Boo to You

Happy Halloween everyone!  And…more importantly…happy birthday to my wonderful momma.  Growing up, Halloween was a special holiday for us.  It was an opportunity to dress up and get great candy but it was also a day we spent with friends and family to celebrate my mom’s birthday.  Every year, we’d eat take-out pizza and birthday cake before donning our costumes and heading to the biggest neighborhood we could find to trick-or-treat.

This weekend was quite a bit different from the Halloweens I experienced as a kid but no less wonderful.  Completely un-Halloween related but the Cardinals won the World Series on Friday night and MU had a terrific come from behind win against Texas A&M on Saturday afternoon…I knew the weekend was shaping up to be pretty terrific.  We spent Saturday night with some of our closest friends who know how to throw a heck of a party.  The evening had a very simple equation…Food + Alcohol + Twister & Ultimate Ping Pong = A GREAT TIME!  JPug and I were vampires…

Sunday afternoon we volunteered at the KC Zoo with Tiger Stripes (an MU Alumni Association service organization) for Boo at the Zoo.  We enjoyed the beautiful weather while handing out candy to hundreds of metro children.  We continued the vampire theme which was a total hit…most of the kids were mesmerized by my fangs which I assured them were NOT real :)

The big weekend culmination was pumpkin carving with friends.  JPug and I used patterns while Blake & Mary free-handed their masterpieces.  I think this might be the first time JPug and I have ever carved pumpkins together but this was Blake & Mary’s 5^th Annual Carve-Off.  Check out the pictures below and vote for your favorite in the comments section…Pumpkin “A” is on the right and Pumpkin “B” is on the left.



Duren A (Right)     Duren B (Left)



Pug Pumpkins

Today’s the big Trick-or-Treat day…have fun, be safe and don’t be stingy with that candy! 

Quick Update

As excited as I was to talk about non-“I” word topics…

The results of JPug’s 3^rd analysis came in this week and were…improved.  Not “normal” but also not the down-and-out, move straight to IVF story that we heard a couple months ago.  So, I’m happy cautiously optimistic to report that we should be starting IUI (if you don’t know what that is…read my previous post) with my next cycle. 

There are still a few potential hiccups we could encounter…1) my body is still getting used to the synthetic thyroid hormone which takes time (although the thought of “time” is super annoying to me, I feel like I’m actually getting more patient as the process progresses).  My TSH (if you don’t know what this is…read my previous post) is lower but the affects the dose has on my body and systems vital to reproduction are still in transition.  2) The hand-off of JPug’s blood tests from Dr. K to Dr. N have been the exact opposite of smooth.  Dr. N needs to complete a full review of JPug’s blood work as he may be able to identify the root cause of any issues. 

Man…Team Pug is a heck of a pair with what seems like a fair amount of problems!

Because I have no interest in blog readers becoming cycle-stalkers, I probably won’t discuss the IUI process a whole lot as we go through it.  I’ll continue to write posts about the process in real time (experiences, thoughts, feelings, etc.) but probably won’t publish those posts until the time is right.  It’s important to me that we share information about the entire process but it’s also very important that if we do conceive, we get through the crucial first trimester before announcing to family and friends.

Enough of this “I” word talk…back to the fun stuff!

Quick & Delish: Crockpot Pepper Steak

One of my favorite hobbies is cooking.  I love trying new recipes and challenge myself to make a sit-down dinner most nights of the week.  I’ll share some of my favorite weeknight recipes labeled “Quick & Delish” to signify tasty weeknight meals that won’t force you to spend the entire evening in the kitchen.  The recipes I’ll share are tried & true…I’ll always include my own comments as italicized remarks within the recipe & directions.  Bon appétit!

Ingredients

• 2 tablespoons vegetable oil
• 3 lbs boneless beef top sirloin steak, cut into strips 
• Note: You could probably use a lesser quality cut of meat as it crumbles when fully cooked 
• 1 tablespoon minced garlic
• 1 medium onion, chopped
• 1/2 cup reduced sodium soy sauce
• 2 teaspoons sugar
• 1 teaspoon salt 
• Note: I would suggest omitting the salt as the recipe is fairly salty, even with reduced sodium soy. 
• 1/2 teaspoon ground ginger
• 1/2 teaspoon black pepper
• 3 green bell peppers, cut into strips
• 1/4 cup cold water
• 1 tablespoon cornstarch
• Hot cooked rice 
• Note: We prefer short grain brown rice and recommend Lundberg which can be purchased at most grocery stores.  If using short grain brown rice, note the cooking time as it can be up to an hour.

 Directions

1. Heat oil in large skillet over medium-low heat.  Brown steak strips in 2 batches.  Add garlic; cook and stir 2 minutes. Transfer steak strips, garlic, and pan juices to 4- to 7- quart Crock-pot slow cooker.
• Note: I prefer to brown the meat on med-high which cooks faster and really seals in the juices.  Once the pieces have a nice caramel color on one side, brown the other side, remove them from the pan and place them in the crockpot.  Add the garlic while browning the second batch.  The increased skillet temperature made it difficult to remove the pan juices once the steak and garlic were cooked.  I removed the steak pieces and added ½ c. of water to the skillet to deglaze.  The additional moisture should loosen the pan bits right up…add the liquid mixture to the crockpot.
2. Add onion, soy sauce, sugar, salt (I would suggest omitting), ginger, and black pepper to slow cooker; mix well. Cover; cook on LOW 6-8 hours or until meat is tender (up to 10 hours).  Once I added all the ingredients to the crockpot, it didn’t look like much.  I was scared to death that the meal would burn while I was at work.  It cooked for right at 10hrs and was perfect when I got home.  If you know your crockpot runs hot, I would suggest reducing the cooking time.
3. Add bell pepper strips during final hour of cooking.  Blend water and cornstarch until smooth; stir into slow cooker.  Cook, uncovered, on HIGH 15 minutes or until thickened.  Serve with Rice.

Makes 6-8 servings.

Thanks to Mary Duren for sharing this quick & delish recipe.

What's Next?

Well folks, it’s official…I’ve summed up the most important topic in the life of Team Pug over the past 17 months into 10 blog posts.  Thanks for bearing with me through the details & information as I let it all spill out.  I’ll be honest, it wasn’t pretty but it’s our reality and I’m glad to get the topic off my chest and out in the open.  At this point, you know the highlights of what we know and from here on out, I’ll write about “I” word topics if we have an update or something strikes me.  Now you’ll get to experience the process right along with us…in realish time.

Throughout the course of the blog I’ve had a couple questions that I’d like to address.  Don’t forget, you can always post your questions as a comment to the post and I’ll respond for all to read.

Q:  You provided a lot of facts and information through your blog but didn’t mix in much about your feelings...

A:  I’m feeling pretty good.  To be completely honest, infertility sucks but I’m thankful to be going through it because I learn more about the process, options and next steps every day.  If it wouldn’t be for the 8+ years of my life and the associated costs, I’d go to med school so I could really know what the heck I’m talking about.  Emotionally, I have good days and bad days (luckily the bad days are few and far between) and I’m really thankful to have an excellent support system of friends and family and a terrific husband. 

Q:  How is JPug feeling about all of this?

A (in his own words):  My first appearance as guest writer, I’m so excited (please note the sarcastic tone).  To be honest, my feelings about this process have been much more analytical and much less emotional than those of my better half.  With each step in this journey my mentality has been “Well, that didn’t work so what do we try next?”  I often feel like I could be a more supportive husband but have realized that listening is my best role.  Guys, don’t tell your wife that she is being too emotional.  That goes over like a turd in a punch bowl. 

I’m sure some probably feel that this blog is a little TMI (that’s Too Much Information for the 50 and over crowd) but we both feel that sharing this info may help others understand the process better and may help those dealing with similar difficulties realize that they are not alone.  I often wonder if people even really want to read everything that we post but figure that just the act of writing the post is a good outlet.  You all are an extension of my listening ears and I thank you.

Going forward, I’m as optimistic as an engineer can be given the: (((50% success rate) X (2% motility) / (2.5 TSH)) ^ (28 days per cycle))) = something we have no control over.  It’s engineering humor folks, I’m not sure how my wife puts up with me.  Regardless of what happens I know that Team Pug will make the best of the situation!”  

Q:  IUI’s success rate is pretty low…is it even worth going through IUI vs. IVF?

A:  Depending on the type of infertility issues a patient and her partner are trying to overcome, IUI can be totally worth it for some couples.  IUI is a much less invasive procedure and comes with less risk (less risk to the mother from a procedure-standpoint and a lower risk of multiple babies).  At less than 10% of the IVF cost, IUI is much easier to swallow financially.  Lastly, the IUI procedure can make a big difference for couples where the woman has a small cervical opening, for example (among other reasons)…the concentration and targeted placement of the man’s sample can make all the difference.

Q:  Can the doctor mix multiple samples from the man for a single IUI treatment?  

A:  Yes…but each sample takes 3 – 4 days to retrieve and samples must be cryogenically frozen in order to be preserved.  If a sample is frozen and thawed, deterioration is about 50%.  If low-count is the issue, cryogenically freezing and obtaining multiple samples isn’t usually the right answer for the couple.    

Some of you may be thinking…why in the heck is this girl airing her dirty laundry on the internet for all to read?  In one word, infertility is isolating.  At a time in our lives when everyone in our age bracket has baby-fever, infertility is the last thing on most people’s minds.  The blog gives me an opportunity to share our story and brings a topic that’s usually swept under the rug to light.  I’m not sharing so people feel sorry for us, I’m sharing so those who haven’t experienced infertility understand a different perspective and so those who have experienced infertility know they’re not alone.  If you know someone who is experiencing infertility, please don’t hesitate to share our story.

Enough of this “I” word stuff for a while…I have a whole post-it note full of other topics that I’ve been compiling for months and can’t wait to share.  My only problem now is what to write first!

The Next, First Appointment

The first Friday in October, JPug and I had our first appointment with Dr. N.  It was quite a bit different than our first appointment with Dr. K although it started the same. JPug had to fill out a slew of paperwork (yes, I definitely did a happy dance that I didn’t have to fill out anything). 

By the way…how do my dogs have a full electronic medical record at their vet that can be easily transferred from clinic to clinic if we move but JPug and I are constantly re-writing (yes…pen and paper) all of our information from one physician’s office to another…even if it’s within the same medical system?!  I digress…but I just had to get that off my chest…back to Dr. N. 

We were ushered back into an exam room and waited just a few minutes before a resident, Dr. P came in.  We discussed our current process to date and he reviewed the results of JPug’s two analyses.  Dr. P would look at the results, ask a question…obviously attempting to determine an underlying cause of the low-count …JPug would provide an answer Dr. P didn’t expect (in a hmmm…this guy seems normal sort of way) and he’d go back to the results again.  Dr. P and JPug went back and forth for about 10 minutes until he finally gave up.  Well, I guess “gave up” isn’t the correct terminology…maybe medical mystery is more fitting.  At some point in the conversation, the term “biopsy” came up which was pretty alarming but Dr. P decided that course of action wasn’t appropriate based on JPug’s additional answers (whoa, big sigh of relief for JPug…no biopsy in that area).  Before Dr. P left the room, he completed a quick exam on JPug to ensure everything checked out…and it did.

A few minutes later, Dr. P returned with Dr. N.  Dr. N is an interesting sort of guy…middle aged, shape reminds me of Santa, Indian decent with a British accent (whoa, this guy is a melting pot of 1).  After a short conversation, Dr. N confirmed what Dr. P eluded to previously…sometimes the cause of infertility is more of a medical mystery than an exact science and we’d likely be moving forward in our conception process through IUI or IVF.  He recommended that JPug have a 3^rd analysis completed as a sort of a tie-breaker between the first two.  The results would give us a clearer path to follow as we continued our journey.  Dr. N prescribed a folic acid/B vitamin prescription medical food (Metanex) that’s typically intended to treat patients with diabetic peripheral neuropathy.  No, JPug hasn’t been diagnosed with diabetic peripheral neuropathy (and no, I can’t really tell you what it is) but Dr. N suggested that JPug try the prescription as it may enhance future counts.

Knowing that we would likely be moving toward IUI or IVF, Dr. N used the remainder of our appointment time to discuss the procedures and their associated costs.  He was very thorough and approached the topic from an academic perspective.  Fortunately, we had researched both topics prior to the appointment and his information confirmed a majority of what we already knew.  He also touched on the genetic impacts of JPug’s low count.  In about 10% of the male-infertility subset of the population, a low count can be caused by a genetic mutation which is passed from father to son.  A female child would not be affected by this mutation but a male child would…100% of the time.  Dr. N stressed the importance of having this genetic testing completed before conception so we’re well informed as parents and can inform our offspring when the time is right.

About an hour after it began, the appointment was over.  JPug left with his vitamin prescription and an order for a third analysis.  The third test has been completed and we’re looking forward to the results.

The Little Orange Pill

During our initial appointment with Dr. K, she prescribed a synthetic thyroid hormone, Synthroid (generic: Levothyroxine) to supplement my thyroid production and stabilize and reduce my TSH level.  Because I’ve always been on the high end of normal but well above the level they look for when treating pre-conception patients, the initial dose was 25 micrograms (basically, as low as the dose can go).  I was to take the medicine daily and have my TSH level re-tested in 6 weeks.

6 weeks went by and I felt…GREAT!  I noticed a difference in energy almost immediately.  Before the medication, I was regularly sluggish in the evening.  I’d have good energy one or two evenings a week but by the time Wednesday or Thursday came, my body was so exhausted that I felt like I needed to go to bed at 8p to catch up on sleep.  With the thyroid replacement, my energy is much higher throughout the day and into the evening.  I’ve been able to drive without feeling sleepy and ride in the car for long distances.  I’m able to exercise after work without being exhausted by the time I get home and work around the house without paying for it the following day (it’s the simple things, right?).  I had no idea feeling tired wasn’t normal because it had been my normal for so long.  Who would have thought a small dose in a little orange pill would make such an impact? 

6 weeks later (the end of September), my blood was drawn and a week later the results were in.  Drum roll please…my TSH was…2.7!  Yes…nearly 2 points lower than it had been previously.  It was still slightly higher than Dr. K’s target for pre-conception but it was much better.  She decided to increase my dose to 50 mcg and test again in another 6 weeks.  I’m currently a couple of weeks into the second 6-week dosage trial and don’t feel much different than I did the first time around.  I’m looking forward to seeing how the increased dose continues to decrease my TSH and am happy to report that another piece of our puzzle seems to be fitting into place.  

IUI v. IVF - What's the Difference?

Alright folks, I'm back in action...sorry for the lack of updates over the past week...things have been extremely busy and I haven't made blogging a priority.  Now, on to a topic I referenced in my last post...IUI and IVF.

IUI 
IUI, or intrauterine insemination, is one type of procedure to treat infertility.  If you've ever heard the term "artificial insemination", IUI is what's being referred to.  An IUI procedure can be done as part of a woman's normal cycle or it can be performed in conjunction with fertility medications.  The procedure itself is fairly simple...a sample is provided by the male (either about an hour before the procedure or can be performed earlier and cryogenically frozen) it's then washed and concentrated by a technician.  Once the sample is ready, a catheter is inserted into the woman's uterus (at the appropriate time of the month) and sperm are injected directly into the uterus.  The intended outcome of the procedure is that the sperm swim into the fallopian tubes, fertilize the waiting egg and the process results in a normal pregnancy. 

IVF
IVF, or in vitro fertilization, is another type of procedure to treat infertility.  The process involves controlling a woman's cycle in a stop/start fashion with hormone therapies, removing mature eggs from a woman's ovaries and allowing sperm to fertilize the eggs in a synthetic fluid medium within a petri dish.  The fertilized egg (zygote) is then transferred into the woman's uterus which hopefully establishes a successful pregnancy.  One IVF cycle takes approximately two weeks.  A sub-procedure of IVF, ICSI (intracytoplasmic sperm injection) follows the standard IVF procedure but a sperm is injected directly into the egg, rather than fertilization occurring in a petri dish.  ICSI can be used for a number of reasons including low sperm count or if sperm have difficulty penetrating the woman's egg.

Additional Details
Besides the procedures themselves, the two main differences between IUI and IVF include cost and rate of successful pregnancy (and ultimately live birth).  The rate of pregnancy through IUI (depending on what study you read) is about 15% and cost is approximately $800 per procedure (before insurance).  As a young couple, the IVF success rate for Joe and I would be around 47% (live birth rate is about 41%) but the cost of this procedure is more than 10x that of IUI (~$12,000 before insurance).

The decision to pursue more advanced technology to help a couple conceive has many factors including: age, financial, medical recommendation, religion and underlying cause of infertility, among others.  Based on our process thus far, it's likely we'll end up using one of these two procedures to increase our chances.  Continued tests and analysis will help point us toward which procedure is right for us and all the while, we continue to attempt conception naturally.

No matter what our decision when time comes, we hope you will respect the process we've been through thus far and respect our decision, whether you would choose the same path or not.

If you have any questions regarding the information I've provided or our process to date, I encourage you to post them as a comment and I'll respond to the best of my ability.

*Please note*  I am not a healthcare professional...the information provided in this blog is a description of our personal process and research I've completed since we began our journey in June 2010.

Today

This post was originally written on Monday, September 26th...

Today was an interesting day.

JPug's second analysis was completed last Monday and I've been anxiously awaiting the results since then.  We received the results of his first test more quickly than I expected (2 - 3 days) so I was sure we'd have the results of the second test by last Friday.  I waited by my phone and was sure to carry it with me when I left my desk at work...but it never rang.  Just after I arrived at work this morning, it finally did.

Before I go any further I should probably explain more about JPug's process to date.  During our initial appointment with Dr. K, she wrote JPug a prescription for his first analysis to ensure everything checked out.  As a reproductive endocrinologist, her specialty is the woman but it's also her duty to ensure everything is ok from the man's standpoint, giving both parents the best opportunity for conception.  JPug made an appointment for the following week and a few short days later the results were in.

Judy, the nurse from Dr. K's office who sounds like she's a southern belle straight out of a Better Homes & Gardens magazine, called me and stated..."His results were a bit off and we'd like to bring him back in another month for a re-test".  She didn't provide further information but her words weren't full of worry or concern.  It's difficult to ask follow-up questions in a situation like this...I didn't have a copy of the results in front of me and I had no idea what "typical" results would be considered as this was JPug's first test.

In the month since the first analysis, I consulted our friends who went through this process previously and they suggested getting a copy of JPug's results...genius idea!  Once we had the results in hand, they painted a much different picture than the short conversation I had with Judy just weeks prior.  It's pretty amazing the various characteristics analyzed during the process...without going into unnecessary detail...across the board, JPug's analysis showed that his numbers were low.  Not close to normal low but more along the lines of 50% (or less) of where they should be low.  By this point we were just a week or so away from the second test so I looked forward to seeing how numbers compared between the two.

Last Monday, JPug went for his second analysis; today the phone rang with his results.  I had tucked the first results away in my planner...as the phone rang, I pulled the results out and grabbed a red pen so we could clearly tell the initial results from the newest set.  Somewhat as I expected but still no less comforting, the second results were low.  Judy provided the name of a male urologist/reproductive specialist (Dr. N) and suggested that JPug make an appointment at his earliest convenience.  Before letting her go, I asked Judy if JPug providing multiple samples for a single IUI treatment is possible.  She went on to say that it's possible and a process their office completes regularly (military families who are trying to conceive, etc.) but we'd need to wait until talking to Dr. N as IUI may not be an option based on the analysis which means we'd need to move directly to IVF.

I know these terms aren't something I've explained to this point...I know what they are because I've lived and breathed this situation for months but most readers don't.  Please bear with me as I'll definitely go into more detail in my next post.  The moral of her words was this...I was crushed.  All I can say is that I'm looking forward to our first appointment with Dr. N and hope to have more pieces of our ever-evolving puzzle soon.

Nearly two weeks have passed since I originally wrote this post.  Our appointment is this afternoon...

Let’s Proceed

Alright, back to our first appointment with Dr. K... 

After we finished in her office, we moved into an exam room.  A technician asked me to undress from the waist down and get comfortable (seriously?!?!  this is one of the most uncomfortable things ever!).  A few minutes later, Dr. K entered the room with the resident and the technician.  So there we were, all five of us (Dr., resident, technician, JPug and me) in a 10 x 8 room trying not to stare at my hooha.  I typically ease awkwardness with humor so I ended up blurting out something to the effect of..."if I knew this was going to be such a big performance, I would have definitely practiced".  Not my best work but it eased the tension nonetheless.

The first two procedures were a pap smear to ensure everything seemed normal as well as a swab they would use for STD testing...pretty basic stuff.

The third procedure was a vaginal ultrasound that's performed from within the uterus (not the typical ultrasound you think of with jelly & a wand on a woman's abdomen).  It's basically a foot-long stick (maybe 2 inches in diameter) with a slightly larger ball at the end which is hooked up to a more traditional ultrasound machine/screen.  The doctor was able to navigate the stick to check my uterus and ovaries for abnormalities, take measurements, etc.  At one point the size of one ovary was much smaller than the other and I asked Dr. K about the difference.  Instead of voicing concern, she just wiggled the stick a bit and said other organs were obstructing the view.

After about 20 minutes, Dr. K was finished with the exam and said everything looked normal.  She commented that the opening to my cervix was unusually small which could hinder conception but otherwise, I was lookin' good...in my mind this was a big sigh of relief.  Prior to the appointment, I convinced myself that she'd say my insides closely resembled Quasimodo and we'd have no chance at conception.  Instead, I was happy to hear that I was 'normal'.   

Once we finished in the exam room, we moved to the on-site lab where they took about 5 tubes of blood each.  The results would provide baseline, genetic and additional STD information.  Three hours later, we were finished with our first appointment and felt like we were moving in the right direction.  About a week later, the office called with the results and everything (except my TSH...no surprise) was normal...yay! more normal. 

What the heck is TSH?

Thyroid Gland, Thyroid Hormone & TSH

TSH, or Thyroid Stimulating Hormone, is the hormone that controls the release of your thyroid hormone by your thyroid gland.  According to WebMD, “The thyroid is a butterfly-shaped gland in the front of your neck.  It makes hormones that control the way your body uses energy”.  You can do all sorts of research as to how TSH relates to the thyroid gland/hormone but I think Dr. B explained it best.  He stated simply “TSH is the jockey to your thyroid horse”.  If the amount of thyroid hormone is your body is low, TSH will increase which stimulates your thyroid gland to produce more thyroid hormone.  A high TSH/low thyroid hormone combination is a condition called hypothyroidism which means your body doesn’t produce enough thyroid hormone.  Conversely, there’s also a condition called hyperthyroidism where your thyroid gland produces too much thyroid hormone.  I haven’t done much research on hyperthyroidism as my TSH has always tested on the upper end of normal (borderline/subclinical hypothyroidism).

Hypothyroidism

There’s a wide range of hypothyroidism symptoms including: feeling tired, weak or depressed, dry skin & brittle nails, not being able to stand the cold, constipation, memory problems or having trouble thinking clearly, and heavy or irregular menstrual periods.  As I researched hypothyroidism more, the symptoms actually made me laugh…aren’t these the same symptoms you see for about a million other diseases, syndromes,  ailments and illnesses folks can be diagnosed with these days?!  Hypothyroidism is treated with thyroid replacement hormone medication; regular blood tests are run to ensure TSH lies within the normal range of 0.5 to 4.5/5.0 (standard U.S. laboratory reference range) or 0.3 to 3.0 (standard range per the American Association of Clinical Endocrinologists).

My TSH Tests & Results
Sept. '09 - 5.23
Jul. '10 - 7.15
Aug. '10 - 4.54
Feb. '11 - 3.55
Jul. '11 - 4.77
Sept. '11 - ??

Why treat if the results are close to 'normal'?
Dr. K's decision to prescribe a synthetic thyroid hormone wasn't based on the symptoms listed above...it was based on my lab results from the previous 2 years.  During our initial appointment, she explained that there have been extensive studies showing that an elevated TSH during pregnancy can lead to a lower IQ in the mother's offspring.  Dr. K's standard procedure is to treat her patients down to a pre-conception TSH level of 2.25 (TSH level while pregnant differs).  Because my TSH was 3.55 at the lowest point and 7.15 at the highest, Dr. K decided to treat immediately, test again in 6 weeks and regulate the medication from there.