Post Post Coital Follow-Up

Had our meeting with Dr. M this morning to review our Post Coital testing results, and the results of some blood work my wife had done last week. The Post Coital test indicates that my wife has, in the words of the Doctor, "perfect cervical mucus" - what a warm compliment. The pH of her mucus is a little low, but based on the fact that there were a lot of sperm swimming around in it, he said this test indicates no problems in this area. Check on that one.

My wife's blood work indicated lower than desired Progesterone levels (8.5 instead of the optimal level of 10 or higher) A low Progesterone level could result in an embryo not implanting into the uterine lining. To remedy this problem, the Doctor is placing my wife on some fertility drugs. As an alternative to Clomid, he described a new drug named "Femora", or something like that, which is typically used to treat breast cancer but is gaining popularity in fertility clinics. It is not approved for this use as a study has never been conducted, but our Doctor has used it with great success for over 3 years. So, my wife will take this pill 5 days out of each cycle to boost her Progesterone levels around the time of ovulation, hopefully allowing the embryo to properly implant. He said there should be no side effects from this pill, and that the "risk" of twins rises from 3% to 7%. He sent us on our way with prescription in hand to have a go via natural methods for another 4 - 5 months. When asked what our chances of success would be, he said about 80%, indicating that he views us as a perfectly normal, fertile couple (with the assistance of this fertility drug, of course)

If this doesn't work, he will examine my wife for endometriosis via laproscope, which freaks my wife out - she has concerns about people messing with her belly button. If that doesn't indicate a problem, we'll move on to insemination. If that doesn't work, we've got a date with IVF again.

We're feeling pretty optimistic, and slightly relieved that the news was as good as we could hope it to be. So, here's to my wife laying in bed with her feet in the air for hours on end each month with boob cancer drugs coursing through her veins. I'm thinking we need a vacation (as soon as we pay that damned $1.3k IVF bill)

Bills: Explained (sort of)

So I went over the new batch of IVF bills last night. Looks like we'll have to pay - the bills are for all of the Progesterone blood tests my wife had during the days leading up to embryo transfer. I'm guessing the delay in receipt of these bills was caused by our insurance company, so shame on me for bad-mouthing IVF Michigan. I wish they would have told us about this though, or at least provided some clear documentation from which I could learn about our liability ... there is no way I could interpret our statements to correctly identify that we still owe money for our procedure. Perhaps I'll scan these documents and place them up here so you can all see what I'm talking about (but I'm sure if you're reading this, you're very familiar with the issues I've described ... and furthermore, I'm sure you have no interest in reading about some other dude's insurance paperwork. If you are interested in this sort of thing, you clearly have too much time on your hands and should find something better to do - if this is the case I encourage you to stop reading this blog immediately)

From here on out I will not leave a medical appointment without a clear understanding of the procedure cost, the amount to be covered by insurance, when reconciliation between insurance and provider will happen and when the patient responsibility portion will end up in my mailbox. I will need all of this in writing before leaving the office. Medical receptionists are going to hate me - but like most things in life, you have to take these matters into your own hands. If you can't trust Doctors, you certainly can't trust the morons that occupy their front desks and billing departments.

Upset ... Mad ... Furious

So we received more bills in the mail from IVF Michigan today, totaling ~$1,000 for services rendered over the time period August - November 2007. Are you fucking kidding me?!?!?!?

When we left our post-failure consultation, I asked the fucking moron medical receptionist to send us a bill for our remaining balance - I wanted to pay it, to be done with the process, done with IVF Michigan and have no outstanding balance. We received a bill for ~$300 the next week, which I promptly paid. In December, I was surprised by another bill for ~$150, just in time for Christmas ... slightly miffed about receiving a bill after having requested to pay our balance in full, I kindly paid this as well.

Now we receive this pile of shit from IVF Michigan. I'm shocked. I want to write something bad about IVF Michigan right here, but I'm refraining until I get to the bottom of this.

... breathe in ... breathe out ...

I'm going home tonight to go over every detail of every bill we've received, identifying amounts paid, services rendered, amount billed to insurance, amount paid by insurance, etc.

Just got a text message from my wife: Cooper just left 6 claw marks on our cherry coffee table. This day just keeps getting better. I'll look forward to him taking a dump in the bed tonight, and the house burning down tomorrow while I'm at work.

Highlights from the Weekend

-Took Friday off work, helped clean the house and took some new photos to add to our listing, BUT, as mortgage criteria tighten, we're fighting a losing battle. Sucks that those of us who were responsible in taking on manageable levels of debt are being screwed by those who let their borrowing habits go uninhibited. We, the responsible, are footing the bill in the form of lost equity, and will bail the system out when we are able to reignite the housing market by bringing what equity we have left to the closing table.
-Wife started her period on Saturday morning. I fear that the post coital mucus sample contained all of the swimmers I was able to deposit. There's always next month ...
-Went to see "Mamma Mia" on Saturday night. Not a bad show ... but comparisons to Hairspray were all too frequent.
-Good friend's wife had her baby. She experienced intense gall bladder problems throughout her pregnancy, requiring morphine at one point. Carly is just under 4 lbs., and is doing fine.
-My wife's good teacher friend delivered her baby - Charlie is also doing fine. The mother is a nice girl, and her husband is a cool guy - we're happy for them.

That doesn't mean my wife isn't disappointed with our own situation. The current batch of baby "work in progress" is coming to an end ... I think there is only one or two pregnancies in the pipe amongst our social network. Looking forward to the end of it. Hopefully we'll learn more on Thursday - maybe we'll step into the "on deck" circle.

Updates, Boring Updates

Not much to report on:

-Our session with Dr. M for post coital follow-up is scheduled for next week
-Session with the Creigthon Model lady scheduled for March 22nd - should give us plenty of time to read this book, and to assess whether or not $500 will buy us any incremental help
-Cooper's teeth are falling out, there is blood everywhere and his breath smells like a cross between a butcher shop and rotting fish. He has taken to playing with one of my wife's old bras. Not very masculine - thinking of giving him an old oil filter to play with instead

Another Avenue

As a result of THIS comment, my wife and I looked into yet another option for solving our infertility woes. The Creighton Model FertilityCareTM System is described as follows:

The CrMS relies upon the standardized observation and charting of biological markers that are essential to a woman's health and fertility. These "biomarkers" tell the couple when they are naturally fertile and infertile, allowing the couple to use the system either to achieve or to avoid pregnancy. These biomarkers also telegraph abnormalities in a woman's health. The CrMS allows a woman to unravel the mysteries of the menstrual cycle.

I contacted a lady in the Detroit area who is a "teacher" of the program - she was very kind, and very eager to provide insights on the program. What really grabbed me was her assessment of the rise of IVF clinics in the U.S. over the past 30 years. She said that IVF clinics, in general, are very eager to bypass diagnosing the root cause of a couple's infertility, opting to proceed directly to IVF - the highest margin-generating procedure they can conduct. The Creighton Model helps people figure out what is wrong through analysis of data, then offers remedies to correct the problems upon diagnosis. The lady told me that after only two months of collecting data on a woman's cycle, they can tell "a lot" of information about what is wrong. She made it very clear that there is "a lot" that they can learn in that period of time by repeating the words "a lot" two times in a row:

There is a lot, a lot we can learn from just two months of charting.

Anyways, this lady is in the process of scheduling an introductory session in which she will provide an overview of the program. My wife and I plan to attend. If we like what we see, $500 will buy the materials required to collect and track data as well as 8 one-on-one (actually, one-on-two) sessions with this lady in which she analyzes our charts, diagnoses and remedies our problems with natural methods. In the world of infertility, $500 is nothing, so we're thinking we are going to proceed. We feel as this can only help, and we can proceed with Dr. M. at the same time as we follow this course. Either way we'll learn more as we walk a little further down the road. What's even better - my hard-core Catholic parents (the ones who drag you out of bed on a Sunday morning when you are still drunk have a mild hangover to go to church) are thrilled as this program is affiliated with Natural Family Planning methods. As long as it works, I'm cool with it.

Just Keep Swimming

My wife went in for her post coital test yesteday morning - turns out there were a lot of sperm still swimming around in her cervical mucus some 7 hours after intercourse. According to the nurse, this is a very good thing. They actually let my wife look through the microscope to see the little guys, and she said there were a ton of them. She made several comments on how cool it was to look at sperm under a microscope - one of those priveleges available only to the fertility challenged.

Apparently my wife's cervical mucus has a higher-than-normal pH level, meaning it is a bit on the acidic side, making for a slightly inhospitable environment for swimming if you're a sperm. On a positive note, to have so many active sperm 7 hours after intercourse indicates that there is a chance (however small) of achieving pregnancy via normal methods. The nurse told my wife we may be ideal candidates for IUI, but that our Doctor would provide more details. We have an appointment with him on Feb. 28th - more details to come at that time.

The only advice the nurse offered my wife was to have sex morning and night around the time of her ovulation - not a bad deal at all.

Ovulation

My wife got a positive ovulation test this morning - she is going in to the Doctor's office at 10:00 a.m. for an ultrasound, where I think they will detect the presence, or lack of a follicle(s). Then we have sex (woohoo!) then my wife goes back in to see if any of the sperm survived (post coital)

Enlightenment in the next 72 hours (just a little)

UPDATE: 11:18 A.M. - Turns out my wife has mature, normal-looking follicle(s) ready to go! So, we have to get up at 3 a.m. to "do it", then she goes into the office at 10:00 a.m. to check if anything is still swimming. Not sure how quickly they can assess this, but I would guess an update will come before tomorrow ends.

My Mom - Fertility Specialist

Here's my mother's advice about our infertility situation:

"Why can't your Doctor take a bunch of your sperm and put them up in there by the eggs so they get fertilized?"

Good point Mom - they probably haven't thought of that. I'll be sure to mention that at our next consultation.

Vitamins

Here's the vitamin schedule I'm currently on - my wife had to go out and buy me the biggest Monday through Sunday pill box they had at CVS (and is it ever convenient - I highly recommend!)

Gingko Biloba
Ginseng
Multi-Vitamin (Target One-A-Day male formula)
Fish Oil
L-Carnitine
L-Arginine
Zinc
Vitamin C
Vitamin E
Vitamin B12
Selenium
Beta Carotene

I take one pill of each vitamin / mineral / herb from this list every day. I have exact measurements for each, if anyone is interested. This is all supposed to have some sort of positive impact on my sperm, according to the book "The Infertility Cure" - the book actually recommends I take twice as much of each vitamin as I am currently taking, but I figure that's overkill. This is an absurd amount of pills to take already, and the theory of "something is better than nothing" has to hold true here. I'm hoping it leads to better / more sperm, and ultimately a pregnancy I don't notice anything different yet. Sperm is still white, sex is still fun. If nothing else, it should aid in overall good health.

Here's the funny part - my wife got a bladder infection a few weeks ago and she thinks it because I'm taking too many vitamins!

Stage Fright

A post completely unrelated to infertility follows -

Just returned from a trip to the rest room where I caused a young gentleman to have a case of stage fright. This restroom has two urinals and two stalls. Normally when there are only two urinals and one is occupied, a polite guy will take one of the stalls instead of the lone open urinal. It's just awkward to relieve yourself so close to another man. Unfortunately, I was already committed to the urinal before I could fully process the situation and react accordingly. Rather than make an awkward retreat to the stall, I decided to tough it out at the second of two urinals.

I stepped up hoping that I would not seize up myself. During the initial seconds of the pee, I tried to relax and just let things flow. I've had stage fright myself a few times, mostly at Michigan State football games where there are huge troughs that the guys line up at and let er rip. Today I was fortunate to experience good flow in relatively short order, but I couldn't help but notice the fellow next to me was not producing. The bathroom we were in is particularly small. It's quiet and cramped in there ... so when one is not doing what he's supposed to do at the urinal, the lack of sound makes it painfully obvious to everyone in the vicinity. To help the guy out, I tried looking around, acting all nonchalant, while pushing harder in an effort to shorten my stay ... I almost wanted to urge him to relax, and give him a bit of a pep talk. He just hung in there (no pun intended) and waited until I wrapped up and left. In the past when afflicted with this problem, I've simply packed up, acting like I had gone, opting to hold it for a little while longer, immediately retreating to a bathroom on another floor, or in another part of the building. I hope this poor guy has managed to finish by now. What a brave soldier he is to see his task through to completion. Admirable.

Pretty Fortunate

I am Catholic. So is my wife. In times of difficulty I tend to turn to my faith for strength - it provides comfort and raises hope for better days. After a brief hiatus following our failed IVF cycle, my wife and I have recently begun going to church again and I'm incredibly relieved that we have.

With this year's Ash Wednesday my wife and I enter a Lenten season that will have a much more profound meaning for us than any year in the past. We are going through the biggest trial of our lives, and I know much soul searching, praying and questioning await us. I think we're fortunate that this is the hardest thing we've ever had to deal with, and I hope we can keep that in perspective as we finish writing our story. Things could be so much worse, and there are people out there dealing with things that make our little issue of infertility look minuscule and insignificant. More than anything, I hope we come out the other end stronger than when we entered. I have a lot of confidence we will, and I think we'll get started on that journey in earnest this week as we go into Lent.

An interesting e-mail forward I once read is below (not sure if the figures are 100% accurate, but it's interesting to note how fortunate we are just to live in this country)

If the world were a village of 100 people:
60 would be Asian
12 European
5 US American and Canadian
8 Latin American
14 African

49 would be female
51 would be male
82 would be non-white
18 white
89 heterosexual
11 homosexual
33 would be Christian
67 would be non-Christian
5 would control 32% of the entire world’s wealth, and all of them would be US citizens
80 would live in substandard housing
24 would not have any electricity (And of the 76% that do have electricity, most would only use it for light at night.)
67 would be unable to read
1 (only one) would have a college education.
50 would be malnourished and 1 dying of starvation
33 would be without access to a safe water supply
1 would have HIV
1 near death
7 people would have access to the Internet

I don't see anything on that list about infertility ... probably didn't make the cut (was beat out by "substandard housing", "unable to read" and "HIV")

There are worse things ...

Pictures

I was looking at some photos on my cell phone and I came across a few of my wife from the day of her egg retrieval. She's wearing a hair net, hospital smock and a dazed, anesthesia-induced smile. To think of how excited she was by the prospect of becoming pregnant, and how devastated she would be weeks after upon receipt of a negative result breaks my heart.

The day I asked my father-in-law for permission to propose to my wife, he told me that while he loves all of his children equally, my wife holds a very special place in her parent's hearts. Having been with her for almost 5 years now, and seeing the look on her face in these photos, I can see a glimpse of how her Dad views her. She is sweet, pure and vulnerable. She depends on the people she loves, and she is easily hurt. These photos say it all, and it breaks my heart to think of how optimistic she was in them. She was right on the threshold of one of her biggest life dreams - becoming a mother. To think that I even have video footage of her arriving at and leaving the clinic from the day of our embryo transfer - needless to say, we haven't watched it.

In any situation I can control, I have no doubt of my abilities to give my wife whatever she wants. Engagement ring? Bigger house? More money? No problem - I will do whatever it takes and go as far as I have to in order to make her happy. I don't mean that to sound arrogant - I mean only to demonstrate my dedication to my wife, and to our marriage. I think that is simply the cost of entry as a husband. In the world of infertility, however, one's control over the situation is completely stripped. You can take vitamins, stop drinking, procreate at the right times, but it all is still up to faith and chance. You can't "hope" for good sperm and have them magically appear. I hate this lack of control. It is a horrible feeling, especially when it has such a dire impact on the woman I love more than anyone in the world.

I hope my wife can one day have the same sense of optimism and hope that she had in the photos from the day of our embryo transfer. I can't make her feel that way, and it certainly isn't happening at the pace I would like it to, but I can support her, and do my best to be understanding of the way in which she handles this difficult process, for as long as it takes. At the end of all this we will be stronger as individuals, and as a married couple, and we will be parents. There are many hurdles to cross between here and there, but we'll get through it and I'll be there for my wife every step of the way, and at the end I'll take a cell-phone picture of my wife holding our baby.

Work, work, work ...

Wanted to finish what I started with the last post:

Wednesday: 13 hours
Thursday: 20 hours
Friday: 12 hours

GRAND TOTAL: 85 HOURS

Needless to say, I haven't had much time to write a post ... looking forward to seeing my wife, and Cooper.