Monday, February 2, 2015

The Shades of Gray

Okay get your mind out of the gutter.  This is NOT a post about 50 Shades of Gray.  (although I'll admit to reading the books and could probably write a pretty entertaining post about them!)  It's about the shades of gray that lie between black and white.  And opinions that vary between experts.

I think I mentioned to all of you that my clinic has a new doctor.  I'm excited about this for a couple reasons.  #1 - she's a woman.  I like this.  #2 - she provides a fresh perspective to my case.  As most of you know we had a phone consult with CCRM and if the outcome of this next FET (with our last 2 frozen embryos) is not successful we will be packing our bags for Colorado.  However, since we still have the 2 embryos we opted to see them through first, before moving on to a new clinic.

That being said, it was great timing when Dr. Emmi joined our clinic.  I had a bad moment when Nurse Jenny informed me that I needed to re-do ALL of my initial testing since it has been 18 months since I started at the clinic.  That was hard to hear.  Obviously I fully envisioned at least graduating from the clinic by this point, if not holding our baby in my arms. (oh how naive I was!).  But since that's obviously not the case we went ahead and took the 8 tubes of blood for all of the consultation tests.  When we did this the first time the only number I was informed of was my FSH since it was elevated.  They told me that the rest of my levels came back within the normal range and I never pressed for the exact numbers.  This time I got the call that my thyroid level was a little high and they wanted to re-test it to determine if Dr. Emmi would treat me for that during cycle.  I did some research and came up with mixed results (shocking I know).  Basically you aren't considered to have hypothyroidism (under active) unless your TSH levels are over 5.5. However there is an ongoing controversy among RE's and more and more of the experts are proclaiming that the normal range needs to be revised to .3 to 3.0.  After reading all of this information I was anxious to get retested if only so I could find out how "high" my level was.  I went in this morning for the blood draw and Nurse Jenny told me that my TSH from last week came back at 3.2.  She confirmed that Dr. H just wanted to see levels under 4, but Dr. Emmi wanted to see them under 3.  Interesting.

Now we wait to see what the re-test comes back as.  Jenny seemed to think if it was under 3.0 she won't treat me but if it's over that, even in slightest, she will most likely put me on meds.  Either way it's refreshing to have that new perspective and feel as if someone is really examining my case.

I start suppression meds next week and then we'll really get this party started.  I'm so looking forward to crossing off the days until transfer.  No I don't ENJOY giving myself shots but at least it feels like we are doing something more than waiting.  Our last transfer (which resulted in a chemical) was in Aug.  In some ways that feels SO long ago and in others I'm shocked that it's been 5 months.  Now that the wait is almost over I'm glad that we did the procedures and the Lupron Depot.  I'm hopeful that my body will be in the best condition for this transfer.  And I'm praying that  9 months from now I'll be holding one (or both!) of those little embryos in my arms.


  1. I agree that this is good news either way. Your new doctor is examining your records and looking at everything with fresh eyes. She's also not afraid to have a different opinion. No matter what the outcome, I think you should feel good about the level of care she's providing! Getting excited for you!

    1. Also, so you don't feel like you're the only one who gets this kind of confusing news and wishes for a black or white:

  2. To throw another hue of grey into the mix, I can offer a differnet number. For patients with established hypothyroidism, our (general) endocrinologists like their TSH to be less than 2.5 prior to starting a pregnancy. There was a study in Italy that found women were at a higher risk of miscarriage when a TSH was >2.5, so the American College of Endocrinologists recommends management to achieve a TSH <2.5 during pregnancy. ACOG has not come to a consensus regarding TSH values, and current does not recommend screening TSH as part of the prenatal labs. I've seen quite a few patients with high TSH values at the start of pregnancy, and all went on to have a healthy normal, baby. The good news is that it doesn't take too long to get your TSH down.