CD 14 and it's IUI time!

Starting this cycle I honestly had no idea if this day would ever come. It's always exciting starting something new, doing a new procedure, taking a new medicine. A new plan feels refreshing and gives you a new hope. I also know that I have been through four doctors and lots of "new plans" and none of them have worked. I have been as positive as I could posibly be. This cycle has just felt different. We made if fun and starting making home movies of us talking about what were doing each day and getting my injections. It's actually the first time in a long time I have laughed and smiled about it.

We got to Portland a bit earlier than expected and went to a Sushi Track about a block away from Dr. Chang's office. I figured I better get it in now, just in case! Then we arrived at Dr. Changs at around 1:15. Dan needed to give his sample by 1:30. Let me just say this now, although these past two weeks I have seen Dr. Chang six times (six portland trips) given myself 11 injections, bruised, six blood draws. That is a ton of preassure to be the male. Although he really only had one major job (aside from moral support and a shoulder to cry on) i'm not sure that I could "preform" under those circumstances. I thought it might be fun and went to try and offer a helping hand but I think I just ended up making him more nervous and decided that I should leave him alone. I told him and I fully ment it that I wouldn't be mad if he couldn't do it, just to relax and everything will happen like it's supposed to. I think after taking a few minutes to relax and calm down he did the deed and he left his semen sample to be "washed" which takes about an hour and we went to Target to window shop and kill some time.

When they "wash" the semen. They get rid off all mis-shaped, un-motile sperm, and any debris (which is usually mucous) They do a post wash count of how many are left and ready to go! Then they put them in a liquid that makes it easier for them to swim and makes them quicker. Dr. Chang let us know that she needs at least 10 million post wash and that's a good/average number. Dan had 21 million post wash! Woo Hoo. Gold start for my husband. The thing is, it only takes one. So we were happy.

I came back around 2:30 and the washing had about ten minutes left so we sat in the wating room like two teenagers kissing and laughing. I thought that doing an IUI would be uncomfortable and completely unromantic. But I don't think we have ever been so loving out in public before. Usually we hold hands and kiss and cuddle. But there was just something about us possibly making a baby that we just couldn't keep our hands off each other. I even got quite a few butt squeezes in Target. :) At the same time I learned two things, I was dissapointed Dan couldn't come to more of my appointmetns. I had never laughed as much or had as much fun. I also learned why he doesn't come more often... Here are two pictures as examples.
The first is the only picture I took. One of us in the exam room waiting for IUI. I mean how many couples can take a picture RIGHT before they make a baby??
Here it is:

Here's Dan's choice for his one and only picture taken. He was laughing and had me laughing so hard at the ultrasound machine in the room. The brand name of this equiptment was: Drum Roll... Siemens. LOL Of course he was prononcing it Semens. He was so excited of his find, he didn't bother taking a picture of anything else. Here's his picture of the day:

I got undressed in exam room 1 from the waist down and Dr. Chang came in with her MA to do the procedure. They placed a catheter up inot my uterus which caused a bit of cramping, but nothing compared to the HSG I had done. Then she injected dan's semen up into the catheter and into my uterus. I laid there for about 15 mintues with my feet up and then got dressed. I will start taking progesterone suppliments on Friday, twice a day until I find out if the procedure worked or not. We also have strict instructions to have sex everyday. So, buisness like usual. :) I have my blood pregnancy test on the 10th of October. So a week and half. About 12 days. Although I might start home testing on Saturday on 10dpo. Although it's unlikely it will show that early, it's going to be impossible to wait!

CD 12 Ultrasound/ 10 Follistim Injections

Yesterday I had my last and final monitoring ultrasound. It was a tad overwhelming. My mom actually took the trip with me. I have been getting so tired driving alone and getting bored and it made for a much quicker trip! I am really thankful that she went. She also got to see some pretty cool stuff and dig a little deeper into what it is I am really going through.

Yesterday at work I also got my Flu shot for the season. I was thinking in my head, getting a little cocky. “Yeah I’ve been injecting myself every single night for ten days straight. I got this.” OUCH. It quickly reminded me that I have been using baby needles too.

My arm was already sore and Dr. Chang’s MA took me back for my normal blood draw. I think my veins are revolting, because it hurt this time. Probably the only time it has ever hurt for them to draw my blood. It also happened to be in the same arm as my flu shot! Take a moment, to think of what a big baby I am.

We went into exam room 1, which should have my name on the door by now. Got undressed and let my mom in. Dr. Chang came in and introduced herself and got down to business. My lining was nice and thick. Perfect. Then as she found my right ovary she asked me if I had been “feeling full?” UH that was an understatement. Seriously my jeans sometimes hurt to put on I feel so bloated. She smiled and I took that as a good sign. Then BAM.  It had only been three days since my last ultrasound. I was kept on my low dosage of 116IU. 4 BIG follicles! One had already reached 23mm. My fears started to subside that I wouldn’t have enough mature follicles to give us good odds this month. Then three others in the right tagged along measuring between17-19mm. 4 mature follicles in just the right ovary. They were ready to trigger. I remembered she really didn’t want more than 5 mature and ovulating. I knew my right was taking to the meds a lot better than the left and I prayed for only one more. The left ovary had 2 mature follicles and they were 18 and 19mm and ready as well. 6 mature follicles. The possibility of six babies.

Dr. Chang didn’t even mention canceling this cycle, which surprised me but also made me happy. I would have been devastated and it is worth the risk. She did however drive home the point about multiples. She repeated that I was still really young, with healthy eggs and told my mom she had already spoken with me about the risk of multiples (1). Then we talked some more about the process for Wednesday. She was going to check my hormone levels to make sure, but was 99% sure she did not want me taking my Follistim dosage for that day. Also that she had hoped to do a pretty mellow cycle this time around because she was afraid of… exactly what had happened(2). Then she said again “I hope you are okay with multiples.” (3) She left the office, I got dressed and we walked out to schedule my IUI (insemination on Wednesday) then before she walked out of the room she said “Just so you remember I did counsel you on multiples.”(4) Seriously four mentions in less than 20 minutes. I was officially freaking out.

The sad part about all of this is, I want to be excited. I want to be hopeful. Those are amazing odds. Honestly I had my panic about having a litter of babies instead of the twins I was hoping for. But it quickly subsided for the fear of none of them taking. We are only looking at a 25-30% success rate for ONE viable embryo. I just wish that this process didn’t jade me so completely. I can think back to the first few months we were trying. It was an adventure I thought about the nursery and what kind of dad Dan would be and over the course of this last year and half. I have lost hope. I have let this shell of doubt and insecurity harden around my heart and I just can’t let myself believe it is actually possible until I see that positive pregnancy test. Otherwise, I’m not sure I could really go through with this month after month. I am trying SO hard to just listen to my heart and know that whatever happens in our life is God’s plan for me. It is so difficult to let go sometimes and just let what will be, happen and be okay with it. Let’s just say I’m a work in progress.

I got a phone call around 6pm stating that Dr. Chang did not want me to take any more of my Follistim medication and to do my trigger shot of HCG at 02:30AM (ouch). This will force my ovaries to ovulate all the mature follicles. Wednesday we will head up to Portland around 11 and dan will need to produce a seamen sample by 1:30. Then they will wash it and we will start our IUI (insemination) around 02:30pm. 36 hours later. This is around the time my ovaries should pop those eggies out. The procedure can take up to thirty minutes and I will lie down with my hips elevated for 15-20 minutes afterwards. Then we will have the dreaded 2 week wait to see if it worked.

I have a lot going on in my mind. We are REALLY wanting twins and we would be happy with Triplets. Anything more than that is scary, but we are a team and we are ready for whatever life throws at us. I hope I can just get my attitude on board with every else’s. Let my guard down a bit and enjoy this. After all it’s not how we pictured, it’s not the most romantic thing in the world, but we could be making a baby tomorrow.

My mother in law gave me this to think about “Attitude is everything…. and a good one is the best!”

CD 9/ 7 Follistim Injections

Friday was my second monitoring ultrasound since starting my Follistim injections. I had done seven injections and had three days of my new dosage. Every time I make the trip up to Portland I honestly get pretty worked up. The trip up there alone is a long one and I have a lot of time to let my insecurites creep in and I end up picturing the worst case senario possible.

I had a really hard day on Friday. I don't know if the injections are making me overly emotional or if it was just one of those days. I just knew walking into some bad news. I ended up making it my appointment about thirty minutes ahead of time. I sat in Dr. Changs waiting room and a new medical assistant took me into the lab area. They drew my blood for my E2 level (which again, I don't know the result other than it was in a normal range).

I went into exam room 1. Did the normal "please get undressed below the waist and put this thin paper sheet over your lap" and waiting for Dr. Chang. She came in and we started my ultrasound. She said my lining was getting nice and thick. Which also ment my estrogen levels are rising. Hurdle number one down, so far so good. Then she took a look at my right ovary. Right away I could tell that my eggs (folicles) were bigger. She started measuring them one by one. There were now 12 eggs in my right ovary and three dominant ones. The largest measuring 13mm and the other two were 12 and 11. Not to shabby.

While she looked for my more stubborn left ovary I asked her how many mature follicles she was wanting. Most of my Google searches said that doctors would cancel the cycle if more than 3 mature follicles were present. For fear of them all implanting. To my surprise my doctor was right on the same page as I was. She said two would be fine but she would like to see up to five. I have been hoping that 4-5 eggs get big enough to ovulate. Not only do I not want to go through this again next cycle, but we are really hoping we will be lucky enough to get twins. Typing that out it sounds greedy. We will be lucky enough to be able to have one baby let alone twins. Only time will tell.

My left ovary still had 12 eggs but most were too small to make the cut this cycle. My right ovary is taking to the medication a lot better than the left. But there were still 2 dominate follicles right on track with the other three. She kept my dosage the same at 116IU and I have another appointment with her tomorrow (Monday) three days after my last ultrasound. She is hoping that on Monday my five dominant follicles will be mature enough to trigger and ovulate. Or at least a few of them. There is always fear that they will reduce in size or dissapear all together. She will know on Monday if I should do my trigger shot on Monday night or on Tuesday night. Depending on when I trigger we will make our appointment for our insemination (IUI). Insemination should be on Wednesday or Thursday. Then we have two weeks of waiting left to see if it worked and we get that positive home pregnancy test. I will write another update tomorrow after my appointment. I am praying for good news. :) Time for my 10th injection!

CD6 Ultrasound/ 4 Follistim injections

Well, yesterday afternoon I made the trip up to the big city. It was time for my first ultrasound after starting my Follistim injections. The 2+ hour trips (one way)are getting old and quick. It's bizzare to sit in the car for so long, go to a twenty minute appointment and then do it all over again. I will do what I have to do, and it's a bummer sometimes but at least I get out of work early sometimes. :)

I got to Dr. Chang's office and went for some blood work. They check your Estradiol (E2) levels at every visit to make sure you are in normal range. I am still a newbie when it comes to the rules of the E2 levels. So far all I know is mine have been fine. Then I went into the exam room, undressed from the waist down and waited. This five or ten minute wait really leaves your mind racing. Usually I try to focus on the fact that I wish I would have painted my toes or what socks I should wear next time.

Dr. Chang then preforms a vaginal ultrasound. If you don't know what that is. Here's a picture.

That sure looks like a ton of fun! NOT.

She first checked the lining of my uterus and said it is thickening nicely. She did the measurements but I sort of forgot to pay attention to the exact numbers, since she said everything was just fine. Next she looked at my right ovary. I should have asked for copies of the ultrasound photo's. The right ovary had 12 eggs (medicaly known as follicles) and she measured them one by one. The largest was at 10mm. They need to get to a whopping 18-22mm before they are mature enough to ovulate. Here's an example (not mine) of an ovary with many follicles.

My left ovary had 12 eggs. That's 22 total! I am really excited about that, seeing how my biggest fear was id show up and the meds wouldn't be working on me. Although most of them are on the smaller side of 9's,8's, and even some 7mm. So my little eggies aren't even half way there yet. I'm okay with slow and steady wins the race!

She decided to increase my dosage just to help them mature a tad bit faster. She raised my dosage from 100IU to 116IU. That gives me hope, if my small little eggs were a lost cause I would think she would have raised the dosage quite a bit.

From my reaserch if six or more follicles mature to the point of ovulation they will cancel the cycle. It could make me very ill and that puts me at risk for way too many multiples. I am hoping that at least 4 or 5 mature. The idea of all five implanting really scares me, but I know people who ovulate 3 follicles and end up with only one viable implantation. I think doctors are most comfortable with 1-3 big follicles.

I have another ultrasound appointment on Friday to see my progress. If I have really sped up the timeline, I'll come back for monitoring again on Saturday morning. If things are still going at a slower pace my next appointment will be the following Monday. I have a feeling after Monday's appointment I will be ready for my "trigger" shot a few days after. Then it's time for our IUI! I'm getting excited. But the percentage of success of all of this is still at a really low 25-30%. I wouldn't bet on those odds. But hopefully, just hopefully this is our lucky cycle!

Fun with Follistim

We met with Dr. Amiee Chang the very last day of August 2011. She has her own practice at the Oregon Infertility Institute in Portland Oregon. The drive is about 2 hours-one way. At this point I am used to all the traveling though, so it’s not really an issue.

Dan actually had the day off and he got to go with me. He almost never can get time off from work and this was a really important first meeting. I’m so happy that he got to go. We showed up and the receptionist/MA had me fill out a prior history packet that would make any infertile woman’s hands get clammy. It was the most detailed prior history packet of all time. Luckily I’m very organized and carry a planner around with me that has literally everything written down in it. Every appointment, cycle day, lab results, periods, what days I took which meds. I also had my medical records sent over from the last two doctors.

We met Dr. Chang and I will admit at first I’m very leery when I meet a new doctor. She impressed me immediately. We sat down gave her some more background information and she laid out a game plan for the next four months.  She let us know that this was all in our hands. We were in the driver’s seat. If we weren’t comfortable doing something then to tell her and she will back off. She said she would do whatever she could to get us to that ultimate goal of getting pregnant. She was soft spoken, confident, and to the point. I was mid cycle when we went into the appointment. We had about two weeks until I could take a pregnancy test. If it was positive, then we were set. If not we’d start the next step. Judging by the blog you can probably tell it was negative.

On CD1 (first day of my period) I called the office and they scheduled me that day to come in for a baseline ultrasound. They look at your lining and your ovaries to make sure that everything is on track. My lining was thick but appropriate for CD1 and my ovaries had several small “eggs” called follicles that were pretty small but consistent with having PCOS. The next step was a pretty intense one, but one that we were ready for.

We decided to move onto injectable fertility medication. I started on CD 2 and I will go in every three days or so for ultrasounds to be monitored. The reason that I am going to be monitored so closely is injectable fertility meds are VERY potent, especially with my young age. Follistim is the medication I have been using. Each night at the same time (8 pm) I give myself an injection of 100 IU. This is a pretty mild dosage. My first follow up Ultrasound is tomorrow CD6, I will have taken 4 injections by then. To monitor my progress and adjust or keep the dosage the same based on those results. Here are a couple pictures of the injection pen and a little snippet of me getting my second injection on Saturday night.

That is the "pen" that I inject into myself.

Above are the different parts to the pen and medications.

Below is a little video taken of me getting my second injection.



I will continue the injections until the doctor feels I am ready to “trigger”. I will give myself an injection of hcg (Ovidrel is the brand name) and that will trigger my ovaries to release all the mature eggs. Each egg that releases has potential to be fertilized.  My doctor thinks I have over a 50% chance of conceiving multiples. Dan and I are really excited about this possibility! Only time will tell. They will call me and give me very specific instructions on when to give myself the hcg shot down to the minute. 24-36 hours later Dan and I will go up to their office. He will give them a semen sample and they will perform an IUI (also known as Artificial Insemination)they do a procedure to the semen called “Washing” to prepare it for the IUI. It increases the chance of fertilization by removing any mucous or non-motile sperm. Then they will put a catheter into my uterus and place the semen directly into it. That way they don’t have to do a whole lot of work. After that we wait and see if any or all of the ovulated eggs get fertilized and implant! I will do another update tomorrow after my visit with Dr. Chang and my ultrasound.  

Luckily we are covered 100% for now. A usual injectable cycle with IUI runs anywhere from 3500-5000 per cycle.  The Follistim itself, runs 1.30$ per IU. Each one of my mild doses of 100IU a night would run me 130$. YIKES! After December some serious budgeting is in store for us.

Our Journey to Get Here..

Honestly I have been wondering how I can possibly put the last 15 months into one blog post. I think that most of the posts will be from my perspective (Tiffany). Hopefully down the road, Dan can share his insight on the husband’s role and how he has felt and handled it all. I’m going to be frank and if you read something that, you don’t like or is too much to handle feel free to stop. We want an unedited place to cry and rejoice.

It all started by accident. Literally. The condom broke and we had the dreaded two week wait to see if I was pregnant. We decided against using a Plan B and in those two weeks we both got excited at the prospect. When my period came, we both were disappointed and had a very honest discussion about our lives and what we wanted. Although it felt crazy at the time, we decided we were ready to really try and become parents. Little did we know what a hard road was up ahead of us.

Around the age of 19, Tiffany was diagnosed with PCOS. Polycystic Ovarian Syndrome.  Here is a quick link to the WIKI website to get a little background if you want http://en.wikipedia.org/wiki/Polycystic_ovary_syndrome . This was something she shared with Dan early on in their relationship, because she knew it could make getting pregnant in the future very difficult.

The first few months we tried like any couple. We learned my cycle and with each passing month we grew more and more disappointed but knew that these things just take time and had fun in the process. By the third month in September we had just gotten back from Vegas, I decided to see a new OBGYN to talk about my PCOS and trying to conceive.

I met with Dr. Donald. He advised we try without doing anything drastic for a couple more months. By November I had every lab test in the book, and they found out I was not ovulating on my own. He decided to get me going on some medications that would get me to ovulate.

 December was the month I started taking Clomid. Clomid is a fertility medication taken orally, in doses anywhere from 50-200mg each. It stops the signal to your ovaries that usually only lets one “egg” mature and ovulate.

I started a regime every month that consisted of:

CD (cycle day, the first day of your period is Cycle Day 1)5-7 take 50mg of Clomid.

Start using an OPK (ovulation predictor kit) three days after the last Clomid pill until you see a positive.

24-38 hours later Ovulation

CD 21 Progesterone blood work to confirm ovulation and see if progesterone was high enough to sustain a pregnancy.

CD29 Home pregnancy test/Period begins.

We did two months of 50mg Clomid, with only one cycle resulting in ovulation.

Next started the monitored cycles. They do an ultrasound at the beginning of the cycle to check uterine lining (got an A+) and no cysts in sight which is a great sign! Those can mean big issues in the infertility world. Then as the cycle went along using another round of 50mg Clomid check to see how the “eggs” are maturing and how many should ovulate. After a seemly successful month still BFN (Big Fat Negative).

Dr. Donald decided that I should see another OBGYN in Portland that may be more experienced with fertility medication. During that month waiting for my appointment he took me off all meds in March/April of 2011 and I didn’t ovulate. Dan also had a semen analysis done to make sure that he was A-OK. His results came back pretty average, no problems there.

May 6^th 2011 my first appointment with Dr. Megan Bird. She was wonderful. She was sensitive to my feelings and also a straight shooter. She was confused as to why I was referred to her and she did not have a ton of experience with infertility. Our next step would be to see a RE (Reproductive Endocrinologist). Usually insurances cover 0%-20% of reproductive medicine. They consider having a baby not a medical necessity. If you ask me that’s a crock of bullshit. One visit with an RE runs around 250$. We made a plan and she decided to give me as many tests as they would at the RE and do a 2-3 month plan with her while my insurance would still pay at 100%.

My first step was an HSG test in the radiology group in Tualatin. You go into a procedure room they take a catheter and put it through the vagina, the cervix, and into the uterus. They inflate a small balloon to make space and inject a Radiopaque dye through the tube and into the uterus. Simultaneously they take video/pictures to watch the dye fill the uterus to see its shape and if there are any abnormalities. Then the dye flows through the fallopian tubes and into the ovaries, to show any blockages or punctures. It was uncomfortable and slightly painful. My test’s results were good. No blockages, fine shape, just a little tipped but that holds the equivalence of someone being left handed. It’s a bit different but no better or worse than an un-tipped uterus.

Here is a picture of what one looks like. This isn't mine but just an example:

Then I did two more unmonitored cycles of Clomid, one 50mg and one 100mg cycle. Both resulting in no pregnancies. My cycles started getting increasingly bad, irregular and she made the decision there was nothing else she could do for me. It was time to see the RE.

The idea of seeing a RE was exciting because that is all they do all day is deal with patients just like me who need help getting pregnant. At this point it had been a long 13 month journey and most days it felt like I was right where I started. We had a long talk about finances and if we could afford to see the RE. We decided that although it would be a struggle financially that we had been trying too long and gone through too much to stop. We laid in bed together and called the insurance company. Chanting “Please at least cover 20%. PLEASE) we found out that until January of 2012 we were covered at 100%. We were elated and made our appointment for August 31^st 2011. In January our coverage goes down to 50%.

This post is very watered down. I just wanted to give a general idea of where we have been, moving forward. It has been a very painful process and I will probably dedicate a post of emotion later on in the blog. If anything, leaving out how many tear filled nights we have had made this a little more tolerable to re live. If I had any other man standing by my side. I don’t think I would have made it as far as we have.