Pardon me while my head explodes

There is so much to process right now that my mind is still so cloudy.

Ok, let's do this chronologically.

My interview yesterday went very well. Mr. Flowers, the guy who would be my boss, spent over 2.5 hours with me. He was very impressed by my resume and analytical ability. He had only two concerns: 1) that I was looking for a job with more immediate results than this one would provide and 2) that I have the negotiation skills to work with uncooperative state/local officials. I did my best to put his fears to rest – I am certainly accustomed to the inefficient and often frustrating pace of the public sector and have been working very hard on my ability to deal constructively with unhappy people. The Regional Administrator, who has heard from my contacts, sat in for 30 minutes or so and seemed pleased with my responses to his questions. One never really knows of course but, since Mr. Flowers told me that he couldn’t come up with a reason to exclude me from consideration, I have high hopes. From what I learned about the position from the interview, it is clear to me that this is definitely my dream job. Let’s hope that I get it!

Mr. Flowers warned me that the process will not be quick (DUH!) and we agreed that I would call him in two weeks to check in. He has more candidates to interview and then the nominated candidates have to be sent to his boss in Washington for approval.

I think Mr. Flowers would make a great boss in many ways: he is truly a kind and gentle person and believes in a work/life balance. And he is incredibly proud of his daughter. I noticed that he and his wife only have one child AND he is a bit older than expected given her age (he told me all about her) so it led me to wonder if they had struggled with IF. I was 100% confident that I could tell him about my situation and any IF treatments, if necessary. The hours are flexible and, after 6 months, I can arrange to work one day at home.

Mr. Flowers is very bright and I am certain that he is great at his job but his thoughts are very unorganized, which made it hard to get concrete info about the position AND to interject points that I wanted to make about my interests and experience. Sometimes I prefer a more formal interview because you have concrete chances to say the things that you believe will make you more attractive as a candidate. But I am hopeful in the way that IF teaches us to be hopeful (you know, that terrible mental struggle between the knowledge that nothing is ever certain and the desperate need to believe that things will finally go your way.)

The appointment with the Reproductive Endocrinologist also went well. Let's call him Dr. Gentle because he is clearly a very kind person, especially since his Medical Assistant raved about how sweet and wonderful he is when she took my pulse.

Dr. Gentle has been practicing in this clinic for 28 years. He is clearly incredibly educated but also easily approachable. I really like him and I thank you wonderful bloggers for telling me to make sure that he is someone I feel comfortable with (HUGS to all of you!!!)

His concerns based on my test results and cycle experiences match my own: the second part of my cycle may be too short to enable implantation. He is concerned by how short my cycle is (sometimes 25 days) and the fact that I spot as early as three days prior to my period. Spotting is never good, as you all know, because it means that the progesterone and other hormone levels may be decreasing too quickly. Does it or does it not annoy you that things that the OB says are perfectly normal (short cycles, spotting, and my hormone levels) actually may be indicators of a fertility problem? Guess that's why there is a field of Repro Endocrinology.

Anyway, back to Dr. Gentle's thoughts/diagnosis....

The ultrasound that I had on day 10 of my cycle in January suggests one of two things: either I ovulated early (as the Radiology physician concluded) or I have a small cyst due to endo.

My blood tests results on Day 3 of my cycle in March indicate that my estrogen was a high, which means one of three things: 1) that what I consider spotting may actually be the start of my period sometimes, which means I took the blood test on Day 4 instead of Day 3; 2) the January cycle was a short one, which caused my hormone levels to increase quickly; or 3) my ovaries are older than my chronological age. We both hope that it is not the third reason.

The plan is to redo the ultrasound before Day 10 of my next cycle. If the cyst doesn’t show up, then we know that it was ovulation that caused it and not endo. If it does, then I have mild-moderate endo which will not require any treatment but may change our protocol. I will also do another series of blood tests on day 3 of my next cycle and count anything that I may think is the start of my period as day 1.

(Is anyone else challenged by knowing the difference between spotting and the start of their period? I felt like such an idiot that maybe I have been wrong. I just think that the first day must involve significant bleeding but maybe that first light sign is actually CD1. Any and all advice on this would be appreciated.)

According to Dr. Gentle, laparoscopies are no longer necessary to detect endo since the presence of a cyst tells the doctors what they need to know. Also, he is waiting to check my tubes because nothing in my history or current medical situation suggests that I have tubal blockage. So, after the next cycle of tests, assuming everything looks normal, he wants me to take Clomid for two cycles because it will regulate my ovulation and extend the second half of the cycle. I will only take one pill per day (instead of two) to decrease my chances of getting migraines (I get them once per month or so now.) If two cycles with Clomid do not work, then I will get an HSG.

I just double-checked my notes from our appointment and realized that my progesterone levels are not the problem, at least according to a blood test I did on CD21 last month. So, it appears (thanks to Dr. Google) that, if I do have a luteal phase defect, it is either due to poor follicle production and/or a uterine lining that refuses to respond to normal progesterone levels. Allegedly, if I place my faith in Dr. Google, this/these problem(s) are easy to correct.

As for Mr. LIW, his SA was normal in terms of motility and volume. However, his PCP did not ask the lab to test for morphology. Though it is rare to have poor morphology when the motility and volume are normal, Dr. Gentle is ordering the lab to check to make sure those little guys are measuring on target.

Once I start my period, I can make the appointment for the tests and then another to see Dr. Gentle to discuss the results. In the next cycle, I am to use the ClearBlu.e Ea.sy OPKs to detect when I ovulate. EWCM can occur for up to 6 or 7 days before ovulation. Since we try every 48-36 hours during what I believe to be my most fertile week, we might just be missing it. The minute I detect ovulation, we are to try for two days.

I walked into Dr. Gentle's office nervous and actually quite sad that we had reached this point in our journey. But I left feeling well-taken-care-of and hopeful that maybe a cycle or two of clomid will do the trick. I was comforted by the fact that he ruled out severe endo right off the bat because the ultrasounds are so sensitive that the inevitable severe-endo cysts would be detectable. Everything he senses is going wrong with my reproductive system fits with my own concerns, which is great. And now I am hopeful that a simple procedure will do the trick.

I know that all of you have been there so I am trying not to get my hopes up that it will be this easy.

I am certainly not naive to the fact that unexplained infertility is still an option here but I have convinced myself on some level that any major problem would already have been detected. That's probably quite a dumb thought but I can't help it. I refrained from asking what older ovaries would mean for treatment because he considers that option to be incredibly unlikely. And I didn't want to freak myself out about something that probably will not be a factor. I am working incredibly hard to only deal with what is right in front of me.

I pushed Dr. Gentle on taking clomid before doing an HSG test because all of my favorite bloggies out there have educated me about the emotional impacts of Clomid. But he was quite confident that the second half of my cycle is the root of the problem. And I can't disagree with him because it all makes sense.

Am I crazy to have hope here? I don't know and so I keep going back and forth in my mind....

I do know that there is finally a hint of sun in purgatory and the exit doors are starting to take shape, albeit only slightly.