Headline of the week: Numbers, Stats and Luck

Friday morning we met with Dr. B at Oregon Reproductive.  All in all, it could have been worse.  I think the worse case scenario I had played over in my mind was the Dr. saying, “There’s really nothing we can do for you. Beat it. Scram.”  But he didn’t say that.  To be honest, we didn’t really learn a lot more than we already knew or suspected.  We had a number of tests done before we went in, but a few need to be redone on a particular day in my cycle.  So now, for the semi-bad news. The one test that did come back and did give us some information was the AMH test or Anti-Mullerian Hormone test.  This test lets you know about your ovarian reserve – or eggs in waiting.  I think they actually said something like primordial eggs, which makes me think they are from the beginning of time, dinosaurs and shit.  If only it was that cool.  For women my age, the number is up somewhere around 5-7, in fact, the higher the better.  Mine came back at a dismal 0.5.  This is not promising in terms of the time we have left to make things happen.  

Why is it so low?  Likely it is an unfortunate side effect of chemotherapy.  A classic example of I wish I had known then what I know now.  At the time, I could have had my eggs removed and frozen.  But, we did not know if my cancer was hormone receptive positive, which meant we wouldn't have wanted to feed the cancer by taking hormones to stimulate egg growth.  And, I didn't want to wait to have the cancer removed and start treatment.  

Plus, I would have been faced with the same financial hurdle back then and even less likely to be able to do something about it.  How would I have paid to have my eggs removed and frozen?  I wouldn’t have been able to and my insurance wouldn’t have covered it.  Plus, unfertilized eggs don’t do the whole freezing/unfreezing process as well as fertilized eggs, so we might actually have found ourselves in the exact same position anyways.  I imagine if we had tried sooner, that perhaps the number would have been higher and we might have been more successful earlier on.  As it stands, Dr. B thinks that it is likely my ovaries are more like a woman in her early 40s than one in her late 30s.  And where fertility is concerned, a few years can make all the difference. The good news is I know at least one over 40 who recently got pregnant the old-fashioned way and just had a baby.  So, if it can happen once, it can happen again, right?

The two tests we need to re-take will give us information about the quality of those eggs that I have remaining.   This test will confirm whether 6 months of chemo some 7 years ago merely diminished the number of eggs I have or if it permanently damaged most or all the eggs lying dormant in my ovaries.  If it is the later, it’s likely a good egg will be few and far between.  It's not impossible that a good egg will surface, but highly unlikely.  So hopefully, at the end of next week, we will finally figure out exactly what we are dealing with.

Dr. B didn’t belabor the fact that the odds are against us.  He didn’t Fox News us into fearing the worst.  In fact, the only statistics he showed us were their success rate with women in my age group, which was around 60% and that the likelihood of having another miscarriage wasn’t any greater after having two.  I thought those were pretty nice statistics to share.

I guess the good news is that we now know what our options are going to be given different scenarios and there are a few.  Again, it will all depend on whether we are dealing with a low number of eggs that are either of good or bad quality or a low number of eggs that are likely all bad quality.  And depending on which it is, we will know whether we will need to do IUI or IVF with my own eggs (hopefully this will be an option) or if we have to use donor eggs.  Dr. B said we would deal with the donor egg option down the road, when we crossed that bridge.  There was still a lot to do before we even have that conversation.

I asked him how normal people pay for this kind of thing and he rattled off a list of ways.  As Brett said, “Well, one shot is basically the price of a nice new car really.”  Too bad we already bought one of those this summer.  Guess that is just another bridge to cross when we get there – sure are a lot of bridges on this damn road.

But all of that aside, I think why we are both taking it so well (and by well, I mean, I'm not crying non-stop. And if I had to talk to anyone about all of this, instead of writing it, I would probably not make it through the conversation without crying.) is that all of this reproductive medicine is pretty f-ing amazing; the science behind all of this and what they can do for people.  It’s insane.  Seriously out of a science fiction novel.   It’s not just about boosting your egg production, taking those eggs, fertilizing them and putting them back.  That’s basically what we are able to do on our own. 

But now, once they extract as many eggs as possible, they make sure they are healthy and able to be fertilized, then they fertilize them and test whether the egg is going to be free of any chromosomal damage or defect before they try to implant that egg or eggs.  Basically giving you the absolute best shot of having a healthy baby because you know that everything is on the up and up.  It then comes down to the implantation and hoping that it sticks, continues to grow, and the cells divide.  It’s likely to go okay if all the chromosomes are okay.   High school science really came in handy while listening to him.  When Dr. B drew the chromosomes all lining up (yes, there were lots of drawings and illustrations), I knew exactly where he was going with this thing.  In fact, the first part of our conversation felt like we were getting 'the talk' about how you make babies.  When I have a teenager, I will record Dr. B giving 'the talk' and just play the video.  

If we do have to explore the IVF option, it is good to know this is possible and hopefully they will be able to get at least one or two good eggs.  We just need one! That’s all.  Out of the 400,000 damn, freakin’ eggs I was born with, we just need one damn good egg.  It doesn’t seem like a lot to ask of the universe, but she apparently is one stingy biatch when it comes to giving up eggs to the +35 set.  I feel like if we could just get one good egg it would likely stick given we’ve had two bad eggs stick in the past.  Sticking doesn’t seem to be our problem. 

But then, what do I know?  Right now it really just feels like it all comes down to luck.  Luck and age really. It’s hard to say whether we have good or bad luck.  I’m lucky that I had cancer early (who says that?!), met Brett, married Brett and after dragging him to a foreign country for two years still like him well enough to want to have his baby (haha), and we still have some time to figure this out.  I’m lucky that chemotherapy exists and that it apparently works really well at killing cancer.  I guess I’m unlucky that it works so well that it kills off poor bystanders, like primordial egg cells.  And Brett said, "You're lucky that you don’t look nearly as old as your ovaries are."  So I guess we’re also lucky that we still have our senses of humor. 

We've been pretty damn lucky so far.  Guess we just need some more luck. Prayers and good mojo (I don’t really know what mojo means, but I think it's like luck).  That’s what we really need.

Monday it is...

Just returned from Dr. B's office, the reproductive endocrinologist that Johnson sent us to.  He managed to do the saline histogram with far less pain than she did, but with pretty much the same lack of result.  Yep, there is some sort of 'stricture' as he put it, a blockage, an adhesion that won't allow the catheter to actually go very far and thus, they can't see anything or know anything - except that I need to do the hysteroscopy surgery on Monday as scheduled.  

The hope is that Johnson will be able to visualize what at this point can only be faintly seen and felt through an ultrasound.  The other hope is that the blockage or adhesion is a small area that she can simply cut through, opening up the rest of my uterus and that all will be back to normal after that.  Well, semi-normal.  Even if all of that goes smoothly and the adhesions are minor, it will require me to be on estrogen for at least a month - which translates into another month or two until we would even be able to try to conceive.  

It's a bummer. But more than that, I'm just pissed that I didn't insist on the histogram sooner.  I knew at the end of November that something wasn't right, that my period felt like it should have come but didn't.  If we had started this process then, well, who knows.  Instead, we are now 5 months down the road and only hoping that 6-7 months down the road, well...that we can actually even be on the road!  Right now, we're just going to have to spend a few months at this pitiful truck stop they call infertility and hope that we actually move forward some time soon.  

I hope it goes well. I hope it's not a worse case scenario.  I hope my doctor knows what she's doing.  I hope that new adhesions don't form.  I hope we are able to try again soon.  I hope we are successful.  

Small Celebrations

Dr. Johnson is awesome.  Yesterday after work, I noticed three calls from a blocked number.  I didn’t give it too much thought since how the hell could I call ‘blocked’ back?  As I pulled up into the driveway, ‘blocked’ called again.  It was Johnson. 

“Hey, how you feeling?” 

“Aahhh, you know, frustrated. I just wish we knew what was going on.”

“I know; I’m frustrated, too.  Not as much as you probably, but I am for sure.”

The thing about Dr. Johnson is that I believe her.  That’s part of why she is awesome, but also because even though I didn’t specifically ask her to, she decided to call a good friend of hers who is a reproductive endocrinologist.  She told him all about me and what has led us up to now.  He has agreed to see me on Thursday before the hysteroscopy the following Monday.  Hallelujah!  I don’t know why this makes me so excited.  I guess it’s just the feeling that an expert in fertility (or infertility, depending on if your glass is half empty) will be giving me some advice and know-how.  He came from Johns Hopkins – he must be a rock star, right?

When I spoke with his nurse this morning, she said that he would attempt the do the saline histogram that Johnson tried to do but was unable to do, along with an ultrasound.  I’m so hopeful that he will be able to do the histogram.  Even that will give us a great deal of information.  If he is able to see the uterine lining, he will be able to tell if there is scarring or any number of other possible physical issues that are the problem.  If there are, then we will go ahead with the hysteroscopy on Monday, but at least with an idea of what to expect once Johnson gets in there. 

And if there aren’t, then we know that it might have to do with hormones, ovaries, or something else.  And then, we can work that route.  Brett says it’s like “House.”  Right…just like it.  I just want to be optimistic that we will get some answers on Thursday.  I really, really hope so.

So now, it’s on to celebrate this blasted birthday.  Brett says I’m being a little Don Draperish about the whole thing. 

Zou Bisou Bisou. 

(And sorry if you don’t get the reference, but you really should be watching Mad Men!)

Where do we go from here...

The weekend after the D & C, we went to the coast with a group of friends and their kids.  I felt like I was in a daze, the fog had never cleared for me.  And truly, I felt empty.  It was like I had been on an adrenaline high since October and now I was crashing hard.  The future seemed bleak.

It wasn't easy for us as a couple either.  I was insistent on our next steps.  Sounding like Obama talking about his jobs bill - WE MUST GET PREGNANT...RIGHT AWAY.  Brett was less than enthusiastic.  We found ourselves at an impasse - I felt certain of the future I wanted, while he felt this was an opportunity to be circumspect about it and went back to a place of ambivalence.  In my head, it made sense, but in my heart, it sucked.  I knew that our experiences with the pregnancy were drastically different.  I had felt the hormonal and physical changes and they were interwoven with my emotions - tightly woven.  For him, the baby was merely an idea, a possibility that was yet to be a reality.  They say women become mother's the moment they are pregnant, men become father's when they hold the baby for the first time.

The first month was rough.  We got through Thanksgiving with a barrage of family and friends.  I had previously imagined this would have been the moment we told everyone that we were having a baby.  And now, we weren't only not telling folks we were having a baby, we weren't telling them we lost one either.  We were as quiet about that fact, too.  I'm not sure the reason, except to say that at that time, I couldn't talk about it without crying.  In fact, that is often true even some four months after the fact.

December 2nd rolled around, a month since the miscarriage.  I'd marked on my calendar that we would start trying again this month, as soon as my period returned.  But it didn't.  I called my doctor frantically, "Why hasn't it started? How long should it take?"  She advised me to wait 6 weeks before calling back.  I did and it didn't come back.  I called again, "It really could take up to 8 weeks. Give it some more time and call back."

I started to see an acupuncturist in the hopes that I could feel like I was doing something besides waiting around.  I kept taking pregnancy tests, thinking that maybe we would be the lucky ones who get pregnant right away after a miscarriage; but no such luck.  Jo, my acupuncturist, is a god-send.  She started me on herbal supplements - false unicorn root (hopefully it is as magical as it sounds) and vitex.  Two herbs known to help regulate your cycle and prepare your body for pregnancy.  But still no period.

After 10 weeks, we went in for blood work.  No thyroid problems, no hormone issues - all signs pointed towards a healthy body.  But still, no period.  She put me on 10 days of progesterone - lovingly called "The Progesterone Challenge." I failed - no period.  I went in for an ultrasound and a saline histogram.  There was the slight possibility that I had scarring in my uterine lining that was preventing regular cycles or any cycle at all.  Unfortunately, she couldn't maneuver the catheter the way she needed and so couldn't do the procedure.  She did notice, however, on ultrasound that my lining was about 1mm - very, very, very thin. 

So, she put me on a month of birth control pills to see if the estrogen would help boost my lining and bring on a period.  I failed this challenge, too.  Nothing.  We had another failed saline histogram, but she did notice that my lining had increased thickening - up to 5 mm, but still, very thin.

It is now, quite possible, that the problem is a scarred uterine lining that is preventing my cycle from returning and ultimately prevent us from getting pregnant as it currently is.  I continue to take supplements, downing raspberry tea like you can't imagine, boosting my herbal supplements, and hoping that it isn't scarring and that my cycle will regulate itself here soon enough.  I am losing hope of that solution each day.

Due to the failed histograms and the lack of cycles, Dr. Johnson has scheduled me for a hysteroscopy.  Not to be confused with a hysterectomy!  I will have to go under anesthesia while she uses a camera to visually look inside my uterus for scarring or other issues that may be at work.  During the procedure she will be able to remove any scarring and hopefully get us back on the train to babytown.

We had originally scheduled for March 23rd, the day before spring break and two days before we head off to Sayulita, Mexico, but we have decided to reschedule.  Although we want to get things going soon, we don't want to potentially ruin our vacation to do it.  So we will wait, something we are getting pretty good at.