Tuesday, September 22, 2009

something new

I learned something today that I didn't know before, despite the fact that the subject has been of increasing importance to me since about the age of 27.

Why 27? Because that's how old I was when I had my FSH (Follicle Stimulating Hormone) level tested for the first time. And I had it tested then because of my family history of premature menopause. See, Super Man and I planned to start trying to conceive the following year and I had spent the prior 12 years on the Pill, so my OB-GYN and I wanted to be sure I hadn't gone through premature menopause, the symptoms of which would've been masked by the effects of the Pill.

I've known all along that FSH is one of the best predictors of female fertility, but I didn't really understand what the numbers meant. When I had my first test at 27, I never thought to ask what my actual number was, only whether it was "normal" or "abnormal." It turned out to be normal (and, thus, we conceived Super Boy several months later). I didn't give it a second thought again, until we started trying for another baby.

I'm not sure what my FSH level was when I had it tested back in 2006; again, I only heard that it was "normal." Again, I didn't think much about it, because I thought that was sort of all set.

It's only been going through the process of a Clomid challenege that I've really started wondering WHAT DO THE NUMBERS MEAN?!?

My Day 3 result was 7.8, which my fertility specialist said was great, as they like to see values less than 10.2. I took Clomid from Friday of last week until yesterday (Monday), and had another FSH test - Day 10 - this morning. The result today was 7.4, and again, I was told that this was "great," and "exactly what we wanted to see."

But I didn't understand WHY this was great and what they wanted to see, so I asked. The nurse told me that the whole goal of the Clomid is to drop your FSH number by a few tenths of a point. They would've been concerned if it had stayed the same or gotten higher, but a drop is exactly what they wanted to see.

All of a sudden, this lightbulb went on in my head and I asked the nurse if a woman's FSH level steadily increases through the course of her life. She said yes. So now, of course, I'm wondering what my 2001 and 2006 levels were! I'd love to see how much lower my FSH was, especially in '01, to really get a sense of how much my fertility has declined in the past 8 years, from 27 to 35.

And it also occurred to me that the goal of the Clomid - in a way - is to cause your body to act more like it did during a more fertile time. Almost like turning back the clock just a tiny little bit. While the net effect was only .4, that could make all the difference in the world. It could cause my ovaries to release that one extra mature egg that will make the difference between me getting pregnant and me NOT getting pregnant. It's staggering, if you think about it.

It's frustrating though, because I'm trying to find some information on the Internet showing what "average" FSH levels are in women of different ages (say, from onset of menstruation through old age), but all I'm finding is that a result less than ___ (my doctor uses 10.2, but others say 9, and some even say 12) is normal, and then they talk about the approximate FSH levels based on the different "stages" of reproductive capacity. In a nutshell, by the time a woman starts menopause, her FSH levels will be around 30, and that will increase to a level that eventually tops off somewhere between 50 and 70, when menopause is complete. I never knew that bit of information either, so I guess I learned TWO things today.

I guess what I'm trying to say is that this business of assisted reproductive medicine is a whole lot more complex than I ever imagined. Sure, specialists do a lot of different test and ultimately what matters is a result of "normal" versus "abnormal," but it helps to understand the actual numbers and to get a sense of the big picture. And FSH is only one part of the equation; other hormones like LH (leutinizing hormone), progesterone, estradiol and prolactin also have their own impact on fertility. For my purposes, those numbers all look good for me, so that obviously makes me pretty happy. I just hope that it's enough to lead us to another baby for our family.

Next steps for me are as follows:

TOMORROW: Hysterosonogram to check my uterine fibroid AND I start using the Ovulation Predictor Kit. Assuming all is okay on the fibroid front, we move forward. If my fertility doctor feels that the fibroid has to come out, then the IUI is put on hold until next month and I schedule the fibroid removal surgery instead. Here's hoping it's the former and not the latter, as I'd hate to see this put on hold now that we've come this far!

THURSDAY: Day 2 of the Ovulation Predictor Kit.

FRIDAY: Day 3 of the Ovulation Predictor Kit AND a mid-cycle ultrasound to see how many egg follicles - and, specifically, mature egg follicles - are developing. That will help them assess whether the IUI is likely to succeed and whether my body is ready for a shot of hCG (human chorionic gonadotropin) to force ovulation to occur the following day. If the follicles are ready, I MAY get the shot and then we'd have our first IUI (intrauterine insemination) procedure on Saturday. If the follicles are not ready, then they'll give it an extra day or two, MAYBE give me the shot of hCG and then do the insemination the next day.

About the hCG shot: I really don't like to take any medications that I don't "need," so I'm hoping that my Ovulation Predictor Kit will indicate on Friday that my LH surge is happening the following day so that I'm ready for the insemination on Saturday WITHOUT needing the shot on Friday. That said, if I forego the shot on Friday and still don't have a smiley face on my Ovulation Predictor by Sunday, I'll have to get the hCG shot on Sunday and we'll have to do the IUI on Monday. And that will be a "must" by that point because Super Man has a business trip early next week and we could miss the very narrow window if we wait for me to ovulate naturally. We don't want that to happen!

SATURDAY or SUNDAY or MONDAY: IUI

So, whenever I actually end up having the IUI done, that's sort of the end of the action. And then... we wait.

Two. Long. Weeks.

I think I'm going to have to do some SERIOUS fall cleaning and purging and reorganizing during those two weeks to keep my mind and body occupied while I wait. Otherwise, I'm likely to drive myself and everyone around me bonkers. (You know it's true.)

Keeping my fingers - and everything else - crossed that this all goes the way we hope and pray it will. Will keep you all posted. And hey - thanks SO MUCH for all the support. Whether we have another baby or not, we are so blessed.

Love,
SW

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