I know you’re probably not a fan, but…

There’s a section in the Twilight series books that is actually pretty profound (I’m hoping I didn’t just lose all credibility there.). For each new chapter as you turn the page, you see one word: the month that is passing/has passed on an otherwise blank page. So as you turn the page, all you see is – for lack of a better description – the character shutting down; shutting out the world. Silence.

It evokes a strange, muted response in the reader; to turn page after page and see only that. A sense of being alone, like one would be in the country on a gray, snowy day, where even the birds make no sound. And even if they did, the thick blanket of snow on land and tree would absorb and drown out any such insolence.

For a long time after my last post, this was my world.

 

June.

 

July.

 

August.

 

September.

 

October.

 

Until here we are, a little over one year later.

I lost that pregnancy on a rainy day in the ER. My follow up appointment with Dr. Albrecht and subsequent ultrasound showed an empty uterus. It was eventually made worse a few weeks later when we heard my stepson’s bio mom was pregnant and had been given my exact due date in January. They currently have a 5-month old little girl. I’d like to say bio mom was mature and didn’t flaunt the pregnancy or birth; however, I can’t because she wasn’t. It was not an easy go of things.

But time moves on and wounds heal. Though the scars are certainly within me, I’m no longer as lost as I was after this last miscarriage. And with healing comes hope. With hope comes looking ahead once more. Making plans. This time for my favorite month and my husband’s favorite number: September 13.

More to come.

So far so good

Other women have told me that the anxiety over one’s pregnancy doesn’t really go away until the baby is actually in one’s arms. So far, that has proven true, but at least it does lessen a bit.

My RE’s office is perfectly happy with my hcg numbers so far:

  • 6dp5dt: 26
  • 8dp5dt: 81 (doubling time: 29 hrs)
  • 10dp5dt: 134 (doubling time: 66 hrs, but I hit the 1.6 mark: see below)
  • 13dp5dt: 513 (doubling time: 37 hrs)

If you’re going through something similar, and you’re a search engine freak like me, you can check your hcg doubling time here. To note, my RE told me that they like to see hcg go up by 1.6 every 48 hours; that’s the textbook increase. When asked, he said that the “double every 48 hours” thing came from OB/GYNs and patients just rounding up to 2 from 1.6. So if you’re numbers don’t double exactly, but they hit the 1.6 mark (like mine did from 8-10dpt), you’re still in the green. The nurse at my RE’s office offered to give me one more blood test for hcg; I had to decline with a hard “noooooo” in order to keep my anxiety in check. Let me rest in a happy place for a little bit.

Progesterone in my blood is on the lower end (8 – 9), but that is to be expected – and is normal – since I’m on Crinone (Crinone delivers progesterone right to the source – the uterus – instead of traveling through the blood). Estrogen has been a consistent >200, which is good. Fun fact to note: my nurse told me that with donor cycles, once the ovaries detect hcg, they kind of “wake up” and start creating a corpus luteal cyst that will create progesterone until the placenta takes over. Normally, a corpus luteum is left after ovulation, but since donor recipients don’t ovulate, we get a late bloomer. How flippin’ cool is that?!?!

The next step now is an ultrasound at 8 weeks to get a look at my little guy or gal (I’m convinced it’s a gal). For now, I’ve emailed Eva with my numbers to confirm pregnancy; I’ll email her again when a heartbeat is confirmed, as they use this information in their stats reporting on DE IVF. They’ve also emailed me with a freeze report; after I left, they were able to freeze 1 x grade 1 hatching blast and 3 x grade 2 hatching blasts. We have FOUR frosty embabies! As I mentioned in a previous post, I’m SO glad we went with PICSI instead of ICSI this cycle.

So…I’ve made it past the first few brackets (a good friend likened the first trimester to a Final Four-style bracket. LOL. It fits…don’t focus too much on what’s in the future; focus on the step/game immediately in front of you. When you win that one, celebrate! Then move on to the next.), and I just want to celebrate this victory! 🙂

And the results are…

There is a Jewish prayer we say upon learning of a pregnancy. It includes the lines, “We tremble with fear and joy. Deep inside me a seed is growing. I am afraid, and I am filled with ecstasy.”

6dp5dt

I couldn’t say it better if I tried. The prayer captures exactly the dueling sentiments that come with the territory of multiple pregnancy failures and years of infertility. This emotional dichotomy seems unavoidable, however, given my history. I am so happy to see that at least one of the embryos took, and has implanted into my womb. I am also terrified of knowing how this will progress. Chemical? Another blighted ovum? A healthy pregnancy? There’s no knowing, no crystal ball to alleviate my anxiety. The most I can do is pray, take the day moment by moment, and – with my husband by my side – plunge into the next few weeks to see where time will lead us.

For now, I’ll just be saying this over and over….

I am pregnant.

Nothing bad has happened today.

Focus on the present, and leave the future alone.

[Partner’s together:] We stand breathless before the Power of Creation that works through us to bring forth new life. We tremble with fear and joy.

[Pregnant Woman:] Deep inside me a seed is growing. I am afraid, and I am filled with ecstasy.

[Partners together:] May this promise of life come to be – our child. We trust in the source of life, this power which grips us within and yet transcends us. Protect this fragile new beginning. May we find love and strength to nurture this gift of fertility and life. Sheltered under wings of love, may we grow to be partners with the source of life in the miracle of creation.

 – Rabbi Sandy Eisenberg Sasso

Plans in motion

“A dream you dream alone is only a dream. A dream you dream together is reality.”

– John Lennon

I just have to mention how much I love my husband, and how thankful I am for him. Through this whole long, sucky struggle with infertility, he has been by my side. Holding my hand, crying with me, experiencing the roller coaster ride with me. I couldn’t have asked for a better partner in this. I know infertility can break couples apart, but I truly feel it has brought us closer together.

Okay, sappy ode-to-my-love aside…when we decided to go back for a second round of DE IVF, we put the process into motion quickly. It didn’t take much to liquidate a portion of our retirement through TIAA Cref (a phone call and some papers to sign), and the funds were transferred to us within a few days. Based on where I am in my cycle, and because my husband’s work schedule is going into overdrive in mid-April, we will be traveling to Brno separately. It’s definitely not ideal, but as he said, we’re going for a reason; this is technically a business trip.

Travel

I picked up our tickets through Justfly, as they have consistently given the lowest prices I’ve seen vs. other travel sites (Expedia, Kayak, Priceline, etc.). I also decided to fly Aer Lingus this trip instead of Lufthansa. DH and I have always wanted to go to Ireland, so I scheduled a 22-hour layover in Dublin for both of us. We’ll both get to spend the night there, and see the city before flying back to the US in the early evening. It’s not the long trip we want (and will eventually take), but it will be amazing to walk around Dublin even for a day.

DH will be in Brno from Apr 9-13 to give a sperm sample at the clinic for freezing (and use to fertilize our eggs). He’s planning on spending a day or two in either Vienna or Prague again, as well. Our first trip there was 1) the first time he’d been to Europe and 2) the first time he had ever been in one of the huge, grand art museums. He’s excited to walk through again! (Not even kidding…he started packing his backpack a few days ago! Looked like a kid in a candy store…bless. 🙂 )

I will be flying out Apr 24-29, with the plan to explore a bit, as well. I also have already scheduled a 90-minute IVF relaxation massage with Henry J. Bartonek. He’s well-known among Brno’s international infertility patients, and for good reason. First, the massage is only 800 CZK, which equates to about $33 USD. Second, it’s just amazing. I walked out of my massage feeling open and airy, without a care in the world. I felt like puddy. Basically, like I had just smoked a bunch of weed. I highly recommend.

As for hotel, I’ve cut out the hotel for us in Prague since we know our way around a bit better; arriving early and taking a train (which I’ve already booked online) straight from Prague to Brno will save us a little over $400 in hotel expenses. I’ve booked the Grandhotel Brno again because we both love the location (across the street from the train station…SO convenient for later arrival into Brno).

I’ve done something a little different for travel with electronics this time. DH and I lugged a laptop over the last couple of times, and it was 1) heavy and 2) a giant pain in the ass with airport security. So I picked up a folding bluetooth keyboard with a smartphone/tablet stand to pair with our phones or iPad, and an Anker Power Bank with ancillary cords. The folding keyboard means our mini-computer (who are we kidding, that’s what phones/iPads/tablets are these days) can be easily stashed in a purse or the front of a backpack for easy access. The power bank allows us to recharge our devices up to 6-7 times before the bank itself needs to be recharged. Games on the plane, y’all!

 

Medical

I had a consult with my stateside RE yesterday, and I feel the need to reiterate how amazing Albrecht Women’s Care is if you’re in the Denver area. Still under the fog of having to fight for every step with doctors in infertility, I walked in with my plan from Eva, ready to push hard, lie, beg, etc. to get kitchen sink-type treatment. Totally not necessary. Dr. Albrecht took my plan from Reprofit and tweaked it to make sure it suited my particular case specifically. I felt SO very taken care of, and it almost made me cry! He laid out a plan for me, answered questions, and even did an endometrial biopsy/scratch while I was there (and the timing was right) so I didn’t have to come in again today or Monday. This is what he set up for me:

  • CD 19 of current cylce: Endometrial biopsy
  • CD 21 of current cycle: Microdose Lupron 10 units daily (for suppression)
  • CD 1 (first day of full flow): Start Estrogen 2 mg tabs (am/lunch/pm for a total of 6 mg daily); 5 mg Prednisone daily (for immune issues); Lupron goes down to 5 units daily
  • Sometime during the first week of my cycle: Intralipid infusion (for immune issues. Also see Care Fertility for more information.)
  • CD 13: Lining check
  • CD 15: Start Crinone 8% (am and pm); Start Heparin 5,000 units (am and pm); Stop taking Lupron; Start 5 days of Doxycycline (antibiotic) for prevention of uterine infection during transfer. ***For the progesterone, the clinic recommended starting with the lining check on CD 12-13, but Dr. Albrecht wanted me to start so that I would have 5 days of progesterone on the day of transfer. He said there’s a specific window for the endometrium to be receptive to implantation, and he didn’t want to blow it. He said an embryo can chill in the uterus for a day or two to wait for the lining to be “right,” but the receptive lining will not stick around for the embryo.
  • CD 19: Transfer day

That’s it for now. More to come as this cycle progresses!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Going Back

This cycle was a negative. DH and I had a long talk, and have decided we are in the home stretch. Time for a Hail Mary.

I’ve always thought of this “journey” as a process; an evolution through time, with ups and downs, information gathering, changing, etc.. However, after several years and God-knows-how-many tries (the last few months really bringing us to a head), we have come to a point where we need to see an end in sight. We feel that the resources – emotional, physical, and financial – we have put into trying to have a child are better placed into having a fuller life with the two of us.

As such, we are giving this one final UMPF. We are going to complete the last two cycles in our guarantee with Reprofit (the Risk Sharing Program (Scroll down to “Risk Sharing Programme” in that link))…the one where we pay for two DE IVF cycles with frozen eggs, and if we still haven’t brought a baby home, the third cycle is FREE. If we just saved money, we wouldn’t be going back for at least another year. We don’t want to wait that long to move to our next chapter (whether that be pregnancy or enjoying life with just us).

So, modeling after my friend who has gone, we’ve made the extremely hard decision to tap into our IRA to fund these last trips. My friend was actually able to take out a loan against her 401k at 4.5% to pay for their trip, but that wasn’t an option for us; it was liquidate a portion or take nothing. Not a light decision to make, given that 1) while we won’t take a hit up front (taking from DH’s 403b would be a 40% hit + income tax…YIKES), we will have to pay income taxes on what we withdraw, and 2) I’m 38, soon to be 39, and DH is 35. After losing a good chunk of our retirement in 2008 (fuck the American bankers who caused that shit show, by the way), we switched everything to be very conservative. We want to be able to retire before 80, so this is no small matter to tap our savings early.

But, we are both still working. That’s the plus side. We’ll be buckling down the budget to essentially repay that money as fast as we can. And cross our fingers that the stork takes pity and sends us a little love in the form of pink or blue.

I’ve emailed Eva to get the ball rolling. DH will be flying over to Czech mid-April to leave two sperm deposits; one to fertilize the 10 eggs we currently have frozen/reserved, and one as a backup in case a third (and final) attempt is needed. I will fly over the last week of April for transfer.

My medications / protocol will be fairly simple. I’ll have an endometrial scratch toward the end of my current cycle, and start estrogen supplementation with CD 1 of my next cycle. I will also start taking 5 mg Prednisone on CD 1. I’ll have to talk with my hematologist about when to start the Heparin, but I’m guessing it will be on CD 6 (bleeding has stopped, and estrogen supps bring a higher risk of clots). Ultrasound on CD 13 to check lining, start Crinone 8% 2x daily on CD 14 if the lining is good, and have transfer (likely two embryos) on CD 19. Relax at home for a week and see what the fates bring.

Wish us luck!

And an update on me…

The two-week wait (the time between ovulation and being able to take a pregnancy test; lovingly referred to as the 2ww) has got to be one of the weirdest times during the infertility roller coaster.

Seriously. We landed instrumentation on a damn asteroid. Can’t science figure out how to speed this up? Chop chop.

Jokes aside, I am currently 4 days away from being able to take a semi-reliable test (more on that later). Back in December, when we were told that we should try with my eggs, the first couple of tries went like this:

First cycle (December): I messed up my meds and ended up with a dominant follicle. My RE changed up the routine for the next cycle anyway, as he still wasn’t impressed with what he saw regardless of my med mishap. We went ahead with a single IUI with one 17mm follicle but, predictably, the hpt was negative.

Second cycle (January): Ovarian cysts on my CD 2 ultrasound. I was told we would need to skip this cycle to let my ovaries calm down a bit (OC are common in FX carriers). Damn.

Third cycle (February): We’re a go! I still messed up my meds, but only by a little. Oops. The result wasn’t too awful, though. Here is a breakdown of what we did…

  • CD 2: Baseline ultrasound to check for any cysts. Green light to start meds
  • CD 3-6*: 10 mg Femara (letrozole) in the evening. (*On the evening of CD 6, I was supposed to double up and take both the femara AND the Follistim/micro-dose hcg. I didn’t; I only took the Femara. Hence my “oops.”)
  • CD 7-8: 300 units Follistim (FSH…I’ve taken Gonal-F as well; just depends on what is available to me at the time), followed by 5 units of micro-dose hcg. (MDhcg is a hard cookie to find research on. It is a diluted form of the hcg used to trigger ovulation (I used Novarel) Per my RE, however, it is supposed to help mature eggs that would otherwise have a hard time making the grade. Anecdotally, it has led to increased fertilization and clinical pregnancy rates. It is taken at the same time as FSH injections, with the dose determined by the RE. Since I’m at the “kitchen sink” part of ttc anyway, I had no qualms about giving it a go.)
  • CD 9: 3 mg Cetrotide (1 kit) to prevent early ovulation (I have a history of this. My body likes to spit ’em out early and immature.), 300 units Follistim, and 7.5 units hcg. My ultrasound today showed 4 follicles: 18, 16, 15, and 12 mm.
  • CD 10-11: 3 mg Cetrotide, 300 units Follistim, and 7.5 units hcg.
  • CD 12: 8:30 am – Trigger time! 10,000 units hcg delivered to my tukis. Ultrasound showed 23, 22, 21, and three 12 mm follicles. I was told the 12mm follies wouldn’t amount to anything.
  • CD 13: First IUI at 9:30 am; 24 hours post-trigger. 77 million of DH’s swimmers at 86% motility. My RE said he likes to do IUIs at 24 and 48 hours post-trigger to make sure we catch ovulation.
  • CD 14: Second IUI; 48 hours post-trigger. 86 million at 96% motility. Supercharged! Lots of ovary pain as I woke up this morning; my nurse said I likely ovulated late the night before. On this day, I also started 5,000 units of subcutaneous Heparin twice daily to combat the inherited thrombophilia.
  • CD 15, 18, and 21: 1.5 mL subcutaneous hcg booster shots. RE said this was to up my progesterone production and create a better environment for implantation. Since I’ve had issues in the past with my progesterone falling into the toilet while I was still pregnant, I also added 1 daily 8% Crinone supplement in the evenings. I’ve gone through all of this so far; I refuse to let something like not enough progesterone tank my chances. Bad eggs creating bad embryos…I’ve learned to deal with that. I would never deal well with not adding something simple like extra progesterone and ending up with another miscarriage.

And this brings me to now, CD 26. I’ve tested every 48 hours so far to “test” the hcg boosters out of my system. I figure by this Friday, 3/11, I’ll be able to see which way the lines are going – lighter or darker – to determine if this shebang worked. I still don’t know that I’ll have a blood test taken next week. If I’m pregnant, I’m pregnant. With the Heparin and daily progesterone, I’m already doing everything I can to keep the baby. A blood test won’t do anything; and seeing a doctor won’t stop a miscarriage. I’ll just make an appointment for an 8-week ultrasound. And if I’m not pregnant, I’m not.

In the meantime, I have e-mailed back and forth with Eva Kopecna, my coordinator at Reprofit. DH and I still have 10 donated eggs on ice in Czech, and we will be paying storage fees again in June to keep them. We paid €90 for one year of storage last July. If this IUI cycle is a bust, well…we’re still squirreling money away for a second trip to Brno for another DE IVF. And you know, I’m actually REALLY missing that region. Funny, no? I learned how to make Czech Goulash (Hovězí Guláš) and Wiener Schnitzel from Vienna, but it just isn’t the same!

Refreshed and ready to go

It’s been about 4 months since I last wrote a post. This time has been taken for my husband and I to just live life. Breathe, heal, enjoy the summer heat. Once summer was over, we continued enjoying the frazzle-free life of not TTC. And then, we both felt we were ready.

I had an appointment with my RE in September to assess how we should move forward, and got some surprising news (both good and bad). The good…Dr. Albrecht from Albrecht Women’s Care (they specialize in treating women with low ovarian reserve) had Day 3 labs drawn and they came back GREAT. So great, in fact, that he believes he can get me pregnant with my own eggs. Holy shit.

FSH: 5

AMH: 1.4

E2: 31

LH: 5

TSH: 1.53

Prolactin: 13

Vitamin D: (The nurse didn’t give me a value, but she said it was great, and they normally don’t see that.)

Did you see that AMH?! That’s up from 0.28 about two years (or so) ago, and up from 0.7 almost 4 years ago. The supplements I’ve been taking (I’ll post them again at the end so you don’t have to dig through my old posts to find that info.) have really worked!

And now for the bad…he also did a saline sonohysterogram to assess uterine architecture, since I hadn’t had an eyes-on exam in a few years. He found what he believed to be a fairly large submucosal fibroid (the kind MOST likely to affect fertility) pushing into my uterus, taking up rent-free space in the majority of my uterine cavity. It was large enough that he recommended surgery over management with medication. He also said he believed that rat-bastard lump of tissue (my words, not his) may have been partially responsible for my recent miscarriages.

Mayo uterine fibroid

So, we scheduled me for a hysteroscopy. I had that done the first week of October. The surgery actually wasn’t bad at all. I went under general anesthesia, woke with a bit of pain, but that was taken care of immediately (my recovery RN accidentally double teamed me with an oxycodone pill and dilaudid in my IV before I was conscious enough to tell her she had the wrong patient information sheet and I wasn’t, in fact, prescribed oxy. I pretty much slept the rest of the day. It was actually quite nice. But…ahem…don’t do drugs, kids.). I had light pink spotting for the first day or two, then I was in the clear. My period came about a week later, a week early. My cycles have been normal since.

When the pathology report came in, we learned that it wasn’t a fibroid invading my space, but an adenomyoma. Adenomyosis occurs when cells from the uterine lining grow into the the uterine wall (think endometriosis, but inside the uterus.). The site referenced with the above link lists the following:

The evidence that adenomyosis causes infertility includes:

  1. In women with adenomyosis, the muscles cells in the uterine wall swell and they function differently than normal uterine muscle cells.
  2. In women with adenomyosis, the lining cells of the uterus do not go through normal changes during the menstrual cycle.
  3. In women with adenomyosis, the uterine lining cells cause inflammation in the muscle wall which interferes with the movement of the fertilized egg inside the uterus.
  4. In women with adenomyosis, there are changes in the uterine lining cells that interfere with implantation of the fertilized embryo.
  5. Surgical removal of adenomyosis or medical treatment with GnRH agonists (Lupron) increases the chance of pregnancy.

Well, fuck.

I’m just starting to feel like a walking fertility train wreck. How many things can go wrong with one fucking person??

That sentiment aside…I just had a second post-surgery check up with Dr. Albrecht yesterday; another saline SHG. He gave us the green light for moving ahead, saying my uterine cavity now looks perfect. He’s also decided to go aggressive with me. Given the fact that I’m 38 with a fragile-X premutation and a history of low reserve, he told us that he wants to shoot for 5-6 follicles for an IUI cycle (we still can’t afford IVF in the states, and I love, love, love my RE right now.), with the understanding that at least a couple of them will be duds. We also discussed the possibility of selective reduction (I’m no Octomom or Kate + 8), but the Doc doesn’t think this will be an issue. He said in cases like mine, he’s had one set of triplets born over the last 30 years, with no selective reductions performed. Hubby and I are comfortable with this, and with Dr. A.

I will be using Femara, Gonal-F, Cetrotide, Micro HCG, and Heparin (he chose Heparin instead of Lovenox for the first trimester and prep as his research has indicated it has a better outcome with clinical pregnancy with regard to autoimmune and inflammation issues) during this cycle. That’s a LOT of daily shots. But very much worth it if we bring home a baby.

I’ll post more once we figure out when this will happen, to include protocol, dosages, medication information, timing, etc.

In the meantime, my supp list, reposted (and confirmed with Dr. A.):

  • 1200mg Fish Oil (600 A.M., 600 P.M. / Spectrum and Nordic Naturals are good brands) **Make sure to consult with your physician before taking a dosage this high. It has an anti-coagulant effect.**
  • 400mg Ubiquinol CoQ10 (Jarrow) in the A.M.
  • 4000 IU Vitamin D3
  • 1000mg Calcium Citrate (500 A.M., 500 P.M.)
  • Fairhaven Health OvaBoost ( 4 pills P.M. / contains CoQ10, 2000 mg Myo-Inositol, melatonin, 100 IU Vitamin E, Alpha Lipoic Acid, Grapeseed Extract, and 400 mcg Folate (there is a difference between Folic Acid and Folate!! Additionally, there is a difference betweenvarious types of Folate.)
  • Neevo DHA Prenatal Vitamin (1 A.M. / prescribed by Dr. A. This is his preferred brand of prenatal for those with MTHFR.)
  • Seeking Health Iron Plus Cofactors (1 pill at lunch)
  • 100 mg Natrol Pycnogenol
  • 81 mg Baby (low-dose) aspirin
  • **New** Added per Dr. A.: 40 mg PQQ (20 A.M., 20 P.M.)
  • **New** Added per Dr. A.: 1000 mg Acai Berry Extract (500 A.M., 500 P.M.)

Dr. A. also told me that if my AMH had been below 1.0, he would have had me on 75 mg micronized DHEA (25 mg 3x daily) from a compound pharmacy.

Well, I think that’s enough info for now. This post has inadvertently turned into a monster. Until later…