My "old" doctor (yes, I'm changing clinics) called me this morning and wanted to reschedule my HSG from today to Friday. So now I'm going on Friday to that alone without Chris and will have to drive that night. :( Oh well, it's just one day.
The new RE (Reproductive Endrocrinologist) is Dr W. She asked me why I was there and I told her Recurrent Pregnancy Loss and Low AMH (Anti Muellerian Hormone- that's the only test I "flunked" at Dr G's and indicates poor ovarian reserve.)
She immediately said she doesn't have much use for the AMH test! Yes!
The old doctor was basing everything on that test. She said it's too new of a test and the result values are not very standardized yet. It was originally studied in London and they use a different value measurement system. Repromedix is a big fertility lab and their website says very plainly that AMH should not be relied upon soley to determine ovarian reserve.
She's very hopeful since I have normal FSH, LH, estradial, follicle count and ovary volume. She thinks those are much better indicators of ovarian reserve. She would love if the AMH test was accuarate but she's had too many women with low AMH have successful pregnancies. She basically said that the AMH shows I'm not a fertile as a 20 year old but we knew that already. She feels that it's just indicative of my age. Now if a 20 year old had low AMH, then it would be a more serious problem.
She also said IVF was something that should be worked up to. There's many steps to try before going there. She said she was confident that I would have a baby. I know that's a standard pep talk but it was still nice to hear her say it. It was nice to hear after the other doctor was all doom and gloom.
Did I ever mention that Dr G is creepy? I told Chris once and he didn't get it until the other day when he felt creeped out too. Maybe someone telling you that you need IVF helps push them over to creepy-dom but I think this guy comes by it honestly.
Back to Dr W: She said it was up to me whether I have the HSG done. It wouldn't hurt and may help since it would "blow out" my tubes. That could clear out any debris in there. So I'm still getting it done on Friday. Again it was nice to hear that she agreed that I didn't *need* the HSG since I've been pregnant twice on my own. One of those tubes has to be open!
I had an ultrasound and there aren't any cysts in my ovaries. So I probably didn't ovulate even though I had all those cramps around CD 13-14 like normal. She said it was still possible but there was no evidence of it.
All her RPL patients are on baby aspirin and prosgesterone. BA helps with implantation issues and is given to those with known clotting disorders. Progesterone helps support the uterine lining. Both are extras to help with a pregnancy. They do no harm but could help. So I'm to start this next cycle.
On CD 3- next week! I'll go in for an ultrasound to verify there's no cysts. She said CD 3 blood work wasn't necessary since I've had two normal FSH cycles. Wow, a doctor wanting to save me money!!
On CD 5-9, I will take 100 mg of Clomid. Clomid masks the estrogen receptors in my body which will cause more FSH to be release. More Follicle Stimulating Hormones = more follicles= more eggs hopefully. Dr W says that it will increase the risk of twins to about 10-15%. Clomid does have some side effects so we'll do a PCT to verify that I'm still sperm friendly and my uterine lining is okay.
On CD 12 I have another u/s and will probably trigger with Ovridel. Ovridel is an injected medicine that mimicks the LH surge. It will "trigger" ovulation, maybe of more than one egg if the follicles are mature.
We are to have sex and then go in the next day for a Post Coital Test. If the post coital is bad, then I'll have an IUI the next day to get the sperm where they need to be.
I'll then start progesterone supplements (think she said 3 days post trigger). Progesterone is produced naturally by the CL cyst in the ovary. However there's some debate whether low progesterone causes a miscarriage or a bad pregnancy causes low progesterone. I'm glad I found a doctor that is willing support with progesterone just in case it will help.
We'll do this for 3-4 cycles before moving on to injectibles. At 3 cycles, we'll talk if I want to do the 4th or move on to injectibles.
So that's the game plan. Baby aspirin, Clomid, timed intercourse, IUI if necessary, and progesterone.
She sounded very positive that we just need to get the right egg and the right sperm together. Hopefully I have the right egg!