Tuesday, May 29, 2012

Day 18

Well, CD18 has come and is almost gone. I didn't realize how many hopes I had hanging on ovulating by today until last night, when I accepted that it just was not going to happen this way. I really hoped that using progesterone to jump-start my cycle would be enough get me ovulating, but it's just not going to be. I called both my regular OB, Dr P, and my MFM OB, Dr W, who will be following my next pregnancy, to let them know what was going on. They both actually called back at times when I was able to answer my phone during my work day, which was basically a miracle. Dr W's nurse called first, and I updated her on the situation since I hadn't told them anything yet. I also told her that I am concerned about PCOS, but that Dr P wanted to treat with Clomid without looking into whether that is the issue or not. I'm not opposed to Clomid, but there is another medication, Metformin, that may be appropriate for PCOS that would help me cycle without (I think) increasing my chances of having multiples. In my mind, because I'm already considered high risk, I would rather try the medication that doesn't increase my risk of multiples, which is also considered high risk. If Clomid turns out to be the best option, then I'm ok with that, but I need to know that I've covered my options. Dr W's nurse said that "would be a great conversation to have with Dr W." I asked if a phone consult would be possible, since I live an hour away and would have to take off work, but she said he would want to see me in person. That's fine if the appointment is worth my time. Miraculously, she got me in next week Tuesday, so I'm pretty stoked. I really thought I would be waiting another month to get in there. Hooray!!
This afternoon, Dr P called me back himself. Although I felt uncertain about his plan before talking with him today, he answered all of my questions and I feel more confident. I do still want a second opinion from Dr W to address which medication is the best fit, but I feel more confident that Dr P is taking my concerns about PCOS seriously. He basically said that he would like to wait and see if I finish this cycle on my own, and if I don't start my period by day 32, he will do another round of progesterone to get me going again, then prescribe Clomid cycle days 5-9, starting with 50mg, then potentially 100mg, then 150mg in subsequent cycles progressively until I would ovulate. If I still don't ovulate on that highest dosage we would revisit the idea of FSH injections, which he said would "increase monitoring and cost significantly." Let's hope we don't have to go there. I told him of my understanding that Clomid is less likely to work if PCOS is the issue, and he confirmed that. I asked him about Metformin as an alternative, and he explained that typically, Metformin works best for women who are insulin resistant and over weight, neither of which I am (to my knowledge). It's possible that Metformin could still work, and I have a friend who doesn't fit the mold and has had great success (due in July :) ), so I'm not ruling it out yet, but that's good to know. I feel like he is considering that possibility, which I wasn't sure of before. Dr P also explained that research is still inconclusive as to whether or not Metformin produces any better results than Clomid. And later in the afternoon he actually emailed me a research article about a study that found that more live births occurred with the use of Clomid than with Metformin. I haven't made my way through it just yet, but I definitely will. So all in all, I feel much more like he is on my side after our conversation.

I realized something as I was lying in bed feeling frustrated last night. When M was born so early, I felt so disappointed in my body. I felt as though it had let me down. All my life, I have been able to just about anything I have wanted to do if I worked at it enough. But now, when it comes to the most important thing to me, my body has failed, and there is nothing I can do about it. I had worked through those feelings as much as possible, and since M is doing so well, it hasn't been staring me in the face for a long time. But once I realized that I am still not ovulating with the assistance of progesterone, I began feeling like my body is letting me down yet again. It's not as though this has been a long process thus far. I feel like I am more frustrated than can be accounted for by the last month and a half. But I think that what it comes down to is that the feeling of my body letting me down this time around is stirring feelings that I thought I had worked past. I can't tell you how sickening it is to know that your body has been unable to carry your baby to term, and to see that tiny baby struggling for life, and know that you are completely out of control. The feeling of wanting so desperately to protect her from every bright light, every loud beep, not to mention the invasive medical procedures, and being utterly unable to do so, is beyond words. It's sickening. Only another preemie mama could really know. The night I came home from the hospital, I just laid in bed, hugging my empty belly, and cried and cried. I don't ever want to feel that again. So the feeling of having no control over my body is a difficult one for me. I'm trying to embrace the body that God has given me and trust that he has entrusted me with this struggle for a reason, but I swing between that knowledge and the conclusion that my body is one selfish POS. It has always treated me just fine, but when it comes to growing another human being, it's just doesn't come easily. Hopefully I'll grow to be more graceful and lean more often towards the former. :)

In other news, part of my effort to embrace my body and know that I am fearfully and wonderfully made has been to sign up for my first 5K! I'm in week 2 of training and I'm actually really excited! I decided that it's time for me to force myself into some "me time" so pushing myself to do this is all about me. My mom, sisters, and a couple friends are also signed up, and I think it's going to be a lot of fun! August 18th- let the count down begin!!

Friday, May 18, 2012

May 18, 2012

Wow, it's been a while! So let's see. I started the 10 day round of progesterone (Prometrium), and Dr P told me that I would start on either the last day of the pill or within the following 5 days, if I was to start at all. In fact, I spotted on day 9 and 10, then started my period the following day. It was very light, but I think maybe that makes sense since I never did ovulate?? Either way, I'm just happy to have started my period at all, thank you very much 83 day cycle!!! So now, I'm on CD7 (not counting the first two days of minimal spotting) and have until CD18 to ovulate on my own before Dr P wants to step in and try Clomid. He didn't sound extremely hopeful that I would ovulate on my own, but I hopeful that I will. I feel like my body has responded to the progesterone in a big way (holy exhaustion Batman!) and since I ovulated last time I came off BCP I think it could happen. I sure hope so! I don't know what I'm going to do once I do get pregnant! I feel like last time we got pregnant so quickly once we decided to go for it, and then I was totally naive to anything that could go wrong until it did, and then, surprise, M was here that day! And there was no time to think about anything because we found ourselves smack in the middle of the NICU roller coaster! This time around, I'm so focused on getting pregnant and now needing help to ovulate, but when I think about pregnancy, I just see so many different possibilities outside of a typical, healthy pregnancy. I know I will be giving myself daily blood thinner shots, so normal basically goes out the window right there, but if that's all the "abnormal" I have to deal with, I will be a happy camper. I keep thinking about potential bedrest more than anything. My MTFM, Dr W, made me feel like getting at least close to term is pretty likely with his game plan of blood thinners, and predicted 34-36 weeks, which sound FABULOUS!! He thought that we might be looking at a NICU stay of 2 weeks or less. If someone would have told me that be before M made her grand entrance, I think I would have been devastated, but after 12 weeks in the NICU, 2 weeks sounds very do-able. I want nothing more than to leave the hospital with my baby though. I always think about what that would feel like, and it just seems to amazing to even fathom. On the other hand, Dr W did say that if I show even a hint of pre-e, like high blood pressure, swelling, protein, anything at all, he will put me on bedrest. Soooo... then I signed up for short-term disability for work, so I have 6 months covered there. One less thing to worry about. But there are just so many unknowns (even more than a typical pregnancy) and I basically can't plan anything until I get there. There are only so many back up plans a person can make! So for now I focus my thoughts on getting pregnant (as if that helps) and pregnancy and all the what-ifs that go with it are just a bridge I will have to cross when I get there. And by "bridge", I mean like a thousand bridges to cross before holding that baby in my arms! One way or another, we'll get there!There's an almost superstitious part of me that doesn't want to try to imagine too many possibilities, because I'm afraid that God's is going to try and surprise me, and if I think I have all the possibilities figured out, he'll just have to come up with a really creative way to catch me off guard... I definitely believe God has a sense of humor. :)

Monday, May 7, 2012

May 7, 2012

So I am on day 6 of this progesterone and although I haven't had all of the horrible symptoms I've heard about, I am definitely aware of it in my body. I'm tired, lethargic, and irritable. We have great friends here for an extended weekend, and that's probably a good and a bad thing for them. I'm definitely glad they're here to distract me from my crabbiness and to give the hubby a break, but I'm definitely not at my best. Breaking up fights between two 2 year-olds all morning definitely had me at the end of my rope and naps came just in the nick of time. The dadas are fishing this afternoon, so I laid down and, although I didn't sleep, I did enjoy the time to myself and feel refreshed. My little poppy seed tried to convince me she wasn't going to take a nap, but fortunately I convinced her otherwise and am feeling recharged. I'm trying to squeeze in a post before she gets up.
I've been reading lots of blogs lately. I've never gotten into them until the past few months, and now I have definitely gravitated towards pregnancy/TTC blogs, preemie blogs, as well as blogs by moms of children with special needs. I don't have a child with special needs but I do work with kids under 3 who have all levels of special needs. I love working with them and I especially love working with them as a piece of their family. Missouri's early intervention program, which is where I work, puts a lot of emphasis on working with families as a whole, the idea being that they are the people who spend the most time with their child and, with the right support and education, are the ones who can have the greatest effect on their children. I recently stumbled upon a blog that brings all of these things together, from trying to conceive with MTHFR, to infertility and IVF, to pregnancy, to finding out their little one would be born with Down's Syndrome, to just recently welcoming him into the world. While catching up today, I read about their ultrasounds, both before and after learning of the DS diagnosis, and it just really got me craving that experience again. I can't wait to be pregnant. With my daughter we had all of the beautiful experiences up until 28 weeks, and they were oh so wonderful. The only part that really wasn't fantastic was the last week, when I was getting so sick, although I didn't know what was happening. When I say "beautiful", I don't mean that I wasn't sick or exhausted or anything like that, but I really did enjoy being pregnant. I think that is one more reason I mourned so hard for the last third of my pregnancy that I (and my daughter) never had. I was looking so forward to the rest of that pregnancy and even delivery. I know that sounds crazy to all those people who experienced that in a way that allowed them to take it for granted. And I don't begrudge them their ability to complain about their experience, although there have been times when I did. It's just that I really was looking forward to experiencing my body doing what it was created to do, to proving to myself just how strong I really am. I felt betrayed that my body instead showed it's inability to do what I still believe I am created to do. How can God create me with such a sense of purpose that drives me to be a mother, and yet my body seems unable to do its part? I guess I did learn just how strong I could be. Just not in the way I thought I would. It takes a lot of strength to have a preemie.
So today I am aching for not only the experiences I had during my first pregnancy, which were overwhelmingly positive, but also the experiences I dreamed of and have been missing ever since. I really hope this first round of progesterone works. Dr P didn't seem extremely confident that it would, but obviously he thought there was a chance or I don't think he would have tried it. I feel like if this doesn't get me to ovulate, then I really am entering the world of infertility. At this point, I feel as though I'm teetering on the edge. I have one beautiful daughter and had no trouble getting pregnant with her, only because I cycled and ovulated immediately after coming off BCP. My body had that assistance. I guess using the progesterone really isn't any different than that. But if this doesn't do it and I have to move on to Clomid, that, to me, is an infertility drug. I hesitate to put myself in that category, because we haven't been "trying" very long. However, we really haven't even been able to "try" because I knew that I wasn't ovulating. I also hesitate because I don't feel as though I have the right to put myself in the same category as friends who have tried for years to get pregnant, and have had innumerable tests and treatments, some of whom have eventually been successful and some not. But I am afraid of entering that world. I did feel a bit validated at my dr's appointment when Dr P said that he was putting the appointment in under "irregular cycles" because that's why I came in, but also adding "infertility" since we had that conversation. At least "infertility" isn't just a word in my head.
My husband asked me yesterday how hard it would be on me if we found out I really couldn't get pregnant. This might sounds like a leap to some, and it is, but in context I knew where he was coming from. We have discussed adoption as a possibility for our family if our next pregnancy is as difficult and/or short as the first one. Both of us feel like it might be a calling for us somewhere down the road and, while that's as far as the conversation had gone, it's in the back of our minds. When our daughter was in the hospital and I didn't yet know what the likelihood was of the same thing happening again would be, we promised each other that she would not be an only child. If it wasn't safe for me to be pregnant again, then we would pursue adoption. Now, we both know that we could pursue adoption for a variety of reasons, not the least of which might be that God simply calls us to do it. But He when he asked about how I would feel if I was unable to have another baby, he said that if that were the case, he would be sad, but that it would seem like God intended that to lead us into adoption. I told him that I feel like the idea of being unable to have more biological children makes me want to cry, even just talking about it, but in the big picture, I feel the same way he does. I don't want to think about not being able to carry another baby inside my body, and it would be harder than I care to think about, but I do trust that God has a plan, and if that's a part of it, we will walk that path in good faith. But just for the record, I don't want to. :) I'm willing to consider adoption even if I do have another baby if that's what God wants! I am so looking forward to watching and feeling another life growing inside me, and to allowing my body the opportunity to get it right next time. I can't wait to see my daughter as a big sister. She loves babies, and while I know one living in our home would be more challenging to her, I know she would be great at it. Only time will tell just when that will happen. Hopefully sooner rather than later!!

Wednesday, May 2, 2012

Game Plan

It's been a good day. I'm on day 73 of my cycle with no sign of ovulation, so I've been frustrated, but I saw both my chiropractor (who is fantastic) and, finally, my OB/GYN. Dr S, my chiropractor, is basically making adjustments to support overall health, as well as reproductive health, and has me on a couple supplements to support reproductive and, specifically, ovarian health. She is also a good friend and, although I am still not ovulating, I always feel better after seeing her. She is incredibly smart and well-educated and it's nice to have someone to talk to who knows their stuff and talks to me like I know mine as well. She makes me feel like more of a partner in my own health than most doctors, which inspires me to to charge of my own well-being.
 My OB/GYN  went well, too. It took a month to get in and I was worried that he wouldn't do anything more than send me on to someone else. I considered making an appointment with a dr I knew would get me in sooner and would probably do an ultrasound to check for PCOS (polycystic ovarian syndrome) at the appointment, which is my first guess as to why my cycles are so irregular. I decided to wait it out and give Dr P a try before going elsewhere. I'm glad I did. Although he didn't check me for PCOS, he did say that he felt like he didn't need to do blood work at this point because he would recommend the same course initially, regardless of the results. So at this point we have a plan and if that doesn't work, the we can do some testing before proceeding with more specific treatments. I would like to know eventually if PCOS is something I need to be concerned about, but at this point, if I can ovulate with the least invasive scenario, (and the least cost!) I'll be happy. We discussed a variety of possibilities and Dr P even drew me a flow chart on the exam table paper, which I proceeded to tear out and bring home with me so that I could share it with Matt. :)
So here's the plan. Because of my multiple blood clotting disorders (MTHFR and Factor V Leiden Mutation) I have to avoid hormones, especially estrogen, so we're trying to avoid having to go on a birth control pill to regulate my cycle. With my daughter, I got pregnant immediately after coming off the pill, when my cycle was still regulated. However, this time I know more about my body, so the pill is out. So we're going to start with a 10 day course of progesterone to see if that will stimulate a period. If I have a period, then I might be able to ovulate afterwards. That's not a sure thing, but because I did ovulate coming off the pill last time, Dr P thinks it's a definite possibility. If I don't have a period he will try FSH shots. I don't know much about this yet, except that it increases the likelihood of multiples (...) Also, if I don't have a period at that point, PCOS is off the table. On the other hand, if I DO have a period, PCOS is a possibility, and he will give me 18 days to ovulate on my own. If I do, we can repeat this process multiple times as we need to until one of those ovulations results in a pregnancy. If I DON'T ovulate on my own, we will then likely proceed with Clomid to stimulate ovulation for 3 cycles. If the Clomid doesn't stimulate ovulation, we can increase the dose to try again. BTW, Clomid also comes with a 10% chance of multiples... After one premature birth, multiples does not sound like a good idea to me, but I guess of that happens, God definitely meant it to...
So that's that current plan. Can you see why I liked the flow chart version?
Another interesting point that Dr P made was that being on a baby aspirin can actually suppress reproductive hormones a little bit. My MFM (maternal-fetal medicine dr) who delivered my daughter when I had HELLP syndrome, wants me on a baby aspirin while trying to get pregnant, and then blood thinner once I get a positive test. So I started that baby aspirin in the middle of this "cycle". I'm wondering if that is the reason this cycle has become so long. Maybe if I hadn't been taking that I would have continued to cycle? I don't know the answer to that. But unfortunately, I need that medication to prevent blood clots. Sp the plan is to stay on it until a few days after starting my period, then come off it until I ovulate, then start it again, just in case I do get pregnant that cycle. Can I just say that it's a little irritating that I have these diagnoses and situations that require conflicting treatments? Hopefully, "a little irritating" is all it is and we don't have too much trouble from here on out. I am glad that I've already been charting my cycle, so I know how to tell if/when I have ovulated. If you haven't looked into the Family Planning Method, I definitely recommend it! I use a book called Taking Charge of Your Fertility. Excellent and informative.
I told Dr P today that I feel like at this point, I'm just taking things one step at a time. The issue of not ovulating and getting pregnant is giving me something to focus my energy on besides the anxiety of staying pregnant, which, after my experience with my daughter, will definitely be on my mind from the moment I get that positive test! So, one thing at a time for now. We'll just keep taking one more step and one more step until I hold that sweet baby in my arms! I know God has it all planned out, and I am trusting that he has the best interest of myself and my family at heart. I took my first progesterone pill on the way home this evening, so here goes nothing!