I just realized something this week. I don’t consider myself infertile. Sure, we’ve been trying to get pregnant for well over three years. And I am quick to label myself infertile. But deep down, I’m not infertile. My baby is just taking the long route in getting to me. I see this as all about a journey, one I detest, but a journey nonetheless. Maybe trip is a better word. Infertility is a trip. Journeys sound so poetic and inspiring. Trips sound irritating and mundane. Yes. Trip is definitely a better word.
Anyway, our “trip” – getting longer by the day – has gone something like this…
First, the fertile part:
- February 2004 – After moving from Maine to Wisconsin in late 2003, we decided we’d consider starting a family once Tahd got a full-time job. I was working part-time and we were living with my parents until we figured out what we were doing, and it seemed irresponsible to try to start a family before that point. That, and our insurance coverage didn’t include expenses related to pregnancy. So when Tahd began his full-time job on the 16th, we decided we’d start trying to get pregnant right away. I’d read that it could take a year, and given the fact that I had preexisting thyroid problems, I figured we should give ourselves some time.
- March 25, 2004 – Although I wasn’t late yet, I decided to take a pregnancy test. It sat on the counter and I vowed not to look at it until the three minute mark. I glanced down at it, disappointed that I didn’t see a second line. I picked it up and carried it to my bedroom and took a second look. The bathroom was dark; the bedroom was not. There was a faint – very faint second line. I even wondered if I was seeing things. But nope – the next day’s test proved it for sure – we were pregnant on our first month of trying.
- June 2004 – It was with uncertainty that I decided to go ahead and have the infamous triple screen testing done. I was less concerned about the fact that some people use triple screen results to have abortions and more concerned that if something were wrong with our baby we could be prepared for those health concerns in the delivery room. Most people get normal results; I was shocked to find out our results were abnormal. We had a 1:116 chance of having a baby with Down Syndrome. Most people have a 1:300ish chance. Additional testing with a perinatologist strongly suggested that it was just a testing anomaly, but because there is some indication that abnormal results on this test can predict placental failure, the decision was made early that if I hadn’t delivered by 39 weeks I would be induced. It was during this additional testing that we also learned we were definitely having a boy!
- November 24, 2004 – After several fetal nonstress tests, our son looked fine. I, however, wanted the whole ordeal to be done. I begged my doctor to induce me a few days earlier. In retrospect I regret this decision, but it felt mostly fine at the time. We were induced at 38 weeks 4 days. Contractions didn’t begin in much earnest until around 8:00am, I started pushing around noon, and delivered at 2:36 in the afternoon. Our son was born at 8 pounds 9 ounces and either 21 or 22 inches long. How sad is it that I can’t remember? We named him on the way home from the hospital – John Gabriel.
Next, the infertile part:
- September 2005 – After much discussion, we decided we wanted to have our children close together. I was really concerned about two things – first, I didn’t want Gabe to remember a time when he didn’t have a sibling. I didn’t want him to grow up resenting the fact that someone had stolen his thunder in any way. Second, I felt that children closer together would be better playmates, so I wanted them close enough to play well together. We started trying even though I was still breastfeeding.
- February 2006 – After having tried for four cycles (I think we took a cycle or two break during that time frame), I was at my annual exam with my ob/gyn. I told him that I was a little perplexed because we had gotten pregnant so quickly with Gabe and had a gut feeling that something was off. Thankfully my ob/gyn has always trusted my instincts, and he agreed that if we weren’t pregnant in two cycles, we could get started on some testing.
- April 2006 – Tahd had a semen analysis. It was quite an ordeal, which I won’t get into because this is my blog, not his, and it seems to me like if he wanted to tell his story he would tell it on his own blog. And since he hasn’t, I’ll assume he wants to keep that story private and will just tell you that in the end, everything was perfect. He is most definitely a “man’s man.”
- Summer 2006 – I had a prolactin test done to see if the breastfeeding was potentially contributing to the fertility decline (it wasn’t) and then had an HSG – a hysterosalpingogram. Basically, I laid on an x-ray table in a pelvic exam sort of position with a huge x-ray device positioned over my belly. The ob/gyn injected radioactive dye in my uterus while the radiologist watched the screen to see where the dye went. If it spills out of the tubes? Good. If it gets stuck? Bad. Mine spilled out. All good. This meant my hormones were normal and my uterus and tubes were normal, so we were cleared for treatment – specifically, a few rounds of Clomid.
- Summer 2006 – As I recall, we did three rounds of Clomid. Basically, Clomid is an oral medication designed to force your body into continuing to produce additional estrogen. The additional estrogen helps the body to produce more eggs or to produce better eggs. However, Clomid actually acts in the brain, not on the ovaries. Because it acts in the brain, it makes some people c.r.a.z.y. I was one of the lucky crazies. I was not monitored during any of my Clomid cycles, and we did not get pregnant during any of my Clomid cycles.
- October 2006 – After three unsuccessful cycles of Clomid, my doctor said it was time to see the fertility specialist – a Reproductive Endocrinologist (RE). He referred us to a local clinic. I loved the doctor. She took time with us, educated me, and seemed highly knowledgeable. All good things. The bad part, however, was that they charged inordinate amounts of money for treatment. A monitored cycle including Clomid and intrauterine insemination (IUI – the turkey baster thing) cost in excess of $2000. And that was the early stuff. In the fertility world, that is crazy expensive. I left that appointment feeling hopeless until I realized I could consider getting a second opinion, of sorts. We called the ob/gyn and got a second referral to a clinic about 45 minutes from our house, but we didn’t use the referral right away.
- October 2006 – I began acupuncture at this point, as well. When I began acupuncture, I decided I wanted to give it about 3 months before we pursued the next fertility consultation. This is why we waited. I basically had 1 treatment a week throughout that time period. It made me feel great, but it didn’t get me pregnant.
- January 2007 – I went to the second fertility consult. I liked this doctor much less; he was brisk, didn’t have fantastic bedside manner, and was 45 minutes from my house. But his rates? Were a fraction of the previous clinic. And as I investigated things further, I realized his success rates were some of the better ones in the nation – certainly the best of those I could find in my area, even if I included Chicago as my area. We decided to do some testing – first blood, then an ultrasound. Everything looked normal, so in we proceeded with a cycle of tamoxifen. Tamoxifen is another oral medication more typically used as a form of long-term chemotherapy for patients who have had breast cancer. However, used in “short burst” form as you do with oral fertility mediations, it can produce similar effects as Clomid without some of the negative side effect. This was true for me. I was much less crazy. This was very welcome. I did not get pregnant. This was very unwelcome.
- May 2007 – After several months of only acupuncture, we decided to up the ante. Infertile patients using Clomid have around a 5% chance of getting pregnant each cycle. Bump up to injectable medication, however, and you have a 20-30% chance of success. The numbers sounded good to us, so we decided to move forward. We also figured if we were spending the money on the meds and monitoring ($1500ish) we might as well spend the extra $300 and have the IUI. We began with an ultrasound to ensure I had no cysts, then began the injectables to stimulate my ovaries into making loads of eggs. Well… correction… not lots of eggs. Jon and Kate Plus 8 are what happen when you get lots of eggs. In fact, higher order multiples can happen even when it doesn’t appear many eggs are developing. When an ultrasound is done, the only thing visible are the follicles – the “sacs” the eggs grow in. Normally, the follicles containing mature eggs are the ones to get larger. However, sometimes eggs mature in follicles that remain fairly small. So although there may only be one or two large follicles visible via ultrasound, there could be many more small follicles containing mature eggs. Injectables+IUI are definitely a risk, and they require close monitoring to be sure the ovaries aren’t overstimulated and the risk of higher-order multiples isn’t too high. The shots really weren’t very painful. The needles are tiny. The more difficult thing was mixing the medication. I had to draw sterile saline solution into the needle, inject it into the powder medication and then draw it all back into the syringe. Sometimes I had to reconstitute more than 1 vial of medication, and I was constantly second-guessing myself, worried I wasn’t doing things correctly. As I progressed, three follicles developed, which was an ideal number for an injectables cycle. The trigger shot was given one evening (the shot that forces the ovaries to begin to ovulate ripe eggs), and 36 hours later I was at the RE’s office – a nurse with a turkey baster – getting “shot up” with my husband’s sperm. The most painful part of the whole procedure was the fact that your bladder needs to be full to help position your uterus optimally for the IUI. I overshot. My bladder was so full I thought it was going to explode. They require you to lay on the table for ten minutes post insemination, and I literally counted the seconds until the timer beeped and I could rush into the restroom. Once again, however, no dice. We weren’t pregnant.
- July 2007 – Ironically, the cycle after my injectables failed I got pregnant on my own. I took a pregnancy test and set it on the table, only to find it an hour or so later with an obvious line. Because pregnancy tests aren’t usually reliable past the ten-minute mark, I discounted it and decided I’d see what the test looked like the next day. The next day, the line came up within the time limit and was clear, albeit faint. I’m pretty sure I took several additional tests that day with similar results. I immediately called my doctor’s office and got in the next day for a beta-hcg test (a blood pregnancy test). When they called with the results, they were negative. HCG (the hormone you have while pregnant) disappears from the blood before it disappears from urine; basically, I had “barely” gotten pregnant – enough to “trip” a pregnancy test but not enough to stick around to let my blood test stay positive past the positive home test. I was devastated. I had already grown attached to the idea of a pregnancy and the idea of not incurring any additional debt. I had imagined how I would tell my family and what it would be like to dig out our baby supplies again and start writing lists of names. It wasn’t that I sat down and took the time to start imagining all those thing; they all came to me simultaneously and instantaneously with the positive test. Sadly, it wasn’t to be. My period came several days late, and we had to move on.
- November 2007 – Once again, I had a spontaneous positive pregnancy test. For some reason, however, I knew it wasn’t a “sticky” pregnancy. This one didn’t hit me as hard, although I did carry the positive pregnancy tests with me in my purse so I could sneak a peak at them and hope. I happened to be traveling to Maine for some Silpada parties and was going alone, so it was very much an inward, reflective time.
- January 2008 – I had begun reading several things about the issue of autoimmune infertility. It is a controversial field; not everyone believes the immune system can cause infertility in the way I was reading. But because of our repeated early miscarriages as well as my thyroid disease (which is also an autoimmune condition), we felt is was worth investigating. We did some initial testing (including blood and DNA tests), had a specialized ultrasound to investigate how well the blood supply to the uterus is functioning, and consulted with one of the most respected and well-known reproductive immunologists in the country. To say I was shocked with the results was an understatement. She found absolutely no evidence that immune issues were attacking my reproductive system. Nada. Even with the thyroid condition – which is known to cause fertility issues – nothing was abnormal. She believed our infertility was primarily an issue of egg quality and urged us to pursue ivf rather than spend any additional money on other lesser treatments. Also, over the past year I had experienced some abnormal spotting during my cycle. When I asked her about this, she attributed it to endometriosis (I have never been diagnosed with endometriosis) and said it was almost certainly to blame.
- Early 2008 – We went through much of 2008 reeling. Rather, I went through much of early 2008 this way. I didn’t realize how overwhelmed I was by the early miscarriages and the constant cycle of hope and disappointment. After the 2007 holidays, I began to shut down, and continued to do so through the early months. It was very difficult and I was emotionally exhausted. This persisted until summer began, and the darkness started to life.
- April 2008 – I had seen advertisements for a mind/body infertility retreat run through Boston IVF in conjunction with Ali Domar. Ali Domar is quite arguably the leading researcher when it comes to the relationship between the mind/emotions and infertility, and I had read much of her work. In books I read that weren’t authored by her, she was invariably quoted. I knew I was at a point in our experience that I needed to deal with the emotional fallout from our issues, and I needed to meet others who were in a similar situation. My parents agreed to watch Gabe, and Tahd and I flew to Boston for a long weekend and a conference. It was wonderful. I can’t recommend it highly enough. We didn’t learn anything particularly novel, but much of what we had read was reinforced and the support we gained that weekend was invaluable. It was also wonderful to be away together for the weekend. Although we had left Gabe overnight, we had never left him for several consecutive nights, and it was a long-overdue getaway.
- June 2008 – At my annual exam, I complained to my doctor about my chronic spotting, which had gotten monumentally worse over the preceeding months. I told him that regardless of the infertility issue, the spotting was exhausting because it was happening almost as many days as it wasn’t happening each month. He suggested my symptoms indicated I might have endometrial polyps, and that I should consider scheduling surgery to have them removed. Some doctors (my RE included) can perform diagnostic hysteroscopies, but my ob/gyn doesn’t have the equipment in his office, so all his hysteroscopies are surgical.
- July 2008 – We went ahead and did the surgical hysteroscopy, and the ob/gyn was correct. I had polyps. He removed them and I immediately noticed a difference in my cycles. The difference, however, was short-lived.
- December 2008 – I scheduled a new appointment with my ob/gyn because the spotting had come back. It was gone for several cycles, but started coming back much more quickly than I expected. He was baffled. Although polyps can come back, he didn’t think they had come back so early, and my symptoms weren’t exactly the same. We talked about options to stabilize my hormone levels and I left debating our options.
- March 2009 – We decided we wanted to pursue ivf rather than additional cycles of injectables. To do this, we needed to get a loan that would cover two to three cycles, and I didn’t think we’d qualify. I selected a company who sent us an offer in the mail, and they approved us right away.
- April 2009 – an initial ultrasound to prep us for ivf indicated my polyps may have reappeared. The RE wanted us to have more diagnostic testing. Given my symptoms, my ob/gyn felt it was a good bet the polyps were definitely there. We opted to go straight to the surgical hysteroscopy, and I had *something* removed, although it wasn’t polyps – just an overgrowth of the uterine lining. The ob/gyn said he had never seen anything like it.
- May/June 2009 – We did ivf. It was a bit of a struggle since I didn’t respond very well to the stims. At retrieval, they got 6 eggs, which was 3 more than I expected them to get. Five of the six fertilized naturally (without ICSI), and on day 3 we put back 3. They were slow growers, which is why we transferred on day 3 instead of day 5. Unfortunately, none of them stuck, and we started the long process of recovering from our failed ivf.
- August 2009 – I started going to acupuncture in preparation for a second ivf sometime in the fall. I went to a new acupuncturist, who I really liked.
- November 2009 – I started birth control pills for the second ivf and ordered the rest of my meds. Unfortunately, I came down with a combination of the seasonal flu and pneumonia. I was very sick! Because I was so sick, the clinic felt (and I agreed) that it would be best to delay the cycle. However, I got sick again in December (strep throat this time) and we decided we didn’t feel good about proceeding.
- January 2010 – My acupuncturist unexpectedly passed away. This isn’t a direct part of my fertility journey, but it really, really sucked.
- February 2010 – After all my sicknesses as well as -having a nose surgery at the end of December, I was feeling really awful – very run down and exhausted. I embarked on a “get healthy” plan to try to perk up my energies.
Next, a poignant part…
- March 2010 – On 9dpo, I got a positive pregnancy test! An early doctor’s appointment showed everything looked on track but I had developed two fibroids. They were not in a position to interfere with the pregnancy.
- April 2010 – Continued monitoring of the pregnancy and fibroids showed great growth with the baby and fibroids that weren’t an issue. We started falling in love with the idea of having a baby soon after Gabe started school.
- May 2010 – Early in the morning on Mother’s Day, we found out the baby’s heart had stopped beating. It was one of the most horrific experiences of my life. I had a D&C the following day and started the arduous process of grieving the loss of our baby. It was a girl, Mara Shirin, and we miss her every day.
Now, a hopeful part…
- May 2010 – I missed my period and discovered I was pregnant again! Still waiting to see how this one turns out!