Thursday, October 15, 2015

Infertility Treatment Before IVF

      The previous post was an emotional one, I know. But I think sometimes we, as a society, believe that only good feelings and news should be openly shared while the sad, difficult stuff gets hidden inside, even though we ALL have sad and difficult things happening in our lives. I say embrace the sadness just as you embrace the happiness and eventually you begin to feel a lightness in your soul as those heavy layers of guilt and shame you've hidden your heart underneath are removed, like the unraveling of a cast that reveals a once broken arm on the mend.  So now that the emotional aspects of dealing with infertility have been examined and witnessed I can move on to the straightforward business of infertility medication.
        In July of 2014 we went back to see the reproductive endocrinologist specialist to stress our concern that we had still not been able to conceive. The doctor then ordered the very first step in infertility treatment, which was to have Chris' semen analyzed for any issues in motility and/or quantity. This tends to be the initial step because a semen analysis is quite easy (and inexpensive) compared to the more invasive treatments that female patients must undergo. Chris' results were great so we were told to continue having sex naturally for a few more months until we had reached the 12 month deadline from when we'd begun trying to have a baby. 
      Still, I felt like I needed to do more so I began to see an acupuncturist for fertility after having read that it might be beneficial. I also started using an app on my phone to keep track of my periods, when I ovulated, and my optimal fertility window. Knowing the exact dates of your cycle, especially when you start your period, is a very important detail throughout the entire infertility process (whether or not you decide to go through IVF) so it's absolutely necessary to keep track of your menstrual cycle.
        In October of 2014 the year deadline was up. I called my fertility doctor and told them we were ready to seek infertility treatment. I stopped seeing the acupuncturist and focused all my energy on Western science. I thought we would meet with our fertility doctor, he'd prescribe me some medications, and that we'd be on the way towards pregnancy, simple as that. But one thing I've learned from this whole process is that infertility treatment takes much longer than you'd expect.
       We had our first official infertility consultation in November, during which I had a vaginal ultrasound to see how many follicles my ovaries were naturally producing. Then I had to have blood work done to make sure I was healthy and to get data on my estrogen and progesterone levels, and then I had to have a hysterosalpingogram (HSG). The earliest the HSG could be scheduled was in January of 2015.
        These were just the prerequisites before receiving any fertility treatment, so, if you're dealing with reproductive issues, know there's a lot of waiting time involved before, between, and after treatments. While we waited for the HSG appointment we continued using an ovulation predictor kit (basically peeing on a stick) and having sex, hoping that this time around we'd get pregnant the "natural" way and then things would be a little bit easier.

       After returning from winter vacation in Austria I had the HSG appointment. An HSG is an x-ray exam in which a dye is pumped into the reproductive organs to check for any tubal blockages or abnormalities in the uterus. It would be the first of many times I would have a tool inserted into my cervix. Oh joy. After getting an all clear from the HSG results we were finally ready to begin the medical treatment. Due to the good HSG results and the fact that my ovaries were still producing plenty of follicles it was decided that I would be taking 50mg of Clomid every day for about a week. Clomid is a drug that stimulates the growth and release of mature eggs, meaning that instead of just one mature egg being released each month I would, hopefully, have at least two mature eggs which, in turn, would imply that the sperm would have double the opportunity to fertilize at least one of the mature eggs. 
        My body responded very well to the Clomid...too well, in fact. Four mature eggs had been released, which caused the RN to worry that we might possibly end up with too many fertilized eggs. She said it's not an ideal situation because multiple embryos can cause complications in pregnancy. Still, she encouraged us to go ahead and have sex anyway. I remember her telling me that she'd be surprised if I didn't get pregnant this time around. Well, she wasn't the only one surprised when, in fact, I did not get pregnant. 
      In February I began round two of Clomid. This time they gave me a pill cutter so that I could switch between 25 and 50 mg of Clomid every other day. They said that even though I hadn't gotten pregnant the first time that didn't mean I wouldn't be able to with the second round even if I had fewer mature eggs to fertilize. I did have fewer mature eggs this time, two instead of the previous four, which made my doctor and RN more comfortable. 
      To make my chances of conceiving even stronger, it was decided that this cycle I would undergo an intrauterine insemination (IUI). This way Chris' sperm would be placed directly inside my uterus, via catheter, where they would be closer to the fallopian tubes, essentially giving them a head start and increasing the chance that at least one of my two mature eggs would be fertilized.
      To prepare my body for the IUI I was given paperwork to read, needles, and an injectable hormone called a human chorionic gonadotropin (HCG), which triggers ovulation of the mature egg(s). The HCG injection is an intramuscular butt shot that must be given exactly 30 hours before the IUI procedure, which for us meant setting an alarm at 1:50 am so we could wake up and prepare the injection for the scheduled 2:00 am shot , then me gripping the closet door frame as Chris stuck the needle in the upper region of my ass. To date that has been one of the most painful shots I've received.  Having it done while groggy with sleep didn't help either.
      The IUI was done an afternoon in early March of 2015. Chris had to bring in a fresh semen sample which was then washed in the lab to separate the actual sperm from the seminal fluid. Then I had to lay down while the sperm were inserted into my uterus, a non-painful process that took about 15 minutes. Afterwards I was told to continue laying still on my back for 30 minutes to an hour and then we went home to wait a couple of weeks until we could take a pregnancy test which, as you know, came back negative.
      Soon after this second failed Clomid attempt Chris got a new job which meant new insurance coverage. We decided that while we waited for our new insurance to be ready we'd put the infertility treatments on hold but continue trying to get pregnant the natural way. Maybe we just needed to relax, like we'd heard from time to time, and pretend that we didn't have any fertility problems; mind over matter, right? I even tried some meditative deep belly breathing techniques for a couple of months and, well, no, of course that didn't work because...
      Once we were established with the new insurance company we were able to dive into the world of In Vitro Fertilization (IVF), one of the last options for conceiving, not taking into account surrogacy or adoption. This is still the current phase of infertility  that we are in. More about our IVF process in the next post. Thanks for reading! 


le coot said...

Wow. I knew fertility treatments were intensive and invasive but seeing those diagrams, needles, tubes, the words "insertion" and "cervix" in the same sentence ...
Next stop, Queasy City!
And what is it about the butt that makes it a good place for shots?
Anyhow, you are really tough to be able to put yourself through all of this.
Also, it makes me really happy to know that there are infertility memes out there.

Love you!

Mami said...

Difficult journey for sure. You're very brave for handling the situation the way you did, and for being able to talk openly about it.
Thank you for sharing such delicate and personal issue. All the efforts will pay off soon!
Love you!