Neg. Sorry

I found out yesterday (via text of all ways) that this cycle didn't work. I did the blood test a day early (13dpIUI), because I began spotting on Friday (12dpIUI) and had a feeling that the only thing holding off another cycle was the Prometrium I was taking nightly.

A few hours after I gave blood, I texted the on-call nurse to give her a head's up to look for my results and asked her to CALL ME once she received them. You know what she freaking did....she texted me back within 2 seconds saying "Neg. Sorry" That is how you freaking tell someone that they aren't pregnant?!

Completely unacceptable if you ask me. Can you at least spell out the whole word NEGATIVE and maybe add "I'm so very sorry" or something?! It's actually possible to convey a heartfelt tone via text, but clearly she is not well versed in this. Just "Neg. Sorry"?! A whole 1.5 words? Really???

I understand that I texted her in the first place, but I chose to do that instead of paging her to provide my full name in writing BEFORE her call back to me; Just thought it might be helpful when she was looking for my results to call me back with. Furthermore, I specifically asked her to CALL ME with the results, because I also had questions regarding using a new medication for our FET (Delestrogen shots) and the immediacy of ordering this since estrogen for FET's starts on CD2, and clearly my period was trying to make an appearance already.

Of course, I called her immediately with my questions and let her know that "I figured I would call rather than play text tag and receive two word responses, especially since this is a somewhat sensitive subject." Is it just me? Am I over reacting? Her "Neg. Sorry" just put a reeeally bad taste in our mouths. Even my husband was annoyed. She apologized for the lack of tact and brevity of her text, but come on. Use your head and think before you text a woman who's spent $25K on fertility treatments this year and still no baby!

Just because I have a medical file 4 inches thick and have been around the block with treatments, it doesn't mean I don't deserve a little compassion when delivering the blow of another negative result. I normally have nothing but good things to say about my fertility clinic, but every once in a while a nurse does something really f'ing stupid, and this warrants a complaint to my RE (who also happens to own the clinic) as far as I'm concerned. He is not going to be happy about it either I have a feeling. This man calls every patient personally after IVF cycle results and will spend a full hour on the phone with you discussing next steps. I'm pretty sure he expects a little more than a "Neg. Sorry" text from his on-call nurse. Ok, I'm done venting now, but it still is kind of shocking to me. Wow, just wow.

Not to worry though, I am ok. There were zero tears. I was probably too pissed off at the nurse to shed a tear, but hey whatever works to get you through the tough times right. We went out to dinner and split a big fat order of chicken fajitas on fluffy white gluten filled soft tortillas. Man, I'd forgotten how good things with flour taste! Ha! I'd also forgotten how yummy the occasional serving of ice cold dairy tastes in the form of Breyer's vanilla bean on top of freshly baked chocolate chip cookies...until today that is!

The past 24 hours have been a fun little hoorah complete with food porn. These cookies are awesome by the way, if you are a fellow GF eater. I'm not going to say they are "healthy" but they have none of the typical unhealthy ingredients like HFCS, hydrogenated oils, etc. and are a better option as far as pre-made cookie dough goes.

Christmas decor is also up, and we are happily enjoying a little holiday cheer...

I actually put this up last week after a sub job which really tested my resolve. I got to listen to a 17 year old brag about her pregnancy and show off sonogram pics for literally ALL of the 1.5 hours I had her in class. Well, outside of the time she spent eating some nitrate filled cold cut Lunchables, a box of Hot Tamale candies, and a rice krispie treat, washing it all down with a Starbucks mocha latte. Nope, I'm not bitter....not bitter at all!

I am working on being non-judgemental towards people who treat their bodies like complete garbage and seem to get knocked up without even trying. It's just really hard when you treat your body like a damn temple 99% of the time in hopes that it could somehow help prepare your body for pregnancy. I certainly wouldn't want to trade places with this very young mother-to-be, but I will never ever be carefree about pregnancy with all we've been through, and that is just a hard pill to swallow. I also couldn't help but think how teenage pregnancy was NOT something to be proud of when I was in school. Oh how times have clearly changed. I think we have MTV's Teen Mom to thank for that.

I took the next day off of work and decorated all day long to force some holiday cheer into our lives. Somehow things are just a little bit better when you come home to Christmas lights. I'm actually enjoying subbing overall and am scheduled for another high school job tomorrow. However, this is an AP class of 10th graders, so I'm fairly certain it will be a pregnancy free day...let's at least hope so.

I assume a new cycle will start tomorrow, which means baseline ultrasound will most likely be Tuesday/Wednesday. I am requesting the use of Delestrogen shots this time around for my lovely yet stubborn lining. I may even request PIO shots in place of Crinone for the progesterone support portion of this FET. I know Crinone is supposed to be equally as effective, but I don't want to keep trying the same things and expect a different result. Obviously, the Estradiol/Crinone combo hasn't worked thus far, and this will be our 4th IVF transfer. Besides, that is how tired I am of putting random meds in my vag. You know you are officially OVER IT when you are actually willing to choose imtramuscular injections via a huge ass needle over putting one more dose of anything inside your lady parts.

So, there you have it folks. We're cleaning out the freezer on this one. Last two embryos and one more shot at this IVF thing.

Reminders

No matter where I turn lately, I see these....reminders of how good we actually have it.
A couple weeks ago, a friend was over and asked innocently, "So whatcha guys doing for the holidays?" You know what my response was? "FUCK the holidays." Yep, it flew right out of my mouth just like that. Wow Emily...Tell us how you really feel!

In my defense, we had just left an outdoor restaurant and as we waited for the check, I sat watching a beautiful family of 3 generations of women having a great evening together...the cutest blonde little sisters playing on an outdoor playground, the mother taking pics of every little move they made, and the grandma with the biggest smile I have ever seen in my life.

I tried my best to see this as the beautiful spectacle is actually was, but inside I was pissed....not only that we don't have our own children, but also that I don't have a mother and my children will never know their grandmother.  What was a perfect dinner at our favorite restaurant, turned into a stream of tears as we paid our check. I pouted all the way to our car and then home to our empty house with non-existent family. I proceeded to drink a ridiculous amount of white wine, because why not? I'm not pregnant! This was a fact reaffirmed loud and clear throughout the evening by my horrendous menstrual cramps as well. I was having a serious case of "The grass is greener."

The real truth? The grass isn't always greener. I am being reminded lately that even when we see what might seem like the "perfect life"  we have no idea what obstacles people may be facing. Everyone gets dealt their own set of circumstances, and I have always kind of felt like infertility is just "our thing" that we've been given to deal with. Outside of infertility, we shouldn't complain. I have the MOST amazing husband in the world. He has a good job with a great deal of autonomy. I have a job where I can choose my own schedule, drive less than a mile to work, and have zero responsibility outside of work hours. We have a beautiful home, can afford healthy food, have access to medical care, and we actually wake up with smiles on our faces most days. In the whole scheme of things, we have it pretty good.

Recently, during my shift at the LIVESTRONG Foundation (where I've been volunteering for almost 5 years) I began a little project that impacted me deeply. If you aren't familiar with LIVESTRONG, feel free to watch this short and very inspiring manifesto...

I have seen that video 20 times, and it still gets me every time. Oh, and just for the record, I personally don't give a shit about Lance Armstrong's personal life or anything he's done outside of creating this amazing organization. 

But anyhoo, back to the project. Every year we hold the LIVESTRONG Challenge, which is a race that brings those affected by cancer together and raises $ for cancer programs. We have blank race bib cards that read "In Memory Of", "In Honor Of", and "I'm A Survivor." Anyone can fill these out and safety pin them to their shirts during the race.

This year, we asked people to donate their race bib cards back to us, and I was given the task of reading through ALL of them, in order to make a giant wall mosaic in our headquarter office....

Holy sobfest. Seeing people write messages to their parents is sad of course, and I know that pain all too well myself. However, the ones written to spouses and children are what really hit me where it hurts. "To Robert...my husband, my soul mate, my inspiration" Talk about a knife to the heart! I had to excuse myself and literally take a "time out" in the bathroom.  I wanted to drive home going 100 mph and just hug my husband to death.

Being exposed to this sort of heartbreak regularly is a continual reminder of how good we actually have it. To be clear, I'm not saying that infertility is any less painful emotionally than cancer. Infertility is a disease in it's own right; Full of disappointments, scary test results and procedures, medical bills, intense pain and suffering, and it can last for years on end, crushing whatever dreams you thought you had for the future. In fact, I've talked to people who've had both cancer AND infertility, and some of them say that infertility was actually harder to deal with. Does that surprise you? Honestly, it doesn't surprise me one bit.

However, how would I feel if I or my husband were handed a life threatening set of circumstances tomorrow? I've known a couple fellow bloggers who have experienced this in the midst of their struggle to conceive. Bethany at An Anchor to My Soul received news that her hubby had testicular cancer right in the middle of trying for a baby, and needless to say procreating became a little less important in the immediate future once that happened.

Just today, I was reading Jennifer's blog "You Must Believe There Are Miracles" and the story of her sister and brother-in-law. Her sister recently gave birth at 20 weeks after complications, to a premature baby who didn't survive, and her brother-in-law had to come to her hospital from a different hospital, because he was undergoing chemo and radiation for his own brain cancer at the time it all happened. I cannot even FATHOM how truly difficult this must be for them. Please stop by and give Jennifer words of love and support if you can.

One thing is for certain; When someone is dealt a second blow like cancer or unexpected tragedy, suddenly infertility doesn't seem like the end of the world anymore. All one cares about is the safety of their spouse or family member over all else.

There is a new show on Showtime called "Time of Death" that explores chronic and end stage disease...

The documentary series follows a group of 8 different people through the process of terminal illness. Please remember these people are all in very late stages of illness, so if you know someone with cancer, they certainly aren't doomed, and this is not meant to freak you out. Do not watch it if terminal illness makes you uneasy.

Maybe I'm weird, but I find this stuff therapeutic. Could be that my mom, dad, step-dad and grandmother all had cancer. It's somehow comforting to know the process of dying and grieving is very similar for most people who experience this sort of thing. Or maybe even more than that, it just gives me a healthy serving of humble pie and adjusts my world view with a clearer sense of perspective.

If you have any interest in checking it out and don't have Showtime, they were nice enough to upload the first episode on YouTube...

Every time I see something like this, in real life or on tv, it makes me even more thankful for the life I have now, even if it's not perfect according to my own plan. I wake up thanking God for all we do have a little more loudly. It's when we get comfortable and just EXPECT all of the good things we already have that our attitude begins to take a turn for the worse. Well I, for one, don't need God or the universe or fate to ask me, "You thought it was hard then? How about now?"

I don't want to be that person that only gains a better perspective once I'm handed an even harder trial to deal with.  I don't want to look back on the last 2.5 years as wasted time, living my life on complete hold, and asking myself what good I did in the world....or more importantly how many happy memories I created with my husband. I don't want November to be remembered as the month we lost two pregnancies in a row. We will be celebrating 8 wonderful years of marriage this month, and I am not going to let infertility steal that milestone from us!

In the end, if it's not in the cards to have a biological child of our own, that very hard realization will never be crushing enough to change the fact that we share a truly rare kind of love that many people do not EVER get to experience in life. That being said, I'm reeeallly going to try my best from now on to be less focused on what we don't have YET and more focused on what we do have. It can all be taken away in the blink of an eye.

So ask me again what I'm doing for the holidays? I'm going to put up my Christmas tree and enjoy it damnit! I am going to enjoy every single second being married and healthy and blessed with a life that is already fulfilling beyond words.

Reproductive Immunology Follow-Up: Eh, Not Sold

I wanted to give a follow-up to my previous blog about RI (reproductive immunology). After speaking to a doctor who practices it, some preliminary testing and extensive consideration, we've reached a verdict on whether or not it's worth pursuing in our situation. However, let me be clear that I'm only speaking to OUR personal situation and no one else's. I know there are some other ladies curious about this stuff as well. I'll share my results here so you can see what they look like.

Re-Cap: We are currently in a Femara/IUI cycle. Before this, after our 3rd IVF transfer and subsequent chemical pregnancy (our 3rd pregnancy loss) we asked our RE, Dr. Vaughn, about need for further testing and/or second opinions. He gave us his blessing to do so.

We spoke with Dr. Sher (Sher Institute for Reproductive Medicine) who felt it was worth looking into possibilities related to implantation dysfunction. He ran a couple tests through Reprosource Labs in Boston, MA.

Results: 
Expanded APA Panel- Nothing new here really. We already knew I had +APA’s (Anti-Phospholipid Antibodies). This just uncovered some additional ones I wasn’t tested for previously with my hematologist...just further confirmation of a blood clotting disorder.

Expanded APA Panel

NK Cell Activation Assay- Test showed NK (Natural Killer) cells were normal in their native state (as they are for most people) but when stimulated with Interleukin 2 (IL-2) they became abnormally elevated. (See IL-2 stim values of 11 on p.1 & 11.7 on p.2.) 

NK Cell Assay: Page 1 of 2

NK Cell Assay: Page 2 of 2

Dr. Sher’s perspective:
-Suggests using Lovenox 40 mg for entire cycle of conception, in addition to entire pregnancy. I’m already doing this anyway. I started Lovenox on CD6 this cycle. I take baby aspirin in the AM and Lovenox in PM.

-Says NK results show heightened NK cell activation with introduction of IL-2. This mimics the same reaction that will occur in my body when an embryo presents in the uterus....My overactive immune system will see any embryo as a “foreign invader” and will then attack it. This can result in infertility (by not allowing successful implantation) or early pregnancy loss (by attacking embryos once implanted).

-Says my suspected ectopic could have even occurred due to heightened NK cells in the uterus, because NK cells do not live in the fallopian tubes...Embryos may seek refuge in the tube in some cases.

-Suggests using low dose steroid such as dexamethasone or prednisone for entire cycle of conception (actually from 2 weeks before cycle begins) to lower immune response. He keeps patients on this until 10 weeks into pregnancy, weaning them off around week 8.

-Suggests doing two intralipid infusions to lower immune response; Once before conception cycle & once upon + pregnancy test. (IVIg is not being used much anymore. Intralipid is just as effective, much cheaper, safer).

-Suggests a combination of Lovenox + low dose steroid + intralipid MUST be used if I am ever to have a successful pregnancy carried to term.


My perspective:
- We have no interest in leaving our current RE at the moment. We just don’t want to spin our wheels with more losses and failures if something other than “bad embryos” or a random “tubal malfunction” is causing our issues.

-I made up my mind ahead of time that if these results came back as merely "borderline high" that I would not take too much stock in them. Conversely, if results came back with multiple values off-the- charts high, we might be more compelled to pursue further testing or a more intensive immunology based protocol for our last FET (if needed after this IUI). However, out of all NK values tested, only two (@ 11 & 11.7) came back just over the cut-off considered high (>10).

- Due to the above, I am NOT sold on the need for a protocol based heavily on experimental immunological treatments. There isn't enough evidence here to warrant my own personal need for intralipid infusions or other controversial immunological treatments such as IVIg and LIT.

-I will admit, there seem to be a few signs pointing to something autoimmune in nature amiss in my body. My hematologist told me previously “Clearly you have autoimmune activity in your body, even if it’s not full blow lupus yet.”

-Because of this, I’ve always wondered if it wouldn’t hurt to at least add a low dose steroid to our protocol. There is some medical literature showing effectiveness of steroids to lower NK cells, as well as to reduce pregnancy loss rates. My RE and I have tossed the idea of adding a low dose steroid around for a while without actually moving on it. At minimum, this is a low risk option I feel comfortable trying.

My RE's perspective (via my nurse):
-Dr. Vaughn has reviewed your questions. He is good with you taking the Lovenox and baby Aspirin.

-Dr. Vaughn and the other doctors at TFC do not do NK cell testing due to the fact the testing is not very conclusive and not enough studies to show NK cells play a role in infertility. Dr. Vaughn is not convinced this is an issue.

-Dr. Vaughn said you were on Dexamethasone for your IVF retrieval in the past and is OK with you adding a low dose steroid to your regime. He wants you to take Dexamethasone 0.5 mg 2 pills each evening.

So, there you have it. We will not be putting all of our eggs in the RI basket so to speak. We'll add a low dose steroid, but that's it. I will continue eating an anti-inflammatory diet as usual, as well as continuing to eat gluten-free & dairy-free to assist in dampening any autoimmune type of activity internally.

Am I glad I had this testing done? Yes, because there is no longer a giant ? looming over my head. Do I think some borderline high NK cells have been THE THING that have kept us from having a successful pregnancy? Not necessarily. I have to agree with my own RE on this one....not convinced. While there is some research showing a correlation between NK cells and infertility/pregnancy loss, it's just that...limited amount of correlation and not causation. If a low dose steroid could potentially squash some risks associated with an overactive immune system or pregnancy loss I'll do it, but I'm not going further than that. I have read up on this as much as humanly possible, and there isn't enough evidence in my humble opinion...and actually the opinion of most RE's out there.

Additionally, I'd like to be frank on my own limited experience. Dr. Sher himself was fairly easy to discredit in my opinion. On one hand, Dr. Sher admits that at least 70%+ of early pregnancy losses are likely due to chromosomal abnormalities. This is something that typically increases with egg age...no RE or RI refutes this. However, he then made the blanket statement... "It's clear that NK cells are THE REASON for your issues" and stated, "You will never be able to become pregnant and carry to term without intralipid, steroids, and Lovenox ALL combined." (insert eye roll here) That is just very far reaching to me, and I don't buy it. I don't think I'm in denial either. There's simply not enough proof to make that sort of claim to me or anyone else for that matter.

Do I think that some women have benefited from immunology protocols and have achieved motherhood this way? Sure. However, I am inclined to believe the number of women out there with TRUE immunological issues affecting their ability to reproduce is fairly small and that there are quite a few women pursuing RI who don't really need it. I have suspicion there are doctors capitalizing on this as a business, and that some of these doctors may care more about a dollar than the Hippocratic Oath.

Could it be that many women with infertility are in search of an "answer" and when they don't get one they turn to the only thing left they haven't tried (like RI)? In some cases, it's possible. After all, it was my own quest to find more answers which led me to Dr. Sher. Unfortunately, infertility is much like a dart game. When one thing doesn't work, we try another. It's one big ole crapshoot basically.

It's worth noting the firsthand accounts I've read through blogs; Women who have had pregnancy losses, IVF failures, years of infertility, and have pursued RI as their last resort in having their own biological child. Some of these women were told the same thing, "You will never have a baby without immunological treatment." How then, have some of them gone on to have their own biological children AFTER immunological treatments have failed?

Other women have pursued donor eggs AFTER immunological treatments have failed, and have gone on to have successful pregnancies without immunological treatment. To me, this is further evidence that it was more likely a case of poor egg quality/embryos for these women.

Vice versa, there are cases where donor eggs have failed, yet the same couples went on to have their own biological child with the addition of immunological treatments. I don't doubt this is true. However, even in cases where some claim "xyz immunological treatment finally got me my baby!" you may read further into it and see that they also did IVF or an injectables cycles with IUI...Well, if there are 6 eggs waiting to be fertilized & upping your chances so exponentially, how can you possibly say with 100% certainty it WAS the immunological treatment and not that you just finally found a good egg or embryo?

Even in cases where successful pregnancy is achieved through timed intercourse in conjunction with RI, in all fairness, there is no way to prove with certainty what caused the success on either end of the spectrum.  Maybe it was the treatment. Maybe it was God. Maybe it was finally the perfect match of a healthy sperm and healthy egg.

Another red flag for me is that Dr. Sher, along with the handful of other RI's practicing in the U.S., do not publish their success rates via SART. When I asked Dr. Sher about this, he became defensive, citing multiple reasons why he's "taking a stand against non-uniform reporting standards." He gets very heated easily, and it's almost comical. I pressed him saying, "I totally respect your decision. Is there somewhere on your website that I can find your own method of success rate reporting, in whatever fashion you've chosen to do so?" His time then became very short, and he directed me to the discussion board of his blog. He is literally updating his success rates via random threads on his discussion board, boasting 70-80% pregnancy rates, with the caveat that 15-20% of these will be lost due to miscarriage most likely.

Is this a joke? He can't even make a well-organized chart or something? He obviously does not track live birth rates (one of the most important criteria to consider when looking at clinics) or he just doesn't want to disclose them. If he supposedly specializes in treating women with IVF failure and higher rate of miscarriage, wouldn't he want to publish live birth rates? Nor does he distinguish between age in his "reporting." Huh? How can you not include that info?

Consider this... If his practice is so outstanding and he is soooo passionate about the need for immunological treatments, why not report these fabulous success rates the same way all other clinics nationwide do (way more exposure and credibility) and find alternative ways to be an outspoken advocate of more stringent oversight of SART reporting. I mean, surely if other RE's saw that his immunological protocols were producing 80% pregnancy rates, they would finally LISTEN to what he's recommending as a "pioneer" in his field, right? Believe me, Dr. Sher seems egotistical enough that recognition at this level would surely be beneficial for him. I just see the whole "I'm taking a stand" thing as a cop-out.

Outside of this, Dr. Sher is not a good listener. He's a bit pushy and salesman like. I had only a few well thought out questions to ask him, but it was hard to get a word in edgewise. It's like he was talking from a script (perhaps the same one he uses for everyone) and basically bulldozed the entire conversation. Every time I asked him politely to justify a remark, he became audibly agitated and was quick to refer me to his ever expansive blog full of his own personal articles, none of which are taken from peer reviewed research journals by the way. It seems his modus operandi is to bombard you with information so that you will think it's all legit.

To his credit, I think it's generous he consulted with me twice and ordered tests for me without charging me a dime for his services. However, ultimately I think it's just a way for him to grow his business. Let's just say, I don't get a "mother Theresa" vibe from him. In fact, both times I've talked with him, I've had an invisible angel firmly planted on my shoulder saying, "RUN the other way!" That is the only way I can describe my first impression and intuitive feelings toward him.

Still, I will say that Dr. Sher must care about his line of work to do it as long as he has. He has 30+ years of experience and has clearly been around a while. I found his book very informative as an IVF newbie not knowing what to expect when we began IVF. I do think though, that his focus as a doctor has perhaps changed over the years. Before RI was ever on the map, Dr. Sher was practicing what we'd consider a more traditional approach to RE. Now, he's focused on working mostly with a specific population of women. I just can't help but wonder if he's reaching a little too far with his recommendations to some women.

So, sorry this is long, but I wanted to give a detailed run down of what my personal thoughts were with my minimal exposure to RI. I realize I did not have all of the possible RI tests run, and that there are many more things like DQ Alpha matching, etc. that exist out there. I am also not in the same boat as a woman with 10+ pregnancy losses or failed IVF's and who might have more reason to accept immunology as THE THING keeping them from motherhood.

By no means do I think women pursuing RI are doing the wrong thing either. I admire any woman who will go to great lengths to create the family that she so desperately desires. Each of us has to weigh our own quest for answers, our own history/risk factors, and our own timeline to achieving motherhood with the recommendations given by any doctor. For now, I feel we are on the right path for us, and that's where we intend to stay as we continue working towards and believing for a family.

IUI #3 is done! All we need is one!

IUI #3 with Femara (Round #5) is officially in the books. Part of the reason we turned this "break from IVF" cycle into an IUI cycle is that it worked for us once before. Exactly one year ago, we became pregnant with Femara + IUI + Prometrium. Also kind of strange....we've actually become pregnant the last two Novembers in a row (2011 & 2012), even though neither pregnancy lasted. Please Lord, let November 2013 be the charm, and if it does happen let it be for keeps!

Initially, I thought maybe if we just copied our exact same BD & IUI schedule as last time, we'd have a good shot. Hold your laughter please. I know there is no rhyme or reason to how things unfold in any given cycle, but the thought did cross my mind to try to mimic our last successful cycle. I gave up pretty early on though, due to the fact that I don't have a working crystal ball and couldn't realistically pinpoint ovulation in advance. 

There are two main issues when trying to plan specific BD dates around an IUI.  A) You typically can't predict exactly if/when you'll get a +OPK. There is no way to know when the IUI will be until less than 24-36 hours before it takes place...unless you have an extremely predictable and reliable response to all medications, in which case, I hate you. Just kidding! B) You aren't supposed to have sex too close to the time of the IUI either, so as to encourage a minimal sperm count at time of IUI. There are a few moving pieces here.

At one point, I thought my body was going to totally rebel and not ovulate at all, washing the entire cycle. The day after my last ultrasound (CD13), the test line on my OPK disappeared completely, which made me want to pull my hair out... It was supposed to be getting darker, not going away! Sometimes OPK's can give a pretty good indication of when ovulation is coming (because the test line grows progressively darker as LH rises), but sometimes the second line just does crazy things, like disappearing, reappearing, etc. LH is just wonky sometimes. I test twice per day and use two different brands (regular & digital) just to cover all bases, but clearly my LH levels were running amok. I STILL hadn't gotten a +OPK by Friday at 5 pm (CD16) so we went in for a second ultrasound.

Thankfully, the ultrasound revealed I was still on track to ovulate soon...

Left ovary: 23 mm (up from 16.5 mm)
                   13 mm (down from 16.5 mm)

Right ovary: 18 mm (barely up from 15 mm)

Lining: 8.4 mm (up from 7.4 mm)

I was slightly bummed that the second follicle on the left had actually shrunk down; Looks like the smaller one was being overtaken by it's counterpart, which seemed to take off. The right follicle was growing sloooow as molasses, but at least it hadn't shrunk and was still somewhat in contention.

Since we had at least one follicle @ 22mm+ and lining was good to go, we got the green light to do an Ovidrel trigger shot...which we purchased at a local pharmacy literally an hour before they closed on Friday night. Remember, hubby had a flight out on Sunday, so we had to do the trigger that night in order to make this IUI happen!

I went to bed without any dinner, because I literally jumped from subbing all day, then to the RE, the pharmacy, home to BD, and finally triggered at 9 pm. No rest for the weary and not even time to eat. Making a baby is work people! I can't help but think of the well-intentioned advice from others who've never experienced fertility treatments, "Just have a lot of sex." OR "Just use an online calculator to input the date of your last period and have sex the days it tells you."  hahaha! So funny. :) Yeah, it turns out it's a little more work for some people.

Looks nothing like our last (successful) Femara/IUI cycle, but here is so far...

The other thing different this cycle is the daily Lovenox shots (blood thinners) beginning on CD6... a little something extra for increased blood flow (since I have +APA's/blood clotting factors). I take baby aspirin in the AM and Lovenox in the PM. I'm happy to report that Lovenox has become easier over time. I still detest this dreaded shot, but the bruising has lessened, and I've found a couple trusty spots that are less painful. If there's any chance it could help and zero chance it can hurt, I'm willing to just suck it up and do it. I will begin taking Prometrium (progesterone) at bedtime on Wednesday (3 dpo) for luteal phase support as well.

We weren't able to BD the night of the IUI (as is normally recommended), because hubby flew out to Amsterdam right afterwards. However, he contributed a whopping 57 million "moving" swimmers day of IUI, along with many million additional in the days leading up to it, so every possible base within our power has been covered. All we need is ONE clean cut and well dressed little guy to show up with flowers and a nice bottle of wine for one super lucky egg.

Shoe Frenzy + Femara Follies: Everything's Lining Up!

I am just going to warn you now; This post is pretty darn exciting! If you've been reading a while, you already know how much I love "before and afters" as well as the occasional home decorating/organizing project. De-cluttering=Free Therapy

How then, have hubby and I lived in this house for almost FIVE YEARS with the fiasco that is our closet? Truth be told, he's been griping about the situation forever, and I've been putting it off...Other priorities and I didn't want to spend any $ to fix it.

This is pretty embarrassing, but we've been living out of these ridiculous hanging canvas shelves. You know, the kind that velcro onto a closet bar and leave all your clothes hanging out of the front in a very dorm room'esque fashion? I'm going to share something with you, but then I'll have to kill you...

Yes, this is the closet of a 35 and 37 year old married couple. So sad.

Have you ever looked in the mirror and thought, "How'd I get so fat?" That is how I feel about this closet...NOT easy to look at! ha! Something just snapped in me last week and I could not take it ONE. MORE. SECOND! Time to bite the bullet and do something about it.

I do not like multiple dressers in the bedroom if I can help it either, because I like an open feel, so I spent last week meeting with custom closet designers, visiting closet showrooms, and haggling with sales reps.  I highly recommend doing this if you have a closet crisis yourself and have the energy. Even if you don't end up buying anything, you will get some fabulous ideas on how to organize it yourself.

I don't think I'll be able to sleep for the next 6 weeks, because that is when 12 new drawers will be custom built into our closet! So exciting!! No more looking at this mess. I will definitely post pics once this side of the closet is done. Stay tuned in December.

The other thing that has been really embarrassing and also quite hazardous is my shoe situation. Apparently, a long time ago I thought it would be smart to pile my shoes into clear plastic bins and slap some Sharpie onto labels to "organize" them. Only problem (besides the fact that it looks like kindergarten class)? I am 5'4" tall and not a good basketball player. Many times while trying to aim for the correct shoe bin a few feet above my head, a shoe will hit the rim and divebomb my face! It happens more often than not to be honest. The more I write this, the more ridiculous I feel.

Anyhoo, we did want to cut costs with the closet people where we could, so I decided to tackle the shoe situation myself. A trip to the Container Store and a couple of broken nails later, I ended up with something so fabulous I should add it to my resume. Prepare to pick your jaw up off the floor once you see the amazing shoe transformation that just occurred!...

BEFORE

TA DAH!! AFTER!

BEFORE

I JUST WANT TO STAND IN HERE AND STARE AT IT!

This shoe project cost less than $200 and what a difference! I had so much fun that it almost makes me want to organize for a living. I can just breathe easier when things are organized. :)

Speaking of work, I started substitute teaching again on Monday. I have not subbed in about ten years (before I became a certified teacher back in FL) but figured I'd be really daring and jump right in to a position with ED (emotionally disabled) and Autistic middle school students. I learned upon my arrival that the woman I was subbing for had a table and four chairs flipped over on her the Friday before. I really know how to pick 'em!

I did end up (gently) commondeering a pair of scissors from said kid who flipped the table, diffused a few meltdowns, and made it home relatively unscathed.  I would like to think I'm good at helping special needs students, but let's just say Monday was a reminder of why I left special ed and started teaching regular ed science when I did years ago. Phew! I am learning how to navigate the online system where subs go to claim jobs and decipher the abbreviations for the assignments I'd rather not choose. My foot is in the door though, and that is all I wanted. So now, I will pick and choose a tad more selectively.

As if this is not enough excitement for the week, I will share one more happening...As you know, I took 5 mg Femara CD2-CD6 this cycle, in order to scoot up ovulation before hubby flies out this weekend. After some discussion, hubby and I decided that if we are going to try on our own with Femara at home, why not up the anty and just go for an IUI? So, we went in for ultrasound monitoring yesterday (CD12) to discuss with Dr. V and see what follicles were brewing in there.

Turns out I am having probably the best response on Femara I've ever had. I have 3 follicles growing nice and synchronously...

Left ovary: 16.5 mm, 16.5 mm
Right ovary: 15 mm
Lining: 7.4 mm

I have only produced two follies max on Femara in the past, so this is good news. I am most likely still a few days away from ovulation, and hubby flies out on Sunday. So, I am testing with OPK's, and if I don't get a + by Friday afternoon, we'll go back to the RE for another ultrasound to confirm everything is mature. If all looks good (22 mm follies), I'll do an Ovidrel trigger shot Friday night and we'll have the IUI Sunday morning before hubby leaves. Honestly though, I'm hoping I'll get a +OPK naturally by Friday so we can do an IUI on Saturday (CD16). One day at a time. It's taken some creativity and planning, but right now it looks like this cycle is going to work out timing wise!

Last Day of the Never-Ending Hormones: Onto Femara During our "Break"

I can do anything for one month, but I am so extremely ready to move forward from this ass dragging cycle of pregnancy loss, surgery, never ending spotting, and estrogen therapy. How can time (as in years TTC) fly by so fast, yet at the same time seem to craaaaawl by (as in each day of this cycle) at a snail's pace?

Today is the LAST of 25 days on estrogen therapy following the hysteroscopy and laparoscopy. I was taking 2mg Estradiol 2 x's/day. My understanding is that taking estradiol post-surgery helps to rebuild the uterine lining and reduce any risk of scarring where things were removed. We definitely don't want that! I've also been taking 10 mg Provera 2 x's/day for the past 5 days to induce a new cycle since the ole ovaries have basically been sleeping this whole month. I have been a sleepwalking zombie on the Provera and would be perfectly fine crashing at 5 pm every evening. Sleeeeeepy dwarf right here. Yawn:0

In case you are interested in seeing what this eventful cycle has looked like...

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Blood test on CD2 showed hCG back down to zero. Then, we were going to do a Femara cycle before moving onto our final FET. HOWEVER, my insatiable quest to dig deeper for "reasons IVF hasn't worked" resulted in the big surprise that somehow my insurance was magically going to cover the diagnostic surgery we'd been wanting for over a year. So, we scrapped the whole Femara idea, and went straight into surgery literally the next day. Oh, and want to see something really cool? Our insurance really and truly covered my surgery!

I was checking my online claims like a crack feind twice a day, sweating bullets until I saw every bright red "pending" turn to it's beautiful bright green counterpart "processed" on each charge. The $28K+ one took FOREVER to go through too, but it finally did. We are beyond grateful that everything went through. We have zero fertility coverage, and this is by far the most help we've had with ANYTHING during the past 27 months of treatment. Looks like our total cost will be $125 (rather than the $20 I was quoted). However, we will take it!!! I am 100% happy we did it, even if it meant a little pain & more waiting to proceed as planned.

Speaking of proceeding, today was my last day of Provera, so I should begin a new "withdrawl cycle" within the next couple days. We are advised to wait until our next "real cycle" before doing our last chance FET, but we've been given the green light to try by any other means. I have felt fully recovered for a couple weeks now, and we are both excited to start trying again.

So, I open our shared online calendar and realize that during the time I will most likely ovulate naturally, my husband will be 5,000 miles and a 10 hour flight away in Amsterdam. He's gone ever so conveniently during my CD17-CD23... Every. Single. Day. of Possible Procreation. If I am going to ovulate on my own, it usually happens CD21-CD23. This is almost comical. I bang my head on the wall and ask, "Why God must I ovulate so damn late? Why can't I just be normal???"

I believe in miracles mind you, but I don't expect to conceive via immaculate conception or Skype for that matter. And maybe it wouldn't be quite as large of a miracle, but I also don't expect to ovulate anytime before CD20 unmedicated. Lightbulb moment: Good news is that I usually ovulate on CD16 or CD17 when taking Femara. Yes! There is always a back-up plan!

I emailed my nurse and got approval to move forward with a Femara cycle. I am actually a big fan of Femara. Main reasons being zero side effects, linings @ 9mm+ typically, and a much sooner ovulation with up to two mature follicles. Another reason? Well, it got us pregnant the last time I took it...even if it ended up being a god forsaken ectopic pregnancy. That wasn't Femara's fault though. Here was our last Femara cycle, which resulted in pregnancy...

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I can't believe that was a whole year ago. Geesh. Time flies when you're having fun and have entered Advanced Maternal Age. Seriously, can someone please stop time while we try to have a baby?

This cycle, I will take Femara 5 mg on CD2-CD6 to encourage a more timely ovulation and scoot it up an additional day if possible...the goal is a CD16 ovulation. This way we'll get to try before hubby's off jet setting. Worse case scenario, we do also have 50 million (post-wash) sperm frozen if we absolutely miss the boat timing wise and still want to try an IUI using frozen sperm. Wouldn't that be some shit if I got pregnant while my husband was in Amsterdam? We'll cross that bridge when we come to it, but for now we'll just take it day by day and use whatever options we have available to us as this cycle unfolds.

Hopefully I will keep myself busy substitute teaching soon. Right after I blogged about how long it was taking to get hired, guess who got an invite to the sub orientation? I completed that today and should be officially hired as soon as my fingerprints are processed. My subbing definitely won't make us millionaires, but anything extra is extra.

I'll be praying for this cycle to unfold just as it is meant to in the coming days....and as always, for peace and patience in the process.
 

*P.S. Today is National Infant and Pregnancy Loss Day. Feel free to light a candle in solidarity at 7 pm. I'll be lighting one for all the families out there who have experienced loss. ((HUGS))

Say What? Pregnancy Loss & Infertility Etiquette

What do we call a child who loses a parent? An orphan
A woman who loses a spouse? A widow
What about a couple who loses a child or pregnancy? There isn't a word to describe them.

In case you didn't know, October is Pregnancy and Infant Loss Awareness month. President Ronald Reagan actually declared this in 1988. Later on in 2006, the US House of Representatives named October 15th National Pregnancy and Infant Loss Day. The purpose of this month is to recognize any parent who has lost children due to miscarriage, ectopic pregnancy, stillbirth, SIDS, and many other causes. Infertility Awareness Month actually falls in April, but I want to touch on a couple things regarding that as well.

3 times now, I've had the fleeting dream of motherhood come close to being realized, only to have it taken right back away. I do not pretend to know what it's like to lose a child at 10 years old, or 1 year old, or later on in pregnancy. My short-lived pregnancies have all been doomed almost immediately upon getting a positive blood result. My suspected ectopic lasted 10.5 weeks, but I knew it was over at 5.5 wks. Still, that doesn't mean that the intense hurt and pain we've experienced as a couple throughout each loss is not real.

Not only have we experienced 3 losses, but we are ALSO experiencing the double whammy of infertility on top of it. When you have spent endless hours praying, wanting, and waiting as patiently as possible....Every extra resource available and every ounce of energy towards finding a solution; It's extremely heartbreaking to still feel like you are at square one to ever becoming a parent. One thing that makes pregnancy loss and infertility especially hard is the lack of awareness.

Learning to handle the comments from others who don't understand what we're going through has been something we've had to work on, and I've definitely not yet mastered it. The other thing I haven't mastered are the feelings left in the wake of the idiotic...I mean, well-meaning but extremely misguided comments we hear. We've had supposed "friends" enthusiastically announce their baby's gender publicly front and center less than 24 hours after we told them we were miscarrying. I've had people tell me horrific stories of children born with deformities or special needs as if to say, "At least yours took care of itself!"  I've heard "Have you considered adoption, surrogacy, or taking a vacation?" more times than I can even count. I am surprised I haven't bitten off my own tongue by now. I try to take in the actions and comments as graciously as humanly possible, but it's hard. And while I do feel compelled to gently "educate" others from time to time, even doing that just becomes sooooo exhausting.

The fact is that there are two types of misguided comments: 1) Those that come from a flat out selfish & non-caring place, and 2) Those which truly just come from a place of wanting to help. Unfortunately, even people who genuinely care can say some incredibly hurtful things without even realizing it.  If there is one thing I've learned the past couple years, it's that people tend to be solution oriented when it comes to someone else's problems. It's made me more aware myself of being a more supportive listener.

Let me be clear. I don't want anyone reading to think this post is intended to gain sympathy. It's not.  It's also not directed at anyone specifically. Believe me, the lack of knowledge in the general public runs rampant. Most of those who comment here on my blog are fellow mom's in the making, but I do get readers from across the globe surprisingly enough...at least that's what my blog stats say. Who knew?

Anyways, I wanted to share some Infertility & Pregnancy Loss Resources with you all. Maybe you can use some education yourself to better help someone experiencing infertility or loss. Or, maybe you need something to share with others to help them understand your own journey more. Wherever you fall in the spectrum, I think these can benefit everyone....

Seleni: Infertility Etiquette 101
Seleni: 11 Things You Should Know About Grief
Dancing Upon Barren Land: for Family & Friends
Dancing Upon Barren Land: Miscarriage or Stillbirth
Resolve: Infertility Etiquette
Resolve: Facts vs. Myths About Infertility
Orthodox Church: Pregnancy & Infant Loss Awareness

There are oodles and oodles of resources on these topics online. If you aren't sure what to say to someone experiencing infertility or pregnancy/child loss get some guidance by doing an online search. Sometimes saying less IS more. Think carefully about what you say BEFORE you say it please.

If you are someone needing more support from those around you, don't be afraid to share resources with people who can use them. It can be a balancing act to handle comments graciously, set boundaries and have our own experiences validated in an appropriate way. One thing is certain though...No one should have to go through this alone. You deserve to be supported in the way that you need to be.

Anyone who wants to participate in Pregnancy and Infant Loss Awareness Day is invited to light a candle on October 15th at 7 PM to show their solidarity. I will be lighting a candle at home and praying for all of the mothers and fathers out there that have endured the heartache that comes with pregnancy or child loss. If you have any other resources you've found helpful to deal with loss OR infertility, please feel free to share them here. We can all learn from each other!