expecting not just a baby, expecting the rest of our lives

Our biggest concern was that with our next pregnancy, paranoia would rule our lives until we saw our baby’s heart flickering on the screen-really until the second trimester to be honest! We were worried that our anxieties would be so significant that they could hurt our babe. Because of these fears we had already decided that if when we were pregnant again we would share our news with our families right away so we could have their prayers. Their prayers to give us strength and peace each and every day.

With all three of our other babies my breasts were tender right away so I knew days before any test would show. I had nothing with this cycle. Nada. Still, I started the progesterone three times daily as the specialist instructed (and let me tell you, it feels like you have wet yourself all 24 hours of the day….every. day.-YUCK!). But, I did it. We truly felt we were not pregnant-so much so that we didn’t even do a pregnancy test 14 days after the IUI as they recommended. Day 15 was a Monday morning and while at the office I thought, “heck, my period is late after all”.

Holy crap. I was so shocked that I almost ran up and down the clinic halls screaming with a pee stick in my hand for all to see….almost. Instead, I showed it to three of our nurses and all agreed, we were pregnant! I took a picture and sent it to Adam and he didn’t believe me! He was working an hour away that day and his disbelief was so great that he drove home right then to see the test himself. He came into my office, I showed him, we shut my office door and hugged one another while crying. We were absolutely amazed. Adam was still so baffled that he made me do another test that simply said yes/no instead of the old fashioned line tests. FINALLY, he really believed.

Incidentally, I happened to open these two cans the week prior at work!

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James 1:17 says “Every good and perfect gift comes from above”. We sent this text to several family members announcing our news! We were elated. We asked for them to begin praying for us, praying for the peace that we so desperately needed. And, I know that they did because we felt it. I know that I at least, was more at ease with this pregnancy than any of the others. I felt that from the get-go it was different. We were actually surprised (well, as much as you can be surprised after an IUI!!!!) so I just knew that everything else would also be different. I felt great-no symptoms at all other than some slight breast tenderness that did eventually develop.

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Per the Tempfer protocol, I started the prednisone twice per day as soon as we found out and did fine with it to start with it. If you aren’t aware, some people do just fine on prednisone while others can have a myriad of side effects. It was tough having to take it twice daily as one of the biggest side effects is insomnia. I, personally, always try to prescribe it in the mornings for my patients to try to help avoid this but in my case that second dose separated from the morning dose was what had been researched and felt to be best for our situation.

I’ve had insomnia since my first year of nursing school (FOR.EVER.AGO!) so I am accustomed to having troubles anyway, but things did worsen. Anxiety, depression, confusion and even psychosis can also happen with prednisone. It is a necessary medication but can be an awful medication. We weren’t scheduled to be seen until we were about 7 weeks along-you know, to check for “viability” (there is that silly word again-GAH, I hate how it sounds!!!).

For eight days prior to that appointment things were definitely not good on the sleep front!

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ready for baby

We were so ready. So ready to make this baby! It had been the perfect amount of time to heal from losing Noelle-9 months.

We both took our antibiotics and I started Letrozole for the first time. I felt great on it other than a bad migraine on the last two days but heck, that is nothing! I was on the Folgard also in addition to my regular prenatal vitamin and DHA that I have taken with all of my pregnancies (we want our baby to be smart, ya know!). For the first time we used the ovulation predictor kits that you can buy over-the-counter. It was so silly. You are supposedly getting ready to ovulate when the line is at its darkest. What does that even mean? For pete’s sake….every morning we are both staring at this stick to see if that day’s line was darker than the previous day or not. Crazy. The specialist had me go in when we thought we were ovulating for an ultrasound with our OB to look at our follicles-I had three big ones (meaning we should be likely to conceive!). When I was leaving the OB said, “I think you are setting up for twins” and smiled at me. I received an HCG trigger shot (which as a side-note had to order out of Omaha as regular OB clinics are having a difficult time getting it now that so many people are using it for weight-loss. The price of it has gone up exponentially!). The trigger shot was supposedly supposed to tell my body to ovulate and they told us to go home and make a baby! Who knows what happened to those gorgeous follicles because we didn’t get pregnant and were so bummed.

I had all of the blood work repeated and Adam (God love him!) was re-tested and you guessed it! All normal. We took antibiotics again and I started the Letrozole again and had a migraine on the last two days again. Feeling like you are watching that obnoxious movie Groundhog Day yet?!

They told us to do the ovulation testing at home again and to call them when it said I was ovulating. We were smart this time! We got the darn test that smiles at you when you are ovulating-it cost more, yeah but was worth it. We got our smile on a Saturday morning and called their office and was told to be there the next morning at 8 for our IUI! We were on the road by noon, off to Denver again. And with this said, let me just say that not only have we been financially and emotionally emptied but our infertility has completely wreaked havoc on our jobs, especially mine. Imagine patients with appointments having to be called-literally last minute- and what could my poor staff say? “er, Shana is ovulating so needs to reschedule your appointment….”. We are both so very thankful that our employers have been as kind and patient with us as they have been, even when we have far surpassed our vacation time, etc.

When we arrived the morning of our IUI, there were all sorts of couples in the waiting room….on a Sunday. This just goes to show how fertility treatments are not a Monday-Friday thing. As with us, these other people probably had to just drop their lives to be there within a certain amount of time, considering you only have a short-precious window of time each month to conceive. The nurse took us to a private room to…ahem (to our Mother’s you can close your eyes now!) produce a sample from Adam. I kid you not. We were quite weirded out. This was an entirely different experience for us. There was a black leather couch and a TV with all sorts of videos. We were afraid to touch ANYTHING!! And, couldn’t stop laughing of course! What an experience! We were happy about how official it was, though. They did an official chain of custody with our sample just like we do for drug tests in our office, meaning it was highly unlikely they would insert some other gentleman’s swimmers into me!

When it was time for the IUI the nurse took us to an exam room and commented to Adam “your sample is the best I’ve ever seen!” (yada yada, he later told me that all he wanted to say in return to her was, “I bet you say that to all the guys”). HA!

As far as procedures go, this was the easiest I had been through. Nothin’ to it! I cramped off and on for about 48 hours after but otherwise easy peasy! As we left their office we took this picture and made the mistake of posting it to facebook. Everyone (I mean EVERY.ONE.) thought we were announcing a pregnancy. We wished! We felt so bad that we took the picture down within an hour.

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We’re a go!

Recovery went pretty good. The thing that lasted the longest was pain when I would empty my bladder. I understand this is normal as when the bladder decompresses it pulls away from the pelvic wall where there were many sutures and of course the endometriosis had been scraped.

Speaking of endometriosis, this was a whole new thing for us. The best way I can describe how I felt post-op is like a pumpkin would feel (not that they have feelings, but go along with me here) after we scrape them out to cut them. Raw, slow-moving. I took a little over three weeks off of work. At the beginning of week two I felt good enough to get a little bored and it is then that I decided I DID want to see my brother’s baby, Colt. We bought a last-minute ticket and I was off to Montana for a week. I had a very long lay-over on the way there but purchased a day-pass to one of the airline lounges so was able to have my feet up. Again, I cannot reiterate how important writing that letter to my brother and sister-in-law was in helping me cope. Going and holding that precious babe was incredible. I wept because I want that for us but I also wept because he was just perfect. I am so glad I went.

We had another (prepaid!) phone consult with the fertility specialist in Denver shortly after to discuss the results from my surgery. Again, he was not optimistic that the surgical findings had anything to do with our problems. He encouraged us to try again, though. I struggled with the info he gave us, though as I had done my own medical research as well as spoke with our local OB and had discovered that endometriosis, can indeed be an issue. It basically can decrease a woman’s egg quality. I was batting a zero! Not only did we have a hostile environment (all those masses and now scars) but crappy eggs, too? I mean, come on! Can we catch a break?! The specialist said that if, in fact, the endometriosis was a contributing factor that we had a year from the time of surgery of “goodness” per se. Basically, a year where I should produce good quality eggs but by that year mark the endometriosis would be back and we would have to readdress it by taking injections or have surgery again. Our time would be cut short because we had to wait the mandatory three months to try to conceive while my uterus was healing.

He also wanted me to have another hystersalpinogram (HSG) before we started trying again to be sure there was no damage to the fallopian tubes during surgery. The HSG was uncomfortable the first time I had it but this time it was painful. I imagine all of the healing scarred areas are why. But, things looked great! We were given the all-clear!

Because of my age (again, he brought that up!) and because of time-constraints due to the endometriosis he recommended the first time we try we do an IUI (intrauterine insemination). While this wouldn’t increase the likelihood of a successful pregnancy, it would help us to get pregnant faster. He had one requirement, though. That I have ALL of my blood tests done again and Adam even be tested again as “things can change”. ALL. THE. TESTS. Are you kidding me? Thousands of dollars worth of blood work and poor Adam! I mean, my Husband is a stud but, come on! What do you do when you are in this situation, though. We were willing to do whatever it would take to have a baby. This is not to say that we weren’t conflicted with it all as we most certainly were. With all three of our other babies we conceived the first month we tried. As I said before, we felt like fertile myrtles! So, we came to a compromise with the specialist and that was that we would do the Tempfer protocol as he recommended including taking Letrozole to help make the entire environment “better” but would try naturally. If we did not conceive in September on our own, we would come to Denver for an IUI.

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Temptation and maybe an answer

In late January we received the packet of information from Conceptions listing what needed to be done prior to meeting with them. Of course, they wanted an ultrasound and HSG which I had already done. I had also had “basic labs” but they sent an extensive list. A twelve vials worth of blood list. As with everything else I had done previously ALL of my tests came back wonderful. I was especially proud of my AMH (antimullerian hormone) level. As the specialist from Conceptions said, “I am really impressed with your AMH; it is that of a young woman”. This gave us such hope as prior to this everything we had heard and were feeling was in relation to my age, like we were quite literally running out of time. The AMH is a measure of a woman’s “ovarian reserve” and good levels means higher odds for more follicles (eggs) and therefore, a live birth.

We got to spend an hour with the specialist and I will admit, his first recommendation was IVF. Conceptions is known for their expertise in the IVF field in addition to doing pre-genetic testing on the embryos before implanting them for IVF. It really is amazing stuff. Basically, they could harvest my eggs and sperm from Adam, make a baby and say, “Congratulations, Mr and Mrs Carter, we are putting in a healthy baby boy today!”. Can you freaking imagine? VERY. TEMPTING. But, just as with anything in life, it wasn’t that simple. It never is. Our concerns were two-fold. First, we believe life begins at conception and because of this we were worried about having multiple embryos (which are babies to us) just hangin’ out somewhere (in a freezer obviously). I have heard of couples with embryos in a freezer trying to decide what to do with them. You can’t just throw them away, you can’t keep having babies forever (unless you are a Duggar), and if you donate them then you will always think of your child being out there somewhere. He was able to comfort our fears regarding that, though because just as they are big on shooting for a healthy “single” baby vs. multiples, they also would only develop one embryo at a time.

Secondly, what if that embryo isn’t healthy? What if it was like Noelle, with trisomy 23 or had trisomy 21 (down’s syndrome)? Again, we believe an embryo is essentially a baby already. We could (almost) justify maybe not implanting a baby with a genetic incompatibility with life (such as with Noelle) but NOT with something like trisomy 21. Can you imagine lying there knowing you were being implanted with a baby that would have down’s syndrome. Now, a healthy baby with down’s syndrome….bring it on! My worry was if it was a baby on the extreme other end of the spectrum….such as with heart defects, etc. Wow, the emotions surrounding that would be so difficult and we could tell that this type of situation may be difficult for the specialist to go forward with as well. IVF just wasn’t for us. One more thing we discussed over and over again also was the cost—$15-25k could make a really nice dent on the cost of adoption!

Once he understood our feelings on this, he was amazing. He respected us completely and gave us other information that he thought we may benefit from. He was happy that my HSG was normal but recommended we consider getting a sonohysterogram. I had actually never heard of it but it essentially is like an HSG only it is only looking at the uterine shape and is done with ultrasound, instead of xray. If this was normal and we decided to go forward with another pregnancy he recommended we consider the Tempfer protocol. Basically, a research study was done trying several things and for some reason, somehow the women were more likely to have a successful pregnancy. Unfortunately, no one has yet to completely determine why….only theorize. But, it was something and we would take it! The protocol included a baby aspirin, both of us taking antibiotics (a zpack) at the onset of my cycle, progesterone three times daily, prednisone twice daily and folgard. The idea is that in case there is some sort of bacterial infectious issue between one of us the antibiotic would help with that. If my uterine lining didn’t thicken enough with the pregnancy, the progesterone would help with that. If there was some sort of inflammatory issue in my body that was not detectable on lab studies, the prednisone would help with this. The folgard is just a super potent folic acid with Vit B 6 and Vit B12.

Finally, he talked with us about ovulation medications (like the Pergonal mentioned previously). He, too did not recommend Pergonal but did recommend Letrozole (as a side note, he was against clomid stating the side-effect profile with clomid is higher than Letrozole and the number of multiples is higher with clomid which I have since confirmed with researching medical literature). He explained to us that the Letrozole would not help to “recruit a better egg” per se, rather would possibly help the overall environment during ovulation to be better.

Part of our discussion:

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We left Denver feeling good (the shopping also helped-IKEA is the bomb!).

The ceiling of the hotel where we stayed also was reassuring as it looked all “reproductive-like”!

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This feeling was short-lived though as I had the sonohysterogram very soon after returning home and it was abnormal. Our OB/GYN couldn’t tell for sure what was wrong-just that something wasn’t right.

I was sent for an MRI which was also abnormal. Abnormal enough that the Radiologist that read it (who happened to be an MD I referred to in my previous practice so he recognized my name on the report) called my cell phone personally within hours of the MRI being done. He requested that we come to Lincoln for a stronger magnet MRI, done by himself….free of charge. The initial diagnosis: I had a uterus didelphys. Two uteruses (uteri?). This could come with it a whole host of other issues and therefore, he was concerned.

I felt like a freak.

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