I had my appointment with Dr Check on Tuesday evening. It began at 6:00pm (and I didn't have to wait long to be called in), and ended at 9:40pm.
I walked out about 5 lbs heavier from all of the paperwork I was given (articles written by the Dr about various subjects - all VERY specific, for example, "Why Progesterone use is Better than Ovulation Stimulation Medication in Women with PCOS" and "How the Uterine Environment is Negatively Affected by the use of Ovulation Stim Meds in Women with PCOS").
I was also happy to hear Dr Check say he respected my wishes to not do IVF, but honestly, I feel that Dr Toth and Dr Peters (SIRM) are more respectful in that manner. The latter two Drs never brought up the subject again (except to say that I may "need" IVF), while Dr Check definately sat there and spoke with us for about 30 minutes about how "most Catholics don't even think there's anything wrong with it," and it's only the "purists" who will avoid it. He went on to tell me a story of an IVF Dr he knows in Italy who has dinner with the Pope once every year. Apparently when he asked this friend how it is he can be on such good terms with the Pope and still run his IVF clinic, the friend responded, "Well, the Church never actually said IVF was wrong."
Finally after his little rant, he made a comment about how, down the line, we may want to consider Embryo Adoption, because (I quote) "I know for a FACT your Church finds nothing wrong with this."
But now into the meat of the appointment.
Dr. Check thinks, quite simply, that I need to get back to basics. He believes that the adhesions have been the major deterrent to my getting pregnant in these past 2+ years since the ovarian wedge resection. (Oh yes, he went off on Dr Steg.man for doing the o.w.r, just like every non-NaPro Dr does... but when he asked why I did it aside from wanting to get pregnant, I quickly responded, "I wanted to fix my ovaries so that they could ovulate on their own for the longevity of my reproductive years, so that I would not need medication just to 'cycle' for the next 20-some years.)
So, in getting back to basics, he thinks we need to stop flooding my system with all of the immune meds and let it recuperate. He made it sound a lot more "medical" than just "stopping all meds." Rather, he thinks there have been adverse effects on my fertility/ovulation/implantation from many of the meds I was taking. He went on to say that he has his PhD in Reproductive Immunology, and that he certainly believes in Natural Killer Cells affecting pregnancy, etc... but that in my case, what will work better than prednisone or Intralipids is progesterone. And ONLY progesterone.
See, something about progesterone in large doses, he explained, will cause a blocking effect on the Natural Killer Cells' ability to do harm to the foreign substances or sperm and/or embryo. It is not enough that my blood work reveals high progesterone levels already, apparently. He tests for progesterone in different ways (I believe endometrial biopsy was mentioned, or a smear). In fact, he did a smear on me that same evening, and even though I got my period the following day, my smear cells (which we looked at under a microscope) were highly estrogenized and not "bound" the way progesterone-influenced cells should be. (I am pretty sure I just lost about 99% of my readers... but please keep reading, believe me, I don't really get it either!)
What else is funky is that my ultrasound showed a proliferative stage endometrium. I saw it myself! It was definately the 3-line, triple-layer PRE-Ovulatory lining. Why the heck would that be?? Could a partial rupture, incomplete rupture, or luteinized unruptured follicle cause this? On my ovaries was seen one "cystic structure" with low-level internal echoes resembling a corpus luteum, measuring 14mm (1.4cm). But an LUF doesn't resemble a corpus luteum... Dr Check thought I had not yet ovulated and that this "cyst" was an endometrioma, because, "sometimes endometriosis is really hard to see." (Yeah, buddy, well if anyone's gonna see it, it's gonna be my surgeon, thank-you-very-much. He wasn't in there for 5 hrs playing Yahtzee with my ovaries.) I kept telling him my period was going to start the next day, and I was already spotting, but he wasn't so sure :P
I can see where he was confused, though, because now, so am I. Pre-Ovulatory smear cells. Pre-Ovulatory uterine lining. Estradiol 66, Progesterone 1.4. Weird.
I asked him if the surgery cycle could be the culprit and he said possibly. Maybe it's just a stress cycle. But he later said, "Well, if your period does start tomorrow and you did ovulate, then your body is WAAAAAAAAAAY off where it should be." (Meaning, my smear cells were not at all what they should look like.) But this is something fixable. With - progesterone.
He then outlined some of the main theories in that one article he handed me about how it has been shown that women with PCOS actually respond BETTER to progesterone support ALONE without taking ANY stimulation medication before ovulation. He said to help the graafian (dominant) follicle with a little boost, he may consider letting me take a couple of doses of FSH (Follistim) towards the end of the follicular phase. But definately not in the beginning.
DH's swimmers were also evaluated and, of course, were perfect. We had a bunch of tests run on them that I've never even heard of before. Passed with flying colors.
Morphology is 4% on the Krueger scale. (As in, 4% of DH's sperm are normally formed.) But Dr Check said this is not at all a problem... when my NaPro Drs have told me in the past not to worry about morphology, I wasn't sure if that was because there was really no way to improve it. When Dr Toth told us not to worry about morphology, I wasn't sure if that was because he knew we wouldn't do IVF, anyway. But when Dr Check told us? Now I am no longer worried about morphology. But I do now call DH "4 percent" as a loving nickname.
Dr Check kept telling me he really doesn't think I "need" all this high-fallutin' medical intervention. He was glad I had not already gone and tried Humira or Enbrel (I was almost headed in that direction) BUT he did say of all the immune treatments, down the line we may consider LIT, since he feels this does yield high success rates and would be something that could benefit us based on our history. (LIT is lymphocyte immunization therapy, and it can be read about here.) LIT is not done in this country, though, because it is not FDA approved, so I would need to travel to Nogales, Mexico. (Many women on my immune message boards have done this.)
He is interested to hear what Dr Steg.man says at our post-operative appointment, because he wants to know if the surgery was "a success or not." In other words, he wants to know if Dr Stegm.an got all the adhesions out. My "Yes, I'm positive that he did" wasn't sufficient for him ;) (And then he gave me a card for HIS surgeon, in case I need another surgery to try to remove the adhesions. Thanks, but no thanks, there's only one surgeon who I trust to cut me open and respect my ladyparts the way they deserve to be respected!)
In the end, it comes down to going back to basics. No immune treatments. No ovulation stimulation (except maybe right before ovulation). Just progesterone.
And while it sounds so simple, there is a more comprehensive medical thought behind it (see above).
But really, who would have thought with my laundry list of issues that progesterone may be all I need?? I'm just not so sure about this... especially no Lovenox, Dr Kwak really had me sold on the fact that my bloodflow is poor due to my clotting factors. How can I resist sticking myself in the belly every day??
I suppose it's worth a shot. 3-6 cycles. It just kills me that another Christmas may come and go without a third member of our family (in utero or out). KILLS me. Can I last 6 cycles??
I need to trust. I need to trust. I need to trust.
I am healed.
Prayer Buddy... I'll need your help.