Thursday, June 28, 2012

Nobody said it was easy......

I go for my betas tomorrow morning before work (blood pregnancy test).  Due to my insurance company policy, pregnancy tests need to be sent out to a different lab, therefore it delays the results an entire day.  One day isn't always easy.  If you were waiting for lab results for cancer screening to come back, how would you feel if they made you wait an entire extra day just to save the insurance company a few bucks?  My sanity is worth more than the few dollars they may save.  So that being said, I tested myself today.  They tell you not to...but I did.  Because the test results don't come in until Saturday, I may not actually hear the results until Monday with it being the weekend.  I can't wait that long.  I've already been waiting 22 months for a miracle.  

To save myself the heartache of telling each and every person who asks if this IUI didn't.  I am still waiting for my 2 pink lines and all the exciting feelings that go along with it.  There's a very small chance the home pregnancy test is wrong...but they are 99% accurate.  I do this everytime...convince myself it's somehow wrong and I'm not doing that to myself again.  With each IUI, I had to hear 3 separate times it was a failure....first with the home pregnancy test, then when my cycle arrives, then again when the doctor calls with the results.  I'll get to do it all over again this weekend.  You'd think it would get easier, but it doesn't and it seems pretty cruel that I need to be reminded so many you know why I blog the results instead of having to repeat myself.  For me, it's like losing a loved one, only I've never even had the chance to love this child.  For everyone else, life goes on as usual.  But for me, I am grieving over my loss...again.  All the self injections of "hormone cocktail", mood swings, weight gain, and other side effects were all for nothing.  All I've gained is a few pounds, a more cynical attitude and thicker skin.  Putting my mind and body through hell was all for nothing it seems.  My own husband can't even understand or relate to what I'm going through, so how can I expect anyone else to?  

For the most part I've come to terms with what's going on.  I've been through the 5 stages of loss in some way shape or form....denial, anger, bargaining, depression and acceptance.  Each day is different and I have some pretty bad days where I'm angry, in denial, depressed, or beg God to grant me a child. Slowly, however I've come to accept that this is how it is.  I can't change it.  I can't ignore it.  It's not fair, but it's the cards I've been given.  Few can truly understand.  It's hard not to get angry at people who have what you long for so much or to be around others whose lives seem so great and carefree.  But even people who have the things I want don't have perfect lives.  

Alot was riding on this last IUI.  Now the only chance for me to have my own family lies with the science of IVF.  Unfortunately it costs alot of we don't have just quite yet.  Like most people my age, I'd rather be putting away for retirement or vacations, but right now this is more important.  It'll take us some time to get there, but we will.  

Monday, June 11, 2012

Today is day 5 on injectable medication.  I do not like needles - who does?  In the past I even avoided going to the doctor to have vaccines needed for school and work.  My heart races and I sweat profusely as the needle gets near.  During my previous 3 IUI's I had other people give me the trigger shot of HcG.  This time around, Chris gave me my first 2 injections.  The first time he accidentally messed up and had to stick me twice.  Saturday I was convinced that I had to do this on my own.  For some reason I needed to.  I have gone through hell and back emotionally and physically the past few months and I needed to prove to myself that I can in fact overcome anything.  I did.  I succeeded three times the past 3 days.  I'm just glad these are small needles.

I barely noticed any side effects with Clomid (the medication I was taking for the past 3 IUIs).  With this new medication I have unfortunately noticed some not so great side effects.  While only on the hormones for 5 days, I already have some moderate skin break out, slightly sore stomach from the injection,  and some bloating.  The bigger and harder to deal with side effects are some weight gain, headaches, and change of emotions.  I notice I am getting angry alot easier...rage is more like it.  At times I get so enraged I feel the devil is going to reincarnate himself through me.  And at times I cry for almost no reason.  I know Chris is trying to be patient with me but he's not the one dealing any of the physical side effects and also fewer emotional wounds (at least I think).  It's MY body and sometimes I wish he'd cut me some slack or be more supportive of what I'm going through.  I'm not doing this for me...but for US.  Men will be men I guess and I know he's trying.  

Today I followed up with the clinic and so far I'm responding very well to the medication.  I go back again Wednesday for yet more blood work and ultrasounds.  I project our final IUI will take place late this week or early next.  Let's face it - there's alot riding on this one.  If this fails we have to move on to IVF.  This is our last hope before spending thousands and thousands of dollars for one chance of a dream.  

While most of you are sleeping, I'm sitting here alone writing this blog tying to sort out my thoughts.  Less than 30 feet or so away, across the hallway, still sits an empty room.  Empty.  It's hard for me to imagine that it could be anything but a baby's room, filled with plush whimsical stuffed animals and a rocking chair.  I imagine how the room would be time and time again.  As hard as it is for me to not think about what's missing in there, it's even harder to think about or imagine what will happen if it never gets filled.  Like many things in life, it's a constant reminder of what I don't have.  Each time I pass by it re opens wounds that are still very fresh.  The past few months I've been so focused on my goal of making a family that I brushed aside any possibility that it may never become a reality.  Even if it does, am I ready?  I haven't had a ton of time to focus on what I will actually do when (and if) I become a mother.  Will I be  a good mother?  How am I going to find time to fit all my daily tasks in, including work?  How will we afford daycare, especially if we have twins?  These thoughts are just a few that swirl throughout my mind, at times clouding my better judgement.  Unlike most couples trying for a baby I have alot more to think about and on my plate so to speak.  Most to-be moms are thinking about HOW to be a mother....I'm just thinking about IF I'm going to be a mother.  

Tuesday, June 5, 2012

Start of IUI #4:
Chris and I are living proof that well meaning  the "relax, take a vacation, and don't think about it and it will happen" advice rarely works.  A few months back, when much more new and naive to the infertility process, we booked a vacation to Mexico.  In retrospect however, the money used for the vacation would have been better served for treatments.  I don't regret it though and in fact I believe God works in mysterious ways.  With the past few months being as stressful as they were, it was much wanted and much needed get away.  It wasn't just a vacation but a temporary escape from everyday problems, including infertility.  I don't live to work.  I work to live, but lately feel like I can add on to that sentence by saying I work to live (and to pay for our infertility treatments).  The life as we once knew it has been forever changed and shaped by our struggles.  Not only has my perspective and outlook on life changed but also physical things such as work....I find myself working 3 jobs to save up for treatments and often mentally beat myself up when I buy simple things such as a cup of coffee the morning after working a 12 hour shift.  I want alot of things in life that money can buy such as a pool for our backyard, but I would never take on extra jobs to pay for it.  I learn to do without and live within my means.  Whoever said money doesn't buy happiness never struggled with not being able to have a baby.  Needless to say the next few months I will be buckling down to save the cash needed for just one chance of that dream.  

The vacation was great.  On any given "normal" day when going through treatments, I can honestly say I think of our problem well above 50 to 75% of the time.  Some days, I'd venture to say 100% of the time.  Many times I try to forget just for sanity sake but it's so hard.  I'll be having a conversation about how to treat one of my patients at work or I'll be out with friends talking about old times and in the back of my mind my thoughts of infertility are shouting at me and racing through my mind.  Sometimes they are so loud I can't even hear what others are saying.  It's frustrating and not fair to myself or the people trying to have my attention.  I can't help it and I know that no one wants to hear my sob story every-time I think of it so I try best to ignore these thoughts.  When in Mexico I only thought of it a few times.  I'm not sure how this is possible, but like I said, God works in mysterious ways.  We enjoyed the vacation and didn't think about baby making too much, even though it was the week I was ovulating.  I'm back from Mexico with only memories, pictures and a few souvenirs.  There is no great story to tell about how we tried and tried to conceive for months and months and then went on vacation to paradise and then magically got pregnant.  We are NOT the minority that this happened to.  Now I can honestly say I've tried ALL the advice so kindly given to us.  It didn't work so we are back to modern medicine and the marvels of science.  When living with infertility you learn the hard way (and pretty quickly) that our expectations and ideas of how we'd like things in life to happen aren't always a reality.  Never in my wildest dreams did I think (or want) to conceive our baby in a petri dish after being drugged with enough hormones to perhaps kill a chicken.  So again, there is no great romantic story that we will get to tell people or our future child about how they came to be.  

At our last consult with the doctor we all agreed to try one more IUI cycle, but with a different approach....injectable hormones.  I responded well to clomid (oral hormone), however the injectable medications will allow for even more eggs to be "harvested", thereby increasing our chances.  This is our last stop before taking the plunge to IVF.  Tomorrow officially starts our 4th, and last IUI attempt.  I will be completing initial bloodwork and ultrasounds and on Thursday will be starting to give myself daily shots of Follistim.  I guess I'll learn more tomorrow on how all this works.  I've learned there's not much patient education involved in learning to give yourself injections.   It's pretty much, "grab your skin and fat, stick the needle in, and press the plunger."  MUCH easier said than done when you hate needles.  

The bump in the road is that I learned some disturbing news about my prescription coverage.  While it's much better than most, it's not perfect.  Months back I remember calling the insurance company to inquire about drug coverage and was pleased to hear that my co pays for most medications would run about $65 per medication.  I used to complain about a $20 co pay, but after learning these drugs can cost thousands of dollars it was music to my ears.  Now all we needed to come up with was the money for the actual procedure.  WRONG!.  Today I learned the catch.  I have a $5000 per lifetime cap.  What does this mean exactly?  Most of these drugs cost hundreds of dollars for one dose.  I still have to pay a small co pay, but the insurance covers the rest.  BUT after they pay out their $5000 I'm on my own and it's all out of pocket.  Today I learned that a 900 unit of Follistim can cost $1600 per vial!  What the pharmacist said is that I can basically use the entire allotment on just ONE medication.  Today I ordered Follistim and it cost about $800 with a $65 co pay....which comes out of the $5000 pot.  What this means is that when and if we need to do IVF we will need to self pay more most of the medications.  When calculating figures on paper a few months back I did not anticipate this.  Most likely this will further delay our attempt.  We've gotten through worse and will learn to adapt.

Friday, June 1, 2012


Due to our recent IUI failure I've been hearing this question alot the past few weeks.  I thought it might be  a good opportunity to discuss reasons why some IUI's fail.  From the articles I've read, success rates vary between 5% to 25%.  

Like most fertility treatments, increasing age of a woman (35 and older) decreases success rates. Unfortunately egg quality tends to decline with age.  At age 18, a woman has a 25% chance of conceiving, however by age 40 her chances decline to about 4 to 6%. A woman also has less eggs or ovarian reserve as she ages since many have already been used with previous cycles (number of eggs left  = ovarian reserve).  

Just because a woman is ovulating doesn't mean that she has quality eggs. Low quality eggs have internal defects such as chromosomal problems or problems with energy production (eggs need to be able to divide after fertilization).  A woman is born with about 1 million eggs that like dormant in the ovaries until they are "activated" by hormones at the time of ovulation. Unfortunately as far as I know of there is nothing that can "boost" egg quality.  Often times, couples with "bad eggs" need to rely on donor eggs.  From my understanding the only way to truly test egg quality is with egg retrieval prior to completing an IVF cycle.  The bad news is that this is very costly financially and invasive (requires a surgical procedure).  Also, after the eggs are retrieved there is no accurate test to assess quality.  Often times it is subjective and based on someone looking at them under a microscope.  Since egg morphology has not been adequately studied, many women go through several cycles of failed IUIs or IVF cycles without even knowing she has poor egg quality.

Last, eggs that are released may be immature and therefore incapable of being fertilized.  During a normal cycle, certain hormones prepare the egg to have the capability of becoming fertilized.  

Blocked fallopian tubes can occur from many factors such as STDs, a uterine infection caused by abortion or miscarriage, a ruptured appendix (causes scar tissue), any previous abdominal surgery (causes scar tissue), ectopic pregnancy or endometriosis.  If the tube is blocked, there is a physical barrier preventing the egg and sperm from coming into contact.  Luckily an HSG test, although invasive and painful, can detect this.  Many times the solution they inject into the uterus during the procedure can unblock the tube. If that fails, sometimes laparoscopic surgery is required to remove scar tissue.

Timing is critical.  After the egg is released from an ovary it only has about 12 hours to become fertilized.  If fertilization fails the egg disintegrates.  It's amazing anyone becomes pregnant with such a short time frame allowed for fertilization. The good news is that sperm can survive for a few days in the woman's uterus.  If intercourse occurs a few days before fertilization, the sperm can already be there to wait for the egg.  Also, with intercourse sperm can travel up the wrong fallopian tube or can become trapped.  Sperm can also swim poorly for various reasons, not allowing them enough time to reach the egg. 

 The IUI must be done in roughly that 12 hour window.  If the IUI is done too early or worse too late (after ovulation has occurred), the chance of the sperm contacting the egg is slim.  IUI has the advantage of helping the sperm get to it's target quicker, however if the egg has not yet matured or has already died the procedure will fail.  To ensure this doesn't happen, it is essential that the woman has several bloodtests to check hormone levels that indicate she is ovulating.  Ultrasounds are also essential to determine the exact time of ovulation.  Nowadays many doctors help mother nature by giving an injection of HCG - a hormone that triggers ovulation. This takes much of the guess work out of the equation....but remember if the shot is given too early the egg will be immature.  If the shot is given too late, natural ovulation may have already occurred.  

If a woman isn't ovulating there is no egg to be fertilized.  No doctor in the right mind will complete an IUI unless ovulation has been triggered with hormones.

This is our problem.  Even though there may be ample sperm, if they are malformed they may not have the physical capability of penetrating the egg to fertilize it.  This is usually caused by deformities in the head of the sperm.  It's like having a million spoons when all you need is a knife.  The spoon just won't do the trick. Many studies have shown poor success rates for IUIs with poor sperm quality.  Sadly there is no known medical treatment to improve sperm quality.  


Sperm can also swim slowly, may not be able to swim at all, swim in circles going no where, or may have 2 tails causing them to swim poorly.  If they can't reach the egg in time, it'll be too late.  Luckily for this particular problem the IUI does the work for the sperm.   Since the sperm are injected directly into the uterus they need not swim far.  Also, if the sperm are normal but there just isn't an abundance of them, IUIs are more successful as it gets the few sperm closer to the egg.