Wednesday 26 October 2016

TMI in one convenient post

(updated at bottom)

Back when I started this blog, I thought I'd be writing a lot about fertility treatments. It seemed logical; we'd been told we would not conceive without IVF and had been referred to The Fertility Clinic. I spent a lot of time reading about (mainly) IVF and considering how I felt about medical intervention. As it turned out, I barely wrote anything about fertility treatments.  The feelings I had to learn to process were entirely different.

This is not a bad thing, but it does feel a bit odd to be writing about fertility treatments now. Despite my five year journey with sub-fertility this feels new (and uncomfortable).

My first cycle with Clomid has ended. It didn't result in a pregnancy, but other than that, there was some good, some bad (as per usual).

The good:
I had signs of successful ovulation, and they all happened around the same time:

  • Abundant CM days 10 through 12 (mainly watery, but I'd read that Clomid dries up CM and that didn't happen in this case)
  • Positive OPK on day 12
  • Temperature rise 1-2 days after positive OPK (not sure when it started as I had poor sleep the first day after OPK. But definitely rose in the days after)
  • Blood test on day 21 showed progesterone at 11.3, which nurse said indicated ovulation (anything over 10 is considered sufficient)
The bad:
  • I had a sonohysterogram on day 12. This was not related directly to the Clomid cycles (they are not monitored with ultrasounds) but to check on the fibroid which a previous ultrasound had shown possibly intruding into uterine cavity. I had to call in to schedule this test on day 2 (the same day I start the Clomid). I'd assumed they would put it earlier in my cycle and was not too happy when they put it on day 12, as that's close to when I typically ovulate (in so far as I'm typical). I had already started the Clomid, but this meant we couldn't "start trying" till the test was done. I decided to go ahead with test anyway, since I don't know for sure when I'll ovulate (but as it turned out I was right, or close).
  • The procedure began with an internal ultrasound performed by a technician (my 3rd this year....sigh) She then went upstairs to get one of the fertility doctors, "Dr. Irish" (not my regular doctor; they take turns doing this procedure). He did the sonohysterogram in the cheerful nonchalant manner doctors (especially male ones) tend to adopt when they are up one's privates. The sonohysterogram went OK. I was mainly concerned about getting some results. Getting an appointment with Dr. Cotter takes six to eight weeks, which is a giant pain when we are waiting on results. It bugs me that people do tests on my body, especially invasive ones like this one, and then I can't know the results for weeks and weeks (and I know they have them). So I was quite anxious to hear at least something about these scans.
  • Dr. Irish, cheerful as ever, assured me that the sonohysterogram results looked good: the fibroid is a non-issue. "You have a pretty big cyst on one ovary, but the uterine cavity looks great." And breezed off.
Wait what? In hindsight there's all kinds of questions I would have liked to ask:
  • What do you mean, cyst? I had had my positive OPK that day: did he see a lead follicle ready to ovulate? or another kind of cyst? How do you tell the difference?! (both normal follicles and abnormal ones are called cysts....because that's not confusing at all.)
  • Could Clomid have caused the cyst?
  • Will the cyst interfere with my cycle and/or ovulation?
  • Will the cyst affect the next Clomid cycle?
But I didn't have the presence of mind (or the background knowledge of cysts) to think of these questions especially when lying on the table half naked. For some reason being in this position affects my ability for analytical thought and self-advocacy. Maybe I haven't had enough practice. Dammit! Two minutes after Dr. Irish and the nurse made their exit, I was frantically googling ovarian cysts on my phone.
  • Oh, one more bad.  Despite the positive progesterone result, my cycle ended on day least four days sooner than it should have if I was right about ovulation (pretty sure I am).
I finally decided that before I take Clomid again (that should be right now, or yesterday), I want to ask about that cyst and if it's a good idea to start it again. I'm not monitored for cysts, but they are a side effect of Clomid and I happen to know I did have one (although not what kind it was). Everything I've read about Clomid, or for that matter any fertility treatment, and everything I've heard anecdotally says you do not start a treatment, you DO NOT PASS GO, if there's a cyst. So I'm not comfortable making the decision to start Clomid again without a doctor's opinion. The nurse I talked to could not give me advice, but she said she would leave a note for Dr. Cotter and ask for her advice. So I hope I hear back from them; I could really use the reassurance.  This feels like sort of a test of The Fertility Clinic to see how helpful they really are, too. Sigh. As I noted before, I really don't feel good at this stuff. I admire all the IFfers who have learned to advocate and make decisions about these kind of things.

Well other than that. AJ turns two this week. So I will write something more cheerful next time.

Dr. Cotter called me back. Of course I was in the middle of teaching and when I see the phone number, I say "sorry: got to take this call" and sweep out of the room to have a conversation about my ovaries. Luckily I have educational assistants who can step in during awkward moments. Well I have to laugh at it because what else can I do.

The information I received as I understood: Dr. Cotter reviewed the ultrasound/sonohysterogram results and gave her opinion that the "cyst" was the maturing follicle (why Dr. Irish didn't just say "follicle" I don't know....). She even told me the sizes that they saw; one was 18mm I think. She said that was not big enough to qualify as a problem cyst. So basically, my body was doing what it was supposed to do, and the Clomid was working as expected. I brought up the short luteal phase: thank you to those people who have told me to ask about that. She said "do you know when you ovulated?" I said yes, pretty sure, because I had a positive OPK and charted temperature. Her explanation was that sometimes in people with low AMH, the follicles "don't behave as they are supposed to," and reminded me that while I'm still relatively young, I have poorly functioning ovaries. I asked about progesterone supplementation, as I'd heard that's sometimes used in similar cases. Dr. Cotter said "yes we sometimes do that," but that it doesn't necessarily make any difference. She said that since this was the first Clomid cycle, she would like to see how I respond to another one first.

Fair enough. It was a good (if perforce quick) conversation and helps me to worry less. (I really need to bring down my stress level about all aspects of life.) Also I can go ahead with Clomid this cycle: will be starting day 3 instead of 2 but she said that was fine.

Thanks to commenters for the emotional support and suggestions of what to ask about! I'm glad I did get a response and it's shown me I have to keep advocating for myself.


  1. My best guess based on you having a cyst on day 12 is that was a follicle with a maturing/mature egg. Was Dr. Irish aware you were on Clomid? Even though they should be reading charts, not all physicians do (bad, bad). Regardless, they should be screening you at the start of each cycle to clear you of cysts. This usually involves both an ultrasound and some bloodwork.

    Good job for pushing for answers. Hopefully they get back to you very soon.

    1. I didn't ask, but I doubt Dr. Irish knew I was taking Clomid. He just did the procedure and was outta there. At least he told me that my uterus looked fine. Dr. Cotter agreed that it was the follicle with the maturing egg. So why not just say "follicle?" grr. Wouldn't it be nice if doctors read charts!

  2. Discuss whether or not you have a short luteal phase, Clomid may have contributed, but if you've had a short O to AF interval in the past its worth discussion.

    1. Thanks, I did mention it. I don't always have a short LP,but it can cycles are often messed up in all kinds of ways. The past few months I've been monitoring more so I understand what's going on. I'll see how the next one goes. If there's a similar problem then maybe we can say there's a pattern.

  3. Ahhh! I'm screaming on your behalf. First it should have been scheduled days 5-10 of your cycle. How frustrating for them to do it on day 12. Second, I would optimistically assume the cyst was your mature follicle otherwise he likely would have said he saw two cysts. Third, definitely ask about short luteal phase (progesterone supplementataion or there some evidence that increasing Vitamin B6 increases phase length.) I also go blank to ask things in the moment, especially pantsless. Navigating how helpful a clinic is can be a huge challenge. Many practitioners default to autopilot and will explain nothing unless you ask. Lastly, I'm still following regularly but been terrible at commenting and balancing my work and stress load. Coming out of it now so I hope to be more consistent.

    1. Thanks for the solidarity! Yeah, day 12 was a crappy day to schedule that test. It probably didn't have anything to do with why I didn't conceive, or implant, or whatever happened (because it sounds like there was at least a chance for it to happen) but it still sucked to have to not try till day 12. I did ask about progesterone supplementation (see update above). Hadn't heard about vitamin b6, thanks for that. Glad to hear you are feeling less stressed. I really need to start feeling less stressed soon!

  4. Glad to hear the clomid cycle is working in that you ovulated and the cyst was a follicle! It is hard to think straight when pants-less but I am glad you got an explanation from the clinic! Best of luck this cycle, and also in coping with stress!

    1. Yes, me too. Getting that phone call makes such a difference. I'm ready to move forward with optimism!

  5. Oh my gosh I can recall this exact frustration so easily. So many questions. And like you describe, I also never thought to ask in the moment and then since at this clinic it's impossible to speak with someone quickly I hardly ever bothered and did my own Google research ;) I was always annoyed when I read about American bloggers' fast replies and detailed test results and feedback. It's great to read that you did get a phone call back in time for your new cycle!

    What I do remember from my Clomid cycles is that they would be either too short or too long - super fun to expect a positive pregnancy test because my period was 2 days late only to find that Clomid can mess up your cycles. Maybe that's the case for you too?

    Good luck with your new cycle!

    1. Ah, glad to know I'm not alone. I know, I read American bloggers too and the experience definitely seems different in the USA: a lot more personalized and easier to actually talk to someone. I feel so much pressure in the appointments to think of and discuss EVERYTHING and that's hard sometimes when you're presented with new information that takes time to think about. At least I did get my phone consult and I feel less lost now. Thanks for your feedback re: Clomid: I guess I should expect anything! I'll try to stay focused on the positive....

  6. Argh, it's so frustrating when you don't get answers the day of a test, or the next day. I hear you on feeling less advocate-y when half naked in stirrups. I always had a short luteal phase on Clomid, and they gave me the fun tin of suppositories with the red wax bullet caps (that I STILL find around the house because I liked to put them on my fingers (they go nowhere near the nethers) and pretend to be a monster, and then the cats loved chasing after them). Why would your doctor wait for another cycle to add progesterone supplementation? I guess it depends on how many clomid cycles you're willing to endure? I'm so glad it was a mature follicle and not a cycle-delaying cyst. Why they don't just say FOLLICLE is beyond me. I am hopeful that the good informs the next cycle and it's even better than this one in all possible good ways. And thank goodness for assistants who can take over when those calls come in. Special Ed is great for never, ever being alone and so being able to deal with stuff as it arises! :) Thinking of you!

    1. Thanks. Haha, I remember you writing about those red caps before: glad you can find some humour in it. Dunno about the progesterone, but I'm glad I mentioned it and if I see a similar pattern again I'll keep bringing it up. I hope I don't. Dr Cotter was pleased that the Clomid seems to be working and I think she did not want to change anything just yet. Appreciate the good wishes.

  7. Arghh, I have had that exact same thing happen! Oh, you have a cyst, which was later explained to me to mean I was about to ovulate. WTF. How hard is it to share that information when you are still in the room with the person? In any event, glad you ovulated.

    Interesting about the short luteal phase and progesterone. I'm pretty sure it is widely prescribed in the USA (in the multiple clinics I've been to, at least) during fertility treatments. I might push on that one a little bit...

    Thinking of you. Really really hoping for good news for both of us this year.

    1. Thanks! If I have a short LP again this time around I'll ask about it again. Dr. Cotter was rather dismissive, but it might be worth pushing.