Tuesday, January 25, 2011

The Conception Chronicles: The Glitch of Injectibles

This is the fifth installment in a short series (which may become an occasional series) about baby making.

So onward to the injectibles.

My wife is pretty awesome with these. Seriously, she just swabs and grabs a spot and sticks the thing in. Much less stress than the one time I triggered myself. Luckily, since she's on pretty low level meds in the world of injectible fertility meds (low dose and only one drug at a time), she gets to use these super tiny needles and doesn't seem to have a lot of reaction to them. Well, no swelling, itchiness, etc. After a couple of days you can totally see little holes where the needles went in. And the bloat...lets just say its probably a good thing this development wasn't in July. You really couldn't take these things and wear a bathing suit without people making assumptions. It was bad enough that the poor woman couldn't comfortably work out.

And then there's the other issue. Even on this pretty low dose, she overresponded. But not really. She overresponded in those damned ovaries producing a jumble of follicles, but of crappy size.  I suppose this is a step in the right direction compared to the oral medication response, but a bunch of little follicles is useless, and a bunch of big follicles are only good if you're doing IVF (in-vitro fertilization, a procedure which is invasive and incredibly expensive, and not on our plate right now). So up and down the meds went, in an effort to get her to produce a couple of follicles big enough to inseminate. And up and up and up the estrogen levels went. High. Over 2000. I have no idea what is normal, but it was clear that was not.

So as her levels continues to soar, the doctors decided it was time to trigger the two almost decent follicles we had and hope the others didn't catch up. And before agreeing to do this, and the insemination, they asked if we are ok with selective reduction, which we had to say yes to if we wanted to move forward. See, the issue with inseminating like this, even with just two almost-ok-sized follicles and some small ones is there is always the chance one of those 12 small ones will catch up in the 48 hours between the last ultrasound, the trigger, and the IUI. And we all know how Jon and Kate turned out (they ignored directions not to have sex due to the hyper-stimulation, if I recall correctly). While you occasionally hear about it, it is next to impossible to carry, say, 6 babies safely and certainly impossible to carry them to term. I'll discuss this more another day, but we did move forward.

After the trigger and IUI, Princess Charming was bloated. Like carrying a small ship in the belly bloated.  While she never had the official OHSS (Ovarian Hyper Stimulation Syndrome) diagnosis, and didn't need (yikes) draining or anything, she definitely had a mild case.

And then a chemical pregnancy. Betas of 57, 83, and 26 at 14, 16 and 18 dpiui. Well boo.

We have decided her body decided there was too much going on with those ovaries and needed to sit out that round.

Monday, January 24, 2011

The Conception Chronicles: Moving on Up

This is the fourth installment in a short series about baby-making.

After the miscarriage (though to be honest, I tend not to think about it like that - we never got to the heartbeat stage. As our doctor put it, the whole thing was just a dud.), we got back on the wagon.  When my dear wife cycled again, we went back to the RE, did more high dose Clomid, and had a dud cycle. I mean dud. Nothing from the ovaries. She ended up on Provera to induce a new cycle, and we started talking injectibles. I think there was another month in here somewhere because her hormone levels were all screwy around Provera time, but its a little foggy at this point.

Injectibles are a weird thing. First of all, you're INJECTING YOURSELF WITH HORMONES.
This is is no way normal (unless you're a Type I diabetic, in which case it is normal, if sucky). There's a variety of different medications out there to induce ovulation, and what I gathered from our doctor (and message board stalking) is the meds you are prescribed vary based on your specific diagnosis and a bit on the doctor's preference.

And they are EXPENSIVE. I mean $$$. Some pharmacies are cheaper than others, and some insurance plans pick up some.  Praise be to my little paycheck, my insurance has pretty nice coverage.  It is capped, but enough to cover 3 or 4 cycles of the meds Princess Charming was prescribed with just a $75 copay per box (a savings of about $1500 compared to what the insurance bills my employer, or whoever exactly pays that bill, and about $900 cheaper than the cheapest non-insurance pharmacy (I looked since there's always the chance of running over the limit)).

Ordering these meds is kind of surreal like ordering sperm is.

Me (faking being my wife, as I always do on medical calls since it is just easier than explaining to 19 people per call that she is my semi-legal spouse AND on my insurance and is not my sister/mother/me): "Hi, I need to order 3 of the crazy-ovary-stimulating-pen-thingies"*
Mail-Order Pharm Lady: "OK. Do you need a sharps container and alcohol wipes?"

I know I would be upset if ordering these things was harder, given how people get pregnant without clearing it with Big Brother all the time, but it is still just weird.

*Fun Fact/Fertility Drug Information: A lot of these drugs come in "pen" and "vial" format. Should you have the privilege of using these things, a nurse will likely walk you through them in an "injectibles class" (in our case, a one-on-one appointment).  The pen is simple - prime pen, click to the dose, add injection needle, inject, return to fridge. The vials are easy-ish, but much more complicated - take Giant Horse Needle, mix stuff in syringe with stuff in vial, suck into syringe, change needles, get air bubbles out of syringe and prime needle without losing the $$$ drug, inject. We did both alone the way and I honestly found the vial method to be rather stressful and am glad we only had to do it two nights and got the nice pens for most of the drugs.

Sunday, January 16, 2011

The Conception Chronicles: Moving Along

This is the third installment in a short series in our conception experience.

So once we got started, we hit some snags.
First cycle on Clomid-just-in-case: not even a single measurable follicle.
Second cycle, higher dose of Clomid: ditto
Third cycle, even higher dose of Clomid: sort of decent follicle. Awesome. Then we show up for our last pre-trigger follicle check and OH look at that fluid! You're ovulating RIGHT NOW. So we go chill in the lobby for a while whilst our Pharmacist thaws. Alas, no dice this cycle.
Fourth cycle, same dose. Slightly closer monitoring, and a single follicle of almost good size (a tiny bit smaller than the 20mm they like to see at trigger - hormone injection induced ovulation - time). 13DPiui (I think, its a little foggy now), positive pregnancy test!! awesome!

Alas, this pregnancy ended in a blighted ovum and a D&C. It was sad, but not heartbreaking. It was almost funny dealing with the doctors and nurses who were so apologetic. I think we weren't as upset as they are accustomed to, perhaps since we haven't been trying for the year+ common in infertility patients. We took this ok, seeing as there was never development beyond the yolk sac.

Fun Fact: Many RE offices put all patients on progesterone supplements as a precaution to help implementation and embryo growth. Crinone, the suppository version, kind of gets stuck up in there and has a texture very similar to feta cheese after a few days. FYI in case the nurse didn't mention it - it is OK to clean it out regularly!

Saturday, January 15, 2011

The Conception Chronicles: Sperm

Part II of a Short Series on Baby Making (Lesbian Couple Version)

As two women trying to have a baby, we instantly had an issue.  On the upside, no need for birth control, so no concerns about pumping the body full of artificial hormones 75% of the year or remembering to buy condoms or charting or the old "pull and pray".

On the downside, sperm isn't exactly sold at the corner store.

There's a two major options for donor sperm: known and unknown. Both have a multitude of concerns I couldn't hope to cover in one succinct post, so I'll work through our reasoning.  In the beginning we strongly considered a known donor.  Using a known donor raises a lot of legal issues regarding second parent adoption and custody.  While this may be fine for some, I am wildly uncomfortable with even the tiniest chance of a issue arising after the baby was born (there's always that possibility a well meaning donor may lose the emotional ability to sign away parental rights after the birth). As a result, we investigated means of mitigating these issues.  One of the big banks (probably more than one, but we looked into one with a local location) does handle targeted donations from local donors in a way which avoided the issues.  In the end, it was a logistical nightmare with requirements for testing and retesting and quarantine, and not at all cheaper than standard donor sperm.

So moving onto unknown donor sperm.  Shopping for sperm is sort of like picking out clothes from a department store. There's a variety of lines: economy, standard, and advanced degree (with different names depending on the bank). There's choices for size (height/weight) and color (race, eye, hair). There's feeling of the material (donor essays, interviews). There's also the option for donors who have the option to be contacted by the product of their sperm once they're 18.

In the end, we selected a non-open donor with a similar ethnic background to us, appropriate height and weight, and coloring similar to Princess Charming (since she is lighter than me, and blond and blue eyes are recessive!).  At this point, we've been through more than one donor - we aren't emotionally attached to them, though it is hard not to be when you see their little kid pictures and read their essays 191 times.

While it sounds overwhelming, when you narrow down the options you consider MUST HAVES, it is not actually all that difficult. And the actual ordering is quite like ordering a pizza...

Fun Fact: Washed (prepped for IUI - interuterine insemination) sperm is pink.

Thursday, January 13, 2011

The Conception Chronicles, First Edition

This marks the first in a short series about baby making.

It is no secret that we're a lesbian couple or that we want a baby. It is sort of (kind of, not really, but sort of) a secret that we're working on it (so if you happen to be a reader who knows me in real life, lets not discuss this on facebook, OK?).

Getting pregnant is pretty easy. Egg, sperm, done. Lots of people have babies very day. People with and without adequate resources and/or stability as "required" by polite middle class society. We're more or less resourced and stable enough, so we started looking into the process in Summer 2009.

After lots of time on the internet reading people's stories via blog and message board, and some time looking into my health benefits, we decided to head to the doctor's. I have some guilt associated with this, since babymaking should (in my mind) be personal and intimate and all that lovely mushy stuff.  I had initially thought we'd find a nice midwife, use OPKs at home, and do some minimally interventionist cycles and see what happened (ala the not-not-trying approach commonly favored by newly trying-to-conceive couples). Alas, donor sperm (seeing as a second immaculate conception is unlikely) is $$$, so a doctor and monitored cycles seemed like a more responsible choice. And, my insurance (unlike my paycheck, but maybe it evens out in the end) is top-notch so most fertility treatment is just the cost of the office visit co-pays and the sperm. Not a bad deal.

So in August 2009, we trekked (the mile) to our local Reproductive Endocrinologist, a lovely man well rated annually who is part of a network of four doctors with several locations in our area. Really, we hit the jackpot with this practice. They're totally awesome, have great hours, are great at handling insurance, and just super nice all around. (Should you be in the Phila metro, I'm happy to make a recommendation.)  I had 3 liters of blood drawn - ok 9 vials or so, but I had to sit in the Scary Medieval Torture Bloodwork Chair for a while to stop seeing spots - and a transvaginal ultrasound (the one that surprises most newly pregnant woman at their first OB appointment). A few days later, I was given a stamp of good health and orders to call on CD1 when we were ready to start.

Then it occurred to us that besides some logistical issues, maybe having me pregnant for the last 2 classes of my doctoral program and my comps (first trimester fatigue potential and all) wasn't a good idea. So in January 2010, we decided to get moving with Princess Charming. Same bloodwork, scans, excellent, lets go.  At her CD3 baseline scan, our RE offered 50mg of Clomid. Super low dose, but can help with an iffy cycle. He said we can take it or leave it. Given the cost of swimmers (about $495 more/month than generic Clomid), we took it. And then the fun began.