Last week we returned to The Fertility Clinic and met with Dr. Cotter again, to review my tests and talk about next steps.
What's new in my skin:
I started bleeding after 30 days on my last cycle. I had one positive OPK and fertile mucous, albeit not on the same days, which was sort of confusing. I suspect I might have had a second LH surge, but missed it. Still, there seemed to be some good stuff going on, and 30 days is a decent length, so I considered it a normal-ish cycle.
Dr. Cotter was on her typical form. I can add a few more zingers to my collection of quotes. As Mr. Turtle observed, "She starts every meeting with an insult so later it's hard to argue with anything she proposes." True enough. Nobody can accuse Dr. Cotter of looking at reproductive systems through rose-coloured glasses.
She started with "You're not better." No, after a year and a half of "trying", I know I'm not better. We went over the results of the tests. My CD2 bloodwork (Estradiol, FSH, LH, TSH, prolactin) was totally wrong. "You were not on CD 2 when you did that blood test." In hindsight, I guess not. I had indeed been bleeding for 2 days when I did the blood test, but then I started bleeding again after only 2 weeks. So that was not a cycle. Dr. Cotter said that my estrogen levels during that "CD 2" test put me at about mid-cycle, possibly ovulating. WTF? We couldn't explain it so shrugged and moved on.
Dr. Cotter then launched into an explanation of AMH (anti-mullerin hormone) that seemed to go on for an uncomfortably long time. A fertile woman has an AMH of between 15 and 25. Well, that was not going to be my number. Under 7, it's very hard to get pregnant. "And yours is 0.9." Which sounds slightly better than zero, but admittedly not much better.
Next were the results of the pelvic ultrasound which I did on day 3 of the next cycle (the one that was 30 days and maybe actually a cycle). I had 2 antral follicles on one ovary and 1 on the other. I don't even know anymore what the normal number is supposed to be; something in the double digits; again, that's not me. As we know.
Dr. Cotter said she saw no need to repeat the blood tests as the other tests told the story well enough. In addition, the ultrasound showed a fibroid of 3.3 cm that might be beginning to intrude into the uterine cavity, but it was not too clear. She recommended a sonohysterogram to take a better look at it.
As for fertility "if you are going to be trying anyway, we might as well do what we can to help." So the plan is to do low dose Clomid on days 2-6. Dr. Cotter said they have seen results with low stimulation on wonky ovaries. "It tends to work best when the last cohort of follicles is being recruited." (Oh, that's a good one.) After taking the Clomid, I will have blood drawn on Day 21 to check for progesterone levels, to see if ovulation happened. If not, they will look at adjusting the dose. I have my prescription for four cycles. And the requisition for the sonohysterogram.
I'm happy with this plan; it seems reasonable enough. But I have a problem. To get the show on the road, I kinda sorta need to know when CD 1 is. Apparently, that's not so easy. Case in point, I am bleeding again on day 11 of this cycle. Is it the fibroid? Unbalanced hormones? The low dose aspirin I was taking? (Cutting that out). Is this my period? Or was the bleeding one and a half weeks ago my period? Or neither?! Cue WTF moments. I might need more guidance what to do in this situation, as it really isn't clear to me.
One good thing though. I have new menstrual products. My frequent periods/EBBs mean I spend a lot of time wearing pads and panty liners (tampons I gave up some years ago; while I don't always have a lot of pain and discomfort, they seemed to increase it when I did). I had been getting a lot of chafing and discomfort from them. In addition to my reproductive issues, I have this cyst in the clitoral area that flares up every now and then (I had a bad abscess last year that require surgery.) So a few weeks ago I started looking into alternatives for period stuff, and finally decided to try cloth pads / liners and now some underwear that is designed to absorb flow. These options are WAY more comfortable. I feel so free knowing I don't have to buy that crap from the store anymore.
So there you go. The joys of further intervention, the limits of physical self. It's tiring and frustrating. But I still feel I have to trying whatever might make a difference, because if not, I'll wonder about it. Humans have a strong gambling instinct, and in this respect at least, I'm no different.