Letrozole

I started Letrozole (brand name Femara) on December 27th. Finally a welcome side effect, super short periods. I took these meds on days 3-7 of my cycle.

This medication is commonly used in high doses in women who are fighting breast cancer. I often find myself wondering how they determine these "other uses" for medications. For example, the shots my mammaw gets in her eyes to treat wet macular degeneration is actually used in high doses to treat colon cancer... it baffles me... who thought "Oh we should inject this in that gimp eye just to see what happens"? Clearly this sector of science is above my pay grade... I never did care for chemistry. Anyways...

Some of the side effects were similar to what I felt with Clomid: headaches, hot flashes, some dizziness, fatigue, night sweats... but the worst thing? Muscle and joint pain. I have a fairly high tolerance for pain... after numerous run-ins with kidney stones... there isn't much pain that I can't deal with. This was intense. I found my OCD self laying on a heating pad with muscle relaxers instead of doing laundry and cleaning. The symptoms also lasted longer on the Letrozole, most likely due to the fact that it stays in your system longer than Clomid does.

These side effects would later come back to bite me when I had gotten more used to expecting the pain, and then confusing the pain for a side effect and trying to muscle through it when I was in actuality passing a kidney stone, however I could finally tell the difference when I started having the tell-tell bladder spasms of yet another stone being stuck at my bladder wall.

Despite all that I was very hopeful for this medication to work for us. I was excited to be on it... my sister-in-law conceived on her second month of taking this drug... and I just knew we would have the same experience!!

No baby round 1. Started round 2 January 23, 2013. No baby. Started round 3 February 22, 2013. I ovulated all three rounds!! Upon the start of our third round, we were informed that this would be the last treatment she could do with us. We would need to go on and make an appointment with Fertility Associates of Memphis, she suggested seeing Dr. Ke. I was encouraged to go on and call them because it can take weeks (and sometimes months) to get in with an initial appointment to see him. I like to be proactive sometimes, so I did as I was told. His first available when I called in February was April 1st. Wow. Guess they were right! And I could always cancel the appointment if I ended up pregnant... which I just knew after all this would happen and I could happily call and cancel, elated that we would begin a different journey.

During our last round, after I ovulated I was given the date to test for pregnancy if I had not yet started my period. March 19th. This was fate... that was our anniversary. What better gift to give my husband on our day of celebration of love than to show him that we were pregnant?! I fantasized about that day... how beautiful it would be to celebrate a pregnancy on the anniversary of our wedding day... I dreamed about it... I day dreamed about it. I tried, in vain, not to get my hopes up. But it felt right. It felt like it was finally going to happen. I prayed harder than ever.

But that didn't happen. Although I ovulated all three rounds, we still did not get pregnant. I was not one of those lucky people who get pregnant after their medications and HSG test... Our anniversary, as much as we tried not to be disappointed, was a hard emotional day for both of us.

Discouraging right?

After crying it out the morning of yet another negative pregnancy test... (I really should own stock in Clear blue easy) We chose to spend the day focused on one another instead of wallowing in our sadness, there was time for that later. All in all it was a good day. At work I received a beautiful delivery of red roses. Surprised and so happy (flowers are a straight shot to my heart)... I was not expecting the second delivery later... chocolate covered strawberries. He really went all out to make me feel special. I did feel that. I felt loved beyond measure. I felt so blessed that this man sees past all of my inadequacies and loves me whole heartedly. We went to our favorite date-night restaurant, splurged on dinner, crab cakes, prime rib, red wine and crème brulee. It was a good day. It was a day filled with love.

 

But during that three month period, something better... something amazing had happened during that time...

Read on...

It's a Marathon, Not a Sprint!

From where I'm standing, Lord, It's so hard for me to see

Where this is going and where You're leading me

I wish I knew how, all my fears and all my questions

Are going to play out, in a world I can't control

 

June to November 2012

Those six months we were on clomid were each challenging in their own way. You've seen the story of our first round, the next five were less eventful. I only ovulated three times out of the six (that count is including the first round when I was over stimulated). So, in actuality we only had two shots at conceiving out of the six. There were many times in there where we thought we were pregnant, but those symptoms were mostly due to the progesterone supplements I took on the months that I did ovulate. By now you know how sensitive I am to side effects from medication, those supplements are no different. The "tell-tell" signs of pregnancy are mimicked by my body on said hormones... nausea, vomiting, bloating, breast tenderness, extreme fatigue ... etc. etc...

 

Because of the bad reaction I had to the first low dose we took, our doctor was hesitant to increase the dosage even after I had months of anovulation. Even now it seems like those days just dragged... time stands still when you really want things to happen. Every month was the same, the side effects never got better (minus the bout of OHSS I had the first time). I became accustomed to them... so accustomed that I forgot what "normal" felt like. My days were filled by managing symptoms, charting the optimum time for us to try to conceive and putting every twinge I felt under the microscope to see if it could possibly indicate something more than what it was.

 

There were countless moments of discouragement and disappointment. Those moments were often magnified by the announcements of others which seemed to inevitably fall on the days I would have a negative test or got the blood results of failed ovulation. Some people call this Murphy's Law of Infertility. I like that... I like anything that gives me the ability to laugh through our struggle. I saw babies being born... I did ultrasounds for my best friend to tell her that her son was developing perfectly to put her worried mind at ease. I watched her belly grow just as I had watched my sister in law's grow. I am proud to say that she has a perfect son, and I love him dearly.

 

There were countless moments of tears, either through emotional outbreaks from the medicine or the disappoint of yet another failed cycle. But there were also moments of comfort and joy... after joining an online support group I found out I was not alone in my feelings and that makes all the difference. I watched my perfect nephew go through many  milestones (often wondering how my child would look if they were side by side through these milestones). Those six months were a roller coaster really. There was one time I thought I might have OHSS again, but it was a false alarm... just "normal" pains, as if any pain should be labeled as normal... my doctor never once discouraged me from calling and being checked out just to make sure there wasn't anything wrong again. I was grateful for that.

 

On the sixth round my doctor finally made the command decision to increase my dosage, I was apprehensive but anxious to keep things moving forward. It was November 2012. I ovulated that cycle, but still did not get pregnant. We got our negative pregnancy test on Thanksgiving day. It seemed no matter how hard we tried, it just wasn't happening for us. It was a hard day for me to be thankful... but we put on a happy face and made it through the day... after shedding a few tears alone in the bathroom before the festivities.

 

After my last round of clomid, I had a follow up appointment with my doctor before we could move on. She walked in and said "How are you doing?" and before I even had a chance to answer she went on to say "Let me guess, frustrated?!" Talk about hitting the nail on the head. We talked more about me that visit than anything else. That is the joy of having a doctor that talks to you like a friend, you can open up to them... you aren't afraid to tell them how you are really feeling. She offered to put me on antidepressants if I wanted them, but encouraged me to try other routes first. She then ordered more tests on me before we could move on with further treatment options.

 

On that visit she encouraged me to start doing yoga on a daily basis. (We also discussed acupuncture but the cost of the visits ultimately discouraged me from doing so.) I did some research (because, that's what I do...) and ordered a yoga DVD from Amazon. I encourage anyone who is interested to check it out. It is called Restoring Fertility: Yoga for Optimal Fertility. The developer has an entire website devoted to helping increase fertility... www.restoringfertility.com The neat thing about this workout, is that it has a different exercise for every phase of your cycle... If anything doing these exercises has helped with my anxiety level... well that and spending a lot of time in prayer, and in research. Oh, me and my researching... I find myself comforted when I can understand exactly what is going on (or not going on that SHOULD be) in my body. The exercise even helped with the muscle aches and headaches I continued to experience...

 

It was during this six month period that I realized this process, for us at least, was going to take some time. We were running a marathon... a marathon that we had not trained for. Anyone can muscle through a 5K without training... but a marathon?! No way. Every month was a struggle to keep going. But this was the path we were being led down... I had faith in my doctor and faith in myself that we were doing the right thing. I had more and more faith in our marriage... the harder our struggle got, the more we learned to cling to one another instead of pushing away. On this same note... little by little I was learning to lean more on God. Piece by piece I was handing him parts of my struggle to help me carry... it wouldn't be long before I gave him all of it, but that is a story for another day.

 

We still haven't reached the finish line... but we keep on truckin' down this rocky road. At least we are on this road together. "Together" makes all the difference.

 

From where You're standing Lord, You see a grand design

That you imagined, when You breathed me into life

And all the chaos comes together in Your hands

Like a masterpiece of Your picture perfect plan

 

One day I'll stand before You and look back on the life I've lived

I can't wait to enjoy the view and see how all the pieces fit.

 

Song: Already There by Casting Crowns

Clomid, the Jekyll and Hyde of Medicine

June 2012

So there we were with these magic pills that are supposed to make my ovaries work. I felt like Jack with his magic beans... this will work. I knew it. It had to, right? I took them as directed. Whoa.

Now if you do your research... you will find that the risk of side effects from this medicine, especially the low dosage that I was on (25mg), is pretty low. I had all of them.

• Hot flashes. These were particularly bad at night, I would wake up drenched in sweat. It was gross and uncomfortable. Not to mention that I work in the only doctor's office in the world that is perpetually too hot. Not a good combination.
• Bloating and abdominal discomfort. Good thing I wear scrubs most days. Whoever invented that drawstring thing is a genius. The other time I would have to spend in either sweats or leggings.
• Weight gain. Yep, I gained 10+ pounds in a matter of days. That's normal right?
• Mood swings. Goodness... the mood swings. I could go from being the nicest person in the world to being the angriest in a matter of seconds. Oh and let's not forget the crying. Just one "joke" from my husband could put me in the floor in a pile of tears in no time. This would take some adjustment. We argued, I got mad at anything he would say. Oh you don't want to eat what I cooked for dinner? Welcome to World War 3. Any jokes felt like a good swift kick in the stomach. Instantly I could produce enough tears to fill a salt water swimming pool. It was awful. I didn't feel like myself. I knew my husband had to be wondering where this person came from and how he managed to marry this lunatic... the hardest part was that I couldn't help it. No one warned us that it would be this bad. For that "medicated" week, I didn't even know who I was and why I had no control over this!
• Nausea. Check.
• Dizziness. We aren't just talking a little bit. We're talking, try to lay in bed and watch the world spin around you kind of dizziness. Like after taking strong pain medicine and seeing "trails" behind things. Like drinking an entire bottle of wine and then trying to work.
• Headaches. Ugh. I have battled migraines and chronic headaches all my life. Why not take a medicine that would compound that?
• Alopecia. To pile on top of how bad I felt about myself... my hair began falling out. Fantastic.

So here I was... with this whole list of things that no one warned me about. Okay so I was warned about maybe one or two. Apparently my sister in law is the Hulk when it comes to taking medication because she barely had any side effects, if only I could be the same way!! I was very sensitive to this medication. You would think that would be a good thing right? I could take this small dose and then voila- PREGNANT!! Nope. Insert severe abdominal pain and more weight gain. Enough to make me call my GYN.

So I went in and they did an ultrasound to see what was going on. "Wow" the girl said... "there's a lot of cysts here." Boy, was there. More than 5 large ones on each ovary, and a variety of smaller ones as well. I knew that stuff was supposed to produce follicles... but that many?

Then I was taken into my Doctor's office, and she closed the door. Well this can't be good. "Are you in pain?" Yes. "How much weight have you gained?" More than I should in a matter of days. "Okay, I'm going to tell you something and it is going to upset you" ... "You shouldn't try to get pregnant this month" WHAT?!? But that's the whole point of THIS!! "You are suffering from OHSS, ovarian hyper stimulation syndrome. The risk of a great number of multiples is too high, and you are my top priority. I think it would be too much of a risk to your health if that was to happen." Tears. "I'm sorry, I know this sucks." What is the risk of this happening? "Well that's the hard part to explain, I have never in my career seen anyone get hyper stimulated from this low of a dose." Ugh. Go figure, me, the interesting case. "I'm so sorry this is happening." At least that was genuine. The thing is, if you get pregnant while suffering from OHSS, it gets worse... much worse... and lasts throughout the first trimester. She got misty eyed herself watching me take all this in. The infertile woman who is now too fertile and told she can't even try for a baby this month. It was awful. Yet another time I regretted telling my husband not to take off work to go with me to an appointment.

When I left I called him on my way home and gave him yet more bad news. I was sentenced to go home and rest. Take the next day off work. AVOID water because that can apparently make the condition worse. Load up on Gatorade and/or PowerAde. No I would NOT be able to run that fun LuvMud 5K we were looking forward to, but I could go and watch, as long as I sat most of the time, and didn't get overheated.  

It was on the way home from that 5K that the cysts began to rupture. Holy cow. It was intense. Miserable. Even with the pain medication. When I got home, all I could do was either lay in the bathtub in the hottest water I could stand or lay in bed on a heating pad... trying to manage the pain. I drank as much as I could... the thirst was indeed excessive. There would be no baby making this month.

Later I would regret agreeing not to try that month. But I would have many "if only" months ahead.

This is when I would begin a strategy to avoid falling back into my depression. I keep a list of blessings in my head. On those bad days I would go through a list of good things in my life. Sometimes it kept the depression away, sometimes it didn't. I still found myself asking many times... "God, why is this happening to me?" "Why does this have to be so hard?" I still wasn't leaning on Him like I should. I should have been casting my burdens upon Him, letting Him help me to carry them... instead I was questioning Him a lot... At least I was talking to Him. FINALLY I was talking to Him on a daily basis. Progress.

I prayed for strength to get through this. At least I didn't have to be admitted to the hospital as many women who suffer from OHSS do, I had a mild case... and if this was a mild case I sure as heck did NOT want to experience a severe one. I would be closely monitored from here on out.

An Interesting Case

I had just started my first round of fertility medication. I was taking 25mg of clomid for five days. Right after I started the medication I would have my first test, a sonohysterogram (also can be called a sonohys, or a sonohystogram). The reason this test was ordered was that there was a defect in my uterus on a prior ultrasound that my new doctor wanted to see the degree of. I knew this defect was there only because my friend who had done my ultrasound at the previous office showed it to me. Those doctors never even mentioned it, much less that it could cause a problem with me conceiving in the future. But my new doctor was way more thorough... and cautious.

Initially the test was scheduled with the nurse practitioner at my new office who performed these tests quite a bit. When I arrived at the office, I was immediately taken to the secondary waiting room while the sonographer set up the room for my procedure. She took me back, I got undressed and she did a transvaginal ultrasound before the procedure began. I was only slightly nervous about this exam, I had learned about it in school, I knew how things would go... and everyone made me really comfortable there.

A few minutes later the nurse practitioner walked in and said "I'm sorry but I won't be doing your exam today," --oh that's weird, I thought-- she continued "Dr. Williams was able to be here today after all and she would prefer to do the test and see everything herself." I was caught off guard, but in a good way. Oh! Well, great!!

The doctor came in and explained the procedure to me. I wasn't prepared for what she said next. "We have a student studying to be a nurse practitioner here today and I was wondering if you would mind if she and our NP watched?" "No, that's fine, I was a student once too, I understand." So there I was.... in stirrups, spread eagle on this table when the two walked in. "Thank you so much for letting us watch Mrs. Jewell... it's just that you're such an interesting case, we don't get to see cases like this too often." Great... I remember being a student... getting excited about the "interesting" cases. NO ONE wants to be an interesting case however. An "interesting" case means you have something wrong with you that most people don't. I never realized until that moment just how uncomfortable it felt to be that "interesting" case. Especially on a gynecology table where they were face to face with my goodies... But it was what it was. I really didn't particularly mind being the subject their learning experience, however I wished I didn't have to go through any of it. Honestly, I just didn't want anything else to be wrong with me.

Based on previous ultrasounds, they thought I had a partially septated uterus. A septate uterus is a congenital malformation, where the endometrium is split to some degree, this can range from a mild septation to a complete septation. In some cases this causes no problems... but in others it can cause implantation issues, miscarriages, preterm labor, etc...

Initially I was told that this procedure might be a little uncomfortable. Whoever said that has never had this procedure done. It HURT. It was not your normal pap smear speculum. This thing felt like a 16th century torture device. Then the catheter was inserted through my cervix. "You might feel a little pinch"... yeah, I almost came off the table. Tears ran down my cheeks... I wasn't crying, it was just a reaction from the pain. She was so sweet about it though when I told her it hurt. She talked me down and I was OK. The speculum was out and the fluid was about to be inserted. She warned me that I could feel heavy cramping as my uterus filled with saline. Oh boy... I did. They let me watch the screen though, and that occupied my curious mind enough to finish the procedure. All in all, the procedure didn't take too long. When I was done, I was SO uncomfortable. She gave me some Advil and a sprite.... and I waited for a diagnosis. At that point, I wished I had taken Mike up on his offer to take me to this appointment. I was not prepared for how uncomfortable I would be... and I was not looking forward to the 30-45 minute drive home.

After she looked over everything, she brought me into her office to talk to me about a diagnosis. I actually had an arcuate uterus. This was good news. An arcuate uterus is an anomaly where there is only a mild indention in the endometrium, and not a septation.

More good news... I was told this type of mild defect is not commonly associated with reproductive issues, although she warned me that although it is not common, it could become a problem. If it was to be a problem in the future she said it could be surgically repaired. The risk in that instance is that scar tissue can form in its place and theoretically cause the same kind of problem that the arcuate uterus could possibly cause in the first place. So which is the lesser of two evils? We would move on as planned from here on out. I was praising God for this not being as bad as she initially thought. More good news? I had follicles forming within my ovaries on both sides... she said this was a good sign that they were being stimulated by the clomid.

I left very achy... very ready to be home and called Mike and told him (once again) "you were right... I should've let you drive me... that was awful!" But we were both happy for the good news. We were cautiously hopeful that this would not become a future problem. I was exhausted. I went home... took some pain meds, a bubble bath and waited for a new day.

A New Start... and a Plan

Beginning of June 2012

Believe it or not, finding a doctor was an easy task. When my sister in law had her baby, I was amazed at how her doctor treated her as not only as a patient but as a caring friend, offering "suggestions" to her instead of telling her how she thought everything should go. She had urged me to go to this doctor before but I didn't want to change at that time. Now? I was ready... I was MORE than ready. I never wanted to step foot back in my regular doctor's office again! And I haven't! (well except to pick up my medical records)

So, I called her doctor... got the nicest receptionist I have ever spoken to on the phone... "I would like to make an appointment with Dr. So and So please."... "Oh, Absolutely! Have you seen her before?" "No, ma'am." "Okay well it might be a couple of weeks before we can get you in as a new patient, is that okay with you sweetie?" "Yes!" if I had anything it was time right? I got an appointment just in time to start medication for my next cycle, if that's what she wanted to do.

In the meantime, I went on a trip. A much needed trip with my mother to the beach. A few days in the sand and sun and outlet malls. I thought of our baby so much on that trip, I spent a lot of time deep in thought, scared of what was to come, going over and over what had brought us here in the first place... but by the end of it I was really missing my husband and ready to start our "infertility journey"

 

 



My first appointment at the new office had finally arrived. I was ready. Scared but ready. I waited all of about 10 minutes before I was taken back to a room. Already an improvement from the hour and a half long waits at the previous office. Once they did my vitals, I waited for the doctor, who was in the room before I knew it. She introduced herself then asked me a few questions... then suddenly she stopped and looked at me and said "you look so familiar, have we met?" Wow yeah once. "We met when you delivered my nephew, 'the mom' is my sister in law." "Yes! I knew I recognized you!" Even more progress. Talking to her was like talking to a friend I had known forever. There was no intimidation, there was no talking down to me, there was only her talking me like I was a person that she cared about!! Talk about PROGRESS!! We went over everything that had been done so far. What my labs were, what they should be, what isn't working. The she asked how I wanted to go about this.

She gave me a list of options:

• We could keep trying naturally for a while.
• We could try clomid.
• We could try naturally and then add progesterone later.
• We could try clomid and progesterone supplements together.

Then she gave me her recommendation... first she asked how badly we were ready to get pregnant? I had told her about her first pregnancy and all my feelings, etc. I told her we were ready to be parents yesterday. She giggled and then said, "okay then. If we are going to do this, I think we should give it all we've got! Here's what I think we should do to give you your best shot..." So there was a plan. I would take clomid on days 5-9 of my cycle. We would start taking ovulation tests on day 9 until I got a positive one and then a negative one. We would start progesterone supplements 3 days after a positive ovulation test and continue them until I either started my period or through the first trimester if we were to be pregnant. She also recommended that we continue charting using the basal body temperature thermometer. She also wanted me to have a sonohysterogram (an ultrasound guided test where your uterus is filled with saline and the interior of the uterus- the endometrial cavity- is evaluated). I left feeling confident... confident about our plan and confident that she REALLY wanted to help us. Just the fact that she cared brought me so much comfort. I was so grateful that she had come into our lives! I remember thinking on the way home... "Okay God, I'm ready... let's do this!" I'm always comforted when there is a plan of action, a direction to head that I can focus on.

I was not prepared for how my body would react to that first round of medication...
____________________________________________________________

If you are starting your infertility journey, the first thing I would ask you is... How do you feel about your doctor? If you have a good relationship, fantastic! If you are iffy... LOOK AROUND! So many doctors these days treat you like just another patient. This is a journey where you need your doctor to be an advocate for you! If you feel like you aren't being treated as well as you should... then that very well might be the case. I know it can be hard making a transition to a different doctor, especially if you have been going to the same one forever. Find someone who has been in your situation, ask them about their doctor, the tests they've done etc... Do research on what should or should not be done in your situation, ask questions... LOTS of questions. Write them down so you don't forget them. Don't be afraid to asks for tests to be done. BE YOUR OWN ADVOCATE TOO.

Second... This process is overwhelming! You are going to need a 'sister' to lean on through this that completely understands what you are going through. Find a support group or someone you can call, text or e-mail when you have questions or thoughts or just need to vent! I understand no one wants to be a member of the 'sisterhood' of women who have lost babies and/or are infertile, but I can tell you that you won't find a better friend than someone who has walked in your shoes. If you are in need of a support group I can recommend one to you. If you need a friend... I'll be your friend. I am here to answer anything you want. thejewells319@gmail.com

You always think the only thing you need to get pregnant is a man... but in our case, we need a doctor too... and a WHOLE lot of faith... and a WHOLE lot of support!!