Support During Infertility

Just a quick post to give a shout out to my wonderful infertility support group!

I never knew there was a support group in my area until a friend in NYC sent me a link to Resolve: http://www.resolve.org/.  Here you can search for a support group in your local area, and lo' and behold I found one just down the street!

Since my husband has been deployed throughout this entire process, these ladies have been such a wonderful system of support and laughs.  I have many friends who are supportive, but they will never fully understand what it is like to go through IVF.  These women know exactly what is involved and each share encouraging stories from their trials and tribulations of infertility.  The leader of our group even checks on me weekly to see how I am doing.  It has been a lifesaver, literally.

So if you are in need of human, in-the-flesh support, please find a local group in your area via the link above.  If there is no local group in your area, start one!  I am sure there are many others that are in need of an active support group in your city.  

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!

Missing

I have not blogged since March, so for about 3 months now. Where have I been? Well, no where really, but I have not had anything new to blog about and I have been a bit unmotivated as well. If I'm honest, I have been feeling a bit down and depressed in these past 3 months trying to sort out what I want to do now.

We met with our reproductive endocrinologist (RE) in May and have sorted out a plan. We are going to do two more rounds of IUI in June and July and then take a break until after September if neither of them take. I will be gone for the month of September to Ghana to do midwifery work, and upon returning, we will try IVF. Since my husband will be leaving for work for half a year in the fall, he will probably have to make several deposits before he goes and I will undergo IVF alone.

These are the things I have been dealing with. Going through IVF alone, spending the holidays along, possibly being pregnant for a large chunk of time alone and my husband missing out on all of this.

On a good note, we have been approved for the Attain IVF program where we will receive 4 rounds of IVF (2 fresh and 2 frozen) for $16,000 USD. If I were under 35, I could have qualified for having a percentage of my fees refunded if our IVF attempts were unsuccessful. But due to being 38, this is not an option because of the reduced chances of having a successful pregnancy via IVF after 35. Luckily my chances do not go down drastically until I reach 40, so I do have a good chance left still and that is why it is important to go ahead with the IVF even if my husband is not here. Every 6 months I wait, my chances decrease as my eggs get older and fewer.

The last bit of news is that I received my anti-Müllerian hormone (AMH) results. This hormone is suppose to be able to tell how much of an ovarian reserve one has and is a serum blood assay that can be drawn on any day of the cycle, unlike FSH, estrogen or progesterone. The results are as follows:

Interpretation	AMH Blood Level
High (often PCOS)	Over 3.0 ng/ml
Normal	Over 1.0 ng/ml
Low Normal Range	0.7 - 0.9 ng/ml
Low	0.3 - 0.6 ng/ml
Very Low	Less than 0.3 ng/ml

My result was 1.1. JUST above the normal cut off range. I have been researching this in journals and have found that IVF is most successful with a value of 1.24 or greater. The articles recommend taking DHEA. A good blog post about this is by Kylie Hughes: DHEA for low ovarian reserve. Her blog research and linked articles show that IVF success was significantly increased with DHEA supplementation for those with low AMH results. Right now my RE is saying my chances with no intervention is only 1.8% per month of conceiving on my own, 8.6% chance with IUI + clomid and around 50% for IVF. I am not sure if my AMH result now will affect that 50% chance for a successful IVF. These are the things I plan to ask her this Saturday when I go for my scan to see how many eggs have developed for this cycle. If there are enough eggs, as there have been in the past, we will do round 3 this week.

Adoption

Last week I had a teenage patient who was gang raped and decided to give her baby up for adoption. She was not sure what race the baby would be, but found a lovely couple who was happy to have a baby regardless of circumstance. The mother of the baby and the adoptive couple were both Caucasian, but the baby had a chance of being Caucasian, or a mixed African American or Hispanic race. The adoptive parents were fully aware of not only this but also that the birth mother could see her baby and change her mind about the adoption at any time leaving the adoptive parents bereft and emotionally spent.

Upon the birth of a beautiful Caucasian/African American baby girl, the mother held her baby close, smelled her, kissed her and then asked the adopting parents, "Do you want to hold your baby?" There was not a dry eye in the room.

At discharge the birth mother hugged the adoptive parents and said, "Thank you for adopting my baby. I know you love her and will give her a good home."

This epic event gave me pause and much to contemplate. If 4 rounds of IUIs do not work, would I be able to give up my dream of having my own biological child and adopt? Would I be able to love another person's child as my own? Would I fall instantaneously in love with a baby as this couple did?

After much soul searching into the deep abyss of hidden feelings, I came to the conclusion that I could not.

I really, truly want to experience it all - conception, pregnancy, labor and delivery, breastfeeding, sleepless nights - the whole kit and caboodle. I know I would be giving up my entire dream if I adopted.

I also cannot imagine that I could love a stranger's child as my own. I see babies born on a daily basis and whilst they are sweet, cuddly and precious, I am not in love with them nor do I feel an emotional connection to any of them. It is hard for me to imagine feeling that same unconditional love and joy for an adopted baby as I see parents express for their own children. There is something to be said about that bond that is formed during pregnancy and the emotions experienced at birth - all of those mechanisms, hormones and emotions link the mother to the child intuitively. I know a bond can be created with an adoptive relationship, I just do not know how it is formed.

I do know that I would not love a child instantaneously. Maybe it would grow over time, but I do not see in myself the same characteristics that this couple had. I have several friends and patients who have adopted and I admire them greatly. They love their adopted children unconditionally and as their own, and for those that also have their own biological children, there is no difference between how they love and treat the children. In my family, I have seen several family members treat their adoptive children and step children differently, and in the case of the step children, horrifically. I know I could never treat a child cruelly but I worry that I would not love an adopted child enough, completely.

My heart does hurt for all those children waiting to be adopted, especially in countries like Russia and Romania where they are failing to thrive due to a lack of love and human touch and solely existing on boiled fruit juice and a couple spoonfuls of food a day. I wish I could love and help them all, but realistically this is not possible.

After looking at countless pages of babies and children waiting to be adopted, I started to wonder why there were not more people willing to adopt. But after looking into the costs for adoption, I understand a bit better. I found that the cost for adopting vs IVF is virtually the same (oftentimes adoption fees are even higher than IVF), and with IVF, parents are given the chance to go through pregnancy and have their own biological child for the same price, if not less. It is no wonder more people opt for IVF over adoption.

This was definitely a challenging soul searching journey that brought up many ugly realities that I was saddened to face. In the end it left me feeling morose and worried that we may not be able to have our own biological children.

If only we could see what the future holds!

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!