Hello ladies, I’m back!  It’s been quite a while and I sure am been missing a lot out here.  How’s everyone doing?

I actually don’t know where to start as far as my journey is concerned but I am definitely am glad to learn that a number of my sisters out here have already achieved their much-awaited BFP’s and pray that you ladies will continue to do well in your pregnancies.  Can’t help but feel emotional on this matter not because of jealousy but because of joy that all your prayers, efforts and waiting have finally paid off.

As for me, a lot of things have taken place these past few months and I just wish I can detail things out.

I had my second and last shot of Lupron Depot on 26-March-2012.  I know that I’ve told you guys that I am supposed to have three but I missed my last shot because Sir Bug and I went out on a month-long vacation and can’t find a local pharmacy that will sell me one.  Anyhows, I didn’t get to experience many side effects on it except for the mild hot flashes and I didn’t get to have my period for three months.  Yeah right, I get to miss those terrible cramps and other sufferings brought about by Aunt Flow’s monthly visit for three months.  

I went back working on 26-May-2012 and had my follow-up check on 28-May-2012 but since Dr. ANB needs to attend to an urgent matter, it was Dr. AMS who covered for him.  I told her that I missed my last Lupron Depot Shot and she came back telling me that I need to take it at once and that I still have three more doses of it to be administered for the next three months wherein I disagreed for Sir Bug and I have taken a break from Trying to Conceive (TTC) for quite some time now and eagerly wishes to continue up with it since it’s already been almost six months past my surgery.  She then phoned Dr. ANB for his opinion and recommendations and I ended up to having scheduled for a Pelvic Ultrasound and a follow-up appointment on Cycle Day (CD) 2.  As per Dr. ANB, I shall be put on Clomid starting from CD 2 to CD 6 once I get to have my period.  That, somehow, gave me a bit of a relief but was suddenly snatched out of it when my conversation with Dr. AMS went on to telling me how difficult would it be for someone like me with Endometriosis to conceive and that the only chance that I have is through In-Vitro Fertilization (IVF) wherein I have to stand in a long queue in order for me to get through if I wanted it to be done in our hospital.  Otherwise, it would be better to have it done somewhere else where I will get to spend such huge amount of money.  

Is she kidding me?  I can’t believe her.  Never had I thought that a specialist like her would have talk to a patient like me in that matter.  I know that reality sucks but I’m pretty sure that neither Dr. HM nor Dr. ANB would speak to me that way.  The two has always been positive and certain on which approach and treatment would suit their patients best.  However, I just let it pass me by and convinced myself that unlike the average and less skilled persons, the more skilled people focuses on possibilities and finding ways on how to do things rather than focusing on the problem itself.

Days have passed and I continued to bloat and been mistakenly been suspected by a lot of people to be pregnant.  Well, I think it’s a compliment and I’ve enjoyed it.  But reality bites, I still am not pregnant!

It was 01-July-2012 when I, once again, felt that horrible cramps and AF came gushing like she was on a rush.  Oddly, I was glad.  I never imagined that there will be a time that AF will be mostly welcome and that I will be that excited to have her in.  I then ran to the hospital to get an appointment but unfortunately, the schedule was full and I was instructed to just walk-in the next day which I did!

Dr. ANB was again out at that time and it was Dr. FY who came to attend to me.  As usual, she went through my history and read me my Hysterosalpingogram (HSG) and Pelvic Ultrasound Findings which says:

Hysterosalpingogram

Findings:

Hysterosalpingogram under fluoroscopy screen after injection of water soluble contrast through the cervical canal.

Normal smooth filling of the uterine cavity.  No evidence of uterine filling defect is seen. Normal smooth filling of the right fallopian tube with good spillage and peritoneal smearing. The left fallopian tube shows normal caliber with smooth filling till its fimbral end where there is saccular dilation at its fimbrial end with no spillage seen during the delayed peritoneal smearing.  Features are suggestive of left peritubal adhesion.

Impression:

Patent right tube.

Left tubal distal obstruction with suggested peritubal adhesion.

Pelvic Ultrasound

Clinical History:

Primary Infertility with history of endometriosis operated, for followup.

Findings:

Anteverted normal-sized uterus measuring 8.0 x 4.0 x 5.1 cm.

Endometrium is central and not thickened measuring 1.0 cm.

No mass lesion is seen in the myometrium.

No free fluid is seen in the posterior cul-de-sac.

Right ovary measures 2.5 x 1. x 3.4 cm with volume of 7.7 ml.  It shows a follicle measuring 1.6 x 1.5 cm.

Left ovary measures 2.9 x 2.0 x 2.9 cm with volume of 9.4 ml.  A small cyst measuring 1.0 x 0.9 cm is seen in the left ovary with low-level internal echoes could represent a small hemorrhagic cyst.

Impression:

Anteverted normal-sized uterus with endometrial thickness of 1.0 cm.  Both ovaries are normal in size, shape and echotexture with a developing follicle in the right ovary and small probably hemorrhagic cyst in the left ovary.  For clinical correlation.

For a while, I thought the world would fall over me.  I waited for six months now to TTC again and having to receive the bad news of having another cyst on your left ovary is a little bit over my comprehension!  But then, I was glad that Dr. FY was quick enough to pick my reaction up when she told me to lie down for she will perform and On-the-Spot Abdominal Scan.  I went on so willingly and all my worries disappeared in a second when she broke the silence when she exclaimed “There is no cyst!”.

Then we continue to talk more while she explained her view and reasons for recommending an IVF.  This time, I didn’t feel that gut feelings that I had when I was with Dr. AMS.  She explained things so thoroughly that I can feel her concern.  Nonetheless, she might have said things so nicely and she was indeed convincing, I still asked for other options and we came to agree on having to be under an Induced Ovulation through Clomid for three months.  I was instructed to take it from CDs 2-6 and she would want me to come back on CD 12 to have my hormones checked.  Unfortunately, the Appointment Desk can’t squeeze me in and she just decided to drop the blood works and let her see me after three months.

Though I am pleaesd with the overall outcome of this check-up, I still can’t help myself but to be sad for it seems that I am, once again, being left out in the wild on my own.  I will have to go through this three-month battle without being monitored.  

Well, what can I do?  At least I see hope came peeking through that small window…  What else can I ask for?

After that worthwhile visit I had with my Fertility Specialist, I wasted no time and went directly to the lab for the required blood works.  While I was examining the request, I just can’t help but take a deep breath and wonder how many vials of blood this time are they going to extract from me?  I remained still for a while and then I realized that I wasn't, at all, required to fast.  Well, let's just look at the bright side of it...

Then, for the third time, I get to see Sarrah, the tech who has tested my patience when she missed the nerve after injecting the needle into my skin and who has to reinsert another one just to be able to do it right.  Had she not had that very pleasant and accommodating personality, I might have freaked out while looking at my arm as she move the needle in different directions trying to hit the right nerve. Nonetheless, freaking out is just wasn't me.  As much as possible, I'd like to remain calm and keep my cool.  I will try to tolerate things as much as I can.

But now that I have in my hand the result of the various blood works that I have undergone, I just find it hard to relax knowing that some of the figures are below or way above the normal range...

Complete Blood Count
WBC : 6.0 (4.0 - 11.0) 10^9/l
RBC : 4.62 (4.0 - 5.40) e^12/l
Hgb : 120 (120 - 160) G/L
Hct : 0.366 (.360 - .540) l/l
MCV : 79.1 (76.0 - 96.0) fL
MCH : 26.0 (27.0 - 32.0) pg
MCHC : 329 (320 - 350)
RDW : 14.2 (11.5 - 14.5)%
Plt : 338 (150 - 400) 10^9/l
MPV : 6.6 (7.4 - 10.4) fL

Serology
HBsAg : Negative (Negative reference range is negative.)
AntiHbc : Negative (Negative reference range is negative.)
AntiHbs : 0.8 miu/ml
AntiHCV : Negative (Negative reference range is negative.)
Rubella IgG Ab : 110.9 iu/ml

Basic Screen
BUN : 2.9 (2.5 - 6.7) nmol/l
SodIum : 138 (136 - 145) nmol/l
Potassium : 3.8 (3.5 - 5.1) nmol/l
Chloride : 107 (95 - 110) nmol/l
CO2 : 22 (22 - 29) nmol/l
Glu R : 5.2 (2.9 - 7.8) nmol/l
Crea : 58 (53 - 97) umol/l

Liver Profile
Bili T : 4.5 (3.4 - 20.5) umol/l
Alk : 66 (40 - 150) u/l
Alb : 44 (35 - 50) g/l
AST : 20 (5 - 34) u/l
ALT : 14 (5-55) u/l
Total Protein : 78 (60 - 83) g/l

Hormonal Tests
LH : 2.9 iu/l
FSH : 6.9 iu/l
Testosterone : 1.4 (0.5 - 3.7) nmol/l

Others
CA 125 : 612 (<35) u/ml
CEA : 1.73 (<5.00) ng/ml
AFP : 1.6 (0.0 - 11.1) ug/l

Having to have seen the underlined figures in my CBC, one can immediately pick up that my MCH and MPV are slightly below the normal range.  But that doesn't worry me much.  Instead, the thing that I am really upset with is having the CA 125 highly elevated than it should supposed to be and I really find it hard to relax learning from the net that high levels of CA 125 is associated with an ovarian tumor or cancer.  I am in desolation and I feel like crying while I am writing this.  I just don't know what to do...

So, the day has finally arrived for me to sit down with my Fertility Specialist and discuss the test results that my dear husband and I got from the lab. This is it, the anxiety will finally have its end or... could it be the other way around?

My appointment was at 9:00AM and I don't seem to be that excited to be present in as early as 8:30AM.  While I patiently waited at the Female Waiting Area, I seem to have seen a beam of light walking my doctor through his way to the clinic.  Just like an angel!  Then, I heard the nurse called my name and I woke up from that weird dream of mine.

I found myself sitting in the doctor's office while the doc scan through my records. The room was very still. He broke the silence by telling me that my hormones were just fine and that the levels are within the normal range except for one particular hormone which he did not mention.  He must have been quick enough to read my worries that he immediately comforted me with these words, "Since everything seems to be fine, the low numbers may be due to an analysis error.  This report may have not been accurate and we'll have to run another test again just to be sure." Admittedly, I sort to have found an instant relief on those words.

I asked about my dear husband's Semen Analysis Report and he replied that the numbers were also within the normal range and that his swimmers seems to be of good quality.  However, he was looking into the "high viscosity" and "liquefaction" thing which he has doubts of.  Explaining how factors like the condition or manner how the semen was being collected can greatly affect the results, he has put into consideration that there might be some slight error on the procedure on how the specimen has been analyzed.  But since the numbers were just fine, he assured me that there is not much to worry about.

He then proceed to telling me that since my hormones and hubby's semen were just fine, our next step is to have the condition of my tubes checked through a procedure called Hysterosalpingogram (HSG).  He said that he was also thinking of having a rerun of the previous blood works that I had and that he'll soon be off for a vacation which means that we'll be seeing each other after four weeks.  Four weeks?  I don't think I can wait that long for I still have some issues on my mind that I have to clear up with him!

The ugly cyst that's blocking the view of my right ovary!

So, without wasting time, I asked him about the ultrasound report.  I told him of the difficulties that Jane has undergone just to have a view of my right ovary because it was blocked by a cyst.  Again, he went back to see my records and asked me to lie on the bed for he will perform a quick scan of my abdomen.  The nurse was so sweet that she immediately assisted me in positioning myself into the bed and applied the gel on my skin.  There it goes... I get to see that nasty cyst again.

The doc then went back to his desk to write a request for a Magnetic Resonance Imaging (MRI) Procedure.  While he was doing so, I informed him of the fact that a hemorrhagic cyst has also been found located somewhere near one of my ovaries in an ultrasound conducted way back in 2007.  He then stopped writing and asked me if I was sure about what I am talking of.  Of course I am!  So far...  I also told him that I still remember my old Gynecologist explaining to me that the size of the cyst that time was just like that of a marble.  It was also in that same procedure that I was diagnosed with Endometriosis.

Upon hearing this, he, once again, changed the plan.  Instead of the previous two procedures, I shall then be scheduled for a Laparoscopy but only after the results of the new blood tests has been confirmed.  He handed me the Lab Request and I was a bit stressed when I saw the number of checks.  Well, what can I do but proceed to the Lab and have vials of blood be taken from me again?

Apart from the fact that I find this session enlightening, it was also a funny thing when a friend of mine stopped by at the clinic and gave me a meaningful grin.  Out of the blue, I asked this question, "Why is it that when people sees you in a clinic like this, they always think of you as pregnant?"  His only reply was, "Don't worry, you will soon be!".  Wow!  Simple phrases like that is enough to make one's heart pound. Enough to keep my hopes up...

I remember one afternoon when I was impatiently seated at my desk, looking at the clock and wishing that time would move a little bit faster.  I just can't seem to wait and get out of work! So, when the clock finally hit five, I immediately logged out and hurried myself out of the building and there...  I was greeted by that warm smile coming from my dear husband who's been patiently waiting for me in spite of the fact that we're running late for a very important appointment

We drove for like five minutes and spent another minute struggling to find a good parking spot. Finally, we found ourselves in front of the Out-Patient Laboratory Reception Area being attended to by a middle-aged tech who handed a sterile container to my dear husband. She pointed her finger towards a door and said, "There, you go collect yours from that room!".  My husband and I looked and grinned at each other and then bargained with the possibility of having to collect the needed specimen from the comfort of our homes.  Well, as expected, the tech disagreed and my poor husband doesn't have much of a choice but to proceed to the Male Toilet and perform his stuff while I stayed outside waiting for him.

With that condition, I know that my dear husband will be having a hard time trying to bring his swimmers out to collect them.  So there am I, caught myself being entertained by watching a medical clip which I have no interest of.  Then, I spent almost thirty minutes of my time talking on the phone and wasted another five minutes walking to and from the hospital lobby.  This is it, I think it's confirmed - he really is having a hard time!

At last, my dear husband finally went out of the room all sweaty.  Poor him!  I handed him some paper towels and pat him dry.  With how he looked at that time, I've figured out that asking the obvious may not help.  So, I just hugged him and walked ourselves outside of the hospital.  It was already in the car when he confessed that it wasn't really easy for him.  I know!

It took us three days before we were able to come back and get the results. Though I don't have a clear understanding of a Semen Analysis Report, the figures seems to be fine with me except for the viscosity thing wherein I have read mixed information from the web.  I admit, I was a bit worried but I know, hubby's swimmers wouldn't be much of a problem than mine.  Anyhows, for those of you with a curious mind, these are the stats that we've got.  

Color : Creamy
Volume : 1.0 ml
Viscosity : Highly Viscous
Reaction : 8.0 (Alkaline)
Liquefaction : More than 1 hour
Sperm Count : 130 million/ml
Abnormal Forms : 20%

Microscopic
Pus Cells : 2-4/hpf
Red Cells : 1-2/hpf
Parasite : NIL
Spermatogenic Cells : 1-3/hpf

Motility - 1 hour later
Markedly Directional : 40%
Moderately Directional : 10%
Non-Directional : 10%
Non-Motile : 40%

Motility - 2 hours later
Markedly Directional : 35%
Moderately Directional : 05%
Non-Directional : 15%
Non-Motile : 45%

Now, whether it is of a good thing or not, all I know is that despite of the condition of how these swimmers were collected, my dear husband was still able to come up with such good figures! ☺

So I was advised by the attendant to come in full bladder for my pelvic ultrasound. My appointment is at 10:00AM but I feel like peeing in as early as 9:00AM.  I just thought of having to hold on to it for I am not sure if I will be able to full it by 10:00AM. Surely, it isn't an easy thing to do but I managed to hold on to it until 10:40AM. Yeah, you've got it right, they've let me wait for 40 minutes or so.

Jane was the name of the tech and she was very sweet.  Without wasting time, she made me lie on the bed, applied the gel and immediately performed a Transabdominal Scan.  There was nothing unusual to it but I wanted to immediately put an end to it so that I can rush to the toilet and pee.

Then, it's time for the next procedure – the Transvaginal Scan (TVS)!  Had I not had this procedure before, surely I’ll be shocked with the transducer (a wand-like device that they insert into the vagina) upon seeing it the way I was during my first scan. Anyhows, it took us quite some time to finish the procedure since Jane can't seem to have a view of my right ovary.  She said that a cyst, probably an endometrioma, was blocking the view.  She also has showed me the other images which, again, I have no idea of what it is all about.

To cut the story short, the session ended well and I have to wait for almost a week to have my hands on the analysis which goes like this:

Transabdominal and transvaginal studies were obtained.  No previous studies are available for comparison.

The patient gave history of prior endometriosis.  The uterus is ‎seen anteverted and measured 9.0 x 4.3 x 4.5 cm.  Normal endometrial thickness.‎ 

The left ovary is well identified and measured 3.2 x 2.9 cm containing few follicles.‎

The right ovary is not seen.  Instead, there is a relatively homogenous, slightly ‎hypoechoic, well-defined lesion seen in the right adnexa measuring 7.3 x 5.0 x 4.8 cm, ‎not demonstrating any flow within it. Its appearance is most in keeping with probable ‎endometrioma. Other differentials of homogenous right adnexal disease considered but ‎are less likely. Further evaluation may be done with pelvic MRI.‎

MRI?  Have I read it right?  Does it mean I have to undergo another test?

For how many years, I have always had these long, heavy and painful periods which are so severe that it interferes and hinders me to go on with my daily routines.  It is due to this reason that, all of a sudden, I decided to pay my doctor a visit with the intention of not just asking for an immediate relief, but to fully eliminate the pain.  Of course, as expected from a Family Doctor, I was referred to a Gynecologist whom, out of good fortune, happens to be one of the best in his field!  I was asked to undergo a pelvic ultrasound and a series of blood works which must be done on the 2nd and 21st day of my cycle while my dear husband was asked to have his semen examined.

It took us how many weeks to complete all the tests and a few days of waiting to finally get hold of the results.  I am looking at the figures below which describe my Hormonal Levels which I have no idea whether it is a good thing or not:

Progesterone : 27.60 nmol/l‎
Luteinizing Hormone (LH) : 2.2 iu/l
‎Follicle Stimulating Hormone (FSH) : 0.7 iu/l
Proclatin : 41.9 (25.2 – 628.8) miu/l
Testosterone : <0.28 (0.5 – 3.7) nmol/l
‎Thyroid Stimulating Hormone (TSH) : 1.710 (0.470 0 4.640) miu/l‎