Understanding PCOS

Since my first consultation with my fertility specialist, I have wanted to blog in order to better explain Polycystic Ovarian Syndrome. I was diagnosed with the disorder roughly 2 years ago, but the way it was recently explained to me completely opened my eyes to just why PCOS has made pregnancy such a hard thing for me.

Many of you know about PCOS (and indeed some of you have it yourselves), but I encourage all of you to read this in hopes that it may be just as enlightening to you as it was to me. And, PCOS is the leading cause of infertility in women - you never know who it may affect - so you may be doing yourself, your daughter, your friend - a huge favor to know what it is and what the symptoms are.

First of all, I'm going to explain what PCOS is and why it makes pregnancy difficult. Then I'll explain the signs/symptoms of PCOS. I made some drawings to try to better illustrate my points. I'm by no means an artist, but I think they get the point across :).

To be vague, PCOS is a hormonal disorder involving a woman's reproductive hormones. For a woman NOT experiencing PCOS, at the start of each menstrual cycle, a woman's estrogen levels are low, and that is when the brain sends a signal to the reproductive organs to begin sending out FSH (follicle-stimulating hormone). FSH causes a woman's follicles to develop into a mature egg that can eventually be fertilized. Although several follicles generally begin to develop, one is usually dominant - receiving more of the FSH - and is the egg that eventually is released from the ovary - it is, per say, the strongest of the bunch - while the remaining follicles disintegrate.

When a woman has PCOS, her cycle begins the same way. When FSH begins to be sent out, in essence, a competition begins for the many follicles to become the "most mature." However, no dominant follicle presents itself, and in general, no one egg becomes the most mature. An egg may not be released at all, or if it is, it generally is not a very good quality egg and thus if it is by chance fertilized, can result in miscarriage, birth defects, etc. In the meantime, the other follicles that were trying to mature do NOT disintegrate as they should, and thus cause what look like cysts on the ovaries (my doctor pointed out that they are actually NOT cysts as the name of the disorder implies, but are, essentially, eggs).

Here's a diagram of what the ovaries look like at the beginning of a woman's cycle:

Notice that the PCOS ovary has MANY more follicles present than the normal ovary.

Now here is what the ovaries look like right before the egg is released:

Again, notice that there is a dominant egg in the normal ovary, whereas the PCOS ovary has no dominant egg about to breakthrough.

Do those diagrams help PCOS make more sense to you? Maybe it doesn't clarify it for you like it did for me, but honestly, this was a major breakthrough in understanding for me. No one had ever explained PCOS to me like this before, and once I understood it I really began to understand why PCOS patients have a horribly hard time getting pregnant and keeping their babies if they do conceive.

Ok, so here's what you really need to know about PCOS. I know that some of these things can be embarrassing for people to admit, but know that you (or your daughter, friend, etc.) are NOT alone. I'll admit that I suffer from almost every single one of these symptoms.

Symptoms (in no particular order or importance or dominance):

1. Irregular/abnormally long periods - a normal cycle is generally no more than 35 days long. This one symptom by itself should be enough to prompt a visit to your doctor.

2. Hair growth on the face, back, chest, toes, stomach, thumbs - PCOS patients have excess testosterone in their system, the cause for this embarrassing "manly" attribute.

3. Difficulty losing weight/gaining weight - a majority of women with PCOS have a hard time losing weight and keeping it off.

4. Difficulty getting pregnant - there are a lot of things that can contribute to an inability to conceive, but it's worth asking about PCOS if you've been trying unsuccessfully for more than a year (I wouldn't even wait that long).

5. Blood sugar issues - women with PCOS can have problems with insulin resistance, and are at risk for developing diabetes

6. Skin problems like acne, dandruff, oily skin and skin discolorations

Keep in mind that not every one of these symptoms have to be present in order to have a PCOS diagnosis. Likewise, my doctor also emphasized that PCOS is a very loosely used diagnosis and may very well be given to women who do not have the disease. The only way to know for sure is to talk to your doctor about your symptoms and have the necessary tests done that can determine if PCOS is the cause.

I realize I've given a lot of information in this post, and for anyone wondering if they or someone they know has PCOS, I would be happy to answer any questions you have. Feel free to ask me in the comments here, on Facebook, or you can send me a private message on FB if you feel more comfortable. PCOS has forever changed my life, and I'm here to help. I'm also here to be a support to others suffering from this. Please feel free to share this post with anyone you feel may benefit from it.

I survived

At first I was afraid, I was petrified...ok, I wasn't really petrified, but by the crocodile tears running down my face as I sat in the fertility clinic business office this morning, you would have thought I was scared for my life. Don't worry - everything's great, I just got a little shaken up. I'll tell you why in just a second :).

First, let me recap what happened on Monday. After working 3.5 hours, I made the now-tedious drive to Vegas for my early cycle blood work and ultrasound. Seriously, the appointment made me a little angry, but I got over it quickly. I mean really, did I seriously have to drive all the way to Vegas for an appointment that took no more than 15 minutes? It's at times like those that I have to remind myself what the purpose of all of this is. Anyways, Monday's appointment was easy - 1 tube of blood and an ultrasound that showed all of my maturing eggs this cycle. Yeah - there is no doubt I have PCOS after that ultrasound. One day I'm going to draw some diagrams, take pictures of them and post them on my blog to explain PCOS better (because it's seriously so much easier to understand with pictures!) but for now you'll just have to try to understand my written explanations. Basically, a healthy woman without PCOS should have about 6-10 eggs each cycle. I had MORE THAN 20. Just how many more than 20 I'm not exactly sure (it wasn't too many more than 20), but still....that's nuts!! Anyways, it was oddly reassuring to see that my body was screwed up - it helps me know that we are doing the right thing by seeking help from fertility specialists. Anyways, the drive home Monday was horrible - thank you mom for keeping me awake by talking to me on the phone! Yeah, I was so tired I'm surprised I could drive at all. Yet another good reason why I stayed in Vegas tonight instead of driving home.

Ok, so on to today and my crocodile tears. First of all let me say that in the past couple of days I really started to get nervous about this HSG procedure today (it's supposed to be pretty painful). I shed a few tears at home wishing I didn't have to go alone and wishing I could know how painful it would be for me, but Jeremy's work schedule just wouldn't allow for him to come with me, and really, the only way I am going to know how painful it is is to have it done. Anyways, I got up bright and early today and was on the road to Vegas at 6:30 a.m. I needed to be at the clinic to do all my necessary paperwork by 9:30. I arrived with time to spare, and impatiently waited for my turn. I was finally called back, and that's when the drama began.

When I first had my consultation, I was told that I would have 3 diagnostic tests done in the surgery center affiliated with the clinic. One of those tests (a hysteroscopy) would require me to be put under anesthesia. Jeremy and I decided that we would forego that test (it didn't seem completely necessary to me at the time anyway) since having him there to take care of me after I was put under anesthesia would be difficult to manage. Well, today when I was filling out paperwork in the business office, I'm given a consent form to sign for anesthesia! Um, no, I'm not having that procedure done...I'm not going under...Almost immediately I started tearing up while telling the office manager (not sure if that's really her title, but that's what I'm gonna call her) I was not having a procedure requiring anesthesia. She then asked the xray tech who was there if I needed anesthesia for the HSG procedure (the one I was planning on having done that wasn't supposed to require anesthesia), and he said yes! Well, I pretty much lost it. I felt like such a big baby. I'm sitting in the office manager's office crying my eyes out thinking that I drove 3 hours on an almost empty stomach, took time off of work, got a non-refundable hotel reservation and stressed myself out about this, and now you're pretty much telling me I can't have the procedure done?! And on top of that I'm not allowed to pee because I have to have a full bladder (and trust me, I had to go!). Yeah, not a good way to start the day.

Anyways, to make a long story short, the doctor stepped in and told me that I indeed did NOT need anesthesia for the HSG, and that if I chose to have the hysteroscopy done today as well then she could just give me localized anesthesia, which would allow me to drive myself to the hotel. She also informed me that if the test I was supposed to have tomorrow showed anything in my uterus, I would have to come back the next week to have the hysteroscopy done anyway. If I had the hysteroscopy today, there would be no need for the test tomorrow. After an internal dilemma of what I wanted to do, trying to figure out things with my insurance, and calming myself down so I could make a rational decision, I went ahead with the HSG AND the hysteroscopy, both under local anesthesia.

So, without boring you with anymore of the details, let me first say that the HSG (which injects dye into my fallopian tubes to see if there are any blockages) showed the my tubes are OPEN! Yeah!! Secondly, during the hysteroscopy the doctor found 3 polyps that she removed from my uterus - polyps can implant on the uterus and take up space in areas where embryos try to implant. So it was definitely a wise choice for me to have the hysteroscopy done today. My follow-up consultation is Dec. 5, and that's when we will see where we go from here (sooo wish I didn't have to wait so long!).

Now, on to the pain part. In the past I have had to have numerous procedures done on my feminine parts. Generally I'm told by the doctor that I will feel some degree of pain or pressure, and generally, the procedure is pretty much done before I even realize she's started. Yes, I'm that lucky. Today I didn't get off so easy, but the cramping I felt with the HSG was no worse than my normal period cramps. Actually, my normal cramps last MUCH longer. One person I know of said that the cramping they felt was worse than labor pains...I don't know what labor pains feel like, but I consider myself lucky. I have a feeling the anesthesia helped :). I cramped a little bit off and on for the next couple of hours once the procedure was over, but that's been about it!

Anyways, let me end this since this is a super long post. I don't have to go in tomorrow since I opted to do the 2 tests today, but because I was tired and under the direction of my doctor I decided to stay the day/night in Vegas and drive back to Lake Havasu in the morning. It's been a pretty good day ( I got some shopping in and ate some good food :) ) but I am bummed that I didn't make it to the temple...I knew there was no way I could go feeling as tired as I do, so I will have to save that for another time. I was pretty tired shortly after the procedure, but I discovered long ago that if I nap during the day I have trouble sleeping at night, so I forced myself to stay awake all day. Add on getting lost driving around Vegas (I desperately need to update my GPS maps) and I'm exhausted. I think it's time for me to go enjoy the gorgeous view of the strip I have from my hotel room :).

This is the week

Well, this is the week. The week of tests, that is. In less than a week I will have completed all the tests I will undergo before we decide if IUI is right for us. I'm excited to get this show on the road.

Monday I will work for 4 hours, then drive the 3 hours to Vegas for an ultrasound and lots of bloodwork (since apparently 26 tubes isn't quite enough, lol). Then, I'll drive home, only to make the return trip to Vegas on Thursday morning again. That's when I will be having a test done that will inject dye into my fallopian tubes to ensure there are no blockages, and hopefully I'll survive the pain. I'm supposed to take 600 mg of Ibuprofen the night before the procedure, another 600 mg about 30 minutes beforehand, and then my doctor will be giving me 800 mg to take afterwards. Fun fun. Thankfully I am staying in Vegas overnight, so I'll go from the clinic to my hotel to recover. I'm hoping I will feel well enough that night to make it to the LDS temple. Then, Friday morning I will be back at the clinic for another procedure that will look more at my ovaries and uterus to make sure that there isn't anything "hanging out" in me that shouldn't be there, lol. And then, I will drive home and wait until my follow-up appointment to see where we go from here.

I'm so glad I found this fertility clinic. They are so on top of things, and they are soooo nice. I feel completely comfortable around everyone who I have worked with there so far, and I don't expect that anyone else I meet there will be any different. They have been so accommodating of my schedule, and are respectful of my wishes. It's too bad not all doctors/doctor offices are so nice! My reasons for getting all this testing done make the 3 hour one-way drive worth it, but their warmth certainly is a very pleasant bonus :).

So, this is the week. I'm so glad it's here. I'm ready to be done with the testing, and even more ready to be a mommy - every test that is out of the way makes me feel one step closer to reaching my goal :).

26 tubes of blood later...

Yeah, you read that title right. Twenty-six tubes of blood. In one day - 25 of them in one sitting. The only reason it wasn't 26 the first time is because the lab tech didn't see the 26th bottle sitting there, waiting to be filled - thus, I had to go back later for that one. What a start to a day!

While I impatiently wait for my cycle to start (only 2 more days of taking the Provera, which is supposed to jump start it), I figured I would get some of the needed blood work done. So, this morning I was up bright and early and waiting outside the lab at 6:40 a.m. - with about 20 other people. Have you ever seen a lab that busy at that time of morning? Welcome to a retirement community in Arizona! Most of the people waiting were fasting and I'm sure were looking to get their tests out of the way first thing...what they didn't anticipate was a 28-year-old trying to get pregnant tying things up as they waited. I must admit I felt a little awkward sitting there waiting with all the people who could have been my grandparents, especially since I had 3 lab slips and a box and most of them only had one, lol. Oh well.

Have I ever mentioned that I really don't like needles? Yeah, I pretty much hate them. Thankfully the tech was nice, and advancements in the phlebotomy world made it so I didn't have to get poked more than once for the first 25 tubes. I don't think I'll ever get used to having my blood drawn, but by the time all of this is over and done with, I'm sure I will be at least a little more "numb" to it, lol!

Anyways, I'm glad I got the majority of the blood work out of the way. When I go in for my Day 3 ultrasound I will have to have more blood drawn, and I have no idea how many tubes that will be. I'm sure there will probably be more in the future too. At least I know it's all for a good cause ;).

Anyhow, moving on from the insane amount of blood I had taken today, can I just say that I was soooo wrong about the Provera suppressing my appetite?! Sure, for the first 2 or 3 days eating anything sweet made my stomach hurt, and I didn't feel like eating very much overall. But after that, oh yeah, watch out! I've been ravenous!! It seems to be tapering off a little now, thank goodness. Other than food aversions/affections, I didn't think I was having any side effects from taking the Provera...wrong! So it generally takes A LOT to upset me and I'm a pretty optimistic person, but I have had a few days where I have been soooooo moody I hardly even recognize myself! Thankfully Jeremy has been spared any of the moodiness (at least I think he has, lol)...but my poor dogs, they are another story. Our puppy in particular - Lily - has been driving me absolutely crazy. It doesn't help that we've had a horribly hard time training her. Hopefully that will soon end though - tonight I enrolled her in a 6 week obedience class at Petsmart :), and we start Nov. 2. I can hardly wait. In the meantime, I'm glad I won't be on the Provera long enough to have Lily drive me nuts more than normal.

For now though, I keep taking my medicine and waiting for my cycle to start...I hope I'm lucky and it will start sooner rather than later, because patience is definitely NOT one of my virtues, and honestly, I really don't feel like developing it at the moment, lol.

One more thing before I close. I just want to thank all of you for your support. You have no idea how much it means to me to know that there are so many people rooting for our success. Infertility testing/treatments are definitely trying to say the least, and each and every one of you are helping me to handle it well. Thank you for being such good friends :).

A good day

I love good days. Really though, who doesn't? Being that I am generally an optimistic person, it's odd for me to not have good days (yeah, I definitely consider myself lucky!). Today was better than just "good" though.

Today was my first day taking Provera, the "jump start" medicine that will get the ball rolling with my cycle and hopefully lead to bigger and better things :). Thus far I haven't had any side effects (aside from maybe suppressed appetite, but I'm TOTALLY ok with that, lol), so that's always a good sign. Nine more days to go! To say I'm a little excited about this whole process is probably the understatement of the century - not that anyone can tell I'm excited or anything ;).

Anyways, so I talked to my boss today about needing off for at least a couple of days sometime in the near future, and she was so understanding about the whole thing. I'm so blessed to not only have an amazing job that I love, but to have a boss who is supportive of the things I am going through at the moment (on a side note though, she isn't the first boss I have had that has been extremely supportive - guess I've just lucked out a lot!). I was definitely nervous asking her if she would be ok with me taking the days off when the time came, but it's clear that she knows this is important to me, and given how quickly I am turning around all the projects she has been asking me to take care of and my offer to work extra hours to make up for the time I will be taking off, it would honestly be silly for her to say no. Still, this is only the start of my third week working there, so I'm definitely feeling grateful that she said yes.

I also got to spend time today with Leah, who is quickly becoming one of my closest friends here. Ever since we moved from Fairbanks I've really struggled to find good friends. I've kept saing to Jeremy, "I need to find my Erika here." (Erika is one of my best friends, who I met in Alaska and sorely miss!) It always seems like everyone has their clicks formed and there's no room for anyone else, but the ward (church) I'm in here in Lake Havasu has been different. From the get go I've felt welcomed and included, and each week it gets better and better. Leah is a single mom with an adorable 6-year-old son, and we've really clicked in the short time we've known each other. And she is going to be a great support during all that I will be going through the next little while with all of this fertility stuff - already she has offered to accompany me to Vegas when I next go, which is a big relief to me since driving 6 hours each way by myself again is sooooo unappealing (Jeremy's work schedule really doesn't allow for him to go with me to all these appointments). She is an amazing woman, and I look forward to getting to know her better as time goes on, as well as many other women in my ward who I've started to bond with.

I'm also grateful for my amazing husband. Yesterday morning before church I was thinking about how badly I needed to clean the house. I didn't say anything to Jeremy about it, so imagine my surprise when I got home and he had cleaned the entire house! (By the way, that's not really a rare occurrence, but it surprises me every time nonetheless!) I love that we never walk out the door or hang up the phone without saying I love you, and that he never fails to make me laugh. I love that he knows how important creating friendships are to me, and how he encourages me to step out of my comfort zone and reach out to others because he knows in the end it will be beneficial to me. I love that he always listens to me, even when I'm discussing every nitty gritty detail of all of this fertility stuff and not making any sense at all. I could go on and on, but I'll stop there, lol.

One more thing to be grateful for today...I had Dairy Queen tonight, and although it tasted absolutely fabulous, my tummy isn't liking it so much. Why on earth would I be grateful for that?! Because it means I will be less tempted to indulge in sweets, which have always been my weakness :). Oh and I almost forgot...they have snow on the ground in Fairbanks, and it was 100 degrees here today...SOOO grateful I don't have to deal with snow for half the year! (Sorry to all my friends in Fairbanks that don't like the snow - I'll think about you all winter long.)

I love being grateful. I love that my dad taught me by his example to always look for the best in people and in every situation in life.

"Each day offers us the gift of being a special occasion if we can simply learn that as well as giving, it is blessed to receive with grace and a grateful heart." (Sarah Ban Breathnach)

Today my heart is more than grateful.

Hope

Well, there is hope after all :). My appointment yesterday at the fertility clinic went fabulously and to say that I am excited for the future would be a HUGE understatement. It was a long day for me overall - working for 4 hours, driving 3 hours there, having an 1.5 hour appointment, and then driving 3 hours home - but is was more than worth it.

Without boring you all with every detail, let me give you the basic rundown instead.

How it went
First and foremost, I am nothing but impressed with this place. I went to Red Rock Fertility in Las Vegas, and from the moment I walked in the door I felt welcomed. Not only is the atmosphere a professional cozy, more importantly the staff are very friendly and seem to have a sense of how important their job is to each of their patients.

I first met with a nurse who went over some of the clinic's procedures and policies with me, and also took the time to discuss my particular insurance coverage and what I can expect to pay for certain tests along the way. I LOVE that they were completely upfront with me and really seem to have my best interest at heart.

After meeting with the nurse I met the Advanced Nurse Practitioner who I will be working with for the majority of this process (who I will just refer to as N), and again, SOOOO impressed by her. She is professional, friendly, and most importantly, she knows what she's talking about. In the time I met with her she helped me better understand PCOS, and for the first time since my diagnosis I was able to actually realize why it makes healthy, viable pregnancies difficult to achieve. I wish I could draw a diagram and show you all what she showed me!

Anyways, N had already reviewed my records from my previous OB/GYN (all 54 pages!) before I had arrived, and had them readily available so I could ask specific questions and she could give specific answers. We talked about my cycles, what we need to find out before we proceed with any sort of treatment, and what my expectations are. Again, she was so incredibly understanding and she took the time to answer all of my questions (which were definitely NOT in short supply, lol).

So, here's....

What happens next
Although both Jeremy and I have been through fertility-related tests in the past, it's been awhile, so my doctor wants to get updated results. Although Jeremy only has a few things he has to do, I on the other hand have a whole heap of tests to go through - some of them I have had in the past, but most of them I haven't. There's a lot of blood work I have to get done, and thankfully all of Jeremy's tests and my blood work can be done right here in Lake Havasu instead of in Vegas. We can get those tests/blood work done at any time over the next couple of weeks.

The rest isn't quite as easy, lol. First of all, a lot of my testing needs to be done within the first week or so of my cycle. Since PCOS makes it difficult for me to determine when a new cycle will begin, I am going to start taking a drug to jump start it. I'll take 10 pills (one a day), and hopefully my new cycle will begin the day after I take my last pill.

On day 3 of my cycle, I will go back to Vegas to have more blood work done and to have an ultrasound done that will check for abnormalities on my ovaries and uterus. Sometime between days 7-10, I will have two more tests done. One test will use X-ray and check to make sure my fallopian tubes are open and unobstructed. The other is an ultrasound exam that uses fluid to identify any lesions in my uterine cavity. There's one more test I am supposed to have done, but it's a little more surgical and not completely necessary, so I am almost 100% sure I will not be getting that one done.

Once all of those tests are completed, then I will have a follow-up consultation with N and we will decide what to do from there.

All these tests mean I have to take time off of work and spend a couple days in Vegas (oh darn, lol). Jeremy won't be able to come with me because of his work/call schedule, but we gotta do what we gotta do. I'm a little leery to ask for time off since I have only been at my new job for 2 weeks, but I think my boss will be understanding...I am trying to time things so that I only have to take off 2 days total, so hopefully things will work out accordingly.

The IUI verdict
In my last post I mentioned that a very large part of the reason I was going to Red Rock was to find out if N thought Jeremy and I would be good candidates for IUI. Although she wants to get all of our test results in before she gives me her final decision, as it stands right now she thinks our odds are pretty good. For most people who are trying to conceive, IUI only has a 10-20% success rate. But, because Jeremy and I are young and because of some other factors she saw in our records, along with how successful their clinic generally is, she said we would have about a 45% chance of conceiving. That's almost a 50/50 chance!!! Again, only time will tell if that's true for us, but it was enough to give me hope that we may very well have a child of our own one day :). If IUI looks like it may be successful for us, we will begin that at the start of my next cycle (the one after this "testing" cycle).

So, there you have it. At the end of my consultation with N she said something that totally took me by surprise but gave me more hope than I could have even imagined having. She looked like she was thinking, and then she says, "ok, so if we do this now, that means we'll deliver you in August - it'll be hot, but oh well." Did those words really just come out of her mouth? Is she HONESTLY thinking that I will be delivering my very own baby in August?? I'm trying not to get my hopes up too much about that, knowing very well that the odds generally haven't been in our favor and that many, many, many couples are unsuccessful with IUI. It's also possible that N may have just been saying that to me to keep me optimistic throughout this whole process. Nonetheless, I'm keeping my fingers crossed and hoping for the best - I really like the month of August :).

The big day

I haven't been very good at keeping up with this blog, but that may change here very soon. Why? Because tomorrow I have an appointment with a top-notch fertility clinic, and one way or another, I'm probably gonna have a lot to talk about.

Ever since Jeremy and I had to stop the foster-adopt process in Maryland, I have slowly been reverting back to the idea that I REALLY want to have a child that is biologically mine if at all possible. It took me quite a long time to adjust to the idea that we would probably never have a child of our own flesh and blood, so it seems like a step backwards almost that I'm now crossing my fingers that we will be able to once again. But this time around, I feel like our chances are better than ever.

This month our health insurance from Jeremy's employer kicked in, and although it doesn't cover very much of any fertility costs, it does cover some. We're taking that "some" and seeing how far it will take us. Unfortunately, there are no fertility specialists in Lake Havasu. In fact, there aren't even any doctors within a 100 mile radius that will perform ANY sort of fertility treatment. So, we'll be traveling 3 hours away to Las Vegas to Red Rock Fertility Clinic. I've read some outstanding reviews about this doctor, and the Advanced Nurse Practitioner who I will be having my consultation with tomorrow specializes in patients dealing with infertility who have Polycystic Ovarian Syndrome (PCOS) - just like me - and in less invasive methods of fertility treatments - like Intrauterine Insemination (IUI), which is what we're interested in. (We simply cannot afford IVF, but IUI is MUCH less expensive.)

We aren't getting our hopes up yet, or at least, I'm trying not to, lol. I was excited to make the appointment, I have been looking forward to it ever since, and now that it's happening in less than a day, my excitement is building more and more. You see, IUI generally only has a 10-20% success rate, although my understanding is that some couples have a much better chance at conceiving with IUI than they do naturally. Given the results of various tests Jeremy and I had done when we were living in Fairbanks, my doctor there thought we would be one of those couples who successfully got pregnant through IUI. We didn't do it then because of financial concerns (we wish we had bitten the bullet and just tried it then anyway), but the doc I'm seeing tomorrow has all of our records from Fairbanks, and I'm hoping has already reviewed them and formed an opinion before I get there tomorrow. After she has reviewed all of our previous test results/history, I'm going to ask her to be 100% honest with me and tell me straight up if she thinks we will be successful with IUI. Her answer will determine what our next step is.

Honestly, aside from being excited, I'm extremely nervous. I soooo want her to tell me that IUI is the right course of action for us, but I'm trying to prepare myself for her to tell me it's not. It's very likely that she will want to run more tests before making that decision, and that's something I'm prepared to do. She also specializes in some holistic fertility treatments, and I'm not opposed to trying some of those if they sound legitimate to me. Whatever she tells me tomorrow, I probably won't be ready for it. If it's more tests, I'll be happy she thinks there's still a chance of some sort and be antsy until those tests are done and the results are in. If it's bad news, I'll probably cry the entire 3-hour car ride home and have to force myself not to sulk the whole weekend or longer. And if it's good news, well, wherever you are in the world, my smile will be big enough to reach you.

I should mention that we do have a plan if we get bad news. If indeed we are told that IUI or any other financially feasible treatment method is most likely just a waste of our time and money, we will once again begin the foster-adopt process, this time in Arizona. We ran into a lot of stumbling blocks with that in Maryland, but I have already contacted the appropriate people here and have had discussions with a woman from my church who adopted a daughter through the foster-adopt program locally - she will be an extremely valuable asset in the process if we have to go that route.

So, tomorrow is the big day. It's weird to think that our expanding family's future depends on what I learn at an appointment at 4:30 p.m. tomorrow. Whatever I'm told though, the truth is I'm glad this day is here. We're ready to get this show on the road, whatever that road may be.