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 :)

A Return to Blogging

I am risen!  Today marks a return to blogging and chronicling my & B's story as we wade through a sea of infertility during our quest to start a family together.  This blog has been conspicuously dormant for the past four months, and very quite for another six months or so before that.  I have been having a silent rebellion against blogging and sharing my feelings with the world for nearly a year, and have finally decided to open up about what has been on my mind and hopefully get back into a regular routine of blogging again.  How fitting that I should make my return on the first day of National Infertility Awareness Week (NIAW), which is recognized April 21-27, 2013.  This first returning post will be my small contribution to the movement, though my busy work engagements this week will not allow me to be much more active than this until the week is over.

My hiatus all started with some comments from friends and family which were well intentioned or at least not meant to be hurtful, but made me feel bad in a way I didn't like, so I slowly stopped sharing my feelings for a while, since so many people who know me personally also follow my blog.  If this was a completely anonymous blog and nobody knew me, I could have shared my frustrations about other people's comments on here as an outlet.  But as it is, I was finding that opening up on here was leaving me vulnerable to painful comments and so I refrained from writing for a while.

Many have been asking me in person why I don't write any more, and looking for updates on our story.  Here we are, one year out from B's surgery and many are wondering if anything has changed.  

I may choose to blog later about the specific comments that made me think twice about opening up in my blog, but only so that people can understand how truly sensitive I am about this stuff and with the hope that it will prevent them or others from making the same mistake again....  or I may just keep silent about it forever because in the end, I know that I am over-sensitive to everything revolving around babies, motherhood, and fertility and nobody with whom I've shared my blog with has anything but concern and love for me, so why would I want to call them out on something that is really my problem anyway?

But for now, I will satisfy everyone's curiosity with an update on where we are one year post-surgery:

No changes.

B had another sample analysis taken a couple months ago, and there were no improvements to any of his counts.  He's pretty much right where he was before the varicocele repair surgery.  Which honestly, wasn't a bad place then either.  He's always been right on the edge.  Always on the low end of normal, or just low enough to be right on the outside of normal.  We always knew the surgery was a shot in the dark, since his numbers did not indicate that the varicoceles were definitively what was causing our infertility, but it was the only treatment we could consider that was covered by health insurance.

With that last sample analysis, we are now pretty much just biding our time until we can try to finance IVF in 2014.  We are always aware of our infertility, but we are barely even TTC anymore, since we don't have hope that the surgery made a difference and it has been technically four and a half years of trying on our own not working (three years of purposefully/actively TTC).  After a while, you just kind of lose hope and give up.  We know our plan is to try to find a way to afford IVF early in 2014, so the end goal seems tangible, like  a light at the end of the tunnel, like the end of this torture is drawing near, and makes each month that we don't get pregnant seem like less of a big deal than it used to be.  

Sometimes.  

Other times things hurt as much as they always have and I can't pull myself out of the pain and depression of wanting what is natural and my human instinct to have, only for my body to work against me and nobody can even tell me why.  

Unexplained Infertility is the worst.

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 ;-)

Where to begin?

image from CBS news web article on teen pregnancy rates in 2011

I'm sitting in a hotel room by myself, relaxing after a long day at an academic conference.  We don't have cable at home so I'm indulging in a little TV time.  As I was flipping through the channels, I stopped on MTV's Teen Mom 2.  As it turns out, they are playing a marathon of Teen Mom 2 episodes.


I've never seen this show before.  My only exposure to it was a couple years ago in another hotel room with a group of girlfriends in our college town.  They were watching the original Teen Mom, or maybe it was Sixteen and Pregnant, I don't know.  But anyway, I was in the bathroom area getting ready to go out for the evening and wasn't really paying attention.  Suddenly, one of my girlfriends who had been trying for a couple of years to get pregnant, ran out of the hotel room crying.


I went after her, and found her in a stairway sobbing.  I tried to console her, to assure her it would happen for her someday, and even said that I understood what she was going through because my husband and I had stopped using protection two years earlier and though we were not "actively" trying for a baby, we were beginning to wonder if we too might have a problem.


Even though I told her I understood, I didn't.  I didn't get why watching a TV show about teenagers who have no business having babies would be hard for her to watch (especially because two of our girlfriends back in the hotel room were pregnant for the first time too).  I didn't get it then, but I get it now.


That was nearly two years ago now, and since then, my husband and I have been through all kinds of intrusive, embarrassing, nerve-racking, and often inconclusive tests.  We have tracked dates on the calendar, charted my temperature, checked the "stretchiness" and clarity of my bodily fluids.  I have peed on dozens of ovulation kit sticks and countless pregnancy test sticks.  Doctors have told us to have more sex, while others tell us to have less sex.  We have gone down the road of assisted reproductive technology (ART) with intrauterine insemination (IUI) and even to the brink of in vitro fertilization (IVF) and back again.  And I swear, if one more person tells me that "maybe it will happen if you just relax"...


So yes, things have changed a lot for me.  If I could go back in time and tell the old me what I know now,  I think I would have been more empathetic with my friend in that hotel stairway.  I don't know what more I could have said or done for her, but I know I would have better understood the pain she was going through.


Fortunately, my friend was able to get better medical advice after changing doctors and was able to start taking a fertility drug to help her ovulate regularly (Clomid).  After only a few cycles of taking Clomid, she became pregnant and in July 2011, gave birth to her son.


My story  does not have a similar happy ending...yet.  So far the doctors cannot definitively tell us why we are unable to conceive.  Part of me wishes that there was something that could be diagnosed and fixed so we could move forward.  I wish our problem were as simple as discovering that there was some pill one of us needs to take, and then we could enjoy our journey to parenthood the same as everyone else.  But as of now, that is not the case.  We fall into the 33% of infertile couples who are diagnosed with "unexplained" infertility.


This new blog will be a place for me to record our experiences as my husband and I navigate the sea of infertility.  It has already been a stormy ride, with many high & low waves, but so far we've been able to hold on tight to each other and together let the winds keep blowing us toward our destination, which hopefully, will be in the land of parenthood :)