Saturday, April 28, 2012

Truth be Told

If you follow me on Facebook, you know that I have opted to allow my blog to show up in my status updates every time I write a new post. Truth be told, I have been torn over allowing those updates to post or not, and even whether or not I wanted anyone on FB to know I had a blog. Why? Because I talk about something very personal on my blog, and I am not sure I want everyone who is my friend on FB to know that I am infertile.

Have you ever looked up an ex on FB, seen their picture and thought, "Wow, I dodged that bullet!" Or maybe FB suggested you friend someone you didn't like in high school and you thought, "Holy crap, she actually posted that picture of herself?! She looks horrible... and fat...." And if you're like me, once you have thought those oh-so-cruel things, you reflect on your life and thank the Lord above that you have been blessed with the life you have. That you dodged that bullet, and that you have only gained a few pounds since high school.

But again, if you're like me, you think of the bullets you didn't dodge. In my case, its infertility. I often think about people from my past having access to my blog, knowing that I am infertile, reading about the intimate details of treatments. To the bullets I dodged, they are probably glad they dodged mine. To the people who gained more than a few pounds, they would probably rather be able say they can hit the gym and lose a few. Because being infertile isn't very easy to overcome, and it sure as hell is not cheap.

There are definitely days where I wonder how anyone one from my past would have handled being married to me and going through infertility with me. Would our relationships have withstood the way mine and my husband's has? Would it have grown stronger the way ours has? How would they have stood by me? And then I wonder if anyone from my husband's past were to find out he married an infertile, would they secretly laugh and think to themselves he probably wishes he had ended up with them?

When I think I was lucky for not ending up with so-and-so because he got fat and looks like trailer trash, I also realize that if that were the path I had chosen, I would probably still be happy in my life. I would still love him if he got a little chubby, because we would have grown chubby together. While I might wish for a better home and more money, I would be happy with the life I had been blessed with. I know this because that is how I feel about my life now.

Fortunately, I married an incredible man. He is the only guy I ever dated who truly allowed me to be me, and loved me just the way I was. He didn't want to change anything about me. He still doesn't (except he wishes I wouldn't spend like I do :D). He is an incredibly intelligent man, a wonderful provider, the best husband and companion I ever could have wished for. In fact, he is a better man than I dreamed of when I was younger. Not only does he provide for our little family, he spoils us (you'll see what I mean as the year goes on).

I often think about how while my lot in life right now is infertility, I am fortunate in that God knew I could bear this burden, and that He has provided for us in a way that we can afford to see specialists, have procedures performed and tests ran, and do medicated cycles. I am so fortunate. I have not yet hit a place financially where I have had to call it quits, nor will I. It is all a matter of how far I am willing to go. My husband has even offered to do IVF in Turkey if that is the route I want to take.

So while I am glad I dodged some bullets, I have also come to terms with the ones I didn't. I have found the blessings in them, and very rarely feel sorry for myself and the fact that having babies is a little more difficult for me. Every cloud does have a silver lining. Not having more children than we do right now means we get to do things we wouldn't if we had more than one. Everything turns out the way it does for a reason.

At the end of the day, I chose to allow my blog updates to show on my FB timeline because even though some people might snicker under their breath that this is my life, I am glad that this is my life. I have my troubles, and they all have theirs. I also don't mind that people realize they know someone who is infertile. Depending on where you hear it, 1 in 7/8 couples is infertile. I happen to be the 1. There are worse things. Scoff if you like, feel bad if you like, but I don't feel bad. My life really is semi-charmed, just like everyone else's. I wouldn't trade my life for anyone's. I really, really wouldn't.

This post is in honor of National Infertility Awareness Week (NIAW).

Friday, April 20, 2012

The Plan, Stan

We have a new plan set out with our new RE. I really can't believe I'm back into this, but I have new hope with this new doctor. He really knows his stuff, and he doesn't have the God complex Dr D did. I got back in to see him on Monday, and this time Hubs was able to skip out of work early to go with me.

Dr H completely agreed to the plan I had asked about last week, which was to have him perform a hysteroscopy to ensure that Dr D isn't hiding anything. He reiterated in this appointment how disappointed he is that the images from January were "lost", and that he agrees with us, that just doesn't happen. Either Dr D is negligent, or he's hiding something, but we're going to find out which.

Our plan is this:
  1. Get me up to 2000 mg of metformin over a 4-week period -- guess what? I'm already there baby! I am handling the metformin so well I upped the dose after the first few days, then I upped it again a few days later, and then I upped it again a couple of days ago. In less than a week and a half, I was up to 2000 mg. I have a little nausea, but not enough to be completely uncomfortable.
  2. Let this cycle run its course on the metformin. No monitoring, no injections, nothing. We just want to see if the metformin does its job on its own.
  3. Hysteroscopy is scheduled for May 24th.
  4. Depending on what Dr H finds, we will either jump into a medicated cycle or a go through suppression for endo.
All of the above is assuming that he doesn't get in there and find that Dr D screwed me over. So there are four possible outcomes:
  1. He finds nothing, and we start medicated cycles.
  2. He finds endometrial growths that are inhibiting potential implantation.
  3. He finds something Dr D did that he can't fix.
  4. He finds something Dr D did that he can fix.
Now, in regard to #2, when I told Dr H that my cycles tend to last 10-14 days, he got a concerned look on his face and said one possibility for the long cycles is endometrial growths inside the uterus. He showed me a picture of what he was talking about, again, no other doctor has ever discussed that possibility with me. I didn't even know that could happen! I won't go into hairy details, but if that is our problem, we are looking at 3-6 months of medications that will suppress the growths, during which time, we will not be able to try getting pregnant.

But let's assume we end up with #1, he finds nothing. We will then begin medicated cycles, and if we have two perfect cycles that should have resulted in a pregnancy, but did not, then he will want to do another laparoscopy to go in and take a very close look at the fallopian tubes. Again, I won't go into details, but he showed me pictures of a tube that looked perfectly normal at first glance, but upon really high magnification, it showed that endometriosis had swollen the ends so badly, they could not pick up eggs. If that is the case with me, it will depend on how badly swollen they are as to whether or not anything can be done. If they are too swollen to repair, then our last option for a baby would be IVF.

CRAZY, right?! How is it that I have been to four REs in 5 years and this is the first time since 2007 that I have had information overload? I should have had information overload like this with Dr D a long time ago. I'm happy we've got a new doctor who knows his stuff, and pissed that I wasted so much time with an imbecile.

As for possibilities #3 and 4, well, if they happen, Dr D will be hearing from my lawyer. There are no ifs, ands, or buts about that.

The most important thing about all of this though is that while I would love to have another baby, I won't die if I don't. My world won't crumble. I have Baby Bean. (Who, by the way, pointed at the fourth chair at our dinner table the other night and again said, "someone's missing.") But I will keep trying until I either get pregnant, or Dr H tells us we've reached the end of our road. Hopefully it is because of the former. ;)

Wednesday, April 11, 2012

Calling all Infertiles with PCOS

Today I met with our new RE, Dr Dub. I could not have imagined how well today's appointment would go. In fact, when I scheduled appointments with Dr Dub and Dr H, I had predetermined that if we did any cycles, they would be with Dr H. Dr Dub was just the third opinion.

That plan has changed.

Dr Dub is an older guy. He's been in the Reproductive business for a long time. It didn't take him long to realize I had been in the ring for a long time too (going on 6 years this year). I started out by giving him a full run down of my fertility history. Then we got down to business. In all of my years of seeing REs, I can't believe none of them ever spelled out things for me the way Dr Dub did today. He didn't sugar-coat anything, and he treated me like what I am, an infertile pro. So he didn't waste time going over the information I already knew from my own past experience.

He was quite unimpressed that Dr D had "lost" my images because he really needed to see them to get a better idea of what the inside of the uterus looks like, specifically the endometrium. He says it is possible there are endometrial growths in the uterus that can inhibit in implantation. If I have any, we will want to take care of them. He also had wanted to see the extent of the scar tissue around the ovary and fallopian tube.

But all of that aside, Dr Dub laid it all out on the table for me.If you have endometriosis, you most likely have PCOS. Now here is where I got new information that I had never heard before. Typically women with PCOS have it because they are insulin resistant. He drew me a picture of how insulin is supposed to work in a normal person, and how it works in patients with PCOS. Basically I don't use my insulin correctly and it affects my hormones and this in turn affects my eggs by either making them unhealthy or by killing them off before ovulation. If the egg is dead before ovulation, all that is left is a fluid-filled sac, or cyst. Sometimes they don't go away, so they build up and build up, which is how you get polycystic ovarian syndrome. He put together all of the pieces of information that were missing from my puzzle.

PCOS and endometriosis contribute to low estrogen and low progesterone. So you have to fight to get a good egg, and then you have to fight to make that egg a comfy place to hang out for 9 months.

When he started talking about insulin resistance, I told him my older brother is a Type 1 diabetic. He shook his head. Then he asked if I had gotten gestational diabetes. We kind of chuckled when I told him I had and that my sister had too. He told me I have what is called "thin PCOS" where my sister has "thick PCOS" because her cycles are irregular, and mine are not.

So my PCOS/Endo issues combined with my husband's low morphology pretty much leaves us with only a couple of options, IUI, IVF, IVF w/ICSI. Dr Dub wants to start right away with a medicated cycle, but not with chlomid or letrozole, he wants to do it with FSH and HCM shots. I told him the injectibles made me bat chit crazy and he said, "Really?! But you handle chlomid fine?" (That is the 3rd dr who has said that to me.) He said usually the chlomid is what makes us women wacky.

He said chlomid has a half life of two weeks, so he never lets patients do more than 2 cycles at a time because it takes an extra month to get the chlomid out of your system. You don't want to build it up too high, or it becomes detrimental.

I told him we had done a cycle with two shots of FSH and one shot of HCG, and I went psycho on my husband. As I finished telling him that, I started to smile and said, "We had done 6 rounds of chlomid by the time I went crazy." Dr Dub laughed and said, "It was the chlomid. It wasn't the shots."

I had never put that together until today!

He answered the questions Dr D wouldn't or couldn't. like why is my estrogen so low: PCOS. How do we fix it: Metformin.

It was a nice, long appointment, and I felt so comfortable talking to Dr Dub. I liked that he didn't treat me like a newby, and that he could tell I had some experience under my belt. I walked out of there going, "Crap! Now what do I do?" I was going to go with Dr H, and since I am on CD1, I was going to call him today to set up appointments for monitoring. But after meeting Dr Dub, I think I want to start the metformin tomorrow and have him do the hysteroscopy.

I don't really have a big plan set out this time. The only thing on my plate right now is metformin, hysteroscopy, and possibly IUI with FSH/HCM.

It is so weird being where I am mentally right now. I'm looking at doing things I didn't think I wanted to do ever again, but that was because I had my information mixed up. It was the chlomid, not the shots. I just kind of feel like I am floating through all of this information and the decisions that need to be made.

I am supposed to hear back from his office on Friday, so I think I will discuss which way to go at that time. I know he already laid out three battle plans for us, but I want to see if we can tweak them just a bit.

 Holy cow. I'm getting back on the horse. And not even the pony. Oh no, I'm getting on the brumby. We're headed for the big leagues.
Getting on the Medicated IF Horse
 The Metformin starts tomorrow, and on Friday I will know if we are going to try to do a cycle with FSH/HCM this month. I kind of hope we do. I want to get the ball rolling. Its time to kick all of this crap into gear and get a baby out of it!

What has this world come to?! This is all so surreal and crazy!

Thursday, April 5, 2012

Plan YA

There is a glitch in the document control system where I work. When you make changes to controlled documents or parts, you create a new revision using the letters of the alphabet (e.g., A, B, C...). Of course there are certain letters that aren't used, due to the similarity and ability to confuse them with numbers. When you get to revision Y, which is the final allowable letter, you have to move to revision YA. It should be revision AA, but the glitch in the system won't let you get rid of that pesky Y, and errors out if you try to move on without it.

Well, I feel like our family plan has moved to Plan YA.

I met with a new RE on Monday, and while I can't say that I feel validated against my last RE yet, I can say that we will probably be moving forward with him for a bit.

The biggest pro is that my husband likes him. He felt like Dr H was flexible with his treatment plans and options, but more importantly, he didn't feel like Dr H had a big huge ego like Dr D. He asked a lot of questions, and I felt like they were all the right questions. A lot of them were things Dr D had either ignored or never asked. Like when I told Dr D pre-op that I had been bleeding for two weeks, he didn't really seem to care the way I thought he should have, especially considering we had not done a medicated cycle in months.

Dr H did agree that losing all images from a surgery is odd, but that was the extent of what he would comment on regarding my time with Dr D. I did not expect him to say anything against Dr D. In fact, he acted exactly how I thought he would in regard to the whole situation of us seeking a second opinion and wanting to change doctors. These guys do not want to get tied up in potential legal battles against their peers, and I don't blame them. So I know they tread lightly when saying another doctor was wrong. He did, however, say that he would do a hysteroscopy to check out the inside of the uterus and the rupture repair site. The beautiful thing there is I get to be awake and see everything. That means there will be no sketchy loss of images.

The thing we liked about Dr H is that he told us we could do our cycles our way. Dr D had always made it very clear it was his way or the highway, especially when it came to injectibles and IUIs. Dr D would NOT do IUI without injectibles, and I was very adamant that I would not do injectibles. We were always at a standstill on that front. However, Dr H said he would do IUI on a natural cycle, on a letrozole/femara or chlomid cycle, or with very low dose injectibles if necessary.Unlike Dr D, he felt it was still advantageous doing IUI on a natural cycle.

At the end of the consultation, he asked us how we would like to proceed. We told him that we would like to have him monitor a natural cycle next month (if we're not pregnant [I'm currently 3dpo]) so that we could get a baseline cycle to determine what, if anything, needs to be tweaked. During that cycle, we also want to do the hysteroscopy. I want to see this repair site with my own eyes. The thought of that combined with being able to have a discussion on what Dr H sees as he sees it is a big deal to me.

Depending on how the next cycle goes and how we feel, we may do a couple of medicated cycles with this doctor.

I know! I know! But know that I am not committing to anything yet. I'm not saying yes, and I'm not saying no. I'm saying let's see what this guy thinks and go from there. We still have a consult with another RE next Wednesday.

As we were driving away from the appointment, I told him I wasn't sure if I was willing to cycle with this new RE because he is the new shiny toy that I must have, or if it is because this is really what we need to be doing. It didn't take me long to answer my own question: it is the latter. The reason I feel that is because I scheduled these appointments well before I went on my business trip and had that heart wrenching realization that I wasn't allowed to give up yet.

There is one major difference between the way I feel right now, and the way I felt a year ago, and that is that my world does not revolve around getting pregnant anymore. In a way, I'm still just going through the motions to say I did. But at the same time, I know that I need to keep going because something deep inside me told me I had to. Maybe it was that part of me that lives life with no regrets. Or maybe it is because there really is another baby in my future. Either way, my heart told me not to quit just yet. Technically, so did Baby Bean.

So here we are, Plan YA, Rev YA. Let's see where this plan takes us. We're on a new ride, but at least it isn't a giant roller coaster anymore.