Wednesday, October 28, 2009

A missing ovary and a potential new problem

It was an interesting appointment today. Here's a rundown of the developments:

* She couldn't find my right ovary. This is the third ultrasound in which it has been missing, spanning two different cycles. I'd think it was gone completely had I not been reminded today that the RE did an ultrasound in September in which it was there (although he did note it was rather small).

* She thinks I ovulated on the missing ovary already. She is basing this assumption on the fact that I had tons of fluid (which I find interesting because last cycle she didn't see fluid on cycle day 13 or 14, despite thinking I had ovulated then as well). She was also able to locate my left ovary and saw several small follicles. I also told her that yesterday I had severe pain on the right side, so she took that as further evidence.

* Other interesting things to note - Today is cycle day 13, so that'd be pretty early for me to ovulate. My temp had been 97.0 but dipped this morning to 96.8. An opk might have been positive this morning, but was confusing because both lines were very faint.

* She also had trouble finding my uterus at first, then found it, thought it might be tilted, and said my lining was thick.

* She had a nurse give me the trigger shot, which I ordered yesterday just in case. No ovary was located, no follicle was seen on ultrasound, but I was triggered. Should I be concerned, or is a trigger shot safe even if there is no dominate follicle? (which there very well may have been, we just can't be sure I guess)

Okay, there's more. And this potentially could overshadow my missing ovary.

I reminded her after she started the ultrasound that she was going to do a post-coital test. She said it should've been done prior to the ultrasound and apologized. She said it might not be accurate due to having done the ultrasound (pretty sure she mentioned the gel, or lubricant, as the reason, but I could be wrong), but then she thought about it and decided that because she was going in my cervix, that shouldn't matter.

To make a long story short, after looking at it under a microscope, she said there were lots of dead sperm and one live one. One. She said technically she has to call the test "normal" even if there is just one still swimming, but she wants to do a semen analysis just to make sure. She seemed to think that the ultrasound could mess up the results and suggested I just do it again next cycle. Not wanting to worry for an entire month that my mucus is hostile, I asked if I could come back in the morning (when I already had scheduled an ultrasound appointment not knowing when I'd ovulate) and she said sure, although wondered if I'd have mucus since I'd be post-ovulatory. That was funny to me, since I've never stopped having mucus on day 13, and usually it goes all the way to day 17 or 18 (not to mention she said it was "full of cells" under the microscope which apparently means it's cloudy [although it has looked clear to me for two days now], so I would assume if it's still cloudy, clear is on the way).

So I'll go back bright and early tomorrow morning for another post-coital. We'll see if it was a fluke, caused by the ultrasound, or if there's a real problem. And if it is a real problem, then more testing will apparently need to be done to find out if it's my fault or his.

On a side note, I'm going to ask something here that might have crossed your mind while reading the previous paragraphs - If ultrasound can somehow kill sperm, then WHY DO WE HAVE ULTRASOUNDS AROUND THE TIME OF OVULATION? Does that make any sense? It's so absurd that I'm starting to think maybe I misunderstood her, but then what else could she have meant? Why else would she think the ultrasound could have affected the test?

I'll be sure to ask her that question tomorrow. Oh, and treatment? Well, she said IVF is the usual treatment although, I'm wondering, isn't IUI more for this problem?). Either way, neither is an option for us. Another possible treatment is using condoms for six months. What? Again, not an option (she said these options in a very matter-of-fact manner, but I don't believe she was suggesting them, seeing that her boss is a big proponent of the Church's teachings and all).

I actually told her that the USCCB website says the licit approach is to abstain for two years. She said she'd never heard of that, but then told me that she has seen some success using steroids as a treatment. The bishops' site also refers to this option but says it's not shown to have much success (although it says at the bottom that the page was copyrighted in 1999, so I'm hoping it just hasn't been updated to reflect all the millions of successes there have been in the last ten years...haha).

Surprisingly, I am handling this all very well. My attitude is that I've never been pregnant, not once in five years, and so this diagnosis wouldn't change anything. I'm way past thinking I have a chance each month, so how could this make me any more sad about it?

The only thing that makes me sad is that adoption seems so unlikely. If it were a viable option, I really don't think I'd have any sadness about this new potential diagnosis. If God wills for our children to come not from my womb but through adoption, well, I have already mourned this and have moved on. I just want to be a mother. But to have a new diagnosis, and have adoption potentially years away, does make my heart a bit heavy, although I ultimately trust His plan for me.

I shouldn't get ahead of myself. I could find out tomorrow that everything is fine. Either way, it's in God's hands and I have peace with that.


  1. I did not realize that your hubby never had a SA to this point(unless I am mis-reading or mis-understanding this post). That is a very important piece of the puzzle! I'm not sure what the church permits regarding that (I'm Protestant) but it is vitally important information when investigating even the earliest of stages of infertility. I am surprised no provider that you have seen didn't push for it any sooner. In the grand scheme of things, it is relatively cheap and often is THE answer (or a huge factor) in revealing a couple's fertility issues.
    As far as the ultrasound gel thing, it's water soluble and it's not like it really stays in you for any length of time. Also we are normally timing ultrasounds for hCG and either intercourse or IUI - if we give an hCG injection in the office, we are recommending times for intercourse or scheduling the IUI approx 24-36 hours later. The gel is most definitely gone at that point! I would be more concerned about the actual parameters on the semen analysis (count, motility, Kruger strict morphology) than the ultrasound gel.

  2. WHOA, whoa, whoa, whoa, WHOA. Hold on just a second... they are using ULTRASOUND GEL on the probe???? First of all, that stuff should not be used internally (it should ONLY be on the transducer head, between the transducer and the protective sheath that covers it). Most places use KY jelly or some other sterile lubricant on TOP of the sheath (maybe this is what she was talking about... I can only HOPE), but (and this part I can't stress enough) FOR INFERTILITY PATIENTS< PARTICULARLY AROUND THE TIME OF OVULATION, YOU ARE ONLY SUPPOSED TO USE WATER AND NEVER USE LUBRICANT!!!!!

    It is generally not a problem (lack of lubrication) for the probe, since O time carries with it natural EWCM, anyway!

    I've had my doubts about some of the 411 you've shared about these ultrasounds in the past (not knowing if what they were seeing was an endometrioma or not, for example), but this definately has put me over the edge. You should NOT go there anymore for an ultrasound!!

    I'm sorry if this is coming across harshly. I just don't think they are doing things properly. And I'm not saying I know more than them after 6 months of studying... but I have talked about this stuff with my NaPro Dr (just recently) and she said that in NaPro, Dr Hilgers has trained all his sonographers/Drs NEVER to use non-sperm friendly lubricant.

    All this being said, however, you should feel a little better about the results of your post-coital. In all honesty, they REALLY SHOULD HAVE cancelled that test, instead of giving you results which were BOUND to be altered from the ultrasound.

    Yikes. I am so ticked off right now for you. Of course all this news would be so upsetting to you, and I cannot believe they put you through that because they don't know how to do a TV scan on an infertility patient!! (This is not just a NaPro rule, btw- I also read it in a "Transvaginal Sonography" book in my Supervisor's office... from the 1990s!!)

    Ay ay ay, I'm so sorry hon. Try not to let this upset you for now. Get another PC Test scheduled for next cycle to ease your mind, and in the meantime come up to visit me and come to my facility (or Dr Jean's) for an ultrasound!

  3. I don't understand. Why do a trigger if she thinks you've already ovulated? Did I misunderstand? Once the trigger is given, you should ovulate within 36 hours--48 hours. The trigger forces you to release all the follicles that are growing. There needs to be one there that is large enough to contain a mature egg for it have a chance of success.

    I do think IUI is the standard for hostile CM, not IVF. But, I really do not think this was a good test of it given the gel (and I'm in a blur on that point, too)and, by the way, how long was it after the BD before the post-c was done? The post-c needs to be redone and properly.

    If they were using KY before ov, that should not be a problem as it should be out of you by the time ov occurs, but I am not convinced that is the stuff they are using.

    Very confused and frustrated for you. Seriously.

  4. BTW, your 2nd to last paragraph, I said pretty much those EXACT same words to DH last night. I really don't care if I am meant to be pg or not- unlike a lot of IFers, I won't mourn my ability to "bear children in my womb" for years and years. I just want to be a mommy. But adoption is impossible right now. And pg is laughable...

  5. I'm sorry more problems are coming up. You should definitely go visit TCIE and also get the post-coital re-done. I hope you can figure out what the situation is soon.

  6. BuckeyeNP - He had a semen analysis done four years ago, and I remember it being "low normal", although I distinctly remember asking my ob/gyn at the time if we should be concerned about the "low" part and she said no, normal is normal. It hasn't been tested since then, although I've always wondered if it should be.

    TCIE - I am not sure! Maybe I assumed that's what she meant, but she didn't? I know I saw the blue gel underneath the plastic covering.. but there's always some sort of gel that's down there afterwards.. know what I mean?? And it was definitely there today. If not because of the gel, what else about the u/s could screw up the test? Just the fact that she was in there maybe? And on the other issue - is it normal to just not see an ovary?

    Ann - She gave me the trigger shot last cycle after she thought ovulation had started that time too. She said it could still help. Anyone know if that's true? And would there be fluid if I hadn't o'ed yet?

  7. I'm so sorry you have to go through all this...
    I wouldn't worry though. If she saw one live one, I'm sure it is fine. A teacher I worked with actually had that problem and the way she described it to me, every single one died. I think Dr. L probably gave the "less is more" explanation to you. Little does she know, you'd be going home to research and ask the rest of the blog world! Praying that everything is fine tomorrow!

  8. K, I am just praying that it was the ultra sound that messed up that test for you. Seriously, I do hope that things test out well in the morning!!!! This just sounds crazy to me! Oh my goodness, I can't imagine how frustrated you must feel right now with these tests and the adoption process.

    I am praying for you!!!! Especially tomorrow morning!!
    P.s. TCIE really sounds like she knows what she is talkng about...I am just clueless about this!

  9. K - I do not think there is a reason to give a trigger if you have already ovulated. The whole point of a trigger is to "trigger" . . . to MAKE you ovulate. That would be different, of cousre, if the hcg was given in doses over several days to extend your LP like Sew & LIM does.

    Keep in mind that I am NOT a Napro patient and I realize their's is a different approach. With my RE, he simply will not do a trigger unless there is a 1.8 cm (18 mm) follie b/c anything smaller would not have a mature egg in it. It would be pointless to trigger before then. In my case (with ov meds), they would continue meds until the follies reached that desired size. Again, I realize that is a different treatment path but my point is the trigger has always been under the same guidelines whether I was on OV-stim shots or not.

    Also, I have never had a post-c done, but I do not think it should be done after any foreign substance such as a gel (whether it was water-based or not) is used. Directions I was given on it specifically said NOT to use any lubericants as it can skew the results. It seems like your Dr. recognized that & struggled with it a bit b/f going ahead.

    I do no know about the fluid as I have never had a post-ov one done. Sometimes one ovary can be harder to see than at other times (mine is the left b/c of the bowel that can obstruct it). I've never had it go completely out of RADAR but then again, I haven't had the surgeries you've had.

    I am sure some of this is a miscommunication on the gel issue, but I would really want to hone in on the trigger shot issue. If for no other reason than maybe you need to be going in sooner & using OV predictor kids if you are currently going in after you have ovulated. (I think I emailed you a while ago on how my RE likes the OV kits to be used to make sure he he is doing the u/s BEFORE you ov).

    I hope you get some good sleep. You've got lots of questions and I am sure your doctor will be able to give some clarification tomorrow. Best of luck.

  10. You haven't done an SA yet? Ok, and did you really say she couldn't find your uterus? Um... hello?! Are you confident about this ladies skills, or should everything that happened today be taken with a grain of salt and the search for a new provider begin?
    How can a trigger shot help if you've already ovulated? That's like flipping the light switch to 'off' when the power is out. Isn't it?! It defeats the purpose. The trigger is to make you ovulate, so if you already did, it wouldn't be helpful at all.
    I think I'm as confused as everybody else, but one thing I feel pretty sure about is that I'd be looking for a new doctor if I were you. I don't think this lady has a clue what she's doing. Maybe then you would have a much better chance for conception!
    Agh, so much stress, and stress is the enemy in IF! Sending you love... :)

  11. K - I'm sorry to hear about this frustrating appointment! I'm super curious to hear what happens today.

    For what it's worth, she saw a lot of dead sperm in our P-C test this week too. She seemed to think that was normal. I agree that she shouldn't have gone through with the test after probing you! I have no clue what kind of gel they use - but you should definitely ask today.

    Again, I'm far from being an expert, but I believe that the sperm should be through our mucus and all the way into our tubes shortly after intercourse. Does that sound right? Obviously you don't want any sperm-killing gel ANYWHERE near your body during ovulation time. I guess my question is... were the sperm dead because of the gel or were they already dead? Maybe you could ask her that.

    Also, if there are still sperm in our mucus in the cervix area hours (or days) after intercourse, does that mean they can still swim up to the tubes and find an egg? I guess that's why they say sperm can live up to 5 days.

    Ugh, just when you think you know these things you realize you really don't.

    Keep us posted!!

  12. O My Goodness. I feel like I know a decent amount about IF and this visit totally confused me.

    Is this Dr. NaPro or not?

    Is the ultrasound equipment good in that office? Our drs. never do u/s in the office for follicular studies because their equipment isn't as accurate as the ones at the ultrasonographers. Even those techs have to really search for my left ovary that really hides, but that was the one I conceived on.

    I have heard of couples conceiving on cycles where they failed a post coital test. I wouldn't put a lot of stock in those tests. But if I were you, I would have your DH get another SA.

    When was your last total hormonal profile? If it has been awhile, maybe that would be a good place to start before seeing Dr. S. I am glad you are coming to see him!!

  13. I hope things went better this morning *hug*

  14. (((()))) Praying the Lord lead you in what to do.

  15. GOSH. I have alot of questions, too... most of which have already been asked by previous commenters...and I agree with whoever was surprised that she couldn't find your uterus?!!??!

    I have always heard that post coital tests are out of date and aren't very reliable...but I think any foreign substance in the vicinity would have the potential to throw off the results, so I probably wouldn't put much stock in the first results...

  16. IT is pointless to trigger if you have already Ovulated or if you don't have a mature follie.