Breathe out......

HOW CAN I WAIT NINE MORE DAYS?!?

I want to know RIGHT NOW if I'm pregnant! 

Had more blood work this morning.  The nurse always calls around 2pm with the results.  My husband heard the message and sent me a text saying she sounded really positive.  :)  So cute!  I listened to it when I got home.  I think she sounded the way she always does. 

Estridol - 1,992
Progesterone - 40.3

Progesterone levels in the first trimester?  10 - 47 (or 90, depending on what source it's coming from).  BUT, we can not get excited.  On Monday the doctor started me on progesterone suppositories - 100mg 2x/day.  I've been trying to find out how quickly they take effect and can raise levels but with no luck.  Some sites I've come across say they make no difference at all.  Either way, higher levels seem to indicate a better chance of pregnancy! 

I was also instructed to give myself an injection of 5,000 IU of hcg tonight.  Which means that I can't take an over-the-counter pregnancy test because I will get a false-positive.  I must wait until Friday April 9th to get the blood test!

Oh, right now I'm just going to believe that I am!  ;)

Just stumbled across this:
Vaginal suppositories of 100 mg progesterone produce a rapid increase in plasma progesterone levels, which peak within 4 hours between 9.5 and 19.0 ng/mL. Over the next 8 hours, there is a gradual fall in plasma a levels.
???

How romantic!

Early this morning my doctor's office called and said since my blood test on Saturday revealed that my progesterone is around 5, they are calling in an order to the pharmacy for me.  I didn't ask but I believe they want to see it closer to 15.  So, we picked up progesterone suppositories.  Yep, suppositories.  They are flat pills a little bigger than the size of a nickle and they fit into a tube that you then put in your vagina and push in, like a tampon.  A friend of mine who is also going through fertility treaments said that you get a discharge from them that is like wet cement. 

Oh, that's hot!

10 million sperm

Back to the doctor yesterday for a second IUI.  This time 10 million were inserted.  Grand total - 29 million sperm.  My second egg had released, as seen on the ultrasound - the follicles had shrunken and there were white dots around the black follicles, blood cells that had entered the ruptured follicle.  It seems impossible that one of his 29 million sperm would not hit one of my two eggs!

My boobs are super sore.  So sore that I had to switch to my exercise bra, thus giving myself uni-boob.  On the plus side, they are so swollen that even when I lay flat they stay perky instead of sagging down to my sides as they started doing around the time I turned 29.

I go back to the doctor on Wednesday to have blood drawn.  I have one more Pregnyl (hcg) injection left and the doctor said he will more than likely have me take it on Wednesday.  More on those results as I get them.....

In the meantime, we have been staying positive and sending out baby-thoughts to the universe.  Today we made some sperm/egg art! 

Oh, go sperm, go!

19 million sperm

19 million.  One of those has got to hit one of the two eggs I'm releasing, right?  19 million!

We did the IUI at 7:45 this morning.  First we did an ultrasound to look at the follicles.  The left one didn't look like it had released but the right one looked like it did.  It took about 45 minutes for the doctor to prepare the sperm.  He inserted the speculum and then put in the catheter and released some of the sperm into my left tube, some into the right.  I stared at a calendar that had a picture of a pissed-off looking cat with a milk mustache.  I couldn't even feel the catheter.

Afterwards, I relaxed there for 20 minutes.  During the sperm preparation (sperm washing), the prostaglandins in the ejaculate are removed.  These can cause cramping and severe pain in the cervix and may even cause the uterus to collapse!  I didn't have any cramping, just continued discomfort from the Pregnyl injections.  Sperm washing can also remove dead sperm and those with poor motility, leaving the strongest ones.  It works best with guys who have a count of 20 to 30 million.  My husband has a count of around 20 to 25 million.

After the IUI, I got my blood drawn for, like, the 100th time this month.  They called later on and said because of those results, we are going to do another IUI tomorrow.  I believe what the doctor is looking at is my progesterone level, which should reach a certain number after the follicles release the egg.  Mine were lower than that and so we send in more troops tomorrow to try to hit that second target. 

He didn't say that I had to relax afterwards but when I left the office I took the bus straight home.  I took a nap, snuggling my hot water bottle against my abdomen.  I have to go to work tomorrow after the appointment and after work we are going to a quinceanera.

Oh, I hope we make a baby!  One baby!

Trigger time!

Today I was given the go ahead for the hcg injection.  The drug my doctor is having me use for this is Pregnyl.  He said after they received my bloodwork and gave me the results that I was to take it right then.  Which means I had to give myself the injection.  Which I've never done before.....

First, I had to prepare the drug, which is very.....ummmm....nurse-y and I am not a nurse.  It's intimidating, using a syringe to suck water from one vial, trying to get exactly 1 1/2cc's, then squirting it into a vial containing the powdered hcg, mixing it, then drawing that back into the syringe, changing the needle to a smaller one that I will use to inject myself, then pinching the fat of my stomach and injecting it.  The needle didn't hurt but something in the medication makes the injection site quite sore.  I did one dose of 10,000 IU today and I was so sore afterward I would wince everytime I had to flex my trunk.

Tomorrow I do one more dose of 10,000 IU of the Pregnyl and by Friday I should have one or two eggs release.  We do the IUI that morning!

It's like a small rodent is gnawing my ass

Ganirelix is evil.  It feels like a gerbil gently gnawing my flesh at the injection site.  I confirmed with a friend who also had to take Ganirelix that this is common.  Well, that you have pain at the injection site.  She didn't necessarily agree that it felt like a rodent chewing your ass.

My friend also said that the gonal-f injection made her super sleepy.  She was on a much higher dose than I am and said she got sleepy immediately.  I've been having a hard time getting out of bed in the morning and thought that might be it. 

I haven't been feeling totally positive about our upcoming IUI.  I think that is partly because it seems impossible that we will finally become pregnant, partly because I don't want to get myself worked up, only to be let down.  But.....I think I need to get pumped up about it!  We will get pregnant and have a baby 9 months from the begining of April! 

Oh, positive thinking!

I sure felt like biting that x-ray tech

I was scheduled for an HSG on Monday.  A hysterosalpingogram.  The secretary from my doctor's office asked if my husband was coming along with me.  I told her he had to work and she responded "....oh.....o-okay."  After I hung up the phone I thought maybe I should do a bit more research on this.  I mean, my doctor just kept calling it an x-ray but the sound in her voice.....

What I find online is a description of the procedure followed by comments from women who have had an HSG.  Most of them were negative.  Then there were those who said it wasn't so bad and you just had to be able to handle pain.  I knew that I would be in that latter category.  I'm no wimp!

Well you know what?  I am a wimp when it feels like I'm being stabbed in the cervix for 2 minutes.  I'm not going to sugar-coat this.  It was horrible.  The doctor inserts a cold speculum, then pushes a catheter through the cervix.  He then injects a dye into the cervix and they take x-rays as it flows into the uterus and up and out the fallopian tubes.  It's done to make sure there are no blockages or cysts in the uterus or tubes.  And it feels like a hot poker is being repeatedly stabbed into the tender tissues of my cervix.

As this is happening, the x-ray tech is asking me if I've seen 'Alice in Wonderland' and starts to blather on about how it wasn't as good as 'Avatar'.  You know what?  How 'bout I bite you?  Is that as good as 'Avatar'?  I just take deep breaths and glare at him.

Some other good info to have before going in:
- you will be made to change into a hospital gown and will more than likely have a "recovery room."  Being escorted to my "recovery room" before the procedure immediately put my guard up.  They should call it something different.
- you may bleed afterward.  I brought a pad with me and it's a good thing because I did have some spotting plus that dye leaks out for the rest of the day and, in my case, into the next day.
- you may have some cramping.  The doctor said I could take Motrin.  I didn't have any cramping but I did feel tender inside for the rest of the day.

This is what I know.

Gonal-F pen & Ganirelix

"The doctor said that if you aren't nice about this, he is sure he can come up with something for me to inject into you," is the warning I gave my husband as he swabbed my ass with an alcohol wipe.

On my cycle day 7, we started injections of gonadotropin hormone, or FSH - follicle stimulating hormone.  It's used to develop multiple follicles.  I'm on a low dose - 75 IU.  This is the third day of injections.  Today we switched over to my left ass cheek 'cause the second one in my right side last night left me feeling a bit sore.  We inject another 75 IU tomorrow along with Ganirelix.  Ganirelix blocks LH - luteinizing hormone.  It's commonly used in conjunction with FSH injections because the body wants to release all those follicles and we don't want that to happen until we are ready to do the IUI.

We must keep our sense of humor about us as we give this a go!  So, for your entertainment.....

Drugs....

Got a big bag of drugs today.  Now to make sense of all of them....

I was wrong in the last post about the drug I'm starting with.  It's Arimidex.  Eight pills today on cycle day 2, eight tomorrow.

What does the interweb tell me about Arimidex?
****
By suppressing estrogen production, aromatase inhibitors trick the pituitary into producing LH and FSH.  This boosts follicle growth.  Many aromatase inhibitors are released from the body within 45 hours. This suggests that taking oral doses of aromatase inhibitors should pose little to no harm to the body or the developing embryo.
*****

My doctor says that it is commonly given to women diagnosed with breast cancer.  The tumor is removed and then they take a dose of Arimidex every day for the next 5, 10, 15, etc. years so that their body doesn't produce too much estrogen. 

He chose to give it to me because it is less potent than Clomid and I don't need that much stimulation. I grow nice follicles just fine on my own.  He is hoping for one or two more than usual since my hubby's sperm do not do well at trying to hit one small moving target.  Now they will have more to aim for.

Taking 16 pills was easy.....

Numbers

I'm trying to make sense of all the numbers I've been given.  I met with my doctor this morning and we went over my blood test results and my husbands most recent semen analysis and set a tentative plan for the rest of the month.

First, my second blood test results:
- Taken on cycle day 21
- Progesterone: 19.10ng/ml
     - Ranges listed on this lab printout:
          - Non-pregnant:
             - Mid-Luteal: 5.2 - 18.6ng/ml
So I'm over the "normal" range?  My doctor didn't specifically say this, just that he didn't really like my progesterone result.  Now, in the "pregnant" column, the range for first trimester is 4.7 - 50.7ng/ml.  My numbers fall in that range but he didn't automatically assume that I'm pregnant.  And I can say that I don't feel pregnant and have all the sensations associated with starting my period in a few days.
- Estridol: 134pg/ml
     - Ranges:
          - Mid-luteal: 49 - 291pg/ml
I fall right in the middle.  So.....good?
- Semen analysis results:
     - Volume: 2ml
     - Sperm count: 12 million/ml
     - Total count in the ejaculate: 24 million
Those are decent numbers.  What the doctor didn't like about the sperm were their motility.  He graded them "poor."  He said they did not swim very far for very long, so he has doubts about whether they can make it all the way up fallopian tubes and then survive there as they wait for the egg.

The Plan -
I was sent home with more semen collector cups, one of which contains a "pink medium."  This substance is apparently very sperm friendly and the doctor hopes to see more sperm swimming around for a longer amount of time in this medium than they did in the empty cup.  I will bring that back in next Wednesday.
On Tuesday I should start my period.  I call the office and the doctor will call in a prescription for me.  I believe the drug he suggested is Antagon.  He said I will take 8 pills on cycle days 2 and 3.These pills are a GnRH (gonadotropin releasing hormone) blocker.  At the pituitary, GnRH stimulates the synthesis and secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH).    By blocking these, the doctor can time when he wants me to ovulate.  We will do an IUI and, since we can time when the egg will come out, the sperm have a better chance of being ready to go and will not be too tired from waiting too long for my egg to arrive.

Am I thrilled that I have to take drugs that will fuck with my hormones?  No.  But I trust this doctor.  I approve of his reasoning for wanting to use these drugs and trust that he would not do anything to cause me any harm. 

Timeline
- Start period
- Take prescription on days 2 and 3 (and I will double check on that drug name because all I can find online about it is that it is administered by subcutaneous injection, not pill, and I know he specifically said pills)
- Bring in semen sample in pink medium
- Take x-ray of fallopian tubes to make sure they are open for the IUI
- Stimulate ovulation and do IUI (around the 4th week of March?)

A little chart of the cycle of hormones on a "normal" cycle, starting on the first day of your period.

Who else starts their morning this way??

I would guess that most couples, at some point, have had some *fun* in the morning before work.  It's only the ones with fertility problems who then put their husbands semen in a vial, tuck it into their bra strap and hop on the bus to take it downtown.

I made it to my doctor's office with five minutes to spare.  My doctor was sitting at the front desk and when I said "good morning," he said "good morning!  Do you have a package for me?"  This is why I love this doctor.  He didn't need my chart in front of him to remember why I am there.  Even more impressive, he then started to go on about my blood results and the next steps we should take. 

This is what I learned this morning:
- He will test the semen sample I brought in and compare it to the other two.  Hopefully the results will be closer to the second analysis, which was the better of the first two, meaning the sperm are not so bad.
- During my luteal phase, on my cycle day 21 (when I had my blood drawn on Monday), my estridol should have been 10x as much as my progesterone.  He said he likes to see estridol over 200pg/ml.  My progesterone was around 19ng/ml.  He said in a perfect study he would draw blood from me every 20 minutes and we would see if the progesterone was going up or down.  He would like to see it over 20ng/ml (as 10x that puts my estridol over 200pg/ml). 
- Of course, those levels (and should they remain that high) would indicate a pregnancy.  At this I scoffed and he giggled.  I'm glad he's not trying to force me to be overly optimistic.  We just had regular ol' sex this month.  That hasn't worked in the last 2 years & 7 months, why should it  work now?

So, today he will get results from the sperm and on Friday I will call him and we will discuss those results.  On Monday or Tuesday I should start my period.  After I am done with my period and before I ovulate, we will probably do an x-ray of my fallopian tubes to make sure there are no blockages (e.g. a weird mucus plug or something).  He said he will more than likely give me something to "stimulate" my system - meaning a fertility drug - but he didn't say when I would start that. 

I don't want to be stamped with the label "unexplained infertility" but weeks of testing, the stress of waiting.....it's rough.

Oh, more questions, more answers yet to come.....

Good thing I never had the urge to do heroin

I'd chicken out before I could get the needle in.  Last week when I had blood drawn I watched her put the needle in my vein.  

Today, I watched as my nurse, Maria, tied the rubber band around my arm and wiped the front of my elbow with an alcohol pad.  I squeezed the foam ball she gave me and saw my vein pop up, thick and blue.  Then she aimed the needle towards it and I looked away.  I wanted to make a scared, squeaking noise but Maria is the type of woman you could describe as a "tough old broad" and I don't want her to think I'm a pussy.

I turned back to watch the blood leave my arm and fill the two vials she had waiting.  I should be getting a call with the numbers from these test results in about an hour.  On Wednesday, I will bring in a sample from my husband and on Friday we will have those results plus my blood work.  I spoke with my doctor briefly today and he said on Friday we will map out our plan!  Seems that by mid-March, we will be trying either IUI or IVF, depending on these test results!