Fertility Consult Scheduled

Today I learned it can take months to get an appointment with a reproductive endocrinologist (RE). So, I decided to give my OB/GYN a call and find out what she wants us to do if we do not get PG this cycle (as she told me to call her after 6 months TTC). I spoke with a nurse, who first asked if we have been charting and/or using OPKs (to which I said yes). She then said Greg and I should come in for a fertility consultation and begin testing. My guess is she will refer us to an RE after that, but I'm not 100% sure. Our appointment is scheduled for the first week in January.

I am excited to begin this next phase! For the past few weeks, I have felt like we are just waiting to hit that six month mark (although we are still actively TTC). In the meantime, I am enjoying the Christmas season :)

My Genotype

I can't remember if I already mentioned my genotype within an earlier post, but I decided to dedicate a post to this topic so it's easier to find. (I know I am always curious to learn the genotype of other CFers.)

My genotype is DF508/R117H.

For those who don't know a bunch about CF, there is some correlation between geneotype and the severity of the disease, and this is why we CFers are often curious about the genotypes of other CFers.

Quick genetics lesson - it takes two copies of the CF gene for a person to have CF. (People who only have one copy are carriers.) From what I've read online, it seems the "milder" gene is always the dominant one. This is why I have mild CF. R117H is associated with mild CF and pancreatic sufficiency. DF508 is the most common CF gene, and, usually, a person carrying two copies of this gene will have "classic" CF (i.e., they will have more lung complications and be pancreatic insufficient).

I feel very lucky to be a carrier of one of the "mild" genes!

Onto Cycle 6

And so begins our last cycle before it's time to call the doctor. I took it pretty well this time. Even though I had my hopes up for a few days, I've pretty much accepted that we will need some assistance in getting PG.

In the meantime, I am trying to focus on the positives of not being PG yet. There are lots of things we can still do that we won't be able to do anymore when I am a stay at home mom. Some of these are:

• Greg and I get more time to be "yuppies" and go out to dinner, go shopping, travel, etc.

• We have more time to save money for a new car, build our emergency fund, and do some home renovations

• I get to manage the construction of my first design (did I ever mention I am an engineer?)

• I also just found out I am going to manage and design a $6 million project

Plus, I can still drink wine, eat soft cheese, and sleep in! Oh, and there is the whole still being able to do what I want when I want to. I'm sure in two years when I am taking care of a baby I am going to look back at the current times with great fondness :)

Toture is...

...when your temperatures are looking better than ever, (they have never been this high at 14 dpo), and you keep getting BFNs. This 2WW is killing me! I keep staring at my chart, hoping it will reveal something I missed the other 25 times I looked at.

CF & Gestational Diabetes

I recently learned on the CF forums that women with CF are at greater risk of developing gestational diabetes. There is some great information in the thread here. I was aware the general CF population is at risk for developing diabetes - it is called CF related diabetes (CFRD), because it is caused by CF related damage to the pancreas.

I did a little bit of online research, and here is my understanding of gestational diabetes in a CFer:

• The CF foundation describes the difference between CFRD and "regular" (Types 1 & 2) diabetes on their website. Basically, CFRD is a combination of Types 1 & 2 diabetes - the pancreas does not release enough insulin, and the body is resistant to insulin (due to constantly battling infections). 43% of adult CFers over the age of 30 have CFRD.

• CFRD seems to be more common in CFers who are pancreatic insufficient (PI). (Pancreatic insufficiency happens when channels that secret digestive enzymes are blocked by mucus. A PI CFer must take digestive enzymes in pill form when they eat.) However, I don't think this means pancreatic sufficient (PS) CFers are not at risk for developing CFRD. Although PS CFers do not need to take digestive enzymes, there is still sometimes damage to the pancreas that occurs. For example, PS CFers are at a greater risk of developing pancreatitis (I suffered from this a few years ago). Therefore, it is my educated guess that even PS CFers are at some risk for developing CFRD.

• The American Diabetes Association's website describes gestational diabetes. Gestational diabetes is similar to type 2 diabetes in that the body is resistant to insulin. They aren't 100% sure of the cause of gestational diabetes, but think it may have something to do with pregnancy hormones "blocking the action of insulin in the mother's body." 4% of "normal" pregnant women will get gestational diabetes.

• I could not find many sources regarding the risk of gestational diabetes in women with CF. One study saw a rate of 14% (7 out of 49 patients). Another study found 7 out 8 pregnant CFers developed gestational diabetes.

So, it seems the risk of CFRD combined with the risk of gestational diabetes means this is something every CFer who is TTC should discuss with their doctor. I know I am going to ask mine about it at my next appointment!

Back to the ENT Today & Thrush

Today I went to the ENT for my 6-week post-surgery check-up. Everything looks good. From now on, he wants me to call when I notice my sinuses getting worse so he can do an endoscopy and suck all the gunk out. He said it should delay the need for another surgery and keep me feeling good. He wants to do this every six months at a minimum. I am excited about it!

On the thrush front, I finished my month of Diflucan about four weeks ago and the thrush started coming back. However, I think I've figured out how to manage it. I've noticed that drinking beer and eating sugary foods really cause it to come back, so I've cut way back on them. I've started gargling with Orithrush every evening and after I decide to splurge on a beer. I also break open an probiotic pill (I like Ortho Biotic) and drink it to get healthy bacteria in mouth (in order to crowd out the thrush). It seems to be keeping things at bay - I still get a little bit of thrush couple of times a week, but the Orithrush really helps knock it out right away. I even carry a small bottle of it in my purse. Hopefully I've found the solution!

Cycle 5

AF arrived 11 days ago, and she hit me hard. I wasn't expecting it. I figured I would take it like each month prior: "Oh, well. Now we have more money to work on our house. Maybe next month." I mean, four cycles TTC isn't that long. It takes the average couple about six months to get PG, and a little bit longer for couples in their early 30s, (like us). But, for some reason, AF's arrival caused everything my doctors have said to hit me: We will likely have trouble TTC.

She came Thursday evening. I was okay. But I think part of me was hoping she would stop - after all, I was only 9 dpo and my luteal phase had never been that short. The next morning she was still there in full force. And then I realized we only had two more months to try before my doctor wants us to come see her for "help." That just didn't seem like enough time. I felt like we just started TTC. I got a huge lump in my throat and struggled not to cry at work.

I feel better now and have accepted things. Greg and I talked and he admitted that, in the beginning, he didn't believe we would have issues either, but now he understands we will probably need help. So, we started looking at our health insurance regarding coverage when it comes to infertility treatments. I also started doing some research. I asked the women on the CF message boards what our next step would likely be, and they agreed it would be Intrauterine Insemination (IUI). (You can see the thread here if you are interested). So, hopefully, all we will need is IUI to help Greg's boys get by my CM, and nature will do the rest :)

In the meantime, we still have a few months to give it our best shot!