Diagnosing: Katie’s Infertility Factors Part 1

Our year was up! Since no pregnancies had occurred for twelve whole months, so we could now see a doctor for potential infertility factors. This was both terrifying and a relief.
doctor with female patient

I scheduled an appointment with Valley OB. I had two specific things to discuss them: the fact that we still were not pregnant (of course) and a somewhat recent change in my periods. They set me up with one of their Nurse Practitioners, Heidi McSweeney. The receptionist raved about how wonderful Heidi was and how she was especially talented at helping women become pregnant. I remember her telling me that if she was in my situation she would hands down go with Heidi “Don’t worry. Heidi’s great, you’ll definitely have a baby within the year!” I remember feeling my butterflies melt away and having a renewed sense of confidence.

Heidi and I discussed a few things. My periods had changed (basically they had changed length/heaviness after 9 years with no obvious cause) and while I was definitely not unhappy about the shorter, lighter periods but any change in your periods when you’re trying to get pregnant could be a bad thing. Heidi told me the change could likely be from the stress of wanting to be pregnant but it could also mean I wasn’t ovulating regularly so let’s run some tests. (if this was a movie, this would be the montage of me being poked over and over for vials of blood to be sent to the lab…with a caption of “And so it began!”)

My blood tests came back mostly normal. But the big one was my vitamin D level–I was EXTREMELY low. Heidi told me that they prefer to have their patients in the 40s for their vitamin D but for sure no lower then 30. Well, I came in at an 11. Ok, super low, but big deal? What does that have to do with anything? More than I thought! Vitamin D affects progesterone, estrogen, ovulation, and other important factors to fertility. Would addressing my vitamin D deficiency make me get pregnant? Not necessarily, but treating it would definitely increase my chances. Enter a prescription strength vitamin D. Getting the vitamin D was helpful right from the beginning by helping with my energy and my winter blues and I could feel my levels going up.

Seeing immediate differences with the vitamin D made us optimistic that maybe that was all we needed to tweak in order to get pregnant. But about 3 months after my first visit with Heidi I started having stabbing back pain, similar to pain I had previously had with kidney infections but much constant. I went back to Valley OB and met with their Urogynecologist Dr. Peter Drewes. I will say it now–we LOVE, LOVE, LOVE Dr. Drewes!!! If I could see him as my primary care physician I would! He’s fantastic.

Dr. Drewes and I discussed my current pain along with the dilemmas we were facing to conceive. We discussed the possibility of Endometriosis Basically,endometriosis is scar tissue growing where it shouldn’t be. On the uterus, or ovaries, or on the organs between those two, or on several things. The tissue gets thicker each month and can also lead to cysts, all of which makes it difficult to get pregnant because the eggs don’t get where they’re supposed to. For some women endometriosis will present itself with lower back pain, just like the pain I was experiencing. This pain, the changes in my periods, my problems getting pregnant, and the fact I have two aunts who have endometriosis (and a third aunt who had ovarian caner, which is sometimes caused by endometriosis) all made endometriosis look like a good possibility. Here’s the catch with endometriosis though–it can only be diagnosed by having a laproscopic surgery. There was a good chance though that if I had the surgery they wouldn’t find anything and the surgery would’ve been pointless. Dr. Drewes told me about how endometriosis is usually easy to treat though. Sometimes they can fix things during the surgery, other times you get a shot once a week or month for 6 months. Depends on the severity.

Dr. Drewes let me know that we could also try medication that induced ovulating if we did not want to try surgery right away. If I were to do the meds, they may work just fine and get me prego within about 6 months. Buuut, if the meds don’t work, I’d be out 6 months and then may need to do the surgery then. Or if the medications did work right away but I did have endometriosis, it would get worse over time, which may lead to problems conceiving with baby #2 or later.Dr. Drewes told me that the choice was up to me and he typically wouldn’t jump to surgery before checking out Jason for male factor infertility, but with all my symptoms he would feel confident in going forward with the procedure.

Jason and I discussed the pros and cons. At the time Jason was uninsured so getting him tested for anything would 100% be out of pocket for us. I was insured and had really great coverage but it was still pricey for two college kids. It was also minor surgery with the typical risks that come with it and at least 2 weeks of being in pain while I fully recovered. And of course, there was no guarantee the surgery would give us any answer. But we decided that the surgery was something we had to do. We needed to know either way and figured if they did find endometriosis we’d finally be able to treat symptoms I’d been dealing with for years. If they did not find anything it would just be added to my list of unhelpful, inconclusive test but at least we would know.

We met with Dr Drewes for my preop appointment and good news for me, we got one diagnosis before even going in! I had called up my aunts to see what their experience had been like with their surgeries. Their recovery time and pain levels varied but they both said the surgery was well worth it and dramatically improved their health. While we were talking they asked if I had been checked for Factor V Leiden, a clotting disorder that runs in our family. No…hadn’t heard about it til then! I asked Dr. Drewes about it though because it could also affect fertility. It wouldn’t play much into conception but it could cause miscarriages and still births and they would need to track me closely when I do get pregnant. He ran the test and yes, I do have Factor V Leiden Heterozygous. Not a diagnosis that would stop us from going through with surgery, but still important for us to know about. We hoped that if nothing else my surgery would bring us more answers!

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