What's Wrong?

After 11 months of being off birth control, and 9 months (7 cycles) of actively TTC, we started our IF workup. I really thought that when I asked my doctor about this, she would say, "Oh, just give it some more time. The average couple takes one year to conceive." I was a bit surprised when, after reviewing my charts, she told me that we could actually start investigating things right then. With my long, irregular cycles, she thought there was a distinct possibility that something could be wrong. So she gave us the option of trying on our own another cycle and then testing, or just moving forward with things. I just had a gut feeling that something was wrong, so we decided to just do the testing. Unfortunately for us, nothing really came up in all the testing. The doctor was still worried though, that given the appearance of my charts (quite a bit of variation in cycle lengths, mostly all greater than 35 days), I might be anovulatory.

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So the plan was to do a natural, monitored cycle, trigger ovulation with an injection of hCG when my follicle reached maturity, and then do timed intercourse (TI). That way, if my LH surge wasn't strong enough to trigger O, the injection would basically guarantee it. Having always had longer cycles, my first u/s was done on CD16. At that point, I had one dominant follicle measuring 14mm and my uterine lining was a little on the thin side at 7mm. The doctor wasn't too concerned though, explaining that since my cycles were longer, it would still take some more time for my follicle to develop and my lining to full develop before I ovulated. So we scheduled a follow up appointment for CD20. The doctor explained to me that most follicles grow 1-2mm/day until they are fully mature. On unmedicated cycles, this would be around 20-24mm. So assuming my follicles were a bit slow growing, the follicle we were monitoring should have been at least 18mm at my next recheck. Imagine my surprise then, when she did the u/s on CD20 and my follicle measured 14mm and my lining measured 7mm. No growth. Really? How could there be no growth??? Slow-growing maybe, but no growth whatsoever?!



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I was surprised, devastated, shocked, and sad. How could this be? Why did my body just stop working in the middle of a cycle like that? Even if my body was producing an LH surge (which I had confirmed with OPKs), telling my ovaries to O, there were no mature eggs to release! Rarely does a follicle measuring only 14-15mm actually contain a mature egg inside. Even if my body were to release a mature egg, my uterine lining was too thin to support a healthy pregnancy. Ideally, your lining should be 8-14mm. It is possible to get pregnant with a thinner lining, but often times, those pregnancies are not viable. So without any mature follicles, we cancelled the cycle and decided to start medications the next cycle.



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I was willing to try the medications to see if we could fix this problem, but part of me couldn't get over the fact that my body wasn't working like it should be. I was broken. I wasn't ovulating. No egg = no baby. For no apparent reason, my follicles weren't growing and my uterine lining wasn't gearing up for a baby like it should be. Something was wrong with my hormones that wasn't allowing my cycle to proceed normally; yet nothing was wrong enough to show up in any of my blood tests. I was sad... sad that I probably wouldn't ever have a baby on my own without medical intervention. I was also upset... angry that I had spent so much money over the years on birth control, something that I did not even need. Oh how nice it would be to have that money back now to pay for fertility treatments - ironic huh?




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So, as I waited for AF to show up so we could start our first medicated cycle, I had some time. Time to let all of this sink in. I was infertile - with a diagnosis of anovulation, I was unlikely to conceive a child without medical intervention. What else might be wrong that I didn't know about? Mild endometriosis? A septum in my uterus? Fibroids? Clotting disorders? What if the first line of treatments didn't work? Would we want to do IUIs? Would we pay tens of thousands of dollars for IVF? I knew plenty of women who started their IF journey thinking they would never go as far as IVF - yet when finally faced with that decision, chose to push forward with it. What if we were faced with that decision? What would we choose? So many questions, so few answers. The worst part was the uncertainty of what the future held for us - where would our IF journey take us? Only time would tell...


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