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.

Rinse, Repeat

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.