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. 

There’s something missing this Christmas

            If you asked me a year ago how I envisioned today, I would have told you, without a doubt, it would be me and my husband, our two cats and a new baby celebrating Christmas. Instead it’s just us and the cats.

            A small part of me still held out hope that I’d get a Big Fat Positive for Christmas. I imagined wrapping up the onesie hiding in the back of my sock drawer and putting it among the gifts to surprise my husband this morning. Everything was perfect for that. My cycle even lined up properly, making today the day I could conceivably test and expect a positive. I sat in the bathroom this morning while my husband was still sleeping, watching the dye slowly move up the test. Wishing with all my heart that there would be two lines. That after all these failed cycles and my infertility diagnosis we would get a Christmas miracle.

           

            Five minutes later I was staring at a stark white test. No baby for me today. It wasn’t as bad as I was expecting. It was still early, my period isn’t due until tomorrow, I could get my BFP a day later. Even though it wouldn’t be on time for Christmas, I’d still be ecstatic.

            All hopes were dashed less than an hour later when I got confirmation that I’m not pregnant. Another failed cycle. A Christmas morning spent sobbing on the bathroom floor.

            A change has happened recently for my husband and I. We don’t talk about it, but we both notice it. We no longer talk about “when” we have a baby. Now we talk about “if”. “If we ever have kids we’ll do this” “If we ever have kids we’ll do that”. We’re slowly giving up hope of this ever happening for us. There is a hole in our life and we may never be able to fill it. My heart breaks when I look at my husband and think about what a great dad he would be, and how I may never be able to make him one. I know next Christmas it will be me and my husband and the cats. I’m losing hope that there will be a baby, our baby, there too.

#infertility #1in6        

Today I want to give up

I’ve always known I wanted children. I’ve known my husband was the man I wanted them with for several years. For several years we talked about our future kids – two girls and a boy – we discussed names, travel plans, lessons and activities, our perfect little house with a yard and some cats, where our family would grow. As a PhD candidate, finding the right time to have a baby was difficult. With the nature of my research I couldn’t be pregnant and continue my work, so holding off until the end of my degree made sense. We would time it so the baby was born when I started writing my thesis, giving me six months home with the baby while still receiving my scholarship, before starting a post-doc and continuing on my way.

Since I had all this time waiting before we could try for a baby, I spent my time researching TTC (trying to conceive). I went for a pre-conception appointment with my doctor to make sure everything was good for pregnancy. This is when things started to derail. I was severely iron deficient and needed to start supplements to raise my iron levels before TTC. That took 6 months, putting the TTC plans on hold for 2 months. Finally, we could start trying. I had great hopes for a pregnancy that first month. My grandma, mom and aunt all had amazing fertility, so I saw no reason why I should be any different.

That first month I was optimistic but nervous. I started tracking my basal body temperature, I monitored my cervical mucus, and I made sure we hit the fertile window as much as possible. That first cycle my luteal phase was too short for implantation to happen, so I moved on to my second cycle. Second cycle my luteal phase length was good, but this is when the problems started. I noticed that after I ovulated I had spotting. Not too heavy, just enough to be annoying. I figured it would go away.

By the fifth cycle it was clear the spotting wasn’t going away. In fact, it had gotten worse.

I went to my family doctor. She thought my thyroid or one of my sex hormones was abnormal, so I had my blood taken. Everything was well within normal ranges. Next she sent me for an ultrasound. It took almost a month to get in. Everything looked normal. My family doctor referred me to an obgyn. It would be another 6 weeks before I could get an appointment. My obgyn ran a few more tests and sent me for an HSG. The HSG was uncomfortable and painful, and I had heavy bleeding afterwards. The obgyn tests were normal. The HSG was normal. My obgyn can find no reason for the luteal phase bleeding and referred me to a fertility specialist.

I’m now on cycle 10. The bleeding started 3 days ago. I’ll bleed for another 7 days before my period arrives and I’ve given up hope of ever having a baby. Month after month I do everything right to increase the chances of conception, and month after month I watch my uterine lining slowly leak out of me way too soon. Month after month I imagine my little embryo looking for a spot to implant, but having nowhere to go. I don’t know how many more months of this I can take. I just want a baby. I just want this bleeding to stop.

It's been awhile/The importance of a name in science

So, it’s been awhile since I wrote a new blog post. I’ve been very busy in the lab and at home since I last wrote. My first paper of my PhD was published at PLoS One in the spring, and just after my paper came out I advanced to candidacy in my PhD program. I attended both the Canadian Society of Immunology and the Canadian Association of HIV Research conferences, and many people were interested in the humanized mice, which I have just started making. I also have been working at a biotech company through the MITACS-Accelerate program. I’m looking into extending my biotech intership for at least another 6 months, and am taking on a TA-ship for the fall. I’ve also taken my first trip to Europe (it was only 10 years in the making) and am now planning my wedding for spring next year!

I’ve been thinking about this blog recently and what I wanted it to be about. I’ve decided to stick with my interests, but it won’t just be about science and cupcaking anymore. As I am trying to get back into my old hobbies and develop new ones, the blog will range from cool science papers, book reviews, recipes, and anything else that I think is amazing.

Today, though, an issue I have been thinking about a lot . . . The importance of a name in science

Since I am going to be married soon, I have been thinking a lot about what name I will use after I am married. All my non-scientist friends that have recently married have just hyphenated their last name, but I have never been a fan of hyphenated names – and my last name and my fiancé’s last name don’t really sound good together. I feel like there is a huge pressure on women in science to keep their name after marriage. A large number of the female students in my program are married, and all of them have kept their name. As a young scientist trying to establish a career, I can understand the desire to have all your accomplishments linked to one name, that having to list 2 names on your CV may be a disadvantage, and to wonder what would happen in the event your marriage fails. It does make me feel bad to consider what will happen if my fiancé and I divorce someday, especially given that we haven’t even married yet, but this name issue is occurring during the time when I am starting to establish my career, and whatever name I pick will be the one I firmly establish myself with. I have published 2 papers and a video protocol with my maiden name. Is that enough to justify keeping it? It means a lot to my husband that I take his name – is that enough to justify changing it? Should I add his name to the end of mine (no hyphen) and use my maiden name for science, my married name personally? Will that be too confusing? And then I turn to PubMed to input both my maiden and married name. Although neither last name is common, 241 results come up for my maiden name, exactly 3 of which are actually mine. My paper from June 2013 has already been bumped to #2, following a the publication of a newer paper by a "name twin" and my paper from 2012 is #8. I may get lost in among the other Farr,C_’s. A quick search of my married name reveals a grand total of 3 papers – none of which have an author with the same initials, just the same last name. Is this the way to go? Will I be looked down upon for changing my name upon marriage? Or will the uniqueness of my new name be a benefit for the future? Does PubMed searchability even matter when trying to establish a career? And, do I really want to give up my spot in alphabetical order from the early start to the very end? :P

CF or CZ or CFZ