When all the testing results were finally back, I sat down with my doctor. He explained that they were all normal. My heart sank. I had been hoping for an easy fix, and that wasn't to be. 10% of couples end up with the diagnosis of unexplained infertility. It is one of the more frustrating diagnoses, but it also has one of the better treatment success rates. My doctor suggested I try Clomid and IUI's. Clomid is a pill that you take for 5 days at the beginning of your cycle. It fools your body by blocking estrogen receptors so that your body thinks the ovaries have stopped making estrogen. This causes the pituitary to send out more signal to the ovaries to get them working again, and this can cause multiple eggs to be produced in a single cycle. It raises the chance of twins to 8-10% and rarely can cause triplets or more. Although I should have been more worried about having multiple babies (the risks of birth defects, prematurity and other problems are higher); like most women struggling with infertility, I just wanted to be pregnant. Besides, it was the side effects of Clomid that had me worried. Clomid can cause hot flashes like women in menopause get, emotional changes (a lot like PMS), pelvic discomfort, and rarely headaches or visual changes. I could handle all of those except the emotional changes. I'd never really had PMS, and I didn't want to start. How was I going to take care of my patients, if I started weeping at the drop of a hat? I wanted a baby, though, and so I took the Clomid.
The first thing I noticed was the hot flashes. They would come at any time of the day or night. My husband accused me of trying to give him hot flashes, because I would throw all the covers onto him in the middle of the night. Patients must have wondered why I would suddenly turn red and unbutton my labcoat in the middle of a consultation. They were an annoyance for sure, but I didn't mind them. It meant I was one step closer to having a baby! I also became aware of my ovaries for the first time in my life. I could feel this dull ache when I got up out of a chair or went over a pothole in the road. The emotional changes didn't really happen. If anything, I was happier because I was actively doing something to help get pregnant. I considered myself lucky.
The first challenge to this happiness came when my very good friend and his wife appeared at our front door with "good news". They were pregnant after just a few attempts. My heart broke. I was happy for them them, but sad and angry for me. I wanted to shout "that's not fair! You've barely been trying, and I have been trying everything possible for almost 2 years without success. It's my turn, not yours! Go back and try some more." Instead, I congratulated them and gave them both hugs. I asked the appropriate questions about due dates and names. I gave them suggestions for OB's. This was just the first in a long line of friends and family who get pregnant easily while I struggled. It never got any easier, but I never gave in to my inner demons and expressed anything other than hapiness for them. Perhaps I got some kharma points for that.
After the Clomid, I had an IUI. This is a procedure where my husband's sperm was washed and concentrated down into just a few drops of fluid (0.5 ml). A speculum is then placed, and a small tube or catheter with the sperm is threaded through the cervix and into the uterus. The sperm is then deposited at the top of the uterus. Although it sounds a lot like the HSG, it is much less uncomfortable. The amount of fluid is so small that it does not make the uterus cramp. The worst part of this procedure was that is was done by my male colleague and doctor, who, up to this point, had not seen me undressed. The drive to become pregnant trumped modesty, however, and the IUI went off without a hitch. The next two weeks were hell. There was nothing to do but wait and wonder. I analyzed every little twinge or wierd feeling to see whether it might indicate a pregnancy. Since, by this point, most of my office knew what was going on, they kept asking me how I was feeling too. It became a kind of ritual:
"How are you feeling?"
"OK, but tired."
"Oh, that's a good sign!"
"I hope so!"
Unfortunately, 2 weeks later I got my period. The happiness disappeared. My coworkers stopped asking how I felt. It was like being on a giant roller coaster. I did 2 more cycles of Clomid and IUI's, but they didn't work either. Up and down went the roller coaster. Time to regroup with my doctor. He suggested a surgery called a laparoscopy. A small incision is made in the belly button, and one or two more small incisions are made down near the bikini line. A scope and other instruments are then placed into the belly to look at the uterus, fallopian tubes, and ovaries. I had fairly bad cramps with my periods, and my doctor suspected I might have endometriosis. This is a condition where the same cells that line the inside of the uterus and grow and come out with your period start growing somewhere else in the pelvis. It can cause painful periods and infertility. I agreed. My good friend and colleague agree to assist in the surgery. I had the surgery on a Friday and was back to work on Monday. There was some endometriosis in there, and they lasered it. My one ovary was also stuck to my pelvis, which can make it hard for the fallopian tube to reach the eggs. They unstuck that as well. Up went the roller coaster. Perhaps this is why I wasn't getting pregnant! I was again happy and optimistic!
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