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Friday, 26 February 2010

Yes, I would like a child, please.

After some serious contemplation, I have decided that, yes, I really truly want to raise a child with my husband. These are the sort of events that I would love to experience in my life:

  • Dressing our baby up like a bear.
  • Seeing them asleep in my arms.
  • Helping them assemble a rock/stick/leaf/shell/etc collection.
  • Make them laugh.
  • Reading to them and seeing their imagination soar.
  • Listening in awe as they speak a second language.
  • Seeing their faces as they discover new places.
  • Creating new family traditions together.
  • Involving them in making family decisions.
  • Helping them figure out how the world works.
  • Doing my best to answer the question "why?".
  • Making a train-shaped birthday cake.
  • Watching the private world that they create with other children.
  • Learning from their unique insight and experiences.
  • Watching their personality develop into a whole new person.


Even if we do have a child, there is no guarantee that we will experience any of these moments. How do you decide to welcome a new person into your home that you have never met? How do you decide that the benefits outweigh the risks? Mel wrote about this leap into darkness a few days ago:
I think it’s brave to put your heart out there, to want something so badly, to allow your entire being to get wrapped up in the potential life of another person. If we make that leap to love a partner or family member or friend, we do so knowing that person, having met them, knowing our compatibility or history. But when we put our entire heart into the idea of a child, we do that bravely. Without answers or information or sometimes even a true understanding of what it will be like to parent.


With this confirmed desire, I called the fertility clinic to schedule our next IUI. However, I learned that this cycle needs to be pre-approved by our health insurance, which means a delay of at least another month. So more waiting and day dreaming for me.

Wednesday, 17 February 2010

Will we be happier with a child?

Having children is a life changing event. Suddenly, there will be this new person in our family. My husband asked me to take a moment to stop and really think about if I truly want a child, or if I am just getting mission-orientated.

Julie addressed the question of "is it worth it?", and one commenter wrote:
This one is tough for me, too. And it's tough because, as much as I truly, madly, deeply love my children, I now realize how much of my own life--a life I really loved--I gave up in being a parent. I miss that life. And I sometimes think that if I didn't get the diagnosis "Infertile," if it had felt like a free choice and not a need to prove something to myself (I'm classic overachiever; having children was the one thing I couldn't 'get right'), maybe I would have made the decision to be childless. And maybe I would have been equally happy, or even happier. That's a hard truth to face.


So I am taking a few days to line up the pros and the cons of bringing a child into our family. Here are the most commonly cited reasons for having children or being childfree:

Reasons to have childrenReasons to be childfree
An additional way to express love for spouseLess global overpopulation
Increased closeness with friends with childrenMore energy and fewer illnesses
More fulfillment and meaning to lifeMore freedom and spontaneity
The experience of parenthoodMore money
The opportunity to provide and receive loveMore privacy
The pleasure and pride of raising childrenMore sleep
To develop personally by interacting with childrenMore time for hobbies
To have a relationship with childrenMore time to develop career
To transmit ones own ideals and beliefsMore time with adult friends
More time with spouse
No problems associated with children


I also ploughed through the literature on happiness, marital satisfaction, and freedom in parents, the involuntary childless, and the voluntarily childfree. It appears that parents and voluntarily childfree couples are as happy as each other, and are both happier than the involuntary childless. Some studies suggest that marital satisfaction may be slightly lower for parents than for voluntarily childfree couples. Mothers state that they have less relaxation, independence, and freedom than voluntary childfree couples.


OutcomeSexParentsInvoluntarily childlessVoluntarily childfreeRef
Well-beingM47.8not included 45.01
Life satisfaction bothnot included 3.52
Global well-being (1-9) F 6.44 6.28 7.06 3
My life is disappointing (1) to rewarding (7) F 5.42 4.68 5.18 3
Satisfaction with personal success (1-9) F 5.94 5.50 6.37 3
Life satisfaction both 23.7 not included 25.2 4
Happiness both 0 (a) -0.17 -0.14 5
-0.18 (b)
Depression both 0 (a)
0.05 (b)
0.09 0.07 5
Life satisfaction both 0 (a)
-0.30 (b)
-0.46 -0.22 5
Depression F 1.68 1.73 not included 6
Life satisfaction F 3.18 2.89 not included 6
           
Marital satisfaction M 33.0 not included 31.7 1
Marital satisfaction both 5.95 not included 6.00 7
Positive marital interactions both 3.49 not included 4.32 7
Unhappy with marriage both 7.4% not included 0% 8
Marital satisfaction (1-5.7) both 4.50 not included 4.75 2
Satisfaction with marriage (1-9) F 6.96 7.84 7.37 3
Marital satisfaction both 91.9 not included 93.6 4
Marital satisfaction (6-45) F 38.2 not included 40.0 9
Marital satisfaction (6-45) M 37.6 not included 38.8 9
           
Amount of relaxation in life (1-9) F 4.26 5.81 5.28 3
Amount of independence and freedom (1-9) F 4.90 6.69 6.46 3
Amount of friendship and love in life (1-9) F 6.72 7.43 6.90 3
           
Satisfied with childbearing decision both 3.87 not included 3.73 2
(a) = close ties to their adult children (standardized to 0)
(b) = distant ties to their adult children


1. Magarick, RH & Brown, RA. 1981. Social and emotional aspects of voluntary childlessness in vasectomized childless men. J. biosoc. Sci.13, 157-167
2. Burman, B & de Anda, D. 1986. Parenthood or Nonparenthood: A Comparison of Intentional Families. Lifestyles: A Journal of Changing Patterns. 8, 2, pp. 69-84
3. Callan, VJ. 1987. The Personal and Marital Adjustment of Mothers and of Voluntarily and Involuntarily Childless Wives. Journal of Marriage and Family, Vol. 49, No. 4, pp. 847-856
4. Somers, MD. 1993. A Comparison of Voluntarily Childfree Adults and Parents. Journal of Marriage and Family, 55, pp. 643-650
5. Connidis, Arnet I., McMullin, JA. 1993. To have or have not: Parent status and the subjective well-being of older men and women. The Gerontologist; 33, 5; pp. 630-640
6. Schwerdtfeger, Kami L. and Shreffler, Karina M.(2009) 'Trauma of Pregnancy Loss and Infertility Among Mothers and Involuntarily Childless Women in the United States', Journal of Loss and Trauma, 14: 3, 211 — 227
7. Feldman, H. 1981. A Comparison of Intentional Parents and Intentionally Childless Couples Journal of Marriage and Family, Vol. 43, No. 3, pp. 593-600
8. Ramu, GN. 1984. Family Background and Perceived Marital Happiness: A Comparison of Voluntary Childless Couples and Parents The Canadian Journal of Sociology / Cahiers canadiens de sociologie, Vol. 9, No. 1, pp. 47-67
9. Lawrence, E, Rothman, AD, Cobb, RJ, Rothman, MT, Bradbury, TN
2008. Marital satisfaction across the transition to parenthood. Journal of Family Psychology. Vol 22(1), Feb 2008, 41-50.

Monday, 15 February 2010

Not pregnant, but alive

I caught two trains in Belgium today to get to the fertility clinic - one at 7:30, the other at 9:30. On my way back, the train was travelling very slowly, and I noticed several men in bright yellow vests walking along the other tracks. As it was snowing quite heavily, I thought nothing of it.

Then on I saw the news item "25 dead in train crash outside Brussels" flash across my desktop. My husband was also due to catch a train that morning, and I had not heard from him since I left the house. My hands were shaking as I called his work, and I was so happy to hear his voice on the other end. He had not heard about the crash, and once I told him the news, he was so glad that I was okay, too.

While I was on the phone with him, I got the call from the clinic telling me that I was not pregnant, and they suggest one last shot at IUI with injectable Menopur.

But all in all, I feel extremely lucky today.

Monday, 1 February 2010

Endometrium thickness

Does clomid really thin out the lining more than injectables? The literature says that it only does this when taken on its own, but not when supplemented with estrogen.
From Dickey and Holtkamp, Human Reproduction Update 1996, Vol. 2, No. 6 pp. 483–506

Does endometrium thickness affect IUI outcome? Yes, significantly (p < 0.01). IUI birth rates per cycle for endometrium thickness at time of HCG trigger:
Regimen6 mm or less6 to 8 mm8 mm or greater
Clomid0%7.0%14.0%
From Dickey and Holtkamp, Human Reproduction Update 1996, Vol. 2, No. 6 pp. 483–506

At my scan yesterday (CD14) my endometrium thickness was 6.9 and my dominant follicle measured 19.6. We triggered last night, and the IUI is today. Looking over my last three cycles, I analysed my data and saw that, while Menopur thickened my lining more quickly, I also ovulated earlier at CD9. For all three cycles, my lining is around the same thickness right before ovulation, and it is far below average. At least this time it's above 6, which means we have a shot.

Friday, 29 January 2010

IUI#3 CD12

I do love having my cycles monitored. I love graphs and tracking my numbers and knowing exactly what is happening. I like knowing what my ovaries are up to and how everything is progressing.

However, our clinic is not very empowering in that respect. They never tell me my hormone levels, and I have to quickly memories my ultrasound numbers as they appear on the screen. Today I asked the midwife what the procedure is, if we decide to move onto IVF. Her response was "you do not decide to move onto IVF, the professor will decide." She went on the explain that for IVF to be covered by the Belgian health care system, patients generally must try three IUIs first.

We are lucky to live in one of the few countries that provides six cycles of IVF to most residents. It pays for this cost by mandating that many of these must be single embryo transfers, which decreases the number of multiples born, and thus lowers the higher costs associated with multiples. The savings made on decreased newborn intensive care usage pays for the cost of providing IVF.

IVF coverage in Belgium:

ageIVF 1 to 2IVF 3 to 6
Less than 36 yearssingle embryo transfertwo embryo transfer
36 to 39 yearstwo embryo transferthree embryo transfer
More than 39 yearsthree embryo transferthree embryo transfer


As for me, my dominant left follicle is still only at 13 mm, and my lining is still only 5.3 mm. Moving very slowly this time around. I'm guessing the IUI might be on Wednesday? We shall see.

Wednesday, 27 January 2010

IUI#3 CD10

I was randomised to clomid this cycle (clomiphene citrate CD3 to CD7, estrogen CD8 to CD12), and as I had some at home that meant that I didn't have to go into the clinic until today. The midwife who was taking my blood looked so young that I was worried that she would be incompetent. I think however the problem was that I am getting old, because she was fabulous. In fact, she coaxed out so much of my blood that I didn't realise that I was continuing to leave little drops of the stuff over the chair and floor of the waiting room. I was so embarrassed to have to get one of the midwives to clean it up for me. Still, better that than leaving human blood around the place.

My follicles seem to be ripening more slowly this time around. Last CD10 with clomid my dominant follicle was at 16 mm, but this time around it is only 11.7 mm. This is great, because I need time for my endometrial lining to thicken up. My lining is only 3.7 mm, the thinnest it has ever been at CD10 - it's gone from 7.6 mm (IUI#1 Menopur) to 4.8 mm (IUI#2 Clomid) to 3.7 mm (IUI#3 Clomid). I have been reading through the literature, and it really needs to be at least 7 mm on the day of the HCG trigger for a good chance of success.

The good news is that the dominant follicle is on my left ovary with the good tube. I should know more when I hear from the midwife this afternoon, but my guess is that I will have another scan in two days (CD12) and that the IUI will be on Monday (CD15).

Monday, 18 January 2010

IUI#3

New year, new IUI cycle. After a lovely vacation and break, it will soon be time to get back on the Assisted Reproductive Technology horse. Yes, I am still involved in the clinical trial, and yes, we have two more IUIs planned before we move on. The plan is:

February: IUI #3
March: IUI #4
April: Break and vacation
May/June: IVF #1
July: Break
August/September: FET/IVF#2

By this time, the theoretical success rate will be over 50%, and hopefully we will be part of that proportion.

Otherwise, we are just taking things month by month. We do not make any long term plans that we would have to change in the event of pregnancy. I try to schedule as many meetings at work in the afternoon, just in case I have to spend the morning at the fertility clinic. My calendar is divided into 28-day increments. I take my daily pre-natal tablet, as I have been doing for the past two years.

As long my husband and I have each other, we will be okay. For the moment, I am his baby and he takes care of me. He makes sure that I am taking care of myself, and that I have plenty of indulgences.

Monday, 4 January 2010

2009 and 2010

Well, our second IUI did not result in a pregnancy. Even though 2009 we may not have succeeded in getting pregnant in 2009, it was still a wonderful year. In my opinion it is much harder to find the perfect spouse than the perfect baby. As long as I have my husband by my side, I am content to wait for a bit longer to expand our family.

Last year we got the ball rolling, started our journey into assisted reproductive technology. We are now in the system, and hopefully a series of injections and probes this year will finally flip the odds in our favour.

Monday, 7 December 2009

IUI #2 insemination

We had our second artificial insemination yesterday. I was sitting in the procedure room, half naked with a towel draped over me for modesty, hoping that my bladder was just full enough. A well dressed woman comes into the room, wearing a short black dress, black stockings, and long black boots. She is holding a tube of sperm, and wants us to read the label to make sure it is correct. We confirm that those are our names, and then she asks me to put my legs up in the stirrups. I realise that she is the doctor!

I suddenly feel very embarrassed and nervous. I am getting accustomed to medical people in scrubs seeing me half naked, but this woman doesn't look a bit like a doctor. Here I am, legs splayed with everything on display, in front of a woman who looks like she's about to go out on a dinner date. I am so flummoxed I forget to ask any questions about sperm numbers or quality.

The IUI itself was a bit painful, but it was over very quickly. Happily, they did not play any love ballads for us while we rested for 15 minutes. They even let me keep an ultrasound picture of the sperm cells entering my uterus (the white dot in the center-right of the picture).




I must say, I am really glad that I have a break from the three-hour round trip to the hospital, the blood draws, and anxiously waiting for the phone to ring between 2pm and 5pm each day. We are taking a break cycle after this one, so we have six weeks of rest and relaxation.

Saturday, 5 December 2009

IUI#2 CD12

CD3-CD7 50mg Clomid
CD8-CD11 Estrogen
CD8 Disappointingly, the dominant follicle is on my right ovary, the one with the partly blocked tube. The follicle is 12.7 mm, and my lining is very thin at 3.4 mm, only 0.35 more than at CD3.
CD10 Dominant follicle at 16mm, lining at 4.8 mm (compared to 7.6mm when I was on Menopur)
CD11 Dominant follicle now ripe at 19mm, but lining only 5.78mm (triple stripe pattern). We trigger with HCG at 11pm. The needle injection hurts.

I have been extremely irritable lately, and my poor husband has had to bare the brunt of it all. He also has this thing about me taking personal responsbility for my actions, so I can't get away with just yelling at him and then blaming it on the drugs. Perhaps they could also percscribe some valium so that I could glide serenely through the days, instead of feeling my blood boil at every minor hindrance.

If this cycle doesn't work, then we will take a month break over Christmas, and then one to two more IUI cycles. If I am still not pregnant, we will move onto IVF. I am ambivilent towards IVF. On the one hand, there will be more medications and drugs and operations. On the other hand, I no longer have to worry about adhesions and blocked tubes, and our chances of success go from 10% to 40% per cycle.

These past IUI cycles have been odd. After so many months of privately monitoring my cycles with temperatures and LH cycles, I am surprised to find a team of midwives now working with me, and wishing me "good luck". I do appreciate the support, and the extra monitoring and knowledge, but the endless blood draws and commuting to the hospital are exhausting. And these area just the IUIs - we haven't even gotten to the hard stuff yet. I hope that all this does not last for longer than it has to.

We go in for the IUI tomorrow at noon. Either way, no injections for at least six weeks. Fingers crossed.

Thursday, 26 November 2009

IUI#2 Day 3

Three days ago.

"An exciting day today, yes?" The nurse asked me while taking my blood.
"Well, it is a rainy day" I answered. I didn't have the heart to tell he that I had already taken a home pregnancy test and recieved a negative result. She just seemed so excited, and then so disappointed when she called me at 4:02pm to tell me the result.

But the good thing is we can sneak in another IUI before everything closes for Christmas. This time I was randomised to Clomid, so fewer injections but perhaps more side-effects.

They are going to start monitoring me earlier, as I responded very quickly to the stimulation last time. My first ultrasound is next Tuesday, December 1.

Today.

Today is day 3, my endometrium is at 3.05mm, I have no ovarian cysts, my bloodwork looks good, so we have the green light.

We have one last chance for a positive pregnancy result in 2009.

Wednesday, 18 November 2009

12dp IUI



Here's how my first IUI cycle went down:

CD2-CD7: 75 IU Menopur. Despite having my wonderful husband to do the injections, they get slightly more painful every day. I am grateful that Mel's book recommends a warm compress, which is a great comfort to my sore belly. Frustratingly, both the Menopur and Pregnyl here in Europe come in these fragile glass ampules that need to be snapped in half to access the powder or solution. This makes the mixing process even more fiddly and difficult.

CD8: Right ovary: several small follicles around 8mm. Left ovary, one large follicle at 15.5mm. I am very happy that the dominant follicle turned up on the side with my good tube. We continue with 75 IU Menopur. They call me to come in again the next day.

CD9: Left ovary follicle now measures 18.6mm, my endometrium measures 7.6mm. It is still strange to see my uterus clammed shut, so used to seeing open pictures on the web. They call me that afternoon, want me to do the trigger that night and come in the next morning for the IUI, which means that I must have started ovulating too soon. Trigger at 11pm.

CD10: Our IUI is scheduled for noon, but doesn't happen until 12:40. My poor bladder is so close to bursting it is all I can think about. The midwives leave us waiting in the room to the sounds of "Eternal Flame" and "My Heart will go On". I lay there, trying not to pee on myself, while being forced to listen to Celine Dion. It is not a very romantic insemination.

CD21: Today, 12 days into the two week wait, with my blood test having to wait until CD29. Fertility friend gives me a score of 35/100 for early pregnancy signs.


~~~~

So, the timing was off, and my endometrium was thin, but at least we will have IUI number 1 under our belts soon. One more 'n' for the clinical trial, either way. If it's negative, then we'll set up the next IUI, and in the mean time I will get my hair dyed and eat lots of soft French cheeses.

Friday, 30 October 2009

IUI #1

Today is Day 2 in our very first IUI cycle.

The lab tests from the laparoscopy came back clear, so I do not have endometriosis. However, with only my left tube completely clear, the odds of pregnancy are slightly lower. The professor estimated that we have a 10-20% chance of success per cycle, with a 40% chance of success over three IUI cycles. Interestingly, he recommends a rest cycle in between each IUI cycle for both psychological and biological reasons.

I have joined the university's head-to-head randomised trial comparing Clomid with Menopur for IUI. Now no matter what the outcome of this cycle, I am increasing scientific knowledge that will help subsequent people with infertility make more informed decisions. They gave me a selection of brown envelopes to choose from, and I chose one that means I will be taking Menopur this cycle. This is my protocol:

CD1:
CD2-CD7: 75 IU Menopur
CD8: Ultrasound and bloodwork - Menopur dose as advised
CD9-17: Possible ultrasounds and bloodwork - Menopur dose as advised

Once the follicles look ripe:

Day -2: Trigger with Pregnyl
Day 0: IUI
Days 0-15: Progesterone suppositories
Day 15: Blood pregnancy test #1
Day 27: Blood pregnancy test #2 and ultrasound, if #1 positive

I am very thankful that I have my dear husband to do my injections. He is an expert at these things, while I can't even bear to watch the instructional video. I am also very glad that I only have one injection per day, it is subcutaneous, and the post-IUI progesterone is not an injection.

The hardest thing will be to try to keep everything in perspective. I am a very goal-oriented person, so if this IUI doesn't end in pregnancy I will feel as if I have personally failed. So my main mission this cycle is to focus on staying happy, to enjoy my time doing the things I love, and to remember that I already have a wonderful life.

Sunday, 4 October 2009

Laparoscopy / hysteroscopy

It has now been one week since my laporoscopy / hysteroscopy. I am recovering well, and they found a cause of our subfertility. I had intrapelvic adhesions between my uterus and abdominal wall, as well as on my fallopean tubes and ovaries. The methyl blue test showed that my left tube is unblocked, but my right tube is partly blocked. The doctor thinks that the adhesions will return in about six months, so we have a few months to try IUI, then on to IVF. The adhesions should not affect our chances of success with IVF.

The surgery really wasn't as bad as I thought it would be. For the previous five days I was on a low-fibre diet, with a bowel prep the night before. On day day of surgery I wore a dress and felt strange without my wedding ring. All the staff were great, especially the nurse who looked after me all day. My husband and I checked in at 8:30, and we had our own private room by 9:30. I got changed into a dashing blue gown with press-studs, sad that they wouldn't let me keep my socks on. I hunkered down under the blanket and started watching TV on my iPhone to distract me. The nurse could see that I was a bit nervous, and offered me "something for the pain" and "something for the anxiety". She looked at my belly and told me it was "good". The nurse took my blood pressure, and did a pregnancy test. At 7 days post ovulation it seemed a bit pointless, especially as abstinence was ordered by the doctor. The funny thing was, I was a bit afraid that it would come up positive, and I would be sent home in disgrace for wasting their time. However, it was negative.

In no time at all it was time for surgery. They even let me hold my toy dog that I had brought with me for moral support (yes, I am 29 years old). The wheeled me until just outside the doors of the operating room. There was a small boy of about 10 who was being wheeled through too, crying and vomiting and sounding terrified. I, on the other hand, was feeling quite mellow. Exactly like myself, but not at all worried or nervous. Yay for tranquilizers. A while later, they had me get off my bed and walk into the operating room.

I lay down, and started to shake. My mind might not have been nervous, but my body was cold and apprehensive. One nurse started sticking all these heart rate monitors all over me, while the anesthesiologist was prepping my drip, strangely in my wrist and not in my hand like in the movies. Everyone was moving very quickly, and they all seemed to know exactly what they were doing. The drip was in quickly, and the anesthesiologist told me that I would feel a bit of discomfort when the medication started flowing. The nurse held an oxygen mask above my nose. I asked them if they wanted me to count backwards from 100, and they said no. The infusion started, felt unpleasant, and within seconds I was feeling very sleepy. I wanted to tell them that I wasn't completely asleep, because I could still hear the beeping, but after that I fell completely asleep.

The doctor's notes say that they first conducted a hysteroscopy, and that my uterus looked normal from the inside. It measures 7 cm. A small biopsy was taken to double-check for endometriosis.

For the laparoscopy, a 12 mm incision was made just underneath my belly-button, and my abdomen was inflated. Three more incisions of 5 mm were then made lower down. From the outside, the uterus looked normal. There were adhesions in the vesico-uterine fold, in the pouch of Douglas between the sigmoid and peritoneum, on the right fossa ovarica (depression that lodges the ovary), and on end of the left fallopian tube. The adhesions were blocking the fimbriae that collect the egg from the ovary and pull it into the fallopian tubes. My corpus luteum was still bleeding. It was coagulated, and a cystectomy was conducted and sent off for further tests.

Methyl blue die flowed quickly through my left tube, but very slowly through my right fallopian tube. The adhesions were removed, my abdomen is deflated, and my catheter and breathing tube were removed.

I remember dreaming about wandering through the cobblestone streets of the city, but the next thing I new two hours had passed, and I was in the recovery room, with my toy dog on my pillow. I was so worried that I would never wake up again that I was just so thankful to be conscious. I started shaking, and the forced warm air under my blanket. I told them I was in pain, and they added something to my drip.

They wheeled me back into my room, and there was my wonderful husband, who hadn't left the room for even an instant. My throat was sore, and they wouldn't let me use my soothers because they had lidocaine in them. But they gave me something else to suck on to relieve my throat. I spent the afternoon dozing and recovering, getting some more infusion of "something for the pain" in my drip, and after that "something for the pain" to put under my tongue. The doctor came over in the afternoon to tell us the results. She said that the adhesions are most likely due to "an infection in the pelvis", which the internet tells me is most likely clamydia, which is very surprising.

I have taken the next week off work. The first 24 hours were difficult. It hurt every time I moved, and I could not lie on my side or sit up without intense pain in my shoulder, due to the residual gas pressing on a nerve. But I was still able to lay on the couch and have a Mad Men marathon, so it wasn't so bad. Every day got easier, and I am surprised how quickly I am recovering. The incisions are tiny, and the stitches are going to be removed tomorrow.

I am so glad that we now have an answer, and I have some neat photos of my uterus to boot. So now that the cobwebs have been cleared away, I am hoping for some good news in the next twelve months.