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

It Just Got Real

If you haven't read the previous post, I'd recommend reading that before continuing.

I'm known for being an emotional man. I cried at my wedding rehearsal, much to the horror of my wife and mother-in-law and the surprise of the gathered family and friends. I cried at the final episode of Lost. I cried watching Marley and Me (but honestly, who didn't??).

But only once, before today, have I cried since this whole journey began. I forget what the context was (after one of the failed IUIs, I think), but MK was really upset and I might have allowed myself a tear or so in front of her. I waited until I was alone that I let the rest out. I never wanted to cry in front of her. I needed to be strong for her.

Today, it got real. This might not work. When they told us that none of the embryos may be frozen, it hit me. We weren't expecting this. Not at all. All of them? Why? How? It was a wave of emotion when I saw the disappointment in MK's face.

I held it in through the procedure. I saw the picture of the two proto-babies they were inserting and said a silent prayer.

It was when we got to the recovery room and we were left alone is when I looked down at MK and couldn't hold it any more.

I always said that I wouldn't be upset until we were out of options and the Doc would finally say "That's it. We're done." It's when we were done with all the natural/science options is when I would be upset. Until then, there's options. There's hope.

Now, knowing that there's a chance that those embryos might not make it to freezing, it got real. I am hurting for those dozen or so almost-babies. I'm hurting for MK. She's been a real trooper through all this.

So just the two of us. We cried together for the first time. After a minute or two, I realized that there's still hope. There's two bundle of cells that might become the next little baby (or babies) Roberts. As long as there's hope...

And we're off....

To the races that is...

I want to start by saying thank you so much for all the prayers and support.  It is really touching when so many people tell you they're thinking about, praying, and wishing you good luck. My phone kept lighting up at a training session today and my table-mates thought I was really popular...or as shallow as the middle schoolers they work with...hehe! 

I had some bloodwork done and a follicular ultrasound today.  I was pretty nervous/anxious so it was a long day.  Pat, my fearless leader through this forsaken journey, was the only one in the office today.  It's nice to think there aren't tons of us fertility-challenged hooligans running around so they can devote enough time to us.

Pat was having a good day because it only took her one attempt to hit a vein.  Her record is 9 attempts my first time having my blood drawn by her.  She told me she's nervous about Monday because she doesn't want to keep using the same vein.  It's starting to scar where they've used my one "good" vein over and over.  It kinda makes me feel like an IV drug user...my veins are going bad...ahhh!  As long as they don't have to go between my toes, they can stick me however many times they need!  

Besides the normal estrogen level (E2) they usually take, they did another CBC to check for anemia as well as some other stuff.  All the prenatals and beef I've had over the last couple of months have paid off, apparently.  My levels were all good!  And all the crack I've been smoking is completely out of my system (I'm joking, again).

My follicular ultrasound was the nerve-wracking event for the day.  I was hoping for nice smooth ovaries, but it was not so.  I have 10+ follicles on my right ovary and 12+ on my left.  They were all measuring small (under 10 mm).  I was a little freaked out, but Pat was very excited.  She even jumped up and down a little which, under the circumstances, was a little rough for me as it was an internal ultrasound.  God, love her.  Anyway, I learned it is good, actually great, to have follicles this early. So yeah for small miracles!

I'm well on my way to 20 eggs, which is what Dr. D is expecting from me b/c I'm so young and vibrant. I'm hoping that this also means it won't take as long to get to the egg retrieval which would be fantastic because it's just that much sooner until we know what we've got.  And I'm sure my boss wants me to get this the heck over with so I'll be back to my awesome self.  (As if I'll be a pleasant, happy-go-lucky, pregnant lady...Well, who am I to squelch his dreams?)  So here's hoping for a quick and productive cycle! Cheers!

All this means that BJ and I start our Z-packs tonight.  This will clear up any VD that BJ has...I'm kidding.  It's just a preventative measure to make sure we don't get sick or clear up any sub-acute infections that we may already have.  It's good timing too, because I'm starting to get that East Tennessee sinus thing going on.  Plus all my little germy children come back to school in a week so I've got that covered, too.  I almost think a Z-pack should come standard to all school employees with school restarting. It could work kinda like the iodine pills they give people who live near nuclear plants...

Any-some-how, tomorrow I begin my Follistim injections and my Menopur.  7:00 am and 7:00 pm, so I'll definitely have some interrupted social time...sigh...or I could do it at work, but I think that would be a little more awkward having to keep my Follistim in the staff refrigerator...But in perfect MK fashion I have a cute little case in which to keep all my medical supplies! I just can't help myself...

Again, thanks for the so many well-wishes!  I really do appreciate them and I'm very blessed to have so many supporters in my life.  Love you all!  I'm going to go practice injecting something into BJ...bwahaha! (I want him to feel included, afterall.)

Your's truly,

Mary Katherine

Dunderheads

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.

(From webdesign.org)

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!  OMG...as 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?     

TTFN,
MK