Doctor, Doctor, Mr. MD

I took your advice. I shaved my legs. I painted my nails. I gathered up all the information I have regarding my own medical history.


I arrived at my doctor’s appointment 30 minutes early with extra glossy lips and a clip board in hand. I typed up a 3-year account of my menstrual cycle and a list of all my recent supplements. I filled out the medical history form the office had sent me prior to the appointment. I even brought in all my supplements (except the royal jelly, which requires refrigeration) and my copy of the Making Babies book, neither of which were necessary.

I felt as prepared as I would ever be. And I figured I knew exactly how this would go down. By the end of the appointment, I would have doctor’s orders for six weeks worth of blood tests, and in two months, I would be back in his office for the results. I was wrong.

John and I met with the doctor in his office. He looked through my medical history and asked me questions. He is soft spoken and kind, and we liked him right away. It helped that we were referred to him by dear friends, so we already felt a level of trust and confidence in him that we wouldn’t normally feel toward a stranger.

After our initial discussion, we went to an exam room. Let’s just say it wasn’t the most fun I’ve ever had. By the end, I felt nauseous and faint. But the worst of it didn’t last long, and it was worth it. I now know some important things I didn’t know before. First, there are multiple cysts on both my ovaries. Second, the doctor believes I have endometriosis and PCOS.

The PCOS part wasn’t a surprise, and because I suspected PCOS, I never really thought about endometriosis. It didn’t occur to me that both might be at play. So, after peeling myself off the exam table and getting dressed, John and I met back up with the doctor in his office. This is where he gave us his professional recommendation, which is to have a laparoscopy as soon as possible.

One thing he said, which I really appreciated, was the importance of having this surgery for my overall health (not just to improve the likelihood of pregnancy). Not getting pregnant is what got my attention, but it is a symptom of something else.

My surgery is scheduled for Wednesday morning. I'd appreciate prayers and good thoughts, and any pre-surgery advice.


UPDATE: Laparoscopy was moved to Thursday. 

I know all that there is to know about the waiting game

(And I'm sorry if you have Boy George's "The Crying Game" stuck in your head for the rest of the day. Better that than "The Macarena." Or "My Sharona.")

When I made an appointment with my OB a few weeks ago, I explained to whoever it was I was speaking with: I have questions for her about fertility. I've been trying to get pregnant for a while and ... nothing is happening. 

I guess I assumed that, armed with this knowledge, the appointment-person would set me up with a non-standard meeting with the doctor, during which I could explain my basal rate temperatures, ovulation tests and suspicions about what I think is going on. With that assumption, I wrote down about ten questions for the doctor, packed my temperature charts in my purse and headed off to war. I mean, the gynecologist.

The next thing I knew, I was flat on my back with my legs in the air and a speculum in my nether regions and couldn't remember half of what I'd wanted to ask. In the past, my doctor's cheerful brevity and ruthless efficiency have been extremely welcome. That woman can do a breast exam and papsmear in five minutes flat, and before you know it, you're back in your car and feeling the least molested you've ever felt following a visit to an obgyn.

I tried to relay my concerns -- tried to convey that I'm not just some silly girl who's been bopping her husband and doesn't understand why she's not pregnant. I mean, I have charts! I've read books! I pee on sticks!

So you're having timed intercourse? the doctor asked cheerfully.

Timed intercourse is the least of it, woman!!! Timed intercourse is for amateurs! I deserve an honorary doctorate from Stanford! is what I was feeling. "Yes," is what I said.

Well, you're healthy. You're 32. Sometimes these things just take longer for some people, she said.

For her to say that was basically an indication of just how much she does not understand my level of obsession. I don't know whether to love her for making the situation seem like it's not a big deal or hate her for not trying harder to get me.

It's not as though she did anything wrong. She ordered up all the necessary tests, which is all I could have hoped for. I guess I'll stick with loving her for now.

So here's the plan. I'm on Day 19 of my cycle. I'll likely welcome Aunt Flo on Day 30. On Day 3 of my cycle, I get to have some blood drawn. Around the same time, my husband will also donate his own sample. Hopefully this will reveal something. Anything, for godssakes.

You never know. Maybe it will happen this cycle! my doctor enthused happily. 

Yeah. And monkeys might fly out of my butt.

Damn

I have now been off everything for three weeks. No hormones. No supplements. No herbs. I feel a TON better. No break through bleeding. No stomach problems. No emotional roller coaster. Oh, and no ovulation.

That's right, according to my trusty little pee sticks, my eggs have taken a hiatus. It is now day 21 and no double line has appeared.

So, what to do now?

I'm not really sure.

I think I need to start adding stuff back in.

With my next cycle, along with the new and improved "healthy living" initiative, I am going to restart with the hormone therapy. I am starting with that instead of the supplements since I know that didn't make me sick. I was on it for a year before I started the supplements, and never had problems. Of course, during that year I also didn't get pregnant, so I don't know if it was having an impact on my ovulation. In the next month I will track it and, if I begin ovulating again, stick with the hormones and flush the supplements.

If I don't? I will try a month on the supplements and see what happens.

My hope is that one or the other was causing ovulation, and that it was just the combo of both that caused the problems. I am hoping the combo wasn't responsible for both the good and the bad, because really, the bad was too bad to even think about the good.

I am hoping there is a simple solution to all of this that I am just overlooking.

I am hoping that I find that solution before all my hope, and patience, are gone.

Annnnnd, breathe.

Avoidance

I finally opened the new patient email my new doctor’s office sent me at the end of May. I knew I needed to fill out a medical history form before Friday’s appointment, and I thought I was being extra on top of it by opening said email on Wednesday night instead of Thursday night or Friday morning. A medical history form is something I might fill out in the car on the way to the appointment while John drives.

What I didn’t realize was:

a.  I needed to ask my three previous doctors (all of whom ran some sort of fertility blood work and performed pap smears on me) to fax my medical records to the new doctor prior to my appointment.

b.  My consultation will likely take 1.5 to 2 hours and include a detailed review of my medical history, a physical exam and two pelvic ultrasounds.

c.  Even though I have insurance, I should have asked what my out-of-pocket expenses would be for this appointment. I happen to have one of those crazy plans that doesn’t pay a dime until I meet the $2,000 deductible, which, from the sounds of it, might happen at this appointment.

So, I’m kind of freaking out, and I’m seriously considering rescheduling. But first I’m going to call my previous doctors in the morning and see if they can track down my medical records. I have copies of some of my blood work results, but not everything.

Then I’m going to try to prepare myself mentally. I’ve been avoiding even thinking about this appointment. I used to not understand why someone wouldn’t want to go to the doctor, especially if the doctor may have solutions to her problems. But now I get it. It’s much more complicated than I imaged.

I have a friend who doesn’t have children, and she and her husband don’t fully know why. It took me awhile to understand that she really doesn’t want to find out exactly what is going on, at least not right now. She would like nothing more than to be a mother (and she has been to doctors and tried various things). But on the flip side, really having answers might mean finding out she will never have children, and she just doesn’t want that information at this time. She’s told me if they found out for sure that children weren’t possible she and her husband would probably have to take a month off work to grieve and plan and refocus their lives. At this moment, for her, it’s better not to know.

I completely understand. I feel torn between wanting answers and wanting to avoid the whole thing altogether in hopes that it will just go away.

UPDATE: My nails are painted. My legs are shaved. I'm off to see the wizard of fertility today.

The doctor visit

I have an appointment with my OB this morning, and I have almost no idea what to expect.

There probably won't be a lot to report, as I imagine she'll just make me a bunch of appointments to ultrasound my lady parts and draw my blood. I've never had an abnormal papsmear, so I don't expect her to be peering into my nether regions and suddenly gasp Oh! Here's the problem! And pull out a sock or something.

It could answer the age-old question: Where do all the socks go? Vaginas.

I joke, of course. What I mean is that I don't expect her to find anything unusual, like a cyst or something.

Just recently I had a realization about something that might be affecting my fertility. I can't believe it never occurred to me before now. And also, I can't believe I'm about to write about it on the Internet.

The thing is, several years ago -- probably eight or nine years ago -- I got bacterial vaginosis. Don't get all grossed out; BV is just an overgrowth of the normal bacteria that lives in your hoo-haw. It is the most common vaginal infection in women of child-bearing age.

But at the time, I had no idea what it was. I thought it was a yeast infection, because I'd never had one of those, either. So I tried to treat it with some shit from the drug store, which didn't work. I may have waited a couple weeks before I finally sought professional treatment. The doctor diagnosed me in minutes and sent me on my way with antibiotics. 

Today I had to go and make myself extra paranoid by googling whether BV can affect fertility, and of course I stumbled across a page that said:

Additionally, bacterial vaginosis can permanently affect your fertility. If left untreated, bacteria from the vagina can travel into your uterus, causing serious damage to your fallopian tubes. This can leave you at risk for future ectopic pregnancies or for complete infertility.

I obviously treated the infection, so I'm not sure if I'm subject to this complication or not. 

Another site said it can lead to pelvic inflammatory disease. 


The CDC says:

Pelvic inflammatory disease (PID) refers to infection of the uterus (womb), fallopian tubes (tubes that carry eggs from the ovaries to the uterus) and other reproductive organs that causes symptoms such as lower abdominal pain.

Interesting. I am no stranger to lower abdominal pain, but my previous physician dismissed it as a torn muscle.

Now, I don't want to pre-diagnose myself, but while I'm on a roll, I went ahead and looked up PID in Making Babies. It led me to a section on Lutenized Unruptured Follicle Syndrome (LUFS), which occurs frequently in women who have had PID.

LUFS "... is a rare condition in which a follicle develops to mature an egg, but the follicle never breaks open to release the egg. LH spikes, the usual signal to start ovulation, but there's no ovulation..."

"LUFS is difficult to diagnose because it seems as if ovulation has occurred: BBT (basal body temperature) rises, progesterone goes up, and other hormone levels are normal."

Also interesting. My LH spikes every cycle, as does my temperature. The only difference is my temperature then usually bing-bongs all over the place after that. The book says the cure for this is simple: A couple of injections of hormones prompt release of the egg, and if the sperm is OK, you've got a winner.

And here's another interesting tidbit that should have any of us who are having fertility issues making appointments with our doctors, pronto:

"Studies have shown that about 25 to 30 percent of women seeking treatment for infertility carry microorganisms that can impair fertility." These can be as simple as the microorganisms from a yeast infection. You could be asymptomatic, but that junk could be throwing everything off. They can kill sperm or infect an embryo if an egg gets fertilized. If this is happening, both partners need to take antibiotics to kill that shit off.

So what I'm getting at is: I have no idea what's causing our infertility. I'll be requesting the full gamut of testing, and will be sending my husband in to have his sperm checked out.

If I have any updates after today's appointment, I'll put them at the bottom of this post later in the day. If not, I'll update next Wednesday!



Update: I can't even really begin to tell you about all the things I forgot to ask the doctor about, like my Vitamin D levels or my wonky temperatures. It was a very brief visit. I told her I'm having trouble getting pregnant, and she instructed me to get some blood drawn on the third day of my next period (I estimate this will be sometime around July 13). They'll be testing for hypothyroid, estradiol, FSH, and prolactin. I don't know what any of that means, so me and Google have a date for later this afternoon. 

I also have a lab sheet for my husband to have his semen tested. I'll wait for my period to start before I make him do that, as well. 

I did ask my doctor about the BV and she says it shouldn't be an issue. If I had PID, she says I'd know. With no history of STDs, I should be fine and probably will not need that test where they inject iodine into your lady parts and see if there are any obstructions. (I am definitely feeling like master of the overshare today).

Lastly, the exam went well, as expected. There were no socks or other foreign objects hiding out in my vagina and she pronounced that everything looked great. And if anyone out there is wondering what an actual professional says about frequency of sex during your fertile window -- my doc says every two days.

Re-evaluating

I didn't post last Tuesday because I was in the emergency room. Well, actually, that's a lie. On Wednesday I was in the emergency room. On Tuesday I was writhing in my bed praying for sweet merciful death. By the time I finally went into the ER I was sure that my gall bladder had given up the ghost, or my pancreas was close to exploding. Neither turned out to be true. Instead, the doctor took a look at the long list of supplements, herbs, hormones, and metabolic pills I was taking and suggested that I might be overdoing it just a titch.

The next day I went to see my OB/GYN. I told her about the hormone therapy I had been doing for the past year, and the "Making Babies" program I had been since March. She nodded sympathetically, and then asked why I was making myself so sick and miserable. She said that from her standpoint none of the things I was doing were going to help in my getting pregnant. They wouldn't hurt, but they wouldn't help. If anything they would just have a placebo effect.

I started to cry.

I want this so badly to work. We can't go back to the assisted fertility model. That was destroying my body, and our marriage. But I obviously can't keep doing this in the way I have been doing it.

So, I'm not quite sure what's next. I have now been off all of the pills (other than my anti-depressant) for a week. I feel better. I am going to keep going to the acupuncturist because that makes me feel good. I am going to stay on the Metformin because it helps with my appetite, and I know it wasn't the culprit. I am off the supplements and the herbs. I think instead I will just try to hit hard healthy living stuff hard. Actually get out and walk and eat the way I should, instead of relying on a handful of pills to pick up the slack.

And I am going to be nice to myself. I am going to remember that I am not the sum of my reproductive parts.

I am going to enjoy what I have.

Out of Town

I'm on the road, but sending many merry thoughts to you and your ovaries. Be back in two weeks.

Flatliner

The appointment has been made! June 22. Commence nerves.

Normal papsmear - no problem. The whole "what's wrong with my baby machine" thing, though ... is a little nerve wracking.

I can play the well-educated guessing game all I want, but the fact of the matter is we simply don't know what is preventing conception. More and more it seems like I hear about people who just can't have kids because of a variety of issues, and if that's me, too? I don't know what my next step is and I can't think about it yet.

Since I began taking my basal body temperature first thing every morning several months ago, I've suspected a progesterone deficiency. The last few cycles in particular have been a bit disturbing -- the temperatures hover around 98 degrees, forming a mostly straight line, rather than that spike in temperature you really want to see at ovulation and afterward.

I have no idea what causes a progesterone deficiency. The internet has a number of theories: Exposure to petrochemicals as a fetus; too much estrogen (fat); birth control pills cause estrogen dominance/ early follicle burnout; stress; hormones in meat.

Of all of those I figure if anything screwed me up it's the birth control pills. And my weight.

Today is my ninth day on the vegan cleanse, and so far, it's had minimal results where my fertility is concerned. I'm noticing more moisture down below, but my temperatures are still wacked. I've lost about five pounds, which is great, but too few to really effect any change at this point.

The goal for the next couple of weeks is to just keep on trucking -- keep losing weight and trying to stay positive. A progesterone deficiency would probably be welcome news at this point: At least there are pills for that.

Any Luck?

The supplemental health guru at Whole Foods is the nicest.

She’s probably 20, and a bit hippie (I mean that as a compliment), and she drinks chlorophyll to make her skin look good, though I doubt she needs to. Ever since she helped Erin and I pick out royal jelly and flax oil, I make a point to say hello anytime I see her in the store.

Anyway, this week we had our usual exchange of pleasantries, and then she casually and politely asked, “So, have you had any luck?”

I seriously wouldn’t have known what she was talking about, but she motioned to the belly area of my torso. “Um. No,” I stuttered and then I turned red and then I promised I’d keep her posted. I mean at this point, I’ve already told her I’m trying to get pregnant, why not continue riding the overshare train.

In other news, I promised about a month ago that I would at the very least call the doctor before June. That deadline hung over my head all month. So, I finally called the doctor’s office on the last day of May and set up an appointment for the end of June.

This would be a doctor I’ve never seen before. He comes highly recommended, and his number has been written on a post-it stuck to my fridge for months. It will be interesting to hear what he says.

In the meantime, I have a few weeks to work on improving my overall health (i.e. weight). I’m currently taking the radical approach of eating smaller portions. It’s a revolutionary idea, I tell you.

The joke's on me

I'm on Day 20 of this cycle, and I'm pretty sure I ovulated two days ago. My temperature spiked (just a little -- only .3 degrees) and then yesterday it crashed back down .4 degrees.

It all looks very familiar. So far I'm much calmer this cycle. In previous months I've been majorly frustrated as I watched my temperature see-saw up and down; a possible indication of a progesterone deficiency. It made me feel hopeless. This month I don't know why -- I just feel more hopeful. I know all hope is not lost. Anything is possible, even in a wonky cycle like mine.

Yesterday I started the 21-day vegan cleanse I mentioned last week, and I'm hoping that helps my body be a more welcoming host, not to mention that it should result in weight loss as well, which would help regulate my hormones.

And today I am officially insured! Now I can make that appointment with my OB and go get poked and prodded. This will be my first "fertility" check. Every other time I've been to an OB they say everything looks perfectly normal and I should be able to have kids just fine. Of course, a few of them encouraged me to do so sooner than later, and perhaps I should have heeded that advice. Not that it's any of their business when I decide to have children.

In the meantime, I'm at the beginning of the dreaded two-week wait. Staying hydrated and nourished, taking my supplements, going on walks. The cleanse keeps me off coffee and alcohol, which is an added bonus and something I should have been doing anyway, I suppose. 

Other than that, I'm just trying not to obsess about it. It's easier said than done, when everyone around you seems to be pregnant or carting around an infant. It's no fault of theirs -- it's just the universe playing a cosmic joke.