Patience, reflection and time – Part 1

I needed over a week to process what happened and then write about it. I honestly didn’t know what to write because I couldn’t process how I felt. Every time I tried my heart felt empty and cold, my throat tight. Today’s story required patience, reflection and time. I’ll start at the beginning.

My friend M is a wonderful person. She has the kind of soul that shines bright before her. Have you ever fallen in love with a girlfriend? Someone you meet and are transported back to childhood days where you immediately want to come up to them and invite them on your side of the monkey bars and give them the other half of your grape popsicle? We became good friends. Several years ago, I confided my problems with trying to conceive, my worries, my fears. She is one of the few people IRL I felt comfortable doing this with. She (39) is about the same age as I am (40). After the years, I could tell that our conversations, my confessing how I wanted having a family in my life were affecting her. She admitted a year ago she was talking to her husband about having a family too. He already had grown children and was preparing more for early retirement than starting over. This was a great source of conflict for her. We supported each other, we talked. When MrBeep agreed for us to try for a family we chose to get married. She, M, agreed to be my Matron of Honor, the only person I chose to stand up with me.

But life gets busy I had not seen her in a while. She lives an hour away so most of our time together required a bit of time and organization. She was going to school and working both a regular job plus an internship. We’d chat online briefly but I knew what little time she had left in a day needed to be spent with her wonderful husband and dogs. So I maybe saw her once in the six months before she finally called and invited me to go to a farm for u-pick blueberries. She suggested a date in the middle of the weekday morning.

Before I left my house that morning, I knew it had the potential to be a “hard infertile day”. Most people take their families to blueberry farms to pick berries. I have seen the blog entries from mommies who take their kids and toddlers, but I am typically fine around families. I try to keep myself positive and optimistic and look the situation as something I hope to have someday rather than something I don’t have. I also really wanted some delicious and cheap northwest blueberries.

I arrived at the farm and noticed her car wasn’t there yet, so I got out of my car and started to douse myself with sunscreen. Her car pulled up, but she didn’t get out. She called me over to come to the car and have a seat. This was not unusual since we both do this to have the other hear some new music we’ve discovered. I got in and she gave me a piece of paper, a hand made card. I read the front and opened the card and there was a ultrasound photo with a clearly defined baby’s face. I was stunned. I wasn’t sure what to say. I was happy for her and turned to say, “Congratulations! What a wonderful surprise and wow this ultrasound looks very detailed, how many months along are you? Four? Five?”

“Seven,” she answered. And then she moved her sweater aside and there was a cute, perfectly round basketball sized belly.

It was like someone hit me square in the chest with a baseball bat. I could hardly breathe. I have never, NEVER reacted this way to finding out someone was pregnant. One half of my brain was jumping up and down cheering for joy the other half was just still. Stunned. I knew I had to stay calm. I knew I needed to act my normal happy self. I didn’t want to ruin this day for her, but I knew it would be tough for me. I gave her more hugs and congratulations then we both got out of the car and walked toward the entrance. We grabbed picking buckets and headed out to the fields.

I kept the conversation light, asked about her husband and her mom. She told me they were so worried due to their age that they kept it a secret from everyone, including her mom (with whom she is very, very close) until she was 5 months along and had the results from amnio. She explained how scared she was when a pre-screening test came out positive for abnormalities. I told her I was sorry she had to go with all that stress alone, but that I understood why she would want to keep private and how happy I am to know that everything is normal. I joked I would love some privacy myself.

To a certain degree inward, my mind was razor focused. I didn’t need to make eye contact. We were crouched down, finding the best looking and ripest berries on the bush while we talked. Inwardly I meditated on the positive side of things, and the patience I needed to exercise to stay calm and keep breathing. I didn’t want to do or say anything I would regret, anything to make me sad, anything to hurt my friend. But it was so hard. We were completely surrounded by families. There were mommies and grandparents with tons of kids excitingly calling out that they found a spider and here’s another handful and look at me look at me. We were in a row all by ourselves, but I was surrounded and drowning.

Then she asked me how my IVF went back in June. I had never called and told her what happened, she knew that I was going to keep things to myself, but I think she was hoping that I would give her good news…but I had no good news to tell. So in the middle of that field, I calmed my soul, steeled myself and quietly told her about things going along well, then the drug not working, the retrieval and transfer and finally being pregnant for only a few days. I told her that we would try again and these things happen and how complicated IVF is, but that it was really hard because I really only have a few chances left.

Then she did it. She was trying to be comforting. I know this. She said, “Oh, sweetie, I’m so sorry. I completely understand.”

That’s when I shattered.

“No you don’t understand” I whispered, starting to cry. “No one I know has any idea how this feels. None of my friends truly understand how it is and I don’t have anyone to talk to and I don’t want to burden anyone.” I was overwhelmed with a sense of loss and sadness. One side of my brain kept thinking, how could she do this to me? How could she take me here, in public, to give me her news? Why would she ask sensitive things of me while I was surrounded by pregnant bellies and happy families? How could she stand there, 7 months pregnant with everything tested and declared OK and tell me that she understands? What had I ever done to deserve this utter disregard of my feelings?

But that’s not how things are, I knew. M is my friend. I love her and know she would never do anything intentionally to hurt me. It just happens sometimes. We do our best to consider the feelings of others, but it is impossible to see the world from every perspective.

This is not my destination. I will write more about the rest of the day, my thoughts and feelings. Please understand that I love my friend and this is not an open invitation to berate her. My entries on this day are a journey to a new understanding of myself using patience, reflection and time.

To be continued…

How to make a fool out of yourself in 1 easy lesson

Step 1:  Publicly declare your frustration and disdain of Ovulation Predictor Test Kits.

Step 2:  Pee on said stick.

Step 3:  Get relatively easy to read and predicted results.

Step 4:  Look like a fool. 

 

Fine.  You only cost a freaking fortune, I guess that’ll teach me a lesson.  Stupid pee stick.  :-p 

I h8 OV Peesticks. Sistahs, can I get an amen?

I just really, really hate OV predictor peesticks. I don't trust the digital ones because I need to see that little bit of pink getting darker and darker but it never seems to look like the example picture on the freaking box. The added bonus is since I took birth control pills for my delayed IVF cycle, I had "breakthrough bleeding" which is not exactly like a normal menstrual cycle and now I can't remember what should be the first day and so I have no idea whether today is day 11, 12, or 13. Why don't they work for me? Is it because I am old? Decrepid? Wrong brand? I even went out of my way to drink only a few glasses water instead of my ususal liter.

AAAARRRRRRGGGGGGHHHHHHHHH!!!!

Thank goodness for other *ahem* bodily indicators or else I would be screwed. I'm thinking OV should happen in the next couple of days so it's time to enjoy the delights of GOF**. I am not smart like MeKate and didn't bother to check my basal body temp this month because well I was supposed to be monitored by doctors and taking complex drug regimes and IVFified and wah wah wah wee wee wee. Feh.

An extra special "you are so wonderful" to everyone who offered such nice comments and advice on my last post on waiting a month. I was upset and nervous. You all made me feel warm and among understanding friends. Thank you.

** happily and blatently stolen from the awesome Kvetch Board of IndieBride/IndieMom. I even posted an article on how to conjugate GOF as a verb. GOF = Goal Oriented Fucking (waaaayyyyyyy better than the disgustingly syrupy sweet term "babydance" which makes me shudder and gag any time I hear/read it.

Taking a shot on goal (aka why I chose to wait)

All I can feel right now is how truly sick I am of waiting.  It seems like 90% of this game is spent waiting for the right time.  I want to be active.  I want to participate.  I want to roll up my sleeves and get to work.  I want to take my shot.

I had to wait for a BFN every month while TTC on our own. I had to wait for the right cycle days to go through tests and procedures.  I had to wait through two uterine surgeries and recovery.  I had to wait for results and healing.  All that waiting took over 4 years.  Even now that we have achieved the place where we are down to business/on to the big stuff/major intervention-o-rama, in the last 10 months I have only been able to try 2 IUI’s (1 clomid + 1 natural) and 1 IVF cycle.  In 10 months.  Everything else has had waiting due to tests and clomid causing cysts and/or a thin uterine lining, now embryo lab closure and recommended months off and now cysts again.  3 out of 10 months that had a shot in hell to work.  Those really aren’t good odds for success.  While I am a very patient person…Yes. Thank you for asking, I AM very sick of waiting.

So back to last Thursday afternoon.  Our IVF coordinator nurse called and told me that the doctors discussed the 14mm ovarian cyst and decided that it was just too borderline for them feel comfortable starting IVF this cycle.  As DocO said to me in the exam room, “the size of the cyst makes it really come down to a judgement call.  It is absolutely on the dividing line in terms of size for when we would postpone.  Obviously if we go ahead and it’s successful and you get pregnant then we would call it the right choice, but if we had to cancel mid-cycle or get bad results then we would call it the wrong choice, but there is just no way to know which on which side this coin would fall.”  The nurse, said that after DocO, the embryologist and the other doctors discussed the case, they thought it would be best to postpone.  I asked about aspirating the cyst and she said they discussed it while reviewing my case, but preferred not to aspirate.  She explained it is an invasive procedure and there is no guarantee there would not be complications or sometimes a cyst just returns anyway.  She asked me if I had any questions and how I was doing.  I started to talk to her about a few details and then just lost it.  I hate it when I cry in front of strangers, but I couldn’t stop myself.  I talked to her between sobs about how frustrating it seems that I am always soooo damned close.  I had some minor success last time, the baseline gave me excellent results and now here I am waiting again. I’m terrified that I’ll just be in the same place a month from now. Which is just one more month of being closer to 41 and do you know how bad my chances become as each month goes by?   She did say that it was really borderline and that if I wanted to continue anyway or get the cyst aspirated that they would do it. She said that if I wanted to talk to DocO that she would have him call me right away and that they understand how upsetting this all can be.  They just wanted to give me the best shot.  They wanted my starting point to be perfect to ensure the best chance of success.

I called MrBeep and told him the news that the IVF nurse was talking to DocO and will call me back soon.  I didn’t know what was the right decision.  Should I wait for the next cycle or just get the cyst aspirated and risk it?  MrBeep comforted me and told me whatever I wanted we could do.  We discussed our options.  We considered if we started the cycle and it was cancelled or failed, then it would be 2-3 months before we could try again.  If we waited, it would be 1 month.  We decided to just aspirate next month if another one came up.  I did have to take birth control a very long time, (14 days) due to the lab closure, and perhaps a shorter length would remove this complication.  One month would probably not be the make or break for my eggs or hormones.  Those have been looking good lately, but the waiting is still very hard on me. I am a person who acts, who has always worked hard to achieve things and that drive does little for me here.  There always seems to be some impediment, some obstacle in my way.  I can’t even get to anything close enough to call utter failure so I can just give up or move on.  I seem to be stuck forever on the bench, waiting to just get in the game.

MrBeep used to play hockey on his college team. (Go Mighty Beavers!)  He explained it to me this way -- the more shots you take the better your chances to make a goal.  So we definitely need to be aggressive to take as many good shots as possible.  But sometimes your best option is to wait a little, get closer and take your shot from the best angle.  Sometimes you have to skate around to wait for that perfect shot.  The truth is we are impressed with our doctors, we consider their knowledge and advice to be very important.  They’re the coach recommending waiting for a different play, better circumstances to get that best shot at goal.  

After discussing it with MrBeep and calming down, we both knew that waiting a month was the right decision.  After talking to him all of my tension disappeared, I didn’t feel like crying anymore and some hope for the future was restored.  He does that for me, he calms my soul.  I am a better person for knowing him, but it is still very hard.  When the IVF nurse called back, I told her I was OK and we would wait.  She was really kind to me and suggested that I enjoy some wine and maybe get a massage some time soon.  She also talked to me a little about a wellness program in the area for ladies going through IVF.  I may check into this.  In the meantime I will do my best to keep my spirit up and practice my slapshot.

Cycle Status – Part 2

It’s late again.  I just turned my computer on for the first time today in and checked my blogger and found out about Sprogblogger’s horrible news.  Please go and give her some love and comfort.  She is one of the most amazing and fabulous people who have supported and helped me beyond measure.  I was so overjoyed for her and now I can’t stop crying.  To have this news on the heels of Mo and Will’s has shattered my feelings of hope.

The RE’s office called back Thursday afternoon for my instructions, they decided that due to the size of the cyst, DocO and his colleagues recommended it was best to wait until next month.  So I am not officially cancelled, but I am postponed and waiting yet another month.  I was upset, I cried like crazy.  But I can’t write about the details right now. I was going to tell all of the reasons why we agreed to postpone rather than aspirate and how I lost it and sobbed on the phone with the wonderful and compassionate IVF nurse, but I won’t write about that today.  I am beyond sad and upset for my friends and my stupid petty little problems are nothing in the midst of this.

Why does this all have to be so heart breakingly hard?

Ultrasound and status – Part 1

It’s very late (1:45 am) and I have friends with their 2 adopted boys staying with us from out of town. I will have to break this post into two sections.  If you haven’t already done so, please take an extra second to visit Mo and Will.  They had some heartbreaking news today.  We need to give them lots of love and support.  I opened up my blogger for a few seconds before bedtime and posting and, well…it is just so awful and made me cry and why do these things happen?

I went in this morning to the RE’s office for an ultrasound.  The plan was to check and see if the cyst on my right ovary had collapsed now that the birth control pills were done and the “withdrawal bleed” has begun.  For more information or to catch up, you can read my prior post, “Are you kidding me?”  MrBeep was nice enough to come with me to the appointment to offer support and well…gosh darn it he is just so smart and reasonable.  He thinks of questions that elude my addled brain and I love when he comes to the appointments so he hears directly from the Doctor what is going on.  So we meet DocO, get right down to business with the wand and…

it’s still there. 

The measurement of the cyst hasn’t gone up or down even a millimeter.  Good ole lefty is hanging tough with no issues.  After the exam I sit there with my paper drape with MrBeep by my side and we discuss the situation with DocO.   The cyst is considered by DocO to be borderline.  A little smaller they wouldn’t think it was a big deal, a little bigger they would be very concerned how it would affect the cycle.  We discussed the possibility of aspirating the cyst.  He said it was an option, but he was concerned about putting me through a medical procedure that may not solve the problem and has the potential for complications.  He made an excellent comment.  “It’s all really a judgement call.  If we go forward, do nothing and it’s a problem that cancels the cycle, that’s bad.  If we aspirate and it acts up, that’s bad.  If we aspirate and it works well then that’s good.  It we leave it alone and it works, then that’s good.  But what we are talking about is something that is likely to affect the cycle and whether we think it is a good idea to take that risk or wait another month.”

I asked him why an ovarian cyst is considered a problem for an IVF cycle.  He explained that having a cyst can affect how well the eggs grow in that ovary.  You can get fewer eggs at retrieval time, you can have problems with the cyst growing larger due to the meds, you can have problems with your overall hormone levels, etc.  Keep in mind this cyst is here before the cycle has officially begun, I have not yet taken any stimulation medication.  Some folks who commented on Sunday had cysts appear after stimulation had already begun or they were many days into their IVF cycle.  I think that REs view this differently than one in the early stage.  This is just my impression.  To read a little more about ovarian cysts, here is a good article.

DocO told me to hold off on taking my first day lupron injection.  He said he planned to take today’s results and discuss the case with his colleagues. (This is their standard operating procedure – more brain power on the problem.  FYI-I love and respect that.)  He said they would call after the meeting in a few hours and tell me what the plan is, whether we will start the IVF cycle or wait until next month. 

After the appointment I walked MrBeep to his car, we talked and I wished him a good day at work.  Then I went home to wait for the call…(to be continued)

Techie Tuesday: Semen analysis a go-go

Welcome to another Techie Tuesday. I am going to provide a few links to some IF techie things. I want to state clearly that I am not a medical professional.  I am a computer geek/IT professional with over 20 years in the computer and biotech industries. A geeky gal who likes to research her condition/situation/whatever. My supreme computer nerdiness has enabled me to dig up some good places on the net.  I read many articles and want to provide links to the ones that have some great info.  Are you like me?  Desperate to research the tests and procedures that have been recommended to you?  I get it.  I’ve been there.  I am still there.  Let’s a go-go.

According to the CDC’s 2005 statistics report, among couples who have ART cycles, male factor counts for 18.3%, multiple factors (female + male) is and additional 18.5%  The report defines male factor: “Any cause of infertility due to low sperm count or problems with sperm function that makes it difficult for a sperm to fertilize an egg under normal conditions.” 
http://www.cdc.gov/art/ART2005/index.htm

So you are having problems getting pregnant.  The RE puts us gals through a lot of embarrassing and uncomfortable tests and procedures.  Well men should get tested too.  I can’t believe sometimes reading about how long some ladies go through infertility work and testing before getting their male counterparts get tested too.  If your OB/GYN or RE hasn’t tested the other half, it’s time to ask why.

The men get their own chance at humiliation with the Semen Analysis and SPA.  I won’t get into any junior high jokes about providing samples in the doctors office.  OK.  Well…maybe one.  MrBeep and I joke about removing all of the standard RE office provided pR0n and replacing it with entirely hard core male-to-male manlove material.  We snicker about the RE docs saying something like “Wow, the SA sample rates are sky-high this month.  More volume than ever!” 

Back to bloggidy work…so the male counterpart gives his sample and then a couple of weeks later you get the results paperwork.  Once you get this Semen Analysis (SA) report and are thinking (as I did) “eh, so?  What does all this mean?” I understood that our test was labeled “abnormal” and that some numbers were below the reference range.  Other numbers were in the normal range, so how bad are things?  How does this affect our chances? 

I don’t really know.  I know they are affected enough that even with my 28-day on-time like-clockwork mad ovulation skillz we can’t get pregnant.  I know that over two years trying on our own we can’t.  I know DocO and the report recommends IVF with ICSI (which worked in IVF #1 very well.  6 eggs mature, all 6 fertilized using ICSI and 4 made it to 3 day transfer).  Below is a sample of how our results chart was laid out.  I have included links to the articles that I feel either explain the test item in better detail or where I have found useful information.

SEMEN ANALYSIS REPORT

Test/Result	Reference Range	IF Optimist Notes
Volume	Normal: 1.5-4.5 ML	if the volume is too low or too high it can indicate fertility problems.  This site gives an excellent definition.
Sperm Concentration	Normal: 20-150 Million/ml	commonly known as sperm count, which is different from total sperm count (see below).  Oligospermia is a term for low sperm count and azoospermia is a term for a complete absence of sperm in the ejaculate.
Total Count	Normal: > 40 Million/ml	A calculation of the number of moving sperm in the entire ejaculate.  Volume (cc) x concentration (million sperm/cc) x motility (% moving)
Motility	Normal: > 50%	What percentage of the sperm are moving normally.  Sperm that don’t move normally cannot swim up the female reproductive system to find the egg.
Progression	Normal: 3 - 4	This describes how well the sperm that are moving are making progress. Only when the motility (% moving) is combined with the forward progression is an accurate picture of sperm movement obtained.
Viability	Normal: 60 – 95%	Sperm may be alive, but not moving. A specialized staining technique is used to determine what percentage of the sperm are alive.
Sperm Agglutination		Sperm agglutination (sperm sticking together) can be caused by various inflammatory conditions, and are most commonly seen with the presence of antisperm antibodies
Viscosity	The desired viscosity is +1 on a scale of +1 to +4, with liquefaction complete within 10 - 30 minutes.	Viscosity is the rate at which semen liquefies. Semen is initially thick and viscous; the thicker the semen, the more difficult it is for sperm to travel.
Round Cells	Normal: < 3 Million/ml	A large number of round cells may indicate an infection
WBC	Normal: 1 Million/ml	All semen samples have white blood count (WBC) in them. If greater than 1 million WBC per 1 ml are present, there is concern of infection.
Morphology	Normal: > 10% Suboptimal: 5-9% Abnormal: < 4%	Normal sperm have an oval head with a long tail. Abnormal sperm may have head or tail defects — such as a large or misshapen head or a crooked or double tail. These defects may impair the ability of the sperm to reach and fertilize an egg.
Acrosome Reaction (test using Sperm Penetration Assay)	Normal: > 9% Abnormal: < 7%	Levels below normal indicate problems of sperm fertilizing egg.  ICSI is recommended if this is the case.

Here are a few more articles I found on the internet that may help you better understand the test and the data breakdown.

Babyhopes.com: What does Semen Analysis Entail?

WebMD:  Infertility and Reproduction Guide – Semen Analysis – on page 2 this article gives a very detailed breakdown on what abnormal may indicate.

Wikipedia – Semen Analysis:  a pretty good article with lots of links to other sources.

An excellent and comprehensive page on Semen Analysis with good definitions.

Another really excellent page of information about sperm evaluation and testing.

An interesting article on a British website on semen and sperm quality.

Video that describes a little about IVF and shows an egg being fertilized using ICSI.

I know that there are a lot of other bloggers out there who have done some excellent research on male factor.  I would really appreciate it if you were to comment with any articles, websites or any previous blog entry (including your own) that you feel particularly useful.  It is all so overwhelming.   Techie Tuesdays are all about making it easier for others who need to find information when first dealing with infertility diagnosis and testing.  Thanks.

Are you kidding me?

I went in this morning for my suppression check.  I have been put on the micro-dose lupron protocol, and I have just finished 14 days of birth control pills.  The first part of the suppression check is getting a blood draw.  The good news is I got my favorite phlebotomist. She is awesome.  I hardly feel a pinch and she never leaves a bruise.  The test today is for checking my estrogen (E2) level.  They do this to make sure that there is no rise in estrogen.  A rise would indicate the birth control pills weren’t doing their job to suppress my natural  hormone response.

Next I was taken into the changing room and given my paper sarong.  I asked the nurse what they were looking for in the ultrasound.  She said they are looking to see all of the follicles in the ovary were still roughly the same size and that there wasn’t a follicle growing much larger than the others.  They are also looking to make sure there are no cysts present.

The doctor called me into the exam room (DrT) and thus began my date with the dildocam.  First she checked the state of my uterine lining, then she measured my uterus.  Both looked OK.  She checked my right ovary next and there it was.  A large black follicle much larger than any of the others and measured at 14mm.  Even I could tell right away it was a problem. 

Dammit.  FFFFFFFFFFFFFFFFuck.

By the way, I think that it sucks I can now understand what I am seeing on a pelvic ultrasound.  DrT then checked the left ovary and that one was fine.  No large empty spaces, no indication of cysts.  Good ole lefty.  “OK.  So what does this big follicle mean?” I asked DrT.  She said that my estrogen levels are an important indicator to determine what comes next.  If they are high, then it means this large follicle may have and egg and may be producing lots of estrogen.  Since it would be way ahead of the other follicles it would be bad to start IVF drugs.  If my estrogen level is low, then this may be just a cyst and we might be able to proceed.  I was told to go home and wait for the test results.  I went home and told MrBeep <sigh>.

Several hours later my phone rang and I talked to the nurse.  The good news is that my estrogen level is low (40 = yay!) and that I should order my meds on Monday.  I am scheduled to come in again on Thursday morning where they plan to do another ultrasound.  The nurse explained that now I am no longer taking birth control pills that I would likely have a “withdrawl bleed” and they are hoping that the cyst will collapse on its own during that time.  I am to bring my lupron with me and if it looks good I’ll take the shot at the RE’s office and the cycle will proceed. 

I  did notice yesterday while I was working on my laptop that my right side had a few sharp pains just left of my hip bone, like it does when I have, oh I dunno, a cyst perhaps?  I thought, “Shit.  I hope that’s not what I think it may be.”  It was.  Anyone want to come over and punch me in the ovary?  Maybe that’ll pop the bastard.

Just for the record, I didn’t have a cyst two weeks ago during my baseline ultrasound. I watched the monitor.  DocO was very thorough in checking.  All looked wonderful.  I was curious and decided to google ovarian cysts.  Do you know what they recommend to prevent them?  C’mon fancy a guess?  Birth control pills.  Exactly what I’ve been taking for the last 14 days. Are you kidding me?

So I’m where?  Oh yeah, that’ right.  Waiting.  Again.  More to come on Thursday.