Tuesday, August 27, 2013

Unexplained Infertility

Labels.  They are everywhere.  As much as we try not to, we are always using them.  During my struggle with infertility, I "gained" this label.

Unexplained infertility, meaning that if there was a reason I wasn't getting pregnant, they couldn't identify it.  This is a label you get if all the tests that are run produce normal results.  My husband's sperm analysis was normal, as were my blood tests for insulin resistance and my baseline ultrasound. My estrogen, prolactin, FSH (follicle stimulating hormone), and TSH (thyroid stimulating hormone) levels were all fine.  It appeared that I ovulated on my own, based on my progesterone levels late in my cycle.  And yet, I wasn't getting pregnant.

I found that not having a reason, not having something to blame, was frustrating.  If you don't know what you're up against, it can be difficult to fight it.  At first, my RE (reproductive endocrinologist) thought that a round or two of Clomid would do the trick.  It would give my body a little boost, maybe help timing a bit.  When that didn't work, he suggested an HSG test. (Click here for a definition)  The test showed no major abnormalities, although my left fallopian tube did not fill with dye.  My RE was sure that this was because I have experiencing some pretty substantial cramping during the test (look for a post describing my HSG experience soon).  I trusted him, and we carried on, bolstered by the knowledge that many woman have a higher chance of conceiving shortly after the test is done, usually because small blockages and debris could be flushed out by the test.  Around this same time, I told one of my nurses that I was having spotting leading up to my period, around 11 or 12 days after ovulation. Dr. B decided to having me take progesterone supplements during my leutal phase.  Progesterone is a hormone produced by the body, the level of which rises after ovulation.  If a woman becomes pregnant, the corpus leuteum cyst, which is left behind after the follicle releases the egg, is maintained by the HCG (the pregnancy hormone) in the blood, so it continues to release progesterone.  If the body doesn't start producing HCG, the progesterone level falls and the lining of the uterus is shed.

Dr. B theorized that perhaps I was a late implanter, meaning for one reason or another, an egg takes a little longer to travel to the uterus to implant.  If it took longer than 11 or 12 days, it was possible that my uterine lining was already beginning to shed before a fertilized egg could implant there.  By having me take supplements, my progesterone level stayed up, and I didn't start my period.  If I tested negative for pregnancy, I was to stop taking the progesterone supplements and my period would start 2 or 3 days later.

Two months later, we switched to Femara.  I responded well, ovulating earlier than even on Clomid.  My normal ovulation was sometime between day 18 and day 22.  This isn't necessarily indicative of a problem.  Most woman ovulate anywhere between CD 11 and 21.  Fertility drugs made me ovulate sooner in my cycle.  Later ovulation can sometimes point to poor egg quality, but not always.

After our first round of Femara, when I found out I wasn't pregnant, I went in for my usual ultrasound. While I was there, I expressed my frustration to one of the nurses.  She was very nice and suggested we do a more monitored cycle and try a trigger shot, which would better time the moment of ovulation and make it stronger.

That month, we conceived.  Did lengthening my leutal phase help me get pregnant?  Did ovulating sooner in my cycle help me conceive? Was it just chance? We can't be sure.  Since we didn't know what, if anything, was behind me inability to get pregnant, we will probably never know, unless a problem arises.  It's possible we could go on and have more children easily.  But we could also experience the same problems.

The point to this post is this:  Fertility issues like PCOS, endometriosis, and low ovarian reserve are fairly well known and if the correct tests are done or if symptoms are noted, the are usually quickly identified and treated.  Less obvious issues (whether there is a known medical reason or not) can also lead to years of infertility.  Maybe a lot of woman labelled with unexplained infertility have a medical issue that just can't be identified yet.  Science has come a long way, but we are constantly hearing of new developments, tests, and treatments, perhaps someday there won't be so many people with this label.  I certainly hope so.  And I applaud doctors, like my own, that try to treat the problem, even if they can't really identify it.  I don't think I'd have my second son if not for them.

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