Tuesday, February 28, 2012

The Fertility Specialist

As I said in our last post, my OB referred us to a fertility specialist after getting the results that my right fallopian tube was blocked. We scheduled our first appointment, which was just a consultation with the Dr. When we got there, I paid my co-pay like I always do at my OB and we met with Dr. Robert Kaufmann. We immediately felt at ease with him, and he spent almost 2 hours with us talking about our history and our options. After detailing what had happened in the previous year and five months, Dr. Kaufmann said, "Wow, you really know your stuff! I wish all of my patients and med students were this knowledgeable about their own bodies!" Of course, I wanted to be detailed and thorough...it's that OCD thing! :)

When I finished laying out our history, Dr. Kaufmann discussed the option he wanted to try for us, and said the words that were confirmation that he was the Dr. for us: "I am not recommending In-Vitro for you guys. I am confident that we'll get you pregnant without having to go there." Of course there were no guarantees, but just to hear that he was optimistic and wasn't jumping straight to In-Vitro was a huge blessing.

After doing a baseline ultrasound and talking about my previously diagnosed issues, Dr. Kaufmann talked to us about his thoughts. He said that he thinks I have Poly Cystic Appearing Ovaries, rather than PCOS because the ONLY symptom of PCOS that I have is that I sometimes produce cysts when I ovulate. He also said that he didn't want to do anything at the moment about my blocked fallopian tube. We were kind of shocked by this, but he explained it this way: He said that if my tube is completely blocked, I can still get pregnant with just one tube. He said that the fallopian tubes are so narrow and tiny that we could risk him rupturing one if he tried to go in to get a better look. He said there was no reason to do a risky surgery when it only takes one tube to get pregnant! Also, he said that it could be that the muscles around my tube contracted during the HSG procedure, not allowing the dye to get through, so it may not be entirely blocked. Either way, he said I had already gotten pregnant (which was a good sign) and he felt like we could just begin with IUI at his office, which they do a little differently than my OB. He said we would wait for me to start my cycle and then would start the IUI process.

By the end of the consultation, we were both feeling relieved and confident about working with Dr. Kaufmann. He explained the process of an IUI cycle with them (which was a little overwhelming!) and then sent us to talk to the lady who deals with the finances. Then she dropped the bomb on us...it would cost us $1200 a month for each month that we did an IUI cycle. Unfortunately, my insurance covers the diagnosis of infertility issues but not the treatment. (Can someone please tell me how that makes any sense??) We said okay, walked out of the office, and I immediately burst into tears over the money! Mike was so calming and encouraging, assuring me that we could make this work, and it would all be worth it to have a baby. I agreed and we made plans to begin in September with an IUI cycle.

So with any IUI cycle, this is basically how it works: I go in once I start my cycle for a baseline sonogram. As long as there are no cysts, I start on Clomid (100 mg) and take that at the same time every day for days 3-7 of my cycle. Starting on day 5 of my cycle, I also begin injections (shots) of Follistim, another fertility drug that is stronger than Clomid. Each night, for usually about 5 days, Mike has to give me a shot of this drug in my stomach at the same time each night. I go back in after I finish the shots for another sonogram. If the follicles (what releases the egg) are large enough, we stop the injections and schedule the IUI. If they are not big enough, I continue the injections for a few more days and come back from another sonogram. I then give myself another shot in the stomach 36 hours before the IUI of a drug called Ovidrel, which triggers ovulation. Then comes the IUI procedure, which I already detailed in the previous post. (What I didn't mention in the last post is Mike having to give his...contribution at the fertility clinic the morning of the IUI, which as you can imagine is his FAVORITE thing!!) After the IUI, I endure the dreaded 2 week wait, and go back 2 weeks after the IUI for a blood pregnancy test to see if it worked. Also during this 2 week wait, I have to do progesterone suppositories every day, to help support the pregnancy...lots of fun! If not, we start this process all over again 2 days later.

*Side note: One of the most frustrating things I hear from people while going through this struggle is, "Just try not to think about it and dwell on it so much." As I detailed above, my life is pretty much consumed with fertility treatments when I am in the midst of an IUI cycle. I have to remember when to take my pills, when to do the shots, how many days I do the shots, how are we going to pay for all of this, and I am in the fertility doctor's office at least twice a week. HOW am I supposed to just "not think about it"?? When you are having to do so much to your body during this process, it becomes difficult sometimes to NOT think about it! Just a word of advice...don't tell someone going through this to not think about it, not worry about it, or stop trying and it will happen...sometimes it's a daily struggle to balance work and other life situations with making sure you do all the doctor has told you to do. It can be pretty exhausting and consuming, so that comment can tend to rub some women enduring this struggle the wrong way.*

So, we endured this process of an IUI cycle with the fertility specialist for the first time in September of 2011. I was terrified of the shots (anyone who knows me knows that I hate needles...hence the "numbing medicine" story, for those of you who know it!) and Mike had to do the shots for me without me looking. As with most things in the process, the shots aren't really a big deal anymore, but they were at first! I always joke with Mike that I hated taking pills and shots before all of this, and now it's just an everyday part of my life! When I went back in for a sonogram after that first round of Clomid + Follistim shots, my doctor realized that they had totally overstimulated me. With Clomid, he explained that they wanted to see 1-2 follicles, with the Clomid + Follistim they wanted to see 3-4 follicles, and I had about 7-8 follicles! He said it was good that I responded to the drugs so well, but he didn't want to do the IUI that month and risk me having a large number of multiples, as that would not be safe for me. We were pretty bummed, but decided to go ahead and try on our own that month to see what happened. We didn't get pregnant that month, so we started over again in October of 2011.

In October, the IUI cycle worked the same way, except they reduced the amount of Follistim that I was injecting each day. When I went for my sonogram, they said everything looked great, and scheduled me for an IUI a few days later. When I was finished and was scheduling my blood pregnancy test, I realized that I would be getting the call about whether I was pregnant or not ON MY BIRTHDAY! I told the doctor that he could make my birthday either really good or really bad! Of course, everyone was telling me it was a good sign that I would get the results on my birthday, but I was trying not to get my hopes up.

The 2 weeks after an IUI each month (or even just after ovulation) feels like years. The waiting is horrible, and the over-analyzing of every "symptom" is agonizing. This month, it felt even longer because of the added hopefulness that I would find out on my birthday. When you go in for the blood pregnancy test, you go between 8 and 9 am and they call you with the results that day after 4:00. That day alone feels like forever!

On November 4, 2011, the nurse called to tell me that the pregnancy test came back positive (YAY!) but I sensed a BUT in her voice. She said, "Your pregnancy test was positive, so you are pregnant, BUT your hormone levels are low." Basically, anything from 1-5 is a negative pregnancy test, and my level was at a 6. She said at this point the only thing we could do was wait to see if the levels increased....there wasn't anything they could do. She said they wanted me to come back on Monday to do more bloodwork and see where my levels were at. I had such conflicting emotions at that point that I didn't know how to feel. We went ahead and told family and a few friends (no fun reveal this time) so that everyone could be praying that my levels increased. That Sunday night, Dr. Kaufmann called me at home to see how I was doing and to let me know what he wanted to see in the bloodwork. He said that they wanted my levels to be doubling every few days, so if I was at least at a 12 by Monday that would be good; anything 15 or above would be great.

On Monday, after the dreaded waiting period, the doctor called to let me know that my levels had risen to a 16!! Mike and I were thrilled and finally felt some relief that maybe this would actually be a viable pregnancy. My doctor wanted to continue to check my levels every few days to make sure they were still rising. At each subsequent appointment, my levels rose to 32, 78, and finally 302! Every test that came back higher was an encouragement, and after the last blood test, Dr. Kaufmann said I didn't need to come back for more blood tests, they would just schedule our first sonogram appointment at 6 weeks. I also went to see my OB during this time and we agreed that I would stay with Dr. Kaufmann through the first 9 weeks, and come back to him at week 10, so we scheduled that appointment. I was so excited to have made it past the 5 week mark (the furthest I got in my first pregnancy) and Mike and I were eagerly awaiting our 6 week appointment where we would get to see our baby and hear the heartbeat for the first time! I was certainly feeling pregnancy symptoms, and relished every one! We felt like it was a good sign that I found out on my birthday that I was pregnant, and my tentative due date was July 12, which is both my Mema's and Mike's Grandmother's birthdays! Despite how our first pregnancy ended, we really felt like this would be the pregnancy we would carry full term.

Little did we know, the Lord had other plans in mind for us and this baby.


  1. That is a serious process my friend! Our miscarried baby was due July 10th. Praying and knowing that God has big plans for you and Mike!!

  2. It definitely is a serious process! Thanks so much, Em! :) Praying for your new little one on the way!