Tuesday 17 January 2017

I need some suggestions

January is more than half done, hallejulah. I don't want to wish away a day of my life but January isn't my favourite month. It feels like everybody is making New Year's resolutions in December and my only thought is: please can I just get through January.

Anyway. We are at a turning point/checkmate/stalemate (I can't metaphor right now) with regards to trying to conceive #2. I'm not feeling very optimistic at this point, not going to lie. But optimistic or not, we still have to decide to do something, or nothing, which is still a decision.

We have completed our 4 cycles of Clomid, 100mcg. No pregnancy achieved. According to progesterone levels, I ovulated the first three cycles (levels were 11.3, 18.9 and 22.1 respectively). All 3 ovulatory cycles had a relatively short luteal phase, according to the charts I kept (about 9 or 10 days). Other than that though I was encouraged to see my charts looking mostly the way they are supposed to for a fertile person. My temperature was low prior to ovulation, then rose, with the highest point about 7 days after ovulation. From there it would plummet. I had one or at most two positive OPK's in each cycle (I stopped testing after BBT rise).

I did not ovulate on the fourth cycle. I didn't ask the number for this one. My BBT chart is basically flat and low, no temperature rise. I had positive OPKs starting day 9. They were positive for about eight days, went negative for three, went positive again. I have never had this happen before. I finally gave up because it was too frustrating. I had various kinds of cervical mucus throughout, some of which looked fertile but as previously noted there was no evidence of ovulation at any point. This cycle lasted for 34 days and finally ended with what looks like a pretty normal period. I was glad that I at least did not need to use the Prometrium to induce a period which wasn't something I wasn't anxious to do. I am now unmedicated for the first time since October. What I notice so far is that my BBT (follicular phase) is lower by 3-4 tenths of a degree than it was when I was taking the Clomid. (I didn't chart prior to taking Clomid so no idea what it was before).

We have the follow up appointment with Dr. Cotter this Thursday. I'm trying to think of what I should ask her / talk about. I don't know if we will be offered any treatment options after Clomid. Maybe she will interpret my 3 ovulatory cycles positively and be willing to try something else, maybe not. I'm also so busy this month I haven't had much time to research or think about things, and it's still hard to think past the disappointment.

From the little I've had the time to read, here are some possibilities I found for when Clomid doesn't work:
  • Keep trying Clomid at same or higher dose (we were given four cycles, but surveying the internet I see that some people have had it prescribed for up to a year ...!!!... )
  • Clomid with a trigger shot
  • Go off Clomid, go unmedicated or take birth control pills for a couple of cycles, try again with Clomid
  • Femara
  • "Injectibles" - not totally sure what those are....needles??
  • IUI (we were not previously considered candidates for this because of male fertility issues)
Does anyone have any ideas of what else we could ask about?

We will also get the results of Mr. Turtle's latest semen analysis. I mainly focus on the female side on the blog, because it's easiest to write about myself, but we are a double infertility diagnosis. So that could be very important information going forward.

I haven't officially been given the results of my salinohysterogram, either, but unofficially I was told everything looked good and I had follicles growing.

I plan to ask if there are any negative side effects to continuing to take DHEA/COQ10 and if not whether Dr. Cotter can refill my prescription for that. I don't feel terribly hopeful right now about "trying naturally." But neither do I feel ready to make the decision to stop.

There is also the donor egg option. Since I wrote this post and this post, donor egg IVF has not become any more appealing to me. I definitely don't have the desire to start that process right away; at the same time I can't yet shelve it permanently.

I took the day off of the appointment. I wish I could spend it relaxing, but I will be busy with individual program plans and report cards which are due this month. The nicest thing I can probably do for myself is get that work done so I don't have to do it on the weekend.

Any ideas to kick start my tired thought process are welcome!!


  1. Honestly, I would get the information from the SA and then decide how you want to proceed. There's a lot to consider and a lot of emotions attached to all of this, so I think having all the information will allow you to weigh all the options, pros and cons, and decide. For some, it's doing more Clomid. For others it's trying new drugs (injectables does equal needles, but some get better responses). And for others it's moving to the next step.

    Regardless, may the road ahead become more clear. I'm sorry you're facing all these decisions.

  2. If I lived in Canada I would totally break into your house for you, since it worked once before! I hope the meeting goes well and you get some good questions/answers, and a clear plan on what to try next! I don't do well with difficult decisions- I tend to put them off until either too late and they are made for me, or I just pick one or the other and jump and hope for the best. I hope as you progress along you have success before you have to make any really difficult ones.

    1. Hahaha you are hilarious! Thanks for making me laugh. Burglary, cancelled IVF, hopelessness......yes so many possible reasons for success! Sometimes you just have to roll your eyes at life. If you ever are in Canada the door is open: no need to break in!! And I hear you on the hard decisions.

    2. I am placing a personal embargo on travel to the US for the next four (to hopefully dear god not eight) years so I may very well end up in Canada sometime- my parents live about an hour south of the border so if they guilt us into making the journey, I intend to guilt them into meeting us in Canada. At least I am not the stealing type- if I did break in to your place, I would just rearrange all your kitchen cupboards!

    3. Well let me know if it happens! I am in Western Canada. We haven't traveled much due to Mr Turtle's graduate work but that will be ending soon, and AJ is getting bigger.....so anything is possible.

  3. Hi Torthuil, Anna here--long time no comment. I have been keeping up with your blog when I can, loved your Christmas post especially. I hesitate to give people input on fertility related topics, because personally I always hated when others gave me their anecdotal "evidence" to support things I should or shouldn't try. But since you requested feedback, I thought I might share a few thoughts.

    After one loss at 7 weeks and two chemical pregnancies in a year and a half of ttc #2, I am currently 9 weeks into what appears to be a healthy pregnancy so far. In case it would be helpful to you, I thought I would share what worked for me. I ended up taking Letrozole (Femara) with an hcg trigger (Ovidrel), followed by estrogen and progesterone supplements during my luteal phase. I also took Letrozole to conceive my son (one loss at 5 weeks during the nearly two years it took to conceive him).

    Granted, we are not out of the woods with this one, but it seems Letrozole did do the trick for me again. In my research after the losses, I found this article indicating Letrozole may improve endometrial receptivity. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279128/
    I don't know for sure, but I have always suspected an issue with my uterine lining has made it difficult for me to get and stay pregnant (history of septate uterus and thin lining). There is also evidence out there that an hcg trigger can increase implantation rates.

    There was a study some years ago (now discredited) which indicated a possible link between Letrozole and birth defects that scared many people away from prescribing or using it. But because Letrozole does not thin uterine lining like Clomid, and because it may in fact increase endometrial receptivity, my RE believes it will replace Clomid as the first-line treatment in infertility over the next decade.

    Anyway, that's my anecdotal two cents. Since Letrozole was incredibly cheap, gave me no side effects, and (hopefully) worked twice for me, I am an advocate trying it.

    I know these are incredibly difficult and deeply personal decisions. I wish you all the best, and sincerely hope 2017 brings you a sibling for your sweet AJ.

    1. Annie! Thanks for commenting and congratulations. So happy to hear from you. Sorry to hear you've had a rocky road to #2 but happy you are in a good place now. Thanks for sharing your experience, that is interesting. Letrazole is the same as Femara if I remember correctly. It does help to hear your experience and I will check out that link. So happy that the comments on my gloomy post are making me smile!

  4. I don't know that I have wise words here, but I think information is power so holding out until you get the SA is a good idea. For me, clomid did absolutely nothing. I was told at one point that doing anything more than 4 times without change (medication, procedure, protocol, or genetics) would not result in anything, so I think something other than clomid would be a good next step if you head in that direction. I really feel given my spectacular lack of success though that I probably shouldn't offer anything up... :) We were also told we weren't a good candidate for IUI because of our male factor, but we did it anyway because 1) we didn't want to jump into IVF, 2) we wanted to see what my body would do with injectibles (follistim, gonal-F, menopur, those kinds of medications) before going all in on IVF, and 3) my insurance paid for injectible medications for IUI but not for IVF, so if I had extra left over (hint hint)...it helped with the cost of IVF which was not covered at all. I don't know what your coverage situation is, but that was super helpful. I hope you can get some answers and work through your options with as much information at your fingertips as possible. I'll be thinking of you!

    1. Thanks for your thoughts. I'll write an update from the meeting soon. Good point about coverage. I'm pretty sure that from last time we are not covered for any procedures but medications are covered. Money is always a factor, but would not be the deciding one for us, more whether a procedure could work and whether it would be worth the stress.

  5. I'm a bit late here, but one thought is a monitored Clomid cycle. My clinic will do that to actually see how you are responding, see what your follicles are doing, etc. I'm a bit fuzzy on whether you have already done that, but I think not.

    I'm back to where you are and wondering if should try Clomid again once things regulate for me?

    1. A monitored cycle is one thing to suggest, for sure. The only monitoring I had was progesterone level testing on day 21. (I had an ultrasound in the middle of the first cycle, but that was coincidence). Clomid did work for you and it sort of worked for me. I'd be open to trying it again. I won't say "If was you" I'd try Clomid again because the miscarriages twice in a row sounds devastating. Argh, it's so hard!

    2. I already called my RE today and asked for a prescription (or a few months' worth) before I leave the US. I left a VM for the nurse so we'll see what she says. If they say no, I'll ask my OB. I'm not giving up. Apparently I haven't reached my max capacity for suffering yet...

    3. Then I wish you the best, for everything!