Our Infertility Game Plan

I decided to write down a little Game Plan through the IUI level of treatment. I have no idea how successful this will be at helping me though those difficult days, but maybe leaning back on these things will help.

I am promising myself the following:

-Unless a situation arises which necessitates that we move on sooner, we will complete 5 (and only 5) IUI cycles before moving on to IVF.

-We will begin at the end of Summer 2010. This is purely for financial reasons.

-As finances permit, we will alternate one treatment cycle with one non-treatment cycle. During the non-treatment cycles, we will either try on our own or take a break, whichever we feel like!

-I will take the entire day off work for the IUIs, if able. I'll use this day to just "baby" myself. :)

-I will try to be kind to Ryan throughout this process, even when the hormones are screaming otherwise!

-I will try to minimize unnecessary 'infertility talk' as much as possible, and make my life about more than just makin' babies.

-As hard as this is, I will try not to over-analyze every symptom during the 2-week wait (time between the IUI and the start of the next cycle). To help with this situation, I will plan lots of time with close friends and my hubby, doing fun activities to distract me (nights out, movies, working on our home) .

-During this process, if I am 'not up to' a particular activity or obligation, I will be understanding of this and will not to feel guilty. I will expect that same understanding from those around me. I deserve that.

-I will be there for my friends who are mothers and experctant mothers, but I will also be there for myself. If something is too painful, I will decline to participate or will reward myself later for getting through it.

-We will begin getting our 3 bedroom ready for a child.

-If we experience a failed cycle, hubby and I will treat ourselves to some TLC; this could be a nice dinner out, a couple days away, or a purchase for our house, just something for the two of us.

HSG - The Sequel

From WebMD: During a hysterosalpingogram, a dye (contrast material) is put through a thin tube that is put up into the uterus. Because the uterus and the fallopian tubes are hooked together, the dye will flow into the fallopian tubes. Pictures are taken using a steady beam of X-ray (fluoroscopy) as the dye passes through the uterus and fallopian tubes. The pictures can show problems such as an injury or abnormal structure of the uterus or fallopian tubes, or a blockage that would prevent an egg moving through a fallopian tube to the uterus.
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I had my first HSG in 2004 when we first began infertility testing. We had been trying to conceive for just under a year. Although the tubes were open and clear, it was not a great experience. At the very least, the procedure can be awfully uncomfortable. At most, it is highly painful. Without going into too much detail, I "popped the balloon" and had to start the whole procedure over, which was even worse the second time around.

This time, I mentioned my balloon popping experience to the nurse. She said that she had never heard of that happening before, and that it must be very rare, which made me feel better.

She took an x-ray of my pelvis and left to get the doctor. I studied my x-ray on the screen, and noticed three white spots on the left side of the screen. Interesting... I wondered what those were.

Soon enough, the doctor came in and proceeded to get things ready. He asked me if I had any questions and I asked what those white spots were in my pelvis on the screen. He told me that they were gas bubbles in my bowel and were normal. I tried not to die. I just pointed out, and asked about, potential farts! So embarrassing, especially because he was young, and not-too-shabby-looking. :-/

So we began the procedure. The doctor and nurse were chatting it up about Twilight and first loves. I put my two cents in, but mostly concentrated on breathing. It was a bit painful, but not unbearable. Once everything was in position, the doctor walked around to the side of the bed with the syringe that held the dye solution. He pointed the screen towards me a bit so I could watch and began pressing the syringe slowly.

The catheter was pointed towards my right tube which filled up easily and we watched the dye spill out on the screen. The left tube remained empty. The doctor moved the catheter to point towards the left side. He mentioned that the dye would continue to flow towards the right side, as that is the easiest place for it to go, where the dye was already flowing.

He said he needed to push hard on the syringe to get the dye flowing the opposite direction and flood the left tube. He told me to take a deep breath and he pushed the syringe. Oh my gosh, the pain! My entire body instantly broke out in a sweat and I felt like I was going to throw up. The nurse ran to get a cold compress. But, sure enough, the left tube filled and spilled over. Success!

Afterward, the doctor told me not to worry about the difficulty with the left tube. Sometimes, the catheter forms a suction and it takes some pressure to start it up again. He assured me that both tubes are empty, clear and completely normal!

The nurse made me lay there for a while afterward with the compress on my face. Apparently, when the doctor pushed the dye through quickly, my face had gone white and I guess I hadn't quite recovered yet. She didn't want me passing out trying to get up. After a while, I slowly got up, changed clothes, and it was all over.

I was so fortunate that Ryan had the day off. He was able to go with me and wait in the waiting room. He was so sweet and supportive. Afterwards, he took me to get a Slurpee (it sounded SO good). We picked up some yummy Mexican food and went home. After lunch, I took a long nap. Not a bad day overall!

I will have a follow-up appointment with Dr S to confirm the test results. If today is any indication, it appears we are on track to begin treatments at summer's end.

In the meantime, Dr S emphasized that we have the greatest chance of getting pregnant on our own within few months following the HSG. Forcing dye through the tubes 'cleans them out' and may open them up a bit. So, on the advice of the doc, we are going to try on our own for a few months while we wait to begin treatment. We aren't too hopeful, but we are willing to give it a go!

Down Moments

I hate those down moments.

You know, those times when everything grinds to a halt and your heart suddenly feels like it weighs a thousand pounds?

It comes out of nowhere.

It could be because I overhear people talking about babies or children or pregnancy. It could be because of some commercial I saw or a comment made to me in passing. Sometimes, it happens for no reason at all.

At that moment, it feels like I will never recover: crushing and heavy. Those first few seconds are the worst part.

Then slowly, somehow, I lift myself out of that moment and continue on my day. Sometimes, it just takes a second, sometimes longer. But eventually I get there, and life is normal again.

But, boy do I hate those down moments.

Questions and Answers

Our appointment with Dr S was awesome. This was the first real appointment Ryan attended with me. I cautioned Ryan that Dr S was a very busy doctor, and we'd be lucky to have 5 minutes of his time.

I was so wrong. Dr S came in, jumped up on the table, and proceeded to answer all of my questions, explaining things in detail. He was in with us for a long time. It was really great.

Topic: Testing

What tests do we need to repeat?

In a way, he'd like us to repeat most of them. The Day 3 blood test was done by my primary doc in August 2009, so that one is still valid (I never recorded those results on this blog, but the FSH was 6.6 in that round of testing).

He'd like a Day 5 ultrasound (to verify my ovary's are healthy and cyst-free), and a new sperm analysis. However, these can be completed during our first treatment at the end of the summer.

In the meantime, I have to re-do the HSG. The one test I'd been dreading. It's not the worst thing in the world, I just had a really bad experience last time. I'm hoping this time is better.

What tests other tests should we do? MTHRF? Postcoital? Immune Issues?

The doctor has no reason to believe I have a blood clot issue, but he noted my concerns. He suggests we continue with treatment for now, but leave the option to test for this open in the meantime.

Dr S believes postcoital tests are old news. He feels they don't give you much information, and said most IVF centers have gotten rid of them altogether. Besides, most issues that are discovered with a postcoital test are eliminated by doing the IUI.

As far as immune issues, this was a big subject of debate in the late 80s, early 90s. The immunity treatments are super expensive, and there is some doubt about how much good they do.

Dr S suggests I continue on with the treatment we have planned. He said that these treatments are just as effective for people who have "unexplained" infertility as they are with people who have an identified problem.

Topic: IUI

Is there any value to doing a monitored, 'natural' IUI cycle?

A young, very fertile couple has a 20% chance of conceiving in any given month. Ryan and I have not been able to conceive for nearly 7 years. According to Dr S, this history indicates we have less than 1% chance of conceiving on our own. An IUI increases a couple's chances of conceiving by about 2%. So, if we were to do a 'natural' IUI cycle, our chances would be less than 3%

On the other hand, the chance of conceiving using Gonal-f injections is about 16%. Combined with the IUI, that puts us at 18%, which is nearly as high as the 'young, fertile couple' described above. Upon hearing this, we opted out of doing a 'natural' cycle, and decided to go with the Gonal-f.

How can we control the amount of medication to reduce the chances of multiples?

He plans to use low doses to avoid this issue. He feels the chances are small. Don't quote me on these percentages because I didn't write them down, but I believe he said the chance of a singleton is around 78%, the chance of twins is around 18%, and the chance of triplets or more is 3-4%. So the risk is there, but it's small.

Could we switch to IVF mid-cycle if there are 'too many' follicles and, if so, what is the cost?

Yes, that can be done, and the cost is approximately $7000(!!!).

Does he feel a medicated IUI treatment plan would ultimately be successful?

He was confident that we are great candidates for a medicated IUI. He thinks we should try this for 4 or 5 cycles, and feels we are likely to be successful (although this is infertility we're talking about, so who knows!).

Preparing for RE Consultation

Wednesday is our consultation with Dr. S. It has been three years since I've been in that office. I am beyond excited to be back and to start this next chapter. I have compiled a list of questions / topics that I want to make sure we address. I hope I am not missing anything...

Topic: Testing
- What tests do we need to repeat? Day 3 bloodwork? SA? HSG? (No, not the HSG!!)
- I want to be tested for MTHFR, a blood clot issue
- Should we do a postcoital? We've never had this test, and I sometimes wonder if my body is 'attacking' his sperm? Is there value to doing this test?
- Along those same lines, I have heard that immune system problems can be the cause of many "unexplained" infertility cases. Are there any other tests that can look for these issues?

Topic: IUI
- Is there any value to doing a monitored, 'natural' IUI cycle? Or are the success rates so small, it's not worth it?
- I will not 'selectively reduce', which means we need to tread carefully through the 'medicated IUI' process.
- How can we control the amount of medication to reduce the chances of multiples?
- Would we cancel the cycle if there are 'too many' follicles? Or would we switch to IVF mid-cycle and, if so, what is the cost?
- Does he feel a medicated IUI treatment plan would ultimately be successful? Is this the treatment he still recommends for me personally?

Things to do tomorrow:
- Call blood bank and confirm blood type. (Check! I am O+ and Ryan is O-. I don't believe there is any complications there, but I'll ask anyway.)
- Call Primary Care Physician and collect last year's blood test results (Check! They will fax it over to Synn's office.)

Yesterday

Seventh Mother's Day trying to become a mom and by far this one was the easiest to get through.

Friday, I came home from work to find a beautiful bouquet from Ryan. He's been buying me flowers a lot lately, and when I asked him why, he said he just felt he should show me how much he loves me more often.

The weekend began with a vivid dream that I was pregnant. I was going about my normal life, but with a happiness I've waited so long for. It felt so real, I considered that dream my little inoculation shot to get me though the weekend.

Both Saturday and Sunday were filled with such love. There were notes, texts, emails, facebook messages, a yummy homemade treat and even a couple special deliveries...

Thank you so much for these, you know who you are. ;)

Sunday morning, I slept in. I received a cute and encouraging email from my mom. I worked on sewing skirts for my nieces. Then, Ryan come home and gave me my first ever Mother's Day card. Yes, that's right. A Mother's Day card for someone who is not a mother. I know some people would disagree with that, but if anyone knows the pain I've been through trying to achieve motherhood, he has...

Here is what was written on the front of the card:

Love means sharing the fun times,
the ordinary times,
and even the challenging times.
It means knowing all the time
that love is sweeter
because it is shared by two.

Inside was a sweet message, including his prediction that my first "official" Mother's Day is very near.

I did go to church the 3rd hour to see my Young Women. I had felt guilty about skipping the first part of church but, once I was there, that guilt faded away. Being there the 3rd hour, it was just like any other Sunday. I have finally learned over the years that I don't have to 'prove myself' on that day. I can just do what I need to do to take care of myself, and that's okay.

The best part of this weekend was doing things for the 'moms' in my life, mine and Ryan's mom and step-mom. It was great to honor each of them.

I will never forget the kindness that was shown to me this weekend. Women who should have been enjoying their special day were reaching out to me. I was awed and humbled by it all. When I finally make it to the other side, and I look into the face of my child, I will see all of you. I am blessed beyond measure. Thank you.

If you don't have anything nice to say on Mother's Day...

I LOVE this post! Happy Mother's Day to every woman: Moms, future Moms, and women with a Mother's Heart.

Written by: Nia Vardalos
Actress/Writer/Director

On May 9th, overpriced flower arrangements will brighten homes, and restaurants will serve multi-calorie brunches. Reminders will be whispered: “hey, be nice to your mom for a minute.”

Sure, Mother’s Day feels a tad manufactured. But if I can get a gift out of this bogus holiday, I’ll take it. Admittedly, I am a giddy idiot on Mother’s Day. I’m also a hypocrite because for a long time I avoided the day as hard as I could. Just the drugstore greeting card rack would make me queasy. I loathed May.

For years, at Spring social gatherings, some women would innocently ask why we didn’t have children. Others would overhear and exclaim what a great father my husband would be, so why on earth didn’t we have kids? When I would give a tight-lipped answer: “we’re trying,” they would not go silent.

They meant well, but they would loudly persist with up-beat advice: stories of this sister or that friend who had tried forever, and then a “miracle” had happened. Others would overhear, and join in. I would instantly feel forehead, upper lip, and low back-sweat from the sudden attention. All I’d wanted was a snack. Now, crudite in hand, I was up against the food table, being advised by pretty, chipper moms bouncing beautiful, pudgy babies on their hips.

A lot of “You Should” advice came my way. From the “latest technique in Europe,” to “just adopt from China” – everyone weighed in. I understood it all came from them wanting to help. It was meant with goodwill. But it was a painful, overwhelming subject for me. I just wanted to throw dip in the air and run. Those were the nice women. Some women were, um, well… they were turds.

The success of my first movie coincided with some awful events in my quest to be a mom. I’ll keep the details private, but quite frankly, it sucked. I was emotionally and physically exhausted.

During this time, I would run into The Coven – a group of not-nice-women. These women had, at one time, been actresses. Now they were married to men in the film industry, or their husbands were in our social circle. They made me nervous.

We all know the type of woman I’m talking about here: the ones who say nasty things to women. The Coven seemed stymied by the fact that they were not working actresses and I, far less attractive, appealing and talented than them, was. Often, I can tell when I walk in a room how people feel about themselves. To the optimist, I represent hope of what is possible. But to the pessimist, I represent the stench of their own perceived failure. I will be the first to admit, wow, I stepped into some good fortune with my first movie. I don’t consider myself particularly special. I got lucky. These women would wholeheartedly agree with my assessment of myself. Sadly, they were not secure women. When they saw me, their mascara’d eyes would shoot daggers at my skull.

Now, as the gossip leaked out that I was struggling to have a child, while these women were on their second and third – they realized they had something over me. They could breed. And I couldn’t.

So, at a casual backyard barbecue, where all were invited to celebrate Mother’s Day, the women of The Coven would surround me, the barren one, to squeal about how “amaaaaazing” their pregnancies had been. How their husbands had looked at them with “awe and gratitude” as they gave birth. How breastfeeding was a “gift.” One woman actually made fun of my anatomy while proclaiming how her body worked “perfectly.” It was sad how they needed to make me feel inadequate, and yes it hurt. And sure, I could have innocently asked: “…did pregnancy hormones grow your moustache, or did you have it before?” But I didn’t. Not because I was so evolved and took the high road… nope, I was scared of them so I would escape as quickly as I could.

Women like this are missing out on real female friendships. Okay, maybe it’s just shoe shopping and cellulite talk, but I value it. I was happy for these women who got to be moms. Why couldn’t they just be kind? It was Mother’s Day after all.

No matter where I went on this day, I was an easy target. If I drank anything non-alcoholic, there were women who would pat my tummy and say “when are you due?” A small social guideline: don’t ask a woman if she is pregnant, unless her water breaks on your flip-flops, a baby arm dangles out of her vagina and she asks you to cut the cord. Then, and only then, may you ask if she is having a baby. Otherwise, shut up.

So, for years, I avoided venturing out on Mother’s Day. I feared the entire day and the feeling of failure it would bring. I would call my sisters, sister-in-law and mom on that day and wish them well. They had the grace and kind-heartedness to never admonish me for not trying this technique, or that plan. My sweet family and my good kind friends never pried. They would always listen when I asked for advice, or when I lost it after the latest route or adoption had fallen through. One good friend even quietly handed me a prayer card.

My own mother is kind, compassionate, ironic, focused, optimistic and above all, discreet. Sadly, some of our friends have lost their mothers. I am thankful for every day I have with mine. My mom possesses all the values I cherish and look for in my friendships and relationships.

And, when my husband and I told our family and friends we’d been matched with our perfect daughter through American Foster Care – their elation was profoundly moving. They welcomed our then three-year-old daughter with a joy and happiness that was beyond anything I could have imagined. There is no limit to the amount of attention, kindness and warmth our families and friends - the “aunties” and “uncles” - shower on our daughter. Over a year later, she is thriving in an environment of love and care.

Some of these people are not parents. Often, at parties, especially on Mother’s Day, these friends and family are the target of the well-meaning questions or downright spiteful comments I myself once endured.

Please, on Mother’s Day, have some compassion. If you see someone without kids, do not ask them why they don’t have children, why they don’t just adopt, or if they are pregnant. Please be kind. Be quiet and pass the dip.

I am writing this for the friends and family who listened, didn’t pry, and above all stuck with me on my quest to be a mom. If I am happy on May 9th, it’s largely because of these people’s quiet empathy and unending encouragement. And, if I am happy on this day, it’s because I am in love with being a mom and so grateful for the circumstances, as painful as they were, that led me to my wonderful daughter. Happy Mother’s Day everyone. I hope you buy some flowers, eat a fattening brunch, and laugh all day.

Now, if you’ll excuse me, I’d like to go call my mom.

Mother's Day

No two words bring such happiness and such pain as "Mother's Day". I am overwhelmed with love and appreciation for my own mother and full of sadness at my lack of motherhood. It is quite a conundrum!

I recently happened upon this blog posting by a woman who, despite years of treatments, never crossed over into the world of motherhood. Seeing adoption was not an option for her, she had to learn to come to terms with her life as a non-mom. Though I'm sure the pain will always be there, she has made it. And brilliantly!

Mother’s Day: A Cultural Crucible
By Pamela Mahoney Tsigdinos

The last week of April and first weeks of May have for years felt like their own special form of hell week. Each year it’s the same. First the signs, banners and fliers start showing up everywhere humans congregate — in grocery stores, outside restaurants, liberally scattered around malls and shopping centers. Then the fiber-optic lines light up carrying headlines and advertisements with unsolicited, mocking reminders of what might have been.

There’s simply no making it stop. Mother’s Day, for a portion of society accustomed to being invisible, is a cultural crucible to be endured. There’s literally no escape even at sacred houses of worship or at movie theaters, the once safe place to tune out the world. (This year the feel-good movie of the season is called simply, “Babies.”)

For me, the emotional torture reached its peak a few years ago when I was newly aware that motherhood would forever remain a concept, a theoretical — not an actual experience I would ever know intimately. More than a decade of trying to conceive with increasing amounts of surgeries and medical intervention had proved unsuccessful.

Ultrasound images of embryos we once cautiously affixed to the refrigerator amid the smiling faces of our family and friends’ children soon found their way into a manila folder along with stacks of doctor forms, prescription regimens and reproductive endocrinology reports. My husband and I found ourselves for a time in limbo assigned to the confounding category of “unexplained” infertility. There were, we were soon to discover, no membership kits, no bonding rituals, no themed parties, no special holidays for the involuntarily childless set.

It wasn’t that I became thin-skinned as a nonmom among the mommy set. It felt rather like I had no skin at all. The sight of a pregnant woman could ruin my day in an instant. But that was only the beginning. I had the unfortunate timing of trying to cope with and mourn the losses associated with infertility at what I’m sure will be remembered as the zenith of the mommy-and-me phenomenon. Mom’s clubs, mommy bloggers and helicopter parents took off like wildfire just about the time my uterus was declared officially closed for business. My barrenness also collided with an onslaught of reality TV shows showcasing supersized families, from the Gosselins to the Duggars. And just to make things really weird, along came Octomom.

This year I’m finding the signs and advertisements don’t elicit the emotional rash they once did.

I no longer have the urge to hit the reply button sending scathing responses to e-mail marketers asking how I planned to celebrate motherhood. Mother’s-Day-brunch providers and flower shops urging early reservations no longer cause me to feel like an outcast among women. I can only conclude that I have crossed the threshold to a once elusive zenlike acceptance.

Amid a societal celebration of all things maternal, I was forced to grow a skin much thicker than I ever imagined. Much like regular inoculations sensitize allergy sufferers to irritating substances, I’m much less reactive to the whole motherhood thing in general. In fact, I’ve developed a powerful protective instinct for women who are today where I once was — lost, angry, sad and mourning the dreams they once held so dear.

This year when the fill-in-the-blank (pastor, priest, minister, rabbi, etc.) asks all women in the congregation who are mothers to stand to be recognized, you might take a closer look at the women who remain seated. There are many among them grateful that only a few hours remain to be endured in the annual Mother’s Day season.