AZFb Microdeletions and a Hysteroscopy

About a week ago E and I went to his follow up urology appointment and received the terrible news that he has a complete AZFb microdeletion. I've started to post a handful of times, but knowing that information hasn't provided us with the answers we need.

The AZF region is located on the long arm of the Y chromosome and there are three segments, the proximal, central and distal, or A, B and C.  Keeping in mind that these microdeletions are extremely rare, deletions in the B region are the most uncommon and have the worst prognosis. After getting my hands on every AZFb paper I could find, the literature concludes that men with complete AZFb deletions do not produce sperm. Men with C region deletions usually have low but usable counts, but B region deletions are an end of the line sentence.  Although E did have several 0 or near 0 semen analyses, he also had a 10 million, 23 million and 2 million, so he is very clearly producing sperm.

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This leaves us with three possibilities:
- The genetic test was wrong, which is unlikely
- All the semen analyses were wrong, which is unlikely since they were done at 3 different labs
- E is an anomaly about whom they will write papers

We just repeated the genetic test but still need to schedule an appointment with the genetic counselor, and have a more detailed semen analysis done at a fertility clinic. We know if we were able to use E's swimmers that we'd have to select for girls, but I'm sure the counselor will want to go over it with us. That and the likelihood of donor sperm, which we are already prepared for.

For me, I had my Hysteroscopy done today, and while it was worse than I was expecting, it wasn't horrible. After the HSG I was picturing the Hysteroscopy as fairly similar, a little catheter threaded up, a numbing injection this time which I was sure would hurt, but nothing too terrible. Instead, there were at least 8 local anesthetic injections into my cervix and let me tell you they HURT, way more than I was expecting. I could feel those suckers all the way down my butt and thighs and they made me shake all over.

Then came the manual dilation of the cervix. Here I mistakenly assumed that since they'd done all those numbing injections, I wouldn't feel anything. Yeah, that was TOTALLY WRONG. I felt every single second of that and it hurt like a bitch. They ended up having to do it multiple times, including one time after they'd tried to put the camera in and it wouldn't fit. Once the camera was actually in, it wasn't horrible and it was pretty cool to see the inside of my uterus on the screen.

During my saline ultrasound, the doctor had seen a little piece of something could be a polyp but she thought it was more likely to be a bit of dislodged lining. It did it fact turn out to be lining, as I had a thick, fluffy lining, despite the progesterone I'd been taking for two weeks to thin it out, so no surgery necessary. Basically everything was normal, normal size, shape, color, it had perfect blood flow, no endometriosis, no polyps, a great lining, basically nothing physical that would prevent an egg from implanting.

At the end of the procedure, the doctor gave us a little print out of shots of my uterus. It felt like a stand in because we don't have a baby for ultrasound pictures, but we took it home for our records. You can't really see anything, just pink walls and fluffy lining.  It's scintilating.

Behold: My Insides

We also had a good chat with our doctor about possibly going with her clinic, since we have to go outside of Kaiser for IVF. I like that she is already familiar with our case and knows how the Kaiser system works, but we'll have to see if it's a good fit once we've met with the genetic counselor.   

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.

A Fruitless Effort

Over the past year, there have been many things going on behind the scenes that I haven't been able to post about. Chief among those is E and I's unsuccessful attempt to start our family. E and I have kept things quiet mostly to preserve our privacy, but I think I'm ready to share a bit anonymously here to help process everything going through my mind. We have chosen to keep these issues private from our family in particular, since we want to surround ourselves with entirely supportive people now that we know we are going to be facing issues.

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E and I have been trying to have a baby for a little over a year now. Remember this post so long ago? Yeah, apparently it's coming true Naively, we thought it would be pretty easy. We have heard all our lives how we were each "first attempt" babies, so we had better be absolutely 100% sure we were ready before trying since it would happen immediately. We tried casually in the beginning, since after all, this baby making stuff is supposed to be fun! We relaxed, went on vacation and didn't think about it too hard. When that didn't seem to work, we progressed to taking things a bit more seriously. I started charting my BBT, we tried to plan better, and I thought for sure this would do the trick. Six months came and went, the national average time it takes most people to conceive, so we stepped things up again and I joined the gym and began taking fertility supplements to try and get healthier. Nine months passed, I added more supplements for both E and myself, and I confess I thought for sure we'd at least be preggo by now if we didn't already have a baby.

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Finally, we hit twelve months and it was time to make an appointment with my Ob/Gyn. I added OPKs (ovulation predictor kits - there's a lot of peeing on sticks in this TTC business) to my routine so I could bring her the most information possible and I went in for my first round of CD3 labs. Surprisingly, or not surprisingly, those labs came back with pretty discouraging results. It looked like there might be something wrong, but really, at only 26 years old, it had to be a fluke. My Ob/Gyn put me on Metformin, a diabetes drug that has the somewhat baffling side effect of improving your fertility, and assured me that I'd be knocked up in no time. Then she ordered another set of CD3 labs to contradict the flukey labs and, now in our 13th month, I went in again. Unfortunately, these results were even worse than the first set, and instead of calling to ease my mind, I got a call that my doctor is now officially "concerned".

I was hoping that all this testing would come back normal, and I'd get the usual "just relax" talks that everyone gives you when you reveal that you're having trouble getting pregnant. I really believed that if we could just de-stress, take a vacation and stop thinking about getting pregnant, that things would just "happen". Instead, my doctor is now throwing around phrases like Cortisol Disorder, Atypical Cushing's Disease and Premature Ovarian Failure.  They're really not sure what is going on with me, but it's officially not something that I can relax away :(