Tue 25 Sep 2007
Bah!
Posted by Liza under TMI, TTC, Are you bored yet?
I am officially not pregnant.
I knew that I wasn’t, having taken 4 home tests since last Wednesday, but there was the tiniest glimmer of hope that maybe the dollar store tests weren’t sufficiently sensitive to pick up the small amount of HCG. The RE’s blood tests are more sensitive, though.
We now have 3 shots left of the donor we used with Noah. I don’t know why, but 3 seems like a lot less than 4. I’m scared it won’t be enough.
And I had the most unproductive, irritating conversation with the phone nurse yesterday. (Who incidentally, never did call me. At 3:15 pm, knowing that they quit calling back at 4 pm, I called needing to know my results. It is so not-nice to leave infertility treatment patients hanging like that.) My regular nurse is out of the office until Wednesday. Let’s call the phone nurse Nurse Indecisive.
If you’re interested in more technical details, they’re below the fold.
You see, at my initial consult, my doctor (we’ll call him Dr. Charming) was of the opinion that the fact I was still (at the time) nursing Noah twice/day was no big deal. Not likely to affect things, given that it was so little time, and that I’d had my period back since February.
Great! Sez I.
Nursing is so obviously a huge source of comfort to Noah. It calms him down more quickly and effectively than anything else. And I love the special time that we have together, mostly me cuddling him, sometimes Noah engaging in Cirque de Soleil-worthy acrobatics and contortions.
At the same time, I was ready to cut back. And frankly, so was Noah. Except for a marathon regression during our trip to Milwaukee (where a slightly nervous Noah nursed like he was 10 months old instead of 18), we dropped everything but the bedtime nursing.
And it’s been like that, now, for about 6 weeks.
Every couple of days, Noah asks to nurse at some other point in the day, but he’s almost always distractable.
Anyway, I saw a different doctor than Dr. Charming when I went in for my mid-cycle ultrasound and bloodwork this month. Let’s call her Dr. Highly Recommended.
I don’t even remember what I said to Dr. Highly Recommended. It was an offhand remark about nursing.
She reacted strongly.
She did NOT think that I should be TTC while still nursing, and when I told her what Dr. Charming had said, she took a deep breath and responded, “Well, let me put it this way. I would STRONGLY advise you not to use up all of your sperm before you wean completely.”
Back to yesterday, and Nurse Indecisive.
Having delivered the bad, if expected, news, Nurse Indecisive asked if I had any questions.
Yes!
I’m concerned about these conflicting opinions on the subject of my now-once-per-day nursing. Here’s what Dr Charming said, but when I saw Dr Highly Recommended, she felt strongly the other way.
“Well, all I can really tell you is that you should listen to your doctor.”
And then my head exploded. I’m sure I said this in a very irritating, high-pitched, obnoxious, and frantic voice, “But they said conflicting things!!!”
“Um, well, Dr. Charming is your primary doctor here, right?”
Yes.
“Then you should listen to him.”
Um. You see, I’m nervous about that, seeing as Dr Highly Recommended disagreed so strongly.
“I really can’t tell you what to do. You should really follow the advice of your doctor.”
I took a deep breath, tired of the circular unhelpfulness of the conversation, not to mention that the official news that I was not pregnant was starting to sink in.
“I understand that. But before jumping into another cycle, I’d really like to have a conversation with someone who can help me figure out how best to move forward.”
“Would you like me to schedule a consult with Dr Charming?”
“Sure. That would be great.”
“Oh dear, he’s not available for that until blahblahblah. I’ll email him your concerns and call you back tomorrow and tell you what he said.”
Deep breath. Telephone tag where Nurse Indecisive says god-knows-what about my concerns, then interprets the answers back to me. I do not feel reassured by this option, but nothing else seems to be available. And I really wanted to get off the phone.
“Great. Thanks.”
All of my friends who go to a different RE practice here in town were told that they had to wean completely before trying again. No exceptions.
But I don’t want to. I don’t think Noah is ready. I think it would suck. (Heh. Pardon the word choice.) It would require a whole new bedtime routine.
What should I do?
September 25th, 2007 at 6:16 am
Yeah. I hear you. It’s really frustrating. I don’t think there’s a conclusive answer and that’s why you’re getting conflicting info. “Your” doctor is being more optimistic and reflecting the view that many women do get pregnant while continuing to nurse at a low level. The other doctors are taking a more strict approach and telling you to do everything you can to maximize your chances at conception. None of them have the emotional connection and the interest in balancing your and Noah’s needs with the desire to get pregnant.
I can’t tell you what to do, obviously, but some things worth considering. Are you listed on the DSR as looking for additional vials? We are hopefully getting more through that route ourselves. Are you getting ultrasounds to show that you are actually ovulating and your lining looks good? Are you using a trigger &/or meds (I think so, right)? If you’re doing all of the above, the next thing to consider is whether it’s more important to TTC now or have a full bio-sib. If the bio-sib piece is crucial, one option is to conserve the vials you have for after you have fully weaned.
I doubt any of this is new info. I wish I could write more but Natalie is demanding my attention and I am running late for work. Good luck and keep us posted.
September 25th, 2007 at 8:24 am
First, I’m so sorry. And I’m hereby giving back your “sad, wet mess” title. It’s yours this month.
I can totally understand how frustrating it must be to a)get conflicting advice and b)not be able to get a third, one-would-think-impartial opinion from a nurse.
I don’t know much, but given that you have a limited supply of your swimmers, even though it’s not what you want to hear, if weaning gives you a better shot at conceiving, maybe that’s worth pursuing? (sorry!)
Also? What Jen said? That, too. Especially about them not necessarily considering the balance between your child and wanting another child.
September 25th, 2007 at 8:24 am
The logical analysis is: 3 shots is all you have. You are not getting younger. Noah, however, is getting older and really can be weaned now even if, in an ideal world with unlimited supply of sperm and more time on the biological clock, you and he might not want to yet.
From the results you are hearing from others, and the strong reaction of Dr 2, (leaving Dr 1 in a clear minority position) it sure sounds like your best chance of pregnancy is NOT to be nursing. So the choice is either proceed TTC now but quit nursing, or keep nursing and wait to try to get pregnant. It sounds really risky to try to do both at the same time under the circumstances.
Wish I had a magic solution for you.
Love, Mom
September 25th, 2007 at 9:57 am
Having not gone through the IVF process myself, I have no advice on that front. sorry. My only thoughts are to echo your mom.
If you decide to wean, I’m sure that Noah is at an age where it won’t be too hard. For him, that is. mostly though, you just have to weigh your options and see what part is most important to you. good luck
September 25th, 2007 at 10:04 am
Thanks, everyone.
Yeah, Jen, I’m listed in the DSR as looking for vials. Unfortunately, both of the other people registered with our donor are too. In fact, they both emailed me to say, “If you find any, would you share?” I think there is no reasonable hope of more sperm.
And yes, I’m definitely ovulating and producing a good lining. I’m also on Clomid and monitoring for ovulation with the potential for triggering.
Incidentally, Nurse Indecisive called this morning to say that Dr Charming is NOT worried about my low level nursing specifically because we know I’m ovulating etc. He also reminded me that in any given medicated IUI cycle, we do only have an approximately 20% chance of conceiving.
September 25th, 2007 at 2:41 pm
I would say to go with Dr. Charming. He’s got all your test results in front of him. The thing with nursing is that it increases your levels of prolactin, and increased levels of prolactin keep you from ovulating. Even having a period doesn’t mean that you’re ovulating, but you’ve had the tests run, the scans run, and you’re ovulating.
I think it wouldn’t be a big deal if you’re sticking with IUIs and you’re sure each month that you’re going to ovulate before thawing.
um, yeah, 3 IS a lot less than 4.
September 25th, 2007 at 3:44 pm
Oh, I’m so, so, so sorry about the negative.
Totally useless anectodal weighing in here: I got pregnant with Joaquin while Max was still nursing. The worry with nursing is that it can inhibit ovulation. Since you’re ovulating, there should be no problem. And hold on, I just read your comment and yay for Dr. Charming giving the go-ahead. I’m happy to know I’m not the only one still giving a big toddler boy his night-time nursies.
September 25th, 2007 at 6:39 pm
There’s some concern that nursing and increased prolactin levels can lead to subfertility even when one is ovulating, which is part of what stresses me out. Ovulating is the big hurdle, but there may be an impact on implantation and sustainability even when ovulation occurs. This is something that stresses me out, but we (most likely) have access to more sperm than you do, so I am not weaning yet. If I only had three vials and little hope of getting more, I might be closer to considering weaning. And a lot more upset.
September 25th, 2007 at 8:23 pm
I’m so sorry, and wishing you best of luck on the next try.
Is there any way to wait 6 months or so until Noah weans, or once this hormone train has left the station is there no going back?
Dr. C and Dr. VHR need to have a conversation about their professional difference, and the time for them to have had it was way back when they opened a practice together. It’s all fine and good to say we’re all going to have our individual approach and bedside manner, but when it comes to a major medical policy like this, they need to figure out what the practice’s guidelines will be and then present a united front instead of disagreeing in front of you, leaving you confused and frightened. You know, like parenting.
September 26th, 2007 at 11:31 am
i have no clue about all the fertility stuff but i do think you are being too hard on the nurse, although it’s understandable why you’d be frustrated and taking it out on her. you asked her a question that she is not qualified to answer. all she can do is talk to the doctor and get back to you, but you already know what both the doctors have to say. you just have to decide which one to listen to. a frustrating situation, but not the nurse’s fault. there is nothing she could have done differently to make it easier on you.
September 26th, 2007 at 12:09 pm
Jen, I didn’t really expect the nurse to have an answer.
What I hoped she would do was agree that the advice was confusing and facilitate a conversation between me and one or the other doctor, or another doctor with the practice, to help me figure out how to proceed. Which she more-or-less did, eventually.
What was frustrating was that she spoke as if she did have an answer, but that answer sounded completely scripted and in context, impossible. It made me feel like she wasn’t listening to me.
September 26th, 2007 at 1:21 pm
It may be that she was trying to navigate between the Scylla of one MD and the Charybdis of the other, without flat-out saying “If I suggest one over the other I will be flayed, flogged, and/or fired.”
September 27th, 2007 at 3:19 pm
Reno, I forgot to mention this earlier. I believe you are my most literate reader — and that\’s saying something! I mean, there\’s also Trista, and Sandra, and a band of merry librarians!