IUI #2 Failure

We're officially moved out of San Antonio. The move was.... a bit horendous. Only because it was scheduled on Thursday/Friday and we just learned that on Monday that week! So very little time to prepare. When our orders didn't come a week out, we assumed we couldn't move by the 15th, so we boght plane tickets back to NC that night. So those obviously couldn't get used, because the movers didn't leave our house until 8:15pm!!! We still tried to get to the airport, but the ticket counters were closed. So we got dinner and went to our friends' house. We bought tickets out for Saturday, but had to get separate airlines.... Boo. :( However, God was gracious we even got tickets! Mine we used Delta Skymiles to get. I'm glad we had them! R kindly got up early and bundled 10-month-old E into the carseat and took us to the airport! She had homemade coffeecake and hot chai/coffee for us, too. She really has become my best friend in San Antonio, even though I only just met her in August/September! Our weekly get-togethers were a real blessing. Her walk through infertility has been such a comfort to me.

And yes, IUI #2 was a big failure. I had one last appointment scheduled with Dr. J and we went over possible scenarios for future treatments. J and I have so much to think and pray and talk about.... So many decisions. None of them are inexpensive. Most likely I can go back in February/March for another IUI, but this time on injectible drugs (gonal-f) rather than clomid (increased pregnancy rates, better quality eggs/follicles). Of course, if I overstimulate (8 follicles for example) I could fly out there are be canceled.... So it takes it to an even higher-stake risk emotionally!

Even though he said they try to be fair as in making everyone wait a certain amount of time before going on the IVF list, because I'm moving he said I could get a special consideration and get on the list. Currently, at my position on the list, I'd be looking at cycling in April 2008, although there is a good likelihood of a few months sooner. Dr. J said, "I just can't see it being April 2008 and you not being pregnant! You're young and you respond well and we can't find anything wrong with you." I told him I couldn't see it either, but I didn't want to take the chance. I said I couldn't have seen it being December 2006 and me not pregnant, but here we are! He let me ask as many questions as I had and spent a lot of time making sure all our bases were covered. I'm so grateful he started working there, he is very good and compassionate!

This last week it's been excrutiatingly hard to kick the discouragement/depression, but I think yesterday I finally did.... for this month, anyway. J and I have had the hardest time reaching any sort of oneness emotionally. It's the most lonely/alienated situation I've been in my whole life.

IUI #2 Completed!

IUI #2 is complete. CD14 (The morning of the trigger, 1 day before the IUI) showed:

E2: 982.2 (not as good as 1447 last time at CD13)
FSH: 6.7
LH: 21.4 (almost surging?)
Left Ovary: 23, 14.9, 4 less than 10
Right Ovary: 10.2, 10 less than 10
Lining 8.7

Timing seemed pretty good, although I continue to be preturbed by the right ovary not having any mature eggs. Sperm post-wash: 73 million, 45% motile (not as good as last time either). I guess that's ok, I just like my chances as increased as possible. The shot was no trouble. J's words last night were, "I'm getting good at this, and I hate it!" Poor him! We got to go in together today and the same resident doctor that did it last time did it this time. She was good, but it was a bit more painful than I remember. This time, I've been completely prone all day. Not risking anything getting up, no matter if they say it's ok. J came home at lunchtime with a pizza (my favorite, btw) and a decaf Starbucks Gingerbread Latte. That was such a sweet gesture! It really made me feel so well taken care of by him.

So now beings the dreaded 2ww.... again. However, I'm going to find joy in it. That's one thing the Lord's been speaking to me lately. To find joy in this trial. So I'm attempting to. I'm so grateful
everything turned out well this time.

I'm curious if I'll feel the HCG hormones this time like I did last time. It's equivalent of what you're feel at 6 weeks past conception. :/

IUI #2 Blood & Follicle Update

The appointment went well. These are CD4 Levels:

E2: 38.5
FSH: 7.2
LH: 9.5
Left Ovary: 6 less than 10
Right Ovary: 5 less than 10

I am going in the Monday after Thankgiving for my next blood/ultrasound. 95% chance I won't have ovulated yet, and they'll prescribe the HCG shot for that evening and the IUI for Tuesday morning. That would be perfect, in my opinion. The alarm clock was 15 minutes fast this morning (accidentally) so I actually left the house at 4:45. Oh well. I got #1 again for ultrasounds. :)

The lady in the lab that took my blood was not good, however! I felt the needle go in WAY too far and it hurt immensely throughout the draw & upon her taking it out. She even asked if I was ok (never had that before). Did she know how bad she was? I even have a bruise, that's a first! The doctor (Dr. M - a good one, but not my favorite) said the usual procedure is to go through 9 IUIs before getting on the IVF list!!! That's a lot! 3 Clomid/IUI, 3 Clomid/Gonal-f/IUI and 3 Gonal-f/IUI.

He did offer to, on an individual basis, consider the fact that we're moving and put us on the IVF list, which is a 12-18 month wait. J & I will pray about all this. Flying back here for IUIs may be more expensive than just doing them in GA. I just don't know. Good thing God promises wisdom for those who ask!

On to IUI #2 I Guess?

Tomorrow I get to go in for a baseline ultrasound and blood work (CD4 actually). I counted and this will be my 13th visit to WH. So I realize that's not a ton of visits, but over 4 months it has felt it at times! By post-Thanksgiving, it should be up to 15 visits. That averages out to about 4 a month. Rambling here, sorry!

Not sure which doctor is doing the ultrasounds tomorrow. But to humor you all, I thought it might be interesting to tell you how these appointments go. It is NOT the typical, call & get an appointment time, be seen, leave. You see, WH is one of the few military infertility centers in the US. They see people from all over. Plus, they have an ob-gyn clinic there, too, so they see regular ladies and pregnant ladies, etc. Their doctors are extremely understaffed, I'd say. So, in order to make it easiest for all their doctors, ALL ladies needing normal pregnancy or infertility-related ultrasounds basically get a paper on the "routine" way to do this. They tell you to show up at 7, get a number at the labratory, get your blood drawn, get a number for an ultrasound, get your ultrasound. Well, ha! It's basically a "cattle call." If everyone shows up, they figure the doctors can do as many women as possible before regular patients show up for their appointments, then if you haven't been gotten to, they'll fit you in that morning if possible. Until then, you must wait! You could be there til noon! Makes sense though.

Now, thankfully my friend R has been through ALL of this. So she actually advised me what to really do. This is how it actually works for me, what I'll be doing tomorrow.

4:00am - Wake, Shower, etc
5:00am - Leave for WH
5:30am - Arrive WH, Come In, Get Number from Labratory, Sit down Outside Closed Doors of Clinic & Wait (read book or have quiet time)
6:30am - (Get irritated looks from the ladies arriving after you, since you'll get #1) Nurse opens Clinic, Go in and get #1, head over to Labratory for Blood Work
6:35am - Labratory doors open, Stand Amazed at ALL the Old People already Waiting with Numbers (10 at least!)
6:45-7:00am - Get Blood Taken Sometime In There
7:00am - Head to Clinic, Get Number Called, Get Room & do the fun "undress from waist down", Wait with huge real sheet on (thank God it's big & not paper!), Get called into next room for ultrasound, Get Follicles and Lining measured, Talk to Doctor, Pray they listen, Get next appointment scheduled
8:15ish - Leave (grab a decaf cappuccino from the coffee shop in the clinic)

By that time, you feel like you've experienced a whole day's worth of activity, when really it's barely time to start work!

I know that might be boring for you all to read, but things like this are a huge deal to me. The military world and the infertility world are so confined to themselves, and so few people even have the slightest idea what it's like. I think by sharing, perhaps it can help us all in general to be more compassionate and understanding when meeting other people in situations we don't know. Like when a friend tells me, "My son was in the NICU for 2 weeks after his birth." And I just say how sorry I am. Truly, I have not entered into her pain and fear and sorrow over that part of her life. If I just try to put myself in her shoes, I believe I can more truly fulfill the command to "bear one another's burdens, and so fulfill the law of Christ." In a Charles Williams sort of way, the "Doctrine of Substituted Love." (If you haven't read Descent Into Hell, you won't understand that.)

Anyway, my perspective has lightened today and all shall be according to God's will. If this all keeps failing, that too must be the hand of God. The God who opened Rebekah's womb when Isaac prayed, who opened Elizabeth and Rachel and Sarah's and Hannah's wombs each. I take comfort in the fact that 3 days after the resounding "Not This Time" being all too obvious, I have fresh Christ-centered perspective again. Glory be to Him, because that is a gift Satan is eager to steal away. I want to guard is preciously, by hearing His Words fresh each morning, and Communing with Him throughout my Day.

And truly, each evening when my dear husband comes through the door looking so handsome in his olive drab flight suit, sweeping me up in his arms with joy at being home with me, I remember that by my marriage, I have been so, so blessed. This is the Season of Life I'm given, give praise, have joy, and turn my future yearnings back to God's timing.

IUI #1 Completed

Last news I got was that we had to move in December, so we only have two more cycles at WHMC! When I went in for my CD12 monitoring, I (fortunately) got Dr. J (the bestest, most understanding and accomodating), and he agreed my next two cycles can be IUI's! Hooray! The morning monitoring was interesting to say the least. I got #1 for Ultrasounds, but the residents had screwed me up by telling me last week NOT to get my blood drawn. Come to find out, I had to get it done. By the time I found that out, about 10 people already had lab #'s. So I waited a while, I think I was the last ultrasound of the morning monitorings, but I was out by 8ish, so no big deal. I'll know better, my instinct told me to just get a blood lab #.

Here were my CD12 numbers's:
E2: 1011
FSH: 3.4
LH: 12
Left Ovary: 14.5, 17.9, 16.4, few less than 10
Right Ovary: 14, few less than 10
Lining: 8.4

As this was Thursday, the doctor said he'd either want a Saturday (CD14) or Sunday (CD15) IUI. He told me to come in tomorrow to see if my LH was surging yet, and if it wasn't we'd do Sunday. I came in Friday (CD13) and got:
E2: 1447
FSH: 2.8
LH: 12

I picked up my HCG shot (Novarel) and was given instructions on using it. WH is doing studies on pregnancy with 12hr or 36 hr post-trigger IUI's. I'm in the 12-hr group, so J gave it to me intramuscularly on Saturday night. I was anxious leading up to it, but the dr called that night to make sure I felt ok (see why I love him?). J did so well (precious husband) that I didn't even feel it, though I did ice the area for 10 minutes beforehand and sang loudly as he injected it. Still, months ago when I mentioned the future possibility of needing him to give me shots, he insisted he'd never do that. When it came down to it, he agreed. Much better than giving it to myself (the doctor wasn't in favor of it for this shot my first time)

Sunday morning was the Big Day: my IUI. Everything went perfectly, and it was only slightly painful cramping for an hour or so. A resident dr and my fav dr did the procedure. Later, when all the follicles were releasing their eggs, my left ovary hurt immensely for the rest of the evening. It was the one that had 3 follicles. I was so very glad to know what was going on and that everything was timed so perfectly. Although - for what it's worth, I chart religiously and my temp shot up that morning. I imagine I already ovulated at least the biggest egg. I asked the doctor about it but he said it should be ok. I'm a little upset they don't do ultrasounds or blood draws on the IUI day, but I guess their philosophy is, we're going to do it anyway, why waste the resources? Sperm count post-wash: 95 million, 55% motile.

I also want to mention, I know I've expressed frustration with the military infertility clinic here. Well, 3 visits ago, for my hysteroscopy and baseline ultrasound, I got another of the 4 staff doctors, but one I hadn't met. I have finally learned who the staff doctors are, and who the residents are, and that the only people with authority and real knowledge are the staff doctors! Anyway, I got Dr. J and he was completely different than the others. Very willing to work with us, initiated asking me how long we'd be in San Antonio, and offered to put us on a faster track since we wouldn't be here long. He's not all caught up in the schedule of how things should go, he calls me personally to verify or inform me of things, and he is sincerely kind and personal. Plus he's good. He answers every question I can think of. So I'm thrilled. From now on, I'm going to try to get appointments with him. So here's hoping for some good news in 2 weeks. But if not, we shall try, try again.

Hysteroscopy Update

Good news! The hysteroscopy went wonderfully! They did not find anything unusual or bad in my uterus, they said it looked great. (So the Reproductive Endocrinologists were right, the Radiologist was wrong.) I was able to watch it all and it was quite interesting; I'm thrilled to know what the inside of my uterus actually looks like. I was given a Valium took take an hour beforehand, and although I didn't feel it doing anything, the firend driving me told me I wasn't giving appropriate answers at times (too slow)! When the doctor initially came in to introduce himself to me, he told me I wasn't acting like someone on drugs. :)

It did take about 20 minutes (as they switched cameras once) and was a bit painful (very manageable and only real hard for a few minutes). Nothing like the HSG. I have never felt so well taken care of at the clinic there. For my other appointments I've felt rather like one face in a million, and as if they were always rushed/busy (or sent me resident doctors who didn't really know much). This time, Dr. J (a head dr) came in early and talked to me (never had him before). He had the kindest bed-side manner I've ever seen in a dr - even let me squeeze his hand during a painful part! They had 2 resident dr's doing the procedure, they were nice and pretty gentle. Then Dr. M (another head dr) came in later to watch during the hysteroscopy also. So I felt like I was really being looked after. Then they did the ultrasound and one cyst was gone, one was down to 1.5 cm from 4 cm (the corpus luteal cysts from too much clomid, 100 mg). So all was good. I will go in next Thursday for my next ultrasound.

Even though I would have liked them to have actually found polyps or something easy to fix (how I hate being unexplained!), I'm still glad of it. They also learned that we have to leave San Antonio for Georgia in January, so they'll do IUI next month if this one doesn't work. They undertand there's a little more priority for us, so I'm thrilled. I'd rather conceive naturally, but while we're here, I want to give it our best shot possible.

Upcoming Hysteroscopy

Well, yes, another cycle without a pregnancy, but God has had lots of things scheduled for these upcoming weeks, so I'm encouraged. I think I've taken this "failure" better than any other (except maybe the 1st couple of months, before I realized how long this would take). I really only dealt with some tears and hurts for a few minutes, and J held me and kissed me and comforted me, and then it was over. Really a blessing. I give God the credit for that.

So, Thursday I go in for a hysteroscopy. (This is where they take a camera into the uterus so they can see exactly what's in there.) The doctors re-reviewed my HSG and determined that they aren't necessarily changing their first analysis, but they are recommending a hysteroscopy so they can actually see what the "abnormal filling" is. They said that if it were polyps, they would not allow a fertilized egg to implant!!! I'm really hoping that's been our problem all along, and that they can do an in-office precedure and remove them (rather than an anasthesia & later appt). Anyway, that's also the day of my baseline blood work and ultrasound. They will check on the growth of my follicles, and my endometrial lining, and then tell me when next to come in.

From then on, I'll be checked fairly regularly like this, and when the follicles are considered mature enough, I will either get or administer to myself a shot of HCG, to induce my body to ovulate. This is just a part of how they do monitored cycles. I do not need it, but it's procedure. That's fine with me. My body has always ovulated nicely, and for the last cycle my 7 DPO progesterone level was a 98!!! That's a great number! They only look for a 10 or 15 on a medicated cycle (the higher the number, the stronger the ovulation). Anyway....

ER Visit!

I So know I'm not the only one on on an unmonitored Clomid cycle, but I have been warned it isn't safe. I have asked to be monitored this 2nd cycle, but the doctors refused. Now I'm mad.

First off, let me say that on Friday J and his 2 brothers left for a wild boar hunt. They were out where there is no cell service, and the little cabin only runs on a generator (no toilet, even), so no phone whatsoever. His 15 year old sister C was staying with me and we'd planned a fun few days. The boys weren't to return until Sunday evening.

I went to bed Friday night with strong lower abdominal pains. Felt like gas. I slept and awoke at 2:45 in severe pain. I went to the kitchen for a Gas-X and my vision got black for 5 seconds. I held the counter. Then I reached up for the medicine.... The next thing I know I'm lying on the kitchen floor, staring at the ceiling, not knowing how I got there or how long I was passed out. I headed back to my room and again, thinking "I've got to lay down", and I wake up to find myself on the closet floor, stairing up, wondering how and why I was there (again, I'd passed out).

I didn't know why I was passing out. I went to tell C what was up. I called a hospital who told me they couldn't give medical advice. They gave me a nurses line to call. The nurse said it was serious and I should come in, but not drive myself. C can't drive a stick, and all I had at that point was one. I didn't want to call any friends at 3 am, and they all live at least 15 minutes away. So I called the ambulance. I have no idea whether TriCare covers that, I tried to look it up, and it looked like they might. I was relaly hoping J wouldn't get upset at me for calling an ambulance!

I was taken to a hospital and the inital thought by the doctor was that my ovaries had ruptured cysts on them. The dr was angry I was on unmonitored clomid (100 mg, which I think you should start out on 50mg) and said it was irresponsible. I have to agree, even though I know it's cheaper to not monitor people & I'd already done one cycle just fine with it. The hospital gave me an IV with Demerol and fluids and something else. The Demerol made me see two of everything and loopy. C read to me and I kept thinking I was saying gibberish. She says I said nothing but moaned.

I had to have a CAT scan to ensure my appendix was ok. It was, but they said I had a lot of fluid and a little blood in my abdomen. That was the cause of the pain/swelling, and I passed out from pain, they said. They sent me home after 9 hours, but told me to follow up with an OB-GYN on Monday (they're all off, so I'll go Tuesday). They said it could have been a ruptured ovarian cyst, and unrelated to the clomid, we're not sure. It seems highly unlikely that I as a healthy female who's never had any pain or trouble with my uterus/ovaries/etc would all of a sudden have a cyst burst.

Right now I'm mad at the dr's at WH for their irresponsibility in this. I'm mad I went through this (almost) all alone. I'm upset J wasn't there for all my pain.

***UPDATE: So I finally broke the news to J as they drove away from the ranch. He took it TOO WELL! He was so calm, I got so upset that he just didn't care! However, he was inwardly upset but just didn't know how to react, he told me. Monday we took the siblings to the RiverWalk and had a grand time. I was in mild pain, and did end up getting a 102 fever that evening/night.

The dr's appointment on Tuesday was a joke, at first. For some reason the files didn't show why I came in - they thought I was just coming in to bug them about the HSG results! All I got this time was a resident dr and they have no authority at WH! She kept trying to tell me that the clomid could in no way cause my ER visit and blah blah. I started crying and basically told her I couldn't stand for this to happen again and I needed answers. J says she looked out of her league & she went off to get one of the staff dr's. He immediately said "Let's do an ultrasound." And he found a "hemmoragic corpus luteal" cyst on each ovary about 2cm in size, and blood/fluid in my abdomen. He said I'd released eggs from both ovaries, and I don't know why they were hommoragic. I had to press for options to keep this from happening agian. He said I could now go on 50mg Clomid, rather than 100, and be monitored! Yes! They didn't have the HSG results back.

HSG Confusion - WHAT???

I had my HSG on 8/23 and the doctors told me it was ok. There was a "whitish area" (the places the dye went was black) on the xray that the tech said looked like "air bubbles." She told me she'd inject more dye, and if it was air it would move. It didn't. She said she'd still call it a normal HSG. When we went in to get ALL results from the doctors (blood, SA, and HSG), they said Everything was normal for both of us. I specifically asked the drs about the white area, they said, "We personally didn't look at your xray, another doctor did, but I'll check it out and let you know." They never did, so I assumed it was good.

Today I went in to a different doctor about a rash (totally unrelated to IF) (a flight surgeon for you military people with 20 yrs as an ob-gyn) and we started talking about my tests and infertility (because I'd seen him for the referral to the IF center). He took a look at my tests and he opened the file on my HSG.... It clearly said there Diganosis: Abnormal! It kept talking about the mass and said possibilities were endometriosis, uterine polyps, sinichea, and versus submucoal fibroids. WHAT?!?!?!? I called the IF line (you can't ever talk to a real person, just leave a message) and left a message asking for an explaination!!!

I got a call back from a resident doctor over at WH. At first she excused it and told me "The doctors here said it looks good, and I can tell you there are 2 doctor's signatures on the file and they're all excellent doctors." I really had to push and tell her I SAW with my own eyes where it said it was an ABNORMAL HSG and that I had a mass in my uterus. Finally, she said she'd check the radiology report. She got silent and said..... "Maybe we need to take a closer look at your file." Sure enough, that was where the discrepancy was. She said the RE and the Radiologist disagree with the interpretation of the HSG. So she said they'd review it on Thursday and she'd call me back on Friday.
I was rather infuriated.... She tried to write me off so many times ("You're on clomid and we can't do anything for you for a long time anyway, why not just wait for your follow-up appointment in November to hear about this?").

However, I am maintaining trust in everything God's taking us through. More later.

Failure

Well, even though the chances of getting pregnant this month were greatly increased, medically speaking, from my HSG and from the Clomid, God did not choose to allow us to conceive this time.

Even though I had some good reasons to hope, from charting, it wasn't so. I am definitely disappointed, but not despairing. Christ reigns, I have eternal life, and He works all things for good to those who love Him, who are the called according to His purpose. The power of Christ is being formed in me. This is a chance to believe God and trust. How can I pass up so great an opportunity?

I do wish I weren't so alone in this, but God obviously wants me to rely only on Him. We'll just maintain hope and keep praying. And I'd ask the same of my friends. Just think of me and pray, when it's on your hearts.

And The Results Are In.....

Unexplained Infertility. How interesting is that?

Here are my Cycle Day 3 (CD3) blood levels (info obtained here, though don't consider it the "Bible"):

FSH (Follicle Stimulating Hormone): 6.6 - A Bit Disappointing (On CD3 it's a gauge of ovarian reserve. Under 6 is excellent, 6-9 is good, 9-10 fair, 10-13 diminished reserve, 13+ very hard to stmulate)

LH (Lutenizing Hormone): 8.4 - That stupid webpage said it should be less than 7! I looked extensively & can't find out why the devil this is. Arg.

E2 (Estradiol): 60.1 - Should be 25-75, levels on lower end better for stimulating, abnormally high levels may indicate a cyst or diminished ovarian reserve.

Here are my Cycle Day 10 (CD10) blood levels, after CD 5-9 on 100 mg Clomid (The Clomid Challenge Test):

FSH: 7.4 - I think agian, should fall within parameters of CD3 level. Darn.

LH: 26.3 - LOL. Look for 25-40 on surge day, which was on CD 16 for me this time. whatever. LH surge leads to ovulation within 48 hours.

E2: 620.3 - LOL again. 100mg of Clomid sure affects me! Look for greater than 200 on surge day, which again was 5-6 days from now!

HSG Experience

Ok so here's the recounting of my Hysterosalpingogram. Can we first say that I experienced much more pain than I expected - but mostly afterward!

Mostly, it was a good experience. The radiologist/doctor originally started using a large looking speculum, but once she saw my cervix, she decided to used a speculum she wasn't as used to. So I was scooted up to the end of the table, and she told me to scoot back, with my legs eventually being straight. I was going slow and the tech apparently didn't think it was fast enough, so she pulled me more up and OW! The speculum had gotten caught on the table and pulled off! It was just a pinch, but to be told that the last 4 minutes of pain/discomfort was for nothing and we were starting over... Arg! She said I had a small laceration on my cervix. :/ Yeah I bet!

After that, she got it on right and I moved back slowly. I did feel discomfort and I could feel the dye go in, but it really wasn't bad at all. Kind-of like cramps inside, it helped to press my lower abdomen... Anyway, I saw my x-rays and the tubes were great. My uterus had a small discolored (light-colored) area that she thought was air, but confirmed (with more dye) it wasn't, since it didn't move. She said they'd look at it further and tell me if it was something. She said everything looked good.

However, when I did get dressed and started walking out, I thought I would pass out! I felt like I couldn't walk, I was in so much pain! In about 5 minutes it wore off, thankfully. But that was it. I took 800 mg of Ibuprofen before and none after. I'm a bit sore inside now, but real good! P.S. I had no drainage, they let me sit on the table for a while. That's probably when it leaked out but I didn't feel it. Some spotting for a few days, probably from the cervical laceration.

What surprised me was the pain afterward.... I was fine for 4-5 hours after the procedure, spent that time at the mall with my sister. And I then had horrible cramps and uterine pain that persisted until the next day. I could not be touched and layed down from that evening until noon the next day (about 23 hours after the procedure.) Apparently it was just the dye getting out of my system.

I was nervous from reading other's experiences, but I was so glad to know what to expect. The procedure wasn't as painful as I anticipated, but definitely I'll always remember it as very uncomfortable. I certainly never want to repeat it!