Thursday, July 24, 2008
It really wasn't bad and I really worked myself up for nothing. I had the endometrial biopsy done today. It took all of 1 minute. After he numbed my cervix he inserted the catheter and told me to count to 5 while he took a piece of my lining. He was done before I even reached 5. It was a little uncomfortable but NOTHING like what other people said it would feel like. A small pinch and cramping that was over before I could blink. The dr. was great. He joked around with Eric and I and encouraged questions. Other drs. I've gone to have done their thing and leave and seemed too busy for questions. One more test to go, the Hysteroscopy, and then I should have a clearer idea of the whole picture.
Saturday, July 19, 2008
I saw the little line...I'm ovulating. So now the next step is to go in for the endometrial biopsy. The endometrial biopsy involves scraping and examining a sample of tissue from the lining of the uterus (endometrium). The procedure makes it possible for the doctor to determine if ovulation has occurred, and whether the lining of the uterus has undergone the changes necessary for the implantation of a fertilized egg and the support of an early pregnancy. An endometrial biopsy can also detect an infection or inflammation of the endometrium. The doctor will be testing to see if the uterine lining responds normally to progesterone, which is why an endometrial biopsy and infertility go hand in hand. An endometrial biopsy can also be performed to test abnormal uterine bleeding, which can also be caused by a hormone imbalance.
Of course I went online to find out more about this procedure since my other doctors never had me do this and I almost cancelled it. Wrong site to read and the name should have given it away(http://stirrup-queens.blogspot.com/2006/07/endometrial-biopsy.html). The women on here are equating the pain to contractions while in labor. Now I know that this is the result I am looking for but I am a wimp with pain. Hopefully the nerves will subside and I'll be fine. I'm scheduled for Thursday morning, 10:45 and plan on loading up with some Motrin beforehand. I know that I need to rule out all possible causes before moving onto IVF and this is just one of the steps I need to take.
Of course I went online to find out more about this procedure since my other doctors never had me do this and I almost cancelled it. Wrong site to read and the name should have given it away(http://stirrup-queens.blogspot.com/2006/07/endometrial-biopsy.html). The women on here are equating the pain to contractions while in labor. Now I know that this is the result I am looking for but I am a wimp with pain. Hopefully the nerves will subside and I'll be fine. I'm scheduled for Thursday morning, 10:45 and plan on loading up with some Motrin beforehand. I know that I need to rule out all possible causes before moving onto IVF and this is just one of the steps I need to take.
Tuesday, July 8, 2008
So I was scheduled for a Hysteroscopy for tomorrow morning. I got a call this afternoon and the nurse said that they had to cancel my appointment because the surgery center is not a participating location with my insurance(gotta love Aetna). Why they didn't realize this before they scheduled me there is beyond me and irritating because they are now delaying the process. I am going to have to wait until next month's cycle starts, call and probably do birth control to prevent ovulation so they can do the test. They only do it one Wednesday a month at Abington. They basically insert a camera to the hysteroscope and put this in your uterus (not sounding like fun to me...the last time they did this it was in conjunction with a surgery so I was sound asleep...this time I won't be). They will be able to tell if there is any scar tissue, any polyps or fibroids. Then I have to get bloodwork tomorrow morning. Eric went already and no lie (because I called Quest thinking maybe he was delirious and they took too much blood!) they took 22 vials of blood. They had to do a separate vial for each test and my rap sheet has 32 tests! Hopefully I won't pass out!
When I spoke to the nurse this afternoon I had asked about my Day 3 FSH level and it was 11 (in the past it was between 8-9). This is the follicle stimulating hormone and it is the main hormone used to produce eggs. By testing this level it can tell a doctor about one's ovarian reserve-hence the biological clock ticking and ticking. The higher the level the closer one is to menopause and decreased eggs. They use a chart to explain the levels:
Day 3 FSH level
Less than 10
Reassuring level. Expect a good response to ovarian stimulation.
10 - 12
Fair. Response is between completely normal and somewhat reduced (response varies widely). Overall, a somewhat reduced live birth rate.
12- 15
Reduced ovarian reserve. Usually show a reduced response to stimulation and some reduction in egg and embryo quality with IVF. Reduced live birth rates on the average.
15 - 20
Generally show a more marked reduction in response to stimulation and usually a further reduction in egg and embryo quality with IVF. Low live birth rates. Antral follicle count a very important consideration.
Over 20
Perhaps a "No go" level in our center. Very poor (or no) response to stimulation. "No go" levels must be individualized for the particular lab assay and IVF center. Antral follicle count a very important consideration.
With my level being an 11 I rate "fair".
They also did a baseline antral follicle count. Antral follicle counts are a good predictor of the number of mature follicles that the dr. will be able to stimulate in the woman's ovaries when they administer the injectable FSH medications that are used for in vitro fertilization. The number of eggs retrieved correlates with IVF success rates. So one asks, How many antral follicles are good? Well, they have a chart for this too!
Total number of antral follicles
Expected response to injectable ovarian stimulating drug (FSH product) and chances for success
Less than 4
Extremely low count, very poor (or no) response to stimulation and a cancelled cycle expected.Should seriously consider not attempting IVF at all.Rare pregnancies if IVF attempted.
4-7
Low count, we are concerned about a possible/probable poor response to the stimulation drugs.Likely to need high doses of FSH product to stimulate ovaries adequately.Higher than average rate of IVF cycle cancellation.Lower than average pregnancy rates for those cases that make it to egg retrieval. The reduction in success rates is more pronounced beyond age 35.
8-10
Somewhat reduced count.Higher than average rate of IVF cycle cancellation.Slightly reduced chances for pregnancy as a group.
11-14
Normal (but intermediate) count, the response to drug stimulation is sometimes low, but usually good.Slight increased risk for IVF cycle cancellation.Pregnancy rates as a group only slightly reduced compared to the "best" group.
15-26
Normal (good) antral count, should have an excellent response to ovarian stimulation.Likely to respond well to low doses of FSH product.Very low risk for IVF cycle cancellation. Some risk for ovarian overstimulation. Best pregnancy rates overall as a group.
Over 26
High count, watch for polycystic ovary type of ovarian response.Likely to have a high response to low doses of FSH product.Higher than average risk for overstimulation.Very good pregnancy rate overall as a group, but some cases in the group have egg quality issues and lower chances for pregnancy.
When they did the ultrasound I had 6 follicles which is a low count. So with the low follicle count and higher FSH level they are saying that my odds are decreased but there is still a chance. They want to run additional tests to make sure there aren't more issues. I guess aging ovaries and endometriosis isn't enough! I'm trying to stay hopeful. There are women with worse situations who have success. My plan is to get all the tests done and get all the facts together to make an educated decision. And to think in school they teach you all about the birds and the bees. Hmmm. If only it were that easy.
When I spoke to the nurse this afternoon I had asked about my Day 3 FSH level and it was 11 (in the past it was between 8-9). This is the follicle stimulating hormone and it is the main hormone used to produce eggs. By testing this level it can tell a doctor about one's ovarian reserve-hence the biological clock ticking and ticking. The higher the level the closer one is to menopause and decreased eggs. They use a chart to explain the levels:
Day 3 FSH level
Less than 10
Reassuring level. Expect a good response to ovarian stimulation.
10 - 12
Fair. Response is between completely normal and somewhat reduced (response varies widely). Overall, a somewhat reduced live birth rate.
12- 15
Reduced ovarian reserve. Usually show a reduced response to stimulation and some reduction in egg and embryo quality with IVF. Reduced live birth rates on the average.
15 - 20
Generally show a more marked reduction in response to stimulation and usually a further reduction in egg and embryo quality with IVF. Low live birth rates. Antral follicle count a very important consideration.
Over 20
Perhaps a "No go" level in our center. Very poor (or no) response to stimulation. "No go" levels must be individualized for the particular lab assay and IVF center. Antral follicle count a very important consideration.
With my level being an 11 I rate "fair".
They also did a baseline antral follicle count. Antral follicle counts are a good predictor of the number of mature follicles that the dr. will be able to stimulate in the woman's ovaries when they administer the injectable FSH medications that are used for in vitro fertilization. The number of eggs retrieved correlates with IVF success rates. So one asks, How many antral follicles are good? Well, they have a chart for this too!
Total number of antral follicles
Expected response to injectable ovarian stimulating drug (FSH product) and chances for success
Less than 4
Extremely low count, very poor (or no) response to stimulation and a cancelled cycle expected.Should seriously consider not attempting IVF at all.Rare pregnancies if IVF attempted.
4-7
Low count, we are concerned about a possible/probable poor response to the stimulation drugs.Likely to need high doses of FSH product to stimulate ovaries adequately.Higher than average rate of IVF cycle cancellation.Lower than average pregnancy rates for those cases that make it to egg retrieval. The reduction in success rates is more pronounced beyond age 35.
8-10
Somewhat reduced count.Higher than average rate of IVF cycle cancellation.Slightly reduced chances for pregnancy as a group.
11-14
Normal (but intermediate) count, the response to drug stimulation is sometimes low, but usually good.Slight increased risk for IVF cycle cancellation.Pregnancy rates as a group only slightly reduced compared to the "best" group.
15-26
Normal (good) antral count, should have an excellent response to ovarian stimulation.Likely to respond well to low doses of FSH product.Very low risk for IVF cycle cancellation. Some risk for ovarian overstimulation. Best pregnancy rates overall as a group.
Over 26
High count, watch for polycystic ovary type of ovarian response.Likely to have a high response to low doses of FSH product.Higher than average risk for overstimulation.Very good pregnancy rate overall as a group, but some cases in the group have egg quality issues and lower chances for pregnancy.
When they did the ultrasound I had 6 follicles which is a low count. So with the low follicle count and higher FSH level they are saying that my odds are decreased but there is still a chance. They want to run additional tests to make sure there aren't more issues. I guess aging ovaries and endometriosis isn't enough! I'm trying to stay hopeful. There are women with worse situations who have success. My plan is to get all the tests done and get all the facts together to make an educated decision. And to think in school they teach you all about the birds and the bees. Hmmm. If only it were that easy.
Sunday, July 6, 2008
How do you know when to move on?
I wish I had started this years ago to fully capture this 5 year journey I've been on so I could look back and remember the emotions and feelings I have experienced. I guess now is better than never.....
To want something so badly but you can't have it. It's a feeling that I struggle finding the words to describe. The realization that I may not be a mother, to not share something so sacred with my husband..how does one deal with this? I don't know....the frustration, the anger, the hurt, it is all becoming more and more overwhelming. To not succeed at something...to fail, my body has failed me....and to not know why is the hardest part. How do you know when to say enough is enough and move on? How do you know when to throw the towel in? I don't.....
I've been to 3 different fertility doctors. I've tried Clomid 6 times and have tried injectible medications 4 times. I'm up to 11 IUIs (artificial insemination). I had a laparoscopy where they discoverd I had deep endometriosis along with a slew of other issues-polyps, a blocked tube, this after being told that a laparoscopy "wouldn't show anything that could be affecting my fertility"-good thing I sought out another opinion! The "good" news in all of this is that I did conceive after they cleaned me out inside. But I miscarried after 7 1/2 weeks on Mother's Day, after just hearing the heartbeat. I was left thinking that maybe that was my sign...maybe this isn't meant to be. How could "he" be so cruel? Maybe the signs have been there all along and I'm refusing to see them.
On my quest to find answers I went to my fourth doctor last week who basically said my ovaries were like "that of a 39 year old". Not something you want to hear as your 33rd birthday quickly approaches. My only hope, if there is any hope, is IVF which of course is NOT covered in the state of PA or by our insurance (after we've already spent thousands on the other treatments). I'm left with the knowledge that I can spend $12,000 for the "hope" that it will work, not even a 50/50 chance especially with my background. Yes, the end result could all be overwhelmingly worth it but what if the results are not +. Am I prepared for the second biggest let down of this 5 year process? I am being consumed by this, by the quest to find answers, consumed knowing that my "biological clock" is ticking away, consumed knowing that although I'm only 33 and should have a few more years left the reality is my body is not 33 but approaching a 40 year old and the success rate is considerably low. I don't know how to see the positive side when the reality is hitting me smack in the face. There is such a void in my life and there is only one way to fill it. I feel unfulfilled personally and especially professionally because I know what my purpose is..to be a mother. I don't know where to turn from here. This isn't the life I planned. My life plan is off course and not being able to control it is so hard for me. I can't let go of not being a mom. I can't deal with the realization that I may not give my parents another grandchild, that I won't see what Eric and I could create....How do I get closure? How do I move on?
To want something so badly but you can't have it. It's a feeling that I struggle finding the words to describe. The realization that I may not be a mother, to not share something so sacred with my husband..how does one deal with this? I don't know....the frustration, the anger, the hurt, it is all becoming more and more overwhelming. To not succeed at something...to fail, my body has failed me....and to not know why is the hardest part. How do you know when to say enough is enough and move on? How do you know when to throw the towel in? I don't.....
I've been to 3 different fertility doctors. I've tried Clomid 6 times and have tried injectible medications 4 times. I'm up to 11 IUIs (artificial insemination). I had a laparoscopy where they discoverd I had deep endometriosis along with a slew of other issues-polyps, a blocked tube, this after being told that a laparoscopy "wouldn't show anything that could be affecting my fertility"-good thing I sought out another opinion! The "good" news in all of this is that I did conceive after they cleaned me out inside. But I miscarried after 7 1/2 weeks on Mother's Day, after just hearing the heartbeat. I was left thinking that maybe that was my sign...maybe this isn't meant to be. How could "he" be so cruel? Maybe the signs have been there all along and I'm refusing to see them.
On my quest to find answers I went to my fourth doctor last week who basically said my ovaries were like "that of a 39 year old". Not something you want to hear as your 33rd birthday quickly approaches. My only hope, if there is any hope, is IVF which of course is NOT covered in the state of PA or by our insurance (after we've already spent thousands on the other treatments). I'm left with the knowledge that I can spend $12,000 for the "hope" that it will work, not even a 50/50 chance especially with my background. Yes, the end result could all be overwhelmingly worth it but what if the results are not +. Am I prepared for the second biggest let down of this 5 year process? I am being consumed by this, by the quest to find answers, consumed knowing that my "biological clock" is ticking away, consumed knowing that although I'm only 33 and should have a few more years left the reality is my body is not 33 but approaching a 40 year old and the success rate is considerably low. I don't know how to see the positive side when the reality is hitting me smack in the face. There is such a void in my life and there is only one way to fill it. I feel unfulfilled personally and especially professionally because I know what my purpose is..to be a mother. I don't know where to turn from here. This isn't the life I planned. My life plan is off course and not being able to control it is so hard for me. I can't let go of not being a mom. I can't deal with the realization that I may not give my parents another grandchild, that I won't see what Eric and I could create....How do I get closure? How do I move on?
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