Adapting to Unexpected Changes During Your Cycles

I started this blog because I wanted to help fellow infertiles. I wanted to create a blog that I wished was out there when I was still trying to conceive. You know, some 20/20 hindsight from someone who's been down this road before. I wish I could write every day, but because this blog is more topical, I sometimes struggle to find a subject that would speak to all of you. Perhaps I'm just having a guilt trip for not writing daily. Anyhow... So when my fellow blogger Fox in a Hen House suggested that I talk about dealing with the unexpected, I thought, "Brilliant!" Today, I'm going to make some suggestions about finding ways to deal with the unexpected changes during a cycle. Let me emphasize that I am not talking about situations that finalize a cycle, like a BFN or no embryos can be transferred. I'm solely going to focus on unforeseen changes that can be rectified.

Fox's current situation is a great place to start: she was diagnosed with Premature Ovarian Failure at age 35. After a few Clomid cycles, she started an injectables IUI cycle. Turns out her body is responding amazingly well to the meds and at her first visit, she had 13 follicles! Exploring her options, she has agreed to convert her IUI cycle into an IVF cycle. Now that's pretty unexpected. Usually you hear of IVF cycles being converted into IUIs, but hardly ever the other way around. Fox took things in stride. She adapted. Was she prepared for an IVF cycle? No. But is she going to make the most of it now? For sure.

We probably adapt to a lot of unexpected changes in our daily lives without ever realizing it. But when it comes to IF cycles, it seems we lose all ability to take a step back and accept the new direction our cycle is taking. We have too much vested in the cycle and are too emotionally committed to just go-with-the-flow. I've said this many times before, no cycle is ever text book. Not a single one of mine ever went according to plan. You have to find a way to realize that it's out of your hands. I know that this is incredibly difficult to accept, especially when it seems that most IF patients are Type-A personalities (why is that?!). You must remember that you have put your trust in the hands of a reputable clinic (tell me you did your research!) and that your body is in many ways independent from you. Some days it will surprise you with a wonderful gift and other days, it will disappoint you, like a disobedient child.

So when you have a curve ball thrown at you during your cycle, you need to find a way to adapt. How you ask? Well for one make sure you get a hold of your RE (do not accept playing telephone and having the nurses be your point person). If your RE is any good, he/she will make the time to review your options with you directly. Ask all your questions -- What's happening? What does it mean for the cycle? What are my options? What is your recommendation? You're not the first patient whose cycle hasn't gone according to plan and you're certainly not the last. If, like in the case of Fox, it's actually good news, you need to embrace it. Cycles are lived in short windows of time (even if the 2 week wait feels like an eternity). If you miss out on an opportunity, you will always look back and wonder "what if...." But sometimes, the news isn't good, and in those situations, you must remind yourself that you have come this far and that it's too soon to throw in the towel. A skillful RE/clinic will make lemonade out the lemons you've been handed. They will find a way to optimize the situation; that's their job.

So, let's review a few unexpected issues that may arise and ways to (possibly) resolve them:

• Making too few or too many follicles --> Adjust the dosage of your meds. If no change occurs by the next visit, consider converting your cycle.
• You're experiencing OHSS --> The excess fluid may be removed prior to your ET or you may need to complete your cycle with a FET.
• Lining not thickening fast enough --> Try high doses of vaginal viagra to increase blood flow and go to daily acupuncture.
• Lining is too thick --> If you've confirmed there's no polyp prior to your cycle, a thicker lining shouldn't be an issue.
• Premature LH surge (i.e., pending premature ovulation) --> Administer Ganilerix to curb the LH surge until all follicles are ready.
• DH was unable to provide semen sample --> Either go in there to "help out" or consider freezing the eggs and do a frozen cycle. 
• DH's sample is less than usual --> If it's an IUI, ask to do another insemination the next morning. For an IVF cycle, you only need a few healthy ones.
• Your embryos aren't dividing well --> You can opt to transfer them on Day 2 or 3. Your body will give those embryos a better fighting chance than a petri dish.
• You were expecting a Day 3 ET, now it's a Day5-6 --> This is actually great news and it means that your embryos are doing very well. 

The silver lining here is that most issues that may arise during the cycle have solutions that you can explore. At that moment you may not be able to see those solutions, but your RE is there to guide you in the right direction. You can be proactive and do a little of your own research to ask the right questions; it's the not-kowing that frazzles us. Plus, don't forget that I'm your disposal. I'm happy to answer any questions and even look things up for you to help you make the best decision.

It Takes a Village to Make a Baby

It's a rude awakening to realize that you will not be creating your baby the old-fashioned way. When you look at your child, you will not remember the romantic situations that preceded his/her conception -- no candlelit dinner, no exotic vacation setting, not even the mundane sex on a school-night. In your case, you will remember the countless shots you took to your abdomen, the daily visits to the clinic for monitoring, the poking, the prodding by more doctors and nurses you can count on both hands, the cold surgical rooms, the anxiety.

The sterile environment of your clinic will become your second home: you'll sign in, wait in a sad room sitting on neutral furniture from the 90s with many other women -- all more anxious than the next -- and hope they call your name soon so you can get out of there. You'll go into the blood draw room, where you'll be lined up but hidden ever so slightly by hospital curtains. You'll try to be pleasant with everyone, because after all these nurses are often times your lifeline; they will call you, give you directions and sometimes they'll break the bad news. Then you'll be ushered into the ultrasound room, where you'll take off everything from the waist down. You've done this so many times, you've lost all prudishness. Staring at the paint-by-numbers art hanging on the walls, you'll patiently wait for your doctor (or ultrasound technician) to knock on the door. You'll wonder how things look in there and what's next. Finally, she/he will walk in and ask you how you are and get to work before you get a chance to answer. You'll robotically say you're fine, but wish you could answer that question honestly: I'm depressed, lost, isolated. Infertility sucks... You'll get your update on your follicle count and quickly get dressed. But not so fast, because you have to stop by the billing office to make sure to pay your co-pay, because after all, this is the business of making babies.

Oh, and let's not forget the best part: you and your partner won't ever be in the same room when your baby is actually being conceived. You had your eggs retrieved in an operation room while your partner ejaculated to an undesirable porn magazine. Romantic, isn't it? And while you're home, wondering what's going on, an embryologist will make the introductions: "Egg, meet sperm!"

So baby-making didn't quite turn out like you'd imagined, huh? You probably won't be able to share any of this with your future child(ren). But the one thing you will have that others won't is a picture of your baby/babies when they were only embryos and that's priceless. You will get attached to that picture they'll hand you at your embryo transfer. In fact, I remember DH drawing arrows with a name for each embryo. If that cycle works, you'll keep that picture forever. If it doesn't, you'll shove it in a folder, along with the rest of them, where Little Anna, Jack and Laura will be nothing more than another scar on your heart.

I wonder what I will say when my child asks me about where he came from. I don't think I have an answer to that just yet, but I will be able to show him a black and white image of himself, and tell him that he was loved when he was only made-up of 8 cells.

P.S. I heard about this children's book called "I can't wait to meet you" by Claudia Bates. Finally a book to help us tell our story. I'll review it on a separate entry.

Are you doing it right? Conception 101

You’re probably thinking, “Come on, are you seriously going to tell me how to have sex?!” Well, not exactly, but before we discuss anything else about infertility, I want to make sure you’re timing things correctly. Many couples think they’re having trouble conceiving when all they really need is to know a little more about the basics of timing sex and ovulation.

Most women’s cycles are 28-30 days. This period is broken up into two phases:

• The follicular phase is from Day 1 (Spotting doesn’t count. We’re talking enough fluids to dirty a pad) of your period to ovulation.
• The luteal phase is from ovulation to your next period.

Once the egg is released from your fallopian tube, it will only stick around for a maximum of 24 hours. So what we want is to have intercourse a few days prior to ovulation (and on the day of ovulation), since sperm can live up to 5 days (if it’s in the right medium – more on that later).

There are several ways to figure out how long your cycles are in total and how long your follicular and luteal phases last respectively. One way is to chart your waking temperature (you need to do this for 3 months to have a clear grasp of your cycles). The second is check your cervix and the cervical fluids (it’s the “medium” I mentioned above. You’re looking for an raw egg-white like consistency). Lastly, you can purchase an ovulation detector kit from a drugstore (just follow the instructions on the box).

So assuming that your cycles are 28 days, then starting on Day 10 you want to have sex every other day. Unlike what some people think, in this case it’s not quantity (i.e., having intercourse every day) but quality (i.e., healthy sperm) that counts. Having sex everyday will actually diminish the quantity and quality of the sperm. Your egg is not going to stick around for tired sperm, so give your partner a rest.

After ovulation, your luteal phase should be around 14 days. If it seems that your cycles are very short, it may be that your body is not producing enough progesterone (P4). If that’s the case, you’ve got your first red flag. Luckily for you, it can be easily rectified by some progesterone supplements.

You want to take your first pregnancy test (HPT)on the day or one day after your period is due. I know the latest HPTs claim that they can detect a pregnancy up to 5 days before your period, but your body could be producing lower levels of pregnancy hormones (Hcg) that the test might not be able to detect that early on. More on the nightmare of pregnancy tests later.

So there you have it: Conception 101. If you want me to elaborate on any specifics above, just let me know. If you have time, I would highly recommend that you get this book:Taking Charge of Your Fertility, 10th Anniversary Edition: The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health