Need some advice

[Thea]

I posted over on WC, but that place looks deserted. Noticed that a lot of folks had moved over here. Sorry about the rambling, just looking for thoughts. Thanks!


We started our infertility testing to figure out what is going on in September. I had all of the blood work done, and a clomid challenge test, which went fine and showed that I was ovulating. Also had an HSG, which was pretty painful for me, and my left tube was blocked. I also have a fibroid that was found on an internal US but the dye filled the uterus fine in the HSG. I had another test done, a tubal catheritization, basically an HSG but they inserted the catheter all the way in to the left hand side. (I had some Verseed and pain medicine by IV so this was OK). The left tube was blocked, but they were able to open it.
DH has had three SA. One before we moved from FL to VT last year that basically had everything OK, but that there were 43% abnormal on morphology. Then he had one here that said 2% normal morphology(they report their #'s different). So we repeated and it said 1% normal. His Urologist sent a letter and said we should try IUI. My RE (actually one in the group, mine is on maternity leave) said we should go straight to IVF. We thought we might have to go there and that is OK, I just want better answers to my questions. The RE we saw on Thursday basically said IVF and told us to schedule a bunch of meetings with the financial, genetics, scheduler, and him. He did not answer my questions, so maybe you guys can help. I know I need to ask him again, but I would feel better if I felt like I knew what I was talking about. So, here goes....

why did the SA's have such different results? I know they use different testing methods, so that may explain it but basically we went from 57% normal to 2% normal!!!

My 21 day progesterone came back as 5.4 My RE sent a letter with the results and said this normal. I have read online that normal is over 10! I have always wondered if my progesterone is too low b/c I always start spotting about a week before I get my period.

If my progesterone is low (so a luteal phase defect that could cause a ferilized egg not to implant) and if my husband has great sperm count, and motlity, but questionable morphology could we not still be getting pregnant, but it not sticking and hy not try progesterone supplements in the luteal phase for a few cycles before jumping to IVF????

Is this a crazy idea, or something worth bringing up? We are resigned to spending the money for IVF. I just did not like the basic statement I got back from the RE last week....it doesn't matter what is wrong with you, his sperm is bad, staright to IVF and we will give you drugs to make sure everything works OK on your end.

OK. Enough blabbing. Just need to hear other people's thoughts.

Thea

P.S. Don't know if my bad feelings about this substitute RE came from the fact that at the beginning of our appt he said, "Why did you make this appointment with ME, why didn't you see your regular MD?" And when I told him she was on maternity leave and I was told to make it with him, he just said "oh." Not a good start.

[paisleydays]

My guess is that they are using a stricter Kruger count on the second and third SA's. My DH has a similar issues and our RE told us that we could choose to spend the money on a likely BFN IUI cycle or we could save the money to pay for drugs for an IVF cycle. It sucked, but we decided to go straight to IVF.

That being said, you are spending a lot of money on an RE, and I think you need to be as comfortable as you can be with the RE you choose. This is such a delicate and vulnerable time--you don't a jerk RE sending you over the edge. I'm not sure I would feel good with an RE who said that stuff to me. Can you maybe get another opinion or do an IVF with a different RE?

[Scooter]

Different labs also have different procedures. With beta hCG tests and with SAs you really need to be able to compare them, and if you're comparing results from different labs it's kind of like apples and oranges. I switched REs and they had us redo our labs so they would be able to compare them with later ones while we were in treatment with them. So that could account for a part of it at least.

Your 21 day progesterone isn't always your 7dpo progesterone, unless you happen to ovulate on day 14. And under 10 is considered low progesterone, I've had multiple REs tell me that. It's odd you'd be told 5.4 was ok; and for comparison when my LP was 11-12 days w/prog of 10.2 my RE put me on prog supplements for that. I think that anyone spending so much money and emotional energy on infertility treatments deserves to feel that her questions are answered, so if you're not feeling like that at this point with this RE, it's definitely worth at least looking around and having a consult with another one. Maybe it's just not a good fit. And I can tell you, there's enough of a struggle with this journey that feeling listened to, respected by, and trusting your RE is crucial.

As for your idea about trying prog supplements, this is your treatment. At any time if you're not comfortable with the plan, you can talk to the RE to change it. I was told to go straight to IUIs but we weren't emotionally or financially ready, so we asked for just clomid & prog supplements first. Didn't work for us, but it was important to us to at least try a cheaper,easier route first. Oh, and also, with the ovarian stimulation meds, like clomid, femara, and injectibles, the idea is to produce 2-3 follicles (eggs) but als to have them be really good quality & mature. Because of this "strong" ovulation, it causes your progesterone to be naturally higher, without even the progesterone supps. It's another option to try, because I've done both ways and together, and the progesterone supps really caused a lot of side effects for me. Something to be aware of, and to talk to your Dr about when discussing options.

[melissafromnc]

It does sound like the 1% normal morphology is using strict Kruger standards. Many labs find this is the only way to have consistency between labs and between the people doing the counting. Kruger standards are very consistent from lab to lab while other SAs just kind of 'look' at the sperm. That being said, if the Kruger results are under 3% normal then most clinics will recommend ivf+icsi. Morphology is really key to getting the egg to fertilize. Even if there are lots of them and they swim well there are fewer to get the job done. That's why icsi can be so helpful because they can pick out the really good looking ones in the lab.

As for your progesterone Scooter is right that it needs to be 7dpo. Do you know when you ovulated? Otherwise you can't tell much from that number.

FWIW, many RE's don't believe in luteal phase defects. Like Scooter said if you have a 'weak' ovulation then you don't have a great corpus luteum to produce enough progesterone (and likely the egg might not be that great of a quality).

Does your RE come back from leave soon? Is there someone else there you can consult with or another clinic? I think it's critical you have someone you feel comfortable with and will listen to you and help you decide on a plan that works for you guys.

[Thea]

Thanks for the replies! It is really helpful sometimes to get the thoughts of people who understand what you are talking about. I really appreciate it.

To answer your questions....

The progesterone was actually 8dpo, because I ovulated on the 14th and it was drawn on the 22nd day of my cycle. Scooter, I found it interesting that you said clomid can actually increase your progesterone as that was the same month as my clomid challenge, so I think it is a safe bet that I have low progesterone.

I believe they told me the two SA's done here were the Kruger, so that makes sense now. Thanks for the clarification. I guess I just need to get used to the idea that because of the SA we really need to go to IVF. It is not something we haven't considered, but I guess we were just hoping that we wouldn't have to go that route. I think I also felt a little short-changed that they did all of this testing on me to have it all come to a 3 minute appointment were all the MD basically said was that we needed IVF.

My RE (who I actually only saw twice, but I really liked her) won't be back until February, but I believe there is one more RE in the group, so I think we will see if we can change. This guy had done my HSG and he was OK then, that is why we had made the appointment with him when I found out my RE was not available.

BTW, melissafromnc, what is ICSI. I guess I will have to look that up. Just when you think you know all the terms!

Thanks again everyone, I really appreciate it.

[Scooter]

Thea, if your 8dpo prog was that low during your clomid challenge test cycle, that's definitely low. :( I notice you're new to the forums. Check out the IVF support thread (http://www.constantchatter.com/showthread.php?t=6388) in the Family Planning groups forum (under the "All Things Family" section), it will give you all sorts of info & support and they can answer your questions. (Btw, ICSI is pronounced "ick-see" and is where they inject a single sperm into an egg to fertilize it. It's another IVF option versus the idea of natural fertilization, where they put a bunch of sperm in there and let one get into the egg by itself. That's why Melissa was saying they could choose the very best sperm to put in the eggs and it would give you the best odds at a good embryo in your case. HTH. You should be getting a packet from your RE explaining all this stuff and your options.)

[craftgenius]

Thea, I've been taking Clomid for 5 cycles. The month before my first cycle on Clomid, my progesterone was 5. On my first 50 mg Clomid cycle it went up to 7. Then they moved me up to 4 consecutive 100 mg Clomid cycles...the last three of those cycles the progesterone was 15, 19, and 20. Clomid definitely increases your progesterone. Best of luck.