My Infertility Case Exposed

My husband and I were married on May 1, 2005… that was 6 years ago.  We were not in a hurry to have a baby then as we were still enjoying our lives as a couple.   I was just only 24 years old then.  Most of my friends were not even married yet.  I have a regular 28-day cycle.  So I thought everything was normal and getting pregnant will come naturally.  There were no pressure, no rush, no worries… we were just enjoying and taking our time…  Little did we know that getting pregnant isn’t as easy as it seems to be for others…

See  An Infertility Specialist After a Year:

After a year, that was when we started getting a little worried.  Is there something wrong with us?  Do we have any infertility problem?  Why am I not getting pregnant yet?  I think it is time to see a fertility doctor…

True enough… once you have been trying to conceive for more than a year without success, it is time to make an appointment with a fertility specialist for evaluation.  Infertility is defined as the inability of a couple to successfully get pregnant after a year of unprotected, well-timed intercourse. 

It is but normal to feel uneasy, and worried of what you will find out through the series of fertility tests you are about to undergo.  Just think of it this way, if you find out what is wrong with you, you can do something about it.  

Fertility Testings for Men

So, we went to a fertility specialist and had our initial fertility tests with her.  She requested for a semen analysis from my husband.  This is usually requested to rule out the problem from the husband.  Results showed that his sperm count (the number of sperm per millimeter) was sufficient but the morphology (the percentage of abnormal sperm) was high.  So the diagnosis was Teratozoospermia or high levels of abnormal sperm.  But normally, OBs do not worry too much on this.  As one of my OBs told us, “As long as there are sperms available, there is no problem.  We only need ONE” 

Being a paranoid, I persuaded my husband to see a urologist, a doctor who has specialized knowledge and skill regarding problems of the male and female urinary tract and the male reproductive organs.  Further blood tests and ultrasound were requested.  It came out that he has varicocele.  This condition is similar to varicose veins but involves enlarged veins around the testes which can inhibit sperm production and affects the quantity and quality of sperm produced.  Varicocele can overheat the testes, thus causing problems with fertility.  However, treating this problem by surgery was not recommended to us by the urologist.  According to him, the surgery will not increase our chances of conception significantly.  He advised us to just proceed with artificial insemination instead.     

Fertility Testings for Women

Now, it is my turn.  There are far more fertility tests to be done for women than men.  Oh, life is really like that… So, here are what I have done so far.  I divided it into four groups so that it would be easier for you to understand it.

1.     Hormone testing – Blood tests are usually done on Day 2 or 3 of your cycle to check for hormonal imbalances or disorders that might be preventing pregnancy.  I was asked to check for the following:

a.      FSH (Follicle-Stimulating Hormone) – this hormone stimulates the growth and development of the follicles on the ovary during the follicular phase or first half of the menstrual cycle; high FSH level show fewer eggs left and poor egg quality; mine is normal

b.    LH (Luteinising hormone) – released by the pituitary gland to stimulate ovulation; mine is low; if you have high LH, you may have PCOS or polycystic ovary syndrome.

c.     Prolactin – this hormone is released by the pituitary gland and high levels can stop ovulation and menstruation; mine is a little bit high probably because of stress

d.    TSH (Thyroid hormones) – responsible for controlling thyroid function; mine is also normal

2.   Monitored Cycle –  This is done monthly to know your fertility status and know what plan of action to take next; Depending on your OB, you are usually asked to go to the clinic on the Day 2 or 3 of your cycle for check up.  Then ultrasound follicle monitoring on Day 6-8 to check if there is an egg and also to check the endometrial lining.  Abnormalities such as polyps and myoma can also be seen during this time.  Another ultrasound for follicle monitoring on Day 10-14 to check on the size of the ovarian follicles, and check on the thickness of the lining of the uterus to help predict the time ovulation. Then, you’ll be given a “schedule” as to when you are to have intercourse.  This is called timed intercourse.  Some OBs also give fertility drugs like Clomiphene Citrate or Femara.  This is for ovulation induction and is taken for 5 days starting from Day 2.  

Through the monitoring done by transvaginal ultrasound, I found out that I do ovulate and I have endometrial polyps and myoma.  Most of the time, OBs will not ask you to have the polyps and myoma removed at once because there are many people who also have those but get pregnant also.  In my case, I had my polyps removed last December 2010.  OB did not remove the myoma or uterine fibroid because according to her, in my case it is not the culprit to my infertility.

3. Tubal and uterine investigations to see if there are any structural (anatomical) problems of the reproductive system that causes infertility; usually done on the first part of menstrual cycle to ensure you are not pregnant

a.     Hysterosalpingogram (HSG) – This is a test where a dye is passed through the fallopian tubes to check for blockages that could be stopping the egg or sperm progressing.  This is done in a hospital, but out-patient.  I had mine done in Chinese General Hospital last 2006.  A small catheter is inserted into the cervix through which liquid dye is injected.  X-rays are taken as the dye passes through to see if there are any obstructions.  I felt heavy cramping during and for several hours following this procedure.  But this just means that my fallopian tubes are not blocked.  According to the technician, no pain, no gain.  Expect vaginal discharge as the dye is expelled from the uterus so do bring a pad or panty liner with you.  After the procedure, the OB gave me antibiotics to take to guard against possible infection.  Result: No blockages in the fallopian tube and I have a normal uterus.      

b.    Hysteroscopy - a thin viewing tool called hysteroscope (a light and camera is hooked to it so that the doctor can see the endometrium on a video screen) is inserted via the cervix into the uterus to check for irregularities or scar tissues.  It is also used to remove fibroids or polyps.

c.  Laparoscopy –is a surgical procedure that involves insertion of a narrow telescope-like instrument through a small incision in the belly button. This allows visualization of the abdominal and pelvic organs including the area of the uterus, fallopian tubes and ovaries.  It also checks for scar tissues, endometriosis and fibroids.  Done under general anaesthesia.

I had hysteroscopy and laparoscopy done at the same time last December 2010 at the Philippine General Hospital to remove my endometrial polyps and also to check if I have endometriosis.  My OB found that I have some implants at the back of the uterus so these were cauterized. According to OB, it will be better to get pregnant within 6 months since there is a possibility that the implants might recur.

     

4.   Immunological testing – This is also done through blood tests to check for reproductive immunological factors.  This is normally done if you have a history of miscarriage, IUI and IVF failures, or an unexplained infertility like me.   The tests can be divided into 5 categories.  Below is a description of each category and its corresponding treatment.

 

Category 1 – Leukocyte Antibody Test (LAT) or Lack of Blocking Antibodies

Some women may fail to produce blocking antibodies to stop the immune system from attacking and rejecting the fetus.  The problem is when the woman shares the same antibodies with her partner; in other words the couple’s DNA is too similar.  Normally the father’s DNA in the embryo tells the mother’s body to set up a protective reaction around the baby.  But when this blocking effect does not happen, the baby is rejected.  Treatment for this is lymphocyte immunization therapy (LIT) in which the male partner or donor’s blood is injected into the woman.

Category 2 – Antiphospholipid antibodies (APAs)

Antiphospholipid antibodies are the most common kind of abnormal immune system problem.  APAs can prevent implantation thus preventing pregnancy in the first place.  Phospholipids are a sort of glue needed in early pregnancy.  Some women, however, produce APA blood-clotting antibodies which attack cells that build the placenta and increase the risk of miscarriage.  Anticoagulants like low-dose aspirin and heparin (a blood thinner) are often prescribed.

Category 3 – Antinuclear antibodies (ANAs)

Antinuclear antibodies are directed against structures within the cell nucleus and can attack the fertilized egg and the cells in the womb.  This can prevent implantation and increase the risk of miscarriage.  This is often treated with steroids like prednisone to suppress the inflammatory process.

Category 4 – Antisperm antibodies

Antisperm antibodies can cause agglutination or even prevent fertilization because they stop the sperm being able to penetrate through the cervical mucus.  It can be produced after an infection.  Treatment for this is usually steroids.

Category 5 – Elevated Natural Killer Cells (NK cells)

Natural killer cells are important.  They make up 50% of all white blood cells and are needed to control rapidly dividing cells like cancer.  The theory is that some women produce too many natural killer cells which will aggressively attack any cells that grow and divide, offering protection against cancer but making pregnancy impossible.  Treatment possibilities for high NK cells are LIT, intravenous immunoglobulins, steroids or rheumatoid arthritis drugs.  The natural solution for this is to take fish oil, specifically EPA, to decrease NK killer cell activities.    

Fertility Treatments

Unfortunately for us, I am positive for Category 1, 2, and 5.  We were advised to see an immunologist and had immunological work-up.  So far, from a LAT of 0%, I am now 100%.  That is after 9 LIT sessions, 4 with husband as donor and 5 from blood donors.  I take Aspirin every day for almost 2 years now.

I have experienced 3 failed IUI (artificial insemination).  2 consecutive IUI last 2007, without any immunological work-up.  And right now, after my LAT has increase last April 2011, we tried for another IUI this May 2011, but unfortunately it wasn’t successful.

Whew, so there goes my long story on my infertility case.  I tried to explain it as clear as possible so that you would better understand my condition.  Many people have been asking me about it, so here it is… If you have other questions, please feel free to ask me.  I’d be more than willing to share with you my experiences.   Happy reading!