IF on TV

(I broke this topic into two posts because it was getting long.  Go here for IF in the movies.)

I always find it interesting when the topic of infertility makes its way into a TV show or a movie.  I was surprised this spring when it popped up in two of the shows I like to watch:  "Hart of Dixie" and "Call the Midwife."  I know you're probably wondering what a nice IF girl like me is doing watching a show named "Call the Midwife" because it's probably all about pregnant women and the birth of babies.  Yes, the show is almost entirely about labor and delivery.  Several babies are born during each episode.  What can I say?  I like BBC period dramas and, well, most other dramas made by the BBC.  (Downton Abbey, anyone?  :)  I've watched it and nearly all PBS's Masterpiece series since they aired film versions of six of Jane Austen's novels a handful of years ago.  I have been hooked ever since.  It is a very happy day for me when the new Masterpiece schedule comes out for the upcoming months.)

SPOILER ALERT:  If you want to watch these episodes without reading about the IF scenes first or what happens to the IF couple, then skip most of this post.  I highly recommend these episodes, especially "Call the Midwife."  I'll list the shows and specific episodes right now and talk in more detail later in the post.  If you do want to watch them, do it soon because the "Call the Midwife" episodes will be free online until 6/17/14 and only two of the three "Hart of Dixie" episodes are still available. 

TV shows:

• Hart of Dixie (CW website) - season 3:  episodes 319, episode 320 (5/2/14), episode 322 (5/16/14)
• Call the Midwife (PBS website) - season 3:  episodes 3, 4, 6-8

**********************BEGIN SPOILER ALERT**********************

Hart of Dixie

Episode 319 - "A Better Man"

The characters:
Wanda & Tom - the married couple with IF who are just beginning medical treatment
Dr. B - the small town's family practice doctor

Here is a scene at Wanda's doctor appointment:

Wanda: "I know this medication is helping me, but I think it's making me crazy.  One second I'm so happy.  I look at Tom.  I love him so much.  The next I see his eyebrows and they are sooo bushy.  I want to tear those eyebrows out, like rip them off his face."
Dr. B: "Moodiness is a common side effect of clomiphene.  Now the good news: it is working! You are officially ovulating.  So you and Tom need to start trying to make a baby tonight. Hahaha.  Bushy eyebrows or not!"

There are more scenes that touch on the pressure the couple feels to "perform" that night and their attempts to "relax" during the day so they're ready at night.  The scenes go a bit overboard—most IFers don't tell everyone they meet that they're ovulating and need to try to make a baby that night—but they do touch on very real issues us IFers face, so I was impressed that aspect was included.

Episode 320 - "Together Again"

The couple goes back to the doctor because AF arrived after the first cycle of Clomid.  There is also a scene where the IF couple is babysitting a baby and the wife doesn't want to give the baby back to the mom, which has probably crossed most IFers' minds at some point or another....right?  (or it's just me)  In the middle of the show there is this scene:

Tom:  Dr. B?  You might want to come.  We have a situation.
(both of them run out of the doctor's office into the town square where Wanda is)
Dr. B:  Oh, she's pushing an empty baby carriage?
Tom:  Oh, I wish.  I wish.

Tom:  Hey, sweetie.  Why don't you show Dr. B what's in the baby stroller?
Wanda:  Of course!  Isn't he wonderful?

This is what they see:

Dr. B:  Oh!  It's a goat...in a onesie.
Wanda:  (angrily)  Your point?

I think dressing up an animal like a baby is supposed to be a new level of crazy caused by the Clomid.  I suppose it's probably not healthy to pretend your pet is a baby...although I understand the desire.  ;)

Episode 322 - "Second Chance"

It only took two cycles of Clomid for Tom and Wanda to get a BFP.  If only it worked like that for everyone...  I was a bit disappointed that that's the extent of the IF storyline, but I guess something is better than nothing.  I hope the short duration of medical treatment in the show doesn't perpetuate a myth that it's that easy for all IF couples to conceive...


Call the Midwife

The show is set in London in the 1950s.  The midwives live together in a convent house.  Some of midwives are Anglican nuns; the rest are single ladies in their twenties.  If you can handle seeing prenatal care and births (nothing graphic shown), these episodes with an IF couple are really, really good.  If you watch them, you might want the tissues handy, especially with episodes 3 and 8.

The characters:
Shelagh and Dr. Patrick Turner - the married couple with IF

Episode 3

Shelagh and Patrick are newlyweds but older than most other newlyweds.  (Shelagh was previously an Anglican nun and midwife.  Patrick was a widower with an 11-year-old son Tim from his first marriage.)  Shelagh hasn't had her period in a while, so she wants to take a pregnancy test, but she needs a doctor's signature to request the test.  She had wanted to surprise her husband with the news, but instead has to ask him to sign the order.  He is very sweet and tells her he will forget that he had to sign it and will act surprised when she gives him the news.  Can you imagine having to wait to receive the results of a pregnancy test until they're mailed to you?  In the meantime, she is overanalyzing her symptoms of possible pregnancy (or lack thereof) just like I have done many times.

Patrick: "Negative this time."  (sounds like other optimistic husbands I know)

Since she hasn't had a period in three months and isn't pregnant, Shelagh agrees to have an exploratory surgery with a local doctor to see if there is a visible problem.  When she wakes up from surgery, she demands to know the results now (again this sounds familiar to me) instead of waiting until she is more rested.  Her husband gives her the news that she has scar tissue throughout her pelvic organs from a previous TB infection.

looks like a nice surgery recovery room

Shelagh:  I know there's no hope.  You don't need to tell me.  I'm sorry.
Patrick:  Don't say that.  So many dreams came true.
Shelagh:  Just not all of them.

I definitely needed the tissues for that scene.  I very much could relate to her broken heart upon hearing the news of infertility, to her apologizing to her husband for being IF, and to her husband trying to comfort her by saying he is so happy to have married her.  DH and I have had similar conversations multiple times over the past four years.

Episode 4

In the Turner household, this scene happens:  (Shelagh is holding back tears.)

Patrick:  What's that?
Shelagh:  The nightdress I was making.  With every stitch I could see the baby's face more clearly.  Now the nightdress will never be needed, and the face won't go away.
Patrick:  Put it in the drawer, Shelagh.  Put it away out of sight.
Shelagh:  I tried that.
Patrick:  This isn't the end of the world.  It's just the end of a road.  We'll find a way ahead.
Shelagh:  I'm looking for it.  I really am.

I have baby and maternity things hidden away under the bed.  If only hiding them would solve all my problems...  This scene was such a reminder of dashed dreams due to IF.

Later Shelagh puts the nightdress in a bag and gives it to the head nun Sister Julienne for the charity box.  It must have been really difficult for her to part with it.

It's unrelated to IF, but Shelagh's choir sings "Ave Verum Corpus" at the end of the episode.  It's one of my very favorite hymns.  Beautiful.

Episode 6

Shelagh's step-son invites the new boy at school over to his house.  The boy's mother Jean comes over as well and has tea with Shelagh as the boys play.

Jean:  My husband and I couldn't have children of our own. Colin's mom died and he'd been put in foster care.  He knows he's adopted.  And we all know we're lucky.

(Shelagh just stares at the other mom like she can't believe she found someone else who is infertile.)

Jean:  And all the way along the more love he's needed, the more love we've found.  We haven't run out yet.

Later in the episode, Shelagh brings up the idea of adoption to her husband.  Patrick is on board with the idea immediately.  The scene where they discuss the idea with Tim, their 11-year-old son, is really sweet.

Shelagh meets with an adoption agency and brings home a pile of paperwork for the application.  She shows it to Patrick, and he is not as excited as he was earlier about the idea.

Patrick:  I don't know why they need to know half of this stuff.  I've never seen so many questions.
Shelagh:  (laughs) Quite.
Patrick:  No.  I'm sorry, Shelagh.  You've rushed into this.  There are plenty of adoption charities, and we should talk to them all.  Find out what conditions they impose.
Shelagh:  No one's imposing any conditions.  They just want to know who we are.
Patrick:  It's perfectly obvious who we are.
Shelagh:  Patrick!  We're filling these forms in tonight.

I'm not sure if he really thought they could find an agency with less paperwork required or if he was trying to put the brakes on the process.  I was a little surprised that he was as open as he was to the idea of adoption when Shelagh first brought it up.

Episode 7

Shelagh and Patrick have the interview with the adoption agency, which doesn't end well.  The interviewer probes Patrick about an omission in the paperwork in his detailed service and work history.  Patrick lies to cover it up.  The interviewer reveals that she found out he was an inpatient at a psychiatric hospital being treated for war neurosis for several months.  He tries to explain it and says that he's since recovered.  It is clear that this is news to Shelagh, but she tries to cover it up.

Shelagh:  We've both needed great strength.
Interviewer:  We believe a child should be placed in a home where truth and trust are central to that home.

(later at their home)

Shelagh:  How could you not tell me?
Patrick:  I didn't think she would go through my entire history.
Shelagh:  She's placing a child.  She needs to know who she is placing it with.  So do I.  What happened to you?
Patrick:  I can't talk about it.

Episode 8

Shelagh and Patrick receive a letter saying that they have been accepted as adoptive parents.  Later they get "the call" that there is a baby girl for them.

Standing outside the door of the nursery at the adoption agency, this conversation happens:

Patrick:  Do you want to go in alone?
Shelagh:  No, Patrick.  This is the closest I'm ever going to get to giving birth, and I want you and I need you to be by my side.

They meet their new baby daughter.  It's a tearjerking scene for sure.

One of the midwives comments to her boyfriend after hearing about the adoption match:

Midwife: She's been given the prize of a lifetime today.
Boyfriend:  The baby?
Midwife: It's just such a magical thought. These souls that have never met being put together for a lifetime.
Boyfriend:  That's quite a deep thought for a Saturday evening.

And in a very happy ending for the season, the head nun Sister Julienne gives Shelagh a present.  When she opens it:

Shelagh:  The nightdress?  You kept it?
Sister Julienne:  For you.  For better times to come.

Now that I've spoiled everything for you, I still recommend watching these "Call the Midwife" episodes if you have time to kill in the next week and a half.  :)

IF in the movies

(I broke this topic into two posts because it was getting long.  Go here for IF on TV.)

Below are my two favorite movies that address infertility in at least one scene.  If I had to give an honorable mention award, it would be to "What to Expect When You're Expecting."  I know, I know.  It's not the typical movie an IFer would watch.  I think I was having a good day and was in a stable part of my cycle so I thought I could handle watching it.  One of the couples in the movie is infertile and is going through the adoption process; I thought the portrayal of that couple was quite good.  The rest of the movie is cute.  :) 

There are other movies that touch on infertility that I haven't seen.  I have seen the trailer and clips from a few scenes of the movie "The Odd Life of Timothy Green" which features an IF couple told by a doctor nothing can be done medically to help them conceive.  Just the trailer and clips made me cry, so it's quite possible I would be a sobbing mess if I watched the whole movie.  Maybe someday.  On a good day.  ;)

SPOILER ALERT:  If you want to watch these movies without reading about the IF scenes first or what happens to the IF couple, then skip most of this post.  I'll list the movie titles right now and talk in more detail later in the post. 

Movies:

• Up
• Julie & Julia

**********************BEGIN SPOILER ALERT**********************

Up

The first time I watched this movie I was hanging out with two single girlfriends of mine.  We were sitting in the living room with the lights dimmed but still on.  It was in the first year of IF for me.  I did not know what the movie was about except that there was a flying house carried by balloons (on the cover of the DVD).  I was definitely not prepared for the opening sequence.  The movie starts off innocently following a boy and girl growing up and eventually marrying.  They are shown painting the walls of a nursery.  You presume they are pregnant or planning to be pregnant soon.

Then this very brief scene appears:

(screenshot from the movie)

It totally caught me off guard.  I feel like that picture could definitely paint a thousand words and really captures the sadness that comes with IF and part of the dynamic of how couples react.  I immediately had tears running down my cheeks when seeing this.  I had a tissue in my pocket and tried to inconspicuously dab my eyes.  My friends had no idea we were TTC and IF.  In the movie there are no details given about whether the wife has a miscarriage or is told she won't be able to conceive.  The scenes following the couple as they age continue until both are gray-haired.  They remain childless for their entire marriage.  After this brief background story of the couple, the main plot begins with the husband (now widower) and a young neighbor boy.  Even though the IF reference scene is very brief, I think it is powerful.  (It has stayed etched in my mind for years.)

Julie & Julia

Both DH and I enjoy this movie.  I just watched it for the tenth or so time last weekend.  It's the story of two women told simultaneously even though they lived decades apart.  Julia Child (the famous cook) is living in France in the late 1940s (married at age 34), and Julie Powell is a 30-year-old wife in modern day NYC who decides to make all of the recipes in Julia Child's cookbook in a year.  She starts a blog to document her progress.  Both ladies are childless due to IF, but IF is not mentioned in Julie's story at all.  (The Julie in real life had PCOS.)  There are two scenes in Julia's life which allude to IF without coming out and saying, "We can't have children."

The pictures below are all screenshots of the movie itself.

Scene 1:  A walk in the park

Julia and her husband Paul are walking through a park in Paris and enjoying the day.  They pass a baby carriage, and Julia turns to look at the baby as it nears.  Paul notices that Julia looked at the baby carriage, and when she turns back around to continue walking, Paul kisses her hand and smiles at her.  It's so simple and subtle, but I'm sure anyone with IF would recognize how supportive Paul is being and how much it must sting for Julia to see a baby.  I wonder if non-IFers would think much of the scene at all.

Scene 2:  In the kitchen reading a letter from Julia's sister Dorothy

  Julia:  Dorothy is pregnant.

 

 Julia:  Oh, Paul.

 

Julia:  Isn't that wonderful?

 

Paul:  Yes.

 Julia:  I'm so happy.

Julia receives a letter from her newly-married sister Dorothy, who is around 33 years old, with the news that Dorothy is pregnant.  Julia's reaction is so true to life.  She starts crying but says she is happy for her sister.  (I cried with her the first time I saw this scene.)  Joy and sadness all rolled into one...that's just how pregnancy announcements are (usually) for me.

What are your favorite movies that touch on infertility?

How to ship blood

In case this is helpful to anyone, here is my little tutorial on shipping blood.  It is really easy.  We've been doing it as long as I've been a patient at the PPVI Institute.  Different labs calibrate their machines differently, and that can mean the same blood sent to two different labs would give noticeably different results.  For this reason, PPVI doctors require a patient's blood to be shipped to the PPVI lab (National Hormone Laboratory) for analysis there.  This is especially important for progesterone levels as all of the standard curves for NaPro are based on the PPVI lab.

[Side note:  Some NaPro doctors have ordered a set of controls from the PPVI lab to be run at their local lab see how closely the local lab's results compare to PPVI.  This allows the NaPro doctor to create a calibration curve to convert the local lab results into the PPVI standard.  Then all the patients for that NaPro doctor don't have to ship blood to PPVI; they can just go to that particular local lab, and the results will be sent to the NaPro doctor like any normal blood draw.]

First you have to find a lab that is willing to let your blood sample to leave their lab and go to another lab for analysis.  Not all labs allow this.  I have had the most luck with hospital outpatient labs; I have mailed blood to PPVI from two different cities.  The independent (not connected to a hospital) labs have all turned me down when I called to inquire about this.  So call around to your hospital lab(s) and ask if they are willing to just draw your blood and centrifuge it and then mail it to another lab for analysis.  You can also ask if they would let you mail the blood yourself (after it has been centrifuged).

In the first city where I lived, the lab was reluctant accommodate my request, but one of the lab admins said she remembered they had done this for a patient who was part of a research study, so in the end they agreed.  After taking down the name of the person giving me permission over the phone, I went to have my blood drawn at that lab and had to re-explain everything to the person drawing my blood.  The phlebotomist was hesitating, but as soon as I said it was for a research study, she stopped questioning me immediately and became very understanding.   Technically the PPVI Institute does do research so it's not totally wrong to say my blood draw was for research.  (Sorry for encouraging little white lies...)  I don't know why "research" was more acceptable than "my doctor wants to use her lab because it's standardized."  PPVI has written instructions on the back of the requisition form (blood draw order form) on how the blood is to be centrifuged before it is mailed, so I reviewed that with the phlebotomist before I left.  I didn't leave until I was confident that my sample was not going to be analyzed in town at that lab.  They promised to mail my blood to PPVI.

In the second city where I live now, the lab admin I spoke to on the phone was much more willing to cooperate.  He even sent an e-mail to all his phlebotomists letting them know that I was coming and what I would be asking for.  When I arrived with my requisition form in hand that PPVI had mailed to me, the phlebotomist said, "Oh, you're the girl we got an e-mail about," and she pointed to a printed copy of the e-mail.  What great service.  :)  I was impressed.  They made copies of the requisition form (which is marked as a "standing order" since I need the same P+7 labs each month) and keep in them in a file with the other frequent customers.

Now every time I go, after the staff person retrieves a copy of my requisition form from the file cabinet, I remind him/her that I'm the special case where my blood will be mailed to a different lab.  I rarely get the same phlebotomist, so I point out the written directions and make sure they understand before my blood goes to the lab for centrifuging.  The lab ladies do know the drill by now, and they even remember my name.  (I met them last month when the phlebotomist wanted me to go back to the lab to make sure everything was going to be done correctly.)

When I first started using my current hospital lab for this, they would ship the blood to PPVI for me.  Because it was not a standard request, they didn't know how to bill me, so they didn't charge me at all.  Then the lab manager decided I should be charged (and I agreed), so they did figure out how to bill me a set fee.  After quite a while doing this (maybe a year?), the lab manager decided that the lab was no longer capable of mailing my blood to PPVI.  I have no idea what changed.  They gave me two options:  have the blood analyzed locally or mail the blood myself.  So now after my blood is drawn, I wait for the lab to centrifuge the blood and separate out the serum.  They hand the tube of serum to me, and I mail it at the post office.  I am very spoiled, but they do not charge me for the blood draw or for the centrifuging.

The specific tests you are having done determine whether you can ship the blood at room temperature or whether it needs to be shipped while frozen.

Here are the different colored tubes the phlebotomist
could use. Make sure red is used. (source)

NOTE:  For the routine P+7 progesterone and estradiol, the phlebotomist only needs to fill one red top tube with your blood, not two.







How to ship blood at room temperature

For these tests:  progesterone, estradiol, prolactin, FSH, LH, HCG, and DHEA

As long as the blood will reach PPVI within 5 days, it is okay to send it without anything to keep it cold.

1.  Pick up your blood sample from the lab.  It takes a half hour or so for my blood to be centrifuged by the lab after it is drawn, so I usually just wait in the waiting area.  When you receive your blood, make sure the tube contains a yellow liquid, not red.  (One time my lab gave me a tube of red blood.  I handed it back to them and said it's supposed to be yellow (the serum).  They apologized for forgetting to separate out the serum and took it back to correct it.)

2.  Put the tube of yellow serum in a ziploc bag.  My lab gives it to me in a ziploc bag with a biohazard symbol on it. 

3.  Put that ziploc bag in a second ziploc bag.  I use a sandwich bag.  Also fold up a paper towel (or some other absorbent material like cotton balls) and put that in the bag as well.  The idea is that the paper towel should be large enough to absorb all the serum if it were to leak out.  The post office requires that the tube of serum be in two "containers" in addition to the mailing envelope, hence the two ziploc bags.

Sometimes my lab used to give me my serum in two
ziploc bags.  I didn't put the paper towel in the bag yet.

4.  Put the bundled up serum in a padded mailing envelope.  Also include the blood draw order form.  Seal the envelope well.  I always use extra packaging tape.

5.  Mail the envelope.  I use the post office for mailing and have it sent as a regular first class parcel, which is the cheapest.  Sometimes the post office clerk asks if the package is liquid, perishable, hazardous, etc., and when you're mailing blood, the answer is yes.  Sometimes they ask further questions to make sure the blood is packaged securely.  I just tell them it is in two separate containers (in addition to the plastic tube holding the blood and in addition to the envelope).


How to ship blood frozen

For these tests:  thyroid, testosterone, and androstenedione

I have only done this twice, and somehow it managed to work out for me.  This is what I did:

1.  Pick up your blood sample from the lab.  It takes a half hour or so for my blood to be centrifuged by the lab after it is drawn, so I usually just wait in the waiting area.  When you receive your blood, make sure the tube contains a yellow liquid, not red.

2.  Put the tube of yellow serum in a ziploc bag.  Put the bag in your freezer for several hours.  (I left it there overnight one time.)  I did this to maximize the chance that the blood would still be cold when it arrived.

3.  Right before you're going to mail the blood, take the bag with serum out of the freezer.  Put it in a second ziploc bag (size of a sandwich bag) along with a folded piece of paper towel or enough cotton balls to absorb all the serum if it leaked.

4.  Put the filled ziploc bag in a large (gallon-sized) ziploc bag.  Also put two ice packs in the large bag.  Seal the bag.

I used two of these ice packs.  The label says it's a "long lasting ice pack."
  The business card next to it is to show scale.

5.  Put the large bag containing the blood and ice packs in a small box.  The box I used was smaller than the size of a shoe box.  Put the blood draw order form in a separate ziploc bag (so it is protected from getting wet) and add that to the box.  Seal the box well with packaging tape.

6.  Mail the box using overnight shipping.  Use UPS or FedEx or some other company.  Don't use the post office because it might not be delivered the next day as requested.

My experience with FedEx
The second time I mailed frozen blood I went to a FedEx store at 5:00 pm.  I had my blood in a small box, but I didn't seal the box in case they preferred that I use a standard FedEx box.  I brought packaging tape and scissors along in case they said I could use my own box.  The store manager said they were not allowed to ship hazardous/infectious things or even sell me the postage/mailing label for my box.  (Technically, blood isn't considered infectious—unless you do have an infection, which I don't—but the fact that it was blood made the manager nervous.)  He said I was free to use the FedEx drop box outside.  He did give me a large clear plastic-like FedEx bag ("clinical pak"), so I taped up my box, put it into the bag, and sealed it.  I filled out a mailing label complete with credit card number and stuck it to the outside of the bag. They would bill me when they picked it up.  I chose next day delivery by late afternoon.  I put it in the drop box.  According to online tracking, the package arrived at PPVI before noon the next day, several hours ahead of schedule.

My experience with the post office
I sent DH to the post office to mail the box with my frozen blood.  It was first thing in the morning on a Tuesday.  It also happened to be the day of a predicted snowstorm, but the post office clerk still said the box would arrive in Omaha the following afternoon.  The receipt even said "guaranteed delivery" the next day.  We had a tracking number.  On Thursday morning, my box was sitting in a warehouse less than an hour from where we live.  It didn't leave my state until Thursday night.  I was upset.  I figured my blood would have been thawed by then and therefore useless.  Friday morning I called the PPVI lab to let them know the situation and asked that they not even do the thyroid tests.  I said I'd send them a new sample later.  Surprisingly the lab tech said my blood had just arrived and it was still cold, so she said they could still do the tests.  I later read online that others complained that the post office's "overnight shipping" was actually 2 or 3 days, so I learned it wasn't just the snow to blame.

If I had to mail blood frozen again, especially if it was summer, I'd prefer to use dry ice.  The lovely Wheelbarrow Rider is more of an expert on shipping with dry ice, and she said you can check the phonebook to try to find a local place to buy some.

A little medical mistake

On the plus side, the medicine I'm taking to reduce my prolactin level (bromocriptine) is working.  Let's focus on the positives here.  :)

My prolactin level rechecked last week was 1 ng/ml.  That's pretty low.  Maybe a tad too low... (goal is under 10; I started at 60)

The endocrinologist mailed me a letter with the result.  She said I should reduce my dose from taking the medicine twice a day to once a day.  I passed the information along to Dr. K.  Apparently there was a bit of a miscommunication when the medication was called into my pharmacy.  This reduced dose is actually what my starting dose was supposed to be.  Ooops.  Dr. K thought the mistake happened because the order was given verbally to the pharmacy instead of in writing.  Also the pharmacist maybe thought there was a mistake with Dr. K's order because it meant I had to cut each pill in half since it doesn't come in smaller doses (which is exactly what she intended).

So I started at double the typical initial dose...  That might explain the crazy side effects I had on the first day or so and the ongoing random bouts of dizziness.  (I almost fainted at Mass last week for the second time.)  I'm glad nothing worse happened.  I hope with this lower dose the dizziness goes away.

The prolactin medicine and/or whatever caused my TEBB to disappear (this is the second cycle without TEBB in a row!) is having a great effect on my hormones.  My P+7 values have been in the normal range for a long time, thanks to low-dose Clomid and post-peak HCG.  However, my P+7 results from last cycle—the first cycle on bromocriptine and no TEBB—set a new personal record.  They pretty much blew all previous months out of the water.

	Last cycle	Goal	My typical value	My previous high
Estradiol	53	>12	30	40
Progesterone	73	>13	20	58

So no TEBB = very happy hormones. If this keeps up, I wonder if Dr. K will have me stop the Clomid?  Now if only this would lead to a pregnancy...  :)

Doctor visit

I had my appointment with an endocrinologist yesterday.  My goal was to find out what the significance is of having a diffusely enlarged pituitary.  Nothing else.  I don't want more cooks in this (IF) kitchen than necessary.  The appointment went okay...apart from the ten minutes or so when I was led to believe I had a brain tumor.  But I did learn what I wanted to know so I'm satisfied.

The doctor spent the first part of the appointment explaining my "macroadenoma."  My heart sank.  (that word means large tumor)  I was sitting there thinking, "I guess I do have a brain tumor."  She said it was just starting to impinge on the optic nerves.  She asked me multiple times if I had any vision loss or problems.  She talked about getting another MRI in six months to see if it decreased in size.  At some point I interrupted her and asked, "So I do have a tumor?"  "Yes, you do, and macro means it's larger than 1 cm."  Then she stopped and pulled up my MRI report.

"My mistake.  No, you don't have a tumor.  Your pituitary is just enlarged.  You won't need another MRI." 

That's a relief (to find out for the second time).  I wish she would have read the report a little more closely.  It's really not fun to be told you have a tumor when you thought you didn't.

She said the enlarged pituitary could very well be a normal variant.  Normal!!  I was not expecting to hear that.  Her only guess as to why my pituitary was enlarged was the HCG I've been taking post-peak for four years.  She said it's common in pregnancy for the pituitary to become enlarged due to the presence of HCG.

She did want to do some labs to see how else the pituitary is functioning, but she said she can't check the hormones I'm being treated for because it won't tell her anything.  The (anterior) pituitary makes six hormones, and I'm on medicine that affects five of them.  (Example:  The pituitary makes TSH, which tells the thyroid to make thyroid hormones.  If you take thyroid hormones as a medicine, the pituitary goes to sleep because TSH isn't needed.)  The only one of the six she could test is growth hormone, so she's doing that.  She's rechecking my prolactin since I've been on the medicine just over a month; she said it didn't matter that I wasn't fasting.  I asked her to recheck my vitamin D, since it was low last fall.  There's something else too but I don't remember what...I do remember the four tubes of blood they took from me.  I'm glad it wasn't more.  :)

She said she would refrain from commenting on my thyroid labs from February if that's what I preferred.  Yes, that's what I preferred.  :)  She did let me know what she thought of them in a back-handed way.

As I expected, she was very skeptical of NaPro, both the long-distance concept and the actual treatment approach.  She asked me why I was originally put on T3 ("because it's standard everywhere to only use Synthroid/levothyroxine") so I explained it was due to low temps, symptoms, and a low T3 to reverse T3 ratio.  (reverse T3 is inactive)  "That's not mainstream medicine," she says.

Clearly.   You can say that again.  (She did say it again later.)  :P

If I didn't roll my eyes, I definitely wanted to multiple times...she wasn't just asking out of curiosity; she bordered on condescending...  The thing that usually stopped her accusatory tone was when I said, "NaPro has some great pregnancy success rates.  They've found    (insert NaPro medicine here)     worked for their patients."  I said that when she asked why I was working with a doc in another state, how I picked PPVI in the first place, and why reverse T3 ratios are used to plan treatment.  She did ask if there were papers published so she could read to learn more.  I told her they (Dr. H) tried, but no one wanted to hear about that.  (Dr. H got sick of journals rejecting his research paper submissions for that reason so he stopped submitting.)  She nodded in understanding.  I mentioned if she really wanted to, she could buy the 1000+ page NaPro textbook.  As soon as I said that, she scribbled something in her notes, but didn't say anything.  I have no idea if she would actually consider purchasing the textbook.  I would be shocked if she did.  I'm supposed to go back in three months for another appointment, so maybe I'll find out then.

With all the questioning she did of my NaPro treatment, I'm a bit disappointed that she didn't ask about naltrexone.  (It's the ONLY one she didn't ask about.)  Knowing that they expect me to say I'm on it to treat an alcohol or drug addiction, I like seeing people's faces when I say it's a miracle drug for PMS.  :)

Debriefing

1.  Did you all survive Mother's Day okay?  I didn't e-mail our pastor ahead of time asking for sensitivity to IF with an alternative blessing that would include IF and miscarriage or an intercession mentioning IF like others were doing at their parishes.  I thought I'd take my chances going to Mass on Saturday hoping that it would be less mother-focused.  We have new priests since last Mother's Day, so I had no precedent to go by.  (The previous priests kept the Mother's Day references to a minimum and did not do a blessing of mothers.)  My plan backfired.  The priest, who was ordained last year and probably has a lot of new-priest zeal, did his best to infuse Mother's Day into every part of the Mass possible.  By communion time, I hadn't shed a tear or even had the urge to cry, so I thought I was doing pretty well.  When I returned to the pew and heard the line in the song ("when we have run with patience the race") that usually makes me cry because it reminds me how long IF has been and how long it might be yet, I lost it and started sobbing—the kind where your whole body shakes and people might be able to hear you.  I tried to stop, but there was nothing to do except try to think of people to pray for and let the tears come until my tear ducts were empty.  (I swear I have gallon-sized tear ducts.)  By the time everyone sat down, I had calmed down, and the tears were down to a slow trickle.  I noticed the wood of the pew in front of me was quite wet...  The priest then asked mothers to stand for a blessing, and under my breath I said, "Please, no..." and the tears picked up again.  I think he was trying to include more people because he said all "past mothers, current mothers, and future mothers" should stand.  I don't know if by "future mother" he meant those who are pregnant?  I'd like to hope I'm a non-pregnant "future mother" but I didn't stand.  His blessing wasn't really a blessing, but three different prayer intentions—for those whose mothers have died, for mothers who have lost a child, and for mothers of living children—so there was really no need for the standing.  I'm glad he acknowledged two groups who would find Mother's Day to be a sad day, but I'm not surprised there was no mention of those who long to be (physical) mothers.  I would guess that to a non-IFer, loss of a dream isn't on the same radar screen as loss of a real person.

Despite a not-so-great start to Mother's Day a day earlier, I spent a quiet day at home on Sunday with DH and tried my best to forget what day it was.

2.  Two very sweet friends sent me messages saying they were praying for me on Mother's Day.  Both were told prior to marriage that they would likely never hold a biological child in their arms, so they knew the pain of IF.  One recently gave birth and the other is pregnant and due in a few months despite doctors' predictions, so the fact that they still thought of me and other childless wives on Mother's Day was a nice consolation.  A couple of my mom friends posted an article on FB about remembering IFers and single women on Mother's Day, so the day wasn't all bad.  ;)

3.  I haven't cried that hard (see #1) in a long time.  AF is here, and there have been no tears.  Last cycle I think there weren't tears until CD4, and that was only because of some trigger like a cascade of pregnancy and birth announcements in rapid succession.  (Why do they come in groups??)  I actually think it has been months since I've cried on CD1, which is not at all how I used to handle CD1.  Either I'm all scarred inside and attempting to numb the pain or I'm learning to accept not being pregnant.  I suppose it could be partially a third option as well—I've given up thinking we'll get pregnant; if I don't get my hopes up during the 2ww, then there's less disappointment when AF shows up because I just know she's coming.  And I don't do it on purpose in an attempt to make CD1 easier; I truly don't have (much) hope about pregnancy anymore.  If God wants to surprise me, that would be fabulous, but at the moment He'd have to do it without any optimism on my part.  (totally within His purview, of course)  ;)

4.  It looks like, from my non-expert eye anyway, that we might have had an effective cycle (where everything is treated/fixed) last cycle.  I'm not excited about one incidence of spotting that happened around ovulation time because, in the past, I've only had that in cycles were I also had endo.  All mid-cycle spotting disappeared immediately after both of my surgeries.  Coincidence?  I hope so.  My periods aren't painful so that is encouraging.  But I am getting a little nervous because it was at this time point after my first surgery (about 15 months) that my periods became painful again.  It's been 15 months since my second surgery.  I really, really don't want a third one.  Right now probably the only thing that would convince me to have a third surgery is unbearable pain; fixing our IF doesn't seem like it would be enough of a reason anymore.  I am hoping and praying something we've done after the second surgery (diet or medicine) is going to help keep the endo away for longer, or dare I say it, permanently...

5.  So now we're on to (hopefully) effective cycle #2.  I am very curious to see if the TEBB stays away again this cycle.  That would be a record for me—two cycles in a row!

6.  I have an appointment with an endocrinologist next week to find out the significance of my diffusely enlarged pituitary.  I hope it doesn't require a pint of my blood to figure out what other havoc my pituitary may be causing besides the elevated prolactin.  :P

IF t-shirts that talk for you

I made some more IF t-shirts for when you want to get your point across without saying a word.  Here are the previous years: 2011, 2012, 2013.  Enjoy!  ♥

And one for a husband to wear.

Need a little homemade pampering?

Yes, you do.  Especially tomorrow when, if you're like me, you wouldn't mind crawling under a rock somewhere and hiding until Monday.

Here are some recipes you could use to turn your home into a mini spa.  Most of the ingredients are really common, and you might already have them at home.  I made all of these recipes and put them in mason jars as a Christmas present for a relative who requested spa items.  They were a huge hit (and not just with the recipient) in case you need gift ideas for the ladies in your life.  I didn't get a chance to try any of the finished products, so I might be making them again for me very soon.  :)  (mason jars not required!)

All of the recipes below involve ingredients that are not in danger of spoiling.  When I was searching for recipes to make, I had to exclude all recipes that included fresh ingredients (meant to be used immediately) or those that required refrigeration because I made everything a few days ahead of time.  If you plan to use an item right away, you wouldn't be limited by those factors.  There are tons more recipes available online, so if there's a certain item you're looking for (face scrub, foot scrub, etc.) or a certain ingredient you want to use (strawberry, etc.), search for it by name.

Tea foot soak  source
1 cup baking soda
1/2 cup salt
4 Tbsp of loose tea* (or the contents of 4 tea bags)

Whisk ingredients in a bowl.  Store in an airtight container.

To use:  Add 2 Tbsp of mixture to a basin of warm water and soak feet in it.

*The original recipe called for peppermint tea.  I used autumn tea because it smelled the nicest of the teas we had in the pantry.


Scented foot scrub  source
3 Tbsp baking soda
1 Tbsp body wash
1 Tbsp water

Mix ingredients in a bowl.

To use:  After soaking feet, gently rub the mixture over your feet.  Rinse well.


Face exfoliator  source
3 Tbsp extra virgin olive oil
2 Tbsp honey
1/2 cup sugar  (I used brown sugar)

Use this 1 to 3 times a week depending on how sensitive your skin is.  It removes dead skin and rehydrates the skin.


Citrus salt body scrub  source
1/2 cup sea salt
1/2 cup sweet almond oil  (I used olive oil)**
1/2 tsp lemon zest  (I used zest from 2 lemons)
1/2 tsp orange zest  (I used zest from 2 oranges)

**In my opinion, this was too much oil.  Add it slowly as you mix it in.  I'd probably use 1/4 cup or less.  I also used about double the amount of zest that the recipe called for because I wanted a stronger citrus scent.  You could use even more zest.

Mix all ingredients in a bowl.  (make sure the bowl is dry so no water touches the mixture)   Store mixture in an airtight container.  Makes about 2 servings.

To use:  Just before showering, swirl ingredients together with your fingertips to mix. Clean body completely and just before exiting shower, apply this mixture to skin in a firm circular scrubbing motion with hands or a soft washcloth. Rinse off the mixture and pat body dry with a clean towel.  It is an exfoliant and full-body moisturizer for use in the shower.


Lemon facial mask  source
olive oil
lemon juice

Note:  I used a ratio of 3 parts lemon juice to 1 part olive oil, so 1 Tbsp lemon juice to 1 tsp olive oil. (3 tsp in a Tbsp)

Mix ingredients in a small bowl.

To use:  Apply the mixture to your face with a cotton ball.


Mocha body scrub  source

1 cup sugar  (I used brown sugar)  
1 Tbsp ground coffee
1 Tbsp cocoa powder
1 tsp cinnamon
generous pinch of nutmeg       
generous pinch of ginger       
1/4 to 1/2 cup almond oil  (I used olive oil)

Whisk together the sugar, coffee, cocoa, cinnamon, nutmeg, and ginger in a bowl.  Whisk in 1/4 cup oil until it is completely combined with the sugar mixture. Stir in the remaining oil by the tablespoonful until desired consistency is achieved.  Store mixture in an airtight container with a wide mouth.

To use: Apply to clean, wet skin in a circular motion. Rinse well and pat skin dry.

Caution:  Those with sensitive skin should consider doing a patch test before using.


Green tea body scrub  source

1 cup of brewed green tea, lukewarm***
2 cups sugar  (I used brown sugar)
3 Tbsp fresh, grated ginger

***this was way too much tea; spoon it in slowly until the mixture is a good, thick consistency; I scaled down the entire recipe and only made a third of a batch.

Mix ingredients in a bowl.

To use:  Step into the shower and rinse body so skin is wet.  Starting at your neck, work the scrub into skin by massaging in a circular motion. Once your body is completely exfoliated, rinse in warm water.  Apply moisturizer to cleansed, scrubbed skin.

~*~

I hope you get to enjoy some of these recipes.  Maybe light some candles, turn off the lights, poor a glass of your favorite beverage, and play some relaxing music.  :)

I am headed to Mass soon and I will be praying especially for all of you who find tomorrow to be one of the most difficult days of the year.

Stay tuned here tomorrow for my annual attempt at getting you to smile a little on an otherwise tough day.  :)

Lemons or something

A very curious thing happened this cycle.

I had no TEBB. (brown bleeding at the end of the period)

None.

This has only happened twice before:  1) the cycle after I finished the IV antibiotics two years ago and 2) the cycle after finishing the ampicillin last August. We've been continuing the antibiotics each cycle from CD1-CD10 in the hopes of keeping it away, but the TEBB reappeared and has been increasing little by little.

In August there was jumping up and down and dancing in the living room and a strong desire to scream out loud out of excitement. (I may have limited it to a small squeal.) :) This time, I'm mostly just scratching my head trying to figure out what made the TEBB go away and staring at my chart in disbelief. Don't get me wrong—I'm very happy to have a pretty red period. (Yes, I just used the word "pretty" to describe AF. After years of brown, which is truly ugly and gross, it seems fitting to me.)

The only things different this cycle were:
1) bromocriptine (to reduce prolactin) - started six days before AF arrived
2) turmeric - started day 6 of this current cycle
2) daily mug of lemon water

I tried to ask Dr. Google if bromocriptine could have an anti-inflammatory effect but didn't get very far, except for one seemingly unrelated article.  I suppose there could be a different mechanism at work, but I can't speculate what it could be. I think starting turmeric on day 6 is a little too late to explain the disappearance of the TEBB.  So that leads me to believe it's most likely the lemon water? It really seems too good to be true that such an easy "treatment" could be responsible...

In the past I had read about foods that were anti-inflammatory and knew lemons were on the list. Someone posted an article on FB about the benefits of drinking lemon water daily, so I decided, "Why not try it?" I figured it couldn't hurt. The directions said to put a thick slice of lemon in a cup of hot water, let it steep for a while, and then drink it. I was a little skeptical about the lack of sweetener in the water, but decided to trust the article. When DH made his daily cup of tea, he boiled some extra water for me for my "lemon tea" as I called it. (It actually sort of does remind me of lemon tea.) I was pleasantly surprised that the lemon water doesn't taste too bad, considering that lemons are so sour.

I had been drinking the lemon water daily for 3-4 weeks before AF arrived this cycle. I didn't write down the exact date I started it, probably because I didn't think it would have this dramatic of an effect.

If anyone has a better idea of why my TEBB disappeared this cycle, feel free to enlighten me. I'm not holding tightly to the lemon water theory. ;) (I spared you from the pun. You're welcome.)

So the TEBB is gone and I had been on the bromocriptine for three weeks prior to ovulation time this cycle...do you know what that means?  If there isn't another issue (still low vitamin D?) or five that remain undiscovered, we might be able to count this as our first "effective" cycle*. After nearly five years of TTC, the concept of me having an effective cycle is completely foreign. The 2WW is going to get rough, especially if I get to the afternoon on P+16 like last cycle. (Thank you, bromocriptine, for lengthening my post-peak phase to the point where the mind games begin.) This cycle I won't be able to tell myself that there is no chance of pregnancy like last cycle (because prolactin was super high), so there is a possibility I could go crazy. ;)  But it's been a very long time since I've had any optimism about our chances of conceiving, and that feeling seems really hard to shake.  I probably should be a bit more excited than I am.


And the scoop on the bromocriptine...

Bromocriptine has definitely required time to get used to it. I knew beforehand that it has a reputation for its side effects; sometimes the side effects are bad enough to make patients switch to another medication that is easier to tolerate. (That other medicine isn't quite as "safe" to take if you're pregnant or TTC, hence starting with the safer but harsher med first. It's quite possible the nicer medicine is also safe, but a bit less is known about its effects on pregnancy.) The list of side effects on the information sheet from the pharmacy was super long...seemingly longer than most other meds I've been on. I just hoped I would be spared from nausea and vomiting. (I'll deal with them if a baby ever took up residence, but not before then.)

I took the first pill with a little fear—the first time I've been afraid to take a new medication. The side effects came rather quickly and wiped me out. I counted six different side effects on that first day, a couple of which were on the "uncommon side effects" part of the list. Lucky me. One of them was full body weakness; I could barely walk (only tiny, slow steps) and I couldn't even lift a half gallon of milk. It felt like I had the flu plus a sinus infection with some nausea on the side. Lovely, right? Thankfully I felt better the second day and the nausea was gone. On the third day I felt totally normal. I thought, "That was it? I can handle this medication!"

On the fourth day, I came *this close* to fainting during Sunday Mass. Yep, dizziness is on the list of side effects. It was warm in church and I was wearing a cardigan, but it wasn't that warm, DH claims. (In my teenage years, I fainted now and again during Mass if it was too warm, so I know the experience.) After nearly blacking out during the prayers of the faithful, I spent a while sitting with my head between my knees (still in our pew), taking slow, deep breaths in an attempt to keep oxygen flowing to my brain and trying to will myself to remain conscious. I recovered by the sign of peace, and the older woman behind me gave me a big smile of relief as I shook her hand. I swear the look in her eyes said, "Oooh, I bet this girl is pregnant." Do you know the look? (One of my Creighton clients nearly fainted once during Mass, and that's what the old ladies told her after Mass—that she must be pregnant. I knew for a fact that she was not.)

The following Sunday I made sure to wear short sleeves. I did start to feel a little dizzy again but no where near blacking out this time. Since then, I sometimes get dizzy if I stand too quickly. Thankfully, other than that, I have no remaining side effects.

Now that I know my body recognizes the bromocriptine, I hope it will be able to do its job and lower my prolactin. I think I'll find out my new prolactin level in a couple weeks.


*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.