Infertility Fatigue Syndrome

29 August 2010

Ever felt like you were going crazy? Maybe you are suffering from Infertility Fatigue Syndrome? That's my new self diagnosis. Here's a proposal for the next Diagnostic and Statistical Manual revision:

Infertility Fatigue Syndrome
Symptoms of IFS include a chronic intense sadness and fear coupled with episodes of hope and optimism. The symptoms are generally progressive over time and are cyclical in nature typically following a predictable 28 day cycle, however there may be some hormonal variability especially when fertility medication is being used. Although it shares elements with other diagnoses, IFS is complex and must be distinguished from generalized anxiety, situational depression, or obsessive compulsive disorder. It also manifests itself differently in the male vs. the female. Obsessive behaviour is very common feature in female patients. They may repetitively check their toilet paper for cervical mucous, purchase copious numbers of home pregnancy tests, and be found lurking on internet forums. Males may become dissociated and lose interest in sexual activity. Interestingly, while the difficulty becoming pregnant is the root source of the distress, IFS may persist beyond its original origin, into pregnancy or parenthood that follows.


It's time to truly take a break and get recharged. The 6 day kayak trip we have planned this week should do wonders for that. True to the diagnosis, I'll be obsessively checking in again when I get back next week.

Real Therapy

28 August 2010

Yesterday was another landmark day. My IVF protocol arrived in the morning, so it was great to have the plan ready to start after this month's break. One surprise was that the Dr. is recommending ICSI, even though the sperm appear fine, because we don't have a reasonable explanation of why the IUI's didn't work. The RE is placing us squarely back into the unexplained category -Darn! Hubs was a bit taken aback at first, but after talking through it and reading the materials we agreed that it just makes sense. He didn't care for the part where the sperm tails get chopped off, but after reading about what I would be going through he figured he could handle that. If you're going to go as far as IVF, why not take advantage of the full meal deal. I'm not likely to produce a plethora of eggs, so we might as well try to increase the fertilization rates.

The counseling session with the skilled fertility therapist, helped immensely. I feel better than I have felt for a long while. The therapist understood all of the medical lingo and what it all means, and what the experience of this is like. A number of times she told me that even though it feels like I'm coming apart at the seams, she thinks I have excellent coping strategies in place and thought I'd done well to get this far. You ivf.ca ladies (and Rick) can pat yourselves on the back for that one. Thank you blog.

One interesting thing about balancing work and IF that she pointed out was that they used to recommend women with IF avoid triggers such as infants and pregnant women, the newer studies show that women who don't/can't avoid these triggers actually fair better in the long run with resolving IF after they stop treatment or become pregnant. On the other hand she said there was no need to be a martyr and that after an upsetting test result or stressful procedure taking a bit of time from work was not a bad idea.

She really thought that in many ways the IVF might be less stressful than the back to back IUI's with injectables that we've been through. Ha! I'd always heard people say the opposite, but I can see where she's coming from with that one. She thought we could do some work with my anxiety, to help cope with the upcoming IVF cycle. The next appointment is in a couple if weeks and I'm already looking forward to it. Honestly it was the best $100 I've spent.

After the therapy session I met with another patient from my clinic who is on a parallel path. Hubs had already had enough uterus talk, so he left us to our tea and it was like I blinked and two hours went by.

So now it's time to put this stuff away for a while. We're taking this week off to do a kayak trip, and have a real rest before IVF is on the doorstep. I feel like I can let is go now for a couple of weeks. Wine and coffee are back in my life for a short while. Ahhh....

In Vivo Therapy

27 August 2010

After getting the news of my last treatment failing, and knowing I need to have the emotional strength to get through this upcoming IVF cycle, I decided it was time to access a therapist skilled in fertility related issues. Earlier this week, I set up an appointment with the counselor associated with my clinic. I chose this person on the recommendation of other fertility clinic patients who have found the sessions very helpful. For me it is worth driving to another city, and paying out of pocket for someone who truly understands and has experience with infertility.

Last night I called my employee assistance plan that I have through work to check to see if this counselor was on their list, and perhaps some assistance with paying for her services. Long shot, I know, but I needed to check it out as every penny counts. My phone call went something like this:

Hello, I am wanting to access some counseling and was wondering if you could tell me if this counselor is on your list of providers?
Alright, we just need to run through a few questions before we can match you with an appropriate provider.
Name, company plan number, blah, blah, blah.
Alright someone will call you back within a couple of days to match you with a counselor in your area.
Wait, I don’t want a counselor in my area, my clinic has recommended this specific person and I’d just like to know if she is on your list. Yes or No?
Alright, you seem stressed, I’ll see if one of our telephone counselors can call you back tonight.

Telephone counselor person calls back an hour later.
Hello, I understand you are needing some counseling?
Yes, I was referred to this specific counselor, and was just wanting to know if she was on your list?
OK, I’ll need a bit more information from you before I can tell you.
What is the reason you are seeking counseling?
I’ve been struggling with infertility for a couple of years and just found out that I need to do IVF.
IV what?
IVF = in vitro fertilization
Oh, so you are pregnant?
No (in a exasperated tone), I am not, that is why I will be doing IVF.
Is this infertility a permanent condition?
I really hope not (nearly breaking into tears).
Alright, the provider that you requested is not listed with us, let me see I can get you in with a counselor in your area for early next week, or if you prefer, I am a counselor and we can talk on the phone now about your concerns.
No thanks, I would prefer to see this specific person because she specializes in this particular area, and understands it.
But you will have to pay out of pocket for her services and with our counseling it will be no charge to you.
That’s fine. The IVF is already costing us $10, 000 so $150 for a counseling session is peanuts in comparison.
Oh my, I’m sorry we couldn’t be of more help. Good luck with the “In Vivo”
Thank you, good bye.

Ha! After that phone conversation I now need therapy more than ever. Hubs and I meet with the therapist this afternoon. The timing couldn't be better.

Birthdays

25 August 2010

Birthdays take on a new meaning as we get older. Remember when you were a kid and the biggest, most important day of the entire year was your birthday? You'd plan your party well ahead of time, invite friends, and rip open your gifts. Everyone would ask if you feel older than you did the day before and you'd tell them, "no, don't be silly".

Fast forward to adulthood and nobody asks that question anymore, but when you ask yourself you could almost feel that biological clock clicking past another notch during last night's sleep.

Age is such a factor with fertility treatments. Adding that one additional number on, feels like the odds just decreased again overnight. Yikes! I just spent my entire 32nd year doing some test, procedure, or treatment related to TTC. All the while the doctors kept telling me I was young and we had time on our side. Today I am another whole year older, and still no closer to having a baby. I am no longer being told that time is on my side. In fact, it's the opposite, we're under a time crunch. I might be young by fertility standards, but my FSH levels don't agree. A predicament to say the least.

With age comes wisdom though. I can honestly say that I'm feeling much wiser than I did on my last birthday. I think of how much I have learned about myself, my husband and my doctors in this process.

So, if 31 was the year of trying, and 32 was the year of tests and treatments, please please please let 33 be the year for an IVF pregnancy. A great birthday gift would be to hear back from the clinic today regarding my protocol, oh and maybe a big birthday cheque will fall from the sky also!

3 Strikes and You're Out

20 August 2010

Progesterone can sure play with your head. After a full 2 weeks and no sign of Aunt Flo whatsoever, I'd almost convinced myself that this could maybe be it. I trucked off to the lab early this morning and waded through the line up with all the seniors to have my beta done. Then it was straight to work visiting other people's babies. This afternoon, I came home a little early from work to wait for the results. When the call came the receptionist sounded really cheery. Then she delivered the news of the lab report:

Serum Pregnancy Test

NEGATIVE Non pregnant female < 5 IU/L



She asked how many IUI's this was. When I told her three, she said that Dr. H was really busy, but would review my file sometime next week but he'd probably recommend trying IVF next. Ok, I knew that was the plan but it still hurts to hear the reality of it. Sigh...

I have a grocery list of questions to ask, but right now I'm too sad to really process anything anyway. For now, I'll let this sink in and go from there. Hubs and I decided that we are going to take the next month off just to be. No injections, no tests, no appointments. We've got some major financial sorting out to do.

Thank you to all my cheerleaders here for all of your kind words of support. It's just not my time yet I guess. Maybe someday it will be. I really don't know anymore.

Yo Yo

18 August 2010

Ok, I know about the roller coaster ride, but now I think I've caught a lift on a yo yo. Now instead of ups and downs in two week intervals, it's happening hourly or even by the minute. Oh, I'm sure that breast tenderness is a good sign, but wait SD you are taking progesterone. No spotting yet, ok it's only 12 days since ovulation. Maybe that twinge is something implanting, oh yeah that would have happened last week.

Loop de loop, walk the dog, oh boy, here we go on the down swing again. Here comes IVF. Maybe I'll never be pregnant? The RE is really positive about our chances though. Ug. The beta wait continues.

The Beta

16 August 2010

My beta for this 3rd and final IUI cycle is coming up on Friday. I think I am the anomaly in the crowd of TTC women in feeling like I don’t want this day to come so soon. If I could I’d just hold it off for a few more weeks I’d be happy. I have no desire to pee on a stick, I never have. In fact, I think I can count on one hand the number of times I’ve taken an HPT in the past 2 years. No, I don’t have incredible self restraint, I’m actually a just big chicken.

The very first cycle we tried, I used the test my GP’s office gave me when I had my preconception check. I was so sure that we’d hit it on the nail on the first go. My period started about an hour later. The next few cycles I bought the expensive First Response tests at $10 a pop. When I tested again, the same thing happened -pee on stick, period comes. Wait a minute, I want my money back -this product didn’t give me the desired results!

Then, the odd time when I’ve had an important Dr.’s appointment coming up, I took one just to rule out that I wasn’t pregnant before moving to the next phase of investigation/ treatment. That single line staring back was always harder to see than a bit of spotting, or that feeling gradually sneaking in that AF was on the doorstep. The first IUI cycle I took one the morning of my beta in an attempt to lessen the blow of the “I’m sorry” phone call. It really didn’t help. Last cycle AF beat me to the beta, but I still had to go get it done. Betas when you already have your period are just no fun at all, especially when the lab lady is giddy with excitement and you have to damper her down.

Most people say that the 2 week wait is the hardest part. No way, not for me. The first part of getting to ovulation is way more stressful. Once that is over, I can pretend to be pregnant and relax and coast for two whole weeks. There’s no poking, no trips to the clinic, no worrying about canceled cycles.

This time I am on progesterone, so it’s not likely that AF will arrive before Friday. Any early signs of pregnancy can be chalked up to the progesterone (breast tenderness, sleepiness). Someone asked me the other day if I've ever felt pregnant. My answer kind of shocked me. "Yes every cycle I think this could be it, but no, I don't know what it feels like to be pregnant, so I'm not sure."

Now I’m wondering if I will even be able to drag myself off to the lab on Friday morning. There is so much hinging on this result, I just want to crawl under a rock and hide from it. I could bring my progesterone (I have 12 weeks of refills) to ward off Aunt Flo and just be happy there in blissful ignorance. Maybe I'd emerge pregnant and be pleasantly surprised?

So, I wait and waffle between bracing myself for bad news, and feeling hopeful that it’s good news this time instead. I brace for bad news because after so many Dr’s telling me that we have a really good chance after procedure X,Y, or Z only to have them end in yet another negative. I almost can’t imagine it being any different. Of course I hope for good news and imagine how amazing that must feel.

So, Friday it's either a postive or on to IVF. Yikes! That rock is looking very comfortable right now.

Status Updates

13 August 2010

I have a love-hate relationship with Facebook. I haven’t really posted much on Facebook for a while. Maybe that is because I’ve hidden all my “friends” who are pregnant, or new mommies. That doesn’t leave many people. Facebook always feels like a big facade anyway. It’s like elementary school show and tell (aka bring and brag). Many of the people on there are from my school days, so maybe that’s why it feels that way. Instead of their new bright red fire truck they thought was the bees knees at age 8, they now show off about their wonderful baby making abilities. However people don’t need/ want to know about the status of my uterus and our struggles to try to compete in this department. I’ve officially run out of vague, meaningless things to put in a status update there. You can only talk about the weather so much.

On ivf.ca, people get it. I feel like I can post what I’m really thinking/feeling and it’s OK. I just have to make sure I don’t get mixed up with where I’m posting. Could you imagine some of the things we put on this site ending up accidentally in a FB status?!?!?

“off for my daily wanding with the RE”
“kudos to me, I just inserted my first progesterone tablet intravaginally”
“spotting again, I think AF is around the corner, argh”
“Hubbie’s sample today was 50 million post wash -nice work boys”

Feel free to add your own TMI status update.

Swallow This One!

09 August 2010

Oral progesterone capsules taken intravaginally. Hmmmm..... The RE warned me that the local pharmacy might not be familiar with this.

So, I wasn't too surprised when I dropped the prescription off to be filled that the pharmacist did a double take. He asked if I had used this medication before and then went to consult with his partner in crime behind the counter. I watched as two puzzled men tried to figure this one out. "Huh? Larry, I’ve never seen this before. Are you sure this is right? Maybe we should call the Dr.’s office to double check?" I couldn't bear to let this go any further so I piped in "Yes, the Dr. wants the oral Prometrium, it’s not a typo." I was hoping I didn’t need to give any further explanation in the busy drug store. They asked me to come back in 15 minutes or so.

While I waited for my prescription to be filled, I picked up a few groceries and began imagining the possible directions they might put on the label:

• Swallow two capsules by vagina twice daily for two weeks.
• Take with a full glass of water on an empty vagina.
• This medication may stain underwear, panty liner use is strongly advised.

Saddle up!

07 August 2010

Who knew I would spend so much time in the stirrups this past year? I've lost track between all of my ObGyn and RE visits, but I'm sure I'm practically a jockey now. At least I've mastered the art of mounting and dismounting with no pants.

Yesterday between sperm and egg appointments for the IUI, Hubs and I went for a walk on one of the trails near the clinic. We saw two women riding horses there, and Hubs made a comment about me getting in the stirrups soon too. Except my horse has a green faux leather coat and a paper liner strip down the middle. Handsome in it's own right but it ain't no pretty palomino.

My TTC horse seems to really like the scenic route on this journey. I'm not quite sure at this point who is taking who for a ride. I guess it's still better than walking.

Anyway, when we got back to the clinic the nurse showed me to the gyn table, and said "you've done this before, you know the drill". I blurted out "Yep, saddle up". She nearly fell over laughing. You really have to inject a little fun into this sometimes.

Multiple Musings

06 August 2010

I feel like I have an expanding balloon in my abdomen, and that's with 4 follicles from controlled hyperstimulation for IUI. I can only imagine what it must be like to have 20 + eggs for IVF -hats off to you ladies. It is quite uncomfortable and I'll be glad to have today's 3rd and final IUI over with. At least I know there is something going on in there. I triggered 24 hours ago, so my foursome should be letting loose any moment.

Dr. H is very positive about this cycle, but keeps reminding us of the higher risk of multiples. Ahhh... I can't believe I'm the girl doing an IUI with 4 equally mature follicles. I'm praying for one to take, OK with two, and terrified of the thought of 3 or 4. Reality check, a singleton would be beating the odds, and more than that would be up there with the odds of being struck by lightening. I have to push that thought of triplets/quads to the back of my mind, and jump in with both feet. Here we go. Wish me luck, but not too much luck!

Four!

04 August 2010

It's 4am on August 4th and I can't sleep, so I might as well catch up on my blog entries.

During yesterday’s monitoring ultrasound the RE announced "FOUR", and I immediately thought of heading for cover from a stray golf ball that might fall from the sky. No, this wasn't an off hit, there were 4 lovely follicles in there -a pair on each ovary. Unlike last time, all 4 are roughly the same size (13-14 mm) and should be reaching the finish line all together in a very tight pack.

The Dr. was very pleased with this response, but did warn us that we were getting into the higher risk for multiples with this scenario. It's funny because a couple of months ago, I would have considered canceling with 4, and now I'm more relaxed about it. The look on Hubbie's face was priceless! He admitted later that he is secretly hoping for twins. I still think we'd be super lucky to get a singleton. We'll see...

The instructions were to do one more injection of Gonal F on Tuesday, bloodwork to check E2 and LH levels on Wednesday, then trigger at 7am on Thursday, and go back for the IUI on Friday. This time we're adding in progesterone tablets taken intravaginally starting 4 days post-IUI.

Four seems to be the theme this month. Hmmm... Golf is such a slow game. We're keeping our fingers crossed for we're nearing the 18th hole and for a hole in one this time. We don't need 4 of them, one will be just great, thanks!

Mother-Daughter Bonding

01 August 2010

A while back Hubs was not able to go to one of my fertility clinic appointments, and my mom offered to come along with me. I have to say it was the ultimate mother daughter bonding experience. It went something like this:

Mom, I’d like to introduce you to Dr. H, the man who will get me pregnant. And you thought it would be your son in law, nope just his sperm. The real action will be in the hands of this man. He’s got a great track record with hundreds of women before me becoming pregnant from his actions.

Yes, the clinic is private, and we are paying for the services we receive there... yes, we are still in Canada. And yes, that single needle just cost me $500.

Dr. H ultimately calls the shots in the bedroom, advising us on what days to have & not have intercourse. Yes mom, I know you don’t like to think about it but I am not a virgin anymore.

They get close up views of the inside of me with this fancy ultrasound. Yes, that wand goes in there, mom. No, it doesn’t hurt. Ha, and you thought you’d just sit back and watch. Nope, he wants to question you about your pregnancies and menopause too.

On the drive home we got talking about how much has changed in one generation. In her prime childbearing years, in those days before the age of 30 when the pelvic bones would be said to “set” making delivery more difficult, she never gave much thought about getting pregnant. It just sort of happened. There was not much to speak of in terms of prenatal care, no ultrasounds, no tests to be run. She said she remembered only wondering if she was carrying a boy or a girl. It would have never crossed her mind that there might be a complication. Dad was allowed into the delivery room much to the chagrin of a few nurses disapproving of this new-age practice. As they left the hospital 5 days later (following a normal healthy vaginal delivery) the staff thought they were being overprotective new parents when they insisted on taking us home safely strapped into our carseats.

After having me and my brother in her twenties, she figured that would be it for children (remember the bone setting thing?). Then at 42 and perimenopausal, ooops there was a birth control failure and another surprise was in the works. That pregnancy was night and day different from her first two. She had an obstetrician following her closely, and opted for all of the testing including amniocentesis and one of the first ever CVS tests done at BC Women’s Hospital. She knew the gender of the baby long before giving birth (revolutionary at that time). She ultimately delivered by c-section and was discharged home after 3 days. The nurses scrubbed my dad in and gloved him up so he could participate in the birth. The carseat was mandatory and had to be checked prior to leaving the hospital.

I feel fortunate to have the relationship I do with my mom. I truly believe coming along with me has given her a better understanding of what this experience is like. Before this, I don’t think she could wrap her head around it at all. It really is quite mind blowing to think of how far reproductive technology has come in a few short years. It is only going to improve. In the future we will look back on how archaic it all seemed. I hope some day I will have the kind of relationship to support my own children through whatever challenges they may face.