Keep your head up.

This is a good one.  An infertility diagnosis is not only sad, it can be humiliating.  Something that comes so easily for what seems like all of your friends and family makes you feel like you should be embarrassed.  In reality, it does make it hard for a lot of people to relate and empathize with what you are going through, but that is no reason to be ashamed.  I've said this before, but it's one of the best things my mother ever said to me through this journey...You wouldn't be angry at yourself if you developed cancer.  You did not ask for this, but you have to accept it.  The sooner you realize that you have a disease, and it is something you have to deal with, then the more energy you can put toward resolving it.  

As for the heels, well, at my height [in the area of 5 feet above the ground], they are practically considered orthopedic. So yes, I wear heels a lot, even to my reproductive endocrinology appointments.  I know you may feel sad, want to put on sweats, and hide yourself in an over-sized hoodie, but I urge you not to.  You, not your husband or significant other, ultimately has to continue taking care of yourself.  Sometimes just going through the motions of putting on your war paint (what my daddy calls make-up) and your cute little outfit makes you feel sassy and battle-field ready. Even when you thought there was no way on earth you could feel that way!  From the MK school of counseling, there is a lot to be said for "Fakin' it 'til you make it!".  I certainly must encourage you, as you pursue fertility treatments, to keep a list in your mind of all of the things you have going for you and go over it every day.  I, personally, am thinking about making a poster and tacking it on my ceiling so I see it as soon as I wake up.  A list by the bed would work, dry erase marker on your mirror, I'm sure if you pinter-stalked around long enough you could find some totes cute ideas! 

I digress...don't forget what being dressed up does for you.  It's easy to be intimidated by a doctor with an alphabet soup behind his or her name of credentials.  Don't be intimidated.  Remember the doctor is on your team, and you are the team captain. So if it takes being dressed up to give you the confidence to speak with him or her, then definitely go for it!

Speaking of doctors and standards, let's talk about them.  Unless you live in a large urban area you may not even have a fertility clinic in your hometown.  Heck, I do live in a larger city with a teaching hospital, yet the closest clinic that does IVF cycles consistently is over an hour and a half away.  So, I urge you to start doing your research.  It may be that your problems can be resolved with medication prescribed by your regular OB/GYN, or it is a reasonable starting place for your given diagnosis.  If they are willing to do the monitoring and IUIs, make sure you find out what their protocol is and what they would do if you ovulate on a weekend. Also, don't be afraid to ask what their success rate is. If they are flexible, have someone willing to come in on off hours to perform the IUI, and have a decent amount of success with IUI's with people diagnostically similar to you, then by all means go for it and save yourself a commute.  That being said, you are probably going to be hard pressed to find a regular OB/GYN who does all of that.

When you start pursuing fertility treatments it is an investment, especially with IVF.  You deserve to know that your money is being well spent.  I encourage you to use resources like the Society for Assisted Reproductive Technologies (SART) published success rates.  Every IVF cycle is going to tell you more about your diagnosis.  So go back to this site often with your new information.  You can sort the data by your age group and diagnosis.  If there is a clinic within a reasonable amount of driving distance that has better results for your given set of conditions...get your hiney over there!  ESPECIALLY note that there are probably plenty of clinics that have just as good results as Colorado Center for Reproductive Medicine (CCRM) and Sher Institute of Reproductive Medicine (SIRM).  In fact, my little clinic in East Tennessee has better stats in some areas than Dr. Schoolcraft at CCRM.  You will probably be quite surprised at the number of clinics that do have as strong of stats as CCRM.  

So you bet the first thing BJ and I do is check out the new data when we are ready to resume our efforts before we make the first call to a fertillity clinic for an appointment.  As much as I love the Fertility Center, Pat, and Dr. D, another doctor may be having better results from a slightly different protocol that he has experience performing.  Another mark of a good clinic is that your choices will be supported, even if it means finding a new doctor.  I already know I have Dr. D's blessing to try somewhere else.  Ultimately, he wants the same thing as BJ and I very much do...a baby of our own.  

In Summary:

1.  I hope you never have to make these decisions.

2.  I hope if you find yourself in this situation, you never forget the blessings you already have.

3.  I hope you find a caring physician that you can work well with and a caring staff who is equipped to meet your needs both in experience and success rates.

Peace, Love and Keep That Chin Up, Lady!

MK

Slow and Steady

I must say for a "small town", we Knoxvillians are pretty lucky.  As I was having my blood drawn again by the new andrologist, Diane, I noticed she had a Yankee northern accent.  I asked where she was from and she said New York.  She worked at a fertility center in Manhattan that claims to be one of the top clinics in the world.  (It does have some amazing stats, but they are the same as my clinic's, FYI...and if you compare Donesky's 20-40 cycles a month to their 200+ a month, the numbers seem better for Donesky!) She has degrees and credentials after her name to make the alphabet look short.  She was looking for a change of pace and a more personal approach to the chaos that occurs in a "top clinic in the world."

A Google search will tell you that the top clinics are Cornell Reproductive Endcrinology (CRE), Sher Institute of Reproductive Medicine (SIRM) and Colorado Center for Reproductive Medicine (CCRM) [This is where Guiliana and Bill Rancic were going when they found out she had breast cancer if anyone watches E!.].  These clinics thrive on IVF tourist patients but, you never become more than a number.  It's like a cattle call...NEXT!

So anyway, we have an experienced andrologist right here in town who's an expert in her field.  Who knew?

Since Diane is fairly new to the clinic, I asked her what she thought of it.  She said she is impressed with Dr. Donesky's research and that he was very progressive compared to even her former Manhattan clinic.  Again, who knew?  I also found out that Dr. D is a bro to one of the doctors at CRE which many consider the best in the country if not the world.  Furthermore, I found out Dr. Donesky's nickname is "The IVF King" here in the Southeast.

I'm getting in to all of this because I have occasionally thought maybe I need to get out of East Tennessee to get help.  The thought of adding the stress and added cost of traveling to this process has been a huge turn off, but the cattle call idea is even worse.  If I need anything, it's support and opportunities like I had today to ask questions, even hard ones.

I took advantage of Diane's huge clinic in Manhattan experience and told her about my last cycle.  I told her my estrogen levels from last cycle and she said they sounded fine.  I told her about all my eggs being "slow growers" and not making it to the blast stage and she immediately said it sounded like they might have been a little immature.  Immature eggs can be fertilized but they have fragile DNA that tends to fragment...sound familiar?  My LH levels and my estrogen levels were getting high which would overcook my eggs.  Dr. D had to make a call, or I may have ovulated on my own and lost all my eggs, so he decided to trigger then.  Looking back, I knew he must not have been happy with the cycle because he was very eager to tell me that he would change things up if the transfer did not work... Not being an MD myself, my theory is thus far, that the Lo-Loestrin did not suppress me enough and my ovaries did not get in line and follow orders.  This time, Dr. D made damn sure my ovaries were suppressed and subservient.

The unfortunate thing is that this is still far from a guarantee, but it is my pleasure to tell you that things are still going quite well and better than last time.  I still have 10+follicles visible that are just over 1cm on each ovary. This is more than last time, and they are still growing more evenly.  My E2 (estrogen) level is 435, which is exactly what it was on my first monitoring appointment of my last cycle.  This is perfectly good for my number of follicles at this level of development.  My LH is now 1.18 which is less than half of what it was at my 2nd appointment from August and my Progesterone is at .361.  Jan, my IVF coordinator, has gone from saying the numbers, "Look good," to, "Everything looks really good!"  I am more achy in my abdominal area than I was at this point last time because I have a lot more follicles growing away.  They are putting some pressure on my ovaries, and it's not super comfy, but hopefully this is just a taste of the discomfort I'll have in the future.  

Peace, Love and Lookin' Good,

MK

When to get help...

If you look at resolve.org (Resolve is the National Infertility Association here in the US), their official recommendation is to seek help if you have not conceived after a year of unprotected sex and you are under the age of 35. Those 35 and over should seek help after 6 months. In the general population, according to my gyno and RE, you would expect that 60% conceive after 6 months, 80% by 9 months, and 92% after 12 months. After a year, you get to the point of diminishing returns. Only 2% of the remaining 8% actually conceive on their own over the next 6 months. It goes down hill or actually, over the cliff at this point. I believe it is something like 0.2% of the remaining 6% conceive on their own by 24 months.

When you get to the 12 month mark with no success, you have every reason to be concerned. Or, if you know you have something wrong with you, like polycystic ovarian syndrome (PCOS) or endometriosis, you have every reason to seek help sooner than later. I am constantly shocked at the number of women I meet in the waiting room (on the extremely rare occasion that anyone is talking to anyone else in the waiting room at the fertility clinic I go to) or on message boards that have tried for YEARS on their own. It's not unheard of for someone to go 4, 5 and even 7 years before seeking help. WHY???!!!

Let's face it sister (or partner to the sister), if you haven't made a baby in 1, singular year, chances are high that it ain't gonna happen. Hand yourself a tissue, cry, and then call your doctor, please! It doesn't necessarily even have to be a fertility specialist (RE) at this point. Your regular ob/gyn probably has several tricks up his or her sleeve. If nothing else, he can probably get some initial tests run for you and refer you to an RE in your area.

What if you don't want to wait a year? Well I sure as heck didn't. Most fertility clinics don't require you to wait a year. Some may have wait lists that are up to a year long. If you live in a densely populated area, I definitely encourage you to call sooner rather than later. You can always cancel. Your ob/gyn shouldn't mind if you request an appointment before a year. If he or she does, do yourself a favor and see someone else. You're paying them, so why not?

For me, I started to get really concerned after 3 months. June 2010, the first month we tried I was really disappointed. In July I tried keeping track of my basal body temperature. It was no help, and I was sad. August (third time a charm month) I used an ovulation predictor kit (OPK). It didn't help us out any, and I was angry and worried. I ordered a Clear Blue Fertility Monitor at the hefty price of $159.00. The sticks you peed on cost $50.00 a month. Each month I madly calculated out my ovulation date and potential due date, which was hard since my periods were becoming more irregular. However, in September, my due date, if I were to conceive would have been June 11, my birthday. Of course my kid would ruin my birthdays for the rest of my life! It makes perfect sense! I was sure that between my monitor and Murphy's Law, it was our month.

It wasn't. I was devastated. I knew something wasn't right. My first clue, I've had since I was 15. TERRIBLE menstrual cramps that kept me up all night, occasionally out of school, and hurt so bad sometimes that I would vomit. The only thing that I found to help was pacing back and forth with a heating pad on my abdomen. I would tether myself to the wall with an extension cord and the heating pad and spend about two hours in the middle of the night walking back and forth in my room. One morning during a particularly bad month, my mom found me still pacing when she came to make sure I was getting ready for school. An appointment was made with my pediatrician, much to my disgruntlement. As if being a teenage girl wasn't bad enough, now I have to share my female issues with a fifty something old man...Thanks Mom!

My pediatrician who I had always hated, anyway, was rather unimpressed. His advice was to take ibuprofen and to make sure I started it before the cramps began. Well good luck to me! I usually had a period every calendar month, but it could have been the first of one month and the 30th of the next. My only clue that I was about to start was cramping. So it didn't work until I tore my ACL doing gymnastics the next year. As luck would have it, after my ACL reconstruction surgery I consistently took ibuprofen all the time. It counteracts the prostaglandins which cause the cramping. For the rest of my gymnastics career that went through college, I ate ibuprofen almost all the time for injuries, soreness etc. My cramps did, for the most part, go away. However, when my gymnastics career ended, my ibuprofen habit squelched, and my cramps came roaring back with vengeance.

Fast forward a few years and two different gynecologists that told me cramping was just part of being a woman, I started using depo provera (at the recommendation of a friend, actually) which eliminated my period and thus the pain. Free at last!

Skip ahead to October 2010, married and trying to procreate. I also noticed that my cramps were starting earlier. My period was coming a lot sooner than my fertility monitor would predict. More red flags!

Mostly because I was afraid of being laughed at, because even my mother thought I was being rediculous for panicking this early. I waited until December to call my gyno, trying all the while. I set an appointment for worsening premenstrual syndrome. My doc already knew we were trying to conceive, and I took my husband with me. Thank God I did.

My doctor told me it was ok that I hadn't conceived yet and gave me the stats I opened this post with. He asked about my cramping and after being told it was nothing by three doctors at this point, I started with my usual gloss over. I just take 1000 mg of ibuprofen every four hours and use heating pads and patches, and I move on with my life. My doctor was like, "How much ibuprofen? How often?" My husband chimed in at this point with an, "it's bad." My doctor and my husband got into a detailed conversation with each other while I sat there with a sheepish look on my face hoping they would eventually remember I was still in the room. Sheesh! At that point it was decided that I would need an exploratory laparoscopy, and I sat there stunned. All I really wanted was a miracle drug that would get me pregnant! Not surgery! Ahh!

Well, the point to this post/non-fiction novella was to encourage you to get help sooner rather than later. Follow your gut. If you think something isn't right, there's a distinct possibility it isn't! Especially you lovely ladies that are starting the conception game with a little more life experience...get help sooner. I don't care if you look 22, but you're really 37. Your ovaries look 37, and you are wasting precious eggs. Why be embarrassed? You wouldn't be embarrassed if you had cancer! All these doctors do all day is help lovely ladies like you. You aren't gonna tell them anything they haven't heard, or show them anything they haven't seen. You have nothing to be embarrassed about and every reason to get yourself help so you can have a beautiful baby and move on with your life!

Well, I'm off my soap box and being handed a margarita! Perfect timing! (I'll explain later...)

MK