reproductive endocrinologist and test result updates

I got my test results back from the doctor on Friday. Everything looked good, except I had about a gazillion cysts on my ovaries. Ok not quite a gazillion...I can't remember the exact number, but it was at least 12 (what you have to have in order to have polycystic ovaries). That, combined with slightly longer cycles and later ovulation earned me a PCOS diagnosis. I can't say that I was super surprised. At my first appointment with the reproductive endocrinologist, the nurse practitioner made it quite clear they didn't like that my cycles were consistently longer than 35 days. And I have a history of ovarian cysts. No one ever said anything about PCOS at that time, but when the NP showed me my u/s of my ovaries, I knew what was coming.

PCOS increases your chances of miscarrying to 40%-45%. Most women have a 15%-20% chance of miscarrying. They are not saying this is why we are miscarrying. But they are saying this is not helping our chances of having a take home baby. So they are treating me with metformin. From what I understand - with pcos you don't always process insulin correctly and that can cause the cysts. Metformin is typically prescribed for diabetics b/c it helps you process insulin the right way. The hope is that will help control my pcos and it won't get worse. It may help my cycles be a normal length and decrease my ovarian cysts. It may also make it a bit easier to lose weight - something that I can do now, but have to work really really hard to do. The RE would like me to lose 10-15lbs, so I'm hopeful it won't be as hard now. 

The other thing that concerned my RE was the fact that I tend to ovulate later in my cycles - usually b/t cycle days 20-30. Ovulating later in your cycle can (it does not always) increase the chances of "genetically abnormal embryos". Obviously this increases the chance of miscarriage. For lots of women, this is not an issue, but with our history of pregnancy loss, the RE wants to try to get me ovulating earlier in my cycle - preferably before CD 16. In order to accomplish this, he will be putting me on a medication called Femara when we are ready to try to conceive again. I'm hopeful that the metformin will regulate my cycles, since they're only slightly irregular and we can avoid the fertility medication. But if not, the RE feels this will give us a better chance for a take home baby.

This is all based on a couple of assumptions - the biggest one being that James has normal genes. So we are hoping to get chromosomal karyotyping on him in the next week or so. We will have those results in about 6 weeks. If they all come back normal, then we go on with the medicine and trying to have a full term baby. If his are messed up our options are pretty limited. We will discuss those if it happens. 

The other assumption we are working under is that something has been genetically wrong with our losses. I had originally been told that was not the case - that the babies were genetically fine. I recently found out that they never tested chromosomes on the first loss. The pathology was normal, but we don't know more than that. With Pepper, the chromosomes would not grow and although the autopsy was good and she looked normal - that does not mean genetically everything was fine. The loss in between was very early and losses that early typically are b/c of genetic stuff. So we're working with the assumption that James and I are genetically fine, but maybe making genetically abnormal babies.

So basically the plan is take some small steps to increase our chances of genetically normal babies and to control my PCOS in hopes of getting our take home baby.

That's our update....