SA Number 5, Christmas Hope??

We just got E's 5th semen analysis back and we are SO confused! I have been shoving supplements down E's throat  encouraging E to take FertilAid for Men, Count Boost for Men and Motility Boost for Men for the past few months and I can't believe they might actually be working. Keep in mind E's hormone levels have always been perfect, so its not like the supplements could correct something that wasn't broken, and we still don't have the results of his genetic testing yet, but look!

SA 1 at Lab A: 0.65 million, 0 motility
SA 2 at Lab B: 0
SA 3 at Lab C: 0
SA 4 at Lab C: 10 million, 0 motility
SA 5 at Lab C: 23 million, 0 motility

Again his doctor doesn't seem to be too enthused, he ordered another SA for him and said we should focus on my procedures tomorrow. The motility is still, and has always been, 0 and the morphology is always N/A, I think because they're don't grade them if they're not moving. We're trying not to get our hopes up since 23 million dead sperm are no more useful than 1 dead sperm, and they might still be genetically defective, but we're so so glad to see the number moving impossibly upwards!

Tomorrow is the HSG and saline ultrasound, I'm not expecting to see anything wrong on either test so hopefully our goodish news streak will continue. 

Merry Christmas Everyone!

Lab Results!

On Saturday we returned to the Kaiser lab for our multitude of tests. E submitted another semen sample and gave another 3 vials of blood, and I had the extreme pleasure of giving 11 vials of blood. The experience could have been horrible, but I got a wonderful tech who found the vein on the first try, even though she couldn't feel it. I'm so grateful for techs like her :)

Now that a couple days have gone by, the early results are starting to trickle in.  My TSH has come down to just below 2.5, which is still high for me but not as bad as we thought it was. It also turns out that I have the exact opposite blood type that I was told I have by Kaiser. In high school I donated blood at Kaiser for my grandmother's surgery, and a few days later was given a little card with my name and blood type on it. For over 10 years I've been living my life and telling doctors that I'm B- when, according to the newest test, I am actually A+. Mind blown. I'm not sure how a mistake could have been made at the blood bank, since I'm assuming my most recent test is accurate, but it will be nice to not need the RhoGam shot if/when we do get pregnant. I'm still waiting on the results of the other lab tests but they'll probably take a few weeks.

In even bigger news, we got E's 4th SA back and the results were totally startling! So far we've had a 0.65 million, a 0, another 0, and this last one showed 10 million! There was still no sign of any motility so we still don't know if we can obtain anything usable but the numbers were so shocking that E didn't believe them. Our doctor has suggested that its a one time fluke and we shouldn't get our hopes up but I've got my fingers crossed. We've been supplementing the crap out of his sperm with FertilAid for Men, Count Boost and Motile Boost and it would be great to know that they're actually working. His next SA, number 5, is on the 23rd and my tests are on the 26th so we're keeping our fingers crossed. 

E Update

After lots and lots of anxious waiting, E's results are in. His lab work was absolutely and completely normal, I'm actually pretty jealous of his FSH level, it was way way better than mine. Unfortunately, or fortunately? his third semen analysis came back at a zero. We aren't sure if this indicates a partial blockage, which would be fixable with microsurgery, or a genetic problem like a lack of the cells that produce sperm.

The next step is a biopsy to see if there are any viable sperm in there. You'd think since all the medical professionals agree on this course of action, that it wouldn't be too difficult to move forward. Unfortunately, you'd be wrong. E can't proceed with his biopsy with his current urologist, he needs a specialist in the urology department at a different Kaiser.  After E's results came in, his urologist said he was referring us to this new urologist. Then, he accidentally forgot to put through the referral before he went on vacation. In the two weeks it took E's urologist to get back from vacation, almost the entire month of November filled up :( We were expecting this so I had tried to schedule the appointment sooner, as both the current urologist's nurse and the new urologist's nurse knew the referral was supposed to be sent, but it was no good.

Now that the referral is finally in, the new urologist's office refused to schedule the appointment because our insurance still shows no infertility coverage. I had to explain that the new coverage is coming and argue with three different people before they agreed to make the appointment.
E has his next appointment on November 25^th, which also happens to be the day I have jury duty and we'll have guests from out of town >_< I expect it will be another consultation instead of the biopsy he's supposed to be having so at least it won't slow him too down too much.

We did get the good news that our new insurance should be in effect as of November 1st but it didn't come quite fast enough to stop the payments for our individual plans. I also called on the first to confirm the new plans and cancel the individual ones, and they had no record of the new ones. I'm assuming it takes a little while for all the paperwork to be processed on their end, but it sure isn't making things easy and the waiting is driving me nuts.

Urological Update

Today was E's urological consult with what turned out to be the director of the department. He was an excellent doctor, really down to earth and honest without being overly optimistic or depressing. E's physical exam was normal, as we had all expected, and the doctor ordered blood work and semen analysis number 3. We're waiting on the results of the blood work now and semen analysis number 3 will be on Monday.

More importantly, he advised us to manage our expectations. Don't get too high or too low. He said he has seen so many couples spend hundreds of thousands of dollars trying to get pregnant without success. That more often than not, people were not the exception to the rule and that he defined success as a baby in your arms, while most clinics define it as a positive test. That we shouldn't tie our self worth in with our ability to have biological children.

On the downside, he seemed to be laying the ground work for what sounded like inevitable bad news. He talked about friends who have wonderful adopted children. How the most important thing is E and I together as a couple, that we're here because we love each other and to not lose sight of that. I know that it's easy to do, that the stress of treatment, the hormones and failures can take its toll on your body and mind. That having a child can come to mean two different things to each partner and that even a strong relationship can be sorely tried.

The doctor said that if E's FSH results come back with a level like 40, we have no hope of having E's biological babies. Right now we're hoping for normal blood work to indicate a mechanical problem somewhere in the factory. Mechanical problems might be fixable, while high FSH, like my high FSH, can't really be fixed.  He said that if a mechanical problem is indicated, that a biopsy would be the next step. Since he agrees IVF is our only shot right now, if he found viable sperm while E was opened up, he would collect and preserve them for IVF.  I think this would save E a procedure, and potentially lots of money, since I don't think E can product viable sperm via ejaculate.

Overall, we were happy with E's new urologist. Now we just have more waiting, for lab work, for the SA, for some indication of what our next step is. We also need to determine whether we want to continue treatment with Kaiser and pursue their IVF clinic, out of pocket of course, or stick with the clinic we had our initial consult with. The urologist spoke highly of one of the IVF doctors in particular, and said he would introduce us, but I'm not sure they'd even be willing to treat me with my FSH as high as it is.

Another Blow

Yesterday the RE called and said that E's second semen analysis came back at 0. As in not One.Single.Sperm present, he might as well have poured water in the cup. This was after a one day hold, versus E's previous SA which was after a three day hold. 

While the RE had previously said he thought E's poor quality sperm was the result of genetics, he has now referred us to a urologist to rule out things like hormone imbalances and physical problems. I had asked about this during our initial consultation but he had tentatively ruled it out since E's first SA did show sperm present. It makes me really glad that we did another SA to confirm, since I was sure there had to be something more going on than just shitty genetics.

This morning, I called and set up an appointment with a urology specialist at Kaiser on the 10th. I'm not sure they are going to be able to do anything since we have no infertility coverage, but I figured it would pay to start with them before going directly to the outside specialist. The RE referred us to an excellent urologist who is one of the top in the country for male infertility problems, but he would be very pricey. Just in case, we called as got some info about him as well and he has an opening on the 17th if Kaiser is no help.  

We also have an appointment with a genetic counselor set up with Kaiser that I think they're going to cover, though the testing will likely be out of pocket. It will probably be a moot point anyway if we have to use a donor, but I am still proceeding with the intent of using E's sperm. I want to have our babies, not just a baby and I'm not ready to give up on that. 

Two wrongs can't make it right: The 30%

I know I said we'd be getting results back by the end of the week, but it ended up taking forever to get our hands on the test results. My cortisol results came back negative for Cushings, which we weren't at all surprised about, but I suppose that is good news. Unfortunately, we did not get so lucky with E's Semen Analysis.

E's results came in last Monday and due to some fax mishaps, we weren't able to get our hands on them last Thursday. Once we did get them, I kind of wished they hadn't come in. It turns out that we are dealing with rather severe male factor infertility - low sperm count, less than 1 million, and 0 motility. It actually says 0, not low, or hey just a few are determined enough to swim, actually 0. What lazy little fuckers. E and I keep picturing them playing on a PS3 like nah, I could move but I'm much too busy.

This news puts us into the worst 30% - 30% of couples have female factor infertility, 30% have male factor infertility and 30%, including us, are unfortunate enough to have both. Basically, we have 0% of conceiving on our own. Kind of like 0% motility.

Today we had a phone consultation with a doctor at one of the local fertility clinics. I don't know the first thing about selecting a fertility clinic, but this one offered a free phone consultation so I figured it was a good first step. E and I spoke with him for a few minutes on the phone and once he heard my lab results he pretty much said, aw crap, you should have started fertility treatment yesterday, you have diminished ovarian reserve/premature ovarian failure/old and moldy eggs.  He was less worried about E's abysmal SA results since all he needs is one spermie to create an embryo, even if it's poor quality and even if he has to go in to E's testicles to get it.

He immediately booked us for the first available appointment after this cycle ends so he can ultrasound my ovaries and see if there are any follicles. There should be some, since I definitely ovulate every month, but I don't know about their quality. And of course, since we have no infertility coverage, this is all going to be out of pocket. After we hung up with him I had to call back and speak to their financial department to find out a little bit more about cost. It seems that the appointment will run us $200 and the ultrasound either $275 or $700 depending on whether it's a regular ultrasound or a fluid ultrasound. This is where I'm officially starting the tab for our infertility treatment (Plus E's SA!), if there's a higher power out there, please have mercy on my uterus and our checkbooks.

(Source)

It seems crazy to be running out of eggs at only 26 but I guess this is our new reality. Even though the doctor didn't tell us anything we weren't already expecting to hear, it still hurt like hell to hear it confirmed. I felt like crying all over again and I think it's really starting to sink in for E. I really hope this fertility clinic is a good place, because I feel a bit too fragile right now to start calling places and asking for references. I'm sure I'll pull myself together tomorrow or the next day, but for now it just hurts.

My positive spin for the day is that if E's swimmers could swim, we would already be pregnant or have a baby right now but have NO idea that I'm rapidly running out of eggs. We would have tried to have a second child in a couple years only to find that I am completely out of eggs and have no chance of having another. Because his sperm can't swim, we have the opportunity to address these problems now, while I still have eggs, hopefully enabling us to bank some embryos and have more than one child in the future.

Two to Tango

Even though we know there's something definitely going on with me,  it takes two to tango and my doctor instructed us to set up a Semen Analysis for E. There is a male factor to infertility in 30% of cases, and another 30% where there is both a male and female factor. Our present insurance doesn't cover any aspect of infertility, so we had to go outside the system and visit a fertility clinic.

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While the staff at the clinic were very nice, I think it was definitely an unpleasant experience for both of us. Poor E had to become better acquainted with a cup than I'm sure he ever wanted to be, and I got to discuss out of pocket price scales for infertility treatment. I keep saying the word "Infertility" and expecting to become desensitized to the sting, but it still doesn't seem like I'm referring to myself. My family doesn't deal with "infertility", my mother had my sister and I at 34 and 38 without blinking, so what business do I have having problems at 26?

As it turns out, the clinic we chose for it's receptionist's kind phone voice, it's close location and low SA cost - only $125 instead of $225 like the bigger clinics, is not in our future insurance network. After a little prodding, they don't like giving out prices unless you're sitting in a closed appointment room, they told me that their IVF cycles are about $16,000 a pop with medication, while an IUI will only set you back about $1200. At this stage, they still don't know what's wrong with me or if E has something going on too, but my doctor seems to be hinting that we need to plan for trouble.

After a few minutes in the tidy but infertility filled waiting room, I also noticed that I felt a little bit out of place there.  All the other patients seemed to be business professionals with about 10-20 years on me and it really hit home again that most people don't have these issues at my age. E and I are still hoping to be younger parents, although that window is closing quickly, and I can't decide if it's a good thing that we're getting a jump on this problem early, or a bad thing that we're already here when we're both supposedly so young.

Our next step is basically to wait. Wait for the endocrinologist to get back to my Ob/Gyn about my screwed up hormones, wait for orders for more tests to be sent in, wait for the SA results to come in for E, and wait to find out why we can't seem to get pregnant.