Bringing You Up to Present : Test Results and Clomid Cycle #3

This post will effectively get y'all caught up to the present day and where I'm at with this fertility journey.

At our sit-down with Dr. M, she wanted to check my insulin and glucose to determine if the Metformin dosage was adequate. Turns out, my buddies I & G are just fine. My insulin resistance is well-controlled by the 1000mg of Met I take every day so she is going to leave that alone.

Mr. Lost went for his semen analysis. It was a little bit of a "production" getting the appointment set and getting him to the hospital. My hubby and I are what I call "good kids" - we like to play by the rules and do exactly what we are supposed to. This meant that Mr. Lost was not particularly thrilled with the idea of being late to work just because he had to "produce a sample". But, as I explained to him, it's at least a 45 minute drive from our house to the only place is this area that does SA. The sample needs to be tested within one hour of being produced, and we were told that to drop off a sample meant that we had to stop at the hospital's registration area anyway - that process alone would add a good 15 minutes. It was in our best interests to have him produce the sample right at the hospital so they could test it immediately and (hopefully) remove any question as to timing or freshness of the sample. He agreed, but he was definitely on edge because of the "good kid" factor and certainly because I think to have your semen analyzed is, on some level, having your very manhood questioned. I understand that they (the men) feel this way, but I don't really "get it". I don't feel like less of a woman because my ovaries don't work. I guess some women do, but I've never (or at least, not yet...) had that feeling.

Anyway. His results.

(Not Mr. Lost's swimmers, just a picture from the interwebs.)

• Total Sperm Count : A normal result is anything above 40 million. He had 46 million in the sample they measured, so that's good. 
• Motility (the number of little guys that are swimming properly) : This number should be above 50%. For Mr. Lost, he had 57% of his swimmers mobilized and moving around. 
• Morphology (the physical characteristics of the sperm - are the tails the right length? are they straight? is the head attached correctly? etc etc etc...) : For the purposes of determining how well-suited the sperm are for fertilizing an egg, a rather strict metric is used to analyze the sperm. If more than 14% of the sperm meet this tighter threshold, it's considered to be an excellent result. Between 5 and 14% is considered OK. Mr. Lost was down at 6%. Dr. M spoke to one of the other doctors in her group about this. Apparently this other doc "dabbles" in some insemination. He's not a specialist, but I guess he plays around at it. Anyway, he said that he has seen couples with a morphology of 6% go either way. It's about 50/50 as to whether or not that morphology will be a limiting factor in getting pregnant. So, Dr. M didn't really come out and say it, but reading between the lines tells me that if we are going to have a problem on my hubby's side of this, it's going to be with that morphology number. Furthermore, Dr. M is very pleased that we do have an appointment coming up with a specialist, even though we are doing a 3rd Clomid cycle right now. This leads me to believe that perhaps this morphology result could be significant. 

So, with those results in hand and a fresh batch of meds, we embarked on Clomid Cycle #3. 

I timed the Provera to jump start my cycle so that, 1) we wouldn't be having to baby dance while The Outlaws were visiting for Easter, and 2) we wouldn't be having to baby dance right before Mr. Lost had his semen analysis done, since the test requires at least 2 days abstinence before hand. 

April 6 was cd1. There was nothing remarkable about the flow. However, what has put an asterisk on this cycle is that fact that a loverly intestinal bug struck on cd2. Yes, right when The Outlaws were here for Easter. Yes, the day before I started taking the Clomid. The loverly bug stuck around until cd6, which means that I have no clue as to whether or not the Clomid was properly metabolized by my body. I don't know if enough of it stuck around to do its job. 

As far as side effects go, during cycles 1 and 2 I experienced hot flashes or just a general warmer than normal body temp. This was not the case during this 3rd cycle - BUT, I was more emotional after coming off the Clomid right around the time I could have theoretically been ovulating. 

The other reason we have a very large asterisk next to this cycle is that the baby dancing didn't happen as often as it should have. As in, it only happened once. We were both feeling a little run down and tired, so it was hard to muster up the energy even though we knew we were supposed to be doing the deed. Mr. Lost is in a busy time at work right now, and he admitted that the stress was probably playing a part. In addition, we've been pretty busy on the homefront which adds to stress for both of us. I will say, though, that on cd 13 when we did the baby dance, I'm pretty sure I had some egg white mucous going on. So maybe we caught things at the right time.

It's a toss up, really. Hence the big giant asterisk. 

The star that means this cycle was less than ideal.

And to be perfectly honest, there is a part of me that said, "Screw it." to this cycle once we found out that we did, in fact, have an appointment with a specialist. A big (HUGE) part of me is tired of dicking around (Pardon the pun, and my language.... if you haven't noticed yet, I occasionally have a bit of a potty mouth.) with no real clue as to what is going on down in Ovary Land. 

So it will be whatever it will be. 

I have to call Dr. M's office to set up the progesterone check for tomorrow. 

I have to call the specialist (Dr. G) to find out if I'm supposed to be getting any paperwork or pre-registration paperwork in advance of next week's appointment. It's scheduled for May 2, which coincidentally (or ironically) is the 5 year anniversary of my mother passing away. 

I have to sit and take things one day at a time, growing ever more impatient for next week's appointment. 

And did I mention that the appointment is on cd27? Even though it will be too early, I'll pee on a stick that morning just in case this cycle meant something after all.

I'll pee on that stick even though I'm sure I won't see two lines.

I'll pee on that stick even though I'm doubtful that I ovulated this month. 

I'll pee on that stick even though Dr. G will probably order up a blood test anyway for confirmation.

I'll pee on that stick because even though this cycle has a big giant asterisk next to it, I still have hope inside me. 

Next week, I'll be sure to post the outcome of that visit. Until then, if you hear the sound of fingers drumming on a table, it's probably just me - expressing my impatience. May 2 seems so very far away.

Back Story : Clomid Cycle #2 & Sit-Down with Dr. M

Wow. Ok. So, I'm sitting  here getting ready to write the story of our second attempt at conceiving with Clomid and I realized that the details are already starting to get a little fuzzy. It was only February - not eons ago! Thank goodness I have a file on my 'puter called something like "Project Baby Timeline". Here goes.


When we last left this story, Clomid Cycle #1 had been a bust, but Dr. M (my gyno) was pretty sure I had ovulated. She didn't want to tweak my med dosages or anything - just repeat at 50mg of Clomid and continue with the Metformin at 500mg twice a day. No biggie.

Cycle Day (cd) 1 of the second cycle fell on cd34 of the first cycle, so I felt pretty sure that I was ovulating later along in the cycle rather than on the "average" cd14. My period was normal-to-heavy in terms of flow - surely this cycle would "mean something" because here we were, already starting off better than the first cycle with its "is it or isn't it?" level of flow. I again took the Clomid on cd3 through cd7. This time, since I thought I was ovulating later along, we postponed the baby dancing until cd 11, 14 and 17.

I went for the progesterone check on cd21.

So much for think that this cycle might be The One.

Progesterone clocked in at a WHOPPING 1.something-or-other.

One-point-too-damn-low.
One-point-ain't-gonna-happen-this-month.
One-point-stupid-f-ing-ovaries.

One-point-let's-make-an-appointment-and-figure-this-out.

One-point-let's-try-again.

I had very light spotting on cd25 though 30. Waaaayyy too light to ever be considered a period. Lighter than that whole "is it or isn't it?" flow that led into the first Clomid cycle.

On cd46, we had an appointment with Dr. M to figure out what in the world was going on. And also to discuss having Mr. Lost tested. Because scheduled baby dancing is not fun, and it's even less fun when you don't know if you're even in the appropriate magic window in time. Here's the rundown of that conversation:

{Thank God I messaged some close friends about the appointment shortly after it happened so I can relay all the info here. And this is (one of the reasons) why I keep this blog - so I can remember everything that's happened on the journey.}

• She prescribed 10 days worth of Provera to jump-start a period.
• She kept me on the 50mg dose of Clomid rather than increase because she thinks that I did respond well in January with the 1st cycle. She thinks that I probably did ovulate, but that timing or other factors just didn't make for success (success = positive preg test).
• She's adding Prometrium (progesterone) on cd14 - 23 to ensure that my uterine lining is thick enough for implantation. That's a picture of it to the right. Little pink balls. She said it's possible that egg and sperm met in January, but that the low progesterone number meant that my lining wasn't thick enough for implantation. 
• She ordered up a round of blood work to check my insulin and glucose in order to make sure the 1000mg of Metformin is enough. She doesn't want to bump it up because she doesn't want to make me suffer the side effects if I don't need to. 
• She ordered up a semen analysis for Mr. Lost. He is less than thrilled about this, but realizes it is necessary. I just want to make sure that we aren't wasting our time - if something is wrong with him, nothing we do with Clomid or anything else is going to make a difference. She said that if Mr. Lost's results are abnormal, we'll be moving on to a specialist - a reproductive endocrinologist. If his results are OK, we'll see how the 3rd cycle goes. If my progesterone is still not right, or if we don't get pregnant, we'll be seeing the specialist. 

Dr. M really wanted to give it one more shot (the 3rd) cycle because she's so sure that I ovulated in January - I'm just not O-ing regularly. I am less confident about January. The internet research I've done indicates that a progesterone result higher than 5 indicates ovulation, but that really, higher than 10 is preferred.

I asked about more testing . monitoring to try to pinpoint or at least narrow down when ovulation is occurring, but that isn't really her thing. She doesn't specialize in infertility, so she doesn't do that sort of thing.

I explained that we have friends who have gone through this infertility thing and then wound up at adoption, and that from what we've heard, certain agencies won't adopt if a parent is over 40. She hadn't heard that, which surprised me, but at least it gave her some understanding on our timing and desire to be more efficient / aggressive. Medically speaking, 37 for Mr. Lost and 31 for me are perfectly fine ages to make a baby so it isn't so much the biological clocks that are ticking the loudest here.

The next post will reveal the results of all that testing and talk about where we stand right now, which is in the middle of Cycle #3.

Back Story : Clomid Cycle #1

So, in November 2011, Dr. M gave me a prescription for Clomid to induce ovulation. The dose was 50mg on cycle days (cd) 3 through 7, and we were told to "do the deed" (DTD) on cd 13, 15, and 17.

On December 28, I began what could best be considered as a light flow. It was more than spotting but less than a full blown period. I called Dr. M's office and the nurse I spoke to said that Dr. M likes to see a "constant flow" in order to judge when cd 1 is. "Well," I thought, "it IS constant.... just low in volume," so I decided to make December 28 officially cd 1. On December 30 I took the first Clomid pill. Fortunately, I experienced no side effects from the Clomid other than a warmer than normal body temperature and a tendency to get mild hot flashes. Some women experience more side effects, including mood swings and increased emotions - like an extreme case of PMS. If you've never tried Clomid before, I would not let the possibility of side effects deter you - the drug absolutely works for many women, but you won't know how you react to it unless you try it.

While I was taking the Clomid, I was doing some research. I belong to a message board for those who have been diagnosed with PCOS, and in particular I follow a thread dedicated to those of us who are on Clomid. Some women there said that they found they were ovulating early with the Clomid, and others said they were ovulating late in their cycle. So, I got the bright idea to extend the time period when we should DTD. We were active on cd 9, 11 and 13..... but then the notion of scheduled "relations" got old. Really old. More for Mr. Lost than for me, but still - scheduled "relations" are not fun relations. We've since learned that you need to up the romance factor to make up for the schedule factor.

We refused to feel bad about the fact that we didn't DTD as much as we probably should have, because we weren't even sure if this cycle would really work or mean anything, thanks to that "is this a period or isn't it?" scenario on December 28.

Beginning around day 9 or so, I also began using an ovulation predictor kit (OPK). The version that I used required you to pee on a stick (some versions use strips of paper). I never saw any positive results from this test, so I was convinced that I didn't ovulate. On cd 21 I went for a blood test to check my progesterone levels - this is the only monitoring that Dr. M does in a Clomid cycle. Other gyn's and nearly all RE's will do ultrasounds to check follicles and whatnot, and this is something we will be pursuing in the future. For this first cycle of Clomid, my cd 21 progesterone was around 3.8.

Now, internet research will tell you that for a "normal" cycle, that number should be around 5 if not higher. The production of progesterone is triggered by ovulation - no ovulation, no progesterone gets made. The progesterone is needed in order to ensure that the lining of the uterus is thick enough to support implantation of the fertilized egg. The progesterone level will climb after ovulation, but if no fertilized egg is implanted, the body is given the signal to stop producing progesterone. That sudden decrease in progesterone is what brings about the next period.

So. My number was only 3.8, but Dr. M was confident that I had shown a response to the Clomid and had ovulated. That had me excited, and I did the normal girly things - my personal Pinterest board suddenly had a "Project Baby" category, full of cribs and nursery sets and birth announcements. I was trying very hard to not get my hopes up, but it was hard to not get excited about the possibility of being pregnant.

Dr. M instructed me to take a home pregnancy test (hpt) on cd 28 if AF had not shown up. If it was negative, I was to wait - if AF had not shown up by cd 35, I was to test again. If that test came back negative, I was to call the office for a serum pregnancy test (blood test). I think I must have tested 3, maybe 4, times between cd 28 and cd 34, which is when AF decided to rear her ugly head. This time around, though, there was no mistaking her - she was definitely a full-fledged period.

So, Clomid Cycle #1 was a bust. Our disappointment was slight and very short lived. As I indicated above, we weren't even sure if this cycle would mean anything. We had come to regard it almost as a "trial run," to see how I would react to the Clomid, to see if 50mg was a strong enough dose, etc. So, no bad feelings - we were just ready to take what we learned into the next cycle..... which is where my next post will pick up. See you then!