Starting Where We Left Off

On Friday, I had my first appointment with the reproductive endocrinologist, Ivan, after my miscarriage. He asked whether I had been trying to get pregnant yet. Hm. I had been told to wait six weeks or one or two cycles - depending on which medical practitioner I asked. This appointment was exactly 6 weeks after my D&C. Though truth be told, we have not been using protection for the last couple weeks. I wasn't ignoring medical advice, but just thought that the likelihood would be so low - since it took me several months to get pregnant the first time. In the end, Ivan told me that the "right" amount of time to wait is really not known, and he knows people who have gotten pregnant right after a miscarriage, but the standard guidance is 1-2 cycles.

So now we start again in earnest. Ivan asked my husband and I if we wanted to start where we left off. Before I got pregnant in January....

Last October, I met a woman at a baby shower who had received a donor embryo. She and her husband had been trying for a while. She was older. She went through fertility testing and found she had a very high FSH. Basically, she was going through menopause. No more eggs. But today, four years later, she was a happy mother via a donated embryo.

A sweet story. But it started nagging me. She looked to be 4-5 years older than I, so she was trying to conceive at my current age. In late November, I decided to go in for fertility testing. Usually, infertility is defined as not conceiving after a year. But, at my "geriatric" age of 38, Kaiser allowed me to proceed with the tests immediately. One of the tests, for FSH, has to be completed on day 3 of the cycle. I got the results in mid-December. FSH of 13. "Slightly elevated for my age" was the diagnosis. I researched madly on the internet. FSH below 10 is considered normal. FSH can go into the 30's- 40's, and indicates menopause. So it was only slight, but considered perimenopausal (http://www.advancedfertility.com/day3fsh.htm). A girlfriend told me that in Sweden, 13 is still considered normal. How she knew, I don't know, but I liked this diagnosis better.

Kaiser wanted me to see the reproductive endocrinologist immediately. First appointment with Ivan. An ultrasound showed that I had a healthy number - a normal number - of antral follicles - a total of 14 in my ovaries (http://www.advancedfertility.com/antralfollicles.htm). This was at odds with the FSH test results, but he still recommended fertility treatment, given my age.

We discussed three options: Clomid, IUI and IVF. I was not considered a candidate for Clomid, the least invasive option, due to my FSH level. FSH is the hormone that tells the follicle, the egg, to develop. An elevated FSH basically means that the body is having to yell to get the follicles to develop. Clomid basically mimics FSH, so more yelling would likely not increase my chance of getting pregnant.

IVF I was familiar with: hyperstimulation with hormones to produce a large number of eggs. The eggs are harvested, then fertilized in vitro - in a lab - then one or more are returned to the uterus.

IUI is in between. Hyperstimulation, but much less than IVF. The eggs are not harvested; artificial insemination is used. IUI was also very inexpensive under my health insurance.

OK, we would go with IUI.

First, I had to take an HSG, to ensure there was no blockage of my fallopian tubes. A dye is injected into the uterus and its flow through the fallopian tubes is observed on an x-ray (http://www.webmd.com/infertility-and-reproduction/guide/hysterosalpingogram-21590). A quick procedure, but the 5 minutes were much more painful than I expected, as the dye pushes on the inside of the uterine muscle.

The dye flowed very vigorously on one side, not on the other. They repeated it, because it was not clear whether the dye was just flowing slowly on the second side. Inconclusive on the second side still. Ivan wanted me to undergo tubal recanalization to ensure the other side was open, before the IUI.

OK. More steps. Right before my HSG, a girlfriend had told me that her sister had gotten pregnant right after her HSG. I didn't put any hope in that story. But then in early February, one week before my tubal recanalization was scheduled, I had a positive pregnancy test! So, maybe there is something to clearing out those dusty tubes.

Back to the present. Starting where we left off. I want to go forward with the IUI now, since I may be entering my fertility twilight years (hopefully not twilight zone). Ivan wants me to complete the tubal recanalization first. So, this will be at the end of June, then IUI in early July. Actually, not too bad of a schedule for my impatient self.

Unless I'm pregnant again before! Wouldn't that be nice.