NFP... When There's No Chance of Conceiving "Naturally"

With it being NFP Awareness week, tons of Catholic writers are discussing NFP, from explaining why newlyweds are afraid of the wrong thing, to when is it licit to use NFP to avoid, to what NFP actually is. It reminded me of this discussion that Amy started, about what might persuade more people to try NFP/NaPro. Many of the commenters focused on emphasizing the "natural" aspect, how it doesn't involve putting "chemicals" that could be carcinogenic into your body. (As a chemist, I take issue with how those words are sometimes misused, but that's an entirely different post.) Kat raised the issue of how NaPro uses many of the same medications that a reproductive endocrinologist would use to treat infertility, which doesn't fit the "natural" aspect being emphasized. Someone may have asked something to the effect of "does it really matter if it's a NaPro doc or an RE who puts you on Clomid?" I know someone else in the discussion said that women struggling to conceive just want a baby and don't necessarily care about treating the source of the problem.

Maybe I'm weird.... hold that thought, I know I'm weird. However, I also don't think I'm the only woman who was diagnosed with "unexplained infertility" and was frustrated by the lack of answers. (I've talked about this with a friend who saw a different RE in the same practice and was also labeled unexplained.) Maybe it's all those years of scientific training, or maybe it's just my personality, but I knew something was wrong, and I wanted to know what it was. Contrary to some of the comments in that discussion, I don't think RE's are skeevy or only out to make money; there are good and bad doctors of every stripe, just as there are good and bad lawyers, auto mechanics, etc. (There are probably even some really good people that are used car salesmen, despite all the jokes.) We had a really great RE, who we worked with for about a year and a half. Before we started seeing her, I was convinced that something would show up in the tests (probably my thyroid), and we'd be pregnant in no time. Getting hit with the diagnosis of unexplained infertility was a major blow, but we trusted our doctor. After 9 rounds of Clomid, we were given the option of switching to Femara, which might or might not improve our chances, or moving to injectables, which she thought would improve our chances, but would cost about $5,000 per cycle. Femara was described as more of a lateral move, whereas the injectables would be stronger medicine. That was the point where we decided to switch to NaPro. We were both fed up with the lack of answers, side effects, and "just push harder" mentality. (Our RE was interested when we gave her some information on NaPro and wished us well; there was never any hard sell or strong push to do IVF. She asked us to send baby pictures; I'm still hoping that some day we will have pictures to send.)

Here I am, approaching a year after our first NaPro visit, and I'm on more medications and supplements than I was with our RE. I'm even back on the same dose of Clomid as I was with our RE. Is there a difference? Does it matter who put me on 50 mg of Clomid CD3 - 7? I would say yes. In our RE's words, her approach was about "pushing the reproductive system harder." I can, and do, grumble about my growing list of diagnoses, but NaPro has truly focused on identifying the problems that I have and specifically treating them, not just pushing my body harder. If it weren't for the extended hormone profile that NaPro does, I would be at a much greater risk for an early miscarriage (or implantation problems). There are times I wonder whether my estrogen and progesterone levels dropping prematurely contributed to our early loss; I feel confident that if it did, the post-peak HCG that I am on will provide the necessary support for the beginnings of pregnancy if we conceive again. 

With my long list of diagnoses and medications, there may not be much "natural" about our NFP-coupled attempts to get pregnant, but it has made me much more aware of my fertility and health. (I think there's a lot to be said for re-branding NFP as Fertility Awareness.) I can't say that I am super hung-ho about NFP and plan to chart forever; if/when we stop trying, I may stop charting, but I would certainly recommend NFP to both couples of normal fertility and infertility. 

Simcha's week of giveaways continues, here and here. And that's another reason to be happy for NFP! (Who doesn't love free stuff?)

Little Happies (1)

Apologies to all my gluten-free friends, but this week's Little Happies features quite a few gluten containing foods (feel free to skip this post!). Since I have returned to eating gluten, Husbandido has been eager to treat me to many of the foods I missed.

1) Sarris Chocolate Covered Pretzels

Before going gf, chocolate covered pretzels were my absolute favorite candy; they have the perfect mix of salty and sweet, and Sarris chocolate is wonderful. (They do make a gf version, but the pretzels were just a hair too crispy and not salty enough. Plus, they're $17.)

2) Pizza Hut Stuffed Crust Pizza

This picture isn't actually of the pizza Husbandido surprised me with last Tuesday; ours was pepperoni and sausage. Beside making a yummy dinner, I had leftover pizza for lunch most of the week! (Husbandido had tried repeatedly to make me a stuffed crust pizza, but the cheese usually leaked out a little. The best pizza crust recipe or mixture we found that was gluten-free was Cup 4 Cup, which is pricey, but worth it for a special treat.)

3) Saturday morning I woke up to breakfast in bed... of Chik-Fil-A Spicy Chicken Biscuit and Hash Browns. Husbandido thought I might be super hungry, so he got me two. The second one reheated really well, and we split it for a fast breakfast on Sunday. Previously he had tried to make a gluten-free version, but the problem was getting the chicken right. 

4) I don't remember exactly which day it was (might have been the weekend before the one just past), we went out to eat at Red Lobster. We hadn't been there since I went gluten-free. Those biscuits are so good! (And again, I had plenty of leftovers to make lunch for both of us the next day. Yay for easy meals!)

I will now cease taunting you all with gluten containing foods that you can't have. (And I'll get my final GF product review post up soon!)

5) Synthroid - I know there are some people who think that Armour is the only way to treat hypothyroidism, but Synthroid has been a miracle drug for me. I have the energy to do things again (including deal with a downed tree), and I've lost 5 pounds in the approximately 2 weeks I've been taking it. I'm keeping a close eye on the weight loss, especially since losing too much too fast is problematic. I also have a definite idea of how much is too much to lose, though it is fun seeing my Wii Fit Mii shrink.

6) Free stuff! Who doesn't love a good giveaway? In honor of NFP awareness week, Simcha Fisher is hosting major giveaways, including a copy of her book. Here's the post for today's giveaways. (I know, I know... we may all be a lift too aware of our fertility or lack thereof, but not all of the items are fertility related.)

Accepting a Gift as Given

The phone rang; I didn't recognize the name or number on the caller ID, so I handed the phone to Husbandido. (I intensely dislike talking to strangers on the phone. I have no problem happily chattering away to friends and family on the phone or talking to strangers in person. Just one of my many quirks, I guess.) I went back to doing whatever it was that I had been doing; washing and putting away dishes, I think. He seemed to be on the phone a while, though, so I quietly asked him who it was. It was that older couple from church; they had seen us at Mass the previous Sunday but hadn't had a chance to come over and see how we were doing, so they called. It could have seemed nosy (or nebby, as Pittsburghers would say), but it didn't. Their compassion and willingness to support us and suffer with us leaves us feeling more like we have a third set of parents. They are truly living out a spirit of adoption, which is a tremendous gift to us. Especially knowing how many others suffer from a lack of support, we acknowledged how fortunate we are to have generally supportive family and friends.

It got me thinking about some of the other gifts we have been given by family and friends. A while ago I was chatting online with an old friend. We've known each other since high school; there have been times that we were very close and times we haven't been as close, but we have managed to maintain our friendship despite very different directions our lives have taken. I was telling her about our IF struggles and some of the side effects I've been going through. In the middle of our discussion, she volunteered to serve as a surrogate for us (I think her words were "As far as I know, I have a perfectly good womb that I'm not using."). My response was a simple "thank you." While we wouldn't use a surrogate, what she was really saying is "You're my friend; you're hurting, and I want to help however I can." To her, this was something she could do to help. My friend isn't Catholic, and it wasn't the right time to get into the reasons why we wouldn't use a surrogate. It was the right time to acknowledge and appreciate the gift she was offering. 

It's the same type of gift we receive whenever someone offers to pray for us. Regardless of whether they're Catholic, or even Christian, their offers of prayers are a gift; they are trying to intercede on our behalf with the divine, however they see it. Months ago, when talking to an old friend (and former fiancé, but that's an entirely different story), we were comparing notes on our fertility problems. He and his wife have tried twice, gotten positive pregnancy tests twice, and twice had the pregnancy be a anembreyonic (a blighted ovum). He would like children, but his wife is reluctant to try again. It got to the point where they were living more like roommates than spouses, to the point where he considered divorce. They managed to improve their relationship, and he concluded that he wouldn't find someone else who suited him as well as his wife and that a disparity in their desire for children wasn't reason for divorce. Though he was obviously hurting from their situation, he listened and offered compassion for what we have been willing to do in our attempts to have children. He asked if I was okay with him praying to his deity for us (he is now pagan, was formerly Catholic). It wasn't the time or place for a theological discussion, especially not one of whether Catholicism considers pagan gods demons. Prayer was one of the few things he felt he could offer. (That doesn't mean I can't hope and pray that he will someday return to Christ, which is, again, an entirely separate issue.) Saying "Can I pray for you?" is really a way of saying "I care and want to help."

We finally received the results of the re-test of my thyroid. Back in September my anti-thyroid antibodies were 288.8, where normal is 9.0 or less. Because of those levels, consistent with Hashimoto's thyroiditis (a diagnosis I had been given previously), our doctor recommended I go gluten-free, which he expected would bring that value down. Upon re-test, after 9 months of being gluten-free, my anti-thyroid antibodies were 287.6, which isn't an appreciable difference. To say that I had mixed emotions at that result would be an understatement. I hadn't felt any different after going gluten-free; while I had lost a few pounds, the results had generally been underwhelming, compared to the results others have had. After some debate, we decided that I should go back to consuming gluten, since removing it had not had much effect. In some ways being gluten-free worsened my eating habits, as it became the focus of what I could and couldn't eat. I had expected being gluten-free to help, but I am trying to see the lack of effects from it as a gift. I am now much more focused on portion control and generally eating better than I was before. I could be upset about the lack of results - I wasn't the biggest fan of going gluten-free; instead I am choosing to take it as a gift, of again being able to eat food that I missed. 

Blerg...

I got my P+7 blood work results yesterday. Of course our doctor is on vacation this week, so I have yet to hear his interpretation, but I can't say that I'm thrilled. For my own reference, I decided to compare them to the last couple of months, where he has been happy with the results. If anyone has any wisdom to share, I'm eager to hear it (for reference, this was on 25 mg Clomid and 2,000 IU HCG P+3,5,7 and 9). I was told to do the blood work on P+6 if P+7 is a Saturday and Monday if P+7 is a Sunday. I'm suspecting that there will be messing around with dosages either for next cycle or after surgery. Granted, I was a bit of a stressed out mess this past cycle, but that estradiol level looks low to my untrained eyes. 

                             5/1             5/30        6/30
Estradiol            15.20         21.03       9.52
Progesterone     37.9          23.1           20.8
Actual CD           P+7          P+6           P+8

Adopt-a-Blogger: July

First of all, if this is your first visit, courtesy of Amy's Adopt-a-Blogger program, welcome and thank you! I cannot begin to describe how much this means to me, and it could not come at a better time (but I'm getting ahead of myself here). If you're curious about the name and heading picture, I explain in my Welcome to Chateau d'If post.

Background: Husbandido and I first met in the summer of 1999, though we didn't start dating until 2007, partly because he looked really young (like 12, though I assumed he was an undergrad) and partly because he was trying to get his life in order. Having known each other for so long before we started dating (and the fact that we covered religion, politics, and children on our first date probably helped, too), we went from starting to date to married in 13 months. I turned 31 on our honeymoon. Four months after our wedding Husbandido lost his job; in addition to losing his income, we were also suddenly faced with bills for COBRA and his tuition (which had previously been covered by his employer). I was working in a temp position, and we didn't know how we were going to get by. It wasn't until March 2011, almost three years after we married, that we started TTC. Though Husbandido had not yet found a job, he had completed his degree in computer science, and we had both felt nudges from the Holy Spirit that it was time. We had learned sympto-thermal NFP shortly after we were married, so I started to get concerned after about 6 months of TTC. (The fact that 35 was starting to loom didn't help.) We started working with a reproductive endocrinologist (RE) in November 2011. We had a positive pregnancy test my third cycle on Clomid, October 2012; unfortunately the pregnancy proved nonviable.

Diagnoses: According to our RE, we were "unexplained," which frustrated me to no end. On the other end of the spectrum is our NaPro doctor; it seems like every time we talk to him, I gain at least one more diagnosis. The current list includes vitamin D deficiency, iron deficiency, poor quality ovulation, type 3 luteal phase deficiency, and, as of our last appointment, probable endometriosis. 

Plan: Now that you're all caught up on our background, the reason that this couldn't come at a better time is that our NaPro doctor thinks that the next step is surgery, which is scheduled for August 6.  Today is my final HCG shot of this cycle (P+9); based on my last few cycles, I expect CD1 to be around July 6. Based on that assumption, we may have one more cycle left before surgery. I'll be on 25 mg Clomid (CD3-7), Biaxin (CD7-20), low dose naltrexone, and HCG post peak (P+3,5,7, and 9) for the fifth time. Barring a miracle positive this cycle or the next, August 6 will have me in Columbus for a laparascopy and selective hysterosalpingogram. I'm not enthusiastic about having surgery, but at this point, it is our best chance at success. As much as I would love to be one of the stories of women who end up pregnant right before surgery is scheduled, I'm certainly not counting on it. As we prepare for my surgery, please pray that I may find peace in the decision and that we may have the grace to accept whatever may come.