Hypothetical of a hypothetical

So we’re moving along with Plan D – completing our IVF homework. Here’s what I’ve accomplished in the last week:

  1. Repeated my day 3 bloodwork. This revealed virtually the same bad numbers as before. Actually, to be fair, they were a smidge better…but probably not statistically significant; FSH went from 13.7 to 13.5, E2 went from 24.6 to 27.2; AMH went from 0.17 to 0.22. More importantly, they didn’t get worse in the past 4 months, which I’ll take as good news. (Funny story about the blood draw: after so many IF-related blood draws, I decided that I was now a needle badass and would therefore watch as the phlebotomist drew my blood…naturally, that was the first time ever that someone missed the vein and had to stick me a second time! I did NOT watch the second stick. So much for being a badass.)
  2. Took blood pregnancy test. No surprises here. This test was a liability necessity before they’d do #4.
  3. Start Zithromax with C. Apparently they want to make sure neither of us has any infections prior to IVF (not sure why this isn’t required for IUI…) I’ll write about the chemistry of Zithromax below…
  4. Saline sonogram & mock transfer. Dr. Y filled my uterus with saltwater and observed it by ultrasound to make sure there were no obstructions that might pose a problem for an embryo. (Kind of like the HSG, except with saltwater in place of the dye and ultrasound instead of x-rays.) He also practiced inserting a catheter to get the ‘lay of the land’ for the real transfer. The whole thing was very anticlimactic. The most uncomfortable part was that I had to do it with a full bladder. (I have a very small bladder and practically live in the bathroom…) I would have asked C to take a picture of this, but it didn’t really look like anything. My HSG photo was much cooler.
  5. Sign & initial 9-page informed consent document. The first 6 1/2 pages of the thing discussed various aspects of the medical interventions involved. Yes, I understand that there may be side-effects of drugs, complications of surgery, that I may have multiples, and that the whole procedure may fail miserably…The unsettling part was the other 2 1/2 pages, which consisted of depressing hypothetical scenarios and our decisions about what we would want to do with our hypothetical embryos. For example, what should happen to our hypothetical embryos…
  • if we fail to pay our embryo storage bill?
  • if one of us dies?
  • if both of us dies?
  • if we are legally separated or get a divorce?
  • after I exceed my “normal reproductive life”? (defined as age 50; phew!)

C was no help at all, and I struggled with how seriously to take the whole thing. On the one hand, I was making a decision about what would happen to our precious embryos – C’s and my potential children (and the only that I might ever have). On the other hand, we were planning for a doomsday hypothetical of a hypothetical. Given my antral follicle count, we’ll be lucky to get one or two ‘good’ embryos to transfer. What are the chances that we’ll have ‘extras’ to store and worry about in the event of further hypothetical catastrophes? In the end, I tried my best to take the questions seriously…If we stop paying our bill or don’t use the hypothetical embryos by the time I’m 50, we’ll donate them to research; if one of us dies or we get divorced, they’ll be made available to the partner who wants them (probably only pertains to me, since if I die or we get divorced, C can make cheaper babies with his new wife!), and if we both die, they can be donated to another couple. Gosh I hope this post is the last time I have to think about such bummer scenarios!

 Still on our ‘To Do before IVF’ list:

  1. Submit C’s semen culture (after we finish the Zithromax course) to confirm no infection.
  2. Attend a ‘teach class’ with the nurse to learn how to do our new injections.
  3. Call the finance lady at the IVF clinic to work out arrangements for payment.
  4. Start taking estrogen (estrace) and testosterone gel.
  5. Do a blood draw (including a progesterone test, and others?) to confirm that my hormones are ‘turned off’ before officially beginning our cycle.

And finally, here’s your IF chemistry lesson for the day:

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Azithromycin (aka Zithromax) is a macrolide antibiotic. That just means that it contains a large (15-member, in the case of azithromycin) lactone ring (shown in blue). Actually, a lactone is defined as a cyclic ester, so “lactone ring” is redundant…kind of like “ATM machine”. Anyway, azithromycin is a synthetic analog of the natural product 🙂 erythromycin, produced by the soil bacterium Saccharopolyspora erythraea. Like erythromycin and other macrolide antibiotics, azithromycin has a sugar part (technically, two sugar parts, shown in green) that dangle off of the lactone ring.

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Rookie mistake

I made a rookie mistake this week. Since I was feeling so optimistic about this cycle, I decided to test early – at 8 dpo (that’s 8 days past ovulation, for the non IFers). I saw the faintest second line, and woke C. to tell him that we were pregnant. I tried not to get TOO excited (after all, C. and I know all too well that a BFP is a far cry from a live baby…), but in my head, I had calculated the due date, lamented the end of my blog (okay, not much of a lament, but I thought about it nonetheless), and imagined how quickly all this ‘infertility stuff’ would be a distant memory. Not wanting to burst my bubble, C. gently asked “What’s the chance that it could still be due to the trigger shot?” to which I replied, “It’s been 10 days. There is no way that protein could still be detectable in my pee after 10 days!!!) I fantasized about our rainbow baby all the way to work, and then decided to Google it. And guess what?

hCG can totally remain at detectable levels…for up to 14 days following a trigger shot!

Ugh. I’m sure all the seasoned IFers out there are like “Duh!”

So what did I do? I tested again at 9dpo, 10dpo, and 11dpo. And the second line was like faint, fainter, gone. 😦

So today C. and I went to meet with Dr. Y. to plan our our next step. (One ‘perk’ from the accident: C. is available to go with me to all my appointments!) I found this meeting super depressing, which is to say, it was exactly like every other meeting at that office… “Yadda yadda yadda, diminished ovarian reserve, yadda yadda, born with all the eggs you’ll ever have, yadda, let’s do another day 3 blood test and antral follicle count, yadda yadda, we can try IVF but you’ll be lucky to get 5 eggs out, yadda yadda yadda…” You get the idea.

Rather than rehash the rest of the conversation, or the tear-filled ride home, I’d prefer to learn and then write about the biochemistry behind how home pregnancy tests work.

Here’s a nifty image I found online. I’ll attempt to caption it in my own words.

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(A) So the purple blobs are hCG, which is present in the urine of pregnant women (and of wannabe pregnant women who had a trigger shot 10 days ago…)

Capillary action carries hCG along the stick (or down in this particular figure; nevermind that HPT instructions definitely do not say to hold the test with pee end up like that…) Anyway, capillary action carries hCG toward where the action is.

(B) The reddish things that look kind of like lobsters holding a blue balloon are the anti-α-hCG antibodies which were pre-deposited on the stick (between the pee end and the viewing end). The antibodies have a pigment attached (in the case of the test I used – FRER – the pigment is pink, not blue). They will grab the hCG (specifically the alpha subunit of hCG – for more about the structure of hCG, see this post) and hold on tight…and be pink.

Now, capillary action will carry the bound-to-hCG anti-α-hCG antibodies, and the free anti-α-hCG antibodies (there are extras that don’t get any hCG) along the stick.

(C) At the ‘test line’, there is a line of anti-β-hCG antibodies (blue lobsters in the figure, although they are actually colorless) that are fixed to the stick. These antibodies also grab onto hCG (specifically, the beta-subunit) and hold tight…and don’t go anywhere. Everybody holds on tight, and the resulting group of anti-β-hCG—hCG—anti-α-hCG sandwiches appear as a pink line on the stick.

Meanwhile, the free anti-α-hCG antibodies (that is, the ones that didn’t get any hCG) continue to be carried by capillary action along the stick.

(D) Finally, the free anti-α-hCG antibodies reach the ‘control’ line, where there is a line of antibodies that specifically bind to the anti-α-hCG antibodies (no hCG needed). These antibodies are the green turtle-heads in the figure, and are themselves fixed to the stick. The resulting antibody—anti-α-hCG complex appears as the pink control line.

I go in for a blood pregnancy test (which works a bit differently; but I’m too lazy to figure out how right now…) on Saturday, but with a negative HPT at 11dpo, I’m decidedly not optimistic about it. I’m also not optimistic about moving forward with IVF, but I’m sure that will pass. In the mean time, I think I’ll console myself with a glass of wine tonight.

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!

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!

Test results

First, another update: I picked up C. in San Jose last weekend and flew home to San Diego with him yesterday. The flight was uneventful (a bit of turbulence, but smooth landing), but he was pretty tuckered out from the trip. Nice to have him home, though. The doggies and I missed him!

Back to the IF world. Now that I’m firmly in the two-week wait, I don’t actually have any news, but figured this would be a good time to fill in some of the holes in my earlier posts…starting with my pre-HSG test results.

I won’t share C.’s sperm test results, for the simple reason that I don’t have the values. (Due to HIPAA or whatever, I never got a copy of the results.) I will say (again) that I hear they were awesome. The best our IF nurse has seen, or so she claimed. C. is happy to believe her, and so am I.

So below are the results of my tests:

1) Antral follicle count. At my first visit with Dr. Y., he performed a transvaginal ultrasound and counted the number of antral follicles (maturing pre-eggs, visible under ultrasound). The idea here is that you can’t actually count the number of eggs a woman has left, so you assume that the number of partially-mature eggs your RE can see under ultrasound will give some indication of how many immature eggs (which your RE can’t see) are there. In general, more antral follicles = good, with ‘normal’ (in other words, ‘fertile’) levels being 16-30. My antral follicle count = 5.

The remaining three are all tests of blood hormone levels, determined from a blood draw on day 3 of my menstrual cycle. The structures of these hormones are shown below:

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Now, despite what my dad said in pretty much every Christmas letter throughout six years of grad school, I am not a biochemist. I’m an organic chemist, which means that I love to look at little chemical structures like the one of estradiol above. I start to get uncomfortable looking at any molecules bigger than about 1000 atomic mass units. Forget about proteins and nucleic acids! Both AMH and FSH (discussed in detail below) are protein hormones, which means that they are long chains of amino acids (AMH is composed of 560 amino acids; FSH is smaller*). If I tried to draw them using the same style of line drawing as estradiol, the drawings would be ridiculously large, indicipherable, or both. Instead, biochemists like to use other representations, such as the ribbon drawings above. The space-filling model is a compromise that makes me a little less uncomfortable, because I can at least see that there are carbons and hydrogens and oxygens, etc. Anyway, back to the tests:

2) Anti-Mullerian hormone (AMH). AMH is named for its role in preventing the ‘default’ development of female plumbing (“Mullerian ducts”…like uterus, vagina, and fallopian tubes) in male embryos. Its significance for infertility testing arises because AMH is released by egg-associated cells (“granulosa cells”) in the ovary, and – like antral follicles – is used as an indirect measurement of how many eggs are left. So, high AMH (>1 ng/mL) = good; low AMH = bad. My AMH = 0.17 ng/mL.

3) Follicle-stimulating hormone (FSH). As the name suggests, FSH stimulates the development of follicles (i.e. eggs) in the ovaries. My RE describes it as being like the gasoline that revs up the engine and gets your ovaries to develop and drop an egg. In young, nubile women, it doesn’t take much FSH (“gas”) to get the egg to drop. In women approaching menopause, you have to push the pedal to the floor to get enough gas for the egg to drop. In other words, low FSH (<9 mIU/mL) = good; high FSH = bad. My FSH = 13.7 mIU/mL.

4. Estradiol (a type of estrogen) is the main female sex hormone. In terms of predicting fertility, estradiol behaves a bit like FSH, in that your body may produce higher levels of estradiol (turning up the gas) as the number of remaining eggs decreases. Moreover, estradiol suppresses FSH production, so someone who has low FSH might actually still be in trouble if high levels of estradiol are ‘masking’ what would otherwise be high FSH. For this reason, REs like Dr. Y. typically order FSH and estradiol tests together… I can’t seem to find ‘normal’ values for estradiol, but since my high FSH levels already indicate very low fertility, I don’t think it matters! My estradiol = 24.6 pg/mL.

A side note about units:

As a scientist, I find it a little strange that every medical test seems to have its own units of measure. A cynical explanation is that perhaps physicians aren’t big fans of scientific notation, and prefer to choose a unit of measure for each test that gives normal ranges with values from 0.1-100 or so…even if it means learning dozens of different units. A more generous explanation is that maybe each of these molecules are being detected in different ways, and the units used might be determined by the detection method and sensitivity.

Regardless of the reason, here’s my guide to units for the tests above:

  • mIU/mL (milli-International Units per milliliter of blood). From what I can tell, the ‘International Unit’ is a biologist’s invention. (Is my bias showing?) It’s sort of like an ‘effective concentration’ that doesn’t translate to anything that a chemist would understand as concentration (like molarity, molalilty, normality, ppm, ppb, mg/mL, % by volume, etc.)
  • ng/mL (nanograms/milliliter of blood) For non-scientist types, a nanogram is one billionth of a gram.
  • pg/mL (picograms/milliliter of blood) A picogram is one trillionth of a gram, or one thousandth of a nanogram.

*For more about the structure of FSH, see: https://infertilechemist.wordpress.com/2013/04/16/injections/

The try

First, an update: After 7 days in the hospital, C.’s risk of further internal bleeding was considered low enough to let him go home. The final tally (after hearing from a team of trauma surgeons, radiologists, and the like) was a bit worse than I said in my last post: 7 broken ribs, 3 broken vertebrae, class 4 lacerations on both liver and spleen, and a hemopneumothorax (blood and air in the chest cavity). Incredibly, he did not require surgery – just a few stitches on his knee, close monitoring for internal bleeding, and a $*#!load of painkillers (more on those later). Since he was in San Jose at the time of the accident, the ‘home’ that they released C. to is his parents’ house. Yesterday, I flew back to San Diego to return to work. The plan is for me to fly to San Jose again on Friday to pick up C. and bring him ‘home’ to San Diego…

But this blog is supposed to be about infertility. As I mentioned before, the timing of C.’s accident relative to my anticipated ovulation date made it unlikely that we would get to try this month. Well…I’ll spare you the details, but suffice it to say that there is at least the possibility (however remote) that I could get pregnant…(Nobody can accuse C. of not being dedicated to baby-making!)

Now whether that would be a good thing is another question entirely. In the past week, C. has been on a laundry-list of painkillers, most opiate narcotics. In the hospital, his drug of choice was hydromorphone (trade name Dilaudid), a fast-acting IV narcotic. Unfortunately, he couldn’t take that one home and had to settle for the ones that come in pill form, including time-release oxycodone (trade name OxyContin); a mixture of hydrocodone and paracetamol (trade name Norco); and ibuprofen (trade name Motrin). The narcotics are all derived from the natural products morphine and codeine, alkaloids produced by the opium poppy. For your viewing pleasure, I’ve pasted the chemical structures below.

If we do get pregnant this month, our baby might come out addicted to prescription painkillers!

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HSG

The HSG took about 5 minutes (excluding time for me to strip from the waist down) and was virtually painless. (I had a few cramps on the drive afterward, but less even than a bad menstrual cramp – not that I ever get bad menstrual cramps…) To the utter bewilderment of my radiologist, I asked to take a photo of the screen. For your viewing pleasure, here’s my uterus and Fallopian tubes:

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I think the fact that you can see the white hair-like projections (my Fallopian tubes) coming out of the white triangle in the middle (my uterus) shows that everything is flowing freely. So plumbing doesn’t appear to be the problem (which we pretty much already knew). Now all I have left for my IUI homework is my injections class next week. Should be fun!

For today’s chemistry lesson, I tried to figure out the likely structure of the dye that they put in my uterus to appear all pretty and white on the x-ray above. I didn’t actually check what they used, but from what I can tell the vast majority of these dyes are small, iodinated organic molecules like the ones shown below. The iodine atoms are the most important part, and are what makes it show up white on the x-ray. There are two classes of iodinated contrast media: ionic (which contain a carboxylic acid group – shown in blue below – somewhere in their structure), and non-ionic (that don’t have a carboxylic acid). For imaging the digestive tract, they often use an inorganic compound – barium sulfate – but I’m going to assume that’s not what they used for my HSG.

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My IUI ‘homework’

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Today, I had my blood drawn for a blood pregnancy test, and picked up my prescription for doxycyline. This is in preparation for my hysterosalpingogram (HSG), which happens tomorrow morning, all part of the ‘homework’ my doctor gave me to do before we can move on with medicated IUI.

The HSG involves injecting a dye into my cervix and taking x-rays of my plumbing to see whether I have any blockages or uterine abnormalities not visible by ultrasound. This whole process would not do good things for a fetus, which is why I had to take the blood pregnancy test today. There is also a slight risk of infection, hence, the doxycycline.

Since this blog is titled ‘The Infertile Chemist’, I figured it should have some chemistry in it… Doxycycline is a broad-spectrum antibiotic (so I should be protected against a wide variety of pesky bacterial pathogens!), designed by chemists at Pfizer in the ’60s. More interesting (to me, anyway) is that it was inspired by the tetracycline family of natural products, including the first tetracycline to be discovered – chlortetracycline (aka aureomycin). Chlortetracycline is produced by a soil bacterium called Streptomyces aureofaciens. (Streptomycetes like S. aureofaciens make tons of cool antibiotics and other natural products.) Chlortetracycline is a polyketide, which means the bacterium makes it by connecting together two-carbon units in an assembly line fashion.

Anyway, I’ll start taking doxycycline tonight, and go in for my HSG tomorrow… I’ve read that it can hurt, particularly if one has blockages, so I’m hopeful that everything flows through without too much resistance. On the plus side, I’ve also heard that women who’ve just had their plumbing flushed by HSG have slightly higher pregnancy rates that month, so here’s hoping!