Taking Infertility to the Skies

     Last Friday, we did something super ballsy. We got on a plane and flew to another state to see a doctor. That is really something I never thought I would do. Ever. I would always read about these couples who travel to SIRM or CCRM from across the country, and thought, wow, that's fucking nuts.

Yet, there we went...off to Chicago to see Dr. Kwak-Kim, one of three reputable Rerproductive Immunologists (RIs) in the country. There is a pretty awesome website that was developed by the fine ladies behind the reproductive immunology group on Yahoo that can be found here. It outlines who should go see an RI, what tests the run, basic costs and which REs will play ball with an RI.

Reproductive Immunology is considered somewhat "experimental" but is gaining traction. It has always made sense to me that the immune system plays a role in conception and pregnancy, so after our first IVF failed, I got to business setting up a consult. I have Celiac Disease, which is an autoimmune condition, and endometriosis, which I also have, is also considered an autoimmune issue. That, combined with my lack of pregnancy in any way, shape or form, led me to seek out an RI.

I researched RIs and realized the Dr. Braverman of NY, Dr. Kwak-Kim of Chicago and the Alan Beer Center - named after the pioneer of Reproductive Endocrinology (who also wrote the book Is Your Body Baby Friendly?) were the main players in this game.

Dr. Braverman charges like $3k to meet with him and requires you to cycle with him, but mostly, I heard he's an ass hat. The Alan Beer Center is in California, and Dr. Kwak Kim came highly recommended. Plus, she studied under Alan Beer himself.

To schedule an appointment, you are required to send her office medical records from all providers - which, for me, included my PCP, Metabolic/Genetic providers for my PKU, my current RE, my surgical OB and my GI doctor for my Celiac. I had all the records sent to my home, and sent them off in a packet, along with the new patient form. I received a call within a week to schedule my appointment - the earliest of which was 3 months later on January 15th. 

We flew in Thursday afternoon, picked up our rental car, and drove the 30+ miles to a Northern Chicago suburb. We camped out in a local hotel for the night and arrived bright and early at 7:45am for a whole host of appointments.

The first thing I learned at my 8am ultrasound was that I can't follow directions for shit, as I did NOT show up with a full bladder. What a fail. I chugged 3 cups of water and they started with a 35-minute internal exam to view my insides as well as the blood flow to my reproductive pieces. Turns out, while blood flow to my ovaries is good, my uterine blood flow isn't great...and the ultrasonographer thinks I will need Heparin.

Also, my endometrioma on my right ovary is actually TWO endometriomas...one bigger one that is squished next to a smaller one. But despite that, the blood flow is good!

The biggest news to come from the ultrasound is that there is a 16mm cyst either on the lower uterine segment or on my cervix...the exact location will be determined after Dr. Kwak-Kim consults with some other practitioners on it. So, that doesn't sound great from a pregnancy perspective.

From there, an external exam was completed and I was ushered to my blood work appointment - where 19 vials of blood were taken. This makes about 40+ vials of blood that have been taken since Christmas Eve. I'm so badass.

After that, I had a health history and physical exam by the NP. She was awesome and totally indulged my NP-student desires but explaining the assessment to me and making sure I heard and felt all of the things I was supposed to.

Finally, a few hours later, we were led into a meeting in a conference room with Dr. KK, a student and some sort of a physician helper. She briefly went over my history with me and explained the preliminary findings from the ultrasound. She was very nice and knowledgeable. We have a phone consult scheduled for Friday 2/5 to go over the full results and receive her recommendations. She also stated that because I'm already diagnosed with autoimmune issues, particularly Celiac, she sent me for a thyroid scan after our meeting, which showed a perfectly healthy thyroid. Finally, we were handed a booklet that outlines all of Dr. KKs treatment protocols.

All-in-all, it was a productive and overwhelming appointment. She suggested putting off our next cycle but I'm going to compromise and suggest a freeze-all. Since the bloodflow to my ovaries is good, I think I should stim well, and of all of her other treatments, there really isn't anything that will affect my egg quality other than IVIG, which we won't do if it isn't covered by insurance. I'm praying that since my NK Cell level is good, IVIG won't be recommended. Our cycle start is estimated for 2/8 so we can have our full results back before embarking on our cycle.

The hard part now is management. Dr KKs results needs to be sent to Dr. W, test results from Dr. W (like my EFT scheduled for Friday 1/22) need to be sent to Dr. KK, and I need to keep up with my old fertility clinic since I will be receiving external monitoring there.

Overwhelming. But hopefully fruitful...at the end of the day, switching to such a great doctor and seeing Dr KK paints the entire picture as much as it medically can. So if things don't work out, or if we move on to donor eggs, I'll know we did everything we possibly could.