Door #2: E2, Brute?
Because it has occurred to me that not all of you share my deep and abiding love for test results, today I offer you two separate posts. We here at Flotsam aim to please, and so allow me to present Door #1—a post about sundry non-reproductive topics, and Door #2—a post devoted entirely to Friday’s rather dramatic visit to Dr. Doctor.
Day 3 results:
FSH: 5.57
LH: 9.81
E2: 46.7
17OHP: 131
Testosterone: A burly 79. A result that should come with a tool belt.
Friday, with diagnostic codes submitted to my insurance company, Dr. Doctor made it official: I am infertile. I will not be able to get pregnant without medical intervention. The final verdict is PCOS with insulin resistance–my ovaries are swimming with so many immature follicles that Dr. Doctor never bothered to count them all. So many, in fact, that she will not let me go straight to injectables, due to the risk of high-order multiples. Her hope is that Metformin and Letrazole IUIs will work, as I have managed to get pregnant before.
The last time I got pregnant was also the last time I ovulated—November of 2004.*
Dr. Doctor and I continue to be besotted with one another–she took the liberty of photocopying all of my lab reports for me because she knows I like to “see the numbers.” There was much “Well what do you think, Doctor?” and “Oh Alexa, you know more about this than I do!”
Things we love:
1. The extended-release version of Metformin
2. IUIs
3. Blood tests
4. Each other
Things we hate:
1. Clomid
2. Sextuplets
3. Ovarian cysts
An attractive and fearsomely youthful medical student was there for the appointment as well, taking furious notes throughout.
The good news was the Nearly’s sperm analysis. Concentration was 117 million per ml., 234 million total.
His total motile: 100.6 million.
The Nearly is quite insufferably pleased with himself.
His viability was only 40%, but with 100 million motile, who cares? Morphology was 11% normal, which confused me, as Dr. Doctor was very impressed with that number and I thought it wasn’t high enough. But again, even a mere 11% of a gazillion is…a lot.
My thrombophilia panel was less cheering. Generally with multiple miscarriages they look for things that give one a greater tendency to form clots. Apparently, on the contrary, my blood takes so long to clot that I would be an unattractive surgical patient—they don’t like you to bleed out on the table:
Prothombin Time—Normal: 8.7-11.5 seconds. My result: 18.3 seconds.
APTT—Normal: 22-36 seconds. My result: 66 seconds.
INR—1.8
It makes this seem eerily prescient, doesn’t it?
I have to admit, I am flummoxed by these results. I assume they could have something to do with my miscarriages, but I cannot for the life of me figure out what. If any of you are hematologists, feel free to enlighten me.
I could either be missing a clotting factor or I could produce some sort of antibody to one of my clotting factors. They took more blood for a fancy mixing test {they mix my blood with different things and see what it does—it sounds like such fun I offered to do it at home, but Dr. Doctor nixed that idea} and I will probably end up seeing a hematologist. One possibility is that something is wrong with my liver, so they are running my liver enzymes. I cannot start my Metformin until those come back next week.
In case my liver was not getting enough exercise, and had become flabby with disuse, I went straight out after my appointment to meet my dear cousin for a drink.
*For those of you just joining us, the last time I got pregnant I was on the minipill, which suppressed my dysfunctional ovaries enough to allow me to ovulate, but not enough to keep the Nearly from knocking me up.
Yes. I got pregnant *because of* birth-control pills.
13 Comments
Jesus, you haven’t ovulated in over a year? Glad they finally caught on to the whole “infertile” thing then.
And I’m totally flummoxed by the lack of clotting, and glad that they’re following up on that.
The metformin, letrozole, IUI combo sounds like an excellent idea. Especially with those stellar sperm. 11% morph isn’t normal, but with a total motile count that high it doesn’t matter much, does it?
Dr. Doctor sounds dreamy.
What a coincidence: the phlebo who drew my blood last (and who knows me outside of the phlebo/patient relationship so knew a little of what was going on with my IF) told me how she had the opposite problem with getting pregnant. The stronger the birth control, the more “fertile” she became. I thought she was offering me some offhanded assvice, but your post reminded me that she said how the BCP seemed to generate “antibodies”. Maybe there was some truth to it. I couldn’t be mad at her. She’s in her 50’s with 5 kids and she lost two others to m/c.
Gaahhh!
So, I was wondering, are there any other fucked-up misadventures that your body would like to spring on you? Come on, now! Maybe one of your ovaries could suddenly just shrivel up, make its way down-tube, and fall right out your hooha. Jesus Christ!
Geez. Hope they can figure out what’s up with the wicky-wacky blood test results. Nice sperm, though, and I’m glad about the forward progress. Official recognition by the insurance company is very very important, so glad that hurdle is cleared and you can focus on truly important things.
How cool are you. You have, like, opposite fertility. Perhaps you and dr dr can write a paper together about it?
And I’d probably want to hit the nearly at this point. I’m sure he’s feeling quite insufferably pleased with himself. Damn those fertile men with their fabulous sperm.
At least it’s a start to answers. That’s the one good thing about it right?
And yeah - when I got pregnant before it was on the pill. Go figure.
That’s so weird, because on the outside — you look totally normal.
Oh, wait, you mean you can’t tell if someone is infertile by just looking at them?
I posted a comment yesterday, but my laptop lost power just as I hit the save button, so anyway, the short version is that I wanted to say thanks for continuing to write about this stuff. You have no idea how helpful it is to me, as a newbie to infertility. It’s clear that you are an advocate for yourself and that you know what you’re talking about.
Good luck with the test results and the Metformin.
Hmm, the blood clotting thing is curious indeed. I hope the fancy mixing tests shed some light on what’s going on.
And I’m so glad you and your doctor are on the same page.
I’m sorry to hear your news, but I’m so glad you have a doctor you love, who already has treatment strategies planned.
Dear Alexa, that’s a nice doctor you’ve got there! Wow, I’d love one like that. Good news on the Male Factor. Weird about the (non-)clotting — it’s good you’re having that checked out.
I hear you about the editor. “Change one little thing: the content.” And congratulations on the car.
Hilarious posts, as usual. (I took Door #1 and Door #2. I am known for my avarice.)
You might also considering researching which clinics in your area are doing in vitro maturation, which is a new technique that was developed for PCOS patients, but which many in the RE field predict will soon become the standard in IVF care. Basically, you are given minimal stims for just a couple of days, then your eggs are retrieved while still immature, and allowed to mature in the lab until fertilization. This technique eliminates the risk of OHSS as well as higher order births, since, as with all IVF, you can determine how many embryos you wish to transfer and thereby limit the risk of multiples. I’m sure that there are major research centers in the US doing IVM, so you just have to find them.
About the blood test results, hmm. I am not knowledgeable in this area so would just be guessing, but, clotting factors need to be in delicate balance or else they will react to each other in a sort of ping-pong-like frenzy in an effort to achieve balance. I wonder if your slow clotting time is causing rebound, intermittent clotting which hasn’t been picked up by testing yet. In serious traumatic injury, this often occurs (rapid loss of blood due to bleeding followed by extreme clotting to stop the bleeding followed by release of anti-coagulant substances to break up the clots, which only causes more bleeding, and the cycle goes on and on — it is called DIC or disseminated intravascular coagulation and is a difficult pattern to break — I wonder if something similar is going on in a very, very minor way in your physiology. Just my wild imaginings–I really have no idea. I’m trying to understand why your clotting factors would be off.
I have also heard that while small amounts of baby aspirin (anti coagulant) may help implantation, larger amounts, like an adult aspirin, can impair implantation. Again, wondering if “too much of a good thing” can create a paradoxical problem. Well, your hematologist will figure it.
Oh, just delete that second paragraph of my previous comment! It doesn’t make any sense in your case because it isn’t relevant. You most likely are missing a clotting factor for whatever reason and hopefully they can find a way to correct that or compensate for it. Also, I’m wondering, how many miscarriages have you had? Because unless you had a lot of them, there probably isn’t any reason to suspect that clotting is a cause.
If you had a D&C, then your hospital path lab would have made a paraffin wax block of the products of conception. You can send the wax slides to a pathologist who can tell if the embryo died from clotting in the placental vasculature (unlikely in your case, but if you are curious, it might be a satisfying thing to do). They can also tell other things, too. I know a pathologist who specializes in reproductive loss and her fees are very reasonable. Just let me know if you are interested.