Jul 26, 2011

IUI #1 and #1.2

I had my back to back IUI's yesterday and today. And beta is scheduled for Aug. 6th! I'll only be 11 (or 12) dpiui which seems soon but I guess I'll know the answer that much sooner. Testing that soon I'll be sure to take the results with a grain of salt as there could still be some trigger in my system but my RE wanted it then and I trust her expertise. 

Oh and I started the progesterone supps today too, aka crotch rockets. They're lovely.

Jul 24, 2011

Woot woot!

I had my millionth follie check this cycle (ok, maybe it was just my 13th follie check) and our one rockstar follie is finally a mature 20mm :) So I just took my trigger and we're doing back to back IUI's tomorrow and the next day. 

And tomorrow is our anniversary. That has to mean good things, right???

P.S. Those trigger shots sting a little bit when administered cold :(

Jul 14, 2011

More tales from the RE's office.

So Mr.Slick works strange hours. I always try to schedule RE appointments he's planning on attending as early as possible so he can go to sleep as soon as we're home fro them. 

On one lovely spring morning we were at the RE's office after Mr.Slick had been awake for almost 36 hours. He was a wee bit tired. They got us back fairly quickly for my blood work and then straight into the u/s room. However we did have to wait in the u/s room for a while. 

I was sitting there, nekkid from the waist down on that thin paper watching my husband fight sleepiness. His cure? He started snooping. 

He first started with just the drawers under the bench he was sitting on. Phew, only pads and more of the bright orange paper gown thingies I was covering my lower half with. I thought I was out of danger at that point. Then he stands up and starts pacing, eyeing the wall of cabinets and drawers on the other side of the exam room. And then the sweat starts and my butt cheeks start sticking to the paper. Oh no, he's going to do it. 

I begged, pleaded with him not to but there was no stopping him. I was too scared of the doctor coming in catching us both "in the act" and me showing her my full moon so I sat frozen only able to beg him to stop. 

He found the lube drawer, the gloves drawer, the towlette drawer, and what he called the torture chamber drawer (speculums). And then he found the condoms. Oh gawd. He took one (don't worry, by this point he already had gloves and a mask on from his previous findings). He then started flying the huuuuge thing across the room like a kite letting it fill with air. 

Then we heard her. She was outside our room talking to someone else. I panicked and gave him my best death glare as he frantically ripped the mask and gloves off but he forgot about the condom now sitting next to him on the bench. 

::knock, knock:: 

She came in and and didn't notice the condom on the bench. As she went to get the dildo cam a condom for our use that day I tried my best to point  with my eyebrows and eyes to the condom. He looked at me so confused and then it clicked. Being the super sly person he is he slowly picked it up and put it in my purse. I breathed a huge sigh of relief and wiped the sweat from by brow. ::sigh:: We made it through the rest of that appointment without incident, thank goodness. 

The condom lived in my purse for a few weeks too. I just couldn't bring myself to throw it away for some reason. 

Jul 12, 2011

Tales from the RE's office.

Setting: A small waiting room with 12 or so chairs and a receptionist on the other side of a thin plastic window. 

We were waiting for our appointment for our first follie check. I was playing Angry Birds and killing those little green dudes (are they pigs? I never watched the intro or read the directions, obviously). Mr. Slick was leafing through a copy of Time magazine as two other couples sat nearby. 

Suddenly he closes the magazine and leans toward me and whispers in my right ear, "I'm sorry."

I look to him and say, "Sorry for wha..." And it hits me. That invisible cloud of death. 

I suppress a cough as Mr. Slick turns a lovely shade of pink. The next thing out of my mouth I couldn't suppress, a giggle. Oh lord, I have the giggles. And now he has the giggles. 

I glance around at the other couples and no one makes eye contact. One lady moves her magazine up to hide her face. Oh goodness, will these giggles ever stop? There's NO way these people don't smell this by now. 

And then? Our redemption. A nurse opens the door and whisks us away for blood work and a follie check. I have never been more excited to lose blood. 

Jul 9, 2011

Dear Mrs.Walker

I love you. 

You have no idea how boring my summer would be without your texts. 

You have NOOOOOOOOO idea (well maybe you do) how much I appreciate being able to vent to you about crazycakes family members. 


Jul 3, 2011

So testing is done, now what?

Now you're in the treatment phase. Treatment will depend greatly on your diagnosis. Some people only require simple treatments and some will skip straight to IVF. It really just depends. 

One of the most simple treatments is a medicated cycle with TI. Common medications for first cycles are Clomid and Femara. Here is the protocol that should be followed for almost any medicated cycle: 

CD3: baseline u/s and b/w - this will be a check to make sure you don't have any cysts, your lining is appropriately thin, your blood flow to your uterus is good and your hormone levels are good. 
CD10-12: Follie check & b/w - this will check to see how and if your follies are growing and to make sure you aren't over responding (OHSS) 
Then you'll go in every few days or so until you have mature follies. Then your RE will either instruct you on when to have sex or give you a trigger shot (to give yourself at home) so you'll O 36 hours later and know when exactly to have sex. 
7DPO: this will be to check your progesterone levels. If your progesterone is too low, then you cannot sustain a pregnancy and then you might be put onto prog. supplements. 

This monitoring might seem extreme but it is so so SOOOOO important. I don't know why anyone would want to risk their reproductive health when there are options to help. Many fertility medications (like Clomid) can be very dangerous. It can cause horrible cysts (read through my old posts and you'll find my personal experience with this), thinned uterine lining which may be permanent, HOM (wanna be the next Kate+8?) and other awful side effects. 

Ok, so you tried a few cycles of TI and it didn't work. The next step would be medicated cycle + IUI. You will follow the same protocol up until the sex part and then instead your husband will go give a sample about an hour before you go in to be sperminated. May the sperm be with you. There are varying levels of IUI protocol's. After Clomid/Femara there are then FSH injects. These increase the odds of pregnancy but then also increase the odds of HOM. They're also like liquid gold as the medications can cost thousands of dollars each cycle. 

Next, if you and your RE feel that IUI isn't working and they want to go to the next step, that would be IVF. IVF is very invasive and very expensive. You will inject yourself at home  (with similar drugs or the same drugs) as you used in an injects cycle. When your follies are ready you'll then go in for an egg retrieval. This is where your RE goes in and removes your eggs - as many mature ones as they can. This might be 20 or it might be 3. Of course higher numbers mean more chances but there are no guarantees. After the eggs are retrieved, they will be sperminated by your RE with your husband's sperm. They will then closely monitor your new embryos. Depending on the quality of your embryos that were fertilized (if any) they will transfer them back in 3 or 5 days after (I've also heard of day 6 transfers). Now, make sure you have a responsible doctor and only transfer 1 or 2 (mayyyybe 3). Don't go Octomom on us and transfer 10, mmmkay? 

Now, that was an extremely sugarcoated version of IVF. It's painful, emotional, expensive, and hard. I've never been in that situation but know a few people that have been through it. 

Now what a lot of people are interested in: Costs. 

These are general estimates based on my own personal experiences. 

Medicated + TI: $500-900 
Medicated + IUI: $700-1500
Injects + IUI: $1000-3000
IVF: $8,000+

None of these estimates include the cost of medications. Once you enter the realm of injects, medications can cost hundreds to thousands of dollars extra EACH CYCLE.

Okie dokie, questions? Comments? 

Think you need IF testing?

Ok, so you think you need to start talking to your doctor about infertility testing. Way to go! It can be really hard to make it to this step. Infertility is defined as: the inability to conceive or carry a pregnancy to term after 12 months of trying to conceive.  If you are over the age of 35, the time of trying to conceive is reduced to 6 months (http://www.resolve.org/infertility-overview/what-is-infertility/)

If you think you need testing, I'd see how much your OBGYN is willing to work with you. I  would first ask for CD3 b/w, 7DPO b/w, and an u/s. All of these things can be done within the same cycle. CD3 b/w can typically be done on CD2-4, so if CD3 falls on a weekend, you should be able to work something out. Now with 7DPO b/w, do NOT let your OBGYN or one of the nurses confuse this with CD21 b/w. CD21 b/w is only useful if you O'd on CD14. The only way for you to CONFIRM ovulation is by charting your BBT (www.fertilityfriend.com is a great website for this). OPK's do NOT confirm ovulation and most RE's are not satisfied with only that information. Your blood work will be checking your hormone levels, thyriod, blood sugars, etc. The u/s will check for any major uterine abnormalities and the overall look of your ovaries. 

If you want a SA (semen analysis) can also be done this cycle. I would make sure to do this before any more invasive tests are ordered for you as this test is SOOOO easy and relatively cheap OOP. 

Ok, so those tests came back. Now, if you're still not pregnant (and if it's been a year of well timed sex), then get thee to a RE!!! Once there, they'll probably take the reigns but if not, ask for a HSG or SHG next. (have you noticed that I haven't mentioned treatments yet...yes, that was on purpose - no treatments should have been ordered yet) This will show a more in depth look of your uterus and check to see if your tubes are all clear.

If this comes back clear, then it's likely treatments will start... (see next post for more info)

The next step in testing is a LAP. This is a diagnostic surgery. It's very simple in surgery terms and most women have easy recoveries. Little cameras will be inserted through small incisions in your belly (mine went in through my belly button) and they'll look around. This is the only way to definitively diagnose endo and other issues. It will also give them a look at other organs around the uterus and inside.  

Sometimes your doctor, whether new or old, might order repeats of tests. This is especially true of shady SA's. If you get bad results with those a repeat will almost always be ordered a few months down the road. 

Ok, this is pretty much it in terms of basic testing.

New to Infertility?

Ok, I'm going to give my own personal rundown of Infertility. This will just be a general overview with some commonly used terms/acronyms, tests and treatments. Hope it can help someone! This will likely take several days. 

First terms/acronyms: 

ART - assisted reproductive technology
BBT - basal body temperature/thermometer
BCP - birth control pills
BFN/BFP - big fat negative/positive 
b/w- blood work
CD - cycle day
CM - cervical mucous
DPO - days past ovulation
DX - diagnosis
E2 - Estradiol (basically your follie growing hormone)
Endo - endometriosis
ER/ET - egg retrieval/transfer
FF - fertiliy friend - www.fertilityfriend.com
FMU - first morning urine
Follie - Follicles (basically your eggs - or what your eggs grow in - kind of...)
FSH - follicle stimulating hormone
HCG - basically the pregnancy hormone - will be given as a trigger for ovulation
HOM - high order multiples
HPT - home pregnancy test
HSG - Hysterosalpingogram
IF - infertility
IUI - intra-uternine insemination
IVF - in vitro fertilization
LAP - laparoscopy
LP/LPD - luteal phase/ LP defect
MFI - male factor infertility
O - Ovulation
OBGYN/GYN - Obstetrician/Gyno (aka your girly bits dr)
OHSS - Ovarian hyperstimulation syndrome
OOP - out of pocket (aka your insurance company is screwing you royally)
OPK - ovulation predictor (kit)
PCOS - polycystic ovarian syndrome
RE - reproductive endocrinologist (aka a fertility specialist)
SA - semen analysis
SHG - Sonohysterogram
TCOYF - Taking Charge of Your Fertility (an AWESOME book)
TI - Timed intercourse
U/S - ultrasound

In my next few posts, I will be using these terms and if I use others I'll try to come back here and add them in.