We're Back!

...well, not quite.

We had the past two months+ off to enjoy ourselves and family time around the holidays. It was glorious!

That said.. I am ready to get back. I am ready to try another clinic and hopefully find a place where we fit. I have had several long conversations with friends, family, my therapist and my husband and it all comes back to being totally upfront with our new doctor from the first appointment. I am going to share our past experience, what we want, what we don't want.

First appointment is beginning of February and we're back. Stay tuned..

xo - amanda

Nov 2013 Updates + A Sign Off (for now)

I am going to attempt to recap the last month or so of our lives in a tiny little blog post. I left off on October 10 - We started and are still in cycle 11 and month 22 and 23. My doctor decided we were going to go with the same protocol as the previous cycle but with an increased dosage of the meds - 7.5 mg of Femara for 5 days, Oct 14-18. I went in for the normal monitoring appointment and there was no growth of follicles. Back in three days - nothing.

In the meantime I had my MRI to check on my pituitary gland (http://madasm.wordpress.com/2013/08/05/prolactin/). It was a semi-traumatic experience. My darling husband came along but had to wait in the lobby the whole time. The nice tech started telling me about what was going to happen and I cried - not an ugly cry or an all out cry - but, tears just falling out of my eyes. Unexplained, I guess you could call it. It was time for the IV crew and it took three different folks FIVE tries to start an IV on me -- see bruised vein below. 

It turned about that everything in my brain was 'normal'. Phil may disagree :). I started a medication that should decrease my prolactin levels which hopefully will help in the aid of getting knocked up!

On 10/30 this cycle started to unravel. Phil and I had a meeting with Dr. E to discuss what's happening and where we go from here. It went terrible. She mentioned IVF 6 times AFTER we told her that it's not in the cards for us. The conversation went a bit like this:

dr. e - is it financial?

mahals - that is a part of it, but not all of it. it is just something we have discussed and it's not going to be our route to being parents.

dr. e - let me show you the stats.

mahals - no thanks, we're not going to do IVF

dr. e - it gives you the best chance to be parents

mahals - while we understand that, we don't want to do that.

I had an ultrasound that same day which still showed nothing so we started another injectable called Follistim. It is a Follicle Stimulating hormone which is supposed to do just that - stimulate my follicles into growing, cooperating!! Three days of injects - nothing. Three more days of injects - nothing.

Then I get another phone call from Dr. E and she goes through the whole song and dance about 'how are you doing?', 'hang in there', we'll get it. And then she said... wait for it... 'you guys should really consider IVF'.

WHAT? I WATCHED YOU WRITE IN YOUR LITTLE NOTEBOOK THAT WE ARE NOT GOING TO DO THAT - IT'S NOT FOR US. WHY ARE YOU BRINGING THIS UP AGAIN? WHY, WHY WHY??

I said, more firmly this time, 'NO, we are not going to do that'. And she said to me, 'Well, I guess we will have to do this slow, tedious process then.'

Done. I haven't been back to that clinic again and will not be going back. If I have learned anything in the last 24 months (besides how strong i am sometimes) it's that you really have to be in charge of your own care. You have to do your research. If something isn't working out - change it.

With all that said - we are on a break. We are not doing any ultrasounds, blood draws, Phil isn't stabbing me with injects.. NOTHING for the rest of 2013. We're going to re-evaluate our situation and find a Reproductive Endo that I can trust and will have a little bit of empathy. In the meantime, I am going to enjoy the Holidays with my amazingly supportive Husband and drink copious amounts of wine :)

While going through my old FB posts I found this little nugget. This is something that I posted right around the beginning of our journey to become parents and it's beyond true. We will keep taking step after step until we reach our goal!

I know my posts have been few and far between but I am signing off until 2014.

Happy Holidays, all.

XO -

AM

cycle 10/ month 21

My last post was less than a month ago, which shouldn't be a huge accomplishment. This cycle was a roller coaster of emotions:

Started on August 30 with the normal routine; ultrasound, plan, go. We decided to go with Femara of 5mg for five days and then reevaluation of what was going on.

On September 12, I had my normal ultrasound which showed no growth of follicles and I left the office thinking that we were done again this cycle. I got a phone call from Dr. E later in the afternoon and she suggested we strongly consider IVF since she's having a difficult time making me ovulate. Phil and I have discussed IVF in the past and it's absolutely off the table at the current moment - it's not even up for discussion. This was particularly devastating to me: you can't make me ovulate? this is my only option? what? She made the determination that we were going to go with a 'stair-step'. This means that instead of taking provera and waiting for AF we were going to jump right back into Femara and do another 5 day dose but at 7.5 mg this time. Drugs, ultrasound, repeat.

On September 23, another ultrasound which showed two follicles of measurable size; a 11.5 mm and a 15 mm and good lining! It was time to use the stored HCG (Ovidrel) shot that we've had in the fridge since May! That night, Phil followed the instructions and stabbed me with the needle. The following two days, the 24th and 25th, I had two positive Ovulations tests - that's new!

Then, I (im)patiently waited for October 7 to take a pregnancy test. Negative. Negative. Negative.

Are we bummed? Yes, of course. But, we have a plan that 'worked' and hopefully it will again. This treatment coupled with getting my Prolactin levels figured out could be a winning combination. Fingers crossed, right? Here we go - on to the next one.

ten words that describe infertility

I am copying and pasting a fantastic blog post that I recently came across - it is from The Actual Pastor regarding Ten Words that Describe Infertility. One year ago today Phil and I had the most exciting, promising and joyous day of our lives - not our wedding, but our first positive pregnancy test. Holy cow our lives changed in that moment. Here we are, one year later from that day and 22 months into this journey and we're still truckin' along.

Enjoy these 10 things because they really, really resonate with me.

XO - A.

1. Lonely. We saw couple after couple get pregnant before us, our best friends included. When they told us, we high-fived them, then we went home, and hardly knew what to say to each other. We felt lost, sad, and even lonelier than before. We were excited for them; we were just very sad for us.

It’s okay to go home and cry your eyes out when your friends get pregnant.

2. Exposed. Everybody wants to give you advice, and some people say incredibly stupid things. My favorite: “You just need to stop trying so hard!” Some people want to know every excruciating detail of what you’re doing to get pregnant. Suddenly, your most private details are the subject of casual conversation. Once people know you’re trying, people want to know how it’s going, if you’ve done artificial insemination, if you’d consider IVF, and how it felt in that small white room with the gross leather chair & the bad magazines.

It’s okay to avoid the question, smile, and change the subject. Keep as many things private as you can (except to a few trusted friends).

3. On Hold. We were always checking the calendar, wondering if we should plan that vacation, or that work trip, because what if we’re pregnant? Then we stopped doing that, because we would have never lived if we would have scheduled everything around a “what if.”

It’s okay to miss a month or two; you have to live your life. This is hard, but over the long haul, it will create more stress if you feel so trapped that you can’t plan anything. We even found that it’s good to take a month off now and then.

4. Invaded. For women, there are so many things entering your body (probes, needles, drugs) and so many people measuring your progress. Even sex, at the mercy of a calendar or a temperature reading, can feel invasive. The loss of control can almost merge into a loss of self.  But, it feels like once you’ve started down this road, there’s no stopping until you get pregnant.

It’s okay to say what you need, and it’s okay to shore up your boundaries in whatever ways you can.

5. Awkward. During one of the first visits where I was given the small cup and ceremoniously ushered into the small room, I actually ran into some people from my church afterwards. Of course they had their baby with them. I had a small cup that contained very personal contents with me. They asked, “What are you doing here?” I mean, what do you say?

It’s okay to laugh at yourself sometimes. And when someone catches you with your cup in your hand, that’s all you can do.

6. Angry. Unfair is the password that gets you into the infertility club. Mary tells a story of a friend asking her if she was angry with God. “No!” she blurted. “I’m angry at pregnant women!” She knew this was irrational, but she also knew that it was good for her soul to be honest in safe places. You actually may be angry with God, and you may need to find some safe places to be honest about that.

It’s okay to express the darkness, even the stuff you’re terribly embarrassed about, because it’s good for your soul. But in the right places, with people who can handle it.

7. Stressed. Even though it seems like a stressed out couple is less likely to get pregnant, The American Society for Reproductive Medicine finds that there is no proof stress causes infertility. Besides, trying hard to “not be so stressed about it” never worked for us. It also didn’t help to “just stop trying.” Everybody has a friend who was infertile for 73 years, and the day they stopped trying, they got pregnant. That never happened with us.

It’s okay to be stressed. Don’t stress about your stress. Trying hard not to be stressed is silly.

8. Despair. The cycle of hope and despair with infertility can take you out. I remember getting so excited when Mary was 2 days late, and just knowing that this time, it’s going to happen! Then, a few days or hours later, when she told me she got “it,” I would plunge into despair. The alternative is to temper your hope so that your despair doesn’t get so low. After about a hundred months of experiencing this cycle, we found that the best route is to keep hoping, and if it doesn’t happen, keep crying. It’s too hard to pretend that you’re not excited and that you’re not depressed. Be excited. Be depressed.

It’s okay to hope, and it’s okay to cry. Keep hoping and keep crying.

9. Loss. This was not how it was supposed to be. This was not what you dreamed it would be. And you don’t know how it will end.

It’s okay if you don’t know how to wrap your mind around your emotions. Be gentle with yourself for not totally having control of how you feel from moment to moment.

10. Ambivalence. Every time you have to go through another kind of treatment, you ask yourself: “Is it worth it? Do I really want it that bad?” And then in the very next breath, you are taken out by the sheer magnitude of how much you want a baby.

It’s okay to want and not want. That’s normal. 

If you’re struggling with infertility, it can be such a dark time. You have to be out loud with each other about what you need, and every journey will be different. You have to give yourselves permission to do this journey in whatever way makes the most sense for you.

credits: http://www.stevewiens.com/2013/03/26/ten-words-that-describe-infertility/

september updates

A looong overdue update - sorry I have been MIA lately. Things in our life, outside of baby making, have been pretty cool. We just got home from Tahoe and it was amazingly beautiful and a fun time with good friends. Phil and I both said that it is one the few places that we would really, really love to go back to!

UPDATES:

• We are in the middle of our 10th cycle, cycle day 11 to be exact. I'm at the doc tomorrow morning for an ultrasound that hopefully shows something more than the previous few. This cycle we stuck with the Femara and gave it one more go before we change drugs, dosages or both. This time it made me a little bit more irritable and had a few more headaches but it is much better compared to the Clomid the first round.  If good thoughts and cheers could be spared - we would take some tomorrow morning.

• I met this morning with another specialist - Dr. Chow and Endocrinology of Minneapolis to talk about my prolactin levels and what that means in the scope of getting pregnant. I learned so many things about the pituitary gland and how very important it is in controlling not only prolactin but a multitude of others functions

Growth Hormone (GH):

Thyroid-stimulating hormone (TSH)

Adrenocorticotropic hormone (ACTH)

Beta-endorphin (CRH)

Prolactin

Lutenizing hormone (LH)

Follicle Stimulating hormone (FSH) - this is the big one that could be affected. 

There is a possibility that there is a very small 'tumor' (non-cancerous) on the pituitary gland that would be interrupting the dopamine and would be increasing the prolactin. In order to determine all of these things I had to give mooorreee blood and if that comes back elevated again, we have to do an MRI to determine if it really is the small tumor that is causing the problems. If it is less than 1cm, we move ahead with drugs to increase the dopamine to take over the small mass. If it is greater than 1cm, it would require surgery to remove the mass and move forward with a different plan.

I really liked this doctor and he seemed to think that all roads lead to getting some answers that coupled with the fertility treatments that we’re already doing would result in a pregnancy!

I have been down this road of ‘hope’ before and have thought ‘this is it’ and then we’re still stuck in the same old pattern – so I am optimistic, but not overly so. We still have to wait a week for the results of the blood work before we even decide if there will be an MRI. So, again, if you have any extra well-wishes or cheers, Phil and I would love to take them off your hands!

xo - Amanda

Mr. Fallon

First of all, I'm obesessed with all things SNL and especially Weekend Update so you can reasonably deduce that I'm a big Jimmy Fallon fan. Also, I am so grateful to have people who speak out about their struggles with infertility. Jimmy Fallon recently revealed the story behind his daughter, Winnie's, name and his wife's struggle with infertility. My favorite quote and something I'm really going to take to heart is the following:

“We tried for a long time — five years. I know people have tried much longer but if anyone out there is trying and losing hope, just hang in there. Try every avenue, try anything you can do. You’ll get there. You’ll end up with a family. It is the most worth it thing. I’m just so happy right now, I’m freaking out.” -- Jimmy Fallon

The Mahal's are 'hanging in there' until we reach our goal of a family. Thanks Jimmy for your wise, wise words.

http://celebritybabies.people.com/2013/08/13/jimmy-fallon-daughter-name-lake-winnipesaukee/

Cycle 9

Yesterday (sunday) was a 'bad day' - there will be good and bad on this journey and yesterday just wasn't the best. I went in for CD13 ultrasound and there wasn't anything of significance except for a large cyst leftover from last cycle. The nurse looked at me perplexed and said 'you're a tough one - how are we going to make you produce eggs and ovulate?'. Her guess is as good as mine.

What now? Start over. Another 10-day dose of provera and then back to the drawing board.

There are many difficult things about this whole thing but the worst is sending my husband the same text after every cycle: nothing yet. start over. We're doing such a good job of staying positive and trying to see the silver lining in everything but it's getting tougher.

I also realized that we're in our 20th month of trying for our first babe. 20 months... that sounds like such a long time, right?

Summer is winding down but I am looking forward to all things fall; The fair, chai tea lattes, leaves changing and football.



Have a great day everyone - A.



Schedule of Cycle 9

CD4:  Ultrasound

CD5-9: Femara 5mg

CD13: Ultrasound

Prolactin

I feel like I could have a lot of my posts on this blog named 'one step forward - two steps back', but that would be unoriginal and weird. It might be fitting in this case.

I got a phone call from Dr. E on Friday and she said that I have increased prolactin. This was discovered during my fasting blood draw last week - fasting until 10am. Who can do that? Well anyway, she recommended me to an endocrinologist in Minneapolis who works a lot with her patients. I called to make an appointment - one month. Always one months.. never fails.

What is prolactin or increased prolactin you may ask? This is all my own research, so bear with me....

If the test shows too much prolactin in your blood, you will most likely have trouble getting pregnant and also might have irregular periods. Too much prolactin is definitely a problem if you are trying to get pregnant, since it can be a major roadblock. You can also suffer from vision problems, headaches and a reduced sex drive as a result of too much prolactin.

Causes of high levels

High levels of prolactin can be caused by a number of things. One of the most common is prescription medications, lack of sleep, or extreme stress or strenuous exercise. Sometimes there are more serious reasons for high prolactin levels, including a tumor on the pituitary gland, or sometimes PCOS can also be to blame. Prolactin levels can also be increased if you have liver or kidney problems as well.

Treatments

If your doctor is able to determine what is causing your high levels of prolactin, and fix the problem, your prolactin levels can begin to drop almost immediately. Once high prolactin levels are brought down, there is a great chance of being able to conceive on your own. It is just a matter of figuring out what is causing the high prolactin levels and how to fix it. There are several drugs on the market right now that can easily treat high prolactin levels in most women and bring them down to a safe level. Just be sure to ask your doctor about what you can do in your case if you think high prolactin levels could be contributing to your infertility.

One more roadblock for the dude and I but we'll get past this one too. Keep on keepin' on. We're still in the middle of a medicated cycle right now so fingers crossed that this will all be Moo (a cows opinion, it doesn't matter).

bummed, but optimistic

We are currently wrapping up cycle 8 of our baby journey. You may think to yourself, '8 cycles.. 8 months. that's not bad'. My cycles are not short and sweet. My longest cycle was 135 days and the average of all 8 is 70 days. Now that we are at the RE we are a little more regular than before. But to us 8 cycles = 19 months.

This cycle was our first medicated cycle and it was a learning experience for both of us. We learned that drugs make me crazy, Philip is the best husband ever and that it takes me 27 minutes to get to the doc in Minneapolis. We also talked alot about follicles.

Ovarian follicles are the basic units of female reproductive biology, each of which is composed of roughly spherical aggregations of cells found in the ovary. They contain a single oocyte (immature ovum or egg). These structures are periodically initiated to grow and develop, culminating in ovulation of usually a single competent oocyte in humans. These eggs/ova are developed only once every menstrual cycle (e.g. once a month in humans). via Wikipedia

We are done with this cycle because I did not have enough mature follicles to move ahead with the IUI. I am bummed, but optimistic (hence the title). We will meet with the doctor and reevaluate everything - what do we do now? up the meds? change meds? These will be all the questions that we ask when we go back.

Schedule of Cycle 8

CD2:  Ultrasound

CD3-7: Clomid 50mg

CD12: Ultrasound

CD15: Ultrasound

CD18: Ultrasound

Thanks all for reading. Have a great weekend and keep enjoyin' that summer.

clomid

Let me tell you a little story about Clomid.

There once was a little girl, and all she wanted was a baby (ace of base?). So, she saw the doctor and they said take this pill and you might have a chance (after all the proper monitoring, tests, etc). What they didn't tell me was that I would be a fire breathing, hot flashing, emotional rollercoaster of a human being.

One day left. That's what I tell my husband.

One more day.. then 5 more.. then an ultrasound to see how those ovaries are doin'.

CD1ish

We're back in the saddle - Thursday is my second baseline ultrasound. I am hoping for better results than last time. Fingers, eyes, toes, ears, arms and nose crossed.. everything crossed that we will actually be able to move ahead with our plan.

Resolve

Resolve.org is a fantastic resourse that I discovered this April during National Infertility Awareness Week. It has crazy cool tools, directories of doctors, support groups, etc. One of my favorite articles was about Coping Techniques. Some of the things they pointed out were Ah-Ha moments for me when it comes to my darling Husband:

Give yourself permission to cry and be angry:

Don't try to shut off your feelings. If you need to cry about the unfairness of one more pregnancy announcement, go ahead. If you need to pound a pillow or pummel a punching bag, do it. When you try to "snap out of it," you waste all your energy.

Give your spouse/partner permission to feel and cope differently than you:

If you're a wife, don't waste energy trying to get your husband to feel as devastated as you do. If you're a husband, don't try to get your wife to be "more like a man"
forgetting about infertility except when she's at the doctor's office or in the bedroom.

DING DING DING. It took me a really long time to realize that Phil and I handle EVERYTHING differently. He's much more stoic and rational and I stomp my feet and pout like a child. Allowing ourselves to cope differently and to allow each other to cope differently has made a huuuge difference.

Improve your communication about Infertility:

You might try what I call "The Twenty Minute Rule", which forces you to limit the amount of time you talk about infertility in a given evening.

After I read this article on coping techniques I decided to immediately implement this into our day-to-day. Talking about it too much brings me down and it makes much much more sense to give it 20 minutes to recognize and then move on.

Tell your spouse/parter how you want to be helped:

But partners are mere humans, incapable of mind reading. If you need to pass up the family gathering that features five nieces and nephews under two, then say so. If you want to be hugged, or massaged, or left alone for a few minutes, or just listened to without any response, you'll be more likely to get what you want if you ask.

I love my Husband, but he's not a mind reader. So far in our journey he has really done what I needed at any given moment but when I want to be left alone or hugged - I will tell him becuase if he does the opposite, I will get upset and then we're in an even more rough spot. This rule is also applicable to many, many more areas of life.

Get more information:

One of the worst facets of stress is uncertainty about the future. You can't get a crystal ball, but you can reduce some of your uncertainty by collecting information.

Why can't I have a crystal ball??

If anyone is looking for more information - I highly recommend resolve.org.

May 16th

May 16.

The due date of our little Blube. The day that I knew would eventually come but had initally hoped that it would be filled with labor, a little one and lots of happy tears - this is obviously not going to be the case. Now it's a normal Thursday - work, hair appointment and maybe happy hour to toast our little Blube.

One Step Forward - Two Steps Back

I had my first baseline ultrasound this morning and the nurse and u/s tech said a lot of things that went over my head. I came away with the following: I had some cysts that were quite large and the doctor may want to sit this cycle out and hopefully let those clear up. Nurse Dory said we needed to do more blood work and then Dr. Erickson would make the final call.

I got to work and waited.. and waited.. and waited.

I finally got the call and we're out this cycle. No drugs, no IUI, no trigger shots. They want the stupid cyst to clear up and hopefully we'll give it a shot again later.

Doctor. Wait. Drugs to start AF. AF. Doctor. Wait. The cycle starts again.

I can't say I'm not disappointed but as my best friend Em pointed out.. It's okay to have 'days' and trust me.. I'm having one. Crying in my cube has become an art.

I'm going fishing with the Husband tonight.. with beers. It will be the pick me up that I need as long as the sun stays out and we don't get snow or some craziness.

Cycle 6 on this extended TTC journey is a wait cycle because of the stupid, dumb cyst. Hopefully cycle 7 will be a go.

The Waiting Game

I have to imagine that waiting for CD1 is not going to be as difficult as waiting for other tests and drugs to start mid-cycle .. but that's where we are. Provera is finished and now, we wait.

CD1 and CD3 are the next big days but they could start in a week or tomorrow. We will see!

WE HAVE A PLAN!!!

I have never been more excited about a doctor appointment in my life. After waiting for what felt like forever Phil and I had an appointment with a RE! After my last appointment with my OB I was desperately hoping that she would listen to my concerns and say all the right things. Phil even said if she didn't hear me out he was going to get up and leave.. We had these concerns for no reason because we loooved our RE, the clinic, the nursing staff.. EVERYTHING. I couldn't believe it.

The Plan: I am started on 10 days of provera to start AF. On CD3 I'm going back in for a fasting blood draw and an ultrasound. On CD12 I will go back for another ultrasound and then we'll start Clomid - 50mg at first. We are going to do that + and Ovidrel shot and IUI (inter uterine insemination).

Philly will also have to have his dudes checked out. I will do an HSG and have all my levels checked.

I can't believe this is our plan...

Our RE told us that she gave us a 40% chance of being pregnant within THREE MONTHS. THREE!

I will do my best to keep this updated as we continue on this journey.



xo - Amanda