Wednesday, May 28, 2014

Was That a Nightmare?

Just woke up from a very vivid dream which definitely had some nightmare qualities. I always have believed that dreams have a strong relation to reality and subscribe to the idea that it is your brain's way of "cleaning house" so to speak, or at the least, resurfacing subconscious issues that are haunting you in some way.

This is the backstory that, in my opinion, informs the dream I just had:

  • I've been in the two week wait (TWW) since two Tuesdays ago and getting a lot of symptoms I hadn't had before. Tracking them in FF, everything seemed like it was pointing to an eventual positive. So I've been optimistic and cautiously hopeful.
  • Last two days a lot of the symptoms have disappeared, my BBT never went very high and actually remained relatively level at 98.2. I'm also getting the kind of uterine cramping that seems more like period cramps. I've also taken two tests that came out negative. So I've been a little disappointed.
  • When I log in to Facebook on my computer, I see every time my invitation to my nephew's 1st birthday party this coming Saturday. Thankfully, we're just barely going to miss it, as our flight gets into LGA around 5:30pm and we have plans with friends.
  • This is the toughest bit: we have two nephews from J's brother. Younger brother, younger wife. They are 1 and (almost) 3 years old. They were both "oops" babies. Really? Honestly?? I understand that accidents happen, but when one of you is a med student not making any money and the other of you is an inner-city teacher, don't you think you'd take every precaution possible? Both of them were born premature and spent extended time in the NICU. For the first pregnancy I was mostly excited, but a little envy crept in because I felt like J should have the first grandkids as the oldest child.
  • My in-laws are thoroughly besotted with these two little ones. In the several months that we lived with them this past year, about 60% of conversation was dominated by the latest and greatest thing that one of these adorable, precious little munchkins had recently done. New songs, silly words, rolling over, crawling for the first time. Each one of those stories is a knife in the heart of a girl who can't get pregnant month after month.

So, the bad dream:

I was visiting my in-laws at their house (not their real house in this dream) and both of the nephews were there also. They were playing around while the three of us adults were scurrying around to go somewhere. At some point, the in-laws were ready enough to take both the little ones out to the car and get them strapped in. Everyone was waiting for me. And suddenly everything for me started to move in slow motion, everything started to go wrong. I had thought I was packed, but I wasn't. There was cleaning up to do that I was responsible for but it wasn't finished yet. I had to go to the bathroom. And they were all outside waiting for me to go. So I went to the bathroom and realized that I was positively gushing blood. There wasn't enough toilet paper to clean it all up, I was making a frightening mess. And everyone was still waiting. I was totally panicked and felt this sense of doom that something was just horribly wrong with me. It was, in a word, disturbing to wake up from that.

Tuesday, May 20, 2014

Chart Obsessions

Not surprisingly, I'm a dedicated member of Fertility Friend (FF). Most ladies I've become acquainted with on the internet use this site/app to help the conception process. Truthfully, I started using the app more as practice. Several months before we were interested in starting trying to conceive (TTC), I downloaded Fertility Friend to get to know my cycle. So I faithfully began tracking my basal body temperatures (BBT) and cervical mucus (CM). A few times I tried incorporating other cervical data like position, texture and openness, but that was a bit much for me. I felt like I couldn't understand the signs well enough for it to be meaningful data, so out the window with that piece! In time I was getting to know my cycle very well and seeing the patterns emerge. It kind of surprised me to see how incredibly regular my periods were and that I have a pretty average cycle, going for 28 or 29 days and usually ovulating around cycle day 13 (CD13). This came as a welcome surprise after years of exceptionally painful periods, concern about endometriosis and 16 years on various birth control pills.
Once we were serious about starting TTC, I picked up "Taking Control of Your Fertility" to supplement the knowledge I was gaining from FF. Even with my stressful job and hectic travel schedule, I was definitely ovulating which was a relief, if not a surprise. Just to cover the bases I started a prenatal multivitamin early on, probably in January 2013. Our official "pull the goalie" month was August 2013. And that first month I obsessed over every little sign every single day, entering any piece of data I could into the FF app, peeing on sticks for ovulation, peeing on sticks hoping I was preggers. Frankly, it came as quite a blow to have a negative result that first month. I was certain I had controlled every variable possible. That with all of my newfound knowledge applied to the process, a positive outcome was a sure thing.
Ahhh the innocence...
Months went by with similar obsessions. Finally, J just couldn't take it any more and asked me to please take a couple months off from the whole BBT thing. So I barely tracked this March and took April off completely. A part of me thought that by not paying attention to the TTC process, it would magically happen. Also, April was the month we moved to Denver, so I guess I thought there was some magic in that, too - finally settling into a place of our own after living with in-laws for 7 very not-private months. But nothing. Bringing us to the present...
I've reversed course and gotten back into FF with a vengeance for the month of May. My ovulation was apparently the day of our first CCRM appointment last Tuesday so now we're at 7 dpo and CD19. When I look at my temp chart, there is a mega jump from pre- to post-ovulation phases. My temps are overall pretty regular in each phase, not sporadic at all. So, as I am known to do, I immediately began jumping to conclusions and getting excited. Then, at some point today, I did a chart overlay. This neat feature allows you to look at your current chart overlayed with any of your other charts. And when I looked at that... well... it wasn't anything special at all. My current chart isn't all that different that the average of all my other months.
For a chick who is so desperate to finally expand her family and who has no job, this is an impossible waiting game! I really need to find some other things to occupy myself with! Why can't I apply this much energy into finding my next job???

Monday, May 19, 2014

Keeping Excitement at Bay... How?

Today we both went in for our 8:30am appointments as scheduled. With the combination of having a fabulous weekend and the zen feeling I get when when heading to CCRM, we were having a lovely morning joking around and enjoying the warm sunshine. All I had on my list was the blood draw for progesterone testing so I was done in about 5 minutes and flipped through a magazine quickly while I waited for J.
He handled the production of his "sample" for the semen analysis with grace and good humor and we headed on out so he could drop me at home and get down to the office. I hadn't asked when we could expect results of either test so I tried to put it all out of my mind while I researched regular OB/GYNs and primary care doctors. CCRM has asked me to get those annual exams up to date. 
After hours of research and appointment making (and, ahem, a brief nap on the couch. oh, also laundry and dishes! see, I'm productive!) I got a call from our CCRM nurse, Elizabeth. My progesterone levels were already back and they looked "fantastic." I was strangely perplexed by the enthusiasm as she continued to explain that at my point in the cycle, 6 days past ovulation (dpo), they like to see above a 10 ng/mL and I came in at 26.7 ng/mL. You see, I was already thinking about how that could be bad news... had already anticipated poor results so that I'd have something to work with, something to correct... That number must be too high and there will be something I need to take in order to balance it out.
As I continued to probe more about what the levels mean, she more or less said that, no guarantees of course, but, I should take a preg test next week just in case. Progesterone is a hormone that will go higher and higher to sustain a pregnancy. It seems that a week after ovulation it should be slightly elevated and then taper off as the corpus luteum dies and stops producing the hormone. If there is a pregnancy, the corpus luteum continues to produce progesterone until the placenta is prepared to take over. Naturally, I went on a googling spree and found a lot of anecdotal evidence that puts most non-pregnant progesterone levels in the teens and a lot of non-pregnant women struggling with infertility somewhere between 6-9 ng/mL. But the bottom line of all of the googling is that every woman is so incredibly different that one hormone test compared to the test results of any other woman is rather meaningless. And taking it a step further, any one number in isolation should be considered simply "out of context" and not very helpful itself. Meaning, my result of 26.7 ng/mL is only relevant when compared to my own progesterone readings on 6 dpo at other months.
It is still completely plausible that they managed to take blood today at my peak of progesterone (and that my levels are just a touch higher than average for whatever reason). But there is also a small possibility that my body is trying to keep a little burrowing bunch of cells alive and well. 
I'm trying so very hard to not get my hopes up. It is just so unlikely for this to be IT after all these perfectly timed but failed attempts. And regardless I'm already imagining it. Every twinge in my lower abdomen I think might be the magic happening. And I quickly try to dismiss it, reminding myself there have been a lot of months that I felt those little twinges and cramps with nothing to show.
So my strategy right now is to periodically remind myself that even yesterday I was completely on board with the process taking a few more months. I need to just let it be, let nature (or Dr. M!) take her course... And in the meantime I'll continue to be extra careful with my eating and consider this extra motivation to keep super healthy for future cycles.

Friday, May 16, 2014

Accepting the Timeline


For years I believed that when I wanted to have a child I would. There wasn't a whole lot of additional thought put towards the concept. I suppose that, if pressed, I would have expected that it could take up to a few tries, but that everything would fall into place rather easily. After all, that was the experience everyone around me seemed to have: Step 1- plan timeline for pregnancy, Step 2- get pregnant. Or, in a few maddening cases: Step 1- oops, I forgot my birth control, we're having a baby!

So I guess I can attribute that mindset to why this has all been so emotionally draining. Even by six months of trying I felt confused and frustrated. When you consider the multi-year infertility hell that some couples endure, being frustrated at six months almost seems laughable. But in the vein of being honest with myself and owning my feelings, that's where I was and have continued to be. I felt like I was doing everything right, so why wasn't I getting the right result?

This week was our first visit to CCRM. I felt optimistic afterwards and am looking forward to going back Monday for a couple of additional diagnostic tests. The last few days I've been doing additional Internet research on the practice and general fertility and, in the process, have found a few personal blogs from former CCRM patients. Their experiences have heartened me even more. Two in particular involved long roads with IVF. So far, J and I are too early here to know if we need IVF or some other type of intervention so the blogs have been more just interesting journeys to read up on as opposed to out-and-out educational or instructional. But they've given me one really important thing, an exceptionally critical lesson: acceptance of the timeline. 

Every month that passes, every cycle that comes and goes, I think I've found some magic answer as to why it hasn't worked yet and I change up some part of the routine: Last month I ran too hard, this month I'll lift weights more; last month I was too excited about it, this month I won't chart or take my BBT at all; last month I didn't get the right nutrients, this month I need tons of spinach/sunflower seeds/avocado/fill in the blank; last month I didn't really have any fertile eggwhitey CM, this month we'll buy Pre-Seed and I'll definitely be preggers; last month I had a few too many drinks/coffees/sweets, this month I'll abstain 100%, enjoyment be damned! Lord, the list of magic reasons will drive you mad. 

This time around, after finishing up another CCRM success blog and gazing out at the full moon lighting up Denver tonight, I have a different mindset. We are in good hands now. Before, we were alone. Now we have experts on our side. They aren't magicians of course, it will take time for them to gather all the information, devise a plan for us and, of course, execute that plan. But for the first time I'm feeling peaceful that we probably won't have a positive this cycle. And it may not be the next cycle. But I'm guessing that within three months we will be closing in on a positive. Maybe it will be a simple tweak of hormones and medications or maybe it will be the long-winded IVF journey. Whatever our timeframe turns out to be, we are on the brink of answers and solutions from some pretty brilliant fertility experts. And for that, I am willing to accept the timeline. 

Wednesday, May 14, 2014

First Real Evaluation


Today was a big day for me personally. And if I'm being honest, it was actually exciting, too! We had our first visit at Colorado Center for Reproductive Medicine here in Denver and it has been one of the first times I've felt truly positive and optimistic about this road we're on in the last several months.

We started off with a nurse taking blood pressure, weight, height and then waited for the doctor to come in. Right off the bat, CCRM impressed me with how prompt everything ran. We expected to be taken at 8:30 and finish between 9:30 or 10am. It was 9:27 when we got in the car! At no point did I feel that we were rushed or that we were just another appointment to check off the list. So I'm glad to see we're in professional hands.

Dr. M was warm and friendly with us and jumped right in to our family and medical histories. When I produced a paper with all of my recent Ovulation Prediction Kit (OPK) strips, Dr. M seemed genuinely glad to check them out! She said it's a great sign that I'm ovulating and, based on the timing, we could do an ultrasound that day and progesterone-based blood work on Monday. J will also go for his analysis on Monday.

Ultrasound
I dropped J off at work so that he could fly out for his first business trip since the new job and then headed back to the office for my ultrasound. They wanted to check out the size and shape of my uterus and the thickness of my endometrium by conducting an transvaginal ultrasound. Right now I'm on Day 12 of my cycle which is exactly when the endometrial lining should be fluffy and thick; a comfy blanket for a fertilized egg to snuggle into and start growing. I came in at 8.2mm which is right in the mid range of what is considered ideal: 6-10mm. Thickness of 5mm or less can present issues since the tissue isn't thick enough to carry enough nutrients for the developing embryo. Since I'm right at ovulation, it should continue to thicken just a bit more in the coming days as I'm in the luteal phase of my cycle.

The other thing the nurse was able to see was the position of my ovaries. She said everything looked great and that my follicle on the right side had already collapsed. That means my egg has already "dropped" which was so cool to hear! I had been confused this morning because my temperature waking up was still in pre-ov lows (97.5) but the OPKs showed that the ovulation window was basically closed. Even though it's been a rough year of disappointments, I always want to make sure we've given it out best shot each cycle!

Blood Work
I already had some blood work done back in December with my NY doctor. That office never shared the results with me other than a voicemail to say, "Everything looks fine." But the results were forwarded to Dr. M's office and she went through the results. Mostly my levels were ok, but estrogen was a little high which can have a negative effect on other hormones.

In addition to reviewing the old test, it is perfect timing in my cycle to go back and have my progesterone tested on Monday. That hormone needs to peak to a certain level in the luteal phase in order for that little fertilized egg to nestle in and stay.

Semen Analysis
This test analyzes a lot more than I originally thought. It evaluates concentration, motility, morphology (shape), and volume. Good money would tell you that all of these factors come out in just the right ranges, but I'm always interested to see results of things like this and evaluate where on the spectrum things fall.


As I said, I'm feeling so optimistic and and really pleased that we are working with this practice. Can't wait for the next report!

A Little Background: The Settling Down


So how did we get where we are? It's been a crazy year...

We lived several years in Manhattan. Many people associate that with "the best of" any number of categories. The best food, the best cocktail bars, the best theater, the best jobs, the best medical care. To some degree that's true and there are many "bests" within infamous New York City. But finding "the best" can be a journey. It comes with a touch of panache to be the latest-greatest-best in any category in a world-class city of millions and along with that panache comes an elevation. You often need to be pretty well-connected or at least well-informed to get access to the best. And so was my experience with doctors. 

I eventually found a top-notch dentist and primary care physician after a few bad experiences. I thought I had a solid ob/gyn, but realized this fall that it wasn't the practice I had hoped. Despite the very accurate and pointed attempts my husband and I were making at conception, this doctor was thoroughly unconcerned until we had reached the one-year mark. That was contrary to several sources I'd come across in my research that said, paraphrasing here, if you are faithfully BBT charting and OPK testing with no pregnancy after 6 months it is perfectly reasonable to go seek a professional opinion. But my doctor was very reluctant to discuss the issue very much with me and I had to be somewhat demanding to get blood work done to test my hormone levels. At the last minute, I mentioned that I was confused by some spotting that I was experiencing around the time I should have implantation bleeding and she finally acquiesced a bit, ordering a Saline Infusion Sonogram for me.

Honestly, I was feeling frustrated about my poor experience with the ob/gyn because, when we left for our travels in early 2013, we gave up our apartment in Midtown. At that point, we were temporarily staying with family in Pennsylvania until J had his next job lined up. The idea of finding a new ob/gyn seemed pointless because we had no idea where we might live next. Back to NYC? Down near Philly? Suddenly Portland, OR, London and Denver all seemed possible also. The job hunt felt interminable. It hasn't escaped me that a good deal of this process may just be a massive lesson in humility for me. Teaching me that, no, I can not have full control over everything. Mother Nature is going to do all of this her way in spite of what I think or feel about it. Lah-dee-dah!

Finally, everything fell into place in early March. In short order, we were on a plane to Denver for an apartment hunting trip. The company moved us out in mid-April. We tried another cycle the old fashioned way, without any BBT or OPK or Pre-Seed, in the midst of all this. I tried to stay positive but generally put it out of my mind. I was also finishing my contract with my former employer and having a somewhat high-stress period. As soon as my work event was closing out, the period arrived with all of it's associated depression.

One of those AF nights I desperately googled "top fertility doctors in denver." One of the first results was a link to an article that placed Colorado Center for Reproductive Medicine (CCRM) in the number one spot for fertility clinics. In the US. There were two practices in Manhattan, but they were not number one. Here we were, randomly relocated to Denver, and we were neighbors with the top fertility facility in the country. My eyes welled up. I emailed to request an appointment immediately.

We were initially scheduled for a consult in late June, but the next day I had a call saying they could take me early - May 13. Optimism has been in full bloom in our house this last week. It's just feeling like a super lucky coincidence right now. Fingers crossed!

A Little Background: The Traveling Around


We left our jobs in March/April of 2013 and took off on several months of travel. Some of the things we heard from people were:
                    Wow that's so brave!
                    Oh my God I'm so jealous!
                    I'd love to quit my job and travel.
                    Holy crap! Are you crazy?
                    I went backpacking when I was 22. Damn, the stories I could tell you...
The common thread from just about everyone was:
                    Great to do that before you have kids.

Yeah, well, sure. Theoretically.

But what if, when all the dust has settled and you're done traveling, that whole kids thing isn't as easy as putting that two-piece puzzle together?

In our last month of traveling through South America, I spent some of my down time reading up on pre-pregnancy preparation and fertility. For over six months I'd been tracking my basal body temperature (BBT) so I knew my cycle inside and out and knew what to expect for ovulation. Near the end of the trip, I started limiting my alcohol and caffeine, made sure I was quitting certain meds and supplements, and was religiously taking a good pre-natal vitamin. We were having a super active trip so I felt good about my physical activity. Once we were back in the states, I nearly eliminated sugar and jacked up my nutrition again with lots of super veggies and fruit - we were both really excited to get back to our normal spinach smoothies, kale salads and oatmeal breakfasts. Marathon prep was a little behind schedule so we both jumped right into that. For sure, I figured, we'd be expecting a third member of the family in the first try! Two cycles at most... If it meant cutting out of the marathon, I could always try again next year.

No such luck. Here we are 10 cycles later a little stumped. At the start of this, I was freshly 30 and J was 31. We just celebrated our two year anniversary. And we're starting to get the questions. You know. The baby questionsWhen? I try to be polite, direct to another topic, even be fully direct with the parents. But it doesn't stop your mind from churning over the issue. Every cycle seemed full of promise. Different symptoms would pop up that were unusual for me: mid-cycle spotting around the time of possible implantation, crazy mood swings, period coming late a few times, nausea, headaches.

I try to accept the fact that it's just barely been a year when some women go through several years of this or, worse, are told they'll never have children. I try to take solace in the "You're still young, no rush" argument, but it feels so conciliatory. My hope was to be young when I had children, that was my intention. J and I have talked about wanting three. Better to start that process as early as possible, don't you think?