IUI Round 2

So, today was our second round of IUI, this time with Dr. P (the fertility specialist). The experience I had today and the days leading up today felt really good. What I like the most about the specialist's office is that they give you so much more instruction that you feel very confident going in to the procedure. More confidence = less stress which is what everyone tells me I need.

I'll start with the ovulation tests. I did use the Clearblue Easy sticks this month instead of the monitor starting on day 8 (which the nurse told me was this past Monday, again leaving me with no guesswork). I had two days of low fertility (day 8 and 9) followed by two days of high fertility (day 10 and 11). I called the nurse when I got the first high read (which is signaled by a blinking smiley face) and we both expected that I would "surge" on Friday (day 12) and do the IUI on Saturday (day 13). Friday morning came and my smiley face was still blinking at me, which of course led to minor panic that these tests were not going to read correctly, just like the past two months.

Luckily, the nurse for Dr. P had already scheduled a day 12 ultrasound for that morning. The ultrasound is meant to check the maturity of your eggs (follicles if we are being technical). I went in and I had four eggs brewing!!! And this time from my left ovary. I had always thought that the ovaries switched back and forth month to month (such a team!) but the nurse said not necessarily. However, mine did and I am super excited about the multiple eggs, which means the femara was working (without side effects so far).

A little surprise came in the form of an injection called Ovidrel. I wasn't expecting to use an injection this first month, but after Dr. P looked at the ultrasound he thought it would be a good idea to essentially force the eggs out. I was instructed to inject on Saturday night (they were specific, between 8pm and 9pm), which would induce my LH surge (the hormone surge before ovulation). The expectation is to get the surge next day (day 14) and do the IUI in the morning of day 15, right as the eggs are popping out.

I had plans for a girls night in with my friends, Anne and Jess. I do NOT want to become that person that doesn't go out and have fun because they are so wrapped up in the procedures and timing and medicine, etc, etc, etc. So, I told the girls post dinner I was shooting up. And, because they are such great friends, they not only didn't care but urged me to videotape the injection and helped me through it. I was a little nervous about self-injecting, but as a pharmacist I have counseled numerous diabetic patients about how they should not fear the needle, so I couldn't really chicken out and have someone else do it. Below are a couple pictures and then the video of me injecting. And no judgement on my stomach, we just finished dinner!!!

Ovidrel box. Kept refrigerated until time to use

Prefilled syringe. You let it come to room
temperature for 20 minutes before injecting

Link to ovidrel injection video:

 http://youtu.be/3Jp2680suKc

Don't you know, low and behold my ovulation test showed peak fertility the next morning, meaning I had my surge, meaning the injection worked! I had set up an appointment for the IUI for 9:00am this morning once we established our plan on Friday. We had to go to a separate lab to get the sperm wash, which was to take about an hour and 20 minutes. My last IUI, they only washed the sperm for 15 minutes. I don't know if that makes a difference, but it seems like it should. As you probably were wondering, yes poor Travis had to produce a "sample" at 6:30 this morning. That is very early to have to produce anything, especially under a time constraint and pressure. 

Solid smiley = Peak fertility!!

Travis with his concentrated "seed." 

                       

We dropped off the sample and walked around downtown for a little bit, got some coffee and went to breakfast. I really enjoyed this time we got to spend together and it helped ease the anxiety of the procedure. Plus, I'm sure huevos rancheros can only help fertilization along. The rest of the  procedure was all pretty technical, picked up the concentrated sample, took to Dr. P's office, got in my stirrups and let the doc do his thing. They had to tilt my cervix again, just like last month, because it wasn't letting the catheter through, but beyond that hiccup the whole procedure went smooth and quick. They had me lay on my back for 10 minutes afterward, just as they had the first time.

Here is the best part of the whole experience. My mom had heard from a friend of ours in Pittsburgh, who is a nurse, that it is important to be on bed rest for the rest of the day post-IUI. All of the docs poo-poo this and say you can go on with your day like normal, but who wouldn't want to take the advice leaning towards rest and relaxation! Plus, you don't really argue with my mom with certain things, potential grandbabies being one of them (reference text below). While I don't think there is a whole lot of science to the theory, my guess is that it goes along with the whole "your body is too stressed and that makes the environment difficult for conceiving" theory, which I believe is probably pretty accurate. Of all the couples I know that have faced infertility, most are driven A-type personalities that probably don't know how to take a day off to relax. Myself included, I have had to work hard to be lazy today, if that makes any sense! Now all I have to do is continue to relax and try to just enjoy myself for the next two weeks. Fingers crossed!

Fertility Testing - Intermediate Level

I've been meaning to write this post for a while but it got pushed back with all of the crappy emotional stuff last week. I went a few weeks ago to a fertility specialist, Dr. Pasquarette, to basically move on to the next phase of fertility testing and treatments. I received a lot of information that I am excited to share!

There are two fertility specialists in Wilmington, NC (for those of you reading locally), but Dr. Pasquarette is the only nationally certified specialist. I had heard from a number of people that he is the best to use, although he had a personality that was just....off. I figured if I'm going to go spend all this extra money and go through advanced treatments that it probably needs to be with the best I can get. I called the office back in April and could not get an appointment until July 2nd. This was frustrating but also a sign of how good he is.

July 2nd came and I actually got to my appointment 10 minutes early which NEVER happens with me (just ask my husband, he LOVES how I'm always late for everything). I walk in, give my name, had my ID and insurance card ready and then the receptionist tells me I had cancelled my appointment. Just as any mature, professional young woman would do, I started crying right in the middle of the waiting room. Thank you Clomid. I knew, with complete certainty, that I had not cancelled my appointment and I just went in to a panic that I would have to wait three more months to see the doc.

Luckily the crazy worked and Dr. Pasquarette said he could squeeze me in at the end of his lunch. He even offered to share his fries. Good doc! Just an FYI, as it turned out, the appointment that was supposed to be after me never showed up; when they called her she said she had cancelled. That was nice because it helped make me look less crazy, at least I hope it did.

So, to get to the actual point of this post, here is what we went over. Dr. Pasquarette explained a number of tests that we could run, but, in his own words, "they were bull shit". He talked that way to me the whole time, as if we were just chatting at a bar or something, which I loved. I could see why others would be turned off by this demeanor though. The "bull shit" tests that I remember him talking about were the post-coital mucus test (talked about previously) and laprascopic surgery (this is not bull shit for every person, just in my case because I have no history or signs of endometriosis and had a clean HSG scan). After going through mine and Travis's health/family history, he confirmed that nothing stuck out as a cause of our infertility. We came up with the following three options:

1. IUI with Femara or Clomid with possible addition of a trigger point injection (I am not 100% that this is the right word, but it sticks out in my mind so we'll go with it. Essentially, it's an injection that makes your eggs pop out of your ovaries, i.e. forces ovulation).

2. IUI with injectable meds

3. In Vitro Fertilization

I LOVED that he gave me the options, instead of just following a strict order of directives. We decided to go with IUI + Femara for the next two rounds and then increase to addition of trigger point for the two rounds following that. Him and his staff were so detailed in how to proceed, it makes me feel so much more confident in what I am doing. The instructions for this round were:

1. Call office on 1st day of period/cycle day 1- they will then call in Femara (2.5mg 2 tabs daily on days 3 through 7)

2. Start Femara on Day 3 of cycle

3. Start testing for ovulation on Day 8 of cycle. He recommended using the ClearBlue Easy, but not the monitor I had been using. He likes using the sticks which are $44.99 for a pack of 10 (1 month supply). I did start using these and they are a little more user friendly than the monitor. You can test any time in the morning, not just in the set 4 hour block, which is nice if you have to pee early or sleep in later than you were supposed to (both of which I was prone to doing). You get a plain circle for low fertility, flashing happy face for high fertility and solid happy face for peak. Overall, it gives you your 4 highest fertility days versus 6 with the full monitor.

Pic of ovulation test on day 10 (today), can't see the flashing. High fertility!

4. If I have not reached peak fertility by day 12, come in for an ultrasound, where they will measure the maturity of my eggs. I would repeat this every 3 days until I got a peak reading

5. Call office on the first day of peak reading (solid happy face). They will schedule the IUI for the next morning. We have to go to a lab to have the sperm "washed" for 45 minutes and then bring that sample to his office for the IUI

He also set me up with a couple additional tests (apparently non-bullshit). He was adamant about me getting a blood test to check if I was a carrier for cystic fibrosis. He also wants Travis's checked. I told him that I had thought you were only supposed to do that once pregnant, and he brought up the point that wouldn't it be too late then to make alternative decisions. For instance, if Travis and I would both come back as carriers, we would have a 1 in 4 chance of having a child with cystic fibrosis. They usually recommend going straight to IVF in this case (not exactly sure why) or some couples may change their mind on having a child. I have not received my results from this test yet, but I am glad he recommended it and I wonder why more docs don't?

We did a sonogram as well to check out my uterus and ovaries and make sure there were no blockages or other issues going on. It gives a different view than the HSG apparently. The sonogram was fascinating, once I figured out what was what. Everything was good but my right ovary was six times the size of my left. They said this is normal with clomid as the ovary that is ovulating that month will likely be spitting out some extra eggs. They saw three. I also had a "fluffy" uterus, which is a good thing! This test ended up being part of the reason I thought I was pregnant last month, which kind of sucks, but interesting none the less! Here are some pics of the sonogram:

Left ovary (i.e. puny, lame ovary). This is a split screen
shot. You can see the size better on the right side shot.
It is the dark acorn looking thing towards the
right corner. There are two lines measuring the size

Right ovary (i.e. super ovary!). It it at the top of the pic,
you can see the thin lines measuring it.  Crazy big compared to above!

My fluffy uterus. Again, you can follow the
lines to see the measurement.

I will be going back to Dr. P in a couple of days once my ovulation test peaks and I look forward to sharing more updates on this new experience!

Tough Break

It's taken me a few days to get back to this blog and to be honest I really didn't want to write tonight. I had a pretty tough past week and I just didn't want to do any more "work" related to trying to get pregnant. But, I think the disappointments need to be expressed, along with the good stuff in order to get a truly accurate picture of the process. So, here goes.

As you all know, Travis and I had an IUI done a couple of weeks ago and this past Saturday was supposed to be day 1 of my period/new cycle. Leading up to this past weekend, everything seemed to be falling in to place. I got my FSH level from the doc (follicle stimulating hormone) and it was 60.8 which is an amazing read. If trying to get pregnant, the goal is to be >10 and on clomid >20. So I knocked that baby out of the park. The reading was done through my ob-gyn and they told me I should take a pregnancy test. I told them no, I was waiting until Monday (about 6 days later) because I had promised myself that I would wait until I was sure I had missed my period. My acupuncturist used a bunch of different needle stick sites during my session last week and told me to relax and avoid lifting anything heavy. Also, the infertility doc (which I am excited to post about next time!) did a sonogram and the epithelium (lining) in my uterus was "fluffy" (which is apparently good) and it showed I had ovulated and there were 3 follicles (eggs).

Armed with all of this info, I became extremely hopeful. At the same time, my boobs started to hurt, my lower back ached and I started feeling really tired. I stopped drinking any alcohol or caffeine and tried to eat a lot of fish, as directed by the acupuncturist. And then came Saturday. I woke up and had one tiny speck of blood and got really upset assuming my period was starting, like clockwork as always. But then, it went away! And believe me, I checked and checked and checked. I had to work that day and probably went to the bathroom once an hour, I hope nobody was tracking! I stayed period-free that entire day and got  even more excited.

On Sunday, I started getting spotting but when I looked it up, it resembled implantation bleeding EXACTLY. Implantation bleeding occurs a couple of days after the fertilized egg implants in to the walls of the uterus, is fairly common and usually appears as dark colored spotting. When my period starts, it is like a tidal wave and usually involved a lot of cramping, which I did not have, so I summed it up as the implantation bleeding and continued to be excited.

Sunday night I could not sleep, I was so excited and nervous. So at 12:15am Monday morning I got up to take my pregnancy test. And it was negative. And then my period started, literally within hours of taking the test. My body had just played a mean practical joke on itself.

I just don't know if words can truly describe the heartbreak that this brings on. The disappointment is overwhelming, I feel like an idiot for thinking I had pregnancy symptoms and it honestly feels like someone has died. It is that burning pain in your heart, an actual physical pain, that I have only really felt in the past when I've lost a loved one. I know nothing actually died, but in my mind for that past week I was pregnant and then with one test I was not, so in that way my baby died. And all that hopefulness that I had created over the past week, just led to a bigger fall this month. Travis had warned me all week not to get my hopes up to high and I wish I had been able to listen to him.

I couple this sadness with fierce frustration. How can this be that hard? We literally put over 100 million sperm right where they needed to be, pumped out three different eggs and provided the most nurturing environment for implantation and growth. I can't wrap my mind, rationally, why this can't work other than my body just can't sustain a pregnancy. This is the fear that I cannot shake this month, even now that the sadness has mostly gone away. 

Top 5 Things Never To Say To An Infertile Couple

I want to preface this list by saying, if you have ever said these things to me, I am not mad at you! I know when people say the following it is with best intentions and I love you all for it, but let's just agree not to say them anymore :)



5. Don't worry, you're next!

This one isn't quite so bad, because it is an encouraging statement. Here is the one problem, us "infertiles" have heard this the past x number of times and we have NOT been next. In my case, I heard this a lot right after we got married and then it died off as people started to realize that we were in fact not next! 

My best friend, Jess, told me one day when we were talking about my issues "I have a feeling you will get pregnant this summer." I really liked this statement, and I of course would not hold her to that (or maybe I should, what could I get out of it?!). The "you're next" is kind of generic but setting a time frame like that makes the person feel like you really do think they will get pregnant soon. Also, hearing a concrete time frame, like "summer", made the statement individualized, like she wouldn't just say this to everyone thinking about having kids. These type of statements are a much better way of telling someone essentially "hey, I'm on your side, it'll be soon."

4. You know how it works right?

This one only stings if you say it at the wrong time of the month. If my period just ended and I haven't gone Clomid crazy yet, I can laugh along with this one. If I just got a negative pregnancy test or my hormones are raging, I might try to take you out. I'm assuming this statement is usually used to try to lighten the mood or keep the conversation funny, because obviously everybody knows how having a baby works (you just keep your window open and hope the stork flies in, duh!). My advice for this statement is proceed with caution! Make sure you REALLY know the person or have a good gauge on their mood/temperament before going there.


3. Everything happens for a reason.

This might just be me being bitchy, because I know this is a popular saying, but I just hate this quote. Even though it may be true, it still doesn't mean anything to the person struggling through. If you dare say this to me, you best follow up with the exact reason. I think that is a good rule of thumb, if you don't have the reason, don't tell me there's a reason!

2. It will happen when you're truly ready.

This one is truly a punch in the gut. Again, I'm sure intentions are good and sure it could be true, but this statement basically says to the person "you aren't pregnant yet because you're not ready to be a parent." Unless the person you are talking to is a serious degenerate just don't say this one. EVER. It's not helpful. Promise!

And now for the #1 thing to NEVER say to an infertile couple.......

1. Just stop trying

Uuuuggghhhh, where do I even begin with this statement. First, there probably was a good, long point where we weren't trying. Second, there is not a switch that we can pull to turn off wanting to get pregnant. Believe me, if I could I would. It is not fun to take medicine, stress out for two weeks and go through the heartache of another failed month. When a couple is ready to stop trying, they will; your advice will not sway that decision. This statement gets double bad points for those that follow up with "that's how I got pregnant." A better way to approach this type of mentality is to ask "what kind of relaxation techniques have you tried?"

So, now you know! No excuses anymore for any of these things to come out of your mouth! What are some other good statements you all have heard?

Small Victories!

When you are dealing with any sort of disease or ailment, it is hard to not just focus on your end goal. In my case, every month if I don't get pregnant, essentially I fail to beat my disease. It's easy to imagine why this would be depressing and frustrating, which are pretty common emotions in couples with infertility (mom, if you're reading this, I'm sure you can appreciate my use of people first language right there!). One good thing about writing this blog, it forces me to focus down on certain topics, and that has made me realize that I have achieved a lot in terms of "disease management", even if I haven't achieved the end goal.

I am one week post-IUI, which is also one week post-ovulation. I went back to my ob-gyn today to get a blood draw for a progesterone level (I'm also pretty sure they wouldn't know what to do without a weekly call or visit from me!). I won't find out the result of that until tomorrow morning, but I did also request an iron level (or technically a hemoglobin level, which is the part of iron that carries oxygen). The goal is to be between 12 and 14 and my last reading was 11.9, i.e. anemic. When I got my draw today, it was up to a 12.9, the highest it has EVER been since I started tracking about 10-ish years ago. As I've stated in previous posts, I have a STRONG feeling that my low iron is a contributing, if not main, factor in our issues and I have battled issues with iron for quite some time. I am so proud that I didn't just give up or resign myself to anemia; instead I researched and tried new options, stuck to a program and got results!

On my drive home, I started thinking about the topic for this blog (just talking about my iron level seemed a little dry) and it led me to really start thinking about some other "small victories" I've had recently. My other biggest accomplishment to date has been implementing the lifestyle changes that my acupuncturist recommended. Her big two things were limiting cold foods/drinks (i.e. no ice, cooked meats and veggies, etc.) and NO soda. I have been six weeks soda free and about two weeks completely caffeine free. I also stopped taking my adderall, which I started  about a year ago. 

I honestly thought I was addicted to caffeine and that I was going to feel AWFUL. While I do seem to lose my thoughts mid-sentence quite a bit more, other than that I feel perfectly fine, maybe even better! I don't get dizzy spells anymore, I still have the same energy level as before and I haven't felt any less motivated to do things. I do feel like eating all the time though, apparently caffeine and amphetamines really do suppress the appetite. Such a glorious side effect, but not worth the thought that it may be contributing to our problems. The point behind me stopping was that caffeine and amphetamines both constrict the blood vessels. Smaller vessels --> less blood flow. That coupled with low iron could have been a pretty bad equation for trying to support an early pregnancy. Small victory: getting my body healthy and thinking outside the box to solve our problem.

The last small, recent victory is this blog right here. I am still overwhelmed by the responses and conversations that I have had with people since starting. It is doing exactly what I'd hoped it would do. People have given me advice and words of wisdom from their past experiences. I've also been able to talk to other young women going through this and, hopefully, help them during their process too. I was so scared to do this blog, thinking people might think it is weird or sad, or worse, nobody would care at all. How silly of a thought that was!

So I encourage ANYONE reading this that is going through something, try to find your small victories as well. Most likely, you're going to run in to more disappointments or troubles, but if you can find some positives, some wins, it really will help you cope with the negatives.