Everything I wanted to know about my Uterus...

In anticipation of my upcoming sonohystogram, I scheduled an appointment to get my bits waxed. I've always done this for all my gyn exams, even before I stated seeing Dr Somebody that I Used to Know. Then I read on Overworked Ovaries that Jen S prepared for her appointment by getting a pedicure and I was inspired to do the same. As a consequence of years of sports, I have such horrible toes and I never saw any point to getting a pedicure, since I would quickly ruin the work of the manicurist. Then, I recalled how when I was in school, my mother used to advise me to dress well on the day of a big exam. Her theory was that if you have a positive self image, you'll feel more confident approaching the test. I decided that by covering the embarrassment of my flawed toes, I could feel even better about myself, which could help me as I received the news of my results.

So about my uterus... It's been a pretty peaceful co-habitation for most of my life. My menstrual cycles were rather benign. No cramps that kept me from missing school or sporting events. No heavy bleeding that caused the humiliation of stained clothes. When I started birth control pills during my quest to be deflowered, there wasn't too much change with my happy-go-lucky period. Then during a routine visit, it was discovered that my blood pressure was 150/110, and I was ordered to stop the pill immediately. Not wanting to face the weight gain with Depo Provera, or the reduced efficiency with condoms, I started researching other alternatives and discovered the Mirena IUD. Hypertension would become the best thing to happen to my reproductive life! Not only did I have a method that was more effective and convenient than the pill, but the period that wasn't too bothersome disappeared completely.

After more than ten years of amenorrhea, I was prepared for AF to return with a vengeance when my IUD was removed. I went to Costco and purchased a large multi-pack of tampons. (Seriously, why did it take manufacturers so long to come up with the multi-pack box?). AF announced herself with barely a whisper. I only need 3-4 light tampons on my first day. The second day I can get by with one pantyliner and on days 3 and 4 (if there is one) I'm just noticing a few spots on the TP. Even during my miscarriage, I hardly had any bleeding. I've scoured all my texts books and there is little written regarding the 'pathology' of hypomenorrhea. I can't recall even having a patient complain about a menstrual cycle that is 'too light' and 'too short'. I gave Co-worker all my medium and super tampons and she went through both boxes before I finished the box of light absorbency ones.

My RE thought it was likely a normal variant. As I was ovulating, I wasn't hypothalamic, and I didn't have any risk factors that would contribute to Asherman's syndrome. It was noted that I may have a slight septum during my initial evaluation, and he had agreed to evaluate with a sonohystogram. The saline infused ultrasound confirmed it's presence and estimated 25-30% depth. He noted that it isn't always clear how much a septum of my size contributes to infertility or pregnancy loss, but he recommended moving forward with a hysteroscopic resection. For the record, I had scheduled a sonohystogram in August, wanting to evaluate my uterus while we waiting for Husband's Clomid to take effect. The appointment needed to be rescheduled and I wasn't able to come in during the required time. My RE examined the films from my hystosalpingogram and thought the septum if present, was only slight and likely insignificant and deferred the sonohystogram at that time. But I am digressing... I'm pleased that he was decisive with the decision to go forward with resection, rather than taking a more conservative 'wait and see' approach.

I must admit I am a little surprised. A part of me thought I'd go in and learn that my uterus is normal and I've been over analysing my scant flow. I feel validated that I pursued having this study done, although it now means another procedure and more waiting. Better to wait and do it right with my new and improved uterine cavity.

Welcome to the Occupation

A few friends IRL have asked what it has been like for me to work in obstetrics while we're struggling to conceive. For the most part, it doesn't bother me. I've been in this job for so long, and for the majority of my career I wasn't interested in procreating. I learned a long time ago to divorce myself from the emotional aspect and view pregnancy as a clinical process. At the most, I'm finding it hard to distract myself right now. I see all of our newly pregnant patients and perform their initial ultrasound. It's truly a privilege to be able to share that experience with those couples who have a viable pregnancy and when it's a heartfelt, happy moment. Lately, I've been wondering if I'll ever have that experience on the other side of the ultrasound wand. At the point in time when I wasn't interested in getting pregnant -and even in the early months of trying to conceive- I had a blasé attitude toward my own potential ultrasound. It's what I do all day, so wouldn't be anything surprising or exciting. Myrtle and a few other friends tried to tell me, 'but it will be different when it's your own!' I couldn't appreciate it at that time. 'No, it will still look the same...' I countered. Co-worker suggested that the appreciation during my scan would not necessarily be seeing the ultrasound images (which are so familiar to me), but seeing Husband's reaction to them. Okay, I relent. If I ever have a viable pregnancy, I will perceive the experience of seeing our baby for the first time as a big deal. I may even shed a tear or two. Previously, I had also rejected the notion of doing the "3-D" novelty ultrasound. It's a lot of money to obtain creepy alien-like images of your baby. I changed my mind when I saw a mother with her daughter during her first ultrasound. I want my mother to have this experience too.  There were a few instances this year when I had a newly pregnant patient who had the same last menstrual period date as I did, and her ultrasound images confronted me with a reminder of what could have been if our procreation was successful. Following my miscarriage, I had a few patients who had an LMP a day or two off from mine, but so far no one with the exact date. Then one day I had a patient who hadn't restarted her period after stopping breastfeeding, and she had no idea how far along she was. I was using our older ultrasound machine, which doesn't automatically calculate the due date. While the patient was getting dressed, I went back to my office and spun her measurements in the gestational wheel of fortune. There it was. 5 August 2013. I laughed quietly to myself and set the wheel down. This particular patient was diagnosed with diminished ovarian reserve and endometriosis during her infertility work up. After successful IVF, she delivered twins less than a year ago and consistently used progesterone only birth control pills while breastfeeding. Ever reminded that fertility is a such a fucker.

I'll try anything...

After rejecting all the bullshit advice from well meaning friends and family, "just relax," "keep your legs up after sex" or "wear socks!" what advice to you take from fellow infertiles? Admittedly, we're a pretty biased group. Following months, if not years, of failed attempts and treatments, it's hard not to believe that what you ate for breakfast contributed to the success, once it is achieved. Some alternative treatments  most often employed include acupuncture and vitamin supplements. The data is light, due to limited studies evaluating supplements, and difficulty analysing acupuncture effects without a true 'placebo' comparative. I came across a journal article that examined many different uses of acupuncture in an Ob/Gyn setting. While the authors noted that the use of acupuncture for infertility is increasing, the only statistically significant benefit was reducing pain during egg retrieval. Co-worker's RE recommended that she start acupuncture. Co-worker asked if she had some statistics to show that it helps achieve a pregnancy, but her RE claimed that it would help her with her painful periods and she asked her "what do you have to lose?" Um, money? thought Co-worker who was finding the bills for her fertility treatments daunting. She had been dealing with her heavy and painful periods since she was a teenager and had learned to cope. She wanted answers to why she has heavy periods and if it was contributing to her infertility and was frustrated that her RE was deferring her laparoscopy and was insisting on doing "one more IUI". It was the one that was successful in impregnating her with twins. A few weeks later, I encountered a local acupuncturist at a holiday party and decided to do a little recognisance work. She identified herself as an "infertility specialist", which I questioned if it was like the title 'Assistant to the Regional Manager'. Acupuncturist who specialises in infertility seemed a little more accurate. I asked a few specific questions on how acupuncture is thought to benefit fertility patients (specifically about increasing blood flow to the uterus) and when during a treatment cycle (i.e in the follicular phase, just before or after IUI or transfer?) should it be performed? She didn't answer any of my questions, but just discussed how all her patients get pregnant, and then she continues to see them and she flips breech babies and induces labour. Really? No one has a 100% success rate. Maybe she didn't want to answer my questions as I was disturbing the 'delicate genius' at a party, but I expected a little more substance from a 'fertility specialist'. She handed me a handful on her business cards. While not completely skeptical, I also wasn't convinced. I decided that doing acupuncture would cut into my exercise time, which also promotes relaxation and improves blood flow.
I was also a little hesitant to start supplements. When Husband first received the results of his semen analysis, he headed to GNC and purchased everything the Google reported would improve sperm counts and quality. Unfortunately, neither the supplements nor Clomid improved his semen analysis much, and the drawer in our bathroom still smells like dried leaves, as I suspect he's stopped taking them. However, I have heard some women reporting improvements with their follicle counts or lab results. Additionally, I was in the 'what do you have to lose?' mindset. Non Sequitur Chica posted a list of doctor recommended supplements on her blog. I picked up all the ones that target blood vessel and endometrial support for about $75. As long as I'm waiting to start treatment, I might as well try to make the most of it. I've also read that some women have tried eating pineapple during the time of embryo transfer to help thicken the uterine lining. I like pineapple and could very well be eating it at that time anyway. If grapefruit juice can cause significant drug interactions, is it that unreasonable to think that other foods could work in weird ways?

Welcome ICLW!

Thank you for stopping by my blog! This is my second time participating in ICLW. I met so many awesome fellow bloggers last month, and I'm really excited to meet some new bloggy friends. Here is the cliff notes version of our story so far and my blog:
Husband and I started TTC in the Autumn of 2011. We had a few false starts, but as I work in women's healthcare, I figured it would happen quickly as I 'know what I am doing'. After only a few months, I became impatient and started using Clomid -still no success. In the meantime, my childhood BFF, Myrtle, practically conceived on her honeymoon and my cousin had a spontaneous pregnancy at the age of 41 while she was "relaxed" in Hawaii. Myrtle is the typical well meaning friend who tries to be supportive, but says all the wrong things. While my cousin, now a two time infertility survivor, forgets what it is like to be in those shoes. There are many posts that address my attempts to cope with their pregnancies, while struggling to achieve one of my own. So why can't the one in ob/gyn get herself knocked up? We discovered that my Husband has moderate male factor infertility and my ovaries are inconsiderate, inconsistent little bitches, who take pleasure in keeping up guessing. He's got limited bullets and I'm a moving target. We met with the reproductive specialists last summer and were encouraged when Husband was noted to have mild hypogonadism and was started on Clomid, with the hope of increasing his count. I kept joking that he was going to ovulate, but he didn't and unfortunately his count was only slightly improved. We received the verdict that we would most likely need IVF -possibly with ICSI, but could give IUI a good faith try for a few cycles. The day before I was scheduled to start our IUI cycle, I got a BFP. Yes, we were one of those stories you hear about. Unfortunately, I miscarried when I was six weeks along. There are many posts that address that event, as writing in this blog really helped me get though that difficult time. Logistics have prevented us from trying for a spontaneous conception in the few months following my miscarriage, so we're anxious to start IUI in February or March. We're planning to do 3-4 cycles of IUI, and if they don't work, will start the IVF process in Autumn after taking a few months to pause and see if we have the miracle conception that lets us avoid IVF. We're going to Hawaii in September (albeit with my parents and in-laws...), but everyone seems to be telling me it will happen there. I mean, no one is infertile in Hawaii -right?

A Marathon versus a Sprint

I joined an online infertility forum when I realised that I needed to vent my frustrations regarding my infertility and Myrtle's upcoming delivery. One of the most helpful comments I received was "it's a sprint for others and a marathon for us". Not only was it a brilliant analogy, but it accurately fit our situation. Myrtle ran track for one season and was a sprinter and I am a distance runner. I did my first half marathon in 2009. I was inspired when a seemingly un-athletic woman in my office revealed that she had done a few marathons (she walked, but it's still covering 26.2 miles). So, I signed up for a "disease race" (term coined by my swim coach who gets inundated with fund-raising requests) and completed a twelve week training program and raised $1,000 for The American Heart Association. I was keen to do another one and maybe consider training for a full marathon, but we started looking to buy our first home. In 2010, we became homeowners and renovation projects consumed all our free time for at least a year. Then, Myrtle invited me to be a bridesmaid in her wedding, which provided the motivation to get back into fitness. I completed two triathlons and re-discovered the fun of racing. I signed up for many 10K events, aiming to do at least 1-2 per month. It's a comfortable distance for me and I figured that I would still be able to partake in the earlier stages of my pregnancy. When the pregnancy thing wasn't happening, I decided to increase my distance and registered for a half marathon. I confess I was trying to tempt fate a bit, but suddenly the race was a month away and I wasn't pregnant and hadn't trained very much. Husband and I were worried if I would finish under the official cut-off time, but to my surprise I ran it in 2:14 -eight minutes better than when I properly trained. Once I discovered that I could prepare for a half marathon in 3-4 weeks, I continued to schedule events to console myself when I received a BFN. Recently, I decided that I needed a new challenge and I found a unique 18 mile run, which is scheduled in May. I can't say I'm trying to tempt fate, as the race organisers allow a full refund (albeit race credit) if you cancel up to ten days before the event (it's a woman only race, and that policy was probably based on possible pregnancies). However, it will be good to focus my training on a new goal. I thought a bit more about the comparison between distance runners and sprinters. Yes, sprinters get much attention. Almost everyone can name Usain Bolt as the Gold Medal winner of the 100 metres in the recent 2012 Olympic Games, but only dedicated runners know that Stephen Kiprotich won the Marathon Gold (along with his friends and family). I also thought about how impressed I was when I learnt that someone I worked with was among the 1% of the population who have completed a marathon. It's a triumphant accomplishment. Almost anyone can run a 100 yard dash. Only a few have the strength to endure a marathon.

The thin line between love and hate...

It a volatile relationship with AF. On the months when she punctuates your two week wait, you hate her. However, when you need her to arrive in order to start treatment, she's your new best friend. It's also possible to love and hate her at the same time. AF finally arrived, my required one 'normal' cycle before starting IUI and also I can now schedule my sonohystogram. Hours before she made her appearance, I had finally made up my mind about going back home. I decided it would be good for me to go. Although it's not the ideal destination, it may be our last opportunity to have a bit of a holiday for a while. Once we start fertility treatments, it will be harder to plan a a get-away around my cycle and monitoring appointments. I decided to go for only 6 days -rather than the entire 10 days that Husband scheduled. It would be less stressful for me to have more time to tie up things at work before going, plus a weekend to myself would be nice. When it comes to visiting family, some times less is more. This break would give me some time to play in New York, catch up with old friends, meet Myrtle for lunch (see her without little Myrtle first) and visit with my parents for three and a half days -just the right amount of time. I got a ticket for a great price and felt at peace with the decision I agonised over. This was just the repose that would be beneficial for my mental health. Then AF arrived. Naturally, the first thing I had to do was to check my fertility forecast. Unfortunately, it does project that Husband and I will be on opposite coasts of the country when I ovulate this cycle. Thanks Mother Nature, I could have used this information a few hours ago. I shared this with Myrtle, who asked for an update, and by the way, still does not know the difference between IUI and IVF despite 5 or 6 detailed explanations. "I think you should try anyway," she advised me. "You never know...". I cut her off before she could say anything else. There is nothing that annoys me more than hearing the words 'you never know'. Firstly, yes I do know. Not only is this what I do for a living, but it's what I've been working on for over a year. Secondly, I realised that Myrtle has never used a fertility monitor to identify when ovulation is imminent. She has no idea what it is like to POAS daily to follow where your cycle is on a day-to-day basis. She thinks you merely have to have sex to become pregnant -with socks on. Following the miscarriage, Husband and I were tempted with the idea of continuing to try to conceive spontaneously. We conceived on our 7th attempt, although it took us nearly a year to be able to have seven valid attempts. The logistical issues of the past two months have confirmed and validated our decision to move forward with IUI. I don't know if I could handle another month of waiting for my O day to arrive at a time that is completely inconvenient and possibly miss yet another attempt. It is our goal to have a baby, not to conceive spontaneously. Besides, if the treatments don't work we'll have all the time until menopause to try to make it happen naturally.

A night at the gay bar...

Almost everyone who grew up in the 80s remembers the opening theme song to the long running show Cheers:
"Making your way in the world today, takes everything you got,
Taking a break from all your worries, it sure would help a lot"
I think just about anyone would embrace that notion, but I disagree with the next few lines in the famed lyrics:
"You want to go where you can see, the troubles are all the same,
You want to go where everyone knows your name"
No. Sometimes you want to get away to a place where no one knows your name and no one shares your troubles. That place is a gay bar. The initial appeal of a gay bar is that any woman can go to dance with her friends and not endure any unwanted attention. Added perks include the fact that all the men in attendance are rather attractive, well dressed and most can actually dance. There's virtually a contest among them to see who has the best upper body. You can claim to be the hottest girl in the room as it's your word against... well no one else's, since no one is looking at any of the few women in the bar. Best of all, you can almost guarantee that no one is talking about their appointment with a reproductive specialist, fertility monitoring, egg quality or semen analysis (well, possibly in a different context). My friend H and I had found the formula for two straight married white women with no rhythm to be welcomed guests at our nearby gay bar. Bring a coffee for the guy at the door (and sometimes have your cover charge waived). Tip the bartender generously. Offer the DJ a Red Bull, and he may play a request (usually Dancing Queen or in memory of the late Davey Jones, Daydream Believer). The gay bar had become our retreat when one of us had a bad week at work and always seemed to renew the bonds of our friendship. So, it was fitting that we were at the gay bar when I first told H that we were trying to conceive. H and I met and became friends at the time in my life when I didn't think I wanted to have children. She was committed to being child-free and not only was this something we had in common, she had reassurance that she wouldn't lose a friend to the motherhood. As awkward as it is for one friend to have a baby while the other is infertile, it's just as hard to have a baby when your close friend is not planning to have one. It changes the dynamics of the relationship, no how much you deny that it won't. I knew I had to tell her that I would be breaking our unspoken pact right away. H was surprisingly supportive. "Hey, if that's what you want, then that's cool" she told me. Months later, when we were back at the gay bar, I disclosed our fertility troubles. "Oh, I'll put you in touch with M!" (a friend from home who also dealt with infertility) "You two will have a lot to talk about!". The next day she introduced us over email and I had someone else to assure me that I didn't have to experience infertility alone. I learnt that you can never underestimate the ability for people to surprise and impress you. As I was coming to terms with infertility I had discovered frustration in friendly sources and surprising compassion and support in unexpected places. A gay bar is the perfect sanctuary to escape your infertility worries for a while. Time to go glitter up!