Frequent Stirrup Appointments

I skipped over Stirrup Appointments 3 and 4 were on Wednesday and Friday of last week, when I reported my follicles.  Appointments on Saturday, Sunday, and Monday were numbers 5, 6, and 7.  You know, the fertility center is surprisingly busy on the weekend - who knew?

#3 : Wednesday : 11 follicles, estrogen at 229

#4 : Friday : 13 follicles, estrogen at 622

#5 : Saturday : 14 follicles, estrogen at 727

#6 : Sunday : 15 follicles, estrogen at 1468 (!)

#7 : Monday : 16 follicles, estrogen at 1813

Monday was also the day of our trigger - scheduled for 10 PM that night.  I had a bit of a breakdown at the doctor's office that day, because it felt like such an important point in the process, and I was confused.  I had run out of Bravelle, but I was supposed to take 300 IU (4 vials) - which I was told I could get from the pharmacy at the hospital.  When I got there to pick it up, they only had three vials, which is what my Rx was written for anyway.  Enter confusion, since this contradicted what the nurse had told me the previous day.  The pharmacist insisted that I should just wait 90 minutes for a courier to deliver more Bravelle, and while I was standing there, his colleague sold another person some Bravelle.  I was confused, angry, frustrated, and upset - so we headed back up to the doctor's office to try to get some answers.

Enter sweet nurse Allison.  God bless her.  She took me to an exam room, sat me down, and listed to me explain what had happened.  And she got it - she understood why I was so frustrated.  She suggested that we go get a cup of coffee while we waited for that morning's lab results, at which point, she would immediately ask one of the doctors on staff what my final stim dosages should be.  By then, the Bravelle should have arrived as well.  Thank god for her.  They did add more Bravelle - 300 IU in the morning, and another 300 IU in the evening.  I can't imagine what kind of tailspin I would have entered into if we had left the hospital with one dose, just to learn that we had to go back for another.

Allison also told us that our trigger was scheduled for 10:00 that night - on the nose - and she gave us our instructions for retrieval day, which would be Wednesday.  This was really happening, and although it wasn't easy getting there, we were finally there.

11 is for losers. I'm feeling 13!

Cycle Day 12.  Day 8 of stimulants.  One more time - ultrasound and bloodwork.

Same ultrasound tech, but this time she's finished The Hunger Games, so she wants more book recommendations from me.  I told her to read Divergent.  She was not willing to give me as much information this morning - just told me that my follicles looked "juicy."  I'll take it.

The nurse called a few hours later to let me know my test results.  Estrogen, which started out Monday at 50.6, and rose to 229 on Wednesday, is now sitting pretty at 622!  Talk about an increase!  I'm really thrilled about that.

My lovely 11 embryos have taken on a couple of pals, to bring my grand total for today to 13 - still just five on the right, and eight on the left.  Yet another ultrasound scheduled for tomorrow...

And just like that, 11 is my lucky number.

Cycle Day 10.  Day 6 of stimulants.  I went in for blood work and an ultrasound.

The ultrasound tech wanted to talk about The Hunger Games, which I'm usually totally down with, but this morning I really only wanted to talk about what she was seeing on the screen.  I didn't know if she would say, but when I asked how everything was looking, she replied "Good.  I see six on this side...and five on that side."  There were more follicles too small to measure, but to potentially have 11 of measuring size?  I felt good.

Then the nurse called, and let me know that my estrogen was up from 50.6 to 229!  Such a relief.  She also confirmed 11 follicles, with 5 on the right and 6 on the left.  After being disappointed and worried on Monday, I'm so happy to know that my ovaries are functioning like they're supposed to in this cycle.  11 seems like a great number - not so many that hyperstimulation is a concern, but enough that hopefully we'll be able to have some really good quality embryos at the end of this.

I'm headed back for an ultrasound and more blood work on Friday.  Let's keep up the good work, ovaries!

Day Four of Stimulants

So, I've been injecting 300 IU (4 vials) of Bravelle and 75 IU (1 vial) of Menopur every evening, in addition to 10 units of Lupron every morning.

This morning, we headed over to the doctor's office so that they could run labs on my blood - see how my hormone levels are progressing.  The nurse called this afternoon, and said, "Everything's fine - your estrogen level is 50.6"  But, she also told me to increase my dosage of Bravelle.  After tonight, I start injecting 225 IU (3 vials) of Bravelle in the morning and in the evening - in addition to the Lupron and the Menopur.

So, I'm nervous that I'm not responding well.  Google, usually my BFF, has done me wrong in this case.  All I read are terrifying stories of low estrogen levels and cancelled cycles.  It's early in the cycle, and the chances that they can boost my estrogen (and therefore my follicles) are good.  But it still makes me nervous.  I really need to calm down.

Stirrup Appointment #2

Well, I had my baseline ultrasound this morning, and it was pretty uneventful.  All looks well, which is really all I can hope for.

I don't start stimulant drugs until Friday - it looks like the practice is keeping me on the calendar that they developed during our IVF orientation.  Still hoping for a retrieval around Valentine's Day!

Cycle Day One...

...and sincerely hoping that this is my last cycle day one of 2012.

Today marks ten days of Lupron, and my period is here.  Even though I've been giving myself injections for a week and a half, this development really feels like we're making progress.  This is the cycle during which we will *hopefully* conceive.

Tomorrow morning, I will head back to the Fertility Center for Stirrup Appointment #2 - or my baseline ultrasound.  Once that's complete, we'll start stimulant drugs.  Bravelle and Menopur, every evening.  I'll keep up the Lupron every morning, although I think my dosage will go down.

After ten days on Cipro, on Friday I had a symptom (yes, just one) that led me to believe that I may have a yeast infection, and I may or may not have flipped the eff out.  I know that a yeast infection is no big deal, but I was really concerned that it may throw off whatever delicate balance we're trying to create here.  I left a panicky message with our nurse, and....she still hasn't called me back.  I'm not happy about that, so I'll be mentioning it at the office in the morning. 

I was worried it would delay my period, would delay my IVF procedures, would cause the whole thing to be cancelled...yes, it was an out-of-control spiral.  Finally, Jared called a doctor friend who assured us that a yeast infection would have no impact whatsoever and suggested that I take a nibble of a Xanax and chill out.  So I did.

I'll be back tomorrow, with a Stirrup Update. Hooray!

Day Four

Today is day four of Lupron injections, day 22 of my cycle.  So far, it's weird shooting myself in the belly every morning, but it's not awful.  The needle to administer the Lupron is small, and the amount I'm injecting is pretty tiny. 

I've found that the area to the left of my belly button is far more sensitive than the area to the right of my belly button.

No side effects to speak of just yet.  I'm tired, but that could be because yesterday I was up at 6 AM, out the door at 8 AM, and not home until 9:30 PM.  A smart girl would have gone to bed when she got home, but I had to stay up to watch The Bachelor.  6 AM came early this morning, but I'm hoping for an early night tonight to recover.

Jared was out of town for days 1 and 2 of the Lupron injections, but now that he's home, he is being wonderfully sweet and supportive.  It's not that I expected otherwise, but the boy does love his sleep - I never thought he would be up with me at 6 AM.  Well, he has been.  He watched me do the injection yesterday and today, and he has been particularly attentive - which is so, so appreciated right now.  This morning, before I got in the shower, he gave me a big hug and told me how proud he is of me. So sweet.

So now I'm just waiting for my period to begin.  Hopefully before this weekend, so we can get started on the Bravelle and Menopur early next week!

Time to get Technical

Well, this it.  Injections start tomorrow.  I'm nervous and excited and overwhelmed and terrified.

I've been on Cipro since Wednesday - which serves to fend of any bacteria that may enter my system on the front end of this cycle. 

Tomorrow morning, cycle day 19, I will be up way too early for a Saturday morning, shooting myself in the belly with 20 units of Lupron.  During a normal cycle, the pituitary gland talks to your ovaries - tells them that while it's great that multiple follicles may be developing, that they should focus on turning the best follicle into an egg and then prepare it for ovulation.  Lupron shuts off that communication between the pituitary gland and the ovaries.  Multiple follicles will develop, but there is no ovulation on the schedule.  In other words, Lupron puts you in a pre-menopausal state.  So I'm a little worried about the side effects that may show up.

Once my period starts, I'll go in to the RE's office for a baseline ultrasound, and to receive guidance about starting additional meds - these will stimulate the developing follicles to GROW, GROW, GROW.  We will also have a better idea of what our timeline will look like for retrieval.

It's nerve-wracking, but I'm so thankful that we're here.  I really really really really really hope this works.

Most Improved

Awards season is upon us!  The Golden Globes will be here before you know it, and guess what - Jared and I deserve a couple of awards too!

At the end of our orientation session with Dr. K, before he handed us off to a nurse for some detailed instruction on medications and injections, he gave us an update.

Even though I was slightly terrified to do so, I had asked Dr. K to order an AMH test to potentially determine my ovarian reserve.  Last year, when my ob/gyn tested my AMH, it came in at 0.1 - VERY LOW.

Interpretation	AMH Blood Level
High (often PCOS)	Over 3.0 ng/ml
Normal	Over 1.0 ng/ml
Low Normal Range	0.7 - 0.9 ng/ml
Low	0.3 - 0.6 ng/ml
Very Low	Less than 0.3 ng/ml

(via this site)

This reading generally drops as you get older - you run out of eggs, your ovarian reserve goes down, your AMH goes down.  Pretty straightforward.

Except...

Fifteen months later, my AMH level tested at a 0.6.  IT WENT UP.  A test indicating my ovarian reserve went up to Low, bordering on Low Normal.  I can't even express how excited this makes me.  Honestly, it's just not supposed to happen.

My shock and confusion was obvious, but Jared turned to me and said simply, "Stress."  And Dr. K agreed.  The ridiculous amount of stress we were under last year, with me in a new job, financial issues, trying to conceive, and learning that we were dealing with infertility, clearly took a toll on my hormone levels.  But I had no idea that the difference would be so drastic. 

Even better?  Jared's sperm count improved as well, so we're in great shape for our IVF cycle. 

2011 has been tough, because we decided to take the year to keep trying for a baby on our own.  We weren't mentally prepared for IVF at this time last year, and it seems like our bodies weren't ready either.  We're that much better off now, and that much more likely to be successful.  It's been really difficult to believe the old adage that 'everything happens for a reason' throughout this process.  I haven't been able to come up with a reason why we're dealing with infertility.  But there is a reason why we didn't do IVF in 2011.  We were meant to do it in 2012, when we're Most Improved.

Chain of Custody

Last Thursday was our IVF Orientation appointment.  Unlike the previous (stirrup-related) appointment, I wasn't nervous for this one, just curious.  We were scheduled to be at the hospital from 8 AM until noon, which seemed like a long time, but clearly, there was a lot of information to go through.

The first third of the appointment was spent with our RE, and he went through a checklist of items.  It seemed to be a risk overview more than anything, which was good - but a little scary.  Overall, our chances of conceiving are about 70%.  Our chance of  miscarrying is no greater than with a normal pregnancy.  There is an increased risk of multiples, which means a high-risk pregnancy, but we're okay with that.  If I have to spend the next ten months in bed, so be it.  Whatever it takes for a healthy baby.

At the end of our conversation with Dr. K, he brought up the topic of custody of any potential frozen embryos we may have at the end of this process. The first question wasn't so bad:

"There will inevitably be embryos which aren't viable for transfer.  Would you be willing to donate them to the hospital for research purposes?"

With a bit more explanation, we replied yes.  We are having IVF done at a research and teaching hospital, so this makes sense to us.

Then he broke out the biggie:

"If you two get divorced, who gets custody of the embryos?"

Um, what?  I had no idea this was coming, and it wasn't something that Jared and I had talked about. I was honestly shocked into silence.  My amazing husband turned to me and said, "She gets them.  But I get the house."  Oh, that joker.

Then the inevitable, "What if one of you passes?"  We decided that the other would take custody - done.

"What if you both pass?"  Another biggie.

We decided that if we both were to pass away, that we would want to donate our frozen embryos to other infertile couples who may need them.  I would like to think that this is standard, but I really have no idea.

These custody decisions were the right ones for us, but I can fully understand how other couples may not want to do as we do.  We have closely followed the debate surrounding the Personhood amendment, and we feel strongly that life does not begin at fertilization.  And that's all I'm going to say about that, because it feels like I'm cracking open a can of worms.

I'm glad we were forced into a conversation that wouldn't have occurred to us otherwise, because I think it's moments such as those where your marriage grows - where you find yourself surprised, impressed, or dismayed by your spouse's reaction - and all of those feelings are valid and meaningful. 

Stirrup Appointment #1

From what I understand, I'll be spending a lot of time in stirrups over the next several months, and stirrup appointment #1 went about as well as could be expected.

I was nervous, as I generally tend to be, particularly when there are plans to insert various foreign objects and liquids inside my body.  Anyway, I didn't sleep very well the night before.  I was up until 2:45 AM catching up on Homeland, which Jared has been telling me to watch for weeks now.  It could probably go without saying that watching multiple episodes of Homeland in the wee hours of the morning did little to calm my nerves.

7:30 AM at the Reproductive Center is kind of weird.  There are actually a lot of people there, and I had to wonder who they were and why they were there.  Were they recently diagnosed with infertility?  In the early stages of treatment, like me?  Visiting daily in advance of their retrievals?  Coming in for Beta testing after getting a positive test at home?  I was most intrigued by the ladies who the nurses seemed familiar with.  How long will it take for me to be a familiar face?

I was pleasantly surprised to be brought back to the ultrasound room by one of the doctors who had won me over on our first visit to this practice.  She's actually a resident at the hospital, specializing in Reproductive Endocrinology, and she truly could not be any more pleasant, caring, or compassionate.

She performed a few procedures on me, with the assistance of another resident:

1. Vaginal ultrasound to check out developing follicles.  I hadn't had this done in a year, so they wanted to take another look.  No biggie.  The wand is a little weird, but it is what it is.
2. Trial transfer to measure my cervix and uterus and figure out which instruments to use for future procedures.  This was very much like having a pap smear.  There was some pressure, but no pain.  Strangely enough, the second resident also performed an abdominal ultrasound during this procedure.  I guess to get a better view from all angles?
3. Finally, the sonohystogram, or saline ultrasound.  I was warned about some cramping during this procedure, since the doctor actually inserts a catheter through the cervix, fills the uterus up with saline, and then inserts the vaginal ultrasound again.  NOT PLEASANT.  It wasn't anywhere near as bad as the HSG, which was my main fear going in to this appointment.  Still, there was a distinct feeling of "there's something in my body that isn't supposed to be there, and I want it out NOW."  I started to sweat, and I thought for a couple of minutes that I might pass out.  Deep breaths and intense scrutiny of the ceiling tiles was about all I could focus on.  Finally, after about seven or eight minutes of mild to moderate discomfort, I was finished.

The doctors didn't really give me much detail about what they saw, although the doctor I like did say to me that everything looked completely normal.  There was also a couple of minutes of conversation during the sonohystogram about a shadow in my uterus, and they weren't sure what was causing it.  They seemed to finally agree that some debris from my uterine wall may have come off when the catheter was inserted, and that was casting a shadow.  I'm seriously hoping that's the case, and not that we're looking at the added complication of cysts or polyps. 

So, that's all we know until next week, when we have our IVF orientation.  I'm looking forward to getting all of our information, setting up a schedule, and NOT putting my feet in stirrups that day.  Until then, work and social life have me buried, so hopefully my anxiety won't be as bad.

Anyone else out there had both an HSG and a sonohystogram?  How do you think they compare?

Return to the RE

Last week, we went in to see our Reproductive Endocrinologist.  It had been a year, and obviously, nothing has changed, so we let him know that we are ready to move forward. 

He re-ordered tests for both of us, since our previous tests were done more than a year ago.  Ten vials of blood for me, three for Jared.  (Hey, at least it wasn't eighteen for me!)

Jared also had the pleasure of handing over a semen sample, after which said to me, "I hope to never have to do that here again."  My response?  "Um, I think you're going to have to do that at least one more time."  Yeah, he completely forgot about the most important time.  Too funny.

And we made appointments.  A saline ultrasound and trial transfer for me.  IVF orientation for the both of us.  We're moving full steam ahead, hoping to have this procedure complete by the end of February.

...
You will never be as young as you are today and your chances will never be as good as with an IVF cycle.

I read this somewhere recently, and I decided that I had to mark it down to remember it, every single day. I'm only getting older, and IVF is our absolute best chance to conceive. There shouldn't be any doubt in my mind.

A Conversation

Now that we've decided to accept my parents' offer of assistance, all systems are go for IVF.  But first we had to have the conversation.

My husband and I were both seriously dreading it.  I mean, come on.  Nobody likes to talk about money...especially if you're asking someone else to give you some.  It felt a bit like saying, "We tried and we failed - will you pay for us to try another way?  A really super expensive way?"

We arrived a couple of nights early for Thanksgiving, and we went to dinner with my parents.  We all knew it was coming, and so our pre-dinner small talk just felt weird.  Inconsequential.  Pointless.  Finally, right before our entrees were served, I gathered together every ounce of determination I had, and I blurted out "Okay, we really need to talk about this.  We've agreed to take you up on your offer to help with the financial obligations of IVF."

It's not like it was out of the blue.  Everyone knew it was coming, but it still felt like the hardest thing in the world to say.  Luckily, I have two of the most generous parents in the world.  I think my dad would have been fine to end the conversation there, with a "Sounds good.  Just let me know who to make the check out to."

However, hubs and I had to talk through some of this.  We had to tell them why it took us a year to accept their offer of help.  We had to outline exactly how much this (and potential subsequent) procedure could cost.  And we drew a parallel.

The cost of IVF roughly equates to the cost of a car.  One cycle = a compact economy car.  Multiple cyles = a luxury car.

My dad's response?  "I have a car.  I could buy a new one.  I don't want to.  I want to spend my money on this instead."

Like I said, I am so incredibly lucky.  With my parents' blessing, we went home and made an appointment with our Reproductive Endocrinologist.  We were going to have a plan, and soon. 

Get in Shape, Lady

Since getting married almost four years ago, I've watched my weight go up and up....and up.  I'm not happy with it, and I haven't been for a while.  I have an extremely busy work schedule, but honestly -  I can work with that.  I also have a husband who loves fast food and fried *anything* - and I'm just lazy enough to join him in consuming whatever unhealthy item he's chosen for that day.

But recently, I decided that I don't want this to be my starting point.  If/when we go through the IVF process, I'll be pumping myself full of progesterone and other lady hormones that are sure to make me swell up way past where I already am.  It would be nice if I was even ten pounds lighter to accommodate for some of that growth.

So what's the plan?  Well, in the short term, I'm eating less.  Not necessarily eating BETTER, but eating less.  The eating better will come, I think.  I need to put together a food plan, and I haven't had a chance to do that yet.  For now, I'm just watching my portions and consuming less food overall.  Also, I'm trying to eat dinner earlier and avoid late night snacking.

Running.  I've been a runner for a long time - since college, really.  But in the last few years, I have been....well, sporadic about it.  And it shows.  So yesterday I started Couch to 5K - C25K, if you will.  It's not that a 5K is out of reach.  I did one in 30 minutes just about six months ago.  But I love the idea of gradually building up to it and re-training my body how it's supposed to exercise.  I'm just not going to stick with anything too intense. I get burned out WAY too easily.  So now that I've recognized that problem, I think I've got a good solution.  Slow and steady wins the race.  Or in this case, slow and steady leads to weight loss before pregnancy.

Plan B

Two years of trying. No baby.  No positive pregnancy tests. 

We've informally decided to move forward with the big guns.  In the next month or so, we will be having the conversation we've both been dreading...we're taking my parents up on their offer to help financially with IVF.

I'm still very scared of this process - especially the big What If.  What if it doesn't work?  What then?

But at the same time, I'm also hopeful.  Maybe by this time next year, we'll have a little one.  Whether we're able to do this with no help or with all of the help in the world - well, with a happy end result, the process won't matter.  I have to keep reminding myself of that.  All of the heartache and all of the tears and all of the conflicting emotions will be in the past if we're just able to have a baby.

I'm not saying that we'll forget.  I could never forget what the last two years have been like.  I'll still never be able to watch 16 and Pregnant or Teen Mom or even those stupid Kardashians with their inane and uninformed baby talk.  I'll probably be the "go to" person when my friends have questions about getting pregnant, because even though I've never been successful at it, I sure know a hell of a lot about how it works.  But I will be able to move on to the next thing - the baby thing.  Seriously - that sounds so much more fun than the "trying to get pregnant" thing.

Zen.

So, up to now this blog has pretty much just been facts.  XXX happened in August, YYY happened in October, blah blah blah.

I haven't talked much about how or why we chose to live with infertility...at least for now.  I know a lot of people opt not to pursue medical intervention in their reproductive processes due to religious beliefs.  That's not the case with us.  In fact, my husband is an Atheist.  I'm Catholic, but I couldn't tell you the last time I went to church - not counting weddings, of course.  Maybe Christmas '09?

Money is the issue.  We have a good-sized mortgage payment every month, and we have a hard time saving.  Yes, we could save if we really really tried, but up to now, we haven't.  I'm not going to offer up excuses for why, and I'm also not going to say that we're irresponsible.  It's not that simple.  But that's exactly the reason why we haven't taken our parents up on their offer to help.  Technically, we could save.  We're not destitute, and we're not desperate.  If our parents swooped in and paid for IVF, it would be primarily because we weren't willing to give up our current lifestyle to save for it ourselves.  And doesn't that kind of defeat the purpose of having a baby?

Plus, there's the whole idea of our parents "buying" us a baby.  Something about that just doesn't sit right with me.  They're all DYING for grandchildren.  I get that.  They can afford it.  I get that too.  But if they shelled out the cash for an IVF cycle and it was successful, part of me would feel like it was their baby - they paid for it.  And if it wasn't successful?  Well, I can't even begin to consider the guilt I would feel for "wasting" up to $15K of my parents' money.  I just can't even process it.

These thoughts and feelings don't translate to others.  I don't think poorly of those who pursue IVF with assitance from their parents.  But given where I am right now, I just can't do it.  There are too many "what ifs" and I'm not sure that my psyche is in the right place. 

So where I am right now?  Cycle day 19.  3 or 4 days past ovulation.  I'm not exactly sure when I ovulated, but I had a couple of positive OPKs over the weekend, so we got down.  This morning I had a weird-ass massage.  It was probably just that I was paranoid about having a massage when we're trying to conceive (an issue that has never bothered me before today), but it just seemed different.  Off.  Way less comfortable than usual - and I've been using the same therapist since the fall.  So I don't know what that's all about.

Chicken

Oh yeah - you want to know the one weird thing that all that bloodwork detected?

I have no immunity to chicken pox.

The doctor's assumption was that I had never been exposed to it, but he couldn't be more wrong.  Actually, I've had chicken pox twice.  TWICE.  Once, when I was very little, I had a mild case.  A few years later, my brother got the virus, and my mom didn't think twice about it, until the little red spots started showing up on me as well.  The second time around, it seems I had it pretty bad.  (Honestly, I don't remember ever having chicken pox, so I just trust my mom's memory.)

So, here's where it gets really weird: you know how the chicken pox virus stays in your spine, and it can eventually flare up as shingles?  And shingles is usually found in older people?  Well, there are an inordinate amount of people in my life who have had shingles. 

My best friend in high school (Helen)

College roommate Shea, sophomore year

College roommate Meredith, junior year

My brother

My sister-in-law

And those are just the ones I can think of off the top of my head. 

That's weird, right?  I've had chicken pox twice, but I have no immunity to it.  People around me keep getting shingles, but I've never contracted chicken pox from them. 

So what does this have to do with my little blog about infertility?  Well, chicken pox can be very dangerous to pregnant women and fetuses, and they recommend receiving the vaccine if you've never had the virus.  My doctor briefed me on all of it, and he recommended that I move forward with the series of shots over a few months...and postpone conception attempts, since the vaccine could actually cause an outbreak of the virus .

Thanks but no thanks, doc.  That may sound callous, but honestly - I'm around adults all of the time.  I've been around several adults with shingles.  I haven't contracted chicken pox.  If/when I have a baby, I will get the chicken pox vaccine post-delivery.   

So that's the chicken-pox plan.  Just like everything else these days, it's wait and see.

Say when.

October 21, 2010.

I had put together a luncheon event for about ninety people, but my 3:30 appointment with the RE was really all I could think about.  I knew that the chances of him saying that all was well were pretty slim, but I really wanted to hear the words, "let's move forward with an IUI."  Intra-uterine insemination isn't the sexiest way of getting pregnant, but it's a lot less expensive than IVF, and it would mean that my husband's swimmers were performing well.

We got to the doctor's office, and we were seated in a small room with a table and four chairs.  Shortly thereafter, we were joined by a young man (resident? intern?) who started going over some of my results with me, but he couldn't answer any of my questions, and I quickly got impatient and annoyed.  This is my FERTILITY we're talking about - don't you think you could brief yourself on the basics before coming in to chat?  He dashed back out of the room, and Jared raised his eyebrows at me - apparently I should have been nicer to the kid.

Then the RE came in.  I like him because he's direct and doesn't sugar coat things.  This is also why I don't like him.

Our results:

My Estradiol = 69.5 (I don't know what this is, but it should be under 75, so we're okay.). 

My FSH = 7.8 (WOO HOO!  Yes, I'm aware that you shouldn't be over 7.0, but compared to my previous month's level of 11.2, 7.8 was FANTASTIC.)

My Antral Follicle Count = 17 (This was determined during the vaginal ultrasound.  They counted the number of follicles that were maturing that month.  If we were to pursue fertility treatments, the more maturing follicles to extract, the better.  17 is pretty darn good.)

Jared's Sperm Count = 4 million sperm/milliliter
Normal Sperm Count = 15-20 million sperm/milliliter.

The RE immediately told us that he wouldn't recommend IUI.  Why would we want to spend $2-3,000 on a procedure that still relies on Jared's sperm to do a lot of the heavy lifting?  They're not performing as they should, and they could use some help.

His recommendation?  IVF.  With ICSI (a process by which they directly implant the sperm into the egg).  ASAP.  To the tune of $12-15,000.

We decided that we weren't going to decide anything right now.  We would at least wait until the first of the year to figure out what we were going to do.  We don't have that kind of money, so if we were to try this sooner rather than later, we would have to borrow money from our parents.

The first of the year came and went.  Our parents have offered to help, but my struggle with that is another post in itself.  It's been seven and a half months since we were at the doctor's office at Emory, and we just keep trying.  There are so many miracle stories out there, and I keep hoping that one of these months, it will be my turn for a miracle.

HSG: Never Again (I hope...)

My hysterosalpingogram (HSG) was scheduled for the morning of October 4th.  The doctor had prescribed me an antibiotic to prevent infection, which I was to start taking 24 hours before the procedure, in addition to Midol for any discomfort I may experience.

I was really, honestly SO SO SO hopeful going into the HSG.  One of my best friends in the world, who struggled with infertility for a year and didn't ovulate due to severe PCOS, was able to get pregnant without assistance immediately following her HSG.

Here's how it works: I checked in to the Radiology department and was shown back to a changing area, where I put on a backwards hospital gown, tied up in some confusing way, and some SEXY thick socks.  Jared waited for me in a small room right next to the changing area, and I headed into the procedure room, immediately across the hall.  We were told that it shouldn't take any more than 15 minutes or so. 

There was a massive x-ray machine and a table, which the nurse asked me to take a seat on while she talked me through the details of the procedure.  I had already heard all about it from my friend, and I had done a bit of research online, so I thought I had a pretty good idea of what to expect.  Basically, you lay down on the table, and the radiologist inserts a tube through your cervix, into your uterus.  Then, he/she pushes dye through that tube and looks at how the dye spreads through your uterus and up into your fallopian tubes.  Sometimes there are blockages in the tubes, preventing eggs from reaching the uterus, which can explain a lot of fertility problems.  For my friend, just the act of flushing out her tubes "jumpstarted" her ovaries to produce eggs.  My big unknown was the pain - I had read that it was unbearable (worse than labor), similar to menstrual cramps, and nothing.  So really, I had absolutely no idea what to expect.

The radiologist came in and introduced himself, and I laid down and pulled my gown up to my chest.  By the way, it's not really a whole lot of fun to be flat out naked in a room with strangers.  Just saying.  They positioned the x-ray so that everything was focused around my mid-section. The nurse stood at the head of the table and told me stretch my arms out above my head and grab her hands to bear down. 

The tube?  No problem.  Like getting a pap.

The dye?  Ow.  Ow ow ow ow ow ow ow. 

The radiologist was being encouraging...until he told me to start rolling back and forth on the table. 

Um, excuse me?  Nobody mentioned that I would need to move during this process.  I have no idea if this pain was similar to labor, but it sure as hell wasn't like any menstrual cramps that I've ever experienced, and I've had some bad cramps.  With tears rolling down my face, I somehow managed a couple of rolls from hip to hip, until the dye made it through both tubes.

The radiologist told me right then and there that my fallopian tubes looked clear, and that everything looked good.  I could hardly breathe, but I think I said something along the lines of a faint, "Yay.  Thank you."  He also reiterated that an HSG can improve fertility in the short term, so that I may get lucky in the next three cycles or so.

He left the room, and the nurse handed me a large maxipad and helped me to the bathroom.  My friend had warned me that the dye was blue, and that I would be spotting blue for the next 24 hours, but mine was clear.  I did, however, have some blood, which was perfectly normal, given that it's a fairly invasive procedure.  I'm pretty sure I was out of there in ten minutes.

Jared drove me home (after scolding me for not keeping the socks.  What can I say?  The boy likes hospital socks.), where I went to bed, beyond glad that when I had said the words "minor procedure" to the woman I report to, she insisted that I take the whole day off.  I stayed on the antibiotic for about another 36 hours, ending that run a bit early because I couldn't handle the digestive issues it caused. 

Three cycles came and went, and it's now April.  Obviously, we didn't get lucky.  But we did have an impending appointment with the fertility specialist, including analysis of all of these tests and a recommendation for moving forward.  Here's hoping.

Back Again

Okay, so I left off with my tale of high FSH/low AMH and a referral to see a reproductive endocrinologist (fertility specialist).  We decided on a doctor at Emory, because (1) it's a great hospital, (2) he has google-able published research on hgh FSH patients, and (3) they take our insurance.  Score!

Our first visit, in mid-September, was AMAZING.  We spent well over an hour talking to two different doctors, both of whom were knowledgable and realistic, but also approachable.  We left there with various instructions, and feeling good.

Jared was to go back for a semen analysis and bloodwork.

I was to go back between days 2-5 of my cycle for bloodwork and a vaginal ultrasound, then again right before ovulation for an hysterosalpingogram (HSG).  We also made an appointment for approximately a month later to go over all of the results.  Our specialist only sees patients on Thursdays - he teaches at the medical school and does research on other days.

So.  I went in on day 4 to get my blood drawn and have the ultrasound.  That really wasn't particularly unpleasant, except for the fact that you have to drink water and not pee beforehand.  The tech was encouraging, saying that she definitely saw developing follicles, but she couldn't tell me how many.  Follicles = Good, because one of those eventually (*hopefully*) turns into an ovulated egg. 

As I was checking out, the assistant says, "Oh, while you're here, why don't you run downstairs to the lab to get your bloodwork out of the way?"

"Um, I thought I did that about 20 minutes ago."

"Oh, no!  You have more tests to run.  We just test a few things from here."

Whatev.  So I went downstairs to the diagnostic lab and they called my name after about a ten minute wait.  I entered the small curtained off area they directed me to, and I literally gasped out loud.  There were EIGHTEEN vials on the tray. 

"Those aren't all for me, right?"  I asked the tech.

"Oh, yeah.  They are."

Dude.  I have never had that much blood taken in my life.  The vials just kept coming.  (And no, I don't give blood.  I have a low threshold for passing out, so doctors have advised against it.)  I'm not quite sure how I kept it together...or how I stayed conscious!  They tested me for every. freaking. thing. under the sun.

I left there a little freaked out, but still really optimistic that our test results would come back normal - hey, maybe the tests from my ob/gyn were a glitch, right?