Chapter 2. Cycling Hope & Heartbreak with Letrozole

Our first type of fertility treatment began September 2020 and our excitement was back to the same high like when we first started TTC (trying to conceive). Oh, I should mention, there are a lot of acronyms in the infertility world, so I'll always do my best to spell them out once. Nothing makes you feel more uneducated than getting lost in the secret code.

Even better, I'll just link a website here with a cheat sheet if you want to learn all of them! One of my personal favorites is AF, for Aunt Flo aka your period. Just keep that one in your back pocket when reading this.

Okay, back on track. The basic idea of using a fertility medication is to help your follicles grow, and most of the time there is trial and error when it comes to the dosage prescribed. Dr. started me out at the lowest dose per the protocol, at 2.5 mg. You take this on CD (cycle day) 3-7 with the hope of stimulating those follicles to grow large enough to ovulate. The second part of the protocol is getting your progesterone checked on CD 21, which is a standard day for all patients because typically you'll have ovulated by then if the dosage worked. I'll be done with the science now, because this is all about my experience and feelings while doing these treatments.

Our first cycle excitement dimmed when the blood results came back. No ovulation. We had to wait until CD 35 for AF plus solidify it with a negative pregnancy test. The most awful combination in my opinion.

Dr. increased the dosage to 5 mg/day, and I repeated the lab and waited for the results. Again, no ovulation, AF, BFN (big fat negative). And the next month, same thing. At this point, it was after Christmas and we had officially reached a year of TTC. It was bittersweet, because all we really wanted was a baby, nothing else.

I wish I could remember exactly how I was feeling in these moments, but I know I was starting to lose hope. I struggled to understand why it wasn't our time yet. Dillon on the other hand wasn't worried, and quickly became my sounding board and rock of reassurance.

We started our 4th cycle at the beginning of the new year 2021, and it felt like a new start. I don't know why when you're going through infertility you are always hyper aware of the fact that you didn't get a baby that year. The simple new year start makes you feel refreshed in a way, and you can say "maybe this is our year".

The blood results came back, and I'll remember this moment forever. I had ovulated for the first time (that I was aware of). We were so thrilled. I remember dancing around the house yelling "I ovulated!" We had definitely learned at this point you have to celebrate every little step forward, you cannot get caught up in comparing yourself to other couples. For us, ovulating was that step forward.

The chances of us getting pregnant on Letrozole with regular ovulation brought us up to a normal ovulatory females chances, about 25%. It felt so good to know that. I felt normal.

But January wasn't our month either, and we were surprisingly okay with that. We felt confident that this treatment could work for us at some point, and at least I had ovulated.

So we continued the same dose the next cycle, and again got the news that I ovulated. Skipping forward to March 2021, we were on our 7th cycle, with 2 successful ovulatory cycles under our belt. The end of March came, and it turned out to be successful ovulation, but again, AF came and the BFN crushed my soul. It's one thing to get AF, but to see the negative test makes it really real that it failed again. It's just a big slap in the face.

At this point, we were wondering if there was anything else we could do. I asked my Dr. for her thoughts, and the nurse called me immediately to explain one option we hadn't tried yet. The trigger shot.

To me, the trigger shot sounded scary, so I was really skeptical. Once she explained it though, I was immediately sold. The trigger shot is often paired with fertility medication like Letrozole and Clomid to help the ovary release the follicle at a more specific time. This makes timing everything that much easier because the HCG trigger shot essentially prompts the ovulation. With this, you have to get ultrasounds to monitor the growth of the follicles so they give you the trigger shot at the right time.

Let me pause here, because up until now I haven't mentioned how much of a stickler I was when it came to any unnecessary appointments and treatments. The money was the first thing I would think of, especially when it came to ultrasounds. And some cycles, I had to do more than one ultrasound within a couple days of each other. Thank goodness for good health insurance, but it still wasn't cheap.

It finally came time to get my first trigger shot, and I was so excited. They had visualized a few follicles that were the appropriate size, and lined up for me to get the shot later that day. After you get the shot, you have a window of 24-36 hours give or take where you can expect to ovulate. But sure enough, the end of my cycle came and so did AF and the BFN.

We got back up, and tried again, and again. After 9 total cycles with the last 6 being ovulatory, and the last 3 with trigger shots, we were ready to give up on Letrozole. They often only give you 4-6 ovulatory cycles total because after that you're not likely going to get pregnant with that treatment.

This was a pivotal moment in our story, because I still felt in my gut that we could get pregnant with Letrozole. Perhaps we hadn't timed it perfectly, or there was something I could have done differently. But there wasn't, and we had to accept it and move on. At this point, I had basically become a monster, and was not myself at all.

I'll never forget one night we were making dinner, and Dillon said something that I got annoyed with and I went OFF. I've never yelled at him or even really fought about something for that matter. He sat quietly and let me explode, and I took my dinner out to the garage and sat in my car and sobbed. I did not recognize this person, and neither did he. I put myself in a time out and took a little time to cool off.

I dragged my sorry butt back into the house, and he just hugged me. I continued to ball my eyes out and apologize. It was literally at that moment we realized we needed to stop the fertility medication. Not that the meds themselves turned me into a monster, but the perfect timing of everything and ovulation makes you go crazy when it doesn't result in a pregnancy.

We were doing everything by the books, yet it still wasn't working, and that is where all my stress stemmed from. I felt like it was a very real possibility that I would never get to be a mother.

We talked about our next steps and we both felt comfortable at that point, as it had been a year and a half of TTC, that we should setup an appointment to go to a Reproductive Endocrinologist. Luckily, where we live has an amazing program that even other hospitals refer their patients to when it comes to infertility.

I called to setup an appointment well in advance because they are booked out several months. They sent me a large packet of paperwork that I completed, and eventually got it sent back. Our appointment was set for September 2021, and it was currently end of June.

The plan in the meantime was to see what my body naturally did, and take the time to learn about my cycles. Plus July was about to be a busy month with two weddings and travels, so the timing felt right. This is when I got super into how food effects your hormones, which I'll write a separate post about because it's fascinating!

I hate to abruptly end this story, but what comes next is too long to add into this one. If you or someone you know is starting Letrozole or recently diagnosed with PCOS, I'm right here for you!

Again, thanks for reading and following along. Someday I hope this can help someone out there in a similar situation, and you can learn from our story, even though it's not over yet!

Until next time,

- CC