TTC - Clomiphene Cycle #2 - Mar 14

Before we begin, we are getting to the part of my blog that might need some translating so here is a helpful link to some fertility acronyms that might help you out.
http://www.fertilityplus.com/faq/acronyms.html

Wednesday 19.03 (CD1 #2). Time to call my nurses at the hospital. Spoke to Stephanie and she confirmed we were all go for the same dose this cycle (25mg from CD3-CD7) as we would assess the dose and look at putting it up if we had no luck again this month.

Friday (CD3) arrived and I decided to take my dose at 6.30pm when I got home from work. They suggest you take it at the same time every day and take at night to reduce side effects as you can sleep through them. Few hours in and feeling ok. Thats great as last cycle I had the hot and cold sweats by this point.

CD4 - CD7 went ok this time, I had a few things to note like nausea, moodiness (my god I have a patient DH) and this time had very dry eyes and sinus resulting in some blood in my nose. Strange as it sounds I found a lot of similar experiences online.

I made it! that was nowhere near as bad as last month. Maybe I have some good luck finally coming?

Friday 28.03 (CD10), time for my blood test. This is to test the Estradiol and FSH levels to confirm if an ultrasound is ready to book as these levels indicate the possibility of growing follicles. I have to get these bloods done before 9am in the morning to ensure the results are back with the nurses in the afternoon. 1.00pm got a call on my cell and it was Stephanie to see if I could come in at 2.30pm for my ultrasound. Great! meds worked! Work was fine, I just said I was going and rocked up to the hospital in time, lucky my work is so close.

My sonographer was lovely. We had a chat about why I was there, she would be scanning my endometrium lining and ovaries to confirm follicle size. She asked if id had one before and I let her know my journey thus far which is great as they had not noted my unicornuate uterus or renal agenesis, that would have made for an interesting scan! haha. She took a few 'good shots' of my kidneys and think she even got a good 3D of my uterus. It seems mine is of a decent size for a 'half', lucky me.

So...here are the results of the scan. Endometrium is 7mm, that is kind of the baseline as far as linings go, but its a pass! they think it should be cushy enough for an egg. 
Follicles... 10! good job Left Ovary! Only one of these seems to be mature @ 16mm which is actually good news for me as reduces the chance of multiples. Good size for follicles is actually 17-18mm and over but as they grow 2mm every 24hrs we should be looking good for O which should be Tue/Wed (CD14/15). Right Ovary could not be spotted on this occasion due to a large amount of gas in my bowels (stupid IBS) so we have no idea where it is or what its doing at this stage but its not connected to anything so shouldn't be an issue. Feeling a wee bit anxious about this as my cycle is currently a reviewed cycle so Im not that closely monitored which means if we did end up in a multiples situation it may not be picked up till later, we will deal with that when time comes I suppose. 

Time for some BMS! (Baby making sex). Nurse has suggested we go for every second day at least to ensure enough of the boys hang around for O and DPO. DH not complaining at all haha but will need to work around our current house guest situation.

Next blood test is Tuesday 8.04 (CD21). This should confirm O and I hope to have nothing but good news for you all, what ever will be will be.

Well test results looked good for O, so my nurse said, for those that need them, I have included the reference intervals below:

Progesterone - 57 nmol/l
Reference intervals:
Follicular        1 - 4
Mid Cycle

Luteal           15 - 100

Post menopausal  <4

Estradiol - 635 pmol/L
Female Reference intervals:
Follicular        46 - 600
Mid Cycle
Luteal           160 - 770
Post menopausal  <200
Male Reference interval <160

LH - 18.2 IU/L
FSH - 7.1 IU/L
LH reference interval:

0 - 9 years       0 - 2.5 IU/L

>=10 - 15 years   Prepubertal range 0 - 2.5 IU/L. 

Levels rise during puberty towards adult ranges.

Adult male        2 - 9 IU/L

Adult female      Follicular                2 - 8 IU/L

                  Mid Cycle                 10 - 75 IU/L

                  Luteal                    2 - 8 IU/L

                  Post Menopause            >15 IU/L

                  Antenatal                 <1 IU/L

FSH reference interval:

0 - 9 years       0 - 6.5 IU/L

>=10 - 15 years   Prepubertal range 0 - 6.5 IU/L. 

Levels rise during puberty towards adult ranges.

Adult male        2 - 12 IU/L

Adult female      Follicular                3 - 10 IU/L

                  Mid Cycle                 4 - 25 IU/L

                  Luteal                    2 - 8 IU/L

                  Post Menopause            >20 IU/L

                  Antenatal                 <1 IU/L

So we waited... and waited... from Day 21 - Day 30. It really is the worst part, esp for the ridiculously impatient... I think I did quite well not to cave and HPT. It's also really hard as most pre-pregnancy symptoms are the same as PMS so you really can't sit around worrying about it all day.

So, Day 30 arrived and so did AF. It was pretty normal with one day of heavy bleeding then 2 days of very light flow. Safe to say it was definitely AF and not implantation bleeding.

We decided to take April 14 off as DH's father was very ill and our house guest also still living with us (not a stress free situation). Was the right choice as one week later my father-in-law passed away :-( May has to be the month! we are conceiving for him as we hoped he would be here to meet his grandchild. I know he will be here in spirit tho xx

May 14 will be our next cycle, waiting to hear if they will be putting me up to 50mg, after speaking with my GP she has advised to be cautious of this due to multiples and my lack of housing for them, also to find out my Fertility scoring so we know were we will be at for IVF waiting lists etc, just incase Clomiphene doesn't work we can plan for the next stage.

Fingers and toes crossed.

TTC - Clomiphene Cycle #1 - Feb 14

Wednesday 12/02 (CD1 #1). I decided it was time to call the hospital to start my first Clomiphene cycle...why wait? Still not up to 56 kgs (BMI baseline of 20) but decided to call the hospital anyway. My nurse at GYN Outpatients was really helpful, normally it would be a case of needing to lose weight, so she said "lets just do it" and see what happens. So she faxed a script through to my chemist for me to pick up and start on Friday (CD3).

Later on that day I found out my husbands grandmother passed away. Tickets were booked for Sunday morning Christchurch to Auckland so we could meet Fraser's sister from Sydney there and drive to up to Whangarei to be with the family.  

After talking to my mother that night she asked if it was a good idea to be starting this cycle with all of this going on? I said, of course! we will be fine, sooner we start the better.

Thursday (CD2) I called the chemist to confirm the script was ready to be collected and they queried why I had half a tablet for Day 3 to Day 5, I said I suppose that's right? I later on found out later in the month that this was not right, on reflection I should have checked with the hospital.

Friday came, Valentines Day (CD3). As I take Thyroid meds in the morning I opted to start my Clomiphene in the evening, so after I got home from work I took my first half a tablet, so 25mg. Later on that night I definitely started to feel hot and cold, wondering if I had picked up a bug. After doing some packing I decided to go off to bed.

Next morning I got out of bed in a rush as things to get done before we left for Auckland but after getting up I found that I could hardly walk fron lethargy, nausea and dizziness. Great... side effects from meds? bug? wasn't sure, all I knew is I got worse throughout the day and was anxious as I had a 7am flight the next morning (Im a terrible flyer anyway).

I made it to Auckland in once piece, just! after a very nauseating drive to Whangarei I spent the next two nights hardly sleeping due to intense stomach cramps, hot flashes and headaches so bad I could hardly move my eyes or head. I managed to make it through the funeral and family get together.

When it came time to leave Whangarei the following Wednesday I was stoked to be going home, and off the meds, still blaming them for these "side effects" which later I found to be common for alot of women but not that common.

CD10 arrived Friday 21/02. Time for my blood-test. Went in before work as need to get them done before 9am so results will be across to hospital that afternoon. Testing for FSH, Estradoil, etc. Results came in, weren't good, so off next day for another blood-test in the hopes we were too early, and nope, levels dropped again. No ultrasound for me this month, the whole cycle was a bust. Nurse said she was concerned my dose wasn't right and she would check with GYN, lets get it sorted and try again next month. I counted out my 30 day cycle and realised that cycle would be just before my 34th birthday.

Time goes by, sooo slowly.

Im normally a patient person but this past year has gone sooo slow. I knew I was in for a long wait tho, they keep telling me good things take time. 

My weight gain has been painfully slow. Jan 2013 to Jan 2014 i think ive gained just under 6 kgs. Im nearly at my optimal weight to start my meds, will be sitting just inside the optimal range so the next 28-30 days will be lots of eating and sitting round to make sure i keep that weight on.

Starting to freak me out a little that by next Christmas we could have a new family member to celebrate with, not getting my hopes up to high tho as my Thyroid is going to make TTC very difficult.

Ill update again when i find out more about the Ovulation Induction. Bring on February!

Finally see the specialist

18.10.13  - Todays the day!

Arrived to my appointment at the Assisted Fertility Clinic to find DH in waiting room, he was early, I late, after getting my car stuck under a railway barrier arm (dont ask haha). We didnt have to wait long and a nurse led us round to a consulting room to wait. We were in there quite some time before Dr Tawfeek and my next med student arrived.

Was not a long appointment, he was on call so answered his phone a few times. He confirmed my unicornuate uterus, one fallopian tube, one possibly two ovaries and my missing kidney. He even drew me a diagram which I thought was sweet, however informed him of the excessive Googling i had done on myself haha.

Regarding my test results, he confirmed its highly unlikely I am ovulating, unsure if its the thyroid, weight, or the UU. Tube looks fine so if egg is present should be making it there. Sooo after talking about my diet, thyroid, plans etc it was decided that we would try the ovulation drug Clomid however  until i can get my BMI up to 20-22 (currently 19) and thyroid TSH level down (was 4.8) needs to be below 2.5, then I would not be able to start.

8.11.13 - Since appointment I have had a great result for my thyroid, its down to 1.4 so will remain on the 100 mg daily Mon-Fri and 50 mg daily Sat/Sun. Seen the dietician and have a diet plan to get that weight on, its tough as the Levothyroxine speeds up my metabolism so I have to pay attention to input/output.

Hope by Xmas ill have a few kgs on me so I can see the nurse at Chch Womens and get cracking.

Its going to be many months of drugs, blood tests and internal/external ultrasounds until we know if its working or not. Lets not waste any time.

My new nephew is due to be born this coming week, so im thinking all that time up at Chch Womens Neonatal ward will have me clucking all over the show.

Update again soon.

MRI again confirms it

17.09.13 - last MRI, I hope!

I arrived way early for my 8:15am appt, which is better than being late. The lady at reception said they may take me early and as luck would have it they did. I had a lovely young man that sat down with me and DH for a chat. He confirmed no IV dye or IV to stop my bowels from moving so they got me in early so we had a bit more time up our sleeve for some extra pics. Best thing about spending 30 mins in this machine was no gown...I got to stay mostly dressed so I was nice and warm, im ridiculously cold most of the time. Upon disembarking the lovely young men that photgraphed my insides confirm they got some great shots of my uterus. Nice work guys lol. 

So, I gave it a week then called my GP for the results...Yup! Its definitely a unicornuate uterus! But a decent size one? Lol. No rudimentary horn that they can see, so still no surgery on the table. Still big question mark on the right ovary, seems to be a now you see it now you dont situation. So all good news so far.... Fingers crossed it stays that way

Right now that those tests were done I called the outpatients at hospital to make sure they were aware and no, was still on wait status, that was promptly changed and lovely helpful lady went on hunt for my HSG results. She also put me on the cancellation list as with only 2 more monthly clinics to go this year It wasnt looking hopeful to see specialist until after Xmas.

Not even one week later my cell phone rang. 3 cancellations! Yipee! All booked in with GYN 10.30am Friday 11th October. This is it. Everything is about to get very real!

Update to come next week...with some answers...Eee im excited and scared at the same time.

MRI Pelvis, second and final?

Letter! Fantastic. Second MRI booked, this time they will be getting up close and personal with my uterus and uber kidney. Last MRI of bowel was inconclusive so this plus HSG will result in diagnosis and plan of attack, hopefully the specialist will see me now.

MRI Pelvis prep includes no eating and drinking 4 hours prior, a IV med to suppress bowel spasms (Buscopan) and an IV contrast dye called Gadolinium which highlights different tissue and blood vessels and aids diagnosis. That one gets flushed out by the kidneys so must check how uber kidney will cope with that, ill put it on the many consent forms I'm about to fill out.

Progress! Feeling great that things are happening, will call ChCh Women's Outpatients tomorrow as I'm curious once this test is complete how long ill have to wait again to see GYN.

Will update again once I get the results and pics, maybe its time to start an album? Lol.

Soy, coffee and Thyroid

Well, it turns out my TSH and Thyroid antibodies are at it again. Confusing as I have now been taking the Levothyroxine for 8 months now and they had dropped a few months back. TSH now seem to be outside the normal range confirm I have a propensity to primary hypothyroidism. Annoyed as my levels need to be 2 or lower to be safe for pregnancy as anything above that heightens my chance of miscarriage and preterm labour not to mention risks with fetal brain development. 

January: TSH 3.8 mlU/L

April: TSH 1.2 mlU/L

August: TSH 4.67 mlU/L

Also Antibodies results show they are also very strong, 90-100% of cases of Hashimotos Thyroiditis and Graves Disease show antibodies. Less than 10% of normal individuals have thyroid antibodies.

January: Anti-Tg (thyroglobulin) 241 mlU/L

August: Anti-Tg (thyroglobulin)  537 mlU/L

January: Anti-TPO (thyroid peroxidase) 244 mlU/L

August: Anti-TPO (thyroid peroxidase) 871 mlU/L

It turns out that consumption of soy products, so soy milk and coffee may be causing issues with my body's ability to absorb the thyroid medication so I've emailed my nurse and GP to see if I have to stop my morning coffee...nooooo! Its the only thing I'm allowed these days haha. So, all in all we may have found a very possible cause of current fertility issues, I may be seeing the thyroid specialist after all. Will wait and see.

Right, heard from my GP and it turns out she never got my blood results but has managed to track them down. Thyroid TSH levels definitely up due to antibodies so shes up'd my Levothyroxine meds to 100 mcg Monday-Friday and 50 mcg on the weekends. Have to do another set of bloods in 6 to 8 weeks to check again. Means we cant TTC while my levels are up so more waiting. Should have MRI done by then.