Superovulation Treatment

On Monday, July 11 I had my first appointment with the fertility doctor since our initial appointment on January 25. Man, that place. I don’t like getting emotional, I am emotional but don’t like to show it in public, I think I’ve cried at work 2-3 times in my entire life. But the minute I walked into the fertility clinic the tears welled up in my eyes. I am a compartmentalizer. I can easily separate areas of life and focus on different things at different times, when I’m at work I’m at work and I (mostly) don’t let the fertility troubles or struggles at home ruin my day or distract me. Same with when I’m at home or even when I’ve been telling friends about my condition – I’m always a bit removed from it, talking about the diagnosis like it’s about someone else and not me.

But the second I walked into that clinic the reality of my situation came screaming back to me and I spent the next 2.5 hours crying. Thank god for incredibly compassionate nurses and doctors.

In fact, later that day as I boarded my flight home with $1,000 of fertility medications on ice in my carry-on bag, I got pulled aside for extra screening (due to the meds) I was cutting it really close to get to my flight and I just started sobbing. I couldn’t stop. I said “I’m really anxious about missing my flight” so they sent a nice man to check and he came back and was like ‘It’s delayed, you’re fine’ but I couldn’t stop crying. Finally I said to the lady going through my stuff ‘I’m sorry, this isn’t about this, I’ve had a really hard day.’ and she just smiled and nodded kindly. Then when she asked me what the medication was for so she could record it and I told her fertility I think she got why I was so emotional. I hated that feeling. I felt like such a victim and such a baby.

Anyways, back to the doctors appointment…. First thing my doctor did was take me for a pelvic ultrasound to look at my ovaries. She couldn’t find my right ovary (which apparently is pretty common – they can be hidden sometimes) but my left one was there. It did have some little black “spots” on it but she couldn’t confirm they were follicles. She said based on my AMH levels, which were <0.08 in January (it should be between 1.5 – 4) she does not believe what she saw on my left ovary were follicles.

What is AMH?

Since AMH is produced only in small ovarian follicles, blood levels of this substance have been used to attempt to measure the size of the pool of growing follicles in women.

Research shows that the size of the pool of growing follicles is heavily influenced by the size of the pool of remaining primordial follicles (microscopic follicles in “deep sleep”).
Therefore, AMH blood levels are thought to reflect the size of the remaining egg supply – or “ovarian reserve”.
With increasing female age, the size of their pool of remaining microscopic follicles decreases. Likewise, their blood AMH levels and the number of ovarian antral follicles visible on ultrasound also decreases.

Women with many small follicles, such as those with polycystic ovaries have high AMH hormone values and women that have few remaining follicles and those that are close to menopause have low anti-mullerian hormone levels.

Following the ultrasound I went back to the waiting room and shortly after went in to see the doctor.

It was not good.

She told me they will try this treatment on me to see how my body responds to the hormone drugs. The goal with these drugs is to make my body produce a follicle and then ovulate an egg, in fact just producing some follicles would be AMAZING because even if I don’t ovulate or create an egg just the production of follicles would make me a candidate for IVF.

However, she doesn’t think it’s going to happen.

In fact, she said there is a 90% or more chance this won’t work. If we try this and it does not work and my body doesn’t respond to the drugs then we’re done with fertility treatments. They will not try any more on me and my next option for actually carrying a pregnancy and birthing a child will be donor eggs.

Oof.

Well donor eggs has been on my mind a lot lately as I know it is a very real possibility for me every single time my doctor brings it up, whether at the in-person appointments or the two phone appointments we’ve had I have not been able to hold in the tears. I can’t even talk about it with her without crying. Hard. I am clearly not ready to pursue that path.

After chatting with the doctor I was taken into a different room with one of the nurses to do my orientation on the medications I will be using. Basically this is how it’s going to go. Instead of including the explanation of each drug below I’ve linked to them through google if you want to read more about them.

  • I continue taking my current dosage of estrace and provera daily until July 18
  • Shortly after I stop taking them I will get a bleed. That is cycle day 1
  • On cycle day 3 I start taking Clomid – 100 mg a day
  • On cycle day 7 I do my first shot of Gonal F (FSH) this is a shot I have to give myself in the belly. I also take Clomid that day.
  • On cycle day 8 I get my first set of bloodwork done
  • Cycle days 7 – 12 I do the shot of Gonal F in the belly each day, I will have my blood taken a few more times during that period as well.
  • By cycle day 12 a few different things might happen;
    • Option 1: My doctor will call it and stop the treatment as my bloodwork will show that the meds are not making my body produce a follicle (they can tell by my estrogen level).
    • Option 2: My bloodwork will show climbing estrogen levels but not quite as high as actually creating a follicle so I will need to get more shots of Gonal F and continue taking them for a few days and continue monitoring my bloodwork to see what happens.
    • Option 3: This could happen on cycle day 12 OR after option 2 happens. If my estrogen level has climbed a lot and they think my body is producing follicles I will rush to my fertility clinic for an ultrasound to check on the follicles. At that point we will either wait for ovulation and do an IUI or we will use a trigger shot to bring on ovulation and do an IUI – an IUI is when they wash your partners sperm and inseminate you with it.

Intrauterine insemination (IUI) is a form of assisted human reproduction. During IUI, your doctor will place washed, prepared sperm into your uterus (womb) and near to your egg at your time of ovulation. This procedure is often combined with fertility drugs to increase your chances of conceiving.

Option 1 is the most likely to happen, according to my doctor. Option 2 would be good, it would mean my body is reacting to the drugs even if I don’t get pregnant this time it would mean we should try this again. Option 3 would be the most ideal of course.

For now I’m crossing all of my fingers, toes and praying for Option 2. I know Option 3 – the best option – is very unlikely for me. But I really hope the drugs at least do SOMETHING to my body so there is hope that a different combination / dosage etc. may be what we need to get to Option 3 in the future. Option 1 is the worst case scenario as it means even a gamut of hormones cannot make my body produce an egg – likely because there are remotely no eggs left in my body. So great to hear at 27 years old.

So, here goes nothing. In the next blog post I will talk about a few of the ‘natural’ things I am going to be trying to do over the next 3-4 weeks to try and help this process. I also plan to blog throughout the entire process.

Bottom line: My husband and I will have a family one day. It might look very different than I ever could have imagined and right now I don’t know what it will look like. And that’s hard. But it’s going to happen. We will be parents and we will have children and a family, of that I am certain.

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