On being Catholic and infertile

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I’m a practicing Roman Catholic. And so, when first faced with our infertility troubles, I made an effort to better understand the church’s stance. (I knew that the church does not approve of IVF, but why exactly? What about IUI? Hormone injections?) Fortunately, while exiting church one day, I spotted the above pamphlet for $0.50. I bought it, and here’s what I learned:

Catholic church-approved infertility treatments:

  • charting (also the only approved form of birth control; we Catholics call it Natural Family Planning or NFP)
  • ovulation test strips/monitors (POAS = not a sin)
  • most testing/evaluation procedures (see exception below)
  • drugs, hormones, suppositories (whether taken for the purpose of encouraging ovulation or supporting implantation or pregnancy)
  • corrective surgery

Unapproved infertility treatments:

  • Testing sperm obtained by masturbation (Yep, jerking off = still a no-no. As an intriguing side note, there are apparently Catholic church-approved ‘perforated condoms’ that can be used to collect semen samples during sex – the perforations are necessary to avoid violating church teaching about contraception. And, suddenly my mind jumps to a wildly inappropriate prank idea…Then, that thought is replaced by a mental image of showing up at Dr. Y’s office and handing him a dripping condom…)
  • IUI or any other form of artificial insemination
  • IVF (or ZIFT or GIFT…do people still do these?)

So, what are the underlying moral objections to these forms of treatment? What I learned in this little booklet didn’t come as much of a surprise. I’ll paraphrase:

  1. The purpose of sex is procreation, so any act that divorces the two is a sin.
  2. Life begins at conception, and any act that destroys life [even an embryo] is a sin.

Now I have to acknowledge that Catholic Church teaching is consistent. That first statement is the single reason why the church forbids masturbation, anal/oral/etc. sex, contraception, and gay sex – all of which represent sex without the possibility of procreation. Assisted reproductive technologies (including IUI, IVF, etc.) on the other hand represent procreation without sex.

It wasn’t hard for me to reject the first argument. In fact, I rejected that argument a long time ago. (Judging by the size of the average Catholic family these days, I think it’s safe to say most American and European Catholics reject that argument, whether consciously or not.) Specifically, I don’t believe that God would make gay people only to present them the unappealing choice between being celibate or a sinner. I also don’t believe that God would limit heterosexual couples to a contraceptive choice that forces one partner to choose between ignoring her hormonal urges each month or getting pregnant with her 12th child… (Incidentally, I was especially surprised a few years back to learn that my favorite Dominican priest, Fr. D. shares this concern!)

The second argument is more difficult for me, and I’ve managed to avoid it during the IUI process, but not if we move forward with IVF. This is the same argument for why the Catholic Church opposes abortion, an issue which I also struggle with – perhaps more so now that we are experiencing infertility. I’ll set aside abortion for now, but what do I think about the destruction of embryos as a result of IVF? If you had asked me a year ago, I would have given a totally lame answer:

“I think it’s great that many suffering from infertility will get to achieve their dream of pregnancy by IVF, but I wouldn’t go to those lengths.”

If pressed, I might have continued that it would seem like “such an extravagant use of resources just for the luxury of my own biological child.” That “there are so many unwanted children in need of homes,” and that “maybe it was God’s way of saying he had another plan for me.” Yup, I was one of those people. I can’t believe my good friend N. (who went through 3 or 4 fresh IVF cycles – I lost count – ultimately resulting in a gorgeous little boy) didn’t slap me across the face when I told her I’d never do IVF. I’ve since apologized for being such a hypocritical idiot!

So my feelings about IVF have changed. Did they change because now it’s me? Because now IVF is my best chance at a genetic child? Certainly that has something to do with it. But something else has changed too.

After a miscarriage at 9 weeks followed 10 months of infertility (not to mention another six failed pregnancies among close friends in that same time period), I just don’t think of embryos the same way. Before this whole experience, I think I easily could have viewed each sperm cell and each egg as a ‘potential baby’. Under the right conditions, they could fulfill their destiny and grow into a living breathing human being. [insert slight sarcasm here]

What is now apparent is that, even under the best conditions I can muster (cushy uterus, healthy & “relaxed” host, optimum timing, perfect super-sperm), I’ll be lucky to get one of my eggs to reach its so-called ‘potential’. And the best chance of doing so is through IVF.

So how can I view the demise of 3- or 5-day-old embryos (assuming I’m lucky enough to get any) as ‘destroying a life’, when they almost certainly would never have existed without IVF, and when we are actively doing everything in our power to help them develop into a baby?

Frankly, I can’t (or won’t) see IVF that way. At least not now. And as a Roman Catholic, I’m okay with that!

Postscript: To those who would call me a ‘Cafeteria Catholic’

I know you’re out there; people who will accuse me of being a ‘Cafeteria Catholic’ or ‘CINO’ (Catholic-In-Name-Only), or what have you. Aside from trotting out my Catholic credentials (baptized, confirmed, and married in the church; attend mass weekly and on all holy days of obligation – including while traveling; fast and abstain during lent; confirmation sponsor to my sister; selected by the priest to serve on my church’s Pastoral Council; etc.), and getting angry (man that term irritates me!), I like to point out two observations:

  1. Everyone I’ve ever heard accuse someone of being a ‘Cafeteria Catholic’ is, by their own definition, a Cafeteria Catholic. It’s hard not to be. The Catholic Church – more than any other church – has an official opinion on just about everything. To not be a Cafeteria Catholic, someone would first have to take the time to learn everything that the Catholic Church teaches, and then take on the Herculean task of adhering to that teaching. Actually, to spot the hypocrisy involved in this accusation, you typically don’t even have to work that hard. Pick an issue outside of Catholic moral teaching (better yet, just pick something outside of the small subtopic of sexual morality) and ask the accuser how they live that teaching in their own life. Almost invariably, users of the term Cafeteria Catholic totally ignore some or all tenets of Catholic teaching on social justice, stewardship of the environment, capital punishment, just war, and so on. (For some reason, these folks seem to be obsessed with sex. Maybe they are angry that they’re not having enough …and are envious of everyone that is.)
  2. The use of the term ‘Cafeteria Catholic’ betrays an utter misunderstanding of where Church teaching comes from. Catholic Church teaching is not static. In fact, one of the things about it that so many fundamentalist Christians find objectionable is that we don’t believe the bible to be the final and supreme word of God. Instead, we believe that God continues to speak through an ever-growing Church tradition. New issues (moral and otherwise) arise, and the Church responds, typically by enlisting a panel of experts and church leaders, who engage in extensive discussions, and prayer, and ultimately arrive at some kind of consensus that is adopted as the official Church teaching. Thoughtful and prayerful consideration of issues is part of the process. Consistent with that tradition, priests are NOT mindless drones that regurgitate official Church teaching. The majority are highly educated critical thinkers, taught to ask challenging questions and grow in their faith through independent thought and prayer. Why should laypeople behave any differently?

If I disagree with American policy (or even a small subset of American policy), am I a ‘Cafeteria American’? Can I be a ‘Cafeteria Chemist’? The Catholic Church is losing enough believers as it is. Do we really want to be in the business of telling people they don’t belong?

I don’t mean to imply that the Church is ‘wrong’ about infertility treatment, and that my beliefs are ‘right’. I fully recognize that my knowledge and experience is inherently limited, that God’s plan is beyond my comprehension in this life. But I also feel confident that I am thoughtfully and prayerfully considering the consequences of my infertility treatment, and as of today, I am comfortable proceeding with IVF if this IUI cycle fails…

Optimistic

I’ve been feeling optimistic all day that this month is our month. It’s kind of cool, because it’s the first I’ve felt optimistic in awhile. I hadn’t admitted it out loud, but ever since our diagnosis of diminished ovarian reserve, C. and I seemed to be moving toward acceptance of the fact that we would need donor eggs in order to get pregnant… Anyway, it’s probably just wishful thinking, but I’m going to enjoy this feeling, however short-lived it may be.

In that spirit, here’s my list of reasons to be optimistic that this will work:

  • I’ve been dutifully taking my baby aspirin, CoQ10 (1200 mg), fish oil (1000mg), prenatal vitamins, and calcium (presumably upping the odds of nice, healthy, energetic eggs).
  • I’m on progesterone suppositories (that should help make a cushy uterine lining for my eggs to burrow into).
  • Despite his pain meds, C. gave an awesome sperm sample for the turkey basting (78 million swimmers, concentrated down to 30 million ‘winners’ who were direct-injected into the back of my uterus).
  • My plumbing got a good flushing during the HSG last month (only supposed to make a slight difference the month it happens, but as long as I’m being optimistic, I’m going to allow the possibility of a residual effect this month.)
  • Thanks to the injections, we had two good-looking eggs that presumably dropped (doubling the odds that one might actually be good relative to any other month).
  • The turkey baster – plus a bonus low-tech deposit the day after – should guarantee that there were swimmers around to welcome the eggs when they dropped.
  • I am 34. (Doctor said better to have my crappy hormone levels and be 34, than have my crappy hormone levels and be 42…even though my crappy hormone levels at 42 would make me more normal…)
  • I’ve cut back on coffee (<= 1 caffeinated cup per day) and alcohol (only one small glass since basting).
  • I’ve been uncharacteristically relaxed for this time in the school year (since C.’s accident, I’ve been accepting help from anyone who offered, and unafraid to say ‘no’ to annoying requests!)
  • C. and I are closer than ever, and I’m more convinced than ever that we would make fantastic parents.
  • I’ve been stocking up on ‘baby karma points’ by helping out a fertile friend on days when her husband is unavailable. I watch her baby girl (born just a couple weeks after the due date for our ill-fated pregnancy) while she puts her energetic 3-year old to bed.
  • Surely there must be some people who get pregnant on their first IUI (15-20%, if Dr. Google is correct), why not us?
  • I am just getting the hang of this whole infertility blogging thing, and will lose all my ‘street cred’ as an infertile if I get pregnant on the first IUI! (Does reverse psychology work on embryos?)

So there you have it! This could be our month. Fingers crossed!

Side effects?

Today was my last class of the semester (hooray!) So now I just have to finish some grading, administer the final (a standardized, multiple choice exam – double hooray!), and get ready for summer research, which starts on the Monday after finals (boo!). I am advising five undergraduates this summer, so I won’t get to take it easy, but they say a change is as good as a break, right? And the summer research schedule is definitely more flexible than the semester, so if we need to move forward with fertility treatments, it should be relatively convenient to do so in the summer…

In other news, I think I might be experiencing side effects from the progesterone suppositories. For the last two nights, I’ve slept poorly (waking up in the wee hours, with difficulty getting back to sleep), and last night had the most disturbing dreams! (Okay, so one likely contributor is the fact that I’ve been watching Burn Notice Season 6 right before bed – that show really took a dark turn this season – but still!) In one dream, I was a fugitive being chased by a CIA operative (definitely Burn Notice-influenced), and hiding – naked for some reason – in a little cave. Just when I was about to be discovered, I woke up in a panic. In the more disturbing dream, my sweet little pug – Winston – was in some kind of accident that caused his entire body to be severed. 😦 He was still alive, but it was such a gory scene, and he was obviously about to die any second. I was inconsolable.

Thankfully, I woke up to find my two fur babies sleeping peacefully:

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I am not looking forward to seeing what the next few nights have in store!

Progesterone

Yesterday I went in for my progesterone blood test, and then started progesterone suppositories last night. I’m supposed to continue with these twice daily until I get a negative pregnancy test or make it past 10 weeks pregnant…

First, the test results: my blood progesterone was 24.49 ng/mL. I think the purpose of this blood test was to confirm that I had indeed ovulated. Normally you expect your progesterone levels to be near zero prior to ovulation, and to rise after ovulation. From what I can tell, 24 ng/mL is on the high side, but within expected variability (and who knows what ‘normal’ is for women pumping themselves full of hormones), so I’ll assume that this is a ‘good’ result.

Next were the suppositories. Here’s what they looked like:

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For some reason, I found the packaging very entertaining. The top view makes me think of a petri dish with a bunch of bacterial colonies – or a disk diffusion assay. The bottom view looks like a bunch of perfectly arranged raspberries! I use the ‘key’ thing to push one suppository out of the packaging morning and night.

After getting over the goofy packaging, I casually mentioned to C. that I wasn’t totally sure how to use them. His reply: “Just put it in your butt!” I laughed and told him that I’m pretty sure it doesn’t go in my butt. C. again: “Where else would it go?” After repeating that it doesn’t go in my butt, he thought for a minute and eventually figured it out…

So, what’s interesting about progesterone?

Well, like estradiol, testosterone, cholesterol, cortisol, etc., progesterone is a steroid. Being a steroid gets a bad rap, but really all that means is that it has the four-ring carbon backbone shown above. The name progesterone is short for progestational (preceding pregnancy) steroid (four-ring carbon backbone above) ketone (functional group consisting of a carbon double bonded to oxygen, and attached to carbons on both sides; highlighted in blue above). Testosterone is also a ketone, while estradiol is an alcohol (highlighted in red).

Fun facts about progesterone:

  • Progesterone (secreted after ovulation to prep the uterus for implantation) is responsible for the ‘thermal shift’ observed by those weirdos (myself included) who go to the trouble of charting their basal body temperature (BBT). For this reason, I’m kind of bummed that I didn’t bother to chart this month…I wonder how big the effect of the suppositories will be on my BBT…
  • In cycles that don’t result in pregnancy (like all the ones in recent memory), progesterone levels naturally drop off after 12-16 days, signalling Aunt Flo (AF) to visit. Since I will be taking progesterone suppositories, this drop won’t happen, and my period won’t start. Instead, I’ll have to go in for a blood pregnancy test. If I’m not pregnant, then the doctor will tell me to stop the suppositories, which will prompt AF. So, no checking the toilet paper for unpleasant surprises this month. (Actually, there have been no surprises from AF since I started charting…one of the few perks of being a weirdo data-junkie!)

The progesterone suppositories are a nice safety net, just in case I wasn’t producing enough progesterone on my own to support implantation (something I had worried about a bit, since my temperature shift is sometimes subtle).

And now, we hurry up and wait! Since this is the last week of classes, you can probably expect a fair number of ‘making sense of it all’ posts coming up. Apologies in advance for that! (Although my non-chemist friends will probably appreciate the break from all the science talk…) Also, I’d like to apologize to any biochemists reading my blog. A molecular biologist friend asked me to ‘lay off the biochemists’, and I will try to oblige! Truth be told, I have the utmost respect for biochemists!

Turkey baster day!

Today, C. and I went in to the clinic to get this turkey basted (that is, for intrauterine insemination or IUI). Here’s what was involved:

  1. C. prepared his sample right before we left for the clinic, then kept it warm in his pocket during our drive. (It takes a half hour for it to ‘liquefy’ prior to washing.)
  2. We arrived at the clinic and waited. This part was long enough to stress us out a bit, since the specimen is supposed to be processed within an hour.
  3. Once in the back, we handed over the sample to the nurse and signed a form stating that it was indeed from C.
  4. We waited again, this time for the doctor (Dr. H.) to ‘wash’ the sperm. More about that in a minute…
  5. Dr. H. came in, and confirmed again that the sample was indeed from C. (After being asked again, we started to actually worry! What if our sample got mixed up with one of the people in the waiting room?…) She complemented C. on his excellent sample. (She counted 78 million sperm per milliliter upon arrival, and 30 million ‘good swimmers’ that made it through the washing procedure and to the final sample. This raised our confidence that they were actually C.’s! 😉 ) Then she explained what was going to happen.
  6. The next part started like a pap smear: me in stirrups, mildly uncomfortable; doctor inserted speculum then swabbed my cervix with a big Q-tip… Then out came the turkey baster! (Actually it looked more like a syringe with a little tube…)
  7. After the basting was done, Dr. H. tilted the bed back and left me there for ~30 minutes to let gravity help the little guys along.
  8. She reiterated the advice to BD tomorrow, just to be sure. And that was it!

The whole thing really wasn’t bad! No cramping at all. (Dr. H. told me I have a ‘quiet uterus’. I guess that makes sense; they’ve had two geriatric ovaries for neighbors this whole time…)

The sperm washing part was interesting to me, since it involves organic chemistry. 🙂 So, why wash sperm?

Aside from the high quality ‘Michael Phelps’ sperm cells, semen also contains slower-moving or dysfunctional sperm, prostaglandins, and bacteria (ew!) The cervix normally acts as a natural ‘qualifying round’ to keep out everybody except those super-swimmers. Since IUI bypasses the cervix, another gatekeeper is needed – hence the sperm ‘washing’.

Here’s the chemical structure of the two major prostaglandins in semen. Prostaglandins are made from fatty acids (hence the long chains on the right side), and always have a five-membered ring.

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Prostaglandins stimulate muscle contractions, which might be good when you’re trying to help sperm get into the uterus (or if you’re 42 weeks pregnant and trying to induce labor – not exactly something I’ve had to worry about…), but if inserted directly into the uterus, the prostaglandins can cause severe cramping, vomiting, fever, and diarrhea. Not so nice.

The next step for me is a progesterone blood test on Wednesday, followed by progesterone suppositories to support a pregnancy (in case there is one!)

Ever the pessimists, we also scheduled an IVF consultation with Dr. Y. so that we have a clear idea of our options if this doesn’t work. Hopefully we won’t need it!

Trigger shot

I had my estradiol and follicles checked today. Two looked like they could drop any minute, so the nurse practitioner – D. – administered the hCG trigger shot while I was there. (Poor C. didn’t get to “stick me” after all!)

For all the data monkeys (like me) out there, here’s a summary of my test results:

Estradiol (E2):

  • baseline estradiol (taken during infertility workup 1/26) = 25 pg/mL
  • estradiol on 4/17 (after 4 days of injections) = 281 pg/mL
  • estradiol today (4/19, after 6 days of injections) = 572 pg/mL

According to this FAQ (http://www.fertilityplus.com/faq/iui.html), the target is 200-600 pg/mL per big follicle; since I only have two big follicles, I think this means I’m good.

Follicle size & count:

  • On Wednesday (4/17) I had three visible follicles, measuring 14.5 mm, 13 mm, and 11 mm.
  • Today (4/19) the same follicles measured 18.5 mm, 16.6 mm, and 11.5 mm. Below is a picture of my biggest follicle, viewed on ultrasound. (The follicle is the black oval just left of center with the dotted cross through it). 18.5 millimeters sounded huge to me, so I posed a penny (also 18.5 mm in diameter) in the photo for reference!

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According to that same FAQ above, it looks like 16-18 mm is a good range for Menopur-stimulated follicles, which is consistent with what nurse D. said. She expects that the smaller one will probably not release, so we’re looking at two follicles this cycle.

Things are slightly less than ideal. For our best chances of pregnancy, our target would have been 3-4 big follicles (to increase the odds of at least one ‘good’ egg taking). But 2 is better than 1, and better than 5+ (in which case we would’ve had to cancel the cycle or risk a multiple pregnancy). In addition, it would have been better to inseminate 36 hours after the trigger shot, but since the clinic is closed on Sunday, 24 hours will have to do! Nurse D. pointed out that it’s better to inseminate early than late, since the sperm can “wait for the egg”, while the egg can’t do the same. (I’m sure there’s a sexist joke to be made there…) She also suggested BDing on Sunday to be sure…

So I’ll be back tomorrow for the insemination. Wish me luck!

Looking good!

So today I had a blood estradiol (E2) test, and ultrasound to see how I’m responding to the Menopur, and all looks good. 🙂

The annoying part is that they only do the estradiol test at the hospital lab across town, and only from 7-7:30 am. So I had to wake up at 5:30 this morning to get ready and drive east to the hospital, and then drive back west in rush-hour traffic to teach my 8:30 class. Fortunately, the infertility clinic is on this side of town, so making it to my 10:30 ultrasound appointment was no problem.

Anyway, the result is that I have two decent-sized follicles, and one smaller one. This is good news, since our target is 2-3 follicles for IUI. Based on the size of the follicles and on my estradiol (281 pg/mL), the nurse practitioner recommended upping my dose of Menopur from 300 IU to 375 IU per injection, and repeating the blood draw (5:30 am wakeup – Boo!) and ultrasound on Friday. Depending on those results, we may do the insemination as early as Saturday!

Injections

After three days of injections, I can honestly say that they’re not that bad. C. seems genuinely impressed at how comfortable I’ve become with it. He also seems to enjoy making references to “sticking me” whenever he can…

So, what is it that I’m sticking myself with each evening?

So far, it’s been Menopur, a combination of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) purified from the urine of postmenopausal women. (Since menopause may not be that far off for me, I’ve got it on my ‘to do’ list to find out how to donate my pee to the cause!) Anyway, the idea here is that both LH and FSH work together to stimulate my ovaries to develop pre-eggs (“follicles”). At the right dose, we can hopefully get my ovaries to prep 2 or 3 eggs. They’ll be monitoring me closely by ultrasound to see if that’s what is happening.

Then, when they give me the go-ahead, C. will inject me with a megadose of (generic) human chorionic gonadotropin (hCG) to trigger my ovaries to drop all the mature eggs at once. That way, when we do IUI (intrauterine insemination, aka the turkey baster), the chances are better of getting at least one “good” egg, and a successful pregnancy. (Of course, this also increases the chance of twins, but at this point, twins sounds a lot better than childlessness, so we’re not going to let that stop us!)

hormones 2

Structurally, FSH, LH, and hCG are all related. They are all dimeric glycoproteins (composed of two separate protein pieces, each with sugars attached). One of the protein pieces (the “alpha subunit”) is the same for all three hormones. What differentiates them from one another is the other protein piece (the “beta subunit”).

The beta subunits of hCG and LH are highly similar, and both proteins bind the same receptor. Here are some fun facts that result from this similarity:

  • I don’t feel too bad about the fact that I couldn’t find an image of LH for the figure above. Just put your nose up to the screen and cross your eyes to see two of the hCG structures – that’s pretty much what LH should look like anyway!
  • When C. gives me the trigger injection of hCG, we’ll be technically using hCG as a stand-in for LH, since LH is what normally triggers ovulation. Unfortunately, I can’t seem to find a good explanation why hCG is preferred for this use…
  • You can use an ovulation predictor kit (OPK, which measures the natural LH surge that triggers ovulation) as a poor-man’s home pregnancy test (HPT). The hCG produced by a fertilized egg is similar enough to LH to get a positive test. Don’t believe me? See: http://tracysue.wordpress.com/2012/04/25/experiments/
  • A corollary of that last fact: after getting my trigger injection of hCG, I would test positive on an HPT. I haven’t decided yet if the thrill of seeing a false positive test is worth the expense of the test, but if I do, I’ll post the test (and freak out any sporadic readers…mua-ha-HA)!

And this brings me to why everyone should prefer OChem over biochem. Small molecule drugs (like aspirin, tetracyline and Clomid – the realm of organic chemists) can often be taken in pill form, while protein drugs (like insulin, Menopur and hCG) pretty much never can. This is because the delicate three-dimensional shape of proteins doesn’t hold up well in the stomach (amid all that hydrochloric acid and digestive enzymes), and because their size (~30,000 amu for FSH, LH, and hCG, versus 405 amu for Clomid) makes it hard for them to get absorbed through the intestine and into the bloodstream. On the other hand, Clomid doesn’t work nearly as well as Menopur and hCG do, so perhaps I should wait to condemn the biochemists…

Anyway, tomorrow I’ve got an estradiol blood test and ultrasound to see whether the injections are working. Stay tuned…

One-woman pharmacy

I went to pick up my drugs for medicated IUI yesterday. Annoyingly, the Kaiser pharmacy at the infertility clinic was out of Menopur – the clinic’s most-prescribed infertility drug – and I had to drive across town to the hospital pharmacy…only to find that they were out of needles?!

On the plus side, my insurance is evidently pretty good, and I got over $2K-worth of prescription drugs, syringes, and needles for $32! I wasn’t as lucky with the supplements Dr. L. recommended (including Coenzyme Q10, omega-3 fatty acids, and baby aspirin). Even with a buy-one-get-one-free sale at CVS, these cost me $134!

Here’s the loot:

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For the chemistry of these, I’ll start with the easy stuff (i.e. the small molecules)… Here are structures of the supplements Dr. L. recommended:

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Aspirin is the acetate of salicylic acid – a natural product from the bark of the willow tree. Coenzyme Q10 is a quinone (hence the Q), and an antioxidant. (The quinone part of CoQ10 is shown in blue above.) Omega-3 fatty acids are a class of fatty acids that contain multiple double bonds with the first double bond starting at carbon-3 (counting from the ‘omega’ end, or the left side on the structures above). Omega-3s are made by plants. People can get them by eating plants (especially the seeds), by eating fish (who in turn get them from eating algae and plankton…), or (in my case), by taking fish oil supplements.

Dr. L didn’t go into detail about the rationale, but said that she recommends these supplements to “maximize the quality” of my remaining eggs. From reading the labels, it looks like all are supposed to promote circulation, which I guess is a good thing for eggs. (Did I mention I’m not a biologist?) There’s also something psychologically satisfying about taking a bunch of pills…feels like I am doing something.

I’ll save the chemical structures of Menopur for another day, since it’s more biochemistry (yawn!); this post is already too long; and I’m hungry!

Wish me luck for my first Menopur injection tonight!

IUI cycle start

So despite C.’s valiant effort, we are definitely not pregnant. 😦

I suspected as much this morning, and it was confirmed during my ‘Menopur Teach Class’ (a required class for informed consent before medicated IUI).

Anyway, as I mentioned before, I needed to schedule a ‘baseline ultrasound’ during the first 3 days of my cycle if I wanted to do IUI this cycle. Since C. and I were already at the infertility clinic for the class, the staff at the clinic was very accommodating and got me in this afternoon for the ultrasound, and for the one-on-one session to teach us how to prep and administer the shots.

Because of the short notice, a different RE at the clinic – Dr. L. – performed the ultrasound. Upon entering her exam room and taking stock of the decor, C. and I appreciated what we assume is Dr. L’s subtle sense of humor:ImageUnfortunately, the decor was the highlight of the visit. Not that we didn’t like Dr. L – we did! But the ultrasound revealed even fewer antral follicles than last time – only 3. And Dr. L. was less equivocal than Dr. Y. Among other things, she said that I would probably hit menopause before age 40. 😦

But the ultrasound did not reveal any ovarian or uterine cysts, which was good news for moving ahead with medicated IUI, and we had our one-on-one meeting with the nurse. Starting on Saturday, I’ll be giving myself subcutaneous injections of Menopur every night, and when the doctor says it’s time, a one-time intramuscular HCG ‘trigger’ injection, which I very much hope C. will give me. I’m strangely proud to say that I gave my first shot today (just saline solution for practice), and it wasn’t so bad. C. (who loves to tease me for my fear of needles) was especially impressed!