Well, so.

November 21, 2008 at 11:55 am (Uncategorized)

I saw the doctor today. And though as I write this I am tormented by superstitious thoughts telling me not to write anything down for fear of jinxing things (before you read any further, don’t get the wrong idea, I AM NOT PREGNANT), I am trying very hard not to entertain those kind of useless thoughts, because I want to share with you. I need to talk about this.

I am feeling optimistic. The doctor came in shaking his head and chuckling to himself. He said, “Well, you are certainly an interesting patient.” He also said, “You definitely seem to have some receptor…”

“Problems?” I suggested helpfully.

“Problems.” He said. I worried.

So here’s the deal: he doesn’t know why the hell I produced so little progesterone after ovulating, but he does not seem to be questioning *whether* I ovulated–he feels he confirmed that with the ultrasound. He really was just shaking his head at the whole progesterone thing. I told him I thought I had had decent progesterone production in at least two previous cycles: one because I had it measured, and the other because I had a temperature rise AND because I got my period before I stopped taking the endometrin, which suggested to me I had my own drop in progesterone that brought on the period. He said those things could have happened even with very little progesterone, so that didn’t tell him much. He did think that perhaps I started producing my own progesterone in this cycle, for two reasons: (1) because the 10.1 level I got after starting the Endometrin was high for Endometrin (as I said before, Endometrin doesn’t tend to raise blood progesterone level by much, which means I must have been doing that on my own), and (2) it took several days for me to get my period after stopping the Endometrin–he said if I had no progesterone of my own my period should have started immediately.

He told me he DOES think that my having had so little progesterone in the first several days after ovulation COULD have caused me not to get pregnant this time. I told him I was unaware that progesterone mattered that much for implantation, that all I figured was necessary was that the lining be there and then you start taking progesterone after a few days to make sure you don’t shed the lining prematurely. He said no, the presence of progesterone, even some right away after ovulation, is involved in the timing of implantation. He said that it’s not that this is not correctable–it is, and they do this sort of progesterone supplementation (like, immediately following ovulation or whenever ovulation would otherwise occur) with frozen embryo transfers and donor egg cycles, where the woman is not ovulating and so needs to have all her progesterone supplemented. He just thinks it’s strange that I didn’t produce progesterone normally; he just doesn’t understand why my luteal response would be so weird. He feels it was necessary that we know that I need this kind of correction. But he thinks that if we start up with the progesterone right away, that should take care of the problem (or help, at least), along with monitoring my progesterone carefully during that period.

He also said that he likes to have two “good” ovulatory cycles and he doesn’t consider the one we just did “good” because of this progesterone problem. So we’ll do this at least twice more.

I also said to him, “Look, I know you said that you’re not sure any of those prior cycles were any good because of how long they were and everything, but I can’t help but feel like I have had six cycles now, and feel discouraged by that number.” He said, “I can’t tell you that you can’t count any of those. I don’t know what happened in those. But I also can’t tell you that they were good cycles either. So we just have to try this a few times.” I appreciated his honesty, and even though I sort of wish he had said, “Those were crap cycles and they don’t count,” I’m sort of glad he didn’t because I wouldn’t have believed him if he did, and I would end up just trusting him less. It’s just common sense–those other cycles MIGHT have been good, we just don’t know.

I will say this: I am so, so glad that we are looking at all these different factors. With the old doctor, Dr. R, I would have just done the same thing thirteen times, or until I couldn’t stand it anymore and threw up my hands and moved on to IVF. She was never going to adjust her plan for my follicular response, for my luteal response, etc. She never would have even looked at my progesterone if I hadn’t bugged her to prove I was ovulating. Or, who knows? Maybe she would have. But five cycles in, she was convinced we were doing everything right and should just keep trying. And maybe it would have worked eventually. And maybe the current Dr. M is on a wild goose chase right now, trying to figure out what kind of random things might be wrong with me and they’re all a bunch of dead ends. Except that it seems pretty clear that there is more going on here than just bad luck. Except that’s kind of what it all comes down to, doesn’t it? Bad luck.

He said, of course, we still don’t know for sure things like whether my tubes are even picking up the eggs I ovulate. And that’s something we won’t know for sure unless I get pregnant without doing IVF. I have never heard of that happening before, the tubes not picking up the eggs, but it certainly seems plausible. I sure hope it’s not true. I also asked him about my eggs, worried they might be of low quality, but he said they are “young” and therefore should be fine. I sure hope that is true. I sure hope I get pregnant this time, or the next. I’m ready, guys. And this progesterone thing sounds promising. I just hope it’s not a wild goose chase.

If it is, it will probably be time to move on to IVF.

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2 Comments

  1. daan said,

    I’m so glad he addressed the progesterone issue. I was really curious about that. I have a few friends who have to take progesterone supplements prior to their IUI’s – sounds like you may need to as well.

    Man, I wish you and Dr. M had hooked up a while back. Take some comfort in knowing there are still some things that need to be “worked” on & you’re not at the “end”….which is where I *think* you were at w/ Dr. R. KWIM? Because of his honesty, I think if he truly felt IUI would not work – he would tell you.

    Fingers crossed.

  2. Mel said,

    I am glad he’s being so proactive instead of just trying the same thing over and over, that’s really good. If one thing isn’t working, you HAVE to mix it up and try new things or add in other meds. I always started my progesterone within days of my trigger shot… I cannot remember exactly how long it was, but it was probably like 48 hours. And I was taking oral and suppositories for whatever it’s worth.
    I am also glad to hear you have some hope! You fall down and you pick yourself back up every cycle. It’s what you have to do, it’s the only way to survive. That desire to have a baby keeps kicking your desire to avoid failure square in the ass and that’s the way you get by.
    You’re in my thoughts and prayers as always. 😉
    *bighugs*

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