Thursday, August 29, 2013

Happy Uterus @ 8 mm... FET is a Go!

My uterus is back to being on my good side. We had our lining check y'day, and it improved to 8 mm.  I was using every holistic trick in the uterus playbook to help it along. I didn't expect it to hop into the double digits or anything, but I do feel better about reaching 8 mm after 5 extra days of waiting. Not because it's my "ideal" number necessarily (Yes, I carry the curse of an overachiever who can always do better), but because we know we gave it the extra shot at improving, and it did. We will take it!

In other good news, P4 (progesterone) bloodwork came back today under 0.2, which means that no ovulation has occurred and we're all set to move forward with our FET on Tuesday 9/3. Yay! We've decided to transfer 2 embryos this time around to increase our chances of success slightly. Given our previous failed attempts, my age (35), and my diagnosis of DOR, transferring two just makes more sense.

I met with a perinatologist yesterday as well for a pre-pregnancy consult. This might seem premature since I'm not yet pregnant, but I had some questions I figured he could answer. My OB/GYN is not exactly on top of things as far as I'm concerned, and I do not plan to stay with her once I'm expecting. Plus, perinatologists are the real pros at assessing risk factors, screening, and dealing with high risk patients.

Previously, my hematologist found the blood clotting stuff and the MTHFR, gave me a script for Lovenox and said, "Take this and baby aspirin when you get pregnant" with no other real instructions on monitoring of anything. Do I just need a preventative dose (40 mg) or a higher therapeutic dose? Is there a test I should take at any point to assess it's efficacy and when/how often? What about folate supplementation for the MTHFR, Rx strength Folgard or Metanyx, etc? How exactly does MTHFR factor into things when it's coupled with the 3 other clotting factors? No one has ever given me any real direction on this stuff. I'm basically just going off of what I've learned from other women and my own virtual research. The internet is full of opposing viewpoints, which change pretty drastically based on each person's set of test results and circumstances.

I'd like to know ahead of time if there is something I'm supposed to be doing, rather than after the fact if you know what I mean. I also asked him about his first hand experience with IVF pregnancies and IVF babies. He actually mentioned a couple things I hadn't even thought of, like the fact that he sees increased risk of pre-term delivery from things like incomplete cervix more often with IVF moms-to-be, perhaps because of all the procedures done on IVF patients before they are pregnant? (his theory) Wow, hadn't even thought of that as a result of too much speculum all up in there.

He also mentioned that IVF twins tend to be lower birth weight and earlier deliveries than even naturally conceived twins. He talked about his patients who have experienced embryo splits (transferring only two embryos and ending up with triplets) and other risk factors. It was great to get the feedback and learn some interesting new tidbits...the type of stuff RE's don't advertise too loudly.

And of course, I asked him about the whole controversial topic of increased natural killer cells, prednisone during pregnancy, and other preventative measures against miscarriage. You may know that this can stir controversy among some doctors, but prednisone has also been seen as the magic bullet for many women who've experienced multiple losses. I do not fall into the category of "multiple losses" at this point. I've only had two losses, and one of them was ectopic (they consider this an "explained loss").

Still, I don't want to have to have 3+ unexplained losses before I ask these questions and then say, "What about prednisone? Can it help prevent this from happening in the first place?" We spoke about autoimmunity, how it may/may not relate to my own situation, where to go from here once I become pregnant, and risks & benefits associated with various drugs being used. He said that he has no problem prescribing prednisone during early pregnancy as an added security blanket against miscarriage once pregnancy occurs, if it's something we want to do.

All in all, well worth the time and cost of the visit. I'm glad I went, because it answered some questions that have been floating around in my head. Hey, if you have questions and they aren't being answered by your current provider, I say go to someone who can try to answer them! It doesn't mean you're trying to create a problem that isn't there or that you're being some sort of hypochondriac. It just means you care about your body and you recognize the fact that you didn't personally go to medical school. It only makes sense to find someone who deals with whatever questions you have, right?

Outside of that, it's hubby's 37th birthday today! We celebrated by getting 2 hour massages and doing lunch afterwards. Maybe some Breaking Bad, Hell on Wheels, and Mad Men on tap for our viewing pleasure this evening. We'll by in bed by 9 PM though I'm sure. Ha!...just being good little boys and girls over here as usual. And then we wait...for a HOPEFULLY successful transfer with two beautifully blessed sparks of life 5 days from now!

Thursday, August 22, 2013

Patience Panties & Deflated Balloons

Looks like I'm putting on my patience panties yet again this cycle, as today's lining check for our upcoming FET was less than stellar @ 7.4 mm. Someone que the deflating balloon to whiz across the computer screen. This is exactly how I feel when I get not-so-great news at these darn appointments...

I do realize that an endometrial lining of 7 mm is "acceptable" for many doctors out there (especially if the lining is trilaminar in appearance) and that technically I am just over the cut-off point. However, if my lining had been .5 mm less they would have told me to wait another full week to re-assess the lining before moving forward with the embryo transfer. Have you ever looked at 1/2 mm on a ruler? Actually, I think it's so tiny it doesn't even appear on a ruler!

After discussing with hubby, we decided that 1/2 of a millimeter is not enough of a cushion to satisfy the nagging voices in my head that will surely remain if we moved forward with a 7.4. Being that my stubborn lining has been an ongoing issue since the beginning of time, I had already adjusted about half of the estradiol doses to be taken vaginally (instead of orally) this cycle in order to hopefully thicken it up a bit more. Clearly it wasn't enough, even with weekly acupuncture in the mix. Seriously, what's a girl gotta do for a decent lining?!

We were given the option to give it another week for the lining to possibly grow, and we've decided to go that route, even though it requires more waiting. There is a very small 5% chance of cycle cancellation (if I somehow ovulate on my own in the meantime), but it is highly unlikely that will happen. So, wait we will. I'm switching ALL doses of estradiol to be taken vaginally and beginning to do warm castor oil compresses daily leading up the the next lining check. I will of course continue acupuncture as well.

It's times like these I'm thankful I don't have a job, because I'll need to lay down for each of the above mentioned things. Praise God for the fact that I have the flexibility for all the appointments and to spend half of my life horizontally! For that I am truly grateful.

I did ask my RE about other meds to help thicken the lining, such as delestrogen shots, Vivelle dot patches and Viagra. I happen to know these are meds used by other doctors to help thicken the lining. My guy, Dr. Vaughn, contends that Viagra has given them lackluster results in the past and that the delestrogen and Vivelle should have no advantage over taking estradiol vaginally 3 times per day. Alright then, if you say so. Let's hope you are right.

Even if my lining doesn't thicken one iota from this week to next, I will have the peace of mind that I've done EVERYTHING to try to get it there.

I've updated our FET Calendar, and here we go again for the next week...
-estradiol vaginally 3 x's/day
-warm castor oil compress daily
-acupuncture weekly

Next lining check is 8/28. It sure would be nice if we could reach 9 mm+ like we did during our fresh cycle. It's happened before, so I know it's possible! It looks like our transfer will now be pushed back to the first week of September. Until then, I'll be sporting these...

Monday, August 12, 2013

A Due Date That Wasn't: Little Green Pills, Good Friends, and Grace from God

So is it still considered EWCM if it's bright green? That is my million dollar question for the day! Perhaps if the manufacturers could do us all a favor and make estradiol pills a different color than bright teal? Believe me, I'm not complaining too loudly. I will take pills over shots any day, and I'm getting quite used to sticking random prescriptions in my vag. If it helps my lining for this cycle, I'm all for it. It just amazes me that something this teeny tiny....

can create such an influx of fertile fluid. My estrogen must be surging like a mofo right now, which is exactly what we want. If only this phenomenon could occur in my body without taking drugs, we just might have a kid by now! Speaking of which, I was supposed to be delivering a baby today.  Instead, I did yard work and stepped in a huge pile of fire ants. Whatever. The sun is shining, and I'm trying not to let today's "due date that wasn't" bother me.

I am thankful today's date hasn't been as hard emotionally as it was the for the first one that passed in July 2012. Sure, it was the first thing I thought of when I got out of bed today, but I just took a deep breathe and told myself that I had a choice; To be pitiful and depressed or to take a look around and appreciate all the good things. I chose to give thanks for all that we have and focus on anything other than what would have been. I am reeeeally trying my best to live in the NOW; Forget the past. Do not worry about the future. Just be grateful and soak in the now.

I started my day off reading a few scriptures that a very dear blog friend passed along. Some of you may know Caroline @ Team Harries Beats Infertility. If you haven't already, make sure to stop by her blog and check it out! It just so happens that she has family in Austin, and we were able to do a quick meet up yesterday.

I can't tell you how REFRESHING it is to connect with other women going through similar struggles who are so caring, selfless, and grounded. This girl is not only drop dead gorgeous, but she is one of the most POSITIVE people on the planet. Her outlook on infertility and life in general is truly inspiring, and I feel like God placed her in my life for a reason. Caroline, you are SUCH A GEM! I would not wish this infertility journey on my worst enemy, but I've got to say I have met some amazing women throughout this process. You all continually inspire me with your strength to keep going.

And like other women I've talked to, I believe this process is also strengthening my spirituality. There have been times in my life where I would consider myself more devout and times where I have seriously questioned my faith. Being a faithful follower is not a perfect process, especially when times are tough, but my relationship with God is one that I believe is real and which I will always come back and look to, both in times of trial and in times of celebration.

I was raised in the Episcopal church, and hubby was raised in Catholic and Methodist churches (I think). We both miss Sunday services and have decided it's high time to find a "real church" (other than t.v. sermons) to attend in person regularly. After all, we definitely want to raise our kids in church, so makes sense to be proactive now. We are basically church hopping until we find one that fits. 2 down, but no cigar quite yet. It will take some time, but I am confident the right one for us is out there.

Outside of that, hubby is still at University of Florida working on his MBA... 7 more days until he returns. I am basically just holding down the fort and being a good little girl here; Eating super clean, treating the ole bod like gold, and trying to remember to take these hulkalicious pills on time amidst the bazillion other supplements I'm on. Tomorrow begins estradiol 3x's daily. 10 days and counting until the lining check!

Thursday, August 8, 2013

Here I Go Again- FET #2

Our natural cycle did not work unfortunately, despite all of our best intentions. We timed everything perfectly, followed all the rules, but with only 1-2% chance of conceiving on our own, I am by no means shocked at the result; Especially when Aunt Flo was only in town for one. measly. day. Sure, there is always room for a miracle from God, and He can defy all odds. However, in this case He chose not to. Realistically, I don't need an MD at the end of my name to know that if my period only lasted for one day, I probably didn't build a thick enough endometrial lining to give anything a place to implant, even if there were perfectly fertilized blastocysts floating around in there looking for a nice cushy place to land.

I had my baseline ultrasound today, finalized our schedule for FET #2, and then proceeded to rock out to some Whitesnake in total rebellion.
Here I go again! Seriously though, I think the lyrics are actually pretty fitting right about now. And because I love you all so much, I will provide you with this classic at the mere click of a button...

I will not be walking down this road alone though of course. The dearest hubby will be by my side once he returns from FL in 12 days (working on his MBA). A few minor changes with this FET as compared to last time:

1) On days when I only take estradiol twice daily I will be doing one dose orally and one dose vaginally. (Last time I did both orally). This will hopefully give a tiny extra boost to my endometrial lining, since meds taken vaginally are absorbed even more than those taken orally.

2) I will have my lining check later in the FET cycle (3 days later than normal). I did this mostly for scheduling purposes (so hubby will be back & able to attend this appointment) but it also gives my lining a good 3 extra days to grow more than it did last time (8.1 mm). I would love to reach 9 mm!

3) We will have our transfer scheduled 8 days after the lining check (1 day more than normal). This was done mostly for HUBBY'S 37th BIRTHDAY scheduling purposes. We have both sacrificed so much in this process, and we have a special day planned for his bday. I want his day to be special because he deserves ALL of the attention on HIM. I opted not to have my feet in stirrups that day, and we'll wait until the following day for the transfer.

4) We plan to transfer two embryos this time around. We were given about 35% chance of conceiving when transferring one embryo, and using two brings our chances to about 50%. I gave up believing in statistic long ago. They mean nothing if it doesn't work obviously, but if doing two will raise our chances while not increasing risk by much, then we figure we may as well go for it. We still have 4 embryos on ice, so we have enough for two more FET's. Hopefully this will be the one though!

5) Lovenox??? I am torn on what to do about using this as part of my protocol again. My RE does not believe it increases pregnancy rates, even in those with blood clotting disorders, like myself. However, I do have a script for it and can get it filled. He said it can't hurt anything, other than the fact I could bleed to death if I am in a car wreck or something. No biggy there!

But here is the kicker....I HATE THIS SHOT. The only way I can do it is to ice the area on my belly 10 min. before & 10 min. afterwards. Anyone who knows anything about TCM (Traditional Chinese Medicine) knows that the goal is to keep that area, and your whole body for that matter, WARM while TTC. That is just one rule that is not to be broken and one that has been followed for thousands of years in Eastern medicine. Remember, Eastern medicine has been used way longer than Western medicine has even existed, and I do believe in a lot of the principles.

I have hesitations to do these shots again for all these reasons; the pain & stressfulness, my RE's belief that it won't help until after I get pregnant anyway (to prevent miscarriage), and the whole freezing of my uterus issue.  Plus, I did use it with our last FET and it wasn't exactly the magic bullet .... a lot of hassle for nothing ultimately.

However, could it possibly help? Who the heck knows!  I've also considered starting Lovenox later in the cycle (around transfer time) instead of early like I did with our last FET (CD5). This way I wouldn't have to endure it nearly as many days and would still have the benefits of having the extra blood thinner during the time when an embryo would be implanting. Doctor's who do Rx Lovenox during IVF/FET seem to fall into two camps: Those who prescribe it early on and those who prescribe it at time of transfer.

My brain hurts from contemplating Lovenox and all the other autoimmune protocols I've seen floating around in infertility cyberspace. Part of me wants to just follow my own doctor's advice and believe in his protocol AS-IS with no tweaks or changes of my own. He has been doing this for quite a long time with good results, and I believe he's a good doctor. Another part of me feels like I should cover my bases with more than just baby aspirin to keep my blood flowing optimally. What's a girl to do?

Thursday, August 1, 2013

Hormone Guide: Survival Tips for Men

Thanks for all the love after my recent post about being depressed. I'm feeling MUCH better now after a couple days to recoup, start reading my new book The Power of Now (mindblowing), and a beautiful day in the 103 degree sun yesterday. I swear, sunshine is my drug!

Then, I get this email from hubby that made me laugh out loud. In case any of you feel your man might need a little help in finding the right words during hormonal times, here it is...

No man should ever wonder what to say again!  :)