Hello, Estrogen My Old Friend

I have a longer posting in my head, but haven’t quite gotten all of it together. However, I want to give an update. We started going in for monitoring appointments on Tuesday, and they seem to be going OK. I am continuing to have about 14-16 follicles. We are seeing growth of about 1 to 2 mm per day, which is on track. Right now my largest is at 14.4 mm and the smallest is about 6.6mm. Once we get at least two follicles to 18mm, we will be ready to give the final hcG shot to do the egg retrieval. They are projecting a Wednesday retrieval. Because it is the weekend I saw a different doctor this morning, and I don’t like her as much as my doctor. She is knowledgeable and nice enough, but she didn’t have the same compassion and empathy as Dr. NiceGuy. I was a bit worried because I had expected to be a bit further along today, and her answer was you are very average and should be OK, and then smoothed it over by telling me that in medicine average is good. I guess . . Hopefully, my average ovaries produce average follicles that will be put with average sperm and become an average embryo that will be implanted into my average uterus and become an average baby. I guess. . .

On another note, my old crazy friend, Estrogen, has come back and I am a bit on the edgy side. My estrogen level one week ago was 33. Now it is over 1100. In other words don't f*** with me right now. It has been a bit of a rough day, but Greg and I have come to a truce and he is being great. Some neighbors had us over for dinner, and it was great to get away and my mind off things for a bit. Now, we are back home enjoying handing out candy to the trick or treaters. Happy Halloween!

Numbers

I have had several different jobs in my lifetime and the one I enjoyed the least was Telemarketer. This was a pretty easy job to get when I was in college, and my roommate was making good money with it at the time (She’s a talker, and I still love her today for it.). Besides developing a thick skin, it was my first lesson in the numbers game. I cannot remember exactly how it goes, but for every 100 calls you make, 80 will hang up or tell you to go to hell, 20 will actually listen and 1 will result in a sale. I am not sure if that is exactly correct, but hopefully the point is clear. I learned that more I put myself out there, the more I had a chance of getting what I wanted, which at the time was to pay my rent and sorority dues.

Since then, I have applied this theory to other aspects of my life. When I moved to Seattle, I learned that the more times I put myself out there joining clubs, going to events and going out to new places the more people I would meet that could lead to more friends. I also, have used this when looking for jobs. The more companies I talked to the more I learned about what would work for me, thus find a good match for them and me. I met my husband online (I am not ashamed admit it.). I found the more men I talked to and dated, the more I narrowed down my tastes and preferences. I made it a rule to always be talking to a minimum of 5 guys at all times with at least one date or more a week. This resulted in my meeting the nicest, most compassionate and supportive man ever, and gladly accepting his marriage proposal a year later.

So, I find myself obsessing about the number of follicles I have ready and waiting to become mature by the nice and expensive drugs I am pumping through my body. Right now, it is a lucky number 16. (Brief fertility lesson – We are born with a certain number of follicles that turn into eggs that we are ever going to have. At the beginning of each cycle, the follicles that were scheduled for that month come up to the plate. These were the follicles that have been scheduled for October of 2009 ever since I was born. So, this cohort, which I believe is the term, are the 16 follicles that I am referring.) I have heard of some women having 30+ at this stage in the game. However, I think there is a point where having too many is not good with all the miracle grow drugs they give you. My number is perfectly acceptable; however, according my rules the more the better. I need to be happy with what I have right now, and try and distract myself. Therefore instead of looking at how many follicles I have, I am going to count how many pokes I have had (dirty), to get to this point. By pokes, I mean how many needles have I endured to date on my quest to have a child. Below are my calculations to date:

Blood draws: 16
Acupuncture: 162
Injections: 33
Total: 211

Now those are some numbers! That is what I am talking about! I hope everyone had a great weekend not obsessing about your numbers!

I Think I Might Have Been His First Too . . .

I think I might have been his first too. . . We went in yesterday morning for the suppression check and Dr. NiceGuy brought a resident in for the ultrasound. He looked more like someone that I needed to sit down and explain the birds and bees, then an expert on my whoo-ha and ovaries (it is still a strange experience for me to have doctors even look my age, much less like someone I may have babysat ). After we exchanged introductions and pleasantries, Dr. NiceGuy and Dr. YoungGuy began preparing the magic wand with a condom (for my protection) and some lube. Dr YoungGuy did an excellent job. He had a bit of a hard time locating my ovaries. However, with all the medicine, poking and prodding over the last year, my ovaries have been hiding the last few months. They are feeling a bit violated and wish everyone would leave them alone. This too has happened with the most skilled nurses and ultrasound technicians in the office before, so I will cut Dr. YoungGuy some slack. With some coaching from Dr. NiceGuy, the ovaries were found and there were no cysts, which is great news. It looked like there were about 16 resting follicles between the two ovaries. They always seem a little vague on this number, so it could be more or less, but I am going to go with 16. After consulting Google, it looks like this is normal for someone my age. It is not a stellar number like a woman in her twenties, but not something to be disappointed about either. The bloodwork to check my estrogen level came back showing that my reproductive system has in fact shut down, so we cut back on the Lup.ron to about a ¼ of what it has been (we continue with the Lup.ron so that my body does not ovulate on its own) and we started stimulation shots tonight. They also drew blood to make sure that I now have the antibody for the chicken pox and we will not get those test results back until Monday. All in all, I am excited with the news

From my previous experience with IUIs, I know that this stage can be a bit nerve racking. Not only is my body being pumped up with hormones, but it is now game time. Starting on Tuesday, we will go in every other day or everyday until the egg retrieval. We will be going in to monitor the follcles to see how they are growing. Once we get enough that are over 18mm they will do the egg retrieval. I am not sure of the number they will want over 18, so I need to research that. It is the time where I usually begin to start obsessing about how things are progressing. Since my follicles have stalled out before I worry whether or not they are growing and this time I am going to worry about how many too. Besides taking my shots, going to acupuncture and trying to relax, there is not much I can do about it. I am going to do whatever I can to get my mind off of it though. The plan this week is to try and go swimming twice, do yoga every day, walk most days, volunteer 3 days, read my trashy romance novel, work on my blog, regular house maintenance and finish organizing our office for my Mom’s visit. If anyone has any ideas of things to help take my mind off of it, I am open. I am also collecting movies to watch. Suggestions are always welcome.

My First

The first time I needed to find a doctor on my own, I called my Mom for advice. She suggested that I find a female doctor. Her theory was that a male doctor could never understand my body as well as a female. I have always used this as a rule when looking for a medical provider. I have a female dentist, female dermatologist, female therapist, female internist and female obgyn. When I originally called our Fertility Clinic, I was excited to be able to see a female RE. She left the practice in July and to be honest, I didn’t think she was the best doctor ever, so I was not completely disappointed. She recommended that I continue my care with Dr. NiceGuy in the same practice. . . a male. I eagerly accepted because he has an excellent reputation and has helped a few of our other friends achieve pregnancy after some long battles with infertility.

However, on the eve of my first ultrasound with the magic wand by Dr. NiceGuy, I am a bit nervous. Now, I am wishing I had broken myself in with at least a male dermatologist. I know it is completely silly and stupid to be nervous about a male doctor giving me an exam versus a female, but it seems a little weird. He is a kind, knowledgeable doctor with an excellent manner that immediately puts me at ease. I guess the good part is it is taking my mind off the fact that if all looks good tomorrow, we will be officially starting this. Tomorrow we sign on the dotted line that we are going to go through with this, we agree that they can take eggs out of me and sperm from Greg and unite them in a petri dish (romantic), that we will pay for it if the insurance doesn’t, and that we will pay a storage fee for any extra frozen embryos (God willing). It is kind of a big deal. It is exciting, but very scary at the same time. It could be the best thing we have ever done or it could extremely disappointing. So, in retrospect the whole male doctor looking up my hoo-ha is not that big of a deal. Plus, I know I will be in good hands, literally I guess. On that note, I will keep you posted.

Not Feelin' It

I live in Seattle . . . yes, it rains . . . it rains a lot and for the most part it does not bother me. I am originally from the Southeast, and I spend a fair amount of energy defending my decision to move to a dark, gloomy place on the other side of the country. The truth is I like the rain. I like that it makes the landscape lush and green all year long. I love waking up to hear rain drops on the roof and rolling over to cuddle up with Greg. I love the way the rain combines with the city lights to make the sky a beautiful orange and purple color at night. I love coming home, walking in our house from braving the rain, and feeling a rush of warm air making me feel safe and secure. I am not saying it is not annoying at times, but that it is tolerable and there are parts of it that I enjoy.

Fall is here now and we are starting to feel the real Seattle again after several months of warm sunshine. Last Friday was one of those typical Seattle days. I made sure to wear my good rain jacket and a sturdy pair of shoes to protect myself from the weather, as I hurried out the door to meet friends. I spent the afternoon with some girlfriends getting a massage and going out for tapas for happy hour. It was nice and relaxing and just what I needed to help ease my nerves and not think about the whole IVF process. While we were talking, one of my friends asked if I was OK that I seemed a bit subdued. I told her the truth the Lu.pron that I am taking right now to shut down my reproductive system is making me feel really flat. I am not happy. I am not sad. I don't feel either way. I then changed the subject because I just did not feel like talking about it at the moment. They gracefully dropped it because they have been wonderful to listen when I need it and to back away when I would rather not go there.

However, I began thinking about it more on the way home driving in the hard rain storm. I began to think, is it really the Lup.ron or is it this process that is making me flat? Whenever I have taken the Myers – Brigg test, I am always borderline introvert/extrovert. Sometimes it comes back as an introvert other times an extrovert. I do feel like this process has made me go inward more than I normally am. I am still reaching out to people for support, but I am really working at it. Honestly, I want to be alone most of the time, but I know that would not be good. I am really trying not to do that, but it is hard sometimes not to go into my shell. I do think some of it is all the medicine going in and out of my body; however, I think a lot of it is just the disappointment and anxiousness that goes along with all of this is staring to wear on me a bit. This is not what I thought IVF would be like. I thought that I would be an emotional grumpy mess. Of course, there is still time once they pump me full of estrogen. I could be begging for this empty feeling inside of a week.

As I continued to drive in the rain pondering these thoughts, one of my favorite songs came on the radio. “Babylon” by David Gray reminds me so much of my journey in rainy Seattle. The first year and half here were hard trying to find my first “real” job and making new friends. I thought it was never going to happen, but I finally found a job I loved and with it many great friends. The song was popular around the time that I started to really get my groove here. It reminds me that I went through something hard, but turned out to be one of the best decisions I ever made. It’s lyrics also remind me that I need to feel this and to remember it. I want to feel this and remember it, so that when my child one day is keeping me awake or talking back to me or just generally driving me nuts, I can remember what it was like to want them so badly that I did whatever I had to do to get them here. Once I reached the house the song ended and I gathered my things to go inside. I made a point of not lifting my hood to protect my head, but instead chose to let myself feel the now misting cool rain. It felt good, as anxiously opened the door to see Greg waiting for me to arrive.

“If you want it
Come and get it
Crying out loud
The love that I was
Giving you was
Never in doubt
Let go your heart
Let go your head
And feel it now”

David Gray

The Schedule

I want to give everyone an idea of what I will be going through for the next month or so. I realize that not everyone reading this blog is familiar with the ins and outs of IVF, so here is my brief amature explanation. The process starts with Birth Control pills and a drug called Lu.pron to shut my reproductive system down. Shutting it downs sounds counterintuitive; however, it helps to get more mature follicles and manipulate the cycle to prevent less complications. If everything shuts down nicely, they will turn me back on high with stimulation drugs to make follicles grow. I will continue on the Lu.pron to make sure that I do not ovulate on my own. We will go in for daily ultrasounds to watch my follicles get to maturity. Once things look good, we will do the egg retreival. Basically, I will be given the Michael Jackson drug (my doctor's words, I swear), and with an ultraound as a guide they will retrieve eggs. The embryologist will inject Greg's sperm directly into them, then put them in the freezer to grow for a few days. After a few days, they will check up on them to see how they are growing. Depending on how they grow and what happens, we could either transfer them back on Day 3 or Day 5. That was not as brief as I would have liked, but hopefuly you get the idea.

Below is a list of what my IVF schedule looks like right now:

9/2 – Met with doctor to discuss IVF option
9/16 – Start period
9/17 – Start Birth Control Pills (BCP) , Day 3 tests. FSH – tests ovarian reserve 4.43 (anything over 10 is bad), Estradiol (E2 or checking estrogen level) – 40 decent, but not great, Thyroid – looks good. Prolactin – Looks good. Test for communicable diseases for GHuman and me.
9/22 – Turns out I never had the chicken pox. Go get chicken pox vaccine to be done 30 days before retrieval. It can be dangerous to get chicken pox when you are pregnant.
10/11 – Start Lu.pron – Drug that works to shut down my natural reproductive system.
10/17 – Stop BCPs
10/22 – Suppression check to make sure my system has shut down, ultrasound to see how many follicles might be there and blood draw for estradiol
10/23 – If everything looks good at suppression checks, things are shut down and I have no cysts we will start stimulation drugs (crank her back up) to help resting follicles to grow. I will take 300 ius of Gonal.F and Menoupau.r
10/28 – Start Daily checks to see what follicles are up to, and once they are mature (18mm) then they will do the retrival.
11/3 – Estimated date of egg retrieval. Sperm is injected into egg via a procedure called ICSI
11/6 – If it is a Day 3 Transfer – They check on surviving embryos. If there are two that stand out over the rest, then they will go ahead and put them back in me. If there are more than two that look outstanding and perfect, they will wait until Day 5 to transfer. Statistically, half of the embryos are lost between Day 3 and 5, and they want to get the very best ones to transfer.
11/8 – If it is a Day 5 Transfer
11/18 – Beta – Blood draw to see if I am pregnant

This is what this look like today pending any changes. There are many things that could happen to delay us, but we will cross that bridge when we come to it. One day at a time.

A Little History

Even at the age of 36, my mother has the ability to embarrass me like no other. She reads the books I am reading to learn more about me, calls my phone without leaving messages at least once a day, tells stories about me to complete strangers and constantly comments on my Facebook postings (even though I have asked her to refrain). As much as she gets on my nerves, I know in the bottom of my heart it is because she loves me and for that I am truly lucky. She can be a bit over the top in her expressions of love, but I have come to realize it is not a bad thing. Not really. The upside is that no matter how down I feel I know I can call my Mom and she is there to tell me how fantastic I am just for being her daughter. She works hard at being a good Mom and as one of her daughters I can say she is successful and has provided me great memories.

One of my favorite memories of my Mother was the time she spent with my sister, Ninny (my name for her, as well as, for the purposes of this blog), and me singing when we were young. We sang in the car everyday on the 30 minute drive to work/school in the morning and 30 minutes on the way home in the afternoon 5 days a week. We had duets where she sang certain parts of the song and cued us when it was our turn. However, my favorite time of the week would be when she would get out her guitar and sing to us. The songs consisted of mainly The Beatles, Simon and Garfunkel and Peter, Paul and Mary songs. The song “Too Much of Nothing” by Peter, Paul and Mary was a song that always made the song list for our mini shows and we sang along happily with her. This song has been on my mind a lot lately for various reasons. My husband, Greg, and I decided about 2 years ago that I would quit my job, we would travel the world and when we were finished a year later I would hopefully be knocked and carrying our child. It was a fabulous plan that worked up until the getting knocked up part. It seems like that is taking a bit longer than we expected and as a result, I am doing “Too Much of Nothing” these days.

I am being a bit hard on myself though, for the last year and half I have been volunteering several days a week working with at risk children, researching graduate school programs and taking a few classes online to get myself ready. I also have had the wonderful opportunity to hang out with some great friends and play with their fabulous children. Last, we have been doing fertility treatments for the 8 months and that keeps me busier than you would imagine. So, I am doing something. This month we are starting our first IVF cycle and there is a lot to do get ready and keep track of all that needs to be done to be successful. Hopefully, this blog will also occupy some time while keeping family and friends up to date with what we are doing. Below is our infertility journey so far, to catch you up:

8/07 – Married 
12/07 – Quit my job and began traveling
5/08 – Last month of birth control, but not officially trying. We had to make sure I did not get malaria after a trip to Africa, so we used condoms in the meantime. Condoms suck when you are married. . . just so you know. Otherwise, I highly reccomende them.
8/08 – Officially started trying to have a baby
12/08 – Read Taking Charge of Your Fertility and start charting cycles and using a Fertility Monitor to pinpoint ovulation.
2/ 09 – Seek advice from Reproductive Endocrinologist (I am no spring chicken)
Lots of test on Greg and me - Sperm Analysis is good. HSG - a test where they shoot dye up your hoo-ha to see if there are any obstructions. Everything looks good. Lots of lab tests and everything looks good.
3/09 – Since we are no spring chicken we started Letrazole/Femera
4/09 - Letrazole/Femera plus and IUI #1(Intrauterine Insemination aka turkey baster with sperm inserted into my uterus = romantic)
5/09 - Attempted an IUI while doing ultrasounds to track follicle growth. Follicles stalled out meaning they did not get big enough to have a successful result. IUI canceled.
6/09 – IUI #2 with injectables and femara (lots of estrogen given to me as a shot in the abdomen or thigh to help follicles to grow) Follicles get to maturirty.
7/09 – IUI#3 with injectables and femera
8/09 – IUI#4 2 day back to back with injectables and femara
9/09 – IUIs are not working, we decided to move on to IVF. Started birth control pills to begin IVF (InVitro Fertilization – sperm and egg meet in a petri dish)
Full IVF schedule in another post

Besides a few slow growing follicles in May, we do not have a clear reason why this is not happening. However, we have faith that we will be parents with some patience and prayers one day. When it does happen, I am sure that I will love them so much that I will embarrass them on a daily basis. Until then, I am going to enjoy my time doing Too Much of Nothing.

“Too much of nothin' can make a man feel ill at ease
One man's temper might rise, while the other man's temper might freeze.
In the days of long confessions, we can not mock a soul
When there's too much of nothin', no one has control.”

Peter, Paul and Mary