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Tuesday, 22 September 2009

Laparoscopy next week

The midwife called me back last week, saying that she had heard that I had some “not so good” news. She was really kind and gentle, and she has me booked in for a laparoscopy next Monday. At first I was really frightened, but then I had a long talk with my husband and he was very pragmatic and thoughtful.

He said that if I was too worried about the procedure, then I should cancel it. If I thought that the benefits outweighed the risks, then I should go ahead but stop worrying. He also gently reminded me that the best possible outcome will result in childbirth, which is much more risky and more painful. And then it hardly gets easier after that.

So, I thought to myself, am I in, or am I out?

I’m in. Now I’m focussing on the short term and long term positives. A low fibre diet the week before means lots of rice bubbles, white bread, and peanut butter. After the surgery I get a week at home with the cats and a pile of DVDs. We also get an answer to the question of endometriosis. And then our first IUI in December.

Raising a child brings joy and delight, but it also involves dealing with crises, disappointments, and pain. It is messy and complicated and stressful. So I am viewing this process as an educational experience. I need to learn how to communicate my thoughts, fears, and needs. To avoid panic attacks, and to act calmly and rationally. To enjoy the delights of each day, and aim directly for happiness and not for proxies.

Monday, 7 September 2009

Empty

"How was your weekend?" my colleagues ask.
"Great!" I answer, thinking I had my first miscarriage.

I told myself that I would think in all the appropriate terms. Zygote, blastocyst, embryo. I know all the statistics. I know that I had a 20-50% chance that it would end too soon. I wouldn't skip ahead. I would take each day as it comes.

But as I felt those twinges inside me, I got attached far too quickly. I imagined being pregnant during the Winter holidays, and the baby being born in Spring. We would have our first child before I turned thirty.

I should be happy, that I know that we can now at least get pregnant, that somewhere inside me a sperm can meet an egg. Objective: fertilisation - achieved. This should be a good sign.

However, I can't help but feel a little empty.

Sunday, 6 September 2009

Chemical pregnancy

I started bleeding today. Chemical pregnancy. Four weeks and six days since my last menstrual period. Twenty one days post ovulation.

We have a houseguest with us, so I must act normal inside the house. So this morning I sat out on the fire escape, freezing in my pyjamas, quietly sobbing while I watched the people down below. Then I logged onto Fertility Friend and ticked 'miscarriage', and was informed that my status had been changed from "pregnant" to "waiting for ovulation".

I don't know where we go from here. I would like to hope that it is a positive sign, that it means that at least one of my tubes is not blocked and the sperm can swim. But why has it taken us this long to even get to this point? Do I still need a laparoscopy? Do we move straight to IUI?

As I look down at all the blood, I can't help wondering where the little poppy seed is, and how it failed to find a foothold in the dark.

Fading

Friday: The midwife at my infertility clinic called me to schedule my laparoscopy. I told her that I had a positive pregnancy test, so I probably should cancel the appointment. She congratulated me, and I asked her to pass the news onto the professor.

Saturday: I went for a walk through the park in the sunshine. I felt happy and full of hope. My womb felt like it was tugging and stretching. As I fell asleep I had to sleep on my back, because my breasts were so sore.

Today: In the absence of a blood test, I took another pregnancy test. I was hoping that the line would be twice as dark as the one that I took 48 hours ago.

Instead, the line is fading, and my spotting is increasing. Things are not looking good for the little poppy seed.

Friday, 4 September 2009

Zwanger

Yesterday afternoon, I picked up a digital pregnancy test, or a "test de grossesse / zwangerschapstest"" as they are known here in Belgium. Sixteen euros. Sheesh. Luckily, instead of trying to fit "enciente/ pas enciente; zwanger / niet zwanger; gravid / ikke er gravid" into the tiny window, there is simply a plus or a minus. So I come home, and use the fancy test. The hour glass flashes, and I put it down to wait. Three minutes later, I return, and I think that I catch a glimpse of a minus sign. Yep, I think, that's more like it.

But then I pick it up, and this is what I see:



It still feels very academic to me. Like this stick that I'm holding is referring to someone else. I still don't feel any difference - just some very mild pre-period cramping.

Still, I know I have to tell my husband. Maybe that will make it real. I pop out to a local baby store. It takes me a long time to walk in. Once in, I feel as if everyone is looking at me. After a long deliberation, I pick up a cute bear onsie for newborns. It looks disturbingly large. I come home, wrap it up, write a note, and order pizza.

Over dinner, my husband tells me about his day. I am terrified of telling him. I still don't feel like it's true, and that I am jumping the gun or making it up. So I give him the gift, and a card that says "I am pregnant. I am due on the 9th of May, 2010. I love you". He looks at me with wonder and amazement, and pulls me over to the couch. "Wow", he says, as we touch noses. I can't stop holding the positive pregnancy test. It is the only evidence that anything is difference. We spend the rest of the evening discussing wills and life insurance and maternity leave and childcare. It still doesn't seem real.

Thursday, 3 September 2009

Pale pink line

So, this cycle I ovulated sometime after cycle day 13. I had a positive luteinizing hormone rise at day 12, but no temperature rise until day 18. If I did ovulate at day 13, then today I am 18 days into my luteal phase. I took a pregnancy test 14 days past my LH surge, when my period was due, but it was completely negative, as usual. I also noticed I had some spotting and cramping, and thus had a few glasses of wine and a cup of coffee, and waited for my period to show up. Today, four days later, it still isn't here. My pregnancy tests will expire in two months, so I figured, why not use another one, even though my temperature is falling.

I remember reading that usually the second line shows up straight away. But mine, as usual, fades to white. I put it down, but then a few minutes pick it back up again. If I look very, very carefully, there appears to be an extremely faint second line. So faint, I must be hallucinating. I pull up the Fertility Friend gallery of very faint positive pregnancy tests, and they all look darker than mine. I pull it out again. It's more than a shadow than a line. The test strip cost a dollar from the internet, is over a year old, and has been shipped over two continents. It's probably not very accurate.

I have had no other signs. No nausea or sore breasts or anything. I feel completely normal.

If it is positive and I had a healthy pregnancy, I would give birth on the 9th of May 2010. That is far too soon and too real and too scary. My hands shake at the thought. It's all too soon. I'm not ready.

So I will test again this afternoon, and we shall see then. But I might pick up the strip and look at it again.

Hmmm...

Thursday, 13 August 2009

So. Surgery it is.

We had our second infertility meeting yesterday. It is mostly good news. All our genetic tests came back normal, which means that we both have the right number of chromosomes, and aren't carriers for any major monogenic diseases. Our blood hormones also look normal. We found out that my husband's sperm morphology is 4%-7%, which is sub-normal, but not really that bad.

Thanks to Fertility Friend, I know that we have had well-timed intercourse for over 14 ovulatory cycles with no pregnancy.

So the next suspected culprit is endometriosis on my side. This is tricky to diagnose externally. I never suspected this, though when I think back my periods do seem to be getting worse with time since I went off the pill. So the professor recommends a laparoscopy/hysteroscopy.

While it is keyhole surgery, it is still surgery. General anesthetic, filling my abdomen and uterus full of gas, and three keyhole cuts - one for the camera, and two for the robot arms. They say that in 50% of cases like ours, they find mild endometriosis, which they repair with a laser during the same operation. After treatment, they move onto IUIs and notice a doubling in success rates compared to women who do not have their endometriosis fixed. We will then have a 10-20% chance of success for the first IUI cycle.

So the expected timeline would be something like:
October: Hysteroscopy
November: Stimulated IUI #1
December: Stimulated IUI #2
January: Stimulated IUI #3
February: Meeting to discuss options

Now I am waiting for the nurse to call me to schedule my first ever operation. I am quite worried and nervous. They say there is <1% chance of complications and that they do around 10 of these operations a week, but I am still frightened of catheters and drips and anesthetic and incisions. Still, I suppose pregnancy and childbirth is no walk in the park either, so I might as well start to get used to strange things happening to my uterus.

I am not looking forward to the pain.

Friday, 17 July 2009

Internal Ultrasound

Yesterday I had my internal ultrasound. Again, it was at the gynaecology ward of the hospital, so I was surrounded by large bellies and excited couples. I imagine this would be very difficult for many.

It was a little bit disconcerting, sitting there half naked with my legs hoisted up to the ceiling while the doctor was asking me about my medical history. It also didn’t help that the technician was new and couldn’t find my uterus or my ovaries. For a while there I was convinced I didn’t even have a uterus, which had me shaking with nerves on the cold chair.

But in the end, my uterus and my ovaries passed this superficial test. They exist, there is no endometriosis visible, and my left ovary has a bunch of immature follicles that are competing for dominance on this CD6.

I asked the doctor if I could get a copy of the images. He looked completely baffled. He said “why, to show your family?”, like I was going to post my grandmother a photo of my empty uterus. So I just told him that I liked to keep a copy of all my medical records. He didn’t give me any images, but I did manage to wrangle a copy of the report.

As for the results of all our other tests? We do not find out until August 12. I called up the Fertility Centre and they only discuss the results in person, during the consultation appointment. They do not release the results before then.

This is very frustrating. I like to do my own research on the implications of the data, but instead we have a single meeting with the head of the centre to discuss strategy where he is holding all the cards. I know that all the information we need about our own bodily fluids is just sitting in a file someone, and I am unable to access it.

So more waiting and waiting for us.

My insides:
Uterus:
Position: ante
Dimensions: L:53 A-P:26 T:32

Endometrium:
Imaging: clear division
Structure: intact

Right Ovary
Imaging: visible
Morphology: Normal
Limitation: Regular
Size: 31
x 23
x 18
Volume 6.7

Left Ovary:
Imaging: visible
Morphology: Normal
Limitation: Regular
Size: 30
x 30
x 17
Volume 8.0

Wednesday, 3 June 2009

First infertility appointment

It's a good thing that am very happy about my life, because it turns out the infertility center works out of the gynecological department in the hospital. So we watched many pregnant bellies walk back and forth while we waited.

We were then interviewed by a younger woman about our medical histories. She did raise her eyes at my numerous graphs and statistics. She asked me for how long I had had a "baby wish", and my husband wryly noted that she did not ask him the same question when it was his turn. I thought I had prepared quite well, but when she asked me how often we had sex per month, that was not a ready figure that I had with me. I pulled out Fertility Friend's intercourse analyzer of my fertile periods over the past 12 months, and she asked "and outside of these times, you do not have sex?" I denied this statement, but now I am sure that she thinks we are celibate for 24 days out of the month.

Then suddenly she said to me, "and now we shall do an internal examination", and made some sort of gesture with her hands. Now? Did she want me to take off my skirt this moment? Yes, she did. She did not ask my husband to leave the room. She did not walk out of the room or give me a gown. She merely stood there, waiting for me to undress in front of her. I felt very shy, and removed my skirt without even thinking to remove my undies. It was only when I sat down on the paper that I realised my mistake. I removed my undies, hoisted my legs up on the stirrups, and in a few seconds she was in and out with a cervix spear.

This was all a little shocking for me. Why is it the act of undressing feels more weird than actually being naked? And what is wrong with draping a bit of fabric over the top to pretend otherwise?

Once I was dressed again, she called in the doctor came in. He looked at my temperature charts and told me that these were the best charts that he had ever seen, which was to be expected, he said, as I was a scientist. Usually, he said, they ask women to track two or three cycles, never... fourteen. I replied that you get a much better standard deviation with an increased N.

He said that the plan was to test my blood at CD21 and CD3 and do a basic internal ultrasound. In the meantime, my husband would be tested for "male factor" (he dislikes being reduced to that phrase) and if that came up normal, they would conduct further tests on me. They would also begin genetic tests immediately, as they take two months for the results to come through.

Today was my CD21 blood test, then I have my CD3 blood test, and then I come back for my ultrasound in a month. We meet with the doctor on August 12 to discuss our next strategy. I tried to ask my questions about donor gametes and embryos, but he said it was much too early for those sorts of questions. But now we are moving forward, and I feel accomplished. In 70 days we should have plenty to talk about.

Friday, 29 May 2009

My answers to their questions

I want to end up with a diagnosis as soon as possible, so I am presenting them with anything in my history that might lead to a diagnosis.

Age: 29
Length of current relationship: 3 years
Trying to get pregnant: 12 months
Date of last menstrual period: 12 May
Age of first menstrual period: 13 years
Days of bleeding during period: 4 days then spotting for another 2 days
Length of periods: 26-32 days
PMS symptoms: Mild
Painful menses: Moderate cramping, one ibuprofen enough for relief
Bleeding between periods: No
Painful intercourse: No
Endometriosis diagnosis: No
IUD in the past: No
STIs: Tested in 2006, never detected
Did my mother take DES while pregnant: Nope, born after 1971
Breast discharge: No
Excessive hair growth: No
Previous pregnancies: None
Previous fertility treatments: None
Family history of disease: No
Sudden heat/Cold intolerance: No
Weight change: No
Hot baths: Warm baths every night
Exercise: 1 hour per week
Possible previous biochemical exposures: chance of sodium azide, ethidium bromide, Listeria, Shigella exposure
Drinks per week: 1-2 during follicular phase, 0 during luteal phase
Smoker: No
Contraceptive use: 1997-2003 BCP, 2003-2007 Implanon, Oct 07-Mar 08 BCP

Rubella vaccination: 1993
Pap smear: Feb 2008 - normal
Chicken pox: 1997
Blood type: O positive

Tests
LH tests: Positive result before ovulation
BBT: Thermal shift after ovulation, luteal phase ~ 14 days
Complete blood count: Normal
Serum ferritin: Normal
Thyroid stimulating hormone: Normal


Based on these answers, I think they should be able to rule out:

PCOS
Luteal-phase defect
Endometriosis
Pelvic inflammatory disease
Asherman's syndrom
Advanced maternal age



But there is still a possibility of:

Premature ovarian failure
Fallopian tube blockage
Cervival mucus defects
Fibroids, polyps
Pituitary tumour
Male Factor

Sunday, 17 May 2009

Questions I plan to ask during our first fertility centre appointment

* What are your office hours?
* Who will be our point of contact?
* What specific tests would you recommend to diagnose our infertility?
* How long will it take to diagnose our problem?
* When can we begin treatment?
* Do you have ties to a donor egg/sperm/embryo program?
* Is an up-to-date laboratory located on site?
* What is your success rate with IUI and IVF in couples under 30?
* How many pregnancies performed at this clinic have resulted from IUI? IVF? Egg donation?
* Do you have a specialization for a certain type of treatment?
* How much will treatment cost? Does that include lab work, procedures and medications?
* What outside resources do you recommend?

Everwhere

I walk past these windows every day on my way to and from work. I don't know how, but these headless manikins always seem so smug to me.


This is why they are called cycles

Because they go around and around and around:



I am a scientist. I like to live in an evidence-based reality. I need numbers, charts, and graphs. I like to make quantitative comparisons. So now I have year's worth of patterns to analyse.




I seem to be ovulating. While my follicular phase is a little variable, my luteal phase seems to relatively long and consistent. But I don't know anything else about my body. Are my eggs getting lost? Are my tubes blocked? Is my mucus or lining sub-standard?

Once again, just waiting for a diagnosis.

Always waiting, waiting...

442 days later

442 days off the pill
348 days trying to conceive
11 unsuccessful cycles

At first as soon as I ovulated and Fertility Friend would tell me my due date, I would start planning. Due in March - Spring. Due in April - maybe will share a birthday with my husband. Due in May - maybe will share a birthday with me? Due in June - long summer days.

But month after month, I kept on seeing the one single line on the pregnancy test. It seemed aggressively negative.

We have tried:
The Fertility Diet
Temping
LH testing
Saliva testing
Guaifenesin
Pre-Seed
Pre-Conceive plus
FertilAide for Men
FertileCM Supplement

And still nothing.

So, not as easy we had originally thought. Something is obviously wrong. This cycle will make 12, and after that we will be officially infertile. We have our first appointment with the Fertility Centre in 17 days. Hopefully we will get a diagnosis, and hopefully technology will be able to treat it.

For us at the moment, controlling prenatal health is the most important factor for us. So if it is an issue of bad sperm or eggs, we are open to the possibility of donor gametes or donor embryos.
Right now, I just want a diagnosis. Then I can start to strategise. I hate not knowing what is wrong, because then I don't know how to fix it.

I have Melissa Ford's Navigating the Land of IF as my road-map to this unexpected destination. So far, it has been a great source of comfort and information. The introduction reads:

"...while you're here, you should know that you have a friend, in book form, to turn to in the middle of the night, when the sea monsters offshore start howling and you just wish you were home."