Posts Tagged ‘infertility’

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Prometrium

October 28, 2009

So, last Friday I was sitting in my desk, about to leave for a little midday run (my special treat to myself on Fridays), and I heard a buzz. My phone! It was a mysterious 703 number. I thought, “that looks like my doctor’s office.” I was surprised to pick it up and hear Dr. B’s voice! Praise be!So glad I did not go on that run earlier, as I had planned.

I had bloodwork done the week prior, but Dr. B was out of the office. In his absence, I cajoled the nurses to give me the low-down on my numbers. I had made an appointment with another doctor in his practice for later this week, and I was not expecting to hear from Dr. B.

All to say, I was pleasantly surprised to get the call. Dr. B always says “thanks for picking up the phone.” And I’m like “ARE YOU KIDDING ME? Thanks for calling me!” He asked if I was busy, and I replied, “I am never too busy to talk to you.” He thought I was being funny. I was serious.

In seriousness, I usually am busy when he calls, so I always end up sprinting out of my cubicle into a less dense part of my office. He inevitably asks something about the calendar or my pharmacy’s phone number, and I have to sprint back to my computer once or twice during the conversation. It is a bit comical.

But that is not what you are interested in. What about the bloodwork?

Dr. B said the first numbers look good, but my levels were a little low on the latter two days. He asked a lot of questions, including “what kind of symptoms do you have?” I replied, “symptoms of what?” He didn’t want to lead my answer, so I just told him the first thing I thought of, which is that I cry all the time. Like, once or twice a day. I cry when I read a touching story in the newspaper, or when I hear something sad on the radio, or when I think about my grandmother or my non-children or most anything. I cried once because my cat is A CAT. I felt bad for him.

I cry a lot.

I used to cry like this one week out of every four — just before my period. These days, it is all the time. Dr. B said it is because my hormones are all whacked out on clomid. Also, am I depressed?

He asked if I had ever taken anti-depressants. I have not. He said there have been some compelling reports about prozac and infertility. Some people have had success concieving while taking very low doses of prozac (the lowest available). Dr. B said he was skeptical about it, but then saw that regime work for 5 of his patients. It seems that when prozac boosts the serotonin, it might also give a helpful boost to other hormones.

I have always been hesitant to take depression or anxiety meds. I know they are lifesavers for many people, and I am grateful for that. But I also know they can have a lot of side-effects, and I figured as long as I can function under my current brain-hormone-situation,  I should stick with it.

So, my first thought on the phone was “no thanks.”

But then the more I thought about it, the better it sounded. I do sort-of have low-grade depression these days (crying, not wanting to get out bed, not wanting to be around humans sometimes … um, yeah, when I put it that way, sounds an awful lot like depression). It seems to be worse with clomid.  I am interested to ask him about it again.

For the time being, Dr. B said he wants me to try prometrium during my luteal phase, to help boost my progesterone numbers. He sent a prescription to my pharmacy ($67 — why can’t everything be as cheap as clomid?).

He also said he wants to talk to Dr. C about it and get her opinion on what I should do. He said he would call me back this week (supposedly by Thursday).

I am happy to try something new. But as I have said in the past, I feel like they are just kind of improvising with me. This whole conversation — “what are you taking again? want to try prometrium? I’ll talk to the other doctor …” — added to that feeling. Sometimes it frustrates me; but oftentimes I feel like this is just How Things Are. When it comes to hormones, I think all doctors end up improvising. For my friends who have suffered with mental illness, I know it has sometimes taken years and years to get the prescriptions right. I saw another friend Sunday who has a thyroid disorder (she found out about it from other signs, not infertility … not sure if she has tried to get pregnant yet) and she said it can often take a while to get thyroid meds right.

Until we get that blessed diagnostic machine that we can hook ourselves up to like a car an an auto shop, I think it is just going to be like this.

So, for the time being, I am facing at least one month on prometrium. Anyone else want to share your experiences? I am a little nervous about how it might affect me — my luteal phase is currently the hardest part of my cycle (I feel like I am in some hormone-induced fog. it is not charming).

Thank you!

And it seems to be impossible for me to write a short post. I apologize.

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Tail-end brown bleeding?

October 23, 2009

File this one under: bodily fluids.

I am here to ask a little about our friend — or shall I say, our enemy — tail-end brown bleeding. I know it exists. And I know it’s generally considered Not A Good Thing. But I don’t know exactly what it is or what it indicates.

Oh ye women wiser than me, help me.

What exactly is tail-end brown bleeding? And what does it mean?

Here’s my situation. I have noticed that I have brown spotting at the end of my period. Is this tail-end brown bleeding? I don’t know. I also know that menstrual blood that starts out looking red can look more brown when it has been, err, sitting around or exposed to oxygen for a while. So I don’t know if the brown spotting I am seeing is just my residual period stuff or the dreaded TEBB. Are there any distinguishing characteristics?

And of what is tail-end-brown-bleeding a symptom? I read endometriosis somewhere on the internet. I have a vague memory of my “Taking Charge” book saying it has something to do with a luteal phase defect — I think she may have said that anything past 2 days post-menstrual brown bleeding indicates a bad luteal phases in the previous cycle. My brown spotting is just for one or two days.

I have not yet had a laproscopy or anything to look for endometriosis, but I may have the endo surgery in the not-too-distant future. My doctor wanted to try other things first, since he said I did not have any of the obvious signs of endo (besides infertility, of course).

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Bloodwork numbers and reference ranges

October 16, 2009

I called and got the rest of my bloodwork numbers from my doctor’s office today, after some cajoling.

I am now on CD 29. No big temperature drop yet, but I expect my period to start Any Day Now.

I am including my numbers below. I’d be grateful for any of your thoughts on what I should ask the doctors to try next. The nurse told me that my first numbers were good but the others were “low.”  (…although they still appear to be in the “normal” range… but the “normal” range is awfully large)

By way of background: This is my second clomid cycle. Without any medication, I ovulated but had wonky progesterone-estrogen levels in my luteal phase. The progesterone was too high, particularly in relationship to the estradiol. The first attempt to fix that was by applying an estradiol ointment — aka “the lady cream” — to “balance it out.” It did not balance it out. Estrogen took over and my cycles were all messed up and annovulatory. Fantabulous.

The new regime is clomid, which I like more than I thought I would (shorter cycles, obvious ovulation, no terrible side effects and it’s cheap!). I also apply 1/2 of an estradiol 1 mg packet each day from when I start the clomid until ovulation. (Dr. B said that part was kind-of optional.)

I am a little (perhaps more than a little) frustrated because my numbers are “low”, yet no doctors are available to give me any advice over the phone on what I should try for this next cycle, and I can’t get an appointment until Oct. 30th.  Although come to think of it, that might be right around the time of my next ovulation, so perhaps there is still hope.

(An aside: I know October 30th is not that far away. Patience, patience. But I feel like I’ve been spinning my wheels with these people for the past year, and I am a little anxious to get things moving.)

Anyway, here are my results…

P+6 or 7ish: estradiol 126 pg/mL
progesterone 18.78 ng/mL

I  went out of town for four days, so I have a data gap.  Now I really wish I had that info.

P+10ish: estradiol 94
progesterone 9.64

P+11ish: estradiol 86
progesterone 8.2

And now for something *truly spectacular*.  Because my Very Friendly inner-city lab actually gave me a print-out with some of my results, I have the reference ranges for what are considered “normal” levels of estrogen and progesterone. This is the kind of stuff I poke around for on the internet all day. Here you go!

Reference range for estradiol
Female:
Follicular Phase: 11-212 pg/mL
Mid-cycle: 18-480 pg/mL
Luteal phase: Less than or equal to 247 pg/mL
Post-menopausal: Less than or equal to 27 pg/mL

Male: 13-54 pg/mL

Progesterone reference values

Non-pregnant female:
Follicular phase: <1/4 ng/mL
Luteal Phase: 3.3-26.0 ng/mL
Mid-luteal phase: 4.4-28.0 ng/mL
Post menopausal: <0.7 ng/mL
Oral contraceptives: 0.1-0.3 ng/mL

Pregnant female:
First trimester 11-45 ng/mL
Second trimester 26-89 ng/mL
Third timester 46-423 ng/mL

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Clomid update, questions

September 10, 2009

We are back from Spain! It was wonderful, and I will post about it soon. But for now I will write this slightly less exciting clomid update, as it seems more time-sensitive.

This was my first clomid cycle. I took 50mg for five days, starting on day 3 (the penultimate dose was taken on the plane and the last dose on our first night in Spain). I noticed no side effects while I took it, praise be! I also applied half of my 1 mg dose of estradiol from a couple days into the clomid until around when I ovulated. (I was supposed to start it with the clomid, but I was still feeling bitter about the estrogen since I blame it for my lack of ovulation last month. My husband talked me into it.) I did have the standard clomid dry spell, but with mucus enhancers I was able to get at least a small amount of fluid.

So, all of that is fine. But I’m not exactly certain when I ovulated (again). So now I am in a P+7 bloodtest quandry (again).

With travelling and time zone shifts, I don’t have any kind of reliable temperature record. I am above 98 degrees now, which is usually post-ovulatory for me.

I usually ovulate late, circa day 18. Clomid people are supposed to ovulate 5 to 10 days after the last clomid does. I figured I would be on the latter end, so I was quite suprised when I took an ovulation predictor test 5 days after clomid and saw two lines (one either as dark as the other or very close). I also had pretty strong pains on the right side in my lower abdomen that day. I’ve never felt ovulation pain before, was that it?  It was kind of like bad menstrual cramps, but one-sided. It was a dull pain in the morning, then got worse through the afternoon. (However, I was nicely distracted by walking around Seville! So I didn’t think about the pain too much.) By the nightime, it was mostly gone. That was also my peak day of cervical fluid for the cycle — though the fluid was not really anything to write home about.

Sooo … that makes it seem like Saturday was the ovulation day. But the next day I took another OPK test just for kicks (I bought one of those packs of 20 that only last for 30 days). There were still two lines, but with one lighter than the other. Could an LH surge still be floating around after ovulation? I didn’t feel any pain that day, and didn’t have any fluid.  I had second lines of varying degrees of darkness on the OPK tests for a couple of days. None now.

At some point my temperature rose, but the whole temperature thing is a little murky because of the six hour time change. I’m wondering if I ovulated later? or on Saturday? Or maybe more than once? Does that happen on different days? (I told my husband we should keep trying in case maybe I was still ovulating and he replied, “Maybe we should just fertilize one egg.” Which kind of cracked me up, what with our lack of any history of fertilizing eggs.)

I need to get a P+7 blood test. If last Saturday, the abdominal pain day, was peak, that conveniently puts the blood draw for this Saturday. Does it make a difference if it is P+9(ish) instead, when places are open on Monday? Or should I go tomorrow, for P+6(or less)?

In another interesting development, it also so happened that I noticed a very, very tiny amount of blood when urinating on Saturday and Sunday morning. Also pain in urination. I was pretty convinced it was a urinary tract infection, but it went away quickly on Monday without any cranberry juice (they’re not into cranberries in Spain) or any other treatment. So could that be a weird clomid ovulation thing?

Wow, this is a lot of information about my body. I feel a little embarrassed.

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New cycle, new regime: clomid (clomid?)

August 26, 2009

I started bleeding yesterday. Goodbye and good riddance to the 45-Day Cycle of Doom.  But it is technically “breakthrough bleeding” and not a period, as I never ovulated.

I have some new information and a new regime for this cycle. My doctor did finally call me last week, and again today — praise be!

Before I tell you what he actually said I want you to picture the ridiculous scene in which his call took place last week: He called in the evening, while my office was in the throes of a large beer-tasting party. Because, errr,  that is just the kind of place I work. There were people all around me, loudly drinking beer and playing music from their computers. I grabbed my cell phone and ran into the next room, which was empty and silent.  But at once point in the conversation, I had to run back to my desk to get the fax number for the lab for bloodwork … causing a surge in background noise. My doctor asked, “Umm, where do you work?”

Ah, journalism.

Anyway, back to my cycle. Last month I had blood drawn on day 25 (the day I imagined would be p7, if I had actually ovulated … which I did not do) and day 41, the day after talking to my doctor. He also ordered bloodwork to check my thyroid levels (what does that mean, anyway?) and said they were normal. Estrogen was also normal. But in both cases my progesterone — you remember that progesterone which last March was astronomically high?  — was almost nonexistent. It was 0.6, four days before my period started. Thus, I did not ever ovulate.

So, it appears the estradiol supplementation did not work. A direct quote from my doctor: “Your body still is screwing up on it.” So he said it is time to try “the old-fashioned way.” Clomid.

It is funny that this is what we’ve come to: clomid. I have mixed feelings about it. I was very anti-clomid a year ago, mostly because it seemed like the thoughtless response of many ob-gyns who don’t want to take the time to figure out what is really going on. When I saw my previous gyn last year, she told me to keep trying for a few more months, then come back for clomid and a reference to an infertility specialist. I cried, as I am wont to do. And I never went back. At the time I thought, “I don’t want to go to some doctor who will prescribe clomid and IVF without even trying to figure out what is happening. I don’t need clomid; I am ovulating.” (well, I *was* ovulating, or at least seemed to be)

With the assistance of some of you wonderful bloggers, I found my nice Fairfax-based NFP-loving Catholic doctor. He wanted to figure out what was (or was not) going on in my body. But after eight months of various tests and lots of waiting, now we are going to try … clomid! Ha!

I guess this is all part of the learning process.

I am glad to try something new, but I am rather nervous about clomid — haven’t others experienced unpleasant hormonal side-effects? I am unstable enough as it is.  I am supposed to start clomid tomorrow and take it through Monday. We leave on Sunday for a weeklong vacation in Spain. I would prefer not to be insane while I am there. Any advice?

UPDATE: The call with my doctor happened at 11 a.m. He indicated the pharmacy would be getting the prescription immediately. As of 4 p.m., there is no prescription at the pharmacy. I called the doctor’s office, they told me to leave a message in a voicemail that says they’ll get back to you within 48 hours. Did I mention I am supposed to start this tomorrow? Oh, sigh!

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40 days and 40 nights…

August 19, 2009

It’s day 40! Same story  … another day with low temps and no direction on what to do next.  My posts are like a broken record recently; I apologize. I am singing the refrain of U2’s  “40,”: “how long? how long must I sing this song? how long? …”

I realized today was day 40 while riding my bicycle to work this morning. I promptly began to cry.

My barren cycle is now as long as Lent.

It’s distressing for the obvious reason: no one wants a cycle that long unless she is enroute to pregnancy. But it also saddens me to think how different the last 40 days have been from my typical Lent.

Lent seems longer, in  a way, because I always learn so much in those 40 days.  Although Lent is a barren time of sorts, it is always a springtime of the soul.

I can’t say the same for my Lenten-length cycle, unfortunately. The last few weeks seem like a blur of the-same-thing-every-day.  I have not given my time to  God in the way I do during Lent. I have not been listening to Him. Instead, I’ve probably spent more time and energy being angry at myself, my body, my estradiol, my health care and even God Himself.

My priest has said that there is no staying-still in the spiritual life. We are like wheels on an incline, and we are either getting closer to God or rolling backward, getting farther away.  I suppose I’ve been rolling away recently, and that is certainly not the way I want to be.

If I am going to live in this barren Lent of infertility — and all in all, it is lasting much longer than 40 days — then I want to give the time and myself to God to fill. I want to allow Him to make this terrible thing good, to make it a springtime of my soul…

Which brings me back to U2’s 40. I could only think of the refrain earlier today when I started writing this post. It seemed a fitting refrain for me: how long do I have to keep complaining about my cycle?  But then I remembered that the song is actually based on Psalm 40.  And it really should be my new theme song for today. Here are the lyrics:

40

I waited patiently for the Lord
He inclined and heard my cry
He brought me up out of the pit
Out of the miry clay

I will sing, sing a new song
I will sing, sing a new song

How long to sing this song?
How long to sing this song?
How long…how long…how long…
How long…to sing this song

He set my feet upon a rock
And made my footsteps firm
Many will see
Many will see and fear

I will sing, sing a new song
I will sing, sing a new song
I will sing, sing a new song
I will sing, sing a new song

How long to sing this song?
How long to sing this song?
How long…how long…how long…

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39 and counting

August 18, 2009

Well, here we are at cycle day 39, and my temperature this morning was a cool 97.1 degrees (very low for me).

I have had my share of 36 day cycles, but I think this one might be the Longest Cycle Ever. Plus, HOW MUCH LONGER WILL IT GO, since I never even had a blessed thermal shift? Can I just have an annovulatory cycle, be over with it and just start my period this week? Oh, I hope so. I just want to start over.

I am at the point of  infertility when I just want to get my period.

This could be my worst cycle ever. It’s not like I am a portrait of female reproductive health: my reproductive system has failed to perform its ultimate and most important function, producing a baby. But in the past, I have at least ovulated (or appeared to on paper), had a thermal shift and subsequently gotten my period. And all in less than five weeks! Not this time.

I can’t help but blame the estradiol. I am applying it every day, as instructed. This was the first cycle of doing so. I feel like it has been a big waste of time and $120. And it has the delightful side-effect of bloat, which is particularly charming in swimsuit season.

I never heard back from my doctor’s office about the blood test results (from my fabricated P+7 two weeks ago), even after a couple of calls. I called again and left a message today describing my extended weird cycle and asking if I should quit the estradiol. It certainly doesn’t seem to be helping anything.

I have not heard back. I am considering just quitting the estradiol on my own. Do you think I should? Or wait until I hear back?

(And for any delusional fans who are wondering if this could be the beginning of the long cycle I’ve been waiting for, no. I did pee on a stick on Sunday. Negative, not that I suspected anything different.  I don’t usually take HPTs, as it seems like adding insult to injury. But I felt like I had to go ahead and get the BFN confirmation, just in case my doctor’s office ever calls me back and asks.)

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