Test Results

We had our $50, 5 minute phone consult on Friday and it was not good :(

The semen analysis results indicated that the male factor infertility is worse now. The test didn’t look at morphology, which was our only male issue on the last semen analysis from a year ago. This tested looked at count, motility and ability of the sperm to swim around to find an egg. While motility was still great, there was a dramatic drop in count. This means that there are not enough sperm getting to the fallopian tubes to try to fertilize an egg, so there is pretty much no chance of natural pregnancy occurring and that IVF + ICSI will be our only option for pregnancy. This result was a bit confusing for us because count was great on the last semen analysis and for all 3 IUIs we did last year. It could just be a fluke result, or something could be going on that has impacted the sperm production. We could do a repeat semen analysis or other testing to try to figure out what’s going on, but this could just add more time and cost more money and not change our treatment plan or success rates, so we are going ahead with the plan to freeze a semen sample and do IVF + ICSI.

My test results were a little confusing. Everything came back in the normal range, but my AMH, which is a measure of ovarian reserve and potential response to the fertility drugs came back on the low side of normal. The RE mentioned that my AMH is closer to what he would expect for a woman that is 38 not one that is 30, which could mean nothing or could mean I am at risk for having diminished ovarian reserve. I didn’t ask for my FSH so I don’t know if it’s on the high side of normal, which would be another indicator of low ovarian reserve, and have not had an antral follicle count down, which is why we don’t know if my lower AMH means anything. Nevertheless, it’s not great because it means that I’m less likely to get a lot of eggs produced. The RE said that a normal response to the fertility drugs would be 5-14 eggs retrieved, but that they would expect me to be on the lower side so maybe 5-8 or 10 eggs, and that I would likely need to take higher doses of the drugs to get these eggs. The fewer eggs, the fewer embryos. In a “typical” IVF cycle it is expected that ¾ of the eggs will fertilize and about 1/3 of those will make it to 3-5 days and be suitable for transfer. Now, ICSI should ensure that all eggs are fertilized, but if we get 5 eggs we are likely looking at 1-2 embryos produced.

This low anticipated result now changes our plan. Ideally, we want to have 3 children, but really more than 1 would be great. When we were expecting a 10-15 egg result we should be able to get 3-4 embryos from 1 retrieval cycle, so unless the first 2-3 didn’t take then we wouldn’t need to do another retrieval cycle. Now that we are looking at 1-2 embryos that changes things, especially based on the AMH and semen analysis results. Now the plan is to “bank” at least 4 embryos so we should hopefully have enough healthy embryos to have 2 kids. We talked a little about doing this because then my eggs would be 30/31 instead of 33+ if I got pregnant from the first round and had to do another retrieval later. Now, we are concerned that my ovarian reserve is dropping or the amount of healthy sperm is dropping so we went to get a bunch of embryos now in case something happens and we don’t have that option in the future.

Testing Completed

We have now completed all of our repeat testing for the new RE. My husband’s testing was pretty straightforward. He was able to get an appointment to do the swim-up semen analysis a week after our appointment, and then he did his blood work right after. Since I have to wait for specific cycle days it took a little longer. Since I was right around ovulation when we had our appointment with the RE I did my 7 days post ovulation test and STI/immunity panel first. I was supposed to go in CD20-22, so 6-8 days post ovulation. Of course, that just happened to fall completely on a long weekend. I thought it would be fine because there is a lab my by house that I could go to that was supposed to be open. Turns out the RE needs to update their information because that lab is not even open on weekends. I also had an optometrist appointment on the Saturday morning so I needed to wait until almost noon before I could go to the lab. I had my husband franctically calling all the labs on the list from the RE with weekend hours to find one that would be open past noon that day. Luckily, there was one that was open. The only one that was open past noon. That clinic was also supposed to be opened Sunday morning but not holiday Monday, but I didn’t want to risk it so I headed straight to the lab after my optometrist appointment. I did not want to have to wait another full cycle to be able to get my progesterone tested.

I hate parking lots and just parking my car in general, and the parking lot at this lab was so narrow and tight, so that sucked. The lab was at a walk-in clinic and it was packed with people. There were 10 people ahead of me at the lab and one older man said he had been waiting for over an hour at that point. In addition, doctors from the clinic were sending people with “urgent” labs that got to jump the line. I really wanted to spend the Saturday of my long weekend hanging around a walk-in clinic. Luckily, a few people ahead of me had disappeared so I got in after about 45 minutes. The lab tech confirmed what cycle day I was on and said I really got screwed with this testing.

My second set of testing was a huge hormone panel done on CD2-4. Of course, this cycle I had a hard time determining when the new cycle started because my bleeding had picked up making it hard to distinguish what was my normal luteal phase bleeding and what was actually menses, so I had to rely on my temps and secondary signs like cramps and my luteal symptoms going away. Luckily, this fell on a Thursday-Saturday so first thing Friday morning I went to the lab by my house. Of course, since nothing can be easy, I wasn’t sure if it was open because I couldn’t find consistent lab hours online. Seriously, it ranged from not open on Fridays, to open at 7:45, 8, 9, 10, so I decided I’d go at 8:30 and if it wasn’t open I’d go to the same one from the weekend. Turns out it opened at 8 so I could have gone earlier and not been late for work, but it wasn’t too bad. There were 8 people ahead of me but I got in in about 30 minutes. I had so much blood taken. The good thing was that AMH was free here (it would have cost $150 in our old province).

Now it’s just waiting. I called the RE and if I want an in-person appointment to get all the results and next steps then we have to wait until May 2. That really upset me so I asked about a phone consult because it’s really just is everything okay for IVF? And do we need ICSI or not? And was able to get a phone consult for March 17 . . . but, we have to pay $50 for this. I’m so over waiting, so I took the phone consult.

Appointment Update

We met with the new fertility doctor about a week ago. My husband and I liked him and he actually trained our old fertility doctor so that makes me more confident in him because she was amazing. He reviewed all of our tests results and he doesn’t seem concerned about my bleeding or the low sperm morphology and said that he’d really consider us to be dealing with unexplained infertility. I’m a little sceptical of that. I know that sperm morphology is sort of hit or miss on if it actually impacts fertility depending on severity and if it impacts functionality of the sperm, but I have a hard time believing that dysfunctional bleeding as severe as mine is not impacting our ability to get pregnant – it’s been 26 failed cycles, so something isn’t working properly. Similar to the old doctor he suspects that my bleeding is either caused by a weak ovulation or a lack of or miscommunication between my ovaries and my uterus, which fits in with why the clomid and progesterone made the bleeding stop.

The doctor didn’t push us right to IVF and said that we could do more medicated IUIs if we wanted, but since we did have 3 failed IUIs he wasn’t sure if any more would actually result in a pregnancy. We did make it clear that we had been planning on moving to IVF when I got the job offer to move so he said that we could start prepping for IVF.

Since it has been so long since we’ve done treatments, we do need to repeat some of the testing and do a few additional tests for IVF. It’s pretty easy for my husband – he just needs the STI panel repeated because there is some sort of health regulation that you have to have the tests done within a year of starting IVF. They also want to do a functional semen analysis to help determine if we need ICSI or not. I didn’t really want to do it, but my husband thought it was a good idea, and he was able to get in within a week of our appointment, so he did it. All of his testing is now done. I have to also repeat the STI panel as well as my immunity testing for hepatitis B, rubella and chickenpox, which I had done yesterday. I also need to repeat my hormone panels, including have my AMH (anti Mullerian hormone, a marker of ovarian reserve) so the doctor has an updated idea of my hormone levels to better plan my cycle medications. I need to have a mock transfer so they know exactly how to place an embryo in my uterus. I did my 7 days post-ovulation progesterone draw yesterday and am now waiting for cycle day 3 for the rest of my hormone bloodwork to be done. Once all this is done we will be able to get on the IVF cycle list, which seems to be a 2-3 month wait to start. I can take femara (an ovulation inducing drug that is supposed to have less side effects than clomid) and progesterone with timed intercourse while we are waiting for IVF if we want to give that a try. I think we will just because it will give us something to do while waiting.

Being infertile on Mother’s Day

Back when we started trying 16 cycles ago, I thought I’d get pregnant right away. My family is full of women that got pregnant easily so I had no reason to believe that I would be any different. Mother’s Day would have had me 12 weeks and I had already planned how to tell my parents. The baby would have been my parents first grandchild so I was going to send them a combined Mother’s Day and Father’s Day gift of mugs saying “World’s Best Grandma” and “World’s Best Grandpa” with an ultrasound picture. I didn’t get pregnant cycle 1, but there was always Father’s Day because I would for sure get pregnant cycle 2. I stopped planning announcements on cycle 8 when my OBGYN diagnosed me with infertility. Even then it never crossed my mind that I still wouldn’t even be pregnant the next time Mother’s Day rolled around.

I think the mothers in my life are amazing. They deserve a day to recognize how amazing they are. But getting through the past few weeks has been incredibly difficult. Everywhere I turn there are advertisements for Mother’s Day. “Show Mom some love by shopping our 30% off sale”, “Last minute Mother’s Day gifts”, “Buy a special gift for your Mom”, “Put Mom at the top of your list”. Social media is full of Mother’s Day things, including this new post going around my friends list: “Motherhood dare! (I accepted) I was nominated to post a picture that makes me happy/proud to be a mom... (only one picture) I'm going to tag some ladies whom I think are fabulous mothers (I know way too many to tag you all - sorry), and can rise up to the challenge of posting a pic of their own. If I've tagged you as one of the awesome moms, copy the text and paste it to your wall with a picture, and tag more moms! HAPPY MOTHER'S DAY (soon) to each of you xoxoxo "I LOVE BEING A MOM and I love all of YOU”

Every single one is a small stab to my heart reminding me that I’m not a mother. Despite doing everything I possibly can to become a mom, I am not. 15 failed cycles, including 2 failed intrauterine inseminations, 3 different doctors, 8 doctor visits, countless blood tests, an HSG, a transvaginal ultrasound, an abdominal ultrasound, 3 monitoring ultrasounds, $1200 on fertility treatments, $600 on medications, a semen analysis, ovulation prediction tests, pregnancy tests, fertility charting app, basel body temperature thermometer, 3 books on charting your cycles and increasing the chances on conception, many research articles on fertility and infertility treatments,  almost 2 years of prenatal vitamins with DHA, extra B vitamins, extra vitamin C, extra vitamin D, baby aspirin, Coenzyme Q, vitamins for my husband, Preseed lubricant – all I see is a stark white pregnancy test. I don’t get to see my husband kiss and talk to my belly. I don’t get to hold his hand and look at wonder at an ultrasound showing us our baby. I don’t get to feel my baby grow inside me, feel my baby kick. I don’t get to hold my baby with my husband, look into their eyes and think “we made you”.

While you are celebrating tomorrow, while you are posting things like the above on Facebook, and even while you are struggling with a difficult pregnancy, a challenging toddler or a mouthy teenager, take a minute – just one – to think about your friends and family that want so desperately to be mothers too. The ones with no living children. The ones struggling, doing everything they can to conceive. They may not have shared their story with you, but with 1 in 6 Canadian couples struggling with infertility and 1 in 4 that have miscarried, they are the woman in front of you at the grocery check out, and the one sitting next to you on the bus, the coworker in the office down the hall, your neighbour, your cousin, your friend. They are struggling to get through tomorrow and they are wishing and hoping and praying with every they have that next year, next year will be the year that they are a mother too.

The Semen Race

There are very few things in the infertility journey that are funny. The diagnosis, the doctor visits, the blood tests, the HSG, the financial burden, the self-doubt, the wondering if you are less of a woman because you can’t have kids, the daily emotional struggle – none of this is funny. However, we did have an amusing moment in the past month with my husband’s semen analysis.

While there are many infertility tests for women, men generally don’t have a lot of testing done. Even though the rates of infertility are similar between men and women, with 35% of all infertility cases due to a problem in the women, 35% with a problem in the men, 20% in both partners, and 10% unknown, usually a semen analysis is the only test a man needs.

Since I’ve already been diagnosed with infertility, we were referred to a reproductive endocrinologist for treatment. My husband needed to have a semen analysis performed as one of the last pieces of our infertility work up. Despite the fact that we live in a metropolitan area, there are not many labs that handle semen samples. My husband called the closest lab, a 22 minute drive from home in no traffic, to make arrangements for his test. The lab does not allow you to collect your specimen on site, so my husband would need to collect his specimen at home and deliver it to the lab within 30 minutes. Although it wasn’t amusing at the time, the whole semen collection and delivery is quite funny.

First, my husband had to book an appointment at a time when it was likely that there would be no traffic. We also had to make sure that his appointment didn’t overlap with my predicted fertile window since you are required to abstain from ejaculating (yes, the instructions did say this exactly) for 48 hours before specimen collection.

Getting from our apartment to the car and then driving to the lab would take exactly 30 minutes - we timed it when he went to get the specimen cup – so I worked from home that day so I could pull the car out front and shave off a few precious minutes.

I spent the hour before leaving listening to all-traffic all-the-time radio to make sure there were no problems on the route. I also obsessively checked the traffic websites for construction or accidents.

I’m an obsessive worrier so I kept telling my husband to remember to put his wallet in his pants, and to have his pants and shoes nearby so we could leave ASAP, and to keep the specimen warm.

I waited out front in the car while he collected his specimen. He was barely buckled up before I was off to the lab. Of course, we hit every red light on the way to the highway. Once I got on the highway I got stuck behind those people that drive 20 below in the passing lane. I had terrible road rage, yelling ridiculous things about the semen sample needing to get to its’ destination and to get out of my way NOW.

I was so stressed out driving because I wanted to drive FAST to get the sample there on time, but I also didn’t want to get pulled over for speeding. I imagined what I’d say to the cop if I got caught in a speed trap “Sorry officer, I need to get this sperm to the lab” or “Can my husband take the car and just leave me here on the side of the road while you write my ticket?”.

Luckily, we made it there 25 minutes after specimen collection. I didn’t get any speeding tickets. My husband found it really weird to walk up to the lab technician and say “I have a sample of my semen for you”.

After the whole semen delivery, we had to wait 10 days for the results. This sucked because they have to analyze the semen right away and would have the results that afternoon, but they couldn’t upload the results on the patient portal. It was 10 days before my husband could get an appointment with his doctor to get the results.

Unfortunately, we found out that we are one of those lucky 20% of couples where both partners have problems. Our appointment with our reproductive endocrinologist is still 6 days away, but based on the most recent medical studies, it looks like in vitro fertilization with intracytoplasmic sperm injection (IVF with ICSI) is our only option.