Thursday, August 29, 2013

The 411 on POAS

Yes, that's right, we're going to talk about pee sticks!!  In case you don't speak TTC, POAS stands for "pee on a stick".  And if you've ever tried to get pregnant, you know there are a lot of choices out there.  And even once you've chosen a test, WHEN should you use it?  And how do you use them properly?

Firstly, there are three main types of pregnancy tests:
  • Cartridge test--Any test which yields two lines or a plus symbol and is houses in a plastic case (cartridge) with a window where the result is viewed.  Available in pink dye and blue dye. Sensitivity ranges from 10 mIU and up.
  • Test strip--similar to a cartridge test, but without the case and only available in the two lined result. Sensitivity ranges from 20 mIU and up.
  • Digital test--a cartridge test with a digital readout of either "Yes/No" or "Pregnant/Not Pregnant". Sensitivity starts at 50 mIU.
There are pros and cons to each kind of test.  For example, digital tests take any guess work about "is there a faint line?" away.  However, they are less sensitive than some non-digital tests, meaning that the level of HCG in the body must be higher.  This means that you'll need to be further along to get a positive result.  Test strips are much less expensive than cartridge tests, but in my experience they aren't as sensitive and can produce evaporation lines more often than other tests.   An evaporation line is a faint ghost line on a pregnancy test not caused by hcg in the urine.  These lines usually develop outside the time limit for reading the results and often have no true color.  So what about pink or blue dye?  Well, it's pretty widely accepted in the TTC world that pink dye is much more reliable in terms of results than blue dye.  Thin second lines are often observed on blue dye tests in non-pregnant women.  I've been fooled by a blue dye before!  Unless the line is quite dark and/or thick, I'd question it on a blue dye!

So when should you use a pregnancy test?  Well, assuming you have a good idea of when you ovulated, implantation is likely to occur 6-12 days after ovulation (on average).  HCG needs a few days to rise to a level that can be detected on a home pregnancy test.  The sooner you test, the higher the likelihood of a false negative result.  We know that it's very hard to wait for the answer!!  We recommend not testing earlier than about 9 DPO, and to try to keep in mind that a negative result before your missed period might not mean that you aren't pregnant.  With both my second (miscarriage/chemical pregnancy) and third round of BFP pregnancy tests, I didn't get a positive result until 14 or 15 DPO, and believe me, I was testing early!

Most pregnancy test directions will also recommend that you take the test with first morning urine.  This is because it is thought that it will contain the highest concentration of HCG.  I definitely agree with this, however, some women find that this isn't true for them.  Some women have more accurate results when testing in the evening.  Try both methods and see what works for you.

So we're down to how to use a pregnancy test properly.  The most important thing is the read the directions very carefully. Remove the test from it's wrapper and remove cap if applicable. Hold the "wick" end of the test in the stream of urine for the time listed in the instructions (this varies by brand and sensitivity) or collect a sample in a clean cup and dip the test (again, check directions, this time may differ depending on your method of testing).  Place the test face up on a flat surface and WALK AWAY SLOWLY!!!

Wait the amount of time indicated in the directions and take a peek.  And remember NOT to trust any result that shows up AFTER the amount of time listed on the directions (usually about 10 minutes).  Lines may show up after the time limit, even in non-pregnant women.

So that's the skinny on pregnancy tests!  We take them, some of us even take photos of them and scrutinize them using photo editing software!  We toss them in the trash and pull them out hours later to look at them again (why do we do this??).  We curse them, threaten to take a red sharpie to show them JUST what that second line should look like, we hoard them, and we take far to many of them in a 24 hour period.  What else do you want to know about pregnancy tests???

Tuesday, August 27, 2013

Welcome new contributor, Teresa!!!

We are growing fast! I'm thrilled have Teresa join us! I've been a reader of her personal blog for quite some time and I really admire her. She's going to be an awesome addition to this blog! Look for her bio and introduction post soon!

Unexplained Infertility

Labels.  They are everywhere.  As much as we try not to, we are always using them.  During my struggle with infertility, I "gained" this label.

Unexplained infertility, meaning that if there was a reason I wasn't getting pregnant, they couldn't identify it.  This is a label you get if all the tests that are run produce normal results.  My husband's sperm analysis was normal, as were my blood tests for insulin resistance and my baseline ultrasound. My estrogen, prolactin, FSH (follicle stimulating hormone), and TSH (thyroid stimulating hormone) levels were all fine.  It appeared that I ovulated on my own, based on my progesterone levels late in my cycle.  And yet, I wasn't getting pregnant.

I found that not having a reason, not having something to blame, was frustrating.  If you don't know what you're up against, it can be difficult to fight it.  At first, my RE (reproductive endocrinologist) thought that a round or two of Clomid would do the trick.  It would give my body a little boost, maybe help timing a bit.  When that didn't work, he suggested an HSG test. (Click here for a definition)  The test showed no major abnormalities, although my left fallopian tube did not fill with dye.  My RE was sure that this was because I have experiencing some pretty substantial cramping during the test (look for a post describing my HSG experience soon).  I trusted him, and we carried on, bolstered by the knowledge that many woman have a higher chance of conceiving shortly after the test is done, usually because small blockages and debris could be flushed out by the test.  Around this same time, I told one of my nurses that I was having spotting leading up to my period, around 11 or 12 days after ovulation. Dr. B decided to having me take progesterone supplements during my leutal phase.  Progesterone is a hormone produced by the body, the level of which rises after ovulation.  If a woman becomes pregnant, the corpus leuteum cyst, which is left behind after the follicle releases the egg, is maintained by the HCG (the pregnancy hormone) in the blood, so it continues to release progesterone.  If the body doesn't start producing HCG, the progesterone level falls and the lining of the uterus is shed.

Dr. B theorized that perhaps I was a late implanter, meaning for one reason or another, an egg takes a little longer to travel to the uterus to implant.  If it took longer than 11 or 12 days, it was possible that my uterine lining was already beginning to shed before a fertilized egg could implant there.  By having me take supplements, my progesterone level stayed up, and I didn't start my period.  If I tested negative for pregnancy, I was to stop taking the progesterone supplements and my period would start 2 or 3 days later.

Two months later, we switched to Femara.  I responded well, ovulating earlier than even on Clomid.  My normal ovulation was sometime between day 18 and day 22.  This isn't necessarily indicative of a problem.  Most woman ovulate anywhere between CD 11 and 21.  Fertility drugs made me ovulate sooner in my cycle.  Later ovulation can sometimes point to poor egg quality, but not always.

After our first round of Femara, when I found out I wasn't pregnant, I went in for my usual ultrasound. While I was there, I expressed my frustration to one of the nurses.  She was very nice and suggested we do a more monitored cycle and try a trigger shot, which would better time the moment of ovulation and make it stronger.

That month, we conceived.  Did lengthening my leutal phase help me get pregnant?  Did ovulating sooner in my cycle help me conceive? Was it just chance? We can't be sure.  Since we didn't know what, if anything, was behind me inability to get pregnant, we will probably never know, unless a problem arises.  It's possible we could go on and have more children easily.  But we could also experience the same problems.

The point to this post is this:  Fertility issues like PCOS, endometriosis, and low ovarian reserve are fairly well known and if the correct tests are done or if symptoms are noted, the are usually quickly identified and treated.  Less obvious issues (whether there is a known medical reason or not) can also lead to years of infertility.  Maybe a lot of woman labelled with unexplained infertility have a medical issue that just can't be identified yet.  Science has come a long way, but we are constantly hearing of new developments, tests, and treatments, perhaps someday there won't be so many people with this label.  I certainly hope so.  And I applaud doctors, like my own, that try to treat the problem, even if they can't really identify it.  I don't think I'd have my second son if not for them.

Welcome new contributor, Amy!!!

I am thrilled to announce that my dear friend Amy has enthusiastically agreed to join our team as a contributor on Ask An Infertile!  I'm esctatic that she is joining us....Well, me!  Now we're an us!  Anyway, check out her bio on the contributors bio tab and look for her introductory post soon!  I'll let her fill you in on the details, but I know she has a quite a story to share and I know many people will be able to relate to her.  She's an amazing woman and get ready everyone, because she is one of the funniest people I have ever had the pleasure of knowing!

Welcome Amy!!!

Secondary Infertility

In addition to my label of unexplained infertility, I had the bonus label of secondary infertility.  This means I had already had the successful pregnancy and delivery of a living child, but was now experiencing a loss in fertility.  When I first began to explore the online community of infertility, I wondered if I'd be accepted.  After all, not only were they unable to find a reason why I wasn't getting pregnant, I already had a child.

My first was conceived 8 months after I stopped taking birth control pills.  Studies show that around 85% of couples will conceive within the first 12 months of trying (source BabyCentre).  Age, overall health, weight, and many other factors contribute to a person's chances of getting pregnant, infertility issues aside.  Since we'd become pregnant with our first son well within that "average" time, I wanted to believe that we'd get pregnant easily the second time.  Maybe even sooner, since I wasn't on any hormonal birth control when we started trying.

However, I had approached it with my husband that we should start trying sooner, rather than later. It's funny, I'd forgotten about that when I wrote my introductory post.  Looking back, I remember now that something in the back of my head doubted that it would be so easy.  Perhaps it was the pessimist in me. Perhaps it was women's intuition.  I don't know, but looking back, I'm glad we didn't wait.

So as I started reading blogs of women suffering from infertility, posting on a TTC site where many of the women had some form of infertility, and blogging about my own struggles, I wondered if I would be looked at differently.  I wondered if having a child meant that I wasn't a true "infertile".  Isn't that strange?  Being an infertile wasn't something I "wanted", but I guess it was more of needing that acceptance, of knowing that my struggled mattered, even though I was lucky enough to have a child already.

I certainly don't compare my experience with infertility to others.  It's not a competition.  To me, if you want to have a child (assuming of course that it's for the right reasons and you have means to support them etc etc) you should be able to have one.  Certainly, I think that the childless woman struggling with infertility has a very different perspective and has experienced a very different pain that I have.  The woman with multiple losses, the woman devastated by a stillbirth, the woman who has tried for years with NO pregnancy at all, they have certainly suffered more than I.  When I received the heartbreaking news that I had lost my pregnancy in the summer of 2011, the first thing I wanted to do was hug my son.  I was thankful that he was there with me, it was such a comfort for me to be able to look at him and feel his little arms around my neck.  I recognize that not all woman experiencing a loss have that luxury.  And not all losses happen early, like mine did.  There is certainly a whole range of pain and severity when it comes to infertility. I just wanted to know that my frustration and my pain mattered.  I just wanted to know that I would be accepted.

Accepted to a club that none of us want to be a member of.

I was, I AM accepted.  We all are.  There are no rules, no standards.  You don't have to meet any criteria.  No children--multiple children--medical infertility--unexplained infertility--no losses--multiple losses.  We all belong.

Friday, August 23, 2013

Welcome to Ask An Infertile!

Welcome to Ask An Infertile!  I'm Melissa, and I created this blog because in my opinion there can never be enough resources and outlets on the subject of infertility, TTC, and pregnancy loss.  I am hoping that this blog will because a place to get information about all forms of infertility.  So many woman have questions, and what do we do in the 21st Century when we have questions?  We Google it, of course!  I know I do.  So again, why this blog?  Well, to answer that, I think I'd better start off by telling you a little more about me.

Today, I'm a 31 year old working mom to two incredible little boys, living in Indiana with my wonderful husband of 9 years and the worlds greatest grandma, my mom.  In 2010, when my first son, Tyler, was 18 months old, my husband and I decided we were going to try for our second child, since we wanted our children to be fairly close in age.  When we had started TTC Tyler, we became pregnant about 8 months after I stopped taking birth control pills, so while I didn't expect us to succeed immediately, I didn't think it would take a terribly long time.  Six months or so, that was my guess, factoring in that fact that I hadn't been using any hormonal birth control since we'd had Tyler.

At the suggestion of my doctor, I started tracking my cycles carefully.  I kept notes on my calendar and purchased a fancy little app on my smartphone.  At that time, my cycles were a little irregular, though not alarmingly so.  Sometimes it was 28 days long, but it could go as long as 37 days.  One thing that became clear pretty quickly was that I wasn't sure when I ovulated.  Over the next few months I tried various methods of predicting ovulation.  I charted my BBT (basal body temperature).  I checked my cervical position (I was terrible at that).  I monitored my cervical mucus (ew).  I eventually turned to using OPKs (ovulation predictor kits).  For awhile, even these stumped me!  The first brand I tried would turn positive and then stay that way for 5 or 6 days! 

When I had been trying for about 7 months, I turned to the internet for advice and support.  I found an online forum and I was suddenly thrust into the world of infertility and TTC on the internet.  I was amazed that not only did others feel like I did, but A LOT of others did!  I started making some incredible friends and following their stories.  Suddenly TMI didn't exist!  We talked about our bodily fluids, we talked about BDing with our SOs and DHs (that's baby dancing with our significant others and darling husbands).  We took pictures of our peesticks and scrutinized them together, fiddling around in photo editors to try to see if that might be a line?  We shared the disappointment of another BFN (big fat negative), gave each other advice, and on good days, shared in the excitement of a friends BFP (big fat positive).  We offered sympathy and encouragement.  Suddenly I wasn't alone in this strong desire to have a child.  And that felt nice.

As nice as it was to have support, I was still getting frustrated.  In April 2011, I visited my primary care "doctor", A, who is actually a Physician's Assistant.  I'd been seeing her for many years and just absolutely ADORED her.  She was her usual awesome self, listening to my frustration, letting me let those few tears fall.  She even shared with me a little of her own struggle for children.  She sent me on my way, asking me to try one more month of charting my BBT (I'd given up on it a few months prior), and telling me to come back for a referral to a specialist if I wasn't pregnant in May.

Just my luck, during that crucial week in May I was sick as a dog with a fever.  Dutiful little patient that I was, I trudged into June, knowing I needed real data to bring back with me.  On June 17th, I posted a picture of my negative pregnancy test, saying I just wanted to get my period over with and go back to see my doctor.  Then a member of the forum said she thought she could see a faint line.  Then another agreed.  And another.

I should interrupt myself here with a note--I have TERRIBLE eyesight.  I've worn glasses since I was a toddler.

Anyway, I hadn't seen anything on the test, but that really didn't mean much.  A few girls edited my photo and yes, maybe that was the start of a line?  Only time would tell.

The next morning, I dutifully POAS (peed on a stick).  And there was a faint, but visible second pink line.  It was the day before Father's Day, May 18th, 2011.  It had taken just over a year, but I was pregnant!

But then, so soon after that exciting moment, I wasn't anymore.  I spotted a little bit on Sunday, but my HPT was darker, which comforted me.  Then I spotted a little more on Monday.  On Tuesday, four days after my first true positive HPT, I took another test and the second line was barely detectable.  I went to the doctor and had a blood test, then went home, put my feet up, and fought from assuming the worst.

Unfortunately, the next morning my worst fear was realized.  My hcg level was already down to the point where they considered the result to be negative.  The nurse actually told me I'd never been pregnant at all.  I was completely devastated.  I sat down and cried.  I drove to work, crying.  I worked, alternating between tearing up every time anyone said hi to me, to trying my damnedest to think of ANYTHING else.  I ended up telling more people that I'd miscarried than had known I was pregnant in the first place.  I felt totally cheated.  And more than that, I felt an incredible amount of depression at the though that I'd gotten so close and now I had to start over.

Logically, I knew that this pregnancy had ended so early, there wasn't truly much more than a fertilized egg, some divided cells.  But in my heart, that was the potential baby I wanted so much.  That was another Tyler.  Maybe a brother.  Maybe a girl this time, a little sister.  But that was ripped away, almost before I could even celebrate it.

I mourned my loss.   I went back to see A, even armed with pictures of my positive tests.  She assured me that, of course I was actually pregnant, but that the egg probably implanted later than usual and so my HCG level never got terribly high before it began to drop.  She said that these kind of miscarriages are called "chemical pregnancies" and they are actually pretty common.  An egg with chromosomal problems, or one that doesn't implant correctly will simply be expelled by the body, which senses that something isn't right.  She said that often women don't even know they were pregnant with these.  But she also recognized that to me, to any woman trying to have a baby, it was a loss, and it was okay, natural even, to be sad about it.

She gave me a referral to a specialist, a reproductive endocrinologist (RE).  As a matter of fact, the same RE that had helped her get pregnant with her little girl.  I called him and made an appointment for the next month.

The cycle after my miscarriage was painfully slow and, well, painful.  I had heavy bleeding and terribly cramps, but it only last about 6-7 days.  I was still using OPKs and instead of a positive result somewhere between CD 18 and CD 22, it was CD 28 before I got a positive result.  I had heard that a miscarriage, even an early one, can mess up a woman's cycle.  Yay.

On July 20th, my husband and I went to see my RE, Dr. B.  I liked him immediately.  He was very understanding and listened carefully, asking thoughtful questions.  He said based on my history, I probably just needed a little "boost" to get pregnant again.   And I learned that since I had one child, I was experiencing what is called "Secondary Infertility" meaning I hadn't had trouble conceiving my first child.  I would later learn that my infertility is also considered "Unexplained Infertility" since a cause for me not conceiving easily was never discovered exactly, although there were a few minor things that I think contributed to it (shorter than average leutal phase, indications of late implantation, low progesterone).  He also told me that although there would be times that I would be disappointed, to try not to be discouraged, because together we'd get through it.

First order of business when seeing an RE is a whole mess of tests.  My husband submitted to a sperm analysis, which came back fine.  I had a glucose tolerance test, and ultrasound, and several blood tests.  Everything came back normal, so Dr. B prescribed me a pill called Clomid.  Clomid is a fertility drug that can cause ovulation in someone who isn't ovulating regularly or can encourage a healthier ovulation in someone like me, who is ovulating, but not at the best time of the cycle (Later ovulation can cause the quality of the egg to be lower). During that time, I was also put on progesterone supplements during my leutal phase, since it was on the shorter side and my RE thought I might be getting my period before an egg had the chance to implant. I eventually did four cycles on Clomid.  While I ovulated on day 15 or 16 each month, we did not get pregnant.  Eventually, I had a test called a Hysterosalpingogram or an HSG.  This is an X-ray test where dye is injected into the uterus so that they can see if there are any abnormalities in the uterus or fallopian tubes.  My result was normal, aside from my left fallopian tube not filling.  My RE attributed that to the cramping I experienced during the test. 

During our final cycle of Clomid, we met with Dr. B again to discuss our options.  We could try another pill, called Femara (Letrizole), which is similar to Clomid, but some people respond better to.  Or we could switch to injection hormones, which are more effective, but carry a higher chance of multiples and, usually, a higher price tag.  After checking with my insurance (which covers some fertility treatments and test, but not all), we decided we would start with Femara and save up money to try injections in a few months.

Month one of Femara passed with Christmas 2011 and a BFN.  In January, we decided to do a more monitored cycle.  Basically that meant that I would return to Dr. B's office for a second ultrasound (I had one every month around CD 3 to check for cysts and things) a few days before I expected to ovulate.  At this appointment, they would check the lining of my uterus to make sure it looked thick and healthy, but not too thick and they would check my ovaries for follicles.  They would also have me inject a medication to trigger a stronger ovulation, called an HCG trigger shot.  This basically mimics the surge of LH (ovulation hormone) in the body, causing all mature follicles to release their eggs.  On CD 13 my ultrasound showed good lining and two follicles that showed promise.  The next evening, I injected $85 worth of medication into my muffin top (LOL) and hoped for the best.  Oh, and a fun side effect of this shot?  Since it contains the pregnancy hormone, you get a positive result on an HPT!  I just had to try that out!  I watched the lines fade, but I wasn't sure they had totally vanished.  Finally, with doctor's orders to test 14 days after my injection, I was excited and terrified to see two pink lines!  I rushed to the doctor for a blood test and was told that my HCG was 12.7.  And I was told that was "probably pregnant".  Luckily, I was able to return with confidence two days later for another test, encouraged by darkening lines on HPTs.

So that's my story.  It took 19 months, an early miscarriage, four rounds of clomid, an HCG two rounds of femara, a trigger shot, many progesterone pills, countless ultrasounds and a lot of home pregnancy tests on OPKs, but I was pregnant.  I was truly blessed to give birth to my second son, AJ, in October 2012.

So.  Yes that was a pretty long story.  Anyway, if you're still with me (please stay with me!), that brings us back to the present.  My sons are 4 1/2 and 10 months, but I still reflect on my journey and how it changed me.  I was "lucky", really.  I've read so many blogs, heard so many stories that was much more arduous than my own.  So many people are still struggling, have experienced grief and pain so far beyond what I had felt.  And even as time passes, I still feel very drawn to this community.

During my personal struggle, I wrote on my personal blogger blog, but I also contributed to a blog on a popular website called Countdown to Pregnancy.  I told my story, the same story as is written above, but with more detail.  And when I finally became pregnant, I stepped away.  But every once in awhile, I still get a notification that I have a new comment.  I got one today.  It was from a girl looking for advice.  I responded and then I started thinking.  I LIKED this.  I was kind of GOOD at this.  I may not have had the most harrowing story to share, but it was one that was related to and I really enjoyed sharing what I knew.

And so, Ask an Infertile was born.  So to speak.

I don't pretend that this is a new idea.  But as I stated way up there at the top of this very long post, there really can't be ENOUGH resources out there.  So here we go.