RE: Diagnostic Testing and Follow- Up

Dear Bundle of Joy,


About a month ago, I met with the reproductive endocrinologist (RE) and talked about my situation. He suggested their routine diagnostic testing procedures to see if anything major sticks out since my OB didn't really have an idea of what was causing this. I went through many procedures that were not the most pleasant things in my life, but it could have been worse, I guess. I just kept thinking that anything isn't too painful that I won't want to try it, if it means a chance of having you come here. Some things that I have done so far:

***With my OB: I did 3 rounds of Clomid. They took blood each time to monitor my progesterone levels. The first round was 50 mg of Clomid, the second round was 100 mg, and the last round was 150 mg. Usually, with this much increase of Clomid, they would expect to see some increase in my progesterone levels. Each time they were around the same... very low. Apparently you should be a level 10-12 (I don't know of what, haha), and I was at a level .5-1! This obviously was disheartening. I had heard of so many women who have had problems and them take the magic drug, aka Clomid, and then conceive... some with twins even. I thought that this would be me too, of course. I was still in shock that  we were having troubles, that of course the journey would here, wouldn't it? After taking this for a couple of months we would be on our way to being a "normal" family and on to our next adventure or chapter of of life... right? No. I remember the day that I got the call from the nurse practitioner. She seemed awkward and hesitant when delivering this message, so I felt obligated to help her out. It went something like this:

NURSE: So, um, we got your blood results back and the progesterone levels came back really low again.
ME: Oh, okay. So are we going to increase it again or....
NURSE: Well, 150 mg is usually the maximum that we would go.... and.....
ME: (I could tell where she was going with this, so I ended it for her) So, are we stopping it then?
NURSE: .... yeah. *SILENCE* We are going to be referring you to a reproductive endocrinologist to conduct some more testing to see if he can set you up with a plan of action.
ME: (So, basically you don't know what's going on.....) Oh, Okay....

End of call. I was in shock and didn't know what to say. I sat at my desk in my classroom.... my "magic" drug didn't work. The feelings of nauseousness and headaches were for nothing the past three cycles. No baby. No hope with Clomid. Tears balled up in my eyes and fell like crocodile tears. I couldn't even hold it back, even if I tried. Down they fell. I finally was able to get it together, when I realized where I was and that someone could walk into my classroom at any moment and see me like that. So, even though I wasn't completely coping/ coming to terms with the fact that we were having problems conceiving you, now I had to deal with the fact that this drug that "everybody" said to take and that it solved "so-and-so's problem", well, wasn't working for us either... So, off to the RE I went.

*****The next part is more of an outline of the diagnostic testing that has been done so far, rather than my thoughts or feelings on things. So... if you don't like TMI, then don't read further, haha*****

1) Blood Tests.... and tons of them! I hate needles- doesn't really make for an enjoyable experience. :/
-----WHAT IT IS: blood tests, obviously... it tested many things like STD's, genetic recessive genes that I could be carriers for, blood type, white and red blood count levels, and other hormones.
-----CONCLUSION: Normal, EXCEPT for my blood counts and Rubella virus. It looked like I was iron deficient anemic. Which wasn't surprising since I was anemic at the end of high school. But, I had thought that I had "gotten over" this--- I guess I should have gotten my blood tested before I stopped taking my iron pills, but I felt a million times better after about a year of taking those supplements. :/ So, I need to go to my PCP, possibly have them run some blood tests, and have a plan of care to manage that. Also, they found that I am not resistant to the Rubella virus. They need me to also go to my PCP and get this shot so that if I do get pregnant, I won't get infected with Rubella and harm our child. But, I did "pass" all the STD screenings... whew, dodged a bullet there... ;) ha.

2) Transvaginal Ultrasound: 
-----WHAT IT IS: This was to look at my overall uterus, ovaries/ egg counts, and to see if there were any cysts on my ovaries.
-----CONCLUSION: My overall uterus looked like it was in great condition: size, shape, etc. My ovaries each had about 8 eggs in them, which he said was great (yay!), but on my left ovary there was a cyst. He said that sometimes this is normal with random cycles and they go away on their own. When we do another ultrasound we will look at this and make sure it is gone. If it isn't, then we might need to look into deeper and figure out if we need to take it out. (ah- surgery!) But, overall, he said that it was a normal test.

3) Sonohysterogram:
-----WHAT IT IS: Sterile Saline solutions fills up my uterus while being examined by a transvaginal ultrasound. The doctor looks at detailed views of the uterus and the endometrium.
-----CONCLUSION: Normal. He said that the size, shape, lining were good and that there weren't and structural imperfections. However, there was a "mass" at the bottom of my uterus. He reassured me that he didn't think it was cancer and that we didn't need to immediately do surgery or anything (whew, dodged that "surgery" thing again!) He said that this mass wasn't anywhere near where eggs implant to start growing so it wasn't a concern of his. He said that we would later talk about what to do with it, if anything.

4) Hysterosalipinogram (HSG): 
-----WHAT IT IS: This is an x-ray procedure which involves injecting a dye through the cervix into the uterus and fallopian tubes. It basically shows if the tubes are open or blocked. Obviously if they are open, that is good because it will let an egg pass through. But, if it is blocked then no eggs can pass, therefore no pregnancy can occur. (I secretly wanted this to show up abnormal so that this quest to find out "what's wrong" would be over and we could "solve the problem"... but apparently that would be too easy, now, wouldn't it? hehe.) They had to inject anesthesia to the cervix which was... let's just say--- not normal. You're not supposed to get shot there haha. But, like I said before... if it will help trying to figure out this whole situation or bring a baby to us, then I will try it if we have the means to do so.
-----CONCLUSION: Normal. It's so interesting how many mixed emotions occur when you hear the doctor say this: normal test... happy and hopeful that this can still be fixed since nothing is apparently wrong, but then sad and disappointed that the problem isn't solved or pinpointed.

5) Jordan's "man" testing:
-----WHAT IT IS: A semen sample is taken and analyzed. They look at: volume, sperm count, morphology, motility, and some other things. Needless to say, Jordan said the clinic for this was VERY uncomfortable... I'll leave it at that. haha. He did that for you, future child. :)
-----CONCLUSION: Normal. Well, I wouldn't be doing Jordan justice... it was WAY ABOVE normal. Yay! That's good.


***FOLLOW-UP Appointment:

After all of these procedures, we set up an appointment to speak with my RE. Jordan was able to come to this appointment, which was nice.

The RE sat with us for about an hour and explained everything to us and outlined everything for us. I love this about him. He gives us all the options and lets us decide... not just "here is the next step without any input from you".

Since all my tests came back mostly normal, the next step is trying Clomid again... but with ultrasound monitoring, not just blood tests like at my OB. This is more accurate and can tell at what point during the cycle I will be ovulating. The blood tests might have been taken at the wrong time if I don't ovulate according to "normal" timing. I could ovulate sooner or later in my cycle that wasn't showing up on my blood tests at that particular time they drew it. If this doesn't show that I am ovulating, then they will pair the Clomid with injections--- AH! SHOTS! Shots that I would have to give myself! I'll get to that hurdle if it comes, but ah! I can't imagine doing that.... Once I am showing that I will be ovulating, then they will be getting a semen sample from Jordan the day before and then injecting it in me at that specific time. This procedure is called Intrauterine Insemination, or IUI. I am so happy because usually this procedure is close to $1000.00 each month, but my insurance will cover it all! We'll just have to cover Jordan's semen "washing" since he doesn't have insurance. But, it is a tiny amount compared to what it could have been! *blessing*

So, the RE suggested to do maybe 3-4 cycles of IUI before trying In-Vitro Fertilization (IVF). I hope and pray that we will know what to do if it gets to that point because it is a huge step and a huge financial expense too, with no guarantees--- each cycle costing from $12,000-$18,000 depending on where you go!!! It's outrageous.

But, for now, we can hope that this might be the procedure that helps get you here. If not, then we'll keep trying and praying for you. Only God knows when it is the right time... maybe now isn't it. But, we feel that we should keep trying and we have faith and hope that things will go as planned and we will be happy with whatever the outcome. I know that God blesses those, whether in this life or the next. I know that if we can't have our own kids here in this life, then I know that I will have the opportunity to do so later and I will make the most of my life and be of service to others that need it.

Doing all that we can to get you here,
Mom and Dad