phase 2, part 4

this morning was the last test of the fertility workup: the endometrial biopsy. this is, as it sounds, a procedure that is done in order to examine a sample of the uterine lining for any abnormalities, cancerous cells, etc. i made the hubby come with me for this one, because i knew it would likely be the most uncomfortable part of the process. in actuality, it wasn't as bad as i expected. the cervical biopsies i've had in the past seem worse in my memory... but maybe i've just toughened up. :)

we had a different doctor again for this test, but she was great: an older russian woman with a great bedside manner. she first did a regular ultrasound to, once again, check things out in there and take more photos of my ovaries and whatever else. then she explained the procedure to me very simply: after inserting the speculum, she'd swab me with some betadine, then put in the catheter and use a tube to suck out some of the lining for 15 seconds. she told me those 15 seconds would be the worst part but that was it. i figured i can handle anything for 15 seconds. and it all happened so fast, i didn't even realize the 15 seconds were happening until she told me we were halfway done. she made me keep talking to her, and totally distracted me. excellent technique.

then the nurse took some more blood. you know, as if i have any left in my body after the past couple of weeks. they're going to check the hormone levels again to make sure they've dropped, now that it's a week after ovulation. i asked her to take it from right arm since my left one is still bruised... now i definitely looks like the reason i've missed so much school lately is due to my crack habit.

afterwards i stayed lying down for a few minutes until the cramping subsided. it hasn't been much of anything since then, though she did tell me i'd probably have some spotting for the next day or so, and NO SEX today or tomorrow. then we had to make our appointment for the results discussion with the doctor. we had a moment of panic when we thought we might not be able to schedule it prior to our trip to turkey in two weeks, but finally we were able to get an appointment for the wednesday before we leave, march 9. that still seems like a long time away to me, but by then at least i'll know for sure if i got pregnant this try, and we'll know what's up before our vacation... for better or worse.

then the hubby took me out for a lovely brooklyn diner breakfast, and now i'm spending the rest of this rainy day on the couch, catching up on work, reading, and probably napping. not a bad friday. and there's nothing else for me to think about or do at this point other than try to ignore the two-week wait. today is day 20, so in a week or so i'll either get my period... or not.

phase 2, part 3

if you want to know the secret to making sure that sex-on-demand happens as it needs to, i'll tell you: be sick for a week beforehand (coming off of your period) so your husband is severely deprived. we had no issues last night, other than him refusing to kiss me because i have been feeling so crappy and he didn't want to be exposed to more of my germs than necessary. also yesterday and today were my ovulation days, so we had double the incentive... hopefully i will be feeling well enough for the rest of the weekend to maximize these peak fertility days!

this morning i went in for the post-coital exam, which was the easiest part of this process yet. it was even less involved than a pap smear. all they needed to do was collect some mucus. speculum in, mucus sucked up, and done! for a pop culture reference on the subject, this is where things went wrong for charlotte on "sex and the city." her cervical mucus was attacking trey's sperm. hopefully this is not the case for me.

today's doctor was much more chatty and helpful than tuesday's, so i asked her something that i'd been wondering about about next week's biopsy. on the off-chance that i do get pregnant, would it be safe for them to be poking around in there and removing part of the uterine lining? she said that people ask that question a lot, but that yes, it is safe. she also told me that she had recently read a study that showed that in cases of early pregnancy when a biopsy is done it may actually cause the embryo to form an even stronger bond during implantation. go figure! she said that a lot of women end up getting pregnant during the fertility work-up, which i've heard and read before. who knows exactly why, but it's something to stay optimistic about, i suppose.

after that i went to a lab to have the additional bloodwork done. these were tests that have to be submitted as frozen samples for whatever reason, and the doctor's office doesn't have the technology to do that. i couldn't decipher anything on the form other than figuring out that one of the tests was for lupus. so i'm guessing these are just more of the same hormonal and genetic tests that they were collecting for last week. it was another 10 vials, not terrible.

so that's it until a week from today: the biopsy. that's the last stage of this process other than the results meeting with the doctor. hopefully we won't have to wait too long to schedule that. this has felt like a long process already.

phase 2, part 2

this morning i went in for the hysterosonography, so that the docs could get some pictures of the inside of my uterus. it wasn't too bad. in terms of discomfort, it was about the same as the hysterosalpingogram (the test that made sure my fallopian tubes were open and the ovaries were working correctly), and even a little less weird than that one since there were no balloons involved. they did the procedure in a regular exam room. first the doctor did a regular sonogram to get the lay of the land, and then she used a speculum and a catheter to inject a bunch of iodine-saline solution into my uterus. that felt crampy and weird, but not awful. then she did another sonogram, after the solution made it easier to see the actual surface of the uterus. i tried to watch on the monitor but it made me a little queasy watching the liquid slosh around in there. she snapped some photos and that was that.

now, this was not the fertility doctor that we met with before, just another doctor that i didn't know until today. so i'll cut her a little slack, i guess... but she left just saying that they'd go over the results with me at our "results appointment" that happens once all of the tests and procedures are done. after she was gone, the nurse told me to lie down for a few minutes to make sure i felt okay, and pointed to the monitor to show me the polyp they'd found. why on earth the doctor didn't share that nugget of information with me, i have no idea. i asked the nurse what that meant and she said sometimes they like to take them out, so they might want to do that, but i'd have to wait to see what the doctor said at my follow-up. but heck, at least she mentioned it. she was also super nice and made sure i wasn't dizzy before i sat up. she even smirked a little when she reminded me about the procedures required for my post-coital test this friday, and said she'd see me then. i appreciated that.

so i've done a little reading about polyps and what i know is that the experts don't even know that much about them. they're growths of cells that are attached to the walls of the uterus, caused by an overgrowth of cells in the lining. any time i hear about cells overproducing of course i think cancer, and apparently it's normal to test them and make sure that they're not cancerous. i suppose the endometrial biopsy that i'm having next week will also test for this. it seems that polyps can be caused by hormone issues, usually only occur in women in the 40s and 50s (ha! or... sigh), and may or may not affect fertility. Some studies have shown that removing the polyps has led to increased fertility in some women, so that's a bonus. it seems there are a couple of ways to deal with them and it doesn't sound awful... my guess is that if there's any chance it might help us conceive i'll have it done. details here: http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=tests-and-diagnosis

so now -- with the memory of the fertility doctor talking about the possibility of prematurely aging eggs -- i'm having visions of my prematurely aging body experiencing early menopausal hormonal shifts and rebelling against ever getting pregnant. but i suppose there's not much to do but wait and see once all the results are in and the doctor has a chance to look over everything and come to some conclusions.

oh, and i have to go for more bloodwork. apparently they need some "frozen" samples and the fertility place doesn't do frozen samples, so i have to go to a lab to have it done... another 10 vials. i think i will go on friday after the post-coital exam, since that doesn't seem like it will be anything much and i'm going to be late to work anyway. as for today, i'm now at work so should probably try to ignore the slight cramps and iodine-saline solution discharging from my body and get some stuff done.

Phase 2

today my Full Fertility Work-up officially began. yes, that means i -- once again -- am not pregnant. and i have to say that this one hit me harder than it has in awhile... possibly the worst yet. but after i spent a good portion of yesterday in a miserable state of mind, i had no choice but to switch gears into Phase 2 of our TTC saga. we tried it on our own, now we enlist the help of the experts. i hoped it wouldn't come to this. i know that's part of the reason i was so, so upset when i got my period yesterday. i didn't want to have to go through this next round of tests and procedures. i would rather not run the risk that we simply have "unexplained infertility" and that we aren't able to rectify the situation easily. but what choice do i have?

i dug out the paperwork we got from the fertility institute and read that if i got my period over the weekend they just wanted me to come in first thing monday morning, so i got myself there at 7am not exactly sure what to expect. i thought i might just schedule all of the upcoming appointments, but they said they could do the bloodwork today (normally done on Day 3 of the cycle). they took 17 vials of blood, which was a bit crazy but not as bad as i worried it might be. they were testing my hormone levels (details here: http://www.fertilityplus.org/faq/hormonelevels.html#female), as well as doing some genetic tests (cystic fibrosis, i think, and something else that has slipped my mind already), and a mandatory HIV test. which makes sense, and would probably terrify me if it was my first but luckily (or unluckily, i guess) i've been tested for HIV several times in my life already. i won't get any of these results back until we have our "discussion meeting" after this whole battery of tests is done and the doc presents us with our options.

after they sucked out my blood and i had some time to rest in the waiting room, they scheduled the remaining three visits that i need to make over the next couple of weeks. since they open at 7am, i won't have to miss too much school, i'll just come in late a couple of days. next tuesday i go in for the hysterosonography, which is a sonogram that examines the uterus for any weirdness. shouldn't be too terrible. next friday is the super embarrassing post-coital test, which is not at all intrusive other than the fact that the hubby and i MUST have sex the night before so that they can make sure things are doing what they should be in the aftermath, and that kind of pressure doesn't always work well for him. but that *should* be right around ovulation time anyway, so hopefully we'll be in the groove already. and then the following friday is the one thing that i know won't be at all fun... the endometrial biopsy. i've had enough biopsies (and many in the nether regions) to know about what to expect from that procedure, and since it's a parent-teacher conference day i will just stay home after that one's over, and will have the weekend to recover.

progress always feels good, to an extent. it's certainly a brighter day than yesterday. of course i'd rather be pregnant right now. but i'm still optimistic that it can happen, and that -- one way or another -- we will be fine. i don't think i'd be handling any of this so well if it wasn't for the support system that i have. my family, friends, and co-workers and their love and understanding mean the world to me. not only does it make life brighter in general and help me to realize that even if we can't have children our lives have so much meaning, but it also helps so much to know how many people out there care for us and are sending us love and positive energy as we deal with this.

i found out this morning that my boss and his wife went through the same struggles trying to have their two daughters, and he assured me that he completely understands and that, especially in our field, "kids come first." while it might seem counterintuitive, being surrounded by so many beautiful and amazing children every day does help me to focus on the big picture. i'm making a difference in the world already. and while the fact that i don't have my own children sometimes breaks my heart, the fact that it's the one thing in life that i can honestly say is eluding me is more of a proud and grateful realization than a downer. i couldn't have a better situation in which to deal with all of this. so bring it on.

cycle 12, day 15

as the fertility window closes for this cycle, i feel confident that we did our very best.

ovulation days: 12, 13
attempts: 11 (p.m.), 13, 14

can't do much better than that. of course, it will be a long two-week wait this time, since this is one of my longer cycles. so we're looking at about a 28 or 29 days, total... meaning my period should come by the end of next weekend. hopefully the time will go quickly and i won't dwell on it too much. i haven't obsessed much these past couple of months, but given the fertility doc's optimistic stance and our diligent efforts i think i'll do a bit more anticipatory toe-tapping this time around. the hubby, too... which is cute. he's been very conscious of my cycle and asked a lot of questions about how everything works. things i feel like i've explained to him before, but whatever. it's nice to see how much he's bought into the process now, rather than just being dragged along with my "i'm getting old!" freak-out. my therapist says all of this matters in the grand scheme of things. it's hard for me to believe that there's truth in that, but she in convinced that if we both weren't ready, it wasn't the time. and we're better than we've been in years... maybe, ever, honestly. if nothing else, it makes the struggle easier to handle. and so... we wait. but together! which is progress. :)

cycle 12, day 9: blessings from the medical profession

it's sad that i've forgotten that doctors are supposed to be helpful and a good use of our time rather than a necessary hassle. i have come to think of my ob/gyn as a freak of nature in the medical profession, but i was reminded today that this should be the norm.

i am so glad that we (i! let me give myself credit where credit is due.) decided to see a fertility doctor. our consultation was this morning, and i realized within the first five minutes how much i was rushing to make sure that i got to say everything i needed to say before i slowly started to see that this guy wasn't pushing us out the door. this was so unlike most of my interactions with doctors in the recent past. he engaged us in conversation for over a half hour, going over both of our medical histories and our lifestyles and how we've been TTC so far. he was so helpful, and so nice, and truly seemed to want to work with us rather than just checking off some boxes on a form and shuttling us off for mindless procedures.

we shared the results of the hubby's semen analysis, and he said that from his perspective he's not seeing why it should keep us from conceiving. it seems that my ob/gyn, not being an expert in the boy stuff, may have simply looked at the percentages when he went over the initial results and didn't take into account the fact that the total sperm count is way above average (which is pretty much what the urologist and our common sense said). the fertility doc said he feels the high concentration of sperm outweighs any negatives and that even though the morphology is on the low side, he doesn't think it should matter. he said by the end of our talk that he actually doesn't think it's "male factor" infertility at all, and he's curious to see what else may be going on with me. sigh.

so get this -- even though today was scheduled as a consultation, we got to do some initial tests! i was shocked by this. when he started talking about our next steps, I assumed I'd have to make another appointment to get things rolling, but we wasted no time. after our talk, we went into an exam room where he did an ultrasound to showed us my cervix, uterus, and ovaries and explained what everything was and how it was supposed to look. everything looked perfect. he said the ultrasound allowed him to see that there wasn't any obvious endometriosis, but that may be something we'd have to revisit later. he also did some cultures; i'm not exactly sure what they were all for, but i'm guessing they may have been STD-infection kind of tests. which i know i've been tested for in the past, but it doesn't hurt, i guess. and then he prescribed me some prenatal vitamins and folic acid, and wants me to get some other vitamins that will improve my egg quality. whew.

this week is ovulation, so he wants us to "try our best!" (obviously) and if we aren't successful, we start a "full fertility workup" when i get my period (probably around the beginning of february). the workup normally includes a couple of things we've already had done (the semen analysis and the hysterosalpingogram), so we won't repeat those. but we will do a bunch of other things. it looks like this:

1. 3rd day of period i have a blood test... a big one. 17 vials of blood, they said. yikes.

2. soon thereafter: i have a hysterosonography, which checks the uterine lining for polyps and fibroids.

3. next: we have a post-coital test, which is an exam 9-12 hours after intercourse to see how my body is dealing with the sperm and such. (the hubby will likely feel a lot of pressure about that specific timeline... we might need some strategies there...)

4. when i ovulate again: i have an endometrial biopsy to check my the quality of my endometrial tissue.

5. when we have a discussion appointment to go over all of the results. all of this will happen within my next cycle... assuming we don't get pregnant this time.

but maybe we will! he was rather optimistic, which i suppose we should be. so we'll do our best this week... i should probably ovulate within the next few days. all in all, it just feels like the right thing to do to have this expert on our side and for us to stop jumping to conclusions that the internet or a pay-service lab suggests. all of these tests are totally covered by my insurance, so we can get as much information possible before we start making big decisions. maybe it will turn out that IUI is still a great option for us, but in the meantime i do not feel badly about taking our time with this most-important process. and now it's a week of "trying" to look forward to... woo hoo!

cycle 12, day 2... an update

after spending the past several days making a zillion phone calls between my ob/gyn's office and the lab to have records faxed and get details on IUI procedures, plus reading online and in books and talking to folks who have firsthand experience in such matters, it was the insurance company that finally pushed me to actually think about our current course of action. go figure.

i called aetna this morning to find out about our deductible for fertility assistance; i knew we have $5000 per calendar year once said deductible is paid, but i wanted to make sure the deductible itself wouldn't cause us to go broke. and the representative i spoke to on the phone not only spent way more time and effort than i expected in our conversation about deductibles, but also offered me some advice about the whole situation. he kept saying throughout, "i mean, i'm just telling you what i know from my position, but you can do whatever you think is best..." but, in the end, i'm listening to the insurance guy.

for those of you who have been following along, you may remember that in the fall my ob/gyn referred the hubby to this private lab that doesn't take insurance for his semen analysis. it was only $125, and my doc suggested them, so we went with it. when those results came back iffy, my doctor proceeded to refer us to a urologist for next steps. this guy also wasn't covered by insurance (not just our insurance... ANY insurance) and was considerably pricey for even a consult. at that point i looked online for urologists the hubby could see that might actually be covered, but found none. i kind of shrugged and figured that fertility stuff wasn't widely covered and that we'd just have to suck it up and do a lot of our own research. no biggie. we're good at research.

so we did. we read about the sperm dna test and knew that we wanted to have that done. since we already knew what we wanted, it made sense just to go back to the same lab. thus we've been dealing with this lab, with varied amounts of satisfaction, since then... and planned to go ahead with the IUI through them as well. this was based on one very rushed conversation that the hubby had with a urologist who works with the lab. that is the only actual medical advice we've had since the initial referral for semen analysis.

but again... i didn't think we had many other options. we knew once the deductible was paid the rest of the costs would be covered, and it just seemed like the easiest route. in truth, i wasn't thrilled about it... particularly because it felt like we were simply going about it on our own. they're a private business -- you tell them what you want and they do it. of course they have medical knowledge. i spoke to a nurse. (what she told me didn't agree with some things i'd read about IUI, but i was willing to let that slide.) but when i talked with a friend of mine who had (successful!) IUI, she mentioned some other possible issues that we might need to explore, and i started to think that having an actual doctor advising us would be really, really nice. but again, i didn't think we had that choice under my insurance plan.

i have to say now that it does seem ridiculous. i live in new york city and i have fancy university insurance. i mean... really.

which is pretty much what the aetna guy said to me today. when i asked him about the deductible, he told me that the out-of-network one was $575, which is what we'd pay going through the lab. but then he said, "i'm just curious... what's the benefit of using this lab rather than an in-network doctor?" when i told him i didn't think there were any and he asked for my zipcode, he replied, "oh... no way. you're in new york." in an instant he pulled up a list of 111 specialists covered by my medical plan all within 5 miles of my house that could provide us with the same services as the lab. 111, when i found zero! how could this be the case? well, because he knew the correct terminology to plug into the search bar for these sort of things: "reproductive endocrinology," of course. in a thousand years i never would have come up with that. THIS IS WHY I NEED MEDICAL PROFESSIONALS. even medical insurance guys know more than i do.

so in a split second of decision-making, i called one of the offices that had a website i liked and good reviews online (http://www.kofinasfertility.com/index.html), had a pleasant conversation with a woman on the phone, and scheduled a consultation for tuesday morning! the deductible for in-network doctors is only $150. AND they're real doctors! with offices in places like brooklyn, where i actually LIVE!

this means, most likely, that we won't do the insemination this cycle... because i will probably ovulate next week. but, in the end, the advantages of having a doctor to guide us through this AND saving a bunch of money will outweigh an extra month's wait time. i am feeling much more calm and confident about the whole thing now that we're not flying by the seat of our collective pants. i mean, i know we don't have all the time in the world. but we certainly have the time to be smart. right? right.