What a weekend I have had. Friday was my appointment with my current Doctor which I made a post about. Basically, Letrozole didn’t work and I am not growing a follicle. She told me that we will try hormone replacements and that I will take estrogen from Feb 13-March 25 and on March 13 add in progesterone for 10 days.
She never really explained what this is supposed to do…what the intended outcome is. I never really feel like she explains things well and our calls are very short. She more or less just says “no that won’t work” or “this is what we will try”. From what I gathered, these hormone replacements are meant to see if we can kickstart my system into working…but she never really explained the point of it or what we will do if this does not work…
As well, it did not occur to me until I was speaking with the new doctor yesterday, but her whole approach is so bizarre. She told me that she likes to start estrogen on the 1st of the month and then add in progesterone on the 14th. But, since we are halfway through a month, I will start estrogen now and then still start the progresterone on March 15th so just have two extra weeks of estrogen…
Why can we not do it the 15th to 15th?! Why am I essentially wasting an additional two weeks? Because she just likes to start these protocols on the 1st of a month?
It feels like I am not really her priority…she is just doing things the way she normally does, and not tailoring anything to me specifically.
So, I think I am switching doctors. Yesterday (yes Sunday) I had a consult with a new doctor and he spent over an hour with me on the call. I don’t think any of my appointments with my current doctor have been over 10 minutes.
I will try to summarize everything he told me. He actually EXPLAINED things, showed me a diagram of what is likely happening in my body and answered every question I had, not to mention he brought up the fact that the estrogen protocol I am on now makes no sense and that I should just take it for the two weeks then add in the progesterone even if that means it is not starting on the 1st of the month…which makes so much sense when I think about it. I was just doing what my doctor said…but this really reminded me how important it is to ask questions, to think critically, and to not blindly do what someone says, even if they are supposed to be the expert.
He explained to me that my hypothalamus is likely suppressed. This is likely due to stress which can be mental, emotional, physical, environmental – all of it. This means that my hypothalamus is not producing GNRH, therefore not signaling my pituitary to make FSH and LH. FSH and LH are what signal the ovaries to mature a follicle and release an egg (ovulation). The egg is what creates estrogen which signals back to the hypothalamus that things are working. This has never been explained to me and even in my last post I wrote how I was a little confused at what the hormones are supposed to do, how estrogen played a role in all of this, etc.
He also explained that ultimately, these hormones are similar to birth control pill but at different dosages. I am not totally sure if what I am taking is more than a regular pill or less… Ultimately, it should induce a bleed (likely anovulatory, but my original doctor said they won’t prevent ovulation…again I am a little confused), and then I am to call his clinic on day one and go in for tests on day three.
He said that I don’t have a pituitary tumor (phew – but I still have the referral to the specialist) nor do I have PCOS (current doctor also said no PCOS). I might still need injections but he actually does do them with IUI patients. My current doctor refuses to do injections unless you are in an IVF setting because according to her, that is “how John and Kate made 8”. I told this to the new doctor and he said that is ridiculous. He uses injections with hundreds of patients each year. It does increase your chance of twins by 15-20% and each year they get a set of triplets but that is basically it. Every few years there is a case where someone gets pregnant with 4 and they have to terminate one (or more – he didn’t specify), but that is every few years and for the hundreds of women who successfully get pregnant with one baby using injections, it is a no brainer that they are useful. He could not believe that my current doctor refuses unless with IVF.
He was so thorough and I felt listened to. He said I am a high risk patient because of my history with mental illness and current anxiety and that my mental wellbeing is most important.
So where does that leave me?
- Take estrogen for 24 days and on day 14 add progesterone for 10 days
- Decrease stress – he said I absolutely have to do this to get my hypothalamus working. I have an appointment with a Naturopath who also does acupuncture on Feb 26th and he is putting me in touch with a psychologist through the clinic
- Blood tests with the new clinic on day three of my bleed after these pills which should be around March 14th (all of the hormones as well as thyroid, etc.)
- Medications if needed – either Clomid, which does the same thing as Letrozole but through a different mechanism or, more likely, the injections that will make the follicle grow the egg.
I still cannot believe how much time he spent with me. And I feel like there is a concrete plan now. These hormones will bring me to March 8th. If I need injections I am hoping we can start those later that month so that I can ACTUALLY TRY to get pregnant in April. April will be 9 months on this journey, I am already 7 months in. He said that decreasing my stress is critical to getting my body working properly…much easier said than done when you have a history of anxiety, have a very busy job, have been struggling with infertility for 7 months now, oh and there is still that global pandemic and everything is shut down and I haven’t seen a friend in months.
But I will get through this. I will ovulate and I will get pregnant. I just have to keep telling myself that and taking all of the steps necessary to get there.