Blogiversary, beta update, and winter cuteness

After I posted our news on Friday, I got notified by WordPress that it was the four-year anniversary of my blog. That makes it five years – give or take – from when C and I first started trying to conceive!

That went by fast – sort of.

I feel a little bit sorry for that little newlywed me, who actually argued with my dashing new husband about when to start trying…so we could. Time. My. Maternity. Leave.

Obama

Mr. Obama finds my naive ideas about family planning hilarious!

But early pregnancy loss, life-threatening motor vehicle injury, crushing infertility diagnosis, and stillbirth notwithstanding, I still can’t help but focus on the positive.

  • I married a wonderful man who doesn’t have a self-pitying bone in his body.
  • We have a gorgeous son.
  • We have amazing friends and family who have supported us through everything.
  • Contrary to the predictions of three different REs, I have managed to get pregnant four times.

 

So while things have not quite gone according to plan, I’m proud of where we’ve come in the last five years, and hopeful for what the next five will bring!

 

***

For those of you who are counting, my beta came back today at 370 mIU/mL. That corresponds to a doubling time of about 33 hours.

doubling time

Looks really good!

histogram 2

I take another test on Wednesday.

***

Lastly, for your viewing pleasure, here are some sweet pics of C. Samuel from our ski trip to Park City over my Spring Break:

Look who has nicer ski gear than me!

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Enjoying the view from the lift.

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C. Samuel wanted to hold our hands while skiing. ❤

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Relaxing in the hot tub after a long day!

My fortnight in pictures

I’m sorry for being a bad blogger lately. My excuses are many: we’ve been busy with visitors and travel, I’ve been ‘using up’ all my writing juices on my promotion portfolio (due September 5), and not much has been happening on the infertility front.

Rather than a long, disjointed ‘catch up’ post, I bring you my fortnight in pictures:

1) Got these beautiful flowers from my mom’s college roommate. She suffered with unexplained infertility for 10 years before having two amazing children, now grown.

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2) Did lot of head scratching mid-month. My fertility monitor (which reads the lower stick) never gave a peak reading this month. (It never even gave a ‘high’ reading!) But the cheap-o OPK (upper stick) did give a positive, so we moved ahead with our plan to do natural cycle IUI.

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3) I snapped this shot just after insemination. As you can see, I forgot my lucky socks. 😦 I put a pair in my glove compartment now so I’ll be prepared next time!

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4) Here’s a selfie of me before giving the sperm to the nurse to wash it. I think the recommendation of sticking the ‘sample’ in my bra to keep it warm in transit probably works better for bustier women than me…

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5) I’m proud to say that I’ve been running regularly, thanks to my sister’s nagging encouragement. Nothing anywhere near my marathon days (my longest recent run was 4.3 miles), but it adds up after awhile. I’m just proud to be doing something active again!

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6) A view from one of my runs… Makes me wonder how on earth I waited so long to run again!

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7) C and I decided to take a trip to northern Sonoma for some wine tasting. We stopped on the way up to enjoy the view.

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8) Funny enough, this is about as close as we got to any wineries on our ‘wine trip’.

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9) Instead of wine tasting, we spent a lot of time beer tasting at Russian River and Bear Republic (below), two of our favorite breweries. I didn’t manage to snap any pictures at Russian River – probably because we were enjoying the beer and company too much! (Our friend M is a brewer there and he and his wife J gave us the deluxe tour.)

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10) Aunt Flo showed her ugly face yesterday morning. For what it’s worth, it didn’t catch me off guard, since I’ve started charting again. Anyway, how could I be sad when I’ve got this joker to cheer me up back at home?

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Message to my fertile friends

Not too much has been happening here. We finally finished up the 10-week summer research session, and I am officially “off” for the rest of the summer. (By “off,” I mean I get to sit on my couch in my PJs working on my promotion portfolio and prepping for fall classes…) It’s nice.

As many of you know, our current plan, in the wake of failed IVF#1, is to spend three months trying to improve egg quality through supplements, while also doing natural cycle IUIs. I’ve been using my CBFM, and was supposed to call the office to schedule insemination as soon as the monitor indicated impending ovulation (by displaying a little egg). We also made a just-in-case appointment for cycle day 16, in the event that the egg never appeared in the monitor window.

Today was cycle day 16, so I went in for that just-in-case appointment. The dildo cam showed no lead follicle: either this is an anovulatory cycle, or we missed ovulation. (Once again, I find myself regretting getting lazy on the BBT charting; if I had kept up, I’d know for sure which it is.) But I’m actually not that disappointed. There’s a very slim chance that we could get pregnant this month, but if not, I’m fine trying again next month.

I’ve also been dutifully taking my long list of supplements. While I have definitely NOT been “living like a monk,” I have been trying to eat well whenever possible. I’ve cut back on coffee, Diet Coke and alcohol – to 2-3 servings of each per week…instead of 1-2 servings per day. (Shoot! Does that make me sound like a lush? I just like my nightly glass of wine!) Thanks to my sister’s persistence, I’ve also started running again. We’ve gone three times in the last week; it’s only been 2.5 to 3 miles each time, but a huge improvement over the absolutely nothing that I’ve been doing for the last year and a half…

*****

But the real reason for this post is that I got an email this week that was equal parts delightful and heartbreaking, and made me want to think carefully about how my words are received.

I hope A will forgive me for sharing parts of her email here:

Hi K,

I’ve been following your blog and seeing that things are not going as you might have wanted.  I’m sorry.  I also realize you sometimes feel ‘ill-will’ according to one of your previous posts about people who have some success.  Knowing that — I still need to tell you …

that we are 18 weeks pregnant and close to going ‘facebook public.’  I didn’t want you to find out on facebook. What you’re going through is emotionally and physically draining, but as you well know — I don’t really know… I don’t understand — regardless of how much I think I might or try.  It’s very personal and I’m really happy for you that you’ve found a support network of women through your blog who do understand.  It’s also wonderful to read about how your relationship with ‘C’ has strengthened and deepened through this difficult time.

…Anyway, I’m emailing you because I didn’t want you to be surprised on facebook and wanted to tell you that you do not need to respond.

I look forward to seeing you again (someday) and I am always thinking happy, reproductive, follicular, warm fuzzy thoughts in your direction.  🙂

Your friend,

A

This message was delightful, because I’m so happy for my friend, who had been trying for awhile for a second child, and suffered a sad loss shortly before ours. I was also deeply touched that she had given so much thought and time to writing such a compassionate message.

It was heartbreaking that such an amazing friend could possibly think I might feel the slightest bit of ill-will towards her or her baby.

So this message is intended for my fertile friends. (The sentiment is equally true for my ‘lucky’ infertile bloggy friends who are now expecting.)

When I shared my blog with you, I made a choice to let you in on my most personal, raw, and unfiltered thoughts. I didn’t do this by accident. It was a sign of just how much I love and trust you.

So, please believe me when I say that I do not, will not bear you or your children any ill-will.

  • If you decide to outdo the Duggars and have 30 kids,
  • If, in your genuine attempts to comfort me you say all the wrong things,
  • If you go on to have an absolutely perfect life full of glitter and unicorn farts with your gorgeous brood of children,*

I will NOT bear you any ill will.

Believe me. It’s the truth. (And if you know me well enough for me to have shared this blog with you, then you know that I’m a terrible liar!)

Now, you may wonder, to whom do I direct all my anti-fertility ill will? Most fall into one of the following groups:

  1. Anonymous pregnant women that I see everywhere. Yes, I know. It’s totally unfair. I have no idea what they’ve been through, or the kind of parents they’ll be. I’m sure if I meet them in the future, I’ll be happy for them then. But for now, I hate them.
  2. People I never liked in the first place. If they never bothered to make time for me or show the slightest interest in developing a friendship before they were pregnant, then I feel no obligation to wish them well in their baby-making efforts now.
  3. Bad parents. These include stupid and/or oversharing parents (STFU, Parents has all the examples you never wanted to know), neglectful-to-abusive parents (Tan Mom gets to be fertile? Seriously?), and truly evil ones (The rumor that World’s Worst Mom Casey Anthony is pregnant again may have been a hoax, but that doesn’t change the fact that she never deserved to be a mom in the first place!)

As you can see, there is no shortage of targets for my infertility bitterness and ill-will.

You, dear reader, are not one of them!

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* References to glitter and unicorn farts are shamelessly stolen from the amazing Jenny at Stupid Stork.

Infertility math*

This post was primarily inspired by a recent, lovely post by Jane at Mine to Command who confronted the myth that stress causes infertility. She delves into the medical literature on the subject, so I won’t provide my own (undoubtedly less eloquent) rehashing of what she’s said there. Go read it! Then come back, if you like.

The myth that stress causes infertility is a pervasive one. And, its logical consequence – namely, that infertiles should “Just relax, and you’ll get pregnant – has lead to a laundry list of charming little chestnuts of advice including:

  • Just adopt, and you’ll get pregnant.
  • Go on vacation, and you’ll get pregnant.
  • Get drunk, and you’ll get pregnant.
  • Don’t try so hard, and you’ll get pregnant.

and so on…

This myth originated – and continues to be fueled – by the observation that indeed many infertile couples get pregnant when they stop trying.

Although I’m not a medical practitioner and haven’t consulted the scientific literature on this particular topic, my intuition (aided by some basic mathematical understanding) tells me that this observation is probably true: many infertiles do get pregnant when they “aren’t actively trying”.

Before you chase after me with torches and pitchforks, please let me explain…

While I do think that the probability of getting pregnant while not “trying” is significant (in some cases rivaling the probability of getting pregnant through medical intervention), the often-touted “logical consequence” of this observation – that infertiles should stop trying to get pregnant…in order to get pregnant – is complete and total hooey!

I’m a chemist, but I nearly minored in math. I’m particularly grateful that I took statistics (both math stats and biostatistics), which comes in quite handy in situations like this…

So, why do so many couples get pregnant when they aren’t actively trying?

As Jane pointed out, this is kind of a silly question. Anybody who is having sex without birth control is, on some level, trying to get pregnant. So immaculate conception and birth control failures aside, everyone who gets pregnant is technically trying. But any infertile knows that there’s a wide spectrum of “trying”, all the way from “pulling the goalie” (aka unprotected intercourse) to spending tens-of-thousands of dollars for the privilege of being poked with needles, pumped full of hormones, subjected to minor and/or major surgery, and violated on a regular basis by an ultrasound wand, among other things…

Statistics provided by reproductive endocrinologists – the infertility experts – tell us that our odds of conceiving are significantly increased by all these interventions. Consider the following per-cycle odds of conception for several common interventions:

Intervention Per-cycle odds of conceiving** Source
timed intercourse 5% Health.com
natural cycle IUI 5-10% Babycenter.com
medicated IUI Up to 20% Babycenter.com
IVF 46% SART

I couldn’t find any odds for “not trying”, but I think it’s safe to say that they would be less than 5% per cycle.

So, how on earth is it possible that so many infertile couples get pregnant after they’ve stopped trying, even though their odds are so much less – more than 9 times less compared to IVF?

The key words here are per cycle. The odds, per cycle, of success from IVF are nine times that for timed intercourse (and >9 times that for ‘not trying’). But how many cycles of IVF do people actually do? Looking around the blogosphere, I can find lots of examples of people who have done IVF two, three, four times. But at over $10K a pop, few people have the financial means (or an IVF clinic willing to risk hurting its SART stats) to do many more cycles than that.

On the other hand, an infertile couple might have 5-, 10-, 20-years of “not trying” to get pregnant. For a woman who ovulates regularly every 28-days, that corresponds to as many as 65, 130, or 260 cycles of not actively trying to get pregnant.

So, how do we do the math to figure out the odds of getting pregnant by “not trying” versus using a technology such as IVF?

Let’s take an example of a couple that tried IVF three times unsuccessfully, adopted a child, then had unprotected sex for ten years:

First, let’s calculate their odds of a pregnancy resulting from three rounds of IVF. (In statistics, it’s actually slightly easier to calculate the odds of something not happening, and then to convert that to the odds of that thing happening…)

  • According to SART, the average odds of a pregnancy resulting from one cycle of IVF for a woman under 35 are 46%. We can express this value as the decimal 0.46.
  • That means the odds of not getting pregnant from one IVF cycle are 100-46 = 54% or 0.54.
  • The odds of not getting pregnant after two rounds of IVF are 0.54 x 0.54 = 0.29 or 29%.
  • The odds of not getting pregnant after three rounds of IVF are 0.54 x 0.54 x 0.54 (or 0.54 to the third power, 0.54^3), which equals 0.16 or 16%.
  • Now, to get the probability of a pregnancy resulting from three IVF cycles, we just subtract from 100% the probability of not getting pregnant: 100-16 = 84%. (Not bad odds! It seems our hypothetical couple – like many of us – was on the unlucky side of these stats…)

Now let’s calculate the odds of getting pregnant from ten years of unprotected sex.

  • For the sake of argument, I’m going to estimate that the couple’s per-cycle odds of pregnancy are a mere 1% (0.01). (Given that the per cycle odds for infertile couples practicing timed intercourse is estimated at 5%, I think 1% odds for “not trying” is actually pretty conservative…as long as the couple is having sex…) If the odds of a pregnancy are 1%, that means the odds of not getting pregnant are 99% or 0.99 per cycle.
  • The odds of not being pregnant after two cycles are 0.99 x 0.99 = 0.98, or 98%.
  • The odds of not being pregnant after three cycles are 0.99^3 = 0.97. In other words, there is only a 3% chance of a pregnancy resulting from three cycles of “not trying” – not even close to the 84% odds from three cycles of IVF.

Like interest on a long-held bank account, things start to get interesting as these paltry odds compound over large numbers of cycles…

  • The odds of not being pregnant after 13 cycles (one year) are 0.99 to the thirteenth power (0.99^13) or 88%. That means the odds of a pregnancy resulting from those 13 cycles is 12% (100 – 88 = 12). In other words, more than one tenth of “infertile” couples will be pregnant after a year of “not trying”. (Thereby supplying ample anecdotal “evidence” for annoying fertiles to misinterpret and hold up to their infertile friends…)
  • The odds of not being pregnant after 130 cycles (0.99^130) are 0.27, or 27%.

In other words, after ten years of “not trying”, this “infertile” couple had a 73% chance of achieving at least one pregnancy. (And remember, that pregnancy could occur randomly at any time during the ten years of not trying…)

How do you suppose most people interpret this series of events?

The facts: a couple failed to get pregnant from three rounds of IVF, adopted a child, and then got pregnant after a few years of not actively trying to get pregnant.

I can think of a couple of likely interpretations:

“After becoming parents through adoption, they were finally able to “just relax” and get pregnant!”

“In adopting, they were able to resolve the karmic imbalance that had previously interfered with their attempts at pregnancy!”

Nonsense! The real reason is far less romantic:

Over the course of many years of regular unprotected sex (albeit without officially “trying”), chances are that at least once, healthy sperm would meet with healthy egg at the right time to fertilize, and travel through the fallopian tube to find a uterus in just the right condition for implantation.

As Jane would say, “it was just their time.”

For women with diminished ovarian reserve (like me) the odds of conceiving by IVF are far below the 46% average I used in the example above (see this post for the depressing stats). Yet it’s not known how significantly DOR affects our chances of success through natural conception (which only requires one good egg each month…) In such cases, it’s easy for me to believe that the odds of conceiving from 100+ cycles of “not trying” could exceed the odds of conceiving from a handful of IVF cycles!

Am I saying we should all “just relax” and abandon assisted reproductive technologies?

No way! I can think of several good reasons to take a more aggressive approach:

  1. I don’t want to wait ten years to have a decent chance at a pregnancy! (Since I didn’t start until 33, I don’t even have 10 years of trying left in my old lady ovaries anyway…) I want my child yesterday! I want to change her diapers, not ask her to change mine. ART gives me the best odds of a child soon!
  2. Unlike in my simplified example, our odds of success are not static. My odds of pregnancy with my eggs – whether via ART or natural conception – are decreasing every month. With that fact hanging over me, it’s hard to justify waiting around for years for a natural conception. I can always try (or “not try”) for a natural conception after trying other family-building options (IVF, adoption, etc.) But ten years from now, if natural conception doesn’t work, I can’t go backwards and do IVF (at least not with my own eggs, which will have long dried up by then…)
  3. It’s not an either/or situation. If the odds of a pregnancy in my hypothetical example were 84% for three rounds of IVF, or 73% for 130 cycles of “not trying”, the total probability of a pregnancy – given that this hypothetical couple used both methods – was an almost unbelievable 96%! (1 – 0.16 x 0.27 = 0.96). Carefully timing intercourse instead of “not trying” should increase the odds further. Trying a combination of aggressive treatment (using ART) and regular unprotected intercourse will give me the very best odds of a biological child.
  4. There’s comfort in knowing that I’ve “tried everything”. If things don’t work out, and I end up on the unlucky end of all these statistics, at least I won’t wonder whether I might have been a genetic parent, “if only I’d tried X…” I’d rather go ‘all in’ now, and then move on to the next family-building option (or child-free living) without regrets.

As you’ve probably figured out by now, my plan is to continue with high-tech treatment…and to break out the Marvin Gaye around ovulation time every month in between!

It’s a plan that will mean a lot of two-week waits,…

a lot of peeing on sticks,…

and charting temps,…

and reading signs…

You’ll understand if I get tired of all the effort and decide to “take a break” and skip the meticulous timing for a few months…

And if, by chance, I happen to get pregnant that cycle,…

For heaven’s sake, DON’T use me as an example of how you “know this girl who got pregnant as soon as she stopped trying!”

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*I can’t write about Infertility Math without acknowledging this brilliant post by Aramis at It Only Takes One.

**Odds shown are for infertile couples (that is, couples who have been trying unsuccessfully for at least a year) in which the woman is less than 35 years old. Other factors can dramatically change these odds. For example, when fertile couples are included, the per-cycle odds are much higher – as high as 25% per cycle for timed intercourse. For older women, the per-cycle odds are lower in each case. Also, note that these stats show approximate pregnancy rates. The live birth rates are (sadly) lower due to miscarriage…

This and that

AF arrived yesterday, so I went to see Dr. Y for a baseline ultrasound this morning. While we are waiting for my supplements to take effect, we figured it couldn’t hurt to do a few cycles of natural IUI. (As C puts it, “so we can feel like we’re doing something…”) Originally, Dr. Y had suggested taking Clomid during the IUI cycles, but I had second thoughts about pumping my body with drugs when I’m supposedly trying to use acupuncture, supplements and diet to achieve a monastic zen-like state that will maximize the quality of my remaining eggs (or something like that…) Dr. Y quickly jumped on board with the plan, especially since he spotted a large ovarian cyst on ultrasound. The cyst would have precluded using any drugs anyway, so natural cycle it is!

The plan is for me to use an over-the-counter ovulation predictor kit (I’ll probably just stick with my CBFM) to detect my natural LH surge, and then to call the office to schedule insemination (aka turkey baster) the next day. The way I figure it, each month we get a chance (however small) that this egg might be ‘the good one’. If this month’s is the good egg, delivering C’s little swimmers directly to my uterus might slightly increase the chance that it gets fertilized.

Plus, summer research is almost over, so I’ve got time to kill. And Kaiser covers it. So, why not?

*****

I went to my second Resolve meeting last week. It was awesome. I got a lot of support in my decision to schedule a phone consultation at CCRM. More importantly, I also got a healthy dose of “it could be worse.”

Not that anybody would have said anything so insensitive, but hearing stories from my sisters in infertility helped remind me that, crappy as DOR is, it is not the worst diagnosis possible. The fact remains that C & I still have one very good option – IVF with donor eggs. Yes, it would mean giving up on genetic offspring (those adorable little hapa babies with my nose and C’s hand-eye coordination…) But it would bring our odds of success with IVF up to 70% or more per cycle. It would also ‘stop the clock’ on our fertility issues, meaning that we could have as many kids as we want, and time them as far apart as we want (well, almost… I think legit clinics refuse to transfer once I turn 50…) And our risk for age-related chromosomal issues would drop to whatever they are for our twenty-something donor.

Oh, and while I’m counting my blessings, I should probably mention that we are in the fortunate position of being able to afford egg donation as an option. (The same might not be said for a gestational carrier, which runs around $100K per try. So, we’re thankful that my uterus seems to be in good shape!)

Don’t get me wrong, I’m not giving up on my eggs just yet, but it’s nice to know that we have a good option tucked away in the sock drawer, waiting for us to pull it out whenever we’re ready. It’s also nice to know that there will be a great group of gals (and guys) down in the trenches with us who will support us, whichever path we choose.

*****

Last but not least, I got the sweetest gift from our fertile friends, S & Q. (These are the same ‘thoughtful ninjas’ who dropped off gorgeous flowers the night before a doctors visit, and a delicious care package of tasty treats on retrieval day.) Last week, the ninjas struck again, this time leaving this St. Gerard keychain:

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(It was timely, as I got it a few hours after reading this post by Risa at Who Shot Down My Stork? about the St. Gerard medal she got from a friend.)

As many of you know, I’m a practicing Roman Catholic (which I wrote about here), and St. Gerard is the Patron Saint of Motherhood. The Church uses a rather broad definition of motherhood here, including expectant mothers and mother-wannabes like me; as a result, couples trying to conceive will often pray to St. Gerard. (Another option is St. Gianna Beretta Molla, Patron Saint of Mothers, Unborn Children, and Physicians.) For any of you who are Catholic (or just willing to try anything at this point), here’s a common Prayer to St. Gerard:

O good St. Gerard, powerful intercessor before God

and Wonder-worker of our day,

I call on you and seek your help.

You who on earth did always fulfill God’s design,

help me to do the Holy Will of God.

Beseech the Master of Life,

from whom all paternity proceeded,

to make me fruitful in offspring,

that I may raise up children to God in this life

and heirs to the Kingdom of His glory

in the world to come. Amen.

Plan D

I made a mistake in my post about progesterone… Despite the suppositories, AF showed up a few hours after my last post. So yesterday morning I snuck out during my students’ final to call the clinic right when they opened.

C and I had decided our plan was to do a baseline ultrasound on cycle day 2 or 3, and see how many antral follicles were visible – if it was 3 or fewer, we would do medicated IUI again; if there were more, we would try for IVF. But when the advice nurse called me back, she said that Dr. Y wanted me to come in on Tuesday – too late for medicated IUI.

When I explained our ‘plan’, she said that upon further reflection, Dr. Y really felt that IVF was our best option and we should just go ahead with that. At this unexpected disruption in the plan – and to my complete surprise – I burst into tears on the phone. (I should probably mention that I have never been a very emotional person. For our first year together, C teasingly referred to me as ‘The Robot’. But infertility is doing its damnedest to change that.) Anyway, the nurse ultimately relented and said they could squeeze me in at 4:30.

The ultrasound showed 6 follicles (lame by most standards, but tied for my best count). It also showed a small cyst (Dr. Y said that wasn’t surprising after coming off a medicated IUI cycle), which means we couldn’t do medicated IUI this cycle anyway. We all agreed to move ahead with IVF, assuming the cyst goes away before next month. (We need a month to do our IVF ‘homework’ anyway.)

Once again, it feels good to have a plan, and to feel like we are moving forward (to what, I don’t know, but I’ll settle for movement toward anything at this point). I would title this post ‘Plan B’, except IVF was certainly not our plan B. By my count, we are on Plan D. Here’s a summary of our plan/backup plan/backup to the backup plan, etc:

Plan A: Pull the goalie and get pregnant “the old fashioned way.”

Plan B: Timed intercourse, using charting (phase 1), charting + OPKs (phase 2), and charting + OPKs + Clearblue Easy Fertility Monitor (phase 3)

Plan C: Medicated IUI with Menopur

Plan D: IVF with my (scarce, presumably crap) eggs

Plan E: IVF with donor eggs

Plan F: Adoption

Plan G: Wait for Guy on a Buffalo to drop off a prairie orphan. (If you don’t know what I’m talking about, click below.)

Plan H: No idea. Suggestions?

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.

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!

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!