Frustration!

I had my appointment with Dr W yesterday, but I don't even think he knew why I was there. I saw him last fall for a "pre-conception consult" to basically discuss the game plan for the next time I would be pregnant, and I think he thought that's why I was there yesterday. He started telling me about all the things we're going to do once I'm pregnant to try and prevent or delay severe pre-eclampsia again. But I already know all of that because we've already had that discussion. When I called, I told his nurse all about my concerns with possible PCOS and Clomid vs metformin, and she said "I think that would be a great conversation for you to have with Dr Webb." I asked if I could talk with him on the phone to avoid having to take the afternoon off work and driving an hour each way, but she said he would want to see me in his office. Fair enough. But I really wish she would have talked to him about it first because he basically just told me that he or Dr P aren't qualified to make the decisions and diagnoses based on my situation. He told me that he wouldn't recommend going over 100mg of Clomid because of the risk of multiples. Specifically, twins would double my chances of severe pre-e. He thought I should give it 2-3 cycles with Clomid, and if I'm not pregnant, regardless of whether I have ovulated with it, I should go see a reproductive endocrinologist (RE) who can figure out exactly what's going on and figure out the best way to help me get pregnant with ONE baby. I really feel like they could have told me over the phone that he wouldn't be able to answer my questions, but whatever. They have my $40 copay, so hopefully that makes them happy.
Based on what he said, I really don't think I'm going to wait 2-3 cycles. If I don't ovulate or get pregnant with this round of Clomid I'm just going to see an RE. I was thinking about calling and setting up the appointment and just canceling it if I get pregnant. I imagine they take at least a month to get in anyway. A friend/co-worker who has PCOS and a complicated history as well has a doctor she loves. He's not technically an RE, but worked with one and did a lot of training with him, and basically has a lot of the same knowledge. She loves him and wants me to see him. I haven't decided yet. Part of me likes the idea of seeing some one I have a good referral to, but the other part of me wants to just go straight to the top and skip the possibility of having to involve yet another doctor. The other benefit is that he shouldn't be hard to get into- maybe a couple weeks or so. I am thinking about calling and explaining my situation and seeing if he thinks he could help me or if I should go elsewhere. I've been burned with that before though, when nurses say they want me to come in, and then at the appointment the doctor says they can't really help me or they just don't have any new information from any of the other doctors I've seen. Yesterday wasn't the first time! I guess I'll ponder it this weekend and hope I ovulate and get KU so I don't have to worry about it!
The good thing that came out of my appointment yesterday is that Dr W realized he hadn't taught me how to give myself shots. I will have to give myself daily shots of blood thinner immediately, as soon as I get a positive pregnancy test, so he gave the the prescription to have ready and a nurse showed me how to do it. I was a teensy bit nervous, but it didn't hurt a bit! Hooray! Ok, so it's an almost microscopic needle, and I'm not even afraid of needles, but I wasn't sure I'd be able to stick one into my own belly. But after trying once, it'll be no problem! I'll have to get creative about covering bruises for my maternity pics though!
The less good thing that came from my appointment, besides all the unanswered questions, was a bit of a freakout. When Dr W started talking about the risk that would go along with twins, I started getting really nervous. Are we doing the right thing by trying again? I wouldn't change anything about our little girl, but I hate that she had to go through so much when she was so small. She is an amazing, strong fighter, but no baby should have to be a fighter! I don't want to do that to another baby. We are so blessed that she has done so well. She "caught up" earlier than the doctors expected and has no real lasting issues from her stint in the NICU, but it didn't have to go that way. Things could go worse next time. I know this is what we want, but when I left the doctor's office yesterday, I felt selfish. Is it stupid to want to try this again? I know this risks aren't as high as they could be, but they're not low enough to be comfortable. And I'm scared. What if things go wrong? I don't want to find myself in another fight for my and/or my baby's life.
I know myself well enough to know that there are days I'm going to feel this way. Most of the time I'm excited about the prospect of another baby and optimistic about having a healthy pregnancy, but there are moments when the risks throw themselves in my face. Yesterday was the first time since our daughter was in the hospital where I really questioned whether we should do this again.
We will try, and odds are good that we will have a healthy baby at least fairly close to term. If not, we'll deal with whatever comes our way. God has it under control, but this is definitely one moment where the idea that He won't give us more than we can handle is not a comfort. It's not that I don't think we could handle anything that comes our way, it's just that there are lots of possibilities that I just don't want to! Today I feel much better and much more optimistic, although still recovering a bit from the anxiety of yesterday. But we're off to the river this weekend for some sun and relaxation with the fam for Father's Day!

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!