IUI #1

Yes, woke up at 4 am like clockwork this morning. Sigh. As I was laying there trying to decide how badly I needed to go the bathroom, I heard a door squeak open. One of my dogs and I both heard it and were up in an instant with an adrenalin rush. When you live by yourself and it is 4 am, this is not a good thing. Turns out my back door (which is a French door going out into the backyard) must have just been closed, but not latched. We are currently having a wind storm and the wind was strong enough to blow open the door. Glad it wasn’t an intruder. As I lay back in bed attempting to go back to sleep for an hour or two, I started thinking about my first IUI. Boy, I was such an ignorant newbie at the time. I am sure that this is the worst kind of newbie. I was so full of excitement and hope and optimism. How could this not work? I had spent 6 months getting everything checked out and ready. I had no known problems and had never tried to get pregnant before. In fact, like many others, I spent considerable effort making sure that didn’t happen.

My college degree is in Information Management from the School of Business. I started out with a general business major, but moved to the Information Management degree after a year of general education. As the saying goes, it was like a duck to water. It was my niche. I love information and have a strong need to know. I also have a strong project management background. I do and have done a lot of project and program management for work, but it really is part of my personality. I am a planner. I really have to have a plan. The plan can change and be updated, but it must be present.

My baseline (original) ttc plan had me delivering a child in February 2005. I figured starting in October should give me plenty of lead time. Of course the more I learned, the more I learned and I realized this could not be as easy as I planned. I was truly shocked when I heard that my chances of conceiving in any giving month with an unmedicated cycle was only 5% and went up to about 10% with clomid and 20% with injectables and this was only if no problems were encountered. With these odds, I was already behind schedule and I hadn’t even started yet. However, in my heart of hearts, I never believed I would be where I am today moving to IVF and having used up all of my insurance benefits. It was just inconceivable to me at the time.

Work was extremely, extremely busy and stressful at the time. I had taken on a new job (a promotion of sorts) in January 2004, but couldn’t give up my old job until May 2004 so I was doing both jobs (my old one and my new one) for the first few months of the year. This was compounded by the fact that each of these jobs were combined in the west, but separated in all of the other regions (east, central, and Canada). Meaning, I was basically doing 4 jobs -- Performance and Process (PPI) and Project Office (PO) Leader for both our SF/Bay Area Solution Centre and the entire Western Region. It sucked, but I really just couldn’t give up my old job yet. I had been leading an effort for the SF/Bay Area SC (BASC) to improve our process maturity to a CMMI L2 for over 2 ½ years and we were in the final preparations for the assessment (process audit) to confirm that we had achieved our goals. I just had to see it to the end even if it meant working nights and weekends to keep my head afloat in the meantime.

I started my first IUI cycle in late April. I had to be out of town for work for a few days so we did my cycle day 9 (cd9) check on cd10 after I had returned. This was just weeks after successfully passing our CMMI assessment. I guess reflecting back now it is much easier for me to understand how I could be so ignorant going into the process because I literally had no extra time for personal research just then. I had been trying to chart my basal body temperatures (BBT’s) since I went off the pill in Nov. 2003, but it was erratic. I did take my temperature every day (or almost), but my sleep patterns were irregular and I never did get a solid pattern. I now know that this was because I was not ovulating on my own and what looked like a nice regular cycle was masking anovulatory cycles and a luteal phase defect.

When I went in for my cd3 baseline u/s, I had an ovarian cyst. I couldn’t believe it. It seemed like every time I turned around there was another hurdle or roadblock. My dr. said I could either wait the cycle out or have the cyst aspirated. I just couldn’t decide right then and there while I was in the stirrup’s so I asked for a few hours to think about it. I got home and called the sperm bank to find out if I waited would I have a better chance of getting one of my top 2 donors. I think I had gotten my 4th choice. Turns out my #1 donor had just come available and I could get him either way if I waited a month or if I proceeded this month. They would swap out since it hadn’t yet been shipped. Perfect, if I hadn’t had the cyst, I would never had called and never known this. I went back and counted the days and went through all of the options on shortest cycle and longest cycle. It was almost certain that if I waited a month, I would be waiting two months because I would be out of town for work the week I would be ovulating next month. I went back to the office several hours later to have the cyst aspirated and left with my clomid prescription in hand. I was so excited to be doing this. I was finally on my way!

I had never used an ovulation predictor kit (OPK) before my first IUI cycle. It actually never occurred to me at the time to try to do a trial run to make sure that it worked and I knew how to do it. I had another u/s on cd14 (Sunday, May 2nd) and was told to start testing and to come back tomorrow for another u/s. Cd15 showed neg. on the OPK. While I was supposed to test once a day, I decided more monitoring was needed. On cd16, I tested 3 times at 6 am it took 6 min. for the surge line to appear, at 1 pm it took 4 min., and at 7 pm it took 7 min. I was told to come in on cd17 for my IUI. I was a bit freaked because I was showing neg. again on the OPK’s. At the time I didn’t realize that it was called LH Surge for a good reason and that I wouldn’t be testing positive for the duration. I had my first IUI on cd17 (Wednesday, May 5th) and my second IUI on cd18. The u/s on both days confirmed that I had not yet ovulated. I was truly freaked out at this point because I had only bought 2 vials of sperm which reportedly only last for less than 24 hours. They did an LH blood test to test those levels on cd18 (since I STILL had not ovulated) and I went back in on the cd19 for another u/s. I was in a panic calling the sperm bank to see if I could get another vial or two of sperm, just in case. Could it be emergency shipped? Not only was my donor not available, I realized that they just can’t react to such short term requests/emergencies no matter how much money you are willing to pay. I am sure they thought I was crazy and truth be told, I was. How could I possibly ovulate so late? If I hadn’t ovulated, the cycle was a bust. My u/s on cd19 (Friday, May 7th) showed that I had finally ovulated. Yes, there was still a chance!

I started officially reporting to my new boss on May 3rd. The first week I reported to her I was out of the office 4 out of the 5 days for my first IUI. We were off to a great start. Her administrative assistant who knew that I needed blood tests (my cd3 FSH/LH levels) while on my last trip to Texas because I needed her help in finding a lab thought I was dying at this point. I really wasn’t prepared to disclose what I was going through, but I couldn’t let them think I was terminally ill. My new boss and her admin. are located in Texas. I suppose I could have just not told them I was out of the office for all of these appointments, but I just couldn’t do that even if they would never know. When you work remote from your boss like I have done for years, I feel it is very important for them to know when you are not working during business hours. I never want to be in a position where my boss can’t get me if they need me in an emergency and not having disclosed I was out. The trust is too fragile. Thankfully, both my boss and her admin. have been very supportive. It has made it easier on me with them knowing what I was going through. It didn’t hurt that my boss has several personal friends that have gone through infertile treatments and had a working knowledge of what I was/am going through.

I am not sure that anyone can prepare you for your first 2ww. I know that I was completely unprepared. It didn’t help that my mom and my sisters kept asking me “do you feel pregnant”. Yeah right. I was at wits end. I had completely turned over my BASC job and was just doing my new job, but there were strong rumors that we would be re-organizing within the next month or two. As such, things had really slowed down. No point in heading too far in one direction at this point when it was all going to change. It would just be a waste of time and resources. I became an internet junkie soaking up everything I could learn more about the process now that I had a little bit of time. I became an avid reader of my clinics discussion board and was reading religiously through the archives when I came across a reference to IVF Connections where other women who were using my clinic supported each other. As I have previously posted, this was just what I needed at the time. From there, another single women pointed me to SMC and I got hooked into that network. I have made a lot of contacts and several really great friends as a result.

I really feel like I conceived on my 1st IUI, but that it didn’t stick. I really think I felt the egg implant. I have often thought back to whether this was all in my mind or not since I have never felt like that again. Granted, I have been on progesterone supplements ever since as well which would mask the symptoms. I can remember it vividly. It was a Thursday and I was working away. I just got a rush and a feeling of intense joy. It was very weird. I just re-read an email I sent to my dr. after that titled “Getting Excited, Should I be?” Even though I find it very embarrassing (even now), I want to be honest on this blog and that is where I was at the time. So, here is the email exchange…..

My email:
Dr. N - In my own humble opinion, I have been doing a great job of not worrying and staying occupied with work, family, and friends during this waiting game… although this has been one of the longest/slowest week that I can remember even with keeping busy. I swore to myself that I wasn’t going to be obsessive over this and do an early pregnancy test at all…or at least until next Tuesday or Wednesday if I just couldn’t stand it. Next Wednesday would be day 30 of my cycle (which is the longest cycle I ever have had) and I am very regular. However, is it possible to actually feel the egg implant? We did the second IUI last Thursday and I think you said that it would take 7 – 10 days to implant so the timing would be right. How soon can I/should I test? I think you may have told me last week when to come back, but I honestly don’t remember. This morning I had mild cramping which was not at all like normal cycle cramping and then a “rush”. I don’t really know how to explain it. Plus, I think my breasts have swollen a size or two this afternoon and are tender. I am just feeling very happy and optimistic. Could all of this just be in my mind? Other than not sleeping very well (although much better than last week), I am feeling GREAT and not at all like I am going to get my period. Logic tells me that at this point I either am or am not pregnant and that only time will tell so what does it matter if I know tomorrow or next week. However, from an emotional perspective, I want confirmation before I get too excited. What do you think? Debbie

His response:
The symptoms you describe are symptoms of very early pregnancy. However, the only way to know for sure is to do a blood pregnancy. The first time this test is positive is roughly 14-15 days after the insemination. Commercially available urine pregnancy tests usually are not positive for a another week after that. You should have had an appointment to come back and see us after the insemination. If you didn’t give our office a call and make one. Good Luck!
Dr. N

Friday night, May 14th (cd26), I started spotting and having minor cramping. By Saturday, I was having major cramping and heavy spotting. I could only lie around and be a couch potato. I even took a several hour nap, which is just unheard of by me. By Sunday, I knew that if I had conceived it was no longer viable. God, I was so sad.

My dr. endeared himself even more to me by not laughing off or discrediting the fact that I had thought I conceived when there was no hard evidence to confirm it. He had me come in for an u/s and beta just to be sure. Turns out that I had another cyst, but I wasn’t cycling this month anyway. Not only would I be out of town while ovulating, I need to take a break and regroup from the roller coaster ride of my first IUI. I had expected the process to take an emotional toll. I could never have imagined the reality. Knowing it and living it are two entirely different things.

Now that I had found the internet school of medicine, I researched to death all of the possible causes of early m/c and my dr. and I decided that we would test my NKA (natural killer test) before my next cycle and we would test my progesterone level 7 dpo of my next cycle. My NKA’s came back normal, but my progesterone levels on my next cycle came back as too low to sustain a pregnancy. If I had conceived with my first IUI in all likelihood I would not have sustained it based on these levels.

Did I conceive on this try? We will never really know. I feel like I did. It could have all just been my imagination and I have never felt the same since. Even if my progesterone was higher, I had ovulated so late that there was a good chance the egg was overmature anyway. Who knows? I was on to IUI#2 much more educated and much less of a newbie.