Round 1: Infertility Treatments

My husband and I met with our reproductive endocrinologist (RE) last week on Friday. We had completed all of our testing prior to the visit, and it was cycle day 1 (CD#) for me, so we were optimistic that we would be able to start something that day. My husband has male factor infertility (low morphology) and I have ovulatory dysfunctional uterine bleeding. I had been doing a lot of reading prior to the visit to see what our options were. There wasn’t a lot of information about my problem, just to try ovulation drugs. The research on low morphology is conflicting, with some papers concluding that the only option is IVF with ICSI and others saying that there is no different in success rates for intrauterine insemination (IUI) with low morphology. (Lockwood et al, Andrology, 2015; Deveneau et al, Fertility and Sterility, 2014)

Our RE gave us a few different treatment options:

1.     timed intercourse and progesterone supplements after ovulation

2.     timed intercourse and ovulation stimulating drugs +/- progesterone supplements

3.     IUI and ovulation stimulating drugs +/- progesterone supplements

4.     IVF with ICSI

She thought the progesterone supplements might help my bleeding, but since my progesterone levels are normal there was no guarantee that would work. The ovulation stimulating drugs should stimulate a “stronger” ovulation which could be enough to stop the bleeding, but if it wasn’t I could add progesterone the next cycle. IUI would increase the chances of success with the drugs. IVF with ICSI would be the most aggressive option, the most likely to have success, but also significantly more expensive than the other options. Our RE did not pressure us to pick IVF and she emphasized that any of the options had a chance of working and that it was up to us to decide how aggressive we wanted to be.

After a year of failed cycles, my husband and I are tired of waiting for a baby. We are not ready to invest tens of thousands of dollars in IVF, but we were looking for a slightly more aggressive approach, so we decided on option 3. Since it was CD1 and all our testing is done, the RE wrote a prescription and we set up the IUI cycle. I would take 50mg Clomid for CDs 3-7, use ovulation prediction kits (opk) starting on CD9, and have monitoring ultrasounds starting on CD12 to make sure I didn’t have too many follicles developing. When I got a positive opk I would call the office and the next day my husband and I would go in for the IUI. It would be hard to fit the IUI in with our schedules, but we would make it work.

I picked up the Clomid from the pharmacy on CD2. The pharmacist went over all the not so scary sounding side effects (hot flashes, headache, dizziness, light sensitivity, breast tenderness) and the scary sounding side effects (vision changes which could be permanent, multiples, thinning vaginal lining). I paid $40 for my 5 pills since infertility treatment is not covered by provincial health care, my work health insurance of my husband’s work health insurance.

Day 1 of clomid: Within 2 hours my head started to feel “off”. It wasn’t exactly a headache and I wasn’t dizzy, but my head just didn’t feel right.

Day 2 of clomid: My “off” head had progressed to a full on headache. Advil helped, but it didn’t go away completely. I had some cramping and nausea and noticed light sensitivity at work. I also had my first hot flash which involved this conversation with my husband

H – you’re hot

Me – Umm, thank you?

H – no, I meant you feel hot

Me – I think I’m having a hot flash

A few minutes later

Me – I’m definitely having a hot flash

On Day 2 I noticed I was hungry all the time. Luckily I carry lots of snacks in case of getting stuck at work late because of bad traffic.

Day 3 of clomid: This day was rough. My headache was constant. I had some dizziness. If I moved my head too quickly I needed a moment to stabilize. Cramps, another hot flash. There is this long hallway at work that leads to a facility I do research in and it was no windows, white walls, white floor and bright fluorescent lights. I could barely walk down this hallway the light was so harsh on my eyes. I just generally felt like shit on day 3. I had RAGE on day 3. It started when I was in the shower. I was upset that I had to go through all this to have a baby and I started to resent my husband because all he has to do is provide a sperm sample, which I get to have cramps and headaches and dizziness, and why couldn’t he at least wash the damn dishes. By the time I got out of the shower I was in RAGING. I rage-cleaned the kitchen and washed all the damn dishes and yelled a bunch, then fell into bed sobbing and begging my husband not to make me take more clomid.

Day 4 of clomid: I woke up with a headache (surprise!. . . not) and was really dizzy. The idea of commuting to work, working all day, and commuting home was just . . . I just couldn’t do it. I worked from home this day. Despite begging not to have to take clomid again the night before, I took my next pill. As much as I didn’t want to, as much as I absolutely hate how it makes me feel, I want a baby so bad and if this little pill is going to give me a shot at having one, I’d suffer through. The headache and dizziness got better with more sleep, and although I was uncomfortable with cramps and killer nausea after my husband burnt some toast, I made it through.

Day 5 of clomid: More of the same. Cramps/bloating, nausea, light sensitivity in that one hallway at work, dizziness, hot flashes, headache.

Day 1 off clomid: Symptoms hadn’t gone away. I had to work in containment this day, and that was really difficult with all the PPE and hot flashes. If this cycle doesn’t work, I’m going to have trouble continuing my work in containment during the clomid phase of my cycle. I had a work event with free alcohol but couldn’t partake because my head was killing me.

Day 2 off clomid: Headache is starting to fade. Dizziness is getting better. I had been avoiding yoga class while on clomid because of the dizziness, but thought I might go today. I did a practice down-dog and it didn’t go well, so I didn’t go. My biggest symptom now is cramps/bloating from my ovaries. I don’t normally have bloating and it’s a weird feeling.

And now I wait for my follicle scan to see how I responded to the Clomid.