What exactly is my malfunction??

While no one has asked, some may be wondering exactly what is wrong with that we have been trying to get pregnant for over 4 years, and still have empty arms. So even if you weren't wondering, today you get to know. :)

When I was about 19 years old, I was diagnosed with PolyCystic Ovarian Syndrome, or in infertility-speak, PCOS. At that time, I was told I would probably have difficulty getting pregnant without the assistance of infertility treatments. PCOS is a collection of symptoms, and doctors still don't know all there is to know about it, but I'll give you the overview. When a baby girl is born she has all of the eggs she will ever have. As she matures and starts menstruating, each month various follicles begin to mature on her ovaries. Normally one follicle takes the lead and becomes the dominant follicle. The hormones are focused on that dominant follicle, and it continues to develop while the rest go away. Inside that follicle an egg is maturing. At ovulation time, a hormone called Luteinizing hormone or LH levels spike, and causes the follicle to rupture releasing the mature egg. Well, with PCOS something goes wrong in the middle of that process and the egg doesn't mature and release. So the little follicles all remain, and turn into small cysts. So on an ultrasound of my ovaries we always see a whole bunch of little cysts. If you go back to your grade school English lessons you will remember poly means many. So I have a syndrome of many cysts. The cysts are just a symptom of the problem though, not the cause. There are many, many other symptoms of PCOS. But this is the most relevant to today's lesson. The cause of PCOS is believed to be related to insulin resistance. For that reason I take medication every day that is actually for diabetes. For many women this medication has caused them to begin ovulating on a regular basis. It hasn't done much for me.

As I said, this I have known for a long time. When we first started trying to get pregnant, shortly after we got married, and it was evident things weren't happening for us, we went to our family doctor. Since we knew I had a problem, we worked on that. He did some tests, he put me on the diabetes medicine, and also learned that I had a low functioning thyroid. He put me on a medication for that as well. Things sill weren't happening, so in early 2005 we went to a gynecologist in Boise that also did infertility treatments. This doctor helped one of my best friends conceive her twins, so we were all for giving that a try. We did some basic testing and treatment with this doctor. Once again he knew that I had PCOS, and was didn't ovulate on a regular basis (if at all.) So we set out on trying to treat that. After the first cycle, they decided to make sure there wasn't a problem with Mark, so that was tested. No problems with the swimmers. Five cycles of treatment later (four ovulatory, one not) we were tapped out financially and emotionally. We had to take a break.

A year later we talked about things, and decided to explore other options. There is a history of adoption in my family. I'm all for adoption. I also don't want to miss out on the experience of pregnancy. One great option out there is called embryo adoption. (Embryo adoption is something so exciting to me, and still definitely an option for us to explore more later. That is a lesson for another day though.) Anyway, we set up a consultation with the only reproductive endocrinologist clinic in Idaho for a consultation to discuss embryo adoption. This whole process is so emotional for me, I broke down in tears in our consultation. The doctor pretty much dismissed everything I said. He said we were giving up before we ever really even tried. He ordered some more tests to be done. The first test was called an Hysterosalpingogram or an HSG. That is when a contrast fluid is injected into the uterus through a small catheter. An x-ray picture is taken as the uterine cavity is filling and then additional contrast is injected so that the tubes should fill and begin to spill into the abdominal cavity. Additional x-rays are taken as this "fill and spill" occurs. When I had the HSG done in December of 3006, we learned that my left tube was blocked. I called the other doctors office where we had done the 5 treatment cycles. I asked them to review my chart and see which side I ovulated on each of the 4 ovulatory cycles. 3 out of 4 were on the left side. So out of those 5 cycles of treatment we only had one good chance. Not very good odds. Even couples with no fertility problems at all have to try more than one month to get pregnant. Below are some pictures from an HSG. They are not from my test, but instead borrowed from a medical website.

Courtesy of Intermountain Medical Imaging, Boise, Idaho.
Figure 1 is an X-ray of contrast material moving normally from the uterus up through the fallopian tubes toward the ovaries. Figure 2 shows a blocked fallopian tube on one side.

The other thing that was discovered in the routine testing at the fertility clinic was an elevated level of FSH, or follicle stimulating hormone. That indicates a "low ovarian reserve." In other words, I'm getting low on eggs. Not too common for a 29 year old. More common for a woman entering menopause.

These things were hard to learn, but so helpful in figuring out HOW to treat me. They know that they need to make sure I'm monitored until I have a dominant follicle on the right ovary. I know that God has a plan, and He is bigger than all of these problems.

This has gotten waaaaay longer than I planned, but hopefully someone has learned something new today!