ICSI

4% morphology. The rest was fine, if perhaps on the lower end of the “fine” spectrum. But with the morphology issue and my history, ICSI is the recommended plan to move forward. It’s not so surprising given previous SAs, but I’m still not quite done processing it.

And what have you been up to?

much, much later

It’s been a long time. So many of you have moved on and have a baby (or even two!) now. I’m very happy for you, I truly am. But also feel stuck in the same place as almost two years ago.

Between moving to the other end of the world an the butt pain becoming too annoying to bear, we stopped trying for a while (as in, back on BCPs). And for a while I was fine with that. But eventually I asked for a referral to Big Teaching Hospital — the wait for talking to one of their endometriosis specialists was 2+ months, but worth it, I think. My doctor seems very experienced (or maybe it’s just that I accidentally found out that she has over 200 papers on the issue, that always helps in impressing a scientist ;) and I feel like she gives me a realistic understanding of what might work and what is less likely to.

The odd part is that, apart from my history, things look okay on my side. Follicles, check, lining, check, ovulation, check, clean uterine cavity, check. So the main data point we’re waiting for is the next SA — if it has significantly improved over the previous ones, we’ll try IUI, otherwise it’ll be IVF. Which is not only much more expensive, but also not covered by insurance in the slightest. We’re lucky in that we have insurance that would cover part of the IUI costs — but if that won’t work for us, it seems a bit like all-you-can-eat: sounds good at first, but perhaps not what you really need. I have no idea how we’d finance IVF, but that has time for later posts. I’ll try to slowly find my way back into this, and, admittedly, I’m not keen on trying to open that particular can of worms.

radio silence

Thanks for checking in — it’s lovely that you guys (ok, girls) care about me so much! Sorry for vanishing without a word — my computer decided that it was a good time to break down, even though I did not take it anywhere near the big magnets. Thus, no updates. Also, I’ve been busy like crazy, and we’ll have a bunch of guests next weekend (which I’m very much looking forward to, but also slightly stressed about), so that I don’t know how much time I’ll have for blogging until after that.

So, the executive summary of the news:

• I was tested for gluten-sensitivity related antibodies, as this is often found in endometriosis patients. Negative. Any idea how much this means, in the sense that my symptoms could still improve if I cut out wheat?
• The MRI is unclear. Lovely. Well, I guess it could be worse and have shown huge problems, so I’m trying to look at the bright side… My doc wants to talk to the MRI specialist again to make sure they look at the right places, so there might be an update lateron.
• The SA was worse, unfortunately. 5% morphology (usual threshold 12-15%), plus motility problems. As far as I remember, last time they only told us about motility problems, so that would be another blow.

I’m not sure how we’ll move on from here. Since my endo surgery years ago we had always assumed I’d be the one with the problems, but now it seems to be both of us (ok, technically we don’t even know if my endo is interfering with my fertility, but it’s quite possible, and the pain is enough of a problem as far as I’m concerned). I’ll schedule an appointment with my doctor and my husband, so that the three of us can sit down together and try to sort this out.
Somehow I had hoped that the SA would bring us good news. H was disappointed as well, though he’s trying not to show it much, and he’s so stressed with work-related things (which cannot be good for his swimmers, but we’re going in circles on that one) that the denial phase works well.

radio noise

All in all, we had a good weekend. With two dinners with friends — and drinks, because, on CD1 and CD2, why not? My strange CD-1 pain was almost absent, but CD1 was rather bad, with burning pain inside my buttocks for a couple of hours. Weird, my dear body, isn’t it? Today I went for the MRI, and last week H did another SA, so we should be getting some results this week. I hope that they’ll be good or, at least, not too bad.

HSG vs. lap

As nothing has happened in a year, although I seem to be ovulating and the LPD is successfully corrected, my doctor suggested to

• re-do the SA, as the period of rest before the last one was too short (they did it immediately at the appointment, which we hadn’t expected), and we don’t know if/how this affects the results — maybe my poor husband is worrying about his sperm quality for no good reason. And the guy doesn’t need more stress than he already has.
• check whether my tubes are clear. And there are two ways to do that, HSG or laparoscopy. The advantages of HSG are that it’s less invasive, no stay in the clinic or general anesthetics needed. However, while it can show that the tubes are clear, it cannot show whether they work correctly, i.e., whether the cilia properly transport the egg towards the uterus* (and, I think, the sperm towards the egg, though that seems contradictory). To evaluate that one needs a lap. And, apparently, clear tubes without the proper movement are about as unhelpful in conceiving naturally or via IUI as blocked tubes. Therefore the doctor I saw in winter recommends a lap. My doc here was less convinced, and said that it depended on what we’d do with the results. A worst-case scenario for me could be that they find the tubes full of endo**, which would make passage almost impossible, or if an egg and sperm meet, it would likely lead to an ectopic, so that we’d need to do IVF for a reasonable chance at (a sustainable) pregnancy.

However, we’ll move next year. Out of the country if not the continent. So we weren’t planning to start any major treatments before that, but keep trying naturally and do tests to make sure conditions are good, we’re not overlooking something “obvious” such as blocked tubes. Based on this, I said we probably wouldn’t do IVF immediately, and then an HSG might be the better choice.

Until I (almost accidentally) read what IVF costs in my home country. About 4k. Insurances even pay 50% for the first 3 rounds, but alas, I don’t have insurance there. I still have to find a good source, but I think costs are similar here… and on the other hand, where we’re likely moving it’s around 10k+. So we could have 2.5 chances at home or here for the price of one chance there…

So, I’m back to considering the lap. Yet somehow, and despite desperately wanting a baby, I don’t feel ready to move to IVF. I’m not even sure why. I think in part I’m afraid of the investment, emotional and financial, with a rather high risk of having nothing to show for it. And if the first round doesn’t work, I’d likely have to stop for the move, although the doctors would just be getting to know me and my body’s reaction to the meds and thus maybe have better protocols for the 2nd round. Maybe I also want to give us a little more time to work this out naturally, but I do want to make sure that everything is in order, so the tubes and the sperm will certainly be checked after the summer. Unless I get pregnant before that… although to be honest, right now I don’t believe I will.

Does anyone have advice on HSG vs. lap, perhaps especially with a history of endo?

* Here’s a video showing lots of information you probably know anyway, but also some cilia movement. I saw someone show videos of functional (coordinated) and non-functional (random) cilia movement in a talk recently, but cannot find it online.
** I have no symptoms though. Yay for that!