December 29, 2012 – A New Chapter

I am sorry for the tardiness of my update.  The holidays were a whirlwind for us!  On the 24^th we met with the fertility doctor.  He was nice, really smart, and talked really fast.  I am hoping he was talking so quickly because he knew Doc could follow and that isn’t how he talks to everyone, because not everyone has had biochem and understands neurochemistry.  If it had been just me he would have had to go slower.  If your doctor ever says things you don’t understand feel free to interrupt and make them explain.  Doctors spend time with other doctors and they tend to forget that not everyone knows the Latin name for everything.  Doc is a big fan of the big words and I regularly make him explain things in simpler terms, because I am afraid he forgets when he speaks with patients. 

We did learn a ton.  For one thing: Clomid actually stays in the body for 35 days.  That is the reason it lengthens cycles.  Clomid initially tricks the brain into thinking you have too little estrogen, so it sends a signal to the ovaries telling them to ramp up production.  This increase causes hyper ovulation; which is why Clomid is a great fertility drug (although they initially thought it would be birth control.  Being part of that study must have sucked.)  However, when you use Clomid for several months your brain gets a little confused because you start taking more Clomid before the previous treatment has worn off.  Eventually it leaves you with excess estrogen building up.  This build up confuses your brain into thinking you have too many estrogen receptors and can actually cause depletion in the number of estrogen receptors available.  This is not a good thing to have happen when you are trying to get pregnant because you need estrogen receptors in order to get the signal to ovulate!  The doctor told me it was probably a good thing that I took myself off of it last month.  I am feeling very grateful that I listened to my body and gave myself a break when I most needed it. 

The doctor also said Clomid sucks.  It has horrible side effects and makes people feel terrible.  I really didn’t learn that, but it was nice to know I am not completely insane for struggling with the side effects. 

This cycle will be the last cycle where I take Clomid.  Ever!  J The only reason I am still on it this month is because I started it 2 days before seeing the new doctor.  Next month we will switch to Femara.  He said it will have fewer side effects but accomplish the same thing. 

He did recommend that we move to IUI (intrauterine insemination).  He explained that there are 2 challenges we humans face in getting pregnant.  The first is ovulating a viable egg and the second is getting a healthy sperm to that egg.  We increase the number of eggs I ovulate with the drugs in hopes of producing a healthy one.  The lab will wash Doc’s sperm so that we are left with the healthy fellas.  They then thread a catheter through the cervix and deposit the sperm at the back of the uterus during ovulation so that they have the best chance to reach the egg.  The shorter distance to the egg also means my body has less time to fight the swimmers off.  The doctor said that using this method 2/3rds of his patients become pregnant within 6 sessions.  The sessions aren’t cheap though, so we don’t know if we will be able to do 6.  Certainly not 6 in a row which would be more than $2,400!  Infertility isn’t cheap. 

We are starting this month. J I have to start taking a ClearBlue Easy fertility test every morning starting on Monday.  As soon as I have my LH surge I call the clinic and schedule an appointment for the following day.  Doc has to give his sample and then an hour later I have the IUI done.  It sounds pretty easy and hopefully it is.  J

Just a product note for those of you trying: I had previously been using First Response ovulation tests but the doctor recommended I switch to the ClearBlue Easy.  I have both this month because I already had the First Response kit at home, but the CBE kit is MUCH better.  First, it gives you a smiley face when you ovulate and a circle when you don’t which I find to be more rewarding than the daily NO I get from FR.  Second, if you don’t use all of your CBE tests (they come with 20) you can use them again next month.  FR’s version shuts itself off after you get a YES, so it can’t be used again which is very wasteful and since the kits are $35 a pop I will go with the one that I can use all of the sticks on!  Finally CBE packages the sticks separately so they can store for a month.  FR has them all in bag with warnings about exposure to moisture ruining them.  CBE wins hands down; I can see why he recommended it!  I like doctors that research products to recommend to patients.  Doc does that with formula brands and other baby items, so of course I think it is brilliant! 

December 04, 2012 – Another Opinion

We are at a fork in the road.  We can keep doing what we have been doing or we can try intrauterine insemination (IUI, AKA: artificial insemination).  Either way I am back on Clomid just before Christmas.  If we keep going the way we have been it means that Doc has to be available for intercourse every other day for about 2 weeks.  This wouldn’t be a problem if he had chosen any other profession.  It turns out working with sick and dying kids isn’t super great for the sex drive.  Not only does he work crazy long hours, but the things he is exposed to during that time isn’t exactly helping maintain a sex drive.  For example, right now he just admitted a set of twins into the NICU and was on call to admit another set.  That is 4 sick newly born babies he will work on just before coming home.  Not exactly a turn on.  Not to mention the stress of working on sick children every day. 

Our other option is IUI.  If we choose IUI Doc has to be available to give a sample 1 day, but we don’t get to choose the day.  When my hormones surge I call the clinic and they set up an appointment within 24 hours to do the insemination.  Doc would need to be able to go to the clinic and produce a sample.  It sounds like a no-brainer; 1 day vs. 14?  Trouble is that he has no control over his schedule and he can’t request time off to go masturbate.  Shocking, I know.  Regardless of our choice it adds stress to his life because I need him to be home and the hospital needs him to be there.  I also still have to take Clomid or possibly take injectable drugs (a terrifying thing for me) in order to continue.  Doing that without knowing whether or not Doc will actually be available to provide the sperm is not an easy thing. 

We will be discussing all of this with a new doctor.  We are not changing doctors; we are just adding a fertility expert to the team, because my doctor doesn’t perform IUI in his office.  On Christmas eve we have our first meeting with him at the fertility clinic.  We plan on talking about all of our options with him.  I will let everyone know how it goes. 

November 28, 2012 – The Results Are In

We finally have some answers!  My HSG was yesterday and went well.  It was painful, but very quick.  It wasn’t the worst pain ever, but I am not going to volunteer to do it again.  I was very thankful that my friend came with me.  It just made everything easier.  Everything looked good on the HSG.  My uterus is well formed and the tubes are still open.  All very good news. 

Doc’s test results took a little longer to get.  The doctor called this afternoon.  There is some concern about motility and they would like to repeat the test.  They have asked Doc to take 500mg of vitamin C every day for the next 3 weeks and then be tested again.  Should the results remain the same, they will move us to insemination. 

Overall these are not bad results because we can do something about them.  It means another month off Clomid, so a nice break for us.  Doc is not thrilled about having more tests or taking additional pills, but he is a good sport and willing to give it a try.  Besides, we all know he secretly loved the 12 step directions for masturbating.  J  He did recently look at my chart and saw that it has 281 results listed.  That is 281 times that I have had a test done and waited on the results.  It gave him a little more perspective about what the last 17 months have been like for me.  Perspective is always good!

P.S. Some people are having trouble leaving comments.  Please feel free to e-mail me if this happens to you!

November 21, 2012 – Grateful On a Day to Be Thankful

Doc and I are grateful for a month without Clomid and the fertility schedule.  Due to his crazy and hectic schedule this month we did, however, forget that Thanksgiving is this week.  I have written before about my theory of being grateful every day, so it seems a bit redundant to have a day to be thankful.  It is also hard to remember holidays because Doc is working, so they are just another day in our household.  We celebrate days off!  Yesterday was one of Doc’s few days off this month.  The day was packed full and included 4 hours of work related tasks, so it didn’t feel much like a day off.  It was the first time that we had been able to talk since my doctor suggested additional tests and a break from Clomid, so that was something to be grateful for. 

We needed the break from Clomid. The idea of additional tests is scary, but we would like some answers.  We should have a few of the answers on Monday.  Doc had the wonderful experience of turning in a sample to the fertility clinic yesterday.  I was downright gleeful that he finally had a slightly embarrassing test.  After 17 months of very embarrassing, painful, and terrible tests/side effects I think I deserve a break.  Doc agreed that it was his turn.  He said that he figured if I can endure everything I have had to so that we can have children then turning in a cup of sperm was the very least he could do.  I love that man.  He had to follow at 12 step set of directions for collecting his sample, which we both thought was hilarious.  He also said that 16 yr/old Doc would have been much happier about the idea of being ordered to masturbate than grown up Doc was.  Obviously, we handled the task with our usual sense of humor. 

My testing will be done on Tuesday afternoon.  Doc is going to be stuck at the hospital working in the PICU that day, so a friend has agreed to take me.  I am so grateful for the friends we have made here.  They are so supportive and wonderful.  It really does take a village, and we have found ourselves in one heck of a village.  God knew what he was doing when he put us here. 

I am nervous about the tests and have heard it described as everything from slightly uncomfortable to horrendous torture.  The reality of the situation is that because I have made the choice to go through with the test, I have no choice but to deal with whatever pain or discomfort the test brings.  So there really is no point in worrying about it.  At this point the answers we get from the tests are worth any temporary discomfort we may experience. 

Regardless of the answers we get, we are grateful for each other and the life we share.  I am so grateful to be married to this amazingly loving, kind, funny, and supportive man.  And as much as I like to complain about his job and the strain it places on us, I am so proud of him and how he chooses to spend his life.  I am grateful for living where we do, being surrounded by the amazing people here, and getting the chance to be a part of something much bigger than our petty struggles.  I am eternally grateful that I am still able to make a difference in the lives of children by helping those that are caring for them and helping to improve the environment of the hospital.  I am grateful for the people who allow me to use my skills and training to help them make informed decisions to help improve the hospital, program, and atmosphere of our world.  Regardless of the answers we receive, this is a wonderful life.  J

November 8, 2012 – We Interrupt Your Regular Program…

My progesterone results are finally in for this month; 5.4.  You read that correctly.  If you have been following my blog for a while you will realize that for someone on Clomid this number is not good.  My normal progesterone draw is around 28 on Clomid.  It is however, a normal number for someone not on fertility drugs.  I didn’t ovulate until Day 18 or 19 this month, so testing on Day 21 may not have been accurate.  I am pretty sure this is the problem because this was the worst ovulation I have ever had.  It felt like a cartoon bomb had gone off in my abdomen.  There is normally some pain and swelling following ovulation, which my doctor explained was blood from the extra ovulation.  This month my entire abdomen was so swollen that it looked like I was sticking my stomach out as far as I could.  Seriously, push your stomach out as far as you possibly can and that is what I have looked like for the last 3 days.  It was so painful I would cry when I tried to pee!  I was getting muscle cramps in my sides and back from having my abdomen extended for such a long period of time.  There was so much pain I just didn’t think I could do this again. So, obviously there was more than 1 egg released this month. 

However, the low test result did earn me a call from my doctor.  This poor man.  He called last night and he sounded like he was miserable with a cold.  He barely even sounded like himself.  I really appreciate him calling me when I know he would have rather been in bed.  Things like that make me really like him, and make it easy to forgive rude nurses and delayed results. 

As usual we were right on the same page.  It is time to take a break.  We have been going at this for a while and we haven’t been successful, so he feels like it is time to take a break and get some additional tests run.  It was obvious that our lack of success was just as frustrating for him as it has been for us, which is nice.  It reminds me that we are a team.  He wants to check Doc’s sperm count, just because it can decrease with age and with ovulation occurring so late in the cycle it is possible that the count is lower anyway.  He also wants me to go in for a study to check and make sure my fallopian tubes are still open. 

I am nervous about the tests and am not thrilled that we have to go through them, but I am also ready for a break.  I just feel worn out.  I don’t know when I will write again.  I am not sure when the tests will be.  They may wait until after this cycle is completed before running any tests, or they could want to do them right away.  I won’t really know until I hear from the nurse to schedule them.  I will keep you updated about the tests, but as of today I am counting myself as on vacation from fertility treatments and the side effects of them.  It is time for some much needed rest and relaxation. 

UPDATE: The nurse called shortly after I wrote my blog.  They will run my test, which is an HSG, during my next cycle between Days 4-16.  Doc tried to explain it to me but honestly it sounds like some form of Cold War torture so I stopped listening.  I picked up Doc’s “kit” and he will make his appointment for later this month.  We should have some answers next month.  On the way into the office to pick up the kit I did run into a lab tech, who asked me if I was visiting them today, and a secretary for my Internal Med doc who stopped to chat.  You spend too much time at your doctor’s office when everyone knows you!  It was sweet of them both to chat with me.  I really love my doctors’ offices. 

November 04, 2012 – Sitting on the dock of the bay

I am sorry it has been a while since my last update.  I didn’t mean to leave everyone hanging.  Really I was just tired of thinking, talking, writing about everything.  I needed a break. 

Currently we are at the end of our try-cycle.  I go in for a progesterone draw on Tuesday (forget election watch, our house is on progesterone watch).  We are very hopeful for some good news, but really we won’t know anything for sure until closer to the end of November.  We have done everything in our power to make this month successful.  Now I just have to relax and wait. 

Doc and I are doing well.  Doc has started his PICU rotation, which means he is gone every day from 6am until 8pm.  I miss him and wish he were able to be home a little more, but such is the life of a resident’s wife.  Obviously November isn’t going to be a good month to try during.  If this try-cycle had extended into November any further it would have been a total loss.  December isn’t going to be much better, as Doc is in the NICU then.  Lots of very sick babies and very long hours don’t make trying easy.  It makes it impossible.  We aren’t sure how we will handle it if we are not pregnant this month.  It will be a discussion we have to include our doctor in on.  It just isn’t reasonable to expect that we will be able to try every other day during these months and have it be stress free.  But that is a bridge we will cross when we come to it.  I am sure my doctor will have some brilliant plan for making everything easier or seem better.  He is good like that. 

Right now I just have to focus on relaxing.  Tuesday will give us an idea of how ovulation went and then we just have to pray we make it to Day 35.  For those keeping track; that means we won’t have good news before November 20^th. 

October 18, 2012 - Round and Round We Go

It is time to start another try-cycle.  I have decided that we will be successful this month.  I am not going to worry about it, because I have already made up my mind that it will happen.  Doc and I have solidified a plan for this month to help make it easier for me to relax.  Doc is managing the calendar for us.  I have several planned dates with friends including spa days, shopping, and lunches.  We have a few interview dinners planned, but those are really a lot of fun and not very stressful.  Doc and I will also be celebrating our 11^th wedding anniversary at the end of this month. 

This last try-cycle was very hard on us.  We had been expecting to welcome our first child into the world just before our anniversary.  Instead we are still at square one, stuck on repeat.  It has been hard for both of us, but we need to keep moving forward.  We are still thankful to have each other.  We are thankful for our amazing doctors who take excellent care of me and who work so well together.  That in itself is a blessing.  Not all doctors work well in a team setting, but both of mine do a great job of keeping each other in the loop and being respectful of each other in order to improve our outcome.  That is a huge blessing.  Doc and I are counting our blessings and moving forward with the full intention of this being our last try-cycle.  We are planning on success.  That is the only plan we need right now. 

October 10, 2012 - Update

I wanted to write a quick update because I realize that my last blog was fairly negative and I really don’t want people to worry about me.  My mood is improving daily, which is a good thing because I really don’t like feeling so negative.  I spoke with my amazing and wonderful doctor/friend and she let me know that there is no permanent damage from the miscarriage and that I healed beautifully.  Above all she reminded me that hope and stress can both play a part in getting pregnant (or not getting pregnant) and that I can always lean on my doctors for additional support when I am struggling.  I need to remember it is okay to let people know what is going on with me so that they can help when I need it.  I am once again reminded of how very fortunate I was to find my doctors and to have so many amazing friends. 

Doc and I discussed our plans for continuing.  This last month was very tough for both of us because I am rarely hopeless or depressed.  My mood is improving after speaking with my doctor though, so things are looking up.  I just need to relax and get myself into a more positive place.  We have decided to continue with Clomid for the next try-cycle.  Doctor’s orders to relax are being followed and Doc and I are working out a way for him to take a bigger part in the schedule and for me to let go of some of the stress. 

October 08, 2012 – Wherefore art thou progesterone?

My progesterone draw was this morning.  For those of you keeping track this was my 22^nd visit to the lab this year (although I have been stuck over 30 times).  The lab techs have to dig for a vein now; I have too much scar tissue blocking access to my veins and even when they get a vein it clamps down before they can complete the draw. 

We had to have it drawn on Day 23 this month because Day 21 fell on the weekend.  The news was not good.  My progesterone is 25.2, also known as not pregnant.  It is actually lower than it was last month.  I am waiting to speak to my doctor about it.  It isn’t encouraging.  I am starting to wonder if the miscarriage left too much damage for us to be able to conceive.  Regardless we aren’t getting pregnant and I really need to understand why.  I don’t like feeling hopeless.  It isn’t a part of my nature, and yet for this month that is precisely how I have felt.  I hate it.  I hate that I feel this way and I hate that I don’t get any answers explaining why we have to face this.  I hate that my feelings get hurt every time someone makes a thoughtless comment about getting pregnant easily or someone having too many children or what a gift children are or worse how lucky we are to not have them.  I just want to scream, “Fuck you!” and then I hate myself for thinking that.  I hate that when people share their happy news with us I have to struggle with the feelings of loss that it brings up for me.  In the 16 months that we have been trying we have known at least that many people that have gotten pregnant, had healthy pregnancies, and delivered (or will soon deliver) beautiful babies.  We have known 0 other people who have miscarried.  I feel like we have been banished to an island where we are being punished for unknown crimes.  L

October 01, 2012 – Ups and Downs

I stopped counting days this month.  I just follow the calendar and try not to think about the rest.  This cycle has been a tough one.  I am really struggling with whether or not I want to keep doing this to myself.  My body feels old and tired.  I am having a hard time being hopeful about success; really I am just in a bad place.  I refuse to allow feeling down to control me though.  I am still getting up and doing all of my regular activities: pay bills, grocery shopping, walk the dogs, lunch with friends, library trips… I am just not enjoying any of it a whole heck of a lot. 

I do know that we ovulated.  It was the left side this month, which is rough.  Although I think we may have also had a smaller ovulation on the right.  I certainly don’t need a test to tell me when we ovulate on Clomid, the pain makes it very clear.  My OB explained that with the increase in ovulation there is an increase in internal bleeding which is why my abdomen swells and is painful for several days following ovulation.  It isn’t something to look forward to that is for sure! 

Things are otherwise good.  This month kicks off the new recruiting season for the hospital.  We have our first dinner this week.  We will drive down to KC with the program coordinator to try and woo a few doctors into applying to our program.  At the end of med-school all the new doctors begin searching for the perfect residency program to complete their training.  They interview and rank programs, the programs rank them, and then the list of top matches is presented during Match.  It is kind of like an arranged marriage.  It is a nerve wrecking process for the new doctors.  I remember quite well what it was like to be in the Match.  I am glad that our new role in Match is a lot more fun.  We wine and dine new doctors and tell them all about our program.  Last year was our first year recruiting, and normally recruiting is left up to the first year residents, but Doc and I really enjoyed the process last year and are participating again this year.  We take a lot of pride in helping this program find the best new physicians to train.  This week’s dinner is just about encouraging people to look at our program and apply here.  After that we have dinners for all of the doctors that will interview here.  It is a busy but fun time to be a part of the residency program!  It also helps to distract us from this other stuff. 

September 22, 2012 – Day 7

Today is Day 7, also known as my last day of Clomid for this month.  It seems like time has been passing so quickly lately!  This is my fourth total dose of Clomid and my 2^nd dose since the miscarriage.   I am trying not to worry about the side effects or whether or not we get pregnant.  I am really focusing on trying to stay in the moment and just relax.   

A lot of the initial side effects are better this time around.  I have a nightly hormonal migraine that sets in just after sunset, but each day it seems to be getting better so I am hopeful that they will be gone soon.  The crying and emotional stuff is still here, but I am surrounded by people who love me and understand that if I don’t sound like myself it is probably just hormones.  I am thankful for their forgiveness when I am cranky and thankful for their laughter when I am crying.  Mostly, I am just thankful for such good friends. 

Doc is stuck on an inpatient rotation this month, which definitely interferes with our trying.  During the first two weeks of the month he was on nights, so he was gone all night and slept all day.  I saw him for only a brief moment when he was getting ready for work and when he first got home.  No quality time.  Then he switched to days and the schedule hasn’t gotten much better.  I see him for about an hour in the evenings.  Unfortunately the hospital is very full right now and that means Doc has to spend more time at work.  I understand that and am glad that his patients have him as a doctor, because I know he takes very good care of them all.  It does however make trying difficult.  Scheduled sex isn’t exactly romantic to begin with, but when you see each other for only an hour out of every day, romance seems like the least of our worries.  Really the problem is that I just miss Doc.  He is my best friend and I find his presence so comforting that being away from him is what makes the rest of this hard to handle.  We had extra time together yesterday and were able to spend a few hours together.  I can’t explain the difference it makes to just be near him. 

Thankfully this month is coming to an end and next month is going to be a much easier schedule.  This should help us with our trying because I will most likely ovulate in the beginning of October.  I am trying not to think about the pain that occurs around ovulation right now.  I just take deep breaths and center myself back in this moment.  Worrying about pain that I know is coming will only make it worse.  So for now I will focus on this beautiful day, take my dogs for a walk, go to the library, and have lunch with a friend.  And I will spend every minute looking forward to the moment when I see Doc tonight.  An hour is better than nothing at all!  J

September 17, 2012 - Negatives into Positives

We are not pregnant. 

Doc and I are doing fine.  We were of course disappointed, but we are just planning to keep going.  I start Clomid again tomorrow and we will follow our schedule for another month.  Our hope is for a healthy pregnancy and baby and for whatever reason, that wasn’t a possibility this month.  We are okay waiting if it means we improve our chances of having a healthy pregnancy and baby. 

September 12, 2012 – Day 26 and Counting

I haven’t had a ton of sleep over the last couple of weeks.  Doc has been working nights so between his absence and the general stress of our situation, sleep has become a rather elusive thing.  Forgive me if I ramble or seem disjointed. 

It is only the 26^th day of this try-cycle; we are done with the trying part and are onto the waiting part.  The cycle usually ends on or around Day 31, so we are still early in the waiting part of the cycle.  My pregnancy test this morning was negative, but again it really is too early to tell if that is true. 

After Doc came home this morning we had an appointment with the OB for an ovary check.  The nurse almost put us in the same room where I had my birthday fun (#7) when she remembered and moved us.  Kind of funny how they don’t put me in room 7 anymore, I am sure at some point I will have to go back there though.  My progesterone level for this month hasn’t inspired a lot of confidence and we are all preparing for another month of Clomid.  The doctor reminded us that it can take up to 6 months to get pregnant, so we should just take it easy (in other words: RELAX!!).  Both Doc and the OB were very casual about the continued trying.  I wanted to cry because it means more Clomid, more side effects, and more waiting.  All of which make me want to vomit. 

We did discuss the if/thens of how to handle upcoming events.  If we are not pregnant I am to call in and get a refill of my Clomid and repeat the cycle until pregnant.  Once pregnant I am to come in immediately for additional blood work and sonograms.  He said they will be watching me very closely.  Doc asked about whether or not we would need to see a specialist (Perinatologist) and it didn’t sound like my OB thought we would need to.  That is actually good news.  Doc was letting his anxiety show a bit with that question.  My OB also said that we can call with questions any time.  He said that he feels comfortable with that because he knows my chart, so if the office calls him with a question from me he will most likely be able to answer it easily.  That is comforting.  I know he sees a ton of patients and his off time is precious (as it is for all doctors) so we will try our best to save questions for office visits.  But if I get nervous, it is always nice to know I can call.  I guess that is the bonus for having such a rough year, the doctor memorized my chart!

On the way home Doc and I talked about how grateful we are to have such a great OB.  He is funny, kind, compassionate, and very obviously wants to see us get pregnant.  The nurse today commented that I must have a very good support system to have handled everything so well this year and when I said “I have an excellent support system” I realized that I was including my doctors and their nurses in that system.  I really feel lucky to have such amazing health care providers.  Our team can use all the help it can get! J

September 8, 2012 – Limbo

My progesterone check was yesterday and it came back as 25.  This is exactly halfway in between my previous 2 scores (pregnant and not pregnant), so we are stuck in limbo again.  We should know for sure by the end of next week. 

I am trying hard to keep myself calm and just go with the flow, and also trying to prepare myself for another month of Clomid.  That is a slightly depressing thought even outside of the desire to get pregnant, because the side effects are so hard. 

Doc has remained relatively aloof on the topic, so I know he is trying hard to keep his own anxieties and excitement in check.  Although he acknowledged how difficult the side effects were by offering me a month off if I needed it.  Also, while fixing up the guest room he refused to comment on it.  When I finally asked if he liked it he replied with, “I do, I think it looks great.  Do you think we are pregnant?”  So I know it is on his mind too.  He is also a lot more hopeful about our 25 than I am. 

The guest room is done.  We went through all of our old school notes and notebooks and threw out a ton of stuff.  We also sold 5 boxes of books last weekend.  It was hard letting go of so much from our past, but it was also nice to make a little room for our future. 

I will see my doctor Wednesday and let you guys know how that goes.  It is just an ovary check, but I also have to ask him how to handle the news of yes or no as he is going out of town the next day.  Having a plan in place for both alternatives will help me reduce my anxiety about everything.  Until then, one foot in front of the other! J

August 29, 2012 – Day 12

We are on to Day 12 of this try-cycle.  The side effects hit me way earlier this time, almost as soon as I started taking the Clomid.  I have had lots of nausea and headaches to deal with.  Thankfully the side effects seem to be abating quickly.  I am feeling better each day, although the emotional toll of being on the Clomid is certainly not easing.  Doc finds the crying particularly funny.  It probably is funny to watch your wife, who normally doesn’t cry, burst into tears while trying to explain why the movie The Hunger Games left out the most important details from the book. 

I am trying to keep myself grounded though.  The dogs keep me company on long walks around town and have been watching as I clean out our guest room.  We refuse to refer to it as the baby’s room, because I think we are both afraid to jinx it.  Regardless, the room is ready for company.  We are both very hopeful this time and we are trying to stay focused on the positives.  There are still fears, but there may always be fears.  Hopefully this time is different though.  Hopefully our journey with infertility will find a happy ending. 

We will have a progesterone draw on Day 21 to ensure ovulation and then on Day 28 I will see my doctor to have my ovaries checked to ensure they are not overly stimulated.  We are back on the try-cycle! 

August 20, 2012 - Let the fun begin!

Today is Day 1 of my 3^rd round of Clomid.  I have been feeling very anxious this weekend.  I indulged in a few pregnancy forbidden foods and drinks (pina colada, donut, sweet tea, deli meat, etc.) and attempted to clean and bake my way out of anxiety.  Waking up at 6am tells me I was unsuccessful.  I can’t put my finger on the exact reason for my anxiety.  I can’t tell if it is because I am nervous about the side effects, nervous about getting pregnant again, or if I am just having some random anxiety.  I just know I am anxious.  It could also be this little fear that we will go through all of this again only to not get pregnant at all.  It is hard to sign up for these awful side effects, the constant poking and prodding, the intense scheduling and to not be guaranteed an outcome. 

This weekend Doc and I reviewed the schedule to make sure that we have our trying days planned for when he is not working and is in town.  He has to go out of town for a few days for work this month, which makes things difficult when we are supposed to be trying every other day.  Looking at the calendar was a little daunting.  I had forgotten how scheduled our lives were when we were trying.  It made me very grateful for our break.  We have Clomid for the next 5 days, flu shot today (so I am covered this season), on Day 21 I go in for a progesterone check, Day 28 is a check to make sure my ovaries are not overstimulated, and Day 32 is a pregnancy test if I haven’t started my period.  Rinse and repeat.  I am really hoping we are pregnant by the end of this cycle. 

August 1, 2012 - The Try-Cycle

It is hard to believe how quickly the time flies.  We are gearing up for another session of trying (which I have dubbed our “try-cycle”).  I have my final HCG lab draw on Tuesday; once the all clear is given we are free to start trying again.  I should start my period within a few days after that and we will start another round of Clomid.  I am trying not to dwell on the side effects and crazy hormone madness that will follow that.  Instead I am focusing on enjoying the last few days of the forbidden fruits.  I am indulging in soft cheeses, pina coladas, spicy foods (which I could only tolerate for the first month of pregnancy before the heartburn kicked in), and a little caffeine (although I am cutting back).  I am also making sure that I am getting myself back on a rigid schedule for my meds, vitamins, meals and sleep.  In short, I am doing all of the things I need to do to ensure we have the best possible chances of conception. 

We are starting to get a little excited about trying again.  It is really hard to explain to people who haven’t struggled with infertility, but you can actually get tired of sex.  I can tell instantly if someone has struggled with infertility by their reaction to a comment about the scheduled trying.  Anyone who hasn’t had forced sex every other day for 8 months will think it sounds like fun.  Anyone who has had fertility issues is more understanding.  When you are on a scheduled fertility period there is no break.  You have taken drugs, suffered side effects, and you may only get one shot.  You have sex regardless of your feelings.  You have sex when sick, if you have company, if you are exhausted, if you are angry with your spouse.  You do it because you have to if you want to have a hope of getting pregnant.  You have sex in the position your doctor tells you to and you stay in bed for an hour after sex, just like the doctor told you.  It isn’t exactly the playboy fantasy.  Thankfully, we had a break where we couldn’t have sex and couldn’t be trying and we are back to being interested in each other. 

I think it also helps that we are both hopeful that our try-cycle will be shorter this time.  We know we can get pregnant, we know the Clomid worked after only 2 months last time, we are hopeful.  We are planning on success.  Wish us luck! J

July 30, 2012 – Checkup

I had my annual checkup with my OB/GYN today.  Doc is away at kidney camp, so it was just me.  This is the first non-emergency/routine visit I have had in a long time. My doctor said he had missed us, which made me laugh.  It does seem that it has become common place to visit my doctors! 

Everything looks good and it looks like we will be cleared to start trying again next month.  This is exciting news!  My doctor said it “is just by the perfect alignment of the stars that we are sitting here today” and he is hoping we will be having a baby this year.  I love that my doctors will be just as excited about us getting pregnant as we are.  This has been a serious journey and they have been walking it with us. We did also talk about my endometriosis.  Since my last period I have been having lower back pain, which is a common complaint with endometriosis.  My doctor said that unfortunately we haven't been able to treat it, because we are trying to get pregnant, but that being pregnant and delivering a baby usually wipe out endometriosis.  So, a whole new reason to want a baby! 

The current plan is to have one more blood test in the middle of next month, and if my HCG is still 0 then we are cleared to try again!  I am to call his office when my period starts to get the Clomid called in and then we are back to business!  While I am not sure I am really ready for all of the Clomid side effects to return, I am really excited to hear that things are getting back to normal.  Hopefully I won’t need to be on the Clomid for long before we are pregnant again, and hopefully that pregnancy will be a successful one!  Wish us luck!! J

July 10, 2012 - Mind the Gap

Our first month of waiting is nearly complete.  It has been kind of strange to be off the fertility schedule.  What is really amazing is how much time it freed up!  I hadn’t realized how much time the doctors’ appointments, medication side effects, and scheduled sex actually took up.  Oh and the break from the pregnancy diet!  I don’t have to be as cautious with what I eat or drink right now and it is so nice.  Imagine a year without alcohol or caffeine!  I also have food allergies that I have to be much more cautious about when I am trying to get pregnant because the medications to treat the severe reaction can cause problems with pregnancy, not to mention the physical stress it puts on my body.  I am borderline paranoid about my allergies on a good day, but on a pregnant day I am full blown obsessive. 

I have been dutifully making the rounds for general physical health.  I have a follow up appointment with my dentist to get some repairs done.  Doc once told me the physical toll of pregnancy on a woman includes enough calcium sucked out of her body to result in the loss of one tooth.  I have 2 damaged teeth following our miscarriage.  I am getting them repaired this week as well as having some preventative things done. 

I had previously thought we wouldn’t be able to start trying again until September, but after checking the calendar I realized I was wrong.  We should have our third negative HCG just in time during August that I could start Clomid again then.  The appointment with my allergist wasn’t until September, so I may have to put off that appointment.  I have asked them to put a note by the receptionist’s desk asking them to call me if they have a cancellation, so hopefully they will get me in before we are trying again. 

As for getting pregnant, Doc and I have talked a lot about our plans for continuing.  Doc has come down firmly on the side of giving it one more try, but not pushing our luck if we have a third miscarriage.  We both want children, but this last miscarriage was just too much.  The idea of risking having another situation like that is just too intense for him.  I forget that while it was a little scary for me, it was a lot scary for him.  The down side of having a husband that adores you is that he doesn’t want to lose you.  Terrible complaint to have, right?  I understand and agree with him.  I don’t want him to be stressed out worrying about losing me and a baby all at once.  He is generally an attentive husband, but during the miscarriage it was obvious he was worried and hyper vigilant.  So, one more try.  We reserve the right to change our minds should the one more try result in failure, but for now that is the plan. 

This last miscarriage changed everything.  The first miscarriage sucked, I don’t want to make it sound as if a miscarriage is ever an easy thing.  It isn’t.  They are scary and depressing and just plain horrible no matter what.  It is just that when you go through a month of contractions and bleeding and then almost die at the end of it… it changes your life.  And for Doc, to have to sit and watch me get weaker and sicker and suffering, it is just too much to ask him to go through it again.  Doctors don’t like to feel helpless and out of control (do any of us?) and that is exactly how Doc felt watching me.  Besides, if you jumped out of an airplane without a parachute and happened to survive the fall, would you be jumping for joy at the idea of doing it again?  Probably not.  So our opinions about how we will handle the next pregnancy have changed.  The last time we were pregnant we were adamant that we didn’t want to know the gender and we were coming down uncertain if we would opt for additional testing during our pregnancy.  This time we are swinging the other way.  Doc said it best, “I don’t think I want any more surprises.”  I have a feeling we will be spending a LOT more time with our doctors during the next pregnancy.  That is okay, we have fantastic doctors and if it will help Doc feel better than I am on board.  I adore him too, and don’t want to make him worry unnecessarily. 

As I am getting physically prepared to go through it all again, we are slowly getting mentally prepared.  The nicest thing about this break is that it has given us time to heal.  I have stopped having nightmares about pregnancy and miscarriages.  I am down to only twinges of sadness about not having children yet.  I have 6, yep count them, SIX friends that are currently expecting and I am genuinely and deeply excited for all of them.  I am even looking forward to throwing a shower for one of my girlfriends.  When you are struggling with something like this, especially when it seems so easy for everyone else, it is easy to get lost in your own pain and to become jealous of others.  You can even start to resent others because it just seems so unfair that it comes so easily for everyone else.  I have cried my fair share of tears of self-pity, but in the end I don’t want to be a jealous person.  I have a good life even if we don’t have children.  I want to be a loving and generous person who gives back to the people around me.  I can’t do that AND be jealous and self-involved.  So, I choose to accept that this is my life.  The only life I have to live and I don’t want to waste it being miserable for things that are out of my control.  I am at a point where I can accept that this is our journey, I don’t know where it will lead or why we have been given it, but it is ours to travel.  So, we will continue on this road, learning whatever life lessons we have to learn, hopefully sharing what we learn with others.  Maybe that is the point of the journey; we just don’t know and won’t find out until it is all over.  J

June 25, 2012 - Less Than 2

It is official!  My HCG is less than 2, which is considered officially 0!  We now have 3 months of chilling out before we can try again.  In an interesting doctor’s order, we have to use contraception for the next 3 months.  Seems a little redundant given our inability to get pregnant without the use of fertility drugs, but whatever.  This does mean that we have until September before we can try again.  It is hard to wait after all we have gone through, but we want a healthy pregnancy and we know my doctor is being cautious because he also wants us to have a healthy pregnancy.  So, we will wait!  I am not sure how much I will be writing during this time, but I will keep everyone up to date with any news we have during this time.  Doc and I are using the time to make sure we are ready when September comes.  Dental visits, checkups, and some allergy testing for me.  I only need to get my HCG levels checked once a month, so hopefully my arms will begin to heal up.  While the waiting will be hard, we were happy to hear that my HCG finally came down! J

June 08, 2012 – A year in review

As the first year of Doc’s residency comes to an end and we prepare to greet the next generation of interns I have been thinking a lot about the last year.  This time last year we were just meeting our personal physicians.  They are amazing and we love them.  Doc decided my Internist was better than his, so he has decided to switch to mine.  Mine is pretty awesome, so I understand.  We met our OB and decided to keep him too.  We were just beginning this leg of our journey.  We had no idea how things would unfold.  We certainly didn’t know they would be as rocky as they were!  We are optimists.  We thought we would be pregnant in the first few months of trying.  We knew that wasn’t reality, but somehow we deluded ourselves.  This year has been full of lessons like that. 

As many of you know fertility treatments are not covered by health insurance plans, so they get paid for out of pocket.  This was news to me too.  We switched insurance companies at the start of the New Year and the new company refused to pay for anything, the previous company would pay office visits and sonograms as preventative medicine.  The change in companies meant office visits, labs, sonograms, and medications pertaining to the treatment of infertility are not covered by our insurance plan.  To give you an idea of how much that costs; each lab is $99 and office visits run $195, sonograms are around $205 at our doctor’s office.  It isn’t a cheap endeavor.

The next thing I learned was that any of the services listed above are more expensive when done at the hospital.  It is FAR cheaper to see a doctor in a nice, comfortable office than it is to go to the hospital.  I want to advertise this fact because many people use the hospital as their primary care doctor and just go to the ER when they need anything.  The ER costs $249 (just to walk in) and going to see my fancy doctors in their nice offices only costs $195.  Lab fees at the hospital are nearly triple what I paid at the doctor’s office too.  That is a pretty big difference in price.  Not to mention I got WAY better care from my doctors than I did in the ER.  I can’t say it enough; find a primary care doctor and see them at least once a year.  It is more than worth it even if you don’t have insurance. 

I learned that fertility treatments can impact a person’s life in surprising ways.  For example, both psychological and physical health is affected.  Not to mention the strain on relationships. 

I learned that a failed pregnancy can cost almost as much as a healthy delivery.  Of course in our case it was an epic failure resulting in nearly $30,000 of bills (most of which were covered by insurance, thank goodness!). 

I learned the value of insurance and am glad we didn't start trying without it. 

I learned the value of having doctors that you really trust and the value of allowing them to collaborate on your care. 

I learned that my body is not unique or special in its appearance.  What does that mean?  It means I have repeatedly walked into rooms containing at least 10 people with the full knowledge that everyone in that room was going to see my vagina; including med-students my husband works with.  My vagina and the rest of my body hold no special power or allure.  They are not worth gossiping about and I am sure no one talks about it.  It isn’t worth getting embarrassed and upset about.  These same doctors are a part of the organization that employs Doc, which means I do get to have dinner and chat with the spouses of people who have seen my vagina.  Embarrassment just makes it more difficult for everyone.  Trust me when I say that your doctor doesn’t enjoy looking at your vagina any more than you like them looking at it.  My doctor can’t make small talk during exams, which makes me laugh.  I like to start talking about non-related subjects because it makes him go faster.  I know his coping is to not connect the body part with the person.  I mess with him because I am cruel and it entertains me.  I once made a joke that he had spent more time with my vagina than my husband had one month and he fled the room.  I love the guy because he is human. 

That is another thing I learned, even though I already knew it I needed a reminder; Doctors are people too!  They are human beings with lives and idiosyncrasies of their own.  Treating them as if they are somehow greater than you will only make it harder to get great care, because if you believe they are better than you, you will be less likely to share embarrassing information that could be crucial to healing you.  Everything you go through is a human thing, meaning there is no reason that you can’t share it with other humans.  I recently had someone comment that I didn’t seem embarrassed to talk about things and my response was, “It is all human stuff, we are all humans.  Why not talk about it?”  I think that sums up the biggest lesson I learned.  I have always struggled with a social filter and I found the perfect profession for that.  As a therapist I was trained to ignore taboos and to talk about the real stuff that people deal with (rape, abuse, suicide, messy emotions, etc.).  This year I realized that we people suffer needlessly because we are unwilling to talk about the real stuff, not just our thoughts and feelings, but our bodies and symptoms we may be having.  That is dangerous.  For example; not making it clear to your doctor that you are having severe bleeding or not asking for additional help for fear that you will be seen as whining. 

It was a year full of lessons.  As we go into the next year of trying to start our family I can only hope that we will carry them with us.  And I will probably still think it is funny to make my OB nervous.  Seriously, it makes me laugh.  Just don't tell him, please.  J 

P.S. My HCG is 3.  I will have another draw in 2 weeks.  Just think about this; each lab costs $99 and I have had over 15.  Thank goodness for insurance!

May 31, 2012 – The Journey So Far

The last six days were heavenly.  Doc had those days off and we spent every moment of it together.  It was the first time in 3 months that we had time to do that, when it wasn’t an emergency.  I cannot stress how important this time together is.  It was time to reflect on everything that has happened.  We had time to process the journey together, which is what we have always done and it is why we are sliding into 11 years of happily married.  Medicine, in general, doesn’t seem to encourage happy and healthy marriages.  We are going to change that.  It is our family and then everything else.  Not a job and everything else. 

We spent some of our time reflecting on our situation.  We weren’t able to deal with all of the emotional stuff when it was fresh, it was just too hard to face.  On the day that we found out about the miscarriage Doc couldn’t go home.  For hours he drove around.  I went with him because I couldn’t bear to not be with him.  We ended up crying at the mall, crying in the car, crying in a booth at Jason’s Deli because we couldn’t face our home, where we had begun building a family and planning a future with children.  When we finally did return home we had things to put away.  Decorations for the nursery, baby’s first onsey, diapers and wipes… things you need only if you have children.  We shut the door to the nursery and walked away from the pain.  It wasn’t until we had time alone together that we could face it again. 

That probably sounds like a horrible way to spend a vacation, but really it was glorious.  Facing it allowed us to make plans for the future again, to put the last 3 months in our past instead of allowing it to be constantly in the present.  We made new goals for ourselves and our family.  We talked about our feelings, apologized for bad behavior (no one likes living with a grump) and came together again.  That makes it sound as if we had been living a horrible life recently.  It wasn’t that we were super grumpy with each other; it is just that we were not ourselves.  Doc and I are affectionate and talkative.  We never lack for things to say to each other and we never have more fun than when we are together.  For the last three months we have been stuck in our individual pain, so it made it hard for us to be ourselves.  We spent time being polite and just going through the motions of what we knew we had to do.  It wasn’t connecting and healing, it was survival.  Now, because of this time we had together we are back and it feels good.  I can finally talk about it all without crying, Doc can talk about it (he tends to not speak when upset), and we are starting to talk about it as a part of our history which allows us to hope for our future.  J 

We still have doctor’s appointments, blood draws, and all of the other hoops to jump through.  We are just back to doing it together. 

May 24, 2012 – Counting Chickens

They say, “don’t count your chickens before they hatch.”  I guess I should say don’t count your HCG before the lab.  My doctor called with my HCG levels last night and it is still 4.  He stated that because of my history of crazy side effects he isn’t willing to let it go.  I have to go back in 2 weeks for another HCG check. 

I am trying not to worry about it too much.  My HCG hasn’t gone up and is very low, so chances are things will work out just fine… having said that I now feel like I have cursed myself.  Maybe I should go running through the streets screaming “I have cancer” and then I would really end up being healthy and fine. 

May 23, 2012 – Normalcy

For the first time in 2 months I forgot to get up and go to the lab for my HCG draw.  It was nearly one before I realized I had forgotten.  I am taking this as a wonderful sign; because for the first time in 2 months this pregnancy and loss weren’t the first things on my mind when I woke.  Instead I ate breakfast, checked facebook, responded to texts and emails, and paid bills.  My old routine.  Things are finally beginning to settle. 

Last week my HCG was a 4, which is technically negative for pregnancy.  The nurse said a period should be forthcoming and then I should be 0 by today.  Friday I had my first period since January.  For my entire life I have thought, “wouldn’t it be nice to not have to worry about periods.”  It turns out the answer is “no”.  Periods are a sign of health.  It is amazing how this change in my thoughts affected my perception of the event.   

 As my hormones have settled, I feel like I am returning to my previous self.  It is very good to be back.  Doc is still struggling with everything that has happened.  I think this is mostly because his work requires him to be focused on others and it leaves no time for him to think about his own situation.  He has had 3 intense rotations while also facing 3 months of very difficult challenges in his personal life.  He has a lot to process and hasn’t had much time to deal with it.  This manifests itself in a bad mood.  I can’t blame him.  We desperately need some “us” time to deal with everything that has happened and to reset our course.  Thankfully he has 6 days off starting tomorrow.  We will be unplugging (as much as we can while he still has to study for boards) and reconnecting as a couple.  Forgive us if we disappear or seem unavailable during this time, we love you all, but we have to put our family first.  It is time for us to finish processing everything that has happened so we can put away these emotions and move on.  So that when we start trying in August we can enjoy the experience.  J

May 10, 2012 – Waiting

I assumed that since we were not currently able to try and conceive a baby that the big waiting game would be over… As usual, I am a moron.  The nurse called with my HCG levels.  Today we are at 7, a whole 2 points less than last week.  She explained that they are hoping it will drop off after I have a period.  So, I am waiting for my first period.  It turns out that my doctor was wrong about it coming this week.  Thus confirming that he is not psychic, which would be really handy for an OB if you think about it.  Regardless I will be going in for my 10^th HCG draw on Wednesday. 

I did just find out that the insurance is doing a really good job of covering all the lab work.  Thank God we have insurance!   Although insurance doesn’t cover anything related to fertility treatment (labs, meds, visits) it has covered everything associated with this pregnancy.  As the bills roll in and we are nearing the end of our 1^st year of trying I am going to add up all the pre-insurance costs of this year and see how much it would have cost insurance free.  I wonder if we will spend as much money on health care as we spent on medical school.  I am certainly off to a good start!

May 04, 2012 – Deep breaths, one foot in front of the other

On Tuesday evening I had a mucous discharge.  Super gross, right?  I thought so.  As promised, I called my doctor’s office about it.  They called me back and said the doctor wanted to see me.  The big concern was, of course, infection.  I knew I didn’t have an infection; no fever, no chills, no odor. We have only had protected sex, so no new pregnancy to worry about either.  My doctor is being cautious and I appreciate that. 

When I arrived the office was full of very young, very pregnant ladies.  Many of whom had several children in tow.   It was depressing.  Don’t get me wrong, I am very happy for everyone who is able to have children, but following my recent nightmare it is hard to be around things that remind me so much of what we lost.  Thankfully the nurse saw me, checked me in, and got me out of the waiting room quickly.  She also gave me my current lab results; my HCG is now at 9.  It is still dropping, which is good, but I was really hoping for 0.  We can’t be done with this nightmare until it is 0 for 3 months.  Until then I get to spend every day worried that I have a new nightmare waiting just around the corner. 

My doctor checked me, everything looks good.  I am tender, but that is to be expected.  He actually thinks I should be having a period in the next week.  I haven’t had a period since January, so I am actually looking forward to it.  It will be a sign of normalcy returning.  I am supposed to call and let them know when I finally get a period.  I think my doctor will be happy to see signs of normalcy returning as well.  This has been hard for all of us. 

Obviously, I am still dealing with the emotional upheaval of the last few months.  My hormones don’t help that situation.  Another factor which is making life more difficult is the impending arrival of Mother’s day.  The mere mention of which has me in tears.  Again, I am not unhappy for all of the amazing moms I know, and I know a lot of really great moms.  It is just that I feel so empty when I see a commercial or ad for Mother’s day.  It just reminds me that I lost our baby.  It reminds me that as of April I have been on prenatal vitamins for a year in preparation for pregnancy.  July marks a solid year of trying and failing to start a family.  It is all just so hard to handle.  I know my hormones are helping to exaggerate my feelings, but it is still hard. 

It is also hard to know what to say when people ask how we are doing.  As a therapist I know that a lot of mental health issues could be avoided if people just talked about real stuff that was going on with them.  However, in practice I have noticed that talking about our situation silences a room in a hurry.  People don’t know what to say in response to our reality.  Having to smile and say everything is just fine just makes me feel lonelier.  I would rather people not ask if they don’t want to know.  People want to know it is over, which is understandable.  However, the problem is that it isn’t over.  The reality is that it won’t be over for at least 3 months, possibly much longer.  The problem is that even when we do get pregnant again it won’t be the same.  How am I supposed to get excited about it again after everything we have been through?