Operation Heads Up is series of write ups about common procedures, medications, tests, and diagnoses associated with infertility. These entries were written by those who have been on the receiving end of the needle or catheter–they are not doctors, just fellow stirrup queens or sperm palace jesters like you. These write ups are meant to give you a heads up before your own experience and provide tips that have worked for other stirrup queens or sperm palace jesters before you. The information should never be used in lieu of medical advice from a doctor.

DIAGNOSES
1. Diagnosis: Anovulation
2. Diagnosis: Endometriosis
3. Diagnosis: Infertility Caused By Scar Tissue
4. Diagnosis: Luteal Phase Defect or Low Progesterone
5. Diagnosis: Male Factor Infertility
6. Diagnosis: Unexplained Infertility
7. Diagnosis: Uterine Anomalies
8. Diagnosis: PCOS

9. Hormone Level Chart (off-blog link)

TESTS OR SURGERY
10. Endometrial Biopsy
11. HSG (Hysterosalpingogram)
12. Hysteroscopy
13. Laparoscopic Surgery (for Endometriosis)
14. Postcoital Exam
15. Semen Analysis
16. Sonohystogram
17. Varicocelectomy

MEDICATIONS
18. Clomid
19. IM Injections
20. Metformin (Glucophage)
21. Progesterone Supplements (oral and vaginal)
22. Sub-Cue Injections

HOW TO VIDEOS FOR INJECTIONS (all videos are off-site)
23. Medications for IVF
24. Videos Galore–IVF Shoot ‘Em Up
25. Ganirelix Injections
26. Gonal-F Injections
27. Menopur Injections 1
27. Menopur Injections 2
27. Menopur Injections 3
28. PIO Injections

TREATMENTS AND COMPLICATIONS
29. IUI (Natural or Medicated)
30. IVF (Fresh Cycle)
31. IVF (FET or Frozen Embryo Transfer)
32. OHSS

THIRD PARTY REPRODUCTION
33. Choosing an Egg Donor
34. Choosing a Sperm Donor
35. Egg Donor Agency List (off-blog link)
36. Gestational Surrogacy
37. How to Tell Children About Third Party Reproduction

ADOPTION
38. International Adoption: China
39. International Adoption: Guatemala
40. Questions for Choosing an Adoption Agency

PREGNANCY LOSS
41. D&C or D&E After a Pregnancy Loss
42. Natural Miscarriage
43. Medical Management of Miscarriage (using medication to control a miscarriage)
44. Testing for Recurrent Pregnancy Loss

MISCELLANEOUS
45. Acupuncture for Fertility
46. Basal Body Temperature (BBT) and Charting
47. Infertility Counseling (Therapy)
48. Ovulation Predictor Kits (OPK)
49. Prenatal Screening and Diagnostic Testing

50. Beta Chart (off-blog link)

LISTS OF QUESTIONS, BLOGGING ABBREVIATIONS, AND SPREADSHEETS
51. Questions When Choosing a Reproductive Endocrinologist (RE)
52. Questions for a High-Risk OB (Maternal Fetal Medicine or MFM/high-risk OB)
53. Treatment Spreadsheet
54. Common Blogging Abbreviations (for the IF/pg loss/adoption community)

Please come back and add your own experience in the comments section for an entry after you have tried the medication or completed the procedure.

If you see a topic missing, propose a new write up.

Each entry follows the same format:

1. Why you would be doing the procedure, taking the medication, or having the test (the reason and common uses).

2. What you can expect (for example, the ins and outs of the procedure or how to give the injection).

3. Problems that may arise and ways to troubleshoot.

4. Personal tips.

If there is a write up missing from the list that you can complete, please email me at thetowncriers@gmail.com. We’re always looking to add information to the list.

If you still have questions after reading an entry, check the Peer Infertility Counselor List and write the person in the proper category directly. Make sure you mention the Peer Infertility Counselor List in the subject line of your email.

You can also search for stories similar to your own through the blogroll.

So…now that the blogroll is growing and growing (keep sending in those links to your blogs!) it’s on to the next part of the Infertility Crusade…

Operation Heads Up.

So, my idea is that this blog–in addition to addressing the emotional side of infertility AND figuring out the things that are helpful/hurtful to the community (a tour book to the Land of If)–could be a friend’s guide to infertility. Not the whole sterile, medical, look-at-my-shiny-speculum side, but the this-is-how-I-got-through-it side.

I received more information about IF from the bulletin boards and chat rooms than I ever did from my OB. And my RE was fantastic when explaining things, but he never told me how to make the injection as painless as possible. He just showed me how to do the injections (without having gone through them himself–so he couldn’t give me insider information). The bulletin boards was where I turned before a procedure or before I tried a new medication.

But then there were the times when I realized I had a question five minutes before I was due to give an injection. And I wished there was one place where the advice was written in an easy-to-read form. Where I didn’t have to wade through a google search. Enter Operation Heads Up.

I want to compile a list of the most common procedures, treatments, and medications and give tips and a “heads up” from veterans to newbies. I’ve already written one as an example–how to give sub-cue injections. The post is below. I will then add a link on the side bar so that people can easily click and find this information in the future. But the best part–since it’s a blog, people can add their feedback. Sort of like the Epicurious of Infertility, where people are talking about their own experience with the procedure instead of commenting on a recipe for Tandoori chicken. So a person can read the original write-up as well as all the comments and be prepared for anything IF throws their way.

Just some comments on my write-up: there are four categories. (1) Why would you be doing… (fill in the blank). (2) What you can expect (either the details of the procedure or how to do something). (3) Problems that might arise and ways to troubleshoot (this section may be blank in some cases). (4) My personal tips (this section was redundant for me because I added my personal tips into section two, but in other cases, you may list things you brought with you to a treatment or things you’re happy you asked for in advance–like a sonogram picture). Obviously, with some topics, the categories may need to be tweaked.

I’ve been compiling a list, but it’s hardly even scratched the surface of A.R.T., surgery, or drugs.

Basal Body Temperature (how to take it)
IM injections
HSG
IUI
IVF (transfer/retrieval)
Hysteroscopy
Laparotomy
Semen analysis
Post-coital exam
D & C
Testicular biopsy
Vasography
Varicocelectomy
Oral (Clomid) and vaginal (Prometrium) medications

What else? Write in with things to add to the list. Should we include common side effects like OHSS? What about things like an ectopic? There are also things that could probably be listed together under one umbrella topic.

Write me directly (thetowncriers@gmail.com) if you want to take a stab at one of these. I’ll coordinate it so that we have one person working on each topic (also feel free to write and suggest a topic AND offer to write it). As they come in, we’ll post it to the list, create a link on the side panel, and people can add their comments.

Ideas? Thoughts? Comments on my own small-mindedness for leaving something important off this starter list?

Why you would be doing a sub-cue injection

There is a wide range of fertility drugs that use subcutaneous (usually abbreviated to sub-cue) injections. These include Gonal F, Follistim, hcG, Lupron, and Antagon. While some people will do unmedicated cycles, more people doing IUI or IVF will use injectible medications.

What you can expect

I always gave myself my injections. I was very squeamish about needles and I came to this decision because (1) I didn’t want to associate my husband with pain and (2) I thought I’d handle it better if I was in control. Know yourself. If you think you would be the best person to give the shot, do it yourself. If you think you’d rather have it out of your hands, pass on the task to someone else. You can have more than one person learn how to give the injection in case your primary person isn’t available on a day when you need a shot. For the sake of clarity, I wrote these instructions as if you are giving yourself the shot. But know that someone else can do all these steps as well.

Get everything together before you begin—maybe ten minutes beforehand. Unless you’re used to giving yourself injections (or having others do it), you don’t want to start preparing things too early or you’ll build a lot of anxiety. In order to do the Stirrup Queens-Giddyup-and-Inject-Yourself method, you’ll need a few alcohol wipes, a sterile gauze pad, an ice cube in a cup, a hot water bottle filled with…hot water, the needles, and a totally mindless half hour of television on tape.

The sub-cue injections I experienced (Follistim and hcG) were both prepared as a powder in one vial with an accompanying vial of sterile water. Mix them according to your doctor’s instructions after swabbing the top of each vial with an alcohol wipe. Take your time. Hold the needle upright and flick it a few times to get the bubbles to rise to the surface. Push them out. Gently (don’t waste any of that expensive medication!).

Pop the tape in the VCR. Why did I tell you that it had to be on the television? Because you need to distract, distract, distract. I always had the bright idea to tape reruns of E.R. Why did I do this? It didn’t distract. It only made me more anxious. Stick to sitcoms, favourite dramas, mindless cartoons.

When the time comes to give yourself the shot, take the ice cube out of the cup and rub it on the area being injected. Rub it for at least one full minute. You really want to numb the area. But don’t do this step until your ready to give yourself the shot. There’s nothing worse than going through freezer burn only to have to do it again and again because you don’t feel prepared for the shot.

When your belly (I always did the shots in my belly) is numb, wipe it off with a final medicated pad. Then take the needle and line it up so it is lightly touching your belly. Pull back your hand at least an inch, look away (distract, distract, distract), and plunge down. You’ll need to glance down and check that the needle is in. Then look away again and slowly depress the plunger. Pull out and immediately cover the site with the gauze pad (there may be a spot of blood). Press the hot water bottle to the site and hold it there for a half hour or so. The heat will help (specifically, the wet heat will help) minimize pain. Follistim is sometimes nicknamed Follisting because it has a burn afterwards. I’m sure there are other comments below giving you a heads-up on the specifics of other drugs.

Watch your television show and relax. You did it. You got through the first shot. Or maybe it’s your second or third shot. Or maybe you return here every time you need to do an injection. That’s okay too. You’re amazing and you’re already a fantastic mother doing so much to bring a baby into the world. Hang in there. The injections are terrible, but they’re worth it if they bring you closer to your family.

Here are some problems that might arise (and ways to troubleshoot)

Sometimes you’ll get bruising. I was never sure what caused the bruises and why they sometimes occurred and sometimes didn’t. There’s not a lot you can do for buising—the body just needs time to heal. You can alternate sides of your belly button each shot and ask your doctor if there are other locations on the body for your sub-cue injections.

Here are my personal tips

Look above—that’s about all I can say about sub-cue shots. Oh, except be really nice to yourself on injection days and get yourself a special treat. Better yet, make someone else get you a special treat—you’re the one enduring the shot!

I am adding blogs as fast as my little hands can type. One question my husband raised as we began this project was whether there was truly an “infertility community.” He questioned whether people identified as infertile in the same way that they identify their culture/place of origin/nationality/religion. Do I put it down on forms? No. But, then again, forms outside my ob/gyn’s office rarely ask me about my fertility. But do I think of myself as an Infertile Jewish American? Definitely. It shapes my landscape and mindset just as much as any other cultural marker. It’s not something I’m happy about, but it’s definitely something that has changed who I am and still affects me.

As you can see when I watch television.

I think that people who have never experienced IF watched that episode and wrote it off as a simple story of post-partum depression, preemies, and a crazy IVF mother (who, by the way, talked her husband into having more kids when he was happy with the triplets they already had. So not only was she selfish, petty, and small, but she also was the stereotypical IF woman who bulldozes over all reason because she is a crazy, hormone-striken, baby lusting fool). It fit into the general perception of A.R.T.

But I watched it and cried. Because it reflected all the hard choices that IF parents make. I understood completely why she would want to use 5 embryos while other viewers judged her because I would want to use 5 embryos if finanically I had one shot at IVF. And I understood why she wouldn’t want to do selective reduction because even though it is the intelligent choice and the rational choice, it is also the difficult choice. And when it comes down to it, I am selfish. And I am scared. And I go into too many what ifs which turns me more selfish and scared in our decision-making.

I am obviously taking a television show a bit too much to heart. But I think that’s what I mean by identifying as infertile. In the same way I am affected when I see Jews portrayed as a stereotype on television, I am affected by the flippant way they dealt with infertility on Friends (and Monica/Courtney Cox was going through IVF and miscarriages! How could they not write a better script?). And as comments have already said, I think the general public doesn’t want to hear the real stories–the average stories. They don’t want to hear about so much love and hope coming together to form one child. They want to judge. They have a preconceived idea about A.R.T. and they want it fulfilled. Tell me the good portrayals of IF/A.R.T. and I’ll show you an infertile artist who created them. The new Dixie Chicks song. The… Well, I’m drawing a blank on any other positive outpouring of emotion that reflects the full reality of A.R.T. rather than just the outlying possibilities.

What I am trying to say (in as long-winded a way possible) is that this blog won’t change over time because I will always identify myself as infertile, even after my last child is born or adopted. And I think that’s why we wanted to keep it going as a clearinghouse for information as well as discussion/debate. Because the landscape keeps changing and hopefully each blog that is currently listed in another category will move into the “pregnancy or parenting after IF” category. Other blogs may come and fill the empty spaces (unfortunately), but we wanted this blog to remain the same. It can be your TTC friend that won’t leave you behind and start blogging about pregnancy and beyond. Because other blogs need to do that, but ours doesn’t need to be any place but here. It will still be here after you go through your first pregnancy and then jump back into IF again through secondary infertility (oy vey–if that happens, I have an emormous box of Kleenex that I’ll mail you). Which means you can drop in and out whenever you need to be here. Because that’s the purpose of community–it bonds and defines you while leaving the possibility for growth and change.

We’d love it if you could put a link to our blog on your blog in order to help others find there way here. Stay tuned for our next big project–Operation Heads Up… Details coming soon.

The first time they aired the quintuplet episode on Grey’s Anatomy, I was barred from the television. My husband asked me why I would possibly need to watch a fictional woman’s IF and NICU experience when I had my very own painful IF and NICU experience. Because…that’s what you do when you hear that there’s going to be an infertility story line on television, sweetheart. You watch it. Like a car crash. And I like Grey’s Anatomy. It’s my one hour of escape every week. Though…not much of an escape when they cover infertility…

Last night, they aired the episode again and I watched it. I’m pretty wary of television in general because messy topics (such as infertility) cannot be dealt with on any satisfactory level within one hour. And Grey’s Anatomy didn’t let me down. The replacement for the lost baby—a dog! Because adopting a puppy is the natural equivalent to having a baby.

Every episode of Grey’s Anatomy centers on one idea, with the idea spoon-fed to the viewer via voiceovers by the main character. Last night’s theme was “being alone.” One doctor inadvertently kills a patient, but stays with him because he doesn’t want him to die alone. A doctor is left “alone” to care for a baby. A prisoner—who was in solitary confinement—swallows razor blades in order to come to the hospital and not be alone. A woman feels “alone” without a daughter and does IVF to build her family. Of course, since they’re presenting IVF to the general public, it needs to be an IVF quintuplet case. Because the average IVF case that results in one child or twins is not possibly as exciting. Nor do these average cases play into the non-infertile world’s stereotypes of A.R.T.

The quints are born early. Of course, in an earlier episode, the woman admits that she knew the perils of carrying five children at once, but she couldn’t do selective reduction because she already knew her children. Even in the womb, she knew their personalities. And, of course, in this episode, the woman who confidently defended her decision prior to the birth now feels guilty and confused. Her guilt and confusion are never resolved. We are just left seeing the mother in the throes of depression—the obvious message being that if we are dabbling in A.R.T., we should take the King Solomon approach to parenting.

The King Solomon Approach…oh…the bane of all A.R.T. decision-making. The extreme financial commitment and the desire for outcome coming together in the perfect storm of indecision-induced depression. The story of King Solomon is that one day, two women and a baby were brought before him. The women were arguing over who was the mother to the baby. King Solomon ruled that they should cut the baby in half. That way, each woman would get to have part of the baby. The first mother agreed to this decision, but the second mother thrusted the child at her and said, “no, you keep the whole child. Protect this baby.” King Solomon then awarded the second mother the baby and knew that she was the actual mother because she was willing to give up her baby (and her own chance at motherhood) in order to let him live. A true mother would do anything to protect her child. Even give up motherhood.

But then you come to the questions raised through A.R.T. IVF (and other procedures) is so expensive and you have so much invested in the process—emotionally and physically. Therefore, you want to use more than one egg in order to build more than one chance to get pregnant per cycle. But the risk is that all eggs could take and you would be left carrying quints. Our clinic asked us on our first appointment if we would be willing to do selective reduction. When I answered negatively, they told me I would never be able to use more than three eggs in a cycle—the limit for the clinic. I was fine with that, except that you hear stories of people who transferred seven eggs and only had one implant. And you start worrying about the money and trying to make each chance the BEST possible chance. And the cycle continues.

The woman in the episode is painted as selfish because she didn’t selectively reduce and therefore give the remaining children a better chance at health. The doctors in the episode are seen as the saviours undoing the damage caused by that poor, deranged IVF lady. And it hurts. It really hurts to see the non-infertile world commenting on something that is so emotional to me. I couldn’t do it—I couldn’t do selective reduction. And it’s a very personal decision. I wish I could be the King Solomon mother who would do anything for her children. But I’m selfish. I want to be a mother. And I would continue any pregnancy in order to be a mother. Of course I’m saying this in a bubble—there are my husband’s feelings to consider. There are others who would maybe be able to present the situation in a different light. But from where I sit, I don’t see much that divides me from the IVF lady on television.

My favourite show just inadvertently called me selfish, petty, small.