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TUESDAY, APRIL 7, 2009

Today is the day, we have been somewhat anxiously waiting for…whatever this “foreign body” is showing up on my ultrasound is disturbing to me. As I said before, it renders as a BRIGHT WHITE object among a field of black and grey sound waves. I am going to ask for the films today when we go in. I like to have everything in my own file, and then maybe I can post for you all to see. It isn’t subtle.

I am challenged by the angles we look at the uterus during the ultrasound, so I am unclear exactly where it is. Suddenly I feel uneducated, I am usually pretty on top of it.

I have a few small pre-op instructions, and as I have reviewed them this morning, I am getting really anxious. Not so much that it will go wrong. From what I understand, there are very few risks…infection, puncture of the endometrium…all less than 1%. I think I am scared of the pain. The HSG and Saline Sonogram were more painful for me than the average bear. I am working hard at just breathing this morning, and not getting worked up. However, I have not been able to keep myself out of the bathroom for long, yikes! Nerves.

The procedure is at 1p, with a check-in of noon. I’ll pick hubby up at 11:40a.

Here are the pre-op instructions:

  • Take 1 Doxycycline at bedtime night before procedure
  • Take 1 Doxycycline morning of procedure
  • No food or water after 10a
  • Bring pre-op meds with you to noon check-in (They called in 1 valium, 2 vicodin)

OKAY! I’ll be interested to see how it goes. I expect I’ll be drugged up after the procedure as they’ll give IV fentanyl or verced during as well. Luck to me 🙂

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TUESDAY, MARCH 31, 2009

Would you believe that the bcp they put me on last week caused this total melt down? I suppose I should have thought of it, but I wasn’t thinking of anything except how to stop the crying. I have stopped that particular bcp (Reclipsen) and gone back to what I was taking before I got married (Levora). Levora never caused any problems, so we should know pretty shortly if this is the issue.

I can say, I am incredibly tired, and for once, grateful I am not working right now.

My parents have been unbelievably supportive. My mother took me to my psychiatrist appointment and waited outside in the car. When I got back in the car she didn’t ask questions, probe for answers, I was shocked. She just wanted to take me to eat, she said I looked a little gaunt. After lunch she came over, cleaned the kitchen and did some laundry. I took a little nap, she read some mags and just sat with me. I felt a little like a child, but I really needed my mom to just be my mom, and she was. I could never put into words how that helped me, and how much it means to me that she did that.

I am exhausted, so that’s all I can journal for today. Interested to see how I progress throughout the week.

TUESDAY, MARCH 24, 2009

Today we are on our way to have our baseline ultra sound…if all is well, we will start our IVF procedure this month. I am crossing fingers, toes, legs (I’ll have to uncross those later!), hoping we are ready to start.

I have an enormous mix of emotions about this. I am still unemployed. The economy is not helping our situation, and we don’t have the time to wait to do this. It is now or never. We keep believing that everything works itself out. No freelance work to be found. I even applied as a cashier at a candy story. NO GO. Overqualified. I just have to laugh. Okay, everyone laugh with me! I thought at least I could help my husband’s very expensive candy habit by working there. And I could merchandise cute windows. Ah, a pipe dream…

Okay, off for the ultrasound, more later…

We’re back…very sad and frustrated…I have to have the hysteroscopy. And I am a bit ticked because there seemed to be some discussion between a couple of the docs a month or so ago as to whether or not I needed it. Ultimately, they decided watch and wait. Well, we watched today and that little bugger is still there. Ummmmm….what the f?

To make matters worse, my doc is going on vacation in a few days and can’t fit me in until the week of April 12. No one seems to understand that is, oh, 3 weeks from now and not only will we miss this cycle, but probably the next if we wait that long.

Can you hear my heart crumbling to pieces?

My husband is trying to find the silver lining…this gives us more time to look for a job for you…we have more time to prepare…and on. He is sweet. He is trying. He can’t get it unless he is in it. It’s not his fault. I don’t blame him. I am not mad, angry, resentful.

Just silently sad.

MONDAY, MARCH 9, 2009

Brief conversation with Dr. Fujimoto…he said that he felt the bright spot on the saline sonogram was likely an air bubble and we should go ahead and review again at my baseline ultrasound when we get ready for our first round of IVF in a few weeks.

YAY! I thank him and am ready to hang up. He is not ready to hang up.

He wants to talk about my Day 3 blood work…my FSH remains about the same, 8.9. However, my Estradiol was 148 and shouldn’t be higher than 60-70. This will make it a challenge to balance my hormones without overstimulating my ovaries.

What does this mean? Can we keep on our schedule? What will we do?

He says: You need to be on the Microdose Flare Protocol. AND, with your husband’s latest test results, and his sperm count going down, I strongly recommend ICSI for you. Ok, ta ta!

That was pretty much it. He is busy. I always talk to him on speakerphone which makes me think he is multi-tasking on me, even though he is totally on top of it.

He did say that I needed to schedule my baseline ultrasound for Day Seven. I’m on it. I WANT TO DO THIS NOW.

MONDAY, FEBRUARY 9, 2009

Today is the day. We have our big appointment with Dr. Victor Fujimoto at the UCSF Center for Reproductive Health. I have been counting down the days. Like Christmas. Remember when you were little, and it seemed like time stretched on and on and on? Then you get to the day and you wonder, what is in store for you?

I had been preparing for weeks. I wanted to know as much as I could as to speak intelligently to the doctor. I didn’t know if he would be the God Complex type or the compassionate type. Would we have much time with him? Or would this just be a quick meet and greet and then he would send us off for more testing. Having most of the preliminary testing done beforehand was a good idea, I thought. {In the end, Dr. Fujimoto was pleased with that as well.}

My husband has a completely different approach. He prefers to hear what the doctor says, then ask questions based on results. This does make me a bit nutty. I think we should have questions prepared for all the options. We STRONGLY disagree here. What a learning lesson for me. I have to remember that we don’t have to think alike, or be the same. And I can’t expect him to act and think like I do. You know, it is probably better that we are different that way…he may be more open to hearing things I don’t since I have everything written down. I tend to get stuck in what I have in my mind.

We arrived for our appointment a few minutes early. I was happy my husband was ready on time, and we were there with time to spare. My husband likes to breeze in at the last moment, rarely thinking of the details that need to be taken care of when we arrive places-is there paper work to fill out…do we need to bring a gift or wine to a dinner party…will we be checking bags at the airport? This is how we ultimately compliment each other.

The women at the front desk were so kind, and knew us both by name. This made me feel so easy, like we were not just another name in their book. The offices were very nice, and well kept. When we walked in, and I was filling out the paperwork, I noticed my husband seemed a bit distant, glassy-eyed. I think the full weight of what was happening hit him at that moment. We had talked a lot about it, but you can never really prepare until you are in a situation, I think. And, he has so much going on at work right now, I know he hasn’t really had the bandwidth to process all of this. He has told me time and again how much he has wanted a “natural baby.” He wants a family so badly, he will do what it takes. And, we will adopt if we can’t have out own. But I know that the idea of the petrie dish makes him sad. Being the romantic that he is, the clinical nature of this knocks the wind out of him.

The nurse called me in to do my initial vitals…weight, blood pressure, temp…and I wonder, why do I wear boots, jeans and a heavy sweater? My weight shows a solid 5-7lbs more than normal. What a chub. I have gained about 15lbs since our wedding. Most people like to say, oh, married life. Really, I have just felt so ill this year that I have not made it to the gym much lately. I promised myself in that moment I would do what I could to drop some weight before we began a cycle. It would be at least 8 weeks. I can do some serious damage in that time! It really just takes focus on my part, and discipline on my husband’s part. He doesn’t like to eat his ice cream alone, so I really have to get him to promise not to tempt me.

Dr. Fujimoto came out to invite us to his office. I love when the doctor comes himself to the waiting room for you. They just seem more accessible to me that way. We went directly to his office, where Dr. Fujimoto had our file, preliminary testing and initial intake form. Prior to our visit, we were required to review and complete a LENGTHY packet of information. Dr. Fujimoto had clearly reviewed our packet, studied our test results and was well-prepared to meet with us. We came prepared with a list of questions and a calendar charting my menstrual cycle, LH surge, estimated ovulation and intercourse dates.

We spent about 15 minutes discussing our previous results with Dr. Fujimoto. At this point, he suggested we move into the ultrasound room where he would perform a vaginal ultrasound. Again, my husband would be with me, with a man I did not know prowling around my coochie! My husband is actually very cool about it, I am the one who is mortified. I am hoping the more we do it, the better I will feel.

Off we went, and I undressed from the waist down. At least this time the table had some cushion, was on an incline and had stirrups. HOWEVER, there was NO MODESTY with Dr. Fujimoto. I had the paper drape over my lap, and when I lay down on the table, he essentially threw it up over my waist. ohhhkaay! This was also the first time that I had a vaginal utlrasound where I did not insert the probe myself. He was not rough or anything, I was just a bit startled…my first meeting with a male doctor I didn’t know, and he was probing me! Like I said, I think it will get easier. And I think I will HAVE to get over it by the time we go in to birth the baby. I have heard that you just CANNOT care at that moment.

During the ultrasound there was a female nurse in the room (who did not introduce herself to me, huh?). Suddenly, Dr. Fujimoto became quite serious and very professional. The casual and friendly atmosphere redirected and my husband and I became silent. I was worried. And, to be honest, I was terribly sad. Heavy news was to come. Dr. Fujimoto began dictating notes to the nurse, describing the number of antral follicles found in each ovary. He gently removed the probe, asked me to get dressed, and invited us back to his office.

When we sat down with Dr. Fujimoto for our second discussion, the air in the room felt a bit dark to me. My husband and I were holding hands, we were determined to be optimistic. This was our first fertility visit, and had the idea that we would be sent for tests and take a few steps at a time towards a diagnosis and getting pregnant. We were so wrong.

For better or worse, Dr. Fujimoto was extremely candid with us. It was hard to hear, we were stunned. BUT, to say we were appreciative is an understatement. His ability to understand complex issues and explain them to people outside the medical profession is unmistakable.

Dr. Fujimoto’s assessment was:

  • My FSH level, at 9.8 units/liter, was high, and drifting upward. This was a surprise as my ob/gyn had reported all my blood work to be in the normal range. Normal range is actually 4-7 units/liter.
  • I had a significantly low antral follicle count of 8 follicles. A normal follicle count would be 40-50.
  • My husband has a borderline low sperm count at 20million.

What did all this mean? Could we proceed with IUI? This was the recommendation from our ob/gyn. This was also the preference of my husband, it seemed the most natural option.

No. With a drifting FSH level, my ovaries and egg quantity are likely compromised. I have a low ovarian reserve, and, like most women, am shedding close to 1,000 follicles per month. IUI would provide us less than a 10% chance per month of conception. IVF would provide us a 35-40% chance per month of conception. Dr. Fujimoto strongly recommended us to move straight to IVF. Indeed, he said that if we wanted to have a family, this was our time. In fact, we had no time to waste.

We left with a handful of cards for the IVF team…the coordinator, the nurse, the billing team, the urologist…I’m sure there are more I can’t remember right now. We all agreed we would spend the weekend deciding what to do and contact Dr. Fujimoto the following week with a decision and/or any follow up questions.

My husband and I walked into the elevator holding hands in complete silence. It is not like me to not start chatting right away. I like to know what he is thinking. I usually need to pry it out of him. I was in shock, though, that we had to move to the most drastic fertility procedure from the get-go. As we walked outside, my husband ran his hands through my hair, rubbed the back of my neck, and kissed the bridge of my nose. I always know how much he loves me when he does this. I couldn’t have married a better man.

My husband went to have his semen analysis, to “give his deposit” as we like to say. I told him not to touch anything 🙂 He said he wouldn’t need any magazines, he would just think about me. Sweet, but what a crock! He should take the opportunity to check it out, just make sure you sanitize!!!

His results read as follows:

Semen Volume: 5.5mL

Semen Color: White

Semen Viscocity: Liquified

Semen pH: 8.0

Sperm Motility: 64%

Sperm Normal Morph: 37%

Sperm Count / cc: 20 MIL / mL

All results here were fairly normal with the exception of sperm count. This was on the low side of normal at 20 MIL / mL. It should be 20 – 100 MIL / mL.

{sigh} We wondered if this was the issue…was my husband’s low sperm count the reason we hadn’t conceived? So far, I had fairly normal results.

During my HSG procedure, the Radiologist suggested I may have a myoma (fibroid) based on the shape of my uterus. He suggested I get an ultrasound to rule out. My test results from the HSG were written as follows:

CLINICAL HISTORY: Infertility

METHOD: Following a cleansing of the cervix catheter was advanced into the uterine cavity and water soluble contrast was injected.

FINDINGS: The fallopian tubes are normal in course and caliber and spill freely into the pelvic peritoneal space. There is a mild indication of the superior surface of the uterus. The possibility of a myoma is raised.

IMPRESSION: Normal uterine cavity and fallopian tubes.

I was able to view the image of my uterus, and it looked like a kidney, not like a pear as it should be. For some reason, I was suddenly stressed. I knew at this point we were headed down a difficult path.

I phone my ob/gyn and requested the order for the ultrasound. She was very laid back about the possibility of any complications or any myoma. She felt confident that we would be able to proceed with IUI. I didn’t feel as confident. I spoke to my husband about it. He seemed to think I was over reacting. My parents as well. I KNEW SOMETHING WAS NOT RIGHT.

I had the ultrasound six days later on January 28, 2009. It was a tough six days for me. It was all I could think about. I did too much research on the internet, and knew too much about the potential treatment / surgery to remove a myoma. It was a potential 4-5 day hospital stay and 4-6 week recovery. Everyone was telling me not to let my mind get away from me. It was a real challenge. I had a deep feeling that internally I was not functioning properly. I had been experiencing incredible pain during my periods and ovulation. I wondered if I had mistaken that pain for a myoma or a cyst.

Every time I have an ultrasound, the technician is unable to execute abdmoninally since my uterus is retroverted. I drink more water than I am supposed to drink, I wait until I think I will burst, and still, I end up having a vaginal ultrasound. This time was no different. EXCEPT…the ultrasound team was running behind and I had to wait an extra 35 minutes beyond my appointment. I nearly wet the table.

It didn’t take long for the tech to realize she couldn’t get a good view abdominally, so she released me to the restroom. I came back for the vaginal ultrasound, and found the tech to be incredibly kind and gentle. She also did something that no other tech had ever done…she gave me results as she viewed them on the screen.

She found two small fibroids and two cysts. My exam results were written as follows:

EXAMINATION: Transabdominal and endovaginal pelvic ultrasound

CLINICAL INDICATION: Fibroids

COMPARISON: 9/13/2004

TECHNIQUE: Transabdominal and endovaginal ultrasound performed.

FINDINGS: The uterus was measured 9.3 x 4.0 x 5.1 cm. A 1.3cm anterior intramural fibroid is visualized. There is a posterior fundal subserosal fibroid that measures 1.2cm. The endometrium appears smooth homogeneous and measures 6.3mm in thickness. The right ovary measures 3.6 x 3.5 x 4.5cm, while the left ovary measures 2.5 x 2.1 x 2.7cm. Two adjacent simple appearing cysts are seen within the right ovary. They measure 3.0 and 2.0cm. The left ovary is unremarkable. No free fluid is seen.

IMPRESSION: Two small uterine fibroids as described. 3.0 and 2.0cm right ovarian cysts.

Based on these findings, my ob/gyn wanted to take a “watch and wait” approach. I must say…I don’t like the idea of having any more procedures, but I don’t like “watch and wait” either. It bothers me to no end that there is something growing inside me that we will just wait to see what happens.

We had our first appointment with the UCSF Fertility Center February 9, 2009…only two weeks away. We just need to get to that appointment, I thought.

In the meantime, my husband went to get his semen analysis.