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.

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.

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???

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.

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.