Or it Could be Nothing

Infertility is alienating. There are all of the acronyms, procedures, diagnoses, etc. Even I don't know them all, but I know a lot of what pertains to and afflicts me, and what some of the other stuff is. The rest I often seek to at least give myself a rudimentary knowledge about, so I can carry on a conversation or interaction with a person dealing with those type of issues. Which means that I feel bad that there really isn't a person that "gets" all of this. Quite frankly, I don't think C and I understand all of what the doctors and information tell us, but I know that we are grateful to those that try and understand what we are going through.

This is all stated because I'm not sure I want to talk about the newest development. It would have to be a phone conversation with all of the distractions and a possibly poor connection and/or battery life and I just don't have the breath in me to explain it all so that it make sense. There is way too much background and explanation necessary and I don't like the implications. So, it will be here instead. The background is located in the post before the wedding anniversary one.

I heard back from the RE's office yesterday morning. They agreed that I did need to come in for a blood draw and that they would run some tests. They weren't sure what type of tests exactly because the doctor was in surgery. I wanted a quantitative HCG (pregnancy hormone) test run, because if it was minimal or negative, I could consider this bleeding a period and begin my next cycle of the tiny yellow pills, but they decided to run a progesterone test. Progesterone is the hormone that raises after ovulation that keeps the endometrial lining in place for potential implantation. When your progesterone dips (usually around two weeks after ovulation), is when you shed your endometrial lining in what we call a period. CD 21 is when they usually run the progesterone tests to figure out if you are ovulating, because at that point, your progesterone levels should be high (if you ovulated) to facilitate a potential pregnancy, or low if you failed to ovulate or some other issue is indicated. So I came and left some blood and waited for a phone call. If my progesterone was low, they would know the cause of my bleeding. Low progesterone is an indicator of some very common issues: luteal phase defect, early miscarriage, and a method to diagnose annovulation. A lot of REs routinely place their patients on progesterone supplements when they are participating in medicated cycles or IUIs. My RE never had me on a progesterone supplement because I haven't needed one. I have 27/28 day cycles (almost perfect) when medicated and a little longer cycles when unmedicated.

My progesterone level on CD 22 was 1.3. Which is definitely why I was bleeding. But there was little indication of why this number was so low and I was bleeding, because I obviously ovulated - I mean we watched the growth of the follicles and triggered them to release. You don't get much more hands on than that. They want your progesterone level over 10 and ideally, over 15. Some women have numbers in the 30-50 range when ovulation has taken place and they are appropriately producing progesterone. In the past, as I stated, I have had no problem with progesterone with numbers between 13-22. The doctor was still in surgery (boy, I hope everything was okay with his patient) and the office was going to consult with him when he came back. An RE's office is open on weekends for necessary reasons, so they said they would call this weekend and possibly run the quantitative HCG test if they needed to with the remaining blood.

Then there was last night. I held off on telling C that I started bleeding on Thursday because it was our anniversary and we had so much going on (picking up the repaired Jeep, my course up North, then dinner, etc.) AND I didn't feel like laying that bomb in his lap. So I told him last night that I had started bleeding Thursday, really early, called the doctor, gotten blood work, and about the low progesterone level. I tried to explain how there was nothing we could do about it, but that the doctor would hopefully know more this weekend. C shut down, as I had expected, I guess. He is so sick and tired of wasting money (as am I). Which is, accurately, what this cycle amounts to: a few hundred dollars down the drain.

Then he surprised me by stating that he didn't want to do any more IUIs/fertility stuff before all of my PFTM was dealt with first. I had been concerned about doing the bladder/medication treatments and physical therapy alongside of IUIs, so I called Dr. B (the bladder doctor's office) and asked about any interaction. They said that their treatments would not interact with infertility treatments, but some of the medications could affect a fetus, so to let me know when I became pregnant. This does cause me pause, because I feel that, after induced ovulation and IUI, that the two week window before we find out if I am pregnant or not, is one during which I pretend/act like I am, in fact, pregnant. Not in my mind, because THAT would be depressing, but for my body - rest, eat well, drink fluids, forgo alcohol, and eliminate any medications or toxins that could be harmful to a teeny tiny developing fetus. So, part of me agrees with C, and the other part wants to hold hard and fast to this plan about doing as many IUIs as possible. He was also concerned about the PFTM (too tight pelvic floor muscles) somehow being a part of our inability to get pregnant. Dr. B says that PFTM isn't a cause of infertility, but that infertility is likely a stressor to the PFTM. However, it is difficult not to see C's point that these muscles are right down in the area where we are trying to get all of my parts and processes to work together and form a baby. Can it just be coincidence? So, I agree that despite what the doctor said, C may have some valid concerns. Which means that we will probably address the PFTM issues first, over the coming months, and then revisit the infertility issues.

I'm not sure what exactly C is going through in his head. Work is stressful (trying doing a mostly outdoors job in three feet of snow and -2 degree weather). I don't know if the fact that our friends got pregnant the first or second time they did IUIs is encouraging him or bothering him about all of these fertility treatments we are doing. Later last night there was a break down. Actual tears from my husband who said he was angry and sad. I just hugged him and didn't know what else to do. I wanted to know exactly what part of all of this made him angry and sad so that I could shelter him from it, but I didn't ask. I don't think that C being this upset is a good sign.

Which brings us to this morning's phone call from the RE's office at 839am. They ran a qualitative HCG test that came back at a 7. Oh, dear. Qualitative HCG tests are done to find out if there is any HCG in the blood stream and exactly how much. Less than 5 is definitely not pregnant, and anything above is considered, well, something else. They want to do another blood test first thing on Monday morning because my level needs to be 5 or less to be considered negative for pregnancy. I asked the nurse (in my just woken up by the call on the cell phone state) what this meant. I must enjoy certain tortures. She said that it had been long enough (nine days) since my HCG injection (the trigger shot) that it was out of my system and that there was a possibility that fertilization had occurred and then not been able to implant. I've never had so many people ask me about my blood flow (are you still bleeding? is it heavy? is it bright red? is it enough that you have to use protection? yes to all). *This infertility stuff, it is as close as they can get to exact science, but really, so much is still unknown.

What do we have here? I might have been pregnant until my body decided to go haywire? A fluke? A numbers game that I shouldn't pay any attention to? OR IT COULD BE NOTHING.

Unfortunately, I still have to tell C about this "nothing."