I've had a few days to marinate on this post, so I'm not as hopped up as I was initially when I wrote this. But I thought I'd post my initial thoughts anyway:
I don't know how to put my feelings into words. I am happy and ecstatic. But those feelings are being overcome and crushed by sadness, anger, and jealousy. If we weren't trying with all of our might and money to get pregnant or if I already were pregnant or had a child, I would just be plain excited.
I am the oldest sibling of 3 kids on my side of the family. I have 2 younger brothers that are 2 yrs and 6 yrs younger than I. As oldest, I've had the privelege of doing most things 'first' as we were growing up. The first to be able to cross the street to get the mail, the first to go to school and then to college, the first to drive, the first to get married. I always pictured that we would get pregnant and be able to give my parents their first grandchild. First.
Instead of being thrilled with the fact that I will be a brand new aunt (and I am thrilled about that), it is being overcome by bitter sadness and tears. Why?! My brother called from 1,000 miles away to tell me that he and his wife are 10 weeks pregnant. It took them 3 months to get pregnant. He was afraid to call me and I was the last in my immediate family to know. I fought back the tears while talking to him and said all the right things like "I'm happy for you guys" and "Congratulations". But I know I didn't exude the joy that I normally would have had my own circumstances been different. That pisses me off because my brother deserves more than that from me. He had told my parents while they were visiting him 2 weeks ago. Of course, my parents didn't breathe a word to me. Maybe that irks me most. Everybody tip toeing around us. They can't be excited about it in front of me. I hate being in the dark, and it really upsets me that this news should upset me and that eveyone knows it. I don't want to feel this way.
It's not like we haven't gotten these types of calls before over the years. DH's siblings have called at least 3 different times with 3 different pregnancies with the same news. We currently have 7 nieces and nephews and one on the way on DH's side. Close friends have called at least 5 different times. That's 8 kids that nobody wanted to tell us about right away because they didn't want to upset us. And I have never felt as crappy with those announcements as I do with the news from my little brother. I knew it would happen at some point. Maybe it is just hitting a little too close to home.
There isn't much I can do about our infertility situation. It is what is is. DH consoled me in that we're doing all we can. I should be happy. Happy for my little brother. He deserves this. And I know that. My brain most definitely knows that. Maybe if I just keep telling myself, the good feelings will overcome the crap feelings. I am happy. I am happy. I am happy.
Monday, March 28, 2011
Saturday, March 26, 2011
Testing 1. 2. 3.
My bloodwork came back normal. DH's test results came back semi-normal. The SA results and bloodwork were as such:
density count: 18mL (want > 20)
total count: 41 million (want > 40)
% motility (moving): 57% (want > 50%)
% morphology (shape): 1% (want 5-15%)
testosterone: 181 (want 200-500)
LSH/FSH: normal
The morphology number is not good. This would indicate IVF w/ ICSI as the solution. Obviously, we've done that. Twice. However, the testosterone level concerned the doctor most. Low testosterone can indicate a problem with the testes, which is the primary failure or it can indicate an issue with the pituitary gland or hypothalamus. Our previous RE tried to treat the testosterone levels with Clomid for 3 months. That might have worked if it had been a testes problem. Because the LSH/FSH were normal and not elevated leads our current RE to believe that the testosterone issue is not because of the testes but because of a problem with the pituitary gland.
DH will be going to the hospital on Monday for more bloodwork and he will have to do a 24 hour urine test. I had never heard of that one before. Basically, he has to collect his pee in a bag for a full 24 hours to be tested. I'm so glad it's not me being poked and prodded this time! Also, he has to get an MRI of his pituitary gland. This will rule out tumors, growths, or any wierd things going on with the gland. Who knew one of us would need an MRI to try to have a baby?!
With hormone therapy, the testosterone levels can get to normal. In cases of trying to get pregnant, DH may have to take HCG shot 3 times per week until we're pregnant. After that, he could take testosterone to keep "normal". The craziest part of this whole thing is that the doctor indicated that if this is the main problem, it could be possible to get pregnant on our own. I told him that would be unbelievable. Literally, I don't believe it. Please don't say things like that to me unless it can really happen!
density count: 18mL (want > 20)
total count: 41 million (want > 40)
% motility (moving): 57% (want > 50%)
% morphology (shape): 1% (want 5-15%)
testosterone: 181 (want 200-500)
LSH/FSH: normal
The morphology number is not good. This would indicate IVF w/ ICSI as the solution. Obviously, we've done that. Twice. However, the testosterone level concerned the doctor most. Low testosterone can indicate a problem with the testes, which is the primary failure or it can indicate an issue with the pituitary gland or hypothalamus. Our previous RE tried to treat the testosterone levels with Clomid for 3 months. That might have worked if it had been a testes problem. Because the LSH/FSH were normal and not elevated leads our current RE to believe that the testosterone issue is not because of the testes but because of a problem with the pituitary gland.
DH will be going to the hospital on Monday for more bloodwork and he will have to do a 24 hour urine test. I had never heard of that one before. Basically, he has to collect his pee in a bag for a full 24 hours to be tested. I'm so glad it's not me being poked and prodded this time! Also, he has to get an MRI of his pituitary gland. This will rule out tumors, growths, or any wierd things going on with the gland. Who knew one of us would need an MRI to try to have a baby?!
With hormone therapy, the testosterone levels can get to normal. In cases of trying to get pregnant, DH may have to take HCG shot 3 times per week until we're pregnant. After that, he could take testosterone to keep "normal". The craziest part of this whole thing is that the doctor indicated that if this is the main problem, it could be possible to get pregnant on our own. I told him that would be unbelievable. Literally, I don't believe it. Please don't say things like that to me unless it can really happen!
Monday, March 21, 2011
TMI
Talk about information overload. After our 3 hour 2nd opinion consult this morning, my mind is a whirlwind of big words, tests, and thoeries. This infertility cyclone involves genetic testing, chromosones, smoking, semen analysis and SCSA, karyotype test, and clomid challenge test.
I put together on a one page document our entire infertility history. This list starts in late 2006 with going off of birth control, includes 2 HSGs, multiple day 3 blood tests, too many SA's to count, working with an OB and an RE, a visit to a uroligist, 6 clomid IUIs, 3 injectible IUIs, and 2 IVFs with ICSI. This little document was a lifesaver since we not only spoke to the doctor, but 2 nurses and a genetic counselor individually. They all asked most of the same questions and it was nice to hand over this one-page sheet of paper to give them most of the answers they needed without having to repeat myself or forget something. I did most of the talking as DH gets pretty quiet during these meetings.
We arrived 30 minutes prior to our appointment. Yes, too early, but I wasn't sure what to expect in terms of traffic, parking, or paperwork. Fortunately, I had already done most of the paperwork and had mailed it in prior to the appointment. I asked if they had received my records from my other doctor(s). The receptionist specifically remembered my records because they summed up to the size of a large novel!
I think we peaked the doctor's curiosity about us, though. That's a good thing. Give him something to think about. To say the least, we have been on a very LONG road in the way of infertility with no BFPs. The ultimate question is why? It doesn't make sense. Based upon our individual history and tests, something should have worked at some point in the last 4 years. Particularly disconcerting is that the embryos during IVF w/ ICSI are arresting on Day 3. The doctor was going to have an embryologist look at my records, but he mostly wants to take a closer look at DH. He even mentioned referring us to some doctor friends in Boston/New Jersey if we end up doing ICSI again. Apparently they are the best in the nation at ICSI. Oh boy.
Like my previous RE had said, day 3 is crucial because the embryo is trying to survive on its own. How I understood it, is that up to that point the embryo is thriving on the woman's chromosomes and then trying to "mix" with the man's chromosomes on Day 3. The embryo may be arresting at Day 3 during this process because there may be sperm DNA fragmentation. DNA fragmentation could be causing the embryo arrest on Day 3 and could cause miscarriage if we did get pregnant. You can't SEE DNA fragmentation or a chromosomal issue during ICSI, so even if they pick out the perfect looking sperm, there could be issues on the inside of the sperm or with the egg itself. The only way to prove that it may be a chromosomal issue is to do a karyotype test. The cost is nearly $1,400 per person, not covered by insurance, and according to the doctor and the genetic counselor the chance of this being 'the problem' for us or the reason for DNA fragmentation is very low (less than 15% in those with male factor infertility and less than 5% in those with general infertility).
In all likelihood, if the problem is from DNA fragmentation of the sperm, it is probably due to smoking. My husband has smoked since he was 18 years old (at least he waited until it was legal) and he currently smokes about a pack a day. That's 15 years of smoking. I don't see how that wouldn't have an impact on his swimmers and I've told him that from day one. Smoking may not affect the count or the shape of the sperm, but the insides of it. Kind of like in humans. You might not be able to see the immediate affects of smoking from the outside, but it sure is doing a number on your insides.
Now, I'm sure you all are rolling your eyes at us, because why hasn't this been called to our attention before? Why didn't we do something about this habit before 9 IUIs and 2 rounds of ICSI? All I can say is that we all know that smoking is bad for us, but people do it anyway. It is addictive and it is hard to quit. Your brain tells you one thing - that you should quit and that it is bad, bad, bad - but your body craves more and overtakes your brain. Smart people can get sucked into this addictive spiral. DH (and myself) are no different. He knows its bad, but by now it is an addictive habit and denial of its negative affect kicks in.
We're thinking chantix is in order. DH already has a prescription for it, but has been reluctant to fill it. He really doesn't want to quit and the drug is not covered by our insurance either. I can't make him do it. His own doctor has urged him to quit due to his high blood pressure and cholesterol. Still he hasn't quit. Now, our infertility doctor is saying that this could be "the big reason", and I'm not sure what he'll do.
Bottom line: I don't think we should try any more major infertility treatments until he has quit. And he has to quit soon because it will take 3 months to get all of the affected sperm out before the unaffected sperm will hit the surface (so to speak!). The doctor mentioned that they could take unaffected baby sperm directly out of the testes for ICSI, but that in most cases a man would rather quit smoking than have a big needle shoved into their balls! He mentioned that we could bypass all of the questions and costs by considering donor sperm. We've thought about it, but haven't decided on it. Not sure if we're ready for that yet. We've come so far already.
If and when we get to the point of ICSI again, the doctor did say they would look at a different drug protocol for me. I didn't press as to what that might be because he seemed more concerned with getting the answer of why this is happening first. We'll cross that bridge when we get there.
Lastly, there is a genetic test we can take that costs around $300 per person that can test for over 100 different genetic diseases. It's a spit test and is pretty easy to do. It's just another cost that we can decide to incur. It is up to us, but the office wants to let us know our options. Our previous doctor never even mentioned genetic testing to us. I think we'll consider it before we go into ICSI again. The genetic counselor also mentioned our mental/emotional health and wanted to make sure that we get what we need in that area, too. Again, more than the previous RE ever offered in that department.
So, where do we go from here? First, DH had an SA today with SCSA testing. This is to determine if DNA fragmentation is an issue. If it is, quitting the smoking is a top priority. Secondary would be to consider the karyotype test for DH even if the risk is small. I could take the test, too. I'm not sure if we want to incur those costs or not. I had some bloodwork drawn and so did DH. They're going to do a panel of a variety of things, among them testosterone for him and prolactin for me. Then, I'll be doing a clomid challenge test during my next cycle. This is to test my ovaries. I've done 6 IUIs with clomid, but they never took blood on day 10 to check how my ovaries had responded. I don't think there's an issue with my ovaries, but ya never know. Why not?
So, like I said, this appointment was information overload. I feel like we're starting over. I am 26-27 years old again and trying to figure out what to do about this not-being-able-to-have-a-baby thing. I'm pretty numb to it all at this point. Overall, the entire office was very nice, as was the doctor. In my mind though, actions speak louder than words. I'm thinking we'll stick with this guy until we can get some more definite answers.
I put together on a one page document our entire infertility history. This list starts in late 2006 with going off of birth control, includes 2 HSGs, multiple day 3 blood tests, too many SA's to count, working with an OB and an RE, a visit to a uroligist, 6 clomid IUIs, 3 injectible IUIs, and 2 IVFs with ICSI. This little document was a lifesaver since we not only spoke to the doctor, but 2 nurses and a genetic counselor individually. They all asked most of the same questions and it was nice to hand over this one-page sheet of paper to give them most of the answers they needed without having to repeat myself or forget something. I did most of the talking as DH gets pretty quiet during these meetings.
We arrived 30 minutes prior to our appointment. Yes, too early, but I wasn't sure what to expect in terms of traffic, parking, or paperwork. Fortunately, I had already done most of the paperwork and had mailed it in prior to the appointment. I asked if they had received my records from my other doctor(s). The receptionist specifically remembered my records because they summed up to the size of a large novel!
I think we peaked the doctor's curiosity about us, though. That's a good thing. Give him something to think about. To say the least, we have been on a very LONG road in the way of infertility with no BFPs. The ultimate question is why? It doesn't make sense. Based upon our individual history and tests, something should have worked at some point in the last 4 years. Particularly disconcerting is that the embryos during IVF w/ ICSI are arresting on Day 3. The doctor was going to have an embryologist look at my records, but he mostly wants to take a closer look at DH. He even mentioned referring us to some doctor friends in Boston/New Jersey if we end up doing ICSI again. Apparently they are the best in the nation at ICSI. Oh boy.
Like my previous RE had said, day 3 is crucial because the embryo is trying to survive on its own. How I understood it, is that up to that point the embryo is thriving on the woman's chromosomes and then trying to "mix" with the man's chromosomes on Day 3. The embryo may be arresting at Day 3 during this process because there may be sperm DNA fragmentation. DNA fragmentation could be causing the embryo arrest on Day 3 and could cause miscarriage if we did get pregnant. You can't SEE DNA fragmentation or a chromosomal issue during ICSI, so even if they pick out the perfect looking sperm, there could be issues on the inside of the sperm or with the egg itself. The only way to prove that it may be a chromosomal issue is to do a karyotype test. The cost is nearly $1,400 per person, not covered by insurance, and according to the doctor and the genetic counselor the chance of this being 'the problem' for us or the reason for DNA fragmentation is very low (less than 15% in those with male factor infertility and less than 5% in those with general infertility).
In all likelihood, if the problem is from DNA fragmentation of the sperm, it is probably due to smoking. My husband has smoked since he was 18 years old (at least he waited until it was legal) and he currently smokes about a pack a day. That's 15 years of smoking. I don't see how that wouldn't have an impact on his swimmers and I've told him that from day one. Smoking may not affect the count or the shape of the sperm, but the insides of it. Kind of like in humans. You might not be able to see the immediate affects of smoking from the outside, but it sure is doing a number on your insides.
Now, I'm sure you all are rolling your eyes at us, because why hasn't this been called to our attention before? Why didn't we do something about this habit before 9 IUIs and 2 rounds of ICSI? All I can say is that we all know that smoking is bad for us, but people do it anyway. It is addictive and it is hard to quit. Your brain tells you one thing - that you should quit and that it is bad, bad, bad - but your body craves more and overtakes your brain. Smart people can get sucked into this addictive spiral. DH (and myself) are no different. He knows its bad, but by now it is an addictive habit and denial of its negative affect kicks in.
We're thinking chantix is in order. DH already has a prescription for it, but has been reluctant to fill it. He really doesn't want to quit and the drug is not covered by our insurance either. I can't make him do it. His own doctor has urged him to quit due to his high blood pressure and cholesterol. Still he hasn't quit. Now, our infertility doctor is saying that this could be "the big reason", and I'm not sure what he'll do.
Bottom line: I don't think we should try any more major infertility treatments until he has quit. And he has to quit soon because it will take 3 months to get all of the affected sperm out before the unaffected sperm will hit the surface (so to speak!). The doctor mentioned that they could take unaffected baby sperm directly out of the testes for ICSI, but that in most cases a man would rather quit smoking than have a big needle shoved into their balls! He mentioned that we could bypass all of the questions and costs by considering donor sperm. We've thought about it, but haven't decided on it. Not sure if we're ready for that yet. We've come so far already.
If and when we get to the point of ICSI again, the doctor did say they would look at a different drug protocol for me. I didn't press as to what that might be because he seemed more concerned with getting the answer of why this is happening first. We'll cross that bridge when we get there.
Lastly, there is a genetic test we can take that costs around $300 per person that can test for over 100 different genetic diseases. It's a spit test and is pretty easy to do. It's just another cost that we can decide to incur. It is up to us, but the office wants to let us know our options. Our previous doctor never even mentioned genetic testing to us. I think we'll consider it before we go into ICSI again. The genetic counselor also mentioned our mental/emotional health and wanted to make sure that we get what we need in that area, too. Again, more than the previous RE ever offered in that department.
So, where do we go from here? First, DH had an SA today with SCSA testing. This is to determine if DNA fragmentation is an issue. If it is, quitting the smoking is a top priority. Secondary would be to consider the karyotype test for DH even if the risk is small. I could take the test, too. I'm not sure if we want to incur those costs or not. I had some bloodwork drawn and so did DH. They're going to do a panel of a variety of things, among them testosterone for him and prolactin for me. Then, I'll be doing a clomid challenge test during my next cycle. This is to test my ovaries. I've done 6 IUIs with clomid, but they never took blood on day 10 to check how my ovaries had responded. I don't think there's an issue with my ovaries, but ya never know. Why not?
So, like I said, this appointment was information overload. I feel like we're starting over. I am 26-27 years old again and trying to figure out what to do about this not-being-able-to-have-a-baby thing. I'm pretty numb to it all at this point. Overall, the entire office was very nice, as was the doctor. In my mind though, actions speak louder than words. I'm thinking we'll stick with this guy until we can get some more definite answers.
Sunday, March 20, 2011
Short Post
I got to day 40 before the evil AF decided to make her appearance. It is what it is. DH said that at least I have some pregnancy tests on hand for the real thing. 2nd IF opinion is tomorrow.
Saturday, March 12, 2011
Day 37
We were planning on having our 2nd opinion appointment right after our vacation on Friday, the 11th. Prior to leaving for vacation, the office called to reschedule for the 21st. What's another week I guess? Also, in my last volleyball game, I fell and sprained my ankle. The spike was beautiful, but blocked. Go figure. I hobbled through half of our vacation with a bruised and swollen foot. Then I was expecting AF in full force by the start of vacation. The worst is having to fly all day with that. The week was seemingly off to a great start.
Now, we're back from vacation and we actually did have a great time! Lake Tahoe was beautiful - we got some great pictures. Our lakeview cabin was nice and cozy with a fireplace. Snowmobiling and driving through the mountains was the best part.
Then, Reno was Reno. We stayed at the Atlantis which is probably one of the nicer casino hotels in Reno.
We had fun gambling - to a point. DH bowled, too. Then, back home again.
But the wierdest thing since my last post is that I'm currently on day 37 of my first full cycle since the IVF. WTF? I am a 28-30 day girl, through and through. AF was scheduled to ruin my vacation, but never showed up. I had a suitcase full of "feminine hygiene products" and no use for them. I (and DH!) was happy for that, but curious about the lateness. The longest unmedicated cycle I've ever had was 36 days, which was years and years ago during the first 6 months of being off the pill. I waited until we got back from vacation on day 34 to do a pregnancy test leftover from probably a year ago. I did it the night we got home because I couldn't wait till morning. Negative. What else should I expect? But seriously, what is going on? Was it the altitude in Nevada that is messing with my cycle? Is it God playing a cruel joke on us? I bought a couple of more tests yesterday, but I hesitate to take them. I've been down this road more times than I can count. I know what the result will be. I'll take them. They'll be negative. Then AF will come. I might as well skip the agony and the hope and just wait for it to come like it always does.
Then, back at work on Friday, when we were supposed to be at my infertility consult, the 26 yr old girl in my office that we just hired not even 2 months ago reveals that she is pregnant. She had told my boss and coworker while I was on vacation. She's due in September. She sits right next to me 40 hours per week and - for lack of a better term - is my assistant. I congratulated her and played through the pain, but I almost couldn't handle it. The rest of the afternoon, I concentrated on my computer screen with tears in my eyes, going back and forth to the bathroom to regain my composure. No one saw. I'm sure my other co-worker felt my grief as she knows my story and the new girl doesn't. It's not fair. I felt so sorry for myself.
But wouldn't it be ironic? We spend thousands of dollars and drive hundreds of miles to do IVF twice unsuccessfully - just to get pregnant all on our own? It's a nice thought. I don't believe it. I'm jinxing it even as I write this. I'm willing - daring - AF to come at any moment.
Now, we're back from vacation and we actually did have a great time! Lake Tahoe was beautiful - we got some great pictures. Our lakeview cabin was nice and cozy with a fireplace. Snowmobiling and driving through the mountains was the best part.
On top of the mountain (9,000 ft or so) on a beautiful, clear sunny day! Isn't Lake Tahoe crazy blue? It mirrors the sky.
Emerald Bay and the little island in the middle. I can't remember what it is called. We were even in a mini-avalanche on the drive up!
Then, Reno was Reno. We stayed at the Atlantis which is probably one of the nicer casino hotels in Reno.
But the wierdest thing since my last post is that I'm currently on day 37 of my first full cycle since the IVF. WTF? I am a 28-30 day girl, through and through. AF was scheduled to ruin my vacation, but never showed up. I had a suitcase full of "feminine hygiene products" and no use for them. I (and DH!) was happy for that, but curious about the lateness. The longest unmedicated cycle I've ever had was 36 days, which was years and years ago during the first 6 months of being off the pill. I waited until we got back from vacation on day 34 to do a pregnancy test leftover from probably a year ago. I did it the night we got home because I couldn't wait till morning. Negative. What else should I expect? But seriously, what is going on? Was it the altitude in Nevada that is messing with my cycle? Is it God playing a cruel joke on us? I bought a couple of more tests yesterday, but I hesitate to take them. I've been down this road more times than I can count. I know what the result will be. I'll take them. They'll be negative. Then AF will come. I might as well skip the agony and the hope and just wait for it to come like it always does.
Then, back at work on Friday, when we were supposed to be at my infertility consult, the 26 yr old girl in my office that we just hired not even 2 months ago reveals that she is pregnant. She had told my boss and coworker while I was on vacation. She's due in September. She sits right next to me 40 hours per week and - for lack of a better term - is my assistant. I congratulated her and played through the pain, but I almost couldn't handle it. The rest of the afternoon, I concentrated on my computer screen with tears in my eyes, going back and forth to the bathroom to regain my composure. No one saw. I'm sure my other co-worker felt my grief as she knows my story and the new girl doesn't. It's not fair. I felt so sorry for myself.
But wouldn't it be ironic? We spend thousands of dollars and drive hundreds of miles to do IVF twice unsuccessfully - just to get pregnant all on our own? It's a nice thought. I don't believe it. I'm jinxing it even as I write this. I'm willing - daring - AF to come at any moment.
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