Initial Consult
On April 8th, 2019 I had my first appointment with Dr. G and it was super informative and straight-forward. He was empathetic and seemed quite optimistic. He addressed my concern about my history of post-anesthesia delirium in a matter-of-fact way. During the egg retrieval process (which requires sedation) I will be scheduled for either the first or the last slot of the day, insuring that I’ll have an extra nurse on staff to be with me. They’ll also make sure to give me plenty of time for the versed to take effect before wheeling me into the operating room (which is a PTSD trigger for me). A few days before the surgery, I’ll also go down for an anesthesia consult to discuss the treatment protocol and get any questions answered. So I left his office feeling very optimistic and like my well-being as a patient was taken very seriously.
Day 3 Testing and Ultrasound
After the initial consult, I went off birth control, since oral contraceptive pills have been found to inhibit follicle growth. Then I had to wait until my next cycle so that they could measure my baseline hormone levels on cycle day 3. They also do an ultrasound to check the basic measurements and structural viability of the ovaries and uterus. Then they count the number of follicles in each ovary (known as the Antral follicle count, or AFC). Finally, they perform a hysteroscopy and a doppler ultrasound to measure the blood flow to my uterus, to determine whether I am likely to be able to support a fetus up to term.
All of my results came back normal except for three. My antral follicle count was a bit low, at 8. They like to see more like 10 follicles in someone my age. Correspondingly, my AMH (Anti-Mullerian Hormone) was also a shade low at 1.51 — greater than 1.6 is considered good for someone my age. Neither of those numbers are big red flags, but they do indicate that time is not on my side. Six months or a year from now, IVF using my own eggs might not be an option at all. Not to worry, our calendar is cleared out for the summer!
The only other abnormal result was my TSH levels, which were slightly elevated (3.22) although still in the normal range for the general population. This is called “subclinical hypothyroidism” and most endocrinologists wouldn’t even begin treatment at this point. However, a fetus in the first trimester has an elevated risk if the mother has TSH levels above 2.5. For reference, most people won’t even feel marked symptoms of hypothyroidism until their TSH is higher than 10 or so. It really depends on the person.
Fortunately hypothyroid is one of the easiest things to treat, and, lucky me, I already have an endocrinologist! (Granted, a reproductive endocrinologist, but he’s done all the general training of course).
So with all of my blood and anatomy results in, plus a normal semen analysis, we are now in a relatively encouraging place to start IVF. I only say relatively because being 38, I am not exactly a spring chicken any more. There are also still a good number of unknowns. How will I respond to follicle stimulation? Will they be able to retrieve enough eggs that at least one of them gets fertilized, survives to blastocyst stage and has the correct number of chromosomes? (Most chromosome abnormalities are not compatible with life. One exception is trisomy 21, which causes Down Syndrome and a life expectancy of 60 years).
I’m trying not to think too far down the line, so time will tell.