Round 1: Infertility Treatments

My husband and I met with our reproductive endocrinologist (RE) last week on Friday. We had completed all of our testing prior to the visit, and it was cycle day 1 (CD#) for me, so we were optimistic that we would be able to start something that day. My husband has male factor infertility (low morphology) and I have ovulatory dysfunctional uterine bleeding. I had been doing a lot of reading prior to the visit to see what our options were. There wasn’t a lot of information about my problem, just to try ovulation drugs. The research on low morphology is conflicting, with some papers concluding that the only option is IVF with ICSI and others saying that there is no different in success rates for intrauterine insemination (IUI) with low morphology. (Lockwood et al, Andrology, 2015; Deveneau et al, Fertility and Sterility, 2014)

Our RE gave us a few different treatment options:

1.     timed intercourse and progesterone supplements after ovulation

2.     timed intercourse and ovulation stimulating drugs +/- progesterone supplements

3.     IUI and ovulation stimulating drugs +/- progesterone supplements

4.     IVF with ICSI

She thought the progesterone supplements might help my bleeding, but since my progesterone levels are normal there was no guarantee that would work. The ovulation stimulating drugs should stimulate a “stronger” ovulation which could be enough to stop the bleeding, but if it wasn’t I could add progesterone the next cycle. IUI would increase the chances of success with the drugs. IVF with ICSI would be the most aggressive option, the most likely to have success, but also significantly more expensive than the other options. Our RE did not pressure us to pick IVF and she emphasized that any of the options had a chance of working and that it was up to us to decide how aggressive we wanted to be.

After a year of failed cycles, my husband and I are tired of waiting for a baby. We are not ready to invest tens of thousands of dollars in IVF, but we were looking for a slightly more aggressive approach, so we decided on option 3. Since it was CD1 and all our testing is done, the RE wrote a prescription and we set up the IUI cycle. I would take 50mg Clomid for CDs 3-7, use ovulation prediction kits (opk) starting on CD9, and have monitoring ultrasounds starting on CD12 to make sure I didn’t have too many follicles developing. When I got a positive opk I would call the office and the next day my husband and I would go in for the IUI. It would be hard to fit the IUI in with our schedules, but we would make it work.

I picked up the Clomid from the pharmacy on CD2. The pharmacist went over all the not so scary sounding side effects (hot flashes, headache, dizziness, light sensitivity, breast tenderness) and the scary sounding side effects (vision changes which could be permanent, multiples, thinning vaginal lining). I paid $40 for my 5 pills since infertility treatment is not covered by provincial health care, my work health insurance of my husband’s work health insurance.

Day 1 of clomid: Within 2 hours my head started to feel “off”. It wasn’t exactly a headache and I wasn’t dizzy, but my head just didn’t feel right.

Day 2 of clomid: My “off” head had progressed to a full on headache. Advil helped, but it didn’t go away completely. I had some cramping and nausea and noticed light sensitivity at work. I also had my first hot flash which involved this conversation with my husband

H – you’re hot

Me – Umm, thank you?

H – no, I meant you feel hot

Me – I think I’m having a hot flash

A few minutes later

Me – I’m definitely having a hot flash

On Day 2 I noticed I was hungry all the time. Luckily I carry lots of snacks in case of getting stuck at work late because of bad traffic.

Day 3 of clomid: This day was rough. My headache was constant. I had some dizziness. If I moved my head too quickly I needed a moment to stabilize. Cramps, another hot flash. There is this long hallway at work that leads to a facility I do research in and it was no windows, white walls, white floor and bright fluorescent lights. I could barely walk down this hallway the light was so harsh on my eyes. I just generally felt like shit on day 3. I had RAGE on day 3. It started when I was in the shower. I was upset that I had to go through all this to have a baby and I started to resent my husband because all he has to do is provide a sperm sample, which I get to have cramps and headaches and dizziness, and why couldn’t he at least wash the damn dishes. By the time I got out of the shower I was in RAGING. I rage-cleaned the kitchen and washed all the damn dishes and yelled a bunch, then fell into bed sobbing and begging my husband not to make me take more clomid.

Day 4 of clomid: I woke up with a headache (surprise!. . . not) and was really dizzy. The idea of commuting to work, working all day, and commuting home was just . . . I just couldn’t do it. I worked from home this day. Despite begging not to have to take clomid again the night before, I took my next pill. As much as I didn’t want to, as much as I absolutely hate how it makes me feel, I want a baby so bad and if this little pill is going to give me a shot at having one, I’d suffer through. The headache and dizziness got better with more sleep, and although I was uncomfortable with cramps and killer nausea after my husband burnt some toast, I made it through.

Day 5 of clomid: More of the same. Cramps/bloating, nausea, light sensitivity in that one hallway at work, dizziness, hot flashes, headache.

Day 1 off clomid: Symptoms hadn’t gone away. I had to work in containment this day, and that was really difficult with all the PPE and hot flashes. If this cycle doesn’t work, I’m going to have trouble continuing my work in containment during the clomid phase of my cycle. I had a work event with free alcohol but couldn’t partake because my head was killing me.

Day 2 off clomid: Headache is starting to fade. Dizziness is getting better. I had been avoiding yoga class while on clomid because of the dizziness, but thought I might go today. I did a practice down-dog and it didn’t go well, so I didn’t go. My biggest symptom now is cramps/bloating from my ovaries. I don’t normally have bloating and it’s a weird feeling.

And now I wait for my follicle scan to see how I responded to the Clomid.

Zika virus research live updates

Zika virus is a vector borne virus transmitted by some Aedes mosquitos. Although it was first identified in the 1940's, it hasn't been studied extensively because it causes mild flu-like symptoms in 20% of people that are exposed to the virus. Zika virus has been in the news in the recent months after an increase in cases of microcephaly were reported in Brazil, thought to be caused by infection of pregnant women with Zika virus during the early stages of pregnancy. Zika virus particles have been found in amniotic fluid and in brain tissue of an infant with microcephaly that died shortly after birth. Travel advisories for pregnant women, women planning on becoming pregnant and their partners have been issued with many countries in Central and South America. This link to microcephaly has not been reported previously. Scientists at the University of Wisconsin-Madison are undertaking studies to understand the pathogenesis of Zika virus, and are updating results live on this website: https://dholk.primate.wisc.edu/project/dho/public/Zika/public/ZIKV-001-public/begin.view

Surprisingly accurate for a Buzzfeed list

http://www.buzzfeed.com/morganshanahan/stick-it-in?utm_term=.op9gempgk#.rvdA3gzAv

1. True
2. True, but not when they are around because it's not their fault I'm struggling with infertility and they get a baby
3. True. Husband: "what day is it?" Me: "it's cycle day 6, I mean Wednesday"
4. I still have no desire to touch my cervix
5. True
6. True (I'm looking at you, friends on TB)
7. True
8. True
9. True. Stop wasting the sperm!
10. True
11. True
12. True. Usually followed by, can you bring me my phone so I have something to do while I'm laying here
13. True. I'm looking at you science conference
14. True. It's 6 days past ovulation. Is that too early to test? *checks Google* Yes, yes it is. HOW DO YOU EXPECT ME TO WAIT 4 MORE DAYS!
15. True. Dr. Google - is a bloody nose an early pregnancy sign? my cat is extra cuddly? I'm really tired today I MUST BE PREGNANT
16. True.
17. True
18. Ashamed to admit, but true
19. True. I have to start peeing on things at work next week as part of my fertility treatments.
20. True
21. Was true. Now that both my husband and I have been diagnosed with infertility I sometimes feel like what's the point because we probably won't get pregnant without medical intervention.

Our infertility diagnosis

Infertility affects one in eight couples. Although many people believe that most cases of infertility are due to problems with the woman, the rates of infertility are equal among men and women, with 35%-40% of all infertility diagnoses being male factor only and 35%-40% of all diagnoses being female factor only. The remaining 20-30% are split fairly evenly between couples with problems in both partners, and unexplained infertility, where there are no problems with either partner but they aren’t getting pregnant.

I was diagnosed with infertility in October 2015 and received the specific diagnosis of ovulatory dysfunctional uterine bleeding in November 2015. The ovulatory part of my diagnosis means that I am ovulating every cycle and the dysfunctional uterine bleeding means that I have abnormal bleeding and that all causes of abnormal bleeding (hormone imbalances, cysts, STIs, polyps, cancer, friable cervix, etc.) have been ruled out. Not only was I devastated when I was diagnosed, but I also felt so guilty – kids have always been something my husband wanted and I may not be able to give him any. Was I less of a woman because I might not be able to have kids? My husband is a fantastic man and he has reassured me several times that he loves me, and that his love for me is not impacted by my broken uterus. He would tell me that he has me, and if we can’t have kids together, we’ll adopt or get a lot of cats.

In January 2016 my husband had a semen analysis as part of the infertility work-up for our reproductive endocrinologist. The results came back that he had male factor infertility – low morphology. He felt the same guilt that I had been feeling – that his wife wanted a baby so bad and he might not be able to give her one. It was my turn to reassure him that I loved him no matter what, and that if we couldn’t have kids together we’d adopt or have a lot of cats.

When my husband received the diagnosis that confirmed we were one of the infertile couples with problems with both partners, a large part of me felt hopeless and lost. The plan of having a family seemed to be slipping farther and farther away from us, and there were dollar signs (lots of them) and months to years of heartache between us and a baby. It shouldn’t be that hard to grow our family. However, a small part of me felt a sense of relief . . . relief that it wasn’t just my fault that we are struggling to have a baby. 

The Semen Race

There are very few things in the infertility journey that are funny. The diagnosis, the doctor visits, the blood tests, the HSG, the financial burden, the self-doubt, the wondering if you are less of a woman because you can’t have kids, the daily emotional struggle – none of this is funny. However, we did have an amusing moment in the past month with my husband’s semen analysis.

While there are many infertility tests for women, men generally don’t have a lot of testing done. Even though the rates of infertility are similar between men and women, with 35% of all infertility cases due to a problem in the women, 35% with a problem in the men, 20% in both partners, and 10% unknown, usually a semen analysis is the only test a man needs.

Since I’ve already been diagnosed with infertility, we were referred to a reproductive endocrinologist for treatment. My husband needed to have a semen analysis performed as one of the last pieces of our infertility work up. Despite the fact that we live in a metropolitan area, there are not many labs that handle semen samples. My husband called the closest lab, a 22 minute drive from home in no traffic, to make arrangements for his test. The lab does not allow you to collect your specimen on site, so my husband would need to collect his specimen at home and deliver it to the lab within 30 minutes. Although it wasn’t amusing at the time, the whole semen collection and delivery is quite funny.

First, my husband had to book an appointment at a time when it was likely that there would be no traffic. We also had to make sure that his appointment didn’t overlap with my predicted fertile window since you are required to abstain from ejaculating (yes, the instructions did say this exactly) for 48 hours before specimen collection.

Getting from our apartment to the car and then driving to the lab would take exactly 30 minutes - we timed it when he went to get the specimen cup – so I worked from home that day so I could pull the car out front and shave off a few precious minutes.

I spent the hour before leaving listening to all-traffic all-the-time radio to make sure there were no problems on the route. I also obsessively checked the traffic websites for construction or accidents.

I’m an obsessive worrier so I kept telling my husband to remember to put his wallet in his pants, and to have his pants and shoes nearby so we could leave ASAP, and to keep the specimen warm.

I waited out front in the car while he collected his specimen. He was barely buckled up before I was off to the lab. Of course, we hit every red light on the way to the highway. Once I got on the highway I got stuck behind those people that drive 20 below in the passing lane. I had terrible road rage, yelling ridiculous things about the semen sample needing to get to its’ destination and to get out of my way NOW.

I was so stressed out driving because I wanted to drive FAST to get the sample there on time, but I also didn’t want to get pulled over for speeding. I imagined what I’d say to the cop if I got caught in a speed trap “Sorry officer, I need to get this sperm to the lab” or “Can my husband take the car and just leave me here on the side of the road while you write my ticket?”.

Luckily, we made it there 25 minutes after specimen collection. I didn’t get any speeding tickets. My husband found it really weird to walk up to the lab technician and say “I have a sample of my semen for you”.

After the whole semen delivery, we had to wait 10 days for the results. This sucked because they have to analyze the semen right away and would have the results that afternoon, but they couldn’t upload the results on the patient portal. It was 10 days before my husband could get an appointment with his doctor to get the results.

Unfortunately, we found out that we are one of those lucky 20% of couples where both partners have problems. Our appointment with our reproductive endocrinologist is still 6 days away, but based on the most recent medical studies, it looks like in vitro fertilization with intracytoplasmic sperm injection (IVF with ICSI) is our only option.