Wednesday, October 29, 2008

My Results from Dr. Toth

Well, 1 day earlier than expected, here are my results:

My specimen tested negative for: Mycoplasma, Aerobes, Yeast, and Trichomonads.
I tested positive for: CT and Anaerobes (under Anaerobes he wrote- "Very heavy actinomyces israelii and very heavy Proprionibacterium granulosum")

Who knew I had Israelis in my crotch?

OK, sorry... I am on the verge of puking, I just had to make a joke before I burst into tears (which I already did when I first read the letter).

Don't get me wrong, I'm definitely happy to be moving forward and getting a treatment plan that will very likely work for us... it's just never fun to hear that you have CT (there are "dirty" connotations with this disease, it doesn't matter if I received it vertically, people will assume I'm a whore).

But I digress. Back to the findings.

DH tested negative for everything except Anaerobes. He found moderate Proprionibacterium acnes in his specimen.

Then, his letter:

Dear Dr. Hilgers:

I appreciate your referring Mr. and Mrs. Blank-Blank to me for a fertility consultation.

Enclosed, you will find the results of the culture studies from 10/09/2008. The most important finding is the presence of CT in Mrs. Blank-Blank’s specimens.

I could not document the presence of CT or any other significant bacterium in Mr. Blank-Blank’s specimen. In a marital situation however we can assume that genital track flora is exchanged, especially CT.

CT can cause infertility, failure in IVF cycles and even if pregnancy takes place a miscarriage readily occurs. Infection with CT can lead to the development of pelvic infections. Lately I am looking at endometriosis as a form of CT caused PID with a significant immune component. Short of any other explanation, women with PCO conditions are born from parents where history makes me suspect a very strong intrauterine infectious vertical possibility. CT is a potent stimulant to the immune system and eventually the immune component becomes the most important issue in infertility. I see endocervical calcification so often with CT infection that in my interpretation they are analogous with the calcifications of the prostate in CT infection. Mrs. Blank-Blank’s cervix has significant calcifications and her ovaries even after the wedge resection show polycystic changes. Her endometrial lining has no structural differentiation

Mr. Blank-Blank’s prostate shows moderate lobular enlargement without change in his urination habits, at least not as of yet. Distinct scarring and calcifications are noted most prominently around the prostatic urethra suggesting causative bacteria entering through the urethra and causing damage in the surrounding structures first before jumping into peripheral zones of the prostate.

The heavily growing anaerobic bacteria recovered from the uterine represent a completely disturbed local flora due to the invading CT.

In my opinion, the Metformin therapy should be complemented with aggressive antibiotic therapy that would give the couple an improved chance. Two issues make me cautious in offering a quick fix of the physical problems and a rapid reversal of the immune issues; if my hunch of a vertical issue is correct, both the eradication of the infection and the reversal of the immune system will take longer and the course is unpredictable.

I am also enclosing a semen analysis report for you, Mr. Blank-Blank. I find all numerical parameters in the good range. The sperm quality will offer a good chance to produce a pregnancy.


Sincerely yours,

Attila Toth, MD.


The SA was the best it's been yet (the only really "good" news). 89 million/mL count!! Motility was a 3 (undulating, rapid progression) and 75%. Morphology I had no idea how to read, but it had numbers in each area, with 79 under "Ovals," 5 under "tapering," 10 under "small," and 6 under "amorphous."

I called the office to see what kind of treatment is needed, and to schedule it. Dr. Toth's recommended treatment for us both is a 10-day IV antibiotic, coupled with 10 days of uterine washes for me (see, I am a dirty whore), and 10 days of prostate injections for DH. We are scheduled to begin November 10th!!!! (Note: Exclamation marks should be read as excitement, fear, hesitation, anxiety, relief, and mania.)

So, I have my answers. Still not sure if we'll be able to TTC again in 2008 (the treatment will make my cycles whacky, I was forewarned). I'm also really concerned about insurance reimbursement. I know the IV is $4,000 alone... I am stuck between a million different emotions right now. I'll be writing more on this later, just wanted to keep you all updated.

8 comments:

Sew Infertile said...

I am on the verge of tears and laughing my a$$ off! You are not a dirty whore, but thank God you finally have some answers. So I am left with many questions as I am sure you are? Is it cureable? That is all I want to know? I don't care how long, can it be cured? :) Sorry, is that demanding? :) IV antibiotic for 10 days! OH MY GOSH! Talk about aggressive? What does that entail!? That letter was written beautifully! I am so nervous about my appointment now, I could puke!!!

LifeHopes said...

Wow. So much to take in!

First, YAY for a great SA result!

I have some questions though. Maybe they will help you in your follow-up questions to your Doc!

What is endocervical calcification in plain english?

What does he specifically mean by "polycystic changes" even after your wedge resection? Are your ovaries polycystic or not?

How common is this varation of Chlamydia?

I also want to know, is all of this curable? The letter didn't really say.

What kind of antibiotics will you be on? Can you do IV antibiotics from your home?

One thing that came to mind is that you might inquire about taking preventative measures for the growth of yeast (even though you tested negative as of now), since antibiotics (especially IV administered) can create some serious yeast overgrowth. (this is from personal experience!) There are oral medications that work well for this.

Your doc has several "hunches" --like the endo being related or associated with Chlamydia based PID. That is not a theory I have ever read or heard about, but does this mean he thinks you still have endo? (I am assuming you did have some endo before surgery ... at least I think that is what I recall reading here on your blog! Forgive me if I am wrong on that).

I am just thinking out loud, and thought it might be helpful to you as you are processing.


Praying for you right now -- that our Lord will give you wisdom on how best to proceed.

eilyn said...

WOW.
You and your DH will be in my prayers!!

on a side note, that was me who posted on Dr. liccardi's site. Also reading your post makes me want to check my vagina out...sometimes i think i have some sort of PID...
God Bless!
eilyn

This_Cross_I_Embrace said...

From what I can gather (from the initial consult, and his 2 books), here are my unprofessional answers to those ?s:

endocervical calcification- the areas of "white" that he was able to see on u/s at my appt, all along my cervical canal. (DH also had these "white" areas, clues of infection sites, along the urethra and near the prostate.)

I believe he means that my ovaries still appear very "polycystic" after wedge resection; proving his theory that even with this line of attack, my PCOS would inevitably return again if I was not treated/cured of the infection that started it all.

Chlamydia Thrachomatis is the main pathogen which causes Chlamydia. It is the most common STD today, with as many as 50% of sexually active couples being + for CT.

Dr. Toth's theory is that yes, with aggressive antiobiotic treatment, we can rid ourselves of this nasty infection. It does need to be more "aggressive" than what many other Drs will do, since he has seen many instances of reoccurance after limited antibiotic treatment.

I don't think I can do the IV from home, because he needs to change the "bag" every day (or something like that). But we'll need to be in the city for 10 days anyway, for uterine washes and prostate injections that only he administers. We're only an hr from NYC, so it's not as bad as it could be.

Thanks for your ?s of concern! I'm still kinda numb from all the info... I'll try to write more tomorrow.

Faithful Infertile said...

Great news on the SA!!!

I am so glad you are finally getting answers! I'd much rather know what I was dealing with, then searching blindly, kwim?!? I have a feeling 2009 WILL be your year! I'm so excited/nervous for you!

Meridith said...

Wow... who knew???

Treatment sure doesn't sound fun, but worth it in the long run...

Continuing to life you both up in prayer (((hugs)))

allyouwhohope said...

Wow. That IS a lot to take in. But like others said, it is much better to know what the culprit is so it can be fixed, no matter what it is. And the fact that it is fixable is all that matters. I hope this is the answer you've been waiting for!

KateB said...

You have an answer as to what the problem could be, and now you have a plan of action to tackle it. How cool is that? Getting so much information at once - especially the "bad" news - can be overwhelming. Thank goodness your DH's SA balanced it out somewhat.