Back in Tampa Labs

With my full day work up complete I still needed to complete Day 3 labs. The office I am working with insists these must be completed by their lab so I had to find a place to draw my blood, spin in down, and hand me the vials for me to mail back to Colorado! Whaaattt?? And all this had to be done on a specific day. So armed with my shipping box and instructions I was able to have the blood draw at AnyLabs.com and then the next day I had to ship the temperature controlled serum with the ice packs overnight via fedex. This was a challenge, I went to the largest fedex location in my area and they don’t take packages like mine….blood, lol. I had to drive to the main fedex location by the mall. Every step of this process is dripping in stress due to the specificity of cycle day and the fear of lost time. Every month that ticks by is sooo stressful.

I dont know why but this was tough. I think I was just so afraid I would do it wrong and cost myself another month. I also was worried the lab would have a different protocol than the office required. But I think some of these practices are ubiquitous.

Honestly, all the poking, prodding, testing, ultrasounds, and overload of information is hard. I keep thinking its harder because I dont have someone in the ring with me but I bet its hard nonetheless.

There is a lot that goes into the fertility picture but your hormones and follicle count give the doc the best idea of your likelihood of success. The purpose of day 3 labs is to look at hormone levels. I talked about AMH in previous post Link here . The other hormones can include:

FSH-Follicle Stimulating hormone. This is a hormone secreted by the pituitary in response to GnRH (gonadotropin reelaseong hormone) which is released by the hypothalamus. FSH goes to the ovaries and triggers follicle growth and eventaully ovulation. FSH works closely with LH.

LH- luteinizing hormone. LS is also secreted by the pituitary in response to GnRH. LH helps the dominant follicle of the cysle grow and be released (ovulation).

Estrogen is low at the beginning of a menstrual cycle and rises to a peak right before ovualtion and then takes a dive and a smaller, flatter peak in the second half of the cylce and falls again. Among its many roles estrogen is responsible for growing and thickening the lining of the uterus.

Progesterone is described as the calm, mama hormone. It is low in the beginning of the menstrual cycle and has a rise and peak in the second half of the cycle, after ovulation. Progesterone is responsible for maintaining the lining of the uterus. If pregnancy doesn’t occur then progesterone falls off and the lining is shed.

Day 1 of the cycle is when you start your period, ovulation is typically day 14 (midpoint) and a typical cycle is roughly 28 days.

What is functional medicine?

The begining of my Functional Medicine learning journey began with nutritional interventions. I am grateful to the people who have supprted my learning aliong the way. I got a running start with Pharmacy Innovations.

I have mentioned functional medicine in my about me and other spots on my platform. I would like to dedicate this blog post to explainaing a little more. Functional medicine is as much of a paradigm shift as it is a novel approach to therapeutic intervention. Functional medicine looks at the root cause of disease as opposed to controlling or treating the result or symptoms of disease.[1] The best way I heard this explained was from a speaker at the institute of functional medicine who said something along the lines of “depression is not because of a lack of Prozac but another underlying cause.” For me it was a realization that 15 years ago, when I was in pharmacy school, we had a handful of oral medications to treat type 2 diabetes and now, 10 to 15 years later, we have even more diabetes and more diabetes meds! So, the meds are not solving the problem but treating the symptoms. Functional medicine is an approach to healthcare where time is taken to delve into the patient's life, background experiences, habits, lifestyle, home and work environments, exposures to toxins and chemicals, stress, psychosocial support, and overall Wellness and health. This approach to health and Wellness takes time and patience. There are no quick fixes in functional medicine. In most cases chronic disease develops overtime and then it takes time to undo that properly. Now, don't get me wrong, medications are used by functional medicine doctors and the standard of care should always be deployed for proper patient care. However, while you are being treated with standard of care you can start to dial back the reasons why there is disease in the first place. Modern medicine is exemplary for treating acute issues. For example, if a patient breaks his arm or has a heart attack, modern medicine is the intervention that is best suited to intervene. But when it comes to chronic disease the modern medicine model does not work as effectively as it does in the acute situations. If it did, we wouldn't have more and more chronic diseases. Take autoimmunity as an example. Autoimmune conditions were rare when I was young, an incidence of 11% in the early 2000s, 10 years later,  it’s now at almost 16% incidence.[2]  That’s a decent jump in just 10 years (that was based on a lab marker for autoimmunity). Functional medicine is grounded in science. A lot of times we are looking at the biochemical processes that run the functions of the body to get to the root cause of why there is a disturbance or dis-ease. Let’s take the example of type 2 diabetes. This disease state is not a result of metformin deficiency, but it is a result of metabolic imbalance or inefficiencies. This disease state can result from a multitude of factors, for example, too many calories in and not enough calories out, or inflammation from a poor diet that also feeds into the first reason. Other reasons could be exposure to environmental toxins that are keeping the body from carrying on its metabolic processes properly. At the end of the day the cause could be different for 10 different patients. The goal of the functional medicine practitioner is to uncover the patient specific root cause and help the patient to reverse the causes of disease and not just treat the results of the disease, which is high blood sugar in our example. If you don’t already know high blood sugar can damage your vascular system. Since the functional medicine approach can take time to have its effect it is very much appropriate to use meds, where appropriate, to pull down the high blood sugar levels until the functional approach has taken hold.

[1] The Instittute for Functioanl Medicine. “The Functional Medicine Approach.” https://www.ifm.org/functional-medicine/what-is-functional-medicine/. 2022.

[2] Dinse GE, Parks CG, Weinberg CR, et al. Increasing Prevalence of Antinuclear Antibodies in the United States. Arthritis Rheumatol. 2020;72(6):1026-1035. doi:10.1002/art.41214

Full day WORKUP: you are going to be sticky!

Next, I made an appointment for my day-long workup and bought a plane ticket to Denver. This appointment was supposed to be timed with my cycle. Well if you are in your 40s you know that your cycles are not so regular. So my normally 21 day cycle decided to be 28 days. It turns out it was ok as long as there is absolute zero chance of being preggers.

So, what is included in a day long workup for fertility? (please note I am not using the word infertility because like I said I never tried to get preggers so I don’t know my fertility status, plus that sounds negative, positive vibes only). Workup for fertility can vary from doctor to doctor and patient to patient. It will depend on you and where you are on your journey. This is my experience and what I have learned as a result. I have referenced the material so it's somewhat informative.

First up: Intravaginal ultrasound to look at ovaries and count follicles. They also check blood flow. Ladies, follicle count is an important number. There isn’t a perfect way to assess ovarian reserve so follicle count and a lab value (AMH) is a good estimate. As we age the quality of our eggs decline. It is more common to have an egg that does not have the properly formed chromosomes. And the potential follicle count each month declines. In other words, less eggs and less quality eggs amounts to a double whammy! Chromosomally abnormal eggs do not survive and increase the risk of miscarriage. The data says that at my age, 80% of my eggs could be chromosomally abnormal. So the follicle count is important for IVF. If the doc retrieves 10 eggs, it is possible that only 2 are viable.

So, I cried with some relief after the tech looked at the second ovary. The first ovary had a count of 6, the second 4… "6 plus 4 = 10." Ten was the magic number that the first doctor was looking for. Mind you, I had 9 with the first doctor, and she said “donor egg.” My new doctor, we will call him Dr. H, said he could work with 9, but 10 was great (this is not a great number in general but good enough for me). I left that exam room feeling optimistic and a little sticky, lol. Oh! An important note on the ultrasound, no coffee (caffeine) is allowed for 48 hours before this procedure. The medical staff need to see good blood flow and caffeine can diminish blood flow since it is a vasoconstrictor. After I was done, I went straight to their coffee bar and got a coffee! Sweet salvation.

Next was a meeting with the genetic counselor. You do have to get screened for rare recessive diseases when considering IVF. Luckily I had already done my genetics with the local doctor. So she just explained when looking for a sperm donor that I would have to avoid anyone who was also a carrier for the one rare gene that could lead to a genetic disease I was carrying.

Next was the hysteroscopy. This is where the doctor goes through your cervix with a little camera (hysteroscope) to look at your uterus. The purpose is to check for scarring, polyps, or anatomical issues with your uterus. Obviously we all do not want to go through the pain and expense of IVF if your uterus is not a proper "bakery." This procedure is a bit more invasive and more uncomfortable and of course, more sticky afterwards. The good news is that it is quick. And all looked good! Yeah!

I regrouped with Dr. H to review the findings so far. Everything looked good, but he recommended Early Embryo Banking. This is where they do 2 or 3 retrievals of eggs, fertilize them, and once all the retrievals are done they test the embryos to see which are chromosomally normal. This results in a bank of embryos so that if I were to lose a pregnancy or embryo, I would already have backups and would not be starting the retrieval process at an even later date and older age. Additionally, there is some cost savings to doing the testing all at once. The chromosomally abnormal embryos are not viable, and therefore not good candidates for transfer.

Next was an HSG! Hysterosalpingography, but lets just call it HSG. This procedure was somewhat entertaining given the 2 lovely ladies that performed the procedure. They were funny and kind and made all the difference. For this procedure one technician threads a tube through your cervix and into your uterus where it delivers contrast dye. The other tech operates the X-ray machine which visualizes the flow of the contrast dye. The dye outlines your uterus and then fallopian tubes. The dye moves though to see if there are any blockages and to make sure your tubes are open. If there is anything anatomically off, the dye will outline it. The dye then spills out of your fallopian tubes. Not terrible but definitely even MORE sticky as you leave.

I want to note that both procedures where they entered my uterus caused some cramping. The cervix does not like to be messed with and cramps in response. I was supposed to pre-medicate with ibuprofen, but that aggravates my heartburn. I took tylenol and was fine. I am realizing that all of this is manageable.

Next came a meeting with my nurse to review and sign all sorts of documents. Super overwhelming. The amount of signatures reminded me of a closing on the purchase of a home. Lots to sign regarding the process and what to do with any remaining sperm and embryos. Wow! That is something to consider for sure. I would love to say that any embryo I didn’t use could be donated to someone else but I am too old to qualify for that. I opted to donate anything remaining to science.

Lab work is extensive. I had to wait for the correct day of my cycle, so I ended up doing most of this in Tampa. They do test you for sexually transmitted diseases since they store the eggs and embryos near others and want to be sure everyone is safe. They tested my AMH.

Of course you meet with the financial department. This is not cheap and mostly out of pocket, depending on your insurance policy. I will share more of my thoughts and experiences on this in another post.

Lastly, a meeting with one of their inhouse counselors who provide emotional support services. They really tried to tell me how hard this would be. They provide some great references and counseling services.

And that was a long day that ended at about 3pm. I was sore, crampy, sticky, and all I wanted was a shower. The team was so very professional, and I felt everyone legitimately cared and enjoyed their job.

Coelho Neto, M.A., Ludwin, A., Borrell, A., Benacerraf, B., Dewailly, D., da Silva Costa, F., Condous, G., Alcazar, J.L., Jokubkiene, L., Guerriero, S., Van den Bosch, T. and Martins, W.P. (2018), Counting ovarian antral follicles by ultrasound: a practical guide. Ultrasound Obstet Gynecol, 51: 10-20. https://doi.org/10.1002/uog.18945

Mayo clinic. HSG. https://www.mayoclinic.org/hsg-test/vid-20084751#:~:text=In%20HSG%2C%20a%20thin%20tube,and%20then%20into%20the%20tubes.

Know Your Status

At age 42 I found myself questioning if having a baby was going to happen. I have never tried to get pregnant. So I made an appointment at a local fertility clinic to get answers. I had a hard time with this particular doctor. We did not connect. And I was not ready for the news I was about to hear. Going into this workup I expected IVF to be the worst case scenario. I was expecting something along the lines of hurry up, but you are good for natural conception. This doctor looked at my AMH (anti-mullerian hormone) and my ovarian follicle count and insisted that I must use a donor egg. WHAT?! So the child would be completely not related to me. Well this threw me into a tailspin. I was confused, frustrated, angry, ok, very angry, and lost. Why was my expectation so far from reality???

Ladies, I am hear to tell you, do not listen to anyone who says "you are young, you have time." And realize these celebrities who are having kids later ages might not be using their own eggs. Sure you can have a child later in life if you are okay with using a donor egg. And there are always exceptions to the rule. GO FIND OUT! Get a fertility workup if you are in your 30's and wanting to wait.

I have learned that many people I know have embarked on the IVF journey. The thing is, we just don’t talk about it. So that person you know who has a child later in life might not be a good model to focus on because you don’t know what steps they took to get there. Now I am not saying its not possible, I am just saying do not assume.

My hope is that what I write helps to guide you on an informed path that is best for you. I would like to encourage more women to talk about reproductive health, including miscarriages. There is such a stigma around a women’s reproductive health. We are in 2022 this aspect of your health should not define you as a person or make you bad juju if you have fertility difficulties. We know more about science than that, right?

The news that I received from the first doctor sent me into a little depression dip. It wasn't until months later a friend really encouraged me to seek out another medical group that was touted as the best. I did a little bit of digging on this medical group. They have offices in several states they are the OG's in reproductive medicine!!! The best. So I made a consultation appointment!!

My first appointment was a phone call. WOW. This doc had/has the absolute BEST bedside manner. So kind, patient, encouraging but honest. I completely understood the picture he painted and this had hope! He slowly explained the next steps he felt made sense for me. Next up was the in person assessment. For this group it was a one day workup. So, I bought a plane ticket.

Did you know??

Your AMH (anti-mullerian hormone) is a blood test that gives a ballpark estimate for how many eggs you has left. This hormone is released by the ovarian follicles. Remember this is just an estimate. This lab can also be applied in PCOS (polycystic ovarian syndrome).

Giving up or Taking Control?

Hello. This is my first post. Thank you for reading.  I am 43 and I want to bear a child of my own.  Correction: I WILL bear a child of my own.  I am starting this blog, partly out of frustration and partly out of love.  I was the girl and then woman who tried to follow the rules.  Did well in high school, went to a State University, and then pursued higher education after my bachelor's.  I dated with the intention of serious relationships and marriage or so I thought.  Hindsight sure is 20/20.  I didn’t make choices that would yield my goal. So here I sit out of time.  So am turning my back on marriage and family or am I taking control? 

There are sooooo many things about life that you realize as you get older. And it is hard to heed the warnings when you are young.  But I did listen when many people said "you are young, you have time." Their intent was a compliment but they were wrong in their message. My mission in writing this blog is to share my story and experiences so that other women may be informed and hopefully do listen to this older, now wiser woman.  I want to demystify assisted reproductive technologies in order to empower women to take smart steps on their own journey of health and happiness.  The world of reproductive technologies is vast and overwhelming even for those of us that live and breathe in the healthcare world.  So let me share what I have learned and join me on my journey through IVF (in vitro fertilization).

I hope that my leap of faith in opening up about my journey is that as a collective, we women, can share our fertility journeys in a supportive and informative way, in other words get the dialogue going.  We need to be better informed, period.