Monday, August 30, 2010

Happy Dance

FABULOUS news! I went for the ultrasound this morning, and there are still viable follicles!!!!! *pause. happy dance. shake ya tailfeather* There are at least 4 that could mature enough to be good eggs, with the lead follicles (the biggest ones) being 13 mm and 15 mm. Keep in mind that follicle isn't considered "mature" until it's 18-20 mm, and they grow at 1 to 2 mm  a day. SO I'm still a few days away, but NOT TOTALLY OUT!  The ultrasound wasn't too unpleasant, and the staff was really friendly. I went for acupuncture tonight, which was SUCH a welcome rest after the crazy weekend.

*Non Fertility Related Moment*
Our sewer system backed up last night and there was poop spewing from every orifice in the house. If this was some sort of test, I think I passed, but Oh. My. Goodness. The gross factor was unimaginable.

Sunday, August 29, 2010

Aside:

TWO months of Clomid and no inseminations. The cavewoman in me is screaming "YOU ARE WASTING PRECIOUS EGGS!!! LIMITED SUPPLY! SUSTAIN CIVILIZATION!"

The Temps Don't Lie

 Basal Body Temperature (BBT) is the temperature immediately upon waking. Before I wiggle around, pee, make the coffee, or check my phone I rummage around under the pillow for my Basal Body Thermometer, listen for the beep, and slide it under my tongue.

BBT is a wonderfully addictive and informative way to track your cycles, but you need to have some sort of chart to add the data to in order to see the patterns. BBT's have very specific patterns each month, and it becomes easy and natural to find those patterns once charted out. There are different variations of "normal" but you will almost always have at least a biphasic chart (2 phases) meaning lower temperatures before ovulation and higher temperatures after ovulation. It's really fascinating actually. Here's an example of my chart from last month. I use FertilityFriend, which is helpful because it also lets you track symptoms, cervical mucous, position, and medications.



Ok, so you can see that my temperatures were generally lower during the first part of my cycle, then I got a big dip (this doesn't always happen, but is really helpful when it does) right before ovulation, followed by  huge jump during/immediately after ovulation. THEN the temps stay high. The longer the temps stay high, the better. If they stay high past the day you would normally start your next cycle, then there's a very good chance you're pregnant. A big drop later in this phase usually means you will start your period the next day. In this chart, the program is putting together all of my information to estimating ovulation (it probably actually happened one day sooner though, after the drop). Once you have 2-3 months of charting, the program gets smarter, and more accustomed to your patterns therefore becoming more accurate the more you use it. There is also an overlay feature so that you can compare months/cycles on the same graph.

One thing about the temperatures, they don't lie. As much as I didn't want to see that temp drop in my chart yesterday, I knew in my heart we missed it this month, and my huge jump today confirmed it.

Here's to starting all over again. *clinks my giant cup of coffee* I'm going to go ahead with internal ultrasound on Monday to check on things in there post Clomid and make sure there aren't any problems. I'm guessing the Clomid is the culprit for these last two bizarre and short cycles, so I guess we'll try our hand at a natural cycle next month. (now where did I put that butter knife....)

Saturday, August 28, 2010

Failure.

I ovulated. Another cycle wasted, another month ruined, another failure.

It's All About The Spit

I rambled on before about OPKs (ovulation predictor kits) and how unbelievably maddening they can be especially for some lucky folks *myself included*. OPKs are normally urine based, they range from super cheap, to ridiculously expensive, and can provide lots of peace of mind and direction or total confusion and frustration, but usually some mix of all four. We'll talk more about peeing on things later, today is all about another fun bodily fluid, SPIT.

OPKs mostly measure Lh (lutenizing hormone) the hormone that surges immediately before ovulation to shove that eggy outta there. It is normally detectable in urine 12-48 hours before ovulation. This is that magic window we're shooting (pun intended) at with IUI/ICI. The problem is when you are shipping frozen sperm in a 22lb tank from California to Texas, you need more than 12 hours notice. ALSO, sometimes the Lh surge isn't detectable, or is easy to miss, in which case you miss ovulation and wait ANOTHER MONTH to do it all over again. Most sperm banks will guarantee the quality of the sperm out of the bank, in the tank for no more than 7 days. (That was a Dr. Suess moment, no?) Some of them only five. So basically, counting a day or two shipping each way, you have to hit it pretty dang close to have them on hand for possible ovulation, and still be able to get them back to the bank if you don't end up using them. Remember, we're talking about $2,000 worth sperm flying around here.

Enter OvaCue--

The OvaCue fertility monitor measure Lh in your saliva. Evidently Lh shows up first in saliva, then your blood, and finally urine. SO the Ovacue can give you a "Peak Day" estimation five to seven days ahead of time *and the crowd goes wild*! This is priceless information for folks in my situation, and helps SO much in scheduling/shipping/medicating etc. You put the sensor on your tongue for five seconds first thing every morning, before eating, drinking and brushing your teeth, and it magically (in my humble opinion) gives you your reading.  You can also purchase it's magic accessory (which actually *does* look like a magic wand) the Vaginal Sensor to confirm ovulation after the fact. While that part might seem inconsequential, since it is *after the fact* it's actually priceless. The sensor gives you an idea of how your ovulation symptoms correlate to ACTUAL ovulation AND let's you know after an insemination how good your timing was.

Below is an example of my current-ish (August) OvaCue screen. As the blue days get darker, I'm getting closer to my "peak" day of estimated ovulation. August the 10th was my darkest peak day, and then it turned pink because I got ovulation confirmation that night. You can also see that it has already estimated my fertile period for September, but those dates will most likely adjust with more readings, and as it gets closer. I can see how it would be SUPER helpful to couples conceiving the old fashioned way (notice I didn't say "normal") and with an endless supply of sperm, but it is especially helpful for those of us that are having our swimmers flown in, and having to be so specific on timing. I've had ovulation confirmation on my "peak" day every cycle so far! I'm IMPRESSED!




Friday, August 27, 2010

Monday, August 23, 2010

Stick It To Me Baby

Oh the things you suddenly become open minded to when it comes to fertility. On the recommendation of several other women on the TTC roller coaster, and my lovely therapist, I decided that spending an hour or so with dozens of little needles stuck in me sounded like JUST THE THING I needed. Turns out when Googling "Acupuncture" in El Paso, you only get two results, so at least I wasn't overwhelmed with choices. I picked the one that had the prettier website (really, cause that's how I roll), and emailed for an appointment.

A few hours later I got a phone call from the calmest woman on the planet. NO. REALLY. She had a soft spoken, slowish speech, and sounded happy. Over the phone. It was one of those moments that make you stop for a second and realize this is a "moment". She worked me in to accommodate my insemination schedule, and I set about looking forward to our appointment two days later.

Her office was about 30 minutes away from my house, and I relished the time to gather myself beforehand. The building was AWESOME. It's an old house in the historical district, and the second I walked in I felt a difference. Im not crazy, (ok...I am crazy, but not about this). It was so cute on the inside. Calm and clean, but bright, warm and inviting, and just the coolest old house anyway with crown molding and a stone fireplace. The energy in that building was perfect, and I felt calm and ready right away.

Enter Acupuncturist.

She had the brightest smile ever, and filled the room right when she walked in. She wore the exact same green scrubs that we wear at our clinic every day, short hair, glasses, and no jewelry. (Important detail to follow-->) She had the best handshake. Strong and firm and determined. This detail really stuck with me after the fact. We filled out some paperwork, looked over the labs that I brought, and then headed back into one of the treatment rooms. I think I kept saying "This is the greatest house", "I love this building", "this is such a great place"! She did a full round of medical questions, fertility questions, looked at my tongue, took my pulse, and up on the table I went. I was face up with my legs up on a block, and still felt abnormally calm. (Aside: I am never, ever, ever calm)

She talked softly, and a slightly slower than a normal conversation, and continued to ask me questions about my inseminations, plans, sperm, etc. I hardly even noticed when she inserted the first needle between my eyes, but I felt the energy from it immediately. The best way to describe it is the feeling that you get when you try to push two magnets together that are the same polarity, you know that "force" that pushes back? It's a milder version of that. Before I knew it she was smiling big and saying "You're all set! Here's the bell for you to ring if you need me, if not, Ill be back in 45 minutes." She told me to relax, breathe, visualize, and rest, which is exactly what I set about doing. This turned out to be more difficult than expected because A) I wanted to know where all the needles were, and what they looked like, and B)I kept thinking THIS IS SO DANG COOL!!! After carefully raising each arm & leg to get a look at my Frankenstein moment, I settled in for the most relaxing half hour I've had in years.

She knocked lightly and came back in, telling me to stay still and "in the zone", and how did I feel? "To be honest, that is the stillest I have been in oh....say..... 27 years!!!" She said "it's amazing what happens when I pin folks to the table"! She removed the needles effortlessly, and we talked about scheduling for our next session. As I got up from the table I felt myself breathing deeper and easier, and feeling calm and quiet. We proceeded back to the front, scheduled my follow up, and went over pricing. She had a "fertility package" already in place! Knew what she was doing! Had experience with all of this mess! I was thrilled. She gave me the biggest real hug, and sent me on my way.

I cried when I hit the car door. For the first time I felt like I had a REAL ally in this whole mess. Someone who understood all of the process and the jargon, genuinely knew what I was dealing with, and how to help me physically and emotionally. I never felt like a bother, or a mess, or crazy (well, crazier than normal), I felt like I finally had someone else to bear a portion of this massive weight. On top of all of that, I felt calm, hopeful, and peaceful.

I've been back several times since, and the awesomeness doesn't wear off. These are "moments". Last visit I asked "Do you think I'll ever be as calm as you?", her answer,  very sweetly, was "No".

Saturday, August 21, 2010

A Run For My Money

It's a new dawn, it's a new day, it's a new liiiiife (okay not really but it kinda feels like it), and I'm feelin good. The start of a new cycle is always exciting, and has the amazing ability to make you forget that the last cycle was a complete and utter failure and get ready for another chance at the crapshoot that is TTC.

I'm going big guns this time, no messin around.  I'm planning a round of Clomid (most likely 50 mg day 3-7), and I'm going to be monitoring follicle size via ultrasound. I think normal protocol is to do the first ultrasound on CD11, and then assess the situation from there. This will allow me to give myself an hCG trigger shot (the brand and dose have yet to be determined) when the follicles are at least 18mm, and then know WITHOUT A DOUBT that I will ovulate  24-48 hours later. I'm planning to trigger and then inseminate 24 and 36 after in hopes of catching that little eggy right on. I am hoping that this will relieve some of the uncertainty and anxiety that tracking ovulation creates, ESPECIALLY since I don't seem to get very clear signs during Clomid cycles.

For some reason this was an exceptionally short cycle, which is not particularly good news as the post ovulation or luteal phase has to be a decent length in order for the egg to have time to implant before your next cycle starts. Lots of women end up with progesterone shots or vaginal suppositories to lengthen that phase and make a nice cushy place for the egg to stick. I'll cross that bridge in a few days I suppose.

I'll be making my Auntie Kristen rounds today to see all the yoga babies and soak up some more of those newborn baby pheromones. If you see a West Texas Amber Alert, you'll know it's me, start preparing the guest room.

Friday, August 20, 2010

Hip Hip

Hooray! The last yoga baby was born on Wednesday, happy (well, mostly) and healthy. I had two year old duty for 48 hours while Mommy was in the  hospital, and it went great! He is super smart, and high energy, so Im pretty pooped, but he was a good boy. I now have the theme song to Mickey Mouse Clubhouse memorized, and yell "OH TOODLES!" when I have a problem I can't solve. :)

The most exciting part about all of this for me is that I'm no longer the only one not pregnant!!!!! AND I'm the *only* one getting any sleep this week!

It's been a longer journey for me than it was for them, and I realize that as in most things, it's more about the journey and what you learn from it, than the destination, but MAN I hate long road trips.

Tuesday, August 17, 2010

A Wheelbarrow For My Ovaries

Normally reproductive age women ovulate one mature egg, from one ovary every month. Some studies show that women may have one anovulatory cycle per year, but there are not many conclusive statistics to prove this theory. For women having good ole normal sex to try for a bun in their ovens, this situation works out just fine.  The bazillion sperm to one egg ratio is alright, and the timing is much easier as fresh sperm can live in a woman's body for pretty much ever (not really, but compared to frozen it seems like it), and timing gets a lot less complicated.

For those of us shooting (pardon the pun...okay not really) for some version of the "turkey baster method", one egg just isn't enough. I've read that success rates for IUI (intrauterine insemination) and ICI (intracervical insemination) can be as low as 6% for unmedicated cycles with just one little eggy. For women/couples spending thousands of dollars per cycle, and waiting months for their BFP (Big fat/freaking/f*#$ing Positive) 6% doesn't cut it.

Enter ovulation stimulating drugs. There are several on the market, some in tablet form, others that require injection into the system. These medications stimulate multiple follicles (the casing that grows the egg in the ovary) so that a woman will release multiple eggs per cycle. Clomid is probably the more widely used specific medication that falls in this group, and happens to be the one I use (not because I necessarily *want* to) . Once you raise the odds a little and have 3 or 4 eggs (or more) released each cycle, the success rates jump up to around 25%. STILL not stunning odds, but certainly better than 6%. Studies suggest, at least with Clomid anyway, your chance of multiples is only raised by 10% (twins) and around 1% (triplets). For most women in my position, this is a risk we are not happy to take, but in my case, after months of natural cycles to no avail, the next necessary step. Contrary to popular belief, drugs like Clomid alone are *not* responsible for Kate Gosselin having a dozen kids and being rude to her husband, or for OctoMom ending up in her ridiculous situation, but they are certainly not without risk.

The side effects for these drugs vary BIGTIME. The most prominent one in the drug literature is multiples (see above), but they also focus a lot on PCOS (polycystic ovarian syndrome).  Ovulation stimulating drugs can cause cysts to grow, or new ones to form, so most specialists will order a pelvic ultrasound before and after a course of these medications to check for and monitor ovarian cycts. It can also cause "hostile" (I swear that is the word they use) cervical mucus. For women doing ICI, or even normal intercourse, this can be a big issue as cervical mucus helps the sperm travel, and keeps them safe from the acidic nature of our bodies in their trip through the cervix. Other women complain of headaches, crankiness, fatigue, nausea, etc. Mine are pretty inconsequential, in the grand scheme of things. I get cranky for sure, gain 5 lbs when I'm trying hard not to, and feel like I need wheelbarrows to carry around my ovaries. That last part may very well be in my head, but I definitely feel "fuller". My biggest complaint about Clomid is something that isn't in the books. For some reason it makes my ovulation VERY hard to track. When trying to inseminate within 6 hours of ovulation, this little point becomes HUGE. I normally do *not* get an Lh surge the months I take Clomid, and therefore about half of the cycles I use it, I end up missing ovulation completely and sending back $2000 worth of sperm and wasting $220 on shipping a 22 lb tank clear back to Cali. Since it isn't without risk, this makes for a super frustrating situation.

I *hate* that I cannot have decent odds without medication, wasting eggs, and crappy side effects, but I want a child, of my own, and refuse to settle into societies rules of how that has to happen. Hopefully the benefit will outweigh the risk and I can still be proud of my choices.

Sunday, August 15, 2010

Hell Hath No Fury Like A Biological Clock Scorned....

So like I said, yoga baby # 2 was born about lunch time yesterday. I would like the record to state that I totally called it the day before at lunch. She is happy and healthy, and I had a breakdown. The first one was a scheduled c-section, so I was a little prepared for it, but this one was a "oh my goodness is 4 am but I think I'm in labor". It is their first child, and they had a hard time conceiving too.... and I was totally "bitter party of one" all day yesterday.

There have been easier sections, and harder times throughout their pregnancies for me. Hard at first, easier for awhile, hard when they started showing, easier again, almost devastating as they welcome their new little peanuts. I realized that through this whole process I never really prepared myself for the day they would actually *have* their babies because I just KNEW I would be pregnant by then, and it would make it a whole lot easier as I had my own due date too look forward to.

OF COURSE I am happy for them, and so thankful that their babies are healthy, and that the deliveries went well, but I'm so ready for my turn.

The baby I lost would have turned one this week, and while I don't think about it daily anymore, weeks like this are always a little harder to swing my feet over the bed and rise to meet the day.

 For those of you that haven't experienced it, I'm sure all of this sounds a little dramatic, but mother nature and women's biological clocks are NO JOKE. Mine is ticking so loudly I can hardly hear myself think.

Friday, August 13, 2010

Baby Girl Pheromones

There are four "yoga girls" that take over El Paso together several times a week, I am one of them. We were all shooting for a bun in our respective ovens last year, and they all got pregnant the same week. No. REALLY. The. same. week. They are all 39 weeks now, and the first little yoga baby was born yesterday. I just knew that I would be shortly behind them, turns out, not so much. I am greatly looking forward to holding little baby Arianna this afternoon, and getting some of those powerful new baby pheromones. Here's hoping I can do it without A) Making a run for it, and B) Bursting into tears.

Wish me luck.

**UPDATE**
No baby snatching, and I didn't even cry. She is tiny, beautiful, precious and makes me even more ready to be in those shoes. I went with my other two *about to pop* pregnant yoga girlfriends, and they were very sensitive. The only downside was the nurse saying "Oh look! You're ALL pregnant!! Oh, well, except you...". Lovely.

**UPDATE #2**
Looks like yoga baby number two is on her way today. It's gonna be a rough week.

Thursday, August 12, 2010

Thursday Aside

If anyone else tells me they are pregnant this week I will most likely stab them with 67 number 2 pencils.

Wednesday, August 11, 2010

Bitter Disappointment

So while it might seem that tracking ovulation here in 2010 would be an easy task, technological advancements in medicine and everything else are insane these days, so surely someone would have come up with a fool proof method of timing inseminations, or sex even, perfectly for ovulation. Such is not the case as was evident, and not for the first time, this cycle. After weeks of fertility meds, natural remedies, acupuncture, meditation, spitting on things, peeing on things and checking cervical position and mucus, and waking up to a beeping thermometer, I missed my ovulation. Therefore the $2,000 worth of sperm I have sitting in my kitchen will have to pack their little bags and head back to California today. An entire cycle, and $300 shipping wasted.

There are four common ways to track ovulation. Cervical position, cervical mucus, basal body temperature, and Lh surge. Hormone fluxes reign over your entire cycle, and you can tell a lot by what is surging, and falling. Your pituitary gland regulates these various hormones, and the timing of their rising and falling. Immediately before, usually 12-36 hours, ovulation, an Lh surge will be detectable in your urine. These tests are called OPKs, or ovulation predictor kits. They range from cheapy to super expensive, and just wading through the waters of OPKs is like being up to your neck in a quicksand pond full of alligators. Not everyone, every cycle will get a positive OPK. I have NO idea why this happens, but about a third of the time, I get nothing but negatives, yet still ovulate normally. This was one of those cycles.

Lh is first detectable in your saliva, approximately 5 days before your urine. From what I understand it goes  saliva, then blood, then urine. So for those of us trying to time the shipping of sperm, this extra notice can be extremely helpful. There is a newish machine on the market that measures your saliva every morning and anticipates your "window of fertility". This machine also has a vaginal wand that provides "ovulation confirmation". This is a jackpot for those of us TTC for multiple reasons. 1) It confirms that you are indeed ovulating, 2) Gives you the ability to track timing after the fact, i.e. okay, we inseminated today, and got ovulation confirmation tonight, so we know we got the timing right this cycle, and 3) It tells you that you can stop peeing on things and have a total breakdown because you missed your window and have to send back your sperm. (as was the case for me this cycle).

Frozen sperm lives anywhere from 8-24 hours once inseminated, so the object is to inseminate as close as possible to ovulation without missing it on either side. Most research indicates that it is virtually impossible to get pregnant by inseminating *after* ovulation, so you always want to err on the side of early.

Since I'm still in breakdown mode, I'll save basal body temperature and cervical mucus and position for another post, go have another huge bucket of coffee, and figure out how to pass the time for the next month.

Thursday, August 5, 2010

Everything You Never Knew About Frozen Sperm

Since there happens to not be a male member in my little domestic family, the issue of sperm becomes,
well, an issue. There is a whole world of frozen sperm out there that is really pretty fascinating. For instance, it ships Fed Ex, can be frozen for years Austin Powers style, and is incredibly, incredibly expensive for those of us whose households don't have a free flowing supply.

Let's start with the bank, the cryobank. Our particular one is the California Cryobank, one of the most well known and well respected out there. I continue to be so impressed with their professionalism and compassion. We start on their website (www.cryobank.com if you're interested in poking around) with a donor search. You can literally see, pick, and screen more about your potential donor, than most of you probably did for your potential spouses. Height, weight, eye color, hair color, skin tone, build, blood type, heritage, occupation, GPA, complete medical history, complete family medical history going back 3 generations and including aunts, uncles, first cousins, and siblings, exposure to chemicals, almost ANYTHING you can imagine. You can purchase a baby picture of the donors, handwriting analysis, facial feature report, audio interview, staff impression, even see which celebrity the staff thinks the donor most resembles. There are anonymous donors, and open donors. The open donors agree to at least one instance of communication after the child is 18. Of course, you pay a little more per sample for open donors.

I am adopted, and possess a freakish amount of personality from my birth parents both of whom I met for the first time at twenty years old. I would be an excellent nature vs. nurture experiment, and let me tell, nature is very, very powerful. It is because of my background that I A) Have chosen an open donor, and B) am very particular about which donors I consider. I would have been furious had there been absolutely no chance for me to meet my birth parents, both of whom I am extremely close with now, and I would never want to deny my child that opportunity. I also have first hand knowledge that no matter how I raise my child, they will have an extremely significant amount of their biological father in them, both in personality, and physical appearance, and I want to be sure I find exactly what I'm looking for. Now, I realize this sounds a little "designer baby" ish, and I can assure you there are moments when you realize you just scratched through that donor because his sister was big boned and his cousin had acne in high school, but for the most part, you  find yourself "attracted" to donors that possess the same attributes you would be looking for in a partner, whatever those personal priorities might be. For me, it's things like intelligence, creativity, athleticism, and a passion for family.

After a certain age, cryobanks "retire" donors. This can create a problem for families that are having a hard time conceiving, or that are attempting multiple children from the same donor. Most banks have a "storage" program for families who want to buy now and squirt later, but that option pretty much depends on financial situation. In our case, we used the very last available vial from our donor last month, to no avail, and had to pick a new donor for the first time since this whole thing started. I was basically "in love" with the last guy, and it was incredibly hard to realize that it wasn't meant to be. I am pleased with our new donor, and hoping we have better luck in the very near future.

Lastly, lets talk price. There are several types of samples, ICI or unwashed, and IUI or washed, are the two most common. ICI samples are samples that have not been pretreated and are suitable for intracervical inseminations. They average $535 for a ONE milliliter vial for an open donor, and about $430 for an anonymous donor. IUI samples are washed before freezing, removing the dead cells, waste material etc, and are suitable for intrauterine inseminations. They are $645 for ONE ml for open donors, and $535 for anonymous donors. Most doctors, couples shoot for two inseminations per cycle, so at minimum two vials per month. Do the math. This doesn't count shipping the 22 lb tank over night both directions, or the extra donor information you might purchase. You can imagine for a couple struggling with fertility for two years how much the costs add up. However, I know when we bring our new baby home, every single cent will have been worth it, but what a struggle in the mean time.

Monday, August 2, 2010

The Beginning

It's been a two year journey so far, and I'm no closer to my destination than when I started. It is the kind of journey that holds hostage every day, every thought, every action, every reaction. Two years of tracking, charting, temping, waiting, waiting, waiting, only to find bitter and complete disappointment at the end of those 28 long days. I have found that fertility is far more elusive than I had ever imagined. It's the hardest thing to go through alone, yet so many women and couples are struggling with this emotionally impossible situation and never saying a word. These posts will be my outlet, and hopefully connect, educate, and give hope to others at the same time.