Let The Diagnosing Begin

So let me take you back (2 years and 7 months ago), to where it all started… Robbie and I got married on July 2, 2016 in a beautiful ceremony at my Uncle’s house. It was simply perfect. Surrounded by 100 of our closest friends and family, we said our vows, leading into the next step of our lives as devoted and loving husband and wife. We had always planned that after we got married, we would have kids. We gave ourselves a two month grace period to pay back some wedding debt, and then we would get pregnant.

It was never a concept we questioned, as no one ever expects to have fertility problems. In my mind, I was 25, a healthy weight, ate a nutritious diet, don’t drink, never smoked, limit chemical exposure, and have a very regular period (if this is too much, maybe stop following along because it is a TTC blog after all). The only downfalls I had were that I never worked out and I love coffee, tea, all of that good caffeine. But if those are my biggest downfalls, its really not all that bad, right?

For the first few months, every month that came and went brought a little more sadness than the previous month of failure but we still remained so hopeful. Next month it’ll happen or its okay, sometimes it doesn’t happen right away kept echoing through my mind. It was December when I broke down and said I know something is wrong with me. I just had a feeling.

Generally if you are under the age of 35 with no pre-existing problems that would affect your ability to conceive, you have to wait for a full year of actively trying before you can get a referral to a fertility clinic. So we waited patiently, monitoring my ovulation, taking my prenatal vitamins, waiting for that one year to come up and hoping for the best in mean time.

September 15, 2017, I went in to get a referral to a fertility clinic (the closest one to us is in Ottawa, just shy of 2 hours away). The one thing no one tells you about infertility is the amount of waiting you have to endure. Seriously its ALL you do. Wait for calls. Wait for your next period. Wait until you’re on your day 3 for blood work. Wait for an ultrasound. Wait for another ultrasound because your body isn’t responding properly. Wait. Wait. And wait some more. We got a call back from the clinic at the end of November (FINALLY), only for them to say the next available appointment was in January. Cue the waiting again.

Well as time always prevails, January 18, 2018 finally rolled around. The initial appointment went for about 1.5 hours, as we met with a nurse and went over our personal and family health history, underwent basic physical exams, blood work for Robbie, and met with our Doctor who would explain the beginning of all our testing we would undergo. For the first time in months, I felt so much relief knowing that my problems were no longer my problems alone. Now, they were in the hands of someone who knew what do to. From here, our next step was to wait for my next cycle so that we could begin the testing on me.

Let the Diagnosing Begin:

To keep this short and sweet because its a bit mundane and blah (but I want to explain everything since I have had so many people ask – how do they even test you?), I went for blood work on cycle day 3 to get a variety of hormone levels tested.
Day 6, I went back to Ottawa for a baseline ultrasound (trans-vaginal – or as one of my friends likes to call it, the wizard wand). This is to check if you have any uterine fibroid or cysts, measure the uterine lining, size of the uterus and ovaries, and to count the number of follicles (follicles are basically the bubble that protects and grow your eggs).
Day 9, back to the clinic I go for a hysterosonogram. With this ultrasound they see if the uterus is “normal” (if I use quotations, its obviously because mentally I’m doing air quotes with my hands) and to see if my fallopian tubes are open. A small catheter is inserted into the cervix, saline water is injected into the uterus, once the uterine lining is seen, tiny saline bubbles water are sent into the uterus which flow to the tubes to see if they are open. A lot of people say this ultrasound is incredibly painful, for me it was just extremely uncomfortable and gave me abdomen cramps for a few hours afterwards. Cycle day 21, more blood work done to test progesterone levels after ovulation.

Testing for Robbie was a whole lot easier (and to be honest, a lot less invasive). All he had left was to do a sperm sample from the comfort of home. In a plastic bag, contained a note of all the requirements for the sperm sample, and a specimen bottle. According to the note (another TMI), after the “sample” (air quotes again) is collected, you have 1) 20 minutes to bring in the sample before the swimmers die and 2) to keep the specimen container in your shirt to keep the swimmers warm and alive. To this day, the thought of Robbie driving off with that sample under his shirt still makes me laugh. For some, this might be a mortifying moment but thank God we have a warped sense of humor.

The Verdict is In:

April 6. The big day of our tele-med video conference call to receive our results. It is so hard to articulate how scary and intimidating this day was. Both of us were so nervous that we wouldn’t get any answers or that we would reach a dead end. Its so easy for your mind to wonder and so many times, we had the what-if we cant have kids conversation, a growing not so lighted-hearted version of pillow talk that was starting to consume our lives.

I’m going to be quite frank and say that although I felt like I was the problem, I secretly hoped it was Robbie. And I told him that for a few weeks beforehand. Now before you think I am selfish, let me explain. The only reason I say this is because I knew if it was me, I would place so much blame on myself. What could I have done to change this? Is this my fault? I felt that the guilt of me being the problem would be overwhelming. On the other hand, if Robbie was the problem, I knew I would be able to look him in the eye and genuinely know that his problem, is our problem. That we will get through this together. Simple as that. No guilt. No shame. No blame.

We waited anxiously in a tiny waiting room with an overtly large screen television, waiting for the connection. It felt like we waited an hour but in truth, it probably was a mere 10-15 minutes.

Finally we connected.

We went over everything. All was well on Robbie’s part: high sperm count and his motility was okay. Mine on the other hand was not what I had bargained for. My blood work came back, bringing forth a variety of concerns. Also the next stuff is a wee bit scientific so in the rare case this blog ever ends up in the hands of someone who knows about this in grander detail, have mercy on my soul for the amount of butchering I am about to do. My follicle stimulating hormone came back abnormally high, which is a signal that the brain is trying to boost the performance of poorly performing ovaries. My estradiol (estrogen) levels came back low, and with a combination of other results, my doctor said this all could indicate possible premature ovarian failure. No, this does not mean that my ovaries are in organ failure per say, it just means my biological clock is ticking earlier than we would like.

She reiterated that my uterus looked good, fallopian tubes were open, and the another concern was my follicle count of 9. A low 9 follicles. The average 25 year old women is expected to have anywhere from 15-20 follicles. She explained that although my count way lower than average, the real concern was the size. She then went on to compare my egg count and quality to that of a 45 middle aged women (her words exactly), and that they were considered immature (also another lovely descriptive word used).

This is were a lot of confusion about my personal diagnosis comes into play. In order to produce a viable egg, your body will develop all of these follicles and naturally one follicle will take the lead (in the odd case, multiples might be released) to be the chosen egg for ovulation. Once a follicle reaches a minimum of 15 mm (ideally 18-22 mm is preferred), its considered “mature” and will be ready for ovulation. Also a follicle just houses your egg – your egg once its released into the Fallopian tubes is about the same size as the period at the end of this sentence.

Basically, what we were told was that my follicles are considered immature, meaning that they don’t reach a size where they are anywhere ready for ovulation. So there was the beginning of a new phase and an official diagnosis: Low Ovarian Reserve.

What Next:

I remember listening to our doctor explain everything and just sat there trying to remember every detail she was stating. Making mental notes along the way as my hand scribbled notes frantically on a once blank page. Finally we came to the end of the appointment and I asked what next?Two options were presented:

1) in-vitro fertilization (IVF) or

2) super-ovulation intra-uterine inseminination (SO-IUI).

IUI was a good option as it was financially more feasible but had a lower success rate of only 15-20%. The term super ovulation just means that they want to stimulate multiple follicles to increase my chances of conceiving. Upon explaining that IVF was our best option (success rate up to 50%, more personalized option based on my diagnosis and doctor recommendation, and a chance of leftover embryos to ensure I have options if my reserve depletes more over the years etc.), we really wanted to be on board with IVF until she mentioned it would cost us $15,000 – $18,000 out of pocket.

I can’t even recall what my reaction was because I think that number stung so bad it stopped my heart momentarily. Upwards to $18,000. Please, use this as a reminder why the average household just cant “do IVF” because there is no way we have that kind of money sitting around for something that isn’t even a guaranteed success.

Fortunately for us, OHIP is just dreamy and I’m telling you, Ontario is the place to be if you have fertility problems. The Ontario government actually covers the medical costs of one round of IVF, you are just required to pay for the medication (which is still thousands of dollars) and storage fees from the clinic. The only downfall is there is a 12-16 month wait list. We both decided on the spot, we would get on the wait list and pursue IUI’s in the mean time since I couldn’t just sit and twiddle my thumbs for the next year.

The moment we disconnected, it was as if on cue, both of us had a moment to breathe and process all the information that was just thrown our way. We sat in that room and cried. I remember so vividly sobbing “I’m the problem” feeling so much blame already. My husband looked at me with tears in his eyes as if we had just received the most wonderful news in the world, and said “why are you crying? We can still have a baby.” And that alone just made me cry even harder, because here was this man that was so uplifting and always finding the silver lining whenever I tried to situate myself under the storm cloud. There we sat, two grown adults crying, me taking pity on myself because I’m the problem, and Robbie because we didn’t have our dreams of having a family crushed.

It wasn’t until a few months had passed, that Robbie confided in me that he really thought he was the problem. That earlier that year, he was exploring the forests of British Columbia and came to an area that was considered a high radiation area. He actually thought that contact with the radiation had damaged his sperm quality. In that moment I thought about how grateful I was the problem, so that he wouldn’t have to live with that guilt.

Every day since that day in April, Robbie has never said or made me feel like the problem. Its always been our journey, us going through infertility. Some days the only reason I could pull myself together is because the love and strength that Robbie endlessly poured onto me. And that I endlessly pour back into him.

Find someone who endlessly pours their love into you,

Rebecca

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