Tuesday, September 8, 2009

Secondary Infertility: First Doctor Appointment

First step: Done! Today I met with a fertility specialist for the first time.

Holy nerves, Batman! All morning I was a mess, anticipating both the best - and the worst - of what could've come from today's appointment. I didn't answer my phone, I didn't call my mom or my husband to speculate about what the appointment would hold.

Instead, I spent the morning (a) having a long - and tear-filled - conversation with God and (b) taking Super Dog for a good long walk to clear my mind and calm my nerves before showering and heading to the appointment.

Still, when I sat in the consultation room first meeting with a resident to go through my history and prior test results and then waiting for the doctor to come discuss my options (praying that he'd use the plural and not the singular - or worse), my palms sweat and my heart pounded while my lungs would not fully inflate. That's always fun.

When at last the doctor came in, I found him to be not overly warm, but definitely focused and straight-forward, which I appreciated. And here's what he said.

A large chunk of what may or may not come hinges on the results of one particular test: the FSH test. It's a test I've had twice before: first, in '01, the year before I conceived Super Boy, and second, in July of '06, a few months after we started trying to conceive a second time. Both times I had this test, it was to determine whether or not I had gone through premature menopause because, as you might recall, my mom and paternal grandmother both went through it very early, which may have a significant impact on my own fertility. Anyway, I'll be repeating this test early next week.

Assuming, that is, that my fickle reproductive system didn't suddenly decide to WORK knowing that my visit to the fertility specialist was imminent! Apparently this doctor has had that happen with two patients in recent months. Here's hoping I'm the third! We'll know this weekend, as my period is due on Saturday. (Wow, aren't you glad you know that about me? Don't worry - I'll wait while you go bleach your brain. ... Good? Okay, let's proceed.)

FSH, for those who are not well-versed in the language of infertility, stands for "follicle-stimulating hormone." FSH is a hormone found in the blood that helps control a woman's menstrual cycle and the ovaries' production of eggs, and hits a peak each month just before a woman releases an egg from an ovary. It also helps doctors determine a woman's egg supply, or ovarian reserve.

I'll need to have this blood test on Day 3 of my cycle. What we want to see is a number that is no higher than about 10-12. If the number is greater than that - specifically if it's a LOT higher than that, then we might be at the end of this journey to have a second baby short of trying IVF (in vitro fertilization), which we've decided we aren't going to pursue. If, however, the number is less than about 12, that's a GOOD sign. (This, obviously, is what we're praying for.) The doctor also wants to check my prolactin level, which seems to be the one blood test my regular OB/GYN did not order over the past few years. I think this will be done at the same time as my FSH.

If we end up with the GOOD FSH result, then the doctor will next do a Clomid challenge. This means that I'll be put on oral clomiphene citrate for about four days in the hopes that the medication will stimulate my ovaries to release a few good eggs during ovulation. Next, the doctor will re-check my FSH level at Day 10 and, assuming my level looks good, will then try IUI, otherwise known as "intrauterine insemination."

Think turkey baster! Well, not quite a turkey baster - more like a syringe filled with a "cleaned" concentration of Super Man's swimmers that will be injected straight into my uterus, bypassing the usual cervical route and giving the guys a better chance of hitting their intended target (... or targets!).

Yes, that's correct: The procedure could result in multiples. The doctor said it happens in about 7% of cases, with the majority of those being twins. Frankly, I'd be okay with that. I always imagined myself having three or four kids but Super Man and I agreed on two when we met and got married, because he already had Super Girl. So, if we end up with one more than we hoped to have, it's far better than the other alternative of NO more, and it's just an added blessing in our book.

One potential snag in the plan - aside from my FSH level being high at the Day 3 test - is the uterine fibroid that the radiologost found during my HSG (hysterosalpingogram) back in June. The radiologist said it was "small", but neglected to take or provide measurements on his report of the procedure, so the fertility specialist wants to take a better look at that by way of a hysterosonogram (a trans-vaginal ultrasound of the uterus following the injection of saline into the uterus). That will take place late next week or early the following week.

Apparently fibroids can interfere with conception if they're of a certain size, and depending on their location. If after the hysterosonogram the fertility specialist wants to remove the fibroid to improve my odds of conceiving, the IUI may be put on hold until next month so I can have surgery (laparoscopy) to remove the fibroid first.

That's all of my required tests/procedures, but Super Man has a little work to do, too. Although, as you might imagine, his "work" is slightly more fun than mine! ;)

Super Man has to provide a new "sample" later this week so they can verify the results from earlier this year (which were analyzed by an outside lab, not their own), and then - assuming all checks out as expected and he really does have Super Sperm - he'll have to provide another "sample" when they do the IUI. His good swimmers will then be separated out from all the other junk and injected straight into the Promised Land, where they will hopefully accomplish their intended purpose. So, yeah, the dude TOTALLY got the easy end of this deal! ;)

I can't tell you how relieved I am at this moment. I realize that this is not the end of the journey; and for that, I'm truly grateful. I'm just glad to know that we still have reason to hope. I tried my best to prepare myself either way, and we may still come to an unwanted end of the road. But that didn't happen today. And I'm so very, very glad.

Peace and love,
Super Woman

7 comments:

  1. Yay Amy! I'll be thinking of you for the next couple of weeks and I'm sure you'll be updating us. As for your Super Man, well, I'll be trying NOT to think of him, at least later in the week ;-) Cause we ALL know what he'll be doing! LOL! Good luck with the whole deal--I'm sure it's gonna come out with a happy ending, however it is that happens. Much love being sent to you guys,

    Nancy

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  2. Take a deep breath, you've made it through the day. I've had that type of doctor appointment...I always hope they won't take my blood pressure knowing that it will be sky high and not accurate. It sounds as though there are some options, every avenue will be explored. Hang in there, I'll be hoping for the best.

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  3. Amy, I am glad to hear that everything went well today. I think we talked a few weeks ago about my concerns for my own fertility. Well I went to see my doctor last weel. I too went through the nerves and sweating etc. before my appointment. I was told that I have anovulation. That means that I don't ovulate on a regular basis. I will be started on Clomid as well. I have to wait 14 days and take a pregnacy test before I can sart the meds. Yes that means no sex for 14 days! Anyway, maybe things will fall into place for both of us real soon. I will be thinking of you often! Jodi

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  4. Thanks for the support, ladies!

    And, Jodi - I'm totally keeping you in my prayers, too. Whatever baby dust I might have, I'll gladly share it with you!! Keep me posted on your process with this, too, ok?

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  5. Thanks for sharing Amy. I truly wish you the best of luck on your current journey. Your faith in God and loving family will definitely help to guide you through the ups and downs (hopefully more ups than downs!) of your upcoming challenges. If kids are meant to be brought up in a loving and caring environment, then I can't think of a better person to be blessed with a larger family.

    Scott

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