Decisions, decisions

[Ladynic]

After yet another failed cycle I find myself contemplating what my plan for the next cycle is. AF will be starting today, and I feel like I wasted hundreds of dollars last cycle on ultrasounds and a trigger shot, just to get another bfn. So it was obviously not the magic solution for me. Honestly I am feeling somewhat frustrated, with both the medical profession and with my body. After some research I am convinced my hypothyroidism is the reason I haven't been getting pregnant. Which makes me angry because I feel like my RE should've told me to save my money and not bother paying $150 for a trigger shot last cycle with my thyroid levels being off. I feel angry with my body because I feel "broken", and it doesn't seem fair. I know at my age it is going to take longer to get pregnant, but my sister-in-law, who is 40, is expecting, as well as my best friend from college, who is literally a month older than me. I can't help but feel like it isn't fair that it happens for them but it isn't for me. I can't help but think that the only difference between me and them is my thyroid problem, which I didn't ask for, and didn't do anything to cause it (at least I don't think so).

I know I just need to be patient, I've only been on my increased dose for two weeks now (I've read it takes about six weeks to really improve your levels). But when you're 42 you already don't have time on your side, so waiting is extra hard. It doesn't help that I actually feel worse right now, I'm extremely wiped out and exhausted, I'm not sure why it would get worse before it gets better but it seems to be.

I've been struggling with what I should do this cycle, and I think what I'm going to do is still try (even though it hasn't been six weeks yet), but not do the monitored cycle or trigger shot, nothing expensive, because I feel like there is a very good chance that it may not work yet this month anyway (since my levels are likely not where they need to be yet). I will refill my Clomid but to me it doesn't make sense to pour in hundreds of dollars when my body may not yet be in a state to become pregnant right now. I also have wondered if I should just go without the Clomid, and try completely naturally again....not that I think it's more likely to work that way, but because I worry that taking Clomid might add extra stress to my body when it is trying to sort itself out on the new dose of thyroid medication. What do you think would be my best course of action? Also if anyone has any experience with trying to conceive with hypothyroidism and what worked / didn't work I would greatly appreciate hearing it.

[Throwaway_panther]

Do you mind sharing what your thyroid levels are? I'm hypo (no thyroid) and have a lot of experience now with it and TTC. It was even a possible red herring for my first three losses.

[atomic sagebrush]

Nic, I'm so sorry this wasn't the month. I would, just as you say, still try without the monitoring and the trigger.

Is there any way to get Femara instead? (I probably already asked you that, sorry!)

[Ladynic]

Throwaway, when I was originally diagnosed (in 2015), my TSH was 21 (so pretty bad). By May of that year (4 months later), I was down to 1.6. My regular doctor was fine with that since it was under 2, but I told him when I had my thyroid levels tested in my thirties (when I was healthy), my TSH was only 1.4, so I really felt like it would be better to get it down more, so he agreed to up my levothyroxine to 88 (from 75). By August it was at a 1.25, and I felt great. Then this past summer it tested at 1.85, which I thought was a bit more of a jump than I'd like to see, but my doctor didn't seem concerned, and I didn't want to be that annoying patient always insisting that my medication be changed. Then my RE checked it earlier this month and it had jumped up to a 2.6 (so almost a whole point in about a six month timeframe, which I was very concerned about). The RE agreed that was too high especially when ttc so he just upped my levothyroxine to 100. He is retesting my TSH as well as my free T4 after having been on it for 6 weeks (so about 4 weeks from now). In the past when my TSH has been fine, my T3 levels were good to, so i seem to be someone who does fine converting the levo to T3. I also tested negative for antibodies (so non-Hashi type of hypothyroidism). I didn't have hypo symptoms until recently, and they hadn't gotten too bad yet, so I didn't suspect my levels were off until I got my results back with my Day 3 bloodwork. I suspect that could be because of the body trying to compensate that happens at the beginning of thyroid failure. In fact, I have been feeling more intensely hypo since taking the higher dose of levothyroxine. Which is also frustrating!

Atomic thank you for the support. I am still struggling with whether I should take the Clomid again or just let my body do things naturally this cycle. I would like to try Femara also, I only was thinking about doing Clomid again since I have a refill left on it (I have a feeling if I call the RE office they will insist I do ultrasounds and the whole nine again, all of which my insurance does not cover, and all of that seems like a huge waste of money to me right now when my body may not be in the condition for a pregnancy yet). I'd rather invest in more expensive fertility treatments after I know the thyroid is not an issue anymore. That just seems to make more sense to me. In the meantime, I'll continue to eat high nutrient foods and exercise when I have the energy to (which hasn't been much lately, but I'm hoping that will change soon).

[atomic sagebrush]

The thing with Clomid is that it can raise your FSH over the course of time and make your egg quality tank. So it's not the best choice for anyone over 38ish. Not only that Femara is better, but that Clomid may be actually worse than nothing. Now, some people in this age range have successfully used it, but I feel like it may be best for you to skip it for now. IT's still seemed to have some pink effects even the month after taking it.

[Ladynic]

Atomic do you think I should just not take the Clomid this month then? I did pick it up, my reasoning was I know when the thyroid is low it can affect progesterone negatively in the luteal phase (and that was one of the problems I had when I was originally diagnosed, I was having shorter luteal phases and spotting before periods and at that time doc said my progesterone was borderline at 10.6 on 7 dpo). However, when I took Clomid last cycle my progesterone was not that much higher at 11.3 on 6 dpo, so I don't know if that helped too much. I had also only been on my higher dose of levothyroxine for about a week though also.

I did have a lot of ewcm and a good lining on the Clomid, and my FSH was 3.96 (without elevated Estradiol), if that makes any difference. However, I've read enough on here to know that you know your stuff, so if you think I shouldn't take it and just go natural this cycle, I trust you judgement!

After I get my thyroid levels tested again and they are in range or close, I do plan to continue with treatment at the RE. It just seems pointless to do that right now when I'm trying to get my thyroid levels healthy (I know hypothyroidism has a huge negative impact on fertility). I did apply to Compassionate Care and they're still reviewing my information for the treatment end of it, but I did get approved already for 25% off prescriptions, which would really help next time I do a trigger shot, or if he puts me on Femara or something else. I get the feeling his next step is going to be to try 100 mg of Clomid though. He made a comment during the CD 11 follicle scan that he "would've put me on 100 mg" had he known I was only going to produce one dominant follicle. Does Femara help you make more than one mature follicle?

[atomic sagebrush]

If your FSH is that low you can take the Clomid if you'd like to, although thyroid can cause unusually low FSH too. My gut instinct, and this really is just what my gut is telling me, is for you to have a month off the Clomid.

Femara isn't better at making more follicles but it may make whatever eggs you get better quality and thus more likely to be fertilized than the Clomid, plus it may make your EWCM better and your lining better to aid in successful conception and pregnancy.

[Ladynic]

Okay, thank you Atomic. I did think about how taking Clomid would still be an added stressor on my body while it's trying to sort itself out with the thyroid issue. Based on my CD 11 ultrasound last cycle, the RE did say I had a "beautiful" (his words) 11 mm lining and a lot of ewcm that he could see on the ultrasound when I took the Clomid, but I typically get a good amount of ewcm anyway. I don't know about the lining.

My RE wanted to try to get me to make more than one mature follicle (which didn't happen on the 50 mg of Clomid), so I'm guessing that's why he didn't put me on Femara instead. I only had 6 antrals last cycle though, which I know is common at my age, but I also read that low thryoid levels can affect AMH levels negatively, so I'm hoping that might improve a little the next time around. I doubt I'd end up with 15 or anything, but I'm eager to see if it improves at all.

[atomic sagebrush]

My concern is more that the eggs you are making are better quality, fertiizable ones and I'm worried Clomid may not be your best bet for that. One egg is enough provided it's a good one and 4 bad eggs wouldn't get you any closer to your goal anyway. Some docs don't use Femara since it was off label use but it's really come into widespread use this past year - might be worth asking about.

Lining does sound good which is good, I suspect the thyroid medication is going to help us out a lot here. FXFXFX!!