I have to get this out

I know I've told a few people now about our most recent update on our fertility, so I apologize if this is overkill for some, but its eating me alive and I have to get it out. The reality is that it's going to be a while for me to get it out. I'm still processing everything.

Last Friday we got the results from some basic testing I had done at my most recent annual visit. A little history to catch some of you up. It took us 9 months to conceive Logan...in that time I ovulated only 2 times, conceived the first time but lost it a few days later and two months later (when I conceived again) we were blessed with Logan. Looking back over my lifelong history it became apparent that I'd experienced delayed or non-ovulatory cycles my whole life. I'll spare you the details of why we know that. In any case, we had a happy, healthy preganancy and received a wonderful little boy. I knew that it was possible that we'd struggle to have another child, but secretly hoped that somehow pregnancy would heal my body's hormone problem that seemed to cause challenges.

We were open to getting pregnant when Logan was 3-6 months old and hoped to get pregnant sometime between him being 6-15 months old. It took 12 months for my cycle to return, so I knew it was unlikely to get pregnant before that happened (although, when going through it, you also know it could happen anytime). My cycle literally started on Logan's first birthday and we were officially trying again. I charted for a few months and found that I was extremely regular in all factors (cycle length, luteal phase, ovulation day, etc.). It seemed as if my secret hope had been granted and I started wondering if I ever had challenges with Logan (you forget a lot about trying after you've had the kid!). This extreme regularity (like, to the hour!) surprised me and was certainly something knew to me so I stopped charting and just figured we'd take it as it came. Whatever happened would happen, and seeing as how my problem was that I didn't ovulate in the past, if we got to a certain point and decided we wanted to be more aggressive with treatment (as my dr calls it) then we'd pop some pills and take care of it. No big deal.

I saw my dr. 16 months after Logan was born for the normal visit and since i wasn't begging for more aggressive treatment and technically my cycle had only returned 4 months before I went in for my appointment she recommended to come see her in the summer (08) if I still had problems. That time came and went and I was accepted into the Ph.D. program officially so I decided to finish residency before getting help having a baby. I'd been holding onto the idea that all I had to do was take a pill to get help and yet I didn't want to do that when I was working & in school full-time. If I was going to try to that level I wanted to be sure I had time to rest or deal with side effects if necesary. So, we decided to wait until sometime this spring to get help.

All that time though we didn't really believe that we would need to get help. I remember after my first checkup after having Logan when I scheduled for my next annual and thinking there was no way I was going to make it until then. There was always the next milestone...for sure I'll be pregnant by... I always thought with a chuckle. Those times have all come and gone. I thought about now I'd be trying for #3. as a chuckle again.

So, because of my work schedule the normal annual was delayed a few months and I figured hey, she was going to bring it up anyway, so I might as well bring it up. (remind me to get to that in a minute). So, sure enough, I get to go through the whole deal with the checkup nurse:
Nurse: Are you using any contraception
Me: No
Nurse: Nothing? Timing? Anything?
Me: No (what, do you think I'm lying?)
Nurse: Oh, ok. It's been a while. Did you just stop contraception? What were you using?
Me: No, we haven't used anything since my son was born.

Nurse drops the subject.

Anyway, sure enough the dr. came in and did the normal pleasant stuff and asked me several times if there were any problems. Nope, not really I said. I mean, I'm not having any problems. Eventually she asked enough times and enough variations to get me to admit that there is, of course, the fact that we hadn't become pregnant in 2 1/2 years. I reminded her what she said last year and explained about school and our desire to wait for "aggressive treatment" until that was over. She was ecstatic that it was the oh so special day 21 (of course, I didn't know that, but i guess it worked out), and we did blood work and scheduled me for a sonogram that had to be rescheduled twice before I could finally make it in.

It took 2 weeks for me to get the results. By this time I knew I wasn't pregnant that cycle and just wanted to know what I was supposed to do next based on the results she had for me. I really didn't think about the results too much during this time, but was curious what they'd have to say.

I admit, deep in my heart I knew that I was ovulating. I also admit that even after 2 1/2 years (1 1/2 years if you count from the time my cycle returned) of trying that even though I've told everyone I have fertility challenges that I didn't believe in my heart that we did. Part of the reason for that is that I hate to be embarrassed or look stupid for things like this. Not that I'm embarrassed to have a medical condition (hello...not allowed to drive in CA?), but more importantly because I didn't want to admit seriously to myself and others that we really had problems because I was sure that as soon as I did admit how painful that admission is, the next cycle we'd be pregnant and I'd look foolish for not being patient enough or faithful enough. Plus, I knew I was ovulating, so it was easy to go ahead and blame it on stress or just saying that it was God's timing and how grateful I am that I'm not living my life the last 3 months with another newborn. And, knowing I had just a short time before I'd be forced to acknowledge that I really wasn't ovulating, take the pills, and get pregnant this summer, easy breezy.

Or so I thought.

When the nurse finally called with her results it was unexpected. All they did was check my hormone levels after what should have been ovulation to make sure I was indeed ovulating and a sonogram to prove that I didn't have large cysts on my ovaries (something I've had before). Even though I mostly expected to hear that I was ovulating I also expected to hear that I had ovarian cysts or odd hormone levels. I was correct with the first but not with the second. She said everything was normal.

Which of course sounds good at first. I asked a few questions about the results to verify what exactly she was looking at to say I was normal and sure enough, no cysts, hormone levels were great for that time in my cycle, etc. I'm looking great. She started to go into her spiel about fertility taking a little while and the dr. won't see me until blah blah blah...sometimes I wonder why they even write in those charts if they aren't going to look at them before talking to him. Eventually I got her to talk to the dr for me to see what I was supposed to do next after hearing lecture about how the dr wasn't going to write me a prescription for clomid over the phone...which was completely unsolicited particularly because I wasn't asking for clomid especially after hearing I was ovulating just fine!!!

Anyway. I have an appointment on the 20th. I know it sounds good that I'm normal, but its about 99% chance that hearing that was not good news. What that really means is that I'm ovulating fine, and for the past +/- 2 years we haven't been able to get pregnant even still. This indicates a much greater problem. It could be a various form of three issues...either it is male-factor infertility or I have structural issues, or I have a chemistry problem (but not a hormone problem). None of these are good.

I believe the next step will be to test for male-factor infertility which could result in three things: normal (everything's fine), no sperm, or problem sperm (low counts, problem with movement, shape, etc.). If its no sperm, there isn't much that can be done...maybe there are structural problems that can be fixed by surgery but not likely. If its a sperm problem, there are a couple options including "artificial insemination" known in the fertility world as IUI or in-vitro fertilization or IVF. IUI is only good if the problems are mild. If everything's normal, then onto more testing with me.

For me, there could be chemical problems so that my body is seeing the sperm as an intruder and killing it off. Or it could be structural problems like a blocked fallopian tube. Chemical problems can be treated by surrogacy or IVF, depending on the situation (but this isn't likely since we already have one naturally). Structural problems are very possible and would be treated with surgery or IVF, depending on the exact problem.

So if you've followed all of this, it appears our options will boil down to the following with the approximate costs:

We can't do anything to improve our chances of becoming pregnant (i.e., no sperm)
IUI - $300-$3000 per cycle, depending on the complexity necesary
IVF - $7000-$15000 per cycle
Surrogacy - depends on the surrogate and specific situations...essentially would be like an IVF procedure with someone else carrying the baby

(notice I've left out donation, either sperm or egg...not against this necesarily for anyone else but we lean away from this for ourselves for now)

Then there is there are obviously two other options other than proceeding with those treatments...adoption or take life as it is and move forward without plans to have any more kids. Either one of these isn't easy either. Adoption obviously is costly for an infant or we have to have the discussion about whether we want to do foster-to-adopt which would be really challenging with me working. Lots of decisions in that as you could tell. But the other option isn't easy either. Because of my medication and knowing that stranger things have happened than having an infertile get pregnant, I will have to track my cycles until menopause or sterilization, which would be hard to deal with the reminder each month that we're not going to have another baby and making the decision toward sterilization would be extremely difficult as well.

So these are the things running through my head over the past couple days. It's extremely hard to know at this point what we'll do because we've got a ton to face in this process. We don't know what the problem is to be able to determine how we could, let alone would want to, fix it.

Before I go to sleep for the night, because I'm tired and drained and my 2 year old is still awake upstairs in his bed and its midnight and I have to wake up and face it all again tomorrow, I want to make sure I mention one more thing. I have not lost faith. Not at all. I am completely ok with accepting either that we have to be patient in knowing God has perfect timing or that God's perfect will is for us to have only one. My heartfelt desire is to have a lot of kids. I don't know that this is God's desire for me. Jason and I have never agreed on the exact number of kids that we'd want and neither of us feel like God has promised us anything more than we have already. So, the challenge isn't that we don't believe God has a perfect will for us or that we don't believe God could and would make us pregnant, but more that we don't know what he wants us to do at this point. We don't know....we don't understand what this is that we are facing. I strongly believe it is for a reason. I strongly believe that with any of the possible outcomes, either that I can deduce or that are left unknown, that God will be glorified as this is my/our top goal in our lives.

But I face the reality that either God wants us to wait, God doesn't want us to have more, or God wants us to have more but have it be a struggle both financially, physically, or emotionally. All of those are hard to swallow. And it will take time. We don't have the money for any of the options above...Logan continues to get older and it makes me sad that he doesn't/won't have a sibling close to his age that he can grow up with (we're looking at about 3 1/2 right now if we get pregnant pretty soon)...I may never get to stay home with my infant, something we've looked forward to with future children. I may never again get to go through the wonderful experience of birth that I loved so much and looked forward to so much. I may not be able to give my husband the daughter he desires. I may never have the house full of boys I desire. maybe no more breastfeeding, no more making baby food, no more cloth diapers. If we do need to pay for some sort of family building option, we'd need to consider if we want to wait a few more years or put off paying debt to pay to have more children...how horrible is that I feel like no matter the option I'd be buying a child.

Anyway...if you're interested there are plenty of "what to say/not to say" articles out there online to help friends/family going through the infertility process. Please promise that if I do get pregnant next month on "our own" you won't say anything to the effect of "see...you just had to wait a little longer" or "see...you were worried for nothing". Right now I just need prayer for strength, peace, and wisdom to get through this season grieving what I thought it would turn out to be and getting excited about what God has in store for us. Pray for my husband and our marriage as this obviously can be a strain in so many ways.

I'm really tired now. I'm going to bed.