My apologies for starting to blog about my infertility journey and then just stopping. After the HSG, things just started spiraling down. It was one hit after the next. It probably would have been a good time to blog about how I was feeling, but sometimes when things get so dark I tend to crawl into a corner to hide.
So, where to start. This is sure to be a VERY long post with all that has happened in the past year. Let's just start with the HSG results. My OBGYN sent me for an HSG and my husband for a sperm analysis before she would start us on Clomid.
My HSG results were inconclusive. That's my term, not the words of the Reproductive Endocrinologist (RE) who performed my HSG. Let me explain. I was on day 5 of my cycle, so I was still partly bleeding. They don't like to do the HSG that early in the cycle, but since the RE is only at our office on Tuesdays it was either do it on day 5 or do it on day 12. My OBGYN said day 12 was too late to do it, so we went with day 5. (My OBGYN could not perform the HSG herself.) So, I met my RE, Dr. Bradford Bopp, for my HSG. I was really nervous. Even now, I can remember lots of crying that morning before my HSG. My husband was working and was meeting me at the outpatient surgery center where the test would be done. I got there around 4 pm. The test was at 4:30 pm. The RE likes to do them late in the day as he heads back down to his main office 2 hours away. I was nervous about having a male RE. I just never understood how a male could know more about the female body than I do. Anyhow, any reservations I had about him were gone the second I met him. He is simply wonderful. He walked me through every step of the HSG and talked to me about what we were seeing on the screen. I noticed that dye wasn't spilling out on both sides and I started to panic. I do the research and I know that one of those tubes is blocked! He pushed more dye, which was really uncomfortable as I recall, but it just spilled out the open side. He nearly immediately calmed me. He said that he was 95% certain that my tube wasn't blocked. He said that he pushed through a clot on my right side, and he was fairly certain a clot was blocking the entrance to my fallopian tube on the left side. He just couldn't 'bust' through because he couldn't get pressure built up to bust through, since the dye was all spilling out the right side. He could see something obstructing, and because I was at day 5 of my cycle and still bleeding, he was pretty confident that was just a clot and my tube is fine. He admitted he couldn't say with 100% certainty, but he was confident enough to tell my OBGYN to start the Clomid. If I wasn't pregnant in 3 months, he said we may want to repeat the test. He said he really did not like to do these tests that early in the cycle because of the clots that haven't dissolved yet. I told him that the following Tuesday was day 12 and I was told that would be too late. He said, usually yes, because they don't want to do anything to interfere with ovulation which occurs around day 14 for most women. I told him that I don't typically ovulate before day 25, to which he replied that day 12 would have been fine then for the HSG. (Just one of the FIRST things that showed me my OBGYN really didn't know much about all of this.) So I say the test was inconclusive, because there was not 100% certainty about my left tube.
Now onto my husband's sperm analysis. The thing about telling the story now is that we have been through so much on this struggle and I know now that I was dealing with a fairly incompetent OBGYN. At least when it comes to infertility and PCOS... and her nurses were even more infuriating! My husband had to go to the RE's fertility clinic for his sperm analysis, but they would not release the results to us since my OBGYN ordered the test. We had to wait a couple days for them to call us. My OBGYN called me personally, she didn't send one of her nurses to do it. She said there were concerns about my husband's sperm. She told me his sperm count was 17 million, which was just the very low side of normal. She never gave me numbers on his motility (speed/movement) or morphology (shape). She only gave me count numbers because I asked for them. She also mentioned his PH level was high, which meant that he could have had an inflammation/infection that was killing the sperm. She said that she would prescribe him an antibiotic and we would repeat the test in 2 weeks. Well, my husband could not take a day off work again for another test. The fertility clinic didn't have weekend or evening hours for sperm analysis. I explained to my OBGYN... well technically her nurses who passed it along. They were hesitant to have my husband go anywhere else because the parameters are different everywhere. Going to the hospital lab would likely show different results and it would be hard to compare them. I understood what she was saying, but we did not have any other options. So reluctantly, she ordered the sperm analysis done at the hospital lab. These results took much longer to get. However, my OBGYN called and said that everything was in normal ranges and we could proceed with Clomid.
This was frustrating because I wasn't monitored at all other than a progesterone test. Then, this progesterone test was like banging my head on a wall. The nurses were ADAMANT on me coming in on day 21 of my cycle for this test. I said, isn't it supposed to be done 7 days after ovulation? They said, yes, which is day 21. (Head. Banging. On. Wall.) I explained that was not true for me. They were so darn certain I ovulated on day 14. I use ovulation tests, I know (even on Clomid) that I don't ovulate that early. No way would a progesterone test be accurate then. The first round of Clomid didn't even work for me. On day 21, I hadn't even ovulated yet. FINALLY I proved my point to the dumb nurses.
So, the next 4 months:
Round 1 (March 2013): 50 mg Clomid days 5-9, and Estradiol (estrogen) days 10-21. Hubby and I had sex the day of my positive ovulation test but we discovered my husband couldn't have sex on back to back days. He couldn't 'finish' which is obviously the most important part. (Red flag beginning to go up in my head here...) Progesterone level at 7 days after ovulation was 8. The nurse tried to tell me I didn't ovulate at all. It's frustrating to know more than the nurses. I use ovulation kits, I chart my temp, I do everything but administer an ultrasound on myself... yes lady, I DID ovulate! I have read up, and anything over a 5 is usually ovulation of sorts, but if it isn't at least a 10 then it's a very weak ovulation with an immature egg. So don't tell me I didn't ovulate! I actually ovulated on day 25 like normal. (Can you tell these nurses had me FRUSTRATED) Needless to say... failed cycle.
Round 2 (April 2013): Dose increased to 100 mg Clomid days 5-9, and Estradiol (estrogen) days 10-21. Same issue with having sex every day around ovulation. So we only got in maybe twice somewhat close to ovulation. Progesterone level at 7 days after ovulation was 11.5... I don't quite remember. My OBGYN was happy with that number. I thought it was still low, even though I ovulated on day 20 this time which was my earliest ever. My OBGYN decided we would stick with that dose because it was working. Once again, not pregnant. However, my temps post ovulation were pretty rockstar. I know I was impressed! They were never that high, and I had pretty high hopes.
Round 3 (May 2013): 100 mg of Clomid days 5-7, and Estradiol days 10-21. Again, issues with sex. I know my husband was feeling the pressure of it all, but I still felt like there was just more to this issue. Progesterone level at 6 days after ovulation (because of the timing of it all, the office would be closed on 7 days after) was 10.5. I was devastated at that number, but my OBGYN was not overly concerned. She did finally agree to bump me to 150 mg IF the cycle wasn't a success. Well guess what, the cycle failed again. Not pregnant.
At this point I decided to take matters into my own hands. I was growing increasingly frustrated with my OBGYN and her nursing staff. She wasn't monitoring me at all. No day 3 tests, no ultrasounds... all these things that seem fairly standard on Clomid. All she was doing was bringing me in 'every other cycle' for a physical exam to make sure I didn't have ovulation hyper-stimulation syndrome. So, the fertility clinic offered a fertility test bundle that included day 3 estradiol, day 3 FSH, and a sperm analysis for $100. My insurance doesn't cover ANYTHING, so this was a deal for these 3 tests. We didn't need another sperm analysis, but the other 2 tests through my OBGYN likely would have been $100 each. So, at the beginning of my next cycle, I went to the fertility clinic without telling my OBGYN. I didn't need her to order the test, so I did it for my peace of mind. While the nurse was drawing my blood, we were talking about everything. I mentioned that my OBGYN wasn't even monitoring me on Clomid, that she just brought me in every other month for a physical exam to check for ovarian hyper-stimulation syndrome. The nurse looked at me puzzled. Well, now I know why. You can't know if a woman has OHSS just from a physical exam! You need an ultrasound! My OBGYN's physical exams were pointless. Just costing me an additional $100 each time. I also learned that my FSH levels and Estradiol levels on day 3 were normal. (SHEW, peace of mind restored) The nurse at the fertility clinic had also brought up my age (35 at the time) and how if we had already been trying for a year, we should have already scheduled an appointment with the Reproductive Endocrinologist. I explained that when I saw my OBGYN in June of 2012 that she wanted us to try naturally through the end of the year and follow up after the first of the year with her. When we followed up, she decided with my history to do an HSG test before we started trying Clomid. So basically, turns out, my OBGYN wasted a year of our time pretty much. She knew when I saw her in June that we had been trying for 4-5 months at that point. She should have done more then. That was the time for the HSG test and to get Clomid going. I should have been to the RE by the end of the year. (*insert MORE frustration with my OBGYN*)
After leaving the fertility clinic that day, I decided that I was scheduling an appointment with the RE in July. I scheduled the appointment for the week after I knew my cycle would end. That way if I DID get pregnant, I could still cancel. The emailed me a packet of paper work to fill out. Yeah, like 30 pages! It was INSANE!!!! However, I had a little over a month to finish it.
Round 4 (June 2013): 150 mg of Clomid days 5-7, and Estradiol days 10-21. Yup, still issues with having sex every day, but by now we were at least able to do it every other day and time it accordingly since we expected the issue. This was a cycle where she wanted an exam, so I came in at 4 days after ovulation. I told her I was ready to go to the RE now, if this cycle didn't work. She advised me to schedule because usually it takes 2 months to get in. She was advising to schedule now and we could continue Clomid until then. Then I told her I had already scheduled it and the appointment was in 2 weeks. All of a sudden, she decides we should do an ultrasound because I hadn't had one done. *facepalm* I was very skeptical because the ultrasounds are supposed to be done BEFORE you ovulate, not 4 days after. I am NOT stupid!!! However, I had never had one done and I was curious to see if I did ovulate... since the nurses liked to argue that point with me. If I would have know the ultrasound was going to cost me $500 I would have thought twice!!! (Nope, insurance wasn't paying) Anyhow, the ultrasound confirmed I ovulated and the corpus luteum was 17mm. That's a bit smaller than they would normally like, but it could have potentially shrunk from it's pre-ovulation size. Then I came back for my progesterone test. It was 6 days past ovulation, but I was leaving for vacation later that day. My progesterone was 13. Not terribly bad for doing the test early, and again they all thought it was a great number. I still felt like it was low. Then, the day we got back from vacation, Aunt Flow showed up and again the cycle was a failure.
I was so defeated, but I had the RE appointment to look forward to. I had scheduled it with the same RE who did my HSG test. I was scared he would want to repeat the HSG test and I really didn't want to figure out how I was coming up with $1,000 again. As it was, the RE appointment was $200. They asked for my husband to do a sperm analysis again so we would have current results. So they scheduled him at 11:30 am. Then we went to lunch and came back at 1 pm for our appointment. (Yes, they processed his results that quick!)
So we talked about a lot of things with Dr. Bopp. He even made my husband feel comfortable which was no easy feat! Then he told me we needed to up my Metformin ER to 1500 mg and I could stop taking the Pregnitude supplement I was trying because it wasn't really helping me. He told me that he could try Femara with me instead of Clomid. Women with PCOS do respond well to it. (He also did, indeed, confirm I have PCOS. No more doubts.) He said the problem was that the Femara was likely not going to get us pregnant. Then that's when the truth came. My husband's sperm were not very well off. 6 million count, only 14% motility, and morphology was 4%. (Low side of normal is 20 million count, 50% motility, and 5% morphology) I remember hardly being able to breath. I asked the doctor why it would have declined so much since the last test. He couldn't see the hospital sperm analysis results, but he had the first one that my OBGYN said was 17 million. He looked at us and said it was actually better than February's results. I was confused. He said that February was 4 million. I told him that the OBGYN said it was 17 million. He said no, he said that was the volume. Not the count. (Banging. Head. On. Wall. Again.) My OBGYN couldn't even read a sperm analysis result! 4 more months of time completely wasted because the chances of us conceiving with my husband's current sperm condition was extremely low.
At that point, he recommended we try IUI. I have also done extensive research on IUI. They like a postwash for 10 million for a chance at REAL success. How in the heck could my husband have anything close to that? He couldn't produce that prewash! Without knowing for sure, I am guessing my husband's problem with back to back days of sex is the fact he doesn't produce much semen in general. He had a very low volume. So when he couldn't 'finish' during sex, it was probably because he didn't have much to 'finish' with. It makes sense to me! I was panicking and trying my best to hold it together. I knew my husband's heart was breaking too. He knew how much this meant to me, to have a baby. He had also wrapped his head around it and was excited about it too. I am sure hearing that he was equally to blame for our issues was devastating to him. So at this point, I basically asked the RE if we should even bother with IUI or if we should cut straight to IVF. IUI seemed like a lost cause to me. He explained that yes, the odds were better with IVF. In my husband's case, they would recommend ICSI with IVF. This is where the insert one of his good sperm directly into one of my eggs to ensure fertilization. Regular IVF, they just kind of 'mix it all' together in a dish. My husband's sperm were bad enough off, that ICSI would provide higher success. However, the RE told us that he really wanted my husband to have a sperm wash done. Basically, they wash the sperm as they would before an IUI and see what kind of good guys they can get. That way, we could see if IUI was an option. My RE said they needed 1 million post wash to do IUI. I was still hopeless about this, but I figured this was much cheaper than just jumping to IVF.
We wrapped things up with the RE and the second I left the office, I crumbled. I couldn't hold the tears back anymore. I was beyond devastated. How would we come up with money for IVF? If we did come up with the money, there are no guarantees it will even work? I had so many thoughts going through my head. Then my husband asked me what I figured he was thinking. "Are you crying because of me?" After he asked that, I was almost hyperventilating I could barely breath, let alone talk. I was really, REALLY upset. When I could breath again, I told him no. I said I don't blame him. I said the appointment was devastating in general. The past year we had thought that my PCOS (and being overweight) was the only issue, then to find out that he has issues too. That the past 4 months of Clomid were just more time wasted. That his sperm was ALWAYS really bad from the first analysis, and my OBGYN was too big an idiot to know it. No, I didn't blame my husband and he wasn't the reason I was crying. I was crying because at that moment, I had no hope. None. I actually cried the rest of the day. I couldn't wrap my head around all of this. I stayed home from work again the next day, because I just couldn't face people. I couldn't bare the thought of running into a pregnant woman. Particularly, the pregnant woman at work who was always outside smoking. That just seemed like a cruel thing to witness so shortly after our news.
On my day off, I did some more research on the FertilAid supplements for men. The reviews seems too good to be true, so I was very skeptical. People were accusing them of paying people to write positive reviews because feedback was often at least 4 stars, if not 5 stars. However, I was desperate. It couldn't hurt to try. My husband wouldn't go to a Urologist because he is terrified of surgery, so really our options were gone. I asked my husband if he would take these supplements if I bought them. At this point, he felt so horrible I think he would have done anything. He agreed. So I ordered FertilAid for Men, CountBoost, and MotilityBoost. At this time they do not have any supplements for morphology. There isn't a lot of research about ways to correct morphology. When the supplements came, I bought an AM/PM pill box and filled them up for the week. We decided to leave them in the bathroom where he would see them and remember to take them. Once he started taking them, I decided to set up that Sperm Wash, but again the problem was my husband couldn't make the local clinics hours. Turns out the main office, 2 hours away, has Saturday appointments. So I scheduled the appointment for October 13th and we decided to just make a weekend of it. We would do the test Saturday morning and then go out that evening for dinner and haunted houses with some friends of ours. We wouldn't have the results right away anyhow. October 13th was just over 10 weeks after our RE appointment. The supplements said they needed at least 10 weeks to turn things around, since sperm takes that long to regenerate. He was pretty diligent on the supplements. He'd miss a dose here or there, but mostly he did good. He also SWORE he saw a noticeable change. His sex drive had increased, he said he was producing more sperm (he could tell), and we also noticed we weren't really having the issues with back to back days of sex. I was getting my hopes up that these supplements just might be working.
Well, I was right. Post wash, he had 8 or 9 million. His motility post wash was around 50%. Of course, his morphology was still 4%. All in all, things had improved and the RE and his nurses were super impressed. The nurse asked if my husband had changed anything since the last test. I said nope, just started taking the supplements. She didn't seem to believe the supplements could be responsible for such a turn around. Mind you, 8 or 9 million doesn't SOUND like a lot... but that was AFTER the wash. Before, my husband was only producing 6 million before the wash. Regardless, our odds were looking a lot better for IUI so we decided to proceed.
At the beginning of November I went in to begin my IUI. They did a day 3 ultrasound for my AFC. AFC is where they count the follicles on my ovaries to make sure I have a normal range. Usually PCOS women have a higher than normal range. I was just normal. 16 on my right ovary and 6-8 on my left ovary. She was having trouble with a finite count on that side. At my age (now 36), having anything over 20 was a good thing. I had 22-24 total. 30 or more total would have been more common with PCOS, so I am just not traditional PCOS I guess. That night, I started injecting myself with Follistim. First just 75iu for 5 days, then my first ultrasound. No growth of the follicles on my ultrasound. That knocked my head out of the clouds, but I guess it's normal as they figure out your dose. My RE increased me to 150IU and wanted me back again in 5 days. At that ultrasound, I had 2 follicles growing on my left and 1 follicle on my right. The largest was on my left. Again, I was wondering about my tube being blocked on the left because of the inconclusive results of the HSG. Anyhow, 3 follicles growing was good! So he kept me on the 150IU dose. The nurse thought he'd want me back in 2 days to check again, which was a Saturday. Nope, he said Monday. So of course, I am stressing about ovulating too soon. He upped my does... why does he want to wait so long when they've grown already. They needed to be around 20mm and currently the largest was 14mm. Oh well, had to stick with his judgment. I knew my trigger shot to induce ovulation was around the corner, so I was researching Ovridel which is the trigger he gave me. Much to my dismay, I found horrible articles about it. A renowned RE wrote a huge article on how Ovridel in it's pre-filled dosage was too weak. That using Pregnyl or basically any other trigger was much better than Ovridel. If Ovridel was to be used, the dose should always be doubled. Okay, now I am just LOOKING for something to go wrong!!!
Well, the Monday ultrasound came and sure enough! One follicle on my right (right took the lead after the last ultrasound when left was winning lol) at 21mm and one on my left at 18mm. The 3rd follicle stopped growing. However, 2 was still great they assured me. The nurse all but KNEW the trigger would be that night, but said she'd call after she spoke with Dr. Bopp. She did call and tonight was the night. They set up our insemination for 11 am on Wednesday, so I needed to take the Ovridel shot at 11 pm that night. That way there was 36 hours in between. My husband had to be in the office at 10 am to give his sample so they had time to wash it before the insemination. So we did all that and we were in high spirits after the insemination on Wednesday. His sperm were the best ever! His count before wash was 90 million!!!! *queue jaw drop* After wash, he had 26 million! His motility was around 70%, morphology was not yet determined because that took a couple days to see. Rockstar results, so to say we had very high hopes would be an understatement. How could this not work? It was short lived though. My temp did not spike on Thursday. In all rules of temp charting, my temp should have spiked Thursday morning to indicate ovulation did occur as planned. Nope. I start freaking out. Then Friday, my temp did go up, but not as much as it had when I was on Clomid. Saturday, my temp was up. So that means, I did not ovulate on Wednesday around the time of the IUI. The nurses knew NOTHING about temp charting, they basically admitted it was kind of a crap shoot. MOST women ovulated 36 hours after Ovridel was given, but some don't. Well, they couldn't confirm it... but I knew I was one of the few that didn't. I ovulated pretty late Thursday more than likely. So almost another 36 hours after insemination. We did have our 'backup sex' on Wednesday night as instructed, but we didn't bother on Thursday. Thursday was a long day for both of us. Then, of course, I needed a 7 days after ovulation progesterone test. The thing is, I KNOW I didn't ovulate on Wednesday, the day of the insemination. However, the nurses have to assume I did when they schedule the progesterone test. *sigh* They scheduled my progesterone test for Tuesday morning. By my counts, that is 6 days after ovulation, and one nurse was telling me I could come in on Monday for it! (5 days after ovulation by my count) I was not looking forward to this progesterone test. They called me the same day with the results. 8.5 So, they wanted to start me on progesterone supplements since it was low. I was a bit frustrated because they did my test a day early even by THEIR timing of when I ovulated. However, I KNOW I ovulated either late Thursday or early Friday, so my test should have been done on the following Thursday at the earliest! So, by my calculations, I had an 8.5 level on either 4 or 5 dpo. So chances are, my progesterone was fine and I didn't need those nasty vaginal progesterone supplements. However, if I was pregnant and my progesterone was low.. and I lost the baby just because I was set on proving the nurses wrong... well I just couldn't live with that. So, a friend of mine had sent me leftover Crinone suppositories that she had from when her RE weened her off them in her pregnancy. At least they didn't cost me a thing. They were horrible though. I hated it so much! Then, of course I had TONS of pregnancy symptoms all thanks to the trigger shot and the progesterone suppositories. However, one thing that wasn't right was my post ovulation temps. They were just low. Progesterone was supposed to make them higher. My confidence was dwindling. I knew it wasn't timed right. Everybody told me Aunt Flow wouldn't show up until I stopped the progesterone. My temps would stay up. So I had to test on 14 days after ovulation to confirm I was or wasn't pregnant. If I wasn't, I would have to stop the Progesterone to bring on Aunt Flow. WRONG!!! My temps started dropping WHILE I was on the progesterone. They were falling right when I figured they would, based on when I knew I ovulated. She showed up right on the 14th day after ovulation. I already knew I wasn't pregnant, but knowing it for sure was a special kind of hell. We spent $1500 on the IUI and $1700 on all of the Follistim and Ovridel for the cycle. $3,200 of our money down the drain. We easily spent $6,000 last year on all of the infertility tests, treatments, and appointments because insurance didn't cover it.
I have been in limbo ever since. The holidays have always been hard since my Dad died in 2010. Then add to it, the failed IUI with a side dose of SERIOUS family drama with my cousins. December 2013 may have been the worst month of my entire life. Eh, scrap 'may have' it WAS the worst month of my entire life. I haven't taken my metformin or my prenatal vitamins in a month, my husband hasn't touched his supplements in a month either. We both need to work at eating better and losing weight, and to say we have no motivation is an understatement. All I have done the past month is find a way to NOT deal with my infertility problems. I need to lose 30 lbs to do IVF. That's what the RE told me. However, I just don't know what I am losing it for. I started out with a lot of optimism about IVF. 3 of my forum buddies did IVF in the October/November/December months. All 3 had positive pregnancy tests! The first one was even going to send me all of her leftover Gonal-F for me to use for IUI or IVF. My RE said that was fine if I trusted her. She was saving me $3,000. She had gotten pregnant on her first IVF cycle and her insurance had paid for the meds anyhow. Well, as if December could NOT get any worse....... I learned on December 11th, that she miscarried at 8 weeks. No growth, no heartbeat. Nobody has heard from her since she shared the news. My heart was so broken for her, and all of my fears of IVF were back. It didn't matter than my other 2 friends had found IVF success (so far at least) and one was even having identical twins. All I could think about was how my one friend went through ALL of this, WAS pregnant, and still miscarried and lost it all. Miscarriage rates are higher in IVF, I know this. How do I feel about potentially spending $20,000-$30,000 on something that might not work? We'd have to finance, and that monthly payment would be a constant slap in the face that we blew money on something that only really had maybe a 28% chance of working for us.
Before somebody mentions adoption as an option... just know it's not an option for us. My husband has some false charges in his past that could or could not arise in the adoption process. We have no way of knowing. So getting invested into adoption and paying a bunch of money that won't be refunded, just to be told we couldn't adopt because of him........ well, I don't want to go there. He shouldn't have to be punished a second time for something he did NOT do. Without going into detail, just know that my husband's Dad really picked winner wives or step-monsters as I like to refer to them. My husband had bogus charges brought against him as a minor that had him in a juvenile detention facility for 2 years. It's not my place to post his business on my blog and he is still very much bothered by the whole thing. So bothered, he was never going to tell me about it. Then his cousin accidentally brought it up a month before our wedding. He thought I would leave him over it, that I wouldn't believe him. I know the person he is and I know his heart, I also know that sometimes common sense is a little lacking with him. He did not do what he was accused of by his evil step-monster, but it could possibly still be following him around. There is no way of knowing for sure, and it's a deal breaker for adoption. So, adoption is out of the picture.
So there is 2013 in review. I don't know what's next. I haven't really thought about it. Well, I have... but I am having trouble finding the will to care. If we can never have kids, it's too painful to think about the rest of my life without them. I love my husband and I love my family. I am not going to do anything stupid like kill myself... but there will always be a hole... an emptiness. It's not a reality I can easily accept. However, I am not sure I can put us SO far in debt on a small chance of our dream coming true.
