Fertility Update: He Said IVF

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He said IVF

I’ve been sitting on this for a full 24 hours, and it still feels like a jumbled mess in my heart and in my head, but here it goes: a recap of our 2nd-ever RE appointment on 6/5/2019.

Our RE yesterday was exactly what I hoped and prayed for. (My prayer was for attentive and empathetic care team because I just can’t deal with healthcare workers brushing off their patients and making them fight for the care they need.) He started the appointment by looking me in the eye and telling me, sincerely, “I’m so sorry you’ve been through this. And so many times,” then, without breaking eye contact, gave space for my response, a meager “Me too” with tears welling up in my eyes on this day I had bravely worn my favorite dark chocolate mascara.

Genetic Karyotyping

He apologized that the precertification for genetic karyotyping hadn’t been submitted to my insurance back in March and had already submitted it before walking into the consultation room. We’re waiting for the final word on that before going ahead with karyotyping, but he explained it should be covered because recurrent pregnancy loss is considered a medical condition (ūüė≥), “So if you have maternity care through your insurance, this test should be covered.”

He PROMISED he would call with the answer from the insurance and– if insurance doesn’t cover it– the cost of the test “because the last thing I want to do is to surprise you with a huge bill on top of everything you’re going through.” After waiting and waiting for no phone call from our last RE about karyotyping or any of our test results, I’m holding him to that promise.

He explained that we want to test for things we can treat.

Before he could finish his sentence, my heart dropped as I thought, You can’t fix genetic issues.¬†I assumed that meant he might not want to do the test after all.

“And this is something we can treat.” Hope again, and then…

IVF

IVF. I clenched my jaw to maintain composure. After nearly 3 years trying to conceive our firstborn and now having two babies 21 months apart with a firm refusal to ever see an RE in those 3 years and a little help from nothing more than Softcups and baby aspirin, this felt like a gut punch. It felt backwards. I felt like an imposter. After all, we hadn’t really been trying yet for a third baby and now IVF is part of the conversation? After conceiving naturally three cycles in a row?

I don’t deserve this care. No, no. Don’t make such a fuss. Please, don’t spend your time and resources on me. I don’t deserve to be taken this seriously. I haven’t earned it yet. I don’t rate. It’s not that¬†serious… Is it? Is this really what it’s come to?

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If the genetic karyotyping revealed that my husband’s and my genes were at high risk of combining to form babies with genetic issues incompatible with life, the treatment option would be IVF with PGS testing. (Well, he didn’t use the term “PGS testing” specifically, but I knew that’s what he was describing.)

I honestly hadn’t done a lot of research on this aspect of infertility, but being in the infertility world for so long, I had put together that this might be a treatment option for couples who had experienced recurrent pregnancy loss due to genetic factors. It made sense scientifically, but emotionally and financially, well, I just can’t even go there right now. We’ll see what the test reveals.

HyCoSy

On my next CD1– the first day of bleeding of my first post-miscarriage period– I’m supposed to call to schedule a HyCoSy (hysterosalpingo-contrast-sonography), which is apparently the new and improved alternative to an HSG (hysterosalpingogram). It doesn’t X-rays, which is awesome because X-ray radiation is cumulative over your lifetime, and the less X-radiation the better, especially when the exposure goes directly to your sensitive eggs! ¬†In my case, they’d mainly look for congenital defects of my uterus, which can’t be seen on a traditional ultrasound exam. If they find any abnormalities, there is an option for surgery to correct it so future babies have a healthy uterine lining on which to implant.

From my patient information sheet:

HyCoSy is a simple and well-tolerated outpatient ultrasound procedure used to assess the patency of the fallopian tubes, as well as detect abnormalities of the uterus and the endometrium (uterine lining). The test requires the use of a contrast agent (agitated saline/air mixture). The HyCOsy procedure is a safe and reliable alternative to the conventional HSG which uses X-rays. No radiation or iodinated contrast material is used for the HyCoSy test.

A normal fallopain tube is not seen with regular ultrasound. The HyCoSy procedure allows integrated assessment of the fallopian tubes, the uterus and endometrial cavity, and the pelvis.  The doctor will [also] be looking for problems such as endometrial polyps, submucosal fibroids, and congenital uterine abnormalities (such as a uterine septum).

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Progesterone Suppository

Finally, progesterone suppositories. I didn’t even have to ask about this, which I know is not the case for everyone, so we are incredibly fortunate.¬† He told us there is a chance we might fall into the 50% of cases without explanation for recurrent miscarriage, in which case, he’d recommend progesterone suppositories. He said it wouldn’t hurt to take them regardless of my progesterone levels and that he’d seen several cases of unexplained recurrent miscarriage have success with progesterone support.

There are hormonal and emotional cons. He explained that taking progesterone can give symptoms that mimic pregnancy symptoms that sometimes messes with patients and said if I was okay with that, he could prescribe it. It only took me a second to decide that yes, I could handle this and that it might actually relieve me from symptom spotting because I could blame any pregnancy-like symptoms on the progesterone. It might actually give me a nice mental break. He then prescribed progesterone immediately and said I could start taking it at ovulation THIS CYCLE (before my first post-miscarriage period)! He believed me when I said I could detect ovulation without OPKs and also believed me when I said my 4-week losses were miscarriages, which felt validating and empowering.

Related: Diaries of a First-Time Progesterone User

I decided not to ask about this but wanted to mention here that my progesterone level was 0.7 on 5/24/19, the day I started miscarrying. I don’t know much about hormone levels, especially not progesterone, but I thought that seemed low considering I still had HCG in my system (a level of 7) and that I hadn’t started bleeding yet. I did start bleeding late that night, but I’m not sure which came first: the low progesterone or the miscarriage.

I did ask if it would be beneficial to test all my other hormones or to track them at different points in my cycle, but he said the one he’d be worried about is progesterone and that we were already taking care of the preventatively with the progesterone prescription. 400mg Prometrium suppository every evening beginning right after ovulation.

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Anthony’s Thoughts

Anthony pleased himself by how well he was able to keep up with the conversation with the RE! After we got home, I sat down and asked where he was mentally and emotionally with trying to conceive. We began the year just wanting to reclaim our sex life and see what happens, but three miscarriages later, it was time to be more intentional. I told him I would have to be more intentional with tracking my cycle if I was going to start taking progesterone at ovulation and that that would make it difficult to stay out of the TTC mentality. He understood and agreed with me tracking my cycle to prevent another miscarriage. Ultimately, he was comfortable with whatever I was comfortable with. I asked him, “Sooo, are we trying to conceive,” to which he replied,

“Sure?”

“Totes bagotes.”

“You got it, baby doll.”

“Just tell me when.”

“I’m in.”

He grunted and pounded his chest.

Just kidding. I procrastinated on documenting Anthony’s thoughts and totally forgot the wording of his response, but basically, it was a confident, “yes.” So we’re trying now.

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