High Hopes

Well, it didn't work.  I had high hopes because I was sure that my curvy cervix was the problem.  The sperm was deposited right where it needed to be, it had 90% motility, the timing was perfect.  I'm not sure what went wrong.  I've heard it takes some couples 5 or 6 tries doing IUI to have success.  It really is all up to chance (Heavenly Father) because the process and circumstances would appear to be the same each month, as long as everything is as ideal as it was this month.  So we definitely still have a few more months of hope before we think about IVF. 


You would think that I've learned you shouldn't put the cart before the horse.  But I haven't. 


I had big plans for painting one bedroom of our new house in the colors that I was choosing for a jungle themed nursery.


I wasn't going to store anything in our nook area off our master bedroom because a bassinette would need to go there soon.


I've bought a few onesies and other adorable outfits that I just couldn't give away to friends who had babies, or I've bought one for them and one for me.


I tried on a petite maternity shirt when shopping with friends just to see what it would look like.


I've looked up numerous tips on how to survive hospitalized bedrest and then the NICU because we've been told to plan on both of those things.


I always am googling or pinteresting cute ideas of how to announce pregnancy to friends and family.  Each time we see Charles' family (1-2 times per year), I have a great plan in mind for how to announce it based on the activities we will be doing or the time of year we're together.


I had big plans of giving Charles' mom a children's story book for Christmas with a picture of an ultrasound in it and a note that said, "Please read this to me when you come visit me in August 2015."  Of course she would start crying.  Or maybe we would take a family selfie in front of the Christmas tree and have everyone say, "Chandra's pregnant!" and we capture their expressions as the camera clicks. 


I really shouldn't do those things.  But each month brings new hope.  And if you don't have hope, what else is there to keep your spirits and motivation up?  We are going to take the month of December off because it is a busy time of year anyway, and we will be with Charles' family during the time the IUI would take place.  Maybe a new year will bring new hope, or new opportunities...     

IUI #1

Charles ended up explaining the situation to his coworkers, and they worked everything out so we he could take 30-45 minutes away from work in the middle of the day to provide a sample.  And of course, they all wished him luck when he left!  Lol!  We met at a park & ride between the fertility clinic and his work.  I had big decisions to make before I left the house what I was going to wear because I wanted the process to go fast for him, but I wanted to keep my garments on in case I got in an accident (plus I would've felt weird not wearing them)! 


We met up at the parking lot and faced a cement wall, and I put jackets and blankets up to shield the windows.  It really felt sketchy to be so secretive and making a little hide-out for ourselves!  Charles got there on time and we had plenty of time to spare.  We were getting into the mood, kissing and touching and such things, and what happens?  A guy walks right in the front of our car and puts a flyer on my windshield as we're just staring at him like deer in the headlights!  Because we definitely needed something to make this situation more awkward!  After that, it was a little more difficult to accomplish our task because we were super paranoid, but we managed.  I kissed Charles goodbye and drove 8 minutes back to the fertility clinic where I proudly handed them the sample. 


I went back to the clinic one hour later, and it was insemination time.  I was surprised to learn that a nurse was going to do it, not Dr. S.  Here goes another month without seeing him.  Oh well, I'd rather have a woman do it anyway.  It was like a pap with a metal speculum and then she swabbed my cervix with, I'm guessing, some type of antiseptic.  She let me know that Charles' motility needed to be >40% and it was 90% after the wash!  Awesome!  Then we verified 3 times that it was Charles' semen in the syringe she had.  And then came the fun part of trying to get 8cm of catheter threaded through my cervix.  I think this is what they had the most difficulty with during my HSG.  Apparently my cervix is curvy.  Charles had a good laugh with that one later, but it was not fun at all during the process!  She curved the catheter and tried to maneuver it through my cervix for about 10 minutes, causing cramps the whole time, and finally it found its way through and she injected the semen into my uterus.  She told me there could be a lot of spotting because of the trauma to my cervix, and she said to call with either result after I test in 2 weeks.  Then I laid on the table for 15 minutes still in the stirrups, falling asleep for a short nap (night shift has enabled me to sleep anywhere), then I got up and went home. 

Syringe with catheter attached (after the semen was shot through)

I was crampy and felt twinges of pain for 2 days after, along with some spotting.  But all in all, I feel pretty good about it.  And I'm curious to know if my curvy cervix has been the issue all along.  We can only hope that IUI fixed our problems!  We will take a $400 fix over a $20,000 IVF cycle!  Keep us in your prayers!


"Faith in God includes faith in His timing."

              

Time Sensitive

Today was a frustrating day.  I got a positive OPK this morning, which would normally be a happy thing because that means IUI will be within the next 24 hours.  IUI (intrauterine insemination) is where they take Charles' swimmers, prepare them so that only the good ones are saved, put them in a tube which is then inserted past my cervix and into my uterus.  This allows the best of the best to be right where they need to be when the egg is released.  They would have to be really dumb to not know where to go at this point!  The chance of conceiving goes up to 20% when you take medication with IUI. 


I had talked with the nurse a couple weeks ago at the beginning of my cycle, and she said I could bring in Charles' sample if he was unable to go to the office himself as long as it was received within 30 minutes, and they open at 8AM.  I thought this was perfect since we live right down the road from the clinic now, and that way he could leave right to work as soon as he gave me a sample.  He would only be a little late to work if I took the sample in first thing in the morning!  I called the office today to let them know I got a positive OPK, and they said the soonest I could drop off the sample would be 12:30PM.  Umm... this does not work.  Charles can't take a whole morning off work.  Then they asked very rudely, "He can't even take time off for this?"  This is not about what he is willing to do.  He wants a baby as much as I do.  This is about his job in customer service where the customer always comes first, and Charles can't just up and leave anytime he pleases, leaving all his work to his coworkers.  Coming in late in the morning was understandable to his boss and coworkers, but leaving in the middle of the day?  Nope.  He can't even predict when his lunch break is (much like my job), so that wouldn't work either.  They just could not understand that.


I got frustrated on the phone, and I said, "Well, I guess we are done here then.  He'll never be able to give a sample in the middle of the day.  We need the first appointment."  I wanted to cry.  The receptionist retorted, "Well, we'll never be able to predict when you get a positive OPK, so we can't ever promise you a 8AM appointment if you're going to call to schedule it the day before."  Actually, I've gotten a positive OPK on Day 12 every single Femara cycle, so we can predict it, but she didn't believe me and said it could vary every cycle.  I said we can try to do the 12:30 appointment, but there's going to be a lot of stress involved.  I will be driving to Charles' work in Bountiful, trying to seduce him quickly, get the sample and fly on the freeway back up to Layton to get the sample to the office within 30 minutes.  I'm not feeling good about this.  I can just picture myself getting into an accident, being brought into an ER, on a backboard with a c-collar on, clutching that sample to keep it room temperature, yelling, "Someone needs to take this to the reproductive office!  And you guys better stabilize me within 90 minutes so I can get there, too for my part!"  But I also know that if it is meant to be, it will work out.  It is all in Heavenly Father's hands.  I just need to take some deep, cleansing breaths.  Wish us luck!             

Same Boat, Different River

Don't get excited because I didn't update last month!  We are still in the same boat.  The boat of 2.5mg of Femara and timed intercourse.  Except now we are paddling in the river of Syracuse, UT where there doesn't appear to be another boat in sight.  It's probably untrue because with more women in their 20's and 30's concentrated in one certain city, there would likely be more women with infertility.  But you wouldn't think so by looking at my new neighborhood and ward.  Our first week at our new ward last week was painful.  "Oh, it's just you and your husband?"  Yes, just us. While they helped us unload the moving van, someone said, "Who is the trampoline for?  You don't have any kids!"  Umm.. I have a niece and nephew who like to spend time at our house, and maybe I still enjoy the trampoline because I don't have stress incontinence when I jump!  I'm starting to think this move was a mistake.  But I do love my house.  And the neighbors are very nice and super friendly.  It's so nice to see kids wearing helmets and playing outside together.  And one day we will have at least one child, and then we'll fit in just perfectly.  But until then, it's going to be even harder than it was.




I haven't seen my usual doctor, Dr. S since my first ultrasound back in July.  My cycle day 10 follicle checks keep falling on a Saturday, so I end up having to go to Sandy and see the on-call doctor.  And of course, my Dr. S is never on-call the weeks I need him!  But he did something really cool last month which made me feel better about things.  He called me out of the blue and said he was sorry I haven't been able to see him for the past 4 months.  He wanted me to know he agrees with what Dr. Moustache and Dr. Oriental advised me to do, and that he goes to bed at night worrying about my kidneys.  Lol!  He said we should have another meeting with him if this month is a bust, and we will talk about IUI or even IVF.  IVF would be safest because he would only transfer one egg at a time (I'm choosing to believe that the Quad Mom situation from Utah could never happen to me!  Her two eggs both divided).  But IVF is upwards of $20,000.  Anyway, it was nice that he called and wanted to let me know he is thinking of us and our journey.




Here are some funny "You Know You're Trying to Conceive When..."isms.


1. You know you're TTC when you know your cycle day better than the actual date.
2. You know you're TTC when the plastic cups in the bathroom aren't for drinking. (gross!)
3. You know you're TTC when you can educate your friends about ovulation and basal body temperature much better than health class in high school did.
4. You know you're TTC when you analyze every twinge or pain in your abdomen.
5. You know you're TTC when you get excited with a sudden wave of nausea.
6. You know you're TTC when you change your work schedule so you're not working during the 3 most important nights of the month.
7. You know you're TTC when it's perfectly normal to text your husband a pic of a positive ovulation test that you've peed on, so he knows it's "go time" that night.
8. You know you're TTC when your nightstand has a BBT thermometer, Preseed lubricant and extra OPKs in it.
9. You know you're TTC when you're glad your period finally shows up when you got a negative pregnancy test 2 days ago so you can start fresh again.
10. You know you're TTC when you don't mind (too much) waking up at 5 AM to have intercourse before your husband goes to work and then be ready again that night.
11. You know you're TTC when playing with your "baby" means taking them for a walk on a leash and throwing a tennis ball 50 times each day.

Monster Baby

Since we are coming up on Halloween, I thought this title was appropriate.  After all, that's what Dr. Chinese/Japanese/oriental/Asian guy and Charles talked about while I had yet another Day 10 ultrasound.

Obviously, last month was a bust.  We tried a grand total of once, then thought that we really shouldn't chance it.  If it was meant to be, then that one time (the day we worried and stressed about the possibility of having twins) would be enough to make it happen.  It apparently wasn't meant to be!  Maybe I would've really had twins.  Who knows?  Anyway, it was kind of nice not to get my hopes up for once because I knew that we hadn't really tried that hard.  So it wasn't as big of a letdown.

This cycle, I took 2.5mg of Femara instead of 5mg.  Then we prayed for just one follicle!  I asked the nurse what the difference is between having one follicle on my own like I used to before treatments, and having one follicle from taking Femara.  She talked to Dr. S (I ask difficult questions!), and he said Femara makes a stronger ovulation with larger and more mature follicles, raises your progesterone which will support an embryo better, and also causes you to have a thicker uterine lining.  So I guess I will keep taking it even though the side effects are no fun.  At least my headaches were much milder this time around on the lower dose.

 

 

Day 10 fell on a Saturday AGAIN, so Charles and I had to drive down to Sandy and get my follicular scan with the doctor who was on-call for the weekend, which was Dr. Chinese/Japanese/oriental/Asian guy.  I just wish I could see my regular Dr. S!  But rest assured, all of these doctors do care about me.  I only have to meet one more, then I will have collected all their cards!  haha.  Anyway, this guy told me I have a beautiful uterus (umm... thanks?), then said I have a huge follicle (26mm, so bigger than last cycle), and 2 smaller ones that didn't look promising.  He then said something like he hoped I didn't have a monster baby because I had a monster follicle and I'm so small.  He and Charles then went off on that idea and we talked about big babies and short women the rest of the time.  These doctors in this office don't care about how the baby comes out, just getting it in there in the first place!  In the end, I asked him if he felt comfortable with us procreating this cycle even though I had 3 follicles, and he said, "Well, Dr. A (maternal fetal medicine doctor) will take good care of you no matter what!"  So is that a yes?  He wouldn't say.  Charles likened it to someone asking him if they should buy a rebuilt car that had been in an accident.  So basically, I'm a damaged car that has been given a clean bill of health.  Lol!  But we felt good about it this time since I only had one mature follicle, and it didn't work last time with good timing and 2 mature follicles.  So here we go!

 

 

          

Stormy With A Chance of Twins

I went for my follicle check (ultrasound) on Day 10, which was on Saturday.  I had to go down to South SLC for it since they are open on Saturdays.  Charles luckily had the day off, so he met me after my night shift, we ate breakfast at Village Inn and then drove down to the clinic.  We had a lovely morning with lots of laughing and joking, probably because we were both very sleep deprived!

When we got into the exam room, I pointed out the magic wand and Charles' eyes got huge.  He started laughing and asked, "THAT has to go up there?"  Not the whole thing, but yes!  I had told him I would need to get halfway undressed and that I felt gross after a night shift.  But it didn't occur to him that the ultrasound wouldn't be on my stomach like on TV! 

Dr. Mustache-and-Eyebrows came in (not my regular doctor) and we got right down to business.  He said there were 2 mature follicles!  Yay!  But then he said the risk for twins was increased with 2 follicles that could possibly both hold an egg inside of them, and he said we'd talk more outside.  I got dressed and we went out into the hallway where he pulled up my recent labs and we talked about the "super ovulation" I'd had last cycle.  I likely had 2 follicles then, too, but we didn't have an ultrasound that time.  He said we have options, and he had the nurse take us into the consult room to talk.

The first option we were given was to get the HCG trigger shot which would make the follicles release their egg(s) in 36-40 hours.  That sounded really good since I had 3 nights off work and we could pinpoint exactly when this whole thing could go down!  But then she said she didn't know if it would be wise to even try getting pregnant this cycle with my kidney issues.  The kidney's workload is increased with even just one baby, let alone two.  At that point, Dr. Mustache-and-Eyebrows poked his head in, and he said he had been thinking more about it and he would strongly recommend we not get pregnant this cycle.  I asked if he thought we should try a lower dose of Femara (which is also the lowest possibly dose and most conservative treatment possible) next time, and he thought that would be a good idea.  So, we made the decision to call it a month, and we left the clinic very down-hearted.  All that pain and bleeding for nothing.  And I still had ovulation cramps and another Femara period to look forward to.  :(

We got home, and I totally broke down.  It always eventually comes down to "Why do I have lupus? It makes my life so hard!  It's not fair!"  Charles comforted me for the millionth time, agreed with me that it wasn't fair, and eventually I fell asleep for the day.  When I woke up, we had some retail and ice cream therapy.

But then I had a thought!  Dr. S said there may be some months when Femara would cause me to release 2 eggs (but no more than that).  He hadn't said if we'd need to abandon those cycles or not!  I couldn't wait to call the clinic on Sunday morning!  The time finally came, and I didn't realize there was no one there, even for phone calls on Sundays. :(   So, I took matters into my own hands.  I tried to look up studies done regarding the incidence of twins on Femara with 2 mature follicles and timed intercourse.  I searched all the trying to conceive forums on a ton of different websites.  I talked to 2 girls in my ward and a high school friend who had had trouble conceiving and had been on Clomid and Femara, as well as one friend from work who had undergone IVF.  The general consensus was that multiple follicles (2) did mean a possibly higher chance of twins, but it also meant a higher chance of conceiving just one baby as well.  I could take that information how I wanted to.

In church, I tried to listen for answers.  The Sunday school lesson was on Job.  After reviewing all of Job's trials, we ended with reading Job 42:10.  "And the Lord turned the captivity of Job, when he prayed... The Lord gave Job twice as much as he had before."  No!  I don't want twice the blessings!    

Many prayers were said that day, and I could see both sides of it.  Trust God that He wouldn't give me more than my body could handle.  Or don't be stupid and risky and just listen to your doctor!  Maybe I didn't get pregnant last cycle because Heavenly Father knew I hadn't had an ultrasound and didn't know I was at an increased risk for twins then, too.  I ended up e-mailing Bishop Ritchie because he is the one I go to when I'm in turmoil!  I asked him if he thought a blessing to not have twins would be something reasonable to ask for.  He said a blessing would be a great idea and that I should always remember Heavenly Father wants to bless me with whatever I need help with.  I just need to ask and then have faith!  But then he said he was worried about me.  Haha!  Oh great!  My wise and knowledgeable father-figure has doubts, after he told me to go for it.

So, Charles gave me a blessing to not have twins, and I took a pink dye OPK test (my clearblue easy was still negative).  Of course, it was blatantly positive!  It was now or never.  We went ahead with things Sunday night, and I didn't feel panicky before, during or after, so that's good I guess.  Now I just have to have faith and trust in His plan for me.  I called Dr. S's nurse today as soon as they opened.  She talked to Dr. S and he highly recommended I cancel this cycle as well, but he couldn't tell me what to do.  The nurse said to go with my gut.  Gut, impressions from the Holy Ghost... same thing.  I don't feel bad that we tried once.  But I think that Dr. Mustache-and-Eyebrows randomly coming into the consult room to specifically warn me meant something, too.  I had my ovulation temperature dip this morning, so we had good timing.  The two week wait likely starts tomorrow.  So we will see...

        

     

Round Two

Taking my temperature last cycle was very helpful!  But it also crushed my dreams two days prematurely.  I saw a beautiful drop in my temperature of 97.19 on Day 11 which indicates ovulation, then it kept climbing daily, to a max of 99.05.  It bounced around in the 98.8-98.9 range for about 15 days, then dropped suddenly to 98.46 on Day 27.  I wanted to cry.  Besides a negative pink dye pregnancy test, my true confirmation of not being pregnant started two days later.

Femara has definitely done weird things to my body.  I was extremely emotional on Day 2.  I'm not sure if this is from meds, or if it was just really hard to accept that I wasn't pregnant after we tried something different (meds) for the first time.  I was at work on Day 2, and I started having really bad cramps.  This felt different than my non-medicated cycles.  It felt kind of like gas pains, sharp stabbing then disappearing and happening again on the other side of my lower abdominal cavity.  I also felt a heaviness like things were growing inside of me.  I turned to Dr. Google (stupid, stupid, stupid!), and found that I could have residual ovarian cysts that didn't dissolve from last cycle.  There is an increased risk for this when on fertility meds.  I have had an ovarian cyst rupture when I was 19, and that was definitely not fun and cost me a trip to the ER.  I made plans to call my doctor on the way home from work, but then I started to feel a little better.  They had already told me they don't normally do ultrasounds at the beginning of each cycle unless I'm doing injections, so obviously they think the risk of cysts is low with just oral medication. 

I got home, then basically had a murder scene in the bathroom.  It hasn't been that bad since I was diagnosed with lupus and became anemic from bleeding so much.  Also, this was Day 3, not Day 1!  What the heck?!  Cue more emotions.  Thank goodness I had a full day of sleeping planned, which is pretty much what happened, along with binge-watching Pretty Little Liars on Netflix.  Even though I didn't feel like it at all, we went out on a double date that night which was the best thing that could've happened.  I love my hubby and our friends who we finally confided in.

I started taking Femara again the night of Day 3.  I thought maybe I could sleep during the awful headaches it causes.  Day 4 was yesterday, and it did not work.  I woke up with my head throbbing, especially anytime I did anything to increase my intracranial pressure (pressure inside of my head) like coughing, sneezing, stretching, yawning, etc.  I couldn't turn my head in church and basically looked like a zombie.  Today is Day 5, and with no headache yet today, I feel hopeful again!  I will have an ultrasound on Day 10 since I ovulated so early last month which was not expected.  So here's to another month of strong and painful ovulation, early morning temperature taking, OPKs, timed intercourse, and hoping the stars align.
     

1st Month with Femara

  1st Month and hopefully only month on Femara!  It wasn't that bad actually.  Not nearly as bad as Clomid horror stories of women wanting to kill their husbands (see ecard below). 

Femara gave me occasional hot flashes, minor nausea and a headache of maybe 6/10.  No emotional mood swings that I could tell.  So all in all, not too bad! 

I went to the Layton office for the first time on cycle day 2, and it was really nice there.  A very friendly receptionist, a water/stone/soothing display in the waiting room, free water bottles, and just a general feeling of zen.  It was very nice.  I was taken back to the room and also shown the bathroom where there were free products to use.  Dr. S came in to the room and we talked for a little bit about what labs I would need today and how my appointment went with Dr. A with Maternal-Fetal Medicine.  I think he was still considering if it was ethical or not to get me pregnant!  haha.  He then did the ultrasound (mandatory before a medicated cycle to make sure there aren't too many follicles that could release multiple eggs).  He said I had 7 follicles on each side, and he had hoped for 6.  Yay for exceeding expectations!  Then he wished me luck, left the room and I got dressed again.

After the ultrasound, I got my blood drawn to test my ovarian reserve again.  He wanted to make sure my first AMH level was accurate, since it had been low for someone my age.  Then I went into a consultation room and met with the nurse.  She gave me an outline of what I should be doing on each day of this cycle on Femara.  I went home feeling very optimistic!

I took Femara 5mg days 3-7.  I started taking my basal body temperature at 5:30 AM every morning I was home, or 3 PM on days when I had worked all night beforehand.  The key is to get 3-4 solid hours of sleep.  I definitely noticed a drop in my temperature on day 10.  I also started using the ClearBlue Easy Digital Ovulation Prediction Kit (OPK) on day 10, but it was negative that day.  I used one of my Wondfo pink dye OPK strips that I had been using prior to seeing Dr. S, and it was almost positive.  I thought that was interesting.  Dye is definitely more sensitive than digital! 

Another negative on the CBE OPK on day 11.  Then, on day 11 at night at work, I started cramping and bleeding for about 6 hours.  Usually when I ovulate I get a feeling of heaviness and have some spotting.  This was hardcore ovulation going on!  I called Dr. S's office when I got off work in the morning and they said to call back if the bleeding starts again.  Days 12-15 I had negative CBE OPKs still!  It didn't make sense.  I called Dr. S's office on day 15, and my progesterone level (which tells if you've ovulated or not) was 28.  Normal ovulation is around 5-10.  Medicated ovulation is 10-15.  So yeah, I definitely ovulated!  It was weird that the CBE OPK didn't pick up on it.  So now we wait and pray and fast and cross our fingers and wish upon a star!                  

Maternal Fetal Medicine Consult

Since Dr. S recommended I meet with Maternal Fetal Medicine (MFM) before conceiving, I decided to get an appointment at McKay-Dee as soon as I could in case there was something he recommended I be doing before getting pregnant.  I didn't think there was much more he could tell me that my specialists hadn't already.  I was pretty much right.  Hopefully my bill isn't too high!  I should get paid for asking better questions and being more prepared than the average patient!  haha.

I waited in the waiting room with 3 other very pregnant women, which is always kind of depressing.  Then I was taken to a consult room with another comfy couch and soft lighting.  This was nice, but in the next room I could hear the quick beating whoosh of a baby's heart beat on ultrasound.  I wished I could've been at the MFM office for that reason.

Dr. A came in, explained he was going to look over some of my test results and clinical notes since he briefly looked over everything and realized I have a lot going on.  He came back about 10 minutes later and asked me to explain all about my lupus and hypertension.  He is a very personable guy, and I think I will like him.

We talked a little about hypertension, and how he wouldn't be terribly worried if my BP was 140/100 if I wasn't having any other symptoms of preeclampsia (increased protein in urine, edema, etc.).  He said I probably already have some microvascular damage, so having a gradually higher BP during pregnancy wasn't going to cause me to have a stroke right then.  If it was a sudden spike up, he would be worried.  But he said if it was much higher than that, I should be in the hospital just like anyone else with a BP that high, pregnant or not.  I didn't tell him it had gotten up to 188/135 last summer!  He echoed my nephrologist in saying that your BP doesn't start to rise until about week 20 of pregnancy.  I was very happy to hear that info repeated because that's almost to the age of viability.

With lupus, there is a higher rate of miscarriage, early and late.  I asked him how early I would see him and if we could prevent an early loss.  He said I would see him first at 20 weeks (yay for not having to spend more money on doctors visits until then!), and there's really nothing anyone can do to prevent an early loss.  He said there is plenty we can do to prevent a late loss, and usually these mothers aren't taking care of their lupus very well or they were having a lupus flare when they conceived.  He said I'm his third patient this summer who was diagnosed as a teenager, almost died from my kidneys being affected so severely, and had barely any problems since then!  I would love to meet these other women!  Darn HIPAA. He also said I could have low-dose steroid treatment if I needed it for lupus, and that it wouldn't cause lasting harm to the baby.

He discussed some labs (APS, anti-SSA, anti-SSB), which indicated my chance of getting a blood clot and having a miscarriage, and if my baby might have congenital heart defects.  If it is found on ultrasound that my baby will have heart issues and their HR is low because they aren't getting enough blood and oxygen, I would deliver by C-section so they can constantly monitor the baby, and I would likely deliver at the University hospital so the baby could go directly to Primary Children's and be on telemetry.  He recommended I take a baby aspirin, just like everyone else has suggested. 

All in all, I knew about a lot of this.  I've done plenty of research, and my nephrologist started telling me a lot of this as soon as I told him we were thinking of starting a family back in 2011.  But it was a relief to get his blessing that pregnancy with lupus and hypertension isn't the worst idea in the world.  Again, if you're reading this, keep us in your prayers!        

 

1st Appointment with RE

The morning of our appointment with the Reproductive Endocrinologist started out with me freaking out because Charles wore this checkered skater-type shirt that I couldn't match, and I wanted us to look "put together" and like we were the perfect couple!  I also wanted us to look older than teenagers.  Charles told me I would pass for a 18 year old teen mom, but only because I put on foundation.  I guess that works, as long as we're married.  haha

We drove down to Sandy, because it was the only office where Dr. S happened to have a Saturday appointment open.  Yay!  Charles could actually come with me, and I didn't feel like I was lying to doctors about having a husband!  Also, distance seriously doesn't matter to us when it comes to this concern.  We were greeted by a nice receptionist, given a welcome packet, and had our pictures taken so they can remember us better when looking at our chart.  That's really smart!  Although, who can forget a short Indian girl who looks like she really shouldn't be a mom yet?

We got called back into Dr. S's consultation office that wasn't really his (he normally is in Layton), and we sat down on a very comfortable couch.  I felt like this is where you put your feet up, your head on a couch pillow and you stare at the ceiling as you recount all of your troubles.  Tissues were also readily available.  He started by saying my name right.  Major points to him.  Then, he made nervous small talk, but it was kind of humorous and didn't make us feel uncomfortable at all.  After that, we jumped right in to discussing my health history first.  He started by asking, "Are you really four foot ten?"  "Uh, yeah..."  You just lost those points you gained.  Better watch your next step!  Then, he said, "Tell me about your lupus."  Haha.  This consumed the next 45 minutes.  Poor Charles was feeling neglected.  We talked about my diagnosis, my 2 month "adventure" at Primary Children's in 2002, high-dose steroids, plasmaphoresis, my surgeries, what systems my lupus affected, the 2.5 years of chemotherapy I did, the 2 years of CellCept - an anti-rejection med so my body would stop hating on my kidneys, how I manage it now, what meds I take, what specialists I see, and on and on.

He admitted to not knowing much about Cytoxan and CellCept, which are two key opponents in our infertility game.  So, he looked them up briefly on several different websites to learn how they impacted fertility.  Apparently, CellCept doesn't have too much of a negative effect.  But Cytoxan is a very high-risk med that can cause a lot of problems.  I already knew that.  But I can promise you that the ICU doctors at Primary Children's weren't asking my mom if she wanted to freeze my eggs while they were busy saving my life, during my first treatment of Cytoxan at age 14.  It wasn't an option to not have chemo.  Dr. S understood how sick I really was when I was first diagnosed, and he made sure I knew that it wasn't my fault I had to have chemo.

He reviewed my hormone labs that my OB/GYN and nephrologist had previously ordered.  My anti-Mullerian hormone (AMH) which measures ovarian reserve was on the low side for a 26 year old woman.  Apparently, I'm in the 20th percentile, so that means that 80% of women my age have more eggs left than I do.  That's a scary thought.  He also mentioned early menopause, to which Charles gave the expected male response.  Great!  So, Dr. S said we need to get started on treatments ASAP to maximize the potential for the eggs I do have left. 

But then he asked a few more questions about my lupus management, and I told him about my blood pressure, and this noticeably changed our conversation.  I told him it got up to 188/135 in August last year when I forgot a dose of Labetalol, was super tired, and had a stressful shift at work.  I was given hydralazine, and then I had a bad reaction to it: migraine, vomiting, BP only came down a little, and HR went up to 130.  He said there are two main drugs they use to treat hypertension in pregnancy: labetalol and hydralazine!  I might not have a choice if I'm in hypertensive crisis. 

He talked to us about fertility meds and said Clomid would not be a wise idea because of the higher chance of multiples, which would be the worst possible thing for my blood pressure since blood volume increases with pregnancy.  So, he suggested Femara, with which you don't release as many eggs as you might with Clomid.  He definitely said the goal would be a singleton pregnancy.  Then, he leaned back in his chair, and said, "You know, there's always other options like adoption."  Yep, and we are planning on that in a few years.  Thanks.  We are here to get pregnant, and we know this is a huge risk we're taking.  With me being a nurse, and Charles and I both being excessive worriers, believe me, we've researched and thought about this A LOT.  I told him that all of my specialists follow me very closely and I have their blessing, and he felt a little better.  He then recommended I see a Maternal-Fetal Medicine specialist before conceiving.  We then came up with a plan.

The Plan: Take Femara beginning with my next cycle, use OPKs more dedicatedly because all the ultrasounds and bloodwork will be based on my results from when I appear to ovulate, and carry on as usual for two cycles.  If there is still no baby, then we'll try Femara plus IUI.  All in all, a very good one hour visit that really made us feel like Dr. S knows us and cares about us individually.  If anybody is actually reading this, keep us in your prayers!                   

                   

Follow-Up

Dr. Lister's nurse called and left me a message that she was recommending I undergo a procedure called a hysteroscopy where they insert a scope to look more closely at my uterus and remove the polyp they found in one of my tubes.  So of course, I didn't take my own advice and googled what is involved in a hysteroscopy!  Did you really expect anything different from me?  lol!  I found out that you are usually sedated for it when it is an operative hysteroscopy, and that was very welcome information.  I'm definitely going to be one of those women that beg for drugs ASAP!  God invented bupivacaine for a reason!

I went to my follow-up appointment with Dr. Lister, and she did a transvaginal ultrasound, a.k.a. the rigid wand of torture that magically emits sound waves.  I think it's funny how they put a condom on it.  Like really, there's nothing more medically advanced to slip over it?  Anyway, after some probing, she determined both of my ovaries looked great.  So, she pulled it out and let me sit up, and we discussed the next step while I still sat there half naked.  Oh the joys of discussions in the OB/GYN office, where you're hardly ever fully dressed!  She said she didn't really think I needed a hysteroscopy to remove the polyp because it was so small and it wasn't fully blocking my tube.  She also told me Charles' second semen analysis looked better than the first, and there were no abnormalities this time.  

So, the next step would be Clomid, a drug that makes you "super-ovulate."  When I texted this to Charles, his mind went to superheroes of course!  (enter in comments about having super strength eggs that can transform into a baby at the speed of light!)  I have heard many horror stories about Clomid, and I'm glad I did because many OBs are quick to jump on the Clomid bandwagon, and some of them don't do proper monitoring.  I learned that you can only take  it for a limited number of cycles in your lifetime, you need bloodwork and ultrasounds throughout the cycle on specific days, it can become a big problem if multiple eggs end up fertilized, and it can thin your uterine lining over time which would make an embryo not be able to stick and stay in the uterus.  Scary stuff.  Not that Dr. Lister couldn't handle it and I'm positive that IHC has Clomid protocols based on recent research.  But I wanted to explore my options.  So, I told her I didn't want to do that just yet.  Then, she very willingly referred me to Dr. Swelstad at the Reproductive Care Center.  That's a sign of a good doctor, when they can refer you to someone that might be able to help you better. 

I called Dr. Swelstad's office, and they don't take our insurance, and we make more than what qualifies for their discounted program.  Boo!  But a consult is practically free (just a specialist copay), so we got an appointment for Saturday!  We went online and filled out our separate history forms because the receptionist said Dr. Swelstad likes to know his patients' backgrounds before meeting them.  I think that's awesome!  So here we go!      

HSG Procedure

My only advice when it comes to infertility testing is: DO NOT GOOGLE how painful something is.  You can google the procedure steps, the risks and the benefits, and what the results may mean.  But pain is something so subjective and different to everyone, that it is pointless to read other people's experiences!!!

I had myself freaked. out.  My OB was in a rush and told me nothing about the HSG (hysterosalpingogram) procedure.  I found it that it's a dye test to assess the size/shape of the uterus and the patency of the fallopian tubes.  I also found horror stories online!  I read all these stories on TTC (trying to conceive) forums about women being in more pain than labor and about having to have their cervixes dilated with metal rods and held open with clamps.  Clamps is such a terrifying word! 

Well, I was a nervous wreck for about a week before the test, and I was sweating like crazy this morning before I went to the hospital.  I never stress sweat.  I took 2 Ibuprofen like they had asked me to do, even though I'm not supposed to because of my kidneys.  I even caved and took my mom with me because I had read stories of women being in so much pain they passed out and weren't allowed to drive home.  So, we got to Outpatient Radiology and signed in.  I had to go to the lab and give a urine sample which came back negative for pregnancy.  I prefer to get BFNs (big fat negatives) in the privacy of my own home, so that was kind of a bummer.  Then, I was taken back to the dressing room where I had to disrobe from the waist down.  They said they would be preparing the instruments while I did this.  I waited for 15 minutes, which freaked me out because I wondered just how many instruments they had to prepare! 

Then, a nice radiology tech came and got me and took me into the x-ray room.  She thoroughly explained everything to me.  I told her I was one of "those" patients who had read about it on the internet.  Although she didn't outwardly do it, I could see she wanted to roll her eyes.  I'm the same way with my patients and families!  Then, I met the radiologist PA before I had to take off my scrub bottoms which was a very nice touch.  We got to shake hands before his hands went into the unknown.  I was also very nervous about having a male radiologist because I've only dealt with female OBs and NPs.  He was very nice and gentle, I have to say.

Here is the procedure for those who want to read on:

There were no stirrups.  I had to just keep my feet on the edges of the x-ray table.  The radiologist cleaned the outer area with betadine, then inserted the dreaded metal speculum.  He then used more betadine swabs to clean my cervix.  Up to this point, it was pretty much like a pelvic exam.  Then, the catheter was inserted.  Apparently I have a tilted cervix, so he had a little trouble getting the catheter through my cervix and up into my uterus.  At this point, I experienced mild cramping.  I gripped the sheet underneath me, but it was nothing to mention out loud.  The tip of the catheter (the balloon) was filled with air so that dye wouldn't leak back out.  This part caused a little more cramping, but still bearable.  There was just a lot of pressure-type feelings down there, not really pain.  The speculum was then removed.  He then injected the dye through the catheter which caused moderate cramping.  I laid on my back for about 10 seconds, then he had me rotate onto my left hip and then my right so that the dye would spill into both fallopian tubes.  I was able to do this with still moderate cramping.  The whole time, I was able to watch the dye flow on the monitor.  It was pretty cool!  The tech in the room helped the PA take pictures and she gave me emotional support when the cramping was at its worst.  I just took deep breaths and gripped the sheet.  Back to supine position, he deflated the balloon, pulled the catheter out and it was done!  They let me "catch my breath" for a minute, then he went over the images with me.  That was super nice because I don't have to wait for 2 weeks until my follow-up appointment to know preliminary results.  I then sat up slowly, didn't feel any reaction to the dye thankfully, (light-headed, dizzy, nauseous, etc.), hobbled in the bathroom and let a lot of dye drain out of me.  Then, I was given a hospital-sized pad (reminded me of when I was 12 before I could use tampons!), and sent back to the dressing room.

It was a very positive experience.  Everything was explained thoroughly, everyone was gentle and made sure I was okay throughout the whole procedure, and the cramps were nowhere near as bad as my Day 1 cramps.  Granted, I did not have a blockage.  If you have a blockage, I hear that's where the cramping can get severe. 

The results: I have a tilted uterus, which doesn't mean I can't get pregnant.  We just might have to be creative in positioning.  My left tube had somewhat of a polyp but dye was still able to flow through.  My right tube had narrowing, but again, dye was able to flow through.  So, there's no real reason why we shouldn't be able to get pregnant from my standpoint.  Yay!      

The Sample

I went to my annual with my Women's Health NP last week.  I mentioned that it had been over a year of trying to conceive, and that I had an appointment next week with the OB she works under.  She suggested we get things going faster and have test results ready by that appointment.  After looking through my lab results ordered by my thorough rheumy and nephrologist, she decided that was sufficient for my testing right now.  So, she gave me a cup  for Charles and instructions.

I had images flash through my mind of Charles having to look at porno magazines in a little "cubicle" along with a few other guys in the same room who were trying to give the same sample.  I was relieved to hear that we could obtain the sample in the privacy of our own home!  The only rule was that we had to get it back to the hospital within 60 minutes.  Game on.

The day finally came when we both had time off together and the lab was open at the same time.  We procured our sample (haha), and had to get past my mom who was sitting at the kitchen table.  It seriously felt like I was a teenager who was sneaking around!  We concealed the specimen cup in Charles' jacket and told her we were going to run errands.  It's not like we are hiding trying to conceive, but it's awkward to just say, "Well, I just helped Charles ejaculate while you were eating breakfast, and now we're going to give a cup of his stuff to the hospital."

We made it to McKay-Dee, and ran inside as fast as we could because it was raining hard.  We got through registration which took longer because there were so much personal information that had changed since the last time Charles had seen doctor.  Finally, they asked for the insurance card.  He gave the lady his Altius card.  The look on her face changed uncomfortably.  Then it hit me.  Intermountain Healthcare isn't an in-network hospital/provider for Altius.  Duh!  Charles has a difference insurance than I do, and I hadn't even thought about that!  She suggested we go to Ogden Regional Medical Center.  We ran out of there as fast as we could, knowing we had about 30 minutes left for the sample to be usable.

We flew on the road to ORMC, went through their registration, watching the clock tick away as we encountered all the same information questions that seemed to take FOREVER.  We had 20 minutes left. Then, we had to wait for the lab tech to come back to the lab because she was drawing blood elsewhere in the hospital.  "Not bigger, just better" is their slogan?  Yeah right!  One lab tech for the whole hospital on the weekend?  Are you kidding?  She took one look at our papers and simply said, "We don't do that here."  Whaaa?!?!  Are you kidding me?!  She wasn't.

Charles was ready to give up.  But I wasn't!  We would have had to wait 3 whole days before Charles could give another sample, and that would be too late to get results next week.  We had 10 minutes left.  So, we got back in his POS (piece of special) car, and by some miracle, it went from 0 to 40 in just a few seconds!  That never happens!  We made it back to McKay, I ran inside first, not caring about who saw our specimen cup of swimmers.  I rushed into registration, looked extremely anxiously at all the registration people and finally someone called our name.  I threw the sample on his desk and said, "We have less than a minute for this sample to be looked at under the microscope, and there's no way I can redo it today!"  Charles walked in and went bright red!  I'm a nurse; I don't care about who sees what bodily fluid.  If you don't want to look at sperm, poop, blood, mucous or anything else that can go in a specimen cup, then don't work in a hospital.  The nice registration man printed out the lab form and sent Charles to the lab with his cup of swimmers while he finished the process with me.  If he was embarrassed, he didn't show it.  But that would've been kinda fun to mess with him if he had been! 

The sperm definitely went on a wild ride, and I hope they survived well enough to be examined accurately!  I guess we'll see when I get results tomorrow! 

 

Moving On

Wow, so much has happened in the past 6 months! Charles had a friend at work (at Murdock Chevrolet), Brandon who decided to get more into his real estate endeavors and so he quit his job at the dealership. He was very persistent in asking Charles if he wanted to sell our house, and I finally gave in to talking with Brandon and seeing what we could get out of it. Our basement flooded in May 2013 thanks to old sewage lines, and that was a huge factor in deciding to move. Ask anyone before that date, and I was dead-set on staying in my 1947 childhood home in Ogden! O-town 4-ever. :)


So, he came over and met with me, Charles and my mom. We wondered what homes with mother-in-law apartments would be like, and if we could find one where the apartment is to the side of the main house (instead of in the deep, dark basement). We went to look at about 5 homes and were not impressed. Some were way too big for the 3 of us, some had little kitchenettes instead of a 2nd kitchen, and some didn't have parking space for all of us. So, we scratched that idea.


Then, we decided to look for houses in Clinton for just Charles and me. Brandon was AMAZING. He took us to see 6 houses every Monday for about 5 weeks. That is at least 30 houses that we looked at (plus 5 from before), and I wasn't particularly excited about any of them. Nothing matched up to my childhood home, and the yards were nowhere big enough to let my Ginny run around freely and chase her tennis balls. Moving wasn't looking all that appealing!


Then, my mom decided she could live in a basement if there was daylight and 3 bedrooms big enough to store all of her stuff! So, off we went to look again at mother-in-law apartments again! We saw about 6 houses that time, and finally found one we liked in Syracuse. We were ready to pull the trigger and make an offer, and my mom freaked out about the money. I don't blame her one bit though; I just wish she'd told us before we got our hopes up! My mom decided we needed to sell our house first in order to get enough money to make a good down payment on a new house.


So, then began the daunting task of cleaning and fixing up our home which my mom had owned for 32 years and had stayed in the family. That meant there is stuff in our house from the 1980's that is not mine and Charles'. It is incredibly overwhelming to clean out other people's stuff! Anyway, after 10 trips to the DI, and having overfilled garbage and recycling cans, we finally were able to put it on the market December 13th. We had no calls until early January, which was just fine with us to get us through the holidays. When Brandon's secretary called to ask if the first showing could happen, I cried the whole way to work. I didn't want anyone breaking into my house and feeling so indifferent about this house that meant so much to me! Don't they know that's where I slept on the floor my first night in America because my mom didn't have a crib? Don't they know my childhood BFFs and I played for hours in my little playhouse outback? Don't they know I practiced the piano for many tearful hours in the basement? But just as we walked through houses in Clinton and didn't care for the carpet or the yard and didn't think about peoples' memories, I'm sure the same thing happened with our house.


After that first showing, we stayed super busy with showings. We had about 2-3 every week, which definitely kept us on our toes with cleaning. I liked to vacuum before each showing just so I could tell where people had walked. "The vacuum lines never lie!" Finally, we got an offer at the beginning of February. Our house was listed for $115K, and they offered $102.5K. Nope. What an insult! Insult to our huge backyard, to the nice condition we had kept the home in since it is pretty old, to our upgrades, just everything.


Then, on February 24th, we got a full price offer. Brandon called and said we needed to jump on it that very day. After more crying on my part and much excitement on Charles' part, my mom signed the contract and we started the whole process. They just did the inspection yesterday, and they didn't find too many things wrong, thank goodness. That might've put me over the edge. It's an old home, and we have given it love! It has been well cared for! They are only asking for a new water heater and for the electrical panel to be looked at by a professional. Easy enough. It also helps that I facebook stalked them and they are a cute LDS young couple. I feel better.


So, here we are, waiting for their due diligence deadline to come next Friday. We will live with my mom until we find something we like with a mother-in-law apt. But turning those keys in and knowing I'll never step foot in the home I grew up in with my mom and sister, where my nephew spent his first 4 years and my niece spent her first day of life, and where Charles and I grew together as newlyweds for the past 4 years, will be the hardest thing I've ever had to do. I've never really moved, so please forgive the instagrams and the facebook posts of me being nostalgic and sentimental. Thank goodness we can take our memories with us.