I guess first things first... all my tests came back "normal" or within normal ranges. That said, The doctor felt it would be prudent to start me on baby aspirin since it won't really hurt but could possibly help in a lot of ways. For me... this means I also have to take a PPI (think prilosec) to protect my now abnormal stomach from getting an ulcer. No big deal, just something extra for me to think about.... something to be a bit more careful with. He also said he would like me to go ahead and start on DHEA which is an over the counter supplement. He said it is the "big deal" in IF treatment right now. It may not be in 5 years, but it is right now and it won't hurt but has been shown to help.
We talked about my theory of not ovulating strongly on my own, thus not having a good corpus luteum which then does not do a good job at sustaining a pregnancy until the placenta takes over. He agreed it could definitly be an issue and agreed with me when I suggested doing just 50mg of clomid to help boost with ovulation. He even thinks it is possible only half a 50mg will do the trick, but left it up to me to decide.
He attributes my previous miscarriages to the hyperplasia, as all my previous specialists did, and feels like it is possible this past loss was just something that could happen to "any healthy woman of childbearing age with no real reason except that it happens." He said he is very proud of me for the hard work I have done to make myself healthy and feels like I have a normal, healthy body which is perfectly capable of getting pregnant and carrying to term. He feels like I will ABSOLUTELY get pregnant and have a baby soon. In his opinion I no longer have PCOS... he said my ultrasound after the miscarriage showed MULTI cystic ovaries not POLY cystic ovaries and my labs were normal. He feels like there is NO WAY I could respond so well to only 50mg of clomid (a progesterone level of 47 mid LP) and have full blown PCOS. Impossible in his medical opinion.
We talked about Aaron's latest semen analysis and the connection to going off SSRIs and he was thrilled for Aaron. He looked over the studies quickly and said it made perfect sense and explained it further to us. He noted how some people absolutely cannot go off their SSRIs like Aaron was able to do. But if Aaron is surviving OK without the SSRIs, it is obviously making a huge difference in his sperm production. He thinks it will likely continue to improve, but the fact Aaron was able top get me pregnant with the improvement already shown is great. He wants us to try on our with with timed intercourse for a few cycles since we have been able to get PG on our own already, but if not successful after a few cycles we will move forward with IUI (intrauterine insemination). The GREAT thing about an IUI now versus a year ago is the cost will be incredibly less. I will not need more than 50mg of clomid ($10-$15) only one u/s ($130) and the IUI ($80) as opposed to 2-3 vials of menopur A DAY ($15 a vial), 4-6 ultrasounds ($130 each), an hcg trigger shot ($15) and then the IUI ($80). That's about $225 now as opposed to $700- $1000 last year. So I guess you can say losing 130 pounds is quite profitable!! hahaha
We talked about taking progesterone after ovulation. He doesn't feel my issue is really related to progesterone since I had great pregnancy symptoms up until the miscarriage. BUT, he will give me progesterone if I want it. It's another one of those instances when it may not help, but it definitly won't hurt. He said for some people it is purely psychological as well... makes the woman feel more comfortable, confident and less stressed which all can help her health in general. Kaiser does not typically give progesterone unless it is connected with IVF, but he is head of the Infertility department and said he would do it for me. They don't even usually do a mid Luteal Phase progesterone draw, but he put in a standing order for blood progesterone levels so I can check it when I want.
We also talked about possible immunology issues and taking prednisone to combat this. He is not one that necessarily "believes" in reproductive immunology, but he is also willing to give me the prednisone if that is what I really want to do. He asked me to first do some labs, then we would talk about it further. He said he even did ivig for one woman who wanted it done... I assured him I would not push him that far! haha
Let's see.... what else? It was a looooooooooong appointment.... over an hour, so I am probably forgetting something. I will edit if I remember anything else.
- baby aspirin daily (with prilosec)
- DHEA supplement daily
- clomid days 3-7
- Mid LP progesterone draw. I can take progesterone if I am not comfortable with the level.
- further blood work possibly leading to daily prednisone.
I think that's it!!
Oh! And I started getting fertile cervical mucus a couple days ago and he gave us the green light to try to conceive!