Thursday, October 29, 2009

Second test results

The results were the same as yesterday.

My doctor didn't seem to think this was anything to worry about. Probably due to my poor quality of mucus, she said. Had I done the post-coital earlier we might have caught the more peak-type mucus and the sperm would be alive.

That sounds reasonable, except yesterday's test was on cycle day 13 (ovulation day), and those dead sperm first hit the mucus on cycle day 12. Not to mention that I only started seeing mucus on cycle day 11, and it's still getting better and better each day, today being the best quality yet. If anything, maybe we'd have a better result tomorrow, not last Monday.

Apparently there's a discrepancy between what she sees under the microscope (cloudy, full of "cells") and what I see when I chart (today has been 10KL). Am I just really bad at making Creighton observations? I suppose anything is possible, but that would mean I don't know the definition of clear, and cloudy. I feel strongly that I have those down.

So I'm thinking this may just be further evidence that there's a discrepancy between when I ovulate (yesterday, or the day before) and when I see my "peak day," according to Creighton. She assumes the mucus was better a few days ago, but maybe it has yet to reach its peak (which is so far the case according to my chart).

And what about everyone saying sperm can live in mucus for up to five days? Is that a myth, or is that just another thing that's true for "healthy" people? Because if my mucus kills sperm on the day of ovulation, then when doesn't it kill it?

Oh, and I asked her about why the ultrasound yesterday could possibly affect the results and she said the gel on the outside of the wand might kill sperm. When I asked then why we do the ultrasounds around ovulation, she said the sperm gets where it needs to go in the first five minutes.

I left the office not sure how to feel. My doctor acted like it wasn't a big deal, but the news that was replaying in my head did seem pretty serious. Two post-coital tests that showed a total of three living sperm? I tend to think this is a bigger deal than she does.

I know a lot of doctors don't believe in doing this test anymore, and there must be a reason they don't like it. Is it due to the possibility of timing it wrong and getting a false negative?

In my gut I don't think the poor result was due to my lack of peak-type mucus. I tend to think my mucus is hostile; it would explain a lot. Yes, I have had numerous problems that all separately would cause infertility, but I ovulate, my cycles are normal, and the problems are under control.

And, like I said before, if the result is due to not testing on a day of good mucus, then that's an issue too because we tested on the day of ovulation and the day after. If my mucus kills sperm on those two days, then when is my fertile window?

Either way, I'm okay with it. Finding this out this morning was as if I heard my progesterone was 16 on peak plus 7 - just average, boring news. It didn't upset me and the thought of a future filled with either no shot at conceiving or grasping at straws to find a treatment for some immune problem with my mucus doesn't stress me much either.

And I feel that no matter what, something was revealed today. We just need to take these clues and examine it further, probably with another doctor.

The next step is getting Ryan's semen analysis done. Although he just took ben.adryl this morning and I heard that can possibly affect the results. Does anyone know how long you should wait after taking something like that?

If there's a problem on his end, we'll figure out if it's treatable. If it comes back normal, we'll look more into what is causing it on my end. This actually intrigues me. Dr. L seemed to think there's not much you can do for that other than trying steroids (I think she said we could do this if it's on my end), which is great and I'll try them for sure, but I can't imagine it's the only option. Hopefully we'll find a doctor who is willing to look into it more. (By the way, a quick google search showed that Clomid can cause hostile mucus. This is my first cycle on it. Anyone know anything about that?)

I also asked her, again, about what to do if the timing of ovulation and good mucus is just off, and she said sometimes things just don't click at the right time and there's nothing they can do. I'm still holding out hope that there is.

I'm exhausted. I think I've driven about ten hours in less than 24 hours. I almost didn't go this morning when my alarm went off at five and Ryan was sick, but I'm glad I did. Even though I didn't really find out anything conclusive (well, at least according to Dr. L), I would've regretted not knowing anything.

I know it might sound corny, but I'm resolved to take each day as it comes. Praise God for this grace, and for hearing this news right around the time when my progesterone is probably rising.

*As I was writing this post, the pharmacy called to tell me that my insurance doesn't cover the post-peak progesterone (endometrin) I was supposed to take this cycle. "Supposed" to take because at $100, I won't be taking it now. So I'm trying to remind myself of what I just wrote - that I am taking each day as it comes. I am being made low and I should rejoice in it.

18 comments:

  1. oh K, I am sorry. This all sounds so confusing. And it's not really instilling a lot of confidence in our doctors for me. Where is This Cross I Embrace? Can we all go get ultrasounds with her?
    I have read that a lot of doctors don't do the post-coital test because the results are often wrong or inconclusive and it doesn't tell them a whole lot. So maybe that is part of the issue.
    Also, clomid can cause hostile mucus?! Come on, can a girl catch a break around here? sigh!
    Your grace in this situation is inspiring!

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  2. I'm so confused. Are you seeing an RE, because this sounds like it is being handled a little lightly. This is no joke- you've been trying to have kids for YEARS. I know you know this...I am just venting some steam myself :)

    I thought the whole point of a medicated cycle with a trigger shot was to catch the follicle before ovulation. This means if you ovulate on CD 13 you need to be seen much earlier than that for an ultrasound. Also, by this point I would think you'd want to produce more than one follicle. I mean, one follicle hasn't been working for the past few years, even though you've been ovulating. I know that my RE didn't think it was successful unless I had 2-3 follicles to trigger. They should be changing or increasing your med dosage based on the number of follies you are producing.

    As for the post coital- well, I suppose you need another SA to determine how the sperm are. If those check out OK then I would disregard the results as the gel and non fertile mucous are probably a factor. You can also try something like Preseed- when we used it we got pregnant. I think my mucous prior to that was not very fertile. I'm not sure what the Catholic church's standing on Preseed is...

    Also, we switched to Femara because the Clomid was making my mucous hostile! It is a side effect of the medication.

    So- sorry that was so long, just wanted to share my experience. I hope you get clarity about where to go from here. Praying for you!

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  3. Did your Dr. prescribe prometrium as your post peak progesterone, because most insurances cover that one. In some ways I would embrace universal healthcare if the abortion clause didn't come with it. I just think it's so frustrating that insurance has so much control over what's covered or not.

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  4. So, I took a look at the link you posted yesterday and it lists IUI with husband's sperm licitly obtained as "neither approved or disapproved". If there was a serious mucus problem, would you then be able to do an IUI?

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  5. My dr. told me the same thing about the first five minutes. That is why I refuse to lay flat after bding. I think IF has me on by my nipples, I'm not going to lay here like a dumb a$$. :) hahaha Sorry, I should back away from the computer. hahaha

    I'm so sorry that you don't seem to be getting "clear" answers. What a freaking mess.

    I thought that clomid dried up mucus making it "hostile". But I have also heard that you can conceive on a dry cycle.

    My mucus is good on clomid for the most part with amoxicillian. :)

    I bet your head is spinning, because it's not like you have clear direction right now. It seems like you are in limbo. :) I'm familiar with that, if you need a padded room, I'm chaning the once supposed to be nursery, changed sewing room, to padded room! :) hahahaha

    IF is taking me kicking and screaming! :) hahahaha Oh and probably drinking while puffing on some smokes too!!! :)

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  6. I'm sorry that another problem has come up. Clomid can dry up/make mucus hostile. Are you on anything for mucus enhancement right now? If not, you should be (in my opinion) if you do Clomid again. I hope Ryan's SA is fine and that the mucus issues are Clomid related.

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  7. Sorry, I hate to beat the dead horse of the SA, but since you said the one 4 yrs ago was "low normal"...would be interested to know if it was done by an ASCCP/technologist using Kruger strict morphology. In my experience, some people think they have had a "complete semen analysis" with a sample dropped off at a hospital lab where some tech did a count and little more. I've even seen it reported from a hospital on a "Urinalysis" report and then crossed out and put "semen Analysis". Uh, yeah, not your specialty, huh? NOT THE SAME!
    At any rate, the semen analysis is a dynamic thing, and a zillion things between 4 years ago and now could have impacted, either for the better or for the worse. I'm not aware of Benadryl having a serious impact. It also takes about 78 days to manufacture sperm, so a benadryl a few nights ago isn't going to have any significant difference one way or the other.

    As far as Clomid and the mucus, because of the way it acts to interrupt the feedback loop, in *some people* it depresses their estrogen, hence thinning the endometrial lining (and probably making less mucus than normal, although we don't spend lots of time analyzing mucus). Some patients make gorgeous follicles on Clomid but they have a 4mm lining and that's going to get them nowhere, regardless of follicles. Those people need gonadotropins.

    As for the Post coital test, since you asked, no it's not really in practice much at least in the RE's I'm familiar with. I think it's been found not to have much value.

    Also I am working from the side of regular ol' reproductive endocrinology...I don't know anything about NaPro ("except what I've read on the internet") so I am not trying to be offensive when answering questions or making suggestions. If I am saying something that is way outside the line of what you're allowed to do, please accept my apology. Wish you the best.

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  8. I am so sorry. I still don't understand what this means for you all because when i had the post coital test done the doctor said even if they saw one live sperm they considered it normal. So wouldn't your results from today be normal???? I am confused!

    I am hoping and praying for you guys. $100 is a lot for a perscription. I just added up everything I take/do for one cycle and I estimated we spend about $360 a month. SH** that sounds like a lot for a BFN.

    Praying for you,
    Amber

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  9. I had to read your post a couple of times to make sense of it all, I can only imagine how tough it is for you! All I've heard about Clomid is that it makes your very dry (which is why so many of us Napro patients also use mucous enhancers). Btw, my doctor wants to try Femara instead of Clomid. I wonder if Femara causes hostile mucous? I definitely think that getting another sperm analysis is in order. Is Ryan on any sort of vitamin regimen? Mr. JB was put on vitamins by our Napro doc to help boost the quality of his sperm. I figure we go on prenatal vitamins, the guys should do something too!

    I'm praying for you!

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  10. I think that Dr. L is more confused than you are. I am really hoping and praying that Dr. S can help you.

    Clomid can dry things up a bit. Usually our patients are on some sort of mucus enhancers. In fact, I took zithromax and mucinex the cycle we had a BFP.

    Have you ever had a complete follicular series? Sounds like you need one to watch that follicle like a hawk and see what it is doing. Maybe couple that with a hormonal profile at the same time. Just a thought.

    Praying for more grace for you.

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  11. Sorry, K. I've read the post and all the great suggestions in the comments and MY head is spinning. I can't imagine what you're going through. No advice, just wanted to let you know I was thinking about you.

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  12. I have to say that I really think I'd have to find a more informed doctor/RE.

    I'm so sorry.

    Continuing to pray!

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  13. Thanks for all your great advice and kind words! Here are answers to some of your questions and some additional questions I have as well, just in case you check back!

    NeNe - How did you know your mucus was hostile on Clomid? Was there just less, or was it something more specific that showed it was actually hostile?

    Callmemama - We decided not to do IUI if it ever was even an issue that it might help (which it apparently may now). For us, it was entering a third party into the act that was the deciding factor (which makes us think it might be disapproved one day).

    Buckeye - Thanks for all the great info!! His first SA was done by my ob/gyn who had no speciality in IF whatsoever. There's a good chance it wasn't done the right way.

    JB - He's not on anything, but probably a good idea just in case. Thanks!

    FJIEJ - Is a follicular series the same as an u/s series? If so, I had that done at TCIE's dr's office two years ago and it showed that I didn't ovulate. That was also before having three surgeries so I hope things are different now. Will Dr. Stegman do that? I want one!!

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  14. Ugh, how frustrating - all of it! As others have said, I've heard that Clomid causes hostile mucus in a percentage of women. I would highly recommend Pre-Seed.

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  15. I am right on board with everything both NeNe and FJIEJ said... I have nothing more to add!

    I don't need nearly as many mucus enhancers on Femara as I needed on Clomid. Maybe Femara would be better for you, especially long-term b/c Clomid can thin out the lining as was already discussed.

    Since they said you already ovulated, your mucus was Type G, and was doing exactly what it should have been doing at that point. On the day of my post-coital, I ovulated literally that same morning. And it was the wildest thing, we saw the slide the following day (when the mucus had dried), and under the microscope I saw Type E mucus throughout the middle of the screen, and then Type G mucus in the corners of the screen. My mucus was in the MIDST of changing. UN. REAL! It looked just like that slide in the Intro Session...
    but yeah, I wouldn't worry about the results.
    If you get another SA, we had ours done at an IVF clinic (unfortunately, only place around here that does them) BUT they did it well. That being said, their morphology results are based on the assumption that people will be going through sperm washing and ICSI procedures, so they are REALLY strict. It looked from our 1st two SAs that DH's sperm were ALL retarded!! But the 3rd (that Dr Toth ran in his lab) showed vast improvement after he was on vitamins.

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  16. (UM, ok, so clearly I did have more to add, hahaha... some one shut me up!!)

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  17. I"m with TCIE, you need a strict Kruger SA, that is how ours gets done. We also go to a fertilty "ivf" clinic for the SA they do the best ones. Also I disagree with your DR on the post coital I think if you are showing mostly dead sperm that's something that needs to be looked into. maybe you should look into a different DR?

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  18. I came across your blog. I'm going through my 3rd time with fertility treatments and wanted to comment.

    If you are leaving the doc's office more confused, then is it possible to find another doctor? My RE would never do a trigger shot blindly and just guess at things. When I do my consultation with my RE he checks everything (I've never done a post coital though)and goes over our expectations and how far we are willing to go. I don't know what you've had done but I've had a hysteroscopy and HSG in the office and tons of bloodwork and dh has tons of bloodwork and 2 SA's so far in the past few months.

    I've done 6 cycles of clomid with no success and 1 cycle of tamoxifen with no success. My first cycle on injectibles with timed intercourse (homework!) was a success. When we decided to have another child 6 yrs later, went through all testing again, and 2nd cycle of Gonal-f we were expecting again (she was stillborn at almost 40 wks though, devastating).

    Clomid is terrible. It makes the mucous so hostile and your lining so thin. I even took an expectorant (Robitussin) to help the quality/quantity and nothing. Being on an injectible cycle is very controlled and monitored very closely until you get mature follies and then trigger. I go in every 2 days for the first week to have u/s and estrogen checked and then every other day towards the end. I also take one baby aspirin a day to improve lining quality.

    Definitely have dh get another SA. A lot can change even in a couple of months. If you are against having IUI done at the office, google at home insemination...not exactly the same as in office with a sperm wash but worth a look.

    I know we can do some desperate crazy things! Before PreSeed came available, dh and I used egg whites during clomid cycles because I had zero cm. You can email me if you like. I've been up and down this road without IUI (insurance won't even cover it) and dh has a low morphology (3%). It really sounds like an at home insemination would be helpful especially if dh has a prob and you have a tilted cervix. Also, a rule of thumb with the trigger is that you will ovulate sometime within 36 hours. 36 hours after trigger is usually when IUI is performed.

    A good doctor really makes a difference!! Sounds like you've got the positive attitude, just need a doc who really knows their stuff and can explain things to you better. If they can't explain what's going on, then they don't know!!

    Emily
    all4mymarine@yahoo.com

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