5dpiui

We had a super busy weekend which is always a good thing when you are in the TWW part of your cycle. On Friday I had a million little errands to do including a mega grocery shopping trip to my favorite Whole Foods (I made a delish tofu stir fry that I was pretty proud of!). Saturday was a bit of a sleep-in day and then packing and food prep. J went to pick up a friend at the airport and we had some spicy egg salad sandwiches (sriracha! yes!) with arugula side salads and homemade key lime pie.

By 1pm we were in the car headed towards Leadville, CO. Based on the heinous traffic, we decided to stop at Breckenridge first to check in to our hotel. A second friend met us there and we strolled around town and had a snack on the sunshiny deck of Modis. Afterwards, J's ultra-runner friends went back to Leadville for the night and J and I celebrated his birthday (32! woo!) with Crepes a la Cart and then the best plate of nachos I've ever had!

Alarms were set for 3:15am Sunday morning. We rolled out of Breck by 4am and arrived in Leadville just after 5am for J's "Silver Rush 50" race. It was a pretty cool start and I was feeling oddly emotional. Was it pride for J? Was it the gorgeous rendition of the National Anthem? Was it just inspiration rubbing off from these 400+ insane athletes who train so hard and believe so deeply in their physical and mental abilities? But it could have been sleep deprivation or a weird hormone spike. Who knows... I've had a couple of weird medications thrown my way this month and I'm sure they are still affecting me.

So I had a long day of chasing J around the mountains, trying to catch him at various points. I spent a lot of time at a sweet little coffee shop and a lot of time in the car. I also spent a lot of time browsing - and subsequently killing my cell phone battery - through the forums on Fertile Thoughts. Very helpful to read notes from and correspond with other ladies where I am. There's a whole section for those of us going through IUI in July and I found one girl in particular who had her transfer on the same day.

5dpiui Summary
Five days later, where I am with things? I had a dip in my BBT this morning, a surprising 97.9, even though I didn't feel chilly at all when I woke up. Haven't noticed much in the CM department, but over the last several days it's either been really wet or creamy. There's been a little <ahem> breast or nipple sensitivity, but I attribute that to the spike in progesterone that should happen after ovulation. I've been feeling something in between cramps and little twinges in my lower abdomen for the last few days. I'm continuing the following:
          Baby Aspirin (81mg)
          Prenatal Multi Vitamin (2)
          Immunotect capsule (2)
          Maca capsule (gelatinized)
And I've stopped taking the DIM supplement. For whatever reason, that seems to stand out in my research as something that should be discontinued after pregnancy so I'm being cautious. I'm reluctant to give up the Maca because I credit that hormone balancer with keeping my endometrial lining nice and thick.

Concerns
Was worried about the spotting I saw on 2dpiui but feel confident now that it was just residual blood from the transfer. With the cramping I'm feeling, I have a worry about ectopic fertilization. The feelings have pretty consistently been on my right side and that's where all of my eggs matured. I've read a few anecdotal accounts of ectopic pregnancies being more common in IUI patients than natural conceptions. But none of those are from particularly reputable sources so I have no idea.

1dpiui

That title looks like some kind of weirdo code. In a way, it is a kind of code. An abbreviation. What it abbreviates is that I'm 1 day past the IUI. Hopefully, when that code looks like "14dpiui" I'll be seeing a nice double line, a plus sign, a smiley face next to the text "Pregnant." I'll take any of those :)

So far there isn't much to report. I've been feeling mega lazy since being told that I should raise my heart rate over 140 bpm - running raises me far above that, an average of 175 bpm. For that reason I went out and had a leisurely 5 mile walk today. I absolutely had to bring my phone and make calls while I walked cause I knew I'd be thoroughly bored. As a reward, I stopped at REI on the way home to do some sleeping bag shopping and grab a few things for J's race this weekend.

When I got home from my walk and went in to shower up, I noticed some brown spotting. My heart kinda stopped for a sec. But I've spent some time reasoning it out. For starters, one day after the IUI means it isn't implantation bleeding. So my other theory: that obnoxious cervix of mine probably bled a little from all the poking around yesterday. After a long bit of movement this afternoon, I think the activity started up the mucous production which drained out the dried blood from yesterday.

There it is. That's my theory. I'm sticking with it. I also joined a forum website yesterday and found another girl on there who triggered and had her IUI the same days I did. Kinda cool! As of today, we have 13 days left in the eternal TWW (2 week wait).

IUI Day! IUI Day!

Here we are. The day of our first (only???) IUI. My anticipation for this day - Wednesday, July 9, has been building for weeks now. Here's how it all went down:

5:15am
ALARM! Took my BBT and it was slightly elevated (97.8 F). Since I had three follicles that looked like they would pop out three little eggies, I wonder if maybe one of them had already released in the wee hours this morning, elevating my temperature? Doesn't matter too much, the appointment is set no matter what!

6:15am
Left the apartment together with J's bike in the back so that he could ride home after work. Butterflies in the tummy! And some definite ov cramps.

7:00am
CCRM opens for business and J has an appointment with the cup. All went well.

7:20am
I drove J off to work about 10 minutes away and stopped for a delicious breakfast myself. Quinoa pancakes with fresh berries, greek yogurt and maple syrup. Heavenly. Put me in a right proper mood sitting out there in the gorgeous Colorado sunshine :)

9:00am
Took the elevator down to pick up J's washed sample from the lab. After washing, his numbers came to 90% motility, 3+ and 42.2 million count. The lab tech was very pleased with the sample and gave me many good wishes on my way out the door. (I also got a peek at the, uh, "sample procurement" room on my way out the door. Yup, Playboys. And a pad laid out on the chair. Sexy.)

9:20am
So here's where the magic happens. It was a room I'd already been in for a previous ultrasound, but this time the lights weren't dimmed since I wouldn't be watching anything on the screen. Aside from the massive discomfort I was about to experience, it was all very much like an annual pap. Speculum (but no cold jelly) and the bright light angled in. I warned the nurse, Helen, that many who have gone before her have been stumped by my cervix. She quickly became acquainted with the issues. It took longer than usual for the catheter to be inserted, but she was as gentle as possible and persevered. Evidently, my cervix has a couple of bends in it which it what makes catheter insertion so difficult. Surprise! Once she let me know that she was in, the whole thing was basically over.  For something so monumental (well, potentially) there is just about no pomp to the whole thing. Just a few pats on the back, a smile or two, and kind "good lucks" on your way out the door.

$425 later, I was in the car on my way home. It's funny, actually taking out the credit card and paying for it had some sticker shock associated. But when I was in my regroup meeting with Dr. M back in June and we decided on IUI, the "few hundred dollars" price tag was a massive relief after the "tens of thousands" quoted on IVF. Phew.

Immediate Impressions
Wow that was so quick and straightforward... I can't believe we might have made a baby today without even being in the same room... I totally hate my cervix and hope it straightens itself out on the day that I'm blessed enough to have a vaginal delivery... The next two weeks need to be the most zen, chill, stress-free weeks of my life... My perspective should be one of complete optimism and positivity. Feeling any negativity about the procedure can only hurt the outcome and it won't make me less disappointed in the end if this doesn't work... We still have some time and patience for a few more tries... But this feels really good, after all, it only takes one tiny egg and one teeny sperm to have a little love affair <3

Oving HARD

Ohhhhmygoodness! The ovulation of three little eggs is definitely a feeling you can, uh, feeeel. Oh lordy. No, it isn't painful and I think it would be a stretch to call it a "discomfort." However, I'm feeling it hard. It feels like subtle cramps. Which I suppose makes sense since there are two or maybe three little cells traveling down a miniscule tube. 2 or 3x what usually happens each month. Woof.

I practically didn't sleep last night, it was definitely after midnight when I finally stopped noticing my racing heart. And I woke up just before the 5:15 alarm, noticing the lightening sky through the shades. There's almost a "Christmas morning" aura around my day. It's a little buzz of anxiety and excitement, nervousness that everything go perfectly right, the thrill that this could be the day.

ahhhhhhhh!

Shoot 'Em Up

... Ovidrel style!

So I managed to "administer" my injection last night. Don't you just love the euphemistic medical language? I poked myself with a needle. Yowzers. My entire life I have been terrified of needles. I would practically hyperventilate when going in for routine bloodwork. Probably until I was, say, 26 when I strangely was compelled to start donating blood. Racing heart, sweaty palms... I can't say I was a strong candidate for self-administering an injection. On the other hand, all of this fertility nonsense has me pretty accustomed to needles now. Surely I do not enjoy a needle to the arm (or belly, or anywhere at all), but if I look away I can handle myself at least.

Of course, the Ovidrel injection required that I look directly at that little pinch of belly fat while I stabbed it with a "quick dart motion."

I made J count down from 5 for me after the alcohol had dried over the injection site. Elizabeth was right, I hardly felt a thing. The anticipation of sticking myself, along with the sight of a syringe sticking out of my abdomen, were positively the worst parts of the whole experience.

I hope with all of my heart I never have to do it again. Not because it was that awful, I could absolutely do it again, with my eyes shut I bet! We just want this to be over. We want this to be it. No more cycles, no more drugs, no more OPK strips, no more weekly envelopes in the mail from Cigna. Just a big, fat positive on my next test.

Pre-IUI Ultrasound

Today was my first check up since starting the Clomid. The ultrasound showed some impressive results!

8:30am - Monday, July 7
The first part of my appointment was the actual ultrasound with Jessica. It was pretty straightforward and I watched on the screen while she measured various follicles. Not much was going on with my left side... as per usual, at this point... but there was some activity going on in the right ovary that she was checking out. The process didn't take long, maybe 10 minutes total. Afterwards, I dressed and headed back to the waiting room and gorged myself on back issues of US Weekly. Amazing how many freaking celebrity babies are in that mag. Including a special spread on North West's first birthday party! Oy...

9:00am - Monday, July 7
My nurse called me in to review the results and do a backdated IUI consult. (Normally this is done prior to starting your Clomid course. I couldn't do the consult at the proper time since we were traveling, but Dr. M went over a bunch of important dos and don'ts at the June 20 appointment.) Other than the superficial side effects from Clomid, like mood swings and hot flashes, there can also be internal side effects. It frequently dries up whatever cervical mucous there is (impeding the production of eggwhite mucous which is problematic for couples using Clomid with intercourse), and can hinder the growth of a nice, fluffy uterine lining which can complicate implantation.
My ultrasound showed really positive results! My lining measured a healthy 8.9mm, which is right where it should be, even in a 100% natural cycle. As the ultrasound tech had suggested, nothing was really happening on my left side. There were three follicles, all measuring less than 10mm and not nearly large enough to mature and rupture as eggs. On my right side, however, there are three good looking follicles. My measurements are 22, 19 and 15mm. Our nurse gave me two insights that I thought were particularly interesting: First, if there are more than 3 viable follicles, they will cancel the IUI cycle due to the chance of multiple fertilizations. Second, as you can probably deduce from that statement, it is more common for the Clomid to stimulate only two viable follicles rather than three and so we've just upped our chances of a multiple fertilization. I had to sign an informed consent form to go forward with the cycle as scheduled.

***

Let's just pause for a moment. People can get real fired up when they hear any of the following: "multiples," "twins," triplets," and "Clomid" even. For people labelled as "Unexplained Infertile" like ourselves, it's important to remember the law of small numbers you're dealing with, as well as the risks associated with multiple embryos. For starters, our chances of getting pregs this cycle are only 8-12%, which I believe is only about half the likelihood of a normal couple conceiving in a given cycle. If we are lucky enough to end up with fertilization and implantation and a BFP (yep, "big fat positive" test), the stats on having two of those eggs become fertilized and give us twins? Only 10%. I'm no mathematician, but 10% of an 8-12% window seem like awfully miniscule odds! And one step further, the chances of triplets - all THREE of my eggs being fertilized - would be under 1%.
In the years that Clomid has become a popular prescription for fertility issues, doctors have come under fire for the resultant multiple births and associated risks. Due to that, many REs (reproductive endocrinologists) are extremely sensitive to multiples and therefore do what they can to control the math.
Women have twins. It happens, naturally. What's the big deal?? That's what I had thought, too. The most common risks in a multiple gestation probably don't seem all that scary to someone who hasn't had a baby because we hear about happy-ending stories all the time: poor vision, pre-term labor, low birth weight. Modern medicine makes these things seem commonplace, but as an expectant mother, you don't want to see your infant up against any of these things. There are also very serious complications that range from miscarriage, stillbirth, diminished brain development (i.e. cerebral palsy) to problems for mom like elevated blood pressure, diabetes, and greater incidence of nausea/vomiting. So... no thanks.

***

The original plan Dr. M devised for me meant that I would monitor my cycle for ovulation with OPK strips and then call the office when I had a positive. Given my great response to the medication and the size of the three follicles, our nurse determined it was best to trigger my ovulation with Ovidrel (an injection of hCG, human chorionic gonadotropin). Waiting too long could either allow the follicle to grow too large, or allow ovulation to occur naturally at a time that wasn't ideal for the IUI transfer in the office. I was given a pre-filled syringe of Ovidrel with strict instructions to get it home to the fridge and then administer it PRECISELY 36 hours before my transfer. So, 9pm tonight. Yipes!

I'm excited. I'm optimistic. I'm hopeful. I'm also a little nervous. Excuse the pun, but I'm afraid of putting all my eggs in one basket - meaning, the mathematical odds of this working on the first try aren't terribly high. So I'm trying to toe the line between optimism and realism. Not an easy line to draw. The current strategy: put all of my faith behind this procedure - we are very strong candidates for success - and if it doesn't work out, know that we've still got plenty of resources to lean on for more attempts.

HERE WE GO!

Cycle Day 7: BOGO Sale

Buy one, get one... Two posts for the price of one. Here's the update of what I didn't know when I wrote the previous post. 

1) I believe I have a new symptom to record: hot flashes. It's summer time and NJ has been having some wretchedly hot 90+ degree days with insane humidity, so I could be off-base here. However, the fact that I'd sit around the air conditioned house during the day and actually feel chilly enough for a blanket and then totally sweat my tush off when going to sleep kind of makes me think... maybe that's what a hot flash feels like! I was literally dripping sweat and had to throw off the sheet and turn the AC down a touch. I hold out hope that I'll never have need for clomid again (!!!!) but in case I do, remember the hot flashes...

2) No in-laws this holiday weekend, after all. Bummer. I've been sitting in the airport all evening waiting for my 5:15 pm flight to depart while they've been at the Philly airport also waiting. Unfortunately their flight was finally cancelled (it's now 11pm). As for me, I did get on the plane for about two hours. But a brilliant airport employee left the jetbridge unsecured and the storm that came through before we pushed off from the gate smashed the equipment into our wing. WOMP womp :( So we all deplaned and have been waiting ever since for a new aircraft to come in from another place in the country with no storms (not a lot of those tonight. hurricanes and storm cells abound!) Hoping for a plane in the next 30 minutes or so... which will get me into Denver just before 2:30am. Poor J needs to come pick me up then. Ouch. 

The Irony:

I really had stopped worrying about wacky mood swings with the in laws. All I'm feeling is a touch over-emotional, but I've been keeping good control of that when I realize it is a chemically induced over-reaction.

The Good News:
None of this effects our ultrasound or IUI schedule! Deep breath in, deep breath out..... Very excited about our dates next week. 

Cycle Day 7

Today is the seventh day of my cycle and I've taken the full course of clomid- all 5 pills at 50mg doses. I'm definitely feeling the overstimulation in the ovaries, though primarily in the right side. In my previous two natural cycles I've had ultrasounds that showed my right ovary was dominant and my HSG revealed a very slow spill of dye on the left. Just gives me pause, room to wonder what the deal is with my left side and why it's riding the short bus. 

Aside from feeling my hyperactive ovaries kicking into gear, I'm pleased to say I'm not feeling many other symptoms - probably because I'm on what seems to be the lowest dose. This last week I've been "vacationing" at my parents' in NJ and my mom and I are swapping lots of stories, memories, general catch up stuff. Whenever she lobs one at me that is even remotely emotional I get crazy choked up. Funny enough, that's the extent of my over-emotional, PMS-y mood swings. So far :) J's parents are visiting Denver with us for this upcoming holiday weekend and I'm a little anxious about ending up with sick mood swings while they happen to be staying with us. Eeek! I'll need to remember to stay focused, present and calm.