First Post

I will begin my blog with a little background about who I am and where I am in the process of my journey.  I am T, a 34 year old physician.  My husband is S, also 34 and a physician. We have been married for 7 years, and have been trying unsuccessfully to get pregnant for nearly two years.

At first, we approached our goal the way many couples do:  timing our activities based on ovulation predictor kits and taking a few relaxing "procreation" vacations.

It became apparent after 18 months of trying that this approach was not getting us anywhere.  I talked to my OB, who felt it was time to begin working us both up for infertility.  She suggested a semen analysis for my husband, and a Clomid challenge (which I will describe in more detail in a later post) for me.

We started with my husband, who (bless his heart) was quite self-conscious about collecting a specimen.  His semen analysis was completely normal.  I did the Clomid challenge, and all the laboratory values came back normal as well.  Because all of our tests were normal, my OB suggested that we try for a couple more months, and if nothing happened, she would refer us to a reproductive specialist.

Three more months passed, and I was referred to Dr. S, a reproductive specialist.  She wanted to repeat the Clomid challenge test, and this time, run a few additional tests including an Anti-mullerian hormone (AMH).  She also suggested a hysterosalpingogram (HSG), which is an imaging study of one's uterus and fallopian tubes that involves injecting contrast dye into one's uterus and snapping x-rays as the  contrast passes through the tubes.

The HSG was completed early last week, and I am happy to report that I am totally structurally normal.  However, the results of my other laboratory work were more concerning.   Although the FSH and estradiol were doing what they were supposed to do during the course of the cycle, my AMH was only 1.0 ng/mL, which is low.  

AMH is a relatively new marker, but is being used as a marker of ovarian reserve.  So, the fact that this is low suggests that my ovarian reserve is becoming depleted.  In addition, Dr. S told me that my cycle length is also concerning, as it is irregular, and on average only 25 days.  Apparently, a shorter cycle length is associated with decreased ovarian reserve and decreased fertility.

Because of this, Dr. S wants to "fast track" us to in vitro fertilization (where eggs are harvested, fertilized, and embryos are implanted into the uterus), rather than doing multiple rounds of intrauterine insemination, (a much less invasive procedure where washed sperm are placed in one's uterus).  The likelihood of IUI being successful is quite small in someone with decreased ovarian reserve.

However, this month we actually are going ahead and doing IUI.  This is simply because we didn't know the results of our diagnostic workup until last week, and we didn't want to waste the month, plus I was already taking the Clomid for the challenge test.  The actual procedure is scheduled for Tuesday.  

So this is where we are starting.....we are just about to do IUI, and in all likelihood will be doing IVF next month.  I will try to give updates as we tackle each step of the procedures.