The First Month

Infertility treatment is exhausting. It is invasive and time consuming and just all around consuming. It's hard to think about anything else when you're constantly being monitored and you see your nurses more than your own family.

Most REs (reproductive endocrinologists) start with as little treatment as possible. When we were given the diagnosis of possible endometriosis, we had two ways we could proceed. I could have a laparoscopic surgery to verify diagnosis (it is impossible to officially diagnose endometriosis without surgery) and hopefully clear up any spots that were causing issues with a laser treatment; or we could move forward with medication for a few months and hope to avoid surgery. We decided to try medication first as it was far less invasive and our doctor agreed with the path we chose.

You start every new cycle with an ultrasound. On cycle day 3, you go in for an ultrasound. They monitor to make sure that you don't have any ovarian cysts, because ovarian cysts will respond very positively to the medication and can grow out of control. If no cysts are found and your uterine lining appears to be shedding appropriately, you get the go ahead to move forward with medication.

My RE put me on Femara (generic name Letrozole), which is actually marketed to be a medication for use in post-menopausal breast cancer patients. The medication actually decreases the amount of Estrogen in your body. At first, we were confused. Why would we want to decrease estrogen? The reason is that your body basically goes into overdrive trying to replenish the lessened amount of estrogen and you develop stronger and bigger eggs. I took the medication every night between 6-8 p.m. from cycle days 3-7.

On cycle day 10 (yes, you get a calendar every month that helps you decipher these days), you go in for another ultrasound and bloodwork. They measure your follicles and estrodial. They're hoping to see at least one follicle at 16 mm or higher. If you have too many follicles, your cycle can be cancelled so you don't end up as Octomom. If you don't have any follicles that meet that size you either postpone for a few days and come back for more monitoring or cancel the cycle and start over next month. It's very hard to describe just how exciting it is for an ultrasound tech to tell you they see an appropriately sized follicle. And it's just as hard for an ultrasound tech to tell you...hmmmm... looks like only a few small ones so far.

Once your blood work comes back from the lab, your nurse calls you that afternoon and tells you if you can take your trigger shot yet. The trigger shot is HCG, yes, the pregnancy hormone. This triggers ovulation within 36 hours in the vast majority of women. You can't take a pregnancy test at this point because it WILL be positive. I was on a few infertility internet forums and lots of women "test out their trigger" to see the positive from the trigger shot fade and hopefully see two lines come back for a positive pregnancy test, but I never did. I didn't want to see two lines on a pregnancy test unless it meant there was really a new life being created.

Giving yourself a shot is a strange experience. The needles are tiny and you don't have to put them too deep, but it's still weird to do it yourself. The first month I gave myself a trigger shot, I was terrified. Mike asked me if I wanted him to do it and I told him that I had a feeling I'd have to learn (I was fairly confident it wouldn't happen the first month). It took me nearly fifteen minutes of preparing but I finally did it.

After the trigger shot, there are two ways that the RE usually goes. Either timed intercourse or intra-uterine insemination. Luckily, my RE didn't think we needed the IUI and so we were given orders (per the nurse) to "have relations" for each of the next three nights. It made me giggle every single month.

Seven days after your trigger shot, you're back in the office for bloodwork. They are now looking for your progesterone level. That indicates ovulation and your body's preparation to take on a pregnancy. Because this had been an issue for me in previous pregnancies, they were watching these numbers closely. The first month was the only month that my progesterone was cause for concern - it indicated ovulation but was a little low for their liking so I then went on progesterone supplements.

Fourteen days after your trigger shot, you take a pregnancy test. If it's negative, you wait for your period to start and you start the process all over. My first month was a negative so we moved on to month two. And three.