We’ve got black circles!

Did the Letrozole work? Are we ready to make a baby? We will find out.

Day 9- OBGYN Ultrasound

I walked into my OBGYN office with confidence that we were going to have plenty of follicles growing and was actually a bit scared we would have too many and Dr. G would advise against us trying this month.

The tech started out measuring the uterine lining, 7.5mm, wahoo! It’d gone up, without any help from the Estrogen patch.

That’s great!

Then the left side- lots of black circles on the screen.

The tech counts 3 follicles, wahoo!

cyst or follicle.jpg

Now we are talking. One of them looked like it was within the string of pearls often associated with PCOS but she counted it anyway.

The largest follicle on that side was 9mm, so still pretty small, but a good start.

On to the right side- 3 follicles, get out! 6 total, wahoo!

Now we have some contenders with the largest on this side being 10mm.

I’m feeling pretty good, although a little surprised they weren’t larger after being on this different medication.

I have the tech fax over the report to CCRM and wait to hear from them.

They didn’t get the results.

Ugh, seriously!

I call the office and have them resend.

It takes a few hours for a clear copy to go through.

Lesson learned: take a copy of the report with me to scan and send myself.

Why are dr. offices using fax these days anyway?

It’s now late afternoon and I’m getting impatient. What will the doctor have me do?

I get a phone call, it’s my sweet nurse Gina. She has the kindest voice, so soothing with a bit of chipper on the end. It’s as though she has a smile on her face as she says every word.

Dr. G wants me to do 3 more days of Letrozole, 2 pills each.

Got it.

Recheck in 4 days, done!

Well… at least there’s some forward movement.

I relax. Everything will be ok.

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Part 2… Round 1

GST-674-07-770x300.jpgHere we go… round 1 with CCRM.

Blood Draw

Before Dr. G can prescribe the Letrozole, I have to go in for a blood draw to confirm I’m not pregnant. I find that to be ironic or funny.

A piece of me hopes that I am, that we don’t have to go through another round.

Wouldn’t that be amazing to receive the news that they can’t prescribe the medication because I’m already pregnant!

A girl can dream.

Confirmed: not pregnant

Ultra Sound

I then need to go in for an ultrasound to ensure I don’t have any cyst that would ‘eat’ the medication.

Confirmed: no cysts

Side comment: the technician did ask if I’ve heard of PCOS before because I have cystic-type ovaries.

… Funny.

Letrozole

Here we go!

Medication: prescribed

Dose: begin taking 2 pills daily for 7 days.

I understand the side effects to be different than Clomid and am hoping that my face doesn’t break out like a pizza and my skin doesn’t hurt like a stuffed sausage.

That was painful and uncomfortable.

Intrigued by the hope of Dr. G, I proceed with hopeful caution.

Hubby is a bit more skeptical as he recalls our OBGYN being just as optimistic.

I guess I just can’t get stuck in the weeds of the ‘what ifs’ and will choose to take it one day at a time, one dose of medication at a time.


Day 6-

The medication hasn’t been too terrible. Actually, I haven’t seen too much of a change except my energy level is a bit low. Praise God that’s all it’s been.

I’m a bit nervous that the medication hasn’t done anything for me because I haven’t had cramps or pains in my lower abdomen and just hope and pray that things are still reacting even though I can’t feel it.

We will wait until day 9 to visit the doctor for a second ultrasound. This will be the indicator as to the reaction to the medication and also where we will learn our next steps.

I am grateful Dr. G has not outlined every step for us as I was too caught up in counting days and plotting out our next moves.

I literally can’t do that this time around. I just get to live in this day, this moment.

God, I trust you and believe you know the timing for our growing family.

And the Dr. Says…

Unfortunate timing as our doctor was out of the office for a week after our lab-work and then booked the following.

…. so after a much-anticipated wait (haven’t I heard somewhere that patience is a virtue?), we have had our follow-up appointment with Dr. G. to find out more about our lab results and hear what he thinks our next steps are for treatment.

No surprise, Hubby’s swimmers look great and the anti-sperm antibodies are negative. No issues on his end and I’m extremely grateful for that.

As for me, here’s the list I can recall-

  • THS- normal
  • Uterus- normal
  • Egg quality/ quantity- normal
  • FSH- normal
  • LH- REALLY HIGH
  • Estrogen- normal

DRUM ROLL….

Conclusion: NOT hypothalamic amenorrheaCB064019 and NOT PCOS (although some of the symptoms and criteria fit with PCOS such as high LH, my testosterone levels are not elevated).

Is this good news?

For the most part, it is. Grateful not to have either of the two but where does that leave me? Somewhere in the middle, Dr. G says.

Diagnosis: Anovulation, not otherwise specified

Treatment: Get me to ovulate!

Dr. G. pretty much nailed my concern. Regardless of what we call my ‘condition’, the bottom line is we just need to get me to ovulate and Dr. G feels all the rest will come together.

He’s positive because I should respond to the medication because I don’t have hypothalamic amenorrhea and because I responded to the Clomid over the past several months.

I’m feeling pretty good about all this news. There isn’t anything major going ‘wrong’ in me, it’s just a matter of helping my bodywork.

What about the Heart shaped uterus?

Dr. G isn’t concerned. Wait, what? That’s great news.

Although on the HSG it looked like a septum, the 3D ultrasound, which is much more accurate, shows a mild arch and nothing needs to be removed)

No surgery necessary!

Wahoo! Grateful, grateful, grateful.

Treatment-

  • Begin on Letrozole. This will be used to make more FSH (to increase eggs)
  • Start with the midway dose which will mean I will take it for 7 days
  • Look at follicles and lining and then trigger
  • timed intercourse (IUI won’t be necessary at this point, Hubby’s happy)
  • Test for progesterone levels (add suppository if necessary)
  • Add estrogen towards the end of cycle, if needed to thicken the lining

Dr. G wants to do this with 3 successful ovulatory cycles. If we are not pregnant, he will then up the dose and add IUI.

Breath of fresh air… this is good news!

Lab Rats

Laboratory-malpractice-Maryland.jpgIt feels as though we are lab rats.

Hubby and I both went to CCRM for a morning of tests that will give Dr. G more information about the two of us and what might be the best course of action to take.

Starting with a urine sample to ensure I am not pregnant, I sort of thought it would be such a fun surprise if they came out and said, “well, we have bad news and good news. The bad news is that we will not be able to do any testing this morning and the good news is you’re pregnant!”

They didn’t.

I proceeded to have a Baseline Ultrasound ($400) where everything looked better than I expected. My uterine lining is thicker than normal and I had 7 follicles in one ovary and 8 in the other! The technician thought I was mid-cycle, pretty cool!

Not sure what that means for us though.

I then was pricked for a blood draw to test: ($555).

Hubby went for his test to see if he has any sperm antibodies that might be hindering the “egg search” ($117).

Then I was taken for my HSG, where they shoot dye up into my uterus and see it move through the fallopian tubes into the ovaries and then out into the body. I was able to see it on the screen as the dye was being injected and sure enough, it spread throughout just as it is supposed to. It was not as painful as the FemVue (the bubbles) I had done 6 months ago, just uncomfortable with minor cramping.

Here’s what I learned:

  • The uterus flips and flops on a regular basis and so today mine was tiled upside down essentially. The technician was not concerned as she sees them flip and flop almost daily.
  • I have a heart-shaped uterus (either a partial septate or bicornate uterus). Today it looks more like a “Y”. This is a bit more concerning.bicornuate_uterus.jpg
  • If Dr. G feels it’s too deep of a “Y” then there may need to be a surgical procedure before moving forward with any medication. A normal uterus is more of a triangle shape at the top with a stick coming out the bottom.

So either:

  1. We move forward with medication as Dr. G is not concerned
  2. Dr. G will want a closer look through a hysteroscopy (where he looks through a microscopic camera) to get a better look at what’s causing the “Y”.

It could be the way my uterus is formed, increased cells gathering or some mass resting on that part of the wall. With a Bicornate uterus, there are greater chances of miscarriage, breech birth, higher deformities and disruptions in the in-uterine development, and possible automatic C-section during birth.

Yuck, I do not like this news.

I am not going to get too wrapped up in the facts and details until I talk with Dr. G. Although it would stink to have to go in for another test procedure, I’d rather know what we are dealing with to ensure a healthy, safe home for our baby to grow.

Today, I go in for my annual OB-GYN appointment and get a full head-to-toe exam plus some more cell gathering and an additional blood draw.

Our follow-up appointment with Dr. G. to understand what’s going and the next steps won’t be for another few weeks (busy man), but I’m ok with that. Give me a chance to work on other things in my life and practice faith in God and what He’s doing and trusting in His timing.

Besides, I need a break from all this prodding and poking!

Crunching Numbers

images.jpgComparing prices between the various fertility specialists in the area.

What will be the best route for us to take?

Trying to get the best care for the right price is time-consuming. My old self would have just gone with the most reputable name in town and said yes to all their recommendations for testing with them.

After doing some additional research though, I can see that if I do some testing out of a different lab, we can save some money.

At one place a test can be $250 at another it can be $100. How can these tests be the same but be marked up so much? Are these prices founded on anything in particular?

We are essentially self-pay as we don’t have insurance. Instead, we are a part of a healthcare sharing group, co-op type, Christian Healthcare Ministries. It’s pretty cool that this is available, especially for people who are relatively healthy. Downside: it doesn’t cover fertility treatments. If we received insurance through my work or Hubby’s work, we wouldn’t have fertility coverage so we are surrendered to being self-pay. With that comes certain discounts, if you ask, which helps a little.

Gosh, it can be expensive though.

…God, I trust you.

It’s hard for me not to get upset and resentful towards those who are able to get pregnant without having to pay. Where it just happens naturally.

But I don’t go there with my thoughts. I am grateful for the medical studies that give us these options. In previous generations, we would just have to accept our childless family. At least we have these options today and for that, I feel blessed with the opportunity to walk down this path.

I do believe that God provides what we need and it’s all a matter of how we allocate the resources He gives. I pray that we are good stewards of His gifts and that we will continue to seek guidance as to which way to go and what steps to take.

Today, I am gathering information so that we can make a decision-based in facts, mixed with faith.

There is a twinge of impatience stirring inside. I don’t want to have to wait on doing all these procedures and tests before we get this next round of medication rolling. I feel anxious about waiting as I am getting caught up in the timing of when we would start vs. when the potential baby would be due. I am hung up on certain dates and seasons that I want to avoid.

Honesty moment

We already have multiple family birthdays in December, plus Christmas and New Years that I don’t want to have a baby during the holidays.

I know I know, I shouldn’t be picky. But if I get to ‘choose’ when to start this medication that will potentially enable us to become pregnant than I feel I have a little control over this.

I laugh because that’s what I said last June when we started the fertility treatments, not wanting to get pregnant to be due during certain months… and look where we are now, not pregnant.

What have I learned, that I can’t control even when I think I have a little say in what happens. I don’t. I like to pretend that I do. Maybe I do, but do I want my will of what I think I want in the timing I think I want it to be, or do I want what God wants for me? It may be harder to live by faith, but there is more peace.

God, I surrender this to you too.