Canopy Cat

Look who figured out how to jump on top of the fish tank. He's oh so clever. Doesn't he look stately posed up there, right before he knocked the fish food off so he could see it roll? Clever boy.

HSGs and Saline Ultrasounds

After much anticipation, I finally had the saline ultrasound and HSG this morning! And they weren't too bad.

The saline ultrasound was worse than the HSG, but the AFC/Exam portion of it was worse than the actual saline portion. I am definitely not a fan of the trans-vaginal ultrasounds, they are fast rising to the top of my things that suck list. The Dr. had a tough time counting follies on one side and had to press down on my stomach while pressing up with the wand which was really uncomfortable. She also had a tough time placing the catheter (speculum, dilate the cervix, thread the catheter through and up into the uterus) so it took awhile, but the saline injection itself wasn't too uncomfortable. All in all, I was really glad E was there holding my hand.

My ovaries looked fine, if rather empty, and my uterus looked fine too. The only concern was that she thinks she dislodged a piece of my endometrial lining when she put the catheter in but she was only 90% sure. If the little blob wasn't endometrial lining, it could have been a tiny polyp so she suggested I come back for another test, a Hysteroscopy. It sounds like an awful test (several needles to my uterus??? while I'm awake??) but she said if we're going to do IVF we might as well check everything :(

I'm still not sure how I feel about it, especially since I'm pretty darn sure it was just dislodged lining. She did a detailed ultrasound before inserting the catheter and it wasn't there until after she put the catheter in. If I go through with the test I'm supposed to start taking progesterone tonight which will thin out my lining and stop the 10.5mm follie she saw developing from maturing. I'm a week away from ovulating, from that little follie being ready to go. Logically I know DH and I have no chance of conceiving with 0 motility but actively preventing any chance just feels so wrong.

Since the RE had such a tough time getting the catheter in, she said she was going to leave it in so we could use it for my HSG. Then she accidentally pulled it out at the end, working on autopilot. Since she does these all day and the radiology department has less experience with cervixes, she put in a second one which was just soooo much fun -_- And as I'd read, you definitely leak saline afterwards, I didn't notice until it went down my leg, while I was still laying there and got my socks wet, ugh. I then got to get dressed with the catheter taped to my thigh, go down 4 floors, fill my prescription at the pharmacy, cross the street to another building, go up a floor and stand in the waiting room since I couldn't sit -_-

That was probably my least favorite part of the experience, the radiologist later asked me how I got there since I didn't have a wheelchair and you don't generally walk around with a catheter hanging out of your ladybits. I told her I took tiny steps lol.  After they wouldn't let E in, and the radiology tech tried to direct me into the wrong position, I was really glad that I'd had it put in by the RE, even if I had an uncomfortable walk. All the radiologist had to do was plug into the catheters IV port and inject the dye. Both tubes were nice and open, the dye shot through one side and after I tiled slightly, shot through the other, and not a single cramp from the dye, though it could have been that I was so uncomfy already I didn't notice.

All in all not too bad, a little uncomfortable but not awful by any stretch. 

SA Number 5, Christmas Hope??

We just got E's 5th semen analysis back and we are SO confused! I have been shoving supplements down E's throat  encouraging E to take FertilAid for Men, Count Boost for Men and Motility Boost for Men for the past few months and I can't believe they might actually be working. Keep in mind E's hormone levels have always been perfect, so its not like the supplements could correct something that wasn't broken, and we still don't have the results of his genetic testing yet, but look!

SA 1 at Lab A: 0.65 million, 0 motility
SA 2 at Lab B: 0
SA 3 at Lab C: 0
SA 4 at Lab C: 10 million, 0 motility
SA 5 at Lab C: 23 million, 0 motility

Again his doctor doesn't seem to be too enthused, he ordered another SA for him and said we should focus on my procedures tomorrow. The motility is still, and has always been, 0 and the morphology is always N/A, I think because they're don't grade them if they're not moving. We're trying not to get our hopes up since 23 million dead sperm are no more useful than 1 dead sperm, and they might still be genetically defective, but we're so so glad to see the number moving impossibly upwards!

Tomorrow is the HSG and saline ultrasound, I'm not expecting to see anything wrong on either test so hopefully our goodish news streak will continue. 

Merry Christmas Everyone!

Jew Tree 2013

This year Hanukkah was so freakishly early that it barely felt like the holidays. We didn't have our tree in time, because who has trees before Thanksgiving? and all our gifts were stored on the top of the living room Armoire. It was pretty sad. Because of the rather pathetic holiday spirit in our house, and the fact that Hanukkah was over on December 4th, it was suggested that we might forgo our tree this year. 

Not having a tree probably wouldn't have been awful, but it's one of the only holiday traditions that E and I have carried with us from house to house. It doesn't feel like the holidays without it, and with all the TTC crap we're dealing with, it turns out it means a lot to have that little symbol of the holidays in our home.

So, E and I began looking. We checked out our usual lot, as well as a handful of others, and nothing was looking right. Our environmentally friendly tree lot, Santa and Sons, had gorgeous trees, but they were all around $200+. The smaller lots had better prices, but really shoddy, sad looking trees. I was starting to get pretty discouraged when I happened upon a Groupon for Mr. Jingles, $35 for $70. Most of their trees weren't "perfect" either and E was starting to lobby for us leaving when bam! there he was. Propped up against the fence in a corner of the lot with a big gnarly bush in front of it, was a gorgeous, hugely fat Noble Fir. E was pretty sure he'd be too big for the space, being nearly as wide as he was tall, but I was in love and he was perfect.

 

Don't let the size comparison fool you! Our tree is a little shorter than normal this year, but the super helpful tree lot guy was 6'5" and he's standing on a little ledge here. E was still pretty hesitant but, helpful again, the tree lot guy sealed the deal for us. Instead of buying the Groupon, because Groupon would take a cut, tree lot guy suggested he just give us the discount as is. He also quoted us the tree at the 7-8 foot price, so instead of $115, our tree was $45. They would even put our Santa and Son's stand on the tree for us. E was sold. 

  

Giddy with our tree purchase, another Mr. Jingles employee loaded him up and we set off to make the very short trip home. I think we got maybe one or two blocks around the corner before we started to seriously regret not purchasing at Santa and Sons. While we love the tree, it was crystal clear that the lot guy had absolutely no idea how to tie it down. We had to stop over and over to tighten the increasingly slack, thin cords, while the tree slipped further and further back and I held onto it out the passenger window. It was an experience I have no desire to repeat and we were so glad to get our tree home in one piece.  Lesson learned: at least where tree tying experience is concerned, you get what you pay for.  Our Santa and Sons trees never budged on a journey 4 times as long. 

Finally we got our beauty home, squeezed him through the front door and stood him on his thankfully sturdy stand. Another surprise awaited us when I realized that our water absorbing floor pad had been peed on by a cat, so we covered the floor with tarp before putting down towels. This system works well for us, it protects the floor from any spills and allows us to fold up the towels and shake out any needles when it's time for the tree to come down. My sister L usually partakes in the tree trimming, so E and I wound our 5 million lights around the tree and waited for L to come over and help with the ornaments. 

All things considered, our 2013 Jew tree has turned out to be a surprising success. Fat and bushy, he fits perfectly in our tree space and looks gorgeous decked out in all our ornaments. I can't speak to his longevity, though I suspect he won't last until February like a Santa and Sons tree, but we are so glad he didn't fall off the top of my car.

Lab Results!

On Saturday we returned to the Kaiser lab for our multitude of tests. E submitted another semen sample and gave another 3 vials of blood, and I had the extreme pleasure of giving 11 vials of blood. The experience could have been horrible, but I got a wonderful tech who found the vein on the first try, even though she couldn't feel it. I'm so grateful for techs like her :)

Now that a couple days have gone by, the early results are starting to trickle in.  My TSH has come down to just below 2.5, which is still high for me but not as bad as we thought it was. It also turns out that I have the exact opposite blood type that I was told I have by Kaiser. In high school I donated blood at Kaiser for my grandmother's surgery, and a few days later was given a little card with my name and blood type on it. For over 10 years I've been living my life and telling doctors that I'm B- when, according to the newest test, I am actually A+. Mind blown. I'm not sure how a mistake could have been made at the blood bank, since I'm assuming my most recent test is accurate, but it will be nice to not need the RhoGam shot if/when we do get pregnant. I'm still waiting on the results of the other lab tests but they'll probably take a few weeks.

In even bigger news, we got E's 4th SA back and the results were totally startling! So far we've had a 0.65 million, a 0, another 0, and this last one showed 10 million! There was still no sign of any motility so we still don't know if we can obtain anything usable but the numbers were so shocking that E didn't believe them. Our doctor has suggested that its a one time fluke and we shouldn't get our hopes up but I've got my fingers crossed. We've been supplementing the crap out of his sperm with FertilAid for Men, Count Boost and Motile Boost and it would be great to know that they're actually working. His next SA, number 5, is on the 23rd and my tests are on the 26th so we're keeping our fingers crossed. 

New RE = More Tests

So after waiting over a month for the urology appointment, the Kaiser system worked a little faster and we were able to get in to see the RE on Black Friday. My overall impression of her was positive, she allowed us to share our story and explain where we are and agreed with most of our assumptions and concerns. For me, she ordered more lab work as well as a saline ultrasound and a hysterosalpingogram. For E, another couple lab tests. Once we begin the procedure for IVF, Kaiser will no longer cover anything so she would like to cover all our bases now.

I will have to go in for my labs on Monday and pick up a course of antibiotics for the hysterosalpingogram since E had to get to work on Friday and we didn't have time. The RE said she very rarely has a case where they can't find any reason at all for male infertility and thinks E might have a microdeletion on his Y chromosome. If he does, the location will play a big part in whether we're able to retrieve viable sperm. And, if we can get viable sperm that produces viable embryos, we will have to have PGD to select for female embryos since any male children will inherit the same deletion.

However, given the information we have thus far, it's likely that we're going to have to use a donor. The RE does agree that I have diminished ovarian reserve and is very concerned that we may have a rapidly closing window to retrieve viable eggs. There was also some confusion over my AFC, during the appointment the RE at the fertility clinic told me 3 and 4 follies for a total of 7. However, the paperwork he faxed over said 3 and 7 for a total of 10, which while it would be AMAZING, doesn't match up with my FSH or my memory. Regardless, the new RE is concerned that in a couple years I will not have any eggs left.

Given that prognosis, we need to think seriously about the IVF vs IUI decision. Kaiser would pay for an IUI, which would be much less invasive and inexpensive. If we were successful, it would probably be at least 2 years before we tried for a second child and by then I might be completely out of eggs. If I did still have high quality eggs left for siblings, we would need to store our donor of choice and do IUI again. If we do IVF now, it will be entirely out of pocket, more invasive and expensive, but will hopefully yield enough embryos that we can freeze some and use them for a second and/maybe third child. It would also mean we would have the same donor for all our children since the embryos would all be made at once.

We've been talking back and forth about it and have just started to casually look at donors online. We won't have DH's results for another month since they have to grow the genetic test in culture, but they probably won't be good. In the meantime, the RE wants me to take DHEA three times a day, keep taking a prenatal and see if I can get my thyroid levels down. While all my tests for the past 10 years have been below or around 1,  my last one was 3. Although it's still technically normal, numbers over 2.5 are associated with much higher rates of miscarriage so I'm going to need to do something about that.

Going back to go forward

The end of November is here and E finally got the chance to see the new urologist. I, of course, had jury duty all day so he had to go by himself. We arranged to keep me on speakerphone, since facetime wasn't private enough, so I could at least listen in on the appointment and hear everything first hand. It was quite awkward pacing the courthouse halls talking about motility, count and the failure of my ovaries, but I'm glad I got to participate.

Even though we've run a whole host of tests, this new urologist wants two more semen analysis tests and another set of labs. E started the blood work and we have a specific schedule for the SAs, I think they're going to be more detailed tests this time. Our last Kaiser SA reported 0 as "less than 2 million" so the new urologist thinks it wasn't a sensitive enough test. Like just about everything in the infertility process thus far, it could turn out to be a good thing or a bad thing.

E might not have a 0 count which would mean he can produce sperm which would be amazing! However it would also mean that there isn't something correctable like a blockage that we could reverse easily to get him to a normal count. There's also the concern about motility though, which suggests that the sperm he's producing isn't viable. It all points to IVF again, so while the particulars have changed, I think the end result is the same. 

Our next appointment is for me on the 29th. I think it's going to be another general "this is how the infertility process goes, these are the tests we run" even though we have already had that conversation with several different doctors. At least I was able to get our records faxed over.

I know the infertility process isn't going to be easy, but I sure wish it was less repetitive.

E Update

After lots and lots of anxious waiting, E's results are in. His lab work was absolutely and completely normal, I'm actually pretty jealous of his FSH level, it was way way better than mine. Unfortunately, or fortunately? his third semen analysis came back at a zero. We aren't sure if this indicates a partial blockage, which would be fixable with microsurgery, or a genetic problem like a lack of the cells that produce sperm.

The next step is a biopsy to see if there are any viable sperm in there. You'd think since all the medical professionals agree on this course of action, that it wouldn't be too difficult to move forward. Unfortunately, you'd be wrong. E can't proceed with his biopsy with his current urologist, he needs a specialist in the urology department at a different Kaiser.  After E's results came in, his urologist said he was referring us to this new urologist. Then, he accidentally forgot to put through the referral before he went on vacation. In the two weeks it took E's urologist to get back from vacation, almost the entire month of November filled up :( We were expecting this so I had tried to schedule the appointment sooner, as both the current urologist's nurse and the new urologist's nurse knew the referral was supposed to be sent, but it was no good.

Now that the referral is finally in, the new urologist's office refused to schedule the appointment because our insurance still shows no infertility coverage. I had to explain that the new coverage is coming and argue with three different people before they agreed to make the appointment.
E has his next appointment on November 25^th, which also happens to be the day I have jury duty and we'll have guests from out of town >_< I expect it will be another consultation instead of the biopsy he's supposed to be having so at least it won't slow him too down too much.

We did get the good news that our new insurance should be in effect as of November 1st but it didn't come quite fast enough to stop the payments for our individual plans. I also called on the first to confirm the new plans and cancel the individual ones, and they had no record of the new ones. I'm assuming it takes a little while for all the paperwork to be processed on their end, but it sure isn't making things easy and the waiting is driving me nuts.