My appointment with Dr. Kwak-Kim was yesterday. I woke up at 4:30am (I'd say bright and early, but it was anything but bright... it was pitch dark, in fact), drove 1 1/2 hrs to La Guardia airport (flights out of LGA were $200 cheaper than out of Newark), and hopped a plane to Chicago, which landed at 8:25am local time. My appointment was at 9:15am. I got there 5 minutes late, which I think it pretty good :)
First off, I not only LOVED the Dr, but I loved everyone at the office, including the front desk girl (who I rarely like, lol)!
First, I had my ultrasound. It was about 45 minutes total, with a complete pelvic ultrasound in grayscale and color Doppler transvaginal of the uterus. Now, I've been on Lovenox 40 mgs 1 x day for 1 and 1/2 cycles already, so when I saw the sonographer measuring the arterial waveforms I mentioned how I almost wished I hadn't started the Lovenox yet. I would have liked to see how much the flow was diminished BEFORE Lovenox. She said that the blood flow was beautiful, and that "at least you know 40 mgs of Lovenox works!" After the sonographer was done, another Dr (I forget her name) came and did her own measurements. At first, I thought she was just repeating the same exam as the sonographer, and when she was searching around for a vessel to get a waveform on, I almost felt bad for her. (In my sonography class, we just had a lab competency final where we had to measure the blood flow in the carotid artery branches- the internal and external carotids. It is extremely difficult to get the transducer directly on those tiny little vessels, and get a good waveform.) Anyway, this Dr was clearly struggling to find the vessels and get any waveforms. Like I said, I felt bad for her! I thought, wow, the sonographer was a pro at getting them, but this one's having a tough time :P
After the ultrasound, I had blood drawn. Quite a few vials, considering I've already had most if not all of the testing done... but I think Dr. Kwak-Kim wanted to run everthing herself and see it all together at the same time. I have no problem with that :)
Then I had a brief physical exam by the Dr. And afterwards, we had our conference.
Turns out, that Dr who ran the "repeat sonogram" was not looking for vessels in the same place as the sonographer. My Doppler ultrasound revealed great blood flow to the exterior portion of the endometrium (the part the sonographer scanned), but very little to no blood flow to the zone where implantation occurs (the part the other Dr scanned). Dr. Kwak-Kim said she rates the blood flow in this implantation zone between 0-5. Mine ranked very close to ZERO!!
It was a bittersweet sigh of relief I had at that moment. I highly suspected there was implantation failure at play in my infertility... but now I REALLY know it. It's bittersweet since, if we can fix this issue, I may have a real good shot at implanting, but at the same time, not to know if I have had losses- what a sad and scary idea. I mean, I can't really mourn for what could very well be my babies' souls in heaven... because I still don't have proof that I've ever conceived. Though, logistically speaking, it seems pretty likely that I have conceived at least once in 37 months.
Dr. Kwak-Kim said she wants me to increase my dose of Lovenox to 40 mgs 2 x day, immediately. Evidently, my clotting factors are severe. I mean, shoot, ZERO BLOOD FLOW to the implantation zone??
She was also really cool about looking at my Creighton Model charts. I showed them to her because I am still concerned about my tail-end brown bleeding, at the ends of my periods, and my periods lasting 8-10 days (closer to 10). She said she wants me to start taking Prometrium to build up a thicker lining, along with Endometrin suppositories (she gave me the prescriptions right then and there!), and also to NOT take the Lovenox while I'm still bleeding, so I will only start the Lovenox after ovulation next cycle, and see if that makes a difference in the bleeding. She is thinking that my luteal phases could and should be a bit longer. Mine have been around 13 on good cycles, but in the past 8 cycles, 11 was more the norm. She said even though my 7dpo b/w reveals "good parameters," that she suspects I can benefit from progesterone supplementation. She then said, "Since you already tried to conceive this month, we'll want to do everything possible to ensure implantation can occur." Wouldn't it be ironic if, after all this, I was pregnant during my 1st appointment with Dr. Kwak-Kim?? She wants me to take an hpt at 10dpo, and if negative, to discontinue the progesterone at that point, UNLESS I feel that I may still be pregnant and it's too early to detect.
The other thing my ultrasound revealed was a large corpus luteum on... BOTH SIDES! So, my confusion over which side of ovulated from this month was merited :) I felt a lot of stimulation on the right side during acupunture this cycle, but on ovulation day itself I felt more mittleschmertz (gotta love that word) on the left. Well, that would explain it! I'm stoked at having O'd from the right, because I tend to ovulate from the left much more frequently (I'd say 80% of the time). And clearly the left hasn't been working for me!
My blood work will all come back within 3 weeks, and at that point I'll have an even more in-depth plan. She went over every single medical procedure and medication I've taken to date, at which point she mentioned wanting to try injectables. It was at this point that I wanted to kiss her! The way she put it exactly was: "Well, you've tried Clomid and Femara for about... 19 cycles, to no avail. I think it's time to try something else." I couldn't agree more! I know with NaPro they don't like to overstimulate, but at this point, hey, overstimulate me, please!! I CLEARLY need more than 1 or 2 targets.
She also said I could eat less sugars and carbs to help with the PAI-1, though this probably won't show a ton of results for me since I'm already thin. However, it will still increase the benefits of my Metformin. Also, I should eat more leafy greens, particularly with MTHFR. All in all, she had great suggestions, and I can't wait to hear what her final treatment protocol will be based on my blood work results.
Oh, and I asked her about the DQAlpha match that DH and I have... she said this is more of a "predictor" test than anything else. It doesn't really mean anything in the absence of APAs and NKAssay, and that our match isn't a serious one.
Overall, she was very knowledgable, and also very respectful of both me AND all of my previous Drs. She never once said anything negative about any of the medications I've been prescribed, or treatments I've received. (This is huge, as any of you know, most non-NaPro Drs will be quick to put down other Drs in their field. It's an ego thing.) I was also really impressed with how she kept consulting my charts. I know I already said this, but really, it blew me away. At one point she asked me, "what does the yellow sticker mean?" Can you imagine any ob/gyn or RE doing this???! The normal reaction my Creighton clients get when they even MENTION their charts to their ob/gyns or REs, is, let's just say, not so favorable.
I will have a definate game plan in about 3 weeks. I also have an office visit set up with my NaPro Dr on September 21st, which is perfect timing. I'll be using her to manage my care under Dr. Kwak-Kim, and also monitor my continued NaPro meds (like LDN, etc.). If you have prayers to spare, please pray that my uterine lining increases in flow, in the event I had a conception this cycle. I'm 5dpo today.
I have so much renewed hope right now, it's fantastic! After an email from Dr Toth last week which pretty much said I have no chance at pregnancy except via IVF... I really needed this hope. I didn't blog about that because I was too depressed, and was waiting for my DA this week. I forwarded that email to my NaPro Dr, though, and she said not to let it get to me... that SHE wasn't near ready to throw in the towel for me, yet :)
That's all for now. In SIL news, she is miscarrying. I'll write more about that later, but from what I have gathered and put together, it sounds as if it was a blighted ovum. The difficulty with that is that the process is LONG and drawn out. I really feel for her in that.