Initial ORM Consult

Michael and I went to our first appointment with Dr. Hesla at Oregon Reproductive Medicine last Wednesday. During the three weeks since scheduling the appointment, I had been thinking that it would be at their clinic near St. Vincent Hospital. My confirmation email said it would be at their westside location, but didn't give an address. I even checked their website before we left work for the appointment, but somehow missed seeing the Barnes road address where we were supposed to go. Instead we drove downtown to their office at Good Samaritan Hospital where the receptionist informed us that we were at the wrong place. My heart sank because we had waited so long for the appointment and I figured we would have to reschedule and wait a few more weeks before we'd be able to get back in. Luckily, we were Dr. Hesla's last appointment of the day and he very kindly agreed to wait for us. We hopped back in the car and made it to the right clinic at 4pm, so we were only 30 minutes late. Still, I felt silly for getting the locations mixed up!

Needless to say we didn't have long to wait once we arrived. A staff member (whether nurse or medical assistant I don't know), led us to a small room that just fit a table, 4 chairs and a sink. She took my vitals (pulse, blood pressure & weight) and took a picture of the two of us for our file. Michael and I thought that was kind of cool--it showed that they care about putting our faces to the information in our file. Well, I guess you would call it "my" file because at a fertility clinic, it seems like only the woman undergoing treatment is considered to be the patient--even if she has a male partner who will be donating his sperm. Michael had to fill out health history paperwork like I did, but his was only about 3 pages whereas mine was probably twice that, and his forms will be kept in my patient chart instead of having his own file.

Michael definitely noticed the focus on me because after the lady finished taking my vital signs and left the room, he said, "They're not really interested in me, are they?" I explained that it was because if we chose to work with them to get pregnant, I would be the one whose body would have to be healthy enough not only to conceive but to maintain a pregnancy. Still, I think he felt left out, so I teased him by asking, "Do you want me to take your blood pressure?" He did consent to hopping on the digital scale that was in the room and we were both happy to discover that neither of us weighed as much as we had feared. :)

The lady was soon back to collect us and take us to Dr. Hesla's office. He was a tall, soft-spoken man with silver hair at his temples. We thanked him for agreeing to see us late, and then he got right down to business discussing our forms. There was quite a stack of paperwork on his desk which included our health history forms as well as the results of the 3 ultrasounds I had over the course of last year, the HSG and blood test. He had to do some shuffling of papers to find what he wanted, but as I had feared, the first thing he wanted to discuss were the cysts on my ovaries.

I didn't make a blog post about the results of the December ultrasound (mostly because I didn't hear from the doctor until FEBRUARY . . . when I did it was just a voice mail message glossing over the fact that she had never gotten back to me with the results and telling me to feel free to call her if I wanted to discuss them. It shows the level of communication among her office staff because I had called her office several weeks earlier and requested that I be sent a copy of the results since I was tired of waiting around for her to get back to me.)

Anyway, basically the results were about the same. I have 3 cysts in my left ovary and one of them keeps getting bigger, little by little. The right ovary also has at least one cyst and possibly more, which brings the number and quality of my eggs into question.

Dr. Hesla said (twice!) that I have severe disease (indicated by the presence of the endometriomas, which are cysts filled with old blood caused by endometriosis), and that in some cases, women in my situation make fewer eggs--but not always. He said he recently had a patient who also had severe endometriosis affecting her ovaries and she was able to produce a good number of eggs when she went through IVF.

He wasn't too concerned about Michael's low sperm numbers . . . although he did say that the problems we both have don't make us good candidates for IUI (the much less invasive, less expensive procedure), which he said isn't actually much better than just having plain old sex. He does not think we would ever get pregnant naturally. :( He did say that they have great success with IVF when the difficulty is male infertility. But before he can determine if we are both good candidates for IVF, he needs to take a closer look at my ovaries.

So the next step will be calling the clinic when I begin my next period (in about 12 days), to get an appointment on either Day 2 or 3 of my cycle and to make a second appointment for Day 10 of my cycle. I'll have to take the "Clomid Challenge Test" which incorporates two blood tests and an ultrasound to determine the quality of my ovarian reserve.

The first part of the test will be a transvaginal ultrasound. I have to say that I am not looking forward to that since I will be having my period. I guess they can kind of tell where the cysts are in relation to my ovaries (the endometriomas look gray and the ovaries more white, I think), and so can help determine how many eggs may be in there.

At the same time as the ultrasound, I'll have a blood test to determine my FSH and estradiol levels. FSH is a hormone produced by the pituitary gland that stimulates the ovaries to develop follicles, which are the small cysts that contain eggs. As follicles develop, they produce hormones (estradiol and inhibin-B) that flow back to the pituitary gland via the blood and tell it how much FSH to produce. Both my FSH and estradiol numbers should be low (FSH less than 13 m1U/ml, estradiol < 100pg/ml) at either Day 2 or 3 and also at Day 10.

At the same time that I have the ultrasound and the first blood test, I will start taking Clomid, which is a fertility drug that will stimulate my ovaries to produce follicles. If I understand the test correctly, I should have a lower FSH level on day 2 or 3 of my period since my pituitary gland won't yet be sending the signal to my ovaries to develop follicles for that month's cycle. As I take the Clomid, I'll get a peak in my FSH and estradiol levels as my ovaries are stimulated to develop follicles, but by Day 10 of my cycle I should have a low FSH number indicating that my ovaries are working to send the "turn off" message to my pituitary gland.

I told Dr. Hesla that everyone was surprised that my fallopian tubes were both open when I had the HSG test (because of my history of endometriosis), and that until proven otherwise, I consider myself to have an abundance of eggs. :)

I had a lot of emotions after the appointment: sadness, anger (that again my ability to get pregnant hinges on having the endo), regret that I didn't begin fertility treatments several years ago, regret that I wasn't consistent with the abdominal massage or the castor oil pack treatments--wondering if I would still have the same problems I do now or if those things could have helped. There's no way to know . . . and I tell myself that I did the best I could, but I still feel guilty.

So now we wait until it's time for me to go in for the testing. If my ovarian reserve is good, we will most likely prepare to begin the process of IVF. If it isn't, we will have more decisions to make. My best friend, Lindsey, has offered us her eggs, but I don't know if Michael is altogether comfortable with that arrangement. We may decide to go the adoption route instead. I guess we'll just have to keep taking it one step at a time and go from there.

It's funny because at this time last year, I was still not ready for IVF . . . in fact I was just about to book my trip to North Carolina to attend the Fertile Soul retreat. I still thought we could get pregnant naturally--if only I did everything right, followed every suggestion, was mentally strong enough. Now I admit that we need more advanced help. The one thing that makes me feel better is the fact that I have spent nearly a full year being pretty consistent with the special diet and with taking the chinese herbs and other supplements. Eileen (who has also been taking herbs and doing other alternative treatments), reminds me that that must count for something--that our bodies must be in better shape than they were before, and that that will work in our favor as we both begin the road to IVF.