Wow – a lot has happened since my last post!
As I mentioned, we scheduled our IUI orientation for August 18th. It was a group orientation with three other couples (which everyone seemed to find a little awkward, but c’est la vie) and the nurse running the session was mostly going over how to give injectables. The plan isn’t for us to use any since I seem to be ovulating fine, so we didn’t get a lot out of it – though I did learn that they recommend that I take 81mg of aspirin (baby/low-dose aspirin) daily to help thicken the endometrial lining. So between that, these crazy prenatal vitamins that have to be taken as two big horse pills three times a day, and all the other crap I take every day for my CF, I’ve really got my hands full with medications!
After the orientation my husband and I realized we still didn’t really have a very clear idea of what the plan was for our IUIs. We also felt the doctor hadn’t really been taking my concerns about my irregular periods seriously, and we’re also feeling stressed about the need to get pregnant fairly quickly to stay on track with my educational plans and medical needs. So my husband drafted a letter:
Hello Dr. ________,
Hope all is well. [Wife] and I attended the IUI orientation this afternoon and wanted to pass along a couple of thoughts and questions for you to consider in crafting our fertility plan as we approach September, the month when we intend to first undergo the procedure. It may be helpful to discuss these items with you, and we would welcome the opportunity to speak by phone at your convenience.
First, we should share that we have a narrow window in which to become pregnant—we intend to make attempts from September through January 2016, and after January, if unsuccessful, we likely will need to wait several years before trying again. In part this is based on attempting to avoid extensive setbacks to [Wife}’s graduate school enrollment and training, but, more importantly, it is based on balancing our desire to have a child with her health. In particular, despite how exciting the news of the approval of Orkambi (the very recently-approved CFTR-correcting drug) has been, [Wife] is putting off starting this breakthrough medicine in order to avoid any possible teratogenicity it may cause—Orkambi has not yet been proven safe in human pregnancy and her CF doctor is not comfortable with prescribing it during fertility treatments or pregnancy. In addition, at least anecdotally, starting but later stopping the drug (for conception and during pregnancy, for example) can leave patients worse off. So while disruption to her career is one thing, risking [Wife]’s health by forgoing the potentially significant benefits of Orkambi is not something we are willing to do indefinitely. Beyond January, mindful of the additional nine Orkambi-less months during pregnancy, the career and health disruptions of waiting for further cycles will be too significant to tolerate.
Second, on top of her somewhat-elevated levels of AMH, [Wife] has had highly variable luteal phase lengths in the last four months: according to Clear Blue OPK results, the respective lengths of time between ovulation and the first day of menstruation have been: 2 days, 14 days, 10 days, and, most recently, 30 days. In the instance of the 30-day luteal phase [Wife] took a pregnancy test which was negative. Based on this this small but recent sample, [Wife] is concerned that: (1) the Clear Blue OPK she is using is not accurate and/or precise; or (2) she may not be ovulating (as possibly suggested by the 30 days between the positive OPK and period [an overall 43-day cycle]). Whatever the case may be, the variability is curious.
Based on the two data points above we are interested to hear your recommendations on how to proceed. For example, given our short window and [Wife]’s recent cycles, two questions that come to mind are:
(i) To further inform the decision about what to do during the coming IUI months, is there a way to determine whether [Wife] in fact ovulates during her current cycle (today is cycle day 8) other than using the (possibly unreliable) Clear Blue OPK? For example, can ovulation be verified by ultrasound? and
(ii) Is there a way to limit the risk of multiples while also promoting ovulation and supporting the luteal phase during an IUI cycle?
In case it is easier to talk through these points, we are happy to give you a call at your convenience. We greatly appreciate your help and your time.
We emailed this puppy over and got a response pretty quickly: they scheduled us for an ultrasound and consultation a few days later. At that appointment (CD13) the doctor measured a few large follicles, of which this was the winner:
We scheduled an appointment for another ultrasound to track its progress given that they usually grow around 2mm per day.
We also formulated a more solid plan: we would monitor my ovulation using ultrasound and OPKs for this cycle, just to see how things progress, then do our first IUI the following cycle since that would fit better with our timeline. The doctor still isn’t comfortable with using Clomid or Femara due to the increased risk of multiples, but did agree to use the trigger shot and progesterone supplements to increase our chances of getting the timing right. He also said the OPKs are so sensitive that they sometimes give false positives, which was likely the issue with my 30-day luteal phase (that wasn’t really a luteal phase).
Yesterday (CD18) I went back for another check and, as it turns out, that follicle is in no hurry. It had only grown to about 15 mm. At that rate I likely won’t be ovulating for another week or so. That would mean that my next ovulation – and our first IUI – would not be until sometime in October given how long and irregular my cycles are.
The more I thought about it, the more I really didn’t want to wait that long. So I asked my husband what he thought about trying to get started this cycle – meaning next week – and he was totally on board.
Of course, these decisions never happen at a convenient time. It was an hour before the doctor’s office closed for the weekend. Luckily they’re pretty responsive and I managed to catch them before they left the office – and it seems like they’re on board too, even though it’ll be a tight timeline for getting our prescriptions. So all of a sudden, it’s happening!
I have an appointment for another ultrasound Monday morning, so hopefully I’ll have an update then. Right now we’re just waiting for this follicle to get a move on and grow! Once it reaches 18-20 mm the doctor will give me the trigger shot, then 36-41 hours later we’ll do the insemination. I’m trying not to get my hopes up, but thinking that I could maybe, possibly have a positive pregnancy test in hand in a few weeks is kind of crazy. I’ve read the books, started the prenatal vitamins, done all the tests, improved my diet and exercise… now all that’s left is to get pregnant!
PS – If you want something funny and sweet to watch, check this out! I stumbled upon this couple’s YouTube channel the other day and I’ve watched hours worth of their videos in the last few days. The wife has PCOS and they documented their three-year journey to conceive, as well as their subsequent pregnancy, delivery, surprise second pregnancy, and adorable baby. They’re also ridiculously good-looking and they make it all look so easy (seriously, this lady has the chillest, fastest, easiest delivery I’ve ever seen). It’s addictive and probably also creating some really unrealistic expectations – ha!