The Baby Bean Blog

Friday, October 29, 2004

2dpIUI: Timing Again

I feel fairly certain at this point that I ovulated yesterday. I took my temp this morning, and it was up. All signs point to yesterday, except that whole pain in my right side thing, but that must have been the previous mentioned option 2 or 3 as opposed to the hoped for option 1. So you'll notice that I've changed my usual post titling format from 2dpo to 2dpIUI. I did this because I believe I am 1 day past ovulation but 2 days past IUI. Oh well. That means that the chances are pretty damn slim at this point, and that sucks. Especially because everything that I know about my cycle told me that having the IUI on cd14 was wrong. I should have been more vocal and insistent with my doctor.

Timing this stuff is such a pain. The night before the IUI, the Bread Winner and I were discussing this very topic. We decided that it would be better if women's bodies could give a clear sign that ovulation was happening. The Bread Winner thought that a flare of some sort should go up, or maybe just a green glow should appear, coming from beneath the skin above the ovary. We then decided that would be a little freaky, so I suggested that a little note could be deposited in the underwear. A friendly, "Ovulation began at 11am and the egg will be viable for the next 24 hours!"

While all of these ideas sounded good, we had to admit they were a bit far fetched. I mean, does my uterus have pen and paper in there? God I hope not. If it does, that could explain why I haven't gotten pregnant yet. So forgoing an internal light source or writing supplies, I thought that perhaps the note could be left in morse code on the underwear by virtue of the cervical fluid that a woman produces when ovulating.

That seems completely reasonable. No extra supplies or power source needed. Just the home brewed cervical fluid, deposited in a clear and informative matter. Women would go to the doctor, take off their panties, and the doctor would looks at the panties for those tell-tale dots and lines that would declare, "Now!"

Really, is that too much to ask?

Thursday, October 28, 2004

1dpo: Timing, Part II

Today I am obsessing about the timing of my IUI. I decided to feel optimistic about the pain experienced last night. I decided that it really was ovulation pain. I also did some research online about the lifespan of IUI prepared semen, and what I read made me feel hopeful. Some of the sites reported what my doctor said--that the sperm can live for 24 hours. Most of them, however, said 6-12 hours. I experienced ovulation pain between 7-10 hours after the IUI, so if those boys can live for 12 hours, I should have been okay.

So I felt good about that as I went to sleep last night. But then, this morning, I took my temperature, and my temperature was in what is usually my "low range" of temps. If I had ovulated last night, my temp should have risen to my "high range" by now. So now I'm wondering if today isn't the day I will ovulate after all. And that would be bad, because even if the boys lived for 24 hours, that means the last one died off about half an hour ago.

Things in Favor of Today Being Ovulation Day
1) For those of you paying attention to the last few posts, you'll know that I generally don't ovulate before cd15, and today is in fact cd15.

2) I've used opks before when I was trying to get pregnant last year with fresh sperm from a friend of mine. Then I relentlessly charted my cycle. Although the opk instructions say that they predict ovulation 24-36 hours later, I noticed that my temps shift tended to occur on the third day after a positive. So if I tested opk+ on Tuesday, cd13, my temp shift would occur Friday, cd16. This would indicate that I ovulate 48 hours after an opk+. In this case, that would be today, cd15.

Counter Arguments
1) A temp rise doesn't necessarily mean that I ovulated the day before. Okay, like 90% of the time it probably does (I don't know the exact statistics). But for some women, the progesterone build up takes longer, so their temps might not go up right away.

2) I've had a cold all week. Perhaps I have a low-grade temp because of that.

3) When I met with the doctor I didn't like last cycle and told him about the lag time for me between opk+ and my ovulation day, he said that wasn't accurate, and that women ovulate 24-36 hours after an LH surge.

Ack
There's nothing I can do about it now. I decided when I started ttc again this time that I would take the burden of figuring this all out off of my shoulders. I would trust the doctor. And since there's nothing I can do about it now, I guess I have two choices: be miserable, obsessed, and stressed or just try not to think about it. I'll know in two weeks.

Wednesday, October 27, 2004

IUI

So it looks like the truth was somewhere in the middle. I was not going to ovulate on cd13. No way, no how. But it looks like I'm also not going to ovulate on cd15 as I thought I would either. I'm am ovulating today, and that means an IUI today.

I tested positive with an opk yesterday afternoon around 4pm. I called my doctor's office as I was instructed to do once I tested opk+. The nurse scheduled me in for a 7:45am appointment. Only....

A positive opk is supposed to give you 24-36 hours notice of ovulation. Between 4pm and 8am, there are only 16 hours. And since I'd always heard that IUI prepared semen only lasts for 6 hours, that meant that all the spermies would be dead by 2pm, and I wouldn't ovulate until 4pm. So I temporarily rejected the 7:45am appointment offer and asked to speak to the doctor.

He was paged and called me back and said that the sperm can live for 24-72 hours. "Even IUI prepared sperm?" I asked. I knew that fresh sperm could live up to 72 hours, but as I said, I'd always heard that IUI prepared semen could only live for 6 hours. He said that IUI prepared sperm could live for 24 hours.

I guess I have to trust him on this one. That's why we're paying him the big money. Well, okay, Blue Cross/Blue Shield is paying him the big money, but you get the point.

So the Bread Winner and I high-tailed it to the clinic this morning, and I've got the sperm in me to prove it.

After the IUI both the first time and this second time, I experience some immediate cramping. This is not unusual. It's your uterus saying, "WHAT THE HELL ARE YOU DOING STICKING THAT TUBE IN ME?" Who can blame it? But for the past two hours (since around 3pm), I've been experiencing cramping on my right side. There are three options:

1) This is ovulation pain. My follicle was on my right side. If this is ovulation pain, I have to hope and pray that my doctor was right and that the sperm do live for more than six hours. Otherwise, the swimmers stopped swimming around 2pm, and my egg is out of luck.

2) This is post-IUI cramping. Very possible.

3) It's all in my head. I know that the follicle is on the right side. I know that ovulation pain/cramping can occur. I want this to be happening, so I've created the pain in my head.

And that's all I'm going to say for now. The dreaded two week wait officially begins tomorrow, and I've got to save up something to write about.

Tuesday, October 26, 2004

Cycle Day 13: Whew, I Was Right

As it turns out, I was right. I'm not ovulating today. What madness would that have been? CD13? I don't think so. How do I know all this for sure now when I was so confused yesterday? Well, simply put, my bloodwork came back negative for the luteinizing hormone (LH). A woman has a surge of LH 24-36 hours before she ovulates. If there's no LH, that means you've still got a couple of days.

So the doctor's office called and told me to use home ovulation predictor kits (opks), and if I get a positive to call them. If I don't have a positive by Wednesday (tomorrow), I'm to come in for another ultrasound and more bloodwork.

I peed on a stick last night and got nada. I did so again this morning, and the test line was getting close to the reference line, but not quite. I have a feeling that when I test again late this afternoon, I'll get my positive. In all likelihood, I will ovulate on Thursday, and what day is that? Why, it's cycle day 15, of course. There's a small chance I'll ovulate tomorrow, but I don't think so. Why? Because I know my body. I hardly ever ovulate before cd15.

And that's the news here.

Monday, October 25, 2004

Cycle Day 12: HUH?

I like to think that I know my cycle. In fact, I've ranted before about how these doctors think they know everything and don't listen to patients who actually live with their bodies. I've covered all of this in this post about my first ultrasound. Long story short, I don't ovulate before cd15.

The doctor wants me to come in on cd12 or cd13, anticipating ovulation on cd14. Since I don't ovulate before cd15, it makes sense to me to come in on either cd13 or cd14. Which I tried to do this time. I wanted to make my appointment for Wednesday, cd14. However, my doctor isn't there on Wednesdays. Another doctor is, but I don't like him as much. So I then tried to get an appointment for tomorrow (Tuesday), cd13. But they don't do ultrasounds on Tuesdays. "Fine," I said, "Give me an appointment for Monday."

I was completely expecting to go in there and have them say what they said in the other post I mentioned--namely that I was many days away from ovulation. Then the nurse sticks the probe in my coochie, and she says, "Well, there's your mucus build up, so we know you're close to ovulating." I looked up. Really?

Then she swings the probe around and says, "Ah, there's your follicle." I looked on the screen at the black splotch that was my follicle and said, "That thing is huge." She nodded. It was 20mm. That's damn close to being ready to pop. I asked, "How about my uterine lining?" She said, "It looks great. You're at 10mm." Wuz that?

Could it be that I don't know everything? Yikes.

They also drew blood, so they'll call me back today and let me know when I should come in for the IUI. The doctor looked at my chart and said, "It looks like we'll probably have a date with destiny tomorrow." I just had to throw that quote in there because it just strikes me as funny. I don't know why.

I'm still a little floored. Ovulation tomorrow? That's cd13. I don't ovulate on cd13. But I guess this time, I might.

Friday, October 22, 2004

Cycle Day 9: A Little Itchy

The big reason I took so much time off of trying to conceive was that I felt I needed to lose weight. That took me about four months, more or less. The last couple of months I spent trying to get all of the crap together that the sperm bank I wanted to use required. I had to get a bunch of tests run, like HIV, Hep B & C, gonorrhea, etc. etc. etc. I tested negative for everything except something called myco-ureaplasma. All I needed to do to get rid of myco-ureaplasma (which I have yet to hear a satisfactory answer about what it is or how I got it even though I've asked my doctor) was to take a ten day course of anti-biotics. Sounds simple enough, right?

That part was simple. However, some women tend to get yeast infections when they take anti-biotics. It's sort of hit and miss with me. I got a bunch of yeast infections about seven years ago--like three in one year. But I haven't had one for a while. However, I noticed a certain itchiness about three weeks ago. As there was a chance I was pregnant, I didn't do anything about it. Then I had my period. So now's the time to take action.

The Bread Winner picked up some Monistat 3 for me, and last night I went ahead and used the first "treatment." Back in the day when I got yeast infections, you had to go seven days, and showing brand loyalty, I used Monistat 7. Monistat has a one day treatment, not surprisingly named Monistat 1, but that just seems suspicious to me. One day? But I certainly was not looking forward to seven days, hence Monistat 3.

My last treatment will be Saturday night, so I should be all clear and ready to go for my ultrasound on cd12, Monday.

Wednesday, October 20, 2004

Cycle Day 7: Timing

Last night I talked to Angel for the first time in a few weeks. Her partner Carol is pregnant and due on 10/31, less than two weeks from now. That is so depressing. Carol and I were supposed to be pregnant at the same time. Not the exact same time, but there was supposed to be some overlap. If anything, I was supposed to give birth first because I started a few months before she did.

Time, time, time. We make all these plans based on timelines. I laugh now when I read message boards and some woman says something about how she's going to wait until next month to start trying to conceive because if the baby was born nine months from now, that would be inconvenient. I read that and think, Yeah, honey, just give it a few months of failure, and you won't give a shit when the kid is born as long as s/he is born.

But the seduction of "timing" this is too great to resist. For instance, the first month that Carol tried to get pregnant, Angel wasn't so excited because of the time that the baby would have been born. Angel was a congregational rabbi, and the baby would have been due right around the time of the high holy days when Angel would have to work non-stop. So when Carol got pregnant on the second month, Angel was happy because the timing was so convenient. Since then, Angel has switched to an administrative job, and it just so happens that the biggest week of the entire year for her new job is the week that Carol is due. Those are the breaks.

You can't stop yourself from planning though. I know that I was really excited by the possibility that I would have gotten pregnant last month, because that would have meant that I would have finished my first trimester right before Christmas. We have decided not to tell anyone about my trying to conceive or the (we hope) pregnancy until I make it through the first trimester. The timing would have worked out perfectly to make the news a great Christmas present for my family--and the Bread Winner's as well. It hasn't worked out that way. Like I said before, those are the breaks.

Monday, October 18, 2004

Cycle Day 5

I feel better today. It's only a week until my ultrasound next Monday. Right now, I'm trying to re-direct my attention to my physical and emotional well-being. Not in a new-agey kind of [insert whispery voice] "I need to love myself" way. No, my interests in staying well are all about my cycle. When I was ttc last year, I got completely crazy and I gained 20 pounds. That fucked up my cycle big time. If I get out of control again, that will make what I am trying to do even harder, so I've got to be good.

I'm doing okay mentally, I think. But physically, I'm starting to slip. I took off all that time from ttc last spring in order to lose 30 pounds (I was already 10 pounds over-weight when I started the first time), and I did it. Just this past cycle, I gained back 7 pounds. That's 7 pounds in four weeks. Yikes. I eat to comfort myself. I eat to feel better. I had learned to control this under normal circumstances, but the two week wait is not normal, and things got a little crazy. So I've got to go back on the straight and narrow: I need to eat good, healthy food. That means no sugar, so no ice cream :( and no cup cakes :(

Friday, October 15, 2004

Cycle Day 2: Starting Over

I woke up yesterday to my period. It was gray and dreary here in Philadelphia, which pretty much matched my mood. It wasn't like I wasn't expecting it. If you've read the last few posts, you know that I was. It's just that it's hard. I started trying to get pregnant over a year ago. Although I have not been actively trying every cycle, it's still been part of my life for the entire time. And it's wearing on me. I've told myself that this process could easily take six more months. Well, five now. And it could take years. I know of people (via bulletin boards) who have been trying for a year or two or more. I can't imagine that. I don't think I could take it. So I'm giving myself these next five cycles, and then I'll have to re-evaluate where I stand in all this.

My grandmother's death this past summer has made me want a biological child of my own intensely. Before she died, I thought that adopting would be fine. And it still might be. But I want to see my grandmother's genes carried on. I want to impart the story of my grandmother's life to this new being who has her blood in his or her veins, her DNA at her or his core. I want this son or daughter to tell the story of my grandmother to his or her children who will also be made of part of my grandmother. I don't want the genetic link to my grandmother to die out.

Well, this is all sort of morbid, but that's where I am right now. I'm usually a little depressed for the first couple of days of my period anyway. Add to that the failure of my attempt to conceive and the gray, rainy days we've been experiencing, and you end up with a rather somber post from yours truly. I'll try to pick up the pace now.

I scheduled an appointment for ultrasound and bloodwork for 10/25, which will be cd12. And the good news is that we don't have to buy sperm this month because we'd inadvertently ordered two months of sperm last month. This is good. We had been anticipating that we would be spending $710 every month, but now it looks like $710 every other month. With our financial situation right now, that is good news indeed.

Wednesday, October 13, 2004

14dpo: All Quiet on the Southern Front

Well, mostly quiet. There has been some spotting. I expect my period to arrive in the near future. It seems to be holding out for the exclusive reason of torturing me, and I am at its mercy. Although my luteal phase is 13 days long, it has, on occasion, been 14 days long, which means that my period could hold out until tomorrow. Grrr. This is frustrating. There's barely a doubt in my mind that I am not pregnant. However, until the arrival of my period, hope remains.

I'd been waiting to post here until I had something more exciting to report than, There's nothing to report. But those are the breaks. I made a pact with myself that I would not take a home pregnancy test until I had missed my period by one day. As my lp could be 14 days, that means waiting until Friday to test--IF my period has not arrived by then. So the only news I could have today would be the arrival of my period, and well, you know, it's not here yet.

I was very frustrated by its absense this morning. I want to put this cycle behind me and start looking forward to the next attempt. So I went to visit my friend Beth-Marie and thereby killed most of the day. Honestly, I'm dead tired, so I might just take a nap now. Before I know it, it will be tomorrow, and by that time, there should be conclusive proof of my period.

Tuesday, October 12, 2004

13dpo: The End Is Near

I described the classic cycle in this post, which also defined the luteal phase of a woman's menstrual cycle. The luteal phase (lp) is the length of time between ovulation and the first day of a woman's period. These vary from woman to woman. The classic length is 14 days, hence the 2ww. If a woman had a 14 day lp, she would expect her period on the 15th day past ovulation (15dpo). However, my lp is 13 days long, which means that I will be expecting my period tomorrow, 14dpo.

When tomorrow is anyone's guess. Sometimes my period arrives in the early morning and I wake up with my "visitor" already present. Sometimes "Aunt Flo" arrives around noontime. And sometimes she hides out until bedtime. But she invariably shows up 14 days after I ovulate. Twice this past year, my lp has been 14 days long as opposed to 13. But I usually have spotting the day before. Spotting doesn't count as the beginning of your period. You need full blood for that.

All of this is to say that I expect to start spotting sometime this afternoon or evening. I might get lucky and wake up to my period tomorrow morning, or I might have to spend another day waiting to know for sure. If I don't have any spotting or blood by tomorrow evening, I'm not sure if I'll take a home pregnancy test (hpt) or not. Part of me feels like I should just wait until Thursday.

I've figured out that an hpt can only tell me for sure if I am pregnant. A negative hpt without the reinforcement of my period has little meaning to me as I can easily convince myself that the test is wrong. That's why I've decided to wait until I've missed my period this time around. Then the hpt will be confirming what I already know, as opposed to telling me what I refuse to hear.

Anyway, hopefully I'll know for sure tomorrow. I'll know Thursday at the latest.

Monday, October 11, 2004

12dpo: Feeling Pessimistic

I haven't had any pregnancy signs thus far. Of course that doesn't mean that I'm not pregnant. As I've mentioned before, plenty of people are pregnant and don't know it for months.

These last couple of days will be really hard, and the above paragraph perfectly exemplifies why: I don't think I'm pregnant....but you never know because XYZ. If my period is going to come, it should arrive on Wednesday.

I managed to keep myself very busy this past weekend, what with shopping, movies, and carpentry. I don't have many plans for the next couple of days, so I need to get some. I still have my home improvement project to work on, so I've scheduled that in for today. A friend of mine broke her foot this past weekend, so I might go over to her apartment under the guise of wanting to keep her company (she doesn't know that I've started trying to get pregnant again).

Unfortunately, there isn't much to report except that I expect to be going through this all again next cycle.

Friday, October 08, 2004

9 Days Past Ovulation: The Thumbscrews Tighten

Tomorrow is a day of significance because 10dpo is the day when it starts being possible to detect pregnancy via a home pregnancy test (hpt). Last night, I took the first step to wasting money by peeing on sticks. I looked on my bathroom shelves to see if I had any hpts. I knew that I had the box the hpts had come in from last winter, but I also knew that ovulations predictors (opks) were in that box (the Bread Winner's effort to consolidate miscellaneous crap). I assumed that we would not still have the hpt box if we did not have hpts. Otherwise, we would have just kept the opk box. Well, I was wrong. We don't have any home pregnancy tests.

I told myself that this time around, I would not test until I missed a day of my period. But it is hard. Very hard. For those who can't imagine it, picture that you might have won the lottery. Might have. It's possible for you to find out whether or not you won the lottery by calling this phone number that costs $10 per call. The catch is twofold: 1) You could wait for four days and just get a letter delivered in the mail telling you whether or not you won, so you don't need to call at all. 2) If you do call, the chances are that you won't get accurate information anyway. You might call and be told, "No, you didn't win," only to find out the next day that you did win. This, of course, encourages you to call every day--maybe even twice a day.

People usually start out this game calling that number, i.e. peeing on $10 sticks, rather than waiting for the letter to arrive, i.e. their period. But after a while, when you've peed on $50-$100 worth of sticks, you start to think that it's just ridiculous. Why not just grind your teeth and wait it out? So that's what I'm trying to do this time around.

The article I mentioned yesterday offers other advice besides the one item I quoted, like #4 Plant a Garden. (I've already got #3 Start a Journal taken care of with this blog.) Everything on her list is designed to help you focus productively on your obsession, as opposed to driving yourself crazy. Other two week wait coping strategies go the other way. They encourage you to focus on something else entirely, like making a quilt or something.

I'm taking a bit from both approaches. I've delegated my two week wait to the Bread Winner. I'm also journaling/blogging. In addition, I'm trying to tackle some home improvement projects that need tackling. And I've been meaning to start carving a headboard for a bed frame. That will be next on my list after finishing a particularly pressing home improvement project.

The Bread Winner and I are going out tonight to see one of my favorite singer/songwriters. Tomorrow we're going to an outlet mall and then probably to see First Daughter. (I admit it, I am obsessed with both Dawson's Creek and especially that hottie, Katie Holmes). Sunday will involve building shelves in my friend Beth-Marie's new shed. Monday, I don't know yet...that will be 12dpo.

Honestly, I can't believe that it was just last Wednesday that I had my IUI. 9 days ago. It seems like at least six months.

Thursday, October 07, 2004

Trying to Give Away My Two Week Wait

Back when I was first trying to conceive (ttc) last fall/winter, a friend of mine sent me a link to an article by Lynn Steen called The Two-Week Wait Activity List: 14 Things To Do When 14 Days Seem Like Forever. Item number 13 reads as follows:

Delegate the burden of the two-week wait. Clearly someone has to worry constantly during this time, but does it have to be you? Divide the days up among your best friends and closest family. On their assigned day they are required to think, wonder, and worry all day about whether you are pregnant or not. At the end of the day they have to call or send you email describing how agonizing it was. Also they have to report to you if they had any "symptoms," such as sore breasts, excessive urination, nausea, bleeding, fatigue…You will be surprised how many people, male and female, have early pregnancy symptoms if they just look for them.

I remember reading this last winter and thinking, "That's great! That's exactly what I'll do during my next cycle! Assign each day to a differen person!" Little did I know that I would not try to conceive for another eight months. And when I did, I would keep my attempts to myself as opposed to telling everyone I know about it like I did last time around. So who to "delegate the burden of the two-week wait" to? There's only one option: the Bread Winner.

The first week wasn't so bad--and there are no symptoms even if you do turn out to be pregnant (for all the reasons I mentioned in this post). So I did not inform the Bread Winner of her responsibilities on this front until last night. She was complaining that her stomach was upset, and I said, "That sounds like a pregnancy symptom. From here on out, I want you to keep track of all of them and let me know."

She got excited about this chore, but then she started telling me fake symptoms or just plain wrong ones. For instance, she started saying that her ovaries hurt so she must be pregnant. I said, "No, your ovaries wouldn't hurt. You might feel cramping in your uterus due to implantation, but the ovaries are out of the game now that you've ovulated."

"Oh," she said. Then she started to describe to me how her breasts felt sore.

Yes, this is an early pregnancy symptom. However, it doesn't usually crop up until the end of the 2ww--like at 10dpo or later. It takes time for your progesterone levels to reach such a height as to cause breast tenderness. Therefore, her breast tenderness at 7dpo rang hollow.

"I think I need to study up on this," she said.

Maybe so, but the problem really is that she seems to be missing the point. In an effort to be supportive, she is just making up symptoms that she does not feel. This is not the point of the exercise. The point is to tell me about things that she does feel when, obviously, she is not pregnant. Therefore, it will ground me in reality when I feel the same things and become convinced that their presense means I MUST BE PREGNANT.

I remember back when I was ttc the first time. I remember feeling cramping in my uterus somewhere around 8 or 9dpo. I thought, "Aha! That must be implantation! I've never, ever felt anything like this before, so I must be pregnant!" But I wasn't. I also remember thinking the same things about some bouts of nausea I experienced. "This has never happened before! I must be pregnant!" But I wasn't.

And as I took time off these past eight months, I noticed during one cycle that I did feel some twinges in my uterus a few days before my period arrived. Another cycle, I felt a little nauseous for a day or two before my period arrived. These things had happened to me, but they were so minor and inconsequential that I hadn't bothered to give them a second thought--so much so that I forgot about them entirely. But during the hyper-awareness of the 2ww, I noticed every little thing, and every little thing was a possible sign of what I most desired.

So I've tried to give away my 2ww to the Bread Winner, but I don't think it's working. It looks like I'll have to keep the burden of it myself.

Wednesday, October 06, 2004

The Halfway Point

So here I am at 7 days past ovulation (7dpo). Once the next seven days have past, I will most likely know whether or not I am pregnant. Actually, if history is anything to go by, I will know if I am pregnant. If I am not pregnant, I will fight that reality with everything that I have. I will cling to the hope that maybe I am pregnant even though the home pregnancy test says that I am not and my period has arrived. Pretty damning evidence, wouldn't you say? But somehow, I've managed to convince myself, nonetheless, that I might just be pregnant anyway.

It's amazing what your mind can convince you of in the face of undeniable evidence. And other people don't help. I remember when I was trying to get pregnant last fall. When my period arrived and I told my mother I wasn't pregnant, she said, "You know, your aunt got her period for three months after she was pregnant, so she didn't even know she was pregnant." This is not what you say to someone who desperately wants to believe.

The first week is done now, and the second begins. The first week was okay. The first week is usually okay. There are no symptoms, real or fantasized. There's no way to know if you're pregnant or not. It's the second week that is hellish torture. First of all, you can start to imagine that you do have symptoms. Around 8dpo-10dpo, the fertilized egg could be implanting. That can cause mild cramping. Other symptoms include sore or enlarged breasts. You might also start to have feelings of nausea. Then there's always that killer sign: frequent urination. In a pregnant woman, frequent urination is caused by her expanding uterus pressing against her bladder. However, if you are completely obsessed and anxious about something, you're going to urinate frequently anyway. All of these signs, by the way, can also just be signs that your period is approaching.

So now the real craziness will begin. I'm going to try to do my best to control my insanity. Try to keep myself busy doing this and that. Today I'm going down to Delaware to visit my friend Beth-Marie. Tomorrow, who knows.

Tuesday, October 05, 2004

The Amazing Sperm Race

I mentioned in my previous post that the fertilized egg fails to implant in the uterine lining as much as 40% of the time. Those odds seem daunting enough as it is. But those aren't the only odds you have to overcome in order to conceive. On top of that, there are all the challenges that the sperm have to go through in order to fertilize the egg in the first place. While I focused on the egg in my last post, I'm going to give the boys their credit and write about them in this post. Because it's easier, I'm going to start off talking about the sperm in a heterosexual intercourse kind of way.

First of all, here are some stats courtesy of the book I have featured in my sidebar, Taking Charge of Your Fertility by Toni Weschler. Page 43 tells us:

Typical number of sperm per ejaculate (2-6 ml): 100-400 million
Typical number of sperm per milliliter: 20-200 million

I know what you're thinking. It's the same thing I thought when I first read those stats. That's a lot of sperm. And the second thought: Do we really need that many? Turns out we do.

Another book, The Pregnancy Bible by Joanne Stone and Keith Eddleman, offers us this description of the nearly impossible journey the sperm embark on once they are ejaculated (at the speed of about 10 miles per hour, you might be interested to know).

"The odds are stacked against sperm ever reaching their destination. When they enter the vagina they aren't fully active and are incapable of fertilization. It's only as they travel through the mucus in the vagina that they become activated and capable of fusing with an egg. Millions get lost in the numerous crevices of the vagina or arrive at the wrong fallopian tube. Others, mainly weak or damaged sperm, are destroyed by the deadly acidic environment in the vagina...

"It's estimated that some 40 million healthy sperm travel through the cervix and across the uterus, a journey that takes about 45 minutes....

"Only around 200 sperm make it to the site of fertilization, but the race isn't yet over. The egg is surrounded by thousands of cells that nourish it. The sperm fight their way through these cells, flipping them out of the way with their tails. When they reach the wall of the egg, a sticky substance on the surface helps them attach. The objective now is to burrow through the outer layer of the egg, called the corona radiata, and through a further layer, the zona pellucida. Several sperm may break through the outer layer, but usually only one reaches the nucleus. When this happens, the head of the sperm fuses with the nucleus of the egg, and the egg immediately throws up a chemical barrier around it to stop other sperm from penetrating." [page 12]

When you think about the above excerpt in relation to the first stats I mentioned, it becomes obvious just how hard these little guys have to work. You start out with 100-400 million, and only 40 million even make it into the uterus. From there, they have many other opportunities to get lost or killed. I find it truly ironic that after working so hard and doing everything right, about half of the sperm still alive end up in the wrong fallopian tube! Let me state the original stats again: You start with 100-400 million sperm and only 200 make it to the egg.

All in all, the sperm travel about six to seven inches from the vagina through the cervix, traversing the uterus and then up the fallopian tube. Six or seven inches doesn't seem like much until you take into consideration the microscopic size of the sperm. For them, it is about the same distance as a human swimming 100 laps of an olympic sized swimming pool. And once they've made it to the end of the distance, it's not over yet as they have to fight their way through the egg's barriers in order to fertilize it. Whew. Quite a job those swimmers have.

My sperm (hey, I bought them, so they're mine) didn't have quite as arduous a task ahead of them because they did not have to swim up my vagina or make it through my cervix. Rather, they were placed right into my uterus. Hopefully, one of them made it to the egg--if the egg was there in the first place.

Monday, October 04, 2004

The Biological Reason for the Two Week Wait

Here is a description of the very, very beginning of each of our lives. This will also explain why a woman has to wait so long to find out if she is pregnant.

Once the egg bursts out of its follicle in the ovary, it is moved along the the fallopian tube in the direction of the uterus by tiny, hairlike projections called cilia. The egg is about the size of the period at the end of this sentence and has a lifespan of 6 - 24 hours. If it is not fertilized within that time frame, the egg dies. If the egg is fertilized, this happens about two-thirds of the way on its journey to the uterus. Thus, fertilization generally occurs in the fallopian tube.

Within hours of fertilization, the cell begins the division process that will eventually create a fully formed baby. The reason that fertilization occurs in the fallopian tube is that the fallopian tube nourishes the developing cells. It also removes the waste products produced as the cells divide. It generally takes the egg about seven days to reach the uterus.

The fertilized egg itself is called a zygote. Once it has divided 4-5 times (reaching 16-32 cells), it is called a morula. The morula divides about every 15 hours and transitions the new life from a solid to a fluid-filled ball of cells. Once this transition is complete, the fluid-filled ball of cells is called a blastocyst. All in all, the evolution from morula to blastocyst takes about three days.

In the meantime, the dead follicle which released the egg (the follicle is now called the corpus luteum, which translates as "yellow body") has been busy releasing a hormone called progesterone. Progesterone stimulates the growth of the lining of the uterus, called the endometrium. It also raises a woman's body temperature in order to help incubate the egg.

This change in body temp is noticeable in any woman who is ovulating, which is why some women chart their temperature daily in order to determine on which day they have ovulated. During the first half of a woman's cycle, her temps will be in a "low range." The second half, after ovulation, she will undergo a thermal shift and her temps will remain in a "high range" until her next cycle starts--if she does not get pregnant. If she does get pregnant, her body temperature will remain elevated. I'm not talking about a 101 degree fever temp. More like 99 degrees.

The blastocyst is an important development because of of its outer layer, which is composed of spongelike projections called trophoblast cells. The blastocyst floats around in the uterus for about three or four days until it gets large enough for these trophoblast cells to grab ahold of the thick, sustaining uterine lining and burrow in. This is called implantation, and it takes about 10 total days for the fertilized egg to reach the point where it is capable of implanting.

Once the blastocyst implants, it starts to release the "pregnancy hormone," human chorionic gonadotrophin, or hCG. This hormone tells the corpus luteum (dead follicle) to keep producing progesterone. Otherwise, the woman's next menstrual cycle would come along, shedding the uterine lining and therefore terminating the very early pregnancy. Also, if the blastocyst fails to implant--for whatever reason--the same result would occur. The woman's menstrual cycle would begin, and the blastocyst would be swept out with the uterine lining. Failure to implant happens more frequently than you would think. Some estimates are that the blastocyst fails to implant 40% of the time.

hCG is the hormone that home pregnancy tests (hpts) detect. Therefore, before the blastocyst implants and starts to release hCG, there is no way to know if a woman is pregnant. The body itself is not aware of the new life floating around, unattached, in either the fallopian tube or the uterus until that point. Although the fertilized egg usually begins implanting somewhere around 10 days past ovulation (dpo), the amount of hCG produced is quite low. This explains why the chance that an hpt will accurately register the hCG is also low at 10dpo. Once the woman has missed the first day of her period, the hCG is produced at such a high level as to cause her to miss her period and is therefore also easily detectible by an hpt. The first day of a missed period is generally 14-15 days past ovulation.

So there you have it. The biological reason for the two week wait.

Friday, October 01, 2004

The Two Week Wait (2ww)

There's a misconception by the general public that as soon as the sperm fertilizes the egg, you can find out if you are pregnant or not. Au contraire. It takes two weeks, more or less, and this period of time between conception and knowledge is called the two week wait. It's spoken about so frequently on bulletin boards that serve as support groups for women in this time slot that it has an abbreviation: 2ww.

The 2ww is as close as I've ever come to hell on earth. Two weeks is an awfully long time to know the results of something you've been hoping for and dreaming about for well over a year--in my case.

Most women are oblivious to the two week wait. Most women who are trying to get pregnant just have sex with their husbands or boyfriends, and then their period comes or it doesn't. Trying to conceive (here's another abbreviation for you: ttc) doesn't really change the scope of their lives. Assumingly, they were having sex before ttc--just using some sort of prevention method. Now they just continue having sex, perhaps more frequently, and that's about it.

For a woman going through artificial insemination, it's a different story entirely. Obviously, we know exactly when conception could have occurred, and we also know exactly when our period will arrive if our attempt has failed.

Home pregnancy tests have gotten very sensitive. Most claim to give you results as early as four--or even five--days before your period is one day late. They are assuming a 14 day luteal phase (the time from ovulation to the first day of your period), so that means that you can take a home pregnancy test (hpt) 10 or 11 days after you ovulated. Of course, hpts are quite expensive, usually running around $15 for two tests. And the earlier you test, the least likely you are to get an accurate response. You will not get a false positive, but the chances for a false negative are rather high. I don't have an hpt right in front of me, but my recollection is that if you take a test at 11 days post ovulation (dpo), the odds are somewhere around 50% that the test will, in fact, give you a positive if you are pregnant. In other words, 50% of the time women who were pregnant used the test, it came back negative. Since you're spending about $7 per test, it gets to kind of be a waste of money. Especially when you could pee on five to six sticks while waiting for your period (one at 10dpo, another at 11dpo, 12dpo, 13dpo, 14dpo, and 15dpo). By that time, you've spent $45 on home pregnancy tests. If you were able to control yourself and wait until you've missed your period by one day, the tests are almost 100% accurate.

So just do that, right? But it is so hard to wait...and wait and wait and wait. Right now I am at 2dpo (today is Friday and I had my IUI on Wednesday, two days ago). I've got twelve days to go. I don't know how I'm going to make it. I will, of course. But it will be a struggle, especially as I get closer to the time when an hpt might be able to give me a positive result.

Perhaps you are wondering why it takes so long to know if a woman has conceived or not. That will be the subject of my next post.