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Wednesday, September 22, 2010

Infertility - Starting with ART


So since there's not anything to really update - I'm still pregnant, as far as I know! - I thought I'd detail our experience after a year of trying to get pregnant, when we started to use Assisted Reproductive Technologies (ART). I hope sharing all of this can teach someone something, or at least help people understand why I can't just relax and enjoy this. Pregnancy doesn't cure infertility - does that make sense? I will always identify myself as an infertile.

After just about a year of being off birth control, I was ready to admit to myself and Rob that my body had let us down. It's a really weird feeling to not have a period naturally. I felt...broken. Combined with the many masculine changes from the PCOS over that first year, I really felt like less of a woman. I'm also the furthest thing from vain, but the physical changes had left me feeling like some Quasimodo. I could see things I didn't like in other people's eyes. So I wanted to start at least doing something proactive to get pregnant and move on with my life.

The first step was to take clomid under the care of my gynecologist. Clomid is an oral medication that works to trick the body into thinking estrogen is low, therefore stimulating the ovaries to produce the hormones necessary for ovulation. It has numerous unpleasant side effects, but I got pretty lucky with it. I had some hot flashes, mood swings, and headaches. But I ovulated! I know I did because I charged my basal body temperature every day (and because I got my period without having to take medication to bring it on).

I started suspecting I was getting some irresponsible care during my second month of clomid. Basically, it can have side effects that contradict the body's ability to get pregnant, ironically. And my doctor wasn't checking for those effects, nor was she checking to make sure I wasn't producing multiple follicles. Kate Gosselin was actually on clomid when she conceived her sextuplets. However, her doctor knew she had over-produced and told her to abstain from sex to avoid high-order multiples. Obviously, she didn't listen. And my gynecologist really wasn't listening to me or taking my questions seriously. Plus, I was ovulating, which I always thought was the huge problem, but still not getting pregnant.


After 3 months of clomid with the gynecologist, I decided to move to someone who really knew how to handle infertility: a reproductive endocrinologist. The doctor was wonderful - our first appointment in December 2009 went a long way to making me feel like someone understood my condition and how to treat it. Both of us felt a lot better after the first meeting. I started on a drug shown to help PCOS women that my gynecologist had refused to put me on called metformin, which treats the insulin resistance that is believed to cause PCOS. I started feeling better and things were looking up.
With the RE, we continued on clomid but added in monitoring of my follicles and uterine lining as well as intrauterine insemination (IUI). In an IUI, the man produces a sample that is "washed" to concentrate the sperm by removing the seminal fluid. That sample is injected into the uterus through a catheter, kind of cutting out the middleman. In this case, the vagina. :) We did 3 IUI cycles with clomid before moving on to injectable medication.
The injectables work more directly than clomid, they are actually synthetic versions of the ovulation hormones meant to stimulate your ovaries to produce high-quality follicles. It's surprising how injecting isn't a big deal after a few days. Although I did it myself occasionally, I generally had Rob do it. Not because I couldn't, but because I wanted him to realize how hard I was working on getting us a baby. But 3 injectable IUI cycles went by with no success.
Then the doctor mentioned in vitro fertilization (IVF). Whoa. That's one hell of a big step.

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