3 Years

Today is our fourth wedding anniversary.  It marks the 3-year point of our TTC journey.

Something that I find even more shocking, is that I just realized that this day also marks over 5 1/2 years of suffering from infertility... even if we didn't realize it until we were a couple years into it. But it's the number our doctors really care about.

You see, we went off of birth control due to other health-related issues for me in September 2008.  That was nine months before our June 2009 wedding.  We tried to be careful *most* months, using condoms or abstaining when we thought I might be ovulating, but back then I didn't keep a calendar or chart temps or anything.  And some months we honestly didn't care and went for it anyway.  Back then we thought we were lucky that we didn't have any oopsies before our wedding.

Beginning on our honeymoon, we decided we wouldn't start "trying" yet, but we also wouldn't try to prevent.  So we just did whatever we wanted and let whatever happened happen.  A year went by as I finished up grad school and again, we figured we must have just been lucky, since we still had not gotten pregnant before we were completely ready.

Where the three-year-mark begins:

By our first wedding anniversary, in June 2010, I had graduated from grad school, was interviewing for my first real professional job, and we knew the time was finally right.  We'd been together for seven years, been through a lot of milestones together, and everything had finally fallen into place for us.  We were officially ready for the next step, we were going to start our family!  Although even then, I distinctly remember B voicing a faint concern that was beginning to creep into his mind.... why hadn't we gotten pregnant by "accident" yet?  We hoped nothing was actually wrong and we really were "just lucky."

I remember being so excited, I started buying all kinds of books about what to expect before you're expecting, I downloaded an app for my smartphone to track my cycle, I even bought ovulation kits and pregnancy test kits.  I think I also bought my first basal body temperature thermometer at this time, having heard you were supposed to chart your temp but at the time not fully understanding why.

Nearly six months passed, and we were still not pregnant.  I needed to have my yearly exam anyway, so I figured I'd ask what steps should be taken to get us checked out just in case, since several of my friends and acquaintances had been suffering from various forms of infertility.

My OBGYN recommended we start with B getting tested first.    In January of 2011 he did and we got our first analysis with low numbers.  We tested again in April, same.  I started getting all my tests done, everything checked out until the HSG... those results came back with a blockage.

We got a second opinion with a urologist specializing in male infertility.  He did a special test on B's sample to check for sperm defragmentation.  Like all his other counts, they came back on the low-end of the normal range.  That cost us $400 out of pocket.

The new doc wanted me to get a second HSG, I did in July and they were able to break through the block this time.  He suggested we give it a couple months.  Nothing.  In October we did our first IUI.  It didn't work.  We wasted $1300 this time.

Our doctor recommended another IUI, I read on my health insurance website that we could get IVF for $5000 down in Illinois, and a friend's sister was able to gather free meds for me.  We thought we'd go for it, rather than doing a few rounds of IUI which would add up to the same amount quickly anyway.  You can read about what happened with that here.

When we decided not to do IVF in January 2012, we decided to do one more IUI in case B's counts improved at all post-wash this time.  In February we did an IUI cycle, but B's post-wash count came back so low this time, they couldn't even in good faith recommend we proceed with the procedure.  $900 wasted.

The urologist suggested varicocele repair surgery to see if it improved B's counts.  He agreed to the procedure and went under the knife in April 2012.  His counts did not significantly improve by the three or nine month marks post-surgery.  At least our health insurance covered this one.

Here we are, over a year past his surgery, and exactly three years past our official TTC date, and well over five & a half years of unprotected sex and still no baby.  Still no hope for improving our situation naturally.  Just waiting.  Planning for IVF next year.  Sitting alone together in the empty house we bought last year with plenty of room to grow our family.

But at least we are together.  And this is our four-year wedding anniversary.  We do have a lot to celebrate today, and we will.  But I just wanted to take these few minutes first to pay respect to everything we have been through together the last 3-5 years.  The strength it has taken for us to face these difficulties is something to be honored and celebrated too.  So today, we really do have a lot to celebrate.  And hopefully next year at this time, we will have even more to celebrate and plan for, especially if the IVF early in 2014 works and we have the baby of our dreams on the way :)

What the heck are varicoceles?

A varicocele (VAR-ih-koe-seel) is a dilation of the veins that drain the testis, known as the pampiniform plexus. A varicocele is similar to a varicose vein that can occur in your leg.

As it turns out, varicoceles are present in approximately 15% of the general male population. They account for up to 40% of male factor infertility, yet nearly two-thirds of men with varicoceles are fertile... so could varicoceles be causing mine & B's infertility?

The answer I've been able to come with so far is "maybe."

Causes

Varicoceles are typically not noticed until after puberty because testicular blood flow remains low prior to that and so these veins do not become apparent until adolescence when blood flow increases.  However many are not detected until a man is evaluated for fertility problems later in life. 

It's not certain what causes varicoceles, but many experts believe a varicocele forms when the valves inside the veins in the spermatic cord prevent your blood from flowing properly. The resulting backup causes the veins to widen (dilate). 

Varicoceles usually occur on the left side, most likely because of the position of the left testicular vein. However, a varicocele in one testicle can affect sperm production in both testicles. 

Our doctor, Dr. Jay Sandlow (I like to refer to him as "Dr. J"), published an article called, "Do varicoceles really affect male fertility?" in Sexuality, Reproduction & Menopause, arguing that it is not the valve that is the issue, so much as the anatomy of the entire drainage system that plays a major role in the the development of varicoceles.

"Because the left side drains into a system with higher resistance (the renal vein), small venules may persist or open during embryogenesis." - Jay Sandlow

Don't ask me what that means... after looking up definitions for venules and embryogenesis, I think it means the way a man's anatomy is formed while still a fetus determines whether he'll have varicoceles, though they aren't detected until after puberty when things really start flowing down there.  Maybe I should ask Dr. J if I understand that correctly though :)

How can they affect fertility?

In cases of where men who have varicoceles happen to be experiencing infertility, varicoceles are thought to cause spermatogenic defects by raising the intratesticular temperature in both the affected and the adjacent testes. However, not all varicoceles affect sperm production, which explains why not all men with varicoceles (in fact, most of them), are fertile.

Diagnosis


When varicoceles are suspected of causing infertility, abnormalities in all of the seminal parameters are usually present.  However, they can also cause isolated defects in sperm count, motility, morphology, or function.  Therefore, according to the article written by Dr. J mentioned above, the results of semen analysis are not a good predictor of the presence or absence of varicoceles.  And so, they are typically diagnosed by physical examination.  Most experts agree that the only varicoceles to worry about are the ones that can be detected by physical examination, though ultrasound can be used to identify them as well.


In our case...


B's were visible right away upon physical examination, and he has them on both sides.  We discovered this back in April 2011, but because the results of his seminal parameters testing were all coming back within the range of normal fairly consistently, Dr. J instructed us to first continue trying naturally for 4-6 months, with timed intercourse (only every other day during the fertile period of my cycle).  


That brought us to September, when we did our first IUI, which failed.  That's also when we learned how low B's "good sperm" counts were post-washing.  It was at that time that Dr. J recommended doing one more IUI, and if the numbers came back that low again post-wash, then he would recommend varicocele repair surgery as our next course of action.


We attempted an IUI earlier this month (February 2012) and his count came back lower than last time, so in effort to save money, we didn't even go through with it.  I was on clomid that cycle for the IUI, so there could have been a chance of increased fertility for us naturally... but I got my period Wednesday night so [sigh] that's disappointing.


So we scheduled the surgery for early April.  I'll post more soon about what that entails and what the success rates are.

Why Even Bother Washing Sperm?

The title of this post, "Why even bother washing sperm?" is what we asked our medical professionals after getting the results of B's post-wash counts this morning.  Before the wash, he had 11 million of the little guys, they say 20 million is normal, but this wasn't a bad number to start with.  Post wash though, we only had 3 million good ones left.  So we wondered, why even bother washing them when you lose so much, why not just put it all up in there and let the good ones fend for themselves.


Turns out their are two reasons according to our urologist's assistant:


1.) We really don't want the dead, slow, or "just jiggling" sperm up in there anyway.  They may have DNA fragmentation or chromosomal abnormalities.  If we'd had intercourse, they wouldn't have made it up into my cervix, that close to the about-to-be released egg(s).  We only want the best of the best to make it in there.


2.) If they put unwashed semen directly in my cervix, it would cause MAJOR pain and cramping. A woman's body creates all kinds of defenses for us. Outside the cervix, special chemicals dissolve the semen around the sperm so that only the sperm gets inside the cervix.  Semen isn't meant to be inside the cervix.  We do want the sperm put directly in there though, because that's what improves our chances of them meeting my egg(s).


So here's how it went down this morning: we had 11 million sperm total.  Of those, 3 million were dead, slow, or "just jiggling," but 8 million appeared to be moving around pretty fast.  Not a bad number.  After the wash, only 3 million made it through the obstacles of washing.  Only 3 million were actually good enough to make through an IUI procedure.  They want a minimum of 5 million good sperm post wash.


Last time we had 4.3 million and felt we were close enough to their minimum to go ahead with the procedure... and it didn't work.  This time we were even less than last time.


If we decided not to do the IUI with such a low count, we'd lose this month.  We had already done the u/s this morning, so we'd have to pay $400 for that, but we'd get $900 back of the $1300 back that we'd paid for the entire package if we cancel the IUI.


We cancelled it.


In the back of our minds, we always knew that the reason we were doing this IUI was to see if B's counts come out as low as they did last time.  If that was just a fluke, then trying more conservative methods such as IUI's would be a better choice for us then jumping to IVF (which we had been all set to do last month... see the navigation bar above for details on what happened).


But if his counts came out low again, then B's Urologist, Dr. Jay (as I like to call him), recommended varicocele repair surgery for us.


I'll post another day about what varicocele's are and what the surgery will all entail.  Right now I'm still just kind of absorbing the fact that we aren't doing the IUI today.  I know we were mostly doing it to see if his counts would be low again, but I had to go into it thinking we were going to have a chance at getting pregnant because otherwise, without optimism, there would be no chance whatsoever of conceiving.  Not to mention how awful the stress of going through all of this for no reason/without hope would be.


The other thing I'm trying to process is that we may now have just transitioned from the category of unexplained infertility to male factor infertility.  


I always wondered if it would feel worse to have a diagnosis, or if I was correct in feeling that unexplained is worse.  So far, I think I was right. At least if you have a diagnosis, there might be some action you can take to try and fix the problem, which for us, may be this surgery.  Even if you had a problem that couldn't be fixed, at least you'd know that and not torture yourself every month trying all kinds of things in vain, or suffering through the two week wait (2ww) month after month. No, you could move on.  You could move on to more extreme ART treatments such as IVF, or move on toward acceptance of adoption or a childless life.  But not knowing always keeps you stuck in limbo!


So it's only been a few hours since I received all this new information, but so far it feels a little disappointing, very surprising, and a little bit motivating.  As my RE pointed out as I walked out of his office this morning, we have a plan of action again now.  And having some sense of control in all this is one of the biggest thing that infertiles struggle with.  So I'm excited to have a little bit of that again.  For now anyway ;-)

Everything will now come your way

I just took a break from blogging to eat lunch: leftover Chinese food from last night, some delicious homestyle tofu to be exact.  I treated myself to a fortune cookie with my meal, and the fortune I received is pictured above.


"Everything will now come your way."  This is could be taken several ways.  Maybe it means that today's appointment was productive and we will be getting pregnant and having a baby soon.  Or, maybe, it means everything bad will come tumbling down upon us.  They always say, "When it rains, it pours."


So this morning B and I got up early and went to the RE's office.  We had seen a picture online of a sign that one fertility clinic had posted in their room where men "collect their samples."  The sign that apologized if some clients were uncomfortable or offended by the pornographic videos in the cupboard next to the TV & DVD player, but that some men produced better "samples" if sexually aroused, and that they [the clinic] were willing to help them do what ever that took [including providing porn].  So, this time, instead of sending B to awkwardly go into the clinic to do his business by himself in a little room off of a busy hallway where he could hear everyone talking right outside the door...I went along to make him feel more comfortable in effort to maximize our chances of success.  Sorry if that's TMI.


We thought we'd be in and out of there within 15-20 minutes, half an hour max.  While we were there, I mentioned my concerns about the results of the OPK testing yesterday.  The nurse ushered us into a consultation room to talk about what our options were.


It was so funny, as we tried to explain what was going on and what our concerns were, nurses, receptionists, assistants, students, and the doctor himself kept revolving in and out of that consultation room to talk to us.  It was like a clown car in that tiny room!


The issue is this: if we got a false positive, then it might be too early to do the IUI today. Today is only cycle day 12.  I usually get the positive with the OPK between days 14-16.  So this is early.  But on our first IUI, I got the positive result on day 12 too.  However, last time, we had paid for the package that included ultrasounds (u/s).  That package is $1300.


When I met with my RE last month to talk about our action plan for this IUI, he had said that everything went so well last time with the u/s monitoring, that we wouldn't need to do it this time.  Doing an IUI cycle without u/s is only $800.  So that's what we planned to do.  Since we'd be saving $500, we would be able afford to do another IUI later this year if we needed to, and would only need to come up with an extra $300.  You see, we'd put $1300 into our flex spending account for the year (originally thinking we'd need that much just for one IUI), so we have to spend that much on medical expenses anyway. Why not spend a little bit more and take two good cracks at making a baby this year instead of just one?


So now that we are wondering if the OPK positive was accurate, the best way to solve that mystery was to do an ultrasound.  I mentioned earlier that I got the postive LH surge on the OPK on cycle day 12 with the IUI last time, just like I did this time.  However, last time, I went in for an u/s the next day and my RE decided that my follicles were to small, so we waited another two days before doing a second u/s.  That's when he decided they were big enough and we did the IUI.  If we would have done it when I first got the positive OPK results, it would have been way to early.  This is why we were so torn about whether it would be better to trust the OPK this time around, or to do an ultrasound and get more detailed information about how close my body is to ovulating.


If we do an u/s now, we'd have to pay for the more expensive package ($1300), and then we couldn't afford to do a second IUI later this year if we need to.  But if we don't do the u/s, and we blindly go ahead with the IUI today, trusting the OPK results from yesterday, then we might be doing it too early and the sperm wouldn't survive in my body long enough to meet my egg(s) when I ovulate.  We'd be wasting $800.


Finally, the RE came in and flat out recommended that we do the u/s because he too was concerned about the results of my OPK.  So that settled it.


By this time it was nearly 9:30am.  We'd been there over an hour, and B had to get to work for a meeting he couldn't miss.  I told him to go, and I'd stay to get the u/s and then catch a cab home.


As they guided me into the exam room, one of the nurses said that they were going to try to move up my IUI from 2:15pm to earlier this morning, as soon as B's sample was done being processed (about another hour)!  That was a huge relief because last night I was so nervous about B's swimmers surviving for almost 6 hours before they performed the procedure on me!


The u/s went well.  On my left side I had a large follicle which was almost ready to release.  On the right, there was a second smaller one that needed a few more days.  Last time I'd had two on the same side, so this was different, and for whatever reason I was feeling kind of good about that.


My RE decided that he was still uneasy about my OPK results, even after the u/s, and wanted to test my progesterone and FSH levels in a blood test.  So they drew some blood and told me as soon as we had the labwork back and got the results of B's post-wash counts, we could do the IUI & I could go home.


I went and got some breakfast in the cafeteria while I was waiting for all these results.  I selected a hard-boiled egg (not vegan, but I wanted protein), a whole grain scone, and a small fruit cup.  I got a soy chai too, but only took a few sips because I decided I didn't want to drink caffeine before the IUI.


When I finished my little breakfast, I walked back over to the reproductive medicine clinic to check on the results of my pending tests.  They led me into a consultation room before they'd say anything... "this can't be good," I thought to myself.


The bloodwork wasn't back yet, but it didn't even matter.  B's post wash count was even lower than last time.

I was shocked.


We had done everything we could think of the last four months to improve our chances.  When they analyzed this "sample" before the wash his numbers were good.  Only 11 million total, but they had still said that was a decent volume for this procedure. So what happened?


Again, this post is getting too long and the next segment of the saga is pretty detailed too so I'll save it for yet another separate post.  Stay tuned for more!


To be continued... again

Nothing Like Peeing on a Stick in the Bathroom at Work

What a roller coaster the last two weeks have been... again.


First off, let me clarify that the stick pictured above and the kind that I was peeing on in the bathroom at work yesterday are ovulation predictor kits, not pregnancy tests.


B and I had scheduled another IUI for this month.  On day one of my period, I had to call my RE back here in WI and let them know I was menstruating.  His nurse sent my Clomid prescription to my pharmacy and told me to take a pregnancy test before taking the medication on days 3-7 of my cycle.  


I had met with my RE right after returning from Dallas last month to ask about using my two Gonal-F pens left over from our cancelled IVF cycle, but that would cost us around $3500 per cycle and B and I only set aside $1300 for a regular Clomid cycle with ultrasound monitoring.  So, not only would using injectables be much more expensive for us, it has huge risks of high-order multiples.  I mean, we're talking like Octomom here.  Those pregnancies are very high risk for the mother and babies, and if you choose to reduce (terminate) the number of fetuses, you risk miscarrying all of them.  So that's not the best option for us at this time.


On day 3 of my cycle I took a pregnancy test (knowing the answer since my period was getting heavier, not lighter), and that night I started taking 50mg a day of Clomid for 5 days.


I'm wondering, what dosage of Clomid my readers have taken?  I know 50mg is the lightest dosage you can get.  But during our last IUI it got me two good sized follicles, so that's exactly where the doctor wants me.  Also, at that dosage, it didn't effect the lining of my uterine wall, which Clomid can do, so this is a good amount for my body.


I felt very bloated all week while taking the Clomid, and actually did gain a few pounds, I wonder if any of my readers noticed weight gain while taking Clomid?


On cycle day 10 I began testing with my OPK.  My RE said to test once a day, preferably mid to late morning after having not peed for four hours.  The kit's instructions will tell you to pee with your first morning's urine, but the doctor feels that the concentration hasn't had enough time to build up by then, so later in the day is better.  I told him that I usually test at least twice a day anyway.  He told me I don't need to do that, but I told him I always do it so I don't miss the LH surge.  He said that's my choice, but if I get a positive surge in the morning, we'd schedule the IUI the next day, and if I get it in the evening, we'd do it the day after the next day.  Whatever you say doc.


Cycle day 10 was Monday, so I was testing with my first morning's urine (just in case) as soon as I woke up all week.  Then I would hold my bladder all morning along and at around lunch time, sneak into the most private bathroom I could find at work and test again (that's where the title of this post comes in).  Then, I'd  test again when I got home from work or before bed, depending on how often I'd relieved my bladder in the 3-4 hours prior.


Yesterday was Wednesday, and I got a negative result in the morning.  I had back to back meetings all day from 9am-4pm, to the extent that I hardly had  time to pee in-between meetings, let alone sit around waiting for OPK test results.  So, I did pee on a stick, but then shoved the tester in my drawer in my office with the stick still in it.  An hour later, when I had a chance to sneak into my office before another meeting started, I looked at it.  It was blank, which is usual with the digital tests, after a while the results disappear because the tester kind of "turns off."  I pressed the eject button to release the tester and, as has happened for me in past experiences, the last test result displayed on the screen.  It was a smiley face!  I had a positive result!


I kind of didn't trust that because I hadn't seen it in real time, so I didn't pee all afternoon and at 4pm snuck back into the bathroom at work to test again. Unfortunately, the tester was malfunctioning and the smiley face wouldn't go away.  I couldn't test with it and didn't have a spare, but had to pee REALLY bad, so I just went to the bathroom and figured I would hold my pee all evening and test again with my other tester when I got home, at around 7pm.


In the meantime I scheduled our IUI appointments for today.  B had to go in as early as possible because he had important meetings later in the morning at work that he couldn't miss, so the scheduled him to give his "sample" at 8:30am.  But they couldn't get me in until 2:15!  I was kind of freaking out that his swimmers wouldn't be as good if they had to wait around all day, but the receptionist assured me it would be fine.


When I tested last night after work with my other tester, there was no smiley face...


That made me question the validity of the test I'd taken at noon and not looked at the results of for an hour, so I thought I'd better say something at our appointment in the morning.


The results of that conversation and the appointment in general are complicated enough to warrant a separate post, so stay tuned for the rest of the story coming soon!


To be continued...

It's officially over

That's it, it's over.  Yesterday was the deadline for taking advantage of the health insurance program's offer to honor their misprinted rate of only $5600 for a fresh cycle of IVF.  It still kind of hurts to actually type out those words.  What a horrible missed opportunity.


I do feel like I have some closure now, because there is no option to change our minds and make it happen and go for it after all.  That time has passed, now we just have to move forward and accept our decision.


I marked the occasion by contacting my RE down in IL to tell her our decision finally.  It was through email, so no response yet, but what can I really expect her to say?  What can I expect anyone to say?


I contacted my local RE too to ask him why I can't use my Gonal-F pens for the IUI I'm doing in a couple of weeks.  My infertility angel friend (my friend's sister) told me she had used these kinds of injectables for some of the IUI's she had done before moving on to IVF.  Why should I waste ANOTHER opportunity when I have these expensive medications that were given to me for free?


He wants me  to use Clomid again.  Clomid doesn't do sh*t.  I used it for my first IUI and only got 2 follicles from it.  Of course I had the lowest dosage, but still.  Come on.  My friends on the Baby Center Forum who are all doing their IVF's right now are getting like 18 or more follicles from the injectables!  We'll see what he comes back with for a response (this was an email too).


I shouldn't say that about the Clomid either.  Two of my very close friends took Clomid, which regulated their cycles & ovulation and they were able to conceive naturally fairly quickly because of it.  One of them just gave birth two beautiful twin boys not too long ago!  The other one, not only did she get pregnant with her beautiful son because of Clomid, but her brother and his wife also took it and got pregnant with twins as well.  So Clomid definitely can work wonders and is a miracle drug for some... just not me.  Besides, ovulating isn't my problem, I do it like clockwork.  Like I've said before, I *wish* I could just take a simple pill and solve the problem behind our infertility issues.  But for us it is not going to be that simple, mostly because they can't find anything that is obviously causing the problem in the first place.


If my WI RE has a good reason why he won't use the Gonal-F with me, I'll donate them to the clinic down in IL.  The nurse there, Lucia, is another angel who collects unused leftover meds  for women in need.  She's the one who called me last Tuesday saying she had something for me.  Unfortunately it still wasn't enough though and I asked her to pass it along to another couple in need.  If I donate the rest of what I already have, maybe it will be like a good karma effect or something and when our time comes around again, someone will do the same for us.