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."