The phone call

Earlier this year I received a phone call.  It was from DH, who was out of town attending a family reunion.  (I couldn't go because of work.)  We chatted briefly about the relatives he saw, and then his voice became very serious.

DH: Um, are you sitting down?  I need to tell you something.

I immediately thought the worst—like someone died or his mom's cancer returned.  I actually did sit down.

DH: You are going to be an aunt.

I was confused at first—none of our siblings are married.

Me: What do you mean?
DH: My older brother is having a baby.  Well, his girlfriend is.
Me:  Oh. Wow.

[Silence]  I sat there in complete shock with my mouth literally hanging open.

Me: I didn't know he was dating anyone.
DH:  I didn't either.  He met her a few months ago, I think.  They haven't been together very long.
Me:  Are they going to have the baby?
DH:  Oh, yes.  For sure.
Me:  Are they going to keep the baby?  Are they thinking about adoption at all?

I was thinking, "Oooh, we could adopt their baby!  Wait...what a weird situation that would be—raising your brother's biological child.  And we haven't even discerned adoption yet.  Okay, scratch that thought."

DH:  They will keep it.  You know how much my brother wants kids.
Me:  Are they taking about marriage at all?
DH:  Actually, yes, but there isn't a date.  They had to tell some of her relatives that they were engaged to keep peace in the family.  In the meantime, she's going to move into his house.

At some point during the conversation I started to cry.  I had a million thoughts racing in my head.  Why do they get to have a baby?  Why can't we?  It's not fair.  They knew each other for a few months at most before they got pregnant.  And now we're infertile, and they're having a baby.  We're supposed to be having the first grandchild, not them.  (It's scary how much I sound like the older brother in the prodigal son parable...being infertile brings out some pretty ugly thoughts.)

Then I realized:  their having a baby has nothing to do with my inability to have one.  This jealousy has no purpose except to make me bitter and anxious inside.  Fertility doesn't depend on whether you're married either...crazy thought.  No one can "earn" a baby...God doesn't work like that.  We should be thanking God they are letting this baby live.  And we should praise them for making the choice to let this baby live..that cannot have been an easy decision.

I've had a while to ponder this.  When I think about it now, it still hurts a little but I think it's mostly because it shines a spotlight on our infertility—reminding me that we can't have a baby so easily (or at all, at the moment), which makes me sad.  I'm trying to see the upside of the situation.  Here's what I came up with:

1.  They live far away, and we rarely see them (less than once a year), so I won't have to face them often.
2.  This might satisfy my mother-in-law's desire for grandchildren for a while, so hopefully she will stop asking DH when we're going to have kids.  DH told her there are some medical "issues" but hasn't been more specific.  You would think that would be enough for someone to back off the subject, right?  (especially given the fact that two of DH's married cousins—on my MIL's side—are infertile, so this is not new in their family...)  We shall see.
3.  I now have an excuse to peruse the baby aisles at stores.  I will still secretly wish it were for our own child, but this will do for now.  (Eh, who I am kidding?  I never needed an "excuse" to browse the baby aisles before.)  ;)
4.  I also have an excuse for a sewing project.  Or an inspiration for one.  More to come when it's finished.

The verdict on HCG

I found out the results of my lab tests from last cycle.  Dr. A wanted to see how my hormones were responding to the HCG injections, so he ordered some post-peak labs on three different days.  I was optimistic that the HCG was helping even before having the labs done.  Since starting HCG, my post-peak phase is about three days longer than before (not that it needed to be longer), my mood-related PMS symptoms are gone (oh, how DH loves that), and my post-peak mucus has nearly disappeared.  DH likes all this evidence that his injection-giving technique has been working; the HCG is getting where it needs to go—very reassuring for him.  Anyway, the labs say my progesterone is much improved since HCG, and estrogen looks good, too.  It's nice to have one problem solved!

Speaking of injections, DH is such a trooper in giving them to me.  I remember telling him after the first few failed TTC cycles, "You know the first treatment I'm going to get is HCG.  You know who gives the HCG injections, right?  The husband.  You know I wouldn't be able to do it."  His eyes got very wide, he shook his head, and he said he would never give me any injection.  Over time he softened a bit so by the time Dr. A actually ordered HCG, DH was willing to administer them.  (thank goodness!)  He was so nervous for the first one, bless his heart.  He had been trained by a nurse, we had general step-by-step written instructions from the clinic, and we had a random website I had discovered that went into great detail for each step.  (DH declined watching the how-to video on YouTu.be that I found...I think that would have made him more nervous.)  I had been told (and read) that the injection shouldn't really be painful at all—just a quick stick.  I suppose that is true if the injection giver is experienced, but for a newbie like DH, perhaps not.  There was some definite offering up of some burning pain that first cycle...  ;)  I swear one time DH rested the needle on my skin and slowly pushed it downward.  I don't recommend that technique.  DH did get the hang of the dart-like motion eventually, and the rest have been pretty much pain-free.  If at some point we get pregnant, I will likely need progesterone injections, which make the HCG ones look like a walk in the park.  For now, I am very thankful for HCG.  :)

The fertile world around me

Lately I have been reminded how fertile my friends are.  A couple weeks ago I received a birth announcement and a pregnancy announcement on the same day.  Two other friends are further along in their pregnancies.  There were two more births this week.  I am assuming there will be another pregnancy announcement shortly since I know a couple who has been TTC for a little while now.

I try to share in their joy.  I really do.  I love that God is blessing so many of my friends with such a beautiful gift.  I express my congratulations in the most heartfelt way I can muster.  Some days I impress myself.  For some reason it is easier for me to be happy and sincere on the phone than by e-mail...perhaps it's because I let myself cry while writing e-mails because no one sees or hears the tears.

After one of the recent births I was looking at the baby pictures posted online, and I just started to sob.  DH simply held me.  He understood and didn't have to say a word.  It felt just like the scene from Ju.lie and Jul.ia.  I was so happy for my friends but at the same time I hurt so much.  I wondered if they knew, if truly knew the magnitude of the blessing they had been given.  Somehow the blessing seems infinitely greater when you're looking at it from across the chasm of infertility.

What's my diagnosis?

Want to pretend you're a hematologist for a day?  Want to show off your Dr. Google skills? 

Let's play* "diagnose polkadot's clotting problem."  I've already tried to do it, and I've come up with a range of possibilities from benign to scary, so I doubt you'll find something worse than I did.

Here's the data you have to work with:

INR - normal
CBC - normal
PT - normal
PTT - very slightly short
Factor VIII - elevated
vWF antigen - elevated
vWF activity - elevated
platelet function (two different assays) - both short closure times

What diagnosis explains these lab results?  Anyone brave enough to try besides TCIE?  ;)

*Sadly I have no fun prizes like holey soap if anyone comes up with the same answer as my hematologist.  I will just be super impressed at your googling skills...and I have high standards when it comes to that.

Doctor #2

In an interesting turn of events, I recently had a consult with Dr. C, who is trained in surgical NaPro.  (random opening in his schedule...fortunately he's within driving distance)  After going over my history and test results, he gave me the plan:  laparoscopy, hysteroscopy, endometrial biopsy, and HSG (to flush out the fallopian tubes) all in one day.  I will be blissfully unconscious the whole time.  (That is really best for all those involved.)  He said he will be prepared to deal with whatever he finds—if there is a polyp, it will removed; if there is endometriosis, it will be lasered out.  He was rather cheerful and almost enthusiastic about it—kind of like a coach motivating his team with the game plan.

Just when I thought it was time to go, he decided he should do a pelvic exam.  I was so close to getting away without it.  As he was leaving the room so I could change into the gown, he asked very nonchalantly if he could do the endometrial biopsy today. 

What I was thinking: "How on earth are you going to get that sample?  That requires going through the cervix...  Can't you do it during the surgery while I'm unconscious?  You're going to be in there anyway.  That was the plan you mentioned five minutes ago."

What I said: "Okay."

Apparently I am easy to convince.  I had no idea what I had just agreed to.  He returned with a nurse and a large tray full of metal objects.  I am glad I didn't know ahead of time what was going to happen.  (I googled it when I got home, and the description sounded worse than what it was.)  It was uncomfortable, and there were lots of cramps.  He needed two samples, so he had to do it twice.  Fun.  Ah, the things we go through to figure out why we can't get pregnant...

Afterward he was silent for a minute and looked like he was pondering something.  Then he asked if I bruise easily (yes) and if my gums bleed easily (sometimes, yes).  Great, now I have a clotting problem.  Why has no one asked me about this before, I wonder?  (especially that dental hygienist who turned white as a ghost at how much my gums bled during a cleaning a year ago...poor girl was traumatized)  Dr. C decided to order a clotting panel and said if the biopsy and labs are normal, then we'll schedule the surgery.  It must have been quite the panel he ordered since it required eight tubes of blood.  He said if the results are abnormal, he will call me.  Otherwise, he won't.  No news is good news, got it.

Less than 24 hours later he called.  The biopsy results weren't back yet, but the labs were.  I do indeed have a clotting problem, one that is out of his area of expertise, so I am meeting with hematologist in a couple months (that was the earliest available).  I wrote down which of the assays were abnormal and consulted Dr. Google.  Not a good idea.  Based on what I found, I came up with a couple possible diagnoses.  Also not a good idea.  (I am not a doctor...what do I know?)  I hope I am wrong, and it's just due to stress, which is actually on the list of possibilities.  Now I have to wait for the appointment with the hematologist for the real diagnosis.

I sent the lab results to Dr. A hoping he would have some insight.  He could not comment specifically on my labs, but it was reassuring to hear him say that many infertile women have clotting abnormalities which are usually treatable, and they go on to have normal pregnancies.  I really could have used that reassurance yesterday when I was convinced I have a horrible disease and will never have children—biological or adopted.  DH likes to call me his drama queen from time to time...  :)

So now we are taking a break from TTC until meeting with the hematologist.  As much as I want to find and fix the cause of our infertility ASAP, I am looking forward to this break.  Infertility is going to teach me patience whether I like it or not.

P+17? Nope, CD1

The third cycle with HCG was a bust.  I did set a new personal record for post-peak phase length:  16.54 days.  Technically I could have gone to the lab to have my HCG level checked (pregnancy test) that morning before AF started, but Dr. A thought peak+17 might be a bit too early to test--HCG from the injection might still be hanging around.  Making it past lunchtime on peak+17 without AF starting was pretty exciting, though.

This cycle we're adding an antibiotic to see if it will eliminate some of the extra bleeding. Can I just say I would be ecstatic if I had fewer days of bleeding?  Obviously, if it helped me get pregnant, that would be great, but less bleeding would definitely be a welcome step.

The 2WW

I remember my first 2WW (two-week wait).  Oh, how sweet and innocent I was.  I was on cloud nine pretty much the whole time.  I was constantly praising God for everything, especially opening DH's heart to TTC.  I had so much hope—a hope that fully expected to be fulfilled.  (Having a 76% chance* of conceiving in the first cycle seemed like pretty good odds to me.)  About halfway into the 2WW, I started spotting.  I had never ever been so excited to see spotting.  "Implantation bleeding," I thought, "right on time."  I diligently kept track of other early pregnancy symptoms.  Toward the end it took a lot of willpower not to take a pregnancy test.  (But I was bound and determined not to test until P+17...no false negatives for me.)  I never quite made it to P+17.  I was crushed.

The second cycle I had 2WW amnesia, I think.  I let my hopes get just about as high as they were the previous cycle, not remembering how much the disappointment hurt when AF came.  Lots of people don't conceive on the first try, I told myself.  If 90% of couples* conceive by the third cycle, there's no need to worry.  Yet I still cried when AF showed up.

Since then my attitude during the 2WW has gradually shifted towards self-preservation: "I'd love to be surprised by pregnancy this cycle, but I'm not really expecting it to happen now."  Change in expectations means less disappointment, right?  Of course, there is always a tiny voice in the back of my mind thinking, "This could be the cycle!"  (This is followed by, "God, could this be the cycle?")  I try not to dwell on it until the end of the 2WW.  I actually look forward to the first week after ovulation.  No more pressure to use certain days.  Either I'm pregnant or I'm not—there is no way to tell, and nothing more can be done at that point (aside from trying to boost progesterone).  It's a nice little emotional break...provided PMS stays away.

But then there's the second week of the 2WW.  Just as I'm starting to mentally relax, I notice what could be an early sign of pregnancy.  Let the mind games begin.  Here's a little peek inside my head:

Fatigue:  Wow, I can barely keep my eyes open.  I really need a nap.  Ooooh, could I be pregnant?  Or might it have something to do with not getting enough sleep the last three nights?  Or perhaps it was that lunch I had an hour or two ago full of carbs—my blood glucose probably just took a nose-dive...I suppose that's it.  Doesn't everyone feel tired mid-afternoon?  But I didn't feel this tired yesterday...hmmm...

Breast tenderness:  I think they're a bit sore.  Am I imagining it?  Hard to tell.  Maybe I'm checking too often so that's why they're sore.  Oh, it's just another PMS symptom.  But taking HCG has eliminated my other PMS symptoms...and I never noticed it before TTC, so maybe I'm pregnant?  Well, I guess I really never paid attention to it before TTC...

Urinary frequency:  I have to go to the bathroom again?  Really?  It's only been an hour since the last time. (grumble)  Maybe this is pregnancy!  No, it's just those ten glasses of water I had today—I did drink more than usual.  Well, at least my kidneys are working.  But I've had that much water before and never had to go this often...

Nausea:  My stomach hurts.  It's not heartburn.  Ooooh, it's really nausea.  This is unusual for me.  It must be that I'm pregnant.  Or could it be related to eating way too much homemade ice cream approximately an hour ago?  I wonder.  But this really feels different from the past when I've eaten too much at once...

Vomiting (only twice since TTC):  I threw up.  First thing in the morning.  It's morning sickness!  Wait, maybe I'm just super nervous about that big meeting at work today.  Or it's because I am up much earlier than normal and haven't eaten yet...but, it's not THAT early, really...

Toilet paper status:  Is that spot red? (after scrutinizing the TP very closely for two minutes...)  No.  Great!  Is it brown?  Wellllllll....maybe?  Oh, it's just not the best lighting in here.  That's why I can't tell.  I should check again to be sure.  It's not really brown.  Maybe the urine is dark because it's concentrated, and it just sort of appears brown.  Or almost brown.  Does that count?  But even if it is brown, it could be implantation spotting.  (five minutes later...)  Oh, I felt something—is that my period starting?  I better go check again...  God, your will be done.  (Are infertiles the only ones to pray before going into the bathroom?)

ETA of AF:  Today is peak + ___ (insert number 13 or higher).  AF could possibly start today.  I should wear a pad just in case.  Oh, but this cycle could be the one.  Yeah, but it would be really bad if AF came today and I weren't prepared.  Fine, I'll wear a pad.  And I'll put three tampons in my purse.  But that doesn't mean AF WILL start...maybe I'll get to the end of the day and find out I didn't need one after all.  That would be nice.

Once upon a time I kept track of (i.e., wrote down) each and every symptom I observed during the 2WW.  (I wanted to be able to answer the CrMS pregnancy evaluation questions accurately.)  At some point a few months ago it became too difficult to constantly focus on them, so I stopped.  Now, if they happen, they happen.  No big deal, right?.  Except I still have those little dialogues in my head whenever I notice one or more of the symptoms.  I guess that hope is still there.  I hope it doesn't drive me crazy.


*couples with normal fertility using CrMS to conceive

The other side

I've worked with couples with infertility or repetitive miscarriages for several years now.  I probably told every engaged couple I met during their CrMS introductory session, "I hope you never need NaPro, but just in case, it's reassuring to know that it's there."  I've even taught engaged couples who started TTC on their wedding night and went on to need NaPro.  It was heartbreaking to watch cycle after cycle pass without a pregnancy...and to see their excitement and hope turn into disappointment and (sometimes) despair.  My heart broke for them...but I never imagined I would one day be in their shoes.

My CrMS chart wasn't textbook perfect, but it didn't have the "major" signs pointing to increased risk of infertility that we're taught to look for on charts.  My mucus was great...really great.  (Seriously, if there was a contest of whose mucus stretched the most, I would win.)  My post-peak phase was well within the normal range.  I averaged very close to the "typical" 28-day cycle.  I didn't have painful cramps during my periods.  I even had a client with an almost identical-looking chart to mine who was super-fertile.  I had pretty much convinced myself we had good fertility.  I really wanted that to be true.  But in the back of my mind, I knew I had too much bleeding.  My periods seemed to go on forever and would be followed a few days later by more spotting.  I tried to rationalize that the mid-cycle spotting was probably just estrogen-breakthrough bleeding, so nothing to worry about.  But I could not explain away the long periods.  Regardless, I still clung to the (naive) hope that we had normal fertility.

While I was in Omaha for practitioner training (before I was married), I showed my chart to Dr. H, the founder of NaPro.  He studied it briefly, handed it back to me, and said, "You need a hysteroscopy."  I was not expecting that, but I figured with 30 years of experience, he knew what he was talking about.  :)  There wasn't a NaPro ob/gyn anywhere near where I lived, so I had to find someone else.  I found a local ob/gyn covered by my insurance who specialized in hysteroscopy and was also pro-life—a nice bonus.  Unfortunately, he did not agree I needed a hysteroscopy.  He ordered an ultrasound and said that the results explained my unusual bleeding but needed no further intervention.  "Come back to see me when you're pregnant," he said.  I was relieved not to need hysteroscopy and didn't pursue it further.

We started TTC last summer.  Six cycles came and went without pregnancy.  (Note:  When charting with CrMS, if you begin TTC and have not conceived after 6 cycles of fertility-focused intercourse, you can be referred to a medical consultant—you don't have to wait the full 12 months like most non-NaPro doctors require.)  It was a little strange to refer myself to the local NaPro doctor (Dr. A), but I wrote the referral letter just like all the rest I had written for clients.  The only difference was the number of charted cycles I sent to him.  Normally if a couple learns CrMS after they have experienced infertility, they only need two cycles charted to send to the medical consultant.  I sent Dr. A more than 40 cycles.  Overachiever, I know.  :)  (I charted long before we were married.)   Dr. A ordered the standard targeted hormone profile, a series of blood tests to measure different hormones throughout the cycle.  He also had me go back to my non-NaPro ob/gyn to see if he would do a hysteroscopy now.  The ob/gyn still didn't want to do it, but he did order a pelvic MRI to check out the anatomy of my uterus.  The MRI showed the same thing as the ultrasound so still no hysteroscopy.

The hormone profile ended up being 11 blood draws over 3 weeks—I felt like a human pincushion.  I really don't like needles, so DH came with me to all but one of the draws.  (I was so proud that I did one by myself!)   The phlebotomists at the lab started to recognize me after I kept showing up and said, "We love our regulars."  The good news is that I think I'm over my fear of needles.  :)  Everything came back normal except for low progesterone at the end of the cycle—a late luteal phase defect.  The treatment was post-peak HCG injections on certain days of the cycle.  Dr. A said the HCG should give us a pretty good chance of pregnancy, but if it didn't work after three cycles, we'd try something else.  So far we've tried two cycles with HCG without success.  We are disappointed, of course, but I think more than usual because Dr. A was rather optimistic about the HGC working.  This cycle he wants some blood tests done post-peak to see how my progesterone is doing.  The next step will probably be antibiotics.  After that, I refer myself to another medical consultant who does surgery...maybe I'll finally get that hysteroscopy.  Is it unreasonable to ask God to let me get pregnant before I would need surgery?  Surgery was not in my original plan.  ;)

Disclaimer about TMI

I'm a CrMS practitioner.  Mucus is a common household word.  It has been for years—even long before I met DH or became a FCP.  So consider yourself warned ahead of time.  Some bloggers write TMI (too much information) on a individual post when talking about personal physiology.  I probably won't do that.  I'll just start talking about mucus or bleeding and assume everyone's comfortable with it.  Just wanted to be clear upfront.  :)

The new girl

Hello, blog world.  I'm polkadot.

Let me just say that this blog was not my idea...it was DH's idea!  Almost from the first day I stumbled upon a Catholic infertility blog, he was telling me, "You should start a blog!"  HAHA, very funny.  Me, write a blog?  I don't even comment on other blogs.  But he was convinced I have a lot to say.  Could it be that I talk his ear off, and he wants some of that diverted elsewhere?  Hmmm...I wonder.  (He denies it, of course.)   :)

The title of this blog comes from a quote from one of my favorite movies.  (BTW—If you haven't seen Bella, I highly recommend it.)  How many times have I told God my plans?  More than I can count.  I wanted to be married by a certain age, have lots of kids, be a stay-at-home mom, the list goes on...  I have given God cause for many a chuckle and probably some roaring belly laughs from time to time, too.  :)  And God has been teaching me in several obvious ways, infertility being the most recent, that He is in charge, not me, and that He has a far better plan than any I could imagine.  And I am learning to trust Him in the process.