Infertility 101

WARNING:  This post may be more information than you ever needed to know…so, if you’re not interested…scroll down to the next post!

Well, timing of this menstrual cycle has interrupted my injection schedule… so I’m on a different route this month.  While on this path, I thought since so many people have questions about what I have been doing to try to get pregnant, I would fill them in.  So, here’s a mini infertility lesson on what we have been up to this year.

First, I approached my ob-gyn about having difficulty getting pregnant due to my irregular cycles.  Doctors usually start with the most conservative treatments, so I started Clomid.  What is Clomid, you ask?   Clomid is a BITCH producing pill.   Oh.  Just kidding.   That’s what happened to me when I was ON it! 🙂

Clomid is the most common drug prescribed for infertility.   This drug is taken orally and stimulates ovulation in women who have polycystic ovary syndrome (PCOS) (which I don’t have) or other ovulatory disorders. It causes the pituitary gland to release more FSH and LH, which stimulate the growth of an ovarian follicle containing an egg.  SO, basically, in lay man’s terms…This medicine (which you take as a pill) stimulates your ovaries to release eggs, so it improves your chances of getting pregnant. It is often tried first because it is considered safe and effective.

Each unsuccessful cycle, the doctor usually increases your dose of Clomid.  Side effects of Clomid are evil…mood swings, (I think that is putting it mildly…..INSTANTANEOUS BITCH is a better description!) hot flashes, breast tenderness, major bloating, and the best…vaginal dryness.  (Which is so not conducive to getting pregnant!) FYI – Did you know that there is ONLY one semen safe lubricant on the market?  It’s called Pre-Seed.   (I actually think that name is HILARIOUS! But then again, that’s my sense of humor!)  Anyway, you can order it online.

Clomid has more side effects than gonadotropins (the next step in infertility) but it costs less, has a lower risk of ovarian hyperstimulation syndrome (I’ll explain that later), and is less likely to result in a pregnancy with more than one baby.  I tried Clomid until June…increasing my dosage with each unsuccessful cycle.

In June, I met with my ob/gyn and said, “This is not working, what else can we do?”  He suggested Femara… and I suggested seeing a reproductive endocrinologist.  He supported that decision, and prescribed Femara until I could get in to see the new specialist.  (little did he know, I had an appointment scheduled for 2 weeks later!)

Femara.  Also not fun.

Femara is an aromatase inhibitor. This class of medications, which includes letrozole (Femara) is approved for treatment of advanced breast cancer. Doctors sometimes prescribe letrozole for women who don’t ovulate on their own and who haven’t responded to treatment with Clomid. Letrozole is not approved by the Food and Drug Administration for inducing ovulation. (However, it is widely used in Canada for this reason).  The drug’s manufacturer has warned doctors not to use the drug for fertility purposes because of possible adverse health effects. These adverse effects may include birth defects and miscarriage.

So, Femara is a bit scary to take.  When you pick up your prescription, it has stickers slapped on all over the bottle, DO NOT USE IF PREGNANT OR PLANNING TO BECOME PREGNANT. Reassuring.

Femara’s side effects are the same as Clomid, for the most part.  I also got huge headaches from it, but I did not notice a mood swing issue!  (Thank God!)    Femara led to another unsuccessful cycle.   By then, I had met with my reproductive endocrinologist, whom I love!  He’s great to work with!  But, more about that later…

I went in on Day three of my cycle the first week in August.  I had a vaginal ultrasound to take a peek at my ovaries and uterine lining.  During the ultrasound, they saw some suspicious mass which could have been either fibroids or tissue that still had to be shed during my period (since I was only on Day three).   I had to have a hysterosalpingogram (HSG).  An HSG is an X-ray test that looks at the inside of the uterus and fallopian tubes and the area around them.

During a hysterosalpingogram, a dye (contrast material) is put through a thin tube that is put through the vagina and into the uterus. Because the uterus and the fallopian tubes are hooked together, the dye will flow into the fallopian tubes. Pictures are taken using a steady beam of X-ray (fluoroscopy) as the dye passes through the uterus and fallopian tubes. The pictures can show problems such as an injury or abnormal structure of the uterus or fallopian tubes, or a blockage that would prevent an egg moving through a fallopian tube to the uterus. A blockage also could prevent sperm from moving into a fallopian tube and joining (fertilizing) an egg. A hysterosalpingogram also may find problems on the inside of the uterus that prevent a fertilized egg from attaching (implanting) to the uterine wall.

My HSG looked great!   No problems!  Because a person usually starts a regimen on Day 3 – 5 each cycle, my specialist did not want to start me on shots in case he found anything during the HSG.  So, I did a cycle combining 3 days of Femara and a few days on injections.  This cycle produced one viable egg when I ovulated.  But, again, we were unsuccessful.

Ovarian hyperstimulation syndrome is the overstimulation of the ovaries that may occur as a result of assisted reproductive technology (ART). ART is a type of infertility treatment that uses multiple eggs at one time to raise the chances of producing embryos that are good candidates for fertilization.  Basically, these cysts can occur after a round of injections due to the medication producing multiple eggs.  While Clomid increases your chance of having twins or triplets (especially twins), women who take hormonal injections are even more likely to have twins, triplets, or more babies. (My doc told me a 20% chace of multiples with the injections).

So, after this first round of Femara and injections, I ended up with a large cyst (Ovarian hyperstimulation syndrome).  Doctors monitor closely for signs of ovarian hyperstimulation through vaginal ultrasounds.  My ultrasound showed a large one!  Unfortunately, the only thing you can do when you have this is to wait…until your body has dissolved the cysts.  So, I went on birth control pills for 3 weeks until the next ultrasound to check if my body had indeed dissolved it.  That was exactly what my body did!

This brings us to September.

We decided to go a bit more aggressive and try straight injections.

You start the first series of daily shots at the beginning of your menstrual cycle. Mild side effects can occur such as feeling sick to your stomach and bloating. Some women have more serious side effects due to multiple, large ovarian cysts (ovarian hyperstimulation syndrome).

The two drugs used for my injections… Bravelle and Menopur.

Menopur is  a highly purified mixture of human follicle-stimulating hormone (FSH) and luteinizing hormone (LH) activity, the most important hormones for inducing the growth of the follicles that produce ova (eggs).  Basically in English, it stimulates egg follicles to grow within the ovaries.

Bravelle basically helps those egg follicles grow to reach maturation so that when ovulation occurs, they can then be fertilized.

AND Ultrasounds are performed every few days during the shots to monitor how many eggs are growing, measure them, and plan for ovulation induction.  Ovulation induction is a type of medical therapy often performed alongside most fertility treatments.  Ovulation induction often triggers the release of more than one egg during ovulation.

Why do we need ovulation induced you ask?

Ovulation is often induced in order to help women who cannot ovulate regularly produce an egg during their montly cycle or in order to trigger the ovaries to release more than one egg during ovulation. Sometimes, inducing ovulation can allow two or three eggs to be released at once, therefore increasing your chances of pregnancy.

How do they induce it?

The ultrasound detects egg quantity and quality as well as measures the uterine lining to insure that it is thick enough to support a pregnancy if the eggs are fertilized.  Once eggs reach 17-20 mm, you are often given an HCG injection.   HCG is the Human chorionic gonadotropin.  hCG is a hormone that is typically produced in a pregnant woman’s placenta. It helps to maintain the corpus luteum, which produces progesterone and estrogen in order to maintain the first trimester of pregnancy.  HCG is the hormone that turns your pregnancy test positive, as it is excreted in your urine.  As ovulation will happen about 36–48 hours after the injection of hCG, procedures can be scheduled to take advantage of this time sequence.

What procedures?

Well, you have to have intercourse during this time to insure that sperm are there waiting when the egg  is released.  Another procedure, IUI.  An IUI — intrauterine insemination — is performed by threading a very thin flexible catheter through the cervix and injecting washed sperm directly into the uterus.  So, with being inseminated comes a whole other set of procedures.  Hubby produces the sample through ejaculation into a sterile collection cup.  Then I have 30 minutes to get it to the doctor’s office!   Plus, I must keep it warm!  (So, picture me driving to the clinic with this cup sitting in between my legs while I drive!)

Once you get to the clinic, the semen sample is washed before it is used for insemination.  This procedure takes 30 minutes.   As soon washing is completed, the insemination is done as soon as possible.  (as described above)

Why do the insemination if you’re also having intercourse?

On any given cycle, any woman has a 20-25% chance of conceiving.   IUIs done with fertility drugs that produce multiple eggs have success rates of up to 30% associated with them.  So, why not do the insemination?  It just adds to the chance of possible conception each cycle!  🙂

So, after a round of injections and IUI, again no success.

October – we tried the same thing.  No success.

November, I had to change the plan a bit as if I did injections, I would need to be inseminated on Thanksgiving Day, and I will be in Chicago – 400 miles away from my doctor’s office.

Our solution:

Rather than skipping a month and chancing my cycle to be whacked out at 60 days again, I am doing another month of the oral Femara pills… but my dosage has been increased a bit.  We’ll see where this cycle takes us…

Keep your fingers crossed!

(I hope this answered some questions you had about our “adventures!”)

3 thoughts on “Infertility 101

  1. I tried to leave a comment last night from my iphone but the links in the comment box wouldn’t work. ANYWAY. I totally feel for you. We went through it all when we were TTC. The IUI’s turned out to be successful, but goodness, it really takes a lot out of a person. I’m extremely private, and the LAST thing I wanted was for the whole world to know that not only was I ovulating, let alone that the cup between my boobs (to keep it warm) was my husband’s sperm.

    I know it’ll happen for you, and I can’t wait to read the announcement!

    :mingling:

  2. Thank you! 🙂

    Yeah, I guess I put it all out there… as I would die if I had to deal with all of this myself.

    Thanks for sharing your story with me! It’s encouraging to know I am not alone!

  3. Hi people!! .!! Happy Thanksgiving! .! 🙂 🙂 🙂 🙂
    Thanksgiving is 1 of my favorite holidays, and each year I like to get into the mood-extend the holiday, when it were-by reading “Thanksgiving novels.” Of course, all these stories are mostly about family and friends, about coming together to heal old hurts and giving thanks for the gift of love. … ”
    Think You Are Better Off Today Than You Had been five Yrs Ago?

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