We met with Dr. Dunn (again) on Friday to go over Jamie's semen analysis results. His numbers were all really good.
Normal Volume is 1.0 - 6.5 mL per ejaculation.
Normal Count is 20.0 - 150.0 million per mL.
Normal Motility is 60% or higher.
Normal Morphology is 70% or lower.
Count 216.1 million per mL
The morphology is a little high, but that is more than offset by the count. The dr. was very pleased with the results, and we are now satisfied that my issues are the only obstacles we have to face. That is an enormous relief, because we are hoping my issues can be fixed with minimal interventions and drugs.
Dr. Dunn mentioned endometriosis again at this appointment. He said I had Stage I when he did my surgery, and it was just a few points away from being Stage II. This does statistically decrease the odds of pregnancy in each cycle.
So here's the plan:
Since I face a statistically lower possiblity of pregnancy, we are going to start doing things to increase my odds from another standpoint. I do ovulate on my own with no issues, but our first step is going to be medication that stimulates the ovaries to ovulate, sometimes producing multiple eggs. More possible targets = higher odds of pregnancy. Clomid is one of the more popular medications of this kind, but it is not what I will be taking. One of the side effects of Clomid is a decreasing of the cervical mucus (which is what creates a hospitable environment for sperm) and a slight thinning of the uteran lining. Thinning of the lining is the LAST thing I need, obviously. This is what makes Clomid an unattractive choice for me. I will be trying a cycle on Femara instead. This drug operates a bit differently from Clomid, but gives the same end result.
Clomid aids ovulation by binding to estrogen receptors in cells and tricking the brain into thinking that estrogen levels are low. When this happens, the brain tells the ovaries to work harder, thus creating more eggs and/or stronger ovulation.
Femara aids ovulation by interfering with the conversion of testosterone into estrogen in the body. So, rather than tricking the body into thinking estrogen is low, this drug actually does cause lower estrogen levels. In doing so, the ovaries are stimulated.
I'm a big student of Google University, but I had never read about the differences between Clomid and Femara. I learned something new!
We are instructed to wait out the remainder of this cycle. When the next cycle begins, I am supposed to call the nurse and come in for a baseline scan. I assume they will be checking the lining at that appointment. Then I begin Femara on cycle day 3 and continue to take it through cycle day 7. I will go for another mid-cycle scan around cycle day 13 or 14. At this ultrasound, they will be able to measure the follicles that my ovaries have produced and tell how many eggs I will most likely release. We are supposed to use an ovulation predictor kit and have timed intercourse (oh how romantic). Then we will see what happens. We'll meet with Dr. Dunn again at the end of the cycle to assess how things went, how my body responded to the Femara, etc. What we hope to learn is that my body does just what it should on the Femara - or better yet...that we are pregnant.
In the event that I do not get multiple eggs on the Femara, we may need to try something different. Dr. Dunn said we might even end up trying a Clomid cycle if the Femara is unsuccessful in producing the kind of results we want to see. If both the more "minor" fertility drugs fail, then we may have to resort to injectibles. This is when our odds of multiple births really begin to increase substantially. I have some major worries about multiples, which is a topic for a different post. Needless to say, I really am praying that the Femara will do the trick. Our odds of twins are only 5-10% on that drug.
So we should be off and running in about 2 weeks.