Posted by: Kate | January 17, 2009

Dignity is Overrated

Little by little, I’m slogging through this latest crop of health issues and getting bits of information here and there; though, because how could anyone expect otherwise, I’m not getting firm answers so much as new questions to ask.  The root canal was done yesterday, and right now I’m in considerable discomfort and can’t chew on that side, but I’m hoping this is due to swelling and healing rather than, you know, needing more dental work.  We’ll see.  And I’ve started the process of x-rays and bloodwork for the lower back pain concerns, and have gotten one disturbing positive test result, but until I have the chance to sit down with my doctor and hear her plan – the appointment is Tuesday at 10:00 – I’m doing my best to avoid obsessing and, more importantly, to avoid Googling.

Which leaves the infertility.  I’m still not pregnant, after over a year of trying.  Having conceived five times – two babies, three losses – while still on the Pill, this seems like an enormous cosmic practical joke.  And I hate practical jokes. (By the way, there’s a lot of health-related stuff in this post, perhaps too much information by some standards – consider yourself warned.)

Remember those Choose Your Own Adventure books, where you would read a little and then decide to either flip to page 95 if you wanted the character to jump into a black abyss, or flip to page 63 if you wanted him to learn to bake brownies? Well, consider that option for this post. Just read the next paragraph, if you just want a quick synopsis and no unpleasant details. If you’re interested in the longer version, keep reading after the line.

The short version is, I’m fine. I had an HSG, no blockages were found, and now I will be referred to a fertility specialist.

The long version is…

The whole concept of birth control has always been a tricky one, for me.  I was good about taking the Pill at close to the same time, every night – I kept the package on my nightstand, on top of my alarm clock, so I had to move it to see the time – and was careful to use backup methods whenever I was on an antibiotic or thought I’d missed a dose or whatever. 

And yet, five different times, a few days before my period was due, I would find myself completely exhausted, slightly nauseous, and a bit more, ahem, endowed than I had been the day or two before… and, sure enough, I’d get a positive pregnancy test.  These were followed, in varying degrees of horribleness, by lost pregnancies in 1997, 2003 and 2006.  Emily was born in 2000, and Jacob, after a high-risk and endless pregnancy, came along in 2004.

Each of these pregnancies were surprises, but none were accidents.  Willem and I had a running joke that we would be talking about our plans and goals, one of us would mention, “Maybe we should think about trying to have a baby,” and *poof*, the mere act of saying the words made it so.  We would joke about how I could get pregnant just by having prolonged eye contact with Willem; how we had to wash our underwear in separate loads just in case.  So funny, such a joke, ha ha ha… Whatever.

After I had Jacob, I breastfed for 18 months, and took a progesterone-only Pill during that time.  After he weaned, I got a Mirena IUD.  I had heard good things about it, how eay it was, minimal side effects, blah blah blah.  I had installed (doctors seem to hate that word for it, but the whole concept is so strange and mechanical that I can’t think of a better term) in June 2006, and in September 2006, within days of finally getting health insurance after a year-plus without, I begged my new OB-GYN to take it out.  The whole time it was in place, I had low grade nausea, cramping, spotting-to-bleeding every day… I just hated it.

From there, I briefly went back on the once-a-week birth control patch, which I’d used for the years between Emily and Jacob with no problems.  Then insurance stopped covering it, so I switched to a pill called Kariva.  Which almost immediately led to no periods at all, and therefore a crap-ton of money spent on home pregnancy tests once a month.  I hated that – I might once have thought that I’d have loved to just stop having periods, but then when they actually do stop, you don’t have a clear sign that you’re not pregnant or that your body is simply plugging along the way it’s supposed to.  By the time I stopped taking the Kariva, with plans to try to conceive, I hadn’t had a period in over a year.

I spent the first half of 2008 trying to get pregnant and waiting until a reasonable amount of time had passed so that I could call my doctor and figure out what was going on.  My cycles were anywhere from 35-60 days long each time, with a very light, two-day period in between.  I had no pain, either along the lines of menstrual cramping or in between times.

Being under 35, the rule of thumb is for a woman to try to get pregnant for a full year before calling her doctor; in my case, because my cycles were so irregular and I had successfully – and easily – conceived in the past, I was seen after about 7 months.  Willem got to make his contribution to science, a process he was allowed to do in the comfort of his own home but then had to take it to the hospital lab himself, which involves an intrusive and possibly HIPAA-violating conversation with the guard at the front desk and then a handing over of, um, evidence to the women at the lab, whom Willem described as Swedish bikini models, one and all.  Poor guy.  He passed his test with flying colors, so the spotlight remains on me.

I started taking Clomid in August.  You take it from Day 5 to Day 9 of a given cycle, then have sex every 36-48 hours between Days 12 and 20 or so, and then wait and see.  If a period comes on time after that, then the assumption is that you are on enough Clomid to cause ovulation, and it just happened to be a no-go for that month.  If the period is late, then the dose gets upped.  I started at the lowest dose, 50mg, and am now up to 150mg.  Last month’s cycle was 38 days long, so in theory I should bump up the dosage; in practice, my OB-GYN won’t prescribe higher doses on her own and will be referring me to a reproductive endocrinologist.  This is the kind of job that I never even knew existed until I entered the world of babies and pregnancies and infertility.

Every few months, on Clomid, you’re supposed to have a pelvic ultrasound, because Clomid can cause ovarian cysts other than those created normally every month when you ovulate. I had this ultrasound just before Christmas, and my doctor’s office left several nervous-making, vague messages in order to eventually inform me that the results were normal. And that, at least last month, I created not just one, but two ovulation-related cysts on the left side. Which, twins? Eek.

My last step – and I know this is really long-winded, and I apologize; it’s mostly intended to let me get a clearer chronology of it all in my head and written out before I go to the specialist, and also might be helpful because I know at least a few of you out there are fumbling down a similar path right now, and also because it’s my blog and I’ll babble if I want to – anyway, my last step with my regular OB-GYN happened yesterday: an HSG procedure, or hysterosalpingogram for short.  I had absolutely no idea what to expect with this – I knew that it meant an injection of dye into the uterus and then a series of x-rays to make sure the Fallopian tubes had no blockages, but that description leaves a lot unanswered.

So, in the interest in furthering public education, not to mention creating some wildly sexy images to implant upon your poor brains, I’ll share the sequence of events.  I arrived at the hospital’s radiology department, and was escorted into a regular x-ray room; the same room, actually, where I went on Monday for spinal x-rays.  (I haven’t checked to see if I’m glowing in the dark by now.)  My OB-GYN was waiting for me, all dressed up in a snazzy lead apron, with that tray of vaguely sinister implements and vials that attends any self-respecting exam of the nether regions.

I was directed to go into the bathroom, undress from the waist down, and put in the open-in-the-back johnny.  Being a rebel, I decided to keep my socks on, too.  I wandered back into the x-ray room, and was instructed to lie on the table and scootch down, just like any other pelvic exam, except that I learned it’s a lot harder to find and hold the proper position without those little stirrup things, with which the x-ray table was not equipped.  The doctor did a quick manual exam, mostly to make sure I was still female and not smuggling contraband, I think, and then the next few steps can go unremarked except to say that they felt, from my end, precisely like an annual PAP smear collection: a bit uncomfortable, but not painful.  She was essentially inserting a very thin tube into the cervix, with a little balloon inflating to hold it in place, and at the other end was a syringe of (clear) dye.

Once that was in place, she draped me with a (blessedly warm) blanket, pulled a x-ray machine over the top of me – the same as is used for any lying-down sort of x-ray, where they can roll the table and the camera around as needed to get the right view, and you just lie there and wonder what dignity ever felt like, anyway.  Then two move x-ray technicians, plus a male radiologist, paraded into the room.  The radiologist pulled over a good-sized computer monitor so that I could see, too, and then at “Go,” the OB-GYN started injecting the dye and he watched the screen.  Presumably, he took some still images, but I could see it all in real-time, not as a series of distinct pictures.  You could see the dye fill the uterus, then follow the lines of the Fallopian tubes – first the right, then the left, though I’m told that’s random – and, upon reaching the end of the tube, just sort of expand into the space around the ovary.  Kind of neat, really; I’ve taken biology classes and seen diagrams, but there’s a vague sense of awe I have whenever I realize that that’s actually what people really do look like on the inside.

Afterward, I was allowed to go back into the bathroom and clean up a bit – it doesn’t create a horrible mess, again just typical for a pelvic exam – and before I left I was told that everything looks perfectly normal.  Which means, great, no surgery or whatever needed to repair a blockage… but it sucks, because now we still have no idea why I’m not pregnant.

So.  Yes, I know, that was decidedly too long of a long version, but it’s information I kind of wanted to have before I had the procedure, but which I didn’t dare to Google because I’m much better at remembering horror stories than normal ones.



  1. I was just about to e-mail you to see how things had gone this week.

  2. It’s strange how it takes not being able to become pregnant, or losing a pregnancy, to become so educated about how it all works.
    I took BCP for years before I got pregnant with Thomas, and like you it was right away with no problems. After I had Tommy I went on a BCP called Yasmin, which gave me a strange rash. I got pregnant immediately after stopping it, and had a miscarriage. Then I spent most of a year trying to get pregnant and having very early pregnancy losses (positive HPT then period a day later). It changed my whole outlook on the gift of fertility and pregnancy. I was blessed to get pregnant with Ryan, and then again (surprise!) with Sean.
    I have since sworn off all artificial means of birth control, for many reasons not the least of which is I hate putting drugs into my body. We had what I believe was another very early loss this past fall.
    So–what I’m getting at–is that doctors seem to know precious little when it comes to unexplained pregnancy loss and infertility. Has anyone explored your auto-immune disorder and the possiblity of a relationship between the two?

  3. Sometimes the HSG acts as a “roto-rooter” and will clean any debris out while doing it’s job. I had been trying nearly a year and half for Buddy (with several miscarriages smattered in, including an ectopic where I lost my right tube). They finally wanted to check to see if the left tube was open. I went in for the HSG and was ovulating around the same time. Went home, got busy – two weeks later, positive pregnancy test! 🙂

  4. Bless you for sharing all this! My HSG is scheduled for next week (though I think I might have to postpone for female-related reasons) and it is wonderful to know more what to expect. And LOL about the socks — I do that all the time too! 🙂

    If you don’t mind, what was the one disturbing positive test result? (Email me if you want.) Since I have lupus, I’m just wondering if it’s a test I’m familiar with. If you don’t want to go there until after Tuesday, I totally understand that too.

  5. I remember these days well, Kate. Not so much from your perspective as I didn’t have any kids yet and just one miscarriage. Good luck with the RE. They are so much more knowledgeable than regular OB-GYNs. Here’s hoping s/he can provide a quick answer for you.

  6. I’m sorry, Kate. That just plain sucks.

    I was just talking with a friend recently about how fertility is such an issue – when you don’t want to be pregnant, every late period is a crisis. When you do want to be pregnant, every period is a let down. Month after month after month.

    I feel very lucky that my problems conceiving that 3rd just boiled down to needing Progesterone. I hope the next couple of months will pop out a surprise for you. I’m keeping my fingers crossed.

  7. Maybe your baby is waiting for the beach house…

  8. That’s interesting. I had never heard of HSG before. Doesn’t sound too bad. Actually it sounds kinda cool. It’s nice that they let you look at the monitor during the procedure.

    If I can get away from my office for a few minutes tomorrow, I think it’s time I call to make an appointment with my OB. It’s been almost a year now. Blah.

  9. Thinking of you and flashing back to my own experience(s) with infertility and all those procedures.

    I completely sympathize. And am frustrated for you.

  10. This reminded me of the many tests I went through, the ectopic pregnancy, the time I was on a table and 8 interns came in to take a peek at my problem pivates… I remember it all like it was yesterday, and it was years ago.

    Thanks for the newsy post. Hang in there.

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