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. 

IUI - the professional turkey baster

So, Travis and I had our first IUI this past Monday. I know it sounds weird but I was SO excited for it, like the kind of excited you get the night before a vacation or when you were a kid waiting for Christmas morning. It felt like we were actively working on fixing our problem and that was just so exhilarating. In the back of my mind, I know it is not good to feel this hopeful, because the disappointment if it fails is so much worse, but your mind is going to think what it wants to think.

I had made the huge error last month of withholding all sex while waiting for the IUI and when my meter failed to read the LH surge last month, we completely missed any chance of having a baby. So, we decided this month to have sex a couple of times during my "high" fertility days, but still gave it a rest for almost 2 days prior to the IUI. This has been explained by many ob-gyn's that an every other day schedule is the best method when scheduling sex for baby-making because they say it takes 48 hours for men to regenerate the required number of sperm to effectively fertilize an egg. 

I had made an appointment ahead of time with my ob-gyn, so we had our schedule down. Travis had to collect his "sample" and then we had half an hour to get it to the MD office. Same as when he went for his semen analysis, we needed to keep it as close to body temperature as possible. I got the pleasure of holding it between my legs while he drove; I'm pretty sure his eager offer to drive was so I would have to be the sperm holder. 

Once at the office, the nurse took the sample and then we just sat around for about 5-10 minutes. Travis went back to the exam room with me when it was time for the procedure, and as I have said in the past, I would highly recommend having your husband/significant other with you throughout these procedures.
1. It really is a comfort. You're doing a lot of things that are foreign and doctors' offices in general can cause anxiety, so a hand to hold or someone to distract you makes a big difference
2. Even though we are not making a baby the traditional way, WE are still making a baby. I think you have to go through this as a team for your relationship to stay strong.
3. Men's faces are just funny when they see some of the equipment that the ob-gyn pulls out. Men are visual creatures and I don't think they can effectively relate to what you as a woman are going through unless they physically see it with their own eyes.

The procedure itself goes in the following steps:
1. The semen is centrifuged down twice until it becomes a concentrated ball of sperm
2. This concentrated sample is put in to a sperm wash in two test tubes

Pic of sperm wash bottle (empty)

3. The ob-gyn rolls and inverts the tubes by hand. No vigorous shaking is what my doc told me. This takes about 5 minutes and the color goes from bright pink to a creamy light pink color
4. The doc then draws up all but literally one drop of the sample in to a syringe that attaches to the end of a skinny catheter (i.e. the turkey baster :) )

Pic of catheter w/ syringe filled with sperm + wash

5. The drop of sample not used is put on a glass slide to examine under the microscope to check out sperm function
6. The catheter has to be inserted up in to your uterus, so they start out much like a typical pelvic exam and slide it on up. The doc reviewed the positioning of my uterus ahead of time, but do not ask me how else he would know where he was anatomy wise. Some things I think are just better not to think about
7. Once the catheter is in place, the wash is squeezed out. It is about 3mL of liquid over all. This places the sperm smack dab where they need to be to easily fertilize an egg

I did have one complication, where he could not get the catheter past the upper part of my cervix. He had to use a second instrument, it's a big long word that starts with a T, but it looked like a long pair of scissors. He told me that this could be painful, kind of like the HSG. Not cool. We all know how much I loved that. As it turned out, there was a burning pain from the instrument (which was only used to help tilt my cervix to provide an easier opening, there was no cutting like with typical scissors, thank God!), but it was not as strong and, because I had experienced it before, it did not give me anxiety. 

Once the procedure was complete, I was supposed to lay on the exam table for about 10 minutes. He went and looked at the sperm sample and then he let Travis look at it to, which I thought was so cool for him. I didn't get to see it, but Travis said it was just amazing how many sperms were in that little drop and how fast they were moving. Good sign!

After the procedure was over, I had a lot of soreness and maybe bloating, which I think were from the tilting and probably some air getting squeezed through the catheter. This lasted about 2 days total and was especially tender on the first day. Anyone reading this that may know, is this typical? Also, how did this procedure compare to yours? I'm thinking the infertility docs probably have more high tech equipment. Finally, somewhat unrelated, does anyone know if they ever double ovulated while on clomid, like on day 14 and 16? I had two temp spikes this month, which seems really weird.

Reflections on a life cut too short

I am going to break away tonight from my typical posts about baby business to reflect on a friend that passed far too soon. A lot of us in Wilmington end up here because we enjoy the beach life or the southern way; many times that moves us far from home. Because of this, a second family is formed where your friends become your brothers and sisters (and in some instances children). The Wilmington community lost one of our brothers today; his name is Nick Mowers, he was a friend of mine and a dear friend to Travis, as with many others. I don't know all of the details and the ones I do know really don't need to be posted over the internet, but I know that his death was sudden and unexpected and he was far too young.

I want to talk a little about Nick as a person, but, to relate this somewhat to this blog, I want to first think about the experience of unexpectedly losing a life. There is a strange mix of deep sadness for the loss coupled with fear of how your life can change in the blink of an eye. People hug their loved ones a little longer and express their feelings a little louder because when something like this happens to a friend, who knows who it could happen to next? There is no rhyme or reason, because if there was, Nick would certainly still be here with us. I think what this tragedy can do is make us all live a little bit harder. If you love someone, tell them; if you want to try something, do it; if you are wishing for something, try harder. From what I know, Nick modeled his life that way; he had fun with his friends, utilized his creativity to do what he loved, cared for others, even those that were hard to care for. These thoughts give me more resolve to continue on my journey towards having children and I hope this would make Nick happy.

So, in closing, I just wanted to share how I will remember Nick. I'll remember always being happy to see him at Slaintes on Saturday afternoons; there was no way I was leaving there without a lot of laughs and I don't think it will ever feel the same. I'll remember the way he could always poke fun of Travis for his preppy tendencies and get away with it. I remember thinking he was just so cool, a man's man that designs jewelry, how often do you find that? I'm sure not everybody got fashion advice from Nick, but if he liked a piece of my jewelry I knew it was a keeper. I'll also remember how he talked about his work as a teacher, how he would lament about his students and the school system, but you could tell deep down that he truly cared for those kids. But I will mostly remember him on nights out, surrounded by his friends, and all of the fun that surrounded him as well. Rest in peace Nick, you will be missed.

If at first you don't succeed...stick a bunch of needles in your body

My most recent endeavor in the fertility field has been starting up acupuncture. I was reading some baby blogs one night after a rather disappointing day when I happened across a post from a lady touting acupuncture. Per her account, she had tried all of the standard therapies with no success and tried acupuncture as a last resort. Her acupuncturist told her there were some issues with her kidneys and by her next cycle she was pregnant. I was at the point where I was taking clomid, mucinex, prenatals, extra folic acid, iron, waiting for a fertility specialist consult and an IUI treatment when I read this. Her story really stuck with me, mainly because it would not add any more medications or hormones. Also, I figured, what could it really hurt?

I actually did a little research on fertility based acupuncture before selecting an acupuncturist and starting treatments. A lot of times I just jump head-first in to things and only realize my mistakes after I'm in the middle of it. There was just something about the thought of someone poking needles in to my body that made me want to get all of my facts straight. Here are the main take-aways I got from my research (of note: my research pretty much consists of what I found on google searches).

* Acupuncture has a number of uses, most commonly used to alleviate pain and stabilize mood, but there is a specific subsection to help with fertility. Not all acupuncturists specialize in fertility, so this is a good start off question to ask when selecting a practice.

* Just like any medical profession, there are levels of certification for acupuncturists. I would recommend using a nationally certified acupuncturist, just as I would recommend using a board certified fertility specialists. No certification, no certainty that they really know their stuff. The major association for certified acupuncturists is The National Certification Commission of Acupuncture (NCCAM). Here is a link where to find local acupuncturists certified with the NCCAM:

www.nccaom.org/find-a-nccaom-certified-practitioner‎

I looked up a few acupuncturists on this site and they were NOT all certified.

* You can utilize acupuncture for fertility before you get pregnant up through your first trimester of pregnancy. There are certain "trigger points" that are contraindicated in pregnancy. Worth it to quiz your acupuncturist on these before getting started; if they don't know then they probably shouldn't be used. Here are the trigger points from an article about infertility and acupuncture:

There are 6 contraindicated acupuncture points which should be avoided when the patient is pregnant or pregnancy is suspected. These include Gallbladder 21, Stomach 12, Large Intestine 4, Spleen 6, Bladder 60, Bladder 67 and any points on the lower abdomen.

* The basis of acupuncture is that every person has an energy (qi) which can be channeled or redirected along specific meridians. These meridians include the small and large intestine, kidneys, liver, spleen, gallbladder, bladder, thyroid and I'm sure many others. Needles are inserted at certain points to redirect this energy to where it is needed.

After some consideration, I contacted Lumina AcuClinic here in Wilmington. The acupuncturist was NCCAM certified, had a fertility specialty and was originally trained in China. I braced myself for the pricing and it was less than expected. The initial consult is $95 and all other following sessions are $75. I was recommended to come once weekly, except for weeks when I am on my period. So, overall expect to pay about $225/month.

My first visit, I was nervous. On top of not knowing what type of pain might be associated, the acupuncturist (Ms. En) told me that I would likely have to make lifestyle changes. I was really liking my current lifestyle so I wasn't too excited to hear about these changes. I sat and talked to Ms. En for about 30 minutes during that first session and she asked me a series of questions about my health history, Travis's health history and both of our families' health histories. She asked about past and current meds, including birth control, caffeine, alcohol and tobacco intake and diet/exercise habits. Finally, she also asked me really specific questions such as "is your mouth dry a lot" and "are your feet often cold."

At the end of all of this, she concluded that my two biggest problems are:
1. Women that take birth control for long periods of time (I did for about 10 years) can take a long time to get pregnant, longer than the normal 6 months that doctors state.
2. I was "too cold" and this was most likely due to an issue with my spleen (i.e. we would be focusing on the spleen meridian).

The lifestyle changes that she recommended were:
1. Try to eat more protein and less carbs. Carbohydrate cravings are a sign of an imbalanced spleen.
2. No more soda, even diet. She said that there is just too much "bad stuff" (my words, not hers) in them and they are doing me no good
3. Try to limit cold foods and drink. Biggest tips: only drink warm or room temp liquids (or at least no ice cold drinks) and eat cooked vegetables in stead of cold, raw veggies (i.e. limit salad). A lot of people think the drink part sounds awful, however I have noticed one benefit. When ordering drinks at a bar or restaurant, the waiters are so thrown off by your request, that they still fill your glass completely full without the ice. If out drinking, this equals a lot more bang for your buck!

I was pretty happy with her assessment, because I felt like it was in line with my theory. When she said I was "too cold", I took that to mean that I did not have enough blood flow. This is in line with my low iron and low blood pressure diagnoses. 

The next step was, obviously, the acupuncture. To prep, you change in to a hospital gown, the one with the ties in the front like you use at the ob-gyn. You lay down on an exam table with a pillow below your head and knees. The acupuncturist will swab the areas with alcohol where the needles will be inserted. Once complete, the needles are inserted from the top of the head down through your feet. A timer is set for 30 minutes, a heat lamp placed over your stomach and a bell set beside your finger. You are supposed to lay still the entire time, if you move it can sometimes send little shock pains down your body. I had an itch on my nose the first time and when I went to scrunch my nose, it did just that starting at the crown of my head. I let that itch go after that.

Needle insertion honestly does not hurt; it feels like a little numb prick, like the sensations you feel when your foot or hand falls asleep. They are localized to the small area where the needle is inserted. Probably about one needle per session will send a little shock wave up the localized area, but that goes away immediately. There are almost no marks left once the needles are taken out, only occasionally on the hands and feet.

The one problem when using acupuncture for fertility, much like any fertility treatment, is you can't really tell if it is doing anything helpful. The only real measure is getting pregnant; there isn't any in between. So, I will just keep my fingers crossed and try to take the suggested lifestyle changes seriously.

Below I've included a number of pictures taken from my acupuncture session today. These will probably "explain" the process better than anything I could write.

Sharps Container and Alcohol

Exam table, gown and heat lamp

Sterile needles, individually packaged

Needle placed at base of head, this one always freaks people out

Needles in and around the belly

Needles in the leg

Needles in leg and foot

Fertility Testing - Beginners Level

When I started talking to my ob-gyn about infertility, he suggested this initial battery of tests:

1. Ovulation tests/fertility monitors (are you popping out eggs?)
2. Semen analysis (are there enough viable sperm to fertilize said eggs?)
3. Hysterosalpingogram (HSG, are there any blockages or hinderances in your uterus/tubes?)
4. Progesterone level (can you support the fertilization/implantation?)
5. Post-coital mucus test (can the sperm get to where they need to go?)

Spoiler alert: everything came back normal :).

I already talked about the fertility tests in the last post, so I just wanted to share my/our experiences with the rest of these tests. I am by no means an expert on this part of the process, so I would love to hear about other's experiences with these procedures and other tests that you may have gone through. I'd like to get an idea of what to expect at my fertility specialist appointment.

Ok, so first up was the semen analysis. We ended up doing this test last even though it is (seemingly) the easiest of the tests to perform. The test was ordered for Travis from my ob-gyn. He sent in a request  form to a lab office and Travis just had to call ahead to schedule a time for the analysis. They require you to set up a time because the "sample" is very time sensitive i.e. it can't be sitting around on someone's desk for a couple of hours until they get to it.

I thought everything about the preparation for this test was hilarious, which looking back was not very sensitive. I especially liked the step by step medical instructions given to us on how to "collect a sample". I wish I still had them to share, but I can't do the ridiculousness of the instructions justice from memory. I'm pretty sure any male over the age of 13 could have written them.

On the morning of the test, Travis was to collect his sample and drive to the lab. I did feel bad for him because it honestly is an embarrassing experience, even if nobody else sees you. I'm sure he is thrilled that I am sharing all of this with you! I wasn't at home while he did it, but I do know that it wasn't as easy as it would seem to collect the sample.  I suppose thinking about fertility troubles and lab analyses are not common topics to get you in the mood. Once collected, he had to take the sample to the lab, with the collection cup in between his legs, within half an hour. Travis has never paid more attention to traffic laws than on that trip, because try explaining that to the police officer that pulls you over.

The analysis came back to my ob-gyn a few days later. The major numbers to take away are:
1. Total sperm count
2. Motility (how many are moving correctly)
3. Morphology (how many are viable)

His total sperm count was 149 million, which according to my ob-gyn is ALOT. That number just blew my mind! I don't remember all of the other numbers, but we were told that 4% of the sperm were viable and moving correctly, aka had the ability to fertilize with an egg. Per my numbers, this leaves approximately 6 million sperm. My understanding is that you want the number to be over 5% viable and/or >5 million viable sperm. My ob-gyn told me that although his % was low, it did not surprise him due to the very high number of sperm. So, the obvious conclusion: my eggs are turning around and hopping back into the ovary once they catch sight of 143 million funky looking spermies catapulting their way! Wouldn't you turn and run if 143 million of anything came chasing you?

After the semen analysis, the men are done. Pretty cut and dry. Of course, us women, we have so many more things that can go wrong with our body. The first test I did was the HSG, which is as painful as it is to spell. I have a very good friend, Shauna, who had gone through this test when she was having fertility issues. I asked her about it ahead of time and that little liar told me it was not so bad! Afterwards I called her out and she told me that she didn't want me to be nervous going in to it, hence the lie!

My goal for this section is not to scare people that are going to have this test. I am going to try to recreate the feeling as best I can remember, because half of the issues with this test came from panic of not knowing what to expect. I took 800mg of ibuprofen about an hour before the procedure. If you have a prescription for xanax or equivalent and a driver, I would sincerely recommend popping one of those suckers (just clear with your doc first!). I had Travis come with me because I was nervous; you can have one person in the room with you during the procedure, they stand or sit up by your head. Travis was so sweet and helpful during the procedure and I feel like going through this procedure together made us feel like more of a team. I would recommend having your significant other come with you (even more than the xanax), it really is a bonding experience.

The test in a nutshell is: dye is injected in to your vagina and travels through the cervix, uterus, fallopian tubes and ovaries. An x-ray is taken, giving a complete image of all your reproductive organs. The pain from the procedure comes from the dye which causes cramping. I would liken the cramping pain to someone starting a small fire inside your body. It felt like a burning, not at all like typical menstrual cramping. Here is why I started to panic:

1. I did not know how long the pain would last. If I could have had a timeline of how the pain would go, I guarantee I would not remember it hurting so bad. Time, when one is in pain, of course seems longer than it really is, but I would estimate the whole procedure took about 5 minutes and probably about 3 of those minutes were burning (cramping) pain. The pain goes away VERY quickly once the procedure is complete.

2. They show the image up on a screen as the dye is injected. I knew fallopian tubes were thin but I didn't realize they were literally the diameter of a thread. I honestly remember looking at the screen and thinking that I had NO fallopian tubes. I could not see the "lines" connecting my uterus and ovaries and there was dye leaking out of the organ area (this is typical). I was so upset thinking that I had no tubes that it intensified the pain I was feeling. Looking back, it probably would have been better to not look at the picture until the procedure was over. The doctor informed me that I had "perfect anatomy", so all that worry was for nothing!

When I started to panic, I began having shallow breathing. Short breaths lead to less oxygen getting through the body, which then leads to more intensified pain. Having Travis there was so helpful, but the VIP was the nurse. She was able to relax me by placing her cool hand on my forehead and starting to count out my breaths (i.e. breathe in, now release for 3, 2, 1, repeat). The measured breaths are such a good idea for anyone going through this procedure, it keeps you breathing normal and takes your mind off of the procedure.

Since I divulged embarrassing info about Trav's procedure, I feel it is only fair to share a little embarrassing info about mine. Once the procedure is over, there will be a lot of leftover "discharge" (dye, lubricant, light bleeding). PLEASE do yourself a favor and bring your own pad from home. They handed me one that literally looked like a small pillow. I walked in to the bathroom a lady and walked out with a makeshift penis. And it made noise every time I walked; imagine the sound a baby's diaper makes when they are toddling around. It was the insult after the injury, so to speak.

The final test that I have done thus far is a progesterone level. This is a simple blood test performed optimally 1 week after ovulation. I plan on having this test again this month because I had been using the old fertility sticks and had a hard time that month interpreting what day I was ovulating. I would also like to see what effect Clomid has had on my level. The goal is to be >10 (not sure exactly what the unit of measure is) and I was at a 10.5. I may have waited too long to take the test due to the uncertainty which would explain why it was close to the minimum. I read that the goal after Clomid is between 18-20, so fingers crossed I will be close to those numbers next time!

I did list another test that my ob-gyn discussed with me but I opted out. It is the post-coital mucus test. Essentially, you have sex, go to the docs office, they take a sample of your mucus and determine whether it is thin enough for the sperm to swim through it. I had discussed my reservations about this process in my last blog, but there is another reason that I decided not to worry about this. The treatment for thick mucus is available OTC: Robitussin or Mucinex. These are classified as expectorants and are mainly used to break up mucus in your chest during a cold/infection. Apparently, they have the same effect everywhere. I started to take Mucinex once daily, even though I do not know if this is a problem for me; I figured it can't really hurt regardless. I start taking Mucinex the day my period ends and continue through my last "high fertility" day on my fertility monitor (usually about day 18), so about 10 days total per month.

I definitely feel like more testing would be a good idea for us, what with my borderline progesterone and Travis's crazy sperm count numbers. While I'm not looking forward to the cost of round two, hopefully it will provide some answers, or at least a little more insight.

Fertility Testing - Am I Ovulating?

As I had mentioned in a previous post, Travis and I were pretty slow to go through the slew of tests that most docs recommend after 6 months of trying. The first test that I believe most start with is basic ovulation tracking.

There are a number of ovulation, or fertility monitors available for purchase over the counter. When I started tracking, which I started probably around month 9, I heard a number of different opinions about which monitor to use. I decided to start with the "cheap" option, which I put in quotations, because at $20-25 per month, it isn't really cheap. I used the Walgreens brand, because I work there, and 20% off sounded good to me. My friend, Shauna, used these when she was trying to get pregnant and recommended using them twice a day (morning and night). The tests are meant to notice a LH surge, which is a hormone that increases about 12 hours prior to ovulation. Doing the test once a day can make you miss the surge in theory if the 12 hours falls between test times. I always "surged" in the morning, so probably once you start to notice a pattern, you can reduce down to once daily. Here's a quick list of likes and dislikes about these tests (beyond the cost component)

* Your fertility is marked by comparing a "test" line on the urine stick versus the "control" line. You can see the line get darker as it gets closer to ovulation time, so even though it isn't exact science, you can see "high fertility" days as well as your "peak" days, which is when the test line becomes the same color or darker than the control line.

* On the flip side, comparing the colors can sometimes be confusing. I had a lot of months where I felt it was the same color/darker for a number of days and others where I wasn't sure if it really did get to the same color. I knew I was ovulating somewhere between day 14 and 16 but was never able to get an exact day.

* It is important to be methodical in your "dipping." The tests give you one plastic cup to use for all of the tests. Just like any standard urine test, you pee in to the cup and then you hold the stick in the urine for 15 seconds. You are not supposed to lift the test side of the stick upwards (so keep it leaning towards the ground or parallel) and then you should interpret the reading about 2 minutes later. Maybe I'm just lazy, but that is a lot to remember in the morning. And peeing on your hand gets old after a while, because what woman can aim straight for that cup?

* Apparently it is weird to show your "pee sticks" to your husband. I would try to show Travis the readings and he sort of just shrank away from them and I don't think really grasped the concept. Or he thought my pee had cooties.

About four months ago, I decided I wanted to try the "premier" fertility monitor, the ClearBlue Easy Fertility Monitor. I was VERY lucky that my friend Melissa had a monitor, which retails at about $200. ClearBlue ofcourse states that you should never share monitors, but if you know someone that has one, borrow it! There are exact instructions on how to reset the monitor for a new user, just make sure you read and reset before the start of your next cycle, because this monitor has you start tracking on day 1 of your cycle. On top of the monitor, there are specific sticks that you buy for the monitor; they cost about $65 for 30 sticks. This isn't so bad after your body gets used to the monitor, because you will only require 10 sticks per month, but at the beginning you usually have to use 20 tests.

I REALLY, REALLY like this monitor. Here is why:

* It tracks your entire cycle, making it easier to remember which day you are on.

* The monitor "interprets" the results for you and gives you a reading of either "low", "high" or "peak" fertility (one bar, two bars or three bars). No deciphering colors! I was able to nail down my ovulation day as day 16 after the first two months.

* The readings lead to an additional benefit, if trying to get your husband on board, because it gives them a very visual display of what is going on with your body. When I started using this monitor, Travis became interested in where I was and was a lot more understanding of the need for scheduled sex. Once he understood this, it made the "scheduling" less of a job and became more enjoyable for the both of us again.

* You only have to pee once a day (you have a 4 hour window) and can pee directly on to the fertility stick for only 3 seconds. Less pee on hands! Also, once you cap the stick and insert in to the monitor, you can go on your way and come back to read the results whenever. The results appear after five minutes, but you can leave the stick in there all day if you wanted to. This is nice for us working women because a lot of times we are fitting these tests in while making lunches, taking the dogs out, putting ourselves together, etc.

Here are a couple pics of the ClearBlue. The first is the display that I got today. You can see the two bars signaling "high" fertility and the cycle day listed. Also there is a pic of the test stick box.

I had one hiccup with the monitor and that was last month. The monitor is supposed to show you about 4 days of high fertility and 2 peak days. Each month, I start off around day 8 or 9 with a "high" reading, which I attribute to the clomid. It stays high through day 15, then day 16 and 17 show peak, day 18 high and then low until I finish out the required tests for the month. Same pattern was happening last month, except for day 16 came and went without a peak. Same on day 17. And then my tests stayed at "high"for the rest of the cycle. There is an apparent "glitch" in the system and if it does not get a peak read then it continues to ask for tests and give high readings until you reset for the next cycle month. If you are using this and this happens, do not waste your time or money when it continues to ask for more urine tests, they won't tell you anything useful. What I read is that this normally occurs for one of the three following reasons:

1. Missing a day or two of testing during your testing window

2. Peeing on the stick for too long (I think this was maybe my problem. I was always worried about not getting enough of a sample, so I often went way over the 3 second mark). ClearBlue recommends switching to a cup collection and then sticking the test in for 15 seconds. If I have another hiccup, I will probably take up this recommendation.

3. The monitor did not detect an LH surge, i.e. you may not have ovulated. This would have completely freaked me out, except I was using another method of ovulation tracking, which I'll explain below.

The other main method for tracking ovulation is to take your basal body temperature. I was recommended this from my acupuncturist so I decided to give it a whirl. I have no idea why I always thought this method seemed stupid, but I did and that is why two years in I had never tracked my temp. So I started tracking about day 12 of this past cycle and I am SO glad that I did. I just bought a standard Vick's oral thermometer and kept it by my bed. The acupuncturist had recommended taking the temp reading before getting out of bed each morning to get the most accurate pattern. My temps read between 97.6 and 97.7 degrees every morning. As I had said above, my monitor did not peak day 16 like expected, but on day 17 I got a spike in my temp to 98.1 degrees. The spikes are supposed to be minimal (I think somewhere between 0.1 to 0.6 degrees). I called my ob-gyn about my mixed readings and they said the temp spike did signal that I had ovulated.

So, the main point with basal body temperature is it will tell you AFTER you have ovulated (about 12 hours after). So, if using this method, it is important to graph out your results to clearly see the spike. From there, your most fertile days will be up to three days prior. This was consistent with my monitor readings, showing high/peak fertility days 14-17. I have decided to continue to track my temps in addition to the urine tests as a back-up. Instead of using a paper chart though, I searched my iphone for basal body temperature apps. There were 19 apps that tracked temps. I am trying OvaGraph, mainly because it was the first free app I saw. Super easy to use, you just set up your cycle length and then record your temps each day. It will show you your readings in list, graph and calender view. Here is a pic of calendar view, my graph still looks weird b/c I only have a few days logged in currently.

You can add some additional data in this app and one of the options reminded me of a third way to track your fertility. I do not do this because I just cannot get over the fact that it is gross! I'm pretty sure this is an immature response, but you know what, everyone has their limits. And mine is testing my cervical mucus. There is a fertility test that your ob-gyn can perform which is more specific, but you can "at home" test the consistency of your cervical mucus by literally reaching on up in to your cervix and examing the mucus yourself. Eww! Your mucus is supposed to thin out around ovulation to help sperm travel up to the uterus. When your mucus appears thinner and can be stretched >2 inches, this means that you are at high/peak fertility. Just for giggles, here is a list of options that you can choose to track your mucus appearance:
* egg white (stretchy and clear)
* watery
* creamy
* sticky
* dry

Just to clarify, I am not poo-poo'ing this method, I just can't bring myself to do it!

In my next post, I'll go in to the other tests that Travis and I have done, because I want to make sure I've covered all of them before what will most likely be a second round at the fertility specialist next month.