What do you think we should do?

It just struck me that I've never asked your opinion of what you think we should do for 2006 in our pursuit of having a child. I don't have a plan right now at all and I'm really wondering what other people think when they read about our situation.

Do you think we will get pregnant again on our own? (it's been 5 cycles since we started trying again -- though the past two cycles I haven't been trying trying just not preventing. It's also been over a year since my myo)

Should we try an IUI? With Clomid or not? (what about the excess estrogen and The Infertility Cure mentioning that it tends not to mix well with liver qi stagnation -- I wonder if I still have that...)

Should we go straight to IVF? (even though this offends our sensibilities and makes it all seem so desperate and only heightens the stress of the situation)

Should I consult a new RE or stick with the one I've ended up with who isn't up on progesterone supplementation? Should we consult with someone outside of our area in another state -- preferably a larger metropolitan area?

What do you think? Please share. Thanks.

Cute Diapering Accessories

I did say that I was going to share some of my pregnancy and beyond links so here are some really cute bags and things.

Diapees & Wipees -- cute little holders for a few diapers and some wipes.

Darling Diaper Bag from Lexie Barnes


I'll add more to this post as I come across more things worth noting.

More Thoughts About Fibrocystic Breasts

So the common things they say to do if you are having PMS and fibrocystic breasts are:

Increase calcium consumption

Decrease caffeine consumption

Make sure there isn't a thyroid problem

Cut back on refined sugars

Increase dietary fiber

Increase B-vitamin consumption

Increase magnesium consumption

Drink more water

Use natural progesterone cream

Increase vitamin E consumption



-----

So I used to eat a fair amount of dairy and I had bad PMS but cutting back to almost none hasn't made any difference so dairy doesn't seem to do anything for me favorable. Less dairy does seem to help with my allergies and digestion so I'm going to stick with that plan.

I've always been a very moderate consumer of caffeine, I didn't drink coffee or cola. I do eat chocolate and have some black or green tea but in moderation. So, that didn't seem to make any difference at all -- in fact I recently started drinking a little more coffee than usual (a few time a week instead of once a month) and it's made no difference.

I've had my thyroid checked several times including a full thyroid panel last summer as it comes up as related to many of my conditions (fibroids, elevated estrogen, PMS) -- each time the test results were so normal it was boring. My mother has thyroid trouble so I thought for sure this might be related for me but evidently not.

Due to my naturopathic and TCM treatment I was told to cut back on refined sugars. It's helped me to feel better but I was never a total nut about eating candy or anything. I've made a concious effort to be careful about my intake of simple carbs. Still I've got sore breast in my luteal phase.

Increase of dietary fiber does seem to help me feel better generally but it hasn't seemed to help with the breast issue at all. Since this helps your body to eliminate excess estrogen I'm sticking with this for general health.

I eat a largely vegetarian diet (though I am an omnivore) and the foods I eat contain a lot of vitamin B and magnesium. Stress depletes b-levels and my work can be stressful and sometimes I don't get enough foods rich in vitamins B or magnesium but I really do try. I was never on birth control pills which can rob the body of B vitamins and magnesium so that's not an issue with me. I have been trying to be better about taking my vitamins but the best I usually do is 4 times a week -- better than nothing in my book.

I am bad about drinking enough water every day -- mostly when I'm at work. I'm much better than I used to be I think.

Natural progesterone cream didn't really seem to do much to help, maybe a little, but it mostly makes my breasts seem to swell more, not necessarily become more lumpy or sore.

And then there's the Vitamin E thing. It's in my prenatal and that on it's own doesn't seem to do anything.

But then there's that DIM/Vitamin E thing. It really did seem to help over the past three days. Today I'm spotting so AF is just around the corner but previously I used to not have my breast stop hurting until I had full-blown AF. It seems so curious to me. And some of the links I've found mention that vitamin E can increase estrogen levels, and also that DIM might do the same -- it just doesn't seem to be doing that to me -- it seems to be helping something hormonally.

(Vasectomy and) Vasectomy Reversal Information

I'm surprised that I haven't really posted about it before but I guess since my partner's reversal was so long ago (1998) that I haven't really gone into it in much detail over the past three years. I'll try to remedy that so that others can learn from what I've learned.

My partner thought that he was going to help out the overpopulation problem and in a fit of idealism and with encouragement from his wife at the time, underwent a vasectomy. That was several years before we met, and as it would happen, on the cusp of the end of his marriage. I can't really speak too much as to how his post-op recovery was though I know that he went in for the procedure alone and was hurt that she didn't even come to see him home afterwards. (Lesson #1 -- it is an emotional thing and the female partner should be there to provide support).

I've had a few sexual partners in my past and so I was a little familiar with what ejaculate looks like. What was weird about my partner's prior to his reversal was that it was thicker than the intact guys I engaged with. I guess this is due to the ejaculate just containing the portions from the prostate and seminal vesicals. After his reversal it returned to a normal looking consistency.

The final product of semen that you see when you come contains only 5% sperm; the other 95% is made-up of secretions from the seminal vesicles (considered an extension of the prostate) and prostate fluid (about 80% of the final mix), which gives ejaculate its whitish color.
From Premature Ejaculation


From when we first started dating he told me he intended to have a reversal, he had already worked through his regrets about having the procedure and so we knew it was on the horizon. From what we learned online at the time, having a reversal within 4-5 years of the initial vasectomy supposedly would help to ensure a greater likelihood of success.

The first step was to locate a doctor who specialized in vas reversals as we wanted this done right the first time. I searched online and at the time, Columbia University had and still has some great vasectomy reversal info and doctors who looked pretty good but through a friend's father who is a urologist in Washington, we learned about Dr. Dale McClure , a urologist specializing in fertility at Virginia Mason Hospital. My partner, since we were still just dating at the time, went for his appointments without me. I remember feeling embarrassed when he came back and told me that Dr. McClure asked about the fertility of his partner (me) and he provided some answer about my having regular cycles -- ack! things were going really fast for me and we'd only been together for a couple years.

The surgery was scheduled to be done through a facility at Group Health Hospital on Capitol Hill; there was some reason it was done there which if I recall correctly might have had to do with both insurance and the technology available. I insisted on being at the hospital the day of the operation, knowing how hurt he had been by the lack of support when he had his vas.

On the Internet prior, we had learned that the medical term for a vasectomy reversal is vasovasostomy and that there was a microsurgical technique used to sew the tiny vas deferens back together again using a fancy sewing technique under intense magnification -- this techique was supposed to have a higher success rates than older techniques.

Prior to the procedure my partner was sedated in a pre-op are and I was able to spend time with him and massaged his feet and kept him relaxed and calm (it was from this experience that he learned how to take care of me surrounding my first d&c and then my fibroid surgery which was really nice for me). The nurses told him that he better be really nice to me and that I was a "keeper". When he was good and loopy on the meds I stepped out into the waiting room and he went into the operatory. I told him that I would be there the entire time he was being operated on so he should know that he wasn't alone ever.

[Graphic detail]
From what he's told me, in the operatory he was awake but sedated during the operation. There was a camera pointed at his testes throughout the procedure, with a screen within his view which was fairly intense for him to watch. The doctor made two incisions into the front of he scrotum and lifted out his testicles to have access to the surgical site (in contrast, vasectomies are done through very small incisions through the back of the scrotum). When it would get too intense for my partner he would tell the nurse to dose him more. It took about two hours to do the operation and then he was moved out into post-op where I was able to come in and see him and rub his feet some more.
[end graphic detail]

We left the hospital that afternoon and went home to rest. He was instructed to not ejaculate/have sexual intercourse for four weeks after the operation to help with healing. Since then I've heard of other doctors wanting to have men begin ejaculating sooner (10 days post-op) to help keep the vas open. I don't know if there is a standard, I assume it is still going to be based on your doctor's own experience and preference. While he was healing the most noticible thing was that his scrotum was HUGE. His balls were swollen to the size of large oranges at least and it took weeks for the swelling to go down.

I believe he was meant to have a semen analysis within a few months of the procedure but we weren't ready to start a family yet and the doctor said that he had found sperm during the procedure from the testical side of the vas. I think it was fear of it not working more than anything that made my partner delay his semen analysis. Finally over a year later he went in and had it done and the results were pretty poor by WHO standards. He was instructed to come back for another test in a few months if I recall correctly. He asked the doctor at the time about some ongoing pain that he had in his scrotum/testes and the doctor thought it might just be part of the healing process. We felt a bit discouraged but only time would tell.

Specific things we learned along the way from our experience:

There might be pain for a while

Sperm counts might be low for a while and continue to improve over time without intervention (we saw significant improvement after 2 years)

Ejaculate consistency will change after the reversal, to a more normal consistency

You should be sure to have a semen analysis based on Kruger morphology standards and not just WHO standards, and also make sure you are tested for anti-sperm antibodies as well

MFI supplement cocktails can actually improve morphology

The our doctor felt that our chances of conception would be better with a repeat reversal (though it wasn't required ultimately because things improved on their own) than with trying TESE/IVF

General post vas reversal fertility info:

There is a greater chance of having ROS damage to the sperm

That the success rates post procedure have more to do with the health and age of the female partner than just on the time between vasectomy and reversal

That there is about a 50% chance of conceiving on your own post reversal

Vasectomy and Vasectomy Reversal Links:

FIND A SURGEON

Society for Male Reproduction and Urology (SMRU) - Member Search

INFORMATION ABOUT THE PROCEDURE

The Patient's Guide to Vasectomy Reversal

Microscopic Vasovasostomy

Vasectomy Reversal - Introduction

Microsurgical Vasectomy Reversal

What's New in Male Infertility Treatment at Cornell
Vasectomy Reversal: The Microdot Method for Precision Suture Placement

Google Groups: alt.support.vasectomy

International Center for Vasectomy Reversal

Vasectomy Reversal - Johns Hopkins

Building Bridges to Conception - Vasectomy Reversal

Vasectomy Reversal Questions &s; Answers

Microscopic Vasectomy Reversal

Vasovasostomy

The Infertility Center - FAQs - vas reveral Qs and As link

Cary Urology Vasectomy Reversal

Vasectomy.com

ARTICLES ON VARIOUS RELATED TOPICS

Warning over vasectomy reversals

Vasectomy - Can it be reversed?

Morphological changes of spermatozoa in proximal vas deferens after vasectomy

Microsurgical Vasovasostomy versus Microsurgical Epididymal Sperm Aspiration/Testicular Extraction of Sperm Combined with Intracytoplasmic Sperm Injection

Some vasovasostomized men are characterized by low levels of P34H, an epididymal sperm protein.

Vasectomy Myth Debunked: NewYork-Presbyterian/Weill Cornell Study Finds Vasectomy Reversal Highly Effective, Even After 15 Years

Vasectomy Reversal & Sperm Antibodies

VASECTOMY

Vasectomy Blog

Vasectomy Information

Requesting Patient Medical Records

It's a good thing to keep a copy of all your records, particularly when you are dealing with an ongoing condition (but generally as well). Request the records be sent to you if you are switching practices as well and then you can bring copies of the records to each new doctor you see --- you will be better informed and it will cost less too.

Some doctors are very strange about not giving you access to your records, they are actually required to do it under the Federal HIPAA law. You have to make a formal written request, and you need to specify both the time period and sometimes even the specific test results/appointments/etc. you are looking for. They have the right to charge you a reasonable fee. (See HIPAA and Medical Record Copy Charges

Here's a great site from the Health Information Management Association about Creating a Personal Health Record with some excerpt below.

Your Rights Under HIPAA:

Right to access, inspect, and copy health information
Right to request correction or amend health information
Right to request accounting of disclosures of health information—who has received it

Accessing Your Health Records
You have the right to access your health records. You may view or receive copies of your records, or instead request a summary of the information. If you receive copies of your records, the office holding the records has the right to charge you the cost of making the copies. You may have to submit a written request to view or receive copies, so the office has a record of your request.

You also have the right to request that changes be made to your health record. If you believe that information in your record is incomplete or incorrect, you can request an amendment.

Amendments can be requested by either contacting the person who made the entry (such as your doctor) or by contacting your healthcare organization's health information management professional. If your request for an amendment is denied you may still request that your request for a change be kept with the record and given to anyone who requests a copy of your health information.


Here's another link that you also might read to help bolster your confidence as a health care consumer if you are having surgery:

Quick Tips -- When Getting Medical Tests

Bad Estrogen

Sounds dramatic doesn't it but there really is estrogen known to be the bad kind, the kind that can lead to cancer. Since I'm not doing acu treatment or chinese herbs right now and its just up to me to try to fix me I decided to do some more research into PMS and estrogen. It's that time of the month (mid-luteal phase) and my breasts are so uncomfortable. The only time I've had real relief for a while was after both pregnancies, I guess due to the pregnancy types of estrogen being dominant then.

So here are some of the links I came across that interested me:

Predictors of the plasma ratio of 2-hydroxyestrone to 16-hydroxyestrone among pre-menopausal, nulliparous women from four ethnic groups

The relationship between physical activity and 2-hydroxyestrone, 16alpha-hydroxyestrone, and the 2/16 ratio in premenopausal women

DIM (Di-Indoly Methane)For Natural Protection from Estrogen's Effects

What I picked out that might relate to me are:

...that since dietary therapy alone hasn't helped, and my mother had PMS as well that there might be a heriditary factor.

...that exercise really might help my body to metabolize the bad estrogen more

...that taking DIM for a while might not be such a bad idea, at least to see if I can detect any changes.

Back from Paradise

So I can now say that if you feel like infertility is getting you down that you haven't been pampering yourself enough and you should make plans to go to Fiji. The people are lovely, the sun and sea and coral are beyond compare, and it's far enough away that you don't find lots of families on vacation -- provided you pick the right island resorts.

I've been happier than I've been in years -- no sign of depression for me (though I've got a touch of PMS right now). All that wonderful sunshine and the warm sea -- we went swimming every day and there was no need for a towel it was so hot every day. My biggest decisions each day would be which bikini to wear and whether or not I wanted a cocktail at happy hour. Sooooo incredibly relaxing.

Oh and here was a thing, my myomectomy incision, the bikini-cut, it fell just below the top edge of my string bikini. How about that? I've never worn a string bikini before but I thought why not start now.

I got lots of exercise as well while on holiday -- running, playing volleyball, swimming, snorkeling, and hiking -- which helped work off some of my fluff. (Some I said, not all)

Seattle is so cold, dark and damp in comparison -- I think I'll just have to move to Fiji and learn how to weave mats.