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.