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!

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.

CCRM Consult

CCRM-Logo_vector_OL.pngWe had the pleasure of meeting with Dr. Gustofson at the Colorado Center for Reproductive Medicine (CCRM) for our fertility consult. He was an absolute delight. We first were welcomed by the front desk helper, who was very cheery and escorted back by a nurse who was kind. Dr. G walked in with a spring in his step and an energy that enabled me to feel comfortable and welcomed.

We talked small-talk for a little bit, getting a feel for his personality which was a delight. Dr. G comes highly recommended by a couple of my friends, so I threw their names out there to make more of a connection.

Funny enough, the friend who told Daniel about me is also a patient of his so the connection feels a little more complete. He was personable and engaging. I immediately felt as though I was in good hands.

He opened a binder of labs and records, all which looked as though they had been combed through with flags coming off the sides of the pages.

Then he asked me to share a bit of my history. I laid it all out for him, starting back when I was 11 years old until now. He listened intently while writing keywords intensely. He then asked some questions to fill in the holes and moved his focus to Hubby to share.

After a quick assessment of our stories coupled with the information he gathered from our records and labs, he offered his thoughts plus some next steps.

Diagnosis: Hypothalamic Amenorrhea

Essentially my body is not engaging in a normal cycle because my brain is not properly communicating with my ovaries.

Dr. G believes this may have started when I was going through puberty. Since I hadn’t ever had regular cycles, he is not sure if this condition was present prior to my exercise bulimia or because of it, but either way, the exercise bulimia, and addictive eating did not help my body to grow into a healthy reproductive state of being. (Thank you God for FA to help me be healthier in my body for the past 11 years!)

Dr. G is quite hopeful for our situation because my body did respond to the Clomid (which many people who are full into the Hypothalamic Amenorrhea do not respond). This is good news. Unfortunately, he did say that the Clomid was probably not the best course of action to take with my situation and believes that with a few changes to the course of action over the next 3 cycles, we will have a positive outcome with a baby.

This is encouraging.

Recommendations:

  • There are a few labs that he still wants to run just to be sure everything is accounted for.
  • A full body OBGYN appointment to make sure everything is okay.
  • I will have to go through an HSG test (where radiographic contrast –dye- is injected into the uterine cavity) to see that the fallopian tubes are open. I already did a FemVue (where they shot bubbles up) but Dr. G wants to see the dye.

Bummer, we should have gone the dye route the first time. This was NOT a pleasant experience and am not looking forward to it.

Hubby has to get checked again too to make sure his swimmers don’t have the antisperm antibody which would essentially ‘blind’ the sperm so that even if a sperm were next to the egg, the sperm wouldn’t be able to detect it.

Fascinating.

Treatment:

Dr. G does not see the need to force a period and (supposing everything goes well with the labs) will start me on Letrozole for days 3-7 of my made-up cycle start. He asks that we do an intrauterine insemination (IUI) to help with the process and will prescribe a progesterone suppository to help improve the receptivity of the uterine lining, enhancing the chances of implantation of a fertilized egg.  Yuck, but okay.

Next stop: Billing

How much is all of this going to cost? We will have to call the office next week to find out.

Our insurance (which is a health cost-sharing program) will not cover any of this so we need to be wise with how we move forward.

Continuing to gather all the information to be able to make a decision on what our next right action will be. Praying God will provide the means to do this if this is what we are supposed to try next.