Sunday, November 18, 2007

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.


Jen said...

Welcome to the world of blogging! And yeah, you'll find there is never too much information!

I'm thinking of you during this crazy long waiting!

Meg said...

Welcome to this wonderful world of blogging, I am rather new myself and have found it a great resource of information and a great community of people here to listen and is great that you have joined.....