Progesterone: The Grinch Who Stole My Christmas

When I got my IUI I asked my doctor about progesterone supplements. I had done some research and noticed many women that had an IUI were prescribed progesterone supplements after. My doctor said she wanted me to do some blood work first do see if it was really necessary, so a blood draw was scheduled for a week later. 

Progesterone comes from the corpus luteum. Basically what happens is after you ovulate, the ruptured follicle turns into the corpus luteum which is responsible for the production of progesterone. Progesterone is an extremely important sex hormone in early pregnancy because it builds a strong uterine lining and helps maintain the lining of the uterus to help nurture a fertilized egg until the placenta takes over around the second trimester. An inadequate amount of progesterone often results in miscarriage or if there isn't a fertilized egg, your period begins. 

Hormones involved in the initiation of pregnancy and the development egg cell (ovum) from follicle to embryo.

Progesterone levels rise after ovulation, and the rise can usually be detected about a week after ovulation. According to BabyMed, progesterone levels about a week after ovulation in a nonpregnant patient are generally at least 8-10 ng/ml. Much lower levels usually mean you did not ovulate. Doctors like to see progesterone levels around 16-18 ng/ml or more in pregnant women.

Want to guess what my progesterone result came back as? 8? 6? 5? Let's try 0.46 ng/ml. This tells me two things: 
1. I didn't even ovulate, which my doctor said makes no sense because of the trigger shot I took which forces you to ovulate and my ultrasound right before my IUI appeared as if the egg had already been released.
2. I have a severe progesterone deficiency or what's also known as luteal phase defect. Super.

Looks like I have the latter and I fit right in with the symptoms, which include:
Irregular periods
Not ovulating
Fibrocystic Breasts 
Low Thyroid (Hypothyroidism -ding ding ding! Why didn't they make this connection before?)
Ovarian Cysts
Reduced oxygen levels in all cells (Perhaps this is why I feel like I'm dying when I run?) 
Anxiety
Indigestion
Headaches and more. 

Everything is interconnected. Also because I have progesterone deficiency, I have a 1000% greater chance of dying from cancer.  According to the American Journal of Epidemiology, "researchers found that infertile women who demonstrated a progesterone deficiency had a premenopausal breast cancer risk that was 540% greater than that of women whose infertility was due to non-hormonal causes. Furthermore, the women with a progesterone deficiency had a 1,000% greater chance of death from all types of cancer." Happy New Year to me. Chris hugged me all night when I told him that. I'm not worried though. I know God has a plan for me.

To finish my story, I found out about all of this the Monday before Christmas. That is why progesterone is the Grinch who stole my Christmas. My family still has no idea I'm going through all this. We were all staying at my mom's house and I locked myself in the bathroom and cried and cried and cried. The Doctor called in some progesterone supplements to the nearest pharmacy just in case of the extremely rare chance I did get pregnant. I know it wasn't going to happen though. It was all I could do to bring myself to taking a pregnancy test the following Friday since I already knew it was going to be negative. And it was. 

What kills me the most is knowing that there very well could have been a fertilized egg, but it didn't have the enough progesterone to nurture it to implantation. Every month my heart shatters into more pieces than the previous. This is hard, really hard.

I hope everyone had a wonderful Christmas and got to feel the spirit of Christ in their hearts.

Progesterone levels after ovulation (midluteal, middle of the second half of the cycle) in a nonpregnant patient are generally at least 8-10 ng/ml. Much lower levels usually mean you did not ovulate. - See more at: http://www.babymed.com/fertility-tests/progesterone-levels#sthash.ikBCoH97.dpuf

Progesterone levels rise after ovulation, and the rise can usually be detected about a week after ovulation. - See more at: http://www.babymed.com/fertility-tests/progesterone-levels#sthash.ikBCoH97.dpuf

Progesterone levels rise after ovulation, and the rise can usually be detected about a week after ovulation. - See more at: http://www.babymed.com/fertility-tests/progesterone-levels#sthash.ikBCoH97.dpuf

Progesterone levels rise after ovulation, and the rise can usually be detected about a week after ovulation. - See more at: http://www.babymed.com/fertility-tests/progesterone-levels#sthash.ikBCoH97.dpuf

Curveball!

So of course once a plan is set perfectly in place my body has to go mess things up. After I got home from work the day of my ultrasound I realized I had forgotten to take an ovulation test that morning. So I took one expecting nothing of it and lo and behold it was positive! Shoot. Shoot. Shoot. Shoot. Shoot! What do I do? The office was closed and in a moment of panic I telephoned the doctor on call. Good thing I did, because he told me to take my trigger shot right away and schedule an IUI for the next day. I felt horrible calling him after hours, especially since he was at his son's viola concert. But at the same time, I think I saved him for boredom because he told me he didn't want to listen to it anyway! Unfortunately the positive ovulation test messed up the timing of everything and made things harder to control. He had me take the trigger shot to help ovulation just in case. The next morning I was able to schedule the insemination in the afternoon and collection for Chris at noon. It messed up Chris's work schedule and meetings but it all worked out. Thankfully his semen analysis was so much better this time. And motility was at 86% compared to 52% last time! Even though I only had one mature follicle, I think the IUI was still definitely worth it.

Just waiting for another IUI!

I asked my ovulation specialist if she could do a quick ultrasound just to see if we could tell if the egg had been released. It was really hard to see but it looked as if it might have and there was a corpus luteum collapsing.
This IUI seemed much smoother and there was a lot less discomfort (even the dreaded speculum wasn't so bad). After laying down for a little while I went on my way and worked from home the rest of the day. Overall things just feel so much more "right" this time. Even though the plan changed a little, everything feels great and I'm so thankful I felt a prompting to take an ovulation test. Had I not, we would have missed it and the whole cycle would have been wasted.

Post IUI Relaxing

Yesterday Chris and I went over to help unpack my mom's new house and we found a tape recording of me when I was a baby up to when I was three. Chris and I kept making eye contact and it was like we were reading each other's minds: We can't wait. Praying this one sticks!

Injections and ultrasounds and a cyst oh my!

It's funny when you're trying to conceive and doing all these fertility treatments how something so small can make such a huge difference. Before treatments I just thought about how sperm meets egg...everything goes right...baby! But now there's so many more steps to think about. The picture just got a whole lot bigger. I'm banking on these teeny tiny follicles to become the right size and then for at least one egg to grow and be released. Then I'm focused on having a good sperm count and praying that one little swimmer finds my little egg. And then for that little fertilized egg to implant into my uterine lining. Then wait for it to grow, grow, grow, and pray I won't miscarry and that in nine months time give birth to a precious child. It is all such a miracle! I cannot wait for ours. It will happen one day, right?

(blastocyst)bl

After doing 3 FSH injections the past week, today I went in for my follicular ultrasound to see if I'm ready to take my hCG trigger shot. They found a fluid filled cyst on the outside of my ovary, but it doesn't look like it will impact this cycle at all. They're going to check on it again in a few weeks. As long as it isn't growing or doing anything abnormal, they're not too concerned. Aside from that I only have one little ripe follicle on my right ovary, at about 16mm. My lining also looks perfect. I will trigger tomorrow night and have my IUI on Sunday. I was surprised when they said that, since I didn't think they would be open on a Sunday, but for time sensitive procedures like this they are. I'm really excited! Hubby and I know what to expect this time around and things just feel better than last time. That means I will take a pregnancy test the Sunday after Christmas...maybe Santa will come late this year? I'd be fine with that!

I'm a visual person, so I like this diagram to explain why follicles are so important. Before we started treatments I thought there's just an egg chilling in my ovary ready to pop out! Ha! There's more to it than that. The follicle has to mature and become bigger for the egg inside to be released from the follicle.

Keeping prayerful hearts for Sunday! 

(blastocyst)(

(blastocyst)

(blastocyst)

(blastocyst)

Try Try Again

I came out of my IUI with small hope. I didn't want to get excited in fear that the it wouldn't work.

But of course I started to have hope, lots of it. Chris too. He was getting excited. I think the pregnancy hormones from the trigger shot started to confuse me into believing this was actually happening. That the procedure worked and we would announce wonderful news to our families come Christmas. But in one moment it's all dashed when you realize you started your period. It came only nine short days after my IUI. Typically it should be about 14 days. We were in California for Thanksgiving with family so I had to hold my all emotions in. I told Chris before bed and I let out silent deep tears. Being around family was probably a good thing because I had to try and act like everything was okay. I think that helped my attitude in moving on.

I wasn't planning on trying in December so we could enjoy the holidays, but everything happened so fast and soon that I decided to go through it all again. Thankfully I will be in another two week wait for Christmas and won't need to see the doctor during that time.

I called our reproductive center and told them the news and asked what we should do this time. We are doing the same treatments as November, so I will be taking Femara and the injections again with the IUI. We know a lot more coming into it this time around so hopefully that will help.

Honestly, it's hard to not to wonder why my Heavenly Father isn't allowing this to happen. I beg and plead with him and hope he will give us a miracle. I have always had a hard time being patient. When I know I want something, I want it now. So perhaps He is trying to teach me patience. The teacher is always silent during a test. Even through the temptations to rebel against hope, I will fight back and hope that much harder.

My First IUI

Well it's about time I post my IUI experience. It's a good thing I waited a couple days because I have been on a roller coaster of emotions, but know I can look back on the experience with fresh eyes. 

The hCG shot definitely got to me. My raging hormones have resulted in countless unnecessary tears. Some women test out their trigger to know when it's out of their system, but I'm just trying to play it cool so I don't become obsessed with it and think I should still have the side effects because it's still in my system.

So here's IUI story #1 (wouldn't it be nice if it stayed #1?!) 

For those of you who don't know, an IUI stands for intrauterine insemination also known as artificial insemination. Basically my husband's sperm is inserted directly into my uterus, creating a more direct route with less obstacles. 

We arrived at 7:30am for Chris's SA (semen analysis) to get a collection for the IUI. They wash the collection so only the best sperm remain. It's crazy to think there are millions and millions of candidates, but it only takes one.

The whole morning my emotions were running high. Nothing felt like it was going right that morning and I already lost hope before I even went in for the IUI. At 9am I got prepped and waited and waited and waited. Finally my sweet nurse came in and talked me through the procedure. They simply insert a speculum (ouch) and then guide a catheter until they find the top of the uterus and then the sperm is injected. It's simple enough that my nurse did the whole procedure while we talked about Thanksgiving to try and distract me from all the pokes and prodding going on. It only took about 3 minutes. After everything was removed, they had me rest for about 20 minutes and then they sent me on my way with good luck wishes.

All throughout that day I had no hope. I kept saying, "We'll have to try this medication next time" and "Next time I rather do this". I was already setting myself up for a negative. But that's how I protect myself. I don't get my hopes up so I'm not crushed when what I hoped for doesn't happen. Needless to say, I cried and cried and cried all day. 

Hormones. Gotta love them.
I had moderate cramping for two days and just took it easy. I am now in what's know as the two week wait. Two weeks until I take a pregnancy test to see if all the pills, injections, ultrasound, and IUI were worth it. My goodness I hope so! All the appointments, medications, and sticking needles in myself is emotionally exhausting!!!

But this is why I'm glad I'm writing this two days later. I found my hope. It's small, but I'm hopeful. There are so many little things that have to go exactly right to become pregnant. It really is a miracle. And that is where I found my hope. I've stopped thinking about the medications and how big my follicles were and if the trigger shot worked. Now I just think of the miracle it all is. It's completely in God's hands. If it's God's will, I will become pregnant. There is nothing more I want to be in life than a mother. I want to have children and raise a family with my husband. The thought consumes every spare moment. It is always in the back of my mind. It is everything to me. 

Ultrasound and hCG Trigger Shot

On Saturday I had my follicular ultrasound. My follicles were still a bit too small, so my doctor had me do a forth FSH injection. He said the follicles grow about 2mm a day, so he set my IUI for Wednesday morning. I'm excited and nervous! Although I've learned by now that I should stop being nervous because every time I am it turns out to not be a big deal at all. 

Oh boy, now I'm bringing in the big guns!

Last night I took the hCG trigger shot. hCG (human chorionic gonadotropin) is a hormone that is used to aid in the follicle maturation process and stimulate egg release. Typically women ovulate around 36 hours after the injection. That puts me at exactly 9am Wednesday morning, the exact time I'm getting the IUI. Timing is very important since eggs only typically live for 24 hours.

On another note, we are doing well. I have slowly been putting up Christmas decorations (yeah, yeah, yeah, you probably think it's too soon...) and we have been addicted to the new show Reign. Life is good and we are enjoying our time together! 

FSH Injections

Needles. Terrify. Me. 

No bueno.

Everyday I watched my Dad inject himself with insulin and it would make me shudder. I prayed I never would get diabetes and have to do the same. I should have also prayed I would never have to take anything else that required stabbing a needle into my stomach. 

When my package arrived with my injections I was overwhelmed and scared to death. I couldn't get over the 1 1/2 inch needles that were included in the box. I thought I was going to have to use those needles until I figured out I only had to use the 1/2 inch needles. Thank goodness! The box contained enough for three 113 unit injections of Bravelle (Follicle Stimulating Hormone). 

Fun fact: Bravelle comes from human urine. Thank you kind donors for sharing your pee with me. 

The package also had my trigger shot for my IUI. The trigger shot is a ginormous dose of hCG that triggers ovulation. Since I don't ovulate on my own this will certainly be necessary. 

(Sorry about the bad picture...my hands were shaking from being so nervous!)

Last night I did my first Bravelle injection. After tears and loving support from my husband I began the process. I had to mix three bottles of the Bravelle with the sodium chloride to get an amount concentrated enough for my dosage. And then I just did it. I stabbed the needle in my stomach and pushed in the plunger and took it out. I felt like a druggie. I freaked when I saw a small amount left in the syringe and stabbed myself again fearing I didn't get enough in. That probably wasn't smart, but I'm still alive. 

I'm not trying to make light of this situation, but joking about it helps me cope. 

All in all was it that bad? No. Was it worth the tears and anxiety? Not really. Now I know the next injection tomorrow will be fine and I shouldn't have to worry. But seriously though...needles are not cool.

The things I will do for an Itty Bitty Ivie!

Back to the drawing board - Month 2 Plan!