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!