My PCOS Journey Pt 2

When last we met, I was hip deep in a country song: young, broke & married. I knew we had plenty of time. At 23/24, it's hard to imagine your life at 35, the infamous age of the decline of female fertility. Of course we had plenty of time! How could we not?

I had a new job and with it, shiny new insurance. Insurance with co-pays and low deductibles to meet. Insurance that allowed for certain infertility testing as long as it was coded for specific conditions and not infertility. And to be fair, while the end game in my mind was to conceive, I have a real medical reason and accompanying issues for not having conceived yet. Whether or not I was trying to conceive, I know now that what I considered infertility testing at the time really is important diagnostic testing for a variety of medical concerns.

So after being married a couple of years and with friends who were slightly older and also trying to conceive, I started making appointments. I finally asked my next primary care doc about PCOS. Oh yes, she told me, that made a lot of sense in my case. I was elated. But there really isn't anything you can do for it. I deflated. Well crap. Fertility doc, here I come. So, I met with the fertility doctor recommended by friends of ours who happened to be struggling with infertility as well, although for a different reason. I was officially diagnosed with PCOS. You know all the funny tv and movie ultrasound scenes, where they're checking for this or that or the not-even-showing-yet baby's heartbeat? Unless they're shoving a condom-covered wand into the actress's vagina, don't consider it authentic. Who doesn't love a good transvaginal ultrasound? Me. I don't. Not in the slightest. I think some of the techs think they're practicing their Wii golf game while they're in there.

{A little basic info - feel free to skip down to the next paragraph if you have been ridiculously and thoroughly educated by way of your own infertility journey.}

The "PC" in PCOS stands for Polycystic - or multiple cysts - and the "O" is Ovary (or Ovarian). Here's what naive lil ole me didn't have a clue about (and frankly most women who haven't been thoroughly educated on the intricacies of menstruation and reproduction don't know): Day 1 of a menstrual cycle is the first day of a period. On that day, the hormone shifts to estrogen production in order to prime the uterus/ovaries for the coming month. You shed the old lining (on average 5 days, but it varies). As the cycle continues, and those hormones have your uterus working on a new lining, an ovary (usually just one, sometimes both) is getting an egg ready. Unlike men, women have all the eggs they're ever going to have at birth. Each month one (sometimes more, which is the reason for twins, the non-identical kind) egg gets pushed to the outside of the ovary into a fluid-filled sac, or cyst. When a woman ovulates, this cyst ruptures and releases the egg to cruise on down the fallopian tube connecting each ovary to the uterus. If the egg is fertilized by sperm, ideally it will implant into the waiting & healthy lining of the uterus to become a fetus. Once ovulation occurs, hormone production shifts to focus on progesterone, believed to be necessary to maintain the beginning stages of a pregnancy (until the placenta forms, which takes over producing enough of this hormone for the duration of pregnancy). Without implantation, the body is signaled to shift hormone production again and will bring on a new period. The mythical standard for this whole cycle is approximately 28 days, with ovulation usually assumed to occur around day 14, but even in women without PCOS, this varies.  In PCOS, when it comes time for ovulation, most of us never have the cysts burst. Over time, our ovaries look like they're covered in bunches of grapes or strands of pearls from all the cysts that never ruptured. Sometimes these cysts can grow and burst later, leading to intense pain, internal bleeding and more.*

On the eve of my having the last bit of fertility testing before we started the medications to assist conception, we hit the first, but certainly not the last, snafu of our journey. I was scheduled for an HSG or hysterosalpingogram and had been given a prescription to bring on a period because it needed to be done on a particular day of a menstrual cycle, something I didn't currently have. Well, since it had been forever ago since I'd had my last period, some, uh, build up had occurred. Meaning when it came, it was heavy and it lasted. The doctor's office told me not to worry about it and scheduled the test based on when the period started. The hospital radiology department doing this procedure however, had a kitten, an absolute kitten, when they found out I was still lightly bleeding. They refused to do the test. They didn't understand how I hadn't called and cancelled. These women clearly had never had a cycle out of sync in their lives and couldn't understand my explanation and basically shamed me. It was humiliating. The doctor's office didn't understand the hold up, as though I had some kind of overriding authority I could have used with the hospital staff that could have made the test happen anyway. Huh? Did I miss something here?

Wait, what's an HSG, you nobody says? With your lady parts held open and your feet firmly planted in stirrups, images are taken while dye is flushed through your uterus and into your fallopian tubes to check for blockages and other issues.* I have never once, not ever, read an account of this procedure where, blockage or clean as a whistle, the patient was not in agony. I have only rarely heard of doctors who request this test prescribing any kind of pain killer.

And before I could get everything lined up again to take another go at the HSG, and thus move on to try the gateway drug of choice for infertility, life happened. All these appointments and tests to this point had taken time, over the course of perhaps two years. By 25, I was out of work and while we had my husband's health insurance, it did not cover any kind of testing. Hell, it would be another year or two before his insurance even offered prescription drug coverage. And before you snarkily question what bowling alley he worked for, his employer at the time was a national insurance company. Their employees had worse insurance than you bought from them. Oh, and that fertility doctor? He quit delivering babies and shifted his practice to sexual dysfunction. Our friends never ended up conceiving with his help, either.

To be continued...

*All mistakes are my own. This is the oversimplified, layman's version of events without my bothering to fact check. However, this post should be the last of the medical info dumps in this story.