Brighter Days

            On Monday of this week we had our first visit to our new doctor! If you are regular reader of this blog, you know that we have not had the best luck with our last fertility specialist. He is a very unpleasant man, with a serious lack of bedside manner. After he told us we were wasting our money seeing him, I booked an appointment at a new clinic. The clinic is called CORM, and is so close to our house that I cannot believe we were driving on the other side of Houston before. Anyway, one of the best parts about this new clinic is that our specialist is a female. Don’t get me wrong, I don’t necessarily think women make better doctors, but when it comes to dealing with my most intimate regions, I would prefer a woman to a man.

            Dr. Schnell is one of two doctors in the practice, and she really is very sweet. Although, we waited in her office a long time to see her, when we were with her she was thorough, professional, and very good at answering all of our questions. She did a physical exam and ultrasound on me, and talked to my husband and me at length about our treatment options. During the ultrasound, she confirmed that I did, in fact, ovulate this last cycle. But, I was not pregnant, a fact I knew because I had just finished my period. I told her about the pain I had during my last cycle, and she agreed that it was most likely due to overstimulation from having two cycles of Clomid back to back without a period in between.

            We learned a lot from this visit. I knew that PCOS made up the majority of female related infertility, but I had no idea that 40% of infertility patients are due to male infertility, caused from slow swimmers to low sperm count and everything in between. My husband has not had a semen analysis done yet, but he will be having one soon. We don’t really have a reason to believe he has issues with his sperm, but you never know. Incidentally, he’s not really looking forward to this test, because, as you can imagine, it is awkward to produce a sperm sample in a doctor’s office.

After my exam, Dr. Schnell spoke with us again about another test she wanted to conduct on me. The test is called a Hysterosalpingogram (HSG). Basically, an HSG is an x-ray conducted after dye is injected into the uterus through a catheter to check if the fallopian tubes are open. This test is usually a test given early in treatment between days 5-10 of a cycle. I had asked for this test repeatedly when we were seeing Dr. Smith. And, although it is normally one of the first and most basic tests, he told me that I did not need it. After seeing Dr. Schnell one time, she ordered the test, and I had it done yesterday. Amazing how much faster things work when you know what you’re doing! I was given a Valium for the test in order to relax the uterus and lessen some of the pain. The test isn’t painful, but it’s uncomfortable. A catheter is thread past the cervix into the uterus where a small balloon is inflated to prevent the dye from leaking out. The balloon is the most uncomfortable part of all of it. The pain is like a normal menstrual cramp. I actually got to watch the dye fill my uterus and flow through both fallopian tubes on the screen. The entire procedure probably took 10 mins, at most. And, the results… ALL CLEAR! This means that when I ovulate, the egg has a clear path to the uterus.

But, the successful HSG isn’t even the most exciting thing to come out of our visit with our new doctor. The best thing is that SHE HAS A PLAN! Every time we saw Dr. Smith, the plan was always to wait and see. There was no clear path. But, Dr. Schnell has a 31 day pregnancy plan. We will go back to see her on May 8^th to start a new cycle. First, I will take a medicine to induce a period (not Provera, which I hate). Then, on day three of my cycle I will start Clomid. She is increasing my dose to four pills instead of three, and I am starting the pills two days before Dr. Smith had me start them. On day 11, I will have an ultrasound, begin taking an estrogen supplement, and receive an HCG trigger shot. Over days 13-15, my husband and I are to have sex, or if his semen analysis is not so great we can opt to do IUI (artificial insemination) with his sample. (The IUI is more effective because it forgoes the sperm traveling through the cervix in order to reach the egg.) Here’s where things get really tricky, I will have another ultrasound, another oral estrogen pill, and two more HSG shots between days 18-31. The extra two trigger shots are smaller doses than the one that forces ovulation. They are used to maintain the egg growth, so that I have a greater chance of not miscarrying early in the pregnancy. HSG is the pregnancy hormone; it is what causes the home tests to give you a positive, so it is not harmful to the baby. After this entire process has concluded, if we are still not pregnant, we will revise the plan and try a more aggressive treatment.

I am happy to report that Dr. Schnell only took me off one medication Dr. Smith had me on, the estrogen supplement. According to Dr. Schnell, if you take this pill daily, it makes it more difficult to get pregnant. It is best to take a higher dose for a few days during the cycle. Since the estrogen I was taking was only available from a pharmacy that did not take my insurance, my husband and I were both pleased to not need it anymore.

In general, things are looking up. I really have a good feeling that we will get pregnant before the end of this year. This new clinic is professional, friendly, and technologically advanced. (They use computers- a concept that Dr. Smith never got.) I’m looking forward to our next visit with Dr. Schnell, and if the worst part is the long wait times in her waiting room, then I would still say she is worth it.