Drug Diary

As a part of treatment you are given a 'drug diary', which is basically a sheet of paper where you mark which meds you have to take on each day.


Here is my cocktail mix: 


Cycle Day (CD) 1 - Baseline Blood test, collect meds
CD2 - Gonal F (150) - (a hormone injection that stimulates the ovaries to mass produce eggs)
CD3 - Gonal F
CD4 - Gonal F
CD5 - Gonal F
CD6 - Gonal F 
CD7 - Gonal F & start Orgalutron (another injection. This one stops your ovaries from releasing the eggs they're producing)
CD8 - Blood test & Ultrasound scan @ 7.30am. Showed 4 obvious follicles and a few others that may not mature in time. Gonal F & Orgalutron
CD9 - Gonal F & Orgalutron
CD10 - Gonal F & Orgalutron
CD11 - Gonal F & Orgalutron
CD12 - Blood test & Ultrasound scan @ 8am. Showed TWENTY (!!) suitable follicles! 8 on my left ovary, 12 on my right. Gonal F & Orgalutron - LAST DOSES! :) Egg Pick Up (EPU) scheduled for 9am on CD 15.
CD 13 - Ovidrel (Trigger injection given precisely 38 hours before EPU occurs) @ 7pm.
CD 14 - Jab-free day - woo hoo! My poor pin-cushion tummy is grateful!
CD 15 - Egg pick up. Start progesterone support, which is NOT an injection - thankfully!


My thoughts on self-injecting - it's not as bad as I expected. All shots are given into the stomach, about an inch or two beside, or slighty under, the belly button. I alternated sides each night. Gonal F is a nice easy to use 'pen', looks similar to an epi-pen and has a short, fine needle that I barely felt going in. Orgalutron was not so kind to me - the needle seems a bit 'blunter' than the Gonal pen, and stung a bit more going in. For about an hour or so after that injection I got a stinging/itchy sensation under my skin and often some redness. I only managed to give myself one bruise in almost 20 injections, and that was on my second last night!

The drugs that are going to help make a baby!

My own personal 'sharps disposal bin' - anyone that breaks in will think I'm a junkie!

Underway!

Our first IVF/ICSI cycle began on July 4th. I went to the fertility nurse to have my baseline blood test and all came back OK. After parting with a large sum of money I had my bag of drugs and was off! I started injecting on the 5th July with nightly injections of Gonal F (to stimulate my ovaries so they produce more eggs). The injection isn't bad at all, although the first one took a lot of mental preparation before I could actually jab myself! On the 7th the nurse called to schedule a blood test and ultrasound for Monday 11th July. I also had instructions to begin my Orgalutron injections on Sunday night. This came with a warning that 'the needle is blunter than Gonal, so expect it to hurt a little more.' Great. The injection itself didn't hurt but the injection site got red, sting-y and itchy for about an hour or so after.

So, BT & U/S Monday - there are about 5 follicles on each ovary. Three on each ovary are growing at the correct rate, whilst the others are a little small and may not mature in time for egg collection. I think we're looking at a haul of 4 (but secretly hoping for 6!) eggs. Back for another BT & U/S on Friday 15th where I expect them to tell me that egg retrieval will be on Monday 18th July....my vacation time will be a little longer than expected!

Pregnant women are smug

If you're one of my pregnant friends and you're reading this, I love you. I really do. But I also love this video and when I need to laugh, this helps.

Crunch time

After our follow up appointment with Dr B last week we decided that our best option is to start IVF. We are hoping to be able to start in July. It is a lot to take in, and we're still getting used to the idea ourselves. But we are excited and relieved to finally have the wheels in motion.

Things you shouldn't say to your reproductively challenged friend/family member

In the time I've been trying to conceive, you wouldn't believe the things people have to say about it. I realise that when confronted with infertility (albeit someone else's) many people aren't sure what to say and blurt out something they might think is terribly helpful. It's usually not. Here is a list of things you probably shouldn't say to me, or anyone else that's having difficulty conceiving.

1. "Just relax and it will happen." I am relaxed. Thanks. And although stress can affect fertility I can assure you that none of the invasive, expensive tests I've had to put my body through suggested I was 'too stressed out' to conceive.

2. "I just have to look at my husband and I get pregnant." Not helpful. It's not about you and how easily you can get pregnant. It's about the fact that I can't.

3. "There are worse things in the world than being infertile." You're right. Natural disasters, war, terrorism, being diagnosed with a terminal illness, etc are all infinitely worse than being infertile. I know that because I'm not stupid. This still does not make me feel better that I can't make a baby. Sometimes, to me, it doesn't feel like there's anything else in my world worse than that.

4. "Maybe you're just not meant to be parents." This often comes from religious minded people who firmly believe God has a plan for us, and that plan might not include children. Well, my plan does include children, so I'm doing what I can to make it happen.

5. "Maybe you've got a hostile uterus (or some other condition)?" You've been watching too much Grey's Anatomy. Don't diagnose me, unless you're my doctor.

6. "Be glad you're not pregnant because you'll get morning sickness/stretch marks/back pain/can't drink alcohol." I'll take it all. I'm pretty sure having a healthy baby trumps all those insignificant 'inconveniences'.

7. "Aren't you glad you can't have a kid, you don't have to deal with poopy nappies, temper tantrums, sleepless nights etc etc etc" No. I'm not glad actually. PS - Don't ever speak to me again. The general rule would be to try not complain about your pregnancy or children to your friend that is dealing with infertility. Save it for your Mummy friends.

8. "I had a friend who got pregnant as soon as she stopped trying." I'm not that friend, our circumstances are most like vastly different, and I have less than 1% chance of getting pregnant naturally I can't see that happening. Again, it's just not a helpful thing to say.

9. "Why don't you just adopt?" If you've never had to research adoption, you're lucky. There are less than 70 domestic adoptions Australia-wide each year. It's not uncommon for a couple to wait up to 10 years to adopt domestically. Inter-country adoption wait times are around 5-7 years. It's not as easy for us as it is for the celebrities.

10. "I hope you get pregnant eventually because being a parent is the best job ever." Here's hoping I find that out for myself one day but, until then, try not to rub it in, OK?

11. "Have you tried *insert any number of things here*? That worked for me." Suggesting sexual positions, telling me to put a pillow under my butt, suggesting I eat certain foods or take certain supplements etc don't usually help people who have a less than 1% chance of a natural pregnancy. And anyway, I tried them all waaay back when I started TTC, back when I naively thought stopping the pill was enough to get pregnant.

12. "Maybe I need to take your husband aside and give him some tips." (Often followed by winking, nudging) I don't need to explain why this is inappropriate. This is often a male's response, and it just makes me want to punch something (usually the face of the person who said it).

13. "I've heard IVF is really expensive." You heard right, and I don't need to be reminded. See my running costs list to the right.

14. "I know how you feel, I took me 2 months to conceive my first baby. It was really depressing" If you felt that way after 2 months, imagine how you might feel after 2+ years. And unless you're in the exact same situation as we are you don't know how I feel.

15. "You're from a really fertile family, so you'll be fine." In most cases of infertility, genetics has absolutely nothing to do with it.

I could add more to the list, but I think I've given you enough ideas! You might be asking "Wow, what can I say?"  Say "I'm sorry to hear that. I'm here for you if you need me." It's also super helpful if you remember things I've told you...for example if I tell you I have a Drs appt scheduled, a message asking how it went is always appreciated.

Recovering

Two weeks on from the surgery and I'm feeling pretty well back to normal. I went back to work a week after the op, made it 2 days then needed another day off!

We are seeing Dr B this week and expect to get a lot more information to help us decide on the next step.

Reasons I'm not rushing back to work

I am due back at work tomorrow but have decided to postpone that for at least another day for a few reasons...

1. The only pants I can comfortably wear that don't irritate my incisions are pajamas!
2. I came to the realisation that teaching isn't really a job that allows 'rest'. Nor does it allow you to go to the bathroom whenever you want - you're governed by bell times :/
3. Walking more than about 20 steps at a time is tiring.
4. I did a couple of things around the house yesterday - load of laundry, sweeping, vacuuming - and felt like I had run 3 marathons when I finished.
5. I checked my accumulated sick leave balance and I have over 45 days, so taking another one or two won't hurt.
6. I still need at least one nap per day.
7. J pointed out that every day at stay home I get paid the exact same as I would if I went to work, so why would I go in and deal with teenagers if I didn't have to?

Day 3 Post-Op

J went back to work today. I am feeling a lot better. I have not taken pain meds since 2pm yesterday. I took a shower last night and changed my dressings. My shoulder pain is improving and no longer feels like someone is stabbing a hot knife into me. My 3 incisions only hurt if something touches them, or if I move/stretch a lot.

I manage to make it to about midday, then I need to take a three hour nap. I am definitely not ready to go back to dealing with teenagers for a few days yet. I also did not really consider how much I walk at work. At home, taking the 15 steps from bedroom to bathroom is somewhat of an expedition, so walking all over school is not going to happen just yet.

Surgery Day

May 20th = Laparoscopy Day! Despite the fact that AHM won't help us with the cost, we decided I needed to go ahead regardless...so armed with my VISA card, off we went.

I had to be at CH Day Surgery by 8.30am. Less traffic than expected got us there half an hour early. I was feeling a lot less nervous than I had been in the past few weeks, though I'm not sure J felt the same! A nurse took me into an office and asked a ton of questions. We moved into a private waiting room where I got changed into my lovely gown, cap and booties! Then Dr B came in to say hi and answer any questions we had. Then another nurse came and asked the same questions as the first nurse. She was closely followed by the anesthetist, Dr M.  J wanted to know why we don't call them anesthesiologists like in the USA. He didn't know. He asked a ton more questions, followed by yet another nurse who finally took me into the operating room. I lay down on the table and starting shaking...not sure if I was cold, nervous or both. Two nurses were fussing around putting on heart monitors etc. Dr B was great, holding my hand and reassuring me while I had a cannula put in. I remember asking them to let me know when they were about to knock me out. Dr M said "I'm just giving you something to get you started, you'll feel dizzy." and the next thing I knew I woke up crying (!?) in the recovery room at around 10.20am. I was in quite a bit of pain and vaguely recall them giving me at least 3 lots of pain meds through my IV. The next hour in recovery was a blur, dozing in and out of consciousness, feeling the pain meds kick in, hearing the buzz of the doctors and nurses tending to other patients. Dr B came by at one point. I yelled (feebly) at a nurse to let my husband know I was still alive! (Turns out she didn't, and poor J was in the waiting area wondering what was taking so long!)

Eventually, at about 11.20am, I was moved into a private recovery room where J was waiting. Little did I know at that stage how much I hit the jackpot by scoring that room. Everyone else was placed in a communal recovery area that had only armchairs, no beds. I'm not sure if I was recovering too slowly, my pain was too bad or what, but I am so thankful that I got that room. After a while I started feeling some serious shoulder pain. Anyone that knows me knows that I have a fairly low tolerance for pain. Even so,  I'm not exaggerating when I say this pain was intense. It's hard to comprehend why you have almost unbearable shoulder pain when they have just done surgery on your lower abdomen. Turns out some of the CO2 gas they pump into your abdomen so they can see what they're doing in there gets trapped. As it tries to escape it pushes on your diaphragm, and here it aggravates your phrenic nerve, which transfers pain to your shoulders (or something like that). This website explains it more clearly. At about 2pm they think I'm ready to be discharged but I have to pee before they'll let me leave. I got up to use the bathroom and the pain in my shoulders as I began moving almost made me pass out. I felt like I was going to throw up, I began sweating profusely. It was not pleasant. The nurse and J got me back into bed and we all realised I wasn't ready to go anywhere just yet. More pain meds, 2 slices of Vegemite toast and a cup of tea later I was ready to leave.

When we arrived back at the house at around 4pm we found Mum dropping off soup and macaroni cheese, doing the washing up and bringing in laundry. What a champ, thanks Mum. Once home, I had heated wheat bags which helped the pain in my shoulders a lot, along with some Panadiene Forte. It was only really bad when I moved, so I tried to stay on the couch as much as possible.
The first night wasn't as bad as I'd expected. I managed to get a decent amount of sleep, but still woke up in pain (mainly shoulder) the next day. As the day went on the pain subsided and we could start to move around a bit more.

So, the surgery was successful. Dr B found that my cyst/endometrioma had actually burst about 2 weeks before, so the clean up for that was all taken care of during the surgery. The ruptured cyst explained why I had difficulty walking/standing without pain for 3 days straight about 2 weeks prior! Apparently a burst cyst often requires emergency surgery...maybe my tolerance for pain isn't that low after all!? He also found and removed a small amount of endometriosis. According to him everything else looks good and we are meeting with him again on June 9th to discuss what the next step should be.

In the mean time I have 3-4 days off work now to rest and recover :)

Update

I'm thinking that I will really try to keep this blog up to date. As grateful as I am for family & friends enquiring how things are going, some times telling the same update 10 times becomes tedious. By writing this blog, the people who we want to keep up to date with our progress will have easy access to the latest news.

We did another round of Clomid in February. It didn't work. Further ultrasounds suggested that the cyst on my ovary was more than likely an endometrioma. By March, Dr B was suggesting that we really need to go ahead with the surgery (laparoscopy)  to remove it. Doing this would also give him a chance to see if anything else was wrong. Ultrasounds and blood tests only tell us so much. He also told us that he thought our best chance to conceive would come from IVF. To do an egg retireval with a cyst/endometrioma in the way would risk infection. Therefore, surgery was necessary before moving to IVF.

We approached AHM, my health insurance fund, and were told that due their belief that this is all a pre-existing condition that they would offer no benefit until the 12 months waiting period had passed (Sept 2011). Not wanting to wait that long, we decided to go ahead with the surgery anyway and booked in for May 20. This allowed us to enjoy our already planned vacation to Vietnam in April.

I am really unhappy with AHM's decision, as I do not believe the condition was pre-existing according to their definition.  My GP & specialist both wrote letters to support this, but AHM's 'medically trained' decision maker disagreed. When I pushed AHM as to whether 'medical training' meant that the person was a doctor they refused to answer. I pointed out that I considered myself to be medically trained as I have a Senior First Aid Certificate, although that would clearly not make me qualified to decide whether someone deserved their operation paid for or not. They didn't enjoy these further questions, refusing to answer them. I will be taking it up with the Private Health Insurance Ombudsman.

So, that brought us to operation day...which I will put in the next entry.

Clomid Fail

Clomid Round One was a failure. My numbers and levels were great, but this just wasn't our month.

So, here we are at Day 1...ready for round 2 in a couple of days.

Clomid Round One - here we go!

Jan 13 - CD1. Called in to the clinic to register the start of my cycle.

Jan 15 - CD3. Started taking Clomid, 25mg/day for 5 days. Didn't seem to have any side effects, most likely due to very low dose. Did have hot flushes, but that may just have been due to the fact it's the middle of summer here!

Jan 22 - CD 10. Blood test. Call back to come in on Monday for more blood tests and u/s. LH 5.1 and Estrogen 425 (I think).

Jan 24 - CD 12. Blood test and u/s. Showing one small follicle on R ovary.  Waiting on call with today's numbers and further instructions!

*edit* Clinic just called with new numbers - LH is 10.8 and Estrogen is 1049. We've got the go ahead to try this month! Dr B thinks nurse missed a more mature follicle on u/s as numbers are higher than expected :)

The first visit to Dr B

In early September we had our first appointment with our fertility specialist, Dr B. We both quite liked him and felt pretty comfortable right away. After looking at the test results from our GP he told J that his SA looked OK and that the focus needed to be on me. So he ordered more bloods for both of us, along with an ultrasound and a Hysterosalpingo contrast sonography (HyCoSy) for me. And so the sub-fertility investigations began...along with the constant outlay of money for various procedures.


J's test indicated that he has around 80% anti sperm antibodies (ASA). Neither of us were entirely sure what this meant, but Dr B said you can get pregnant with 99% ASA and that it was not cause for concern at this time.


My HyCoSy was not pleasant. Quite uncomfortable, but not painful. Had some cramping following, but the news that my fallopian tubes were 100% clear and open made me feel a lot better! The ultrasound showed a small cyst on one ovary. This led to a preliminary diagnosis of Polycystic ovaries, but not PCOS. They also saw some signs of endometriosis. Dr B suggested a laparoscopy to investigate further. Of course, he only operates in private hospitals and my private health insurance will not cover it as it's deemed to be a pre-existing condition. This means that I have to serve a 12 month waiting period, which will bring me to  Sept 2011.


A follow-up ultrasound in early January 2010 showed that they cyst has not grown and with this knowledge it was decided that we could hold off on surgery (which would cost us in excess of $2000) and wait until out health fund will cover it.


In the mean time, Dr B has put me on a 3 month course of Clomid to "give nature a helping hand" as he put it. As I do appear to ovulate every month I am only on 25mg from day 3-7 of my cycle. I have some friends who successfully conceived with Clomid, so I'm hopeful. If we have no luck in 3 months, then we can look at other options - going ahead with the surgery (no guarantee that this will aid conception), IUI and IVF are all on the cards.