Phlebotomist's dream, ultrasonographer's nightmare

Much has happened since my last post.

1.  I had my first blogger meet-up!  It was lovely.  The group included Rebecca (The Road Home), Ania (The 411 on the 418s), E (God's Plan is my Joy), and TCIE.  It was as if I was chatting with old friends, even though I had never met any of them before (except TCIE).  It was so nice to talk to ladies who completely understand what it's like to be infertile and Catholic.  And since Rebecca had just had her surgery, we of course had to swap surgery and doctor stories.  I wish they all lived closer so I could hang out with them more often.  :)

2.  I earned this:

I had my ultrasound (US) series.  TCIE was so kind to let me stay at her house the entire week and a half. Hers is the only clinic besides the PPVI Institute itself where Dr. K would allow the series to be done.  TCIE explained to me in detail what a NaPro US entails and why it has to be done by a NaPro-trained ultrasonographer.  She told me they have tried to work with other ultrasound centers that are more conveniently located for out-of-town patients, but no one to date has been able to do a satisfactory job.  Her clinic has a detailed worksheet that they've sent along with patients who go to outside centers, so you would think the ultrasonographer would be able to handle checking boxes and filling in blanks if it's all spelled out for them.  Apparently that is not the case.  Some things on the checklist are not taught in ultrasound school, and others are simply not part of the template report that many centers use, so it's too much work to make extra observations or measurements.  TCIE said even when the patient holds a copy of the worksheet and asks for certain things while she is being wanded, the ultrasonographer still doesn't always cooperate.  I understand now why Dr. K insisted I go to a NaPro ultrasonographer, and I am thankful I had the opportunity to do so.

Here's how my US series went.  TCIE described it as an "ultrasonographer's nightmare."  It doesn't seem THAT bad looking back...

CD6:  I had my baseline US.  It was the only one that included both a pelvic US (on the belly) and a vaginal US (internal).  (The rest were vaginal only.)  I completely forgot that I was supposed to have a full bladder for the pelvic US, but luckily I had drunk enough water that day that my bladder was full enough to proceed.  A follicle on my left ovary was identified as the one that would likely progress toward ovulation.  There was a shadowy area of my left ovary that looked suspiciously like an endometrioma (endometriosis on the ovary).  I was told it doesn't necessarily interfere with pregnancy since they see endometriomas in pregnant patients sometimes...  [Note: it turned out not be an endometrioma.]

CD9:  I started to observe fertile mucus just before the US.  The US showed that my cervix was dilated a tiny bit, and my endometrium was thicker than it was on CD6.  These were good signs.  (The endometrium is supposed to grow in thickness as you get closer to ovulation.)  The follicle on the left ovary didn't grow at all since CD6.

CD11:  This was the third day of good mucus.  The US showed my cervix was dilated more and my endometrium was thicker than CD9.  Progress!  However, my follicle on the left ovary still hadn't grown at all.  (Nothing was happening on the right either.)  This was not consistent with my mucus, endometrium, and cervix status.  At this point it was possible that 1) the follicle could have a quick growth spurt right before ovulation or 2) the follicle would be too small when it ruptured at ovulation.  Still it was puzzling that I was having good mucus with zero follicle growth.

CD13:  This was the fifth day of good mucus.  I don't usually have more than five days in my mucus cycle, so I expected that the follicle would have grown by now.  The US showed my endometrium was thicker than CD11, and my cervix was still dilated.  Unfortunately, that silly follicle still did not grow one bit.  This really didn't make any sense.  Why was I having a normal mucus cycle, normal endometrium growth, normal cervix dilation, and zero follicle growth?  Neither TCIE nor the doctor could explain it.  When I spoke to DH on the phone, he joked that Dr. Hilgers should use me as a case report in his next book or presentation.  I hoped someone would be able to figure out what was going on.  I didn't particularly want to be a case report...I just wanted my ovaries to work!  A few hours after the US, I had 10KL that stretched three inches.  (Yes, I just wrote how much my mucus stretched.  I have no shame.)  :)  I also had very obvious left-sided abdominal pain (mittelschmerz), which I have observed occasionally in past cycles.  I mentioned this to TCIE in the evening.

CD14:  TCIE told the doctor about my mittelschmerz and fabulous mucus from CD13.  She called me and said that the doctor wanted to run some labs (estradiol, progesterone, FSH, LH) to see if that would give us a clue of what was going on.  I drove to the clinic to have my blood drawn.  The woman who drew my blood took one look at my arms and complimented me on my veins.  (She had her pick of four easy-to-access veins.)  Just about every phlebotomist who draws my blood comments that I have good veins.  I wish I could take credit for them.  hahaha  At least it made one person's job easier.

CD15:  It was Peak+1.  I had a six-day mucus cycle, which is great.  At least my cervix was on its best behavior this cycle. :)  I wish I could say that about some other organs...namely my colon.  Yes, my colon.  You'll see why in a minute.  The US showed my cervix was closing up, and the follicle was as dormant as ever.  The blood work from CD14 was perfectly normal for someone who had just ovulated.  The doctor was completely stumped.  TCIE continued the US and guess what she found on the left ovary?  A corpus luteum!  (that's what the follicle becomes after ovulation) That meant I ovulated!!  But the follicle we'd been watching since CD6 on the left ovary was still there.  The corpus luteum was not near that follicle; it was in a separate location but still on the left side.  What did this mean?  I have a dumbbell-shaped left ovary.  The corpus luteum was on the other half of the ovary.  We had never seen this half of the ovary before this US.  Apparently the half of the left ovary with the dormant follicle had very nice, clear borders so there was no reason to suspect that my ovary was dumbbell-shaped. So you might be wondering why the other half of my ovary didn't show up on any other US...that would be thanks to my very active, redundant colon.  My colon has extra loops to it (a normal variant which I knew about before the series), and the loops covered up the half of my dumbbell ovary containing the follicle that eventually ruptured.  For whatever reason, my colon decided to get out of the way on CD15 so we could see the corpus luteum.  Silly colon.  Unfortunately, we don't know how big the follicle got before it ruptured.  Follicle size is important to know.  (If the follicle is too small, it's not a good ovulation.)  The corpus luteum looked "fresh" which meant I likely ovulated on CD14, which was consistent with the blood work.  How's that for a textbook cycle?!?  Ovulating on CD14 and Peak Day!!  ;)

On the bright side, measuring follicles is something any ultrasonongrapher can do, so if Dr. K decides that she wants to know how big my follicle gets before ovulation, I could have that done locally.

3.  DH was able to visit for a short time while I was having the US series done.  We spent a whole day in New York City, which was a lot of fun even though there was snow and slush on the ground.  It was his first time there.  The timing of his visit was okay but not great in relation to ovulation.  I don't think I can completely blame our not getting pregnant this cycle on the timing though (as much as I want to!).  There's obviously something still wrong, and I wish we could figure out what it is.  I still have lots of TEBB, so that's one thing to focus on yet.  I am really curious about where Dr. K will want to go from here.  I'll find out in a few days when I receive her feedback on my cycle review.

4. While I was staying with TCIE I visited these beautiful shrines, each with first class relics of the saint.  I offered prayers for bloggers still waiting at each one.

National Shrine of St. Rita of Cascia in Philadelphia

St. Rita is a patron saint for infertility and hopeless cases.  Her parents prayed for many years to have a child before St. Rita was born.

Shrine of St. Anne in New York City

St. Anne went through a period of infertility before becoming the mother of the Blessed Virgin Mary.  She is a patron saint for those facing infertility.