The Shortest Day in the Year

Happy Winter Solstice, everyone!

If I have any fellow Great Gatsby fans out there, you know that Daisy wants to plan something to celebrate the longest day in the year. As I’ve gotten older, not only has the “shine” imprinted by my high school English teacher on The Great Gatsby worn off, but this detail in particular seems more and more silly.

Sure, at first glance it seems like something you’d want to celebrate… until you realize that every day after the longest day in the year gets shorter and shorter, darker and darker… Now, the shortest day in the year, on the other hand, that feels so much more optimistic to me these days. Starting today, and for the next 6 months, each day will be a little longer and a little brighter than the one before. And thanks to the appointment we had yesterday…

we have a little more reason to celebrate!

At 10am yesterday, Jason and I had our first appointment at the Wake Forest Baptist Health Center for Reproductive Medicine. We saw Dr. P and her current resident. LOVED Dr.P, not so crazy about the resident. But hey, he’s learning, right?

We spent the first few minutes updating our medical records, insurance, and all that fun stuff, then hung out with one of the medical assistants while she got my BP, height, weight, and entered my family history into the system. Then, we chatted with the resident for about 5-10 minutes.

It seemed like it might have been one of the first times he was sent in to talk to new patients alone. He definitely lacked good “bedside manner” and he also lacked the details of our situation. He’d taken notes before he came in, but they were incorrect. He was mistaken about the time frame for the miscarriage and thought I’d had a D&C… two strikes, buddy! He seemed a little more interested in the Strabismus in Jason’s eyes and Jason’s family history of Myasthenia Gravis – granted Jason gets very excited talking about his eyes – than he did about anything going on with me. He zeroed in on our exercise routines and on how much biking Jason typically does (not a lot, currently). He didn’t seem to recall my polycystic right ovary and seemed to confirm that our visit to the Center for Reproductive Medicine was relatively early in our fertility journey. We know this and are thankful for it, but we wouldn’t have been there without the referral. Ultimately, he circled back and asked how long we’d been married… interesting order of questions. But like I said, he’s learning. As we say in the south, “bless him.”

When he left the room, Jason looked at me and said, “you don’t like him, do you?” Geeze, was I that obvious?

Then, Dr. P came in… she was WONDERFUL! Very warm, caring, and knowledgeable – and good at communicating/educating us. I felt like she “got me.” She talked through all of the numerous things that have to go just right in order to even get pregnant, and that even normal, healthy couples only have a 25% chance of getting pregnant each month. Infertile couples only have a 2-3% chance without assistance, that jumps to about 15% with drugs and planning, 20% with insemination, and IVF for people my age is around 70% effective (Wow! But that doesn’t come without the chances for multiples, as many as quads or quints!). Infertility is caused 40% of the time by female factors, 40% by male factors, and 20% of the time the cause is unknown.

She agreed that, right off the bat, we know one barrier is my lack of ovulation – which hasn’t happened in about 7-8 months, even with Clomid. She talked about PCOS, but that I don’t really fit the stereotype for that. She talked about another disorder (I’m currently blanking on the name) that can be caused by high levels of exercise and a lack of estrogen getting to the brain to stimulate ovulation. I more fit this stereotype, but the fact that Provera has worked for me in the past contradicts this (Provera requires estrogen to work). So… I’m somewhere in the middle.

Either way, she seemed confident in being able to work around all of these obstacles with various techniques, and planned to put me on Femara – a drug that, like Clomid, stimulates ovulation. Her plan is to be much more scientific about things and have me come back for ultrasounds throughout the process, so we can watch the ovaries get stimulated, watch the eggs grow, predict the exact time frame of ovulation, and actually give me a shot to spur that ovulation. Crazy! Awesome! Oh, and she said that we’ll never try the same thing for more than 3 months – if it didn’t work the first 2-3 times, it likely won’t work times 4-10. This Type-A girl was loving it! She also wanted to go ahead and do an ultrasound to check things out for herself and possibly some blood tests to check my hormone levels.

We saw the most exciting thing on the ultrasound that we’ve seen yet!

And no, I’m not currently pregnant (sorry for the buzzkill).

We saw a highly developed follicle on my right ovary which indicates that I may ovulate on my own this month! She predicted within the week. Wow! I didn’t think we’d hear that. That means we have some “homework” this week, as she put it.

Other good news from the ultrasound included the statement “your uterus is BEAUTIFUL!” (ha!) and a normal/high antral follicle count (AFC) – 10 on one side, 12 on the other. After seeing all this, Dr. P was even more confident in being able to get us pregnant! I also LOVED that she was the one who did the ultrasound, not a different sonographer. This allowed her to look around and get the answers to all the questions she had.

Of course, seeing that I may ovulate on my own changes the plans slightly. We are to do our “homework,” and if I don’t get a period in the next 3 weeks, that could be a really good thing… or not. If not, we’ll get to work on the Femara, hormone levels, and more intense monitoring of the situation. I’m trying not to get too hopeful for this month (because again, all things normal… it’s only a 25% chance), but it’s hard not to (then again, 25% of pregnancies end in miscarriage… I’ve already been a part of the 25% once, why not now?)!

While, it didn’t really seem to make sense to interrogate Dr. P and her resident, here’s what I gather about the questions I had going into the appointment…

General questions:

  • What’s our outlook? How hopeful should we be?
  • On a scale from 0 to 10, where 0 is the worst case you have ever seen – a couple who will not conceive, and 10 is the easiest case you’ve ever seen – you are confident that there won’t be any real trouble and the treatment path is clear, where are we?
  • We know cysts are an issue, but will we look for any other issues, hormone levels, for example? How do we balance treating the problems that we know exist versus learning more about things we haven’t checked yet?

It seems that we have every reason to be pretty hopeful and optimistic. Dr. P confidently said “we’ll get you pregnant,” and I plan to hold her to that!

They also seem open to exploring other issues. Jason is to have a semen analysis after the next few weeks of “homework” are complete and her interest in monitoring my hormone levels and doing a dye test to see if my tubes are open is also comforting (if a little anxiety inducing…).

Questions about my left ovary:

  • Is this ovary even working? (It definitely hasn’t done anything since May – the pregnancy resulted in ovulation from my right ovary)
  • Is it 1 or 2 cysts?
  • What type of cysts?
  • How long have they been there?
  • What do we do about these cysts?
    • Is surgery necessary?
      • If so, what does that timeline look like? When? Recovery? Try again?
      • If so, how likely is it that I retain a functioning left ovary?
      • If not, how do we treat them?

I do still wonder if this ovary is actually working. It showed a high/normal AFC, but again it’s my right ovary that is about to ovulate. I’ll be bringing this up in the future.

She still wasn’t completely sure if it was two separate cysts or two cysts that had joined together. They are likely with dermoid or endometrial, but dermoid is more likely since I’m not in pain.

Also, since I’m not in pain, she would rather not do surgery, as that would likely do more damage to the good eggs I have on the left side. At this point we just monitor them. She also talked about potentially doing a dye test in the future (which I’ve heard is super painful) to make sure my tubes aren’t blocked (yes… one of many other things that can get in the way!)

Questions about my right ovary:

  • My understanding is that the state of my right ovary is less-concerning than my left, is that correct? Why?
  • Why would this ovary have become polycystic after the miscarriage?
  • How do we treat the multiple cysts?
  • How does this treatment work with the treatment for the left ovary?

The right ovary is definitely less concerning than the left, seeing as how it is potentially about to ovulate and didn’t appear to be polycycstic in the ultrasound.

Questions about my most recent period:

  • I took Clomid during days 3-5 of my last (November) cycle, had bloodwork on day 21 which indicated that ovulation had not occurred. Then, I took 3 days of 10mg Provera on days 25-27 (stopped because I was told not to take Clomid and figured it didn’t matter), but I subsequently started on day 31 (1), 4 days after the last Provera (on a full 10 days of Provera, I get a period ~2 days later).
    • Did I get the period from the limited Provera?
    • Could the Clomid have actually worked and the period/ovulation was delayed a little longer than expected?
    • Does this cause us to question anything about my progesterone levels or anything else?

She thought that most likely the recent period would have been brought on by the Provera. 

Sorry for the long post… with that we’ll get to work, try not to get our hopes up, and look forward to a Merry Christmas.

TL;DR: Good news at the Wake appointment! Liked the doctor. May ovulate on my own. Have a back-up plan in case that doesn’t happen. Many reasons to celebrate and be merry.





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