A very infertile day for me…..

f9043432b5426e9c8f4e2620c6e84ed4Today was difficult, SO and I had an appointment this morning with the ultrasound department. It was for an internal scan, to look at my ovaries, and see if they were developing follicles and therefore eggs. Unfortunately this time my ovaries didn’t respond to hormone meds at all. Which is heartbreaking. I was on the maximum dose, so I’m not really sure what’s next. Which is scary!!

I was distraught after the appointment, and have luckily been able to speak to my T. Who as usual made me feel less like a failure, and encouraged me to call my doctor and ask questions. Something so simple, but in the mood I’d got in, I couldn’t even think to do that. I rang them anyway. I have more scans and blood tests next Monday. To see if anything has changed then. They say it will most likely not as I will be too far into my cycle. The fertility doctor has said though that there are more options. I asked if this was it, they said no, of course not. I don’t know why I’m panicking. I’m glad i was able to talk it through with T.

Anyway, I’m going to try to research things a bit. Again. I’m not just reading things this time though. I’m gonna add it to this post. For me to go back to, and to show T because when I start going on about my fertility meds and etc she has no idea what I’m talking about. She actually asked earlier if no eggs meant I couldn’t have a baby. She maybe expects them to appear as if by magic, or hopes they will. For my sake. Anyway that’s that. Let’s Google…….

So I have Endometriosis and PCOS (Polycystic Ovarian Syndrome) both are known to cause fertility issues.

Endometriosis is a condition where the endometrial cells lining the womb move to other parts of your body. Each month these cells react in the same way to those inside the womb, building up and then breaking down and bleeding. Unlike the cells in the womb that leave the body as a period, this blood outside the womb has no way to escape. Endometriosis alone is not said to effect every womans fertility, but some studies do say that women with the disease produce a chemical from the endometrial lesions that is pretty toxic to eggs and halts egg production. When trying to conceive a lot of people have laparoscopic surgery to remove lesions, which can give a woman an increased chance of becoming pregnant for 12 months afterwards. This is something I have tried, to no avail.

chart_endo_look

Women without Endometriosis have nice pink tissue around their ovaries and reproductive organs,  where as those with Endometriosis can have lesions, brown spots, and scarring and the tissue looks less pink and healthy.

Women with mild Endometriosis before scarring has occurred are given a 7-10% chance of conceiving per month. The more severe the Endometriosis, the lower the % goes.

Women with PCOS ovaries are generally bigger than average. The outer surface of their ovary has an uncommonly large number of little follicles (the sac of fluid that grows around the egg). In PCOS, these follicles stay immature, and never grow to full development or ovulating to produce an egg that’s capable of being fertilised. For the woman, this means that she rarely ovulates (releases an egg) and is therefore less fertile. In addition, women with PCOS don’t have regular periods and may go for many weeks or months without a period. Other side effects of the condition are excess weight, acne, excess body hair and raised levels of hormones such as luteinising hormones (Stimulates ovarian follicles to produce sex hormones, and surges later in the cycle to make the follicle tar and release an egg) , androgens (male hormones), anti-Mullerian hormones (similar to LH/FSH hormones used to detect ovulation). Each of these play a part in a womans cycle and the imbalance goes against fertility.

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Women who have PCOS are given a low chance of conceiving without help. Most women need the help of fertility drugs, such as Clomifene(Clomid)/Metformin.

With the drastically decreased chance of me conceiving alone, we had to seek help. Our fertility Doc currently has our life in his hands really. He has given us our first course of treatment after our initial analysis. My SO’s semen analysis came back as expected for his age and etc. He’s fine. My bloods were okay and hormones settled. No hormone surges as expected though. So after about 18 month our doc prescribed me Clomid. Initially on the lower dose of 50mg. As I don’t have a cycle naturally, before I could start the Clomid, I had to take a course of another drug (Norethisterone) which induces a period. It can also be used to delay periods, apparently. Anyway, that worked as expected. Roughly 12 days after taking the first Norethisterone, I began a much-anticipated period. Strangely I was excited about it.

Under Clomid treatment you are instructed to begin the Clomid on the first full day of your period. So I did. Admittedly all those hormones made me feel rubbish but all was worthwhile I guess. Nothing changed however, and the low 50mg dose didn’t make ovulation happen. As we all know, when ovulation occurs, the egg is either fertilised and becomes a baby, or it continues down into the Uterus and becomes a period. A month after my first treatment I saw none of the above, no period or baby, meaning no egg had been made/released. So natural thing is to try a higher dose of Clomid. So it was raised up to 100mg, but as before, I had to take drugs to induce a period. Although this time, they were Letrozole. It did as expected, and as before I took the Clomid felt rubbish, then had my scan this morning.

On the scan they should have seen one or more enlarged follicles in my ovaries. Which would mean that the follicles were maturing ready to release an egg into my fallopian tube. However nothing was apparent, and there was still just the many little follicles caused by PCOS. So basically the Clomid didn’t work for me. It didn’t stimulate my ovaries to produce an egg, and obviously, without an egg, you can’t have a baby.

Menstrual-cycle

Now upon researching I found that apparently, around 25% will not ovulate with Clomid. If ovulation doesn’t occur a stronger drug is needed. Doctors will say you are Clomid resistant. Some try Clomid again with Metformin (An insulin resistance drug) because increased insulin in the ovaries can cause Anovulation (failure to ovulate). They can  also offer ovarian drilling, but there are other options which should be considered first as it isn’t as commonly used these days due to possible complications. Injectable hormones can also be tried, there are many different types of injectable hormones, like Follistim, Bravelle, or Novarel. These are given alongside close monitoring by your doctor. Each one can be used for a specific need, such as fulfilling a hormone surge that your body doesn’t do by itself.

Have to admit, injectables sound scary!!! I think my SO would pass out watching me administer them!

For now I think that’s about all I can even look at, because the next steps would be IUI (Intrauterine insemination) or IVF. However without egg production I can’t do either without thinking about donor eggs. They also do a procedure now called In-Vitro Maturation, where immature eggs are removed from the ovaries without the use of drugs and matured in a lab before being fertilised. I don’t know cost or possibility of that though….

It’s just a whole who knows kind of thing’!!!

There you know as much as I do!

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Siobhan. X

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