The Girl Who Cried IUI

Now I know I’ve said this before, but strap in – this is going to be a long one.

You’re caught up, our last IUI wasn’t “lucky number three“, so the waiting game began of when my next cycle would start. For those of you who don’t know me, I am a planner. I planned that I would start my cycle exactly 29 days after the last began, like always. Everything would be perfect – I would start on a Friday, baseline on a Sunday which was Dr. F’s weekend rotation, follicle scan would be a Tuesday and our IUI on a Thursday, both of those days being Dr. F’s days to work at the office near us. It was all set to be another perfectly timed cycle to line up with his schedule. LOL, the joke was on me.

Every time I went to the bathroom on Thursday (testing day), and Friday, I was hoping to have started my period. It never happened. I know that stressing ruined it for me. Saturday came, still nothing until 9 pm and all I could think was “what kind of crock of shit is this?” My clinic has a rule that if you start your period after office closing, then CD1 starts as the next calendar day. So Sunday it was, which was totally fine being that CD3 was a Tuesday meaning Dr. F would be in our local office.

CD2 (Monday, August 19)
I didn’t want to tie up the line for the on-call nurse over the weekend, so I didn’t call until Monday morning to schedule my Tuesday appointment. The only catch was… Dr. F would be in the main office that day. Of course, I had the option to schedule my appointment there with him, but I decided to stay with Dr. E (who we had for our first IUI). Side note – I never called the clinic to tell them about our failure a few days prior.

CD3 (Tuesday, August 20): Baseline Ultrasound
I always try to take the last appointment of the day (hello, anxiety), but I’ve started considering myself a pro at this point and knew I could muster the courage to go into work, after all, it was just an ultrasound. We arrived a few minutes early and were called back right on time, but much to my surprise, Crystal said “No vitals today!” (I guess all of my bitching and moaning finally paid off!) We went down the hall to our room, I gave my urine sample and we waited, and waited, and waited. This was the first time we really had any sort of wait at either location, but I kept telling myself there was a reason, I just assumed there was another patient that had a more pressing matter than we did. Turns out, Dr. E was waiting to hear from Dr. F about switching my meds. *I forgot to mention this, during the voodoo time of our third IUI, I asked Dr. F what we would do if it was to fail. He said I would be switched from Letrozole to Clomid (queue the panic). I had heard horror stories about the Clomid Crazies and knowing that he isn’t a big fan of the drug made me even more apprehensive. But he’s the expert, I’m just the hopeful, wannabe pregnant, pin cushion.

Once Dr. E came in, she confirmed that I would be switching to Clomid and would be put on the highest dose (queue some more panic). She warned me of the major side effects and that if I were to have any vision issues or headaches that I was to call the clinic right away. And good news, while the side effects may start with my first dose, they don’t typically ramp up until five to ten days after finishing the full prescription. OKAY, so just 16 days of CRAZY. No big deal, right?

All checked out fine for my baseline, now to just schedule our next appointment, fill my prescription and get to work a mere two hours late! Having to take so much time away from work is incredibly nerve-wracking, however, my boss is so incredibly understanding!

If you follow me on Twitter, you saw I tweeted about the first side effect being the cost. I was shocked when the pharmacist said “This isn’t covered by your insurance. How would you like to pay?” but I’m not really sure why I was. If you remember, Letrozole is a breast cancer chemotherapy drug so it is covered, leaving me with a $7.00 bill each month. However, Clomid was created specifically for ovulation induction making it an uncovered drug. When I asked the pharmacist how much it would be I was fully expecting her to tell me $300 which wouldn’t have mattered as I didn’t have the option, but luckily, it was just under $60 for 18 pills. Phew!

Why the switch? If you’re wondering why I was switched from Letrozole to Clomid, it’s because my clinic and Dr. F believe that if a patient hasn’t responded to a drug after three consecutive cycles at the highest dose, then there will be no response. So instead of wasting time on a drug that we know wasn’t working, I was switched to a stronger drug at the highest dose. If this one doesn’t work though, that’s a discussion for another day.

CD6 (Friday, August 23): The Clomid Crazies Part I
HOLY CRAP. No amount of research I did could have prepared me for what was in store. Let me paint the picture of my day for you.

I had the day off, which was a blessing like you wouldn’t believe, so J took the day off too. We had a few errands to run but then planned on spending the day at Universal Studios in Orlando. After several hours of debating what going or not going, we finally left the house exactly three minutes before driving into a terrible storm. And that’s where it all went downhill, I started crying over rain. RAIN. RAIN. I’m not talking regular tears, I’m talking boo-hoo, couldn’t catch my breath, sobbing. J immediately turned the car around and kept trying to calm me down, but you can’t just come down from the Clomid Crazies that easily. Roughly 10 hours of crying later, I decided I had enough and needed to throw in the towel hoping this was the worst of it.

CD7 (Saturday, August 24): The Clomid Crazies Part II
It happened again. But this time, my crazies were set off by my lunch being too hot. I’m sure you’re laughing at how ridiculous this all sounds, but I promise you, my tears were set off by nothing more than rain and chicken that was too hot to eat. Again, once I started crying, I couldn’t stop until I went to bed. Luckily, this seemed to be the last of it!

Why the strawberry flavored water? The taste of Clomid is absolutely horrendous, unbeknownst to me when I took my first dose. The taste made me gag on all three pills and I knew I had to somehow mask the flavor. Wine isn’t an option, so flavored water was my choice.

CD12 (Thursday, August 29): Follicle Scan
J and I arrived at the office, as usual, this time we had the last appointment of the day and were feeling good about it. Once again, Crystal didn’t need to take my vitals, so we headed to our exam room and I made my way into the bathroom for a urine sample. This time, although I remembered to pee in the cup, I became completely nervous and couldn’t pee for the life of me! I pushed on my bladder, thought of waterfalls and ran the sink until I could finally get exactly three drops in the cup! As soon as Dr. F and Crystal came into our room, immediately apologized for not being able to give more a sample (don’t worry if this happens to you, only a few drops are needed). “First things first,” said Dr. F, “how did the Clomid treat you?” To which I said:

“It made me effing crazy. I cried over the rain and hot chicken.”

I knew things weren’t looking good for my follicle scan as Dr. F was quiet for what felt like 10 minutes, but it was really just about a minute. He finally says “Alright, I see some follicles but they aren’t quite where I want them to be.” I took this as “Welp, I’m screwed this whole cycle is a bust.” This scan took a little longer than normal as he kept searching for a mature egg that could have somehow been hiding (like an Easter egg hunt), but I just knew it wasn’t good. I sat up and we started the conversation. Although I had four measurable eggs, none of them were mature. On my left ovary, I had a 9mm and a 10mm. On my right ovary, I had a 13mm and a 15mm. The only good number out of this scan (the silver lining, if you will) was my uterine lining at 8.5mm making it the best it’s ever been! If you’ve been paying attention, you know that none of those are big enough to trigger, so we were given three options and had a decision to make. But wait, there’s more – each of our options were tentative pending Hurricane Dorian that was heading straight for us and I would be going back on Clomid for whichever option we chose and we wouldn’t have Dr. F for any appointments. LOL, the joke was on me again.

Option 1
– take Clomid for two nights (that night and the next, CD12 and CD13)
– repeat my follicle scan at the main office on Saturday, CD14
– have our IUI at the main office on Monday, CD16

Option 2
– take Clomid for two nights (CD12-13)
– repeat my follicle scan at the main office on Sunday, CD15
– have our IUI at the main office on Tuesday, CD17

Option 3
– take Clomid for two nights (CD12-13)
– repeat my follicle scan at the main office on Sunday, CD15
– skip our IUI and do Timed Intercourse

This was a lot of take in with so many variables between the weather, my follicles and ovulation, so we leaned to Dr. F for his ideal choice. He said he wanted to see my follicles become mature over having an IUI. Being that we are about an hour and a half from the main office, he shared the same concerns about us being on the roads. There was also the possibility of the main office having to close as the hospital it is located in is on the water in downtown Jacksonville and has flooded in recent hurricanes. So, we decided to go with Option 2: take the pills, let my follicles grow, then have the IUI five days from this day. We left the office entirely defeated, dropped off my prescription, picked up sandbags for our house and bought a few hurricane supplies not knowing what we were in store for. If you’re wondering, my Clomid pills tasted just as bad the second time around.

CD15 (Sunday, September 1): Follicle Scan #2
A lot of Florida was under mandatory evacuations for the hurricane, so we left our house in plenty of time for our 9:30 a.m. appointment and somehow didn’t run into one bit of traffic. I thought that by getting there early I would have a few minutes to collect my thoughts (aka overthink everything) in the waiting room. NOPE. We were called back as soon as we checked in. Our nurse went through the usual then said “Great news, we have Dr. W and Dr. D here today, so you get your choice! Who would you prefer?” I told her I prefer Dr. F, but since he wasn’t available, either one was fine with me. She returned a few minutes later with Dr. W who had an incredible bedside manner and personality, but didn’t have the greatest news as he did my scan. The 9mm and 10mm follicles I had on my left ovary each shrunk a millimeter, which we knew was a possibility as Dr. F said he expected them to fizzle out. On my right ovary, my 13mm increased to 14mm and my 15mm increased to 17mm, not the best but not the worst. However, my lining went down from 8.5mm to 7mm which was shocking. We left with a trigger shot and plans to return Tuesday morning for our IUI pending the hurricane.

CD16 (Monday, September 2): Trigger Shot
The hurricane was still headed our way but we weren’t sure if we would feel direct impact or outer bands, so we decided it would be best to cut out the majority of our drive by staying the night at my sister’s house, 35 minutes from the main office. This meant I would be doing my shot at their house. This was only my second time doing this, but I kept telling myself it would be just as easy as the first time. And it was!

CD17 (Tuesday, September 3): IUI Day
We finally made it! Due to all of the variables, we didn’t know that we would make it this far, so pulling into the parking garage felt like a huge accomplishment. The clinic had notified all patients that the hospital would be closing early that day at noon and would remain closed through the following day, so the waiting room was packed and it seemed like every nurse was working and several of the doctors were there, too. A few minutes after checking in, J was called to do his part. Once he returned and the pressure was off him, he decided to starting talking to me and trying to make me laugh. Doesn’t he get it? I was so anxious that I did NOT want to talk or laugh.

Then it was my turn. Our nurse shows us to the end of the hall to our nice, big, corner room! She starts by saying “Have you had an insem before?” I wanted to say “DUH, look at my chart” but I knew they were busy so I just said “Yep, three failed insems.” She then apologized several times and made me tear up… hold it together, Kate! Before she left the room, I wanted to test my luck and ask if Dr. F was available, of course not (insert eye-roll). I emptied my bladder, undressed from the waist down, put my luxurious pink paper sheet over my lap, and was greeted by Dr. E shortly after and she told me to assume the position. (She didn’t really say it like that, she has more manners than I do!) Dr. E gives slightly different numbers than Dr. F does and told us J’s collection had 57 million motile sperm, which was higher than our first but lower than our second and third IUIs. I know Dr. E was trying to keep me calm as she knows how I am but I wasn’t ready for small talk! *You know the awkward small talk during dental cleanings, imagine how much more awkward those conversations are during fertility treatments.*Normally, Dr. F just gives me a play-by-play of what is going on, which she did too, but mixed in some talk about hurricane preparations. Side note: no matter what they say, I’m always relieved when I hear, “I found your cervix, looks great!” There’s such a thing of your cervix being closed for treatment and I’ve read just enough about that to know I never want that to happen to me. I’m warning you – do not Google this!

A minute later, we were done and our nurse left but Dr. E stuck around to talk a little more which was so nice and reassuring that the REs truly care about each patient at the FIRM! She gave us our backup schedule – that night, the next night and then the following night. As soon as she left, J said “Did you hear that? Three nights in a row? I’m requesting Dr. E from now on for every appointment!” I rolled my eyes so hard that I’m shocked they didn’t get stuck like that, but 15 minutes later we made our journey home to wait for the hurricane and for testing day.

Important information: Remember, our IUI was on CD17 and my period comes like clockwork every 28-29 days. If you’ve done the math, you figured out that testing day will be on CD31, so there is a chance that I won’t make it to testing day this time. I’ve never had that happen, even before treatment. I’ve always been able to test before getting my period. I’m nervous of the potential let down but I am trying so hard not to think about it. I’ll let you guess how well that’s going! And yes, I know – you test even if you’re bleeding.

Like every time before, here is my list of medications:
– Dose: 150mg/day
– Days: CD3-8 and CD12-13
– Side effects: thought that the world was ending. Kidding, but in all seriousness, you know about my uncontrollable emotions, but on top of that I had horrible hot flashes, one (or two) episodes of rage, two headaches that I don’t think were related but I want to mention this as headaches are a major side effect. Lastly, I know I didn’t have heart-palpitations but after reading the extensive list of side effects, I started thinking I was having them, but in hindsight I know that was all from the craziness side effect.
Novarel HCG Trigger Shot
– Dose: 5000iu
– Day: CD16
– Side effects: redness, itching and tenderness at the injection site

PS – If you’re wondering, we were lucky enough to not be in the direct path of the hurricane, we were just hit with some of the outer bands.