From Infertility to Conception

I always wanted to share our story of infertility.  I've heard a lot of percentages out there from 1 in 10 to 1 in 8 couples face infertility issues.  I don't know if this number also includes those who have to face secondary infertility but its a real issue that affects probably a lot more people than you realize.  There are a lot of "closet" infertility couples.  We were one of those.  It was a couple of years before we told our family members and it was only in recent months did we tell other people.  Our reason for being a "closet" infertility couple was simple, it wasn't anyone's business (this is where I will give you simple advice that I wish I could go on a HUGE tangent: never, ever, never NEVER, never ever even-if-you-are-besties never ever ask someone when they are having kids (or more kids).  Just dont.  Ever.  NEVER. Got it?!)  

I've read TONS of stories of people with infertility problems and really no one had a story just like ours.  That was a little disappointing because it would be nice to know there is someone out there who experienced the exact same problems.  But it was also comforting because a lot of couples have had to wait a lot longer, spend a lot more money and had a lot more invasive problems then we did.  How grateful that made us for our own situation.  One reason why I wanted to share our story was for those closet infertility couples out there to give them another story and another set of problems that they can either identify with or get perspective from. 

Our story's kinda long, we've had a lot of hiccups.  If you're just wanting to know the gist of our experience you can read just the bolded sections below. 

About four years ago we decided to start our family. I knew we needed help in getting pregnant.  I have always had highly irregular periods which makes it near impossible to plan to get pregnant.

We were living in Glendale at the time so I went to a OB/GYN in Burbank.  When I told her I wanted to get pregnant and it was problematic because I had highly irregular periods she pulled a paper towel out of the dispenser on the wall and wrote down instructions for using Clomid on it.  Wow, she was really invested in my case.  She sent me on my way with an afterthought of getting some blood work done.  Otherwise she told me to start Clomid.

When I was almost down with my first cycle of Clomid I got a call saying my thyroid was flagged and I needed to make an appointment with an endocrinologist.  At my appointment I told her I was at the end of my Clomid cycle.  She told me to stop immediately because I didn’t want to have a thyroid problem while pregnant.  I actually felt devastated after that appointment.  I remember calling Sean, crying, tell him we’ll have to put off getting pregnant for a couple of months.  It felt like a huge set back.  Little did I know it would be LOTS of months before we would make any headway.

Over the next couple of months I took lots of pills, had an ultrasound done on my neck, went on an iodine free diet (extremely difficult especially because I wanted my salted popcorn!) and ingested radioactive iodine to take some thorough scans of my thyroid.  In the end they found nothing and sent me on my way, diagnosing me with Graves Disease (hyperthyroidism) which basically meant, you-don’t-show-any-signs-of-thyroid-disease-so-we’ll-slap-you-with-a-catch-all-disorder.   

We could have resumed but since I did not like my OB/GYN (really, writing my instructions on a paper towel?!  Geez, show some concern for your patient) and we were moving to Valencia, we decided to wait till I found a new doctor in our new area. 

This time around my Dr. ordered lots of tests on BOTH Sean and I before she would start us on Clomid (why didn’t my other OB/GYN do that?!).  She ordered a semen analysis for Sean and tons of blood work for me.  A couple of weeks later we got the call letting us know that Sean’s analysis came back with not the best news.  He had low morphology which meant he had a high percentage of misshapen sperm leaving few to be healthy enough to fertilize an egg.  With my anovulation problem compounded with this, we really needed help to get pregnant.

The Dr said the morphology could be affected by a condition called varicocele (which about 10% of all men have) and she referred him to a urologist who then referred him to a radiological urologist at UCLA.  He confirmed that it was varicocele and that Sean would need surgery.  They would insert a catheter in his vein to help with the flow of blood (apparently if the testes get too hot from back flow of blood it can affect the morphology of the sperm).  He was so nervous for the surgery but was such a trooper.  It was enjoyable to be there when he was still recovering from his anesthetics. 

Yes they went in at his neck to get to the vein around his testes, doesnt make sense but there you go.

We had to wait a while to see if the surgery worked.  About 10% of men who have the surgery don’t see any improvement and Sean fell into that percentage.  His morphology levels still put him in the infertile range. 

In the mean time my blood results came back with great news.  Other than the fact that I don’t have periods, I was great on the fertility chart- excellent quality and quantity of eggs.  My hysterosalphingogram or HSG also came back normal (they basically shoot dye in your uterus and then take X Rays to make sure there isn’t damage-it feels like you’re being blown up from the inside out in case you’re wondering).  

All those squiggly lines mean I dont have damaged tubes.  My fertility Dr. joked that I should frame this as artwork and not tell people that its my uterus, weirdo.

With all our test results in, our Dr. allowed us to go on Clomid.  This is the cheapest and easiest technique for those trying to get pregnant.  The pills help ovulation so it’s easier to time everything.   Looking back it was a waste of several months because our problems combined meant we needed more help than just a pill.  Three failed cycles later, we were on our way to a fertility doctor.

Dr. Najmabadi was the best thing that happened to us.  At the time he had a small office in Valencia where I was able to go to many appointments.  His main office was in Beverly Hills but his hours were early and he was open on Saturdays so that meant it wasn’t too much of a disruption to my work schedule to go in for appointments.  And you have A LOT of appointments.  I felt really good after my first appointment.  I knew that it would work.  I just didn’t know how long it would take but I knew we would get there. 

He suggested that we do some genetic testing to rule out anything that would cause miscarriages.  At the time it seemed like such an expense with little benefit but compared to the overall cost of the entire experience it was a drop in the bucket and I am glad we did it.  A lot of people will try to get pregnant and cant or have miscarriages then they do genetic testing and they find something that was causing those problems.  If you do the testing first, you nip it in the bud. 

I found out I only had two problems.  One was minor (as far as getting pregnant), I’m a carrier for a deaf gene.  The second was a bit more serious but not much.  I was a heterozygote carrier for MTHFR.  Bottom line, I couldn’t process folic acid like everyone else so I would need special folate and at a higher dosage.  Folic acid is important for the growth and development of your baby and it reduces miscarriages.  So I had to switch to a new (and expensive) prenatal vitamin and to start taking baby aspirin (to help reduce miscarriage).   During this time we also learned that my thyroid blood tests put me in the hypothyroidism spectrum (why the switch, I dont know).  But all I had to do was go on a pill.  Now we could finally get started.

Dr. Naj told us that his recommendation would be to go straight to IVF because of Sean’s low morphology.  We didn’t want to make that jump because it would be much costlier.  So we decided to try IUI first.

IUI is when they stimulate ovulation in the female and then place the sperm directly in the uterus.  The idea is to help the sperm on their long journey to fertilize the egg. I went on injection shots to stimulate my ovaries.  I had major problems with this. Like A LOT of people, I have an aversion to needles, but lately I’ve realized I have full blown anxiety towards needles.  Not only do I feel the needle going in but I can feel the needle in me and if it’s in me too long I start to laugh (yes weird reaction but there you go) and go extremely weak.  How on earth was I to survive shots in my leg?!

Luckily for me the first round was only Follistim, a very small micro needle in a cartridge that reminded me of an Epi-pen, which would go in my leg.  Sean was my nurse and he did great.  Although one time I forgot my medicine at work (long story) and I knew I had to give it to myself.  Sean was completely convinced that he would have to come to my work to give me the shot but I (thankfully!) was able to do it on my own (albeit I did mess up a little I was so nervous).

My easiest shot.  Small needle and in the leg.

Remember when I said there were lots of appointments with the doctor?  Well, you basically went in every 2-3 days to do ultrasounds to see if follicles were growing on your ovaries.  We discovered that the drugs weren’t working fast enough so they upped the dosage.  The follicles finally grew to a good size and then I had to inject the HCG or “trigger” shot which was time sensitive.  It triggers ovulation.  The timing is important because then you go in for the actually IUI 36 hours later (the time it takes for the egg to be released).  They had washed and cleaned Sean’s sperm and they used a catheter to put it in my uterus.  I laid on the bed for 30 minutes and then they sent me on my merry way.

It didn’t work.  AND we learned some information that would push us back a little more.  The follicles that didn’t burst forth the egg were very large still.  They hadn’t subsided.  This is a sign of Ovarian Hyperstimulation Syndrome or OHSS.  We couldn’t go immediately into another cycle because the drugs that I would be on to increase follicles would increase the already large ones and they could burst and cause other problems and ultimately I could be hospitalized.  To fix this the Dr. told me I needed to go on birth control for a month to “quiet” my body.  Another waiting period.

Finally I was able to start again.  Knowing I needed extra help from drugs, the Dr increased my Follistim dosage and put me on an additional drug, Menopur.  This was going to be a bigger shot and it had to go in my STOMACH.  Oh boy, I was flipping out.  I knew that I was just too weirded out to have Sean give me that shot so I did it myself but he was right there holding me every time.  He was such a support.  I only cried once.  

I had to mix my own medication with this one, it was fun acting like a scientist.  But not fun shooting it in my stomach.  :(

SIDE NOTE: I cried because I didn’t want to give myself any more shots.  It was mentally challenging.  Sean told me how brave I was and I immediately dismissed the thought.  Brave was fighting a huge fire-breathing dragon with only a sword.  And I definitely was NOT that kind of brave.  But then I started thinking about why fighting a dragon was brave.  It was brave because you did NOT want to be doing that, you wanted to be tucked up safe in your cozy bed.  Did I WANT to be giving myself shots?  No!  I was having mini therapy lessons right before each shot.  I realized that I was indeed brave.  I straight up faced my anxiety towards needles and ended up being shot around 120 times (some of those with my own hand).  It didn’t get easier, I just dealt with it better.  Bravery took on a whole new meaning doing those insufferable days. 

We went in again for our second IUI.  We were pros by now. 

It didn’t work.

We knew if it didn’t work that we wanted to go straight to IVF (of course with hindsight we should have done it first).  I still had OHSS so I had to wait a while before we started.  I knew what to expect from our IVF cycle because I was on almost the same medication during my second IUI.  I still took Follistim and Menopur but I had two more shots that would be added, Omnitrope (a human growth hormone and what Sean informed me is the drug of choice for athletic steroid users) and Ganirelx.  I still took my trigger shot but the next step was different. 

My counter wasn't free of drugs for several months.

Do you see that needle?!  Much bigger!

Red, white, blue and yellow pills, very patriotic.

IVF is when they retrieve the eggs during an operation and then they fertilize them with the sperm.  After they grow in a petri dish for 3-5 days they implant them back into the uterus.  We decided that because of my OHSS I would freeze my embryos and wait for a month then thaw the embryo and implant. 

I was really nervous for my egg retrieval because it was a legit operation.  I wore an operation gown with booties for my feet and a hair net.  I had to get an IV for the anesthetics which I DID NOT enjoy.  My defensive mechanism is to laugh (remember?) so I think I weirded out the anesthesiologist.  The operation was short and I recovered extremely well.  We also got great news that they were able to retrieve 41 eggs!  That is pretty much unheard of.  They immediately fertilized them and the Dr. called me every day after that to tell me how many fertilized and how many were dividing.  By day 5 we had 13 (yes a big drop but still a VERY good number) and on day 6 they were able to freeze 2 more.  I had 15 little embryos waiting on ice for us.

Pre-operation

During our waiting period we had a huge decision to make.  How many embryos were we going to implant?  Most IVF patients start with a fresh cycle and they put in 1-2 embryos.  If it doesn’t work they can try a frozen cycle and usually they put in 2-3.  These numbers are based on what infertility problems the couple are facing and how well they think the body is going to accept the embryos.  Since we didn’t do a fresh cycle we had no idea how well my body would accept the embryos.  I knew for sure we didn’t want to do 3 embryos but did we want to do 2?  It was a huge debate that we kept going back and forth on (good thing we had such a long waiting period).  Ultimately we decided on 2 embryos because as Sean put it, we didn’t have the money to do it again immediately and what would we rather have, two kids or no kids?  I was nervous about it, but 2 it was. 

After our waiting period we went in for the transfer.  Our embryos thawed perfectly and it was a go.  It was similar to the IUI but the placement was different.  They had to use a special catheter and ultrasound to guide the embryos to the magic spot. It was a bit painful because my cervix was not in the best position for the procedure so the placement of the catheter caused moderate cramping.  But it was really cool to see the two embryos squirt out of the catheter into the uterus via the ultrasound.

 

One of the two blastocysts that we implanted.

The two white spots are the embryos.  You can see the tip of the catheter touching the bottom one.

Now it was the waiting game again.  It wasn’t hard at first to wait.  We had to wait a full two weeks to come back for a blood test.  Around day 8 I started to get nervous.  I was getting anxious and wanted to know.  By day 10, I made a decision.  Day 10 was when we were tested when we did IUI so I didn’t see why we couldn’t do home pregnancy tests now.  Sean was opposed to it at first because he didn’t want it to be not accurate.  I knew whatever the result would be that I would take it with a grain of salt.  We did three tests over the next three days (I found some old ones under the counter) and they all came out positive.  I wasn’t feeling any symptoms so it was hard to believe.  I went in to get my blood drawn and they gave me a call later and told me not only was it positive but the numbers indicated that both took.

We were having twins.

Continue to the next blog post to finish our story or click here.