Latest Update

We have decided not to do a 4th round of IUI.  I would have had the scan this past Monday with intrauterine insemination on Wednesday, but we have weighed the pros and cons and decided against it.  Our RE said that she has seen many successful pregnancies happen with the 4th round, but there were just too many cons to consider.  My thought process was that I did not want to be pregnant in Ghana in case I -

• have severe nausea
• have an ectopic
• have a SAB (spontaneous abortion/miscarriage)
• need a D&C

I also was concerned because I will have to take anti-malarial tablets and of the 3 kinds that are recommended for Ghana - Malarone, Mefloquine or Doxycycline - none are safe during the 1st trimester.  I definitely do not want to contract malaria whilst I am there, but I also do not want to cause undue harm to my unborn child.  Which, I guess in theory, could happen with not taking anti-malarials and contracting malaria AND with taking anti-malarials.  According to the WHO, pregnant women are more vulnerable to malaria as pregnancy reduces the immunity to malaria (an immunity of which I have none of) and increases ones attractiveness to mosquitos due to hormones and pheromones.  Contracting malaria in pregnancy increases risk of illness, severe anaemia and death.  Maternal malaria also increases the risk of a SAB, stillbirth, premature delivery and low birth weight, which is the leading cause of infant mortality in Ghana.

All these thoughts culminated in us skipping our last round of IUI.  

We met with our RE this past week, and told her our decision.  We discussed doing a 4th round when I return from Ghana, but we are already booked for an IVF start date of 27 October, so there was not a way to squeeze in both the IUI and IVF start in October, especially with having to take anti-malarials for 2 weeks post-return.

So, we now are set for the following schedule, some of which has been completed:

1. Husband do pre-IVF infectious disease blood work 
2. Re-apply for Springstone IVF financing at end of August
3. Leave for Ghana beginning of September
4. Husband donate sperm for freezing on 2-3 separate occasions during September
5. Return from Ghana early October
6. IVF counseling 3 October
7. Husband leave for 6 months
8. Begin IVF cycle 27 October

I know there are many more steps between 3 October and 27 October, but I do not know what they are yet.  We will find out on the 3rd!  I know I do need to let Attain know that we are beginning our treatment on the 27th.  They are providing us four rounds - 2 fresh and 2 frozen - for $16,000 USD.  I also need to work out our financing.  Our clinic wants the money up front, so we are going to go through an IVF financing company called Springstone.  We applied earlier with them and were approved for the IVF amount with monthly payments of $300 for 60 months, $335.97 for 48 months, $412.44 for 36 months or $573.50 for 24 months.  It IS quite expensive, like a monthly car payment (which thank goodness, we do not have), but we are going to have to use the financing route as we do not have $16,000 in cash to pay up front by October.  Unfortunately, our application was only good for only 60 days, so we will now have to re-apply.  I hope we are able to secure as good of a rate and financing for the whole amount when we reapply at the end of this month.  

It's nerve-wracking thinking about all that needs to be done and the possibility of not having a successful outcome whilst being out $16,000.  I am trying to be positive, of course, but the fear is still there.  I had a dear friend who just went through her 4th failed IVF attempt.  It is heart breaking.  I am truly hoping and praying for success on the first go-round.  I'd like to get our money's worth, but really, I'd much prefer early success.

Rounds

This week has been all about rounds and rounding.

On the trying to conceive front, Friday was my day 1.  I'm beginning my 4th and last round of IUI treatments.  I pick up my Clomid today to begin taking days 3-7.  I have my US and blood work on Monday, August 8, and then my IUI will probably be 2 days later if all goes well.

This week was my 2nd week in hospital and I did heaps of rounding on postpartum patients.  I saw 4 patients and their teeny, tiny, adorable babies.  Four patients may not seem like a lot, but postpartum rounding takes a long time.  It is the first and only time the patient sees a midwife during the day and they have loads of questions stored up to ask on top of all the questions I need to ask them and the exam I need to complete.  Then there is also time I have to allot for discussion of their birth and fielding any complaints they may have.  The pressure arises as the clock tick-tocks away knowing that I have patients one floor down in labor that I must get back to and round on as well.  It is a great juggling act of time management, to say the least.

This week I caught 3 babies (bringing my total to 4) and they all went so much easier than last week.  I was able to both protect the perineum, provide space for the baby if needed in the vagina, and coach the patient on breathing and pushing.  I really feel like it is coming together so nicely.  All of my babies had nuchal cords - one I lifted over the baby's head and the other two I helped the babies slide through them.  The transition from catching to tummy is going smoothly now too.  No more fuddling and fussing.  We had a few lacerations (or lacs as we call them), and I began to learn how to repair.  I have not yet attempted it on my own, but I experienced a lot of relaxed teaching time.  I look forward to my first hands-on experience.

All in all my clinicals are going quite well.  I am learning heaps every day and growing by leaps and bounds in my practise and knowledge.  I am also working at the same time with the new OB/GYN interns that have just started and that is a neat experience.  It is fun to be "babies" at the same time and grow up together.  My midwife preceptor teaches the interns as well on the low risk side of labor & delivery, so we are learning side by side.  Hopefully one day what these new interns learn from the midwives about normal, low risk births will make an impact in their own practise with women.  I already hear some interns calling what they do catching instead of delivering.  Wow!  So exciting!  The word of midwifery is spreading.

Friday's News - MRI

This day did not go as planned.

It all started off with me driving 50 minutes in moderately heavy traffic (read: people who leisurely drive in the left lane and prevent you from passing) two cities away to have my MRI done. Upon arriving at the facility they tell me that I must be mistaken as they do not do MRIs. They point me towards the hospital up the road and advise me to check there. I call my referring RE's office and I am on hold for 10 minutes, so I hang up and go up the road. The hospital radiology department has no record of my name. My RE's office calls back and says, "Oh sorry. Someone must have given you the wrong information. You are meant to be at the hospital here." What??? I am in the wrong city? I was so hot at this point - literally and figuratively! It was 40 C/104 F already at noon and even with the air con in my car cranked to the max, I was still sweating. I begrudgingly drove another 30 minutes to get to the correct hospital and finally had my MRI.

It took about 45 minutes in total for the pelvic MRI, which I was surprised by. I thought with only having to image a small area that it would take less time than a full body MRI. I was too hot and tired to ask any questions though, and after 45 minutes of lying flat and still on a hard table my lower back was killing me as well (due to a previous SI sprain that flares up from time to time). Luckily I was able to pass the time listening to NPR, which helped with not thinking about the teeny tiny cavity I was in.

After my MRI, I do some yoga stretches (downward dog, padangusthasana) in the changing room to ease my back pain and then side step over to the cafeteria to stock up on some nuts, water and fruit before I hit the road again. It is now 3 hours since I left home, and I have to drive another 30 minutes to my acupuncture appointment which will last another 2 hours. Days like this make me really miss the days of public transit in the EU!

I make it to my acupuncture appointment just in the nick of time. I'm all bothered and irritated, but my practitioner is calming and serene. I quickly shed some of my stress. I hop up on the table and have many needles placed in carefully selected areas all over the front of my body including my head (acupuncturist says it is to lift my mood - ha!). I lie there for 30 minutes having a hard time relaxing. My mind is racing and the halogen lamp is bothering my vision even when my eyes are closed. My acupuncturist then removes all the needles, has me lie on my stomach and then places many more needles along my back including one directly in my SI joint. I practically leap off the table on insertion, but it magically starts to feel better immediately. I lie there for another 30 minutes and this time I am able to fully relax. I can no longer see the halogen light in my eyelids and I drift off to a floating type sleep with vivid images flashing before my eyes. Before I know it my practitioner has returned to remove my needles and I am now happy and buoyant. My stress is gone. How does acupuncture do that? It really is so incredibly amazing to me. I eagerly look forward to my next week's visit.

I should hear back from RE in about a week's time. Fingers crossed for good news and that we can proceed with our last IUI, and then IVF in October if not successful.

Post script: I'm on day 9 of my juice detox and it is going well. I feel like I have heaps of energy and have even lost 4 kg/8#. These past few days I have not lost anything more, so I have been a bit worried. I hope I can lose more weight while continuing to feel great.

An Auspicious Round 3

Thursday, 9 June -

Day 1 of cycle. Called clinic and my Clomid and hCG were called in for me. I pick up Clomid at my local neighbourhood pharmacy (only $3 with insurance) and the hCG is sent via FedEx by Walgreens to my front door (also only $3 with my insurance).

Saturday-Wednesday, 11-15 June -

Taking Clomid 50 mg 1 x a day for days 3-7.

Saturday, 18 June -

US to check my follicles. Sadly, I only have 2, maybe 3 that have developed (previously I have had 4-6), but my RE still has hope. There is a spot of concern though - a fluid filled sac in the wall of my uterine muscle. It does not appear to be ominous, but it is peculiar as it was not there in the beginning, showed up in my diagnostic US, was gone for my HSG and round 2, and now has resurfaced. If this IUI does not take, then I will undergo a hysteroscopy and biopsy to find out what it is, but in the meantime, per my RE, I am not to worry about it. Since it is not of immediate concern, the IUI will continue as planned.

Monday, 20 June -

0700 My husband drops off his sample. I do not have much hope as I just had a dream that night that the clinic called us and told us not to bother coming in as his sample was too small.

1030 rolls around and there is no call, so I head into the city to the clinic.

1120 we are shown to our room and I am asked to undress from the waist down. I always like to wear tunics or dresses so I do not have to feel so naked. I take my capri leggings off and sit in the chair chatting with my husband. I do not want to hop up yet on exam table as I never know how long I will have to wait and I hate feeling like a patient.

1125 My doctor pops in just 5 minutes later and asks if I am ready. The nurse and doctor verify with us that the sperm sample is my husband's (what a nightmare it would be to be injected with someone else's sperm!). We confirm that it is. They then give us the good news that the sperm count today was over 10 million - our best count yet! Woo hoo!

1130 I get into position - lithotomy, stir ups, the whole lot (although my midwifery preceptor likes to call them footies - she says that is less threatening). So I am up in the footies preparing myself for a very long and uncomfortable ordeal as it has been before, but it was amazingly super quick this round. Speculum was inserted, sperm was drawn up into a syringe, catheter with syringe attached was inserted through the cervical os via US guidance and voilà!

1132 In under 2 minutes 10 million + sperm were injected into the top of my uterus. We were all surprised. There was no bending, turning and readjusting the catheter or filling up my bladder more. My RE said, "I am taking this as a good sign!" She said she did not know what was different except that my bladder was not as full, but it was quite a different experience and visit. An very auspicious round 3.

1145 After a 10 minute 'psychological' rest and paying our $300 IUI bill, we are out the door, arms around each other, both exceedingly happy.

I told myself before I went into round 3 that I was not going to get my hopes up. The previous 2 times I had such high hopes and was über stressed during the procedure and throughout the 2 week wait (maybe that is why the previous IUIs did not go very well!). Both times ended in a day or two of prone position depression and heaps of crying. This time I did not want it to be like that. I have read The Secret and do believe in positive thinking, but this time I did not want to have such high hopes that could be so disastrously dashed. So I have taken up a nonchalant attitude. I want it to happen, I hope it happens, I am thinking positively that it WILL happen for us eventually, but if it is does not happen this time, I am okay with that. Due to this attitude, I was happier and more relaxed at my visit and am now going to go on with my life for the next two weeks without the obsession and worry that consumed me for the previous 2 rounds. I am hoping things will be different this round, but it will not be the end of the world if they are not.

Now, I am off to spend the week with my husband doing renovations to our home in hope of having it all done very soon. All of these home projects will surely keep my mind active and occupied. My uterus and right ovary (where all my eggs were again - I do not think at this point that my left ovary is working at all) are a bit sore and crampy, but I am hoping that will dissipate later today. No time for bed rest though when there are so many projects still left to complete!

Ghana bound

I have decided to do an elective in Ghana via Work the World in September when I am on my 3 week break between summer and fall terms. There I will be working in a hospital in Takoradi - a 4 hour drive west of Accra along the coast of the Gulf of Guinea. The experiences other midwives and students have had sound phenomenal. I am quite excited to go, albeit a bit nervous as I have never been to Africa and do not know what to expect of the country or the healthcare. I imagine it will be quite shocking at first and not at all what we are use to in our Western industrialised nations.

To enter Ghana I had to have a pre-travel appointment with the travel clinic and found I needed both Typhoid (only good for 5 years and my last was in 1991) and Yellow Fever, which certification of receipt is required to enter Ghana. Upon receiving the news that I was not pregnant (again) I quickly secured my vaccinations since you cannot take either whilst pregnant due to the live viruses they contain.

This now delays my next IUI since I need to wait a month before trying to conceive after taking these vaccinations. I was a bit skeptical about trying another round of IUI in May though, as both Malaria meds are pregnancy C category and if pregnant, I cannot take Doxycycline at all. I also read that mosquitos are more attracted to pregnant women (hence why many pregnant women in Ghana also have malaria), so I am a bit leery about that. I am following up with my physician to ensure it will be okay to be pregnant and go to Ghana. I definitely do not want to work so hard to get pregnant to then put my baby or myself at risk of being infected with a disease.

I have asked for a consultation with my physician, but it seems that all appointments are booked up for consults until May. That is a bit disappointing. I am hoping to get in before we do our next round as I would like to discuss our short term and long term options. Obviously I know we can do another 2 rounds of IUI, but there are further issues to contemplate. I will be gone to Ghana for 3 weeks in September, and sometime around September my husband will also be leaving on business for 4+ months. We hope to inquire about sperm freezing as well as speak about our options with IVF to include how it would work if my husband is gone, financing, risks, etc. I never thought I would consider IVF, but it looks like we are heading that way. I just do not know how it will work with me being out of country most of September and my husband leaving the same month. Possibly we have to do egg retrieval and insemination before he leaves with implantation after I return? These are the questions I would like to learn answers to.

I will be 39 this November. I feel like my time is running out. I want to be pregnant before I turn 40 as success rates after 40 drastically decrease while risks of Down's Syndrome and other age related issues increase.

Gosh. Hoping for a miracle!

BFN

... aka Big Fat Negative.

Took a pregnancy test on Wednesday and it was negative. Started spotting on Friday. Period started in full force today, Saturday. This has got to be THE worst period I have ever had - heavy bleeding, countless golf ball size clots and the worst cramps I have ever experienced. I do not like taking meds, but I have taken 2 Fioricets and 4 ibuprofen. I was going to head down the Percocet way, but am finally feeling some relief. Thankfully! I am not sure if the medicines I am taking to get pregnant are having a direct impact on my menstrual period or not. My physician said Clomid can increase bleeding and dysmenorrhea with periods. I also added progesterone suppositories to this round, so maybe that also has an impact?

Sorely disappointed again, but at least we are only out $250 instead of $500 (although $250 is not small change either).

Round 2

This past Sunday we went for our 2nd round of IUI. This time I forewent the US and hCG shot to force ovulation thinking that it might go better if I went with the natural rhythm of my body. I used ovulation sticks to detect my LH surge and then went in the day after my surge was detected, which was Sunday.

I did not have any ovarian pain this time around and since I elected not to do the US, I do not know how many eggs were produced. There is at least one, but I am thinking there is not much more than that since I did not have the ovarian pain and tenderness this cycle. I actually felt nothing while on Clomid this time.

On Sunday, my husband's sperm, after washing, was only 4.5 million this time. As aforementioned, below 5 million/ml is not good, but they still went ahead with the IUI since it was close to the 5 million. I was really shocked and disappointed that we went from 9 million the 1st round to half of that on the 2nd round. I know I should be thinking positively, but I am just not very hopeful this go round.

Since my period started earlier than expected this last cycle, the doctor also gave me some progesterone suppositories to give some support during the luteal phase. I am hoping that helps a baby stick!

On Monday, my husband had a follow up urologist appointment that I also attended. The physician was quite knowledgeable and helpful. Of the three repair options for the varicocele, my husband has decided on the laparoscopic procedure as it is minimally invasive and has the highest success rate over the old standard procedure of going through the muscle with a long hernia type scar or placing materials in the veins to occlude them. It is a longer surgery time - up to 4 hours - but it has the highest rate of being successful the first time, it has a faster recovery rate and it has a high success rate for increased fertility. The only drawback is that we cannot pursue any assisted fertility options for 4 months after his operation. That means that we will need to finish up these 4 rounds of IUI before he can have his surgery. This places his surgery in July of this year. The urologist also stated that it can take up 9 months to see a marked improvement in fertility but that up to 60% of patients will then go on to conceive naturally.

I am not sure what is going to happen in our future, but I really truly hope that one of these IUIs are successful and that we do not have to visit the dreaded IVF decision or hope and pray for a spontaneous, natural pregnancy 4-9 months after the varicocele repair.

Round 1

And should it take, what a sweet Valentine's Day gift that would be for us!

I woke up this morning feeling fine. Tired at 0530, but no aches or pains. My husband collected his specimen and then kept it warm between his legs on our drive up to the city. We had to drop it off at 0700 to be spun, cleaned and consolidated into the most healthy, best swimmers. They were thankfully able to obtain a 9 million/ml concentration. Greater than 5 million is needed for Intrauterine Insemination (IUI). 10 million is ideal and 20-30 million provides the highest rate of success. However, if we were at the 20-30 million count, we would not need IUI. The sample was just short of 10, but the doctor was positive about our chances.

At 0825 we entered a waiting room filled with other couples. I was surprised to see so many people receiving fertility treatments on the same day. I guess I did not realize there are many people out there struggling with infertility issues as well. For some reason I had it in my mind we would be the sole couple waiting for our procedure. On one hand it comforted me to know that I was not alone in this endeavor, but on the other hand it made me contemplate the reason as to why so many of us have fertility issues.

At 0845 we were finally called back. The procedure began easily enough. It is a standard speculum exam and then the doctor takes a syringe filled with semen and attaches a long catheter tube to the end.

This is then inserted into the external os of the cervix, through the internal os and then into the uterus itself. All guided by ultrasound (US).

Upon initiation of the IUI, there seemed to be two problems. My uterus was anteflexed and my bladder was not full enough. After about 10 minutes of not being able to get the catheter to bend to a 120 degree angle, I was given a reprieve to drink more water. 15 minutes later, the physician returned, viewed my bladder via US and determined it was fuller and had thus helped to straighten out the curve in my uterus. This time they used a similar tubbing as the one above, but longer and more bendy - one that is typically used with IVF - and with a full bladder and a bendy catheter, the doctor was able to enter my uterus and inject 9 million happy and healthy sperm.

Overall, the procedure went well. It was painful (think menstrual cramps) on the first attempt, but upon the second attempt, with the right equipment, it all went swimmingly. There was less pressure, no cramping and it was very quick on the second attempt. We even got to watch the semen inject into the uterus via ultrasound. It was exciting to witness the possibility. Now it is all up to chance. Here's hoping one of those swimmers makes it to one of the eggs released and that he has the fortitude then to burrow into the egg and make it inside.

Now on to celebrate a day of love. Happy Valentine's Day!

Side Effects

So far I have not experienced any side effects from my 5 day stint on Clomid. According to my physician the most common side effect of Clomid is hot flashes. According to Drugs.com website, the most common effects are:

Blurred vision or vision problems (spots or flashes); breast tenderness; dizziness; enlarged breasts; enlargement of the ovaries; flushing; headache; hot flashes; lightheadedness; mood change; nausea; pelvic pain or bloating; stomach pain; vomiting.

Thankfully I have have had none of these nasty symptoms. I did experience some pain and tenderness in my right ovary, but that seems to be related to the amount of follicles Clomid induced on my right side.

I gave myself my subcutaneous injection of hCG last night and to be honest, it was not as bad as I feared. The injection site was a bit sore and tender to touch but that quickly dissipated. I did, however, experience some side effects with the injection. Shortly thereafter I began to have a pretty severe headache and then a few hours later felt nauseous. According to Drugs.com these are common side effects along with feeling restless or irritable, mild swelling or water weight gain, depression, breast tenderness or swelling and pain, swelling or irritation where the injection was given.

I do have to admit that I have been quite irritable lately, but I cannot tell if that is due to the stress of everything or due to the medication.

This morning I awoke with a continuing headache and still feeling slightly nauseous. I also have tenderness over my right ovary and pain in my right lower back as well. I know I am in the thick of it now, but this all makes me wonder if it is really worth it. Do I really want to be pregnant? And at what cost? I am feeling quite blue today and second guessing my decision to go through with IUI. These feelings also makes it crystal clear to me that I cannot go through IVF if IUI does not work.

I guess the part that weighs the most heavily on me is that I am completely normal reproductively speaking, and yet, I am forcing my body to mature more eggs than normal and now forcing my body to ovulate off its normal rhythm. Being someone who is as natural as they come and one who enjoys keeping the body healthy and fueled through natural means - organic food and yoga - it seems a stark contrast to be doing something so artificial to my body. Especially when I do not have any fertility issues. Men are lucky, aren't they? Even when the problem lies with them, we still have to be the ones to endure the treatment. If only they could have a share in all this fun. Joy!

With that said, I am looking forward to tomorrow morning. I am hoping with all hope that the first time takes (and that it is not a twin gestation!). Fingers crossed on both counts!

Day 10

Today is day 10 for me. I have taken the 5 days of Clomid and had an ultrasound this morning. It seems the Clomid only worked on my right ovary but I have 4 follicles greater than 10mm plus a few more. Nothing on my left greater than 10.

Will be giving myself the hCG "trigger" injection this evening to force ovulation and then going in for the spin and wash sperm cycle and IUI on Sunday. Even though I am a nurse and am completely okay with giving injections - I am not looking forward to giving myself an injection.

I definitely was shocked by the cost of this round of IUI. $310 for today and another $300 for Sunday. Insurance paid for Clomid but nothing else. After living in Europe where fertility treatments are paid for or covered by insurance, it is disappointing that we find out NOW whilst living in the US that we need fertility treatments and that they are not covered by insurance. We are really hoping that one of these four treatments take (preferably the first one!) as we cannot imagine going through and paying for IVF. I know many people have had success with it but I have watched a friend go through 2 cycles of IVF with such struggle. Thankfully she now is pregnant after her 2nd attempt, but everything she went through was heartbreaking.

Ahhhh the stress! I must think positively, keep stress at bay and go hop on my mat. Ashtanga always makes everything better!

First signs

Our conception project, if you will, began in March 2010. At first it was a casual endeavor, not taken too seriously. After several months of no magic, I decided to buy a Clear Blue Easy monitor to see if and when I was actually ovulating. I was elated to see that, at 38, I was still ovulating every month. I had renewed hope.

August creeped upon us with no change in the story, so I decided to get checked out by a fertility specialist. Typically infertility is a diagnosis attached to those who have been trying for one year without success, but being 38, I knew we needed to be checked out at the 6 month mark. What a relief it was to find out everything was completely normal with me and I had heaps of antral follicles on my ovaries (meaning I had good ovarian reserve as we women are born with a finite amount of eggs and as we age this number drastically decreases).

With this encouraging news, we went back to the drawing board and doubled our efforts. We tried everything we read or heard about from friends and family. I tried Vitex agnus-castus, we tried using pre-seed lubricant (which a same age couple swore by), I drank fertili-tea, we both went to acupuncture and took Chinese herbs and I even did Sirasana (headstands) and meditation after intercourse to use gravity and mind power to will those little sperms to meet the egg.

Nothing worked.

In the meantime, we moved and life carried us away with busyness. We finally found a reproductive endocrinologist in our new city that we really liked and we both went in for a full exam. Our results came in and lo' and behold, my husband has a very low sperm count as well as low morphology, low motility and 47% dead sperm. It was bad news. When the doctor said I would only have a 1.8% chance of ever conceiving naturally, I cried.

My dear husband then doubled his efforts with the herbs and acupuncture. He already eats very healthfully and is in ultimate physical health, so he was not sure what else to improve upon. He saw a fertility urologist during this time, but left without any explanation as to the cause of his low counts. A repeat test in a month's time showed the same results.

That brought us to our only option - to undergo assisted fertility treatments. Our chances for pregnancy with Clomid + IUI (intrauterine insemination) increases from a 1.8% per month chance to a whopping 26% (average 15-20%). So we are giving it a go. We had hoped we could have done everything naturally, but no such luck.

We are now starting our first cycle. Fingers crossed for a sticky outcome!