Friday, March 16, 2012

  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.  


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. 

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