Post-IUI follow up

Remember how I was worried we'd missed our ideal ovulation window for our first IUI two weeks ago?

Well, on Christmas Eve (8 days past IUI, or 8dpIUI), I had some spotting. I thought, oh great, my period is on its way and this cycle didn't work... I was pretty bummed. But then later that night - nothing. Christmas Day - nothing. I tried one of my cheapie pregnancy tests on Christmas day (even though I'd sworn I would not cave and do that), and could just barely make out a line. I mean I had to seriously squint and get the lighting just right. So I still thought, nah...

But then no Aunt Flo by the day after Christmas, so that day I went to the store and bought 'good' pregnancy tests. Apparently First Response Early Result (FRER as they are known on the trying to conceive message boards) are sort of the gold standard. So I bought a 3-pack.

I got a faint line on the first one. Not as faint as on the internet cheapie from two days before. Even David could see this one. The next day, I took another, and 48 hours after that, the third one. Here they are:

See how that test line got darker over the 48 hours?

I had one Clearblue Digital test from a pack of Clearblue ovulation tests I'd bought awhile back, so I used that one too - this was on 11dpIUI -

Somehow the word "Pregnant" is a lot more real than two lines! Yikes.

Today was 14dpIUI and I went to the clinic for my blood test. They called this afternoon with the result: 92. 

According to the webernets, the average hcg at 14 days is 48, so 92 is really good. 

I am scheduled to go back Friday for a follow up blood test, because if everything is ok, the #s will double within 72 hours. 

After that, they will schedule an ultrasound at 7 weeks (so three weeks from today). They said if everything goes well, at that point I will be sent to my regular OB and won't see the RE any more. 

We are feeling a little bit surreal and not really letting ourselves get too excited. We honestly did not believe it would work the first time. Of course we are happy that it did, but I think due to our issues getting here, we are a lot more guarded than we would have been otherwise. I think once we know the numbers double, we'll breathe a little easier. Then once we can see good stuff on ultrasound, we'll feel even better. We'll probably tell the kids at that point (so if you are reading this and see them in the meantime, mums the word!), and make a big announcement a little later.

Due date is September 8... so weird! I've felt a little crampy, a little tired, and some smells have bothered me (like garlic breath!), but overall I feel fine.

IUI

Today was my first IUI. Cognitively, I knew all along I'd only have about 24 hours' notice when this happened, but it still threw me for a loop yesterday when the nurse called and said that it would be the next day. I like to have more time to really psych myself out about this stuff! (But maybe it's a good thing not to have too much time.)

My poor husband had to go and give his part an hour before my IUI. Every time I am at the office and I see a man come in, I feel bad for him. Which really is stupid, honestly - as the nurse, Colleen, said to me today, "Compared to what you women have to go through, the man's part is extremely easy." Truer words!

I was nervous to leave the kids alone that long, so my kind friend Rachel came over to stay with them. We thought my mom would be over shortly to relieve her, but my mom's doctor appointment went way late this morning, so she ended up not making it. After David's deposit, then, we opted to bring him back home and I would go to the IUI alone. I was really nervous about going at all, much less alone, but I was more nervous about leaving the kids alone that long, so it was the lesser of two evils.

I watched youtube videos and read articles, so I knew pretty much what to expect. It's basically like going for a pap smear, a little bit more invasive and uncomfortable than that. I was surprised that the whole thing was done by the nurse. I just assumed it would be done by the doctor, but I never saw him. I've never actually even been touched by the doctor - we've met with him in twice, in his office, in chairs - but everything else has been done by nurses, ultrasound techs, and phlebotomists.

This is the ceiling light I got to stare at while I laid there afterwards. 

Here I am lying down, waiting... I need a haircut.

The first part was painful because my cervix is an elusive sucker and she had great difficulty finding it. That took three or four minutes. Then the actual insemination was fairly quick. 

They take the man's sample and 'wash' it so that only the strongest, most motile sperm are left. So the actual amount that was left for me after that was tiny. She said there were 15.2 million motile sperm in that sample, and they like it to be over 5 million, so that was good. David is the Fertile Myrtle in this family! 

I had to lie down for about 15 minutes afterwards, then I was free to go.

Now, it's just a wait. I am scheduled to go back in 14 days for a blood pregnancy test. Obviously I'll be testing at home before that time so I will know the answer. I keep reminding myself there is only a 10-15% chance of success with each IUI cycle, so that means there is an 85-90% chance it will not result in anything.

I am a little worried that we missed the best window for this. After I had to do the second round of Clomid, the nurse told me to stop using OPKs at home, because I was being monitored in their office every other day. For the most part I kept doing them anyway, because I was in the habit and I had bought so many of them! But on Sunday, I just didn't feel like doing one, so I didn't. Then on Monday they said I was surging. I think if I'd done OPKs at home Sunday I would have already known that and maybe we could have done IUI on Monday, because when I woke up today (Tuesday) my temperature was already a little high, a sign that ovulation had already occurred. 

Monitoring and FINALLY!

IT'S GO TIME, MISTER BEAN!!!

I went in this morning for one of my every-other-day monitoring appointments (which we've started referring to as "a poke-and-probe," since it involves drawing blood, then poking me with the ultrasound probe, mega fun all around). My right arm has good veins but has been stuck so much lately, I look like a heroin addict. My left arm wouldn't cooperate (I believe those veins are smarter and hide deep in my arm when a needle comes out), so she had to take it from my hand. Ewww. I never look - I don't like seeing my own blood - and I thought she was done, so I looked down at my hand because they always want me to hold a cotton ball on while they get a band-aid out. Well, I looked too soon and saw a metal needle sticking out of my skin. I nearly barfed. I'm not a queasy person by nature, but with all this estrogen coursing through my veins!? I can't be held responsible for my behavior!

I actually kind of forgot about the appointment after it was done, because I had so much other stuff to do. Came home about 9am and got the kids into the school work as fast as possible, because once done, we had several errands to run, before picking up my oldest's friend (which we do every Monday). So we did our grocery shopping and other errands, got the friend, and came home. When the doctor's office called around 1pm, I was like, OH! Right... So I was not expecting what they had to say.

"It looks from your blood work like you are starting to surge, so we're going to go ahead and schedule your IUI for tomorrow." Uhhh... come again? I was expecting something like, "The follicle is ___ mm now so come back in ___ days for another monitoring appointment." Something along those lines. 

I had stopped using the at-home ovulation tests since I was going in so often to be monitored. They said I didn't need to. I mean, I still did at least every other day, but not religiously like before. So when I got off the phone with them, I immediately took all 3 types of OPKs that I have. Here is my result:

Top: Clearblue Digital Advanced

Middle: Wondfo 

Bottom: Clearblue Digital

Apparently, the advanced, isn't so advanced, since the other two test (oh, AND bloodwork and ultrasound!) all showed I was in fact having my LH surge. And that advanced test cost more! Waste of money.

Anyway, I was so excited! And simultaneously, freaked out! Tomorrow!? That's so soon! 

David said he can take time off (sick time - he never uses it) to go. He has to leave his sample at 10am, then my IUI is at 11am. The lab needs time to wash the sample so it's ready to use. They said my part of things will only take about 15-20 minutes total. Kind of weird... for some reason it seems like it should be longer or more difficult. (Not that I'm complaining.)

I know the odds of it working aren't great. IUIs have about a 10-15% success rate per cycle and a lot of couples need 3 cycles before it works. But it does work the first time for some people. So... I'm optimistically hopeful.

Uuuuuh.... yeah.

I'm not new to the idea of transvaginal ultrasounds, at all. I think I had my first one when I was 10 weeks along with Lucy, our first child. I had them with all three pregnancies, as they are the best way to get a view of a first trimester developing fetus. I have had them non-pregnant too, when I've had pain or whatever issues that needed looking at.

Now that we see a reproductive endocrinologist (and by we I mean, most of the time, me), I have had many, and continue having them. I'm at a point right now where I get to have them every other day! What a lucky girl am I!?

Riding the gold, mirrored elevators at The Women's Hospital

When I went for Saturday's, I at least got good news afterwards that I had ONE follicle developing - it measured 14mm at its largest but the average measurement was 12mm so they are calling it that. I have to go back every other day to have my blood estradiol checked and more transvaginal ultrasounds to check its growth. Once they think it is large enough to trigger, I'll need to use my hcg shots (Ovidrel... or rather, get my friend Cathy, who is a nurse, to give me the shots!) then we'll do IUI. So for now, it's just chunks of 48 hours of waiting interspersed with a fun hour visit to the RE to be poked and probed.

Clomid

This probably sums up David's feelings on having a Clomid wife.

"Houston, We have sperm!"

Just kidding. That'd be weird.

The surgeon who performed David's VR told us to not get a semen analysis (SA) done until at least 4 months after the surgery. Apparently, sperm take about 90 days to fully complete their development in a man's body. Who knew right? I was always under the impression that men make millions of new ones every day. Which I guess in a way is true, but the ones that actually come out are about three months old.

However, we have a microscope at home (a gift from the grandparents to the homeschooled kids... don't tell the kids we used it for this) so we would periodically just take a peek at a sample for funsies. The first time we looked was kind of dismal - but granted, this was only six weeks or so post-op.

You see there are a few wrigglers, but not many, and those that are visible seem to be kind of immobile. 

But then we tried again at about 10 weeks post-op and had much better results:

This time, we saw lots of swimmers. Some still seemed to be clumping, but definitely better than the previous sample.

I had my annual exam at the gynecologist's office in June and talked to her about the VR. She's a funny woman and says whatever comes into her mind, but I trust her very much as a doctor. She was surprised but supportive and said she didn't see any reason why I couldn't get pregnant again. 

But it just wasn't happening, and my cycles were totally wonky. One would be 23 days, then 51 days... like that. So in August when I went to see my GP for a regular checkup, I told her what was going on, and she said for me to go ahead and see a reproductive endocrinologist (RE) due to my age and the other issues we have. "It's better not to waste any time, in my opinion," is what she said. I was surprised she referred me to an RE so quickly, but now looking back, I am glad. The RE's office got us in a couple of weeks later.

Since we don't exactly live in a budding metropolis, there is only one RE office here (Boston IVF), and only one doctor who works there (Dr. Griffin) along with nurses, ultrasound people, etc. The sucky thing about it is that it's located inside The Women's Hospital, so every time I go in, I have to pass pregnant women and huge glossy photos of newborn babies. The office itself is careful not to have pregnancy magazines or photos like that, but it's still a tough reminder every time. 

Our first meeting with Dr. Griffin was most information gathering. He asked us each a ton of questions. He then told us what tests he wanted to run. All David got saddled with was a SA, which we assumed. I on the other hand was signed up for a bunch of bloodwork that involved fasting (I think they took 8 vials), and an internal ultrasound on the third day of my period. Oh boy. I've had internal ultrasounds before, they are not fun, but not all that horrible once you are used to them, but I never had one during my period before. That was a whole new kind of awfulness. Also there was a student observing that day. Super awesome.

Most of my tests came back good. The one most concerning, Ovarian Reserve, came back rated "excellent," which  means that I have plenty of eggs left and am not expected to enter menopause any time soon (it does not, however, determine the quality of those eggs, which is really the issue in your 30s compared to your 20s). One test that was a bit off was my thyroid. Normal is under 3.0 and mine was 2.71, but Dr. Griffin said that for trying to conceive, he prefers it to be under 2.5. So I started a low dose of a thyroid medication to try and bring that down.

David's SA results were really great! His total count was 113 million. The motility - the ability they have to swim around - was a tad low at 29%, but Dr. Griffin said this was normal after a VR and would likely go up with time. He told him to take a vitamin E supplement in addition to a daily multivitamin, but David was already doing this. So we were relieved.

After all our tests were done, we met with Dr. Griffin again to make a plan. He proposed that we try to induce ovulation by me taking Clomid, and then do IUI (intrauterine insemination) in addition to timed intercourse. He felt this would give us the best odds. 

We had more waiting to do because first I had to wait for a period to my pre-treatment testing, and then I had to wait for another period to start our first IUI cycle. In between, I got very sick with bronchitis and a sinus infection. I had felt a cold coming on, the day David and I went to get our flu shots, but didn't feel too terrible. I believe getting the flu shot while my body was fighting an infection is what made me sick for so long. I was sick for five weeks straight - took 2 different antibiotics, 4 different cough medicines, and a steroid. I never ovulated all that time (I am in the habit of taking my temp every morning and using ovulation predictor tests every day too).

Finally in mid-November we started the cycle. I took Clomid on days 3 through 7, then started using the OPKs daily. I never got a positive so on day 16 they had me come in for bloodwork and ultrasound (yaaaay), and said I "didn't respond at all to the Clomid." Great. So I went through all that for nothing. The Clomid made me feel crazy. I felt weepy one moment, insanely angry the next. Not constantly, but at unpredictable times. I also felt a lot more tired than normal, but didn't sleep well. I got all the SIDE effects, but apparently none of the INTENDED effects.

I thought they'd say to wait for my period and try a higher dose the next cycle, but they said Dr. Griffin wanted me to start a 2nd round of Clomid at 100mg (was on 50mg) that very day. It's something called stair-step protocol. So I've now been on the 100mg for five days (last dose was last night), having all the negative side effects again. They told me not to do the OPKs myself any more and to come in on Saturday morning for blood work and ultrasound to see if I've responded, but I have so many OPKs I've just been doing them anyway.

The RE said to use Clearblue OPKs, which I do not like, for two reasons. One, they are expensive, and with long cycles like mine, that really adds up. Two, they only give you either a smiley face, meaning you are about to ovulate, or an empty circle, which to me looks like a zero. I do not like that. So I also use these cheap ones called Wondfos, that cost about 40 cents each, and give you 2 lines. When the test line is as dark as the control line, you consider it positive. Here are a few days' worth of my tests, with the most recent on the bottom:

It does look to me line the test line is getting darker, but not there yet. So I'll keep testing, and go in on Saturday.

I have to say, even though this is just cycle one, I don't know how long I can do this. The medication makes me feel crazy, and going in for these appointments all the time is really hard. If David didn't work from home, there's no way I could do it, because you aren't allowed to bring children into the office (ironic since you're in the office in order to get children). 

VR

Once we made the choice to go with Dr. Sommers in St. Louis, we had to schedule the surgery. Since he has a medical practice outside of performing vasectomy reversals (VRs), he only does the surgery a couple of days per week. We were able to book Monday, May 12, at 10:00 a.m. We started putting money aside from each pay check so that when the time came, we were able to pay $3,000 cash (if you pay by credit card, they charge $3,300). I have never carried so much cash around in my purse before!

We had decided not to tell the kids, or anyone else, what we were doing. The reasons for not telling our kids were mainly that we did not want to worry them. Lucy, our oldest, is a natural worrier. This child worries about anything, and if she doesn't have anything in her life at that moment to worry about, she'll dream something up - like, "What if I throw up in the night?" - and get all bent out of shape over it. So Dad having surgery, possibly a new sibling... why put her through that when it was quite possible it would not be a successful surgery. The typical success rate - measured by a return of sperm, not pregnancy - for vasectomies as old as David's is about 60%. For similar reasons, we opted to not tell our parents/families either.

We decided to drive to St. Louis the Sunday before his Monday surgery, since it was a morning surgery, and thus we could be sure to arrive on time and not have to get up super early. It happened to be Mother's day that day - so apropos. Due to some previous trips, we'd racked up enough hotels.com nights to get a free stay, so we found a nice hotel and only had to pay about $20 for taxes. We went swimming at the hotel, ate some good pizza next door, watched The Amazing Race, and went to bed. David and I did not sleep very well.

We told the kids that Daddy was going to see a "man's doctor." We explained that the way a woman goes to a woman's doctor (they know I go to a different doctor sometimes), men sometimes have to go to men's doctors. We also said Daddy would be getting shots and be a little sore. They understand getting shots. We made it out to be no big deal so they wouldn't think it was a big deal.

The office was much like any doctor's office you would find in a mixed residential/commercial part of a suburb. We paid at the front desk, and our kids were shown a room where they could hang out. Dr. Sommers asked David and me to come back to his office. We sat down and he briefly went over, with a diagram, what the surgery would entail. He then gave David a dose of an antibiotic (just a precaution) and a teeny tiny drink of water (they can't stop surgery midway and let you use the toilet) and sent him to the bathroom. While he was gone, the doctor asked me about what I planned to do during the surgery. I told him we were going to pick up David's prescriptions, then do some shopping at Trader Joe's. He asked if I knew where to go and I said I was somewhat familiar, because the temple, where we were married, was not far from there. He was intrigued that we were Mormon and wanted to know the Church's stance on sterilization. I told him that I had learned that the Church's official stance was against it, but this was not something we knew seven years before, when we had it done. I'm not sure it would have changed our minds, but I do think it would have been nice to have known and at least considered that when weighing our options.

(Back story: the actual snippet - pun intended - about sterilization may be found in the official Church Handbook section 21.4.15: "Surgical Sterilization (Including Vasectomy)
The Church strongly discourages surgical sterilization as an elective form of birth control. Surgical sterilization should be considered only if (1) medical conditions seriously jeopardize life or health or (2) birth defects or serious trauma have rendered a person mentally incompetent and not responsible for his or her actions. Such conditions must be determined by competent medical judgment and in accordance with law. Even then, the persons responsible for this decision should consult with each other and with their bishop and should receive divine confirmation of their decision through prayer." Yet another section of the very same Handbook, 21.4.4, says, "The decision as to how many children to have and when to have them is extremely intimate and private and should be left between the couple and the Lord." So, it's a mixed bag, honestly.)

David then returned from the bathroom, and they were ready to begin surgery. Dr. Sommers had a surgical assistant in there with him. We said goodbye and the kids and I took off to Trader Joe's. After that, we stopped at CVS to fill his prescriptions, then went to a nearby park that the doctor had told me about. David was awake and able to text me throughout the surgery, which was reassuring. We had only been at the park a few minutes when he texted me to say that it was almost time to pick him up. His total surgery time was less than two hours.

We picked him up and started back for home. The numbing agent was beginning to wear off already, so we started the ice packs. Rather, pea packs. I had purchased two bags of frozen peas at TJ's. And David took some ibuprofen. He was comfortable enough on the three hour drive home. He had more swelling and pain than with the original vasectomy, but was well enough to work the next day (in pajamas, with frozen peas in his lap). By about a week, his pain was pretty much gone.

It's a good thing he works from home!