After the less-than-pleasant experience at the first fertility clinic (see this post for slightly more details) we decided to go to a second clinic for a second opinion – with the hopes that it would be a better experience. This second clinic, AWC for short, was amazing! Night and day experience from the first clinic, and we discovered a lot more information about why nothing was working out.
Technically, I believe our diagnosis is still “unexplained infertility” at this point. But we’ll start at the beginning of the appointment.
DISCLAIMER: I am not a doctor and nothing I say should be considered medical advice. This post is for informational purposes only. Please discuss anything with your doctor before changing any aspect of your medical care!
We started with the doctor, and she spent 45-60 minutes explaining and talking to us, in detail, about what she thinks is going on and how she plans to help us conceive! It is rare to spend that kind of time with a doctor and have their undivided attention the entire time. It was amazing! Then we spent the rest of our hour and half with the nurse practitioner going over some logistical details based on the plan we came up with the doctor. The doctor was able to help piece together a lot more of the puzzle and explained some areas where I was unclear.
First, the tests I’ve already had for fertility: AMH, estradiol (estrogen), thyroid, one 21 day progesterone check, prolactin, a resting follicle count, and an HSG. Dan has had a semen analysis. I’ve also had immune system testing (you can learn more about that here) that wasn’t technically for infertility but ran tests they like to run for infertility. The portion of the immune system testing they talked about during the consult was confusing, and I need to talk to the doctor in more detail about it before I can write about it – however, it shouldn’t cause a problem with me conceiving so we aren’t doing anything about it right now.
Dan’s semen analysis is 100% perfect in every way, but the doctor went through the results in more detail to better explain to us what they meant. The extra detail was appreciated. Because the semen is the “end result” for male fertility, we do not need to do any additional testing or procedures for Dan.
My first test was the HSG. The new doctor couldn’t tell from the images what they were showing, except she could tell my uterus looked good. The HSG report itself said “normal fill and spill” so we’re assuming the test was normal for now (if there continue to be problems, I may see about doing a repeat with AWC to make sure everything is truly normal). Normal is good as the HSG looks to make sure the uterus and Fallopian tubes are clear so the egg can make the journey to the uterus and has a chance of sticking around. I go into more detail about how conception works and the HSG in this post.
Prolactin, AMH, estradiol, thyroid, and progesterone are all blood tests. My prolactin is interesting. I had it tested in February this year (2018) and it was totally normal. However, when I had it checked recently it was elevated. My regular OBGYN explained that it could be due to not fasting prior to the test (they aren’t totally sure why), and suggested checking it while fasting. It was still elevated, but it’s not elevated enough for treatment or an MRI (to check for a benign tumor that could be causing the elevated level). For now, since it’s barely elevated, we’re going to proceed as if it’s normal.
My estradiol, thyroid, and progesterone are all also totally normal and in range. However, AWC likes to have two points of reference for progesterone in one cycle before they make that determination, so this next cycle I will do those two blood draws.
AMH is an interesting one. AMH stands for anti-mullerian hormone. The AMH essentially checks your ovarian reserve. Women are all born with all of the eggs they will have for their entire life. The eggs are all immature until we hit puberty and start menstruating. Each cycle where we ovulate, the body starts to mature multiple eggs, then it picks the best one, stops the others from growing, and releases the best egg. There was a survey of over 17,000 women (yes, 17k) to measure average AMH levels at different ages to get reference ranges.
While any AMH level over 1.5 is technically “good,” that’s the level for a woman in her late 30s, which is when we know that fertility starts to decline. According to the detailed chart the fertility doctor showed us, my levels are “good” but at the level of a 36 year old woman – I’m 28. Because they’re much lower than they should be for someone my age, we’re rechecking them. Sometimes, LabCorp (the company that processes all my labs) aren’t as accurate for these specific hormones, so AWC sends them to a lab in California that specializes in female hormones. Hopefully, this will show that my AMH is actually normal for someone my age. If it turns out the AMH levels from LabCorp were accurate, then I’ll receive the diagnosis of “diminished ovarian reserve” (which literally means I have less eggs than the average woman my age).
The first fertility clinic did the resting follicle count ultrasound, but no one seems to have the results (AWC is trying to retrieve them from the first clinic – if they’re unsuccessful, I have to have the ultrasound repeated). Hopefully, that will come back well. Even if my AMH is low, if my resting follicle count is normal then I do not get the “diminished ovarian reserve” diagnosis (at least, as far as I understood it). The resting follicle count ultrasound shows the doctor the actual number of eggs I have available to mature. I’m hoping that the ultrasound can be retrieved and looks normal.
AWC likes to check testosterone levels as well. All women have testosterone in their bodies, even though it is thought of as a male hormone (everyone has both estrogen and testosterone, just in different amounts). A certain level of testosterone is necessary for the ovaries to function at optimal levels. To test for the testosterone levels, they check both “testosterone” and “DHEAs.” I had my blood drawn for the test right after our appointment, and it actually came back the same day. Unfortunately, my testosterone and DHEA levels are both lower than they should be – significantly lower. Thankfully, there’s a supplement that should help boost my levels back to “normal.”
Overall, we have a plan of action that Dan and I are very happy with. She didn’t even mention IVF until we were near the end of the appointment. She said that every few months of a current course of action not working (if that’s what happens) we’ll sit back down and discuss what needs to be changed. Our first course of action is getting me onto a large list of supplements, and doing testing again to determine when my ovulation occurs in my cycle (and so that we can do blood tests). For my next cycle (projected to start between the 3rd and 5th of December), we’re going to do the ovulation testing and diagnostic testing. The cycle after that, we’re probably going to try Clomid, unless something in the testing tells us not to. We’ll increase the dose of the Clomid, compared to what I did before, and hopefully that will be helpful. During the Clomid cycle, we’re going to do a lot more monitoring to make sure everything is going the way that it should. We’ll probably do Clomid for several cycles, but may decide to do an IUI sometime during the Clomid cycles. If I’m still not pregnant, we’ll regroup, and either switch medications or try something else. If we still can’t get me pregnant after several re-plans, then we’ll start to talk about IVF. Thankfully, IVF at AWC is much cheaper than any other place I’ve looked up, so it may actually be an option for us down the road.
Every fertility clinic is different, so the supplements mine is giving me may be different from your own clinic. I’m not passing judgement, just relaying information. I have been taking a prenatal vitamin and methyl folate (methyl folate is more easily absorbed than folic acid – which is what my prenatal contains), but I will be switching to a different prenatal if I tolerate the samples because it contains methyl folate; ultimately, the new prenatal will be a lot cheaper than my current combination. I also already take Vitamin D3 and Omega-3 (fish oil) at the correct doses, so I don’t need to change those. Supplements I need to add: DHEA (due to the low testosterone levels), CoQ10, Inositol, and Pyrroloquinoline Quinone (PQQ). Thankfully, the clinic had samples of some of them, and I was able to find everything for decent prices. Due to my sensitive system, I have spread out starting the different supplements so that I can [hopefully] narrow down if one is bothering me. I’ll be starting with the DHEA, then the Inositol, then the CoQ10, then the PQQ, and then will be switching prenatals (because that should be when I run out of my current one). It will take a little over three weeks for me to get onto all of the supplements.
The DHEA supplement is a little different than “take this until you’re pregnant” (all the others are). Two weeks after I start the DHEA supplement, we need to recheck my testosterone levels to see if the dose needs to be adjusted. Hopefully, it will be an easy process, but knowing my body I’m not being overly optimistic about that!
I will do my best to keep you all updated on my progress through this journey with the new fertility clinic. I’m more likely to do small, frequent updates on my Instagram (findinglifessilversun), so be sure you’re following me there! While this process is overwhelming, I’m a lot more confident that I’ve found a team I can count on to help me through it – and that makes all the difference in the world.