Monday, November 30, 2015

A completely unexpected diagnosis...

As I discussed in our previous post, I had a follow-up visit with my gynecologist to discuss my blood test results. Fully expecting to receive a diagnosis of PCOS, I was very surprised to find out that my ultrasound was completely normal and my blood work was all within the normal range, with the exception of my prolactin level. I was officially diagnosed with "Hyperprolactinemia" (fancy term for elevated prolactin level). This likely explains my irregular cycles.

What causes prolactinemia?
There are a few different reasons why the level might be elevated. One of the reasons can be an enlargement of the pituitary gland or a pituitary adenoma. Due to that, I have to have an MRI to rule-out this possibility. I'm waiting on my doctor to complete the pre-authorization process with my insurance company to get the MRI scheduled.

I have also been referred to work with a reproductive endocrinologist. I really like my gynecologist -- the doctor she has referred me to is the endocrinologist who helped her with her own infertility issues.

Yeah... there really is no sugar-coating the fact that an elevated prolactin level suppresses ovulation. And, if I have a pituitary adenoma, it can make pregnancy more complicated (pregnancy hormones can cause the tumor to grow). I honestly thought I had PCOS, but that is often resolved with fairly simple medication to achieve pregnancy. This is a potentially more complicated diagnosis.

I hope this MRI can be scheduled soon, just so that I can meet with the reproductive endocrinologist soon.

I'm honestly feeling fairly defeated today. Pregnancy has been a constant and happy discussion in our home. Several of our friends have recently welcomed new babies or announced pregnancies. Of course, it is hard to not get caught up in the "why me?" and "why us?" We are also trying to avoid jumping to conclusions or relying on Google for answers before meeting with a specialist.

I will likely post again after I feel like I have my own emotions processed a little more around this situation.

Sunday, November 29, 2015

Rule Out: Polycystic Ovary Syndrome (Part 1)

Well this post is not an easy one to write, but necessary to document our journey to parenthood. We also questioned about posting about it -- we aren't sure if we would ever share this blog with people we know (i.e., our parents, siblings), but we want to make sure anything we share here is something we would feel comfortable sharing with those people. Therefore, we will be limited in the healthcare information we share. Some people feel fully comfortable in sharing intimate details of their TTC journey -- things like temperature charts that include things like cervical mucus charting. That's great some people can be so open about things, but we think some things should remain private.

That said, we are currently waiting on a diagnosis to explain A's irregular cycles. A had a regular check-up in September and she shared a concern with her doctor that she could have PCOS, based on irregular cycles. A has some of the symptoms, but not all (e.g., it is a condition often considered for women who have trouble losing weight, while A has trouble gaining weight). However, PCOS can still occur in slim women.

What is PCOS?
From the PCOS Foundation: PCOS (Polycystic Ovary Syndrome) is the most common endocrine disorder in females. There are many signs and symptoms that a woman may experience. PCOS cannot be diagnosed with one test alone and symptoms vary from female to female. Early diagnosis of PCOS is essential since it has been linked to an increased risk of developing several metabolic diseases such as diabetes and high cholesterol.

A's diagnostic testing included an ultrasound and extensive blood tests. We have the preliminary results from the ultrasound, which indicated she was in the "very high" range of follicles. While this does not definitively confirm a PCOS diagnosis, it is consistent with hallmark signs of PCOS.

I received a call from the doctor to indicate that something came up "abnormal" in the blood test and the doctor would like to meet with her to discuss this further. I have a doctor's appointment scheduled for Monday (November 30th) to find out what showed up in the blood test. While I am feeling a little nervous, my gut feeling is that the blood test is just confirming the PCOS diagnosis I had already suspected.

What would it mean if I have PCOS?
PCOS involves an increased level of testosterone, which can suppress ovulation. This means that even though I am having cycles, the irregularity of the cycles may mean they are anovulatory cycles. If I'm not ovulating, that means we will have a much harder road to achieving a natural pregnancy.

If I do have PCOS, the likely recommendation will be the use of medication to achieve normal ovulation. This involves the use of medications such as Clomid or Femara. While women with PCOS often successfully conceive with the use of these medications, there are many possible side effects associated with those medications.

One of the side effects to consider is the increased potential for conceiving multiples. The reason for this is because when ovulation is artificially stimulated through medication, multiple eggs can be released. The risk of multiples is about 1 in 10 pregnancies achieved through this medication, compared to 1 in 100 of pregnancies occurring without medication to stimulate ovulation.

Watch for an update tomorrow after the appointment.