Synopsis: We realized how much of a miracle our first pregnancy was when the same protocol that worked on the first try two years previously, failed three times this go around!
After the birth of my first child, I decided not to prevent another pregnancy -- no birth control whatsoever. If the first one was so hard to come by, I would happily take another one "too early"! I have heard of some women's bodies "resetting" after a pregnancy, and of being super fertile after a long struggle getting pregnant the first time. If that was to be my destiny, I would accept it!
I had no such luck!
Around ten months after giving birth, and after a couple of months worth of charting anovulatory cycles and using OPKs, we returned to our fertility specialist for help. To make matters more urgent, we had just learned we would be moving out of state in a few months, and our insurance would be changing.
Our fertility specialist, understanding our concerns about losing our coverage for infertility, decided that we could at least fit in a few attempts at IUI before our move. She recommended I wean my baby so that breastfeeding would not limit the effectiveness of fertility treatment.
For my first cycle, we did what had worked the first time: 5 days on Femara, an HCG trigger shot, and an IUI. My uterine lining was not as thick as desired at my follicle ultrasound, so I was prescribed Estrace, administered vaginally, for the two days leading up to the IUI. The day after the IUI, I began my Progesterone suppositories. And two weeks later, the results of my blood test were negative.
For my second cycle, we tried the same protocol: 5 days on Femara, an HCG trigger shot, and an IUI. No need for Estrace. I had 3 good follicles. The day after the IUI, I began my Progesterone suppositories. My hopes were high, imagining triplets, or twins, or at least a singleton! And two weeks later, the results of my blood test were negative. This was extremely crushing news, after such a hopeful follicle ultrasound. At my baseline ultrasound for the next cycle, I cried. I felt so defeated. And it felt so unfair that I had to get right back on that horse, without a chance to grieve.
For my third cycle, we adjusted the protocol slightly: 5 days on Femara, a Gonal-F injection to give a boost to my follicle development, an HCG trigger shot, and an IUI. Again I was prescribed Estrace leading up to the procedure. Only one good follicle. The day after the IUI, I began my Progesterone suppositories. And two weeks later, the results of my blood test were negative. I kind of expected it this time.
For my fourth cycle, we again adjusted the protocol: 5 days on Femara, a double Gonal-F injection to give a boost to my follicle development, an HCG trigger shot, and an IUI. No need for Estrace. Only one good follicle. Following the follicle ultrasound, we met with the doctor, who recommended that if we didn't get a positive result this time, we should move onto IVF. My caring, wonderful doctor performed the IUI herself this time, which meant a lot to me! I thought it was so kind of her to show that kind of interest in me, and I appreciated her support. The day after the IUI, I began my Progesterone suppositories. And two weeks later, the results of my blood test were POSITIVE!!!! HCG was 173. We received the happy news 3 days before leaving for our cross-country move. Truly miraculous!
Showing posts with label Letrozole. Show all posts
Showing posts with label Letrozole. Show all posts
7.17.2017
4.27.2016
Intrauterine Insemination (IUI)
Synopsis: An IUI can be a viable treatment for infertility if you have PCOS!
After two years of trying to get pregnant, we made an appointment with a fertility clinic. The doctor confirmed my diagnosis of PCOS after looking through my medical records (especially blood test results) and recommended we try an Intrauterine Insemination (IUI).
I took Letrozole (Femara) for 5 days at the beginning of my menstrual cycle. This drug is used off-label in treating infertility; it is a breast cancer drug but can stimulate the ovaries just like Clomiphene (Clomid).
I went in for a baseline ultrasound early in my cycle. The following week I had a second ultrasound to confirm that my follicles looked good. I gave myself a shot of HCG (to stimulate ovulation), and then, two days later, went in for the actual IUI procedure. I was sent home with instructions to follow-up with intercourse that day, and to begin progesterone suppositories (progesterone is a hormone that supports pregnancy) the following day.
The procedure itself is much like a gynecological exam. You lie on the exam table, with your feet in stirrups, and the medical professional inserts a specula. The washed & prepared sperm are in a syringe attached to a catheter that is threaded through the cervix. Once inserted, the sperm are injected into the uterus. At the time of this writing, I have experienced 4 IUIs, and there can be some painful cramping! Fortunately, the process is fairly quick & straightforward. Following the IUI, the patient's pelvis is elevated slightly and the patient rests for 10-15 minutes.
After two years of trying to get pregnant, we made an appointment with a fertility clinic. The doctor confirmed my diagnosis of PCOS after looking through my medical records (especially blood test results) and recommended we try an Intrauterine Insemination (IUI).
I took Letrozole (Femara) for 5 days at the beginning of my menstrual cycle. This drug is used off-label in treating infertility; it is a breast cancer drug but can stimulate the ovaries just like Clomiphene (Clomid).
I went in for a baseline ultrasound early in my cycle. The following week I had a second ultrasound to confirm that my follicles looked good. I gave myself a shot of HCG (to stimulate ovulation), and then, two days later, went in for the actual IUI procedure. I was sent home with instructions to follow-up with intercourse that day, and to begin progesterone suppositories (progesterone is a hormone that supports pregnancy) the following day.
The procedure itself is much like a gynecological exam. You lie on the exam table, with your feet in stirrups, and the medical professional inserts a specula. The washed & prepared sperm are in a syringe attached to a catheter that is threaded through the cervix. Once inserted, the sperm are injected into the uterus. At the time of this writing, I have experienced 4 IUIs, and there can be some painful cramping! Fortunately, the process is fairly quick & straightforward. Following the IUI, the patient's pelvis is elevated slightly and the patient rests for 10-15 minutes.
My Infertility Timeline (#1)
Synopsis: It took two years to get pregnant, in spite of trying various medical interventions to help the process!
After two years of marriage, we decided we wanted to try for a baby! I stopped taking hormonal birth control and started reading Taking Charge of Your Fertility. I like to plan, and I was going to plan this baby, that's for sure. I began charting my basal body temperatures to figure out my cycles so we could have the best chances of pregnancy.
And then, my menstrual cycles went haywire. Like, 4 months without menstruation, then a month of spotting, and no rhyme nor reason to my temperature charts. Prior to using hormonal birth control, my cycles had been pretty regular, so at first, I attributed all of this to the hormonal changes of going off of birth control.
After six months of this, though, I decided to see a doctor. Blood tests revealed elevated prolactin and testosterone levels, and this combined with obvious anovulatory cycles landed me the PCOS diagnosis. I was prescribed Metformin and encouraged to lose weight.
Eight more months passed, and in spite of losing 30 lbs and having my cycles regulate, my doctor's advice was always, "Keep doing what you're doing, and call when you get pregnant!" At this point, at least, an HSG test was ordered, and a semen analysis was ordered for my husband.
My fallopian tubes were normal and there were no blockages. And my husband's semen analysis was "above average" -- no problems there. This was good news, but also confusing news, as my temperature charting indicated that ovulation was occurring each cycle, and now we knew that the tubes were fine as well. My doctor's advice was still, "Keep doing what you're doing, and call when you get pregnant!"
I decided to switch doctors, as it was obvious to me that the original doctor was not taking this as seriously as I thought she should.
After an unfruitful 17 months of trying to conceive, my new doctor had a new game plan for us. I was prescribed Femara and instructed to start using ovulation predictors in addition to charting my temperatures. When the test strips indicated impending ovulation, we were to abstain the day of the test and then have intercourse the next day.
Six cycles (=6 months) on increasing levels of Femara, and with charting and ovulation tests clearly indicating ovulation, and we still had had no success! I was understandably disheartened.
Almost two years to the day of when we had started trying to conceive, we met with our fertility specialist for the first time. She was impressed with my thorough documentation of everything, and that I had already had all of the pertinent testing done and had brought my medical records along for the appointment. Based on all of the factors, she decided that at this point, the cause of my infertility was unexplained by PCOS or anything else. Her recommendation was to try intra-uterine insemination (IUI) for the next few cycles, and potentially move on to in-vitro fertilization (IVF) if I still wasn't pregnant after that.
I was so thrilled & grateful that, because I was early in my cycle at that point, we would begin immediately! I had a baseline ultrasound the same day as our consultation and began an additional round of Femara.
I took Femara for CD5-9, had an ultrasound mid-cycle to check follicles, triggered ovulation with an HCG shot, and went in for the IUI. The next day, I began progesterone suppositories. Blessedly, 13 days later, my blood HCG test came back positive. I could hardly believe our first IUI had been a success!!
After two years of marriage, we decided we wanted to try for a baby! I stopped taking hormonal birth control and started reading Taking Charge of Your Fertility. I like to plan, and I was going to plan this baby, that's for sure. I began charting my basal body temperatures to figure out my cycles so we could have the best chances of pregnancy.
And then, my menstrual cycles went haywire. Like, 4 months without menstruation, then a month of spotting, and no rhyme nor reason to my temperature charts. Prior to using hormonal birth control, my cycles had been pretty regular, so at first, I attributed all of this to the hormonal changes of going off of birth control.
After six months of this, though, I decided to see a doctor. Blood tests revealed elevated prolactin and testosterone levels, and this combined with obvious anovulatory cycles landed me the PCOS diagnosis. I was prescribed Metformin and encouraged to lose weight.
Eight more months passed, and in spite of losing 30 lbs and having my cycles regulate, my doctor's advice was always, "Keep doing what you're doing, and call when you get pregnant!" At this point, at least, an HSG test was ordered, and a semen analysis was ordered for my husband.
My fallopian tubes were normal and there were no blockages. And my husband's semen analysis was "above average" -- no problems there. This was good news, but also confusing news, as my temperature charting indicated that ovulation was occurring each cycle, and now we knew that the tubes were fine as well. My doctor's advice was still, "Keep doing what you're doing, and call when you get pregnant!"
I decided to switch doctors, as it was obvious to me that the original doctor was not taking this as seriously as I thought she should.
After an unfruitful 17 months of trying to conceive, my new doctor had a new game plan for us. I was prescribed Femara and instructed to start using ovulation predictors in addition to charting my temperatures. When the test strips indicated impending ovulation, we were to abstain the day of the test and then have intercourse the next day.
Six cycles (=6 months) on increasing levels of Femara, and with charting and ovulation tests clearly indicating ovulation, and we still had had no success! I was understandably disheartened.
Almost two years to the day of when we had started trying to conceive, we met with our fertility specialist for the first time. She was impressed with my thorough documentation of everything, and that I had already had all of the pertinent testing done and had brought my medical records along for the appointment. Based on all of the factors, she decided that at this point, the cause of my infertility was unexplained by PCOS or anything else. Her recommendation was to try intra-uterine insemination (IUI) for the next few cycles, and potentially move on to in-vitro fertilization (IVF) if I still wasn't pregnant after that.
I was so thrilled & grateful that, because I was early in my cycle at that point, we would begin immediately! I had a baseline ultrasound the same day as our consultation and began an additional round of Femara.
I took Femara for CD5-9, had an ultrasound mid-cycle to check follicles, triggered ovulation with an HCG shot, and went in for the IUI. The next day, I began progesterone suppositories. Blessedly, 13 days later, my blood HCG test came back positive. I could hardly believe our first IUI had been a success!!
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