I went off the pill pretty much right after we got married. DH had been told early on in our relationship that if he wanted to be with me, he'd better want to have kids. Now DH has never been keen on kids, though he's absolutely fantastic with friends' children and our nieces and nephews. I think he just doesn't want to finally have to grow up, even though he's already over 40.
We had a little fun the first couple months, and then I started temping and charting on fertility friend. Even though I wasn't totally certain I was completely ready to have a kid at that point, given where I was in my residency training, I was convinced it was going to take a long time for us to get pregnant, and figured we'd better have at least 6-12 months of trying under our belt before anyone would take my claim of infertility seriously.
I say I knew I'd have trouble because I'd been having crazy spotting throughout the month for at least 9 years. I'd tried tons of different times of pills while in Germany, none of which made any difference. My gynecologist over there also tried me out on vitex agnus castus (homeopathy is pretty accepted in Germany), but that didn't help much either. As a last resort she sent me for a hysteroscopy and D&C to see if anything looked wrong and to see if giving me a cleanout would put things back the way they belonged. None of it worked - I was right back to the spotting as usual.
My gynecologist in med school diagnosed me with PCOS based on bloodwork he did (high LH:FSH ratio) and my ultrasound results. I do get a fair bit of acne, and maybe have a little more fair hair over my body than some. And I have a spot that's thinning on top of my head. But I'm thin, and don't have many other symptoms.
So we started trying right away. I had fairly low basal temps, but saw a temp shift most months. Twelve months later, we'd still had no luck, despite usually trying at the right time each month. Why the hell did we get so worked up years ago when we had to broken condom scares in a row? It seems really silly to me now!
About 13 months after we started trying, I did an endocrinology rotation for a month as part of my residency training program. One of the endocrinologists (Dr. K) has a special interest in reproductive endocrinology, the Creighton method, and NaPro technology. Since I was really interested in that stuff too, I managed to spend one of her clinics shadowing her to see what sorts of things she did. Her patients showed us their Creighton method charts, and I immediately recognized myself in them. Long, irregular cycles, tons of mid-cycle and luteal phase (LP) spotting, little fertile cervical mucus (CM). They all had a diagnosis of PCOS too, and she was putting them on progesterone supplements to try and get the hypothalamus and pituitary back into whack. Of course I later found out one of them got pregnant on progesterone supplementation alone. If only I could be so lucky...
At the end of my time there, I asked Dr. K if she might consider taking me on as a patient, and luckily she was ok with it. She was sweet enough to squeeze my consult in on her lunchtime before I had even finished my rotation, and put me on progesterone supplementation right away. She told me to not try to get pregnant in those three months because I wouldn't end up with a healthy pregnancy (I still tried the first month, to no avail). Initially the spotting got a little better, but it didn't continue.
The next step was a hormonal profile where I had to do bloodwork every other day for three weeks or so to see how my LH and estradiol behaved pre-ovulation, and then how my estradiol and progesterone behaved post-ovulation. (I'm acutally crazy enough to draw my own bloodwork with a butterfly needle, because my work hours as a resident mean I have to be at the hospital from 6:45am till at least 4:30pm each day. And official lab hours are 7:45am-4pm. A little conflict there?) Of course, my estradiol and progesterone were low post-O. She then put me on HCG shots for luteal support because they should boost the estradiol and progesterone. I did two months of that alone with God-awful spotting throughout the LP.
I talked her into trying me on some clomid after that, hoping that a better ovulation would lead to a better luteal phase. We started off with 3 days of 25mg of clomid, but that didn't do much. The next two cycles were on 25mg clomid CD3-7 (5 days), and things looked slightly better in terms of the spotting. We added low-dose naltrexone (4.5mg a night) after the first month. Still no success either. And when we bumped the clomid up to 50mg CD3-7 the next two months, my CM totally dried up despite the B6, guiafenesin, and even amoxil she put me on to enhance it. My progesterone numbers were good mid-LP with the HCG, but the estradiol was still not great.
After two dry and spotty months on the 50mg clomid, we decided to give letrazole a try, at 5mg CD3-7. My first month on that coincided with a trip to Germany see family and tack on a vacation in Italy. The vacation was great (I love Italian food!), but the fertile CM dragged on and on, and I finally ovulated after we got back to Canada, about a week later that I'd expected to. That's happened before when I traveled long distances though. I did the 6dpo bloodwork and heard from Dr. K that the results showed a so-so progesterone and a crummy estradiol. She said I should do the same thing the next cycle and then we'd figure out the next step from there.
We had a little fun the first couple months, and then I started temping and charting on fertility friend. Even though I wasn't totally certain I was completely ready to have a kid at that point, given where I was in my residency training, I was convinced it was going to take a long time for us to get pregnant, and figured we'd better have at least 6-12 months of trying under our belt before anyone would take my claim of infertility seriously.
I say I knew I'd have trouble because I'd been having crazy spotting throughout the month for at least 9 years. I'd tried tons of different times of pills while in Germany, none of which made any difference. My gynecologist over there also tried me out on vitex agnus castus (homeopathy is pretty accepted in Germany), but that didn't help much either. As a last resort she sent me for a hysteroscopy and D&C to see if anything looked wrong and to see if giving me a cleanout would put things back the way they belonged. None of it worked - I was right back to the spotting as usual.
My gynecologist in med school diagnosed me with PCOS based on bloodwork he did (high LH:FSH ratio) and my ultrasound results. I do get a fair bit of acne, and maybe have a little more fair hair over my body than some. And I have a spot that's thinning on top of my head. But I'm thin, and don't have many other symptoms.
So we started trying right away. I had fairly low basal temps, but saw a temp shift most months. Twelve months later, we'd still had no luck, despite usually trying at the right time each month. Why the hell did we get so worked up years ago when we had to broken condom scares in a row? It seems really silly to me now!
About 13 months after we started trying, I did an endocrinology rotation for a month as part of my residency training program. One of the endocrinologists (Dr. K) has a special interest in reproductive endocrinology, the Creighton method, and NaPro technology. Since I was really interested in that stuff too, I managed to spend one of her clinics shadowing her to see what sorts of things she did. Her patients showed us their Creighton method charts, and I immediately recognized myself in them. Long, irregular cycles, tons of mid-cycle and luteal phase (LP) spotting, little fertile cervical mucus (CM). They all had a diagnosis of PCOS too, and she was putting them on progesterone supplements to try and get the hypothalamus and pituitary back into whack. Of course I later found out one of them got pregnant on progesterone supplementation alone. If only I could be so lucky...
At the end of my time there, I asked Dr. K if she might consider taking me on as a patient, and luckily she was ok with it. She was sweet enough to squeeze my consult in on her lunchtime before I had even finished my rotation, and put me on progesterone supplementation right away. She told me to not try to get pregnant in those three months because I wouldn't end up with a healthy pregnancy (I still tried the first month, to no avail). Initially the spotting got a little better, but it didn't continue.
The next step was a hormonal profile where I had to do bloodwork every other day for three weeks or so to see how my LH and estradiol behaved pre-ovulation, and then how my estradiol and progesterone behaved post-ovulation. (I'm acutally crazy enough to draw my own bloodwork with a butterfly needle, because my work hours as a resident mean I have to be at the hospital from 6:45am till at least 4:30pm each day. And official lab hours are 7:45am-4pm. A little conflict there?) Of course, my estradiol and progesterone were low post-O. She then put me on HCG shots for luteal support because they should boost the estradiol and progesterone. I did two months of that alone with God-awful spotting throughout the LP.
I talked her into trying me on some clomid after that, hoping that a better ovulation would lead to a better luteal phase. We started off with 3 days of 25mg of clomid, but that didn't do much. The next two cycles were on 25mg clomid CD3-7 (5 days), and things looked slightly better in terms of the spotting. We added low-dose naltrexone (4.5mg a night) after the first month. Still no success either. And when we bumped the clomid up to 50mg CD3-7 the next two months, my CM totally dried up despite the B6, guiafenesin, and even amoxil she put me on to enhance it. My progesterone numbers were good mid-LP with the HCG, but the estradiol was still not great.
After two dry and spotty months on the 50mg clomid, we decided to give letrazole a try, at 5mg CD3-7. My first month on that coincided with a trip to Germany see family and tack on a vacation in Italy. The vacation was great (I love Italian food!), but the fertile CM dragged on and on, and I finally ovulated after we got back to Canada, about a week later that I'd expected to. That's happened before when I traveled long distances though. I did the 6dpo bloodwork and heard from Dr. K that the results showed a so-so progesterone and a crummy estradiol. She said I should do the same thing the next cycle and then we'd figure out the next step from there.
So with that bad news fresh in my ears, I headed home for Christmas with my family, and down to visit my brother and his family. He, of course, has managed to conceive and have two beautiful kids with his wife in the same time we've been trying to have one. At Christmas, one was 19 months old, and my SIL was 34wks pregnant with number two. And my spotting got worse and worse while I was there. I enjoyed quite a few glasses of wine with dinner over the holidays, and totally gave up all hope for the cycle.
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