Friday, November 29, 2013

Lining @ 9.1: PEO & Transfer on the Horizon!

Raise your hand if you've spent/will be spending at least one day of your holiday weekend in stirrups. Anyone? Anyone?

I've gotta give it to the staff of my fertility clinic, because they NEVER get a day off. Of course, mad props to my fellow TTC'ers out there forgoing Black Friday shopping to run to doctor's appointments, to labs to give blood, to pharmacies for their meds, and back home to joyfully inject ginormous needles into their behinds.

In all fairness, I can't complain too loudly. This is basically all that has been going down at our house for days now, and we plan to continue this trend throughout the weekend...

Triscuit has the good life!

Plus, despite the running around, this morning could not have gone any better. I'm happy to report that after only 4 doses of Delestrogen shots, my lining is ready @ 9.1 mm! I'm so glad we requested these shots.

My clinic only requires a 7 mm lining to move forward with IVF/FET, but I REALLY wanted to see it over 9 mm. I will not ever be one of those women who gets a lining in the double digits, and I know that. 9 was my own personal threshold to feeling 100% confident that my uterus is ready to receive our last two remaining embryos. Obviously, there are many moving piece to a successful FET, and the lining is only one of them, but gosh darnit it is nice to not wonder if it's really going to be good enough. It's far enough over the cusp of what's acceptable, that I just feel better mentally about this part of the equation.

Did a P4 (progesterone) blood draw today, and as long as that comes back nice and low (showing no ovulation has taken place) then we get the green light to begin PEO (progesterone in ethyl oleate) injections tonight. We'll do these for 5 days, and the transfer will be scheduled for 12/4....just in the nick of time yet again. Hubby flies out on 12/5.

For anyone who's done PIO injections, you can see that the PEO solution is much different just by looking at it. PEO contains the exact same amount of progesterone medication per dose, but the medium used is different; It's compounded with ethyl oleate rather than oil, which results in a clear lightweight liquid rather than a yellow heavy liquid. The PEO medication is about the consistency of water, thus requiring less effort to plunge into the muscle, a smaller needle, less pain, less lumping under the skin, etc. I have yet to do one (tonight will be the 1st time) but from what I'm told, this is supposed to be easier than PIO.  Make no mistake...the needle is still big and scary, and it's a fair amount of liquid (1 mL), but I'll take whatever I can get in regards to having a thinner solution to inject.

We still have a ways to go, but all in all, things are playing out well thus far. I'm releasing all better judgement to remain guarded out the window and letting in a ridiculous amount of hope in it's place. Yes, I am getting my hopes up super high for this FET to work. I just feel really good about things this cycle, like something IS going to be different. I figure we've got absolutely nothing to lose by expecting something different....that it can REALLY work this time. I can see my hubby get a little guarded as my excitement becomes more apparent, but at this point I'm not worried about protecting my own heart from the possibility of failure. I've decided I will cross each emotional bridge that comes along the way. Staying hopeful and positive and open and expectant for a successful cycle is the ONLY way I am going to be. Period. 

Take a listen if you can use a reminder to stay positive and think good thoughts. Love this song...

Saturday, November 23, 2013

Warm Tootsies

Have you ever in your life seen tootsies as warm and cozy and relaxed as these??

I've want to send a big THANK YOU to one my dearest blog buddies Jessah @ Dreaming of Dimples. Despite all she has going on with out-of-town fertility treatments, working full time, and organizing fun events to bring joy to others (like mug swaps throughout the blogosphere), she still took time to send me these super fun and very LUCKY socks to wear. Breaking these out today was MUCH needed, because they totally saved my mood.

Here is where I get honest. There were a few tears this morning. I have been doing really well staying positive and hopeful and at peace. More quiet time each day with myself and with God is helping, and I am generally in a really good place. It was just one of those times where true feelings can strike at a moment's notice. 

This morning at the gym, I was situated on a machine next to a woman who I knew had just given birth and was in there "working off the baby weight." I've tried to avoid being around this chick, because it just hurts to watch everyone around me have babies when I still haven't. I don't even know this woman, but we have a mutual friend who felt the need to tell me how she got pregnant with #2 not even trying...out having a good time on NYE last year with the hubby and BAM it happened. Not sure why I needed to know this detail, but my friend felt the need to tell me for some reason?

Of course we tend to work out at the same time, so I got to watch her baby bump grow for months, as she continued working out like a crazy exercise feign doing push-ups, squats, long intense sessions on the stairmill, the works. As if Kerri Walsh winning the gold medal in volleyball while 5 weeks pregnant weren't enough. Now I get to watch this pregnant chick go nuts in the gym every day and come rub her belly near me as she stretches.

Clearly intense exercise doesn't affect all people in the same way in regards to fertility. Nope, I'm the lucky one who becomes anovulatory and loses her period for 3 years straight from being "too athletic." Alrighty then, I'll just be over here doing the elliptical (a.k.a. workout for wusses) since I'm "not allowed" to work out intensely and am treating my body as if I am already pregnant. No, I'm not bitter about this at all. Can you tell?

I was trying not to let this stranger's return to my workout space bother me, and I tried my best to just look the other way, but it's like there was an elephant in the room or sorts...but just inside my own brain of course. When hubby asked me on the drive home how I was, I divulged how it just hurts to watch everyone go through each trimester and then post-pregnancy. We were actively trying long before this woman accidentally got blessed with a child, and here I am STILL TRYING as her baby is all cozied up safely with the rest of her family at home. It just sucks feeling like everyone else gets to experience milestones of life while you are just plain STUCK in the same place.

Sorry for such a long tangent, but just to bring it back...My point was supposed to be that I am thankful to know I'm not completely alone and that there are women out there who do get it, even if we are all separated by thousands of miles. I truly do not know how women survived pre-internet.  Lord knows I have zero friends in real life who have been through this, and it gets tumbleweeds blowing by lonely.

To have a friend whom I've never met in person, who would take the time to send me something as simple as a pair of lucky socks along with a super sweet card means SO MUCH to me. I will also say, that if you've never put on a pair of bright striped socks that go all the way up to your knees, you must try it! It's an instant mood lifter! I had no clue how much fun these would be! So, thank you my dear Jessah for making me smile on a morning where it's been really easy not to. Thank you for thinking of little ole me. :)

And since we're on the subject of warm tootsies, I have got to share my other new favorite toy with you. I saw this Luxury Foot Warmer in a catalog and knew I had to order it. I am very cold natured and always trying to keep my feet warm, so this is absolutely perfect! There are a few different ways I've been using it.

I call this "Pigs in a Blanket"...

This is the absolute best position though. The "Tootsie Roll"...

If you have cold feet constantly like me, I highly recommend ordering one of these. Seriously the BEST purchase I've made in a while. As you may know, Chinese medicine correlates being cold natured with kidney yang deficiency, and there is a lot of importance placed on having warm feet while trying to conceive. Having warm feet increases blood flow to meridians connected to the pelvic organs. That is why TCM practitioner's are so adamant about patients wearing socks and slippers during conception cycles, and especially throughout IVF.

I need all the help I can get with blood flow and my lining, so I'm using this puppy every day. It's much more efficient than warm foot soaks if you ask me, because it heats up super fast, you can leave it on longer, and it doesn't leave your feet wet and cold afterwards. Plus, it's so small and lightweight you can tote it around and use it in any room of the house. Love this little gadget!

It's coming in handy this weekend as we welcome cold and rainy temps in the 30's here in Austin. Hubby and I are aiming to break an all time record for between him studying for his MBA of course. Yesterday we went to see the new Hunger Games movie right smack in the middle of the day and had a lunch date at a favorite Mexican spot. Tonight, we have plans to see Whitney Cummings stand-up live with two other couples and do dinner at another favorite spot downtown. All in all, these are all reminders that life is good.

I'm sure there will moments tonight where I'm reminded yet again that we aren't parents, since the couples we are going with all have beautiful young children. I can pretty much guarantee this will be a main topic of discussion. I'm just preparing myself ahead of time to sit close to hubby and hold him a little tighter if/when those conversations take over. I can't just hide my entire life from people with kids to protect my own heart, so I'll try my best to be happy for them and let their stories be a reminder of what we have to look forward to...hopefully some day very soon.

Thursday, November 21, 2013

Opening the Door

Yesterday, I was telling my acupuncturist how at peace I feel with this last FET. Some people might look at this schedule of injections and appointments and think it's the last thing on earth they'd want to go through to have a baby. Yet, I'm actually feeling better about this cycle than I have the last two FET's. Why?

For one, doing something different this round has given me a new sense of hope for a positive outcome. I don't care if it requires taking more meds or involves more needles. It's different, and different is good! I do realize how tricky having this pesky thing called hope can be of course, because it's what makes defeat all the more painful if it ultimately follows. Still, I'm choosing to be brave enough to let down my guard and allow hope into my heart.

Secondly, looking back on all we've been through the past 2.5 years and looking ahead to everything happening this cycle, I TRULY have the peace of mind that we have done and are doing ALL that we can to make this dream come true. I've tried my best to maintain a healthy balance of micromanaging every aspect of our treatment, while also trusting in the doctors and God's plan. Is that even possible? Ha!

However, the fact that we've followed all the "rules" that we've been given by our RE, our nutritionist, and my acupuncturist since Day 1 of us actively TTC'ing can at least give us peace of mind that if this doesn't work, it's nothing that we did wrong. At the end of the day, it's either going to work or it's not. Even if it doesn't work, at least I won't have any regrets that "I shouldn't have eaten that" or  "I shouldn't have run that marathon."

My acu reminded me that even though we still have meds to do this cycle and appointments to go to and the actual process of the FET, really our work is done. It took some string pulling to finally get the low dose steroid and the Lovenox added to our protocol, and the fact that we are pulling out the big guns for my lining development is reassuring. The only thing we haven't added is intralipid infusions (as recommended by Dr. Sher to lower borderline high NK cells). I'm not completely sold on my need for this controversial immune treatment, and thus we've made the decision to stick with our current RE and just counteract possible immune activity with a low dose steroid.

As many of you would probably agree, just having a feasable plan in place that you feel comfortable with and that your body will HOPEFULLY respond to is sometimes one of the biggest hurdles once you're knee deep into IVF. There are never any guarantees, but I feel really good about our plan. I feel like the hardest part of this cycle is already over.

My acu also reminded me that our only job now is to "Open the door" focus our energy on inviting our future child into our lives and open the door for it to happen. She talked about how sometimes when we work so hard at dotting i's and crossing t's, that we can sometimes forget that we also need to "just be" and allow the powers that be to intervene. She reminded me that sometimes the things that take the very LEAST amount of energy can also be the MOST powerful. Focus on making a good plan yes, but don't forget about the easy and powerful aspect of opening your arms up to receive what is sitting right in front of you...doing something as simple as turning the doorknob and allowing what you want to come in without any interference.

"So I say to you, ask, and it will be given to you; seek, and you will find; knock, and it will be opened to you.- Jesus Christ (Luke 11:9)

"In oneself lies the whole world, and if you know how to look and learn, then the door is there and the key is in your hand. Nobody on earth can give you either that key or the door to open, except yourself. - J. Krishnamurti

"Don't spend time beating on a wall, hoping to transform it into a door." - Coco Chanel

Spending quiet time meditating, praying, or just listening to music is something I do most days of the week, but I still feel like I've been slacking in the spiritual department. Even though I feel I've grown closer to God throughout this journey overall, I know I've lost some degree of my connection to my own inner strength.

The fact is, that before all this TTC'ing, I spent more time actively visualizing what I wanted in life. I am a big believer in dream boards and meditation, and the law of attraction. And yes, I do think you can be a Christian and also believe in the law of attraction. I think people who aren't open to the idea of the attracting what you want in life really just don't know what it's about. Some might make a blanket statement of "Oh, that is new age garbage" or "hocus pocus" or something along those lines. Honestly, I don't see a vast separation between believing in God for what you want, and also believing that what you think about and speak over your own life also has power. To me, both of these outlooks are tightly woven and mesh perfectly together. "What you think about and thank about, you bring about."-  I believe that! Check out 100 quotes from "The Secret".

No better time to open up the future nursery door and start spending some more time in I used to when we first started trying for a baby. I dug out my vision board that I made 2+ years ago...

And the onesies and bibs that I bought around the same time...

I couldn't help but think of our two little blastocysts that will be transferred in only a couple weeks time.  I also cracked open the journal I'd been keeping where I would write to our future child. I started this journal on 1/26/2012 but hadn't written in it since 9/10/'s been a while. I felt compelled to make a new entry.

I want our future babies to know they are wanted and that we are here, ready and waiting with open arms. I even whipped out a contract I'd written to God a while back....

This was a suggestion taken from a sermon by Joel Osteen, where he talked about his sister's infertility and how she wrote out a contract with God, reminding Him of His promises and asking for them with expectancy. It's not wrong to ask boldly for what we what and also EXPECT it according to His own promises in scripture.

Sure, I could just think about all this stuff in my head, but having something to see, feel and touch makes it easier to arrive in a centered quiet place each day and OPEN THE DOOR to what we want in our lives. I'm choosing to look at this cycle as "us time." There will be no worry, or second guessing, or "work" to be done. All we need to do is follow the plan that's already been set each day and adjust accordingly as things unfold. Our only job now is to open the door and allow whatever is meant to be to enter.

Tuesday, November 19, 2013

Booty's Not Going to Like This

Today's RE appointment was 1 part baseline ultrasound & 2 parts complaint fest. I kinda hated to start off this cycle on a negative note, since I'm resolved to keep things all butterflies and unicorns up in my psyche for our last chance FET. However, I honestly felt I needed to bring up the whole "Neg. Sorry" nurse communication thing to my RE.

I am not a timid person, but my RE is just so darn likeable and even keeled that I hate to complain to him personally. Yet, he's the one who owns the place and has the power to change things, so he did get a small earful today. Of course, he was extremely thankful I brought it up along with a couple other things that have bugged us about their level of service as of late. He just kept thanking us, taking the blame, saying they need to do better and how it was unacceptable and they WILL do better.

Seriously, this last FET better work, because that is how badly I want it to work out with Dr. Vaughn as our RE. I want to be able to thank him for his help, to show him baby pics someday, and for us to have the satisfaction that we've been in the best hands possible...which is what I felt in my heart at our first consultation with him. I've got to admit though, that lately as much as I love this man as our doctor, we are losing a tiny sliver of faith in the relationship each time we have a failed IVF transfer. 3 of those can really start to wear on you emotionally, financially, physically, and spiritually.

Nevertheless, here we are onto FET #3 (IVF Transfer #4).
The moment is NOW, so that is the moment I'm focusing on...not on what we'll do if this doesn't work. I feel like we've got nothing to lose at this point by putting every single little ounce of faith and mojo and positive thinking into the fact that THIS IS GOING TO WORK!

We are doing things a little differently this time around too...

1) 0.3 mL Delestrogen (IM shots)- to increase lining thickness, instead of oral/vaginal Estrace

2) 1 mg dexamethasone- low dose steroid to calm any inflammation, perhaps lower uterine NK cells (which I tested slightly high for), increase receptivity of the uterus (in theory)

3) 1 mL PEO/Progesterone in Ethyl Oleate- (IM shots)- to maintain lining, instead of Crinone suppositories

4) 40 mg Lovenox (SubQ shots)- to reduce viscosity of blood/increase blood flow, counteracts blood clotting factors (which I test + for). Have used this in the past, but not for full cycles with all IVF transfers.

This is not going to be fun, with 3 shots (2 of those being IM and 1 that feels like liquid fire ants) scheduled on the same day sometimes. However, it would make absolutely no sense to just keep using approaches that haven't worked at this point. I don't want to keep doing the same thing and expecting a different result. We have changed it up a little with each previous IVF transfer, but only in dosaging and not really with type of meds as much.

We're going the more painful intramuscular route this time around with hopes that maybe, just maybe, my body might react differently if I am plunging a big ass needle full of the goods straight into my ass cheek with no chance for escape! What did we sign up for though??? Look at this thing!

ALL the way in? Are you sure?

It is even scarier in person, I assure you. And yes, that is the injection needle, not the drawing needle. T minus 1 hour until hubby plunges our first dose of Delestrogen into my gluteus maximus. I am gaining all possible strength from my fellow friends in the infertility community for sure. I know plenty of women who have given themselves these shots IN THEIR OWN ASSES! If they can do it, so can I!

I've posted our FET #3 Calendar with our meds schedule, anticipated transfer date, and test date at the top of the page next to the rest of them. Please keep us in your thoughts as we embark on our final chance at IVF. We need all the good vibes, baby dust, and spare prayers for a miracle that you can muster!

Sunday, November 17, 2013

Neg. Sorry

I found out yesterday (via text of all ways) that this cycle didn't work. I did the blood test a day early (13dpIUI), because I began spotting on Friday (12dpIUI) and had a feeling that the only thing holding off another cycle was the Prometrium I was taking nightly.

A few hours after I gave blood, I texted the on-call nurse to give her a head's up to look for my results and asked her to CALL ME once she received them. You know what she freaking did....she texted me back within 2 seconds saying "Neg. Sorry" That is how you freaking tell someone that they aren't pregnant?!

Completely unacceptable if you ask me. Can you at least spell out the whole word NEGATIVE and maybe add "I'm so very sorry" or something?! It's actually possible to convey a heartfelt tone via text, but clearly she is not well versed in this. Just "Neg. Sorry"?! A whole 1.5 words? Really???

I understand that I texted her in the first place, but I chose to do that instead of paging her to provide my full name in writing BEFORE her call back to me; Just thought it might be helpful when she was looking for my results to call me back with. Furthermore, I specifically asked her to CALL ME with the results, because I also had questions regarding using a new medication for our FET (Delestrogen shots) and the immediacy of ordering this since estrogen for FET's starts on CD2, and clearly my period was trying to make an appearance already.

Of course, I called her immediately with my questions and let her know that "I figured I would call rather than play text tag and receive two word responses, especially since this is a somewhat sensitive subject." Is it just me? Am I over reacting? Her "Neg. Sorry" just put a reeeally bad taste in our mouths. Even my husband was annoyed. She apologized for the lack of tact and brevity of her text, but come on. Use your head and think before you text a woman who's spent $25K on fertility treatments this year and still no baby!

Just because I have a medical file 4 inches thick and have been around the block with treatments, it doesn't mean I don't deserve a little compassion when delivering the blow of another negative result. I normally have nothing but good things to say about my fertility clinic, but every once in a while a nurse does something really f'ing stupid, and this warrants a complaint to my RE (who also happens to own the clinic) as far as I'm concerned. He is not going to be happy about it either I have a feeling. This man calls every patient personally after IVF cycle results and will spend a full hour on the phone with you discussing next steps. I'm pretty sure he expects a little more than a "Neg. Sorry" text from his on-call nurse. Ok, I'm done venting now, but it still is kind of shocking to me. Wow, just wow.

Not to worry though, I am ok. There were zero tears. I was probably too pissed off at the nurse to shed a tear, but hey whatever works to get you through the tough times right. We went out to dinner and split a big fat order of chicken fajitas on fluffy white gluten filled soft tortillas. Man, I'd forgotten how good things with flour taste! Ha! I'd also forgotten how yummy the occasional serving of ice cold dairy tastes in the form of Breyer's vanilla bean on top of freshly baked chocolate chip cookies...until today that is!

The past 24 hours have been a fun little hoorah complete with food porn. These cookies are awesome by the way, if you are a fellow GF eater. I'm not going to say they are "healthy" but they have none of the typical unhealthy ingredients like HFCS, hydrogenated oils, etc. and are a better option as far as pre-made cookie dough goes.

Christmas decor is also up, and we are happily enjoying a little holiday cheer...

I actually put this up last week after a sub job which really tested my resolve. I got to listen to a 17 year old brag about her pregnancy and show off sonogram pics for literally ALL of the 1.5 hours I had her in class. Well, outside of the time she spent eating some nitrate filled cold cut Lunchables, a box of Hot Tamale candies, and a rice krispie treat, washing it all down with a Starbucks mocha latte. Nope, I'm not bitter....not bitter at all!

I am working on being non-judgemental towards people who treat their bodies like complete garbage and seem to get knocked up without even trying. It's just really hard when you treat your body like a damn temple 99% of the time in hopes that it could somehow help prepare your body for pregnancy. I certainly wouldn't want to trade places with this very young mother-to-be, but I will never ever be carefree about pregnancy with all we've been through, and that is just a hard pill to swallow. I also couldn't help but think how teenage pregnancy was NOT something to be proud of when I was in school. Oh how times have clearly changed. I think we have MTV's Teen Mom to thank for that.

I took the next day off of work and decorated all day long to force some holiday cheer into our lives. Somehow things are just a little bit better when you come home to Christmas lights. I'm actually enjoying subbing overall and am scheduled for another high school job tomorrow. However, this is an AP class of 10th graders, so I'm fairly certain it will be a pregnancy free day...let's at least hope so.

I assume a new cycle will start tomorrow, which means baseline ultrasound will most likely be Tuesday/Wednesday. I am requesting the use of Delestrogen shots this time around for my lovely yet stubborn lining. I may even request PIO shots in place of Crinone for the progesterone support portion of this FET. I know Crinone is supposed to be equally as effective, but I don't want to keep trying the same things and expect a different result. Obviously, the Estradiol/Crinone combo hasn't worked thus far, and this will be our 4th IVF transfer. Besides, that is how tired I am of putting random meds in my vag. You know you are officially OVER IT when you are actually willing to choose imtramuscular injections via a huge ass needle over putting one more dose of anything inside your lady parts.

So, there you have it folks. We're cleaning out the freezer on this one. Last two embryos and one more shot at this IVF thing.

Sunday, November 10, 2013


No matter where I turn lately, I see these....reminders of how good we actually have it.
A couple weeks ago, a friend was over and asked innocently, "So whatcha guys doing for the holidays?" You know what my response was? "FUCK the holidays." Yep, it flew right out of my mouth just like that. Wow Emily...Tell us how you really feel!

In my defense, we had just left an outdoor restaurant and as we waited for the check, I sat watching a beautiful family of 3 generations of women having a great evening together...the cutest blonde little sisters playing on an outdoor playground, the mother taking pics of every little move they made, and the grandma with the biggest smile I have ever seen in my life.

I tried my best to see this as the beautiful spectacle is actually was, but inside I was pissed....not only that we don't have our own children, but also that I don't have a mother and my children will never know their grandmother.  What was a perfect dinner at our favorite restaurant, turned into a stream of tears as we paid our check. I pouted all the way to our car and then home to our empty house with non-existent family. I proceeded to drink a ridiculous amount of white wine, because why not? I'm not pregnant! This was a fact reaffirmed loud and clear throughout the evening by my horrendous menstrual cramps as well. I was having a serious case of "The grass is greener."

The real truth? The grass isn't always greener. I am being reminded lately that even when we see what might seem like the "perfect life"  we have no idea what obstacles people may be facing. Everyone gets dealt their own set of circumstances, and I have always kind of felt like infertility is just "our thing" that we've been given to deal with. Outside of infertility, we shouldn't complain. I have the MOST amazing husband in the world. He has a good job with a great deal of autonomy. I have a job where I can choose my own schedule, drive less than a mile to work, and have zero responsibility outside of work hours. We have a beautiful home, can afford healthy food, have access to medical care, and we actually wake up with smiles on our faces most days. In the whole scheme of things, we have it pretty good.

Recently, during my shift at the LIVESTRONG Foundation (where I've been volunteering for almost 5 years) I began a little project that impacted me deeply. If you aren't familiar with LIVESTRONG, feel free to watch this short and very inspiring manifesto...

I have seen that video 20 times, and it still gets me every time. Oh, and just for the record, I personally don't give a shit about Lance Armstrong's personal life or anything he's done outside of creating this amazing organization. 

But anyhoo, back to the project. Every year we hold the LIVESTRONG Challenge, which is a race that brings those affected by cancer together and raises $ for cancer programs. We have blank race bib cards that read "In Memory Of", "In Honor Of", and "I'm A Survivor." Anyone can fill these out and safety pin them to their shirts during the race.

This year, we asked people to donate their race bib cards back to us, and I was given the task of reading through ALL of them, in order to make a giant wall mosaic in our headquarter office....

Holy sobfest. Seeing people write messages to their parents is sad of course, and I know that pain all too well myself. However, the ones written to spouses and children are what really hit me where it hurts. "To husband, my soul mate, my inspiration" Talk about a knife to the heart! I had to excuse myself and literally take a "time out" in the bathroom.  I wanted to drive home going 100 mph and just hug my husband to death.

Being exposed to this sort of heartbreak regularly is a continual reminder of how good we actually have it. To be clear, I'm not saying that infertility is any less painful emotionally than cancer. Infertility is a disease in it's own right; Full of disappointments, scary test results and procedures, medical bills, intense pain and suffering, and it can last for years on end, crushing whatever dreams you thought you had for the future. In fact, I've talked to people who've had both cancer AND infertility, and some of them say that infertility was actually harder to deal with. Does that surprise you? Honestly, it doesn't surprise me one bit.

However, how would I feel if I or my husband were handed a life threatening set of circumstances tomorrow? I've known a couple fellow bloggers who have experienced this in the midst of their struggle to conceive. Bethany at An Anchor to My Soul received news that her hubby had testicular cancer right in the middle of trying for a baby, and needless to say procreating became a little less important in the immediate future once that happened.

Just today, I was reading Jennifer's blog "You Must Believe There Are Miracles" and the story of her sister and brother-in-law. Her sister recently gave birth at 20 weeks after complications, to a premature baby who didn't survive, and her brother-in-law had to come to her hospital from a different hospital, because he was undergoing chemo and radiation for his own brain cancer at the time it all happened. I cannot even FATHOM how truly difficult this must be for them. Please stop by and give Jennifer words of love and support if you can.

One thing is for certain; When someone is dealt a second blow like cancer or unexpected tragedy, suddenly infertility doesn't seem like the end of the world anymore. All one cares about is the safety of their spouse or family member over all else.

There is a new show on Showtime called "Time of Death" that explores chronic and end stage disease...

The documentary series follows a group of 8 different people through the process of terminal illness. Please remember these people are all in very late stages of illness, so if you know someone with cancer, they certainly aren't doomed, and this is not meant to freak you out. Do not watch it if terminal illness makes you uneasy.

Maybe I'm weird, but I find this stuff therapeutic. Could be that my mom, dad, step-dad and grandmother all had cancer. It's somehow comforting to know the process of dying and grieving is very similar for most people who experience this sort of thing. Or maybe even more than that, it just gives me a healthy serving of humble pie and adjusts my world view with a clearer sense of perspective.

If you have any interest in checking it out and don't have Showtime, they were nice enough to upload the first episode on YouTube...

Every time I see something like this, in real life or on tv, it makes me even more thankful for the life I have now, even if it's not perfect according to my own plan. I wake up thanking God for all we do have a little more loudly. It's when we get comfortable and just EXPECT all of the good things we already have that our attitude begins to take a turn for the worse. Well I, for one, don't need God or the universe or fate to ask me, "You thought it was hard then? How about now?"

I don't want to be that person that only gains a better perspective once I'm handed an even harder trial to deal with. 
I don't want to look back on the last 2.5 years as wasted time, living my life on complete hold, and asking myself what good I did in the world....or more importantly how many happy memories I created with my husband. I don't want November to be remembered as the month we lost two pregnancies in a row. We will be celebrating 8 wonderful years of marriage this month, and I am not going to let infertility steal that milestone from us!

In the end, if it's not in the cards to have a biological child of our own, that very hard realization will never be crushing enough to change the fact that we share a truly rare kind of love that many people do not EVER get to experience in life. That being said, I'm reeeallly going to try my best from now on to be less focused on what we don't have YET and more focused on what we do have. It can all be taken away in the blink of an eye.

So ask me again what I'm doing for the holidays? I'm going to put up my Christmas tree and enjoy it damnit! I am going to enjoy every single second being married and healthy and blessed with a life that is already fulfilling beyond words.

Wednesday, November 6, 2013

Reproductive Immunology Follow-Up: Eh, Not Sold

I wanted to give a follow-up to my previous blog about RI (reproductive immunology). After speaking to a doctor who practices it, some preliminary testing and extensive consideration, we've reached a verdict on whether or not it's worth pursuing in our situation. However, let me be clear that I'm only speaking to OUR personal situation and no one else's. I know there are some other ladies curious about this stuff as well. I'll share my results here so you can see what they look like.
Re-Cap: We are currently in a Femara/IUI cycle. Before this, after our 3rd IVF transfer and subsequent chemical pregnancy (our 3rd pregnancy loss) we asked our RE, Dr. Vaughn, about need for further testing and/or second opinions. He gave us his blessing to do so.

We spoke with Dr. Sher (Sher Institute for Reproductive Medicine) who felt it was worth looking into possibilities related to implantation dysfunction. He ran a couple tests through Reprosource Labs in Boston, MA.


Expanded APA Panel-
Nothing new here really. We already knew I had +APA’s (Anti-Phospholipid Antibodies). This just uncovered some additional ones I wasn’t tested for previously with my hematologist...just further confirmation of a blood clotting disorder.

Expanded APA Panel

NK Cell Activation Assay- Test showed NK (Natural Killer) cells were normal in their native state (as they are for most people) but when stimulated with Interleukin 2 (IL-2) they became abnormally elevated. (See IL-2 stim values of 11 on p.1 & 11.7 on p.2.) 

NK Cell Assay: Page 1 of 2

NK Cell Assay: Page 2 of 2

Dr. Sher’s perspective:
Suggests using Lovenox 40 mg for entire cycle of conception, in addition to entire pregnancy. I’m already doing this anyway. I started Lovenox on CD6 this cycle. I take baby aspirin in the AM and Lovenox in PM.

-Says NK results show heightened NK cell activation with introduction of IL-2. This mimics the same reaction that will occur in my body when an embryo presents in the uterus....My overactive immune system will see any embryo as a “foreign invader” and will then attack it. This can result in infertility (by not allowing successful implantation) or early pregnancy loss (by attacking embryos once implanted).

-Says my suspected ectopic could have even occurred due to heightened NK cells in the uterus, because NK cells do not live in the fallopian tubes...Embryos may seek refuge in the tube in some cases.

-Suggests using low dose steroid such as dexamethasone or prednisone for entire cycle of conception (actually from 2 weeks before cycle begins) to lower immune response. He keeps patients on this until 10 weeks into pregnancy, weaning them off around week 8.

-Suggests doing two intralipid infusions to lower immune response; Once before conception cycle & once upon + pregnancy test. (IVIg is not being used much anymore. Intralipid is just as effective, much cheaper, safer).

-Suggests a combination of Lovenox + low dose steroid + intralipid MUST be used if I am ever to have a successful pregnancy carried to term.

My perspective:
- We have no interest in leaving our current RE at the moment. We just don’t want to spin our wheels with more losses and failures if something other than “bad embryos” or a random “tubal malfunction” is causing our issues.

-I made up my mind ahead of time that if these results came back as merely "borderline high" that I would not take too much stock in them. Conversely, if results came back with multiple values off-the- charts high, we might be more compelled to pursue further testing or a more intensive immunology based protocol for our last FET (if needed after this IUI). However, out of all NK values tested, only two (@ 11 & 11.7) came back just over the cut-off considered high (>10).

- Due to the above, I am NOT sold on the need for a protocol based heavily on experimental immunological treatments. There isn't enough evidence here to warrant my own personal need for intralipid infusions or other controversial immunological treatments such as IVIg and LIT.

-I will admit, there seem to be a few signs pointing to something autoimmune in nature amiss in my body. My hematologist told me previously “Clearly you have autoimmune activity in your body, even if it’s not full blow lupus yet.”

-Because of this, I’ve always wondered if it wouldn’t hurt to at least add a low dose steroid to our protocol. There is some medical literature showing effectiveness of steroids to lower NK cells, as well as to reduce pregnancy loss rates. My RE and I have tossed the idea of adding a low dose steroid around for a while without actually moving on it. At minimum, this is a low risk option I feel comfortable trying.

My RE's perspective (via my nurse):
-Dr. Vaughn has reviewed your questions. He is good with you taking the Lovenox and baby Aspirin.

-Dr. Vaughn and the other doctors at TFC do not do NK cell testing due to the fact the testing is not very conclusive and not enough studies to show NK cells play a role in infertility. Dr. Vaughn is not convinced this is an issue.

-Dr. Vaughn said you were on Dexamethasone for your IVF retrieval in the past and is OK with you adding a low dose steroid to your regime. He wants you to take Dexamethasone 0.5 mg 2 pills each evening.

So, there you have it. We will not be putting all of our eggs in the RI basket so to speak. We'll add a low dose steroid, but that's it. I will continue eating an anti-inflammatory diet as usual, as well as continuing to eat gluten-free & dairy-free to assist in dampening any autoimmune type of activity internally.

Am I glad I had this testing done? Yes, because there is no longer a giant ? looming over my head. Do I think some borderline high NK cells have been THE THING that have kept us from having a successful pregnancy? Not necessarily. I have to agree with my own RE on this one....not convinced. While there is some research showing a correlation between NK cells and infertility/pregnancy loss, it's just amount of correlation and not causation. If a low dose steroid could potentially squash some risks associated with an overactive immune system or pregnancy loss I'll do it, but I'm not going further than that. I have read up on this as much as humanly possible, and there isn't enough evidence in my humble opinion...and actually the opinion of most RE's out there.

Additionally, I'd like to be frank on my own limited experience. Dr. Sher himself was fairly easy to discredit in my opinion. On one hand, Dr. Sher admits that at least 70%+ of early pregnancy losses are likely due to chromosomal abnormalities. This is something that typically increases with egg RE or RI refutes this. However, he then made the blanket statement... "It's clear that NK cells are THE REASON for your issues" and stated, "You will never be able to become pregnant and carry to term without intralipid, steroids, and Lovenox ALL combined." (insert eye roll here) That is just very far reaching to me, and I don't buy it. I don't think I'm in denial either. There's simply not enough proof to make that sort of claim to me or anyone else for that matter.

Do I think that some women have benefited from immunology protocols and have achieved motherhood this way? Sure. However, I am inclined to believe the number of women out there with TRUE immunological issues affecting their ability to reproduce is fairly small and that there are quite a few women pursuing RI who don't really need it. I have suspicion there are doctors capitalizing on this as a business, and that some of these doctors may care more about a dollar than the Hippocratic Oath.

Could it be that many women with infertility are in search of an "answer" and when they don't get one they turn to the only thing left they haven't tried (like RI)? In some cases, it's possible. After all, it was my own quest to find more answers which led me to Dr. Sher. Unfortunately, infertility is much like a dart game. When one thing doesn't work, we try another. It's one big ole crapshoot basically.

It's worth noting the firsthand accounts I've read through blogs; Women who have had pregnancy losses, IVF failures, years of infertility, and have pursued RI as their last resort in having their own biological child. Some of these women were told the same thing, "You will never have a baby without immunological treatment." How then, have some of them gone on to have their own biological children AFTER immunological treatments have failed?

Other women have pursued donor eggs AFTER immunological treatments have failed, and have gone on to have successful pregnancies without immunological treatment. To me, this is further evidence that it was more likely a case of poor egg quality/embryos for these women.

Vice versa, there are cases where donor eggs have failed, yet the same couples went on to have their own biological child with the addition of immunological treatments. I don't doubt this is true. However, even in cases where some claim "xyz immunological treatment finally got me my baby!" you may read further into it and see that they also did IVF or an injectables cycles with IUI...Well, if there are 6 eggs waiting to be fertilized & upping your chances so exponentially, how can you possibly say with 100% certainty it WAS the immunological treatment and not that you just finally found a good egg or embryo?

Even in cases where successful pregnancy is achieved through timed intercourse in conjunction with RI, in all fairness, there is no way to prove with certainty what caused the success on either end of the spectrum.  Maybe it was the treatment. Maybe it was God. Maybe it was finally the perfect match of a healthy sperm and healthy egg.

Another red flag for me is that Dr. Sher, along with the handful of other RI's practicing in the U.S., do not publish their success rates via SART. When I asked Dr. Sher about this, he became defensive, citing multiple reasons why he's "taking a stand against non-uniform reporting standards." He gets very heated easily, and it's almost comical. I pressed him saying, "I totally respect your decision. Is there somewhere on your website that I can find your own method of success rate reporting, in whatever fashion you've chosen to do so?" His time then became very short, and he directed me to the discussion board of his blog. He is literally updating his success rates via random threads on his discussion board, boasting 70-80% pregnancy rates, with the caveat that 15-20% of these will be lost due to miscarriage most likely.

Is this a joke? He can't even make a well-organized chart or something? He obviously does not track live birth rates (one of the most important criteria to consider when looking at clinics) or he just doesn't want to disclose them. If he supposedly specializes in treating women with IVF failure and higher rate of miscarriage, wouldn't he want to publish live birth rates? Nor does he distinguish between age in his "reporting." Huh? How can you not include that info?

Consider this... If his practice is so outstanding and he is soooo passionate about the need for immunological treatments, why not report these fabulous success rates the same way all other clinics nationwide do (way more exposure and credibility) and find alternative ways to be an outspoken advocate of more stringent oversight of SART reporting. I mean, surely if other RE's saw that his immunological protocols were producing 80% pregnancy rates, they would finally LISTEN to what he's recommending as a "pioneer" in his field, right? Believe me, Dr. Sher seems egotistical enough that recognition at this level would surely be beneficial for him. I just see the whole "I'm taking a stand" thing as a cop-out.

Outside of this, Dr. Sher is not a good listener. He's a bit pushy and salesman like. I had only a few well thought out questions to ask him, but it was hard to get a word in edgewise. It's like he was talking from a script (perhaps the same one he uses for everyone) and basically bulldozed the entire conversation. Every time I asked him politely to justify a remark, he became audibly agitated and was quick to refer me to his ever expansive blog full of his own personal articles, none of which are taken from peer reviewed research journals by the way. It seems his modus operandi is to bombard you with information so that you will think it's all legit.

To his credit, I think it's generous he consulted with me twice and ordered tests for me without charging me a dime for his services. However, ultimately I think it's just a way for him to grow his business. Let's just say, I don't get a "mother Theresa" vibe from him. In fact, both times I've talked with him, I've had an invisible angel firmly planted on my shoulder saying, "RUN the other way!" That is the only way I can describe my first impression and intuitive feelings toward him.

Still, I will say that Dr. Sher must care about his line of work to do it as long as he has. He has 30+ years of experience and has clearly been around a while. I found his book very informative as an IVF newbie not knowing what to expect when we began IVF. I do think though, that his focus as a doctor has perhaps changed over the years. Before RI was ever on the map, Dr. Sher was practicing what we'd consider a more traditional approach to RE. Now, he's focused on working mostly with a specific population of women. I just can't help but wonder if he's reaching a little too far with his recommendations to some women.

So, sorry this is long, but I wanted to give a detailed run down of what my personal thoughts were with my minimal exposure to RI. I realize I did not have all of the possible RI tests run, and that there are many more things like DQ Alpha matching, etc. that exist out there. I am also not in the same boat as a woman with 10+ pregnancy losses or failed IVF's and who might have more reason to accept immunology as THE THING keeping them from motherhood.

By no means do I think women pursuing RI are doing the wrong thing either. I admire any woman who will go to great lengths to create the family that she so desperately desires. Each of us has to weigh our own quest for answers, our own history/risk factors, and our own timeline to achieving motherhood with the recommendations given by any doctor
. For now, I feel we are on the right path for us, and that's where we intend to stay as we continue working towards and believing for a family.

Monday, November 4, 2013

IUI #3 is done! All we need is one!

IUI #3 with Femara (Round #5) is officially in the books. Part of the reason we turned this "break from IVF" cycle into an IUI cycle is that it worked for us once before. Exactly one year ago, we became pregnant with Femara + IUI + Prometrium. Also kind of strange....we've actually become pregnant the last two Novembers in a row (2011 & 2012), even though neither pregnancy lasted. Please Lord, let November 2013 be the charm, and if it does happen let it be for keeps!

Initially, I thought maybe if we just copied our exact same BD & IUI schedule as last time, we'd have a good shot. Hold your laughter please. I know there is no rhyme or reason to how things unfold in any given cycle, but the thought did cross my mind to try to mimic our last successful cycle. I gave up pretty early on though, due to the fact that I don't have a working crystal ball and couldn't realistically pinpoint ovulation in advance. 

There are two main issues when trying to plan specific BD dates around an IUI.  A) You typically can't predict exactly if/when you'll get a +OPK. There is no way to know when the IUI will be until less than 24-36 hours before it takes place...unless you have an extremely predictable and reliable response to all medications, in which case, I hate you. Just kidding! B) You aren't supposed to have sex too close to the time of the IUI either, so as to encourage a minimal sperm count at time of IUI. There are a few moving pieces here.

At one point, I thought my body was going to totally rebel and not ovulate at all, washing the entire cycle. The day after my last ultrasound (CD13), the test line on my OPK disappeared completely, which made me want to pull my hair out... It was supposed to be getting darker, not going away! Sometimes OPK's can give a pretty good indication of when ovulation is coming (because the test line grows progressively darker as LH rises), but sometimes the second line just does crazy things, like disappearing, reappearing, etc. LH is just wonky sometimes. I test twice per day and use two different brands (regular & digital) just to cover all bases, but clearly my LH levels were running amok. I STILL hadn't gotten a +OPK by Friday at 5 pm (CD16) so we went in for a second ultrasound.

Thankfully, the ultrasound revealed I was still on track to ovulate soon...

Left ovary: 23 mm (up from 16.5 mm)
                   13 mm (down from 16.5 mm)

Right ovary: 18 mm (barely up from 15 mm)

Lining: 8.4 mm (up from 7.4 mm)

I was slightly bummed that the second follicle on the left had actually shrunk down; Looks like the smaller one was being overtaken by it's counterpart, which seemed to take off. The right follicle was growing sloooow as molasses, but at least it hadn't shrunk and was still somewhat in contention.

Since we had at least one follicle @ 22mm+ and lining was good to go, we got the green light to do an Ovidrel trigger shot...which we purchased at a local pharmacy literally an hour before they closed on Friday night. Remember, hubby had a flight out on Sunday, so we had to do the trigger that night in order to make this IUI happen!

I went to bed without any dinner, because I literally jumped from subbing all day, then to the RE, the pharmacy, home to BD, and finally triggered at 9 pm. No rest for the weary and not even time to eat. Making a baby is work people! I can't help but think of the well-intentioned advice from others who've never experienced fertility treatments, "Just have a lot of sex." OR "Just use an online calculator to input the date of your last period and have sex the days it tells you."  hahaha! So funny. :) Yeah, it turns out it's a little more work for some people.

Looks nothing like our last (successful) Femara/IUI cycle, but here is so far...

The other thing different this cycle is the daily Lovenox shots (blood thinners) beginning on CD6... a little something extra for increased blood flow (since I have +APA's/blood clotting factors). I take baby aspirin in the AM and Lovenox in the PM. I'm happy to report that Lovenox has become easier over time. I still detest this dreaded shot, but the bruising has lessened, and I've found a couple trusty spots that are less painful. If there's any chance it could help and zero chance it can hurt, I'm willing to just suck it up and do it. I will begin taking Prometrium (progesterone) at bedtime on Wednesday (3 dpo) for luteal phase support as well.

We weren't able to BD the night of the IUI (as is normally recommended), because hubby flew out to Amsterdam right afterwards. However, he contributed a whopping 57 million "moving" swimmers day of IUI, along with many million additional in the days leading up to it, so every possible base within our power has been covered. All we need is ONE clean cut and well dressed little guy to show up with flowers and a nice bottle of wine for one super lucky egg.