Rx: Clomid

So we had our regroup appointment with Dr. M on Friday the 20th. As I mentioned, I was kind of freaking out about it, expecting a bunch of news that I wasn't excited about. Stuff that would just extend our timeline.

Well! Wasn't I surprised!

VARICELLA
My number one freak out was about the varicella (chicken pox) vaccine. I felt devastated when our nurse told me that it was highly recommended that I start the series. It is a live virus vaccine taken in two doses separated by 30 days. After the second dose, you must wait an additional 30 days for the live virus to dissipate and not put a potential pregnancy at risk. Looking at my current cycle on the calendar, that was putting us at a three month delay which just felt like an absolutely crushing blow.

When I discussed my chicken pox history with Dr. M on Friday, however, she gave me a pass! Her opinion was that after having the vaccine only 2 years ago and having such decreased immunity to it, I am most likely in the small minority of people who are never fully immune. No continual vaccinations will change that. I just need to be careful, of course, about who I am around and the level of travel I plan over the next several months. No problem!

ENDOMETRIOSIS
After my fun trip to the ER on Day 1 of my last cycle, I had a hunch that Dr. M may suggest a laparoscopy to look for endometrial tissue outside of my uterus. She certainly was concerned after hearing my account, and the procedure was suggested. However. Dr. M also cited recent studies showing that removal of the tissue is really only effective for pain management, not fertility. Since my pattern seems to be a entire year without much pain at all, it seemed like overkill to have a surgical procedure to A) look for something that may not even be there and B), if found and removed, would likely not affect fertility. There are risks with even the simplest surgeries. If you were desperate to have a baby and someone was telling you that your entire reproductive area would be at risk for infection or worse... how likely would you be to sign up? I'm a total ninny about pain, but this pain only jumps out and grabs me once a year. It's just not worth the risk.

Putting a laparoscopy on the shelf also takes away a month (cycle) of surgery/recovery time. Deciding not to go forward was a major win for our timeline and also fully supported by Dr. M. We're feeling good about the choice. She also prescribed me vicodin as a "just in case" measure so I can stay out of the ER if there is a next time.

DRUGS/ASSISTED INSEMINATION
My next freak out was a bit of a catch 22. I'd started feeling really weird about the concept of someone else impregnating me in a lab. So impersonal, the very definition of clinical, it made me feel sad to think that J wouldn't even be in the room when I got injected with the magic juice. The catch 22 here is that I also realize that we are basically out of options now. There's no point in continuing to try unassisted.

Dr. M's assessment: I will start Clomid starting on Day 3 and we will try for an IUI cycle. Clomid goes for 5 days. Around Day 10 or 11 I am scheduled for an ultrasound to measure my follicles. At that time I'll also be doing OPK testing and then they schedule J to come in to provide his sample. The lab takes 2 hours to "wash" the sperm and then I will come in to have the washed sample inserted into my uterus. No, it's not romantic. But maybe it'll finally be the solution we need.

This should feel similar to having a pap smear. After the procedure, I get about 10 minutes to rest and then just go about my day. Go about my day? Seriously? No sure how I'll be able to do that. An IUI cycle is far less expensive than IVF and so we can go a few tries in terms of affordability. One caveat of a Clomid-assisted cycle is that you should only go for three cycles on this medication. I suppose because of the effect that it has on your hormones and the overstimulation of your ovaries, it starts to get risky to use it for more than 3 cycles without a break.

So we're starting right away. None of the delays that I was so worried about in the last couple of weeks. This pretty much puts us exactly where I hoped we would be on the calendar when we first started talking to CCRM. A week ago I was thinking that we had to wait for three months. Now, in one thirty minute appointment, I'm carrying this hope that in the next three months we may have some good news! What a relief. On the one hand, I almost want to celebrate. But that feels a touch premature right now. For the time being, we're happy to just feel a sense of relief and be able to finally make forward steps.

Setbacks Continue

One of the reasons I was so excited and relieved to get on board with CCRM was the feeling that we were finally entering a pattern of moving forward. And I need to keep the perspective that just by being a patient there we are already better off than going cycle after cycle on our own. But, for today at least, there's no moving forward. We're stuck in a waiting period. Again! Still!

I just heard from our nurse to go over my most recent set of tests. Prolactin=normal. Testosterone=basically normal. Rubella=immune. Thyroid=normal. Thyroid antibodies=normal. Blood chemistry=normal. Vitamin D=good. DHEA= normal. Blood counts=mostly normal, low white bloods cells due to my sniffly nose that day. Antibody screen=negative (that's good). So what was wrong? Varicella. Ugh. 

Bottom line is that I don't have enough antibodies against chicken pox. Despite the fact that I was immunized as an infant, had the virus, and then re-immunized two years ago. The impact of re-immunizing again feels pretty steep right now: 60 days from the date of the first shot (it is a series of two). The earliest possible date we can try for conception again is 3 months away. September. Just thinking about how far away that is makes me tear up. I'm so damn frustrated. 

It would be possible to move forward without the vaccination series. We would need to sign a waiver for CCRM. The chances I end up catching chicken pox in these next summer months seem completely ludicrous. But there is still a chance and if we sign that waiver, move forward with a conception plan, and I get this ridiculous virus while pregs, I'm at risk for pneumonia and the baby at risk for all sorts of nasty. birth defects. Seems like one hell of a gamble. Sure, the odds that everything goes according to plan with no virus in the picture are good. But it takes about .3 seconds to realize the risks outweigh those good odds all day long. So yes, we could sign the waiver. But we don't really have a choice, do we...

Our regroup with Dr. M is this Friday. That's when we'll discuss what our best options are going forward. I'd been looking forward so much to this meeting. Now I just feel like it will be frustrating to talk about things that I can't touch for 3 months. I'm just so sad right now. 

Scar Tissue

... is a great Red Hot Chili Peppers song. It's also becoming a big fertility concern of mine.

Back in 2007 I had back to back "abnormal" pap results so in early 2008 my gyno scheduled me for a colposcopy. I was 24 at the time and was more worried about the potential of a cervical cancer than my baby making future. Realistically, the priorities are correct... But did I not ask the right questions or do enough research?

In the last 3-4 months I've had two different technicians need to insert a catheter into my cervix. Both times went... poorly... The first time, for a saline infusion sonogram (SIS), was extremely painful. The technician told me at one point that my cervix kept "running away." Apparently it would kind of recede back up and away from the catheter. But she went right ahead and shoved it up in there. <wahhhhhhh> Not frigging comfy at all.

The second time was for the HSG last week. This tech was so much more gentle and, for the procedure, she determined that it wasn't 100% necessary to insert the catheter right through. She came right up as close as she could and then began injecting the dye. Fortunately, that was a go. I mentioned the fact that  I am on the "small" side as far as lady parts are concerned, brought up the difficulty in the SIS, and also the colposcopy. Colposcopy was the magic word. She picked right up on the presence of scar tissue and said that what she was seeing could definitely be a complicating factor to entry.

Naturally that has made my imagination go wild. I have spent about a year now thinking of every reason under the sun I may have trouble with natural conception. I briefly considered scar tissue or something related to the abnormal paps quite a while ago, but my so-so gyno from NY dismissed it out of hand. And now I just keep thinking... if a thin little catheter has trouble getting in, is it possible that scar tissue blocks the entry in a major way? Blocks out even all those itty bitty little spermy guys? There's something maddening about the possibility that all of our tries over the last year have been pointless. Especially as I watch so many others make their pregnancy announcements. Some of them, younger than me, are already on their second ones. And of course all of the people out there who get pregs "accidentally." What a sting.

Running on Low

My optimism was at an ultra high last month starting up with CCRM. But as all of the various test results roll in, I feel my positivity and excitement waning a bit. In a way, it seems like a strange reaction to continually hearing "everything looks normal!" and "Your numbers look great!" I guess I was placing my bets heavily on the prospect of finding a hormone level that wasn't quite right or something similar that could easily be corrected with a prescription, a pill, or lifestyle change.

Last Thursday I went for a hysterosalpingograph (HSG) and associated x-rays at the CCRM Lone Tree office. That was on cycle day 7. The HSG x-rays show my uterus is a little tilty. The dye spilled out from my right fallopian tube rapidly but was a bit delayed on the left side. Evidently, this is of no concern. My tendency towards perfectionism finds this bothersome, but I'm not the expert here! At least both sides are open. The technician was a lovely woman, probably around my mother's age, and very comforting while she explained all of the steps. When the procedure was complete she walked me through the back side of the office to reach the main hallway. As we passed a couple of doors, she indicated, "This is where you'll come for your retrieval and all of our labs are upstairs."

BAM. That was a sudden knock on the head. It took a few more hours to fully sink in. It was the certainty with which she mentioned it, the breezy way she pretty much diagnosed me on the spot. Starting this process with CCRM Of course you realize that IVF or some sort of clinically assisted insemination is a possibility. But I'd never considered the meaningful details of it. The impact it would have on our lives to have a baby with the intervention of lab. Obviously a lab baby is better than no baby, especially if it is genetically yours. But it is a bit of a hurdle to get over, emotionally, to picture that magic moment: you, with your feet propped up in stirrups, hospital gown and paper roll keeping your skin from touching the padded vinyl table. A doctor between your legs injecting your husband's sperm into your uterus in hopes that one little sperm cell finds the egg. Or, if you made the major financial commitment, maybe she is injecting already hatched embryos. And you'll go home with the desperate hope that in several days one of them will attach itself to your endometrial lining. Is Mr. J even in the room with me?

That picture is a far cry from the real magic... a romantic getaway for a long weekend, or maybe just a sleepy Saturday morning. The two of you together, alone, no doctors or technicians. And a couple of weeks later, the excitement of a double line, a dark plus sign, the digital "Pregnant" reading. The excitement of knowing that the two of you are bringing life into the world, just the two of you. Complete magic. Just the way it's supposed to be.