I'm 90% certain

I'm 90% certain...that I'm not pregnant and that I am a nutcase.

I have lost the faith.  I will be testing tomorrow morning though regardless of how I feel now.  Why?  I don't know.  Maybe because tomorrow afternoon I may feel differently than I do now and will become obsessive if I don't test.  Interesting logic, right?  Stranger things have happened.

Seeing a negative test doesn't upset me when I am 90% certain it will be negative but seeing a positive could really make my weekend.  Regardless, I'd like to just get it out if the way.  

Maybe that is what testing tomorrow is all about... Getting it out of the way.  I'd much rather test negative on a Saturday than on a Monday.  If I tested negative on a Monday morning I would dwell on it all day at work whereas on Saturday I would be able to focus on other things in my free time.

Blah.  

It's been 2.75 years.  

Ugh.

I am telling you 2014 is the year.  It is!  I know I said that about 2012 and 2013 but this time I mean it. 

 If for nothing else 2014 is the year that I start liking my life more.  It is the year to quit my job and focus on myself for once.  The year to be taken care of rather than caring for others.  Maybe 2014 will be my year of selfishness.  I think I am entitled to a little of it.

Ugh.  Selfish.  I don't like the sound of that.

I don't know what I am trying to say anymore or how I ended up here I. This thought process but this is a look into my fragile state at the moment.  Little things can snowball into big things in no time.  It's a challenge, surely.

At least it's Friday.  Yippee for Friday.

An interesting couple of months.

I was upset to find out that our December cycle was cancelled but didn't dwell on it too much.  The holiday season distracted me accordingly just as it would have if I had a two week wait.

Surprisingly, my December ovulation was delayed by more than a couple days due to a bad cold.  This is a surprise because on the 2.5 years of BBT charting I have never, and I mean NEVER, had a delayed ovulation due to illness.  This was unfortunate considering our timing, my sickness and the late realization of the delayed ovulation.  We miss the window. 

That was unfortunate but at least the delayed ovulation situation kept things interesting.

Interestingly, it happened again this month!  Just as I was getting over the cold from last month I caught another one.  This one was much milder so I didn't expect it to delay ovulation but IT DID.  This was a very welcome realization because it meant that we could try this month when we though we otherwise would miss the opportunity due to my husbands work travel plans.  What a nice surprise.

So I am in my TWW.  I am 9 DPO.  I am doing pretty well.  I am not too obsessed.  I will be testing on 11 DPO, so on Saturday.  Lately my LP phase has been 10-12 days-shorter than I'd like. 

I am not too hopeful, honestly.  We have been at this for so long without a positive test that I have my expectations set on IVF.  But that is another post.

And so I wait.  

Rainshower:  having delayed ovulation brought on by back to back colds is not pleasant.

Rainbow:  The delayed ovulation allowed is to try this month when we otherwise expected to miss the window.

Not being able to try...

Not being able to try is worst than trying and failing.  I like to be able to say 'at least we tried'.

Unfortunately I have two large cysts on the side I ovulated from last month.  Not good news. The RE won't let us cycle with meds this month.  I get it but that doesn't mean I'm happy about it.

"You could still try on your own", said the nurse.  

Gee thanks.  As if THAT has really been working out for us lady.  If we didn't need help getting pregnant and staying pregnant we wouldn't be your patient. Some people.  I wonder if they realize their blunder after they say it?

Today just sucks.  

We won't be able to do a medicated IUI until February now because my husband is traveling in January.  

The hope for a 2014 is so small now.

Damn it.  2013 was supposed to be my year.  That didn't happen. 2014 was definitely supposed to be my year.  That is looking bleak at this point.  I am so bummed.

The good news on the job front though:  I have an end date set.  I picked it.  I'm sticking with it.  Regardless of the state of my belly, I will be free of this awful job on August 1, 2014.  So in that way 2014 WILL be my year.

Having the end date helps me keep going when I can't stand another minute at work.  It helps me have something tangible and real to look forward to.

I may be quite pregnant, pregnant, barely pregnant or not pregnant at that time and it will still be my last day.

What will I do with my time?  Plenty.

My primary hope is that I will be growing a baby.  All other endeavors will be what I WANT to do FOR ONCE.  Since age 16 i have never taken a break.  I have never been without a job.  I have never taken time to 'find myself'.  I will need to use that time to find myself again.  I am lost in this grief, this disappointment, this expectation that I need to be doing something productive with my life even if it isn't fulfilling.  I need to find something that will fulfill me.  I need to be happy.  I need to break free of the daily doldrums.

Thank goodness I have a husband that wants to provide for me while I figure all of this out.  He is so supportive of this decision it brings me to tears.  As he says, "you have spent years supporting me and now I want to support you".  

I think I won the jackpot when I met him! He is my world.  He is the only one that understands my situation.  I love him so much.

I'm still here. I'm still not pregnant.

It's been an interesting couple of months.

I have a new Reproductive Endocrinologist.  I still have my tubes.  I just finished my first Follistim cycle with an IUI.  A BFN was expected.  A BFN is what we got.

I am on CD3.  I had an ultrasound and bloodwork this morning.  I am awaiting the results but I do know that I have a cyst.  Not sure the size or how this impacts the intention to cycle again this month with Follistim... 

Cysts. The story of 2013.  One step forward, two steps back.

It is depressing to think about the lack of progress that has occurred since my 3rd miscarriage.  (Meaning I haven't been pregnant since July 2012).

Technically I have secondary infertility now.  We are two follistim cycles away from IVF.  Which could be delayed by this stupid cyst and will be delayed by my husband travel plans for work in January.

Delay after delay.  A 2014 baby is looking to be a long shot at this point.

I am bah-humbug during December.  Oh, and I'm approaching another birthday.  

Good times all around.

Rainbow: I have my tubes.  I haven't had another miscarriage.

Rainshower: Another birthday without a baby.  I have friends that have had three children in the span of my TTC marathon.  It is hard to see these children growing up knowing their ages match up to all of my losses.  Recurrent Pregancy Loss just stinks.  Add Secondary Infertility on top of RPL and it blows!

Hydrosalpinx? Paraovarian Cyst? The Mystery Continues

It's been awhile since I've written.  Here is what has happened in September so far...

       Pre Appointment with my RE:

• I spent Labor Day worried sick awaiting an appointment with my Reproductive Endocrinologist.

      Appointment:

• I was relieved to hear that my RE didn't think I had a hydrosalpinx.  Especially after convincing myself that the removal of my tubes was imminent.  He called it an 'artifact'.
• Results of End-of-August ultrasound: 
• " Complex cyst on the right ovary measuring 12x11mm probable residual follicle.  11x14mm left paraovarian cyst and 12x13x7mm tubular filled area in left adnexa which may represent a hydrosalpinx.  No ovarian cyst in the left ovary. "
• I wasn't too worried that he wasn't too worried about the paraovarian cyst because my focus had been on the possibility of a hydrosalpinx.
• I was expecting to have an HSG to rule out a hydrosalpinx... didn't happen.
• I wasn't expecting my RE to say "Let's get aggressive and put you back on Clomid"
• I was a little shell shocked in the appointment.  I was SOOO relieved to hear he didn't think I had a hydrosalpinx that I was much more willing to go along with his new clomid plan.  I would have fought tooth and nail if I had been in my right mind.
• I later became VERY worried about the paraovarian cyst because of a little internet research (basically ovarian cysts can resolve themselves during pregnancy while paraovarian cysts do not.  Paraovarian cysts continue to grow during pregnany often requiring surgery DURING PREGNANCY).  Freaked out yet?  I was.

       Post Appointment:

• My husband was at the appointment.  Thank goodness.  He was able to help me process and provide a couple good points to consider moving ahead. 

       Moving ahead?

• After the end-of-August ultrasound and after convincing myself that my tubes were toast I decided that it was probably time to switch RE's.  I always knew that if we were to get to the point of doing IVF I would have to switch.  My clinic is great but not the greatest in my area.  I live in Boston and have MANY options for clinics.  I need to be at a better one for something like IVF for many reasons.  
• Something else is nagging at me too.  This hydrosalpinx may have established itself as a result of my polyp removal surgery.  My RE was in that area for the surgery and could have injured my tube(s) in the process if locating my polyp.  It was a difficult surgery for the Doctor due to my retroverted uterus and the location of the polyp at the top of my uterus.  For the record I place no blame on my RE nor do I have any hard feelings about this unfortunate situation. Every procedure has its risks.  There is no need to dwell on the why/how this happened.  It certainly isn't going to fix my fluid filled tube(s).  Instead I need to focus on next steps. But if I stuck with this office I would probably but be able to fully trust the doctor anymore because if these fleeting thoughts.

        New Reproductive Endocrinologist:

• I have already putting the wheels in motion for a new RE.  As much as I will miss this office and as much as I appreciate them helping me through many hurdles I know that if I stay with them and things don't work out I will blame myself for sticking with the same RE.  
• Part of my decision to switch also is because I need to also consider the opinions of my family.  My in-laws are in the medical field and aren't too happy that I am not at one of the top offices right now (although they haven't said so they were thrilled to hear that I will be switching).  Not being at a top office really didn't bother me after the experience with my first RE who was at a top office.  That was NOT the right place for me at the time.
• I need to take this potential diagnosis as a sign that I need to move on.  I feel like I am about to break up with my boyfriend or something.  I am dreading it because I do like him so much.

      CD 2 Ultrasound - September 22:

• The ultrasound technician told me that she could see the "area of interest" from last month and that it is still there but small and that it is hard to tell if it is a paraovarian cyst or a hydrosalpinx.
• Nurse phone call...
• She said: I have a small cyst on the right, probably a corpus luteum cyst.  Nothing to be concerned about.  Start the clomid tomorrow.
• I said: What about the paraovarian cyst?
• She said: You will have to talk to your Doctor about it.

Rainshower: This is no artifact.  It is something.  Yet they want me to go forward with the cycle and medication?
Rainbow:     I am so grateful I have an appointment with another RE soon to make sense of all of this.  I just don't know who to trust anymore.

Hydrosalpinx?!

Let me backtrack a bit...

• In early July I found out I had two cysts (one large on the right and one small on the left).  

• Last month I had one cyst (probably the large one getting smaller).  

• This month I have a small cyst on the right (the large cyst STILL isn't gone) AND a few smaller ones on the left side.

No bueno.  I was not happy when I left the ultrasound but wasn't too upset about it.  I was just a little frustrated that the cyst wasn't gone and that it looked like there were more small cysts.  I just don't understand.  I have never had problems with cysts before - even when I was taking clomid. 

I wasn't too concerned about the small cysts at the time because it was possible that they were antral follicles.  Antral follicles are small follicles (about 2-8 mm in diameter) that are 'on deck'.  They are the follicles that are waiting their turn to become a dominate follicle.  Sometimes these follicles can look like cysts on an ultrasound so I was not concerned.

This was not the greatest news but still isn't the worst news I received at my CD3 ultrasound.  The other information the nurse told me in a followup phone call with the results - I have fluid in my fallopian tube by the cyst and more endometrial lining than I ought to on CD3.  "So we are going to have to skip this cycle.  I am going to have your doctor look at these results and schedule you an appointment so he can talk to you about this"

Wait, what? 

"What was the name you used for the cyst again?" I asked. 

She said "It isn't a cyst.  It is fluid in your fallopian tube.  It's called hydrosalpinx"

"Umm, ok" Clearly I had no idea what this all meant but knew it couldn't be good if I now have to see the doctor.

I scheduled an appointment for Wednesday and then went back to work for a minute before Dr. Google began begging me to look into this fluid situation.

What I found was frightening.  

If you google 'fluid in fallopian tube' the only thing you get is "hydrosalpinx" so that HAD to be what the nurse said over the phone.

Here is a nice summary I found at the top of the search results:
http://www.pacificfertilitycenter.com/infertility-diagnosis/hydrosalpinx

According to the website:
A hydrosalpinx is the medical name for a fallopian tube that has become filled with fluid due to injury or infection.  
Injury or infection?  How did I injury it?  I haven't had an infection either.  WTF.

Hydrosalpinx usually affects both fallopian tubes, (even when only one tube is affected, there is usually some residual damage to the other)
Oh great.  Just great.

Hydrosalpinges (when both tubes are affected) is a very severe form of tubal damage and pregnancy is usually only achieved with In Vitro Fertilization.
Wait, what?!
Cue the tears.  There was no stopping the internet searches now.  I had to keep looking into this.  Could I really be forced into IVF because of this stupid fluid?

Hydrosalpinx commonly results from a long-untreated infection in the fallopian tubes. A number of situations may lead to fallopian tube infection, including:

• The residual effects of a prior sexually transmitted disease such as chlamydia or gonorrhea
• Prior ruptured appendix
• Excessive tissue buildup due to endometriosis

None of the above applies to me.  I've never had an STD - I've been tested throughout the years.  My appendix is fine and to my knowledge I don't have endometriosis.  This doesn't make sense.  Was it the IUI, the progesterone suppositories, the uterine polyp removal surgery?  I have lost track of the number of transvaginal ultrasounds I have had- its been so many.  Could it be from that?  How is this possible?

The inflammation and healing process resulting from such infection destroys the delicate finger-like fimbria, which extend from the end of the fallopian tube to the ovary. Fimbria are responsible for carrying the egg to waiting sperm and moving egg and sperm together for fertilization.
Wonderful.  That's not good.  That's really bad.

When injured, fimbria become fused together, thus closing off the tubes. Fluid then collects in the fallopian tubes, making it impossible for them to function.
Fused together.  Seriously.  Could this get any worse? 

In some cases, especially where the hydrosalpinx is small, this type of blockage can be repaired, allowing pregnancy to occur naturally.... A laparoscope is surgically inserted into the abdomen and an incision is made to open the blocked fallopian tube. Recovery from this procedure is relatively rapid and normal activity may be resumed within a few days. 
Oh good, MORE surgery.  REAL surgery.  Through my freaking belly button.

Because ovarian health and egg quality decline after the age of 35, reversal surgery is more viable for younger patients who can afford the additional wait time. 
hmmm, I'm 33, 34 in 4 months.  What is this additional wait time?  A couple of months?

Patients conceiving after tubal surgery must be monitored very closely for a possible ectopic pregnancy.
OMFG. It just got worse.  The fertilized egg may get stuck in there now?  Seriously.  I have enough problems with the recurrent miscarriage worries and concerns.  Now I have to worry about an ectopic?  sigh.

Because of the low chances of success with attempts at surgical reconstruction of the tubes (some studies have shown a 10% pregnancy rate in the year following neosalpingostomy for hydrosalpinges), and because of the increased risk of ectopic pregnancy, most women experiencing significant tubal damage are advised to move directly to IVF.
The final nail in the coffin.  A YEAR?!  Increased risk of ectopic and a 10% pregnancy rate. IVF it must be then.

In order to increase IVF success and a healthy pregnancy, it may be recommended that the damaged portion of the fallopian tube be removed entirely before treatment, as in some cases, fertility enhancing drugs may have the adverse effect of causing fluid buildup in the fallopian tubes. Blocked, fluid-filled tubes also can leak into the uterus, posing a risk of infection after embryo transfer.
Stick a fork in me - I'm done.  This is no quick fix.  Another disappointment another delay.  I'm no closer to holding a baby in my arms as I was 27 months ago when all of this began.

With that bombshell I had to leave work.  Once knowing this possible diagnosis I could not focus on anything else.  Thank goodness the nurse waited until the end of the day to call me back so I could work a little longer.

I am devastated.  I am heartbroken.  I am mad.  I am let down - yet again.  I cried on and off all night and didn't get much sleep.  I am in mourning.  I am mourning the loss of my fallopian tubes before they are even gone.  Let's get rid of them.  NOW!

This is so hard.  Never did I imagine it would be half this hard to have a baby.  Never did I think it would get this bad either.  No tubes now?  No possibility of having a baby naturally again.  No unplanned surprise baby.  No luck.

I realize that I am not yet diagnosed with this condition.  I know that.  My husband hates that I do this.  He hates that I am diagnosing myself.  He the optimist, I am the pessimist. 

I like to be prepared.  I like to know what I am up against.  I'd like to go into my appointment informed.  I also want to prepare myself so I do not fall apart when the doctor delivers the unpleasant news. 

This doesn't mean I cannot have a baby.  It's just another obstacle to overcome.  Another step to take.  I haven't gotten this far by being a wallflower in this path to parenthood.  I am an empower patient that has become my own advocate.  That is my biggest lesson thus far.  SPEAK UP.  DON'T LET THE DOCTOR WALK ALL OVER YOU.  If your gut tells you something is wrong than listen!

I am incredibly lucky in one regard.  My state requires insurance companies to have fertility coverage.  I can have IVF.  I have excellent insurance.  This is not the end of the road for me.  I may be taking the scenic route even though I started out on the highway but I WILL make it to my destination.

I am already thinking ahead...
1.  Doctor's Appointment                                                 September 4
2.  HSG to confirm the hydrosalpinx diagnosis               September 10 (CD 14)
3.  laparoscopic salpingectomy (removing the tubes)     October 17 (in a dream world)
4.  Recovery                                                                    October - November
5.  IVF                                                                             December (fingers crossed)
6.  Baby :)                                                                        September, 2014

Rainshower: My tubes aren't looking too good right now
Rainbow:      It's 2013.  I don't need tubes to get pregnant (although it is much easier if you do).

Another Month, Another Negative Test

I am preparing to go into my blood test Monday morning.  I hate these blood tests because I already know the answer. It's negative.

What is even worse is the awkward conversation with the nurse when she calls with the results.  They always seem surprised that I am not devastated by the news.  It's almost as if I am encouraging THEM to keep trying.

I test early so I can come to terms with the outcome and start a new cycle with a clear mind.  I treat it as a fresh start and am optimistic about next time.  Perhaps this is rare considering the astonishment of the nurses that I speak to.

Am I really that strange?  Is it really that uncommon to test early and already deal with my emotions and disappointment prior to being told by the nurse?  Apparently.

Why a blood test if I already know the results?  Well, most of the time it is required if you have had medication (Clomid, HCG shot, etc.).  

For me though it does provide a little peace of mind.  My third pregnancy and miscarriage was a complete surprise. I tested negative and then got what I thought was my period (but kept spotting for longer than usual).  When my spotting turned into bleeding mid cycle I called the doctor and had a blood test that confirmed I was pregnant and miscarrying.  This is exactly why 'light' periods make me paranoid now.

So our first, well timed, IUI was a bust.  No May baby for us.  I would have LOVED a May baby:(