Monday 12 September 2016

Next

Last week we returned to The Fertility Clinic and met with Dr. Cotter again, to review my tests and talk about next steps.

What's new in my skin:

 I started bleeding after 30 days on my last cycle. I had one positive OPK and fertile mucous, albeit not on the same days, which was sort of confusing. I suspect I might have had a second LH surge, but missed it. Still, there seemed to be some good stuff going on, and 30 days is a decent length, so I considered it a normal-ish cycle.

Dr. Cotter was on her typical form. I can add a few more zingers to my collection of quotes. As Mr. Turtle observed, "She starts every meeting with an insult so later it's hard to argue with anything she proposes." True enough. Nobody can accuse Dr. Cotter of looking at reproductive systems through rose-coloured glasses.

She started with "You're not better." No, after a year and a half of "trying", I know I'm not better. We went over the results of the tests. My CD2 bloodwork (Estradiol, FSH, LH, TSH, prolactin) was totally wrong. "You were not on CD 2 when you did that blood test." In hindsight, I guess not. I had indeed been bleeding for 2 days when I did the blood test, but then I started bleeding again after only 2 weeks. So that was not a cycle. Dr. Cotter said that my estrogen levels during that "CD 2" test put me at about mid-cycle, possibly ovulating. WTF? We couldn't explain it so shrugged and moved on.

Dr. Cotter then launched into an explanation of AMH (anti-mullerin hormone) that seemed to go on for an uncomfortably long time. A fertile woman has an AMH of between 15 and 25. Well, that was not going to be my number. Under 7, it's very hard to get pregnant. "And yours is 0.9." Which sounds slightly better than zero, but admittedly not much better.

Next were the results of the pelvic ultrasound which I did on day 3 of the next cycle (the one that was 30 days and maybe actually a cycle). I had 2 antral follicles on one ovary and 1 on the other. I don't even know anymore what the normal number is supposed to be; something in the double digits; again, that's not me. As we know.

Dr. Cotter said she saw no need to repeat the blood tests as the other tests told the story well enough. In addition, the ultrasound showed a fibroid of 3.3 cm that might be beginning to intrude into the uterine cavity, but it was not too clear. She recommended a sonohysterogram to take a better look at it.

As for fertility "if you are going to be trying anyway, we might as well do what we can to help." So the plan is to do low dose Clomid on days 2-6. Dr. Cotter said they have seen results with low stimulation on wonky ovaries.  "It tends to work best when the last cohort of follicles is being recruited." (Oh, that's a good one.) After taking the Clomid, I will have blood drawn on Day 21 to check for progesterone levels, to see if ovulation happened. If not, they will look at adjusting the dose. I have my prescription for four cycles. And the requisition for the sonohysterogram.

I'm happy with this plan; it seems reasonable enough. But I have a problem. To get the show on the road, I kinda sorta need to know when CD 1 is. Apparently, that's not so easy. Case in point, I am bleeding again on day 11 of this cycle. Is it the fibroid? Unbalanced hormones? The low dose aspirin I was taking? (Cutting that out). Is this my period? Or was the bleeding one and a half weeks ago my period? Or neither?! Cue WTF moments. I might need more guidance what to do in this situation, as it really isn't clear to me.

One good thing though. I have new menstrual products. My frequent periods/EBBs mean I spend a lot of time wearing pads and panty liners (tampons I gave up some years ago; while I don't always have a lot of pain and discomfort, they seemed to increase it when I did).  I had been getting a lot of chafing and discomfort from them. In addition to my reproductive issues, I have this cyst in the clitoral area that flares up every now and then (I had a bad abscess last year that require surgery.) So a few weeks ago I started looking into alternatives for period stuff, and finally decided to try cloth pads / liners and now some underwear that is designed to absorb flow. These options are WAY more comfortable. I feel so free knowing I don't have to buy that crap from the store anymore.

So there you go. The joys of further intervention, the limits of physical self. It's tiring and frustrating. But I still feel I have to trying whatever might make a difference, because if not, I'll wonder about it. Humans have a strong gambling instinct, and in this respect at least, I'm no different.

15 comments:

  1. Yay for having a plan! Hopefully the low dose clomid will makes those ovaries behave themselves. Bleeding sucks regardless, and must be absolutely maddening when you are trying to find cd1! I don't have any ideas on how to figure out cd1, apart from BBT charting (which I love to bang on about because I love charts so much) but charting can be confusing too and temps can remain high for the first few days of a cycle, which would make the whole thing useless in your situation. I hope there is something out there that can help you figure it out though. Best of luck!

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    1. Thanks for the solidarity. I've pretty much made up my mind to count this as one cycle until I've seen some evidence of ovulation, which I usually see eventually, even on the crazy cycles. The bleeding seems to be pretty light. I don't want to waste a Clomid cycle. I'm temping again. All low so far. I hope between that, the Ovacue, OPKs, CM, even trying to see feel cervix position, something will let me know what's going on. I just have to remember that it doesn't entitle me to understanding or success: I do my thing (and MR Turtle) but we can't guarantee anything. Expectations are so easily dashed. But my one and only pregnancy happened on an epically messed up cycle, so there's something to be said for staying in tune with my body.

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    2. Absolutely! And when in doubt, sexy times!

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  2. Why is your RE not helping you pinpoint CD1? She prescribed Clomid but decides to leave it to you to determine. That doesn't seem helpful at all. Never mind building trust. Ugh.

    I like your plan. It's a good one. I just wish your RE was more supportive.

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    1. Well, I haven't specifically asked for help yet....But it probably wouldn't hurt to get their perspective. Thanks for the encouragement to be more assertive :-)

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  3. Agreed with Cristy...is there some advice your RE can give to help with CD1? I always had a hard time with pinpointing "full flow," which was what they told me constituted CD1. It seems so fuzzy. Are you doing Thinx? I have considered those panties. This round of Depo has not been kind to me and I've had to wear a panty liner or pad every day for 8 weeks, and then today got what resembles a heavy period out of the blue. I have a lot of discomfort from the unbreathability of the pads/liners, especially when it's been hot. If these alternatives work for you I might check them out! Your RE sounds like a tough cookie. I hope the clomid helps, and that you can find that pesky Day 1. I hope the gamble pays off.

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    1. Yes! I'm using Thinx and Gladrags. The Gladrags worked well with last period, and Thinx arrived just in time for this breakthrough bleeding or whatever it is. I have very light flow so I haven't tested the Thinx thoroughly, but I wore a pair all day today and it was great: totally comfortable and I didn't have to remember to rush to the ladies with sanitary napkins. The Thinx marketing materials claim you can wear it all day which if true would be great for school. As for the current situation, I'm pretty sure it's not a real period because it's light and not getting heavier (and it's not pregnancy, I tested). It's too late to start the Clomid or make the Sonohysterogram appointment even if it was. But it wouldn't hurt to call in and explain the situation and ask what to do. Thanks for commenting.

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  4. Super interesting update, albeit a frustrating one for you. Like you, my cycles are way off. This last one was 19 days. What? I'm positive I never ovulated. I finally saw a woman who specializes in perimenopause-related issues and we decided a few things: DHEA, COQ10, herbs/supplements, baby aspirin, keeping my thyroid low, and taking progesterone starting at ovulation (if I think I've ovulated). She things that with low AMH, etc., I'm likely not making enough progesterone to support a pregnancy if I had one. It's worth a shot.

    I'm rooting for you and look forward to your next update, no matter what it is.

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    1. The 19 day cycle sounds familiar; I've had those a few times this year. Mine rarely go longer than about 26 days, however. Are you taking the low dose aspirin throughout the cycle or only during the luteal phase? I was taking it (self-prescribed) all the time but then read that long term use could cause internal bleeding and wondered if that might be responsible for the light bleeding I described in this entry (seems to be finished now). So I stopped taking the aspirin. Maybe I will restart for a limited amount of time if I see evidence of ovulation, I don't know. Thanks for sharing your plan. Sending the good wishes back your way!

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  5. Hi Torthuil, Dr. Cotter sounds just like the charmers that I saw when I was doing treatments! No foreplay, just straight in with the bad news first. Identifying CD1 when you're all over the place with bleeding sucks big time: you must be frustrated... I know two people who had similar factors to me who had luck with Clomid. it's a bit of a lottery but definitely worth trying. It made me feel homicidal but I knew these women who swore by it so I tried it; only once though. Maybe I should have persisted. I've also heard good things about COQ10 for low AMH. As the comment above mentions, progesterone is a huge factor - it was only when I had come to the end of my tether that I found out I had never had enough progesterone support to sustain a pregnancy: the last Dr I saw pointed this out to me and it had been overlooked till then, but by that point we had decided to call it a day. So I always tell people to push their doctors on this subject. Also unruptured follicles - I looked like I was ovulating but the follicles were not rupturing, and I only conceived the month that the clinic actually ruptured the follicle for me because it was standing in the way of a new cycle; yet they would not follow up on this and admit that I probably needed this doing every month. So many things they gloss over: you really have to self-advocate. Best wishes :)

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    1. great comment, thanks for the thoughts and ideas. I will ask about the progesterone when I start the Clomid cycle; I imagine I'll have to wait for the first progesterone test to know what's going on though. Good point about the unruptured follicles too.

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  6. Phew. I don't envy you for either the interventions nor the menstrual products experiences (one advantage of taking BCPs to avoid endometriosis...) I did have several dentist visits just to make sure my doctor's visit average doesn't drop too low.
    Good luck! I hope it works out soon.

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    1. hahahaha! I need to see the dentist too.

      I've never been on hormonal birth control: don't like the idea of it, and anyway I never needed it. I'm glad it helps with your endo, anyway. I'm so glad I worked up the nerve to try different menstrual products.

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  7. When you post, I feel like you are writing about what I've been up to or what is going on with my cycles. My 19 day cycle was so bizarre and involved mid-cycle bleeding so who knows what it really was. Anyway.

    Are you taking DHEA and COQ10? And I read the comment above about progesterone. My newest doctor has me on progesterone every cycle from when I think I ovulated until bleeding. Same logic as the woman mentioned above.

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    1. Yes, I'm taking 75mg of DHEA and 200mg of COQ10 daily. Progesterone supplementation hasn't come up at my clinic, but I'm getting my progesterone tested this cycle, so I can ask about that. I need to have a list of things to ask lol!

      Last cycle I did have a positive OPK then a temp rise (after the light bleeding) so now I'm sure that what I have is my period (and what a heavy mutha of a period it is).

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