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.