Curious

I read today that Gonal-f is made out of Chinese hamster ovary cells. I have some questions.

Why hamsters?

Why do they have to be Chinese?

How do my ovaries know what to do with Chinese hamster ovary cells?

Who thought of this?

Is it possible that there will be little bits of Chinese hamsters in my eggs? Because I’m not particularly fond of hamsters. Although they may be sold at PetSmart and kept indoors as pets for first graders, at the end of the day they are just small, furry rats.

Infertility is so weird.

-J.

Three Cheers for my Ovaries!

I knew they could do it. I waited four full weeks, which in infertility time is roughly equivalent to several decades, and got the payoff I wanted: This morning's ultrasound revealed my dysfunctional but eager ovaries to be cyst-free and ready for some follicular fun. Instructions for tonight: 37.5 IU of Gonal-F; return on Monday for bloodwork and ultrasound.

I hate it when something I didn't want to happen actually turns out to be a good thing, but I think the break has been good for me. I'm back and in fightin' form. Ready to kick some infertility ass.

-J.

PS Congratulations and good thoughts go out to Lisa! In addition to being genuinely happy for you, one infertile's success somehow feels like a victory for all of us.

Eggshells

I can't believe it and I'm scared to say it out loud (or even type it) but according to the blood test, I'm pregnant.

I'm excited and happy and I really can't believe it...but I'm also terrified. I keep going to the bathroom expecting to see my period. I'm terrified that things can't possibly go right - so many women have miscarriages, and we've had so much trouble - it just seems unlikely that things will actually be okay.

I don't mean to be ungrateful - I'm so, so happy to know that I actually can get pregnant, and feel so lucky that our fifth fertility treatment worked. My husband tried to reassure me by telling me that if something happened, we'd just keep trying. Then I told him that the law in Massachusetts defines infertility as "inability to conceive in a 12 month period" which means that if I have a miscarriage, we can't start fertility treatments again for 12 months.

He was a little shocked by that.

I guess excitement and happiness are trumping worry...sometimes. I actually feel sick a lot - but when I don't, I worry that it means that the production going on inside me has stopped.

My husband asked again when I'd feel comfortable and start to worry less - and I said, "In nine months." Which isn't totally inaccurate...but I will feel better after our ultrasound and MD appt on June 10th, and after 12 weeks, and after amnio...

- L.

One and a Half Pink Lines?

So, Sunday morning I woke up and decided that even though it was five days before I was supposed to get my period, I would take a test. I know, I know, they tell you not to...they tell you to wait for the blood test. But with all this stupid waiting, I decided to indulge. I got what I thought was a negative - there was the faintest, faintest hint of a second line, but I figured the test just always looked like that (you'd think I'd know - I've seen approximately 43 negative ones).

I got back into bed and whimpered to my husband about a million things, including that now if the IVF (in July) worked, I'd be having the baby at the worst possible time for me in terms of work, and I might have to quit my job...he consoled me, and tried to hide his disappointment, and we went back to sleep.

Sunday night, we went to friends' house in Wellfleet, and had an amazing dinner (complete with champagne and wine and after dinner drinks to celebrate their new house). The night was fabulous, and we decided to stay over. On Monday, we woke to the kind of day that really makes calling in sick worthwhile - crystal clear skies, light breeze, sun shining off the harbor. I decided to use the second test in the 3-test "value pack" (how $22 for something you pee on can be a value, I don't know). Nothing.

I didn't want to throw it away in their trash can (evidence!) so I wrapped it in a lot of tissue and stuffed it back in the box. A few hours later, as I was packing my bag, I decided that it was gross to put that in with my cosmetics, so I took it out to re-wrap it and throw it away.

The second line was there.

At least, I thought it was. It was fuzzy and wierd-looking, with undefined edges, but it was definitely there.

My husband was out getting coffee and bagels, and when he FINALLY arrived back, I said, "Can you look at this?"

"Oh my God." He said.

"It's positive!"

"Okay, that's sort of what I thought too, but I couldn't tell, it was such a wierd second line, and it's lighter than the test line, and..."

"I knew it! I knew it would work this month!"

We ate the best tasting bagels I've ever had.

But then, the doubts started.

What if it's just a chemical pregnancy? What if the HcG shot just made the test look positive? Even if I am pregnant, what if it doesn't last? What if I miscarry? If I miscarry, I'll have to wait 12 whole months to start fertility treatments again (thanks, Mass law and insurers!)!

My husband wanted me to blog that night, but I just couldn't. First of all, I'm not sure it's true. I get a blood test tomorrow, but I still won't feel 100% until I'm at least 12 weeks - actually, scratch that. I won't feel 100% until I give birth.

I'm so used to negatives and sadness and disappointment that I just can't let myself be happy yet.

Second of all, I feel guilty.

If I am pregnant, what about my friends who aren't? Before, we were bonded by our bad luck, bonded against the Bump Watches, and baby shower invites, and stupid comments from stupid people. I feel like a traitor.

My counselor at the Domar Center said a lot of women get more anxious after they find out they are pregnant, and I completely agree. After working so hard for something, is it worse to have it taken away than not to have had it at all?

As my husband would say, "happy thoughts, happy thoughts." I'll try.

- L.

Never Thought I'd...

...admit to doing this. I'm back at it - Googling and Yahooing til 2 a.m. - trying to figure out how early I might have signs of pregnancy. I know it's insane, a bad idea, stupid and won't help - and that it could hurt. I am so scared to get my hopes up...but I can't help it. I had gotten so used to my cycle - get period on day 29, ovulation cramps on morning of day 15, ovulate on day 15, iui on day 16, pimple on chin on day 23-24, cramps on day 28-29 and period again.

Then I started the FSH shots. And I ovulated (well, I triggered ovulation) on day 9, had the IUI on day 10, and on day 16, my chest became so sore that i can hardly stand to have a sheet on top of me. The nurse (who called me!) said it could be a good sign...and then I went with my sister to see her OB today, and asked her if it could be a sign, and she said it was too early for breast tenderness to be caused by pregnancy, and that most likely, it was a progesterone increase from the shots.

So what did I do? Instead of believing a really nice, kind, insanely smart doctor, I'm up til 2 hoping that Annie Lynn from Maryland, who had similar symptoms at 6 days "dpo" and then found out that she was pregnant, is more on target than a doctor whose been seeing pregnant women for 15 years.

The problem with hoping is the disappointment. The problem with not hoping is that I fear that pessimism could affect my chances of getting pregnant...

Ugh. I cannot believe that I am googling things like "sore boobs" (you should see what that brings up, by the way). I cannot believe that I am writing about it. What's happened to me?

I guess the only good news is that if you're experiencing infertility, you're not the only one fighting insanity at the same time!

- L.

Cysting Out This Month

Remember how I got my period a mere nine days after my IUI and the only thing keeping me from jumping out a window was the hope of a fresh, spanking new cycle? Not so fast, said infertility. You're getting too smug. Here's a dose of reality: Two huge cysts on your right ovary.

When the tech at my day three baseline ultrasound asked me whether I was in pain, I knew that couldn't be a good sign (in fact, I think that's #1 on the Top 10 Things You Don't Want to Hear When There's an Ultrasound Wand in Your Business). The nurse called me that afternoon and confirmed my fear: the cysts were too big to proceed with another treatment cycle, and I had to wait until they went away. I was benched for a month. When she told me to call them on the first day of my next period, I laughed out loud. "Where have you been?" I wanted to ask. "That won't happen," I actually said. "I'll need medication to bring one on." She told me to call back in 28 days.

It was all pretty dismal; she may as well have said, "Call back in an eternity." Infertility is a cruel exercise in forfeiting control for type A people like me, even when there's something you can actually do, like inject yourself like a champ every night. When there's absolutely nothing to do but wait? Well, it's almost unbearable.

I did some research and found that some docs prescribe birth control pills to eliminate cysts, and called back the next day. I spoke with another nurse who said that sometimes people like me can actually ovulate from the cysts, even if they wouldn't normally. She said she couldn't see why I'd need the Pill, suggested that I wait the month and said I was welcome to try the good old fashioned method while I waited. How quaint.

It's not in my nature to get too hopeful; the risk of being hurt is too great if I'm not prepared for the worst at all times. But somehow when it comes to wanting a baby I'm a glutton for punishment. I just keep thinking of what a great story it would be: "So we did the injections for a month, which didn't work...but the next month, without any medication, I got pregnant!" Not to mention the fact that I'd be all done -- no more medicine, ultrasounds, blood test, sadness. It's a lovely thought.

One more week to go. If no period by next Wednesday, I call for a blood test. We'll go from there. I'm learning not to assume anything anymore.

-J.

Insanity

Okay, it's official. I'm completely insane. Think I'm exaggerating? Listen up.

Last Tuesday, I was told that my follicles looked good (I had four) and that Wednesday night I should give myself the shot that would make me ovulate, and Thursday and Friday, go in for an IUI.

Tuesday night, my husband was unable to sleep because of excruciating pain in his shoulder. We spent Wednesday in and out of doctor's offices, going for an MRI, meeting with a neurosurgeon at 9 p.m. He told us that my husband had a ruptured disc in his neck, and had to have surgery immediately. As he pointed to the MRI and explained everything, I held it together. But a few minutes later, as he scheduled the surgery, I started to cry.

Was I scared that my husband was having surgery that had a risk of paralysis as a side effect? Worried about the pain he'd endure recovering from a surgery that required a 3 inch cut in his neck, and the moving of his vocal cords and spine? Concerned that the surgery involved removing a disc, grafting bone between his vertebrae and then holding the whole thing together with a metal plate?

Well of course I was. But was that why I was crying? Absolutely not.

I was crying because I'd given myself shots in the stomach and endured blood tests (my greatest phobia) and ultrasounds, and for what?

I hope that the hormones had something to do with my very selfish reaction - of course I was worried about my husband. I just wanted him to um, give me a sample before he headed for the OR.

I don't know how he did it with all the pain he was in - but he did. The morning was an exercise in comedy - I had to go to the Old Person Medical Supply Store to buy sterile cups from a kindly 78 year old with white hair, a malfunctioning hearing aid and poly blend pants ("What do you want dear?" "Um, a sterile cup?" "What for?" "Uh, like the kind you use for urine samples." "Urine samples? You should get those done at your doctor's office, usually..." I wanted to scream at her: IT'S FOR MY HUSBAND TO JERK OFF IN!! BECAUSE I CAN'T GET PREGNANT AND I NEED THE THING RIGHT NOW BECAUSE I HAVE EXACTLY 48 MINUTES FOR HIM TO GET OFF UNDER THE INFLUENCE OF OXYCONTIN AND CARRY THE SAMPLE IN MY BRA TO THE IVF CLINIC!Any more questions?")

and then race them back to the house where my poor husband, who was in torturous pain, had to produce the sample, which I then raced to the clinic.

As I handed the sample to the lab tech, I was laughing so hard she likely thought I was... insane. But she laughed too when I told her the story, and said, "If you'd gotten pulled over for speeding you could have given theg cop the best story of his career!"

Anyway, part of me thinks this month will work because there is just no way it should. And I think my priorities are back in place...but we'll see what next month brings.

Q and A about FSH and IUI

Ah, more alphabet soup! And more blogging from me (can you tell that I'm done with school for the summer?) - I've had a lot going on recently.

Luckily, the injections worked! Well, insofar as they produced four follicles. Before starting this cycle, I knew basically nothing about how this all worked - so I thought I'd share what I've learned this week.

1) What is FSH with IUI?
My insurer requires that I do two cycles of IUI (intrauterine insemination) with FSH injectibles before I can do IVF. My doctor says this is a waste of time (see below, #2).

2) What is the success rate of IUI with FSH?
For me (no known problems, and husband with excellent sperm counts and motility) apparently it's about 20% per cycle. This means that after two cycles of FSH with IUI, 36 out of 100 women will be pregnant (20% the first month, and 20% of the remaining 80 the next month). Clomid with IUI was about 10% per month for me, which means that after three months (I did three cycles) of Clomid with IUI, 27 out of 100 women will be pregnant.

3) What is FSH with IUI?
FSH is follicle stimulating hormone, and I get it via injection. I use the Gonal-F pen, and started injecting myself once a day (they tell you to do it between 5 and 10 p.m. and I've been doing it at about 10:30). It looks like a pen - and you just push it onto a needle (it's short, and skinny, not that bad) and then inject the dosage that your doctor prescribed (mine was 112). Then you inject yourself in the thigh or stomach (they told me to do it in the stomach).
You do this starting on day 3 of your cycle, and on day 7, they started giving me blood tests and ultrasounds. Once follicles are the right size (see #4 below) I give myself a HCG shot, which induces ovulation. On the next two days, we'll take a sperm sample to the lab, where they'll "spin" it, and then inject it directly into my uterus (painless - unless you're in the 1% of women who have a prostaglandin reaction - which I am - and then you'll have very bad cramping for about 3 hours after the IUI. They can improve that by washing the sperm twice - which they did for me last time, and I had almost no cramps!).

4) How many follicles are you supposed to produce and what size should they be?
According to my nurse (and the internet) they like to see about 4 follicles for an IUI cycle. Any more just increases the risk of multiples, and doesn't improve pregnancy rates. They like the follices to be close to 20 mm (or at least for the largest one to be). Follicles are the little sacs that the eggs sit in - without drugs you'll usually produce one per cycle.

They see and measure the follicles via ultrasounds (not the over the belly type either - this is a nice wand that goes...guess where?). They measure your estrogen level by taking blood.

So for me, today (day 8 of my cycle) I had one follicle that was 18 mm, one that was 16 mm, one that was 14 mm and one that was 13 mm. I had two on each side. My estrogen level was 568 (what?) - apparently it's about 200 per mature follicle. So I'll do another shot tonight, and assuming the follicles grow at the rate they have been (about 3 mm per day for me) tomorrow I'll have a 21, 19, 17 and 16 and by the time I take the HcG shot, they'll be a little bigger.

The needle for the HcG shot is a little scarier, but like I've said before, you can pretty much do anything you set your mind to...

My last question is whether my total cycle length will be shorter (for vacation planning purposes of course! You can't really leave your doctor's neighborhood during days 7 - 14 or whenever you are ready for ovulation and IUI). I usually ovulate on day 15 of my cycle, and get my period exactly 14 days later. This time I'll be inducing ovulation on day 10 of my cycle - so based on me in the past, I should get my period on day 24.

Do you care? No way. Unless you're about to go through this, in which case, you're probably like me - googling "FSH and IUI" to death.

Hopefully this was helpful...and hopefully I'll be in that elusive 20% this month.
- L.

Happy ISD

Happy Infertility Survival Day! That's right, it's May 4th (the first Sunday in May - before Mother's Day). And hey, we use acronyms for everything else in our lives (FSH, IVF, IUI, DPO...) so why not Infertility Survival Day?

Doesn't really have the same ring as "Happy Mother's Day" does it?

I have to admit that I never thought I'd need a national infertility survival day - or be sort of glad that someone (the author of Infertility Sucks) came up with one. But I've been dreading Mother's Day without realizing that I'm dreading it.

I realize that there are all these dates and events for which I thought I'd be pregnant (my high school reunion, weddings, Christmas, etc.) and as we were planning trips, I'd think things like, "well, Napa would be a bad idea because I probably won't be able to drink wine."

Mother's Day 2008 was one of the days for which I had a different vision. When we got married two years ago, I figured we'd need a babysitter along with dinner reservations to celebrate our second anniversary. And last year on Mother's Day I thought, "yikes, next year maybe I'll be getting a card!"

Instead, I'm writing about Happy Infertility Survival Day. Not really what I was expecting - no pun intended.

- L.

Getting Used To It

You can get used to anything. This is my lesson for this week. If someone had asked me last year if I'd ever be able to give myself a shot, I'd have said NO WAY. I get queasy and lightheaded just thinking about syringes, and I faint every time I get my blood drawn (no donating for me).

But last night, home alone, I gave myself my first shot. My husband had a baseball game, and I didn't really want him to see me grabbing an inch of fat on my stomach and jabbing a needle into it, anyway.

The wierd thing was, I wasn't that nervous. At least, I wasn't until the minute I was supposed to give myself the shot. I'd been watching that PBS series, "Carrier," about life on a Navy aircraft carrier. The chaplain had just given a speech in which he said, "If you think you're biting off more than you can chew, maybe you've underestimated the size of your mouth."

I thought about that, and figured my mouth is pretty enormous, and there's a good chance I can handle giving myself shots.

But then I got the needle ready (I'm using the Gonal-F pen, and frankly, it's not that scary - sort of like an Epi Pen I think) and sort of lost my nerve. I moved from the bathroom to the bedroom in case I needed to lie down right afterward. I didn't - but the hardest part was the two minutes before I injected myself. I must have cleaned the skin six times.

Once I took the plunge, so to speak, and got the needle in (I jabbed way too hard by the way - your skin isn't made of metal - all it takes is a little poke) it didn't hurt at all. In fact, the hardest part was getting the stupid needle off after I injected myself!

While I'm not looking forward to doing it again tonight, I've already learned that minimizing the waiting is a good idea (think, Just Do It) - get the pen ready and just go ahead and stick it in.

I have to admit that I cried after I did it. It just made it all so real - I can't get pregnant. I so really can't get pregnant that I have to give myself shots in the stomach.

The online videos definitely helped, and now I just have to come to grips with handling the blood tests I'll have to have next week. The worst part for me is that they have to be done early in the morning - and my first fainting episode coincided with getting my blood drawn early in the morning (it was a disaster - I keeled over and there was blood everywhere when I came to). I guess I'll just have to convince myself that I can bite off more and keep chewing...

In the mean time, it's ten p.m., which means it's time for shot #2.

- L.