Day 3 Baseline Ultrasound and blood work

I have to take a second and be paranoid, OK?  Bear with me.  I went to my RE’s office for my baseline ultrasound and blood test.  It is the first item on my protocol sheet.  So the lady took some blood, she was an absolute pro, was funny and cheerful.  It was a nice way to start my way too early day.  After the blood draw I waited in the reception area to be called for my ultrasound.  And about 15 minutes of waiting a doctor walked by with his coat/briefcase/etc.  The front desk person mentioned something to him as he walked by that she thought he was scheduled earlier in the morning or something like that.  I smiled.  No worries.  I figured they accidentally scheduled me before the doctor was due to arrive. 

I did ask for the earliest appointment so I could get to a (suprise!) resolve.org Washington State Family Building Conference in Seattle that started at 9am.  Two of the doctors from my RE’s office were going to give a talk on different subjects and there was a presentation scheduled to take you through what happens to the retrieved eggs once they hit the embryology lab after transfer.  The geeky side of me is totally fascinated by all this sci-fi stuff.  I didn’t want to be too late.

After another 5 minutes or so I was asked to come back and get undressed, don the totally chic paper sarong and head into the ultrasound “lounge”.  We took a look with the ole trusty dildo cam and everything looked good.  My cysts (a drug reaction to Clomid) were all gone and both ovaries were looking good and each showed about 8-10 follies percolating along.  Not bad for an old gal who hasn’t been on any meds for a couple of months now.  The doctor said that looked very good, uterus seemed fine, etc.  The cam got put away, I was able to sit up and then the Dr. said  something to me that was surprising.  He wanted to know why I decided to do another IVF cycle.

“Ummmmm” I said, “I’ve never done an IVF cycle.  I’ve only done two IUI’s.”  I then went on to explain the fibroids, the surgery to remove them, my DH sperm issues, the D&C to remove polyps/adhesions and now jumping to IVF is what was recommended by two doctors at his office.  After my quick history was told to him he said something similar to Oh yes.  Well that’s fine.  And then he left the ultrasound room.

I didn’t think too much of it at the time but since then my mind keeps going over and over the interview.  Why did he seem to be concerned about an IVF cycle?  Was it because things looked good enough that I didn’t need it?  Did he see something that I should be concerned about?  Am I missing something?  I know that it is probably because he was rushed and didn’t have time to read and absorb my file.  He may have read IUI but thought IVF, but man…the whole thing makes me worried and a little sick inside. <sigh>  Maybe I should learn to keep my mouth shut and find out more by listening?  Am I making too much of a little comment?  Any advice or opinions out there?

Oh well…off to the Resolve.org conference. 

I had to change the bulb in the stairwell today…

Q: How many optimists does it take to screw in a light bulb?
A: None, because they're sure the light will come back on once it's ready.

AF is on her way, slowly but surely and I’ve got the massive headache to go with her.  I typically don’t get much of a headache with AF, but today I got to enjoy some pretty heavy handed dentistry on my front right tooth.  The pressure my dentist had to exert to set a new crown in place was quite severe.  He was very nice as always and felt bad to have to do it, but it was necessary to get the crown high up into the gums.  So I have a headache from that and I think that AF has kicked it up to Defcon 3.  <sigh>

The Washington chapter of Resolve.org is putting on “The Washington State Family Building Conference” this weekend.  I think that I may actually get my lazy toochis over to Seattle to attend.  The whole impending IVF in May (according to the schedule sent by me RE office) is getting me a bit nervous and I typically need to feel like I have a grasp of what is going on to feel much more comfortable.

Has anyone attended anything put on by Resolve?  If I go to the event I’ll be sure to make a report.  Stay tuned.

CDC ART Report Info and Links

Are you a statistics fan? Do you like pie charts? How about bar graphs?

Does this make you...hot? 

Well if it does then you should check out the CDC webpage and annual report on Assisted Reproductive Technology (ART). 

 

http://www.cdc.gov/ART/ – this is the main page with links to the different areas the CDC monitors and researches for ART.

 

http://www.cdc.gov/ART/ART2006/index.htm

The ART report provides an in-depth picture of the type, number, and outcome of ART cycles performed in U.S. fertility clinics. It also includes individual clinic tables that provide ART success rates and other information from each clinic.

 

I am still reading through this and I find is both fascinating and informative.  Have you read this report?  Any opinions?  Did you use this to help you find your RE?

 

If you are a really huge data geek, the data is available in excel form so you can make your own pie charts.  Mmmmmmmmm pie charts.

Techie Tuesday: SHG (Sonohysterogram)

Welcome to another techie Tuesday.  I am going to spend a few moments providing links to some IF techie things. I want to state pretty clearly that I am not a medical professional.  I am a computer geek/IT professional with over 20 years in the computer and biotech industries. A geeky gal who likes to research her condition/situation/whatever. My supreme computer nerdiness has enabled me to dig up some good places on the net where I have found some good info.  I wanted to provide those links so others who are in the same situation as I have been.  Desperate and wanting to find out as much as you can about the procedures that have been recommended to you.  I get it.  I’ve been there.  I am still there.

 

After getting my HSG check earlier in the month. I was also scheduled at the RE’s office to get checked out with a SHG (sonohysterogram).  Sonohysterogram is a fancy way to say “ultrasound-whoohaa-checker-upper”.  My doctor recommended this test in addition to the HSG because this tests gives the doctors a better look at the inside walls of the uterus while it has been expanded with sterile saline. 

Here is a some good description on HSG from my clinic's website:

Sonohysterogram (SHG)
The sonohysterogram (SHG) is similar to the hysterosalpingogram (HSG) in that it helps us to evaluate the uterine cavity. But, with the SHG, saline rather than an X-ray dye is instilled into the uterus and the progress of the saline is tracked with ultrasound rather than X-ray. The SHG provides clear views of the uterine muscle along with the endometrial cavity. Thus, we are able to see abnormalities like fibroids by SHG that cannot be seen by HSG. Also, by using ultrasound, we can utilize new 3D ultrasound technology that allows us to rotate the image of the uterus to obtain the best diagnostic picture. Even the most subtle abnormalities can be clearly seen with SHG allowing for accurate treatment planning. Unfortunately, the SHG does not provide any information on the fallopian tubes so it cannot replace the HSG.

I also found that this article has a good description of the procedure. 

 

Why would your Dr. recommend a SHG?

Well the way I see it, your RE clinic should perform this test to determine the following thing:

1. Do you have any uterine abnormalities that may be causing your infertility?
A few years ago it was with a combination HSG/SHG that we found a fibroid that was likely to be a source our infertility.  After it was surgically removed, a new SHG test showed some adhesions (scar tissue) and polyps that may cause PID (pelvic inflammatory disease).  This can also affect whether or not you can become and stay pregnant.  Some ladies who have unfortunately miscarried have had fibroids found that may been attributed to their loss.  I don’t have endometriosis or PCOS, so I can’t talk on those subjects, but if anyone has a blog that discusses the methods of their diagnosis, I would  be happy to provide a link.

Here is a good web article about using ultrasound to diagnose IF problems:
http://www.webmd.com/infertility-and-reproduction/guide/ultrasound-for-infertility

How does an SHG feel? What is involved from the patient's point of view?

Going through a SHG for me was relatively easy.  You are asked to arrive at the doctor’s office with a full bladder.  OK. Well, good point.  Trying to go through your day getting enough liquid in your system to make a “full bladder” without overdoing it, desperately hoping you don’t piddle on the floor like some excited cocker spaniel can be a bit tricky.  But I digress…

After taking off your clothes below the waist, you are given what I call “the paper hula skirt” to wrap around you for privacy/modesty/who are we kidding?  Then you enter the ultrasound room and are asked to sit in the exam chair (y’know the one with the stirrups).  In my RE’s office I have never had a technician perform the ultrasounds.  It has always been one of the 4 RE docs who perform and interpret the exam.  I like this aspect a lot.  They get to see first hand what is going on.  This is yet another reason why I dig my RE’s office.  I have been poked and prodded by all of the doctors at one time or another.  I find that they are all stellar professionals.

 

And now on to the fun part…once in the exam chair, they put the ultrasound goop on your belly then smear it around with the barcode reader looking thingy.  When that is in place, a speculum is used to access the cervix and a catheter with saline solution is introduced.  Then the speculum is removed and they insert the dildocam (what is the real name for this thing anyway?  The vagascope? Pooterviewer?).  I was able to watch while they inflated the uterus with saline and DocO pointed out some fleshy bits where the endometrial lining was supposed to be smooth.  “Yup.  It looks like a few polyps and adhesions.  The good news is that I don’t see any new fibroids affecting the cavity.  A simple D&C and polypectomy will take care of that.  Then I expect we can get a really good looking lining to help with implantation for the IVF.”

 

How did it feel?  A little uncomfortable, but mostly because they are moving the wands around inside and out while your bladder is full.  The saline push didn’t cause me any discomfort, especially since the HSG earlier in the month was quite uncomfortable, but this was because they were trying to open up the constricted fallopian tubes.  All and all I was very happy with the result.  Knowing a cause to something that may have negatively affected the results of my earlier IUIs made me feel better and helped me keep optimistic that things would look better in the future.

Techie Tuesday: HSG (Hysterosalpingogram)

Hello folks. Today is techie Tuesday. I am going to spend a few moments providing links to some IF techie things. I want to state pretty clearly that I am not a medical professional.  I am a computer geek/IT professional with over 20 years in the computer and biotech industries. A geeky gal who likes to research her condition/situation/whatever. My supreme computer nerdiness has enabled me to dig up some good places on the net to find info. I have been up many a late night trolling for data and more information on this whole infertility thing. Anywho...

So on 4/2/09 I got to "enjoy" a HSG exam by my excellent RE. Ill call him DocO from now on. DocO is great. He is pleasant, smart and doesn't pussyfoot around (heh...get it) when it comes to his IF diagnosis protocol or recommendations for treatment. He seems very efficient, experienced and confident. He never comes off as arrogant or pushy. I like that a lot. If a RE treated me like dullard, I'd be outta there faster than you can say, "You want to put that WHERE?!?"

Here is a some good description on HSG from my clinic's website:

Hysterosalpingogram (HSG)
The HSG is an imaging test that allows us to evaluate the inside of the uterine cavity and the fallopian tubes. This test involves injecting a small amount of dye through the cervix while tracking the progress of the dye by X-ray as it fills the uterine cavity and traverses the tubes. The structure of the uterine cavity and tubes is reflected in the pattern of dye. By knowing this structure, appropriate treatment can be recommended. Even with IVF, knowledge of tubal status is important. Research has shown that the presence of even one blocked and dilated fallopian tube, called a “hydrosalpinx”, decreases the pregnancy success rate in an IVF cycle. The hysterosalpingogram (HSG) does not tell us everything about the structure of the pelvic organs. It does not show the muscular wall of the uterus or the ovaries. It is possible to have a normal HSG but still have a significant pelvic factor such as fibroids, adhesions or endometriosis. But, vital information on tubal condition is best obtained through HSG .

Why would your Dr. recommend a HSG?

Well the way I see it, your RE clinic should perform this test to determine 2 things:

1. Are you fallopian tube open or blocked?
   If they are both blocked, then sperm cannot meet the egg when released by the ovaries. If both tubes are fully blocked, then you will not be able to get pregnant without IVF or perhaps surgery to fix the fallopian tubes.
   
2. Is your uterus a normal shape?
   If you uterus is of an unusual shape, then there are issues the RE must address. The first time I had a HSG in 2007, they found a submucosal fibroid that severely distorted the shape of my uterus. It was suggested that the abnormal cavity shape acted like an IUD, so while eggs may have been fertilized, when they came to the uterus, they were unable to attach to the uterine lining. HSG can also find if you have a bicornate uterus or a septum that divides the uterus.

Here is a video that shows the HSG xray:
http://www.youtube.com/watch?v=yORqDQKCkX0

Here is a good web article about HSG:
http://www.webmd.com/infertility-and-reproduction/guide/hysterosalpingogram-21590

How does an HSG feel? What is involved from the patient's point of view?

Here is my recent HSG experience. The test was done in the hospital across the way from my RE's office. I checked in to the outpatient area, then was taken to a room and asked to remove all clothing (except my socks) and dress in one of those tie-in-the-back/hey-is-it-a-full-moon-tonight gowns.  I also was given a robe to cover me bum (cheeky monkey). A nurse walked me down a couple of doors to the procedure room. There was a soft exam table with clean sheets and a pillow below a large x-ray machine. DocO was there waiting for me, we shook hands and enjoyed pleasant greetings.

I hopped up on the table and got the old "scoot down...a little more...a little more" routine until I was in the proper location, then the x-ray machine was adjusted over my lower belly. DocO was nice and explained what he was about to do before each step to help put my mind at ease. This article gives a good description in the section, "How is it done". Refer to that for the medical stuff.

How did it feel? Pfffffftttttt...wellsir? The speculum is never, eh...fun. The clamp/tenaculum felt like a rough fleshy pinch. Places know that they are being handled in a manner that does not befit a lady. When the fluid/dye was injected, it didn't feel like much until things are getting quite...ahem...full. And then they seemed fuller and fuller and yowch quite a bit uncomfortable. The x-ray showed both my tubes blocked. Now this can show up because they are truly blocked or  because of a spasm. A spasm?  DocO explained that since the uterus is a muscle, the introduction of the fluid can cause it to contract, therefore blocking the tubes during the test. Sometimes to counter this effect, more fluid/dye is injected which causes more pressure and can either cause the uterus to contract in a different way and allow passage for the dye, or can forcibly clear minor blockages of the fallopian tubes.

So he added more,
and more,
and more,
until it felt like I was going to bust.

I didn't feel pain per se, but I did eventually get quite uncomfortable and crampy. Have you ever needed to pee so much you were on the brink of pain? Yup. Just like that.

DocO and the nurse noted my discomfort and finally stopped the dye injection. This immediately made me feel better and then it was all done. It took about 10 minutes from the time I stepped into the room. We got the information we needed. The tube blockage was a concern, but since we are going on to IVF it isn't too dire.

Here is a page from the Mayo Clinic site that describes different tests that evaluate the uterus.

After the test I went home and worked. It's good to have a pad on when you finish the procedure and for the rest of the day. Some of the dye/fluid will need to clear out of your system and you may notice a tiny bit of spotting. I was generally fine, although I was a little sore inside, kinda like when you know that AF is due any minute. 

The Optimist View:

The good news is that this test is completed and there were no major malformations or anomalies in the uterus that caused DocO great concern. He did notice some shadows on the test that he thought indicated polyps or adhesions. I was so relieved to see no fibroids had returned from the prior year's surgery and that my uterus was of normal size and shape. My next scheduled test was going to determine that in a few days time. That test is called a sonohysterogram or SHG.

Why is the Optimist View section necessary for my blog? The truth is I need to write about the things that keep me optimistic.  I believe in positive energy for my own mental wellbeing.  I don’t choose to focus on the negative things.  I am not a Pollyanna.  I well aware of the fact that “the odds” are not in my favor and if the circumstances  become medically critical, then I promise to admit defeat gracefully and choose a different path for my life that doesn’t involve biological children. 

Please feel free to leave a comment with your experience or information with a HSG test. I may make things much easier for others who need this treatment to know what to expect.

Take the Clomid Challenge

"Do I have to study?" I wondered, “If I take the CCCT (Clomiphene Citrate Challenge Test) do I win a medal? Can I get a happy face on my term paper?” Well...sort of. It was simple...kind of...well you see there was this snowstorm. I'm getting ahead of myself. Let's start with the geeky part.

In Dec. 2008, the RE's office asked me to come in on day 3 of my cycle for a baseline ultrasound and to give blood for the hormone evaluation. Here is a good article that includes a description on the baseline ultrasound from www.bellybelly.com.au and some more info on infertility preliminary tests.

As I understand it, the Day-3 blood, along with the Day 10 post-clomid blood test assesses the levels of hormones of FH, LH and Estradol. The combination of the blood test results and the baseline ultrasound which includes checking the ovaries, uterus and an antral follicle count are used to estimate ovarian reserve and egg quality. This test made me particularly nervous. I was 39 when I gave blood for the test in early December, but I was going to turn 40 very very soon. If you look at fertility rates in patients who have poor numbers for this CCCT test, the chances that they will get pregnant using their own eggs is significantly reduced per cycle. Sometimes going from a 70 to 30 percent probability. That’s a huge drop. I have read some infertility blogs where women are concerned about their egg quality, fail several IVF cycles, but never mention anything about this test in their writings. I am always curious if their doctor’s office performed this test and whether they had a good or poor result.

Here is the best description I found on the net for the purpose of the Clomid Challenge test:

Clomid Challenge Test
The Clomid challenge test is another way to predict ovarian reserve. A poor result is an indication that advanced reproductive technologies, using the patient's eggs, will not be successful. Estradiol, FSH, and LH are measured on day three of the menstrual cycle. Clomid is administered on day's five through nine; the FSH level is measured again on day ten. An elevated level on day ten is considered abnormal. Most patients who have an abnormal Clomid Challenge test are advised to use donor eggs or seek adoption.

So I gave my blood and had by ultrasound, then I took the clomid pills on days 5-9 and was ready go go on for my day 10 blood draw, but there was this huge snowstorm that had been going on for days and they couldn’t get anyone into the office on a Sunday for the blood draw. The RE’s office was very nice and promised, since we had to do the test again next month, that they wouldn’t charge me for the cost of the test at all (not even for the next month’s test).

My RE’s office lists their success rates and I believe these are the ones report to the CDC, but they also break down the success rates into further categories of “Good Prognosis”, “Medium Prognosis” and “Poor Prognosis.” I am very lucky. My CCCT test results showed my ovarian reserve is fine and that I “passed” the test with good results. In the words of DocO “you have the best numbers possible for a women of your age. BUT…this doesn’t mean there is any time to delay. We are still talking about 40 year old eggs.” Yeah, I know but this sure helps a lot toward my goal of staying optimistic.

TTC History (the long version)

***updated July 19, 2009**
I decided to post the very long story of our TTC journey. Everything started with uterine problems that have caused me great trouble and delay. When I was 34ish, I could tell that some things started to change in the operation of my monthly cycle. It is one of the main reasons that I really took stock of my life and realized how much I wanted a family with my SigOther. I had no idea it would take us so long just to get to this stage.

Please forgive/enjoy my shorthand style of storytelling below, but I thought it was going to be a quickie sidebar entry. One of the other blogs I read had an awesome history listed as a side link, so I started to make one too...but I realized it got so long that I changed it to a regular post. I may add an abbreviated version as a sidebar later. 

It's funny...looking back and reading it seems like so much. The truth is while you are experiencing it, these all just seemed like little setbacks and issues. Is that why I still to choose to be an Optimist? I am healthy and happy. My DH is the best person in my life and now we are really going to embark on the serious journey. I'm excited.

---

June 2005: Stop using BCP's tell SigOther (SO), “Me want baybee, nom nom nom.” SO = “lemme thinkaboutit.” He is in charge of BC during this time.

Apr 2006: Go to RE, get full workup. SO = minor male factors, Me = small 2cm intra-mural uterine fibroid found. RE suspects the fibroid may be acting like an IUD, but isn’t 100% sure, could be a combination because of MF. RE recommends major abdominal surgery to remove fibroid/preserve fertility. This procedure requires a 2-month recovery period where I would not be able to work. Other less invasive procedures available, but not recommended when trying to preserve fertility. Yikes.

Apr 2006-May 2007: Invasive procedure + Work issues = Let’s try TTC on our own. Result: no dice. Fibroid is now getting huge and causing health issues including pain and anemia.

June 2007: Return to RE. Us: “OK, we’re really for the major surgery.” RE: “Good news. I recommend a local doc who does a great job with a less invasive, laparoscopic approach.” Us: “W00t!”

7/7/7: SigOther proposes: “Will you marry me? Let’s have a family.” Me = “Yay!”

July 2007: Request appointment with surgeon/OB.

Sept. 2007: Best Friend/SigOther of 10 years now = DH. Happy happy, joy joy.

Sept. 2007-Oct 2007: Appointments with surgeon/OB. Exams, tests, ultrasound, etc. OB’s response “Wow! That’s a huge fibroid! It’s the size of a small orange.” Went from 2cm to 11cm diameter in less than 2 years. Surgeon recommends hysteroscopic myomectomy with 1-2 week recovery. This takes the least invasive (vag) route and he thinks he can get the whole thing. I agree to try this with the understanding that it may not get the whole thing. Surgery scheduled in Nov. Yay!

Nov. 2007: Surgery postponed ‘til 12/26. Merry freaking Xmas. Grrrrrrr.

Dec. 26, 2007: Surgery goes fine. Recovery excellent. Now we wait to see if they got the whole fibroid tumor all out. Come back in 6 weeks for checkup/ultrasound.

Feb. 2008: 5 weeks later…OUCH! Pain, pain, pain, pain, pain. Emergency room visit, etc. Ultrasound shows more than half of fibroid still remains and pain is due to its dying/degenerating. I guess it was buried in the muscle pretty deep.

March 2008: Laparoscopic myomectomy. Tiny little incisions, less invasive. Surgeon is a pro, he gets the whole thing out and triple sutures my poor uterus (which had grown to the size of a normal 3 month pregnancy).

April 2008: Checkup indicates all is fine, fibroid gone. Surgeon recommends that we wait TTC for 4 months.

August 2008-Nov. 2008: TTC on our own = no dice. BFN all around. Did all of the charting, POAS ov tests, etc. Timing seems right, but now we think that the MF may be enough of an issue that we no longer wait.

Nov. 2008: Back to RE. Try IUI no meds = BFN

Dec. 2008: 50mg clomid + IUI = BFN, DH samples have low count. CCT is cancelled due to snowstorm. Oh, and as an added bonus, I turned 40. Grrrrrrr.

Jan. 2009: Clomid poorly affects uterine lining, making it too thin. IUI cancelled, we try on our own, BFN.

Feb. 2009: Colomid exceptionally bad for uterine lining, developed ovarian cysts. Lining is really thin. We’re off that drug for good. Egg quality test for me = good.

March 2009: Wait for cysts to go away before we start IVF. HSG and SHG tests reveal some adhesions and polyps. RE recommends D&C to remove these before the IVF as this may interfere with implantation.

April 2009: D&C goes great. Polyps removed. It’s just like prepping the soil in springtime for planting.

May 2009:  Recovered from the D&C, everything is working well.  Started my IVF cycle #1 using an Antagonist Protocol (Gonal-F and Cetrotide).  Stimmed very well for 7 days lots of follicles and good E2 levels, but then antagonist didn’t work.  LH surged so HCG trigger was administered.  Despite all setbacks, retrieved 10 eggs, 6 mature and all 6 fertilized using ICSI (Yay!). 

June 2009:  Transferred 4 8-cell Day 3 embryos. Low positive shown but didn’t last (chemical pregnancy).  Doctor suggested in follow up meeting that antagonist didn’t prevent LH surge for me, but otherwise many things went well.  Suggested cycle off and then try again with a different protocol.

July 2009:  Micro-dose Lupron Flare protocol recommended by RE.  Blood work and baseline ultrasound look good.  Start IVF #2.  It’s on like Donkey Kong.

Hello World

http://en.wikipedia.org/wiki/Hello_world_program

A little bit of geek humor for those programmer types out there. I mean, how else do you start to learn a new language?

I am taking today to set up the site, enjoying the bright sunny layout even though the weather here may be rainy and gray.