If you haven’t read the first part of our infertility story, you can do so HERE.
Time for Professional Help
In the summer of 2018, it was time to seek help with our fertility journey. I knew about the Creighton Model System of fertility charting and NaPro Technology – but of course I just knew surface information. My first question was if Tricare military insurance would cover NaPro treatment. I started my sleuthing on that front and also began searching the NaPro hashtag (#naprotechnology) on Instagram for encouragement.
It was through social media, of all places, that I found my infertility tribe. I began following several people who had used NaPro for their fertility issues, several of whom had been infertile, adopted, and then ended up getting pregnant! I loved reading about their hope and success stories.
Through Instagram I also found Holly, who would become my FertilityCare Practitioner (Creighton charting instructor). Ironically, she is located in Texas and works at the NaPro doctor’s office, Dr. J, that is less than 10 minutes from my parents’ house! (This is the same “Dr. J” that Daisy refers to in her posts.) Holly works with clients both in the NaPro office and long-distance, and I was so thankful that she took me on even with my crazy time difference being in Germany!
Starting Creighton Fertility Charting
I had a free trial consultation with Holly in June 2018 to see if she’d be a good fit. She was, and I signed up for classes, she mailed my Creighton charting materials, and we had our first class on July 25. I was incredibly nervous! It almost felt like I was back in nursing school and I was going to get graded or judged for mistakes on my fertility chart.
However, all my anxieties and fear were for nothing. Holly is an amazing lady and we’re so blessed to have her on our fertility team, and I can call her one of my friends now, too. Our first meeting put my nervousness at ease. I also had email access to her in between classes. I was self-taught with the Sympto-Thermal and Marquette methods, so it was great having a expert that I could consult with on my many questions! (She’s been teaching Creighton for 17 years.)
After our first class, she promised to ask Dr. J if he did long-distance medical consulting, as she was not sure. It turned out that he would do it! About a month later, I submitted my medical history for Dr. J. He wanted to see at least two full cycles of my Creighton chart before sending me for a hormone panel. Being in Germany and coordinating things long-distance was definitely a test of my patience. Had we been stateside, things would’ve moved along much quicker and easier. But, nothing could be done to change our circumstances so I just had to bear with it.
Long-Distance NaPro Technology
Eventually Dr. J and I were in email communication with each other and he evaluated my Creighton chart. In early September, he emailed me a detailed write-up of what he wanted performed, as he suspected a progesterone issue/luteal phase defect – which was probably causing my bad PMS. He gave me very specific instructions on what blood work he wanted done and when. This is something I absolutely love about NaPro! Each testing protocol is based off the individual woman’s cycle, not the “textbook” 28-day cycle and having hormone levels drawn on day 21. This assumes that every women ovulates on day 14 of her cycle every month, which is almost never consistently the case! NaPro is individualized medicine, which equals more accurate results. They also like to see trends and not just a snapshot of one day, hence the eight blood draws Dr. J wanted over the course of my next cycle.
In mid-September I began the labs through the clinic on base: several estradiol draws pre-Peak (pre-ovulation till ovulation), estradiol and progesterone post-Peak (post-ovulation), as well as thyroid, LH, FSH, and testosterone levels. Anxiously I would check my Tricare patient portal every few days to see if the results were up. Finally, the labs were finished and I sent the results to Dr. J for his opinion.
At some point during the latter part of 2018, I also came to the conclusion that I had to stop self-prescribing supplements. One of my “hobbies” had become doing research on natural remedies for infertility. I tried different protocols and supplements, all of which clearly didn’t work in bringing about pregnancy. So I made a pact with myself: I would only take supplements that either 1) were recommended by one of my healthcare team members, or that 2) made some kind of concrete positive difference in my health. Otherwise, I needed to cut out the rest for my own sanity and our budget.
Answers and Solutions for PMS
I received answers about my hormone panel in early October. While my hormone levels were essentially normal (progesterone was just slightly low), my PMS still indicated a problem. So Dr. J prescribed progesterone supplementation to treat it. By this point, I pretty much dreaded the second half of my cycle and wasn’t even worried about becoming pregnant – I just wanted to not feel like a crazy person! For seven to nine days before my period, I was wracked with PMS symptoms, mostly anxiety (sometimes debilitating), breast tenderness, irritability, headaches, bloating. I’d also sometimes get more than two days of spotting. This is not normal yet we women continue to suffer for years with this stuff!
But I had yet another hurdle to jump through. I asked the base clinic about getting this prescription, but it wasn’t possible to have a Rx filled there from a doctor back in the states. During all this time, I was on Tricare Prime, which meant that in order to get any type of care outside the clinic, I needed a referral and authorization from my primary care provider on base. I decided to change to Tricare Select so that I did not have to rely on the base clinic for authorization. It would also be easier to get NaPro treatment covered using Select.
I contemplated finding a German OB/GYN, bringing him or her the recommendation from Dr. J, and getting bio-identical progesterone prescribed through that route. But by this point, we were about a month away from traveling back to the United States to visit Mark’s family for Thanksgiving. It felt overwhelming to try finding not just a German doctor, but one who would agree to my plan. I figured that Dr. J could call in the progesterone prescription to a pharmacy in Wisconsin, and I would bring back a 3-month supply. Then I was planning on visiting my family in Texas in February for the birth of our niece. At that time I could get another refill of progesterone and diagnostics done in-person with Dr. J.
Now that we had a plan to move forward, I felt more patience. I could see the light at the end of the tunnel! I was so close to getting relief from my PMS, too. Mark and I had a wonderful and too-short visit with his family in Wisconsin for Thanksgiving, and I got my precious Rx of progesterone injections! I had enough to last me three months until I was back in the states….or so I thought.
Bio-Identical Progesterone Injections
I was so excited to get started with the shots! I instructed Mark on how to give the intramuscular injections to me and he did a fabulous job. It was great to have him involved in my care! I immediately began to feel relief for my PMS within that first cycle. (With NaPro, bio-identical progesterone is given in the luteal phase, after ovulation, to mimic the body’s natural production of the hormone. They never use synthetic progestins, which are a different chemical structure than natural progesterone and carry risks and side effects.) I still experienced some PMS about five days before my period for the first two cycles of progesterone, but by the third and fourth (spoiler alert) I was feeling almost none! Hurray!
While the progesterone was prescribed for treating PMS, I knew that a good “side effect” could be pregnancy. I really got my hopes up for that first cycle. When one is on progesterone, NaPro doctors generally like patients to test for pregnancy on Peak+12 day. (That means, 12 days past one’s peak fertile day.) This is because if one IS pregnant, they want the patient to continue on progesterone to reduce risk of miscarriage. My Peak+12 day was the day that my family arrived for Christmas in Germany. I fantasized about how we would announce our pregnancy to my family on Christmas Day, and it would be the best Christmas ever! But I also knew that if that pregnancy test was negative, at least I would have the fun distraction of my family being in town.
It turns out that the latter scenario was true. I got a BFN (big fat negative) on December 17, 2018. I had stopped obsessively testing for pregnancy because the emotions just became too hard to take monthly, and this was a bummer. But I focused on my family and we still had the most fabulous Christmas together!
My Mistake
It was the new year of 2019 and time for my second round of progesterone shots! However, to my dismay I realized that my vial of progesterone was almost gone! I couldn’t believe it – how was that true?? The Rx paper said it was a quantity of 10, so with giving three shots per cycle that meant three cycles plus one extra shot!
Embarrassingly as a nurse, I had calculated my dosages incorrectly. Dr. J wanted me to take 2 mL three times per cycle, which equaled 100 mg of progesterone. Each vial held 10 mL of progesterone – so that meant each vial contained just five dosages. I was so upset with my mistake and for not asking for additional vials at the pharmacy!
There were 4 mL left in the vial, and I needed three more injections. I called Dr. J’s nurse and asked if I should just do 1 mL (50 mg) per injection, and she said yes. At least it was better than nothing. But then the next cycle, the final one before going to Texas, I would have nothing. I ended up ordering natural progesterone cream from a UK supplement company, and used that in my post-Peak phase just to tide me over. Injections are much more effective though, and NaPro doesn’t recommend dermal progesterone. (Over time it can build up in one’s fat stores and then release at random intervals, possibly messing with ovulation.)
Going to Texas for NaPro Surgery
Finally, it was time to travel to Texas!! I was going for about five weeks. Mark wasn’t able to take time off so I went alone. Before going, I called Dr. J’s office and discussed what I was to have done while there. First we would do a follicle series, which is internal (transvaginal) ultrasounds to detect ovulation. About a week after that, I would have laparoscopic surgery to look for endometriosis, and he’d also check for uterine issues and blocked Fallopian tubes. A few months before this, my younger sister had the exact same procedure with Dr. J, and he found she had endometriosis. This meant that I was at a 7-10 times higher risk of having it than the general population. I know it sounds weird, but it made me glad because it meant possibly, finally, having a reason for our infertility.
Come back soon for Part 3 of our infertility journey and to read about my experience with NaPro Technology surgery!