Two years ago, we rather nervously decided to chuck the birth control pills and go "commando" so to speak. We weren't ready to actively attempt to start our family, but if it happened on its own, that was fine by us. So for the next 18 months, give or take, we were casually optimistic that when the time was right, it would just...happen. It didn't. Meanwhile, babies were sprouting right and left among friends, family, and general acquaintances. Then in December of last year, after a phone call from our closest friends to tell us that they were happily expecting, David finally admits to me for the first time that he's suffering from what I like to call "parental jealousy" and is ready to actively start trying for a family of our own.
I visited my OB/GYN not long after this admission for a yearly checkup to make sure all systems were go, as it were. All tests and bloodwork came back normal, but given my history of unpredictable ovulation and irregular menstrual cycles, my doctor decided that we would benefit from Clomid right off the bat. The first cycle of Clomid was in January, and I must admit that I secretly hoped that cycle would not be successful, and was relieved when we discovered that it wasn't. I am a bridesmaid for my cousin's wedding in October, and if the January cycle had worked, I would have been due the week before or the week of the wedding.
Cycle number 2 had the same results as Cycle number 1, but I was not discouraged. As a pharmacist, I had studied everything I could find on Clomid and its success rates and knew that it offered a 20% success rate within the first 3 to 5 cycles. I was sure that Cycle number 3 was going to be our lucky month. We had planned a romantic weekend getaway to Gatlinburg and it just happened to correspond to ovulation time. When we got a negative pregnancy test and I started my period, that was the first time I cried.
I tried my best not to get my hopes up on the next cycle. I knew my chances were running out because Clomid is only used for a maximum of 6 cycles. I was also experiencing some side effects with double vision and sensitivity to light, so I knew I couldn't take too many more cycles with the drug. The visual side effects are rare, but when they occur they can be pretty debilitating; I was having to wear my sunglasses on cloudy days and when the sun was out, I wore the dark glasses until the sun had completely set. We had to dim the lights in the house in the evenings as well. At the end of the 4th cycle, I was feeling exhausted every day. I could barely keep my eyes open at work during the day, and when I came home, I was in bed by 9:30 p.m. at the latest. I thought for sure I was pregnant this time; others even commented on my exhaustion as a sure sign that I "must be pregnant". I wasn't. This was the second time I cried.
When I called my OB/GYN for another cycle of Clomid, I asked them to test my husband. We had talked about it and my husband was the one who suggested it. I told them that I couldn't do much more of the Clomid because it was really making my eyes hurt, and I was getting a little nervous that the effects would be long-lasting or worse, permanent. None of the literature I had read regarding Clomid's side effects ever suggested that the visual changes would be permanent, but I was worried all the same. On the last day of Clomid of that 5th cycle, my OB/GYN herself calls me at home. They received the results of David's analysis, and the news wasn't good. The test showed that most of the sperm had an abnormal morphology, meaning they were shaped funny (heads too big, too small, kinked tails, two tails, etc.). Abnormally shaped sperm are not able to fertilize an egg (which I guess is part of natural selection...abnormal shape probably means abnormal DNA). She said that our best hope would be in vitro fertilization (IVF) because the lab would be able to hand pick the normal sperm out of the sample and use a special technique to insert the sperm into the egg to fertilize it. She said that even the normal sperm may have difficulty fertilizing an egg on their own. She then referred us to a Reproductive Specialist and wished us luck.
In the weeks leading up to our consultation with the Fertility Specialists, we did a TON of research on abnormal morphology, IVF, ICSI (the procedure of inserting the sperm into the egg), and whether there were any other viable options that we could pursue. I was very nervous at the thought of IVF; all of the injections and the surgical procedures and the costs were a lot to take in, especially when there can never be a 100% guaranteed success rate. We didn't know how we were going to afford this procedure because our insurance wasn't going to cover any of it. The next thing on our agenda was to tell our families. We hadn't even told anyone we had started trying because we weren't in the mood for the "how's it going" questions that would be sure to follow. With this new development, however, we felt it was time to fill everyone in on our plans. The families were very excited and understandably apprehensive about the IVF; we knew exactly how they felt because we were feeling the same way. Our biggest anxiety over the whole entire process was quelled when David's dad offered to give us the money for the procedure. With that huge weight lifted off our shoulders, we were able to be more excited and hopeful that this would work out for us.
When we met with the fertility specialist, he seemed confident that IVF would be successful for us. He did an ultrasound on me to make sure that everything looked normal and healthy, and he gave me a diagnosis of PCOS. PCOS, or polycystic ovarian syndrome, is a disorder in which the ovaries produce too much male hormone testosterone. The ovaries normally produce testosterone, but in a very small amount. When there is too much, it throws all of the other hormones out of whack, including estrogen, progesterone, and insulin. This results in failure to ovulate (anovulation), difficulty losing weight, and difficulty getting pregnant (hello me!!). Back in December, my OB/GYN had mentioned that she suspected PCOS but drew blood levels that came back within normal limits. The fertility specialist said that often blood levels come back "normal" but PCOS can still occur in patients who are very sensitive to hormone changes (me again!). So the fertility specialist prescribed metformin to help with the insulin resistance caused by the PCOS, and said that should be able to help me lose at least some weight. He told me a story of a patient of his that lost 130 lbs in 6 months after starting metformin...completely a "results not typical" situation, but I was still amazed. All of the other tests were normal and we decided to pursue IVF.
So we started on the drug regimen at the beginning of July to prepare us for the IVF procedure. I took three weeks of birth control pills plus the injectable drug Lupron to quiet down the ovaries and suppress my normal hormone production so that I would not ovulate on my own. David and I also took 10 days of antibiotics to make sure any covert infections were taken care of.
Tomorrow I go for an ultrasound and bloodwork to see if my ovaries are as "quiet" as they want them to be. If everything looks good, I will start Follistim injections tomorrow night. This drug will stimulate the ovaries to produce multiple eggs/follicles for retrieval in about a week to 10 days or so. I will go for an ultrasound every few days where they will measure the size of the follicles; once they reach a certain number of millimeters in diameter, they will be extracted and fertilized with sperm. Three to five days after fertilization, I will go back and have two of the best embryos reimplanted into my uterus. The rest of the embryos will be frozen for us to use later. Two weeks after that, they will draw blood and do a pregnancy test. Oh how I am praying for a positive result!
