“Infertility reveals the darkest & most vibrant days of your life. Lean in & honour both” – @mstiagendusa
When I began this investigative journey, I went into all my appointments not expecting them to find anything or pin-point anything. I just expected the worst-case scenario – which for me would be to find out that our infertility is “unexplained”, because I mean what do you do with that?! In the same breath, however, I feel like each time I see someone or have some sort of test, SOMETHING always comes up – almost as if my body wants to deduce it to SOMETHING and consequently influencing the specialist to think the issue is “this” then it’s “that” then again “maybe this!” So I am a bit anxious now when I go for any testing because there is always something!
So the first thing that has been ruled out is PCOS – I do not have the 2 features to meet the criteria as explained in my previous results post so that’s good – all I have to contend with is the irregular periods (and suspected irregular ovulation). Turns out though, in ruling out PCOS, something else was discovered in my right ovary during the transvaginal scan. I quote ‘There is a 22mm x 22mm x 10mm area of increased echogenicity on the right ovary with peripheral vascularity on colour doppler. Collapsing follicle or Endometrioma?’ I knew something was off when the surgery called to say the doctor wanted to see me to discuss my scan results because usually when there is nothing to raise an alarm, the secretaries tell you or they arrange a telephone call with the GP. But still, I was very chilled when I went in for my appointment until she mentioned endometriosis. Up until that point, I genuinely knew nothing about endometriosis – I had heard about it and knew people who suffered from it but I knew nothing about it especially in the context of trying to conceive. So obviously I asked the GP lots of questions and she basically explained that Endometriosis is a condition where tissue similar to the lining of the womb starts to grow in other places, such as the ovaries and fallopian tubes (NHS). And potentially this might be what is going on in my right ovary. We also started discussing my stint in hospital (that birthed this whole journey) and how the pain was on the right side of my pelvic area and even that morning before I saw her and the 2 days previous, I had this tinge of pain in my right pelvic area where the ovaries are located but I just put it down to ovulation ? I don’t know. And it’s a pain I often have but it’s such a slight pain (compared to period pain) that I have always just brushed it off. Also, I have very painful period pains which is another symptom of endometriosis. We both agreed that the coincidence was a bit much BUT she also explained that because of the timing of the scan and where I was in my cycle (I had just ovulated – the nurse confirmed it at the time which made me so happy!) that it could be the collapsed follicle when the egg is released and if not fertilized results in a period. And this would make sense because a few days after my scan my period came.
Endometriosis does not necessarily cause infertility but there is an association with fertility problems, although the cause is not fully established. Even with severe endometriosis, natural conception is still possible. As the severity of the endometriosis increases, scar tissue (adhesions) become more common and the chance of natural conception can decrease. There is an association between infertility and endometriosis, but the cause has not been fully established. Minimal to mild endometriosis sufferers have an almost normal chance of conception but some sufferers are infertile for unclear reasons. In cases of moderate and severe endometriosis chances of natural conception are reduced. This is because there are more adhesions that can trap the egg and stop it from moving down the Fallopian tube. Drug treatments have not been found to improve fertility. However, the removal of cysts, adhesions and nodules during surgical treatment has been found to increase chances of conception. Endometriosis can cause delay in getting pregnant, but once you are pregnant, pregnancy is expected to be no different from normal. There are reports of women who had more pain in the first few months of pregnancy. In general, pain improves, but may return after giving birth as periods return. © Endometriosis UK
It’s easy to speculate and run wild with explanations but speculations serve as assumptions to be confirmed or ruled out so I will be having the scan again but this time at a different time in my menstrual cycle, however, I have to see my gynae first who will further interpret the scan results and perform the second scan himself. This won’t be until the end of September because our appointment was booked 8 weeks in advance to give time for my hubby’s sperm results to come back. That’s another thing, sperm analysis results take the LONGEST time! Had I known this we would have started the investigations with him. Another update – regarding my blood/hormone results – I saw my gynae who interpreted the results and said my hormones look fine and do not suggest PCOS or a hormonal imbalance of any kind. Again – good! I then asked about what my GP said that I may not be ovulating and he said well because of your irregular cycle you are ovulating irregularly we know that but what the GP meant is that it is harder to know with your cycle when you are actually ovulating, is it slightly earlier than the norm or much later, we cannot guarantee when you will ovulate like we would be able to with a more regular cycle. So on this point I just want to stress the importance of specialism in medicine – my GP is not as equipped to make a gynaecological diagnosis from my hormone results as someone who trained in that specialism. So GPs speculate because that’s the nature of their investigations as GENERAL practitioners but a specialist like a gynae can give you more (dare I say accurate) insight on your results because that’s their forte and they will know, having dealt with thousands of samples of data and outcomes what is a red flag or not. My gynae was very calm and satisfied with my blood results that it put me at ease. My husband then asked about what our options are likely to be in terms of treatment and the gynae advised that it now depends on the sperm analysis; if my hubby’s sperm analysis is abnormal then our only option is IVF but if his sperm is normal then there could be interventions available to us before IVF such as hormonal treatment (clomid) for me to regulate my irregular cycle or IUI which is basically intrauterine insemination of my hubby’s semen into my womb at the optimal time for potential fertilization. My husband has been a dialysis patient (due to renal failure) for over 10 years now and he has regular dialysis which the gynae advised can affect sperm quality so there is that speculation – hopefully to be ruled out! (I will write about dialysis in another post at another time because I think that’s a condition that almost no one knows about – even I didn’t know before I met him – and it can happen to anyone and both my husband and I are big on raising awareness about kidney failure).
So, sperm analysis tests for several markers of sperm health, including:
- the number of sperm in 1 milliliter (ml) of semen
- the size and shape of the sperm
- the ability of the sperm to move correctly
In couples that have been unable to conceive, some estimates suggest that there is a male factor present in 40 to 50 percent of cases, resulting from one or a combination of:
- low sperm count in a sample of semen
- poor sperm movement, known as motility
- abnormal sperm size and shape, known as morphology
Sperm count or concentration
World Health Organization (WHO) guidelines suggest that a normal sperm count is at least 15 million per ml or no fewer than 39 million sperm per sample. Having less than this indicates a low sperm count.
Sperm motility is the ability of the sperm to move efficiently. Low motility can reduce the sperm’s capacity to move through the female reproductive system to fertilize the egg. In a typical sample, at least 50 percent of the sperm will demonstrate normal motility.
Morphology refers to the size and the shape of the individual sperm. Normal sperm have a long tail and oval-shaped head. Abnormally sized or shaped sperm can have difficulty reaching, penetrating, and fertilizing the egg. Normal semen contains a minimum of 4 percent sperm with standard form.
So this is where we are so far… I have generally been quite busy (enjoying my love affair with SUMMER) and haven’t really been thinking about this too much but I was with my puppy (Leo) the other day and I realised that I haven’t cried in months about this infertility thing. My husband initially said I couldn’t have a puppy years ago but I’m now thinking how strategic his change of mind was when he told me in April that he would be getting me a puppy. I had been in hospital, I had been so down, had cried so much about this infertile life but I kid you not I have not cried once since Leo came into our lives. I don’t know if my hubby knew the effect a puppy would have but it has worked. Obviously, he is not a real baby and he will never replace the desire for one but now I am never home alone, or upset for too long because I just see his face and all is well in the world. Even now I’ve been typing for a couple of hours, he has been whining the whole time and he is giving me the sad puppy eyes. As well as filling my heart with a new kind of joy he has kept me so occupied that I haven’t spent much time feeling childless.
All in good time. This I know.
love & light