and now, what you've all been waiting for: the results

we had our appointment with the fertility doc today to go over the zillion and one results from all of the procedures and tests. and, i have to say, the outcome is probably ideal. i honestly would have been miserable if he'd said, "you're perfect in every way and we have no idea why you're not getting pregnant! just go home and keep trying!" but, obviously, i didn't want to get terrible news about my health. thus, my perfect scenario was realized: there are some things going on that could very likely be impacting our fertility, BUT they should be easy to fix.

we were there for 45 minutes and i still love the doctor so much. he went through every single test result in detail, including each and every blood test that they ran with the huge vat of my blood they collected over three visits. he had looked over everything, including the records sent from my regular doc, and prepared a huge detailed and organized file with multi-colored tabs to document everything. it was very satisfying.

RESULTS
overall, i am in very good health. the results were negative for all of the bad genetic stuff like sickle cell anemia and cystic fibrosis as well as for all of the infections and STDs and whatnot; not only do i not have any of them now, i never have. that was the most interesting thing i learned from the conversation, actually, that your blood is a record of your body throughout your life. it showed that i had chicken pox, and that i have been immunized against hepatitis B, and also that i had parvo (fifths disease) at some point in my life, although neither i nor my parents realized it. fascinating stuff.

but i digress. in addition to being clear of nasty stuff i also had normal results for the hormone tests. my ovaries have lots of healthy eggs and are producing them normally, and my estrogen and testosterone levels and whatever else are rising and falling as they should throughout my cycle. i am also totally normal in most of my other body functions, such as liver, thyroid, etc. my cholesterol was slightly high but nothing terrible (and i didn't fast before the test, so it may not even be accurate). the only thing that came out of the blood tests that is important to note is that i carry two genetic mutations that have to do with blood clotting. for normal, healthy nonchild-bearing folks, this is mostly irrelevant and doesn't impact their lives in any way. for normal, healthy pregnant women, they just need to take medication to make sure they don't develop blood clots. but it may be a bigger deal for me... more to follow.

the other thing that the tests showed was that there is something not quite right with my uterine lining. there are two parts of the lining (endometrium): the glandular lining and the endometrial stroma, which is connective tissue. these two parts have to be formed together in a particular way in order for a fertilized egg to implant and thrive. right now, mine probably won't allow that to happen. the doc said that even if an egg did manage to implant, this condition causes repeated spontaneous abortions. but he also said that scraping out the lining and letting it start from scratch will hopefully fix that, and also remove any polyps that are there. he said the one we saw in the sonogram photo may or may not actually be a polyp, but if it is one it needs to go. so that's something that will need to be done.

the third thing that the doc shared with us is that he's pretty convinced that i have endometriosis, which is a condition in which endometrial-type cells develop in other parts of the body, usually around the ovaries, causing lesions and sometimes scar tissue. these cells respond to hormonal changes as the regular endometrium does, which can wreak havoc with your periods and fertility. if it's bad enough, there's a chance that the tubes can actually become deformed from scar tissue so that the eggs don't ever make it out. the doc said that almost always when he sees a woman under 35 with otherwise normal test results, awful periods (which i have developed over the past couple of years), and a partner with decent sperm counts (which he insists the hubby's are) that endometriosis is the cause of the infertility. once they remove the cells, pregnancy is often very simple.

but in order to do that they have to do a surgical procedure. it's called a laparoscopy, and it consists of inserting a scope through my belly button and something else through the bottom of my pelvic region in order to get a closer look at what's happening down there. this allows them to see around and behind the ovaries and tubes to really be certain that everything is working correctly. while they're in there, they can laser away any endometriosis that they find. they can also, in my case, scrape out the uterine lining. it's like two surgeries for the price of one! aren't i lucky.

but before any of this happens, i have to see a cardiologist. when i was younger, my pediatrician discovered an abnormality in my heart that they kept a very close eye on throughout my teenage years. one of the valves that is supposed to be a tri-cuspid (meaning it has three flaps to let blood through) is only a bi-cuspid. for years they thought this might cause me problems, but eventually they stopped monitoring it because it seemed to be rather harmless. however, in pregnancy when the demands on the body increase tremendously, this could be an issue. add to that the blood test results that showed i may have issues with blood clotting, and we could have a serious problem. the doc insisted that i see a cardiologist before we take any other steps, to make sure that i'm healthy enough to handle a) surgery and b) a possible pregnancy. in fact, he called a reputable one at the hospital and talked to him this afternoon, so all i need to do is call and make an appointment.

NEXT STEPS
so, to recap concisely, here are the issues at hand:
1) blood clotting/possible heart issue
2) uterine lining problem
3) possible endometriosis

the first thing i need to do is see the cardiologist. as soon as he clears me for surgery (assuming he does), i schedule the laparoscopy. the doc wants this to happen in the beginning of my cycle, after my period has stopped but before ovulation -- so i'll need to look at my calendar and figure out how that works. after the surgery (and the 5 days or so he says i'll need to recover) we will hopefully be good to go. as long as the surgery doesn't reveal any bizarro issues with my tubes, the doc said he'd probably advise us to keep trying on our own for a couple months, possibly with the aid of injections that would up my ovulation rate (giving us a better chance of conceiving). if that's still unsuccessful, we'd probably try IUI. but, again, this assumes that my tubes are totally functional.

if the laparoscopy reveals problems with my tubes, in vitro will be our only option. the doc said -- in light of our financial concerns about dropping the $10k this costs and the fact that my insurance only gives us $5k per calendar year toward any fertility assistance procedures -- that we'd be sure to save that whole $5k to put toward in vitro, if that's the case, rather than wasting time with IUI when it won't be useful. but we're hoping it won't come to that. (although my inlaws have already offered to pick up the tab for the $5k our insurance wouldn't cover if that's the only way they'll get a grandchild.)

so for right now, it's the cardiologist and then hopefully the surgery. and then we'll know even more and will be able to plan for the next (and hopefully last) step. the doc is very optimistic. he said his job is made easier by people in our situation. and so i am also optimistic. this is the best i've felt about this matter in months, even though i'm staring down a not-so-fun surgery. if it leads to us finally having a baby, it will be worth far more than that discomfort.

and the best part? there's absolutely nothing i can do until i get back from my trip in two weeks. i can't even wonder or worry right now, really. so i can hop on a plane and leave the stupid ovulation monitor at home (i can't figure out how to deal with the time zone change anyway) and just enjoy life and love and vacation for awhile. won't that be grand?