We had a great appointment with Dr. Sizemore on Wednesday! It was a completely different experience than my typical appointments at the Vandy practice. First of all, I called last week and got an appointment at a convenient time this week. Whoa. There's just the two docs in the practice, a few nurses, a phlebotomist, and a receptionist. After the very short walk from the parking garage that had plenty of open spaces, I walked in and the receptionist (whom I had never met) called me by name. The office was calm and peaceful, but the waiting area also had a few of Becca's favorite toys, so she was happy. They took us back as soon as I finished my new patient forms. (Funny aside - John got there before we did, so he started filling out my forms, sweet man, but appeared baffled by the "gynecological history" section...like he couldn't even mark whether or not I was sexually active. When I mentioned it, he joked that he would rather put "not enough" instead of a simple "yes" or "no." :) ) After the weigh-in (down a few pounds!) and blood pressure (higher than normal - this was the 4th appointment of mine and Becca's day), we had just enough time to look up the numbers for my docs in Louisville (which we needed to request my records) before Dr. Sizemore came in.
Pause. I've got to tell the Candler folk that Dr. Sizemore looks just like Mark Rogers-Berry. Similar mannerisms and everything. I find this simultaneously weird and comforting. But the last doc looked like Dr. Brelsford, who, while he may be an excellent professor, is not someone with whom I would necessary discuss my lady issues.
Okay, picture go forward. (Special reference for Brandy H. there). After a few minutes of catching up and talking about how amazing Becca is (remember, he was the first person to lay eyes on her tiny self), we got down to business, which, thankfully did not involve an actual exam of my business. We gave him the run-down of the difficulty conceiving Becca (4 months, quick PCOS diagnosis, Metformin) and on our attempts over the past 12 months (pre-conception consult with the maternal-fetal pre-eclampsia specialist, adjustment of psych meds, temperature monitoring, 4 rounds of Clomid at 50 mg a day without monitoring from the doctors (don't get me started), irregular periods, even on the meds, a billion pee sticks, 5 months of Metformin, and a general lack of follow-through from the doctors). I also mentioned that I still have pain from my c-section, 2 years later. (The pain is internal, not at the incision site.) We wondered if that could indicate an issue, since I didn't exactly give myself much time to heal; besides, the c-section is the only difference John and I could really identify between this time and last time.
I asked him if he thought we were crazy for trying again, and he said no, that we seemed to be aware of the risks, which he didn't think were deal-breakers. Then he said that we really ought to be able to get me pregnant, and from that point on, everything was in terms of how and when and never if. That was such a change! My poor overscheduled doc at Vandy was so ready to send me over to the infertility specialists (that we can't afford), but John and I didn't feel like we had really done everything that a general OB could do (like follow through on the actual treatment plan). The root issue is that I don't ovulate reliably or predictably, even when I was on Clomid. Oligomenorrhea (infrequent periods) is a gynecological problem outside of trying to conceive, so a general ob/gyn is equipped to treat it, and insurance covers it. We all agreed that if I can ovulate, then I ought to be able to get pregnant, so that's our goal. (Of course, there may be other issues, but since I did get pregnant before and do have trouble ovulating, this is the first issue we have to deal with - until we get past it and something else crops up, we'll assume that there aren't other issues.)
So, how are we going to convince my body to ovulate? Here's the plan:
- Fortuitously, I have (mostly) started my period today, making this cycle day 1. That's convenient, because we were going to have to wait for a new cycle or jumpstart a new cycle (with progesterone) to get this party started.
- On day 3, I'll have blood drawn to measure my FSH level (follicle stimulating hormone?). These levels will tell us how my ovaries are functioning. (I don't really understand the science behind it yet, but I'm okay with that.) Turns out day 3 is going to be on a Saturday, which would make this test impossible at the Vandy practice since they aren't open on Saturday. Neither is the new practice, but the outpatient lab at the hospital (Williamson Medical) is, so they've already sent the order over, and I can just stop in on Saturday.
- On days 5 through 9, I'll take 100 mg of Clomid. Before I had been on 50 mg and ovulated 2 out of the 4 months, which is just about what my average without the medicine had been. Clomid, by the way, is not covered by insurance, but the ten pills I need for this cycle's dose only cost $16. We can handle that. :)
- Starting on day 12, I'll pee on sticks (ovulation predictor kits - OPK's) at least once a day in hopes of catching the Lh surge (a hormonal spike) that precedes ovulation by 24 - 36 hours. This could be tricky because apparently I have a quick surge and drop or something because I have never once gotten a positive OPK test. Apparently I'm not alone in this, though the doctors both looked at my quizzically when I told them so. My dear sister-in-law once referred to OPK's as "a complete racket." Still, I dropped another $40 on this month's pee sticks. (By now I totally would have gotten my money's worth out of the $200+ fancy fertility monitor that I guess I should have purchased to begin with.)
- That week is John's favorite week of the process. I'm a fan of it, too. 'Nuff said.
- On day 21, I'll go in for another blood draw. This time they will measure my progesterone level in order to determine whether or not I actually ovulated. (Progesterone is much higher in the second half of your cycle. That's why many women are really tired before they get their period.) At this point, it is too late to fertilize an egg that has been released (they only live for a day or two), but it will tell us whether the Clomid has done its job.
- About a week later, as Dr. Sizemore said, we'll get our positive test result. NBH (New Baby Hill) will (would, really) be due right around Becca's 3rd birthday. Voila!
Speaking of injections, if I don't ovulate at this level of Clomid, next cycle he may give me an HCG injection that somehow magically makes me ovulate (in some circumstances). If I do ovulate but don't get pregnant, we may do a...crap, forgot the name...they may inject my uterus with a bunch of fluid and look at it on an ultrasound or something or other and check for scarring from the c-section that might be causing problems. (He offered to go ahead and do this, but we opted to wait until we really get a good Clomid cycle with the appropriate tests before exploring this possibility further. A much better approach, I think, than the old doctor who told me I just had gas. Nice.) If we are still having trouble in a few months, we may have John tested, but with guys it tends to be a bit more all or nothing in terms of fertility, unless there has been some kind of significant illness, physical trauma, etc., and since we conceived Becca, then we don't really anticipate an issue there.
I think that's about it. I hope this makes sense; I'm incredibly tired today. Becca seems to be shifting her sleeping pattern...as in, not sleeping as much. Dislike. I also noticed while writing this that I know much less about the medicine and physiology of infertility than I do about all of Becca's medical and developmental issues. And I'm okay with that. I know enough to understand what's going on, and at the moment our issues are pretty clear-cut, unlike many of little missy's. It's kind of refreshing to have problems that doctors have seen a million times instead of always being the exception. But it's still nice to be treated like you aren't the millionth patient they've seen that day.
Oh, and as an added bonus, he wrote me a prescription for Nexium so that I can stop buying Zantac in bulk. (Turns out if you are having to take Zantac 5 days a week, you really ought to be on something stronger.) And since I had a coupon, the extra prescription got me another $10 Target gift card, so I won free money, right? (I won't mention that the Rx cost $30 on its own, though...) Still, it justified a purchase of uber-cute Halloween p.j.'s for for my favorite little witch.
All in all, we are feeling much better! Thanks for the encouragement and kind kind thoughts!