All of us coping with infertility have in common similar struggles. But we've arrived where we are for different reasons. I want to explain one of my reasons. (And I'll explain the others later).
I have endometriosis. Stage III (Advanced) endometriosis to be exact.
Endometriosis is:
A condition where the lining of the uterus, which is usually shed during the monthly period, begins to grow internally outside of the uterus. There are different theories as to why and how this happens, but a common one is that the lining, at some points in time for certain people, flows back and out the fallopian tubs. Then, rather than my immune system taking care of these foreign cells immediately, they attach themselves to other organs and grow and shed there, often causing scar tissue.
My endometriosis was found on my abdominal walls, uterine walls, bladder, and ureters. Microscopic endometriosis was growing within my uterine walls causing it to be spongy to the touch. I had an endometrioma growing on my right ovary that was likely causing the pain I experienced prior to surgery, and my doctor was shocked at the advanced stage of my condition.
Because my endometriosis was extensive enough and because some of it was not removed during surgery (those cells in my uterine walls that were making it spongy), my doctor decided my best course of treatment would be to take six injections of depo Lupron over the course of six months. One shot would be given every four weeks. Depo Lupron is a GnRH agonist, and while I don't want to get into the specifics of how it works and what it does (not because it would be dull, but because I'm sure I don't totally understand), I will give you my explanation... Apparently GnRH agonists shut down your reproductive system and eliminate hormones from your system. They allow your system to rest while eliminating those microscopic cells. Depo Lupron essentially sends you into a temporary menopause for however long you continue the injections. I was prepared to be in a state of menopause for six months -- complete with all of the symptoms of menopause that women experience.
How does endometriosis cause infertility?
Many women diagnosed with endometriosis will find that cells have caused damage to their ovaries and/or to their fallopian tubes. Damaged ovaries could result in poor egg quality and/or prevent proper ovulation. Blocked fallopian tubes would prevent fertilization by keeping the egg and sperm from meeting. In addition, it is thought that certain toxins are released in the body because of endometriosis around the time of ovulation. These toxins can affect the uterine lining and the overall environment for fertilization and later implantation. Any interference on the part of endometriosis in this delicate process can be detrimental -- obviously.
It is widely recognized that IVF is the most successful option for women with advanced and severe stages of endometriosis. Many doctors will begin by offering IUI treatments when endometriosis is less severe, but research shows that success rates are low. Always do your own research but also consult your doctor when making these important decisions -- infertility is not predictable, so one case doesn't determine the outcome of another.
Some literature out there suggests that women with endometriosis have a slimmer chance of success with IVF than the average woman undergoing the same procedure but for different reasons. I've found some articles that argue this point and others that refute it. Those that suggest this lower success rate do seem to note at least a subtle correlation between those toxins I mentioned earlier and difficulty with implantation. IVF removes the whole process from the body, so obstructions in the fallopian tubes and influence of these toxins on sperm would not be factors. Either way, though, women with advanced to severe endometriosis have highest chances of conception through IVF.
My concerns lie in the fact that I do have advanced endometriosis and I did have an endometrioma (or chocolate cyst as they are sometimes adoringly called -- isn't that just the cutest name?). The literature that suggests my chances are lower than others undergoing IVF freaks me out. I should probably stop reading it, but I'm out of control. I wanted to go into this procedure with a realistic but positive outlook, and it's really hard to marry the whole realistic thing and the positive thing when we're dealing with infertility here. They just don't work well together.
Without really getting in there and beginning stimulation, we don't know how my ovaries will respond, how many follicles I'll produce, or whether or not those follicles will contain healthy, mature eggs. It's such a gamble. I know for a fact that my tubes aren't blocked (structural stuff was checked out during my lap surgery), so that's not my issue. We don't know my endometriosis's impact on my egg quality, and I'm afraid that these "NKa" toxins will inhibit implantation once we've done all the hard work.
In the meantime, in an attempt to ease my worries, I've been ignoring other pressing tasks in order to stalk message boards for evidence that there are women out there (and hopefully lots of them!) who have advanced or severe endometriosis and have gotten pregnant through IVF. And they do exist.
I just hope I can join them.
Wednesday, August 28, 2013
Tuesday, August 27, 2013
cruel joke.
My husband is in school to be a medical professional. He came home today with the assignment of contacting hospitals in a particular urban area for quotes on facility fees for non-complicated vaginal deliveries. It's for a healthcare course where they're examining the current system in the U.S.
Because none of these hospitals have taken him seriously or given him the time of day to answer his questions when he presented himself as a student, he decided to call as a potential patient.
Here's the dialog I'm listening to in the other room:
"Hi, my name is Jason, and my wife is pregnant. We are uninsured but would like to start preparing and are shopping around for the hospital we plan to use. Can you tell me the cost of the facility fee for a typical vaginal delivery?"
...and my wife is pregnant.
HA!
Yet another reminder that I'm not pregnant. And we don't have to make these calls. And none of this is really happening.
Thanks universe -- you're so funny.
Monday, August 26, 2013
how we got here.
Let's go way back.
Since the time of my first period, they've been really painful. Like, I hadn't felt pain like that when I got my first period. One time when I was 16, I woke up in the middle of the night with the worst cramps. I didn't even think I could walk. I eventually made it up the stairs from my room in the basement to the bathroom and threw up. Because it hurt that bad.
After years of painful but very regular periods, I got on birth control when I got to college. They assured me that it would help with cramps and other PMS symptoms. And it did. Birth control helped the pain, and although it caused other issues I wasn't too pleased with, it was nice to have a break.
Fast forward six years to age 24, and I was married and thinking about starting a family. I knew from earlier experience that I wasn't one to return right to my regular cycle after stopping the pill, so I planned to go off of birth control earlier than I might want to so that I could be sure my cycles were back to normal by the time we wanted to start trying to conceive.
As expected, my cycles weren't normal right away. I think I got my first period off of birth control like eight weeks after finishing my last pack. From there the gaps got narrower, but they still weren't regular -- not even a bit. I had six-week cycles, 40-day cycles, 28-day cycles, etc. I kept track of my cycles on a calendar, knowing it might come in handy. This lasted more than a year. At my yearly appointment, I brought up my concerns. My doctor said some people just really responded differently to hormonal changes, but he thought checking my thyroid and doing other bloodwork might be informative. So we did. And everything came back normal.
My husband and I moved to a different state, and it was time for my next yearly exam -- and this time I wanted things figured out because we were ready to start a family. She echoed what my former doctor said. Birth control probably wasn't to blame, and maybe I just thought I had had regular cycles pre-birth control but really didn't. Just to check things out, she wanted to do some bloodwork also and check my various hormone levels at specific times in my cycle. So we did. And it came back normal.
I bought ovulation strips on Amazon so that I could try to figure out if I was indeed ovulating. You know, it would be awful if I wasn't. I didn't want to waste any more time, so I started peeing on those things right away. And obsessive me became obsessed. I downloaded an app on my iPhone that would help me to keep track of my cycle. Guess what? I got a positive ovulation test strip two days in a row. I was ovulating, and I was so excited. In my mind, my doctors were proven correct. Everything was working fine, and we should start trying.
So that month -- the month I got my first positive OPK strip -- we had unprotected sex and thought wishfully about having a baby together. But I got my period a couple weeks later.
No fear, though. That was our first shot. Being the researcher and reader that I am, I got online to really figure this whole process out. I read everything. I learned about taking my basal body temperature, checking my cervical mucous, looking for signs of ovulation like mittelschmerz and egg white mucous, and charting all of the info on my phone and paper and pencil charts. I had one on my fridge. Every morning I woke up to the sound of my 6:30 alarm -- weekdays and weekends, on vacation or at home -- and took my basal body temperature. I recorded my findings on my phone immediately. I woke up and checked my cervical mucous. I even checked my cervix. I noted all of this. Then I would transfer it to the paper copy. It was such an involved process. We timed sex; we did everything perfectly.
After six months of doing everything right and timing everything right, we still weren't pregnant. That's okay, though, right? A majority of people are pregnant by then, but we will definitely be pregnant by the year mark. I didn't really believe my self-talk or the shit everyone else said to me, either, though. I scheduled an appointment with my OB/GYN because I thought maybe six months of trying might warrant some investigation. Nope. I'm fairly certain she thought I was crazy. She told me to come back at nine months if it was really worrying me. So I did, because I still wasn't pregnant then either. But I don't think she remembered telling me to come back at nine months, so it was just kind of frustrating. Then she told me to come back at the one-year mark. That's when I would be officially infertile and could be referred to someone who actually knew what the hell they were doing. But stay positive! she said as I left. Don't let this stress you out. Just enjoy the trying! It'll happen, she told me.
Then it was February -- the one-year mark -- and I still wasn't pregnant. I knew it. Something was wrong, and everyone just wasted a year of frustration and hope and disappointment. No one listened to me, and now they were going to? Because I had hit a magic number of months of being childless?
I met with another doctor in her practice, and she didn't seem to know much either. She looked at my charts and asked me some questions and said that it sounded like I was ovulating and that everything was probably fine. Had my husband been checked? she wondered. Nope. No one ever offered to check him, and oh yeah, semen analysis isn't even possible in the town we live in. So she was going to refer me to a specialist in a larger city. Did I want Dr. So-and-So or Dr. What's-His-Name? I don't know -- what the hell is the difference?
I was referred and was able to make my own consultation appointment within a couple of weeks. Luckily they had a cancelation, and I could get in two weeks later. The anticipation was killing me.
At my very first appointment with my brand new reproductive endocrinologist, I was first interviewed. They wanted medical history, they wanted family history, and they wanted to hear about what I knew about my cycle. They made copies of the 12 charts I had so meticulously kept, they took several viles of blood, and then I was able to meet the doctor in his office. He read through my information and asked me what I thought was wrong. I don't know... maybe I have low progesterone?
(Did I mention that by this time I had read every article and blog and message board on the internet that even mentioned infertility? Also, I had read three books about infertility and several on conception and pregnancy. I was definitely hypothesizing myself...)
He agreed that it could be a possibility, but he didn't think that was my only issue. We discussed my slight pain during intercourse. (I didn't get it all the time, just when circumstances were right). We discussed my mom's experience with endometriosis before conceiving me. We discussed my dad's sister's experience with endometriosis before conceiving her kids. We discussed my aunt's inability to have children because of premature ovarian failure. (And it was beginning to look like heredity wasn't working in my favor...) We discussed my irregular cycles. And then he sent me down the hall to change into a gown for a pelvic exam and transvaginal ultrasound.
I couldn't believe they were being so thorough so quickly. He started with the exam -- with nurses and resident in tow. Immediately he found the spot that caused me to wince with pain. He wasn't surprised. And look at this, and look at that. All signs of what he thought might be endometriosis. Next, he did the ultrasound and immediately found a total of 27 cysts on my ovaries. I wanted to cry right then and there. The term poly-cystic ovaries was thrown around, and then I really wanted to cry. I knew people who didn't have children because of PCOS, and here I was.
They sat me up, and I asked questions. They got out pictures of endometriosis. They explained the cysts. I would be scheduled for surgery in two weeks to investigate the presumed endometriosis and to check on the cysts. If endometriosis was found, they would remove it with a laser. If the cysts were too big, they could be drained. After surgery, a treatment plan would be developed and pursued.
I still felt very emotional, and so I asked if this was going to be the end of the road for me. They smiled and said no -- this was all very mild compared to what they see on a daily basis, and things were very hopeful for me. This could all be treated.
YES. I was on a high like I hadn't experienced in a long time. Not only did I have answers, but they were treatable answers, and I would have my baby. I would have to be patient and endure a little bit, but it would be worth it.
My surgery was exactly two weeks later. My husband went with me and was there to speak with my doctor when it was over. My husband recorded my doctor's comments on his phone so that I could hear exactly what they found.
I did indeed have endometriosis. I also had an endometrioma (bad news). There was endometriosis on my abdominal walls, my uterine walls, my bladder, and my ureters. It was bad. It was Stage III Advanced, and my doctor couldn't recall ever seeing such an advanced case on someone my age. 26 years old. After he reviewed all of the photos and information, he would determine a treatment plan and would be able to discuss it with me at my post-op appointment. That's all the information I had for two weeks.
At my post-op appointment, he reiterated the extent of my endometriosis. He was shocked I wasn't in more severe pain for the past several years. He couldn't believe it was so out of control because I was so young. (None of this shock and awe was helping my psyche at the moment...) My cysts were small and nothing had to be done with them during the surgery. They decided to start me on six rounds of depo Lupron the following month to further address the endometriosis. I would receive one injection of the drug in the rear every four weeks, and as a GnRH agonist, it would shut my reproductive system down and allow it all to rest. Microscopic cells of endometriosis that remained in my uterine walls (causing my uterus to be "spongy") that could not be removed with the laser during surgery needed to be taken care of, and the Lupron would eliminate them. I was nervous about these shots because they would send me into a temporary menopause -- and at a very accelerated rate. For six months I would be without estrogen, which could in turn reduce my bone density. Side effects such as hot flashes, headaches, mood swings, depression, and insomnia were to be expected.
I got my first shot in May 2013 and experienced very few side effects. I got my second shot in June 2013, and the hot flashes began. They were miserable, and the midwest heat and humidity didn't help a thing. In the meantime, my husband went in for a semen analysis, you know, just to make sure everything with him was okay and to confirm that we only needed to focus on my issues. Well, he ended up with a severely low sperm count, poor morphology (3%), and low motility. We were both devastated because we felt our chances of conceiving were slashed again. He went in for further bloodwork and a karyotype to see if we could get some answers. Everything came back normal, and I was reminded of how frustrating "normal" can be when you know it's not. "Normal" just meant that we wouldn't get any real answers, and there was nothing to treat. No way to make it better.
My doctor offered to refer my husband to a urologist who specializes in male fertility and partners with him on IVF. It was our only shot at figuring this thing out. We received a copy of the referral letter in the mail, and it was the first time I had seen or heard my doctor say anything about IVF. And he was indeed saying that IVF was his recommendation for us if we wanted to conceive. That was our answer. This was worst-case scenario material only two months before, and here we were. Reality. IVF.
At my appointment to get my third Lupron shot, I was met with information I hadn't expected. At next month's appointment -- the appointment that would normally be reserved for my fourth shot -- we would have a consultation with the doctor. My husband should plan to be there, and I could expect to have another pelvic exam. If my husband and I decided that we were interested in moving forward with IVF, the doctor would check me out and consider forgoing the final three shots in pursuit of IVF. From there I would be sent home with drugs to treat my cysts, birth control to keep my system dormant and to reintroduce estrogen levels, and all of my vitamins. We would even discuss a schedule of when to do IVF.
This was big news, and it was a lot to wrap my mind around. I thought I had three more months on these shots and several months even after that before we'd have to make a decision.
After talking with my husband, we decided IVF was a path we wanted to take. At least once. Because it's our only option, we feel we owe it to ourselves and our efforts to give it a shot.
We arrived at my fourth appointment armed with dozens of questions we needed answered. We knew that we could be leaving there officially beginning the IVF process, or we could end up just continuing the shots based on what my doctor found. My RE began the consultation by answering all of our questions and explaining the process and the timeline. He explained that a pelvic exam would give him a good idea of how my body has responded to the Lupron, the condition of my uterus, and my current pain level. The exam revealed that I was no longer experiencing any pain, he felt my uterus was firm and healthy, and he was impressed with how well I had responded to the injections. Three months of grueling hot flashes (this shit was no joke) paid off, and really, I had been so lucky to not experience some of the more severe side effects.
SO. We could move forward with IVF if that's what we wanted to do. He explained that the success rate is 50/50; it's the national average. He explained that there's no way of knowing what issues may come up until we're in the middle of it. He explained the travel schedule, the time commitment, the time management involved, and the procedures. I had read about all of this before. I knew all of these answers.
But I was completely overwhelmed.
He stepped out of the room so that I could get dressed and we could meet with his fertility nurse to go over details. As the door shut behind him, I buried my face in my husband's shirt and cried.
This was wonderful news. We could move forward. Maybe we would be pregnant in four months time. This was awful news. We can't have our own children naturally. The future of our family will ride on this one procedure that is just as likely not to work as it is to work.
Fuck.
I composed myself and we gathered our things and made our way to her office. She was very good with us and explained the financial side, the scheduling, the time frame, etc. I felt informed, and I felt good about the decision we were making.
I was given three prescriptions to take for the next three months: birth control, Metformin to help treat my cysts, and Dostanex to treat elevated Prolactin levels. I would continue taking vitamin B6, fish oil, prenatals, and calcium supplements twice daily. And I would continue taking my prescription vitamin D weekly. I was to continue drinking lots of water and asked to consider gaining five pounds or so because "it couldn't hurt." I committed myself to abstaining from alcohol, exercising daily, and trying to eat right while adding some calories to my diet. I was told to come back in October 2013 to be checked over and to do a "trial run" of the egg retrieval/implantation process so that they could measure the dimensions of my uterus (more on why later). From there, they would schedule my tentative egg retrieval day -- sometime in early December -- and determine when to start me on my IVF drugs. The fertility nurse gave me a hug, asked me to try to stay positive, and sent us on our way.
And we walked out the door...
The process now begins.
Since the time of my first period, they've been really painful. Like, I hadn't felt pain like that when I got my first period. One time when I was 16, I woke up in the middle of the night with the worst cramps. I didn't even think I could walk. I eventually made it up the stairs from my room in the basement to the bathroom and threw up. Because it hurt that bad.
After years of painful but very regular periods, I got on birth control when I got to college. They assured me that it would help with cramps and other PMS symptoms. And it did. Birth control helped the pain, and although it caused other issues I wasn't too pleased with, it was nice to have a break.
Fast forward six years to age 24, and I was married and thinking about starting a family. I knew from earlier experience that I wasn't one to return right to my regular cycle after stopping the pill, so I planned to go off of birth control earlier than I might want to so that I could be sure my cycles were back to normal by the time we wanted to start trying to conceive.
As expected, my cycles weren't normal right away. I think I got my first period off of birth control like eight weeks after finishing my last pack. From there the gaps got narrower, but they still weren't regular -- not even a bit. I had six-week cycles, 40-day cycles, 28-day cycles, etc. I kept track of my cycles on a calendar, knowing it might come in handy. This lasted more than a year. At my yearly appointment, I brought up my concerns. My doctor said some people just really responded differently to hormonal changes, but he thought checking my thyroid and doing other bloodwork might be informative. So we did. And everything came back normal.
My husband and I moved to a different state, and it was time for my next yearly exam -- and this time I wanted things figured out because we were ready to start a family. She echoed what my former doctor said. Birth control probably wasn't to blame, and maybe I just thought I had had regular cycles pre-birth control but really didn't. Just to check things out, she wanted to do some bloodwork also and check my various hormone levels at specific times in my cycle. So we did. And it came back normal.
I bought ovulation strips on Amazon so that I could try to figure out if I was indeed ovulating. You know, it would be awful if I wasn't. I didn't want to waste any more time, so I started peeing on those things right away. And obsessive me became obsessed. I downloaded an app on my iPhone that would help me to keep track of my cycle. Guess what? I got a positive ovulation test strip two days in a row. I was ovulating, and I was so excited. In my mind, my doctors were proven correct. Everything was working fine, and we should start trying.
So that month -- the month I got my first positive OPK strip -- we had unprotected sex and thought wishfully about having a baby together. But I got my period a couple weeks later.
No fear, though. That was our first shot. Being the researcher and reader that I am, I got online to really figure this whole process out. I read everything. I learned about taking my basal body temperature, checking my cervical mucous, looking for signs of ovulation like mittelschmerz and egg white mucous, and charting all of the info on my phone and paper and pencil charts. I had one on my fridge. Every morning I woke up to the sound of my 6:30 alarm -- weekdays and weekends, on vacation or at home -- and took my basal body temperature. I recorded my findings on my phone immediately. I woke up and checked my cervical mucous. I even checked my cervix. I noted all of this. Then I would transfer it to the paper copy. It was such an involved process. We timed sex; we did everything perfectly.
After six months of doing everything right and timing everything right, we still weren't pregnant. That's okay, though, right? A majority of people are pregnant by then, but we will definitely be pregnant by the year mark. I didn't really believe my self-talk or the shit everyone else said to me, either, though. I scheduled an appointment with my OB/GYN because I thought maybe six months of trying might warrant some investigation. Nope. I'm fairly certain she thought I was crazy. She told me to come back at nine months if it was really worrying me. So I did, because I still wasn't pregnant then either. But I don't think she remembered telling me to come back at nine months, so it was just kind of frustrating. Then she told me to come back at the one-year mark. That's when I would be officially infertile and could be referred to someone who actually knew what the hell they were doing. But stay positive! she said as I left. Don't let this stress you out. Just enjoy the trying! It'll happen, she told me.
Then it was February -- the one-year mark -- and I still wasn't pregnant. I knew it. Something was wrong, and everyone just wasted a year of frustration and hope and disappointment. No one listened to me, and now they were going to? Because I had hit a magic number of months of being childless?
I met with another doctor in her practice, and she didn't seem to know much either. She looked at my charts and asked me some questions and said that it sounded like I was ovulating and that everything was probably fine. Had my husband been checked? she wondered. Nope. No one ever offered to check him, and oh yeah, semen analysis isn't even possible in the town we live in. So she was going to refer me to a specialist in a larger city. Did I want Dr. So-and-So or Dr. What's-His-Name? I don't know -- what the hell is the difference?
I was referred and was able to make my own consultation appointment within a couple of weeks. Luckily they had a cancelation, and I could get in two weeks later. The anticipation was killing me.
At my very first appointment with my brand new reproductive endocrinologist, I was first interviewed. They wanted medical history, they wanted family history, and they wanted to hear about what I knew about my cycle. They made copies of the 12 charts I had so meticulously kept, they took several viles of blood, and then I was able to meet the doctor in his office. He read through my information and asked me what I thought was wrong. I don't know... maybe I have low progesterone?
(Did I mention that by this time I had read every article and blog and message board on the internet that even mentioned infertility? Also, I had read three books about infertility and several on conception and pregnancy. I was definitely hypothesizing myself...)
He agreed that it could be a possibility, but he didn't think that was my only issue. We discussed my slight pain during intercourse. (I didn't get it all the time, just when circumstances were right). We discussed my mom's experience with endometriosis before conceiving me. We discussed my dad's sister's experience with endometriosis before conceiving her kids. We discussed my aunt's inability to have children because of premature ovarian failure. (And it was beginning to look like heredity wasn't working in my favor...) We discussed my irregular cycles. And then he sent me down the hall to change into a gown for a pelvic exam and transvaginal ultrasound.
I couldn't believe they were being so thorough so quickly. He started with the exam -- with nurses and resident in tow. Immediately he found the spot that caused me to wince with pain. He wasn't surprised. And look at this, and look at that. All signs of what he thought might be endometriosis. Next, he did the ultrasound and immediately found a total of 27 cysts on my ovaries. I wanted to cry right then and there. The term poly-cystic ovaries was thrown around, and then I really wanted to cry. I knew people who didn't have children because of PCOS, and here I was.
They sat me up, and I asked questions. They got out pictures of endometriosis. They explained the cysts. I would be scheduled for surgery in two weeks to investigate the presumed endometriosis and to check on the cysts. If endometriosis was found, they would remove it with a laser. If the cysts were too big, they could be drained. After surgery, a treatment plan would be developed and pursued.
I still felt very emotional, and so I asked if this was going to be the end of the road for me. They smiled and said no -- this was all very mild compared to what they see on a daily basis, and things were very hopeful for me. This could all be treated.
YES. I was on a high like I hadn't experienced in a long time. Not only did I have answers, but they were treatable answers, and I would have my baby. I would have to be patient and endure a little bit, but it would be worth it.
My surgery was exactly two weeks later. My husband went with me and was there to speak with my doctor when it was over. My husband recorded my doctor's comments on his phone so that I could hear exactly what they found.
I did indeed have endometriosis. I also had an endometrioma (bad news). There was endometriosis on my abdominal walls, my uterine walls, my bladder, and my ureters. It was bad. It was Stage III Advanced, and my doctor couldn't recall ever seeing such an advanced case on someone my age. 26 years old. After he reviewed all of the photos and information, he would determine a treatment plan and would be able to discuss it with me at my post-op appointment. That's all the information I had for two weeks.
At my post-op appointment, he reiterated the extent of my endometriosis. He was shocked I wasn't in more severe pain for the past several years. He couldn't believe it was so out of control because I was so young. (None of this shock and awe was helping my psyche at the moment...) My cysts were small and nothing had to be done with them during the surgery. They decided to start me on six rounds of depo Lupron the following month to further address the endometriosis. I would receive one injection of the drug in the rear every four weeks, and as a GnRH agonist, it would shut my reproductive system down and allow it all to rest. Microscopic cells of endometriosis that remained in my uterine walls (causing my uterus to be "spongy") that could not be removed with the laser during surgery needed to be taken care of, and the Lupron would eliminate them. I was nervous about these shots because they would send me into a temporary menopause -- and at a very accelerated rate. For six months I would be without estrogen, which could in turn reduce my bone density. Side effects such as hot flashes, headaches, mood swings, depression, and insomnia were to be expected.
I got my first shot in May 2013 and experienced very few side effects. I got my second shot in June 2013, and the hot flashes began. They were miserable, and the midwest heat and humidity didn't help a thing. In the meantime, my husband went in for a semen analysis, you know, just to make sure everything with him was okay and to confirm that we only needed to focus on my issues. Well, he ended up with a severely low sperm count, poor morphology (3%), and low motility. We were both devastated because we felt our chances of conceiving were slashed again. He went in for further bloodwork and a karyotype to see if we could get some answers. Everything came back normal, and I was reminded of how frustrating "normal" can be when you know it's not. "Normal" just meant that we wouldn't get any real answers, and there was nothing to treat. No way to make it better.
My doctor offered to refer my husband to a urologist who specializes in male fertility and partners with him on IVF. It was our only shot at figuring this thing out. We received a copy of the referral letter in the mail, and it was the first time I had seen or heard my doctor say anything about IVF. And he was indeed saying that IVF was his recommendation for us if we wanted to conceive. That was our answer. This was worst-case scenario material only two months before, and here we were. Reality. IVF.
At my appointment to get my third Lupron shot, I was met with information I hadn't expected. At next month's appointment -- the appointment that would normally be reserved for my fourth shot -- we would have a consultation with the doctor. My husband should plan to be there, and I could expect to have another pelvic exam. If my husband and I decided that we were interested in moving forward with IVF, the doctor would check me out and consider forgoing the final three shots in pursuit of IVF. From there I would be sent home with drugs to treat my cysts, birth control to keep my system dormant and to reintroduce estrogen levels, and all of my vitamins. We would even discuss a schedule of when to do IVF.
This was big news, and it was a lot to wrap my mind around. I thought I had three more months on these shots and several months even after that before we'd have to make a decision.
After talking with my husband, we decided IVF was a path we wanted to take. At least once. Because it's our only option, we feel we owe it to ourselves and our efforts to give it a shot.
We arrived at my fourth appointment armed with dozens of questions we needed answered. We knew that we could be leaving there officially beginning the IVF process, or we could end up just continuing the shots based on what my doctor found. My RE began the consultation by answering all of our questions and explaining the process and the timeline. He explained that a pelvic exam would give him a good idea of how my body has responded to the Lupron, the condition of my uterus, and my current pain level. The exam revealed that I was no longer experiencing any pain, he felt my uterus was firm and healthy, and he was impressed with how well I had responded to the injections. Three months of grueling hot flashes (this shit was no joke) paid off, and really, I had been so lucky to not experience some of the more severe side effects.
SO. We could move forward with IVF if that's what we wanted to do. He explained that the success rate is 50/50; it's the national average. He explained that there's no way of knowing what issues may come up until we're in the middle of it. He explained the travel schedule, the time commitment, the time management involved, and the procedures. I had read about all of this before. I knew all of these answers.
But I was completely overwhelmed.
He stepped out of the room so that I could get dressed and we could meet with his fertility nurse to go over details. As the door shut behind him, I buried my face in my husband's shirt and cried.
This was wonderful news. We could move forward. Maybe we would be pregnant in four months time. This was awful news. We can't have our own children naturally. The future of our family will ride on this one procedure that is just as likely not to work as it is to work.
Fuck.
I composed myself and we gathered our things and made our way to her office. She was very good with us and explained the financial side, the scheduling, the time frame, etc. I felt informed, and I felt good about the decision we were making.
I was given three prescriptions to take for the next three months: birth control, Metformin to help treat my cysts, and Dostanex to treat elevated Prolactin levels. I would continue taking vitamin B6, fish oil, prenatals, and calcium supplements twice daily. And I would continue taking my prescription vitamin D weekly. I was to continue drinking lots of water and asked to consider gaining five pounds or so because "it couldn't hurt." I committed myself to abstaining from alcohol, exercising daily, and trying to eat right while adding some calories to my diet. I was told to come back in October 2013 to be checked over and to do a "trial run" of the egg retrieval/implantation process so that they could measure the dimensions of my uterus (more on why later). From there, they would schedule my tentative egg retrieval day -- sometime in early December -- and determine when to start me on my IVF drugs. The fertility nurse gave me a hug, asked me to try to stay positive, and sent us on our way.
And we walked out the door...
The process now begins.
Sunday, August 25, 2013
it's grief.
This may just be a difference between men and women when it comes to infertility. Or maybe it's a difference between me and other people. I don't know. But one day when my husband and I were having an emotional conversation about the path ahead of us and how each of us is coping with our situation, I brought up the word grief. I didn't think this would be any kind of controversial term for what I'm experiencing. In fact, in my mind it's the perfect word for what I'm experiencing. I'm a combination of sad, rational, pissed, excited, overwhelmed, guilty, and anxious. I've been in denial, I've been sad, I've been angry, I've bargained, and I'm working toward accepting whatever will be the end to this journey. That's grief, right?
My husband didn't understand why I would use the word grief. In his mind, there's nothing to mourn here. We haven't lost anything. It's just that what we wanted to happen when we wanted it to happen didn't ... but we're not any worse off than we were two years ago.
Yes, I see what he's saying. I was not one day holding my child in my arms only to have it ripped away or to watch it die. Nope, that definitely didn't happen. What did happen, though, was that I had this dream for oh, like 20-some years, that I would be a mother to a child that was this perfect combination of the man I love and myself. I had this dream that I would be pregnant and that my husband and I would enjoy the secret between ourselves for a little while and then have such fun telling those we love that we were bringing this new, incredible human being into the world. I had this dream that I would give birth to another person -- a person I would love more than anything ever. And it would be this love that I couldn't even imagine, couldn't even begin to fathom. I had this dream that I would foster my child's growth and development, that he or she would need me and love me, and that my husband and I would be partners in raising these amazing human beings who would contribute great things to our world. And we would be so proud and so honored that they came from us.
This was the dream I had. In fact, I made a lot of plans around this dream. I chose to be a teacher because I thought it would be a wonderful career to have as a mother. I would learn so much about children and parenting just by doing my job each day. I would have the perfect schedule for raising kids. It would allow me to be home with my children when they were home. I bought specific vehicles because of their safety ratings and their child seat accommodations. I bought insurance expecting it to help supplement my income when I was on maternity leave.
That baby that I dreamed about never arrived. I didn't lose it because it was never here. But you know what I have lost? I lost a future that most of us assume we're guaranteed. Because instead of going through all of those steps that I dreamed about, I'm learning that I can't have any of that the way everyone else does. I need to undergo dozens of invasive medical procedures. I need to have surgeries and be on months of injections. I need to be on strict vitamin and prescription regimens. And even with all that, my husband and I cannot together make a child.
But remember, I didn't lose anything. No baby was taken from my arms. It's just that this big dream -- this dream that dictated my whole life -- was taken from me. And so I mourn that I can't have children the way everyone else can. I cry because this hole inside of me can't be filled the way I imagined. I grieve the loss of an easy, joyful path to motherhood.
See, it's grief. I'm sad that there is no baby in my arms after all that. I'm pissed that I've done everything right and have nothing to show for it. I'm bitter that so many parents take for granted the thing I've worked so hard for. I'm envious of all of the mothers out there who have experienced the greatest miracle of all and who might not even realize it. I feel all of these things silently for the most part because it's much more difficult for others to recognize grief over something intangible than tangible. But to me, my loss is very real.
No, I will not abandon my path to motherhood -- even though it's a long, windy, treacherous one. I will be a mother someday because that's what I want most in this life. And when I can calm down and think rationally I am able to remind myself that it will be more a matter of patience and resilience than anything. Sometimes, though, that's not comforting enough.
Sometimes I just have to grieve.
My husband didn't understand why I would use the word grief. In his mind, there's nothing to mourn here. We haven't lost anything. It's just that what we wanted to happen when we wanted it to happen didn't ... but we're not any worse off than we were two years ago.
Yes, I see what he's saying. I was not one day holding my child in my arms only to have it ripped away or to watch it die. Nope, that definitely didn't happen. What did happen, though, was that I had this dream for oh, like 20-some years, that I would be a mother to a child that was this perfect combination of the man I love and myself. I had this dream that I would be pregnant and that my husband and I would enjoy the secret between ourselves for a little while and then have such fun telling those we love that we were bringing this new, incredible human being into the world. I had this dream that I would give birth to another person -- a person I would love more than anything ever. And it would be this love that I couldn't even imagine, couldn't even begin to fathom. I had this dream that I would foster my child's growth and development, that he or she would need me and love me, and that my husband and I would be partners in raising these amazing human beings who would contribute great things to our world. And we would be so proud and so honored that they came from us.
This was the dream I had. In fact, I made a lot of plans around this dream. I chose to be a teacher because I thought it would be a wonderful career to have as a mother. I would learn so much about children and parenting just by doing my job each day. I would have the perfect schedule for raising kids. It would allow me to be home with my children when they were home. I bought specific vehicles because of their safety ratings and their child seat accommodations. I bought insurance expecting it to help supplement my income when I was on maternity leave.
That baby that I dreamed about never arrived. I didn't lose it because it was never here. But you know what I have lost? I lost a future that most of us assume we're guaranteed. Because instead of going through all of those steps that I dreamed about, I'm learning that I can't have any of that the way everyone else does. I need to undergo dozens of invasive medical procedures. I need to have surgeries and be on months of injections. I need to be on strict vitamin and prescription regimens. And even with all that, my husband and I cannot together make a child.
But remember, I didn't lose anything. No baby was taken from my arms. It's just that this big dream -- this dream that dictated my whole life -- was taken from me. And so I mourn that I can't have children the way everyone else can. I cry because this hole inside of me can't be filled the way I imagined. I grieve the loss of an easy, joyful path to motherhood.
See, it's grief. I'm sad that there is no baby in my arms after all that. I'm pissed that I've done everything right and have nothing to show for it. I'm bitter that so many parents take for granted the thing I've worked so hard for. I'm envious of all of the mothers out there who have experienced the greatest miracle of all and who might not even realize it. I feel all of these things silently for the most part because it's much more difficult for others to recognize grief over something intangible than tangible. But to me, my loss is very real.
No, I will not abandon my path to motherhood -- even though it's a long, windy, treacherous one. I will be a mother someday because that's what I want most in this life. And when I can calm down and think rationally I am able to remind myself that it will be more a matter of patience and resilience than anything. Sometimes, though, that's not comforting enough.
Sometimes I just have to grieve.
thankful.
Before I get going with my long list of complaints, my 'why me?'s, and my 'you don't understands', I want to put something else out there. While I've endured a lot of heartache and soul-searching over the past two years, I have a good life and have been granted much to be thankful for. I believe it's incredibly important to stop every once in awhile (and I probably should do this more frequently than every once in awhile) to reflect on what's going well and all of the reasons that I really am lucky. Yes, I'm lacking the one thing in my life that I long for more than anything. But most other aspects of my life are wonderful, and many people out there can't say that.
I have the most amazing husband who loves me beyond measure. He is kind, attentive, giving, patient, and gentle. We might not always get each other -- and this infertility experience is sometimes trying on our relationship -- but never do I question his love or devotion to me.
My marriage is strong and unwavering, and we don't have to question our resistance to challenges. I know how lucky I am here.
I have a younger sister who listens. She loves me and shows it. Her touch is kind and comforting, and she never lets me forget that she's always with me even though she's far away.
I have a mother who has modeled independence and strength to my sister and I and who continues to show us the importance of change and growth in ourselves. And to be held by her today is just as comforting as it was as a child.
I have a supportive and loving family -- both my own and my husband's (who I do consider to be mine as well).
I have girlfriends who know me inside and out, who will laugh and cry with me, and who never let me feel completely alone.
I have had the opportunity to earn an incredible education and continue to do so. This will provide me with so many more opportunities for success in the future.
I truly have everything I need. Love, support, a sense of self. A roof over my head and good food in my belly. I don't have to want -- well, except for that one important thing.
I am healthy and able, and I must remind myself of how lucky I am in this regard more regularly. My body works (on a daily basis anyway). My mind works (or so I like to think...).
My sweet puppy can bring me so much comfort each day and that I can have the opportunity to love her.
I have the freedoms to make choices for myself and for my family.
I'm grateful that...
I have the most amazing husband who loves me beyond measure. He is kind, attentive, giving, patient, and gentle. We might not always get each other -- and this infertility experience is sometimes trying on our relationship -- but never do I question his love or devotion to me.
My marriage is strong and unwavering, and we don't have to question our resistance to challenges. I know how lucky I am here.
I have a younger sister who listens. She loves me and shows it. Her touch is kind and comforting, and she never lets me forget that she's always with me even though she's far away.
I have a mother who has modeled independence and strength to my sister and I and who continues to show us the importance of change and growth in ourselves. And to be held by her today is just as comforting as it was as a child.
I have a supportive and loving family -- both my own and my husband's (who I do consider to be mine as well).
I have girlfriends who know me inside and out, who will laugh and cry with me, and who never let me feel completely alone.
I have had the opportunity to earn an incredible education and continue to do so. This will provide me with so many more opportunities for success in the future.
I truly have everything I need. Love, support, a sense of self. A roof over my head and good food in my belly. I don't have to want -- well, except for that one important thing.
I am healthy and able, and I must remind myself of how lucky I am in this regard more regularly. My body works (on a daily basis anyway). My mind works (or so I like to think...).
My sweet puppy can bring me so much comfort each day and that I can have the opportunity to love her.
I have the freedoms to make choices for myself and for my family.
Saturday, August 24, 2013
let's be honest.
Infertility is the worst. It’s the worst feeling. It’s the worst experience. It’s the worst truth to discover.
I’ve planned for motherhood most of my life. Literally. I chose my career around it. I’ve picked out names. I’ve bought vehicles with motherhood in mind. I eat right; I exercise. I make the right choices. I’m prepared for this, and I want it badly.
But now, here I am, and I’m infertile, and I can’t have that baby I’ve dreamed about. That baby isn’t even really a dream. To me, he or she is real. And I just can’t make it all happen.
It sucks. It fucking sucks.
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