“Honey, with all due respect, this ain’t my first rodeo. That wand has massaged my ovaries more times than my husband has massaged my back.”
That was my response to the ultrasound technician a few months back when we started back at the fertility clinic. Don’t worry, it was said with good-humour – they way I’ve embraced this entire journey. I asked her to confirm if what I was reading was correct: “So, I have an AFC of 11, down from my last results. You saw 5 follicles on the left side and 6 on the right”.
She was shocked that I knew what I was talking about and stumbled with her response. “Ahhhhhh, I don’t remember what they were.”
While her work was as magical as having a wand up my yahoo could be she has a wee bit of polishing to do with her responses when there are educated patients.
We’ve been at the fertility clinic for the last few years. We were originally referred as I had 3 unexplained miscarriages at 7, 11 and 6 weeks. My last miscarriage was in September 2011. Since then we have not been able to get pregnant.
I haven’t fretted about not being able to conceive. My mantra is happiness is a way of travel, not a destination. I love our life. It’s as near perfect as I ever imagined it could be. Our marriage is easy. We’ve given The Beast a stable home with nature at our doorstep and have been able to provide her with the care and attention she needs. My career is one where I get to learn from amazing people every day. I get to give back to my community and help those in need. I really don’t have anything to complain about.
This September I scheduled an appointment with my fertility specialist, Dr. Claman at the Ottawa Fertility Clinic. He’s a straight shooter, non-BS type and I very much appreciate that about him. He ends every visit with “I hope the next call from you is telling me you’re pregnant.” I wanted to get a sense of if and how my body has changed. In a couple of months I will be 38 years old, an age where your chances of conceiving are already diminished.
Our first tests back were the standard blood work to test hormone levels and an internal ultrasound. The first ultrasound was to check my Antral Follicle Count (AFC). Those are the results I read back to the technician.
My follow-up visit with Dr. Claman confirmed what I had read. My follicle count had dropped slightly. He explained that these tests could reveal results one day that differ the following day. It wasn’t that big of a deal and not to worry.
The news wasn’t all that bad. I still had active follicles. To put things in context, the normal range for AFC is 22 – 35. My count sat at 11. As described by the Advance Fertility Center of Chicago, a range of 9 – 13 antral follicles is a “Somewhat reduced count [with] slight to moderate reduction in chances for pregnancy success as a group.”
At this same appointment we decided on next steps. As I would still like to try to conceive naturally (I’m not sure if I will try IUI or IFV at this point) I would go on Femera. This drug is commonly used to treat breast cancer patients, however, has been proven to stimulate ovulation in those with unexplained fertility. It is similar to Clomid with fewer side effects. My ovulation pattern would be measured through more blood work and ultrasounds.
Dr. Claman walked me through things. “Taking this drug increases your chances of multiples.” Got it. Sixty seconds later: “So what does this drug do?”
“Gives you hot flashes?”
Don’t worry, I always nailed the re-write exam in school.
Following a good laugh – Claman less amused than me – he carried on. I had to sign some papers acknowledging the increased chance of multiples, he gave me my prescription and ended our appointment with “I do hope your next call to me is to say you’re pregnant”.
Femera is started on Day 3 of your cycle. I could have sworn he said Day 5 so when I picked up my prescription on Day 4 and talked to the pharmacist, the window had passed. I really need to start writing these things down. November it was then!
With my prescription filled I was ready to go. My annual trip to the Royal Winter Fair was the first weekend of November and according to my schedule, my period was due to arrive when I got home. So I left the Femera at home on my vanity. Of course my period had other plans for me. It decided to join me that first day in Toronto. A call to hubs and we determined that to get the drugs shipped to me on a Friday at 3:00 was unrealistic. We would wait until the next month to start.
Fast forward to December and I am at 24h Tremblant. This time I am ready for whatever my monthly decides to throw at me. And a curve ball it was. Fanny arrived early again. Day 3 came and I took the first one. No side effects at all. I was shocked. That was until I awoke the next morning.
Day 2 brought hot flashes like I was hanging over the flames of hell. I have never, ever been so gawd damn hot in my life. Even if I were a greek goddess with beautiful men fanning me with palm tree leaves no relief would have been provided. In fact, I’m sure it would have made it worse. Mmmmmm. Greek gods. Sorry. I digress.
I was covered in a film of sweat. I know, hawt, right? Did you know your legs can sweat when you’re lying naked on the bed doing absolutely nothing at all? How the hell was I going to make it through the rest of the days like this? Thankfully Days 3, 4 and 5 were back to 37º C or 98.6°F aka normal body temperatures.
When you go on these drugs you have two ultrasounds in that first month. One on Day 10 of your cycle and one on Day 19. Day 10 determines if the drugs are doing what they’re supposed – helping to produce healthy eggs. Day 19 is to monitor that the egg actually released.
At my first ultrasound the technician confirmed I had one big healthy egg. “Go!” she excitedly proclaimed. I had a little less enthusiasm. Yes, it was great that the drugs were working but having 3 unexplained miscarriages, I needed to know everything was working. So I didn’t run home and jump my husband like I was instructed to do. Who follows the rules, anyway?!
I received good news on Day 19 – the egg had been released. All my lady bits were doing their thing.
My follow-up appointment for this round of testing was just last week. While I am still positive, it was less than stellar. I have AMA or Advanced Maternal Age. Which by the way I hate the name. “Advanced Maternal Age”? Sounds like my grandmother not the zippy 28 year old I will always be. No one needs to know the truth. This is commonly referred to as low-egg reserve. My FSH (Follicle Stimulating Hormone) level is high indicating a reduced ovarian reserve. Again, the Advanced Fertility Clinic Centre of Chicago summarizes in laymen’s terms:
Both FSH and LH hormone are produced by the pituitary gland at the base of the brain. When a women goes into menopause she is running out of eggs in her ovaries. The brain senses that there is a low estrogen environment – and signals the pituitary to make more FSH hormone. More FSH is released from the pituitary in an attempt to stimulate the ovaries to produce a good follicle and estrogen hormone.
Think of it like stepping on the gas pedal in the car to get going. The FSH is the gas, and the pituitary gland releases FSH to get a follicle “going” at the beginning of every menstrual cycle. If there are less follicles left (and perhaps lower quality follicles) the amount of “gas” has to be increased to get a follicle developing.
In a menopausal woman, the gas pedal is on the floor for the rest of her life – even though there are no follicles (or eggs) left. The woman’s body never gives up trying – FSH levels are permanently elevated.
Women in menopause have high FSH hormone levels – above 40 mIU/ml. As women approach menopause their baseline FSH levels (day 3 of their cycle) will tend to gradually increase over the years. When they run out of follicles capable of responding, their FSH will be high and they stop having periods.
“Sarah, I really hope your next call to me is to tell me you’re pregnant. I’m thinking about you.”
Where does that leave us? I have a six month prescription for Femara. That’s about my run way. If there’s ever a time to use the Mobile Mom Ovulation Calculator app and schedule some time for booty calls, it’s now.
So, excuse my while we turn into rabbits for the next six months.
Photo source. Used with permission.10