TTC: CHART 18 (3/19/15-4/18/15)

I have a gut feeling that I am very, very close, from 17 months of trying and from my cycles leveling out. With every new cycle, I gain more information about how my body responds to different medications and protocols. I'm thankful the medical advancement of my generation. I develop a kinship and love for women who are TTC’ing: The struggling, the currently pregnant, the moms-to-be, the career warriors, the already-moms having their hands full with one or multiple children—I appreciate all they go through for their chance at mommyhood. They, too, know the depths of my pain, which may seem negligible and shallow to those who don’t undergo this ordeal. I think that when we do get pregnant, our little ones will be the luckiest humans in the world because they are wanted so very badly.

Wine is starting to look tempting again despite my 4-months-dry streak. We have gambled and banked on successful IUIs since we've been trying so long, fueled by how my OB thinks that with our stats/odds, a couple of IUIs are a sure bet, so she really hyped us up to the idea. I begin to mentally prepare for the fact that I may need to move on to other options if a few more IUIs don't work out for us; I haven't exhausted all of my options yet. I spend time in my garden, watch my seedlings grow, and take comfort in the fact that at least I can see visible progress, that I can grow and raise something. Either from stress, daily gym workouts, or some weird Letrozole side effect, I start losing weight. The medicine also causes me to break out, which is unusual as I’ve always had dry skin and am not used to dealing with painful acne.

The last three cycles were great in proving that I can ovulate with assistance, but we keep changing the variables (50mg Clomid, 100mg Clomid, 2.5mg Letrozole). My ovulation is always on different days, but for this cycle, we are sticking with the same protocol (2.5mg Letrozole) for IUI #3. I ask my OB to refer me to a Reproductive Endocrinologist (RE) at the fertility clinic that my medical clinic is affiliated with. I think I need closer monitoring of my cycles, whether through some repeated hormone blood work or extra supplements/suppositories prescribed, instead of the standard drill of follie ultrasound, Ovidrel, IUI. I finally secure my RE appointment for May 12^th 2015. These people are booked out for months! I decide to go with the RE who performed my first IUI--she is very calm, personable, and encouraging; the procedure went smoothly and didn't hurt at all; and she's got rave reviews from her patients. I've also started looking at IVF clinics (my RE's clinic also does IVF, but it's not one of the better ones for that). I know I'm jumping the gun and still hope hard that IUI will be the ticket for us, but the two good IVF clinics in my area have about a 7-8-month waiting list, so I decide to secure a December appointment. It's a good time to figure out insurance matters for the next year and see which plans we may want to be on and how much money to put aside.

March 30^th 2015, my husband and I celebrate our 14 years of being a couple by going to Ruth’s Chris Steakhouse, one of my favorites. I break my 4-month streak by having some wine, a red blend called the "Prisoner" upon recommendation of our waitress. It’s primarily composed of Zinfandel, and I savor the sweet honeyed notes, woody accents, and the right astringency on the palate to wash away the fat in the meal.

I go in for a CD12 follicle ultrasound, and just when I think I’ve got the timing down pat and don't change any variables, my ovulation date shifts again. The good news is they do find a maturing follicle on my right side. The biggest one on the right measures at 18mm, and there is a runner-up at 10mm, but we don't think it'll catch up in time. Endometrium is 8.5mm, which is pretty good for where I am in my cycle and should be pretty ripe and cushy by ovulation time. Because the follicle is still too immature to trigger, I am scheduled for a follow-up ultrasound 2 days later. Follicles mature at an average rate of 1-2mm per day, and the endometrium lining grows about 1mm per day. I ask for a 7DPO progesterone test (also called a CD21 progesterone test, due to it usually being scheduled on Day 21 for typical cycles ending in roughly 28 days).

I am determined to get the timing right for this IUI. Third time’s the charm, they say. I do crazy calculations after my ultrasound and figure the follicle will be around 20-22mm by trigger day, and will be at most 24mm by IUI time (24 hours later) and hopefully ready. I’ve never taken math so seriously in my life.

April Fool’s Day 2015, I go in for my follow-up ultrasound. The dominant follicle grew to be 23mm, and endo lining is at 10.5mm, almost on point to my estimate. My IUI is scheduled for the following morning, 22-23 hours post-trigger. “Many women have gotten pregnant on that very exam table,” proclaims the OB in the clinic who administers my IUI. This time, the tenaculum doesn’t have to be used. In countries such as Croatia, women get about a week of leave after Assisted Reproductive Therapy (ART) procedures and up to a year of partially paid maternity leave. Up to now, I have gone back to work after an IUI. Today, I decide to take a vacation day off to rest and see if that does any good.

In this cycle’s TWW, I start eating pineapple core; the idea is that the bromelian, which is found most concentrated in the fruit’s core, is supposed to help with implantation. It’s weird, it’s kind of hippie, but I give it a shot. I also drink rosebud tea during my follicular phase under the instruction of my acupuncturist to help manage my stress level. It has a calming effect and is an ingredient for overall women's health since it's often added to herbal tea medicine. I mix it with the normal herbal teas I drink, like peppermint and chamomile.

The bills start trickling in for the first IUI, a slap to the face of how we’d still have to pay for what didn’t work. I also fork over a hefty check to Uncle Sam for taxes. Babies are expensive even before they come into being. I fill out 15 pages of forms with invasive questions as a pre-requisite to see the new RE. Insurance does not make this infertility journey any easier; I call them daily to hassle them about charges they should rightfully cover and save myself thousands after they double-check and re-bill.

MY 7DPO progesterone results arrive: 18.6, which is characterized as “normal” in the given range of 4.44-28.03ng/ml. They say anything over 15 during an LP is good.

When I start sinking into despair about another cycle potentially coming to an end, my husband surprises me with his saved up TTC knowledge: "Well, we still don't know for sure yet. Your temp today is still above your coverline." Whoa! He knows what a coverline IS! He even used the word in a sentence! I do show him my charts occasionally and he's very involved in this TTC journey with me. There's not much I keep from him in regards to TTC, but sometimes I feel he's just nodding along without it really sinking in to indulge me when I'm talking about human chorionic gonadotropin and hysterosalpingograms (words I couldn't even pronounce before TTC, let alone define). But he's really with it!

On April 16^th 2015, I take another HPT at 14DPO. Testing becomes an adrenaline-infused, heart-pumping anxiety session lasting 5 minutes when I’m afraid to look at the timer counting down. I feel like so many things intensify and grow into monsters in our head. Not to discredit these very real feelings of anger, disappointment, and loss that come from failed TTC attempts, but to continue having hope, we've got to quiet and shrink our own monsters and nightmares to manageable size. I sing the Anastasia song, “Journey to the Past” in my head as I wait:

“Heart don’t fail me now,
Courage don’t desert me,
Don’t turn back, now that we’re here;
People always say life is full of choices,
No one ever mentions fear…

Somewhere down this road
I know someone's waiting,
Years of dreams just can't be wrong...

One step at a time,
One hope, then another,
Who knows where this road may go..."

The test reads negative.

I’m fine until I exit the bathroom and see the hope on my husband’s face; he had waken up half an hour earlier that morning, and I feel like I’ve failed him and myself yet again. I turn into a weeping mess for an hour. He never gives me the added pressure of saying that he desperately wants kids, but I know that part of him still hopes, especially knowing how much it means to me. My emotions today have run the gamut of sorrow and anger, especially at my own body, like I don't know what else I can do to make it work. Though I'm willing to move on to IVF, I am now jaded with science and wondering if even that will fail us. Even if conditions and timing are all correct, statistics show that there is still only a 50% chance that a pregnancy will occur.

We decide to take the next cycle off from IUIs, just continuing my Letrozole prescription and trying naturally. My husband’s birthday is coming up in May, and he's been wanting to take me to Vegas to dine at some of the fancy restaurants. I want to do something special for him after he's been such a trooper through all this craziness. I'm glad we finished filling out the RE pre-req forms as I don't want to have to go through them after a failed cycle as yet another reminder of my barrenness. I'm thinking we probably won't get to start IVF until the end of the year due to the wait, in which time we will plan our overseas trip to Thailand and Bali like we've been wanting to do. Travel was a big part of our lives before TTC, and I've been so afraid to do anything—drink wine; travel far; exercise rigorously. I've been afraid to lift things, climb things, run until I hear the wind whistle in my ears. I just need a reminder of how beautiful life can be again after so many heart-shattering dark days.

What little time we are left with to mourn; it's not like you can keep claiming "bereavement" for month after month of failed TTC. I feel like the only time I have to cry is that space between waking up and driving in to work, and then I need to put on my tough-girl game face. Throughout the day, I can feel myself often slipping away to a faraway place in my head, and I wonder how my thoughts and overall outlook would have been different today if I had seen 2 pink lines instead of the lone one.

At Costco, and there is this little girl who must've been 2 years old, huge eyes, blue dress, blue bows in her hair. She is so cute that it kills me that she isn’t mine. You know it's bad when you start desiring other people's kids. At home during my evening showers, I have ugly, hard, shower cries—ones that come complete with animal wails and a sinus headache afterward—wishing the water could wash away some of the internal hurt.

My husband moves to a new role at work, one that we both know will be impeaching on our normal time together as it can require late-night hours. I picture spending a hard weekend eating and sleeping alone after a negative pregnancy test. I tell him honestly that I don't know if I can stand his job taking him away at all odd hours of the night when we're at this stage of trying to grow our family and the timing for monitored cycles means so much. I grieve for the women whose husbands take frequent business trips, or those soldiers frequently deployed overseas. It tears at me how selfish I am being: I can’t even support his career aspirations now because I am so needy for a baby. I’m aware that I've pulled plenty of 10-12 hour workdays in the past as well, but when a baby comes into the picture, I'll have to change my work habits as family has always been a priority for me, even though I do want to balance a career after becoming a mom. The continued or late-night absence of a parent due to work, especially now that we're both comfortable with finances and are not just making ends meet, is not how we'd like our kids to grow up. So we'll both try for careers with flexible and fairly regular hours and be there for their extra-curricular activities and a part of their lives.

My insurance has only approved Letrozole until the end of May. I feel like a drug addict, terrified that my body will revert to those anovulatory cycles with no beginning, no end, no way of knowing. Nothing's worked: Relaxing, stressing, vacations, work, natural, science, begging, praying, sober, drunk. Sometimes it feels like my hormones have run away with the good parts of my personality; I hate myself and what TTC has done to me. It’s trying on a relationship, one of those difficult husband-wife ordeals. I feel like my self-confidence has shattered, and I am so ashamed.

Takeaways: There is a study about improved pregnancy rates with IUIs done on a full bladder. They call it “passive straightening of the uterus” as the full bladder pushes the colon away from the uterus for visibility. For trans-abdominal ultrasounds to assess the uterus condition, the same protocol is mandatory, but not for IUIs. People with tilted or retroverted uteri claim that IUIs tend to cramp less if done on a full or partially full bladder.