Intermenstrual Bleeding

RBC

Last month I took 50 mg of Clomid, unmonitored, on cycle days 3 through 7. I didn’t exactly expect it to work, but I had an extra script lying around and figured, meh, why not? While the Clomid failed to help to get me pregnant, it did give me some seriously painful cysts. I then had a particularly hellish period and figured that was the end of it.

Except that it wasn’t the end of it. This current cycle that I’m in—the one following the failed Clomid attempt—I’ve had intermenstrual bleeding 13 out of the 19 days since my period ended. If you’re wondering what intermenstrual bleeding is, because I’d never heard of it until this week myself, it’s “Vaginal bleeding that occurs between a woman’s monthly menstrual periods.” The causes of it can range from the benign to the frightening (thank you, Dr. Google). Every website I visited on the topic said that IM bleeding should be evaluated ASAP.

{{TMI WARNING!}}  My IM bleeding ranged from both bright and deep red to various shades of brown to nearly black, and was accompanied by both small, dense clots and large, goopy clots. Yuck fest. I ovulated super early on CD 12, and then the IM bleeding picked up serious speed: as in, I just kept bleeding and bleeding and bleeding… but it was definitely not a period. The bleeding became like whoa heavier after sex. I eventually began to avoid sex altogether because, aside from Carrie-esque blood everywhere, intercourse was also painful. To top things off, the bleeding would intensify after—errrm—using the restroom, in which case streams of blood and clots would flow for hours afterward. Scary stuff for anyone, especially for a gal who’s had two ovarian cancer scares in the past. Okay, TMI session over.

Completely freaked out and not knowing who else to call, I emailed my RE, Dr. C. Within minutes of my email, the clinic called me to book a scan and blood work for the very next morning. Bonus awesomeness points to Dr. C! Not that he really needed any more awesomeness points: the man is a medical rock star.

Fortunately, my scan was overall normal. The cysts were gone. Dr. C did point out a couple pools of blood on the u/s screen that shouldn’t be there, but I never did get the location of where the blood was pooling. His take was that I either had a cervical infection or an ectopic pregnancy due in part to the Clomid. So, yeah: maybe something minor or maybe something completely terrifying! The results of my blood work would be what would solve this mystery. My blood was drawn and I was released to spend the rest of the day awaiting the results.

It’s been over 3 months since I’ve had the pleasure of awaiting an important results call from the clinic. Sheesh, did I ever not miss that feeling: carrying my cellphone everywhere, even to the bathroom, so I wouldn’t miss the call. Obsessively checking my phone for missed calls in case it magically turned itself to silent mode. Staring at—but not having any appetite for—lunch due to frayed nerves. You guys know what I’m talking about… I was a nervous wreck at work waiting for the clinic to call. Luckily I was able to wring my hands in relative privacy by closing my office door and only speaking to Boss when needed. Some days it pays to be queen, or, at least, female. Boss senses when I’m having medical girl issues and gives me a wide berth.

After what seemed like an eternity, the nurse called with my results. And much like the ultrasound, my blood work was also normal. So, no weird hormonal changes, no infection, and no ectopic. Confusing, right?

The consensus was that I should begin taking medroxyprogesterone, a/k/a Provera, to induce a [real] period.  I didn’t get much of an explanation about why I’m taking Provera, but I think it’s supposed to help reset my natural cycle. I’ve only just begun taking it and so I have no way of knowing yet how it will affect me, nor do I know if it’s supposed to make me start bleeding or stop bleeding. Does anyone have experience with this drug?

I really want to blame all this craziness on the Clomid, but I can’t prove that it’s the cause of things. Either way, I’m staying faaaaar away from that stuff from now on. If the Provera resets my cycle and I have no more IM bleeding, then good. If the IM bleeding continues, I’ll need a referral from Dr. C for more comprehensive testing. Praying that this medicine will take care of things.

Update to follow.

 

 

 

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The Meeting (and the due date)

About six weeks ago, Dr. C left me a voicemail: “I’m really disappointed to hear about how things went this cycle. Let’s chat,” he said. I’m pretty sure this was code for the fertility blogger’s infamous “WTH meeting” I read about from time to time (and that’s “What-The-Heck” in case you’re wondering. No swearing here!). I never wanted to go to one of those. So I did what I do best and put it off.

After several weeks of dragging my feet, I finally I got around to calling the clinic back. Even then I took my sweet time, scheduling the meeting out weeks in advance. I wasn’t alone in not wanting to go: Jake sure didn’t, either. He saw no point in meeting with Dr. C, and I understood his feelings. I had this mental image of us walking the walk of shame down the hallway to Dr. C’s office, passing by all the staff who would give us pitying looks because they knew why we were there.

Of course, it went nothing at all like that. Jake eventually warmed up too, and in the end he told me the meeting was actually worth having.

Even though we covered a lot of ground during our 30 minutes, it also felt like we didn’t really get anywhere. I asked Dr. C every single question I’d had during the past nine months. He graciously took the time to answer each and every one. Toward the end of the meeting Dr. C said that, even though I’d given him quite a workout, he appreciated patients like me who come in armed and ready. He also half-jokingly offered me a job in his practice.

drfake3
Stock photos lie. This is not how a WTH meeting looks.

Since you guys know how much I love lists, here’s the highlights:

AMH/DOR/Egg Quantity: My AMH was 0.62 a year ago. I had another AMH panel drawn during my WTH visit. The results will take several days to come in.  Last year, Dr. C conservatively figured that my low AMH could’ve been due to my having one ovary. This year he changed his opinion and said that my score wouldn’t have made a difference, because whether I had one, two, or three ovaries (who has 3 ovaries????), DOR is DOR is DOR.

Egg Quality: Besides my low egg reserve, there’s also a quality issue of my remaining eggs. I again declined Dr. C’s suggestion of using donor eggs. It’s important to me to be biologically related to our child, and using donor gametes goes against my beliefs. After the meeting, this whole egg quality thing had me feeling pretty bad about myself: Did my “bad eggs” make me directly responsible for all our losses? I’m only 34. Aren’t donor eggs something for older women? Why is this even something a doctor is talking to me about?

Pelvic Adhesive Disease: Dr. C kept throwing this term into my diagnoses until finally I had to ask what exactly pelvic adhesive disease is. Here’s the lowdown: Endo adheres your insides together. After surgery to remove the endo adhesions, new scar tissue forms from removal of the endo adhesions themselves. This new scar tissue adheres your insides together yet again, resulting in PAD. It’s like an ever-spinning wheel of adhesive insanity! Of course Dr. C couldn’t prove it diagnostically at our meeting, but the fact that my ovary hurts, oh I don’t know, ALL THE FREAKING TIME makes him think PAD is a culprit, along with recurring endo. Hooray.

Laparoscopy: It makes sense to me—and I said so, too, bluntly—that all this IVF/ART business is like putting a band-aid on a gunshot wound. As long we ignore the endometriosis factor then we’re not really treating my fertility issues, we’re just trying sneaky backdoor methods to get me knocked up. Since IVF is tabled for now (donations welcome!), Dr. C gave me a referral to a local gyn surgeon he highly recommended. This would be my fifth surgery and third laparoscopy. It might seem counterintuitive to have surgery because of the whole PAD thing, but surgery is the option I’m most in favor of. Jake and I have a lot of discussing to do before I make the final decision, since there’s a few things going on in our personal lives with work, school, moving, etc. that might make having a lap a bit tricky right now. We will see. And, of course, I’ll let you guys know!

IUI: I’d always been told that IUI for endo patients is a total waste of time and money. However, Dr. C feels that that’s not necessarily true if the IUI is done soon after a lap. In that case, the endo is gone so it’s no longer a factor. Until we’re able to do another IVF, Dr. C suggested Clomid IUIs with injectables following the lap. It seems like we’d be going backward to move from IUI to IVF back to IUI.  I’m 50/50 about this option, but leaning more toward “no.”

Implantation Issues: This one’s a biggie. Since no one can see implantation happening (or not happening), it remains this mysterious, elusive, intangible thing for doctors. I  walked away from the meeting feeling like I didn’t get a lot of answers about possible implantation issues, as Dr. C couldn’t offer any real solutions. After three losses, Dr. C feels that implantation is definitely a factor to investigate… somehow. But there’s not much to be done diagnostically that I haven’t already done. Basically, the implantation issue went nowhere and I’m not thrilled about that. To be revisited.

MTHFR: Along those lines, we reviewed my RPL panel and Dr. C espoused how unremarkable it was. Here’s where I could use some serious input from you guys: When I asked Dr. C why he didn’t include testing for MTHFR on the panel, his response was (literally), “It doesn’t really make a difference.” This didn’t sit well with me. That can’t be true, right?! Anyone? I mean, there’s entire websites dedicated to MTHFR. I really, really wish that REs took RI more seriously. It’s to their patients’ detriment that they don’t.

Scratching the Itch: Last year I had asked for an endometrial scratch prior to starting IVF. Science is iffy about whether ES helps prime the uterus for an embryo, but it certainly doesn’t hurt (scratch that, it does hurt, physically, a lot. Pun intended) to have the procedure done anyway. He wasn’t opposed to it last year, but Dr. C eventually talked me out of having it done. During our meeting, though, he recommended I have an ES done prior to doing IVF again… You can’t even begin to know the depths of my frustration when I reminded him that I’d asked for an ES last year and we didn’t do one!

The Miscarriages/RPL:  All Dr. C could tell us was that m/c #2 was likely due to an abnormal embryo, and that m/c #3 could have been another abnormal embryo or an implantation issue alone or both. We did ICSI last time around, but not PGS. Dr. C recommends PGS for any future IVFs. I have reservations about the reliability of PGS and I don’t believe it doesn’t harm embryos (science says so, too!), plus I have moral issues about destroying embryos that don’t pass the PGS test. This is one thing I’m really firm on. Since I never had any miscarried embryos to biopsy, there’s no telling. Again, a more thorough RPL panel might have helped here… Maybe one that included MTHFR.

Okay, wow, now that I’ve written it all out it seems pretty clear to me that we need to get a second opinion (or a fourth, really). Dr. C is the third reproductive endocrinologist that I’ve treated with, but I’m not so dedicated to the practice that I won’t get another opinion. REs don’t know how a patient will respond to IVF the first time, and it can take a few cycles to get the right protocol down; I totally get that. I guess the whole purpose of a WTH meeting is to go over things, try to come up with what went wrong, and make plans to change what needs to be changed the next time around.

With that said, I’ve looked into RI treatment with Dr. Braverman. I even went so far as to start dialing his number for the free consultation. I mean, logistically it’s somewhat doable: Braverman’s office is only 2 hours away. Boss would even work with me for all the time I’d need to miss from work. There’s a semi-local clinic where I could be seen for non-NY appointments. But, it’s all so stupidly expensive and my insurance covers none of it. Another door closes.

With no real solutions, I feel I’ve basically said nothing this entire post up ’til now… except for a whole lot of “maybe’s” and “I don’t know.” Which is pretty much how I feel about things too: maybe this, maybe that, and I just don’t know.


 

Finally, it wouldn’t be right for me to end this post without making mention of my due date… well, one of them anyway. I’ve added the due date to all the other tough moments of being in the fertility trenches. I like to think of them as a collection of battle scars. As scars become layered on top of each other, they form a thick skin. And a thick skins helps us toughen up and soldier on, even when our insides are all soft and battle-weary.

June 9, 2016 would’ve should’ve been my due date for pregnancy #2. Instead of a baby on June 9, I got my period. Seriously. Jake sent me a beautiful bouquet of flowers at work that day to let me know he didn’t forget either, which meant so much to my heart. I think about it every single day and I will always hold a special place in my heart for the little person who should be here with us now, but is in Heaven instead. I love you, S.W., and You Are Missed.

In S.W.’s memory, this charm hangs from my rearview mirror, for when I look back while still moving forward.

mcheart

  Peace.