Treating Infertility

On June 11 after all of the infertility testing was completed, we had a consultation with the doctor to determine what the next steps needed to be. I was put on Metformin (started with 500mg and was told to work up to 1500mg). Metformin is an insulin resistance medication often prescribed for PCOS that helps regulate blood sugar which somehow gets the hormones straightened out. It is a pretty difficult medication to get used to. It really messes with the digestive system which is why you start with one pill and try to work up to three by adding another one every week or two. The pills are also huge which is sort of a pain. I was also told to take low-dose aspirin which has an unexplained positive effect on fertility and prenatal vitamins. So at that point, I was taking 5 pills each night. When my next cycle started (who knows when that would be), I would take fertility medicine and we would do the IUI procedure (think turkey baster).

You may be wondering about the cost of all this testing and treatment. Luckily, my employer's medical insurance includes up to $10,000 (lifetime) for fertility treatment. Additionally, many of the tests and maybe even some of the treatments were coded as a birth defect rather than infertility. We are extremely fortunate in that all of this only cost us a hundred dollars or so (most of which was for the medications).

Cycle Day "CD" 1 was July 1st. CD 3 through 7 I was put on a low dose of fertility medicine called Femara/Letrozole which was one pill per day. Luckily, the only side effect I had was a few hot flashes (some people have a lot of side effects with these types of medications). I was put on a low dosage because it is sort of a trial and error calculation to determine how much you need to get an egg to develop and grow and how much is too much, causing multiple eggs to develop. The low dose seemed to be enough because on CD 10 I had an ultrasound and there was a follicle measuring 12 (the goal is to get it to grow to around 20). The hope was that it would continue to grow. And it did - at CD 13 the follicle was measuring 19. It was a little later than normal but since my cycles are a little longer it made sense. Since the follicle was big enough, I was told to take Ovidrel which is a shot you have to give yourself in the stomach to tell your body to release the egg from the ovary. I could not get myself to do it myself so I had to have Brett inject me. The needle was so tiny that I didn't even feel anything. On CD 15 we had the IUI which was pretty awful and painful. Because the egg was on the right side, they had to inject into my right cervix which is very difficult to get to. Starting on CD 17, I had to start taking progesterone suppositories twice per day. Let's just say I am glad I am finally done with those! On CD 22 I had my blood drawn to determine whether I had ovulated (which would mean the egg was released). They are looking for a number above 10 and mine was at 20. Then it was the waiting game - after seven days I would take a home pregnancy test to see if this worked. On July 29, I took a test and it was negative. So we would have to start over next cycle. The doctor said that if IUI didn't work after 2-3 times we would have to move on to IVF which Brett and I were not comfortable with.

The next cycle started August 1. We decided to not do any treatment this cycle because Brett was traveling for work probably around the day that we would need him and we also had a vacation scheduled in Las Vegas at the end of the month. We would wait until the next cycle started... which was taking forever! It was almost the end of September (close to 2 months) and I had not started another cycle.

Investigating Infertility

At my first appointment with the infertility doctor on April 20, 2009, I had a physical exam, an ultrasound, and blood tests. I had done quite a bit of research on fertility issues in the past due to my uterine abnormality so it did not surprise me when I was diagnosed with PCOS (poly-cystic ovarian syndrome). This was diagnosed in part by the ultrasound which showed many follicles on each ovary and in part by the blood test which showed that my blood sugar was lower than normal. I has previously suspected that I might have this because I experience some of the other symptoms, one of which was an irregular menstrual cycle - I would go anywhere from 45 days to 9 months between periods. PCOS is a very common cause of infertility in women and is basically caused by a hormone imbalance. This causes the eggs to not fully develop or release from the ovaries - which creates the follicles that were shown in the ultrasound.

The next appointment I had was an MRI on April 29th. The purpose of this scan was to determine which type of mullerian anomaly I had. Depending on the type, it is sometimes necessary to have surgery in order to increase the chances for a successful pregnancy. I was diagnosed with a didelphic uterus which was great news because the pregnancy outcomes are the best and there is not a surgical procedure to correct this defect. On May 4th I had an IVP performed to look at my kidneys because many people with mullerian anomalies also have kidney abnormalities. A lot of people have extra kidneys. The IVP showed that my kidneys were normal - I have two and both are functioning.

On June 3rd I had one of the most painful procedures I have experienced. It was an HSG where they basically insert dye into the cervix which is pushed through the uterus and eventually into the fallopian tubes. This test was a check to make sure my fallopian tubes were not blocked and that an egg could pass from the ovaries to my uterus. Because of the pain I was in and the difficulty in accessing the right cervix, only the left side was tested but it showed that that tube was in fact open.

Getting Started

We had known since we were in college that having children of our own would likely be a challenge. I was diagnosed at that time with a mullerian anomaly. This means that there is a birth defect that makes my uterus abnormal. There are different variations of mullerian anomalies but mine is such that my uterus is basically divided into two small uteri. I was diagnosed during one of my annual pelvic examinations. My doctor discovered that I had an extra cervix and an ultrasound confirmed that my uterus was also abnormal. The pregnancy complications that generally result from this type of abnormality include miscarriage, preterm labor, and growth restriction.

We had decided that since we might have problems, we would not use birth control after we were married and would see what happens. We didn't want to eliminate the possibility of having children if "our time" happened to be right after we were married. At the same time, we were hoping that time would not come too soon because we wanted to enjoy a year or so of newlywed bliss. ;)

After about ten months of "seeing what happens" nothing had happened. We still didn't know if we were quite ready to have a baby but I wanted to see a doctor just to make sure that there was nothing I could do to help prevent a miscarriage in the event that I did get pregnant. After doing some research, I found that I needed to see a reproductive endocrinologist. So I called an infertility doctor in our area and set up an appointment. Generally, you would have to wait until you had tried to conceive for 12 months without success to be considered "infertile." But since I knew that I had problems they let me go ahead and schedule an appointment.

Welcome

We went to Vegas and lost all the money we put on the table (and in the slot machines), but it turns out we had some luck in the end. After months and months of trying, doctor visits, a self-administered shot, pills, and a procedure that felt much less than natural, it finally happened. So what happens in Vegas does not always stay in Vegas. Here's the story of our "Vegas Baby."