6w5d and 7w3d Ultrasounds

I have actual photos of our little baby! Maybe he/she looks like a blob now, but I was assured that would change in just a matter days.

At our 6 week 5 day ultrasound lil' pumpkin had a heart beat of 137 and looked big for age (though the RE didn't measure at this scan).  We were able to see and hear the heartbeat on the scan and things looked perfect.

You can see the yolk sac on the bottom below the baby, it looks like a ring and the baby is the above it, closer to the uterine wall with the beginning of the placenta forming, creating an outline.

Here is baby at 7 weeks 3 days, looking quite a bit bigger, he/she measured 2 days ahead at 13.9mm (which is good news according to the perinatologist since that means there is no slowing of growth). The heartbeat was beating great at 155:

Above the word BABY you can see the actual umbilical cord arching above the baby and it is attached to the placenta. The tech thought I had an SCH/tiny bleed at the top of the placenta, but the doctor disagreed. The baby's head is on the left facing down and the feet are on the right facing upward. It looks like you can see tiny hand buds on either side of the body. I asked about the dark spot in the baby's head and was told it was a normal part of development and had a name, but I don't remember the term.

I started feeling really sick at the 6 week mark and that has continued. I feel that it's a good sign and it provides me reassurance, even though it is very difficult to function a lot of the time. I also continue with intralipids, Lovenox, baby aspirin, folate/B12, fish and krill oil, calcium, and prenatals.  I have a long way to go yet and my next scan is during week 9. It's hard to wait that long but if things still look good, I will have passed my previous loss anniversaries. Most of the time I try not to think too much about being pregnant, it helps me cope and makes the time go a little faster while I wait to get out of the danger zone.  Stick baby, please stick.   

1st Ultrasound 5w2d

My RE brought me in for an early ultrasound today at 5weeks 2days along. The pic above isn't mine, but this is what the screen looked like! Heh.  I was nervous but feeling ready for whatever the news would be.  As soon as the tech turned on the ultrasound screen, I could see one nicely sized gestational sac. So...my beta wonkiness and slow down must have been due to losing one of the embies early on. I did feel some sadness about that, and yet also real relief that one of the embies was pulling through.

As she focused in on the sac, we saw the yolk sac too. I asked about a fetal pole but it was too early to see it clearly. The RE assured me later that this was totally expected at this stage. The gestational sac itself was measuring ahead at 5w5d, so that was comforting. He also said the sac was placed ideally in my uterus.

I left feeling very happy because I have a rationale for the slowing beta finally. I also know the pregnancy is progressing with one embryo on target and that it is not an ectopic pregnancy, nor is it a blighted ovum (because there is a yolk sac present).

I go back for another ultrasound when I reach 6w5d, so I have a bit of a wait, but the wait will be a little more bearable now. I am so grateful for the compassion and understanding of my RE today.  

Progression Pics of Wondfo, FRER, and Dollar Tree Tests

I pee on a few sticks most days to check progression even though it is not an exact science by any means.  I have an endless supply of internet cheapies that will otherwise go to waste in my closet, so I've been using them up during this pregnancy, in addition to a few other sticks. It's been kind of fascinating to see the way different tests respond to HCG. For those searching for HPT progression pics, my POAS-aholism is for your viewing pleasure. ;)

The first set are my Dollar Tree tests. The interesting thing with them is that they have continued to get darker just up until about 19DPO (my beta was 1,555 that day) and then they look the same-with the control line just a hair darker than the test line.  This makes me think that they hit a threshold with the dye around a beta of 1,000 and that they won't get darker anymore. They get the prize for progression with changing dye the longest.

UPDATE: 11/12/12:  I continued to take the Dollar Tree tests and the test line finally became darker than the control line on 26 DPO (before that it was looking about the same darkness):

The second set are the cheap wondfo's from Amazon. You can see that by 14-15 DPO the test and control lines were equally dark and that they haven't changed since despite my HCG levels rising from 300 (13DPO) to over 1,000 by 19 DPO. Their threshold is less than Dollar Tree store tests and so while they pick up the earliest BFP's, I would say they stop showing progression with betas in the 500+ range.

The final set are the more expensive tests, the First Response Early Result (FRER).  They seemed to darken up until 16 DPO, which is when the test line became darker than the control line. I like that they have the kind of dye range, but they too seem to have a threshold in the 500  beta range- as if the dye has done all it can do and simply doesn't look any darker after that. 

UPDATE 11/12/12:  I continued taking FRER's every other day and found that by 25 DPO, the test line looked the same darkness but the control line faded and continued to fade on 27DPO. So, these do keep changing, it just took a long time:

Anyway, it's important to note that these tests do not continue to darken indefinitely if you're using them for progression purposes (at least not until much, much later on and even then they hit a threshold!). At this point, my tests can't give me a lot of new information and the one reason to keep testing would only be to catch dramatically falling hcg. Also, please note that some days the lines looked lighter, only to darken up again...that was due to my urine being more dilute or because the dye just seemed less in that particular HPT. One day of lighter tests doesn't mean anything....it's only if they continue to lighten that you need to consider things further. 

Happy stick peeing! 

Betas # 1, 2, and 3

Today I am 5 weeks pregnant.  My betas have been a bit wonky and I'm not sure what to think, but so far they are:

6dp5dt/11DPO: 96
8dp5dt/13DPO: 307 (28 hour double time)
14dp5dt/19DPO: 1,555 (60 hour double time)

The slowing doubling time is of concern, even if it is in the very slow end of "normal," but it could mean a variety of things-- it may be just a random slower beta and means nothing, or one of the embryos implanted but is now arresting, or the hcg is starting to decrease because the pregnancy isn't viable.  I won't know more until I either have another beta drawn or an ultrasound during the 6th week.

I'm staying very busy with family and church and reminding myself that it's not in my hands anyway...what will be, will be.  God alone knows. I feel at peace in general with the situation and we do have 2 more tries if this one fails (not that I'm particularly excited about going through this process again). But it is possible that this, our last effort to have a child together, will not work. If so, I will not have any regrets or wonder what more we could have done.  I will know that I did my best to give my DH the child he longs for and my DD a sibling-something they both want so very much.

I use this blog to express worries that I don't share anywhere else; it's a bit like a journal and has a similar therapeutic effect. Of course, it is pretty one sided, dealing only with the one topic of infertility and the attempt to have a baby, and so all the broader life stuff that happens in a day is missing...like my walk with DD today to pick Autumn leaves to decorate the table with or my time teaching a group of youth about prayer.  

Yet I also know, having been involved in the infertility and recurrent loss community for some time, that it is comforting to know you're not alone and that others struggle and have similar feelings.  I have found that no one understands or "gets it" outside of women who have had the same experiences.  So this blog is for those women, and selfishly, for myself -to have an outlet, since I refuse to burden my loved ones with the ins and outs of this whole process. I know there are plenty of like minded women out there who understand exactly what this is like.

BFP at 4dp5dt!!

I got a faint but very much there BFP on 9DPO/4dp5dt.  I actually had a maybe something there line on 8DPO, but it was way too faint to call it. It has been an intense emotional rollercoaster ever since. In fact, the day of my BFP I felt completely unexcited, just totally pessimistic, bracing myself for anoher loss because I have had almost nothing in the way of symptoms. In fact, this has been completely different from any pregnancy I've ever had in terms of symptoms (or lack thereof).  I don't know if the reason is that my hormones are not being produced by my own body (estrogen and progesterone)  or if it is different simply because it is a donor egg/embryo.  But I have become accustomed to knowing when I am pregnant because I have so many predictable symptoms. I do have a few, but they are very mild and minor...fatigue, tightness in the abdomen, and some round ligament pains. I have had some nausea, but not much.

However, when my test darkened up on the afternoon of 10DPO, I felt hopeful again because the line was so much darker than the day before. But on 11DPO, my morning Wondfo test looked the same, if not lighter than previously and I was down all day, fighting tears. I decided to get my beta done early then, feeling like I couldn't be in limbo any longer. I was shocked when that evening, at 5:30pm, the clinic called to tell me and that my beta hcg was 96! I had to make them repeat it several times because I was in disbelief. Never have my initial betas been that high. 

So, tomorrow I'll have my second beta drawn. This will be very telling...if it doubles, I will draw a deep breath. With so many losses under my belt, it's hard to believe I could get good news, but things have been going well so far. I may not know until Monday what the results are...it's so hard to wait. Eeeeeps.

The Embryo Transfer

We had our embryo transfer last Friday and it was quite an emotional experience, but all went well. For those who are interested in what to expect, I'll lay out the details.

First, 2 things to keep in mind before you arrive for a transfer:

First, it is important to shower and ensure you have nothing scented (including deodorant)  on you. So forget styling products for your hair or scented lotion, etc. I did purchase unscented deodorant because I was worried about going without it on the big day.  But it's important for the embryos not to be exposed to any kind of harsh foreign particles that can be in the air from scented items.  The same goes for anyone who goes with you to the transfer. I personally was alone at the transfer to save money on airfare.

Second, bring a bottle of water with you and drink plenty. They want your bladder to be very full because the transfer will be guided by abdominal ultrasound and a full bladder effectively presses down on the uterus, making it more visible on an ultrasound, which means they can see what they're doing much better.

Here's how my transfer played out...

I arrived at 9am and did not have to wait more than a minute. The nurse, who was serendipitously named Mary, helped me into the transfer room to check my bladder on the ultrasound and make sure that it was full or filling enough.

She then went through the actual procedure of the day and covered the post-transfer do's and don'ts which included:

-no sexual intercourse until after the second beta
-no caffeine
-no simple sugars, avoid simple carbs as well
-no exercise or stress or anything that will raise the heart rate
-no smoking and avoid all second hand smoke (run from it in fact)

I signed off on the information given to me. She left the room and I texted DH, only to see that he had texted me saying, "I'm right there with you, Baby Love...dreaming of our future together. I love you sooooooo much! xoxoxox. " It seriously melted my heart. I texted him that I was about to see the pics of our embies!He texted back, "Exciting! I'm right there holding your hand."  I responded, "I love you so much honey, I can feel you here!" He wrote, "Holding your hand and running my fingers through your wondrous hair, kissing the back of your neck."  It really helped me feel relaxed and happy, like he was right there with me in those moments.

Next the embryologist came in. This was a great time because she had photos of our beautiful embryos.

Seeing these little embryos made tears come to my eyes and I was filled with emotion, knowing that one or both of these could be our future child(ren). She explained that they are 5 day "Expanded Blastocysts" and were rated as Grade 2, which is very good quality, though not perfect, which very few embryos make (Grade 1).  She also re-confirmed our profile and the numbers assigned to us, which I had to sign off on, stating that these 2 embryos were in fact ours and from the profile we picked.

I was undecided about whether to transfer 1 or 2 embryos when I walked into the office, but I have to say, seeing both of them on the photos really had me hooked...my heart practically leapt out of my chest. I had been praying daily for the donor, for the eggs, and then as soon as I knew the eggs had been retrieved and fertilized, I began praying for God's presence, love, and light to be with all the embryos.  I sent DH the pic and told him that they recommend transferring both. He wrote, "You are wondrous beyond words. The most beautiful person I will ever know." And then, "They're beautiful Honey!"  We texted back and forth and decided on going with the embryologist's recommendation of transferring both.

After the embryologist left, the nurse came back in to reconfirm that my bladder was ready and then called in the RE. The doctor came in and I had a chance to ask him about his recommendation for transfer as well. He too recommended transferring both, and said he did not feel that a twin pregnancy was a big risk, that it was safe, and that our chances of twins was only 10-15% and that pregnancy was 65-70% when transferring both. At one point he said reassuringly, "You will get pregnant." I texted DH  the news and he wrote back, "Love you forever" and I wrote, "Let's do this! Love you!"

It took some time to get a good view of the uterus on the ultrasound because my uterus hangs so far to the right side of my body. Once they had a good view (meanwhile the ultrasound was pressing deep into the abdomen/full bladder!), they used the very uncomfortable tongs that they use in pap smears to get a good view of the cervix. They cleaned the cervix and also inserted a medium into it that is conducive to the embryos. Next they placed an outer catheter up through my cervix and into the uterus and you could see the tiny catheter on the screen.

Only after everything was in place did they call the embryologist to come out of the lab with our embryos.  They reconfirmed my identity and our assigned number and I then thought, "Wow, I sure hope they have the right embryos!"  She came right in, so as not to expose the embryos to the air for more than a few seconds. The embryos were inside a tinier pipette that both the embryologist and the RE put into place and inserted into the outer catheter. The embryos, which are in a medium themselves, were essentially flushed gently out of the pipette and into my uterus. It was then that the RE said, "there they are!" as he pointed to the screen. You could see them there, a tiny dot of white light. (You can see them because they're inside a protective air bubble.)

I asked for a photo and they took one while we waited for the embryologist to return to the lab and confirm that the embryos were both out of the pipette. She called back and I heard her say, "It's all clear!" At that point they were able to remove the catheter and tongs.  It felt so good because all the equipment was quite uncomfortable (though not what I would call painful). I will say, the only time I've been that "exposed" before was during labor!

Both the nurse and the doctor shook my hand and told me to get up and get dressed so that I could use the bathroom. You don't need to lay down because the embryos are placed in the lining, which is akin to placing 2 grains of salt on to a peanut butter sandwich. While the medium may flow out later, the embryos themselves aren't going to fall out. :)

After the much needed bathroom break, I was escorted out and wished good luck. I left feeling truly high and so very happy. I called DH and told him the good news of a successful, uneventful transfer.  Really, it wasn't a big deal, and from start to finish the transfer itself only took about 15 minutes.

So, now we wait. My beta isn't scheduled until another week from now...which is way too long to wait! Of course, I will be POAS before that. Come on embies...stick baby stick!!

Close Call! Breakthrough Bleeding Before Lining Check

I failed my lining check on Monday (cue complete freak out noises). I have been a basket case.

My uterine lining needed to be close to 8mm for the big lining check and it was only 5.9mm. I knew there was big trouble when I started having break through bleeding on Saturday...it continued through Tuesday, easing up to spotting yesterday (Wed). My RE looked at the ultrasound during the check and announced, "You're not ready!"  I had to fight tears.

So what happened?  Basically, my RE explained that not every woman metabolizes estrogen supplementation the same and the Vivelle patches were not enough to keep my estrogen levels up and so I began having withdrawal bleeding.  I was a complete disaster on the flight out to CA...during my layover in Chicago I locked myself in a bathroom stall to sob for 20 minutes and looked red and puffy all day (prompting a flight attendant to ask if I was sick).  I was certain my cycle would be canceled with all the bleeding I experienced.  And I cannot express how hard it is to get THAT close to a transfer and then believe it's going to be taken away.

As soon as the bleeding started I began taking estradiol, 6mg orally (2mg morning, noon, and night) and 800mg of ibuprofren. Amazingly, this did the trick and rebuilt my lining just enough to pass my recheck today.  Less than 72 hours from my failed check, my lining was up to 7.87mm...putting me close enough to the 8mm's to move forward with the cycle! I am elated and even the nurses were cheering for me when I walked out of the ultrasound room.

The clinic coordinator called me later today to tell me that I am to stop Lupron on Sunday morning, begin Progesterone (PIO) that night, continue estradiol until Saturday, and continue the Vivelle patches indefinitely...my transfer is scheduled for October 19th and I just bought my tickets!

This coming week is my 40th birthday and sincerely, this is the best birthday gift I could ever imagine. I am so thankful for this amazing answer to prayer. I can't get these DEmbies into mah' belly soon enough! ;-)  

The Donor Embryo Cycle Begins

I've never been so happy to pop a pill before...every morning since CD 3 I have been taking a birth control pill to quiet my ovaries until I start Lupron next Wednesday. The way I see it, each pill is getting me one day closer to the transfer of our little DEmbies.  Eeeeee!!

I took great satisfaction today in re-arranging my cupboard in order to accommodate and organize all my meds. It's like a doctor's office in there with all the needles and vials and swabs. My eyes widen every time I look at the jumbo 22 gauge Progesterone needles though! They are freaky big.

Here is my cycle schedule:

Sept. 8th- CD 3:  Start birth control pills

Sept. 17th- CD 10: Baseline Ultrasound at the RE's (beg for Intralipid Rx)

Sept. 19th- CD 12: Begin Lupron injections in the morning! 10 units sub q.

Sept. 20th -CD 13: Stop birth control pills (last day on the 19th).

Sept. 24th- CD 17: Reduce Lupron to 5 units. Begin Vivelle (estrogen) patches- 2 patches .1mg every 2 days.

Oct. 8th- CD 31: Fly to CA for the lining check!

~Oct. 9-14th: Donor Egg retrieval- Stop Lupron. Begin Progesterone injections - 1 ml. Continue Vivelle.

~Oct. 14-19th: Fly to CA for Transfer!

The big question weighing on my mind right now is whether to transfer 1 or 2 embryos. I wouldn't mind 2 babies, I just fear the complications of a twin pregnancy, especially when I'm already so fearful of problems with my cervix given all the disruptions to it during the miscarriages and Asherman's surgeries. At the same time, I'm very fearful that the the embies won't stick given my history of RPL and 2 really ups our chances of getting preggers. I'm praying for wisdom on this question.

Goodbye August Embryo

While it would have been amazing if we'd had a real miracle happen in our miracle month, it didn't. My betas were measured and were only 9 and then 11. I have to go back tomorrow for another blood draw to make sure they're going down to zero. It's really unnecessary since the pee sticks don't lie and they're almost negative now. But I will go back to prove to the clinic that I'm really not preggers anymore. 

While it was a completely chain yanking experience to get a lovely BFP on our last TTC cycle before the donor embryo cycle, I will say that part of me is relieved. Relieved because I would have been worried sick every single moment, waiting for the shoe to drop. I have come to believe we just cannot get our sperm/egg combo to make a baby. Period.  So, the much safer and much less scary option is to move forward with the donor embies...where healthy sperm and egg come together to make a healthy embryo. And a learned embryologist can study the embryo and see what we're dealing with before putting another embryo back into my uterus. 

I want to make another entry about that process...but for now, I am disappointed this didn't work out. And to realize we're up to 8 (known) losses is pretty stunning. I am on the far edge of the statistics, beating the odds in all the wrong ways. 

I asked DH if we could nickname this embryo "August." He agreed. We both like the name, it happened in August, and all our Angel babies are "A" names. So...goodbye dear August, I wish you could have stayed. 

Time to Play "What does this line mean?"

I got the oh-so coveted + digital today...there is something about reading the words "Pregnant" that makes it all seem real. However, I am far from comforted because I am playing the "what does this line mean?" game. You play this by peeing on pee sticks and comparing them to earlier pee sticks for ages to see if they are getting "appropriately darker."  What is appropriately darker? I dunno, this is definitely not an exact science. All kinds of things can change the lines in any given test, so it is notoriously unreliable: urine concentration, what you ate/drank, the sensitivity of the particular test, the dye amount, etc.  Do women do this anyway? Heck yeah. The reason is that over several days, lines that don't darken up are indicative of a chemical pregnancy. I've been there, done that. It is limbo time though for sure. I had some kind of progress in hcg because my FMU and SMU tests were darker than yesterday's...noticeably. And while I had a negative digi yesterday, it's positive today.  But was it enough of an increase? I don't know, I wish it were darker.  But then I had to go and ruin it anyway by taking one (okay three) tests with late evening urine tonight and they came up looking WAY lighter.  So...back to the pessimism. 

The thing is, any little bit of hope that a slightly darker test provides, can actually become crushed hope later: I've had too many losses to feel confident and to fear this hope. So instead it's like going from worry to worry. I know I shouldn't play this pee stick game, but until I get 2 beta results, it's all I have to prepare myself for what might be coming.  I should get a beta result on Tuesday and hopefully get another drawn then too.  Then I'll be in beta purgatory. But for now, I'm just playing the pee stick line game...and it's really not fun. Every time I do it, I'm filled with anxiety...if only I could stop playing. 

My Miracle Month Part II: The Plot Thickens

I am 10DPO today and as of last night, we have a BFP on our hands (above) on this, our very last TTC cycle before moving on to donor embryos. I wish I could say I'm purely happy, but I am scared to pieces and primarily fearful about this being yet another loss that will cause us to lose the wonderful DEmbryo match that we signed on the dotted line for just 24 hours prior to getting this shocking BFP.

My mind is racing..there is excitement in the sense of "Maybe this is really it...DH and I will finally get our take home baby!" and then there is the more dominant voice of "Oh no, not again, why now?? I can't handle another loss and I don't want to lose our DEmbies..we're almost there!!"

So, trying to be rational now, and here are the possibilities as I see them:

1.  This will be yet another chemical pregnancy that will only set us back a few days and we will continue as scheduled with the DEmbryo cycle. This seems the most likely thing given our history and multiple chemical pregnancies.

2. This will be a long, drawn out miscarriage cycle that will cause us to lose our DEmbryos (a double loss), and we will have to wait quite awhile before we can move on to new DEmbryos. (I can't even think about things like late term loss, a D & C or D &E, or messing up my uterus again.)

3. I feel this is the least likely scenario, but would truly be the "miracle" that we have hoped and prayed for these past 3+ years of TTC: we will actually carry this pregnancy to term and have our long awaited take-home-baby.

Obviously my main fear is around #2.  But, I have to say, no matter what happens, I will survive and no one can ever say I didn't do everything I possibly could to have a baby with DH. So, for now, I am praying, trusting, and doing everything I can to give this very early pregnancy a shot.  Lord... have mercy.

My "Miracle Month"

I was reading another blogger and she called the month before starting IVF her "miracle month" because it was her last chance to miraculously fall pregnant before jumping into IVF.  For me, this is my miracle month because it is the last month/cycle before we move on to the donor embryo cycle. I like the term because it is full of hope.  

Strangely...I have had a lot of pregnancy symptoms this cycle.  It has been over three years of trying, 7 losses, and this is the 5th and last cycle of the Neupogen/Lovenox that my RE had prescribed to help us overcome our 6 HLA matches.  Today is only 8DPO, so it's too soon to tell, but my temps have been higher than they have ever been in any cycle (pregnant or not, medicated or not), I've been having a lot of personal "classic" pregnancy symptoms that I get on pregnancy cycles: BFP dreams, cramping toes, a sore throat, runny nose, daily skin breakouts, tugging round ligament pains, gassy/burpy, and super bloated.

On the other hand, it's just too unlikely that this would truly be my miracle of a month.  It will probably be BFN or, worse, another loss that will mess up our big DEmbie cycle.  So I'm nervous...because I'm not too sure I want a BFP, they don't end well for me. But this is also our last chance...what if  we get a miracle, a REAL miracle? 

The Biology of Pregnancy with a Donated Embryo

I thought this was a beautiful read...and while it was written about using donated eggs, it totally applies to donated embryos. It was written by Cara Birrittieri and it is a list of myths she seeks to dispel...I'm listing the third one since that is the most powerful to me. Reading this made me feel even more excited about the prospect of using embryo donation for us. The booklet in it's entirety can be found here: http://www.fertilityneighborhood.com/bin_web/images/uploaded/DonorHandbook_ForWEB_v1.pdf

You probably learned the following in your high school biology class, but most of us need a review to dispel many of the myths around baby making and making a baby with a donated egg. To create an embryo that will grow into a healthy child, you need genetic material from two different gene pools. The combined genetic material instructs the developing fetus to become a boy or a girl, tall or short, have curly hair or straight, blue eyes or brown.
...
Myth number 3: Perhaps the greatest myth surrounds pregnancy. Many believe the uterus is simply an incubator. Nothing could be further from the truth. The most important aspect of all pregnancies — including egg donation pregnancies — is that as the fetus grows, every cell in the developing body is built out of the pregnant mother’s body. Tissue from her uterine lining will contribute to the formation of the placenta, which will link her and her new child. The fetus will use her body’s protein, and then she will replace it. The fetus uses her sugars, calcium, nitrates, and fluids, and she will replace them. So, if you think of your dream child as your dream house, the genes provide merely a basic blueprint, the biological mother takes care of all the materials and construction, from the foundation right on up to the light fixtures. So, although her husband’s aunt Sara or the donor’s grandfather may have genetically programmed the shape of a new baby’s earlobe, the earlobe itself is the pregnant woman’s “flesh and blood.” That means the earlobe, along with the baby herself, grew from the recipient’s body. That is why she is the child’s biological mother. That is why this child is her biological child.

Many recipients ask, “Is the baby actually my flesh and blood?” Not literally. No baby is really its mother’s flesh and blood because the truth is that every fetus builds its own flesh and its own blood. Still you might wonder, “If it was my own egg, wouldn’t the baby then have my blood?” No. The baby might inherit your blood type, but would still be making its own blood, just as it makes its own skin and hair texture, and nails and teeth. Besides, with or without egg donation, the baby might have inherited his or her blood type from the father’s gene pool.

Think of it this way: every baby is a complete, self-contained, unique human being. You will meet this person when he or she is born. To try to sort out the genetic contributions at that point is like trying to break a cake down into flour, sugar, water, and yeast after it has been baked. It is now a cake, no longer separate ingredients.

A New Direction: Donor Embryos

The outcome of this fourth Neupogen cycle is yet to be seen, but last night I hit a gigantic rock solid wall: we have too many obstacles to overcome for this to ever work. I am doctorless now because of some new policies with my specialist in NY who will no longer monitor patients out of state.  My husband's sperm fragmentation is sky high (24%) and the most recent studies are showing that a live birth with this kind of fragmentation, even with IVF, is slim to none, especially given my aging and limited eggs.  My body is clashing with his genetics with our 6 HLA matches, and even if we can overcome that with medicine/Neupogen, we can't clear the other obstacles.  What hit me last night was the truth I've been running from for these 3 loooooong years of infertility: we are NEVER going to make a healthy baby between us.  It's as if the universe is sending me a message...and I am finally able to hear it: 6 miscarriages, 5 failed medicated cycles, and 32 more failed natural cycles later.  I assumed though, that my husband, who has been so negative about alternatives to natural conception for so long (eg adoption, sperm donors, IVF, etc.), would never go for what seems like the only option left to us. In fact, his unwillingness almost lead to a divorce just 2 years ago until I gave in and dropped the whole subject. 

But tonight, I took a deep breath, said a prayer, and gave him my reasons for wanting to move on to embryo "adoption" (okay, that's not the legal term, but it makes intuitive sense)...basically to have healthy donor embryos transferred into my healthy uterus. I am completely humbled and in awe by my husband's reaction after I made my case...he said, "I love you and I want you to be happy and so yes, let's look into this."   I pressed him a bit more, somewhat in shock, and learned that he agrees with me and is actually excited about it too,  and he is willing for us to sign up and start looking at potential matches right away! We even agreed on a clinic and program in California.  To say that I am elated and on Cloud 9 would be a huge understatement: I started crying the most joyful tears imaginable  as we held each other a long time on the couch.  He is my new hero and I am falling in love with him all over again.  He amazes me...just when I think I "know" what he will do and say, he catches me off guard and shows me a side I didn't know was there. And I know it's a huge leap for him: the sadness of never having a biological child of his own...and yet, he is able to see past this. 

This is an amazing, momentous night, and I am going to look back on this day, July 31st, with deep joy, because tonight we begin the journey of a thousand steps that I truly believe will finally lead us to the miracle I've been praying for, for these many years.  The fact that my husband's heart has been changed to accept this new path is a miracle in and of itself, for which I thank God. 

And I never, never want to forget what this decision, his love, and this night means to me. This is our new direction, this is the way forward, and I am not going to look back with regret ever.  

Third Cycle on Neupogen/Lovenox/Intralipids

I am nearing the end of my third cycle on this medical protocol to theoretically fix/calm our allo-immune problems. This cycle is a BFN despite great BD timing though. On my second cycle our timing was so-so, but I had a flood of strong pregnancy symptoms early on and sky high temps that disappeared during the implantation window. I was really crushed because it feels like the protocol didn't work, although I know it could have just been a bad egg/sperm issue too.

We are thinking we may give it just 3 more cycles for a total of 6 months to try this protocol and if that doesn't work, we have will have hit the wall, officially. We have tried everything short of IVF, which we can't afford and with my few and aging eggs, probably wouldn't work.

I have been thinking a lot about whether we should pursue adoption or simply stop trying to give my daughter a sibling. It is a gut wrenching decision to be faced with and I have been hopeful, only to have my hopes crushed so many times, that I just don't know how much more I can take.  The fear of an adoption falling through puts me into feelings of absolute fear and trembling. It seems like nothing has worked out and nothing will.  I know that hope is that last thing to die...and mine seems to be on life support. 

Neupogen/Intralipids/Lovenox Cycle #1

Lord have mercy. I think this cycle is a bust.  We jumped the gun and thought I had ovulated, only to realize I ovulated later, so our BD timing was off by about 2-3 days.  Still in the fertile window, but not great timing.  A BFN today on 10DPO, so I think I'm out because I am just not feelin it and my temps have been on the low side since ovulating.

So, here is what I experienced for side effects on this first round:

Intralipids: Nothing other than a bit tired/headachey afterward. The worst part was just sitting there for over 2 hours with the dang needle. Really a breeze overall.

Neupogen: I have felt a bit achey in my joints all cycle long and the day after my first injection I felt some bone aches. Nothing much though, it's practically side-effect free!

Lovenox: I think this gave me some bloating, gas, and a lot of crampy/twingy sensations in my abdomen. The main problem with this drug is injecting it! The med stings like mad during the injection and locally at the site for about 20 minutes afterward, like a burning sensation. It leaves bruises every time at the site, most of them are not too bad, but I have one GIANT bruise the size of an orange on my abdomen. Seriously looks like I was beaten. The other problem is that a few times the injection site leaked, and leaked, and leaked blood...over 15 hours once, right through my clothing at work twice. I contacted the doctor but they just said this was not that uncommon. If it had continued I would have needed to get my platelets checked.  Argh.

So...I'm anxious to get on to a new cycle already. Now I wait for ages for Aunt Flow, who never shows until 17 freakin DPO with my long luteal phases. Had a good cry this morning, I always get so depressed around this time on BFN cycles.  Infertility SUCKS major sour pickles.  

Affordable Neupogen and Intralipids

I just put this together for the ladies on Fertility Friend on the immunology board by request, so I'm posting it here to for anyone searching! These are sometimes prescribed for women suffering from immune related loss/infertility. I have elevated Natural Killer Cells and alloimmune issues (6 HLA matches with my husband).

Affordable Intralipid Infusions

Prices may vary by region in the US, but the best price I've seen and used was by hiring the Walgreens Infusion Service to come to my home for an Intralipid Infusion: 20% IV, 100 ml, infused over 2 hours. (This was going to cost $300 at a local office with a private doctor.)

As self-pay, I paid:

$80 for Infusion Nurse
$50 for the Intralipids
$15 for Supplies
=$155.00

Affordable Neupogen
Most insurance companies (not all, so check!) will not cover Neupogen for pregnancy. I priced Neupogen from many sources, pharmacies, etc. One of the challenges with Neupogen is that it must be refrigerated/kept cold and cannot be jostled/shaken, which makes ordering it in the mail from outside one's country very difficult.

The best price I found was by purchasing a Walgreens "Prescription Club Membership" for $20 (individuals) or $35 (families) a year. By having that membership, one can save almost $100 a vial on Neupogen as well as many other medications.

At this time, the biggest savings is to purchase the 300mcg/1 ml vial of Neupgoen (not prefilled!!) and not the 480mcg/1.5ml. If you purchase it in bulk, you save a little more money too. 1 vial=$249.99 or in bulk (3+) 1 vial=$246.

My cost as of of May 2012:

4 vials of Neupogen, 300mcg/1ml = $246 a vial ($984 total)
with the Walgreens Prescription Club Membership

Neupogen is prescribed based on body weight, so it will vary a bit based on what you weigh. I am able to get a little more than 5 doses out of each 300mcg/1ml vial. It is taken starting at ovulation, so assuming I take it for 11 days each TTC cycle, it costs $492 in a BFN cycle. In a pregnancy cycle, taking it for a full 30 days, it will cost $1476 per month. It is taken for the first nine weeks, so for a pregnancy it would cost $3444 (in my case).

To me, this is reasonable given the cost of IVIG or LIT as alternatives to Neupogen. IVIG is usually about $3000 per infusion and multiple infusions are generally needed. Getting LIT involves travel to Mexico at this time, so that adds up over several visits.

A New Diagnosis: 6 HLA Matches and Absolute DQ Alpha Match

After 3 years with no helpful answers, I feel like I'm finally getting the answers we've been searching for. Not only did we discover and treat the Asherman's, but we finally had a full immune panel done with Dr. Braverman of NY, who specializes in recurrent loss and reproductive immunology.  Most of my bloodwork came out normally although I have slightly elevated risk for blood clots due to heterozygous mutations for both ACE I/D and PAI-1 (4G/5G) genes which will be treated with Lovenox. 

However, the really BIG finding is that my husband and I share way too many HLA genes! We actually share 6 genes but 3 of them are homozygous on DH's side, so that means our embryos are going to constantly look too much like me genetically (eg altered self) instead of an embryo (eg non-self).  When the body sees what appears to be altered self (like cancer), the immune system launches an all out attack. This is actually the opposite problem with organ transplants where HLA genes need to be the similar...in pregnancy they need to be different!  This may explain why my NK Cells are slightly elevated too: my immune system has been attacking our pregnancies over and over again. I am officially at 6 consecutive losses but I know there have been more that were lost so early that we couldn't get to a positive beta/HPT.  Dr. Braverman says that 5 or more matches are significant, with certain matches being more important than others. One of the discoveries is that we have an "absolute DQ Alpha" match of 4.1 (05) which is the worst possible gene because it most resembles cancer to the immune system according to Dr. Alan Beere. 

Here's our HLA gene panel:

Me:

DQ Alpha: 1.3, 4.1 
DQ Beta: 03,06
HLA A: 02, 24
HLA B: 33, 51
HLA C: 01, 05
HLA DRB1: 11, 13
HLA DRB3: 01, 02 
DRB4, DRB5

DH:

DQ Alpha: 4.1, 4.1
DQ Beta: 03, 03 
HLA A: 02, 32
HLA B: 15, 51
HLA C: 07, 14
HLA DRB1: 11, 12
HLA DRB3: 02, 02 
DRB4, DRB5

I highlighted all our matches....6 total but more like 9 with 3 of them being homozygous (the same) on DH's side. The only gene without a match is HLA C. Who knew we were so much alike? It's so weird!!

Some RE's say there is no treatment for this kind of genetic match and that a woman must use a surrogate to ever have a baby with her husband because the interaction is between her body and her husband (not her eggs). Others treat this with heavy doses of IVIG (super expensive) and steroids/prednisone and/or LIT (injecting the husband/partner's leukocytes into the woman's body...only done in Mexico at this time since it was outlawed in the US).  However, Dr. Braverman is treating this problem with success using Neupogen. Neupogen seems to be a miracle drug for this issue and while it's expensive, it's nowhere near as expensive as routine IVIG or flying to Mexico over and over again for LIT. 

Neupogen deserves a post of it's own, so for now I will list my treatment plan, which I started this cycle under Dr. Braverman's monitoring:

-Intralipid Infusion for elevated NK Cells (before ovulation, after a BFP)

-Lovenox for clotting risks at ovulation

-Neupogen at ovulation for the HLA matches

Here's a funny site describing why HLA genes need to be different in partners...apparently they match people up by analyzing their DNA!
http://www.genepartner.com/index.php/science

Wish me luck! Prayers accepted!  We're trusting God and utilizing science. :)

I Beat Asherman's :)

I am here to tell you that all is not lost if you develop Asherman's. I completely freaked out when I was diagnosed and I had a moderate case, but after 1 surgery with the right surgeon, all scarring was removed and did not return. Sometimes, it will take more than one procedure, but it can be beat. On my follow up hysteroscopy (after surgery) that was done here locally by a different RE, we were amazed that absolutely no scarring had come back and so no further cutting was required.

The KEY to beating Asherman's is not only prevention (avoid a D & C if at all possible!!), but having it treated by only experienced Asherman's surgeons. I cannot emphasize this enough because most OB's and RE's are not trained or experienced to handle AS despite what they say.  An experienced surgeon will NOT make AS worse (which many doctors do inadvertently) and they can do in 1 or just a few surgeries what it can take others many procedures to accomplish.  Basically, if treating AS is not something a doctor does every week, then don't have them treat you.

I have an HMO but found out that one of the top AS surgeons was in network. My surgery was totally covered but I did have to fly to Boston to have it done. In the end, the only expense was airfare and a one night hotel stay. Not bad for getting my uterus back in perfect shape!

The timeline was:

January 2012: diagnosed with Asherman's with an HSG at my request after 2 years of no diagnosis despite my complaints to doctors of a lighter/shorter period since my D & C's

February 2012: Asherman's hysteroscopic surgery to remove scarring followed by a round of estrogen. I treated myself with enzyme therapy (Medizym V), Red Rasberry tea and Castor Oil packs during recovery.

March 2012: Follow up hysteroscopy showed no return scarring.

April 2012: Cleared to try and conceive again!

Asherman's Syndrome: I Have It :(

Okay...I am devastated. I am going back and forth between crying, raging, being despondent, and being in denial.  My "questionable" HSG has become very definite: I have a very serious case of Asherman's Syndrome, eg intrauterine adhesions and scarring from my D & C's following 2 miscarriages. I emailed my image (above) to an Asherman's specialist in CA and he confirmed what I knew after seeing my films...there is significant scarring throughout my uterus that requires surgery. The uterus should be a solid white triangle shape without any blank space. Instead the stupid balloon is floating around in the center of my uterus (bad radiologist move) and large adhesions can be clearly seen all along the right side and in the top left near the tube of my uterus. I think I see a tiny bit more scarring near the right tube too.  My cervix and my tubes are open though...you can see the contrast flowing through them on either side.

My emotions are ALL over the place.  This looks really, really bad to me and I don't know what my chances are with surgery for full recovery.  I cannot believe that 2 RE's and 2 OBGYNs missed this over the span of 2 years. All the lost time, wasted money, the terrible grief and heartache of infertility and 3 more early miscarriages because of this...and I never had a snowball's chance in hell of having a healthy pregnancy with a broken uterus like this. I'm almost out of eggs and have lost 2 years of trying fruitlessly.

The scarring/Asherman's was caused by the 2 D & C's I had back in 2010.  It's possible that I have some retained placenta too and if I do, that's really bad news. 90% of Asherman's is caused by a D & C..some are caused by other uterine surgeries (like removing fibroids and polyps), C sections, or infections. The severity of it determines the liklihood of treating it succesfully...the statistics are low, maybe 30% when it is severe, 40% over all, but pretty good when it is mild at 80%.  I think my case is pretty severe though. Tomorrow I will see another RE who deals with Asherman's and find out what he says. Asherman's is way more common than people think and not only is it undereported but it often goes undiagnosed (like it would have for me had I not PUSHED for an HSG despite being told I didn't need one). I read that up to 40% of women can develop Asherman's when they've had more than one D & C. 

I am so furious with the OB who caused this, with the RE who missed it back in 2010 when I had a hysteroscopy, and most especially with my current RE who not only missed it on an SHG just weeks ago, but went on to tell me to "ignore the HSG" results and continue with the injectable cycle anyway.  He actually refused to order an HSG for me when I requested it previously. If I had listened to him, I would be trying fruitlessly, perhaps doing failed IVF's, until I hit menopause! Or worse, concieved only to lose a baby again, perhaps later, because Asherman's can cause second and third trimester losses.  Talk about medical negligence!  A total lack of medical ethics and terrible advice that would have put me and a baby at terrible risk. He is FIRED from ever being my RE again.

Asherman's can also cause ectopic pregnancies because when an embryo finds the uterus inhospitable, it will move back into the tubes to find a better implantation site.  No surprise now, but my suspected ectopic was in my right tube...obviously due to the inhospitable right side of my uterus covered in scar tissue.

What I don't know is if the Asherman's is THE cause of my subsequent losses or if there are still some immune issues going on.  At any rate, the first item on my list is surgery to get this repaired as much as possible. I am flying into to Boston to see one of the best Asherman's doctors, an "A list" RE on February 27th. I so hope he can help me.  If you are ever diagnosed with Asherman's...make sure you see someone very experienced with Asherman surgeries!  Most OB's and RE's can make it worse or just don't treat it succesfully. You can learn more and join the Asherman's support group at ashermans.org. 

Just wanted to report that I told me first RE that I feared I had Asherman's after my second D & C because my period changed from being 5 days of heavy/medium flow to barely 3 days of medium/light flow. Any change in a period can be a symptom following a D & C. Of course....he STILL missed it. I don't know what one must do to get a correct diagnosis for Pete's sake.

I don't know how many surgeries I will need now or how long this battle is going to last or even if there is any hope for me. I may be at the end of my long and painful journey to have another child.  I hope not.

I'm so scared...so angry...so sad. 

HSG Confusion on First Injectable Cycle...Oy!

Well, my beeeeautiful chart did not end in a BFP.  I had a lot of BFM's (big fat maybe's) though, especially on the FRER's that did turn up a more clear and visible line after they dried. I'll never know if it was another early chemical or not and I would like to think it wasn't.

However, I was already scheduled to start my first injectable cycle and began injects with Follistim on CD5, 150 IU, then tapering to 100IU and 75 IU until CD10. The BIG freakin problemo is that I had an HSG on Tuesday and this has thrown my life into chaos because the results were questionable.

The ONLY reason I was having the HSG, as ordered by my OB, was to check if my tubes were open and clear. I wanted to know that was true before doing injects and I also wanted the therapeutic benefit of an HSG (cleaning the pipes for greater fertility).  I wasn't worried about my uterus at all since after my last D & C for retained placenta, I have had a hysteroscopy that was clear, several ultrasounds measuring a good, thick lining around ovulation, and a sonohystogram that was clear just 8 or so weeks ago by my new RE.  Unfortunately, during the HSG the radialogist had some concerns about irregular filling patterns on the right of my uterus and on the left top of the uterus near the tube.  He said it might indicate adhesions.  I had the report faxed to my RE's office and the nurse told me to go ahead and continue the injects as planned. I was happy and figured the findings must not be tooooo terribly worrisome. Still, I knew I would follow up.

Well, I started the Follistim and it was easier than I could have imagined. I don't even feel the needle it's soooo thin. I've been pleased as punch about this and wondering why the heck I didn't do this before.

But yesterday morning the OB called and wanted to consult with me about doing surgery this cycle. He thinks these potential adhesions could be causing my losses and says I shouldn't get pregnant now. Of course, that means I could have Asherman's...which is completely terrifying to me.

So, I've been in a tailspin about what to do. How did I have a clear uterus before? How was this not seen on previous tests including the hysteroscopy!?  I know HSG's give false positives and negatives 15-20% of the time. Could that be the case? How serious is it if there's something wrong?  It is serious enough to lose the $500 on the Follistim (that can't be used in another cycle because it's already been opened)?  Serious enough to risk more surgery that could cause worse scarring???  I just don't have the answers.

So, DH and I are baffled. I called my mom, an OBGYN nurse, and she said she would continue with the injections.  I did my third injection last night, but am just not sure if I'll continue.  At some level, I feel like I have nothing left to lose on this cycle and if it doesn't work, I'm out the meds, just as I would be by stopping them.

The only thought I had was to get a second opinion, preferably from an expert. I just don't know who that might be though.  I wish I had done this HSG a long time ago, or just waited until after this cycle so I wouldn't have to second guess everything now.

Why can't I evar catch a break? Seriously. This is total poop.

My Pretty, Pretty Chart

I've had the best chart of MY life this cycle, starting on Christmas Eve. Of course, I tested yesterday and it was BFN, so the verdict is still out. My temps have been higher over all and then on 10DPO I had a big temp drop followed by a temp rise again this morning. I am hopeful that the dip on 10DPO is an implantation dip and my temps are looking triphasic. We shall see...in the meantime, I love looking at my pretty pretty chart! Screenshot above for your viewing pleasure.