The First Day 1 – Follicular Tracking and an hCG Injection

After putting in our order for sperm (which ended up being $1667.75 for two vials, by the way!), the next step was just to wait!  Unfortunately, we had a little longer to wait that we would have liked, as we went to Mexico over the Christmas holidays for our honeymoon.  Due to the risk of Zika virus, our doctor recommended we wait until 2 months after our return date to try to get pregnant, just in case.  That was a little bit discouraging, as we had already waited three months for the consult and have been wanting to have a family basically forever.  But, better safe than sorry, I suppose.  So, by my calculations (I had been tracking my cycle for the last 5 months) we could “start trying” the first week in March.

This gave me quite a bit of time (or at least it felt that way) to get everything ready.  And by everything, I mean my body.  I began a pretty rigorous schedule of yoga, weight training and healthy eating, to try and give us the best chances of conceiving.  I figured, if I’m healthy and my hormones are normal and my cycle is consistent, how could IUI not work the first time, right?  I wanted to use this time to really get in the mind frame of having a baby, and also try to set myself up for the best pregnancy possible.  Have I mentioned that I’m a planner?  At the same time, I was trying to live in the present and not get ahead of myself with the endless questions that lurked in the corners of my mind.  What if it doesn’t work the first time?  Or the second time? What if it never works?  What if my body isn’t good enough?

Not wanting to go down that road (because stress definitely does not help increase fertility), I buried myself in reading pregnancy books and working out.  I tried to look at this extra waiting time as a gift instead of a drawback.

The next step in the IUI process was to call the fertility clinic on day 1 of my cycle (the first day of my period), upon which they would give me an ultrasound appointment for follicle tracking.  As a woman who normally dreads her period, I was so excited when Aunt Flo came to visit!  I nervously called the nurses at the fertility clinic and they gave me my first ultrasound appointment scheduled for day 10 of my cycle.  Yay!  The purpose of these ultrasounds is to see if you have a follicle (which is the part of the ovary that holds an egg) that is developing appropriately.  This allows the IUI procedure to be scheduled naturally and very accurately.  No point in tossing a bunch of sperm in my uterus, if there is no egg to be seen, amirite?

On day 10 of my cycle, I showed up at the ultrasound clinic very early and very excited to start what felt like the first real step towards IUI!  Once again, it was my favourite transvaginal ultrasound.  The tech was very nice and had me insert the ultrasound wand myself and was very discrete about everything, but it was not the most wonderful start to a day.

Later that day, I received a call from the clinic which I anxiously answered and heard the rivetting news that I would need yet another ultrasound.  To be honest, I wasn’t completely surprised because I do have a longer than normal cycle, about 30-33 days.  The first ultrasound had not shown enough follicular development, so I was scheduled to come back in on Monday after the weekend.

Apparently, my left ovary had gotten it’s crap together over the weekend because after my ultrasound on Monday I had a date for my IUI appointment!  March 2, 2017.  My left ovary had a follicle that was developing nicely.  I was so nervous when I got the call from the clinic and I just repeated what the nurse said to me a million times to make sure I heard it correctly.  I probably sounded like a rambling idiot, but I just couldn’t believe we actually had a date!  I might be pregnant in a couple of weeks!!!  Tears welled up in my eyes and I called my wife right away to tell her the news.  If a phone call for an appointment can make me cry, can you imagine the effect pregnancy hormones will have on me?  I’m sure lucky my wife thinks I’m cute.

The final step before the IUI appointment was not something I was particularly excited about: an injection of hCG (human chorionic gonadotropin).  This injection induces ovulation within 24-36 hours, so the idea is that you take it 36 hours before the insemination so that the sperm is waiting in the fallopian tubes for the egg to arrive.  An egg can survive for about 24-48 hours, whereas sperm can live up to 5 days!  So gross, right?  I like to think of hCG as a little kick for the egg to jump out of it’s follicular home and find a sperm friend!

I can’t even count the number of injections I’ve given to patients over the years, but I have never injected myself with anything and it was kind of freaking me out.  I went to the pharmacy on my way home from work and picked up the medication.  The brand name was Ovidrel and it was $96 for one dose (cha ching!).  For that price, this stuff had better work.  I was pleasantly surprised to find it in a pre-filled syringe pen, which meant I didn’t have to use my cool nursing skills drawing it out of a multi-dose vial.  The injection was to be done at 10:30pm on Tuesday, as our IUI appointment was for 10:30 am on Thursday.  The Ovidrel is supposed to induce ovulation within 24-36 hours, which is why the IUI procedure is scheduled for 36 hours after the injection.  My wife and I are basically grandmas already, because 10:30 pm is waaay past our bedtime, but of course we made an exception for something so important.

At 10:25, I began preparing the syringe, which just required a little flicking and clicking of the dial to ensure the correct dosage.  It was a subcutaneous injection (which means it goes below the skin, in some fatty tissue) and I didn’t have any trouble finding a pudgy bit on my tummy.  I cleansed the area with an alcohol swab, took a deep breath and plunged the needle in.  Seeing how freaked out I was, my sweet wife offered to give me the injection for me, but I figured it might hurt less if I did it myself.  I slowly injected the Ovidrel and held the needle in place for a full 10 seconds after finishing, just to make sure the entire dose was delivered.  It wasn’t nearly as bad as I thought it was going to be, thank goodness, but it wasn’t high up on my list of things to do on a Tuesday night.

On top of all of this, I had to rearrange my work schedule around all of these various appointments, which again isn’t a big deal in the grand scheme of things, but also increases the stress of the process.  I’m lucky that I have a decently flexible job with vacation days and a supportive manager and staff, otherwise I’m not sure how we would have been able to do it.  Our big appointment on March 2, meant we both had to take an entire day off of work, as the clinic is 2 hours away.  But we really didn’t care too much about that, as it meant we were one more little step closer to starting a family.

-K

P.S. – If you’re enjoying reading our journey so far, you should follow me  because it’s gonna get juicy soon!  If you scroll up, you should see a box show up in the bottom right hand corner where you can enter your email address.  Thanks for the support!   ♥

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The Pick – Finding Our Dream Sperm Donor

Now that we knew the direction we were headed, it was time for the fun part: sperm shopping!  To be honest, we weren’t really sure what to expect from the whole experience.  Was it just like a big Sears catalog or something?

Actually, yeah, that’s pretty much exactly what it’s like.

There were three sperm banks that were recommended to us by our fertility doctor: Repromed, Fairfax and Outreach Health Services.  Our doctor had said that all the sperm banks have fairly comparable prices (higher prices were for extended genetic testing and “open” donors who were willing to be contacted in the future) and the quality and testing of the sperm is all federally regulated. So, we just started browsing through the different catalogs to see what exactly this process was about.  Everyone I talk to about this always wants to know: what do you get to know about the donors?  Are there pictures?!

You get to know pretty much everything you could know about a person, without actually meeting them.  And yes, we get to see some pictures too!

The Repromed sperm bank, for example, shows the race, maternal and paternal ethnic ancestry, blood type, hair colour, eye colour, skin tone, height, weight, bone size, education, occupation, interests, CMV status, if the donor is open to future contact (or not) and donor portfolio (which includes more details on family history, personality and some pictures of the donor’s eyes/ears/hair/lips/body type and a blurred out photo of the donor, to protect privacy).  And then, if that’s not enough, there is the option to upgrade (for an extra fee, of course) to see extended donor profiles that include a temperament report, donor essay explaining why they wanted to donate, audio recording of an interview, donor likeness photographs and staff impressions.  The other sperm banks had a similar set-up with the bulk of the donor information available on their website (sometimes you needed to create a login to view the profiles) and then additional information available at an extra cost.  The American sperm banks even let us see pictures of the donor from childhood into adulthood!  It was just like Facebook!

We began this whole process knowing very generally what we were looking for in a donor: some post-secondary education (both my wife and I have a couple of degrees and we value education very highly), overall good health, good family history, creative and somewhat talented in the arts (both of us love music!), intelligent and active.  So, basically the perfect man.  Should be easy enough to find, right?

I sometimes get overwhelmed picking a movie on Netflix (that’s now my wife’s job, thank goodness), so to preserve my sanity we started with some criteria that were easy to narrow down.  After coming up with a “short list” of donors, we could then move on to the other aspects of the donor.  As we quickly discovered, it didn’t take much time to get bogged down in the various personality traits and specifics of each donor.  To us, the easiest criteria to narrow down was the Rh factor and CMV status (more on this below!), since they were a simple “positive” or “negative”.  Making a baby never sounded so romantic, right?  Rh and CMV aren’t often considered when a straight couple decides to start trying to have a baby.  In fact, I know lots of people that don’t even know their own blood type, let alone the blood type of their partner that they are trying to get pregnant with!  At around $800 (or more) a pop, we figured we would go for perfection and pick our dream donor.

Rh factor (short for “Rhesus factor”) is a protein present on the surface of red blood cells.  This protein can be present or absent in people, which is where the “positive” and “negative” comes from when talking about blood type.  I have O negative blood, which means I have O type blood and no Rh factor present on my red blood cells.  According to Canadian Blood Services, only about 15% of Canadians are Rh negative (with similar statistics around the world).  This means that our choices for an Rh negative donor will be quite significantly limited.

So, what’s the big deal?  Why does that matter when picking a sperm donor?

Well, that’s where it gets a bit complicated.  Obviously, an Rh positive and Rh negative couple can still have a baby (otherwise our population would be a whole lot smaller!), but the complications come when the baby is Rh positive and the mother is Rh negative.  This is called an Rh incompatibility.  If the mother is exposed to the fetal blood (normally the placenta prevents mixing of maternal and fetal blood) through trauma, amniocentesis or bleeding during pregnancy, then the mother will create Rh antibodies.  These antibodies are designed to damage Rh proteins and can cause problems in future pregnancies, if future babies are also Rh positive.  The maternal antibodies can damage the baby’s red blood cells and result in severe anemia (very low hemoglobin).  Confused yet?  If you’re nerdy like me, this is a nice FAQ page from the American College of Obstetricians and  Gynecologists about Rh incompatibility.  There is treatment in the form of an injection that mothers can receive to prevent formation of these Rh antibodies that is given in the seventh month of pregnancy and after delivery.  Our fertility doctor told us that it’s not the end of the world if our dream donor happens to be Rh positive, but it would just mean having those injections and slightly higher risk than finding an Rh negative donor.

I promise we’ll stop with the biology lesson soon, but one more thing!  CMV status.  Cytomegalovirus (CMV) is a fairly common virus that does not present with symptoms in people with healthy immune systems.  It can be problematic in people with weakened immune systems, as well as babies who are infected before they are born (this is called congenital CMV).  Congenital CMV can cause premature birth, lung/liver/spleen problems, small size at birth, among other symptoms.  There is a very, very low chance of transmitting CMV through a sperm sample, but the risk is not zero.  Therefore, it is worth considering when selecting a donor.

Now that we had our short list of Rh negative and CMV negative donors, we narrowed down based on our other criteria.  We were left with about 5 donors.  All had good education, good family history and positive personality traits like confidence and creativity.  On paper, they were all perfect men with glowing DNA.  So, where do we go from here?

After some discussion, we decided that we wanted to find a donor that was very similar to my wife.  It was important to both of us that she feel connected with the baby, so finding a donor that shared some of her key personality traits and interests seemed like a good place to start.  My wife is delightfully dorky (in a Battlestar Galactica kind of way) and she is very talented with all things math related.  Her intelligence makes me swoon and her nerdy comments make me roll my eyes on a regular basis.  Picking a donor that was similar to her, would be as close as we could get to have a baby that shared both of our DNA.

With this in mind, we narrowed our short list down to our dream donor.  He had a bachelor’s degree and works with computers (nerd factor: check!), blonde hair and blue eyes (just like my wife!), he enjoys theatre and acting (artsy factor: check!) and was open to the child contacting him in the future.  On that note, we had some debate around whether we wanted an open donor or not.  I felt very strongly that we should give our child the oppourtunity to reach out and contact him in the future.  We can’t predict what will be important to our child, and I wouldn’t want to regret having closed that door forever.

At the end of the weekend (we spent two days making our decision) we came to the realization that as much as we try and control the variables, the nature of creating a child is that DNA is all random anyway!  We can’t predict if our kid is going to end up with my brown eyes or our donor’s blue eyes.  But any way our child turns out, he or she will be so, so loved.  And that is what’s really important.

-K

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