Pop some popcorn and curl up with my RE visit :) In 1000 words or less.
Oct 2 2008 10:51PM  My RE appointment, 10/2/2008
When we got to the RE, we filled out some paperwork and were taken to the consult room right away. First they got my weight and blood pressure (a little on the low side they said) and they we waited for the MA to come in. She had us read over some paperwork while we waited for the RE.
The RE came in and went over our pre-consultation forms. We spent a good amount of time discussing our relevant medical histories. Then we got down to business!
He gave us a packet with a powerpoint presentation called “fertility diagnosis and treatment options.” A good 60 slides worth of information. Then we went over the whole process – basically BIO 101, about how ovulation occurs and the hormones involved.
We talked about how trying to conceive is inefficient! Basically there is a 22% chance of conceiving each month. 57% pregnant within 3 months, 72% within 6 months, 85% within 1 year, 93% within 2 years.
So basically 85% of couples will conceive within their first year. Out of the remaining 15% (that’s us!), ½ will conceive in year 2, and after year 2, the rate goes to only 1-2% chance per cycle of conceiving. He joked that Fertile Myrtle has a 22% chance each cycle, while “Infertile Myrtle” only has a 1-2% chance each cycle naturally.
Couples experiencing IF – 25% BOTH male and female factors, 35% female factors, 35% male factors, and 5% unexplained (that’s us again).
Causes of IF are either tubal, male, anovulation, uterine, or cervical.
To evaluate IF, we’d need to see:
1) Egg quality
2) Implantation factors
3) Mechanical factors
4) Male factors
I’ve had the CD 3 testing done and he went over my results with me. Originally I had just received a call from the ob/gyn saying my results were “normal” so I didn’t really question them! Turns out, they weren’t exactly normal. RE said he likes to see FSH <10 – mine was 6.9 :) He likes Estrogen to be <50 – mine was 57 (could just be the lab, not definitely ME). Then they see what your egg reserves are like, and it’s called AMH and he likes them to be 1.0 (meaning you have a really good amount of eggs) and mine was 12.0! He said this COULD mean I have “androgen excess” – although I don’t have any other symptoms of it right now. He said people with this can either be categorized as obese or lean. I’m the “lean” type and he said there’s a 1-2% chance I could have diabetes and a 5-10% chance that I could have a “pre-diabetes” condition.
He went over normal tubes and normal uterine cavities… and would like to see my HSG xray films ASAP – although they were also reported to be normal.
Now, DH had his SA done and again we were told the results were normal. NOT EXACTLY! He likes for there to be >2 cc volume: DH had 1.0 (he said that’s okay though, shouldn’t cause a big problem). He likes to see >20 million sperm/cc: DH had 146 million :) He also likes to see the shape (morpohology) as >10%, and DH’s was 4%. That’s not good. He said he’d consider us to be “MILD” MF (male factor) but predominately unexplained thus far.
We talked about CONSERVATIVE treatment possibilities.
There’s OI (ovulation induction) via Clomid or Gonadotropins (injectibles), there’s IUI (intrauterine insemination).
With Unexplained IF, here’s our options, pregnancy rate, and multiples:
-DO NOTHING: 2%, 1/90
-CLOMID: 5%, 1/10
-CLOMID + IUI: 10-12%, 1/10
-INJECTIONS + IUI: 20-25%, ¼ to 5
-IVF: 50-60%, 1/3 to 4
NEXT STEPS:
1) GTT – I need a Glucose Tolerance Test to make sure that I don’t have Diabetes
2) He needs to see my HSG xray films
*Background Info: We found out that our IF benefits will be dropped as of 1/1/09. This was brought up to the RE and we asked him to keep that in mind when determining our treatment since until then, we are covered for all diagnostic procedures, Clomid, Injectibles, and 6 IUIs.
Since AF is due on Saturday and I need this blood testing done and a class on injectibles BEFORE we start the injectibles and IUI… he told me to start birth control as soon as AF starts. He wants to basically stop my cycle so we can get all of the testing done and then we will start it again. This is so that we don’t have to waste a month waiting for bloodwork, then doing injectibles before O, then doing the IUI. Proactive guy! He said I’ll have to come in a few times a week while on the injectibles so I can be monitored to make sure that I am not producing too many eggs.
Good news: I can stop temping and using CBEFM! I am beyond thrilled to be able to hand over the control to someone else and not have to worry about when I am ovulating, what my temperature is, etc. He’ll monitor me through bloodwork and ultrasounds.
Well, I think that’s all. It was a LOT of information, but the RE explained everything really well. At the end of the appointment, we went over my insurance coverage/copays once more with the financial specialist and made another appointment for 2 weeks at which point bloodwork/testing will have been completed and we will take the Injections class and have our follow-up visit, and get started! :)
I am so thrilled to have a plan, and hopefully be on our way to a BFP!
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