The Journey, So Far...

I typed out a nice neat little index page with page numbers for Dr. Schoolie when I submitted all 250 pages of our medical reports.

Going through the process of organizing my records was a tedious and emotionally exhausting task.  Each portion brought up memories of how we felt at each turn.  It also made me feel frustrated that there wasn't a more efficient way to navigate through the difficult waters of IF.

May 2008	Semen analysis:  1.6 million
	Normal pelvic ultrasound
	Hormone levels tested but not on cycle day 3.
June 2008	Semen analysis: 1.6 million
Aug. 2008	D has bilateral testicular biopsy under the direction of urologist.  Findings: bilateral hydrocele and meiotic arrest.
	D has infection after this procedure, and is treated twice with antibiotics (for two weeks each time). Up until 1.5 years after this procedure, D has infrequent “stabbing” pains in his testes.
Oct. 2008	Dr. Nada, Enocrinology consult, no findings referred to another endocrinologist.
Nov. 2008	Scrotal ultrasound: focal hypoechoic regions within the superomedial aspect of both testes measuring 1.2 and 1.4 cm.  Likely related to previous biopsies.  Bilateral small varicoceles are demonstrated.  Small right hydrocele.  3mm cyst on left epididymal head.
Dec. 2008	D- Endocrinology consult with second endocrinologist found no abnormal results. CBC normal.
Jan. 2009	New clinic #2 Semen analysis. 0.6x10 6/ml
Feb. 2009	Semen analysis (washed), total motile count 4 million.
	Day 3 FSH: 23.8 IU/L Day 21 Progesterone: 48nmol/L
	Genetic screening and other blood work (day 21 and other).
	2nd opinion with Urologist.  His opinion was that the testicular biopsy was unnecessary, and that the results showed only a focal diagnosis.   No further recommendations.
Mar. 2009	Hysterosalpingogram: Right fallopian tube patent, left tube irregular, curved, tortuous and dilated, left tube appears blocked.  Antiverted, anteflexed uterus. Right ovary 2.5cm x 1.3cm, left 2cm x 1cm. Small irregularities in uterine lining.
	Diagnosis: Premature ovarian failure, advised to consider donor programs.
April 2009	New Clinic: #3 Dr. Snowflake
June 2009	IVF cycle suggested to be changed to IUI.  Cycle cancelled: My sister had a massive stroke at age 28 (from an undetermined cause).
Sept. 2009	Day 3 FSH: 6.5 IU/L
	Operative Hysteroscopy to remove small amount of scar tissue near embryo transfer site.  Pathology Report: Endometrial curettings (1.0ml of hemorrahigic tissue and mucoid material): proliferative endometrium.
May 2010	Sonohystogram, results normal. (Dr. Snowflake).
Nov. 2010	FET #1: Transferred 1 donor embryo (from couple #1), rated “cleaved 4-6 cell”. HCG <1.0
Feb. 2011	Adopted 6 blasts via Snowflakes Created in 2005
April 2011	New clinic: USA, Dr. M Frankenstein
	Semen analysis: Grade A, low count, borderline morphology.  Semen frozen (unused as of Oct/12).
	Monitored for one natural cycle: Doctor says follicles didn’t mature as expected. Decided to proceed with adopted embryos.
	Day 2 FSH:  19.6 mlU/ml Follicle count: 7?
July 2011	FET #2: Donor embryos, 2 unrated blasts.  Embryologist says they are unrated because they were still collapsed 2-3 hours after they were thawed. HCG <1.0
Sept. 2011	FET #3:  Donor embryos, 2 blasts 6BA & 5BB  HCG <1.0
Nov. 2011	FET #4: Donor embryos, 2 blasts 4AA & 4BA, HCG = 75, (6 days after transfer), 1547 (13 days after transfer).
Dec. 2011	Miscarriage confirmed at 8 weeks
Jan. 2012	D&C after incomplete natural miscarriage
	Started 75mg DHEA/day
Mar. 2012	AMH tested: 0.42ng/ml
	Day 3 FSH 17.5 mlU/ml
April 2012	IVF with ICSI (own eggs) Medication: · 40 units of Leuprolide on cycle days 3 and 4. 300 units of Gonal-f for 16 days, the last 8 days of stimulation 150 units of Menopur. · See cycle sheet for other meds. · 500mg Flagyl & Doxycycline for both of us in case of subclinical infection (2 weeks).  Started one week approximately before transfer. Retrieved 9 mature eggs + 2 immature eggs, 7 fertilized, 6 survived. Ratings on day 5: 1.     EBL: C1 2.     BL: B1 3.     EBL: A 4.     Mor: B1 5.     Mor: A 6.     Mor: “?” 7.     Mor: A
	Semen analysis for ICSI
	2 transferred, 1 blast 4AA and 1 early blast (unrated) HCG = 38.4 (10 days after transfer). Bright red spotting 14 days after transfer (HCG =278), miscarriage 22 days after transfer.
	Tested natural killer (normal), DQ Alpha (normal) and MTHFR (positive for heterozygous copy of A1298C mutation).
May 2012	Day 3 FSH 11.1
June 2012	Semi-natural FET cycle attempted. Ovulated on day 11, doctor not expecting this early, cycle canceled.
July 2012	FET #5: own embryos, 2 transferred, 2x day 5 morulas, A & B1. Started new protocol of 81mg ASA, 10mg prednisone, 40mg Lovenox at time of transfer.  500mg Flagyl & Doxycycline for both of us in case of subclinical infection (2 weeks). HCG 1.8, then declined.
Sept. 2012	FET # 6: own embryos, 2 transferred, early blast with “?” rating and blast rated 3AB. Changed protocol (81mg ASA, 10mg Prednisone, 40mg Lovenox) starting one week before transfer. HCG <1.0
Nov. 2012	Consult with Dr. Schoolie.

Mixed messages

Sometimes I feel like we have taken the most backwards, mixed up path to try to resolve our IF.  One of the first questions Dr. Schoolie asked was to tell us a coles-notes version of our fertility history.  I took a deep breath and summarized the best I could.  Even Dr. Schoolie agreed that we been through things a little backwards.  Although, he politely referred to it as us responding to the “mixed messages” received from our doctors.

Some of the messages we have been given were:

 1.  Dr. Whisper, OBGYN.  A small, kind man who is notoriously soft spoken.  I've heard from a nurse that works with him that when he is delivering a baby that they have to ask him to speak louder so they can hear him. 

Message:    After some very basic testing, he whispers to me that my FSH is within the acceptable range.  He scribbles some calculations on the SA report,  along with the word "sterile".  He might have been talking to me, I don't know.  His voice was low and I think I was in shock.   I go to the parking lot, and bawl my eyes out, wondering how the hell I am going to tell D this news? 

2.  Dr. Ballhacker, Urologist. 

Message:  I like to touch testicles without gloves on, and you will never really know if I wash my hands between patients.  D, you need a biopsy of both testicles.  You won't find out until later, by another more competent urologist that it is a completely unnecessary procedure and will not alter your treatment plan regardless of the outcome.  This is because either way, you will need to use IVF with ICSI to even have a remote chance of conceiving.  Post-operative, you will need to learn to live with stabbing pains in your nuts for the next year or so, especially after intercourse.  

3.  Dr. Nada. Endocrinologist.

Message:  D,  I've got nothing to tell you. Everything looks normal.  Let me send you to a friend from my residency days, Dr. Dandruffbeard. 

    

      4. Dr. Dandruffbeard, RE.  

Message: You are here to see me because you think your hubby’s swimmers are the reason you haven’t gotten pregnant.  Really, I would like to drop the bomb on you that your eggs are actually the deal-breaker here.  Your other FSH test was done on the wrong day, so it really gave you a false sense of security.  It’s 30 minutes after we close, and my wife is waiting for me for dinner.  Please consider donor eggs as your only option.  Oh, and by the way, right now you would need to find your own donor because of the regulation changes in our province.   If you would like to try your own IVF cycle, it would require approval of our ethics board.  Despite your age of 28, your chances of IVF are very slim, less than 5%.  Your eggs and ovaries are yucky, little hideous things and look more like someone who is 45 years old.

5.  Dr. Snowflake, RE.

Message:  I'm sorry.  Yes, your eggs really do suck.  And your sperm aren’t great either.  We would try one IVF cycle with your gametes, but really we would just be taking your money.  For closure, we will however allow you to do this.   Really though, you should look into donor embryos.  (They did not mention of donor eggs.) 

Side note: My sister had a massive stroke on the eve of what we thought would be our egg retrieval.  Our focus turned towards helping her rehabilitate for a year.  When the fog lifts, we decide that we would like to try with donor embryos through the Snowflake program.  We thought that even if we had a one baby through IVF, we likely wouldn’t have two.   We wanted to end our fertility-misery and just become parents.  Numerous mix-ups happen including one particularly upsetting one which resulted in a cancelled cycle.  All because they didn’t notice our donor embryos were day 3 embryos and they let me go to far in my cycle to transfer them.    

6.   Dr. M. Frankenstein, RE.  I call him this because he has a very large, rectangular head, and keeps his black hair short with spikey little bangs.  And, because the first day we met him he had a problem where one of his eyes was completely bloodshot.   

Message: Why didn’t you use donor eggs instead of embryo adoption?  When asked if we could try our own IVF his answer was “we don’t stick needles into people who don’t have eggs”.  He “allowed” us to proceed with the second set of donor embryos.  After the donor embryos were used, suggested we try our own IVF after supplementing with DHEA for a few months.   Bingo-bango, I miraculously made 11 eggs!!!!!  Those 11 eggs turned into 6 viable embryos.   6 months later, all 6 embryos were gone.  For the last two cycles, the doctor suggested Lovenox, Prenisone and Asprin, and some other antibiotic protocols.  Dr. Schoolie later calls this protocol for my situation as “voodoo”.   As a last ditch effort, he tells me to laproscopy and HSG to investigate my uterus, and that they might need to tie your tubes if there is disease in them. 

Side note: Two pregnancies, one from donor embryos and one from our fresh IVF cycle leave us wondering what the real problem is? Embryo quality? My uterus? Something else?

7.  Dr. Schoolie, RE.  

       Message:  You do not need laproscopy or a surrogate.  You may need your tubes tied if there is disease in them. Your embryos are probably mostly abnormal, which is why they aren't surviving very long.  You likely only create one normal embryo from a batch of six.  Unless you do CCS, you will not have any more information about why your cycles keep failing.   Your FSH 3 years ago is what jumps off the page as the biggest deal-breaker.  However, you had a decent result with your last IVF.   Consider OE IVF if you can emotionally and financially afford it, at the end of it you will have a baby or an answer.  Consider DE IVF as well.

 I've said to D before, that if we only knew how many cycles we needed to complete to end our IF journey this would be so much easier.  If only we knew that a positive ending awaited us at the end of this long, winding road, we could withstand it.  But, I guess life just doesn't work that way.   So here we stand, staring at Dr. Schoolie hoping that he know's what he's doing.   Will he "school" the other doctors?