Sunday, December 30, 2012

End of the Year

And again, it's been awhile since I've posted.  I'm not even sure if that many people are going to read this since I've given up Facebook, which is where I publicized new posts.  But as I've stated in the past, this is still partly for my benefit, so I will keep writing.  One of my goals for the new year is to write more frequently.

The last post mentioned that we were moving on to IVF.  We did an IVF cycle over Nov/Dec.  It took a lot longer than I expected it to.  Between meds to start my period and then more meds and then multiple doctor visits until my follicles were ready, it was a long time.  It didn't work.

Leading up to the IVF I had this intense apathy regarding the whole thing.  That continued throughout the cycle.  I didn't really care about what was going on.  I think some of that was my way of coping emotionally, distancing myself from the up and downs.  I also did not have any expectations of success with the cycle.  When they called with the results, I was not shocked at all. Whether this was the cause or the result of my apathy, I don't know.

The only real emotion I had was anger.  I'm pissed that we spent $10k (out of pocket b/c insurance sucks) for NOTHING.  The only thing we got out of it was a couple of extra eggs that developed further after my implant and were frozen to use later.  I know this is good and a big deal, but considering the stakes of the intended results, it's a pretty crappy consolation prize.  I'm just so angry that we threw away money.

Which has led me closer to being ready for adoption.

At my support group a couple months ago, a couple came and talked about the foundation they had started to support couples going through domestic adoption.  (This was before we had even decided on IVF).  I realized after hearing them speak that I was nowhere near ready to consider that stage.  That has completely changed.  I feel like if we're going to be spending all this money, we might as well be putting it towards more of a "guaranteed" result.  I know adoption is a long and complicated process, but it seems a little more secure than all of these medical procedures.

I'm not completely there yet, but it wouldn't take much to push me over the edge.  However, I know, Joel is not ready.  The unsuccessful IVF round hit him a lot harder than it hit me.  He expected good news, I didn't. I try to remember that it's not just me this is affecting and this round really drove that home.

So now we need to decide what to do.  I've already decided we do nothing until after my next period.  I'm so sick of having all of these chemicals in my body that I just want some time to be normal.  My periods have been completely wonky (not that their timing was ever normal before, but once I got them, they were always the same).  After this we can either go to IUI (something we didn't try before, but we have to do 3 rounds if we want insurance to cover any IVF) or pay for our own IVF again.  I'm partially leaning towards paying for our own IVF.  I just see the IUI as being a step backwards in effectiveness.

Neither option really excites me.  But little does these days.

Sunday, September 23, 2012

Apathy

It's been a really long time since I've been interested in posting.  I think that's the general tone I've got right now.  I wasn't interested.  I'm not super interested now, but I just need the outlet.

The last time I posted was July.  I was waiting to take a pregnancy test.  It was negative.  We went to do a second round of injectables and when they did the baseline ultrasound found I had a cyst on my ovary.  Apparently this is really common.  The doctor put me on birth control for a month and I came back at my next period to check on the cyst.  It was gone, so we went ahead with a second round of injectables with timed intercourse.  That was also negative.  So the past two months, nothing has really happened.

We've decided to move on to IVF.  We had a consultation with the doctor last week and so that's all set up for when my period starts next.  Basically if my period is on time (which that's a joke in and of itself), we're looking at an egg retrieval and implant in November.  If the timing doesn't work out, we'll do it in December (we figure since I'm off the entire month, that's a good time).

I've started going to a local support group and that's been good.  Just a chance to meet with other women and couples who are going through this and can understand helps.

But I'm finding that I'm having a hard time working up any emotions about this whole thing at all.  I'm not really that excited about the IVF.  But I'm not really sad to see all these pictures of a friend's new baby...I just feel like I don't care.  The funny thing is, that's what makes me emotional.  It scares me that I'm so uninterested right now.  Thinking about the IVF and the scheduling just makes me feel like I'm waiting for routine outpatient surgery that's no big deal.  I'm not even getting my hopes up about the IVF.  I just feel like it is what it is.

Maybe that's not quite correct.  It's not that I'm not getting my hopes up as in I expect a negative outcome, but when I think about IVF, I don't get excited.  I don't get that feeling of "Maybe this time!".  It's just, blah.  Yep, we're doing IVF...Whatever...So I was thinking for school next week...

The worst part about all of this is that I don't even want to talk about it with anyone.  Even Joel.  I find I am distancing myself from him and others because I just can't deal with anymore positive bullshit from people.  I don't want to hear how everything will work out in the end and how great it will be when it happens.  You know what?  It might not happen.  So fuck your platitudes and leave me alone.  Thank god people have stopped telling me to relax.  Because I swear I will scream at the next person who says that.


Sunday, July 8, 2012

Playing the waiting game...AGAIN

I've decided I need to rename this blog, "The Process of WAITING".  It seems like all I'm ever doing throughout this whole thing is waiting.  I wait for blood work, I wait for my period, I wait for results.  Wait, wait, wait.  (I also feel like I've discussed this before....but I'm too lazy right now to go back and look)

Well, right now we're waiting to test.  We just finished up our first month of super duper medicines (ya know, as opposed to just the regular medicines).  The first few days were just the oral tablets of Letrozole (Femara).  Then after that it was the three days of Gonal-F with the shots.

On day 10 I went in for my 10 day ultrasound.  Everything looked really good on the ultrasound.  My right ovary had one mature follicle and two that were almost there, but would be ready in time for ovulation.  She also said I had one mature follicle in the left ovary.  Apparently that's a lot.  The nurse kept saying, "Please be empty, please be empty" when she started to look at the left one.  So basically with multiple follicles it puts me at risk for multiples.  She said because of the Letrozole, that really decreases the chances of triplets or quads, but she said, "I can't say you wouldn't have two".  This is, of course, if everything goes well and something actually gets fertilized, etc.  But it was still kind of exciting to hear.

Joel and I have talked about it and we're fine with having multiples.  I mean I know it's more difficult (and I'm  not professing to know exactly how hard it is).  But I have a hard time thinking that anyone who has issues with fertility would say, "No, we're not really ok with that.  Let's spend more money to do it again."  But who knows, there are all kinds of circumstances out there.

It was hard to leave there not being excited.  She sounded really positive and the most interesting part is she told me to skip the Antagon (Ganirelix) completely!  We went straight to the Ovidrel that night (which is the shot that forces me to ovulate).  Then 36 hours after the shot is when the "timed intercourse" comes in to play.  It was funny that that ended up being the morning of 4th of July (which worked out well since we both had the day off and didn't have to worry about taking time off of work to...well, basically come home and have sex).  We joked about the possibility of conceiving on the 4th of July and picked out some appropriate names:  Betsy for a girl (you know, as in Betsy Ross) and Jefferson or Sam (as in Uncle Sam) for a boy.

Now I know this is all getting ahead of ourselves.  There is still a lot to happen that could not work and we know that.  But as always it's so hard not to get excited.  This is where the waiting comes in.  I can take a pregnancy test on Wednesday, July 18.  Fortunately the new school year starts tomorrow so I'll have a lot to take my mind off of it...

...10 days left...

...sometimes anyway.


Sunday, July 1, 2012

A fly on the wall

So we have started the shots...(I feel like I need dramatic music here).  Today is day 9 of my cycle and the third day of shots.  I feel like every time we start something new in this process it's a pain to figure out.  It was a pain to figure out all of the insurance.  It was a pain to figure out the timing of when to come to the doctor and what to do for that.  Now it's been a pain trying to figure out how to schedule the initial doctor's appointment for the cycle.

With the round of medication we are doing, once my period starts I have to get a baseline ultrasound done on days 1, 2, or 3.  Well of course my period started on Friday at like 4:30, too late to go to the doctor.  The office said if that happens, count Saturday as day 1 and then come in on Monday for the ultrasound.  This would normally be fine, however I was out on Friday for a training and felt really uncomfortable taking Monday morning off too (since it's the last week of school).  Also I didn't have my plan book at home and had no idea what to even put in sub plans.  It was like the perfect storm of bad timing.

So I scheduled a half day for the afternoon and left a message at the doctor for them to call me back Monday morning.  I talked to them Monday morning and apparently they ONLY do ultrasounds Mon-Fri in the mornings.  They said they don't do them in the afternoon and I would have to come back on Tuesday morning.  I started getting pissed at this point because I had already booked a sub for that afternoon, couldn't cancel, and didn't want to be out for ANOTHER half day during the last week of school.  After a long conversation the nurse finally said that the doctor could authorize an exception and I left a voicemail for the doctor.  Fortunately she let me come in that afternoon.  The silliest part in all of this was that the actual ultrasound took ~8 minutes.  Oh well...now I know and from now on I can just get the ultrasounds done before school at like 7:30 and not have to take any time off.

Everything was normal at the ultrasound.  My uterus was nice and thin and the ovaries were resting (which always makes me think of Joel when he cooks steak or something and it needs to rest...).  So I took the Letrozole, which was just a couple little pills, for days 3-7.  Then on day 7 we started the shots.

That first time was pretty ridiculous.  My friend Karen said she would have loved to have been a fly on the wall to watch.  I think the conversation went something like this:

Joel:  Ok, are you ready?
Me:  Yes...(needle comes close, how I knew I have no idea since I wasn't looking)  Wait!  Hang on, ok I'm ready.
Joel: Ready?
Me:  Yes....wait!  Ok, go.

I think that happened a few times before he finally just did it.  And of course it wasn't that bad, just a little prick.  Although I think I asked him 4 times if he did it right...

The worst part was last night.  We had a wedding to attend.  I'm supposed to have the shot between 6-8pm and at approximately the same time each night.  Well the first night I got the shot at 7:45pm.  So we were trying to figure out how to give me the shot at the same time while we're at the wedding.  We couldn't really both go in to the bathroom.  We talked about just going out to the car.  But of course I was wearing a dress.  I had these visions of us in the car in the parking lot with my dress hiked up (the shot goes in the stomach) while Joel is injecting me with something as strangers walk by.  We ended up just doing the shot before we left.  It wasn't exactly in the right time frame but hopefully it's fine.


So now I just have one more shot tonight and then I go back tomorrow for another ultrasound and blood work.  They'll call me tomorrow with directions on what to do from there.  If everything looks ok, then I start the Antagon for a few days and then the Ovidrel.  So we'll see!

Saturday, June 16, 2012

Preparation for the first round

I haven't written much in awhile.  It's been a crazy time of year with EOGs at school and trying to close out one school year while simultaneously getting ready for the next one (I swear I love year round).  But I pinky swear promise I will be writing more regularly now.

Especially since...drumroll please...my first round of medications/injectables just arrived in the mail today.  As I mentioned (aka ranted) in my last post I had to skip a month of treatments because of communication issues.  We've finally gotten everything squared away and are now just waiting for my next cycle to start so we can begin this process.

Over the past month I have learned a lot about insurance and bureaucracy.  (hahaha I just totally typo-ed that for a moment as bureaucrazy...how appropriate)  After my appointment last month, to get back on track I had to start by attending the nursing class to learn how to inject the medication.  Er, well, Joel and I had to attend the nursing class so JOEL could learn how to inject the medication.  I'm not afraid of needles or anything, I can donate and draw blood with little fuss.  However there is no way you are going to get me to inject myself.  That just gives me the creeps.

So anyways, we attended the nursing class, got all of the information and they submitted my prescription for me to the specialty pharmacy they work with.  (Because of the type of medication you can just go to Rite Aid.  You have to order it through a specialty pharmacy you mails it to you.)  That specialty pharmacy calls me to get all of my insurance information.  However there are a few numbers I don't have on my Aetna insurance card.  (Here is another tip/warning for people)  Apparently when you are dealing with prescriptions they not only need your Group # and ID #, they need something called a BIN, the Pharmacy Group #, and a PCN.  So if you ever have to deal with specialty pharmacies, make sure you have that information.

So I call Aetna to get that information.  (Of course I'm leaving out the copious amount of time I spent on hold throughout all of these phone calls)  Apparently Aetna contracts their pharmacy stuff through CVS Caremark.  So I call them.  Finally I get the information I need and call the specialty pharmacy back, we set up a date for delivery and I'm good to go.  About a week later, the DAY BEFORE, I'm scheduled to get the medication shipment (which we have to be home for because it requires a signature), the pharmacy calls and says, oh by the way, we don't work with your insurance you need to go with someone else.  le sigh

So then I had to go through the WHOLE process all over again with the pharmacy who is handling the prescription.  I guess it's part of the CVS Caremark company.  My favorite part is when the lady with CVS Caremark tells me I need to get my CVS Caremark insurance number because she's in one department and doesn't have access to my insurance information.....I was just thinking in my head "IT'S ALL THE SAME COMPANY!!!"  Why on earth I had to do the legwork and track down this number (by calling someone IN THE SAME COMPANY) I have no idea.  It just royally pissed me off.

But everything worked out in the end and we have the medication:


  • 1 Sharps Container
  • 3 pre-filled syringes with the Ganirelix (I don't have this stuff in front of me, so I don't remember all the spellings)
  • 1 bottle of progesterone vaginal suppositories
  • 1 bottle of Letrozole tablets
  • Alcohol swabs
  • 1 pre-filled Ovidrel syringe
  • 2 bottles of Gonal-F with empty syringes
Total:  $231 after insurance.  Altogether it was like $1200 or something before insurance.  And who knows how many times we'll have to do this.

Wednesday, May 16, 2012

Don't Wait!!

I had my appointment for my baseline ultrasound today.  Yeah, that didn't happen.  I can't begin to express how pissed off I am.  After our initial consult with the doctor, she gave us a lot of information.  What I took away from it was, when my next period starts I need to call to set up the HSG and we will move forward with the next stage of treatment, starting with the baseline ultrasound and the medications.

Apparently that's not what needed to happen.  I should have called like two weeks ago to schedule the class I have to take to teach me about the medication and how to administer it.  At that class is where they submit the prescription for the medication to insurance and the medication gets mailed to my house (since it's a specialty medication).

All of this takes 1-2 weeks.  You're supposed to start the medication on day 7 of your cycle.  So clearly, by going today it won't be ready in time for me.  In other words, I will be taking no medication this month.  This month is a total wash.  There are so many things I wish were different about this situation.  I wish I had asked more clearly what our next steps were, exactly.  I wish she had made it more clear how long this process takes.  I wish when I had scheduled my appointment they looked to see if I even had a prescription submitted!

 The worst part about all of this is I didn't even find out any of this until I'm sitting in the exam room, half undressed with that stupid paper "blanket".  The nurse comes in and starts asking some questions and basically realizes that I don't have a prescription submitted.  So because I can't do the medication cycle, the baseline ultrasound is useless.  And of course I got emotional.  I just wish I didn't cry so easily.  It's not like I was crying in a sad kind of way.  I just cry when I get emotional.

So the lesson to be learned, please don't wait.  If you are starting any type of medication or moving up the ladder in terms of treatments, call and find out exactly when things need to happen!

That's all I have to say about that.-Forrest Gump

....what he didn't say was I'm too pissed to talk about it any more.

Thursday, May 10, 2012

The importance of checking voicemail before complaining

I just checked my voicemail (I don't like voicemail and rarely check it, so the message has been sitting in my mailbox for a week).  I had complained in my last post about not getting my "egg reserve" test number back and of course that's what the voicemail was!  My results were 2.3, anything over 1.4 is good.  I hadn't expected that number to be low (and neither had the doctor).  So now we just wait to see when my period starts!

Upcoming decision

I know it's been awhile since I've written.  I've been on track out (I teach at a year round school-I follow the yellow schedule or Track).  I always have these grand plans for track out.  I make these lists of all the things I'm going to do, all the projects I'm going to work on, how I'm going to work out everyday.  Then I get into it and I'm like, "I've worked so hard, I can take a day off".  And that becomes another day and before I know it, it's time for my workdays.  Oh well.  I actually do better on a schedule.  I find myself to be much more disciplined in getting things done.   If I have to go to the gym straight after work, I'm much more likely to go then if I have to leave from home.

Anyways (yes I put an -s at the end of that), today is day 29 of my cycle.  This was the month where we are on an increased dose of Clomid (100mg).  I'm not expecting anything to happen.  I mean, nothing happened before.  Before any of you say it, don't.  You know what I'm talking about.  The whole, "now that you're not expecting it or thinking about it, it might happen!"  That is among the things people who are dealing with infertility do not want to hear (that's a whole other blog post...I need to start making a list.  Maybe David Letterman has already done, "Top 10 Things NOT to Say to an Already Crazy, TTC Lady).

However, we're nearing the end of the cycle.  I expect my period in the next 1-5 days.  Once it does come, I have to go in for the HSG (remember that's the test to see if my tubes are blocked).  Joel has been bugging me about getting the first oil change for our new car (yes, this does have a connection, just go with it).  I didn't want to do it too early over my track out, so I figure I'll just get it done on the same day I do my HSG as I'll have to take a half day anyways.  Might as well get the plumbing in both me and my car taken care of....(and there it is).  I just realized that I never got the results from my "egg reserve" test.  I'll have to ask when I go in.

After that though, we need to really make the decision.  Do we go with only medication, including injectables or do we go to intrauterine insemination (IUI) or IVF.  Joel is definitely leaning towards just medication for a few months.  I am too.  I'm super scared of the needles though.  I can get my blood drawn or get a shot any day of the week.  Those needles don't bother me because I don't have to look.  I do not think I can handle giving it to myself .  Joel may have to come with me to the nurse class where they teach you how to inject it.

In the spirit of information and being a resource, I wanted to share what I have found about the medication that I would be taking (whether we go with just medication or IUI).  All of the information here is how I understand it after research.  It is possible I have misunderstood something or presented it incorrectly.

I spent a couple hours reading all about the exact process that goes on inside my "girly bits" with the eggs and the hormones and needless to say it gets confusing.  I will try to simplify it a little here.

There are two "actions" for lack of a better term that are kind of used here to improve fertility:
1. Ovulation Induction:  This is the process of taking medication to force ovulation.  Ovulation is the rupturing of the ovarian follicle and releasing an egg.  This can be induced with the medication Femara (chemical name Letrozole).  What is interesting is that the main use of Femara is actually for some breast cancer patients.  It is taken to prevent the cancer from coming back.  Femara is the equivalent of the Clomid I have been taking.
2. Ovarian Hyperstimulation:  This is the process of using medication to stimulate the development of many follicles (which would lead to more eggs being released).  There are a few medications used for this, Follistim, Bravelle, or Gonal F.  These medications are follicle stimulating hormones (FSH)

I would be taking a combination of Femara and then one of the other 3.  I would also take a medication called Antagon (Ganirelix) which inhibits the actions of gonadotropin-releasing hormone (this is a hormone that is responsible for releasing FSH and LH from the pituitary).  I would also take a medication called Ovidrel, a hormone called hCG which causes the eggs to finish maturing and be released.

So long story short (TOO LATE):
-F/B/GF to cause more than one egg to develop
-Femara to induce ovulation (all those eggs being released)
-Antagon to...I have no idea.  My guess is to let the medication FSH do the work instead of natural since it inhibits natural FSH from being released.
-Ovidrel to help the eggs finish cooking...I mean maturing.

WHEW.  I feel like I should get an honorary medical degree based on the amount of biological reading I've done.  Now the decision that we need to make is whether we will JUST do the medication with timed intercourse (having sex at the IDEAL moment) or do the medication while also injecting the sperm into my uterus (IUI).  Like I said before, Joel is leaning towards the former.  Mostly to save us the money in our fertility benefits.  We have a set amount of fertility insurance for the lifetime of the plan (which I know is more than many have).  But that means one time use only.  If we drain that money and it doesn't work, we have a much more significant cost to pay for IVF (the next step).

I think I agree with him.  I mean it makes sense to try this new medication regimen for a few months without the more serious intervention (IUI).  Who knows, the additional medication past the Femara/Clomid just might do the trick.  Once we decide, I'll keep you all posted!!

Saturday, April 28, 2012

SMA & genetic testing

http://gma.yahoo.com/blogs/abc-blogs/parents-bucket-list-dying-baby-girl-goes-viral-180155213--abc-news-topstories.html

I just read this article about a baby, Avery, who has spinal muscular atrophy (SMA) and will likely die before her 2nd birthday.  In order to celebrate the time they had left, her parents created a bucket list for Avery and are blogging about the things she accomplishes off of her bucket list.

SMA is one of the genetic diseases that our fertility doctor recommended we test for.  I spent some more time today looking into one of the tests that the doctor gave us a brochure for.  The company is called Counsyl (counsyl.com) and they offer what they call a "Universal Genetic Test" that tests for 100 genetic diseases.  One of my first red flags was that they did not give the cost for the test on their website.  I don't like that.  If you want me to consider buying your product, I need to know what I'm going to be investing before I get involved.  They did say that many insurance companies cover it and that  "a discounted cash price is available for the Counsyl test".  That is my second red flag.  If you can offer a discounted rate, why don't you just offer that to begin with?  Why do you have to charge more?  Anyways, it looks like the test is about $350 for one person and $700 for two.  After reading more online it looks like this test was originally offered straight to the consumer, but is now available only through doctor's offices.  The most current information I could find, not from the company website was 2 years old.


I think the most telling fact was this:  Counsyl executives say 35 to 40 percent of people tested are carriers for at least one disease in the test. In about 0.6 percent to 0.8 percent of cases, they say, both members of the couple are carriers for the same disease.  So we have a less than 1% chance of carrying the same disease and even then it is a 25% chance of having a child with that disease if we are both carriers.  What is 25% of .8%?  However, I think it all boils down to fear and guilt.  How scared are we of that tiny little percent affecting us and how guilty will we feel if we do have a child with a genetic disease and hadn't done any testing beforehand?


What is also a little scary is that as the doctor mentioned, most pregnant couples don't get access to this information because they don't have the pre-pregnancy doctor's appointments.  They just get pregnant.  So these tests are being offered to the people who are already desperate for a child and probably most vulnerable to the fear factor I mentioned.  Who wants to work this hard for a child and then risk losing it, no matter how small the risk.  I don't mind fear tactics in advertising, I can tend to shrug them off (home security commercials come to mind).  However this test seems to be specifically targeted to the people most vulnerable to those tactics.  Doesn't make me want to jump at their test very much...


The other option she gave us was a test for the two most common genetic diseases, CF and SMA.  Not sure about the cost as that's not being offered by an outside company.

I had written earlier that I was unsure about getting the testing done for various reasons, some of which I mentioned above.  However I am fairly sure I will be getting the testing done, most likely the more limited one.  I think the thing that really convinced me (brace yourselves, the mother of all bad reasons is coming) was the picture of the parents in that article.  It wasn't the picture of the child or even the description of what she is going through.  But seeing them and knowing that this disease could affect people like that...those people seem to be the perfect model of everything society wants.  They are beautiful, look well-off, happy, college sweethearts, etc.  If these paragons of society can be affected, then anyone can and I don't want to take that risk.  (I know that is a very stupid reason to make a decision.  Don't say I didn't warn you)

Thursday, April 26, 2012

Teacher Fired for Infertility

http://news.yahoo.com/teacher-fired-receiving-fertility-treatments-211311476--abc-news-topstories.html

I'm going to start by saying that the following entry is 100% my opinion on this article.

I think what the key issue of this article/situation should be has nothing to do with fertility treatments.  I believe the investigation needs to focus on whether her bosses gave her permission to do something and then later revoked that permission and fired her for it and whether that is legal/allowed.  It also needs to focus on the details of her contract and whether there were provisions in it for firing on moral/ethical grounds.

I personally believe that when you sign up to work for a private, religious school (of a religion you don't follow) you open yourself up to all kinds of rules.  They might think things and expect things of you that you don't agree with.  I would imagine they have every right to do that as a private organization (I'm not sure of what the exact law says, but I feel like I remember reading it's pretty lenient towards private organizations setting their own moral/ethical codes).  It is your responsibility as an employee to know what those rules are and decide if you are willing to follow them.


Unfortunately the sensationalist media is trying to blow this up by making it about a cause.  Whether that is her and her lawyer's strategy, I can't say.  But she will get more sympathy as this woman trying to have a baby, than as a woman who was fired for no reason.


As with all news reports, there is more to this story that we don't know.  Maybe I am naturally suspicious of people taking their cases to the media, maybe I am automatically biased towards schools.  I'm just not 100% ready to throw my support behind this woman as someone being judged and treated unfairly for infertility.

What I am not going to get into at all is the church's opinion that IVF is "an intrinsic evil".

Wednesday, April 25, 2012

Triangle Infertility Support Meetup

I've decided to go a step further promoting Infertility Awareness.  I've created a meetup group called the Triangle Infertility Support Meetup.  If you or someone you know is interested in meeting others who are going through similar experiences in the Triangle area, please consider joining our group (or pass this link on).

http://www.meetup.com/Triangle-Infertility-Support-Meetup/

Monday, April 23, 2012

Initial Fertility Specialist Appointment

Wow.  Joel and I just got back from the doctor.  There is a lot of information to process.  It's funny, I felt like we were on this magical mystery tour.  First we started in the waiting room (which appeared to be furnished by TJ Maxx) and then was moved to a couch in a hallway where they took my height, weight, and blood pressure.   From there we met with the doctor to discuss our situation.  After, she took us to the financial advisor to discuss insurance options, who then took us to the lab area for my blood work!  I also stopped by the bathroom, so I feel I really experienced the entire office.  Although we weren't in any of the..."sample collection rooms" as I have decided to call them, but that would have probably made me giggle.  (There was a guy there who was dropping off a "sample" and it was really funny/cute to watch him.  So of course that made me think of Joel and I had to grill him about his experience).


I think overall we had all of our questions answered and are in a really good place about deciding what to do next.  I feel like she gave us a lot of information and now we have an idea of the options ahead of us.  I think she did agree with us though that just doing another round of Clomid at the increased dosage was not the most ideal choice.  She said by the time you get to round 4 or 5, if you haven't already conceived, you should probably move on to other options.


She did say that she was 100% confident, we would get pregnant again.  Whether that is naturally or with help is the only unknown.  I wish I could share her optimism.  I believe her when she says that we will get pregnant again, the question is whether we make it full term.  I guess I've just seen too many women who go through rounds and rounds of treatments and still are not carrying a baby to term (if they get pregnant at all).  Let's just say I'm not completely convinced.


We have already done most of the testing we need to do, but today they did one more blood test that is checking my AMH (anti-mullerian hormone) levels.  This is basically a measure of my "egg reserve" or a measure of my remaining egg supply.  She assumes for me it will be fine because of my age, but she said there are some people for whom it is a problem.  I'm all for any kind of informational testing by the way.  I think the more information you have, the better equipped you are to resolve any problems.


The next step is going to be conducting a HSG (hysterosalpingogram).  This is a check to see if my fallopian tubes are open.  They inject a dye that will show up on an xray into my uterus and if it spills out of the end of the tubes, they know they are open.  Again, she's pretty sure they will be open (since I was pregnant once, one of my tubes is open), but still wants to confirm.  This I will wait to do until after my next period starts (unless it magically doesn't start because of this last round of Clomid).


At this point she brought up genetic testing.  She made the point that most people who get pregnant never get this information because they are not put in a situation where someone would tell them about it.  She gave us information regarding a test for Cystic Fibrosis (CF) and Spinal Muscular Atrophy (SMA), both fatal.  Carrying these genetic diseases is semi common in Caucasian people, about 1 in 30.  If both parents are a carrier there is a 1 in 4 chance of passing it on.  If we are tested, we are both carriers, and we go with IVF, then we have the option to biopsy the eggs and only implant healthy ones.


I'm not sure how I feel about all of this (yes, I know I just said I was all for informational testing).  On the one hand, yes, it would be nice to know.  On the other hand, what would we do with the information?  Do we take the risk and whatever happens, happens?  Could I live with myself knowing that I knew this was a chance but didn't do anything about it (if our child was born with the disease).   Are we willing to take such extreme medical action as biopsying the egg if we are carriers?  Actually, I'm sure we are willing, I think the better question is will we be ok with it?  I know I'm jumping the gun here a little, but I feel like I need to think about all of the options and outcomes to make a decision.  Joel and I are still talking about it, but I feel like we are leaning towards getting tested.


Finally we came to the heart of the matter.  If all the tests come back normal, what to do next.  She basically said we can move to the next step, which is IUI (intra-uterine insemination) or go straight past that to IVF (invitro fertilization).  There are a few considerations here including time, money, and multiples.  


The medication we would take that goes along with the IUI has a higher chance of giving multiples (ie-twins).  She basically said if we were completely against multiples, then we should skip this option.  We're not, so we eliminate that as a consideration.


Time becomes a factor when we think about how much time we want to spend working on getting pregnant.  We've already been at this for almost two years and she said there is nothing wrong with wanting to move straight to IVF (which she said has ~65% success rate).


Finally, money comes into play.  One round of IVF costs ~$15,000 and I believe the financial advisor said the IUI is ~$8500 (I have to confirm that with her).  Through my insurance I have no infertility treatment or medication coverage.  My insurance will cover tests and doctor visits, but no fertility procedures.  On Joel's insurance we have a one time use of $10,000 of infertility coverage (which includes medication).  So the question becomes do we want to use up some of the pool of money towards IUI or move straight to IVF.  IVF has a higher success rate but is also more medically invasive (I believe, I'm researching it now).


As of right now we have made no decisions.  Joel is leaning towards moving straight to IVF.  For him it's a numbers game.  He sees the 65% chance versus 15-20% of IUI.  For me, I can't explain why I'm hesitant to jump to IVF.  It seems so drastic.  I feel like we should try all of our options first but I don't have any good reason to believe that.  I don't know if it's the way I try to have everything so orderly and IUI is the next step, so that's what we have to do next.  I think I need to stop thinking about it in terms of steps and just see it as a variety of choices with no prerequisites.  I also need to do more research...

National Infertility Awareness Week

Well, the timing couldn't be better.

http://www.resolve.org/national-infertility-awareness-week/home-page.html

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Sunday, April 22, 2012

Moving On

After the really rough month of October, we moved forward with trying to get pregnant again.  My doctor told us to wait a couple of months so in Dec/Jan we got started.  After a few months of nothing we decided to try using a fertility monitor.  I did some research and went with the Clearblue Fertility Monitor. http://www.clearblueeasy.com/clearblue-easy-fertility-monitor.php

I would highly recommend this to anyone looking for a fertility monitor.  It was about $125 for the monitor and about $35/box of 30 test sticks.  I bought all of this on Amazon.  The monitor is easy to use and has a very clear, easy to understand display. 

Every day the monitor tells you what day of your cycle you are on and then tells you whether it needs a test done on that day.  I think it had me test everyday from day 10-25 or something like that (it's been awhile since we've used it).  First thing in the morning, you have to pee on the stick and then just click it into place on the monitor.  It then tells you the level of your luteinizing hormone (LH-which starts ovulation), either in 1, 2, or 3 bars.  Your 3 bar days are supposedly your peak fertility days and are days on which you should have sex. 

We used the monitor from about May-October with no results.  By then we started thinking about seeking medical advice. I already had my yearly exam scheduled in December, so I decided to bring it up then.  I think the hardest thing to hear is "you've been pregnant before, so we know it can happen".  That's all well and dandy, but doesn't make me feel better after months of nothing.

(Don't even get me started on what I hate hearing....that's a completely different entry)

At that appointment, we discussed the lack of progress and they had me come in for blood work.  The blood work determined that I was not ovulating (still trying to figure out if it's possible to get a positive reading on the fertility monitor but not actually ovulate).  As not so great as that was, it actually made me feel a little bit better.  I feel like I finally had some small reason for why things weren't working and a place to start from in trying to fix it.

Because I am not ovulating I was prescribed a medication called Clomid.  This is a medication that induces ovulation.  Fun little fact:  Clomid has been around since the 60s and originally they thought they might use it as a contraceptive since it has some anti-estrogen properties!  Clomid is taken for 5 days on days 5-10 of the menstrual cycle for no more than 6 cycles.  I started on the 50 mg dose.  On day 21 my doctor does blood work to see if I ovulated.  I have been on the 50 mg dose for 3 months (Jan, Feb, March).  Because there have been no results, they have increased me to 100mg.   Joel has also been in to be tested.  Other than one tiny dip, his results were all completely normal.

I've been a little frustrated about the decision to up the dose to 100 mg.  I'm not sure that this is the best route for us to go.  The Clomid caused me to ovulate on the 50 mg.  It seems to me if I am not getting pregnant, we need to start looking at other things.  In order to get a second opinion and learn a little bit more about our options, Joel and I have a consultation tomorrow at a fertility clinic.  I'm looking forward to the chance to get more information and possibly start moving on a more productive path!

That brings us to the present (yay for no more flashback stories).  I'll keep you all updated as things happen or as I feel the need to talk!

Acronyms

Wow!  So even reading for 20 minutes online about infertility and trying to conceive, one can get lost in a whole new world of acronyms.  In some cases there is a whole culture on the message boards discussing pregnancies, conception, and infertility.  I found this website with a very long list of acronyms and what they stand for.  Hope it helps!

http://www.freespermdonorregistry.com/index.php?option=com_content&view=article&id=10-fertility-acronyms&catid=10-information&Itemid=190

Dealing with loss

When we first started trying to get pregnant, I was confident that things would happen quickly. You hear all the time how careful you have to be to avoid unwanted pregnancy. What is the message we're supposed to take away from that?  I assumed it implied how easy it was to get pregnant.  Add to that the fertility genes I had hoped to inherit from my mom and I knew it wouldn't take long for things to happen. In my infinite wisdom I started telling anyone and everyone that this would probably be my last year of teaching.

Soon something did happen. In October, 2010 my period was late. While I was on the pill, my period was regular, practically to the hour. Ever since I stopped taking it, however, it has become very irregular. So I wasn't sure exactly how late it was. We decided to take a test and it came back positive.  I remember being happy, but not surprised.  At the time I was still confident that getting pregnant would happen and so when it did, I was ready.

I called my doctor to schedule an appointment and of course rushed right to the bookstore to buy the classic What to Expect When You're Expecting.  I remember reading through those first few chapters, trying to guess which developmental picture was the closest to what my baby looked like.  At no point in those first couple days did I even think about the possibility of losing it.  Then I started reading about chemical pregnancies.  I think it was then that I started to get a bad feeling.  I don't profess to be psychic or even claim I sense things before they happen.  I just remember having a really bad feeling for a couple days.

Chemical pregnancies occur when the egg is fertilized, but the egg never fully implants into the uterus.  The only way you would even know if they happen is if (like us) you took an early home pregnancy test, got a positive and then a few days to a week later get your period and/or a second pregnancy test with a negative reading.  According to the information I've found, these are actually quite common with sources saying anywhere from 50-70% of pregnancies end in miscarriage (many of those with the woman not even knowing she was pregnant, just having a slightly late period).

Anyways, I had scheduled a doctor's appointment to confirm the pregnancy.  The morning of the appointment I started cramping and spotting.  Normally I do not cramp during my period, so this was unusual.  In the car on my way to the doctor, the cramping was pretty strong and this is when that bad feeling came back.  I'm pretty sure I knew what was coming.

Between this visit and the follow up a few days later, the doctor did a couple of blood tests to compare hormone levels and internal ultrasounds to confirm, but it was determined that I had miscarried.  After that first appointment where we had pretty strong suspicions about the loss, it took everything I had not to cry in that doctor's office.  I did not want them to see me crying over what could hardly be called a pregnancy.  

I'm sure I was no more than a couple weeks in (because of my irregular cycles, I couldn't estimate when that period should have come), but it didn't seem to matter.  I grieved.  I felt guilty about grieving.  I mean, who was I to mourn the loss of two week pregnancy when there are women out there who have lost babies after hearing their heartbeat or giving them a name?  Even today, I still feel a little guilty.

One of the hardest parts about all of it was having to tell my parents.  I wasn't worried that they would be disappointed, I think I just didn't want to admit my embarrassment at having told them so early.  I have, harshly, learned the lesson to keep any pregnancy secret for the first couple months.

Looking back, one of the things I remember the most is how supportive Joel was.  I understand now that it was a loss for him as well, but in the middle of it, all I could see it as was something happening to me.  He has since repeatedly been there for me as we have faced the repeated arrival of my unwanted period.  In some ways our difficulties conceiving have convinced me that much more of what a wonderful father Joel will be.






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Initial musings

Well this is the first entry in my blog describing the process of trying to pregnant (I guess technically the second entry since I accidentally deleted the first one). I'm sure there are a million other blogs out there from people who are going through similar situations, but I feel like I want to tell my story. I hope it might help someone, though even if it doesn't it makes me feel a little better. I also threatened my hordes of friends and family that I would start a twitter account just to keep them updated after every doctor's appointment and blood test.

(On a side note, I feel very Doogie Howser-ish right now. Between the internal monologue going through my head, the clicking of the keys, and watching the words appear on the screen it is all very 80s sitcom)

I should probably start by describing what is going to be in this blog. This blog is all about the experiences we are going through trying to get pregnant. I'm going to be talking about my period, ovulation, and many of the private details about my body and the *ahem* activities needed to conceive. In other words, now is your chance to get out!  For the most part, this will be a place for my personal thoughts and ramblings and possibly a place for people to share their feelings/experiences.  However, I also hope to provide resources and information that I've found interesting/helpful.

To introduce myself, my name is Katie and I am 30 years old. I am originally from Michigan. I moved here in the summer of 2006 and have taught 5th grade for 6 years. I met my husband in April of 2007 and we married in May of 2009. We started trying to conceive in July of 2010 when I stopped taking birth control pills.  Currently we are at the very beginning of the infertility spectrum.  I'm not sure how far we'll need to go, but I'll describe it as we move through each step.