The Plan

We had our surgery consult this afternoon. The doctor (we'll call her Dr. D) started out by saying that we know a lot more now than we did last time we met with her. She said there is some good news:

• my prolactin levels are normal
• my FSH level was very good
• The Bee's SA came back with good results

All of these are things we have working for us.

Some news that we now know that is not so good:

• my progesterone level was borderline low
• we don't know from last cycle if I am ovulating (ever or irregularly)
• my DHEAS level, which is a precursor to testosterone, was a little elevated, which can be a sign of PCOS
• I have cysts on both of my ovaries
• I have endometriosis on both of my ovaries (most likely, but they cannot diagnose for sure without a laparoscopy)

The next step, as we have known, is a laparoscopy to diagnose and treat endometriosis. She suggested that within the 6-9 month window of opportunity after the laparoscopy that I take Clomid to stimulate ovulation, since "a titch" of PCOS could be at play here, too. She kept saying that there is inconclusive evidence pointing towards PCOS:

• The slightly elevated DHEAS levels, but so slightly elevated that if there weren't infertility issues, they wouldn't even pay attention to it
• The cysts on my ovaries, but they are not typical of PCOS - mine are larger and fewer. These "chocolate cysts" which are common in endometriosis, could be kind of obscuring the true appearance of my ovaries, though
• The irregular ovulation or anovulation, since nobody could tell what was going on last cycle

Whether or not I have PCOS, the Clomid would help us take full advantage of my fertility while the endometriosis is more under control.

Dr. D said that waiting until June or July would be just fine. I am young and there is no time pressure yet. She seemed to think it might be good for me and The Bee to take a few months off from the whole fertility circus anyway, to give my body some time to recover from stress.

She talked about the mind body connection and, more than once, mentioned that both endometriosis and PCOS are treatable and usually have pretty good success rates as far as treatment and pregnancy go. She said that I need to think positively and suggested that we try to relax and maybe even go on a vacation before having the laparoscopy done. To her credit, she did preface the "relax and go on a vacay" with "I know you have probably been told this and it is hard to do, but taking care of yourself, both physically and mentally/emotionally is very important in all of this. I truly believe that positive thoughts are important." I, the ultimate pessimist as of late, know that nothing is a given. There is a chance that we'll follow through with this and be the most positive, enthusiastic people in the universe and still won't have a baby. But there is also a chance that we will.

So, the plan is to call the surgery scheduler when I get my period in June. Somewhere between day 5 and 11 of that cycle I will have the laparoscopy where they will go in through three 5mm incisions (one through my belly button - yuck!) and remove the cysts from my ovaries, the endometriosis from my ovaries (and any other endo they see) and they will assess my fallopian tubes. After that, we'll have to decide if we want to chance it and see if I can ovulate on my own and get pregnant or if we want to start Clomid the following cycle, which would be July.

In the meantime, I am going to try to take care of myself. I am not going to use OPK's or chart BBT (you have no idea how much I have LOVED not charting the horrible and hideous BBT!!). I will still keep track of my cycle using NFP but will try not to obsess. Dr. D said, "You never know...if you are ovulating irregularly, something could happen between now and June." I appreciated her encouragement and kindness, but I have a hard time believing anything will make the next 5 cycles more successful than the last 17 have been.

So, here we go, waiting for June or a miracle!