Duh, Bloodwork

I totally forgot to tell you guys that my progesterone test came back just fine. It was a 15, whatever that means. It was 16 last month, so I figure it must be good. The nurse said "I guess you're just going to ovulate late in your cycle"..... Um, nope. I have a 32-35 day cycle so I ovulated right on time, thanks. Which is what I already knew from my 9 previous Clomid cycles. And which I've told them at every doctor's appointment since time immemorial. I've been late all my life. I will be late to my own funeral. If I hadn't been at the church by 7 AM the morning of my (3 PM) wedding, I would have been late to that, too. I was late being born, a little late walking, late starting this whole period thing, and late to get married. I'm late. It only makes sense to me that my ovulation (when it chooses to happen) should be late, too. *sigh*

Anyhoo, that's the deal with the bloodwork. Have a great Thursday!

Friday Already?

Wow! It's been a week since I posted! Or rather, a week and a day. I had no free time to even think about posting this week, so be impressed that this is up today!

My doctor's appointment last Thursday was....interesting. I was pleasantly surprised by the change in my doctor's bedside manner; he was friendly and helpful, and didn't make me feel like a failure at all. However, my ultrasound showed no sign of ovulation. Dr. B and I discussed raising the dosage of Clomid that I've been on to the highest dosage they can provide. I asked about blood work, but he said it wouldn't make any difference. But I knew something was just not right. My body gives clear signs when it's ovulating, and they were all there this month. How could I be so wrong about my own body?! I asked Dr. B if the fact that I have a 35 day cycle and usually ovulate "late" around CD 20 would make any difference. He said absolutely, and I gave up some blood. But it was pretty clear that I had not ovualted, and that my body was no longer responding to Clomid as expected, no matter what I thought. I left the office and made it to the car before I burst into tears. I cried most of the way home, asking God why on earth this has to be so hard. I trust Him, but it hurts to get knocked down every month. And you'd think a nine month break would help, right? Nope. Not in terms of pain. Heading home last week it was as if my last appointment had been January, not May 2009. Hurts just the same as always. I spent the rest of the night incredibly depressed, feeling like a complete failure and feeling pretty much hopeless. I hate that feeling. How could I have been so wrong?

Friday I called the patient messaging service about a million times for the results of my blood work. It was testing for progesterone, which would be present if I had ovulated. The results were finally in around 3 PM. And I ovulated!! I was right! I did know my body, and it was working like I expected! If I hadn't been determined that I knew what I was talking about I would have gone home and been depressed and sad, ready to give up. I would have raised my Clomid dosage to an insane level unneccesarily. Thank God I stood up for what I knew to be right. I've been so glad to see comments from other women dealing with infertility, women with PCOS ("cysters") and other people looking for answers. I'm so glad we can come together like this in such an unprecedented way. Today I would say to you: know your body. Be confident that you know it best. Doctors are great, and well-trained doctors are a Godsend. But stand up for your body and for what you know to be right. Demand blood work and the respect that you deserve. Thank God Dr. B trusted my self-knowledge enough to order a simple blood test.

So now it's CD 2 and we're gearing up for another month of this craziness. I have learned so much from infertility. I'll post about it soon, I promise, but just know that it's a learning experience for sure.

For now, let's

Thank God....It's Friday!

Praises

Brian's bonus check came. Let's just say that God hears prayers, and He is soooo good. We needed help and all we could do was trust. Turned out pretty good!

Both of our spare rooms are cleaned out and look lovely. That makes me such a happier person, and it feels like our house went on a diet. Ahhhhhh.....

I am thankful for YaYa Princess, who is willing to answer my most disturbing questions and discuss the most bizarre personal aspects of our lives. Usually while at work. I love her and cannot image not having her to share a brain with! Rumor has it she's pretty darn good at her job, too. Top 5 or something like that.

Requests

On Monday, my Aunt Frances passed away. She was married to my dad's oldest brother, and she had been ill for a very, very long time. Please be in prayer for her family.

Aunt Margie, Daddy's third sister, was diagnosed with cancer Monday. I have no details on her prognosis or treatment, but I know it's not good.

Uncle Roy is Aunt Margie's husband. He was also Aunt Frances' brother (a brother and sister from one family married a brother and sister from another family). He's had a pretty sucky week. He could probably use some focused prayer in his time of grief.

Brian's family (mom, dad, and Nurse Baileys) are supposed to come down this weekend. However, they are also in the middle of a blizzard, apparently. So please pray that they can actually come to Virginia, and that their travels are safe.

Brian's life at work is going to get nuts for a while. Please pray for him and for everyone else there.

Heading Across The Mountain

I can tell that in the past nine months or so you've all just dearly missed hearing about all our reproductive nightmares. I know, I know. You just need to hear about periods, ovulation, cramps, and side effects. And whoa! The internal ultrasound details. I hear you, I feel your pain and longing. So, just for you, we're going back to the clinic in search of a baby. You know, so you can hear about vomiting, nausea, cramps, and birth plans. Sounds like a win-win, no?

Seriously, though, this is my first month back on Clomid. Or The Clomid, as I like to call it. Like The Heroin. It's currently day 26 of this cycle, and it's a bust. But we're cool with that, because it was through no fault of our own. I'll explain in a bit.

In case you are not completely versed in the ways of infertility and how one gets All Knocked Up Using Medical Science, lemme give you the run down. I'll educate folks, because I happen to know that my readership has doubled since the last time we were trying to get pregnant. You know, from two to four people now tortured by my drivel! It all starts (for me, at least) with 10 days of progesterone to start a period. Which worked for me this month for the first time since I was 17. Yay for small victories!! On the fifth cycle day, I started with 200 milligrams of Clomid. I take this nightly for 5 days (cycle day, or CD, 5-9). My fertility monitor starts asking for test sticks around CD 8 or 9, and this month went to "Medium Fertility" on CD 10. Usually that's closer to CD 16 for me, so this was unusual. My monitor usually goes to "Peak Fertility" and I typically ovulate on CD 20, and then go to the clinic for an ovary check via internal ultrasound and blood work around CD 22 or 23. Except for this month....when my monitor failed to move past "Medium". It's CD 26 and according to the monitor I haven't ovulated and am not close. Which I am pretty sure is wrong, based on what my body is telling me. So, I'm off to the doctor to be poked and prodded, donate some blood for a progesterone test, and see what's up. Unfortunately, I don't get to see our regular guru this month, but instead will see his partner. Who is a lovely doctor and very knowledgeable. With no bedside manner. I always come back from visits with Dr. Williams happy and positive, holding out hope that maybe I'm pregnant. From Dr. Bateman, I come back home and wait for my period since he's sure I'm not pregnant and a complete failure. You get the idea.

So that's the process. Now, why is it not our fault this month is a bust? Because our involvement in this process is limited: Take medications. Pee on sticks. Do the necessary actions on Peak Day and the day after. Show up for ovary check a week later. Lather, rinse, repeat. We were ready, willing, and able to do all of that....except the Peak Day part. Because the monitor didn't give us any heads up, and your chances of becoming pregnant by happy coincidence is somewhere around 30%, if I'm not mistaken. I think the problem is that our box of test sticks is set to expire in March. So maybe they're too old to do the trick. We'll try again next month with freshly-minted technology pee sticks and see what happens. We're not too upset, and we're not really disappointed, because if I ovulated then we're on the right track. Besides -- we'll get pregnant when God wants us to, and not a moment before.

This afternoon I'll be off to the doctor, across the mountain. It'll be a short, quick trip so I won't get to see Little Bro and Sweet Lizzy (hi, guys!). Hopefully I'll be coming home to put up curtains in our bedroom. Yay for making a house look like you live there....after two and a half years..... Anyway, by the time you read this, I should be in the car and striking out for Charlottesville. Brian will be staying with the kids - pray for him.

Decisions, Decisions

Today was my ovary check appointment with the Fertility Gurus. I only have two kids in care on Mondays, and one of those is on vacation this week.  The other one leaves at 12:45, so as of then I was off work! Brian worked last night from 3 AM until 1 PM today (!!!!), so he was able to go with me to Charlottesville.  I love when we can go together to these appointments; I dearly love spending time with Brian, and the two hour round trip is a good chance just to catch up and talk about our day.  And while I know that it helps the parents of children I provide day care for to have Brian watch the children when I have to leave for appointments, having him there for moral support is wonderful; it seems more like a "team effort" when we're both there.  So around 1:45 we headed off for Charlottesville.

One of the reasons we both wanted to go to this appointment was to discuss IUI further with the doctor.  We haven't committed to it before this because we were determined to continue to try for a few more months before turning to more invasive procedures. But we're numbers-people, and need to know a lot of facts before we commit to anything.  

So many things have stood in our way to getting pregnant, and it seems like as soon as we conquer one problem another one springs up.  We can't help but wonder if God isn't putting these obstacles there to force us back to his timeline.  No matter what we think, God knows when we'll have children, and how.  We can do everything we want to push things along, but until He's ready for us to be parents, we won't be.  That has become very, very obvious to us in the past few months, and we've discovered that banging your head against a wall gives you a headache.  

So, we've come to the realization lately that we have approached a crossroads in our fertility trials.  Basically, commit to IUI and put all our resources into that for now, or commit to adoption and be finished with all fertility treatments.  The two are not compatible, so we have a choice to make.  Unfortunately, there is so much to think about for both cases.  Today we wanted to get some numbers from the Gurus about success rates for IUI.  

We met with Dr. Bateman today (not our regular Guru, but he's growing on us).  We let him know what we're thinking, and that we're very interested in IUI.  From our research, we've learned that the national average success rate is between 4-23%, depending on the clinic. That's a huge span, isn't it?!  The Guru said their current success rate is 10%, and that there sometimes seems to be an unexplained cumulative effect; your success rate goes up after three or four consecutive inseminations.  With that cumulative tendency in affect, we'd be looking at maybe a 30% success rate.  Not guaranteed, of course, and there's no promise that I'll have that cumulative effect, but we're looking at somewhere between 10-30%.  

In addition, we figured up the cost.  Which, not including lost income, would be $504 per month.  We're figuring we'd need to commit to a minimum of 5 months to get that cumulative effect and let it work for us, which brings us to just over $2500.  Strangely, we don't have that lying around.  In order to afford that, we'll take the next few months "off" -- no Clomid, no inseminations, no appointments.  Just going back to being normal people with normal lives.  That'll save us about $130 monthly, but that won't touch our IUI Total.  So, we'd be scraping all the time -- don't look for us to go anywhere or do anything.  We'll be saving.  

Of course, in increasing our chances of getting pregnant (30%!) we also have to seriously look at my miscarriage risk.  Dr. Guru put it at about 20%, up 5% from the national average for "normal" people (you know, people without PCOS, infertility, or a big butt).  Currently, losing a baby in utero or from prematurity is my Absolute Biggest Fear That Keeps Me Awake At Night.

Down the other road (that diverges in a wood?) is adoption.  We're currently looking into domestic adoption of a non-white or mixed race child.  There is a huge surplus of non-white children to be adopted because white families are wanting to adopt lily-white children that will look just like them.  We do not have this need.  Not knocking you if you choose to adopt yourself some white babies.  But I don't mind if all my kids are of different races, if they look like me, or not.  Sure, knowing what our genetic make-up would look like would be cool.  Having a baby sleeping in the crib by the bed would be faaaaar cooler, thanks.  If that kid is not white, I'm not really going to be bothered.  Want a baby now, thanks.  IUI wouldn't mean that we don't adopt if it doesn't work, just that we'd be putting on the far-back burner until we were done with treatments.

The drawback for adoption?  It's E X P E N S I V E, ya'll.  Like new-car-expensive.  Like new-cars-for-both-of-us, fully-loaded-expensive.  See above about not going anywhere, doing anything, skrimping and saving.  Woot.  And the wait could be months or years.  Based on the need for people to adopt non-white kiddos, probably shorter.  But still, it's not immediate.   Much like making one yourself, you know?  And did I mention it costs a lot?  Yep.

So, we're taking a while to examine our options, regroup, huddle and discuss our next down, and decide which path to take.  We'll be praying for wisdom and guidance, as well as acceptance of God's will.  We'd be most appreciative if you'd do the same for us.  I'm not sure when we'll have a decision, but you'll know where we're going when we do.  

What's Goin' On, What's Goin' On

10 Baileys Points if you can identify the inspiration for the title for this post.

I know I said I'd try to update with what all has been going on around here lately, and then kept you all waiting. It's been a long couple of days, so bear with me. Nothing much terribly important has been going on in the grand scheme of things. Unless you are me, in which case it's been a seriously stressful two weeks. Here's the background....

I use the Clearblue Easy Fertility Monitor to keep track of my cycle and find the two most fertile days to get pregnant. I highly recommend this little gadget to anyone trying to get pregnant, infertile or not. In fact, when the YaYa Princess decides to have herself a little tax deduction, I'll be happy to loan her my monitor, provided it's not in use at the time. And at something like $200, begging/borrowing/stealing is highly recommended. I bought mine secondhand and will gladly pass it along when we're done with our family. You know, in like 10 years when it's probably obsolete. But I digress. Every morning at 7:30 I push the button on this handy little computer. It records the time and cycle day, and if necessary prompts me to pee on a stick (POAS, if you're part of the infertile community). Then I put the stick in the monitor, it does some manner of magical divination (or scientific reading, whatever) and tells me my Fertility Status. Low days are like any other day, high fertility days may be a good day for ...um...yeah. And The Peak Day is the most awaited day in all of Infertilityland. That day and the next day are the best days to get all knocked up, or inseminated if you're going the full medical route. A fortuitous day, no doubt. The science of this works like so:

Your body uses hormones to control your cycle and fertility. You know that, I'm sure. I start out the month (we call it a "cycle", you know...) with Clomid on cycle days 5-9. Somewhere around CD 11 I start P'ingOAS. The level of estrogen in your body (and consequently in your bloodstream) begins to increase as you near ovulation. A follicle or two begins to form on your ovary, which contains the egg. At this point, viola: "High Fertility" is indicated on the monitor. This is a good day for extracurricular activities, but not mandated. Ha! Man-dated. ;) 24-36 hours before you actually ovulate, your body releases lutenizing hormone, called LH. This is the handy little chemical that makes your follicle rupture, releasing the egg. The follicle goes on to do other cool things, but they are not part of this story. So, this LH surge is picked up by the fertility monitor in your urine (actually, my urine, thanks) and the monitor goes to Peak Fertility. This means: Get Busy. Ovulation will be in the next 24-36 hours, so the following day is good, too. Since an egg has a lifespan of 12-24 hours, you need to have the other ingredient there prior to the egg. Cart before the horse sort of situation. After your Peak Day, the monitor stops asking for test sticks and you go back to waiting. This is called the Two Week Wait (TWW) in the happy infertility community. Basically the length of time between ovulation and either your period or a pregnancy test.

Sounds easy enough, right? Except for this month, when my life went like this:

CD 5-9 Clomid

CD 11 commence peeing on technology

CD 18 high fertility reading -- right on track for me to ovulate at day 20 like usual. That day 14 thing is bull, by the way

CD 19-26 still high fertility. No peak, no change, just ...................................high.

At this point, I worried. Actually, I commenced worrying around CD 22, but that's neither here nor there. By CD 26, I called Jan The Very Cool Nurse at my fertility clinic. She was equally puzzled, and concerned, and scheduled me for an emergency appointment Tuesday morning. This meant Brian had to change his schedule really quickly and we had to pay for an ultrasound....again. This is a monthly occurrence, so not too big a deal. But worrisome when you don't have a little window in your abdomen to see what's goin' on. The likely scenario was that I had not ovulated, and was going to need a little further chemical encouragement to pop that follicle. Or that I had ovulated and the monitor had missed it somehow. You know, because $200 technology isn't foolproof. But if Jan was worried, that worried me. That's where I was when I posted the other day, letting you all know that I was off to the doc's.

The ultrasound showed at least one, and possibly two follicles on my ovaries. It was impossible to tell if they were ready to pop, or if they already had ruptured and were now corpus luteum-s. Corpi lutei? Only a blood test would tell, checking for that ever-useful hormone, progesterone. I've posted about that before, so I'll spare you the link. An elevated progesterone level would indicate that I had ovulated, and a low level would indicate that I needed help to do so. Help in the form of a "trigger shot" of hCG. Since I was unable to stay in Charlottesville to get the shot if my blood work came back low, I got to learn how to give myself a shot, and was sent home with syringes and hCG to shoot myself up later that night. I was told to call back in an hour for my results.

This is where it gets a bit anti-climactic. My progesterone level was an 11, which indicates that I ovulated. The doctor estimated that it was around CD 20, based on my progesterone level. My monitor missed it. Two weeks of wondering and worrying, 2 hours of driving across the mountain, $130 of doctor's bills and hCG costs, and a 20 minute lesson in how to stab myself effectively in the stomach because of a minor technological malfunction. Fun, and totally typical in the infertility journey that tons of people travel. The good news is that I ovulated, and that our timing may have been good, and I'll know in a week or so if I'm in the family way. Praying, you know.

Here's what just popped into my mind: no one knew about this but the people in this house. That day was stressful and a bit scary (read this link to understand why: Ovarian Hyperstimulation), and no one knew. Because infertility isn't something you talk about, or put on your church's prayer list, or mention to your grandmother or cousin, or sometimes even your best friend. I've been amazed lately to find out the people that we know that struggled or still do struggle with infertility. All by ourselves, usually. I once mentioned to the YaYa Princess that no one makes eye contact in the fertility clinic waiting room. It's kind of weird, actually. So I would encourage you to make yourself open to your friends and family so that if they need to talk they feel comfortable. It can be a cold, lonely journey, and I really wish that everyone had as many outlets as we do. We're blessed with family and friends who are open to hearing about our weird experiences, too much information, and blogs about cervices. Not everyone is this lucky, so please be understanding and gentle to them. Maybe there's someone at work who is grouchy, or seems tired or irritable. They may be dealing with infertility quietly, and need someone to care. You may be able to help someone who is going through such a situation as we faced this cycle. Uncertainty, failure, and anxiety are not fun -- be a help to someone you know!

Now, I'm off to bed. Having spent an entire day dealing with vertigo for some reason, I'm exhausted. Smooches to you all, thanks for listening, and goodnight. Oh, and a shout out to The Bum - we heard about Cooper's little journey away from home, and we'll be keeping you in our thoughts and prayers. I hope he's home soon!! Night, ya'll.

Update from the doctor

Yesterday was my follow up appointment with Slush. Here's a little background in case you need it: PCOS sucks, I don't ovulate, I have literally no uterine lining. After a month of estrogen replacement therapy and progesterone to simulate a normal cycle, I started Clomid this cycle, about 24 days ago. At that point, I planned for blood work to check my natural progesterone level and made an appointment with Slush. It's all timed out to coincide with particular cycle days, and the blood work is to make sure that I ovulated, based on progesterone level.

So, I went to Slush's office to follow up and plan our next attack. I already knew that I hadn't ovulated, based on my daily temperature chart. Slush was nothing if not honest and blunt. She said that my progesterone level was an "abysmal" 1.4. It should be around 20. Based on my lack of uterine lining coupled with my abysmal progesterone level, we had a few options...
1. Increase the level of Clomid
2. Skip straight to Femera, the 2nd line of fertility drugs
3. Go to the reproductive gurus at Martha Washington

Slush said that she doesn't think that a higher dose of Clomid is going to do a thing. And that skipping to Femera leaves us nowhere to go. And, given my numbers, it most likely won't work. We can try Steps 1 and 2 and then refer me, but that's wasting time, energy, and emotional toil. Because she doesn't think it's going to work anyway. So, Slush said she pretty much had nothing more to offer me, except a referral across the mountain. Check out their website, if you'd like. If you've heard good things, please leave me a comment. I'll be seeing Dr. Williams, who it seems is knowledgeable in PCOS issues.

As always, losing weight is key in PCOS management. As though we all want to be fat, right? Whatever. Low carb diets have been reported to work well with PCOS, and I have followed a low carb diet in the past. We now focus on a natural, un-processed diet with little refined white sugar or other fake food. We like to use whole grains and honey or other natural sweeteners. Not eating grains, fruit, or vegetables is alien to our way of eating now. It's not like we've always eaten this way, but it's been keeping us healthy and boosted our immune systems. Now, I'll be eating meat. Lots of protein, little to no carbs. I'm not thrilled about it, but I'm willing to give it a shot. Please, have a piece of bread in honor of me.

Okay, laundry calls. My appointment is September 16, at 2 PM, if you're the praying type person. We'd appreciate it.