Well, Here We Go...

Why hello birth control pills. I haven't seen you in several years. Never thought I'd take something that prevents pregnancy as part of a process to get pregnant. Then again, I never thought we'd be doing IVF. If I understand things correctly, it is to give my ovaries a break so they will respond better to all the stimulants next month. Also, it allows the doctor to start controlling the entire process. I believe they can even alter the schedule a bit by adjusting the number of days the BCPs are taken. We have no need to rush things so I anticipate taking all 21 of the active pills and overlapping the Lupron injections the last seven days or so.

Embryology 101

Today we went in for a no funny business session about ART - that's assisted reproductive technology for the uninitiated. As luck would it, Dr. NFB led the session with the embryologist and the IVF nurse. She got right down to business and explained the general process (stimulation, retrieval, transfer). We already had our consultation with her so this information was not new. Then the embryologist walked through what he does from egg retrieval to embryo transfer. Fascinating. 

He showed pictures of each step from egg (oocyte) to blastocyst and explained what he looks for at each point. Here is what he said (I think - I wrote quickly): 

• Day 0 - The doctor aspirates the follicles first thing in the morning, which includes the egg and follicular fluid. He then finds all of the mature eggs (it is possible to have empty follicles and immature eggs) by looking for a "polar body".
• Day 0 -He incubates the eggs for a few hours and adds the sperm in the early afternoon. If doing IVF, sperm are added to the petri dishes with the eggs and nature takes it course overnight. If doing ICSI, he injects a sperm directly into each egg.
• Day 1 - Checks for fertilization in the morning; late on day 1 cell division begins.
• Day 2 - Hopes to see 4 cell embryos, but 2 and 3 cells are ok. Based on how they are developing he and the doctor decide if we are going to do a 3dt or 5dt. 
• Day 3 - 6, 7, or 8 cell embryos
• Day 4 - He can't count the individual cells anymore so it is referred to as a morula 
• Day 5 - The embryo divides into the cells that will become the baby and the cells that will become the placenta. This stage is called a blastocyst. 
• After day 5 the embryo will start to hatch - this has to occur for implantation and needs to occur in the uterus

It is truly amazing that all of this has to go correctly and then continue to go correctly for months to create a human. How in the world does anyone reproduce?!

There were eight other couples there besides us. They were soooo quiet before the session got started it was making me laugh. Same thing used to happen to me at church. Allison and I spent many a mass stifling our giggles. 

I asked the embryologist who babysits the embryos when he has a day off. He said he grew up as a dairy farmer where there were no days off and so he will be there if there are embryos in his lab. Someone else I know (DAD!) grew up on a dairy farm and now I have every confidence that this guy has his lab in perfect order and is very protective over it. Our embryos will be in excellent hands. 

I tried to add some levity at the end. Some guy asked who gives "all those shots" and the nurse said she would teach both of them how to administer the shots. I then asked if the guys could learn to do it by sticking themselves. The girls laughed, the guys looked scared. 

Our Stress Relief

Lucy. She loves kibbles, tuna, her stuffed mouse, packing paper, and fleece blankets. Oh, and she has asthma, but you would never know that because she talks to us VERY LOUDLY.

Family & Friends

Infertility is hard to understand, hard to explain, and hard to grasp. There is a lot to learn and come to terms with whether you are an infertile couple or close family or friends of an infertile couple. Part of my intentions with this blog is to try to provide one window into this seemingly secret world. I will eventually (probably) change this blog from being invite-only to public. I have a list of reasons why I think so many treat infertility as taboo, but that is for a different post on a different day. And, truthfully, while I have started to open up to you, I’m not ready to extend that to anyone and everyone. I’m not the best example of breaking that taboo, but I promise to try.

One of the biggest steps to breaking down the infertility stigma is awareness and education. There is a great organization out there called RESOLVE which is working on that very topic. Their website has helpful information and I have put the link in the sidebar. My Mom came across a portion of their site this morning which I had not yet seen. It is all about friends and family. It really was very helpful and I encourage everyone to read through it (click here or link in the sidebar).

It opened my eyes to the fact that infertility doesn’t just affect the couple, it affects the entire family. Now that I think about it, of course it does. I’m sure it sucks just as much for our parents or siblings to be surrounded by their friends bragging about their grandchildren / nieces / nephews (or worse – complaining about them) as it does for us. There is so much uncertainty in infertility and I can’t tell you how or when this will end for us. But it will end someday.

A couple of additional points stuck out to me (well, the whole thing did, but you can read it all there).  One, infertility is a medical condition. We aren’t dealing with this because we are stressed out, or because we don’t know how to make a baby, or because God is punishing us. I don’t believe in a vindictive God. Two, the pain of loss and uncertainty is very real. I have tried to tell my self that things in my life could be worse. I’m sure they could. But that isn’t for anyone else to decide or judge. Also, I’m not sure how thoroughly some people have really thought about what if they weren’t able to have biological children when there is apparently nothing wrong. We hold out hope every single month that this will be our turn and we have had to cope with a lost opportunity every single month. As time goes on, it raises more questions about whether this will ever work. Sometimes it really sucks; sometimes we cope by focusing on plans for the next round.

The RESOLVE website mentions that family and friends should ask how they can be supportive. I’ll just tell you rather than making you ask. Trust me when I say that just the fact that you care means a ton. Positive thoughts and/or prayers are much appreciated. Letting us talk to you about it, whether through this blog or over the phone, is a huge gift. Know that we care about and want to hear about what is going on in your life too. Don’t avoid us or avoid telling us news about friends or family. We’ll deal with it. Your support of our treatment decisions is also important to us. I know there is controversy regarding infertility treatments; if you disagree, just don’t tell us. We are trying to create a family here, not conjure up the devil.

Finally, Chris and I have had almost a year to process infertility. We are doing so much better with it, but everyone needs their own time and own ways of processing it. Please let us know if you have any questions about what we have learned or how we have handled something. As for news on successes or failures – assume no news is bad news and we won’t hold out for very long on any successes.

Thank you for your love and encouragement. We’ll get through this.

We're in This Together

A couple months ago I came across an article on CNN about infertility from the husband’s perspective. At first I was thrilled! Not only was someone willing to discuss infertility, it was a DUDE! But as I got further along in the article, the author used phrases like, “when she has a failed cycle” or “when she has a canceled IVF due to poor response.” STOP! Since when is infertility her problem?

Chris and I have never considered this process to be mine or his alone. We want children together and therefore, whatever path it takes us to get there is also done together. Yes, I bear the brunt of the treatments and side effects and it has seemed to take a greater emotional toll on me. But not once has Chris ever considered this my problem. Failed cycles involve both of us. If in the end, we find out the primary problem is male factor infertility, I will not consider this his fault or his problem either. Marriage and parenting are partnerships where each person has to give 100%. Infertility treatments should be no different.

Chris is every bit as involved as I am except for the actual procedures. He comes to every appointment, he researches, he asks questions. The RE office doesn’t just talk to me. If he answers the phone when they call, they'll talk to him. He always comes back to the exam room and is equally addressed by the nurses and doctors. In fact, we see more couples in the waiting room than women alone.

Further, Chris is very thoughtful and protective. He has jumped out of bed 45 minutes early to make me breakfast because the Kryptonite has made me feel queasy. He surprised me with fancy ginger ale (made with actual ginger, not “natural flavorings”) because I am not drinking beer any more. He cooks dinner while I nap from not sleeping the night before after having hot flashes and bad dreams thanks to the Kryptonite / Clomid cocktail. So while Chris can’t pop the meds, he certainly makes it as easy on me as possible.

I can’t imagine feeling like I was going at this alone. And I’m sure Chris can’t imagine not being every bit as involved as he is. We are in this together, after all this is for OUR family.

There's That Sign Again

I returned from vacation to find the following email sitting in my inbox. This came from a very nice coworker who has no idea about our situation. She was still pregnant with #1 when we started trying and is now 2 weeks from her due date with #2. I'm pretty sure she also thinks that everyone gets pregnant on the first try. Ugh.

I hit delete as I grabbed my purse and left for our IVF consultation.

Subject: pretty happy today!!!
Text: I just found this parking space in front of the building!!!!! I love the NJ office! I'm a dork and excited to come to work tomorrow to use it.
Attachment:

$$$$

We are required to have a “financial obligation discussion” with the practice’s IVF financial advisor before they will begin any procedures. I figured we would call them sometime next week, but in typical exceeding all of our expectations fashion, the lady called Chris this morning. It is SO NICE to go to a practice where they all talk to each other, they all read the charts, and they are very prompt. In fact, they order my hCG trigger shots from a pharmacy in Cleveland and that pharmacy always calls within an hour of us leaving the appointment to confirm our credit card and mailing address.

She went over all of the insurance and financial aspects with Chris:

• Office visits: considered in-network, my insurance will cover 100% after my $30 per visit co-pay.  Estimate out of pocket without insurance is ~$2,500.
• Lab and embryologist: considered out-of-network. My insurance will cover 70% after a $750 out-of-network deductible. We have to make a deposit of $4,000 before any procedures and then be reimbursed by the insurance company for whatever they will cover (at their rates, of course). 
• Medications: not covered by health plan, but are covered by a prescription plan. No word yet on our OOP cost. We already told the IVF nurse that we have to order from CVS Caremark to receive any drug coverage. They will order from wherever is the least expensive for us, but apparently CVS is terrible to work with. Great. If no insurance, I think the meds are $3,000-$5,000.
• ICSI if added at the retrieval is an additional $1,500. They will submit to insurance, but not sure it is covered.
• Assisted hatching if added before transfer is an additional $500. They will submit to insurance, but not sure it is covered.
• Cryopreservation (aka freezing) of any embryos is $675 for the first year and $306 each additional year. Not covered by any insurance, 100% OOP.
• Chris's insurance company will not cover any infertility treatments so everything related to him will be OOP. Unfortunately only a few states require insurance to cover infertility. 

At least my insurance will cover most of this. And the good news is that if for some reason this doesn’t work the first time, it looks like we will have insurance money left over for another round. My lifetime maximum infertility coverage is $10,000 for medications and $20,000 for services.

IVF Consultation

We had our initial IVF consultation with Dr. NFB today. She is by far the best medical provider we have ever worked with.

Anyway, IVF is a lot of work. And expensive. And there are many needles. Worse, I have to give them to myself or trust Chris to do it. This makes me feel faint thinking about it. I wonder if she’ll give me a box of smelling salts to go along with this. Below are the notes we took and answers to the questions we asked. Of course all of this doesn't matter if we are lucky enough to be pregnant this cycle.

• My IVF protocol (exact schedule TBD)
• Attend an IVF class next week (9/29)
• Call CD1 and the IVF nurse will schedule some appointments:
• Blood draw for me: testing thyroid, prolactin levels, rubella immunity, blood type and, as required by the great State of Ohio, infectious diseases (HIV, syphilis, Hepatitis-B and Hepatitis-C). We have also elected to see if I am a carrier for cystic fibrosis and a muscular skeletal disease that I didn’t write down fast enough.
• Sonohysterogram: inject saline into the uterus and observe with an ultrasound. Checking for polyps, fibroids, or anything else that could cause problems with implantation. Easier to pronounce and MUCH less involved than the HSG which was done in a hospital with contrast iodine and continuous x-ray.
• Trial transfer: Dr. NFB performs a transfer but with no embryo. It is to make sure the needle will work and that she knows exactly where to put the embryo(s) when the time comes.
• More tests for Chris – no details yet, but will probably include an antibody test. Stop reading this bullet if you don’t like details. Basically, the body can launch an attack on itself. Semen can actually damage or kill its own sperm. The lab adds a substance to a sample of sperm and checks to see if it binds to the sperm (binding = bad).
• Blood draw for Chris: apparently the State of Ohio also requires the male to be tested for infectious diseases (HIV, syphilis, Hep-B and Hep-C). If my test results come back as a carrier for cystic fibrosis or the other disease then Chris will also be tested.
• IVF nurse draws up detailed medication schedule
• Start birth control pills on CD3, take for 3 weeks
• Start Lupron subcutaneous injections – will overlap with BCPs and injected daily until egg retrieval
• Stop BCPs, continue Lupron alone for 4 days
• Suppression check: ultrasound to make sure that my ovaries look ok and are quiet. Blood test for something (I think estradiol levels)
• If all looks ok, start stims: Follistim and Menopur subcutaneous injections until retrieval (still doing Lupron injections. Daily injection count = 3)
• During stims, appointments every 2-3 days to monitor follicle growth via ultrasound and to check estradiol levels via blood draw
• Once follicles reach ~20mm each, hCG intramuscular injection. I have had these before, but never had to do it myself!! It has to be done 36 hours before retrieval, so that will be ~8:00-10:00 PM. The office is not open at that time to stab my ass for me.
• Egg retrieval (ER) and 1 day of bed rest
• Start progesterone-in-oil injections (PIO) on day of retrieval. TEARS! Daily intramuscular injections based in oil, not water. These will continue for 2 weeks. If I’m pregnant, then they continue for 2-4 more weeks depending on how fast the placenta starts producing it on its own. I’m not going to be able to sit. I’ve already volunteered Chris to give these to me. Good thing he has played darts before.
• Embryo transfer (ET) on either day 3 or day 5 post-retrieval. Abbreviated 3dt or 5dt. If we have several good quality embryos, they will let them continue to grow in the lab for the extra days so they can isolate the best of the bunch for transfer. If we only have a couple good embryos then they do a 3dt. She thinks because of my age we will have a 5dt. Three days of bed rest. 
• Two weeks later: beta check
• I seemed to stop responding well to Clomid – does that cause any concerns for my response to Follistim?
• No, completely different drug
• Will we work primarily with you throughout the whole process?
• Yes, the IVF nurse will do her best to schedule everything so that we see her for most checks and for the ER and ET
• Any reason we should take a cycle break before starting IVF?
• No, there is no difference in the pregnancy rates so it is totally up to us
• Given we are ‘unexplained’, any concerns about my uterine lining or anything that might cause implantation problems?
• No, even with the Clomid, which can cause thickness problems, I produced a thick enough lining and from the looks of the all the ultrasounds I don’t appear to have any polyps or fibroids. Will take a closer look with the sonohysterogram.
• Will I be awake during the egg retrieval? (what I really wanted to know is if the sedative is a truth serum – not that I have anything to confess, but I would like to just not say anything while Dr. NFB and the nurses have needles where sharp objects should never be stuck)
• No, while it is not a general anesthetic, it is a heavy sedative and will cause me to sleep. I might be able to respond to direct commands, but that’s about it. Plus the sedative contains an amnesiac. This sounds like what they gave me when I had my wisdom teeth extracted. My poor Mum. “How long was I in there, because I swear it was only like 2 minutes? Wait, how long did you say it took? Did I cry? No, oh, but how long was I in the room? And did I cry?” NO!
• Do you recommend ICSI (intracytoplasmic sperm injection)? This is where they fertilize the eggs directly.
• No, she doesn’t see any reason to recommend it. But, we will authorize the embryologist to make a game time decision if he doesn't think the eggs and/or sperm look like they will work well on their own
• How often will we hear about the progress from retrieval to transfer:
• They can tell us how many follicles they aspirated at the retrieval. Later that day the embryologist will call with how many eggs are mature. At the end of day +1 he will call with a fertilization report. On average, about 75% of mature eggs will fertilize. End of day +2 will call with whether we are doing a 3dt or 5dt. End of day +5 will tell me how many they will freeze (we are hoping for at least a couple).
• Do you recommend acupuncture?
• Whatever I want to do to relax is fine, but if I want to do acupuncture I need to start now because all those needles can cause more anxiety for some people. She does not want my first acupuncture treatment around when I start stims.
• Can I stop taking bromocriptine (aka Kryptonite)? It's a hangover without the party.
• No, not until I get pregnant. Damn.

I like to understand everything that is going on, so I tend to research things on my own. Here is what I found out about the medications:

• Birth control pills – nothing anyone doesn’t already know. The point in an IVF cycle is to start suppressing ovulation as the doctor wants to control that process
•  Lupron – stronger ovulation suppression drug. It acts as an agonist at the pituitary gland receptors and causes a reduction in estradiol and testosterone levels. Also noteworthy: it is used to treat the symptoms of prostate cancer. At least my prostate will be in good order...
• Follistim - synthetic FSH (follicle stimulating hormone) stimulates the ovaries to produce more follicles. Dr. NFB prefers this brand over Gonal-F because it is easier to self administer
• Menopur - equal parts FSH and LH (luteinizing hormone) to stimulate the ovaries to produce and mature more follicles. Dr. NFB wants to use this in conjunction with Follistim because she believes it helps with egg quality
• hCG - chorionic gonadotropin to trigger the final stages of egg maturity, will cause ovulation which is why it is important to time this injection exactly as directed so they can retrieve the eggs before ovulation
• Progesterone-in-oil - prepares the uterus for implantation and decreases the maternal immune response to the embryo. Need injections because the cells that naturally produce progesterone are aspirated during the egg retrieval. 

Infertility is Not Fair

Nobody deserves to go through infertility. Some could have a greater appreciation and understanding of the miracle it takes to conceive a baby, but this process isn't something I wish upon anyone.

I have recently been able to let most of the feelings of injustice go. 

I spent a lot of energy over the past year wondering what I did wrong in my life to deserve this. As if this is payback - karma. Despite all of my thinking I couldn't come up with anything. I feel so happy and grateful to be married to Chris. I am a trustworthy friend. I take decent care of my body, eat relatively well, exercise off and on, never experimented with any drugs. I truly love my family and friends. I am educated, have a good job and a comfortable home. Further, there are PLENTY of people out there who don't seem to deserve to conceive easily, but they do. Why would God choose to punish me while he lets someone addicted to cocaine or someone who is going to neglect their child have a baby? 

Blaming myself is clearly not rational. It is not my fault. There isn't anything I did or didn't do to bring on infertility. Like many of the unfair things in life, it just happened.

There is another element of unfairness in infertility. The vast majority of the fertility treatments fall on the female. Sometimes with male factor infertility the guy has to have surgery to correct something. Other than that, all of the treatments are the female's responsibility. The medications and their side effects, the ultrasounds, the blood draws, the procedures. If we end up doing IVF, I am the one who will have to give myself injections, go in for monitoring appointments every other day, and undergo an egg retrieval. The female also has the constant physical reminders of the process: failed cycles, cramps, medication side effects, injection site pain, ultrasounds, and then the tortuous two week wait where every twinge and itch could be a pregnancy symptom. That said, Chris does everything he possibly can - comes to all the appointments, helps me stay positive, researches with me, listens.

One day I had a revelation and decided that the female burden of infertility is entirely fair. At the end of this process, I plan to be pregnant. I get to grow a baby and give birth. I will happily endure any medication or procedure to experience that gift. All side by side with the most wonderful and supportive husband who would gladly take some of these procedures off my hands if he could. He's even offered to give himself practice injections so he knows how to help me do mine.

Voodoo? Maybe...Maybe Not

At this point I am willing to do anything to improve our chances of conceiving. We have no idea what is wrong and our remaining treatment cycles can be counted on one hand. Fixing this feels very much out of my control. Unlike anything I have ever encountered in my life, I can't just think about it hard enough and long enough to solve this one. My brain can't make sperm meet egg.

So I've decided to control everything that I can. Some of it may make sense, some of it may seem ridiculous. But I need to do whatever it takes for me to feel like I've set us up for success. For almost two years now I have avoided all NSAIDs (non-steroidal anti-inflammatory drugs - ibuprofen, naproxen) during the two week wait. Same with herbal teas.

This month I made a few more significant changes. I cut out caffeine and alcohol. I already drink decaf coffee and tea, but I put the diet cokes in the basement. I stopped getting iced teas when we go out to eat. And sadly, I have not popped open a beer, even after a long, hot day of yard work. Confession: Chris had one last Saturday and I had a couple swallows. I'm Catholic and Irish - I can't be expected to go 100% dry. 

I also stopped exercising. It is widely known that strenuous exercise can stop ovulation, and therefore, fertility. But I came across some articles that suggested that some women have a very sensitive uterus and even moderate exercise can hinder implantation. I don't know if I'm one of those women. All I do know is that the month I was briefly pregnant was the same month that I wasn't exercising at all because of a stress fracture in my foot. Coincidence? Maybe. What does it hurt to not exercise for a few months and see what happens?

I still practice yoga. I try to avoid getting my heart rate above 110bpm so no hot or vinyasa yoga. The stretching and breathing does wonders for my mind and body. On that note, I have also tried to calm my worried and busy mind. I try for 10-20 minutes of meditation every evening before bed. It is hard!! But it works. I've had insomnia off and on my entire life. Lately it was all on. I'd sleep from 11:00 to 4:00 and that's it. The next two hours before my alarm went off were spent burning up the gears in my head. For the past month, I have been able to fall back asleep using my breathing and meditation techniques. I think more sleep has put me in a better mood overall. 

So, will all of this help? I don't know. But I certainly think the stakes are high enough that it's worth a try. 

INNER PEACE

A few weeks ago, Chris and I were flying back to Ohio from Seattle. We were on an older plane with the drop down 2” video screens every four rows rather than the personal TVs in the back of each seat. The upside is that the movies are free as long as you have your own headphones (and who doesn’t these days?). Remember when you had to pay to rent the crappy headphones with the dual plastic tubes that plugged into the armrest? 

The benefit to the individual TVs is that you get to select your movie, but did you know those damn things have swipe strips for your credit card now? Of course those lucky jerks in first class get it for free. And guaranteed that pompous guy who talked very loudly on his Blackberry in the gate area just so everyone could know he is, in fact, God’s gift to business deals is sitting in first class as you are herded on past. You know the type. Certainly he should be working on his next sales pitch rather than watching the free movie. 

It’s not bad enough that you are crammed into a seat built for a four year old and sitting next to some lady who doesn’t follow the unwritten “the armrest is the line” rule. Noooo! They make you pay $6 just to try to forget that you are in hell; a metal, pressurized, smelly, wrong temperature, germ laden tube 32,000 feet in the air with 128 strangers. How often do you think they disinfect those trays off of which you are supposed to eat your three peanuts? SICK!  

I digress. While on this cross-country flight, the airline was kind enough to show Kung Fu Panda 2. The panda's guru told him that the only thing he was missing in his quest to be a Dragon Warrior was ‘inner peace’. His response, “So that’s it? I just need inner peace?” I feel just like him!! A book I recently finished reading said that chances of conception go up for those who remain calm – that stress can effect implantation in some cases. Just like the panda, all I need is inner peace.

Only it’s not that easy. Some days are great and I think I’ve stared at infertility in its ugly face and told it that it doesn’t bother me. But then sometimes I go for days thinking I’ll never be able to climb out of this lonely, bitter, expensive place. The Kung Fu Panda also discovered achieving inner peace is not easy. At one point in the movie, he starts banging his head on the wall and shouting, “INNER PEACE! INNER PEACE! INNER PEACE”!  Yes!!! That is exactly what I’m talking about! This is now a favorite phrase in our house – always said in ALL CAPS.

Vacation Canceled

We canceled our cruise in late November as the deadline for refunds was quickly approaching. When we booked it there was a chance we would have to cancel if we were too far along in a pregnancy as you have to be earlier than the 24th week to cruise. Unfortunately, we canceled it because there is a chance we will be in the middle of IVF. It is not worth the stress of trying to fit something as complex as IVF around a nonrefundable vacation.

If our last IUI attempt is successful this month then we can look into rebooking it or going in early winter. Here's to hoping for a January "babymoon". Cheers.

Do Not Pass Go, Do Not Collect $200

The 12 month mark is the guideline for when to seek help for couples under 35. When we hit that point, I scheduled an appointment with my OB/GYN.  I knew fertility specialists existed, but didn't think we had been in the game long enough for that.  I will tell anyone and everyone now that you should head straight to that specialist.

Honestly, it didn't seem like a bad idea at the time. The doctor knew which tests she wanted conducted and had a course of treatment. Plus insurance covered everything except the co-pays. 

However, I should have listened to my gut and left immediately. I am sure the practice is a great for OB/GYN matters, but really should not even pretend to treat infertility. Why? Here you go:

1. No weekend appointments. Apparently ovaries are supposed to have an internal clock and stop their process unless it is Monday - Friday, 8:00am to 5:00pm. Yes, that is correct. My fertility was limited to business hours. This was very stressful for us.
2. No monitoring on Clomid, even after I asked. I had read that it is possible to end up with Ovarian Hyperstimulation Syndrome (basically very enlarged ovaries). Her response was that Clomid was no big deal and completely safe. Thankfully this has never been a problem for me, but our specialist treats Clomid with much more care.
3. No clear instructions on when to come in for the IUI and when we finally pushed for answers, we discovered it's up to us to tell them. We had to rely on home monitoring using $0.93 ovulation predictor kits.(OPKs detect luteinizing hormone which surges 24-48 hours prior to ovulation).
4. Do you know how much it sucks to sit in a waiting room for two hours while pregnant lady after pregnant lady parades on by for her weekly check-in? They have kazoos, party hats, and pregnancy club t-shirts.

All that said, the actual treatment cycles were the icing on the cake. The first month I was on Clomid was a bust because we apparently weren't using the right OPKs and missed our opportunity for an IUI. You think they could have told us this when we called for instructions TWO WEEKS EARLIER. The second treatment cycle was ok.

The third treatment cycle was appalling. I waited for an hour longer than I should have waited. You know those swimmers have a shelf life, right? They don't live forever in a test tube. When they finally called me back, the nurse practitioner proceeded to tell me that they had received a new centrifuge and didn't know how to work it. She laughed as she said they had everyone in the office reading the instructions and finally pushed some buttons and it seemed like it worked. I was dumbfounded. As soon as I walked out of the front door I was able to come up with a litany of things I should have said about their carelessness with agreeing to do a procedure for which they did not know how and more than that, their insensitivity regarding how stressful and emotional this is for the infertile couple. But of course my shock overrode any ability to speak in the moment. 

We decided to give the OB/GYN one more shot. Mostly because it was so inexpensive and partly because I was hesitant to embark on the fertility clinic journey. I thought that if the OB/GYN process did the trick then maybe we had just run into bad luck. Starting at a fertility clinic meant we had problems that a general doctor could not solve and that bad luck could not explain. Isn't admission the first step to getting help? Turns out that is a hard one to do.

Anyway, we stressed for two weeks about receiving a positive OPK on a Friday or Saturday (recall they don't do weekend appointments). We ended up being ok with the timing and Chris called first thing on a Monday morning to schedule the IUI. They told him that they could not do the procedure because they had run out of "IUI kits". I was, once again, in disbelief. I called the office and asked if my husband had heard correctly.  He had. This time I managed to get out, "so we are totally screwed for yet another month because you ran out of kits and didn't tell us beforehand?" "Um, yes, sorry." I was about to say more but the tears started coming. I was at work. Awesome. All I could do was hang up on the nurse as she was telling me that I could try one of the fertility clinics in town. 

We called both fertility clinics, but understandably, they wouldn't do an IUI on a new patient without a consultation first. I did a little more research on the two fertility clinics, found the clear winner, and called the next day to schedule our consultation.

Improving the Odds

I think a little introduction to our world of infertility would be helpful at this point.

We go to a practice where the doctors are all board certified Reproductive Endocrinologists. They did a residency in obstetrics and gynecology and then went on for a fellowship and further study in reproductive endocrinology. They only do fertility related services. There is a lab on site, although blood work is sent out. 

The office is completely void of references to babies and pregnancy. Thank God. Apparently I'm not the only one who would rather not be reminded of it. It does not feel 'clinical' at all. The walls are covered in warm, textured wall paper, the waiting room furniture was picked from a modern decorating magazine, and I have never seen an issue of Parenting magazine on the table. Even the exam rooms aren't cold and uninviting. There are no pregnant ladies in the waiting room.

We tend to nickname everyone, our doctor included. We call her Dr. No Funny Business (Dr. NFB). She is smart, explains everything she sees and what treatments she wants to do, and answers all of our questions. We really couldn't be more pleased with her or the nursing staff. The nickname Dr. NFB is because she is all business. I never have to prepare any small talk topics in advance and she answers our questions honestly. 

If details make you squirm in your seat, skip this rest of this post. You were fairly warned. 

Because we don't know what is wrong, our current treatment plan is just to improve our odds of conception. For a 'normal' couple, each cycle carries a 20%-25% chance of conception.  Once we hit the year mark our odds of conceiving with no assistance dropped to 3%. Enter: fertility doctor. A combination of Clomid and intrauterine insemination (IUI) improves our chances to 10% per cycle. I think the easiest way to explain this is to walk you through one of our cycles:

• CD1 (cycle day 1): call office and schedule an appointment
• CD2: Scan and Script. Ultrasound to make sure I don't have any ovarian cysts. If there are no cysts, Dr. NFB writes a prescription for Clomid
• CD3-7: Take Clomid to increase the number of eggs produced. Normally, women produce one egg each cycle. Clomid works by blocking estrogen receptors thereby causing the pituitary gland to produce more follicle stimulating hormone (FSH). More FSH = more follicles. Each follicle contains one egg. Doses start at 50mg.
• CD12: Scan and Stab. Ultrasound to check the follicle count and size. If one or more are considered nearly mature (around 19-20mm), they give me a 10,000mg human chorionic gonadotropin (hCG) injection to force ovulation of all mature follicles. This is not a small needle. You should have seen Chris's eyes the first time they stabbed me in the back with it. If the follicles aren't big enough, they don't trigger with the hCG and we come back the next day for another scan.  
• CD13: Assuming we 'triggered' yesterday, we drop off Chris's donation at the lab at 7:30am and return at 9:00am for an IUI. In that hour and half, they do a sperm "wash" to isolate the best of the bunch. The IUI bypasses the treacherous journey through the cervix. 
• CD28/29: either I'm pregnant or not. If not, rinse and repeat. 

Are you thinking, "Damn, that's a lot of doctor appointments?" Yes, yes it is. Minimum is three appointments per cycle. Luckily for us, Chris pretty much sets his own schedule and I just leave work when I need. They don't know, I don't tell. 

At this point, we have completed that schedule three times and are part way through the fourth. The first one resulted in a miscarriage at 5 weeks. It was very early, but still, we thought maybe it was finally our turn. This will be our last IUI attempt. We are crossing all our fingers and toes that this works because the next step for us is IVF. IUIs are a cake walk compared to IVF in terms of medications, procedures, time off work, expense, and emotions.

No Escape

You know how when you are thinking about buying a new car and then suddenly everywhere you look, you see someone driving that car? You wonder, "Was there a special sale I missed? How did these instantly become super popular? I swear I didn't see this many on the road two weeks ago." 

Well, not being pregnant is JUST like that. Only worse. Because a car is a car - you can save up for it, buy it on a whim, or find a different car to be excited about. Not so with your genetic material.

Seeing pregnant ladies, hearing about pregnancy, seeing babies and baby things makes me anxious. I have a hard time with Facebook news feeds these days. At least 40%-50% of my news feed is baby related.

I generally do what I can to avoid running into baby related situations. I don't surf around on the internet picking out nursery themes or walk down the baby aisle at Target. I stay as far away as possible. However, it seems that no matter how much I try to avoid it, I run into it all.the.time. I give you this weekend as my case in point.

Our plans: lots of yardwork on Saturday, watch Boise St play in the evening. Run a couple errands and do nothing on Sunday. Seems pretty un-baby related right? Ok, so here is how things really went down:

Saturday: do some yardwork, come inside and check Facbook. In my news feed: a pregnancy announcement, two babies decked out in Husky gear, and someone asking for a recommendation on baby gates. The baby gate lady was actually someone who started trying the same time we did; they have a 9 month old.

Saturday night: Chris and I were watching football. A commercial comes on about some couple looking all over town for an apartment, but it's all ok because they were driving a fuel efficient Chevy. For some reason the lady was like 8 months pregnant. Really? This is a CAR commercial and I'm watching FOOTBALL.

Sunday: at a party supply store. Found the wedding decorations for my sister's bachelorette party only to discover that it shares an aisle with all the baby shower stuff. Because marriage and babies go together like peas and carrots. Go to Target - of course the medicine we need is the same aisle as the baby food. Go to Giant Eagle, see an open space, and then read the sign that says, "For Expectant Mothers or Mothers with Young Children." And finally, return home and hop on Target's website to find out more information about something we had just bought. Their home page is a giant picture of a smiling baby and the phrase, "woohoo! it's the baby sale."  F YOU WORLD.

Unexplained Infertility

For now, unexplained infertility is our official diagnosis. Not so helpful. How do you treat something that is unexplained? The bright side is there apparently aren’t any major defects. The downside is we have no idea what needs fixed. Clearly something isn’t working. You don’t get through 20 failed cycles without there being something wrong.  I don’t think it is just bad luck at this point.

We started the diagnostic regimen with my OB/GYN in November 2010. She first conducted a hysterospalpingogram  (HSG) – bonus points if you can pronounce it. This is also referred to as a dye test.  Not the most pleasant experience I’ve ever had. An HSG is when contrast iodine is injected into the uterus while being observed with a continuous x-ray. The point is to see if the fallopian tubes are open and the uterus is normal.  HOLY HELL that dye hurt. The whole experience was uncomfortable, but the dye part was downright painful. The information I read beforehand described it as “period-like cramps.” Bullshit! I’ve never had cramps like that. Anyway, I survived and even went back to work. Results: textbook – all clear!

She also did a 7dpo (days past ovulation) blood test to check my thyroid and progesterone levels. Both were normal and the quantity of progesterone indicated that I had, in fact, ovulated. Finally, Chris had to have a sperm analysis. If I can do the dye test, it’s only fair that he have to do this. His results: normal count, motility, and morphology.

We had more diagnostic tests done when we switched to the reproductive endocrinologist in May 2011. She took more of my blood to check for a number of different hormones. One very important hormone is AMH (anti-mullerian hormone) which indicates the remaining ovarian reserve. My results were exactly in the middle of the normal range. She did an ultrasound to check for ovarian cysts and endometriosis. All clear as well. Finally, another sperm analysis for Chris. We paid a little extra to have a strict morphology test, which is a harder one to “pass”. He passed.

The only thing I haven’t had done is a laparoscopy, aka exploratory surgery. They go in with a camera through your belly button to have a look around. This is actually the only way to officially rule out endometriosis. Given that there weren’t any indications of this, we decided it wasn’t worth the time, discomfort, and money. 

IVF may finally give us some answers when an embryologist can observe my eggs, the fertilization process, and blastocyst growth under a microscope. Until then, we are officially unexplained.

First, A Few Rules

Hi, welcome. This is not the path to parenthood that I thought we would have to take. However, it is the path we are on.  I don’t know where it will lead or how long it will take to get there. But given that this process is so involved, and truthfully very emotional, I thought the easiest way to keep you up-to-date is through a blog. That way you can check-in when it’s convenient for you and I can update everyone at once, when I feel up for it. I do have a few conditions though:

1) I find it easiest and most therapeutic to write as if I were talking to you in person. Therefore, this will not be a literary work of art. I am giving little regard to proper grammar and sentence structure.

2) The entire reproductive process has become very clinical to us. Up until two years ago, I thought it was as simple as deciding you were ready for kids, pulling the goalie, and voila, about a year later you have a little family. Cute. How romantic. Not our story.

For nearly a year we have been immersed in all the little details of reproduction, and even more so once we started seeing a reproductive endocrinologist. Hormone levels, follicle counts, cycle days, sperm counts, medications, etc. are everyday conversation. The reproductive process is fascinating and intricate, especially for someone who likes to understand the way things work. Honestly, I’m amazed anyone can get pregnant without help. My apologies if you aren’t as comfortable with this as we are, but I will share anyway.  You can choose to skip what you don’t want to know.

3) Finally, please keep our journey confidential. This process has already made me feel completely out of control of my own body and my future. I am hanging on with a tight grip to the little pieces that I can control.  Telling people about it and opening up like I am with this blog is already a stretch for this very introverted person. I appreciate knowing that my thoughts are only being extended to those whom I have chosen. There will be a time when I will be comfortable with you speaking about this with others. I will let you know when that time comes.