Precursor: I’m not sure that I 100% understand what is going on with my body. This is how I recall it, but I was very stressed out, nervous and overwhelmed (my blood pressure was 140/90!!!) so forgive me if it doesn’t make sense. PLEASE, ask questions if it doesn’t. He encouraged me to bring in a list of questions next time I see him =)
So I met with the gynecologist yesterday. As it turns out, he’s not just a gynecologist. He started as an OB, practiced that for 20 years. He went back to school to study reproductive medicine and actually brought IVF to northern California. He has stopped practicing IVF as he has retired several times, but he loves what he does and is good at what he does, so he continues to return and retire repeatedly. He now sees patients once every two weeks strictly for PCOS and menopause – hormone management. As some of you know, I was told about this doctor through people at my work (he works at my clinic). I work with several providers who refer patients to him all the time, and fully trust him and believe in him. Every one of his patients has just raved, and raved, and raved about him. People call him the “God of Gynecology.” Prior to meeting with him, I got some lab work done.
He walks in to the room and says, “Well, you don’t have PCOS.” YES!!! FWIW, I do not have endo either.
He goes on to thoroughly review my lab work with me. He told me about four different things that cause infertility in people with PCOS. Unfortunately, I only remember two of them. He said that people can have really high LH, which causes the ovaries to never receive the signal to ovulate. He also said that people can have high testosterone, which causes a whole slew of issues, one of which is also anovulation. I do not have either of these. He goes on to tell me that my LH was actually very low, that my estrogen was also very low, and that my LH to FSH ratio was off. Based on this information, he said, “I don’t think you’re ovulating every cycle. If you are, it’s not at the right time in your cycle.” He then looks at my BBT charts and he feels that January, February and July were anovulatory (my temps are higher in my LP kinda, with some dropping below the coverline, but almost all of them are JUST above the coverline). Well, he didn’t JUST say that, he looked at them and said, “See, this one here, that’s a classic anovulatory chart.” (Emphasis on classic. That stung a little). He says that he’s all for BBT, but that it’s very old school and he prefers to go by lab work over anything. He asked me if I was using OPK’s, which as you ladies know I am. I have gotten 2 cycles with positives, one cycle I never got a positive. He feels that despite the positives that my body isn’t fully releasing an egg. The hormones are there, but there isn’t enough of them to get the job done. The plan for this is to confirm anovulation by doing CD14 bloodwork, including an estradiol and an LH. He says that my ovaries are just asleep, and need a “kick in the butt.” He plans to kick my ovaries in the butt by doing a few rounds of monitored Clomid, starting with 50 mg, in combination with an HCG shot. Is that a trigger shot?
He thinks I have a second problem – a luteal phase defect. This is based on my lab work, my chemical pregnancy and my period history. I start spotting with a temperature drop at 7DPO. An LP defect doesn’t necessarily mean that it’s too short (which is what I always thought), just that there is something wrong with it. He thinks that I do not produce enough Progesterone to make a secretory endometrium* thus I do not have an environment for an embryo to implant to, grow in and be sufficiently supported in. To prove his theory, he is going to do two things: post O blood work for progesterone, and an endometrial biopsy (yikes!!!!) which is scheduled for next Tuesday (double yikes!). He thinks the endometrial biopsy will show that it is not the “right” endometrium for that point in my cycle. Does anyone have any experience with an EMB? I am terrified of it. If you know my history, you know that I had cervical stenosis at 11 years old. I had a dilating procedure that was literally the WORST pain I’ve ever been in. He plans to treat this with putting me on oral progesterone.
*Apparently, there are 2 types of endometriums. Secretory and proliferative endometrium. The secretory one is prepared by Progesterone during the LP; it is full of nutrients and designed to support the growing embryo. The proliferative is prepared by estrogen – both things I am lacking. Is that right? Has anyone else heard of this?
In summary, we are doing these things: Verifying anovulation by checking E2 and LH on midcycle with ultrasounds, check a sperm analysis, and also confirm anovulation/LP defect with CD22 progesterone levels and endometrial biopsy. Start with Clomid 50 mg, with ultrasounds, and an HCG shot. Then, start on oral progesterone. If no go in 2-4 rounds of Clomid, he said he’s gonna “blow my tubes out.” Is that an HSG?
So, all in all, I feel really good about my plan. Like I said, he’s technically retired. He was not doing any IF patients (is that what I am?). I dunno what his nurse said to convince him, but he is taking me on. He is coming in specifically for me to do this biopsy next week. I feel so honored to have met him and that he is doing this. I feel like I am in such good hands.
Does anything I said make sense? Am I completely misunderstanding things? What questions should I ask him?