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Archive for January, 2012

Thoughts on infertility

I’m at the end of cycle #18. FF thinks I’m 9dpo, but I think I’m 12 dpo. FF originally gave me CHs on the day I thought I o’d, but later changed them. And since I didn’t OPK this cycle, I admit that FF might be right. Or not. So I’ll find out when I o’d based on when AF starts (luteal phase length). Our BD schedule wasn’t good this month because after the lap I wanted to take enough time to heal, and not put much pressure on this cycle. And then I was traveling for work around the time I might have been fertile. But technicalities aside, I’m at the end of my cycle, at the point when I normally give up on being pregnant and have some sort of emotional breakdown. And on top of that, as soon as AF starts I’ll be taking my first Lupron injection and won’t be able to try again for 3-4 months. I had my mental break down last night, and am still feeling a bit emotional this morning.

Sometimes I think about blogging instead of just keeping this journal. I mostly obsess about ttc, but I don’t want it to define me, and I worry that if I start to blog about it, it will start to define me. I’m lots of other things as well. I’m a professional librarian, tenure-track faculty at a university. I’m a step-mom to two super fun boys. I’m married, but still have to deal with a BM. I have an ex-husband who cheated on me and left me for his gf. All of these are huge topics that are big parts of me, but I don’t feel like they belong in the same blog, and I know I can’t keep up multiple blogs. So for now I’ll just keep quietly journaling on bbc.

Today I wanted to mention a great blog post I found last week. In it, the author mentions three different types of infertility: relationship, situational, and medical. I identified so strongly with this because I’ve been through all three types of infertility. When I see others feeling upset when their friends get pregnant easily, I have to admit that I don’t feel quite as strongly as they do sometimes. But after reading about these different types of infertility, I realize that I’ve been infertile for 7 years. And a few of those years I’ve had equally strong reactions to friends getting pregnant. At times it’s been really difficult watching my friends achieve so easily what I’ve been wanting so desperately. Over time I’ve gotten used to it though, so I’ve calmed down a bit. And, honestly, even though I don’t seem to be able to get pregnant, I still feel closer to it than I have at most points in the past (except at the beginning of ttc when I thought it was just weeks away). At least I’m taking steps in the right direction, finally.

My first husband and I got married in 2002. We agreed that we both wanted two children, but wanted to finish graduate school first (both of our 2nd masters). We even named our babies Sasha and/or Trevor. As we watched our student debt pile on, my then husband thought maybe we should only have one child so that we could pay back our student loans easier. I wasn’t totally on board, but I did agree that things might be easier with one, so I was ok with it. In 2005 I finished school and got my first professional position. I started dreaming about starting a family, but my husband wasn’t ready yet. I was ok to wait, but not long. And every time we talked about it, he kept putting the date off longer. And then he said he didn’t want children. And then he said he wanted children, just not with me. This was relationship infertility. When we divorced, the loss of Trevor and Sasha was huge. These were the babies I imagined having with him, and they were never going to exist. I think I mourned this as much as the loss of my marriage. People would say “thank god you didn’t have any children.” But I never felt that way. In fact, I felt that that comment was the most insensitive comment I’d ever heard. I wished that I’d had children so that I could put all of my energy into protecting them.

At this point in my life I wondered if I was ever going to have children. No one wanted to have children with me, and there wasn’t much I could do about it. It was situational infertility. This was the hardest part of infertility I’ve dealt with to date, and lasted from 2007-2010. It was exactly the point in my life when I thought I’d be starting a family (early 30s). My friends were starting families, and I watched them as my life went backwards. I had strong emotional reactions to pregnancy announcements, facebook posts, and even walking into Babies R Us gave me panic attacks. I made plans in my head for how to move ahead if I didn’t find anyone to make a family with. I decided I’d wait a few years, and then seriously investigate donor sperm. But it was overwhelming to think about doing it by myself.

Luckily, my now husband came into the picture. We’d known each other since 3rd grade. We agreed to get married, and we both want children together (even though he already has two from his previous marriage). The number is still up in the air, but we’ll tackle that at a later point, because right now, making one is proving to be incredibly difficult. We agreed to start tttc a few months before our wedding. The was my first experience ttc ever, and I was so happy to finally be at this point in my life! The first month I worried that I might have a bump under my wedding dress. The next month it wasn’t such a concern, and then we got married, still no bfp. I thought a bfp was always a few weeks away. I obsessed about childbirth and healthy pregnancy options. I daydreamed about being out of work for 3 months. And then I realized that it wasn’t happening. Trips to the RE started. The initial diagnosis was lowish sperm count and motility. And then we found out that my problems were even bigger. And here we are today. The idea that I’m infertile has really just sunk in. I thought, especially with the lowish sperm count, that we just hadn’t managed to get lucky yet, but given enough cycles and enough BD we’d get there. But then I had to have surgery, and realized that I probably wouldn’t get pregnant without surgery. And now I’ve been diagnosed with Stage III endometriosis, and see statistics like 30% of those with endo can’t get pregnant. This is medical infertility. It’s new and scary to me, but still feels less horrible than the other types of infertility I’ve experienced. I still have hope every month, which I never did at the other points. It’s much more of a roller coaster, but I have a strong, supportive husband. And we’ve agreed that we want a family together, even if that means adoption at some point in the future. And because I have two stepsons whom I love very dearly, I know that I don’t need to be biologically related to my child. I strongly feel that I’ll be a mom at some point in the future. I don’t know when or how, but I know it will happen, so overall I have hope, which I never had in the other two infertility stages.

I’ll be starting Lupron this week or next week. Which technically puts me back into situational infertility, even though it’s just for 3 months. No wonder I’m feeling so emotional about it, because my last bought of situational infertility was horrible.

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Post op

Damn. Now that I’ve had my lap, I was hoping my RE would have a clear path to getting me pregnant. But he’s a good Dr., and gives me information and lets me make my own decisions. This decision is Lupron vs. no Lupron. Lupron is a drug that puts you into a chemical menopause for several months. The theory is that it helps endometriosis calm down so that the environment is more friendly for conception.

My diagnosis post lap: Stage III endo and inconclusive dye tests. My right ovary was huge with endometriosis inflammation (endometrioma)! I had small scarring on my uterus, and some adhesions on my left tube and ovary. Luckily, I don’t have the type of endo that covers the pelvis region and tends to create lots of pain and is the reason for hysterectomies later in life (my aunt has this).

The no Lupron argument: My endo is primarily ovarian without alot of implants in other parts of my reproductive organs. They removed the endometrioma, and now everything should be working fine. Pain isn’t a primary problem with my endo, and Lupron is really used to help quality of life for people with severe pain. Lupron is a nasty drug with nasty side effects, and I don’t like to take any more medication than I need to. On the endo board I read that endo specialists don’t prescribe Lupron to TTC patients because it doesn’t do anything to help TTC.

The Lupron argument: My RE says that there’s not a lot evidence to show that Lupron increases odds of conception, but it’s possible that it helps the odds 5-10%. Which isn’t a lot unless you’re part of that small percentage. And it doesn’t seem to hurt the odds, other than putting it off 3 more months. Even though I had a huge endometrioma on my right ovary, my left side seems to have been ok, and I know I’ve been ovulating on my left side, but clearly it hasn’t worked, although I did have some adhesions on this side that were removed. I’ve read that endo creates a hostile environment and may possibly impede implantation. The lap probably didn’t do anything to help this. My RE is not an endo specialist, and did not do complete excision. But the theory is that Lupron would calm that environment. If I take Lupron he does an add-back therapy to help hormone levels. He said that Lupron needs about 10 weeks to be most effective, but we’ll only do 1 month shots at a time, so if the side effects are absolutely horrible I can stop after 1 or 2 months.

I went into the appointment thinking that I’d take the Lupron if he recommended it, and it was part of his normal protocol. However, he didn’t recommend either way. He gave me the information and is leaving the decision entirely up to me. When he first started giving me info, my initial reaction was to not do the Lupron, but when I started looking at the pictures and seeing that there were little bits of endo here and there, I started to think that maybe it would be the right answer. I left thinking that I would probably do it. But I’m ovulating this week, so we’ll go ahead and try timed intercourse. And then I thought that maybe we could just try timed intercourse next month too, and if nothing happened (likely with DH’s low sperm counts), then I’d move on to Lupron. Although that will likely just make the process one month longer.

Also, unfortunately, I’m going to have to do an HSG before any more high tech treatments because my dye test was inconclusive. If I take the Lupron we’ll just do it in the middle of the Lupron treatment.

Sigh. What a complicated mess. It feels like it’s still going to be a long time until things are lined up properly.

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I had my lap surgery yesterday. The doctor seemed pleased with how it went. They removed the endometrioma on my ovary, found and removed more endo on the back of my uterus, and said the left tube and ovary were functioning fine, but were stuck to my abdominal wall or uterus with adhesions that they removed. The RE spoke to my dh after and seemed confident that this is why we haven’t been getting pregnant. (Although there are still low numbers for my husband’s count).

I ended up staying in recovery for 5 hours instead of the estimated two. When I woke up I was hardly able to breath and my heart rate was skyrocketing. Then when they tried to move me to a chair my blood pressure plummeted and I had a hard time breathing again. So I stayed on my bed a while longer and slowly worked my way upright in a chair. Then the nurse started talking about how to care for the incisions and I nearly passed out again. So then they gave me an anti-anxiety drug, but had to keep me until they knew that I wasn’t going to have a reaction to that. So I finally went home around 4:30 after getting there at 6am, with a three hour surgery.

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