Second, Second Opinions

If I thought I was confused after round two of appointments, I am well past confused after today's appointment. Today was with a well established clinic in Atlanta. It was the first IVF clinic opened in Georgia, way back in 1983. They, as a group, have certainly made a lot of advancements in the treatment of infertility. How does that help me? I'm not sure yet. But back to my confusion.

Let's go bullet style on the topics on which there are varying opinions:

• Progesterone- ACRM puts me on Prometrium unless my progesterone is 15, medicated cycle or not. Dr. Massey at SMFI told me that it sounded like they were hunting for an idealized number; he was satisfied with all of my levels. Dr. Slayden at RBA said mostly the same thing. The level 15 is based on an old study from the 80's. He said that progesterone is a hard thing to place as it is constantly moving. A progesterone level can vary A LOT from one hour to the next. He did not recommend progesterone supplements and was more curious as to what my luteal phase might have been naturally. 
• Fibroid- Dr. Massey saw a fibroid, "clear as day" he said. He couldn't understand why no one else had found it. His nurse was in the room and she said the same thing. None of the doctors at ACRM ever said anything. Dr. Slayden specifically hunted for a fibroid today and said that there is nothing, not pea-sized, not walnut-sized, and certainly not lemon-sized. 
• AMH- ACRM tested my AMH level in May of this year. It was 5.4. This of course started the PCOS Debate of 2012, but ultimately, it was decided that I am young, with a lot of eggs, and that explains the elevated number. Last month, I went to a seminar at RBA and I got my results today: 2.54. WHAT THE????? I asked if it normally varied this much, already knowing that, no, it doesn't. AMH isn't on a scale of 1-100, it's more like 0-10, but mostly 0-6. Dr. Slayden confirmed that it shouldn't change this much, and commented that it is probably an issue with different labs. Lovely. I will definitely ask for a new test in a couple of months. Dr. Slayden was happier with the 2.54 as it is not indicative of PCOS, I on the other hand, like the idea of lots of baby making years ahead of me, as I will most likely need everyone.
• Endometriosis- My doctor as ACRM shrugged my endo questions aside explaining that most women have some degree of endo, and it won't change treatment unless it is grade 3 or worse. She didn't feel that I had stage 3 or higher, therefore, no laparoscopy. Dr. Slayden disagreed, saying even stage 1 can affect pregnancy rates. He is curious about endo, but doesn't think it's a sure thing. He didn't see anything on the ultrasound and I was "smooth" as far as the pelvic exam went. He wants to run some blood work and discuss endo further in a month or so.

Despite the confusion, we both L-O-V-E Dr. Slayden. He was soooo nice, very talkative, extremely knowledgable, and he really thought outside of the box. He also listened to all of my thoughts, and appreciated my overly anal, borderline OCD display of medical records, BBT charts, and TTC timeline. I love being appreciated.

So, what is Dr. Slayden's plan of action? Well, run a whole bunch of other tests for starters. Another pint of my blood was lifted today. Yeesh! I'm on my period and I'm already anemic. He wants to test for chlamydia. Yep, you heard me. More specifically he wants to see my antibody levels in regards to the bacteria. The bacteria can apparently cause issues in the tubes whether the bacteria was obtained via sex or breathing. Didn't know you could get chlamydia that way? Me neither. He also wants to look at my CA125. As far as I can tell, this is to see if I might have endometriosis, or if further testing is worthwhile. And because it wouldn't be right to skip over PCOS, we are going to run more labs to hopefully confirm once and for all that I do or do not have PCOS.

We've unanimously decided to go with Dr. Slayden for the time being. I say for the time being because, obviously, we reserve the right to change our minds, but if we do actually get to the IVF point, we might revisit Dr. Massey for his 40% discount. Or we might say "screw US healthcare" and go abroad for a vacation plus IVF for the same cost. Time will tell.

So, December looks a lot like a medicated cycle for the Greavu's. We have A LOT of appointments. Sam is seeing a urologist for a few more tests (more on this later) and I am going to be monitored off meds. Dr. Slayden wants to see what I can accomplish on my own. Hopefully, after this cycle, we will have gained greater insight into what the heck is going on and have a clearer plan forward. Because the one thing that all three doctors do actually agree on is this:

I should be pregnant by now.

Well doctors, we couldn't agree more. So lets get this show on the road.