Fertility Testing - Intermediate Level

I've been meaning to write this post for a while but it got pushed back with all of the crappy emotional stuff last week. I went a few weeks ago to a fertility specialist, Dr. Pasquarette, to basically move on to the next phase of fertility testing and treatments. I received a lot of information that I am excited to share!

There are two fertility specialists in Wilmington, NC (for those of you reading locally), but Dr. Pasquarette is the only nationally certified specialist. I had heard from a number of people that he is the best to use, although he had a personality that was just....off. I figured if I'm going to go spend all this extra money and go through advanced treatments that it probably needs to be with the best I can get. I called the office back in April and could not get an appointment until July 2nd. This was frustrating but also a sign of how good he is.

July 2nd came and I actually got to my appointment 10 minutes early which NEVER happens with me (just ask my husband, he LOVES how I'm always late for everything). I walk in, give my name, had my ID and insurance card ready and then the receptionist tells me I had cancelled my appointment. Just as any mature, professional young woman would do, I started crying right in the middle of the waiting room. Thank you Clomid. I knew, with complete certainty, that I had not cancelled my appointment and I just went in to a panic that I would have to wait three more months to see the doc.

Luckily the crazy worked and Dr. Pasquarette said he could squeeze me in at the end of his lunch. He even offered to share his fries. Good doc! Just an FYI, as it turned out, the appointment that was supposed to be after me never showed up; when they called her she said she had cancelled. That was nice because it helped make me look less crazy, at least I hope it did.

So, to get to the actual point of this post, here is what we went over. Dr. Pasquarette explained a number of tests that we could run, but, in his own words, "they were bull shit". He talked that way to me the whole time, as if we were just chatting at a bar or something, which I loved. I could see why others would be turned off by this demeanor though. The "bull shit" tests that I remember him talking about were the post-coital mucus test (talked about previously) and laprascopic surgery (this is not bull shit for every person, just in my case because I have no history or signs of endometriosis and had a clean HSG scan). After going through mine and Travis's health/family history, he confirmed that nothing stuck out as a cause of our infertility. We came up with the following three options:

1. IUI with Femara or Clomid with possible addition of a trigger point injection (I am not 100% that this is the right word, but it sticks out in my mind so we'll go with it. Essentially, it's an injection that makes your eggs pop out of your ovaries, i.e. forces ovulation).

2. IUI with injectable meds

3. In Vitro Fertilization

I LOVED that he gave me the options, instead of just following a strict order of directives. We decided to go with IUI + Femara for the next two rounds and then increase to addition of trigger point for the two rounds following that. Him and his staff were so detailed in how to proceed, it makes me feel so much more confident in what I am doing. The instructions for this round were:

1. Call office on 1st day of period/cycle day 1- they will then call in Femara (2.5mg 2 tabs daily on days 3 through 7)

2. Start Femara on Day 3 of cycle

3. Start testing for ovulation on Day 8 of cycle. He recommended using the ClearBlue Easy, but not the monitor I had been using. He likes using the sticks which are $44.99 for a pack of 10 (1 month supply). I did start using these and they are a little more user friendly than the monitor. You can test any time in the morning, not just in the set 4 hour block, which is nice if you have to pee early or sleep in later than you were supposed to (both of which I was prone to doing). You get a plain circle for low fertility, flashing happy face for high fertility and solid happy face for peak. Overall, it gives you your 4 highest fertility days versus 6 with the full monitor.

Pic of ovulation test on day 10 (today), can't see the flashing. High fertility!

4. If I have not reached peak fertility by day 12, come in for an ultrasound, where they will measure the maturity of my eggs. I would repeat this every 3 days until I got a peak reading

5. Call office on the first day of peak reading (solid happy face). They will schedule the IUI for the next morning. We have to go to a lab to have the sperm "washed" for 45 minutes and then bring that sample to his office for the IUI

He also set me up with a couple additional tests (apparently non-bullshit). He was adamant about me getting a blood test to check if I was a carrier for cystic fibrosis. He also wants Travis's checked. I told him that I had thought you were only supposed to do that once pregnant, and he brought up the point that wouldn't it be too late then to make alternative decisions. For instance, if Travis and I would both come back as carriers, we would have a 1 in 4 chance of having a child with cystic fibrosis. They usually recommend going straight to IVF in this case (not exactly sure why) or some couples may change their mind on having a child. I have not received my results from this test yet, but I am glad he recommended it and I wonder why more docs don't?

We did a sonogram as well to check out my uterus and ovaries and make sure there were no blockages or other issues going on. It gives a different view than the HSG apparently. The sonogram was fascinating, once I figured out what was what. Everything was good but my right ovary was six times the size of my left. They said this is normal with clomid as the ovary that is ovulating that month will likely be spitting out some extra eggs. They saw three. I also had a "fluffy" uterus, which is a good thing! This test ended up being part of the reason I thought I was pregnant last month, which kind of sucks, but interesting none the less! Here are some pics of the sonogram:

Left ovary (i.e. puny, lame ovary). This is a split screen
shot. You can see the size better on the right side shot.
It is the dark acorn looking thing towards the
right corner. There are two lines measuring the size

Right ovary (i.e. super ovary!). It it at the top of the pic,
you can see the thin lines measuring it.  Crazy big compared to above!

My fluffy uterus. Again, you can follow the
lines to see the measurement.

I will be going back to Dr. P in a couple of days once my ovulation test peaks and I look forward to sharing more updates on this new experience!