Clomid: Round Two

It is with a heavy and ever hardening heart that I begin to tell you about my last round of infertility treatments. I feel torn with what I am about to tell you because attached to it is a piece of me where strength and hope survive while at the same time am cautious and frustrated.

So basically here is what happened. I started round two of Clomid on August 11th. I told all the important people in my life that this time it would work. I promised some of the most amazing women I know that they were going to be aunts so very soon. I ovulated on the 19th day of my cycle which was August 29th and did everything the doctor told me to do. I felt that I we were successful and my husband convinced himself of that as well. As the days went on I second guessed myself. Four pregnancy tests later I knew we were not pregnant but my husband (the strongest man I know) kept the faith. This another way infertility hurts people.

As a woman you know when you are not pregnant, hoping with every fiber of your being that you are pregnant and still trying to fool yourself that you have a chance at being pregnant. Here is where your intuition starts to hurt you. It is when your husband has decided that you have been successful and he has protected you from another month of pain and disappointment by giving you what you think is the impossible. However, in all actuality he has done none of that because on day 34 of the cycle (mine anyway) you get natures bad news that for after another month you have failed. 

So we ended cycle two of Clomid. I called Dr. B to discussed what was next. As of today we have the hubby scheduled with the top doctors in the state for an analysis. I am starting round three of Clomid tomorrow.  I don't want to skip over all the hard work, emotions and involvement it takes to complete a cycle of infertility treatments because my husband is so far beyond amazing that it is indescribable. To put your unborn child first before your goals, dreams or aspirations is more than I can say for most people. My husband is the best man I know and I am so proud to be married to him. I am the first to admit he has not been the best person his whole life but given the chance and strength to change  is all he really needed.

Also, after all of this craziness I did't want people to complain that I think my problems are worse than theirs. The truth is no matter where we are in this journey it all sucks. I have not faced half the difficulties others have faced and am glad for that. However, I will learn from those who have gone before me. I will hold hands with those I fight through this with. I will more than anything tell all those who are travailing behind me what to expect. Because, at the end of the day I must put my head down and drive forward. 

I know that even though I failed last time I am holding myself capable of succeeding this time.

Dear Amy

Originally tonight I was going to write about our second round of Clomid since it has recently ended (spoiler alert we are now on round three). I had the post all written out in my head and then I turned on my computer. My Facebook page automatically opened as it always does and there was an alert. I decided to read my alert before venturing away from Facebook and onto Blogger. I was really dead set on writing frantically about round two but something told me to slow down. Upon reading my alert I was told I had a comment regarding my 'being brave' post. Here is what the comment said "Barbara, thank you for sharing your blog post. I read aloud to my husband. We just experienced our 4th pregnancy loss, 2 ectopic and 2 miscarriages (no live births) and are struggling greatly (me doing most struggling right now)." The woman who wrote this lives 2,641 miles away from me and knows nothing about me outside of this blog.
I was stopped dead in my tracks. Here I am waking up every day having an internal battle debating if I can go on, holding back tears every time I hold a friends child, looking into my husbands eyes wondering when he is going to give up on his broken wife and then all of these childish and immature thoughts are stopped by a complete stranger. A stranger who is more like a sister to me than my own blood relatives because she simply knows what it is like to be me.
As soon as I read this comment I thought to myself how dare I for a moment think the way that I have. Wow, how dare I put those to shame who are like me by questioning my own strength. Really, how dare I embarrase my husband by second guessing his love for me and more than anything how dare I do or say anything that will cause someone to pause on their journey through infertility because of my words or actions.
Amy, I do not know you but I will tell you this...your struggle is my struggle. Your husbands pain is my husbands pain. Your child who is trying to come into this world is the best friend of my child who is trying to come into this worlds. We may not know each other but through our pain and experiences we are family.The same is true for all of us who are going through this. Amy, you are my sister, my best friend, my confidant and my mirror image. Please stay strong for me and I promise to keep going through this battle for you. Very soon our beautiful children will be here and we will introduce them to each other.

 

Being Brave

On Friday I was meeting with one of my restaurant managers and going over edits to a flyer for an event she was having. For those of you who do not know me I work in the marketing department of a privately owned quick service restaurant chain. This means that I do whatever needs to be done to support our 39 restaurants and my boss (who I appreciate more than she will ever know). Going back to the story, as the GM and I were going over edits my phone rang and it was my OB's office. For what felt like a year but was only 10 seconds I debated on answering the call. I went back and forth between what was more important my job or the possibility of having a baby. Finally, I answered the phone not because one won out over the other but because they are both tied together (a post for later). I was as discreet as possible allowing the GM to look over my shoulder at my computer screen as I talked so she could continue to review her file. After I hung up we made notes about what she wanted to be edited. Then she said something that both terrified me and comforted me at the same time.

She told me that through my work with social media we were connected. She had learned about this blog and had read it. She then proceeded to tell me how brave I was and that she supported me. I dismissed this because I am an introvert and can't handle situations like this. Later as she was leaving she ran into my husband in the parking lot (again for those of you who don't know me my husband and I work for the same company) and she told him how much she loved my writing.

When I got home that night I was a bit upset. I didn't know how to be with this obvious compliment she had given us. I had such a mix of emotions that I didn't know which was right. After breathing and letting things set in for 24 hours I finally figured it out. I am writing this blog for me. I am writing so I don't go crazy. I really didn't expect for this many people to read it. Most of all I didn't feel brave. Actually, I struggled with the fact that someone called me brave. So like I always do I looked up the definition of brave. According to Merriam-Webster the definition of brave is to show courage which in turn means the mental or moral strength to venture, persevere and withstand danger, fear or difficulty. Upon reading this I could understand why my GM said what she did but I still feel like I don't deserve the title of brave. 

To me I am just a woman who really wants to have a family with my husband. It doesn't matter to me if it winds up being ours biologically or by way of adoption. Also, if for some reason neither of those two options work out I will still have my family members on both sides to spoil. I guess in the end I am beyond honored that my GM thinks I am brave. For me I like to believe that I am learning to be strong.

Clomid: Round One

Right now I am posting quite a bit since there is so much to tell to get everyone caught up to where we are today. So now it is time for the story of our first round of treatment. On July 13th 2013 I started taking my first round of Clomid. Dr. Burgoine decided when he and I spoke that we would start with three rounds of 50 mg tablets taken once a day starting on the 5th day of my cycle and ending on the 9th day of my cycle.

Let me tell you a more about this medication for those who are unfamiliar. Clomiphene (trademarked as Androxal, Clomid and Omifin) is a selective estrogen receptor modulator that increases production of gonadotropins by inhibiting negative feedback on the hypothalamus. This drug has become the most widely prescribed of all fertility drugs. It is used in the for of its citrate to induce ovulation.

That didn't sound too bad so I grabbed my prescription (which insurance doesn't cover) and took my first dose. Then I thought hmm maybe I should find out what type of side effects I might get from this. So this is the list.

First the most major thing that had caught my eye was: long term therapy (past 6 cycles) is not recommended to avoid the increase of cancer risk. Okay well I am only doing three but it is nice to know I am taking something that is known to cause cancer. I thought at that point I should start looking at the common side effects first. Let's see there is swelling of the hands or legs (didn't get that so win for me), abdominal pain and swelling (didn't get that so win 2 for me), shortness of breath (got that but not too bad so 1/2 a win), weight gain (umm yeah 6 pounds so big time loss) and nausea or vomiting (didn't get that so win but had I got that maybe the weight gain wouldn't have been so bad). So then we look at the more serious side effects of Clomid. Ovarian enlargement presenting as abdominal or pelvic pain, tenderness, pressure, or swelling (all good there). Flushing (oh you mean hot flashes yup got those), breast tenderness or discomfort (yup got those too), blurred vision or other visual disturbances (would sensitivity to light count...yup got that), headache (thank goodness that was a big no) and abnormal uterine bleeding (would have ran straight to the ER so thankfully no). Being the slight hypochondriac that I am did call the doctor and verified that the symptoms I was having was okay.

To be honest if that was all there was to part one then heck this would be a cake walk. For any of you in the know you will know that is just the tip of the iceberg. In addition to taking the Clomid I now have to take a daily prenatal vitamin. To be honest I really like this part because I bought them as a gummy chew so it is like being forced to eat candy!

However, there is the charting which kind of nulls the fun of the gummy vitamins. So I have this awesome (insert sarcastic tone here) chart that I have to write on every day. Here are the categories I get to fill in. Month, date, day of cycle, coitus, menses, medication and temperature. I don't think I would be so self conscious about this if I was the only person who had to look at it. Unfortunately this is something that I have to share with my doctor. To me this is a lot of personal information but I sucked it up because it meant we had a chance at a baby.

See how much fun charting can be (also insert sarcastic tone here). This wasn't the end of what I had to do though. I was asked to purchase a full cycle ovulation kit and add that to the chart as well. Seeing as my only option for a full cycle was a gross dip stick into cup option I decided I would buy five of the week pee on a stick option (hey sometimes we have to get creative). So here is another part of my daily routine.

Alas I can't say this first round was over that easy. I had to also have my tubes tested to make sure there were still in full working order. Let me tell you a little about that test. It is really called a Hysterposalpingogram (aka HSG test). It is done in an X-Ray clinic after the menstrual flow has stopped and the lining of the uterus is thin. A radio-opaque dye is injected into the uterine cavity and the passage of the dye into the uterine cavity and then into the tubes and from there into the abdomen can be seen by a high powered X-Ray. We pause now for me to explain to you in laymen terms what this means. You schedule time off work for you and your husband to go to this appointment and it has to be on the days the lab says because it has to be at a certain point in your cycle. Two big things to note here. One your work has to really be understanding that you need time off at the last minute and it doesn't matter what meetings it interrupts. Two your husband really needs to go with you and if he doesn't he better have a good excuse like he is on his death bed (you will find out why soon). After being layered in lead (everyone) and told many times that this is a good test and everything will be okay (do get nervous because I didn't and should have) the doctor comes in. Yes a doctor actually has to be the one doing the test it is not left up to a nurse or technician. You then look at this super super long tube but much thinner than a straw and they explain to you that the injection is going to start soon. I will skip over gory details but I will tell you this it is so not comfortable. Now the imaging begins and I go back to the medical terms. A normal HSG finding is where the dye appears black and outlines a normal cavity and Fallopian tubes such as the name applies (hystero = uterus; salping =tubes; gram = image). A normal finding will show the tubes as two long thin lines one on either side of the cavity and when the dye spills into the abdomen the (open) tube appears as a smudge in the X-Ray. An abnormal HSG may show a problem in the tube. If a tube is blocked at the cornual (end) of the tube then no dye enters the tube and the tube cannot be seen at all. If the block is at the fimbrial then the tube fills up but doesn't spill into the abdomen. One common solution during this test if a tube is found to be blocked is to use the catheter which is administering the dye to force the tube open. Okay I am going to stop again to go back to what happened with us. During the original distribution of the dye my husband had to hold my hand while the doctor told me what was happening and the nurse kept telling me that the results we were going to get were worth it. All of that was because it felt like your worst period times ten. Then when the doctor saw the right tube was open I could breath just a little. She then moved to the left tube (the trouble maker of the family) and right away found it was blocked at the start. She explained that she was going to attempt to force it open and my husband and I locked hands as he put his forehead to mine. What happened next felt like a testament to our goal and our marriage. As the doctor tried to force the catheter to clear my tube I felt the most excruciating pain I had ever had to go through. I thrashed from the waist up as to not mess up what she was doing, I screamed (not quietly) out in pain begging for it to stop, I squeezed my husbands hand hard enough I was sure I broke it and I looked into my husbands eyes as I cried begging him to make it stop and seeing he wished with his entire being that he wanted to. After what seemed like forever but was only five minutes of this the doctor determined that without surgery the tube would remain closed. So I got dressed and my husband took me miserable and in pain back to work.

So on August 10th the last day of my cycle after all I described above I took a pregnancy test (one of a million in my life). The results spoke for themselves it would be another round of treatment. At least we had got over the first hurtle right.

What's Wrong with Me

I have a feeling I am going to jump around a lot in this blog but oh well. So in the background story I talked a little about my Ectopic back on 7/1/12 but didn't really explain what was wrong with me and I think that was because there are so many different reasons infertility exists. For me, it is important to define mine. Dr. Burgoine (who I am sure you will hear a lot about) is one of my heroes.

Dr. Gary Burgoine

Before the surgery when Jay & I told him that no matter what, being parents is very important to us none of us knew what we were in for. When you have to deal with an Ectopic pregnancy surgically, many times for safety and ease the tube is removed.

Ectopic Pregnancy

Fallopian Tube Removal

Once the tube is removed you lose the ability to conceive on that side therefore diminishing your chances to 50%. I consider myself to be very lucky because Dr. Burgoine was able to save my left tube by making a small incision and removing the pregnancy.

When I woke up from my surgery I really expected to hear that he had removed the tube and that I should keep trying with my right side. Instead I woke up to great yet horrifying news. Dr. Burgoine was able to save the tube using the procedure pictured above however there was quite a bit more wrong with me than anyone knew. In order to explain lets look at a normal uterus.

As you can see the ovaries sit right in line with the opening of the Fallopian tube. This is because the eggs develop from the ovaries and are released into the tube at which point they become fertilized and then travel down to the uterus and the fertilized egg attaches itself to the lining. As Dr. Burgoine was looking at my reproductive system when he was removing the nonviable pregnancy he noticed a few things and went to work to fix them. He found that my left tube not only housed this ectopic pregnancy but it also had scar tissue build up that had been part of the reason the pregnancy was not able to pass through to begin with. He also noticed the same kind of scarring in the right tube. I have never been diagnosed with Endometriosis so I can't deny or confirm that had anything to do with the scaring. In addition he found the my Ovaries were attached to my Fallopian tubes which is not how they are supposed to be either. Truth be told from what he found it was a miracle I have ever been pregnant in my life.

Blocked Tube Scar Tissue

Closest Representation I could find if the tubes were attached to the ovaries.

So the extra time Dr. Burgoine spent during the surgery was to detach the ovaries from the tubes and clear out the tubes of any blockage. Thus giving me a fighting change to have a normal reproductive system. So as of this surgery on 7/1/12 we should have been good. Unfortunately this was not the case. When a woman is deemed infertile she and her husband undergo a battery of tests which help determine why they are infertile. This helps the physician determine the best medical course of action. These tests and the first of my infertility treatments will be discussed in my next post.

To everyone like me I keep you in my thoughts everyday so that one day we can all smile and celebrate a viable life growing inside us or an approved adoption. No matter how our babies come our lives will be complete when we have them in our arms.

The Back Story

I am writing this because if I help even one person to not feel as lost as I have then the pain required to write this was worth every second. For those of you who stumble upon this blog and don't know us I wanted to provide you some back story.

My husband and I meet at work on his first day at our company. It was love at first sight. In fact it only took 8 days from the time that we met to be in a committed relationship. All of three months later we were engaged and 13 months after that we were husband and wife a.k.a the Johnson's. We were married barley seven months when I was rushed to the hospital only knowing that I didn't feel good and something was very wrong. What we all found out after four hours and lots of tests was that I was almost 12 weeks pregnant but it was ectopic and very close (minutes) from rupturing and causing serious life threatening damage. It was at this point we were told we needed to wait just a few more moments for the OB surgeon who was on call to arrive at the hospital. Our world crumbled around us in the eight minutes it took Dr. Burgoine to arrive in my ER room. When he did, his bed side manner immediately won me over. He told me the facts which were as follows: to save my life he had to surgically remove the pregnancy. It was not viable, I was not a good candidate for Methotrexate plus due to how far along I was and the what the imaging test showed we had to get into surgery very soon. For those of you who don't know when you have a surgery to end an ectopic pregnancy it tends to mean you lose the Fallopian tube that is housing the pregnancy. I knew this at that time because of past experiences you will read about below. It was at this point Dr. Burgoine asked me and my husband tell him how we were feeling. I explained with my husbands approval that having a child meant the world to us. If there was any possibility we could save the tube so we had more of a chance that would be amazing. We also explained that we felt comforted and trusted him so whatever he saw to do during the surgery we would ultimately be okay with. Within a few minutes I was being rolled into an operating room and being given medication which made me sleep faster than I could say I was scared.

I woke up three hours later after a surgery that lasted two and a half hours. Typically this type of surgery doesn't take that long but there was a good reason. Dr. Burgoine had actually cared and listened to us (in my experience this is as rare as a four leaf clover growing on Mars) and he made sure I kept my tube and at the same time fixed some other problems that were really wrong with how my whole reproductive system was put together. Here is where it really gets good. He was called to the ER at about 10 pm and stayed after the surgery was over and I regained full consciousness to explain in detail all he had done, with drawings since the cameras were broken during the surgery. This included a Q&A session with a doctor who looked like he really needed sleep at this point. The emotions were so overwhelming. I was so happy and so sad and so angry all at the same time. A few days after being release I went for my follow up to Dr. Burgoine's office and I asked him to please be our OB. Only once had I met someone who cared as much about their patients as he did and that person is our families primary care physician the amazing Dr. Kassay. I am happy to report that he took the position with pleasure.

Here is where things start to get harder to talk about. This was not my first experience with being pregnant and to this day (9/7/13) I still have no living children. This is a post long in the making and difficult to write. I have tried more than 10 times to finish this and every time I get stopped by my emotions. So, I started by going to go over the summary of my past. When I was 14 years old I found out I was pregnant for the first time. My initial reaction in addition to the oh *&#% was to tell my parents. I sat them down in the living room the same day I found out and told them "I have something to tell you" to which my mother jokingly replied "You're pregnant aren't you" and I responded "Yes". All of a sudden the whole atmosphere and my relationship with my parents changed. I am not going to go into details about what happened next because it is really not relevant now. The long and short of it is that I had an abortion and that I woke up in the middle of it scared. The doctor that was preforming the procedure was frighted (both from being new and having something unexpected happen) causing him to injure my left tube before the anesthesiologist could put me back to sleep. That being said since then I have suffered multiple miscarriages and three ectopic pregnancies. The ectopic I told you about earlier was the second of the three. The first ectopic I had was when I was 25 years old and without medical insurance. Because it was caught early and I couldn't afford any treatment I was deemed a good candidate for Methotrexate and it had to be injected three times before it worked. This is a whole other story but it made me aware of what ectopic pregnancies were and the different outcomes that people could have.

In June a little before the year anniversary of our life changing event my husband and I decided it was time to start trying to have a baby. I scheduled an appointment with Dr. Burgoine to discuss fertility treatments (because it had been nearly a year of unsuccessful trying naturally). We are now currently at the end of round two of our first go at fertility treatments which I will talk about in following posts. Once I realized I was infertile I did some research.

I am part of the 6% of United States women who are infertile and used to be part of the 10% of United States women who have impaired fecundity. Women with impaired fecundity are those women with the impaired ability to get pregnant or carry a baby to term and women who are considered infertile are those who are those who are unable to get pregnant after at least 12 consecutive months of unprotected sex with a consistent partner. When Dr. Burgoine told me I was infertile I knew for SURE there were many other women like me that I could connect with for a support group. Unfortunately that was just wishful thinking since all the women I knew had just impaired fecundity and had never progressed to infertility. Just to make sure I double check with the CDC and they said the same thing (http://www.cdc.gov/nchs/fastats/fertile.htm).

When I saw this I started to ask myself where it all started because like most people I look for something to blame first rather than looking for how to fix it. I gave in and started to look into the percentage of women who were infertile since birth and I found that data doesn't really exist. I was frustrated at first since I sincerely expect an easily available answer to every problem I was having. When I resigned myself to the fact that there might not be an easy or available way to determine those who has been infertile since birth compared to those who have had medical problems that caused their infertility I started to move forward. So I started to look back on my history. Not just because I have that internal desire to know why something is happening to me but because if I could figure it out maybe just maybe I could help fix it. So I started at the beginning, such a novel idea right! As I started to look into percentage of women who have had medical problems leading to infertility and trying to drill down to which problems were the main causes I stopped dead in my tracks. I finally realized until I let go of the "why" and focused on the "how" I wouldn't get anywhere. So I call Dr. Burgoine and told him to bring it on! So on 7/13/13 just one year and 12 days after my initial surgery I told you about at the beginning of this post I started my first round of Clomid. An oh so awesome drug I will explain in detail on my next post very soon.

To everyone like me I keep you in my thoughts everyday so that one day we can all smile and celebrate a viable life growing inside us or an approved adoption. No matter how our babies come our lives will be complete when we have them in our arms.