Plan, Shman.

I joined J for his urologist appointment yesterday. This was a follow-up after having his first consultation and additional testing.

First, the blood work was perfectly normal, and there are no hormonal issues to worry about. Good news!

Second, the ultrasound showed a minor vericocele (a varicose vein) on the left side. It’s not severe enough to warrant surgery based on the other results. Ok news.

Third (the other results), the repeat SA showed a count of 23 million and motility of 85%! Normal count and motility - light years away from the previous results. Excellent news! (The first SA was, I found out several days after the results came in, incomplete. Meaning J missed the target a bit, and the entire sample didn’t make it into the cup.)

The not-so excellent part of the results was the morphology. It was done using Kruger’s criteria, a stricter, more conservative, method. Out of 200 sperm analyzed, 0 were normal.

But the urologist emphasized that morphology is not clearly associated with fertility. As currently performed, it’s a subjective measure, and it hasn’t been demonstrated to correlate with function (i.e. fertilization). So while it’s measured, and could potentially impact fertility, it’s an unreliable test at best.

The urologist said that if I was perfectly healthy with no fertility issues, he would see no reason not to recommend continuing to try naturally. But since I have the endometriosis and the tubal issue to deal with, I need to consult my RE again with this new information. I just went back on the pill (b/c we thought J had sperm issues to overcome, and because my cramps have become unbearable). I am going to discuss surgery for the hydrosalpinx and the endo with my RE. We may not be able to make a decision about trying naturally vs. IVF until she gets a better picture (literally) during the surgery.

The other good news is that J was able to add me as a domestic partner with his company for the purposes of health benefits, and it is effective immediately. This means that I can take advantage of the limited IVF coverage available through his plan. We just hope that it remains covered next year, as well, since we may not do IVF until then. (if at all!).

I like a good plan

I am not a very spontaneous person by nature. I like the occasional pleasant surprise (flowers from my sweetie! work is letting us go home early!), but generally I like to have a plan.

So walking out of my RE appointment today with some sort of plan was such a relief.

First we talked about J. He wasn't at the appointment but we discussed his first SA results and next steps:
1) Repeat SA, but at a different lab that measures morphology by Kruger's rather than WHO method.
2) If results are similar, follow up with bloodwork to test FSH, LH, testosterone, prolactin, TSH. May also want to do the following genetic tests: chromosomes, y-microdeletion, cystic fibrosis screen.
3) See a urologist who specializes in male infertility. She gave me two references in our area.

Then we talked about me. My periods have become increasingly more and more painful since going off the birth control pill last December. I've had lots of mid-cycle spotting, but otherwise regular periods, and am confident that I'm ovulating. She did an ultrasound. My right ovary and tube look ok. I have an endometrioma (about 2cm) on my left ovary. This seems to be recurrent as one was removed during my lap in 2007, which returned within six months. As of last December, it wasn't visible, but here it is again. The worst news is that my left tube, which is twisted around my ovary, is hydrosalpinx (filled with fluid). According to the RE, this could cause problems with implantation when we do IVF.

So the plan for me is:
1) Have CD3 bloodwork done. If the 2nd SA results are similar to the first, go back on continuous birth control to try and keep the endometriosis from getting worse and avoid having painful periods.
2) Go back for a follow-up visit in September to see how the cyst and left tube look.
3) Possibly have a second laparoscopy to a) drain the tube, b) pinch off the tube, or c) remove the tube about 2-3 months before IVF. Also remove as much of the endo as possible.
4) Start on Lupron about 2 months before IVF to get the endo as quiet as possible and because it has been shown to improve IVF results .

Then we would do IVF after the first of the year, when we hopefully have some insurance coverage for it.

If the 2nd SA results are significantly improved, we will reassess, but I'm not counting on that.

I feel like a huge weight is off my shoulders. If we follow this plan, we will have about 5 months of not TTC, which will mean:
1) No stress about trying to have sex on particular days.
2) No temping/charting (not a big deal but nice to not have to worry about waking up around the same time every day and stressing if I have to get up to use the bathroom in the early morning)
3) No avoiding the bathroom for hours in order to use the ovulation predictor kits.
4) No ups and downs hoping for a pregnancy and being disappointed.
5) Regular coffee! I had given this up at the beginning of the year.
6) A break from acupuncture (most people find it relaxing, I do not).
7) No herbs from my acupuncturist (blech!).

It wasn't great news today, but I'm feeling more positive about everything than I have in months. It's a good feeling.

I am such a nag.

I couldn’t help myself. After asking J twice last week to call his doctor with no results, I asked him Monday night and then sent an email reminder yesterday morning. And…he called! He now has a referral for a repeat SA and a follow-up appointment with his GP on July 30. I was really hoping he would schedule an appointment with a urologist, but I guess he wants to see his regular doctor and get a referral from him, even though he has a PPO and could pick a urologist himself. I am trying to be satisfied with the progress such as it is and not be critical.

I am such a control freak! But at least I recognize it, and knowing is half the battle, right? :)

Now I am looking forward to my RE appointment tomorrow. It just feels good to be talking to doctors about our issues and hopefully moving forward, even if it is by teeny tiny baby steps (no pun intended).

The results are in...

After a week away for work, and a hectic weekend, life finally seems to be settling back to a more normal pace. J and I are enjoying our new living arrangements (read: living together!). The dog seems thrilled with her new digs as well, despite fighting a bronchial infection brought on by an enthusiastic drink from an industrial sprinkler (who knew?).

Over the weekend we received J's results from the testing of his swimmers. The good news? Several factors are normal. The bad news? Some critical numbers, motility and count, were low. Too low, in fact, to do morphology. J was, understandably, disappointed, but didn't seem too shaken up by it. I think it helps that he has a friend who has similar challenges.

I'm left wondering, though, what this means about our combined fertility (or infertility, as it may be). How much of it is due to my endometriosis? Are we destined for IVF? Or do we still have a chance to conceive naturally?

And none of this is easy for me, planner that I am. Because J has responsibilities to follow up on his side, and although I know he wants a baby as much as I do, he seems less driven to make the necessary phone calls immediately, as I would do. There's nothing wrong with that, except that it makes me crazy. And I don't want to be a nag. So I sit and twiddle my thumbs, and try to think about other things.

And it only sort of works.