My First RE appointment

So this last Thursday was my very first RE consultation with Dr. Frozen Embryo. Sorry for the late post but it's taken me awhile to put this together.

I started out the day extremely nervous. I had no idea why and was so bothered by it. This should be a day I look forward to! Finally someone that has some concrete experience, someone that has studied this, someone that won't tell me all is shot to hell. But then I thought, but what if he does tell me that it's all shot to hell? And that my ovaries are doomed and that there's no chance? I know it's an unrealistic scenario...especially for an RE, afterall isn't that what they are here for? To turn things around? But I guess suddenly faced with the opportunity to find out what the hell is going on down there, just threw me into a tizzy.

Finally I got to the afternoon and darted out of my office. I was so lucky that my boss was out of town and I didn't have to explain that I was going to a "Physical Therapy" appt. that may take up to 2 hours. That's my new code name for my fertility appointments by the way. Physical therapy...for my hip that's been bothering me. I came up with it after my hip started hurting me after the gym one week and I had mentioned it to a co-worker. Pretty swift eh? Anyways I digress.

I finally made it over there with limited traffic (which in L.A. is like a friggen miracle). Once I got into the office my husband was already there filling out paperwork. Even though we got there 15 minutes earlier than our appt. we still weren't seen until 4p. I was slightly pissed. I thought if they make us wait more than a 1/2 hour I'm going up there to complain. It's enough that we are paying cash for this whole event but they are making us wait too? I know that it's a little unrealistic to think you're never going to wait but I just was in no mood. I just wanted to get in there and get the info before I changed my mind and ran out. I hated that I had to be there. I hate that our insurance doesn't cover any of this and I hate that my husband decided to sit right next to the "success" picture board. Damn him.

Right at that moment they called us in. Thank God. So to make a long story short I really like him and my husband (who had given me a pep talk before we went in about not giving in and letting him take us for a ride on anything we don't need) liked him too and agreed to all the tests the doctor suggested. I was a little timid about bringing all my info in such as fertility.friend charts (do you know you can print out from there? It's great!) in addition to the records from my ob/gyn for fear of being labled the crazy infertile. But he loved it and said that he very much appreciated everything.

We carefuly went over everything first in my ob's packet. He asked for clarification on tests etc. and jot down notes.

We then moved on to background info. Not too bad there. From what I've read I thought there would have been more explicit questions. But not really. All he really asked is how long we've been married.

From there we moved on to any info I printed out from fertility.friend and we further discussed my cycles. He also noted that I was extremely organized with my printouts. Not really something I could take credit for (except I guess compulsively logging on to the website and putting everything in each day of my cycles. With a VIP membership they offer a really nice print out of all your information in as much detail as you would prefer. I was definitely impressed myself.) And then finally on to my husband in regards to his health and medications he is taking (more on this later).

All in all he said what we were going to discuss was a problem of re-current miscarriage and not infertility because after all it's obvious I can get pregnant (oh sounds super simple mr. frozen embryo please do tell). And so he went on to explain the 6 most common reasons why women have miscarriages and each one's solutions, which I will further list in bullet points below just to help organize my thoughts. By the way thanks to everyone who lists their RE appointments in great detail, I actually reviewed quite a few such right before I had my appointment and it really helped calm my fears. Not to mention reminded me about some questions to ask.

And so here we go:

1. Chromosomal Abnormalities: We've all heard this one before. It's the main thing to blame usually for a first miscarriage...of course when you get to the second or third and so on you start to question what the chances are. This was the first thing he mentioned although it appeared (at least in his opinion) that this is the least common reason among reoccuring miscarriages. I can't really remember the percentage but it seemed like an awfully low number accounting for re-occuring miscarriages. He did mention that although it has been thought in the past that a sperm was healthy if conception occured when all was said and done (or in my husband's view point.."hey I got it there, so it had to be healthy, what happened after that is no longer my neck of the woods") if the pregnancy did not continue it was most likely the fault of something on the women's side. But today they are learning that even though conception does occur a defective sperm can cause a miscarriage and/or chemical pregnancy (by the way he considers a chemical pregnancy a miscarriage as well). This was news to my husband so I will gladly post it here. Anyways this basically is the old "egg/sperm wasn't of great quality" pregnancy would have never continued, story. The solution to this is to check egg/sperm quality. If egg quality is poor he suggested IVF so that he can specifically pick out the strongest ones (both sperm and egg) and fertilize from there. I asked him about clomid but he said that he would not suggest it specifically for me because of the effect it has on uterine lining etc. and the fact that he doesn't think I need it because I'm already obviously ovulating. (My ob was suggesting clomid on the off chance that it would help me spit out a million eggs and hopefully I would catch a good one) but he did caution me about the affect it has on the uterine lining. I was quite happy that he did not want to make me into a crazy egg making machine.
   
   
2. Uterine Septum: Yup, he got out his handy dandy model of a uterus (I truly feel this is done specifically for the husband) and explained how an extra muscle forms and therefore if implantation happens on this septum it could cause miscarriage due to the lack of blood supply in the septum. He noted that this could happen very early in the pregnancy as well as further along. He went on with more detail than that but I'll let dr. google help out with any of you reading that would like more information on this. The test for this is an HSG and the solution is a relatively uncomplicated procedure to remove it (or so he says). Although I'm sure there are all degrees of complications with this but in general he really didn't show any concern. As soon as I get AF (still waiting - currently CD 29) I am to schedule my appt. for this. I asked about the cramping that happens during and he said he'd recommend to take a few IBprofin before. Has anyone tried that? Major cramping scares me a little but I guess I've been through worse at this point.


3. Hormones: Now we're talking. He noted my Level 7 of progesterone at cycle day 21 in November when I was concerned that my cycle lengths were dwindling by the minute. And said that it was definitely low. Although he agreed with the progesterone taking during the beginning of the pregnancy, he advised that this might have been too late already and suggested that I be put on progesterone as soon as I ovulate (I believe that was the timeline he gave). Deep down I still feel this to be the reason I'm miscarrying but maybe it's just because so far it's the only test that I've taken and received a not so great number. And so operation haul in the progesterone is on the list. He is also testing a bunch more hormones for me to see if there are any others lacking. Honestly I can't remember which ones. But he said if there were any others lacking he might suggest "injectables" a word to which I still need to do research on. I'm thinking a whole bunch of shots and some crazy mood swings. How fun. Was I just complaining of major cramping during the hsg? Hmmm how naive of me.
   
4. Blood thinning: I knew it!!!! And then there was much talk about my slightly elevated ANA and the effects of blood clotting etc. And so here's where I asked my baby aspirin question. I was so excited that there was something I could take, relatively cheap, and easy that could possibly be my miracle cure to this. It's all the rave as you know on every fertility website but when mentioning it to my ob she quickly poo poo'd on my parade by strongly advising against it and saying that if anything it might encourage bleeding. And so I mentioned it again to Dr. Embryo. And he said...YES!!! Yes take it by all means starting immediately. Playing devil's advocate I quickly told him about my ob's concerns and he explained that it's not strong enough to cause major bleeding and it definitely helps. Yay!!!! And so I've been taking it religiously since then. I'm to have some blood results from my rheumatologist faxed to him so he can see exactly how okay I am in that area. But in case this might be an issue with blood clotting good ol' Herapin is supposed to be my miracle drug. I know I've read some ugly stories on this somewhere but I can't seem to find them right now. I figure I won't go digging until we have some concrete answers as to if this is the problem. Hopefully all I'll need is the baby aspirin.
   
5. Male sperm issues: I knew it!!!! So I touched on this above but he further explained how now a days we are finding more and more that even not so perfect sperm can lead to conception but then later miscarriage. This was really bugging me this time around because I have to confess I honestly did not think I would get pregnant this last December for one big reason. My lovely hubby completely forgot just days before the high surge time that hot tubs are off limits and spent (he says) about 10 minutes in one. I was furious with him and hounded him to never do it again. I thought for sure nothing would happen. But sure enough I did get pregnant...to which he quickly pointed out...see hot tubs don't affect sperm count or quality! Uh not so fast there buddy. I know it's far fetched but I wonder if this could have caused the last miscarriage. Since then we haven't talked about it again accept for me threatening his life if he goes into a hot tub again. But I did not mention this to the doctor in fear that I sound too naive. My husband did give him info on some medication he is taking (for slight depression sometimes) and the doctor thanked him and said that although in the past it was thought to not affect pregnancies they are finding also that medication taken by the male may very well have an affect. He said the solution to this would either be 1) to stop taking the medication 2) give him another type of medication to inhibit any type of effect of his current medication (didn't get too much info on this) or if it's just a matter of the overall poor quality to I think do an IUI with the best quality of the bunch. Again it's getting a little fuzzy about all what was said but that's the jist.
   
6. Nothing at all: And last but least. When I asked him at the end what he personally thinks is the problem looking at all my information, he said finally that most likely it's the last situation which is that there is nothing at all wrong. That there is a possibility of doing all these tests and finding that everything is humming along. This often times is the most common case scenario he says. Although there are things that can be done to move things along faster (IVF?) if this is the case we should have no problems moving forward on our own.

Let's hope. Well at this point I'm not so sure that the "nothing at all wrong" is quite frankly the best case scenario but it certainly sounds like the cheapest at this point. If I had to vote for something to be wrong it sounds like the progesterone thing and if necessary the septum thing might be my first choices. And so now we wait. They took a bunch of blood from both of us. I got swabbed for my cells on the same day and the hubby has made an appt. next week to give a donation to the "bank". And we are just waiting for good ol' AF to appear so that I can schedule my HSG. Oh the excitement. Care to make a wager anyone on what you think is the issue? Maybe I'll put up another poll... :)