Culture attempt #2

We did a second seminal fluid collection while at my parents' house.  Awkward.  I managed to slip out with the sample under the guise of "I'm going shopping" (which was also true).  DH didn't come along when I dropped off the sample.

I don't know if the "you must get the sample to the lab within 30 minutes of collection" requirement applies when you're only getting a culture done (no sperm counts this time), but I did manage to get to the lab within 30 minutes.  Yay.  One less thing to worry about.  When I arrived at the lab, I handed the technician the order from Dr. K.  He stared at it for a while and then left to ask someone if they could do the culture.  I told him I had already confirmed by phone that their lab could do it.  He returned and said it could be done, but his tone left me questioning whether it would be done correctly.

I just heard back from a PPVI nurse.  The lab did do the culture!  And they found a new bug!  It's probably not good to be excited that DH and I have a bacterial infection, but I'm relieved that they were able to identify the bacteria (enterococcus), and it's something that is treatable.  DH will be taking three weeks of moxifloxacin, and I will be taking three weeks of ampicillin.  I can't take the moxifloxacin (it can't be taken while trying to conceive), and DH has to take the moxifloxacin because it penetrates the prostate where this bug is hiding out.  The nurse said taking ampicillin would prevent the bacteria from being passed back to me.  So we'll be starting those soon...hopefully this week.  I hope this treatment works!

How to do an HCG injection

Since I've been on HCG for a while, I thought I'd make a little tutorial of how to give yourself a subcutaneous HCG injection.  HCG is used primarily post-peak to increase estrogen and progesterone levels.  It's one of the first treatments NaPro doctors recommend for PMS.

Make the HCG solution

My HCG comes in a solid form and needs to be reconstituted in water.  The pharmacy sends it this way so it doesn't have to be kept cold during shipping.  The vial contains 10,000 IU of HCG.  I add 7.5 mL of water resulting in a solution where 1.5 mL = 2,000 IU.

*A note about needle gauge:  I've used syringes with a gauge ranging from 20-23 for reconstituting HCG.  It just depends what the pharmacy sent me or what I have on hand.  The larger the gauge, the smaller the needle.

Gather the supplies:  vial of bacteriostatic water, HCG vial, 3 mL syringe, and alcohol wipe(s). 

Remove the plastic cap from the top of both vials.  (They are already removed in the picture to the right.)

Obviously I took the picture on the right after I added all
the water...just pretend you can't see the liquid.

Wipe the top of each vial with an alcohol wipe.

Remove the cap from the needle.  Fill the syringe with air.

Insert the needle into the vial of water.

Flip the vial and syringe upside down.  Press the plunger all the way to inject air into the vial of water.  This will make it easier to fill the syringe.

Pretend this was a picture of the vial of water from
the previous picture.  The concept is the same for
filling the syringe with either water or liquid HCG.

Make sure the needle tip is covered by liquid.  You don't want to draw up any air into the syringe.  Fill the syringe with 3 mL of water.  You will likely have air bubbles in the syringe as you're drawing up the water.  Flick the side of the syringe barrel with your fingernail or knock it gently with your knuckle to force the air bubbles to rise to the top.  Press the plunger upward slightly to release the air bubbles back into the HCG vial.  Draw more water into the syringe if necessary to reach the 3 mL mark.











Remove the needle from the vial of water and insert the needle into the HCG vial.  Inject the water into the HCG vial.  Repeat this again with 3 mL of water.  The third time, fill the syringe with 1.5 mL of water.  This will be a total of 7.5 mL of water added to the HCG.















Invert the HCG vial several times to mix the solution thoroughly.








Write today's date on the vial.  The HCG is good for 60 days from the date of reconstitution.

If you're not giving an injection right away, put the reconstituted HCG in the refrigerator.


Give the HCG injection

*A note about needle gauge:  I've used syringes with a gauge ranging from 22-25 for HCG injections.  The larger the gauge, the smaller the needle.  So go with a 25 gauge needle if you have a choice.

Wipe the top of the HCG vial with an alcohol wipe.  Also use an alcohol wipe to clean the area of skin where you plan to do the injection.  I clean a large area of skin so I don't have to aim for a particular tiny spot.
 
Wait a little while for the alcohol on the top of the vial to dry.  Do not fan it (or your skin) to try to speed up the drying.












Remove the cap from the needle.  Fill the syringe with a volume of air equal to the amount of HCG you want to inject.


















Insert the needle into the HCG vial.  Press the plunger down all the way to inject air into the vial of water. This will make it easier to fill the syringe.

















Flip the vial and syringe upside down.


















Make sure the needle tip is covered by liquid.  You don't want to draw up any air into the syringe.

















**Note:  My prescription says each dose of HCG is 2,000 IU. This is 1.5 mL of HCG according to my directions for reconstitution above.  Adjust the volume accordingly if you are prescribed a different dose.

Fill the syringe with 1.5 mL of HCG.  You will likely have air bubbles in the syringe as you're drawing up the water.  Flick the side of the syringe barrel with your fingernail or knock it gently with your knuckle to force the air bubbles to rise to the top.  Press the plunger upward slightly to release the air bubbles back into the vial.  Draw more HCG into the syringe if necessary to reach the 1.5 mL mark.

Remove the needle from the vial.

Very gently press the plunger until a drop of liquid appears at the tip of the needle.  That way you know you've pushed all the air bubbles out.












Pinch the area of skin you plan to inject with your non-dominant hand.  I do the injection in my outer thigh.  I just can't handle the thought of doing an injection in my belly.



Hold the syringe in your dominant hand.  In a quick motion, like you're throwing a dart, stick the syringe into your (pinched) skin so the needle goes in all the way.**  Press the plunger down to inject the HCG until you've injected all of it.  Remove the needle from your skin.

**If you do the injection correctly, you should barely feel the needle going in.  It can be virtually pain-free.

If you are super careful, put the cap back on the needle.  Untwist the needle to separate it from the syringe barrel.  Put the needle in your sharps container.  Cleaned out, hard plastic bottles work well.  I use an old plastic olive oil bottle.  A laundry detergent bottle would work too.  Throw the needle-less syringe barrel in the trash.

Store the liquid HCG in the refrigerator.  Discard 60 days after reconstituting it if not used.

If you prefer watching a video tutorial, search Y.outu.be.  I watched a few videos before attempting to do the injection for the first time.

SA drama

Click on the image for the novena text.

The lab didn't do the semen culture on DH's sample.  We have to redo the seminal fluid collection.  :(  :(  :(

Here's the story...

Before Dr. K would decide on what treatment we might try next to combat my TEBB, she wanted to have a semen culture done to see if that would identify any other unwanted bugs that may be hanging around.  Her nurse mailed us the order (written on a prescription pad) along with the collection kit (unlubricated, perforated condom and a sterile container).  If ever you need a kit, you can order one from the PPVI Institute without a doctor's order for $20. 

I remember how we did the semen analysis (SA) two years ago.  Our city isn't that large, and there is only one clinic in town that does SAs.  That clinic requires the man to make an appointment when he will drop off his sample and spend five minutes with the nurse giving his medical history.  I called the clinic to make the appointment.  The receptionist said they would not accept the paper order I was holding in my hand; she said the clinic had a specific order form that Dr. K would have to fill out and fax to them directly.  I hoped that this extra step would ensure that the semen culture would be done because I was a bit worried they would miss that request and just perform the regular SA with counts, morphology, etc.  After some back and forth with PPVI, they confirmed that they had faxed the order to the clinic here.

I called the clinic again to make the appointment.  Surprisingly the receptionist asked me if DH was going to collect his specimen in the clinic or if he would be bringing it in.  I guess we're not the only ones to do the collection at home, although I'm not sure how many people actually use a kit so it can be done through a "normal" act of intercourse.  (Using a perforated condom is anything but normal...)  The receptionist said we were to abstain for at least two days prior to collection, but no more that four days.  (PPVI had told us to abstain for at least four days.  I was going to follow PPVI's recommendation over the local clinic's recommendation.)  The receptionist also reminded me that the specimen should arrive at the clinic within about 30 minutes and should be kept at body temperature during transportation.  The clinic is five minutes away, so we figured this wouldn't be a problem.

We were ten minutes late for the appointment.  The collection itself was awful.  I was extremely relieved that we had a specimen to take to the clinic.  We brought the paper order along that PPVI had originally sent us.  I told DH to show it to the nurse and remind her that we needed a culture done.  He did that.  The nurse said it would be no problem and kept the paper order just in case.

We did the collection post-peak, so I decided to wait until our next cycle review to ask PPVI for the results.  (Actually I did call the local clinic to see if we could get the results over the phone like I did two years ago, but the nurse said we had to get the results from Dr. K.  Can't blame a girl for trying.)  I suppose a little waiting never hurt anyone.  ;)

When I received the cycle review e-mail, the nurse said our clinic had not done the culture.  She didn't have any results to share with me--not even the sperm count, etc.  She said Dr. K had spoken with the medical director at the local clinic to find out 1) why they never told Dr. K they couldn't do a culture since they had her request in their hands (on THEIR form!) far in advance and 2) why they never told DH they couldn't do a culture.  The director told Dr. K that their clinic doesn't do semen cultures and that we (meaning DH or me) would have had to have coordinated with the local hospital lab (totally unaffiliated with this clinic) to arrange for the culture to have been done there.  How were we to know this?  Dr. K was really frustrated.  DH and I are really frustrated.

I called the medical director to find out what kind of arrangements would have to be made and whom I should call at the hospital.  After a few days of messages left on various voicemails and then some phone tag, the medical director called me back.  It was bright and early in the morning when I wasn't exactly awake and fully lucid.  (Mornings are not my best time.)  He said that in his twenty years as a doctor, he had never heard of anyone ordering a semen culture.  He said there's no link between infertility and infection, and a culture wouldn't tell you anything useful.  He said he was under the impression that he had talked Dr. K out of ordering a culture.  No, Dr. IVF, you didn't talk her out of it!  She, unlike you, actually wants to fix the underlying problem(s) in our infertility.  And if you want to be intellectually lazy and not bother to investigate the newest discoveries in the treatment of infertility, that's your business.  Thankfully not all doctors think like you.  (I did acknowledge to him that the connection between infection/endometritis and infertility is not widely known among mainstream doctors, and he agreed.)  I told him that Dr. K had helped couples conceive by treating their infections.  I almost told him to look up Dr. Toth online so he could learn about how infection is related to IF.  But I realized that I still needed his help if I wanted to have this culture done, so I bit my tongue and limited my comments so as not to antagonize him.  I explained that I had symptoms of an on-going infection, so the culture would hopefully help identify the bacteria involved because the endometrial culture I had done was only partially helpful. 

He then reluctantly shared the information he had.  He had spoken with two different doctors from the hospital's microbiology lab.  They have never done a semen culture.  I really had no idea that this was an unusual test to order...  They are unwilling to do a semen culture because they don't have a protocol to do one (and there were two other reasons that I don't remember because I wasn't really awake).  He suggested that I try calling the independent lab in town to see if they could do it.  I'm wasn't holding my breath, because if the hospital can't or won't figure out how to do it, the independent lab sounded even less promising.  And yeah, after calling them, they won't do it either.  :P

The nearest larger city where there might be a chance of getting the culture done is over an hour away.  So we'd have to stay overnight in a hotel to make that happen.  And that's if I found a lab who could accommodate this request.  The other option would be to try to find a lab in the even-larger city where my parents live and do the collection while visiting them.  It's not ideal, obviously, but it seemed more feasible than the hotel option.

I called the big hospital's lab about twenty minutes from my parents' house that I've used for blood draws in the past.  The person who answered the phone was quite knowledgeable and was able to confirm rather quickly that their lab could do the culture.  I even asked her how they would do it--to double check that she understood what I was asking for.  She said they'd treat it like any other "reproductive culture," let it grow on a plate for two days, and identify all bacteria that grew (if any).  What was even better was that we could drop off the sample at any time 24/7.  No appointment!!!  Actually, DH doesn't even have to come along.  I can drop off the sample myself (which will be much less conspicuous...no need to explain to my parents where I'm going.)  ;)  PPVI sent us another kit, so I hope everything works out this time.

After asking again, I did get the results from the first SA that was run locally.  All DH's numbers were normal.  They were actually better than the numbers from two years ago (which were also normal.)  At least one of us has a correctly-functioning reproductive system.  Although I told him he probably needs to have super sperm to overcome whatever is wrong on my end, hostile uterus included...  ;)

God enters through the wound

Enough sitting on this post.  Time to press publish...

So it's been weeks since the IF retreat, and I've sort of been waiting for a big epiphany to hit me or some kind of mental breakthrough in how I see infertility or understand it.  But there hasn't been any big epiphany, at least up until this point.  Maybe something will hit me sometime down the road, but for now, my main reaction is that I'm happy I attended the retreat.

It was a nice-sized group--just under twenty people.  A handful of us wives came alone; others attended as a couple.

The best way I could describe the retreat is if you think of infertility like a wound, the wound was open, exposed, and raw the entire weekend.  Because the environment was so safe--everyone had personal experience living with IF--there was no need to try to put on a brave face or stuff your feelings down so others don't see.  There's really never (well, rarely) a chance to be so open and honest with your emotions and your pain in regular life, unless you have a very understanding or sympathetic friend, and even then it's limited because, let's face it, even the best of friends can't handle constant pain and sorrow from you all the time.  Perhaps I'm just speaking from my personal experience though.

A side story...

My most understanding friend whom I see only a couple times a year always asks me sincerely how I'm doing--meaning she wants to hear about IF and my struggles with it.  The last time I saw her, she let me share my pain with her for a while.  Just when I thought she might be starting to grasp (a little) of how deep IF pain is, she changed the topic, indicating she had reached her tolerance level of depressing topics.  I wasn't intending to go on much longer about IF, but it did surprise me that she essentially cut me off.  I realized it's not really accepted in polite company that you dwell on sad things for too long.  You can be a little sad, but not a lot sad, or if you're going to be a lot sad, you had better keep it short.  (Obviously you can do that with your husband, but I'm talking in a public setting.)

Back to the retreat...

These were strategically placed around the room. 
And they were passed around frequently.

I was not in a particularly emotionally vulnerable time in my cycle, but tears were just below the surface at all times, and it did not take much to start them flowing.  And flow they did.  Flood might be a better word.  I have not cried so much in a short period of time in a while.  Sometimes I cried because the intensity of the pain of IF would just hit me in waves.  Even though I think about IF often, I don't necessarily dwell on it for hours at a time...but the retreat kept IF in the center of my thoughts for much longer than I'm used to (hence the frequent tears).  Other times I cried when hearing another woman's IF story, realizing how deeply she was hurting.  I am the queen of sympathetic crying.  What was so nice was that I didn't feel embarrassed to be crying like I would if I were anywhere else besides home.  I think most of the ladies cried at some point during the retreat, but I tried hard to keep my gaze on the speaker and not the attendees (although it was easy to see out of the corner of my eye when a box of tissues was handed to another person).

One of the best parts about the retreat was the fellowship.  A small group of us ladies stayed up chatting until 4 a.m. and if we didn't need to be up a few hours later, we probably would have talked longer.  I figured I could sleep when I was back home, but I would only get to see other (real-life!) IFers for a short while, and I wanted to make the most of it.

The weekend was definitely not all serious.  I haven't laughed so much in a long time.

To me these represent the tension I face with IF:  hoping for that
miracle child knowing God could heal our infertility if He chose to
vs. knowing that true satisfaction and joy in this life comes from
God alone and trying to find contentment in that no matter what
happens with our IF.

One of my favorite parts of the weekend was a panel discussion with four couples who had different outcomes from their initial infertility:  one remained childless, one adopted an infant, one had two biological children, and one adopted through foster care.  So often adoption is presented as the solution to IF (usually by people who are not IF); I was glad the theme of the weekend was not, "Just adopt."  While it was great to hear from the couples who adopted (or had biological children), I was most interested to listen to the childless couple.  They were probably close in age to my parents.  This was the first time they were sharing their story publicly.  It was very emotional for them.  They brought up things they had long buried or maybe had never voiced aloud.  It really reaffirmed for me how deep the pain of IF is--that even though they had done meaningful work and ministry throughout their adult lives and had a loving marriage, the pain from IF never goes away. 

One part of their story really touched me.  They attended a Marriage Encounter (ME) weekend years after they knew they would never have children, and it was during that weekend that they were first able to really talk to each other about their emotions surrounding their IF.  That was the same way it happened for DH and me.  I remember before going to the ME, I would try to explain how I was feeling to DH, but I felt like I wasn't getting through to him--like he saw my feelings as some typical female over-the-top emotional (over)reaction.  But it was through the dialogues of that ME weekend that allowed us to break through whatever communication barrier we had before so that he could finally hear and understand where I was coming from. 

(Side note about ME:  When we were engaged, it was recommended to us that we attend a ME weekend after four years of marriage because at that point (sometime between four and seven years of marriage), the chemicals of attraction change.  Before that point, spouses would get a natural "high" (lovey-dovey feeling?) just by being in the same room with each other; after that point, the only way to get that "high" is through physical touch between the spouses.  Often couples will reach this point and feel like they "fell out of love" because they don't have the same warm, fuzzy feelings toward each other.  So the antidote was to attend a ME weekend to learn new tools of communicating and relating to each other to combat the change in feelings that would be coming soon.  It was recommended not to go earlier in marriage because you get the most benefit from the ME weekend by having plenty of marriage experience to draw on (at least four years).  I definitely see how that was true.  Newlyweds just wouldn't have much concrete to talk about--they would be discussing hypotheticals of how they would react in certain situations.  Neither of us really enjoyed the weekend or the style of communication that was taught, but for the major breakthrough we had about IF and our very different emotional reactions to it (if only because we were forced to discuss the subject (of our choosing) for a defined period of time) the entire weekend was worth it.)

Back to the retreat...

These are some of the things I took from the retreat:

• Marriage is all about self-gift.  Self-gift is the most important first step in our relationship with God and with others.
  
• Whenever we face suffering, we're told to "offer it up."  Sometimes instead we'd rather hear, "Yeah, that suffering is awful."  But offer it up doesn't mean suck it up and deal with it.  It has profound theological meaning (to unite the suffering with Christ on the cross) but sometimes you don't realize its significance until later.
  
• St. Henry II and his wife St. Cunigunde were childless, so they could be a good patron saint couple for IF couples.  (It's hard to find a saint who was permanently infertile.)  Most likely their childlessness is due to a vow of celibacy in their marriage...  BUT...according to the super accurate and always trustworthy wikip.edia, historians may have mistakenly assumed that their lack of children meant celibacy, implying that there's a chance they could have been infertile!  (I stopped reading after the wik.ipedia entry so maybe there's a better source out there, but with multiple spellings of Cunigunde, I wasn't up for the searches.)
  
• The (hard but necessary) question to ask is:  "Lord, how else (besides children) do you want to bless the world (not just me)?"
  
• God enters through the wound.
  
• Grace flows through wounds.  Look at the crucifix.
  
• Suffering always does something.  It's not a void.  It forms us.  It shapes us.  It teaches us.
  
• "Infertility is my stigmata." -RD  (It is a physical reminder of Christ's suffering.)
  
• God exults us when it would bring about our sanctification.  He humbles us when it would bring about our sanctification.

Aside from the wonderful theological truths that were discussed, I think the most significant mark the retreat left on me was that it acknowledged that infertility is really, really painful.  That probably sounds too simple or obvious.  Subconsciously I already knew that, but I needed someone else to affirm it.  (Not that the blogs don't affirm it--they do--I just needed it in person for some reason.)  When every discussion about my infertility with an IRL friend results in downplaying the pain or having the friend liken it to "just another of life's disappointments, like not getting the job you want, etc.", I start to wonder if I really am overreacting or over-doing my sadness.  But no, I'm not.  IF really does hurt that much.  And there are others feeling the same way.  Oh, how I wish we all lived closer and could hang out more often.  Live fellowship with other IFers is so great.  :)