Plan of Attack

Today was the moment I have waited for since my referral in January - I had my appointment at the fertility clinic and met my new doctor!

I had no idea to expect, but this doctor has met all of my expectations, and exceeded some. He wanted to know about me - everything about me including all my past experiences, birth control, medical problems, surgeries, etc. He wanted to know our time-scale (did we want to be pregnant now? or in the future?), and when I emphatically said, "NOW!" he was poised and ready for action. 

A quick internal ultrasound (I'm getting so used to these!), and weighing in on my medical history, he made a plan of attack.

Clearly, he said, my hormones are out of whack. Clearly, I'm not going to be ovulating on my own. I'm CD 16 and, from my scans, not likely to ovulate any time in the future. So, we are going to bring on a period with Provera, then start me on Clomid with a trigger shot and constant monitoring. He wants to be as involved as possible and be able to make changes as needed throughout my next cycle.

One little set back is that it appears I am not immune to rubella, despite just getting my booster shots just last year. So I've made an appointment with my GP to get this done next week, and then I have to wait 2 weeks before starting Provera. After that, it's Clomid days 3-7, then near daily monitoring from CD day 12 onwards. When they see a follicle ready, they'll trigger its release and BAM! It's baby making time!

If that round doesn't work, they'll up the dosage on Clomid until it DOES work. And if, for some reason, it still isn't working, we'll have another meeting to find a different plan. My doctor isn't the wait and see type of person. He's trying to help me pregnant ASAP. Yay! Someone in my corner!

This is the moment I am beyond grateful that my hubby's little swimmers are superstars without a single abnormality to speak of. My tubes are clear, my uterus and lining looks good, the endometriosis is gone for now, all of my ovarian cysts are of manageable size... it kind of feels like now or never. 

So with this plan of attack, I feel so much more calm. Something will actually be happening. Not in 3-4 months, but in a few weeks. We actually, really, have a chance this time. Less guess work, more possibility! I even took my planner out to look at "how pregnant I'd be" by this date or that. Then I quickly closed the planner before I got too far ahead of myself. I've done this before - tried to plan ahead, thinking it would happen swiftly and easily - and that left me more devastated than ever. 

This is a great plan, and I'm happy to moving forward in leaps and bounds instead of inches. But I shouldn't jump to the finish line yet, nothing is promised or guaranteed. Still, I can't help but smile. Something good might be happening soon, so I'll keep up the positive thinking and cross my fingers and toes. 

One Inch At A Time

In a "normal" woman's cycle, which lasts an average of 28 days, ovulation occurs on day 14 and then you cross your fingers for 2 weeks while you wait to find out if you were successful that round. If it's positive, GREAT! If it's negative, oh well, you only have to wait two more weeks to try again.

Now I have yet to meet someone with a perfectly "normal" cycle, but I would say the majority of women fit into this basic pattern. I, sadly, am not one of them. Instead of ovulating every 28 days, my body gears up to ovulate several times, but never quite succeeds due to a lack in the proper hormones (estrogen and progesterone) and an overproduction of the wrong hormones (androgens). This is a two-fold whammy. First, it leads to delayed ovulation and incredibly long cycles. I don't mean a 35-40 day cycle. I mean more in the 90-120 day cycles - 3 to 4 months worth of waiting. The second problem is that each time an egg is not released, it decreases in quality. This means that when it is, in fact, released, it is less likely to result in pregnancy. And then women with PCOS have a higher chance of miscarriage, gestational diabetes, preeclampsia, and premature diabetes. Well isn't PCOS just filled with sunshine and butterflies and rainbows of good news?

My doctor recommend I decrease my BMI from 25 to 22, as losing weight and eating healthy are two of the best lifestyle changes to increase the chance of ovulation. I have been exercising more and eating very healthy, so now it's just going to take time to see the changes. As I said before, I am a "lean PCOS" because my BMI is in the normal range but I still may have too much insulin in my body, making it difficult to lose weight and causes even more problems. But my recent decrease in weight means...

... I was lucky enough to *finally* ovulate on my own on April 8. My temperatures increased and stayed increased for 13 days before AF arrived. This is great news for two reasons:

1) I am actually, in fact, ovulating (even if it is very very late)
2) My luteal phase (LP), the second part of the cycle, is long enough to sustain a pregnancy

For us PCOS girls, ovulating on your own is a cause for celebration in itself. Most women end up needing treatment to cause their cycles to end, but I was lucky enough to start a new cycle myself. Hurray! (popping a bottle of champagne now!)

So after celebrating my ovulation, I had that tortuous "two week wait" - the time between ovulating and testing. I even had a slew of symptoms, like most women do, which could by PMS or pregnancy. I threw up several times for no apparent reason, so I was very hopeful. Unfortunately, this cycle was not the one but for now I'm enjoying little victories. And the throwing up? Hubby and I both have some kind of stomach bug and neither of us have felt well for over a week, so that explains that.

The best news now is that I have had a pre-op appointment and have just been scheduled for my actual surgery on Tuesday. Yay! That's months before I expected to be fit in, moving things along nicely. The doctors will be doing an HSG, which is where dye is squirted through your tubes to check if they are open. If they aren't the doctors go in to remove any blockages. With my history of torsions, it is quite likely they are blocked, so even if I ovulate on my own, it couldn't get through to be fertilized. They are also going in laparoscopically to check out the condition and location of my ovaries. My left ovary is still riddled with cysts, but my right ovary is cyst-free and smaller than they think it should be. This could be from my previous surgery when they had to cut through my ovary to take out the cyst. Either way, I should come out of the surgery with more answers and at the very least information for my fertility clinic appointment - which is in just two weeks! 

Although I am disappointed with not falling pregnant after the last never-ending cycle, at least something is happening. We aren't just sitting around, twiddling our thumbs, waiting for my hormones to magically regulate themselves. I am so grateful for the NHS, my doctors, and the treatment I have been receiving. I appreciate being proactive and moving forward, one inch at a time. 

Keep Living Your Life

Once you decide it's time to have a baby, it can be a very stressful time in your life. When you are trying to conceive (TTC), you are warned to always behave as if you were, in fact, pregnant already. Some doctors recommend not drinking any alcohol, decreasing physical activity, taking prenatal vitamins, decreasing travel, etc. This is to provide the best chances for your baby, should you indeed fall pregnant. But what about those women that take years to get pregnant? Should they act as if they are pregnant for years? Then your entire life revolves around this one thing, that may not change for a long while. 

I had been hesitant to sign up for anything or plan any trip in the early months of TTC. I kept thinking to myself, maybe I'll be pregnant by then, so I shouldn't waste my money on that! By now, I've become a bit more rational and realized you have to just keep living your life. If you don't, you can end up obsessing and feeling really depressed about actually doing anything with your life while you are waiting. 

As for me, I've just signed up for a half marathon and a half ironman. One of my doctors has recommended I get down to a BMI of 22 (!) so races are a good way to have a goal to reach while decreasing my weight. Apparently, losing body fat can trigger ovulation in women with PCOS. I am one of the lucky ones, a "lean" PCOS with an acceptable BMI. These races aren't only good for decreasing my weight, they are also giving me something to look forward to. I've decided that, worst case scenario, I can just pull out of the race. It will mean I lose some money - but if I'm pregnant, I don't think I'll mind much. I'm also looking into a few local trips to take - things I'd like to do one last time pre-baby. Like a trip to Cinque Terre, Italy, or a weekend visit to Croatia. In fact, I'm taking recommendations for travel in Europe if anyone has any ideas! 

Finishing my first half-ironman!

If you're reading this because it is also taking you longer than you thought to conceive and you are wishing for your rainbow, how do you keep living your life? That glass of wine with dinner (savoring it and wondering if it might be your last), that soak in the hot tub, that exotic beach vacation? Because while TTC can really affect your current life, you shouldn't have to stop living.