Yes, I will be a better mother.

There are women that become mothers without effort, without thought, without patience or loss and though they are good mothers and love their children, I know that I will be better. I will be better not because of genetics, or money or that I have read more books but because I have struggled and toiled for this child.

I have longed and waited.
I have cried and prayed.
I have endured and planned over and over again.
Like most things in life, the people who truly have appreciation are those who have struggled to attain their dreams.
I will notice everything about my child.
I will take time to watch my child sleep, explore and discover.
I will marvel at this miracle every day for the rest of my life.
I will be happy when I wake in the middle of the night to the sound of my child, knowing that I can comfort, hold and feed him and that I am not waking to take another temperature, pop another pill, take another shot or cry tears of a broken dream.
My dream will be crying for me.
I count myself lucky in this sense that God has given me this insight, this special vision with which I will look upon my child that my friends will not see.
Whether I parent a child I actually give birth to or a child that God leads me to, I will not be careless with my love.
I will be a better mother for all that I have endured.
I am a better wife, a better aunt, a better daughter, neighbor, friend and sister because I have known pain.
I know disillusionment as I have been betrayed by my own body.
I have been tried by fire and hell many never face, yet given time, I stood tall.
I have prevailed. I have succeeded. I have won.
So now, when others hurt around me, I do not run from their pain in order to save myself discomfort.
I see it, mourn it, and join them in theirs. I listen. And even though I cannot make it better, I can make it less lonely.
I have learned the immense power of another hand holding tight to mine, of other eyes that moisten as they learn to accept the harsh truth and when life is beyond hard.
I have learned a compassion that only comes with walking in those shoes.
I have learned to appreciate life.Yes, I will be a wonderful mother.

~Author Unknown

Dealing with Friends Kids & “I am Pregnant” News!

A lot of our friends have been getting pregnant or have had kids recently. Generally speaking, I have been fine being around kids and friends who have kids. I absolutely adore kids and am ever ready to play with them! I love socializing and enjoy going to baby showers, birthday party etc. Things only get uncomfortable when I am completely surrounded by mothers only (where discussion revolves just around pregnancies, motherhood and their children). I also seem to get frustrated when I see parents who are highly irresponsible towards their parenthood role… I seem to start asking “Why Me?”

I have realized that I get disheartened when I hear about close friends getting pregnant. I feel frustrated and out of control (I am not jealous). It has already been a yr since I started this process… and I don’t know how long this journey is going to be! I am hoping for a miracle! Though, I have been getting very happy, excited and hopeful about hearing from friends and acquaintances that have gotten pregnant after having health/fertility issues! It’s a big morale booster!

Recently, I learned that one of my close friends baby girl has Down Syndrome! I was devastated to hear that! Going through the treatment makes you feel out of control and helpless… though situation like her make you realize how unpredictable life is and you have to make the best of what you have! I have always believed in the quote “It is in your moments of decision that your destiny is shaped -Anthony Robbins”, though my recent experiences make me want to believe that destiny supersedes decisions!

Family & Friends

We did not tell both sets of parents about our situation till we finished our diagnostic work. Things are so complicated and uncertain that it is hard to fathom the situation and the last thing we wanted to do was confuse and stress out our parents! Our parents have been supportive and that is very encouraging! We hope to please them with a grandchild (hopefully) sometime soon!

Only handful of my friends know about my fertility treatment. It is very difficult to really understand fertility issues unless you go through it and I have realized that not all the people I speak with about fertility, are able to digest it well! I personally expect (active) reciprocation back from the opposite person (when I am speaking with someone). I have gotten much closer to some of my friends due to the treatment and unfortunately drifted away from some. It is not that I am trying to disconnect and be selective, but I feel the need to protect myself (psychologically). If I feel that the opposite person in not comfortable hearing about the treatment or is not reciprocating well, I feel disconnected and insecure! I do not blame any of my friends for their reactions or behavior towards my treatment. This has been a great learning experience for us and it is unjust to expect someone else (not involved in the treatment) to understand (the process and the psych behind) it completely. Resolve.com has some great tips for such situations: http://www.resolve.org/site/PageServer?pagename=cop_tainf_home.

IUI – Almost Cycle # 2

I went in for day 3 b/w and u/s for this new cycle (early February 2009). I was positive and hopeful! There was 1 cyst on my left ovary. The doctor mentioned that if the cyst is not secreting any hormone (which would be detected in the b/w), we should be okay with starting a new cycle. The b/w was good; we could start the 2nd IUI cycle!!!

I started off with 75 IU of Follistim again (for the next 4 days). I had started to feel a little discomfort during these 4 days. I went in for day 7 b/w and u/s. I had more than 5 cysts each greater than 50 mm in my right ovary and a few small ones in my left ovary! My ovaries were almost double the size. The cycle had to be cancelled! I was disheartened!

Currently, I am towards the end of this “waiting” cycle. My ovaries have cramped once in a while and I have been tired at times… no other pains in this month! I am going for acupuncture once a week and have not really done any yoga this month (I am too afraid that my ovaries are the size of a football). Hopefully, I will get my AF naturally and the ovaries will be fine.

IUI – Cycle # 1

I started my IUI cycle towards the end of January 2009. The cycle medication normally starts with b/w and u/s on day 3. I was towards the end of my menstrual cycle and was hoping that my AF would start soon (so that I could start my IUI cycle)… though nothing seemed to happen till day 35! So I went in for u/s and b/w to see if I could be induced. Surprisingly, I had not developed any lining on my uterus (to shed during a period), so even if I had been induced, it would not work. The b/w it seems turned out such that… my hormones were at a level that one would have during day 3 of a new cycle. So my RE decided to start my medication.

I administered Follistim (http://www.follistim.com) every night (75 IU for 4 days, 100 IU for 4 days and 150 IU for 2 days) at home starting on day 3 of the cycle. I was scared big time to poke myself in the belly the first night, but honestly it wasn’t bad at all. Though I did realize that I had different sensation every night (from no pain to sharp pain to tingling sensation)! I guess things changed as my body hormone level went up/down. Follistim made me bloated, tired, my boobs were sore, nipples were extremely sore, I was a lot more thirsty, had an increased appetite. My follicles went from too small (less than 10 mm) to 15 mm + as soon as I up’ed my dose to 150. With PCOS (excessive follicles in the ovaries), the doctors do not want to stimulate you to quick, because it could cause a severe hyperstimulation (OHSS: http://en.wikipedia.org/wiki/OHSS). I was monitored (b/w and vaginal u/s) on day 3, 7, 9, 11 and 13. On the 13th day of the cycle (3 follicles > 18mm @ right ovary and 1 follicle > 15 mm @ left ovary), I administered myself the prefilled syringe of Ovidrel (http://www.drugs.com/mtm/ovidrel-injectable.html)! We were supposed to go to the RE on day 14 for the 1st insemination and day 15 for the 2nd insemination (My RE does 2 insemination to increase the chances of catching the ovulation post induction).

Insemination went well! Husbands sperms were collected (both days – good count) and were washed (Sperm Washing: http://en.wikipedia.org/wiki/Sperm_washing). The insemination procedure did not take very long (approx 10 mins) and there was no pain or cramping or bleeding involved. I rested both the days after IUI. The Ovidrel did make me bloated and soar. My ovaries cramped, my feet hurt bad, caused headaches and I was very thirsty… it was manageable and it all subsided within 3-4 days. I went in for progesterone check 4 days past first insemination. Progesterone level was 6.4 units, the doctor recommended taking an Ovidrel shot to up the levels (10 or above is required for implantation to occur). I had similar symptoms to my first Ovidrel shot, though the intensity of all the pain was higher! My ovaries were cramping badly and I couldn’t move much, had some chest pain and had difficulty urinating! I was afraid it was OHSS! I ended up calling the emergency line at the RE’s office and spoke to a nurse. According to her, as long as I had not stopped passing fluids (urinating), I should be okay. She scheduled an u/s and b/w appointment for the following morning. The u/s revealed a few cysts in the right ovary (not very big). Cysts normally subside by the end of the cycle. Sometimes they can persist through pregnancy. If they don’t subside a cycle might have to be skipped (if not pregnant)! My RE mentioned that bloating and pain normally increases towards the end of the day (because of physical activity throughout the day). He also mentioned that since the Progesterone levels were above 3 units (during the progesterone check 4 days past insemination), ovulation had occurred and these cysts were not just left over eggs.

My OHSS symptoms subsided in the next week or so. I was perfectly fine initially during the 2 weeks waiting (2ww). With all the medication I had had thus far, it was hard to tell if all the changes/symptoms were pregnancy symptoms or medication. My August 2008 experience had taught me not to read too much into these symptoms. Though it did not stop me from looking up information online… it just made me a little cautious and less anxious! However as the 2ww almost came to an end, I couldn’t stop myself from trying an EPT! I used the Walgreens brand (I had spent enough $$ last yr to realize that the brand name didn’t make much of a difference) 2 days prior to going to the RE’s office for b/w! It was slightly positive, though it could have been the Ovidrel (HCG)! I tested again the day before (b/w) and the line was much lighter than the previous day! I was kind of mentally prepared for a BFN at the RE’s!

Never ever has this treatment not surprised me (till date)! My b/w results were indeterminate. My HCG level (pregnancy hormone) was 3’ish. If one is not pregnant, the levels are below 2 units. Progesterone levels were 6’ish (not suggesting pregnancy). I was asked to come again 2 days later for another round of b/w. Even though I had anticipated this (after my EPT), I was frustrated and angry! Why me!?! I cried a lot that day, didn’t want to speak with anyone. Though I calmed down after speaking with my husband at night and I was pretty normal from the next day. The second round of b/w was definitely a very BFN for sure! My AF started the following day. I cramped like never before… I could hardly move during the first half of the first day!

Acupuncture & Yoga

By the time I was wrapping up my diagnostic work, I had come across a lot of articles and forums about acupuncture (http://en.wikipedia.org/wiki/Acupuncture) and fertility. Acupuncture is supposed to increase the blood flow towards the reproductive organs, create a balance in your well being (by managing energy) and is also believed to be a stress reliever. It is recommended by most RE’s (my RE does, especially for IVF). At this point of time I was ready to try anything that would help. There are a lot of acupuncture centers around where I live… though it’s very difficult to find a place which is tried and tested! There is not much information available out there with reviews and experiences et al. I called up a few places and compared their information. One of my friends had tried acupuncture (not for fertility) and she had good things to say about the place, so I decided to go to the same center. I visited twice a week until my IUI, followed by the day before and right after the 2 insemination, and then once a week until my IUI results (that is the general norm) during the first cycle. Acupuncture can be pricey! It is not always covered under insurance (my insurance doesn’t cover it). Though the centers normally have some payment plans. The one I go to charges me $50 per visit (initial consultation is $125).

I was a little worried about the needle poking, but it turned out fine. Its normally just a small prick… though my acupuncturist did hit a bad spot close to my right toe and that area has been soar (to touch) ever since. We have been using an alternative spot (for that location) since then. The sessions last for around 45 minutes to an hour. I have felt very relaxed during and after the acupuncture session. It is hard to tell as to how well it is working towards the fertility treatment. My approach towards it is that, it is probably not going to harm me and it’s at least calming me down during/after the sessions… and less stress is always good during this stressful experience/period.

I had practiced Yoga when I was younger and I absolutely loved it. I decided to start it again a month before starting my IUI (I purchased Fertility Yoga by Monica Morell: http://www.fertilityoga.com/index.html). It was very refreshing and I felt calmer and more in tone with my body once I started yoga. Buying a DVD and performing the mudras (posses) at home is a cheaper option than joining a yoga studio. And since I had performed yoga before, I knew most of the posses and it was just a matter of getting back to it. There is a lot of information available online as well. However, depending upon the phase of my cycle, I have had to stop it at times. Ovaries can twist (with the posses) when they are hyper stimulated with all the medication… and that’s just not worth it! Also, some of the posses are not supposed to be performed during the conception/implantation. Speak with your RE/nurse about Yoga during your medicated cycle/treatment.

$ Insurance $

If you think you might have any fertility issue, make sure you get a fertility coverage… it’s worth the extra money you might have to pay! Diagnostic work can go up to a couple of thousand $ depending upon your situation! Medications, monitoring and procedures are expensive and can add up. IUI’s cost up to $5,000 and IVF’s cost up to $15,000 (depending upon where you live/RE). Double check your insurance for the exact coverage, log every conversation and keep track of your bills/invoices. With all the co-pays, things still add up! Fortunately my insurance at least covers 4 Clomid cycles, 3 IUI cycles and 2 IVF cycles!

Treatment – IUI / IVF

After approximately 4 months of diagnostic work (between two doctors and all the tests), the RE finally suggested that IUI (Intra-Uterine Insemination: http://en.wikipedia.org/wiki/Intrauterine_insemination) with injectables made better sense in our case (to start off with). In lay mans language, since there was a sperm morphology issue, it would be better to assist the sperms in getting to the egg without them having to go through the vagina and the cervix. Plus, instead of Clomid (which is what most people start off with for ovulation induction) (http://www.webmd.com/drugs/drug-11204-Clomid.aspx?drugid=11204&drugname=Clomid), my RE wanted me to start with the injectables, which would help in creating more eggs, thus increasing the chances of conception (higher success rate)! Hopefully IUI will work, if it doesn’t work, we would have to go towards IVF (In Vitro Fertilization: http://en.wikipedia.org/wiki/IVF)!

More Diagnostic… HSG & Saline Ultrasound

The diagnostic included a Hysterosalpingogram (HSG: http://www.advancedfertility.com/hsg.htm) to make sure my uterus was okay and fallopian tubes were open. During a HSG, a catheter, or tube, is placed into the cervix, X-ray dye is slowly injected into the uterus which comes out through the fallopian tubes into the abdomen. The dye is radio-opaque, meaning it is detected by an X-ray. The X-rays taken during the procedure evaluates the condition of the uterus and the fallopian tube. HSG is performed between day 6 to 10 of your cycle (assuming your periods are 5 days or shorter). Abstinence is required right from the beginning of the cycle (I missed one cycle because the radiologist didn’t clearly inform me about it… so beware! Fortunately my cycle was very short that time, and I could make a quick appointment with the Radiologist again). I took Doxycycline the day before, the day of and the day after HSG (twice a day). This is an antibiotic and is used to prevent uterine infection. I was asked not to take Metformin the day of HSG. I had to fast for 3 hours before the procedure, had to take an enema to clear my bowel and had to take Tylenol to help reduce cramping/pain during the procedure. The procedure is short… I had intense cramping when the dye was introduced. Though, it disappeared right as the dye passed out of the uterus!

The HSG didn’t quite go well! The radiologist suspected that my uterus had horns… my fallopian tubes were open. I had no idea what the heck that (horn) meant! But it of course didn’t sound +ve!!! I came home confused and looked up information online… never had I known that in reality there are different kinds of uterus (Uterine Abnormalities are congenital: http://babyjava.net/main/index.php?blog=3&title=uterine_abnormalities&more=1&c=1&tb=1&pb=1) I was devastated, I just wanted to know that my uterus was alright and I could carry a baby if I were to get pregnant! Appointment with the RE was couple of weeks away! I was very nervous the day I went to meet my RE. He suspected a septum in the uterus. A septum can divide the uterus into two sections, reducing the space available for a baby to grow, thus causing a miscarriage (along with other possible heath issues for baby/mother). If there is a septum, it could be surgically removed. The procedure takes place right after the AF (when the uterine lining is minimal); recovery period is 2 months (cycles) before one can start TTC again! He wanted to confirm the presence/absence of the septum by performing a saline ultrasound (Sonohysterogram/ Hysterosonogram).

Saline ultrasound is performed right after the AF at the RE’s office. It involves infusing sterile fluid (saline solution) inside the uterus. Thus the walls of uterus separate from each other and any abnormalities that might have been hiding will be easily identified by performing a vaginal u/s. It did not seem as intense as the HSG. There was not as much prep work required and there was no cramping during the procedure. News was +ve… there was no septum, there probably is a slight indentation at the top of the uterus, but is not significant enough to be operated upon in an attempt to fix it. I was relieved… if I was going to get pregnant, my uterus was not going to be a complete disaster! We could now start with the actual treatment!

Fertility Diagnostic

The extra money that was going towards the insurance finally came to good (?) use. In October 2008, we started going to the RE. We have been fortunate enough to be living in a big city, where finding good doctors and other resources are not as difficult as it would have been had we been living in a remote hamlet!

During the initial blood work (b/w), my husband’s b/w result was great! My cholesterol and sugar was on the higher end of normal limit, which is commonly found in case of PCOS; my insulin was higher than the average that women my age have (but with in limit); there was an imbalance between my testosterone-estrogen-progesterone, fortunately my thyroid was normal; rest all looked okay. Initial ultrasound (u/s) showed several follicles (20+) in each ovary (no cysts). I had hoped that the 20 lbs that I had lost in past 1 yr would help me with all these PCOS related issues; however things didn’t quite change much (from my previous annual b/w)! FertilityPlus.org is a good reference for hormone and fertility bloodwork levels: http://www.fertilityplus.org/faq/hormonelevels.html.

My RE wanted me to start with Metformin which would help with the insulin and sugar levels, and testosterone, as well (PCOS & Metformin http://www.ovarian-cysts-pcos.com/glucophage-metformin-pcos.html).

In the mean while (during my diagnostic phase), my husband underwent semen analysis (SA), which revealed that he had a good sperm count, motility, volume; but a lower than average morphology. This, from what I have read, is very common since there are very strict requirements for the morphology if someone is undergoing fertility treatment. Had my condition been normal, the morphology would not have been as significant an issue as it is turning out to be with my PCOS. To me, since his sperm count was good, lower morphology was not as bad an issue as it would have been, had he had a bad sperm count with a bad morphology (example: 1 good in 100 versus 10,000 good in 1,000,000).

My Baby to Be’s Father

I have probably gotten a lot closer to my husband ever since we started TTC, than I have for as long as I have known him. He has been a pillar in my life… always positive and hopeful; he has had to deal with my tantrums, my mood swings, my crying…! And I can’t thank him enough for all that he has done for me! Fortunately, we both have been on the same page about our views related to fertility and the associated treatment!

Baby To Be

Till date, all the signs/symptoms, diagnostic work, treatment that has been performed, I have looked up on the internet. To me the blogs, the forums and medical websites are re-assuring. A way to cope with the struggle, a way to build hope, and a way to stay positive! The things I read are not always positive, but it gives me hope that there are women out there who are dealing with what I am going through… there are treatments for those struggling and there is hope and a positive outcome! The Title “Baby to Be” makes me feel positive and hopeful, yet futuristic!

The Journey Begins

I am not a writer, neither have I blogged before. However, I have realized that with the fertility treatment, I have gained a lot of insight, consolation and hope reading various blogs, forums and medical websites. This is an attempt on my part to share the information I have (gathered), the experiences I have been through… one of the most important journeys in my life till date! It has almost been a year (already) since the real journey started (as of March 2009), and the initial part of this blog is a part of that journey followed by current happenings!

I was diagnosed with Polycystic Ovarian Syndrome (PCOS) in 2000. I was in college and it did not mean much to me at that time. I was on medication for few months (to regulate periods (AF)) and then it was a thing of the past (I was back with my regular AF and no symptoms). In 2004, it resurfaced again, I started having all the classic symptoms of PCOS (acne, weight gain, mood swings, facial hair growth, male pattern baldness and of course irregular AF). That’s when I started Yasmin (Birth Control Pills – BCP… yes I didn’t take BCP till then)… it worked like a charm on me… as if nothing had ever happened. My skin was so good during the 3 years that I was on Yasmin, that people actually complimented me! In the meanwhile I got married.

I have always loved children and to me having babies was a dream I had cherished forever! Two years into our marriage, we had financially and psychologically/biologically started preparing ourselves for parenthood. I lost around 20 lbs (I have never been skinny… a little on the heavier side, have considered myself athletic (I have been a (national level) athlete for 9 years)), watched my diet and exercised, tried to stay positive. We both knew that fertility could be a possible issue and didn’t want to delay things too much (wanted to have the first child at least by 30). We made sure that we took some extra coverage in our insurance so that it would cover fertility treatment (just in case).

My gynaecologist suggested that starting prenatal vitamins in advance would not harm. So I started my prenatals in February 2008. I wanted to accustom my body to it and be physically/biologically fit before I got off of my BCP and started TTC (trying to conceive) (Fertility Acronyms & Abbreviations: http://www.fertilityplus.org/faq/acronyms.html). In April/May 2008, I got off of my BCP… and then started the yo-yo ride!

For the next few months, my AF was all over the place… short (2-3 days long) to long (2 weeks of spotting); …cycles were short (3 weeks) to long (5 weeks). I wanted to give my body some time to regulate itself before we TTC. I felt like I ovulated (Ovulation Signs & Symptoms: http://www.ovulation-calculator.com/preconception/commonsigns.htm) during the first cycle off of the BCP. In the following months there was no way to tell whether I actually ovulated. I spent a good amount of $$ on the Ovulation Prediction Kits (OPK), but felt like they were useless (since they never turned out +ve). I had started entering signs, symptoms, physical/biological changes etc in my calendar ever since I started taking the prenatals, but things stopped making sense. In August 2008, we decided to try… and during that month, I could tell… that either I was going to have a baby in May 2009 (I felt like I had all the symptoms of early pregnancy) or my PCOS (symptoms) was coming back in full swing! From what I have read thus far… your early pregnancy symptoms, your cycle symptoms, PCOS symptoms are quite similar. And your brain can do a fabulous job of interpreting it in your favor! I had bad acne issue, bloating, mood swings, tiredness… of course it was a big fat negative (BFN) (on the Early Pregnancy Test (EPT))! Blood work turned out negative as well. Since, PCOS was a suspect, my gynaecologist decided to do some hormonal check as well. My testosterone was super high (90+), estrogen was low (making my doctor believe that I had not ovulated and would do so in a week or two)… though I was confident I was going to start with my AF in the next couple of days (due to PMS). We did another round of blood work in the next few days, there was no change in hormone levels, and the very next day my AF arrived!

My gynaecologists verdict was that I was not ovulating (anovulation) and was going to have to be induced! In spite of knowing that this could be a possibility, I was not very pleased by the confirmation! He suggested that I can either try to get on to medication under his supervision or see a Reproductive Endocrinologist (RE). I absolutely love my gynaecologist, but I needed something more organized, more systematic… someone who would monitor me day in and day out, someone who could answer my questions. I chose to see a RE! I am a scientist and I need informed “information” to be confident about what I am doing. Lack of information makes me feel out of control… and to me seeing a RE was the only systematic way of dealing with fertility (with constant monitoring and feedback). The fertility clinic we go to consists of a group of 10 RE’s and have good reviews and results. The doctors/nurses can be reached 24/7/365! It’s generally very difficult to find doctor reviews and recommendations. Some of the websites I looked at to decide which doctor I wanted to choose are: Vitals - http://www.vitals.com/, HealthGrades - http://www.healthgrades.com/, UCompareHealthCare - http://www.ucomparehealthcare.com and hospital website reviews in our area.