IUI #2

I got the official news today that my first IUI did not work. What made it really hard hearing that this month is because there was a bit of confusion with my tests.

I had blogged earlier that I was testing out my trigger shot, and I got negative tests on 7 DPO this month. The test was also negative the next day on 8 DPO. But on 9 DPO, after two days of negative tests, I had four positives. Four beautiful even-John-could-see-the-lines positives. I knew for sure I was pregnant. But the next day at 10 DPO, they were negative. And every test after that was negative, too. We don't understand what happened. Our guess is that there was some tiny bit of the hormone that was sitting in a bit of tissue, and finally released into my body later, turning the tests positive. I don't think it was another early loss. It seems a bit early for that to have happened.

Here are the tests from this month. The two on the bottom are two of the positive ones from 9 DPO right under negatives from 7 and 8 DPO. 

It was such a rollercoaster and I'm so exhausted and emotionally worn out. The worst news is that this upcoming month, IUI #2, is the last treatment that we can afford. If it doesn't work, I don't have any idea what we'll do next. I don't feel comfortable trying on my own because of my history of miscarriages. I want to be watched very closely and be on progesterone at the earliest possible moment. I do have some refills of Clomid and progesterone left, so I guess it would make sense to use those up. But I feel like I've been put through the ringer. I am so tired and don't know how much longer I can take it. Maybe taking a break would be good for me.

I'm just waiting for my new cycle to start, and we'll do this all over again. However, we are raising my dose of Clomid from 100 mg to 150 mg to try to get more follicles. Especially if it's the left ovary's turn. We want to try to get one or two on the right.

EDIT: After my appointment, we decided to stay on the 100 mg Clomid, and add a shot of Bravelle to increase number of follicles. Increasing the dose of Clomid doesn't always mean a higher number of follicles.

Join the Movement and Speak Out!

In honor of 2013's National Infertility Awareness Week, I decided to make my voice heard by participating in Resolve.org's Bloggers Unite Challenge. Infertility is defined as "a disease or condition of the reproductive system often diagnosed after a couple has had one year of unprotected, well-timed intercourse, or if the woman has suffered from multiple miscarriages and the woman is under 35 years of age. If the woman is over 35 years old, it is diagnosed after 6 months of unprotected, well-timed intercourse" (Resolve.org, "Frequently Asked Questions About Infertility"). 

I decided to become a strong supporter and advocate for the infertility community sometime after my first miscarriage. It put me into a deep depression that made everyone, not just myself, miserable. I had feelings of hopelessness, abandonment, loneliness... Things I felt because I was completely alone in my battle. I was uneducated about infertility and pregnancy loss, and had no idea that help was out there.

I had to work on my own to pull out of it and find my happiness and joy again. Once I did, I was a new person. I was stronger and knew I could overcome anything thrown into my path. It was then that I knew I had to make my voice heard. I had to let everyone out there experiencing infertility know that they are not alone. During that time, I resolved that I would never let anyone I know go through what I went through.  I had to let all of my friends, family, and members of my community know what infertility is, and how to help those in their lives who are afflicted with it. I had to let everyone know that infertility is hard, but it sure doesn't have to be lonely. It can be overcome solo, but why not make it easier and do it with support?

I utilize Facebook quite often to discuss infertility with my friends and acquaintances, joining in on Resolve.org's discussions and posting updates about my own struggles. I love writing in this blog, Progressing in Circles, where I discuss my own treatments and pick topics to discuss and teach. I was a writer for a website belonging to my alma mater where spoke up about my journey. Many of the readers were very receptive to that, and a few have contacted me to find more support. And lastly, I am very excited to announce my latest project that I have been working on for the last few months, The Infertility Survival Guide. It's a book that is aimed toward infertile couples in my church, and gives advice, validation, and just a hint of humor about how to survive as an infertile couple in a very fertile and family driven world.

Looking back, I am very proud of my efforts to expand understanding and support for the infertility community. Even though I feel like I should be doing more, I am doing all I can at the moment. It's always a very touching moment to receive emails and messages from friends, and sometimes even strangers, complimenting me on my advocacy and asking for help. I wish I had had someone in my own life to talk to when I was in the dark about infertility, so I'm glad that I can be there for other people.

Now, I encourage you to also speak out. Whether or not you have infertility, you do have a voice. Infertility awareness is more important than a lot of people know. It is a real disease that affects an estimated 7.3 million people in the United States alone. Because it's such a private issue, it's taboo in many societies. But, it can cause a lot of depression and anxiety due to feelings of loss, struggles with self-esteem and worth, unfulfilled ambition, and other hidden emotions. It's very real, and shouldn't be ignored!

So, the solution? Educate, educate, educate! Resolve has so many amazing articles available to aid in answering any question. First, please read all of the following pages to learn as much as you can about the disease and the best ways to help.

What is Infertility?

• Frequently Asked Questions about Infertility 
• Infertility Diagnosis
• The Hidden Emotions of Infertility
• Fast Facts

For Family and Friends

• When Infertility Strikes
• Myths and Facts
• Infertility Etiquette 

Second, post on your own blog, Facebook, Twitter, etc. Please help us to expand Infertility Awareness Week to reach the ears of more people than ever before. Chances are, there are many people you know who are silent in their struggles. Be open about infertility, and you'll be amazed how many people may approach you about it and share their story.

And lastly, be a listener and a support for those people. There is no reason for infertility to be lonely. Nearly 1 in 8 couples of reproductive age suffer. We are far from alone! We are out there. Be open and be an encouragement. I know many friends who were scared and ashamed of their disease until they found someone willing to give them support. Be that support. To read more from me about that, read "Comfort IN, Dump OUT" posted earlier this week.

If you are suffering from infertility yourself, there is hope! I strongly urge you to find a support group, either local in your area, or online. I never could have been this strong and hopeful without my support groups. They are invaluable resources.

And remember, there are many ways to build a family. Even though going a different route may not be the one you expected, it will still get you to your end destination. It's just like taking a long car trip. One time, my family was making a six hour drive from my grandma's house back to our home. We were in the last hour of our journey, and couldn't wait to get out and stretch our legs and take a shower. However, we were stopped and sent on a three hour detour due to the river flooding. It was utter mayhem in the car with complaining and whining. But, there was nothing we could do about it. The only thing we could do is take the detour if we wanted to get home. We ended up getting home late, but we still arrived. The extra three hours hadn't changed anything. Our house was the same, our toys were still in our rooms, and our cats were still waiting for us. The only thing that had changed was us. We ended up on the most beautiful drive we had ever seen. Some parts were slower and very winding, causing us to slow down and drive more carefully, but others displayed the most gorgeous countryside, farms, animals, and color-changing trees we had ever seen. We saw such beauty, and were able to actually enjoy the journey it took to get to our destination.

The infertility journey is much the same. Many times you may be sent on a detour that is not of your choosing, and sometimes it will be slow and winding, but you can still learn and grow so much stronger than you ever were before. And, after that journey, you can still arrive at your same destination of having your family. Your detour may take you through many different ART treatments, adoption, and perhaps even lead you to the decision to live childless. But all are good, and all can give you peace and fulfillment, and be that destination you have been working toward.

Speak up about that journey. If you are in the process, share it to inspire others! Speak about those gorgeous trees out the car window. Share the beauty you have found in yourself during this journey. Talk to your support system about that flooded road. I know it's scary to open up sometimes, and it's not encouraging when people say the wrong things. But how will they ever know the right things to say if we don't teach them?

Read more about National Infertility Awareness Week here
http://www.resolve.org/national-infertility-awareness-week/about.html

"Comfort IN, Dump OUT"

John showed me a wonderful article that was written for the LA Times recently called, "How not to say the wrong thing" by Susan Silk and Barry Goldman. The tag line states, "It works in all kinds of crises – medical, legal, even existential. It's the 'Ring Theory' of kvetching. The first rule is comfort in, dump out." All quotations in my post come directly from the article linked above. 

One of the authors of the article was diagnosed with breast cancer, and it surprised her how many inappropriate and and just simply wrong things were said to her. One story she told was when a work colleague came to visit, but she was too tired to have visitors. The work colleague was very offended and told her, "This isn't just about you." Confused, she replied, "It isn't? My breast cancer isn't about me?" 

They realized then that a lot of people don't know how to react or treat people in the middle of a crisis. So they came up with this great theory to help.

"Draw a circle. This is the center ring. In it, put the name of the person at the center of the current trauma." This first direction is simple. Who is involved? For the author who had breast cancer, it would be herself. 

"Now draw a larger circle around the first one. In that ring put the name of the person next closest to the trauma." This could be a spot for a spouse, or others directly affected by the trauma.

"In each larger ring put the next closest people. Parents and children before more distant relatives. Intimate friends in smaller rings, less intimate friends in larger ones. When you are done you have a Kvetching Order." 

So what do you do with this order? The directions are simple: Comfort in, and dump out. It goes on to explain that those in the center ring can dump any feelings out to anyone. They are in the very middle of the crisis, and can complain to anyone. And, others can do the same, but only to the people in the larger rings. 

A diagram from the article demonstrating the theory.

My favorite paragraph in the article talks about this more. "When you are talking to a person in a ring smaller than yours, someone closer to the center of the crisis, the goal is to help. Listening is often more helpful than talking. But if you're going to open your mouth, ask yourself if what you are about to say is likely to provide comfort and support. If it isn't, don't say it. Don't, for example, give advice. People who are suffering from trauma don't need advice. They need comfort and support. So say, 'I'm sorry' or 'This must really be hard for you' or 'Can I bring you a pot roast?' Don't say, 'You should hear what happened to me' or 'Here's what I would do if I were you.' And don't say, 'This is really bringing me down.'" 

People need to send the comfort in, and dump out. Don't dump your feelings further into the circle. It's never helpful. Dump your feelings to people further out in the circle, to those who are further from the problem. Give nothing but comfort and support to those further in by saying things like the author listed above. It's a simple rule, and is just brilliant.

So why am I posting about this on my infertility blog? Because this is just the sort of thing that is absolutely applicable to infertility. Comfort in, and dump out. The best way to be supportive is to simply follow the order. I know I have posted this before, but this Infertility Etiquette article from Resolve is the exact kind of things that people in the larger circles can do for their infertile friends in the center circle.

And, finally, I made my own diagram following the directions above.

The gossipmongers always dump in.

For many people I know experiencing infertility, this is a really stressful problem. For me, there hasn't been much of a problem recently. The only thing I can think of is when I spoke in church to the entire congregation and told our story. I opened up about how long we had been trying, about our three miscarriages, and feelings about it. I'm glad I did, but at the same time, wish that people knew what to say to me afterward. I had all kinds of reactions from "Oh, I know exactly how you feel. It took me five months to conceive my last child, and it was so hard, and complain complain," and "I know this great energy/voodoo/spiritual/shaman/prayer ritual that will make you fertile," to "Don't you know that the Church has an adoption service? Why don't you just use that?" and "Have you tried going on vacation?" Luckily, you, my wonderful friends, have been nothing but supportive. I truly admire everyone for their kindness and support these last few years. You're all the very best kind of friends I could have. Thank you for reading my blog these past months, and for listening to everything I have been teaching you.

NIAW

Today is the first day of National Infertility Awareness Week. It will go through Saturday, April 27.

Our purpose in celebrating NIAW is to let those with infertility know that they are not alone, help them find resources that can help them, and educate the public about infertility. It is a very scary, heartbreaking, lonely, and frustrating time. Since it's so private, many people are not open about it. It's a very misunderstood disease, which leads to a lot of problems.

I am going to do my best this week to help accomplish those goals! I have spent the last few weeks working on posts, and already have a few ready to go. I encourage you to also do the same! Please participate and help us spread the word! Here are a few options for you to consider:

Resolve's Bloggers Unite Challenge: Share your thoughts with your readers by writing under the topic of "Join the Movement..."

The Infertility Voice NIAW Facebook Timeline Covers: Change your Facebook cover for the week to show your support.

Wear an Infertility and Pregnancy Loss ribbon this week

Donate to Resolve to help fund educational events, support groups, public awareness initiatives and advocacy efforts.

And lastly, show your love for your infertile friends and let them know that you are thinking of them!

I'm excited about this week, and hope that you enjoy the posts that are to come!

Cost Round Up

We are really starting to feel the financial strain on us due to our treatments. Previously, I discussed that our medicated and monitored cycles had cost us between $500-600. With the IUI, the cost went up. 

Again, this is what I pay without help from insurance.

Appointments:

• Baseline- $200
• Follicle check- $200 
• Second follicle check- $200. This is not always necessary every cycle, but definitely a possibility. I did need it this time.
• IUI procedure- $400

Medications:

• Clomid- $20 for 100mg dose.
• hCG injection- $60
• FSH injection- Usually $120, but I got mine as a gift from the office.
• Progesterone- $45
• Baby aspirin- Didn't cost enough to factor in.
• Prenatal vitamins- About $5.

Tools:

• Ovulation predictor kit- $12.

Labs:

• Blood pregnancy test- $45. 

Optional:

• Pregnancy tests- I did decide to test out my trigger (I was bored and couldn't resist) so I bought a new 50 pack from Amazon again for $16. 

The total from this cycle ended up being just about exactly $1200 (and would have been $1300 if I had paid for the shot the office gave me). We paid a portion of that with the very generous donation from my parents toward treatments, but ended up paying well over half with our own savings. It's really starting to come down to the wire. If it doesn't work this time, can we afford another IUI cycle? If we can't afford it, do we just go natural and try on our own? Do we go on birth control and take a break for a little while? 

It's sad how much money affects treatments. It's very frustrating that money is getting in the way of me completing my journey. This is a huge hurdle for many couples who go through infertility, and is never an easy one, especially with a vast majority of insurances not covering any part of infertility treatment. 

Trigger is Gone

So, I did decide to test out the trigger. I just relaxed about it a lot more, and didn't stress this time.

So I am at 7 days past my IUI today, which means that I am 8 days from having the trigger shot. Last month, I didn't see it turn negative until 11 days after my shot. And this month, surprisingly, I had it turn negative today. So it is negative 3 days earlier than before. I'm a little disappointed because I have heard that the hCG can aid with implantation a lot, but I guess there isn't much I can do about it.

Trigger tests this month, last one from today at 7 DPO.

The tests last trigger, bottom test at 7 DPO. Still positive.

I guess there really is just no telling what my body is going to do month to month.

Visible Embryo

One of my guilty pleasures is tracking the progress of my could-be-baby after ovulation until I can test to see if I'm pregnant. There is a really neat website called Visible Embryo that has pictures, explanations, and all kinds of neat things. It starts with 1 day past ovulation, and continues on stage by stage to show the growth all the way until birth. I always just follow along at the beginning, watching how my baby would be growing, just in case I'm pregnant.

From Infertility to Pregnancy Conference. Also, Contest.

I encourage everyone to access and watch this conference being broadcast via internet. It's starting on April 21 and going through May 4. The conference will feature lots of expert speakers who will discuss many different areas of infertility. Just register on the site (it's free!) and check out the schedule to make sure you don't miss the talks you are interested in.

From Infertility to Pregnancy Virtual Conference

I also came across this amazing opportunity to win a free IVF cycle from the Northern California Fertility Medical Center. Entering is simple, and must be done by April 28. Even if you don't live close, wouldn't it be worth travel costs to win a free IVF cycle?! I entered and hope I have a chance!

When Should I See a Specialist?

This is a question that everyone starts to ask themselves when it starts taking longer to get pregnant than expected. I remember starting to have this question pop up in my mind once I hit the three/four month mark. And while this is actually a very normal amount of time to conceive, I think a lot of couples can be impatient and start feeling like it's taking too long. It doesn't help that stories fly around about how often accidents happen, or how teenage girls get pregnant all the time. There is a myth that floats around that it's easy to get pregnant.

So what is a normal time to expect to get pregnant? The American Society for Reproductive Medicine says that if a woman is under the age of 35 to start seeking help after unprotected intercourse for one year, and for women over 35, six months. So if it's taking longer than you expected, so say, more than two or three months, you are still doing okay. Sometimes it takes a little longer for some to conceive, and there isn't a problem. It's just up to luck. But once the six month/year mark comes up, it's time to start seeking some help.

However, sometimes one can suspect something is wrong without needing to try for that long. RESOLVE.org posted that if you answer yes to any of the following to visit with your doctor.

• I have painful periods.
• I have irregular periods.
• I can not pinpoint when I ovulate.
• My partner/I have a history of STDs.
• I have an unhealthy Body Mass Index (BMI). (underweight or overweight)
• I have had more than one miscarriage. 

As for who to go see, that's a personal decision. I initally started treatment with an OB/GYN because my insurance covered it. They are able to run the simple, initial tests like a semen analysis and do ultrasounds, prescribe medications like Clomid/Femara and progesterone, and order imaging tests like a hysterosalpingogram. Some OB/GYNs are comfortable starting infertility treatment, and some aren't.

The best bet is to go directly to a specialist, a reproductive endocrinologist. They are the most skilled in this area, can help diagnose problems quicker, and get you set on the course of treatment that you need. It's worth it to go directly to a specialist. My only regret is that I wasted time "doctor hopping" instead of going immediately to the person who could have helped me best. 

The IUI

At my ultrasound yesterday we saw one beautiful follicle ready to go. A second did not mature in time, but we are really okay with that. It only takes one, right? So I was given my hCG trigger there at the office, meaning that ovulation will occur 24-48 hours after the shot. So it will be sometime this afternoon or evening. I haven't decided if I will test out my trigger this time. It seemed to add a lot of stress before. I may just do a test or two here and there just to see what it's doing.

We went back today for the collection and insemination. John described the collection as the "most awkward moment of my life." And I will stop there. We handed it over to the lab there, and they prepared the sample. What happens is they wash it to get rid of any dead or imperfect sperm, take the healthy ones, and place them in a liquid that helps them to "swim" better.

While we waited, we walked around the mall that is just down the street. And not that it matters, but I got some really cute new sandals! Anyway, when we went back, they put us in a normal exam room, and when the APN came in to do the procedure, she announced very excitedly that we had an amazing sample! Sperm count, post wash, is considered normal at 15-18 million (Average is between 18 and 40 million). In the 20s is excellent. And we had 36 million! We were really excited to hear that. Once again, the prayers helped!

The procedure itself went really fast. It started out similarly to a pap smear, with all of that funness. Then she inserted a catheter in the cervix, injected the sperm sample, and that was it. Really simple. After, she left and had me lay down for about 15 minutes. She turned off the lights for some reason, which we thought was funny. Nap time!

I will have a blood pregnancy test done on April 26th. I am not sure if I will post about the results, positive or negative, because we don't know when we would tell people once we know I'm pregnant. We still have to come to an agreement about that. I don't often do this because I have always been so open, but I would really appreciate no questions about my results. Just so we're able to keep things private if we want. Thank you!

Secondary Infertility

While I don't personally suffer from secondary infertility, I have a lot of friends who do. Secondary infertility is "the inability to become pregnant, or to carry a pregnancy to term, following the birth of one or more biological children. The birth of the first child does not involve any assisted reproductive technologies or fertility medications" (Resolve.org, "Secondary Infertility"). This is an extremely sensitive issue, and not just from comments and misunderstanding from the "Fertile Myrtles."

I decided to write a little about this for a few reasons. The first is to encourage me to try to understand secondary infertility better. The second reason is because I saw the following question posted on RESOLVE: The National Infertility Association's Facebook page:

"One of our Facebook Community members wrote: 'I am upset with people sometimes. I just started IVF for secondary infertility. We are lucky to have one child. My last baby was a still birth. I can't stand it when people repeatedly tell me to be thankful for my only living child. My dream was to have two children. I don't know how to tell them off without hurting their feelings. Any advice? Really, I am getting close to blowing up at people.' Please leave your comment for her below:"

The comments that followed were all over the place, from telling the woman that "You really should be thankful for your child. Stop being so angry and enjoy the one you have," to some really good words of support. The surprising thing is that all of the comments, insensitive ones included, came from members of the infertility community. 

I can understand both sides of the issue. For those going through primary infertility (like me) who haven't been able to have even one child, it's so easy to feel like the women going through secondary are being ungrateful for the child that they do have. When we would do anything to have even just one child, it's hard to see someone complain, "I can't get pregnant!" when they already have one. It's easy to think, "I would do anything for just one! Appreciate and love the one you have! At least you have one." 

On the other side, I can understand that it's still extremely heartbreaking to experience infertility, no matter how many children one has. I think of the pain month after month, the disappointment when seeing failed cycle after failed cycle. That could not possibly be easy for anyone. John and I had always imagined having three or four children. True, we will be happy if we are blessed with just one, but there will still be a sense of loss for the other children we feel should be in our family. I'm sure those couples going through secondary infertility must feel something similar. It must be truly saddening and frustrating to begin your family, and then not be able to feel completed. I have also heard a lot of sorrow coming from, "not being able to give my child a sibling." 

Those men and women with secondary infertility need and deserve just as much support and love as those with primary. It's harder to know who they are, and sometimes you may not even know the people in your life afflicted with it. It's easy to look at someone with children and think that they are not struggling. I guess the main point here is that you can never judge someone. Never just assume that they don't have problems, and don't assume they aren't grateful for their children. All of the friends I have talked to love and adore their children completely, but simply yearn for more. Not one has ever taken their child for granted. They understand what it really means to appreciate the gift that they were given. 

Three Cheers for the Right!

I had my ultrasound today to check on my follicles and see if I was ready for the IUI. And while everything wasn't quite ready yet, we are so so so happy to report that all of my activity is happening on my right ovary! I had one dominant follicle measure 12 mm, with a few smaller ones. A mature follicle needs to measure at least 18 mm. I will be going back for another ultrasound on Thursday to see if everything is ready, and plan to do the IUI on Friday. The APN was nice and gave me a shot of follicle stimulating hormone, which will encourage the follicles to mature. And the best part is a drug rep just stopped by their office and left a sample of the FSH shot, which she just gave to me at no charge! It is usually about $120, so that was a very generous gift! She gave me a double dose of it to try to increase the number of follicles that will mature. We're hoping that a second will mature in addition to the dominant one.

Thank you everyone, because I feel that your prayers worked! We had great news, and hope that the trend continues. If everything works out, I'd be due on January 1st, 2014. We're hoping for New Years twins!