Body Movin'

I'm pretty much paranoid ALL OF THE TIME. Two weeks ago I started to feel much better. Less tired, emotional, nauseous, congested, and more hydrated. I've even lost the few pounds that I've put on in the last couple of months. All of this happened rather suddenly, which caused me to freak out.

"Okay, what's going on? This doesn't seem right. Everything started so gradually, why would it end so suddenly. Something MUST be wrong."

I called Dr. K and scheduled an appointment for last Tuesday. I would have gone in sooner if I could have. Dr. K tried to reassure me that I was nearing the end of the first trimester and I should start to feel better anyway. I agreed with him, but pointed out how suddenly and how many things had changed. I think it started to make him worry.

Of course, it was just paranoia. The ultrasound was fantastic.

Ryan: "I told you so."

He's always cool as a cucumber. The growing grape was dancing around like Ryan does on stage.

Baby Darton

9w6d, 2.97 cm, HR 172 bpm

Ryan thinks it looks like a puppy. Sometimes I wonder about him. ;)

You're the Prayer Inside Me...

I wasn't completely honest in my last post. Two days after the Ragnar Relay Race, it was time to take the home pregnancy test again. I had been disappointed in the past I didn't want to watch the stick develop and have my heart sink. Instead I turned it face down and let it develop for 10 minutes before I turned it over with Ryan beside me.

*gasp*

It was positive!!! I was shocked. Speechless. Is it for real?

Although I had just come home from a long night shift, we headed back to the hospital for blood work confirming the pregnancy. I slept in fits waiting for Dr. K to call me with the results.

*gasp*

It was positive!!!

I don't think I really believed it would work this cycle. I didn't have the hope that I had last cycle. It didn't seem real. I wanted to tell the world, but it was still early and everyone says you should wait until 12 weeks to let the cat out of the bag...just in case.

The next night I was in so much pain I texted Dr. K and he told me to come in the next morning for an ultrasound. He confirmed that I had OHSS. Since I was pregnant, Dr. K informed me that it could take weeks to months for the swelling in my belly to go down and it might get worse before it gets better. By that time, I might have a baby bump anyway! He told me to take it easy and not do anything strenuous. Take work off if I needed to. An ultrasound was scheduled two weeks later to see the heart beat. I was so EXCITED!

Was it because of the acupuncture?

Was it because my ovaries were overstimulated?

Was it because I wasn't working much these last few weeks?

Was it because I'm not as stressed?

I told my Nurse Manager the good news and showed her my bulging belly. It was pretty obvious how painful it was. Luckily work was slow and she was able to take me off the schedule for the week. The following week I was on call and never got called in. 2 weeks to take it easy...was NOT easy!! I was bored out of my brains but couldn't stand for very long and got winded going up the stairs. I was literally in bed for most of those 2 weeks. It felt like torture and was in a world of hurt.

When I did go back to work people were suspicious. Co-workers commented that I had a "glow" and many asked how the fertility treatments were going...trying to pry information out of me. A few were bold enough to ask outright if I was pregnant. I laughed and told them, "I hope so!"

It still didn't feel real, but sometimes I remembered that there was a little person starting to grow inside me. I would whisper sweet things to this little being. Tell it all that I hoped for... trying to ignore and hide my fears. I started a list of names, I spent hours finding websites, and checked out half the library.

Ryan met after a night shift for the 6 week ultrasound to see the heartbeat. He was so excited, he brought the camera. Dr. K put the gel on my swollen belly, and worked his way around my huge ovaries. The excitement faded quickly.

Silence.

There was no heartbeat.

Dr. K apologized and told us that the embryonic sac was much too small for how far along I was and he didn't see a heartbeat. It was an abnormal pregnancy and possibly ectopic. I would most likely miscarry, but they would draw labs to make sure.

I was numb.

Based on my Hcg levels when we confirmed pregnancy at 2 weeks, my Hcg should now be 25,000. It doubles every other day. My Hcg levels were only 875. Dr. K told me I should stop taking the progesterone to allow for a miscarriage.

What if something crazy happened. Since I had so many follicles that were borderline, is it possible that I ovulated later? What if I was pregnant, but it didn't take and I ovulated a few days later and a new egg implanted....

What if...

What if...

What if...

I wasn't ready to let go of something I had worked so hard for, and suffered so much pain for. Dr. K let me wait two more days and do follow up blood work to see if my Hcg levels would double like they should. My Hcg levels two days later were barely over 1,000 when it should have been at least 1,750.

Was it because of the Ibuprofen?

Was it because I ran the race?

Was it because I took Ex-Lax?

Was it because I took a suppository?

I stopped taking the progesterone and waited to start bleeding. It was Mother's Day weekend as well as my birthday and we had plans to go camping. Dr. K was concerned that I wouldn't be near civilization if anything were to happen, but I wanted needed to get away for a few days. Maybe I'm a little dramantic (romantic + dramatic), but I wanted to bury my little one in the beauty of nature rather than have it flushed down the toilet.

I didn't bleed.

Since my ovaries were still gigantic, they were producing high levels of progesterone and keeping the pregnancy. I would need to take medications for force a miscarriage, otherwise the embryonic sac would continue to grow and would result in a more painful and traumatic miscarriage later. What if I wasn't supposed to miscarry? What if it really was a viable pregnancy? I didn't want to miscarry unless I absolutely knew that this was an abnormal pregnancy. Dr. K. scheduled another ultrasound. I was now 7 weeks pregnant.

Silence.

There was no heartbeat.

I picked up my prescription and inserted the 4 pills. The cramps started within an hour and lasted 36. It was several hours until I started to bleed, followed by 2 weeks of severe depression.

I cried as bled into the toilet.

Do I have a hostile uterus?

Are my eggs poor quality?

What is wrong with me?

I cried when I flushed my prayer, my hope, my heart.


Once upon a time I was pregnant...

You're a Poem of Mystery

The last 6 weeks have been rough for me. This last round of fertility treatments has done a huge number on my body. A little recap...

My follicles were a little sluggish responding to the medication, growing slowly and requiring larger doses. It seemed that there wasn't a follicle that wanted to take the lead, so we just kept plugging along and increasing the dose or the number of days I took a certain dose. Till the bitter end, not one claimed the leadership role. Finally I had 3 that were large (mature) enough to release an egg, the problem was that I had no less than 6 and possibly 9 others that were borderline mature and could possibly ovulate as well. Dr. K reiterated the risk of having multiples, but we again hedged our bets since we've faced that risk before and come up empty handed. We decided to go for it and did the insemination.

That weekend I went with a group of girls to San Diego where we spent our days relaxing and being lazy. It was refreshing and a little alien to not have anything to do. However I was feeling a little self conscious next to these beautiful twiggy girls since I was noticeably bloated. I didn't think too much of it and it seemed to go away once I got back to L.A.

The following weekend was Ragnar. Ryan and I had been training (not too intensely) for this 200 mile relay race for the past several months. We were excited and admittedly nervous. Neither of us had ever done a race before, but we heard it is a lot of fun and less about running than it is about the experience. We borrowed vans from Toy Bombs and Gardner and decked them out in true Rompompachop (our team name) style. Everything was green light go...except for my belly. I was bloated again! It was even worse this time!

My first leg I prepared by taking popping 800mg of Ibuprofen before my run to muscle through the pain and avoid any headaches that I'm notorious for. Things went fairly well, but something definitely had to be done about my gas because Gas-X wasn't working. At least that's what I thought was causing the bloating. Maybe I was constipated and the gas couldn't get through the road block.

Before my next leg, we stopped by the store and bought some Ex-Lax, and suppositories. I would flush it out and be good to go! The Ex-Lax worked like a charm and I felt 75% better. I was able to rest comfortably before our next leg. I spoke too soon! By the time it was my turn to run, I was bloated again! Good thing it was a shorter leg. I popped another 600mg Ibupofen and was on my way.

Next solution...the dreaded suppository. It worked to say the least and I felt a bit better, but not was well as after the Ex-Lax. There is no possible way that anything was blocking gas from getting out now, but I was STILL bloated! I was so bloated that I was short of breath and looked more and more square. Although painful, I popped another 400mg Ibuprofen and suffered through my last leg to the end without adding too much to my anticipated time.

We finished the race behind schedule, but with high spirits. It was a lot of fun and would do it again next year...as long as I'm not bloated.

As it turns out it wasn't gas. Remember OHSS? Yep. This time it was for real. Yeah, last time I was pretty much a wimp. This time it was the real deal. I kept getting bigger, and bigger, and bigger. I called Dr. K. at 1:30am because it was so painful I couldn't sleep and I was having a hard time breathing. He scheduled an ultrasound the next morning and it confirmed that it was indeed OHSS and my ovaries were 5"x7"....or the size of oranges. They were so large that they were pressing on my innards and diaphragm and making it hard for me to breathe. Sure breathing was a concern, but a bigger concern was making sure my ovaries didn't twist on themselves and cut off blood circulation, essentially killing the ovary. I also had to carefully monitor my fluid balance. When ovaries are that large they get "leaky" and leak fluid into the abdomen (ascites) which is very painful and can cause electrolyte imbalances that need to be corrected in the hospital. If I collected too much fluid too quickly in my abdomen they would have to aspirate some of the fluid out with a needle....Yikes! At this point Dr. K told me to take it easy and limit my physical activity and avoid Ibuprofen. Wait. WHAT?! I just ran a race! I told him that we had just finished a race not more than 36 hours earlier and I was popping ibuprofen like it was candy and his facial expression was the equivalent of him shitting his pants. The average person wouldn't pick up on it because Doctors are masters at masking emotion (it's part of the job), but being a nurse I have developed a keen awareness to subtle twitches and stiffness that betrays the calm they portray. I knew it was pretty serious by his response.

Apparently if you are attempting to become or already are pregnant you should stay clear of Ibuprofen. I did not know this...and I'm a nurse! What the hell? Is this common knowledge? I asked around the unit at work, and not a single person knew this...unless they had recently been pregnant and only because their OB/GYN gave them a list of meds to stay away from. Geez it would have been nice to know BEFORE hand that Ibuprofen is a no no! Before anyone gets on their high horse about how I should have known better or looked it up in Drug Handbook...I'm sorry I don't have time to look up every medication, and I thought my MD would for sure give me a list of medications to avoid, especially since I've asked before if there was anything I should stay away from.

As far as the swelling was concerned, Dr. K could only recommend Tylenol and heat packs. If the pregnancy test was negative they could give me a medication for it to go down more quickly, but if I ended up pregnant then I was looking forward to having a swollen belly for weeks to months.

No working for me for a couple of weeks. Good thing it was slow at work and I kept getting called off.

I could hardly breathe, gained 10 lbs of water weight, was in a lot of pain and looked 6 months pregnant. This better be worth it!

That was the first 2 weeks....

Strike Three

*Sigh*

I've had a hard time getting up the energy to blog about this again, but I guess I want to document my journey. Maybe one day in the future (hopefully with a baby in my arms), I'll be able to look back and say, "Whew, I'm sure glad that's over. It was worth it, but man that was a bumpy ride."

Here's the skinny....

Since I responded almost too well to 75 IU of Follistim last round, Dr. K. had me start with 50 IU this round. 3 days and an ultrasound later, I had produced a lot of little follicles, but none of them were nearly the size they should have been. Dr. K. bumped the dose up to 75 IU for 2 days with an ultrasound to follow. *grumble* Now the ultrasound showed a lot of medium sized follicles, but none had "taken the lead" or were big enough to ovulate yet. So Dr. K. had me do 2 more days with 75 IU with another ultrasound to follow.

The next ultrasound showed I had a lot of large-ish follicles, but none were quite ready to ovulate again! Dr. K. decreased my Follistim dose to 37.5 IU for two days with an ultrasound to follow in hopes that a few of the follicles would finally be ready to ovulate.

By this time I could really feel it. By it I mean it was painful. It felt like someone had sucker punched me in the ovaries. Essentially they were like expanding balloons, stretching tighter and tighter. It hurt to run, it hurt to stretch, I was bloated, had diarrhea, nausea and the beginnings of a nasty headache that would last a week. Remember OHSS? I pretty much had mild/moderate symptoms of OHSS and it sucked big time.

Back at Dr. K's office I had not one, two, three, even four follicles taking the lead, I had a lot of huge-ish follicles that could potentially ovulate. I think he counted 4 follicles that would definitely ovulate and 6 more that might ovulate. Dr. K. filled us in on the potential risks (multiples) with proceeding with the IUI and gave us the option of abstaining this round. It felt like such a waste to sit this one out. A waste of money, time, and discomfort if we didn't do it. I didn't want my suffering to have been for nothing...I wanted to go for it. Theoretically we had 3-4 eggs last time that didn't "take"...maybe we would be increasing our odds.


To spare me some of the rage, Dr. K. cut my progesterone dose in half for the first five days. Ryan and I were sneaky and took a short trip to Durango to visit my sister and her family. I totally expected to feel a little bit of rage while I was there and even worried I might get short tempered with my niece and nephews, but I didn't.

Sadly, my progesterone levels after 5 days weren't high enough so Dr. K. bumped me back up to 200mg Progesterone twice a day. I expected to Hulk out on the higher dose, but I didn't. I actually felt pretty good, normal even. My ovaries weren't hurting any more, I wasn't bloated or nauseous, and my headache was gone. Finally!

As you can tell from the picture above, I took the pregnancy test on 2/22 and it was negative. WTF is an understatement. Are my eggs bad? Is my lining healthy? What is going on? Do I have a hostile uterus? I want some answers. We had felt really good about this round since I had so many follicles and didn't Hulk out. It was really hard seeing the result come back negative for a third time.

Tomorrow I am trying acupuncture for infertility. There are currently several research studies going on that have shown some favorable results. Maybe when East meets West I'll get lucky.

Beautiful Sunday

Hey, hey, hey it's a beautiful day...

The ultrasounds this morning looked promising with one follicle at 20mm, two at 16mm, and another at 15mm (we want them bigger than 14mm). My blood test showed that I'm not "surging" which means I'm not ovulating on my own. My estrogen levels are good, but for what ever reason my progesterone and LH are still low. This is probably why we have fertility problems. Maybe I'm able to create follicles, but I don't surge. My lining is 12-14mm (we want at least 7mm). It's nice and luxurious...perfect for a little blastocyst to snuggle down into. :)



Instead of my daily injections, tonight at 10:30pm I inject HCG to make me surge. Our IUI is scheduled for 9:30am Sunday morning!

Keep crossing your fingers, sending energy, and saying prayers!

If at First You Don't Succeed...

We are trying again.

Since my previous round of Clomid and IUI didn't succeed and I had significant visual side effects, I can't continue to take Clomid. Following an ultrasound which showed a lot of small follicles and a blood draw for my estrogen levels, Dr. K prescribed Follistim. Things looked pretty good so Dr. K gave me to "go ahead" to start daily Follistim injections at a low dose of 75 IU. The injections really aren't bad. The sticker shock of $600 for two vials was MUCH worse.

After 3 days I went back in for another blood draw to check my estrogen levels. Too high, too high! Dr. K explained that women with PCOS have a very narrow therapeutic range with FSH injections and even a small amount can over stimulate the ovaries. If they are over stimulated the chances of becoming another octomom go up and so does the risk for Ovarian Hyperstimulation Syndrome (OHSS)...which can be, but is rarely deadly. Yikes. We toned it down a notch and he had me reduce my injection amount to 37.5 IU each day for the next two days.

Today I went back for another ultrasound and estrogen level check. What we want to see are a few big follicles instead of a lot of little follicles. Yay! I have 2 follicles that are right where we want them and 2 more that are nearly there. That means I possibly have 4 follicles...or eggs (if they all release) that could fertilize and implant. Exciting! Although I DON'T want quadruplets or even triplets, it is exciting to know that my ovaries are doing what they are supposed to be doing! I have hope for this round. Honestly, with the last round I wasn't too hopeful since my lining was so thin, but this time I have 4 follicles AND my lining is thicker!

For the next 2 days I continue with the 37.5 IU injections and go back in for another blood draw and/or ultrasound on Friday. If things still look good then I will inject HCG to create a LH surge and do the IUI on Sunday! Looks like I might have enough Follistim for another round at this low dose. I wonder what the shelf life is if this round works. Hmmm....

Keep your fingers, toes, and eyes crossed! Say your prayers and send your energy!

Please and THANK YOU!

Wars Waged and Battles Fought

I've been thinking about this post for a long time, and how I was going start. I'm having a hard time putting my emotions into words, and perhaps it is because it is something close to my heart.

I want a baby. I'm not talking about your usual want, like when you want a doughnut or a new pair of shoes. Sometimes I think I even NEED those things, because I CRAVE them. No, this want is deeper, a more visceral want. It's something that I ache for, my heart aches for.

My nephew Jonas Hughes

We "trying" to get pregnant, but before you start congratulating us and wishing us the best (I still need your well wishes though), this is not the usual trying. It's not the kind where you toss out your birth control and start paying attention to ovulation calendars, basal temperatures etc. Oh how I wish it were that easy!! We are "trying" with medical interventions.

Back Story:
I remember walking with my friend Sarah H. when we were 9-ish discussing what our future husbands would look like, what qualities they would have, what type of profession they would have, how old we wanted to be when we got married, how many children we wanted and the ratio of girls and boys. I told her that I wouldn't be able to have children. She looked at me and said, "How do you know?" I replied, "I just have a feeling." I wanted 6 (3 or 4 is plenty), I think she wanted 4. I really did have that feeling and it worried me. It still worries me. Was it pessimism, self fulfilling prophecy or premonition? Could I really have been that in tune at that age?

I was relieved when I finally came of age and "became a woman" at nearly 16 (16 or later, as a rule of thumb indicates abnormalities). All of my friends had come of age years earlier. I was a late bloomer by medical standards. Even after I had my first menses, things didn't go smoothly. No monthly visits for me. They were all over the place. Every so often I would have sharp pains in my abdomen. Although I didn't know what it was at the time, I could tell it had something to do with my ovaries. It felt like they were in a vice and someone was jabbing them with a large sharp needle. The pain never lasted too long so I didn't worry much about it. At 18, my general physician suggested I start birth control in hopes to kick start my body onto a regular cycle. I stayed on it for a few years and at 21 decided to see if my body had finally gotten a clue on how to do it properly.

A year went by...nothing. Not a drop.

Friends tell me that I am lucky. No cramps, bloating, I'm saving money, etc., but for me it meant I wasn't normal. I want to be normal...at least in this area.

I went to see a recommended OB/GYN. He drew some blood, did an exam and said, "Well, I think you have Polycystic Ovary Syndrome, but I can't be certain because your hormone levels are within normal limits and you don't fit the typical profile of a woman with PCOS." Nervously I asked him if I was infertile. He said, "We won't be able to tell that until you start trying to get pregnant, but I can tell you that you are going to need help. The pain you are having is probably ovarian cysts that have ruptured. In the meantime, you need to keep your uterus healthy by shedding your lining every month with birth control. It will also help prevent additional cysts from growing." A trip to the ER (to rule out appendicitis) confirmed PCOS.

Currently:

Since we've been married we haven't been preventing, and more recently we have been actively "trying". In March I saw an Endocrinologist who put me on 500mg Metformin (diabetic medication that can also stimulate ovualtion in women PCOS) every day in hopes that it would stimulate my body to start ovulating. To my excitement, I started to have breast tenderness. Was Metformin the answer? After 3 months, still no period and the tenderness went away and hasn't been back. In May, she bumped it up to 1,000mg. In June, she bumped the dose to 1,500mg and she gave me a referral for a Fertility Specialist. In July, I was taking 2,000mg Metformin but even that wasn't working. It was time to take it to the next level. In August my Fertility Specialist added 50mg Clomid every day to the mix hoping to stimulate an egg follicle to grow. For a review on how complex ovulation really is click here. After 8 days and the start of intense hot flashes we did an ultrasound to see if anything was happening...nothing. My doctor increased my dose to 100mg every day plus the Metformin. 8 more days later and another ultrasound...follicles!!! They weren't /mature or big enough yet though. They needed to double in size. We came back 3 days later for another ultrasound...no growth. He increased the dose to 150mg Clomid and 2,000mg Metformin. 8 days later and after experiencing blurred vision and tracers in addition to the horrible hot flashes, the ultrasound showed 2 follicles that had "taken the lead" and were the appropriate size and ready to ovulate. SUCCESS!!!

Hold you're horses.

That is just the beginning. Now I had the follicles, but I still needed to release the egg, have it fertilized, and hope that it it implants. To ensure that the follicles launch the eggs (I might have released 2) I had to give myself a shot. We wanted to increase our chances of success, so 36 hours later Ryan gave a sperm sample *cough* that was washed, spun down and concentrated. An hour after the sample as given, I was artificially inseminated. We had homework too. For the next 3 days we needed to "get busy".

Now we wait.

Well, I do more than just wait. I still have to take the Metformin and Progesterone in addition to prenatal vitamins. Unfortunately, higher the doses of Clomid mean the thinner your uterine lining becomes. Eggs want thick luxurious lining to nestle down into. Progesterone helps build this lining. I was on near max dose of Clomid and because of my visual side effects, I won't be able to try it again. Vision is too closely connected to the brain and they don't want to take any chances. Good thing those 2 follicles were ready to go, otherwise we'd be back to square one.

After 2 weeks of waiting I take a pregnancy test to see if it actually worked.

I'm scared. What if it doesn't work? I've tried to keep myself emotionally distant so if it doesn't work I won't be completely heartbroken. I've always planned on adopting , so I have a back up plan, but in my heart of hearts I REALLY want this to happen. I want to feel my belly grow, and feel a little person moving inside. The process is so tedious and technically structured when you can't conceive naturally. Because of this, I've realized how special and miraculous having a baby truly is! There are SO many things that need to happen just to get pregnant let alone produce a healthy child (those are a whole new set of fears). If it doesn't work, I can't promise I won't cry.

There is so much frustration with not being able to conceive. I know pregnancy can be difficult, uncomfortable, and probably down right miserable, but sometimes it's hard to listen to friends and co-workers complain about their hardships when I would give anything for the same opportunity. Sometimes I want to take them by the shoulders and shake them and say, "Be grateful damn it!" I hate to think that in my life time I've only had a handful of opportunities to conceive naturally, opportunities that I may never have again without intervention. Most women have the opportunity every month and often feel that it is a curse. I hope my lady friends pause and give thanks for the ability you have been given to be able to create life. I have to fight for that gift.

The entire process is very expensive. My insurance covers some, but not all of it. We haven't received any bills yet, and I'm a little nervous to see how much this endeavor will cost us. If it works, it was well worth it. If it doesn't we are looking at even more expensive options.

Sometimes it feels like I'm wishing for this:

When I've been given this:

I'd be happy to settle for something like this:

So today is the day. It's been 2 weeks.

I could use a prayer, positive energy, luck or a combination of all three.