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.
