IVF # 1 - Cancelled Due to High TSH

That's right - cancelled not because of high FSH, but TSH!

I saw my wonderful PCP (Dr. Ian Shantz) on Tuesday and expressed my concerns about my TSH level that could be impacting my fertility. (If you remember, my levels have ranged from a 3.4 to a 4.3 and my RE was "keeping an eye on my levels"). So, he ordered a TSH test in conjunction with some other routine bloodwork I ended up getting drawn on Thursday. When I got home from work yesterday (Friday), I received a voice-mail message from Dr. Shantz's associate, Dr. Freas. I was surprised that someone, especially a doctor, had gotten back to me so quickly. Dr. Freas informed me that all of my bloodwork came back fine -- except for the TSH, which shows that I could have an underactive thyroid gland (a/k/a hypothryoidism) and which could have a great role in my infertility problems. I didn't know what the level was and it was too late to call him back, so I pondered whether or not I should bring this concern up with my nurse during today's "Lupron Evaluation" / IVF baseline appointment. After consulting with my wonderful Fertile Thoughts forum ladies, I reluctantly decided to let her know since the general consensus was if my TSH level was too high, it could impact my IVF cycle. And why go into an expensive IVF treatment if my chance for success wasn't as optimal as possible? Yes, it would really stink to have to wait for yet ANOTHER cycle, but what's another month of waiting in the broad scheme of things if it means that I will have a greater chance for that cherished BFP?

So, I went to today's appointment not feeling very optimistic. Here I thought all I had to worry about were cysts and if I had any antral follies, not hormone levels already! While I was getting my blood drawn (they just test for pregnancy, progesterone (p4) and estradiol (e2) during the "Lupron Evaluation"), I mentioned my most recent TSH test. The nurse told me that Shady Grove just changed their TSH IVF cut-off from a 3.9 to a 2.5! That means that I could NEVER have been able to cycle if my levels varied from a 3.4 to a 4.3 in the past! So why didn't they do anything to address my levels back in the beginning of the year? And they would have let me cycle this time because testing for TSH is not part of their standard protocol. Someone dropped the ball. Anyway - since I didn't yet have Thursday's TSH result, my nurse said that they would check my TSH level today, too.

While I was waiting for a call-back from Shady Grove, I contacted Dr. Freas, who turned out to be incredibly informative, supportive, and kind. He told me that my level was either 4.8 or 4.9, which was way too high. He told me of a story of a patient he had who had who was trying to get pregnant and had a level similar to mine. Soon after she started her thyroid medication, her levels stabilized and she got pregnant immediately. He offered to call a prescription of Levoxyl into my pharmacy in case I would be allowed to start my IVF cycle in conjunction with the thryoid medication. However, he did advise that it would probably be best to hold off on cycling until my levels came down to ensure the best possible response to my IVF, not to mention that a high TSH level could cause ovulatory problems, problems w/ implantation, and problems with the development of the baby. He also told me that he was going to go ahead and see if the lab could do a full thyroid work-up with my blood from Thursday (hooray if I don't have to get poked again!) to get a more complete picture of what could be going on to affect my fertility. I can't tell you how much I appreciated Dr. Freas' call and his proactive approach in helping me.

Back to my Shady Grove results -- Lo and behold, they were too high -- 3.19. [Sidenotes of Interest: 1) This is actually the lowest reading I have had so far (and BCPs typically cause levels to be higher) and 2) This reading differs by 1.61 from Thursday's bloodwork! Hmmm.] The doctors told me that I should not proceed with this IVF cycle in order to get my TSH levels under control. I informed the nurse who called me back that my PCP had already sent a prescription for me to take 75 mcg/daily of Levoxyl. She relayed the information to the RE on call who said that was a good plan and that I was to follow-up with my nurse on Monday in order to see what's next. In the meantime, I should discontinue my BCP and baby aspirin.

So, while I am disappointed that I can't join the "varsity" ART league, I feel at peace with waiting until I know that I will be at my best for my IVF cycle.

The Journey Begins.....

FSH = 31.4. That's how this all began. What in the world is FSH and what does that number mean? Well, in the past three months, I have learned a whole lot. Unfortunately, what I learned was not good when it comes to trying to conceive a child.DH (Dear Husband) and I got married in April 2008 in a lovely wedding ceremony in the Riviera Maya Mexico. I was 35 years old; DH was 31. I waited a long time to find the man of my dreams and it was well worth the wait. I would have waited even longer for him if I had to. We seemed to have had the perfect relationship timeline. We went out on our first date in June 2005; DH proposed to me in January 2007; and we wed in April 2008. We figured that we'd enjoy a few years of marital bliss as a couple before adding any children to the mix. The media had led us to believe that women could have children in their 40s with no problems, so we thought we had plenty of time. However, I always had a sinking suspicion in the back of my mind that I didn't have as much time as every other woman did to have children. That's what led me to tell my OB/GYN at an appointment in October 2008 that after six months of not having been on any birth control, I was not yet pregnant. Since I was then 36 (and she had told me the year before that after 35 a woman's eggs "fall off a cliff," she immediately advised me that it was time to see a Reproductive Endocrinologist and referred me to Shady Grove Fertility Clinic. We met with Dr. Gilbert Mottla of Shady Grove's Annapolis office in November 2008. He didn't seem to be overly concerned since I was still on the "younger" side of seeking specialized help. He prescribed the basic infertilty tests for DH and me (CD3 ultrasound, CD3 and other bloodwork, and an HSG for me) and told us that if the results all come back normal, DH and I could get some OPK test strips and then just have timed intercourse and be on our merry way for another six months.Well on November 10, 2008, I got the call about my CD3 bloodwork results. All of the things they tested for were pretty much normal....except for my FSH level. 31.4. The nurse told me that it was high and advised me to come back in to speak to the doctor about the results. Of course I didn't wait until our next doctor's appointment because I am an immediate gratification kind of girl, so I immediately started googling everything I could learn about FSH. That's when the panic started to set in because my research basically found that having a high FSH level (mind you, anything over 10 is high, let alone 31.4) is a death sentence for eggs. Here is a very simple and unscientific definition of FSH from the highfshinfo.com website:"FSH stands for follicle-stimulating hormone. It is a hormone that is produced by the pituitary gland that, in the female, stimulates the ovaries to develop a follicle (the housing that accompanies the egg prior to ovulation) – each month. It can be thought of metaphorically as the gas pedal which causes the ovaries to ovulate each month. As women age, it becomes more difficult for the ovaries to ovulate as the supply of eggs gets reduced and so the level of FSH rises (in order to push down the gas pedal further) over time. When a woman enters menopause, her ovaries are depleted and the gas pedal stays depressed permanently; that is to say the FSH level remains high. It is also possible for young women to have prematurely high FSH. "I was also led to believe that having a high FSH was probably the worst case scenario that a woman who wanted to get pregnant could ever have. Pretty much anything else would be fixable or workable. But since a woman is born with all of the eggs she will ever have, once she runs out of them, she can not get pregnant. Period. I also read that many doctors suggest that the only way a woman with a high FSH can conceive is by using donor eggs -- which is something that DH and I were not willing to consider -- at least not anytime soon.Luckily, during our follow-up appointment, Dr. Mottla did not tell me that he couldn't treat me. While he did bring up the donor egg schpiel, he also expressed that he would take things as far as we wanted to go to help me get pregnant. He also said that he was not as concerned about FSH numbers as he was about the number of antral follicles -- because if you don't have any follices, you don't have any eggs to fertilize. Unfortunately, my antral follicle count corresponded with my high FSH number -- but at least I had a few! I asked Dr. Mottla what our course of treatment would be and he said that he'd put me on FSH injectible drugs and try an IUI (intrauterine insemination) on me. He told me that he didn't want to put me through an IVF (invitro fertlization) if I couldn't get enough eggs for the procedure. However, after additional research, I learned that IVFs are the better way to go with girls with high FSH, so I'm not sure why he didn't want to go this route with me first. I will do what he suggests as first to see how my body responds to the medications, but if after one or two attempts, the IUIs don't work, I will push to go the IVF route.Anyway, I could go on and on and on about everything I've learned thus far about FSH, but I will spare you any more details for now.