Dealing With Day One

I do not dare to claim I am an expert on this.

It is my first day 1 since starting this blog, but I thought I'd pass along the things that have made it easier for me over time.

The caveat being- I think the primary thing that makes day 1 easier is time.  When you've had 15 months of the 2 week wait it becomes less surprising when day 1 rears its ugly head again.

Things that make day 1 less mopey and more la dee da:

1. Lowering your expectations

• If I assume each month that I will not get pregnant then getting pregnant at this point would feel like a 70 degree day in March (I live in Ohio people) or a run during which I do not want to die at some point (a month of running does not make me a runner)- something wonderful but so unexpected and fabulous that it would just feel awesome to get to experience.

2. Anticipating and preparing for what lies ahead

• Basal body temping has actually helped with this because I know that when my temperature goes back down 6-7 days after likely ovulation that I am probably not pregnant and can start to deal with those emotions before day one says "Sucka! Here I am again!"

3. Enjoying things you couldn't if you were pregnant

• A nice big glass of wine, a giant order of sushi, some soft unpasteurized possibly listeria laden cheese (goat is my favorite variety) can do marvels.

4. Finding an alternate outlet for your emotions

• My hubby thinks I intermittently find new obsessions and maybe I do but having a more positive focus can completely change your outlook.  Running, decorating my house- doing little crafty projects and planning our bathroom remodel, having a good meal with a good friend can put your mind somewhere else and for much longer than the distracting activity itself.

5. Allowing yourself to cry if you need to

• No matter how long it's been, no matter where you are in the process, it sucks to feel that disappointment again- in yourself, in your body, in god or whatever you believe is controlling this chaos we call life.  It sucks, plain n simple.

Day 1...
You sneaky little bastard...
I'd like to say goodbye to you for at least 9 months.

Take this as your notice.

The Elephants in the Room

Sometimes I feel like a social pariah.

I am that person that makes you feel awkward with my honesty.

I don't hide my secrets to make you feel more comfortable.  I don't mind that you know I am possibly a little insane.

I think it's mainly other people's issue that I have so many elephants in the room.  Their discomfort with real life and its occasional downright shittiness is not my problem.

Lately, I have told several people in my life that I am close to and not that close to varying degrees of information about our infertility struggle.  Typically, the not that close to people get a shorter version because they are saying something moronic and I would like to save them the embarrassment of taking their foot out of their mouth.

While I know infertility can be an awkward topic- you know it involves your uterus and his testicles and sex... gasp, it is such a big part of my life right now that it doesn't feel awkward for me.  Love, marriage, baby carriage- seems like pretty run of the mill stuff.  I just haven't figure out yet how to make other people feel more at ease.  I will make a comment or relate something that challenged my attempt at a positive outlook and its crickets.  I know people don't know what to say but they really don't have to say anything at all- just listen openly, avoid making me feel like a freak, and understand that it sucks.

For the past 3 years I have felt one elephant or another staring at me from across the room refusing to leave and take with it the heaviness in the air.  First my brother and now this.  My friend told me the other night that she has just recently felt like she was getting me back after my brother's death.  I think she is right in a way.  He passed away March 25, 2010 and at that time my life was fucking great.  That week was actually one of the best weeks of my life until the walls came crashing in. 

March 25th was a Thursday.  The Thursday prior I had found out my husband (boyfriend at the time) matched in his first choice program for residency which meant he would be in the same city that I would be in for the next 5 years (very relieving since I had matched 2 months earlier and we couldn't couples match).* On Tuesday we found our house and that night he proposed.  On Wednesday we made the offer on our house, it was accepted, and buying it was in the works.  On Thursday while cooking dinner we got the call that my brother was missing and while driving to my parents house got the second call that he was dead.

I honestly thought life could not get any better and then was bitch slapped by reality for being so damn naïve.

Since then I have struggled with how/when to tell people about my brother and answers to simple questions like "How many siblings do you have?" I will always say 2, "I have 2 brothers," because I do but now I don't.  It's hard when you are just getting to know someone and they ask you that question and you answer and follow it up with "But one of my brother's passed away a month ago, a year ago, not too long ago" ect. and you can feel this tension rise between you.  I am not telling you my brother died for sympathy.  I do not want your sorrow.  I am just answering your question.  3 years ago, today, 30 years from now I will always have 2 brothers.

Obviously everyone handles death and grief in a different way but for me I want people to know him.  I want people to know that mental illness is common and awful and treatable and breaks your heart.  There are times I wish he died of cancer because when someone's follow-up question in the above conversation is "What happened? or How did he die?" I answer he committed suicide and that thickness in the air becomes stifling.  There is such fear and misunderstanding and judgment riding on that word.  When you say cancer there is just sadness, sadness and injustice. 

I do not mean to imply that losing a loved one to cancer or to any other cause is somehow easier than suicide.  It is not.  It is just different.

Just as I was starting to feel I had butted that old elephant out of the room.  Or at least started to learn how to ease the tension.


Infertility is the new elephant in the room.










*For those unfamiliar- being a doctor is a lot more challenging on your personal life than many people realize. Between med school and residency you pretty much give up your 20s (for me this will span age 22-31).  In your last year of medical school you must decide on your medical specialty and then go through an arduous application and interview process culminating in a match- meaning you rank programs and they rank you and a magical computer system matches you up and tells you where you will spend the next 3-7 years of your life.  That's right-you do not decide, not directly at least.  If you happen to choose a few particular programs that are in a different match system you are not able to do a couples match.  For a couples match you can submit your own and your significant other's rank lists together with the goal to match you in the same city even if it means one of you will end up at a program you ranked lower in order to be together.

Basal Body Temping

I have started trying to track basal body temperature this month for the first time.  I had avoided doing this in the past because it felt like it would be just one more daily reminder of our infertility and add to my stress/anxiety.

I think the amount of time this has now been going on and starting this blog have both helped me to not feel that way.

I also didn't jump on board to chart BBT because of all the things that may be the underlying cause of our unexplained infertility having enough sex/sex timed around the likely time of ovulation is not one of them.  When you have sex every day to every other day you shouldn't be missing your window of opportunity.

That being said, with the plan to start Clomid in August I felt like it wouldn't hurt to get a better idea of when I'm ovulating to give Clomid all we've got and hopefully avoid the need for further infertility treatment. 

That still doesn't mean that I always remember!  It's hard to wake up to my alarm which always feels too early and try to not move much and reach over to grab the thermometer. 

I did some reading about BBT on BabyCenter and other websites and on the thermometer insert.  Here is what I gathered:
-Before ovulation your basal temperature should range 97.2-97.7
-About 12-24 hours after ovulation your temperature rises by 0.4-1 degrees and will remain elevated for at least 3 days, or until menstruation
-If you become pregnant it will remain elevated throughout the pregnancy
-Since the temperature elevation does not occur until after ovulation, it only helps you if you notice reliable patterns over time. Your most fertile days are the 2-3 days before the temperature rise.

www.clearblue.com

You can also use cervical mucus to help predict timing of ovulation but I've never really noticed this changing so I haven't put any effort into figuring that out.

This month my temping worked out pretty closely to what is listed above.  My cycles range 28-32 days and Days 1-14 my basal temperature ranged 97.2-97.6.  On day 15 it jumped to 98.05 and has remained in the low 98s to just below 98 range since then.  This should mean that I ovulated around day 13-14 which is a little surprising given my cycle is often closer to 32 days.

I guess I will just have to follow it the next few months and see if it helps.  My OB/Gyn told us to have sex every other day on days 8-18 of my cycle.  My hubby asked if that was at a minimum (cue my red face!).  She said, "No at a maximum" which really surprised both of us.

We are no good at following rules.



***Update:
I posted a little too early. My temperature remained elevated for 7 days then fell to 97.7 and continued to remain in the pre-ovulation range 97.2-97.6.  I began menstruating on Day 28 which fits with ovulating on day 13 or 14 since the luteal phase is typically fixed at 14 days.

Ambivalence... Well Yes... and No

The other best friend I mentioned in my last post is currently in town visiting her family and I was lucky enough to get to spend last night drinking wine and catching up with her. 

She is the only person I have admitted my big secret to:
Sometimes I have some ambivalence about getting pregnant.

I can't figure it out really.  I want to be pregnant so badly.  There are times I think about it all day and have a longing from my heart, from my whole being to carry a baby.  Times it physically hurts.  For months I cried each time my period came again.  I looked for any sign I could be pregnant- nausea, sore boobs... I mean there are times I am crazy.  Legit crazy.

Then there are days I think- Can we really do this? Will I be a good parent? How far am I willing to go?  Maybe it just isn't meant to be and we are pushing for something impossible with likely dire results? Is it worth the stress on our marriage infertility has already caused prior to even starting treatments? 

I don't know if this ambivalence is just another protective mechanism my subconscious is utilizing.  Like, hey I can be okay without having a child just to try to make this whole situation less shitty and downright awful.

And I worry if I'm not all in, if we're not all in, should we really be trying to have a baby at all?

My BFF's Baybee

This morning my very best friend in the world had a BAYBEE!!!

We have been friends since freshman year of high school, since we were 14 years old, for more than half our life time now.  We bonded over her scumbag cheater boyfriend- I may have a predilection to hold a grudge- I can fake a smile but still secretly hate him the occasional time every year or two that I have to see him at the wedding of an unfortunate high school friend who possesses more forgiveness in their heart than I do or happens to like scumbags.  I digress, she is basically my sister from another mister... and mother.  I don't have any sisters of my own so I consider her mine which makes her baby my niece!

Anyway, we started trying to make babies around the same time (I think my hubby & I actually started a month or two earlier), so she probably knew something was up when month after month I didn't tell her I was pregnant but after finding out she was pregnant I was afraid to tell her I wasn't pregnant either.  It might sound crazy but I didn't want her to feel any guilt over being pregnant when I was not.  I didn't want it to be awkward. 

I didn't want her to worry that I felt anything other than happiness about her pregnancy.

But if I'm being honest, I did. 

I cried the night I found out she was pregnant.  No, not in front of her when she told me and no, not out of joy.  I cried for myself and my empty, empty uterus.  I had never felt such a juxtaposition of emotions.  Every ounce of me was so unbelievably happy for her and her husband who I also love.  At the same time every ounce of me was sad that I couldn't be sharing the same joy, that I couldn't be pregnant with her.  I don't like to admit that I was jealous but there was a part of me that was jealous- a small, fleeting part, mostly I was just sad.

After talking to one of my other very best friends (who is also a mutual friend from high school) about all this infertility business and starting the infertility evaluation and having my mini melt down over my "abnormal" vaginal ultrasound, I decided to tell her.  I haven't really told her about the part of me that felt sadness that night she told me she was pregnant but I think if I did she would understand.  She knows I love her and could not be more happy for her but she also knows I'm human- we lived together for 3 years- how could she not?

The thing was, she was amazing about it all.  We were just the same best friends- one a with a little more luck than the other. I don't know why I thought that would change or be in jeopardy.  And for most of the rest of her pregnancy I was just happy and excited for her.  I threw her a fabulous baby shower- drank a few too many glasses of wine afterward and felt a little sad for myself but other than that I was happy, happy, happy.

And today, when I got to meet her beautiful daughter, I was in awe- in awe of this amazing baby that my friends made and nourished for 9 months, in awe of her amazing strength to deliver her baby with a smile on her face and sleep through most of her labor (with Pitocin on board!), in awe of how beautiful she is (no cone head at all!), in awe that I get to be a part of this little one's life.

Let's Hear It For the Boy...

Let's hear it for my man...
Let's hear it for my baby...

Although the boys seem to get off easy with the infertility work-up, I have to admit that masturbating into a cup in a public place/clinic is not exactly my idea of a good time!  Luckily my hubby is committed to this process too and had his testing done, painful or not.

Cheers to him and us- his testing was normal too!

For the most part...

He had the WHO Semen Analysis done, not the Kruger.  The basic difference is that the Kruger test is more strict- it gives more detailed information about sperm morphology and predicts fertilization rates in vitro (in the test tube) and presumably in vivo ("in life" aka in the body).  I didn't really know to ask about which one he was getting done until afterward.  If he has to have it repeated at any time I will ask for the Kruger.  For a great overview on evaluation for infertility and treatment options I recommend this book.  Even with my medical background, we don't learn much about infertility and treatment in medical school and I thought this book provided some great information.

As far as his semen analysis, the volume, pH, concentration, motility, and morphology were all normal.  The only abnormality was his white blood cell count which should be <1 million/mL and his was 1.5.  This could potentially suggest that he had an infection of some sort- a epididymitis or prostatitis but without any symptoms that is pretty unlikely.  My OB/Gyn didn't know exactly what to make of it- if it was relevant to our infertility or not and recommended that my husband see a urologist.  The urologist was equally unimpressed and said that there is no clear evidence that this influences fertility unless it effects other sperm factors (aka motility, morphology which were normal), however since the rest of our work-up had been completely normal he recommended antibiotic treatment.  Ciprofloxacin for a month it is!

Since the rest of our work-up was normal our plan had been to start Clomid this month but not knowing if this could be affecting our fertility combined with the fact that our work schedules are completely opposite for the next 2 months we've decided to hold off for now.

So just waiting...

Grumble Grumble

Today at work I saw a young patient (>5 year younger than me) who was pregnant with twins and had a BMI of 72.

BMI = Body Mass Index

 

18.5-25 = Healthy

>30 = Obese

>35 = Morbidly obese

72 = Apparently healthy enough to get pregnant (with twins!)

 

These are the times I have to try not to get upset and discouraged.  I shouldn't feel any malice or jealousy toward this patient but it is hard not to think "then why can't I get pregnant." I am healthy (for the most part, BMI 21), my husband is pretty healthy, we have good stable jobs, we are educated, we have supportive families. Why not us?

Despite my poor work out habits I am in decent shape, but my hubby & I both decided we wanted to try to be more healthy so about a month ago we signed up to run a half marathon in January. We figured 7-8 months to train we can do that. 

 

We are running the Disney Half Marathon. I have never run more than 3 or 4 miles in my life so we'll see how this goes.  My goal isn't really to lose weight but to hopefully get into the best shape of my life.  I lost 4 pounds after our first 2 weeks of running!  My goal is to get killer runner's calves.  I may be slightly obsessed with some well defined gastrocs.

Anyone watch the MTV True Life where the guy gets calf implants?  That would totally be me- breast implants no thanks but I'd love me some huge calves. So I'm going to keep running out this aggravation/frustration hopefully into legs like those.

My Ute is a Beaut!

My OB/Gyn called me on Monday to confirm that the transvaginal ultrasound was abnormal and recommended a pelvic MRI to further evaluate. I scheduled the MRI for the next week on my day off.  Such a great way to spend the day off!

On the plus side, the imaging center at the hospital my OB/Gyn's office is associated with was super nice.  It had this nice locker room to change in and the MRI techs were super friendly.  I had to get an IV for contrast which I didn't anticipate. I looked like a pin cushion that month between day 3 blood work, day 21 blood work and the IV.  IVs kinda hurt- who knew?  I feel like this whole experience will make me a more empathetic physician. Being a patient, even when you're not really sick, it sucks. The radiology tech was asking me about myself while placing my IV and when I told her I was a medical resident she offered to make me a copy of the MRI images to take home. Score!

MRI itself was pretty uneventful.  Again, it is harder than I imagined to sit still for 45 minutes.  I'm pretty sure I had some myoclonus at the end after trying so hard to stay still for so long. I brought home the disc of my uterus which my husband and I looked at- ha! I look at brain imaging all the time but pelvic imaging was a whole new beast.  I couldn't exactly tell what I was looking at and googled a bunch of normal and abnormal (septate and bicornate) uteri for comparison. 

 My actual uterus

 

Looked more like the normal ones to the hubby & I but we waited to hear back from my Ob/Gyn.

A different view, labeled for your viewing pleasure

 

Turns out, My Ute is a Beaut! Normal, A OK, Ripe for baby makin!

The Beginning, The Vag Cam & Why I'm A Terrible Patient

Over our vacation this past March, my hubby and I went to see my OB/Gyn to start the infertility discussion (I know we are so cool and adventurous!). Technically we weren't "infertile" yet- as in I had 1 more month at that point until we had been trying for 1 year without success and I love my OB/Gyn (she is young and deals with my crazy quite well) and she recommended we start getting testing done- lab work up, transvaginal ultrasound, and semen analysis BUT she overall didn't seem too concerned. She told me she doesn't see too many 28 year olds that are infertile.  I am a lucky one- YIPEE!

So we proceeded with testing for me- blood work Day 3-LH, FSH, TSH, estradriol, and prolactin (help determine ovarian reserve, look for PCOS or a prolactinoma) and Day 21- Progesterone (to determine if I ovulated)- which all looked A okay! Yay! Then in between the blood work (Day 7), I had my first and I'm still hoping last interaction with the vag cam.  I know I'm a doc and all and so maybe that should make me comfortable with all these awkward medical procedures but I am a much better doctor than patient.  First of all, I am nosy and made the mistake of telling the ultrasound tech that I was a doctor and to please tell me what she was seeing/if she saw anything concerning and second of all, it's odd being a doctor and patient (aka knowing enough to be dangerous/worry like a maniac while simultaneously feeling that you shouldn't ask too many questions because you should know the answers/you don't want to be that pain in the ass patient). Anyway, so there I am with a large phallic shaped probe in my vagina with the tech telling me your right ovary looks good, there is a small cyst on your left ovary but that's normal at this time in your cycle then dead silence... and more silence... and more silence. So finally I muster up the courage to say, "So you're looking at my uterus now...?" She responds, "Well, something just doesn't look quite right." Then points to the screen.  "Something is just not right here- It's either a septate or a bicornuate uterus."  I really thought I was gonna lose it right there, vag cam still in place.  My eyes were welling up and I was trying ridiculously hard not to break down there in front of the tech like the weirdo I am. In life's awesomeness it was Friday afternoon so I knew I'd be stuck with my worry all weekend until I heard from my OB and in other goodness my husband was on call that night so I would be alone with it too.

I called my husband from the parking lot basically hysterical and he being as wonderful as he is told me to drive back to the hospital. He met me outside, sat in my car with me, calmed me down for a while. The problem is I'm a pediatrician and so I know what a misshapen uterus can mean- difficulty getting pregnant but more commonly premature delivery.  We had already discussed that we didn't know how much risk we wanted to take on if we had to pursue more invasive fertility treatments (ie IVF) and this just made me feel like any of those options were off the table.  While I wanted to have our baby, I didn't want to have the risk of extreme prematurity which brings a myriad of life long problems.  We talked about surrogacy.  That's where I was in that moment.  I know it probably sounds crazy but I see the worst of the worst outcomes from infertility treatments (after working 3 months in the neonatal intensive care unit) and I just don't think I'd be willing to take on the added risk.  Can you tell my type A personality is always thinking three steps ahead?  I pulled it together enough to drive home and then texted one of our very good friends.  I knew I couldn't spend the night alone.  Thank goodness for good friends.  After a beer and some more tears, it seemed silly to be upset. I just needed to wait to hear the final report from the OB/radiologist.

A Litte Bit of This, a Little Bit of That

When we got married back in September 2011, while on our short but wonderful honeymoon my husband said "Let's just go off birth control and start trying now." I was a little taken aback by this and being the type A crazy planner that I am said "Why don't we wait 6 months or so and start trying in March?" I can't remember why I had that timing in mind exactly and wish now that I had just listened to my husband but alas we stuck with my plan because as my husband likes to point out- I always get my way.  I don't know if I just wanted some control over the situation and wanted some time together as newlyweds before the inevitable chaos of a baby.  My mom had been pushing us to get pregnant before we were even married and I think part of me just wanted to make that decision completely on our own terms.

Maybe that is why I still haven't found the courage to tell my mom what is going on with the baby making business.  She has made incessant comments basically since we got engaged which have only worsened now that we've been married for 1.5 years and are still remarkably (in her eyes) childless.  I love my mother but living in the same city as my family for the past 7 years especially with all this recent pressure has been challenging.  I know that it's not fair to get angry with her for making comments when she isn't aware of what is going on, but that doesn't make it easier to smile when she brings over another item for the child we do not (and more importantly cannot) yet have. Yes, I tell people when we have new friends over that we hide our children in the rooms upstairs because we have- a) a play set in our backyard (left by the previous owners), b) a little chair and table set (given to us by my mother), c) a child's Ohio State chair (also given to us by my mother). And creepily enough the locks on the doors upstairs (our hopefully maybe someday kid's rooms) have been turned inside out so that we could actually lock them in- don't ask me what the previous owners did to their 2 children, they seemed normal enough during our brief interaction at the closing.

I just don't know what to expect when I break the news to my mom- I think a part of me won't be able to hold back the anger toward her for making so many damn comments when we have enough stress on our plate and then I picture her face and her utter disappointment and I just can't imagine telling her.  See I am the only hope for the near future for them for grand kids. Unless my 21 year old brother knocks someone up which no one is hoping for.  My other brother who was 2 years younger than me passed away 2 days after my husband and I got engaged (just over 3 years ago now) and since then my parents have been much more overbearing which I sometimes can accept and sometimes cannot. I feel like my parents are counting on us to bring something happy back into our family's life and that is just not my damn job.  In reality my mom would probably feel profusely guilty because I think she thinks just like everyone else does- You just have to want to be pregnant, have lots of sex, and poof! it is so.  I swear if lots of steamy sex was all it took to get pregnant we'd have been pregnant, had the baby, and been pregnant again by now.  So if not steamy sex maybe cold hard science will do the trick!

So here goes...

Have you ever looked up infertile in the dictionary?

According to thesaurus.com it is an adjective 
definition: not bearing fruit, young

Then you get to the flattering synonyms:
Barren, depleted, DRAINED, arid, desolate, LONELY, SOLITARY, UNINHABITABLE, waste, wild, fruitless, infecund (which I had never heard until my browsing of thesaurus.com despite my 8 years of post-high school education), and finally UNPROLIFIC

That is how all this craziness makes me feel- UNPROLIFIC

You know when I got married 20 months ago... and started trying to conceive 15 months ago... I just didn't think we'd be here. 
There were times I thought, "Oh no! What if I am pregnant this month after having a few too many glasses of wine at that wedding last weekend?"
Or "What if I can't hold it all together once I have a baby? How will I balance being a doctor which I love and being a mother which I am sure I will love infinitely more?"

But I never thought (until several months in with a still uninhabited uterus), "What if I can't have the family I've always imagined? Or at least have a baby, one, just one baby?" when everyone I know seems to pop them out like candy.

But here I am... lately without much hope or humor or grace. So maybe in the process of writing this and purging myself of my bitterness and sadness I can figure out a better way to handle the lot we've been dealt, stop feeling so damn sorry for myself, and figure out how the hell we're gonna make a baby.