A Year of Trying… and Failing

Over the course of the last year Kaptain and I have been trying to conceive.  As we have no baby to show for our efforts you’ve probably already came to the conclusion that we struggle with infertility. I’ve been keeping track of my experience with trying to conceive for a long time by journaling. While we’ve talked to a plethora of people about what we’re dealing with, I wasn’t sure about going public until the last week or two. As 1 in 8 couples experience fertility issues, I finally made the decision to share my journal in hopes that those of you who are struggling know that you are not alone. Also, for those of you who are fertile, fertile, fertile- I’d love to share so you can be a better support to friends and family who may not be as fortunate with procreation. I know this is massive as it’s sums up the last 12 cycles and kicks off cycle 13’s attempt at baby making. Going forward, this will be a proper journal that isn’t just a long rambling monologue. Feel free to ask questions or to share your experiences.

We hit the ground running. As most of us didn’t learn in health class in school, there are only about 5-6 days a month a woman can get pregnant. It breaks down to a few days before ovulation, ovulation day and usually a day after.  That first month we hit them all and started mentally preparing ourselves for a pregnancy. Not getting a positive test was shocking. I had spent my whole sexually active life making choices to ensure I wouldn’t have a surprise pregnancy and living in fear that I would end up pregnant if a man so much as sneezed in my direction. Alas, I was grossly misinformed. I doubled down my research efforts and we made the decision to share that we were trying with a few of the people we’re closest to.

So, what’s an HSG? Oh, the lovely HSG. This test consists of a blue dye filling your uterus and Fallopian tubes via a catheter inserted into your cervix then X-rays being taken to observe whether the dye is able to freely move throughout your reproductive tract. Although neither of my tubes were blocked and therefore the experience wasn’t particularly painful, I had made sure to schedule the procedure during my vacation and my BFF Jen drove me to and from the appointment. Thank goodness she did because my nerves got the best of me and I nearly passed out multiple times.

While I endured pokes and prods and X-rays, Kaptain’s contribution consisted of the simple awkward experience of going to the hospital, being escorted to a private room and, ahem, producing a sample. His key learning to share with all the men who have to do this is to remember to bring your phone or tablet as the 1996-2000 Playboys probably won’t be particularly inspiring.

This was the first time where I could begin to understand why infertility erodes so many relationships. I was tracking everything from cervical position to menstrual flow to emotional well-being. I had to change my eating, exercising and even medication habits. Kaptain had to have sexual intercourse 4-6 times monthly and ejaculate in a cup. Luckily, he was onboard. But from perusing the fertility forums I knew he was not typical. A lot of men feel their masculinity is being questioned when asked to provide a semen sample and refuse. Also, many partners prefer not to know which days the fertile window consist of although the woman has to be aware. This constant pressure on a female partner is stressful and although Kaptain is supportive, we too still experienced frustration at the organic inequality of it all.

While awaiting the results of Kaptain’s SA, he decided to begin a keto diet. We had learned that males who are obese have more estrogen reducing the amount and quality of sperm so this felt like something he could do to increase our chances while personally getting healthier. Key learning: ketogenic diets for diabetics can be detrimental. On July 13th we headed to the obgyn to get Kap’s SA results. He felt listless and groggy. He was actually so out of it that he stayed in the car and I went into the doctor alone. The doctor shared that all was well except for morphology and motility. FYI: morphology is the shape of sperm. The average male has about 96% of sperm with irregular shapes, (enlarged heads, 2 tails, no mid-piece, etc). Kaptain’s sperm consisted of 99% irregularly shaped. Motility is the amount of sperm actively moving. Kap’s motility was 27%. My doctor attributed it to Kap’s diabetes being not as controlled as it should be.

When I got out to the car and prepared to share this less than stellar news, Kap was even more listless. We went to an emergency clinic and quickly learned he had slipped into diabetic ketoacidosis. He was hospitalized for the next 5 days and our lives drastically changed. He had to rapidly increase his fitness routine, change his diet and change his medications. Although he’d been diabetic for over a dozen years, this was his first foray into daily insulin injections and was the first time he really seemed sick to me.

With all these positive changes spurred on by a near death experience, it would seem like the ideal time to conceive. But what we have to remember is that the sperm ejaculated today were created 3 months prior. That means that any semen created before the 3rd week of July would likely not be top-tier quality nor would it result in pregnancy. Luckily, when I visited the doctor to get the results of the SA, he referred me to a local Reproductive Endocrinologist. I received my giant packet of information and questionnaires to complete and we were set for our consultation appointment on October 24th.

While awaiting the appointment, there was plenty to do. We still kept trying for a free baby. Yes, I am literally referring to a baby conceived without spending money on medical interventions. I also spent time learning about what my insurance covers with fertility treatments. I am very fortunate to work for Ascena brands which has a lifetime benefit of $25,000 towards fertility treatments. I know I’m lucky as entirely too many families go into debt or essentially are forced to be childfree due to the expense of fertility treatments.

This is the perfect time to segue into the, “Why not just adopt?” topic. Remember me saying I like to research what interests me? This is one of those topics. Let’s start with infant adoption. In the US, there are far more families looking to adopt healthy infants than there are healthy infants to adopt. This has created an inequality in supply and demand and therefore a lack of this being a likely option for most families. Domestic infant adoption usually will run around $40,000+. That is not counting additional medical expenses the birth mother may need, travel, etc. International adoption is even more expensive. In both cases, adoptions can and often do, fall through.

Well, what about adoption through foster care? So, this is still very much on our radar though it comes with its own set of challenges. Healthy children in foster care where parental rights have been terminated tend to be older. 9+ years to be specific. With these additional years comes additional trauma and difficulties experienced by these children. This doesn’t mean they aren’t good kids who deserve a good home but it does mean there will likely be additional challenges to a successful integration into a home. Younger children in care will usually have the goal of parental reunification. This means they child may be in your home 6 months, a year or two years then go back to their parents. Hopefully it’s a successful reunification but there is always a possibility they face the same experiences as before and are removed again. Even if parental rights are terminated, generally there is a preference for children to be adopted by family members. That means that you can foster with the goal to adopt, feel like you’re almost there and then a stable aunt, cousin, grandparent, etc comes forward and they are the preferred adopter. Knowing these challenges to foster care adoption is what made me so open to Kaptain’s suggestion of trying for a biological child first.

The reason I’m mentioning the challenges associated with adoption is oftentimes when a couple or an individual does decide to be vulnerable and share their struggles with fertility, it is very easy to say, just adopt. There are two reasons this advice needs to stop. One- adoption isn’t right for everyone. And two- it’s hard. It’s not like the episodes of Little House on the Prairie where you just go to the local orphanage and pick out a couple of kids to put on the wagon and take home. It may take several years and be financially draining before it comes to fruition. That doesn’t work for everyone.

This brings us to October. We had our first RE appointment and it was pretty positive overall. I liked the way our doctor explained fertility in a way that really made sense. He said some people are born with the ability to run very, very fast. Some aren’t. Regardless of workouts and other outside factors, these two groups of people will never have the exact same abilities. Fertility is the same way; some people are the Olympic hopefuls of procreation and others are the equivalent of those who can’t pass the presidential physical fitness test. He felt good about my results and even with the morphology and motility issues, there were still 51 million sperm headed for my egg. He gave us the option to keep trying naturally a couple more months or get prepared for a medicated and monitored IUI, (intrauterine insemination). As we were going into my fertile window the week of the appointment, we decided to give it one last old-fashioned try while mentally preparing ourselves for IUI.

No such luck. 😦

So, then we started the process for the IUI. The first day of my period I called the RE’s office and let them know I started and we would be doing an IUI this Cycle. There was only one small hiccup. Their lab to process the sperm for the IUI is closed 2 days annually: Christmas and Thanksgiving. Guess who’s Cycle exactly lined up with sperm processing day being on Thanksgiving? Argh. So, they gave us the option of medicated timed intercourse. I said sure and made the appointment to go in for a baseline ultrasound the following Monday morning.

Baseline ultrasounds. Fun stuff. This is a vaginal ultrasound done approximately the 3rd day of the menstrual Cycle. The purpose of this ultrasound is to determine the size of the lining of the uterus, (right thickness to support pregnancy), and a lack of cysts on the ovaries. The reason they check for cysts is the hormonal drug used to give stronger ovulation will also make cysts grow. If you have a cyst on your ovary when you’re taking it, you will likely end up in the ER.

My ultrasound experience was pretty typical from what I’ve read. Cycle day 3 is my heaviest period day by far. Like dumping the divacup 3 times in a day level of heavy. When I went into the ultrasound room, there was an addition to the usual set-up for the table: what looked like a doggy piddle pad.

Yep. So, they are prepared for the crime scene currently transpiring down below. I went ahead and disrobed from the waist down and waited on the nurse and ultrasound tech. I also got to stare at the transvaginal ultrasound wand or twatwand as it is somewhat affectionately called by those who see this thing far too often. There it was all pre-loaded with a dollop of lube. The nurse and tech came in fairly quickly and while they did my ultrasound, I expressed my concerns about timed intercourse opposed to IUI. Because we are dealing with mild MFI, (male factor infertility), medicated timed intercourse doesn’t do a lot for us. Mainly it just allows me to drop 2 eggs instead of 1 for his sperm to target and due to all the monitoring we know almost exactly when ovulation will be. The nurse agreed and looked at the calendar again. If my next ultrasound showed the follicles growing slowly, we could do the trigger shot the Saturday after Thanksgiving and do the IUI Monday morning. If the follicles were growing quickly, we would do the trigger shot that day then have timed intercourse that night and Thanksgiving night. When they left the room and I stood up, the piddle pad was a bloody lubricated mess. This day I did not envy their jobs even a little. I cleaned up and headed out with the knowledge a week and 2 days later we would know if it was an IUI or TI Cycle.

In the meantime I went and picked up a 5 day supply of Clomid that would be taken daily from Cycle day 5 through Cycle day 9. Clomid has been around since the early 60s and is used to make women ovulate/superovulate. That means that on Clomid, the average woman produces 1.7 eggs opposed to her usual 0 or 1. Since I ovulate every month by all testing accounts, I would likely produce more than 1 egg on Clomid. Because Clomid impacts hormonal balances, there are some pretty big side-effects. Hot flashes, extreme emotional responses, ovulatory cramping and blurred vision in some cases. My sister had really strong emotional responses to Clomid when she was going through fertility treatments so she recommended some pre-work. She said to have Kaptain make a video that says he loves me, why he loves me and if I’m questioning that, it’s the Clomid. She also told me to write a note to myself about how I feel now, (positive, excited, etc), and read it daily. It sounded kind of silly but I’m glad I took her advice.

I’ve never been so happy to sign off for a package. I quickly opened the box and dug though all the packaging used to keep the medicine at the appropriate temperature. I put the little box with my pre-loaded syringe in the fridge then attempted to put the shot out of mind until it was time.

The day before Thanksgiving we went in for my ultrasound. Kap was able to go with me since he’d taken the day off work so we could go to San Angelo for our Thanksgiving meal that afternoon. This appointment did not go the way I’d hoped. I had only one mature follicle already measuring at 22mm. Based on my extensive googling, it appeared this follicle was already ready to go. Our doctor set us on the course of trigger shot that evening, intercourse the following evening and intercourse two days later. I was super frustrated when we left. I tried explaining to Kaptain how low our chances of conception were but because our RE had previously said we may get pregnant on our own if we just kept trying, Kap didn’t get how dire the situation was. We got in a big fight about it on the way to San Angelo but the upside is he ended up googling a bunch of information on conceiving with weak motility and morphology and finally understood why I was so frustrated.

Medicated timed intercourse has nearly a 0% chance of supporting us conceiving. In other words, this course of action was pretty much doomed from the beginning. We did follow it through, though. The shot, the timed intercourse, progesterone blood work 7 days later and a pregnancy test a week after that. Ironically, my period had already started so I had the amazing combo of getting blood taken for a pregnancy test and my day 3 transvaginal ultrasound all on the same appointment. Fun.

The positive of my period coming early is that my next cycle wouldn’t sync with Christmas so we’d be able to do a medicated IUI. This was super exciting for us as an IUI has about a 10% chance of working each cycle with MFI and advanced maternal age. Yes, that’s still a 90% chance it won’t work each month but it was still the best chance we’d ever had. The medicine schedule was the same for timed intercourse but because my follicle developed so quickly the previous month, the nurse scheduled me back on the 10th day of my Cycle instead of the 12th for my ultrasound. When I arrived I had multiple follicles all growing at a healthy rate. She scheduled me to come back again the next morning for another ultrasound. That was Friday and my follicles were growing again really quickly. She had me trigger the following night and come in Monday for my IUI. Kaptain had to provide his semen sample an hour before the IUI so the semen could be washed. Washing is a special process that separates the motile sperm from non-motile sperm and semen as a whole. While he did that I was chugging water at breakneck speed as my RE prefers to do IUIs with full bladders as it helps guide the catheter.

Unfortunately the lab processing the semen was short-handed and running behind. That meant we were sitting in the waiting room of the RE for almost 2 hours with my bladder nearly bursting. It sucked. Finally we went back. First, our RE and nurse showed us Kap’s washed sample and we had to sign that the name on the sample matched his. Then we were able to see his numbers. 55,000,000 motile sperm!! The RE had us take a picture of the result because it was so much better than the 15,000,000 required for an IUI to likely be successful. Then I laid back. With an IUI, a speculum is inserted to allow visibility of the cervix. Then the opening of the cervix is cleaned with a large swab to remove any extraneous mucus. Now for the catheter. Just like with the HSG a rubber catheter is inserted into the cervix but this time it’s fed all the way into the uterus as a nurse is doing an ultrasound on the lower abdomen to monitor the process. It was unpleasant. My RE’s office has a large monitor so I could see the ultrasound of the catheter in my uterus. He then took the washed sperm and inserted it via the catheter. Afterwards he removed the catheter, speculum and covered me with the sheet. The nurse dimmed the lights and left a 10 minute timer on for me to lie there as there have been statistics to support a lack of movement directly following IUI increasing the odds of pregnancy.

Finally the timer went off and I was able to clean up and go pee. Best. Feeling. Ever. Kap and I drove away on cloud nine. I’d had multiple follicles. He had a ton of motile sperm. Now we just needed to get through Christmas and I’d come back for my monitoring appointment the 27th. I started reading up on likelihood of multiples, my company’s LOA policy, etc. For the first time in a long time I had hope. After all, we’d even been wearing matching lucky socks and boxers for the big day.

That did not last. On the 27th my progesterone test showed the lowest progesterone I’ve ever had. 5.4 to be exact. Even if I did manage to get pregnant, with progesterone that low, miscarriage is extremely likely. I was prescribed prometrium 100mg twice daily through my pregnancy test on January 2nd. Yay. Another hormone being pumped into me. And progesterone is one of my least favorites for what it’s worth. Guess what hormone is produced during PMS? Yep. It was a blast. On the 30th I started spotting and on the 31st my period started in earnest. I wasn’t pregnant again. This was a harder one to take. Having hope is one of the worst things that can happen when you will likely be met with disappointment. And this time we’d had so much damned hope.

Kaptain and I had to have a very real talk about the path we were on because this process had taken a toll on me. My anxiety was through the roof and I’d gained 40 pounds over the last year as trying to conceive had become all-consuming. I knew I couldn’t do this semi-indefinitely the way some couples do. I’m not taking a jab at those couples. I completely respect their decision to keep trying but I cannot do it for years and years and years. With IUI, it typically will work within 3 cycles if it’s going to. We put a 3 cycle cap on IUIs. With IVF, each cycle has its own odds of success so we agreed upon only enough until my lifetime benefit for fertility treatments is depleted. That’s it. If, at the end of that, I’m not pregnant we move on. We adopt or we live childfree. What we don’t do is keep chasing bad money with good money while damaging both my mental and physical health.

At the 3rd day of my cycle I went in for my pregnancy test. Yes, it’s required 14 days after every procedure even if I’ve already gotten my period. Luckily, they were able to also get me in for a monitoring ultrasound to start the next IUI cycle. This one was tricky as I was traveling out-of-state with my boss on days 10 and 11 of my cycle but I was willing to try to make it work if at all possible since there have been some stats to show higher likelihood of success with consecutive IUIs. I assumed everything would be the same this time until I went to Walgreens to pick up my prescription for Clomid. This time I had been prescribed 100mg daily. When the RE’s office called to confirm my negative pregnancy test, my nurse let me know the doctor wanted to see stronger ovulation from me for this Cycle hence the double dose of Clomid.

That brings me to the current Cycle. For our second IUI I had 3 good size follicles: 17, 21, 17. I triggered 36 hours before with an Ovidrel shot which Kap gave to me. It’s hard to believe how scared of needles I used to be. Now it’s just part of my monthly process. Ovidrel trigger around CD12, blood work for progesterone at CD21 and blood work for pregnancy test at day 28. Woohoo. I know how to party.

Day after tomorrow I go in for a pregnancy test to evaluate the outcome of the most recent IUI. I’m trying to be positive but I struggle sometimes to have faith it will work out. I’m currently 11 DPIUI and still getting negative HPTs (home pregnancy tests). Statistically, it should be showing up by now if it worked. It is hard to have hope when you know there is an overwhelmingly large chance something didn’t work. On Friday we’ll have our definitive answer and we’ll go from there. Until then, we wait.