The Arrival of a Little Lady

It's been awhile, but our IVF cycle is finally complete! Miss H arrived on 10/23 at 9:04 a.m. She was 7 pounds 1 ounce and 20 inches long. As I'm writing this, she's sleeping on my lap, which is pretty much what she does most of the time: eat, sleep, and scream for a diaper change. :-) So far she has been a wonderful baby! She slept in her Rock-n-Play for the first couple nights we were home and then we moved her into her crib with a swaddle. She goes down at night between 9:30 and 11 p.m., wakes up around 4:30 a.m. to eat and have a diaper change, and then goes back to sleep until sometime between 7 and 9 a.m. We completely realize how spoiled/blessed we are and hope/pray that it continues!

I went into labor at 40 weeks 3 days, which was 4 days before I was scheduled for an induction. It was a Tuesday morning and I woke up to go to the bathroom at 4:53 a.m. (about 8 minutes after Brian left for work) and realized my water had broken. It wasn't dramatic, but it was definitive. :-) I immediately called Brian who answered his cell phone with "This is either really good or really bad…" I told him that my water had broken, but that I wasn't experiencing noticeable contractions and for him to stay at work for his morning shift. I then hopped in the shower (because I'm a freak about cleanliness) and proceeded to get ready. After I was ready, I packed my bag (which I had kept putting off) and then took Gatsby out. Then I fired up my work computer, sent out a flurry of e-mails on pending issues, and let the necessary parties know that I was on leave effective that morning. :-) Brian kept checking in all morning and asking me when I should call the doctor. Since it was so early, my obstetrician's office wasn't open yet and I didn't want to call the on-call doctor, since I wasn't having contractions yet, so I told Brian that I'd alert family members at 7 a.m. and then call the doctor when the office opened at 8 a.m. Then I ate a bowl of Cheerios, drank some grape juice, wrote several thank you notes that were pending, filled out my absentee ballot, and paid several bills. When I spoke to the doctor, they told me to come into the office at 9:30 a.m., so I still had time to kill. :-) When I was walking out to the mailbox, I started feeling some contractions and I realized that I was probably going straight to the hospital from the doctor. So, then, I kicked it in high gear and packed up all of Gatsby's stuff for the boarders and decided to pack Brian's bag too. I left the house around 8:45 a.m., took Gatsby to Suite Paws, and met Brian at the obstetrician, who confirmed that my water had broken and that I was 3 cm dilated and told me to go to the hospital. Since we had 2 cars at the doctor, we decided to take one car home and tie up some loose ends at home (like feed the cats) and then we were off to the hospital!

When we arrived at the hospital, we went to patient registration where the lady working the desk had a huge freakout because I was in labor until we (and another nurse) were able to make her realize that the baby wasn't coming right that second in patient registration. Once she calmed down, she took all my information and they got me a wheelchair. We then went to another desk to sign waivers, etc., and I proceeded to spill my tumbler of water all over the floor. Not because of any dramatic labor thing, but because I'm an idiot. :-) We were then taken straight to a room (the obstetrician had called ahead) bypassing triage because if your water has broken, then you have an automatic admission to the hospital!

We got to our room and proceeded to be bored out of our minds for a long time. We both just kinda played on our phones the whole time. When they checked me at the hospital, I was still at 3 cm and we decided to wait an hour or so before starting Pitocin to get my contractions stronger. When the doctor eventually came back and I hadn't progressed much, so we started Pitocin (because I didn't want to wait too long to progress and end up with a c-section). Around late afternoon, the contractions were getting stronger and I was progressing, but quite slowly, and I knew it was going to be a long night so I opted for an epidural. It took about 1.5 hours to get the epidural in after I requested it and during that time my contractions started getting a lot stronger and I knew I had made the right decision for pain relief. The epidural was really nice, but by late evening, I was feeling some pain from the contractions and we asked anesthesia to up my dosage. Fortunately, they did, which also allowed them to continue to pump up my Pitocin throughout the night. My little "magic" epidural button we set to give me drugs every 20 minutes and I pushed it pretty much every 20 minutes on the dot, so that I could get some rest. I never really slept all night, but I did rest. Brian also rested in a really uncomfortable chair all night. I was checked several times and continued to progress, but not quickly.

By 6 a.m. the next morning, they determined that I was at 10 cm, but the little lady was up pretty high. Because my epidural was maxed out after a night magic button pushing, I needed for it to wear off a bit so that I could feel my contractions to push. That was when things really started to suck. I got sick several times and each contraction began to feel stronger and stronger and they were hurting a lot. Around 7:30 a.m., they were setting everything up for me to push, but it was taking forever and I was in a lot of pain with each contraction. I pretty much sat zoned out with my eyes closed and Brian kept putting a wet washcloth on my forehead, but I was starting to get irritable (as one who was 27 hours into labor without any food might do) and I definitely had a bit of an emotional breakdown with the nurse. It probably wasn't my finest hour, but I was exhausted and ready to be done. The super nice nurse was really, really nice and helped me talk through it. Brian was also great throughout everything. He advocated for me when I needed it and would go out to talk to the nurses to get what I needed ASAP. I know it was a very long night for him, just staring at my contractions and H's heart rate on the monitors.

Finally, they were ready and it was time to push (with each contraction)! I wasn't terribly efficient at first, but I figured it out and got quite efficient. In fact, little H was ready to make her arrival and the doctor wasn't there yet, so they told me I needed to stop pushing and wait. I was pretty much like "you've got to be f&(*ing kidding me?!" but I did my best. Waiting for like 5 minutes. Eventually the doctor got there and it was like something out of a movie! She came running in, got in her outfit without missing a beat, and was ready to roll pretty quickly. At that point though, they needed to scoot me down the bed and they asked Brian to help move me (he was on my left side). In all of the chaos of the doctor arriving, he didn't hear them, but I did. I looked at him and he was just kinda looking around and I was like "JESUS CHRIST, BRIAN, LET'S GO!!!! MOVE ME DOWN THE BED!" (I did apologize later and I know he just didn't hear what they asked in all the chaos!) Once I was in position, we were ready to go and H arrived within about 2 minutes.

When she arrived, it took her about 15 seconds to cry and then they immediately put her on my chest and I met my sweet baby girl for the first time. It was pretty incredible. She was totally alert and just looking around. After the cord stopped pulsating, the doctor let Brian cut it and then the two of us just pretty much stared at H for a while. Brian took several pictures and texted the family. :-) Once the doctor got everything with me set, she came up by my head and admired H for awhile. I will forever remember what she told me: "Aren't IVF babies just amazing? I have twins from IVF that are about to turn 6." She was right--they are pretty amazing! After a bit, they swaddled H up and gave her some eye drops and a Vitamin K shot and she laid on the table for a bit while they checked her out. At one point, I looked over at her and she was just laying there, chill as can be, staring around the room. It's pretty amazing that her personality was that evident--mere minutes after she was born. Brian held her for a bit while they got me ready to move to my postpartum room and then we all moved over there. Once I got in my new room, my vitals were checked and so were H's and eventually all the grandparents arrived! While my parents were there, I passed out from exhaustion (and pain killers) and H got her first bath with Brian and my parents photographing the whole thing. Eventually, I woke up and was able to take a shower!!!!

And then we all 3 settled in for a 2 night stay in the hospital where nothing eventful happened--just lots of well baby and postpartum mom checks! (All of my postpartum drama started AFTER we left the hospital!)

H on 1/31/13 (5 days after conception):

H on 10/23/13:

It's pretty amazing what happens in 9 months. 

Infertility Diagnostic Testing

I've wanted to write this post for about six months, but I keep running out of time to sit down and write it!

After about a year of trying to conceive without success, most doctors will concede that it's possible that you may be facing infertility, but it's very difficult to get the doctor to recommend that you see a specialist. In our case, Brian was seeing his general practitioner and an endocrinologist and neither would come out and directly say that we should see a fertility specialist. I'm not sure why, but I assume it's because they don't want you to go off and see another doctor and never come back to their practice! Pretty ridiculous. We asked for recommendations and never received any help, so we took matters into our own hands and researched various clinics.

I highly recommend that if you think there's an issue that you go see a fertility specialist as soon as possible. There is quite a lot of diagnostic testing for infertility and many of the tests have to been done at certain points during the menstrual cycle, so it's possible that it could take several months from your initial appointment before any procedures are done for conception.

When you're watching all your friends and family members announce their pregnancies, that can be a very, very, very long time period to wait.

Some of the diagnostic testing is a little unnerving, so I thought I'd review the various diagnostic procedures that we experienced. Of course, every person and body is different, so what's painful for one person, may not even be an annoyance for another.

Men

Semen analysis: In our case, most of the semen analyses were conducted by Brian's endocrinologist while Brian was on testosterone medication in hopes of improving sperm counts. It takes about 6 weeks for the body to make sperm, so you can expect that if you are on testosterone medicine that you might have several analyses over several months. (Note, if you have low testosterone and are also trying to conceive, you must make sure your provider knows this because gels to increase testosterone will also kill sperm and destroy your counts.)

Pain factor: -3/10
Embarrassment factor: 400/10
Recovery time: Negligible

Women

Blood tests: 
If you have infertility, I hope you have good veins because you're going to have your blood drawn a lot. I had my blood drawn at least 13 times from September 2012 to January 2013 (plus two more draws in February for my pregnancy tests). Your doctor will be checking your AMH, LH, progesterone, prolactin, and estradiol levels. If you decide to do IVF, you'll also have your blood drawn for infections disease testing (as required by the FDA). I had recently had my annual physical, so I also already had results for cholesterol, glucose, and other typical checks, which your doctor may also do if it's been a while.

Pain factor: 1/10 (for me); 4/10 (for Brian, who also had infectious disease testing)
Embarrassment factor: 0/10
Recovery time: Negligible

Diagnostic ultrasound: 
You will also have a lot of ultrasounds throughout the entire process. The diagnostic ultrasound looks at the shape of your uterus, the location/size of your ovaries, and if you have any cysts in your ovaries and fibroids in your uterus. The parts of your body that they're looking at are very small, so the only ultrasound that works is a transvaginal ultrasound wand. (The good news is that you do not have to have a full bladder like you would with an abdominal ultrasound. The bad news is that the vaginal wand can be a bit uncomfortable at times.) These become less painful as time goes on, but they are definitely uncomfortable, especially if the doctor has to manipulate the location of the wand to get a better look at things.

Pain factor: 2-4/10
Embarrassment factor: 2/10 (but after the 3rd one probably 0/10)
Recovery time: Several hours to a day. You will likely have some internal soreness and possibly some spotting.

Hysterosalpingogram (HSG) test:
There is a lot of information about this test on the Internet and I was pretty terrified going in. The purpose of the test is to check to make sure your fallopian tubes are clear from any blockages. The test is done by a radiologist. A speculum is used and a tube is inserted into the tip of your uterus, just past your cervix, and a fluorescent dye is sent through the tube while the X-ray machine takes a series of pictures. My doctor recommended that I take Advil a few hours before the test.

Pain factor: 9/10 (Though during the test, it very much feels like 10/10; I almost yelled aloud and in the moment, I wasn't sure if I could take the pain. Fortunately, the worst part was very quick. The other bad thing is that because there was an x-ray involved, Brian was not allowed in the room with me. But I was very glad that he was there to drive me home.)
Embarrassment factor: 5/10 (I was not pleased with the radiology clinic we used and did not like the facility, nurse, or radiologist.)
Recovery time: A day or so. I was sore for several days. For the hours immediately following the test, there is also some leakage from the dye, so a good pad is necessary.

Saline ultrasound:
In my case, my HSG indicated a small "doughnut" shaped indention in my uterus, so the doctor suggested a saline ultrasound to look at it more closely. Saline is inserted into the uterus and the doctor looks around with a transvaginal ultrasound wand. This was slightly uncomfortable, but nothing like the HSG test.

Pain factor: 5/10
Embarrassment factor: 4/10
Recovery time: A day or so. Again, I experienced some internal tenderness and some slight spotting for a day or so afterward.

Endometrial biopsy:
Before our first IVF cycle, my doctor strongly suggested an endometrial biopsy to ensure the mass in my uterus was gone, so that it wouldn't affect any embryo transfers. This procedure, for lack of a better phrase, "vacuums" out your uterus so that any masses or tissues are forced out. A speculum is inserted and a vacuum aspirator is inserted into the uterus to force everything out. Any tissues removed are also sent to lab for abnormal cell growth. Again, my doctor told me to take Advil a few hours before the test.

Pain factor: 10/10
Embarrassment factory: 4/10
Recovery time: Quite a lot longer than expected. I was quite sore. My doctor told me that I could have spotting for a few days. In my case, it was more like a two weeks and it was very similar to medium-flow period.

So, that's pretty much it, but the good news is that if you do end up pregnant, then nothing (in at least the first 27 weeks) will be nearly as painful as the tests. Also, the pain from running a marathon is still worse. :-) So, if you've done that, you'll be golden.

Still TBD if labor and delivery + recovery is worse. ;-)

"Why Don't Y'all Just Adopt?"

Or, "Well, there's always adoption!"

For some reason, that question and statement seem to be said a lot when a couple explains that they are struggling with infertility. (For the record, if you say it to someone facing infertility on a particularly emotional day, you're likely to get knocked upside the head.)

Children who need a forever home is a major problem. It is an impossible problem. It is a gut-wrenching problem. And it is a problem for which all of society is responsible. 

Infertility is a medical condition. If you can be "cured," it requires medical treatment. 

In no other situation do we ask people who are sick to "fix" a societal problem.

Although it seems awfully convenient that people facing infertility are the perfect solution for these parentless-children, it isn't. In some situations it may be the perfect solution; in many others, it isn't.

The decision to stop pursuing the conception of biological children is an extremely emotional decision. It requires a grieving process and each couple has to come to that decision at its own pace. Once that grieving process has occurred, then it is possible to consider the possibility of adoption, which comes with its own challenges and opportunities.

So...why didn't we decide to adopt?

Well, we thought about it. A lot. In fact, last summer while we were waiting to see if a medicine was working we spent a lot of time looking into adoption. We first became aware of North Carolina's foster care system at our annual, statewide church assembly in June. At a session focused on how churches can support foster parents or those looking to adopt children out of the foster care system, we learned that there are not massive fees or monetary requirements to adopt a child who is a ward of the state. And we learned that if just one family from every church in North Carolina adopted one child approved for adoption from foster care that there would be no children available for adoption in North Carolina. What a wonderful thought!

We were incredibly intrigued. So we got the paperwork. We looked over it and over it. We signed up for an information session with Wake County (all foster care and adoption-from-foster-care in North Carolina is done at the county level). We went to the session. We found out that "our" child could still stay on Medicaid, we would receive a stipend from the state, and, most importantly, we would be able to give a child a home.

We looked at the website, where, yes, you can see children available for adoption. It's heart-wrenching. They say stuff like "I just want someone to love me." "I just don't want to be separated from my brother." "I just want my own room."

We prayed about it. We went on a road trip to Montreal and talked about it on the way up and the way back. We talked to friends. We talked about how we felt about adopting a child of another race. How would I learn to do a black female child's hair? I read a book about how to best assimilate an adopted child into a new home and how to deal with the unique challenges. Would we pass a home study? Do we have enough fire extinguishers? Would we want a sibling group?

There are so many questions and things to consider.

But there were two very nagging, major questions:

• Were we really ready to stop pursuit of a biological child?
• At age 30 and 31, could we start our parenting with an 8 year old child (the average age of a child in foster care)?

When it came down to it, we had enough doubts about our answers to those questions that we felt it was important to pursue assisted-reproductive technology. And we knew that if there was any doubt, that we shouldn't pursue adoption right then. When it's someone's life, you have to be sure.

So that's what led us to our reproductive endocrinologist.

However, we still feel very connected to the adoption process and we hope our life leads us to a point where we're able to pursue it.

At some point. When we're ready.

Baby? Baby!

So, when we last left off, Brian was excitingly telling you that we had 11 eggs retrieved. And then two months of silence. Because, well, it worked! We are having a baby in October!

So, let's see...

Our egg retrieval was on a Saturday morning (there are no weekends in IVF). And, not just any Saturday morning, but the Saturday morning after a lovely snow and ice storm on a Friday afternoon. We watched the weather for like a week in advance and were like "You've got to be kidding me." By late Friday morning, we realized that the roads were going to be pretty bad all afternoon and that they would freeze over into the night and present a problem for our 7 a.m. appointment that's about 30 minutes away. So, we got our stuff together, hopped in the CR-V, and drove across town in snow and ice to spend the night in the Hampton Inn that was right by our doctor's office (2 min. drive). This was absolutely the right decision because were able to relax the night before and got to sleep in. 

When we got there Saturday morning, the office was buzzing. There were at least 3 procedures that morning and tons of nurses and doctors. Brian and I were so grateful at the incredible care we received. All of these people were working on a Saturday morning and traversed incredibly slippery roads to get to the office. They were all so friendly! Our doctor even spent the night in the office the night before so that she didn't have to deal with the ice! If you know anyone who needs a fertility doctor recommendation in the Raleigh area, please, please get in touch with me.

The egg retrieval process requires that the egg donor (that's me!) be under anesthesia, so Brian and I had a lot of time to sit around and check Twitter while I got lots of IV fluids and anti-nausea medicine. When it was time to go, they wheeled me off to the procedure room, but this time it was a bit different. Because one of ovaries sits really high and behind my uterus, the doctor wanted to keep me awake for a bit while she checked my positioning to make sure she could reach all the follicles. At that point, I knew that I still had follicles (remember last month I had ovulated early and there were no follicles). And then the nurse turned up the anesthesia and the next thing I remember they were wheeling me back down the hall. In the middle of the hall I said "DID IT WORK?" and they said yes and that they had retrieved 11 eggs. I was so overcome with emotion. I couldn't believe we got through the retrieval and that they had that many eggs. The doctor had been thinking 8 eggs would be fantastic! Afterwards, I recovered for a bit and then we were able to leave. The roads were clear so we stopped at KFC and had takeout fried chicken, mashed potatoes, and slaw. It was soooo good.

And then we took a nap. :-)

In the middle of the afternoon, the doctor called to check on me and let us know that out of the 11 eggs retrieved 9 of them were mature and all 9 were injected with sperm.

The next morning we were at church when I realized I had missed a call from the doctor. I don't think I've ever not heard a word ever said at church like during those 20 minutes. Brian was serving as the assisting minister so he was sitting at the front of the church and I kept trying to get his attention. I kept mouthing DOCTOR-PHONE over and over and he was not getting it. Until, eventually he did and he was like GO TAKE THE CALL. I bet the people at church thought we were crazy. So as soon as it was time for the offering, I hopped up and ran out into the hall. And then I decided to go to the bathroom in case the doctor had bad news. So, I stood in the stall with my phone and listened to her message: 

"Hi Laura, it's Dr. Copland. I'm calling with good news. Actually, 100 percent good news. All 9 of your eggs have fertilized and are growing." 

I was so ecstatic and when I came out of the bathroom, Brian was pacing nervously, in his robe, in the narthex. We were so overjoyed (and texted our families as soon as church was over).

The next few days were a waiting game. At day 3, we heard that five of the fertilized eggs were growing right on target, three were a few days behind, and the last was another day behind. (This is pretty typical growth, which is why the more eggs they can harvest, the better the chances.) We scheduled our embryo transfer for day 5.

At our embryo transfer, we found out we had two "almost-perfect" blastocysts and a couple other embryos that were lagging a bit behind. The embryologist recommended that we transfer the two blastocysts to increase our chances of pregnancy (and, of course, multiples)! Brian and I asked them to step out for a bit and we talked it over for about 2-3 minutes. We decided to go ahead and transfer both blastocysts. If we ended up with twins, we would figure out a way to handle it! :-)

The transfer itself was really cool. I was completely awake and Brian was able to go back in the procedure room with the doctor and the embryologist. The doctor explained to us what was happening and we were able to see her transfer the blastocysts. (It looked like two dashes of white on the ultrasound screen.)

Our two sweet little blastocysts, one of which is now a little fetus! I think they look more like Brian. (Isn't it amazing that each one contains the complete DNA for an entire human being?)

And then we waited. With nothing to do.

That is the hardest part. Until the two week wait, we were actively doing something every day (injections, phone calls, appointments, etc.)

But, for two weeks, there is nothing to do except analyze every twinge in your body. Compounding this, the trigger shot that induces ovulation contains a synthetic version of the human pregnancy hormone (HCG), so you can't even obsessively take home pregnancy tests with accurate results.

Friends, all I did was read message boards and then I couldn't take it anymore, I took a pregnancy test at 4 days past my transfer (4DP5DT). It was positive! But was it real? So, I took another pregnancy test (many times multiple tests on the same day) for the next 7 days. And then I started consulting pharmacological sites to detect the half life of my trigger shot. I created a spreadsheet to calculate the half life!!  

Every single pregnancy test was positive. OMG! But there's always that fear that it isn't real and or will be a chemical pregnancy or a very early miscarriage. 

Fifteen days after our egg retrieval (on my sister's birthday), I had my blood test at the doctor. And then another test 48 hours later. All positive with increasing HCG.

We've also had ultrasounds at 6 weeks, 8 weeks, and 9.5 weeks. At each ultrasound, we saw the baby (just 1!) and saw/heard the heartbeat! At 9.5 weeks, the baby was kicking up a storm. It was pretty amazing.

So, that's where we stand now...just a few days short of 12 weeks. I've had nearly constant nausea, lots of exhaustion, and plenty of other annoying symptoms, but all-in-all it has been a pretty good first trimester. We are incredibly grateful and excited to see what the next six months bring!

The dog is very excited about the baby. The kitties hate everything.

That'll do.

Much more to come later, as I'm posting this from the fertility clinic, but: egg retrieval this morning, 11 retrieved and they all look good. We'll know in a day or so how many fertilized and how many (and when) they'll be transferred.

For all the crappy days we've had, today almost makes up for it. Things couldn't have gone much better. Thanks for all of your prayers and well-wishes, and since they worked well this time, keep it up that the eggs fertilize and they're able to transfer a couple of them.

Whew.

Science!

(Source: Know Your Meme.)

As a former chemistry nerd (I was a chemical engineering major at NCSU, until I realized that I'd much rather sit around and write papers), one of the most interesting things about going through IVF is learning about all of the medical procedures and how the medicine works.

At the beginning of each cycle, I have my blood checked to measure my Estradiol levels and have a baseline ultrasound to ensure that there are no cysts in my ovaries and to ensure that everything looks OK. After I've been on stimulating hormones for several days, then I go back for an ultrasound and a blood check every other day until the egg retrieval.

I have had 11 ultrasounds since mid-September, which I think is more than are conducted during 9 months of pregnancy!

The first time Brian and I saw an ultrasound screen, it looked pretty much like a bunch of static. Today when I looked at it, I could actually see the discrete follicles and could understand exactly what the doctor was describing. It's fairly amazing how much practice helps. :-) (The ultrasounds also confirm that my uterine lining thickens for implantation as the Estradiol levels rise.)

I am very, very, very fortunate that I have really good veins, so blood draws are not an issue. I could never understand why people didn't like needles, until I witnessed Brian get his blood drawn last month. As it turns out everyone is very different, it took the nurse several times to eventually get his blood, whereas she has just done mine on the first try! (I've never had a nurse *not* get it on the first try.)

Before our first round of IVF we had to have our blood drawn and run through a panel of tests (as required by the FDA). The good news is that neither of us have

• hepatitis,
• HIV, or
• Syphilis.

I also received confirmation that my blood type is, indeed, O+ and that I've had the chicken pox and have received my rubella immunizations. (Separately, we've also both received a booster for Tetanus, Dyptheria, and Pertussis.) And before our IUI, I had my Prolactin and several other hormone levels checked.

Because I ovulated early for our first round of IVF, with each blood draw this time, they check, in addition to my Estradiol level, my LH and progesterone levels. The goal is for the Estradiol to rise and for the LH and progesterone to stay low. (A spike in LH/progesterone would indicate that my pituitary gland is telling my ovaries to ovulate.) So far it's working! In particular, I think it's incredible how my Estradiol levels rise (over the course of 11 days): 48.4 -> 435.4 -> 757.4

So, how does all this happen? Well, that's where the chemistry comes in!

(Source: Our kitchen table.)

A few days into a cycle, I start injections twice a day (just under the skin with a very thin needle in my stomach) of a drug called Lupron, which suppresses my ovaries (by telling my pituitary gland to dump out all the LH and not tell my ovaries to ovulate). 

After a few days of Lupron, then I add in two drugs called Follistim and Menopur. These drugs stimulate my ovaries. The Menopur is powder in a vial, so I'm able to inject the Follistim (which is a liquid in a needle) directly into the Menopur vial. Then I take the Lupron injection and inject it directly into the Menopur vial. THEN I take 0.5cc of NaCl (saline solution) to finish dissolving the Menopur powder. Then I draw all the liquid up into a needle and do one injection. I could live without giving myself the shots, but I love mixing up all the medicine. It reminds me of chemistry lab!

If you're interested, this is a neat video by another fertility clinic that shows how most of my medicines are mixed. I watched it a lot in December to make sure I didn't mess up!

(Source: Carolina Conceptions.)

I do this twice a day for approximately 10 days. The injections usually sting for about 20 minutes, but they really aren't too bad and because none of them are injected in a muscle, it doesn't hurt once the stinging stops.

Now, as extra insurance to make sure I don't ovulate early, after several days of stimulating medicines, I add another drug called Ganirelix, which also tells my brain to not ovulate. This injection comes in a pre-filled syringe and I have to inject it separately each night. Last cycle, I was able to mix it in to the Menopur vial, but this month I'm not supposed to because I'm also on Lupron. 

The goal during all of this is to get my ovarian follicles to grow and produce as many mature eggs as possible, so that they can be retrieved by the doctor, while also telling my brain "no, don't ovulate yet!" It's really quite miraculous!

Once the doctor sees on my ultrasound that the follicles are the right size, I'll stop taking all of the previous drugs and do one final injection of a drug called Ovidrel, which tells my brain "OK, NOW. GO!" and if this is timed exactly right (36 hours after the injection), the doctor can go in, while I'm under "waking anesthesia," and retrieve the eggs out of each follicle to start the in vitro part of IVF. :-)

If you're curious, some of these drugs make people really crazy because of the hormone changes. I have been very, very fortunate with few side effects. I've had a few moments were my temper has been really short, but, in general, I'm not too crazy. (At least I don't think.)

Ugh.

Pretty much all you can say after today.  I know it's been a while since either of us posted anything here, so here's a Cliffs Notes version of where we've been over the last month or so:  we decided to start IVF this month, which meant two weeks' worth of medicine for Laura - injections, medicine mixing, you name it; it would have made a pharmacist blush - and we scheduled an egg retrieval for this morning.

At which point a problem appeared: there were no eggs to retrieve.

This, in the words of our doctor while Laura was still recovering from anesthesia and had no clue where in the world she was, isn't good.

One of the medicines Laura was taking is supposed to suppress ovulation.  Basically, each egg grows in its own follicle, and when it matures the follicle ruptures and the egg(s) start making their way down the fallopian tubes.  For IVF, you have to beat the clock, because the procedure involves pipetting out the stuff inside the follicle and retrieving the egg in the process.  After ovulation, it's impossible to retrieve the egg - and the medicine wasn't strong enough to keep ovulation from occurring.

The doctor said that this happens about once a year.  Lucky us.  That'll be $Texas, please.

So we'll regroup and try again at some point.  The timing is totally up to us, but will need to wait for a menstrual cycle to complete, so no earlier than early January or so.  And this time, they'll change up the medication to the extra-strength model, which will hopefully do the trick.

Going through this today reminded me of how important it is to have two partners walking hand in hand on this journey.  This morning, I was a wreck.  I mean, doing everything I could to just keep from breaking down and bawling with the doctor in the room.  It's really the first time in this whole process where I've come close to losing it.  But Laura, bless her, was generally OK - broken up and upset, yeah, but strong enough to prop me up.

Yes, the roles have been reversed at times.  I've had to be the stiff-upper-lip type more than a couple times during this whole process when she was really upset.  Today, it was her turn.

You never know when you're going to need a shoulder to lean on.  But without question, you'll need one at some point.  Having that around makes all the difference in the world, and today it made what could have been a super crappy day only a sorta crappy one.

The Party Bus (Or: ICSI Is Not The Number That Identifies A Commercial)

(Warning: this post talks about rather graphic stuff.  It's way easier to just type it out rather than dance around it in endless euphemisms, so if you don't want to hear rather frank discussions of what happens in fertility treatments, you might want to go elsewhere.  But then again, if that's the case, why are you reading this blog?)

So, we did our first IUI treatment a couple of weeks ago on a really damp and gloomy Friday morning.  Suffice it to say that the weather should have served as our first clue on how the day was going to go.

In a nutshell: not well.  My washed sperm count was 500,000; for the highest probability of success, it needs to be above 1 million.  Not surprisingly, it didn't work.

Back up a second.  What's a "washed sperm count"?  In order to inject the sperm into a uterus, they have to remove the sperm from the, ahem, produced specimen.  (In blunt terms: the semen in the collection cup.)  Otherwise, the uterus will reject the semen, since it's never supposed to get in there; the cervix usually handles that job, but since IUI bypasses the cervix, the sperm need to be removed from the semen before they're injected.  Sperm washing is the process by which that happens: basically a big centrifuge separates the components, then an embryologist isolates the best-performing sperm and prepares those for injection.  The sperm count after that preparation is the washed sperm count.

(Total aside here, but worth mentioning simply for comic relief: fertility clinics are likely the only doctor's offices with subscriptions to porn-on-demand services.  Hey, you gotta do what you gotta do, and there is serious business to be attended to, right?)

So, my washed sperm count was too low, and it seems like it probably won't get any better.  My total count was 13 million per mL, which isn't too far below normal but hasn't moved much since the last time it was checked, in July.  In other words, they've corrected about as much as they can, and where I am now is probably where I'll stay, with some minor variance.

So we'll probably move onto plan B (C? D? I've lost track), which is something called IVF with ICSI.  You probably know what IVF is, but ICSI is something new-ish (last 10-15 years or so) that corrects for the problem I have.  Most IVF is focused toward female infertility: PCOS, irregular cycle lengths, that sort of thing.  Until ICSI (which stands for intra-cytoplasmic sperm injection; you'll understand in a second) came along, guys with non-swimming sperm pretty much had no option other than crossing your fingers and hoping it works.

ICSI replicates the process of the sperm fertilizing the egg, courtesy of a microscopic pipette that takes one sperm and sticks it into the egg, which in theory should get the ball rolling.  It corrects for sperm that can't find their way around the female reproductive tract, and it is also a godsend for low sperm counts; you only need as many individual sperm as you have eggs, so instead of needing a million you might need five or six.

Even in my low samples, they can find six sperm that could fertilize an egg.

Unsurprisingly, the success rate for ICSI is astronomical: our doctor told us that it usually is around 60% effective.  In fertility, 60% is as close to a sure thing as you're ever going to see.  The only complications are if they can't find any perfect sperm (that could cause trouble for fertilizing the egg and getting the embryo development process going) and whether or not the egg implants.  Considering traditional IVF usually has a 35-40% success rate - and likely lower for us given our situation - this is a very good thing.

And in the meantime, ultrasound pictures and pregnancy announcements continue to pop up on Facebook about as much as political posts and lolcats.  The more things change, the more they stay the same.

At this point I kind of feel like I'm standing at a bus stop where three or four routes make stops.  I'm waiting for one route, which hasn't come yet, and meanwhile 30 buses have stopped for the other routes and picked up the other folks waiting.  After a while you get really tired of waiting, but what else can you do?

The one thing that I'm sure of: when our bus does show up, there's going to be one hell of a party on it.

(In regards to the title: every commercial on TV and radio has something called an ISCI - Industry-Standard Commercial Identifier - code assigned to it; it's almost like a barcode to identify the commercial and make sure the correct one is running.  I just thought it was interesting that the acronyms are so close, even though they have absolutely nothing to do with one another.)

Book Review: Hannah's Hope

Today is Pregnancy and Infant Loss Remembrance Day, which is a day of remembrance for pregnancy loss and infant loss. For those of you who have experienced a miscarriage, stillbirth, or infant death, I am thinking of you today.

***

Fairly quickly after we were faced with the possibility of infertility, I reached out to an acquaintance who I knew had also dealt with it. She had kept a blog and posted on Facebook and sent me a ton of information in an e-mail. I still refer back to it from time to time. One book that she suggested that was helpful to her was Hannah's Hope: Seeking God's Heart in the Midst of Infertility, Miscarriage, and Adoption Loss by Jennifer Saake. After Brian and I went back and forth many times on various decisions (including visiting an information session by Wake County on adoption and foster care), I decided to look into this book to see if it was something that I would be interested in. There was a Kindle version, so I purchased it for about $9 and started reading. I would read it pretty closely for several nights and then put it down for a few weeks. I finally came back to it a few weeks before my birthday when I realized that I was not coping well and needed better solutions.

The author has dealt with countless reproductive issues (medical infertility, lost adoptions, and miscarriages). She now has two living children. I really enjoyed most of the book and found it very helpful as a way to know that what I was feeling (anger, bitterness, sadness) was normal, even if it wasn't healthy. The book uses the story of Hannah, who was barren, in I Samuel 1-2 as its narrative guide and has 16 different chapters, including discussion on "Envy, Jealousy, and Rivalry", "Is God Punishing Me?", How Long Does It Hurt?", and "Bitterness of Soul." Each chapter starts out with a "brief fictionalized look at a portion of Hannah's story" that uses the historical context of Hannah's time period with the the author's own experience with barrenness. At first I thought I would find that approach too hokey, but I grew to like it and it really helped me identify with Hannah. There are also short sections at the end of each chapter for "Burden Bearers" that help explain why people facing these crises act like they do.

Clearly, this book is completely based in the Bible (Bible passages appear on most, if not all, pages), so if you're not coming to infertility from a Christian perspective, this is probably not your book. Though, it still might be worth a look. There is good stuff here.

What I Liked

• The author has experience. She's dealt with a lot of stuff and has experienced about everything you can imagine with this subject. She knows what she's talking about.
• The advice for "burden bearers" was spot on. I know it's not easy to interact with someone dealing with infertility because one day (or minute!) the person can be fine and the next emotional or withdrawn.
• The Bible passages cited were comforting and reassuring. It was nice to realize that what I was feeling had been felt by many, many other women.
• This subject needs to be talked about and discussed. Too often couples suffer in silence or friends  and family ignore the situation because they don't know what to say.
• The author is very clear on her beliefs and limits, but she does not come across as preachy or judgmental.
• Nearly all facets of how infertility affects your life are discussed. 

What I Didn't Like

• I'm not a woman who has always wanted to be a mother. A lot of the support for women's infertility comes from that perspective. At times, this book gets close to that point. Stuff such as Since I was 3 years old, playing with my dolls, I knew I was born to be a mother. When I was 3, I wanted to be a waitress and then a banker and then a teacher and then an astronaut. I pretty much assumed I would be a mother some day, but I certainly didn't think about it all the time.
• In some places the author is too conservative for my liking; there are some discussions of "serving your husband." Although the author did talk about how that respect should go both ways, in her relationship, she sees her husband as the leader who makes the final decision. Brian and I are pretty darn equal in terms of who is "in charge" so that argument didn't resonate with me.
• There was a brief discussion on how infertility could create marital infidelity (through a physical affair or turning to pornography) that was so ridiculous that all I could think about was one of those "I'm Addicted to Pornography" shows that appear on A&E or whatever network. It came across as women are so weak.

All-in-all, I thought this was a very good book. It helped me keep my emotions in check and attempt to understand how I was feeling. Many of the Bible verses were very comforting to me and it has helped me create strategies to cope.

Where Do We Go From Here?

As I sit here on the last day of my 29th year, I'd love to say that this was a great year. But, it wasn't.

It was an OK year, but definitely not a great year.

There were several wonderful moments:

• Discovering yoga and the wonderful people in my class
• Completing my 2nd half marathon and 2nd marathon (and enjoying the training cycle!)
• Facing my fears in the Warrior Dash
• Completing my first duathlon
• KPRD kickball championship
• A cruise to the Caribbean with my family over Christmas
• A great road trip vacation with Brian to Canada (poutine!)
• A wonderful weekend in the mountains with Brian's family

There were also lots of bad moments:

• Horrible, recurring colds for both of us all winter (including 4 bouts of pink eye and a staph infection in my eye)
• An infertility diagnosis that left us with many questions and still no answers
• Serious, life-altering sicknesses of family members
• An emotional goodbye when my grandmother's house was sold in Hickory, which opened up lots of untapped grieving

Unfortunately, it seems, a lot of the bad things started happening around January and it's been never ending since then. For me, the stress of all this has manifested itself into weight gain (about 20 lbs. since January). While I'm determined not to turn this blog into a fitness/healthy living blog, it would be silly for me to ignore the obvious. The weight gain is a significant stressor for me.

Admittedly, I am not in a good place right now. I've had a lot more bad days than good days lately and I think I realized that I was pretty close to rock bottom when I just started crying uncontrollably at church on Sunday for no apparent reason. Thankfully we were in the back and I could sneak out pretty easily.

I've had a lot of diagnostic procedures done lately and everything checked out OK. I am very excited about our medical plan, but it is nerve-wracking. There are so many unknowns.

So, where do we go from here?

Since Sunday, I've started making a conscious effort to deal with stress as healthily as possible:

• I'm keeping a food log.
• I'm trying to get some exercise, even if it isn't hardcore running or cycling. I go to yoga twice a week and on other nights, I'm trying to just walk or have some type of activity.
• If I don't feel like being active, I take a hot bath to decompress.
• I vent to my mom, dad, and Brian.
• I'm finishing the Christian-based infertility book that was recommended to me, Hannah's Hope: Seeking God's Heart in the Midst of Infertility, Miscarriage and Adoption Loss, and I've ordered a Bible Study on dealing with infertility.
• I'm saying no and pulling back from having too much to do. Quite honestly, most often I just want to spend time with Brian, other family members, and our sweet animals. Because I'm introverted, that quiet time is where I get my energy and that's what I need right now.

So, tomorrow, on my 30th birthday, I have a plan. I'm going to wake up and do 30 sun salutations at sunrise (7:10 a.m.). I'm going to go on a bike ride (maybe 30 miles if I feel up to it, maybe fewer). I'm going to listen to my husband's radio shift, where he's playing several of my favorite pieces (including Appalachian Spring). I'm going to read a little and maybe watch some TV. I'm trying a new recipe for chicken tetrazzini for dinner. I'm going to enjoy the day, be thankful for all the blessings in my life, and take care of me.

And, I'm hoping and praying that I can carry that positive energy into the next decade and leave the negativity behind.

Always Pick the Fertility Doctor Named After Your Cat*

* Unless you named your cat Kevorkian.

Wrong Choice

Right Choice

When it came time to pick a fertility clinic and a doctor, Brian and I had a tough time getting recommendations from our family doctor and Brian's endocrinologist. We had a recommendation from one friend, but that was pretty much it.

One thing that was very important to us was that the doctor was easy to talk to and that the clinic seemed rooted in medicine, not emotions.

I am immediately turned off by clinics that try to appeal to women's emotions with becoming pregnant. For example, there is a local clinic that actually airs radio commercials that start off with a baby crying and say stuff like

To most women, that's just the sound of a baby crying. But to YOU that's the only sound you want to hear. The sound of your baby crying. All you can think of...all you've ever dreamed about...is holding your beautiful baby.

Give. Me. A. Freaking. Break. 

1. That's not how I roll.
2. I very much want to be a mother, but it does not define me. I have plenty of my own goals independent of having children.
3. Are there actually women who think like this?

So, I told Brian that I would not have a doctor or a clinic that preys on emotions like that. The whole process is already emotional and stressful enough; the last thing we need is some doctor trying to complicate the situation to make more money.

We are very fortunate to live in an area that has several clinics and two major medical university hospitals. We looked through reviews of the two hospitals and found that one had better reviews and success rates than the other. As we continued to look, we found a new clinic had recently opened up that had two double-board-certified doctors from the university hospital that we really liked. As we read through their profiles, we really liked them both and one of them had the same last name as our cat, Copland. She also is an accomplished cellist, which appeals to Brian's classical music roots. Certainly divine intervention!

Brian called and spoke to the patient care coordinator who was incredibly friendly and welcoming and set up an initial consultation. (We also verified that the office was in-network for our insurance!)

Dr. Copland was very easy for us to talk to, answered questions directly, and based all her answers in medicine. She also made it very clear that every decision is elective and OUR decision. 

So, to reiterate:

Copland-kitty approves of Copland-doctor

***

Brian and I also really want to thank everyone for the incredible outpouring of support we got for making our journey public. We really can't thank you all enough.

I knew we had made the right decision on Saturday night. It was an emotional day and I was feeling pretty overwhelmed and exhausted by everything that's happening this week. A friend sent me a hilarious video to have on hand to watch whenever I'm feeling stressed out/annoyed. There's no way she could have known that I was having a rough day, but she completely made it way better! :-)

So, why put this stuff on a blog, anyway?

Yes, it's probably improper (in the Emily Post fashion) to write about things as personal as trying to have a baby.  That needs to change.

Infertility has been going on for a long time, way longer than Laura and I have even known each other. And it's one of those things that I think everyone knows someone who has dealt with, but it has to be left unspoken.

Oh, you can't (easily) have kids?  That's a real shame.  Let us never speak of this again.  Boy, that football game last night was crazy!

I'm a firm believer in everyone having their "thing."  I'm not going to go so far as to say that God gave us infertility problems to make other people aware of the issue, but I do think that two things are true: one, that we have a responsibility to de-stigmatize (at least as best we can) infertility, and two, to spread the word that the best way to deal with it, as we've learned, is to be completely open about it.

No, I don't think that we're going to have millions of people lined up to run a 5K for infertility awareness or drive around town with half-blue/half-pink ribbons stuck on the back of our cars.  Hey, if someone wants to start the Susan G. Komen Foundation For The Cure Of Infertility, sign me up - but that's not where the change is going to come from.

It's going to come from stuff like this blog, from knowing people who go through it and who want others to know what's happening.  Not for sympathy, or for selfish reasons, but simply to get the word out that this does happen, and it's high time that we get out of this 1950s mindset that there's something wrong with you when you don't fit the mold.

Well, yes, there is something wrong (thank you for noticing), but that's not the point.

So, yeah, this blog will probably have too much stuff in it than you feel comfortable knowing, but I'd rather put too much information out there than not enough.  Not enough information leads to suffering in silence.  Too much leads to support and understanding from others.

Give me the latter any day.

And so it *really* begins [for L]

Next week is a milestone week in fertility treatment around these parts. It will be the second and third diagnostic procedures that I have.

Although B has had many tests and doctor's appointments, I haven't had too many yet. (Though, it is funny that now we're seeing a reproductive medicine specialist that I'm considered the primary patient. I guess it's that whole bearing a child part.)

Last week I had some blood drawn that will be tested to determine my progesterone and prolactin levels, both of which are very important hormones in the fertility process.

On Wednesday morning, we have an appointment with our doctor who will do an ultrasound to check everything out and make sure my uterine anatomy is OK. Afterward, we'll meet with her to review the blood work and set up a treatment schedule/review options.

On Friday afternoon, I have an appointment at a radiology clinic for an HSG test, which is a diagnostic procedure on the fallopian tubes. I've read online and heard from several other people that sometimes this test is very uncomfortable/borderline painful. BUT, everyone is different, and I've been told by doctors that I have a high pain threshold, so I'm hopeful it won't be a big deal for me. Regardless, B is going with me so that I don't have to drive home.

Because various tests have to be done at various stages of my cycle, the HSG test has to be done after the meeting with the doctor. The doctor mentioned at our preliminary meeting that we would begin creating a treatment plan at the ultrasound appointment, so I'm curious how the HSG test and its results will fit into everything.

If we could start a treatment cycle in October, we'd be ecstatic. It seems like we're always on some version of a two-week wait!

Prayers and kind thoughts are always appreciated.

***

I should also mention that B's test results from his last analysis were very good. They're not normal, but much closer than the first test and our doctor said that they were definitely good enough to make IUI an option.

Choices, Aggravations and Dents In The Wall

I think the hardest part of this whole process has been the reactions I have when I find out other people are having kids.  Even if I don't know them well (Facebook friends or what have you), it's still a punch in the gut, and when it's someone I do know well it's that much more difficult to take.

That's why it's noteworthy that I found out today that a couple friends of mine are expecting their third child, and I didn't immediately feel jealousy, anger, frustration and all those familiar emotions that have been showing up almost on a schedule for the last year and a half.

We've spent a lot of time talking about our options, whether we wanted to just remain childless and enjoy our lives without kids (spoiler alert: no thanks, although the allure of taking vacations whenever and wherever we want sure is appealing), adoption, surrogacy, you name it.  At times the decisions can seem overwhelming - one minute you're all but picking up the phone and calling a doctor, the next you put the phone down and get questions ready for an adoption agency, and then you find out that someone else is having a baby and you're just sitting there thinking "for heaven's sake, make it stop!!"

So, what to do?  Everyone who knows the situation will offer their own advice, but at the end of the day the reason I didn't feel upset at all earlier today is a simple one: we finally made a decision on what we wanted to do, we followed through on it, and for the first time in what seems like forever, there's hope at the end of the road.

Everything you read says that you shouldn't delay in getting help conceiving if you decide that's what you want to do.  Much as we might want it to, time doesn't wait for anyone to get pregnant, and the odds only get higher with age.  That's not to say that anyone should go running to a fertility clinic after a month of trying to conceive, but intuition is a powerful thing.  We knew that something was wrong, and we started from there.

In my case, stupid as this sounds, I couldn't grow a beard.  You know those people who can grow a five o'clock shadow by about 11:30 in the morning?  I'm whatever the opposite of that is.  I knew that wasn't normal, and it was always in the back of my head that there was probably a hormonal imbalance, but it wasn't until my doctor ran some tests to confirm that the puzzle started to fit together: without testosterone, it's tough to grow a beard, and it's also tough to produce sperm, which is a slightly important step in having children.

So I finally got on medication to help boost the testosterone, which worked about as well as anyone could have hoped, and......nothing.  Still no babies.  Still everyone I know getting pregnant every time someone sneezed.

If you know of a wall, chances are I had banged my head against it more than a few times.

But then we finally made up our mind, wading through the seemingly endless menu of choices, that we were going to go to a fertility specialist (more on this later).  That was going to be our plan, darn it.  We were going to do everything we could to have a baby, and whether that came naturally or with help, we were committed to it.

Making that decision took the weight of the world off my shoulders.  Finally, we have a road map that gets us to where we want to go.  It's still no guarantee - in reproduction, very little is - but we're more confident than we ever have been that it really is only a matter of time, one way or another.

The moral of the story?  Decide what you're going to do, and follow through on it.  Don't let yourself become paralyzed by analysis.  The longer you wait, the more that knife in your stomach will turn every time someone tells you they're pregnant.  It's not worth waiting - as soon as you're confident in your decision, run with it, and stick to it.

Maybe then you can fix all the dents in that wall.

And now we wait...

B had a doctor's visit this morning and we're waiting for the results. We're hopeful (but cautious!) that the numbers will have improved. After we get the results, we're planning to set an appointment with a fertility clinic.

Waiting isn't easy. I keep thinking through how I'll react to various scenarios. I want to pretend that if it's not great news, that I'll be OK, but I doubt it. I'm sure I'll be a mess and hate everyone. Ugh.

If it's great news, then it was be really exciting, but also make us wonder what steps we need to take...

So, not much to say. We have no idea when the doctor will call with the results. Hopefully we won't have to wait too long.

Doctor's Report

Last week, B went back to his endocrinologist. The report was quite positive. His testosterone numbers are all within the normal ranges and have remained stable since his last check in the spring. The doctor was really pleased with the progress. He also ordered another sperm analysis and the doctor printed out the results from the one done in February. The numbers in February really weren't great at all. They are all quite low, which we knew but it's always tough to see it on paper.

The new analysis will be done in the next few weeks and the hope (and prayers!) is that the normal testosterone levels will kick start sperm production. I'm not really expecting a miracle (but I'd certainly take it). After we get the results for the next analysis (fortunately, the doctor will call with those and B doesn't have to back for an appointment), then we are expecting to set up an appointment with a fertility clinic.

We are so fortunate to live in an amazing location with AT LEAST 3 fertility clinics (that's what I've found so far!) and one of them appears to be one of the best in the world:

Our IVF (InVitro Fertilization) Program is host to four board-certified reproductive endocrinologist and infertility specialists (of which there are less than 1,000 nationwide), highly experienced embryologists and laboratory support staff, specially trained nurses, and the most advanced technology available.

I also read that the head of that program writes THE textbook on IVF, so I'm really hoping that we can set up an appointment with (and afford!) them.

One of my goals for August is to talk with our insurance company about our coverage and get an appointment set up. I know we have lifetime coverage limits of $25,000 for each of us, but I really want to understand what all that means because reproductive technologies are so expensive. Based on numbers thrown around on the Internet, it seems like we could blow through those amounts in a 3-4 cycles of treatment. But, of course, everyone's insurance is completely different. The good news is that with all the endocrinologist appointments and lab work, we've already hit our deductible for the year, so we're only paying 20 percent of any services/prescriptions until December 31.

Personally, I'd really like for us to be able to go with IUI because it's *slightly* more natural (OK, not really, but it seems like it), but if that's not possible, we certainly don't want to spend a ton of money something with a lot lower chances.

I know that the clinics will push us to go with IVF because they make a lot of money off that procedure, so it will be really interesting to see what they say. I fully plan to arrive with a notebook and a ton of questions! (My mom keeps joking that we're probably going to end up with triplets.)

Friends and Family

One of the most helpful things to us is the amazing support we receive from our friends and family. From our church family praying, our parents offering support that goes well beyond anything we could ask, and our friends, we are truly blessed.

I've really noticed this as one of our closest friends recently told us that they are having a baby. We are (really, truly!) so excited for them! The thing that's meant the most to us is that this couple has gone well out of their way to be so respectful of our emotions and feelings. They announced the news to us privately in a way that gave us privacy to work through our emotions and even went so far as to tell us beforehand when they were going to announce their news to the world via social media. Being prepared for that announcement was so helpful.

They have gone well out of their way to be sensitive and that means so much. We know that it is a sacrifice for them to think of us during their time of incredible excitement. But, because they did, it makes us even more excited for them.

I can't wait for our future children to have them (and their future children!) in their lives because they have set such a wonderful example of friendship, kindness, and compassion.

Frustration

I'd be lying if I didn't acknowledge that some days are tougher than others. There's not always a rhyme or a reason why, but sometimes it's just hard. Occasionally, someone mentions something about their baby or you see something online and it sets off a floodgate of emotions.

Yesterday was one of those days. It was one of those days from the second my feet hit the ground when I got out of bed and it was one of those days when I cried most of the way to work. It sucked. I had a horrible feeling in the pit of my stomach all day. B knew it was one of those days too. He sent me a really sweet e-mail and did his best to make me feel better. It's amazing to have that support.

I was proud of myself though. After my morning meltdown, most of the day at work went pretty normally and I was able to get everything done that I wanted to do after work (vote, mow, cook dinner, and go for a short run). I was really proud of myself of fitting in the run at 9 p.m. It made me feel a lot better.

You just do what you can to get through and know that tomorrow will be a new day.

Today was much better! Thank goodness. :-)

B's doctor didn't have any good recommendations for a reproductive endocrinologist at his appointment Monday, so B is going to ask his actual endocrinologist for a recommendation at his appointment next week. If that doctor doesn't have a recommendation, then we'll just pick one and go from there. We're lucky to live in an area with lots of choices.

Happy With Two

At our meeting with our pastor last Thursday, he really stressed that we focus on medical stuff when it's appropriate, but then when it's not necessary to think about infertility that we focus on being as happy as possible as a couple and really focus on loving each other. Of course, this is easier said than done when the worrying starts, but it's definitely something that we have been striving really hard to do.

On Friday after work, we took our bikes up to one of the local lakes and rode about 13 miles on the greenways there. The rest of this weekend we really focused on eliminating clutter and getting rid of some things we no longer need (an old TV, two DVD players, and 16+ bags of books). I was glad to see it all go. :-) Also, when we do have a child, we'll have to do some rearranging for a nursery and I'd like to have as little clutter to remove as possible. I think we're well on our way! Next weekend I'm planning to tackle a few of the kitchen cabinets that are unruly.

We're also each focusing on other things that we enjoy doing. B is getting back into bike riding (hence Friday's ride). He loves riding his bike, but really hates hills and heat, so it's always good when we can go to a trail that's mostly flat and very shady. I'm also starting to train for a half marathon that I'm going to run in November. I've run for several years, but I always end up in a bit of a funk after a major race (I completed the Shamrock Marathon in March). I'm ready to get started again and I'm really looking forward to having a dedicated training schedule. The time I spend running is always really good for me mentally. I always come home in a better place than when I started. I also do yoga 1-2 times each week, which is so important to me because it allows me to have some time when I'm not focusing on anything but my body and my breathing.

Our pastor told us that he doesn't believe it's God's plan that we do not have children, but that he doesn't necessarily know if it's God's plan that we do have children. :-) So, he stressed, it's really important that we live our lives right now to the fullest. He mentioned that he knows how much love we have in our relationship and he really encouraged us to focus on that because that is where all of the good things in our family will come from.

I also started reading the book Hannah's Hope: Seeking God's Heart in the Midst of Infertility, Miscarriage, and Adoption Loss by Jennifer Saake, which was recommended to me by a friend who also dealt with infertility. It's really good so far and I think it will be really helpful. It parallels stories from Hannah in the Old Testament, who was barren, with the author's own personal stories (she struggled with infertility, had several miscarriages, and several failed adoptions). It provides ideas and suggestions to make the journey a bit more bearable.

Our Story

My husband and I are in our late twenties/early thirties. We have a very lovely house in a wonderful neighborhood in suburbia where we live with our sweet dog, Gatsby, and two cats, Copland and Mozart. At this point, these three "babies" are pretty much our world. It absolutely makes our day to come home from work and have them waiting for us with so much enthusiasm.

We've been married for a little over six years and decided in early 2011 that we really wanted to focus on having a family. We tried with no success for a year and then while my husband was at the doctor for a checkup in February 2012, we learned that he had low testosterone and a very low sperm count (it's important to note, though, that the sperm count isn't zero).

We were pretty crushed and spent several months waiting while my husband took medicine to improve his testosterone levels. There isn't medicine you can take to increase sperm count, but my husband's endocrinologist was hopeful that by increasing the testosterone, it would kickstart sperm production naturally. In April, he returned to the doctor and his testosterone had increased, but they did not do another semen analysis.

Later this week, he'll be returning to our general care provider and his endocrinologist to get more tests done and we're planning to ask our general care provider for a referral out to a fertility specialist.

So, at this point, we're still in a bit of a holding pattern, but both of us are confident that is about to change. We're excited to move forward and see what technology can do for us!

We are also incredibly blessed with an amazing support system. Both sets of parents are amazing and are supportive of what we're going though and the ups and downs. Our siblings are always there to lighten the mood and we have a wonderful group of friends—many of whom live in our neighborhood.

We also attend a Lutheran Church (ELCA) and have an amazing pastor and Bible Study that helps us see how God works through our trials. We have semi-regular meetings with our pastor and our faith helps guide our decisions. We expect that our faith will be especially important as we traverse the murky waters of reproductive technologies and their ethical implications.

So, we have no idea how this will turn out and I think we're slightly nervous to make our journey public, but we both feel strongly that infertility is wrongly stigmatized. (And we're tired of being asked why we don't have kids!)