Our "Extra Special" Wedding Anniversary Celebration

Last May 1, 2011 was our 6^th wedding anniversary.  As usual, people kept on asking …Where are you celebrating your anniversary?   Are you going out of town?  Travelling abroad?  Having a candle-light dinner in a 5 star hotel?  Naaahhh… None of the above.

Where were we?!?  We were at Cardinal Santos Medical Center in Greenhills, inside the clinic of our OB for our artificial insemination.  Yes, that was a Sunday, so there were no people in the Medical Arts Building of the hospital, only me, my husband and our OB.  What a way to celebrate our anniversary, isn’t it?

Artificial Insemination, also called AI or IUI (intrauterine insemination) is a method of assisted conception wherein the “washed” sperm is introduced into the woman’s uterus at around the time of ovulation, with the aim of getting the sperm nearer to the egg.  This procedure is often combined with fertility drugs.  However, for our cycle this month, we did a natural cycle + artificial insemination, meaning we did not take any fertility drug.    

So first, my husband collected the sperm and put it inside a sterile container.  Then our OB “washed” the sperm, which means the sperm was separated from the semen and concentrated.  The process took more than an hour with the swim up technique.  After this, the insemination took place. 

The concentrate was injected to me via a catheter that was passed through the cervix and into the uterus.  It was relatively a painless procedure with a little discomfort likened to having a pap smear.  I also felt a little cramping during the procedure, which was just normal.  I rested for 30 minutes and then went home already …

It is advisable to avoid strenuous activities after the insemination.  Though from what I have researched in the internet, it is okay to get up and move around after IUI because your cervix close, keeping the newly deposited sperm right where it should be.  But of course, it won’t hurt to take it easy for a few days.  OB also asked us to contact the following day to help increase the chances of conceiving.

The success rate of an IUI is around 15% per cycle.  The cost we paid for the procedure alone was Php10,000. 

Pregnancy test was asked to be done on May 17, 2011.  It is usually asked to be done after 2 weeks or so.  Unfortunately, my period came exactly 2 weeks after the insemination.  So, that’s another unsuccessful artificial insemination for us…

But life goes on… 

My Infertility Case Exposed

My husband and I were married on May 1, 2005… that was 6 years ago.  We were not in a hurry to have a baby then as we were still enjoying our lives as a couple.   I was just only 24 years old then.  Most of my friends were not even married yet.  I have a regular 28-day cycle.  So I thought everything was normal and getting pregnant will come naturally.  There were no pressure, no rush, no worries… we were just enjoying and taking our time…  Little did we know that getting pregnant isn’t as easy as it seems to be for others…

See  An Infertility Specialist After a Year:

After a year, that was when we started getting a little worried.  Is there something wrong with us?  Do we have any infertility problem?  Why am I not getting pregnant yet?  I think it is time to see a fertility doctor…

True enough… once you have been trying to conceive for more than a year without success, it is time to make an appointment with a fertility specialist for evaluation.  Infertility is defined as the inability of a couple to successfully get pregnant after a year of unprotected, well-timed intercourse. 

It is but normal to feel uneasy, and worried of what you will find out through the series of fertility tests you are about to undergo.  Just think of it this way, if you find out what is wrong with you, you can do something about it.  

Fertility Testings for Men

So, we went to a fertility specialist and had our initial fertility tests with her.  She requested for a semen analysis from my husband.  This is usually requested to rule out the problem from the husband.  Results showed that his sperm count (the number of sperm per millimeter) was sufficient but the morphology (the percentage of abnormal sperm) was high.  So the diagnosis was Teratozoospermia or high levels of abnormal sperm.  But normally, OBs do not worry too much on this.  As one of my OBs told us, “As long as there are sperms available, there is no problem.  We only need ONE” 

Being a paranoid, I persuaded my husband to see a urologist, a doctor who has specialized knowledge and skill regarding problems of the male and female urinary tract and the male reproductive organs.  Further blood tests and ultrasound were requested.  It came out that he has varicocele.  This condition is similar to varicose veins but involves enlarged veins around the testes which can inhibit sperm production and affects the quantity and quality of sperm produced.  Varicocele can overheat the testes, thus causing problems with fertility.  However, treating this problem by surgery was not recommended to us by the urologist.  According to him, the surgery will not increase our chances of conception significantly.  He advised us to just proceed with artificial insemination instead.     

Fertility Testings for Women

Now, it is my turn.  There are far more fertility tests to be done for women than men.  Oh, life is really like that… So, here are what I have done so far.  I divided it into four groups so that it would be easier for you to understand it.

1.     Hormone testing – Blood tests are usually done on Day 2 or 3 of your cycle to check for hormonal imbalances or disorders that might be preventing pregnancy.  I was asked to check for the following:

a.      FSH (Follicle-Stimulating Hormone) – this hormone stimulates the growth and development of the follicles on the ovary during the follicular phase or first half of the menstrual cycle; high FSH level show fewer eggs left and poor egg quality; mine is normal

b.    LH (Luteinising hormone) – released by the pituitary gland to stimulate ovulation; mine is low; if you have high LH, you may have PCOS or polycystic ovary syndrome.

c.     Prolactin – this hormone is released by the pituitary gland and high levels can stop ovulation and menstruation; mine is a little bit high probably because of stress

d.    TSH (Thyroid hormones) – responsible for controlling thyroid function; mine is also normal

2.   Monitored Cycle –  This is done monthly to know your fertility status and know what plan of action to take next; Depending on your OB, you are usually asked to go to the clinic on the Day 2 or 3 of your cycle for check up.  Then ultrasound follicle monitoring on Day 6-8 to check if there is an egg and also to check the endometrial lining.  Abnormalities such as polyps and myoma can also be seen during this time.  Another ultrasound for follicle monitoring on Day 10-14 to check on the size of the ovarian follicles, and check on the thickness of the lining of the uterus to help predict the time ovulation. Then, you’ll be given a “schedule” as to when you are to have intercourse.  This is called timed intercourse.  Some OBs also give fertility drugs like Clomiphene Citrate or Femara.  This is for ovulation induction and is taken for 5 days starting from Day 2.  

Through the monitoring done by transvaginal ultrasound, I found out that I do ovulate and I have endometrial polyps and myoma.  Most of the time, OBs will not ask you to have the polyps and myoma removed at once because there are many people who also have those but get pregnant also.  In my case, I had my polyps removed last December 2010.  OB did not remove the myoma or uterine fibroid because according to her, in my case it is not the culprit to my infertility.

3. Tubal and uterine investigations to see if there are any structural (anatomical) problems of the reproductive system that causes infertility; usually done on the first part of menstrual cycle to ensure you are not pregnant

a.     Hysterosalpingogram (HSG) – This is a test where a dye is passed through the fallopian tubes to check for blockages that could be stopping the egg or sperm progressing.  This is done in a hospital, but out-patient.  I had mine done in Chinese General Hospital last 2006.  A small catheter is inserted into the cervix through which liquid dye is injected.  X-rays are taken as the dye passes through to see if there are any obstructions.  I felt heavy cramping during and for several hours following this procedure.  But this just means that my fallopian tubes are not blocked.  According to the technician, no pain, no gain.  Expect vaginal discharge as the dye is expelled from the uterus so do bring a pad or panty liner with you.  After the procedure, the OB gave me antibiotics to take to guard against possible infection.  Result: No blockages in the fallopian tube and I have a normal uterus.      

b.    Hysteroscopy - a thin viewing tool called hysteroscope (a light and camera is hooked to it so that the doctor can see the endometrium on a video screen) is inserted via the cervix into the uterus to check for irregularities or scar tissues.  It is also used to remove fibroids or polyps.

c.  Laparoscopy –is a surgical procedure that involves insertion of a narrow telescope-like instrument through a small incision in the belly button. This allows visualization of the abdominal and pelvic organs including the area of the uterus, fallopian tubes and ovaries.  It also checks for scar tissues, endometriosis and fibroids.  Done under general anaesthesia.

I had hysteroscopy and laparoscopy done at the same time last December 2010 at the Philippine General Hospital to remove my endometrial polyps and also to check if I have endometriosis.  My OB found that I have some implants at the back of the uterus so these were cauterized. According to OB, it will be better to get pregnant within 6 months since there is a possibility that the implants might recur.

     

4.   Immunological testing – This is also done through blood tests to check for reproductive immunological factors.  This is normally done if you have a history of miscarriage, IUI and IVF failures, or an unexplained infertility like me.   The tests can be divided into 5 categories.  Below is a description of each category and its corresponding treatment.

 

Category 1 – Leukocyte Antibody Test (LAT) or Lack of Blocking Antibodies

Some women may fail to produce blocking antibodies to stop the immune system from attacking and rejecting the fetus.  The problem is when the woman shares the same antibodies with her partner; in other words the couple’s DNA is too similar.  Normally the father’s DNA in the embryo tells the mother’s body to set up a protective reaction around the baby.  But when this blocking effect does not happen, the baby is rejected.  Treatment for this is lymphocyte immunization therapy (LIT) in which the male partner or donor’s blood is injected into the woman.

Category 2 – Antiphospholipid antibodies (APAs)

Antiphospholipid antibodies are the most common kind of abnormal immune system problem.  APAs can prevent implantation thus preventing pregnancy in the first place.  Phospholipids are a sort of glue needed in early pregnancy.  Some women, however, produce APA blood-clotting antibodies which attack cells that build the placenta and increase the risk of miscarriage.  Anticoagulants like low-dose aspirin and heparin (a blood thinner) are often prescribed.

Category 3 – Antinuclear antibodies (ANAs)

Antinuclear antibodies are directed against structures within the cell nucleus and can attack the fertilized egg and the cells in the womb.  This can prevent implantation and increase the risk of miscarriage.  This is often treated with steroids like prednisone to suppress the inflammatory process.

Category 4 – Antisperm antibodies

Antisperm antibodies can cause agglutination or even prevent fertilization because they stop the sperm being able to penetrate through the cervical mucus.  It can be produced after an infection.  Treatment for this is usually steroids.

Category 5 – Elevated Natural Killer Cells (NK cells)

Natural killer cells are important.  They make up 50% of all white blood cells and are needed to control rapidly dividing cells like cancer.  The theory is that some women produce too many natural killer cells which will aggressively attack any cells that grow and divide, offering protection against cancer but making pregnancy impossible.  Treatment possibilities for high NK cells are LIT, intravenous immunoglobulins, steroids or rheumatoid arthritis drugs.  The natural solution for this is to take fish oil, specifically EPA, to decrease NK killer cell activities.    

Fertility Treatments

Unfortunately for us, I am positive for Category 1, 2, and 5.  We were advised to see an immunologist and had immunological work-up.  So far, from a LAT of 0%, I am now 100%.  That is after 9 LIT sessions, 4 with husband as donor and 5 from blood donors.  I take Aspirin every day for almost 2 years now.

I have experienced 3 failed IUI (artificial insemination).  2 consecutive IUI last 2007, without any immunological work-up.  And right now, after my LAT has increase last April 2011, we tried for another IUI this May 2011, but unfortunately it wasn’t successful.

Whew, so there goes my long story on my infertility case.  I tried to explain it as clear as possible so that you would better understand my condition.  Many people have been asking me about it, so here it is… If you have other questions, please feel free to ask me.  I’d be more than willing to share with you my experiences.   Happy reading!

Obando Fertility Rites: Dance Your Way to Fertility

The Obando Fertility Rites is a Filipino dance ritual wherein men, women and children of Obando, Bulacan, Philippines and other devotees and visitors from other towns in the Philippines dance in the streets in the form of a religious procession primarily in order for the spirit of life to enter into the wombs of women.    Most participants of the fertility dance ask the patron saints for a son or a daughter, a husband or a wife or good fortune.

This is a three-day fiesta honoring the town’s patron saints.  Each day is dedicated to a particular patron saint. 

May 17 for St. Paschal (San Pascual Baylon) – Patron Saint of Fertility, Wealth and Abundance and also of childless couples who wish to have male babies in particular

Photo taken from this site.

The Franciscan missionaries introduced St. Paschal, or San Pascual Baylon, to Obando, Bulacan during the 18^th century. Like St. Clare, he also became the patron saint of fertility, wealth and abundance. St. Paschal’s surname, Baylon, was taken to mean "one who likes dancing", ultimately derived from the Spanish word bailar, the verb form of "dance".

There is an anecdote about a miracle St. Paschal worked that tells of a childless couple from the neighbouring town of Hagonoy, Bulacan. They encountered a crab vendor who recommended that the couple to go to Obando to participate in the mid-May dance ritual in order to ameliorate their condition. Upon arrival at the Obando Church, the couple was stunned when they discovered that the face of the image of St. Paschal inside the church looked exactly like the face of the crab vendor they had met earlier. This story forms the basis for St. Paschal's patronage of childless couples who wish to have children, particularly male babies.

May 18 for St. Claire (Santa Clara) – Patron Saint of those who would like to request for a mate and to bear children, female babies in particular

Photo taken from this site.

St. Clare is the oldest patron saint of Obando, Bulacan. She was the first saint to be enshrined at the chapel built by the Franciscan missionaries in Catanghalan, the old name of Obando Town.  

She was a nun in Assisi, Italy, during the 13th century, who founded a congregation known as the Poor Clares based on the devotional teachings of St. Francis of Assisi. St. Clare has been considered the patron saint of good weather because her Spanish name meant the brightening of the skies after a season of storms, which later became the basis why the residents of Obando, Bulacan, believed in offering eggs at the base of the altar of St. Clare to pray for good weather. Eggs are offered to St. Clare because her name also means claro (albumen) in Spanish.

May 19 for the Our Lady of Salambao (Nuestra Señora de Salambao) – Patron Saint of Fishermen and A Good Harvest

Photo taken from this site.

On June 19, 1763, the image of Our Lady of Salambao, also known by the long title "Our Lady of Immaculate Conception of Salambao", was also introduced to Obando, Bulacan. 

Local legend narrates the miraculous discovery of the Virgin Mary's image when three fishermen named Juan, Julian, and Diego dela Cruz caught it with their salambaw, a fishing net supported with bamboo crosspieces and mounted on a raft. At the time they were fishing at a place known as Hulingduong, Binwangan, at the town of Tambobong or Malabon. When the fishermen decided to bring the image of the Virgin Mary to the neighbouring town of Navotas, their fishing boat suddenly became heavy and immobile. When they eventually decided to bring the image to Obando, their fishing boat quickly lightened and became easy to paddle. Thus, the image of the Our Lady of Salambao was added to the high altar of the Obando church. Our Lady of Salambao eventually became the patron saint of fishermen and a good harvest.

The celebration begins with a concelebrated mass at the San Pascual Baylon Parish (Obando Church) at around 7am.  The mass usually ends after an hour.  This is then followed by the procession of the three saints and then the dancing of the devotees to the beat of bamboo instruments with the tune of Santa Clara Pinung-Pino.  This continues for the duration of the festival, with the image of the particular Patron Saint of the day leading the procession.

After the procession, participants will return inside the church for the blessing from the parish priest.  More dancing happens here and some devotees will share their stories on the miracle that this dancing fertility rite has given them.  There will also be chance for you to kiss the relic of San Pascual Baylon.   

This May 17-19 2011, it is expected that once again many devotees and visitors will come and join in the fertility dancing in Obando, Bulacan, Philippines in the hope that through the intercession of the patron saints, their wishes and prayers will be granted.

Interested to dance your way to fertility?

Here’s how to get there:

Location Map of San Pascual Baylon Parish (Obando Church)

If you are commuting, ride a jeepney bound for Obando or Paco in Monumento (At the back of Victory Mall and Puregold Monumento).  The fare is approximately Php20 per person.  You have to go down at Petron and walk your way to Obando Church as roads are being closed and traffic are rerouted during the fiesta.

If you are bringing a car, you can follow this route: (1) Monumento -> (2) McArthur Highway -> (3) Left at Potrero Elementary School then go straight stay right-> (4) Go all the way then turn left at the main road -> (5) Go all the way then there will be an intersection, turn right at Francis Market then straight ahead-> (6) You’ll see a statue of the Katipunero at the left side, turn left then go all the way to the main road again then turn right -> (7)Go straight and you will reach town Obando, Bulacan.

For parking spaces, ask the barangay tanods.  They will gladly assist you.

Things to remember:

1. Better to be at the church by 6:30am to avoid walking too far as roads will be closed and traffic will be rerouted during the event.  Mass will start at 7am to be followed by the procession at 8am. 

2. Bring bottled water so that you will not get dehydrated.  Although along the procession, many residents of Obando give out bottled water or prepare water in plastic cups for the participants of the festival.  This I believe is their way of welcoming the devotees and visitors. Filipino hospitality.

3. Bring anything to protect you against the heat of the sun – umbrella, hat, sunblock

4. Bring towel and extra t-shirt in case you perspire a lot while dancing.

5. Bring lots of energy to sustain the entire dance routine.

6. Bring your cameras so that you can take pictures of the festivity and share it with us.

7. Prepare to be swept away by the overflow of devotion, faith and gratitude from the testimonials of the devotees.

Some people may or may not believe in this, but it is worth a try.  There is no harm in trying.  As long as you believe in your heart and in your mind that God will grant you your ardent desires, the miracle of having a baby will come true.  Dancing is just a way of showing your intent to have a child, but it is still your faith and your sincerity that will determine the outcome of your actions.  So, believe and happy dancing! 

  

My Infertility and Blogging Story

                                                    http://www.flickr.com/photos/aidanmorgan/

When life hands you lemons, make lemonade!  This old saying simply means that if life gives you something sour, turn it to something sweet.  In my case, my lemon is infertility.  I have been married for 6 years already, but have not been blessed with a child yet.  I have never been pregnant, at least not to my knowledge.  Sometimes, I find myself thinking, if only I could just know it’s possible...  But when I hear stories of people who have lost their children through miscarriages, I know that God has not allowed it to happen to me for a reason.  
    

Infertility is indeed a very stressful event in a person’s life.  It is only those who have been or is in this journey who can truly understand and relate to this.  As for those who have never been through it, count it as your blessing.

It is just but normal for anybody in this situation to have feelings of anxiety and depression.  I too have my own share of getting depressed specially during times when fertility treatments and test results don’t turn out that well.  But, we all know that feeling depressed about any situation in your life is not going to help us.  So, why dwell on something you have no control over?  You have to learn how to accept infertility and brace through this journey with optimism.

That is why, instead of focusing in this one aspect of sourness in my life, I thought of turning it into something more fruitful and more useful… like… This Infertility Blog!

I created this blog to share with you my journey in dealing with infertility… an outlet to discuss my feelings and all the ups and downs of trying to get pregnant and conceive a child.  I hope that my infertility story can provide a resource for others who are struggling with infertility and through this they may be inspired to keep the faith and never give up.  Live one day at a time.  Enjoy life amidst infertility.  This infertility journey may not be what we have wished for, but I do believe that God has reasons for everything.  This could just be a part of a bigger plan He has for us.  Be patient and we’ll see it through… together.

Although in all honesty, there are times when it would be hard to keep the optimism… because it is not only the sourness but also the bitterness of the lemons which we can taste…  But, hey, why not make the best of what you are given.  Stay positive and laugh it out!  The dream of getting pregnant and conceiving a child makes this infertility journey all worthwhile.

How about you?  What do you do when life gives you lemons?  Here are some suggestions I have found in the internet…

• When life gives you lemons, don’t forget to say Thank You :)
• When life gives you lemons, go get yourself some salmon and some sushi rice. It's lunchtime ;-)
• When life gives you apples say: Oi! What happened to the lemons?
• When life gives you lemons, alter their DNA and make super lemons.
• When life gives you lemons, ask for salt and tequila!
• When life gives you lemons, look it hard in the eye and say "I didn't order this!'
• When life DOESN’T give you lemons, you’ll soon find that you miss them.
• When life gives you lemons, be thankful, it could have been ... .
• When life gives you lemons, great, lemons contain Vitamin C!
• When life gives you lemons, grow an orchard and start a lemon business making millions.
• Life gave you lemons? Life didn't give me anything!
• If life gives you lemons, ask for the receipt so you can exchange them for oranges.
• If life gives you lemons, ask why it can't give you money instead?
• When life gives you lemons, do what we all do with unwanted gifts… Thank the giver, then re-gift it to someone else.
• When life hands you lemons, make lemonade. Then, find someone whose life has given them vodka, and have a party! Don't forget to invite me ;-)

As for me, when life hands me lemons, I’ll blog about it!  Happy Infertility!