New Insight

I had an appointment today with Dr. Glatstein, my reproductive endocrinologist. I wanted to have a checkup with him to see what our plan would be for future kids and to go over what happened in the cycle with the twins. And now I know what happened...

First of all, of my eight eggs, here is what happened to them. One of them did not fertilize, two of them divided before being fertilized (it's a meiosis thing), three of them fertilized and then became multinucleated (this means that there is more than one nucleus in a cell, and the doctor will not transfer or freeze these type of embryos because of the high rate of miscarriage and abnormality), the last two are the ones that continued to divide and are now The Twinners. The doctor suspects that I have an egg quality issue which has been causing our problems. Why a perfectly healthy 26 year old should have egg quality issues, I don't know. But it is what it is and the doctor would not change our protocol at all (except for a minor change in medication because of what my insurance covers). He does not recommend doing any other kinds of treatments first (like IUI or clomid), since IVF is what worked and we think that there may be this minor egg quality problem. Also, he doesn't recommend ICSI or PGD because the eggs didn't seem to have problems fertilizing...only one of the available eggs didn't fertilize (the two that divided early weren't available so they don't count). Also, we don't have any known genetic issues, so there's no reason to do PGD. Also, we both agreed that we're only transferring one embryo at a time since I'm not allowed to have twins again. In order to make me feel better, though, we're going to freeze anything that's still cleaving (growing) on day 3 and I'll get to help choose which embryo to transfer based on how all of them are growing. Of course then I asked him if it would be possible for us to get pregnant on our own, and the doctor reiterated that it would be possible. It's a statistical thing...if I have decreased egg quality, there's just less of a chance of me getting pregnant in any given month (say 5% instead of 20%), and there's a higher chance of miscarriage if I develop one of these multinucleated embryos. That may explain my miscarriage on my first IUI! Anyways, I like now having some type of diagnosis and knowing what my next steps are. I need to have all of my testing done again (blood tests, semen analysis, SHG), and then I can start a cycle whenever I want. It most likely won't be for a while since we want to put about 3 years in between the twins and another baby and I'll want to try to plan for a delivery when it won't interfere too badly with school, and we'll get a chance to try on our own for a while. Then, if the statistics just don't go in our favor, we can start in on an IVF cycle when we're ready.

In other news, in case you hadn't noticed, TODAY IS THE TWINS' BIRTHDAY!!!! HAPPY 1st BIRTHDAY!!!!!!!!!!!!!!!!!!!

Pregnancy Plan

So, we saw the RE today and here is the plan. First, I have already started taking Dostinex to lower my prolactin level and I will continue on that med until I get pregnant. Second, I'm going to start on 25mg of Clomid next month and they will monitor my endometrium to make sure it is not too thin. I'll also have an HCG shot to force my body to ovulate once my egg(s) and endometrium are ready. If that doesn't work or if it makes my endometrium do bad things, then we'll go for the injectibles and possibly IUI as well. Hopefully I'll be pregnant this cycle and won't have to do Clomid! (Wouldn't that be awesome?!?)

My Rabbi ROCKS!

So, I had an appointment with a new RE (who is totally amazing) at the beginning of the week. This is someone who my Rabbi trusts. The doctor ordered some more tests for us and said that we do need to get a semen analysis. Then we just had to wait for him to speak with the Rabbi...and then...today my Rabbi gave the ok for us to make the appointment for the S/A!!! So, that's going to be done on Tuesday and I'll update here with the results when we get them. Until then, I'm in the TWW and hoping that I'm pregnant now. :-)

Reproductive Endocinology

I had my first visit with a reproductive endocrinologist on February 1st. Even though it has only been about 6 months of TTC, my OB/Gyn diagnosed me with PCOS a few months ago and my periods have been very irregular. He had me do some blood work at that point to see if I really do have PCOS and we met with him again yesterday where he did an ultrasound. Here is what he found:

My right ovary seems to have the classic PCOS look (ring of pearls). It also appears that I ovulated recently. YAY! Based on my symptoms, blood work and this ultrasound, he confirmed that I do have mild PCOS and should continue taking Metformin as I had been prescribed by my OB/Gyn. We decided to keep trying on our own for a few months, but we can always go back if we're not successful soon.

And here are the results of my blood work:

• FSH - 7.51
• Estrogen - 38.7
• LH - 17.8 (this is high from PCOS, because I was only CD 7 when it was drawn and not close to ovulation)
• Progesterone - 0.673
• Prolactin - 10.2
• TSH - 1.83
• Free T4 - 1.53
• Total testosterone - 85.3 (anything above 82 is high, and this is down from 111 in December, so it looks like the Metformin is working)
• DHEA-S - 391

Hopefully the Metformin will continue to bring down my testosterone levels and will help me to get pregnant soon!

RE Follow Up

I had a follow up appointment with my RE today (my first appointment was background and getting bloodwork done so I didn't post about it). We did an ultrasound which showed that my right ovary has signs of PCOS and my left ovary showed that I ovulated. :-D The ultrasound coupled with my bloodwork points to very mild PCOS. Since I'm ovulating relatively normally, the doctor says that I can stay on metformin once or twice a day and that I have the option to do clomid if I feel I need to. Also, if I'm not pregnant in a few months he can do monitored cycles as well.