Follicle Stimulating Ultrasound

Today I went in for my follicle stimulating ultrasound.  Things lately have been a little hectic (to say the least).  Last Monday I went in for my baseline US and everything looked good.  We decided to increase my Femara (fertility medication similar to clomid) to 7.5 mg (which is triple from my original dosage).  Since last cycle we increased it to 5.0mg and I still only had one mature egg we decided to up it one more time to see if we could get a couple of mature follicles. 
Last time I had ultrasounds on cycle days 11 and 13 with the insemination on day 16.  Today was cycle day 12 and I was a little nervous because I didn't want to have to come in AGAIN for a second ultrasound and another $200. 
Last Friday I called the fertility clinic and had them switch my appointment from 9:30 this morning to 3:30 in the afternoon due to my work schedule.  I was a little bummed at the idea of having to drive all the way down to pleasant grove again after work, but figured there wasn't another option. 

This morning at 5 am I received a call from work letting me know I was going to be cancelled for the day (which NEVER happens).  So relieved I put my head back on the pillow and slept in until 8:30!  Once I was conscious enough to use my phone I called the clinic back and had my appointment switched back to 9:30 at their Murray site. 

Once I arrived at the clinic I barely had enough time to flip open the Better Homes and Gardens magazine before my name was called and I was brought back to the exam room.  After a quick and routine undressing from the waist down I sat impatiently waiting for the nurse practitioner.  Once she entered we immediately began to discuss how the increased dose of Femara had worked.  I told her my cycle had only lasted for 3 days and then for some bizarre reason I spotted for 7 days after that.  The nurse practitioner was a little concerned with the unusual spotting and as she began the ultrasound the uterine lining became her number one concern.  Laying there helpless and watching her squinting eyes examine the screen had my heart racing.  Finally after what seemed like eternity she said my lining was looking normal, but a little on the thinner side.  She was to prescribe me estrogen to help build the lining. 

Next she navigated over to the right ovary and was instantly greeted by a 20mm egg. Keeping my fingers crossed she traveled over to the left ovary where it took a little more investigating before she could find the follicles. A 12mm, 13mm, and 14mm sat on my left ovary.  None mature enough to release, but maybe in the next couple of days they will grow up.  At this point I am a little sad at the fact that we aren't having another US to see if those follicles mature, but I guess there is security in knowing we have at least one mature follicle.

After the ultrasound I met the nurse and nurse practitioner outside the exam room and the NP handed me a prescription slip for the estrogen.  During her explanation she stated that they were tablets, just like a normal pill, but that she wanted me to insert them vaginally and apologized for how weird it was.  I of course reassured her that at this point NOTHING was too weird and I would do as she prescribed.  She was a little concerned, however, that I would ovulated before Friday with such a large follicle already. So I was also instructed to do my lovely ovulation kit pee sticks daily.

The rest of the week has been planned.  I have to take estrogen vaginally twice a day for the next 3 days.  Thursday at 3:30 in the morning I have to get my HCG shot and Friday at 3:30pm will be our insemination.

Dearest Family,

Dearest Family,
Over the last 16 months we have been trying to get pregnant. About 4 months into our journey we found some issues and sought the help of my OBGYN doctor. With the help of fertility medication and other tests we thought things were looking up, but by February we realized our issues weren’t entirely based on regular ovulation, but that there was an issue with the sperm as well. From that point we decided to team up with our doctor and attempt intrauterine inseminations (IUI). Our doctor was optimistic and said he would do a max of 6 inseminations (one a month) until I was either pregnant, or had to seek additional assistance. After 4 cycles of IUI and no success, we decided to forgo the inseminations at our general OBGYN and seek help from a fertility clinic. This past August was our first meeting with the clinic and they also seemed optimistic. Through tedious blood work and testing we were able to find that some mucous like fluid could have been plugging the fallopian tubes and after the mucous was removed we proceeded with our 5th IUI hoping for success. After a failed fifth attempt, we now come to you, our family, asking for your help. Over the course of this next month we will be performing our 6th and final IUI. If unsuccessful, we will have to look into much more invasive and expensive procedures, specifically in vitro fertilization. We ask for you (if you would like) to join us in fasting and prayer on November 4th, 2012.

We would like to thank you for all of the love and support you have shown unto us over the years and also thank you for your wonderful examples. We love each and every one of you dearly and words can truly not express our gratitude to have you as members of our family. We hope that through faith our desires of becoming parents will come true.


Love,


Lance and Christine

Wednesday

This past Wednesday was the final day of my two week wait (tww).  After the artificial insemination we had to wait 2 weeks to find out the results (pregnant or not pregnant).  I happened to have my clinicals at Riverton Hospital that day and was able to sneak away for a half an hour to go down stairs to register and get my blood drawn.  Then came the most difficult part.  WAITING. It was probably the longest hour I have ever experienced in my life full of anxiety, anticipation, fear, and nervousness.
I decided to not wait for the doctor to call me with the results and instead looked them up... 

 <5 not pregnant

5 or more pregnant 

 (normally it should be in the hundreds or even thousands depending on how far along you are)

my result:     2.

Yes. 2... which is less than 5 which means I'm not pregnant.  Extremely disappointed I tried to carry on the rest of my day.  A few hours later my doctors office called me and the conversation went as follows

"hello is this christine?"

"yes it is"

"hi this is (i forgot her name) a nurse from the Utah Fertility clinic.. How are you doing today?"

"uhh.. I'm okay"

"sooooo you know your results"

"haha.. yes I do."

"so you aren't pregnant. Your period should start in the next couple of days.  go ahead and call us when it starts and we will get you scheduled for your next cycle"

perfect. (i thought sarcastically)

The following day. 10 minutes before my midterm started my period decided to join the stress party.  

It was definitely a good thing my teacher had a bowl of Halloween candy on her desk... I was in desperate need to chocolate in the form of Milky Ways, M&Ms and Twix.. and yes I ate all of them.

“Thy will be done” and “in Thine own time.”

Over the last month, I have been bombarded by many (more than ever) asking if I was pregnant.  At first I felt very hesitant to tell people, but as our trial to get pregnant became more and more complicated, it was a relief to just openly talk about it.  With the majority of co-workers, friends, and family now knowing we are seeking fertility help, it has become a little overwhelming when people (not very close to me) ask what the latest news is.  

Going into our 5th IUI and our 1st IUI at the fertility center I felt as if this was our only shot (although I know that isn't true).  With the amount of money we have already invested I felt my prayers and pleading turn to an expectation or a frustration that if this one cycle didn't work, I was bound to never have children. ever.  I know that is a little dramatic, but I felt as if I could not endure another negative result.  I could not be disappointed again.  

With the fertility medication I have had to take this month I have literally found myself going CRAZY.  I am literally a CRAZY person.  The littlest things that don't really matter make me extremely upset and things that shouldn't affect me frustrate me beyond belief to the point of tears.  Just last week I found myself curling up in a ball on the couch with my puppy, just crying from sadness, then 15 minutes later I was throwing things in rage and ate a happy meal while facing a wall in our spare bedroom.  I know.  I am crazy. 

We spent this past weekend in Saint George with our good friends and while everyone was up talking and hanging out I was tucked into bed at 10:30 each night because the progesterone wouldn't allow me to stay up any later.  We toyed with the idea of taking a pregnancy test on Sunday, but decided against it since I had a HCG shot and that stays in your system for 10+ days.  We arrived home Sunday night and just as I was getting ready for bed I thought that I saw spotting... and that it was a negative. again.  Luckily when I woke up Monday morning there wasn't any spotting and my period had not started.  I have spent the last 24 hours hoping and praying that my period would not start, and I have 24 more hours until I can take my blood HCG test to get our official results.  

I know that the majority of my posts aren't sugar coated with gospel doctrine or optimism because I don't like to sugar coat things.  I like to tell things how it is.  Each and every day I am not jumping for joy grateful that we have been given this trial, and while I know that everything happens for a reason, it is hard to always look at things from such an eternal perspective.   There have been moments where I have felt lower than low and other moments where I know things will work out according to the Lords time, but now more than ever I truly do know that things are going to work out and that I have to learn to be okay with the negatives, because it will only make the positive that much sweeter.  

This morning when I woke up I had the impression to listen to a general conference talk as I got ready for school.  I don't normally do this, but I picked up my phone and turned on Henry B. Eyring's talk from Sunday of General Conference.  Below is just a little excerpt from his talk that I felt was so applicable to me...

“For there is a time appointed for every man, according as his works shall be.”⁵

We remove the pavilion when we feel and pray, “Thy will be done” and “in Thine own time.” His time should be soon enough for us since we know that He wants only what is best.

One of my daughters-in-law spent many years feeling that God had placed a pavilion over her. She was a young mother of three who longed for more children. After two miscarriages, her prayers of pleading grew anguished. As more barren years passed, she felt tempted to anger. When her youngest went off to school, the emptiness of her house seemed to mock her focus on motherhood—so did the unplanned and even unwanted pregnancies of acquaintances. She felt as committed and consecrated as Mary, who declared, “Behold the handmaid of the Lord.”⁶ But although she spoke these words in her heart, she could hear nothing in reply.

Hoping to lift her spirits, her husband invited her to join him on a business trip to California. While he attended meetings, she walked along the beautiful, empty beach. Her heart ready to burst, she prayed aloud. For the first time, she asked not for another child but for a divine errand. “Heavenly Father,” she cried, “I will give you all of my time; please show me how to fill it.” She expressed her willingness to take her family wherever they might be required to go. That prayer produced an unexpected feeling of peace. It did not satisfy her mind’s craving for certainty, but for the first time in years, it calmed her heart.

The prayer removed the pavilion and opened the windows of heaven. Within two weeks she learned that she was expecting a child. The new baby was just one year old when a mission call came to my son and my daughter-in-law. Having promised to go and do anything, anywhere, she put fear aside and took her children overseas. In the mission field she had another child—on a missionary transfer day.

Submitting fully to heaven’s will, as this young mother did, is essential to removing the spiritual pavilions we sometimes put over our heads. But it does not guarantee immediate answers to our prayers.

Abraham’s heart seems to have been right long before Sarah conceived Isaac and before they received their promised land. Heaven had other purposes to fulfill first. Those purposes included not only building Abraham and Sarah’s faith but also teaching them eternal truths that they shared with others on their long, circuitous route to the land prepared for them. The Lord’s delays often seem long; some last a lifetime. But they are always calculated to bless. They need never be times of loneliness or sorrow or impatience.

Although His time is not always our time, we can be sure that the Lord keeps His promises. For any of you who now feel that He is hard to reach, I testify that the day will come that we all will see Him face to face. Just as there is nothing now to obscure His view of us, there will be nothing to obscure our view of Him.

I can honestly admit that over the past 16 months Lance and I have found ourselves pleading with bargaining within our prayers that we might be blessed with the opportunity to become pregnant, to become parents, to have a heavenly spirit sent here to us.  As I listened to this talk I realized that we need to stop asking for what we want, but instead to let Heavenly Father give us what he thinks we need, when we need it.  

While we are still hoping these next 24 hours will go without error and that we might get good news tomorrow, I am still okay in knowing that if it isn't this time, it will happen.  Someday. When the time is right.

For more on what we believe click here:   latter-day Saints 

Expensive

One of the things I think that has really hit Lance and I in the past few months is just how expensive this entire process was.  We knew as we pondered the idea of going to a fertility specialist that there was a very good possibility that we would have to do in vitro which would be about $12,000.  Just thinking of that large lump sum had us in panic mode, so we decided to continue with the less expensive option, but just this past week I realized less expensive is all relative.

I went to Target a few days ago to order more contact lenses.  The lady used my insurance and since I have eyemed which pays for a large portion I ended up with a $15.00 bill for a 6 month supply of contacts.  I felt like I was being thrifty and 15 bucks was chump change.  I pulled out my Health Savings Account debt card (which the funds are deducted from my paycheck bimonthly) and figured I had plenty to spare.  A few moments later the lady came back telling me the card had been zeroed out and I still owed $1.53.  WHAT?!?! I had put hundreds upon hundreds of dollars into that account. How can it be completely empty?!  So I grudgingly paid the other $1.53 with my normal debt card.

Lets start from the beginning:
(2011)
1 round of Femara         $6
HCG blood test             $20
Progesterone blood test $20
(2012)
9 rounds of Femara      $36
Lance's Semen Analysis $188
Pregnancy Tests           $50.00
Ovulation Kits               $120.00
Nausea Medication       $67.81
IUI x4 (at OB office)   $ 1120  ($280 a piece)
Initial Consult             $391.64
Xray HSG Test            $138.00
Labs                           $1200.00
Round #5:
Fertility Rx (HCG and Progesterone) $124.78
3 Ultrasounds                $576.00
IUI @ Fertility Center    $350.00


Grand Total:  $4408.23

It amazes me how each payment wasn't super large so I didn't think we had spent much money, but when I calculate it out I am in complete amazement at how much we have spent on trying to get pregnant alone (not to mention the occasional visit to InstaCare).  The next question I'm sure you are all wondering is why isn't insurance paying for any of this?
Well lucky us for having a $1500 per person deductible (which we still haven't hit) because Utah health insurance does not pay to get anyone pregnant or cover infertility so a good portion of these costs weren't even billed to insurance.  I just got a bill directly from the office. 

So a few weeks ago Lance's dad was asking how things were going and jokingly I said "well how bad do you want a grandkid? we are currently accepting donations!"  In all seriousness we are doing okay paying for all of these unexpected and extra expenses, but the thought of having to spend another grand or so doing another IUI, or even 12,000 for in vitro is extremely overwhelming.

*Family: we love you all, but don't expect expensive christmas gifts this year ;)

Progesterone

Yesterday while attempting to study for two tests I suddenly got EXTREMELY tired. Tired to the point I could hardly hold up my own pencil.  With failed attempts to take a nap (thanks to my puppy) I pressed on and went to school.  After the exams I left straight from school and headed up the hill to work.  Talking to my dad on the phone as I drove seemed to be the only thing that could keep me awake.  I even opted to take a 10 minute nap in my car while in the parking garage with a car alarm blaring next to me.  I spent the rest of my 8 hour work night trying hard to focus on studying and in the end I only made it to 9:45 before I HAD to go home (I normally get off at 11).  With little sleep between my night shift and todays day shift I find myself today in the same situation.  Why is all of this relevant to TTC? Well let me tell you.

A year ago my OB had my progesterone level checked 7 days after ovulation.  The higher the number the better and mine was boardline good, so he wasn't too worried.  Progesterone is the hormone that helps build up the uterus lining for implantation to occur successfully.  Progesterone also helps develop the embryo so the more progesterone you produce once the egg is fertilized the better.  (low progesterone can result in a miscarriage).  Since my body is naturally producing progesterone I am already tired (like most pregnant people...) But the fertility clinic is being proactive and cautious so they prescribed me vaginal suppositories of progesterone to take for the next 25 days.. (and longer if I am pregnant).  So my natural supply of progesterone + 100mg of progesterone = double the side effects.   A few of those side effects include dizziness, headaches, TIREDNESS, lethargy, and nausea.  Luckily I haven't been subjected to any nausea, but tiredness, headaches, and lethargy are definitely taking over my body.  As I mentioned the prescription is a vaginal suppository which looks like a bullet that is inserted similar to a tampon.. but is never removed because it slowly dissolves... leaving a lovely milk lotion like discharge.  I figured since I place one each night before bed, that by the time I wake up the medication would be almost out of my system, until I read that the half life is 26 hours (meaning half of the medication effects are diminished in 26 hours and by that time I am placing a new one).  The things you go through to get a gummybear, but it'll be worth it :)

number 5

talking to lance before we enter Utah Fertility Center

Today was the day of our 5th IUI. When I tell people that we are doing artifical inseminations there first question is when do you start... and my response is well... today is our 5th.... then they look at me with shock all over their face. 

tiny room. Lance looking a little uncomfortable

my best friend... the transvaginal ultrasound... (luckily i didn't need to use him today.

So artificial insemination or intrauterine insemination only increases your odds of getting pregnant by 10%.  With our additional medication, ultrasounds, and procedures the fertility clinic can increase odds to 15-20%.  

Lance headed down to the fertility clinic at 9am to donate his swimmers.  At 10:30 we met back up at the clinic and waited for the doctor.  Today we had a nurse practitioner perform the insemination and this was the first time that Lance has chosen to stay for the entire procedure.  It was nice to have someone to talk to during the 15 minute wait (afterwards) instead of just playing family feud on my phone.  Lance took a super attractive picture of me laying and waiting that looks like I'm eating a pole...

The table they had me lay on was SUPER high tech.  The NP was able to RAISE me up to her level.. and then afterwards tilt me so my bottom was up higher than my head.  

So far so good.  Tomorrow night I start vaginal progesterone suppositories for the next 25 days.. and we do a blood pregnancy test in a couple of weeks.

HCG spike. Ready to Rock & Roll

Checked this morning to make sure the HCG shot from last night worked and low and behold it did. The two strips are pregnancy tests which are positive with two lines. (A urine pregnancy test is just testing for an increase in HCG in the hormone, which is present when you are pregnant, or in my case present since I just injected HCG into my belly last night). The smiley face is testing my LH hormone surge indicating that my follicle or egg is getting ready to be released.

What does this all mean? We are ready for IUI tomorrow. Yay!!

Like clockwork

Tonight was the night for my HCG shot. The injection has to be exactly 36 hours prior to insemination and since mine is scheduled for Wednesday morning at 10:30 am I had to receive my shot at 10:30 tonight. I wasn't too afraid as I have given many shots (yay for nursing school), but lance was pacing like a crazy person. Almost as if he was nervous about getting a shot, but he was just the one giving it!! After I drew up and mixed the medication I handed the needle to lance and taught him how to give his very first subcutaneous shot. Needle-ess to say he did a very good job. 😜

Work and Fertility

After nearly two weeks of waiting for my ovulation days to come I was finally scheduled to come into the office last Friday, my cycle day 11.  I had spent the last week playing phone tag with a nurse at the fertility clinic in regards to the uncomfortable itching I was feeling down below.  Apparently it is common to get yeast infection when hormones are drastically changed.  Lucky me. 
I was scheduled to work a 12 hour shift on Friday, but thanks to my kind co-worker Heather, I was able to go to my appointment and then come into work after, while she came in 4 hours early to cover for me. 

Lance and I went to the clinic and by this time I had become a professional vaginal ultrasound guru.  Pee prior to the procedure. check.  remove clothes from the waist down. check.  lithotomy position. check.   As soon as the nurse practitioner came in I drilled her with my numerous questions about the complications this yeast infection would cause in regards to antibiotics and intercourse and side effects.  After that was all settled we proceeded with the ultrasound which showed a nice thin lining of 2mm and two follicles (eggs) 12 mm big, one in each ovary.  Apparently 12mm isn't big or mature enough so we had to schedule another ultrasound for Monday (which I just so happened was also scheduled to work.  Just as we left our 5 minute long appointment we were notified that our ultrasound bill would be $192 bucks.. Yes. $192 dollars for 5 minutes with the nurse practitioner.

Sunday night I called my charge nurse and told her the same scenario was happening and that I would need to be delayed or cancelled so I could make it to my ultrasound appointment.  She couldn't guarantee anything and instead called me at 4:30 am to let me know that I would NOT be cancelled and that I would either have to call in sick or come in to work.  Not wanting to take a sick day I woke up at 5:30 and left my house for work only to become extremely frustrated when I saw that we only had 9 patients total in the entire unit (and one CNA can handle 9 patients...10 is when another CNA is necessary).  Happy with only a 5 patient workload I finished all of my work in a fraction of the time it would have typically taken me and was even able to finish some homework while I waited for a call light to go off.  at 8:20 I decided to call and reschedule my ultrasound for the following day (which was not ideal, but a necessity).  Right after rescheduling my appt I walked up to the front of our unit and began talking to my co-workers about what was happening.  After finishing my story they all said... well go to your appointment now, we can handle things here.  Ahhh a slight sign of relief I hurried and called the clinic back to undo my cancellation.   Rushing out the door and to the office that was 20 minutes away I called Lance and we met up in Murray.

Walking into the office I was full of apologies to staff for my confusing coming..not coming... coming chaos.  It felt like deva vu as I peed, stripped, and lithotomy positioned it.  This time, however, my lining was grown to a healthy 6mm from the previous 2mm, and my right follicle was 19mm (>18mm is a mature follicle).   Happy about the right follicle we anxiously searched for the left follicle to learn it was still 12mm.  Slightly bummed at only having one mature follicle and my dream of twins thrown out the window I gave a frown to Lance who seemed content with the idea of only one follicle... haha!  Afterwards I hurried and got dressed and exited to meet with the nurse. 

We scheduled our IUI for Wednesday at 10:30am with Lance's collection for 9:00am although I am scheduled to be at clinicals on Wednesday... (of course)!  I was slightly surprised by how specific timing is with the fertility clinic.  I have to inject myself with HCG via tummy shot at exactly 10:30pm tonight to allow for exactly 36 hours of work before my insemination.  When we went to the OBGYN for IUI Lance would drop off the sample and within 10 minutes my IUI was performed.  I suspect the go into much more detail for the cleansing and preparation process of sperm. 

-keeping our fingers crossed!