Wednesday, November 28, 2007

"Infertile. Please be sensitive."

I've been staying away from my blog the last two days mostly because work has kept me really busy and I honestly haven't thought about it too much (too much is a relative term). That is until this afternoon when I showed up for my dentist appointment and there was the hygienist freshly back from her maternity leave with brand new baby pictures all over her work station. Lovely. She also looked about 10 years younger than me (or maybe that's just my bitter brain at work).

She asked if I've had any health changes since my last cleaning and as I answered "no," I couldn't help but think that my last cleaning was 6 months ago and not much has changed since then (or, come to think about it, since the one prior to that a year ago). Sure, we've moved on to IVF and have 18 embies on ice, but we're still not pregnant. We still have not had a chance to get pregnant since we started IVF and we still don't have any answers as to why this is.

The experience was topped off with a fun discussion as I was getting up out of the chair to leave:

The Hygienist: So are you doing anything tonight?
Me: Not really, just going to go work out and then probably do some work.
Her: Oh, I can never find time to work out and I really need to lose this pregnancy weight. Do YOU have kids?
Me: No. (bite my tongue and hold back a million things I want to say but I know it wouldn't be fair to her)
Her: I just never seem to have any time now that I have a BABY! just exhausts me. Yet another circumstance of someone meaning absolutely no harm and, yet, having no clue how much their words hurt. Sometimes I think it would be easier if I walked around with a hat or a tattoo on my forehead that says "Infertile. Please be sensitive."

Here's the good news-my teeth are clean and no cavities. At least one part of my body is doing the right thing.

Sunday, November 25, 2007

Deep Thoughts (yes, I occasionally have them) - Warning-possibly offensive

Hopefully I won't offend anyone with this post. If at any time you start getting the slightest bit offended, please stop reading.

Having called myself "pro-choice" pretty much my entire life and, oh, by the way, having a uterus, I'm disturbed by some recent events in my home state. There is a group led by a 20 year old, home-schooled little girl in Colorado that is trying to get a measure on the ballot that would define life as beginning when an egg is fertilized, thereby making "crimes" against embryos prosecutable including certain forms of birth control since it makes the uterus a "hostile environment." This is a cowardly attempt at sneaking in the back door to overturn Roe v. Wade. This story bothers me on so many levels.

First, having grown up in a post Roe v. Wade world, I (and most of my friends) have largely taken for granted our right to choose what happens with our own bodies. It terrifies me to think the next generation (my kids!) could lose this right and grow up in some scary twilight zone flashback in time where women feel they need to resort to back-alley abortions. (Did anyone see that HBO special "If Walls Could Talk?" Scared the bejesus out of me!).

Second, having been very responsible (for the most part) in my younger years, I believe in the pill and in birth control in general. Although it all seems pointless now, I was on the pill for 13 years. And there were reasons other than birth control. Many women use the pill to help regulate their cycles, make their cycles more predictable, and to reduce PMS symptoms. I know having now been off the pill for almost 2 years, that it really did help ease up on the cramping each month and made having a period just a bit more bearable.

Third, having gone the route of IVF, I obviously do not believe that an embryo is a person. Is it "life?" Maybe...well, yes, in a strictly technical sense of the term-in the same way plants are "life," bacteria are "life" (wait, did I just compare our embryos to bacteria?), etc. If put in the appropriate conditions, these things can grow into something I really consider "life." If put into the appropriate conditions (hopefully!), our totsicles can grow into real, live, human beings. But I obviously don't plan on transferring all 18 of our frozen embryos for fear that disposing of them means I'm a murderer. I'm crazy, just not that crazy. And I certainly don't feel like the clinics who do research on embryos and who help conceptually challenged people like ourselves achieve a life-long dream are murderers.

I know this is a really touchy subject, but it irks me that people think they can tell me what to do with my body and with the "fruits" of my loin. I find it particularly disturbing that the measure in Colorado is being led by a 20-year old girl (yes, a GIRL! she should know better) who claims God told her to help embryos when she was just a kid. Seriously? What about helping people who are already PEOPLE, who are suffering, homeless, broke, sick, etc.? Come on, kid.

If this measure (or similar measures which are pending in other states) makes the ballot, please, please, please tell me anyone reading this will vote against it.

Saturday, November 24, 2007

Evil B*tch Goes out to Lunch

B and I spent most of the day yesterday shopping for ornaments and other fun Christmas decor for the HUGE fake tree we bought on December 26th last year.  We put on Christmas music and proceeded to hang approximately 200 glass ornaments on the tree, wind garland around the banister, hang stockings, etc., etc.  B said he's never seen a Jew get so excited about Christmas (I'll save the explanation of this for another post at another time).

We were having a grand ole time and felt like we really accomplished something when it was all said and done.  At the end of the night, we sat on the couch and admired the tree in silence.  This is when the evil b*tch invades my head.  I'll call her EB for short.

One minute I'm thinking how completely content I am and how cozy the house feels with all the decorations and the next...well, I'm sure you can guess.  EB takes over and I was thinking about how my transfer should have been done already, I should have completed my bed rest and had a very relaxing week and we should be sitting on the couch, admiring the tree, AND hoping against hope that the FET actually worked.

Surprisingly, I was able to sleep last night even with these thoughts, but when I woke up, EB was not gone and, in fact, had taken up full residency in my head.  B has learned enough by now to know that I'm not mad at him or something he's done, but really just MAD.  I've never felt anger like this in my life--anger that just sneaks up on me, triggered by nothing and lingers on and on.  Luckily I had a lunch set up with Mama Wannabe and had something for both B and I to look forward to (a fun bitch session for me, and me out of the house for awhile for him).  It was a great 3 hour (!) lunch and was enough to shove EB back into the shadows for awhile.  Thanks Mama Wannabe!

Friday, November 23, 2007

Black Friday Baby Store

What time do the stores open today that sell babies? If I knew where one of these stores was, I would camp out there overnight in 20 below weather to bring home a baby. Is that inappropriate?

But seriously, I love sleep WAY too much to get up that early to shop today. Plus I think it would be a little scary to witness other shoppers in their holiday shopping frenzy in the middle of the night. Do you think there were a lot of car accidents early this morning with so many sleepy people on the road in the dark? Or were they all so excited for the deals (the deals, the deals!) that they were wired and wide awake? I'm in awe of these people; they baffle me.

Thursday, November 22, 2007

Acronym Test

I've seen others do this, but can't remember where, so unfortunately can't give them credit. It made me laugh. Hopefully it will make you laugh too.

I asked B to tell me what the below acronyms stand for. To give him a little credit, I don't think he's ever looked at one message board or IF blog.

AF: Always fertile
IUI: In-vitro uterine insert
IVF: In-vitro fertilization
ICSI: I come so insert (what?!)
BFN: Big friggin nothin (how appropriate!)
BFP: Big friggin pregnancy
TTC: Test, transfer, cope
IF: Infertility
2WW: To wish and wait
DH: Damn happy people
RE: Random embryo (huh?)
ART: Another rough testing
BCP: Birth canal part
POAS: Part ovarian all sperm
PUPO: Please undergo partial orgasm
FET: Frozen embryo transfer
HPT: Human papolone transfer (?)
OHSS: One hysterectomy should suffice

Here's what they really mean (for those of you unfamiliar with the lingo):

AF: Aunt Flo (period)
IUI: Intrauterine Insemination
IVF: In-vitro fertilization
ICSI: Intracytoplasmic Sperm Injection
BFN: Big fat negative
BFP: Big fat positive
TTC: Trying to conceive
IF: Infertility
2WW: Two week wait (between transfer & pregnancy test)
DH: Dear husband
RE: Reproductive Endocrinologist
ART: Assisted reproductive technology
BCP: Birth control pills
POAS: Pee on a stick
PUPO: Pregnant until proven otherwise
FET: Frozen embryo transfer
HPT: Home pregnancy test
OHSS: Ovarian hyperstimulation syndrome

Happy Thanksgiving!

Giving Thanks

10 Things I am thankful for (in no particular order):

1. Our family
2. Our marriage
3. Our friends
4. Our dogs

5. Our jobs
6. The roof over our heads
7. Our vehicles
8. TV
9. Heat & A/C
10. Science & Technology

Tuesday, November 20, 2007

A Small Village on Ice

Had our regroup with the doc and we are moving forward with the D&C. The doc didn't seem to think waiting to see if it resolved on its own would do much good. He didn't see the point of trying to move ahead with another cycle, checking the lining and risk another irregularity. Plus, with the shared risk program we are in, another cancellation would still count towards our allowed 3 frozen cycles and we'd be down to 1 left before having to move to another fresh cycle (and having to go through another round of stimulation medications and a retrieval).

We were told that studies have shown success rates increase after D&C's and that some clinics have even begun to include them in their standard protocols for IVF patients. I thought that was a little nuts, but what do I know?

They will also send the tissue to pathology to see if they can determine the cause of the irregular lining as they cannot tell what it is from the ultrasounds. Going ahead with the D&C was a no brainer for us given these two factors (increased success rates and diagnostic testing). Also, insurance will actually cover this procedure (even with us doing it at the CCRM surgery center instead of the hospital), which is a first for us! It's about time those bi-weekly premiums started paying for something. Of course, we will likely still hit our out-of-pocket max this year, but at least there is a max in our plan.

We scheduled the D&C for December 10th (with pre-op appointment on the 7th). I wish we could have gotten it out of the way sooner, but the doc didn't have an opening until the 4th and I will be too busy at work that week to fit it in. The doctor confirmed that recovery is pretty simple and that most people are able to go back to normal activity the next day. I'll reserve judgement for December 11th as they say the same thing about retrievals and that certainly wasn't the case for me.

Once we do the D&C, we wait for AF to arrive and then start another FET cycle. So we are definitely looking at early 2008 for our next shot at this. I know in the grand scheme of things, waiting another couple of months isn't a big deal, but every set back is hard to take and the waiting is miserable. I've never been a very patient person, so this process has been a true growing experience for me. It is hard to live your life and make plans when you are waiting for a cycle to start and can't predict when it will occur.

I thought I'd go out on a limb and ask the doc what his thoughts were about mandated insurance coverage for infertility treatments and why Colorado wasn't one of the 15 states that mandates this. He wasn't at all interested in discussing that topic, has no interest in politics, and no time for it. Not surprising I guess, but I found that a little disappointing. I guess there is no incentive for the doctors to care whether or not insurance covers the procedures they perform. It's not like he has a lack of patients because of it--his schedule is always booked.

The doc did think that thawing 9 instead of 6 probably makes sense. He said "we have a small village on ice, we've got to do something with them!" Then he made some comment about the embryos getting antsy, making noise, rattling the cages, and disturbing the other embryos. Apparently he thinks our kids are trouble makers, even at the embryo stage! Strange man.

Monday, November 19, 2007

Pictures of my niece, Katie

Pre-Regroup & a Sweater

I'm getting a little nervous for our regroup tomorrow, so thought I'd make a list of questions for the doc.

1. What does he think the "irregularity" in my lining is and what caused it? Could it be a polyp? Could it be cancerous? Will it grow back after a D&C?
2. Why couldn't we see it on earlier ultrasounds?
3. Could we have predicted trouble with my lining thickening on the meds given earlier similar issues with the IUI meds?
4. What are the chances that the irregularity will resolve in its own and how long would it take?
5. Are there options other than the D&C?
6. If we decide to do the D&C, do we have to wait or can it be scheduled right away?
7. What are the risks of the D&C?
8. Is the D&C just a treatment, or can we use it to do more diagnostic testing?
9. Is the procedure done in the CCRM surgery center?
10. If insurance won't cover it at CCRM, can we do the D&C through our OB's office?
11. How long does the procedure take?
12. What is recovery time for the D&C?
13. What is the plan after the D&C? How long before we can start a new cycle?
14. Will the D&C increase our chances of conceiving (i.e. is it really like "cleaning out the cobwebs?")
15. What does the D&C cost (assuming insurance won't pay for it)?
16. What would you recommend we do differently for the next FET? Can we avoid Lupron? Can we add something to help the lining sooner?
17. Since we only have 2 FET's left in the shared risk program, would you recommend we thaw 9 out of the 18 frozen embies instead of 6 at a time?

So many questions (did I miss anything?)...we're going to get our money's worth out of this appointment. I'm sure the doctor won't have answers to a lot of these questions, but we have to ask, right?

This next thought has absolutely nothing to do with what we are going through, but it's been bugging me. We were at Costco last night and I was buying this super-soft sweater. The guy at the register commented on how soft it was and woman who was putting our stuff back in the cart reached over to pet the sweater as well. Then they kept going on and on about how soft the sweater was and the woman proceeded to comment on every other purchase we were making. Do they teach people who work retail to do this? I mean, if I wanted a commentary on what I'm purchasing, I'd be the one giving it. Good thing I wasn't buying anything embarrasing like depends undergarments or something! Regardless, that sweater is getting a good washing before I wear it.

Sunday, November 18, 2007

My Nieces

Today is November 18, 2007. One year ago today, my niece, Ariel was born and passed away. I'm thinking of her and of my brother and sister-in-law today and hoping they have found some peace in the past year. I hesitated at first to post anything about this today as I didn't want to draw more attention to Ariel's memorial day, but I know she is never far from their thoughts. And I couldn't well post anything without mentioning it because she (and they) are in my thoughts.

Two weeks ago today, my niece Katie was born. I have yet to meet her, but I think of her often and I'm busy making her Hanukkah/Christmas gift so that hopefully it will be done in time to ship to Albuquerque. I think of her future and hope that she will love visiting our house and that B and I will be the "cool" Aunt and Uncle (within the ground rules set by her parents, of course).

We have a regroup appointment with the RE on Tuesday morning to discuss the D&C. I have many questions, but really just don't want to think about it too much until then (yeah right). Each morning when I go into the bathroom, I am confronted by the syringes, progesterone oil, and estrogen patches that I'm supposed to be well into by now. It seems ridiculous to want to take more shots, but I do because it would mean being one step closer to finally achieving our dream. I've decided that I am going to pack these supplies away into the box they came in and put them somewhere out of sight until I need them again. I'm tired of looking at them and wishing...

So that's what I will do today along with maybe cleaning out the pantry and grocery shopping for Thanksgiving (and throw in some football watching).

Perpetual State of Waiting (warning-long post)

I'm joining the blog bandwagon because I can't sleep. This isn't a toss and turn for an hour not able to sleep. It is a wide awake for who knows how long, there are now infomercials about infomercials on my 600 channels of Directv, can't sleep. I've found numerous forums for venting my frustrations over the last (almost) 2 years, but this one is comforting because it is utterly selfish. A virtual "dear diary." I have G and K to thank for enlightening me to the convenience of blogging.

A little over a year ago, B and I came to terms with the fact that we may not be able to conceive naturally. This wasn't an easy thing to accept since our diagnosis was "unexplained infertility." B's guys are healthy, my natural reproductive system is as reliable as a swiss watch, and still...nothing. I never realized that "unexplained" could be considered a diagnosis. Doesn't a diagnosis mean they've pinpointed the problem? In the world of infertility, "unexplained" means medical science, as advanced as it is, cannot determine what is preventing us from conceiving. The medical profession's way of dealing with this little dilemma is to experiment. Here is a (not so brief) synopsis of our experiences with infertility treatments.

Science Experiment #1 (and 2, 3, 4, & 5): The intrauterine insemination ("IUI"). In this procedure, the man's sperm is collected ( nature, some of these posts may be graphic and as any infertility patient will tell you, any privacy or prudishness was dropped at the door of the infertility clinic, so welcome to our world of not-so-private parts). If I had any artistic ability whatsoever I would insert a cartoon here of a couple dropping their private parts into a box at the front door of the clinic.

The clinic takes the man's "sample" and "washes" it to remove debris, dead cells and any guys that aren't swimming. The sample is then placed into a catheter which is inserted inside the woman and deposited in her uterus. An IUI is meant to provide a little help to get the sperm where it needs to be in order to fertilize the egg. Of course, it doesn't solve all problems such as blocked tubes, inability for the sperm to fertilize the egg, or problems with implantation of the embryo in the uterine lining.

Most reproductive endocrinologists ("RE's") recommend no more than 4-6 tries at IUI's because the success rates diminish to nothing at that point. We spent our 5 (I think) tries at IUI fervently wishing it would work because we didn't want to move to the next step.

Science Experiment #2: In-Vitro Fertilization ("IVF"). During IVF, a woman injects herself with multiple medications on a daily basis to stimilate both ovaries into producing multiple, similar-sized, follicles. She undergoes numerous vaginal ultrasounds and blood tests (requiring daily visits to the clinic) to determine when the timing is exactly right. When the time is right, she takes a "trigger" shot which prompts the follicles to mature in precisely 36 hours. Exactly one hour before this is to occur, she undergoes a surgical procedure whereby a long needle is inserted through the vaginal wall into each ovary to carefull suck out each egg one at a time. The embryologists then look at the eggs under a microscope to determine if they are mature and then combine one egg with numerous (I think it is in the hundreds of thousands) sperm to see if it will fertilize. The woman begins estrogen and progesterone therapy in addition to an antibiotic and baby aspirin to prepare her body for pregnancy. The eggs that fertilize (embryos) are monitored to see if they will begin growing (i.e. through cell division) and the ones that look the most promising are placed into the woman's uterus (referred to as the "transfer") using the same procedure as an IUI.

Science Experiment #3: Intracytoplasmic Sperm Injection ("ICSI"). For cases where the sperm isn't up to par or (lucky us) in cases of unexplained infertility, the embryologists will manually inject one sperm into an egg to help the fertilization process.

Detour on the road to the science fair: In some cases, the ovaries can become over stimulated causing a syndrome known as Ovarian Hyperstimulation Syndrom ("OHSS"). OHSS can cause fluid retention in the abdominal cavity, nausea, vomiting, and bloating among other unpleasant and possibly dangerous symptoms. The ovaries become abnormally enlarged and tender. One of my fellow infertility ("IF") pals described the feeling very eloquently as "walking around with tennis balls in your sides." If OHSS becomes an issue, the transfer is cancelled and all viable embryos are frozen for possible future use. In our case, our first "fresh" IVF cycle resulted in 27 follicles (yikes!), 20 of which matured and 18 of which fertilized with the help of ICSI. However, along with a great response to the medications came OHSS and an estradiol level of 10,000 (which is quite high, can be dangerous, and would have gotten higher with pregnancy) that landed me in the emergency room 3 days after our egg retrieval. The cycle was cancelled and all of our 18 embryos were frozen. This was back in mid-to-late September.

Science Experiment #4: Frozen Embryo Transfer ("FET"). For this procedure, I started with a pack of birth control pills (ironic, isn't it?) to regulate my cycle, added some more injections to suppress my ovaries, and began estrogen therapy to build up the lining of my uterus. If all were to have gone as planned, some of our embryos would have been thawed, monitored for growth and 1 or 2 transferred into my uterus. Success rates for FET's are not as high as those for fresh IVF cycles, but they are still worthwhile and the cycle is generally much easier to handle (at least physically). Unfortunately, my lining was not cooperative (it is so frustrating when your body does things out of your control and without your knowledge) and our transfer date was moved back twice (which meant more shots and more hormones). Just as we were approaching another possible transfer date, the most recent ultrasound showed an "irregularity" in my uterine lining. The RE is now recommending a procedure to clean out the lining before we can start over.

Detour from the detour: Dilation & Curettage ("D&C"). In this procedure, under general anesthesia, the cervix is dilated and the inside of the lining is carefully scraped to "clean out the cobwebs." The hope is that after the D&C, the lining will grow back normally and allow the embryo(s) to successfully implant upon transfer resulting in pregnancy.

I'm sure by now (if you're still reading), I have either put you to sleep, grossed you out, or given you nightmares and I apologize for that. Nothing about the disease of infertility is pretty or proper. That being said, I am usually willing to talk about this because I don't believe it is anything to be ashamed of or that we did anything to bring this on ourselves. We are lucky because we have an opportunity to benefit from medical science and because our family and friends are very supportive. And another positive thing that has come out of this process, I've overcome (mostly) my fear of needles and realized that I am brave and strong.

On that note, I'll sign off for the night (I think I'm finally starting to put myself to sleep with this long-winded post) and send some positive thoughts to our 18 frozen embies. May they someday (some of them) go from being freezer buns to buns in the oven.

Thursday, November 1, 2007

Wondering what the acronyms mean?

2WW = Two week wait (between transfer and pregnancy test)
AF = Aunt Flo (period)
ART = Assisted reproductive technology
BCP = BIrth control pills
BFN = Big fat negative
BFP = Big fat positive
CCRM = Colorado Center for Reproductive Medicine (our clinic)
CD = Cycle Day (CD 1 is 1st day of period)
D&C = Dilation & Curattage
ER = Embryo Retrieval
FET = Frozen embryo transfer
HPT = Home pregnancy test
ICSI = Intracytoplasmic sperm injection
IF = Infertility/infertile
IRL = In real life (as opposed to virtual life online)
IUI = Intrauterine insemination
IVF = In-Vitro fertilization
OHSS = Ovarian hyperstimulation syndrome
PIO = Progesterone in oil (injection)
POAS = Pee on a stick (i.e. home pregnancy test)
PUPO = Pregnant until proven otherwise
RE = Reproductive Endocrinologist
SA = Semen analysis
TMI = Too much information
TTC = Trying to conceive