Reporting in from my RE appt this afternoon. My bloodwork cane back great. FSH was something like 5.7 which she said was excellent. Thyroid WA normal too. She gave me an u/s to check on my fibroid, etc. The fibroid was down from 6x9cm during my pg to 3x4 cm. It is intramural, in the wall of the uterus, but not impacting my lining or interior form. That is a relief. My lining was good and she counted 9 antral follicles on the left, which she thought was great. My right ovary had a few follicles but was far more quiet.

I remember that when I had cyclic pain in the past the u/s always showed ovulation on the left. Then fibroids in TCM are linked to blood stagnation, and my fibroid is on the right. It makes me think that maybe I should try some arvigo massage to help improve circulation.

She said the short LP was of some concern as we could be conceiving and miscarrying. She said she wouldn't want to try meds while I'm still nursing. She thought it would be a good idea to have my partner have another s/a.

We had a nice visit and i told her about my delivery and how my fibroid surgery with her was a positive experience that prepared me for my c/s. I told her to feel free to share anything from my history that might be helpful to other patients. I'm glad I went as now I can just work on tweaking things. My RE said to consider the door open once we had weaned if we might want to try letrozole or clomid.

I just scheduled an appointment with the RE for the week after next. I pressed to get CD3 bloodwork done before going in, as AF is due next week and that would be a lot more useful for the consult -- otherwise we might have to wait until mid-November as my cycles are running around 5 weeks most times.

I called my partner to let him know I scheduled a consult and he started going on about how we haven't been trying at all and that we need to try 30 times and be all mechanical about trying. I reminded him that I've been charting and we have been timed correctly. I got AF back two years ago, which means I'm ovulating.

Talking to my partner just left me frustrated. Here he keeps asking me if we are going to have another and then when I try to take the next step to get some professional input he starts to act like he knows better.

I decided that you guys were right, that a consult with the RE, who has specialized training in this area would be the quickest way to get the input that I want. I've worked with this RE before, she did my fibroid surgery and repeat d&c. It isn't like I'm going to talk to some unknown person.

The big business of fertility medicine

As I was driving to work yesterday I heard mention on the local NPR station of an upcoming program about fertility medicine. I didn't catch when it was and searching their site hasn't been helpful so I decided to do a general web search. I did find some other interesting artitles that I thought you might enjoy so here you go.

I think this first one is the program I heard about on the radio, about the unregulated big business of fertility medicine:

The Baby Business - Here and Now Podcast and a transcription on the Living on Earth site
Infertility is a painful prospect for hopeful parents, but Harvard Business School professor Deborah Spar also saw infertility as a big business, 3 billion dollars in the U.S. alone. And she says, should we view it more as a business.
Wed, 08 Mar 2006 16:58:02 EST

The Fertility Race -- a series of radio shows from Minnesota Public Radio about fertility


All Too Conceivable - Slate.com, an article about the short-lived NBC show Inconceivable


It's interesting listening to the program after our recent stint back in with the RE. I'm feeling pretty okay right now, and my period just show up yesterday even. I feel liberated right now, like it doesn't matter if we conceive or not. I don't think I wrote about it here but my sister called me last week and I told her about our recent struggles and how I just didn't like how it all felt and she said right away, quite earnestly and supportively -- "but you have so much else going on in your life." It was said with love and compassion and a deep understanding of my value and worth, something only a sister who loved you could say or perhaps a very dear friend.

I found out this week that one of my infertile buddies finally birthed her little girl, she got pregnant right as my last one was failing. And then another online buddy, this one dealing with Spleen Qi Deficiency and infertility and being treated by an acupuncturist, she got a BFP and I'm really pleased for her.

While in New York a few weeks ago, my friend Jen mentioned that it was odd for those of us who meet in the online space to have access to each other's lives in this deeply personal and intense times of our lives as we deal with fertility and family. I think she's right, it's downright profound that we should even think to share so much of that experience with relative strangers online, though it speaks volumes to the relative amount of stress the experience comes with that we need to talk about it so much. The only downside of it is when you find out that you are in the very small group of people who don't concieve on their own after two years. And then watch as others pursue fertility treatments, some of which are not available to you due to other health issues. And then when the situation changes and you realize that you have philosophical issues with fertiity treatment and that you don't want to do it (that's me right now), it just makes it hard to relate a bit to those who were infertile and are now mothers. Those who were infertile and are now pursuing treatment. Those who were infertile and are pursuing adoption.

I think that God has a purpose for me yet, be it as a mother or in some other role. I just need to be the very best me I can be in the meantime so I'm refocusing on life outside of baby-making. I'm able to focus around the house like I haven't been able to do in several years due to the emotional disruptions of fibroids, infertility, surgery and miscarriage. I'm able to focus on growing at work and I'm really proud of my strength and determination. I still care for my online friends so much, and I've been pleased to see that they are as awesome in person as online. There's a great gift in that and someday I hope to see more of them as I travel around.

Goodnight for now.

Introducing my new fibroid

I just had my RE appointment this afternoon and it was an interesting experience. My partner basically laid it out there for her, that we were feeling that it was worse to get pregnant than to not get pregnant -- since losing the pregnancies was far worse than not having them. She suggested that we try using Femara to induce ovulation for a few cycles, in the hopes of promoting a stronger ovulation. After a few cycles we could then move on to trying IUI. She said that really, in spite of my partner's poor morphology, that getting pregnant on our own really was the ultimate test of his fertility.

We also discussed and scheduled a HSG for next week, to check for adhesions, any damage to the lining from the two d&cs and make sure the tubes are open. Sounds reasonable, and its what I wanted.

I brought up again that I had read that low ferritin had been linked by some doctors in Britain to lower fertility and increased miscarriage rates and she dismissed me and said that she had never heard that and it wasn't something that she would check for on her own. If I pressed she would do the bloodwork but whatever.

Then she suggested that we do an ultrasound right then and there to see about any new fibroids. Sure I thought, but there weren't any when I had my ultrasounds around the last miscarriage. Low and behold, there was a brand new 2.5 x 3.5 cm intramural fibroid, but away from the uterine lining and towards the outer wall of my uterus. I was in total disbelief. I just went through major abdominal surgery just 14 months before, and there wasn't anything on the scan last June. How could this happen so fast, and in the same are of my uterus?

She said it seemed to be pushing the right ovary out of the way a bit, distorting it on the scan. How nice eh? She said she doesn't think it is causing me any problems right now. She also checked my lining via ultrasound and said that it didn't appear inconsistent which can sometimes be an indicator of adhesions. I'm going to have an HSG on Tuesday next week to check my tubes. If that all looks okay then we'll try for a few cycles using Femara/Letrozole to see if maybe there is an ovulation dysfunction that we can override.

As my doctor was leaving the operatory I said dryly, "well at least I've been growing something in there," and she totally didn't know what to say but then she laughed (my twisted sense of humor overwhelms them you see).

So what should we name this new little interloper?


Some of the lovely things you find in the RE's office.

Baby Steps

I bit the bullet today and scheduled an initial consult with my RE (the RE who did my surgery and helped me through 1-1/2 miscarriages). We're going to see if we can stick with her, recognizing her limitations but also the leverage we have with her and her staff.

I set up an initial consult with her since we never had one with her. I just ended up in her care after my previous RE left the clinic and trusted her with my surgery and that's where it was left off. I sort of feel like let's start over with all this and see where that gets us. Yes, I have lots of information and opinions but we also want to know her take.

I think I mentioned before, but the plan that was laid out for us by more then one RE was:

1. Have surgery to remove fibroid
2. After healing (3 months), try on our own for three cycles or so
3. If not pg then move onto Clomid/IUI for three cycles
4. If not pg then consider moving onto IVF (possibly with ICSI -- though with the SPA test his sperm performed really well so this shouldn't be an issue)

We were going to do a trial of Clomid/IUI in July '04 but then got pg and had the firsst m/c. Then we started TTC again after my surgery and retained tissue experience in Feb '05 only to get pg the third cycle and then lose that one as well. It's like we never get to go to the next step. Sharing it with you guys just reminds me of the feeling I had with each loss that maybe God was trying to tell me something -- it's so hard to know that though.

My appointment is scheduled for February 14th - Valentine's Day. I know that's a bit of a downer but at the same time it fits in really perfectly with my cycle -- so if we don't get pg this cycle (and chances are we won't based on our past lack of success) then AF is due right about then and there will be time to either get right into a Clomid cycle or do the HCG or both. There's a chance we might change the appt so to not ruin v-day but for now that's where it stands.

I also just set up a time to review my medical records so I can pick out the sections that I need for my files, which can supplements the ones I already have so I can transfer the files to my RE's new clinic.

One step at a time, right?

My Medical Care Providers Over the Past Three Years

Before having to deal with infertility I had the unfortunate luck to have been injured in a car accident back in 2000. Through that experience I realized that my healthcare providers didn't have my best interests at heart, they wouldn't let me know to come in for a follow-up appointment, sometimes I was referred to lame care providers. I came to understand that the only one fully vested in my recovery and well being was me. That helped set the stage for the adventure that started when we got into TTC.

September 2002 -- Internist diagnoses fibroid (dump internist due to issues with getting appointments and information from her in the couple of years in her care -- I had to wait a week for an appointment when my neck went out and I was in constant pain and couldn't turn my head).

October 2002-March 2003 -- worked with a naturopathic doc who helped me gain better balance in my diet and lifestyle but also wanted me on a ton of supplements. She asked me if I had considered adoption and how long I intended to cut back on alcohol and taking prenatal vits in a way that wasn't entirely supportive so I stopped going there.

February 2003-May 2003 -- Met with RE#1 who I liked and she did an okay job but she left the State and clinic after a few months. She told me I should have my fibroid out after my HSG but to find a new surgeon. Even though my basel temps charts showed that I had regular cycles and temp rises consistent with ovulation she dismissed them after saying "yes you ovulate" and then told us we should do the HSG and then move onto IUI with Clomid and that she could "make me ovulate" which I didn't like the sound of at all.

June 2003-Nov 2003 -- Met with RE#2 to try to figure out if I needed to have fibroid surgery or not. He decided to give me a fertility work-up (just blood work) and wasn't a good listener. He told us that my partner had anti-sperm antibodies almost certainly and we would need ICSI to conceive (you won't be able to conceive on your own he said). While he knew his stuff I really didn't like him and his arrogance so I left him after one last consult in Nov to review my pooled progesterone results and to see if he would provide care if I had a fibroid embolization instead of abdominal surgery for my fibroid. It ended with a strong conversation about fibroid embolization.

July 2003-Sept 2003 -- Gyn #1 who I was scheduled to have my fibroid surgery with but I got such a bad feeling from her that I cancelled the surgery 10 days before and decided to pursue other options.

November 2003 -- consulted with an interventional radiologist about having my fibroid embolized (they block the blood flow using small particles through the uterine arteries). He was nice but I wasn't sure and couldn't find a gyn to provide support to this procedure.

Dec 2003 -- met with Gyn #2 who was all right but a little young and I cried in her office and she just looked at me, offered no consolation or anything. Her office was hard to book appts with so I decided to bag them.

Jan 2004-May 2005 -- started working with acupuncturist #1 after prompting by a couple of friend in alternative medicine. He was very nice

April 2004-current -- fell down the stairs and reactivated my back injury from a car accident in 2000 prompted a visit to chiropractor #2 (chiro #1 took bad care of me after my car accident)

Jan 2004-July 2004 -- met with RE#3 who was very nice and a good listener. We were going to try clomid/IUI under his care in July but we got pg on our own in May. He did my first d&c but left the clinic the following week; he told the nurse that I didn't need to have my beta checked post procedure which was wrong. I had continued bleeding for weeks afterwards due to retained tissue and had to see RE #4.

August 2004-current -- RE#4 took care of me after my m/c showed to be incomplete. We decided to wait it out rather than try methotrexate to avoid doing a repeat d&c so soon after the first one. With my enlarged fibroid not decreasing and the retained tissue not resolving on its own she was the one who did my surgery on both in November.

June 2005-current -- acupuncturists #2/3 work together in a practice that specializes in fertility. I went to see them first the week of my miscarriage as I was in so much pain.

Sept 2005 -- gyn #3 was very sympathetic, but gave signs of being a little conservative such as 37 week c-section due to my myo though he did say that they would take good care of me on a subsequent pg.

I'm not really a problem person but I wasn't really to take standard b$ care from my docs, especially after seeing how lame they were 5 years ago after the car accident --- you have to look out for yourself.

Report from the ob/gyn visit today

My appointment went well but I was really upset by the end of it, having to explain about all I've been through. The doctor was very nice though and when he saw that I was getting upset he switched over and started saying lots of consoling, positive things which was what I needed. We talked about a c-section delivery and how he would do that and I learned some about their practice. He was a little confused as to why I was seeing an RE without having fertility treatment but finally I think he got it, just circumstantial that we hadn't yet gotten to any fertility treatments. I feel like Annie in the musical, "I think I'm gonna like it here."

I dropped by my RE's office which is now on the next floor down to say hi the office staff who know me pretty well now. Still feeling upset, I decided that I wasn't ready to go in to the office so I went home and took a nap for an hour and a half (I did get up at 5:30 this morning) and then felt tired and icky after I woke up. I cooked lunch and made some passionflower tea to calm my nerves (good stuff) and realized that I was holding my muscles related to my uterus. I've been feeling crampiness like after my HSG. I think it was the PAP that set it off, probably brought back pain memories as well.

I finally got into work after 2pm. C'est la vie right?

Back from the doctor's

There are two ways to interact with a doctor. One is to sit back and see what they tell you. The other is to research more about your situation, symptoms and options and then ask a lot of questions. I prefer the latter as the former doesn't get you very far with today's managed care and insurance limitations. Doctors seem to get a little less engaged (if they ever were otherwise I don't know) and just give you the standard answer. I don't want the standard answer, which I anticipate was that our second loss was just bad luck. I want real answers.

So, I'm waiting in a consult room and my RE comes in and asks me how I'm doing. I said I was there to see about what next in light of my recent loss since even she thought there was possibly something more. I then told her, "I'm going to throw a lot of information and observations at you and I want to hear what you think" to which she agreed.

I mentioned the diagnosis of adrenal exhaustion from my naturopathic doctor a couple years ago, about my consistently low progesterone levels at each testing (not rock bottom low but always kind of a non-performer) and about how my recent acupuncture pattern has evidenced a consistent kidney yang deficiency which translates into weak adrenal functioning.

I mentioned my night sweats during my luteal phase and she said some women are really sensitive to drops in their estrogen level. Then I told her about the night sweats during my pregnancy which she said was common. I said that while I know it is a symptom of pregnancy that the stories that I've read online don't have this symptom until further along and that the ones I've seen with it starting early have also been losses. Obviously just circumstantial but when I said I had the sweats really early on I think she understood the difference.

I mentioned my charting and about how a nurse and an acupuncturist worked together to look at charting symptoms and that I have a characteristic slumping mid-luteal phase consistent with a type of luteal phase defect -- in spite of my consistent and regular ovulations and periods.

I then brought up about my sensitivity to stress and about excess cortisol and how that might impact my T3 levels and that I'd never had a full thyroid panel done. She agreed and said lets take a look and put down for the anti-thyroid antibodies which was brought up in one of the loss forums I was on. I told her that thryoid problems had surfaced for other women in my family around childbirth and that while I had always tested normal for TSH and T4 that I wanted to make sure there wasn't anything we were missing.

I talked about my pregnancy symptoms which she said could have been my body reacting to a poorly performing pregnancy as much as anything else. I mentioned the cycle I got pregnant and all my hormonal ups and downs over the past 6 months. About vitex, which she knew nothing about and I really want to send her some printouts about it, and rhodiola rosea. I mentioned the book Coming to Term and about how it said that up to four losses in a row didn't increase your risk. She hadn't heard of the book and wrote it down in her notes to check it out. We agreed that we would hold off testing for anti-phospholipid antibodies and some of the other standard repeat loss tests for now.

She said that because I'm thin she didn't think diabetes was an issue but I told that I didn't think that I had a disease or anything, but I've noticed I'm more sensitive and want to know if there's possibly a little something there as I've definately been feeling weird about eating sugar and simple carbs. She said that one a few occasions she has come across thin women with blood sugar issues that she didn't expect and thought it was worth ruling out. I asked about testing for adrenal functioning with a glucose test and mentioned the 24-hour test my partner had done. She said okay but instead we would do a fasting glucose and insulin test which since I had breakfast will be tomorrow morning.

She said when she was in medical school she thought she had 3 out of 4 diseases that she read about. I told her that really I don't think I'm diseased but I want to rule out a few things that have shown up as a part of my acupuncture treatment and since these hormones are part of the supporting cast the affect my fertility I want to make sure that we don't ignore it. I'm not a hypochondriac really. I told her about how for years I had poor eating habits and high levels of stress and anemia -- that I really ran my system ragged.

I asked if we could test my ferritin to check my iron stores and she thought we should to the full blood count again as well. She also wanted one more beta HCG to make sure it had all gone down. Yeah well, for some reason that test always makes me sad since I've had like a dozen draws to watch me get unpregnant and only 4 to watch it rise.

When I told her about feeling like needing a little break due to all that my body has been through over the past year she agreed, it was a lot for one person to go through physically. She said when we were ready to start trying again give it a few months and if nothing happened then we coudl talk about ways that she might be able to help out, which I took to mean Clomid or another fertility drug, Rx progesterone perhaps in a different format, etc. Ugh. I don't want to think about it.

I won't get test result for many of the things until Tuesday next week. I wonder if anything will show up.

For Someone Going in for Her First Infertility Appointment

If you are going in to see an RE (reproductive endocrinologist) it is good to have an idea about what will happen, know more about things that will be tested and also understand the range of things that could contribute to your fertility non-performance.

Usually the plan is to start with the least invasive testing and analysis and then progress into more invasive as required. Here are the usual steps:

1. Blood work
2. Semen analysis
3. HSG (before trying IUI or Clomid)

Here are some links to sites and article that I've found over the past couple of years that have been the most helpful about the general infertility workup (I've got loads of links on specific conditions and hormones as well, but I'll have to publish those in other posts.)

I like this section quite a bit for getting a handle on what you want to get out of your fertility treatment. It's very thorough.

Making Your Fertility Treatment Plan:
How to Avoid Hit-or-Miss Fertility Treatment

Here's a good link about testing:
A Comprehensive Infertility Work-Up

Here are hormones levels to reference:
Hormone Levels & Fertility Bloodwork



Another page about infertility tests

This article (Infertility Care and the Role of the Compounding Pharmacist - PDF format) has some info about how your chart can indicate different issues with follicular development and hormones

This page is for a group in Britain that does pre-conception consultations. They are after healthy mothers and babies, it might give more insight into nutritional issues for you:
FORESIGHT PREPARATION FOR PREGNANCY PROGRAMME


Remember at your appointment that your treatment plan needs to match up to your social, financial, spiritual and ideological beliefs. Be sure to communicate if you are not comfortable with anything they recommend. I've known couples that wouldn't have a semen analysis due to religious beliefs so don't be shy about standing up for yourself.

Going Back in for Testing

I just called my RE's office to set up at "What Next" appointment after talking to the nurse there for a while. We haven't used any birth control since February 2000, and then it took us two years of fairly diligent trying (2002-2004) to finally get our BFP only to have it be a blighted ovum. In spite of the delay in our return to TTC until February (so the second half of 2004 was out) I still can't help but feel like there is something else at play. I haven't had my panels done since Feb 2003 and a lot has happened since then and I'm older now too.

I'm also going to get CD3 bloodwork done since that's tomorrow and I can just make sure that hormonally everything is swimming right (at the end of AF in my last cycle I had this odd temp rise that seemed unusual to me). The nurse said it might be time to have another HSG as well, not fun but I want answers.

My partner wasn't upset by the tests but he has this idea that my fibroid was the root of all evil and I'm not convinced that it was. When you can read stories about women having pregnancies with 5 tumors the size that I had (how they do it I don't know), it just boggles my mind. He keeps telling me that we just have to have a lot of sex. We have been having a lot of sex. I have three years worth of records of the majority of times we had sex -- somedays we even did it twice and you can't mark that down as a double in the charting program I use. Maybe I should do the math for him and tell him how many sperm he has deposited over the past three years and maybe then he will understand my frustration.

He wants me to just start over like it was the beginning again and we were just coming to this place where we are TTC in our lives. I don't know about you but I can't just erase three years of stress and heartache without a lobotomy. He got all pissed with me and said "I hate when you get like this" and I just said goodbye and hung up.

If we end up pg I can tell you it will be a result of all my hard work, research, hours of commiseration with my online buds, some surgery, some tests and not just because we had a lot of sex!

It's raining, it's pouring...

After I found out about my fibroid I cried a lot. I cried for 3 days when they told me about my fibroid. I was so upset that my eyelid twitched for 3 months after that! After every doctor's appointment I had I was an emotional wreck afterwards.

A mean RE at the local university fertility clinic told us on a Friday that we needed IVF with ICSI and that we woudn't be able to conceive on our own. The next day we had to go to a wedding and someone from asked me discreetly about my fibroid (we lied and said that was what the Dr's appt was for, we didn't want any one to really know about our fertility problems) and I lost it and had to leave the wedding before the toasts. My partner couldn't get out of there as quickly for social reason so I just sat in the car and cried for 20 minutes by myself on a side street.

I had another time last spring, right after my HSG when I found out my uterus was wrapped around my fibroid and my doctor told me I should probably have the fibroid out. I went to dance class a couple days later -- surely dancing would help me feel like my body was mine again. But there was a guest instructor and when she wanted me to correct my pelvis alignment and I left the class sobbing.

Over Christmas my OB that I had made 2 months beforehand come up so I decided to get another opinion. Aside from crying the entire time in her office when I left I started sobbing in the parking garage and had to wait a long while until I was settled enough to drive.

Another time, at the beginning of the year, after yet another Dr appointment I had to leave dance class again and just cried in the hall while I waited for my partner to finish. It was all so stressful, I was unclear as to what to do, and it seemed like we would never have children without some major medical interventions.

Sheesh!

So, I've been keeping you apprised of my situation. I just got off the phone with the RE (RE#2) and here's what he told me...

...that they won't do fertility treatments on me unless I have my fibroid treated

...that if I have the embolization they won't accept me as a fertility patient

...that they recommend myomectomy

...that he no longer authorized the MRI

They won't do fertility treatments if I have the embo because they are worried about the uterine wall being weak (weaker than a uterus that has had multiple fibroids removed -- aka. myomectomy!?) and the possibility of multiple births being so much higher with fertility treatments. They are also a little concerned about not the liability but their stats, that somehow I might compromise their success rates.

Heck, no one knows why I haven't been able to get pregnant, it could be any of the following that I've been able to deduce...

* sperm morphology
* low progesterone (I started using natural progesterone cream)
* anemia/low ferritin (being treated)
* fibroid (though I've never even been kinda sorta pregnant)

I don't even know what to think know. It seems like my options are a) leave it up to God, or b) do the embo and then leave it up to God, or c) do the embo and do fertility treatments if needed, elsewhere.

We're not interested in adoption.

Maybe I should just go save the dying children in 3rd world nations and give up on this mother thing.

Back from RE#2

I've just gotten back from a visit with the RE and guess what my pooled progesterone test showed....I have low progesterone. (I feel like I have a twisted mind because I'm glad they actually found something off in my endocrine system). The doctor said that they would have to supplement me during the second half of my cycle when I was trying to conceive (um, wasn't that what I was already doing?). My progesterone is 9.4 and I found mention of it on a site that said "A level above 15 ng/dl is desirable".

I brought up the desire to have UAE with him and he said he could tell I was extremely knowledgeble on the subject -- thanks of course to the ladies on the NUFF group and on the embo list. He wasn't aware that there was anyone doing the procedure at that medical center (and the RE is the head of the fertility clinic) so my research and consultations with the IR may help other women as well. He did mention that he was understanding my willingness to be a guinea pig (which I am), since there isn't that much information (no randomized studies) on the affects of embolization on fertility.

He told me that I should continue taking iron supplementation ongoing due to my heavier periods. I know this to be true even though my menorrhagia (heavy periods) are nothing compared to the flooding some other women have reported in the NUFF group. FYI my period lasts a full 7 days, it is a little heavier now than when I was younger (I'm now 33) but not dramatically so. I do have some clotting and I do also double up on protection since a bad episode with flooding when I was in high school.

He said that there wasn't a link between hypothyroidism and low progesterone (although Dr Lee mentioned that low progesterone may mimic mild hypothyroidism).

I have a referral/Rx for the MRI now so I can schedule that and get more info.

So, it wasn't that bad and we didn't get into any arguments. He's going to consult with the IR next week.

Stay tuned for more info soon.

Going in for a Consult with the RE about UAE

I'm going in to see the RE (reproductive endocrinologist) next Friday. He's one of the doctors I interviewed for my myomectomy (the one I cancelled last month). I needed to continue working getting more information, particularly about my hormones, and he was the only one that suggested that I have my progesterone level checked prior to surgery. I just did the pooled progesterone test this past cycle, 3 blood draws on days 5-9 post ovulation. I'll get the results at this appointment. (I'm kind of hoping they say that my levels are low, just so that there would really be something wrong with me -- do you ever feel that way too?)

I'm feeling a little nervous about going in and telling him that I want to have the embolization procedure instead. I'm afraid of having to get into a disagreement with him, where he doesn't believe in UAE for women trying to conceive. Well, if I don't like his reaction then I just will have to work with a different doctor.

One thing I've been thinking about is that for years I had low level anemia and none of my doctors made a big deal about it. I didn't like to take pills/vitamins and besides my doctors said that some women just tend to run anemic. My naturopath that I started seeing right after I was diagnosed with my fibroid last year thought that this anemia needed correction and I think she was right. I was so used to having low energy that I didn't even realize the affects, or even that I could feel differently. I think probably a lot of us had heavier periods our whole lives and didn't understand the affects of that on our health.

I still have low ferritin, at least as of September. I basically have to just take iron supplements ongoing. Luckily I've found a chewable type that is agreeable with my system. Related to the fertilty issue that many of us are dealing with, I found this mention yesterday and thought it interesting (link to full article is below), especially in light of the fact that many of us our anemic here.

"Be sure your iron levels are adequate. A blood test (a ferritin level combined with an iron level and iron binding capacity) will tell you this. Unfortunately, doctors are trained to say the iron is normal if your ferritin level is at least 9 ng/ml. Although a ferritin level of 9 shows you have enough iron to prevent anemia, one can have infertility from ferritin levels less than 40. Because of this, I would look at your ferritin test results yourself and make sure the level is at least 40 ng per ml. In a study of women with infertility with ferritin levels less than 40, half of the women quickly became pregnant when put on iron. If for some reason you are unable to get your ferritin level checked, it is not unreasonable to take iron (e.g. Ferrous Sequels 1 tablet 1-2 times a day for four months). I also would take iron if the percent saturation of iron (calculated from the iron & percent saturation tests noted above) is
under 22%."
From: Effective Holistic Treatment for Infertility