On Monday I started spotting. I called the clinic and they moved up my pregnancy test day but it didn't look good, it was already 13 days in, I'd been testing at home and all negative, so I knew it was a failure. As soon as it was official, my first stop was Starbucks for a Gingerbread latte and big chocolate muffin. I hadn't had caffeine in nearly a month. Then I spent the rest of the afternoon Christmas shopping, which was a great distraction except for the mall full of babies. Worse, this was the mall in the South end of town, which is lower-rent, so the mall is full of teen moms with their babies. I try to avoid this mall for a few reasons, but teen moms everywhere is really painful when you're dealing with infertility. Last night I fixed myself a really really strong cocktail. Also, first in a month.
I went into this cycle very optimistically. I was enthusiastic that this would be it because the timing was so perfect, not just to take time off to do the cycle, but also it would have given me a late August due date and I cannot begin to explain how incredibly perfect that would have been with various elements in our life. I was so excited when, on day 3, I was told that I still had 7 really great embryos and I was scheduled for a day 5 transfer. Day 5! If your embryos are good enough to make it to day 5, then you've got about a 50/50 shot! Age no longer matters! I thought 3 would make it, transfer 1, two more frozen chances if the first doesn't work. It was sure to work. But no. I arrive on day 5, they get me ready, I'm in the stirrups, and the embryologist comes in to inform me that none have made it to Blastocyst stage. Given how well they were doing two days before, I know now that means they all started to fail the day before. It's not totally hopeless. According to the lab director, about 25% of day 5 morulas were successful last year in my clinic. The problem is that on the day of my transfer, no one in the room was able to share that information with me. I did feel mislead. And it's not the first time on this journey. If I'd had the information, I might have chosen to transfer more than one, but no one had ever discussed this possibility with us, and the doctor performing the transfer seemed to think single transfer was still best. The lab director would have advised me otherwise, but he wasn't there in the room. No one in the room suggested a change in plans. These are all issues to discuss with my doctor when we meet next to review the cycle.
I cry a lot. The promise of doing the cycle in the first place filled me with such hope. Now I am back to where I was when I first got the diagnosis. I don't know if I'm going to try again. If I try again, it won't be for four months (at least I know that much, which is better than when I first got the diagnosis and didn't know if, when, or ever). I'm back to feeling broken, damaged, and there is nothing I can do. No amount of relaxing, lifestyle changes, visualizing or praying is going to unblock my tubes. I can't go back and transfer more on day 3 (clearly in hindsight, that is going to be the best plan for me for any future attempts). So there is nothing to be gained from being angry about what went wrong. Which just leaves me with the deep sadness and patience.
I still look at adoption as an option. But there is still the complicating factor of having to wait until after we move. But at least the moving plans are beginning to firm up. 2013 was a bad year, my other half had a brain tumour, but it was treated successfully, he's recovering very well, and after a long hard search for his dream job, he finally landed it and in 6 months we will move half-way around the world! So adoption of a child in need of a loving stable family is still a possibility. It just means more waiting, and then navigating a new system. 2013 started so bad, and ended so good for him, I'm disappointed it couldn't end on a happy note for me too.
And that is where we leave things at the end of 2013, officially the worst year of my life. Pass me another bottle of Pinot Grigio.
Thursday 19 December 2013
Tuesday 10 December 2013
2 days post transfer
Two days ago I transferred one morula. I was disappointed that none of the seven embryos had made it to blastocyst stage by day 5, given how well they were going before, but maybe they just needed a few more hours? That's what I'm telling myself, it's easier to think that if the average time to morula is 96 hours from fertilization, and my retrieval was 11am (not sure what time ICSI was performed after that), and then transfer was at 10am, that gave them less than 120 hours to become blastocysts. So I also don't want to know how many were frozen the following day because if it's none, then I'm going to lose a lot of hope. Instead, I'm carrying on with my day under the belief that they all became blastocysts by the next day, including the one inside me, and today it should be hatching. So that's where I am today. Thinking happy thoughts. And drinking lots of Gatorade because it really seems to help with my swollen tender ovaries.
Friday 6 December 2013
Waiting
The waiting is the hardest part.
Day 3 - still 7 perfect little embryos, dividing just as they should. Transfer set for Sunday. And I'm going crazy. They aren't even in me and I already feel like I'm pregnant, knowing they're growing so well, and wanting to shout it from the rooftops. At the same time, I have to wait to transfer, wait for implantation to occur, and then wait to see if the growth continues and progresses and for the positive pregnancy test, which won't officially happen for two more weeks!
Sometimes I worry that I'm putting too much hope on this working. Based on all the research I've done, the age effect sorts itself out in egg retrieval and survival to day 5, but there is little to no age difference for the blastocyst transfers. So I'm giving myself 50/50 odds for this single embryo transfer, and feeling confident that at least two will be frozen in case it doesn't take. So I don't know, does this make me overly optimistic, or cautiously realistic? I really really really (infinity) hope this works, but if it doesn't, I can enjoy lots of wine and chocolate and coffee over the holidays because I have back-up. I haven't had wine or caffeinated coffee/tea and very little chocolate since the IVF cycle began. I've been a very good IVF patient. I already eat like I'm pregnant. I take my vitamins. I take my progesterone. I eat my veggies and fresh fruit and yogurt. I haven't dug out the maternity clothes box, even though I'm tempted (I was especially tempted with the extreme bloating leading up to retrieval). I wish there was something more I could do, but all I can do is wait. And the waiting is the hardest part.
Day 3 - still 7 perfect little embryos, dividing just as they should. Transfer set for Sunday. And I'm going crazy. They aren't even in me and I already feel like I'm pregnant, knowing they're growing so well, and wanting to shout it from the rooftops. At the same time, I have to wait to transfer, wait for implantation to occur, and then wait to see if the growth continues and progresses and for the positive pregnancy test, which won't officially happen for two more weeks!
Sometimes I worry that I'm putting too much hope on this working. Based on all the research I've done, the age effect sorts itself out in egg retrieval and survival to day 5, but there is little to no age difference for the blastocyst transfers. So I'm giving myself 50/50 odds for this single embryo transfer, and feeling confident that at least two will be frozen in case it doesn't take. So I don't know, does this make me overly optimistic, or cautiously realistic? I really really really (infinity) hope this works, but if it doesn't, I can enjoy lots of wine and chocolate and coffee over the holidays because I have back-up. I haven't had wine or caffeinated coffee/tea and very little chocolate since the IVF cycle began. I've been a very good IVF patient. I already eat like I'm pregnant. I take my vitamins. I take my progesterone. I eat my veggies and fresh fruit and yogurt. I haven't dug out the maternity clothes box, even though I'm tempted (I was especially tempted with the extreme bloating leading up to retrieval). I wish there was something more I could do, but all I can do is wait. And the waiting is the hardest part.
Thursday 5 December 2013
Verdict 1 - fertilization
I had to call it verdict 1, because obviously the pregnancy test at the end of all this will be the big verdict 2.
I'm thrilled that my fertilization report is very very good. 13 eggs were retrieved. 11 fertilized with ICSI. Today, day 2, 9 are dividing perfectly and are beautiful little 4-cell embryos. I know they won't all make it to day 5, but it looks very promising that we will have a day 5 single blastocyst transfer and some to freeze!
I'm thrilled that my fertilization report is very very good. 13 eggs were retrieved. 11 fertilized with ICSI. Today, day 2, 9 are dividing perfectly and are beautiful little 4-cell embryos. I know they won't all make it to day 5, but it looks very promising that we will have a day 5 single blastocyst transfer and some to freeze!
Wednesday 4 December 2013
Retrieval day!
FYI - I started writing this post the night before retrieval. Then I was interrupted and didn't finish. Tried again after retrieval, but again didn't finish. Take-home message: retrieval is a busy time.
Yesterday morning was my egg retrieval and they found an extra one! So 13 retrieved total. I only expect 10 mature though, and I'll get the fertilization report and transfer time tomorrow (2 days after retrieval). Retrieval was not fun, but it's over, and after the pain meds wore off (and they gave me a lot - their words), I was feeling pretty good, and the meds they sent me home with don't make me woozy, which I like. So now I "take it easy" - not bed rest, I need to get up and walk around for 5 minutes every hour. I need to stay well hydrated, and I need to thus pee a lot.
There was a lot I didn't know about IVF injections before I started, and now I feel like a pro. Everyone's protocol is different, but there are some consistent similarities. So I wanted to share what I learned.
Down regulation - I was on birth control pills for 20 days. This started on day 3 of the previous cycle, and then on the 18th day of taking the pills I was scanned to make sure my ovaries were "quiet" and lining thin. The purpose of down regulation is to get your hormones, ovaries, and lining to a good starting point before stimulation. Think lining up at the starting gate. When the scan looked good, I got my instructions when to stop and wait for the next cycle to begin. There are different down regulation protocols, and some women are put on what's called a short protocol, in which there is no down regulation. As much as we all want to get the show on the road, the short protocol is usually used with older women and women expected to be poor responders.
Follicle Stimulating Hormone (FSH) injections - it's just as it sounds. Naturally, your body would produce a surge of this at the beginning of each cycle. In IVF, you start around day 3 taking high doses. I was on two injections daily for 10 days: 225 units of Puregon (cut to a half dose on the last day) and 75 units Menopur. There are numerous brands of FSH, and dose will be determined by a number of factors, but this is a critical part of the protocol. These are also the most expensive of the drugs, easily accounting for 75% of my drug expenses in this cycle. So the older you are (or the older your ovaries think you are, regardless of what it says on your driver's licence), the more you will pay in drugs because this is where most of the variation in protocols occurs too. The higher your day 3 FSH level (naturally), and lower your antral follicle count, the more of these drugs you'll need to produce a decent number of follicles for retrieval.
GnRH antagonists / agonists - there are several brands of these, and they don't all work in the same way, but they all have the same effect: to prevent you from ovulating before retrieval and let the non-dominant follicles catch up. Ordinarily, about a week into a cycle, one or two follicles would become dominant, and the smaller ones would shrivel up and die. These dominant follicles start producing more and more estrogen, which would eventually reach a critical level that says "we're ready" and initiate the LH surge to kick off ovulation. In IVF, you don't want that to happen, so on the 5th day of FSH injections, I began a 3rd: Orgalutran. It comes in pre-filled single-use syringes so I didn't pay much attention to the dose. I took that with the FSH for the next 6 days. Meanwhile, my follicles kept growing, my estradiol kept rising, but my LH stayed nice and low.
hCG Trigger shot - On the final day of injections (all 3 injections were taken at the usual time this day), and exactly 36 hours before my scheduled retrieval, I took a single shot of Ovidrel. This is a synthetic form of hCG (it's the CG, as 'h' stands for human) that is a stand in for the LH surge. It also came in a pre-filled single-use injection pen. This injection gives the follicles a final maturation push, as well as start to loosen up the follicles for retrieval. Timing of this injection is very precise. This is also the chemical that pregnancy tests react to, so as long as it's still in your urine, you will get positive pregnancy tests. Some women with pee-on-a-stick obsessions test out the trigger - take a test each day and watch for it to become negative or at least fade substantially, then if it starts to get dark again you know that is your pregnancy taking hold, not the trigger shot. I have every intention of doing this, simply because I have a big box of test strips ordered from makeababy.ca before my diagnosis, and what else am I going to do with them? I don't see much point in starting this before transfer day but I might.
What the heck, I'll go do it now, I need to see what a positive test strip looks like!
Yesterday morning was my egg retrieval and they found an extra one! So 13 retrieved total. I only expect 10 mature though, and I'll get the fertilization report and transfer time tomorrow (2 days after retrieval). Retrieval was not fun, but it's over, and after the pain meds wore off (and they gave me a lot - their words), I was feeling pretty good, and the meds they sent me home with don't make me woozy, which I like. So now I "take it easy" - not bed rest, I need to get up and walk around for 5 minutes every hour. I need to stay well hydrated, and I need to thus pee a lot.
There was a lot I didn't know about IVF injections before I started, and now I feel like a pro. Everyone's protocol is different, but there are some consistent similarities. So I wanted to share what I learned.
Down regulation - I was on birth control pills for 20 days. This started on day 3 of the previous cycle, and then on the 18th day of taking the pills I was scanned to make sure my ovaries were "quiet" and lining thin. The purpose of down regulation is to get your hormones, ovaries, and lining to a good starting point before stimulation. Think lining up at the starting gate. When the scan looked good, I got my instructions when to stop and wait for the next cycle to begin. There are different down regulation protocols, and some women are put on what's called a short protocol, in which there is no down regulation. As much as we all want to get the show on the road, the short protocol is usually used with older women and women expected to be poor responders.
Follicle Stimulating Hormone (FSH) injections - it's just as it sounds. Naturally, your body would produce a surge of this at the beginning of each cycle. In IVF, you start around day 3 taking high doses. I was on two injections daily for 10 days: 225 units of Puregon (cut to a half dose on the last day) and 75 units Menopur. There are numerous brands of FSH, and dose will be determined by a number of factors, but this is a critical part of the protocol. These are also the most expensive of the drugs, easily accounting for 75% of my drug expenses in this cycle. So the older you are (or the older your ovaries think you are, regardless of what it says on your driver's licence), the more you will pay in drugs because this is where most of the variation in protocols occurs too. The higher your day 3 FSH level (naturally), and lower your antral follicle count, the more of these drugs you'll need to produce a decent number of follicles for retrieval.
GnRH antagonists / agonists - there are several brands of these, and they don't all work in the same way, but they all have the same effect: to prevent you from ovulating before retrieval and let the non-dominant follicles catch up. Ordinarily, about a week into a cycle, one or two follicles would become dominant, and the smaller ones would shrivel up and die. These dominant follicles start producing more and more estrogen, which would eventually reach a critical level that says "we're ready" and initiate the LH surge to kick off ovulation. In IVF, you don't want that to happen, so on the 5th day of FSH injections, I began a 3rd: Orgalutran. It comes in pre-filled single-use syringes so I didn't pay much attention to the dose. I took that with the FSH for the next 6 days. Meanwhile, my follicles kept growing, my estradiol kept rising, but my LH stayed nice and low.
hCG Trigger shot - On the final day of injections (all 3 injections were taken at the usual time this day), and exactly 36 hours before my scheduled retrieval, I took a single shot of Ovidrel. This is a synthetic form of hCG (it's the CG, as 'h' stands for human) that is a stand in for the LH surge. It also came in a pre-filled single-use injection pen. This injection gives the follicles a final maturation push, as well as start to loosen up the follicles for retrieval. Timing of this injection is very precise. This is also the chemical that pregnancy tests react to, so as long as it's still in your urine, you will get positive pregnancy tests. Some women with pee-on-a-stick obsessions test out the trigger - take a test each day and watch for it to become negative or at least fade substantially, then if it starts to get dark again you know that is your pregnancy taking hold, not the trigger shot. I have every intention of doing this, simply because I have a big box of test strips ordered from makeababy.ca before my diagnosis, and what else am I going to do with them? I don't see much point in starting this before transfer day but I might.
What the heck, I'll go do it now, I need to see what a positive test strip looks like!
Sunday 1 December 2013
Day 10
I was back again for another monitoring appointment this morning. Everything looks great and I will take my final injections today, a trigger shot of hCG tonight, and retrieval is set for Tuesday morning! I'm so excited I don't know what to do with myself. I have 10 mature follicles, which is excellent. Also excellent is that I don't have to take any more shots after today. Yay! I have to take progesterone suppositories after retrieval, which I hear are gross and messy, but it sure beats more shots!
Today I also learned beware of units of measurement. I had been wondering why my estradiol numbers always seemed absurdly high. Come to think of it, my progesterone is always absurdly high. But now I know it's a different unit of measurement! I don't know what this means in terms of my progesterone numbers, but my E2 numbers have been right on track all along, which is good.
Now, what can I do to keep my mind occupied? This is the hard part. I have all day today and tomorrow to try and keep my mind busy. Then after retrieval, waiting for the call with the fertilization report. Then waiting for the call for the progress and whether it will be day 3 (Friday) or day 5 (Sunday). Then waiting to see if it works. I hope I'm not getting my hopes up too high, but I have high hopes for this to work! I can't help it!
Today I also learned beware of units of measurement. I had been wondering why my estradiol numbers always seemed absurdly high. Come to think of it, my progesterone is always absurdly high. But now I know it's a different unit of measurement! I don't know what this means in terms of my progesterone numbers, but my E2 numbers have been right on track all along, which is good.
Now, what can I do to keep my mind occupied? This is the hard part. I have all day today and tomorrow to try and keep my mind busy. Then after retrieval, waiting for the call with the fertilization report. Then waiting for the call for the progress and whether it will be day 3 (Friday) or day 5 (Sunday). Then waiting to see if it works. I hope I'm not getting my hopes up too high, but I have high hopes for this to work! I can't help it!
Friday 29 November 2013
Day 8
Another day closer, and it's all I can think about. Today I was back for more blood work and an ultrasound scan. I lost track of how many follicles they measured, but the biggest two were 17mm. Now I wait for the call. I'm trying to busy myself with work, but I'm tired and uncomfortable. I'm lying on the couch with my laptop, but still… It's lunch time so I could justifiably get up and make something to eat. I feel guilty about how unproductive I've been this week, but I'm just so tired. I sleep really well, and feel great in the morning, it's the afternoons that are the worst. Also, the injections are getting harder not easier. The Puregon is pretty easy still, but the Menopur burns more each time, and the Orgalutran seems harder and harder to get in.
Wednesday 27 November 2013
6 days in...
I've taken my 6th day of shots today. I am officially feeling like a human pincushion. Also, I found that the thicker tummy flab is more comfortable than grabbing a thinner spot a little lower. Maybe that's why there are so many different experiences with these shots, it depends partly on our adiposity. I have enough to go 4 more days but I really hope it's only 3. Yesterday I started to get a little uncomfortable. Today, I am officially uncomfortable. Especially on the left, which is weird because while the follicles are pretty close to even on both sides, the biggest one is on the right by 2mm.
Yesterday was my second monitoring scan. At my first, 12 antral follicles were counted (7 on the right and 5 on the left). Yesterday, on my 5th day of injections, I still had 12 follicles, but 6 on each side?! There is one bigger one on each side, measuring 13 & 11mm, and then 5 on each at roughly 8mm. But that was yesterday and they grow on average 2mm per day, so when I go back in for monitoring on Friday, they should each be 6mm bigger. So that explains the discomfort, and I just expect it to get worse over the next few days as I count down to trigger. It reminds me a lot of the discomfort of late pregnancy, ironically. Also ironic, I've lost 5 lbs in 3 days while on these injections, but I'm so bloated and uncomfortable I can't fit into anything anyway.
Yesterday was my second monitoring scan. At my first, 12 antral follicles were counted (7 on the right and 5 on the left). Yesterday, on my 5th day of injections, I still had 12 follicles, but 6 on each side?! There is one bigger one on each side, measuring 13 & 11mm, and then 5 on each at roughly 8mm. But that was yesterday and they grow on average 2mm per day, so when I go back in for monitoring on Friday, they should each be 6mm bigger. So that explains the discomfort, and I just expect it to get worse over the next few days as I count down to trigger. It reminds me a lot of the discomfort of late pregnancy, ironically. Also ironic, I've lost 5 lbs in 3 days while on these injections, but I'm so bloated and uncomfortable I can't fit into anything anyway.
Saturday 23 November 2013
Jelly Belly
Good ole belly fat - finally you come in handy! Today is the second day of IVF injections. Each day, so far, is two needles in the belly. The anticipation is worse than the shot, and as the days go by that should improve too. At 4pm I get out my gear. I lay out all the bits and pieces for each of the two shots. First I do the Puregon 225 units - my FSH shot. That's easy, it's a preloaded injection pen, I just attach a fresh needle, dial it up to the right dose, and jab away. Second is the Menopur, 1 vial - FSH/LH combo shot. That one involves mixing and I swear I spent 10 minutes fussing over an air bubble in the syringe. It also has the reputation for "burning" but it's really mild. I'd say yes they feel different, and if I had to characterize one as "burning" that would be the one, but I expected worse. So jabbing myself with needles every day is not as scary as I thought.
Fun facts: Menopur is made from the urine of post menopausal women. Rumour has it they could be Italian Nuns. Before you start cringing, basic hormone replacement therapies are made from horse urine. The Puregon is vaguely described by Merck Pharmaceuticals as "produced from mammalian cells". Is the mammal in question a protected trade secret? Is it multi-mammal, like a 100% "meat" hotdog? I don't know. I'm not sure I want to know. All I know is it's bloody expensive. Roughly $2400 for 10 days, vs $750 for 10 vials of Menopur. I guess urine is cheaper than mystery mammal.
Fun facts: Menopur is made from the urine of post menopausal women. Rumour has it they could be Italian Nuns. Before you start cringing, basic hormone replacement therapies are made from horse urine. The Puregon is vaguely described by Merck Pharmaceuticals as "produced from mammalian cells". Is the mammal in question a protected trade secret? Is it multi-mammal, like a 100% "meat" hotdog? I don't know. I'm not sure I want to know. All I know is it's bloody expensive. Roughly $2400 for 10 days, vs $750 for 10 vials of Menopur. I guess urine is cheaper than mystery mammal.
Sunday 17 November 2013
Last day, next step
Yesterday was my last birth control pill. I had an ultrasound on Thursday, and everything looked good, ovaries were "quiet" and endometrium was thin. We're one step closer! I feel a bit like getting ready to launch a space shuttle. I'm not sure where in that analogy is "lift-off", maybe my first FSH injections? Last Thursday was like the "all systems ready" green light, and next up is the clear weather forecast.
I took my basal body temperature periodically through this birth control pill stretch, and it was very "luteal" which tells me my progesterone has been holding steady, so now I'm just waiting for it to crash back down. Should be interesting to temp throughout this cycle, but then I won't know if I'm pregnant because I'll be on supplemental progesterone after retrieval. As the day gets closer, I'm nervous and excited, and very very hopeful!
I took my basal body temperature periodically through this birth control pill stretch, and it was very "luteal" which tells me my progesterone has been holding steady, so now I'm just waiting for it to crash back down. Should be interesting to temp throughout this cycle, but then I won't know if I'm pregnant because I'll be on supplemental progesterone after retrieval. As the day gets closer, I'm nervous and excited, and very very hopeful!
Tuesday 12 November 2013
Countdown!
There are so many milestones along this IVF journey, and today I'm getting excited about the next one - the end of the oral contraceptive down regulation. Bright and early, two days from now, I will have an ultrasound to check and make sure I don't have any cysts. It's the next step to beginning medication injections, which could start in as little as a week! I'm just so excited I want to bounce off the walls! The next few weeks will be like a child counting down to Christmas!
Monday 4 November 2013
The hormones...
One week into my birth control pill protocol, and I feel horrible. My boobs hurt. I'm really irritable. I'm tired. Yesterday I was nauseated. It's everything of a luteal phase, but without the "yay, maybe this is a pregnancy symptom". I took the pill for about 10 years, and I don't remember any of this. Maybe because I took it so long I don't remember. Maybe because I was pretty young when I started (17-ish?). You know what is ironic? I've had these luteal symptoms for about 4 years. I call it "four years of morning sickness and feeling like I'm pregnant". I didn't remember feeling any of it before I really was pregnant, but maybe I just didn't know what it was. When I was pregnant, I remember thinking, hmmm, this morning sickness is a lot like what I've been calling "migraine" for most of my life because it was a nauseous dizzy headache. Although sometimes it is vertigo too. All very hard to differentiate. Until I started tracking my cycles trying to get pregnant, and lo and behold, it was progesterone! So I went to my doctor for some tests, back before I was actively trying to conceive complaining of these symptoms to my doctor. First off, he didn't believe I wasn't pregnant. Second, and this is why I went when I did, I also had intense pain around one kidney which he was convinced was an ectopic pregnancy. Turns out it was a UTI, even though I didn't have any symptoms. But the progesterone symptoms didn't go away. The doctor suspected it was cyclic (because I said it was) and offered to put me on birth control pills. His reasoning was that it was ovulation related symptoms. Which it was, just not the act of ovulation. Birth control pills work by disrupting the endocrine system and often it's just by tricking your body into thinking it's already pregnant. With progesterone. That is what inhibits ovulation naturally happening again within a given cycle or when you actually are pregnant. So I have to say, I'm not surprised that the symptoms of birth control pills are the same as the sucky feeling of early pregnancy or luteal phase in general. Long story short (too late)… I can't wait for this part of the protocol to end.
I have also answered the question of why birth control pills, and what role they have in an IVF cycle. The goal is to make sure the estradiol level at the beginning of the stimulation cycle is low. There is no consensus on how low it should be, my clinic likes it under 200, and the birth control pills for a few weeks will do that. There seems to be some debate about the importance of a further GnRH antagonist for a few days before FSH shots start, but I need to do more reading on that. The argument is that a further few days of Lupron or something like that to manipulate the pituitary improves ovarian response to the FSH, but that probably depends on the individual. It's not about quantity, it's about quality, and 4-6 good quality eggs is what my clinic wants. I read a study that found outcomes were best if 6-15 were produced, any more or less and the success rate was not as good. I don't remember if the outcome was clinical pregnancy or live birth, I suppose I will have to look it up and post it here.
I have also answered the question of why birth control pills, and what role they have in an IVF cycle. The goal is to make sure the estradiol level at the beginning of the stimulation cycle is low. There is no consensus on how low it should be, my clinic likes it under 200, and the birth control pills for a few weeks will do that. There seems to be some debate about the importance of a further GnRH antagonist for a few days before FSH shots start, but I need to do more reading on that. The argument is that a further few days of Lupron or something like that to manipulate the pituitary improves ovarian response to the FSH, but that probably depends on the individual. It's not about quantity, it's about quality, and 4-6 good quality eggs is what my clinic wants. I read a study that found outcomes were best if 6-15 were produced, any more or less and the success rate was not as good. I don't remember if the outcome was clinical pregnancy or live birth, I suppose I will have to look it up and post it here.
Thursday 31 October 2013
A new kind of two week wait
The two week wait is what the trying to conceive community calls the time between ovulation and when you find out if your efforts were fruitful. Right now I'm beginning a new two week wait, a few days into my down regulation birth control pill protocol, I noted on the calendar that exactly two weeks from today will be my first early morning ultrasound.
And I have to admit, it's strange being back on birth control pills after all these years, and especially as a step towards getting pregnant. The idea is to regulate my hormones, make my lining thin, and make sure I have no cysts. It's all about getting me to a good starting point, and I'm sure that over the next two weeks I will read a lot more about how this all works. But right now, I just need to remember to take it every night at 9pm until my scan in two weeks.
Monday 28 October 2013
IVF protocol officially starts today!
This is an exciting day. A week and a half ago, we had our marathon IVF orientation session. And it was a marathon. Two hours of instruction with the nurse, including all the injections and the protocol plan, 10 minutes with a financial officer, and two more hours with a psychologist. My brain hurt from all the information I absorbed. When we went home I had a headache and was exhausted and honestly was confused about what day it was. I wanted nothing more than for it to be Friday afternoon and to have a weekend to rest, but no, it was Thursday and I would have to be up early for work the next day. And the following Monday was the surgery. We are working on a tight schedule with a narrow window of opportunity.
I'm so glad they squeezed us in before my other half had a tumour the size of a grape removed from his brain (he's doing great, btw). Now with the surgery down, the protocol begins tonight with 18 days of birth control pills. Seems so counter-intuitive, but it's to get my hormones and ovaries to the starting gate. On that 18th day, I go in for an ultrasound bright and early. If that looks good, I stop the pills, wait for a bleed, and then on the third day go for another ultrasound and blood work. And if that looks good, I start injections that night! Puregon 225 and Menopur 75, every day, and then about 5-6 days in the regular monitoring begins. Finally, a use for that muffin top! Estimated retrieval is the end of November, which could not be more perfect with my schedule to take some time off and rest (I've been recording Grey's Anatomy to save just for that). So now I've got my fingers crossed for a positive pregnancy test for Christmas, and an estimated due date in late August.
So excited!!
I'm so glad they squeezed us in before my other half had a tumour the size of a grape removed from his brain (he's doing great, btw). Now with the surgery down, the protocol begins tonight with 18 days of birth control pills. Seems so counter-intuitive, but it's to get my hormones and ovaries to the starting gate. On that 18th day, I go in for an ultrasound bright and early. If that looks good, I stop the pills, wait for a bleed, and then on the third day go for another ultrasound and blood work. And if that looks good, I start injections that night! Puregon 225 and Menopur 75, every day, and then about 5-6 days in the regular monitoring begins. Finally, a use for that muffin top! Estimated retrieval is the end of November, which could not be more perfect with my schedule to take some time off and rest (I've been recording Grey's Anatomy to save just for that). So now I've got my fingers crossed for a positive pregnancy test for Christmas, and an estimated due date in late August.
So excited!!
Thursday 10 October 2013
Good morning probing
Yesterday was the anxiously awaited saline sonohysterogram, the fun cousin of our favourite fertility diagnostic test, the hsg. In the sono, like the hsg, a catheter with a balloon is inserted through the cervix into the uterus, where the balloon is inflated. Then sterile saline is injected to open up the uterine walls (which usually lie flat against each other like a sandwich) while our trusty friend the transvaginal ultrasound probe visualizes the walls of the uterus.
I was in fear of a giant polyp waving back, like this:
The letter A is pointing to a big ole polyp. First off, mine didn't look anything like this, it looked much much much smaller when "fully" inflated with saline (B) and those muscular uterine walls (C) also look huge. Maybe this image is enlarged relative to what my doctor had on screen.
Once the procedure got going, and that balloon was inserted, words can't describe the pain I experienced. In places I didn't know existed, aside from the brief jab during the hsg. This sono though, pushed through that pain. Ironically, when I was expected to feel "cramping" I did but it was no big deal. I felt certain in those moments that the pain was evidence that my entire uterus was fused together like a grilled cheese sandwich and the pain was ripping adhesions. As that was not the case, I have no explanation for the excruciating pain, all I know is that it only happened during these two procedures. Which I never ever want to repeat.
Good news, everything was clear, and a nice ripe follicle was identified on the right ovary that will ovulate sometime in the next few days, not that it has anywhere to go. Bad news, I'm still on the maximum daily dose of Advil from the pain of yesterday's probing. My other half asked where all the eggs go if my tubes are all blocked. I suppose they are all reabsorbed into the body, but I can't help but picture my abdominal cavity full of little globules.
Next week, IVF "class" - can't wait to see what that's all about. I bet there is a test.
I was in fear of a giant polyp waving back, like this:
The letter A is pointing to a big ole polyp. First off, mine didn't look anything like this, it looked much much much smaller when "fully" inflated with saline (B) and those muscular uterine walls (C) also look huge. Maybe this image is enlarged relative to what my doctor had on screen.
Once the procedure got going, and that balloon was inserted, words can't describe the pain I experienced. In places I didn't know existed, aside from the brief jab during the hsg. This sono though, pushed through that pain. Ironically, when I was expected to feel "cramping" I did but it was no big deal. I felt certain in those moments that the pain was evidence that my entire uterus was fused together like a grilled cheese sandwich and the pain was ripping adhesions. As that was not the case, I have no explanation for the excruciating pain, all I know is that it only happened during these two procedures. Which I never ever want to repeat.
but I could go for a grilled cheese.
Good news, everything was clear, and a nice ripe follicle was identified on the right ovary that will ovulate sometime in the next few days, not that it has anywhere to go. Bad news, I'm still on the maximum daily dose of Advil from the pain of yesterday's probing. My other half asked where all the eggs go if my tubes are all blocked. I suppose they are all reabsorbed into the body, but I can't help but picture my abdominal cavity full of little globules.
Next week, IVF "class" - can't wait to see what that's all about. I bet there is a test.
Monday 23 September 2013
Surviving the thaw
We froze a sperm sample last week in advance of the super major endocrine crashing surgery (for which we still don't have a date). They take the sample, divide it into 8 "straws" and then this morning they thawed one to test. The good news is they survived the thaw. The bad news is that enough survived for ICSI, but not for natural fertilization. I was hoping to avoid ICSI. A big part is the extra cost. $1500. Not covered by OHIP. Nor is the sperm banking by the way, even though both have become "medically necessary".
Under normal circumstances, the "best" sperm win the race. This is what makes me nervous about ICSI. Despite what the clinic doctors said, I am an avid pubmed user and I know there is data out there to suggest that there may be more risks of fetal abnormalities with ICSI simply because the best, healthiest sperm didn't win the race. Whether the sperm was not strong enough to do the job on his or her own, or whether the egg was developing a harder less penetrable zona (shell if you will, although it's not a shell per se), the need for ICSI arises when one or both parties are not in tip-top shape. It's giving a helping hand sometimes to genetic material that otherwise wouldn't make the cut. It's not the process of ICSI, it's the selection of sperm to use. The success rate for ICSI (and there are twice as many as non-ICSI IVF done in my clinic) is not nearly as good. This, and the studies that show more potential problems with ICSI outcomes all reflect pre-existing problems. If only a small number of sperm survive the thaw, they are clearly the best, so I guess the selection process is pretty simple. It just makes me nervous. I wanted to make this as natural as possible, just by-passing my damaged tubes. I want minimal ovarian stimulation. I want 6 follicles. I want them to fertilize because they want to, because they are healthy, and develop the same way, and I dream of 3-4 good embryos, transfer one and freeze the rest for later. And never have to do another retrieval cycle. Maybe I'm being naive.
I also had a dream the other night that I was asked to care for 3 foster babies, infants, but they were all boys and all I could think was why are they all boys? I hope it's not a sign.
FYI - the original page from which I found this image is well worth a read,
I mean with a headline like "will swallowing semen make my girlfriend gain weight" how could you resist?
Under normal circumstances, the "best" sperm win the race. This is what makes me nervous about ICSI. Despite what the clinic doctors said, I am an avid pubmed user and I know there is data out there to suggest that there may be more risks of fetal abnormalities with ICSI simply because the best, healthiest sperm didn't win the race. Whether the sperm was not strong enough to do the job on his or her own, or whether the egg was developing a harder less penetrable zona (shell if you will, although it's not a shell per se), the need for ICSI arises when one or both parties are not in tip-top shape. It's giving a helping hand sometimes to genetic material that otherwise wouldn't make the cut. It's not the process of ICSI, it's the selection of sperm to use. The success rate for ICSI (and there are twice as many as non-ICSI IVF done in my clinic) is not nearly as good. This, and the studies that show more potential problems with ICSI outcomes all reflect pre-existing problems. If only a small number of sperm survive the thaw, they are clearly the best, so I guess the selection process is pretty simple. It just makes me nervous. I wanted to make this as natural as possible, just by-passing my damaged tubes. I want minimal ovarian stimulation. I want 6 follicles. I want them to fertilize because they want to, because they are healthy, and develop the same way, and I dream of 3-4 good embryos, transfer one and freeze the rest for later. And never have to do another retrieval cycle. Maybe I'm being naive.
I also had a dream the other night that I was asked to care for 3 foster babies, infants, but they were all boys and all I could think was why are they all boys? I hope it's not a sign.
Tuesday 17 September 2013
Weighty issues
Before I moved last year I was at a svelte 133lbs (give or take a pound), and comfortably sporting size 4. I'd completely revamped my wardrobe in size 4. I'm only 5'2" so don't get too too jealous, I was still at a BMI of 24, but life was good and I was pleased, even if everything was still flabby and no way was I going to wear a bikini. Since I moved, and we started trying to get pregnant, it creeped up. Just a tad, but I'm sitting at 140 and have been for a few months. I let this happen. First, because every month I assumed I'd be in maternity clothes in no time, and second, because my stupid hormones give me almost constant mild morning sickness (and have for the past 4 years) that is effectively managed with the same trick as real morning sickness - food. Carbs and nuts especially. At some point along the line I discovered that B6 and magnesium supplements keep the queasiness at bay, so now my only excuse was not to introduce a diet or new workout because maybe this month will be my month.
When I got my diagnosis and it started to sink in, and I started to think I'd never be pregnant again, I searched for a 30-day-abs program that a friend had posted on Facebook a while back. I was planning to start, but never got around to it. Where have we heard that before? I did start randomly doing cardio, but life gets in the way sometimes (again, if you let it). Now that I'm hoping to have a successful IVF before the year is out, getting those washboard abs I never had seems silly. I should still do more cardio, and I should still drop 5-10 lbs so my pants fit again, but who cares about abs.
Well, I've found my calling. The totally-won't-be-undone-by-pregnancy 30-day-ARMS! Thank you Jodi Higgs!
When I got my diagnosis and it started to sink in, and I started to think I'd never be pregnant again, I searched for a 30-day-abs program that a friend had posted on Facebook a while back. I was planning to start, but never got around to it. Where have we heard that before? I did start randomly doing cardio, but life gets in the way sometimes (again, if you let it). Now that I'm hoping to have a successful IVF before the year is out, getting those washboard abs I never had seems silly. I should still do more cardio, and I should still drop 5-10 lbs so my pants fit again, but who cares about abs.
Well, I've found my calling. The totally-won't-be-undone-by-pregnancy 30-day-ARMS! Thank you Jodi Higgs!
Day 1 - success!
Panic attack!
I don't want to trivialize the experience of people with panic attacks. I think I'm just having very mild ones. But they are interfering with my ingenious plan to work from home as much as possible. We are closing in on the likely timeframe for my husband's surgery. His major major surgery. But we still haven't been given a date. Our reproductive endocrinologist (RE - the fertility doc) is aware of how quickly it is likely to happen, and is working with us to freeze some sperm. But no date for that either. I wish I could carry on full steam ahead like he is with an attitude of "get as much done before they call" but I can't seem to do that. Instead I'm having regular panic attacks. Sometimes it's a near paralyzing anxiety that keeps me from doing anything except reading my fertility board. Sometimes it's heart pounding, racing, or whatever that was last night - it seemed to be composing a hip-hop song with a crazy irrational beat. I haven't even gotten dressed yet this morning and I'm already paralysed. I have a meeting at 9:30, it's 9:05 and I'm in my robe. Luckily it's online and no one can see me, but I can't go for a run until it's over.
I only have two tricks up my sleeve to cope with this right now. One is running. I literally feel like I am running away from the anxiety, and while I'm running it feels like it's working, but it doesn't seem to last.
The other is SleepyTime Tea, coupled with something mindless like a talk show to distract and sedate me ever so slightly. It gets my heart rate back down closer to normal, but I don't seem to settle enough to concentrate on any work. And it seems strange to drink it so early in the day.
It's taking everything I have to keep up, to keep going. On the days I go in to my office, I'm pretty effective, and they end up being long days. So far, no one is the wiser. I was waiting until we have a date set to tell my boss what's going on. I was tempted to tell him on Friday. Now I'm tempted to tell him this week. I'm not sure what would happen if I needed to take stress leave for a few weeks, it's not like someone can just come and take over for me. Can they? What would happen if I were hit by a bus and in a coma for 6 weeks? There must be a contingency plan. My contingency plan has never extended beyond a day or two.
9:18 am. Time to shake it off as best I can. Get dressed. Eat something. I can do this.
I only have two tricks up my sleeve to cope with this right now. One is running. I literally feel like I am running away from the anxiety, and while I'm running it feels like it's working, but it doesn't seem to last.
The other is SleepyTime Tea, coupled with something mindless like a talk show to distract and sedate me ever so slightly. It gets my heart rate back down closer to normal, but I don't seem to settle enough to concentrate on any work. And it seems strange to drink it so early in the day.
It's taking everything I have to keep up, to keep going. On the days I go in to my office, I'm pretty effective, and they end up being long days. So far, no one is the wiser. I was waiting until we have a date set to tell my boss what's going on. I was tempted to tell him on Friday. Now I'm tempted to tell him this week. I'm not sure what would happen if I needed to take stress leave for a few weeks, it's not like someone can just come and take over for me. Can they? What would happen if I were hit by a bus and in a coma for 6 weeks? There must be a contingency plan. My contingency plan has never extended beyond a day or two.
9:18 am. Time to shake it off as best I can. Get dressed. Eat something. I can do this.
Saturday 14 September 2013
Full steam ahead!
Yesterday we had our first IVF consult meeting. I was so anxious a few hours beforehand that my hands were shaking and my heart was racing. I didn't think it was appropriate to have a glass of wine to calm my nerves, but I found some SleepyTime tea in the cupboard, watched a mindless talk show, and managed to take the edge off enough to not be a complete basket case.
Our doctor was great. She explained everything really well, including what we need to do because of our "special situation" and had everything ready for us to begin the pre-tests (my OB had sent everything, but there were a few special tests the clinic needs). They require basic infection screens, and we did it right away. I need a sonohysterogram (where saline is injected into the uterus to inflate it and then ultrasound is used to look around) to make sure there aren't any polyps that could cause a miscarriage. I need to repeat my cd3 bloodwork because even though my FSH was low, estrogen wasn't measured and abnormally high estrogen can also suppress FSH making it misleading. Follicle Stimulating Hormone (FSH) levels begin to rise late in the luteal phase as progesterone and estrogen drop, causing FSH to peak around 3 days after the first day of menstrual bleeding. When ovarian reserve gets low, FSH levels tend to rise overall making the peak even higher, but it's just a symptom, you won't improve your ovarian reserve by trying to lower FSH and occasionally it can be misleading. So both of those tests can be done for me in my next cycle and fingers crossed I could have my first IVF in November. We also have a mandatory 3 hour information session with a nurse and social worker. We are waiting for that to be set up too.
The big deal is the recommendation that we freeze semen samples and soon. This is critical. The surgery will have a direct effect on his endocrine system, and the long-term consequences are uncertain, from a fertility point of view. He could get a hormone replacement regime that only results in a brief period of poor sperm quality, an indeterminate period of poor sperm quality, or permanent sterility. So this is a one-shot deal. Pun intended. But we are going full steam ahead!
We left the clinic but hadn't really discussed anything together, privately. After we had our private discussion, and had decided that yes, we're doing this, we were excited. We wanted to celebrate. We didn't celebrate when we first decided, yes let's try and make a baby (although I know some do) so it was strange that we were feeling this way. So now the surgery preparations are in full swing, and the IVF preparations are in full swing. It's a crazy but exciting time.
Our doctor was great. She explained everything really well, including what we need to do because of our "special situation" and had everything ready for us to begin the pre-tests (my OB had sent everything, but there were a few special tests the clinic needs). They require basic infection screens, and we did it right away. I need a sonohysterogram (where saline is injected into the uterus to inflate it and then ultrasound is used to look around) to make sure there aren't any polyps that could cause a miscarriage. I need to repeat my cd3 bloodwork because even though my FSH was low, estrogen wasn't measured and abnormally high estrogen can also suppress FSH making it misleading. Follicle Stimulating Hormone (FSH) levels begin to rise late in the luteal phase as progesterone and estrogen drop, causing FSH to peak around 3 days after the first day of menstrual bleeding. When ovarian reserve gets low, FSH levels tend to rise overall making the peak even higher, but it's just a symptom, you won't improve your ovarian reserve by trying to lower FSH and occasionally it can be misleading. So both of those tests can be done for me in my next cycle and fingers crossed I could have my first IVF in November. We also have a mandatory 3 hour information session with a nurse and social worker. We are waiting for that to be set up too.
The big deal is the recommendation that we freeze semen samples and soon. This is critical. The surgery will have a direct effect on his endocrine system, and the long-term consequences are uncertain, from a fertility point of view. He could get a hormone replacement regime that only results in a brief period of poor sperm quality, an indeterminate period of poor sperm quality, or permanent sterility. So this is a one-shot deal. Pun intended. But we are going full steam ahead!
We left the clinic but hadn't really discussed anything together, privately. After we had our private discussion, and had decided that yes, we're doing this, we were excited. We wanted to celebrate. We didn't celebrate when we first decided, yes let's try and make a baby (although I know some do) so it was strange that we were feeling this way. So now the surgery preparations are in full swing, and the IVF preparations are in full swing. It's a crazy but exciting time.
Thursday 5 September 2013
Do you put your trust in fate?
It feels like Kismet. Fate. Today the Universe delivered. I got a call this afternoon that there is a cancellation next week and the clinic can fit me in for my initial consult. This is it. Here we are, September, when my life gets really chaotic. I have worked it so I only have to work out of town 2 days a week, and I have two semi-open and one completely open day. Thursdays are my day. Thursday is the opening. Score one for good luck.
As soon as I got off the phone I called my other half to make sure he'll be there. He needs to be there, and I accepted without even checking, but he didn't have any conflicts and I told him to mark it in his calendar. Score two for good luck.
My anxiety was subsiding already, and now I'm psyched! There is a lot to be anxious about. We are still waiting to hear about his surgery date. Will we get the chance to do anything before his surgery? Will they freeze and store his sperm? How does he feel about it? Should I buy a lotto ticket and make it a trifecta? The future is always uncertain, but everything always works out in the end.
Ironically, while my womb might get a dust-off, my aching old joints just ix-nayed my afternoon run plans.
As soon as I got off the phone I called my other half to make sure he'll be there. He needs to be there, and I accepted without even checking, but he didn't have any conflicts and I told him to mark it in his calendar. Score two for good luck.
My anxiety was subsiding already, and now I'm psyched! There is a lot to be anxious about. We are still waiting to hear about his surgery date. Will we get the chance to do anything before his surgery? Will they freeze and store his sperm? How does he feel about it? Should I buy a lotto ticket and make it a trifecta? The future is always uncertain, but everything always works out in the end.
Ironically, while my womb might get a dust-off, my aching old joints just ix-nayed my afternoon run plans.
Wednesday 4 September 2013
Why does calling my doctor fill me with such anxiety?
Here is the way health care works in Canada (at least my experience of it). If you think something is wrong, but not so much so that you're dying, you call your doctor and make an appointment. That appointment could be within a week, or it could be a month from now, depending on whether your schedule is flexible enough to take the random slot that's open (aka probably your doctor's 10 minute lunch break). You go to said appointment and the doctor orders up some tests (or you get a diagnosis and prescription on the spot with instructions to "come back if it doesn't improve in two weeks"). If the doctor isn't really concerned, you get the standard "you'll hear from us if anything is abnormal" and chances are you won't - but trust me, if for example your cholesterol is through the roof, you'll get that phone call inviting you back! If the doctor thinks something is wrong, you're booked in for a follow-up as soon as they expect the results, like the time my doctor was convinced I might have an ectopic pregnancy, and didn't believe me that I wasn't pregnant but sent me for blood tests and had me come back the next day! I haven't seen my OBGYN in about 6 weeks now. The last time I saw her she said I'll get a call about an ultrasound appointment and from the fertility clinic. I got the ultrasound call quickly, which made me concerned / pleased that I really am in need of fast-tracking. But then the day of the ultrasound I got a call rescheduling. So I waited, the ultrasound rolled around, and I knew my OBGYN was away that week so I went about my business figuring I'd get a call. I haven't had a call, and it's been 3 weeks since the ultrasound. Not a call from my OBGYN to say there was a problem with the scan, and not a call from the fertility clinic to schedule my consult. Most of the day, I've sat with both numbers in front of me, to call, but I get filled with such anxiety at the thought of it all. Finally, 20 minutes before they close for the day, I got up the nerve. Please leave a message. I hung up. I guess I need even more courage to leave a message than I can muster in the span of one business day.
Ups and downs
I was doing well, acceptance-wise. For about two weeks I was at peace and accepting of the infertility and ready to move on. I could look at babies, even hold babies, and not feel that tremendous pain. I was feeling good about how nice it is to have a mature self-sufficient child rather than a baby or toddler who needs constant attending. But then something happened. I crashed. I've been a barrel of near explosive anxiety for two days. It's not just the infertility, the bulk of the anxiety has to do with the fact that my other half is waiting for a date for surgery. Major surgery. And I'm trying to plan the next 12 weeks knowing that any minute now he's going to get a surgery date and I need to plan around it but I can't wait, I need to finalize commitments in the next two days. The last thing I should be worrying about is an IVF consult appointment. But I am and I don't know why. I can't seem to motivate myself to get other things done. I'm at the brink of tears day and night. I started running again, which only helps temporarily, and really does feel like a brief chance to "run away" from the anxiety that is eating me alive.
Tuesday 20 August 2013
Ouch my ovaries hurt!
It seems like cruel torture that I can't un-know everything I've learned about tracking my ovulation. For the second month in a row, it's my left ovary that is massively swollen and aching. Last month it hurt for three days before ovulation. This month it was just really swollen and painful for one night (and starting to ache again today). We watched a documentary and something absurdly funny happened, and laughing HURT! In my ovary! Which was also funny since we were watching a documentary on the G-Spot!
I peed on my last ovulation predictor strip last night. I was saving it, in part because there was just one and if I tested too early and it was negative then what? Well, it was positive, but again, not very meaningful since it was the only one I took. I don't know if I was early in the lutenizing hormone surge, midway, or late! Anyway, it's gone. I just wanted to use it up.
Now I wish I would just hurry up and ovulate so my left ovary will stop aching. I mean seriously, it really hurts! I used caster oil packs every second day for about a week, in hope that I can naturally clear the blockage (I've got nothing to lose at this point), and I think the proximal blockage was on the right, so I hold on to this shred of hope, that just maybe it will happen. Meanwhile, I wait for ovulation to actually happen, feel grumpy and cranky and tired. I need to get out for some exercise. And I'm out of bananas. I wish I could be a fly on the wall at the fertility clinic, hear my case discussed, get some sense of when I'm going to get that consult. I'm going bananas. There was a time when I didn't know what this ache was, and that it will be soon followed by aching breasts. These things happened but I didn't pay attention and didn't know what it meant. And life was good.
I peed on my last ovulation predictor strip last night. I was saving it, in part because there was just one and if I tested too early and it was negative then what? Well, it was positive, but again, not very meaningful since it was the only one I took. I don't know if I was early in the lutenizing hormone surge, midway, or late! Anyway, it's gone. I just wanted to use it up.
Now I wish I would just hurry up and ovulate so my left ovary will stop aching. I mean seriously, it really hurts! I used caster oil packs every second day for about a week, in hope that I can naturally clear the blockage (I've got nothing to lose at this point), and I think the proximal blockage was on the right, so I hold on to this shred of hope, that just maybe it will happen. Meanwhile, I wait for ovulation to actually happen, feel grumpy and cranky and tired. I need to get out for some exercise. And I'm out of bananas. I wish I could be a fly on the wall at the fertility clinic, hear my case discussed, get some sense of when I'm going to get that consult. I'm going bananas. There was a time when I didn't know what this ache was, and that it will be soon followed by aching breasts. These things happened but I didn't pay attention and didn't know what it meant. And life was good.
Monday 19 August 2013
What's going on in there?
When I was pregnant, I didn't feel my baby kicking until an ultrasound tech said "do you feel the baby kicking? she's kicking right now". Oh, that's what that is? So many things going on in there, most of it digestive functions, I didn't know how to tell the difference. I needed it pointed out.
Over the past year I've become more and more in tune with various sensations. But I'm not always confident. I think I've got gas figured out. I think I've got my ovaries figured out. Today, my uterus seems to be up to something, but I can't tell what it could be, that's the biggest mystery. Unless it's my bladder playing tricks on me. Hello in there, what's going on? I wish I was a trained ultrasound tech or radiologist and could just scan myself and take a peek. I wonder if they do that? I bet they do.
Over the past year I've become more and more in tune with various sensations. But I'm not always confident. I think I've got gas figured out. I think I've got my ovaries figured out. Today, my uterus seems to be up to something, but I can't tell what it could be, that's the biggest mystery. Unless it's my bladder playing tricks on me. Hello in there, what's going on? I wish I was a trained ultrasound tech or radiologist and could just scan myself and take a peek. I wonder if they do that? I bet they do.
Thursday 15 August 2013
Depression
So far today I've eaten cake and not much else. This may or may not be an improvement over yesterday, when I was eating the frosting direct from the can. Not my best days. And not helpful behaviour, I know this. Comfort eating gives short-term comfort and long-term pain. I know what I should do, but keep coming up with excuses. The current level of stress, anxiety, and uncertainty in my life... it's a wonder I can keep my cool when the phone rings and I get excited only to hear "Max" offer to clean my ducts again.
Being on the brink of depression seems like par for the course when it comes to infertility. There are many days when I don't want to bother showering, getting dressed, brush my hair, when I don't feel like "doing" anything. Days when I don't have any interest in eating. Days when I feel an overwhelming urge to binge on sweets or junk food. Days when all I really want to do is curl up in bed and cry. But I can't do that. I have to carry on. And this is how I cope, what I know I have to do to keep from falling into that pit.
1. Recognize the signs.
Some of the signs of depression have to do with change. Change in appetite. Change in sleep. For someone who has been trying to conceive for a long time, changes in appetite and fatigue were also "early pregnancy signs" that you learned were just hormonal responses to ovulation. It's the progesterone. That late luteal phase pms may also hit you at the same time you start to despair that yet again this isn't your month. Whammo! Time to nip it in the bud.
Another sign is loss of interest in the things you usually enjoy. It's a double-edged sword. On the one hand, the things you usually enjoy might be what keep you sane. That you let them slide is part of the problem. You need to kick your motivation into high gear and make yourself enjoy it again. Or do something else, anything else, to get some joy back in your life. If that fails, move on to step 2.
2. Exercise is a mood enhancer.
Go ahead and google it if you don't believe me. There are literally thousands of medical studies showing reduced depression symptoms in various patient populations following a wide range of exercises, from low impact meditative exercises like Tai Chi and yoga, to more intense cardio. It also enhances cognitive functioning. Often my excuse not to get the exercise I desperately need on any given day is that I have high priority desk work to finish. But if I just took a nice long break and exercised, I'd get through it more efficiently when I come back to my desk! I just did this today, and it really did help. I was pretty down in the dumps (I ate cake for breakfast and lunch, remember). I was getting mentally sluggish, but I forced myself to go for a nice walk, and now I'm feeling better. Not as great as if I'd gotten my...
3. Vitamins.
If I'd eaten more fruit and veggies today I'd be feeling even more alert, energized, and my mood would be better. I swear by a banana a day to keep my mood at it's best. But I also take a B6/B12 supplement. Of all the vitamins I've taken during this fertility journey, that is the only one I took for non-fertility benefits. B6 is not water soluble, meaning you don't just pee out excess; I stick to a maximum of 100mg/day.
Sometimes the circumstances that cause us extreme stress and give us plenty to be depressed about are beyond our control. So we have to do our best to keep our bodies and minds healthy to get us through the storm. Eating healthy and exercising are a good start. Stress, anxiety, and depression can also tempt us to engage in unhealthy behaviours - comfort foods, smoking, alcohol... these things might feel good and helpful in the short term but it's an illusion, they all leave us worse off and prolong or worsen the depression. Life sucks sometimes. Acknowledge it, give yourself a few minutes to experience the sadness, but then you have to pick yourself up and carry on!
Being on the brink of depression seems like par for the course when it comes to infertility. There are many days when I don't want to bother showering, getting dressed, brush my hair, when I don't feel like "doing" anything. Days when I don't have any interest in eating. Days when I feel an overwhelming urge to binge on sweets or junk food. Days when all I really want to do is curl up in bed and cry. But I can't do that. I have to carry on. And this is how I cope, what I know I have to do to keep from falling into that pit.
1. Recognize the signs.
Some of the signs of depression have to do with change. Change in appetite. Change in sleep. For someone who has been trying to conceive for a long time, changes in appetite and fatigue were also "early pregnancy signs" that you learned were just hormonal responses to ovulation. It's the progesterone. That late luteal phase pms may also hit you at the same time you start to despair that yet again this isn't your month. Whammo! Time to nip it in the bud.
Another sign is loss of interest in the things you usually enjoy. It's a double-edged sword. On the one hand, the things you usually enjoy might be what keep you sane. That you let them slide is part of the problem. You need to kick your motivation into high gear and make yourself enjoy it again. Or do something else, anything else, to get some joy back in your life. If that fails, move on to step 2.
2. Exercise is a mood enhancer.
Go ahead and google it if you don't believe me. There are literally thousands of medical studies showing reduced depression symptoms in various patient populations following a wide range of exercises, from low impact meditative exercises like Tai Chi and yoga, to more intense cardio. It also enhances cognitive functioning. Often my excuse not to get the exercise I desperately need on any given day is that I have high priority desk work to finish. But if I just took a nice long break and exercised, I'd get through it more efficiently when I come back to my desk! I just did this today, and it really did help. I was pretty down in the dumps (I ate cake for breakfast and lunch, remember). I was getting mentally sluggish, but I forced myself to go for a nice walk, and now I'm feeling better. Not as great as if I'd gotten my...
3. Vitamins.
If I'd eaten more fruit and veggies today I'd be feeling even more alert, energized, and my mood would be better. I swear by a banana a day to keep my mood at it's best. But I also take a B6/B12 supplement. Of all the vitamins I've taken during this fertility journey, that is the only one I took for non-fertility benefits. B6 is not water soluble, meaning you don't just pee out excess; I stick to a maximum of 100mg/day.
Sometimes the circumstances that cause us extreme stress and give us plenty to be depressed about are beyond our control. So we have to do our best to keep our bodies and minds healthy to get us through the storm. Eating healthy and exercising are a good start. Stress, anxiety, and depression can also tempt us to engage in unhealthy behaviours - comfort foods, smoking, alcohol... these things might feel good and helpful in the short term but it's an illusion, they all leave us worse off and prolong or worsen the depression. Life sucks sometimes. Acknowledge it, give yourself a few minutes to experience the sadness, but then you have to pick yourself up and carry on!
Wednesday 14 August 2013
Seeing Red
My inbox tends to be full of junk. Junk I subscribe too, but junk nonetheless. Too much of it is baby crap, or related online shopping crap. I should unsubscribe or flag it as junk but I'm not ready. I still cling to hope that I might want to buy something else from early-pregnancy-tests.com or babysteals.com but the regular reminders that I'm not pregnant and nothing they sell can fix that is something from which I soon will need a break. And gap.com - I really only need one deal a week, if that, we all have too many clothes, every closet in my house is stuffed.
But this was just too funny. I check my email and there is the regular (luckily not too regular) email from early-pregnancy-tests.com (FYI - shipping to Canada takes way too long and not worth it to save a few bucks on test strips). The email advert included the following:
"Well, researchers have found that the color of a woman's clothing may also be a fertility indicator. Women are more likely to wear red during their most fertile period, and men usually find women in red more attractive. Men are even more willing to spend the big bucks on a date when you wear red!"
And why is it funny? Because with no thought put into it whatsoever, I grabbed a red t-shirt this morning. And my cervical fluid is screaming for Barry White and that bottle of Rosé in the fridge. Plus, it's our anniversary and we're going out for dinner. I guess I should wear the red dress tonight, not the black. And here is the actual research study, if you like reading that sort of thing (I know I do). It's an easy read, and a simple design. I can also easily think of improvements to the design, but the numbers are pretty striking. I could probably do a quick replication over on my ttc forum.
So, what are you wearing?
But this was just too funny. I check my email and there is the regular (luckily not too regular) email from early-pregnancy-tests.com (FYI - shipping to Canada takes way too long and not worth it to save a few bucks on test strips). The email advert included the following:
"Well, researchers have found that the color of a woman's clothing may also be a fertility indicator. Women are more likely to wear red during their most fertile period, and men usually find women in red more attractive. Men are even more willing to spend the big bucks on a date when you wear red!"
And why is it funny? Because with no thought put into it whatsoever, I grabbed a red t-shirt this morning. And my cervical fluid is screaming for Barry White and that bottle of Rosé in the fridge. Plus, it's our anniversary and we're going out for dinner. I guess I should wear the red dress tonight, not the black. And here is the actual research study, if you like reading that sort of thing (I know I do). It's an easy read, and a simple design. I can also easily think of improvements to the design, but the numbers are pretty striking. I could probably do a quick replication over on my ttc forum.
So, what are you wearing?
Ultrasounds
This morning I had my long awaited ultrasound. It was far more comprehensive than I expected, but I'm glad (not sure what they're looking for on my kidneys, but at least they are both where they should be). As usual, the lovely tech (who is very lovely because that was very warm belly jelly) couldn't tell me anything about what she could see or couldn't see, aside from the fact that my c-section scar will remain visible on the scan until my womb is as dusty as an egyptian tomb, and the blood flow to my right ovary is so fantastic I could hear my heartbeat! It didn't occur to me until I got home that I could have asked for a picture, although I'm not sure what I'd want to see. I don't really have the trained eyes to see anything meaningful if there is no baby. So no answers today, just more sit by the phone and wait. After an HSG though, internal ultrasound is downright pleasant, nothing but warm and fuzzies!
Ultrasounds can be torturous though. First there is the whole "arrive with a full bladder and then sit there and wait, trying not to burst" thing. On top of that though, when it's an ultrasound for infertility, sitting in a waiting room full of pregnant ladies is also torture. Plus they give out number cards in random order just to mess with you. Everyone else is there with a support person, sometimes with toddlers in tow, which is something I don't really understand. I guess they needed the support person there more than they needed the support person to watch the kids at home.
Ultrasounds can be torturous though. First there is the whole "arrive with a full bladder and then sit there and wait, trying not to burst" thing. On top of that though, when it's an ultrasound for infertility, sitting in a waiting room full of pregnant ladies is also torture. Plus they give out number cards in random order just to mess with you. Everyone else is there with a support person, sometimes with toddlers in tow, which is something I don't really understand. I guess they needed the support person there more than they needed the support person to watch the kids at home.
Tuesday 13 August 2013
Support for adoption
Shortly after I began trying to conceive, I joined online communities. At first I would just read all these posts and answers. And then I began participating. Whenever you google "is X a pregnancy symptom" you get these forums. Why? In part because search terms we use as laypeople is not the medical terminology, so we don't get the medical literature (when I want medical I go to pubmed.org). For about a year I played the symptom spotting game with other members of the ttc community, but then they would get pregnant and go away and I'd be left feeling very old and cranky and sad. I started visiting the fertility treatments forums, but as I wasn't being treated for anything, and still not, I didn't feel like I belonged there either (although they helped me to know what to expect). But then I started perusing the adoption boards.
What are the adoption boards like? Well, strange. There are many things happening on the adoption boards. There are prospective adoptive parents looking for support or with questions about issues or concerns from their perspective. These can range from sadness about an adoption falling through, or behaviour challenges in an adoptive child with an attachment disorder or a disability. There are young women considering giving up their child and still on the fence or wanting to know where to go and what to do. This combination - the pregnant mom and the prospective adoptive mom brings about the creepiest of posts - the too-much-information-please-pick-me audition. I call it creepy because the moment a young women posts that she's thinking of putting her baby up for adoption, there is this vulture-like response of "I'll take your baby!"
I get it. I really do. My gut says the same thing, but it's still creepy. I'll be going through extensive screening. Social workers will "match" a child to our family. I can only imagine how frightening it is for a young woman to go online and ask questions only to be leaped on by random strangers who want her baby. It's all I can do to keep from doing it myself, but I know the helpful thing is not to volunteer myself but to share the relevant information. And the most relevant information I can share, is that you need to get information relevant to your jurisdiction, your community even. I can dream about some random pregnant teenager reading my posts and deciding I'm wonderful and wanting me to raise her baby. It's not going to happen like that. I'll complete my intake, home study, and PRIDE training. Then I'll wait for a call. It's going to take time, but I'm patient.
The third group that live on adoption boards are those with adoption-gone-wrong stories. They are hurt, either because they were birth moms who were coerced into giving up a baby, or a few were adopted by families that weren't as well screened as they should have been. The board I frequent has a core group of these ladies who are vicious as snakes, biting the would-be adoptive moms and frightening the pregnant ladies. Because of these ladies, I sometimes think there need to be three unique boards to provide support. On the other hand, we need to have this three-way dialogue. We need to hear the concerns of the birth moms. We need to hear the concerns of the adoptive moms. And we need to hear the horror stories so we make sure their experiences are never repeated. There was a recent discussion on assisted reproduction on the CBC Radio programme Line In The Sand. The discussants were bioethicists. One of the bioethicists kept coming back to adoption, and the ethical responsibilities we have towards children that are already here with us on this planet, and the imbalance that exists that makes artificial reproduction more accessible than adoption. In Ontario, 50% of children who are "crown wards" are available for adoption, yet only 9% get adopted.
I know exactly why everyone wants a baby, the earlier the child enters your family the more he or she is moulded to your family. If the placement is before 6 months you have no reason to be concerned about attachment issues. If the placement is before 3 years, the child likely will have no memory of prior experiences, but may have some behaviour patterns. The older the child, the more there are entrenched behaviour patterns. I grapple with this too. But then I grapple with the older child who needs a home and feel just as much a deep desire to make that happen. If you are open, you'll be matched quickly. We don't get to pick our biological children, we shouldn't turn adoption into a shopping experience either.
What are the adoption boards like? Well, strange. There are many things happening on the adoption boards. There are prospective adoptive parents looking for support or with questions about issues or concerns from their perspective. These can range from sadness about an adoption falling through, or behaviour challenges in an adoptive child with an attachment disorder or a disability. There are young women considering giving up their child and still on the fence or wanting to know where to go and what to do. This combination - the pregnant mom and the prospective adoptive mom brings about the creepiest of posts - the too-much-information-please-pick-me audition. I call it creepy because the moment a young women posts that she's thinking of putting her baby up for adoption, there is this vulture-like response of "I'll take your baby!"
I get it. I really do. My gut says the same thing, but it's still creepy. I'll be going through extensive screening. Social workers will "match" a child to our family. I can only imagine how frightening it is for a young woman to go online and ask questions only to be leaped on by random strangers who want her baby. It's all I can do to keep from doing it myself, but I know the helpful thing is not to volunteer myself but to share the relevant information. And the most relevant information I can share, is that you need to get information relevant to your jurisdiction, your community even. I can dream about some random pregnant teenager reading my posts and deciding I'm wonderful and wanting me to raise her baby. It's not going to happen like that. I'll complete my intake, home study, and PRIDE training. Then I'll wait for a call. It's going to take time, but I'm patient.
The third group that live on adoption boards are those with adoption-gone-wrong stories. They are hurt, either because they were birth moms who were coerced into giving up a baby, or a few were adopted by families that weren't as well screened as they should have been. The board I frequent has a core group of these ladies who are vicious as snakes, biting the would-be adoptive moms and frightening the pregnant ladies. Because of these ladies, I sometimes think there need to be three unique boards to provide support. On the other hand, we need to have this three-way dialogue. We need to hear the concerns of the birth moms. We need to hear the concerns of the adoptive moms. And we need to hear the horror stories so we make sure their experiences are never repeated. There was a recent discussion on assisted reproduction on the CBC Radio programme Line In The Sand. The discussants were bioethicists. One of the bioethicists kept coming back to adoption, and the ethical responsibilities we have towards children that are already here with us on this planet, and the imbalance that exists that makes artificial reproduction more accessible than adoption. In Ontario, 50% of children who are "crown wards" are available for adoption, yet only 9% get adopted.
I know exactly why everyone wants a baby, the earlier the child enters your family the more he or she is moulded to your family. If the placement is before 6 months you have no reason to be concerned about attachment issues. If the placement is before 3 years, the child likely will have no memory of prior experiences, but may have some behaviour patterns. The older the child, the more there are entrenched behaviour patterns. I grapple with this too. But then I grapple with the older child who needs a home and feel just as much a deep desire to make that happen. If you are open, you'll be matched quickly. We don't get to pick our biological children, we shouldn't turn adoption into a shopping experience either.
Wednesday 7 August 2013
Back to square one...
Update - it was a cruel two-day tease. Back to square one. Would I like a glass of wine with dinner tonight? Yes please! And an extra helping of chocolate.
I used to do something "special" for myself at the end of every failed cycle. A consolation prize. Preferably something I would be giving up "when I'm pregnant next month"... a nice bottle of wine, sushi, smoked salmon, decadent coffee, dye my hair... it's getting old and I've run out of ideas. For the first time though, I'm not sad. My mind wanders instead to never having to give up coffee, or trying that 30 day abs plan I saw online. I think with time I'll come to accept my infertility, even if the IVF opportunity doesn't materialize in time.
I used to do something "special" for myself at the end of every failed cycle. A consolation prize. Preferably something I would be giving up "when I'm pregnant next month"... a nice bottle of wine, sushi, smoked salmon, decadent coffee, dye my hair... it's getting old and I've run out of ideas. For the first time though, I'm not sad. My mind wanders instead to never having to give up coffee, or trying that 30 day abs plan I saw online. I think with time I'll come to accept my infertility, even if the IVF opportunity doesn't materialize in time.
Monday 5 August 2013
My love-hate relationship with BBT
I've been tracking my cycle for about 8 years (or most of my post-pubescent life if you include circling a date on my calendar with a red pen - but I didn't keep those, that was just for month-to-month use). For 7 years I used an online program named "mymonthlycycles" that was good but had the most obnoxious pop-ups. I've printed out the data so I never need to go back. When I started trying this time around I had a smart phone and tried using some apps instead. The first few I tried were garbage, either that or I didn't get the hang of using them properly, but all the data from the first two months entered was lost. Then I made a breakthrough. I discovered Fertility Friend. I had tried basal body temperature charting before, using pencil and paper. If you've never charted basal body temperature, it's based on the basic principle that during the follicular phase of the menstrual cycle, estrogen is dominant and rising as the dominant follicle grows. This increasing estrogen causes other changes to occur that can also be charted - namely to the cervical position and fluid. Then, when ovulation occurs, the follicle that released the egg becomes what's called a corpus luteum, which produces progesterone instead. The abrupt shift from an estrogen producing follicle to a progesterone producing corpus luteum causes an abrupt shift in the basal body temperature, the body's temperature at rest. The role of progesterone is to prepare the body for pregnancy and it's also to blame for all those fun pms symptoms and early pregnancy symptoms we can't distinguish from pms symptoms. So when charting, you look for a series of lower temperatures followed by a series of high temperatures. The last day of low temperatures is the most likely day of ovulation.
I was charting before I conceived my daughter, but ironically not the month she was conceived. To make a long story short, we were going camping and I didn't want to bring it with me so I didn't bother. Fertility friend had a great online tutorial that helped me get back into the practice, and by entering the data in the app, all the guesswork was taken away. It was so easy. I just set my alarm, enter the data, and voila! It took no time to pin my ovulation day and know my luteal phase length. Then came the first time I was "one day late" and the temperature was still high. It came on month 6. I had one day of serious excitement followed by devastation. Instead, I had to accept my luteal phase had a margin of error. Two months later the same thing happened, high temps for one extra day (from 12 to 13, and now 14). What the heck, right? I was going crazy. I thought my pregnancy tests were defective so I went to the store and bought the premium tests. Still negative. I just didn't get it. Then four reasonably normal but disappointing months. I was truly getting the hang of this charting though. I no longer needed ovulation prediction kits, I knew when it was happening as it was happening. I was in tune with my body. I also didn't need to waste any money on early pregnancy tests, my chart always delivered the bad news with the same temperature drop on the same day. One month, I was even one more day late, but that time the temps were low so I didn't get excited. I didn't know what was going on, but assumed it had something to do with vitamin experimentation. I had mastered the art of temperature charting. But I was determined to keep at it. All that time and effort, I wanted to see my pregnancy chart. I didn't want to stop charting and then get pregnant (although if I thought it would work I'd try).
So why is it a love-hate relationship? I love the sense of control and knowledge it gives me. I know when to expect the cycle end, within a day. I hate that randomly it will throw me a curve ball, give me false hope. I know that the most likely explanations for those two wacky months are either changes to my vitamin regime or a small short-lived corpus luteum cyst. Or the least likely given my blocked tubes - a failed implantation. False starts, as I like to call them, are incredibly common. It's the same reason why not all the eggs retrieved and fertilized for IVF will grow. Some eggs are duds. Some sperm that make it to the finish line are still duds. Some don't come together properly. Most don't make it, and we never know. Estimates are as high as 75% or as low as 40%, but it's pretty hard to get a good estimate.
I love the consistency of most of my charts. I hate the odd-ball charts. You want to read into them. Like today... I'm 13 days post ovulation so I should be flatlined at 36.5 or so. Instead my temperature shot up this morning. I got excited of course and ran to pee on a stick. Negative, no doubt about it. Then I heard number one daughter coughing and realized my allergies, which have been unbearable all summer but vary day to day, might not be allergies (this weekend anyway). The last time I had a cold (Feb - 2-3dpo), my temperature spiked the same. It must be that, right? I have two blocked tubes, that is the only reasonable explanation for such a high temperature so late in the cycle.
And this is what I hate. I'm expecting to see red every time I go to the bathroom today. I don't need a virally-induced temp spike giving me false hope. I love you Fertility Friend, I love the various features in your charting app and on your website, and I've relied on you for more than a year now. But I need to quit you. I put a lot of energy in hopes of seeing a pattern emerge that was different from the rest, one that you would change from a black line to a green and congratulate me on my pregnancy. But with two blocked tubes, that's just not going to happen. I can hold onto hope in the back of my mind that it's a misdiagnosis, that only one tube is hopeless, but I can't fixate on it day after day as I have.
It's also very hard to put fertility challenges out of your mind when you have daily reminders of your cycle day. When you are charting, you have a daily reminder. I would spend hours on the site, and others, obsessing over every sign. Until I get my first IVF treatment, my sanity needs me to move on. If I magically get pregnant when I'm not looking (some call this stop trying and you'll get pregnant - BS if you ask me), I'll be mad that I didn't capture it on a chart!
I was charting before I conceived my daughter, but ironically not the month she was conceived. To make a long story short, we were going camping and I didn't want to bring it with me so I didn't bother. Fertility friend had a great online tutorial that helped me get back into the practice, and by entering the data in the app, all the guesswork was taken away. It was so easy. I just set my alarm, enter the data, and voila! It took no time to pin my ovulation day and know my luteal phase length. Then came the first time I was "one day late" and the temperature was still high. It came on month 6. I had one day of serious excitement followed by devastation. Instead, I had to accept my luteal phase had a margin of error. Two months later the same thing happened, high temps for one extra day (from 12 to 13, and now 14). What the heck, right? I was going crazy. I thought my pregnancy tests were defective so I went to the store and bought the premium tests. Still negative. I just didn't get it. Then four reasonably normal but disappointing months. I was truly getting the hang of this charting though. I no longer needed ovulation prediction kits, I knew when it was happening as it was happening. I was in tune with my body. I also didn't need to waste any money on early pregnancy tests, my chart always delivered the bad news with the same temperature drop on the same day. One month, I was even one more day late, but that time the temps were low so I didn't get excited. I didn't know what was going on, but assumed it had something to do with vitamin experimentation. I had mastered the art of temperature charting. But I was determined to keep at it. All that time and effort, I wanted to see my pregnancy chart. I didn't want to stop charting and then get pregnant (although if I thought it would work I'd try).
So why is it a love-hate relationship? I love the sense of control and knowledge it gives me. I know when to expect the cycle end, within a day. I hate that randomly it will throw me a curve ball, give me false hope. I know that the most likely explanations for those two wacky months are either changes to my vitamin regime or a small short-lived corpus luteum cyst. Or the least likely given my blocked tubes - a failed implantation. False starts, as I like to call them, are incredibly common. It's the same reason why not all the eggs retrieved and fertilized for IVF will grow. Some eggs are duds. Some sperm that make it to the finish line are still duds. Some don't come together properly. Most don't make it, and we never know. Estimates are as high as 75% or as low as 40%, but it's pretty hard to get a good estimate.
I love the consistency of most of my charts. I hate the odd-ball charts. You want to read into them. Like today... I'm 13 days post ovulation so I should be flatlined at 36.5 or so. Instead my temperature shot up this morning. I got excited of course and ran to pee on a stick. Negative, no doubt about it. Then I heard number one daughter coughing and realized my allergies, which have been unbearable all summer but vary day to day, might not be allergies (this weekend anyway). The last time I had a cold (Feb - 2-3dpo), my temperature spiked the same. It must be that, right? I have two blocked tubes, that is the only reasonable explanation for such a high temperature so late in the cycle.
And this is what I hate. I'm expecting to see red every time I go to the bathroom today. I don't need a virally-induced temp spike giving me false hope. I love you Fertility Friend, I love the various features in your charting app and on your website, and I've relied on you for more than a year now. But I need to quit you. I put a lot of energy in hopes of seeing a pattern emerge that was different from the rest, one that you would change from a black line to a green and congratulate me on my pregnancy. But with two blocked tubes, that's just not going to happen. I can hold onto hope in the back of my mind that it's a misdiagnosis, that only one tube is hopeless, but I can't fixate on it day after day as I have.
It's also very hard to put fertility challenges out of your mind when you have daily reminders of your cycle day. When you are charting, you have a daily reminder. I would spend hours on the site, and others, obsessing over every sign. Until I get my first IVF treatment, my sanity needs me to move on. If I magically get pregnant when I'm not looking (some call this stop trying and you'll get pregnant - BS if you ask me), I'll be mad that I didn't capture it on a chart!
Saturday 3 August 2013
Dialogues and Secrets
A lady on one of my fertility treatment message boards posted this link to a beautiful essay about infertility, aimed at helping friends and family understand. Click here to read the essay.
I've had many a conversation, online, about how to discuss infertility with friends and family. Note, all these conversations were online. Why? Because we didn't tell people we were trying to have another child. Like so many, we just assumed it would happen and then we could tell them when one was on the way. I told exactly one friend. We were trying at the same time, both for number 2. Then she succeeded. Month after month she would ask how it was going, if I was pregnant yet. If I felt up to talking about it, and certainly in the early months I did, back when I was stepping up the game, she'd tell me I was trying too hard. Tell me to relax. Kiss my dusty old womb! It's a good thing I wasn't relaxed, that I was charting and knew my cycle inside and out and knew exactly when I ovulated and when to consider myself "late" and knew when something was wrong. I was mad. How dare you tell me to relax. What do you know about it? There is no such thing as trying too hard. You can drive yourself crazy, but you can't try too hard. Knowledge is power. So this is what it was like trying to discuss my failing month after month, with one of my best friends. I'm a pretty patient person, but if I had to listen to such painfully unhelpful crap from people I don't love quite as much, I might have snapped. At least I'm an atheist. I feel so sad for the ladies who think God is punishing them or doesn't think they are worthy of parenting. Or worse, they get that from so-called loved ones. So that's why I don't talk openly about the struggle. I think that is one of the reason so many don't talk about it. Or hide in online forums.
But we need to talk about it. We need an open dialogue about infertility. It's not just about age. There are many many causes, some more treatable than others. When I was young and wanted children but wanted to accomplish other things first, I was painfully aware of the age factor but had some misconceptions. I thought IVF was something "old" ladies did because they waited too long. I didn't know at the time that it's the age of the eggs that matters more than the age of the womb, and that IVF with 40+ year old eggs doesn't have a very good success rate. In general, fertility really doesn't take a nose dive until 42-43. In my late 30s, I still have a reasonably good chance with IVF if the only problem is my tubes being blocked, since my hormone tests all came back great. According to the stats published by my clinic, the IVF success rate for women under 35 was 47%, for 35-39 year olds it was 40%, and for women over 39 it was 18% (2009-2010 data). As I read it, those were success rates per fresh cycle. Very encouraging, although clearly I've got very little time left. But what is also clear is that the vast majority of IVF was among women under 35, nearly 2:1. There are so many causes of infertility, I don't think I could do it justice. My point is that we need to open the dialogue, the public dialogue, about the diverse causes of infertility, and the pain that couples experience. Fertility is sometimes tied so strongly into our sense of what it means to be a women (or a man). When I couldn't breastfeed, it was a huge blow to my sense of what it meant to be a woman. I felt so deficient, and I had such a profound sense of failure as a mother. This is what distinguishes a woman from a man and I failed. Infertility is the same, once again I feel broken, and like less of a woman. It's a devastating feeling. I imagine men with infertility feel the same way, it's why they don't want to get vasectomies even though it's so much easier and safer a procedure than getting one's tubes tied. Nature tied up my tubes without my permission. I'm angry. I cry a lot. I don't know what to do. Because it's secondary infertility, I have a basement full of maternity clothes and baby things that I don't want to give away but I have such a deep fear that they are going to waste. I loved pregnancy. I want that again. I want to be able to talk openly about my struggles. But I can't. I'm afraid. It's intensely private because it's also about your sex life with your partner. And don't get me started on how it can ruin your sex life (I'll save that for another post).
I need a few more people to lead me out of my closet. I'm not brave enough yet.
I've had many a conversation, online, about how to discuss infertility with friends and family. Note, all these conversations were online. Why? Because we didn't tell people we were trying to have another child. Like so many, we just assumed it would happen and then we could tell them when one was on the way. I told exactly one friend. We were trying at the same time, both for number 2. Then she succeeded. Month after month she would ask how it was going, if I was pregnant yet. If I felt up to talking about it, and certainly in the early months I did, back when I was stepping up the game, she'd tell me I was trying too hard. Tell me to relax. Kiss my dusty old womb! It's a good thing I wasn't relaxed, that I was charting and knew my cycle inside and out and knew exactly when I ovulated and when to consider myself "late" and knew when something was wrong. I was mad. How dare you tell me to relax. What do you know about it? There is no such thing as trying too hard. You can drive yourself crazy, but you can't try too hard. Knowledge is power. So this is what it was like trying to discuss my failing month after month, with one of my best friends. I'm a pretty patient person, but if I had to listen to such painfully unhelpful crap from people I don't love quite as much, I might have snapped. At least I'm an atheist. I feel so sad for the ladies who think God is punishing them or doesn't think they are worthy of parenting. Or worse, they get that from so-called loved ones. So that's why I don't talk openly about the struggle. I think that is one of the reason so many don't talk about it. Or hide in online forums.
But we need to talk about it. We need an open dialogue about infertility. It's not just about age. There are many many causes, some more treatable than others. When I was young and wanted children but wanted to accomplish other things first, I was painfully aware of the age factor but had some misconceptions. I thought IVF was something "old" ladies did because they waited too long. I didn't know at the time that it's the age of the eggs that matters more than the age of the womb, and that IVF with 40+ year old eggs doesn't have a very good success rate. In general, fertility really doesn't take a nose dive until 42-43. In my late 30s, I still have a reasonably good chance with IVF if the only problem is my tubes being blocked, since my hormone tests all came back great. According to the stats published by my clinic, the IVF success rate for women under 35 was 47%, for 35-39 year olds it was 40%, and for women over 39 it was 18% (2009-2010 data). As I read it, those were success rates per fresh cycle. Very encouraging, although clearly I've got very little time left. But what is also clear is that the vast majority of IVF was among women under 35, nearly 2:1. There are so many causes of infertility, I don't think I could do it justice. My point is that we need to open the dialogue, the public dialogue, about the diverse causes of infertility, and the pain that couples experience. Fertility is sometimes tied so strongly into our sense of what it means to be a women (or a man). When I couldn't breastfeed, it was a huge blow to my sense of what it meant to be a woman. I felt so deficient, and I had such a profound sense of failure as a mother. This is what distinguishes a woman from a man and I failed. Infertility is the same, once again I feel broken, and like less of a woman. It's a devastating feeling. I imagine men with infertility feel the same way, it's why they don't want to get vasectomies even though it's so much easier and safer a procedure than getting one's tubes tied. Nature tied up my tubes without my permission. I'm angry. I cry a lot. I don't know what to do. Because it's secondary infertility, I have a basement full of maternity clothes and baby things that I don't want to give away but I have such a deep fear that they are going to waste. I loved pregnancy. I want that again. I want to be able to talk openly about my struggles. But I can't. I'm afraid. It's intensely private because it's also about your sex life with your partner. And don't get me started on how it can ruin your sex life (I'll save that for another post).
I need a few more people to lead me out of my closet. I'm not brave enough yet.
The big decision
IVF vs adoption
I always said I wouldn't do IVF, that I would adopt if it came down to it. There are so many children in my community, Crown Wards, in need of a Forever Family. It just makes sense to give them a home before going to the huge effort and expense of creating a new life. Hypotheticals are all fine and dandy, but it took no time at all to change my tune. But it wasn't easy. After the diagnosis, I told my partner and we waited until later in the evening to talk about it. He wanted to know what it entailed. I'd already read everything about it on my hospital's website, and I was unsure but tempted. The more we talked, the more adoption seemed like the "right" choice.But the next day, all I could think about was what I was giving up. My first birth was not what I wanted. I went into preterm labour at 31 weeks, and while they stopped the labour and stabilized me for a few days, my water broke, the baby was breech, and an urgent c-section was necessary. I remember one of the nurses commented that I was surprisingly calm. My response was that there was nothing I could do, it's happening. Call me crazy, but I want to experience childbirth, natural childbirth. So I spent much of the past year worried about whether or not I would qualify for a vbac - a vaginal birth after cesarian. I found the vbac rates for my hospital (encouraging). I found a website that calculates risk (less encouraging). I held on to hope and knew that in the end it would depend on factors that can't be known yet. I held on to hope that a full-term vbac would also give me a second chance at breastfeeding. When I had my preemie, I spent a lot of time researching factors related to milk production and breastfeeding success with preemies. I didn't come up with much other than a basic belief that preemies are one of the reasons formula exists.
I wanted a second chance at both. This is what I was giving up by passing on the IVF opportunity. But I grappled with this decision. I knew that this was ultimately a selfish choice. I would have to come to terms with that, and explain it to my partner. This is selfish for me, not for him, it's entirely my physical experience that I want, he doesn't get to experience it. He's concerned about my health, the risks of IVF to me. I'm apprehensive about the process, giving myself needles, and the ethical questions of what to do if there are any "leftover" embryos. The options are freeze and use in the future, donate to another couple, or donate for medical research (stem cells, precious stem cells - I support that research in theory, but will I support it personally, physically, directly). I think I'd be getting ahead of myself to make that decision now, I don't even know if IVF is an option, I have to wait for the consult. And if I go through with it, there might only be a small number of embryos. And the more I think about it, the more I want to try.
It's no longer IVF versus adoption in my mind, it's "and". I can do both. I want to do both. I've already contacted a social worker with the Children's Aid Society, and because of certain situational factors we need to wait another 3-5 months to get started. I'm waiting for the IVF consult. I hate waiting, but I know ultimately the time will pass, it always does. Meanwhile, number one daughter has gone from wanting 3 sisters to 5! I think the adoption intake worker will like the sound of that, but we will need a much bigger house!
In the beginning...
My Story
So much for adolescent egocentrism, call it adult egocentrism, I never thought it would happen to me. I make jokes about dusty old wombs and stale eggs, but at the ripe old age of 37 my doctor delivered the blow - rush referral to IVF. When I was younger, naive, I always said that wouldn't be me. I wouldn't wait to have kids until I was too old and needed IVF, I said. No kids after 40, I said. If the choice was between IVF and adoption I'd adopt, I said. Little did I know that IVF after 40 solves nothing, it's the stale eggs, not the dusty womb that's to blame. My eggs are just fine and dandy, and I'm not quite 40 anyway, no, the problem is my tubes. I never considered that somewhere between my first child and trying for a second that my tubes would get completely and utterly blocked.
I started to suspect something was wrong at about the sixth month of trying. The first three months were passive - not trying not preventing. I gave it three months au natural. Then I pulled out the big guns. I started charting basal body temperature again - I'd tried it before using pencil and paper so I knew the basic ideas, but now there are apps for charting that make it even easier! I used Fertility Friend, a site and app I absolutely love. I set my alarm faithfully every morning, even on weekends. I even impulsively bought a digital ovulation prediction kit (on sale). I joined online forums and learned all the ins and outs of using the kits, buying bulk test strips online, and thought I'd finally take control and it would happen! No. That first month of charting I ended up in the emergency room with a hemorragic corpus luteum cyst rupture. Let me tell you, you walk into the ER and tell them it feels like labour but you're not pregnant (yet), they don't leave you in the waiting room very long. I was an occupant of the ER for 18 hours. Then suddenly, around midnight, a doctor walks into my room (that's when you know it's serious, they put you in a room with a door and private bathroom rather than a bed behind a curtain, or maybe that's just because it was clearly gyno), tells me the diagnosis and says I can go home. Still groggy from the morphine, no questions answered (like why did it take 3 ultrasounds and a CT to diagnose it?), I get a cab home, sleep it off, and was fine in the morning.
So the six month mark coincided with a doctor's appointment to follow-up on the cyst rupture. I had a basic work-up, ultrasound, and pelvic exam. My doctor seemed pretty confident I'd be pregnant within the next 3 months because all my tests were fine. Off I went with the well-meaning but incredibly condescending, annoying, irritating, etc advice to have lots of sex and be patient. If you're reading this and you've ever said that to someone, know that in their head they gave you a mental smack. Yes, those were daggers in her eyes.
Four months later, I was back in the doctor's office, this time with a reluctant partner who really didn't want to have his man juices questioned, who really didn't want to have to produce a sample, bring it to a lab, and wait for results. No wonder he dragged his heals to do it, but it had to be done. I requested more tests for me, a hormone panel, and an x-ray of my tubes. The hormone panel was fine. The man juice was plenty manly. The referral was put in for the x-ray, an HSG, that first required a specialist referral, was a long depressing wait. It took 5 months to get the appointment. Five months of experimenting with vitamins and old wives tales (what better cure for a dusty old womb than an old wives tale, right?) all the while still charting basal temperature, peeing on sticks, and mastering the art of cervical position. I even had high hopes for the "stop trying and go on vacation" trick, but no. It was great to get away and have a vacation though!
The day came for the specialist appointment. I was full of hope again. We went together. She ordered up an even more comprehensive hormone panel for me, another man juice analysis, and the HSG. The HSG is a pain in the butt to schedule. It took 6 more weeks to get that scheduled. I'd read many accounts of it, some painful, some not. I wasn't anxious, I was eager. It's not fun, I won't lie, but I'm a trooper. My goal is childbirth, after all, I can handle getting poked at with a catheter. The test works like this. A dye is pushed into your uterus, and it should flow back out through the fallopian tubes (referred to as spillage). It was pretty clear that one side had proximal blockage, nothing was going in. The other side was unclear, and I was told to wait until the radiology report. A week later, in her office, is when I got the news. All the hormones look good. Everything else is good. Except the tubes. The radiology report said no spillage. Both sides blocked. Recommendation - IVF. And now I wait. First I need an ultrasound, to check for fibroids and polyps because the uterus also didn't look right during the HSG. Another two weeks.
So I wait. Maybe putting it out of my mind would help, that's my other half's strategy for life. Drives me crazy. I want to plan. I want to be prepared for every possibility. Maybe I'm ruminating. I hope this is therapeutic instead.
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