The TESTS!!!

Before we even got to start the cycle, we had to take SO MANY TESTS! After knowing about all of them I think I would be a nervous wreck if I got pregnant without being tested for everything to make sure I was healthy and my body was ready! By the time we had our IVF Consultation, I had already done one small part: the blood test (well the first one). With that blood test they were able to get my values for my:

• Anti-Mullerian Hormone: gives them an idea of my egg supply, or ovarian reserve.
• Thyroid Stimulating Hormone: indicates thyroid function
• Prolactin: which can inhibit the hormones that trigger ovulation. It is also the hormone responsible for producing breast milk, which is why most women don't ovulate as long as they are breastfeeding

All of my results had been normal, which was good news. We ended up having plenty of time to get all the rest of the tests done, because after discussing my case with the other doctors at a weekly meeting where they all get together to discuss their patients, Dr. Moore called and told me he thought it would be best for me to go on a hormone called Norethindrone for three months to help treat my endometriosis before we did IVF. <Just a side note: I think the weekly meeting the doctors have together gives patients a huge advantage-even if I only work directly with one doctor, I have a whole team of them working together on my plan of care.> I'm pretty sure I had already started on birth control pills by this time in preparation for our first IVF cycle. Every time I ovulated, my endometriosis would worsen (because of the thickening on the uterine lining.) Birth control pills prevent ovulation; Norethindrone helps prevent the growth of the uterine lining during menstruation. Both of these together would help thin my uterine lining to prepare me for the IVF cycle and hopefully keep my endometriosis from worsening. We were pretty disappointed that we were going to have to wait an extra three months to start. That would push our first cycle back to November.

The next test I was sent in for was another blood test for them to find out my blood type, test for antibodies in my blood (RBC Antibody Screen) and check to make sure my rubella antibodies were still effective. Remember that MMR vaccine you got as a kid? Rubella is the "R" part and a disease that can cause serious birth defects if mothers contract the disease while pregnant. As it turned out my rubella antibodies were low, meaning my immunity to the disease was wearing off, so I did have to get a booster shot. Everything else was all normal and good.

Next it was Ryan's turn: the sperm test. This was the only thing Ryan had to do in the testing process. He gave a sample (I am sure you know how that works) and they tested the sperm to make sure they were strong enough to penetrate my eggs by putting some of them in with hamster eggs and leaving them overnight to see what happens. This part still makes us giggle a little...Ryan was going to make little hamster babies (not really, but you can't tell me that's not the first thought that came to your mind too!) They also did a general count and assessment to see how many were shaped normally and moved well. The penetration test came back 10/10, his count was on the high end of normal and most of the little swimmers had normal shaped heads, one tail and were able to swim straight, so all in all GOOD NEWS!

The last test was a genetic test where they test for over 100 genetic disorders and diseases (see them all here). The test would see if I had the recessive gene for any of the disorders (things like cystic fibrosis and spinal muscular athrophy). If I had tested positive for any of them, then Ryan would have done the test as well. If we both had the recessive genes for any of the disorders then that would mean there was a 25% chance that a baby would have that disorder and they could then take extra precautions to prevent and extra testing to catch and treat (the ones that could benefit from treatment) them in the baby early. For this test I had to spit into a tube-I had to FILL the tube with spit-first thing in the morning before eating or drinking anything. Then I packaged it up with what they provided and sent it to a lab that does genetic testing (Counsyl). It was a weird experience! But the test results were negative, meaning I did not have the recessive genes for any of the disorders, so Ryan did not have to be tested.

Even though we had been delayed for three months, we were still trying to look on the bright side: this would give us more time to come up with all of the money so we would hopefully not have to take out a loan and it would ultimately up our chances of success with IVF, so we had to think of it as a good thing!

Our Initial IVF Consultation

In order to really go over In Vitro Fertilization (IVF) in detail, Dr. Moore had us come in for an IVF consultation a week after our first appointment (July 2013). With my endometriosis diagnosis he estimated that the live birth rate for a fresh IVF cycle (embryo transfer after egg retrieval) would be about 65%. He explained the process beginning to end, including the shots, risks, cost and finally the tests.

The Process and Hormones

I would first contact the nurses to get on the schedule for a transfer week. They would send me a calendar that outlined everything I needed to do. I would start with 6 weeks of continuous birth control pills (active pills only-I would skip the placebo pills and start a new pack). Sounds crazy right? I was surprised that the first step to getting pregnant was to take pills that prevent pregnancy! But the birth control pills quiet everything down which enables the doctors to control my cycle in order to time everything just right.

From there it would be a matter of adding in other medications one at a time...Lupron injections for two weeks, then add in the Follicle Stimulating Hormone (FSH) injections ending with Pregnyl, an HCG (Human Chorionic Gonadotropin) shot 36 hours before the egg retrieval. In the meantime Ryan would have to take antibiotics, just to make sure he wouldn't have any bad bacteria in his semen sample the day of the egg retrieval. (I will get into more detail about each medication/hormone and the side effects I experienced later when I talk about my experience with the egg retrieval and embryo transfer.)

The egg retrieval date would depend on the size of the follicles containing the immature eggs. All of these hormones would trigger my body to release multiple eggs rather than just one like the body does during a normal ovulation. They would have me come in for an ultrasound to check on them every day (starting on a certain date) until all of the eggs were mature enough to collect them. The egg retrieval would be done under sedation. They would use a small catheter guided by ultrasound to basically suck the eggs out (again...I'll go into more detail when I write about my experience with the process.)

After egg retrieval I would start taking antibiotics (a pill-yay!) and progesterone injections. Then we would just wait to see how many eggs fertilize and develop into embryos. On the fifth day of growth they would transfer one or two of the 5-day embryos (blastocysts) into my uterus. We would wait two weeks then come in for a pregnancy test. The doctor estimated that they would get anywhere from 10-20 eggs, with 8-18 fertilizing. Overall he estimated we would end up with anywhere from 3-8 embryos in the end. It all sounded so perfectly planned and simple really. All I had to do is follow directions and the doctors would take care of the rest.

The Risks

• Risk of multiples (which is what EVERYONE thinks when they hear IVF!): 
• If they transferred two embryos then our risk of a twin pregnancy would be 50% and the live birth rate 37% (it is not uncommon to lose one twin before delivery-usually very early in the pregnancy.)
• If they transferred just one embryo the risk of twins would only be up to 11% (slightly higher than the risk of a naturally occurring twin pregnancy, which is just over 3%.)
• Our risk of having triplets or more would be less than 1%.
• I would have a 2 fold increased risk of the baby being Small for Gestational Age (SGA), Preterm Labor and Gestational Hypertension. For this reason IVF pregnancies are considered HIGH RISK pregnancies.
• Birth defects: 2-4% (same incidence as a naturally occurring pregnancy)
• Ovarian Hyper Stimulation Syndrome (OHSS): 1-2%
• Ectopic Pregnancy: 1-2%
• Everything else (bleeding, infection, human error, etc.): 1-2%

 

The Cost

The cost of our first IVF cycle, which would be fresh embryo transfer, without ICSI (Intracytoplasmic Sperm Injection) would be $8900 (ICSI is a process where they inject the sperm into the egg when the sperm cannot penetrate the egg on its own...we did not need that, but if we had it would have cost an extra $1200). Medications were not included in the cost and would be an extra $2000-$3000. Because Utah is not a state with a mandate requiring coverage for infertility treatment, none of these costs would be covered by insurance, even this consultation that cost $165. (Fortunately my doctor was able to put endometriosis instead of infertility as my reason for the rest of my visits so they could all be covered.) Each frozen embryo transfer would be $2720 with under $500 in medications. To cryopreserve (freeze) our extra embryos it would be $1000 with a storage fee of $435 for each year after the first one.

By the time Ryan and I made this appointment, we had already done a significant amount of research about the costs and options. Like many infertility clinics, UCRM also has a money back guarantee program. We went in for this appointment with our minds made up that we wanted to do the guarantee program. The doctor explained that with the money back guarantee program they place you in one of three tiers based on history and age. We would have to transfer two embryos on the first try and if it didn't take we would do one frozen embryo transfer. If that did not take either, then we would be refunded about 80% of the cost (which still would not include medications). If we got pregnant on the first or second try (and that pregnancy resulted in a live birth past a certain week) then we would not get any money back. <After talking to the manager (who I actually went to high school with) later that week we found out that it would cost $17,900 to do the guarantee program. They had some finance options he gave us information on and emailed us all the terms. We still wanted to do it. We thought it was our best bet because if it didn't work we would get back enough of our money to try a few more frozen embryo transfers.>

The Tests 

The tests were an interesting part...there were so many different ones that I think that could be an entry all on its own! Here is a list for now, but I will go into more detail (including definitions) about all of them and my (and Ryan's) results later.

• Anti-Mullerian Hormone
• Thyroid Stimulating Hormone
• Prolactin Levels
• Blood Type
• RBC Antibody Screen
• Rubella Antibody Screen
• Counsyl Genetic Screening
• Sperm Assessment
• Sperm Penetration Test
• Ultrasound (more specifically, a sonohysterogram)

These would all need to be done before we even started the IVF process! It seemed overwhelming, but we still left this appointment feeling SO hopeful and excited! Talking about the babies we would have someday finally seemed like a more realistic conversation than what we would do with all the money if we won the lottery. We couldn't wait to tell our families about the new path we were about to take.
 

This appointment happened on July 16, 2013...we went through so much more before we even got to our first IVF cycle in February 2014! Keep checking back to find out about the tests, the procedures, the emotions and the medications and side effects!

UPDATE April 28, 2014

Update on our progress with Cycle #2: I have been on birth control pills for the last seven weeks (active pills only-so no period) and started on Lupron yesterday (Sunday), which is a drug that helps suppress ovulation. Both the birth control and Lupron are used to control my cycle so they can make sure my body is where it should be by the time they transfer the embryo. The Lupron is the first of my injectable drugs and the mildest as far as side effects are concerned. The needle is tiny and I just inject it into my stomach once a day. (Easy now, but the first shot back in January was really hard to do!)

My Appointment Today

Today I went into the doctor for an Endometrial Biopsy (also called womb scratching), which is a quick, simple procedure where they take a flexible tube (like a catheter) and insert it through the vagina and cervix into the uterus and then literally scratch the lining of the uterus. The healing process has been shown to help with embryo implantation-some studies even say it can double a woman's chances of becoming pregnant when done before IVF. They use the procedure on women who have had an unsuccessful transfer with a good quality embryo (like we did back in February/March). ABC News did a good story on the procedure in 2012: Womb Scratch May Boost IVF Success.

As I have been told prior to my HSG and two Sonohysterograms, I was told this too would be "uncomfortable." I have learned since the other procedures that uncomfortable is a nice way of saying it's going to hurt, but in a way that doesn't scare you. Maybe we should be taking that word for its more literal meaning: not able to be comforted (not the dictionary definition, but if you break down the word it makes sense.) Knowing better, I looked it up. I Googled the procedure and read comments from women on blogs and message boards all over the Internet. Thank GOD for the Internet!!! Reactions ranged from "not so bad" to "I wanted to kick my doctor in the head."  Needless to say, I still did not know what to expect when I went in this morning.

I was told to take ibuprofen thirty minutes before my appointment, but that was my only instruction. I got there and stripped from the waist down (something that now seems all too normal at visits to the doctor) and from there it was very similar to getting a pap smear...until the doctor started the scratching part! I don't know how my pain tolerance compares to other women; I'd like to think that my painful periods for the last 15 years have provided me with somewhat of a high threshold for pain where female issues are concerned, but THIS HURT!

I usually can manage to take slow deep breaths and deal with the pain without making any sounds, but every time the doctor scraped that tube against my uterine wall I couldn't help but yell "Ow, ow ow!" He'd scrape once, then again so soon that I never had time to recover from the last. BUT I am glad he made it quick: he literally counted to six, scraping on each number, and it was over just like that. I understand both opinions I found online: it hurt like hell, but really it wasn't that bad because it is so quick. It literally took seconds compared to the 5-10 minutes of constant "uncomfortable" pain caused by other procedures. So, Dr. Moore, if you're reading this, tell other patients to read this post prior to an endometrial biopsy if they want to know exactly what to expect and what it REALLY feels like!

It still hurt pretty bad for about five minutes after, but then on the way home (and now three hours later) it just feels like the cramps I typically get on period day one. I asked the doctor why I had to take the ibuprofen because I really didn't think it helped and he said that it would be worse without it and to keep taking it for today. So I will...because I don't want to know what the cramps feel like without since it's still uncomfortable (I'm using that word for its more common meaning now) with the ibuprofen in my system.

After I got home, I had lunch with my husband and niece. (We are babysitting my sister's almost-two-year-old today, so Ryan got some parenting practice while I was at the doctor. His only condition: he would not change any diapers). She always cheers me up! She's the cutest toddler: so spunky, talkative, happy and loving. When he went back to work, I got to really spoil myself and relax: I put my niece down for a nap and then curled up next to her and took a nice little nap myself! After what I went through this morning I think I deserved it! ;-)

Our First Appointment With Our RE

After visiting our new found RE, Dr. Moore for the first time, I had a million thoughts swirling around in my head. I decided that maybe that would be a good time to start writing in a journal (I wish I had kept up with it a little better.) The following are parts of my first journal entry after that appointment (I left out details that I already wrote about in my last post):

July, 15, 2013

       "Ryan and I have been trying to get pregnant for 26 months now with no luck. I have even started to feel jealous of other women who have miscarriages because at least they know they can get pregnant! To make it harder, between our families there have been four pregnancies since we started trying. Three of those babies are now around a year old and another is due later this summer.
       "Last May, after trying for a year, I went to see my doctor. He referred me to another doctor who could do a laparoscopy. That doctor thought that we would be able to get pregnant without it. He sent me for an Hysterosalpingogram (HSG), which is a procedure where they insert a small balloon/catheter into my uterus, then inject a dye and watch on a special kind of x-Ray to see if the dye moves through the Fallopian tubes and into the ovaries (where it leaks out into your body and is absorbed.) It was a miserable and painful experience! They did it to see if my tubes were blocked. Everything came back normal so the doctor started me on Clomid."

*My previous post can fill in the rest of the details between the last half of 2012 and first half of 2013.

       "On Monday last week Ryan and I had out first appointment with Dr. Moore at the University of Utah Center for Reproductive Medicine. I had spent the week before making sure my medical records for every exam, test, procedure and ultrasound I had undergone in the last decade were faxed to Dr. Moore's office so he would have copies of everything to review before my appointment. He already knew my entire history by the time we showed up for our appointment! The more questions we asked and the more we talked to him, the more we liked him. He is young, but he is also familiar with all the latest technology, procedures and statistics. The thing we like most is that he seemed to really listen to us; he gave us recommendations for our unique situation and considered everything he learned about us as important in finding a solution.
       "When everything was done, we learned that our chances of becoming pregnant without doing anything are only 1-2%. If I have a laparoscopy to treat my endometriosis and then do IUIs (it usually takes a few tries) with fertility medications it would up our chances to about 10%. This is what the doctor initially recommended we try because the laparoscopy would most likely be covered by insurance (IUIs are about $400 each time) so it would be the most cost effective option. If after a few failed attempts we want to spend more money, In Vitro Fertilization (IVF) would be the next option. We decided we would rather skip straight to IVF. Overall the success rates at UCRM were over 70% (for pregnancy, 60% live birth rate). Dr. Moore has helped 40 couples get pregnant and have babies in his first year and a half or so with UCRM. He has had 7 couples undergo IVF and get pregnant on their first try. Seven of those 40 successful pregnancies were his IVF patients-in other words he has a 100% success rate so far.
       "Although having a plan to do IVF gives me hope and we have the start of a plan in place, all week I kept waiting to feel sad. A 1-2% of becoming pregnant naturally is a BIG BLOW! That's almost like NO chance! I keep thinking I should be upset and waiting to break down and cry-it's a harsh reality to come to terms with! But instead I only feel relief. It's hard to explain, but it's like knowing it is nearly impossible to get pregnant without help takes some of the pressure off. I even started my period Saturday night and wasn't ever really upset about it. I guess it just feels good to have an explanation even if I really don't know why I can't get pregnant at least I know that it is unlikely (at least without medical help) so I don't get my hopes up every month. It sounds so sad when I write it all on paper like that but I really do feel okay. 
       "Now I have something to look forward to. It will not happen for a few months because we need time to save the money (it is EXPENSIVE), but at least now I have real hope that it will happen for me. I guess part of the reason I feel so calm about this whole thing is because for the last year I've been afraid that I might not be able to have children at all; so to hear that I can probably get pregnant at all is good news.
       "Tomorrow morning we have our IVF consultation. They will have the test results for the hormone tests they drew blood for last week and we will go over everything we need to know about IVF. Tomorrow we put the plan in place and come up with a time line!" 

From the Very Beginning

I got married for the first time right before my 19th birthday. Now I realize I was WAY TOO YOUNG and did not even really know who I was. I had always wanted to be a mother and he was eager to have kids, so I got off birth control six months later and we started hoping for a pregnancy. I did not know very much about ovulation and fertility at that point. We tried for over a year before I started tracking my basal body temperature. Even with careful timing we had no luck.

The next step was to talk to a doctor. The doctor we saw was a family friend of my ex-husband's. He put me on Clomid to see if that would help. We tried Clomid for a few months with no success then stopped when the refills on my prescription ran out. Thankfully, I had no idea what I was doing and so I did not waste money on doctors, procedures or medications at that point. From there we just left it to chance and good timing and hoped for the best. Once we got divorced after just over four years of marriage, I found myself grateful that I never achieved a pregnancy with him. I won't put him down publicly, but he was definitely not the person for me. Without a child we were able to sever all ties and I hoped I would never see him again (unfortunately I have had a couple run-ins with him over the years).

Shortly after the divorce, I went to the doctor for painful periods and pain in between periods. They found that I had cysts on both ovaries and told me the pain in between periods was likely due to ovulation. This is when I first became familiar with ovulation kits; I was told to buy one because they wanted to make sure I was ovulating (which I was). They put me on birth control to help make my periods lighter and it was years before I would learn anything else. Without insurance I did not stay on the birth control for long, but it did seem to help when I was on it. Several years later I went back to the doctor and had an ultrasound where they again said I had cysts. They started monitoring them, having me come in for ultrasounds every few weeks (for MONTHS), until the cysts got to the point that they needed to be removed.

In the middle of that mess, in November 2008 I met the man who would become my forever husband. Ryan and I met the Sunday before Thanksgiving watching football in a bar. He was there with some coworkers and I was there with a friend. His coworker (neither of us can remember his name) was trying to talk football with me (I was wearing a 49ers jersey), but he clearly knew nothing about the sport. Ryan walked up to get after him for being rude to an employee earlier whom was a friend of Ryan's (and whom, coincidentally, had been my roommate until about six months before). He was waiting for the guy to finish his conversation, but when he heard me talking about football he ended up joining in the conversation. We got so into the conversation with each other that his coworker gave up and walked away. We talked all night and he asked me out on a date (I know...rare these days). The following Tuesday we went to dinner and a movie (he got stuck at work late so we actually just had an appetizer.) We talked for so long that we were late for the movie. I can't remember everything we talked about, but I do remember we talked about kids and our family goals for the future. It was perfect and he was a perfect gentleman the whole night. He even gave me a quick kiss on my porch after a long goodbye.

In December, on New Year's Eve, I went in for a laparoscopy to have the cysts on my ovaries removed. Ryan, who I had been dating for barely more than a month took me in for the procedure. Once they got in with the camera so they could see, they realized that I didn't actually just have cysts, I had severe endometriosis. What they saw on the ultrasound was actually endometrium tissue. It was so bad that one of my ovaries was twisted and stuck to the side of my uterus. They cleaned me all out and put me on birth control to slow down the growth of the endometriosis in the future, but told me that when I did want to get pregnant I would likely have to come in for another laparoscopy.

Ryan and I were married in October 2010 and I quit taking the birth control in April 2011. This time I was more savvy. I started tracking my cycles from the very beginning on an infertility app on my phone. I quit smoking, I started drinking only occasionally and I cut back on caffeine (which I quit altogether in November 2012). I tracked the dates and time of day every time we had sex (talk about a romance buzz kill) and even recorded every little twinge of anything I felt in my body, from breast tenderness to pelvic pain. In March 2012 I started using ovulation predictor kits (I peed on a stick every day, for those who aren't familiar with them) and tracking the days I got a positive for the LH surge that happens just before ovulation. In May that same year I went in to see my doctor loaded with all of this information. He referred me to another OB/GYN who could do a laparoscopy, which he thought should be the first step due to my history.

When we first met with this doctor he said he did not think we needed the procedure. He claimed that he had helped many women with endometriosis get pregnant over the years without doing a laparoscopy to clear up some of the endometriosis first. He put me on a double dose of Clomid (which stimulates ovulation) and had us keep timing everything and trying on our own for a few months, then upped me to a triple dose, which still didn't work. Next he sent Ryan in for a semen analysis and scheduled us for an Intruterine Insemination (IUI), which is a procedure where the doctor injects the sperm directly into the uterus right around the time of ovulation. By this point it was December.

Just after Christmas I got my period. I think that was the most devastating period (and mind numbing cramps...probably worse because I was so upset) in my entire history of devastating periods! We were in St. George visiting Ryan's parents for Christmas and I had not even brought tampons with me because I was so sure I was pregnant. I left to go buy tampons and spent 20 minutes crying in the truck in a golf course parking lot before I made it to Walmart, where I also bought tissues and mascara so I could clean myself up! By the time I got back Ryan had told his parents and grandmother (who was also there) and texted our sisters, my parents and my best friend giving them the news and also asking them not to talk to me about it-at my request.

The next six months are kind of a blur...it was a lot of tracking cycles and intercourse and pains. At some point the side effects of the Clomid got so bad (especially the hot flashes)-and I didn't think it was helping anyway-that I quit taking it. I did some research and decided that we needed a more personalized plan than what we were getting. The doctor we were seeing always talked about all his successes with other patients and shuffled us through a routine-we felt like cattle. I decided a Reproductive Endocrinologist would be better to see than an OB/GYN, so I started doing more research.

The doctor we decided on was Dr. Andrew Moore with the University of Utah Center for Reproductive Medicine. We chose the clinic because it is a research hospital so they always have the newest treatments and technologies and because their entire team of doctors sounded excellent. We chose the doctor because he specialized in infertility and pelvic pain, had EXCELLENT patient reviews and because he was young. We liked that he had only been an official doctor for a few years-that meant he was fresh out of trainig so he would be up on all of the newest research and he would still be excited about his work. Once we met with him we knew we had made the right choice. We left our first appointment feeling hopeful, a little relieved and actually excited about our plan of care. That is a story for another day though...

The Reasons I am Sharing...

I have wanted to start a blog for a very long time, but always find myself so busy that I am afraid I will not be able to keep up on it. If you know me, I am a bit of a control freak and do not like to start a project unless I know I can finish it! After twelve long years I finally graduated from the University of Utah with a Bachelor's degree in Mass Communication last summer and just this week I finished a year long Graduate Certificate Program to become a Certified Mediator. With all that schooling done, I have a feeling I am going to have some more free time to do some of the things I love, one of which is writing.

 I have been very focused on our baby-making journey, especially since we decided to do In Vitro Fertilization (IVF). Obsessed might be a better word than focused. I find myself searching for more information online (best and worst case scenarios, pregnancy symptoms, every little physical ailment and how it relates to my reproductive system, etc.) and thinking about it constantly. With all of the injections and pills and appointments to keep straight it is hard not to think about it. Not to mention all of the friends and family members with pregnancy announcements and new babies arriving. Sometimes I am shocked that I have not driven myself crazy yet! With all my focus in that one place I decided why not write about it.

Writing is like therapy for me. I am not very good at keeping a regular journal because I hate feeling obligated to write about my boring every day life. With such a fabulous camera on my cell phone, I feel like my day-to-day life is pretty well documented in pictures! However, when something big happens I do like to write about it. Dealing with infertility is that something big. It plays with my emotions and causes a great deal of pain in my life. Writing helps me work through that pain.

I bought a journal almost a year ago and have only written in it twice, but if you looked through the notes on my phone you would find dozens of entries of all lengths detailing how I am feeling and what I am thinking during the times I feel the worst emotionally. Writing those feelings down (or typing them into my phone) helps me get all of those emotions out so they don't bring me down into despair. Sometimes I even delete them later when I go back and read through them. It sounds bad to delete a journal entry about a time of darkness-even if it was a painful time it was still a part of my life-but for me deleting the note is like letting go of that negative emotion. Some of them are jealous writings about other people (usually pregnant ones) and when I no longer feel that jealousy I delete the note and let go of that negativity.

Throughout our journey through IVF I have been very open about what is happening every step of the way. I have not gone into detail about my emotions and deepest thoughts, but I have shared my experiences and test results on Facebook. In doing so I have found several others who have or are experiencing infertility. Some of them ultimately achieved a pregnancy and now have little ones, which gives me hope, and others are still trying. The ones who are trying are the ones I feel the most connected to right now. There are probably others who are going through what I am, but not ready to share. Those are the ones I really hope I can help by being completely open about what I am experiencing and how I am feeling. If I can give others hope or even share an experience they can relate to so they feel less alone then I have done what I intended to do.

Consider this my disclaimer: I will be blunt. I will be honest. I will be emotional. I might say some things that sting or maybe even shock some. I plan to share everything that I think or feel (or have thought or felt) along the way, so please don't be offended. If you disagree with me, that is completely fine and I respect your feelings and opinions, all I ask is that you also respect mine (even the ugly ones).