Today's Doctor Visit

Good evening,

Well, hubby and I went to our appointment today and what the doctor said was at all not that bad.  When we went in he said he have been reviewing my records/labs and he wanted to touch base on how to proceed given that I have gone thru 3 treatments.  He again explained that when he ran my labwork in June the level of my Antimullerian Hormone (AMH) was at 0.3ng and the normal level should be between 1ng and 6ng.  What this hormone does is it measures my ovarian reserves.

I looked it up online and this is the description it gives:
AMH is a protein hormone structurally related to inhibin. It too is expressed by the granulosa cells of the follicle in the reproductive age and controls the formation of primary follicles by inhibiting excessive follicular recruitment by F**** therefore has a role in folliculogenesis. Substantial evidence exists that AMH levels correlate better with ovarian reserve then either FSH or Inhibin and research on AMH continues. At present, if used clinically, the interpretation of AMH levels should be performed in the context of other clinical measures. The normal range for AMH is .41 ng/ml - 6 ng/ml.
(I got this information from this website: http://www.fcionline.com/fertility-preservation/infertility-age.html)

Then he went onto explain that it takes approximately like 84 days for a little little pin to become a full grown follicle in order to be fertilize. 

He said that apparently I had a good response to the treatment, but however not always does it result in conception.

He then explained that there are 3 options to consider:

1) Try the treatment on another cycle but he wasn't sure if that will make a huge difference

2) Try a treatment that he said many doctors don't use lately because of the high risks associated with it.  He explained this treatment is bypass the Lotrizole/Femara and go straight to injectables from CD2 to CD 7/8.  However, this approach is very risky because there is a very high risk for multiples , 3, 4, 5, 6 and they can't be controlled as to how many there will be.  He also went to explaining other complications that may arise from it including Ovarian Hyperstimulation Syndrome (OHSS).

3) IVF - he said we could also decide on going to IVF where they would use my eggs and hubby's sperm and mix them in the lab and they can clearly see how the 2 interact and how the embryos result.

4) Last option-ultimate option... donor egg

I asked him about switching meds on the treatment.  He said he could change the femara to Clomid that some women react better with the Clomid but with the injectables he said that the other one has no change in its pharmacology head to head they are the same.

He said 2 factors in my case are sort of working against me: 1) age and 2) weight
He said with the age we can't really do anything about it of course, but with weight he thought it would be helpful if I try losing more weight.  He said he honestly understand what I have gone through with the weight loss, the gastric bypass..that's something close to his heart..he has a niece who had gastric bypass and his father died due to complications of obesity. He knows it's not easy.

He did recommended me a medical supervised clinic where they give me a rigorous plan and I can lose as much as 17 lbs in a week then every week little less but he has had patients and a personal friend of his who have lost a tremendous amount of weight fast and have kept it off.  If we would be interested in that.

Hubby asked if we decide to pause for now and concentrate on my weight loss and exercise if we were to lose opportunity in waiting longer.  Dr said that losing the weight will certainly help and make it easier to what we want to accomplish.  He advised us not to hold off for more than 6-8 months.

So, we decided to take a break for now...since fertility meds are expensive and focus on my weight loss.  I came out of there feeling great.. very motivated and positive, thank God!!!!!
Today I ate very very good... I had a protein bar for breakfast (20g) protein, then for lunch I had a salad with lean turkey slices, snack I had Greek yogurt with pineapple.  For dinner I had a hamburger patty about 3.5 oz with low fat cheese and some ketchup.  After dinner, I went to a 1 mile walk with my dogs.

I am going to go back to working out like I was before....like 6-8 months ago.. I was working out 6x/week for 1 to 1.5 hours.. combination of weight training and walking.

For food.. I just have to go back to what we are supposed to eat... no junk food, no more chips, no more snacking junk... I am also going to hold on carbs.. eat some maybe 1 or 2x a week but that's it.

I am going to see how I can do on my own since we have the tool of the gastric bypass and I know with me the exercise is key.  If I don't see that I can lose a lot, I might consider the clinic...it might be what I need to catapult me for that extra 80 lbs that I need to lose.  I don't know if the clinic have had gastric bypass patients in the past and I am going next week for the free consultation to find out more about their program.  I don't lose anything to check it out.  Obviously, I won't lose 80 lbs in 4 months... but would be nice if I could lose like 50 lbs.  Also, the Dr is not going to hold me "hostage" if I can't lose sometihng like 50 lbs in 4 months... he understand that this is hard.

Ohhh!!! I almost forgot.... I asked him how does my PCOS affect in the whole picture here..he said according to the labs he has ran my levels of FSH (I think it is.. not sure) are normal and I don't fall under the PCOS category.  I was SOOOOOO happy to hear that.... I didn't know 100%.

I then asked him if it could be the Fortamet helping that the endocrinologist has be under to help with ovulation.  He said that the Fortamet might be helping with the ovulation, certainly, but that I really don't have the PCOS.

I was so thrilled... I can't even describe it.  I have heard that PCOS could be eliminated with surgery but it was not 100% guarantee.

Anyway..... so today was my day 1 of starting back strong on my weight loss efforts... tomorrow I plan to get up at 6am and work out for 1 hour at least... between weight training and 1/2 hour walking with doggies which they keep me at a quick pace.. they are 2 mini doxies but mainly the male one thinks he is a greyhound. 

Just wanted to give you all an update.... so there is light at the end of the tunnel..

Plan is to concentrate on losing more weight in the next 3-4 months, try Clomid, injectables for the next round or two and if that doesn't work, then we might do IVF.

We'll see....

Thank you all for your comments, suggestions, words of encouragement and understanding.  I love this board!!!

:-)

About #2 -- It is actually a treatment RE's use that ALL.THE.TIME. Injectables WITH IUI. Yes, there is a risk of multiples, but for a woman who cannot get pregnant in the first place, the risk is not that high. AND, you should be monitored every few days, so if you have more than 3 or 4 lead follicles, they can cancel the cycle. They can adjust your meds to get the optimum number of follicles. As for OHSS, it really is RARE and not usually on just injectable/IUI cycles. You see it more on IVF cycles.

And with regards to your weight...are you ovulating? The #1 reason weight is a factor in preventing pregnancy is because many obese women do not ovulate. As long as you are actually releasing an egg, I would take this with a grain of salt. Fat women get pregnant every day (those that are ovulating).

Your AMH is low...and you may eventually have to go do to donor egg. But, they are VERY VERY expensive. So, it would be worth it to try an straight injectable / IUI cycle first and possible a straight IVF cycle just to give it a chance. To this point you haven't even done IUI, so in my opinion (and I know my fertility treatments), the cycle "attempts" you have had until now have been half assed. I am not telling you this to make you feel bad -- I am trying to be realistic with you.

I am assuming this was an RE. Your RE needs to be more aggressive with you, or you need to find a new RE. Again, I am sorry I am not full of lollipops and rainbows, but I know you want to have a child -- you need to do everything possible to make that happen.

And, on that note, I won't give you anymore advice...just know that tough love about the matter is sometimes what some people need to get going on the right track.

Ann,

Thank you for giving me your opinion and advice..this is the reason why I post in this board to get your input on this.    I saw your post last night I am seriously thinking about it.  I will talk to hubby about it tonight and see if we try option #2 and see how I react.  IVF I can't do just yet..his insurance doesn't cover that and I have to wait for the new insurance coverage that starts in January.

I am thinking also to get a second opinion with another RE.  Yes, the doctor is a RE. The doctor did not tell us to pause..it was something that hubby came up with and at the moment I thought it was a good idea. 

Honestly I am just tired of waiting and waiting to try to get pregnant.

I am just not sure what to do next.... I just got up, let the dogs out and I am going to workout now in the a.m.  I do need to get back in that habit anyway.

I asked the dr about IUI but he said that if a couple is having relations when they are supposed to within 24-36 hours of trigger, the IUI won't be much difference.  (Which actually now that I am thinking about it that doesn't make sense, otherwise why can't I get pregnant?)

I am so confused...........I really don't know what to do..... do we change our minds and do a cycle of injectables or do we seek a 2nd opinion????

Thanks....we have to think about it.

Yikes!!  If your doc told you that IUI isn't much different than if the couple is having relations, you need to RUN!  IUIs put the washed sperm up into the uterus, so that there are millions there waiting for the egg(s).  With normal intercourse, only the ones that make it in the fluid and through the cervix have a fighting chance.  Many women have gotten pregnant through IUI that were not able to successfully do so with timed intercourse.

Also, with IUI, you should be triggered, so you know nearly exactly when your egg is going to release and so the placement of the sperm in the uterus can be timed much better.

Another thing to think about -- if you aren't triggered (not sure if you have been for the last three), usually only the lead follicle will release.

Good luck.

Hi Ann, thank you so much for giving me so much info. It really helps. Yes, that is what the dr said about how a IUI works. I asked my hubby this am about what dr said and he said that what the dr said was that IUI will work better for couples where the hubby has motility issues, low sperm count and problems. Then he went over hubbys results again and hubbys soldiers are average and/or above average in some aspects. In my case, he prefers going to IVF.

He did say that we could do couple of more rounds w Clomid. Again, I want to emphasized that he did mentioned that overweight women do get pregnant every day and he never mentioned to stop treatment.

This was a decision that hubby and I took. I think hubby thinks it might be good to take our minds off for a few months. I think it might be a good ifea. I might be more relaxed and losing even if it is 20 lbs it will help anyway.

I know God has a plan for us and it will happen when He want it to happen.

However, I just might consider getting a 2nd opinion, it wouldn't hurt.

I did wal yesterday a mile w/dogs and today 1.5 miles in 25 mins.

I will keep you posted.

You already know my history and etc. I have kept up by reading your updates. I just wanted to say if the issue is you, IUI might help. We weren't getting pregnant and hubby's sperm wash was great. Our RE doesn't mess with meds unless you do IUI. Why go through with all the injections/meds when you can help the process with a trigger and washed sperm right up to the right place.

Obviously, this is just advice and you have to do what you and hubby feel is best with your physician. I wouldn't spend any more money on treatments without IUI in the mix.

Best of luck!!
Traci

I THIRD the ladies above.   I'd go for the IUIs w/drugs WHILE you are following your stricter weight loss plan.   Why can't you do both???    Most insurance plans pay for IUIs; you might have to pay for the drugs though.   The only addition in the process is the inconvenience in time for the ultrasounds and the actual timing of the insemination.   As Ann said, the ultrasounds will inpoint exactly when to do the insemination within a 6-12 hr. window so it is NOT the same as "here, take the drugs and do it naturally".    And, multiples is rare at your age and with your ovarian reserve.   Quite frankly, following better food choices and exercise might increase your chances too as the lowered carb intake will help the hormones and certainly the exercise will help with the stress of the whole process.    I will say it gets tougher to do this stuff around the holidays so you might want to try one in the next 2 months before all that chaos starts.   The you can IVF come Jan/Feb.     Good Luck!!!  

I fourth everyone else's opinions (someone else already thirded it LOL) .  As Ann suggested...I'd strongly advise to get a 2nd opinion.  It certainly wouldn't hurt to do so.  Unfortunately, Ann knows a lot about the various fertility treatments...and what she's saying makes sense re the IUI.

If I were you, I'd combine the plan from DH and the IUI...Do the injection drugs and IUI...and do the weight lose/better eating/exercise.  Neither can hurt the other.  At least try it for two cycles and see what happens...then if you need a month off before the new insurance kicks in, as suggested by the previous person...take off December and/or January or so...then you can consider the IVF if necessary (but hopefully it wouldn't be necessary).

I do understand wanting to take a break...God knows I know how stressful the ttc process is and how that biological clock screams in your ear month after month, everytime AF comes...but I would severely limit any breaks that you take - maybe a month every 3-4 months...especially if they're telling you your ovarian reserves are low. 

Whatever you decide...I do hope you get your BFP and it's sticky as can be.

Thank you all for your advice... this is great advice... I really appreciate it.  Well, right now I think the best thing is to take a break and try to relax.  Anyway, either IUI or IVF is not covered under the plan right now...

Ann, I did forget to say... that yes, I was triggered the 3 times we tried...actually they doubled the Ovidrel in try #2 and #.

I will just think positive thoughts...

You never know what might happen during this off season from meds...

:-)