16 December 2012

Initial Consultation

So it ended up that I was off the pill for five months before getting to the clinic.  I first went on the pill when I was 19.  As a teenager, I had never had "normal" periods in the sense that I only had about 4-6 a year.  The pill was a life-saver for me.  It regulated my periods so I didn't have to wonder all of the time if I was getting my period or not.  I was on the pill a long time.

At some point when I was 27 or 28, they took me off the pill because I had high cholesterol and was overweight.  My periods were again not regular and it was frustrating and annoying.  I was off the pill for a couple of years.  I don't remember how it happened now, but my cholesterol lowered, I moved, and I managed to get back on them.  I was on the pill until my emergency surgery to remove an ovary due to a large dermoid cyst.  I had a few months off and then went back on the pill, but this time on Cerazette which is a progestogen only pill which had the awesome side effect of eliminating my periods altogether.

I didn't have high hopes for my menstrual cycle going off the pill this time.  So imagine my surprise that for the past six months I've had six 'normal' periods, pretty much monthly.  Go figure.

So after five months I got back in touch with the clinic and arranged my first consultation appointment.  The clinic was calm and quiet.  The staff were friendly.  I met with the head doctor for the consultation.  We discussed my personal history, why I was looking into egg freezing, what my concerns were.  I could sum them up as follows:
  • I have a history of irregular periods, I did not know if this was a sign of a less than optimal fertility.
  • I have one ovary left.  I did not know if this made me not particularly suitable for egg freezing.
  • I'm 38.  Obviously at this age your fertility starts to drop anyway, so I didn't know what my overall chances were, aside from the whole one ovary thing.
  • I have a history of one very bad dermoid cyst and I have been told that I have a small one on my remaining ovary that is monitored every year.  I wanted to know how the drugs used in egg retrieval would interact with cysts.
The doctor I met with was very calm and answered all of my questions.  He wasn't pushy in any way and I didn't feel that he was trying to "sell" me anything.  I'll put down what I recall of his responses in the same order as above.
  • My periods have been regular since going off the pill.  Without further tests, it's not an outstanding indication of anything wrong.
  • One ovary is not ideal obviously, but does not mean I'm not suitable.  Again, further tests are required for a better picture.
  • 38 is getting older but still a reasonable age.  The doctor told me about women who come to him at 40, 42, 45 and how he wishes they came sooner.  He explained how freezing my eggs now would freeze my 'chance' at 38.  He said, I could obviously still get pregnant naturally.  I may never use the eggs.  I may decide to use the eggs.  But that it simply gave me an option that I otherwise wouldn't have and that option would be 'frozen' at my chance now, at age 38.  Which, he reiterated, was not necessarily horrible.
  • We discussed the cyst and my mother's history of cysts.  He said it's very unusual for hormones to affect dermoid cysts and that he wouldn't consider it an issue, though obviously they would monitor it carefully.  And also, the procedure will always come with some risks.  He rightfully noted that I would be rather protective of my one remaining ovary and that it was sensible to not want to do anything that might damage it.
So that was the bulk of my questions answered.  He said that the first steps in assessing my chances at egg freezing would be to do a follicle count on my ovary using a vaginal ultrasound and to do an AMH (Anti Mullerian hormone) blood test.  He said if both were poor, then I would probably not be a good candidate for egg freezing and might instead want to consider egg donation in the future.  If both were good, then I would be a good candidate for egg freezing.  If one was good and one was bad, it might make the results uncertain but it would still be possible.

He told me that in order to try to assure best odds for a future pregnancy, I would ideally want 15-20 frozen eggs.  He suggested that if one assumes an 8-10 egg collection per cycle, that I would be looking at 2 cycles.  He said if they were only able to get 5 eggs in a cycle, I might want to consider 3 cycles, though obviously cost becomes an issue.  They don't recommend more than 3 cycles.  I should add that at this point, I believe I can only afford 2.

So with all of that information, I went ahead with the ultrasound in the clinic.  I was intrigued by the ultrasound equipment, seeing as I have the same test every year on my remaining ovary it was shocking to see how much more powerful the equipment they had was.  Also, it was 3D.  I got to see my uterus like a shining golden chalice.  He said it all looked healthy and normal.  And then my ovary.  I'm looking at the screen, looking for my ovary, because I do this every year and he's showing me something about the ovary and I'm like, "Oh, is that black spot the ovary?" and he's like, "No, that's a follicle.  All of those black spots are follicles.  The entire thing is your ovary."

Really?  I'm used to my ovary being the size of a circle I make with my thumb and pointer finger on the screen, not the entire size of the screen!  He clicked and mapped things and looked around a lot.  He said he didn't see any sign of the cyst that I get checked for every year.  That was kind of weird.  But then, when I was on the operating table, they looked for it visually and didn't see it.  Still, I swear I see it every year on the ultrasound they do at the hospital but I sort of have to believe this guy knows what he's looking at.  At any rate, it was a good result as I had 9 follicles showing on the ovary which is apparently a reasonable amount.  So that meant I was a reasonable candidate for egg freezing.  But I had to do the blood test to find out the rest of the story.

So on to another part of the clinic.  Paid just shy of 500 pounds for the consultation, ultrasound and blood work.  Then met with the nurse who took my blood.  They said they'd get the results back to me in a couple of weeks.  I updated my mom (obviously) and went home to think about everything and wait on the results.

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