August 1: WOW.

Not to be a negative nelly, but this is not the post I expected to be writing. I'm normally not a pessimist, but after 8 months of negative ovulation tests, I didn't expect to have a positive one on the first round of Clomid.

Day 14 went, 15, 16, 17, 18, 19. I called my doctor on Day 20 and asked "on what day do I consider this a failed cycle?" She told me to keep testing for three more days, it's in the realm of possibility that I'll still ovulate. She ordered a blood test too to have my progesterone levels tested, which I did yesterday, on Day 21. 

Yesterday morning, I had the blood test. I went home a noon and did an ovulation test. The test line was noticeably darker than previous tests. Whoa, but I thought it was a fluke. Not a positive test yet, but noticeably darker. I took a picture of the test so I would know what it looked like to compare the evening test to it.

So, yesterday evening, I tested again, around 6:45. The test was even darker! I was excited at this point because wow, COULD I BE OVULATING SOON?

So, I stayed up a little late to test again around 10:45. BIG FAT POSITIVE! (picture below)

Wow. Wow. Wow.

I guess I've been stuck in the mindset of "must get my body back to functioning normally" that to now have a positive OV test... it's crazy! Now instead of getting my body back to normal, I can switch gears and start actually thinking about CONCEIVING.

Of course, all of this is hopeful. There are still many other things that can go wrong, and our chances of conceiving each month (since I'm 31.5) are still only about 15% (which is normal). But still. WOW!

July 18: Clomid Day 3

Clomid is going well(ish) so far. I felt very nauseated the past two mornings, but I ate something first this morning before taking the pill and felt much better this morning. In the evenings, I'm EXHAUSTED.  So very strange. I'm not used to coming home and being completely drained.

Two more days of Clomid and then ovulation tracking begins. I ordered new strips and little cups from Amazon-- total came to under $30, which was nice.

I very much hope this cycle works. I'm having a hard time remaining optimistic but not putting all my hopes on this cycle (since I'd be crushed). I know many couples try for many more months than just 8 months, but after 8 months of issues, it'd be pretty darn nice if the end of month 8 produced a positive pregnancy test.

July 16, 2013: Clomid, Day 1

This morning began day 1 of Clomid. I am excited and hopeful, and trying to remain optimistic. I also don't want to over-expect either. I know, for many people, it does not work the first time or the first round of Clomid. Still, I'm optimistic.

I'm also hopeful that the Clomid will help to regulate me. Even if this cycle doesn't result in pregnancy, I think it will be a partial victory if my cycle starts around when it should. To have gone 8 months after birth control ended but only had 4 periods (the fifth brought on by Provera), it will be very nice to have that more regulated so things can move a little bit faster (no more waiting 50+ days between cycles, hopefully... 28 days or even 28-35 days would be great!).

So, here we go. I also ordered another package of ovulation strips. I'm hoping that life will say "ha ha" to me for buying the big package (50 ovulation strips) by having this first round be successful, me getting pregnant, and having 30 leftover strips. :)  I know, I know, the likelihood is low, but one can still hope, right?

July 12, 2013: Provera Success!

The Provera worked (meaning I also successfully rocked the "Provera Challenge", which should mean that nothing else is wrong with my system-- just a hormonal imbalance, knock on wood), and I finally had a period.

Weeks of cramping, bloating and breast tenderness.
Followed by two pregnancy tests to confirm I wasn't pregnant.
Followed by 10 days of Provera to stimulate a period.
Followed by 4 days of spotting (FUN, right?)
Finally followed with a very heavy period!

I may never complain about my period again. Truly.

So, July 16 it is: Clomid starts! Day 5 of my cycle.

Late June, 2013: No period

Come day 40 of my cycle, I contacted my doctor about stimulating a period to begin. She agreed and put me on Provera, a drug which will jump start a period (and is often used in conjunction with Clomid anyway). Ten days on Provera should produce a period within 3-7 days.

I had been feeling for quite a while like a period was coming, but after weeks of PMS symptoms and no period (heavy bloating, light cramping... and no, I was not pregnant), I was ready to get this party started and try with Clomid. So Provera it was!

Mid-June 2013: GYN Appointment

At my new gynecologist appointment (a mere 4 days after getting the wrong results from my GP, whom I had been referred to by my inept nurse practitioner in early April), I was pretty honest. Here's pretty much what I said:

Look, I'm not trying to be pushy or impatient. But, I've had two blood tests now where I'm not ovulating. I've never had a positive ovulation test (more on that in another post). None of the other signs (mucus, etc) have ever been positive. I don't think I'm ovulating. That's not me worrying about it, that's just me looking at the facts. I don't want to wait the requisite "year of trying before seeking help" if I know that trying to get pregnant will not be effective. That's like telling someone to drive somewhere but they don't have a car. No matter how hard they try, they're not going to get there by driving. I want to be cautiously proactive here. I don't want to waste more months.

The GYN did an exam (I hadn't yet had my annual, so we were able to do some annual stuff associated with the appointment for insurance purposes). She then discussed my options.

• Wait and do more progesterone blood tests, though since it had already been 14 months since my majorly hormonal birth control was removed and 6.5 months since my Mirena was removed, it likely wasn't going to have a major change from my body normalizing (since that normalizing should have already happened), OR
• Be put on Clomid, a drug which specifically treats women who are not ovulating due to hormonal imbalances (me... at least, we hope there's nothing else wrong).

I decided that since I'd waited a while since the birth control removal and had a lot of cycle problems and then two blood tests indicating I was likely not ovulating, CLOMID WAS THE WAY.

The doctor told me that I would start Clomid on day 5 of my next cycle (my appointment fell on day 27 of my cycle, so hopefully, that wouldn't be too far off). I would take one pill every morning per day, from day 5 to day 10. Thereafter, I would monitor and note my LH levels using ovulation kits which predict ovulation. She also told me the Clomid may/should help in regulating my cycle length. 

So now, the wait was on to start my next cycle....

Mid-June 2013: Second Blood Test Results

I got the second blood tests back on June 11, after the blood test was taken three days before. I was anxious, but I had calmed myself down and prepared myself that the tests would be low and prove, once again, that I had not ovulated.

I got the phone call from my GP's nurse practitioner early in the morning. She was bright, cheerful, and gleefully told me that my results were "NORMAL!!!" I was shocked and ecstatic. I confirmed that she mailed me my results and then proceeded to have a gloriously happy day. I was normal. My body was ovulating. I could do this!

When I got home, I looked at the results.

The nurse practitioner told me the wrong results. I wasn't normal. My progesterone was .72, which was even LOWER than it had been last time (remember, normal = above 10). It was even on the low end for the early phase in my cycle, which, for normal people, is between a 1 and 5. I was FURIOUS.

I called the nurse practitioner back first thing the next morning. You could tell that she didn't know what was going on and how to read the results because she started fumbling.

Finally, she recommended me to another doctor, a new Gynecologist!  Thank goodness.

This doesn't take away from the fact that I was LIVID. It wasn't like I was getting some innocuous test results back. I wanted to know if my body was naturally doing what it should, which would greatly impact my ability to have children. Of COURSE I wanted results that weren't screwed up!

I immediately called the new doctor and made an appointment. Crazily enough, I was able to call on a Wednesday and get an appointment for Friday. Whew. Finally feeling proactive.

Mid-May 2013: Referred back to my GP

As explained in my last post, my nurse practitioner (who was with my gynecology/midwife office) told me to go to my general practitioner (GP) for any followup. This was very frustrating, since:

•  Wanted another bloodtest, but would have to wait a while, since my period could be 40+ days and then it had to be done on day 21 of the next cycle (so it could be as long as two months until the next blood test!)
• My GP wasn't really a specialist either-- why wasn't I being referred to someone who would be able to help me? 
• We were now entering the sixth month of trying,
• Based upon the symptoms in previous months, this was a wasted month, since even if I had a cycle and had a period, the symptoms were pointing to me not ovulating.
• Everyone kept telling me "DON'T worry about it!" Me worrying or not worrying was not the cause of my body refusing to ovulate. It wasn't like my body perfectly was working and my stress was causing me not to get pregnant!

So, I waited. Luckily, the next cycle was only a 34 day cycle, so I only had to wait until mid-June. My GP was ok too and didn't require me to come into the office for a workup in order to approve the test. She also retested my thyroid too, just to make sure. 

I decided it was ok to be referred back to the GP, since at least she didn't charge for an appointment, which might not have been covered by my insurance (which may have interpreted the appointment as unnecessary).

April 2013 Bloodtests

At my April 2013 appointment, I was sent home with paperwork to have a blood test done on Day 21 of my cycle. The test would check out my progesterone levels (which should have been high), my thyroid (should be normal) and do a pregnancy test (you know, just to make sure, since clearly the doctor thinks I can't pee on a stick).

Unfortunately, because of my irregular cycles, my April appointment fell on day 43 of my cycle. Yup, I hadn't started a period since the end of the Mirena Crash in late Feb. So, I had to wait for my cycle to begin, and then wait another 21 days before I could take the blood test.

Luckily, the period started a week after the appointment, which put my blood test the first week in May.

The pregnancy test came back negative (no surprise there).

The thyroid test came back SLIGHTLY elevated (nothing to worry about there).

The progesterone levels came back at a little over 1... where it should have been at least a 10. Levels that low likely meant I did not ovulate.

The nurse practitioner though, came back all hunky dory and said "likely this is just a fluke." I was quite upset, because a progestrone imbalance is a) able to be addressed with medication and b) would cause my irregular cycles (since progestrone levels stimulate the body to do different parts of the cycle). It would explain so many things.

The nurse practitioner also said "you can get another bloodtest if you want, but I'm going to refer you to your general practitioner." This felt VERY odd to me.

April 2013 Appointment

I kept my April 2013 appointment, even though I ended up having a cycle which pretty much ended my symptoms from the Mirena Crash. I was already feeling a little antsy about the nurse practitioner/ midwife practice, so I was beginning to feel like they were on thin ice with me.

However... SO much of the literature about conceiving says 1) don't worry about it (hard to do, but trying), and 2) worry once you haven't conceived after a year of trying. So, if you ask "why didn't you just switch doctors?", my response is "well, it felt like I had been trained to not worry and wait a year." Come April, we'd only been trying for a little over 4 months, so complaining felt like 1) worrying, and 2) being very impatient. I really didn't want to come across like the preppy whiner who was complaining that she couldn't instantaneously get pregnant. I feared I'd look ignorant and like I hadn't read my materials (that there is only a 15% chance each month of conceiving, etc).

So, I went to my April appointment. And I cried in the office out of frustration.

Side note: I'm not normally a crier. I was just FRUSTRATED. Nothing was working-- my cycles were all out of whack. 80+ day cycle, 60+ day cycle, 45+ day cycle, 60+ day cycle. And, as I'll write about later on, never a positive ovulation test. 

One would think that a crying woman (whom has previously been composed and optimistic in all prior appointments) would alert the nurse practitioner/midwife that maybe I should be forwarded to a specialist. Nope.

I should also add that at this appointment, as well as the appointment when I had my Mirena removed, the walls were so thin that I could easily hear the ultrasound and heartbeat of a happily pregnant woman in the next room.

The nurse practitioner decided to have a blood panel ordered to measure my progesterone levels and check my thyroid. It had to be done on a specific day of my cycle (day 21) because I SHOULD have ovulated at that point and thus have a high progesterone count. Thyroid could throw my cycle off kilter too, so that's why that was tested. And, of course, I had a pregnancy test thrown in to the bloodwork(sigh).

Gynecologist Selection

Way back in 2005, when I moved to the town I'm in up in the Pacific Northwest, I got a new gynecologist. He was in his 60s, and not really my style. But, I had a lump in my breast, needed an annual, and wanted an appointment sooner rather than later and his practice was with the overall healthcare group that I liked.

After getting the lump checked out (via ultrasound-- determined benign!) and getting the annual out of the way, I switched to the other doctor in his practice after one more annual with this doctor. I switched to a female (never had a female GYN before, thought that'd be nice). So, for 2007,2008, and 2009, I switched to her. Something just seemed off with her though...I finally did some digging and found out that she had a preference in treating women her age (late 50s, early 60s) and dealing with menopause. Well, that wasn't me.

Around that time in 2010, I was at a friend's house, and she had recently switched to a Midwifery Center by our local hospital. Apparently, they LOVE to care for women in regular care long before they get pregnant because they greatly enjoy having a pre-established relationship with someone before they get pregnant. I thought that this practice was where I wanted to be when I did eventually have a child, so this set-up seemed perfect. Plus, I had many people recommend their practice and had used their facilities to have their children.

However, this meant that most of my visits for annuals were with midwives (whom were also nurse practitioners). When I was going through my Mirena Crash, it became evident that they really weren't as equipped as they should have been to handle things that fell outside the purview of "normal" (Unless it came to pregnancy complications, I guess).

This is why, after the things that happened for the next several months, I switched doctors. More to come on that.

Mirena Crash

The home page of the Mirena website says the following:  

Your healthcare provider can remove Mirena at any time, 
so you can try to become pregnant right away

Turns out that's true for many, but not all. Some women don't snap straight back to fertility-- some women have the "Mirena Crash."

For 2.5 months after I had Mirena, I was miserable. Bloating, incredibly sore breasts (I couldn't sleep anywhere past about 90 degrees on my side because they'd HURT), abdominal cramps. Mood swings-- I'd go from being a normal person to incredibly emotional and teary at the drop of a hat. 

I also had no period. I had what I thought was a period two days after Mirena was removed, but no period. 

So, when I finally called my gynecologist's nurse practitioner in early February, she said "Oh, I THINK YOU'RE PREGNANT!"  

Ok, let's take a step back here. Nurse practitioner/midwife:
You have my education and job history. You've met me and hopefully realized I'm not a blithering idiot. I'd think the first step of most women in first world countries with these symptoms (especially a missed period) would be to TAKE A HOME PREGNANCY TEST. And then, when the period did not start, take another a week later. And then, when still no period, take another. And another. And another. I'm CALLING YOU WITH A PROBLEM AND IN PAIN and your first thing you jump to is not "did you take a test" or listen to me tell you I'm miserable and ask "why"? Instead, you make my heart flop to the floor and insist I'm pregnant? 

Back to the story... I told her "no, I'm not pregnant. I've taken tests. I'm not pregnant." Nurse practitioner: "Oh, we'll see. I think you are!"  I really wanted to smack her over the phone. Instead, in my post-Mirena-induced haze, I started to cry. "No, I'm not." I explained everything.

I think she thought I was crazy. "Mirena Crash"? Maybe I did sound crazy. I had only learned to search for Mirena Crash after a friend of mine informed me of the term because her friend had the same repercussions after stopping Mirena and had discovered the phrase. I hadn't discovered it in all my internet searches, but when I started searching for "Mirena Crash" I finally found cases just like mine. Just searching for "Mirena problems" had yielded an annoying array of people who had, actually, no problems and almost immediately got pregnant post-Mirena. "No problems here- Mirena is the best! 4 months pregnant and conceived after only being off Mirena for 3 days!" NOT what I wanted to hear (and another reason I'm starting this public blog).

The nurse practitioner finally told me that I could make an appointment for early April. Hopefully I'd have had a cycle by then.

I did have a cycle (FINALLY) in late February, which felt like the dam bursting. All my symptoms post-Mirena went away, and I felt free. However, I kept the appointment in late April because if my cycle hadn't regularized, I wanted to discuss that with the nurse practitioner.

Birth Control: What I was on

I had been on a total of three different types of birth control. In 2007, I was put on Yaz (like the pill, but with less hormones, supposedly). Luckily, I have not had any of the blot clot issues or anything that Yaz is right now dealing with in lawsuits. However, in 2008 I decided to switch to the Nuva ring, since that was less hassle, easy, and consistently dosed me up rather than give me ebbs and flows in hormones like a pill did.

Still, even with the Nuva ring, I had hormonal swings (not pleasant for my husband-- I'd get depressed and moody for a few days a cycle). It was immensely nice though, to have a predictive period. My entire life ever since I started getting my period, it was never very predictable. One cycle would be a month, the next would be two. The longest I went in between cycles was three months.

Knowing what I do now, I probably would have had a blood workup done in my early 20s when I was off birth control but had funky cycle lengths.  I remember my mom saying that she had varying length cycles too, but so I didn't think anything of my funky cycle periods. Then I went on birth control which controlled cycle lengths so I didn't think of it. I didn't think this problem would rear its head again when I went off birth control....

In April of 2012, I switched from the Nuva ring to Mirena for two reasons. 1) I was vain and thought it'd be nice to not have a cycle for a while, particularly when we would be traveling internationally, 2) with Mirena, you have the ability to go off of it and not have a recuperation period-- you can get pregnant instantly and not have to wait 4-6 months like you do with many other birth controls, including Nuva ring. This way, we figured, when we did want to start trying, there wouldn't be the 4-6 month period where my body was normalizing.

So, come November when we made the decision, I was on Mirena. I had it removed the first week of December.

Late November 2012: Jumping into the deep end of the pool

In November 2012, my husband (B) and I decided to jump feet first into the deep end of the pool and stop birth control. After years of being on birth control, this felt very rash and irresponsible-- sex without birth control? I mean, what if we got pregnant?! Well, that was the point.

In all honesty, it was a dramatic 180 degree reversal. All my life before that point, it had been "DON'T get pregnant." College then grad school then early professional. My life before this point (I was about to turn 31) was "Don't get pregnant." I had seen friends and others experience the joy of parent hood, and also the expense and time. I knew, desperately, that I wanted to be a mother someday, but mid to late 20s was not the time frame.

So, to go from "no pregnancy desired now" to "pregnancy desired NOW!" was a dramatic switch. Don't get me wrong, it was a decision we built up to, excitedly. But pulling the plug and going off birth control is a 180 degree action. With birth control= likely no kids. Without = anything can happen.