Fifth Doc's a Charm (Bullet Style)

Positive

• RE #5 is an affable, grandfatherly man; henceforth, he shall be known as Dr. Werthers.
• Dr. Werthers called our religious convictions about not freezing or discarding embryos "laudable."
• Dr. Werthers also seems to have a subtle, sarcastic sense of humor. I never knew for certain if he was joking or not, but he peppered his remarks with little asides (with his nurse as straight man). For example, while running through my history of doctors, he said something to his nurse about how many women like Dr. [Ego], how Dr. [Ego] is very handsome and knows it.
• Speaking of the nurse, she also seems caring and personable.
• The intake questionnaire, consultation, and exam were far more thorough than the other two clincics' were; my appointment lasted at least an hour and a half (not including time in the waiting room before the appointment even started).
• Dr. Werthers actually engaged in dialogue and took my opinions and preferences seriously.
• The doctor and nurse are hopeful that we can do egg freezing in conjunction with IVF and will do all they can to get insurance approval.
  

Not-So-Positive

• During the ultrasound exam, Dr. Werthers saw what could be a fibroid in my uterus. He'll look into it further once he has seen my X-ray films from last year's HSG.
• Every doctor I've seen now has offered a different explanation for our infertility. Dr. Peppy attributed it to a luteal phase defect. Dr. Owlish called it unexplained, possibly caused by mild endometriosis. The possibilities Dr. Werthers threw out: PCOS (!?... I have none of the normal indications for that), elevated male hormones (!? again... not exactly what a girl wants to hear), this potential fibroid, poor egg quality, etc. Now I know he's just brainstorming and wouldn't actually diagnose any of those things without further testing; but still, it doesn't inspire confidence that no doctor has agreed about the reason we can't conceive.
• Dr. Werthers still recommends transferring no more than two embryos for a woman my age, even with our history of failed IVF. He'll study our previous embryology reports, but his initial recommendation is to fertilize 3-5 eggs and then make a decision about how many to transfer based on embryo quality. We'll have to keep negotiating to find the right balance between being cautious (no, I don't want octuplets) and aggressive (I don't want to squander our remaining 2 IVF cycles, so I want to fertilize more eggs, but we are firm about transferring all living embryos).
  

What's Next

• Track down remaining records to fax to Dr. Werther (embryology lab reports, HSG X-ray films, most recent semen analysis).
• After they review those records, the nurse will call about any further testing needed.
• Figure out if egg cryopreservation is a viable option (will insurance cover the IVF cycle that yields the eggs? how much would we have to pay for cryopreservation and subsequent fertilization and transfer?).
• Do IVF, possibly adding heparin as a can't-hurt-might-help medication.
  

I Felt a Little Sheepish When He Said, "So, I'm the Fourth Doctor You've Seen?"

On Monday, I saw a new doctor, to get another opinion after our less-than-pleasant consultation with Dr. Ego. I liked the new doctor quite a bit; he was sympathetic, ready to take my opinions into consideration, and eager to offer help. When he heard our position on not freezing embryos, he said that he did not think IVF would be worthwhile for us. In his opinion, the limitations imposed by fertilizing a small number of eggs make the risks of IVF outweigh the potential benefits. However, he tried to offer as many other options as possible. He asked if we would be open to using donor embryos and gave me a list of the embryos that they currently have available at their clinic. (He also informed us that insurance companies consider donor embryos cycles the same as fresh IVF cycles; that means we'd have to choose between dFET and IVF for our remaining two covered cycles.) He said that we could continue to do IUIs. He mentioned that, judging by our records, it's entirely possible that we could still conceive without medical assistance. And he directed me to an article that he had recently read that mentioned a Christian fertility doctor in Oklahoma (turns out he had his facts a little mixed up, but I appreciated the effort all the same).

All that to say, I definitely like this doctor's personality a lot, but Aaron and I aren't sure what to pursue next. We'll probably take a break for the rest of the year, regardless; we don't really want to squeeze fertility treatments into the next couple of months that are already full of business trips, our anniversary, Thanksgiving, and Christmas. In the meantime, we're praying for guidance as we consider all the possibilities. Do we look around for a doctor who will do IVF within our parameters? Do we try one of the other medical options, like donor embryos or more IUIs? Do we pursue adoption? Do we just rest as a family of two and wait to see what the Lord does?

"We do not know what to do, but our eyes are on you" (2 Chron. 20:12).

"But I trust in you, O Lord; I say, 'You are my God.' My times are in your hand" (Ps. 31:14-15).

Wheeee! I'm Writing My Own Content Instead of Providing Links!

I continue to be displeased by Dr. Ego and his clinic. Since Dr. Owlish left the practice, there has been a huge turnover among all the support staff as well (nurses, ultrasound techs, receptionists). Now, not only do I dislike my doctor, I also sense a general air of incompetence at the whole clinic.

A week ago Thursday, I showed up for day 3 blood tests and ultrasound. I had asked for an early appointment, because I teach at a homeschool co-op on Thursday mornings now. However, what normally takes 15-20 minutes took over an hour that day. First, I had to wait a while to be seen. Then, the nurse didn't have my charts and didn't know what to do. When she figured it out and started to prep my arm to have blood drawn, I asked if they were running all the extra panels Dr. Ego had suggested (Factor V Leiden, MTHFR, various antibody checks). Blank look. Eventually, I had to give them my copy of Dr. Ego's notes (which thankfully I still had in my purse) so that they knew what to do. After the nurse painstakingly coded all 5 vials of my blood, I waited again for an ultrasound. Finally, I was free to leave - at exactly the time I should have been starting my first co-op class.

That circus of an appointment cleared me to do the Clomid challenge test (a test to determine appropriate medication dosages for IVF). After five days on a high dose of Clomid (who knows what that has done to me, since I come close to overstimming on the lowest dose of Clomid!), I revisited the clinic for bloodwork. As I settled into the chair and rolled up my sleeve, the nurse (different than the previous one) said, "I have to draw about 6 vials today; do you want to lay down?" I asked what tests were being run. "Factor V Leiden, MTHFR, various antibody screening panels." I told her those had been drawn the previous week. She went back to check my charts and then returned to say there were no records of those tests being done. So it was all done again. Hmph. (I don't have results yet.)

Now I'm supposed to have a e-tegrity test done at the end of this cycle, to examine the enzymes in my endometrial lining. This test is not covered by insurance, so Aaron and I have been debating whether we want it done or not. However, it may be a moot point, because a precondition of the test is that I use OPKs (ovulation predictor kit) and call when the line darkens to indicate my LH surge. I've been testing every morning for the past four days, and the line is getting fainter, not darker. I tend to ovulate early (day 11-13), so I'm guessing the high dose of Clomid caused me to ovulate even earlier. I'll call the clinic later today and see what they want to do if that's the case.

In the meantime, I finally called another doctor yesterday. I had gotten a recommendation from a friend, but I haven't had the time or inclination to go through the hassle of setting up an appointment and getting a new referral. However, when I called this potential new doctor and my insurance company, I found out that my referral is global, not tied to a specific specialist. So I can see any RE I want (in the network) without having a re-issued referral. I can't believe how easy it is! My consultation is set for Oct. 20; I'll find out then if this other doctor will work with our preferences about IVF or not. Please pray that he will!

In an Attempt Not to Bias Readers, the Doctor Character Doesn't Get Named until the End. Also: Sorry, This is a Long One

Scene: midday Monday at the offices of The Fertility Institute at Posh Hospital; a slightly nervous couple waits to speak about IVF with a doctor they have never met

Doctor: Hi, nice to see you. (shakes hands) So, why hasn't this worked yet?

Andrea: That's what we'd like to know.

Doctor: Well, we can't tell. You're young. All your numbers look great. You've had a number of mature follicles every cycle. Your sperms counts are fine. But IUIs only give a 17-18% chance of pregnancy. IVF, for patients your age, has a 70% success rate. So I really want to push things. I want to increase your dosage and get as many eggs as we can.

Andrea: But...

Doctor: Then I'm going to say we do IVF with ICSI. (spelling it out and speaking slowly while writing on a chart) That's intra... cytoplasmic... sperm... injection...

Andrea: Yes, we know. We've actually done two IVF cycles with ICSI at a previous clinic. (thinking to herself, "It's all in that fat stack of patient records you're holding; have you glanced at those?")

Doctor: Oh. (glancing at papers) I see that.

Andrea: When we did IVF before, we only...

Doctor: (back to the chart he's writing out) So we're going to run a bunch of tests first, to make sure we don't miss anything and we have the best chance of making this work. We'll do a Clomid Challenge Test, to determine the best dose of medications for you. We'll do some bloodwork to check for antibodies that would fight against pregnancy, and for blood-clotting disorders. We'll do one test - and this one isn't covered by insurance - to check for enzymes in your endometrial lining that would support a pregnancy.

Andrea: Okay, all those tests sound fine. But you should know, we don't want to freeze or discard any embryos. We want to fertilize a small number of eggs and transfer all the viable embryos.

(silence)

Doctor: Boy, kids. That really, I mean really lowers your success rates to almost nothing. I mean, I understand, I respect where you're coming from. But if you don't give me any out, I can only let you fertilize three eggs. What if they all fertilize? Three embryos is the most I'd be comfortable to transfer, and I can't take the risk of you having more than that.

Andrea: Well, when we talked about all this with Dr. Owlish, he told us that only one out of every five eggs has the genetic material to turn into a viable pregnancy. So he suggested we fertilize 6-8 eggs.

Doctor: Hmm, Dr. Owlish is usually more conservative than me. I can't let you do more than three. What if we end up with four embryos, and you have quadruplets? They'd probably have all sorts of disabilities. They wouldn't be able to take care of themselves, you wouldn't be able to train them. I would haunt you for the rest of your lives. Your lives would be a living hell.

Aaron & Andrea: ... Um, we know the concerns, but our history...

Doctor: I know my numbers. I can't do more than three.

Andrea: Look, we don't want high order multiples, either. But we fertilized four eggs at our previous clinic, and we only ended up with two embryos for a day 3 transfer for our first cycle, and one embryos that barely made it to blasocyst for a day 6 transfer for our second cycle. So doesn't that show...

Doctor: I know my numbers. We're better than your previous clinic. We have much higher pregnancy rates.

Aaron: But doesn't our track record have an influence?

Doctor: Every cycle is different. I know my numbers.

Andrea: So why, if we know fertilizing four of our eggs in the past did not result in four embryos to transfer, would it be different here?

Doctor: Better eggs. Better lab.

Andrea: Well, have you worked with patients who only fertilized three eggs before? What were the results?

Doctor: It runs the gamut. Some end up pregnant. Some don't make it to transfer. We don't have many patients who restrict us this way. I respect your position, but you have to respect that I know my numbers. I can't do more than three. You might be able to find another doctor in this area that would work with you, that would let you fertilize more eggs, but they don't have the success rates that I do. I'm sorry, kids; I know this isn't what you want to hear.

Andrea: (this is going nowhere; let's change the subject) So, we run all these tests during one cycle?

Doctor: Yes. (standing up to leave) So call on day one and we'll get you started.

Aaron & Andrea: Wait! Dr. Owlish also suggested donor embryos?

Doctor: Hmm, that's really rare. Nobody wants to do that.

Aaron & Andrea: more questions...

Doctor: more non-answers... Good luck! (exit)

(end scene)


So, how do you interpret the conversation? We were less than pleased. Whether he's right or wrong about the number of eggs we should fertilize (and I'm inclined to think he's wrong, because we know what happened with four eggs fertilized), he is not the kind of doctor I feel comfortable working with. Though this was the first time we met, he didn't do any introductions and he never addressed us by name. He didn't really listen to anything we said, and he seems far more concerned with his precious numbers than with the individual patients sitting in front of him. I'm trying, with mixed success, not to be angry at this doctor. I'm glad that my confidence is not in doctors but in God, who does hear me. Our plan, at this point, is to go ahead with all the tests (doesn't hurt to gather more information) while researching other doctors in the area and considering our next steps.

Oh, and I think the blog nickname for this particular medical professional will be Dr. Ego.

Mixed Messages

Last Wednesday, I visited the clinic for a post-IUI scan of my ovaries. The first time I did an IUI at this office, the nurse told me that the purpose of the ultrasound was to see if I was producing enough progesterone. If the ovaries measured above a certain size, that indicated sufficient progesterone production. If the ovaries measured smaller than the desired size, then an HCG booster shot would need to be administered. The nurse I saw this past week gave me a completely different interpretation of this scan and its purposes. According to her, my enlarged ovaries mean that I am slightly hyper-stimulated and that it is not safe for me to take the standard-protocol HCG booster. So according to the first explanation, a bigger ovary measurement is a good thing; way to go, ovaries, no more HCG needed! But according to the second explanation, a bigger ovary measurement is bad news; sorry, no more nice HCG for you. Which is it? I don't know. How much affect does it have on the ultimate outcome of the cycle? I don't know that either. But I'm content to wait and see; I go in for the beta on Monday.

"But as for me, my prayer is to you, O Lord.
At an acceptable time, O God,
in the abundance of your steadfast love answer me in your saving faithfulness."
(Psalm 69:13)

Laissez-Faire Attitude Exhibit B: I Took My Trigger Shot an Hour Late on Friday and Didn't Get Anxious about It

Thanks to those who prayed for our IUI yesterday morning! The Lord mercifully caused things to go quite smoothly, despite the fact that we were exhausted when the alarm sounded and not eager for the whole IUI process. We didn't have as rushed of a morning as we often experience on IUI day. We made it to the clinic with ample time, and we were even seen early, which meant we could make it to church.

In keeping with my new, accidental laissez-faire attitude toward this cycle, I didn't pay too much attention to the report of the sperm counts for the IUI. They gave me numbers, but I honestly couldn't remember what the ranges are for good motility and post-wash count, and I didn't feel like asking. So the numbers were just... meaningless numbers. I started to look up the information this morning, then I decided that I didn't really have time to search around. Yes, knowing what kind of counts we had for this IUI might give me some idea of what to expect, but simply knowing the numbers and statistics won't affect the outcome of the procedure. So I'll just wait in blissful, distracted-by-settling-our-home ignorance.

As we sang yesterday morning in church:

We offer our lives to proclaim
What a Savior!

Anything can happen with this IUI, as long as it results in a proclamation of the greatness and kindness of Christ.

I Probably Didn't Really Have Time to Re-Write Showtune Lyrics, Anyway

At this morning's follicle check and blood draw, the nurses thought I would likely be on Follistim and Repronex for another day, back for blood and ultrasound tomorrow, then probably scheduled for a Monday IUI. I had run out of Repronex, so I had to "borrow" some from the clinic in case I needed it tonight. On my drive home, I began composing alternate lyrics to the Les Miserables tune, "One Day More," to post as a description of the pending plan. I could hear the different sections - me, the patient, in place of Valjean, the nurses in place of the Thenardiers (no insult to the nurses intended; their instructions just fit the rhythm) - joining in a glorious, swelling medley of assisted reproductive technologies. When I stopped to fill up the tank of my car, I was trying to think of rhymes for "ovary," "Follistim," and "Repronex" - not an easy task. I filed the idea away to come back to after work.

Then I checked my patient voicemail box, and found out that the doctor actually wants me to stop meds, to take the HCG trigger shot tonight, and to come in for the IUI on Sunday. So much for my new Broadway hit! Please pray for us on Sunday morning.

(For those who like the numbers, here's the run-down: two 17mm follicles on the left, a few 13s on the right, and E2 at 1023.)

(Also, it bothers me that I don't have accent marks in the proper places for all the French words and names, but I don't have time to figure out how to do that right now; please imagine little slanted hash marks.)

Oh Yeah, There's More to Our Lives than Home-Ownership

So, not only did we move into our new house this weekend (hello, boxes that are still everywhere!), I also started medications and appointments for a new IUI cycle. A friend who was helping me unpack our kitchen laughed at the initial contents of our new fridge - a large jug of water, a bowl of leftover potato salad (from a night we had spent painting at the house), four boxes of Follistim, and one box of Repronex. Rather telling of our priorities at the moment!

I don't think I've mentioned this yet on the blog, but Dr. Owlish has left the practice (he moved to be closer to family, so I guess I can't begrudge him that). It was disappointing, as we had been so pleased to start seeing him, but we trust God's timing. I've been handed over to the other doctor at the clinic, but I haven't actually seen him yet (and may not for some time, who knows?). He's a very respected doctor in the field, nationally, so I assume I'm in good hands, but I don't know if we will click with him personality-wise in the same way we did with Dr. Owlish. Anyway, the new-to-me RE reviewed my charts from the cycles I did with Dr. Owlish, and he decided to add Repronex into the medicine mix. I don't really know what it does, but I've been too swamped with all the house stuff to worry about asking. It's another injectable drug, one that I mix myself. Then I squirt the Follistim into the same syringe, so I only have to give myself one shot total instead of one for each medicine. It makes for a lot of needle juggling, especially once I've sterilized things and don't want to set them back down! I've taken this combination of meds for three days now, and a check-up today showed dozens of small-to-medium follicles on each side (the largest were 13, 12, and 10 mm) and an E2 level of 202. I'll continue the same doses (75 IU of Follistim, 37.5 IU of Repronex) for three more days and go back for ultrasound and bloodwork on Friday.

It's kind of strange to have infertility treatments feel like an afterthought, amidst all the business of settling our new home, but I'm grateful for the temporary shift in focus. I pray, of course, that the upcoming IUI will be successful, but I have such abundant evidence of God's kindness all about me right now that it's easy to trust him for the future. No matter what happens, I know that he has positioned us well for whatever will come next.

No Menopausal Nuns Were Hurt in the Making of this IUI ::updated::

When the nurse called with the results on Friday afternoon (E2=285, follicles measuring 15, 13, 10, and 9 mm), she told me to come into the clinic again on Saturday morning for more bloodwork and another ultrasound. At that appointment (to which I rode my bike), C-Pug declared, "Your lining is gorgeous!" My follicles measured 18, 15, 11, and 9 mm, and my E2 had gone up to 495. The doctor instructed me to take one more dose of Follistim on Saturday night, and then I took the HCG trigger shot last night. The IUI is scheduled for 10 a.m. tomorrow (Tuesday) morning. Please pray!


(For those who don't spend all their time immersed in the world of infertility terminology: E2 is a specific estrogen which should reach levels of 200-600 for every mature follicle; a mature follicle (the sac in which the egg grows) is 18mm or larger; HCG is human chorionic gonadotropin, a pregnancy hormone (the medical form is derived from the urine of pregnant women and menopausal nuns) that mimics the effect of another hormone (luteinizing hormone, or LH) which induces ovulation; IUI is intra-uterine insemination.)

::update::
(As I mulled over this post later while I drove around on some errands - what? doesn't everybody do that? - I realized that I gave inaccurate information in my parenthetical note at the end. It's actually follicle stimulating hormone, or FSH, I think, that comes from the urine of menopausal nuns. Which makes more sense. How would menopausal nuns secrete HCG? Anyway, the title of the post still holds.)

Cycling... and Cycling

I had my second ultrasound and bloodwork appointment for the current IUI cycle this morning; I'll get all the numbers (follicle measurements and estradiol levels) this afternoon, but the ultrasound tech said everything looks "gorgeous" - apparently, her favorite adjective, since she uses it every time I see her - and that things are really growing. This particular ultrasound tech is really darling, so I hereby decree that I will nickname her Cutie-Patooty-Ultrasound-Girl, or C-Pug for short. By the way, my protocol, for any who are curious, is 75 IU of Follistim per day (a lower dose than my last cycle, and I think this will work much better for my production-happy ovaries).

So I have two weekend assignments for you:

1) Both Monday and today, I rode my bike to the clinic. It's only a 20-25 minute ride each way (as opposed to a 10-15 minute drive) on a nice route between our apartment and the hospital. The nurses had instructed me not to add any new excercises during the IUI cycle, so technically biking isn't forbidden for me, but I'm starting to wonder if it's too much. What do you think? I'm popping up a poll in the right side bar, so go ahead and vote.

2) Legal wheels are still turning on the house stuff post-inspection. But that doesn't stop my mental wheels from spinning with decorating ideas. (I figure, hey, whether we end up buying this home another one, I'll still be decorating something.) So tell me in the comments, what are your favorite decorating and design resources - websites, magazines, books, stores, etc.?

Happy Friday!

Six One, Half Dozen the Other

Today marks the start of my sixth IUI cycle. I have mixed feelings about that. On one hand: Yay! Cysts are gone! Another chance to get pregnant! On the other: Hmph. Six IUIs; really? How did I get to be that person, the barren woman with a litter of failed infertility treatments in her wake? Counting our two IVF attempts in with all these IUIs, and it won't be long before my medicated cycle counts number in the double-digits. When do we just say, "Enough," and move on? I've started to have thoughts like, "If we had started to pursue adoption when we realized we were infertile, we might have a child or even two by now." But here I take comfort in God's sovereignty; we've sought his will, he's led us down this path of medical intervention, and he will build our family in his way and time. All those "what if" questions are fruitless; I only need to trust that God is good and he is in control.

So, IUI #6, here we come. I start the Follistim injections today (I think; I need to get a call from the nurse to confirm my instructions), and the actual IUI will probably fall mid-June.

Please, Lord, let this one work.

Swell

The beta on Monday confirmed what we already knew on Sunday - negative. I'm disappointed, of course, but seeing that sadness and satisfaction in Christ can co-exist. If continued infertility is how God is going to receive the most glory from my life, I'm resigned to persevere in this trial.

So today I went in for my CD3 ultrasound. I warned the nurse that I expected cysts, as I've ended up with anywhere from one to four cysts after almost every single previous medicated cycle. The nurse sweetly said that she chose to think I'd be cyst-free this time around. But this morning I blew my own record out of the waters. As soon as the nurse began the ultrasound, she murmured in shock and asked if I was in any pain. Then she started typing measurements. A lot of measurements. Just guess how many cysts I have.

TWELVE.

Eight on the right ovary, four on the left, some as big as 4 cm.

I'm an ova-achiever. (Ba dum bum CHING.)

So now I've got a prescription for BCP to suck the life out of all those cysts. Hopefully, they'll all be gone by my next cycle so that we can do another IUI in June. In the meantime, I think I'll enjoy the recovery break, and I'll avoid any twisting, jumping, or abdominal exercises!

A Letter from OfIRM to Mr. Aaron Patterson

Dear Sir,

We here at the Office for Infertility Repercussion Management (henceforth OfIRM) regret to inform you that your wife has turned into a snail. This unfortunate side effect of the progesterone suppositories is marked by a distinct trail of slime* left wherever she goes. While strict clinical studies conducted by OfIRM have proven that women taking fewer than two(2) suppositories per day are at no risk of becoming snails, a dose of three(3) or more daily suppositories has been shown to cause rare cases of gastropodism. Your wife's doctor, considering the risk negligible, prescribed a course of three(3) progesterone suppositories per day. Regretfully, Mrs. Patterson appears to be one of the select group who does, in fact, succumb to gastropodism. However, we of OfIRM assure you that gastropodism does not necessarily preclude the possibility of pregnancy. (See Exhibits A and B for evidence of the potential concurrence between snails and gestating women.) Gastropodism is not a permanent condition; upon discontinuation of the progesterone supplementation, your wife should revert from her temporary state as a snail to her usual human form. In the meantime, should you have questions regarding how to care for your wife as a snail, please contact the toll-free number for OfIRM and request Brochure #SE44898, "Managing Gastropodism: The Care and Feeding of Snails."

Sincerely,
The Employees of OfIRM

*OfIRM and its subsidiaries cannot be held liable for any costs incurred for the cleaning of dining chairs and/or seats in cars as a result of said trail of slime.

Super Size

Want to double the amount of traffic to your blog overnight? Apparently all you have to do is participate in Works-for-Me-Wednesday. Holy moley! Welcome to all of you visiting from Rocks in My Dryer.

I had an ultrasound this morning to measure my ovaries post-IUI. Judging by the reactions of the nurses, they are plenty large (I didn't ask for exact size, and I wasn't told). The right is much bigger than the left, which lines up with how I've been feeling. (I suspect a cyst, since I had them with every previous medicated IUI.) No need for the HCG booster shot, and I have instructions to call if I feel any severe pain. For now, me and my progesterone suppositories keep trucking along for the remaining week and a half until the blood test that reveals all. Amazingly, I don't feel any real anxiety or impatience as I wait to find out whether this IUI worked or not; I thank God for his Spirit's work in my heart to that end!

IUI Report

Everything pretty much worked out for the IUI this past weekend. My appointment on Thursday morning showed a number of growing follicles - one 15mm, one 14mm, three 13mm, and one 12mm. My estrogen levels had risen to 673, just over triple my previous levels from Tuesday. I knew from the size of the follicles that I wasn't quite ready to trigger yet, and I suspected that Dr. Owlish would want me to come in again on Friday. So before I received my instructions, I went ahead and made a preemptive phone call to the clinic to say that I would be attending my grandpa's funeral on Friday and would be unable to make any appointments that day. The nurse who called back reported that they could work around my schedule and gave me instructions to take a lower dose of Follistim that night, to trigger Friday morning, and to schedule an IUI for Saturday morning. I had a few questions about the protocol (why was I triggering in the morning if I should have had a monitoring appointment that day? why was the IUI only 24 hours after the trigger shot rather than the usual 36?), but after playing phone tag for the whole afternoon, I gave up and decided to just follow orders without getting more information. The HCG shot was not too hard to mix up and take, although I did have a reaction at the injection sight (a quarter-sized red welt) and I felt some unpleasant side-effects for a couple days (slight queasiness, tenderness, etc.). The nurse said that next time, if there is a next time, we can dilute the shot more. The IUI itself was a piece of cake. Since this clinic is so close to our apartment, we could relax at home instead of killing time in the waiting area between dropping of the sperm to be washed and the actual procedure. The nurse who performed the IUI was very gentle; I didn't have any cramping when she inserted the catheter. Then, she actually let Aaron push the plunger to send the sperm on through to the uterus; that was a little strange but also made the whole thing feel a bit more personal and less clinical. (The first word that came to my mind for that sentence was "sterile" instead of "clinical" - but it seems somehow wrong to use that word when describing our attempts to overcome infertility!) So now we're in the waiting stage. I only have one check-up between now and the pregnancy test at the end of the month. With everything surrounding my grandfather's death and funeral (which I'll write more about later), I haven't taken much time to think about the IUI or look ahead to what the results might be. I am asking that this will be the time when the Lord removes the thorn of infertility from us, but for the sake of Christ I am content with these hardships for now.

P.S. Thank you to all of the family members we saw over the weekend who expressed that you are praying for us to have children; it means more than you know to be so surrounded by support.

Ready, Set, Go!

The cycle for IUI #5 has officially begun. I visited the offices of Dr. Owlish for my first monitoring appointment this morning. According to the ultrasound gal, everything (antral follicles, uterine lining, etc.) looks "gorgeous." This afternoon, I retrieved my instructions from my clinic-assigned voicemail box (fancy!). I start with 100 units of Follistim tonight and keep that up until my next monitoring appointment on Tuesday. Let the fun begin! (That may sound strange, considering I'm referring to giving myself daily shots and pursuing procreation in a highly technical and medical manner, but after such a long break from treatments I feel almost giddy about proactively cycling again!)

Hardly Different

Today I visited the offices of Dr. Owlish for a lesson in injections, in preparation for the upcoming IUI cycle. If I had know that I would be watching the same instructional video that I saw back in November of '06 (thanks, handy timeline!), I would have brought popcorn to lessen the boredom a bit. Film-making doesn't really qualify as one of the strengths of the fertility pharmaceutical industry. When I met with the nurse afterwards, I declined her offer to go over all the Follistim instructions again. After three IUIs and two IVFs with the stuff, I think I'm familiar enough with the process. What is new for this IUI is that I will be mixing up my own HCG injection. At my previous clinic, the trigger shot prescribed came in the form of a pre-filled syringe. The prescription sent from Dr. Owlish's office includes two vials - one of powdered drug, one of fancy medical-grade water - and two needles - one to mix the contents of the two vials and draw up the combined HCG concoction, and one to administer the injection. This is definitely the next step in my career as a professional self-shooter-upper. Another interesting difference in protocol between the old clinic and the new is that a few days after the IUI, I'll have an ultrasound to check my ovary size. If the ovaries don't measure up, I'll take an HCG booster shot (half the dose of the trigger) in order to notch progesterone production up. Who knew that there is a direct correlation between ovary size and progesterone levels? Other than that, IUI #5 shouldn't vary too much from IUIs #1-4 - except, very hopefully, in the end result. Right now, I'm just waiting for my next cycle to start, so we can start trying again for the first time in a while.

Upon Review, I Should Have Found a Synonym for Confident that Begins with the Letter "D"

Anti-climactic. Brief. Confusing. Confident. All those words describe Wednesday's post-op appointment with Dr. Owlish.

Anti-climactic because I had already received a call from the pharmacy last week about filling my prescriptions for an IUI with injectable meds. Follistim - check! Novarel - check! An astonishing 63 progesterone suppositories - check! Since the progesterone supplementation will only be required for either the two weeks between IUI and beta (quantitative pregnancy test via bloodwork, for all you fertile laypeople out there) OR for approximately the first trimester of a pregnancy, I can only conclude that Dr. Owlish is supremely optimistic or that I will be using an uncomfortable quantity of suppositories for the two-week-wait. Anyway, the premature pharmacy call told me pretty much all I need to know about the treatment plan now to follow the laparoscopy.

Brief because I waited about an hour for about a 10-15 minute meeting with Dr. Owlish. He must have had a crazy day, evidenced by an untidily askew tie and a demeanor almost opposite of his usual leisurely, let-me-thoughtfully-and-sympathetically-answer-all-your-questions manner. In other words, he seemed rushed and we didn't talk for very long.

Confusing because he blithely brushed past the matter of my bent fallopian tube ("It was clear. HSGs can be faulty.") and instead dwelled on the biopsy of my bellybutton mole (of all things!) ("Not cancerous.") and of the pelvic tissue ("Stage I endometriosis. We got it all out."). There I sat, prepared with all kinds of now moot questions about my tube. The few questions I scrambled up about the endometriosis diagnosis met with limited answers. "It was in my pelvis?" (As in, that's a rather unspecified location, doc; what organs was it on?) "Yeah, your pelvis." "Oh. Okay." Now that I've had three different (and two faulty) diagnoses for our infertility, I feel a bit uncertain and wary.

Confident - that adjective belongs to Dr. Owlish. I continued probing about the endometriosis. "Will it come back?" "Yes, but not for a year, and we're going to get you pregnant before then." Dr. Owlish is supremely certain that I will be pregnant very soon. Which is kind of reassuring, but kind of makes me want to mitigate his assurance by abandoning any optimism I have for an opposing, negative realism. But all in all, I'm glad Dr. Owlish is so determined on our behalf.

I do still have hope that we will conceive soon. If that hope is a full balloon, this appointment let a bit of air out, but the balloon is still inflated and floating. I'm praying for good things and seeking to keep my confidence in the Lord.

Infertility Timeline

I've added an infertility timeline in the left sidebar, below the blogroll. I thought it would be helpful for any newer visitors to my site who want a quick snapshot of my history of diagnosis and treatment. At the bottom of the timeline, I've noted what and when my next step will be. I get that question a lot, so I thought that would make a helpful reference. I'll try to keep it updated regularly.

When putting the timeline together, I discovered that I had completely forgotten about one of our IUIs! I had been thinking (and telling people) that we did three, two with Clomid and one with a combination of Clomid and Follistim. But we actually did a fourth with Follistim alone. I think I forgot about it because we were already gearing up for our first IVF at that point, doing tons of research and having lots of conversations about whether that was a step we wanted to take or not. Still, how strange to have almost no memory of an entire course of our infertility treatment! If nothing else, at least documenting the timeline restored that part of our story to my mind.

Now, I need your opinion. Do you like the placement of the timeline, or would you rather have it above the blogroll? And do you like it ordered from oldest to most recent events, or would you prefer the order reversed so the next step is at the top of the list?

I Am a Delicate Flower

Recovery has progressed quite well so far. I haven't needed the pain medications at all since the day of the laparoscopy (which seems like such a waste of a powerful prescription!). The shoulder soreness has eased up some, to the point that I hardly needed to apply heat at all yesterday. So I attempted to return to work today. You know, my strenuous job as a church secretary. Which I do from home.

Y'all. (Weakness makes me feel all Southern-belle-like.)

Sitting upright at a desk is taxing stuff.

I worked for a total of three hours, catching up on e-mail and voicemail, and oh, the exhaustion! The achiness! The fresh (though slight and not worrisome) bleeding! I took due notice from my body and returned myself to reclining on the couch. And now I shall take a nap. Work can wait.