Last week marked the start of our 12th month TTC. It was the first time in a long time that I was actually excited for a new cycle to begin…because it means that we get to attempt our first IUI (intrauterine insemination) this month!
I called my reproductive endocrinologist (RE) the day my period started and scheduled an ultrasound for cycle day (CD) 3. At this appointment they checked my uterine lining to making sure it was thinning appropriately (it was), my ovaries to make sure there were no cysts (there weren’t), and drew blood to make sure my progesterone and estrogen levels were appropriately low for this part of the cycle (they were).
Since I cleared the preliminary tests with flying colors, I was given a prescription for Femara (letrozole) – 2 pills (5mg) once daily for CD’s 3-7. Femara is typically prescribed for post-menopausal women with breast cancer, so it sounds super strange to use this medication for fertility (and it is technically an off-label use of the medication) but it’s become fairly commonplace for use in fertility treatments over the past few years due to the fact that it suppresses estrogen production and thereby tricks the body into producing high levels of follicle stimulating hormone (FSH) which encourages your eggs to develop a bit faster. Femara is used a lot for women who aren’t ovulating on their own. Though I do ovulate each month on my own, I have a left unicornuate uterus which means I can only conceive on the months I ovulate from my left ovary. That said, we’re hoping Femara increases my egg production to the point that I produce at least one good follicle on each ovary so I have the possibility of conceiving with greater frequency. Cool, huh?!
I’m on CD6 now, so have just one more day’s worth of Femara to take. This morning I woke up with some lower back achiness, which I understand can be a side effect of Femara. I haven’t had any other symptoms thus far. The achiness is significantly more prominent on my left side, so I’m naively hoping and praying that it means my left ovary is cranking out a nice egg, ha!
I have my next ultrasound next Saturday (CD12) to check out my ovaries and follicle(s) size. It’s a general rule of thumb that your follicle(s) should reach around 20mm in size by the day you ovulate, so we want to see some juicy ones hanging out in there on Saturday. If there are any mature follicles in my left ovary on Saturday, they’ll trigger ovulation with Ovidrel and I’ll come back 24-36 hours later to do the IUI. If there is a very-close-to-mature follicle in my left ovary, they might have me wait another day or two to trigger ovulation, then schedule the IUI for 24-36 hours post-trigger shot. My doctor also ordered me a daily estrogen and progesterone supplement to take post-IUI to encourage implantation. He also ordered me an hCG shot, and as of this moment it’s unclear whether he plans to administer the hCG shot before or after my IUI. I was curious about the hCG trigger, as it’s common to give a shot of hCG prior to the IUI, but this article talks about the significant increase in IUI success with post-IUI administration (19.6% success with post-IUI administration vs 10.9% with pre-IUI administration), so needless to say I will advocate for a post-IUI hCG shot.
At my CD3 ultrasound my RE’s nurse did tell me that I shouldn’t make any drastic changes to my normal routine over this cycle, which intuitively makes sense; introducing new variables into your routine could alter your normal cycle, hormonal balance, etc. I have a feeling that this week leading up to my CD12 ultrasound will move at a snail pace because I am just SO EXCITED. Until then, I’ll just be over here taking good care of myself…eating well, exercising and getting fresh air, praying fervently, and trying to relax as much as possible.