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Archive for the ‘general infertility’ Category

One of the really annoying things about Blogger is that there's no easy way to respond to comments that I receive… It doesn't provide me email addresses for commenters, so I can't just email a response to a comment. And it doesn't do comment threading, so you'd never know if I responded direclty to a comment unless you keep looking at the comments on an individual post. This is, by far, my biggest frustration with Blogger. So I'm going to address some questions here.

1. Someone asked what I would do if I had to have an IUI on Saturday. (I think this was My Reality, but I'm not certain and I'm too lazy to look it up right now)

This is a somewhat complex question. First let me explain the whole Saturday problem in the first place: I'm an Orthodox Jew and there are a number of restrictions that I have on Saturdays (my Sabbath, or "Shabbos"). Shabbos is supposed to be a day set aside from weekday activities. A rest from the mundane. A completely different kind of day from the rest of the week. That being said, I don't drive on Shabbos. I don't write or exchange money on Shabbos. I don't cook, work, affect electricity, or play a musical instrument on Shabbos. I hate describing it this way, because it sounds as if Shabbos is all about all the things you CAN'T do, and that's not how I try to look at it. Shabbos starts at Sundown Friday and ends about an hour after sunset on Saturday. Nearly every Friday night, we have company over for a festive meal (and if we don't have company, which is rare, we still have a nice dinner). Saturday we go to shul (synagogue), take long walks, read, spend time together as a family, have a nice lunch with friends (usually… occasionally it's just us at home, but still a nice meal), take naps (something I never get to do during the week). So although there are a lot of things I can't or don't do on Shabbos… it is an extremely enjoyable day that I look forward to all week.

All that being said, there are a number of problems with me being at the fertility clinic on a Saturday. The first, most obvious, problem is driving. I can't drive to the clinic, so if I had to have an IUI on Saturday, I would have to spend the weekend in a hotel near the clinic. This is completely doable, but not without its drawbacks (primarily dealing with having food). My clinic is situated within walking distance of several hotels, though none are especially convenient. Still, it's doable. There are lots of other little problems, all of which are easily handled: I don't write, so I can't sign in or fill out any forms, but those things can all be taken care of ahead of time. I don't exchange money, but I could pay my copay ahead of time or have them bill me (they have a lot of Orthodox patients, so they've grown accustomed to such things). Those are all doable.

The bigger (and least surmountable) problem for me is that being at the fertility clinic on Saturday is not really in the spirit of Shabbos. It takes me out of the calm beauty that characterizes Shabbos for me. It forces tension into a day that would otherwise be focused on my relationships with God, my family, and myself. Practically speaking, it would also require that I figure out what to do about Julian. If we both had to be at the clinic, we'd have to have someone watching J (though obviously we could take turns being at the clinic since that's usually what happens if I have an IUI during the week anyway. It's rare that S is present for the actual IUI (he's been there 2 out of 5 times), but that's because of practical reasons. We both have jobs. If I have an IUI on a Sunday, we go together. Otherwise, he's only there for his part.

The nice thing about IUI is that it is somewhat more flexible with timing than IVF is. With IUI triggering a day earlier or a day later isn't so much of a problem. With IVF, there's less flexibility with egg retrieval and even less flexibility with transfer, so it's much harder to avoid Shabbos retrievals or transfers. So far, with five IUIs in my portfolio, I've never had to have a Saturday IUI, though I know it could happen. Mostly, my doctors are aware that Saturdays are big problems for me, so they've been able to avoid it. If I had to have an IUI on a Saturday, my rabbi would tell me I could do so, with some restrictions (as noted above), but I'm not sure that I would do it. Given my particular issues, IUI itself doesn't really increase my odds of achieving a pregnancy in a given cycle. What increases my odds significantly is the ovarian stimulation and triggered ovulation (since my problem is primarily anovulation and there's no male factor involved, and so on). However, if I had an IVF procedure fall on a Saturday, which is far less avoidable, I would find a way to make it work. There's an awful lot more at stake with a given IVF cycle than with an IUI cycle, so I feel much more strongly about it in that case. I'm not saying I definitely would not do an IUI on a Saturday, but I think it's unlikely… besides, like I said, I've never really had to consider it.

That was probably far more information than any of you wanted to know.

2. re: my right ovary always being the producer, someone asked if I was cycling every month or every other month (I think this was Kris)

This is a good question. My first IUI was in February, the second was in March. Then I took some time off and the third IUI was in June, fourth in July. Then I was pregnant until October 10th and wasn't able to start a new cycle until the end of December. IUI #5 was in January, and IUI #6 (this current cycle) will be in February. So while I've skipped months, I've generally had 2 back to back cycles. IUI doesn't require rest cycles in the same way IVF does. So I think that it really is true that my left ovary is a complete and total slacker. I wish it would get the memo that it's time to shape up and earn its keep!

3. re: my wonky estradiol levels… someone (Kris, again, I think) asked if I was on estrogen support/supplements

I am not, and I get the impression that this is far more common with IVF cycles than with IUI cycles. I have had notoriously low E2 levels for all of my cycles, but the levels at least have still increased appropriately, even if they are always a bit on the low side. Last cycle and this cycle seem to be the exceptions. This is my last IUI cycle. My next cycle will be an IVF cycle, and will likely include estrogen as part of the protocol. If I were planning another IUI cycle, I'd probably ask if there would be any advantage to me taking estrace or something similar to improve response. I'm theoretically a good responder in general, it's just that my estrogen levels these last two cycles have been puzzling, at best.

4. Finally, Thalia asked (re: my wonky estradiol levels) if I'd considered taking a month or two off in case my body just needs a break.

I might believe that my body just needs a break, except it was forced a break just recently. I had to take several months off after my miscarriage for my hCG levels to go back down and then I had to have a rest cycle before I could go back to an IUI cycle. It was an extremely miserable time, because nothing puts me on edge about this whole infertility thing than not doing anything. Either way, this is my last IUI cycle, and I'll be on birth control pills from the time this IUI fails (anticipating around Feb 20th) until mid-April. I would only take them for three weeks, but that would put retrieval or transfer dangerously close to the first days of Passover, which I absolutely will not allow to happen, so I'll be waiting to start an IVF cycle until right after Passover. So whether my body needs it or not, I'll be taking a bit of a break. I'm not loving staying on birth control pills for that long, because as most of you know I've already got crazy ridiculous migraines and BCPs will only make them worse. I'm not entirely certain how I will function, but I'm sure I'll find a way.

Those are all the questions I can think of, but if you have any others, let me know and I'll post again.

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One of the really annoying things about Blogger is that there's no easy way to respond to comments that I receive… It doesn't provide me email addresses for commenters, so I can't just email a response to a comment. And it doesn't do comment threading, so you'd never know if I responded direclty to a comment unless you keep looking at the comments on an individual post. This is, by far, my biggest frustration with Blogger. So I'm going to address some questions here.

1. Someone asked what I would do if I had to have an IUI on Saturday. (I think this was My Reality, but I'm not certain and I'm too lazy to look it up right now)

This is a somewhat complex question. First let me explain the whole Saturday problem in the first place: I'm an Orthodox Jew and there are a number of restrictions that I have on Saturdays (my Sabbath, or "Shabbos"). Shabbos is supposed to be a day set aside from weekday activities. A rest from the mundane. A completely different kind of day from the rest of the week. That being said, I don't drive on Shabbos. I don't write or exchange money on Shabbos. I don't cook, work, affect electricity, or play a musical instrument on Shabbos. I hate describing it this way, because it sounds as if Shabbos is all about all the things you CAN'T do, and that's not how I try to look at it. Shabbos starts at Sundown Friday and ends about an hour after sunset on Saturday. Nearly every Friday night, we have company over for a festive meal (and if we don't have company, which is rare, we still have a nice dinner). Saturday we go to shul (synagogue), take long walks, read, spend time together as a family, have a nice lunch with friends (usually… occasionally it's just us at home, but still a nice meal), take naps (something I never get to do during the week). So although there are a lot of things I can't or don't do on Shabbos… it is an extremely enjoyable day that I look forward to all week.

All that being said, there are a number of problems with me being at the fertility clinic on a Saturday. The first, most obvious, problem is driving. I can't drive to the clinic, so if I had to have an IUI on Saturday, I would have to spend the weekend in a hotel near the clinic. This is completely doable, but not without its drawbacks (primarily dealing with having food). My clinic is situated within walking distance of several hotels, though none are especially convenient. Still, it's doable. There are lots of other little problems, all of which are easily handled: I don't write, so I can't sign in or fill out any forms, but those things can all be taken care of ahead of time. I don't exchange money, but I could pay my copay ahead of time or have them bill me (they have a lot of Orthodox patients, so they've grown accustomed to such things). Those are all doable.

The bigger (and least surmountable) problem for me is that being at the fertility clinic on Saturday is not really in the spirit of Shabbos. It takes me out of the calm beauty that characterizes Shabbos for me. It forces tension into a day that would otherwise be focused on my relationships with God, my family, and myself. Practically speaking, it would also require that I figure out what to do about Julian. If we both had to be at the clinic, we'd have to have someone watching J (though obviously we could take turns being at the clinic since that's usually what happens if I have an IUI during the week anyway. It's rare that S is present for the actual IUI (he's been there 2 out of 5 times), but that's because of practical reasons. We both have jobs. If I have an IUI on a Sunday, we go together. Otherwise, he's only there for his part.

The nice thing about IUI is that it is somewhat more flexible with timing than IVF is. With IUI triggering a day earlier or a day later isn't so much of a problem. With IVF, there's less flexibility with egg retrieval and even less flexibility with transfer, so it's much harder to avoid Shabbos retrievals or transfers. So far, with five IUIs in my portfolio, I've never had to have a Saturday IUI, though I know it could happen. Mostly, my doctors are aware that Saturdays are big problems for me, so they've been able to avoid it. If I had to have an IUI on a Saturday, my rabbi would tell me I could do so, with some restrictions (as noted above), but I'm not sure that I would do it. Given my particular issues, IUI itself doesn't really increase my odds of achieving a pregnancy in a given cycle. What increases my odds significantly is the ovarian stimulation and triggered ovulation (since my problem is primarily anovulation and there's no male factor involved, and so on). However, if I had an IVF procedure fall on a Saturday, which is far less avoidable, I would find a way to make it work. There's an awful lot more at stake with a given IVF cycle than with an IUI cycle, so I feel much more strongly about it in that case. I'm not saying I definitely would not do an IUI on a Saturday, but I think it's unlikely… besides, like I said, I've never really had to consider it.

That was probably far more information than any of you wanted to know.

2. re: my right ovary always being the producer, someone asked if I was cycling every month or every other month (I think this was Kris)

This is a good question. My first IUI was in February, the second was in March. Then I took some time off and the third IUI was in June, fourth in July. Then I was pregnant until October 10th and wasn't able to start a new cycle until the end of December. IUI #5 was in January, and IUI #6 (this current cycle) will be in February. So while I've skipped months, I've generally had 2 back to back cycles. IUI doesn't require rest cycles in the same way IVF does. So I think that it really is true that my left ovary is a complete and total slacker. I wish it would get the memo that it's time to shape up and earn its keep!

3. re: my wonky estradiol levels… someone (Kris, again, I think) asked if I was on estrogen support/supplements

I am not, and I get the impression that this is far more common with IVF cycles than with IUI cycles. I have had notoriously low E2 levels for all of my cycles, but the levels at least have still increased appropriately, even if they are always a bit on the low side. Last cycle and this cycle seem to be the exceptions. This is my last IUI cycle. My next cycle will be an IVF cycle, and will likely include estrogen as part of the protocol. If I were planning another IUI cycle, I'd probably ask if there would be any advantage to me taking estrace or something similar to improve response. I'm theoretically a good responder in general, it's just that my estrogen levels these last two cycles have been puzzling, at best.

4. Finally, Thalia asked (re: my wonky estradiol levels) if I'd considered taking a month or two off in case my body just needs a break.

I might believe that my body just needs a break, except it was forced a break just recently. I had to take several months off after my miscarriage for my hCG levels to go back down and then I had to have a rest cycle before I could go back to an IUI cycle. It was an extremely miserable time, because nothing puts me on edge about this whole infertility thing than not doing anything. Either way, this is my last IUI cycle, and I'll be on birth control pills from the time this IUI fails (anticipating around Feb 20th) until mid-April. I would only take them for three weeks, but that would put retrieval or transfer dangerously close to the first days of Passover, which I absolutely will not allow to happen, so I'll be waiting to start an IVF cycle until right after Passover. So whether my body needs it or not, I'll be taking a bit of a break. I'm not loving staying on birth control pills for that long, because as most of you know I've already got crazy ridiculous migraines and BCPs will only make them worse. I'm not entirely certain how I will function, but I'm sure I'll find a way.

Those are all the questions I can think of, but if you have any others, let me know and I'll post again.

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ARGH.
I wrote a really big, long, thoughtful post about a Washington Post article entitled My Father Was An Anonymous Sperm Donor. Then my browser crashed and blogger didn’t save the post, even though I’d saved it as draft already.

I was, frankly, unimpressed with the article itself (it was obvious that the author was merely 18), but I do think it brought up some interesting issues. Issues I’d love to discuss at length, but I don’t have time to reconstruct the whole post right now. So maybe later. In the meantime, check out the article and let me know what you think.

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ARGH.
I wrote a really big, long, thoughtful post about a Washington Post article entitled My Father Was An Anonymous Sperm Donor. Then my browser crashed and blogger didn't save the post, even though I'd saved it as draft already.

I was, frankly, unimpressed with the article itself (it was obvious that the author was merely 18), but I do think it brought up some interesting issues. Issues I'd love to discuss at length, but I don't have time to reconstruct the whole post right now. So maybe later. In the meantime, check out the article and let me know what you think.

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Protected: “They Say”

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” They Say “

Don't you just hate how "they" say a lot of things without really knowing you or your personal situation? "They" say that having children changes you forever. "They" say you can't possibly understand how children change your life until you have them. "They" are correct. I have had a foster son for almost 2 years now and my life is different. And I have changed forever, just as I changed forever with every major life experience: highschool, going to college, breaking up with my first boyfriend, getting married, buying a house, getting a real job. And yes, acquiring a child. I mean, I didn't get my child the old fashioned way, but I'm every bit his parent and couldn't be more his parent if I'd given birth to him.

Anyway, back to "them"… "They are right. I'm a different person now.

"They" will say that maybe I should be careful what I wish for when I wistfully think of a gaggle of siblings for my foster son. "They" sometimes even say, "Oh, you can have my kids… you'll find out soon enough that they're not worth it."

"They" are not always correct. And you know what else? What "they" don't realize is that even though having kids changes you (and this is not necessarily a bad thing), NOT having kids also changes you. Or at least it changes you if you can't have kids. I know I look at things more cynically sometimes, and I've lost some of my naivetee (not sure if that's a good or a bad thing). I also know that I can look at myself with more humor now. I can laugh at my failures and I can see how ridiculous this whole process is. That, I think, is a good thing.

I used to think that infertility had made me more sympathetic to people. I think, though, that it's done the opposite. When I read people's infertility blogs, sometimes I can't help but think, "oh just quit your whining; you'd think you're the only person on the planet who had one failed IUI." But the women who write these hysterically funny blogs in the face of devastating infertility problems… my heart breaks for them, even as I'm guffawing at their well-written, but painful, adventures through the land of infertility. It's almost like I've become selectively sympathetic, and I'm not sure why.

It's true that infertility hurts. A lot. It's painful no matter where you are in the process. Trying to conceive sucks ass because when you really want something, it always feels like it's *just* out of reach until it's finally yours. So the day a woman says to herself, "that's it, I'm officially trying to conceive," it becomes a laborious process. Every little twinge matters. Every cramp is a sign of impending doom. Every headache could be an early pregnancy sign. Starving? Obviously early pregnancy sign. Not hungry? It HAS to be an early pregnancy sign! Everything matters! Everything is a sign! And unless you're one of the lucky ones, you'll probably come crashing down the first time you take a pregnancy test, because we all test too early and too often. For most women, the agony is short lived and within a few short (but agonizing) months, she finds out she is expecting. We infertiles, though, the ones that have figured out that the old fashioned way may just not work for us… we start to change. In some ways for the better… I certainly have learned to appreciate my life for what I DO have, even if I don't have a baby. And in some slightly less flattering ways… I'm definitely more snarky and short tempered than I used to be.

I guess I don't really know where I'm going with this. I guess I'm just tired of people trying to suggest to me that they know better than me. That they know what's good for me, or what my life is like or what my pain is like. No one knows how ANY other person feels about anything. One infertile may feel and respond to her plight in a completely different way than the next infertile. Even if I've been through the same number of IUIs as my buddy Jane, that doesn't mean I have any idea how she feels. I can't say, "I know exactly how you feel." I can't KNOW how she feels. I can sit there and listen. I can be there for her if she needs a hug. I can offer advice if she asks for it, or keep my mouth shut if she doesn't. But I can't KNOW anything.

And neither can "they".

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So I've decided to start a blog devoted exclusively to my infertility posts. Well, not that I promise never to let a bit of my real life pop in now and then, but mostly I'm figuring that a lot of my friends inside the computer really don't want to have so much information about my reproductive life. Still, I do desire an online outlet for my infertility craziness, so here I am. I don't know yet whether I'll tell any of my friends in real life about this blog. I obviously won't object if they stumble upon this blog one way or another, but sometimes I wish I were a bit more in-the-closet than I am. I always intend to keep my mouth shut about things, but then I just blurt out information. I'm hoping that having a blog where I don't have to censor myself as much will make it easier for me to censor myself in real life.

So here's a bit about me:
I am 30 years old, married 3 1/2 years, and have a beautiful 2 1/2 year old foster son. My husband and I have been trying to conceive, well, since our wedding day, I suppose. Before we got married, we knew we might face some challenges, because I have PCOS and had an extremely irregular menstrual cycle. We tried charting and all the normal stuff. A year after we married, we talked with my OB/GYN about what else we should be doing and she gave me Clomid. Five cycles of Clomid later, and still no pregnancy, I was good and bored. Oh, I was ovulating for sure, based on my temperature charts, but no pregnancy.

I think in September or October of 2005 we finally went to a Reproductive Endocrinologist at "The" Clinic to go to around here, much to the annoyance of my OB/GYN. I get the impression that the two professions don't exactly love each other too much, and I'm not really certain why.

All tests came out as expected for a chick with PCOS. No other problems found. HSG was negative, SA was stellar, I had (not surprisingly) polycystic ovaries (duh).

The RE didn't want to do anymore Clomid cycles, as I'd come close to reaching the lifetime limit on how much Clomid they like women to take. So… on to IUI with injectible FSH it was. Whoopie!

Cycle 1: My first FSH/IUI cycle was February 2006. Picture perfect cyle, for the most part, and as everyone expected I would, I responded brilliantly to extremely low-levels of Follistim. Life was good. I romantically made my husband come with me to the actual IUI appointment figuring if we were going to conceive a child, it would be nice if he could at least be in the room. Hah! The IUI was quick and painless and rather, if you'll excuse the pun, anticlimactic. "That's IT?" I asked, incredulously. That's it. I almost felt like there ought to have been at least a little discomfort for my trouble. Not that I'm asking for unwanted pain or anything, but sheesh! There was no WAY this could work if it were that painless! Unfortunately, I was right. Cycle 1 (or 6 if you count the five failed Clomid cycles) was a failure.

Cycle 2: Took up all of March. It was the cycle that would never end. Slowly, slowly, my dosage was inched up bit by bit. I was still responding really well, but no follicles were jumping up and saying "Pick me! Pick me!" So that cycle I had 10 ultrasounds in 29 days. My IUI was on CD31. Two weeks later, I was out of town, so couldn't have my Beta done, but I didn't need it anyway, since CD1 reared her ugly head in the middle of my vacation.

Cycle 3: was a blessedly quick cycle. CD1 was June 12, 2006, and the IUI was a mere four ultrasounds later on June 27th (CD16). Though the cycle failed, I'm still very grateful that it was such a quick cycle because I threw up every single day that I took the Follistim. Every. Single. Day. In the first two cycles, I had some mild side effects from the Follistim and some truly evil side effects from the Prometrium suppositories that I took for two weeks after the IUIs. But this cycle… oh boy did it suck. Every evening I would take the Follistim shot, and an hour later I was start to feel nauseated. I would be up all night feeling sick and then throwing up most of the day. I usually felt better in the evening after work, and then I'd take another shot before bedtime and an hour later… lather, rinse, repeat. "How odd!" said my nurse. "I've never had a patient with that side effect," said my doctor. "Well, it could happen," said my pharmacist husband. Duh. Of course it could happen. It DID happen! Anyway, Cycle 3 failed, so on to…

Cycle 4: Present day. Cycle 4 started 13 July 2006. As usual, I'm responding well to the drugs, but since I have PCOS, I'm super-sensitive to Follistim, so they have to be very careful not to give me too much. My current status is that I have a bazillion little follicles (hence the sonographer's usual "My, but we have perky ovaries today!" which led to this blog's title), and 4 worth measuring, only 2 of which are likely leaders. Left Ovary (never the forerunner, it seems) has follicles measuring 9.9 and 8.9 mm and Right Ovary has follicles measuring 13.4 and 10.4 mm. My estrogen level is up from two days ago at 113. So far so good. The follistim still makes me feel nauseated, but I haven't been throwing up as much, which is great.

Tomorrow I have an appointment with my RE to talk about what to do after this cycle. Originally, the RE wanted to do 5 IUI cycles before talking about moving on to IVF. Her reasoning is sound. There doesn't appear to be a medical reason that IUI wouldn't work for me. She believes it is simply a matter of time. My numbers look good, I respond well to the FSH injections. Can't ask for much more. However, I don't want to do a fifth IUI cycle at this point, particularly in light of the fact that Follistim makes me so ill all of a sudden. I mentioned this to her at one of my monitoring appointments and she said no problem and that we could lay out the IVF protocol at my consult and just hope that I never need the information since Cycle 4 is obviously going to be successful. Hah! I can't even type that with a straight face!

So here we go…

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