To the Baby Doctor, AKA the RE

For those unfamiliar with the acronyms most infertile's use, RE is short for reproductive endocrinologist.  Also known as fertility specialist.  Finally, 16 months after trying to have a baby, my doctor gave me a referral to a specialist at the OB/GYN Clinic on base.  This appointment was long awaited.

I arrived at my appointment early and prepared.  A blue folder held my BBT charts from the past year, Chris's semen analysis results, and a list of the medications I currently take.  Minutes after letting the front desk know I was there, I was called back by Andrea, Dr. King's assistant.  She weighed me, took my blood pressure, and confirmed my medications before sending me back to see Dr. King.

He happily greeted me and asked "Have I seen you before?".  I replied that no, I had not seen him before either. He then explained to me that he is a civilian doctor and has been in this field for 42 years.  He is not a reproductive endocrinologist because they did not have that title when he went to school, but he has plenty of experience with all sorts of reproductive issues.  He said he also likes to do his own x-rays and ultrasounds so he has first hand knowledge and because he knows what to look for.

Dr. King confirmed that I had been trying to have a baby for 15 months, and I corrected him that it was now 16.  Yes, time passes.  He first asked if my husband's semen analysis came back adequate, and I handed him the results.  He did a bit of math and determined that there should be enough healthy sperm to do the job.  He then asked if my cycles were regular (they are) and I handed him my charts.  I was amazed when he looked at just a few cycles worth of charts and said he noticed that my temperatures were taking a long time to reach their peak in my luteal phase.  He explained this means I could have low progesterone.  Basically, progesterone is secreted by the corpus luteum after ovulation.  It is important because it matures the lining of the uterus so that a fertilized egg can implant and go on to a healthy pregnancy.  If there is not enough progesterone, the lining will not mature enough to support a baby.  To find out how much progesterone I am making I must have a blood test about a week after ovulation.  Finally a step toward diagnosing!

Photo Courtesy of Jennifer Morrow on Flickr

The next thing he did was a pelvic ultrasound right then and there.  I can honestly say I wasn't prepared for that!  He asked me if I wanted to empty my bladder, and yes I did if I was going to have a wand up there.  No need to make it more uncomfortable that it was already going to be.  I put on one of those awkward hospital gowns that is held together by a tiny ribbon at the top, sat down on the examination table, and placed a blanket over myself.  The next experience was the coolest thing ever and a much better experience than my first transvaginal ultrasound.

Despite the machine freezing when he wanted to capture an image (they had to restart the machine WITH the wand inside me. Nice huh?) he was able to show me my uterus, my endometrium and a division of muscle or tissue that he noticed in my uterus.  Then he showed me each of my ovaries and what he thought to be my corpus luteum, which he said looked a little small.

After Dr. King got a thorough look at my lady parts, we sat down and discussed my game plan.  Like I mentioned before, I need to get my progesterone checked about a week after I ovulate.  He also wants to do an HSG (hysterosalpingogram) X-ray to determine if I have any blockages in my uterus or fallopian tubes.  He couldn't fit me in this cycle, so I need to call at the beginning of next cycle to set it up.

Back to waiting.  At least I am starting to get some answers on this journey through infertility.  I hope my lady parts don't require too much of a fix to get pregnant.

Pain and my Primary Care Manager (PCM)

You may know how frustrated I am with my PCM, who is also my GYN. Not only on the level that we have been TTC for 15 months with no success and she has done nothing, nada, zilch about it, but also because I have been having female issues that she has refused to acknowledge. I'm going to warn you now that this entry will contain details of the feminine nature, so if you get queasy now is the time to stop reading. I promise there are no gory details.



Ever since I stopped taking hormonal contraception, my body has not been the same. They say your body is supposed to resume it's normal reproductive functions within a few months of stopping the pill and for most women it does. What they don't tell you is that it may take years for some to resume normal funtioning. My first few cycles were anovulatory (no ovulation), which I expected and I tracked through charting and using FAM (fertility awareness method). I also charted other signs and symptoms that were cycle related such as flow and duration of menses. A few months into charting I noticed that before my period began I would spot for no less than three days. I accounted it to my body adjusting to being off hormones. I figured it would eventually stop.

Fifteen months later, it hasn't stopped.

In fact, I feel like the symptoms are becoming worse. Back in August I went in to see my GYN because I was having mid-cycle pelvic cramps. They did a pelvic exam, pressed on my right ovary and it was tender. So they guessed I had a functional cyst and had me schedule a pelvic ultrasound. The earliest ultrasound they could get me in for was three weeks later. That's the ever ineffecient base hospital for ya.

By the time I went it, my pain had already dissipated and they found nothing. No fluid, no remains, absolutely nothing! I used that follow up meeting with my GYN as a chance to mention that I've been having increasingly painful menstrual cramps and her advice was to fit in more cardio exercise and take ibuprophen. I am by no means sedentary and recently ibuprofen is not strong enough for my pain anymore.

I had my annual female parts examination in December. I mentioned that we had been TTC for a year with no pregnancy yet. She said her protocol was to have the man tested first before testing the woman. I figured it wouldn't be a problem getting Chris done, yet since we are dealing with the clinic at the hospital, it took ages to get him in and get a viable test. By the time we got his test results and learned that his swimmers are fine, I'd had two of the most painful periods in my life.

It's hard to describe how much pain I experienced. Those that have been through child labor might sympathize. I felt like my uterus was having one constant contraction. My womb felt like it was squeezing itself like a fist. My usual treatments of a heating pad and ibuprofen barely took the edge off. And 800 milligrams of ibuprofen would barely last two hours. Yeah, I was SOL for the next six hours.

My last menses led me to leave work early and head to the emergency room on base because the unabating pain was so intense from my rock hard uterus. By the time I got to the ER, ironically it had subsided to a dull ache. They made me give them a urine sample so they could rule out pregnancy. I knew I wasn't pregnant. It felt the same as previous periods and I'm sure it would feel different if I was having a miscarriage. The doctor finally came to see me, poked around my abdomen, and said I just needed stronger pain medication. He prescribed me Naproxen and Tylenol. I wanted to scream at him that something must be wrong if I needed stronger pain medication for a period. He told me to follow up with my doctor. Duh.

Now that I'm nearing the end of this current cycle, I can look back and say I've noticed I've been more crampy than usual. It reminds me of that August cycle in which I thought I had a cyst. This cycle, I cramped substancially for five days after ovulation. I maybe have a slight twinge or pressure around ovulation, but never dull achey cramps that go on for days. The pain went away after an acupuncture treatment (more on that later), and came back last night at nine days past ovulation.

I see my GYN tomorrow and boy do I have some questions for her. I'm going to ask to be tested for Endometriosis and Polycystic Ovary Syndrome because when your body is in pain it's trying to tell you something.

By now I am really realizing something is not right with my body. Infertility being the first sign. Severe menstrual pain being a second.

Please keep me in your thoughts and pray for the best.

Swimmers, Semen Analyses and a Dead End

For some reason, I have been putting off writing about this subject. I suppose if I don’t quite have it sorted out in my head yet, it feels like it comes out a jumble in writing. Second, I feel the need to be sensitive to Chris’s feelings because I know he doesn’t like having his personal life on the internet for all to see, so I will be exercising caution.

In the first week of January, Chris went in for his first semen analysis (SA). He felt like the sample wasn’t good, and sure enough, it wasn’t and they couldn’t tell much from it. His doctor told him to go ahead with another one. No problem, right? The second one was scheduled for the third week in January. Annoyingly it coincided with my stress delayed ovulation, and I didn’t want to miss a chance to conceive, so he cancelled it. His next one was the following week, on the 24th.

Between the first SA and the second, I had two whole weeks to worry. I worried that he wasn’t producing enough semen or sperm. I was afraid that his years of working with chemicals and toxins from the air planes had done irreparable damage to his little guys. I feared that his reproductive organs had been harmed and that’s why we haven’t been getting pregnant.

Chris went to his next SA and had a doctors appointment the 2nd of February. I didn’t find out until after the fact that the appointment was with a urologist [a doctor for manly parts, I guess?]. He hadn’t told me his PCM referred him. Thank you, Husband. That morning after his appointment, Chris texted me that his swimmers are nothing out of the ordinary. He’s not super fertile but he’s not infertile.

A huge weight lifted off my chest when I heard that. He is fine! But guess where that leaves me? Either we have unexplained or female factor infertility. With me coming off birth control pills and all my end of cycle issues, I’m guessing it’s me. Now that the male is evaluated, I should be able to go to my doctor and start a work-up.

Yet, just when we started to get somewhere, I find out the timing couldn’t get any worse. Chris’s last day in the Air Force is the 10th of this month. The end of this week. Chris is looking into extending our insurance for a few more months and I hope it pulls through. Otherwise we’re at a dead end for a while.

Continue to pray for us.

Angels Appear in the Darkest Hours

If you're human, you've experienced so much fear about an impending situation, and you knew it was irrational.  Yet you couldn't stop your self from thinking about all that could go wrong and how awful it would be.  Basically imagining the worst possible situation.

That's how I was before I got my last two wisdom teeth out today.  Yep, you heard me.  I've been through the procedure before.  I had my bottom two out when I was fifteen.  Now, ten years later, the top two had to come out because they were growing sideways and crowding my upper molars.  Not pleasant.

The sane part of me knew I had done this before and I obviously survived, but the other less-sane part of me was terrified of going under the anesthesia.  I was afraid of not waking up.  I was afraid of waking mid-operation.  I was afraid of what I would do while under, because I would have zero control.  All these things could happen, but happen very rarely, so I was at very low risk.  Considering I've been under before without complication, I honestly had little to worry about.

When it was time to take me back for the extraction, a young woman in teal scrubs called me back.  I laid down in the lab chair which was halfway between sitting and laying.  It felt odd because I wanted either to be sitting upright or laying down.  She looked at my file and asked me about any allergies and confirmed who was here to drive me.  Then she began sticking the circle patches to my chest to monitor my vitals.  A steady beep let me know my heart was beating.  She strapped a small mask over my nose, said she was going to start the nitrous oxide before the IV to relax me a bit, and instructed me to breathe through my nose.

I heard a hiss and felt cool, sweet scented air stream out the tubes.  She looked at my file once more and asked how long I had been trying to have a baby.  "Almost a year" I replied.  She explained that she had tried for three years to get pregnant with her husband.  She went through fertility treatments, even IVF, with no successful pregnancy.  They eventually divorced, though she never said why.  Then recently, her doctor had her switch birth control and during the period where she wasn't on any, she got pregnant  from her boyfriend.  She hadn't thought it was possible because she tried for so long.  She now has a ten month old little girl and is the light of her life.

She then told me she knows what it's like to get disappointed and depressed because she was there.  She also said she prayed and had faith, but God hadn't wanted her to have a child when she wanted one.  And when she finally did get pregnant, it happened in his time.

After she said those words, I felt a welling up of joy inside me and had to hold back tears.

She went to my right side to the IV drip ready and left the room.  I thought about what she had said as the nitrous made me feel light.  When she returned she asked how I was feeling.  I asked her if it was normal to feel light.  She said yes and that she could turn it down if I wanted.  It didn't really matter to me at that point so I didn't answer.  She then said she was going to put the IV in me.  I pulled my arm out and squeezed my clammy fist while she stuck it in my hand.  A dizziness washed over me and she laid the chair back all the way.  

She asked if I was feeling loopy yet and I nodded yes.  My eyelids felt heavy and my body nearly weightless, I looked up at her and asked "Who are you?".  She smiled and said "Ang" and notified me the doctor would be in shortly to start my IV.  The doctor touched my shoulder and asked how I was doing.  I told him "fine" then I dreamed of laying under a golden sky.

I honestly believe I was visited by an angel, or messenger of God today.  The events that happened in that doctors office before I went under all line up too well to be coincidence.

First, she went into detail about her ttc journey.  She did not have to ask or even share that information with me.

Second, I was compelled to ask "Who are you?".  Who asks this when you know very well that she is a nurse or assistant.  And I could have asked her name, but I didn't.

Third, her response was "Ang", which is probably short for Angela or Angelina.  Wikipedia says Angela is a female given name. It is derived from the Greek word ángelos (αγγελος), meaning "messenger of God".

My First Ultrasound Experience

Going in for my very first ultrasound wasn't how I had imagined it.  In my mind, I would have a growing bump for a belly, my husband would be right beside me, and we would be peering up at the monitor listening for a heartbeat and looking for a little bean nestled inside me.  That was very much not the case.  There were no warm feelings of joy and happiness, only feelings of fear.  I was afraid of what she would see on the screen and if I would have something ominous brewing inside me.  Would it hurt?  Would I pee my pants?  I only had questions on that day.

So, when the day for my transabdominal and transvaginal ultrasound came, I was jittery.  I was supposed to begin drinking 32 ounces of fluids 1 1/2 hours before my appointment and finish drinking them 1 hour before.  Summed up, I had to drink a ton of fluids in a half hours time.  My belly was full as well as my bladder.  Mission accomplished.

When the technician led me to the exam room it was nearly completely dark.  The only lights were coming from a soft glowing light, the monitor, and the hallway outside.  She had me lay down and tuck a towel under my pants so jelly didn't get my pants gross.  Without warning she said "warm jelly" then squirted a bunch on my belly.  I caught a sniffle in my throat as I thought It isn't supposed to be like this.  The first time is supposed to be special.  I let the thought go as she began pressing on my bladder making me feel like I had to pee really really bad.  And she would push on it over and over again for the next few minutes.  Then she had me get up and go pee (finally!) then come back in and get ready put my feet in the stirrups.

This is the part I was super nervous about.  I saw the wand covered and sitting in a little holster next to the monitor.  Panic tried to take control, so I didn't look at it as I waited for the tech to come back in.  She took a while in my opinion, or I just got ready really fast because I was ready to have the exam over with.  When she came back in, she had me put my hand between my legs and insert the wand myself.  I was relieved she didn't do it.  Awkward ultrasound tech looking at my coochie?  No thanks.

It felt uncomfortable at moments because she had to press on my cervix to find my ovaries.  Thankfully it did not hurt like I was expecting.  She would move it around a bit and the monitor would beep.  At one point, I asked her if my ovaries looked healthy.  All she said was "So far so good".  That's it?  Gee thanks.  At the end she gave me a lecture about how I shouldn't take anything she said for medical advice, she is just a technician, and my doctor is the one to talk to about the results.  How could I use anything she said?  She hardly said a thing!

I left feeling very moist and slightly disappointed she didn't tell me more.  Now I have to wait two weeks to see my doctor.  The joys of military clinics.