Getting Pregnant - Part 1

Finding Out I Have Fertility Issues

When we decided we were ready for our first baby I stopped taking birth control.  After I stopped taking birth control, I stopped getting my period and I knew something wasn't quite right.  I also gained 40 pounds after stopping the pill.  I went back to Weight Watchers and started working out more, but nothing was working to shed that weight.  I started tracking my basal body temperature (your temperature right when you wake up in the morning).  After you ovulate, your BBT should rise.  If you become pregnant, your BBT will stay elevated.  If you do not, it will drop right before your period begins.  I saw no rise, no fluctuations whatsoever.  Since I wasn't even ovulating, there was no trying to get pregnant.  Without some kind of change, there was no hope in getting pregnant.

After a couple months with no change, I decided to go to the doctor.  My doctor wanted me to wait a few more months to make sure that the effects of the birth control weren't still wearing off.  He also had Tim tested to rule out any other issues.  This is something that OHSU would have had us do as well, since there is no point in taking fertility drugs if there are other fertility problems that need to be solved.  Thankfully, his results were excellent.  After a few more months with no changes, I went back to the doctor and he referred me to the Fertility Clinic at OHSU.  We were able to get an appointment at the fertility clinic the very next week.

Tim and I drove up to Portland for our first appointment.  I had googled my symptoms and had come to the conclusion that I might have PCOS.  After talking with us, our new doctor informed us that he thought I had PCOS as well. PCOS (or polycystic ovary syndrome) is a condition that affects the ovaries.  Women with PCOS generally have small cysts within the ovaries and the ovaries don't make all the hormones it needs for an egg to fully mature, so ovulation does not occur. 

My doctor explained our options to us.  When you aren't ovulating, there are two drugs that the clinic prescribes: Clomid and Letrozole.  The purpose of both these drugs is for the ovaries to develop a mature egg and release it.  If the oral drugs don't work, there are hormone shots.  My doctor said that the shots will make almost everyone ovulate, but often too many eggs will be released and you can't continue with the cycle as it becomes too risky.  The next option is in vitro fertilization.

The first thing our doctor wanted to try was Clomid. In women that don't ovulate, 75-80% will ovulate when taking Clomid, and 40-45% will get pregnant within 6 months.  Because fertility drugs aren't exactly good for you, our doctor explained to us that after 6 cycles of taking fertility drugs, we would try something else.  Clomid works by elevating the follicle-stimulating hormone level (I couldn't tell you how the drug does this).  With the proper hormone levels in place, a follicle (which contains an egg) can mature and release the egg. 

Since I hadn't had a period in months, I started by taking Provera for 10 days to induce a period.  I then took 50mg of Clomid on days 3-7 of my cycle.  I experienced mild symptoms from the Clomid similar to PMS.  Not fun, but certainly manageable.  I continued tracking my temperature hoping to see that rise I had been waiting for. 

A few weeks after our first appointment we drove up to OHSU again for the mid-cycle scan.  The purpose of this ultrasound is to see whether or not the drugs are working.  If they are working, at least one mature follicle should be visible.  Unfortunately we were met with multiple levels of bad news.  Bad news: the drugs didn't appear to be working.  Worse news: There was a large mass inside my right ovary.  If ovulation occurs, the ruptured follicle turns into a corpus luteaum, which secretes progesterone.  Progesterone is a hormone neccessary to pregnancy.  Since there was a chance the mass could be a result of ovulation, a blood test was done to measure my progesterone level, but it was too low to indicate ovulation.  The ultrasound also confirmed that I had PCOS, since it showed small cysts inside my ovaries.  I had another ultrasound scheduled at Salem Hospital to determine what the mass was.  At this point, any chances of getting pregnant were on hold.