Post-Appointment Details

Sorry I haven't posted; it's been a little crazy at our house this week, what with the lack of sleep on Petite's behalf, trying to get my Christmas cards out the door (God I'm slackin; I usually have those done by the first weekend in December!), cleaning in preparation for my parents' arrival tomorrow afternoon for the holidays, shopping, other appointments, etc. Anyway, here's the scoop on how things went in Montreal.

We first saw Dr. Tan's fellow -- a lovely woman -- who took down many of our details and went over our latest round of bloodwork and testing. She expressed concern about the thickness of my endometrium on CD4 (just over 10... far too high really), and concern about the cyst, and concern about the heavy bleeding I've been experiencing.

She indicated that a functional cyst, even if removed, will return in most cases. Thus if birth control pills won't get rid of it, and if it doesn't disappear between now and our IVF cycle, they'll aspirate like they did before.

She was worried about the endometrium. As she told us, women who have PCOS are usually prone to developing hyperplasia (the growth rate of endometrial cells is quite rapid) and if left unchecked or treated, it CAN develop into something serious (aka cancer). However, if checked and treated, all it may need is medication to control it. And if it isn't hyperplasia, it wouldn't need anything at all of course. To be certain, she recommended an endometrial biopsy, so she booked that for the same day, right after our appointment with Dr. Tan.

Next up, we saw Dr. Tan. First we went over our results from our first (and only to date) IVF. He was pleased, of course. Then we talked about my LH and FSH (both quite good). We talked about the cyst. We talked about the heavy bleeding and endometrial lining. He recommended that I continue with the Provera that my Ottawa-based RE prescribed as that can help thin out a thick lining and may help the cyst issue. Next, he wondered about my HbA1c. That's a test that measures glucose levels over a period of weeks/months. While my fasting glucose is fine, he wants to check the long-term stuff to ensure I'm not diabetic or borderline. I doubt that I am and I'm not worried. So I'll get that bloodwork done in the next week or two. After that, Dr. Tan looked at my last results with the menopur. Back in the fall of 2008, I was taking 225 IUs. He said that given my age and the previous results, he'd recommend bumping it to 300 IUs for the next IVF. He said that they would follow the same protocol, doing ICSI and assisted hatching and graciously, he's going to allow me a general anaesthetic as well, which is something they usually don't do and of course, isn't normal for their Quebec patients who receive federal funding for IVF. Like I said to the fellow, I'm paying for this out of pocket. If I want general for the retrieval, I'll get it or I guess I'll go somewhere else. Dr. Tan was happy to let me have a general if needed. I think it'd be better for everyone if we do it that way! Though, I might try to push through and just have the twilight stuff. We'll see as time goes on. We aren't doing this tomorrow, after all. Through the appointment, I was comfortable referring to various blood tests, and other medical terminology of course. He stopped and looked at me, "Are you a nurse?" I laughed. "No, but I've been dealing with infertility for a very long time. I know what I'm talking about, and now I'm an advocate for infertiles and for obtaining funding for Canadians." He was pleased by this as he still can't understand why one province or two might give preferential treatment based on residency. It's discriminatory and as he said, it's time to change that.

So after the details were decided, we moved out of the consultation room and after a short wait, we popped over to an exam room to do the endometrial biopsy. (NOTE: Gentlemen, you might like to skip this paragraph.) For those who haven't had the pleasure (I jest of course!) of an endometrial biopsy, the procedure is fairly simple. Assume the, now familiar, position. And lady, dear mother of all that is holy, when I tell you that you'll need a long speculum, get a long speculum, willya? Don't make me suffer through a few attempts with a less-than adequate device that just friggin' WON'T reach my cervix, m'kay? When you get the right length, then we can proceed. *waits patiently* Got it? Good. Let's get on with this, shall we? Then with the speculum inserted, she took a long (more than a foot and half I'd estimate) straw-like, flexible, thin catheter-type thing, inserted it past the cervix, into the uterus and with a few pokes and pinches, withdrew endometrial lining (deep red in colour) and pushed the material out of the straw into a specimen jar with fluid inside. She did this entire procedure twice, pulling bits of lining from a few areas inside the uterus, deposited it into the jar, closed the cover, and shook the jar to mix thoroughly. And off to the lab it went: results will be expected in 2 weeks to 2 months. And she prescribed an antibiotic (doxycycline) to ward off infection that might occur post-procedure.

Next up, we got an appointment for hubby with the urologist who did his PESA a few years ago. Dr. Chan went over hubby's results from last time, examined him quickly and proclaimed that he'd use the same procedure, extracting sperm samples from two sites on Hubby's left testicle), and he expects the same results. Just in case, we still have a vial of donor sperm on ice at the hospital. We could use it if needed, but Dr. Chan and Dr. Tan expect we won't need it. And right on the spot, hubby and the doctor signed the consent forms. All done! Whew!

That was it for the bulk of the appointment. We now wait for the biopsy results. When they come back, we are to call Dr. Tan directly and he'll set up the next steps for us. He was quite happy to be able to do that for us and he expects good things from our next IVF as well. I'm glad he's optimistic. Truth be told, I'm optimistic too, but God, I'm so afraid to be! This whole 'trying again' thing has me sorta tied up in knots. I'm terrified of failure after such a good result the first time. And we don't have the money to fund more than one try this time either. So I have to temper my hopeful thoughts a little and realize that we may not get this lucky second time around. One step at a time, right?

On Tuesday, after we'd arrived back in Ottawa, I called my RE here to get the requisition for the bloodwork (HbA1c) and to check on the prescription for Provera and when I need to take it (CD 12-25). They were happy to know about the biopsy as well. I'll make sure they get results too.

There you go. Now we wait, I get my bloodwork done and fill my Provera prescription. And with luck, we can get the ball rolling in a few months.

In the meantime, oh God, if anyone has ideas about how to get a toddler to stay asleep in her bed overnight, let me know?! We're EXHAUSTED! Hubby is doing final exams this week so he'll get a bit of a break after this. But right now, we're stumbling through our days. The other morning, I fell asleep at a stoplight on my way to work! The car behind me honked and I came to my senses. I need more than the few hours of sleep I'm getting. Gotta fix this.

The other day, Hubby was doing Petite's bedtime routine with her, and he said, "Go give Mama a kiss," and she did. She walked right over to me, threw her arms around my neck, snuggled in close and then backed off my shoulder a bit, tilted her head up and brought her lips in to give me a sweet, little open-mouthed kiss. I almost cried. Seriously.

A milestone: I've booked Petite's "first haircut" for this coming Saturday, December 18. Two years to the day that we got our BFP. And my angel is about to have her hair trimmed. I can't really put it off any longer; I won't have my daughter going on vacation with a mullet! LOL

Love to all in Blogland. Still reading your blogs, but I find it harder to comment lately. Again, the "need more time" thing is coming into play. But I am reading! Promise.