For those of you who follow me on twitter, you’ve likely heard the news already. I had a baseline ultrasound and bloodwork this morning. It’s CD4 of an induced cycle – meaning I didn’t ovulate last month so I had to take progesterone to induce a period.

Results?

The Good: I have NINE antral follicles. When I was first diagnosed with POF (Premature Ovarian Failure)/DOR (Diminished Ovarian Reserve) I had TWO. So this is definitely good news. My personal best, that I know of, is thirteen (although I think it went higher I never got specific counts). But I’ll take nine.

The Bad: Six of those nine are on the ovary with no tube. Leaving only three on the ovary with a tube.

I would prefer the opposite. But I’m still thrilled with nine. Based on my last AMH of 0.34 I was hoping for six (but not really confident I’d make it). In the past, although my AMH bounces around like it’s not supposed to, it always seems to correlate to my current AFC (antral follicle count) – When my AMH was 0.1 my AFC was 2 so I kind of just multiplied by three. Very scientific. 😉

The Weird: One of the six follies on the non-tubed ovary measured 12mm. And my lining was triple-stripe. Despite the fact that it is CD4 and I am still bleeding (although it’s been super light as usual) it looks as if I’m set to ovulate soon. The doc is not overly concerned about that, however. As your reserve dimishes, your cycles become wonky (don’t I know it!) and weird things happen. Although I have NEVER ovulated early, there’s always a first time for everything.

So I’m concentrating on the fact that I have nine follicles total.

There are still some eggs in my basket. Amazingly.

[Again, I wonder about changing my twitter handle.]

Assuming my HSG looks OK, I think the RE will approve this crazy IUI plan for next cycle. Which apparently may come earlier than expected. Although, knowing my body, and more importantly my ovaries, I’m not holding my breath waiting for early ovulation.

This will be my third HSG. I hate them but I guess it’s necessary. Depsite being suspected of having some tubal disease because of the 2nd ectopic pregnancy, I fully expect my remaining tube to be open and clear. Oddly, I trust it more than I do a Day 3 transfer.

Or maybe not “oddly” given past experience. And the fact that it makes no logical sense to me to suspect my tubes of being diseased just because my last embryo happened to wander up in to one. The docs put more stock in where the embryo journeyed to than where it was coming (running?) from. Personally, I suspect my uterus is just some really horrible inhospitable place and that’s why my embabies run screaming from it to anywhere else that might be more inviting.

Or maybe they really are just directionally challenged.

[Again, I ask for someone to create EmBabyGPS – the tiniest GPS known to man, so easy to use a not-yet baby can do it, and it comes preprogrammed with a map of the uterus.]

Regardless of what may or may not be going on with my embabies and girly parts…

…if you want different results – try something different.

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AMH

February 28, 2012

I had my blood drawn today. For my third AMH.

For those not AMH savvy… AMH = Anti-Müllerian Hormone. It’s a somewhat “new” test and is supposed to indicate a woman’s ovarian reserve. Essentially, there is no way to count how many eggs you have left in your basket, but this hormone level is supposed to indicate the number of eggs left. In fact, there is research that suggests that measuring this hormone level can accurately (within a few months) predict WHEN a woman will enter menopause.

Unlike FSH (which should be measured on day 2-4 of your cycle) this test can be done at any time. In theory, your AMH level should peak before puberty, remain somewhat constant until your early 20s, and then begin to decline gradually. While there is never a one-size-fits-all in medicine, IT IS NOT SUPPOSED TO FLUCTUATE.

But then… I’m a medical anomaly.

So… the books are open. I’m taking bets. What will my AMH be THIS time?

Background… I do appear to be ovulating, my cycles have been 28-33 days recently. But I am having hot flashes and night sweats.

My first AMH was 0.1 and I was told (by my GYN) that children would not be possible. My RE, who said children might still be possible although not probable, otherwise concurred with the diagnosis since I had 2 antral follicles and was having hot flashes and night sweats.

After a surprise IVF (I was originally told I didn’t have enough eggs left for IVF), a devastating ectopic and LOTS of recovery time, my antral follicle count (AFC) increased. And apparently my AMH did as well. My AFC jumped to the teens and my AMH miraculously increased to 0.9 – a feat that was not supposed to be possible.

Since the original anovulation, hot flashes, night sweats, waking up in a bed with sweat-soaked sheets… my body has seemingly made a comeback. I actually managed to have semi-regular cycles without hot flashes in between the ectopics. I had a few normal cycles after the second ectopic and then the hot flashes came back.

Based on symptoms alone, I predict this AMH will come back somewhere in between 0.1-0.9. I think I’m placing my bet on 0.3.

Who’s in? I’m sure I can come up with a prize for the winner….

So… I haven’t posted in awhile. I think I start every post these days with an apology for being a bad blogger/tweep. Such is life. I’m busy. As in BUSY. Working full time, packing, planning a move that I won’t be able to make with Right Guy, taking care of Pops… I hate not being able to plan anything. Right Guy will be moving (as will our stuff) next month. I will likely move in with Pops. At present it seems like he may hang on for awhile. Which is good and bad. It’s great to still have him around but I can’t start my new life in Seattle until he’s gone. Bittersweet whirlwind of emotions. But that’s not what I want to write about today. Today I’m back to all things infertile and medical.

As I mentioned in my last post my last MRI showed that my uterus appears to be healing itself. Slowly. So I probably won’t need surgery. But I’m still benched from TTC/FET. However, that MRI also revealed lots of antral follicles. More than I’ve ever had according to my RE. I didn’t ask for an exact count. So she retested my AMH. My AMH was 0.1. Now it is 0.9. That is not supposed to be possible. Under other circumstances perhaps you would assume that one of the results was incorrect. Except that all other indications agreed with the results at the time. When my AMH was 0.1 I had 2 antral follicles, an FSH of 16 and severe hot flashes/night sweats. Now that’s 0.9 I have (presumably) >13 antral follicles and I’ve now been off my estrogen patches for 10 days. That’s the grand experiment. Will the hot flashes return without the estrogen? I’ve been more or less OK until today. There have been a few moments that may have been hot flashes or may just have been the 90 degree weather or the fact that Pops keeps his house at 80+ degrees. But this morning… no denying it: hot flash. But no night sweats. So that’s good. Those are the worst. I think I will try to stay off the estrogen for this cycle (assuming I HAVE a cycle) and then have my FSH tested on CD3 next month.

In conclusion [I feel like I’m writing a 3rd grade essay but I’m really only now getting to my point], in the grand scheme of things I’ve been getting lots of GOOD news lately. And I recognize that. So please don’t think I’m too whiny. All this good news is somewhat disconcerting because it defies logic. AMH is not supposed to go up. Pops is supposed to be getting worse, not better. Even when it’s good news it can throw you for a loop. It changes your reality. It was easier to plan next steps with the bad news. Now it’s impossible to plan anything. It’s like an interminable two week wait. You have no idea whether you’ll be able to attend that “kegger” because you might be preggo. 😉 Well, I have no idea where I’m going to be living or working in 2 months. Or whether I’ll have health insurance. I have no idea whether Pops will still be alive next week let alone 2 months from now. So I can’t plan a trip or even commit to an event more than a week in advance.

Oy. I just want to plan SOMETHING. So I plan to POAS for the first time in a long time. I guess I’ll start today. If I am going to have a normal cycle my LH should surge soon. Not that I can do anything about it.

MRI & Bloodwork

May 4, 2011

I have posted some of this in a previous post and some on twitter but I thought I’d consolidate and give an update on everything. It’s all a little complicated.

MRI
The MRI showed a “fluid pocket” in my uterine wall. This is the remnants of the ectopic pregnancy. Apparently the fluid is blood. Anyway, it’s this fluid filled hole that makes my uterus weak and potentially unable to sustain a future pregnancy. But the latest MRI shows that it is SMALLER. So the docs are hopeful that my body will continue to heal itself. Which is GOOD news. Except for the fact that I’m STILL benched. They want another MRI in 3-6 months.

Also on the MRI… apparently I have quite a lot (for me anyway) of antral follicles. My RE says there are too many for a person with an AMH=0.1. So she’s retesting it. She’s also testing my estradiol, FSH and progesterone. It seems that after completing my course of prometrium to induce a period I may have ovulated on my own. There’s really no telling what my body is up to these days. It’s a complete mystery and my RE doesn’t do anything without consulting her entire team about it first. sigh This is also potentially good news. Although puzzling.

Also on the MRI… maybe. My RE said she wasn’t convinced but apparently other members of the team thought they saw an extra opening on my cervix. I can’t even begin to wrap my head around that one. So for now I’m just going to pretend she didn’t say that. But at some point I’ll have to get a sonohysterogram to check that. Fun times.

Most of the bloodwork should be back today or tomorrow. But it takes two weeks to run the AMH. I’ll update this post as results trickle in.
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UPDATE: I did indeed ovulate on my own before the prometrium could induce a period. Estradiol and FSH are appropriate for being in luteal phase and on estrogen patch.

Quick Update on MRI

April 28, 2011

I should know better than to expect one test to give me a definitive answer. That never happens. And yet, I continue to expect it. Silly me.

I had thought the MRI would show that I was OK or that I needed surgery. What it actually showed… progress. I think.

Just to explain a little… my ectopic pregnancy occurred in the myometrium (muscle wall) of my uterus. It took almost 6 months for beta HCG to reach zero. But there is still a blood pocket there which could cause my uterine wall to weaken and rupture from any future pregnancy. My RE had no idea whether this would heal on its own or if I would need surgery to strengthen my uterine wall. Apparently it is smaller. Which is good. My RE is conferring with her colleagues today about what next steps should be. But I think I’ll be able to avoid the surgery. Which is excellent. I wasn’t sure I wanted to go through with that surgery anyway.

Also good: the MRI shows that my antral follicle count is more than it was last year and more than should be expected for someone whose AMH=0.1. So my RE wants to retest me. It’s possible that I have more eggs in my basket than we originally thought. Which is also good news. Of course, there’s still the adenomyosis to worry about. But I can’t do anything about that.

What is not good news is that I STILL don’t have a definitive answer and I’m STILL benched. This wouldn’t be so bad if the rest of my life were normal. But right now, EVERYTHING is up in the air. I have control of NOTHING. My father is dying, but not imminently and we don’t know when that will be. My best guess is June. Which is when I’m supposed to move. Right Guy will have to move without me and I’ll follow when I can. I just can’t plan for ANYTHING right now.

I know I should concentrate on the upside of all this. In the grand scheme of things this MRI is GOOD NEWS. I just need something in my life to be a little more concrete right now. My EDD was May 9 and as that date looms near I become more and more anxious about the fact that I am STILL benched.

chance card

I feel like I’m playing monopoly. I’m on Connecticut Ave (just before Jail) and somehow I pull a Chance card that says “Take a walk on the Boardwalk” and I whiz all the way around the board. I skip IUI entirely and GO STRAIGHT TO IVF. Um… wait. What?!

boardwalk cardIt was a HUGE decision to make and I had to make it in about an hour. But we’re going for it. It just makes sense. I’ve had an amazing response on my first injectibles cycle. Even before I started the shots I had a high (for me) AFC (antral follicle count) of 13. This morning I had 7 follies 12-15mm. (well one of them was 11.9). Here are the choices my RE gave me:

1a) Cancel this cycle. She considered the risk of high order multiples too great.

1b) Right Guy and I discussed moving forward anyway and just relying on selective reduction if we needed it. I already have the Ovidrel and the plan was for intercourse at home anyway. This choice was not sanctioned by my RE but we felt it was worth considering.

2) Try some shots of pure LH to see if that would stop the smaller ones from growing more while maturing the larger ones. I would have to drive to another city (20-30 mi) to acquire this medication and there’s no guarantee that this strategy would work so I’d still potentially end up back at option #1.

3) Convert to IVF. Gulp.

We have chosen option #3. And after making this decision, my RE says she thinks it’s the best option. She never thought she’d be having the IVF discussion with me. She’s completely mystified. She described my ovaries as “an anomoly.” She’s hopeful that this will work but says if I don’t get pregnant on this IVF cycle she will want to retest some of my levels (specifically AMH). This is not supposed to happen with numbers like mine (AMH=0.1 & FSH =16). So now she’s questioning the numbers. Although, if the numbers are correct, this is likely my only/best shot. So I’m taking it.

Double gulp.

But it looks like it’s going to happen. And soon. Egg retrieval will probably be this Sunday or Monday.

If anyone is curious about the exact protocol I’ve been one that has worked so well I’ll post it soon and then update here to link back to it.
UPDATE::
Here’s a link to the protocol specifics and results before IVF conversion: Bravelle + Menopur.