FSH & Hysteroscopy Results

Well it looks like its time to try and make a baby again....

The Hysteroscopy
Last week I had a hysteroscopy with Dr. T and the procedure went well. I love my new clinic already. As they were putting me to sleep Dr. T told me to dream about visiting my family in Panama on a sunny beach. When I woke up I had a heating pad on my stomach and a pillow underneath my head. Dr. T came in and told me the procedure went well and that he removed a small polyp. He also said my uterine lining looks good and that anatomically we are good to go for my fresh IVF cycle in November.

FSH Results
Dr. T also gave me my FSH results after my hysteroscopy and my FSH is 5.9 and he said he is pleased with that. I will continue birth control pills and make an acupuncture appointment at the clinic next week, as well as make a payment on my upcoming cycle. Below is a chart explaining FSH from Advanced Fertility in Chicago and I found it to be quite helpful:

Day 3 FSH level	FSH interpretation for DPC Immulite assay
Less than 9	Normal FSH level. Expect a good response to ovarian stimulation.
9 - 11	Fair. Response is between normal and somewhat reduced (response varies widely). Overall, a slightly reduced live birth rate.
11- 15	Reduced ovarian reserve. Expect a reduced response to stimulation and some reduction in embryo quality with IVF. Reduced live birth rates on the average.
15 - 20	Expect a more marked reduction in response to stimulation and usually a further reduction in embryo quality. Low live birth rates. Antral follicle count is an important variable.
Over 20	This is pretty much a "no go" level in our center. Very poor (or no) response to stimulation. "No go" levels should be individualized for the particular lab assay and IVF center.

Tons of Baby Dust to Everyone,

Second Opinion

I had my first appointment with my new RE on Thursday. I think it would the understatement of the year to say that I felt overwhelmed. I spoke with both a younger doctor and the doctor I made the appointment with. They were very thorough and explained things to be very well. However, I still feel uncomfortable.



In all honesty, I don't think my apprehension has anything to do with doctors anymore - I think I'm just sick of dealing with this and sick of how it is consuming me. Oh, and I'm also sick of being a human pincushion. I believe I have been poked and prodded more this year than the Pillsbury Dough Boy himself.



However, unlike Poppin' Fresh, I don't enjoy it as much (and I don't giggle when it happens , its more along the lines of "I can't look at the blood you are about to draw because I will cover the walls of this place with vomit and then pass out.").



So without further adieu, here are the tests that will be run on Mr. SB and I - in list form because even though I'm not a Type A, I feel as though lists give me a handle on the chaos that is my infertility.



1. Seman Anaylsis
I questioned this one because hey, I'm able to get knocked up so why do we need this? They explained that sometimes an abnormal sperm will fertilize the egg and because of the abnormality, it will result in a miscarriage. They will take Mr. SB's sperm and do what they call a swim up (I laughed out loud at the name of this...Hi, I'm apparently 13). If some are abnormal, they will take the normal ones and do an IUI with me.

2. Glucose Intolerance Test
Because of my PCOS, they want to test my insulin levels beyond a simple blood test. Apparently my blood tests were on the higher side of normal (ummm did I mention that no one told me this?!), so they want to take it a step further. I'm excited because I get to drink that big sugar drink (I'm a sugar fanatic. Fun Dip is my BFF).

3. A round of antibiotics after my period
In case there in an infection, this will clear it up. Therefore, eliminating this possibility.

4. Estradiol, FSH and a Transvaginal Ultrasound on day 3 of my cycle.
Shockingly enough (please note sarcasm), my old OB did not test me for these on the correct day of my cycle, so they will need to be done again.

5. HSG
This was questioned as well because again, I'm able to get pregnant. The doctor told me that maybe only one tube would be open. I'm still wondering if I want to do this or not.

So this is where we go from here. During the appointment, it crossed my mind that hey, maybe this guy is preying on my infertility. So because I am never the one to sit out the sidelines (or shut my mouth), I called him out. Probably not the best thing to do since this will be the guy that will be poking me with needles, but I've never been the quiet, shrinking violet and I wasn't going to start now.

And what he said made sense. He said that I came to him to get answers, and he wants to test me for everything he thinks could possibly give me those answers. I accept this explanation.

So, if all comes back well, we start back on Clomid with Progesterone supplements and baby aspirin. This also satisfies me, as I have been pushing for the progesterone supplements with my old RE after M/C #3. Further down the line, if things still aren't working out, they will do IVF with hand-selecting the embryos.

I'm happy to have another plan of action, but still in the back of my mind I'm wondering if I am being taken advantage of. I'm opening the floor to your opinions. Let me know if you think this guy is being thorough, or just trying to get more money from my insurance company.

DOA?

No, just DOR. Official diagnosis in my charts of Diminished Ovarian Reserve.

My FSH came back at 10.2. My RE had hoped that the level was high from my last test due to the cysts on my ovaries. But apparently, that wasn't the case. I've got grandma eggs. After everything we've been through to "fix" me, I'm still stuck with the same predicament. Expensive treatment.

I just sat in our ladies room at work (don't worry, there are couches and comfy chairs in there so I wasn't on a toilet or anything!) and cried for the longest time. I just can't take much more of these hits. "You're broken." "You're fixed!" "Ooops sorry, you're still broken."

So we meet with the RE on the 24th to plan the next cycle. He wants to see my next 7dpo bloodwork to check my ovulation before deciding what I will go on.

The nurse said it will definitely be injections because of my age. No IUI though because we don't have sperm issues. We're looking at around $2,000 a cycle.

I'm really starting to feel defeated.

And so I watch another month wasted while I wait to see the doctor.

Go directly to testing, do not pass Go, do not collect $200

After only have some breast tenderness and not my normal pre-AF cramping and no holds bar bitchiness, my confidence in our work for cycle #6 was on the upward swoop. I was even beginning to think that we would actually have something to celebrate this weekend...silly rabbit. CD 10 brought a temp below my coverline (BAM) and CD 11 brought another fairly low temp even though I slept horrible (BAM) and CD 12 starting with spotting (BAM BAM). By noon, I realized that is wasn't CD 12, but really CD 1 of cycle #7. Now I know 6 months for a 26 and 25 year is not unheard of or even considered IF, but I was getting concerned. I never really had luck with OPKs. Yes there are positives in my chart, but except for one most were almost positives, an itty bitty sliver of the line may or may not have been slightly darker than the control. Also many of these "fake" positives occurred after my thermal shift. I was determined to be proactive.

I spoke to a nurse at my OB's office this morning and went through the whole explanation. I just got off the phone with my OB's recommendations. Ready for them?? I have to have CD 3 blood work tomorrow to look for FSH levels and then need CD 20 blood work to look for progesterone levels. She also wants me to continue using OPKS (even though I switched to CBEFM last month) and if/when I see a positive, we are to have sex that night and the next. Can I start tell DH I got the positive now, so we can have lots of sexy time this month??

I also outed us to my mother. I wanted to see if she wanted to go out for lunch after my bw since I will be right by her work. I basically broke down on the phone, but it felt good to tell her. I have been wanting to talk to her and get her support, but I can't help but feel like I am letting her down. I am her only child who is even considering having children and we aren't doing a very good job at it.

On that note, I am going to end this post before it morphs into a pity party. I just have to keep reminding myself:
1) a June baby is perfect for us which means conceiving in September
2) I can enjoy my friend's bachelorette party next Saturday
3) I won't be pregnant at her wedding
4) I may be able to ride all the roller coasters in Disney in August
Most importantly, 5) I am happy, financially secure and am married to my best friend.

I will update you ladies when I get the results!

Be careful what you wish for.

Disclaimer: There are no pictures in this blog entry. I didn't write this to entertain. I cried almost every second I was typing. This isn't about being bitter, this isn't about being sad, and it most certainly isn't about trying to make people feel better about what we're going through. This is about life. Real hard honest painful unfair life. If you're looking for funny pictures and entertainment, you're going to have to look elsewhere.

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Be Careful What You Wish For

When we got our male factor diagnosis, I cried. I told my husband that I would rather have something be wrong with me, so this didn’t have to be on his shoulders.

What an idiot I was.

Since I was a young teenager, all I have ever wanted in the world is to be a mom. All I have wanted to do is to take care of my babies. Raise them and have the best family I can have.

Now I’m 34 years old… and I’m being faced with the possibility that we might never have that family.

3 weeks ago, I found out that our first IVF cycle failed. I knew that I didn’t respond the way they thought I might. I knew that our embryos were pretty sub-par. But I also KNEW that I was over-suppressed from the lupron. I KNEW that with a different protocol, I would respond better, and my eggs and subsequent embryos would kick ass.

Dr Z had other ideas. Half way through my stims, he became convinced that I had diminished ovarian reserve (DOR), AKA really old sucky eggs. He said that if this cycle didn’t work, he was going to do some additional testing.

But I KNEW it wouldn’t be necessary.

I was so wrong. About everything. And as usual, Dr Z proves why we picked him as our doctor.

The tests came back. My AMH is 0.5. That sucks. It worse than sucks. It’s sucktastic.

He says that he's not ready to throw in the towel YET. He likened my ovaries to a baseball team. He said that I have the players, but it was difficult to tell what condition they might be in, and how many might be on the bench. I said, "Great, I'm the New York Mets" (and honestly, after being a Mets fan for my whole life, I should be used to the disappointment).

Dr Z said now that he knows what the problem is, he can treat me more appropriately. He said my ovaries are a lot older than I am... probably about 42 or so… and now he has to treat me like that. He wants to see how I respond to a new protocol (my nurse should be calling me later today with details). But he also said that if this next cycle doesn't work, his recommendation would be donor eggs (DE).

My husband and I had already had a LONG talk the morning before we spoke with Dr Z about where we were going to draw the line. I finally know where he stands with all of the options, and I'm relieved about that. He's okay with DE, but not donor sperm. Okay with domestic adoption, but not embryo adoption.

We won’t move on to DE until we get a second opinion. So, if IVF #2 fails, we plan on probably getting two second opinions: one at Colorado Center for Reproductive Medicine (CCRM), a leading center for ART, via phone consult and another at a leading medical center in Manhattan. Following those, we'll probably be moving onto DE.

However, DH is convinced that now that we know about these issues, IVF #2 is going to work.

I'm going to start acupuncture again, start seeing a chiropractor and we're going to try to go to an infertility counselor, because i'm really depressed. The IVF not working was bad enough - now I’m a devastated mess. There hasn’t been a day without crying since I found out. I don’t know how much more I can take.

There’s no question now that I’m in good hands. Dr Z clearly knows what he’s talking about. I can't imagine many people would have looked at me last cycle and said DOR. I thought I was just over-suppressed, but he saw my response and said, “Look, even with your normal FSH and normal antral follicle count (AFC), something is wrong here. This isn't because of medication. We need to run more tests.”

He was right. I hate it - but he was right.

He also said that my blood work came back positive for the genetic mutation MTHFR. I’m going to find out exactly which mutation tomorrow, when I get copies of my blood work. Dr Z says I don’t have to take any blood thinners, but he has me now on very high dose folic acid. I’m taking a total of 5mg daily. He says that he needs me on it for 4 weeks before we can try again, so we can still plan on cycling for March. I’ll have to continue taking the high dose folic acid as long as we’re TTC or pregnant… which right now feels like the rest of my life. Another complication of MTHFR is elevated homocysteine levels. However, my homocysteine levels are normal.

I’m sorry that this was so long. It’s all the information I have. I feel like all of my dreams are slipping away from me. It’s very easy for people to say “oh, it’s not bad news” and “oh there’s still hope” but this is the end of the world for me.

I’m 34 years old and my eggs are crap.

The worst thing about this is the not knowing. In the beginning, my evaluation was normal. Every single part of it. Dr Z says these tests are really expensive and the insurance companies won’t pay for them unless they can be shown cause, which the failed IVF cycle gave us. I wish we had known about this 2 months ago. Or 7 months ago when we went through our initial testing.

And I hate what this has done to me. EVERY girl I see whose only diagnosis is MFI, I think to myself “that’s what you think” or “for your sake I hope so”.

Because up until 2 days ago, MFI was my only diagnosis too… and I had all the hope in the world.

Now it will be a miracle if I can even use my own eggs.

From the top to the bottom in one phone call.

Be careful what you wish for.

Guess who is a big fat failure?

FUIF

My doctor called us late this afternoon. He said he didn't want us to have to wait for an appointment to discuss the cycle. He asked if my husband was there (he was) and asked to be put on speaker so we could all talk. He stayed on the phone for almost 40 minutes answering all of our questions and giving us the next step.

He's concerned about why my ovarian response was what it was even with the good Antral Follicle count (15) and FSH (5.97). He thinks because my ovaries responded really slowly (i didn't really respond until stim day 11), that there's reason to be concerned about the overall health of the eggs themselves. He called the possibility "Advanced Ovarian Age".

Additionally, he's also concerned about the lack of implantation, so between that and the questionable egg health, tomorrow i'm having a RPL panel done (b/c he wants to do the genetics and the clotting factors) and an AMH.

He said once he gets the results back, we'll be able to plan the next step for changes in my protocol, etc.

Meanwhile, i can expect the worst period of my life to start in the next couple of days. When I asked him if I should expect it to be heavier than normal, i heard him flipping through my chart and he says ," um your lining was 16. Yeah."

He said that he takes my lack of pregnancy very personally and he IS going to figure this out.

He said that the AMH will tell a lot.

Personally, I think i was oversuppressed on the BCPs and Lupron and that all of this will come back normal. I mentioned that to him, and he said that either way, i won't be on lupron next cycle, and he'll most likely start me out at max doses of stims, because he'd rather rev me up and coast me, than barely make it to retrieval like this time.

I guess we'll see.

This is the hardest day I've ever had. I've spent most of the afternoon in tears. Thankfully my husband has been here and my sister just brought me some dark chocolate.

I don't know how long it's going to take me to get past this and move on, but I DO feel a little bit better having a plan.

A non-Infertility part of our plan is that I will be getting a new job. I've applied to Bayada to do pediatric home care/visits, and with any luck, i'll be able to start there in the next couple of months. It's not what I really want to do, but we've decided that I have to reduce my stress level before starting my next cycle. my 3 major sources of stress are school (can't be changed), infertility (unfortunately, can't be changed) and work.

Work is the only thing I can change - so it's game on.

I'm hoping when it comes time for our next cycle to start, we can time it so retrieval/transfer will fall between jobs, so I don't have to worry about the time off.

I know this was really long. If you made it this far, thank you. If you have any thoughts, thank you for those, to, in advance.

The penguin is very very sad.
photo credit

Big Test Tomorrow Morning.....

Tomorrow morning I will be using the First Response Fertility Test after a few sketchy cycles to determine once and for all if I am just crazy-bad at temping.....or if God-forbid, something might be up. Obviously the test is not comprehensive, but it will be a good starting point. I am excited, but also a little scared. Basically the test checks FSH level to determine the quantity and quality of eggs, thus an indicator of a woman's ability to get pregnant. I am hoping and praying that tomorrows test will have a positive result....I just want to know that when we start trying in a couple months, that we at least have a better idea of my ability to conceive. That way if there is a problem, we know where to start.

Maybe it is too early to worry.....maybe I am jumping the gun. But the more I think about it, the more I realize that I want to be as proactive as possible now so that when the time comes to TTC, I am as informed and knowledgeable as possible about what is going on with my body. I will post results tomorrow.....keep your fingers crossed that all is well!

Day 3 and S/A test results

This is a follow up to my day 3 post found here! I have received the results from my bloodwork!!!  It's all good news too, so let me get started.

So as noted before, I had the following tests:  AMH, FSH, Estradiol and LH all tested.

Here are the results:  For the AMH, which to me, was the most important given the age factor, came back with a 3.9 and the RE likes to see 2.5 or greater, so I'm great with that test!  {Huge sigh of relief}

My day 3 Estradiol came back as 29 and the doctor likes to see it below 80.

My FSH came back as 6 and the RE likes to see it below 8.

As for the ultrasound results, I posted here but my resting follicle count is 20 on the right side and 10 on the left side. The RE likes to see at least eight with both ovaries combined.  So I'm well above that which makes me so grateful and relieved.

The S/A results are back and although I know the results, I won't post them just yet until I can read the results and the explanation.  I will say this, there is a minor issue with the morphology but I've been told and understand that it's not a HUGE issue.  Also, the count and motility were great!  More on the S/A results later.

My next post will be about the HSG.

Until then,
Sunshine Bud

Taking the Emotional Leap

Mr. Sunshine Bud and I have put all we have, and then some, into making a baby.  I've devoted months to charting, we've spent plenty of time BDing and we've experienced the emotionally draining ups (time to test again) and downs (it's negative, once again!).  We have done absolutely everything we physically can, to conceive on our own.  Emotionally, I was and yet, I wasn't, ready to get help.  I have had to overcome this emotional hurdle, so we can begin seeking the help we now need.  I had to realize, the sooner I begin seeking answers and possible treatment, the sooner we'd have the baby of our dreams.

Wednesday (9/30) was the day that I've known would come.  We met with the RE to figure out what the issue may be and to take the next steps in the journey to conceive.  I wanted to cry but NOW I'm fine.  We have the beginning of a plan as I've outlined below.

The plan for me is:  I will have blood work taken on day 3, which will test for FSH, Estradoil, AMH & LH.  Then between days 1-5, I will have an ultrasound for the Basal Antral Follicle count.  Finally, on day 6-12, I will have an HSG performed.

The plan for Mr. Sunshine is far easier.  He will have his SA completed on Oct. 7th.

Since AF started late last night, I will call and set up my blood for CD3 today.  This test will determine my ovarian reserve.  This is done by measuring my "day 3 FSH".  FSH or Follicle Stimulating Hormone is the all-important hormone that signals the ovary to release an egg.  The fewer good eggs (and good follicles) left, the more FSH is released.

By measuring a baseline FSH on day 3, my doctor can get an indication of how close I might be to having fewer and less viable eggs.  And THAT is just scary, but I'm over it.

The AMH or AntiMullerian Hormone is also used to determine ovarian reserve in older women (isn't that nice - they just called me old!).  AMH levels reflect the number of follicles present in the ovaries and can estimate how close a woman is to menopause!!!

Well, that's all for this post.  My next post will detail the ultrasound and HSG.

Until next time,
Sunshine Bud