REsults

The meeting this morning with the RE was OK, at best, but I'm not certain another clinic would do anything differently (aside from the bizarre social worker requirement, which I still do not understand) so my thoughts of transferring to another office remain just thoughts. I'll stay put for now.

I brought my list of questions, and the RE answered most of them without my asking.

1. Heart rate- There is some evidence to support the theory that babies are smaller if the mother's heart rate during pregnancy is frequently very high. The RE knows of no evidence linking an elevated maternal heart rate with infertility or difficulties conceiving. Nurse TMI is full of crap.

2. Monitoring- Based on my consistent and fertile-seeming hormone levels (as measured in the CD3/CD22 and clomid challenge blood work), plus the fact that I have no trouble detecting an LH surge each month, the RE believes nothing can be gained by monitoring while I'm on clomid. She feels it is safe to assume that the follicles are mature when I ovulate because it's the hormonse released by the follicles that naturally trigger ovulation to begin with. Monitoring makes more sense in combination with injectibles, when the dosages can be tweaked as the cycle progresses to achieve desirable results. With clomid, there is no opportunity to adjust the dosage, so the information gained wouldn't be useful. She said she would schedule a CD12 u/s if I insisted on one, but that it would be completely unnecessary.

3. Next step- For insurance reasons, we cannot move on to IVF immediately if this cycle does not succeed. My carrier requires two cycles of FSH/OI (ovulation induction)/IUI before they'll authorize an IVF cycle, regardless of my age. My RE prefers to do an injectibles/IUI cycle before moving on to IVF anyhow because it gives her the opportunity to see how a patient responds to the drugs before getting into an IVF cycle... a rehearsal, more or less, before the big show. If I am not pregnant by 3/24, we'll do FSH/OI/IUIs in April and May. If I'm still not pregnant by Memorial Day, we'll take the month of June off from TTC (like that's possible) in preparation for a July IVF. I'll be 42 before my first child is born, if that's the case. I'm keeping my focus on NOW. I don't want to think about next year already.

4. Rh-factor- The blood type of our donor has no affect whatsoever on our chances of conceiving.

5 & 6. Maintaining a generally healthy lifestyle and diet are all the dietary advice she provided. Odds are that my lack of success to-date is simply attributable to my age and the fact that not every egg is viable/fertilizable. I didn't specifically ask if there were foods or supplements that she would recommend.

Throughout the meeting, the RE kept saying things like, "If you continue with us," and "The other clinic does this the same way." The nurses recorded in my chart that I'd hung up on one of them, and she asked me about that. I explained the conflicting information I had received, coupled with the stress of an extremely tight timetable which no one in her office seemed concerned about. She defended the nurses, but also seemed to understand where my frustration came from. I told her I have no plans to move to another clinic (especially since the next-closest one is 12 miles further away and their weekend office is yet another 20 miles beyond that, AND more than half their staff are men).

So, staying put, for now. And now that we have the word on Rh, we're hitting the catalogs once more.

onward to #6

There's no doubt left. Today is decidedly CD4 and I'm picking up the clomid on my way home from work tonight. This cycle will be a tad different though, if I have my way. For one thing, I am going to twist as many arms as necessary to have some monitoring done by the RE's office. I want to know exactly what is going on through the whole cycle. Just how many follies are there, and are they mature enough to expect fertilization when I ovulate?

We're switching donors, too. Not so much by choice, although we agreed to a 3-and-you're-out plan back when this started. I was willing to give lucky #18 one more shot, but he's retired and is now in limited supply. I'll leave what's left for the folks who are trying for a full sibling for babies #18 helped them conceive already. We're back to the catalogs now, and once again feeling like this process is so random and wierd. I need to find out from the RE if matching my Rh-factor increases our chance of success. It does limit the options available, but if it raises the odds I'll do it. Lucky #18 was the same Rh-factor as me... but Im sure we'll find someone else we like.

On Saturday, C told me he didn't care if our baby was Asian, African, Caucasian or any other race. I can't let go of the early images I dreamed of a baby with C's beautiful blue eyes. But I am much more concerned with a healthy family history, so if the "best" donor happens to have brown or green, or even orange eyes (haha... ), that's who we'll go with. Unfortunately, sticking with C's traits narrows our choices considerably. Also unfortunately, removing those preferences makes narrowing the immense pool of donors very difficult.

There are worse problems to be had, for sure, than too many donors to choose from.

So, my questions for the RE this week-
1. Nurse TMI told me that my heart rate should never exceed 130 BPM while I'm TTC. Is this true? If so, how do you explain all the women who got pregnant while living their normally active lifestyle?
2. What explanations can be offered to explain why our attempts haven't worked yet? What can we do this cycle to make sure we learn something from it, just in case IUI #6 meets with the same result?
3. What is our next step, if this cycle doesn't work?
4. Would our chances of conceiving be increased if we select a donor with the same Rh-factor as me?
5. Do you recommend any supplements or complimentary, alternative treatments that might increase our chances of conceiving?
6. Are there any foods I should try to avoid (aside from the obvious "bad for you" foods), or any that I should make more prominent in my diet to help things along?

Almost second-guessing myself.

No AF yet. Only the preamble, which has been around, off and on, since Sunday. I was so certain AF was going to arrive last night that I "celebrated" twice- caffeinated coffee in the afternoon, and a big glass of wine with dinner. I regret the caffeine. My body just isn't used to it any more. Within about 25 minutes, I was jittery and hot, and my hands wouldn't stop shaking. I slept horribly last night and blame it entirely on evil caffeine. Regardless of my reproductive plans, I think I am done with caffeine for good. The wine, on the other hand, was lovely and I thoroughly enjoyed it. The rest of the bottle is in the fridge, just waiting for AF to arrive and blast all doubt from my mind so I can toast to the next cycle.

It's CD32 now. Still preambling, so I remain certain that AF is only hours away. But I've believed that for three days now, and my BFN was too early to be taken seriously. Could I be completely misreading my body? I really don't believe so, and even if I thought I could be that mistaken, I refuse to buy another HPT. Either AF will arrive over the weekend, or I'll visit the RE for a beta on Monday. I'm not even mentioning AF to C. I don't want to get his hopes up.

One of the big things I think we miss in dealing with IF is the chance to truly surprise our spouses with the big news. I used to imagine buying C a card for whatever holiday was near; a card from a child to "Daddy," so I could give it to him and watch him react to the news the card would imply. I think maybe that's why, when we do finally become pregnant, I don't want to know our baby's gender until we meet her/him face to face. I still want some element of joyous surprise in this process that has become so regimented and clinical.

no dice

It's official. This cycle is a bust. I have to remind myself, though, that I accomplished a lot in the last 4 weeks. I passed the clomid challenge, had two mammograms, and submitted to an HSG. I know now that there is no obvious reason for the five IUI cycles to have failed, aside from the most glaring excuse. If I were 30 instead of 40, I bet I'd have gotten pregnant by now.

I really wanted to see the RE before CD3 so we would have options, but the earliest appointment I could get is next Wednesday, CD7-ish. The RE, and all of the doctors in the same practice, are on vacation this week. Probably because they all have kids who are off school for the week. Blast them! I did have a chat with one of the nurses this morning, who explained that the RE had outlined in my chart a clear plan for the next cycle if this one didn't work. I'm not too happy with this "plan," though. It sounds exactly like the plan I followed for the last 3 cycles... 100mg clomid CD5-9; OPKs from CD12 until I get a positive, then consecutive IUIs. No mention of monitoring or adjusting the dosage. No one knows if the clomid is doing too little or too much or anything at all. More follies doesn't necessarily mean better ones, so maybe I'd be better off unmedicated. I just don't know. And the doctor isn't around for me to ask.

I feel like they just don't want to spend any time or effort on me. I want attention. I want some proof that the clomid/OPK/IUI protocol does what it's supposed to (up to the point of conception, which we obviously haven't achieved yet). I want to rule out all possible explanations for why I am not a mom yet. Another same-old-sh*t cycle will either get me pregnant or do nothing. I won't necessarily learn anything from it, but there should be a lot to learn if only the doctor would pay attention and meet with me DURING the damn cycle. I don't think I'm asking too much, and I plan to insist on monitoring of some kind this cycle when I see the RE next week. I think that's perfectly reasonable. And that way, if it doesn't work, at least I'll have one more piece of information in my arsenal.

I thought about seeking a second opinion, but I really don't feel like starting from scratch with someone new right now. Also, the other nearby fertility clinic is staffed by a lot of men. Ever since an inappropriate groping by a physician when I was 22, I've stayed away from male doctors. I've never had a male doc examine my female bits, and I can't imagine being comfortable with it. It's awkward enough, but at least a female doc has the same parts as me and has probably been intimate with a speculum before. I know there are probably some wonderfully compassionate male REs in the world. I just don't want one.

So, back to the drawing board. Tomorrow will be CD1. I'll start my clomid on Monday. There's no time to get a prescription for something else, like injectibles. So I am stuck with repeating my last three attempts. They say that repeating the same actions over and over while expecting different results is the definition of insanity.

synchronicity

It's odd. I noticed this week that there are at least three other women out there in blogland who are on the same calendar as I am this cycle. We're all CD29 today. The others were all stronger than I and resisted the urge to POAS longer than I did (unless they did it and didn't 'fess up publicly). Yesterday's BFN might be fact, or it might be a symptom of excessively-early testing. I'm suspecting it's fact, though, as the usual preamble to AF's arrival has definitely begun. Instead of scheduling a beta, I'll be scheduling a consult with the RE to determine where we go from here.

Skeptical as I am, I still have a shred of hope that I'm misreading my body and AF won't arrive at all this week. But, realistically, I see that as a very distant possibility.

Anyhow, it's interesting to see how many TTCers shared a common CD1 this go-round. It's kind of like the synchronizing of cycles that happens among co-workers or teammates or close friends who spend a lot of time together. And I feel encouraged by it, as if we're playing the odds and buying a load of lotto tickets together in the hopes that at least one will be a winner. And even if I'm not the winner this cycle, it's been great sharing the cycle with these other women. Go us!

I'm such a sucker.

I wasted my last pee-stick this morning. I don't expect AF until Thursday or Friday, so according to the instructions, a test this morning was only 53% accurate at best. But for some reason, maybe because it was early and I was still half-asleep and needed to pee and worried about wasting FMU,... Yeah, I used up my last HPT. And, to no one's surprise, it was negative.

I am NOT buying any more HPTs. AF will either start or not. If not, I go to the RE for a beta on Friday or Monday, depending on which nurse's instructions I choose to follow. If AF arrives, I'll make an appointment to discuss with the RE what comes next.

I'm still concerned about the whole heart rate issue. I did some more research online over the weekend and couldn't find a single mention of the effect of my heart rate on my fertility. I'm skeptical, but I'd really like to find some actual proof that nurse TMI is wrong. I am working at job #2 tonight and will try to take it easy as much as I reasonably can. I could understand keeping my HR within the same range as when I'm not TTC, but 130 BPM is really really low, and so arbitrary. I mean, isn't 130 BPM completely different for a sedentary person as compared with someone who's regularly active? And as I mentioned, I've known plenty of women who became and remained pregnant while actively participating in a competitive soccer league. True, they weren't 40 years old, but I should think that age would affect egg quality not so much the ability to conceive.

What do I know. I pee on sticks when I know the results won't count.

"Symptoms"-
- spotting on Saturday morning, 9DPO;
- moderate cramping/tugging sensations in the abdominal area woke me up Friday night;
- oddly positive mood since 6DPO, with a tendancy to melt into tears with the slightest provocation.

It's likely nothing.

heartrate, shmartrate?

Well, it looks like soccer and my second job may be joining caffeine, alcohol, and sushi on the banned list. Even before I started working last night, my HR from walking around and talking escalated to 120 BPM. I wore the monitor while I worked and found it beeping at me several times, when my HR exceeded 143 (10% above the target rate). I quickly lowered it by walking and taking deep breaths and generally trying to will myself relaxed and calm, so I swear it wasn't over 130 for more than 8 minutes out of the whole hour. But I know for certain now that when I play soccer my HR is way over 130.

I played soccer last Monday, at 4DPIUI. I tried to take it easy, but now that I'm a little more familiar with my heart rate I know it was well over 130, and it likely stayed there for at least 25 minutes or so during the course of the game. Damn.

I visited Dr. Google, but didn't find any information. All I did find was the effect of maternal health and habits on fetal heart rate. Not what I needed. From experience, I know women can become pregnant and continue to be pregnant while participating in a soccer league. My mother played when she was pregnant with my youngest 3 siblings. Countless teammates have resigned at the end of a season, explaining "surprise, I'm pregnant" and that they didn't want to play into their second trimester. I've heard from teammates that they were given the go-ahead by their doctors to continue playing as long as they felt comfortable doing so (weight and balance-wise). The concern always seemed to focus on protecting the fetus from being struck- elbow, ball, foot- all could potentially cause harm, but apparently a 1st-trimester fetus is well protected and not in danger from the usual soccer blows. I never heard anyone mention maternal heart rate.
Until nurse #3 at the RE's office mentioned in passing that during the whole process of TTC, I should never allow my HR to exceed 130BPM. She didn't know there was a way around the "partner MUST drop off sperm" rule. Should I believe her about the HR advice? It's hard to know whom to trust. I guess "better safe than sorry," but I don't want to give up my #1 hobby unnecessarily. I need a second, and possibly a third, opinion.

Has anyone else be advised to keep their heart rate below some threshold while TTC?

learning my beat

One of the nurses told me a few weeks ago that when TTC, I should not allow my heart rate to exceed 130 beats per minute. I've tried to measure my HR on the equipment at my gym, but I don't trust the results. Half the time, I get an error message because I'm not gripping the sensors properly. The rest of the time, my HR seems to jump from 165 one minute to 34 the next. I don't know what my resting rate is, so how will I know what 130 BPM feels like? My second job involves a bit of running, and I love to play soccer, but I don't know what my HR is during those activities. Have I been sabotaging my TTC efforts?

So, I bought a heart rate monitor. As I sit here typing, I am back and forth between 78 and 84 BPM. I am working at the 2nd job tonight and plan to wear the HRM there too. I'm only working an hour, so if it turns out to be uncomfortable or too bulky I won't be inconvenienced for long. I'm dreading it, though, because what if my slow-jog HR is over 130? Ignorance was bliss. I played soccer on Monday, and worked on Tuesday night and figured as long as I wasn't out of breath and my heart wasn't pounding in my chest, I must have been OK. I'm afraid I'll learn that I need to give up the second job until after we get pregnant and have a baby, and then a sibling for baby #1. Egad! That could mean years of not doing what I love, which coincidentally earns just enough to pay for most of my extra insurance coverage. And no playing soccer! Wow... aside from when I had knee surgery in my early 20's, I've played continuously for almost 34 years. I can't bring myself to run unless I'm chasing a soccer ball, or chasing kids chasing a soccer ball. My fitness level will likely suffer. Not that it wouldn't be worth it, mind you. I guess I could to the gym more often and just take it slow and easy.

I hope I don't have to add soccer to the list of things I've given up in pursuit of parenthood.

Interminable TWW

I'm trying to stay busy and distracted, but all I'm really doing is ticking off the days until I might reasonably POAS. I have one test left from last fall and I'm not buying any more. Even if this cycle doesn't take, there's really no need to spend money on the little torture devices. Unlike ovulation, I don't need to know with pinpoint accuracy the moment my hormone levels shift. I want to know, of course. But I think it just exaggerates the waiting when I might test too early, on purpose, just so I don't have to believe a BFN. Instead, I am PUPO as far as I'm concerned. Pregnancies are measured from LMP, so by that rule I am 3 weeks along. I'll revel in that thought and push rationality aside for now. Maybe I won't POAS at all... at least not until the day of a blood test, so I am forewarned.

lullabies

The more I thought about it, the more I wanted to solicit suggestions for my lullabies play list. I'm planning to make a CD with all of these (and more) songs which I'll take with me to the delivery and also to play for the baby as s/he drifts off to sleep. As I mentioned, I've been working on this list since C proposed and I started imagining our children with his sparkling blue eyes.

So here it is, my lullabies list. This isn't a list of songs I love, or even of songs I love that are peaceful. These each contain some kind of nugget that speaks to parenting or childhood or the joy of bringing life into the world. If you know of any songs that would fit this idea, please let me know. The list is pretty short, considering how long I've been thinking about it. I'm sure I'll be more aggressive in seeking out appropriate additions once I see a BFP.

David Wilcox “This Old Car”
Don White “I Know What Love Is”
Dar Williams “The One Who Knows”
Bruce Cockburn “Somebody Touched Me”
Patty Griffin “Heavenly Day”
Luka Bloom- “Thank You for Bringing Me Here”
Susie Burke & David Surette- “All My Life”
Billy Bragg- “I Keep Faith”
Israel Kamakawiwo’ole- “Over the Rainbow”
Cheryl Wheeler- “Gandhi, Buddha”
Joni Mitchell- “The Circle Game”
Meshell Ndegeocello- “Beautiful”
Neal & Leandra- “Rich”
Chris DeBurgh- “for Rosanna”
Garnet Rogers- “Oh How Happy You Have Made Me”
Greg Brown- “I carry your heart with me”
Paul Simon- “Father and Daughter”
Elvis Costello- “My Three Sons”

And so it goes

IUI #5, part 1 completed. FF decided that I ovulate today, and the OPK turned positive last night. I'm never sure if I should record that as yesterday or today, but it really doesn't matter. My BBT hasn't risen yet, so I'm certain ovulation didn't happen yesterday. If it's today, then this morning's IUI should cover the window of opportunity. Another IUI tomorrow will cover the rest of the window. I'll have my informal, POAS results around Valentine's Day. Maybe a day or two later.

Not much to say about the IUI itself. I was the only patient in the waiting room with a big box o'dad. Everyone else's paternal genetic material was in a human package. I signed all kinds of forms and left the cryo-tank with the nurse. I reported back just over an hour later for the procedure, identified the specimen three times (once on paper, once by looking at the vial, and once by comfirming donor traits), zip-bam-boom and it was done. Lucky #18 is a very good donor... 33 million swimmers in the tiny vial today. Thank you, Mr. 18! Tiny bit of cramping when the cannula went through the cervix, but otherwise utterly painless. The midwives had me relax, lying down, for 20-30 minutes after an IUI. The RE's nurse gave me just under 15. I doubt it makes a difference, but it made me wonder. I recently watched The Big Lebowski, so I pulled my knees to my chest and rolled slowly from side to side just for the hell of it. Can't hurt, right? Tomorrow, I'll bring the iPod and listen to the lullabies play list I've been compiling since C proposed and I started picturing our children. One of these days, I'll post the list and ask for suggestions.


Yesterday's snow cooperated fairly well. C was called in to plow when he was on his way home from work. He dashed in, fed the dog while the truck warmed up, and ran back out again. The roads weren't all that bad, so I brought him some dinner and coffee on his route. He'll be one sleepy camper today, though. He returned home just before midnight, then got up at 5 to start another working day. Everything did work out just fine- we even have a notary in the family. I'm still feeling very positive about 2009. One month down, 11 to go, and January was pretty darned good.

reprieve

C didn't sleep last night. With the potential for three conflicting commitments, he was on edge all evening. But he came up with a solution, and it looks like the weather might semi-cooperate. And, to top everything work-related, I finally received a call from one of the nurses at the RE's office- if I have a notarized, signed letter from dear C granting me permission to drop off the sperm, then he doesn't have to do it himself.

Was that really such a big deal? For weeks, the other staff at the RE's have been insisting that my "partner" MUST drop off the sample. They made no allowances for exceptions and gave the impression that it was do-or-die. Today, the nurse who's apparently the "expert" on protocols, said it's not a problem as long as we have the letter. Just a letter. Notarized, yes. But still, just a letter. Why doesn't anyone else in that office know there are ways to work around the rules?

That leaves us with just 2 conflicting obligations, neither of which involve our fertility. The wind is raging, and the snow is definitely falling, but it's accumulating slowly. It started before 7 this morning, and we have almost an inch on the ground at noon. It's not plowable yet, and at this rate we should be OK for a few more hours. As a back-up, C arranged for a family friend to fill in if the call to plow comes before C gets home from work. So it looks like everything is working out fine. The IUIs will happen and C won't miss work, and someone will be plowing his route if the call comes in.

No matter what, everything always works out in the end.

to further complicate things...

I almost forgot- C is still under contract to plow for a nearby town. It's supposed to snow tomorrow, possibly into Wednesday. The forecasters disagree on the track of the storm- some call for 3-6 inches of snow while others call for a dusting. Since it'll be too cold to change to rain this time, he'll probably be called out to plow if we hit 4-inches. Hopefully, that won't happen at all. But if it does, please dear weather gods, please let it be after 6 PM. He could conceivably leave a little early if he gets called out to plow in the afternoon, but bad weather and the usual rush-hour traffic will make him late reaching his route. He's supposed to be on the road, plowing, within an hour of getting the call. Unfortunately, I don't know how to operate the plow.

So, he could potentially be needed in 3 places at once. I know that he'll do the RE's bidding if it comes down to making a choice, but I really hope we don't have to make that decision. He's been laid off for 2 1/2 months now, with nothing to do most of the time. And now that he has the baby-making commitment, he suddenly has all these other things to do too. Wierd, isn't it?

just because everyone else is doing it doesn't mean it's right

The headaches never seem to end, and I am just about convinced we need to find me a new RE. Oh joy of joys, C started working on Friday. Hurray, right? This is just the luck we were hoping for in 2009, isn't it?

The RE requires that, for all IUIs, the partner drops off the sperm sample. This might make sense when the partner is also responsible for producing said sample. But when the paternal genetic material arrives via FedEx, why does it matter who delivers it to the RE's office on the morning of an IUI? C started working on Friday. I expect to ovulate on Wednesday. I bemoaned their policy last week, when I was in for a CD10 blood draw, but C was unemployed at the time and the conflict wasn't threatening this cycle (which, of course, will be THE cycle... the one that works, so we won't have to worry about any cycle after this one, right?). In fact, that's the response I got from the nurse, "We'll just have to get you pregnant before he goes back to work."

Well, he's working, albeit temporarily, and I'm not pregnant yet. And when I ask about the policy, I get the old argument, "We require the same of everyone. Even a lesbian woman's partner has to drop off the sperm for an insem. We have clients who are fireman, teachers, police officers- people who have to be to work earlier than the doctor's office opens. They all have to adhere to this rule too." Honestly, I don't care about them. They usually have vacation time or sick time at their disposal. They don't jeopardize their employment by taking a couple of hours off. We could handle the smaller paycheck if all this took was missing an hour or two of work, but if C isn't there, a crew of 5 union employees sits and waits. He won't be employed long if that happens. His current gig is as a contractor, but he's hoping that they'll hire him for real when the construction season swings into gear. Missing a few hours, especially the critical first hour or two of the day, could blacklist him with this company and others.

We'll do it if we have to. Is this another test to see if we "really" want to have kids- as apparently we had to prove to the social worker? Do they want to see just how much we're willing to sacrifice? If they have a valid reason, I won't quibble. But I really don't understand what their rule accomplishes.