Today was the long-awaited day: our first appointment with the fertility doctor.
The doctor we chose was booked out for 6 weeks from our first inquiry, so we had plenty of time to prepare. Soon after scheduling our first appointment I read Taking Charge of Your Fertility – a highly informative book that I would strongly recommend – and I started charting my basal body temperature and cervical fluid. This is how I determined that my cycles have been getting longer (around 35-40 days) and that even though I have had the characteristic rise in temperature following ovulation, I’m not producing the fertile-quality cervical fluid one would expect.
The doctor began the appointment by going through the information my husband and I had provided in our new patient questionnaires, then explained that the most common issue affecting CF patients’ fertility is thick cervical mucus. He went over some of the blood tests he would recommend, including basic screening tests for non-CF-related issues like fragile X and STDs, as well as thyroid and hormone tests. He also recommended a semen test for my husband, who was relieved to hear that he can produce a sample at home and bring the sample cup in a discreet little paper bag as opposed to having to “perform” in the men’s room at the clinic.
Finally, the doctor went over the process of artificial insemination or IUI. Since we’re still pretty young he suspects that the issue has more to do with thickened cervical mucus due to CF than anything else, and he explained that IUI is often enough to overcome the issue. He also explained that if I’m not ovulating, or if the IUI is unsuccessful, we could move to Clomid and/or IVF – but he seems to be in favor of less invasive methods if possible, which is nice. He also explained that though our insurance covers 3 IUIs, they aren’t very expensive – around $600 a pop – so if it requires more than 3 to achieve a pregnancy it’s something we can pay out of pocket for without much trouble (in the grand scheme of things). IVF, on the other hand, runs upwards of $12,000 a cycle, and since our insurance only covers 3 IVFs, we want to be conservative about how we use them.
Then, the moment of truth: the ultrasound. The doctor took a good look at my uterus and ovaries and showed me everything on the screen, which was really interesting. It was amazing to see the little follicles on my own ovaries on the screen! The scan was nearly all good news. My uterus, endometrial lining, and fallopian tubes all look normal. My ovarian reserve looks great and I have plenty of eggs developing on each ovary. The only thing he found that was a bit concerning was that there were potentially too many eggs developing on each ovary: 8 on the right and 11 on the left (including the largest, which looked to be this month’s winning egg for ovulation purposes). He said this could be a sign of PCOS, but he didn’t seem overly concerned about it.
He did ask me to come back in a few days for a second scan since it was difficult to determine whether I was just about to ovulate or had just ovulated. The largest follicle was a bit too small for ovulation, meaning it was either still growing to ovulation size or had recently ruptured and was decreasing in size as fluid leaked out. I’ll be going back on Thursday so he can have another look. This is important because he’s trying to determine exactly what my cervical mucus is like around ovulation. If I’m about to ovulate within the next few days, my cervical fluid seems, frankly, pretty terrible. He said it’s so thick that it’s essentially forming a plug similar to what he would expect to find in a pregnant woman – meaning sperm have no shot of getting through it to get to the egg. If I’ve just ovulated, my mucus quality is still poor, even though he would expect it to have lower moisture content at this stage anyway.
So, all in all, he seemed really optimistic. He said finding poor quality cervical fluid is actually good news, because if that’s all there is causing the problem – which the blood tests can help confirm or deny – that’s a pretty easy fix through IUI. If there’s more to it we’ll find out within the next few weeks as my husband and I get our testing done. But at present, in his words, “We’re throwing Michael Phelps into an empty pool.” Ha!
The doctor’s final recommendation was to set up an appointment with a high-risk OB/GYN to establish care, so that once I’m pregnant I can smoothly transition into that doctor’s care for the remainder of the pregnancy. So, that’s the next step… and I’m hoping I can find someone I like as much as the fertility doctor. He spent about an hour and a half with us and was so thorough and kind. Things are off to a good start!