October 25, 2011 - Give me a break

I think it is time to give myself a little break from worrying about infertility. I decided that this month I need to let go of some of the constant worry and reminders.  Doc and I discussed it and he is going to take over some of it.  For this month he’s going to be counting days and I’m just going to follow his lead.  I’m not going to be taking any ovulation or fertility tests.  I’m just going to try and enjoy my favorite month of the year.  I need to break. 

As for our other looming decisions, we’ve discussed those as well.  We’ve decided that I will see the specialist next month, by myself.  Doc will be working his inpatient month in November, which means I will only see him when he needs to sleep or be home so he doesn’t have a duty-hour violation.  By getting all the pre-work done by myself I am hoping that we can push the surgery back to a month when Doc is more available.  I think the hospital will give him time off for the surgery if it isn’t during an inpatient month.  They can’t afford to be short a doctor during those months.  The hospital is short a few doctors right now and until those positions are filled all of the current doctors need to be working steady.  While I hate putting things off, I hate the idea of doing it completely on my own more.  I can’t ask the hospital to sacrifice a doctor when I can so easily move the dates I need my husband. 

So, we are continuing on this path until we hear otherwise.  This month started out rough, but now that I’ve decided to give myself a little break things are looking a lot better.  I realize that not everything is in my control and I am doing everything I can to improve our odds.  The rest is in someone else’s hands.  J

October 18, 2011 – Doctor, Doctor

It has been a rough couple of weeks.  Last week we had another failed pregnancy.  I became very ill last Monday.  I tied to ignore it and tried to go on with my daily life, but by the time Doc got home I had been unable to eat anything and was not keeping things down.  The nausea continued for two days, along with shaking, sweating, and just general ickiness.  There was no fever, so I knew it wasn’t a virus.  I already had my doctor appointment scheduled for Monday, so I waited to talk to her then.  Even though in the moment it felt very urgent, I knew there was nothing that could be done to stop it. 

Yesterday I saw my doctor.  I love my doctor.  I explained everything that happened and she ordered some additional tests.  I’ve been having a pain in my left side since Monday.  It hasn’t been bad, but I know better than to ignore pain.  For once the news that we were not pregnant was good news.  If I had still had elevated levels of HcG it would have pointed towards an ectopic pregnancy, which would have made yesterday suck a lot more than it did.  Unfortunately, it did lead to a doctor’s order to see a specialist, “sooner rather than later.” 

For those of you that don’t know about endometriosis; it is a disorder where the lining of the uterus grows in places where it should not.  When it grows in these incorrect places (like the abdomen) it is still functioning, so when the rest of the lining is shed, this incorrectly placed lining attempts to shed.  Only when it sheds into the abdominal cavity it causes internal bleeding.  Pain is just one fun side effect.  The real trouble begins when the body attempts to stop this internal bleeding.  As a part of the “healing” process it creates scar tissue in places where it should not be and can cause problems when it attaches normally free floating organs to one another.  I once had a doctor describe it as trying to pull apart tissue paper that has been glued together.  Not a nice picture when you consider this is my abdomen.  It causes the individual pain when they move.  The solution for this problem?  Surgery!  L

One of the side effects of all this healthy living I have been doing (increasing my iron, adjusting my hormones) is that the lining has been shedding more.  Simply put, there has been a lot more internal bleeding going on.  So a new pain, which has developed in only a few months, is not a good sign.  The internal bleeding is one of the many reasons that patients with endometriosis have trouble conceiving.  When the uterus attempts to grow, existing scar tissue prevents expansion, which isn’t good for baby. 

So, I have orders to see the specialist.  I know we will need to schedule surgery, but one of the problems is finding a good time to do that.  Doc doesn’t exactly get a lot of days off and he needs me to take care of things around here, like walking our crazy dogs and grocery shopping.  I had a similar surgery done when I was 20 and while the surgery itself isn’t bad, the recovery days sucked. Doc is scheduled to be in his inpatient rotation next month, which means he is working pretty much non-stop for that month.  He won’t be able to hold my hand for the surgery, much less take care of me afterwards.  Not to mention my extreme dislike of surgery.  Irony of all ironies; I am actually afraid of doctors.  J  I will figure it out; I am just finding all kinds of reasons to avoid thinking about it today. 

Almost every thing else looked good during my visit.  I’ve got low blood pressure, which considering my family history of heart problems and high blood pressure is good news.  Almost all of my blood levels were within the range of health.  The only problem with my blood work was that my iron is still low!!  I have made so much effort on this one variable!  I eat red meat, I eat leaf greens, I eat beans, and I take prenatal vitamins plus an additional supplement of iron!  Now I find out I have to double the supplements I take!  I don’t understand how I can still be low!  For those who have never take iron supplements before, they suck.  They cause all kinds of trouble.  I love the way my doctor gave the order though, “if you can tolerate it, double your supplement.”  Sadly, we all know I will tolerate it.  I went through a month of stomach aches when I started it all in the pursuit of baby-making!  I’m not stopping now!

October 3, 2011 - Welcome to October!

Welcome to October, my favorite month of the year!  Of course right now we just know it as month 4 of trying to get pregnant.  I have to say that even though our doctor told us we were going to have trouble getting pregnant, and even though in 10 years of marriage we have only gotten pregnant once, there was a part of me that thought I would be pregnant by now.  Sadly, we are not.  I’m really disappointed and feeling pretty down today, so forgive me if this isn’t as hopeful as usual.  I wanted to be honest and share all sides this struggle, and some days just suck more than others.  The dark secret of the moment is that I cry at the mere mention of family, or sight of a big baby bump, and at pampers commercials.  Yep, the thought of dirty diapers makes me cry, and not in the way you might think!  I realize what we are missing out on, which makes me sad.  L

Doc and I have had a lot of thinking to do about how we will continue this journey.  We are very fortunate that Doc’s job provides us with excellent insurance, which doesn’t require a waiting period for pregnancy.  We are also blessed with access to some of the best healthcare available.  See, Doc is a resident at one hospital, but that hospital is part of a large organization of hospitals, clinics, and private practices.  Fortunately, any physician in that network is considered “in network” for our insurance, so we can pretty much see any physician in our area and if we incur expenses at the hospital, the program will cover a portion of the bill.  It’s like being part of the mob, if the mob were a huge group of fantastic doctors whose goal it was to make the world a better place by providing top-notch healthcare.  The downside (doesn’t there always have to be a downside?) is that fertility treatments are not covered at all by our insurance and while the hospital can write off things like supplies, the doctor performing the tasks still has to be paid.  So, while we have access to the best healthcare, it doesn’t matter because we can’t afford the treatments.  Which is today’s second suckfest, I know.  L

So, what have Doc and I talked about?  We have been trying to figure out how much money we should spend on trying to get pregnant and whether we should consider adoption instead.  Med-school was very expensive, and more than a fourth of our income will go towards student loan payments for the next 10 years (at least), and residents don’t make that much money (McDonald’s money) and despite common opinion, doctors really don’t make as much as people might think (at least pediatricians don’t), so we have to consider the financial ramifications of our choices.  For the moment we have decided to continue on with trying to get pregnant, with a better understanding that we may have some tough choices ahead.  There are a lot of tests and procedures that have to happen before fertility treatments can begin, so we need to talk to our doctor about spreading those tests out so that we can make the process more affordable.  Hopefully this won’t add too much time to the process, because as we all know I’m old and the clock is ticking on my fertile years.

Keeping in touch with our doctors has become second nature now that we understand how much more smoothly things go when our doctors are informed.  We’ve signed releases so that the OB and GP can communicate, which also makes it possible for our GP to order and run tests that might cost more if done at the OB.  It helps that our GP was a resident in this network and she understands how to get things covered either by insurance or the hospital.  In a couple of weeks I have my next scheduled appointment and we will discuss options for spreading out testing.  I will also check to see if she has any helpful money saving tips or if she knows which tests will get us the most info for the money.  We need to be proactive in our situation, which means we need to be doing our own research and we need to walk into appointments informed.  Hopefully our doctor appointment goes smoothly and she has some good ideas for improving our odds.  I’ll let you all know what we figure out! J

September 27, 2011 - Timing is Everything

When Doc & I first met we were young and pretty much your typical college students.  We functioned on minimal sleep, ate way too much junk food, and regularly closed bars that had live bands.  To top it all off, we couldn’t keep our hands off of each other.  It didn’t seem to matter that we had less than 3 hours of sleep.  Sometimes we even skipped sleep so that we could have of some quality time together. 

Fast forward 13 years and you have a different story.  Not that we have less love for each other (I’d argue the opposite) and it isn’t that we don’t enjoy each others company (he’s still my best friend & I’m his).  It is just that now we have a ton of responsibilities and pesky lives to live.  We don’t close any bars (or go to them at all), we don’t go to live shows, junk food gives us tummy aches, and we don’t skip sleep unless we absolutely have to.  When we do skip sleep we are supper cranky and really not functioning well.  So, imagine how difficult it is to conceive with only a 24 hour window of opportunity.  It wouldn’t be that hard if we actually had a full 24 hours, but the reality is that we end up with a much smaller window.  Doc worked 16 hour shifts this weekend, so that knocked us down to 8 hours of actual time together.  By the time he came home, he was understandably exhausted, so he was pretty much in an eat/sleep mood.  Not exactly baby-making heaven, but we of coursed worked it out J

The thing I find myself becoming more and more frustrated with is Doc’s job.  Not that I’m complaining about my husband running off to save babies ever day.  What I get frustrated with is that we have absolutely no control over when he works.  We don’t get a say.  He works long, hard hours, getting paid the same as your average McDonald’s employee and our lives get put on hold in the process.  This is frustrating because we put our lives on hold to get here, so that he could go to med-school.  We moved because medicine demanded it.  I lost my career in that move.  We will most likely be facing another move in 2.5 years again because medicine will again demand it.  It just leaves me wondering “when will this be our life again?”  I refuse to put off starting our family any longer, so medicine can kind of suck on that.  And it isn’t that the hospital is asking us to, it is just the reality of his job that makes it difficult.  When you only have 24 hours to try and make a baby, timing is everything. 

September 23, 2001 – The Sweet Week

Each month is packed full of stuff to remind me that we are struggling with fertility.  All of the monitoring, testing, & trying (J) serves as a daily reminder.  But for one week each month there is relief.  For that one week I can be hopeful and anxious and wonder if we have finally managed to start our family. 

Of course, so far, that one week has had a very sad ending.  It has been followed by a day that is personally devastating and full of self-doubt.  And on the worst months, I wonder if we aren’t being punished for some great error and that is why we are having trouble conceiving.  If we are somehow living our lives incorrectly and the punishment is the withholding of this one pleasure. 

Then the realist in me kicks back in, and I know that this isn’t punishment, it is biology.  I was diagnosed with endometriosis when I was 20 years old and it was going to make getting pregnant very difficult.  I also believe that we all have lessons to learn and things to accomplish and things happen exactly as God intends.  So, while I am ready today, God has additional plans for us.  We will get pregnant in his time, and he has a purpose for this struggle. 

September 20, 2001 – If only this were an Olympic sport!

I feel like I am in training.  It started around April with prenatal vitamins and baby books.  Of course, if you are taking prenatal vitamins you should also take DHA, so 2 pills already.  All of this was, of course, doctor recommended for a woman of my age (apparently the Friends stars lied, 33 is old in reproductive years) to start vitamins before we started trying.  Done. 

Then came blood work… lots of blood work.  After that we added a thyroid med and additional iron.  I’m the only person I know taking 400% the daily recommended amount of iron just to have a “normal” blood level.  Yes I eat red meat (now) & love leafy greens; I just have abnormally low iron.  Anyone who has ever taken prenatal vitamins or additional iron can tell you they tear your stomach up!  I spent 2 full months with daily stomach aches.  Awesome, but if it helps with the baby-making I’m all over it.  Of course the increase in iron meant we needed to increase fiber too.  Oh joy! 

I also gradually increased my daily activities.  While I loved being a therapist, it didn’t encourage a lot of activity.  I sat in a chair or on the floor working with kids all day.  While we had excellent facilities to engage the children in more active play (basketball court & track), it turns out depressed kids just aren’t that into physical activity.  Now that I’m home I can take the dogs running, go for long walks, clean, and do all of the other things I was neglecting before. 

All of these are good things to do, especially when trying to conceive.  And so we happily tried.  It was very casual at first, a bit romantic even.  The thrill of doing something new.  Then a month went by… no baby.  We decided to get a little more serious with our efforts & plotted everything on the calendar.  I had a good idea of when our trying would be most successful, then we took an every other day approach.  Most people don’t realize that an ovum is only viable for between 24-32 hours, but sperm can remain in the uterus for up to 5 days.  So, trying every other day was a pretty safe bet… no baby. 

I realize the doctor told me this wouldn’t be easy, but I’m hopeful by nature, so my hopes were being crushed monthly.  As time passed, we continued to get more and more serious about our efforts.  We are currently up to daily efforts along with lots and lots of tests.  Home pregnancy tests, followed by fertility tests, rounded out with daily ovulation tests. All this so that we can one day see 2 pink lines!  

Over the last 6 months I’ve made numerous and sweeping changes in my life, all to improve our chances at successfully creating life.  It is hard to be the woman in this equation.  I’ve changed everything from the pills I take daily (I’ve given up any OTC med that my doctor hasn’t ordered me to take), the amount of sleep I have, my overall stress level, the amount of exercise I get, the water I drink, and the food I eat.  Doc has had to increase his water consumption and in the process of conception his orgasms are far more important than mine.  So, when it comes to the fertility Olympics, it kind of sucks to be a girl.  J

The Dreaded Question

The journey to residency was full of major changes for us.  It started in the last year of medical school.  During the fourth year of medical-school hopeful young doctors all over the country (and in a few others) go through the dreaded process of Match.  Match sucks.  It is essentially speed dating for doctors in which they hope to be matched with the perfect residency program.  Each doctor interviews at several residency programs, they rank each other, and if the residency wants the doctor & the doctor ranks the residency highest, then a match is made.  Match is announced in March and residency starts by July. 

For us this process was the bane of my existence last year.  Doc had a ton of interview offers.  We decided to cap the speed dating at 12 interviews.  The interviews include an informal dinner followed by a full day of interviews at the hospital.  The most shocking thing we discovered about the process of becoming a pediatrician is that your life is no longer your own, and it is no longer private.  Doctors have no filter, so when sitting at a table full of them I’ve come to expect what are normally deemed inappropriate questions to become common place. 

The most popular question is of course about how many kids we have.  Not “do you have any children?” but “how many children do you have?”  There is nothing more embarrassing than sitting at a table full of the worlds most fertile people (serious we know a pediatrician with 8 kids) and saying that we don’t have any children.  You can see the assumptions go around the table: “must be something wrong with the marriage” or “she must be frigid”.  The question is always followed by my husband or me trying to delicately explain, without going into detail, that we would love to have children but haven’t yet been successful. 

Eventually we used this question to inquire about healthcare and child care options provided by the program.  We would simply respond with, “we are looking forward to starting our family very soon.”  Most of the time this response satisfied people’s curiosity.  There is always the exceptional individual that doesn’t catch on though.  We actually had a doctor inform us that “no one trusts a pediatrician that doesn’t have kids. You need to have them so you can have street cred.”  WOW!  How does one respond to this?  I mean everyone is a child at least once in their lives, so that is some experience.  Childhood is a pretty well documented stage of life; med-school should have illuminated a good deal of process.  Not to mention the moral ambiguity present in having children simply so people will trust you!  Then I started thinking about gynecologists.  No one questions a male gynecologist, but he lacks the body parts and the personal experience of his expertise.  So, a pediatrician that doesn’t have children right out of med-school seems a lot less awkward when compared to a gynecologist that has NEVER had a uterus even after 30 years of practice, right? 

Needless to say, we didn’t rank that program very highly at all!

July 27, 2011 - The Epic Battle

My blood work came back and we now have the doctor’s approval to try and have a baby, which is good because we have already started trying.  I’ve been taking prenatal vitamins for more than a month and they started me on additional iron… basically my stomach hurts all the time now.

Something my doctor said in my visit keeps rolling around in my head.  Although the physical exam went well he told me that endometriosis can cause my body to produce an extra defense against sperm.  Basically, my uterus has extra sperm-killers.  All I can think of is the Family Guy episode where Stewie shrinks himself so that he can stop his parents from having another baby.  He is flying around in a little spaceship shooting lasers at sperm.  The thought of an epic battle occurring in my uterus is kind of funny to me.  Now we just have to figure out how to defeat Stewie!

July 26, 2011 - The New Doctor

Today we had our first appointment with the new OB/GYN.  It was the first time I’d seen a male OB/GYN in more than 13 years.  Before the move I had an amazing female doctor.  Seeing a male is just a different experience.  He was very busy, and the appointment felt rushed.  I didn’t get to know him as much as I would have liked. 

We reviewed my medical history (a brief version) and he ordered a titer for Rubella to make sure I have been vaccinated.  If I haven’t been vaccinated then it will be an additional 3 months before we can start trying again.  He also made sure I was aware of how difficult it was going to be to get pregnant because I was diagnosed with endometriosis when I was 20.  He created a plan, we would try for 6 months (until November) and then if we hadn’t conceived by then we would do a fertility work up.  It may require me to undergo another surgery.  I will do whatever it takes to get pregnant.  The hard part is thinking about the reality that none of it really means we will conceive, it just means we aren’t giving up. 

Being married to a physician has some benefits, but it also has some downfalls.  For example, Doc didn’t get to meet the new doctor today.  He had to round in the nursery, so he wasn’t there to help me explain everything in doctor terms.  Hopefully they will meet soon though.  It is always better to have Doc in the room; doctors listen to each other far better than they listen to patients. 

Overall, it was slightly depressing.  I was hopeful that we were already pregnant, so hearing that we aren’t kind of sucked.  We will march on though.  Next month may be our lucky month.