Am I still infertile? Was I ever?

Has this week passed slowly or what?  I am anxiously waiting Monday’s u/s.  I truly believe there is more than one in there because my body is responding much quicker to this pg than it has to my last pg.  (But maybe that is how it is for second pregnancies?)  I feel my uterus already, it is painful to lie on my stomach or have Iz lie on my stomach.  I am having problems sleeping because it is uncomfie.  Please let it be a single!!!

Iz was jumping on me last week and I told her to stop, that I have a baby in my tummy and she might hurt it.  “A baby in your tummy? Can I see it?” she asked pullig up my shirt.  I thought she would forget it in the way of her normal 3 year old self, but she has brought it up several times when we are playing around and tickling in the evenings.  Last night I told her that she would be a big sister and she said “Thank you mommy, thank you, thank you” and gave me a big hug.  Isn’t that the sweetest?

Another question that I have been pondering is if I am still (or ever really was) infertile.  I was briefly posting on an infertility board (the IUI section) and enjoying reading about everyone’s struggles.  It was great to feel like I was part of the community and there were other people going through the same testing/procedures as I was.  But now that I got a BFP, and only after 1 month of IUI, I don’t feel like I can post there anymore.  I still feel like I am not a “real” infertile, but a subfertile or a slow fertile which is irritating since I dont’ fit in anywhere.  When I get pg on the first IUI, it isn’t the same sense of accomplishment or celebration as someone who went through 6 IUI or 16 or was TTC for 5 years.  However, I dont’ fit in with the people who can get pregnant easily and on their own either.

<>I will update Monday as soon as I know anything!

Back with numbers

We got back from FL yesterday after a very short trip to visit Mike’s family. It was a nice visit, they kept us busy and would barely let us out of their site. We stayed at a hotel this time because there house is small and I sometimes need a little privacy and separation from the over-loud TV. We told them another reason we were staying at the hotel was to let Iz play in the pool, she loves the pool. So they went out and bought a big inflatable pool which Iz loved and kept us at their house quite late (we couldn’t let her into the pool until after 6:30, it was too friggen hot.)

The day we left I had a blood test to check the hcg levels and they were 3424, almost exactly average for Day 23 of a singlton pregnancy. (Check out this data base.) I had my second test today which will hopefully show the proper increase. Our first u/s is next Monday (8/20) to make sure there is just one in there. After the u/s, if all goes well, I think we will finally feel this is going to happen and can start telling people and making plans.
Someone asked in comments if I still disliked my RE after getting a positive HPT. The answer is a resounding YES. The man had little to do with my care or treatment and has not seen me once since our initial “get to know you” chat in his office. If he has had any input into our case, his comments have come through the nurses which makes it very difficult to ask questions in response. So I don’t like him and wouldn’t recommend him (though my feeligns toward his nurses are quite affectionate.) My opinion on the subject is moot, though, since he is the only RE in a 100 mile radius and if we ever need infertility treatment again, we would probably use him unless someone else moves to town.

I will update later with the new hcg level.

UPDATE: 20228 with a seperation of 5 days. That gives a doubling rate of 1.95 days, pretty perfect, but now we are at the median value for multiple pregnancies at 28 days. Hmmm, can’t wait for the u/s!

WOOHOOO!!!

Sorry if I kept anyone anxiously waiting, the results are in and I am, for the moment, pregnant!  We are sooo happy, and so very lucky, I was sure we wouldn’t get a positive result with our first IUI.
The reason I haven’t written is because I have been on travel for 2 weeks.  We leave again tomorrow to visit Mike’s family, then when we return, school stuff with start for me.

Because I have been out of town, we haven’t had a blood test done or anything.  I go in tomorrow for the first beta, then I will go back after we get back from FL.  The first u/s will be the week following (the week of August 20).  Until we see a single heartbeat, we won’t be resting easy.  Until then, I am counting our many blessing.

More on my funny trip and stressful test taking when I get back from FL.  Thanks for the emails/comments!

the dreams have begun

Last night I had my first pregnancy dream.  I dreamt I was seeking treatment for cancer and that I was being closely monitored.  I had just finished my first round of treatment and beginning my second which included lots of needles everywhere (think acupuncture) and a little buzzer went off on an alarm around my wrist.  It said “5 days pregnant” and had a little picture of a many celled embryo (is that what they are called that early?).  I asked my doctor to stop to the treatment but she said I had to have treatment or I would die and she continued.

<>Maybe that is more of a nightmare?

I had tons of dreams like this for TTC #1, but have been spared while TTC #2, oddly enough.

<>I continue to have pregnancy symptoms.  I thought this was from the trigger shot, but it seems to have left my system (BFN on HPT yesterday).  One more week.

I realized last night that I probably won’t be able to do IUI next cycle after all since I am taking two trips, one to DC and one to FL.  If the timing were perfect, we could still do it, but otherwise we will just have to skip this month.

cruel reality

The cruel reality of these drugs I took to make lots of follicles and trigger ovulation is that I feel SO pregnant.  Oh, it kills me!  I am sleepy and sick to my stomach and I feel bloated and heavy.  I feel more pg than I felt when  I was pg.  I am obsessed and can’t stop reading the medical journals and blogs and googling all the different permutations of iui and statistics and success etc.  Each hour is passing oh so slow and it has only been 48 hours since the procedure.  Everything I got is crossed that this one took.

I need to find something else to do with my time.

IUI statistics explained

Mike pointed out I had made some (embarassing) mistakes in my post on statistics. I went back and fixed the numbers below. After a 36 minute walk tonight, we arrived at this method to getting the “right” numbers. Apply with caution.

Assume your chance of getting pregnant with one follicle from IUI was p%. (This is the biggest unknown of the whole process, I don’t know what it is for me or anyone else. It is probably something between 0 (if you have completely blocked tubes or no sperm) or 20 which is the normal fertile person’s statistic.) Your chance of not gettign pregnant from one follicle would be (1-p)%. If you have n number of follicles, to calculate your probability of getting pregnant, complete the following (use the decimal numbers, i.e. 10% = .1):

Prob of not getting pregnant = (1-p)^n

Prob of getting pregnant with anything = 1-(1-p)^n

Prob of getting pregnant with a singleton = (p*(1-p)^(n-1))*n

Prob of getting pregnant with twins = (p^2*(1-p)^(n-2))*n!/[(2!)(n-2)!]

Prob of getting pregnant with trips = (p^3*(1-p)^(n-3))*n!/[(3!)(n-3)!]

Prob of getting pregnant with quads = (p^4*(1-p)^(n-4))*n!/[(4!)(n-4)!)

Prob of getting pregnant with "m" babies (for m<=n) = (p^m*(1-p)^(n-m))*n!/[m!(n-m)!]

If p=.05 (5%) and n=6 (my guess for my rate and the number of follicles I currently have):

Prob of not getting pregnant = 73.5%

Prob of getting pregnant with anything = 26.5%

Prob of getting pregnant with a single = 23.2%

Prob of getting pregnant with twins = 3.1%

Prob of getting pregnant with trips = 0.2%

I think these are the statistics my RE gave me when I asked for the probabilities of getting pregnant with twins and trips. He said “If pregnant, you have a 10% probably of twins (~3.1/26.5) and a 1% probability of getting pregnant with trips (~.2/26.5)” so I deduce he thinks I have a 5% chance of getting pregnant with a single follicle.

I promise not to bring this up again (until the next cycle…)

there is a sperm party going on in my uterus

I had the IUI this morning.  Everything went fine.  I chugged a bunch of water beforehand (required) so my bladder was painfully full when they did the procedure.  When I first went it, I asked them to not waste any time because it was hurting.   The inserted the catheter, then the sperm.  It was quick and painless and after lieing there a few minutes I hurried to get dressed and relieve myself.

After an extreme search of medical literature today (using google scholar), i think our pregnancy chances are just at or below 20%.  Why it doesn’t work like normal statistics, I don’t know, the whole thing is very non-linear.  I finally found the paper I was looking for that had a bunch of studies and broke things down in relation to follicle number, total motile sperm, and fertility diagnosis (though they didn’t include primary/secondary).  It had for our follicle number the maximum likelihood of getting pregnant, about 18%.  I like this number.  To me it is optomistic, but still limits the number of high order multiples.

I was wrong about something else too, our doctor didn’t do our IUI, his nurses did it.  In fact, I am beginning to suspect that the person I met wasn’t a doctor at all, but an actor.  What am I paying this guy for?  Let’s hope I get pg and quick so I can write an angry little letter to him letting him know I don’t like beign treated like an ATM.

awash in statistics

Since we received the news that i had 6 follicles last week, Mike and I have been trying to calculate the chances of us getting pregnant and the chances for high order multiples to decide if we were going to go through with the IUI. I asked the doctor the day we went in for our first consultation what would happen if I made too many follicles and he said we would cancel the cycle and he would advise us to “use protection” which I thought would be funny if the first month we seek fertility treatment we have to use condoms. He made the point that this is why they do all the monitoring, though (not for all the money!) so that they could determine if there was a high chance for high order multiples and cancel the treatment. I never asked him, though, how many was too many. Since we were aiming for 2 or 3 follicles, I thought 6 sounded like a lot but when the nurse called us with instructions and to schedule the IUI, she said that if we get pregnant, we have a 10 percent chance of twins and a 1 percent chance of triplets. She didn’t mention the normal pg rate (I didn’t ask) but the numbers we have heard many times is 15-20 percent. So having a 20% chance of getting pregnant and a 10% chance, on top of that, of having twins, is really only a 2% chance of twins which sounds startlingly low. The nurse didn’t have her calculator handy, though, and I didn’t ask her the hard math questions I would have asked the doctor if he had called (ha ha). After this conversation, we had a couple of hours to decide whether to go through with the procedure or cancel so Mike and I set out to ask Dr. Google and calculate the statistics ourselves (hey, my physics phd has to count for something, right?).

Let me first say how appalled I was not to be able to find better statistics in the literature. I am not an expert on statistics or anything, but I when I have to publish some statistics with my work, I usually have 3,000-30,000 sample size. I saw papers published on IUI with only 100 – 300 couples with no really big studies. With such small sample sizes, it is difficult to separate out the different populations. For instance, they would quote pregnancy statistics for IUI with 1 follicle (around 8%) and for people with “2 or more” (around 17%). Ideally you would like them to divide those subsets by specific number of follicles and into groups with different diagnosis (poor sperm quality, ovarian function, undiagnosed, etc.) and people experiencing primary or secondary infertility. Obviously if you only have 100 couples in your study, you can’t subdivide it up in too many categories or each couple would be in a category by themselves.

Second, let’s take a moment to apply basic statistics principles. If our personal likelihood of getting pregnant from a single follicle was 10% (a typical rate I hear bantered around alot) our probability of NOT getting pregnant from each egg would be 90%. Then with 6 follicles we would have :

53 % chance of NOT getting pregnant (.9*.9*.9*.9*.9*.9) which leaves a

47% chance of getting pregnant in some way.

<>To get pregnant with a singleton, we would have a

<>35 % chance (.1 * .9 * .9 * .9* .9* .9) * 6 – the number of combinations

<>10% chance of getting twins (.1*.1*.9*.9*.9*.9)*15

1.4% chance of having triplets (.1*.1*.1*.9*.9*.9) * 20 – a little high, but a risk we are willing to take

.1% chance of having quads (.1 * .1*.1*.1*.9*.9)*15

0.005% chance of having quints

0.0001% chance of have six

Note this is a 35% chance total, to get the percentage of pregnancies that would result in a singleton, you would have to divide 35/47 =  74%.  So if your doc says something like “If pregnant, you have a 90% chance of having a singleton” this is the number he islooking for.  This means we would have a 10/47  = 21% chance of  twins and a 3% chance of having trips.  These are higher than my doctor quoted me, but he could have been using a smaller overall percentage. If so, he has not shared that percentage with us.

The problem is that we have no way of knowing what our chance of getting pregnant is with this procedure since 1) we have no diagnosis, though I hope we can rule some things out and 2) even if we did have a diagnosis, we wouldn’t have the statistics from the literature. From my understanding, the different problems we could have are a) poor ovary function and/or egg quality, b) clogged or damaged tubes, c) inhospitable uterus, d) poor cervical mucus/anatomy, or e) poor sperm quality (this is not a complete list in general, but I have no other known problems, so I think this represents a complete list for us). I think I have proved my ovaries work ok, though I don’t know anything about egg quality. My tubes weren’t blocked during the HCG test, but they did appear swollen. My uterus was ok for Iz and the lining appears ok. I don’t know anything about the mucus/anatomy. Mike is ok. So I think for us, the most likely diagnosis could be partial tube damage (there is no way of knowing for sure without surgery), poor egg quality or poor mucus/anatomy.

If the problem is with the tubes or the eggs, IUI isn’t really going to help things and our chances of getting pregnant (and having multiples) is going to be significantly lower than the numbers above. If the problem is with mucus/anatomy, the IUI might raise our chances dramatically. Let’s say it raises our personal chances to 20%, then we have

74 % chance of getting pregnant with anything (1-.8^6)

<>39 % chance of having a single

<>25% chance of twins

<>8 % chance of triplets

Now the numbers are in the scary, must cancel range. But since we have no idea of our personal chances, we can’t make any informed decisions. Instead, we are accepting the general “10%” rule and have decided that with those numbers, we are willing to through with the procedure. My part is scheduled for 10:45 in the morning, Mike has to make his deposit earlier in the day.

Can I just say again how much I detest my RE (and I don’t even really know him since I have only interacted with him on one consultation visit.) How did he get a 2% twin chance? Is that just a number he pulled out of his butt (probably) that applies in general, to all of ART, but not at all my specific case? Or does he have a number he is applying to us as a likelihood of pregnancy, like 10%? I don’t see where he got his numbers from, but a 2% twin pregnancy chance is much lower than my poor calculations returned. I ASSume he will be doing the IUI tomorrow so I will get the pleasure of his company in my vagina, but I hope to sit with him and have a little talk after that is over, insuring him that I too can multiply numbers together. I also want to know what he had to say on the HCG films.

Two more comments, then I am off to bed. First, it fillls me with a perverse pride that I made 6 follicles. Hey, at least I can do something right. Second, Mike gave me the trigger shot last night (a little owie) and I have felt pregnant all day. What is in that stuff?

ps I am 34 today.

What happened to 2?

Every time I read about a set of sextuplets being born, I think about what transpired when these people got pregnant.  My understanding is that most of these people get pregnant while taking fertility drugs and/or doing IUIs.  How many follicles is too many follicles did these people have to get pg with 6?  What were their doctors thinkign when they did an IUI with so many follicles?  At the same time, most of the time people who take clomid do it with no monitering so they have no idea if they made 2 follicles or 20.

<>I asked lots of questions about numbers of follicles when we started down the IUI journey.  How many should we expect? 2 or 3  What happens if we don’t get more than 1?  We try a different pill.  What happens if we get more than 2 or 3?  We cross that bridge when we come to it.

<>My scan revealed today that I made 6 mature follicles.  Now obviously, 6 mature follicles does not 6 babies make.  We have gone through 15 mature follicles with no baby yet in sight this go round.  But 6!!!  The idea seems so real to me now that we could potentially have multiples.  Twins would be ok, taxing but ok.  More than twins would not be ok.

So what do we do now?  Continue with the IUI, dial things back to regulary old timed intercourse or  use protection and wait for next month?  I don’t know.  The doc will “review our case and diagnosis” and get back to us with our statistics.  All this gd statistics.   My feeling is that he will argue to go ahead with the IUI, that 6 mature follicles don’t equal 6 babies.  I have no idea what we will ultimately decide.

infertile thoughts

One of my favorite bloggers currently writes an infertility blog for a magazine.  This blogger is amazing, funny, interesting and, BTW, infertile, though her infertility takes a different turn than many, she gets pg easily, but cannot carry to term for various reasons.  As soon as she started writing this magazing blog, she got pg with twins and is currently hoping to stay that way.  The magazing blog has a second blogger that wasn’t around for many months and just posted for the first time a couple of days ago.  This second blogger has been… on maternity leave after just having twins via IVF.  There has been, well, an uproar.  Here we have 2 women, one a very recent mother and another pg with twins writing an infertility blog.  Where is the woman currently slogging through multiple negative pregnancy tests, crying on her toilet every 2ww?  Where is the woman trying to decide between REs and IUIs and IVFs, sorting through statistics and contemplating adoption?

Not on the magazine’s blog, that is for sure. I just don’t think I can read about infertility from women who are not currently trying to get or stay pg.  If you aren’t trying to have kids, you aren’t infertile, you are just lucky.  Maybe this is too narrow a view, maybe infertiles feel infertile after they have kids or don’t have kids or move on, maybe it is something that stays with you.  I dont’ feel that way though.  It took us a long time to have Iz and after I had her, I never questioned it.  It is taking us a long time to get pg again, but if we do, I hope I will forget the sorrow and pain I am feelign now, like I did with Iz.

<>I have an u/s on Friday AM with a possible IUI next Monday.  I will let you know how it goes.