It's getting nice out so soon this year.  Flowers are blooming, birds singing.  With it being winter, the past few months I've spent most of my time inside and haven't really ventured out much.  In fact, I can't say that I've done many things I once considered fun and honestly I can't say the weather has much to do with that.  The other day I decided to go for a walk since the weather was great.  I thought it would be a nice change and thought it would be helpful to take my mind off things.  But I couldn't help to notice children playing in their yards, Dads throwing ball to their kids, or mothers pushing their strollers through our neighborhood.  So much for getting my mind off things.  The fact is that practically everywhere I go and everything I do inevitably has some reminder of what I don't have and what I'm going through.  I can't complete a shopping trip without noticing babies being pushed in carts or accidentally walking through the diaper isle.  I can't drive home from work without seeing a daycare or children scurrying home from school.  It's completely unavoidable.  Things that I was once oblivious to I have now become so incredibly in-tuned and sensitive to.  It's not normal for me to cry over a Huggies commercial.  I wonder what has happened to me.  I am no longer who I've known my whole life.  I don't know this person and most of the time don't like being this person.  Like many dealing with our situation, the struggles of infertility have consumed my life, my entire being.  I struggle to have some sense of normalcy in my life and struggle to enjoy the people and things I once used to.  On the brighter side, I know that this will forever change who I am and not all of it for the worse.  Adversities in life somehow and in some way make us learn alot about who we are and who we want to be.  I can only hope that with all these struggles, I will become a better person and also help a person or two along the way do the same.  


So while I'm dealing with preparing for more upcoming treatments and more poking and prodding into my life and what was once considered private areas, I am also learning to find my way and enjoy life like I once used to.  It's quite a daunting task since I have daily reminders of what I don't have.   I feel like everyone else around me is living and enjoying life, while I am stuck still, not moving forward.  Everyone is moving forward, doing things while I am here in the same idle position, going unnoticed.  This holding pattern I'm in seems to last a lifetime.  Our time is little here on earth and I want to be able to enjoy it while I'm here, however the circumstance I'm in makes it nearly impossible.  I know this too shall pass but like I said, it seems like a lifetime.  


To make matters more difficult, even little things I used to like such planting a garden can take some amount of money.  The fact of the matter is that if we need IVF treatment, it's very expensive.  Each few dollars I spend on something else, takes more time for our chance of our hopes coming true.  We planned and paid for a vacation a few months prior to receiving the news that IVF may be our only option....other than waiting the months or years it could take to happen on it's own.  As much as I'm annoyed I spent money on something I don't really need as it could have been better used towards treatments, I can say that I'm looking forward to it.  Most likely for the next several months I'll be working 6 day work weeks and this may be our only break to slow down a little.  I have many regrets about alot of things...not trying for children sooner, spending money that wasn't essential for home upgrades, and letting myself get into the mental state of mind I'm in.  But I can't take it back and I can only move forward from here.  


I write my thoughts down on this blog as a form of "therapy" I suppose.  I don't think I've ever been depressed....at least not for more than a few days.  I hope that by saying what's on my mind will help me to let some feelings go.  It's important for people to understand that while someone may look okay on the outside, you don't always know what's going on inside.  I'm not just talking about myself either.  It should be a lesson learned for all; until now I never really gave it much thought that someone I know and love could be going through something terrible without me ever knowing or understanding the severity of it.  Different things impact people differently.  While having children may be the single most important thing in my life, it doesn't necessarily mean that it's someone else's.  Part of the reason I do this for all to read is to give others and understanding of how our situation impacts my life and also the lives of others dealing with these struggles.  I think because people don't feel comfortable talking about it, it goes unnoticed.  The person in this situation could have just as easily have been you, so lesson learned is to try to be more intuitive and sensitive to others because you never know what they are dealing with.  

CHANGE OF PLANS:

  This past week my doctor and I spoke about all of our options.  Last Friday, when I was told my negative results of our second IUI, his colleague spoke with me and gave me the advice to stop doing the IUIs and move onto IVF.  I too agreed since all the research articles I read thought the same.  We were both devastated to hear the news that pretty much all our months of trying and all the doctors visits were all for nothing.  We still weren't pregnant.  We know it will be a huge financial struggle to afford doing IVF and will need to work hard to save the money over the next few months.  It seems very daunting, especially since there's no guarantee it will work. It's also concerning that in the meantime time is ticking.  

   While I respected Dr. Sobel's opinion, I wanted to confirm this with the doctor that originally met with us.  On our first meeting he promised me that if I had any questions or concerns, he would address them immediately and return my call that day if possible.  He was right and he did; I can't tell you how much that means. He too agreed that completing the IUIs will not change Chris's sperm morphology which is essential for fertilization. However he did state that by doing nothing, our chances are even slimmer.  While the IUIs probably won't work, there's always that very small chance and that it is still more of a chance than we have on our own.  My insurance covers the majority of 6 IUI procedures...after that we are on our own and must self pay for any other treatments including IVF.  He suggested finishing the remaining IUIs since insurance covers most it and it won't set us back much financially.  There's still a small chance of it working.  If they all fail, then we have no choice but to move on to IVF.  My thoughts were that we couldn't afford IVF treatments until a few months anyways.  Rather than doing nothing in those few months we may as well try and have a little faith.  The only thing I have to lose is getting a few emotional scars along the way.  Each month is alot of running around to appointments and is also a huge emotional rollercoaster ride.  The ups and especially the downs are more than I can bear sometimes.  So it was easy to agree with Dr. Sobel and give up on the IUIs.  If I don't try then I won't be disappointed.  After my initial hurt over the last negative result, I had to pick myself up, dust myself off and gain the strength to start it all over again.  We missed out this month, but will pick up the IUIs sometime the beginning of April.  I must say that I needed this month off.  In the meantime we are still trying to diligently save money for the worst case scenario.  We will be prepared to move onto IVF if need be.  As a healthcare professional myself, I know all too well that each of my colleagues can differ on opinions on how to best treat a patient.  There are many roads to get to the same destination.  So I'm not angry about the difference of opinion between the two doctors.  

WHAT IS AN IUI?

IUI is a procedure where they take Chris’s sperm and inject them directly into the uterus.  The idea is that the sperm have less distance to swim.  By putting them closer to the "target", it may help increase chances.  It works best for cases of low sperm count, or if they are poor swimmers...not so much for deformed sperm (poor morphology).  The first few days of my cycle I must go to the doctor for initial bloodwork to assess hormone levels and for an ultrasound to assess ovary function.  Day 5 to 9, I take a medication called clomid to help the ovaries produce multiple follicles (each follicle houses one egg).  Typically during a cycle, only one egg is released, however with clomid you get a few more (around 2 to 3). This may somewhat increase the chances.  Some women require increased milligrams of this medication to achieve this affect.  Some side effects of clomid include abdominal or pelvic pain, breast tenderness, mood changes, hot flashes, multiple births, nausea, vomiting, visual disturbances and a condition call OHSS or ovarian hyerpstimulation syndrome, which could require hospitalization.  Research is controversial as to whether or not clomid causes cancer.  I'll take that chance.  Some women who undergo IUIs are required to take stronger injectable medication such as Lupron in order to produce more follicles.  I've been pretty lucky because I respond favorably to Clomid and have not experienced many of these side effects.

About a week later, I return to the doctor to have more bloodwork and an additional ultrasound.  They assess the ovaries to see how many follicles were produced and the maturity of the follicles.  If the IUI is completed too early or too late, ovulation may be missed and therefore no baby made.  Once the egg is released there is only about a 12-hour window to complete the procedure and fertilize the egg.  The egg will die in 12 hours of being released if not fertilized.  Also, just because you have a follicle, there is no way to check and guarantee that it contains an egg inside or the quality of the egg.  Immature eggs are incapable of being fertilized.  They measure the size of each follicle to give them an idea when the follicles are mature enough to cause ovulation. A good follicle will measure 25 mm.  If they are large enough, the IUI will be completed in the next day or two.  If not, then I must return for additional ultrasounds to continue to monitor follicle size. It is imperative they don’t wait too long or ovulation will be missed and the procedure will be cancelled.  To ensure the likelihood  this does not happen, I must give myself a “trigger shot” of HCG (human chorionic gonadotropin).  It’s a small needle injected into the stomach or thigh.  Being a needle phob, I was terrified of this.  In the end, the first time I had to get a friend to do it for me.  HCG triggers ovulation within 38 to 40 hours.  This is when the IUI will be completed.  It can be a bit annoying to have all this work around my work schedule.  I can't speed up or slow down mother nature and when I'm ready I have to take time off of work.  

The following day, Chris produces his “sample” which I'm sure places him under a great deal of pressure.  I have to keep it warm on the drive to the office to ensure the sperm don’t die and only have a half hour window to get it to the office.  Upon arrival they place the specimen in a special machine, kind of like a centrifuge, that spins and “washes” the sperm.  This ensures that most of the sperm they are using are “the good ones”.  This process takes a little over an hour. Sperm must also be washed because raw semen cannot be inserted directly into a woman’s uterus. This is because semen contains chemicals called prostaglandins. Prostaglandins cause muscular contractions and are responsible for cramps during menstruation and pregnancy. If raw semen is placed directly into the uterus, rather than going through the cervix first, it could cause severe pain and cramping. It could also cause the uterus to collapse, causing severe complications.  After washing is complete, most clinics want at least 5 million sperm…remember normal is 20 and above.  From the research articles I have read, pretty much all state that less than 5 million has a 0% chance of working.  Our last procedure we only had about 5 million. 

Once the machine washes the sample, it is placed into a flexible catheter.  The catheter is inserted through the cervix which is very uncomfortable and causes moderate pain.  After the sperm are injected you must lie still for 5 minutes, then are discharged home to hope the sperm works it’s magic within the next 12 hours.

There is no way to tell if you are pregnant until about 2 weeks later.  Fertility specialists term this the 2 week wait (2WW).  If your cycle starts before the 2 week mark, the procedure failed.  If you make it 2 weeks, a blood sample is taken to see if you are pregnant.  Often home pregnancy tests cannot detect pregnancy this early.  Also, if the HCG trigger shot was administered, you could get a false positive.  Blood tests are also more reliable than urine tests.  The blood pregnancy test checks for beta HCG levels.  If you have a certain amount, you are pregnant.  

I'm lucky to work with all women.  Imagine explaining why you're missing work to a male boss?  Many of my appointments are at 7:00 am, which is when I start work.  If you didn't tell them what you're up to, I doubt they'd believe you had a doctor's appointment that early.  Being in the health care profession, most offices don't open till 8 or 9.  While at first it was quite embarrassing, it's become the norm for me to have one sentence with the words sperm, ovulation, insemination, and so on.  The nurses and doctors see pretty much everything and know pretty much everything about your business.  Other than inviting them into your bedroom, they know it all.  So with all that you get used to it pretty quickly.  If I talk about things that make other people uncomfortable, then it's their right to let me know.  All this is a fact of life and so I think that they are the ones with the problem, not me.  Life's conversations aren't always about unicorns and rainbows.  Don't listen if you don't want to hear. 

Last Friday was the worst day of my life.  I've dealt with some difficult circumstances before, but I can honestly say this was the worst.  The fact is that I have to keep re-living the worst day of my life every month I find out I'm not pregnant.  This past Friday was different.  You see, I had my second IUI Feb 24th and was waiting two long weeks to see if my blood pregnancy test came back positive.  I had a feeling it would be negative since the nurse doing the procedure was highly discouraged with Chris's sperm count.  A minimum of 5 million are required for most IUI procedures and we barely scraped enough together.  Normal is 20 million or more.  I like to keep myself educated about things.  The better informed I am, the more I feel in control.  Being a physical therapist I have access to Medline so I looked up articles about achieving conception with poor sperm morphology.  I don't solely rely on Google searches because not everything you read it true.  From what I've researched, the chances of conceiving with our numbers has been 0%.  Also, most articles suggest that IVF with ICSI provides the best chances.  IUIs are virtually pointless for our problem.  But I guess if you don't try, you don't know.


So anyway, I had my blood drawn at 7 am Thursday morning.  I couldn't take the agony of waiting so I cheated and took a home pregnancy test the night before (13 days post IUI)...it came out negative.  They say it's possible to have a positive test 13 days after the procedure but recommend waiting at least 2 weeks for accurate results.  I was disappointed but in my mind I convinced myself there's always a small chance of a false negative.  I went to work Thursday, didn't sleep but about 2 hours that night, and went to work Friday and waited....I waited 36 hours.  At 3:05 I got the call from the doctor.  I could tell from the minute I heard the sound of his voice that it was not good.  He delivered the bad news.   I wouldn't want that job.  I felt like I was just told I received the death sentence or was given the diagnosis of terminal cancer.  I was sitting at my desk at work and thank God was at the end of my day.  I wanted to throw up and crawl in a hole.  I mustered every ounce of courage I could to hold my head together and not cry.  We talked for awhile and he confirmed my suspicions that the IUIs weren't working and we should consider IVF if we want children.  I don't remember the walk to my car.  I don't remember the drive home.  I'm not much of a cryer, especially in front of Chris but these days the tears have been flowing endlessly.  I do my best to keep them flowing in the privacy of my own home because I know it's awkward for others.  I was so pathetic Chris had to pick me up off the bathroom floor after I sobbed my eyes out.  The last straw was that I just started my cycle and the failure was again confirmed.  How could this be happening again?   My mind knew that the chances were bleak, but in my heart I let myself hope and believe it could happen.  Again my hopes and world came crashing down in a split second.  But I can't feel sorry for myself and I need to regain composure and strength in order to pick up the pieces.


So now what?  Our first step is to complete another test called a sperm penetration test (SPT).  This is the craziest thing I've ever heard but they use hamster eggs (yeah, the rodent we all had as childhood pets) and test Chris's sperm to see if it has the ability to penetrate the egg wall.  If it does, there's a very small chance doing what we're doing now could work after a few years to months of trying (clearly it must take awhile since it's already been 19!).  If his sperm are incapable of penetrating the egg, it confirms that they will have to have an additional procedure called ICSI with our IVF.  For basic IVF, they harvest my eggs, retrieve them surgically with a long needle and then place them along with Chris's sperm in a petri  dish to do their thing.  Romantic right?  Not the picture I had in my mind how I'd conceive my child.  If his sperm can't penetrate the egg to fertilize it in the uterus, it won't happen in the petri dish either.  To solve this problem they use a special needle and inject one sperm into each egg for and additional cost of about $1,500.  Basic IVF costs about $10,000 per fresh cycle, excluding medication cost.  Step two is to set up another meeting with the doctor to go over everything and then set up a meeting with the financial people to help figure out how we're going to pay for all this.  While we want a family with all our hearts, we are responsible enough not to go into debt to do it.  I want to enjoy my baby when it's here and not be stressed about money.  I'd sell my liver if it would help.  Step three is to save money by working.  I work full time as a physical therapist and also have a part time job 2 Saturdays a month at another clinic.  I've decided to take on a third job on the remaining weekends doing per diem work at the hospital.  That'll mean working every weekend for awhile, but it's temporary and the only way.  Chris will do overtime and possibly look for a part time job but if unable we've decided he'll have to be Mr. Mom and take over all household chores.  We've thought of other ways such as fundraising money, borrowing from our retirement or even selling my eggs.  So far nothing has panned out for alot of different reasons.  Hard work and determination is our only ammunition to fight the battle.  I haven't begun to think about any steps beyond that like what happens if I'm lucky enough to get pregnant, or what if it doesn't work, how will we afford this all over again, what if we have to live without ever having children?  Right now I can only deal with this and we're doing the best that we can.  I'm still angry that so many other couples have it so easy and seem to take what they have for granted.  For example, I hear parents commenting how annoying it is to pull an all nighter for a sick child.  What I wouldn't give to deal with a vomitous, cranky, sniffling child!  So all you parents out there, learn to be thankful for what you DO have.  You could be us.  


I remember months and months back when we first started to consider trying how we were ever going to afford daycare costs in our area ($1000 to $1200 per month).  I knew we'd have to make sacrifices and I was finally in a place in my life that I was okay with that.  While it's important to be prepared, I realize how trivial all that seems.  Now, that is the least of our worries.  I can only hope and pray that if we are lucky enough to have children that I will remember these days.  


We have a mortgage and are unable to refinance as our house is worth less than what we bought it for.  We have little credit card debt, but unfortunately have school loans. Both our cars are over 10 years old so we are also worried about that.  We have a few house projects we wanted to finish but they were started before we knew all this would happen.  They'll have to wait.  We were lucky enough to acquire a time share before all this happened and have talked about selling the whole thing, or even a week of it, however due to the economy that may not be possible.  At the time we purchased it, we didn't count on having to save money for a fertility fund.  I wish I could take it back, but hindsight is 20/20.  We're going to try everything under the sun other than asking and begging on the street corner for money.  That'll be our last resort.  We want to do this the right way if at all possible.  If anyone has any suggestions it would be greatly appreciated. 


So temporarily until we can finish our last medical test and save money for IVF, we are in a holding pattern.  For a little while we will not be able to receive any treatments.  We are completely on our own, the way it used to be.  The only difference is this is looming over our heads.  While we save, valuable time is being wasted but there is no other choice.  Most people needing IVF go through the same thing.  In the meantime, besides working 3 jobs, I'm going to do some reading on the matter.  I've even considered joining the support group at our fertility clinic.  This has finally taken it's toll and I may have to break down and seek more structured help.  Alot of people have been kind and supportive along the way (my mother in law, my sister Darlene, my co workers, and countless friends and even strangers that have learned my story from facebook).  Thank you because without your little words of encouragement and interest in what's going on I'd be traveling down a much darker road than I currently am.  


I plan on blogging regularly as it's therapeutic for me and also offers others to learn from my perspective how dealing infertility can change a person.  It also provides me a way to educate people.  Sometimes the things we fear the most are what we don't understand.  I could take the path more travelled and keep my feelings to myself, but what good would that do?  I'm choosing the path less travelled.  

September 2010 to November 2011: 14 months of trying to conceive by ourselves =    FAIL
December  2011: Clomid cycle =                                                                                   FAIL
January 2012: another month of trying natural conception =                                          FAIL
February 2012: IUI number 1 =                                                                                      FAIL
March 2012: IUI number 2 =                                                                                          FAIL

Is anyone sensing a trend?  Counting 19 consecutive months of failed attempts.  Yesterday we again got the opinion of our reproductive endocrinologist that we should consider IVF.  Although we were originally told that we should try 6 IUIs, because the sperm morphology is so bad, they recommended we stop where we're at now an consider other options.  When I heard him say that without IVF I most likely will not have children, I couldn't breathe, think, feel.  I wanted to throw up. While the chances are better with IVF, there is still no guarantee.  We are classified as having severe male factor infertility and fall within the small 3% of people with infertility that need IVF.  Lucky us.  There are no medical treatments for poor sperm morphology.  As discussed with our doctor, IUI doesn't help increase morphology or our chances.  I'm not sure why they even suggested it in the first place then. If we had any other problem with me or with Chris, we would be great candidates for IUI.  We have the one diagnosis where it's pretty much a guaranteed failure.  So why the big deal?  We are lucky enough that IUI is mostly covered under my insurance plan for 6 trials.  IVF is not.  The process in time consuming and invasive.  Minimum cost per trial is around $15,000....medication alone costs between 3 to 5 thousand each month.  Sometimes it can take up to 3 trials.  While we have good jobs and make a decent living, we don't have that kind of disposable income.  While we wait and save, we are wasting valuable time.  We are beyond angry that it's so easy for alot of other people to have children.  It's not fair.  Why is it so hard for us?  It's not fair that to even have a chance of a family we have to pay thousands and thousands of dollars.   We never thought this would happen to us so we’ve never planned for it.  Who does?  Most people our age are figuring out how they can put money away for retirement, home upgrades or how they are going to pay for their children's education.  Instead, we are budgeting for our fertility fund.  


It's starting to take a toll on our marriage. In my earlier posts, I said that this process is unique because it can both pull you closer together and tear you apart at the same time.  Funny how that is.  I wish the problem were with me.  I think we'd have better chances that way.  I'm not angry at Chris whatsoever but AM angry at the situation.  The problem could easily be with me and also isn't his fault.  But I am human.  I can't help to feel resentful towards him as hard as that is to admit.  I can't help to think that things would be different if I married someone else and that if it weren't for him, we would be in  a place.  It's raw, unfiltered feelings.  I love Chris with all my heart.  Clearly I am not with him for his hair or his money but because over the last 12 years I grow to love him more and more each day.  OK, maybe not on the days where he does something stupid, but most days.  He tries, but he's a guy.  It's expected he can't relate to this as much as me and that's hard to deal with sometimes.  He's the one and only person that has a real understanding of how I feel.  I'm an independent person and don't like to be told what to do and I don't like sharing my "real" feeling with people....even my own husband.  This process is helping me to let all that go, let him and others in, and learn that having and sharing feelings is ok sometimes.  I am slowly learning to rely on him for support and ultimately I hope that will win over everything else to keep us together through all this.  If this is God's way to teach me a lesson, it's pretty cruel, but working. 


As the number of failed attempts grows, I become less hopeful.  I can count and recollect each and every of those 19 times.  It's easy to get discouraged.  Each month is an emotional roller coaster ride.  Some days I am hopeful and some are filled with despair.  But inevitably, each and every month I start my cycle and there is no baby.  The room next to ours still remains empty.  Each month I inevitably receive this painful reminder.  The days leading up to the start of my cycle I can't help but to grow excited and hopeful that this will be our month.  Each month my hopes come crashing down.  I can't tell you how bad that moment feels and how long it lingers.  Sometimes I can't breathe.  It is so incredibly difficult to go to work every day and have to pretend everything is ok.  I can't cry in front of my patients.  While I may seem fine on the outside, some days on the inside it is taking every ounce of courage I have just to make it through the day.  Sometimes while I have conversations with other people about different things, I'm STILL thinking about it.  I can't get it out of my head.  I'm not an emotional person in the respect that I cry easily in front of others, but some days it's all I can do to hold back the tears.  

Take a moment to consider the life of someone with a chronic illness like MS or someone paralyzed with a spinal cord injury.  Mostly these are not life threatening illnesses. But who could argue they are earth shattering and life changing. . .In our lives, in our marriage, this IS earth shattering and life changing.  Chris is great with children and no doubt will make a terrific father.  In the past,  I on the other hand, never really liked being around children so much.  I don’t know when or what changed.  I love my child so much already and they aren’t even born.  Sometimes the things you can’t change in life end up changing you.  I don't want to compare myself with people that have these terrible diseases but I can honestly empathize with some of what they must feel and how out of control they feel of the situation sometimes.  As a physical therapist that treats these types of patients, I am glad I've acquired this skill to make me better at my job and a better person.  But why is it that insurance covers majority of medical treatments for these people and not for someone with a disease of their reproductive system? Each of our bodies has about 12 systems, with our reproductive system being one of them.  Insurance often covers everything under the sun for every other system expect the reproductive system.  Only recently was it recognized that infertility is a disease of the reproductive system.  Why do other non life threatening diseases get so much attention and medical coverage? Why is it ok for someone suffering with a life changing disease like arthritis or parkinson's to talk about their feelings so openly but the same isn't as acceptable for someone with a reproductive disease?  Just because you can't see it doesn't mean it doesn't exist and  hurt.

I can't count the number of times I've heard someone say, "don't give up hope" or "it'll all work out".  I'm not a pessimist but a realist.  I’ve always been really hopeful I’ll win the lottery or have a supermodel figure and clearly that hasn't happened yet either.   I'm still waiting on the boob fairy to fly my way also.  Advice like that, while meant to help, sometimes trivializes what I feel and is just meant to place a bandaide on a gaping wound.  I know I have to have hope, and I do.  But unless you can say you’ve dealt with the same consistent heartache month after month you don’t have room to judge my "pessimism".  It’s easy not to look up when everything is down.  While everyone can hope it all works out, can anyone guarantee that?  Only God can.  Each month I hear those words, it's like a broken promise because each month it's not ok and it's not working out.  Like I said, I have some hopes too but no one else but me and Chris has to have those hopes come crashing down month after month.  Sometimes it's just easier to be a little less hopeful because by being prepared for the worst, you protect those feelings a bit.  Alot of people have told me stories of how they know someone who went through the same thing and now they have children.  That's great for them but not everyone is that lucky.  There are also many couples out there who don't have that great story.  No one talks about them.  There's always that chance we could be one of those couples.  I know I'm giving mixed messages:  I want and accept support but at the same time don't always like what I hear.  I guess it's the nature of the circumstance.  Through all this some of you have been such a great support and I am very thankful.  

RESULTS


Back in December the majority of our testing was completed.  We had an appointment December 27th with Dr. Schinfeld to review our results.  I remember struggling through the holidays because the unknown of what could be the problem was killing me.  I needed to know.  Christmas day was especially hard because the Christmas prior I remember thinking that this time next year we'd have a baby.  Not so.  I tried not to get jealous of Chris's brother who has two beautiful little boys.  I wanted to play with them but it's a difficult and rather painful reminder of what we don't have.  I too wanted to experience what's it's like to take my kids to the grandparents for a fun day and spend family time together.  Instead, Chris and I came empty handed.


I remember being so anxious the weeks prior wondering what could be wrong.  As reality started to hit home that we really had a problem, I became obsessive about learning possible causes for infertility.  I already knew that most of my other tests came out with good results.  While you may think this is good, it's actually more difficult to treat unexplained infertility.  How can they fix something when they don't know what's broken?  Statistics show that couples with unexplained infertility have a more difficult time conceiving. I was absolutely convinced this was our problem.  As I suspected, my results were normal...plenty of eggs, no tubal blockages, no cysts or fibroids, normal hormone levels, I'm ovulating, no genetic disorders or STDs and no scar tissue.  Unfortunately there is no test for endometriosis so this is always a small possibility.  As far as I know it can only be diagnosed through exploratory laproscopic surgery.  At the time, our doctor didn't feel this was necessary since the tests were normal and I'm pretty regular with my cycles and ovulation.  So onto Chris.  Chris's blood tests came back normal, however from the semen analysis he was diagnosed with teratozoospermia.  As much as it was difficult to hear we had a problem, I was relieved they at least found the cause of all our months of heartache and anguish.  I can now empathize a little with people who have unexplained and undiagnosed diseases.  




Semen is analyzed for the following:         
Total volume :  normal is between 2-5 ml..........Chris's was a little below normal
Total sperm count:  normal is over 20 million per ml. Oligospermia means low count ..........Chris had    
     an outstanding 108!                         
Motility (are they swimming)?  Obviously you want good swimmers.  Sperm are graded A, B, C, and D.
       A means you have a great swimmer that swims in a straight line 
       B means the sperm are swimming in crooked lines
       C means they are moving but not swimming forward
       D means they are not moving at all
      While not 100% normal, most of Chris's were pretty good swimmers 
Morphology (shape of sperm):  Sperm are supposed to have one  oval shaped head and one long tail.      
    They are assessed by head deformities (such as a cone head), midpiece deformities, or tail deformities (such as having 2 tails).  These deformities can cause the sperm to swim poorly or have the inability to penetrate the egg.  The standard of assessing morpholgy is via the Kruger Strict Morphology.  
    Over 15% is normal, 5% to 14% is sub optimal, and less than 5% is poor often requiring IVF with ICSI (intracystoplasmic sperm injection) to achieve conception.  Chris fell in the 2 to 4% range. So we had a diagnosis.  Teratozoospermia, or abnormally shaped sperm.  




While Chris isn't as active with this blog as I am, he supports me and feels it is a good idea.  I can't speak for him and how he feels, but I'm sure there's alot of weight on his shoulders.  We have learned there is no cause for teratozoospermia...it's not something he did, ate, smoked.  It just happens and medical research is not advanced enough to determine why.  For all they know it could be genetic or the way he was born. Sadly, there is no cure.  Besides being sterile, it's the worst case scenario.  If it were any other problem, it could be fixable. I think we are at least both relieved to have an answer but at the same time a little pissed since we both come from a family of "fertile myrtles".  Why us? What did we do?  Since it's not something that can be changed, we have few options.  Two to be exact.  Our first is IUI or intrauterine insemination and the second and more expensive is IVF with ICSI.  So we are now in the process of completing a few rounds of IUI.  I'll explain them later in my upcoming posts.  I'm hoping and praying with each breath that one of them works.  






                                                                                               

What is infertility and when should you consult a specialist? 

       According to the Resolve Website, the national infertility association, “Infertility is a disease of the reproductive system.  1/3 of infertility can be attributed to male factors, and about 1/3 can be attributed to female factors.  In about 20% of cases infertility is unexplained, and the remaining 10% of infertility is caused by a combination of problems in both partners. It is diagnosed after a couple has had one year of unprotected, well-timed intercourse, or if the woman has suffered from multiple miscarriages and the woman is under 35 years of age. If the woman is over 35 years old, it is diagnosed after 6 months of unprotected, well-timed intercourse."

What brought me to Abington Reproductive Medicine?

       Typically I avoid going to the doctor.  Everyone at work was required to have a physical with our family physicians and I thought to myself that I may as well quit procrastinating and bring it up.  At the time we were trying for well over a year.  She recommended University of Pennsylvania or Abington Reproductive Medicine, both of which are very reputable.  I chose Abington simply because that’s were my insurance dictated where I go.  According to US News and World Reports, at least two of their doctors (Dr. Schinfeld and Dr. Somkuti) are among one of 304 nationally recognized doctors in reproductive endocrinology. My doctor, Dr. Schinfeld, is also recognized in Philly Magazine as one of the top docs in the Philly area in reproductive endocrinology….not too shabby for my insurance coverage.  He completed his training at Boston Hospital for Women--Harvard Medical School.  He is the founder of Abington Reproductive Medicine, and is the Director of the Division of Reproductive Endocrinology and Infertility at Abington Memorial Hospital in Abington, PA.  He serves as Clinical Professor at Jefferson Medical College, and Adjunct Professor OB/GYN at Temple University School of Medicine.  Needless to say I feel I am in good hands.

My initial consultation:

            Prior to my appointment I was emailed a large amount of paper work including a very extensive medical history form.  It asks questions such as allergies, prescriptions drug use, illegal drug or alcohol history, ethnicity of both mother and father, a large section on family history including and genetic disorders such as Downs syndrome, history of STDs, and other embarrassing questions relating to sex and bodily functions I’m not at liberty to discuss.  They want to know it all.  From that moment I knew this was going to be quite the task to let a complete stranger know more about me than I know about myself.  In the end Chris and I  knew it was the only way.

            So I met with Dr. Shinfeld myself…Chris had to work.  Together we reviewed our history for accuracy.  We sat in this office, not in an exam room, and talked for a little over an hour.  He explained the general concepts of what they do.  He’s a bit quirky, but like most smart people, you’ve got to expect that.  He seemed to have good beside manner.  He then asked if I had any questions. Strangely, I couldn’t think of many.  I didn’t do my homework because somehow I thought this still really wasn’t happening and everything would work itself. But now I’m not so sure. 

            At the end of the consult they do an internal ultrasound to assess your ovaries and make sure you aren’t pregnant.  Believe it or not, it’s happened to some lucky women on their first consult. I couldn’t tell you how hopeful I was and then how disappointed I was to find out that was not the case. The final part of the appointment was a urine sample and drawing of about 15 vials of blood.  Anyone who knows me well, knows what I will do to avoid needles.  I can’t even begin to tell you how incredibly anxious I get.  From the blood, they check for STDS which could impact fertility and complete genetic testing. I swear they took enough to clone me.

         The first 2 weeks I visited the doctor 6 times for additional testing.  I can remember it being very stressful to rearrange my work schedule but luckily I am blessed with great co workers whom I consider good friends. It was crucial that certain testing was done on very specific days of my cycle for accurate results…times of appointment were not flexible due to the nature of the tests. 

Additional Testing:

       Since part of the reason for this blog is to help educate others, I’d like to share a synopsis of some of the tests.  I hope it gives you an appreciation for the science behind this technology as well as how hard some were to go through. 

1)             Clomid challenge test:  A test to look at ovarian reserve (how many eggs do I have?). I was placed on oral medication (Clomid) for 5 days.  Clomid stimulates the ovaries to produce eggs.  Side effects are horrendous and numerous but glad to say I didn’t have any. After the medication is completed additional bloodwork is done to assess your FSH (follicle stimulating hormone) levels.  The lower the FSH level the better, meaning the more eggs you have.  FSH, secreted by the pituitary gland, promotes development of a follicle (the structure that houses and releases the egg each cycle).  If there is a large quantity of FSH, it is the brains way of saying…."you don’t have a lot of eggs left so hurry up and use them".  You’d think it would be the opposite.  

2)             Hysteroscopy-  Evaluates in inside of the uterine cavity (endometrium) for polyps, scar tissue, or fibroids with a hysteroscope (device with a telescopic camera).  These things often prevent a fertilized egg from implanting in the uterus.  Due to the invasive nature of the test, it must be completed early in the cycle to prevent miscarrying should you be pregnant.  Antibiotics are also taken for several days to prevent infection. I believe this is when I had a loud wake up call because I can honestly say this was the most traumatizing experience in my 33 years of existence.  I went by myself…the doctors say it’s pretty “routine” so I assumed it was no big deal.  I took their word and didn’t do my own homework.  Stupid.  Sure it’s routine for them because they do this everyday…not to mention none of them have a uterus.  I should’ve known then.  The test is performed in an outpatient surgical center.  After completing additional paperwork, I was taken to a room, dressed in a gown, placed in a bed and waited.  Nurses, dressed in surgical attire, wheeled me into the surgery room.  The hysteroscope (for those curious enough, you should google it to see this thing) is inserted through the cervix.  Fluid is injected into the uterus to help get a clearer picture with the camera.  They also scrape the uterine lining for a biopsy.   
                         25 years ago I had appendicitis and I remember that pain vividly.  I'm not a larger person but during the procedure a nurse had to physically hold me down.  I even remember the nurse "trying" to be helpful and keep me engaged by saying, "But look there's your fallopian tube."  Like I cared at the time! I didn’t expect that amount of pain because I wasn’t told to.  Later, I’ve read that this test can be more painful than natural childbirth.  Somehow, still in some pain, I managed to drive myself home, crying all the way.  The bad news was that the next day I had to have a similar procedure.  I was beside myself, crying for hours and contemplated calling all this quits.  In the morning, on my way to the next procedure, I was crying on the phone to the nurse.  Later I found out I had the option of receiving general anesthesia…I was so angry, and still am, that this was not disclosed to me. I literally had nightmares for days about that ordeal.

3)             Hysterosalpingogram (HSG) – In the radiology department,  dye is injected into the uterus via a catheter.  The dye fills the uterus and fallopian tubes.  A series of xrays is taken to assess if fallopian tubes are blocked, preventing sperm from reaching the egg.  Believe it or not, while this test was extremely uncomfortable, it was not painful.  Unlike the experience the previous day, the staff was very supportive.

4)             More bloodwork:The rest of the testing consisted of additional ultrasounds and blood work on specific cycle days to check certain hormone levels such as estradiol, luteinizing hormone (LH) and progesterone.  LH is the same hormone ovulation kits use to measure when you ovulate  Progesterone helps the uterine lining to prepare for the fertilized egg.  Some women miscarry due to low progesterone levels...the egg becomes fertilized, however is unable to implant due to insufficiencies in the lining.  For me, the science behind everything is amazing.

 Chris's Testing:                                                                                            

       Chris, being male, was the luckier one as he only had to visit the doctor for tests twice.  He was also required to provide a urine sample and blood samples.  In addition had to provide two semen specimens for analysis and also had a visit to a reproductive urologist.  In the semen samples they check for alot of different things including volume, total sperm count, motility, morphology (are the sperm normally shaped) and so on.  We have both learned more than we ever need to know about what a normal specimen should be as well as the human reproductive system in general. 

Is testing covered by insurance?                                                         

      It depends on your insurance carrier. Most cover testing, not treatment.  I believe my copays for the first few weeks of testing came to about $500.  I received the bill and was shocked to see that a 5 minute ultrasound charges the insurance company between $200 and $325.  A single blood test is about $145.  While expensive, I guess what these tests have the potential to find out is priceless.  

Imagine life without the ones you love.  For those with children, imagine life without them.  Most of you would probably die for them.  Imagine how you’d feel if you lost one of them.  You’d feel anger, grief, loneliness, helplessness, and inconsolable sadness.  Each day these emotions loom over us like a black ominous cloud.  

I’ve never felt the joy seeing double lines on a pregnancy test. Nor the thrill of enjoying life growing inside of me, being called mommy and the joy when you see your child’s face for the first time.  Both of us are grieving something we’ve never even had. Each morning I take my fertility medication, each visit to the doctor, each month we get a negative test, each time I hear a child laugh or cry or hear stories of others’ happiness on facebook I am forced to deal with these emotions.  We are surrounded by it.  Consumed by it. I don’t have the luxury ignoring it and not thinking about it.  Ignoring the problem isn’t a cure.  It won’t get better with time, it won’t get better with stress relief and it won’t get better without medical intervention.  Without help, the chances of us conceiving on our own are very bleak.  In normal individuals there is only about a 25% chance of conceiving each month.  While the doctors never gave us a percentage, we know the odds aren't in our favor.  Unfortunately the “relax and wait” advice we received from many will not help this time around.  Sometimes while these comments are meant to soothe our hurt, they are just adding salt to the wound.  However, we understand this is a difficult topic and we whole heartedly appreciate everyone's kind words and efforts, thoughts or advice.  It’s not easy for us to talk about it either.  

We've committed that by doing these posts we'd be dead honest and not hold back.  Each of you must know that while we love you all, it’s sometimes difficult to be around some of you…especially those who have what we don't.  Many of our friends already have a family. All of our brothers and sisters do as well.  It's hard when the most important people in our lives can't relate.  As I've said before, lots can sympathize but few can empathize.   We want to be joyful for other's happiness but sometimes the amount of envy is overwhelming and often, despite our biggest efforts, causes us to isolate ourselves from others.  Please know it’s nothing anyone has done or said, it’s just a horrible side effect of the circumstances.  

The next few posts I was thinking of sharing some of the medical tests and interventions we've already been through.  It's not for all, but like I said we're not holding back.