Beginning

Please note:  I started this blog two months ago, but I am moving it to this location so that it can be public and anonymous.  All of the old posts from the original blog have been moved here, so the date for all of these entries will be Thursday, August 25, 2011, even though they were created throughout July and August.

Though I would like to create posts on this blog about a variety of things, many of the posts will be about our journey through infertility.  Anyone who knows me knows that I am a talker and I express almost every thought that comes into my head, but this process has been a little different.  It isn't a privacy issue or one about embarassment, it is just painful and difficult to express to those who have never experienced it.  This first post will briefly describe what our journey has been so far and how we got to be here.

My husband and I are high school sweethearts and have been in a relationship since we were sixteen.  After I finished college and graduate school and he finished automotive school, we both were officially employed in late 2006.  He had been working as a driver, then a technician at the same dealership for a few years and I landed my first teaching job in October of 2006.  Within months, we moved in together for the first time when we were 22.  We lived in that little one-bedroom apartment for two years and it was in that apartment that we were engaged.

It is worth noting that we are far from traditional and were perfectly happy with our living arrangement.  We began looking to buy a house in 2008 and finally purchased our little house in November.  When we purchased our home, however, and when we decided to get married, it was all with family in mind.  We would have happily lived together for years if we did not believe that we were ready for children, but we wanted to start a family and we bought our little dream house and got married in order to do so. 

Even before we married, we gave a brief shot at trying to conceive in March of 2009.  Call it naivete, but I was born on Christmas Day and I thought that I would love to have a Christmas baby.  We tried somewhat casually in March and officially stopped "preventing" that Spring.  We were married in June of 2009 and immediately began actively trying.  In June, July and August, we were only just beginning to learn about ovulation prediction kits (OPKs) and charting, so we made a more informed and intentional attempt in the fall, hoping for a summer baby.

Looking back, I feel like I was naive to think that I could plan for a particular season.  I hoped that if I couldn't have my Christmas baby, at least we could have a summer baby so that I could be home with the infant for as much time as possible before returning to work in September for the new school year.  I also hoped that I would miss as little paid time as possible and avoid using disability insurance and maternity leave.  Once we went through the three-month window of the fall without conception, we discussed it and decided to continue trying to conceive (TTC) indefinitely, regardless of the projected due date.  I remind myself, however, that many couples can plan their pregnancies and that there was no way I could have known that we would have this experience.

I cannot remember exactly when the internet became a major part of our journey, but I know that I stumbled on The Bump website through it's connection with The Knot, which I used extensively for planning the wedding.  Through The Bump (TB), I discovered basal temperature charting and ovulation predictor calendars, as well as all sorts of specialized vocabulary and information for TTC.  I also discovered one piece of information that changed my life - that infertility is defined by the inability to achieve pregnancy in one year of TTC.  I'm not sure what I thought infertility was before, but within a few weeks of finding out this information, I would be in this group without ever really considering the possibility.

On TB, there are 40+ message boards for women of all degrees of pregnancy, motherhood or TTC to communicate with each other and exchange information and support.  In "lurking" on the infertility boards, I realized that I suddenly fit in this definition and that I should seek help relatively soon to make sure that there wasn't a larger problem preventing us from conceiving.  In the late summer of 2010, I decided to pursue help.

Of all of the phone calls and conversations I have had in this journey, the first one was probably the most difficult.  I called my primary care physician and made an appointment to seek a referral. After a brief conversation about my overall health, I had to explain to my doctor why I was there.  It was totally nervewracking.  I explained to the male doctor that my husband and I had been trying to conceive for over a year and we would like a referral to the fertility care center at a nearby medical complex.

For many reasons, my husband and I decided that, at this early point, we would keep our troubles private.  So many people have so many opinions about assisted reproductive technology (ART) and we had no real answers at this point.

Over the next few weeks, my husband and I went through the typical battery of fertility tests:  the semen analysis (SA), uterine ultrasound, hysterosalpingogram (HSG) and blood tests.  During the SA, the doctors analyze the sample for not only count, but also the quality and motility of the sperm.  In the ultrasound, they analyze the shape, structure and lining of the uterus to detect any abnormalities, cysts, fibroids, or other issues.  Finally, during the HSG, the doctors conduct an x-ray after flushing the uterus with a dye solution to detect any blockages in the tubes from the ovary to the uterus.  In our case, all of our tests came back normal.

In all couples who seek fertility treatment, roughly one-third of couples find themselves in this same "unexplained" category.   Therefore, it is not uncommon for all of the tests to come back normal even after a year or more of TTC with no success.  While it was comforting to find that there were no immediate problems, such as male factor infertility (MFI), polycystic ovary syndrome (PCOS) or anatomical abnormalities, the "unexplained" diagnosis can lead to more anguish than any other. 

When a couple is diagnosed as suffering from unexplained infertility, the potential for conflict, overanalysis of behavior and internalizing is enormous.  When no underlying problem can be found, conjecture about possible causes are thrown around and it is difficult to avoid resentment or tension in the couple's relationship.  In our case, this tension-causing and self-punishing factor was my weight. 

I have struggled my whole life with my weight and I completely understand the implications that it has for my health.  It is very difficult for me to lose weight, much less to keep it off for an extended period of time.  When the fertility doctor (reproductive endocrinologist, RE) mentioned it, however, my heart sank and I immediately began to worry about pressure from others and potential tension between me and my husband.

The facts that I have been able to find are that weight may delay fertility, it can affect egg quality, and it comes with increased risk of gestational diabetes (GD), but the facts are vague and many doctors disagree on the actual effects.  So here I am, stuck in the middle of this.  It's difficult to know that losing weight will certainly be among the hardest things I have ever done in my life, but it also may not improve my chances of having a baby.  I am also so afraid that it may mean that people might judge me for it or begin watching and monitoring everything that I do and eat.  It's not a nice place to be.  It's just too easy to blame weight and ignore any other issues that may not have been discovered yet.

So this is pretty much where we stand now.  There is no real way to test the quality of my eggs or evaluate some other factors without going ahead with in-vitro fertilization (IVF).  Currently, we are in the midst of our fifth interuterine insemination (IUI), the first three with Clomid and the last two with Femara. 

Clomid and Femara are intended to increase the signals that the brain sends to the ovaries to develop more follicles of better quality.  The hope is that after taking Clomid or Femara, the ovary(ies) will produce 1-3 mature eggs for fertilization, or follicles.  Depending on the dosage of the medication and the protocol, these drugs are typically taken for five days on the third through seventh day of the cycle (CD3-7) or the fourth through eighth day (CD4-8).  On the twelfth day (CD12), an ultrasound is performed to see how the follicle(s) have grown and progressed.  If there are more than 2-3 follicles, the cycle will typically be canceled to avoid a high-risk multiple pregnancy.  If the follicles are of the appropriate size and appear mature, the patient typically "triggers" ovulation that evening with a subcutaneous injection, such as Ovidrel.  Thiry-six hours later, the IUI is performed at the doctor's office. 

So far, on every cycle, we have developed one follicle and it has never been fully mature on CD12.  Each time, I have had to go back on CD14 for another ultrasound before I got the approval to trigger.
 
The IUI itself is a simple procedure and seems to be far more traumatic for my husband than for me.  Earlier in the morning, the male partner must produce a "sample," either at home or in the doctor's office.  If it is collected at home, it must be transported quickly to the office for a process called "washing."  Once the sample is dropped off and paperwork signed, the sample goes through a process that concentrates the sperm into a tiny sample of higher-motility and higher-quality.  There is about an hour window between the sample drop-off and the IUI, so it takes up a good chunk of the morning. 

During the IUI, the RE simply transfers the sample with a catheter, theoretically bringing the highest quality sample exactly to the tube to improve chances of fertilization and implantation.  The process itself is usually painless, but I have experienced some pretty intense cramping after the fact, ranging from oh-that-hurts-a-little to doubled-over-in-pain-and-running-back-to-the-car-in-the-Walmart-parking-lot. 

Because we are on our fifth IUI and most REs typically do six, we are beginning to consider the very likely possibility that IUI will not be the path to a baby for us.  While it is possible to do IUIs with a more aggressive protocol of injectible ovary stimulation medications, these are very expensive and only marginally more successful than oral medications. 

If these next IUIs do not work, the next logical step in treatment is IVF.  There are many pitfalls here, however, not least of which being financial.  We really cannot afford to do IVF out of pocket, so our only option is to buy packages of IVFs and frozen embryo transfers (FETs) with a fertility finance company.

Over the coming months, we will be researching our options and "shopping" REs to find the most reasonably priced options with the best care and success rates.  We are also looking into adoption and we plan to attend informational meetings to gauge whether or not this option is for us.