Cathy (another of Dr. Schmidt's wonderful nurses) called me a little while ago and said that she got the rest of my labwork results. The main result that they were waiting for was AMH (anti-muellerian hormone). This is an even more accurate indicator of ovarian reserve than FSH. My AMH level is 0.16 (almost undetectable). "Normal" is over 1.0. Cathy said that this number makes it very unlikely that my FSH level was a lab error. My high FSH level plus my low AMH level mean that I have officially entered premature ovarian failure (POF). This essentially means that my body is in early menopause. My ovaries no longer function properly, and the few eggs that I do have left are probably not viable. This explains why my ovaries have not responded appropriately to the high doses of strong ovary-stimulating medications I have taken for the last 8 months. Cathy said that Dr. Schmidt is not one to give up without a fight, so it is still possible that he may want to try the most aggressive IVF protocol on me for one cycle to see if he can stimulate enough eggs to make some viable embryos. But, she said it is more likely that he will suggest doing IVF using donor eggs instead. I am going to ask him to be completely honest with me, because I don't want to waste an IVF cycle (our health insurance company covers 2 IVF cycles completely per lifetime, and any cycles after the 2 covered cycles are completely out of pocket ... one IVF cycle costs approximately $12,000-$15,000) if there isn't a realistic chance that my ovaries will respond to the meds.
So, at least I have some answers now. I will have more answers after we meet with Dr. Schmidt on Wednesday. I am feeling a profound sense of loss right now. I guess you could say that I am grieving for the loss of my fertility as well as the loss of a baby (from my own egg) that I always thought I would have. Cathy said that she can't believe my numbers are so off the charts, considering my age (she called me "young" ... I am definitely not feeling the slightest bit young right now, but I appreciate her saying that). She raised concerns about the radiation treatment that I had two years ago for thyroid cancer, which is what I have been afraid of all along. My biggest regret now is that I didn't look into harvesting my eggs before the radiation treatment. I don't know what I was thinking. I guess there's no point in dwelling on that ... there's nothing I can do about it now. I'll just wait and see what Dr. Schmidt has to say on Wednesday.
Friday, February 25, 2011
sad, confused, overwhelmed ...
I received an order in the mail (from Dr. Schmidt) for about 15 different blood tests that I needed to have done on cycle day 3 (the third day of my period) if I ended up not being pregnant this time. This blood work needs to be done in preparation for IVF. There are lots of things they need to check for before jumping into the land of IVF. I had my blood drawn on Monday morning (2/21). They had to draw 8 tubes of blood!!
Anyway, I called Dr. Schmidt's office several times this week because I was very anxious (and afraid) to find out my current FSH level. My FSH level back in July 2010 (when we first started infertility treatments) was 12.3. That is elevated, but still manageable. Carol (my favorite nurse) called me this afternoon with my current level. I could tell as soon as I heard her voice that the news wasn't good. My number is 21.4. My heart sank to my toes when I heard the number. Based on everything I've read, most reproductive endocrinologists (fertility doctors) don't even attempt IVF once the number is greater than 20. I didn't know what to say except "wow". Carol said not to panic (too late!), and told me that there is a chance that the lab made an error. Yes, I suppose that is possible, but I'm not holding my breath. She said that Dr. Schmidt also looks at another blood test for anti-mullerian hormone. That was part of the workup from Monday, but the result won't be available until next week. She said that even when the numbers seem terribly dire, there are still options. I can't remember what else she said ... I think I was too stuck on 21.4. If that number is correct, then my ovaries are essentially no longer functioning, and I have no chance of getting pregnant with my eggs. That means our only remaining options are IVF with donor eggs (my amazing sister, Heather, has graciously and sincerely offered her eggs to me), surrogacy (not something I really want to consider, for a number of reasons), or adoption. I am feeling terribly sad. I can't seem to wrap my head around how my FSH could have skyrocketed so much in only 8 months. I have been browsing the internet tonight for answers and more information, but this has just left me feeling more confused and sad.
We will be meeting with Dr. Schmidt next Wednesday (3/2) to go over the blood work results and discuss our options. I guess I will know more and have more to report after that appointment.
Anyway, I called Dr. Schmidt's office several times this week because I was very anxious (and afraid) to find out my current FSH level. My FSH level back in July 2010 (when we first started infertility treatments) was 12.3. That is elevated, but still manageable. Carol (my favorite nurse) called me this afternoon with my current level. I could tell as soon as I heard her voice that the news wasn't good. My number is 21.4. My heart sank to my toes when I heard the number. Based on everything I've read, most reproductive endocrinologists (fertility doctors) don't even attempt IVF once the number is greater than 20. I didn't know what to say except "wow". Carol said not to panic (too late!), and told me that there is a chance that the lab made an error. Yes, I suppose that is possible, but I'm not holding my breath. She said that Dr. Schmidt also looks at another blood test for anti-mullerian hormone. That was part of the workup from Monday, but the result won't be available until next week. She said that even when the numbers seem terribly dire, there are still options. I can't remember what else she said ... I think I was too stuck on 21.4. If that number is correct, then my ovaries are essentially no longer functioning, and I have no chance of getting pregnant with my eggs. That means our only remaining options are IVF with donor eggs (my amazing sister, Heather, has graciously and sincerely offered her eggs to me), surrogacy (not something I really want to consider, for a number of reasons), or adoption. I am feeling terribly sad. I can't seem to wrap my head around how my FSH could have skyrocketed so much in only 8 months. I have been browsing the internet tonight for answers and more information, but this has just left me feeling more confused and sad.
We will be meeting with Dr. Schmidt next Wednesday (3/2) to go over the blood work results and discuss our options. I guess I will know more and have more to report after that appointment.
Saturday, February 19, 2011
really.really.really.really.sad.
I am typing this post with tears running down my face. In the midst of one of the worst nights I've ever had at work (all three of my patients developed major issues that almost got them transferred to the ICU), my period started with a vengeance. I went in the bathroom to cry three different times during the remainder of the night at work. In the past week alone, I had three dreams that I was pregnant. They were so vivid that I even remember the details of watching the pink line appear, crying tears of joy, and calling people to tell them the amazing news.
On this week's episode of "One Born Every Minute" (an 8-episode documentary on Lifetime that was filmed at the Labor & Delivery unit in my hospital), one of the featured couples was 17 years old. They didn't plan to get pregnant, and didn't even seem very excited about having the baby. That was really hard to watch. Life is so unfair sometimes.
I have terrible cramps (so bad that they are making me nauseated), I didn't sleep well today, and I have to go back to work tonight (and rereading this blog post, I realize that I am sounding whiny and feeling sorry for myself. Ugh. I will be back on my feet again soon ... I just need to feel sad right now.). This infertility journey is the pits.
On this week's episode of "One Born Every Minute" (an 8-episode documentary on Lifetime that was filmed at the Labor & Delivery unit in my hospital), one of the featured couples was 17 years old. They didn't plan to get pregnant, and didn't even seem very excited about having the baby. That was really hard to watch. Life is so unfair sometimes.
I have terrible cramps (so bad that they are making me nauseated), I didn't sleep well today, and I have to go back to work tonight (and rereading this blog post, I realize that I am sounding whiny and feeling sorry for myself. Ugh. I will be back on my feet again soon ... I just need to feel sad right now.). This infertility journey is the pits.
Monday, February 14, 2011
feeling optimistic, but still being realistic ...
One week from today, I will be taking a pregnancy test (assuming my period hasn't started by then). I am still having some pelvic cramping, which is a good thing. While I am feeling hopeful and trying to stay optimistic, I am also thinking ahead. If I am not pregnant now, we have decided to move on to in vitro fertilization (IVF), which is the end of the road for fertility treatments. I have done quite a bit of research on IVF, and the success rate is 50-60%. The quality of my eggs has always been suspected as the cause of my infertility. I have read several research articles about the effect of radioactive iodine (the radiation treatment that I had in 2009 for thyroid cancer) on eggs. There is some speculation that this type of radiation can damage eggs, which is what I have been afraid of all along. With IVF, my mature eggs will be extracted from my ovaries, and that's when Dr. Schmidt will really be able to determine the quality of my eggs. While FSH levels (see this post) can be a good indicator of ovarian reserve, the quality of the eggs can't be determined until they are taken out of me. So, if I am not pregnant this month, it will be good to finally know what's going on with my eggs.
I left a voice mail for Dr. Schmidt's nurses this weekend, asking what I need to do to prepare for IVF, in case I'm not pregnant. Patty (one of the wonderful nurses) called me this morning and confirmed that Dr. Schmidt agrees that it will be time to do IVF if this cycle wasn't successful. She said that Brian and I will need to meet with Dr. Schmidt to discuss everything, and she scheduled that appointment for 3/2 at 4:00. Of course, I will be more than happy to cancel that appointment if I am pregnant, but I'm glad to have it scheduled. Patty told me that I will have to skip a cycle if I'm not pregnant, to get all of the paperwork signed, meet with Dr. Schmidt, and get of all the medications ordered. Plus, I will start taking a daily intramuscular injectible medication called Lupron about a week before my next period (after the one that will start next week if I'm not pregnant) begins, and continue taking it for at least two weeks. This medication completely shuts down my body's production of FSH and LH. That way, my follicle growth and subsequent egg retrieval can be controlled more precisely. Timing was very important with IUI, but it is critically important with IVF.
Patty told me this morning that my progesterone level from my blood draw on Friday was 12.4. If I remember correctly, that's the highest it's been since I started injectible meds. Patty said that as long as the number is over 3, ovulation definitely happened; as long as the number is over 10, pregnancy can occur. So, I am encouraged by this number. :)
If I am not pregnant this time, I will need to have blood drawn on the 3rd day of my period, to check my FSH level (see the first paragraph of this entry for more info about FSH levels ). My FSH was last tested in July, and it was a reasonable level at that point. It is possible that the number has increased since then. If it has increased too much, this will indicate that my ovaries are no longer functioning well enough to allow me to get pregnant with my own eggs. At that point, we will have four options: IVF using donor eggs and Brian's sperm; surrogacy; adoption; or deciding that we are ok with not having children. It's very hard for me to even think about having to choose one of those options, but it is always in the back of my mind.
For now, I am going to keep on keeping on for the next week, hoping that my period does not start, and wishing, hoping, and crossing every crossable body part that I get a BFP (big fat positive) pregnancy test next Monday. So, here's to wishing and hoping ...
I left a voice mail for Dr. Schmidt's nurses this weekend, asking what I need to do to prepare for IVF, in case I'm not pregnant. Patty (one of the wonderful nurses) called me this morning and confirmed that Dr. Schmidt agrees that it will be time to do IVF if this cycle wasn't successful. She said that Brian and I will need to meet with Dr. Schmidt to discuss everything, and she scheduled that appointment for 3/2 at 4:00. Of course, I will be more than happy to cancel that appointment if I am pregnant, but I'm glad to have it scheduled. Patty told me that I will have to skip a cycle if I'm not pregnant, to get all of the paperwork signed, meet with Dr. Schmidt, and get of all the medications ordered. Plus, I will start taking a daily intramuscular injectible medication called Lupron about a week before my next period (after the one that will start next week if I'm not pregnant) begins, and continue taking it for at least two weeks. This medication completely shuts down my body's production of FSH and LH. That way, my follicle growth and subsequent egg retrieval can be controlled more precisely. Timing was very important with IUI, but it is critically important with IVF.
Patty told me this morning that my progesterone level from my blood draw on Friday was 12.4. If I remember correctly, that's the highest it's been since I started injectible meds. Patty said that as long as the number is over 3, ovulation definitely happened; as long as the number is over 10, pregnancy can occur. So, I am encouraged by this number. :)
If I am not pregnant this time, I will need to have blood drawn on the 3rd day of my period, to check my FSH level (see the first paragraph of this entry for more info about FSH levels ). My FSH was last tested in July, and it was a reasonable level at that point. It is possible that the number has increased since then. If it has increased too much, this will indicate that my ovaries are no longer functioning well enough to allow me to get pregnant with my own eggs. At that point, we will have four options: IVF using donor eggs and Brian's sperm; surrogacy; adoption; or deciding that we are ok with not having children. It's very hard for me to even think about having to choose one of those options, but it is always in the back of my mind.
For now, I am going to keep on keeping on for the next week, hoping that my period does not start, and wishing, hoping, and crossing every crossable body part that I get a BFP (big fat positive) pregnancy test next Monday. So, here's to wishing and hoping ...
Friday, February 11, 2011
waiting, waiting, waiting ...
This feels like it has been the longest week ever. I can't believe insemination was only a week ago ... it feels like it was a month ago. Time truly seems to slow down during the 2+ weeks between insemination and pregnancy test/period.
I've been having some pelvic pain and bloating in the last couple days. It's not like anything I've felt before during this part of my cycle, so I called my doctor's office to ask about it. I explained that the pain initially felt like it was more on the right side, but it has now become more low and central. Carol (amazing nurse) explained that the pain could be a couple different things. First, the right-sided pain could be the result of some of my follicles not releasing their eggs and instead turning into cysts. These cysts grow rather large and collect fluid. They also cause fluid to collect in the abdomen. They can cause a significant amount of pain and are not uncommon when the ovaries have been stimulated with fertility meds. These cysts are what Dr. Schmidt looks for when he does the baseline ultrasound every cycle on day 3. If there are any cysts present at that time, I have to skip a cycle. :( So far, this has not happened, and I hope it never will. What a double whammy ... to not be pregnant AND to have to skip a cycle. That would be so sad. :(
The more central, low pelvic pain is a good thing, according to Carol. She said that implantation can take place as early as 5 days after ovulation (which would have been Wednesday), and there can be pelvic pain associated with implantation (since this triggers a whole bunch of hormonal changes as well as the placenta starting to grow). She said that if this pain continues, it is a very good sign and may mean that I am pregnant. Of course, I was over the moon when I heard that!! Now, I can't think about anything else. I can't believe there might actually be a little bean (or two, or three ... haha!!!) growing inside me right now. I am SO trying not to get excited, but I just can't help it. So now, I am just wishing and hoping that this pain continues!!
I will be getting my blood drawn later this morning, to check my progesterone level. This level will confirm that I ovulated, and the higher the number, the better. I should get a phone call from one of the nurses on Monday, letting me know the results of the bloodwork.
For now, I just have to be patient ... wish it wasn't so hard!!!
I've been having some pelvic pain and bloating in the last couple days. It's not like anything I've felt before during this part of my cycle, so I called my doctor's office to ask about it. I explained that the pain initially felt like it was more on the right side, but it has now become more low and central. Carol (amazing nurse) explained that the pain could be a couple different things. First, the right-sided pain could be the result of some of my follicles not releasing their eggs and instead turning into cysts. These cysts grow rather large and collect fluid. They also cause fluid to collect in the abdomen. They can cause a significant amount of pain and are not uncommon when the ovaries have been stimulated with fertility meds. These cysts are what Dr. Schmidt looks for when he does the baseline ultrasound every cycle on day 3. If there are any cysts present at that time, I have to skip a cycle. :( So far, this has not happened, and I hope it never will. What a double whammy ... to not be pregnant AND to have to skip a cycle. That would be so sad. :(
The more central, low pelvic pain is a good thing, according to Carol. She said that implantation can take place as early as 5 days after ovulation (which would have been Wednesday), and there can be pelvic pain associated with implantation (since this triggers a whole bunch of hormonal changes as well as the placenta starting to grow). She said that if this pain continues, it is a very good sign and may mean that I am pregnant. Of course, I was over the moon when I heard that!! Now, I can't think about anything else. I can't believe there might actually be a little bean (or two, or three ... haha!!!) growing inside me right now. I am SO trying not to get excited, but I just can't help it. So now, I am just wishing and hoping that this pain continues!!
I will be getting my blood drawn later this morning, to check my progesterone level. This level will confirm that I ovulated, and the higher the number, the better. I should get a phone call from one of the nurses on Monday, letting me know the results of the bloodwork.
For now, I just have to be patient ... wish it wasn't so hard!!!
Saturday, February 5, 2011
the waiting game ...
Yesterday was our big day. Brian had to be at the lab at 7:30 AM, and then we enjoyed breakfast together at Cosi (yum). We had to be back at Dr. Schmidt's office at 9 AM. Dr. Schmidt's smiling face always makes me feel good. He came in with the vial of liquid baby-making gold and said that this was going to be the month I get pregnant. I sure hope so. He had some trouble getting the catheter through my cervix and angled forward into the top of my uterus, so the insemination process was more painful than usual. I ended up bleeding for most of yesterday and am still feeling crampy (he said that all of this is normal and wouldn't affect my chances of getting pregnant at all).
I will start taking Prometrium (progesterone vaginal suppositories) twice a day starting tonight, to make sure my progesterone levels are high enough to sustain a pregnancy. I will stop taking the Prometrium on 2/16, in case I am not pregnant. That way, I will be able to have a period. If I am pregnant, I will have to start the Prometrium again and take it for the entire first trimester (and possibly longer).
I will have my blood drawn to check my progesterone level on Friday (2/11), and I will give myself an HCG booster shot that day, too. My official pregnancy test day is February 21. That day seems so far away. I really struggle with being patient when it comes to this whole infertility journey. It's so strange knowing that for the next 2+ weeks, my body will know whether or not I am pregnant, but I will not. I'm starting to feel pessimistic already. :( I'm just so afraid to get my hopes up.
I will start taking Prometrium (progesterone vaginal suppositories) twice a day starting tonight, to make sure my progesterone levels are high enough to sustain a pregnancy. I will stop taking the Prometrium on 2/16, in case I am not pregnant. That way, I will be able to have a period. If I am pregnant, I will have to start the Prometrium again and take it for the entire first trimester (and possibly longer).
I will have my blood drawn to check my progesterone level on Friday (2/11), and I will give myself an HCG booster shot that day, too. My official pregnancy test day is February 21. That day seems so far away. I really struggle with being patient when it comes to this whole infertility journey. It's so strange knowing that for the next 2+ weeks, my body will know whether or not I am pregnant, but I will not. I'm starting to feel pessimistic already. :( I'm just so afraid to get my hopes up.
Tuesday, February 1, 2011
3 big fat follicles!!! :)
I had my ultrasound and estradiol blood draw today. To my surprise and amazement, my follicles are ready!! I have 3 big follicles in my left ovary. A follicle is considered mature once it reaches 15 mm in size. Mine are 14 mm, 20 mm, and 21 mm. :) Dr. Schmidt shared my excitement today. He told me that it appears we have finally found the right cocktail of meds for me. To give a comparison, my follicular phase (the amount of time between the first day of my period and the day of ovulation) was 19 days last month (and even longer in previous cycles) and will be 14 days this cycle. That may not seem significant, but it is a really big deal. In a "perfect" cycle, the follicular phase is 14 days. I have never had a perfect follicular phase in my life. So, this is huge. I was on cloud nine driving home from the doctor's office. Unfortunately, it took me awhile to come off cloud nine enough to fall asleep today. Last night was my first of three 12's in a row at work, and I only ended up getting about 5 hours of choppy sleep today. :( But it's ok. Maybe the sleep deprivation is a sign of things to come in about 9 months? ;)
So, Carol (my wonderful nurse!) called this afternoon with my instructions for the next few days. She told me that my estradiol level is 164. In some past cycles, it never even got that high. In the cycles when it did get that high, it took a lot longer. So, I am going to do one more night of injectible meds (1 of Bravelle and 1 of Menopur, instead of 2 Bravelle and 1 Menopur) tonight, and then I will do my HCG trigger injection tomorrow night at 9 PM. Then, Friday will be the big day. We have to be at the lab at 7:30 AM for Brian to do his thing, and then we have to go next door to the office at 9 AM for insemination. I am trying my hardest to not get my hopes up, but of course those attempts are futile. Everything seems to be going right this time, and I can't help but believe that this is a good sign.
So, here we go again ... :)
So, Carol (my wonderful nurse!) called this afternoon with my instructions for the next few days. She told me that my estradiol level is 164. In some past cycles, it never even got that high. In the cycles when it did get that high, it took a lot longer. So, I am going to do one more night of injectible meds (1 of Bravelle and 1 of Menopur, instead of 2 Bravelle and 1 Menopur) tonight, and then I will do my HCG trigger injection tomorrow night at 9 PM. Then, Friday will be the big day. We have to be at the lab at 7:30 AM for Brian to do his thing, and then we have to go next door to the office at 9 AM for insemination. I am trying my hardest to not get my hopes up, but of course those attempts are futile. Everything seems to be going right this time, and I can't help but believe that this is a good sign.
So, here we go again ... :)
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