HSGs and Saline Ultrasounds

After much anticipation, I finally had the saline ultrasound and HSG this morning! And they weren't too bad.

The saline ultrasound was worse than the HSG, but the AFC/Exam portion of it was worse than the actual saline portion. I am definitely not a fan of the trans-vaginal ultrasounds, they are fast rising to the top of my things that suck list. The Dr. had a tough time counting follies on one side and had to press down on my stomach while pressing up with the wand which was really uncomfortable. She also had a tough time placing the catheter (speculum, dilate the cervix, thread the catheter through and up into the uterus) so it took awhile, but the saline injection itself wasn't too uncomfortable. All in all, I was really glad E was there holding my hand.

My ovaries looked fine, if rather empty, and my uterus looked fine too. The only concern was that she thinks she dislodged a piece of my endometrial lining when she put the catheter in but she was only 90% sure. If the little blob wasn't endometrial lining, it could have been a tiny polyp so she suggested I come back for another test, a Hysteroscopy. It sounds like an awful test (several needles to my uterus??? while I'm awake??) but she said if we're going to do IVF we might as well check everything :(

I'm still not sure how I feel about it, especially since I'm pretty darn sure it was just dislodged lining. She did a detailed ultrasound before inserting the catheter and it wasn't there until after she put the catheter in. If I go through with the test I'm supposed to start taking progesterone tonight which will thin out my lining and stop the 10.5mm follie she saw developing from maturing. I'm a week away from ovulating, from that little follie being ready to go. Logically I know DH and I have no chance of conceiving with 0 motility but actively preventing any chance just feels so wrong.

Since the RE had such a tough time getting the catheter in, she said she was going to leave it in so we could use it for my HSG. Then she accidentally pulled it out at the end, working on autopilot. Since she does these all day and the radiology department has less experience with cervixes, she put in a second one which was just soooo much fun -_- And as I'd read, you definitely leak saline afterwards, I didn't notice until it went down my leg, while I was still laying there and got my socks wet, ugh. I then got to get dressed with the catheter taped to my thigh, go down 4 floors, fill my prescription at the pharmacy, cross the street to another building, go up a floor and stand in the waiting room since I couldn't sit -_-

That was probably my least favorite part of the experience, the radiologist later asked me how I got there since I didn't have a wheelchair and you don't generally walk around with a catheter hanging out of your ladybits. I told her I took tiny steps lol.  After they wouldn't let E in, and the radiology tech tried to direct me into the wrong position, I was really glad that I'd had it put in by the RE, even if I had an uncomfortable walk. All the radiologist had to do was plug into the catheters IV port and inject the dye. Both tubes were nice and open, the dye shot through one side and after I tiled slightly, shot through the other, and not a single cramp from the dye, though it could have been that I was so uncomfy already I didn't notice.

All in all not too bad, a little uncomfortable but not awful by any stretch. 

New RE = More Tests

So after waiting over a month for the urology appointment, the Kaiser system worked a little faster and we were able to get in to see the RE on Black Friday. My overall impression of her was positive, she allowed us to share our story and explain where we are and agreed with most of our assumptions and concerns. For me, she ordered more lab work as well as a saline ultrasound and a hysterosalpingogram. For E, another couple lab tests. Once we begin the procedure for IVF, Kaiser will no longer cover anything so she would like to cover all our bases now.

I will have to go in for my labs on Monday and pick up a course of antibiotics for the hysterosalpingogram since E had to get to work on Friday and we didn't have time. The RE said she very rarely has a case where they can't find any reason at all for male infertility and thinks E might have a microdeletion on his Y chromosome. If he does, the location will play a big part in whether we're able to retrieve viable sperm. And, if we can get viable sperm that produces viable embryos, we will have to have PGD to select for female embryos since any male children will inherit the same deletion.

However, given the information we have thus far, it's likely that we're going to have to use a donor. The RE does agree that I have diminished ovarian reserve and is very concerned that we may have a rapidly closing window to retrieve viable eggs. There was also some confusion over my AFC, during the appointment the RE at the fertility clinic told me 3 and 4 follies for a total of 7. However, the paperwork he faxed over said 3 and 7 for a total of 10, which while it would be AMAZING, doesn't match up with my FSH or my memory. Regardless, the new RE is concerned that in a couple years I will not have any eggs left.

Given that prognosis, we need to think seriously about the IVF vs IUI decision. Kaiser would pay for an IUI, which would be much less invasive and inexpensive. If we were successful, it would probably be at least 2 years before we tried for a second child and by then I might be completely out of eggs. If I did still have high quality eggs left for siblings, we would need to store our donor of choice and do IUI again. If we do IVF now, it will be entirely out of pocket, more invasive and expensive, but will hopefully yield enough embryos that we can freeze some and use them for a second and/maybe third child. It would also mean we would have the same donor for all our children since the embryos would all be made at once.

We've been talking back and forth about it and have just started to casually look at donors online. We won't have DH's results for another month since they have to grow the genetic test in culture, but they probably won't be good. In the meantime, the RE wants me to take DHEA three times a day, keep taking a prenatal and see if I can get my thyroid levels down. While all my tests for the past 10 years have been below or around 1,  my last one was 3. Although it's still technically normal, numbers over 2.5 are associated with much higher rates of miscarriage so I'm going to need to do something about that.