Aa
So Frustrated!
Well, for those who read my previous post, I got my MRI results last night. Everything was normal. I should be happy because that means that nothing's terribly wrong in my brain. Which is good news, right? But it's so frustrating because now that means that we still don't know what's wrong with me. It's been 5 long years (with several years of misdiagnosis), and we're still no further than when we started 5 years ago. I have no idea where we go from here because I didn't actually get to talk to my doctor (he just left a message on my machine that the MRI was normal, and hung up, and I didn't get it until after office hours), and he's not in the office today. I cried all night last night. I feel like I have nobody to help me through this (my dh is great, but he doesn't quite understand how I feel, and he also feels like he has to be the strong one, so he just tries to be ever so optimistic). And now I have to sit here at work all day and hold it together when I really just feel like screaming my head off. Sorry for the rant, but like I said, I really need someone to talk to about all of this, and I feel like you ladies would understand more than anyone else.
I am glad I can be of some help. Here are some common tests:
Basic infertility evaluation: What should be included in the initial infertility evaluation?
History
The doctor will ask questions about your past to try to get clues as to the cause of your infertility. These questions will be regarding your medical, surgical, gynecological, and obstetric history, as well as some "lifestyle" questions.
A review of fertility-related records from other doctors that you have seen is also important.
Physical exam
A directed physical exam that may include a pelvic ultrasound should be performed.
Ultrasound can help us discover abnormalities with the uterus, fallopian tubes and/or ovaries. We can sometimes see evidence of pelvic scarring, such as when an ovary appears to be stuck to the uterus. We can also get some information regarding the woman's potential for adequate ovarian stimulation for infertility treatment cycles by counting antral follicles.
Assessment of ovarian reserve
This is a very important assessment of a woman's remaining egg supply. It is generally done with day 3 FSH and estradiol testing and a vaginal ultrasound assessment of ovarian volume and antral follicle counts.
Assessment of adequacy of ovulation
This can be done in a variety of ways.
About 25% of all infertility is caused by an ovulation disorder. One type of ovulation problem, polycystic ovarian syndrome, is usually quite amenable to treatment with medications.
Semen analysis
This is a very important test and should be done early in the evaluation process. If a severe sperm defect is discovered, the testing on the female partner might be modified, and therapy can be immediately directed to the problem.
About 25% of all infertility is caused by a sperm defect and 40-50% of infertility cases have a sperm defect as the main cause, or a contributing cause.
Blood tests
Depending on the individual couple's situation, various blood tests on either the female or the male may be needed.
Blood tests that might be needed include day 3 follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, testosterone (T), estradiol (E2), progesterone (P4), 17-hydroxyprogesterone (17-OHP), thyroxin (T4), thyroid stimulating hormone (TSH), lupus anticoagulant (LAC), anti-cardiolipin (ACL), and possibly other tests
Immunological testing has not been proven to have any value in infertility patients without a history of 2 or more miscarriages.
Hysterosalpingogram (HSG)
This test is done in order to assess the anatomy of the endometrial cavity of the uterus and the fallopian tubes. The HSG is usually scheduled to be done between days 6 and 13 of the cycle - this also depends on the specifics of the woman's normal cycle.
This test is usually performed in the radiology department of a hospital.
About 25% of all infertility is due to a tubal factor.
Laparoscopy
This is a surgical procedure and should not be performed until the basic testing has been done on both partners. In some cases, laparoscopy will be indicated to look for pelvic scarring or endometriosis.
I have found a good site for you to start your research. Go to
http://www.webmd.com/infertility-and-reproduction/tc/Infertility-Tests-Overview
for more information. It is a start. There are many others. If/when you have any other questions, ask away. I'll give you any knowledge I have!
Stacie
Basic infertility evaluation: What should be included in the initial infertility evaluation?
History
The doctor will ask questions about your past to try to get clues as to the cause of your infertility. These questions will be regarding your medical, surgical, gynecological, and obstetric history, as well as some "lifestyle" questions.
A review of fertility-related records from other doctors that you have seen is also important.
Physical exam
A directed physical exam that may include a pelvic ultrasound should be performed.
Ultrasound can help us discover abnormalities with the uterus, fallopian tubes and/or ovaries. We can sometimes see evidence of pelvic scarring, such as when an ovary appears to be stuck to the uterus. We can also get some information regarding the woman's potential for adequate ovarian stimulation for infertility treatment cycles by counting antral follicles.
Assessment of ovarian reserve
This is a very important assessment of a woman's remaining egg supply. It is generally done with day 3 FSH and estradiol testing and a vaginal ultrasound assessment of ovarian volume and antral follicle counts.
Assessment of adequacy of ovulation
This can be done in a variety of ways.
About 25% of all infertility is caused by an ovulation disorder. One type of ovulation problem, polycystic ovarian syndrome, is usually quite amenable to treatment with medications.
Semen analysis
This is a very important test and should be done early in the evaluation process. If a severe sperm defect is discovered, the testing on the female partner might be modified, and therapy can be immediately directed to the problem.
About 25% of all infertility is caused by a sperm defect and 40-50% of infertility cases have a sperm defect as the main cause, or a contributing cause.
Blood tests
Depending on the individual couple's situation, various blood tests on either the female or the male may be needed.
Blood tests that might be needed include day 3 follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, testosterone (T), estradiol (E2), progesterone (P4), 17-hydroxyprogesterone (17-OHP), thyroxin (T4), thyroid stimulating hormone (TSH), lupus anticoagulant (LAC), anti-cardiolipin (ACL), and possibly other tests
Immunological testing has not been proven to have any value in infertility patients without a history of 2 or more miscarriages.
Hysterosalpingogram (HSG)
This test is done in order to assess the anatomy of the endometrial cavity of the uterus and the fallopian tubes. The HSG is usually scheduled to be done between days 6 and 13 of the cycle - this also depends on the specifics of the woman's normal cycle.
This test is usually performed in the radiology department of a hospital.
About 25% of all infertility is due to a tubal factor.
Laparoscopy
This is a surgical procedure and should not be performed until the basic testing has been done on both partners. In some cases, laparoscopy will be indicated to look for pelvic scarring or endometriosis.
I have found a good site for you to start your research. Go to
http://www.webmd.com/infertility-and-reproduction/tc/Infertility-Tests-Overview
for more information. It is a start. There are many others. If/when you have any other questions, ask away. I'll give you any knowledge I have!
Stacie
Okay, my suggestion is that it is time to get much more aggressive. This is getting old, I am sure, and you want that baby! You have been doing a lot of "let's see if this works" for all of this time. No more of that. Go into your re's office educated and ask questions and you'll get a much better result.
Here is what I would do if I were in your place (and I was a year and a half ago):
1) investigate on the net what tests other clinics suggest patients do before treatment. Go through and check of the tests that you've had and insist that your new re does the ones left (to rule out any major problems) I can help you find lists of tests if you want me to. If your re doesn't think you need a particular test (which you may not), make sure you're comfortable with his reasons.
2) get dh tested again for peace of mind. You can eliminate his sperm as an issue if he has positive results in both of the tests. You'll also be able to reasonable rule out that the cyst is not interfering with your baby quest.
3) it sounds like you can ovulate when medicated, although you are not exactly sure if it was every month. I suggest that you move on to injectible medication like gonal f or follistim (it's more expensive, but it is much stronger than clomid. For me it worked better and didn't cause the nasty side effects clomid did). These medications are made of the same hormone your body makes to tell itself to make follicles. Then you'll need a trigger shot of hcg to tell your body to release the eggs. The good thing here is that you'll know the exact day of ovulation (approx. 36 hours after the trigger shot). You can try a natural cycle of bding or I would move on to an iui.
4) plan for 3-4 iuis (artificial insemination). This will place the sperm as close to the egg as possibe and make your chance at getting pg greater. The cost is relatively inexpensive (my clinic charges $500) so this is a good place to start.
5) if that isn't producing results, then start thinking even more aggressively (ivf would be the next step) I bet you won't have to go to this step because you have already become pg once, so the odds are higher for you to conceive again.
I hope this helps some! I think your baby is going to be here soon. Don't give up!
Here is what I would do if I were in your place (and I was a year and a half ago):
1) investigate on the net what tests other clinics suggest patients do before treatment. Go through and check of the tests that you've had and insist that your new re does the ones left (to rule out any major problems) I can help you find lists of tests if you want me to. If your re doesn't think you need a particular test (which you may not), make sure you're comfortable with his reasons.
2) get dh tested again for peace of mind. You can eliminate his sperm as an issue if he has positive results in both of the tests. You'll also be able to reasonable rule out that the cyst is not interfering with your baby quest.
3) it sounds like you can ovulate when medicated, although you are not exactly sure if it was every month. I suggest that you move on to injectible medication like gonal f or follistim (it's more expensive, but it is much stronger than clomid. For me it worked better and didn't cause the nasty side effects clomid did). These medications are made of the same hormone your body makes to tell itself to make follicles. Then you'll need a trigger shot of hcg to tell your body to release the eggs. The good thing here is that you'll know the exact day of ovulation (approx. 36 hours after the trigger shot). You can try a natural cycle of bding or I would move on to an iui.
4) plan for 3-4 iuis (artificial insemination). This will place the sperm as close to the egg as possibe and make your chance at getting pg greater. The cost is relatively inexpensive (my clinic charges $500) so this is a good place to start.
5) if that isn't producing results, then start thinking even more aggressively (ivf would be the next step) I bet you won't have to go to this step because you have already become pg once, so the odds are higher for you to conceive again.
I hope this helps some! I think your baby is going to be here soon. Don't give up!
Thank you so much! Talking to you has been so helpful! I have another appt with the RE Tuesday morning. I plan to go in there way more educted than I did the last time. If you know of a specific list of what tests we should consider, please let me know. Otherwise, I can just look around the internet at a few and see what I can find.
Any advice anyone has before going into this next appointment would be much appreciated! I'm starting out with a new attitude this time!
Any advice anyone has before going into this next appointment would be much appreciated! I'm starting out with a new attitude this time!
No, I don't mind at all. It actually helps to talk to someone who knows what I'm talking about. Most of my friends/family have never even heard of a RE, much less all of the rest of it.
Okay, maybe you should give me a brief history on what you have done so far...what meds have you taken, what procedures, etc. That way, maybe we can find something you can try next or at least talk to your re about next time you see him.
I would have dh's sperm analyzed one more time. I was told that two tests were the most conclusive and not trust one test (maybe my re was being overly cautious?).
I would have dh's sperm analyzed one more time. I was told that two tests were the most conclusive and not trust one test (maybe my re was being overly cautious?).
I hope I am not sounding intrusive. I was hoping the two heads are better than one idea might apply here, but if you would rather not, I totally understand,
I'm actually not sure that I'm ovulating at all. Before we started ttc, I went on the depo-provera injection for one year. It stopped my periods (which were regular before that), and I've never gotten them back. I have had a period with provera, and I have had a couple on my own (but they're short - about 3 days). I chart my bbt and it is all over the place. I've been pregnant once, so I have obviously ovulated at least once. I also have a cyst on my left ovary, but the re didn't seem concerned with it.
Dh has only been analyzed once. They found a small cyst in his scrotum, but it doesn't seem to be preventing anything. Everything else was normal.
Dh has only been analyzed once. They found a small cyst in his scrotum, but it doesn't seem to be preventing anything. Everything else was normal.
I just wanted to say that I'm not going to be on the computer for the rest of the day most likely, but I will check back in tomorrow. Take care.
Ok, so rewind to the beginning. I took the depo for a year, then we decided to start trying to get pregnant. So I stopped taking it and started waiting for af to return. And I waited some more. At that time I lived in Dayton, OH. My doctor told me that it could take up to a year from af to return. After about a year and a half, still nothing. So she started treating me with provera to induce af. Which sometimes worked and sometimes didn't. We did this for another year and a half or so and sill nothing. Then we moved, and I had no insurance for a brief period, so we kept trying but didn't go to a new doctor for a while. Then I found an OB/GYN here, and started seeing him. He diagnosed me with pcos based on my "symptoms" and some blood tests and re-started the provera and we got pregnant right away. Then we mc in January 2006. My first "cycle" following the mc (starting af with provera again), he started me on clomid. He started me with 50MG a day which we tried for about 6 cycles, and then increased me to 100MG. We had just assumed the problem was on my end all along since I didn't seem to be ovulating regularly. But we finally got really frustrated and had dh tested about 6 months ago. Then I decided to seek out an RE, which wasn't an easy task around here. So my initial visit with him, he looked over all of my records and did an u/s. Based on these, he said it wasn't pcos because my ovaries weren't polycystic, and my hormone levels didn't indicate pcos. So then is when he told me of his 3 possible diagnoses. And that pretty much brings us up to date.
So is the problem that you are not ovulating regularly?
Your right about the vague sound of the other hormone problem speech. I'd call the doctor back for clarification and his plan of finding out what those problems can be,
Has dh had more than one sperm analysis?
Your right about the vague sound of the other hormone problem speech. I'd call the doctor back for clarification and his plan of finding out what those problems can be,
Has dh had more than one sperm analysis?
I just had the first visit with this re in March. He looked over all of the bloodwork and u/s's that I had had done, and the info on my mc (all of this through my OB/GYN who prentends to know what he's talking about, the same one that diagnosed me with PCOS), and he said that it was not PCOS he saw 3 possible problems. He said that one was premature ovarian failure. So he did an FSH test, and it was only 4.6, so that's really good, so my ovaries aren't failing. The second was a blockage in my brain preventing the signal from reaching my ovaries and making me ovulate. Thus, the MRI. And that found nothing. The third is "some other hormone problem." Which seems really vague to me. And I live in a very rural area, so I already have to drive 2 hours just to see this re, there are no others nearby.
I am so sorry they didn't find anything on your mri. I know how frustrating it is to not have answers. It is a horrible place to be,,,and can be so depressing.
Have you been with the same re for the entire time? I find it strange that your re hasn't ordered the basic tests (mentioned to you in your previous post) before you went to the mri. Have you considered changing res and finding one who is more proactive? Or you can take the list of tests with you to the re and insist for them to be done. You mighgt also try one of the well know clinics because they often do phone consults (often for free) as a way of checking to see if your current re is being aggressive enough.
We didn't find my issues until they did the thrombophilia blood work. These tests look for blood clotting issues...lo and behold, they found something (after 2 and 1/2 years). Of course, they were only suggested after my 2nd ivf miscarriage. Would have been nice if they had let me do the tests first.
Know that there are women here who know what you're going through and have the same frustration and pain. It always makes me feel a little better to know that others are going through the same thing although I wish no one would have to! Take care of yourself and do whatever you must to get the answers you want. You are your own best advocate.
Have you been with the same re for the entire time? I find it strange that your re hasn't ordered the basic tests (mentioned to you in your previous post) before you went to the mri. Have you considered changing res and finding one who is more proactive? Or you can take the list of tests with you to the re and insist for them to be done. You mighgt also try one of the well know clinics because they often do phone consults (often for free) as a way of checking to see if your current re is being aggressive enough.
We didn't find my issues until they did the thrombophilia blood work. These tests look for blood clotting issues...lo and behold, they found something (after 2 and 1/2 years). Of course, they were only suggested after my 2nd ivf miscarriage. Would have been nice if they had let me do the tests first.
Know that there are women here who know what you're going through and have the same frustration and pain. It always makes me feel a little better to know that others are going through the same thing although I wish no one would have to! Take care of yourself and do whatever you must to get the answers you want. You are your own best advocate.
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