No stone unturned

Dr. K gave me her recommendations in my last cycle review: two new drugs to take. I am going to start Clomid (25 mg on CD 3-5), but not until next cycle because my pharmacy didn't have any in stock when I called. I guess I'm a bit surprised they didn't have any since I assumed that was a fairly common drug. Oh, well. I guess that just means we'll have one cycle where I'm only adding one new drug instead of two. Dr. K also wanted me to start Cortef to try to combat my TEBB. Cortef is hydrocortisone, a steroid. It's used to treat adrenal fatigue. I haven't ever been tested for adrenal fatigue, but that is the only remaining cause of TEBB—of the six causes that I know of—that hasn't been explored for me yet. Infection could still be playing a role since we've only tried two antibiotics. (I am reminded of one of my clients whose TEBB was eliminated with the third antibiotic her doctor tried...) I am actually kind of excited to try the Cortef. Obviously if it helps us get pregnant I will be overjoyed, but I am very curious to see if it improves my TEBB, and I'm glad to have a break from the antibiotics. My face, neck, back, and chest are finally starting to clear up after a horrible acne breakout (maybe the worst since high school…yuck) that started suspiciously close to the time when I finished the second of the two back-to-back antibiotics. My theory, supported by Dr. Google, is that after the antibiotic effects wore off (yay, clear skin for a couple weeks!), a crop of really bad bacteria took up residence. Even my sweet DH, who claims never to see my acne, commented to me yesterday that my skin looked so much better than recent weeks.

Back to the Cortef…since I wasn’t supposed to start taking it until AF stopped this cycle, we won't know its effect on the TEBB for another month at least. I am also interested to see if it affects me in other ways—good side effects, if you will—like increased energy, improved concentration, etc. I looked at the list of symptoms for adrenal fatigue, and if I have any of them, they are very mild. For example, if you asked me if I have fatigue, I would say no. To me, fatigue would mean dragging through the day or having trouble staying awake. But I would qualify that by saying I am pretty much always open to taking a nap if the opportunity presents itself (give me a pillow and a flat surface), and I would have no trouble falling asleep even if I didn't "feel" tired and even if I was getting plenty of sleep at night. If I fit it into my schedule, I could easily sleep 10 hours a night or more. I bet that sounds odd. I wonder if it could be like what happened with taking naltrexone. If you had asked me before taking it if my mood was low/poor/etc. (even excluding PMS days), I would have said no, but after taking high-dose naltrexone I could definitely notice my mood was improved and not just post-peak. I guess I never knew any different so I assumed my mood pre-naltrexone was normal. That's how it is with my energy level; I don't know any different so I assume this is normal. I can function well enough during the day. I just happen to like to sleep. ;) But I would be pretty excited if taking Cortef made my energy and alertness even better. We shall see what happens. The jury is still out because I haven’t been taking Cortef very long.

And speaking of the naltrexone, I am up to 50 mg per day. I was at 25 mg but that just wasn't helping my PMS enough. When AF arrived this cycle (while taking 50 mg), I was much more stable emotionally than usual even though I still had some CD1 blues, and I'm attributing it to the higher dose. I hope this lasts.

Of course new meds means more pills to pop each day. I was feeling kind of maxed out in the pill department until recently when I found a couple of my supplements are sold in gummy form. Now I get to eat candy every day.  ;)  I wish all medications were available as gummies. That would certainly make the life of an IFer undergoing treatment a little brighter.

I made the graph below for fun and out of curiosity. These are all the TTC-related medications and supplements I’ve taken since we started TTC in summer 2009. The spike in February 2011 is for my laparoscopy. The graph does include the gummy supplements I’ve been taking lately, but I don’t count those as a “burden” anymore. They almost should count as negative pills because they’re so fun to take.  :)   I should mention that I could decrease my pill count by four if I ordered my vitamin B6 online (500 mg capsules). It’s easier for me to buy it locally, but the store only sells 100 mg capsules, so I take five of them.

My daily pill counts (TTC-related)

DH wanted to see his pill count too, so I added it to the graph.  He's the red.  But I'm guessing you could have figured that out.  ;)


P.S. I have a list of my current meds on the right side bar if you were wondering.

Confessions of an IF girl

Most of these topics are seemingly taboo on an IF blog and for good reason, I suppose. An IF girl can still dream though...

1. I own a glider (chair) and matching ottoman that are obviously designed for a nursery. They are white with pastel cushions. I obtained them for free; I don't remember if we knew we were IF at that point. I have plans to recover the cushions with a non-nursery-inspired material which would be suitable for the living room. Luckily they fit in the closet which is where they sit at present hidden under a stack of boxes.

2. I own maternity clothes, some of which were purchased after our IF diagnosis... I think my current collection includes: two pair of pants, a pair of sweatpants, a skirt, at least four shirts, and a spring coat. (Technically I am keeping an old winter coat that is too big for me now—for the singular purpose of using it during a winter pregnancy.) The pants I bought on super clearance before we even started TTC after a pregnant friend complained to me how expensive maternity pants are. At that time we were planning to start TTC soon (after my regular ob/gyn finished running some tests related to my unusual bleeding...wow, that was a long time ago). Then the unexpected happened which delayed our TTC plans quite a while. I knew circumstances could change quickly so whenever I went shopping I kept an eye out for non-maternity clothes that could be also worn during part of pregnancy (extra long or roomy in the front). I still do that. My only rule is that it has to look good on me now (and not just if I had a large belly). I may actually wear one or two maternity shirts as part of my normal wardrobe. Might as well make use of them, right? :) The maternity spring coat I wear all the time. I bought it because it's cute. And because I could wear it should I miraculously become pregnant...let's not kid ourselves here. You'd never guess it was maternity. I get compliments on it occasionally so I don't think anyone can tell. I really should cover up the label inside the collar though... One of these days I'm going to visit a friend who takes my coat to hang it up, sees the label, and asks me about it. :P

3. I am still not comfortable giving myself the HCG shots, even though I've been self-administering them for the past 9 cycles. I sit there—for a long time—with the filled syringe in hand and chicken out while attempting to stick it in my thigh. I am lucky the medicine doesn't completely go bad (while at room temperature) in the time it takes me to actually inject it. Thankfully my P+7 blood work has shown that the HCG is helping, so at least the P+5 shot is going well.

4. I have planned out exactly how I would tell DH if we became pregnant. I had the idea before we were IF but I didn't buy the required item for the announcement until after we were IF. It's hidden in a secret spot with the maternity pants and some rubber duckies we received as a wedding present.

5. As long as I'm not within about 5 days of CD1, I (usually) like looking at pictures other people's kids and babies. I recently stalked two friends' Facebook pages to see if they had given birth yet. Being bombarded with Christmas letters and pictures of babies in December was an exception—that was too much. I had DH prescreen them for me and remove all the pictures. I looked at the pictures when I could handle it (and one at a time). I really appreciated those that had a separate card. If we ever have kids, I hope I remember never to do the photocards. Sending a photo inside of a regular Christmas card is a better alternative, in my opinion.

6. DH and I sometimes talk about baby names. I started "the list" with my favorite names before I met DH. (Don't all single girls discuss this with their other single girlfriends and update each other when preferences change?) Of course once DH entered the scene I let him add his preferences. (awfully nice of me, huh?) I'm currently trying to convince let DH get used to my top boy name, which didn't get added to the list until recently. He's a choleric so these things take time. Maybe by the time we'd have the chance to use it DH would like it... Boys names are hard for me. I have a long list of girl names ready to go (all of which I love) but only one or two boy names, and I only like the boy names so-so.

7. DH has (not often but at least twice) looked at my stomach during the late post-peak phase and addressed the nonexistent-but-hoped-for baby by name. He uses two of my favorite girl names. He is eternally optimistic about a future pregnancy. I'm glad at least one of us is. If only his attitude might rub off on me a little... :)

I don't always live in dreamland but it's nice to visit every once in a while. :)

I'm not the only one who will admit to these things, right?

Phlebotomist's dream, ultrasonographer's nightmare

Much has happened since my last post.

1.  I had my first blogger meet-up!  It was lovely.  The group included Rebecca (The Road Home), Ania (The 411 on the 418s), E (God's Plan is my Joy), and TCIE.  It was as if I was chatting with old friends, even though I had never met any of them before (except TCIE).  It was so nice to talk to ladies who completely understand what it's like to be infertile and Catholic.  And since Rebecca had just had her surgery, we of course had to swap surgery and doctor stories.  I wish they all lived closer so I could hang out with them more often.  :)

2.  I earned this:

I had my ultrasound (US) series.  TCIE was so kind to let me stay at her house the entire week and a half. Hers is the only clinic besides the PPVI Institute itself where Dr. K would allow the series to be done.  TCIE explained to me in detail what a NaPro US entails and why it has to be done by a NaPro-trained ultrasonographer.  She told me they have tried to work with other ultrasound centers that are more conveniently located for out-of-town patients, but no one to date has been able to do a satisfactory job.  Her clinic has a detailed worksheet that they've sent along with patients who go to outside centers, so you would think the ultrasonographer would be able to handle checking boxes and filling in blanks if it's all spelled out for them.  Apparently that is not the case.  Some things on the checklist are not taught in ultrasound school, and others are simply not part of the template report that many centers use, so it's too much work to make extra observations or measurements.  TCIE said even when the patient holds a copy of the worksheet and asks for certain things while she is being wanded, the ultrasonographer still doesn't always cooperate.  I understand now why Dr. K insisted I go to a NaPro ultrasonographer, and I am thankful I had the opportunity to do so.

Here's how my US series went.  TCIE described it as an "ultrasonographer's nightmare."  It doesn't seem THAT bad looking back...

CD6:  I had my baseline US.  It was the only one that included both a pelvic US (on the belly) and a vaginal US (internal).  (The rest were vaginal only.)  I completely forgot that I was supposed to have a full bladder for the pelvic US, but luckily I had drunk enough water that day that my bladder was full enough to proceed.  A follicle on my left ovary was identified as the one that would likely progress toward ovulation.  There was a shadowy area of my left ovary that looked suspiciously like an endometrioma (endometriosis on the ovary).  I was told it doesn't necessarily interfere with pregnancy since they see endometriomas in pregnant patients sometimes...  [Note: it turned out not be an endometrioma.]

CD9:  I started to observe fertile mucus just before the US.  The US showed that my cervix was dilated a tiny bit, and my endometrium was thicker than it was on CD6.  These were good signs.  (The endometrium is supposed to grow in thickness as you get closer to ovulation.)  The follicle on the left ovary didn't grow at all since CD6.

CD11:  This was the third day of good mucus.  The US showed my cervix was dilated more and my endometrium was thicker than CD9.  Progress!  However, my follicle on the left ovary still hadn't grown at all.  (Nothing was happening on the right either.)  This was not consistent with my mucus, endometrium, and cervix status.  At this point it was possible that 1) the follicle could have a quick growth spurt right before ovulation or 2) the follicle would be too small when it ruptured at ovulation.  Still it was puzzling that I was having good mucus with zero follicle growth.

CD13:  This was the fifth day of good mucus.  I don't usually have more than five days in my mucus cycle, so I expected that the follicle would have grown by now.  The US showed my endometrium was thicker than CD11, and my cervix was still dilated.  Unfortunately, that silly follicle still did not grow one bit.  This really didn't make any sense.  Why was I having a normal mucus cycle, normal endometrium growth, normal cervix dilation, and zero follicle growth?  Neither TCIE nor the doctor could explain it.  When I spoke to DH on the phone, he joked that Dr. Hilgers should use me as a case report in his next book or presentation.  I hoped someone would be able to figure out what was going on.  I didn't particularly want to be a case report...I just wanted my ovaries to work!  A few hours after the US, I had 10KL that stretched three inches.  (Yes, I just wrote how much my mucus stretched.  I have no shame.)  :)  I also had very obvious left-sided abdominal pain (mittelschmerz), which I have observed occasionally in past cycles.  I mentioned this to TCIE in the evening.

CD14:  TCIE told the doctor about my mittelschmerz and fabulous mucus from CD13.  She called me and said that the doctor wanted to run some labs (estradiol, progesterone, FSH, LH) to see if that would give us a clue of what was going on.  I drove to the clinic to have my blood drawn.  The woman who drew my blood took one look at my arms and complimented me on my veins.  (She had her pick of four easy-to-access veins.)  Just about every phlebotomist who draws my blood comments that I have good veins.  I wish I could take credit for them.  hahaha  At least it made one person's job easier.

CD15:  It was Peak+1.  I had a six-day mucus cycle, which is great.  At least my cervix was on its best behavior this cycle. :)  I wish I could say that about some other organs...namely my colon.  Yes, my colon.  You'll see why in a minute.  The US showed my cervix was closing up, and the follicle was as dormant as ever.  The blood work from CD14 was perfectly normal for someone who had just ovulated.  The doctor was completely stumped.  TCIE continued the US and guess what she found on the left ovary?  A corpus luteum!  (that's what the follicle becomes after ovulation) That meant I ovulated!!  But the follicle we'd been watching since CD6 on the left ovary was still there.  The corpus luteum was not near that follicle; it was in a separate location but still on the left side.  What did this mean?  I have a dumbbell-shaped left ovary.  The corpus luteum was on the other half of the ovary.  We had never seen this half of the ovary before this US.  Apparently the half of the left ovary with the dormant follicle had very nice, clear borders so there was no reason to suspect that my ovary was dumbbell-shaped. So you might be wondering why the other half of my ovary didn't show up on any other US...that would be thanks to my very active, redundant colon.  My colon has extra loops to it (a normal variant which I knew about before the series), and the loops covered up the half of my dumbbell ovary containing the follicle that eventually ruptured.  For whatever reason, my colon decided to get out of the way on CD15 so we could see the corpus luteum.  Silly colon.  Unfortunately, we don't know how big the follicle got before it ruptured.  Follicle size is important to know.  (If the follicle is too small, it's not a good ovulation.)  The corpus luteum looked "fresh" which meant I likely ovulated on CD14, which was consistent with the blood work.  How's that for a textbook cycle?!?  Ovulating on CD14 and Peak Day!!  ;)

On the bright side, measuring follicles is something any ultrasonongrapher can do, so if Dr. K decides that she wants to know how big my follicle gets before ovulation, I could have that done locally.

3.  DH was able to visit for a short time while I was having the US series done.  We spent a whole day in New York City, which was a lot of fun even though there was snow and slush on the ground.  It was his first time there.  The timing of his visit was okay but not great in relation to ovulation.  I don't think I can completely blame our not getting pregnant this cycle on the timing though (as much as I want to!).  There's obviously something still wrong, and I wish we could figure out what it is.  I still have lots of TEBB, so that's one thing to focus on yet.  I am really curious about where Dr. K will want to go from here.  I'll find out in a few days when I receive her feedback on my cycle review.

4. While I was staying with TCIE I visited these beautiful shrines, each with first class relics of the saint.  I offered prayers for bloggers still waiting at each one.

National Shrine of St. Rita of Cascia in Philadelphia

St. Rita is a patron saint for infertility and hopeless cases.  Her parents prayed for many years to have a child before St. Rita was born.

Shrine of St. Anne in New York City

St. Anne went through a period of infertility before becoming the mother of the Blessed Virgin Mary.  She is a patron saint for those facing infertility.

The world is not ending

But it sure feels like that on CD1.  :*(

On the bright side, I'll get to spend time with TCIE for my ultrasound series this cycle.  My baseline ultrasound is on Monday.  :)

Goodbye PMS, hello desperation

I didn’t have PMS this cycle!!  Praise God!!  DH thinks I’m a completely different person.  The naltrexone (32 mg/day) not only got rid of the ugly mood symptoms I used to have consistently post-peak (irritability, anger, depression, etc.) but it actually made my mood better than a normal non-PMS day.  It’s like a weight has been lifted, and I feel free to be happy.  I think I’m actually happier and more perky than usual.  This is the part that DH is still getting used to.  (He tends to be on the serious side.)  :) 

At least with PMS he knew exactly what to expect.  I would feel my mood turn sour and tell him I’m PMSing.  He would leave me alone.  Sometimes giving me extra compliments or hugs helped defuse my short fuse but often it was best if we just sat in different rooms.  (Sounds not so healthy for marriage, I know.)  But DH reassured me every month that he was not taking it personally, and he knew that he didn’t do anything wrong.  We learned very quickly that nothing important could be discussed on my PMS days, especially anything where we might disagree.  I was not capable of much rational thought those days; I was pretty much pure (negative) emotion.  But this cycle that was totally gone.  This is seriously amazing.

DH says this isn’t real; this is just polkadot on drugs.  Hahahahahaha  

It has me wondering though:  Is this my true normal (healthy) state that naltrexone has restored?   Were my endorphins so deficient before which caused the PMS and now they are back to normal levels?

It took me a while to get up to the 32 mg dose.  PPVI had me start at 4 mg/day, and every 10 days the dose doubled.  After I survived 10 days of 32 mg/day (divided up into four doses throughout the day), I could start taking the whole dose at night.  The final dose will now be 50 mg at night.

Since I “graduated” from 32 mg (compounded) to 50 mg, I can now get the prescription filled at a local, non-compounding pharmacy.  Apparently 50 mg is a typical dose for someone being treated for alcohol or opioid addictions, which is why normal pharmacies carry it.  (Did you know that’s what the rest of the world uses it for outside of NaPro?  I had to convince my doctor during my health scare in October that I did not have an addiction to drugs… haha)  The nurse from PPVI said I can either take 50 mg or 25 mg (by cutting the pill in half).  Since my mood has been too so good, I think I’ll try taking 25 mg daily to see if that’s enough to keep PMS at bay.  I don’t mind being extra smiley all the time, but DH is a little weary of it, so maybe 25 mg will be the perfect dose.

Months ago I had called around town to find a pharmacy that carries lactose-free naltrexone.  I found one pharmacy that had it.  When I called them on Friday afternoon to see if my new prescription was ready, they said they didn’t have any in stock and couldn’t order it until Monday.  Boo.  I'm not sure why they couldn't tell me that in one of the previous three times I called them last week...  :P

Unfortunately I ran out of naltrexone, and it was two days before my cycle ended…  Very poor timing.  I don’t know if it was naltrexone withdrawal or just normal plummeting hormone levels that come with a new cycle, but I cried uncontrollably on and off all day for two days—on both the day before CD1 and CD1.  It hasn’t been that bad in a long time.  When DH tried to comfort me, my tears soaked his shirt so much he had to change it.  :(  I knew CD1 was coming the day before it happened because my temperature dropped, so that was part of the reason for tears.  (I still have to monitor my temperature occasionally while on T3, and I know when my temperature drops, AF will arrive 24 hours later.  Long ago before I met DH I charted sympto-thermal for my own knowledge.)  I hope I’m more stable this cycle...

Because of the arrival of AF, Mass for Gaudete Sunday wasn’t the joyful occasion it’s supposed to be.  Do you know how many times words like “brokenhearted” or “sorrow(ful)” were mentioned during Mass?  At least six times at our parish.  I know because I cried after hearing each one because it reminded me of our IF.  With all the exhortations to rejoice, I tried but I told God I could not.  Instead I told Him this cross is crushing me.  Prayer Buddy, I offered it all up for you.

I don’t know whether to laugh or cry in admitting this.  DH and I went out Sunday afternoon to finish Christmas shopping.  I saw a woman holding a baby.  I had the urge to take the baby.  Bad, polkadot.  Bad idea.  I know I’m not the first IF girl with this thought.  Maybe the second, but definitely not the first!  It kind of shocked me to have that thought.  It happened again while we were out.  Twice in one day.  Yikes.  I promise I will never take anyone’s baby, but wow, did I feel desperate! 

I’m kind of feeling like Rachel in the Old Testament when she says, “Give me children or I shall die!”  (Genesis 30:1)   I understand the desperation.  I hate feeling this desperate, but it is what it is right now.

*sigh*  

God, will you send us a baby soon?  Please?  Thanks in advance.  :)

On grief

Today is our two-year anniversary of living with IF.  On 12/8/09, CD1 arrived marking the end of six failed TTC cycles (with fertility-focused intercourse).  I’m sure I was a sobbing mess at Mass for the Solemnity of the Immaculate Conception that night, especially during the reading from Luke about the Annunciation.  Not that Bible passages normally pour salt in a wound, but I think that night hearing about someone else (even the pure Virgin Mary…) conceiving a child (even the child Jesus…) would have been a painful reminder for me of our new undesired state.  The reading does contain the beautiful and comforting words “for nothing will be impossible for God” in reference to Elizabeth’s miraculous pregnancy, but I’m not sure that was much consolation for me that night.

It’s been a long, hard two years.  Really I should say two and half years that we've been TTC because the sorrow and pain didn’t just appear suddenly on 12/8/09.  Each of those cycles before we were labeled as IF added tears and heartache little by little so that by the time we fit the definition of IF, we were grieving.

Grief of this magnitude was new to me.  I had mourned the loss of beloved grandparents in the past, but the deep sorrow that followed their deaths didn’t last very long.  I had known both clients and friends who were struggling with IF, but I never imagined the depth of pain that they experienced until I experienced it firsthand.  If I had been a better FCP intern, I would have read one of the books they recommended on IF so I could sympathize with my IF clients better…but I didn’t.  With each new CD1 I mourned the loss of what could have been but never was and then tried to pick myself to try again in the new cycle.  Each new CD1 re-opened the emotional wound that had never completely healed in the previous month.  My dreams of having a large family (or even conceiving one child) died a little each month.

Without realizing it, I started going through the first 4 of the 5 stages of grief:

1.  Denial:  This isn't happening to me...  I can't be infertile...
2.  Anger:  This is so unfair!  Why does everyone else have no problems conceiving?!?  Grrr...
3.  Bargaining:  I would do anything to have a child.  Maybe if I promised to be more holy...
4.  Depression:  The sadness is overwhelming.  I feel so empty and alone.
5.  Acceptance:  It's going to be okay whether we have a child or not.  We can trust God.

I was stuck in denial for a long time.  It actually made me postpone starting NaPro for a little while because I was convinced we just needed to try another cycle or two.  Seeking help from NaPro meant that I was admitting we had a problem, which I did not want to do.  Once I started a new treatment (HCG was first), I refused to add another, thinking that all we needed was the current treatment.  I was in complete denial for months that I would ever need surgery.  No, not me.  I don’t need surgery.  (Looking back I laugh a little, but at the time I completely ignored all the stats I knew about rates of endo among IF women.)  I thought I would be different from all the IF clients I had sent to a NaPro surgeon.

Anger was more subtle because it seemed to be provoked by specific situations where (I assumed) any reasonable person would respond in the same way.  Usually it would rear its ugly head when someone announced a pregnancy.  I remember clearly the day when I learned of my now sister-in-law’s unexpected pregnancy.  The anger was intense, but I thought it was a natural response and didn’t connect it to grief.  (I think I was in denial about my anger!)

Once denial faded a little, bargaining took over.  All of a sudden I was ready to do almost anything to become pregnant.  Surgery?  Yes, please.  ASAP.  More supplements and prescriptions?  Bring ‘em on!  I think it filtered into my prayer life too as I found myself making deals with God.  God, if you bless us with a pregnancy, I will __________.

Depression was most obvious and consistent from CD1-CD3 of each new cycle.  But I would find myself slipping into it at completely random times during the cycle also.  Out of the blue, maybe at work, maybe while driving, I would be overcome with a wave of incredible sadness, the kind that feels like it will never end and is worse than anything I had ever felt before.  Even though the pain was profound, I knew God was close by my side—whether I could feel His presence or not (and some days I could not)—which brought me comfort.  On the days when trying to offer up the sorrow was too hard or it felt like it wasn’t helping, I would stare at a crucifix and think, “If such a great good can come from something so horrible as Jesus dying on the cross, surely there will be at least some good that will come from all this suffering.”  During the first year of IF, I thought I knew what depression was.  I probably did.  But in the cycles following my surgery (Feb. 2011), the depression I experienced was magnified.  It literally felt twice as painful, twice as deep as the depression episodes I had before surgery.  I had so hoped that surgery would be the final answer for fixing our IF.  I knew many people who conceived in the months shortly after their surgeries.  I thought that surely within six cycles, we would be pregnant.  We’re currently in the middle of the eighth cycle post-surgery.  It’s like we’re infertile all over again.

Acceptance has been slow in coming.  Sometimes it brings a great peace, but it doesn’t always last very long.  On one such day, I told DH confidently, “It’s okay if we can’t have kids.”  When I said it, I meant it 100%.  The next day DH asked me if I still felt the same, and I said maybe 50%.  This one is the hardest spiritual battle for me—trying to reconcile my desires for children with whatever God’s will is for us.  I want to get to the place where I can say, “Thy will be done,” and accept it if that doesn’t include children.  Sometimes a more honest prayer is:  “God, help me to want to want your will to be done.”

From the little I’ve read on the subject of grief, people tend to progress through the five stages linearly or circularly (see my lovely illustrations here).

Sometimes you can revert back to a prior stage you thought you moved past.  Even though I’ve pretty much described a linear progression in my experience here, it’s mostly a broad overview from memory.  In reality, I think a more accurate diagram of the five stages would be this:

Notice all the bouncing around among the stages...  This picture might represent the span of one cycle, or on my more crazy days, it could all happen in a single 24-hour period. ;) 

All I have to say is thank God for a wonderful, supportive DH who puts up with me on my emotional roller coaster!  And thank God for all of you and your prayers.  Knowing that I'm not the only one going through this is a huge blessing!  Your encouragement and empathy means the world to me. :)

PPVI news: plans for expansion

I know this is a little late, but I wanted to share this news just in case you hadn't heard about it...

The PPVI Institute announced that it is planning to expand their facility.  Exciting, right!?!  The property next door to the current PPVI building is up for sale, and PPVI is trying to purchase it.  You can read the proposal in this pdf.  They want to build an addition onto the Institute, which will enable them to have 10 physicians.  Ten NaPro physicians!!!  Can you imagine that???  Think about what that would do to the waiting times that patients currently have to endure to see one of their surgeons!  Right now they have three physicians on staff.  From the pictures, it looks like they're going to double the size of the building.

So now they're trying to raise money for the loan to buy the adjacent land which apparently is very time-sensitive.  They put out an urgent request recently with the (now past) deadline of November 21st.  I couldn't find on their website or Facebook page if they raised enough money for the land loan already.  We're on the Institute's mailing list, and we didn't receive a (paper) letter about this request until after the deadline, so maybe the deadline was more of a suggestion to show how urgent this is?  You can read the letter from Dr. Hilgers here.  If you have the means, you can donate online at the PPVI website and specify that your donation is for the capital campaign.  The letter we received asked for a donation of $750 to purchase "one unit" of the new building.

If you can't support the Institute financially, please keep them and this effort in your prayers.  I would love to see these plans become a reality.  Think of all the couples that could be helped by this expansion!  Let me say it again:  ten NaPro physicians!  How amazing would that be!

Here's a 13-minute video that details the background of NaPro and the Institute.  There are some great pictures of Dr. Hilgers from the 70s or 80s in the first 3.5 minutes.  :)

Dreams, meds, and Murphy's Law

This post is rather random.  You've been warned.  :)

1.  The only typical side effect with naltrexone, according to a PPVI nurse, is vivid dreams.  I experienced that a couple times when I first started LDN, but haven't noticed it since then even though my dose is much higher.  But this week, I had two very vivid dreams related to IF back to back.  In the first, DH and I adopted a baby girl.  We picked her up from an airport parking lot at night.  It was a very strange scenario, but I woke up and thought it was true for a moment.  It felt very real.  In the second, I was having an ultrasound during my post-peak phase and learned I was pregnant.  I was so excited by the news.  When I woke up, it felt as if I had truly had the ultrasound the day before.  Granted I was groggy from sleep, but it took a lot of mental effort to figure out (convince myself?) that I did not have an ultrasound and was not pregnant.  In the dream I was several days further along in my cycle than I am in real life so it really was not possible.  IF must be really getting to me if the new theme for my dreams is babies.

2.  DH and I started a second round of antibiotics—Zithromax.  It's in the same family of antibiotics as Biaxin, so I am optimistic that it might help.  Given the side effects I had from the last round of antibiotics, I was a little nervous about this one.  The package insert was comforting: “This drug is usually well tolerated.  Less than 1% of patients discontinued therapy due to side effects.  The most common side effects are diarrhea (5%), nausea (3%), and abdominal pain (3%).”  I was not happy to see that nausea was on the list though.  I told DH I'd take diarrhea over nausea.  He looked at me like I was crazy.  Since he couldn't remember the last time he was nauseous, I told him he must have forgotten how it felt because surely no one would pick nausea over diarrhea. ;)

At dinnertime on day 2 of the Zithromax, I started feeling mildly nauseous—just like how it started with the Flagyl on day 2.  I had flashbacks to last month.  I didn't think I could take three weeks of it again.  It's one thing to endure nausea and vomiting during pregnancy knowing that there will be a baby at the end of it, but to have to endure in order that you might possibly get pregnant (no guarantees, of course) is really tough.  I figured I would wait and see what happened the next day.  Fortunately, there has been no nausea since that night.  Thank you, God!

3.  I am a little extra hopeful this cycle.  I have no reason to think the Biaxin did any good because my TEBB lasted as long as usual (5 days).  But—perhaps irrationally—I am secretly hoping that maybe the drug did reduce inflammation enough in my uterus to allow implantation.  And I've been at my current dose of T3 for almost a month, so this is the first full cycle where it might have an effect...  I can make up scenarios all day long hoping this month will be the month, but that doesn't change reality.  I know that.  Please don't lock me up for insanity just yet.  :)  Plus it's Prayer Buddy time, and we all know how pregnancy rates among IFers increase dramatically during this time...  To me, new treatment + extra prayers = more hope. :)  (No pressure, Prayer Buddy.  haha)

The other reason for more hope this cycle is that I noticed breast tenderness for the first time in a long time, and it hasn't gone away yet. So my hope isn't completely irrational. ;)

4.  After ordering meds from Kubat's regularly for a while now, I've decided there is some version of Murphy's Law that applies.  It would go something like this:

If you need your refill in W days (e.g., W = 4 days), it will be delivered in X days, where X>W (e.g., X = 6 days).

If you don't need your refill for Y days (where 7 < Y < 14), it will be delivered in Z days, where Z << Y. (Z = 3 days to be exact)

Note: << means "much less than" here.

In other words, if you plan ahead, you'll get your refill quickly, and when you don't call until 4 days before you run out, you won't get the meds in time, even though 95% of the time you receive your meds in 3 days.

5.  I will be glad to be able to get my naltrexone locally instead of from Kubat's as soon as I'm up to 50 mg, which hopefully happens tomorrow when the nurse returns my call.  The PPVI protocol for increasing naltrexone has had me calling PPVI when I have 4-5 days of pills remaining to report how I'm feeling.  It takes a day for the nurse to return my call, meaning Kubat's gets the order for the increased dose when I have 3-4 days of pills left.  (I asked a nurse if I could call earlier than 5 days, and she said, "No, we have to follow the protocol."  I said in my experience, Kubat's sometimes needs more than 4 days...  She said 4 days is plenty.  Isn't it ironic that my meds didn't arrive in 4 days after that conversation?)  This stresses me out a little, so I just wanted to give you a heads up in case this would ever apply to you.  If you have the choice, give Kubat's a week to be on the safe side. :)

6.  DH and I are trying to focus on Advent even though everywhere we go is Christmas, Christmas, Christmas.  The only decorations we have up are the stockings and the Advent wreath.  We won't be putting anything else up including the tree until December 17th, the start of the O Antiphons and the "final" countdown to Christmas.  A dear priest friend of ours suggested this idea to us before we were married.  He reminded us that Catholics celebrate on a feast day and afterwards, not before.  I need that reminder to help prepare for Christmas.  It's been really nice to do our evening prayers with the Advent wreath lit.

7.  Tomorrow is St. Nick's Day.  I hung our stockings, and DH set out his shoes.  (He grew up with the shoe tradition, and I grew up with stockings, so we're trying to merge them.)  He asked me if I minded if he opened his presents in the morning while I was still sleeping.  He gets up much earlier than me and didn't want to wait until he gets home in the evening, even though this is how we've done it every year.  I said I wanted to open them together, so if he can get me out of bed at the crack of dawn, we can open them together.  Getting me out of bed might be a challenge.  I think he might resort to carrying me to the living room if I'm uncooperative.  He is really excited about the presents.  It's sweet. ;)

Talking about IF

I did something I’ve never done before.  I told someone I barely knew that we were infertile.  Actually, I did it twice in the span of a week.  This is a big deal for me since I’m super private about personal stuff.  Normally I’d want to tell someone about our IF as much as I’d want tell someone we were having marriage problems (we’re not).  Being shy and an introvert, I have to build trust with someone over time before I share anything personal.  But in these two situations, I decided to take a risk…

The first conversation started as any get-to-know-you conversation goes.   What do you do?  How long have you been married?  Do you have kids?  They were seemingly innocent questions until the woman dropped every IF girl’s favorite question, “So don’t you WANT kids?”  It struck me as a bit odd because of the setting.  It was the lunch break during an all-day marriage prep session at our parish.  I was sitting with the couple who was going to co-present the talk on NFP with me after lunch.  We had done the talk together once before, so she knew we were going to talk about being open to life.  Perhaps she was checking my credibility as a Catholic NFP instructor?  Or maybe she was just curious because of how long we’ve been married.  (I think other people’s curiosity about family size and TTC timelines is my biggest pet peeve…)  Anyway…  The question caught me off guard but she seemed trustworthy enough, so I admitted, “We’ve been trying for years.”  I could tell she immediately felt guilty for asking the question.  Her eyes widened and she repeated, “Years??  Oh.  I’m sorry.  I’ll pray for you.”  I was impressed at her response.  It’s probably the only “correct” response you can say to an IF girl that won’t hurt her feelings.  Since many people don’t naturally come up with an acceptable response, I wondered if she’d previously had this conversation with someone else.  It turns out she did; one of her good friends was infertile.  I shared a bit about NaPro, and she was going to pass the info along to her friend.  The rest of the conversation went as well as I could have hoped.  She asked questions and listened to my answers, offering no advice whatsoever.  If there were an IF sensitivity training course, she would have passed with flying colors.  :)

Side note:  The conversation made me think that everyone should have an IF friend who can teach her how to respond appropriately to someone with IF in case IF sensitivity doesn’t come naturally…

The second conversation happened at a party hosted by a woman from our parish.  I had never met her before that night, but we had spoken on the phone.  Our conversation started almost exactly like the one I described above—length of marriage followed by, “Do you have any kids?”  She answered the questions first, stating she had four young children.  When she asked me, and I said we didn’t have kids yet, she said, “Oh, you’re infertile, too.”  It wasn’t a question.  It was a statement.  It felt refreshing that she would just assume we were IF.  All I had to say was, “Yeah,” and she proceeded to tell me her IF story and how she adopted her children.  She was rather outgoing, so I think she would have shared it with me even if I wasn’t IF.  I could have talked to her all night, but I think it’s bad party etiquette to monopolize the hostess’s time...  I did get to ask her details about adoption, and she was a wealth of information.  She said that when she and her husband realized they were infertile, she didn’t want to do any testing to find out what was wrong; she wanted to pursue adoption right away.  I had never met anyone who didn’t want to know the reason for her IF, so it was interesting to hear her perspective.

Based on these two encouraging experiences, I may be more likely to share our IF with someone now.  I know that just because two individuals responded well doesn’t mean everyone else—or anyone else—will.  I mean, I’m not ready to go shouting it from the rooftops (i.e., Facebook) that we’re IF.  But at least it built up my courage a bit knowing that I can talk about IF without breaking into tears.

Distractions from IF

What a month and a half it has been.  It all started with an ER visit due to the worst pain I’ve felt in my life.  Several doctor visits, tests, procedures, and some prescription medication followed.  I have some lovely new pictures of my insides to add to my collection from my laparoscopy.  Everything turned out to be normal except a small hernia, which the doctor shrugged off and said we don’t have to do anything about.  The hernia doesn’t explain the pain I had, so some of the procedures may be repeated at a future date if the pain ever returns.  So far, that pain was just a one-day occurrence.

What compounded things a bit was that my body did not react kindly to the cocktail of medications I was taking.  Shortly after starting the above-mentioned prescription for a problem the ER doctor assumed I had, I started the antibiotic Flagyl to possibly combat my TEBB.  Meanwhile, I had been slowly increasing my naltrexone dose under Dr. K’s direction to reach the usual dose they prescribe for PMS.  Managing to take all the pills at the right times was the easy part (surprisingly).  One medication was to be taken twice a day with a meal, another was not to be taken within an hour of eating (twice a day), and the third taken four times a day.  (This excluded my T3, which is taken every 12 hours on an empty stomach, and the probiotic, which was not to be taken within 2 hours of the antibiotic, but prior to eating.)  The hard part was dealing with the nausea and vomiting that resulted.  It became pretty predictable at night.  Naltrexone anytime after 6 PM plus either of the two new meds within hours of each other resulted in my GI system declaring war.  When it got bad enough that I couldn’t think straight, I would be reduced to tears.  I admit I’m pretty weak when it comes to that... No amount of eating after dinner would prevent or lessen the nausea (but it would give me heartburn so I slept on the couch in a sitting position several nights).  Sometimes it would return after I had fallen asleep, and I’d go sit on the bathroom floor in the middle of the night until my stomach decided it was empty enough.  If my experience is similar to what happens during pregnancy, I have a new profound respect of what women go through.  I even tried to imagine that I was pregnant (I wasn’t, of course) to try to make dealing it better, but that didn’t help. 

I spoke with Dr. K’s nurse several times.  She said my side effects were really unusual for naltrexone; most women have no side effects and actually feel great.  She thought that my hernia was further exacerbating the medication interactions.  (She also informed me that it would cause extra nausea and heartburn during any future pregnancy on top of what is normal for pregnancy.)  She gave me suggestions on how to try to reduce the side effects, including lowering the naltrexone, which helped sometimes.  I ended up just sticking it out since the antibiotic was almost gone, and I was tapering off of the other prescribed medication from the ER visit (which was deemed unnecessary after all the tests).  Just a few days ago, when I was down to only naltrexone and T3, all my side effects disappeared.   In fact, I felt great.  Fabulous even.  It kind of feels like the small high you get after exercising.  Or like the time right around ovulation where you feel extra motivated to get things done.  So this is how naltrexone is supposed to work.  I love my naltrexone now.  :)  I’m really looking forward to post-peak this cycle to see if my PMS is gone.  And I’m almost to the point where I can take non-compounded naltrexone just once a day (easier than four times a day and cheaper hopefully).  I’m at 32 mg (compounded) per day now.  The end goal is 50 mg (non-compounded) per day.  Things are looking up!  :)

So after DH and I took the Flagyl simultaneously, there has been no change in my TEBB.  Bummer. I wonder if they’ll try a different antibiotic next.  Maybe Biaxin?  I know that worked for one of my clients to get rid of her TEBB.

This whole series of events took my mind completely off of IF (and blogging and even reading blogs) for quite a while.  I missed everyone and have some catching up to do!

We’re thinking seriously about doing the ultrasound series to monitor ovulation in January.  PPVI said it would be best if DH could come along so we could TTC, but right now we’re just planning to have me go alone.  It may be possible for DH to come for a couple days, but we won’t know that until the last minute because of his work schedule.  I am looking forward to learning if my ovaries are doing their job!