Urological Update

Today was E's urological consult with what turned out to be the director of the department. He was an excellent doctor, really down to earth and honest without being overly optimistic or depressing. E's physical exam was normal, as we had all expected, and the doctor ordered blood work and semen analysis number 3. We're waiting on the results of the blood work now and semen analysis number 3 will be on Monday.

More importantly, he advised us to manage our expectations. Don't get too high or too low. He said he has seen so many couples spend hundreds of thousands of dollars trying to get pregnant without success. That more often than not, people were not the exception to the rule and that he defined success as a baby in your arms, while most clinics define it as a positive test. That we shouldn't tie our self worth in with our ability to have biological children.

On the downside, he seemed to be laying the ground work for what sounded like inevitable bad news. He talked about friends who have wonderful adopted children. How the most important thing is E and I together as a couple, that we're here because we love each other and to not lose sight of that. I know that it's easy to do, that the stress of treatment, the hormones and failures can take its toll on your body and mind. That having a child can come to mean two different things to each partner and that even a strong relationship can be sorely tried.

The doctor said that if E's FSH results come back with a level like 40, we have no hope of having E's biological babies. Right now we're hoping for normal blood work to indicate a mechanical problem somewhere in the factory. Mechanical problems might be fixable, while high FSH, like my high FSH, can't really be fixed.  He said that if a mechanical problem is indicated, that a biopsy would be the next step. Since he agrees IVF is our only shot right now, if he found viable sperm while E was opened up, he would collect and preserve them for IVF.  I think this would save E a procedure, and potentially lots of money, since I don't think E can product viable sperm via ejaculate.

Overall, we were happy with E's new urologist. Now we just have more waiting, for lab work, for the SA, for some indication of what our next step is. We also need to determine whether we want to continue treatment with Kaiser and pursue their IVF clinic, out of pocket of course, or stick with the clinic we had our initial consult with. The urologist spoke highly of one of the IVF doctors in particular, and said he would introduce us, but I'm not sure they'd even be willing to treat me with my FSH as high as it is.

Another Blow

Yesterday the RE called and said that E's second semen analysis came back at 0. As in not One.Single.Sperm present, he might as well have poured water in the cup. This was after a one day hold, versus E's previous SA which was after a three day hold. 

While the RE had previously said he thought E's poor quality sperm was the result of genetics, he has now referred us to a urologist to rule out things like hormone imbalances and physical problems. I had asked about this during our initial consultation but he had tentatively ruled it out since E's first SA did show sperm present. It makes me really glad that we did another SA to confirm, since I was sure there had to be something more going on than just shitty genetics.

This morning, I called and set up an appointment with a urology specialist at Kaiser on the 10th. I'm not sure they are going to be able to do anything since we have no infertility coverage, but I figured it would pay to start with them before going directly to the outside specialist. The RE referred us to an excellent urologist who is one of the top in the country for male infertility problems, but he would be very pricey. Just in case, we called as got some info about him as well and he has an opening on the 17th if Kaiser is no help.  

We also have an appointment with a genetic counselor set up with Kaiser that I think they're going to cover, though the testing will likely be out of pocket. It will probably be a moot point anyway if we have to use a donor, but I am still proceeding with the intent of using E's sperm. I want to have our babies, not just a baby and I'm not ready to give up on that. 

Bad News and (Not So) Easy Choices

This morning, or more accurately this afternoon, E and I went in for our infertility consultation. Even though I tried to be optimistic, it was disheartening to have our challenges laid out so plainly. The RE went over all our test results and all our options, which are extremely limited. Because E has such severe male factor infertility, we can only go with IVF. Because I have so few eggs, we can only go with IVF. So basically, even if we were only dealing with one form of infertility, we'd still need to do IVF to get pregnant.

Right now E is a bit of a wild card. We're not sure whether his sperm are non motile because they're dead, or because they're just lazy fuckers. Our doctor ran another SA on E and we should have those results tomorrow, but considering the poor quality of his boys overall, the doctor is suggesting that we split the eggs.

Lets say we retrieve 13 eggs, and 10 are mature enough to use. Our RE is suggesting that we use E's sperm for 5 of the eggs and donor sperm for the other 5. That way, if none of E's swimmers are able to produce viable embryos, we still have those 5 other hopefully good quality embryos to implant. If we didn't do this and none of E's swimmers were able to produce embryos, the cycle would be cancelled and we would be out all the money we had spent.

I am not in much better shape than E. I had my AFC and while my uterus looked just fine, my ovaries only had 7 antral follicles between them. That's a pretty awful number for a 26 year old, the RE was hoping to see more like 20, making my high FSH a fluke. Unfortunately, that wasn't the case, my awful numbers are accurate and I really am running out of eggs. Yay :(

Now we get to wait for a phone call tomorrow. If E's results are improved, we can proceed with IVF. If they're still awful, we need to seriously consider whether we're okay with using donor sperm.  E was really against it when we discussed it before, but it might be the only way we can achieve a viable pregnancy. It's a lot to deal with and we're going to have to do some real thinking.

Out of control

I think the most difficult part of the infertility process for me has been the loss of control. I'm one of those people who really doesn't like to be out of control and unfortunately, infertility is something I have absolutely no control over right now. Tomorrow is our first consultation with an infertility specialist where I'll have an AFC done, a ultrasound to count my resting follicles, and we'll be going over IVF and any other options. This whole process has been weighing on my mind, I even dreampt about it last night. The doctor was doing my ultrasound and telling me that actually my eggs were just fine and if we could simply make E's swimmers swim, we could do IUI instead. I'm not sure if I should be holding out hope for that, but I've got my fingers crossed.

If it were only the infertility, I would probably be able to handle it just fine, but instead we seem to have walked into a shit storm of problems. Over the weekend, my best friend J's mother had a stroke. She is like my other mother and it's really hard to see her so out of control too. The doctors originally said she'd be back to normal within a day or so, but now it looks like she will need a little more time to recover. A stroke, even a small one, is a big deal and should serve as a big warning to her that it might be time to slow down and take some time for herself.

Then, to add to the general stress, this morning I woke up with ringworm. That's right, I said RINGWORM. Weeks ago I brought Button to the vet because she wasn't feeling well. They ran some blood work and had to shave her chin to get access to a vein. A weekish later she had some fur loss and dry flaky skin on the back of her neck and chin so I called and asked if it could be something like ringworm. Our vet reassured us that it was just stress, which was easy to believe because she stressed herself out so much that she gave herself a fever, and directed me to put some neosporin on it. As it turns out, the clippers they used to shave her chin weren't completely sterile and she brought home ringworm along with a prescription for a new diet. Joy.

I for sure have ringworm where Button lays in my lap, and I may have some on my thigh as well. It's making me feel really gross and I was freaking out about the doctor tomorrow thinking I'm diseased until I realized that I could just put a band aid on it. I think it might be time for me to slow down and take a breath too -_-

That B*tch AF and Planning for Maybe Someday

AF arrived with a vengeance today that viciously stamped out any hope that we might still conceive on our own.   Even though I know, logically, that E's swimmers can't swim, everything about this month pointed to possible success. I was taking Metformin, FertilAid and FertilCm, we used Preseed, our timing was literally perfect.  I thought that maybe, just maybe, one really determined guy might have made it through. Plus, we just ordered a whole bunch of vitamins for E to improve his count and motility, and the laws of the universe clearly dictate that we should get pregnant right before we get a chance to use all those expensive goodies we already paid for. Apparently, E's swimmers didn't get the memo.

So after feeling miserable and sorry for myself most of the day, with the added PMS hormones making me feel like my chest was/is being crushed under the weight of my grief and yearning, I decided to distract myself with some photoshop decorating. I wanted to work on picking out a new aquarium to replace my current set up that is getting a bit old, but my mind was too stuck on babies.  I will blame the hormones again, but the truth is that it's difficult to think of much else these days, hormones or no.

I've mentioned before that I'm a bit of a planner. I like shopping in advance, prepping early, spreadsheets with color coded lists and goals and budgets. With this one track mind, I already have a vast amount of baby stuff stored that I've been buying over the past twoish years. I won't confirm its existence, but there might even be a list of every item organized by size and type so as to keep me from over buying in any one category.  First it was just a really adorable onesie or toy that was too cute to pass up and easy to put away for the future. Then several stores had unbelievable sales, there were some great craigslist finds, a fantastic thrift store and before I knew it I had amassed enough designer baby clothing to open a small boutique.

I have a very strong preference for gender neutral items and for the most part, didn't purchase anything that you couldn't put on a boy or a girl. There are a couple girly outfits, maybe 4? that I figured I could sell or gift if we don't have a little girl, but everything else is pretty neutral.  We could probably have twins tomorrow and have enough clothing to dress them until they're 2, with occasional gaps where one size category is a bit light. We also have my favorite LifeFactory bottles, some organic baby products, a couple blankets, some towels, some toys, even two terry cloth crib mattress covers. I freely admit that baby shopping was a form of birth control "we are waiting to have a child now, but I can buy this and know we'll be able to use it in the future!" and it has definitely helped me feel prepared and like we're making some sort of forward progression in the face of our complete lack of success.

Among my shopping goodies is the crib set and some nursery decor that I can't wait to use when we're finally successful. I fell in love with it the moment I saw it and haven't wavered in my desire to use it since. Using it as a starting point, E and I have already designed the nursery we'd like our future baby to have. Of course this was based around the idea that we'd have a singleton baby, but I'd feel perfectly comfortable adapting it to twins if we end up that lucky with IVF. Again, it's very gender neutral and it gives me hope that one day we'll have a baby to go with it.

I fully realize that it's kind of pathetic to be planning a nursery for a baby that doesn't and might never exist, but I have to hope that we will be successful eventually, even if we have to do multiple rounds of IVF. E and I want to be parents too badly to give up, however we have to build our family, and photoshopping our favorite items together made the weight crushing my chest feel a little lighter this evening. I think I might be a bit of an oddball here too, from my limited experience with the infertility world, it seems that most women find it too painful to see and interact with babies and the things that go along with them. I feel completely the opposite, spending time with my wonderful friends and their equally amazing kids makes me feel even more hopeful for the future instead of depressed about the present.

There's no denying that our fertility present sucks really, really hard right now, but someday in the not so distant future, I will be putting together this nursery for a little one of our own.

Two wrongs can't make it right: The 30%

I know I said we'd be getting results back by the end of the week, but it ended up taking forever to get our hands on the test results. My cortisol results came back negative for Cushings, which we weren't at all surprised about, but I suppose that is good news. Unfortunately, we did not get so lucky with E's Semen Analysis.

E's results came in last Monday and due to some fax mishaps, we weren't able to get our hands on them last Thursday. Once we did get them, I kind of wished they hadn't come in. It turns out that we are dealing with rather severe male factor infertility - low sperm count, less than 1 million, and 0 motility. It actually says 0, not low, or hey just a few are determined enough to swim, actually 0. What lazy little fuckers. E and I keep picturing them playing on a PS3 like nah, I could move but I'm much too busy.

This news puts us into the worst 30% - 30% of couples have female factor infertility, 30% have male factor infertility and 30%, including us, are unfortunate enough to have both. Basically, we have 0% of conceiving on our own. Kind of like 0% motility.

Today we had a phone consultation with a doctor at one of the local fertility clinics. I don't know the first thing about selecting a fertility clinic, but this one offered a free phone consultation so I figured it was a good first step. E and I spoke with him for a few minutes on the phone and once he heard my lab results he pretty much said, aw crap, you should have started fertility treatment yesterday, you have diminished ovarian reserve/premature ovarian failure/old and moldy eggs.  He was less worried about E's abysmal SA results since all he needs is one spermie to create an embryo, even if it's poor quality and even if he has to go in to E's testicles to get it.

He immediately booked us for the first available appointment after this cycle ends so he can ultrasound my ovaries and see if there are any follicles. There should be some, since I definitely ovulate every month, but I don't know about their quality. And of course, since we have no infertility coverage, this is all going to be out of pocket. After we hung up with him I had to call back and speak to their financial department to find out a little bit more about cost. It seems that the appointment will run us $200 and the ultrasound either $275 or $700 depending on whether it's a regular ultrasound or a fluid ultrasound. This is where I'm officially starting the tab for our infertility treatment (Plus E's SA!), if there's a higher power out there, please have mercy on my uterus and our checkbooks.

(Source)

It seems crazy to be running out of eggs at only 26 but I guess this is our new reality. Even though the doctor didn't tell us anything we weren't already expecting to hear, it still hurt like hell to hear it confirmed. I felt like crying all over again and I think it's really starting to sink in for E. I really hope this fertility clinic is a good place, because I feel a bit too fragile right now to start calling places and asking for references. I'm sure I'll pull myself together tomorrow or the next day, but for now it just hurts.

My positive spin for the day is that if E's swimmers could swim, we would already be pregnant or have a baby right now but have NO idea that I'm rapidly running out of eggs. We would have tried to have a second child in a couple years only to find that I am completely out of eggs and have no chance of having another. Because his sperm can't swim, we have the opportunity to address these problems now, while I still have eggs, hopefully enabling us to bank some embryos and have more than one child in the future.

Love is a Verb

I came across an article on Facebook this afternoon that I almost didn't click on. It was called "I Didn't Love My Wife When We Got Married". My first thought was "Well why did you get married then??" but it was an intriguing title and hooked me just enough to click the link. I casually read through it, pausing at the point where the writer talks about his accelerated courtship, and began to pay a bit more attention when he talked about how the fire of a new relationship died away in the face of practical daily life.

I’m a ridiculous, emotional, over-sentimental sap.  I guess that’s why I told my wife I loved her on our second date.

I had tried really hard up to that point to hold it back, honestly.  I wanted to tell her on the first date, but I knew that would probably be weird.

I still remember her reaction.  She kind of gave me this half-shy, half-amused smile.  Then she nodded and looked off into the sky.

I wasn’t heartbroken by the response.  I think part of me recognized that she was much smarter and more modest than me.

But as time has gone on, I also realized that she knew something that I didn’t.
Like most Hasidic Jews (we both became religious later in life), our dating period lasted a very short time.  After two months of dating, we were engaged.  Three months after that, we were married.

And that whole time I was swooning.  This fire was burning in me, a fire that burned just like that second date: I was in love.

But then we got married, and everything changed.

Marriage, quicker than I was ready for, did this thing: it started sucking away that emotion.

I tried so hard to keep that fire going, to keep that emotion alight, but it got harder and harder.

I mean, how you can feel that burning love when you’re sitting at the table discussing how to use the last twenty dollars in your bank account?
How can you feel it when you get into an argument?
How can you feel it when you think it makes perfect sense to put your socks on the floor after you’re done with them, and she has this crazy idea that they need to go in the laundry basket?

There was no way I could keep that dating fire burning as practicality invaded our lives.
And at first, it drove me nuts.  That emotion meant love!  That excitement was how I knew I cared for her!  But suddenly, life was this grind.  Even when I was with her.  Especially when I was with her.

And even worse, it seemed that the harder I tried to be sentimental and lovey-dovey, the less it was reciprocated.

E and I were together for 9 years before we got married and I think a huge part of our relationship is explained by the idea that love is a verb. We started dating when we were only teenagers, a bit selfish and certainly swayed by that burning fire of new romance. I think we may have felt even more of that passion than some people, since our relationship developed first as a teenage love and then later as a more adult love. I "fell in love" with handsome and funny E in high school, and then all over again mature and charming E in college. I won't lie and say we didn't have some serious pitfalls along the way - after all, growing up is tough to do when you only have to think about yourself and your own feelings, let alone another person - but it wasn't until our relationship became "boring" that I think we truly fell in love.

But it wasn’t that she wasn’t giving me love, it just seemed to come at different times.
Like, when I offered to do the dishes.  Or make dinner after she had a hard day.  Or, once we had a daughter, when I shared the responsibility of watching over her.

I don’t think I noticed this consciously for a while.  It just kept happening.

But I think it had an effect on me.  Because as our marriage progressed, I found myself offering to help out around the house more and more.

And after each time, there would be this look she would give me.  This look of absolute love.  One that was soft and so beautiful.

It took me longer than I care to admit to understand what was happening.

But eventually it became clear.  Through giving, through doing things for my wife, the emotion that I had been so desperately seeking naturally came about.  It wasn’t something I could force, just something that would come about as a result of my giving.
In other words, it was in the practicality that I found the love I was looking for.
And what was even more interesting was that once I realized this on a conscious level, and started trying to find more opportunities to give, the more we both, almost intuitively, became lovey-dovey.

And now, as I’m a bit older and a bit more experienced with this relationship, I’ve finally come to realize something. Something I haven’t wanted to admit for a long time, but is undeniable.

I didn’t love my wife on that second date.
I didn’t love her when we got engaged.
I didn’t even love her when we got married.

Because love isn’t an emotion.  That fire I felt, it was simply that: emotional fire.  From the excitement of dating a woman I felt like I could marry.  But it wasn’t love.
No, love isn’t an emotion or even a noun.  It’s a verb.  Better defined as giving.  As putting someone else’s needs above your own.

Why wasn’t I getting reciprocal lovey-doveyness when we were first married?  Because it wasn’t for her.  It was for me.  An emotion I had in my chest.
And even when I let it out of my chest, it wasn’t love.
Being sappy isn’t love.  Telling someone you love them doesn’t mean that you do.
And that’s why my wife just gave me that half-smile.  She knew, even if I didn’t, what love really is.

Read the rest of the article here.

I've been told that my relationship with, and now my marriage to, E is "boring" on more than one occasion.  I usually shug it off because really, the flashy passion of a new relationship is much easier to see and explain than the quiet love in an old one. In our house, love is emptying the dishwasher, cleaning the potty box or folding the laundry. It's picking up E's Fav Red Starburst or putting his registration sticker on because he hates doing it. Sure there are romantic dinners and date nights out, but there's nothing sexier than a man who will clean the potty box without being asked.  While it's a little sappy, and I still find Disney movies sweet, I do think this particular author is able to capture the giving action of love with honesty and clarity.

Now if only E and I could get a chance to fall in love all over again over changing diapers and late night feedings. We're still waiting to hear back from the endocrinologist and fertility clinic but hopefully we'll have good news soon.

Two to Tango

Even though we know there's something definitely going on with me,  it takes two to tango and my doctor instructed us to set up a Semen Analysis for E. There is a male factor to infertility in 30% of cases, and another 30% where there is both a male and female factor. Our present insurance doesn't cover any aspect of infertility, so we had to go outside the system and visit a fertility clinic.

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While the staff at the clinic were very nice, I think it was definitely an unpleasant experience for both of us. Poor E had to become better acquainted with a cup than I'm sure he ever wanted to be, and I got to discuss out of pocket price scales for infertility treatment. I keep saying the word "Infertility" and expecting to become desensitized to the sting, but it still doesn't seem like I'm referring to myself. My family doesn't deal with "infertility", my mother had my sister and I at 34 and 38 without blinking, so what business do I have having problems at 26?

As it turns out, the clinic we chose for it's receptionist's kind phone voice, it's close location and low SA cost - only $125 instead of $225 like the bigger clinics, is not in our future insurance network. After a little prodding, they don't like giving out prices unless you're sitting in a closed appointment room, they told me that their IVF cycles are about $16,000 a pop with medication, while an IUI will only set you back about $1200. At this stage, they still don't know what's wrong with me or if E has something going on too, but my doctor seems to be hinting that we need to plan for trouble.

After a few minutes in the tidy but infertility filled waiting room, I also noticed that I felt a little bit out of place there.  All the other patients seemed to be business professionals with about 10-20 years on me and it really hit home again that most people don't have these issues at my age. E and I are still hoping to be younger parents, although that window is closing quickly, and I can't decide if it's a good thing that we're getting a jump on this problem early, or a bad thing that we're already here when we're both supposedly so young.

Our next step is basically to wait. Wait for the endocrinologist to get back to my Ob/Gyn about my screwed up hormones, wait for orders for more tests to be sent in, wait for the SA results to come in for E, and wait to find out why we can't seem to get pregnant.