We met with our Reproductive Medicine doctor via Zoom for our first consult. He asked many questions about our history, caught up to what we’ve currently done, and gave us our options.
1. Continue Letrozole and potentially increase the dose 1-2 times more.
2. Schedule an HSG (Hysterosalpingography) a radiology procedure that is used to view the inside of the uterus and fallopian tubes.
3. Continue Letrozole and add a trigger (Ovidrel) shot, with timed intercourse or IUI (intrauterine insemination) as many times as we want.
4. Jump straight to IVF (in vitro fertilization).
I learned that more meds and higher doses is really only an option with IVF.
I truly like this doctor. He is, confident, kind and calming when discussing all. He offered to discuss if at any time my insurance covers something differently if done at a different location, or in an alternate way, he would try to help.
I went through some of my obvious questions. What can I do differently?
His answer was to take the Progesterone as prescribed (suppository) in my cycle and take your current supplements as you are. “Try not to stress. 🙂 We can get this done.”
We first continued with the Letrozole and increased the dose.
In July, we added the trigger shot with timed intercourse.
If I started my cycle, I notified the doctor’s office that I started, then I began taking the Letrozole.
I would go in for an ultrasound around cycle day 10 to see if I had any follicles present on either ovary. They could be on either side, but they needed to be of certain size; the goal was greater than 18mm. If the follicles were present and of size, I would trigger within 24 hours of the ultrasound. The trigger shot would help kickstart ovulation, “I was going to ovulate.”
Then, we would have timed intercourse over the next 36 hours.
If you’re curious, there was not much required down to the minute or second- thank youuuu, Lord! But, honestly it’s just still weird to have a schedule. Ya do what ya have to do!
From the get go, Adrien and I have been very open and upfront with our emotions about all of this. We’ve just been committed to not letting this affect us as much as possible, any part of “us,” and to just communicate, communicate, communicate. I’ve so appreciated that from him and for us. I’ll touch more on this coming up…
After the open window for intercourse, I would start Progesterone within 48 hours of taking the trigger shot and take it for two weeks. If I started my cycle, I would stop the Progesterone.
My very first ultrasound in July, I had 1 follicle on my left side that was 21mm. Good news.
On my right, there was one growing, but it was less than 10mm.
This same plan continued through October- Letrozole, ultrasound, follicle(s) present, trigger, intercourse, Progesterone.
I only ever had 1-3 follicles on the left, big enough to trigger. I would have 1-3 little follicles on the right, but they always commented my right ovary “just would not wake up.” My largest follicle was 22mm.
During each of these months, we never completed an ultrasound at the beginning of my cycle to really see “what I was starting with.”
In September, they asked me to come in and do an ultrasound at the beginning of my cycle. However, they did not say and it did not click with me at the time, that this is where we could see what my AFC (antral follicle count) is. It just did not cross my mind.
Until I was lying on the table. Adrien was not at this appointment because I thought it would be pretty quick and routine, as it was different than seeing how many follicles I made prior to a trigger shot.
As soon as she started, it clicked. I thought, “CRAP! I’m about to either get good news, or REALLY bad news.” PIT IN STOMACH.
I had 2-3 follicles only on my left ovary. They could not even find my right ovary during this ultrasound. They told me for a “normal” ultrasound at this time, they would expect to see 10-15 follicles and low is 4-6. If I didn’t want to hear it, they said it.
“You’re the perfect candidate for IVF.” “We’ll be unsure of how many eggs we can retrieve until we’re in there. Or, if they even have good quality.” “Time is against us.”
They didn’t say I “could not” get pregnant, but they were very concerned.
TEARS WERE FLOWING. The Nurse Practitioner was SO KIND to sit and explain, and answer every question and what if. I had prepared for this result, but I was not mentally and emotionally prepared that day. I was just caught off guard for a second.
I called Adrien, contacted my closest friends, and we were back to praying.
I immediately asked that they draw my Estrogen and FSH labs during this time, so we could just double check I was not entering menopause early. No ovarian reserve, no right ovary, I just needed to know.
My labs were appropriate, which really kept my head above water. I know my system is still working, but why isn’t it “working?”
I did proceed with an HSG in September. Again, we had to be sure I was not pregnant prior to this procedure and I was not. This procedure was outpatient and I was fully awake. It was pretty quick, not too uncomfortable, and no downtime.
The result was negative, my tubes were open and good to go. Another checked box.
Our next appointment was our last in person appointment with our Reproductive Medicine doctor for now…
Talk soon!
xoxo- Kara
Our Waiting For Little Ouellette 