This is Only a Test

So, it was an emotional week and a half while we were out of town. I woke up most mornings disoriented and wondering if it was going to be a happy day (wedding festivities) or a sad day (funeral related events). There is so much to share I hardly know where to start. The fun of the weddings, the sadness of the funeral and the wonderful stories about my grandfather. Then, I realized I hadn’t really posted about our last RE visit because I was still trying to understand what had happened myself. And before I knew it, we had even more developments along that front this very morning so I will tackle the RE visit in this post.

This RE appointment was the one I had made way back in February after a visit with Dr. Receptive. In that time, Dr. Receptive helped me get my FSH retested, along with a progesterone test on 7dpo. There was a total of 3 blood draws for this series of tests and every single one of them, including another day 3 FSH, came back within normal range. My second day 3 FSH was as freakishly normal (5.9!) as my first day 3 FSH was freakishly high (31.1). I had no idea what to make of it and because I was still experiencing perimenopausal symptoms (shorter and lighter periods, shorter cycles, possible night sweats, vaginal dryness) and I knew that women with high FSH could have fluctuating levels, I just waited for my appointment and prepared myself to hear that they would consider only the highest FSH when determining responses to ART and a rehash of the donor egg talk, etc. I also drew up a nice little summary of all my test results and the cycle days they had been done on and prepared questions I had about what to keep on top of in terms of my overall health due to the impending loss of regular hormone function (bone density, heart disease risk). I also prepared myself for the fact that this was a teaching hospital and just like my last RE appointment, I might very well spend most of my time talking to a fellow and have only a little time with the RE, so I made sure I had concise questions and prioritized them for the precious few minutes I may have face-to-face with the RE.

As with most of my experiences with doctors these last two years, I was in for a shock. First of all, we only waited a few minutes for our appointment to begin. Then, the doctor who walked in the door and spent the entire time with us was the RE himself! Dr. Thorough-and-Direct (“TAD”) had actually spent time reading my file before the appointment. He not only said so, but repeatedly throughout the appointment made references to what he had read in my medical file. When I mentioned my additional test results and brought out the summary sheet I had compiled, he asked to look at it and read every footnote I made about each test. Then came the biggest shocker of all. His take on my fluctuating FSH was that one of the tests was probably wrong, perhaps the result of a lab mix up. Because of my lack of hot flashes, I probably was not going through ovarian failure, despite my other symptoms. And so he felt it was probably the first test, the high FSH reading that was wrong. He thought the symptoms I had were troubling and thought that it could mean that I’m nearing the end of my fertile years, which meant we should proceed with some type of fertility treatment sooner rather than later, but we should try with my eggs. He thought we may still have a chance with using my eggs because in my previous ultrasounds during my miscarriage and my last fertility evaluation, they saw follicles! I was confused as to why I wasn’t told this before and it turns out that both times when the doctors saw “cysts” they were referring to the presence of follicles. All along I had thought “cysts” were a bad thing but Dr. TAD said these were antral follicles they saw and there were 4 on one side and 5 follicles on the other. He said that they prefer to see 5 and 6, but the numbers I had were good. Each time, I would bring up something that worried me and he would matter-of-factly explain to me why he felt we should not delay and proceed with treatment to see how I would respond. Throughout our appointment, I got the distinct impression Dr. TAD considered all the issues and concerns I threw at him (and I was throwing it all at him, especially at the end, mainly in disbelief that we were hearing good news) carefully and thoughtfully and still coming to the conclusion that I was not going through ovarian failure. He also mentioned that if he had only the first FSH result to go on, he definitely would have suggested we “close up shop.” But, in light of the normal levels in my second test plus that fact that my progesterone level at 7dpo was much higher than what he would have expected, he felt that at the very least my corpus luteum was functioning correctly which suggests something my ovaries were doing something right. When I brought up my concern that my egg quality may be bad (hence the miscarriage and subsequent difficulty in getting pregnant again) he said that there was really no way to know how good my eggs were. But, he felt that there were still eggs left because it seemed to him that I am ovulating and it could mean just trying to “call out a good egg.” He then suggested we do IUI with clomid or injectible IUI first. By this time, I was so overwhelmed with emotion and so determined not to start bawling like a baby in front of him, I was speechless and choking back tears. Mr. Worrier took over asked about the difference between the two treatments and expressed our desire to go with a more aggressive versus passive route. Dr. TAD thought if we wanted to be more aggressive, we could do the injectible IUI instead of the Clomid. Dr. TAD remarked that he felt my case was very interesting and said that he wanted to bring my case up in their next weekly meeting where all the RE’s and fellows in the medical group discuss their cases. Then, the doctor who runs the ART treatments in their department would contact me and follow up on what they thought we should do next. He told us we would have to get Mr. Worrier’s sperm analysis before we start any treatment and referred Mr. Worrier to an urologist for his ED issues. At no time during our appointment did I feel like he was rushing to finish our appointment and go on to his next one. At no time during our appointment did I feel like I was bothering him with my incessant need for reassurance that he wasn’t missing something and forgetting to take into consideration some aspect of my situation.

Mr. Worrier and I walked out of that appointment stunned and shell-shocked. Of all the things we were prepared to hear, ovulation induction with IUI was not one of them. We were and still are being cautious with our hopes. I am willing to accept that one of the FSH tests was wrong, but I feel like I have had my hopes dashed too many times to completely trust Dr. TAD’s assessment that the error lies in the high FSH result and not the normal FSH result. I have trust in him, but I am too fearful and protective of my heart to trust my trust in him, you know? I don’t even want to know what the chances of pregnancy with ovulation induction/IUI are. I know it is lower than IVF but I find that I am not even remotely curious at this point. I just want to know what the truth is. I just want to know if I have any eggs that will respond to ovulation induction. I feel like a possible answer to that is the only thing I’m assured of if we do this and that is all I’m counting on.

(I did notice I allowed myself to let in the possibility that I can get pregnant with my eggs. I found myself fondly searching and looking for babies and toddlers for a couple of days after meeting with Dr. TAD. And seeing my visibly pregnant cousin, C. at her brother’s wedding was a lot easier to do knowing that possibility was out there.)

While we were gone, we got our follow up call. It was from the same doctor who gave us the news about my high FSH in October (and who I have yet to meet in person). He is the doctor who works with all the patients undergoing fertility treatment (they only do Clomid and injectible IUI here. For IVF, they send you to their another clinic.) I called Dr. No Face back this morning and found out that they’re suggesting we start with Clomid for the ovulation induction/IUI instead of injectibles. The reasons for this are:

1) I'm young and they believe with the test results I have that I am ovulating. But, I'm not getting pregnant with one egg so they want to try to induce more than one.
2) Injectibles are stronger meds, so they want to go with Clomid first to reduce the chance of multiples because of my age (he actually said "complications" which I take to mean multiples among other things).
3) Clomid would also tell us if my high FSH was the mistake or my normal FSH was the mistake. If my FSH is high, Clomid would not do anything and they would know since they would monitor the follicle stimulation via ultrasound. Clomid is also the cheaper alternative and less involved than doing injectibles, but will tell us the same thing about my response to FSH.
4) They want to start this for my next cycle without waiting for Mr. Worrier’s sperm analysis and urology appointment. Their thinking is that we've waited long enough and he’s gotten two women pregnant so even if there are issues with his sperm it's not so bad that there is no possibility of fertilizing an egg.

So, all of a sudden it's like we've jumped back on the speeding train again and I
wonder, is this where I want to be? When we were trying, Mr. Worrier’s ED made an already stressful time, even more stressful. In some ways these last 6 or 7 months of thinking there was no chance we’d get pregnant with my eggs have allowed us to live our lives more contently.

We’ll have the option to try to freeze some of Mr. Worrier’s sperm ahead of time to reduce some of the stress, but another part of me thinks, hey, we might not even need to worry about having sperm. There is no guarantee this IUI won’t get canceled because of cysts (the bad kind) or my lack of response. So, to keep my sanity intact, I am treating this as another test, not as a chance of getting pregnant. A test to see if I have any eggs at all and if I do, if any of them will respond like the 33 going 34 eggs they should be.

Because being told that the first FSH results may be wrong is almost impossible to believe. It is like being told you don’t have cancer anymore, that it has miraculously disappeared. And much as I would like to believe in that possibility, I just can’t go there yet. So, if I get close to actually going through with the IUI, be a friend, won’t you, and remind me that this is only a test, ok?