My wife and I got married when I was 25 and she was 30. We had been dating and engaged for about three years already. We were in no hurry to have kids as we were both gleefully working our hearts out and figured we had all the time in the world. Add to that the fact that I was still very much in the single guy mindset that getting a girl pregnant is the worst thing that can happen in life (death is a close second). Getting married does not change this mind set AT ALL! It actually take several years before the thought of pregnancy and kids sinks in and you can start thinking about it as a positive thing.

You must remember that men are trained from their teenage years that the rules of the game are simple: if you can get laid, you win. If you get laid BUT get the girl pregnant, you lose. Game over!

After we were married for about a year, my wife started kicking around the idea of having kids. It took more than a bit of convincing to get me to agree with this idea. Ultimately, we compromised. We agreed that she’d stop taking “the pill” and we’d stop using any other protection. “When it happens, it happens” became our mantra.

I was content when month after month she still was not pregnant, figuring that I had been given a little more time to enjoy being young and married. Unfortunately, the months kept on going with not even a hint of a pregnant wife.

My wife went to the OB/GYN for a checkup after a year of trying and mentioned to her that we’d been unsuccessful. The doctor did a bunch of checks and tests and told her that she didn’t see anything obviously wrong, but recommended that we go see a fertility specialist just to get checked out but that there was still nothing to worry about.

So she books an appointment with the clinic she was referred to by her OB/GYN – “Reproductive Specialists of New York”. She was given a consultation with the founder, Dr. Gabriel San Roman.

She came back home from the appointment feeling positive. Dr. San Roman had assured her that we were both yound and healthy and he felt that, barring some negative tests, we’d have no problems having a child. The next step, he told her, was that we’d both need to go in and have a full battery of tests done to find the problem.

THE WALK OF SHAME

Testing day comes. We head to the clinic first thing in the morning. I’m expecting the normal stuff that goes into physicals. I am about to be suprised…

First off, I fill out a several page questionaire on my medical history. Next they send me off to the blood room where they take tube after tube of blood. I’m watching all of my blood getting packaged up and start to envision a secret cloning lab somewhere making an army of me’s – hahaha…

Now the fun starts. Just when I thought I was done, a surly looking older woman comes over to me and introduces herself as a nurse. She tells me that we’re off to “produce a sample”. I’m suddenly struck with a vision of being on “The Apprentice” and tasked with creating a sample product to be sold that night on the home shopping channel. Oh, but the truth was much more brutal than “The Donald” could ever be. I was led through a hallway right and left and right again until I was thoroughly lost. Surly nurse lady is not up for small talk and literally says nothing the entire time. We make our way to a door on the left that is slightly ajar, with a big sign on it that reads “DO NOT ENTER OR KNOCK WHEN DOOR IS CLOSED!”. Eyebrows up, I know this can’t be good. Surly nurse lady leads me into the room I will forever remember as the “Ejaculatorium”. Inside, it is a surprisingly large room based on the intended use. The lighting is quite dim and might be almost romantic if it wasn’t in the middle of a doctor’s office. Surly nurse lady gives me the grand tour. To the right of the door is a sink with a full list of instructions. Of course she decides that I may not be able to read and proceeds to go over the instructions in painstaking detail: Wash your hands thoroughly with soap water.

“Wash your penis thoroughly with soap and water from the base of the shaft to the tip. Take an alcohol swab and wipe the head of your penis thoroughly”

(right about this point I’m ready to freak out laughing harder than I ever have before OR watch blood flow right through the skin of my face because I’m blushing so hard). Now, remove the sample cup from the sterile plastic packaging and unscrew the lid. (Let me tell you, that cup is huge! I was hoping beyond hope she didn’t say “please fill this”) Now that we got penis prep instructions out of the way, we continue the tour. Inside the room is a stall with a toilet with one of those hospital type curtain divider things for privacy. She says I can use that if I prefer (What???). To the left of the odd toilet setup is a table with a TV and a VCR on top with a collection of VHS movies next to it. I’m now half interested to see what the professional clinical movies are like and I wonder to myself if they’ll be cheesy or not. To the left of the TV table is a full sized leather couch. It instantly dawns on me why the couch is leather (easy cleanup) blarff!!!. To the left of that is a (leather) La-Z-Boy recliner.

 

 

 

 

 Surly nurse lady tells me how to operate the VCR (ya know, cuz these are so new I may have never seen one before) and points to their selection of tapes. She then tells me that when I’m finished, I must bring the ‘sample’ I’ve ‘produced’ down the hall to the lab door, where I will leave it for processing. Then she says very sternly “Make sure you leave the door OPEN when you leave! Open!”. I give her a “Roger, that” and try to look as ready as I can so she’ll leave me to my shame. She’s standing there like there’s more to say and I’m now fully expecting her to give me a lecture on how to masturbate, since she’s explained every other facet of this operation in such excruciating detail. Well apparently that’s the one thing she decided I probably knew how to do already and left.

I decide to at least git ‘er going so I wander over to the video tape collection to the what we have. I see two things that suprise me. One is a sign that reads “All movies are inventoried before and after each use. Any missing movies will be billed to your account”. Ohhhhh Kay… The next thing I notice is that these movies are not the innocent clinical type that I expected. This are hard core porn movies with titles that explain that in brutal detail. And not your regular porn either! There are ones with lots and lots of participants and several other “niche” varieties.

At this point I’m starting to considering making a run for the exit, but I quickly resign myself to the fact that this is going to happen one way or another.

Fast forward

After producing my sample, I wash up and button up and make my way to the door. I open it hoping beyond hope that there’s no one outside to see me leaving the scene of the crime. Well my hopes were dashed when I realized that there is a woman in an office directly across the hall from me. Her desk is facing the door I’m trying to sneak out of. She looks up at me and then quickly away. My face turns beet red. My eyes drop to the floor and I turn down the hallway and head for the lab to make my delivery.

I arrive at the drop off door for the lab and luck is with me. It’s a dutch door (the top can open separately from the bottom creating a counter) and no one is there. I’m spared further humiliation. I leave the cup on the little counter and make haste back toward the waiting room. I almost make it there when surly nurse pops out from a doorway and catches me!

Her: “Did you leave the specimen with the lab tech?”

Me: ”uh, yeah, on the counter”.

Her: “Did you give it to a person or not???”

Me: “Uh, no there was no one there”Her: “You can’t do that!!! It MUST be given to the lab tech directly!” 

What is an IUI??

Now that both my wife and I have been tested for just about everything and come back normal, we are officially diagnosed with “Unexplained Infertility”, which basically means they have no idea why she hasn’t gotten pregnant.

So my wife heads off to the doctor to have a “what next?” appointment. I have to work so she goes alone. They suggest we do an “IUI” which is short for Intra Uterine Insemination”. This is basically when you take some home tests and/or an Ovulation monitor and wait till your wife is ovulating. Once the tests say she is, you produce a “sample”, the docs office processes the sample stripping out everything except the sperm. Now they put it in a thin straw, put the straw through the vagina and inject the sperm directly into the uterous which will hopefully have an egg on the way.

My wife agrees and they give her a prescription for Chlomid. This drug is supposed to help you ovulate and can make you produce two or three eggs, which should help your odds of getting pregnant.

So wifey starts her drugs. We get an Ovulation Monitor and a bunch of ovulation tests (which work just like home pregnancy tests – pee on a stick) and we’re off to the races. She watches her monitor religiously and when the little symbols say she’s about to ovulate, she calls the doc and asks what next. They said we should come in the next day for the IUI. My wife tells them that I will be at work so it’ll need to be either before or after. The nurse replies “oh he doesn’t have to come in, you can just get the sample at home and then bring it straight here”. WHAT WHAT WHAT THE HELL????? I went through the most embarrassing, forced sexual experience in my life and didn’t have to??? No, says the pleasant nurse on the phone. We can get a sterile cup from the drug store, I can fill it and give it to my wife. They suggest she puts the cup between her breasts on the way up to keep it close to body temperature. As long as she can get there within an hour, it’ll be fine.

Attention men and women that love them: YOU DO NOT HAVE TO WHACK IT IN THE DOCTORS OFFICE! Save yourself the trauma and embarrassment! Do it at home and maintain what little dignity you can in this process!

So we go fetch a cup from the drug store the night before, I set my clock and wake up early to do my deed. My wife and I try to time it so that she takes delivery just before she’s going to leave so that we are well within the time limit. It works out, she dutifully drops the cup between her breasts and heads off to the doctor while I head off to work.

When my wife arrives, she drops off the cup. They tell her to come back in two hours for the procedure. She heads over to Starbucks, has a coffee and kills the time then heads back to the docs. The procedure was done within about 10 minutes. They brought her in the room, brought in my “washed” sample. Showed it to her with a name label on it to double check it’s the right guy’s stuff (a bit disturbing as you know this process was created because they’ve made mistakes before). Once she confirmed it, they popped the straw in and fired the boys into the uterous. They told her to relax and hang out for a few minutes, then she was free to go back to work or whatever she wanted to do.

We waited and waited for the results. When we finally did the home pregnancy test, it was dissapointing. Negative.

That was the beginning of our journey into “Unexplained Infertility”.

Suffice it to say that “Reproductive Specialists of New York” and Dr. San Roman was a total body shop and a waste of time. They just kept upping our doseage of chlomid and doing IUI’s forever. Eventually we got suspicious that they were milking us for insurance money. After substancial research by my wife, we moved over to North Shore University Hospital where we did finally get pregnant and are currently expecting a baby girl.

I will write detailed posts about the rest of our experiences with Reproductive Specialists of New York and our eventual move to North Shore University Hospital.

Technorati Tags: Chlomid, Infertility, IUI

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1. Infertility: Follistim, Ganirelix and Pregnyl, OH MY!  Welcome to infertility drug injections 101… Follistim, Ganirelix and Pregnyl....

Soooo, after another unsuccessful month of using Femara with an IUI, we headed off to see Dr. H at North Shore LIJ Center for Human Reproduction for another infertility checkup. He does a quick sonogram and confirms that the room is vacant, a la “no bun in the oven”.

Dr. H says, “Are you ready to go to the next level?”. We simply reply, “yep”.

We’ve been trying to conceive with Clomid and Femara, both natural and IUI for a couple of years. We had two that ended in miscarriages and the others never took. Ah, the joys of unexplained infertility.

Dr. H tells us that he’d like to do a round or two of injections with IUI’s and then head over to IVF land if those don’t work. While the thought of going IVF is scary because we’ve kind of always looked at IVF as “the last resort”, it’s also comforting in a way because this could also be our best chance of success. Dr. H jots down some notes and directs us to go see the nurses after my wife gets dressed. He calculates that based on this being day 2 of my wife’s cycle that we need to start the drugs immediately.

What are Follistim, Ganirelix and Pregnyl?

Follistim is a hormone that will trigger your ovaries to produce large quantities of eggs. The average woman will ovulate one egg per month. With Follistim, you can produce a LOT more.

Ganirelix is meant to keep you from ovulating early. Since your body is only used to having one egg at a time, it wants to drop each egg as soon as it’s ripe. We want them all to come down together, so you take Ganirelix to keep them in a happy bunch.

Pregnyl aka HCG Shot is the same hormone that women produce naturally. The difference here is that the shot you take is about 10,000 times more of the hormone that you would normally produce. This is done to make all the eggs rain down together.

The nurse brings us over to the “education room” which is just a cubicle with brochures and samples of various drug products all over the place (who ever came up with the term “hospital clean”???). She runs through a blistering fast, crash course in assembling the Follistim pen, dropping the vial into it, screw on the needle, dial in the dosage and stab my wife in the gut while counting to five. Wait! Don’t forget that you need to pinch the crap out of her belly first and stab THAT with the needle. Whoa…

The nurse (who now sounds like an auctioneer) then runs us through the process for Ganirelix and Pregnyl, which are normal syringes and are pretty much the same process as the pen. We smile and nod while our eyes glaze over. We sigh in relief when we are handed a dvd with most of those instructions on it.

Next we have a round of confusion as we try to determine which drugs our insurance will cover. If they won’t cover the Follistim, then we have to go for another brand that does pretty much the same thing except that it doesn’t have the handy pen injector. Instead you have to take a freeze dried pill, drop it in a vial, put some sterile water in it, mix it, suck it up in a syringe and then inject it. Luckily we are spared further misery when we find out that our insurance is A-OK with Follistim. There is a catch, however. Apparently, these drugs are extremely expensive (in the $2,000 to $3,000 range) and our insurance normally wants us to order the drugs from them and they’ll ship them. Since we don’t have time for that, we have to get a special authorization from them. After jumping through some hoops, they finally come back and tell us they’re giving us a one time authorization to get them from some pharmacy we’ve never heard of. The pharmacy will deliver them to our house later that day.

After some serious complaining with the pharmacy (they wanted to deliver by 11pm!) the infertility drugs showed up at our front door around 8pm. Luckily, my wife remembered to ask them to include a box of the Alcohol Wipes. Much more convenient and safer feeling than a cotton ball and a bottle of alcohol.

We crack open the dvd and start watching. It’s pretty scary and intimidating at first. I’ve never given a shot to anyone in my life and considering that these drugs cost more per ounce than gold, a mistake could be either very painful for my wife or very expensive or both. The truth is, once I watched the dvd and put the pen together, it became clear that this wasn’t as big a deal as we thought it was.

Here are a couple of pointers that I was worried about that the dvd explained.
     – The Follistim drug should be refrigerated until you are going to use it. They actually suggest leaving it out at room temperature for a few hours before using it as it can be more comfortable. Once you start a vial, it can be left at room temperature and is good for about a month.

     – The needle should be removed and thrown out after each injection. There are spares that come with the vials of Follistim.

     – when you are dialing in the doseage, if you accidentally go to far, do NOT try to go back the other way. This will just squirt out some of the Follistim. Instead, keep going all the way up. You can then push it back down and begin again (do it slowly to make sure you are actually at the end and aren’t going to spray the whole vial out).

Let The Fun Begin!

With some nerves and trepidation, we pull up a chair, sit the wife down and prepare. Wipe everything really well with alcohol, take the Follistim pen, screw on the needle, crank up the dial to 150 iu, pinch the wife’s belly, tell her to look away (she’s squeamish) and go in for the kill. The needle is extremely thin and went in suprisingly easily. I slowly pushed in the plunger while counting to five, unpinch the belly then pull out the needle. Not so bad after all!

Just nine more days of this to go!

10 Days Of Side Effects

Over the next 10 days, we get the routine down pretty well. By the end of the second day, my wife is quite bloated and feeling pregnant even though she’s not. Most of her clothes become too tight and she’s generally uncomfortable.

About 5 days into the cycle, we started doing the Ganirelix injections in the morning and continued the Follistim injections in the evening.

We go in to see Dr. H a couple of times for check ups and ultrasounds to see how the eggs are progressing. On our last checkup, we had 7 or 8 eggs. The doc ordered a blood test to check levels and said he’d get back to us. When the levels came back, the doc was concerned that my wife may be susceptible for hyper stimulation and may produce too many eggs for IUI (due to risk of multiple pregnancies) so he told us to drop the Follistim dosage from 150 iu to 75iu. We were then told to do this for a few more days then use the Pregnyl (HCG shot) on Sunday.

Three Days of IUI’s

Following the Pregnyl (HCG Shot) on Sunday, we were scheduled for our first IUI insemination on Tuesday.

I was finally called up for my end of the process and went to meet my date (a cute, sterile, plastic specimen cup) first thing in the morning (I am NOT a morning person). My wife and I have a system worked out where I deliver the now occupied cup to her just as she is ready to head to the doctors office (I do NOT fulfill this obligation at the doctors office if at all possible based on past experience and my need to retain the little pride I have left after this process). We try to go to the doctors office together whenever possible, but I also try not to take too much time off of work.

She dutifully places the cup between her breasts (suggested by the doctor’s office to keep it near body temperature) and she heads off to see Dr. H for the IUI insemination. The insemination is uneventful. The nurses and lab techs compliment me on having a sperm count of 54 million and a motility of 97% (never thought I’d get the gold star in THAT subject – LOL).

The post insemination sonogram shows that the eggs in the right ovary are just about ready to drop, but the ones in the left ovary have not quite gotten to that point yet. He asks my wife to come back in the following day for a second IUI insemination. This is fairly normal for them. If they catch the egg just as it’s about to leave, they like to do a second IUI the next day to (as they say) sandwich the egg between two doses of sperm thereby all but guaranteeing the egg will have some company at some point in its journey down the tubes.

Wednesday morning, more of the same… Me and the cup spending more quality time together in the morning. I hand off the boys to my wife and she heads off to see the good doctor. More compliments are received today on the sperm count with my all time record of 63 million and 97% motility.
So much for being told to abstain for two days prior to the iui to keep the sperm count up. The post iui sonogram shows the the right ovary has released the eggs but the left one won’t let ‘em go. Meh! Doc says to come back again tomorrow! Holy Moley!

Thursday morning… I’m now starting to feel my relationship with the specimen cups is suffocating me. I think we need some time apart. I do what I gotta do and hand off the goods. No compliments today though. I have produced a measly 28 million sperm. I believe morale is down at the factory and the union has commenced a work slowdown out of protest. Doc delivers the goods and post IUI sonogram shows the eggs have left the building (yay!).

Now We Wait

The problem with using the injection fertility drugs is that they artificially raise the horomone levels that pregnancy tests use to tell you if you are pregnant. This means that  you can’t use the old “pee on the stick” pregnancy test. You have to go to the doctor’s office for a blood test 10 days after the IUI.

As we’re waiting for the 10 days to pass, thoughts of twins and other scenarios dance in my head. Of course I’m worried about the possibility of multiples as they are much more complicated, but I’m also excited as I can’t help but feel that with 7 or 8 eggs and three days of IUI’s we HAVE to have achieved at least ONE pregnancy.

Well, we didn’t have to wait long, my wife got her period a full five days early and blew out any hopes or thoughts of pregnancy. What the hell???

We went to see the doc on day two after the period started. He asked us if we wanted to do another month of injections with IUI and if that didn’t work, go to In Vitro Fertilization. We agreed that that seemed like the best way to go. He did and sonogram and confirmed that there was nothing going on. He didn’t explain anything or ponder what went wrong with us. He just accepted that there was nothing there and carried on. To add insult to injury, he found several cysts on the ovaries (a known side effect of the infertility drugs) and said that ruled out using the injectables this month (fuck!).

Dr. H said if we wanted to, we could do a natural (no drugs) IUI this month based on our fertility monitor, but he’d leave that up to us.

He told us to schedule an In Vitro Fertilization consultation with him in the mean time, which is apparently a requirement before starting THAT lovely process.

…Man will occasionally stumble over the truth, but usually manages to pick himself up, walk over or around it, and carry on. – Winston Churchill

Technorati Tags: Egg, Follistim, Ganirelix, Infertility, Injection, Insemination, IUI, IVF, Ovulation, Pregnyl, Sperm, Unexplained

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