Saturday, July 30, 2011

Don't read this. It's whiny.

What are you doing? I said DON'T read this!

Out of the blue, I've had a terrible day. Anytime I have a moment to myself I start crying. I don't have any medication to blame, so it's just me being a candy-ass. Although, maybe it's the $2,000 bucks in unexpected bills I've received in the last couple of days? $1,000 of yet which will probably be resolved, but that still leaves us with a chunk of change that our insurance unexpectedly did not cover missing from our "rainy day" funds. I think it's also a bit of reality setting in.

When I get in a funk like this I spend too much time on fertility treatment message boards. These do nothing to uplift my spirits and usually only remind me how awful things can go. Today one woman found out her fifth and last IVF cycle did not work. I can't even fathom having to subject yourself to this process that many times, and then for it to not work, beyond unfair. There are always a few success stories. Several first time IVFers have come forward, which you'd think would be encouraging, but it kinda feels like the chances of your cycle working are statistically decreasing.

The other thing about message boards is that they are cult-like and confusing. You need a decoder ring to interpret most of the posts. For instance, "I'm 5dp3dt and HPT is still BFN. Bhcg is not until 12dpt." In English that would be, "I'm 5 days past a 3-day embryo transfer and my home pregnancy test is still a big fat negative. My beta HCG blood test is not until 12 days post transfer." There are a bunch more acronyms some of which I still don't understand after 6 months of reading this infertility Greek. And what is with the big fat positives and big fat negatives? I only like to hear the words 'big fat' associated with my paycheck. I'm not sure why big fat is standard, but it makes me feel silly to say it.

When I first started visiting these websites, I always scoffed about how I would never be like these women, and lo, here I am. While I refrain from the big fats, I'm now officially a member of all these boards. They can be useful in getting a better idea of what things are going to be like. In fact, none of the ladies have said an IUI is just like a pap smear. In that sense, they can be useful. However, you need to be on top of your game mentally and realize that once women become pregnant they tend to drift off and leave us still-barren folk to our despair. I can't blame them. We are a pretty dreadful group. We do give each other a lot of support and "(((hugs)))", but it isn't the same as talking to people in person. If only more people would open up about it before they were cured I think it would be easier on all of us.

It is starting to become real for me. I'm taking my last "pill" on Monday and things will get real serious real fast. I have my baseline on Thursday, which I'm just now realizing is a make-or-break day. If I have any cysts, I'm done for at least another month. Boo! The birth control should resolve any that I may have had, so I have no reason to think I will have a problem. Except that in the past year everytime something "shouldn't be a problem" it's turned into a problem. Through this whole process I keep thinking the tide has to turn, but I need to come to grips with the reality that it might not. Just as I don't deserve infertility, I don't deserve IVF to work. I want it to, but it's not as if the more despondent or sad I become the better my odds are or the more deserving I become.

Well, I need to suck it up and enjoy my last weekend night before school kicks up. There will be better days, but for now I think I'll have some wine with my whine.

I told you not to read this,

Thursday, July 28, 2011


So blogging has been a super awesome experience thus far.  From people at work to Facebook friends, I've been very blessed with prayers and support.  I've also started getting a lot of questions, which I totally don't mind to answer at all.  I wouldn't blog if I didn't want to talk about it.  I'm by no means the authority on any of this stuff, but I'll happily tell ya what I do know.  So here is what I've been asked the most...

How are you doing now after your biopsy?
Well, fine now.  The second day was worse, and I took some real drugs, used my heating pad, and lazied around a bit.  Yesterday and today I've had some mild cramping off and on, but as long as I take ibuprofen I'm fine.  I don't even have to take it in the middle of the night, so it's not anything like my menstrual cramps.  I will say I'm not looking forward to having it done again if I need to go another round, but it won't stop me either.

Have you tried taking a trip/relaxing/getting drunk/standing on your head/etc. and so forth?...
Yes, all of the above and tons more. We even got a dog thinking it would be a distraction in a positive sense...No luck... So on to IVF, but I do have one awesomely cute puppy.  It was especially awesome when she cuddled with me after I was so distraught from my previous failed attempts.  It's great to have something that depends on you to keep you grounded.

Do you think it was all that gymnastics that made you infertile?
No gymnastics did not make me infertile, nor did it make me short.  I have several former teammates who are parents.  It may have made me crazy and high-strung, but not infertile.

Do you know fertility drugs will give you cancer?
     Uh, well, my doctors have told me that being infertile makes me more susceptible to ovarian cancer.  It turns out that a lot of infertile people use fertility drugs (go figure!).  There is no conclusive proof that the drugs increase your chance of cancer because you already have an increased chance of getting cancer. I really want to have a baby, so even if they had conclusive proof, I'd be taking my chances. Thanks, for thinking of me, though.
     The more you ovulate, the more your chance of cancer increases. I guess Mrs. Duggar from 20 Kids and Counting is going to live forever.  I'm hoping that I can have my babies and then get rid of my time-bomb ovaries when BJ and I are done building our family.  What I think is pretty interesting is that I'm using a lot of medications that are used to treat cancers in smaller doses. Femara, for instance, which works similarly to Clomid, is used to treat breast cancer in post-menopausal women. It is crazy how many things they can do with one drug.

I know somebody who died from an air bubble in their injection.  Be careful!
I realize this isn't a question, but hehehe!  I saw that movie, too! Um, I'm not injecting anything into any arteries or veins, nor are we talking about huge amounts of bubbles.  I'll be careful, but I'm gonna take my chances, thanks.

Is BJ going to give you your shots?
I'd say we have about as much of a chance of that happening as BJ has of getting pregnant, himself.  The man loathes all needles passionately.  I've been doing good to have him holding my hand while I've had crap steps!

MK, did you know that Clomid can make you really emotional?
Have you read my blog?

Don't you worry that your kids will have fertility problems?
All the does make me feel guilty, so I've started looking into it. The first IVF baby, Louise Brown, conceived a baby naturally and gave birth to a healthy son in 2006.  Even better, her younger sister, also born via IVF in 1982, conceived naturally and gave birth in 1999...when she was, um, I would wager that she thought she would have a fertility problem, and it didn't work out for her so much. (OOPS!) It doesn't seem like infertility is genetic, which makes obvious sense. It's an awfully hard gene to pass on since we've only had assisted reproductive technologies for 30ish years, and they've only been really successful in the past 10.

Are your kids gonna have birth defects?
I hope not. IVF babies seem to have exactly the same rate of birth defects as the naturally conceived population. There are even some studies that show a decreased rate of birth defects which makes sense.  I've been on prenatal vitamins for about a year and a half so I should have plenty of folic acid.  They have a lot more control in an IVF cycle than in a natural cycle.  They are going to hand select my best eggs and BJ's best sperm, so hopefully my child(ren) will be perfectly healthy!

So, uh, are you gonna have a ton of babies?
I don't plan to...with an IVF cycle and using two embryos, I have 60% chance of conceiving, 30% chance of having twins, 4% chance of triplets and a minuscule chance of quads or more...

Wait, how do you get triplets from two embryos?
They aren't really sure why, but IVF babies tend to become identical twins at an increased rate over the naturally conceived population.  Dr. D thinks that maybe all the catheters and adventures that IVF embryos are put through may cause a tiny bit of damage that creates a cleaving point for the embryo to splice itself, thus creating identical twins.  So triplets would be both embryos implanting and one becoming a set of identical twins...YIKES!

Do you want twins?
I'm waffling...It would be great to be one and done, but then it would also be sad to know I'll never have a newborn again.  I'm also scared of one newborn to be honest, so I can't imagine trying to care for two.  People do it all the time, so I'm sure we'd survive but it's a bit overwhelming. I also have to think that I'm already going to be a high-risk pregnancy, so twins would just be an additional risk.  After talking to another lady who just conceived twins on the same protocol as I'm going on, I was all about it. They would be so cute!  Then I met someone with twins and thought that the behemoth twin stroller was not cute at all. (I know...I never said I wasn't ridiculous!...besides I've had my eye on a really cute singleton stroller for quite a while...) I'm sure I'll even be sad over the embryo that didn't make it if I end up with a singleton, but I'll take whatever I get and probably be absolutely ecstatic.

Are you going to pick the gender/hair color/eye color/etc. of your baby?
While pre-implantation genetic diagnosis (PGD) is available it's about $5,000 per embryo. So, uh, we'll keep it as old-fashioned as possible and be surprised.  Fertile couples have used IVF to have family balancing, but that is kind of weird to me. I'm kind of disgusted that a fertile person would subject themselves to this craziness. I'm shallow enough to admit I want a blonde baby, but I think I'm gonna be alright if it doesn't happen...besides there is always hair dye...

Are you scared?
Terrified! Not of any of the procedures, but at the possibility of it not working. (Note that not being scared of procedures does not preclude me from whining about them!) The good thing is, that they will learn a ton about my reproductive issues that they just can't figure out with fertility tests and IUI's such as my egg quality.  So hopefully, Dr. D will be able to figure out what went wrong and come up with a solution for us.  But I just can't fathom that outcome right now...way too depressing.  HAPPY THOUGHTS!

What's been the weirdest thing so far?
Probably during the 2nd IUI when the nurse asked BJ if he wanted to push the plunger on the IUI catheter...BJ stuttered and said, "I've only had environmental science in college.  I'm not qualified."  I guess that isn't weird, but it was really awkward for BJ and funny to me.

Are you going to tell your kids they were conceived through IVF?
HECK YEAH!  Ya'll breeders are gonna be so jealous when your three year-old asks you where babies come from, and I will simply and truthfully tell mine from the doctor's office.  SCORE!  I don't see why not.  Maybe they'll have an inkling of an idea of how much they were loved before they were even born.

Are your kids going to be spoiled?
Have you met my parents?  I hope so.  I want nothing more than a fulfilling and enriching life with lots of opportunities for my kiddos.  However, I don't want to be "that couple" with spawn of Satan because my children are too precious to be disciplined.  They may be over-loved, but BJ and I both agree that difficulty conceiving does not excuse poor discipline on our parts.  That is the grandparents job, and I'm sure my daddy will exceed expectations!

What are you gonna do if it doesn't work?
UGH!  Take a little time to mourn. I will have actually had a miscarriage at this point, so I think I'll deserve a little time.  Figure out what we can learn from this cycle and do what my doctor says I need to do to prepare for the frozen embryo transfer (FET).  I'll be absolutely devastated, I know that much.  BJ and I'll just have to sit down, examine the facts, and decide whether to try again.  We may also start looking more seriously into adoption.  It seems a little cruel that with adoption they request that you prepare a nursery when you may not have a baby to put in it for a really long time, and I know I'm not ready for that, yet.  Hopefully we don't have to find out what I'm going to do.  Although, I have threatened to start working out again and audition with Cirque du Soleil.  I think I could be a tumbler, especially on their criss-crossing tumble tracks.  There is also medical school...who knows? Again, I hope we don't ever have to find out...

I think that covers about everything...if ya got something else, feel free to ask. The worst that is going to happen is I'll make fun of you...hehe...

Tuesday, July 26, 2011

Christmas in July!

And apparently I was naughty. :P  I still have a hard time not getting excited when I get a package, and today a very special one was delivered. Oh, my...

(All my meds for my IVF cycle!)
I am doing a Ganirelix protocol, so I'll stop taking Lo Loestrin (the pill) on 8/1 and then I'll just have to stick to my prenatal and baby aspirin for a few days.  I don't have any reason to suspect that I have a clotting disorder which is what the baby aspirin is about.  I think Dr. D figures, however, that if you are spending mega-bucks on an IVF cycle, let's not have something bad happen that a $5.00 bottle of medicine could have prevented.

Once I get the all clear from my baseline scan, BJ and I will both begin a Z-pack.  Occasionally an infertile couple will have some underlying infection that has created a problem with conception.  The antibiotic will knock that out.

Starting 8/5 I have Follistim and Menopur which are both Sub-Q injections that will go in my tummy. They will help me lay lots of eggs...we're shooting for 20!  I'll use one in the morning and the other in the evening.  I can't wait for the first time I have to excuse myself from company so I can go shoot up. "Excuse me I gotta go shoot some stim."  I would have never made a cool drug addict...

Depending on my response, about midway through my stimulation meds I'll start the Ganirelix.  This medicine prevents an early surge of luteinizing hormone which is the hormone that makes you ovulate. It is yet another sub-q injection so I'll be up to three a day!  Yippy!

The IVF coordinator and Dr. D will tell me when to trigger with my Lupron injections.  It's a series of two sub-q injections that have to be given EXACTLY 36 hours before my egg retrieval.  It's typically used to treat prostate cancer in men.  So kinda strange, but they have found it helps prevent OHSS during controlled ovarian hyperstimulations...anway, it will ripen my eggs so they are ready to become babies and halt the progression of my prostate cancer.  Two-for-one!

On the evening of my egg retrieval, I will start taking my progesterone in oil (PIO) injections which have to go in my hip, and are pretty nasty because the oil is so thick.  I'll also start wearing Vivelle patches which are estrogen supplements. (I'm not sure at this point, if I'm getting ready for gender-reassignment surgery, or pregnancy.) Those drugs are supposed to beef up my lining so that it is the consistency of peanut butter by the time I get to my transfer.  After my transfer, I'll take start taking Endometrin and Prometrium to help with my progesterone deficiency.  I'll stay on the last two until I have a negative pregnancy test (boo) or until my regular OB/GYN says I don't need it anymore at the end of my first trimester (PLEASE, PLEASE, PLEASE!).

So let's compare:

BJ's Meds (yes, those are gummy vitamins)
My 60+ needles...

Clearly, fertility treatments are sexist...

Peace, Love and Spawning

Monday, July 25, 2011

The Worst is Over?

I tell ya, between the blood letting and injecting myself with used pregnant women's pee (that is how they get HCG for my Pregnyl shots), fertility treatment is downright medieval.  Today's big adventure solidified this thought.  Dr. Lecter...I mean Dr. D told me last week that he was not even interested in the results of my endometrial biopsy, he just wanted to damage my uterus.  Apparently reproductive endocrinologists are exempt from the hippocratic oath. Seriously though, the idea is that the healing process will make my uterus that much nicer of a place for my baby blastocysts to live for 37.5 more weeks.

So this morning, around 8:15 I took my trusty old dose of 1000mg of ibuprofen.  I did find my Xanex in my hidden stash of things to save for a rainy day, so I took one of those, too. It was a good thing for me because it stopped the shuddering. 

The one positive thing is that the procedure is relatively quick.  Dr. D doesn't like to make a big production of it, so he uses tools that are less painful and does not use a tenaculum that wounds the cervix.  The quickness is the trade-off for the lidocaine, however.  I haven't had it any other way, so I can't recommend one method over the other.  Not that I would ever recommend it, period.  So, sans any numbing agents, Dr. D did his thing.  It sobered me up right quick.  So much for my xanex high. It's a bizarre and unpleasant sensation of sucking and stabbing in your nether-regions.  Your uterus becomes real unhappy real fast, so it cramps in response to the foreign objects that have invaded its territory.  Once the biopsy is taken, Dr. D used what is basically a plastic rod complete with a ruler called a uterine sound to measure my uterus.  It is how he knows how far into my uterus he'll need to put the embryos during the transfer.  This also caused a lot of cramping. :(

BJ's hand and I survived the procedure.  I have a nice bruise on my finger from where I bit it, but I'm proud to say that I did not scream or scare anybody out of the waiting room.  Even Dr. D said I did great and that this was the worst thing that was going to happen this cycle.  Coming from the man who said IUI's were just like Pap smears, I'm not putting a lot weight into that statement.  They had me remain lying, because the procedure frequently causes a vasovagal response (fainting).  I admit I was completely ok with laying low for a few minutes. 

Dr. D told me I would be "back to normal in about 15 minutes."  Dr. D is a liar. It's 5:30pm and while I'm not in severe pain at all, I'm just uncomfortable. It feels kinda like I've been punched inside my uterus. I took 800mg more of ibuprofen around 12:15 and was able to go to my meeting at work, but my uterus made sure I was constantly aware of its disgruntlement.  This evening I'm continuing my ibuprofen regimen and have added a glass of wine and a heating pad.  My golden retriever puppy and I are having a lazy evening on the couch.  
This =
happier MK and Emma Grace.
BJ and I spent the next two hours signing consent forms and coming up with contingency plans for our snow babies if anything should happen to us.  We have decided to put our frozen children up for adoption in the case of our premature demise.  This all depends on us having enough surviving embryos to be frozen after my retrieval in 3 weeks (YIKES...SO EXCITED!). 

We also went over all the risks and reasons that the cycle might have to be cancelled.  I could care less about the risks to me, but the causes for cancellation were a bit overwhelming.  An IVF cycle can be cancelled for several reasons including not having enough follicles, lab error, developing ovarian hyperstimulation syndrome (OHSS), the egg retrieval may go badly, my eggs may be junk, BJ's sperm may be junk, fertilization may not occur, etc. and so forth.  So you can see where that can leave us kind of spooked.  My one big fear at this point is ovulating before my egg retrieval, which Pat assured me won't happen.  I love Pat.

I also got to learn how to mix my medications, some of which are a bit more complicated than others.  Some even come with DVDs!  My doses may be changing throughout my stimulation period, so I'll have to call in daily to check with my doctor and the embryologist on what needs to be adjusted.  I kind of feel like I'm someone's organic chemistry experiment.  I just hope they are better chemists than I was!

Well, I'm gonna pop some popcorn and enjoy my new flicks, Your Friend, the Menopur Injection and PIO:  More than Just a Pain in the Ass.

Happy Spawning...
MK & Emma Grace

Sunday, July 24, 2011

Let the fun begin...

BJ came with me to my follow-up appointment following my Follistim/IUI crash and burn.  We met with Dr. D who immediately opened up with, "I think it's perfectly fine to go ahead and pursue IVF [in-vitro fertilization]."  I felt like a weight had been lifted off my shoulders.  Dr. D got to drawing his charts as he tends to do and gave us stats for couples our age.  Out of 100 patients that go through IVF with his clinic, 60 will achieve a pregnancy.  Out of the forty left, 20-23 will have success with a frozen embryo transfer (FET) and ten more will be successful on their 2nd FET.  That is such an unbelieveable improvement over 10-13% and a miracle for our less than 2% chance on our own.

So this is the short version of what it entails.  I will be on a cocktail of stimulation medication starting on August 5th.  Dr. D would like to see me produce 20 eggs at my egg retrieval (ER), which will hopefully be some time during the week of the 15th.  To help overcome BJ's dunderheaded sperm, the embryologist will perform intracytoplasmic sperm injection (ICSI).  This involves using microscopic tools to pick up a sperm tail first and using a super tiny needle to inject it straight into the egg.  It is my personal belief, that while progesterone deficiency and annovulation are treatable on my part, we just can't overcome the fertilization hurdle.  So I think IVF is our answer. Five days after the retrieval, they will transfer embryos (ET) back to me.  BJ and I have elected to transfer back two embryos.  I figure there are two of us and two of them, so it will be fair.  There is a movement to only use one embryo, but Dr. D has found that it lowers the success rate from 60 to 50%.  I think we can handle twins, so it is not worth decreasing my chances.  Four-five days after the ET, I will go in for my progesterone test, and 9 days after that I'll go in for my beta HCG (blood pregnancy test) .

Dr. D took his time to explain the procedures, and then we were taken once again to work with the financial coordinator.  She explained the costs to us and we chose to purchase a package that included the ICSI, Fresh embryo transfer, and one back-up FET if the fresh doesn't take.  So at the end of this, we have over an 80% chance of having our own child at last.

We then met with Pat once again, who was absolutely tickled for us, which is kind of funny, but you'd have to know Pat.  Her confidence is contagious.  She gave me prescription prenatal vitamins, 70pp of reading material on the procedures, and a sample of birth control pills...yes birth control pills... They want to shut my ovaries down so when I start my stimulation medications it is a hostile take-over.  I have actually really enjoyed being on the pill because I feel like I'm not losing out on anything.  It has been a great mental vacation from the past 7 months.  I've even been able to relax on the T-totaling and let loose while it was still summer.  Let me tell ya, I missed me some of my daddy's adult slushies this past year. 

Since I had BJ held captive at that point, I elected to go ahead and have our IVF panel run.  It is a series of blood tests that check for everything from cystic fibrosis to STD's.  BJ has only had his blood drawn once before...Apparently where he comes from, modern medicine is still voodoo science.  Anyway, he was very brave and did not cry as they took 5 vials of blood.  Poor guy was sweating, looking away at a wall, and having me rub his neck, but he did survive.  He walked around holding his arm like it might fall off until we got back to our car.  An hour later while we were eating lunch he told me he was dizzy...poor thing...The good news is, the hard part is over for BJ!  (He's shaking his head no...[insert evil laughter])

I have had the occasional panicky thought about it not working, but all-in-all, I've been in a lot better place emotionally.  We made the decision to let all of our family know what we were going through.  BJ encouraged me to start this blog, and I tell ya, so far it has been a phenominal experience.  I have gotten so many kind words and well wishes from so many different people.  I want to thank all of you for your love and support and to steal a line from Ellen, back atcha!

Right now, I think BJ's a little more nervous than I am.  This is the last chance in the sense that it is the end resort procedure when it comes to fertility, but that doesn't necessarily mean we cannot try again.  One of the biggest things I'm looking forward to (aside from the baby, of course) with IVF is all the control. I am still a control-freak, afterall.  I will know how many follicles I have.  I'll get updates for my meds every other day.  I will know exactly how many eggs were retrieved, and how many fertilize.  I will know how many embryos make it to blastocyst stage and the quality of the embryos.  I'll know how many I have to transfer (2) and how many we will have to freeze.  I thank God that I live in a time where physicians have been given the knowledge and abilities to help us spawnless folk.

Meanwhile back at the ranch, BJ and I have continued our vitamin regimens.  We've also added a vitamin C supplement to his multi-vitamin and vitamin E.  I am taking my prescription strength pre-natals as well as a baby aspirin and my Lo Loestrin. Tomorrow, the 25th, I will have to undergo the dreaded endometrial biopsy.  It is the only thing I'm totally dreading.  (In fact I'm taking a break from foraging my house for my bottle of Xanex to write this post.) Dr. D is also going to do a "mock transfer" to map out the best location in my womb for my babies. I guess nothing is too good for Roberts spawn... Afterwards we are going to sign all our consents.  We even have to make a contingency plan for our snow babies (the frozen embryos) in case we get a divorce. (As if BJ could get off that easy [insert more evil laughter].) After that, I get a lesson on how to deliver all my meds. It's a bit overwhelming, but I'm really excited to get this process started. 

Wish me luck tomorrow!

Peace, Love & Spawning,

Saturday, July 23, 2011

Attempt Numero Tres: Nothing's Charming

I met with Dr. D on the 3rd day of my next cycle.  We discussed that Clomid was not only not working for me, it was working like a really expensive form of birth control.  Dr. D, not wanting us to shell out 10+ grand unless absolutely necessary, wanted to try at least one more round of IUI, but this time using straight follicle stimulating hormone (FSH).  These are the injectable drugs.  The downside of them is that they only improve our chances by 1%, and they cost some major dough.  Four days worth runs about $500.00.  They also increase your chance of multiples dramatically.  We would be going from a 10ish% chance of twins to nearly a 30% chance of twins and 2% chance of triplets.  On the positive side, they don't intefere with your uterine lining.  It was a fair trade-off. 

Let's talk about the multiple situation...I, previous to my personal fertility dilemma but post John & Kate + 8 hoopla, thought, 'Well, clearly they did not need fertility treatments if they had that many babies.' I don't feel that way at all anymore. I think 4, 5, and 6+ babies are ridiculous, and with a good fertility specialist is completely avoidable, but twins and triplets do not a bad doctor make.  Typically these higher order pregnancies are the result of IUI's, not IVF. During IVF, the fertility specialist and you have complete control over how many embryos are transferred back. In my case, I barely ovulate, and as Dr. D says, who even knows if my eggs actually even leave the follicle.  So instead of just having one microcosmic chance of conceiving during a normal month, a medicated cycle with multiple follicles increases my chances, even if only incrementally.  Dammit, I'll take it.  A responsible fertility specialist should look at a quad or higher order pregnancy as a bad thing.  They should know when to cancel a cycle because there are too many mature follicles.  The vast majority of fertility treatments result in 1 baby.   The point is don't scoff at people undergoing fertility treatment for having multiples.  It's kinda an all or nothing game, and the chance of these freakish pregnancies with a blue-million babies should remain less than 1%.  That's my beef...

Dr. D and I also discussed that 8 million-post wash sperm was not so good.  BJ had been taking a multi-vitamin and a vitamin E supplement for a couple of months to help improve sperm quality.  We knew we couldn't get his morphology to improve, but we thought the more sperm, the more normal shaped sperm there would be. We learned that the washed sperm were not necessarily all the correctly shaped ones either. Apparently BJ's dunderheaded sperm can be great swimmers despite their block-heads. Dr. D thought we would see a lot of improvement in this round, because it usually takes 3 months for the vitamins to make their peak impact on sperm count and motility.

After a quick lesson from my favorite nurse, Pat, on how to give myself subcutaneous (sub-q) injections, I was sent off with my Follistim kit and started injections that night.  I am by no means a needle-phobe, luckily.  My poor husband, not so much.  Anyway, giving myself the injections in my tummy was no big thing at all.  Sub-q injections require tiny needles that you can't even feel.  The only time I had any stinging was when I got in a hurry and didn't let the Follistim warm-up to room temperature.  (It has to be kept refrigerated.)  The 55 degree medication did not feel so good when it hit my 98.6 insides.  Every night for the next two weeks I gave myself 150 IUs of Follistim.  The only real side effect I noticed was extreme fatigue, which isn't even one of the side effects listed as common.  I may be blaming the Follistim for my mental and emotional fatigue from the failure of the last cycle, but I swear I could have slept 24 hours and still been tired. 

They monitor you a lot more closely when you use injectables because of the increased chance of developing ovarian hyperstimulation syndrome (OHSS).  That is when your normally almond-sized ovaries blow up to the size of softballs (or bigger) and cause fluid to collect in your abdomen.  It only happens in 2% of women undergoing fertility treatments, but it has the potential to turn deadly.  Besides extreme pain from the swelling and fluid in the abdomen, you can also start collecting fluid in your lungs.  Not a fun way to go, and definitely not something you want to have happen.

Any-some-how, I had four ultrasounds during this cycle.  My lining was much improved and even my right ovary got its lazy butt in gear and started producing follicles. My uterine lining went from 8mm to 11mm.  I had three mature 18mm+ follicles on my right and 2 potential follicles that were a little smaller on my left.  Considering my lack of success, Dr. D was fine with proceeding with an IUI this cycle even though I had a 2% chance of conceiving triplets...if I conceived.  I was instructed to set my alarm for 1:00am so I could give myself my Pregnyl injection.  Tis another bitchy thing about fertility treatments...even when you don't want to be thinking about it, you have to do crap like wake yourself up in the middle of the night to stab yourself with a needle.

At 1:00am Britney Spears, "Toxic" seranaded me as I drowsily got my injection tool-kit out.  Ever the needle-phobe, BJ stayed far, far away saying, "I'm sorry baby, I just can't." Wuss...Thanks to my awesome organic chemistry lab at Ursinus College, I skillfully mixed my medication and loaded the syringe.  Pregnyl is an intramuscular injection (IM) so it has to go in either your butt or your thigh with an 1.5 inch needle.  It can be a bit intimidating especially at 1:00am.  I counted to three and stabbed, but then remembered I didn't check for air bubbles...DAMMIT.  So I pulled out the syringe, changed the needle and swabbed up my other thigh...this time I made sure the medication was loaded into the needle and stabbed myself again. This time it went off without a hitch, and I got to limp back to bed.  If you ever have to inject yourself with's worth taking the time to find the check-sheet your nurse gives you!

34 hours later BJ, having done his thing, and I showed back up at the fertility clinic.  I was really excited because of my amazing follicles and even had been joking about my triplets with my best friend who had already named them Nicole, Nikki, and Nicolette.  (Her name is Nicole if you haven't figured that out yet...) To top it off with even better news, Pat marched right into the exam room proclaiming that BJ's sperm count had gone from 102 million pre-wash (AWESOME) to 33 million post-wash (EXTRAORDINARY).  The procedure went much the same as the last, with some mild discomfort. 

Since lifting heavy things within 48 hours did not help so much last time, I chose to take it pretty easy.  Not bed rest per say, but nothing strenuous.  I didn't run or even walk briskly for 48 hours.  I also started progesterone supplements immediately after the procedure this time.  When I went in for my progesterone test it was over 40 which is the level you would expect for a woman during her 2nd trimester of pregnancy.  I got really excited.  I thought this has to be it.  Surely my progesterone would not be so high without a reason.

The progesterone level was taken on a Wednesday, and I was having a ton of PMS/early pregnancy symptoms.  My boobs hurt to look at.  BJ even gave me lots of compliments about my enlarged bustline.  I totally found myself wishing I'd doubled up on the sports bras when I used the elliptical or ran. But then, by the weekend it just stopped.  While it's not too uncommon for symptoms to come and go, this just felt different.  By early the next week I was back to where I usually was with cramping and achiness like every other disappointing month.  I knew it hadn't worked, and I was decimated.  I elected to quit taking my Prometrium a day early because I didn't want to have to wait any longer for the next cycle to start, and the Prometrium can delay your period.

I told the nurse with a stiff upper lip my test was going to be negative.  She tried to stay optimistic and say I didn't know for sure until I had the blood test results.  She had me wait while she ran a quick version of the beta HCG test. She came to get me with the results and told me that I had been right, and I, despite my best efforts, broke down anyway.  God bless, Pat.  She rubbed my shoulders and let me cry.  She told me how it took her 13 years to conceive and how she felt so worthless and constantly questioned what she had done to deserve her infertility.  It was great to have someone validate my feelings of worthlessness and not make me feel like an idiot for feeling like that. 

She asked me what I wanted to do.  I told her I did not think I could make it through another round of IUI.  I had the most follicles I had ever had, and BJ had his best sample, and I just knew if it did not work this time, it was not going to work.  I had that same gut feeling I had after three months of trying on my own.  IUI's were just not going to be our ticket.  She told me she would put the bug in Dr. D's ear about pursuing IVF.  Stupidly, I had been a little scared of broaching the subject because I didn't want Dr. D to feel like I didn't believe in him.  When you depend on somebody so much, it's easy to sit back and become a passenger when you still need to be holding the reins.

I was resolved.  I went home and told BJ that I was done with IUI's.  Fiscally it was not worth it anymore.  By the time we tried three rounds of Follistim/IUI's, we would have spent half the cost of IVF.  I'd rather put my money where the odds are much higher.  BJ looked at me and simply said, "lets do it."  He's pretty dang awesome, that one.

And now, we are all caught up...

Attempt Numero 2: Clomid Hates Me...

So just like the previous month, I cried a lot.  OK maybe I cried a lot more, it was pretty rough. We did have the debriefing appointment with Dr. D. He was very consoling and told us that sometimes it takes a cycle or two to figure out how my body will respond to medication. He was pleased that I did ovulate despite having such a rough start with barely any follicles. I don't think I appreciated how bad off I was at my first ultrasound during the previous cycle which let me get my hopes pretty high. Dr. D thought Clomid would work for me, but I needed to take it for a few extra days. Most people just take it for 5 days, and I would be taking it for 8.  He reminded me again, how he had no reason to suspect that I could not get pregnant, we were still just trying to figure out how to make it happen.

A long, awful, and still pretty weepy 2 weeks later, I was finally able to start my clomid again...and have hot flashes again...and have sob-fests, again.  They had me come in for my first ultrasound (US) and I was really nervous.  I was so green last month, that I no clue what all could go wrong.  This month, I knew a lot more, and was definitely more anxious about everything. The US showed that once again, my right ovary was hibernating.  My left, however, had a couple of follicles.  The lining of my uterus, however, was only 4mm.  This isn't so good.  They really want it at 10, but 7-8 makes pregnancy plausible.  The nurse explained to us that it may be due to my "small" uterus. Dr. D says that some of his "petite" [insert eye roll] patients don't ever get a thick lining because there is just not enough room.

OK, so a little more about Clomid... As I've said before, for most people with ovulation issues, Clomid works great. For a few of us (and of course I'm included in this group), it may improve ovulation, but it also leaves us with some undesirable side effects, too. If you remember, Clomid works by blocking the estrogen receptors in your brain that tell it when it is time to ovulate. This gives you more time for more follicles to mature and better quality eggs are released. The bad thing for some of us with Clomid, is that the estrogen is what tells our uterus to develop a nice cushy lining. In addition, it can increase the overall "hostility" of your uterus and cervix by making it an unhappy place for sperm to live. Ideally, intrauterine insemination will allow the sperm to bypass these obstacles, but you still need a thick lining for the embryo to snuggle up to and make a home in for 9 more months.

I went in every other day for the next 6 days for my US and bloodwork. Each time my follicles got a little bigger, and my lining incrementally grew. By the third ultrasound, I had two follicles that were 18+mm, which indicates that they are mature and ready to be "triggered" so I ovulate. My lining had made it to 6.5mm, so there was some hope. I couldn't believe this was actually going to happen!!!! The nurse gave me a shot of Pregnyl, which is human chorionic gonadotropin (HCG). This is the same hormone that home pregnancy tests detect when you are pregnant.  After the shot is given, you are expected to ovulate within 36 hours. So they scheduled my IUI for the next afternoon about 34 hours post trigger shot. I still couldn't believe it was actually happening this time, and I kept asking my nurse if they could cancel for any reason. Patiently, she told me over and over it was really going to happen...YAY!!!!

The next afternoon, BJ deposited his sample to the clinic. We also learned that he had to sign an affidavit saying that he knew that our intention was to use his sperm to create a pregnancy in me, his wife. I sure would like to see the lawsuit that made this necessary. So fair warning gentlemen, if a woman ever asks for a sperm sample, you should be suspicious about her intentions.

It takes about an hour for them to prepare the sperm. They spin the sample in a centrifuge and perform what they call a swim-up test. This means only the best and the brightest of the sperm are used for the insemination. Since the sample is going directly into the uterus, it doesn't need to be protected in seminal fluid which contains prostaglandins and would make me cramp like a dehydrated football player. So once they go through 2 or 3 "swim tests" the lab tech gives them a little dose of caffeine and a pep talk. Apparently, sperm are about as smart as UT's offensive line...

So, BJ and I are in the exam room, and they bring in a test tube with pink liquid that is what his sample looks like post wash. They show you the test tube so you can confirm that it has your partner's name on the label. They told us BJ's pre-wash count was 92 million, but the post wash sample was down to 8 million. Dr. D said this was fine, but it is definitely on the low side. Your goal is at least 10 million with 5 being the absolute minimum. What we didn't know at the time is that this took us from a 9-12% chance, to about a 5% chance of conceiving.

Then the fun begins... Two male doctors at this point have told me, "Oh, an IUI is just like a pap smear." Apparently, neither of them have had a pap smear nor an IUI. I think there are a few women that don't have any discomfort, but I apparently am not one of them. Generally speaking, the sensation of something being forced up my cervix is not pleasant.  Dr. D struggled a bit to get the catheter in place. I had quite a bit of cramping during the procedure, but it doesn't take two minutes. After the sperm were deposited within inches of their goal, they raised the table and had me lie with my hips up in the air for 10 minutes. I would go in the next week for a progesterone check, and then the following week for my beta (beta HCG level to check for pregnancy).

Since we were going to be moving that weekend, I tried to take it as easy as I could that evening. I had some mild cramping, but it wasn't too bad. Dr. D. said it was no problem for me to be lifting or doing anything heavy, but my uterus definitely its presence known when I did that weekend. Dr. D later explained that my endometriosis was probably coming back and making my uterus a little more sensitive to all of these procedures, but it shouldn't effect my chance of conceiving. Lucky me...

I cramped on and off for the next week. Every twinge made me wonder if I was having implantation cramping (cramping that can occur when your blastocyst baby settles into the lining of your uterus). It is so easy to let yourself over analyze every little symptom. On message boards people obsess with what may and may not be early pregnancy symptoms. It's tough because you can totally trick your body into having symptoms even if you aren't pregnant. In addition, PMS symptoms are also early pregnancy symptoms so that just heightens the madness. Much more easily said than done, try to not obsess. I also found it better when I had over-scheduled myself and stayed really busy. The time goes by much faster.

It turned out that I did have a progesterone deficiency. It was Dr. D's hope that the Clomid, which did increase the size of my follicles, would help improve my progesterone levels. The remnants of the follicle after you ovulate become the corpus luteum which releases progesterone to help create an ideal environment in your uterus (thicken the lining). Since Clomid had given me two large follicles, you would expect that I would have two corpus lutea (see Daddy, all that Latin in high school is paying off) making plenty of progesterone. I was put on Prometrium, a progesterone supplement, two times a day.

The next week I had my blood pregnancy test. My symptoms at this point were all the same as I was used to having so my gut instinct was that since nothing was different, the IUI had not worked. That did not mean that after the longest hour of my life when I finally got the call from a medical assistant, I was not absolutely devastated when she said it was negative and to stop taking the Prometrium. She also said rather unsympathetically, "If you want to try again, just give us a call when to start your period." As if I had another option? I bawled my eyes out, and, once again, my wonderful husband was right there to hold me and get me through it.

The one good thing (if anything could be good) I thought was that for the first time since I've been trying to conceive I was able to take Ibuprofen before I started my period.  So I hoped that at least I would not be in pain this round.  The endo definitely makes the lack of success worse because in addition to the devastation of not being pregnant I get to look forward to hellacious cramping for a few days. Talk about insult to injury, or maybe injury to insult in this case.  My pain level has also increased over the past 3 months because the Clomid can accelerate the regrowth of lesions. So, I took 800 mg of ibuprofen every four hours around the clock.  Despite the prophylactic ibuprofen, on the night before my birthday, I started having severe cramps at 1:30am.  These were probably the worst I've had since BJ and I started trying to have a baby.  I spent the next couple of hours heaving, sweating and pacing with my trusty old heating pad.  I finally broke down and took some Tylenol #3 at 4:00am left over from some surgery some other time.  It relaxed me enough to at least lie still. It was a rough 24 hours to say the least and not a very happy birthday.


Thursday, July 21, 2011

Attempt Numero 1: I hate Clomid...

As soon as I was done crying over my previous failure (March cycle on 50mg Clomid), I started taking 100mg of Clomid to get ready for my first attempt at intrauterine insemination. I took it on days 3-8 of my cycle. The previous month, besides growing more emotional, I really didn't have too many side effects. By the third night of 100mg of Clomid, I woke up @ 2:00am burning up. I am generally it was 94 degrees out today and I'm wearing a hoodie kinda this really threw me off. I woke BJ up and said, "I think I'm hot." His response..."Good for you." It was a bizarre sensation. My thighs felt like I'd done a thousand squats and were really burning from the inside out. It radiated through the rest of my body from the inside. It finally dawned on me that this was a hot flash. I never paid much attention to my mom when she complained of hot flashes.  I had no clue what it was actually like. Well ladies, let me just say we don't have a lot to look forward to. For the next couple of weeks, I would wake up in the middle of the night drenched while being hot and freezing at the same time. Oh, and the emotional side-effects...

True Story:
We were getting ready to move to our new house. I had bought a glass-top coffee table to go in my conceived, ultra-hip contemporary living room we were going to have. One evening after work, I saw my new coffee table and had a meltdown.  I stared at the coffee table and just sobbed for hours. Finally, I called my mother and bawled to her about how I'd never be able to adopt because we'd never pass a home inspection with a glass coffee table. There was no reasoning with me. I was adamant that I had ruined any chance of ever adopting because of this coffee table and there was no sending it back, because I had bought it on sale. My mother, who is a retired social worker, tried to console me by telling me social workers aren't worried about your furniture during a home inspection, but with dogmatic conviction I proceeded to argue with her that yes they did. I could never provide a safe home...At the time it all seemed to be a rational response and made total sense. So ladies on clomid, it's best to refrain from making any important decisions such as paint colors, furniture, or even what to wear without help because of its potential to induce nuclear meltdowns.

I went in for my first ultrasound (US) and bloodwork on the 11th day of this cycle. My right ovary was apparently taking the month off, but my left did have a few follicles.  Unfortunately, they were too small to be very promising. A few hours later (and this is how it goes from here on out) the nurse practitioner calls you and lets you know when you need to come back in again and what you need to do with your medications. Because of my lack of progress on such a large dose, my doctor wanted to try a step protocol, and he had me take 100 mg of Clomid for 8 more miserable, waking up in the middle of the night, behaving like a raving lunatic days.

I had my next set of labs the day of prom. (I'm a faculty advisor for the prom committee.) My right ovary was still on vacation, but my left had 2 large follicles. They measured between 22-25 mm, which is large enough to be considered mature. After a quick lesson on how to give myself my Pregnyl injection (medication to trigger ovulation), she sent me off and told me she would call me shortly with instructions. I drove back to help finish decorating absolutely elated. I was truly happy for the first time since right after my surgery. I felt hopeful.

But alas, the nurse called with not good news. My blood work indicated that I had already ovulated and they would not do the IUI because it would be a waste of my money. (You only have 24 hours after ovulation to fertilize the egg, and they had no way of knowing when exactly I had ovulated.) Dr. D's partner called me a little later to check on me and encouraged me to make a follow-up (a de-briefing would be more descriptive) appointment. So just like that, it was all over, and I had 0% chance of having a baby this month. Talk about emotional whip-lash. There I was with rolls of multi-colored mesh, seashells, and Chinese lanterns bawling my eyes out yet again...

Thanks to some amazing friends who just happen to be co-workers, I was able to pick myself back up and get through prom.  I even managed to not lynch the pregnant student who had sobbed in my office for a half hour because her prom dress no longer fit.  No lie...She even came over to show me how a seamstress used the material from the hem to increase the side seam. Thanks a-lot, MTV...
Having to cover up some red-eye, but blessed to work with these amazing people!
I got home really late that night and had a breakdown.  I was so angry.  I wanted to destroy something. (Mind you, I had taken Clomid that morning.) I threw a tantrum full-out with kicking, screaming and punching that would have made an angry 2 year-old stop and say, "You crazy, lady." I felt like such a loser because I wouldn't get to try to have a baby even with medical intervention.  I hated my body for being so damaged that it didn't even respond to medication correctly.  BJ was there the whole time holding me, soothing me, saying all the right things, and saying nothing at all when I needed him not to.  Even through all the darkness of that moment, it's hard to forget how wonderful it was to have my UH-MAZING husband right there with me.  Oh, the thrill ride of fertility treatments...

Until later,

Wednesday, July 20, 2011


As I was saying...BJ followed through with his semen analysis (SA).  The nurse told him they would call him with preliminary results and then we would have a follow-up with our reproductive endocrinologist (RE), Dr. D.  So, we waited, and waited...and waited.  This should have been a clue.  They probably do not call if they don't have anything positive to say.  Nevertheless we were anxious (OK I was dying, BJ could have waited months) to hear our results.  We were relieved when they finally called to set up an appointment nearly 10 days after BJ had his test. 

On our first trip to the fertility center we learned that there is apparently an etiquette when you are in the waiting room of a fertility clinic.  Don't look anyone in the eye, attempt to look more pitiful than the woman/couple next to you, and don't talk.  I'm not sure why...I mean, hell, bottom line is none of us are making babies.  You'd think we fertility challenged folk would want to have somebody who could relate to talk to.  Not so, apparently...we just prefer to wallow in our own misery.  If you're not miserable, well, just give yourself some time in the waiting room, and you'll get there.   

Once we were looking appropriately pitiful enough, BJ and I were taken into Dr. D's office. Dr. D went over the results with us.  He told us there were three things that they look for; count (the number of sperm), motility (how well they swim and amount of "forward progression"), and morphology (shape).  BJ's count was fine, not outstanding, but fine.  BJ's motility was normal, but his Kruger's Strict Morphology, was 6%.  Normal is considered to be above 14%.   Sperm should have 1 head, a reasonably sized tail, and the head should be more oval in appearance.  BJ's sperm tend to be too round on top, which makes it difficult for them to penetrate my eggs.  I liken them to being shaped like Stewie Griffin's head from Family Guy.  The unfortunate thing about having poor morphology is that unlike having a low count or poor motility, you cannot treat morphology. What you've got is what you've got.
My immediate reaction was 'oh, no we're going to need a sperm donor'.  Dr. D started drawing out a chart for us.  He told us that with our set of conditions, we had less than 2% chance of conceiving on our own.  He went on to say, that less than 2% is as low as he will tell people because it's embarassing when they walk in 9 months later with a baby.  So basically less than 2%, is 0% with built-in error. That was hard to swallow.  He said that if BJ had between 10 & 14% morphology, we had a great chance to conceive with intrauterine insemination (IUI).  With 6-9% range, Dr. D said we would have a 9-12% chance with a combination of clomid and IUI. (A "normal" couple has a 20% chance in a given month.)  With injectable medication we would get a 10-13% chance. He recommeded we try 3 or 4 cycles of the Clomid/IUI protocol.  If BJ had 5% or lower morphology, they would have immediately recommended in-vitro fertilization (IVF).

This is when I started bawling...but they're pretty used to this at the clinic.  They have boxes of Kleenex everywhere.  Tons of nurses to hug and pat your back...they've got quite the system.  Dr. D asked BJ if I had been taking Clomid and BJ told him I had.  Dr. D whispered to him that a lot of my reaction could be contributed to the Clomid.  MEN! if being told that  you have practically no chance of having a baby without intervention is not upsetting if you aren't taking Clomid.  I immediately hated both of them...which probably meant that, yes, it was the Clomid, whatever. Still pisses me off...The one good thing he did say was, "Nothing in your chart scares me.  It's not a matter of if you can get pregnant, it is a matter of what will it take."  I have since repeated these words almost daily.  I even considered a tattoo in Latin, but it's pretty long...

We then met with a financial coordinator who told us what our insurance would cover, which is not much, however I still consider myself pretty lucky.  They will cover anything that doesn't directly potentially create a pregnancy.  All the monitoring before the IUI or IVF would be covered, which is a huge help, and I'm very thankful, but it still leaves many procedures and most of the medications up to us.  It is a good idea to set a budget with your partner, because there is the potential to shell out tens of thousands of dollars.  It's clearly a personal matter, but you have to start thinking about how much you want to spend on treatment and if you want to save some to potentially adopt with.  Adoption is awfully expensive too, and often is more expensive than an IVF cycle.

BJ and I had a lot to chew on and a lot of decisions to make.  I called Dr. B, my gyno, to let him know the results of BJ's SA.  Dr B. was very encouraging, but said that since we were dealing with dual factor infertility, that sticking with an RE would be his recommendation. I would recommend that for anyone else, too.  Fertility clinics are set up to help you around the clock.  An OB/GYN usually has to stick to regular office hours which can make the timing of everything rather difficult. With that as the plan, I filled my new script for Clomid.  What did we have to lose?     


Monday, July 18, 2011

How I Got Here Part 3: The Follow-Up

After my surgery, Dr. B. had told my husband that I did have endometriosis (endo), but he was able to remove all the lesions.  I did not have any adhesions which is pretty lucky since I've probably had endo since I was 15.  It turns out that being on Depo Provera (birth control shot) had been a good thing because it halts the progress of the endo.  A lot of people with fertility struggles who used depo like to blame it.  While it may take a while for your cycles to restart, I don't know of any legitimate research that says it harms fertility.  So, if you don't want the more drastic medications to slow endo down, and you aren't interested in spawning, it's definitely an option you and your doc could consider.

Anywhoselbees...I was feeling great in the weeks following my surgery.  My follow-up was scheduled for three weeks post-op.  In the meantime, I was free from pain, free to continue to try to spawn, and I was mentally doing better, too.  I had it in my head that Dr. B was going to tell me I was good to go and that my year of trying would start from March now that my endo had been cleaned out.  I really thought I was going to be able to conceive.  For most people with endo, they have an increased chance of getting pregnant in the 6-9 months after their surgery.  Thinking that my mom's fertile genes would kick in now that the obstacle of endo was removed, I really thought it was my time.

Unfortunately at my post-op check-out, I got slapped in the face with reality.  Dr. B. told me that my chromotubation (fallopian tube check) was great.  The dye spilled easily.  My anatomy was all normal, no fibroids, deformities or anything else wrong with my uterus.  He said he was able to remove all the endo I had, which wasn't much.  I am considered to have mild endo.  This sounds great right? Well, apparently it's not.  Dr. B. could see no reason why I had not been able to conceive.  With severe endo, you have tubes all tangled in scar tissue and adhesions that create physical barriers that prevent pregnancy.  When you have mild endo, you can usually still get pregnant, but when you don't, you really don't.  It depends on your fertility specialist's beliefs, but a lot will go ahead and give you an unexplained infertility diagnosis if you have mild endo and have not been able to conceive.

Dr. B told me that he was also concerned with my irregular periods which were now 26-43 days.  He told me he would write a prescription for Clomid for me to use my next cycle, and that it would help me ovulate at a more regular interval. 

Pardon the interruption for a quick physiology lesson!  In a typical functioning female (as in not me), after your period starts, which is the beginning of your cycle, your pituitary gland and hypothalmus tell your ovaries to get busy by releasing follicle stimulating hormone (FSH).  As your ovaries develop many follicles (they are basically cysts, that contain an egg).  When one or two follicles begin to mature, they release estrogen.  The estrogen then tells the hypothalmus to stop releasing FSH.  This is why most humans do not have litters of children naturally.  Luteinizing hormone is then released by the pituitary, and the most dominant follicle will release it's egg.  The other follicles simply dissipate and the eggs that were in them are gone forever.

BUT WAIT!  YOU'RE NOT NORMAL...OK, well here comes Clomid to save the day.  Clomid blocks the estrogen from telling your hypothalmus that the eggs are ready.  So for people who naturally don't have enough time in their cycle to let their eggs mature, Clomid gives them that time.  A side effect of this, is that it allows other follicles to catch up so you may release more than one egg.  Your chances of having twins goes up from less than 3%, to just under 10%.  You have less than a 1% chance of having triplets or more on Clomid.  For lots of people clomid works just great.  If you haven't conceived in about 6 cycles, however, it is probably time to move on to something different.

OK, back to me. It is my blog after all...

My doctor also said that we could go ahead and try intrauterine insemination (IUI).  I was dumbstruck.  This appointment did not go the way I had planned at all. He explained that the procedure was similar to a pap smear.  They use a catheter to place the sperm directly into the uterus so it is that much closer to the egg.  He asked if I wanted to go ahead and try IUI's or try naturally.  Without thinking, I immediately said I'll try naturally.  I was having some serious denial issues.

As I checked out, I noticed that my billing diagnosis said infertility.  I saw a card for a nurse practitioner at a fertility clinic.  I picked it up without really thinking.  I made it to my car with my prescription in hand one hand and the fertility clinic business card in the other, got in the driver's seat, and had a meltdown.  The ax had officially dropped, I was indeed infertile.  I called my wonderful husband, and he had me come to meet him at his office.  He patiently let me sob through the details of my appointment and told me he was willing to do whatever he needed to do.  He encouraged me to email the nurse practitioner at the fertility clinic.  He wanted me to get a second opinion.  Which is not to say either one of us doubted Dr. B at all.  We both just needed to be told by someone else before we could accept it. 

The nurse practitioner responded to my email the next day while I was at work.  She said the next step for us would be to have BJ's swimmers looked at (semen analysis).  Knowing that BJ had said yesterday he was willing to do whatever, I thought, 'OK, I'll just get the logistics of how that will work and what times were available.' I called the clinic and said I was interested in procuring a semen analysis for my husband.  They asked for his information, which I just happened to know, and the receptionist said, "How is 8:30 am Monday?" I responded, "Perfect!"  She asked for his health insurance info which I did not have all the details of, and told me it was fine, she would be emailing him shortly. Uh, oh...

I tried to call BJ to let him know what I had done, but when he answered the phone he immediately said, "Can't talk now, in a meeting," and quickly hung up. Oh, boy, I was gonna be in trouble.  It was not 20 minutes later that I got a "WTF" text message.  To which I responded, "Exactly, but in a cup."  After the initial shock of my guerilla semen analysis approach, BJ quickly resolved himself to go through with it.  So, if you ever wanna play a practical joke on a can apparently set up an appointment for them to have a semen analysis without their consent.  I guess this makes sense.  How many men would actually take the initiative to have this done and call for an appointment? I gather from my experience that it's not many...

Peace, Love and Spawning,

Saturday, July 16, 2011

And now for something completely different...

I've thought I would do something different and introduce you to my super-hero husband with an interview...and so you could get a male's perspective on this whole make-a-baby quest...

M: BJ, tell me about yourself.
B:  28 year-old, I am 28, right?

M: Yes, why don't you just brag about it...
B: I work in higher education.  I enjoy it.  I'd like to be a communications scholar, news junkie...

M: I'm bored.
B: I know, right?  I'm not that interesting.

M:  I am beginning to think this was a bad idea...So, what was your master plan for life?
B:  I wasn't sure I was going to get married.  I lived in a small town, and I had pretty much tapped out the dating pool.  Then, I met you and I wanted to get married, have a family, and have a career in journalism.

M:  Why'd you marry me?
B:  Cuz I love you.

M: Why?
B:  We just clicked.  You're beautiful, smart and funny.  We just work together...we fit.

M:  You're ok with going on the record saying I'm smart?
B:  I guess it's too late.

M:  You bet!  When did you want kids?
B:  At some point...I didn't have a timeline.

M:  Were you ok with my master plan? (Married for 2 years, then have kids)
B: Um, yeah.

M:  Well, moving on. Tell me when you started to worry about our lack success spawning.
B:  A lot later than you.  It probably wasn't until I had my semen analysis with Dr. D.

M:  Makes sense.  Did you think I was insane for worrying?
B: No, I thought you were impatient.

M:  Well, thanks.  I thought you were que sera, sera.  Why do you think it's so different for us?
B:  Because you [women] are programmed to breed and give birth.  For you, in particular, I think this is one of the few times you've had a problem and couldn't just get it fixed right away.

M:  Try the only...Why do you think some people wait so long to get help?
B:  I don't know.  It could be a number of things.  They don't want to know something is wrong.  Or, they just don't think they have to have kids right away.  Not everyone gets pregnant on the first try.

M:  Our mothers did...
B:  Yeah, but they're not everybody.

M:  Would you encourage couples to get help sooner?
B:  Yeah probably after a year.  If you're older, probably sooner.

M:  (Smiling) You read my blog?
B:  No, it was from meeting with Dr. D.

M:  (Laughing) Ok, well, what has been the hardest thing so far?
B:  Watching you be disappointed month after month and that ongoing depressed state it has caused you.

M:  How about you? Were you disappointed?
B: Yeah.

M:  I'm sorry.  So, you had a test to check your fertility.  Do you wanna talk about it?
B: Not really.

M:  (Laughing) That is ok...
B:  It's not that big of a deal.  There's just not that much to talk about. I just wanted to make sure it wasn't just you or not you at all with the problem.

M:  Aww, you're sweet.  What were you thinking when Dr. D said you had abnormal morphology?
B:  I guess I just wanted to know if there was anything I could do to fix it.

M:  I was scared we'd have to use a sperm donor, and then I wondered how much Elijah Wood's sperm would cost.  Who's sperm would you want to use?
B:  Ben Affleck

M:  Yuck!  OK, to be fair, what celebrity egg donor would you want to use?
B:  Katy Perry, but only if we could do it the old fashioned way.

M:  (Mouth gaping)
B: What?!  She's on my hall pass list.

M:  Well, good thing you can't, then. How are you with the whole fertility treatment thing?
B:  Kinda taking it as it comes.  I'm both excited and hesitant.  I feel like this is the last chance if it doesn't work. (We are starting IVF this cycle.)

M:  That would be sad.  Can we not try another round?
B:  I guess so.  If we have the money.

M: (Sighs) I hate that part.  What's been the scariest thing so far?
B:  Probably the first IUI attempt that was botched and you had that freak-out.

M:  Yeah, I can be pretty scary.  Do you still like me?
B:  (Shakes head yes) You're alright.

M:  Just alright?
B: Yeah.

M:  I'm fishing for compliments. Try again.
B:  You're nice?

M:  That's better...Do you want a divorce?
B: No!

M:  Why do you think so many couples facing infertility end up getting divorced?
B:  Maybe some men just want to move on.  It's such an emotional hardship and some men can't deal.  Some women can't either I assume.

M:  How do you deal?
B:  Well, I don't have to grieve every month like you do.  I guess I have other things to distract me from it.  I'm not going to be real upset until they sit us down and tell us we have no more options.

M:  What would you say is the current theme song of our relationship?
B:  I don't know.  What do you think?

M:  "Hit Me with Your Best Shot"?  I would say that Sia song from the last Twilight movie because it sounds sad and pretty, but I can't understand what she's saying so I don't know what it's about.  Maybe "Keep Breathing" by Ingrid Michaelson.
B:  That works.

M:  So, why don't we just adopt?
B:  It's definitely an option.  but I'd rather keep trying until we can't.  I'm just not ready to give up on having our own child.  I don't mean adoption is a bad thing, I'm just not ready.

M:  I feel the same way.  I think that is something that has really helped us.  We may have different levels of anxiety about this whole process, but we are on the same page when it comes to our plan of attack.  Ok, who's worse?  MK on Clomid or Cruella DeVille?
B:  MK on Clomid, definitely.

M: How 'bout MK on Clomid or Leona Helmsley?
B:  MK

M:  Really?
B:  Yes.

M:  I guess I don't ever see it as that bad...
B:  It's pretty bad.  You are nasty and you snap, but not only that, you withdraw and want to be alone.  All unabomber like...

M:  Well, I do want to keep some of my friends, and they probably wouldn't tolerate raving lunatic bitch, MK as well as you.  I'm truly sorry that I've hurt your feelings.  It's just the Clomid talking.  It's kind of like being possessed.  Do you have any advice for dealing with raving lunatic bitch, MK, that you could pass on to other super-hero partners dealing with their hormone-crazed counter-part?
B:  Patience!  Alone time, too.  It's important to get away sometimes.  Infinite patience.

M:  You know I love you, right?  You're pretty amazing!
B:  (Smiles.)

M: Do you have any other thoughts or advice for other manly men doing the infertility thing with their partners?
B:  Have patience.  There really isn't a lot you can do.  Love them, support them, and try to keep things as normal as possible.

M:  God, I love you!  So, how am I as a journalist?
 B:  Not too bad.  You're no Lois Lane.

M:  Wow, I was totally having an "Anything You Can Do, I Can Do Better" moment, and you just burst my bubble.  Anything else?
B:  No.

M: (Sighing.) Men!  Can't spawn with 'em, can't spawn without 'em.

And we're out,

How I Got Here Part 2: The Lap

No, not the clap, the lap...As in laparoscopy...

I had a really low-key Valentine's Day without any chocolate-covered strawberries. I figured it would not be in my best interest to be throwing up what would look like blood clots. I worked out for an hour and a half thinking it would be a while before I could do that again. Took shower #1 as directed by my pre-op instructions...I found it rather disturbing that I needed to be told to take two showers before going to the hospital. Do people really show up dirty for this kinda thing? Eww...Anyway, I laid out my clothes which included a new pink sweater from Victoria's Secret that I bought for myself as a pity gift, skinny jeans and my Uggs. (My dorky-ness even confounds me at times.) I set my alarm for 4:15 am and laid there until it went off.

Showered (#2), hair straightened and ready to go, BJ and I hit the road by 5:00 am to make the 6:00 am show time. On the way down "Brick" by Ben Folds Five played on my iPod which made us giggle...(we're kinda sick like that...)

I get taken back to the pre-op area and my blood pressure is something ridiculous for me like 150/100. (My normal is 90/70.) I kept asking the nurses when I would get my Rufy (yes, I'm talking about the date-rape drug), and they just kept saying soon. They started an IV, during which BJ cringed and cowered in the corner because he hates all things related to doctors. (He can watch Saw, but not his wife getting stuck!?) The anesthesiologist met with me and told me they did not use Ruhypnol, which was disappointing because the cocktail I did get, really didn't do it for me. My doctor came by and told me what to expect when I got rolled into the operating room, lots of people running around and the like. He told me he would be there before they put me under.

(Ok, so maybe the drugs were working a little bit)

I find the waiting before the surgery to be some of the least fun not soon enough I was kissing my still green husband, giving up my pink fuzzy blanket (it's generally really cold in hospitals), and putting on a super sexy hair cap. The operating room was even colder. They had me scoot myself over to the operating table, and then scoot my head up, and then scoot down to the other end of the table while they tried to figure out what to do with my 5-foot frame. Just as my doctor said, people we're running around and sticking things on me including these nifty little air massage things to keep me from getting blood clots in my lower legs. Dr. B was there rubbing my arm until I went out. The last thing I remember was seeing one of the nurses attaching the stirrup to the table, and looking at my doctor and either mouthing or saying (I hope mouthing) "oh, shit."

So while I was completely out they inserted a breathing tube and then placed a port with a camera and a few other devices in my belly button. They inflated my torso with air so they could get a better picture. My insides were inspected for any deformities, lesions from endometriosis, or anything else that could be an obstacle to our quest for spawning.

A couple of hours later that could have been 30 seconds for all I knew, I was waking up in recovery. The nurse came over and asked me how I was, and I kept saying, "My beav hurts." The nurse asked, "What hurts?" Emphatically I responded, "My beav." The word beav, while once used frequently, has not been in my vernacular since I graduated from college. It is amazing how messed up anesthesia can make you. My mind felt completely coherent, but I was too sleepy to put the effort into sounding least that is how I felt. Anyway, the nurse smiled and nodded and dosed me up with something probably with more interest in shutting me up than pain relief. I was not in extreme pain at all. It kinda just felt like I had lost my virginity again...less fun, and with more drugs...

The second time I woke up, I saw BJ, and all was right with the world again. I didn't care if anything hurt. I was just like, "He loves me," then back to sleep. I was starting to stir for good and was really thirsty. I tried to drink, but I immediately started hurling. Anesthesia and I have never gotten along. So then I got dosed up with all kinds of anti-nausea meds and remember the nurse saying this is a good time to take her home hoping that I'd sleep the entire way back and not puke on anything. I got dressed mostly by myself and decided I needed to use the bathroom again without being babysat. So I took off leaving BJ confused and the nurse asking where "Miss Independent" went. Apparently, I had a catheter placed (another eww, gross, sorry), and it kinda messes with your bladder's sensibilities for a bit. I thought I had to go, but 10 minutes later, I gave up. I opened the bathroom door to find that the nurse was standing there with one of those "wide load" wheel chairs. I was humiliated. "Which side do you want me to sit on?" I asked her. She was just told me to get in, and I was getting more drowsy, so I did. I can imagine the nurses were all relieved...

Upon, returning home I whisked myself to bed. I slept most of the rest of the day, and when I woke up, I was in no pain. Peeing was still a little weird and seemed to take forever. I was a little sore, and my incisions stung, but no real pain. I've only had orthopedic stuff done that involved bones, so this by comparison, was a breeze. Food didn't seem too appealing to me, still, but other than that I felt downright plucky. To my surprise, because I was expecting it, I didn't have any bleeding. I was however unthrilled to see that there was a 3rd incision just over my left hip bone. BJ swears my doctor told me this would happen if I needed any lesions or adhesions removed, but I apparently had selective hearing...Anyway, I was immediately in less pain after my surgery than I had been in for almost three months. My husband let me drunk-dial my boss (thanks, baby) and tell him I felt fine and could come in to work. He told me to go back to bed, and I did.

I was still pretty nauseous the next day and had some dry heaving. That was probably the worst thing. My ab muscles were really sore, so the heaving motion wasn't making me feel too good. My mother, who had come down to stay with me when BJ went to work, became obsessed with getting me to eat. Every time I tried, I started heaving so it really wasn't worth the effort. To control the pain from heaving my mom gave me a percocet, which in turn, also makes me sick. In hind-sight, I should have had my husband ask my doc for a prescription for phenergan...oh, time. Which is the unfortunate thing about endometriosis, there quite often is a next time as it comes back...especially if you don't get pregnant. Anyway, the final torture came when my mother tried to make me drink warm Jell-O. I've always thought my mom had a touch of Munchausen by proxy (crazy parents that get off on making their children sick), but the warm gelatin really sealed the deal. It didn't take 15 seconds to be up-chucking that heinous concoction.

The next day my doctor's partner called in some Phenergan for me. I immediately felt better after I woke up and was able to keep down some soup. I think I did have some weird discharge, but a super-thin panty-liner was more than enough to take care of it. My abs were still pretty sore, so I thought I was going to kill my husband when he wanted me to watch The Wild & Wonderful Whites of Boone County. Laughing was still not a pleasant situation at this point. Besides eliminating comedies from your routine and having anti-nausea meds on-hand, my other suggestion is to keep some cranberry juice on hand to help with any bladder weirdness, which I also had, but it wasn't bad.

By Friday, 4 days post-op I was ready to get out of my house. BJ had gotten a new job and we were in the middle of house-hunting during all this craziness.  I was then chauffered around several different neighborhoods and went furniture shopping. By late afternoon, I was getting pretty sore so back to bed I went. Saturday morning I felt great. I felt like a brand new person, and like an idiot decided to go for a run. I made it about 50 yards out of pure spite, but I was comfortable enough to walk a couple of miles.

I went back to work full-time on Monday and was able to really run by that Wednesday. We were even able to resume our procreation efforts after a week. Again, I can't say enough good things about my doctor. I never had the shoulder pain that people almost always get from the leftover gas used to inflate their bellies. I had immediate relief from my endo pain. He did a great job making me feel as comfortable as I could be. Thanks, Dr. B!


Friday, July 15, 2011

How I Got Here: Part 1, "You need surgery"

So, BJ and I had been trying to spawn, unsuccessfully for 6 months. During that time, my menstrual cycles continued to get more wonky. I had been on depo provera (the shot that lasts three months) for birth control for just over three years. My last shot was in August 2009, and my periods restarted March 1, 2010. From March to June, my cycles were 31 days apart. 'Perfect,' or so I thought...

June 2010, I noticed that I started having mid-cycle pain, known as mittelschmerz (leave it to the Germans). It wasn't terrible, just uncomfortable. Over the next few months this mitttelschmerz grew from mild crampiness to sudden stabbing pains that just kind of ripped through my torso without any warning. It seemed like I was constantly uncomfortable the majority of my cycle culminating with my menstrual cramps that were just unbearable at this point and every bit as bad as they we're in high school with cold sweats, nausea, and extreme pain. Luckily, they only lasted for 48-72 hours, which turns out to not necessarily be a good thing, either. Also my cycles had become more irregular going from 27 days to 35 and everywhere in between. This made trying to nail down when I was going to ovulate, next to impossible. To add to the fun, I was growing more and more uncomfortable during the act of trying to make this love child.

OK, so 6 months flew by (not at all, actually...) and I'm in my gyno's office with my husband. He told me I wasn't so irregular yet, that I needed Clomid. I took this kind of hard because I had it worked out in my head that Clomid was going to be my miracle cure, like it was for a friend of mine. One Clomid cycle and bam, she was prego. So then he asked about my pain. I was already starting to get embarrassed for wasting his time, (my doc didn't make me feel that way, I just am sensitive about coming off as a malingerer) and, as I mentioned before, started in with my gloss over about how I survive. The 1000mg of ibuprofen every four hours caught his attention, and BJ was able to involve himself in just how bad my periods were.

My periods had been this way all my life, so I didn't know any differently. Anytime I mentioned it to a medical type, I was dismissed. I had never considered endometriosis because I incorrectly assumed that I would have sporadic mid-cycle bleeding which I never did. I was really angry that three different doctors never took the time to find out just how much pain I was in. Take-home lesson, if you're in pain, go ahead and whine to your doctor until he listens. Oh, and extremely painful periods are not normal or "just part of being a woman." You have my permission to slap anyone who says that to you...

My doctor wanted to perform a laparoscopy. He described it as a "band-aid" surgery, and I'd have two small incisions, one in my belly button and one just over my pubic bone. The surgery is the only way to diagnose endometriosis (endo for short) as it doesn't show up on ultrasounds. I was a little shocked that exploratory surgery was necessary, especially when all I wanted was Clomid.

After taking a week to think about it (da Nile ain't just a river in Egypt), I decided to go ahead and schedule the surgery for February 8th, just after when I expected my period to end, like my doctor wanted. My doctor called me back and explained that in addition to the laparoscopy with possible endo lesion removal I was going to get the full spa treatment. He also wanted to do a hysteroscope, possibly a D&C, and the chromotubation. (I explain these in more detail in my "so you decide to get help" post.) I was kinda like, 'hmm you conveniently left all of this out.' Whatever, I want a baby...

So I sat down with my boss later that week and told him that I had to have surgery. I have found that if you have male superiors, a few tears, throwing out words like vagina and ovaries, and mentioning gynecologist pretty much will get you what you want. He, bless his heart, mentioned that between his two daughters and wife, had a lot of experience with malfunctioning female parts. I have been very blessed to have quite a number of amazing friends, co-workers and relatives who have been such great cheerleaders.

January came, and I spent my spare time charting my symptoms, still trying to procreate, and researching endo. Holy bananas! I had no idea that all this extra pain I was having was related to my possible endo. If it's not bad enough to be in terrible pain for three days out of every month, it also hurt like hell to go to the bathroom. I had found over the previous couple of months that if I did not eat or drink anything while on my period, the pain wasn't quite so bad. I wanted to take as much pressure off my lower abdomen as possible. Who knew this was yet another symptom of endo? I was constantly having what I would describe as a sinus headache of the uterus. I was getting pretty miserable and had been having a lot of trouble staying asleep. I would be woken up with random cramps and pelvic pain in the middle of the night, and not be able to go back to sleep. 'Snot fun.

I also started reading message board responses on infertility sites about endometriosis and surgery, and came out rather horrified. Things in the wrong place, glued to the wrong parts with scar tissue and never working again. Holy crapola! So then I made the mistake of asking my nursing student friend about the surgery and she spouted off facts about ectopic pregancies being more common with endo and sometimes the only thing that could be done was a hysterectomy. Now, I was certifiably scared. Then she tried to soothe me with "It's no big deal they do laps all the time. Oh, and you'd be shocked at the number of people that just walk in and out of the operating room." Oh, geez...The idea of being under anesthesia in stirrups has never exactly been on my bucket list. Now I got full body shudders every time someone mentioned my surgery...still do, ick!

February 1st came and went, and so did the 2nd, 3rd, 4th and 5th...but my period never came. As if I needed anymore problems! My secretary told me about the old wives' tale of parsley inducing your I tried sucking on Parsley for the rest of the week (desperate and super-yuck), but I ended up having to postpone my surgery to the following week. On Friday the 11th, still nothing and I had not slept because of my cramps for two nights. I felt awful and started puking in the middle of an in-service meeting. (I'm sure the director thought I had a hangover...*sigh* if only). I called the nurse and she asked me to come in and do some labs and see my doctor. He explained that I might have to take Provera to induce a period or that I could be pregnant and it was just too early to detect with a home pregnancy test. The last thing I needed was to get my hopes up about being pregnant. He slunked back in after he got my labs back and told me it was negative and he was sorry. He was reassuring in the sense that this stuff happens a lot and I could reschedule as many times as necessary. He also gave me a prescription for Lunesta, and I slept really well for the first time in 2 months.

And lo, the next morning my period came after just 43 days... I guess I just needed to be scared into it. Surgery, then baby, here I come!