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?