Friday, December 21, 2007
My family is more than a little out of the ordinary. I was born when my parents were barely 21 years old (oops!), and they divorced when I was just a toddler. I always wanted a sibling, and my mom always another child, too, but as I grew up, she remained single.
Fast forward to my college years, as my parents actually got remarried... to each other. See, I told you that it is an unusual situation. My mom, by now in her early 40s, began to try to get pregnant. Months went by, each without success. She did have one "chemical pregnancy" during this period, but it was over before she knew it had begun. She went through basic fertility testing and was found to have a normal exam, a normal FSH (6-ish, I believe) and a normal HSG. My dad (who had another child from a second marriage along the way), also checked out fine. Anyway, somehow my mom also discovered Toni Weschler's "Taking Charge of Your Fertility" book and began to chart her basal body temperature. She also used OPKs to predict ovulation each month, and from these two methods knew that her ovulation was normal. My mom was basically told that she was facing difficulties because she was over 40, and that not much could be done for this.
My mom even joined an early version of a fertility message board... it was called "Fourtility" (cute name) and was an email LIST-SERV (remember those?) for couples in their 40s who were trying to conceive. There was a mix of women dealing with primary and secondary infertility, and there were women from around the US and even from other countries. Many were doing IUIs, IVF, etc. There were some happy endings, but a lot of sad stories, disappointments, and losses sprinkled in. (As a brief aside, I remember reading these messages and thinking "I hope to GOD I never have to go through any of that!!" Ever since reading all of that, I became afraid of infertility, and here I am. Wah. But wait, this post is not about me!)
The happy ending is that at age 44 1/2, after over 2 years of trying, my mom finally found herself pregnant. I was a know-it-all first year med student by that point, so I told them not to get their hopes up. I didn't tell my friends, because I didn't believe it would last. After one med school lecture on normal reproductive physiology, I went up to the lecturer afterwards and shared the story. I said, she's about 12 weeks along... what are the odds that this will work? He told me that 12 weeks sounded pretty good, and that she had a good shot.
I didn't allow myself to get truly excited until I heard the beautiful words, "46 XX,"... a chromosomally normal baby girl based on amniocentesis results. The pregnancy went smoothly for my mom, other than pretty severe morning sickness and a fall down a few stairs resulting in a dislocated elbow at around month 7. Finally, on December 21, 1998, just 1 day before her due date, my little sister J was born to my mom (by then age 45 and 3 months)! Yes, J and I are 23 years and 11 months apart in age. And I'm thrilled that she's here!
Happy 9th Birthday, J!
J and my mom in November 2003.
J as my flower girl, October 2006.
Wednesday, December 19, 2007
My temperature was even higher (99.1) on Monday AM, but this was probably due to S and I getting into some unhappy discussions at bedtime, talking for most of the night, and then getting probably about 2 hours restless sleep before temp time (5:40 AM). We're fine now, though.
Part of the discussion actually centered on the fact that he felt like the fact that I needed to create a blog means that somehow our communication is not good enough in meeting my emotional needs. I tried to explain that it's not like that at all. He is meeting my needs as my husband and partner in this process, but this blogs fills the need that I have to communicate with other women who are in this unfortunate circumstance. I've told several real life friends about our IF struggles, and most of them feel pretty uncomfortable discussing it. They never really ask how it is going, since they presumably don't want to upset me or deal with my possible raw emotion. One has been great (and is the one who knows about this blog - hi KT!), but I do need to correspond with people in the same circumstance, too, ya know? Not to mention that I feel hope when I look through the blogrolls and see the many, many people who eventually got pregnant. Anyway, S is welcome to read this blog, too. (Hi honey!)
I wasn't surprised by today's results because I wasn't feeling any more breast symptoms, and my AM temp dropped yesterday (Tuesday) to 98.6 F. That would normally be a really high temp for me, but everything has shifted up by about 0.3F during this cycle. I blame the Clomid (2 eggs = 2 corpus luteums? lutea?) and the yucky vaginal progesterone. Well, at least I get to stop that stuff for now.
So, I cancelled this AM's beta-HCG, and asked the RE's office if I would be able to do another IUI cycle if I don't have a CD2/3 ultrasound. After all, S and I are leaving for Florida on Sunday (we're visiting his family for Christmas), so it may not be feasible. They said, basically: no ultrasound, no Clomid. I guess the point of a CD2 ultrasound is to verify that I don't have any cysts greater than 10 mm that Clomid might stimulate to grow. I am 15DPIUI today, and I believe that I am 14DPO by my chart. My LP is usually 14-16 days, and therefore my period usually starts on 15DPO to 17DPO. I really hope that it doesn't start on 17DPO this month because that would put me on track for CD2 on Sunday, which will NOT work. Ack.
I think that this second IUI will be our last, and that we'll move onto IVF with ICSI after that. Since we suspect that MFI (morphology) is our "main issue," continuing with IUI much longer seems like it might not work.
Truthfully, I'm scared of IVF. I'm not really scared of the injections, (although I probably will be when the time comes). Rather, I'm scared of the exorbitant costs (no IF coverage insurance policy, here) and the possibility of not making enough eggs, of not having any embryos grow, OHSS, and most of all, I'm afraid that if IVF with ICSI doesn't work, maybe nothing will. I know there are other options out there, but I'm not ready to really think about them just yet.
Sunday, December 16, 2007
You have to admit that this ( <---- ) is a beautiful looking chart.
I marked today's temperature as "disturbed" only because one of the floor nurses paged me (inappropriately) at 3:50 AM, and then I was awake for over an hour trying to get back to sleep. But still, it looks promising.
That's not even mentioning the symptoms. Yesterday my breasts finally started feeling funny, and I remember thinking... ahhh! This is really it!! Today, the feeling has continued. It's a weird sensation; they feel sore when I am just sitting here thinking about them, but they are not at all tender to TOUCH. In addition, I am having occasional pains deep in my pelvis. I just had another one as I've been typing this, in fact.
Of course, I reminded myself again and again that I am taking this vaginal progesterone and that it is probably the cause of the new symptoms. And I didn't report any of these vague symptoms to S because I didn't want him to get excited and then face a possible negative.
I waited all weekend to test, because it's still a bit early, and I didn't want to test in the morning and then have to rush into work. After a long and exhausting day, I finally got home tonight at about 8:30 PM. I felt unusually calm as I "peed in a cup" and dripped four tiny drops into the well of my Dollar Tree HPT. The urine raced across the strip. The test line came up dark pink immediately, but nothing on the test side. A few minutes later, there was a funny pink blob that followed behind. At a couple of points, after then 10 minute mark, it seemed to almost coalesce into a line at the approximate location of the test line. I thought, "hey, an evap is better than nothing!" I tried to capture it with a digital camera for HPT expert opinions on Ovusoft, but my digital camera's batteries were dead. Soon thereafter, even that pink ghostly line dissipated and disappeared. All I am left with now is a starkly negative HPT.
So, I'm 12DPIUI. Perhaps only 11DPO, so I *suppose* there is still some glimmer of hope. Still, if I am feeling anything "real", I would think that the HPT would be positive by now. I thought I would cry, but I am simply numb. S didn't seem that surprised either. I think he is pretty much already fixating on IVF as our solution. But even that is not always perfect.
I'm still luckier than
most all of the patients that I saw today. One guy went into the ER with chest pain, thinking he had a heart attack. Instead he had a hemoglobin of 4.9 (normal is about 13-17), a platelet count of 10,000 (normal is 150,000 to 450,000), and a new diagnosis of acute leukemia. I need to remember to be thankful for my health and that of my family and close friends. S and I will get through this and we will have a baby someday.
Wednesday, December 12, 2007
Obligatory IUI update: 8DPIUI and (likely) 7DPO. My temps are still looking good. No symptoms whatsoever so far. Hey, isn't progesterone at least supposed to make me feel pregnant? Something? What is this breast tenderness that "normal people" get every month when they ovulate, get their period, take progesterone, or take birth control pills? I've now done all of these things and I don't think I have ever in my life had sore breasts. What's wrong with my breasts??
I left part of this as a comment on Alison's blog, but I thought I'd share with the rest of you. A few weeks ago, S and I were woken up at about 4 AM by some scratching in our ceiling. I was really trying to forget that it had ever happened, because the idea of sharing our house with a critter of some kind really freaks me out. Unfortunately, I knew it was real since S remembered the incident too.
Unfortunately, the scratching in the ceiling sound returned last weekend. It was pretty loud, so S suspected a RAT. I absolutely cannot stand the thought of dealing with it (or even seeing it), and I'd rather just hire a "professional." This is kinda ironic, because I'm definitely the more frugal person in our marriage. Anyway, S wanted to try to set traps, etc.. I reluctantly agreed as long as he does EVERYTHING. I don't want to touch the traps, bait them, check them, or deal with any potential dead rats!
Well, he set 4 traps on Sunday (placing them outside but near a potential entry point). Monday, nothing happened. Well, I lied, because I did start looking at the traps, but I only look at them from like 15 feet away until I see that they are empty. Anyway, by Tuesday I was shocked to see that every last lick of peanut butter was gone from those traps, but the traps had not sprung closed. It turns out that S had not set them just right, so last night, he rebaited them. He was sure that we were going to catch something now, since "something" had obviously eaten the peanut butter.
As of this morning, nothing. But as of this evening...we apparently caught our first RAT!! S threw it in the trash can before I got home, and I'm too scared to even look at it. I'm so glad he's taking care of this one 100%. :)
Unfortunately, rats (specifically "roof rats," as opposed to "Norway rats") are apparently pretty common here in San Diego. They love to live in palm trees and iceplant. For that reason, I don't like palm trees or iceplant. I have had some dealings with mice in the past, but I've never knowingly co-habitated with a rat! I really can't stand the idea! I'm still trying to assure myself that the rat was never actually "in" our house. It was just in the wall/ceiling...and that's not the same. Right?
Anyway, I am glad it is dead. I hope there aren't many more. (I'm going to keep deluding myself that it was the only one. And in a few days, S is going to patch the suspected entry point.) But yeah, we're still setting traps, too.
Monday, December 10, 2007
OK, lovely topic. It's really probably TMI -- you are forewarned!
As you may recall, my RE prescribed progesterone suppositories, 200 mg intravaginally, 3x/day.I've been using them since the early morning hours of 12/6. For the first few days, I noticed that I was having a bit of thick white creamy vaginal discharge that looked exactly like the powder in the capsule. No big deal... I simply am not absorbing everything, right?
However, yesterday (12/9), I started developing a watery yellowish discharge. There is a lot of discharge to the point where I am having to use a pad instead of a pantiliner. In addition, my entire vaginal area feels irritated and kinda sore. It is not malodorous or frothy.
Well, I called the RE's office today and explained the situation. The nurse asked Dr W (why can't I ever just talk to the doctor myself??), and Dr W apparently said that "this is a normal side effect of vaginal progesterone". They recommend that I continue it, or else I'll "need to use the shots" (Progesterone in Oil or PIO, which I have read about now, and the large guage, 1.5 inch long needle into the gluteus maximus simply does not appeal to me.) So, for now at least, I am trying to persevere with the suppositories.
ARGH. This is so annoying to me because:
1) I don't think I even need progesterone supplements. This is a clomid/IUI cycle, not IVF. I always have a long luteal phase. I've never spotted a day in my life.
2) The progesterone supplements that I am using are from a "compounding pharmacy" -- which means that they cost 2-3x as much as Prometrium. I'm assuming that the RE is getting a cut of the $$$.
3) I don't think I can honestly deal with this much longer. They would probably make me continue these for several months if I actually got pg. Yowwww. It hurts just to think about it.
4) How are people actually supposed to have sex while using these kinds of suppositories?? ICK!
I hope some of you can impart some wisdom on this subject.
Sunday, December 9, 2007
You may have noticed that I have been unusually quiet, with infrequent postings over the past few days. My mind feels quiet, too. I always feel a certain calm during the first week after O, after my temperature rises, because the O is finally over! I've ovulated, we've timed everything as well as possible, and all there is to do is wait. I can't obsess about any symptoms (or lack thereof) because I know that implantation doesn't occur until about 7DPO to 10DPO. I'm actually able to concentrate on other things and get a few things done. The only other time that feels this peaceful is the week of my period, and that week is more of disappointment fading into acceptance and then transforming into new resolve. After about CD11, I start fretting about ovulation and timing, and that lasts for about a week or so until ovulation is finally confirmed.
At about 8DPO I start going nutso about wondering if my breasts hurt, what my temp is doing, whether my cervix feels hard/soft/open/closed, if that pain down there is implantation, etc etc. Usually I don't feel much, though, and that makes me just sad. For anyone who is going to read this blog towards the end of this week...you are forewarned!
Ovusoft is calling me only 3DPO (O Thursday, because my temp didn't rise above the coverline until Friday), but I think today is really more like 4DPO. By OPKs I am 5DPO. Too bad my IUI was Tuesday, and I probably didn't O until Wednesday. On the other hand, last Monday I was worrying that I had already ovulated overnight on Sunday/Monday. I don't think it is possible to get it all perfect (at least using OPKs), especially if you are dealing with MFI...
A big "Congratulations!" to Hilary over on her blog "The Trying Game." It's not 100% confirmed, but it looks like her first IVF was probably successful!
Now we IUI girls need some inspiration!
Thursday, December 6, 2007
I continued to feel really ambivalent about the progesterone suppositories, but in the end I decided to go ahead with it. S really thought that I should, and even my (also medically-oriented) best friend thought that it sounded like a "can't hurt, might help" sort of intervention. So, grimacing at the idea that I was throwing away $78, I did it.
I called the RE to see whether I could wait to start them until today, because I wanted to see if my temp would rise this AM. The nurse asked Dr G, and he said that he still recommended that I start them yesterday. However, I reasoned that this would interfere with my plans for some PM lovin', and who knows what kind of effect it would have on any spermies in the final cavalry. So, in reality I didn't put in the suppository until my middle-of-the-night bathroom break at 1AM, but oh well. I guess I'm a little non-compliant sometimes!
My temp this AM was 97.9, signifcantly higher than the day before (97.4), but still not above my coverline (98.0). However, my usual coverline is more like 97.7, and I'm blaming my higher pre-O temps on Clomid. I hope that the temp rise means that I ovulated, and isn't just an artifact of vaginal progesterone. Hmmmm... I'm hoping for something above 98 tomorrow.
In other news, I forced myself to send one resume and cover letter this AM. Also, Must! Start! Writing! Clinical! Trial! Proposal!!! There is just not enough time in the day, especially with my full time hobby of obsessing over TTC stuff. :>
Tuesday, December 4, 2007
I got to the RE around 11:30AM. The nurse called me back to the exam room pretty quickly. I told her that I was going to use the bathroom, but she suggested that I should keep a full bladder because "it sometimes makes the procedure easier."
She returned a few minutes later holding a long catheter which appeared to be resealed in its original plastic packaging. Our names were on the outside, and the nurse said that she had made sure that it was S's sample being pulled up into that catheter.
I was kinda nervous, so I was flipping through a random magazine..."Country Living" or something like that. Dr. A came about 5 minutes later. He's the one that I just met last Friday, at the time of my CD12 ultrasound. At that visit, he was very upbeat and I liked him a lot. Today, he was a lot more hurried. When he entered the room, I started babbling about my concern that I had felt my ovary aching all weekend, but that the aching feeling was completely gone as of Monday morning, before my LH surge. Thus, I wondered if I already ovulated more than 24 hours earlier. Rather than addressing this concern, he said something like, "Well, let's do this insemination now," and got busy with the speculum, etc. I think after it was all over with he sort of tried to smooth it over by saying, "You may feel things all the time, but you can't really know what is happening in the ovaries."
Anyway, the post-wash total motile sperm count was 11 million. Decent enough, I suppose, considering our MFI issues. Dr A said that he likes to see at least 5 million. On most of the websites that I have found, the goal is more than 10 million. So, I am satisfied.
Anyway, the insemination itself felt like something worse than a Pap smear, but better than the HSG. It was maybe about the same as a Pap smear with cervical polyp removal.** Dr A had some difficulty inserting the catheter into my cervix. He said that my cervix was open, but that the angle made it difficult to insert the catheter. At one point, the nurse tried to help by placing the ultrasound probe over my bladder, but they couldn't seem to see much and it didn't seem to help.
However, just about a minute or two later, he suddently said, "Think happy thoughts!" without explaining himself further. Well, I tried to relax and waited about 30 seconds, and then I said, "Does that mean that you got in and were doing the insemination, or that you were still trying to get the catheter in?" He confirmed that the insemination was now complete. I said something like, "Well, not exactly how I thought I'd get pregnant, but I hope it works!"
I was told to wait there for about 10 minutes. I tried to stretch it out to more like 15 minutes, but I got bored after about 12 minutes. I read the magazine cover-to-cover, and then I tried to relax a bit.
Next, I went out to the main area and the nurse gave me a one-time dose of doxycyline. She also wanted me to schedule a pregnancy test (beta-HCG) for 12/20. I went ahead and did that, but told her that I obviously will cancel the appointment if my period starts before that. In reality, I'm going to take a $1 home pregnancy test, and if it's negative there is no way that I am going to come in and pay $50 for a beta-HCG to tell me that.
I then asked the nurse about whether Prometrium (vaginal progesterone capsules) would be recommended. When we initially discussed treatment with Dr G on 10/18, he had mentioned that I would be taking Prometrium after my Clomid/IUI. I remember being surprised at the time because I am Woman of Long Luteal Phase (always 14-16 days) and my post-O temps tend to be great. The fact that Dr A didn't mention it tells me that perhaps Dr G and Dr A have some differences in their practice style. I would think that if anyone could skip Prometrium, it would be me.
So, the nurse asked Dr A about it and he apparently said that yes, they do want me to take the vaginal progesterone. However, they do not want me to use standard Prometrium, but rather they want me to buy "their special own brand of micronized vaginal progesterone". This is available only in the pharmacy downstairs in the building, and costs around $80. Somehow, this entire thing seems fishy to me. I think that Prometrium is just fine, and in reality I don't think I need either one. I don't like the fact that my temperature curves will be essentially meaningless on vaginal progesterone. On the other hand, I suppose it can't really hurt anything but my wallet, so I'll probably go ahead and do it. I'm thinking about it overnight, because I don't have to start until Wednesday anyway.
Anyway, I'm happy that it is over. Now it's time for the dreaded Two Week Wait. I usually do pretty well for the first week, but start getting really excited and nervous around 8DPO or so...
** I had a small, recurrent cervical polyp that had to be removed on several occasions before it finally went away. The procedure itself is the same as a Pap smear (speculum exam), except that they then the grab the polyp with a long forceps and twist it 'til it breaks off at the base. Next, they general cauterize the base with silver nitrate. This thing first showed up as an asymptomatic finding on annual exam when I was about 25, and had to be removed about 3-4 times, up through the age of 30. It has been gone now for several years, and the doctors whom I have spoken with think that it will not impact my fertility.
Monday, December 3, 2007
I checked again at 2PM, and this time the OPK was just a tiny shade off of positive. I know from past experience that it would be truly positive within another hour or two. I called the nurse and basically told her that the OPK was really close, and that it would definitely be positive if I checked it again... At this point she started sounding really confused, and that she might advise me to call back tomorrow, so I just said, "Actually, never mind. It IS positive." So we are on for IUI#1 tomorrow AM!! S will do his part at around 9AM. And I will come in at 11:30 or 11:45 AM. The nurse told me that one of the doctors is doing an FET (frozen embryo transfer) at 11AM, so I will be getting my IUI when they are finished with that. I need to be at breast cancer clinic (my work) by 1PM, but I'm going to lie down and wait at least 15 minutes afterwards no matter what. I don't want those nice washed spermies to dribble back out. If I'm a few minutes late for clinic, too bad! They can get by without me.
I'm a little bit paranoid, though, because my left ovary is no longer aching today. I wonder if it is possible to ovulate BEFORE the LH surge (ie overnight last night). I hope not, because I don't think the egg will be alive at 11:30 AM tomorrow. I'm trying to trust the idea that you don't ovulate until 12 to 36 hours AFTER the LH surge, but I don't understand why my ovary feels so normal now. WAH! Argh! Or... I can also stress about the opposite scenario. Maybe tomorrow at 11:30 AM is too early. Well, I'm trying not to worry and just realize that there is nothing I can do about it, and hopefully the reproductive endocrinology industry knows what it is doing.
Well, since I have at least one potential friend-in-real-life reader who has not dealt with OPKs (hi KT!), I will show a picture to demonstrate what the heck I am talking about. I know it seems a little crazy to be labelling and taking pictures of OPKs, but... well... trust me, this is
The idea is that the OPK is positive when the test line (on the left) is as dark or darker than the control line (on the right).
Sunday, December 2, 2007
Beautiful day today... cool, breezy, but clear air from the recent rains. S and I went out to M.ission T.rails regional park in hopes of seeing some of the streams running. Well, the river was flowing, but the minor streams were still mostly dry. However, the trees were pretty with their yellow leaves, and we saw a coyote, too! He was trotting up a steep hillside, and I only spotted him because he was moving against a bare area for a moment. As soon as he reached the usual chaparral part and stood still, he became completely invisible in the landscape! That is the second coyote that S & I have seen recently. The first was in the canyon right near our house, and we were really close to that one. I always thought they were more nocturnal, but apparently not! Last time we were at this park, we saw a rattlesnake, so it is always interesting.
I hope I understand the purpose of putting d.ots in w.ords like th.is. It's to throw off search engines, right? Well, I don't mind if someone searching "Clomid IUI morphology" finds my blog, but I don't want someone who is looking for info on the above park to find it!
We had a good time at dinner last night with P&L. The subject of IF did not come up! Today I was talking to another one of my friends (she's a primary care MD) and she kinda implied that she didn't think that IUI for MFI seemed like a very logical idea. GRRR! I know she didn't mean to be negative, but I didn't like hearing it. She took over 1 year to conceive her first, and then just TTW (tried to whatever) and conceived her second, and is now pg with #3... who seems to be sort of an oops!
I gotta go get some work done. I have Monday's VA clinic and Tuesday's breast clinic to prepare for! Not to mention that whole "applying for a job" thing. (Blech!)
Saturday, December 1, 2007
My OPK is still negative, though. I just hope I don't miss the O day altogether. We got busy last night, just in case. We probably won't do so again until after the IUI because Scott wants a few days to "build up his supply." I think they recommend that for guys with MFI issues. On the other hand, I hope I O on or before Tuesday because we don't want "stale" sperm in there, either.
We're having dinner tonight with our friends, P & L, who had IUI and IVF in the past. Unfortunately, I don't think we can talk about it with them because it never worked out for them. See, the guy P is a colleague of mine, and we went to an out of town conference last spring. I was hanging out with him and another coworker one night, and kinda lamenting my (at that point) 5-6 months of inability to get pg. (Yes, I am pretty good friends with these particular male co-workers! We are all married.) P was kinda tipsy when he told me that he and L had gone thru varicocele repair, IUI, and IVF, all without success. I don't know if he ever would have told me without being half-drunk, and I don't know if his wife L knows that I know, and I don't know whether it's an incredibly sensitive and raw topic to her. So while I would probably learn a lot from hearing about their experiences, I don't think I'll be bringing it up tonight. P tells me that the long term plan is to adopt, possibly from China. (They are both Chinese-American, incidentally.) I truly hope that they have a child someday, no matter how that happens. I know that they will be great parents.
Friday, November 30, 2007
So, I arrived to the RE's office in a somewhat bedraggled, soggy state. Immediately, I was called back to the ultrasound room. The nurse asked me if it would be OK if a resident watched, although Dr. A would be the one doing the scan. "Um, sure..." As a fellow (and resident as recently as 2004), I certainly understand the need for medical education. I honestly wouldn't have cared if the resident had wanted to do the scan, either, as long as Dr. A was watching to make sure that he doesn't missing anything. I can't say that I'd want a resident to do anything more invasive, though. Also, I know that I do not personally know any of the OB/GYN housestaff, so I'm not worried about the guy recognizing me. I guess I'll meet a few of them during my Gynecological Oncology rotation in January, but so far, I don't. Anyway, the resident came in, watched the ultrasound monitor, and really didn't say a word the entire time.
This was my first time meeting Dr. A, and I liked him quite a bit! Probably because of the good news that he delivered...
3 follicles are growing! They are 10 mm, 15 mm, and 16 mm. Dr. A thinks that I will most likely ovulate 2, which in my mind is perfect!! I am really excited about this! He said that Clomid usually doesn't make many more than 1 or 2 good eggs, and that it's the injectables that have the potential to produce a lot.
He then asked, "Can you come back tomorrow for another ultrasound?" Er, no. He was thinking that I was going to be getting serial ultrasounds followed by an HCG trigger shot. I told him that the original plan was for me to use OPKs to detect my LH surge, and then to come in the next day (O day) for an IUI. He said, "Actually, that's fine as long as OPKs work for you. I have actually done a study comparing spontaneous versus triggered ovulation and the pregnancy rate is equivalent."
He then made me really happy by saying that the follicles look great and that I have a good chance with IUI. I know he is not really familiar with my case (as we have never met before), so I said, "Yeah, but we have sperm issues... 1% morphology..." To this he said that no one really knows about whether morphology is relevant, except in the IVF setting. He said that they go forward with IUI no matter what the sperm count is on the day of the procedure. And then he quoted Wayne Gretzky (hockey player), something about "You will miss 100% of the shots you never take." (I love how google can help me look up that quote in less than 15 seconds!) Of course, I was liking him more and more by the minute as I'm hearing him say all of this.
I teared up for a minute as he left the room. I guess I'm daring to hope again... (Fingers crossed, knocking on wood, and jumping over all cracks...)
Thursday, November 29, 2007
Dr. G reassured me that he didn't expect them to go away. I'm not clear whether he meant "ever" or "not this soon." I actually asked people on the "Dealing with PCOS" forum on Ovusoft whether anyone had any experience with cysts resolving or not resolving on metformin, but only one person replied. Hers had disappeared, but her ultrasound had been done after many months on metformin.
Anyway, I left that appointment with a prescription for 5 days of Clomid (50 mg, CD3-7) and an appointment to return on CD12 for another ultrasound. I tried to question Dr. W about the purpose of this ultrasound. Is it to make sure that I don't have too many large follicles? She said, basically yes, and that they sometimes cancel cycles if the person has 4 or 5.
So now I am of course on pins and needles wondering how many big follicles that I'll have tomorrow. I want more than one, certainly, because of our sperm issues. They need more egg targets! And obviously, I don't want to have 4 or 5, because they'll probably cancel the cycle.
So, I'm hoping for 2 or 3 eggies. However, I truly hope that we don't have multiples, though. I feel like pregnancies with multiples are pretty scary. I worry about all the freaky medical stuff like twin-twin transfusion, cord accidents, prematurity, etc... Not to mention the extra stress of dealing with two babies at a time. Unfortunately, one friend of ours lost one of her (IVF) twins at term due to a cord accident. Such a devastating loss! I guess there is no way of knowing whether the same thing might have happened with a singleton pregnancy. That all being said, I also have two friends who have had successful ("spontaneous") twin pregnancies. Both sets of babies were early, but don't seem to have any long term problems that I have heard about. I'm sure that if I ever do get pregnant with twins, I will grow to love the idea and get over my fears. But if we had more than 2... I think we would probably make a very difficult decision and reduce. I think I would be too afraid of the consequences of prematurity to go forward. Wah. I pray that I never have to face this kind of situation.
One other fear has been on my mind. I took CD3's Clomid with no problems. I took it at night because my appointment was in the later morning and I didn't have a chance to pick up the prescription until that evening. CD4 was Thanksgiving Day, and again, I took the pill in the evening.... after that gigantic meal. TMI alert: Afterwards, I was kinda burping up/regurgitating a bit of the food (this happens to me sometimes when I'm really really full) and I spit some of it out. Of course, the next day I started worrying that maybe that tiny Clomid pill came up instead of getting absorbed. I certainly hope not!
I prepared myself for a few days of vaginal dryness, night sweats, and bitchy moods, but actually none of these things occurred beyond a tiny bit of warmness at night that I wouldn't have even noticed if I wasn't looking for it. The lack of symptoms is another reason that I'm kinda scared that the dose wasn't high enough, or that I didn't absorb it all.
I guess I'll find out tomorrow, CD12. My ultrasound is at 9:30 AM. I'll be starting OPKs tonight, as we'll be using the results to time the IUI. I already had some eggwhite CF today, so I'm betting on Monday or Tuesday (CD15-CD16) for the IUI. (fingers and toes all crossed!)
And now I'm officially all caught up!
On CD8, I went for my saline sonohystogram. Dr. W, who is a new (female) partner in the RE's office, performed the ultrasound. I was kinda hoping that my cysts had disappeared, but there were still lots and lots on each ovary. My endometrium looked good, and there was no sign of any endometrial polyps. This lovely experience last about 3 minutes and cost $450.
We had pretty good timing, and I ovulated on CD16. (Which was pretty good, but I had ovulated on my own on CD15 the month before without metformin). I had a little bit of hope (which I kept trying to squash lest I be disappointed) that maybe metformin alone would do the trick and I would finally end up with the elusive two lines. I tried not to get obsessed, but I did anyway.
During this cycle, S had his urology appointment with Dr. B. Apparently, Dr. B specializes in male fertility and vasectomy reversals. The entire experience of was really disappointing. S has a very tight schedule in the afternoons, and he only had between 1 PM and 3 PM free from work. His appointment was at 1:30 PM. (I came along for moral support and because I wanted to hear what the urologist would say.) Luckily, the medical office building is only a few minutes from his workplace. Right away, the receptionist told us that Dr. B was in surgery and she didn't know when he would be back. Well, the doctor didn't arrive in the building until after 2 PM, and there was another patient in front of us.
At about 2:23, we went to the receptionist and told her that we would need to reschedule. At that moment, Dr. B came out and said, "Let's go!" Of course, at this point we have less than 20 minutes until S would need to leave to get back to work. Dr B spent way too much time asking questions that were already answered on the questionnaire, and going over the semen analysis out loud. At the same time, he didn't offer any theories as to why S might have the morphology problems and borderline counts. He examined S for just a moment. I even went into the exam room for this part, and commented on the orchiometer (the set of "balls on a rope" of various sizes, that the doctor can use to estimate testicle volume). Then, during the exam, Dr. B made these comments about how S's testicles were really great in size, definitely on the top of the end of the range. Afterwards, S and I both thought that he probably says this to lots of guys... to try to make them feel better even despite their lowish sperm counts!
Well, Dr. B didn't feel much except "maybe" a varicocele on the left side. He recommended an ultrasound ($300), bloodwork (I haven't priced that yet), and then a followup appointment. Have I mentioned yet that the appointment itself was $300 for about 15 minutes? If we end up doing varicocele surgery, that usually runs about $3000. Argh. I have done the research and it seems like varicocele surgery has iffy results at best, especially if the varicocele is small. We have several couples as friends who have dealt with infertility stuff. Two of the men have undergone varicocele surgery, and both said that nothing improved afterwards. Finally, Dr. B recommended that S consider trying some supplements. He gave us a bottle with 6 or 8 sample pills in it. S did end up ordering it... and it's almost $300 for just a few months' supply. That is OK with me, but I wonder if Dr. B is getting a kickback.
Dr. B also made some comment that he was "impressed" that Dr. G was recommending that we do Clomid/IUI instead of proceeding to IVF with ICSI. It wasn't clear whether he meant "WTF is Dr. G thinking?...your morphology is bad!" or "Wow, I'm surprised that Dr. G is potentially giving up over $10,000 in case these two get lucky with the IUI."
Well, by the end of the cycle I tested twice (10DPO and 13DPO, I think) and I had two BFNs. By 16DPO, my temperature dropped and a new cycle began! And now I am almost caught up to the here and now...
Wednesday, November 28, 2007
The waiting room of the RE's office is kinda fancy with full length glass panels and doors, instead of a plain door like all the other offices in the building have. It looks nice, but doesn't exactly feel discreet. Not that we need to be discreet, though...right?? The office is located just off the elevator, on an upper floor of a medical professional building. S had already described it to me as he had been there twice already to give samples for semen analyses. As we walked through the door, I was really surprised to see a familiar face sitting behind the receptionist desk. "Is your name T___?" I asked. When she answered in the affirmative, I reminded her that we had worked together at Dr J's office way back in 1994. I was 19 years old, summer after freshman year of college, and had worked as a receptionist. T__ was a transcriptionist. She is a lot older, more like my mother's age, but I had always liked her. I reminded her of my old last name and we started reminscing about some of our other co-workers as well as Dr. J, our old boss. T___ looks great; she literally has not aged a bit in the 13 years since I last saw her.
I gave T___ my basal body temperature charts to give to Dr. G. When we were called into the consult room about 20 minutes later, I was happy to note that he had reviewed them in detail. Right away, he didn't like the fact that my ovulation day has been variable from CD15 to CD26. He also saw that I had made notations for "acne" on the days when my skin flares up with a pimple or too. So he was immediately suspicious for PCOS. He asked me about the excessive hair growth thing. The truth is that I do have a few coarse hairs that crop up under my belly button and chin, and even a couple dark (but not really coarse) ones around my areolae. At the same time, I feel like almost every woman that I know (or see) has something similar (or plucks/waxes to get rid of them). So, I have never been 100% certain about what is normal and what is not. Meanwhile, S and I answered lots of other questions about our medical histories, etc.
Right in the middle of the consultation, Dr. G wanted to do an ultrasound on me. I was glad that this was included since we were paying out of pocket. Sure enough, I had lots and LOTS of cysts. Like...over 20 on each ovary, in the typical "strand of pearls" configuration. I apparently also had increased ovarian stroma which is also typical. Dr. G thought that my endometrium looked unusually thick, too. (What did he expect at 14DPO???) Because of this, he wanted me to get a saline sonohystogram at some point in the near future.
Next, we reviewed the results of S's second semen analysis. We were really disappointed that there had been no improvement; in fact, things looked quite a bit worse:
- Concentration: only 9 million/mL (!!) (down from 25 million/mL in June)
- Volume 2.8 mL (down from 4 mL in June)
- Total count: 25 million (this is down from 100 million in June)
- The motility was OK...
- But unfortunately the morphology was unchanged at only 1% by Kruger strict criteria.
Based on my apparent polycystic ovaries, Dr. G wanted to start me on metformin. I kinda questioned him on this since I obviously ovulate every month even despite polycystic ovaries. How then would metformin help? He didn't have a specific answer but implied that perhaps my ovulation would be "better." He also said that studies have shown that women who are undergoing stimulation for IVF actually have higher rates of pregnancy if they are on metformin. This isn't due to better ovulation (as these women are getting other meds for stim anyway), but seemed to be an indepedent effect.
His overall strategy is for me to start with metformin alone for 1 cycle. During that cycle, he wanted me to get a saline sonohystogram on CD7-10 to re-evaluate my endometrial lining and rule out any endometrial polyps. After that cycle, I would start with Clomid IUI. Meanwhile, he would refer S to Dr. B, a urologist who specializes in MFI.
I was surprised to hear him recommended IUI instead of IVF with S's morphology issues. I had previously been pretty sure that our counts and morphology put us into the "immediate IVF with ICSI" category. Dr. G said that it might come to that, but he wants to try IUI for 1 to 3 cycles first since it is so much less invasive (and less expensive).
I left the appointment armed with a prescription for metformin and a renewed sense of optimism...
Monday, November 26, 2007
The woman (let's call her Dr. S) is about my age. She listened to my TTC complaints and told me that I probably needed to relax. She looked at my temperature curves for literally less than 1 second before setting them down. I bet if I weren't a doctor too (at the same institution), she probably wouldn't have ordered anything. However, she did agree to order a semen analysis for S, and basic bloodwork for me. I was not impressed when she told me that I could get the blood drawn that very day. Ummmm....it was cycle day 30 or so, and my temperature was plummeting. I said, "Don't you want me to get that drawn on cycle day 3 since you are testing my FSH?" She said, "Uh... do whatever you want." I literally think that even with that reminder, she had no clue what I was talking about.
Unforunately, 6 months later, I am still trying to get the bill for these blood tests paid (it's over $500) because she coded the visit as "Pap smear" and didn't put down anything about my irregular cycles to justify the check of FSH, TSH, prolactin, and estradiol. I have been in frequent communication with the billing department since early October, but it still is not resolved. On the other hand, I was greatful to have normal TSH, normal prolactin, normal FSH (5.2) and normal estradiol (18).
S scheduled his semen analysis for late June. Dr. S asked for him to get it done at the offices of Dr. G, a local reproductive endocrinologist. So, he did that. It took almost a week to get the results, because Dr. G's office refused to release them to me directly. They wanted to give the results to Dr. S. Unfortunately, Dr. S had no idea how to interpret the results and she had to call Dr. G's office to speak to one of the reproductive endocrinologists to get an interpretation. (I actually appreciate that she did this). So, anyway, she finally called and the results were not good. They were:
Concentration: 25 million/mL ... OK, not great but in the low/normal range
Volume: 4 mL
Total count: 100 million
Motility: 44% rapid forward (OK, maybe a little low)
Morphology: 1% normal by Kruger strict criteria.... this is really bad. "Severe teratozoospermia."
Dr. S said that Dr. G's RE colleague said, "We like to see the morphology at 4% or so. Tell them to keep trying, and if they don't get pregnant in 4 more months, get a hysterosalpingogram (HSG) and make an appointment with us. "
I started researching everything I could about morphology, and finding very few answers. S doesn't smoke, drinks only socially, and doesn't have a habit of using jacuzzis, laptop computers, or riding a bike. He didn't have any recent illnesses, and he's actually really healthy and fit. He did have an STD during college but was treated right away. He did switch over to 100% boxers when we found out. I was hoping that maybe the poor morphology was a fluke, and that the problems would resolve. I was terrified of the notion that we might have to undergo IVF someday.
I found other people with MFI on ovusoft and clung to the stories of men with 1% morphology who had fathered children in the past or present. I found at least one blog (http://infertilityblog.blogspot.com/) in which the author (a reproductive endocrinologist) maintains that morphology is not a real problem! I hoped and prayed for a summertime pregnancy. Still, when my period showed up yet again, I scheduled my HSG... this would be completed in late August, after 1 more full cycle.
Well, my period sure enough came around again, and it was time for the HSG. The HSG itself hurt like hell (for about 1-2 minutes), but I didn't have any blockages. The radiologist blithely told me that she was reviewing HSGs with a medical student, and "a huge proportion of the women had OB first trimester ultrasounds within a few months of their HSG." I thought this was encouraging at first and clung to the hope that maybe some invisible debris was now gone, thus opening my tubes. Although, in retrospect, I wonder how many of those women had actually gone to an RE soon after their HSGs. Maybe those are all IUI and IVF babies that she is seeing.
Well, we tried another cycle and then scheduled S's second semen analysis, with a reproductive endocrinology appointment to come a few days later. I still clung to the hope that maybe, just maybe, I would get pregnant with Cycle 10 and cancel the appointment at the last minute. But... no such luck. On October 18th, we had our appointment with Dr. G, the RE.
To be continued...
Sunday, November 25, 2007
In the course of hanging out with S on a regular basis, I no longer ate Lean Cuisine and other ultra-low cal fare every day and I gradually gained back about 12 lbs. I now have settled into the 132-134 lbs range, size 8 or possibly 10, and I'm fine with that. Although, honestly, my body looks best at 125 lbs.
Backup for some info on my periods. I got my period in sixth grade, a few weeks before I turned 12 years old. My cycles have usually been about every 33 days or so, although they have occasionally been 28-29 days and sometimes up to about 45 days. I must admit that they were getting really irregular right before I met S, at my lowest weight. I figured that it must be my hypothalamus screaming in hunger. Meanwhile, I did notice that my skin was kinda annoying. Instead of the forehead/hairline type pimples that I got as a teenager, I started getting occasional pimples at the far lateral cheeks, along my jawline, and sometimes on my chin and around my mouth. Ugh!! When S and I started dating, I did get onto the pill (Yasmin) for probably about 18 months or so and my skin did clear up.
By the time that we got married, I was 31 and S was 39. Career-wise, it seemed like third year of fellowship would be the ideal time to have a baby. So, I went off the pill after just about 1.5 months of wedded bliss. ;) And, yes, we do move fast. About 3 weeks after getting married we also found a house proceeded to buy it!
I remember the very first time that we had post-pill, no birth control sex. I really believed that we might possibly get pregnant from that very first encounter, but I knew that I probably ovulate later (based on previous cycle lengths). I knew about Taking Charge of Your Fertility (TCOYF) from my mom (more on that later), so I bought the book immediately and started charting my daily temperature. Cycle day 14, 15... 18, 19.... 22, 23 passed, but no temp rise and therefore no ovulation. It was really frustrating as S and I were trying to have sex either every day or every other day, but my temperature stayed stubbornly low. My first ovulation was on CD26! I was elated to know that my body seemed to be working. I blamed the delayed ovulation on having just come off the pill.
I became pretty active on forums.ovusoft.com, participating in various TTC forums, etc. I remember thinking that it was probably going to annoy people (namely, people who had been trying for a long time) when I got pregnant after just a few cycles. I thought that I would definitely be pregnant in just a few months, if not immediately.
I also remember my very first pregnancy test. I took it on Christmas Day, 12DPO of that first cycle, and I was so excited that I could barely sleep the night before. It was negative, of course, and we walked on the beach that afternoon. I remember telling S, "it's OK, we'll probably have a baby or I'll at least be very pregnant by this time next year." My temperature dropped a few days later and I got my period.
Cycle 2 was a bit of a bust because I noticed some egg white CF but we didn't have sex on the best day or two because we had a bit of a stupid argument and it just didn't happen. The egg came on CD15 that time. My body seemed to be back on track! I knew it was a longshot, but I tested on my 32nd birthday anyway. Another Big Fat Negative (BFN, to use the lingo of most TTC boards out there).
Cycle 3, I ovulated on CD20. Our timing was decent but we got another BFN. The stress of trying to time sex to ovulation was starting to get to us. S noticed that the volume of his ejaculate seemed to be less with multiple subsequent days of sex, too. So, we decided to go ahead and try some Ovulation Predictor Kits (OPKs) for Cycle 4. I was actually a bit reluctant because it seemed to make it feel a bit more like a science project, and less "natural", somehow. Ha! If I knew then what I know now...
The OPKs were frustrating at first (negatives for 10 days in a row), but they finally correctly predicted my ovulation on CD25. We again had good timing, and I had a beautiful temperature chart, but alas... another BFN. We tried again for Cycle 5, and another BFN. At this point, mid- May 2007, I began to suspect something might be wrong, so I made an appointment with my OB/GYN.
To be continued...
When it became clear that the mid/late-20s baby plan wasn't going to happen (I wasn't married, or even in a serious relationship), I started thinking that if I wasn't married, or at least in a very serious relationship by age 35, I would become a single parent by choice. I wasn't sure who my sperm donor would be (friend or banked), but the idea was pretty real to me. I searched some internet sites and read as much as I could about it. I told family and friends about the plan, just so that they wouldn't be shocked when the time came. However, I was still in my late 20s, so I didn't go much farther than that.
Meanwhile, the stresses of medical school and residency began to take a toll on my body. By the middle of residency (age 28), I was about 25 lbs above my ideal weight. At 5'5", I was up to 155 lbs and wearing a size 12. My BMI was 26, which falls into the lower end of the overweight category. And I was really beginning to suspect that my weight was affecting ability to find a good relationship.
I began reading a livejournal group based on Weight Watchers and the success stories really impressed me. On October 23, 2003, I started to seriously decrease the amount of food that I put into my body. I also started trying to run again. (I'm an ex-cross country and track runner, so I consider that "my sport.")
By December 2003, the first person (an ER attending) asked me if I had lost weight. "Yes, 7 lbs, THANKS!!" I completed my residency in June 2004, and started working as a per diem/urgent care physician for a year before starting my fellowship in hematology/oncology. By September 2004, I reached my goal weight of 125 lbs, which was a loss of 30 lbs! My appearance was drastically changed. Instead of size 12, I was wearing a 6. I then became kinda obsessed with it all and proceeded to lose even more weight. Quite honestly, I was reading a lot of unhealthy blogs on the internet, and while I never went to extremes myself, I found them kinda inspirational. Or, using the lingo of those blogs, "thinspirational." When I hit size 4 and 118-121 lbs, I was starting to notice worrisome signs like being cold all of the time, and having a resting pulse rate in the low 40s, and even a few times in the high 30s... Soon thereafter, I celebrated my 30th birthday.
Just about 5 weeks later, I met S...
I'll write more later... I'm getting to the infertility stuff, I swear!