The moment of truth

DH and I are just finishing up a three-week course of antibiotics to treat the infection found on the semen culture.  We started them on peak day last cycle.  We would have started them earlier in the cycle but there was some mix up at the pharmacy that delayed things.  I was bummed that we wouldn't be able to take advantage of the mucus-enhancing side effects of ampicillin.  My mucus is usually pretty good, but more of the good stuff wouldn't hurt.  ;)

Once AF arrived, I started to get a bit nervous.  Would there be TEBB?  Waiting for AF to taper off was like the final days of a 2WW where there is some chance of pregnancy.  I just wanted to fast forward a few days to find out what would happen.  During the heavy and moderate days, I tried to observe if the color of the bleeding was different in any way, which might give me a clue as to whether the antibiotic had successfully eliminated my TEBB.  Nothing was different as far as I could tell.  I tried to be patient.

First day of light bleeding--no brown.  That's typical for me.  I sometimes have two days of light or very light before the brown starts.

Second day of light bleeding--no brown.  No need to get excited yet.  This is still normal for me.

Third day.  Now it's very light, and the color is bright red.  Every time I went to the bathroom, this was me:

Is there brown?   (source)

What?  No brown??   (source)

Surely this was a fluke and the brown was coming.

Fourth day.  Pinkish red.  No sign of brown.  Now every bathroom trip looked like this:

Still no brown!!!  (source)

Now it seems like AF is done except for some pink. This is me now:

There was no TEBB!!!  (source)

The one other cycle where I didn't have any TEBB was right after the IV antibiotics over a year ago.  That happiness lasted all of one cycle because DH wasn't treated simultaneously and the TEBB came back the next cycle.  (I also suspect that my endo had already returned at that point.)

But this time DH has been treated too.  And I am free of endo.

You know what this means?

This might be our first real chance of conceiving.  Ever.  This is the first time all of my known issues have been fixed or treated at the same time.  We've been TTC for more than four years.

We're going to try to make the most of this time.  Since my uterus had a lot of inflammation at the time of my surgery in February, I'm doing what I can to try to decrease inflammation in case it was not caused by the infection (but I'm hoping that it WAS caused by the infection...).  I'm not eating sugar in any form (or any substitutes like honey) along with the rest of an anti-inflammatory diet that I've been doing for a long time.  A couple ladies have told me about a possible (anecdotal) link between TEBB and tampons, so I haven't used tampons since my surgery.

I don't know how long the TEBB will stay away.   I doubt it will be permanent.  At the NaPro conference a few weeks ago, Dr. H said that even when both spouses are treated, the infection usually comes back eventually.

But for now, we begin counting effective cycles; essentially our TTC clock has been reset to zero.  An effective cycle is one that looks normal (and presumes or knows ovulation occurred), has a good mucus cycle, has normal P+7 estrogen and progesterone levels, and has all known medical issues addressed (including appropriate management of stress).  There also should be more than one act of intercourse during the fertile time.  NaPro usually recommends TTC for 12-18 effective cycles.

This is cycle 1.  I think I might be ovulating early this month because I've had some decent looking mucus during these last few days of spotting.

St. Jude, pray for us.

Find a NaPro surgeon

Since the FertilityCare website does not yet have a separate list of the ob/gyn graduates of the year-long NaPro surgery fellowship with Dr. Hilgers, I have been keeping track of them for my clients who want to pursue surgery.  I created a map with their locations.



View NaPro surgeons in a larger map

If you click on each marker, I listed the name(s) of the surgeons, their current address, and website.  For some of the websites, you'll have to search for the physician by name.

Twelve ob/gyns have completed the fellowship.  One worked with Dr. H for a year before there was a fellowship.  Three more will be trained in the next year, including Dr. H's own son!

Note #1:  I added another ob/gyn surgeon to the map (the yellow marker).  He did not complete the year-long fellowship.  However, he did do a rotation with Dr. H and has co-authored a paper with him, so he is very aware of Dr. H's techniques.  He completed a fellowship at the Center for Endometriosis Care in Atlanta, so his training is excellent.  He is a medical consultant (trained in medical NaPro).  I would recommend him as highly as any of the other surgeons listed.  He gave a presentation at the 2012 FertilityCare annual meeting about his surgical techniques and research.

Note #2:  Dr. Stegman had been trained in NaPro surgical techniques and practiced in Camp Hill, PA.  Before he retired, Dr. Stegman trained another surgeon (the red marker) to take over for him.  That surgeon now practices in Louisiana.

This map does not include the many medical consultants who were trained in medical NaPro, a six-month program involving two separate weeks in Omaha (usually).

I will try to keep this map up to date.

IF memes

The first in a series!  Here's the post-peak edition.

 

Treating endo pain without surgery and other NaPro updates

As I get ready to head to this year's Creighton Model and NaProTechnology conference, I was looking through my notes from last year's meeting.  I learned a lot of fascinating information and wanted to share it here before my brain is filled up with all kinds of new stuff from this year. 

1.  There is a possibility that charting CrMS and getting treatment from NaPro can be helpful in early detection of breast cancer.  This is a huge project for the future to understand this better, but Dr. H has done some preliminary work.  He found that infertile women with low progesterone were 5.4 times more likely to have breast cancer than infertile women whose infertility was due to non-hormonal causes.  In his study, breast cancer patients had statistically significant lower progesterone levels starting on P+5.  Their estradiol levels were normal.  Breast cancer patients also had statistically significant lower mucus cycle scores and higher variability in the length of their post-peak phase (about 5 days variation vs. 2 days variation for non-breast cancer patients).  A mucus cycle score is a way to numerically rate the quality of mucus in a given cycle; a higher score is better.

2.  Only 9% of cycles have ovulation occur on day 14.  Ovulation occurs slightly more often on day 15 or day 17 (11% of cycles).

3.  If you or anyone you know has been on progesterone support during pregnancy in an attempt to prevent miscarriage, you might know that most non-NaPro physicians think it's unnecessary, silly, etc., especially after the first trimester when the placenta is supposed to take over production.  Dr. H swears by it though and has a standardized progesterone curve that he uses to determine how good or bad a pregnant woman's progesterone levels are given how many weeks gestation she is, which guides the dosing of progesterone.  Previously there had been no study showing that progesterone was beneficial, especially after the first trimester.  Dr. H didn't think it was ethical to do such a study because half of the pregnant women would have received a placebo (no progesterone), and he didn't want to risk them losing their babies in order to publish a study to satisfy the skeptics demanding, "We want to see the evidence."  (evidence is good, of course, but at what cost?)  Now there is really good news: This study--a double-blind, randomized controlled trial (the best type of study)--is underway!   Well, it was underway as of last summer.  How is this possible, you ask?  What about the poor women at risk for miscarriage who get the placebo?

This is probably the only situation that I can think of which made it ethical to do the study:  A NaPro physician (Dr. V) in another country was following Dr. H's progesterone protocols on his pregnant patients.  Dr. V's boss found out and demanded that he show the boss the study supporting this practice or else stop prescribing progesterone to all pregnant women.  Dr. V was in a bind.  He also believed the progesterone was doing some good, and he could not bear the thought of withholding progesterone from his patients, especially the ones with a history of miscarriage.  So he said to his boss, "How about I conduct the study to come up with the evidence that progesterone is beneficial?"  His boss agreed.  Dr. V figured that this way half of his patients would get progesterone, which was much better than none of his patients.  He later got approval to do the study.

This is huge.  Huge.  I hope they'll give us an update at this year's conference how the study is going.

4.  Random fact of the day:  Endometriosis has been found in men.  In women, it has been found outside the pelvis--in the brain, eye, and lung--so the theory that endo is caused by backward flow of menstrual blood through the fallopian tubes doesn't explain everything.

5.  An audience member asked one of the physician presenters, "What anti-inflammatory diet should we recommend?"  The presenter said, "I would defer to the bloggers on the answer."  Love it!!  Probably 98% of the room had no clue what he was talking about, but I had a giant grin on my face.  How would this physician know about the IF blogs?  He's married to a blogger.  :)  The audience member waited for him to elaborate.  He then said the diet would include:  no gluten, dairy, sugar, caffeine, alcohol, or red meat.  It would also include supplemental omega 3.  He said his wife was on a "boatload of omega 3" when she conceived.  The audience member asked him to define "a boatload."  He said at least 2000 mg/day.  Another physician, an expert in omega 3, said that the EPA content of the fish oil supplement was the key ingredient and should be at least 700 mg daily.  They also mentioned that it's important to try to increase the ratio of omega 3 to omega 6 (so decrease omega 6 while increasing omega 3).  Red meat has omega 6 and is generally pro-inflammatory.  Omega 3 (in fish oil and flax seed) is generally anti-inflammatory.

6.  Two doctors had different answers for how to control endo pain without surgery.

The first said this combination of four items works for his patients:

• 5000 IU vitamin D daily
• at least 2000 mg of fish oil daily (EPA content at least 700 mg)
• low dose naltrexone
• diet with no gluten, dairy, or sugar

The second gave a long list of possible things to try, including:

• 100 mg of vitamin B1 daily
• 400 mg of magnesium twice a day beginning one week before CD1 and ending one week after the period
• 600-800 mg of Motrin every 6 hours beginning the day before CD1 and continuing through the painful days of the period (usually 2-3 days); the Motrin should be taken with food
• 60-100 mg of pycnogenol (this may also heal the endo)
• eliminate meat from the diet (works for some)

7.  Dr. H has often said that one of his big regrets is that he didn't insist that women chart during pregnancy from the beginning of his career.  He thinks there is so much more we could know about the signs of possible pre-term labor on the chart if he had many charts to study.  What he does know is that observing 2W (wet) in pregnancy usually means a cervical or vaginal infection.  Spotting in pregnancy also means infection most of the time.

8.  Sleep deprivation causes the same symptoms (low temperature, etc.) as thyroid system dysfunction.  Getting enough sleep is important!

9.  A good endometriosis surgeon needs to

• find all the endo
• remove all the endo
• prevent adhesions

Because a surgeon who doesn't do endometriosis removal regularly can actually do more harm than good (if his techniques aren't superior), it's best to go with a surgeon who specializes in endo.  I have heard NaPro surgeons (those trained by Dr. H for a year) say that they have done surgery on patients who had a previous endo surgery with a non-specialist and that the surgery could have been a lot shorter if the first non-specialist surgeon hadn't made things worse (e.g. adhesions everywhere caused by the first surgery).

One of my favorites

I first came across this prayer in college.  I used to take it to Adoration with me.  I love the image of speaking to God as if I were sitting on His lap (if God had a lap).  It inspired part of my previous post, so I thought I would share it.

Visit to the Blessed Sacrament

My child, you need not know much in order to please Me; only love Me dearly.  Speak to Me as you would to your mother, if she had taken you in her arms.  Have you no one to recommend to Me?  Tell Me the names of your relatives, of your friends; after each name add what you wish Me to do for its bearer.  Ask a great deal; I love generous hearts that forget themselves for others.

Tell Me about the poor whom you wish to help, the sick whom you have seen suffer, the sinners whom you would convert, the persons who are alienated from you and whose affections you wish back.  For all recite a fervent prayer.  Remind Me that I have promised to grant every prayer that comes from the heart; and surely those prayers are heartfelt which we say for those we love.

Have you no favors to ask for yourself?  Recall all the needs of your soul, and tell them to Me.  Tell Me simply how proud you are, how self-indulgent, sensitive, selfish, cowardly, idle.  Ask Me to help you to improve.  Poor child, do not repine!  There are in heaven many saints who had the same faults as you; they prayed to Me, and, little by little, they were cured.  Do not hesitate to ask Me for the gifts of body and mind; for health, memory, success.  I can give everything, and I always grant requests for gifts that will make souls more holy.  What do you want today, My child?  Oh, if you knew how I long to do you good!

Have you no plans to interest you?  Tell Me all about them.  Do they concern your vocation?  What do you think of?  What would you like?  Are you planning some pleasure for one dear to you?  What do you wish to do?

And have you no thoughts of zeal for Me?  Do you not care to do a little good for the souls of those whom you love, and who perhaps forget Me?  Tell Me of those who interest you, what motive urges you, what means you wish to take to do them good.

Confide in Me your failures.  I will show you the cause.  Whom do you wish to see interested in your work?  I am the Master of all hearts, and I lead them gently where I please.  I will place about you those who are necessary to you, never fear!

Have you nothing to trouble you?  My child, tell Me all your little crosses.  Who has pained you?  Who has wounded your self-love?  Who has treated you contemptuously?  Tell Me all; and then say you forgive and forget; and I will give you My blessing.

Do you dread something painful?  Is there in your soul a vague fear which seems unreasonable, and yet torments You?  Trust fully in My Providence.  I am here; I see everything; I will not abandon you.

Are there about you friends who seem less kind than formerly, who neglect you through indifference or forgetfulness, without your having consciously done anything to wound them?  Pray for them and I will restore them to you, if their companionship be good for you.

Have you no joys to tell Me?  Why not confide in Me your pleasures?  Tell Me what happened since yesterday to console you, to make you happy, to give you joy.  Confide in Me and you shall find peace.

An unexpected visit has done you good; a fear was suddenly dispelled; you have met with unlooked-for success; you have received some mark of affection; some trial has left you stronger than you supposed.  All these things, My child, I obtained for you.  Why are you not grateful?  Why do you not say, “I thank You?”  Gratitude insures further benefits and the Benefactor loves to be reminded of His bounty.

Have you no promise to make Me?  You know I search in hearts.  Men are deceived, but not God; be frank.

Are you resolved to avoid that occasion of sin, to give up the object which leads you astray, to withdraw your friendship from that person who is irreligious and whose presence disturbs the peace of your soul?  Will you go at once and be kind to that companion who offended you?

Well, my child, go now and resume your daily work.  Be silent, modest, patient, charitable, prayerful; love the Blessed Virgin dearly and tomorrow bring Me a heart even more devoted and loving.  Tomorrow I will have new favors for you.  Only this one thing bear in mind, My dear child, that I have loved you with an eternal love.  Love Me in return.

~Author unknown

I asked for an egg

It was that gospel reading this past Sunday.  The one that if you’re infertile (or have any unanswered prayer) it makes you feel really uneasy if you listen to it at face value—like you’re doing something wrong or not praying enough or just not worthy of having your prayer answered.  I’ve asked God a thousand times to heal our infertility and allow us to conceive, yet He hasn’t said yes to that particular prayer.

So this was my brain during the second half of the gospel reading…

Luke 11:9-13	polkadot
And I tell you, ask and you will receive; seek and you will find; knock and the door will be opened to you.	Okay, I’ve been asking to conceive for a long time.  Why isn’t the door opening for me?
For everyone who asks, receives; and the one who seeks, finds; and to the one who knocks, the door will be opened.	Don’t cry.  Don’t cry.  Don’t cry.  Don’t cry.
What father among you would hand his son a snake when he asks for a fish?	Shoot.  Can’t stop the tears.  Just don’t make a sound.  Deep breath.  Calm down.  No sobbing in church.  Don’t make a scene.  Your parents are sitting on the other side of DH.  Thank goodness the pew is empty to your right.
Or hand him a scorpion when he asks for an egg?	But I asked for an egg (baby).  Wow, that’s a lot of tears.  They just keep coming.  Don’t move.  Don’t draw attention to yourself.  You can grab a tissue when you sit for the homily.
If you then, who are wicked, know how to give good gifts to your children,	This homily better be good.  I hope he addresses this point.  I know this gospel isn’t about getting everything you want, but I still want to conceive.  It’s just my human desires talking here.  Why does it feel like I’ve been given a scorpion instead of an egg?
how much more will the Father in heaven give the Holy Spirit to those who ask him?	The “egg” is the Holy Spirit.  See??  It’s not about getting what you want.  It’s about getting the Holy Spirit.  But I still want a baby.  Lots of babies.  I hope the priest clarifies this.

Note there were two voices in my head competing for space and dominance…one in purple (human/emotional side) and one in red (rational/faithful side) above.

The priest’s homily was precisely what I needed to hear.  I’m sure he wrote it just for me.  A minute or so into it, it struck me how good it was, and I was very close to turning on my cell phone so I could record it.  I decided not to because my phone takes a while to turn on.  I probably wouldn’t have been able to record much because the homily was very short.

His main point was: God’s will is exactly what we would choose for ourselves if we had all the facts.  We don’t have all the facts.  Therefore, we have to trust that what God wills for us and gives us is what we need in order to increase our holiness to ultimately end up in heaven for all eternity.  Even when life is difficult and we face suffering or pain, we have to remember that God sees the whole picture and can see the fruits that will come from each trial.  He wants us in heaven.  The road to heaven may not be easy.  In fact it probably won’t be easy.  But He wants us to keep persevering through all the hardships we face.

It reminds me of something a favorite priest of mine used to say, “God didn’t create us so that we’d have a great, happy time here on earth.  He created us so we’d have a great, happy time with Him in heaven.”  That’s not to say He wants us to be miserable during our lifetime, but rather that this life’s purpose is directed toward eternity and should be viewed in light of it.

I know in my heart that God is not Santa Claus.  He doesn’t give me everything I ask for, even if I make a nice list and keep reminding Him of said list.  He gives me what I need.  He will gladly answer any prayer that would help me become more holy.  As much as I would like to think that I know what would fit that criteria (e.g. I think having a child would make me more holy), I don’t get the final say.  I will still continue to ask, but always with the caveat of “if it is Your will, God.”

“My Lord and my God, you created me to praise, reverence, and serve You, and by this means to save my soul.  The other things on the face of the earth You created for me, to help me in attaining the end for which I was created.  Help me, therefore, to make use of them insofar as they lead me to my end, and to rid myself of them insofar as they prove a hindrance to me.  Aid me by Your grace to make myself indifferent to all created things, as far as I am allowed free choice and under no prohibition.  May I not prefer health to sickness, riches to poverty, honor to dishonor, or a long life to a short life.  But let my one desire and choice ever be what is more conducive to the end for which I was created.”

~St. Ignatius of Loyola, whose feast day was July 31

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.  :)