Category Archives: reproductive health

relevant phrase: “on the topic of pelvic floors”

this morning i came the closest to throwing up that i have come in all my ten weeks & three days of being pregnant. & it wasn’t even because of morning sickness! it was because of a migraine. i have heard that some women who are prone to migraines have fewer symptoms while they are pregnant. (i have actually heard that about a lot of weird stuff, including arthritis, which you’d think would be worsened by the weight gain & altered center of gravity involved with pregnancy.) maybe i got a migraine because i was a little dehydrated. it was over 100 degrees yesterday & i arguably didn’t drink enough water. but i am worried i’m going to be one of those women whose migraine symptoms are the same or even worse during pregnancy.

about four months after jared & i moved in together back in 2008, swine flu hit the news. at the time, jared usually got up at around 6am to get ready for his long train commute to work, & i got up with him because otherwise we hardly would have been able to spend any time together, & i would have felt like a total jerk for sleeping in every day until 11am when he had to get up at 6am. so one morning jared woke up to get ready for work, & i woke up too & immediately burst into tears because i had such a horrible migraine. jared went to take a shower, & when he came back to get dressed, he found me writhing around in bed, sobbing hysterically. “do you have swine flu?” he asked.

“i don’t have swine flu!” i apparently sobbed, which made jared laugh REALLY hard, because apparently i sounded sad about not having swine flu. i did my best to get back to sleep, & woke up six hours later still feeling terrible. i got out of bed to get some advil, but just standing up made me throw up. migraines are the worst.

anyway, i didn’t throw up this morning. jared was kind enough to bring me some ibuprofen (i know, i know, it’s contraindicated during pregnancy, but when i tried to figure out why, all i found is that it can cause heavy bleeding during childbirth, if taken, like, right before delivery–if someone else can point me to some study that shows that ibuprofen will cause my baby to grow an extra set of limbs or something, i’ll stop taking it, but for now, i don’t really see the problem in downing a couple of advils once or twice a month) & i snoozed until 10:30am & begged off going to the pool.

yeah, i haven’t thrown up once during this pregnancy. i haven’t even come close. i was pretty nervous since almost everyone i know & definitely every pregnancy blog i’ve read goes on & on & on about how awful morning sickness is & how all the did while they were pregnant was puke. i even followed one blog for a while on which the author would write at length about how she peed herself a little every time she threw up–& she was throwing up a few times a day. she wrote about how she had to keep a change of outfits at work for the inevitable pee emergencies. & this is someone who was pregnant with her first baby! apparently her pelvic floor has no muscle tone whatsoever. i was worried that this was some kind of secret truth of pregnancy that no one talks about–that you just pee yourself all the time, until it starts to seem normal to be covered in pee. but that definitely has not been my experience even a little bit. knock on wood, i guess?

i’ve definitely experienced nausea, just for the record, & it has even been severe enough a few times that i spent literally the entire day in bed, sleeping (my only respite from the nausea, which actually seem to get worse after i eat, & is particularly triggered by just plain water). i’ve been nauseous pretty much non-stop for the last two & a half weeks. but never have i felt the need to vomit.

on the topic of pelvic floors: when i had my HSG done right before i got pregnant back in april, the nurses were trying to distract me from what i imagined to be the unbearable agony of the whole thing by asking me lots of questions. & of course they asked if i was trying to get pregnant, if it would be my first baby, did i want a boy or a girl, etc etc. at one point, one of them gave me this stellar advice: “it’s never too early to start doing your kugels, even before you get pregnant.”

i actually laughed out loud. for kind of a long time.

this is a kugel:

it’s a very delicious jewish noodle dish. YUM.

this is a kegel, which is what she actually meant:

an exercise to strengthen your pelvic floor, helpful for maintaining continence throughout life, even after the trauma of a vaginal delivery.

not that i would turn down the opportunity to enjoy kugel on a regular basis!

another thing i want to enjoy on a regular basis is GARLIC KNOTS. jared & i went to the royals-cardinals game in kansas city on friday with our friend cait (the culmination of the I-70 series, which is apparently a rivalry on par with yankess-red sox, or hatfields-mccoys). we got pizza first, & after i devoured a whole platter of garlic knots…i ordered a second platter for the road. they took so long to cook that we missed the opening pitch, which was apparently thrown by a very drunk jon hamm (“mad men”‘s don draper). throughout the game, cait kept saying, “what do you think jon hamm is doing right now? we need a hamm cam.” she also observed, “your baby is going to have the bluest eyes ever. you both have such blue eyes! are you trying to create an aryan super-race?” to which jared replied, “worst. super-race. ever.” i told her that she should get a fake hollowed-out pregnancy belly for the next time we attend a game & fill it with cheap beer. i think that’s what jon hamm did because he was nearly falling down drunk when he helped lead the crowd in “take me out to the ballgame” during the seventh-inning stretch. we stayed for the friday night fireworks, which were set to a confusing disco medley that included a surprising amount of queen’s “bohemian rhapsody”. after the grand finale, the beefy royals fans in front of us started chating, “U-S-A! U-S-A!” because, you know. fireworks are inherently a celebration of america. when we got home, at like 1am, i discovered that my garlic knot consumption had in fact been so fevered that i had marinara sauce splashed on my forehead. it’s the miracle of being ripe with child: you just don’t give a fuck about dignity anymore, like at all.

positive home tests, negative blood

so. i am having a completely rotten TTC week. a few days ago, at six days post-ovulation, i took a home pregnancy test. i definitely wasn’t expecting anything that early–usually implantation doesn’t happen until at least 7DPO, & it takes a few days after that for enough pregnancy hormone to build up in the body to trigger a positive test. most early testers don’t get a positive until 9DPO.

so imagine my surprise when the test showed a very faint second line! i tested four or five more times that day, & ALL the tests showed two lines! i showed the tests to jared & even he saw them.

it’s faint, but it’s there!

i tested again the next morning & got a slightly darker line. i tested two more times that morning & got two more positive tests. i was pretty much out of my mind with excitement & hope. i decided to cut to the chase & ask my doctor for a blood test. the science claims that pregnancy hormone will show up in blood before it will show up in urine, so a blood test is more accurate than a home test. most ob-gyns & midwives want blood test confirmation before they consider a woman truly pregnant. & a qualitative blood test can detect as little as two or three units of hormone in the blood, while the most sensitive home tests available need at least ten unites before they become positive. i figured that if the hormone was showing up on home tests, surely my blood test would be positive.

i see a second line!

i had the blood draw on thursday, 7DPO. EXTREMELY early–some doctors refuse to do a blood test before a woman has missed her period. but my doctor gave the okay when i explained that i’d gotten eight positive home tests. i waited around on thursday afternoon for the nurse to call with the results, but she didn’t. i spent all morning yesterday clutching my phone & carrying it everywhere with me so i wouldn’t miss the call. i just KNEW she was going to be giving me good news. i continued to test, & all the tests continued to be positive. the lines continued to get darker (but were still very faint–which makes sense because i’m still so early).

it’s a little darker!

i tried going for a walk to clear my head & distract myself from waiting for the call, but it didn’t really work. i was so anxious about the call that i finally wound up bursting into tears. when i calmed down, i called the nurse & begged for the results. my usual ob-gyn & her nurse were out of the office, so i was speaking with a different nurse i didn’t know. she told me the results were back but they hadn’t yet been okayed by a doctor. she said she’d put in a request for the on-call doctor to review them & give permission for them to be released to me. we hung up & i paced around the house frantically until she called back twenty minutes later.

after a lot of brouhaha & exposition about how clomid works & when tests become positive in relation to ovulation (i wanted to yell, “cut to the chase, woman! this is not my first time at the rodeo!”), she gave me the results: negative. they did a qualitative beta & my pregnancy hormone level was less than one. not even a whisper of possible pregnancy.

she elaborated that i was still really early in my luteal phase & that i should call for another blood test if my period is more than four days late. as if i wouldn’t, hello.

i was so stunned that i couldn’t even cry. i reported the results to jared & then i went outside & sat on the porch & just stared into space. it was 90 degrees out, but i started shaking & feeling cold. my teeth were chattering. i think i literally went into shock. after a while i went back inside & laid down on the couch for an hour or so. when i started feeling less shaky, i got up & went online & ordered another round of ovulation tests  , & several different brands of home pregnancy tests. i have been testing with wondfos, & some people think they are unreliable & have a tendency to evap. an evap would be a gray or colorless line where the test line should be, a line that looks like an indentation & has no color, a splotchy & inconsistent test line, etc. every test i did featured a thick, pink, solid line. generally, an evap line that is thick & consistent will be colorless, & an evap line with color will be splotchy. ALL of my tests (& by that point, i had done around twenty) showed a perfect-looking positive line.

i did another test yesterday before bed. positive. i did two more tests this morning when i got up.

also positive. & the test line is plainly getting darker.

but a blood test is the gold standard. supposedly any positive urine test that is not supported with a positive blood test should be considered a false positive. false positives happen, but they’re extremely uncommon. evap lines happen, but they are also relatively uncommon. i have never heard of a woman getting twenty to thirty false positives or evap lines in a row. i used this same brand of test, & the same lot number, last cycle & i didn’t get any lines like this.

i’ve done some google sleuthing & i’ve found stories from other women who had positive home tests, negative blood tests, & were indeed pregnant. their bloodwork eventually became positive, but in some cases, it took weeks. i can’t figure out how this would work, from a science perspective. if the blood isn’t detecting pregnancy hormone, how could it possibly be in urine?

four years ago when i had my abortion, i took several home pregnancy tests. they were all positive. i went in for the abortion at six weeks & had an ultrasound done. the tech couldn’t find the embryo & insisted on giving me a blood test to confirm pregnancy. she told me the blood test came back “inconclusive” & referred me to the ER for a possible ectopic pregnancy. sometimes with ectopic pregnancies, the pregnancy hormone level is lower than it should be for gestational age (although the range of what’s considered “normal” for gestational age ranges pretty widely). i was panicked & went to the ER. they did another ultrasound there & found the embryo in my uterus right where it should be. its size correlated to suspected gestational age. i had the abortion a week or two later & never got another blood test, so i have no idea if another blood test would have shown unusually low levels or if i just had an incompetent tech or what.

i’m really confused & really sad. i can’t help testing, & my heart soars when i see that second line (EVERY test for the last three or four days has been positive), but i’m so confused by the negative blood test. my game plan for now is to just struggle through the next week or so, & if i’m still getting lines at 15DPO–especially if they continue to get darker–i’ll request a second blood test. but i’m pretty upset. i want to be excited about my pregnancy right now, not staring at positive tests, wondering if they’re real. this sucks.

saving your budget & your mental health while trying to get pregnant, part three

all right, here’s where we get to the good stuff. pregnancy & pregnancy tests. i have a lot of feelings.

chemical pregnancy a chemical pregnancy is a very early miscarriage. these are incredibly common & are usually due to a chromosomal abnormality in the blastocyst which prevents it from developing properly. basically what will happen is that you’ll get some positive pregnancy tests, maybe even blood test confirmation, but the hormone levels don’t go up/start dropping, or your pregnancy tests turn negative again. remember what i said about how most people have a 20% chance of getting pregnant in a given cycle? chemical pregnancies are the reason for the low numbers. a lady has about a gazillion eggs & a dude makes about a germillion sperm–not all of them are going to be grade A quality. if a defective sperm fertilizes a good egg, or a good sperm fertilizes a weird egg, that embryo probably isn’t going anywhere. if you frequent trying to conceive messageboards a lot, you will see lots of women with signatures talking about their “angel babies” that passed away at like 3 weeks, six days. these are chemical pregnancies/early miscarriages, & the only way they were caught is because the lady was trying or suspected she was pregnant & was testing early. in the average lady that isn’t trying to make a baby happen, her period will come as usual & she’ll have no idea that there was ever a fertilized egg in there. (this is also why all the obnoxious GOP legislation about how “life begins at conception” & “fertilized eggs are people too” is so bogus. there’s no way to tell that an egg has been fertilized or that conception has happened. you have to wait until the blastocyst implants & starts generating pregnancy hormone before any test, even a blood test, will know it’s there.)

pregnancy tests okay. this is where a big chunk of the “saving your sanity” part comes into play. but first, some thoughts on pregnancy test brands.

there are A LOT of options out there. but the budget-conscious lady is going to want a test that provides the most accuracy for the least amount of money. may i once again suggest wondfos by formosa medical? you can get a bag of fifty off amazon.com for like $15. & once you have contracted baby rabies & are desperate to get pregnant, you are going to be using A LOT of pregnancy tests, so do yourself a favor & order a bag right now. & don’t be coy & just order ten. you know that’s not gonna cut it.

i like wondfos for a lot of reasons. they’re dirt cheap, they can detect ten units of HGC (that’s the pregnancy hormone–& ten is WAY lower than pretty much any pregnancy test available in a drugstore), & they don’t come in a lot of packaging, so they’re better for the environment. when i say “pregnancy test,” you probably picture a plastic doodad with a cottony bit to pee on. they come two or three to a box & cost between $7 & $20. wondfos are tiny little plasticky strips, each in a little foil pouch with a tiny bag of silica to keep the test from getting all weird in humidity. they show up on your doorstep in a big ziplock bag. no muss, no fuss, when it comes to all the unnecessary coverings & wrappings. they’re dipsticks, so you pee in a cup & then dip ’em for three seconds. the result will come up within five minutes. if you think you see a line, you can dip another right away because they’re like 15 cents each or something. hours of fun!

tests from the drugstore come in three varieties: pink dye, blue dye, & digitals. digitals are great because they give you a clear answer–no squinting to see if there’s a second line. but they don’t usually detect HGC until it’s at a pretty high level–over 100 units in a lot of cases. so it is entirely possible to get a false negative on a digital, just from testing too early.

blue dye tests are widely reviled in the trying to conceive world. they are usually less expensive than pink dyes, but they’re notorious for evaporation lines that can function like false positives. they work great if you’re actually pregnant–i used them when i got pregnant in 2008 & they couldn’t have been more accurate. my blue dye at five weeks came up blazingly positive in literally all of two seconds. but if it’s early days, they can be heartbreaking. in my experience, they almost ALWAYS evap, which means a very thin line appears where the test line should be. it might even be unmistakably blue. (a calling card of an evap is that it’s gray or colorless.) but if it’s not as thick as the control line, it’s an evap. & it sucks to see that little sliver of blue when you just want a positive result. you can make yourself crazy, squinting at it to see if maybe it’s thicker than it looks.

so just skip the blue dyes. but a word of caution about pink dyes: they evap too! lots of ladies swear by first response early result tests, which are spendy. they’re like $13 for a box of three, but they say they detect pregnancy earlier & some women swear up one side & down the other that they don’t evap. THEY DO. TRUST ME. my understanding is that the company recently changed the way the antibody is applied to the test & now they evap like a motherfucker. i’ve even had full color bright pink evaps. basically, if the line lacks obvious color, is not as thick as the control line, or doesn’t have consistent color all the way through (ie, is patchy/colorless anywhere), throw it out & don’t look back. it’s for your own good. wondering if that test could maybe somehow be the start of a positive will only crush your spirit & destroy your dreams.

another budget option is tests from the dollar store. yes, the dollar store! they’re only $1 each, they’re pink dyes, & they’re reasonably accurate. but a word of caution: once they have dried, they evap like crazy. it seems like they always show a shadow line & again, you can drive yourself to the very brink of insanity looking for color. if you decide to experiment with dollar store tests, heed the time limit & throw those suckers out after three to five minutes. & don’t go looking in the trash for them later.

with digital tests, do not be tempted to take them apart to look at the test strip if you get a negative result. just accept that it’s a negative. digitals almost always have two lines inside. IT DOESN’T MEAN YOU’RE PREGNANT. sorry, it just doesn’t. many a woman has been driven to despair by taking apart a digital test & seeing two lines.

all right, when to start testing? listen up, because i am only gonna say this once: IT IS IMPOSSIBLE TO HAVE PREGNANCY SYMPTOMS BEFORE YOUR BODY IS MAKING PREGNANCY HORMONES. here’s a little science lesson: the egg is released at ovulation. if you’re lucky, it will be fertilized shortly thereafter. it then must travel down the fallopian tube to the uterus. this journey can take anywhere from five to fourteen days. once the blastocyst has implanted, it sends a message to the body to start secreting HGC. it usually takes at least two days for enough hormone to be coursing through a person’s system for her to start feeling anything. this means that the absolute EARLIEST that a person could have pregnancy symptoms would be like seven days post-ovulation. i’m sure we have all met women who had unprotected sex one time & started crowing the next day about how they feel so exhausted & nauseated, they just know they’re pregnant. THIS IS NOT SCIENTIFICALLY POSSIBLE. it doesn’t matter how sensitive you are to your body’s rhythms & hormones, you will not experience pregnancy symptoms until your body is making pregnancy hormone. there’s nothing to react to until then! if you are feeling tired & nauseated two days post-ovulation, there is a very simple diagnosis: baby rabies. you want to be pregnant so badly that you’re psychosomatically manifesting the symptoms. sorry, but it’s true.

now, i am a big fan of testing early & often. actually, i hate it because it makes me insane, but i do it anyway. during the two week wait, i seriously spend at least a few hours a day staring at pregnancy tests, looking for lines. it’s ideal not to mimic this behavior, & i am working at getting myself under control. but it is true that some women find it calming to take a pregnancy test whenever they want. as long as you can be strong & just throw the test out if it’s negative, you should be okay. but it’s unwise to start testing before seven days post-ovulation. even seven is pushing it. it’s better to wait until nine if you can. if you’re still getting negatives at fifteen days, you can rest assured that you are most likely not pregnant. occasionally a woman will have a very late implantation–i’ve heard of nineteen days, 23 days…i’ve even heard of women that never got a positive test & finally had their pregnancies confirmed via ultrasound at like eleven weeks. these women are outliers & you will go insane if you think about them too much. if you’re getting negatives at fifteen days post-ovulation, start working to accept that you are not pregnant & get ready for your next try.

personally, i like to chart through the two-week wait. if your temp starts dipping at around 13 or 14DPO, you know you’re probably out of the game. pregnancy generally makes temperatures stay high or they even spike to a whole new level after implantation. when this happens, it’s called a triphasic chart. just don’t stress about it too much because lots of women get pregnant without triphasic charts, & some women with triphasic charts are not pregnant. just try to take a lot of deep breaths & try not to stress too much over every temperature, or twinge, or desire for a nap. keep your eye on the prize: a baby. a positive test is just one step along the road to a baby.

fin.

saving your budget & your mental health while trying to get pregnant, part two

semen analysis if you’re not getting pregnant & you don’t have any known issues that could be compromising your fertility (or even if you do!), it’s important to get the sperm checked out. if you’re using donor sperm from a clinic, it’s already been checked for quality, but if you’re using a known donor or you’re just a couple trying to make a baby the old-fashioned way, the dude should go in for a semen analysis. he just does his business into a sterile cup & drops it off at the lab & they check it out. if the dude has low counts or poor morphology, you’ve got an uphill battle on your hands. there are simple things he can do to try to raise the counts (boxers instead of briefs, not using his laptop directly on his lap, don’t do anything that makes anyone want to punch you in the nutsack), & there are also medications he can try. semen analysis can be a little bit on the pricy side if his insurance doesn’t cover it (a lot of programs don’t)–around $200. but the good news is that if everything comes back normal, hopefully you’ll only have to do it once.

fertility bloodwork a doc will order this before prescribing you any drugs. they’re checking out your levels of luteizing hormone, follicle stimulating hormone, thyroid function, etc. if any of those levels comes back weird, it can indicate a fertility issue & potentially a protocol other than the typical “throw some clomid at it & see what happens” course of treatment. my levels all came back normal, so i can’t speak to how a person would proceed if anything came back weird. this is INSANELY expensive if your insurance doesn’t cover it–nearly $1000.

insurance basically, if you’re going down the road of seeking medical treatment for infertility, you’re going to need some halfways decent insurance. you’ll at least want something that will cover bloodwork because you’re probably going to be getting a lot of it. & you’ll probably want insurance anyway so you can get good pre-natal care once you’re pregnant, so don’t dilly dally. i personally was enrolled in medicare after being on disability for two years, so i don’t have any experience comparison shopping. but if you’re low-income, there are usually county lawyers you can see that can help you choose a program that fits your budget.

acupuncture some people swear by this. they say they tried to get pregnant for a year, started acupuncture, & were knocked up within two months. i tried it but i did not care for it. i just find it impossible to sit still & do nothing for an hour. acupuncture can also be expensive, like $50 a session, & very few insurance programs will cover it. your best bet for saving duckets on acupuncture is to find a community clinic. they usually operate on a sliding scale. i paid about $15 a session. you’ll most likely be enjoying the experience in a room with a bunch of other people instead of a private room with a nice table, but if cutting costs is your bottom line, it’s not a big deal. no one is really trying to make conversation in an acupuncture clinic, so you can just zone out & pretend you’re alone.

HSG this is the dye test i had the other day, in which a radiologist shoots contrast solution into the uterus to make sure the tubes are open for business. this is pretty much the first quasi-invasive infertility treatment a doctor will order, because no one’s getting pregnant if their tubes are blocked. it functions as a treatment as well as a diagnostic–in some cases, the force of the dye will clear minor blockages. studies have been done indicating that pregnancy is twice as likely after an HSG, just because it “clears out the cobwebs,” so to speak. the average couple has a 20% chance of getting pregnant in any given cycle. an HSG can boost that chance up to 40%. it remains to be seen if it will work for me, but i’m keeping all my fingers & toes crossed & praying to a photograph of my friend jessika rae, who is my own personal fertility goddess. (she was sleeping on my couch the last time i got pregnant.)

preseed this is a “personal lubricant,” as it were, that was specifically designed to enhance fertility. supposedly other lubes contain some weird junk that can kill or maim sperm. preseed doesn’t have that stuff in it. it mimics a lady’s natural fertile mucus. it can be purchased at some drugstores & online (amazon sells it). it can be especially helpful to women that are on clomid because clomid is an anti-estrogen, & as such, it can dry up natural cervical mucus. mucus is important because it creates a home for sperm while they are hanging around, waiting for the egg to put in an appearance. a lack of cervical mucus, or hostile cervical mucus, kills the sperm off faster. sperm can live for as long as five days in fertile cervical mucus or a reasonable fascimile thereof. & you know, sometimes it makes sex more fun.

soft cups these can be purchased pretty much anywhere–i got mine at the grocery store. they are soft flexible cups that go into the vagina & cup the cervix. they are sold as a menstrual alternative to pads & tampons, but some ladies like to use them after sex/insemination to help hold the sperm up near the cervix. i have heard ridiculous stories of women using tampons to achieve this same effect. ladies! don’t use tampons! i understand the fear that all the sperm is just going to leak out before it gets where it needs to go, but…tampons?! they’ll just soak the sperm up & kill them with all their bleach & dioxin! if you are really worried about the sperm falling out of you (which shouldn’t be too much of a concern–most of the sperm that are going to go anywhere are up & inside the cervix within sixty seconds of ejaculation), try a soft cup. as an added bonus, they are insanely comfortable. i have a keeper too, but i hate it because it’s all rubbery & pointy. soft cups are the bomb. you can’t even feel them. (although they are not reusable & the keeper is.)

hydration it’s always important to stay hydrated, but especially around ovulation. if you’re dehydrated, your body will compensate by not making as much cervical mucus. you want LOTS of mucus, okay? this is especially important if you’re a little older. over thirty, your body just naturally doesn’t make as much cervical mucus as it used to. so drink lots of water!

robitussin some women swear by this shit. they drink it around ovulation. it works as a decongestant when you’re sick by thinning your mucus so you can breathe more easily. it does the same thing with cervical mucus. it won’t make your body make MORE, but it will thin what you have so it will go a little further. i personally have not tried this, but it’s cheap & readily available at any drugstore, so i thought i’d mention it.

(to be continued again!)

saving your budget & your mental health while trying to get pregnant, part one

okay, i am not pregnant yet, but i feel like i know a lot of stuff about trying to conceive at this point, & maybe some of it will be useful to others. i’m also going to write about all the different stuff i have tried so the next time someone says to me, “you should really try fertility charting,” or, “ovulation tests really helped my grandma’s best friend’s neighbor’s daughter,” i can just point them to this entry so they’ll shut the hell up.

charting this is pretty much the first thing people try when they are trying to get knocked up. i started charting back in 2001 in order to avoid pregnancy. it’s a system of noting your body’s fertile symptoms in order to avoid or maximize your chances of pregnancy. you take your temperature first thing every morning, make a note of what’s happening with your cervical mucus, note the texture & position of your cervix, & check whether your cervix is open. at peak fertility, your temperature will be low, cervical mucus should be relatively copious, clear, & stretchy, & the cervix should be high (difficult to reach), soft, & open. the day after ovulation, your temperature should start getting higher, the cervix will drop & become firm & closed, & cervical mucus should dry up or become creamy. i charted for years by printing out the sample form in the back of taking charge of your fertility by toni weschler, which provides a gazillion times more info about fertility symptoms & how to chart. when i got serious about getting pregnant, i started using an online tool at fertilityfriend.com. i signed up for a VIP membership so the website remembers my info & creates algorithms to help predict my most likely fertile time. it also runs my luteal phase symptoms against the info provided by other members so i know how my experience stacks up against women who have managed to get pregnant.

charting is important because every body works differently. if you’re just having sex/inseminating on or around cycle day 14 & wondering why the hell you’re not knocked up, you need to chart. lots of women ovulate sooner or later than that, & if you’re not timing the introduction of sperm properly, there’s no way you’re going to get pregnant. don’t bother with online ovulation predictors–they seriously just tell you to have sex fourteen days after your last period. that doesn’t help anyone but the few women with textbook perfect cycles.

ovulation tests it took me a few months to come around to the idea of using ovulation tests. i figured i was charting my fertile symptoms & that was good enough. & for some women, it is. but ovulation tests can help take the guesswork out of things. they test for luteinizing hormone, which spikes 12-48 hours before ovulation. when the test line is as dark or darker than the control, it’s positive. these things can be spendy, so my method is to use the cheapo tests made by formosa medical. they’re called wondfos & you can pick up a bag of fifty for like $12 on amazon.com. when my fertile signs start picking up speed, i like to test four or five times a day, & i can do that with the wondfos because they’re seriously like twenty cents per test. an ovulation test from a drugstore is considerably more expensive, which would encourage a budget-conscious lady to maybe only test once a day, which could cause her to miss her surge.

once i get a positive result on a wondfo, i like to back things up with a clearblue easy digital test. these things are very expensive. at target, a box of twenty costs $35. but there’s no question with them: if a surge is detected, a smiley face pops up. if there’s no surge, you get a blank circle. if you’re only using them to back up the wondfos, you’ll only need two or three per cycle, so a box of twenty will last ages (though hopefully you won’t need them that long, because you’ll get pregnant first!).

once you get a positive ovulation test, it’s important to NOT STOP HAVING SEX OR INSEMINATING! so many women seem to think that a positive test means they have ovulated, all done, now they just have to wait for a positive pregnancy test. NOT TRUE! the ovulation test looks for LH, which surges right BEFORE ovulation! the ovulation tests should become negative again before ovulation happens. so basically, keep having sex/inseminating as much as you can for three or four days AFTER getting a positive test. the ultimate goal is to get a fresh batch of sperm in there the day before, the day of, & the day after ovulation. charting can pinpoint the day of ovulation (you know it’s happened once your temps go up & stay up, creating a biphasic temperature pattern), but not until AFTER it happens. so just keep boning, okay?

clomid it seems like some women don’t realize that regular ob-gyns can offer infertility treatment. you don’t need to start seeing a reproductive endocrinologist (which can be considerably more expensive, depending on what your health insurance covers) right away. an ob-gyn can order basic fertility bloodwork (checking LH, FSH, progesterone, etc), prescribe fertility meds, order an HSG, etc. most women have an ob-gyn anyway because they’re getting regular pap smears (RIGHT?).

my ob-gyn ordered all my basic bloodwork, & based on the information i was able to provide her through my charting, she prescribed clomid & progesterone support for me. clomid is basically a starter fertility drug. women do three to six rounds, perhaps of increasing dosages. they take it for five days at the beginning of their cycles & it works to promote ovulation–to help a non-ovulating woman release an egg, & to help an ovulating woman release more or better eggs. some women report certain side effects on clomid: hot flashes, headaches, nausea. i haven’t really experienced any of that, but then, being the child of two of the biggest drug addicts east of the mississippi has instilled in me a certain natural tolerance for drugs. i almost never get side effects from anything. taking clomid closer to ovulation (ie, cycle days 5-9) supposedly helps create one more mature & well-developed egg, & taking it earlier (cycle days 3-7) helps create more eggs. it’s a quantity versus quality issue. i ovulated on my own without clomid, so i am now experimenting with taking it earlier. more eggs means more chances for fertilization…although it also means a slightly increased risk of becoming pregnant with multiples.

it’s also worth noting that clomid is pretty inexpensive. a five-day treatment at 50mg (the usual starting dose) is only $9. so there’s really no reason for anyone to drive to mexico for black-market clomid. doctors can’t wait to prescribe it, & it’s very affordable.

progesterone my charts made it obvious that i have a luteal phase defect, most likely caused by low progesterone. this is one of the most easily treatable fertility issues a person can have. it just means that the latter half of my cycle (ovulation until my next period) is short. the average is twelve to sixteen days. mine was nine or ten. after an egg is fertilized, it takes about a week for it to journey down the fallopian tube & implant in the endometrial lining. if a woman’s luteal phase is too short, her endometrium will have started to break down already by the time the fertilized egg has arrived, & it won’t have anywhere to implant. i could have been fertilizing eggs every month, but my luteal phase was too short to give them a chance to turn into anything. progesterone supplements are used once ovulation has been confirmed (it’s important not to start them too soon because they can prevent ovulation altogether or create mucus that is hostile to sperm) & support the endometrium for longer, giving a fertilized egg a fighting chance of turning into an embryo.

i’ve tried two kind of supplements, crinone & prometrium. crinone is a gel & it is pretty fucking disgusting. once it’s been in the body for a while, the gel breaks down into these tiny plastick-y balls that are horrifying. it’s also crazy expensive–$250 for two weeks of treatment, if you don’t have insurance. prometrium is also expensive, but not nearly as bad a crinone. $250 gets you a 30-day supply, & there’s a new generic available for $200. it’s a capsule suppository. far less disgusting, & it worked better for me. with crinone, my LP was extended to twelve days. not bad, but not great. with prometrium, i got up to twenty days. some women have to get a shot of provera to bring their periods on after doing progesterone support, but not me. mine always comes once i stop using the progesterone.

(to be continued!)

enter the blunderdome: HSG edition

well, i took jared to the airport on thursday morning so that he could fly off to massachusetts & present his research on historical responses to flooding in the connecticut river valley at a conference called “riverscaping”. his flight left at 7:30am, which means he had to be at the airport at 6:30am, which means we had to leave lawrence at 5:30am, which means we had to get up at 5am. jared is pretty brilliant in a lot of ways, but he has definitely has a blind spot when it comes to timing travel arrangements in a way that enables people to sleep. i was so desperate to get back home & go to bed that i was actually pushing the car up to 90 miles an hour on occasion. i’m not proud of that. it’s bad for the car & pretty dangerous for me as a driver. but i made the entire drive from the kansas city airport to lawrence in seriously about 35 minutes. that’s gotta be a record.

on friday i went in for the HSG. what a fucking experience. i was completely panicked about this test, which is an indication that i thought i had a pretty good handle on what to expect. i knew that it was all basically set up like a pelvic exam, except that the doctor would push a catheter through my cervix & use it to inject contrast dye into my reproductive system & watch the whole thing on some kind of monitor to make sure the dye was able to push through my fallopian tubes, ensuring that they are open & ready for the business of baby-making. that all sounded pretty horrible, but i had decided that i was willing to do whatever it takes, within financial reason, to get this baby thing on the road.

first i had to register at radiology. the person checking me in asked how to pronounce my last name & i explained (rhymes with my first name–see-air-uh zee-air-uh). she said, “i’ve seen that name on paperwork floating around the hospital & always wondered how it’s pronounced.”

um…what? i am literally the only person in the world with this last name. it’s not like i’m unaware that my name is going to be on various forms & papers if i go into the hospital every two weeks to have some random test done, but is it really necessary for some random registration woman to basically tell me that my personal medical info is just floating around for various hospital administrators to peruse? it reminded me of the time i went to vote, & i checked in with the registration ladies, who were like, “CIARA XYERRA! we saw that name on the list & we just couldn’t wait to meet the person with the unusual name!” uh, that’s great but maybe zip it because all this voting shit is supposed to be anonymous. i know i did it to myself by giving myself such a stupid, conspicuous name, but i really wish people would chill the fuck out about it.

anyway, after i registered, i was passed off to a nurse who walked me through the procedure, discharge instructions, consent paperwork, etc. she must have been a kindergarten teacher in a former life because she actually read every piece of paperwork out loud to me, pointing at the words like she wanted me to sound them out with her, & stopping to extrapolate on some of the more difficult concepts, like the meaning of the word “speculum”. (hint: i have one tattooed on my left arm, i think i understand the definition.) she told me the name of the doctor doing the procedure & then whispered, “you’ll really like him. he’s one of our cutest doctors!”

um…great? seriously, in what world do i give two fucks about the relative foxiness of the person that is about to jam a catheter through my cervix? is being pantsless in front of him supposed to be easier if he’s attractive? because i really don’t have a lot of feelings about being pantsless in front of people providing me with medical care, particularly gynecologic care, full stop. it’s not a big deal. & at the risk of sounding overly precious, a person is going to have to be dumbfoundingly jaw-droppingly attractive for me to notice, considering that i am dating jared, who is pretty much the cutest dude to ever walk the planet. maybe i’m just a one-dog woman, but i really don’t take note of the relative physical merits of other men. sorry, dudes.

the nurse took my vitals & sent me off to put on a hospital gown & robe. i thought about running for it–just fleeing back to my car & not getting the procedure done. but i was already checked in & i was worried that the hospital would bill my insurance anyway since i had already signed all the forms, so i followed through.

i don’t know what i was expecting. i guess i thought the whole procedure would be more like a pap smear, atmosphere-wise. paps are just done in offices, & you lay on an examining tables with stirrups & it’s all pretty chill. it’s the same room where they weigh you & take your blood pressure & stuff. it’s medical, because it’s a doctor’s office, but it’s not all hospital-y, if you know what i mean. (maybe i have just been to too many doctor offices–they don’t bother me.)

instead i was ushered into a really scary room with huge machines everywhere & half a dozen people wearing radiation vests. i laid down on a table that was free of stirrups. i just had to prop my feet up on a ledge & do my best to hold my legs steady. nurses were swarming all over me with warm blankets & cold compresses, trying to distract me from the procedure with questions about where i’m from, what i do, how i like living in kansas, whether or not i already have kids. the HSG itself hurt a bit, but it wasn’t nearly as bad as i expected it to be. it definitely wasn’t something i ever want to do again, but after hearing so many women describe it as “the most horrible thing that’s ever happened to me,” i was prepared for much worse. i had to tip my pelvis from side to side, which was really weird, & then i got a fresh blanket from the warmer & the doctor showed me the photos he’d taken. everything looked absolutely perfect. the nurses took my blood pressure again to make sure i wasn’t about to have a vaso vagal episode, & then i was free to put my pants back on & leave.

jared had told me to remember that i have his love & support, but all i could think during the procedure was that he wasn’t there, or even in the state, & i was being subjected to this huge scary machine & all these nosy hospital personnel on my own. not that he could have done anything about it…i just wanted him to be there. i went home & spent the rest of the day cuddled up with charlotte in bed, reading harry potter & the goblet of fire for the 50th time.

a caveat: of course i feel weird about posting my personal medical info all over the internet, but fertility problems are really common & it seems like people are reluctant to speak about them openly. i understand, because people really do say the stupidest things. just the other day, a friend of mine recommended that i check out taking charge of your fertility & start charting my cycle to make sure i’m timing sex at the right time for getting pregnant. *sigh* i guess people who haven’t struggled to get pregnant don’t get this, but trust me–the first thing a person does when she realizes that she’s not getting pregnant quickly is start charting to make sure she’s timing things properly. the overwhelming majority of women start charting before they ever start making doctor appointments & filling prescriptions for fertility drugs & subjecting themselves to catheters in the cervix. i’ve been charting for twelve years. that’s how i knew i had a progesterone issue. basically, i just hope that sharing my experiences with this crap can serve as an apocryphal, anecdote-based resource for other ladies that are dealing with similar problems.

& i beseech my readers who are not trying to conceive to PLEASE be mindful of what you say to those of us that are. think of infertility as any other medical situation. would you presume to tell someone with cystic fibrosis to look into percussion therapy (one of the most basic cystic fibrosis treatments)? would you suggest that a friend with a sprained ankle try the radical new therapy of over-the-counter anti-inflammatories? probably not, because you recognize that such suggestions would be presumptuous & condescending. so PLEASE don’t tell a woman with fertility issues to relax, or look into charting, or take a cruise, or get her hormone levels checked out. we either already know that shit, or know that your suggestions are useless. i know people just want to say something encouraging, but basic sympathy goes so much futher than elementary fertility 101 advice.

no children

things have been really exciting down in the trying to get pregnant mines. i did my third round of clomid this past cycle. this was my last round at 50mg. the doctor said that if it didn’t work (which is to say, if i did not get pregnant), she would double my dose & order an HSG. these are things about which i have feelings.

clomid is not actually the safest drug in all the land. it works by stimulating a person’s ovaries to riped & release eggs. sometimes it stimulates a person’s ovaries into releasing more than one egg. sometimes it does its job so effectively that a person’s ovary twists around on itself under the weighty bushel of ripened follicles it is sporting, which can cut off blood supply to the ovary, cause excruciating pain, & sometimes even lead to the emergency removal of said ovary. & since you obviously need ovaries in order to ripen & release the eggs that will hopefully become fertilized & turn into embryos, losing an ovary can indeed impair a person’s fertility. which is less than spectacular when you consider that like 99% of people taking clomid are doing it to address a problem with fertility. (the other 1% are people who got their aunt georgie to bring back illegal clomid from mexico because they are so desperate to conceive multiples & become the next octo-mom. seriously. there are entire websites devoted to helping women get their mitts on black market fertility drugs & conceive multiples. scary shit.)

& an HSG…it’s short for hysterosalpingogram. it’s a test in which a doctor shoots some crazy fluorescing dye into a lady’s reproductive system & checks everything out a monitor to look for any scarring or blockages that may be preventing her from becoming pregnant. it’s a diagnostic tool but it can function as a treatment sometimes, because the force of the dye has been known to unblock fallopian tubes. from what i understand (which is admittedly not much because i think this is the kind of thing i probably shouldn’t think about too much), the dye gets up into the uterus via a cannula that is inserted through the cervix. UGH UGH UGH DO NOT WANT.

remember that abortion i had four years ago? it worked the same way. a narrow cannula was inserted through my cervix & vacuum suction was applied to remove the contents of my uterus. the vacuum aspect didn’t bother me at all, but having something pushed through my cervix HURT LIKE A MOTHERFUCKER. apparently i passed out for two hours, although i have no memory of this. all i remember is pain. pain which probably feels like kittens licking my hand compared to the process of natural childbirth, but nonetheless. i tried to get an IUD a few months after the abortion, so i wouldn’t end up accidentally knocked up at any point in the future, but i couldn’t cope with having the little scrap of plastic pushed through my cervix. it brought back unfortunate memories of the whole unmedicated abortion thing. don’t get me wrong, i don’t regret my abortion at all & it’s not, like, emotional trauma that makes me have feelings about. & pretty much everyone else on earth gets some kind of painkiller or anesthesia before an abortion. i did not because of my vaso vagal syndrome (a breakdown in my body’s primary pain receptors). i knew that i have a tendency to pass out in response to pain, & that it’s not just “haha, she fainted, no big” passing out. it’s a life-threatening blood pressure crisis. the docs at the clinic didn’t want to take the chance that anesthesia would interfere with their efforts to revive me if my blood pressure started dropping…which it did.

anyway! so yeah, i am so not excited about having this test done. but if it sheds some light on why i’m not getting pregnant, & maybe paves the way for a pregnancy in the future, i guess it’s a good thing.

i had a lot of excitement last week when i took a fancy drugstore test & got TWO LINES! & they were both PINK! check it out, bros:

OMG OMG OMG

people always say it doesn’t matter how faint that second line is–if it’s there, you are pregnant! i called the doctor, but she suggested that i try to relax through the weekend & come in for a blood test after a few days, closer to the date of my next expected period. so i tried. but of course i couldn’t resist taking another test on sunday…which showed absolutely nothing. negative as can be. i swore i wouldn’t cry about not getting pregnant anymore. this was our ninth cycle trying, & trust me, it’s just not sustainable to maintain the level of emotion required to experience devastation month after month after month. but i couldn’t help it. i cried. & then i bought a pack of cigarettes because…why not, you know?

i still don’t know what this was all about. it could have been a bad test. it could have been an especially awful evaporation line (where the antibody strip on a negative test is visible enough to appear to be a second line–although an evap is not supposed to have color at all). it could have been a chemical pregnancy, also known as a very, very early miscarriage. it would appear to be a normal cycle to anyone who was not obsessively taking pregnancy tests on a daily basis. there’s really no way to know, & it doesn’t really matter. the bottom line: not pregnant. again.

i went in for a blood test anyway just to confirm the negative result, & the woman checking me in recognized me because i’m at the hospital getting blood tests for one trying to conceive-related thing or another like every two weeks. she asked if i was having a standard round of tests done because they have a different protocol for that. i was like, “no, i’m trying to get pregnant so i just get a lot of tests run.” not because it was her business. i was just making conversation. i don’t really see the point in keeping quiet about my fertility woes, you know? it’s not like it’s anything to be ashamed of.

i have medicare, so she had to ask me the medicare insurance coverage questions: are you a veteran? are you receiving black lung benefits? is your visit today to address an accident or injury? she chuckled & said, “i love asking pregnant women that last one. they’re always like, ‘how did she know it was an accident?’ hahaha!”

i kind of chuckled politely & said, “oh, if only it were that easy.” you know–hint hint, lady, did you not hear the bit about how i’m TRYING to get pregnant & this is like my seventh blood test in the course of two months? do the math.

she continued to laugh & said, “you know, you get a little fast & free with the wine coolers one night & the next thing you know–whoops! you’re booking some time in the maternity ward!”

i lost my temper & said, “or you’re moving into your fourth cycle of fertility meds & you have to get blood tests every two weeks in order to assess your hormone levels because it’s been almost a year & you’re still not pregnant.” that shut her up. seriously though! how the fuck do you get a job at the hospital when you’re that fucking clueless?