Wednesday, July 14, 2010

A Blessing

Okay, seriously? This blogging thing kinda kicks my butt. Maybe one day I’ll be blogging more “real time” instead of blogging the past. But I suppose in order to do that, I would have to post more than once every four months. Eh, we’ll see how it goes!

So, because of the hormone testing they had done early-on, and because my progesterone levels were “good but not great” post-ovulation, one of the treatments they had me try was HCG injections. After ovulation, I would inject a small amount of HCG over 8 days. HCG is the hormone your body produces when you’re pregnant. The thought is that the increased HCG would cause my body to actually produce a higher amount of progesterone, thereby helping prevent an early miscarriage due to low progesterone. Aside from self-administering injections (I could write another whole post on my changing relationship with needles!), the worst part for me was that having HCG in my system would prevent me from taking an over-the-counter pregnancy test. The presence of the injected HCG in my urine would cause a PT to give a positive result even if I wasn’t pregnant. In order to get a true read of whether I was pregnant, I would have to have blood work done to measure the HCG, and then do it again 2 days later to see if the level had increased. It’s a minor thing, but it made me sad that I wouldn’t get to have the stereotypical experience of taking the test at home and showing the two little lines to Darren.

I had to go off the HCG in preparation for my laparoscopy in November, though, and we never went back on it. Once it looked like my issue was structural rather than hormonal, there seemed little point to paying for the injections (they weren’t covered by my insurance). I can’t say I was sorry to leave those needles behind.

Dr. D had always stressed that if the post-peak phase of my cycle ever went more than 2 days longer than it had before, I was to take a pregnancy test. If that pregnancy test was ever positive, I was to call the office right away. My post-peak phases tend to be pretty short – 11–13 days, generally. Darren has always filled out our Creighton chart before bed each night, so I wasn’t even always aware of how long my cycle turned out to be. After that last appointment, where they determined that it wasn’t really worth it for us to pursue further treatments, we were still charting but somewhat half-heartedly.

In March, my parents came to visit. They always stay in our guest room, so between having houseguests, work, and everyday life, neither Darren nor I was paying much attention to my chart. I realized mid-way through March, though, that it seemed like maybe my cycle was going a bit long. I asked Darren one night what cycle day it was, and how many days post-peak. He answered that it was cycle day 32, and that I was peak+15. I did quick, very complex math (“Yup, longest post-peak was 13 days, now we’re at 15, that’s 2 days longer”) and said, “Well, I guess I should take a pregnancy test tomorrow morning?”

I got out of bed and dug around for the box of pregnancy tests I bought a few years ago. I had taken a few pregnancy tests back before we even started Creighton or NaPro Technology, all of them being negative. For some reason, I had bought another box of tests, but I never even opened it. I think it’s an odd sort of mercy that my cycles had never really gotten to the point where I was taking PTs every month and being faced with the negative results. So I pulled out my box of unopened PTs, unwrapped the plastic, and noticed that the test expired in October of 2009. Huh. Well, they were what I had, so I went and placed them by the toilet so I could take my test first thing in the morning.

My attitude toward the whole thing, as I settled back into bed, was mostly nonchalance. I didn’t have any expectation that the test would be positive, and so I really didn’t want to take it at all. Those few tests I had taken early-on were miserable! I didn’t want to once again have the experience of watching the test and waiting for that second line to appear. However, it sort of seemed like we were at the point where we didn’t have a choice. Doctor’s orders, you know!

My alarm went off at 5:45, and while Darren was still asleep, I went and peed on the little stick. I had decided that I wasn’t going to torture myself by watching the test develop, so I left it on the back of the toilet and went to comb out my hair before my shower. I really tried to give that test the 3 minutes ordered by the instructions. I gave it as much time as I could, then went back to the toilet and picked up the test.

Two lines. Two pink lines. TWO. LINES. Ohmygosh, two lines!

I put the test back down on the back of the toilet, hopped into the shower (still have to go to work, obvs), and burst into tears. The test was five months expired! What did that even mean? I cried hot tears all through my shower, and could only pray, “Please, God. Please, God.” Over and over. Over and over and over. I think my tears were happy ones, and my feeling was hopeful, overall. After all, this was more than I’d ever gotten before, and more than I ever expected! A positive pregnancy test!

I continued getting ready, brushing my teeth and whatnot, and the whole time I was googling on my iPhone “expired pregnancy test”. The message board consensus seemed to be that the sensitivity of the PT deteriorates over time, but that if you actually got a positive result on an expired test, you were probably pregnant. !!!!!

I woke Darren around 6:30 to tell him the news. I normally wake him around 7 when he walks me down to the car, but I knew that I would cry when I told him, and I didn’t want to ruin my makeup. Priorities, people! I woke him, told him, “It’s positive!” and showed him the test. He was happy, but subdued. He told me later that he wasn’t sure whether to believe the test, since it was expired. We hugged, and I cried some more.

I knew that, per the doctor’s instructions, I needed to call the doctor’s office right away. Once they opened in the morning, I called and told them that I got a positive result on an expired test and that I planned to buy more tests that night and test again just to be sure. The receptionist told me that I could just come into the office, and that they could test me there. I made an appointment for noon that day.

We had to figure out a way to get Darren out of the house for the appointment (he works from home), since my parents were staying with us. I didn’t want to get their hopes up needlessly (“Darren is going to the doctor with Shelby. I wonder what for?”). He made up some story about needing to take some additional documents to our tax guy, and I picked him up at 11:45.

Once we got to the doctor’s office, I re-did the pee test, and then waited for what seemed to be a really long time for the tech to come get us. Finally, the door opened, and she called my name. As we walked back to the exam room, I asked her, “Do you know?” She nodded. I said, “Is it positive?” She said, “Yes!” She took my weight and my blood pressure (which turned out to be really high and kind of freaked the doctor out, but it was just from the excitement), then left Darren and I alone to wait for the doctor. Ohh, we could finally believe it! The reality hit both of us (Darren especially), and we both cried. He told me how happy he was for me.

The doctor came in (not Dr. D but a different doctor) and congratulated us. She tempered our excitement a bit, though, by reminding us that our goal now was to make sure that we didn’t miscarry. She could see from my chart that my low progesterone levels put me at risk for miscarriage, so I would be starting progesterone injections that day. The initial dosage was 200 units 2 times per week. I wouldn’t be able to self-administer these (they go in my hip), so I could either come into the office or have Darren administer them. The thought of Darren giving me a shot kinda ooked me, so I decided that for the time being, I would go into the office for them. By my LMP, I was 4 weeks 2 days pregnant. It comforted me that we knew so early and were able to start the progesterone treatment right away.

And so! We had finally been given what we had hoped for for so long – a little tiny life, made up of the two of us!

Still to come: telling my parents, progesterone, and my feelings from the “other side” of infertility.

Friday, June 11, 2010


I suppose this post could also be called "The Results - Part 3".

I was very surprised when we came away from our appointment with a 4th possibility.  Need to refresh your memories as to what I thought the three possibilities were?  No worries, I did too.  To review: 1) Doctors who performed HSGs 1 and 4 were incompetent; 2) Doctor who did HSGs 2 and 3 was incompetent; 3) Something about my physiology is changing.  Who could believe there'd be a 4th option?

It turns out that my doctor was equally flabbergasted at my inconsistent HSG results, so he called the doctor who performed tests 2 and 3 (the ones that showed my tubes being blocked and partially blocked).  Let's call her Dr. Seaver.  Dr. Seaver explained that there's a difference in how she performs the test versus other doctors (like the ones who did 1 and 4).

Most doctors perform the HSG by placing a catheter into your uterus, inflating a tiny balloon to prevent the catheter from falling out, and then pushing dye into the uterus and hopefully out the tubes.  Dr. Seaver does the test in such a way that she's able to test each fallopian tube individually.  She advances the catheter to the opening of each tube, one at a time, and injects the dye directly into the tube.  Because she's injecting into the tubes, which are more fragile than the uterus, she isn't able to use much pressure.  The uterus is a stronger/thicker organ, and is able to withstand higher pressure of the dye being injected directly.  The tests that showed my tubes being open used a higher pressure, which may have caused my tubes to appear open when they normally wouldn't.  Or perhaps the test cleared my tubes?

What that meant, in my case, was that the condition of my fallopian tubes was probably somewhere between the two results.  My tubes probably weren't completely normal, but they probably also weren't completely closed and partially closed (5% chance of conception we had been quoted).

This certainly muddied things, we thought, in terms of deciding whether to have the fallopian tube resection in order to remove the blockage.  Thank goodness we asked the doctor about that during our appointment, because he confirmed with Dr. Seaver that with these latest results, they wouldn't even consider the procedure for me.  In order to have a successful procedure, the doctors have to be able to pinpoint the location of the blockage.  Since I had a normal test result, there wouldn't be a way to confidently identify the blocked portion of the tube.  Thank God we decided to have the fourth HSG instead of just having the fallopian tube resection!

So where did that leave us?  Our doctor explained that we were at the point of diminishing returns, in terms of fertility treatments.  He felt that the pain and cost of continuing to encourage ovulation probably wasn't worth it, since my fallopian tubes were somewhere between blocked and open.  I cried, and we asked the doctor for information on adoption.  He gave us a compassionate smile, and the adoption information, and we left his office.

As crushing as it was to hear that we had come to the end of our fertility-treatment journey, I think in some ways I was ready for the news.  After the last HSG (the normal one), I just kind of shook my head.  In my mind, I kept saying, "This is God's game."  Not that the whole thing was just a game, but that we were playing by his rules. Our whole road of fertility treatments had been filled with curves.  When we thought we had things figured out, something else would come up - some new complication.  First, they thought I was ovulating but my hormones were out of whack.  So they regulated my hormones.   When we still didn't conceive, they thought my fallopian tubes might be blocked.  So we tested my tubes, and they were normal (the first time).  When we still weren't getting pregnant, we started daily ultrasounds to confirm ovulation.  When I didn't ovulate, they gave me a triggering injection.  When, after three months of triggers, I still didn't conceive, we scheduled the laparoscopy to look for endometriosis.  The laparoscopy didn't find endometriosis, but found blocked tubes (twice).  Then after all of that, a fourth HSG showed normal tubes.  I'm exhausted just re-reading that.

So after the fourth HSG, I honestly just had to laugh and shake my head.  "This is God's game," I told myself.  Obviously, he's the one in control of the whole situation, and we had done everything we could to help things along, and it just wasn't happening.  I never ever thought I would get to this point, but I honestly felt peace over the whole thing.  I had done a lot of mourning since the laparoscopy and the blocked-tube results.  Not mourning that I might never be a mother, but that I might never be pregnant.  And somehow, through all of that, I finally, miraculously, came to a place of acceptance.  It was the first time since we had started trying to conceive that I really, truly, felt peaceful.  It really was amazing.  I still felt, in my heart, that I would get pregnant one day.  I really had that sense, but I thought it would be years in the future.  I thought that we would grow our family through adoption, probably adopt a couple of kids, and that one day, when I least expected it, God would surprise us.  And I felt a huge amount of peace in that.

Darren and I have always been open to the idea of adoption.  We both felt so strongly called to be parents, that if we couldn't have biological children, we wanted to parent other children who needed a family.  However, neither of us was ready to jump into adoption right that second.  The last three-and-a-half years had been a huge roller coaster, and as eager as we were to start our family, we weren't ready to jump on another roller coaster so soon.

We had a really busy February, with a quick trip to visit Annie and family and then our trip to the Winter Olympics.  I honestly gave zero thought to fertility, aside from noticing that I had really great mucus the whole time we were in Vancouver.  Once we got back home, we decided that we probably ought to take advantage of the symptoms.  Looking back at that chart, I like to joke that we didn't make an "Olympic" effort. Heh.

And so we went about our lives.  I went to jury duty, and then my mom and dad came into town for a two-week stay to celebrate their 40th anniversary.  We had some celebratory things planned, but we had no idea that there was a surprise in store that none of us expected!

To be continued . . .

Wednesday, January 27, 2010

The Results - Part 2

There wasn't much time to really talk with the doctor after she did the hysterosalpingogram (HSG) the second time, so we went to her office the following week to discuss game-plan.  She more or less repeated what she had said during the exam, which was that my left tube was completely blocked, and my right tube was partially blocked.  Without corrective action, she estimated that our chances of conceiving were about five percent.  FIVE. PERCENT.  Which, okay, to be fair, isn't zero percent.  But really, five percent is just about zero.

The good news was that she could do surgery to remove the blocked portions of my fallopian tubes.  It was good news, because we had assumed that if we needed this type of surgery, we'd have to go to the Pope Paul VI Institute in Omaha to have it done.  So being able to have the surgery within a couple hours of home was definitely good news.  She also said that my fallopian tubes had enough length that she would be able to remove a section without impacting their function.  

There was plenty of bad news too, or at least news that made the decision a lot more gray for us.  For couples that have this type of surgery, the success rate (in terms of couples who go on to conceive) is between 40% and 50%.  Those certainly aren't stellar odds, but it's better than 5%.  Having the surgery increases your risk of having an ectopic pregnancy, so you have to be examined really early on in your pregnancy to make sure the egg implanted in the uterus.  OMG, I just cannot imagine what would happen to me if we actually finally (FINALLY) managed to conceive, only to have it be an ectopic pregnancy.  And finally, while my insurance covers costs related to the diagnosis of infertility, it doesn't cover any sort of treatment.  So this surgery (inpatient, with 2 to 3 day hospital stay), would have to be paid for out of pocket.  Yikes.  Since my laparoscopy cost multiple tens of thousands of dollars, and that was outpatient, I knew this more extensive surgery was going to cost much more than that, and would probably at least wipe out our savings.

Darren and I had said before beginning any of these fertility treatments that we would pursue them only until they became so cost-prohibitive that they might prevent us from adopting.  So the prospect of wiping out our savings (for a surgery with a 40-50% success rate) and not being able to adopt (not to mention buy a house) gave us serious pause.  We left the doctor's office that night telling her that we would need to think about this before making any decisions.

All of these appointments happened back before Christmas.  We took a lot of time thinking and talking with friends and family about what they thought we should do.  It's just impossible for us to be objective about things at this point, and not that friends and family are able to be truly objective either, but it really helped to talk with people that have a little more distance from our situation.

After Christmas, we met again with our primary fertility doctor.  We told him about my laparoscopy, and the repeat of the HSG and those results, and he was completely mystified.  He had never had a patient have a normal HSG followed by an abnormal one, and didn't really know what to make of it.  Obviously, THIS IS NOT COMFORTING.  We eventually decided that it might be a good idea to have the HSG done one more time, this time by the medical group who did the test initially in 2008 (and where my tubes tested normally).  I asked the doctor if he thought there was value in doing the test a 4th time, or if it was just wishful thinking, and he said he thought it was 50-50.

Gah, is this boring?  There's a whole emotional/faith component to this that I'm completely leaving out, for now at least.  That might need to be a different post.

HSG number four was on Monday, this past Monday.  As each radiology tech and doctor asked if I'd this done before, I explained how this was my fourth test, and how I'd gotten conflicting results.  They even pulled out my results from a year ago and confirmed that, as I remembered, my first HSG showed normally functioning tubes.

The neat thing about the HSGs is that I can see the same thing the doctor sees on the x-ray screen.  So I get to find out the results right then and there.  I lay down on the table, and they place the catheter, and then begin to fill my uterus with dye.  The dye in my uterus makes the shape of a little triangle, and the little fallopian tubes look like squiggly little lines coming from two corners of the triangle.  I lay there, and I can see the little squiggly lines, and I think, "I can see squiggly lines. Are there two squiggly lines?" I remember from the very first exam that the dye spilling out the ends of the fallopian tubes looks like wispy clouds.  I look at the screen, and I think "Those look like wispy clouds - are there two wispy clouds?"  Pretty soon, the doctor says that he's taking out the catheter and that I can sit up.  And then he says the words that I absolutely did not expect him to say: "The test was normal.  Both of your fallopian tubes are open."

And then everyone is smiling, and telling me what good news this is, and I'm just kind of smiling and flabbergasted because this is just the last thing I expected.  I was so prepared to have this test reinforce the last two.  But no, now I'm batting 500 with these test results.  So I smile, too, and say that yes, it's good news.  But it would also be good to have some clear answers.

There seems to be three possibilities: 1) The imaging group that did tests 1 and 4 is incompetent; 2) The surgeon that did tests 2 and 3 is incompetent, or; 3) Something about my physiology is changing, either from cycle to cycle, or within each cycle.  We have an appointment next week to talk with the doctor about what all of this means, but for now, I'm feeling a lot more hopeful.  For now, I feel encouraged that my tubes aren't always closed.  That's more than we had a week ago.  I feel like my hope has been renewed, just a little bit.  It's enough, for now.

The Results - Part 1

So, uh, it's been awhile since I had surgery, huh?  I've needed to do an update here for a long time, and I'm sure you've been waiting on the edge of your seat!  Shall we?

The last few months have been a bit of an adventure.  My surgeon didn't find any endometriosis, and that's a good thing.  During the procedure, she also performs a hysteroscopy (using a scope to look for inflammation inside the uterus) and a hysterosalpingogram (injecting dye inside the uterus to see if it flows out the fallopian tubes).  I had a hysterosalpingogram done in November of 2008, and everything looked normal.  However, the test during my surgery showed that my left fallopian tube was completely blocked, and the right tube was only partially open.

This was a huge, huge shock to me since I had gotten a normal test result just a year ago.  Afterward, the doctor explained that the test results could be the result of where I was in my cycle when the surgery was done.  She said that the lining of my uterus was very "thick and fluffy" and it's possible that the lining could have interfered with the dye flowing down the tubes.  Her recommendation was to repeat that portion of the test on my next cycle, at a time when my uterine lining was less thick and fluffy.

We repeated the test in early December and got identical results.  Hearing that news was just . . . crushing.  When I had the test done in 2008, and it came back normal, it felt like that was one less thing we had to worry about.  Physically, I was normal, and so we just needed to figure out the hormonal aspect.  After addressing the hormonal stuff for a year with no success, finding out that something was now physically wrong was just too much.  I was in tears before I even left the x-ray room that day.

To be continued (shortly) . . .