1st Appointment with RE

The morning of our appointment with the Reproductive Endocrinologist started out with me freaking out because Charles wore this checkered skater-type shirt that I couldn't match, and I wanted us to look "put together" and like we were the perfect couple!  I also wanted us to look older than teenagers.  Charles told me I would pass for a 18 year old teen mom, but only because I put on foundation.  I guess that works, as long as we're married.  haha

We drove down to Sandy, because it was the only office where Dr. S happened to have a Saturday appointment open.  Yay!  Charles could actually come with me, and I didn't feel like I was lying to doctors about having a husband!  Also, distance seriously doesn't matter to us when it comes to this concern.  We were greeted by a nice receptionist, given a welcome packet, and had our pictures taken so they can remember us better when looking at our chart.  That's really smart!  Although, who can forget a short Indian girl who looks like she really shouldn't be a mom yet?

We got called back into Dr. S's consultation office that wasn't really his (he normally is in Layton), and we sat down on a very comfortable couch.  I felt like this is where you put your feet up, your head on a couch pillow and you stare at the ceiling as you recount all of your troubles.  Tissues were also readily available.  He started by saying my name right.  Major points to him.  Then, he made nervous small talk, but it was kind of humorous and didn't make us feel uncomfortable at all.  After that, we jumped right in to discussing my health history first.  He started by asking, "Are you really four foot ten?"  "Uh, yeah..."  You just lost those points you gained.  Better watch your next step!  Then, he said, "Tell me about your lupus."  Haha.  This consumed the next 45 minutes.  Poor Charles was feeling neglected.  We talked about my diagnosis, my 2 month "adventure" at Primary Children's in 2002, high-dose steroids, plasmaphoresis, my surgeries, what systems my lupus affected, the 2.5 years of chemotherapy I did, the 2 years of CellCept - an anti-rejection med so my body would stop hating on my kidneys, how I manage it now, what meds I take, what specialists I see, and on and on.

He admitted to not knowing much about Cytoxan and CellCept, which are two key opponents in our infertility game.  So, he looked them up briefly on several different websites to learn how they impacted fertility.  Apparently, CellCept doesn't have too much of a negative effect.  But Cytoxan is a very high-risk med that can cause a lot of problems.  I already knew that.  But I can promise you that the ICU doctors at Primary Children's weren't asking my mom if she wanted to freeze my eggs while they were busy saving my life, during my first treatment of Cytoxan at age 14.  It wasn't an option to not have chemo.  Dr. S understood how sick I really was when I was first diagnosed, and he made sure I knew that it wasn't my fault I had to have chemo.

He reviewed my hormone labs that my OB/GYN and nephrologist had previously ordered.  My anti-Mullerian hormone (AMH) which measures ovarian reserve was on the low side for a 26 year old woman.  Apparently, I'm in the 20th percentile, so that means that 80% of women my age have more eggs left than I do.  That's a scary thought.  He also mentioned early menopause, to which Charles gave the expected male response.  Great!  So, Dr. S said we need to get started on treatments ASAP to maximize the potential for the eggs I do have left. 

But then he asked a few more questions about my lupus management, and I told him about my blood pressure, and this noticeably changed our conversation.  I told him it got up to 188/135 in August last year when I forgot a dose of Labetalol, was super tired, and had a stressful shift at work.  I was given hydralazine, and then I had a bad reaction to it: migraine, vomiting, BP only came down a little, and HR went up to 130.  He said there are two main drugs they use to treat hypertension in pregnancy: labetalol and hydralazine!  I might not have a choice if I'm in hypertensive crisis. 

He talked to us about fertility meds and said Clomid would not be a wise idea because of the higher chance of multiples, which would be the worst possible thing for my blood pressure since blood volume increases with pregnancy.  So, he suggested Femara, with which you don't release as many eggs as you might with Clomid.  He definitely said the goal would be a singleton pregnancy.  Then, he leaned back in his chair, and said, "You know, there's always other options like adoption."  Yep, and we are planning on that in a few years.  Thanks.  We are here to get pregnant, and we know this is a huge risk we're taking.  With me being a nurse, and Charles and I both being excessive worriers, believe me, we've researched and thought about this A LOT.  I told him that all of my specialists follow me very closely and I have their blessing, and he felt a little better.  He then recommended I see a Maternal-Fetal Medicine specialist before conceiving.  We then came up with a plan.

The Plan: Take Femara beginning with my next cycle, use OPKs more dedicatedly because all the ultrasounds and bloodwork will be based on my results from when I appear to ovulate, and carry on as usual for two cycles.  If there is still no baby, then we'll try Femara plus IUI.  All in all, a very good one hour visit that really made us feel like Dr. S knows us and cares about us individually.  If anybody is actually reading this, keep us in your prayers!