Sunday, September 25, 2011

New Beginnings vs Same Old S***

With the new year came new determination. I decided it was time to know what was happening in my body. I called an RE's office and made an appointment. I filled out mine and Patrick's history before the appointment and waited anxiously for January 25 to come. I had started charting again with my new cycle which had started Jan 7.
Even though we were still trying to eat healthy, we had gotten off track over the holidays and getting fully committed to the healthy living was hard. I was not following as closely I needed to be so my cycles had returned to normal... ie. NOT normal.
January 25, 2011
I was the youngest one in the waiting room at our new Dr's office, Houston Fertility Institute. I felt out of place, but I just KNEW I would finally get the answers and attention I so badly wanted.
I liked our doctor from the moment we met him. Dr. Griffith is soft spoken, calm, knowledgeable, with a sense of humor, and a knack for reassuring and making you feel at ease. I'm using his name because I have nothing but good things to say about him, or the rest of his staff, and definitely recommend them if you are in the Houston area and looking for a clinic.
Dr. Griffith went over our histories, asked us a few more questions, and immediately told me he knew there was a problem and that I was likely going to need surgery. His exact words to me were, "Pain is never a good thing. It is always an indication of something going on."
He said we could do an HSG- a procedure where they inject dye into the uterus and fallopian tubes and take an X-ray to look for blockages or other problems- but he was so sure that they would find something he said he felt comfortable skipping that step and moving straight to a laparoscopy... provided Patrick's semen analysis came back normal. At this, Patrick goes stiff.
Patrick- "Semen analysis?"
Dr- "Yes. There is no use in cutting on your wife until we know there's not an issue with you."
Patrick- "O-Okay. What does that include?"
Dr- "We would get a semen sample from you and analyze it under a microscope to make sure there are no problems."
Patrick- "What if there is a problem?"
Dr- "Depending on what it is, we would retest to make sure it wasn't just a fluke and if we got the same results we would refer you to a Urologist to see if it can be corrected or if we would need to work around it or move straight to IVF."
Patrick's eyes were huge and he sat there a moment, processing. Then he asked, "How do you get the sample?"
I held back a laugh and could tell the doctor was doing the same.
Dr- "You would come into the office, we have designated rooms, the staff will give you a cup, and you will masturbate to ejaculation."
Here, Patrick's eyes nearly bulged out of their sockets and he turned into a snickering 10-year-old boy.
Dr- "You can also do it at home and bring us the sample, but it has to be here within 45 minutes."
We then discussed the possibility of endometriosis, he confirmed my PCOS diagnosis and told me it was actually fairly common for women to present with cases similar to mine, and he promised that I would never have to take Clomid again. He said that we had age and time on our side and he felt confident that I would one day be a mommy.
He sent me to have blood work to see where I was in my cycle and told said that if I wasn't close to starting on my own, they would give me medicine to bring on a new cycle so we could get the diagnostic ball rolling.
February 2011
Patrick had his semen analysis done Feb. 11 and they called him the same day and told him everything looked good.
I had started Prometrium the day after our first appointment, but a mistake at the pharmacy had given me only half the dose needed and I didn't start until Feb. 16, 11 days after my last pill. It worked out, though, and with Patrick's normal results, Dr. Griffith said we should proceed with the laparoscopy. It all happened fast from there. A week later, on Feb. 23, I went in for surgery.
I don't remember much about what the doctor told us after I woke up in recovery. I remember him telling me I had a lot of scar tissue on my left ovary, and that it looked like I had been having cysts rupture (I had felt them, but thought them to be gas pains or constipation pains until he described what it would have felt like) and that the scar tissue had fused my left fallopian tube to my ovary and that he had to cut the tube because it "was sabotaging everything".
Even though I didn't understand most of the whats or whys... hell, I was so out of it from anesthesia I barely understood simple English, as the post-op video Patrick took of me showed... I understood that I still had one tube and that meant I still had a chance to get pregnant on my own.
Patrick on the other hand, took what the doctor said to mean that we now needed IVF to get pregnant. (Dr. Griffith had actually said that even though I only had minimal scar tissue on my right side and my right tube was open, the presence of scar tissue raises concerns of HOW open my right tube is, which raises concerns of the possibility of ectopic pregnancies, so they recommend IVF to lessen the likelihood of an ectopic)
Needless to say, Patrick was crushed until I spoke to the doctor the next day and cleared this up.
March 2011
A week later we met with Dr. Griffith for my post-op.
Turns out, I had a hydrosalpinx of my left fallopian tube. In response to injury, the body sends inflammatory cells to the area, and the inflammation and scar tissue results in a loss of fimbria (the frilly tissue at the end of the tube that sweeps up the egg when it's released from the ovary) and a closure of the tube. The tube then fills with inflammatory fluid and becomes distended. My tube had basically gotten caught up in the scar tissue from my ruptured cysts, had a inflammatory response of its own, causing more scar tissue, and filled with fluid. This was the cause of all my pain. As my cycle progressed and my left ovary tried to ovulate, it was causing more fluid to gather in my tube, with was now being pulled between my ovary and uterus.
Dr. Griffith also felt that we probably were getting pregnant, but the inflammatory fluid draining from my left tube was coating my uterine lining, preventing implantation and, in essence, sabotaging everything.
FINALLY!!! Answers!
Next, he said that, given my excellent ovarian reserve and the fact that Patrick's semen analysis made their Hall of Fame, he was certain that I would get pregnant.
I could practically see Patrick's head getting bigger at the mention of "Hall of Fame" and "his semen analysis" in the same sentence. Dr. Griffith joked and said that Patrick's results were so good they were hung up in the back room. I figured he was just trying to encourage Patrick and assure him everything would be okay, and I was grateful for it.
Dr. Griffith said that our next course of action would be to put me on injectables with timed intercourse and see what happened. He said that we would have a 15% chance of multiples on the injectables and usually he would lower that chance in patients with one tube, but given Patrick's little swimmers, he was going to keep them at 15%. I have always wanted twins so this was fine with me. We agreed to do the injectables.
After we talked a little while longer about options, chances, etc., he sent us out to talk to Brittany at the front desk to discuss insurance coverage and cost. We walked out of his office with high hopes.
It didn't last long.
Our insurance covers NOTHING.
Brittany told us that the monitoring for a cycle of injectables would cost $1500. I died a little inside. I would happily spend that and more if I knew it would work, but if I was to shell out that much money and not get pregnant, I would feel like I flushed it down the toilet. (And at that point I still had no idea how much the medicine was!) I asked her if we could do another cycle of *dumdumdum* CLOMID while we figured out our finances and decided if we could afford to continue. She said no problem and we left, discouraged.
Two weeks later, I was back in the office for Day 3 blood work and ultrasound, crossing my fingers that Clomid would be good to me now as there was no way that we could afford the injectables if we weren't sure they would work. After living with Patrick's inflated ego for two weeks, I also asked the receptionist for a copy of his semen analysis, certain they couldn't have been THAT good.
They were. So good, he insisted that we post them on the fridge.
His concentration was at 177.5 million/mL...impressive. Coupled with the fact that he produced a volume of 14mL, Patrick produced a total of 2.485 BILLION sperm. That's right, BILLION! Even with a slightly crumby 67.61% motility, it still left him with 1.68 billion motile sperm.
Hall of Fame is right. At least we don't have to worry about his swimmers! (Probably the only thing we don't have to worry about in this quest)
A week later, after taking the Clomid, as I checked in to my day 12 appointment to check on the progress of my cycle, I had my card ready to pay my $40 co-pay when Brittany says, "Okay, its going to be $800 today."
I nearly fainted.
After I stared at her dumbly, I managed to ask why so much. She told me that the monitoring for Clomid cycles was $800 and that, now that I had been diagnosed, my insurance wouldn't cover my monitoring any more. I told her I had not been told it would be so much and asked if I could put half on my credit card and have a few days to get the other half together. She agreed and I felt sick as I handed over my card. There went half of my injectable cycle on Clomid!
April 2011
I responded very slowly to the Clomid that time. I didn't trigger until day 18 and didn't ovulate until day 21. We timed it very well...knowing almost exactly when you're going to ovulate REALLY helps ;) ,
and we hoped that it was going to be $800 well spent. Let the TWW begin!
We went to mediation on the lawsuit for the house on April 11 and they settled!!! We were ecstatic to be done with that nightmare! We didn't get what we wanted but we got enough to fix the house as long as we do some of the work ourselves and budget wisely. Things were going our way.
My 14DPO pregnancy blood test came back negative. Time to reconsider out options.
May 2011
After our failed cycle, I explained to Dr. Griffith that we couldn't afford to move forward with treatment and we had decided to just try on our own for a few months as we saved up for the next step. A few weeks later he called me and said that he had a treatment option that he felt would be a good fit for us. He said that the reason I wasn't responding well to the Clomid was that my estrogen was high (790 at ovulation with only one mature follicle) and that he thought switching to Letrozole (Femara) would produce positive results. He then told me that, as they don't use Femara very often since its not approved as a fertility drug, they were willing to do my monitoring for free for a few cycles to see how I respond. I was thrilled!!!!
June 2011
When I went in for my day 3 BW/US, the US showed what the tech thought was a cyst on my left ovary, and my E2 came back at 101, so they wanted me to do two weeks of birth control and come back.
Turns out the "cyst" is just the way the fused tube sits on my ovary, because two weeks later it was still there and my E2 was down to 31.3, so they gave me the go-ahead to start the Femara.
I ovulated on the left side.

As I have now pretty much caught you up, I will cover July and August in my next post because it's kind of a long one and needs to stand alone.

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