IN STIRRUPS ONCE AGAIN (WARNING - TMI)

I have a really good feeling about this cycle. Everything seems to be falling in to place, and everyone (Kev, Dr.Z, his nurse) is really positive about this round of IUI. And that brings us to today.

Today marks the first day of this 2WW. I HATE the 2WW. But, I suppose one good thing about going back to work on Tuesday is the fact that it will keep my mind off wondering about the possibility - even if only for 8-10 hours a day.

Let me tell you a little bit about how the IUI works. I first have to pump my body full of hormones for a couple of weeks (see two posts down) to turn my ovaries into super-duper-egg-makers. The night before the IUI, Kev & I do a little baby dance, after which I stay horizontal for as long as possible to keep gravity working in the little swimmers' favor. The day of the IUI, Kevin makes a "deposit" into a sterile receptacle and we rush it to the doctor's office about 35 minutes away. Dr. Z takes the sample and puts it onto a centrifuge and washes it so that there is just sperm - no extra stuff needed. I lie back with my feet in stirrups,while Dr.Z opens me up and inserts a super long catheter into my cervix and injects the sample. He says a little prayer and a yabba-daba-do, then he closes up my cervix and I lie on the table with cold metal equipment hanging out of me for about 20 minutes. That night, to give us better chances of conceiving, we do another little baby dance.

The whole process is only minorly painful. Mostly mild cramping except for the fact that my ovaries are the size of oranges by this time and are very tender, so when Dr. Z was looking for my cervix and pushing on my abdomen, I yelped like a puppy being punished. He told me to stop laughing. Laughing. I wish. I'm mostly praying my ass off. Please do the same.

BABY DANCIN' COMING UP

I had a doctor's appointment today and it went wonderfully. Everything looked fabulous. Optimum for IUI!

Here's what's going on:

> four follies ranging in size from 17.8 - 19.5
> endometrial lining 8.0
> estradiol 1,954
> HCG inject tonight at 2:30 am
> baby dance Thursday night
> IUI Friday at 3:30 pm
> baby dance Friday night
> baby dance Saturday morning

So after two weeks of injections, we're trying one last time with the IUI thing.

I do have dozens of medium sized follies that might cause me some problems. Because of them, I am at an elevated risk of Ovarian Hyperstimulation Syndrome (OHSS) again. After I get the trigger shot tonight, I will have to take it super easy. No strenuous activity. Looks like Kevo's bringing up the laundry baskets from the basement from now on!

ONE MORE TRY AT IUI

I finished the 21 days of the Pill on Tuesday and am currently on cycle day 2. I had an ultrasound this morning that showed that the three large cysts that were holding us back had withered away and my sleepy little ovaries are still polycystic. This is good news. I will start stimming (stimulating my ovaries with injectable drugs) tomorrow in order to attempt another IUI. So for roughly the next two weeks, I will be getting shots in the stomach and ass, getting bloodwork taken a few times a week, and having ultrasounds a few times a week. Oh, and I'll also have an HSG. The bloodwork monitors my estrogen levels, while the ultrasounds monitor the growth of follicles on my ovaries and the thickness of my endometrial lining. The HSG is a procedure where the doc forces liquid dye through my fallopian tubes (it's terribly painful for some, but I seem to handle it okay). Keep in mind that although I am currently covered under THREE insurance policies, all of these expenses come right out of our pocket. No one covers infertility treatments. Insurance companies act like I've elected to have these disorders - that infertility is something that I've chosen. Bastards.

Anyway, I thought I'd include a picture and explanation of what a month in the life of Gina & Kevin on infertility meds is like. In the above picture, I have laid out all medicines that I will pump through my body over the course of about 28 days. They are aligned from left to right in the order in which I will take them. Follow along...

Pre IUI cycle:

Metformin 2000 mg daily (This is to regulate insulin which my body does not do on its own thanks to PCOS. Without it, all sugar and carbohydrates turn to fat instead of energy like in a normal body. I've been on this for two + years.)

PreNatal vitamin daily (This is obviously to prepare my body for baby. I've been on this for five years.)

Birth Control Pill (I take this between medicated cycles in order to let my body - especially my ovaries - rest from the hyperstimulation. It pretty much gets me ready to go into overdrive.)

During 28 day IUI cycle:

Follistim (FSH) - Injected subcutaneously in my stomach CD 3-7 (This makes my ovaries produce a whole bunch of follicles and tells them to GROW!)

Puregon (HMG) - Injected intramuscularly in my ass CD 8-19 or 20 (This makes my ovaries pick a few - between 1 & 4 - dominant follicles and only make them grow. These follicles will *hopefully* each release the egg inside it after the next step.)

Pregnyl (HCG) - Also injected into one of my bum cheeks once my follicles and endometrial lining reach an acceptable size (This tricks my body into ovulating. The mature follicles each release their egg to make their way through the fallopian tubes, hopefully to meet Kev's little swimmers.)

Prometrium - Taken until I get a period, or if I am pregnant, until my Dr. tells me to quit (This makes my endometrium a nice and hospitable place for the fertilized eggy to attach and grow.)

Crinone (Unfortunately, I haven't ever gotten this far in any of the IUI cycles. It is a progesterone gel that is inserted vaginally that ensures the endometrium stays nice and cozy for the little growing babe. Maybe this time I'll get to use it.)

So there you have it, folks. A month in the life of an infertile trying IUI. We are ready to roll. Wish us luck!

A 2WW DIGRESSION ON PCOS

I am currently in what is known in infertility circles as the Two Week Wait or 2WW. This is the period of time between ovulation and finding out if you are pregnant or if you need to take the next step on your infertility journey. This cycle, Kevin and I underwent a more aggressive infertility treatment than just the oral meds and monthly shots. We did IUI - intrauterine insemination. It was our second attempt - the first cycle, my ovaries basically over-responded to the injections, causing me to be dangerously close to Ovarian Hyperstimulation Syndrome. A week or two of little to no physical activity and a month of ovarian rest, and we were ready to try again. This month Kevin gave me shots for fourteen days, then made it in a cup. We rushed the sample to the RE's office where it was washed, prepared, and injected directly into my uterus. Thus, we are in the 2WW. We'll find out if the IUI was successful this Wednesday. Keep us in your prayers.

This post isn't about the IUI though; it's about PCOS.

I was diagnosed with Polycystic Ovarian Syndrome in 2003. I underwent a plethora of emotions. First, I was relieved. There was a definitive reason why my cycles were so berserk. On top of that, it explained the weight, the hair, the acne, the depression. Next, I was angry. Why hadn't anyone found this until now? I was 26 for pete's sake! What the hell is wrong with the dozens of doctors I had seen in my post-pubescent life? Finally, I felt sadness. I was sad for Kevin and me. I knew that this meant that we would have a more difficult time conceiving our family than a couple who did not have to struggle with the hurdles of PCOS.

PCOS is a serious condition that is not only difficult to diagnose, but difficult to manage. As I learned more and more about this endocrine disorder, my life began to make more sense. All the things about my body that had bothered me for years were finally explained. It wasn't my fault. I wasn't doing something wrong - there was actually something wrong with my body. Following is a list of symptoms that women with PCOS may experience. Not all women with PCOS share the same symptoms. Of the fifteen below listed symptoms, I suffer from twelve of them.

Symptoms of PCOS:
infrequent menstrual periods, no menstrual periods, and/or irregular bleeding
infertility because of not ovulating
increased hair growth on the face, chest, stomach, back, thumbs, or toes
ovarian cysts
acne, oily skin, or dandruff
weight gain or obesity, usually carrying extra weight around the waist
insulin resistance or type 2 diabetes
high cholesterol
high blood pressure
male-pattern baldness or thinning hair
patches of thickened and dark brown or black skin on the neck, arms, breasts, or thighs
skin tags
pelvic pain
anxiety or depression due to appearance and/or infertility
sleep apnea

PCOS also could have been the reason for my recent miscarriage. The miscarriage rate in women with PCOS is increased 20-50% when compared to women without this disorder. PCOS sufferers are also more likely to develop gestational diabetes during pregnancy. Not only is it harder for us to get pregnant, it's also harder for us to have a healthy pregnancy.

Women with PCOS have greater chances of developing several serious, life-threatening diseases, including type 2 diabetes, cardiovascular disease (CVD), and cancer. There is no cure for PCOS. Symptoms can be managed through a high-protein, low-carb diet and exercise.

It is the PCOS that continues to make our journey to conceive so difficult.

A CONDENSED RECOLLECTION OF THE PAST TWO YEARS

We have been working with an incredible reproductive endocrinologist since August of 2006.  After several office visits and ultrasounds, he put me back on 2000 mg of Metformin, Clomid, and a once-a-month ovulation trigger shot of HCG.   The very first month (October) I was on this protocol, we conceived!  We were ecstatic.  We picked out names, envisioned the nursery, and started looking for an OB/GYN.  A few days before Christmas, we had an ultrasound that showed no heartbeat or fetal growth.  The baby had stopped developing a few days before, and we were devastated.  The D&C was scheduled for a couple of days before New Years.  It was the hardest Christmas season I've ever experienced.  

We continued trying to conceive using the same protocol for the next ten months.  Each month brought us another BFN (big fat negative).  I underwent a surgery in September 2007.  My doctor performed a laparoscopy, hysteroscopy, another D&C, hysterosalpingogram, cystectomy, and he zapped my endometriosis with a CO2 laser.  I was in recovery for about a week, then we picked up with the same protocol.  Month after month I was greeted by AF, which was actually a big step in the right direction in my reproductive health because I had never had regular periods.   Regardless, period equals empty womb.

It seemed like we had been TTC with the same protocol forever.  Finally, this spring we ordered injectible medicines from Great Britain to begin an IUI cycle.  The first month I was on the meds, my ovaries over responded.  My estradiol levels were so high that the lab's equipment couldn't even read the numbers and I had dozens of medium-sized follicles among the few dominant ones.  The cycle was then cancelled.  Damn.  After a month of ovarian rest, we were finally able to try again.  This time, I injected for 18 days and the IUI went off without a hitch.  Now, I'm in the two week wait.  

My blood draw is scheduled for July 2.  Our sixth wedding anniversary is June 29.  If we are pregnant, implantation should occur on the 27th.  Should I test on the 28th?  Theoretically, we could have a double celebration.  On the other hand, it could put a real damper on things.  What to do?