cannot make my husband a father. I blame myself every time, because it is my body that has failed.

A Most Useless Place... The Waiting Place

     Wednesday, we went back to the doctor to work out our pregnancy plan. I prepared my heart for two possible outcomes: 1-we wait a month to see what my body will do on its own; 2-we start treatments (most likely Clomid) this month and see how my body reacts. Dr. Smith chose the wait and see method, which isn't that bad, because it gives my body a chance to get pregnant naturally. But, I worry what will happen this month with my hormones. Since we already know that my hormones are unbalanced when I am off the birth control, I wonder if, in one month off the pill, they will revert back to their abnormal levels. If that happens, what will that mean for us moving forward with treatments. Dr. Smith did make one thing pretty clear: the likelihood of me actually ovulating on my own is minuscule, because I haven't had a "spontaneous period" since 2009. I believe in prayer, and I believe in God-created miracles, so I KNOW it is possible for me to have a period this month, but I am also prepared for that not to happen. In three weeks, we are to go back to the doctor to repeat some blood work to see what actually did happen to my body this month. We have to wait the three weeks, so that the birth control can work its way out of my system. At that time, we will create our real pregnancy plan.
     I asked the doc about Clomid as a starting point next month. And, I learned of one pretty intense side effect that I had not read about in my research. WARNING THIS IS A LITTLE GRAPHIC SKIP AHEAD IF YOU DON'T WANT TO READ IT! Clomid does cause women to ovulate, but it can cause the body to stop creating cervical mucus, which would mean that the sperm would not be able to get to the egg anyway. This essentially defeats the purpose, so it doesn't work with every women's body. I have read that if a woman doesn't get pregnant in three tries on Clomid, she never will. This is the reason why.
     In the meantime, while we await for the next three weeks, we have received the best doctors orders anyone get get: have sex every other day. If you are reading this blog, and you already have planned children, you know the importance of timing. All the best literature on the baby making subject says sex everyday will cause the sperm to not be mature enough, and abstaining from sex for longer than five days will cause more dead sperm than living. Most (s)experts recommend every other day for the most viable sperm and optimal opportunity for conceiving. Some may say that this is a lot of work, but it is also a lot of intimacy. I love my husband. Why wouldn't I want to be intimate with him? I think it also helps that we are still technically newlyweds.
     Anyway, stay tuned for more info in three weeks. And, please keep praying for us. God has already begun to create a miracle in my body through balancing my hormones in only two months. I cannot wait until I can help God grow a miracle in my body.

"You can get so confused that you'll start in to race down long wiggled roads at a break-necking pace and grind on for miles cross weirdish wild space, headed, I fear, toward a most useless place. The Waiting Place..." Dr. Seuss Oh, the Places You'll Go

Back Home

Last week, my husband and I went to Ohio to spend time with my family. The trip was eventful, fun, and filled with lots of babies. Friends' babies, brothers' babies, twin babies, plane babies, lots of babies. Don't get me wrong, I love babies, but while I was awaiting the test results that would determine how well my body was responding to the birth control, every time I finished holding a baby I felt scared, sad, and conflicted. In many ways, I guess, I have thought these particular test results seemed so much bigger than any of the others we have had. To recap, the doctor put me back on birth control in hopes that it would raise my estrogen levels and lower my testosterone levels. When we went back to the doctor last week, he did some blood work to check the progress. He determined before the blood tests that he really wanted me to stay on the birth control for another month. Fast forward to two days ago... I hadn't heard from the Dr. Smith, which is really unusual considering we have literally driven 45 mins to his office to sit for five minutes while he asks, "So, how are you doing?" So, I made a phone call to his office. When, the nurse called me back, I received news that I actually think is worse than the "one more month on the pill": "Dr. Smith said your test results were satisfactory; you should continue treatment for the next three months; and follow-up after that." I was devastated! Three months! That is NOT what my husband and I had talked to him about.  Nearly every time we go to him, I cannot stop myself from asking when he thinks we'll be able to move forward with actual fertility treatments, not just balancing my hormones. Each and every time he says that he is not prepared to make that call yet. Not to mention, if the results were satisfactory, why were we not going to go off birth control and try to get pregnant again. So, I stood up for our fertility, and said that this was not acceptable, and that we did not want to wait another three months on birth control to restart trying to get pregnant. The nurse was sort of rude and sarcastic as she told me, "Well then, I'll just tell the doctor that you don't want to wait three months and see what he says." She didn't need to be like that. I get that she deals with anxious mothers-to-be daily, but this was about me, and my treatments. When she called me back, she said that Dr. Smith wants to see us next Wednesday, and that we should discontinue taking the birth control until we develop our "pregnancy plan". PREGNANCY PLAN!!! We finally are getting to the big meeting with the doctor. The one that will determine how we will move forward, and what we will do (besides the obvious) to get pregnant. Now, I feel nervous, excited, and scared. I know that it could be this month, next month, next year, several years until we actually get pregnant, but I guess I feel the same as any first-time potential mother. With the added pressure that comes with already knowing there are problems with the plumbing, and there is a potential for sex to become more about the mechanics and less about the love-making. It's obviously too early to be concerned that my husband and I will get to that super frustrated place that many couples with fertility problems get. But, I'm a worrier. Mostly, right now, we need some prayer. Prayer that this pregnancy plan works, isn't overly expensive, and that it doesn't put pressure on our marriage. I will fill you all in next week when I have more details about the pregnancy plan.

In the belly of the whale...

Today I went back to the doctor to repeat my blood work and talk about the side effects I've been having on the birth control. I left feeling defeated and alone. My husband has been very active in this whole process, but he was unable to go with me to this visit, which added stress to the already stressful event. After every other visit my husband and I have had the long car ride home to talk about what our doctor just told us. I'm usually emotional, and the husband is great at giving me a new perspective. He typically considers any visit that our doc doesn't pull the plug a success. I can see his point, but I'm reaching a point of frustration with the whole process. Don't get me wrong, I love that our doctor doesn't want to move forward with treatments until my hormones are balanced enough to allow the treatments to be a success; but it's so hard to leave there not knowing what will come next and feeling that my body once again failed me. I really got no answers today about anything. The doctor isn't convinced that my headaches, stomachaches, sour milk taste, insomnia, or nightmares are connected to my medicine. He has given me other outlets to try before we blame the pills and change courses. I can understand his point, and am completely willing to try anything he suggests at this point. But, it was his next directive that broke my heart a little more. I have another month of birth control pills to take. I thought this would be it. Today would be the day we could look ahead; and if not today, next week after the blood results came back. Instead, the doctor told me that he feels, given the things I told him about the possible side effects I'm having, my body is ready yet. I know that this isn't our doctor pulling the plug yet, something my husband has already reminded me, but I can't stop my heart from hurting. I have done my homework and educated myself on my condition and all of our treatment options, I have become my own advocate, but I cannot make my body cooperate. I am willing to try anything to get pregnant, but I cannot make my body cooperate. My heart aches to be a mother, but I cannot make my body cooperate. I feel cheated. I did everything right, so why can't I have this? The anxieties are starting to take over, and it is becoming harder and harder to not dwell on the what ifs. My two biggest worries: what if we run out of time?; and what if this isn't God's plan for us? People say I'm crazy to question either of these, because we're still so young, and God wants to make families. But, the truth is that neither of these things is reassuring, because they are the fears closest to my ever breaking heart. Each time treatment gets pushed further back, the doubts creep in and take over. I'm really scared. And, no amount of reassurance seems to change that. I'm scared of what will happen and more scared of what might not ever happen. I am leaving you today with a final thought from a song I heard recently. Today, this has been my heart's song:

"At the first glimpse of light I'll be looking for you, Lord. At the first glimpse of light I'll be looking for you, Lord. At the first glimpse of light I'll be looking for you, Lord. I'm in the belly of the whale. The first step I take I'll be headed the right way. The first step I take I'll be headed the right way. The first step I take I'll be headed the right way. I'm in the belly of a whale. The first song I'll sing I'll sing it to you, God. The first song I'll sing I'll sing it to you, God. The first song I'll sing I'll sing it to you, God. I'll sing Hallelujah. From the belly of a whale. Why do you love a hear that's not beating? I have a heart that's not beating. But I was born for Hallelujah. I'm in the belly of a whale." - In the Belly of the Whale by Scott Orr

Being My Own Fertility Advocate

All the books I have read say the same thing: be your own advocate by educating and involving yourself fully in the process of infertility treatment. As a librarian, it is in my nature to research ad nauseum, so I never doubted that I would read nearly everything I could find on the topics of PCOS and infertility, particularly if there was information that included both topics. The first two books I read were completely about infertility treatments, because that was what was available in the library where I work. They were great books that actually got me excited for the process. I was nervous about how to approach the subject with friends, family, or even colleagues, but these books had some great suggestions. Furthermore, both books were really encouraging when it came to possible treatments for women with PCOS. I learned that NO treatment was off the table! That was the greatest news, because our first infertility doc (the idiot I mentioned in my previous post) limited our options to using Clomid and, when that failed, which he was certain it would, we would need to try in vitro fertilization (IVF), a very expensive and invasive process. I was so ecstatic that these books were proving a doctor I already didn’t trust dead wrong. I would stop reading at points to tell my husband about the “latest treatments”, or about how there are even some holistic approaches, such as acupuncture, that I never even thought of.

I continue to be amazed by how far technology has progressed. My husband and I were able to have talks about what we felt would be the stopping point, as in “how far is too far”. We have different ideas on this point. My husband is a science guy with scientist parents. He believes that technology can never push the envelope too far. That the more we learn and evolve as a people is further proof that God allows us to grow and evolve. I believe that when we create life, even if it is in a Petri dish, then it is life, and shouldn’t be discarded. Although this creates another moral dilemma, because what if you are one of the lucky ones to have five great eggs, but you don’t want five children. Do you donate your eggs to other families? Leave them frozen just in case? It’s a lot to think about. I know there are many Christian organizations that do not support IVF for this very reason. It’s a moot point currently, because we haven’t even started the most basic of treatments, but it isn’t something my husband and I have ignored, and it is all part of the process of being your own advocate. Incidentally, we have found a good compromising point that we both feel comfortable with.

When it comes to educating yourself, just like any other facet of life, there have to be some boundaries, which is something I learned first hand this week. In my first post I referenced a book by Dr. Vliet called PCOS:. I have officially stopped reading this book, because it crosses the line from informative to downright scary. I did not realize how deadly the effects of PCOS can be, and I suppose knowing that I am at a greater risk for stroke, heart attacks, and diabetes is necessary, but it really just plain freaked me out. The book not only scared the crap out of me, it did little to console the trauma it was inflicting. Dr. Vliet didn’t provide the comfort I found in other books, because that wasn’t her goal. Her book was not about fighting infertility or being your best fertility advocate; it was about what it means to be a woman with PCOS. I realize that someday I will need to fully come to terms with ALL aspects of PCOS, not just the ones concerning infertility, but today is not that day. To be the best advocate for my health, I had to put aside some of the information that added unnecessary stress, and live for today. Incidentally, I cleansed my mind with a mind-numbing teen love story, and just started a new PCOS book that focuses specifically on infertility. In the introduction alone, I was already reassured with this statistic: 70% of women with PCOS can conceive naturally once their hormones are balanced (another tack in the win column for Dr. Smith and his treatment regiment), and 90% of women who cannot conceive naturally can conceive with fertility treatments (Harris, 2004). On a side note, this means my husband was right about both of these books. He told me not to get the one by Dr. Vliet, but I insisted it would also be helpful. I hate it when he’s right :)!

I wanted to end by sharing with you what my officemate said to me as I was telling her about the big, bad, scary book: “If you want to know your future, open the Bible and read about God’s love. That is your future, April. Not just what you read in that book.” How right she was!

Love to all- April

Favorite I have read so far:

Schoolcraft, William (2010). If at first your don’t conceive. New York: McMillan.

Book reading now:

Harris, Collette and Theresa Cheung (2004). PCOS and your infertility. Carlsbad, California:

Hay House.