RE Consult

I got home from my RE consult a little while ago. I want to write this all out now, while it's fresh in my mind.

There's good news, there's not so good news, and there's one thing I'm having a hard time believing/accepting as true.

The good news is that according to my day 3 labs, my ovaries function like a 30-year-old's (the RE's words). This month, my day 3 labs were:

FSH: 5.4
AMH: 4.1
estradiol: 22

She said those are all normal, and quite good. Since my ovaries are functioning so well at 41, she thinks I'm headed for a later menopause. Oh goody, I get to bleed for a long time to come! She doesn't think I need to do any testing, like an antral follicle count, because the bloodwork already tells us that my ovaries are functioning and that I still have eggs left.

The not so good news is that my eggs are old. This wasn't news, really - I knew that. I liked the way she explained the egg situation... She said to think of it as a gum ball machine full of gum balls. The white gum balls are normal and the red gum balls are abnormal. When you're young, the machine is mostly full of white gum balls, with some red ones dotted in. When you get older, most of the gum balls are red, with some white ones dotted in. That's why the chances of a successful pregnancy are so much lower for older women - because the likelihood of getting a white gum ball is so much lower.

She recommends I try clomid for the next two IUIs (since I have two more to go until IVF would be covered). She completely understands my desire NOT to have twins (or higher-order multiples), but she said the most recent research, which is published in the very reputable New England Journal of Medicine, I believe she said, shows a 1.3% chance of twins with clomid for my age (and 2.7% with letrazole). That's pretty low. And she also said she tells people not to get either too upset or too excited if they are initially pregnant with twins, because there's a pretty good likelihood that one won't be carried to term. I can't imagine getting pregnant with twins, though, and NOT freaking out because I would just wait for one of them to not make it! How is that possible?!

Assuming two IUIs with clomid don't work, I could move to IVF with insurance coverage. She said that with my current ovary function, the likelihood that I would get a lot of eggs with IVF is high, which makes me a good candidate for PGS. That said, she also said that PGS accuracy is still evolving, and that some embryos that test as normal aren't actually normal, and vice versa. But, if I choose to do PGS, she'd be more comfortable transferring only one embryo, since the likelihood of having a mis-diagnosed embryo is fairly small (I think she said 3%). The cost of PGS is around $5000, and is not covered by insurance. Ugh! But it does seem like it would make sense to do, so I don't end up doing a bunch of FETs with abnormal embryos. And it would save me the heartbreak of potential miscarriages from bad embryos. She suggests still doing the genetic testing they now do early-ish in pregnancy even with a PGS-tested embryo, due to the occasional false results.

I asked about my progesterone level. She doesn't think the midwives ever should have even tested it, because as she said, "if you test your progesterone and you don't like the result, you could test it again in 30 minutes and you'll like that one". It's pulsatile, meaning it goes up and down often, so she never would have even had my progesterone tested. She said I can stop using the suppositories anytime I want. Yay, except that even with her permission, I'm not sure I want to do that just yet, until I know for sure that this cycle didn't work. I won't use them again without her order, but I may wait it out this month, just... because.

She suggested I do the clomid challenge test with one of my next two cycles, because in the event I do move to IVF, insurance would require it, so I may as well already have it done. She said insurance will cover the bloodwork for the test even before I've done 6 IUIs. She sent a prescription to the pharmacy for clomid in case I decide to use it, and I just got the text alert that my prescription is ready. Yikes!!! What would you do? Clomid for IUI #5? Wait til IUI #6?

The one thing she said that I just can't wrap my head around no matter how hard I try is that she doesn't think the symptoms I felt in my last three IUIs were anything. She called it surveiller attention or something like that, meaning that I felt the symptoms because I was looking for them. She said when you're just going about your life, not trying to get pregnant, you don't notice the normal luteal phase symptoms (like breast tenderness) because you're not looking for them. But when you're consciously trying to get pregnant, and you're analyzing every little thing, you suddenly notice what was always there.

No way. Absolutely no way. Don't they always say to trust your gut? Well, my gut says - strongly - that something was trying to happen. There's no way all those symptoms were completely in my head, or that I always have them and just didn't notice them before. Especially the second IUI, in November, when I was totally convinced I was pregnant. She said chemical pregnancies always delay your period. Well, that may be so, and maybe they weren't officially chemical pregnancies, because maybe things didn't get far enough to be considered an actual pregnancy at all, but I'm telling you, those symptoms were REAL. I just can't be convinced otherwise. Plus, I was desperately wanting to feel breast soreness last night, the evening of day 5 post IUI - just like all the other times - but, nothing. Not even a little bit. So what explains that? She said if I wanted to test it, I could come in for an HCG test if I feel those symptoms again, because if I was feeling true pregnancy symptoms, they could possibly detect a spike in the HCG at that point. She just kept saying the early symptoms aren't reliable, but I just can't wrap my head around it. NO WAY that was all in my head!!

I told her I didn't have much hope for this current cycle, and she asked why, which is how we got into the whole conversation about early symptoms. She did say that women come in convinced they're not pregnant all the time and they are, so we'll see. She also said girls are known to cause earlier and more intense symptoms, so now I'm convinced that if by chance I AM pregnant right now, that it's a boy!