... to discuss an entirely different one: Infertility 2.0.
You know how I've been thinking I've been ovulating a bit later in my cycle, based on OPKs? Well, yesterday was CD23, and while I'd thought I'd O-ed on CD18, I was having some symptoms that made me suspicious, so I used another OPK.
Positive, on CD23, six days after a positive on CD18. Or, at least, what I *thought* were positives. Of course, I immediately thought, what if I'm pregnant, and the OPKs are picking up the hCG instead? Well, that turned out not to be the case, so I tried again today, with a different brand of OPK I had lying around. This one was negative, but middling negative, not what you ought to see the day after your LH surge, or a week after it.
So, of course, the next thing I did was to pick up the phone and call my clinic's head nurse, better known to me as Mom. (It's so helpful sometimes, having a mom with 20-plus years as an RE nurse...)
My mother said that 1) Answer brand OPKs (the cheap 20-pack you can get at Walgreens) suck -- their patients get more false positives and false negatives with those than any other brand. They recommend ClearBlue. 2) if they were legitimate readings, not stick errors (which the middling negative I got today supports), something's not right.
Mom says that late ovulation is usually bad news. If I'm really legitimately ovulating today, on CD24, the egg is probably not going to be very good quality -- long cycles, with long periods of hormone activity, cause them not to mature very well. On the other hand, if I ovulated on CD18, it might not have been a very "good" ovulation either. Even if a follicle released an egg of OK quality, I may not be producing enough progesterone, or there may be something else wacky with my LH/FSH.
If it's just the one wonky cycle, OK, fine, that's how they go sometimes. However, it also calls into question the legitimacy of all those other "ovulatory" cycles. This one isn't especially different -- I just happened to retest even though I thought I'd already ovulated.
My mom said, maybe you just need a little bit of Clomid. Now, Clomid and letrozole both were complete failures for me the last time around, but things are at least somewhat different now. I'm having regular cycles, and there's some kind of ovulatory activity working, even if it isn't completely right. There's reason to think it's a reasonable option.
I went into the clinic for a progesterone level today. If I did O last week, it'll be elevated, though possibly not enough to sustain a pregnancy. If I didn't, it'll be negative, and we'll recheck in a week to see if I'm ovulating today. Either way, it's time to at least think about doing some monitoring next cycle. After that, who knows?
I dislike the thought of Clomid. I didn't enjoy it the last time around, and I'm unhappy at the idea it might have come to this. We'd talked about how, if we need more aggressive treatment, we'd wait a while, maybe a year. We know that ART comes with downsides for us, namely high risks of OHSS and multiples, and we haven't yet sorted out whether we'd try another IUI cycle or head directly to IVF. And now, we're talking about starting up the "gateway drug". If Clomid doesn't work, will we be able to say, no, let's sit on it for a while before deciding to move down the path?
Lots of questions, and not a lot of answers today.