Archive for the ‘testing’ Category

h1

Bloodwork numbers and reference ranges

October 16, 2009

I called and got the rest of my bloodwork numbers from my doctor’s office today, after some cajoling.

I am now on CD 29. No big temperature drop yet, but I expect my period to start Any Day Now.

I am including my numbers below. I’d be grateful for any of your thoughts on what I should ask the doctors to try next. The nurse told me that my first numbers were good but the others were “low.”  (…although they still appear to be in the “normal” range… but the “normal” range is awfully large)

By way of background: This is my second clomid cycle. Without any medication, I ovulated but had wonky progesterone-estrogen levels in my luteal phase. The progesterone was too high, particularly in relationship to the estradiol. The first attempt to fix that was by applying an estradiol ointment — aka “the lady cream” — to “balance it out.” It did not balance it out. Estrogen took over and my cycles were all messed up and annovulatory. Fantabulous.

The new regime is clomid, which I like more than I thought I would (shorter cycles, obvious ovulation, no terrible side effects and it’s cheap!). I also apply 1/2 of an estradiol 1 mg packet each day from when I start the clomid until ovulation. (Dr. B said that part was kind-of optional.)

I am a little (perhaps more than a little) frustrated because my numbers are “low”, yet no doctors are available to give me any advice over the phone on what I should try for this next cycle, and I can’t get an appointment until Oct. 30th.  Although come to think of it, that might be right around the time of my next ovulation, so perhaps there is still hope.

(An aside: I know October 30th is not that far away. Patience, patience. But I feel like I’ve been spinning my wheels with these people for the past year, and I am a little anxious to get things moving.)

Anyway, here are my results…

P+6 or 7ish: estradiol 126 pg/mL
progesterone 18.78 ng/mL

I  went out of town for four days, so I have a data gap.  Now I really wish I had that info.

P+10ish: estradiol 94
progesterone 9.64

P+11ish: estradiol 86
progesterone 8.2

And now for something *truly spectacular*.  Because my Very Friendly inner-city lab actually gave me a print-out with some of my results, I have the reference ranges for what are considered “normal” levels of estrogen and progesterone. This is the kind of stuff I poke around for on the internet all day. Here you go!

Reference range for estradiol
Female:
Follicular Phase: 11-212 pg/mL
Mid-cycle: 18-480 pg/mL
Luteal phase: Less than or equal to 247 pg/mL
Post-menopausal: Less than or equal to 27 pg/mL

Male: 13-54 pg/mL

Progesterone reference values

Non-pregnant female:
Follicular phase: <1/4 ng/mL
Luteal Phase: 3.3-26.0 ng/mL
Mid-luteal phase: 4.4-28.0 ng/mL
Post menopausal: <0.7 ng/mL
Oral contraceptives: 0.1-0.3 ng/mL

Pregnant female:
First trimester 11-45 ng/mL
Second trimester 26-89 ng/mL
Third timester 46-423 ng/mL

Advertisements
h1

Adventures in bloodwork

October 14, 2009

I apologize for my blogsilence since my last blood test results a month ago. Words left me for a while after my grandmother died. I may write more about that later.

For now, I am back for another very special edition of ADVENTURES IN BLOODWORK.

When we last left our heroine, she had just learned of her hormone levels on a clomid cycle. Lovely though they were, they did not lead to a pregnancy. So she was back at it again this month — this time for P7, P9 and P11 estradiol and progesterone. A simple enough task … and yet will it be? Nothing is truly simple on the infertility rollercoaster. Stay tuned for a very long post …

***

Last Friday was P7-ish. Perhaps P6 — I am not exactly sure.  But I wanted to get my bloodwork, because I was going to be out town that weekend to visit my granddad in South Carolina. My plan was to ride my bike from work to one of the labs downtown during the day. Simple, yes? No. Work got in the way, as it is wont to do, and I  was too busy to leave my desk before 4, when all the labs downtown closed.

So, I send a desperate email to my husband, who discovers a new lab that stays open until 6. Problem solved! Kind of. Now I just have to get there.

It is a new lab on U Street — an area famous for jazz, late-night chili and vibrant night life. Not so famous for its medical labs. At least not yet! Due to another work-related delay, I had to get a cab there. So, I open my wallet and hope for the best.
The best does not come.

Several blocks from my office I realized my insurance card was still sitting on my desk, where I had taken it out so I could call and ask about getting bloodwork from SC (verdict: forget it, too complicated). So the cab driver turns around, I run back to my office, get insurance card, get back in the cab, get stuck in traffic and watch the clock tick down to 6 pm.

I start to wonder if God really wants me to get this bloodwork.

But then, glory be, traffic clears. The cab arrives at U Street. It’s 5:57 pm. There is a glimmer of hope! Me and my suitcase (for weekend trip, not for bloodwork) run down the block. No lab. I run the other direction. Still can’t find it. Frantically call husband. The address is wrong. Frantically call lab. I look up and see a banner across the street advertising the lab. LO AND BEHOLD!

The previous labs I have utilized were either in big office buildings or in a hospital. This one is not. This is your inner-city lab. It is in a row house in a part of the city known as “Little Ethiopia.” It is between restaurants and shops, across the street from a large gay sports bar. There were guys out front selling hacked copies of movies from China.

I live in the District in part because I love an urban adventure, so frankly, this was right up my alley. But I was just a little bit nervous about ringing a dirty doorbell for a place that would eventually be sticking me with a needle. I go for it anyway, and am rewarded by meeting the extremely friendly man (African immigrant, I think) who runs the place,  He stayed open even though it was time for him to close. He’s already one up on LabCorp.

The lab is on one floor of a rowhouse, and it feels kind of like walking into some sort of little government agency in a small town. There is a desk, a computer, a printer.  I sit next to the desk, help them enter my information in the computer and watch as he reads the requirements for estradiol and progesterone tests. I notice that most of the paraphenalia in the office has to do with urine drug tests. It appears that is their specialty — I assume that many of their neighboring restaurants send people over.

When it’s time for the blood test, I  head to the corner, where there is a chair with an armrest . The Very Nice Man is giving me a pep talk and asking me to pump my arms like I am lifting weights.It’s a little different than my experiences at LabCorp.  He chants: “OK. We’re going to do this! It’s going to be easy!” Pretty soon I figure out the pep talk is really for him.

It is possible I am the first person ever to get a blood test there.

Very Nice Lab Man gets ready, inserts a needle. “I got you!” It hurts. There is no blood coming out. I have done this enough times that I know it’s not right. I tell him it’s not working. I point to the other tiny holes in my arms, marked by so many previous blood tests. He sticks a new needle in one of those. This time it works. Thank you, Jesus.

After a bit more help with paperwork, I dash out of the office onto the metro and am off to the airport.

Four days later, my arm still hurts from the incorrect stab. But a glutton for punishment, I return for my next vial of blood, because I just love the friendly, quirky local business. He does a better job with my next two blood draws.

Today was the last blood test (P+11 or 12) and Very Nice Lab Man greeted me with a “Hey! I just called your doctor’s office! I got your results!” (Again, this would not happen at LabCorp.) He prints out a copy of the results for me, tells me they look good.

One glance and I can see they don’t look good, at least not to me. First progesterone is 18.78. Second one is 9.64. I am not pregnant. I manage to hold it together in the office, but as soon as I leave, I burst into tears on the sidewalk. I’m a big weeper, to be honest, but this crying episode is the real deal: scrunched up face, waterworks, crying noises.

I pull myself together — kind of — and start to run to work. Two people (also African immigrants?) stop on the street and ask me if I am OK. I am touched by their kindness. This is in DC, where you can be lying on the sidewalk with a severed limb and people will just cruise right by, eyes glued to their blackberries. But these two kind souls stop for me. I tell them I am fine. They clearly do not believe me. They do not move. I say, “No really, I’m OK. I’m fine. I’m fine.”

I’m fine. I am used to being Not Pregnant, after all. Right? I gave up on monthly mourning a long time ago.

But I’m not fine. I am crying. I am bursting into tears at work — which is generally not a cool thing to do in my office. I had been so hopeful this cycle. I had a new treatment, and everything seemed to come into place. I even imagined all sorts of (phantom) pregnancy symptoms the past few weeks … so now in addition to being infertile, I am also crazy. I guess I have “hysterical pregnancy” like the  wife on Glee.

I was so hopeful. I guess I didn’t realize just how hopeful until today.

h1

Diagnosis, test results, crazy numbers!

June 10, 2009

I had an appointment with my awesome doctor, Dr. B, a few weeks ago to go over the results of my various tests. To back up a bit, at our first appointment in February, Dr. B looked over my charts. My husband’s semen analysis looked good. My previous bloodwork looked good, but then again it might have been meaningless. My normal OBGYN had just ordered it for the day I happened to be in her office, not even asking what cycle day it was (it happened to be election day and cycle day 8). Dr. B wanted to see what my levels would be like on cycle day 3.  He ordered more bloodwork for day 3, a saliva test throughout one cycle and an HSG to see if anything was blocked.

I had already received the phone calls declaring the bloodwork and the HSG “normal.” I was very curious what he would say about the hormone panel from the saliva test. Would it show something was off? Was I just crazy?

Well, when he walked in the room, the first thing Dr. B said was: “Well, it’s not all in your head.”

My body appears to be doing OK with the basics. I’m ovulating (or I appear to be). My cycles are really long, but that does not concern Dr. B too much (I find the long cycles a little annoying, myself). The first half* of my cycle before ovulation looks pretty “normal.”  (*not really “half,” more like two-thirds — given the long cycles.) It’s in my luteal phase where things get wacky. My progesterone levels shoot up, apparently way above what any normal non-pregnant human should have.

And here I had wondered if I might have a progesterone deficiency. Ha!

The shape of the graph looked pretty good: my progesterone levels went up, stayed there, then dropped with my period. But the numbers on the y-axis (those charting my progesterone) were more than twice as large as usual, Dr. B said.

I guess I am just an overachiever when it comes to progesterone production.

Meanwhile, my estradiol is not-so-high, so the balance is all caddywampus. Dr. B thinks my progesterone is overwhelming my estrogen. And perhaps that is (one of) the reason(s) I am not getting pregnant. He said he can’t do anything to lower my progesterone, but he thinks it might help to raise my estrogen in an effort to put the two in better balance. So during my luteal phase, I’m applying an estradiol topical gel — which my sisters and I have lovingly dubbed “the lady cream.” Besides mucus enhancers, the estradiol is my only treatment right now. (not sure how I feel about that, but I am trying to just trust.)

Dr. B said if I do not get pregnant by, say, September, I should schedule a laparoscopy with Dr. L to look for endometriosis. I don’t have any of the painful “symptoms” of endo, but plenty of people have endometriosis with no symptoms. It’s the next thing to check off on the list.

I am assuming I will have surgery in the fall.

I called the office back last week to ask for a read-out of my test numbers, since there was not time to write it all down at my appointment with Dr. B. These numbers really are something to behold. I wasn’t sure whether to laugh or cry.

The numbers are all from a saliva test, and I don’t know if the scale is different than the blood test results (umm… I  hope it is? Does anyone know?). Regardless, I think you can see that things are clearly off-balance.

For your viewing pleasure:

Day 5 estradiol 4, progesterone 41 pg/mL

Day 9 estradiol 4 progesterone 43 pg/mL

Day 13 estradiol 2 progesterone 56

Day 17 estradiol 7, progesterone 76

Day 21 estradiol 11, progesterone 67

Day 23 estraiol 7, progesterone 120

(wait! it gets even better!)

Day 25 estradiol 5, progesterone 701

Day 28 estradiol 3, progesterone 734 (!!!)

Day 30 estradiol 4, progesterone 725

Day 33 estradiol 4, progesterone 165

Day 35 (really day 1 of my next cycle) estradiol 3, progesterone 46

h1

HSG test

March 27, 2009

This post may be interesting for someone who wants to know what to expect from her HSG test. I was grateful to read a some other first-hand experiences before I went. It sounds like the level of pain can vary from person to person. Some said they felt nothing, and one person with severe endometriosis said her HSG was the worst pain she had ever felt.  Endo can be very painful, so that’s pretty bad!

For me, the test was not nearly as bad as I expected — definitely uncomfortable but not awful. It got pretty painful at the end, just as the doctor was saying, “See, that doesn’t hurt, does it?” HA!  I had menstrual cramp-esque pain for a few hours afterward, but went straight to work without problems and felt normal by the afternoon.   I did have some odd (cervical?) discomfort for the next couple of days. I went running that afternoon, and suddenly felt a strange pain in the general region of my cervix. It hurt the rest of the night. The following day, it felt odd — not really painful, but sort of uncomfortable …  I guess I was aware of my cervix, which is not something I can usually feel when walking around, you know?  I was worried about it, but felt back to normal in two days. I had spotting for two days, then it stopped for a day, then started again. My doctor’s office said that was normal, and you can have some spotting for up to 10 days!

Here’s the play by play of the test:

My husband came with me to the radiology center.  He did not join me for the actual test (I don’t think it is allowed), but  sat in the waiting room reading the newspaper. We wanted him to be there in case I felt crummy afterward or the results looked bad, so I wouldn’t have to tell him on the phone or have a breakdown all by myself.  It was wonderful to know he was there, but as it turned out, I  could have survived on my own.

I had my test done at Washington Radiology Center, which does all kinds of x-rays, scans and other tests. (I went to their office on K St.)   I was very impressed with their efficiency, helpfulness and professionalism throughout the process — including my numerous insurance queries, calls to make (and change) the appointment and the exam itself.

I was (somewhat irrationally?) nervous about the exam, but was reassured as I got off the elevator and saw all the people in the waiting room that morning. It made me feel more normal. And I felt grateful that my infertility problems — as terrible as they seem to me — are not something worse. With the notable exception of my reproductive system, I am healthy. For that I am grateful.

They called me back right on time, and I changed into a hospital gown for the test. My mettle started to fade a bit when I saw the machine  — it was a daunting-looking huge metal table. But it wasn’t too bad.  The doctor inserted a speculum, which stayed there for the duration of the test. Lovely. He attempted to insert a catheter into my cervix, but it did not work at first, so he had to dilate my cervix first. The dilate and insertion was not pleasant — sort of a sharp pain.

Throughout all of this, the doctor was quite chatty — asking me all sorts of questions about where I live, what I do, etc. I think he was trying to keep my mind off the fact that he was inserting a lot of uncomfortable devices into my nether regions. But guess what? It didn’t work! I wanted to tell him, “Listen, let’s cut the small talk. Just let me be quiet and concentrate on breathing.” But …  I never say stuff like that and he was a really sweet man, so I, of course, obliged him with (very brief) answers to his questions.

Back to the test — once the lovely devices were in place, he inserted the dye, which flowed through my fallopian tubes fine, showing no blockage. Hooray! It was all very quick. I watched the process on the screen, but I was disappointed with what was actually visible. I was hoping I would get a clear pictures of my uterus and fallopian tubes and see how the whole thing worked. But (to me, at least) it basically looked like two lines, my fallopian tubes. I saw no uterus.  This was pretty disappointing, as I wanted the test to indicate whether or not there are any problems (endo?) in my uterus. I’m still not sure if it can do that — does anyone know?

When the doctor reviewed my results with me, I protested, “But you can’t even see my uterus!” He said he could see my uterine cavity and could tell it is the right shape (I think?), and that it looks good.  This is all obviously good news, but I don’t know how many other problems can be ruled out with a clear HSG. I guess I should just rejoice in not having blocked tubes!

The doctor told me  that people often have increased fertility for a few months after the exam and asked me to notify him if I get pregnant. That got my hopes up pretty high for this month — only to be dashed by a weird cycle. I’m on day 19 now and have seen no sign of fertile-quality cervical fluid or a clear temperature shift. Am I even ovulating? Sigh. I had such a lovely cycle last month!

An interesting side-note: the HSG doctor  knows my OBGYN in Fairfax! They used to work together at a hospital back in the day. This made me quite happy. He was a bit mystified why someone who lives and works in DC would go see a doctor way out in Fairfax. As I was lying on a metal table with a speculum between my legs at the time,  I did not particularly want to get into a long conversation about the Catholic practice, NFP and infertility. So I just said that “a friend” goes to this doctor and recommended him, and that we both really like him. This is mostly true, the “friends” being two women I have never met but whose blogs I enjoy, AYWH and Jeremiah 29:11. Thanks to you both!