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.

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.

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?

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.