Tears Out of the Gray

No time for Part 2 this weekend, unfortunately. My mom was in town this weekend for some moral support (THANKS Mom!!). Had a blast with her and then spent all my extra time getting ready for a big presentation at work tomorrow (please wish me luck...SO nervous! :). But, I did want to write this quick drive by post to share this...

I was driving to the airport on Friday night to pick my mom up from the airport. It had been a very long day with lots of running around. I was tired and perhaps a little grumpy. Mat Kearney's "Closer to Love" came on the radio. I've probably heard the song before, but I guess I've never really listened to it. This time I did.

Next thing I knew I was in tears. It was this that got me:
She got the call today
One out of the gray
And when the smoke cleared
It took her breath away
She said she didn't believe
It could happen to me
I guess we're all one phone call from our knees

More specifically, I think it was this that really hit me:
I guess we're all one phone call from our knees

I think we've all had that phone call (IF-related or otherwise). The one that started us down this path. Or, worse yet, kept us on it...another bad news blow.

But, there are also the good news...no, the amazing, life changing, never thought this day would come, GOOD news phone calls, too. Those bring us to our knees, too. We've all had the first kind of phone call. Many of us wait for the second.

So, on Murgdan's beta eve, I send best wishes to her for that second type of phone call...with tears of joy out of the gray.

Also to Mrs. B, Jen, JackieMac, LowFatLady, and everyone else out there beginning cycles that will hopefully end in that second type of phone call, too, I hope along with you that it does.

And, for the rest of us somewhere in between, I leave the song that brought me to tears as we wait for our own "brought us to our knees" good news phone call...


or full video here:
http://www.youtube.com/watch?v=YbdxzSHn-QM&feature=related

The Baggage we Bring to the Island: Part 1

Like father, like son...

In most families, it goes something like this:

"I see Xavier got your throwing arm!" Like father, like son!

"Aidan looks like quite a character, just like his dad!" Like father, like son!

"Caleb seems good with the ladies, too!" Like father, like son!

In our family, the phrase takes on a slightly different connotation. My mother-in-law has a painfully vivid recollection of a moment driving home from the doctor, after my father-in-law was diagnosed with severe chronic depression, where she hoped beyond hope that her sons would never have to know that same anguish. She has an equally vivid memory of a similar wish that her sons would never have to experience the social stigma and myriad of complications (emotional and otherwise) that accompany male factor infertility.

Those particular wishes were left unfulfilled. God had a different plan, fate if you will, that only years later came into focus. Sometimes she apologizes to me for the genetic cards my husband (and I through marriage) was dealt. Having experienced both depression and MFI first hand, she wouldn't wish it on anyone, least of all her own son. Having only begun to walk a few steps in her shoes, I couldn't agree more.

But there's more to it than that. What I already know from the years we've spent battling my husband's depression is that sometimes the depression takes everything you've got. It sucks us dry and leaves us marooned on the shores of a desert island. Sometimes he forgets that we're together on the island and that's just one of the many reasons it's so painful. But, when we find each other again and are there together, battling the endless baking sun and the battering waves, we're okay....eventually we make it back to the mainland, and we're stronger for it. Much, much stronger. Infertility is every bit the same. And, just like my mother-in-law, I wouldn't wish it on my worst enemy. But, I know that we'll be better for it. We'll be a stronger couple, "better" parents, and a more grateful family.

It's also true that genetics isn't the only thing that determines our fate. Personality plays a role, too. When we received our first SA results (via a phone call to me from my OB/GYN), I was devastated. But, I was told that I had to survive on the island by myself for awhile. From their past experience, both the nurse and my mother-in-law told me not to tell my husband. "Let it come from the doctor," they said, "He'll take it better."

When my father-in-law was given similar news in the late 1970s, the urologist used the "s-word": sterile. Furthermore, they were also told that they would never have biological children. Social stigma and ego proved to be too much. He was beyond livid, but over time that anger transitioned into his first diagnosed chronic depression episode. I was warned to expect a similar reaction, though it would be far from our first experience with depression.

But, this was not like father, like son.

My husband is remarkably okay with our MFI because we have a plan. I'm grateful for his calm and for the fact that he does not tie his sperm count, motility and morphology to his own self-worth. At the same time, it turns the tables a bit. I'm left as the one struggling to find the other on the marooned island. Such emotional extremes are hard to process...how can he feel as strongly about starting our family as I do when remains so even keel about it? But, I know that he shows his concern and caring by agreeing to the SA so early, by going to the specialists, by being my shoulder to cry on and never judging my emotions.

What I heard at the urologist appointment this week was that our odds of needing ART to get pregnant are extremely high. I expected to hear that, but it was (and is) still jarring. It still unnerves me and causes me to mourn the loss of the "quick and easy" conception that so many others around me are experiencing.

What my husband heard was that we can and will get pregnant, it’s just a matter of how. And, that's all he needed to hear. I'm grateful that his perspective is often my shelter on the island...that what depresses him, doesn't me and that what depresses me, doesn't him.

Fate and genetics. They don't live in isolation. I still believe that God only gives us what he knows we can handle. As it turns out, we were given some genetic issues to overcome. But, we were also given the perfectly balanced personalities to weather the island storm until we can overcome them. The irony is not lost on me...and I'm grateful.

-------------------------------------------------

Thanks to Mel for writing her post "I Watched Funny People and What I Learned about MFI" about the unique kinds of baggage that accompany an MFI diagnosis. I've appreciated the many responses left by others experiencing the same baggage. Please head over to read her post and the insightful responses!

Part 2 will explain why I (we) choose to talk about our journey through depression and MFI when so many others do not. The stigma that goes along with talking about MFI is another piece of luggage to add to the pile.

CD1 but it's okay...

My grandpa's PET Scan came back cancer free today...

Puts a bit different spin on CD1 this month...

I'm grateful...for him.  And it's nice to not feel in quite such a rush to make sure he's still around to see his first great grandbaby.  I'm grateful for that, too!

And, most of all, it's proof that miracles do happen!

Show and Tell: Our Anniversary Vacation!

It's that time again...I'm raising my hand and walking to the front of the class for our weekly Show and Tell tradition.  Stop by Mel's place to see what the rest of the class is sharing...

As for me, I'm sharing love, smiles and romance (fair warning: this post may be sickeningly sweet in a few places).  That's right...our 5th anniversary vacation!!  Just to paint the picture completely, you should know that we got married in 2004 and honeymooned at Disney World and Las Vegas (working for an airline has a few perks...).  Mere months after that, we moved to Minnesota, many miles and states away from any family.  For the the four years that followed "vacations" involved visiting family...something we love to do, but we were also yearning for the "throw caution to the wind, no one's schedule but our own, romantic hotel room"-type vacation!

Fast forward to May 2009.  We had recently moved to Texas and were within driving distance of most of our family. The family that was farther away were already in the process of moving closer.  All was finally right with the world.  Hubby also happened to have amassed a mile-high collection of Marriott points during the relocation.  With our fifth anniversary right around the corner, the stage was set for our first true vacation in five years!  No one had to twist my arm to say "HECK YEAH!!!" to the idea of a three day weekend in San Antonio at the Marriott Rivewalk!  I couldn't think of a better way to celebrate five years married to my soulmate...just the two of us, a hotel room with a beautiful view, a balcony that overlooked the city, the Riverwalk to discover, and no agenda other than enjoying each others company!

So, here are some pics from our fabulous anniversary trip!!

From our hotel, the San Antonio skyline with the Riverwalk below:

A fun one of the Torch of Friendship and the Tower of Americas:

Random along the Riverwalk:

And, the happy couple! 

Happy Anniversary Sweetheart!!

I love you more!

Wacky Wednesday Hodge Podge

Some thoughts...

Thanks for the comments about yesterday's post. I agree with you on taking care of the hormonal issues first. That makes the best sense. I've just seen so much mixed info on the varicocele repair, that I'm not putting much stock in that. And I'm grateful that the doc isn't pushing it too heavily (yet). I'll definitely be picking up Dr. Silber's book "How to Get Pregnant" this weekend(thanks Murgdan for the recommendation!)!

Clinical trial update...
I called about the clinical trial just to get the information. I feel better knowing what all of our options are! The current clinical trial doesn't work for us. However, they have a new one beginning in January that will likely offer a much better discount. No word on inclusion/exclusion criteria yet, though. Will be keeping fingers crossed that, if we still need this option, we qualify in January! That timing works out great for us anyway. Long enough to get some of hubby's issues worked out (hopefully) and a few more months to save.

Crafty circle update...

Still looking for one more participant in the crafty circle/craft-o-rama! Check it out here...

(Thanks for the awesome pic Suzy!! Check out her awesome blog Not a Fertile Myrtle!)

No Surprises, but No Great News Either

Count: 5 million (normal 20 million)
Motility: 22% forward movement
Morphology 0%
2 Varicoceles (small to medium)

So, no surprises. The varicoceles were new info, but not a huge surprise to me. I really liked the doctor. Very matter of fact, while still not unnecessarily scaring us. And, he gave us a ton of information to read and think about...which I LOVE!

Basically, we were told that right now our only/best chance was IVF w/ ICSI. However, he's not ready to send us down that path just yet. First, we had bloodwork done today and will do a second SA to confirm the first on Thursday. Dr. B has a hunch that hormonal imbalances may be at play and the blood work will show that. If that's the case, he suggests Tamoxifen to increase count (and possibly morphology). His hope is that he could get us into the range that made IUI possible (20 million count/4% normal morph). He made no mention of getting pregnant naturally as an option for us.

There is also the option of varicocele repair. However, based on what research I've done so far, and Dr. B's description of it's efficacy, I'm not exactly jumping on that train just yet. If the bloodwork comes back normal, I'd almost rather put the money that would go toward the varicocele repair towards the IVF clinical trial going on locally. I don't know...

So many what ifs still. Tamoxifen or not. Varicocele repair or not. IUI or not. Clinical trial or not. I'm not sure what's too early to at least start investigating or get the ball rolling on the clinical trial. I don't want to wait so long that the trial is closed to new patients. But, I also realize that any improve we can make betters are chances of successful IVF if it comes to that. I'm torn on this one. I think I'm off to do some research on Tamoxifen's success rates with morphology improvement...

In the meantime humble readers...did you or someone you know deal with MFI due to varicoceles or hormonal imbalance? If so, what treatment did they choose and did it work?

SA Results: Count, Motility, and Morphology Explained

In an effort to get my thoughts untangled before the urologist appointment this afternoon, I thought it might be helpful to write them down here. I plan to take this cheat sheet with us to the doctor tomorrow so that I can make sense of all of the numbers he throws at us. Because this post is likely to get long, I'll probably post two separate ones later this week or soon thereafter...one on morphology in more detail (the most concerning item for us since we currently have 0% normal morph) and possible "treatments"/remedies for MFI issues (though there seem to few and they seem to be mostly a crap shoot!)

The process of interpreting SA results or figuring out how to improve them begins with collecting the sample. With that in mind, this excerpt from Dr. Mark Perloe's "Miracle Babies" gives some great tips on how to make sure the best sample possible ends up at the lab. The exercept doesn't give too many specifics, though, so I'll direct you here for more specific instructions. Of course, if your doctor gives you different instructions, use those! The only tip that we were given that doesn't appear in those resources is that if your collecting at home and transporting the sample to the lab, be sure to keep the sample at body temperature (tip: keep the sample cup in DH's breast pocket, for example).

So, now the all important collection is done and your doctor calls with the results. Motility, morphology, volume and count...what the heck does all that really mean? Here are the "normal" ranges that I've been able to find. Keep in mind that the categorization "normal" seems to be somewhat subjective depending on the clinic/doctor.

Sperm Count/Concentration
Sperm count is the number of sperm typically found in a milileter of fluid.
Normal range: 20 million to 150 million. Average is 60 million.
Low: Greater than 10 million; Less than 20 million.
Very Low: Less than 10 million. This is otherwise known as oligospermia.

Motility/Mobility
Motility is a measure of how many sperm are actively moving at certain times after ejaculation. The better the swimmers swim, the more likely they'll be able to reach the egg.
Normal: 50% moving at one hour post-ejaculation.

The WHO (World Health Organization) further categories motility into the following four categories:
Grade a (fast progressive) sperms are those which swim forward fast in a straight line.
Grade b (slow progressive) sperms swim forward, but either in a curved or crooked line, or slowly (slow linear or non linear motility).
Grade c (nonprogressive) sperms move their tails, but do not move forward.
Grade d (immotile ) sperms do not move at all.
More excellent information on motility here (the reference source for the above).

Volume
Volume is just the total amount of fluid in the sample. This measure is also why all of the SA instructions stress the importance of making sure that the entire sample is collected.
Normal Range: at least 2 milileters

Morphology
Morphology is a measure of how the sperm or shaped. Normal sperm have oval heads, a connecting middle piece and long, straight tails. Anything not meeting those specifications is considered abnormal. The morphology measurement is the percentage of abnormal sperm in the sample. The more normally shaped the sperm are, the more likely they will be able to fertilize the egg.

There are two standards for categorizing morphology. You can read more about the WHO Criteria vs. the Kruger Strict Criteria here.
WHO Criteria
Normal>60% normally shaped

Kruger "Strict" Criteria (sperm must be perfect to be considered normal)
Normal>15% normally shaped

Particularly useful Kruger categories from fertilitydr.com:
>=15% normal: Normal range - Good prognosis
5-14% normal: Sub optimal range - Prognosis is fair to good, however, the lower the percent normal, the lower the chance of successful fertilization
0-4% normal: Poor prognosis - Will usually need IVF with ICSI

There is conflicting information about the importance of morphology, which is why I'm planning to talk about morphology in more detail in a later post. In brief though, if the count is high, 20% normally shaped may be more than enough to get the job done. 20% normal morph with a count of 100 million still leaves 20 million normally shaped sperm. That's in the adequate range. However, the lower the count gets and the higher the number of abnormally shaped sperm get, the fewer "good" sperm are left to do the job.

For us, for example, we have low count (number to finally be disclosed at this afternoon's uro appointment) along with 0% normal morphology. Even if we can get the count up, we've still got zero normally shaped sperm. That's obviously a big problem. We'll see where the urologist stands on the morphology controversy soon enough.

That's enough for now. More on treatments, morphology and possibly varioceles at a later date. I hope that this proves to be helpful for others who find themselves in a similar situation in the future! Please feel free to add any useful resarch that you've unearthed (or other blog posts you've found with helpful information) in the comments!

The rest of the resources used in this post can be found here:
IF Optimist, Then (kudos to my fellow blogger IF Optimist for some equally great research!)
WernerMD
Your Total Health (iVillage)
Bluegrass Fertility Center
Malpani Infertility Clinic