Some Answers to Questions

One of the really annoying things about Blogger is that there's no easy way to respond to comments that I receive... It doesn't provide me email addresses for commenters, so I can't just email a response to a comment. And it doesn't do comment threading, so you'd never know if I responded direclty to a comment unless you keep looking at the comments on an individual post. This is, by far, my biggest frustration with Blogger. So I'm going to address some questions here.

1. Someone asked what I would do if I had to have an IUI on Saturday. (I think this was My Reality, but I'm not certain and I'm too lazy to look it up right now)

This is a somewhat complex question. First let me explain the whole Saturday problem in the first place: I'm an Orthodox Jew and there are a number of restrictions that I have on Saturdays (my Sabbath, or "Shabbos"). Shabbos is supposed to be a day set aside from weekday activities. A rest from the mundane. A completely different kind of day from the rest of the week. That being said, I don't drive on Shabbos. I don't write or exchange money on Shabbos. I don't cook, work, affect electricity, or play a musical instrument on Shabbos. I hate describing it this way, because it sounds as if Shabbos is all about all the things you CAN'T do, and that's not how I try to look at it. Shabbos starts at Sundown Friday and ends about an hour after sunset on Saturday. Nearly every Friday night, we have company over for a festive meal (and if we don't have company, which is rare, we still have a nice dinner). Saturday we go to shul (synagogue), take long walks, read, spend time together as a family, have a nice lunch with friends (usually... occasionally it's just us at home, but still a nice meal), take naps (something I never get to do during the week). So although there are a lot of things I can't or don't do on Shabbos... it is an extremely enjoyable day that I look forward to all week.

All that being said, there are a number of problems with me being at the fertility clinic on a Saturday. The first, most obvious, problem is driving. I can't drive to the clinic, so if I had to have an IUI on Saturday, I would have to spend the weekend in a hotel near the clinic. This is completely doable, but not without its drawbacks (primarily dealing with having food). My clinic is situated within walking distance of several hotels, though none are especially convenient. Still, it's doable. There are lots of other little problems, all of which are easily handled: I don't write, so I can't sign in or fill out any forms, but those things can all be taken care of ahead of time. I don't exchange money, but I could pay my copay ahead of time or have them bill me (they have a lot of Orthodox patients, so they've grown accustomed to such things). Those are all doable.

The bigger (and least surmountable) problem for me is that being at the fertility clinic on Saturday is not really in the spirit of Shabbos. It takes me out of the calm beauty that characterizes Shabbos for me. It forces tension into a day that would otherwise be focused on my relationships with God, my family, and myself. Practically speaking, it would also require that I figure out what to do about Julian. If we both had to be at the clinic, we'd have to have someone watching J (though obviously we could take turns being at the clinic since that's usually what happens if I have an IUI during the week anyway. It's rare that S is present for the actual IUI (he's been there 2 out of 5 times), but that's because of practical reasons. We both have jobs. If I have an IUI on a Sunday, we go together. Otherwise, he's only there for his part.

The nice thing about IUI is that it is somewhat more flexible with timing than IVF is. With IUI triggering a day earlier or a day later isn't so much of a problem. With IVF, there's less flexibility with egg retrieval and even less flexibility with transfer, so it's much harder to avoid Shabbos retrievals or transfers. So far, with five IUIs in my portfolio, I've never had to have a Saturday IUI, though I know it could happen. Mostly, my doctors are aware that Saturdays are big problems for me, so they've been able to avoid it. If I had to have an IUI on a Saturday, my rabbi would tell me I could do so, with some restrictions (as noted above), but I'm not sure that I would do it. Given my particular issues, IUI itself doesn't really increase my odds of achieving a pregnancy in a given cycle. What increases my odds significantly is the ovarian stimulation and triggered ovulation (since my problem is primarily anovulation and there's no male factor involved, and so on). However, if I had an IVF procedure fall on a Saturday, which is far less avoidable, I would find a way to make it work. There's an awful lot more at stake with a given IVF cycle than with an IUI cycle, so I feel much more strongly about it in that case. I'm not saying I definitely would not do an IUI on a Saturday, but I think it's unlikely... besides, like I said, I've never really had to consider it.

That was probably far more information than any of you wanted to know.

2. re: my right ovary always being the producer, someone asked if I was cycling every month or every other month (I think this was Kris)

This is a good question. My first IUI was in February, the second was in March. Then I took some time off and the third IUI was in June, fourth in July. Then I was pregnant until October 10th and wasn't able to start a new cycle until the end of December. IUI #5 was in January, and IUI #6 (this current cycle) will be in February. So while I've skipped months, I've generally had 2 back to back cycles. IUI doesn't require rest cycles in the same way IVF does. So I think that it really is true that my left ovary is a complete and total slacker. I wish it would get the memo that it's time to shape up and earn its keep!

3. re: my wonky estradiol levels... someone (Kris, again, I think) asked if I was on estrogen support/supplements

I am not, and I get the impression that this is far more common with IVF cycles than with IUI cycles. I have had notoriously low E2 levels for all of my cycles, but the levels at least have still increased appropriately, even if they are always a bit on the low side. Last cycle and this cycle seem to be the exceptions. This is my last IUI cycle. My next cycle will be an IVF cycle, and will likely include estrogen as part of the protocol. If I were planning another IUI cycle, I'd probably ask if there would be any advantage to me taking estrace or something similar to improve response. I'm theoretically a good responder in general, it's just that my estrogen levels these last two cycles have been puzzling, at best.

4. Finally, Thalia asked (re: my wonky estradiol levels) if I'd considered taking a month or two off in case my body just needs a break.

I might believe that my body just needs a break, except it was forced a break just recently. I had to take several months off after my miscarriage for my hCG levels to go back down and then I had to have a rest cycle before I could go back to an IUI cycle. It was an extremely miserable time, because nothing puts me on edge about this whole infertility thing than not doing anything. Either way, this is my last IUI cycle, and I'll be on birth control pills from the time this IUI fails (anticipating around Feb 20th) until mid-April. I would only take them for three weeks, but that would put retrieval or transfer dangerously close to the first days of Passover, which I absolutely will not allow to happen, so I'll be waiting to start an IVF cycle until right after Passover. So whether my body needs it or not, I'll be taking a bit of a break. I'm not loving staying on birth control pills for that long, because as most of you know I've already got crazy ridiculous migraines and BCPs will only make them worse. I'm not entirely certain how I will function, but I'm sure I'll find a way.

Those are all the questions I can think of, but if you have any others, let me know and I'll post again.