HUH?! Results update..help me understand this all, pleeaase! sorry super long..

bravegrace22

So today DH & I went to the OBGYN for our follow up to review all of our test results. Forgive me if this becomes nonsense, my brain is so foggy trying to figure it all out. I think I'll just throw all these numbers out and hopefully someone here can shed some light on things:

DH's SA: 

appearance & liquefaction=normal

motility= 64; ref. 50-100%

ph=7.0; flag. L; ref. 7.2-8.0

volume=2.0; ref. 1.5-5.0 (note:"sub-optimal sample. some sample had spilled into bag". but dr said not to worry

sperm count=70; ref. 60-150  10^6/ML

morphology=68%; no ref.

head defects=18%

neck/mid-piece=11%

tail defects=4%

---------------------------------------------------------

ok then there's my pelvic ultrasound results. -___- when i was first contacted after my initial u/s i was told (by phone) that my uterus looked fine, both ovaries looked fine, but that there was (1) 5cm wide cyst on my left ovary. i was told to contact the obgyn i'm currently working with and from that apt. he had me do a follow up u/s to look for any change in cyst. 

i never got a print out of either u/s result until i asked--don't know if this is common practice?

today i asked for a print out of everything..both u/s, sa, & b/w. i was just reviewing them and noticed that the cyst had been listed on the right side on my first u/s and thus, on the second, a note made about prior cyst being gone. i am already having to figure out my next step for breast lump because u/s tech was a freakin idiot...can't believe something happened with this too.

anywho here are the stats:

#1 (cd 14) #2 (cd3)

Uterus: position-anteverted anteverted

   visualized-well; appears-horrogenous                 no similar notes

   measurements- 7.4cmL x 4.2W x 3.4H  55.2cc volume 5.1L x 4.4W x 3H  35.2cc volume   

     endometrium: visualized, thickness-6.1mm visualized, thickness-5.2mm

     fibroids: none none

Ovaries:

Left: 2.5cmL x 1.6W x 1.8H  3.7cc volume 1.6L x 1.6W x 2.6H  3.4cc volume

size: appears normal in size & appearance appears within normal limits

Right: 5.5cmL x 4.6W x 4.1H  54.2cc 3.2cmL x 2W x 2H  6.6cc

size: see comments appears within normal limits

Adnexa, Fallopian TUbes, Cul-de-Sac: (DH & I had a good laugh about that term)

Left & Right Adnexa appear normal Left & Right Adnexa appear normal

Cul-de-Sac:

Appears: Normal; Fluid: none visualized Fluid: small amount

Adnexa & Ovaries: The left ovary is within normal limits The ovaries are unremarkable in appearance (darn I was hoping they were superstars!) 

There is a 4.8 x 3.3 x 4.2 cm complex thick walled,  The previous complex right ovarian cyst seen on prior study of 05/28/14 is no longer

multi-septated right ovarian cyst evident. There is a small amount of free fluid in the cul-de-sac.

There is a small amount of adjacent fluid. No evidence

of polycystic ovaries.

What's everyone think about our 'bits'?

The other thing I wanted to mention is that both OB's seemed quick to mention clomid as an option. Today, he said that the 'cyst was gone' so that's great...not really, now we still aren't any closer to diagnosis & have to do less effective procedures to see what's going on in there..and is it really gone?? Then he said that he wanted me to go ahead with the HSG at the start of my next cycle, see what that shows, even if it's clear to start on clomid for up to 3 cycles increasing dose 50 to 100 to 150 if needed, if we are still not pregnant after everything testing normal & clomid, then he'd refer us to the RE and we could talk about IVF. He actually said IVF is an option now or later, but since out insurance doesn't cover it, then he assumed we'd wait and try out the clomid. I asked if we would monitor with u/s if we started clomid & he said that he has in the past, but that it would prob be unnecessary cost to us as it wouldn't tell him much. i also asked if i should be concerned that the pain (we thought was from cyst) on my left side had not gone away and future cysts due to clomid-he said not to worry that it's prob nothing & no issue as far as clomid.  grrr. when we got back out in the waiting room i whispered in DH about reading so many testimonials on here concerning monitoring and that there was no freakin way we were doing clomid without.

What do y'all think our next step should be?? and is there anything that stands out in our numbers?

Sincerest thanks to anyone who stuck it out and read this whole post!

PS I Can NOT f-in wait for the RE in 12 days, although I'm already cringing at the future bills

BunnyBerry

1. Your husband's SA results are awesome! Especially to have those numbers when part of the sample was lost, it's really great. 70 million total, 64% motility, both excellent. The morphology must be measured by a different method than I'm used to, because usually 5-10% is normal. I'm guess this is not "strict Kruger morphology" but the type my DH had for his SA in China, where the result was like 80% good morph. So maybe someone else here can shed light on that part, or you can ask the doctor about it?

2. It's totally normal not to give the patient a copy of the ultrasound images for a cyst. I've never been given the US images for my cysts (similar to yours - 5cm and 6cm) or for the monitoring ultrasounds once treatment started. It's great that your prior cyst has resolved, it sounds like (if the green is the update and the blue is the past time?). And if they said "is no longer evident", then yes, it's really gone.

3. So relieved that you told your DH you're not doing Clomid without monitoring. Actually, I might be jumping the gun here but from what you've shared, I would say move onto the RE. If you've already experienced your year of infertility, there's no need to "keep trying" with the OB just to see. Do you temp to know if you are already ovulating anyway? You've had only an ultrasound and SA, and personally I would prefer the RE to do the HSG and get firsthand picture of my body. There's also a lot of blood work, especially hormones, to be checked and an RE is the expert and piecing together the evidence and determining the best course of action. There's no guarantee that Clomid would be that best course. And it's so weird the doctor said, if Clomid doesn't work you can go to the RE to talk about IVF. Actually, there are so many interim options and possibilities and I would only want to trust an RE with these treatments.You might be a good candidate for Femara/Letrozole instead of Clomid, which is much kinder on the side effects. 

As long as that doctor doesn't try to give you unmonitored Clomid - best of luck with whatever you choose!!

catlover790

I'm sorry about the confusion over the cyst! And I'm sorry that you have a lump on your breast, I hope that it's nothing serious. In reading the results you have there most of the things say normal next to them so I think that's good! I also do think your OB's comments are not how I would want to look at it; I think there are a lot of different options than just clomid, then ivf depending on the diagnosis. Good luck, I think an RE will be much more helpful!

bravegrace22

Thanks for your feedback @BunnyBerry!

BunnyBerry said:

1. Your husband's SA results are awesome! Especially to have those numbers when part of the sample was lost, it's really great. 70 million total, 64% motility, both excellent. The morphology must be measured by a different method than I'm used to, because usually 5-10% is normal. I'm guess this is not "strict Kruger morphology" but the type my DH had for his SA in China, where the result was like 80% good morph. So maybe someone else here can shed light on that part, or you can ask the doctor about it?

yay! & the note under morphology says "sperm morphology classification referenced to W.H.O. laboratory manual fifth edition 2010" if that helps at all

2. It's totally normal not to give the patient a copy of the ultrasound images for a cyst. I've never been given the US images for my cysts (similar to yours - 5cm and 6cm) or for the monitoring ultrasounds once treatment started. It's great that your prior cyst has resolved, it sounds like (if the green is the update and the blue is the past time?). And if they said "is no longer evident", then yes, it's really gone.

I didn't receive images of u/s's just the results i posted (measurements, notes, etc.) just thought it was a little odd that he didn't have a copy of them at the appointment while we were going over them, it would've been nice to follow along with and be able to ask all these questions that are popping up now. yes, the green is update and blue is initial, but the notes are for right side when the cyst was on left. 

Thanks for the 'atta girl' with the clomid decision:) i wouldn't have even known to protest had it not been for this board. i have tempted in the past and am currently temping, but not really for long enough, and diligently enough to know for sure. it seems, though, that i am ovulating reg.

 

bravegrace22

catlover790!

BunnyBerry

Aha, sorry I missed that...well if there was one right cyst mentioned and one left cyst mentioned, sounds like a good reason to confirm!

I never saw the printouts of ultrasound results, I have just tried to see what's going on and keep it in my head (follie counts and sizes, lining thickness on different cycle days), but yes it makes sense, why do they act like our own medical records are such a secret? Probably because it's work for them to keep us updated. And our RE's office charges $5 per page to transfer records to another office, so I wonder if it's some kind of way of keeping us in the dark about the details so we can't go for a new opinion? I don't know, hope not.

bravegrace22

Yikes! that seems crazy for something that shouldn't really take that much effort. I love that my PCP has a patient portal where they just upload all your info so you have access to it..just wish the rest of the offices would do the same! 

I had just missed them when i noticed the flub with the cyst, so I'm going to call the ob in the am.