Back in December, after my second miscarriage in a row, I decided to seek out the help of Reproductive Endocrinologist.  I had a nagging feeling that something was wrong even though my Ob/Gyn assured me that that I was just having a string of bad luck and that "these things just happen".  I did a lot of research and took recommendations from friends.  I ended up choosing a place that had a recurrent loss program and is also ranked in the top 5 programs in the country.  I ended up choosing a doctor that US News rates as being in the top 1% of doctors in the specialty field of reproductive medicine.

Don't get me wrong, I am overall impressed with the place.  I see many happy pregnant women coming and going.  Normally, seeing pregnant women upsets me, but seeing pregnant women at the RE's office makes me happy and hopeful.  I think my doctor did an excellent job at handling my d&c.  I had a much shorter recovery time that I did after my first d&c and an overall better experience.  Here are a few things that have bothered me, though.  I need to get them out.  Apologies in advance for this rant.

1.  I was nearly scheduled for the wrong procedure during all of my testing.  I was inadvertently scheduled for an HSG when I should have been scheduled for a hysteroscopy.  They also tried to schedule me for the procedure outside of the regular window, which I read that you were supposed to have it done (between cd 5-10).  Luckily I thought something was wrong and called and got everything straightened out. 

2.  I had lots of blood tests taken for various genetic disorders.  It turns out that they forgot to run one of the tests so I had to go back and get more blood taken.  Huge pain in the arse.

3.  After my 3rd miscarriage, they basically told me there was nothing they could do other than IVF w/ PGD and that we should just try again and hopefully at some point the stars will align and we'll have a sticky baby.  I asked about the ovulation induction meds and the RE agreed to try them out on me since my cycles are so long.  They have not looked in to my FSH/AMH to see if it is abnormal since I am not of "advanced maternal age", but I have heard stories of people my age having issues with this causing unhealthy eggs.  They have not suggested testing my husband's sperm to see if there is an issue there.  They basically told me I was having bad luck.  I feel like at a place that is so highly ranked, that they should be able to do a little more.  Right??

4.  I feel like most fertility clinics try to push you towards ART rather than trying other methods.  Since I am not doing IUI/IVF I feel that they do not monitor me closely enough.  I am given this breast cancer drug to hopefully move up my ovulation date and I am left to Google to find out the possible side effects and generally what to expect.  Seems like I am only expected to call if I get pregnant.  I called the office yesterday to ask when they thought I should start taking opks and the nurse told me she wasn't very familiar with the drug I was taking.  I asked her if she thought it would move my ovulation up and she told me she didn't know.  I asked her if I could get blood taken at the end of the 2ww and she said that was probably a good idea.  WTF.  I have to ask for that?  They don't tell me to do it?  What about checking to see if I actually ovulate on this drug?  Ultrasounds/blood work?  I get nothing.  I have been completely abandoned by my doctor's office.  Left to my own devices...my own research. 

I have been feeling rather hopeless the past few days.  I feel like no one can help someone like me.  They can make a woman who does not ovulate, ovulate.  They can make a women with no tubes get pregnant.  They can genetically engineer a baby in a test tube and put it into another women.  But, they can't help someone who has regular, but long cyles/late ovulation and gets pregnant fairly easily only to habitually miscarry right away.  They can't find anything wrong with me so they just give up.  I feel like I should just wear a name tag when I go into the office that says lost cause.  Can you tell I am not having a great week?  Maybe it is the Femara.  I guess I'll Google it to find out.

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I never EVER in my wildest dreams thought that I would be here right now.  I never thought I would be uttering the words, "tomorrow I am starting fertility meds".  Yes, tomorrow is the day that I enter into the world of the assisted and unknown.  Please wish me luck.

I spent most of my younger years trying not to get pregnant.  I was religious about taking my birth control down to the exact time...12 PM every day.  If I ever diverted from that time I would force the use of condoms as well.  If I was on an antibiotic...condoms.  If I was just feeling really fertile...condoms.  I was soooooo worried about getting pregnant.  Man, if I only could have been that lucky as to have an accidental healthy pregnancy.  Never did I think that I'd actually be one of those sad women who can't seem to have a healthy baby.  I get angry just thinking about it.  Why did I waste all of those good fertile years starting my career, buying a house, going out with friends?

I am one of those people that doesn't even like to take Advil for a headache or Tums for heartburn.  I usually ride out the pain...suffer through it.  After my d&cs I did not take any pain meds to prove that point.  I don't like help from others, I'd rather do things on my own.  It was hard for me to admit that I had a problem with pregnancy and needed to seek medical help.  Why would I have any reason to think that I could not have a baby?  I have always prided myself in my healthiness and figured that because I treated my body well, it would treat me well in return.  I guess that things just don't work like that.

I think I had good reason to believe that I wouldn't have any problems having a baby.  My mom is one of the most fertile people on earth.  She had seven children over the span of almost 20 years with almost no issues.  Granted she started much earlier than I (at the ripe old age of 24), but she also gave birth to my youngest sibling in her early 40s.  She only ever had 1 miscarriage in all of those years, but she was in her 40s.  I love my mother to death, but I am seriously jealous of her fertility.  I never thought I would say that either.

But, I digress...

Tomorrow starts the next chapter in my TTC journey.  Hopefully I don't freak out and decide not to take the meds.  I only wish my RE would give me a little more guidance besides writing me the prescription.  I'll have an update tomorrow.

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Oh Google, why do you let crazy hormonal ladies that are desperate to become pregnant search for fertility drug information?  I have successfully caused myself to freak out about the drug that I am going to start on Wednesday.  Popping that 6-letter word into the text box and clicking search has led me to some terribly scary articles and warning about using Femara as a fertility drug.  Fantastic.

My RE prescribed me Femara instead of Clomid recently to see if that might have an affect on shortening my cycles, moving up my ovulation date, and causing me to produce healthier eggs.  She told me that the drug was much easier to handle than Clomid, handed me a prescription, and saw me out.  Not a whole lot of guidance there.  :-(

Apparently, this drug has been used since around 2001 by fertility doctors to stimulate ovulation in women who don't ovulate or strengthen ovulation in women who already ovulate.  Femara is approved by the FDA to treat breast cancer patients as it inhibits estrogen production.  When used for fertility purposes, this drug is used almost identically as the drug Clomid is used, but has less side effects such as mood swings, decreased cervical mucous, and a thinned uterine lining.  The success rate is almost identical between the two drugs, but Femara is NOT approved by the FDA for fertility usage.

A Canadian study published in 2005 found that women who took Femara as a fertility med had a much higher risk of birth defects than women who were taking Clomid.  This caused the drug's maker, Novartis, to condemn the drug for fertility use.  Other studies have been done since 2005 and none have shown any higher risk of birth defects unless the drug is taken while pregnant.  It is considered a class D medication and should never be taken while pregnant.  Due to the fact that Femara is taken early in the cycle (usually cycle days 3-7 or 5-9) and it has a short half-life, it is not present at the point where pregnancy begins.  I question why REs would prescribe a drug for fertility that they thought had a high liklihood of birth defects?  I hope they have done all their research here.

I have trolled many different sites over the past few days trying to find success stories and I have found many.  I have also found many stories about ladies who it has not worked for or ladies who were cautioning against its usage.  It is enough to make any infertile woman go crazy and second guess an already tough decision that was made to start messing with nature.  Even after all of the tortuous reading, I am still going forward.  I hope I won't regret it.  Gulp.

Here is my protocol for my "prevention" cycle with Femara that I have researched (my RE basically just said take it from cd 5-9 and call us if you get pregnant):

1. Start 1 pill a day regimen on cycle day 5.  Continue 1 pill a day until cycle day 9.
2. Start opks on cycle day 10.
3. Hopefully ovulate between cycle day 14-17.
4. Wait 2 weeks and take a pregnancy test to make sure I am NOT pregnant.
5. Call doctor to get blood test to BE SURE I am NOT pregnant (I am not risking birth defects).
6. Get period, rinse and repeat minus protection.

Here goes nothing...

References:

The pros-
Letrozole (Femara) for Infertility Treatment:  http://www.ivf1.com/letrozole-femara-infertility/
Femara (Letrozole) for Infertility, Ovulation Problems and PCOS Treatment: http://www.advancedfertility.com/femara-letrozole-fertility.htm

The cons-
Femara: Warning Against Use for Infertility: http://www.drugs.com/news/femara-warning-against-infertility-1636.html
The Troubling Femara Infertility Connection: http://www.fertileheart.com/the-troubling-femara-infertility-connection/

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Normally, any women who is TTC does not want to get her period.  Now a woman who has recently had a miscarriage...it is all she thinks about.  When will I get my freaking period?!  Is there something wrong with me?!  Well AF finally came today and I was quite happy to see her.  Her visit means I can finally start moving forward again.

After my first m/c and d&c, I was not yet charting.  I really had no idea when or if I was ovulating and thus no idea when I would get my period.  The wait for my first AF after my first d&c seemed like an eternity.  My Google searches regularly consisted of "how long after a d&c will I get my period", "what is the normal amount of time it takes to get a period after a d&c", "is it normal to not have your period 6 weeks after a d&c".  My search results almost always included several hits regarding Asherman's Syndrome, which totally freaked me out.  From Ashermans.org, "Asherman's syndrome occurs when trauma to the endometrial lining triggers the normal wound-healing process, which causes the damaged areas to fuse together. Most commonly, intrauterine adhesions occur after a dilation and curettage (D&C) that was performed because of a missed or incomplete miscarriage, retained placenta with or without hemorrhage after a delivery, or elective abortion. Pregnancy-related D&Cs have been shown to account for 90% of Asherman's Syndrome cases."  At one point after my first d&c, I had convinced myself that I had Asherman's...then I got my period a few days later.

The cycle following this d&c has been different for 2 reasons.  First of all, I charted this cycle.  That has been the most helpful thing for me.  I knew that I ovulated and I knew that I was going to get AF today.  No surprises and no freaking myself out that I had Asherman's.  Secondly, this chart is starting to somewhat resemble that of a normal female's.  Yes, I still ovulated late, but not as late as usual and my luteal phase was a full 12 days with no spotting!  NORMAL!  I am not sure if it is the b6, the red raspberry leaf tea, the acupuncture, the yoga, or a combination of everything, but something is working.

For anyone who has had a miscarriage and a d&c, I would strongly recommend charting your bbt, taking opks, and checking CM with a tool like Fertility Friend.  That way you won't be guessing what is going on with your body.  Maybe you won't ovulate, but at least you'll know.

My temp took a nosedive this morning and I just knew AF would show up...she did.  My RE's office does not "believe" in charting.  When I called them up once to ask them a question about my chart they snidely replied that they don't believe that works and that temperatures are too variable.  I am glad that I did not listen to them and continued to chart...otherwise my yoga class this morning would have turned tragic.
:-)

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I have been beating myself up about this for many months.  I have heard through many an infertility/miscarriage forum that having a longer cycle with late ovulation is a sign of poor or diminished egg quality.  Ever since going off the pill a little over a year ago, my cycles have been anywhere from 35 days (first 2 cycles off the pill) to 41 days (in cycles following miscarriage).  I verbalized my concerns to my RE who tried, unsuccessfully, to put my mind at ease by saying that a late ovulation does not automatically equal poor egg quality.

A few days ago, a girl in one of the miscarriage forums posted an article that she had found that completely refuted the theory of long cycles/late ovulation = bad eggs.  A gentleman by the name of Dr. Thomas Hannam posted an article with the exact opposite theory.  In his article he stated, "Delayed ovulation -day 13 or later- is not a sign of egg quality concerns; in fact, it is more commonly a sign of an excess ovarian reserve, generally a good thing."  Now compare that statement to something that I just found on BabyMed.com, "Delayed ovulation may be a sign of poor egg quality."  Another blurb on StorkNet.com, made by Dr. Sam Thatcher states, "The average cycle length is 28-29 days. The farther one deviates from the norm the greater the likelihood of poor egg quality, lack of ovulation. Delayed ovulation is also associated with an increased risk of miscarriage. The rate of infertility is very high when cycles are over 35 days and I do not even recommend testing for ovulation, just progressing with therapy. At 32-34 days you may be somewhat borderline for normal ovarian function."  Ok really?  Wow.  This doctor doesn't even want to give a longer cycle a chance at having a natural successful pregnancy.  Now I am thoroughly confused.

Back to Dr. Hannam, I read his biography and he seems legit.  He runs a large fertility clinic in Toronto, Canada and looks to be quite successful in his practice, judging by the patient testimonials.  I am wondering where he got his information though and how medical professionals could have such differing opinions on this subject.  I would love to speak with him and pick his brain about this.

A few other major points from his article that intrigued me:

-Earlier ovulation (days 8,9,10) can be a sign of lower egg quality especially if you once had a normal ovulation day and now your ovulation day is consistently earlier. 
-Spotting ahead of your period can be a sign of poor egg quality.  Apparently lower quality follicles are associated with less progesterone production.
-Shortened cycles can be a sign of poor or failing egg quality.

Ok so reading the article by Dr. Hannam, I would not think that my cycle length/ovulation days are an issue.  If you Google late ovulation and poor egg quality you get a million hits.  If you Google late ovulation and good egg quality you get  the Dr. Hannam article along with a bizillion other articles about late ovulation and poor egg quality.  What gives?  Am I doomed or blessed?  I posted a question to his blog about my situation.  I'll report back if I get a response.

References:
How your menstrual cycle reflects your egg quality: http://www.fertility.ca/2008/06/how-your-menstrual-cycle-reflects-your-egg-quality/

Long Cycles and Delayed Ovulation: http://www.babymed.com/menstrual-period/long-cycles-and-delayed-ovulation

Delayed Ovulation: http://www.storknet.com/cubbies/infertility/exst19.htm

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Picture this...you've been through your 3rd miscarriage in 7 months.  You have recovered physically and finally feel like your body is starting to feel "normal" again.  Mentally, you are starting to round the corner from grief, sadness, and despair to the road of acceptance, peace, and hope.  You feel like the bleak days of the past are behind you and you are finally looking forward to the future again.  Then you open the mailbox and find a $500 bill from the hospital for your last D&C (dilation and curettage).  Just like a ton of bricks it hits you...ugh this really did happen.

I am actually quite lucky when it comes to medical bills.  I have great insurance and my company, very generously, reimburses my co-pays, which in this case will be $500.  I can't imagine if I didn't have insurance.  We would have to take out a second mortgage or I would have to start stripping (jk).  Here is the breakdown of the cost:

Pharmacy- $66.85
Other Pharmacy- $1.36
Medical/Surgical Supplies- $332.50
Laboratory Services- $769.00
Operating Room Services- $7,774.00
Recovery Room- $890.00

GRAND TOTAL: $9,833.71

Multiply this by 2...yikes.  Actually my first D&C was at least 2-3 thousand dollars more for some reason.  They were both performed under different doctors and at different hospitals so I guess that there is a lot of variation between them.  I have heard from several people that it costs more money to have a dead baby removed them to give birth to a live baby.  How utterly sad is that?  I pray that the next time I need to go to the hospital, that it is to give birth to a healthy little baby.

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I feel like I have spent the last year of my life wishing I had a baby.  Looking longingly at young families and wishing that I had what they had.  I have hoped for it and prayed for it.  Meanwhile, around me, there seems to be a great baby-boom going on.  I have heard other friends excited pregnancy announcements and then attended their baby showers.  I have gotten their birth announcement cards and visited them while they were on maternity leave.  I have picked out little outfits and fun toys for baby's first birthday party.  The jealousy is strong, but I try not to let it get the best of me.  I put on a happy face even though I am so sad inside.  I want nothing more than to have a child.  I know that my husband and I will be great parents.

One of my dear friends recently told me that their spouse had been unfaithful.  I was shocked and saddened to learn that after over 10 years of marriage, one had decided that they were not completely fulfilled with the other and found someone outside of the relationship to supplement.  Besides my friend feeling the grief, anger, and sadness about the situation, they have several small children in the mix.  When asked for the reason for the infidelity, the unfaithful spouse replied that they wished that they were young, unattached, and childless.  They were tired of being a spouse and parent.  This is after the couple did not have the most smooth road before and during pregnancy.  After the infidelity took place, the unfaithful spouse decided that it (infidelity) wasn't everything it was cracked up to be and stopped.  They are going to try couples counseling, but it is undetermined whether they will be able to repair the damage that was done. 

Hearing my friend's story made me so sad.  My heart hurts.  Could it be that we only want what we don't have?  Why is it that things that we don't have are so much more appealing than the things we do have?  We spend so much of our time wishing it away...a bigger house, a nice vacation, more money, a better job, more fun...  Are we ever really content with what we have right now?

I am totally guilty of this.  I have been wishing my days, weeks, months away, trying to have a baby.  It is all I have thought about for the past year.  Maybe I need to take a step back and look at the things that I do have.  I have a wonderful husband who loves me.  We have so much fun together and there is no one else I would rather spend my time with.  I have a loving family that I am so grateful for.  They listen when I need to talk and never judge me for the choices that I make.  I have great friends who I have fun with but can also vent and cry to when I am feeling low.  My job isn't perfect, but it is stable and pays the bills.  I can even say, that once in a while, I actually enjoy what I am doing.  :-)  I have a nice house in a safe neighborhood and cute and cuddly pets.  I am healthy. 

The moral of the story is, the grass is always greener on the other side.  Sometimes you don't have to look over the fence to see what your neighbor has and can look to what you have and see the fulfillment in that.  My husband and I really want to start a family, but right now we are just happy together.  I think there is real beauty in that...being happy with what you have right now.

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