First Trigger Shot and What I’ve Learned Since Trying to Conceive

Tonight I will take my first trigger shot! I am both excited and nervous. I’m not exactly thrilled about sticking a needle into my stomach…but hey, it’s what I’ve got to do and there are worse things.

Of course this also means hubby and I will have to ‘do the deed’ tonight and according to my doctor, the next three nights. Not that hubby is complaining and honestly, I’m not either. My body is responding naturally to the growing follicles as if I’d ovulate on my own and so my fertile window is open and therefore my sexual appetite has increased over the last few days. Nope, no complaints!

Then we have the dreaded two week wait…something we all have to go through and something we all hate. Even if you’re hoping to NOT be pregnant, the two weeks drag on slower than sand in an hour glass. It’s like watching every tiny grain of sand drop to the bottom of the glass, and then the next, and then the next…each one falling slower than the last.

During this time we’re like mad women, driven crazy by the what-ifs. What if I am pregnant, what do I do then? (Call the doctor, of course but in that moment your brain is a haze and common sense just doesn’t exist). What if I’m not pregnant, what do I do then? What if I am pregnant but it isn’t viable or something is wrong?

All the while we’re also over analyzing everything our body is doing during this time. I have a headache today, could that mean I’m pregnant? I swear I can feel something happening down there, I must be pregnant! My nipples tingled, I felt dizzy or nauseous, I burped…it has to be a symptom!

Most of these thoughts happen only days after ovulation and of course it’s far too early to tell anything considering it takes seven to ten days for the fertilized egg to finally embed into the uterine lining…or for the unfertilized egg to drop into the uterus just to be expelled during menses. But that doesn’t matter right now – everything we feel just HAS to mean something!

In the meantime we spend hours upon hours googling everything we can, even if we’ve already done extensive research before. Everything from early pregnancy symptoms to watching videos of women in labor so we’re “prepared” for the big day.

We talk to women in groups on social media sites, have conversations in chat rooms, talk with every woman you know that is pregnant or had kids before to see what they went through, not to mention the apps we’ve downloaded onto our phones that keep us occupied indefinitely.

I have learned more about my body (and my husbands) during this time than I care to admit. Do you remember health class in school when they reviewed sex-ed? Yeah, things have changed since then…what your teachers taught you was black and grey compared to the vivid technicolor details you’re about to, if you haven’t already! Here are some examples, some of which you may already know but things I’ve learned since embarking on this journey.

In school I was taught the basics – you have sex, the sperm makes its way through the uterus and up to the Fallopian tubes where it meets the egg and BAM, you’re pregnant. Just like that. There was also a funny infrared video of a man getting an erection that made us all giggle, but that’s besides the point.

Sure, they went into more detail too.. I was taught that the strongest sperm would worm its way into the egg which would trigger the egg to harden so no other sperm could penetrate it (unless you have multiples of course). Now I’ve learned that the egg may have more involvement in this in that it could actually choose which sperm to fertilize with.

To add more power to women, I’ve also learned that we may be ‘growing’ eggs throughout our entire fertile age, up to menopause. It was once believed that we were born with a certain amount of eggs which would age along with us and die off as we get older, thus making our chances of conceiving harder the older we get.

Yes, age still plays a factor in our ability to get pregnant however, it is more due to hormones and such rather than the production of eggs, or lack there of.

I’ve also learned more about our menstrual cycles month to month. I wrote about freaking out when I had my period while on Femara…normally this wouldn’t be a big deal since women are usually put on Femara three days into their period but I started the medication without a period, so starting it mid way scared me. While I might be growing follicles as the medication intended, would my lining be thick enough for the egg to implant?

Apparently, yes! Just a few days after stopping my period, my lining was already beginning to thicken AND I also discovered that once a woman ovulates, the hormone progesterone is released which thickens the lining even more to prepare the body for the egg. If the egg isn’t fertilized, the lining is shed which is what our period is. The cycle then repeats – though for me it doesn’t always work out that way because of my PCOS.

The ‘string of pearls’ which is indicative to PCOS are actually tiny cysts left behind when immature eggs never fully develop. If there is no ovulation, there is no period. Although that isn’t necessarily true either because I’ve had periods before without ovulating which is due to hormones elevating and dropping.

As I wrote earlier, I’ve also discovered that once the egg is fertilized (or not) it takes around seven to ten days for it to reach the uterus – that is unless it becomes ectopic which is when the egg implants in the Fallopian tube. It is impossible to have symptoms of pregnancy until the egg implants (you’re not technically pregnant until that happens)and the hormone HCG is released into your system. It is this hormone that will be detected in pregnancy tests and is why we must wait at least two weeks from ovulation to test.

I’ve also found out that women with PCOS can have false positive ovulation tests. While they can work for some women, I am not one of them. I was getting positives each month while on Clomid and it turned out I wasn’t ovulating, but I was having a period at the end of the month. So confusing (and frustrating)!

I’m also not one of those women that can judge where I am in my cycle by checking cervical mucus (a topic I never thought I’d be okay with discussing and honestly, I still find the thought a little gross). I know what it should do though…early in your cycle it should be dry or break apart easily. Then it’ll get creamy and lotion like. The closer to ovulation the more it’ll thin out and get sticky and stretchy like egg whites, which is supposed to be most fertile but watery cervical mucus is also just as good. After ovulation it should dry up again.

I only remember one time I’ve experienced egg white consistency and it was years ago. I’ve never been really dry but I’ve had lotion like fluids and watery, which is what I’m experiencing now since I’m close to ovulation but I’ve had watery fluid before. I simply cannot tell just with cervical mucus alone. I envy women that can!

I’m more in tune to my body now, more so than ever before. Especially when it comes to my mood. Most women know (even if they don’t admit) that moods change during our cycles, most notably during PMS. I’ll admit that I can get irritable close to my period and since I want to be pregnant so bad, I get crabby and sometimes depressed when my period comes. But, do you notice the differences in your mood during the rest of the month?

The Femara has given me more hope than I’ve had in a long time and I’m sure that has played a part in my mood this cycle but with the help of one of my (many) apps, I can see changes in how I feel with correspondence to my cycle.

I knew I was going to start my period when I was put on the Provera because that’s what it does. It didn’t change the fact that I still became a bit bitchy when it started. Then I had to go through my tests before starting my Femara and you know by now that I started my period while taking that.

This period was a little different because my normal PMS symptoms are also physical. Usually my breasts become more soft and very sensitive and painful. I also get really bad cramps and a very heavy flow. While my flow was heavy this last time, I have very little cramping and absolutely no changes in my breasts. This might have made it easier on my mood, however the fear that my period could interfere with everything working, I would go from being fine to crying because I wanted this to work and I was sure it wouldn’t.

Then I found out that I could still get pregnant so fear alleviated. Of course I’m more at ease now and I can’t contain my excitement but aside from that, I’ve noticed that the more my follicles grow and the closer I get to ovulation, the happier I’ve become. In general I feel really good and for someone that has battled depression their whole lives, I tend to notice when I feel good.

I’ve also mentioned that my sex drive has increased. This is probably the bodies natural response, after all, you can’t get pregnant without sex and it must be timed with ovulation. Knowing that we are using the trigger shot today, I didn’t want to ‘have relations’ with hubby yesterday so we can “conserve” his supply. Easier said than done but I suffered through the night as tempted as I was.

I’m obviously hoping that I’ll get pregnant and not have to go through this again (until the next time at least) but if it isn’t our time yet, I’ll be curious to see if this pattern continues next month.

There’s much more that I’ve learned recently but I don’t intend on writing a book on the subject so I’ll end it here. I just find it so fascinating especially when comparing other women to myself and how diverse we all are. I also love discovering new things about myself and what my body is capable of. Anywho, wish me luck!

 

Follicles of Size

Due to Thanksgiving holiday, I had to go to my specialist an hour away to get my ultrasound done on the 25th. An hour-long drive for a 15 minute appointment…Ugh. But hey, it was worth it.

I arrived at the office and they immediately took me in for my ultrasound. Given it was to measure my follicles, it was transvaginal. Awkward, yes. Uncomfortable at times, yes. There is nothing natural about guiding a long probe into your vagina then having a technician moving it around inside you – pressing and massaging the uterus to get a good picture.

Thankfully I had good news. The Femara looked like it was working. Despite my period ending only two days before hand, my lining was already thickening and I had two dominant follicles, one at 13mm and another just a bit smaller. I also had a few others but not notable. I was ecstatic! Maybe this will work!

I got my blood work done and went home. They called me later that day saying I’d need to have another ultrasound Monday the 28th but this time it would be closer to home at a place I had never been before but with which they work closely with.

Today is the 28th… I did indeed get my ultrasound and more good news – my follicles are now 17.5 and 16.9! Not far left to go! Trigger shot, here I come! I’m just now waiting for a call back to see what I should do next. Do I go for yet another ultrasound or wait a day or so and trigger without it?

But here is my vent for the day because not everything went A-Okay.

I had my blood drawn before my ultrasound and while I’m sitting there with my hubby at my side, the lady that was going to draw my blood tells me that she is the fertility specialist at their office. Now mind you, she had already mentioned how I could have gone there instead of Boston IVF (which is my specialist and happy that they are), but she mentioned it again and I naturally just blew it off.

Next she asked me if I had good veins. I’ve never had problems with blood draws. I have a large vein in each arm right down the middle – no one EVER misses. So, she puts on the tourniquet and says, “Oh, yes you do have good veins.That’s surprising because people like you usually don’t.”

‘People like me’?! What the hell? Go ahead and say what you’re thinking lady. Just come out and say “Fat people” or “Obese people”…either way, is it really necessary to point that out?

Needless to say, I’m not thrilled. I will only deal with them for my blood work and ultrasounds as needed until I get pregnant (if I don’t find another place to go in the meantime) but any thoughts I had before about going to them for OBGYN care, screw that! I may be overweight but I am still a person and you should treat me as such. I know what I weigh and I don’t need you pointing it out.

People like me…seriously. You keep saying crap like that and ‘people like me’ will slap the shit out of you.

Femara

It would take about a week to get everything in place as far as paperwork was concerned so I was instructed to call back by the end of the next week to get  yet another lab faxed for more blood work to be sure I wasn’t going to start my period. And again, the week dragged on.

Blood work was normal and so that day I was prescribed my first ever round of Femara. I had heard that people with PCOS that tried Clomid without success had great results with Femara and so I was beyond excited to start! After so many years of trying, my doctor doesn’t want to waste time (one of the things I absolutely LOVE about him), and so he started me off on a high dose of 7.5 mg for five days.

My doctor had explained that I didn’t need to start my period before beginning. If the medication is successful then my lining would grow and I’d ovulate and either become pregnant or have my period. To my dismay, three days into the Femara I started spotting. I called the nurse who told me that spotting was okay and to look out for bleeding and clots. By the next day I had just that. I freaked out!

After talking to my doctor, the nurse called me back and told me to continue the Femara another 5 days (ten days total) and to still go in for my blood work and ultrasound to see what the Femara is doing and hopefully I’ll be growing healthy follicles. I specifically asked if this bleeding meant the end of this cycle or could this still work and she told me that it could still work.

My blood work and ultrasound will be done on Friday, November 25th (which also happens to be mine and my hubby’s birthday). I am still bleeding although it has slowed down quite a bit and I am still very anxious and very worried. I am keeping my fingers crossed!

Tests and more tests…

Two months ago (from the date I wrote this blog), in September, I got to meet my specialist. I was a nervous wreck going in. I thought for sure it would be a waste of time, yet again. We sat down and I began to rant.

“I’ve done my research and I’m also a part of an online group of all plus sized women that can attest to having perfectly healthy pregnancies and some of them weight much more than I do!” I went on and on and patiently he waited until I was finished and then said, “I’ll help you.”  Can you imagine the relief?!

We talked about family history and he did discuss that my weight was a factor for IVF but he only wanted me to lose around 15 pounds for that. In the meantime, we would do everything else to get us pregnant. I should try to lose the 15 pounds during that time so if it came to IVF, I’d be ready. The first step however, was blood work for both me and hubby and the dreaded HSG test to be sure my fallopian tubes were open.

We had a plan and by the next week I was in getting my baseline blood work before starting Provera to jump-start my period. Three days into my period it was back to the lab for more blood work to check my hormone levels and both of us had to get genetic testing. A week later it was time for my HSG test.

I was glad I shaved my legs. The changing rooms were located inside the waiting room and although I was covered by two robes (one covering the back, one covering the front), I felt so naked sitting there waiting. My knees were shaking by the time they led us to the radiology room for the x-ray. I got up onto the table and my husband, now wearing a heavy lead apron, stood at my head and held my hands while my doctor tried to get the stupid catheter into my cervix.

This was the worst part. The catheter (as it was explained to me) was a little rigid and so it kept catching onto the wall of the cervix instead of bending with the cervix to go in. Eventually he finally got it and I was experiencing a bit of cramping at this point but nothing unbearable. The technician then brings the x-ray machine over my body and positions it.

How strange it was seeing the inside of my body in real-time. I could see myself breath, the bones of my pelvis, and though it was pointed out, I couldn’t make out my uterus for the life of me until the dye was introduced. I watched as the dye filled the small cavity of my uterus and then up and out the right fallopian tube. It didn’t go anywhere near the left side despite me turning my body to try to get it to.

He then explained that sometimes the dye chooses the more dominant side. He would have been worried about a blocked tube if the dye started up the left and then stopped or got to the ovary and bubbled out. The fact that it didn’t go into the tube at all did not mean that it was blocked and he seemed confident that it wasn’t blocked. That was good enough for me.

*Gush* the dye poured out of me as I sat up and it was the most unnatural feeling ever. But, I was glad it was done. They gave me a pad to wear just in case of more leaking and sent me on my way. I only had some light cramping for about a day and for that I was thankful.

That day we also went to get my husband’s semen analysis done. Now, personally we don’t believe in pornography so I went in to um, help him. He also had to get more blood work and after that, we went home with our next appointment scheduled for that Friday (the tests were done Monday). I was surprised at how fast everything was moving, but very pleased.

The closer the appointment got, the more nervous I became. I wasn’t scared about the blood work results but I was nervous about my husband’s semen analysis. Let’s just put it this way, there wasn’t much in the cup when we had finished getting his ‘specimen’….

Blood tests all came back normal. I must have been a little worried because I did feel some relief there. Semen analysis: Normal. Volume, Motility, everything was perfect. A huge sigh of relief and I sagged in the chair as the weight lifted. Then my excitement built. We were moving onto our next steps!

Roller Coaster Ride

Now, let’s fast forward to more recent times….

I met Matthew at a friend’s house and we hit it off right away. I knew with all my heart that he was ‘the one’. We got engaged early and after a year of living together, we got married. Immediately we started trying for a family. Months went by and nothing…

My family practitioner couldn’t do much to help and so he sent me to a respected OBGYN. Unfortunately, he was on call during my appointment and so I had to meet with another doctor at his practice.  It was the most horrible experience of my life where a doctor was concerned.

I went through my family history and talked about my PCOS and the struggles I’ve had with weight loss, since I was now back over 200 pounds – 240 pounds to be exact. She flat out told me that she would not help me get pregnant unless I lost weight and that I should strongly consider gastric bypass.

I was thirty years old. I would have had to wait a year before being considered a candidate for the surgery and then would have had to wait over another year before considering having children, if the drastic weight loss didn’t get in the way of conceiving. I was floored!

I went home crying that day thinking that our dream would never come true. That lasted for about a day before I became enraged! How dare she! My body isn’t broken and I know more than a few women much larger than me that have had successful and healthy pregnancies. I immediately called up the OBGYN I was supposed to see that day and booked my next appointment.

What a difference! My doctor said that, while there are complications that can arise with persons overweight and being pregnant, it was no reason for me not to try. I already knew about the increased risk of high blood pressure, gestational diabetes, and preeclampsia and all could be monitored and managed if need be but the increase of risk was not that much greater than any other woman in this world. His plan: start me on Clomid.

Clomid was the cheapest and easiest to start on. I would continue with my Metformin and thanks to Provera to jump start my period, I would begin Clomid on cycle day 3 and end on day 7.

I was warned about the side effects and wow! The hot flashes were INTENSE! I nearly stripped all of my clothes off in the middle of Target one day because I honestly thought that if I didn’t, I was going to die!

Shortly after taking the medicine, I noticed little twinges in my ovaries and I just knew that it was working. I used ovulation tests (not knowing at the time that PCOS could cause false positives) and detected a surge right around the time I was supposed to. My hubby and I did the deed every other day and prayed that it would work… it didn’t. I started my period exactly when I should have. However, I wasn’t discouraged. This was the first time I’ve ever known when my period would start and it actually did! Maybe my body just needs more time to get this right!

Two more cycles went by and on the last one we increased my dose but the result was the same. It ended in a period and then my doctor told me what I didn’t want to hear. He couldn’t help me any further, it was beyond him as a OBGYN and I would have to go to a specialist (which my insurance wouldn’t cover).

Determined, we made the appointment the next day for a week out. It was a tediously long week…

The next hour will be summed up as quickly as possible. Yes, they could help me but no, they wouldn’t because well, basically I’m too fat. I was told to get under 200 pounds before they would help and then we talked about other medication that could help, IUI, and IVF and then I was sent on my way.

I was defeated again. I cried, I screamed and yelled, I laughed at the whole situation. In the end, there was nothing I could do except try my hardest to lose weight which inevitably resulted in me gaining weight instead.

Then a ray of hope! (Don’t you just love this roller coaster ride?!) My husband got into a really good job that would give him benefits that would actually help pay for fertility treatment. The trick was getting through the temporary stage to hired on permanent to receive the benefits. And so the months ticked by until finally it happened.

I was prepared. I knew when his benefits would kick in and so I called three – three I tell you – fertility specialists. Two of them wouldn’t help me because of my weight. At this point I’ve reached my heaviest weight at 275 pounds (thanks to quitting smoking which I had started again because of this stress to begin with). One of the specialists said they would help when I get down to 240 which is exactly the weight I was when I sought help a year ago at the other place that turned me down. This frustrated me beyond belief!

The second wasn’t much help and I didn’t care for the receptionists attitude anyway. Finally the third said they would help up to IUI however, they did have a BMI limit for IVF. Okay, I can deal with that, at least it’s something! Just let me off of this damned roller coaster ride!

Metformin

The first marriage didn’t last long and I did not become pregnant. Why oh why didn’t I pay more attention to the doctor about this PCOS thing… I did my research online and I understood what I read but back then, the “remedy” was weight loss. Lose weight and everything will correct itself…yeah, sure.

At one point I dropped down to 175 pounds in a matter of months. I went from going over a year without a period to having one every three or four months on my own but not consistently. I had a long term boyfriend during this time and still, no pregnancy.

My second marriage is a story in itself. Let’s just say it was five years of hell but despite that, we tried and tried and tried…again, nothing. By this point I had begun to hear rumors of medication that might be able to help.

Metformin was promising for those with PCOS and I had an on again off again relationship with that pill. It did nothing. Actually, I wouldn’t even start my period until I went off the medication!

All that diarrhea for nothing!

Women Don’t Shave Their Faces…

Let us start at the beginning….

What do I know or care at twelve years old? I’m certainly not determined to start a family any time soon and okay, according to the doctor I should have started my period by now, so start me on the pill so I can be done with this!

Yep, twelve years old was when I was diagnosed with PCOS (poly cystic ovarian syndrome). Back then it meant absolutely nothing to me. I didn’t understand it and could have cared less. I knew what puberty was and that it had started early for me (far too early in my opinion) and I knew that with puberty there would come a time I’d start my period…but it didn’t happen on its own.

Aside from not starting my period, I had gained weight suddenly which was what tipped off my doctors twenty years ago. Tests were performed and sure enough…I remember the discussion about being put on birth control pills in order for me to have a normal monthly period. I can do that. Take a pill every day and once a month I bleed for a week and that’s that.

I also remember the doctor pointing out the fine hairs on my upper lip and telling me that the PCOS causes a hormone imbalance and the extra testosterone my body produces is what has caused it. He said he could get rid of it for me so that other kids wouldn’t tease me about it but as soon as I heard ‘laser removal’, I was out! First off, my insurance at the time wouldn’t cover it but even if it had…the word ‘laser’ alone scared the crap out of me.

The pills did their job. I took it every day and had a period every month. It didn’t do much for my weight until I reached high school when it finally helped me maintain my weight at 215 pounds. Diets never worked and all I kept hearing was “exercise!”, but how much more exercise where they expecting when I did martial arts five days a week for an hour and a half each day, never mind the time I spent out with friends doing God knows what. Between the excess hair and my weight, I was relentlessly teased by my peers and my depression hit an all time low.

Then at the age of eighteen, stubborn and blindly in love, I married. I wanted a family and so I took myself off of my birth control. It was then that the hair on my upper lip wasn’t the only hair I had to worry about. My chin created a stubble and it was then that I decided to start shaving. I knew I was all woman but at times I felt less than so. Women don’t shave their faces….