Tests and more tests..

I haven’t updated in a while mostly because there hasn’t been a whole lot to update about. July wasn’t a particularly productive cycle – I went in for the entire set of tests that REs dump on you. The list is not for the faint: blood tests for thyroid hormones, sugar, all teh reproductive hormones, STDs, genetics (I think I refused this) and a few others that I probably forgot; ultrasound; sonogram. Not fun at all. The fasting glucose test especially sucks – I almost fainted and had to get myself pushed up in the queue because I really really need my breakfast. I was thinking of updating when I had some results but apparently only the doctor can tell you anything. And that appointment’s only next week.

The thing that’s frustrating me the most at my RE’s clinic is that they’re so busy. I suppose, on one hand, that’s a good sign that they’re good at their jobs. On the other, I could only get an appointment with him a month after my tests. And in the meantime, there goes another cycle. This one is especially frustrating because having a medicated/monitored cycle in August would have been relatively easy – I don’t have to travel for work and my work is relatively flexible (if busy). Now, September is going to be a pain to try and schedule ultrasounds and such around travel. Sigh. I should try to see if they’ll start me on something without an in-person visit.

The only medication that I actually did try was a synthetic thyroid to try and get my TSH levels down a little more (so apparently for the ttc population, normal levels don’t cut it. They have to be really good for the doctors to be happy with it). I lasted 2 weeks before deciding that the resultant trouble swallowing/lump in my throat was not normal. Let’s see what the doctor says at my appointment.

 

What’s in the water?

I’ve apparently hit the age where suddenly, all of my friends are pregnant. I don’t know why I didn’t expect this – I guess I expected some of them to wait longer; others to take more time. It’s not that I’m not happy for them. But at the fifth pregnant person of the day (baby shower season) and the tenth facebook friend of the month to announce, well, mostly I wonder ‘why not me?’

Talking about it more has brought a level of normalcy to infertility. But.. it’s still a lonely path. That most don’t understand. With each passing cycle, I worry that more of my eggs have gone to die. Then again, if I’m not ovulating.. does that bode well for my egg count?

I hate how people don’t talk about the issues. Suddenly, everyone’s comparing notes about morning sickness and tests and plans. And.. I feel left out. And lost. And while clearly that’s not the reason I want a baby, it does make me feel even more lonely along my path. It’s hard to even muster up the cheerfulness to congratulate people anymore on their news. And I’ve been knitting baby things for many of my friends who have had babies but with this round.. I just don’t know if I can do it.

Yet another induced cycle

First order of business when I got home was to call my RE and get a prescription for progesterone. The second was to start tackling the mountain of laundry. 40+ days into the cycle and no sign of a period. It was expected and I managed to wait till the last day before I took a pregnancy test (-ve).

Taking the provera dose this time was oddly depressing. I think with each induced cycle, I’m completely paranoid about harming a potentially healthy pregnancy. Of course, this is all ridiculous – I’ve taken too many tests/confirmed in multiple ways that there isn’t a pregnancy but some small part of me is eternally hopeful that this one is the one that worked. Well, I never said that I was being rational.

I don’t know if it was all the travel or the provera but I’ve been so tired. Like fall asleep at promptly at 8pm, right after dinner. And even after sleeping 9+hrs being tired. Not sleepy really, just tired. I felt the same thing with another progesterone formulation (prometrium), so I wonder if this is similar?


Since moving to our apartment, I’ve started a little indoor garden. I’m historically incredibly bad at maintaining plants – I’ve even killed a spider plant which is notoriously hard to kill. I’m going to fault the lack of enough light because, this time, many of my plants are thriving. I’ve found myself ridiculously pleased with their success. Even though my body is failing at growing a baby, at least, I’m capable of growing something successfully.


During all the travel, one of the books I read was Nia Vardalos’s “Instant Mom”. It was a wonderful read, but maybe not the best travel book. So much of her emotions and experiences resonated and I kept tearing up. I wonder what my fellow passengers thought. It did make me think more about this journey – how long we want to try, what happens if we can’t conceive, whether we would consider adoption and from where.A lot of this is premature, I know, but I’d rather have mental plans than be completely blindsided.

A break

The last few weeks have been crazy – a lot of work travel between my husband and myself, all at once. And a little bit of fun travel because, why not? It was definitely an adventure and I got to see beautiful parts of the world and I’ve totally loved it (even as a homebody who hates being away from my own home). Of course, my low-carb diet went out the window – as a vegetarian, the choices in that part of the world are carbs. And some fats. And maybe an occasional glance at a vegetable. I was so relieved to get back to the US and have a nice solid salad!

How does this affect the parts of life relevant to this blog? Well, next on the list is a workup with my (new) RE. As with everything, tests are timed with my cycle. Which has disappeared. Again. I expected that, given the results of my last ultrasound (which didn’t show any growing follicles). So timing might work out after all – I’ll induce as soon as I get home and then go in for testing.

Of all things, I’m proud of the fact that I (still) haven’t taken a pregnancy test. It’s day 40 or so. Mostly, I wanted to prove to myself that I can back off if needed. And that I can think about other things and not go crazy obsessing over fertility. It helps that I had a ton to think about and be busy with – some of my research got some great publicity, so that’s been kinda cool and exciting.

Off to the RE..

So far, I’ve been working with my OBGYN. I really like her – she actually treats me like an adult which is somehow rare with many doctors. But I think there comes a point when closer monitoring is helpful. And I think I was getting impatient with her slower approach. I understand that I’m not quite as old as many infertile patients but I passed 30 this year. I no longer feel like waiting and seeing how much nature works out. So.. I’m switching.

I met with an RE this morning. I’m not positive about it – it’s a guy and I’ve never had a male women’s health doctor. And I’m feeling a little lost and dumped into a whole pile of procedures. From what I can tell, this is the normĀ  – when you come in, they want to measure everything to get a good baseline.

By measure everything, I think they really do mean everything. There’s a hormone panel (with FSH, LH, Estradiol, Progesterone, Testosterone, TSH, DHEA and lost track of what else). There’s a diabetes panel (with both fasting glucose and Hba1c). An STD panel (which seems superfluous). A genetic screening panel (which also seems superfluous – neither hubby nor I are in any risk groups). Plus an ultrasound. I have to say, I’m not convinced that all that blood can be drawn in a day. I’m totally bringing a jug of orange juice. And some chocolate.

My next concern is whether we can get the testing done within this cycle. For once, I’m hoping that my period doesn’t show up – we’re traveling a bit so testing would be impossible then. No period means that we can induce and then test once we’re back.

I’m just trying to take a step back and whatever happens happens. We’re being proactive but there isn’t much more we can do at this point. So I’m trying to relax about it a bit.

Marriage as an achievement

A recent article making its rounds through my network was a HuffPo article about how marriage isn’t an achievement. (“Getting Married Is Not an Accomplishment”). I get their idea – career achievements are just as important (if not more so) than relationship ones and should be celebrated as such. Sure.

What actually drove me nuts was a comment by a friend about how babies aren’t an achievement either. Like hell. And that’s an awfully insensitive comment to make – how do you know what is/isn’t an achievement for someone? When I (finally) get pregnant, it’s a huge achievement for me. Not just a milestone but my triumph over my body. Screw you, PCOS! Screw you, ovaries which don’t ovulate! It’s a culmination of years of hoping and praying and sob-fests and blood draws and invasive procedures. Of course, I’m going to celebrate. And rejoice. With anyone who happens to be in my vicinity. Does that diminish the importance of my career? No. Its just that this is a huge life-changing, longed-for miracle. And I’ll be damned if I’m going to let someone take away the joy of that.

 

No medication -> no ovulation

This cycle was an unmedicated cycle – my doc was concerned about the strong response to Clomid. But I still went in for monitoring to check if I was. Lo and behold, I wasn’t. The leading follicles were 10×5 and 7×7 which aren’t nearly big enough for ovulation (ideally they should be 18×18 or so).

Personally, I’m a little mistrustful of the results. All these monitoring days are computed off a 28 day cycle. With my last cycle at 31 days, it seems likely that this one is also a little longer. Though for the follicles to get big enough, it would need 4-5 days to grow (it seems like they grow 2mm a day?). At any rate, we decided to just monitor BBT, and go in for a blood draw if there is an increase. (BBT is the only method that’s really working for me – in cycles when I know I’ve ovulated, there’s been a really beautiful trend.)

I’ve noticed that with time, I’ve become much more attuned to the way my body functions. Last month, I definitely felt.. heavier during ovulation time. Not sure how else to explain it. This time, I didn’t feel anything in the days leading up to the ultrasound, so I wasn’t particularly surprised at this. But since then, I’ve been starting to feel heavier again. So off of very noisy, very little evidence, I’m still hopeful.

The upshot of all this is I decided I just want to go to a fertility clinic rather than just dealing with my OBGYN. I really like her but, at this stage, I’d much rather prefer more aggressive treatment and monitoring. Also, I think they’d have more data and experience with PCOS. And as a data person, this gives me a huge amount of mental relief. We’re traveling again next month so I have an appointment right after we get back.

Searching for a clinic is yet another exercise. The one I think I’m going with was recommended by my OBGYN (“We like him because he sends us back a lot of pregnant women”). Online reviews seem mixed – it’s a massive practice so there seem to be a lot of baby-making factory comments. So maybe it’s a bit impersonal and businesslike? On the other hand, if it gets me a baby, do I really care? Plus, I don’t think I need hand-holding as much as data, fact-sheets and statistics.

On the plus side, I called my insurance to figure out infertility coverage, and it looks like I’m pretty much covered (though we really need to switch to a lower deductible plan). Thank God! The insurance in this country drives me nuts. No one wants to be sick. I’m not going to the doctor to get a wand shoved up my private parts for fun-zies. Why on earth would I take meds or tests that I don’t need? And despiteĀ  being incredibly well educated, I still barely understand insurance. It took till this year for me to really understand what a deductible was. (I still stand by the name being misleading – when I hear the word, I think of money being deducted from ..someone. I suppose it’s deducted from me? But that’s an awfully awkward way of thinking about it.) Also by covered, they really just mean that I’m not liable for 100% of costs – I think I’ll still owe a substantial chunk.

At the end of all this I’m back to .. waiting. Till we get through the next cycle or two. Have a consult with the fertility place. Run more tests. Figure out a plan of action with them. The timing kinda sucks – by the time I start meds I’ll be back to traveling for work again. And I can see my stress-free, non-career-penalty maternity leave slowing melting away.

Balancing life..

I think one of the hardest challenges for me in this life-phase is balancing all my concerns about conceiving and pregnancy with other things in life. Who am I kidding – everything has been a challenge. This is just yet another one.

I’ve realized fertility pops up in my life in the weirdest ways. Like not getting enough work done because I’ve been spending too much time googling things during the 2ww (I really need to start curtailing that). Still, that’s a relatively easy problem to solve (and mostly occurs because I’m in a bit of a lull work-wise).

Other weird times to occur recently – when my brother-in-law was visiting. I haven’t talked to my in-laws about any of our fertility issues. No reason really – they’re perfectly nice, understanding people but I just haven’t been in the mental space to open up the topic with them. But if I did, I’d probably talk to my mom-in-law or sis-in-law.. not the b-i-l. Partially because he strikes me as the kind of guy who gets all squeamish about the girly things in life. Perhaps I’ve misjudged. At any rate, he came at one of the worst times – right as I was finding out that this cycle didn’t work. And all I wanted to do was stay home and cry. And couldn’t. I suppose it could have been worse. It could have been a couple of weeks before and everyone realizing that no, we don’t want to stay up late and hang out because his baby brother needs to get down and dirty.


For better or worse, I made the decision to share my struggles with some of my close friends. I’m the sort of person who needs to talk problems out with others to process them so it’s been a help just knowing that I can be frank with certain people. It’s had other advantages. As I’ve revealed my struggles, others have shared theirs too which has been infinitely comforting. There’s a huge difference between knowing that an undetermined 10% of the population struggles with fertility and actually knowing other people who have experienced it. And the anecdotal evidence from friends is substantially less biased (and more optimistic) than what I read online or in books (which all tend towards the extreme bad end – otherwise, where’s the story).

On the other hand, this has certainly opened me up to criticism and (inadvertently) hurtful comments from others. There’s the people who are totally into naturopathy (which is fine) but then judge me for using meds. There are others who judge me for using meds because they didn’t. And then there’s the extremely useless advice – ‘relax’, ‘don’t stress’, ‘it’ll happen when it happens’, ‘it’s fun- you get to have all the sex you want.’ Especially hurtful are the ones who have struggled to conceive and still say things like, ‘you just need to relax. that’s how we got pregnant.’

In the end, I’m not sure if it was a good decision or not to share. At any rate, I can’t take back things I’ve said. But I am becoming more wary about who to share with and who not to.

And onto the next cycle

I think the worst part of the trying-to-conceive process is the endless waiting. At the beginning of a cycle, you’re waiting for your period to be over so you can start trying. I suppose the actual trying phase is less waiting :). But then there’s the two week wait. In which I get increasingly crazy as time goes on. I start being quite normal. I end by googling every little symptom and estimating chances of having conceived.

This time it was especially hard because I knew I had ovulated so some of the guesswork was out. So day 28 comes.. and I was spotting. I usually spot for a day before my period so I was devastated. Of all days, it was mother’s day. But I cried for a bit, then put on a smile and went to hang out with some friends. Which turned out to be a good move – getting out in sunshine and enjoying the wonderful weather and food was cheering. And by the end of the day, I realized that there was only that bit of spotting. And so I hoped. It was too late for it to be implantation bleeding but spotting in the first trimester seems not-uncommon. Plus, with three follicles, who knows what happened. And it went on – for the rest of the week, I’d see a tiny bit of spotting, be devastated and then hope when there wasn’t anymore. Honestly, I think a part of me knew I was deluding myself – I’m usually not bad at picking out pre-period signs. And.. period came on day 31. Which sucked. But at least I was off this crazy what’s-going-on roller coaster.

Things I’ve learnt from this cycle – even doctor estimates of ovulation time can be off. Assuming a luteal phase time of 14 days, that puts ovulation day as day 17/18 — not 14/15 that she was expecting. So we could have barely missed the window. What does worry me is what if there’s another issue that we’re not diagnosing? Some issue with cervical mucus? Or the lining? Or.. idk, egg quality? I keep having to tell myself that even with clomid, that’s only a 30% chance in a cycle and it’s not surprising that the probabilities didn’t work out.

Honestly though, my biggest relief in this cycle has been that there wasn’t any pause. I went in for a day 3 baseline ultrasound (which kinda sucks to be bleeding and totally exposed). And scheduled the rest of the monitoring cycle. Let’s see – I’m off meds for this cycle (my doctor was concerned with the strong reaction to clomid so I’m doing one month on, one off). And praying for this cycle.

Day21 Progesterone

Actually, I was wondering whether to post this or not. After all, the internet doesn’t need a blow-by-blow of all my stats. Still, this blog is more for me (and those going through similar situations) than anything else.

Anyways, I had my day 21 progesterone blood work done. This test measures whether or not you ovulated – after ovulation, the progesterone levels in the body steadily rise till they hit a peak at ovulation+7days. A measure > 18 (i think the unit is ng/mL but not sure) is considered conclusive proof of ovulation. And mine was above that! Finally! Of all things, I’m overjoyed, if only that I know that I really truly ovulated.

It’s ridiculous how big of an achievement this seems to me. I guess I’ve been thinking of this whole process as a series of little steps and victories. Did I get my period? Yay! I’m on a functioning cycle. Did I ovulate? Yes! I suppose it’s my way of debugging the process and almost unit testing it.