Another Twist in the Plot

Well this was a fun and exciting month. I went in for my typical baseline ultrasound at the beginning of the month and was told that I have a gigantic cyst! LOL at the fact 
that the doctor said it so casually. Apparently it is "only the size of a golf ball"- so no big deal!?!?!?!? While he's over there saying no big deal I'm over here going holy crap I have something the size of a golf ball me and I had no idea! This is why I preach about having monitored cycles. 6 cycles with no cysts and nothing different about this one and BOOM, cyst. Want to see what it looks like? Here you go-

I've heard many people talk about how their doctor just prescribed Clomid or other medications and never get monitored. What's the big deal you ask? Well being on those medications can cause a cyst to grow and potentially rupture and then not only will you be in tremendous pain and in the emergency room, you could end up losing your entire Fallopian tube. No big deal right… Just kidding! So anybody out there thinking about just getting an unmonitored cycle to see how it works, to save money, or because your doc said it is ok-caution caution caution. Not only caution but running the other direction, because you really want to risk your fertility completely? 

So since I decided that I would like to keep my tube in the semi OK condition that it is, I'm on the bench for the month. No treatments, no chance at getting pregnant, nothing. Just sitting here keeping the bench warm. I feel like the little kid who just kicks the dirt while the other kids go play. 

One would think that this is no big deal, what is another month when you have already been doing this for 20 months, except one doesn't understand infertility. There are many things that I had planned to do this month and canceled due to when treatments would've been. These included going to an amazing conference for my coaching business, going home to visit family and friends, and going out with Jeff for a weekend away. We cancelled all of these events due to how the treatment cycle should have progressed. And welcome to infertility, you cancel your life and then you end up with the cycle cancelled. Sometimes it's just so frustrating. 

This is just one really good example about how ladies who suffer from infertility live their lives. It's always month-to-month, cycle to cycle, treatment to treatment. You try and plan your entire life around cycles and monitoring days. And at the end of the day you are reminded that you have very little control over the situation and life isn't fair. It is at times like this where I start to think that infertility is synonymous with life isn't fair.I have to remind myself: 

I will admit, I am starting to lose some faith that this will ever happen. Anyone who knows me knows that I am an upbeat person who usually sees the glass as half full. But it gets harder and harder to trust and have faith. Some days are dark and dreary. Some days just suck. I have a very strong faith and trust in God's plan, but sometimes that faith is hard to maintain. So for today, I am going to put this here, so that even though I am feeling shaky-I can be reminded of his promises  until they come true. If any one can spare some extra prayers, I would be very happy to accept them. 

 

So that's the update, nothing. But I promise you I will try to update more often so I'm trying to fulfill my end of the deal. Check back in a week or two and I'll let you know where we sit on the situation.

Decisions Decisions Decisions

So I am probably the worst blogger ever. The main problem is that not a whole lot new happens when you have infertility. It feels like you're living life on repeat, constantly counting days, taking medication, giving yourself (or trusting your husband to give you) a shot, testing, and then starting it all over again when that month fails. I feel like my blog would sound something like this: 

  so this month was another bust, more money out of pocket, and 

          I hate insurance again. But on the bright side I'm getting to know the nurses and Dr. on a first name basis and they don't even need my chart anymore to know who I am. 

So you probably wouldn't want to read my blog anyways because you would be bored to tears. I'm sure by now you're asking yourself, if she's got nothing to write about, then why is she making a new post.

Will you see that is a great question to ask! We have been asked by a lot of people what is going on and we are to the point where we have some decisions we have to start making. Let me just give you a quick synopsis of our trying to Cutie Pie Humphrey so far in case you are just joining! (Or skip down to the part that says "So now what" to find out what this post is really about!) 

-12 months of perfectly timed trying to conceive
-visit the RE and start 2 months of testing
-get diagnosed with PCOS, a block right tube, and hypothyroidism-full story Here
-Treatment starts! 

Here is the shortest summary of each month! 

-January-I take Letrozole plus a bunch of other things to grow pretty eggs and see if it works. It works somewhat, but I have super lazy ovaries. After a brief argument discussion and demanding to up my dose but stay on this med we move on to Month 2. (Want more details-read about it HERE)

-February-Upped dose of Letrozole which works, sort of. Ovaries are still lazy but getting closer. Move on to Month 3

At this point we decided we were ready to move on to trying meds plus IUI. What is IUI? Google or read about it Here

-March-All the meds, plus some and I insist on early monitoring to see when the egg is ready so we can add a trigger shot. So now I order a shot each month that I trust Jeff to give me each month. The plan works, I have a perfect cycle with a beautiful egg released on the good side. Still not pregnant. Look at my month in pills:

April-Repeat April's plan but then we see the egg is on the blocked side and so that month is cancelled. No IUI, no miracle pregnancy and on to month 5. 

May-Repeat March's protocol again. Everything goes 100% perfect. All numbers are great and everything looks awesome. Still not pregnant. On to Month 6.

See, told you-boring updates would have been all you got in this blog before now. 

So now what????

Now we as a couple have decided to start looking into IVF. But that is not covered at all by insurance (well none of it has been by them) and the VA won't pay for it at all ether. We are grateful that the VA has paid for our testing and most of the costs of the IUI, which has been a huge blessing.  But now it seems dumb. They will keep paying $2000 a month for something that is not working and has like a 5% success rate at this point but refuse to pay for something with a 60% success rate. Way to be cost effective VA.

What does that mean? We will continue to do this same treatment route with IUIs (and hope that maybe just maybe it will work) as we save up for IVF since the VA will keep covering it for a while. But that also means we are now saving up for IVF. We are looking at 2 or 3 different clinics and have to make a decision which we want to go for. The price does not change that much regardless of where we choose, but different sites have different protocols, packages, and requirements. Big picture, we are now working to save around $25,000. Yep those zeros are correct. You read that right. So yeah, trips back home to MN are now going to be few and far between. Vacations are no more and our budget just got real tight. But in the end we know it is the right choice and we will make it in a heart beat to have our dream of a family. 

So that is where we are. Budgeting, saving, and waiting. As we go forward with this process I will update more, promise, for real this time. 

Check back soon-or subscribe and it will tell you when to check back! ;)  

Treatment starting!

So I have been working on a blog post all about PCOS. It's taking longer than I had that because I wanted to research and give more than just my experience, since I was just diagnosed and I don't really know whole lot about it. The problem with PCOS is the fact that it's such a varied disorder and everybody experiences a different reaction to it that it's hard to find a lot of concrete facts. And now my heart feels like I want to share more about what's happening in our journey right now. So look for the PCOS blog in the near future, maybe next time. I just want that want to be really good. 

So what's going on with us? That's the question we get a lot of the time and the problem is it's usually, waiting. Well we are moving into our first TREATMENT CYCLE!!!! 

So here's what's happening… You ready for this? To understand what treatments do, you have to understand some basics about cycles in general. Some people may know this, but most people have no idea!!! The things they leave out in basic health class. 

Everything in fertility has to do with the woman's cycle, seems reasonable right! So the basics are this. You have phases of your cycle. The cycle starts when a women gets her period, called cycle day 1 (CD 1). This is the menstrual phase and the phase everyone knows about. After starts the beginning of the follicular phase. Follicles grow eggs until one is matured and released (average is CD 14, but could range from CD 8-CD 50 and beyond). This is the main indicator of how long a woman's cycle will be. The day the egg is released, called ovulation day, is the beginning of the next phase. This phase is the luteal phase. This phase typically lasts 10-16 days with the average being 14 (14+14=28-why they say the average cycle is 28 days....but rarely is it actually). During this phase the lining of the uterus continues to thicken and prepare for the potential of implantation should sperm meet egg. If a woman gets pregnant, no CD 1, if not she will shed the lining and CD 1 comes and the whole thing starts over. 

Confused? Here is a pic :) 

Take Aways:

1. You can only get pregnant if you ovulate (no egg no baby)

2. You are only fertile for about 4 days a cycle(Sperm live 4 days, egg lives 1)

3. Cycles can be monitored and charted with science

4. Your period is never late. If your cycle is going long and if you are not pregnant, you ovulated later that month

How does a gal know where she is in the cycle and if there is a problem? By temping. Every morning, for the last 16 months, I take my temp when I wake up. Well actually I set an alarm for 5:15, everyday of the week (weekends included) and temp. This is called your basal body temp. By charting this temp I can see when a jump occurs (which happens and is sustained after) the day after O. Here is a typical chart from a great site called fertility friend. This site is fantastic if you are thinking about trying to conceive or just want to learn how your body works!!! I tell you, there are so many things I was clueless about in my own body! 

As you can see, in the follicular phase temps are pretty low, then a jump and starts the Luteal phase (LP). A drop at the end of LP signals impending CD 1. The nice thing, once I get those red cross hairs-I know to the day when my cycle would start. Never surprised! 

Well, just when you think you know your body and you know your cycles and everything, your body switches it up. Bodies can be jerks like that… Especially mine it seems (Thanks PCOS). So we went through all of our testing and we made our game plan, I talked about that in the previous blog that you can find here. The plan is to take a medication called Letrozole which is a generic form of femera. The way this drug works is you take it for five days (CD 3-7, 4-8, or 5-9).  Letrozole lowers estrogen which causes the brain to raise FSH and thus stimulates the ovaries to do their job (hopefully). So I was just waiting for my cycle, call in this prescription, and then start this next cycle with a renewed sense of hope. 

Here is an easy to see way of how it works: 

Well sometimes a cycle doesn't end, ever. So I had to call in to my doctor and get a prescription for medication called for Provera. This mimics the luteal phase and tricks your body into thinking it ovulated.  Well my body didn't ovulate so we had to make it think it did. I took the Provera, this isn't the first cycle so I kind of figured I knew it was going to happen. Last time I took it for 10 days and the next day was CD 1. Boom!  So I start the Provera and I thought my cycle and start the next day just like the last time. Once again bodies are jerks. I had to wait two solid weeks for that cycle CD 1 to show up! When you're trying to get pregnant the last thing you want to hope for CD 1 because that is the one sure fire way you know you're not pregnant. When you have IF and are trying to get pregnant, it seems you are forever waiting on CD 1 to get something started! 

So two weeks later, my cycle started. So now it is on to letrozole. I'll be taking this drug on days 3-7 with the hopes that it causes my follicles on my ovaries to grow, ovulation to happen around day 14, and at least one or two eggs to be released (we would be just fine with twins :) ). Keep watching for more updates to see how the story unfolds. One can only hope that my body will decide to get it back on track and do what it supposed to do!

Infertility (IF) diagnoses

So many people have been asking what is happening now, when am I going to update the blog, what is going on. Welcome to IF. It is a whole bunch of planning, planning, planning and then waiting. Waiting for the next cycle, waiting for test results, waiting for meeting with the doctors, waiting. So while we are in this waiting process, I thought I would write a blog about how IF is determined and what testing goes into it.

If you saw the video I made, you know that it can take a perfectly healthy couple up to a year of well timed intercourse to get pregnant. Some people get pregnant right away, others it takes almost a whole year. You have a 20% chance each month. Some people may think that there is a problem or it's infertility after a couple of months, but it's really just them being impatient. After that year, or six months if the woman is over 35, a couple can make an appointment with the reproductive endocrinologist (RE), or a fertility specialist. I always advocate for using an RE over your OB/GYN because REs specialize in getting people pregnant and spend years training in this field. OBs, even ones who "specialize in fertility" only received about a month of training in fertility. Usually the first meeting is just a history gathering, a planning session, and question answering.

The RE will usually ask about family history, if a woman has regular cycles, if she is been tracking her temps each morning or using ovulation predictor kits to check her ovulation, and about a million other questions. If that woman has short cycles or long long cycles, doesn't know if she's ovulating, or has other symptoms (painful periods, short luteral phases, etc), it will play into what testing is done. I am no expert at all tests out there so I can only tell you my experience, others have different ones.

The first step is for the man to have a semen analysis. So Jeff gave a sample (guys have the easy part ;) ). When looking at a sample, they are looking for a few things including count, motility, morphology, and defective sperm. Count is the overall number of sperm, motility is how well they swim (both speed and direction, no swimming in circles!), morphology is their size and shape (helps determine if they can get into the egg), and defects could range from having two heads to no tail and more. Jeff's test came back great, with the exception of morphology. He saw urologist who was not worried at all and neither was our RE. The RE basically said morphology is like soldiers who didn't bring all their gear, they may still get in and win, but it will be much harder and more may die in the process. Yep, I can never get away from military comparisons. They said that this was most likely not our problem. So Jeff gets a pass and just has to take vitamins to maintain his health.

My testing was not quite so easy. The first thing I did was went in on day three of my cycle and had around six or seven tubes of blood drawn. The testing included looking at levels of testosterone, FSH, LH, thyroid hormones, estradiol, and a genetic panel done. Most of my levels came back within a fairly normal range, except my thyroid. That was high and so I was started on a medication called levothyroxin to hopefully bring it back down to normal levels. I am not a genetic carrier for anything so that is pretty awesome to know too. At that same visit an ultrasound done to look at my ovaries and uterus. My uterus was perfect but my ovaries (along with some other symptoms) showed that I have a condition called polycystic ovarian syndrome (PCOS). I'll write about that another time, because that is a whole post by itself. About a week later I went and had an HSG done. This is a test where they essentially check to see if your Fallopian tubes are open and functioning. If you want to read more about it, click HERE. This site include descriptions, tube pictures, and some facts. My left tube has no problems but my right one is inconclusive. As of right now it's considered blocked but the doctor said that he didn't feel comfortable stating whether it was open or blocked because the test was somewhat inconclusive. So we are treating it as blocked. There's nothing that can be done for this except surgery and even surgery has no guarantees. They could perform the surgery, we would be benched for a few months, and within a few months the tube could be blocked again and so it is really not beneficial.

What a normal HSG looks like

 Credit

Since many times PCOS can be caused by insulin resistance, my doctor also had me do a two hour glucose test. This consisted of drinking a bottle of highly concentrated sugar water, tasting very similar to the orange drink at McDonald's, and then waiting two hours. They drew my blood both before and after and tested the levels to see if I was at risk for diabetes or potentially had diabetes. That test came back that I was fine and not insulin resistant. Thank goodness for small victories! I have now started referring to the lab people as vampires though, because I see them so often and they take bunches of blood! They laugh when I do. :)

After getting all the results we had another meeting with our RE. It was determined that the cause of our infertility was most likely the PCOS causing weak and sometimes no ovulation, high thyroid, and the morphology didn't exactly help. So our plan is to take a medication called Femera (Letrozole) on days three through seven of my next cycle, and hope that that brings on a stronger ovulation than I've been experiencing. Hopefully this will be enough to help us meet cutie pie Humphrey. Time will tell!