Second Opinions

It's been about a month now since we received the news about my poor ovarian reserve. T wanted to get a second opinion before we made any decisions. I really did not because I figured we were just going to get the same news because my numbers were so bad. But, I love my husband and he wanted a second opinion, so I agreed. Yesterday we went in to the new doctor for a consultation and I realized how much I had resigned myself to never having kids again. This doctor has a COMPLETELY different philosophy than our previous doctor. I am so glad I decided to get a second opinion.

Just the look of Dr. S's office inspires confidence. A beautifully decorated office that doesn't even look like a doctor's office until you get into the back where the equipment and rooms are located. His office was covered with awards, achievements and pictures. Pictures of all the babies they had helped bring into this world. It was a warm, inviting place. And Dr. S was a very personable, likeable person. He sat us down and had us talk first - talk about what we wanted, what had brought us there, etc. I felt so comfortable talking to him, not nervous or scared. And he wanted to start treatment right away. This surprised me so I reiterated that I had been told I had poor ovarian reserve and we had previously been told our only real option was egg donor. He reviewed my numbers again and stated that the numbers weren't great but numbers didn't mean we had no real treatment options. Then, he went on to outline what he thought we should do.

Dr. S said that one of the big things for us right now is that I haven't been ovulating. He asked, if I haven't been ovulating, how can we know for sure that my eggs aren't any good? That simple question really stopped me. I mean, yeah, my numbers indicate there is a problem as compared to the "average" 35 year old woman, but does it really mean that my eggs aren't viable? If I haven't been ovulating, how do we know that my eggs can't be fertilized AND implant. We know now that T has some morphology issues but his blood work has shown that the medication is helping to correct that problem. Could it be that when I was ovulating, before we went to see a specialist, that my eggs weren't being fertilized because T's sperm couldn't break through and get in to fertilize the egg? But since I am not ovulating now, we can't know if my eggs can be fertilized and implant. Dr. S said to go to the worst case scenerio - egg donor- as a treatment when we hadn't even tried any other less invasive treatments was jumping the gun. First, we need to see if we can get me ovulating again. Then, if I do get an egg or two developing, we can use medication and doctor monitoring to say when the prime time is to try to fertilize the egg(s). He recommends I go on the oral fertility drug Clomid at the start of my next cycle and then be monitored to see if eggs develop.

What a completely different outlook this doctor has as opposed to the last doctor. Start out small and work our way up. Dr. S didn't rule out egg donor. He said that might still be in our future but that we should try other, less invasive and less expensive treatments first. I think of it as you wouldn't use a sledge hammer to hammer in a nail. You would start out with a small hammer first to see if that works. So, oral Clomid to start and then bring in the heavy hitters like injectable drugs if that doesn't work. After that, maybe IVF or egg donor. Start out small.

I started crying in Dr. S's office after he started telling us this. I realized I really had pretty much given up on having any more children, and hearing him say something so different from what we had previously been told, I broke down. I started having hope again. We still have a long road to haul, but.... Going from egg donor to an oral fertility drug is like night and day.

It makes me regret having gone to the other doctor and wish we had started out with Dr. S. We wasted so many months just on testing and never even TRIED any treatments. I know a lot of my testing was already complete before we even saw Dr. S, but, Dr. S was telling us how he wanted to start without mentioning the various tests that might be needed. Before I brought up what the previous doctor had stated and we reviewed my numbers. The other doctor was so focused on testing and getting that high success rate. Dr. S seems focused on getting us pregnant and not on his success ratio. I feel like the other doctor only wanted to do what had the highest potential for success quickest based on my numbers. I can't help but wonder if that office is more focused on their statistics than on the patient. I have a friend who also went to my first doctor's office and received the same treatment option - egg donor. She, too, is now going to Dr. S's office. Egg donor has the highest rate of success so is that the main reason they push it instead of trying other options first? I don't know but I do know that I am done with that office whatever the outcome with this new doctor. Numbers don't make a person and all I need is ONE egg and ONE sperm to get pregnant. Maybe this time we will get them.

And the results are in

I haven't posted in awhile and I am sad that this post is going to be so negative. T and I had our consult with the doctor to go over our test results and go over our options. Based upon what I was hearing from the nurse when she would give me the results of each test as we took them, I knew it wasn't going to be fantastic news. I didn't expect it to be as bad as it was, though.

The doctor's recommendation at this point is that we try egg donor or embryo adoption. I have such poor eggs that if we tried IVF with my eggs, we only would have about a 5-10% chance of success. If we try egg donor or embryo adoption, it would be about 60-70%. He said that there is always a chance that we could get pregnant on our own, I am not sterile, but the odds are not good at all. Apparently, the endometriosis that I have battled all my reproductive life has destroyed my chances for another genetic child by damaging my ovaries and/or eggs. After my surgery when I was 17 or 18, I thought I was fine. That the endo was in remission and we had caught it in time. Apparently not. That or there was more damage than originally thought and we were very lucky to have gotten pregnant with B.

I am so unbelievably devastated by this news. I haven't been able to stop crying since we found out. One minute I have it under control and the next I am crying all over the place. I can't even talk about it (or write about it for that matter) without crying. I haven't really talked to anyone about it since we found out. T and I haven't even really discussed it, yet. But my dear, wonderful husband understands this, thankfully. I had to go to work after our appointment and receiving this news. T left roses and a lovely, handwritten card for me to find when I went out to my car after work. He, too, is understandably upset but is giving me space and time to come to grips. I am lucky that he is so understanding and willing to let me get myself together before we discuss anything. He did state today that he would like to get a second opinion before we make any decisions. I am unable and unwilling to make any decisions right now so that sounds like a good idea to me.

I guess I am going to let myself process this and grieve for a little while, and then we will try to figure this out. Get a second opinion is the first step, I guess. I am not too optimistic on that front. We don't have much extra money so I am worried about that. How do we best use the resources we have? Right now that is too much for me to even think about - I am so not ready to explore alternative options. Maybe in a few days or weeks. I do know that every time I look at my daughter right now, I start crying and thank GOD that I have her. I think this would be even harder for me if I didn't have her.

THE GOOD AND THE BAD

My period finally came, yay. I called the RE office and had my initial blood work done yesterday. I start the clomid on Thursday and go in for my second set of blood work on Tuesday. Keep your fingers crossed for me, we are hoping for a low number. The nurse also suggested we take advantage of the fertility drug and get some ovulation predictor kits so we can see if/when I ovulate. Then its...well, I think you know :). She said they have had people get pregnant because of taking clomid during the test. I am not getting my hopes up, but, wouldn't that be fantastic.

I have some good news and some bad news. The good news is that I have lost 7 lbs as of last week. I am hoping that I am approaching, if not already reaching, the magic mark where my periods will start naturally occurring on their own. That's the goal for right now. Eventually, I hope to lose enough so that my hormones regulate on their own and I can get off the Metformin.

Now, the bad news. If T and I haven't had bad luck, we would have no luck what so ever. Our luck just can't seem to turn the corner in a good way. After months of harassing my dear husband, he agreed to go in and have a full physical. T had been having issues with reflux and that was my biggest concern. I also wanted him to get his cholesterol checked because he has been medicated for it being high and heart disease runs in his family. T comes home today from the physical and tells me he has to go see a cardiologist, the EKG shows he may have had a small heart attack. Talk about being floored. Then, I was soooo mad. Very unreasonable, I know. T does not talk about his health with me. If I look at him and think he doesn't look like he is feeling well, and I ask him, all I ever get is.."I'm fine" or "It's OK." I have been on him for months about taking his meds (which he wasn't) and getting a check up. All I could think was, that SOB, if he has a heart attack and dies on me, I am going to kill him. Very unreasonable.

After this goes through my head, I start crying. Then, I call T's mom who is a nurse. I figure, if T isn't going to listen to me, maybe he will listen if his mother and I both tag team him. It worked. Dirty pool but I will do what ever I need to to make sure he is healthy and with me. T's mom has had bypass surgery because of the family heart disease issues and she insisted that T get a referral to her cardiologist.

T is very aware of the seriousness of the situation. The doc has told him he needs to lose some weight and get some more exercise. Thankfully, T was able to tell her that we had already started the GI diet. He promises me that he is going to stick to it and take it seriously. He also said he is going to get more exercise, even going so far as to promise to do some of my Yoga DVDs with me. Being a man, I am sure the pounds will melt right off him now that he has put his mind to it especially since the guy doesn't have that much to lose to get to a healthy weight. I hugged him and told him I love him and am willing to play dirty pool to keep him around. I also told him if he has a heart attack, I will nurse him back to health and then make his life miserable :).

This past year has been brutal to us. I keep thinking, we have to get a break soon. I hope it comes soon because I am so tired of nothing but bad news. It gets you down and makes for a very negative attitude.

4 lbs

Apparently, changing my diet and exercising in addition to the Metformin has helped because I have already lost 4 lbs. Yay, me!! I haven't been following the low GI diet completely because I have been trying to eat up what food I do have in the house. In this economy and with finances the way they are, I just can't throw away food because I am starting a new diet. So, I have been doing the diet as best I can with the food I have and I still have lost weight. Yippee!!!

Today I went to the grocery store armed with my list of approved food and ingredients for various recipes. Since the diet relies so heavily on fruits, veggies and whole grain foods, it is a big change in how we have been eating. I was very worried about how much my grocery bill was going to be. I figured it was going to be higher than normal. It seems like all the food that is good for you is also more expensive. I was pleasantly surprised to find my bill was actually LOWER than normal. We must have been buying some expensive junk before. Granted, I didn't buy much meat this trip because I have plenty, but, still, it was about $20 lower than normal. Now we will just have to see if I bought enough to get through the week.

Poor T is not as excited as I am about changing the way we eat. The only junk food I bought this week was Oreos mainly because of B (that girl loves her Double Stuffed), but also because I don't want to completely deprive us of snackedly goodness. Total deprivation would probably back fire, quickly. T was a bit less than enthusiastic about what I bought and what will be available for him to eat. I strongly suspect he will be making a side trip to the store before the week is out. That or sneaking at work. That's OK with me. Right now it is more important for me to stick to the diet than him. I can work on him in the ensuing weeks :). B, on the other hand, so far doesn't seem phased by it. She was very happy with her salad today and really enjoyed trying a mango for the first time. I made sure to include some salami, which she really likes, so it wasn't completely different. Being so young, she will probably have less trouble adapting than T and I. I am really hopeful that we can stick with this. B will grow up eating healthy so it will be second nature to her to eat healthy when she is a teen and adult. If we get nothing else out of this than that, I will feel it has been worth it and productive.

The other good thing is that I have gotten 2 co workers looking into starting the low GI diet. One is interested for herself and her husband, and the other interested for her father who has recently been diagnosed with diabetes. Now I have at least one buddy for support as we work towards losing weight and getting healthier. T is doing this for me but I don't know that I would say he is all that interested or someone I will turn to when things get tough for moral support. He will be there in a pinch but day to day complaining, I think I would do better with a fellow woman and dieter.

I have read that losing just 5% of my weight can improve conception by 70% in a woman with PCOS. 70 % - WOW. I am already half way there. I know I have other issues involved with our infertility but at the very least, maybe I will start having regular periods again and possibly even start ovulating on my own again. If I can get my progesterone and estrogen back under control, I might even start sleeping better again because too low progesterone and too high estrogen can both cause insomnia. I have to admit, I have been sleeping better the last few nights since I started taking the Provera. Hormones are really funny things. I never realized what havoc they can cause when they are even just slightly out of whack.

Provera, we meet again

I had blood work done yesterday because my period still hasn't started. Surprise, Surprise - my progesterone levels are low again so I get to start taking Provera again. The upside is that it will start my period and then I can get my Clomid Challenge Test. The downside, it will probably be about another month before that will be done. This waiting is so torturous. I can barely stand it.

I did take the opportunity to ask the nurse a few questions about some of the results from my previous blood work. My biggest concern was my AMH level (Anti-Mullerian Hormone). A very basic explanation is that AMH blood levels indicate the size of the remaining egg supply - the ovarian reserve. Normal AMH levels are over 1.0 ng/ml. My level was 0.2 ng/ml. This is very low, dismally low. It looks like I have an egg quantity issue. The nurse, however, said that they can still help me as long as my FSH levels (Follicle stimulating hormone) are low. FSH is the hormone that helps produce mature eggs by stimulating the ovaries to get follicles to develop. Immature eggs rest inside follicles, stimulate the follicle and you stimulate the immature egg to develop. Higher levels mean the body is having to work harder to get the follicle to develop. High levels are not good. So if I have low AMH and high FSH, it means I would have poor egg quantity and quality - premature ovarian failure. You normally see high FSH levels in menopausal women. The higher the FSH, the likelihood of responding to infertility treatments like IVF is poor. As long as my FSH levels are within an acceptable range, I could still respond to fertility drugs, though I would probably have to take inject able drugs as opposed to the oral kind. The inject able drugs (inject able gonadotropins) are the same hormones as FSH. So very scientific. Basically, I have an egg issue in addition to a hormone issue. How bad the egg issue is will determine if fertility treatments are even an option for me. The Clomid Challenge Test will determine my FSH and where we go from here.

Now, T and I are practicing patience and playing the waiting game. I want to know my levels BUT, I don't want to know. T says hope is still alive right now and we need to hold on to that. Unfortunately, I am having trouble staying optimistic. T is a glass half full kind of guy and I am the glass is half empty fill the damn thing up kind of gal. Optimism has never been my strong point. I have all these scenarios going through my brain, none of them good. I am afraid to hope, I think. Because if I hope and we get bad news, it will crush me. As long as I believe it is going to be bad, if we get good news, I can be surprised and ecstatic. If it is bad, then I have already started preparing myself for it. See - glass half empty but with the expectation that it can be filled up.

I think I need to back off on my research for a bit and take a breather. Reading all this stuff that can happen or what things might mean is just stressing me out. I am filling my handy dandy note book up with so much stuff to ask the RE that he is going to freak when he sees me walk in with all these pages. I remember when I went to one of our early pediatrician appointments with B and I was full of questions I had gleaned from various parenting magazines and books. I was so worried about milestones and her development and kind of freaking out. I remember the doctor sat me down and said the first thing we need to do was throw away all those books. Charts and levels and standards do not make a child and each child is an individual and they don't develop on a time line. I think I need to adopt that philosophy to this situation and step back, take a breather and wait for all our results to come in. Easier said then done. I guess I need to work on my practicing patience.

My wonderful husband

My posts so far have been fairly depressing and negative so I wanted to be a bit more upbeat. I got home from work last night and was surprised at the door by T who bent me back romantic movie style and kissed me the same way. He had a hot bubble bath waiting for me, candles all over the bathroom and bedroom. He fixed me a drink and we shared a wonderful bath together. Then, yes there is more, he gave me a lovely massage after the bath. It was heavenly. We spent the next hour sipping our drinks and talking quietly before we went to bed. I asked him why he was doing all this, I have to admit I was a little bit suspicious :). His answer, just because... What a wonderful, fantastic way to end the day. I have my bad days and then, T does something like this that lifts me up and lets me know how loved I am. I guess I was wrong about Monday blues coloring the rest of the week.

The grass is always greener...

Have you ever watched the show Lost? I recently started watching the first season on DVD and was hooked. Too bad it is ending after this current season, huh? Typical. Anyway, probably the major theme underlying this first season is changing yourself/reinventing yourself, a clean slate. Basically, the old you is gone so its time for a new one who doesn't have to be held to the same constraints and screw ups as the old you. Wouldn't that be absolutely fantastic? To be able to reinvent yourself and start all over?

I started thinking about this and thought, OK, if I could change one thing in my life, what would it be? Definitely my job. I dislike shift work, working so many holidays, the mandatory overtime, the politics, working in the evenings away from my family, and the list goes on and on. I think a large part of my stress and unhappiness in life is a result of my job. Unfortunately, leaving my job is not something that is going to happen anytime soon, if ever. I have been thinking that if I could go back in time, I would not have taken this job and would have continued for my master's degree after I received my bachelors. If I could have gotten my master's back then, I think I would be in a job that I wanted and that would not stress me out so bad and bring me such unhappiness.

I have been daydreaming about never having taken my job, being more educated/better qualified, having a better for me job, for days now. What would it have been like? How much more money could I have made? What other kinds of people I might have met? What would my life be like now?? WHOA WHOA WHOA !!! That last one kind of grabbed my attention and made me realize something -- what would my life be like if I had never ended up where I am now? I would never have met my husband to begin with. If I had never met my husband, I never would have had my precious B. B is the one thing I can look at in my life and can say I helped make this spectacular, wonderful person happen. She is the best thing that has ever happened to me and the best thing I have ever done. And if I had never taken my current job, she would not exist.

I realized that by changing one aspect of my life, I would have completely altered the path my life has taken. Would I possibly be happier, wealthier and less stressed? Definitely. But I also wouldn't have the one thing in my life that makes up for all the rest, the one thing in my life that I would walk through fire - my family. I wouldn't have T or B and that is just not acceptable.

So I am in a crappy job, stressed out, financially not where I wanted to be at this point in life, but I have my family. I have my B who gives me the greatest joy in my life everyday by just being my daughter. Maybe reinventing myself, wiping the slate clean isn't as fantastic as I thought it might be.