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!

Back Story : 2010 to the Present

So let's catch up, shall we? In June 2009, I lost my job and my health insurance. In November 2009, we moved back to the town I grew up in and regained health insurance. Up through this point, I was not taking any meds to control my PCOS or prevent pregnancy. I was (carelessly?) cavalier about the whole thing - if it happened, it happened, but I was pretty sure it wasn't going to happen.

Moving back to this area after 7 years away meant finding all new doctors. Coincidentally, during this time period one of my Facebook friends (let's call her Ms. Hepburn), someone I've known since elementary school, "liked" a page or group relating to PCOS. I saw that and sent her a message. Despite the fact that we hadn't been all that close recently, I figured it was worth a shot. I explained that I saw her update and was wondering if she had PCOS, too. I also mentioned that I was looking for a gyno. Ms. Hepburn gave me the name of Dr. M and said that it was Dr. M who diagnosed her, that she was a great doctor, great personality, etc.

In the fall of 2010 I made an appointment to get an annual exam and get on the patient roster for Dr. M. We were finally ready to start our family, so that was a topic of conversation as well. Dr. M was familiar with Metformin as treatment for PCOS and gladly gave me a prescription for 1000mg per day. We settled on that dose because it controls my insulin and glucose without overdoing it on the side effects. Dr. M indicated that many women are able to ovulate and successfully conceive with just the Metformin alone. I wasn't as optimistic as she was, but she wanted to give it a full year to see how it would regulate my cycles.

It turned out that the Met brought about visits from AF about once every 60 days - so twice the "normal" cycle length. At my annual exam in November 2011, Dr. M indicated that she was OK with that cycle time ... but I wasn't. She had mentioned in 2010 that the next step after Met would be Clomid, a prescription drug that induces ovulation. So I brought up the Clomid at this visit in 2011. She was totally on board with prescribing it for me. I had some other medical issues (unrelated to my fertility) to clear up, so I waited before starting the Clomid.

Clomid Cycle #1 began at the very end of December 2011.... and you know what? I think this is a good place to take a break. These posts have gotten pretty darn long, so what do you say we maybe give each Clomid cycle it's own posting? Sound good to you? Great. Until next time, then.......

Back Story : 2003 - 2009

When we last spoke, I had said that I faithfully took The Pill with few problems from 1999 until 2003, and that I saw Dr. R faithfully until 2002. Let's pick the story up once more...

In May of 2003, Mr.  Lost and I were engaged and planning a fall wedding. AF had been coming along more or less normally, but by May she had gone missing again. Being more than a little bit paranoid, I peed on a stick or two (home pregnancy tests, or HPTs) but got a BFN (big fat negative). Puzzled, and still paranoid, I found myself a new gyno in the town I had been living in for less than a year. The initial exam was fine, and I don't really remember much about it. She did bloodwork which showed that I wasn't pregnant, and she switched me to a different brand of The Pill. For a few months, AF came quite regularly... and then she disappeared again.

Once again paranoid about being pregnant, I scheduled an appointment. The gyno I saw in May was ironically out on maternity leave, so I saw a nice older doctor named Dr. B. Once I got over the fact that Dr. B very strongly resembled Santa Claus, we got along swimmingly. Great personality, truly caring and none of Dr. R's infamous anal probes. He switched my pill again..... and a few months later, he switched it again..... and a few months later, he switched it again..... You get the idea. AF would visit regularly and then disappear mysteriously. I think I was on 4 or 5 different versions of The Pill after my initial prescription for it. Dr. B changed the dosing so that I would only get a period 4 times a year instead of 12, even though I saw AF's monthly visit as reassurance that I wasn't pregnant. He was part of the camp that said that women don't need to menstruate every month, whereas I was of the camp that saw getting a period as being "normal" and as an indication that I wasn't pregnant. Starting a family was just about the furthest thing from our minds at that point.

Finally, Dr. B reached a point where he (very nicely) said, "I can't do anything more for you. I think you should see a Reproductive Endocrinologist (RE) who can give you more assistance and find out what is going on with your PCOS." Up until this point, no one had ever really done anything for my PCOS - we weren't interested in having kids, so there was no need to really do anything.... or so they had thought.

I believe it was in 2005 or 2006 that I had my first RE visit with Dr. H. She was a very nice woman who was the first to enlighten me about the connection between PCOS and the insulin/glucose cycle. She also ordered up my first transvaginal ultrasound. Oh the joys of being probed with a wand. I learned that my left ovary apparently likes to hide - that was an uncomfortable lesson to learn. More bloodwork ensued. She was a big fan of the glucose tolerance test (GTT). That test, in one word = YUCK. She wanted me to lose weight - at least 10% of my current weight - and she suggested the South Beach Diet (more on my diet history in another post). She put me on yet another version of The Pill. She also gave me a prescription for a diabetes drug known as Metformin (the generic form of Glucophage). It's been shown that if you regulate insulin, you will in turn regulate testosterone and ovulation. Met came with some unfortunate side effects (stomach-related, namely diarrhea). I had done some research on my own and found that if I was on the extended-release version of Met, the side effects may be diminished. Unfortunately Dr. H didn't acknowledge or accept that there were two different versions of Metformin. Instead, she switched me to Avandia.. I had been on Avandia for a month or two when I was scheduled for a re-check with Dr. H. At that visit, one year after our first, she told me that she was leaving the practice for personal reasons. At my next check-up, I began seeing Dr. H's replacement - Dr. L.

My first visit with Dr. L. was in 2007 right as the news about the risks of taking Avandia was hitting the airwaves. In a "better safe than sorry" move, Dr. L took me off of Avandia and put me back on the Metformin - the extended release this time, thank God. She may or may not have changed my prescription for The Pill - I really don't recall. I do know that she was not a fan of the GTT, and instead looked at fasting insulin and glucose, as well as A1c levels, to determine how well I was responding to the drugs. At that point, I wasn't consistently following South Beach, and she wasn't a huge fan of it, so she referred me to a dietitian (more on that in the diet history to come). I saw Dr. L until 2009. I was not incredibly faithful to the dietician, the Met or The Pill. In fact, at my last visit, I think I had been off The Pill and The Met for several months. I didn't really disclose this to her. I think I had just reached a point of giving up. AF was more miss than hit. I was pretty sure I wasn't ovulating - if I was, I would have gotten a visit from AF. The Met side effects weren't fun - she had me on 1500mg and encouraged me to try 2000mg. We still weren't ready for kids, so I kind of had an attitude of "why bother with any treatment". My main reason for that last visit with Dr. L in 2009 was because I had lost my job, which meant a loss of insurance. "Squeeze one more visit in before the benefits are gone," was my logic.

I left that appointment and continued drug-free until 2010, which is where we'll pick up again next time.