The Next Step

We've decided to go ahead and take a big step, and go see an RE (Reproductive Endocrinologist). I've set my appointment for January 2nd. I'm excited about this doctor. He got his undergraduate degree from the same university that John and I attended, and from looking at his bio on the clinic's page, I'm pretty sure we go to the same church. He is very experienced and has a lot of world wide recognition. I hope he'll be the perfect doctor for us!

I know it's going to be expensive, and we have other expenses besides medical ones, but we think that we can at least go see what he says. We don't have to jump in and start really expensive treatment. I just want an expert opinion about our next course of action.

Of Course...

I have had a lot of conflicting information and opinions about my test results. I asked all of my friends in my infertility support group who said their RE's rate my 10.3 as a low level for post ovulation progesterone. I talked to a family member who is a nurse practitioner in an OB/GYN office who said that my level is low. But I (finally) got a hold of my doctor who said she thinks my levels are fine and wouldn't prescribe me medication. And another friend of the family is an OB/GYN and said that my level looks fine, and that it can't hurt to take it, but recommends that I get the opinion of a specialist.

My heart is crushed. I was so excited and thought that maybe I had finally found something good in this, and something that could help. But it looks like it's just another confusing piece of information that no one can agree on.

Merry Christmas.

Christmas

Christmas is one of those hard holidays for me, and most infertile people, actually. I know there is so much to think about at Christmastime, and it's such a lovely and charitable holiday, which is why I try my best to really think about all of my blessings at this time of year.

But it's still impossible to ignore all of the parts of Christmas that I wish I had. Taking my children to meet Santa, watching Rudolph, Elf and Scrooge with them, watching them sing at the school's holiday music program, seeing their faces light up Christmas morning when they wake me up at 4 AM to open presents, Christmas family photos, playing Santa, teaching my children about baby Jesus and the Nativity story, the kids waiting for Grandma and Grandpa to come over... Christmas has so much focus on families, and a large part of it is dedicated to the children. On the RESOLVE.org page I linked above, a quote says, "One RESOLVE member describes Christmas as 'Santa Claus and rosy-cheeked children in every store, buying toys and gifts for other people's children, hanging only two stockings on your mantel, seeing the Nativity scene on display everywhere.' The everyday reminders of infertility are magnified a hundredfold. The joy of seeing children sitting on Santa's knee, lighting a menorah or ripping open a present is destroyed when every child reminds you of the one you don't have yet." Last year on Christmas day, I cried while I thought to myself, Maybe next year... I have to hope that it will happen next year. Will I tell myself the same thing again this year? This year is going to be much harder, too, because I am going to be together with my siblings and their kids. And it might be a selfish feeling, but I really can't help but feel that I will be out of place and left out. It's hard when everyone else who will be there has moved onto the next stage of life.

I have had to work on and resolve a lot of feelings when it comes to infertility. I can handle so much more now than I ever dreamed I thought possible. But, maybe because holidays like this come around so infrequently, or because I always imagine that Christmas will be so important once I do have children, or because I think of what my Christmas would be like if I hadn't lost my babies that I'm just not sure what to do with these feelings yet. This is going to be a huge trial and a big time of growth for me. I'm going in blind because I'm not sure exactly what to expect. My first instinct is to run away and just avoid all of it. But, I'll just have to jump into my aunt role and try to make this an amazing Christmas for my nephews, enjoy eating family dinner, and hope that the Lord will help solve the heartache I feel this time of year.

We will also take a quick escape for a few hours on Christmas morning while we go see Les Misérables at the cinema. We have to treat and help ourselves, too, don't we? I think we'll need that time together at Christmas, just our tiny family of two.

The Results Are In

So, the results! My number was 10.3 ng/mL. To get an idea of what that means, here are the normal ranges for progesterone.

For females 18 or older:
Follicular Phase (Before ovulation)     < 1.0
Luteal Phase (After ovulation)            2.6 - 21.5
Postmenopausal                                < 0.5      

So, I'm within the range, but it's still considered low! Most doctors say that anything above a 10 shows that you ovulated, so that's really good that mine is above that. However, it's still low, so my body might not be getting enough progesterone to make a good, thick, healthy lining. If there isn't a good lining, the egg can't implant well, therefore causing miscarriages.

Do you know what that means?

I think (I hope!) I have my answer.

I haven't confirmed with my doctor for sure what we will be doing, but I'm almost certain that I will be taking Prometrium during the luteal phase to increase my progesterone. So, when (yes, I'm going to say "when!") I get pregnant, my levels won't be low anymore, and I shouldn't lose the baby.

When I opened my test result today and saw the number, I just sat in the car and cried of relief. I hope this is it! And I hope that my doctor agrees that it's too low and allows me to take the medication. It doesn't hurt to take it, so if I want it, I should be able to have it just in case.

Today's the Day, and Good News!

Well, today is the day that I go get my blood drawn for the progesterone test. I am very nervous, and excited, and anxious, and emotional. As soon as the results are back, I will know if all I need is one little pill for two weeks out of the month to finally have the blessing of my first child. After almost three years, could this finally be the last piece of my answer?
UPDATE: I will get results on Tuesday!

The very, very good news is that the Clomid seems to have reminded my body that it's supposed to ovulate every month. I was so afraid that this last miscarriage would mess up my body again like the first one did. But I seem to be on a good track, predictably ovulating on my own. I feel like I can relax and say that I shouldn't need Clomid anymore! That's one giant piece to the mystery puzzle solved! I should be able to continue to get pregnant on my own. Now we just need to figure out how to make those little babies stick. And I'm dearly hoping that there is a solution.

Being Open

I know it's very different for a woman in my position to be so open about everything. It's not often that you will encounter someone who is willing and eager to talk about her reproductive system on the internet with friends and even complete strangers. But I feel that it's important for me to do it.

Infertility is such a taboo topic. And I understand why, since it's such a private and personal thing, and many times it can be embarrassing. A friend shared this video, and I liked it so much that I decided to share it, too. It has some good points showing the difference between being completely private about infertility versus being open.

http://studio5.ksl.com/?nid=56&sid=22789147

Also, tested negative today. Looks like I'll most likely be doing the progesterone at 8 days past ovulation next month. I'm hoping for low numbers! That would be such an easy solution.

The Plan for the Near Future

I just had a lengthy visit with a new OB/GYN today to ask about options after having three miscarriages, and we have a new plan.

First, some exciting news. During my annual exam, we found out that I ovulated yesterday or today. YAY! That is such a relief because with the first miscarriage, I was completely out of whack, my body stopped ovulating, and was just a mess. But this time it looks like everything should be staying normal. I'm remaining hopeful.

So, we have some plans.

Plan A: In case by some weird cosmic, voodoo magic, God-sent miracle I get pregnant the third month in a row (wouldn't that just be so unexpected??), I have a lab order to go have a beta-HCG and progesterone level check immediately (progesterone typically needs to be at or above a 20 to have a viable pregnancy). It's possible that I have been miscarrying because of low progesterone. If the levels are low, she already sent in a prescription to my pharmacy for Prometrium to combat the low levels. If the hormone levels look good, then we'll just pray for a healthy pregnancy!

Plan B: If I'm not pregnant and have a period, I will test with an OPK again to find out when I ovulate. Then, 8 days after I get a positive, I will go have a progesterone level test. Progesterone is somewhere between 10-20 in the days after ovulation. If that level is low, I will take the Prometrium every month after ovulation to create a welcoming environment for eggs to implant and grow.

Plan C: If I am not pregnant and discover that my progesterone level is good and not low, the next step is to visit a specialist. She gave me a referral already for a fertility clinic in a city not too far away that has a great doctor. They can help with other tests, like ones looking for immunologic and chromosomal disorders.

I'm hoping that in the next few weeks my diagnosis of unexplained infertility can change to a real diagnosis! I don't want to have to visit the specialist!

Also, we finally have our Disneyland trip planned! We're going this coming Monday-Wednesday. This is definitely the best thing I can do for my mental and emotional health right now! I can't wait.

where is my peace?

I just really don't understand. If I am doing everything right, and upholding my end of the bargain, then why aren't I being blessed with what I have been promised? Why do I have to go through all of this pain and emotional trauma? Why me? After waiting, and waiting, and waiting only to be disappointed many times while watching my friends lap me two and three times over, when will it be my turn? How much longer do I have to wait?

Another

Third pregnancy, third miscarriage. I don't know how much longer I can do this.

We were both amazed when I found out that I was pregnant again right after the early miscarriage in August. My period was late, so I thought I might as well test, knowing that I couldn't be pregnant again so fast. I couldn't quite believe my eyes when I saw the positive tests. Hoping that the lines wouldn't disappear, I kept testing every morning and slowly watched as my lines got stronger and darker. I finally let myself hope and get excited! Maybe this one would be it! I felt good about it! I started looking into the future- we could surprise everyone at Thanksgiving when I made it into the second trimester. I might have a cute little bump for Christmas photos. The baby would be born around the beginning of June, right after school was out for the summer, so John and my mom could both be here all the time. The timing was perfect and we were excited.

A few of my wonderful positives

Yesterday morning I went to my clinic to get my Proof of Pregnancy for insurance. But when I did the urine test, it was completely negative. The nurse told me that since I had a good positive the day before at home, it was most likely a false negative because the hormone couldn't have worked its way out of my body so fast. So I went off to the lab for a blood draw for a beta hCG, which measures the exact amount of hormone in the blood (which came back the next day showing I was pregnant). I had felt a little icky all weekend and had more cramping than usual, so after the negative test, I started to suspect things weren't right at all.

I went home, and a few hours later started to lose the baby, this time just a day shy of 6 weeks. The nurse called shortly after to let me know that my beta level was just a 6. Enough to prove pregnancy, but much, much too low to be viable.

There is really something wrong with my body, and I wish the doctors could figure it out. I really thought this could be it.

Chemical

A few days ago, I tested positive for pregnancy. It was a faint line, but definitely there on the stick. My first positive in over two years! Worried that it was an evaporation line and not an honest positive, I took another test a few hours later. And that one was positive, too, showing up within just a minute or two, right in the time limit! And the next test a bit later in the day, positive! It wasn't just an evaporation line. These were the real deal! The hormone hCG is generally supposed to double every 24 hours, therefore making the test lines get darker. I couldn't wait to test again the next day to see my line get darker.

But it wasn't. 

The next day, my test still showed positive, but the line was so faint I could hardly see it. Definitely much lighter than any of the three tests I took the previous day. The second test of the day, even fainter. Day three, completely negative. There are two explanations for this.

First, a chemical pregnancy is a fancy name for a really early miscarriage. Now, because tests are so sensitive, women can test before their period and get a pretty accurate result. And if women are trying to get pregnant, of course they will test early, like I did. But many pregnancies end in miscarriage. A chemical pregnancy is one that ends in miscarriage 5 weeks or earlier- before a gestational sac would have been big enough to be detectable on an ultrasound. The doctors just rely on detecting the chemicals to determine pregnancy. Many of these miscarriages are just about the same time or a few days later than a period would be, so many of these women wouldn't have even known that they were pregnant if they hadn't tested. In these cases, either the egg doesn't quite implant right, or it did implant, but no embryo started to grow and the mother's body figured it out pretty quickly and shed the empty sac immediately.

Sometimes false positives can happen. Usually, one gets false positives because of improper testing, or it was an expired test, or she had fertility treatment that included injecting hCG. I know those are not the case for me because I followed directions exactly, the tests were brand new, and I am not on medication that would turn a test positive. But sometimes it's possible for a test to turn positive even if the woman is not pregnant. These are very rare.

We can never know what actually happened with me since I didn't do an hCG blood test at the doctor's office, which would have been able to tell me how much of the pregnancy hormone was in my blood, if there was any at all. John likes to think that I had gotten false positives because he feels it's less sad. I like to think that I was pregnant and the baby didn't grow, so I had a chemical. That gives me hope knowing that the sperm can meet the egg, which was my number one worry. I'm actually relieved and celebrating the fact that there isn't a big road block preventing the sperm from reaching their destination.

I am a bit surprised at how well I am handling it. I'm disappointed, let down, and a bit sad, but not super depressed. I just had a feeling when I saw the positive test for the first time that this wasn't going to work. So when I saw the lines get slowly lighter, eventually turning back to negative until my (for lack of a better word) period started, it was just a confirmation that my impression was correct. I think it was God preparing me for what was going to happen.

I also don't even know if there was a baby at all. In miscarriages this early, a lot of times there is just an empty sac with no embryo. It's not as sad to me to lose an empty gestational sac, so that is how I have to think about this.

It was also easier because it was so early on. If I had gone on for a few weeks thinking I was pregnant, it would have been much harder. I would have let myself start to get excited, and probably would have started telling my close friends and family. I'm glad that it ended so early, at 4.5 weeks. Not long enough to really consider myself as being pregnant.

It might have also helped that I have gone through something like this before, and saw how I survived and that everything has turned out to be okay. Different, deviated from the plan, but okay. The world didn't fall apart, the sun still rises every morning, and other good things in my life continued to happen. I guess I can say I have officially accepted my disease. Whether that's out of inner peace or just plain defeat, I don't know. But it helps me to survive.

Well, 24th try, here we come.

Moved

The move is over. Whew! And a bit of good news- I think I actually ovulated without Clomid this month! I didn't do OPKs to be sure, but I had my tell tale ovulation symptom. It went away already, so I'm not sure if I got pregnant, but we'll have to see.

I just found out that another one of my friends had a miscarriage. My heart aches so much for them. I had a hard time not crying when I heard. I don't wish that pain on anyone. One thing that I am grateful for after all my experience is that I can help others when they are going through the same thing.

One Line

No two lines for me this time. Maybe the 23rd time is the charm?

We will be moving to another state in about two and a half weeks. It will be a miserable move, being stuck in the tiny cabin of a moving truck unable to go faster than 65 MPH with two cats who are mortal enemies. So, we have decided to wait to take Clomid until after the move. August will just be to exhausting and stressful.

Triggers

The familiar ache that sometimes happens in my gut and chest was happening again tonight. That ache that tells me that something is missing. I don't know what triggered it. I know my triggers. It happens when I'm surprised with things like hearing about friends' babies or seeing pictures on Facebook, hearing another pregnancy announcement, seeing my Pinterest page completely full of someone adding ideas to their "nursery and baby" boards, and pretty much just being at church... But I didn't come across any of them today. It's also a weird time, since it's not at the end of another unsuccessful cycle. That is when I am most sensitive. I'm pretty good at handling things the rest of the month now, which has come after a lot of practice and time.

I know people have gotten offended when I have mentioned that I'm sensitive about these kind of things before. When I say, "I need to leave church early today, I'm sorry," or "I wish you the best with your baby shower, but I regret to say that I cannot attend," I have had some pretty offended and non-understanding reactions.

Once, on my personal blog a long time ago, I went through a brief crisis and wrote about how I was having a hard time because I had had a really bad day and had several triggers all at once. I wrote about my feelings and how I was hurting, and wrote that I was annoyed at how much oversharing occurs on Facebook. I did not blame or condemn other people for making me feel that way, and actually admitted that I was being sensitive. I said that while people are free to do as they wish, I still didn't understand why people turn their Facebook pages into shrines about their babies. Someone, who decided to write it as "anonymous" so I wouldn't know who it was, wrote a very harsh reply, chastising me for my feelings, and saying that I had no right to feel that way or say those things about mothers. They said that once I was a mom that I would feel completely different and understand, and do the same exact things, basically telling me that I would eat my own words later.

After I read that comment I swiftly deleted it, then proceeded to cry for a while. Why is it that, in general, infertile women and men are not shown much sympathy and caring? When people hear that a woman cannot conceive a child, careless and insensitive things are said to her. When I am having a hard day and feel a lot of emotion at once, my feelings get brushed off, and I'm told that I just need to "get over it." Infertility is defined as a disease- a real medical issue. I didn't choose this any more than someone would choose to have any other disease. Would you tell a visibly sick person to just "get over it"? When I had my miscarriage, the most common thing people said was, "Oh, well, you'll get pregnant again later," in a flippant way. I just lost my child. My baby died. Would you say, "Well, your mom will just get remarried and you'll have a father again later," to someone who's father had just passed away? 

People are just not aware and educated about infertility and how it can affect a person. They just don't know what to say, or what to do to help. I hope I'm doing my part in educating you, my family, friends, and strangers. Be a support. Be understanding. When in doubt, just ask. "What can I do for you?" "What do you need?" And the best thing to say, "This really sucks. I can see it's really hard for you." Just lend some validation and lots of hugs. Please don't offer unsolicited advice, please don't tell me a story you heard once about a women who was infertile and did something that got her pregnant, so it's sure to work for me, too- I have a plan made up with my doctor that I need to follow, and please don't tell me that I'm just stressed and need to relax, and then I'll get pregnant. It's no more helpful than telling a person with cancer that if they just relax, they'll be healed. 


I appreciate the love that I have received from those in my life. There have been times when I felt the comfort I needed, and those times stick out in my mind almost daily. 


I have reworded this post many times, and can't get it to the point where I don't feel like I'm being harsh or lecturing. If you feel that way after reading this, I'm sorry. It was not my intention at all. I really just needed a place to express how I'm feeling, and was trying to help others to know what I need when I'm feeling down. Anyway, I want to end this post with a little bit of dark humor. I found this video very amusing, probably because I have heard at least half of these things from people. I feel that laughing and finding humor in things helps a lot. 

OPKs

On all three Clomid cycles, I saw a positive OPK (ovulation predictor kit) at cycle day 15, meaning that ovulation would come approximately 24-48 hours later.

With this being a natural cycle, I had no idea if I would ovulate or not. Since I don't think I ovulated at all before the Clomid, I wouldn't have been surprised if this cycle was the same.

But, I was testing, hoping to see a positive the last few days or so, and today, on cycle day 15, I got it!

Being able to tell if an OPK is positive or not can be really tricky. With HCG, or pregnancy tests, just the presence of a second line indicates a positive. With OPKs, there is always a second line, the test line, and it has to be as dark or darker than the control line. You could see where the confusion would come in.

Luckily, some smart person invented a digital OPK to make it simple.

If there is a smiley face, it's positive! I have to get the simple ones, because I would make myself go crazy having to judge the lines myself. I do get some practice, though, because there is a stick that you can use to still see the lines with the digital tests. (You can't do this with digital pregnancy tests! There will always be a second line with those, even if it's negative). So I know what a smiley face line looks like:

The first line is the test line, and the second is the control.

Well, I hope I helped educate on OPKs a little bit!

Something to Look Forward To

John and I have decided that we are going to take a trip to Disneyland in October if I'm not pregnant by that time. It makes it so much easier to accept bad news if there is something happy to look forward to. Now, I can be happy either way- either pregnant or spending a few days in the Happiest Place on Earth.

We had wanted to take a trip to Disneyland in April, but it didn't end up working out. I think that October is the perfect time to go. When I used to live in Southern California, we would take trips every once in a while, and October was our favorite time to go.

We don't have a specific day picked out to go, so by estimation, I only have about 80 days to wait!

I've been testing with an OPK the last few days, and they have all been very negative. I'm hoping to see a positive in the next few days. I don't know if I will ovulate, since this is my natural cycle. So, we'll just have to see!

A Plan

I visited with my OB/GYN this morning to go over my test and talk about what we want to do next. She agreed with the radiologist that the left tube is blocked, and couldn't tell if the contrast dye was able to push it open or not. So, we'll just go with it being blocked for now, and be pleasantly surprised if it's open later (I anticipate needing to do more HSGs in the future).

As far as what to do next, we discussed options, and decided to not go to a reproductive endocrinologist (RE) yet. She said that if/when I go see one, they will do a lot of monitoring with ultrasound to track my whole cycle. The only thing I can see when I think about doing that is watching money I don't have fly out of my pocket.

What we all felt was better was to do a few more rounds of Clomid. What surprised me was that she prescribed six more cycles, putting me at a total of nine, if I need to take them all. I had read that it's not the best to take more than six cycles close together. But, she's the doctor, so I will follow what she says. Plus, I'm taking a one month break between, so it's three months on, one off, and six on. But, hopefully, I will not have to end up taking all of it! I'm just not going to worry about it now, and then decide later if I want to take it all. I can also take more breaks between those cycles. I'd probably end up doing that.

So, if I still find myself barren at the end of this natural cycle, I'm back onto the Clomid.

Results

I had my HSG this afternoon. What a terrible experience! They all lied to me. It was just miserable because it was so painful. The worst part was when the radiologist injected all of the dye. It was the worst cramps I've ever had times 100, plus nausea. I feel better now, two hours later, but it was really hard to take at the time.

I haven't heard from my OB/GYN yet, but the radiologist told me that the right tube is open really well, and the left is clogged. A tiny bit of dye was let in, but it's not completely open. Hopefully the dye getting in there will help with that bit of junk and get it out of the way. So, since the right is open, they probably won't do anything to fix it. I'm really relieved that I don't need to go into surgery or depend on IVF right away. I will know more about what to do next when I talk to my doctor.

John was lovely and held my hand the whole time during the test, then stopped to get me an ice cream cone and a Coke on the way home. I was so glad that he was there with me! 
I dread the day that I have to get this test done again. 

The Next Step

On Friday I will be going back to the doctor for a Hysterosalpingogram, or HSG. It's a test where they inject dye into the uterus and then take x-rays so they can see my uterus, fallopian tubes, and uterine lining, and get an idea if there is a problem or not. It's not supposed to be too painful. They recommend that you take 600 mg of ibuprofin an hour before going in, and they don't need to use anesthetic. My friends in my support group told me that they were crampy and sore for a while after, so plan to have someone else drive and rest in bed for the evening.

I'm excited but nervous for the test. I want to know if there is something that they can diagnose so I have some closure, and know what I need to do next.

At the same time, I don't want both of my tubes to be blocked. If just one is blocked, they won't do anything to fix it. For both tubes, there is surgery available, but I hope I don't have to take that route. That's a solution that not many doctors recommend nowadays. Most just push you toward IVF instead. Depending on the problem and which type of surgery I would need, I think I would rather look into surgery first, since it would be cheaper.

But hopefully, I can finally have some answers. Plus, when the dye is flushed out,  it can sometimes open up the tubes and can get rid of some build up that may be causing some problems. So the test itself may actually help me.

Progressing in Circles

Welcome to those who have chosen to come visit from my regular, personal blog. And welcome to those who are here to just read and experience our journey with us.

I chose the title "Progressing in Circles" because I could not think of a better description for what has happened in our journey. Every time we feel like we are doing something proactive, every time we feel like we are one step closer, we always end up starting back on square one, where we began two and a half years ago. And yet, we are progressing in other ways- emotionally and spiritually. We are progressing in areas of our life while still never reaching the end of the road. Hence, we are progressing while going in circles.

I would prefer to not give out a lot of personal information, in case I decide to share this blog with strangers or long-distance friends. But I will use our first names to keep it personal.

I'm Allie, and my husband John and I married in June 2009. We began trying to have children earlier than we had planned- we are believers in God, and felt like He was prompting us very strongly to start trying to have children. Neither of us felt like we were ready for kids, but we did not ignore the prompting. Looking back, I'm glad we followed it, because now I know it was so we  could start this arduous process sooner rather than later and have more time on my clock. So in February 2010, I went off the pill and our journey began.

Six months later, I took a pregnancy test, and it came up positive. Even though we had no idea how we were going to care for this baby, we were beyond ecstatic to begin our family. We knew that we had family members who would help, and we are both hard workers who would contribute and raise this child no matter what.

A few weeks later, on September 7, 2010, I had a miscarriage. I was seven weeks along, and it was the most heartbreaking experience we have ever endured. I already had so much love for our baby, and I could not believe that he or she was gone. It took a long time to recover from it, and I'm still not fully healed from it. We were back to square one.

We were able to begin trying again in January 2011 when my mensus started up again. But I immediately knew that something was wrong. I had had regular, exact 30 day cycles since the first month they began when I was 15 years old. But now, my cycles would vary anywhere between 40-65 days long, and I wasn't sure if I was even ovulating at all. I went to my doctor, and she did some tests on both me and John, and didn't find anything wrong, so she prescribed birth control to try to regulate the cycles. I took it for three months the fall of 2011. When I got to come off of it just in time to hope for a Christmas miracle, I discovered that it hadn't worked and my cycles were still as wonky as before. I had no idea what was going on with my body, and I was disappointed that the birth control wasn't able to fix it. Back to square one.

I changed doctors after that to get better patient care. In March 2012, this OB/GYN had a long talk with me, reviewed my tests, and decided to put me on Clomid for the next three months. Finally, I felt like I was truly being proactive in my treatment, and I knew that this would work. April passed, May passed, and then June was over without any success. Back to square one.

So, here we are. We are living life day to day at square one, finding other things to focus on and do, but this is still a constant worry in the back of my mind. We have a long road ahead of us. I just hope that we can finish our final circle, our final lap in this seemingly endless marathon, soon.