After our initial consult with Dr. Schoolcraft, our new specialist, we decided to get a jump start on round two of IVF. On Tuesday of this week, we started our work up and attended an orientation. The room was filled with other couples from around the world going through their own infertility struggles. We now know that THIS is the place to be. While we are not 100% confident that we will have another baby, we are 100% confident that our new doctor will do everything it takes to make it possible.
My lab work so far has indicated that my ovarian reserve has decreased since our last IVF cycle. My AMH is now 0.9, below average for my age. An ultrasound found 8 resting follicles on my ovaries, while 12-13 is normal. Although these numbers are low, our new doctor is confident that we will still get a good number of eggs from retrieval. And since we made a child before, we should be able to get at least one normally fertilized egg--an embryo. If we are lucky to have multiple embryos, our doctor will transfer two.
On Tuesday, I had a hysteroscopy where a microscope was inserted into the uterus to look for scar tissue, polyps, fibroids, etc. I am happy to report that everything looked normal. However, I still need to have a biopsy of my uterus to determine if I currently have the receptor cells needed for embryo implantation. That biopsy has to take place at a certain time in my cycle, but I will likely have it done within two weeks.
Today, I had a hysterosalpingogram (HSG). This is an xray of the uterus and fallopian tubes with injected dye. I had this imaging done before, in May of 2014 by our previous fertility specialist. She was not gentle with the procedure and I was terrified to have it done again. I explained this to our new doctor, and he prescribed me Percocet to get me through the procedure. However, it completely backfired on me. I'm not used to narcotics, so this drug had me feeling very loopy, and I threw up three times before the HSG was done. Not pleasant for me, and probably not pleasant for the lovely nurse and technician that were with me. But, this HSG was so much better than the first one. It wasn't painful and the equipment used was much more updated. The results? Both tubes are completely blocked again. But, I am suspicious that they are both blocked in the exact same places as they were before--right tube blocked proximal, left tube blocked distally. When these same results were found in May of 2014 by our previous doctor, I underwent surgery in which she claimed to clear both tubes. So, is it a coincidence that both tubes are completely blocked in the same manner as they were before? Something we will discuss with our new doctor at the next consult. But, with these results, we now know that there is a good chance that the first IVF cycle failed because of the tube blockage. Since the left tube is blocked distally (at the end, closer to the ovary), it fills up with fluid, which has no place to go except back down the tube and into the uterus. This fluid is toxic and can destroy a thriving embryo. We will never know for sure, but this is a probable cause for the failure. To prevent a future failure, my tube (or tubes) will be cauterized to prevent the flow of toxic fluid into the uterus. In a way, this makes me really sad. Once cauterized, I'll never be able to use that tube (or tubes) again. But, on the other hand, I can't use them anyway since they are blocked from scar tissue and adhesions that result from endometriosis.
Andrew and I have a lot of lab work that we are still waiting to hear back on -- genetic testing, semen analysis, general lab work, etc. Tomorrow, I go back for a doppler of my uterus to ensure normal blood flow. They tried to do it on Tuesday with the ultrasound, but I had caffeine in my system, which affected the doppler results. We could see the way the blood was pumping so abnormally through the uterus, and it was a real eye opener. I don't consume large amounts of caffeine, but what I do get from chocolate, coffee, and tea could affect a baby. For that reason, I am completely cutting out caffeine during this cycle. If the doppler is still abnormal tomorrow, without any caffeine, I will likely go through acupuncture again to get the blood flowing normally.
Once all of our results from the work up are in, our doctor will develop our IVF protocol. It will likely be as aggressive as it was before, meaning a lot of medication to stimulate the ovaries. We have already decided that all of our fertilized eggs will be tested for chromosomal abnormalities. Since we have already failed one IVF cycle without chromosome testing, it would be wise to ensure that a future failure is not due to a chromosomal abnormality.
We knew that treatment with this new specialist would be more expensive, but we are willing to roll the dice. While our last cycle with the previous doctor totaled around $20k, we are now looking at $32k, which includes the large amount of medications I will need and the chromosome testing of the embryos. It's very scary to take another chance, but we just can't put a price on having a baby, and we are not willing to give up yet. Hopefully, we will be pregnant by the end of the year.
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