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"I have to be honest with you - your level of infertility is EXTREME."

Those were the RE's words yesterday verbatim. I just sat there; I didn't know what to say, but I thought for half a second that I was going to vomit right there. He went on to explain:

"You are O-ing on your own with no medications; your P4 level this cycle was a 16.8. Your husband's semen analysis is fine. Your HSG shows that both tubes are completely open. The transvaginal u/s showed that while your uterus is retroflexed, its shape and size are fine, and both ovaries look perfect; no evidence of PCOS. Your blood work has all come back perfectly normal. And yet despite all this, you've only had one pregnancy in the last 15 years; not just that you have only one child, but that you've indeed only been pregnant ONCE. You have extremely severe "Unexplained Fertility."

I always expected that I would break down in tears when I finally heard from an RE what I had known my whole adult life - I am broken. But I didn't. The closest I could come to describing what I felt at that moment would have to be "numbness." It was almost like I'd shut down emotionally. I started to grab for my purse, since he was obviously telling me that I'll never have another child, when I heard him say:

"But there's hope!"

First thing I thought of was, "Oh sure there's hope. It's called IUI/IVF and it comes with a humungous price tag that I can't afford." But since he's such a nice Dr, I decided to hear him out. After all, I got a sitter for this.

"I'm not going to lie, our options are pretty limited. The OBs you've seen before have thrown loads of Clomid, Femara, Progesterone and Metformin at you, and they've all been no help whatsoever. We've already established that you're O-ing on your own. We really only have 3 options available for us at this point. 1) IUI - $800 + meds per cycle, and is NOT covered by your insurance. 2) IVF - $9,000 + meds per round, and is NOT covered by your insurance. And 3) you can try injectable Follistim (FSH) and Ovidrel (hCG), and since you'd be using them with timed intercourse and NOT artificial incemination of any kind ... they ARE covered by your insurance!!!"

Guess which option I chose ...!!

And the best part is that he's perfectly OK with starting with this very next cycle!! As soon as AF shows (which should be tomorrow), I will send his office an email stating that AF has arrived. They will contact their supplier of Follistim (a place out of Pennsylvania, I think) and Ovidrel, and they will overnight them right to my door. I'll start using the Follistim every day with the little pen-type syringe thingy, and I'll be coming in every few days for u/s monitoring of my egg follicles to see how many I have maturing and how large they're getting. Once they've reached a mature size, the RE will give me the green light to give myself the Ovidrel trigger shot, which should force ovulate ALL mature follies. By forcing ovulation of multiple follies, we should have a MUCH higher chance that at least ONE of them puppies gets fertilized and does the trick!

I walked into the RE's office yesterday feeling down about the whole process, was hopelessly depressed by the middle of the appointment, and walked out feeling more hopeful than I have in years! Please keep your FX that this allows me to FINALLY carry, deliver, and hold another precious baby - or two!

@2frsty- that sounded like an emotional rollercoaster today! I'm so glad your insurance covers the follistim and ovidrel! I did Follistim and ovidrel last cycle ($660 total). Both can be given in the lower abdomen subq. The follistim injections I didnt even feel. The needles are soooo small and the pen only needs to be purchased once. It's just little follistim vials that are inserted into the pen. I hope it works perfectly and you get the perfect amount of mature follicles!
Keep us updated on all your follicle scans!
Lots of prayers going up for you hun!

Thanks lady! Oh, and Kasey wanted me to tell you "Hi" from her! She's right at 27 weeks along with a baby girl, and she looks amazing! How have you been lately??

The Factor V Leiden means I am at higher risk for blood clots & placental issues, and I have 2 occurences of heterozygous MTHFR mutations which can cause a shit ton of problems both with fertility & all kinds of other stuff. I am going in the morning for fasted blood work to check my homocysteine levels, and since I am not processing folic acid properly, whether my homocysteine is high or not, I'm getting an Rx for an active form of methylfolate to take instead. I'll decide more about how to proceed once I know about my homocysteine. Hemochromatosis is an iron overload disorder that is very unlikely to cause problems for me until menopause when I stop having my cycle. The treatment for it once high iron levels are detected is bloodletting/phlebotomy.

2Frsty - I am sorry for the grim info from your RE. I hope he is able to help you this cycle. Have you had any genetic testing done?

I have not, but I think I'm going to ask him next cycle (if we don't get knocked up this cycle of course) if my insurance will cover it. Was it just a simple blood test?

AFM: Here I sit at 15 DPO with a stark white and no AF. Nothing. My boobs are back to normal, I've broken out on my face in a few spots, and the whole situation is pissing me off like crazy. I think I'm going to send my RE a message and since I'll probably get AF over the weekend, I'm hoping that he will go ahead and order it tomorrow so I will have it and I won't miss my shot to start on the right day.

2Frsty - you might want to do the testing before you try again. That is only a suggestion, of course. I just sent you a message. Yes, mine was a blood test, but some companies use buccal swabs instead to get cells from inside your cheek.

Oh, and AF finally showed today, so I'm having a baseline ultrasound done for this cycle in the morning.

AF due to day :( and yesterdays test was neg, so many symptoms but must it all be in my head? still hope i am but yes this is hard work and quite stressful, tell myself every month I cant go through it all again but we do, most def crazy ;)

@Phat, did they do the basic genetic test or the one that test for 200+ genetic disorders? My RE originally only did the basic which only tested for about 50-100, thats when I found out about the MTHFR and SMA1. After I decided on IVF is when they did the more extensive one and found the Sanfilippo Syndrome A and Fumarase Hydratase Deficiency. Do they want to test your DH?

Mandy - They did one that checked 102 things. I'm considering doing 23 & Me to check for others. They have not mentioned testing him. Right now I'm not having my husband tested but am considering it. I am more focused on having my children checked right now because MTHFR can cause behavior issues. My son has ADD & is very defiant, my middle daughter has been displaying symptoms of ADD since she was about 5 or 6, and my youngest has some concerning meltdowns that are not what you "normally" see in young kids at that frequency. I got an order today to check for a glutathione deficiency and for heavy metals (urine). My RE's office doesn't have what they need in house to send them to LabCorp, so I will have to go on my own. My van was acting up today, so I came back home instead of going to the lab. Everything I get done is about 1/2 hr from my house.

I had my homocysteine levels checked today & imagine I'll have the results early next week. My ultrasound showed nothing of concern on my left side. She could only see one possible follicle starting, and the 30mm one I was really worried about is completely gone along with the other 7 or so I had on it.

My right side has 16, 11 & 11 follicles already, and there are 4 other smaller ones. The bigger ones are possibly follicles left over from last cycle that have not yet resolved. She said the RE will definitely exclude the 16mm as viable. She is supposed to let me know if they are going to switch me to Femara to start tomorrow, and if they do they are supposed to prescribe Estradiol for my lining, too. The RE did agree to prescribe me MetaNX instead of just stuffing me with extra folic acid like he originally suggested. Once I know I am tolerating the MetaNX well, I will add methyl B12, see how I do with it & start looking at other things I may want to add.

I have had severe depression, ADD, and anxiety for as long as I can remember. I am 41, and by age 15 I was on anti-depressants. If I had been born in another time, I would have been given meds much earlier. If my MTHFR mutations are the cause of my disorders, fixing them could be the single biggest life-changing experience of my life outside of the birth of my children. I have hope for the first time in a very long time that the remainder of my days will not necessarily be with me and this cloud over my head. I literally wake up daily wondering if it's the day I'll be in bed for a week because my depression has me paralyzed like it has in the past when my medicine stopped working. It could also be huge for my son as we have had some very heartbreaking things happen with him which could possibly all tie back to MTHFR. It could mean my daughters may never have to face the mental challenges we have had. So while I'm frustrated we've never been tested, I have something great to look forward to for the first time ever. I am extremely emotional and grateful right now.