Hope on the Horizon!

It's been too long, I know!  Things happened pretty quickly for us over the spring/summer, so it was hard to keep up.  No excuse though, so I will do my best to catch you up on everything.

After we found out that the cyst had grown, we were obviously upset (see last post).  Luckily for us, a promising phone call came from Dr. P later that day!  She consulted with an RE at Mayo Clinic in Rochester (shout out to my hometown!) and they decided that we could try one round of IUI before moving forward with surgery.  The concern is that the hormones necessary for IUI can make cysts grow even more, and the bigger the cyst the more likely it can cause complications.  For IVF they would absolutely remove the cyst first, but for IUI, mine was still small enough that one round of the hormones, they thought, wouldn't do much damage.

This meant that, since I had just started my period, we could get on track to try IUI that month (June)!  So, we scheduled the IUI for the 15th, and scheduled the cyst removal operation for July 10th (a mere 8 days before I was supposed to be the matron of honor in my best friends wedding!  Thank you again, Emily, for not freaking out when I told you!).  If the IUI worked and we conceived, we would cancel the operation, but if not then it was scheduled before I would lose insurance coverage.

So, on to the process for IUI!  I was given a prescription for Clomid, which I would take cycle days 5-9, and start ovulation kit testing on day 10.  I was supposed to call when I got a positive test kit or by day 13 to schedule a follicle tracking ultrasound (check to see if I was ovulating and if the follicle looked promising).  I was also told about the HCG trigger shot, an injection of hormones to get my body to ovulate when they wanted me to.  I figured since I had gotten positive test kits in the past (even if later in the cycle than "average") I didn't need to pre-order the HCG (it's way cheaper if you order it ahead of time).

Well, day 13 (also Saturday, June 13th, convenient!) came with no positive kit.  This didn't surprise me, as we had determined I usually ovulate later in my cycle.  However, letting the follicle grow too large can have adverse affects as well, so I went in for the ultrasound.  They found three follicles, all on my left ovary!  One was measuring large or mature, so they wanted to go forward with the HCG shot.  I, of course, thought that I knew my body well enough and that if waited just one more day, surely I would get a positive test kit tomorrow!  Dr. P compromised and said if I didn't get a positive test kit in the morning, to take the shot before 10 am, and then insemination was scheduled for Monday the 15th.

From Bad to Worse...

Well, on Monday June 1 we had our consultation with Dr. P.  We went in hopeful, but with realistic expectations based on our test results throughout the “observation month”.  It didn’t help that my period was a day late (was due on Sunday), so we were already extra hopeful.

Well, Dr. P officially declared it: unexplained infertility.  Based on our data and the time we’ve been trying, the likelihood of conceiving on our own is only 1-3%.  That was a bummer to hear, but we tried to stay positive.  She said that if I wasn’t pregnant, the recommended course of action at this point would be to start Clomid and try IUI, intrauterine insemination.  This would increase our chances up to 10–15%.  The only issue would be the cyst on my left ovary.  If it was gone, or even the same size, then we could move forward.  However, if it was bigger, then surgery would likely be required before we could start a treatment cycle, because treatment would likely make the cyst grow.

For those of you who don’t know, my birthday is coming up at the end of August, and at that point I will have to get off my parents insurance.  They have been extremely generous in allowing me to stay on their plan, and it has great coverage for infertility treatments.  I’ve met most if not all of the applicable deductibles, so we’ve been hoping that we could get pregnant before I turn 26 and we have to start a new insurance plan.  The idea of adding surgery to the schedule really threw us for a loop, so we left the appointment nervous, but still hopeful that either A) I was pregnant! Or B) the cyst was gone.

That hope literally lasted about 15 minutes past the appointment, as I got my period soon after.  However, we were still holding out hope that the cyst would be gone and we could start Clomid and try IUI.  I called the clinic that evening to set up an appointment for an ultrasound to check for the cyst the next morning.

I went in for the ultrasound feeling hopeful that the cyst would be gone.  They seemed surprised when they orginally found it that I hadn’t had pain with it, and since I still didn’t have any significant pain, I figured it was gone!  So, legs up, butt down, hello Mr. Happy Wand!

Right ovary first, looks good.  There’s a second screen that faces the bed so I can see what the NP sees.  She switches to look at the left ovary, and immediately my heart sinks.  It’s bigger.  I don’t even fully understand what I’m looking at but I can tell that compared to the right one, the left ovary is much larger, and mostly a different color.  The NP’s face drops, she knows this wasn’t the news I was hoping for.  It went from 2.75 to 3.7 cm.  She told me I could get dressed and left to see if Dr. P was available to come talk to me.

Dr. P was on call and with another patient, so the NP told me that they would call me later with next steps, but that based on our conversation the day before, it would likely need to be surgery.  I was devastated.  This wasn’t part of the plan.  Not that any of this was, not that I ever in a million years imagined we’d be unable to conceive naturally on our own, but we had come to terms with the idea of medication and insemination, but not surgery.  Surgery that would cost a lot, and push back our first treatment cycle, when we’re already feeling the pressure of time for insurance reasons.

A lot of tears were shed that morning.  I went home instead of going straight to work to talk to Kory and try to pull myself together, and I could tell he was disappointed too.  Not in me, just in the entire situation.  But he had a test to get ready for (interview process) and I had to get to work, so I dried my eyes and put on a smile.  Now we just have to wait for the phone call from Dr. P to discuss surgery.

The HSG

Before I get into the details of this particular procedure, I wanted to backtrack for one second.  Everyone knows it takes 2 to make a baby, and you'll notice that up to this point all the testing and tracking has been focused on me.  After my initial blood-work in December, and before our appointment in April, I asked Kory to set up a test for himself, since the process of testing for him is really no different than any other random afternoon he has off (besides the drop off I suppose).  He called the clinic to ask about male fertility testing, and was told he couldn't be tested until I was enrolled in their infertility program.  I couldn't believe it!  I felt that this was not only sexist, but also unfair for any man who wants to be more informed about his health!  What if a man in a same-sex relationship wanted to be tested because they wanted to have a child?  Anyhow, I digress.

The point is, they did have Kory submit a sample before my HSG, because this is a more invasive test and it makes sense to rule out any problems he may have before moving on with this procedure.  All his test results came back "within the normal range."  It did bother me that he wasn't given any specific numbers, but I plan on asking about that at our next consultation.  So with his normal results, we move on to the HSG.

HSG stands for hysterosalpingogram.  Basically, it's an X-ray of the uterus, and more importantly, the fallopian tubes.  However, fallopian tubes are, according to my radiographer, about the size of a pencil line.  Not a pencil, but a line drawn BY a pencil.  This means they're basically invisible unless you light them up, and you can't really see if they're blocked unless you have something to look for that's getting through.  So, they insert a catheter and inject dye into the uterus, then take pictures as the dye travels up the fallopian tubes and hopefully spills out into the body cavity at the ends.

When I scheduled my HSG, they told me they often recommend people take the day off, as they can experience some discomfort throughout the day.  Also, I was to report one hour early for an injection of icantrememberwhat.  I had asked the scheduler if this was something my hubby could come to, since he's trying to be very involved and for moral support, and she said it wouldn't be a problem, so Kory planned on coming.

Well, the morning of the appointment came, and Kory worked an overnight shift the night before.  He was super tired, so we decided he would sleep the extra hour that I was just waiting, then come for the actual procedure.  I got my injection, which I found out was basically a high dose of liquid Tylenol in my tookus, and was told that I should probably eat a little something before the procedure if I hadn't yet.  That would have been super nice to know before hand, because not only had I not had breakfast, I had forgotten to grab my purse.  Luckily, for some reason the main desk at the entrance of the clinic had a basket full of packets of saltines.  Score!  Kory came a few minutes before I was called (granola bar in hand for me, love that man!) and we went back.

Now, for anyone who has never been to a radiologist, their rooms are VERY different from a regular doctors.  A high, long metal table in a big room full of big equipment.  Then, we were informed that they prefer no extra people be in the room during the procedure, because they'll be moving around, I'll be moving (what?!) and they don't want to expose anyone to unnecessary radiation (which makes sense I suppose).  So poor sleep deprived Kory had to wait in the waiting room, but we told them to bring him in before discussing any results.  So, Kory specifically asked me to let readers know that if you're ever in this situation, men do not need to be at this appointment.  It's great if they have nothing else going on, but in his case, the extra sleep would have been time better spent.

So, Kory leaves, and I'm instructed to "assume the position" which any woman who's been to a gynecology appointment knows means feet in the stirrups, bottom at the edge of the table.  Only in the radiology department, they have no stirrups, so I was told to put my heels on the pieces of tape on the corners of the table.  Not really official, but effective.  The doctor inserted the speculum, then the catheter.  I told there might be some pressure, it might be uncomfortable, but I felt fine.  Hey, maybe this won't be so bad!  Maybe those woman on the Glow app don't have as high a pain tolerance as me!  Ha!  So naive...

So, speculum and catheter in place, I am instructed to "scoot" up towards the middle of the table, without moving my legs too much.  This ended up being a group effort, as the nurse pulled the sheet, the doctor held the tools, and I wiggled my way up.  Definitely one of my less dignified moments; I sure am glad I have a sense of humor and don't get embarrassed too easily.

Now I'm in the middle of the table, the X-ray is positioned over me, and the doctor starts injecting the dye.  I'm told to expect "a little pressure"...I'm OK.  "A little more pressure..." HOLY CRAP there it is!  Like the worst period cramps, but concentrated in a smaller area and sharper.  This isn't to scare anyone, just being honest, it sucked, and I was holding back tears.  It didn't take too long though, and then it was done.  Kory was brought in after I got dressed and we were told that, big surprise, everything looks normal!  Official results wouldn't be given for 72 hours, but from what he could see it all looked good.

While happy with the positive results, we couldn't help but be frustrated.  Test after test was saying everything was "normal".  Why can't we get pregnant?!  Also, lesson learned: always double check if you should eat or have an empty stomach or if it matters before going in for tests.

Health History: Part 2

December 9, 2014:  Seriously uterus?!  Still nothing?  You know, as sucky as periods are, they're kind of necessary to "reset" the cycle, the cycle that is so necessary for the creation of human life!  So, back to the lab for another pregnancy test (negative) and Progesterone challenge.

December 24, 2014: Merry Christmas, and welcome back Aunt Flo!  Fabulous timing, but at least we can get back on track with the baby-making!

I started using OPKs (ovulation predictor kits) sometime in this in-between time.  Little test strips you put in a cup of pee to tell you if you're ovulating.  Bought a big batch from Amazon, I didn't really want the publicity of buying baby-making supplies in public.  Believe me, I got over that pretty quickly too.  The frustrating part was that in these three months, the strips only really showed a positive once, which led me to believe I wasn't ovulating regularly.

April 10, 2015:  Well, they said if we weren't pregnant by now to report back.  I called and set up the appointment, and we were sent a big packet of questionnaires to each fill out.  If you're shy about your body or your sex-life, pray you're not infertile, because you have to be willing to lay it all on the table (literally and figuratively).  So, paperwork in hand we reported to the clinic.  Our (NP) Nurse Practitioner was amazing!  I was worried that she wouldn't take us seriously since we're young, healthy, and really had only been actively trying for slightly under a year, but she was so warm and caring.  She went through the different tracks we would potentially be pursuing, costs, tests, etc.  The entire meeting was a bit overwhelming (especially the financial part), and then went down to the lab, for more blood work for me.

So, tests and results: 

Blood Type: O negative

Rubella: Positive (meaning I have the anti-bodies, good for potential future babies)

Anti-mullerian Hormone:  1.7 (this test shows ovarian reserve, 1.5-4 is considered normal, 1-1.5 is considered "low-normal")

TSH: 2.00!  That's right, my TSH levels went down on their own, which is great, but at the same time means this isn't the cause of our lack of womb occupancy.  Which means no real answers.

I was instructed to continue my OPKs, and report for an ultrasound when I get a positive test, or by cycle day 16 to confirm ovulation.

April 16, 2015:  Oops, I kind of forgot about the "by cycle day 16 at the latest" part.  BUT I got a positive OPK today (cycle day 17), so off to the clinic I go!  Now, maybe this was naive of me, but when I think of ultrasounds, I think of goo on the belly and a scanner similar to a grocery store cashiers.  Nope, this was to be a trans-vaginal ultrasound.  Basically, a phallic looking wand that gets lubed up and stuck up.  Remember when I said shyness and infertility don't work?  So, I'm laying there and the NP is waving her wand around taking pictures of my ovaries.  Righty looks great, healthy sized follicle, perfect shape, she says I'll probably ovulate that night or the next morning.  A wave to the left and..."Hmmm.  Well that's...I wonder what that is.  Hmmm.  Have you had any pain or pressure on this side?"  No...(internally panicking while simultaneously telling myself to relax).  NP points to a gray blob on the screen that, to me, is no different than the rest of the gray blobs, and tells me that she's not sure what exactly it is, and she'd be asking the doctor to take a look.  Most likely a cyst, but she wants to make sure.

April 17, 2015:  I get the call, apparently it's likely a hemorrhagic cyst.  When a follicle releases the egg, sometimes it bleeds and creates this kind of cyst.  Good news was they usually heal naturally within 2 cycles.  Bad news was that if I didn't ovulate in the next cycle and we wanted to try Clomid (medicine that encourages ovulation), I couldn't go on if the cyst was still there, since the medicine would likely encourage the cyst to grow, not heal.  So, follicles don't seem the be the problem.  Let's just hope for a missed period and positive pregnancy test, then we don't have to worry about it!

April 23, 2015:  Blood-work confirms it, I ovulated!  Progesterone: 15.63.  Usually they want to see 10 or higher for an unmedicated cycle, so this was promising!

April 30, 2015:  Sup Aunt Flo.  How's it hanging?  A day early too!  We'd hate to give me even a day of false hope.  Actually, that is better than a day late.  Moving on, I guess I'll get that HSG scheduled.  Did I not mention that before?  That's the next test in line.  And it gets a whole post all its own.  So, to be continued...

Deep Breath...

I've tried to start this post a few times now, and it's funny because I'm never at a loss for words.  Seriously, ask my husband! Or my parents.  Or my sisters or my friends.  They'll all tell you that if I've got anything, it's words.  And yet here I sit, unsure how to start this story, this journey, this confession of sorts.  I suppose the best way is to start with a warning.  This blog will contain personal information about myself, my husband, our health, and our journey in trying to expand our family.  Due to the personal nature of the main topic here (fertility and baby making), some topics might make readers (friends, family) uncomfortable.  Please know that Kory will have the chance to look over every post before it's made public, and I am open to answering any and all questions!

That being said, the first couple of posts will contain our fertility journey up to this point.  If you want to join us, read on!

Health History: Part 1

September 28, 2013: Kory and I got married!  We knew we both wanted kids, preferably sooner rather than later.  We both wanted to be young parents and knew we wanted multiple children, but we also wanted some time to just be married!  We decided to postpone the baby-making for a while.  (Disclaimer - while we weren't actively trying to conceive, our birth control methods were less than stellar, and my older sister commented multiple times on her shock that we hadn't had a "surprise" miracle).

December 2013: Well that lasted long.  How fun would an anniversary baby be?  Plus it takes most healthy couples 3-12 months to conceive, and considering our lack of surprises, maybe it will take a bit longer for us?  Maybe we should just stop "preventing" and see what happens!

May 2014: I downloaded Glow, an app that tracks your cycle, fertility, provides tips for conceiving, and has a community function that allows you to ask questions, make polls, and get support from other app users.  "This should help, at least with the timing."

Please note, while our parents are incredibly loving and supportive, and we are extremely grateful for all they've done for us, we chose not to inform them of our decision to start trying.  They all thought we were still quite young and needed to be more stable in our careers before thinking about a child.  We, on the other hand, were in the mindset of "there's never a perfect time to have a baby, but people make it work with much less than we have".

September 2014: Well, obviously no anniversary baby for us.  But a trip to Chicago was a wonderful anniversary treat for us.  Just keep trying...

November 2014:  Hmmm, that's weird.  I haven't gotten my period since September 9th.  I didn't get my period at all in October.  And negative pregnancy tests ruled that option out.  And now it's mid-November, still no period.  That's it, I'm calling in the professionals!

November 26, 2014:  Dr's appointment summary: Blood-work drawn to run a pregnancy test (negative), Prolactin check, and TSH check.  Prolactin and TSH (thyroid stimulating hormone) both come from the pituitary gland and are important for fertility.  Prolactin check was normal, but my TSH level was 2.69.  For a normal healthy person, TSH should be 0.4 - 4.0, but for someone trying to conceive they want it to be below 2.5, so mine was slightly elevated.  Lack of a period (amenorrhea) is a concern if it's been three months, so I'm instructed to report back for another blood pregnancy test and a Progesterone challenge if dear Aunt Flo doesn't show by December 9th.  The Progesterone challenge just means I'd take some high doses of Progesterone to kick start my period.  I'm also told that due to my slightly higher TSH, if we don't conceive in 3-4 months, I can come back to have it checked again and potentially start further testing for the scary "I" word (infertility).

Normally Dr's won't refer young, healthy couples to a fertility clinic unless you've been trying to conceive for over a year, but due to my uncooperative uterus we get to jump-start the process!  Yay?

Did I mention I HATE having my blood drawn?  So this was fun.  Little did I know it was only the beginning.  To be continued...