Where do I begin? From the moment I pulled into the parking lot I was overcome with a sense of dread. Maybe it speaks to my inexperience with this that I was more worried about running into someone I knew at the RE clinic than what I might actually find out about my body.
DH and I texted each other from our cars, having driven separately. He works less than 1 mile away from the RE clinic. The proximity to my workplace would make me even more concerned, but he wasn’t bothered by it. The odds of someone actually noticing his car are slim.
We trailed in behind another couple. The waiting room was tiny. Nervous bladders were emptied. My blood pressure was great despite my stress. When 3:00 finally rolled around we were escorted the RE’s office and we began combing through the basics like medical history and any lab results collected in recent years.
He expressed his condolences about the twins and I held my breath as moisture sprung to my eyes. In retrospect, how dumb was I to not prepare for the obvious trigger? Repress, repress. Compose and deal later. He proceeded to tell me I shouldn’t be in his office for another 6 months, and informed me that assistive reproductive technology is riskier than natural conception. Fine, the usual disclaimer. He said he’s happy to proceed with diagnostics and discuss options from there.
|My CD3 Level|
He gave me a brief overview of the treatment plan. We’ve conceived before, so he doesn’t see any point in attempting IUI instead of timed intercourse unless semen analysis reveals something weird. He’d normally start with Clomid, however expressed that fertile women actually experience reduced fecundity with Clomid due to problems with uterine lining; he thinks Clomid would hurt rather than help me. The next line treatment would be injectable gonadotropins (synthetic FSH, like Follistim, Gonal-F, Menopur), however he expressed concern over the risk of high-order multiples. Finally, there is IVF, which would in his opinion be most successful without risk of multiples. But more information is needed to know what materials I’m working with.
We discussed my recurrent chemical pregnancies. I’m not sure he’s convinced I’m not making it up, but if I were in his position I would be skeptical too, so I’ll allow him that. He did set up a standing order allowing me to go in for beta-hCG draws whenever I want, so I can go in around 7-8dpo (which is when I usually get my strongest early positives, which fade away anywhere from 10-14dpo) to validate I’m actually seeing weak positives.
I will also go in at 7dpo for vitamin D level, progesterone, prolactin, and most importantly anti-Müllerian hormone (AMH) level. On CD3 I will have my FSH and estrogen rechecked. Although my TSH isn’t great, he does not want to check my T3 or T4; I’m a bit grumbly about that but I will wait to see what my other labs say. I forgot to ask about checking my testosterone level but have since emailed to ask about it.
He offered me a hysterosalpingogram (HSG). I brushed it off initially, questioning whether I really would need such a procedure knowing I conceived the twins from both ovaries. Both tubes were clearly patent before, but someone has reminded me that things change. Does anyone have any thoughts or recommendations on HSG?
(If you’ve read this far, thanks, kind soul, because I think I’m boring even myself.)
He reminded DH and me that we should lose weight. Yes, I know, I continue to work on it. In fact, I’m rather vocal about trying to lose weight, trying to emphasize to others I’m focused on that rather than desperately trying to conceive.
RE does not believe DH has any sperm issues, and I would agree based on our track record, but since we’re going down this path now it only seems fair to check him too. He is less than enthused. I’m also not thrilled about the idea of having to abstain prior to collection! We usually abstain for most of the two week wait, so I figure he can do it then. Not that it matters. Last cycle I finally lost all expectation, seeing the faint second line appear and then fade again over the course of ~4 days with minimal hope and zero surprise.
In March I will be traveling during my fertile window, so it’ll be a forced break. That puts us at April for a medicated cycle… if that’s even appropriate depending on my ovarian reserve. Everyone knows we were instructed to wait a calendar year after losing the boys—a recommendation based on emotional rather than physical recommendations by the perinatologist—and people are beginning to look at me sideways and with expectation. Everyone senses I should be pregnant now. I frequently get asked with meaningful emphasis, “How are things?”
The boys have been on my mind a lot this week. The idea of trying with assistance, of confronting what must be my declining fertility, all while approaching the anniversary of loss. Grief comes in waves.