Saturday, November 22, 2008

So THAT'S what an RE is

I had my first ever visit to a real live RE on Thursday. Infertility is not covered under my plan but complications of pregnancy are, and the doctors helpfully seem to be lumping anything that will help me achieve a sustainable pregnancy under this heading. I was very disappointed, though that the office did not say "RE's OFFICE" but, just like the ones at home, said "OB/GYN - Infertility Clinic"*. Ah well.

I have, I am happy to say, been very thoroughly investigated already for absolutely everything that can be a cause of recurrent miscarriage. So no more tests apart from a couple of swabs, another progesterone level, and just to check up on an old health issue, I need to get a fasting glucose and insulin level at some point. I hate it when they insist on 8 hours fasting when I know my glucose levels are through the floor after 5, it's 1 pm and I ate breakfast at 8.

It was about day 23/24/25 yesterday (depending on how you count it and when I ended up ovulating this cycle) and my progesterone turned out to be 11. OK apparently for an unstimulated cycle but not as high as previously. My ovaries looked good, my FSH levels were pronounced "fine", apparently Righty was on this month, and Lefty looked a little small (going out of business, or just not awake this month?). However...

The lining of my uterus was very much not what it should be. Not very thick - only 5mm - and very dense - no 3 layer pattern. In some ways this is disappointing. In others it is kind of a vindication.

It's disappointing because, hello, has no-one thought to look at it before? When I've been in for testing, why has no-one said "come back on day 21 and we'll look at your lining"? But then, I remember I have had an internal scan on about day 26 before and was told it was all thick and nice and, and I quote, "juicy". Plus I had a doppler at day 21 which was pronounced "fine", though it was for an experimental study and I have no idea if that would tell you anything about lining thickness/quality or if it was just a random number.

So maybe it's an intermittent problem, or a new problem - if the latter, new since about 18 months ago. Anyway, it doesn't sound good, and I'm on my first ever course of progesterone suppositories. Lovely. Also daily baby aspirin ("but I was told not to take it as it prevents implantation" "Well, it's all just voodoo medicine". Reassuring!).

I asked a few more questions too: Clomid, no, not helpful if you are ovulating, and if you are old. Also discovered later it doesn't do good things for the endometrium. DHEA, makes you feel more upbeat and gives you higher sex drive. Otherwise, not much proven effect. Metformin, we'll see how the blood sugar and the insulin levels are.

I've been mulling over the whole thing: the RE suggested PGS ("but I've been told it doesn't work"; "oh, yes, that's true, recent studies suggest it isn't any use" - er, so why suggest it). And surrogacy (Great Pumpkins - is she actually suggesting my eggs might be fine? And worth using?). And donor egg ("your FSH is OK but you might have more success with younger eggs"). Personally, she'd go down our own preferred route of adoption, if we have to choose some other route. But she knows other couples will try other things first.

In some ways this diagnosis is very frustrating - it doesn't appear to be easy to treat, and if it is (as it may be, though it seems unlikely) due to adenomyosis (sp?), it's pretty much impossible. If I'd had the diagnosis earlier, perhaps something could have been done. My body may preventing my babies from growing, even though otherwise they would have been fine.

But in other ways it makes me feel a little better. It's not all just because I'm old, and because my eggs are coddled. I had my first miscarriage "quite young" at 37 (thank you, blush blush). I continually feel guilty that I didn't get married younger, that I didn't meet Mr. Spouse when we were younger, that it's all my fault for jaunting off round the world and not knuckling down to finding a spouse before I was 30 (while of course I was completely ignoring every single man I met in every country I lived in, and fighting off marriage proposals left right and centre, and never having failed relationships/crushes on gay/uninterested friends). But perhaps I would have had this problem if we'd got together when I was in my 20s too.

*To be strictly accurate, at home it would say "Gynaecology - Infertility Clinic".

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