Visit to the Fertility Clinic and A New Plan!

This trip to the fertility clinic came a little earlier than we had planned, but as I wrote around mother's day, I felt strongly that it was time to look into testing, because sometimes testing itself can take months and months.  We don't feel ready to try pregnancy again quite yet, but we are ready to find some answers for the future.

I'm so glad I listened to this feeling, because as soon as we were talking with our doctor (who is amazing, brilliant, has probably a dozen degrees, and is a recipient of the "Most Compassionate Doctor" award) I felt like I was in the exact right place at the right time, doing what I should be doing.  It was a great comfort to me.

To start out with, after we had discussed my very LONG and detailed history, I was thrilled to hear him say basically "They've been focusing way too much on blood clotting factors, it might not have anything to do with that."  THANK YOU.  I have never actually had a blood clot, and with all the anti-clotting therapies I've done, I was feeling really discouraged and thinking there must be more to the puzzle.  He said they haven't even done the "normal tests" to determine what caused the miscarriage.  Granted, because of the blood clotting disorder he does want me to begin on a baby aspirin when we start trying to conceive as a precaution. Which is what I did with Jack and what I feel like is safest for me and a growing baby.  But I don't think it's going to fix any problems.

He said although it's possible that thrombophilia may cause problems with miscarriages, and he can't rule it out for me, he believes MOST of the time, Leiden Factor V does not affect the outcome of a pregnancy.  (Once again, thank you!  I think 11% of the population has this factor and many don't ever know they have it).  This is a very conterversial topic in the medical field, but when it comes down to it, I don't know what else we can possibly do with this issue.  I've done any treatment that would be used if this was the actual issue.  He said about the same thing for the low Protein C and S (although he wants to repeat that bloodwork and see if any activity has changed since my last two tests).

This brings us to the second blood issue, MTHFR (once again, this is not a naughty abbreviation but an actual diagnosis).  I told him "Well they ruled that out as causation because there were no clots and my homocystiene was not elevated when I lost the pregnancy"  He kind of shook his head and said while that might make sense from a hematologist's point of view, the problem with MTHFR is broader than that.  In a nutshell, this disorder is like an enzyme deficiency.  So when I take folic acid, my body can't really convert it into a usable form (which he called metafolin).

My other doctors compensated for this difference by having me take a ton of folic acid, but if I still couldn't convert it into a useable form, what was the point?  Everyone knows how important folic acid is for the start of pregnancy- without it the baby can have severe neural tube defects that can end the pregnancy very early.  My eyes widened as he was explaining this- could it really be that simple?  And then the real kicker- he told me that there is a prescription prenatal that contained 1 mg of Metfolin.  Meaning instead of taking crazy amounts of folic acid and trying to convert it, I can actually just take the active form.  HELLO?!  DID NO ONE ELSE IN THE MEDICAL FIELD KNOW ABOUT THIS?!  Did you know you can BUY METAFOLIN ON AMAZON?!  I feel somewhat annoyed that I didn't understand this concept (since I work in the vitamin field) and also that no one else explained this to me!  So he wrote me a prescription and told me to start on this prenatal right away, he wants me on it for several months (and even through my entire reproductive life).

Also, after reviewing my history, he has decided that I should continue with Progesterone supplementation in future pregnancies, but he will be prescribing double the amount that I used with my last pregnancy (thank you that's what I wanted before!).  My progesterone levels from previous reads during pregnancy were lower than he was comfortable with.  Thankfully, it looks like I will be allowed to use vaginal suppositories/pills instead of injections!  Yay!!

As far as my thyroid, it is being managed well for the most part, so I just have to stay on my daily medication.

So now we move on to all the other testing that they want to do to find problems and causes.
Unfortunately, before they can do any more testing, I have to have the Implanon removed from my arm (ACKKKK).  I expected as much because that form of birth control messes with all your hormones, etc.  I am dreading getting it out because it was so awful getting it in...but I knew it was going to have to come out at some point.  I need to have it removed, and then will have to wait at least 2 months (2 regular cycles) and then they can start the other testing.  I am looking forward to having the Implanon out though, it hasn't been the easiest on my body.  I have really felt the hormones affecting me.  I've gained weight on it and have felt more run down (and have had horrible unpredictable bleeding).  All of those things should get better once it's out.  I would love to lose some weight!  It does make me nervous to go off of hormonal birth control (just call me fertile myrtle) but I'm sure everything will be ok.

One of the first things he wants to look at is my egg quality.  Normally having poor egg quality is a problem with older women, but you never know, so we need to check it.  The same goes on Kevin's side, so the doctor wants to do a semen analysis to make sure there aren't sperm that have "bad DNA." Motility and those other kinds of problems with sperm aren't on our list because we don't struggle to conceive, just the DNA side of it.  Hopefully we can hold off on this test because it is more expensive, and there isn't too much you can do about it.  This test is further down on the list to be done if they rule everything else out.  If this turns out to be an issue, there are two options.  The first is using a sperm donor (we're not interested in that option) or you can just try to improve the overall health of the sperm hoping that they will provide good DNA packages.  So the Dr is putting Kevin on a special vitamin/amino acid supplement starting now, to basically make sure the sperm is as healthy as possible.  He needs to be on it for several months also.

Probably one of the first tests we'll do after the two month wait period is to rule out any problems with the anatomy of the uterus using a saline ultrasound, which they will use to evaluate the cavity and such.  This makes so much sense to me and I've wanted to do something like it for a while.  They will check for fibroids or any type of damage.  I always wondered about this because my first baby was over 9 pounds and the birth was really hard on me, and then I've lost all babies since then, could there be some type of internal trauma or damage?  I'm excited to get the results back from this test, because either way it will put lots of my questions to rest.  Not as excited to have the procedure done however...it's one of those they tell you is just "uncomfortable" but then offer you Valium if you want it.  Riiiight.

Then, of course, lots of blood work is required.  They want to redo some of my large blood panels to check them against previous results (like my antiphosphilipid one, protein c and s, etc).  They also want to do blood work to check certain hormones like Prolactin at certain points in my cycle. And they will check my blood for immunity to diseases I've had immunizations against.  If immunity doesn't seem strong, they may re-vaccinate me (unlikely, I've had all my shots and boosters).

The Dr mentioned that because none of my doctors did an ultrasound during the last four pregnancies, he can't confirm that they were actually in the uterus, and could have in fact been ectopic pregnancies that ended on their own.  That is scary to think about.  If that was the case, I'm thankful that I never had any rupture!  He explained to me that because of my history with recurrent miscarriage that my risk for ectopic pregnancy is much greater and I always need to be aware of that possibility.  Once I become pregnant, the clinic will do a transvaginal ultrasound at 5 weeks and 2 days, because at that point they can see a sac and confirm that the pregnancy is in the uterus where it should be.

Testing that makes sense for us to have (but I'm hoping we won't end up doing) is the karotyping.  It's not genetic screening in this case (we're not looking for genetic diseases) but rather it checks to see if Kevin or I have what's called "Chromosomal Balanced Translocation."  In a nutshell this means that we turned out ok, but part of our chromosomes are off (but somehow balanced each other out to make it act normal so we turned out normal).  This is fine for the person with the balanced chromosomes, but it becomes tricky when the chromosomes try to mix and it can create problems.  Once in a while, it can somehow work though, which would explain Jack being perfectly healthy.  I would love to do these tests just to know, but we are going to wait on them unless we aren't getting answers from the other tests, because it's about $500 a person at the cash cost.  And who knows about insurance helping at all these days...  So the karotyping will probably have to wait a while (if it's necessary at all).

A test (that I have to do for sure) is freaking me out just a little bit- A CLOMID TEST. ahhhh!  Run for your lives!  My cousin is pregnant with triplets right now from this miracle-making medication...so I'm just a little anxious about the idea of needing to take a high dose for 5 days straight.  This is not to help me conceive, it's so they can see how my body responds to ovulation and makes sure that everything responds properly to make a nurturing environment.  But just knowing how easily I get pregnant, I told Kevin he has to live in a different house while I'm taking Clomid.  I'm pretty sure if we shake hands while I'm on Clomid I will have quintuplets.  

I am a little concerned about the scheduling of all these tests, since they have to be at an exact time on my cycle (so can only be scheduled a day or two in advance) and the clinic is 45 minutes from my house.  Also, I can't take Jack to these appointments for obvious reasons.  Also, Kevin is in full time doctoral school and I work from afternoon to night.  So I am wondering even logistically how we are going to make this happen... but I'm praying something will somehow work out.

We walked out of the clinic seeing dollar signs...that part is a little crazy.  The good news is we have a few months before we can start testing, and our loans finally came in to help with the normal bills, so with me working some extra hours we should be able to save up for at least a couple tests at a time.  If it's God's will for us to take this journey, it will work out somehow.

Occasionally my hope turns to sudden fear and I think, "What if it really is my blood and they really can't do anything for it?"  But we just have to take this one day at a time and have faith.  Fear like that doesn't help anything.

I felt so overwhelmed walking into the clinic and seeing pictures of all these miracle babies on the wall.  I know it's possible for us, even though it might be a lot of work, money, time, patience, stress, and "uncomfortable procedures" (just say painful already).  The doctor was very happy to see we have a son and it gave him confidence that it's possible again.  Sometimes I feel a little mad at the world that we have to go through this process and I wonder why it can't just be simple.  But I try to get rid of that attitude pretty fast.  It is what it is and I'm just thankful there is so much help and hope available.  Kevin told me he can't wait to hold another newborn of his own and tell them "You were hard, you caused a lot of problems." haha- wouldn't that be the most wonderful thing in the world? I'm sure he wouldn't even be able to fake scold them because he wouldn't be able to wipe the smile off his face.  

We are dreaming of you baby.  We hope this leads us to you. <3