Well, it's been almost five months since I last wrote but I'm still not pregnant.
I finished my strict diet with Dr. Weight and achieved my goal of getting my BMI under 30 (lost over 50 pounds). I've mostly kept it off since then too (just gained a few pounds over Christmas that I haven't focused on getting off yet).
Back in August "J" and I went to a free group consultation at a local fertility clinic. There they offered a free AMH test. I thought, "why not?" I'm listing the result here along with the previous results for comparison:
Test 1: 0.21 (CD 21)
Test 2: 1.01 (CD 5)
Test 3: 0.49 (CD 16)
Test 4: 0.83 (CD 28)
Um, what? That fourth test was taken two months to the day after the first one. When the fertility clinic called me with the results, I asked the nurse why my numbers were all over the place when AMH is supposed to have stable results (at least over a short time period). She said they saw results like mine occasionally but that they couldn't explain it. She just encouraged us not to wait too long to "try" - ha!
In September I began BBT tracking and clearly ovulated on CD15 (later confirmed by a Progesterone test - this time my result was 14.77, much better than before!). With a 27 day cycle, this meant my luteal phase was 12 days which is sufficient. Per BBT tracking, in October, November, and December I ovulated on CD 14 or CD 15, and I got positive OPKs each of those months, too!
Each month we remained hopeful as each month there was something new to try. In September I'd been on Metformin for a few months (due to high insulin). In October we added Synthroid (my TSH was 4.3 which is considered normal according to most labs but should be between 1-2 for TTC). In November we tried adding Progesterone (mostly because it couldn't hurt and could help if any part of my problem conceiving was related to low progesterone).
In October I also had food sensitivity testing done. Pre-diet my CRP (a blood test which shows inflammation in your body) was 9.4 when it should have been under one. Post-diet it was down to 2.9. Dr. Weight suggested this drastic of a difference in ~14 weeks was likely due to the removal of some food to which I was very sensitive. The food sensitivity testing seems to have confirmed her suspicion - I am "severely" sensitive to Wheat, Gluten, and Green Peas (none of which I had during my strict diet). I am also moderately sensitive to nine other things and minimally sensitive to 23 others. I have worked very hard to remove ALL of these foods from my diet (as internal inflammation could absolutely be a culprit behind infertility) and my CRP test from last week showed I'm down to 0.21! I find that amazing and it gives me such hope that now I will be able to get pregnant.
That being said, we've now been actively TTC for 14 months without luck. At this point, I have addressed all health issues which I know to address (though I am in the midst of working with a GI doc who suspects Celiac Disease - I have an endoscopy and colonoscopy scheduled for later this month - and I will also be meeting with an endocrinologist this week so make sure my thyroid is where we need it to be and that it stays there while we TTC and during any achieved pregnancy).
So, pre-January 1st, I bit the bullet and signed up for the most expensive health care plan my company offers which - thankfully! - provides awesome infertility coverage. "J" and I have an appointment at a fertility clinic tomorrow and we are ready to do whatever it takes to get pregnant. Insurance will pay for up to six medicated cycles with IUIs, and up to three IVF cycles. How amazing is that?!?
I have great faith that with all of those chances SOMETHING will work.
I hope to use this space to chronicle our journey at the fertility clinic. Wish us luck!
Wednesday, January 8, 2014
Thursday, August 15, 2013
A Little Background - Part 3
I met with the doctor I will call Dr. Weight on June 27. The Office Manager took my blood pressure and it was very high - she's didn't blink. She weighed me and my weight was - well, let me just repeat that my BMI was 38.9 so it, too, was very high. Again, she didn't blink (thank goodness; I was tired of judgemental medical personnel). Next I met with Dr. Weight who spent an hour taking a very detailed history. She was so sympathetic to my concerns (both about losing weight and trying to get pregnant) and so reassuring that she could help me, that I felt hope for the first time in a long time. After scheduling blood work for early the next week, I left there and went straight to the hospital for my HSG.
Honestly, I expected the HSG to be awful (other blogs I'd read online referenced lots of pain); however, for me it was no big deal. In fact, I left MUCH happier than when I went in. Although I'd expected to be told my left fallopian tube was completely blocked (per laparoscopy when I was 27) and I suspected my right tube was at least partially blocked (cause of ectopic last summer), I was thrilled when the doctor indicated that my x-ray showed a normal uterine shape and the injected dye spilled freely from not just one but BOTH fallopian tubes!
The following week I went in for my blood work with Dr. Weight and I lost count of how many vials of blood they took. I got my initial diet plan which would serve as a starting point until my blood work came back. We talked a little more about coordinating with Dr. Awesome - specifically, that I was going to delay "trying" to conceive (and, in fact, purposely avoid) during the first 12 weeks of my highly calorically restricted diet, but that we could continue with any other tests he wanted us to do.
The end of that week "J" and I met with Dr. Awesome so go over the result of the four tests he'd ordered at our "Why Aren't We Pregnant Yet?" visit. We already knew the my Progesterone at 8.62 on CD 21 indicated that I was ovulating. He affirmed the HSG results showed that my uterus and fallopian tubes looked good (praise God!). Then we learned that "J's" semen analysis showed that he has NO problems... he's even better than "normal" (which made him ecstatic! He's so proud to have such good swimmers. I, too, was so relieved to learn we'd only be dealing with a "me" problem rather than a "me + him" problem). Finally, we talked about my AMH.
You may remember my first testing showed me at a 0.21. Well, my second result came back at 1.01 which - although in the "normal" range - still only put me at 25% for my age. Dr. Awesome proclaimed this as proof of lab error on the first round and said the second round was slightly disappointing but no big deal (he'd only be concerned if I was in the bottom 10th percentile). I pushed back a bit - we consider the first one wrong because we don't like the result but consider the second one right because the result is acceptable? No way; not when the results are supposed to be stable! He asked if I wanted a third test and I said I did.
Final AMH results?
Test 1: 0.21 (CD 21)
Test 2: 1.01 (CD 5)
Test 3: 0.49 (CD 16)
That's right. In the span of less that one month's time, the same lab returned three very different results. Test 2 leaves me with a little hope; tests one and three do not. Is this the reason we aren't getting pregnant? Do I have old, crappy eggs?
Dr. Awesome urged me not to freak out but, instead, to go spend 12 weeks working with Dr. Weight as we'd already discussed. He said sometimes losing even 5% of one's body weight can have a huge impact on fertility. He also assured me that if after 12 weeks I wanted to be more aggressive (think Clomid), that he was willing to talk about it. I left feeling slightly discouraged but mostly optimistic.
************************************************************************************************************
I have now been working with Dr. Weight for almost six weeks. I have lost 29.5 pounds (30 tomorrow, I hope!) and my BMI is down to 33.8 (my blood pressure is way down, too!). My initial blood work results were quite alarming. According to Dr. Weight, I "could have been eating nothing but lettuce and not losing weight." Based on my blood work, she also was not at all surprised I was having a hard time getting pregnant. She basically told me to stick with her and not not only would she get the weight off of me, but she'd help me get pregnant, too! (She joked we could feel free to name the baby after her - at least a middle name.) Could it really be so easy?
So, there you have my background. Now will you walk with me day-to-day?
Honestly, I expected the HSG to be awful (other blogs I'd read online referenced lots of pain); however, for me it was no big deal. In fact, I left MUCH happier than when I went in. Although I'd expected to be told my left fallopian tube was completely blocked (per laparoscopy when I was 27) and I suspected my right tube was at least partially blocked (cause of ectopic last summer), I was thrilled when the doctor indicated that my x-ray showed a normal uterine shape and the injected dye spilled freely from not just one but BOTH fallopian tubes!
The following week I went in for my blood work with Dr. Weight and I lost count of how many vials of blood they took. I got my initial diet plan which would serve as a starting point until my blood work came back. We talked a little more about coordinating with Dr. Awesome - specifically, that I was going to delay "trying" to conceive (and, in fact, purposely avoid) during the first 12 weeks of my highly calorically restricted diet, but that we could continue with any other tests he wanted us to do.
The end of that week "J" and I met with Dr. Awesome so go over the result of the four tests he'd ordered at our "Why Aren't We Pregnant Yet?" visit. We already knew the my Progesterone at 8.62 on CD 21 indicated that I was ovulating. He affirmed the HSG results showed that my uterus and fallopian tubes looked good (praise God!). Then we learned that "J's" semen analysis showed that he has NO problems... he's even better than "normal" (which made him ecstatic! He's so proud to have such good swimmers. I, too, was so relieved to learn we'd only be dealing with a "me" problem rather than a "me + him" problem). Finally, we talked about my AMH.
You may remember my first testing showed me at a 0.21. Well, my second result came back at 1.01 which - although in the "normal" range - still only put me at 25% for my age. Dr. Awesome proclaimed this as proof of lab error on the first round and said the second round was slightly disappointing but no big deal (he'd only be concerned if I was in the bottom 10th percentile). I pushed back a bit - we consider the first one wrong because we don't like the result but consider the second one right because the result is acceptable? No way; not when the results are supposed to be stable! He asked if I wanted a third test and I said I did.
Final AMH results?
Test 1: 0.21 (CD 21)
Test 2: 1.01 (CD 5)
Test 3: 0.49 (CD 16)
That's right. In the span of less that one month's time, the same lab returned three very different results. Test 2 leaves me with a little hope; tests one and three do not. Is this the reason we aren't getting pregnant? Do I have old, crappy eggs?
Dr. Awesome urged me not to freak out but, instead, to go spend 12 weeks working with Dr. Weight as we'd already discussed. He said sometimes losing even 5% of one's body weight can have a huge impact on fertility. He also assured me that if after 12 weeks I wanted to be more aggressive (think Clomid), that he was willing to talk about it. I left feeling slightly discouraged but mostly optimistic.
************************************************************************************************************
I have now been working with Dr. Weight for almost six weeks. I have lost 29.5 pounds (30 tomorrow, I hope!) and my BMI is down to 33.8 (my blood pressure is way down, too!). My initial blood work results were quite alarming. According to Dr. Weight, I "could have been eating nothing but lettuce and not losing weight." Based on my blood work, she also was not at all surprised I was having a hard time getting pregnant. She basically told me to stick with her and not not only would she get the weight off of me, but she'd help me get pregnant, too! (She joked we could feel free to name the baby after her - at least a middle name.) Could it really be so easy?
So, there you have my background. Now will you walk with me day-to-day?
Monday, August 5, 2013
A Little Background - Part 2
In November 2012 "J" and I began actively trying to conceive (TTC). My menstrual cycles have always been very regular (28 days), so initially we had hope that if we just timed things right, we'd be pregnant again quickly. I assumed I ovulated around cycle day (CD) 14 (and had cervical mucus signs (CM) which backed up that suspicion), but did not know for sure. During our three month "break" post-MTX, I'd looked into charting my temperature but - for various reasons - that didn't work well for me and I quickly gave up. So, in November I bought some ovulation predictor kits (OPKs). Over the next few months I tried several different brands all throughout my cycle. NEVER did I see a positive indication of ovulation. Frustrated, in June "J" and I scheduled an appointment to meet with my OB.
My OB, whom I'll call Dr. Awesome, was so wonderful throughout our ectopic experience. Initially I was worried about meeting with him because we'd only actively been TTC for seven months and I'd heard that most MDs won't consider an infertility diagnosis or workup of any sort until you've been TTC for a full year. However, Dr. Awesome couldn't have been more awesome. He took us and our concerns very seriously. He said that with me being almost 33, us knowing that I have endo and a blocked fallopian tube, a history of only one pregnancy which was an ectopic, and my failure to get a positive OPK or a BFP in seven months that we definitely did the right thing by coming in.
Dr. Awesome ordered blood work to test my progesterone (he thought it was a coincidence that I was there on CD 21 - it wasn't. I'd been doing my internet research!) as well as to test my Anti-Mullerian Hormone (AMH) to see my level of ovarian reserves. He also went ahead and ordered a Hysterosalpingogram (HSG) which is an x-ray that uses a dye to check the uterus and fallopian tubes. Finally, he ordered a semen analysis for "J." We set an appointment for the next month to go over the results of everything.
A week after our appointment, Dr. Awesome called (on a Saturday, no less) with my blood work results (see what I mean about him being awesome? He didn't make me wait until our appointment to learn everything!). He said my Progesterone was 8.62 which indicated that I had, indeed, ovulated that month (a happy surprise as I was beginning to think I just wasn't ovulating). However, my AMA came back low. Very low. Low as in 0.21. Dr. Awesome was convinced there was a lab error, and he ordered a repeat test. I went in a few days later for another blood draw.
"J" had no trouble scheduling his semen analysis (SA) and was able to do what he needed to do. We did, however, have a hard time getting results from the testing location to my OB. It took a phone call from my OB's office the morning of our results appointment to finally obtain them.
Scheduling my HSG appointment, however, was a bit traumatic for me. I called the place Dr. Awesome recommended and, after taking all of my information and scheduling the appointment, the receptionist asked me my height and weight. After I told her, she curtly said "You'll have to call "X" Hospital and schedule with them." I questioned her as to why and she responded that my BMI (38.9) was too high to do the HSG there. I was terribly embarrassed. I called the hospital and was able to schedule without problem; then I called my husband and cried. After reassuring me that I'm beautiful and he loves me just like I am, he said he would support me in whatever I wanted to do. We hung up and I looked up the number for my old OB who closed her practice four years prior to open a new practice in which she specializes in various womens' issues including weight loss. I scheduled a consultation with her for the end of June.
*With my next post (A Little Background - Part 3) I will finish "catching up" to present day.
My OB, whom I'll call Dr. Awesome, was so wonderful throughout our ectopic experience. Initially I was worried about meeting with him because we'd only actively been TTC for seven months and I'd heard that most MDs won't consider an infertility diagnosis or workup of any sort until you've been TTC for a full year. However, Dr. Awesome couldn't have been more awesome. He took us and our concerns very seriously. He said that with me being almost 33, us knowing that I have endo and a blocked fallopian tube, a history of only one pregnancy which was an ectopic, and my failure to get a positive OPK or a BFP in seven months that we definitely did the right thing by coming in.
Dr. Awesome ordered blood work to test my progesterone (he thought it was a coincidence that I was there on CD 21 - it wasn't. I'd been doing my internet research!) as well as to test my Anti-Mullerian Hormone (AMH) to see my level of ovarian reserves. He also went ahead and ordered a Hysterosalpingogram (HSG) which is an x-ray that uses a dye to check the uterus and fallopian tubes. Finally, he ordered a semen analysis for "J." We set an appointment for the next month to go over the results of everything.
A week after our appointment, Dr. Awesome called (on a Saturday, no less) with my blood work results (see what I mean about him being awesome? He didn't make me wait until our appointment to learn everything!). He said my Progesterone was 8.62 which indicated that I had, indeed, ovulated that month (a happy surprise as I was beginning to think I just wasn't ovulating). However, my AMA came back low. Very low. Low as in 0.21. Dr. Awesome was convinced there was a lab error, and he ordered a repeat test. I went in a few days later for another blood draw.
"J" had no trouble scheduling his semen analysis (SA) and was able to do what he needed to do. We did, however, have a hard time getting results from the testing location to my OB. It took a phone call from my OB's office the morning of our results appointment to finally obtain them.
Scheduling my HSG appointment, however, was a bit traumatic for me. I called the place Dr. Awesome recommended and, after taking all of my information and scheduling the appointment, the receptionist asked me my height and weight. After I told her, she curtly said "You'll have to call "X" Hospital and schedule with them." I questioned her as to why and she responded that my BMI (38.9) was too high to do the HSG there. I was terribly embarrassed. I called the hospital and was able to schedule without problem; then I called my husband and cried. After reassuring me that I'm beautiful and he loves me just like I am, he said he would support me in whatever I wanted to do. We hung up and I looked up the number for my old OB who closed her practice four years prior to open a new practice in which she specializes in various womens' issues including weight loss. I scheduled a consultation with her for the end of June.
*With my next post (A Little Background - Part 3) I will finish "catching up" to present day.
Friday, August 2, 2013
A Little Background - Part 1
Growing up, I loved babies and kids. In fact, my mom almost lost me in the mall when I was two years old because I followed a baby into a store. I started working as a Mother's Helper when I was 10 and was babysitting by the time I was 11. I taught lessons and coached swim teams; I nannied for a couple years. I got my teaching degree. More than anything, I looked forward to becoming a wife and a mother.
When I was 27 I had a large ovarian cyst that, even with medication, wouldn't go away. As I was about to take an out-of-county nine month teaching assignment, my doctor and I thought it best that I go ahead and have a laparoscopy to remove it. Before the surgery, I asked my surgeon to check my fallopian tubes (I had no reason to suspect a problem - except maybe intuition?) while she was "in there." Post surgery I received the news that my ovarian cyst was removed (non-cancerous... yea!) and that my ovary was saved. Unfortunately, the surgeon discovered I had pretty bad endometriosis (endo). Luckily, she was able to remove most of it. I was also told that while the "dye test" showed my right tube was open, my left tube appeared to be completely blocked (no dye passed through at all). I was terribly disappointed when in my post-op appointment I asked what my chances for getting pregnant were and was told - if the endo came back - probably only about 20%.
Fast forward a few years. I met a wonderful man who would become the husband of whom I'd always dreamed. We began having unprotected "relations" (though we were not yet actively trying to get pregnant) in January 2012. In July 2012 we conceived. My period was almost a week late before I FINALLY got a positive pregnancy test (I knew I was pregnant and was so frustrated at the BFNs I kept getting). Although my husband (I'll call him "J") and I were thrilled, I was also scared there was a problem (intuition again?), especially when I retested two days after getting a positive and saw that the test line had not gotten any darker. My OB wouldn't see me until I was 6 weeks pregnant, so I begged my PCP to order an HCG quantitative. I received the results - 35 - just before I started spotting. I called my OB again and begged them to do something, anything. The next day - two days after my original HCG quant - they retested me. My HCG was 42 (it should have doubled in 48 hours). What followed was a horrible two months of my HCG rising and falling, multiple ultrasounds that never showed anything (except - maybe - proof that I ovulated from my right side), a diagnosed "suspected" ectopic pregnancy, a shot of Methotrexate (MTX), and a long wait for the pregnancy to be officially over. It was awful.
While more than anything J and I just wanted to try again, because of the MTX we had to wait three months. In November 2012 we began actively trying to conceive.
*With my next post (A Little Background - Part 2) I will pick up our story starting in November 2012.
When I was 27 I had a large ovarian cyst that, even with medication, wouldn't go away. As I was about to take an out-of-county nine month teaching assignment, my doctor and I thought it best that I go ahead and have a laparoscopy to remove it. Before the surgery, I asked my surgeon to check my fallopian tubes (I had no reason to suspect a problem - except maybe intuition?) while she was "in there." Post surgery I received the news that my ovarian cyst was removed (non-cancerous... yea!) and that my ovary was saved. Unfortunately, the surgeon discovered I had pretty bad endometriosis (endo). Luckily, she was able to remove most of it. I was also told that while the "dye test" showed my right tube was open, my left tube appeared to be completely blocked (no dye passed through at all). I was terribly disappointed when in my post-op appointment I asked what my chances for getting pregnant were and was told - if the endo came back - probably only about 20%.
Fast forward a few years. I met a wonderful man who would become the husband of whom I'd always dreamed. We began having unprotected "relations" (though we were not yet actively trying to get pregnant) in January 2012. In July 2012 we conceived. My period was almost a week late before I FINALLY got a positive pregnancy test (I knew I was pregnant and was so frustrated at the BFNs I kept getting). Although my husband (I'll call him "J") and I were thrilled, I was also scared there was a problem (intuition again?), especially when I retested two days after getting a positive and saw that the test line had not gotten any darker. My OB wouldn't see me until I was 6 weeks pregnant, so I begged my PCP to order an HCG quantitative. I received the results - 35 - just before I started spotting. I called my OB again and begged them to do something, anything. The next day - two days after my original HCG quant - they retested me. My HCG was 42 (it should have doubled in 48 hours). What followed was a horrible two months of my HCG rising and falling, multiple ultrasounds that never showed anything (except - maybe - proof that I ovulated from my right side), a diagnosed "suspected" ectopic pregnancy, a shot of Methotrexate (MTX), and a long wait for the pregnancy to be officially over. It was awful.
While more than anything J and I just wanted to try again, because of the MTX we had to wait three months. In November 2012 we began actively trying to conceive.
*With my next post (A Little Background - Part 2) I will pick up our story starting in November 2012.
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