My Stork Got Lost

Nothing super new to report this time around.  I had one, maaaybe two follies that would ovulate.  I got my surge yesterday and went in this morning, and sure enough, there they were, plain as day on the ultrasound.

A bit of good news – after all that hullabaloo last month with Quincy…no, he never went to the doctor.  Or even made an appointment.  We worked out a compromise.  We both decided to treat last month as a fluke; he was nervous, whatever.  So we agreed that we’d try again this month, and if he had any more problems at all, he’d make that appointment with the urologist.

We tried something else, too.  I had read that, just like women can take Robitussin or Mucinex (anything that’s guaifenesin) to increase fertility-friendly CM, men can take Sudafed (or the generic pseudoephedrine or phenylephrine) to increase their…uh…volume. Naval fleet.  Strike force commandos. Swim team.

So a few days ago, he started taking Sudafed before bed.  I dunno if it was that or that last month was a fluke, but he had no problems today.  I think he was more relieved than I was.

So, yeah.  Two follies.  No problems with swimmers.  No ovulation yet, so we go back and try this again tomorrow.

 

Awww. My doctor missed me, which puts a smile on my face even though this post is a hard one to write.

Come to find out, I was supposed to go in to her office 14 days after my IUI – on May 29 – for a beta test.  Well, no one told me that.  Whups. I think Dr. Koopersmith thought Dr. Landay covered it before the IUIs, and Dr. Landay thought Dr. Koopersmith was going to tell me when I had the procedures done.  Ah, well. In the overall list of crazy mixups that have happened to me with various doctors (who shall remain unnamed…Dr H…), this was minor.

I didn’t call until I officially got my period.  I kept getting negatives on my tests at home, so I just waited for my period. She said she was about to call me yesterday and check in before she saw my name on her schedule this morning.

Here’s where the bad news comes:  I needed to come in for a beta test because home tests aren’t reliable.  They don’t ever trust them.  Ever.  Home tests are qualitative, meaning they measure if and only if the HCG is there, whereas beta tests are quantitative, meaning they can measure the precise amount of HCG in your blood stream.  Way more accurate than peeing on a stick.  They can pick up literally ONE mIU/mL, whereas home tests can only first detect hCG around 25mIU/mL.

I was using the cheapie internet sticks, because you can buy them for like a nickel each, and avoiding the First Response Tests, because while they have a sensitivity of as low as 6.3 mIU/mL…they’re expensive.  Like, eight bucks a pop, if you buy them on sale and mortgage your house.

Anyway, why did I need to come in?  Because I have such a regular period…and I was super late…and while we can’t prove it since I didn’t friggin’ come into her office, Dr Landay is fairly certain this was another chemical pregnancy.

Well, crap.  I didn’t know.

This isn’t like before.  I NEVER got a positive test at home. I may have had “signs” that I chose to ignore, but I didn’t feel the same way as back in September/October. It sucks, sure, but I think I’m dealing with it well enough.

Let me say this, first and foremost:  My Dr T was right.  It sucked that I got that cyst/rupture/torsion thing, but I’m completely in love with Dr Landay. She’s the best.

Anyway, moving on to notes from today’s baseline reading:

I now have seven follies.  Five on the right, two on the left.  So, they switched.  Usually my left ovary has four and my right as two…so I guess the hormones are working?  Kind of?? I grew one more than I’ve ever had, but still I’m supposed to have between 25-29. So 7 is…depressing.

She also mentioned the dreaded words.  Hormone injections.  I only grew two mature follies last cycle on Clomid, and they were both small.  Mature follicles should be between  20-25mm, and mine were only 16mm and 19mm. So, if the IUI doesn’t work this cycle, we’re adding injectable hormones to my slurry in July.  Oh yay.

I’d take the Clomid CD3-7, and then starting on the 8^th day until I ovulate I’d have to shoot myself in the tummy.  So let’s please please please pray it works this cycle. I don’t like needles.

We’re moving forward, meaning I’m back on Clomid tomorrow. Same dosage.  Oh, joy.  Because crying at random stuff and hot flashes make a girl feel special.

Random things I’m crying about today:

• injectable hormones
• only 2 follicles on my “good” side
• the $1350 bill I just had to pay to the clinic
• overall feeling of dread that I’ll go bankrupt before this works
• one of my critters ate my favorite wedge this morning and left it lying in pieces right in front of our pet camera, like he was proud of it

Okay, I guess those aren’t nearly as random as coffee and raisinettes, but give it time.

I really need a drink.

Well.

Officially out today. On CD 33, I finally got my period.  Which is technically like, 5 days late for me. I knew it was a no-go, I’ve wasted so many tests since the day my period was late.

My temp stayed really high until yesterday, which did give me a little hope, but I guess BBT isn’t always accurate.

Everything I’ve read says that BBT should drop 14 days after ovulation.  If it’s still high 18 days past ovulation, it’s a tell tale sign of pregnancy…and mine dropped the 18^th day. And I had a CLEAR triphasic pattern.  Like, textbook.  And my cervix was still super high. And I was cramping and exhausted since 8DPO.

But what do I know about this crap, right?

Everyone says that no matter what those little POAS strips say, you can’t know for sure until you get your period.  Well, I got mine.

I called my doctor to let her know it didn’t work.  I’m going back in for another baseline ultrasound tomorrow and we’ll do this all over again.

This is an uncomfortable post to write, but it’s really on my mind and I’m completely stressing out about it.  So, be forewarned…TMI here.  Way, way too much.

We had our first IUI on Saturday.  It went pretty great, as far as I could tell.  However, I had not ovulated yet, and when you go in for an IUI and haven’t released your eggs, they recommend doing another IUI the following day.  That way, you’ll be inseminated the day of and the day after your ovulation, which greatly increases the chance of success.  Before the eggs are released is always ideal, so the sperm can already be hanging out in the uterus when the egg arrives.  Sperm can swim around in the uterus for about five days, but eggs are fragile.  Once they are released, they live twelve hours, tops.  So, pre-ovulation IUIs are the best.

But, to optimize your chances of getting pregnant, if you still have follicles when you go in for the first IUI, they recommend a second procedure 24 hours later.  This is fine.  I’m totally on board with this.

On Saturday, I had places to go after the IUI so Quincy collected his specimen at home, and then I brought it with me to the clinic.  This is totally fine, as long as it arrives within an hour of the…deposit…we’re good.

Sunday rolls around. Yesterday.  Quincy goes to collect his baby juice…and nothing comes out.  I don’t mean that he couldn’t…ya know. I mean he did, but nothing came out.

Major freak out from both of us.

By now, I’m running late to the appointment so Quincy comes with me, hoping he can try again at the office and get something to work with.

I’m panicking the entire way to the clinic.  I know we had a good IUI yesterday, no problems, and this is only an insurance run. But it brings up a bigger issue of possible male infertility.  What if times in the past, we tried and there was no sperm? Argh.

Anyway, he goes into their little room and tries again, and got a tiny, barely noticeable amount in the cup.  Dr Koop said she could work with it and put it in the wash.  After the wash was complete, however, there were only a few live sperm swimming around.  I asked her how many, and there were so few the computer couldn’t even count them.  She tried to make me feel better by saying we only needed one, but seriously.  If out of literally millions swimming around we have problems conceiving, it seemed kind of a waste of $600 to try the IUI with literally only about a DOZEN.

Thinking about it, I wish we would have just cancelled the IUI yesterday and saved ourselves $600.

Dr Landay called today to talk about the “issue”.  She’s referring Q to a urologist to see if he has any blockages. He hates doctors and I know he’s not going to want to go.

I feel sick.

Okay, people!  Here it is!!! IUI #1 is in the books!

Oh, boy, where to begin?  Well, first of all, it’s Saturday.  And it’s late.  And I had an amazing day, which may or may not have included alcohol (it’s okay, I asked my doctor about it.  Chill.)

First of all, I got my surge yesterday and called in.  This is Dr. Koopersmith’s weekend, so I was scheduled for 9am today for our very first insemination!! Since it was a Saturday, Quincy was able to…er…do his part… at home, and I arrived at the office specimen in hand (well, in a cup, because ick). Dr. K immediately put it in to wash.

To wash.  I know.  Sounds bizarre.  This may get a little gross.  Bear with me.

So, injecting straight baby goo directly into a uterus is not a bright idea.  There’s a lot of other, uh..stuff…mixed in with the swimmers and shoving everything up inside a nice sterile environment like the uterus is a recipe for infection.  Usually, there’s a nice little cervix and some slimey stuff to keep everything except the little swimmers out of The Great Beyond. So, they need to wash it.

I know, I’m super technical.

Anyway, once everything was cleaned, concentrated and ready to go, we did another ultrasound to see if I’d ovulated yet or, if not, how large my follies were.  I had not, and I had one decent follie and one that she described as “meh.”  It was below 20mm, and while they’ve gotten successful pregnancies with smaller ones, size really does matter.  Bigger is better.  Insert your own punchline here; I’m tired.

Anywho, we proceeded with the actual insemination.  It was..uncomfortable, but not necessarily painful.  And I think the only reason why I felt anything at all was that my cervix was closed and she needed a little extra maneuvering to get the little turkey baster up there. (Catheter, whatever.)

Which brings up an interesting point.  My cervix was closed.  On the day of my ovulation.  This may be another reason why I’m not getting knocked up.  Swimmers can’t swim upstream if the dam isn’t open.  Dam it.

(See what I did there?!?! I’m cracking myself up.  Too much port wine…)

So that was it.  Ten minutes with my butt propped up and we were finished.

Oh, I forgot to mention that I arrived at the clinic fully decked out like an extra from Robin Hood.  See, my best friend’s birthday was yesterday, and months ago, we all decided to celebrate with her at the Renaissance Pleasure Faire.  And if I’m gunna do something like this, I go full out, head to toe cosplay.  Because.

And yes, I am convinced Dr K thinks I’m crazy.  She was all like, “Hey, I get it, man.  You just, ya know…you do you.”

She may not have actually said those exact words, but it’s been a long day.  But I did ask her if it was safe to eat, drink and be merry at the Faire, and she assured me that I could do whatever.  And boy, did I.

We go back in tomorrow to do this all over again.  Without the cosplay.

 

Had my doomsday ultrasound this morning – to see how many follicles I grew on Clomid and whether we could proceed with insemination.

But – my first big hurdle has passed!  We had to make sure that:

• the Clomid grew follicles
• I didn’t hyperovulate and grow too many

I have three follicles!  She said that’s good, she can work with three.  They’re not mature yet, they’re about 12mm, which is small.  They have to be 20mm to ovulate, so I’m a couple days away.  I’m to keep testing and call when I get my surge, and no matter what she’s scheduling me a Saturday appointment, and possibly Sunday.

Anyway, follicles.  Follicles grow and release eggs when they mature. She said one could mature, or all three.  She won’t know until it happens.  The chance of triplets is VERY SMALL – less than 1%…but if all three eggs mature, we could maybe have twins. Still a small chance, less than 8%, but it’s there. Not really wanting twins, but 2 is better than none.  I’ve been reading and most women who grow less than 4 mature follicles only have one baby.  It’s when four or more mature that you could start thinking multiples.

We’re still under doctor’s orders to hibbidydibbidy every other night and call when I get my surge.

Looks like we’re good to go for my first IUI!

 

 

Random ass things I’ve cried about this week:

• Homer loves Maggie Simpson
• Raisinettes are tasty
• Coffee is amazing
• My puppy snores
• My nephew had a birthday
• My little niece is turning 6
• A little boy hugged a dog

 

No symptoms, she said.  I’ll be fine, she said.

So, yesterday, I had my CD2 ultrasound.  She verified – again – I only have 6 total follicles.  2 on the right, 4 on the left.  Not ideal, BUT – she finally got my AMH level back.  AMH is a hormone that is produced by the ovaries and shows your ovarian reserve.  She said for women my age, she likes an AMH level of 1.2.

Mine was 2.25.  Meaning, even though I don’t have follicles, I have a huge supply of eggs remaining. Which makes sense, I guess…my body isn’t producing follies, so the eggs just chill out in my ovaries all microscopic and stuff.

This is really good news. Clomid actually helps to create follicles.  My eggs aren’t the problem, it’s the…transportation?  Getting them from the ovaries.  This is where Clomid comes in.

Clomid is what they call an estrogen inhibitor.  It blocks estrogen from being released in your brain, which tricks your body into thinking there’s not enough estrogen to mature eggs. Which sets off a chain reaction.

It causes your body to release a TON of estrogen, which is what gets the eggs ready to mature, and then that estrogen creates a TON of FSH, which creates a bunch of follies, which in turn, makes TON of luteinizing hormone (LH), which actually triggers ovulation.  Why is this such great news?!?!

Because all my tests have come back so good, and my follies really seem to be the only problem…

Dr. Landay sees no reason to wait until June for an IUI.  We’re proceeding.

THIS. CYCLE.

Holy cow!  I was expecting it in June, but to have it moved up a month…this is so amazing!!!

So, knowing that, I got my prescription for Clomid yesterday (!!!). I take 100mg daily  – at the exact same time – for the next 5 days.  There are supposedly side effects – sore boobs, cramps, headaches.  PMS-like symptoms.  But I took the first two tabs at 7am and I still feel fine. So, we shall see.

Anyway, on CD8 (the day after I stop Clomid) – two things happen:

1) I start testing every day between 10am-3pm for my LH surge with the ovulation predictor kits.

Why in the afternoon?  Because I can call in and SCHEDULE MY IUI!!!

2) Even though we are PROCEEDING WITH IUI!!!! Quincy and I still are under doctor’s orders to hibbitydibbity every other day from CD8 on. It’s hilarious that we will be under doctor’s orders to monkey around. He gave me the Vulcan eyebrow when I told him that.

Deep breath! The big test is next Wednesday, May 11.  This *should* be right before my LH spikes.   I go in at 8am for another ultrasound, where she counts my follicles again to see how many the Clomid produced.  If I made too many, she has to cancel the IUI – can’t risk having multiples. But if it only created 1 or 2 more, we are go for launch.  If it didn’t make any more, I may have to switch to injectable Clomid next cycle. Ick.

Barring any bad news on May 11, I continue testing for my LH spike (which, I know my cycle, it’ll occur either the 12^th or 13^th), and I go in the very next day with Quincy for the insemination.  She does another ultrasound that day, too, to see if I’ve ovulated or am just about to ovulate. If I’ve already ovulated, she only does the one IUI.  If I’m just about to ovulate, we inseminate that day, and I go back in the next day for a second IUI.

So, with a little luck…I’ll get inseminated either May 13^th or 14^th. Possibly both.

Oh man oh man oh man!

Some facts:

Chances of successful pregnancy through insemination using Clomid is 16.4% for the first cycle, 39.4% through the first three cycles.  After that, it drops to 1%. Basically, if it doesn’t work the first three times…it ain’t gunna happen.

Chance of TWINS with Clomid/IUI is only 8%.

Chance of TRIPLETS or HIGHER is less than 1%.

So I’m not worried about that.. even though my sister WANTS me to have twins..eesh…she can pay for double day care!

Okay, so the hydrosonogram was a cake walk compared to the HSG.  Just a little moderate cramping, nothing at all like the HSG, no vasovagal reaction, no passing out.  It was over in a couple minutes.

Then she went over my FSH levels.  They are NORMAL!!  Also, no antiphospholipid antibodies.  She rechecked my HSG, NORMAL!!  No obstructions.

My ONLY diagnosis right now (she’s still waiting on AMH levels from the lab, they tell her how many eggs can mature) is decreased ovarian reserve, which isn’t the end of the world, as long as eggs are still releasing. Oh, and low progesterone, which is 100% treatable, she said it’s not even something to worry about.

Moving on…she received Q’s SA from one lab.  He had decreased volume (TMI, sorry, but the next part is super cool).  Normally, the volume is 2, his was 1.5.

BUT – she said it was “literally the best report” she’s ever seen.

Motility – how the guys move – is supposed to be 5%.  That’s normal.  “Excellent” motility is 14%.

His was 19%.

Concentration – how many soldiers are actually swimming around – is supposed to be 20.   “Excellent” concentration is 40.

His was 121. One-twenty-freaking-one!!!!!

Morphology –  how they look, how their heads and tails look – his number was off the charts. They’re all really healthy and not deformed in any way, perfectly shaped swimmers. So he officially has medically diagnosed SUPER SPERM. Because he needed another ego boost!!

Even better news –

She sees no reason for IVF at this time!!  We can do IUI.  Intrauterine insemination, where they take Q’s super sperm, wash it, concentrate it, and basically turkey-baster it up my vadge directly into my uterus on the day of my ovulation. Which is $800-$1400 per cycle…not $20,000. She wants to try a couple cycles of IUI and see where that gets us.

So, moving forward.  She wrote me a prescription for DHEA, it’s a supplement to help my ovaries produce mature eggs.  She said I may get a little acne, but it’ll be worth it. It takes 3 months to really be effective, so we’re starting now, in case we end up having to do IVF in a couple months, depending on where IUI gets us. But we’re not thinking about that yet.

Starting first day of my next cycle, around April 29^th, she’s putting me on oral Clomid.  It’s a fertility drug that causes me to release more eggs (2-4) when I ovulate.

She’s going to monitor me during May, see how many eggs I release, etc, and then either keep me on Clomid or switch to injectable (ew) Clomid if I’m not releasing enough eggs for her liking. Then the next month…JUNE!!!…Quincy and I both go to the office first day of my ovulation, Q’s parties into a cup, and she will inseminate.

Right then. In June.  Around June 12^th. Omg this is really happening.

I had my consult with my new fertility specialist this past Monday but I’ve been so slammed at work I didn’t get a chance to update anyone. So, here’s the skinny:

Her name is Dr. Landay.  I am absolutely, 100% in love with her.

I’m not exactly sure what I was expecting when I walked in, but I was blown away.  It was a quiet office on the second floor of an unimposing building in Sherman Oaks.  There were fresh flowers in a vase on the coffee table, surrounded by two super comfy couches and a couple of arm chairs. And a Keurig coffee machine sitting on an end table.

If there wasn’t a receptionist’s window to my right, I wouldn’t know I was in a doctor’s office.  It felt…homey. Very comforting, not at all sterile and stark like I imagined a fertility clinic to look like.  It took only a few minutes to be called into my consult, and my first impression of Dr. Landay and her entire staff is, simply, “wow.”

First thing we did was discuss how long Q and I have been trying. I told her that we decided when I was 25 that we would stop using contraception, and if it happened, fine….then we started actively trying September 2012 (when he proposed). She was a little shocked to learn that we’ve been unable to conceive in nearly 9 years of unprotected sex. That’s when she broke it down for me:

Every month of ttc naturally, there’s a 20% chance of pregnancy within the first year. Meaning most normal couples get pregnant within 5 months of trying.

After that, from months 13-24, the chance of getting pregnant drops from 20% a month to 3% a year. Yes, a year.

After the second year of trying and not getting pregnant…conception rate plummets. To less than 1% lifetime.

Life. Time.

That hurt, a lot. But it was also a little easier knowing that all these years, Q and I haven’t been doing anything wrong. It’s just not going to happen…without fertility treatment.

She took my complete medical history. I walked her through my really lupie years, switching to gluten free, my cysts, the miscarriage, everything.  Then she started asking a bunch of questions – if I worked out, how much I worked out, how many servings of fruits and veggies I ate a day, if I drank coffee or any other caffeinated beverages, etc.

Oh, and apparently having less than one drink a month doesn’t actually count as “drinking”. The more ya know, right?

She set up a plan, of sorts. I just happened to be on cycle day 23, which was the perfect window the check my progesterone level. Progesterone is only released after ovulation, so a progesterone level of 3 or higher means you definitely ovulated. A normal progesterone level for a week after ovulation is greater than 10.

Mine was 8.4.

A little low…more indicative of 5dpo when I was actually 11dpo. But, proof positive eggs are getting released. But…they can give me progesterone. It’s fixable.

(And YES, they already called and gave me my test results.  The very next morning.  I got an actual phone call from the fertility coordinator, explaining my results and what they meant. I was shocked.)

Anyway, back to the appointment. Because of my auto immune history and miscarriages, she also checked my antibodies and thyroid. Antiphospholipid antibodies (common in auto immune patients) will cause miscarriages, but it won’t explain infertility.

I’m waiting the results of all those tests (she drew 7 vials of blood and had to send those off to another lab).

Next week, on my next cycle day 2 or 3, I go back in for more blood work and an ultrasound. She’ll check my FSH level (follicle stimulating hormone, what causes eggs to mature), my AMH level (anti-mullerian hormone, it shows the overall “ovarian reserve” – how many eggs are still left in your body), and the ultrasound will tell her how many follicles I actually produce each month.

FSH levels should be between 10 and 20. The more FSH your body needs to produce to mature eggs and ovulate, the less likely you’ll have viable ovums that can implant. Also, an FSH level of more than 20 means you’re in perimenopause. So I’ll know more next week once I get my period.

Lastly (for now), some time between cycle day 5-9, I go BACK in for a hydro sonogram…where they stick a catheter up my cervix, fill my uterus with water, and look around for cysts, polyps, endometriosis, anything that will interfere with implantation. Supposedly, it’s less “uncomfortable” than the HSG.

Super Fun.

She also added to my vitamins: in addition to the prenatal+DHA vitamin I’ve been taking forever, she also added 1000mg of calcium and 1000 IU of vitamin D, daily. And a new hormone supplement called DHEA, which stabilizes/boosts hormones. It takes about 3 months to really start working, so it’s technically prep for IVF, if needed.  But we’re hoping I don’t need that.

I think that’s about it. Once she gets the results of all these tests and procedures (she asked for the images from my last ultrasound and HSG with Dr H), we’ll talk about which treatment option is best.

The entire appointment lasted nearly three hours.  THREE HOURS.  She sat there and talked with me, listened, wrote down notes, explained everything…it was amazing.  There’s a ton of treatment options out there that we try.  I don’t feel so alone any more.

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