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!

2nd Post Coital

Back to the doctor's office for a second post coital test! 

Today is cycle day 14.  We abstained for two days, up until last night when we were instructed to have relations again. 

Today, I was told that my cervical mucus is a little too thick.  The doctor could see some sperm swimming in there but not many.  Could be because it was cd 14 and we missed the day when it would've been at just the right consistency - maybe yesterday.  Yesterday was Sunday, so no office visits.  We also could see a 23mm follicle on my right ovary, meaning that I should ovulate any time now.  My uterine lining was also very thick and had the right amount of layers, ready to accept a fertilized egg, should one be in there.

I had blood work today, as well.  The results were:
Estridol - 169pg/ml (picograms per mililiter)
Progesterone - 1.3ng/ml (nanograms per mililiter)
FSH - 12mIU/ml (mili-international units/mililiter)
LH - 49mIU/ml (mili-international units/mililiter)

Some of these are to be done on cycle day 3 so I don't really know what the numbers mean when the tests are done on cycle day 14.  I go back on Monday and get more blood tests done and bring in a sample from my hubby, so I'll get answers about these results then.

Time to have relations!

On Thursday, my cycle day 10, my husband and I had "relations," as my doctor puts it.  So on Friday, cycle day 11, I went into the office for my first post-coital test.  The doctor removed some of my cervical mucus from my cervix and peered at it under the microscope to see if it was being kind to the sperm my husband sent in about 12 hours before.  Turns out, it was a little inhospitable but some of the little guys were still hanging out.  Good sign.

We also got a look at my ovaries and uterus.  The lining of my uterus was where it was supposed to be, though now I'm forgetting the exact measurements.  Ten milimeters, maybe?  We saw a 15mm follicle on my right ovary, so this month I will be ovulating from that side.  My doctor said that follicles grow about 2mm per day, so by my cycle day 14 it should be around 21mm in size.  Eighteen milimeters and over is great, in the world of fertility testing.

Since it was only my cycle day 11 and my cervical mucus was not in prime consistency, I will go back on Monday for another test and to have my blood drawn to check my hormone levels.

Science.....Science.....Science.....

When you read the title, throw in some new-agey space sounds 'cause that's how it sounds in my head.....

On February 15th we had our appointment to discuss our test results from December.  On the advice of a friend who is also ttc, we switched doctors.  Totally happy with that decision!  The clinic we were at before was more of a baby making factory.  At the new office, the doctor came out to the waiting room to shake our hands as we filled out our paperwork.  *heavenly sounds*  We spent an hour talking in his office about all the things that can make conception not happen. 

Specifics in our case:
- All of our blood work came back fine.  Hormone levels are spot on, no stds.
- My uterus ultrasound revealed no abnormalities and the follicles they looked at at that time were of the proper size.
- Hubby's semen analysis - this one shocked us.  His first one revealed that he only had 6 million sperm (below 10 mil is considered bad).  The second one - 21 million!  The doctor said that the results could be so varied because of the way the samples were produced - the first one in a hospital bathroom by himself and the second, at home, with me (please hold your applause).  So, when we're having sex he could be producing even more because, well, I'm so damn hot and sexy!  Okay.....the doctor didn't say it like that but that's totally what he means.

All such good news.  Then why aren't we conceiving? 

Other factors:
- The motility of the sperm may still be poor.  They might not have the strength to move up the cervix, through the uterus into the fallopian tubes.
- The morphology may be poor.  Some might have two heads, some might not have tails, etc.
- If hubby had had some sort of physical injury to his groin area (just one knee to the balls, even), he might have a tear in the wall between where the sperm are made or travel and his pelvic cavity.  (The doctor did throw in a lot of terms here - epididymis, vas deferens, prostate, etc. I'm gonna keep it simple but feel free to study male anatomy on your own.)  His body might then send in white blood cells to destroy these cells they usually don't have contact with, the sperm.  His own body could be killing his sperm.
- Or, I might be killing his sperm.  When his sperm enter my body, my body might recognize them as foreign and send WBCs to kill them.

These are the things we don't yet know and what we're going to look at next.  More tests.  First up, the post-coital.  Hadn't heard of this one!  In our case, the doctor wants us to abstain for two days.  We had sex on Monday, none on Tuesday, none today, and tomorrow night we will have sex.  On Friday morning (my cycle day 11), I go in to the office and the doctor will use a catheter to enter my cervix and suck out some of my cervical mucus.  He will check to see if my cervical mucus is being hospitable to my guests and if the sperm are having a good time.  I will also have some blood drawn to check my hormone levels.

The following Friday I will go back in to have an ultrasound.  We'll take another look at my uterus to make sure it's building up an inviting lining, one that an embryo might like to hang out in.  We might also do a x-ray of my fallopian tubes, since no one has looked at those yet.  More blood will be taken to check hormone levels.  Hubby will also produce a sample that morning (with my help. *wink*) and I will bring that in.

After all these results are in, we hope to have a solid answer as to why we aren't conceiving. 

Oh, to be continued.....

The day grows near....

It has been forever since I've written.  Really, it is just because there is nothing new to put into a blog focused around fertility treatments.  Life has went on as usual - work, work, work, day off with husband, work, work, work, class, work, work, work.......

Four days from now, though, we meet with our doctor.  We have chosen a new doctor at a different practice.  No offense to the previous doctor.  He was nice and all but the office was more of a baby making factory than a patient-focused clinic, we felt.  A friend of mine recommened this new doctor after she had a great appointment with him.  We are both excited to meet him and believe we will not only get help in making a baby but will also get some answers as to why we are having trouble to begin with.

I've been thinking a lot lately about what it will be like if we do get pregnant.  What all is going to change once we have a baby?  Part of me starts to freak out and worry that I can't do this.  And the other part of me feels like I will not be complete if I do not have a child.  Part of me wants to wait another 10 years before deciding it's time and the other part of me thinks I'm too late already.

Regardless of all that, on Monday we go over all our test results and decide on a plan.  Today I have a short work day.  Thursday through Saturday are long work days.  Sunday I will do a bit of work and relax with S.  Then comes Monday. 

The time grows near.  The clouds part and the sun shines through.  Or will it be, the clouds converge over the city and rain pours down?

Oh, dramatic G!  The day you've been waiting for!

Hi, Science, I like your syringe.

Yesterday I was talking to someone about how we are on the IVF path now after having tried many alternative treatments.  This person, being very much into alternative treatments, encouraged me to keep on the holistic path.  She was very positive about it and when we parted ways I felt renewed, like I could keep trying.

I came home, removed a wooden carving that I felt might be sending out negative vibes, set the herbal supplements on the kitchen counter, and starred the dates on my calendar for the days when I would force my husband to have sex no matter how tired he might be.

Later that night I realized that, once again, I was bamboozled into taking advice from a woman who could just look at her husband and get pregnant.  A woman who has no idea what we've been through.  

I want to be one of those women who lie on their back, snap their fingers and get knocked up.  And you know what?  That will happen.  It will happen when I lie on my back, feet in the stirrups and have a syringe inserted through my cervix and a embryo placed in my uterus. 

I'm tossing out all those supplements and erasing those  little stars from my calendar.

Knock me up, science!

Fact Sheets

Before I jump into this topic, let me just say that my last post bordered on the crazy-must have a baby-stereotypical infertile lady-edge that I so hate and I realize that.  Anyway......

Doing some research and have found plenty of disheartening and disturbing information about fertility testing and treatments on the American Society of Reproducive Medicine's webpage.  Interested?  Look here - Fact Sheets. 

Did you know that the ovary-stimulating medicine given to a woman who is participating in fertility treatments can sometimes cause her ovary to twist on itself, cutting off its own blood supply, thus requiring surgery to untwist it or remove it?  Jesus......

I want to pretend that IVF is gonna be cool and interesting, like that elementary school science project where you create a papier mache volcano and then make it explode......but my uterus is not a papier mache volcano. 

Oh, blissful ignorance!

Reproductive organs don't discriminate

This is what I have to remind myself of as we yet again receive a phone call with that bittersweet news - "I'm going to be a dad."

Remember....
Reproductive organs don't care if you love each other very much.
Reproductive organs don't care if you just bought a bottle of cheap wine and pity fucked each other.
Reproductive organs don't care if you have money or don't have money.
Reproductive organs don't care how old you are or if you have a nice car.

My asshole uterus certainly doesn't care what I want.  And my husbands balls?  They're doin' their own thing, regardless of what he wants them to do.

I'm working my way through these angry feelings.  Give me 24 hours.

Oh, reproductive organs...