Reproductive Immu...what?

   Today was my consultation with Dr. Kwak-Kim.  She is a reproductive immunologist.  Her patients include women with unexplained infertility, multiple failed IVFs, and recurrent pregnancy loss (although that's not her complete list).  When I found her, I was searching for any answer I could find as to why we still aren't pregnant.  Seeing that there are about 6 RIs in the country, 2 of which being in Chicago, I felt that it was a sign I should at least see if there was anything else we are missing.  I was reluctant to keep the appointment once we found the polyp and my labwork was all coming back normal.  The office assured me that there could possibly still be other things wrong and I should still keep it.
  Luckily, I live about an hour south of the office.  I have read stories of couples who fly across the country to see her.  I was instructed not to eat anything after 10pm, then an hour before my appt to drink 32 oz. of water.  The also said it was okay to take my meds, so I took them with my first 8 oz of water and hopped in my trusty Jeep for my little road trip.  I opted to go alone, so that Jeremy wouldn't have to take another day off work.  I know some of the area because my inlaws live nearby, so I wasn't too worried about where I was going.
  When I finally got there, I checked in, filled out their standard forms and waited.  I was the first appt and the only one there.  I was called back for my ultrasound a few minutes later.  We did an external ultrasound first just to check structure and such(hence the 32oz of water).  Yes I still have a uterus and ovaries, phew!  Next came the transvaginal.  Oh Joy.  Let me tell you.  The ultrasound alone was worth the drive!  I forgot to mention that while they have the ultrasound machine next to me, they also have an additional monitor posted near the ceiling  directly in my line of vision so that I could watch the ultrasound too!  So cool!!!
  We looked at structure more, she took some measurements, and did a dopplar study to look at blood flow.  Remember a few months ago when I questioned the RE if maybe I was PCOS?  Well low and behold on the ultrasound today I had multiple cysts on both ovaries.  As soon as she looked at them, I knew.  I'll get more into that in a minute though.  She also looked at my bloodflow to both my ovaries and uterus.  That showed some decreased flow as well, more so the left ovary and uterus, which could explain why my right ovary responds better.  We also scanned my thyroid then, since thyroid issues can also be seen in PCOS.  A radiologist will read the images, which should take about 2 weeks.
  Next up was the blood draw.  They put me in a recliner lab chair and started pulling tubes.  22 vials.  Yes you read that right, 22!!  The nurse asked which vein would be best, so I pointed her toward my RE nurse's favorite.  Amazingly enough, she got them all on one stick!  I was beyond impressed.  I was then moved to a room to meet with the nurse practitioner who did a physical and interview.
  Finally I was moved to the conference room to meet Dr. Kwak-Kim.  She was absolutely wonderful!!  She has battled infertility herself, so I felt comfortable talking with her.  I also cried about 4 times in the appt.  whoops.  Damn you IF!  She explained that typically she sees IVF failure for 4 reasons.  Genetic, endocrine, immunologic and hematologic.  As far as genetic, she said there is a 15% chance the failure was due to genetics, meaning there's an 85% chance it wasn't.  That made me feel better.  It sounds like she is looking more towards immune and hematological due to my family history and what she saw from the ultrasound.  Endocrine is another factor she's considering because of the newly developed polycystic changes we are seeing in my ovaries.
   Our game plan will depend on how my labwork comes back.  We have a follow up appt on 4/19 to talk about them and make our plan.  Her recommendations until then were to try to lose more weight, reduce my BMI (which will all help especially if I'm PCOS, as well as stress reduction).  She also recommended that we not cycle in May.  Her reasoning is that with my lower AMH level, I'm working against time.  If I cycle without fixing problems, I run the risk of overstressing my ovaries.  Doing so could cause premature ovarian failure.  We don't want that, especially if I am not considering donor eggs at this point.
   I talked to Jeremy when he got home from work and agreed that this is a doable option.  We want to give this the best chances we can.  She had also said that chance of success from IVF starts to plateau after 3 cycles.  I don't want to waste my best cycles.  So it looks like I have a phone call to make tomorrow to reschedule my cycle for June.  I also need to talk to my boss to work on time off again.  I wish these things would happen before I make my work schedule.
   After the appointment, I stopped at a pretty huge mall on the way home.  They have a LUSH store there.  I may or may not have spent an hour or so in the store indulging in some retail therapy.  It's better than crying in the car, right?