Lunacy and Lunar Cycles

Sadly, we realized that D wasn't pregnant on Sunday when her menstrual cycle decided to make its appearance with the full moon. Thirty-four days when she normally has a twenty-six day cycle! Seriously? D's always hated her period, but now that hate has evolved into more of an intense, seething hostility. Tomorrow, D goes in for an ovary check, which we've both decided is just an excuse to charge patients for an unneeded ultrasound. All the technician does during the first ovary check of the cycle is confirm that D's ovaries are still there. Where would they go? Anyway, after the ovary check, she'll be prescribed five days worth of Letrozole and one Oviderel (HCG) shot to induce ovulation once the follicles are large enough. Here we go again... For some reason, I think straight baby-making is more fun.

Peeing without the Stick

So, today is the 21st -- PT Day (Pregnancy Test Day). Of course, both D and I couldn't stand the wait and decided to jump the gun and test early yesterday, mid-afternoon. Sadly, the test came up negative, but we're hopeful that we just tested a little too early and/or D's pee wasn't as concentrated as it needed to be to get an accurate reading (the instructions recommended either using first morning urine or holding pee for a certain number of hours prior to testing). Since we did neither of these, we had planned to re-test this morning with the recommended first morning urine, but in her normal sleepy, zombie-like state, D peed without testing while I was in the shower. Hence, we've decided to wait until tomorrow morning. D's last period began on the night of June 22nd, which makes today the 30th day. By tomorrow, she'll officially be three days late. While we both are thinking optimistically because of her lateness, we're still skeptical given the negative reading yesterday. We're also unsure of whether inducing ovulation with the HCG shot can delay her period. So, we'll wait some more... And I'll make sure to put the toilet seat up before I go to bed tonight just in case a comatose D decides to direct her sights on the toilet without being armed with the stick.

Musak and Stirrups

I hope everyone's thinking positive thoughts for us. We had our first IUI procedure yesterday. Before the procedure, the nurse asked us to verify that the donor's number was the same as that marked on the vial. Then the doctor told us about the donor sperm's concentration (40 million per ml) and motility (65%), both of which were apparently excellent for a frozen specimen. You go Eagle Scout Drummer! During the IUI, a catheter is used to inject washed sperm directly into the uterus. D said that it hurt a little. The whole procedure took a momentous five seconds -- we exhausted ourselves worrying about this for the last three months and it's over with one five second plunger push. How anticlimactic!? Afterward, D was told to remain lying down for fifteen minutes before dressing, so we were left in the room listening to bad Musak with D's feet in stirrups. Despite the unromantic, sterile atmosphere and the Air Supply, I still managed to get weepy thinking of the possibilities while D and I held hands and waited for the nurse to return. Our next appointment, which is to test D's progesterone level, is scheduled for one week after the procedure. Pregnancy, though, can't be confirmed until one week after that -- the 21st. Since it is a thirteen day wait, maybe it's not appropriate for me to ask that you keep your fingers crossed, but do think positive thoughts.

Page One of Our Family Fairy Tale

The follicle had grown to 15mm by the time of our Saturday appointment, so we were told to give D the trigger shot on Monday evening and schedule the IUI for Wednesday. At 12:45 tomorrow, D will be inseminated.

We're a little worried that the timing isn't right, but then again worrying seems to be old hat for us these days. We bought an ovulation predictor kit Sunday evening and have tested D practically every hour since. The box is supposed to be a one-month supply but I'm certain that it won't last us longer than Wednesday morning.

Monday (pre-shot) went something like this:

1. First, we panicked when we couldn't find the medicine, which over a month ago we had carefully placed behind the eggs in the refrigerator. I frantically threw yogurt containers around in what seemed to be a frenzied dance as D said over my shoulder "Where the hell is it?! What did you do with it?! I put it right there!" (We finally realized that it had somehow fallen to the first shelf).

2. We were all set to go -- washed hands, clean work surface, sterile gauze pad, rubbing alcohol, cotton balls, pre-filled Ovidrel syringe -- check. We then read the instructions and realized we had to wait for the medicine to return to room temperature prior to administering it. Of course we then panicked about not knowing how long it takes for medicine that has been in the refrigerator to return to room temperature. And we had no idea how we would know when it was room temperature.

3. After waiting about twenty minutes, we then freaked out again over the brevity of the directions that came with the medicine and frantically searched for videos on YouTube to make sure we were properly clearing the air from the syringe and injecting it correctly. When in doubt, check YouTube. Who would think that we'd find one? http://www.youtube.com/watch?v=A55hXymEXnQ

4. I watched D stand with the needle positioned at a 90 degree angle ready to stab it into her pinched abdominal flesh for what seemed like twenty minutes while she laughed and said things like "This just isn't natural [...]. I don't think I can do this [...]. I can't do this!" I offered to do it for her, but D was apparently more scared by that idea than stabbing herself.

She finally did do it (which is good because although I offered I didn't know if I could really do it), and after reporting our injection success to the soon-to-be grandmothers, we settled in for a night of catching up on recorded TV shows.

So, Wednesday is the day that we hope our son or daughter's life begins.

Once upon a time, on a Wednesday afternoon in July...

Hoping for stained blouses...

All of that pep rally spirit you've been exuding seems to be working, but don't put those pompoms down yet! On cycle day 9, today, D had a follicle sized 13.4 mm. Follicles apparently grow about 2 mm per day. With 18 mm being the optimal size for the release of a mature egg, D's follicle should be done "cooking" on cycle day 11 or 12. At that time we will be instructed to give her the HCG trigger shot. So, if all goes well, the insemination would be scheduled for days 13 or 14 (Monday or Tuesday). We should hear more when D's bloodwork is analyzed later this afternoon. Apparently, they can tell more specifically where she is in her cycle by her estradiol (E2) levels. So, please keep cheering and twirling those batons for a few more days. Hopefully, if all goes as planned, sometime in late March of next year, I'll be going to work with spit-up on my blouse -- and I really do mean that I'm wishing for that.

UPDATE:
The bloodwork came back with 102 E2 level, which is good but indicates that the follicles are still maturing (200 E2 per mature follicle.) So, we have another appointment on Saturday (day 11) for a second ultrasound and blood test. If the follicles have grown up enough by then, the doctor will recommend that the HCG shot be administered that day. Monday then would be THE DAY!

Pep Rally for Follicles

D took the prescribed medication as instructed, but her ovary check on cycle day 10 did not show enough "action" for the nurses to get excited about. Are her ovaries supposed to be discoing, I wondered. "Action," we've since learned, refers to follicle growth. D had some follicles but they were all really small. We were asked to return for another check in a few days to see if the follicles had grown.

I chanted "GROW, GROW, GROW!" to D's ovaries over the next couple days, thinking that maybe those little follicles were just confused or unmotivated and needed a pep rally. Well, no such luck. The second check revealed six follicles on one ovary, but none of the six were more than 9 mm. Apparently 18 mm. is the optimal size for insemination.

The good news is that Dr. Jaffe was utterly unfazed by this information and told D that there is absolutely nothing to worry about. D craftily asked the same question several times just to make sure:

"So there's nothing to be concerned about?"

"No, there's nothing to worry about."

"So, we shouldn't be worrying about anything then?"

"No, we'll just monitor things this month."

"So, we're just monitoring this month?"

I wonder if all patients do this weird parroting thing.

Since I didn't attend the second appointment, I came home from work armed with a gazillion questions even though D had given me a play by play on the phone while she was at the doctor's.

"So, she said that we shouldn't worry? Did you ask her specifically if there was anything wrong?"

Can you believe that this is what we've been reduced to? We used to have intelligent conversations in which we rarely repeated ourselves and now look at us!

Anyway, it seems that D's body just didn't have the response to the medication that they would have liked, but there are other medications to try. So, no insemination this week, but we'll start the whole cycle again soon. Grow, follicles! Grow!

Doc Martin

Tuesday of this week, we had a consultation with Dr. Jaffe. Both D and I agree that Dr. Jaffe has a similar bedside manner to Doc Martin, which if you're unfamiliar with the show, means that she essentially doesn't have one. I find the fact that she doesn't sugarcoat anything oddly comforting though. I feel confident that since she hasn't driven us to tears(yet), that our prospects for pregnancy are good. Anyway, she did say that because D has a low ovarian reserve (this is based on AMA level; she has a .6 and .7 is preferred), she'd like to take an aggressive approach with us -- meaning that D will take ovulation inducing drugs and the doctor will monitor follicular growth through ultrasounds to determine the optimal time to inseminate. This was the first we heard of this low reserve, so we were pretty concerned, but Dr. Jaffe seemed unfazed. In fact, when D asked if that meant that this would be our only chance to have a child, she answered with an emphatic "No" but added that if we want a second, we shouldn't wait too long after the first. Our plan for the end of May / beginning of June will look like this:
1. D will call to schedule an ovary check on day one of her cycle.
2. The ultrasound ovary check will occur on days two or three.
3. If everything looks good, then D will be started on a five day regimen of
Letrozole (we chose this drug because it has less side effects and is less likely to produce multiples than the more popular and less expensive alternative Clomid).
4. On day eleven of her cycle, D will have another appointment for a follicle scan to see how her follicles have responded to the drug.
5. D will then be sent home with an injectable drug called Ovidrel to induce ovulation and be instructed to administer it on a particular day (based on the size of her follicles in the scan.)
6. Two days after the Ovidrel shot is administered, D will then be inseminated through an IUI procedure (this is where the concentrated or "washed" sperm is injected directly into the uterus.)
7. A week after the IUI, D will go in for a Progesterone check.
8. One week later, we'll either be excitedly buying pregnancy tests or waiting around for the next time we can try again.

It actually felt really good to finally order some of our donor specimens to be shipped from California Cryo to CRM -- it felt like the beginning of something. What's weird is I have almost begun to feel like my contact over there at California Cryo, Shawn, is an old friend since I've spoken with him so often about paperwork, medical authorization, etc. So when Shawn wished us "Good luck being Mommies!" before he hung up with me this last time, I couldn't help but smile.

D and I have been tossing around baby names for weeks now -- actually we've made about a zillion solid name decisions that we thought (at the time) were definites and (as would be expected) consequently reversed those decisions -- we already went through Sophie, Sophia, Isabel, Isabella, Jaden, Sebastien, and Skylar. Right now, we like Gracie and Hannah for a girl and Dylan and Jaxson for a boy. I'm partial to Gracie because my grandmother's first name began with a G, but I have a feeling we'll go through a few million more than this before delivery day.

I'm about halfway through She Looks Just Like You: A Memoir of (Nonbiological Lesbian) Motherhood by Amie Klempnauer Miller. It's not the greatest writing I've every seen, but it's certainly heartfelt (I teared up a few times and was thankful that I had my sunglasses on.) There are so few books about our experience! Perhaps if this all goes as planned, I'll write one. : )