Disney Dreams

I recently returned from a conference in Orlando. I decided it would be just wrong to go there for any length of time and not go to Disney World, so I did. I was 10 or 12 and accompanied by my parents and younger brother the last time I went to the Magic Kingdom. Needless to say, things have changed a bit since then--for me more so than the Magic Kingdom I discovered.

"When you wish upon a star...anything your heart desires will come to you," just didn't have the same ring it did back then. I spent some time trying to come up with new lyrics to the Disney tune that are more reflective of life's complexity. You know, something like, "Please don't wish upon a star, it won't get you very far, sometimes you'll get what you want, or you may not."

Granted, it's not very catchy, but it's more honest. Maybe the whole Disney thing is a necessary stage of development, I don't know. When are kids able to understand and accept the somewhat ordered chaos that is life without fearing that they'll be overcome?

It feels like a lot of adults want to escape to the land of Disney too--to go to a place where everything is magical and your wishes come true. Not that I've stopped wishing or hoping, but I'm putting some action with my hopes.

Second Opinions

My appointment with the Repo Endo at UCSF was surprising…but good…or at least not bad. Granted, it was a terrible time for the appointment (I’m highly emotional pre-menstrually), and I cried at regular intervals (I didn't even make it through the "how long is your cycle" question--no kidding).

I really just wanted to talk and get a second opinion, but of course I got another complete intake exam, including my favorite--transvaginal ultrasound with antral follicle count. It’s not your average ultrasound. When they’re probing around deep and looking for follicles in your ovaries, it can get a little painful. Not to mention the anticipation of watching the screen for any signs of follicles, and hearing the count—8 (that’s 4 less than my other doctor saw 6 months ago).

I was sure she would agree with my other doc's recommendation and give me her blessing to go forward with IVF. When she didn’t, I was stunned. You’d think I’d be happy to hear that I may not be as bad off as I thought. But when she said she thinks I should do two more cycles of clomid (or letrozole) with IUI before moving on to IVF my heart dropped. I was so ready to go forward, pull out the “big guns” and get some answers. I already had a week off work and have been telling everyone February is the month.

I asked a lot of questions and she was very patient with me. She showed me some concrete data and talked about research that she is involved in. She said that FSH is not predictive of pregnancy rates (for IVF cycles) in women under 38. She's also seen cases in young women who don't respond to aggressive stimulation (as in egg donors), but can produce one good egg and have a successful pregnancy.

She also wants to actually see the films from my HSG. Depending on where the adhesions are she felt like surgery might be helpful.

When I left her office I was totally confused, but over the next few days things settled out a little. There's really not much to loose with two more cycles, and there's a lot of potential gain (less cost, less stress, less risk) if it works. I know the odds are still only 8-10% per cycle, but my acupuncturist is sure we can bump the odds up a bit with acupuncture and herbs. I also think I need a little more experience with disappointment before I potentially face the BIG disappointment that a failed IVF cycle would be.

So, I'm waiting to hear about possible surgery, then gearing up for a few more IUI cycles before the big IVF.

Open Enrollment

It's open enrollment time at my place of employment. I'm considering doing what I never thought I'd do--sign up for Kaiser. You may or may not be familiar with the HMO giant of the west coast. To some it's the devil to others a savior. I won't go into my personal feelings about it, let's just say they're mixed.

The reason I'm thinking of going to the "other side" is that they will cover 50% of infertility services including IVF (at least according the reps, I'll call member services to confirm). My current Blue Cross plan covers 0%. That's a significant difference. My only concern is that there will be a long waiting list or they'll make me jump through a bunch of hoops that I've already been through to prove that I really need IVF. I'm hoping that with two independent recommendations and my demonstrated "failures" with other means they'll let me move quickly to IVF.


Has anyone else used Kaiser for IVF? I'd really like to get some feedback from women who have done both the private and big HMO way. I have to decide by Dec. 12, so I have a little time to do some more research. Thoughts?

Exposed

If you didn't hear Fresh Air today, please listen to the podcast (available at www.npr.org by selecting programs tab, then Fresh Air...sorry, I'm incapable of making links work).

Mark Schapiro spoke with Terry Gross about his new book, Exposed: The Toxic Chemistry of Everyday Products and What's at Stake for American Power. I could give you my interpretation of the interview, but I think NPR has a pretty good synopsis:

Investigative reporter Mark Schapiro explains in a new book that toxic chemicals exist in many of the products we handle every day — agents that can cause cancer, genetic damage and birth defects, lacing everything from our gadgets to our toys to our beauty products.

And unlike the European Union, the U.S. doesn't require businesses to minimize them — or even to list them, so consumers can evaluate the risks. Schapiro argues that that policy isn't just bad for public health: In an increasingly green economy, he says, American businesses stand to get shut out of a huge market.

One of the main reasons the EU is so inclined to look ahead to long-term health consequences of chemicals used to manufacture these products is that European governments pay for health care (it's not just because they're so progressive and environmentally conscious). They actually have an incentive to keep people healthy, what a concept! When you get cancer in the US it's on your dime. Too often our government is more concerned about what's good for business than what's good for people (I know, it's been said a million times, but it's too true).

The crazy about this "bad for business" argument, is that when the EU implemented stricter regulations on chemicals and toxins they did not experience the big hit to business that US regulators and businesses are so concerned about. There wasn't any measurable effect to the market.

Call me crazy, but I strongly believe that these toxins, so pervasive in our modern life, are one of the factors contributing to the rise in endocrine and hormone related problems, including infertility.

Let's stop being afraid to demand more from our elected officials and regulatory bodies. I'm tired of seeing the consequences of inaction.

Culture and conception

I saw a young father and his daughter in clinic the other day. We were finishing up the visit when he asked if I had children. I shook my head and told him no, not yet. In response he said something that roughly translates to, "that's weird".

To this young Mexican immigrant the idea that a married woman of my age would not have children was just that--weird. He didn't mean any offense, he just thought it was strange. On the other hand, I know people in their 30's who are single, or married but not ready for kids, who would be find it equally strange that we're even thinking of having kids at such a young age.

We all make decisions. Which is better? I guess it depends on where you're coming from. At every stage of life and in seemingly every decision, we are influenced by our culture, why should conception be any different.

Shopping

Many mundane and everyday things take on new significance when you're living in the limbo land that is "trying" to get pregnant. For example, shopping.

My sister-in-law is getting married in December. I've been thinking about buying a new dress for months now. Every time I went into a store to look I couldn't stop thinking (hoping), "...maybe I'll be pregnant by then...I don't want to buy a dress I won't be able to fit into." Then I would look at things with empire waists that I might be able to pull off either way (like the one pictured). The thing about this strategy is that you run the risk of looking pregnant when you aren't. I don't want people jumping the gun on me. Besides, if I'm not pregnant I need to embrace my non-pregnant body. I finally decided to go for it and bought a dress this weekend (that doesn't make me look pregnant). By this time even if I were to conceive between now and December 22 I wouldn't be showing. So I figure I'm safe.

It's really happening...

We finally had our pre-IVF visit last week to go over the treatment calendar, medications, etc. I had hoped we wouldn't get to this point, but my ovaries aren't getting any younger, and I'm still not pregnant, so we're moving forward. I do have an appointment for a second opinion at UCSF in early December, but I don't really expect they'll tell me anything different. It will just be nice to have another set of experts review my history and give recommendations.

The IVF consult was overwhelming to say the least. I'll have to be on 9 different medications throughout the cycle including an injection in the morning and two in the evening. I'll have 6-8 appointments for various ultrasounds and blood tests before and after the egg retrieval and embryo transfer.

We left the office feeling a mix of excitement and fear. Excited that we might be pregnant in the next 4-6 months, afraid we won't be. What else can you do though. I guess those are pretty normal feelings.

We decided to wait to start any of the meds until after the holidays. I don't want to be all pumped up on hormones, worried about keeping my follistim cold and staying on schedule while we're visiting family. I can't help but hope that next year we'll be taking a baby to meet the extended family too, but I'm trying to take it a day (at least a month) at a time.

There's always a reason

One thing I still have a hard time getting away from with all this is the need for cause and effect. I believe (I think I've said this before) that some things just happen. There's no reason, at least no good reason. Still, I find my self wondering, trying to pin the blame on something.

Yes, my doctors have given me reasons: my hormones are off, my left tube is blocked, I don't have many antral folicles, I have endometriosis...but why is all that stuff messed up?

"Well, I did have a glass of wine that night...I didn't eat very much today...I have a stressful job...I forgot to take my herbs...it's been a while since I went to yoga...I can't take care of myself sometimes, maybe I'm not ready for a baby..."

In my rational mind I know that none of these things are preventing me from conceiving right now, but when I'm looking for a reason it's easy to go there--to blame myself somehow. It must be my fault. Something I did or didn't do. I don't know if there's really any getting over that feeling. I am working on it though, and it's not as strong as it has been.

It's a hard balance. I know what I do or don't do has an impact, so I want to do everything I can, while at the same time leaving space for the mysterious. As I've said before, a lot of stuff doesn't make sense, and I have to learn to live with that.

Seasons

I'm a little peeved with Lauryl (the acupuncturist). At my appointment this week I mentioned that I'm meeting with the IVF coordinator at the RE's office next week and am still planning to to the IVF cycle sometime in Jan or Feb. She proceeded to tell me how this was not a good idea. It went something like this, "Oh, don't do it in the winter, kindey yang is low in the winter, the spring would be much better...just look at nature."

While a part of me would like to be all earth mother about this, I'm also afraid of waiting too long and missing my chance. Not that another few months would make a big difference, it just seems ridiculous that in the context of something high intervention like IVF the seasons or cycles of the moon would really have anything to do with it. Babies are conceived all the time, every season.

So, I'd like to take an informal poll, when did you conceive? Winter, Spring, Summer, Fall? Is there anything to this seasonal stuff?

Zero to Four

I just returned from a three-day introduction to life with quads. Two girlfriends from nursing school and I went to Texas to hang out with our friend Suzanne and her four bundles of joy.

I know that multiple births is a risk with infertility treatments, but I really just want one at a time. Which I guess is what most if not all parents of multiples wanted, but fate had a different idea so they adjust their expectations and boldly go forward (Suz and Joe, you're truly amazing).

I always wonder what it will be like when I spend time with newborns, what kind of feelings will come up. Honestly, I loved every minute of it. I feel hopeful about our next step with the IVF, and have been able to avoid the sadness and resentment that has come up in the past.

Holding those babies for hours and hours had a wonderful and calming effect on me I think. I am confident that somehow, someday, I will be a mom. That feels good.

Tears and Needles

The place I go for acupuncture is in the country just outside this "groovy" little town in the Russian River wine country. The place is small and tranquil. It has this almost other-worldly vibe to it. Laurel (the acupuncturist) has been doing it for over 20 years and her practice is almost exclusively dedicated to women before, during, and after childbirth. She's treated hundreds, probably thousands, of women over the years and is acutely attuned to what it is to be a woman and live in your body and its cycles.

I was her first morning appointment last week. We usually talk for a little bit, she sticks me with needles from my head to my toes and then leaves me to myself for the next 30-40 minutes. At this last appointment though, she stayed for a little while after the needles were in. She talked to me about my body and this child that I long to carry within me. She encouraged me to trust that life is unfolding as it should and to try and see this waiting as a gift. I'm usually just annoyed and turned off by this kind of thing, but for some reason it struck me differently that day. I started crying, and kept crying for the first 5-10 minutes of my session. It was the first time this had happened on the acupuncture table. I've heard that people can have all kinds of different emotional reactions during treatments, but I've always just felt relaxed and restful. I guess it was just time to cry.

Watch your mouth

Today after my weekly therapy appointment (which is great by the way, really changing the way I process and perceive myself and the things around me) I went to get my hair cut. I mentioned to the stylist that I was going to visit my friend who recently gave birth to quadruplets. She didn't say anything for a second, then said something like, "She must have taken the pills, right?" Which is really none of her business, but yes in fact she did. Then she proceeded to go on a mini rant about how she thinks that reproduction really isn't something to be "messed with" and that she thinks some people can't have kids for a reason, etc., etc. I mostly tuned out, but am pretty sure she included some comment about how it's dangerous when you start playing God too.

I was shocked. It felt like the kind of completely inappropriate thing that Michael Scott would say to the woman who just got pregnant through IVF, making everyone really uncomfortable (if you don't watch The Office, you should).

Especially in this area where it seems like every other woman you talk to has had some type of fertility treatment. Who does this woman think she is? Does she live in the same world I do? Since when is it only OK for the sick and dying take advantage of every advanced medical technology available while those trying to create life are restricted and accused of "playing God"? I guess there must also be a "reason" that couples and single women much less "fit" to be parents than we are have more kids than they can take care of. I kept my mouth shut, neither agreeing or disagreeing. My therapist would probably say I should have spoken up for myself, but I didn't. Maybe I'll be more prepared next time.

Liver Congestion and Castor Oil

I've had three visits with my acupuncturist now and this is my diagnosis: Liver Congestion. If you aren't familiar with Chinese medicine, as far as I can tell they view disease as disruptions or imbalances in Qi. Organs usually involved in infertility are the kidney, spleen, and liver. My diagnosis was made based on my pulses (measured at three different places on the radial artery at three different depths) and the appearance of my tongue, which looks pretty good according to Laurel, especially compared to my pulses.

In order to smooth out my Qi and get the blood moving to "decongest" my liver I'm taking herbs (Qui Gong Peony), getting acupuncture, doing yoga (especially twisting postures), and applying Castor oil packs. I'm not giving up on Western Medicine fixes, just taking a break and exploring other possibilities. The Castor oil isn't as bad as it sounds either. I'm supposed to apply it to my abdomen, cover with a flannel cloth and a hot water bottle and leave it for at least an hour three nights a week. The University of Maryland Medical Center actually endorses it as a treatment for endometriosis. I still haven't found an explanation for why or how it works, but it's kind of a nice quiet time with my hot water bottle and Castor oil, so I'll keep doing it I guess.

Writing it all out like that makes it sound like I'm desperate. In a way I guess I am, but that's not how I feel most of the time. I just that this (having a baby) is really important to me and I want to give it a good try. If I have to let go of this hope at some point I will feel better knowing that I tried (almost) everything.


I think every woman in this situation at some point asks herself, "What am I willing to do? What can I live with? When is it OK to stop?" I'm still trying to answer those questions, but for now I feel authentic about where I am and what I'm doing.

Hormone Free

This cycle was the first one in the past 4 months that was free from synthetic hormones (no Clomid!). If you were around me during the Clomid days you know that for about a week around my period I went a little crazy. At the time I denied the effects of the meds. I thought it was just me reacting to stress and disappointment (I tend to be overly emotional anyway--especially premenstrually). Now that I've had a cycle without intervention to compare it to, I can see that the Clomid was definitely a factor. I know my poor husband and parents were worried about me. I cried uncontrollably. I would call my folks and end up hanging up because I couldn't talk between the sobs. My husband would come home to his wife laying in the middle of the living room floor listening to sad music, tears streaming. Yes, it was bad.

These days I'm feeling much more stable and the tears are less frequent. I still got a little weepy when one of my co-workers (who is my age with 3 adorable kids) asked me if I wanted to have kids, but I was able to talk to her about it and recovered quite nicely. I guess when you wait seven years people start to think maybe you don't want kids, when actually I am trying everything to have them.

BBT

Although the desire for pregnancy has consumed much of my energy for the past year, one thing I've managed to avoid is charting my basal body temperature (BBT). None of my doctors are particularly interested in it, and I wasn't about to sign myself for anything else to do that would cause me to focus on my fertility or lack thereof. But it looks like that's about to change.

Last week I went for my first appointment with my new acupuncturist--she wants to see my charts. She was really nice about it, tried to sell me on the idea, "it's about checking in with yourself, knowing your body better," but I'm still not excited. I'm not sure exactly why I'm so resistant to the idea. Maybe hidden in my BBT charts we will find some key to my troubles, or maybe I'll just spend my first waking moments with a thermometer stuck in my mouth and a chart on my bedside table, reminding me that I'm trying to get pregnant.

Confessions

I think it's time to get this out there. For almost a year now, I have been carrying around a pregnancy calculator wheel in my purse.

Now, before you think I'm totally crazy, I don't look at it every day (anymore). I guess it's an occupational hazard, having easy access to such things. Maybe it's time to let go of the pregnancy wheel, but it just feels good to know that I can quickly and easily check my estimated due date based on my LMP or date of ovulation at any time, if for some reason I needed to.

I guess this speaks to the issue of planning. I'm a bit of a planner. This issue (wanting to be pregnant, knowing I could be at any time, yet not knowing when it will happen, understanding that it may never happen), is particularly tricky for planning purposes. I wouldn't agree to plan our last vacation until it was no more than 6 months away, just in case I got pregnant in the meantime, I wouldn't be more than 6 months along and could still travel relatively comfortably. I guess at some point I'm going to have to let this go. It might be time to get rid of the wheel.

Just Relax

If I had a dollar for every time someone told me to "just relax" I could probably pay for a cycle of IVF. It's a great idea, but have you ever tried to "relax" about one of the most important things in your life, something that you want with all your heart, but have no control over? It's not easy. Nonetheless I decided to give it a really good try this past week. We spent a week in Zihuatanejo, Mexico. It was pretty close to paradise, and quite possibly the best vacation ever. Maybe it was the timing of it that made it so fabulous, but honestly, we had a great time. I'll spare you the details...lets just say a week of nothing to do but whatever you want at a great resort on the "Mexican Rivera" with the love of your life is good for the soul.
I haven't uploaded our pictures yet, but our hotel was just to the right of this frame. We spent most of our time right there on the beach and snorkeled around those rocks. Did I mention we had a fabulous time?

Oh, and about parabens. Some of you were asking what they are. Well, they are a class of preservatives used (rather ubiquitously) in cosmetics, soaps, and shampoos (though you can find products that are "paraben free"). Officially, they're considered safe, but recently there has been increased controversy. They are what is known as xenoestrogens, which means they act like estrogens, but can't be metabolized by the body in the way that plant and human estrogens are. The most concerning effects are related to reproduction and breast cancer. There's a good article in wikipedia about parabens and xenoestrogens if you're interested.

The Infertility Cure

It's a pretty lofty title. I'll let you know how it goes.

The acupuncturist I mentioned earlier, who specializes in women's reproductive health issues, recommended it when I asked for some research on the subject of alternative therapies and success rates with infertility. The author has personal experience with infertility and the introduction is full of women's testimonials praising her work (she's an acupuncturist and Traditional Chinese Medicine practitioner) and sharing their amazing success stories.

I hope someday soon I'll have a success story too. In the meantime I'm picking up my yoga practice again, starting acupuncture, eating organic as much as possible, and trying to avoid plastics and parabens (a prescription from my acupuncturist). If nothing else I should be good and purified after this whole process.

Weigh In

Today I bought a scale. I haven't had one since I moved out of my parents house when I was 18. So why did I suddenly feel the need? Well, one of the first things my Repro Endo told me at our initial consult was that I should gain a few pounds (incidentally my mom had given me the same advice a few months earlier). My weight fluctuates between 115-120 and has for the past 15 years or so I guess. At 5'5" that makes my BMI 20 (less when I'm below 120 lbs.). Anything 19 or less for BMI is considered underweight. There is apparently a delicate balance in terms of weight and fertility. Too little and you're less likely to get pregnant, but too much hurts your chances too. Go figure. As if there wasn't enough turmoil surrounding weight and body image.

So back to the scale. I decided if I'm going to get serious about gaining this weight (my goal is 128-132) I needed some way to check my progress. It's hard for me to try and eat more without knowing if it's doing any good. I've never been someone who eats for the sake of eating. I eat when I'm hungry, and if I'm busy sometimes I don't eat then. I've always been good at feeding other people (literally and figuratively), but denying myself. A big part of my self-care plan is listening to my body and feeding it. So far I've switched from skim milk to soy milk (I don't like the taste of 2% or whole), am trying to snack more (nuts are my friends), and end most nights with a bowl of ice cream (if you missed the ice cream post you should check it out).

Today I weigh 120.6 lbs, so I still have 8-12 lbs to go. I'm not opposed to gaining weight, but I've been essentially the same size for the past 15 years. I'm generally happy with my body and feel like I am a healthy weight. It's scary to think about intentionally gaining. I'm trying to remind myself it's not about the weight, I'm getting my body ready for a pregnancy. If you have some good calorically dense, high fat (and healthy) snack ideas I'm looking for suggestions.

Negative

Negative is a word that we throw around a lot in health care. Sometimes negative is good, i.e. "Your HIV test was negative". But for a woman trying to get pregnant, negative is not what you want to hear when your talking about the results of a quantitative Hcg (blood pregnancy test). That's what I got this week.

It wasn't enough that the home pregnancy test was negative (yes, I caved and took 2 last week). Since it had been 2 weeks since my IUI and I still hadn't started my period I had to do the blood test, then wait anxiously for the results. I totally expected it to be negative, but when I actually got the call I kind of lost it. Lucky for me I had a friend who took me to the beach.

It was late afternoon on a beautiful sunny day so we walked and talked for several miles down the beach, only seeing 5-6 people the whole time. It was just what I needed. So much about the ocean is therapeutic for me, the smell, the sound, the vastness and connectivity of it. It helped make a no good, very bad day into one with a more nuanced meaning; loss and sadness with beauty and friendship.

The Fog

I don't know exactly what changed, but I feel like I've turned a corner, or, to use a geographically appropriate cliche, the fog is lifting.

The past several months have been so full of anxiety, doubt, fear, sadness, and anger, I was beginning to forget what I felt like when I was "normal". Now something is different. I feel more positive and less tearful than I have in months, and I haven't even had my first acupuncture appointment yet. I think part of the cure has been allowing myself to open up and share this burden. Maybe the therapy is starting to pay off too. As a result, I've made a commitment to taking better care of myself, and have started to do it (details on what that entails is a topic for another post). A wise friend said, "The longer you wait, the harder it is (to learn to take care of yourself)." She's in her 50's and is still learning.

I'm very lucky to be around people who care about me and to have such wonderful friends and family (who are farther away than I would like) to support me too. I just want to say thanks, I'm actually doing really well.

Luteal Phase

I'm nearing the end of the second half of my cycle now (AKA the luteal phase). It's always a weird time for me, the time between ovulation and the start of my period...wondering if maybe this time it will work. There's nothing I can do to make it go any faster. Progression toward this goal of conception is limited by the cycles of my body--the same cycles that should theoretically make conception possible. So I wait.

At our last appointment my doctor said she thinks my luteal phase is shorter than it should be. She prescribed Prometrium (progesterone) to try and help lengthen my cycle. So now I'm confused. Usually my period starts around cycle day 26-27. If it's any later than that I can hardly keep myself from taking a pregnancy test (which I hate doing because I am inevitably disappointed). But with the added progesterone I don't know what to expect.

I am not under the impression that I am pregnant right now. I know that my chances are slim, and we are planning to do an IVF cycle in January. In the meantime I've tried to get rid of any expectation, but that's hard to do. I don't know if it's even possible. I want to be hopeful without setting myself up for major disappointment. For now though, every day without a period is a good day. I'll deal with it when it comes.

Alternatives

I realize most of this blog has been about the various medical treatments I am seeking to improve my odds of conception, but western medicine isn't the only or the first avenue I have pursued. In March I went for an initial evaluation with a licensed acupuncturist (no, the picture is not of me, but it's pretty representative of the treatments). He is a friend of a friend, and was great. For the next 3 months I went about every other week, weekly at first though. He also recommended some Chinese Herbs, vitamins, and a liquid called Moxa that I applied to my abdomen daily and heated with a hairdryer (funny picture right?). I’m not sure if it was the effect of the treatments or just a result of where I was in the process, but I felt better emotionally when I was doing all that then I have since. My husband thought it was all kind of silly, and would tease me about my “voodoo”. It seemed sad and desperate to him, but I think it helped provide me with a sense that I was doing something about the problem. The time I spent every day with the heat of the hairdryer mixed with the smell of the Moxa on my belly was actually a nice time to focus on my body and take care of myself.

I felt like I had to give it all up after I went for my evaluation with the Repo Endo though. I couldn't justify spending more money on treatments that have little or no proven efficacy (though I still think they’re probably helpful), when it looked like I was going to need medical treatment due to my underlying conditions. Now that I’m going to take a little break from all the medical treatments I’m thinking about going back to acupuncture on a limited basis. There’s apparently a woman who practices in a nearby town in a beautiful setting who specializes in acupuncture for women’s reproductive health concerns. If anyone has any fabulous alternative medicine stories to share I’d love to hear them.

Mixed Feelings

This little graphic pretty much sums it up. There are so many conflicting feelings associated with infertility. Sometimes I'm just sad, other times I'm angry about the apparent injustice of it all, and then there's the guilt. I feel guilty for waiting when I knew I had endometriosis, guilty for putting my personal and professional goals before my desire for a family. We all make our choices, and I don't know if I would have done it any other way, but sometimes I still feel guilty. I'm happy I have options, and sad that I have to work so hard for something that should be so natural. I'm afraid I'll try everything and nothing will work.

My feelings about friends and family with small children or who are pregnant can be complicated and confusing as well. I am usually able to separate my sadness from the joy I feel for them, but there are twinges now and then that are hard to avoid. It's usually more of a "left out" feeling than real jealousy. I want to have the experience too, but can't, at least for now. If you're reading this and are a friend, I still want to know if you're pregnant and I'll still love to play with your kids. I am truly happy for you, I'm just sad for me too. I'm trying to recognize these feelings without judgement and accept them as they come. It's all part of the deal.

Ice Cream

I work with a wonderful nutritionist who is currently 24 weeks pregnant. She and her husband tried for over a year before they conceived. She actually went to her appointment with the Reproductive Endocrinologist and had a positive pregnancy test at the visit. I've talked to her about our situation and she's really supportive.

She came to work the other day telling me about a study she read that showed increased pregnancy rates for women who had a diet high in ice cream, cheese, and other high fat diary products and decreased rates for women with diets high in trans fats. What a great study! I've always loved ice cream, and knew in my heart it was good for something. It's nice to have a recommendation from a nutritionist to eat more ice cream and cheese. If and when I get pregnant I'll have to come up with a new excuse.

OPK

OPK is what those in the know call the Ovulation Predictor Kit that is supposed to tell you when your most fertile time is. You can buy one of these kits at any drug store and if you follow the directions on the box, they're simple enough to use. Test your urine every morning starting on day 11 and when the test line is as dark as the control line you know it's time to have sex. But that would be too easy. If you're really serious about trying to get pregnant you have to scrap the box directions and instead test your second morning urine starting on day 11. This gives you your baseline negative result. When the test line is just slightly darker than it was the day before you call the office and they schedule your IUI for the next day. First of all, who pees twice before 7:30 anyway? I have to set my alarm early just so I can pee once and try to go back to sleep so I don't have to do the test at work. Second, how am I supposed to remember how faint the line was the day before? I guess I could keep a shelf full of the weeks OPKs laying around, but that's just gross. I just do the best I can. It's on my mind today because I think I had a positive OPK this morning, but they gave me the HCG injection to stimulate ovulation just in case, since I have to get the IUI tomorrow anyway (I'm going out of town Thur, so was in a bit of a time crunch).

As for the ultrasound, well...not so great. The two follicles on the right were still too small, but the one on the left looked good, 21 mm. That's unfortunately the side where my tube is blocked, so it doesn't look promising. My doctor said Clomid is just not the drug for me and she would recommend moving to IVF at this point. That's a big step. I think I'll need some time to process the whole thing, and save up a bit (IVF runs around $11,000/cycle). My doctor "owes" me an IUI at no charge (long story), so that's really the only reason we're even doing it tomorrow. It's a long shot, but why not.

Hystero

No, this isn't my actual hysterosalpingogram (HSG), but it gives you a reference point. I had been putting it off for a while, I'm not really a fan of procedures, but my doctor finally convinced me it would be good to "complete my work-up". Like I said, I had a normal HSG 4 years ago, and neither me nor my doctor expected that much would have changed, but I did it anyway--this time without the benefit of anesthesia.

It wasn't terrible, but it was by no means comfortable. My husband couldn't get out of a work commitment so I took a friend who was 9 months pregnant (was--she delivered a healthy baby girl yesterday!). Both of us work in health care and knew what the procedure was, but neither one of us thought about the fact that they weren't going to let a pregnant woman any where near radiation. When they called me in and my friend got up to go with me the woman looked at us like we were crazy and told her she couldn't come with me. I, being hormonal and nervous, started crying. This got us through the door and by the time it was over we had convinced the radiologist to let her stay until they took the X-rays. The painful part was inserting the instrument for the dye anyway, so she got to stay for that and hold my hand.

I got the results the next day and it looks like there are some adhesions on my left side that would likely prevent an egg from passing through. A little of the dye leaked out on the left, but not much. The right side looked good though, so if and when I ovulate on that side I have a much better chance than the left. Repairs are not very effective (about 20%) and IVF is (about 50%/cycle for my age), so she said most people skip the repair and move more quickly toward IVF. I was surprised, but not all that upset by the news. It felt more like, "OK, so now I have a little better idea what I'm dealing with." I'll know even more after my second follicular ultrasound tomorrow. I'm hoping for big follicles on the right side--but trying not to be too hopeful at the same time.

Clomid

You've probably heard of clomid. It's a synthetic hormone that stimulates increased follicle production (more follicles=more eggs). It's sort of a "baby step" in terms of cost, side effects, risks, etc. My doctor felt like given my age it was an appropriate first step. Some people get pregnant on clomid alone, but one of the side effects is decreased cervical mucus production (sperm need cervical mucus to help them get into the uterus), so comid is more effective when combined with intrauterine insemination (IUI). Please don't call it "artificial insemination" it sounds so much worse--like I don't feel "artificial" enough already.

Our first cycle of clomid was pretty uneventful. On the lowest dose I still only produced one mature follicle that released one egg. We went ahead and did the IUI, but it didn't work. The next cycle I took the clomid at a higher dose with "timed intercourse" instead of the IUI because the we were going to be out of town when I needed the procedure. That didn't work either. This cycle I took clomid at the higher dose but am being monitored more closely. I had a follicular ultrasound today to see how everything was going. So far it looks like there are 2 small follicles on the right side and one larger one on the left. They were all still too small to be ready to release an egg, so I'll have another ultrasound on Tuesday to see if they have continued to grow.

It's a waiting game. I try not to be obsessive about it, but it's hard not to be the way the treatments are set up. Every day I have to think about what day of my cycle it is, am I supposed to be taking a pill, testing my urine, having sex, not having sex, getting an ultrasound?...it seems endless, and this is just the beginning.

In the begining

In June of 2003 I had a diagnostic laparoscopy because I had been having pelvic pain and dyspareunia (pain with intercourse). At that time I was diagnosed with endometriosis. The doctor removed some of the adhesions with a laser and said the damage was pretty minimal and my fallopian tubes were unaffected. She was very positive about future fertility.

That fall my husband and I both started grad school, not our ideal time to get pregnant, so we waited. After all, I was only 23. We knew we wanted kids at some point, but felt like our lives were full and happy without them for the time being. It really wasn't until last fall that I started getting a little anxious about my fertility. This was largely precipitated by a lunch program at work. A local Reproductive Endocrinologist came for a continuing ed. program and kind of scared everyone who was over 25 and didn't have kids. I had my 3 day FSH (follicle stimulating hormone) level tested and it was 10.8, which is pretty high and signals some type of decreased ovarian reserve and/or egg quality.

I was shocked, usually women with this level of FSH are 37, not 27. I didn't want to believe it. "Maybe the test isn't predictive in women who aren't infertile. Maybe if you randomly tested 100 healthy women some of them would have elevated levels and it wouldn't effect anything," I thought. After all, we hadn't even tried. Maybe I would get pregnant right away. So we decided we'd better start trying.

We tried without intervention for the next 6 months. In May I had my initial appointment with the Reproductive Endocrinologist. She went over my history and all my lab tests and said I likely have diminished ovarian reserve or premature ovarian failure and would need treatment if I wanted to get pregnant. She went over all the options while I was crying in her office. I knew it was coming, but I really wanted to believe it wasn't true. So began our journey to conception.

The Perfect Forum

I've been thinking about it for a while now, going back and forth, and I finally decided that blogging is probably one of the easiest ways to talk about infertility. It's a sensitive but important topic. Friends want to be supportive, but don't want to ask about it all the time. I want to be open and share this journey, but relaying the same updates to friends and family over and over can be depressing. So here it is, "my infertility blog."