Tuesday, July 27, 2010

Sp.erm DNA fragmentation: what's next

For Q&A #2
Mrs. Katia asked: I'm wondering, though, if you ever re-checked Mr. Hammer's sperm fragmentation after a few months on the supplements? We might have the same problem here, and my husband is on pretty much the same stuff! I was excited to see that. However, we aren't going to send in his sperm before trying again. I'm just curious if you know there was a difference in the dna integrity or if you're hoping like we are. Thanks!

Excellent question and one we’ve been debating about for a few months now. Prior to our cancelled IVF cycle #3 we were set on not checking. The reason was because the decision would not change if we were doing IVF or not. But now that we’ve had a chemical pregnancy via IVF to IUI conversion we’ve become more curious about whether all these supplements have been effective. We’ve never had ANYTHING happen with our 5 other IUI’s. And we have time to get it checked prior to IVF #4. Being faced with the very real possibility that IVF will not work for us has made us wonder now, with supplementation, if we could ever get pregnant on our own. And the chemical pregnancy has given us some hope – crazy huh? Will that stop us from IVF #4? Nope. But if we have to move on to adoption it’s not like we’re going to stop trying on our own. The question then comes, do we stop the supplements? If they work, then the answer is no. But how will we know if we haven’t tested! And that is why we are now thinking it might be worth another check. Plus we’re currently on my insurance which will pay for 60% of the cost. Not too shabby when you consider that almost everything else is out of pocket.

So it’s very possible that in August we might be retesting Hammer’s DNA fragmentation. For those of you reading that are thinking, “What on earth is she talking about?” Don’t feel in the dark! This is a very rarely tested sperm analysis. We only got it tested because we kept getting gorgeous day three embryos to transfer that would end up in BFN or miscarriage. Typically the egg DNA drives the first three days of cell division, after that the sperm DNA kicks in and if it’s no good then there is no baby. Here is an excerpt from an article in RESOLVE about SCSA (the DNA test):

  • "Sperm DNA fragmentation has little or nothing to do with the parameters that we measure on the routine semen analysis. It has little to do with the shape of the sperm or whether the sperm are moving. It is a completely independent variable. Men with otherwise normal semen analyses can have a high degree of DNA damage and men with what was called very poor sperm quality can have very little DNA damage. More importantly what has also been demonstrated is that the degree of DNA fragmentation correlates very highly with the inability of the sperm to initiate a birth regardless of the technology used to fertilize the egg such as insemination, IVF or ICSI. Sperm with high DNA fragmentation may fertilize an egg and embryo development stops before implantation or may even initiate a pregnancy but there is a significantly higher likelihood that it will result in miscarriage. By testing for sperm DNA fragmentation, many cases of formally “unexplained” infertility can now be explained. Many of those couples who have been previously unable to conceive with what would be considered extreme measures have been diagnosed with high sperm DNA fragmentation and treated. It is now very clear to see that having this information about the quality of the sperm can be tremendously helpful to couples and their physicians."

Hammer’s family has a history of infertility on his father’s side so when everything looked good but left us empty handed we pushed for this test and TAH-DA! 48% fragmentation, which is really, really bad.

<15% normal
15-30% good to fair = IUI or IVF for higher % in the range
>30% poor = IVF w/ICSI

If you want to read more about it, Conceive This!, wrote a really great post about it. And then there is also this website where I took the excerpt from, that provides another explanation.

So what causes it?
  • "The causes of high DNA fragmentation are those same causes of male factor infertility that we have known about for years such as chemical/toxin exposure, heat exposure, varicocele, infection, age, smoking, testicular cancer, radiation, and anything that increases the free radical levels in the semen among a list of many other things. It is very important to understand that sperm DNA fragmentation can change with time and it can be improved in many cases. The goal of a male factor evaluation is to seek out the causes of poor sperm quality and try to correct them so conception can occur naturally or to improve the sperm quality for IVF and maximize the chances of success."
How we have been treating the problem: (Hammer’s Supplements)

-Vitamin C 1000 mg (500 mg morning and evening)
-Vitamin E 800 IU (400 IU morning and evening)
-L Acetyl-Carnitine 1 gram
-L Carnitine 1 gram (morning and evening)
-Pycnogenol 100 mg
-Co Q-10 75 mg
-Centrum’s One-a-Day Men’s Health

In addition to vitamins we are both drinking antioxidant smoothies:

1 oz acai juice
1 oz pomegranate juice
1 oz frozen wheat grass
½ cup organic blueberries
½ cup organic orange and/or pineapple juice
½ cup organic yogurt
2 tbsp raw honey

I will say that, for myself, after 6 months of drinking these smoothies, plus a multivitamin and 100 mg Pycnogenol I went from having questionable antral follicles on my left ovary to having excellent numbers on both sides with my left better than my right! So if it worked for me I really hope it worked for Hammer.

*As before if you have any other questions for me just leave them in the comments and I will do a post about them.

Friday, July 23, 2010

Old Plan, New Twist

For Q&A #1
Karaleen* (Kdactyl) asked: "Are you going to insist on a different protocol or see another RE? I know you are concerned about response and the fact that your current RE has not changed much up to try for a better result..."

Our meeting yesterday went well. After giving things some thought and a ‘pre-cancellation’ conversation I had with my RE, we came to a decision that we hoped our RE would support. Hammer still wants to continue at this clinic so nothing has changed there. I didn’t want to do another microdose cycle since this last one was such a disaster. We concluded that we’d like to go back to what we did with cycle #2 because at least we got 8 mature eggs and a pregnancy from it. And since this IS our last cycle it was better just to do what we know worked rather than try something new again and end up with another disaster.

The good news is that our RE started off the meeting with the same suggestion. He didn’t think another microdose cycle would be a wise decision. I was happy about this because he had initially been talking about that during our ‘pre-cancellation’ conversation. I also wanted to explore dropping the lupron a bit so instead of 10 and then down to 5 maybe 8 and then down to 4 or 5 and down to 2.5. He wasn’t supportive of that suggestion because he felt that giving me 6 vials a day of stims (450 IU) would overcome the suppression enough to hopefully get us 10-11 mature follicles. I was disappointed to hear this and honestly I’ve been mentally contemplating being ‘lazy’ with my doses and self adjusting it anyway – is that bad? I do fear that if anything went wrong I would totally blame myself and I’m scared for anything to go wrong because this is it, seriously this time. Unless the clinic cancels me we are going ahead with retrieval and hopefully transfer.

I also picked his brain as to if he thought I had diminished ovarian reserve or was a poor responder. I was pleased to hear that he didn’t put me in either category but did say that I might be one of those people with insensitive FSH receptors. But that seems unlikely since my FSH has always been normal – also his opinion. Even he said with my AMH he would have guessed 3 vials a day would have been enough. So instead he said it’s like I have the ovaries of a 36 year old. Funny, I’ve know lots 36 year olds who rock the stims. In fact I know more that do than don’t. Oh well. I guess I was always mature for my age emotionally so why not add my ovaries into that category.

So mid August we’ll be starting our last cycle by trying to recreate cycle #2 with a happy ending this time. BCP, 10 u Lupron – then down to 5 u, 6 vials of Gonal-F/d, and 1 vial of Luvaris/d.

Ok now a slight confession (please don't be mad):

My test wasn’t totally negative on the 16th but it was very faint (FRER) and it was also only days 9 post booster and not the recommended 10 days. Why the IVF nurse had me test a day early I don’t know but my RE’s nurse told me to test again the next day. I did and while it was still positive it was also lighter. I tested Sunday and Monday as well watching the line fade more each day. Finally this Wednesday AF made her appearance. When the RE asked when I had started he was surprised to learn it was ‘late’ compared to what he had anticipated. He confirmed that we likely had a chemical pregnancy. Hammer and I are just going to take this as good news that my tubes are open and his boys reached their target. Also we never had anything happen with our five clomid IUI’s so maybe these vitamins are working. It also reassured us again that cancelling was the right decision; those eggies might not have been the healthiest since my body really didn’t like microdose lupron. It also opened Hammer up to the possibility of seeing a local Dr that does NaPro technology if IVF does not work and we have to go on a wait list for adoption. I guess that’s a topic for another day but first I want to focus on IVF#4. So bring on more wheat grass smoothies and vitamins! Mmmm; yummy.

If you have any other questions for me just leave them in the comment section and I'll write up a post about it.

*I just had to tell you your name is SO pretty!

Thursday, July 22, 2010

IVF #3 Summary

I wanted to post the timeline of our second IVF cycle to close it out so here it is:

  • May 25 to June 2 - Take antibiotic (Mr&Mrs Hammer)
  • May 25 to June 14 - Take BCP
  • May 27 to June 25 - Accupuncture pre-retrieval
  • June 15 - Supression check E2 = 13, good antral follicle count on BOTH ovaries!
  • June 17 - Microdose lupron 20u 2x/d
  • June 19 to June 28 - Bravelle 225u (3 vials) 2x/d
  • June 23 - follie check #1 R - 9,8.5, 7 L - 8, 8, 7, 6 lining 5mm, E2 = 282
  • June 25 to June 28 - Add in Luveris 75u (1 vial) in A.M.
  • June 26 - follie check #2 R - 12.7 x2, 12.9 L - 11.5, 11.3, 11.1, 10.3, 8.2 lining 8.8mm, E2 = 871
  • June 28 - follie check #3 R - 21, 17, 15.5 L - 16.5, 15.5, 14, 12, 11 lining 11.5mm, E2 = 1592
  • June 28 - Egg retrieval cancelled due to poor response (~4-5 mature follicles). Trigger for IUI.
  • June 2/9 - Trigger
  • July 1 - IUI
  • July 5 - Accupunture
  • July 7 - HCG booster (1 ml)
  • July 16 to July 19 - HPT = Positive but line fades over the next 3 days; Chemical Pregnancy

On to our final IVF#4

Wednesday, July 21, 2010

Q & A - Fire Away!

I've had lots of really great questions from some of my readers but haven't really figured out a good way to respond so I thought I'd do a Q & A session. I have three questions already that I'm going to do posts on from:

Amber @ Fertility Hiccups - Acupuncture: what to expect
Mrs. Katia - Sperm DNA fragmentation: what's next
Kdactyl - IVF#4: the plan

I'll be addressing Kdactyl's questions first because my "What-the-flip" (WTF)* appointment is tomorrow. So I"m just opening up the floor for anyone to ask me any question and I'll post a response.

*'What-the-flip" is how I say it because I just can't bring myself to say the f-bomb.

Tuesday, July 20, 2010

Winner, Winner, Chicken Dinner!

Sorry for the delay in posting the winner of my giveaway.  The winner is....

Amber at Fertility Hiccups

Congratulations Amber.

Leave me a comment with your mailing address and I'll send you your prize.

P.S. Don't worry I won't publish your address :)

Friday, July 16, 2010

A Long Shot

That's what we knew this IUI was, a long shot.  So today we were not overly surprised that the HPT was negative.  We're both at peace with our decision to convert IVF#3 to IUI and are hopeful to give IVF#4 one last final try.  Thank you all for your prayers and support!

Thursday, July 8, 2010

7dp IUI and a Giveaway

Today marks the half way point of our IUI converted IVF cycle; although, thanks to the HCG booster I can’t test for 10 days which would be 17dp IUI – Bummer. But! I don’t have to take any more shots which is awesome. Then again, I also can’t tell you if I’m having any symptoms because I still have trigger-boob-soreness, etc. I can definitely tell that my progesterone is elevated as I’ve had severe indigestion for the last 5 days making eating or sleeping impossible. That was identical to the last two IVF cycles. And you know what else nobody tells you? (TMI Warning) When you ovulate a crap-load of eggs and have multiple corpus lutems pumping out the progesterone you get major constipation. I thought that was just a weird side effect of PIO but no, it’s progesterone in general. I have been having cramping on and off yesterday and today. While it could be implantation it could also be the progesterone causing my ute to cramp (or gas pains! yelch).

Basically, I know nothing right now as far as what may or may not be going on down there. And my hope level is dependent upon how I maybe feeling at that particular hour. I do have moments where I think, “Nah, it couldn’t happen like this. I would be too easy! And after four years of infertility, people like us don’t get it easy.” But oh how nice easy would be!

Ok now onto the Give Away!

I received, Waiting for Daisy, from Hillary at Making Me Mom and while I read it right away I lapsed on getting out a giveaway post. (What can I say, I had a crappy 2009 = 2 deaths, 1 near death & a miscarriage).

It’s a nice, easy read about a real life couple dealing with infertility and eventually having a child. While I enjoyed the book and the hope that eventually our family will be complete even if it’s a long painful journey I wasn’t a fan about her mildly preachy ending. In summary she basically said that women get too worked up about not getting pregnant right away and run off to a RE, drop all sorts of money on procedures and tests when eventually they would have gotten pregnant on their own. Being a person who has dealt with infertility for several years and can safely say that we need help, that message kind of deflated the book for me. I worry that this message is what non-infertile people will take away from the book. But then, why on earth would a non-infertile want to read this? Basically, I wouldn’t recommend it to any of my non-infertile friends to help give them some perspective. But for infertiles it’s nice to know that someone who walked in our shoes has published a book about their struggles.

So on to the rules for the give way:

1. Leave a comment on this post*

2. Read the book

3. Have a giveaway at your blog to keep the book circulating

Now that wasn’t so hard was it? I’ll take entries up until my HPT day (July 16th) and then use Random.org to pick the winner. I’ll contact you to get your mailing address so you can receive your prize.

*If you want to leave a comment but not be entered in the drawing just let me know in your comment.

Friday, July 2, 2010

Two Cranky Ladies

Well we had our IUI yesterday and everything went really well. Mr. Hammer supplied some excellent numbers and quality as far as the troops were concerned. I actually felt myself ovulate from both sides around 1:00pm that afternoon, OUCH! So I think the timing was good. Unfortunately my girls are making me pay for shooting off way more follicles than occurs naturally. I feel like I’ve been bruised from the inside. I think they are cranky and telling me all about it.  I’m sure I’ll feel better in a day or so and from what I can remember it’s better than the retrieval (of course I was also on some really good drugs for that procedure).

We decided just to take the whole day off together. After everything this month we both felt we needed a mental health day. (And after feeling the eggs launch it was a good decision too!) I started thinking about my past IUI”s with clomid plus hcg trigger shots. I remember feeling ovulation pains around 10am the day after the trigger and thinking, “should I be ovulating already?” And then the next day when we did the IUI, I wouldn’t have any ovulation pain. When I did my first IVF I was panicked that I was ovulating the day before retrieval just as before but surprised to learn that they were all still in place the next morning. When I asked about this the RE on call said that lupron helps keep them in place longer. I know what I’ve read says you will ovulate as early as ~24 hours after the trigger without suppression but I’m just suspicious that my body had a mind of its own. Of course it’s all speculation and Hammer’s thought is that even if it was on time his boy’s would have been too genetically retarded for it to work. I hope that with a ton of eggs and vitaminized sperm that we can make it work this time. It’s hard not to have a little hope!

P.S. If we had gone through with the retrieval we would be 1 day post and getting our first fertilization report. Let’s hope there is some fert-magic going on in my tummy today!