Monday, May 31, 2010

The waiting game

It has been a crazy cycle! I took Femara this month starting on cycle day (CD) 3 through CD7 which was actually back at the end of April. Generally, I ovulate around CD15 or 16, but this month it looks like I didn't ovulate until CD24 which was on 5/20. So here I am 11 days past ovulation (DPO) and my temps are still up, but then, that's not unusual for me. It will probably be another week before I know anything.
TTC is all about waiting, though so you'd think I would be good at it by now. I wait for my ultrasounds, wait to ovulate and then, there's the 2 week wait (well, 3 week wait for me) to find out if our efforts paid off. It's a repetitive process that, after even a few months, gets pretty old.

Thursday, May 20, 2010

Nope, life's not fair.

So, I've been meaning to add this, but haven't had time yet this week so now you get a double blog day.
Tim and I went to brunch an then the zoo on Sunday for a friends birthday. As I'm sure you can imagine, the zoo on a beautiful Sunday was well, a zoo. The day was filled with watching children and their parents interact, something I try and avoid if I can. Seeing how some parents treat their children is a reminder that life isn't fair. People who either don't deserve to have children, or don't appreciate the children they have never cease to amaze me.
I witnessed small children, maybe 2 or 3 years old, getting hit for minor things and called names like "moron" or "idiot" for making mistakes that little ones make all of the time. It made me really sad, and angry at the parents for not appreciating their children.
I am all for consistency and discipline, but when things are said or done in anger or frustration, they are almost always excessive and unnecessary. I guess a lot of it goes back to how I was raised. My parents spanked my brother and I, but I never felt abused, because they took time to calm down before doing it. I never felt like I was hit out of anger or frustration and I don't believe they spanked us until we were old enough to understand what a spanking meant. I was never called mean names, ever. I can't think of any scenario that would make it OK to call your child a name.
I try and imagine that the parents doing these things likely had this done to them as well. It's no excuse for someone to treat their child that way, but it helps me to deal with my own anger at those parents.
I feel so blessed to have had such wonderful parents growing up and I really believe that Tim and I will be good parents too. I hope that we get the chance to find out someday.

From if to when to if

Before Tim and I got married and even a little after, we weren't entirely sure that we wanted to have kids. We both like children and we were emotionally and financially stable enough that getting pregnant would be a blessing, but we didn't know how we would handle it. With Tim flying all of the time and me spending my time split between research and my residency, we weren't sure how we would make it work. So, when our conversations turned to having children, we always said if.
As time went on, we both began to feel a strong urge to add a baby to our family and once we decided that it was what we wanted, we changed our if to when. When we have a baby we will... I think that phrase was uttered 500 times in the first 6 months of TTC. We talked about names, we talked about discipline, we talked about traveling and family and all of the things that change when you have a baby, which is pretty much everything.
After we reached the 1 year mark, and I had to officially accept that we were dealing with infertility (IF), I changed my phrases back to if. If we have a baby... If we get pregnant... I can't seem to make myself switch back. The uncertainty that we had at the start of our marriage about having children is back and I hate it. IF has made me if the possibility of children.
One of my good friends noticed this recently and said Could you try saying when? and I just looked at her and said No, I can't. She told me that every time I say if, she is going to insert a mental when because she has faith that it will happen for us somehow, someday. I really hope that she is right. I want my when back.

Wednesday, May 12, 2010

If I never hear any of these phrases again...

I will be a happy woman.

1. "Don't drink the water"...(this is so overused I can't express it), it also comes in the fun variety of "If you want to get pregnant, you should try the water where I work"
2. "As soon as you stop thinking about it, you'll get pregnant so just stop thinking about it" Um, yeah, that's like telling someone not to think about breathing. This phrase also comes in the form of "you're trying too hard", "you should stop trying" and "you should look into adoption, then you'll get pregnant for sure"
3. "Having a baby is overrated, you should just enjoy being married"
4. "Since you don't have kids, you wouldn't understand..." Yeah, thanks for reminding me. This one comes in several forms too like "you'll understand when you have children" or "you think that is bad, just wait until you have kids"
5. I could also do without the constant "So, any news?" or "Anything new and exciting with you??" This is generally accompanied by raised eyebrows, flared nostrils and an expectant grimace which quickly turns to a frown when I say, "nope, how about you?"
6. "Really, (you're so lucky) my husband just has to look at me and I get pregnant"

For good measure, I'd like to throw in these gems:
"ugh, morning sickness sucks, you have no idea"
"I can't wait until this baby gets out of me" Generally followed by my back hurts, I want a drink, my feet hurt, I'm bloated, I'm tired... Yeah, well, I'm infertile, so I don't want to hear about it.

If you have ever uttered any of these phrases (and yup, I'm guilty of it too), please take a moment to reflect on the effect that they likely had and never use them again.

Letters to my doctor

So, here is the full version of the letters I sent to my previous doctor. I am still so happy that I was finally heard. It feels unprecedented, which is actually kind of sad.

First, my original e-mail-

Dear Dr. -- and other doctors of --:

I expressed concern at my follicle scan this morning regarding the volume of Novarel which is given as a single intramuscular injection. Ten milliliters seemed like an unusually high and unnecessary volume to give IM. When I expressed my concerns, I was told that this medication is given as two, 5 cc injections. I continued to state that this seemed unnecessary, and was told that if I don’t like the dosage, I should take it up with the drug company.

I wanted to inform you that I have in fact contacted the drug company and was told that it is not necessary to give this medication in a 10 cc volume. As they show in the instructional video on their website, it can be reconstituted in as little as 1 cc. (
http://www.ferringfertility.com/medications/trainingguide.asp)

Attached is a letter from a nurse at Ferring Pharmaceuticals explaining this as well.
Please, do not continue to give this medication to patients in 10 cc. It causes unnecessary harm.
I will also fax a copy of this letter to your office.


Thank you,
Lisa

E-mail from Ferring:

Thank you for contacting Ferring Pharmaceuticals Clinical Hotline in regards to Novarel. Please see the following in regards to guidelines for the reconstitution of Novarel.

It is recommended that the amount of diluent used to reconstitute NOVAREL is selected on the basis of the dose to be injected.

--For ovulation induction requiring doses of 5000 IU to 10,000 IU, the volumes of diluent usually used for reconstitution are a 1 to 2 mL
--For cryptorchidism or hypogonadotropic hypogonadism requiring doses of 500 IU to 1000 IU, the volumes of diluent usually used for reconstitution are 10 to 20 mL

Thank you

Amy


Then, my final e-mail to the owner of the practice-

Dear Dr. --,
I wanted to tell you that I received your voicemail last night and to let you know how much your call meant to me. As I am sure you know, women going through infertility experience a roller coaster of emotions, but the one feeling that takes hold and will not let go through the entire processes is helplessness.
Feeling like my voice was heard, even if I had to fight harder than I should have, meant more to me than you will ever know. I wish you and the other doctors luck in your practice; however I feel that it is best that I move on to a specialist for my infertility treatments.
I hope you understand.


And last, the reply from the doctor which I just received:

Thank you for your kind reply. One of our beliefs in the physicians need to keep listening and learn from whatever valid source they encounter. Thank you again for being that source. We wish you well with your efforts. You will obviously be a great Mom.

I am now ready to let this go...after I do my happy dance a couple more times.

Tuesday, May 11, 2010

Real vindication came today...

I got a phone call from the owner of the ob/gyn clinic today. Apparently he received my e-mail regarding the Novarel and he wanted to let me know that they stand corrected regarding the administration. I can't even begin to describe how amazing it felt to get this phone call. It is posted below for your listening pleasure. I cut out the first few seconds of the call to protect the name of the doctor and the practice. By making this phone call, he has helped me to let go of some of my anger. All the same, I will only return to that practice once more. To pick up my medical records.

video

A poem

Here's a poem that I found (I'm not really creative enough to write one of my own)
For those dealing with IF, it will surely hit home. For those who know someone who is dealing with IF, please take a moment to read it, the questions and statements made are so common and none of them are helpful. Don't say them...

Useful Advice
You're 37? Don't you think that maybe
It's time you settled down and had a baby?
No wine? Does this mean happy news? I knew it!
Hey, are you sure you two know how to do it?
All Dennis has to do is look at me--
Some things just aren't meant to be.
It's sad, but try to see this as God's will.
I've heard that sometimes when you take the Pill--
A friend of mine got pregnant when she stopped
Working so hard. Why don't you two adopt?
You'll have one of your own then, like my niece.
At work I heard about this herb from Greece--
My sister swears by dong quai. Want to try it?
Forget the high-tech stuff. Just change your diet.
It's true! Too much caffeine can make you sterile.
Yoga is good for that. My cousin Carol--
They have these ceremonies in Peru--
You mind my asking, is it him or you?
Have you tried acupuncture? Meditation?
It's in your head. Relax! Take a vacation
And have some fun. You think too much. Stop trying.
Did I say something wrong? Why are you crying?

Author of infertility poetry Catherine

Monday, May 10, 2010

Vindication

As a follow up to my earlier post:
I decided to contact the drug manufacturer and ask about the proper resuspension of Novarel. The nurse was appalled that the doctor would give a 10 mL injection (or even 2, 5 mL) injections. She told me that the drug could be reconstituted in 1-2 mL and given that way. She also sent me an e-mail which conveyed this information to pass on to my (former) OB/GYN.

I sent a letter to the OB and all of the doctors in the practice with this information and then made an appointment to see an RE. I am happy to report that I will be seeing this new doctor on Thursday. I have hope again, I feel powerful again and when struggling with infertility, these feelings are like gold. :)

Feeling Defeated

So, yesterday was Mother's day and I tried to sulk, but Tim wouldn't let me. We spent most of the day running errands which was a good distraction.

Today, I went in for a follicle scan to see if I am ready to trigger and do the IUI. The trigger, Novarel, is an HCG injection that has to be given IM. I had to pick up the medication yesterday at the pharmacy and bring it with me today in case they wanted to give it. When I got the Rx, I looked at the instructions and it said "inject 10 milliliters (mL) intramuscularly for 1 day". I freaked. No one gives that much volume as an IM injection. It's f-ing crazy. So I went online and tried to look up how people give the medication and I went on the bump and asked the ladies how they have gotten it. It turns out that generally, the medication is reconstituted in a smaller volume if it is all being given at once IM so I felt better. Until my appointment.

The follicle scan showed only one follicle with any potential, but it is still too small to trigger so I have to go back in a couple of days to see what happens. While I was there, I told the doctor that the instructions on the Novarel freaked me out, I couldn't believe that they would give an injection of 10 cc IM. He laughed and said "yup, but we actually give it as 2 shots" I just about broke down right there. He told me that if I didn't like it I should "take it up with the company".

I just want to cry right now. I feel so defeated and so unheard. I don't understand why my body won't just do what comes natural to the vast majority of women. Sometimes I just want to give up.

Thursday, May 6, 2010

Infertility Creeps In

Last week, my best friend's father was tragically killed. He was here one day and gone the next. It has been such a hard time for her and her family and I wanted to be there to help her through it.
Tim and I drove up to see her for the wake and funeral this week. My heart goes out to her. I know what it's like to lose a parent and I know that there isn't anything I can say to make it better. I actually didn't say much. I tried to distract her and ask about other things, but I knew better than to tell her that it's going to be alright or that it will get better in time, because those sentiments didn't help me when I was grieving.
As I sat with her, I listened to the things that people said to her and her mom in an attempt to comfort them and one thing was said over an over again--"he will live on in his children and grandchildren". The statement is true and I do think that it offers comfort to the family, but for me, sitting there, it made me want to cry.
I know that the past few days weren't about me or my own struggles and I would never expect anyone to edit their comments to someone just because I am sitting there, but it was still like a knife twisting in my heart.
What if we never get to have that? What if we are a genetic dead-end? What if something happens to Tim or me? What will people say when they realize that they can't use those comforting words? Who will keep Tim occupied or help him with arrangements when I'm gone? How would he cope? How would I cope?
It is amazing to me that even in this time when there is already so much grief, infertility can creep in and somehow make it that much worse.

Wednesday, May 5, 2010

Moving Forward

Well, I have an appointment with my doctor tomorrow to discuss our options. I am expecting that we will do u/s monitoring, HCG trigger and hopefully IUI. To be honest, since I am not working with an RE (reproductive endocrinologist), I may not be able to get IUI, this month. If that's the case, I will ask my doc to refer me to an RE as soon as possible. I don't want to keep wasting cycles without doing everything possible.