Monday, July 18, 2011

How I Got Here Part 3: The Follow-Up

After my surgery, Dr. B. had told my husband that I did have endometriosis (endo), but he was able to remove all the lesions.  I did not have any adhesions which is pretty lucky since I've probably had endo since I was 15.  It turns out that being on Depo Provera (birth control shot) had been a good thing because it halts the progress of the endo.  A lot of people with fertility struggles who used depo like to blame it.  While it may take a while for your cycles to restart, I don't know of any legitimate research that says it harms fertility.  So, if you don't want the more drastic medications to slow endo down, and you aren't interested in spawning, it's definitely an option you and your doc could consider.

Anywhoselbees...I was feeling great in the weeks following my surgery.  My follow-up was scheduled for three weeks post-op.  In the meantime, I was free from pain, free to continue to try to spawn, and I was mentally doing better, too.  I had it in my head that Dr. B was going to tell me I was good to go and that my year of trying would start from March now that my endo had been cleaned out.  I really thought I was going to be able to conceive.  For most people with endo, they have an increased chance of getting pregnant in the 6-9 months after their surgery.  Thinking that my mom's fertile genes would kick in now that the obstacle of endo was removed, I really thought it was my time.

Unfortunately at my post-op check-out, I got slapped in the face with reality.  Dr. B. told me that my chromotubation (fallopian tube check) was great.  The dye spilled easily.  My anatomy was all normal, no fibroids, deformities or anything else wrong with my uterus.  He said he was able to remove all the endo I had, which wasn't much.  I am considered to have mild endo.  This sounds great right? Well, apparently it's not.  Dr. B. could see no reason why I had not been able to conceive.  With severe endo, you have tubes all tangled in scar tissue and adhesions that create physical barriers that prevent pregnancy.  When you have mild endo, you can usually still get pregnant, but when you don't, you really don't.  It depends on your fertility specialist's beliefs, but a lot will go ahead and give you an unexplained infertility diagnosis if you have mild endo and have not been able to conceive.

Dr. B told me that he was also concerned with my irregular periods which were now 26-43 days.  He told me he would write a prescription for Clomid for me to use my next cycle, and that it would help me ovulate at a more regular interval. 

Pardon the interruption for a quick physiology lesson!  In a typical functioning female (as in not me), after your period starts, which is the beginning of your cycle, your pituitary gland and hypothalmus tell your ovaries to get busy by releasing follicle stimulating hormone (FSH).  As your ovaries develop many follicles (they are basically cysts, that contain an egg).  When one or two follicles begin to mature, they release estrogen.  The estrogen then tells the hypothalmus to stop releasing FSH.  This is why most humans do not have litters of children naturally.  Luteinizing hormone is then released by the pituitary, and the most dominant follicle will release it's egg.  The other follicles simply dissipate and the eggs that were in them are gone forever.

BUT WAIT!  YOU'RE NOT NORMAL...OK, well here comes Clomid to save the day.  Clomid blocks the estrogen from telling your hypothalmus that the eggs are ready.  So for people who naturally don't have enough time in their cycle to let their eggs mature, Clomid gives them that time.  A side effect of this, is that it allows other follicles to catch up so you may release more than one egg.  Your chances of having twins goes up from less than 3%, to just under 10%.  You have less than a 1% chance of having triplets or more on Clomid.  For lots of people clomid works just great.  If you haven't conceived in about 6 cycles, however, it is probably time to move on to something different.

OK, back to me. It is my blog after all...

My doctor also said that we could go ahead and try intrauterine insemination (IUI).  I was dumbstruck.  This appointment did not go the way I had planned at all. He explained that the procedure was similar to a pap smear.  They use a catheter to place the sperm directly into the uterus so it is that much closer to the egg.  He asked if I wanted to go ahead and try IUI's or try naturally.  Without thinking, I immediately said I'll try naturally.  I was having some serious denial issues.

As I checked out, I noticed that my billing diagnosis said infertility.  I saw a card for a nurse practitioner at a fertility clinic.  I picked it up without really thinking.  I made it to my car with my prescription in hand one hand and the fertility clinic business card in the other, got in the driver's seat, and had a meltdown.  The ax had officially dropped, I was indeed infertile.  I called my wonderful husband, and he had me come to meet him at his office.  He patiently let me sob through the details of my appointment and told me he was willing to do whatever he needed to do.  He encouraged me to email the nurse practitioner at the fertility clinic.  He wanted me to get a second opinion.  Which is not to say either one of us doubted Dr. B at all.  We both just needed to be told by someone else before we could accept it. 

The nurse practitioner responded to my email the next day while I was at work.  She said the next step for us would be to have BJ's swimmers looked at (semen analysis).  Knowing that BJ had said yesterday he was willing to do whatever, I thought, 'OK, I'll just get the logistics of how that will work and what times were available.' I called the clinic and said I was interested in procuring a semen analysis for my husband.  They asked for his information, which I just happened to know, and the receptionist said, "How is 8:30 am Monday?" I responded, "Perfect!"  She asked for his health insurance info which I did not have all the details of, and told me it was fine, she would be emailing him shortly. Uh, oh...

I tried to call BJ to let him know what I had done, but when he answered the phone he immediately said, "Can't talk now, in a meeting," and quickly hung up. Oh, boy, I was gonna be in trouble.  It was not 20 minutes later that I got a "WTF" text message.  To which I responded, "Exactly, but in a cup."  After the initial shock of my guerilla semen analysis approach, BJ quickly resolved himself to go through with it.  So, if you ever wanna play a practical joke on a can apparently set up an appointment for them to have a semen analysis without their consent.  I guess this makes sense.  How many men would actually take the initiative to have this done and call for an appointment? I gather from my experience that it's not many...

Peace, Love and Spawning,

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