Thrombophila Results and Breaking Ties

Sorry for the delay in posting about our visit to the RE this week.  I had started the post that afternoon but then I had a 3 day work trip the very next day.  And to top it off the monitor on my laptop cracked so it was basically unusable and hence no lap top to write my post.  But now I'm back home with a computer so here it is!

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We met with our RE regarding all the thrombophilia blood work I had done and everything came back as normal except one: MTHFR A1298C heterozygous. Apparently if you have to have one, this is the one to have. Yea me. And we never would have known about it if I hadn’t pushed for the test. Seriously, we are our own best advocates.

So what does this mean? Well it could effect implantation as well as clots that could have cut off blood flow to the baby. Although our RE is in the camp of Drs that only partially believe that it’s a problem so he wasn’t much help there. Honestly being back in that clinic talking with a Dr. that I have lost my trust in was so emotional for me. And to top it all off, as the RE was going through my results he absent mindedly pulled out our last ultrasound photos to get them out of the way while reviewing our chart and left them right there IN FRONT OF ME. So the whole time I had to stare at these pictures. Who does that?!?! I was really too emotional to talk and Hammer asked most of the questions, he did a really good job speaking for us. Here are some of the questions and answers we got back:


So do you think the MTHFR is part of our issues?

Not necessarily but I would put you on Folgard in the future.

So then as far as a possible embryo adoption cycle, would you do anything different?

I’d irritate the uterine lining because it might help with implantation although we generally use that for women who cannot conceive and you have proven that you can. It would really just be prophylactic since I think it might be an implantation issue. I’d also do the folgard as discussed and increase the progesterone.

Interesting that you would increase the progesterone. Do you think that this was our issue since the progesterone was 6?

No, your corpus luetum at that point in time was gone and the placenta should have taken over in the progesterone production so that’s probably why it was low.

So you don’t think that the progesterone could have been low the entire time due to an IVF cycle where you needed to give me progesterone thus causing a potential clot and preventing the placenta from functioning correctly?

Well most women don’t even need progesterone but we give it anyway because we don’t know who those women are necessarily.

Right, but in my case I wasn’t on any progesterone for nearly four weeks so could I have been one of those women?

[Here is where our RE generally makes odd faces and grunts while he tries to come up with an answer and generally ends up just repeating himself]

So if we did another IVF cycle what would you do differently there?

Same thing as the embryo adoption: uterine irritation, Folgard, increased progesterone and assisted hatching. [way to read our record because we did that this time!] You could also take DHEA at 50 mg.

Wouldn’t you want to test my testosterone levels first?

No, you certainly wouldn’t have high testosterone [Red flag for me here ladies because from what I've read you should never give it without testing first!]

So you wouldn’t change up the stimulation at all?

No other than maybe give you another 75 units of stims.

When we had a follicle check by Dr. S, he asked if we were on a combination Clomid/Injectable regimen?

I would not do that.  There isn't enough proof that it helps.


At this point I was completely done.  I feel like the deadhorse in the proverbial saying and he has the whip.  Seriously, what more can you get out of me using the same protocol every time!  We basically ended the meeting with him telling us to take some time to come up with a plan on what we want to do next. 

Afterward, Hammer and I sat in the car for a bit to talk and absorb everything.  While we did not come up with a plan, we did both agree that we were done with this RE.  Hammer himself said that he didn't feel our RE understood how to help couples that fall outside of the norm like us.  Finally!  He sees what I see!!!  We did discuss getting a second opinion at a clinic an hour and a half away (and that was Hammer suggesting this too!) but we're not moving ahead with that right now.  Although we have learned that this clinic basically takes the patients that ours cannot get pregnant and need more unique, individualized protocols.  Honestly it's not a given that this will happen but Hammer is more open to still trying after the most recent events. I think now I understand why I felt unresolved about ending treatment before.  I was so frustrated at why I could not feel resolved about our treatments coming to an end and ready to move forward with adoption.  I felt a bit of jealously for people who had this clear direction that I was lacking.  I'm not sure what God is doing right now, why he allowed this pregnancy to happen and end the way that it did.  The way is not much clearer than before and we are still praying for direction but we do feel that we are closer than ever to figuring things out.

I am my best advocate

So after some thought, I did not get my blood drawn on Saturday.  Instead, I waited till Monday and requested that they add in the test for MTHFR.  Which they did.  So later that afternoon I had 5 vials of blood drawn; one for each test.  We'll have our appointment to get the results on 1/25 and maybe we'll have some answers.

Completion

Today AF arrived which signaled the completion of our miscarriage. Really everything with the D&C was text book. I barely bled the day of the procedure, had no bleeding for 20 days after the surgery and took about 5 weeks for AF to arrive. I suppose if you have to go through one this would be the best outcome.

I also got my list of additional blood tests that I will have drawn tomorrow:

• factor V (Activated Protein C Resistance) - treatment = heparin or aspirin; may need Foligard if due to high homocystine levels

• antithrombin III (AT III) - treatment = heparin

• protein S (normal is greater than 60% non pregnant, greater than 35% pregnant; If positive retest for free and total values) - treatment = heparin

• factor II (Prothrombin) - treatment = heparin

So at our next appointment we'll get those results as well as for the other two tests for anticardiolipin or lupus anticoagulant.

I am curious why he is not testing for the following:

Protein C - recommended to be tested along with protein S
Fibrinogen
Factor XIII
fibrinolysis (PAI-1)
thrombosis (Human Platelet Antigen-1)
Methylenetetrahydrofolate reductase (MTHFR) gene

I know that I've read they have been associated with 2nd and 3rd trimester loss but I have also heard that a high number of people have MTHFR and that if it is associated with another of the clotting tests that it's a bigger problem. Hmmmmm.

Thank you for all your kind comments and those that shared your stories. It's been a great encouragement. And let me clarify that when I say, "I'm to blame" it's more a wording rather than a negative thought I have about myself. So no stinkin thinkin is going on :)

D&C Results Are In

We just got the results of the D&C. There was NOTHING wrong with our baby.


Of all the results I prepared myself for this was the one I feared. Strange really since it should give us some comfort and joy to know that we can make healthy babies. But now I have to deal with what caused our baby to die. Was it my body? Or worse, was it because of a lack of progesterone because they had told me to stop giving it? I have literally being avoiding this possibility because I have been afraid to let my mind wander down such a dark path of anger and blame if I didn’t have any proof. But now I’m not sure what to think. I am getting more blood drawn for additional tests to see if for any reason my body rejected the baby. Until I get these results I’m still going to withhold my judgment for my own mental health. I still need to recover emotionally from this loss. I should know in 2 weeks if I am to blame or our clinic.

D&C and Next Steps

I delayed posting this because really, who wants to read about a D&C at Christmas? Not me. But I wanted to get this out and over with before the start of the new year. That way we can put this horrible mess behind us and try to move forward.


On Thursday Dec 2nd Hammer and I drove to the outpatient surgery center. I had been NPO (no food or liquids) since midnight and my stomach was a ball of nerves. We checked in at the front desk and I swear the lady knew why I was there because she kept giving us these, “I’m so sorry” eyes the whole time. Hammer and I sat in the waiting room and I snuggled into him with my head on his shoulder. I could not believe that we were actually waiting to have this procedure and my eyes would well up with tears from time to time. Finally a nurse came to take me back to the pre-op room and I had to leave Hammer behind for a bit. As we walked towards the big double doors to the pre-op area I had to stop and broke down and cried. The Nurse gave me a big hug and I apologized that the reality of what was about to happen just hit me hard. She wrapped her arms around my shoulders and said that we’d walk through together. And we did just that all the way to my pre-op room. Once she drew the curtains closed she gave me a huge hug and then to my surprise told me that the Lord has not forgotten me and has plans for us. Wow. She was so sweet getting me settled in and once she was done she went and got Hammer so he could sit with me. While we waited in pre-op Hammer kept kissing me and telling me to remember each one. And then at one point he told me that he was talking his vitamins because he heard that couples are more fertile after this procedure. We had a longer wait than expected because our anesthesiologist got a phone consult. During that time I kept rubbing my tummy and saying goodbye to the little one that was not meant to be. Once he was off the phone he came in to tell me what anesthesia I would be on but really all I cared about was that I was out cold and wouldn’t remember a thing.

Finally they came to take me back. I was wheeled into the operating room and helped up on to the table. The anesthesiologist asked me some questions which I don’t really remember now because he was adding my drugs to the IV. I do remember my doctor attaching the leg harnesses to the table and I had a moment where I realized what an unattractive position I was about to be in with my legs splayed in the air. And at that same moment I realized the lights were spinning around above me and the last thing I remember saying was, “Oh good, the lights are starting to look funny.” And I was out. The next thing I remember was coming to in the recovery room. My first instinct was to reach out and touch my stomach but that brought on the realization that it was all gone now and I wept. I had a new nurse attending to me and she brought me tissues and sat with me. And to my amazement again this new nurse told me that the Lord has plans for us. She let me cry, comforted me and never left my side except to get Hammer when it was time to leave. It was overwhelming to think who these women are that spoke words of comfort to me in our time of sadness. They did not know us, our faith, what we had been through but both of them spoke the same words, “The Lord has plans for us.”

I spent the rest of the day sleeping off my anesthesia on the couch while Hammer took care of me. I was sore and had to take ES Tylen.ol for the pain. The next day my mom came and stayed with me while Hammer went back to work. Later in the day my brother stopped in to keep us company and watch movies. By evening time Hammer came home from work and my dad even stopped by. We all had dinner together and honestly it didn’t feel intrusive or overwhelming, in fact I enjoyed having them all there.


Saturday, Hammer was determined to make our house look Christmas-y. Secretly I think he thought it would cheer me up. He put up the outside lights and even took me out to get a tree. I only wanted a small one but we ended up leaving with the biggest tree we’ve ever had. The stump barely fit in our tree stand. But Hammer insisted on it even though he had to carry and put it up with very minimal help on my part. Later that day he brought up all the boxes of decorations even though he ended up putting most of them by himself once I had tuckered out and passed out on the couch. I appreciated all he did that day as my initial response was to do nothing this year. But now that Christmas has come and gone I think it would have just put me in a more depressed mood to have done nothing.


Sunday evening was my parent’s church’s annual Christmas Cantata which my mother performs in every year. It’s also the church where Hammer and I were married. While we attended I don’t think I was prepared for the overwhelming flood of emotions that hit me. Sitting there made me think about all the dreams and plans of a future together, of a family that were made on our wedding day. And now we sat there 6 years into our marriage, childless, with nothing to show but years of heartache and two losses. I broke down into tears and cried nearly the whole time.


Afterwards they had refreshments and I ran in to the choir director and his wife. They learned that morning of our loss when my mother shared with them what had occurred (she had asked me first). They went on to tell me that their own daughter is now expecting after 7 years of trying and loss and she too had been silent about their struggle and asked her parents to say nothing. Because of this they had suspected that we were having the same issues and revealed that they had been praying for us for the last two years. I was so touched and it brought me to tears once again. I now understand why my mom had asked to share with them.

Three times I had been touched by words of comfort; twice from a stranger and once by a family friend who I had been reluctant to let into our struggle. It has made me realize that we are not forgotten and that the support of trusted family and friends is so important. I will not sugar coat the fact that going through our second Christmas in a row after a miscarriage is one of the most difficult experiences to endure. But I do feel hopeful and I don’t know why exactly but I just feel like we are going to be ok.

We have an appointment for Hammer with an Andrologist at the end of January and maybe we’ll get more answers. But for right now the fertility treatments are done. We still need to discuss the option of embryo adoption but the appointment for the adoption agency is on hold until next year. We just need some time. I am still waiting for my period to come. I’ve read that it takes 10 days after the procedure for your hormones to come down and 20 days without bleeding for your body to reset properly. I have not had any bleeding since the day of the procedure and we’re now at 26 days post D&C. Hopefully AF will be coming soon. I’m actually looking forward to her arrival as it will finally signal the end of this whole debacle. Our results from the D&C are not back yet but we will have an appointment hopefully in the next couple of weeks to discuss the results of the testing and my blood work. Right now I am just using the clinic to get the testing done and trying not to burn bridges in case we need to use them for embryo adoption. I hope that 2011 will finally be the year for us to expand our family one way or another.

Wrapping my Mind Around it All

Now that it's been a little over a week since our D&C I've been trying to get a grip on everything that happened starting with how our IVF cycle ended now that I have all of the information. So here is the whole synopsis.

I guess when they called us with our blood hcg on 10.23.10 the level was 5 and apparently anything 5 and under is negative. So the RN just told me the blood value was negative. I got my period the next day which I thought was odd because normally after I stopped the progesterone it takes like 3 days to come. But I figured it was a blessing. I had a normal 4 day, full blood, yucky, crampy period. Then we went about our lives trying to move on. We went out, ate sushi, drank wine (a glass) etc. I was tired but it was also daylights savings time so figured my body wasn’t adjusting well. Then around Nov 8^th or so I was having mild nausea but it would come and go and wouldn’t be every day so I really thought nothing of it. That same day I started having what I thought was ovulation pain on the left side. I had that sharp twitching that lasted just for a a few seconds and never happened again. I went home that afternoon and took an ovulation test which came up very positive. Even though we didn't 'prep' Hammer for that cycle we did enjoy our selves that night. I had ordered some Instead Cups as I had heard they might help keep the boys up near your cervix. I thought this would be a good time to try them out but certainly didn't think that anything would come of it. On a side note, the Instead Cups fit "most" women but I am not one of those women. When I took the cup out after only a few hours and feeling very uncomfortable the whole time I saw blood and it freaked me out. I have never had mid cycle spotting but I figured that maybe I just irritated my cervix too much trying to make my first attempt to put it in. Total disaster. So I resolved to get a Diva Cup instead which come in different sizes. November 11th was our meeting with the RE and while I sat in the office with him making random guesses that my eggs must be bad because "what's left," I was actually pregnant, oh the irony.

I went to get the flu shot on Monday Nov 15^th and had to fill out the same form 3 times because I kept circling ‘yes’ that I was pregnant and I totally didn’t think I was. I chucked it up to wishful thinking and fatigue and got the shot. A few days later the nausea came in full force and while I never got sick it was hit or miss if I could get up the urge to eat anything. I thought I got the stomach flu from the shot and totally forgot about how I had mild nausea the week before. Later in the week my mother kept telling me to take a HPT but I refused rationalizing that it didn't make sense because I was only a week and a half post ovulation, or so I thought. So certainly my nausea couldn't be morning sickness. My period was supposed to arrive on Friday Nov 19^th but because we’ve been dealing with this for 4 ½ years I’m not really quick to test and wanted to wait to see if it was actually late. We had a wedding for my cousin that weekend so we were out of town and staying at my parents house. I have to admit that over this weekend I did start to get suspicious. My boobs were totally getting sore, the fatigue was setting in but the nausea was lifting a bit and the food cravings and aversions were starting. I was starting to feel more like I did with our first pregnancy where my symptoms started right away. So based upon that factor I thought that maybe we did get pregnant on our own. I never thought that it could be from our IVF cycle because I had a blood test that was negative and period!

When Monday Nov 22 rolled around and my period was nowhere in sight I took a test and it came up positive immediately. Hammer and I were shocked but we totally thought that it had happened naturally. I called my RE and asked for a blood test. The next day we were shocked again to hear it was over 61,000 which falls around levels for 8 ½ to 9 weeks. They immediately scheduled us for an u/s the next day. I took the day off of work just in case which turned out to be a very good decision. At the ultrasound the room was a bit crowded as it was our RE, a student, Hammer and myself. When the image of our baby showed up on the monitor I was totally shocked to see just how far along we were. This was the first time we had ever seen not only a placenta, but an aminotic sac and a little baby attached by it's umbilical cord. It had little hands and feet but as much as I tried to see it there was no flicker on the screen. I kept saying "I don't understand, I had a period, I had a negative blood test." Our doctor did measurements and officially told us that he didn't see a heart beat. He then started rambling on about the crown-to-rump length but honestly after I heard that there was no heart beat I didn't hear anything else. I was in total shock but I do remember telling him that I can't end the pregnancy just yet. After the ultrasound we went back to his office and I slumped into one of the chairs and kept saying, "I don't understand" over and over again. He said that we would be just fine waiting till next week and had his RN schedule another ultrasound for the following Wednesday. When we left the office we went to see my mom who was in town and told both her and my brother, who happened to be there, our shocking news. My mom is a former pathophysiology professor so she was whipping out her manuals and asking us developmentally what we saw on the monitor. It was at about 7 1/2 to 8 weeks development. We went through Thanksgiving weekend in a state of shock and sadness. I totally felt pregnancy symptoms the entire time which was confusing. I could barely eat any of the Thanksgiving meal as I was having food aversions and spent most of the night asleep on the sofa at my Aunt and Uncles house. As the week went on leading up to our appointment I noticed that I started showing. I also discovered I could only fit into two pairs of pants. I'm not a large person so it was very apparent that at only 91/2 -10 weeks that my tummy was sticking out already making it much more emotionally difficult to know that our baby was gone.

The day before I requested to have my hcg and progesterone done so we would have the results at our appointment. The following Wed I had both Hammer and my mother come with me. I also requested no student be present as it was just too much to handle that again. Unfortunately the ultrasound confirmed again what we had already learned the previous week. My mom was there to ask questions that we just wouldn't think of to ask or be too emotional. The baby looked smaller on the screen but I think it just wasn't as good of an angle as the last time. This time we could wrap our minds around it a bit more and felt more prepared to make a decision. My hcg though had continued to go up and was now near 70,000 while my progesterone was only 6. I was hoping that maybe if the hcg was going down it would help make a decision but I was surprised to hear about the progesterone. I have to say it made me suspicious since I hadn't been on progesterone at all. But our RE said that the majority of women don't need the progesterone and likely what I thought was ovulation was my corpus lutem twitching as it worked to increase the progesterone. But I still wonder as I have heard that low progesterone that does not cause bleeding can still cause a decreased amount of blood to the fetus. Our RE offered to let us go another week if we needed it and did say that we could do the Cytotec to bring on a natural miscarriage. But I was completely traumatized by that experience and I only had a gestational sac of 5 weeks that time. We decided to do a D&C because we wanted to have a pathology report done to see if it would give us some answers since we've tried for so long to get this far only to have so much happen and end in tragedy. I had a d&c scheduled for the next day (Dec 2). Since I was 10 week along and my placenta was quite large I didn’t want to try to have a natural miscarriage anyway. There was no knowing when it would actually happen since my hcg kept on rising and I was totally showing already. I don’t think I could have handled having to buy maternity pants just to wait out a miscarriage. And since I didn’t have any medical care, i.e. I stopped my progesterone and thyroid medication, we wanted to know if that was the cause of our loss or if it was genetic.

[I'm going to brag about my mom here because I think she is amazing]

On another note, my mom hated our RE. It made all my feelings more justified. I completely trust her medical opinion above all else as she is literally a walking medical dictionary. And she went head to head with him on the DNA fragmentation. Apparently because I had been talking to her about it she went and looked up the research herself. As editor of a medical journal and NIH grant reviewer she knows good research from bad and agrees with the research on DNA fragmentation as a likely cause of our issues. As we sat there still in shock and disappointment we did enjoy our RE getting his butt handed to him while my mom argued her points. Way to go mom.

Upcoming post...D&C and next steps.

At Peace

Thank you for all your prayers and support.  Today we went in for a follow up ultrasound but we did not see any growth or signs of a heart beat.  I am scheduled for a D&C tomorrow morning.  Last time I did the Cytotec pills but that was when I just had a small sac and this is much more significant.  Also this way Hammer and I can have a pathology report done to see why we lost our little one.

It is interesting to note that when we questioned further if our first beta was truly negative we found out that it was in fact 5.  Apparently they categorize anything 5 or less as negative.   That is fine except that ours was clearly not a true negative.  It has shaken my confidence in our clinic and leaves me feeling that they helped put us in this bad position.  I know it might not have changed the outcome but it does add to our frustrations. 

Shocking Update and Desperate Need for Prayer

Oh where do I even begin.  So I was expecting my period on Friday of last week but it was late.  I decided that maybe I was still messed up from IVF so Hammer and I decided to wait until Monday to test if I hadn't gotten my period yet.  When Monday rolled around and AF was no where to be seen I pulled out a free internet cheapie, did the deed and in mere seconds the test turned up positive.  We were shocked.

I called my RE's nurse that morning and went in for a blood draw late that afternoon.  Some where around 11am the next day I got a call but I could not have been prepared for what she was about to tell me.  My HCG was over 60,000.   I was speechless.  She told me that my RE thought that maybe the first beta was a false negative but since I 'bled' i.e. thought I got my period, we didn't do the repeat beta. 

I was scheduled for an ultrasound today at 10:30.  Sure enough there was a gestational sac, yolk sac, and fetal pole.  But to our dismay there was no heart beat.  The baby is measuring a bit off based upon dates, i.e. more like 7 weeks.

Hammer and I have decided to wait and do a repeat ultrasound next Wednesday.  We are asking for you to pray with us for a miracle.  Our hope is that some how this baby implanted so ridiculously late that we are just looking too early for a heart beat.  We know that the chances are extremely slim but God does do miracles. 

I still cannot get over the fact that I've been walking around for the last four weeks completely unaware that I was even pregnant.  Looking back I did have some tell tale symptoms.  But I think because I had such heavy bleeding immediately after our negative results, and that the bleeding lasted for four days we just could not imagine that I could be pregnant.  I mean for Pete's sake I thought I ovulated.  I even took an ovulation test!  As a side note I did go back and pee on another ovulation stick to see if maybe it would come up positive now that I knew I was pregnant and it did so I am just floored and very confused.  Please pray for us during this time.  We can barely wrap our minds around what has all transpired in the last three days.  Going from thinking we conceived on our own, to having extremely high hcg, to an ultrasound without a heart beat.  It's just excruciating and even more painful having seen a little baby with it's tiny arms and legs inside of me.

Fertility Misfits

We had our WTF(lip) meeting last Thursday (11/11) and we walked out of there more frustrated than before. This is why I have taken my time posting about it because I’ve had to wrap my mind around all the emotions I’ve been having since then.

Our RE’s determination is that I have poor egg quality. When asked what makes him think this his reply was, “What else is there?” I argued my normal FSH, AMH, normal to low-normal ovarian reserve, and our quality day 3 embryos which are powered on my egg’s DNA as well as my husband’s DNA fragmentation. His reply was that he really didn’t believe in the DNA fragmentation so the only thing left was that it must be my eggs. He continued that regardless of what the labs might say I didn’t stimulate the best so it must be my eggs. But when I brought up that a poor responder was categorized as someone who makes less than 4 mature eggs and that has not been the case with me. I always have ended up with 6 or more mature eggs at retrieval. I may not respond great but I also don’t think I was on the right protocol for me. Our RE shrugged and said that this was the best guess he could give us since he didn’t believe in the sperm DNA. Nice. This is why I wanted to go somewhere else for our last IVF. Clearly I was not going to win this battle and it was better to drop it since I still needed their help for a few things.

We asked for a copy of our records for a few reasons A) We wanted all of the SAs that we’d had since being there B) I wanted documentation of all the drugs I had been on C) and we might get a second opinion at another clinic about 2 hours south of where we live (this is a big might by the way). We also got the names of two physicians that specialize in male reproductive health. Not just a urologist but an andrologist. There were only two physicians that I had found on my own that work in this specialty in our state and it was good to know that these were the only two which were recommended. So we have our appointment set up for January 14th. We went with the younger of the two because we are both sick and tired of older physicians who are so set in their ways. Plus the younger one does some of the newer surgical techniques that are better and less invasive so we are also hoping he might be more open to our DNA problem as well. The other one had been practicing for over 30 years and he sounds as old as the hills. I’m sure he’s very smart but I don’t want to go from one old dog (RE) to another only to find out that he just agrees with our RE.

We also found out more about the embryo donation program at our clinic. Basically they require that the couple has to have used donor eggs first. What? What if you have a male factor issues? Nope, they make you have to use donor sperm and you are not eligible for donor embryos. Well that is just not an option for us for our own personal reasons. I’m not forking out the money for donor eggs just to have them fizzle out as well because of our retarded sperm so that we can get donor embryos for ‘free.’ But we did hear good things about a clinic in Tennessee that is very reasonable in price although we still have to do the homestudy piece with them. (Apparently that is not a requirement with our clinic)

So our next step in that adventure is meeting with a local adoption agency to do the homestudy. Hammer works with a guy whose sister-in-law is a co-founder of one of the largest agencies in our city. His co-worker is going to pull some strings to get us in quickly to start the discussion. So you know, these strings won’t get us a better homestudy or a quicker match so we’re not bumping anyone.

In the meantime, my body actually ovulated on its own, ON TIME. Wow. That has never happened before the first cycle after IVF. I was thankful that I didn’t have to go through more frustrations with my own body. I was totally caught off guard by it so we missed taking advantage of it but honestly I don’t think we could have even been emotionally ready so it’s no big deal. In the last few weeks we did decided that if we were going to continuing trying on our own we’d invest in a fertility monitor. I ended up buying an Ovacue because it gives you an estimate of ovulation 5-7 days in advance. Since we have to ‘prep’ Hammer for 7 days prior to BDing for ovulation I thought this was better than a Clearblue which is only 2-3 days warning. The other benefit is that you don’t have to buy any test strips as it has a sensor that tests the hormones in your saliva. Apparently all these hormones show up in your saliva before they even hit your blood or your urine. So we’ll see how that goes and I’ll keep you updated. Eventually I will likely make an appointment with the doc who does NaPro technology but for right now this is MORE than enough to keep us busy. That and we just want to enjoy the holidays. So on that note, if I don’t post before hand – Happy Thanksgiving to you all. I may not be commenting on your blogs but I am reading them, all of them (and not just the ones on my blog roll which is seriously out of date!)

Day By Day

That’s how I’ve taken things, one day at a time. The first few days were spent very tearful and I was thankful to still be at the beach where I could just ‘be’ and hide my red swollen eyes behind sunglasses. On the way home we stopped to visit one of my husband’s best friends. When they get together it’s a non-stop laughing session. And we needed it. We needed to laugh so hard at the dumbest things until our sides hurt, until it hurt to breathe, until we cried because for the last few days these things were brought on by sorrow and not laughter. We needed laughter.

During the drive home we tried to talk about ‘what next’ because it’s helpful to me but not for Hammer. He needed time and I needed to plan and the discussions were not productive. So we had to back off. I found it more difficult to handle the emotions now that we were headed home. Its one thing to lie on a beach and accept the outcome but it’s another to have to head back to your life and realize that it will not include a pregnancy and a child of our own.

We both took the day after our return off of work to recover, do laundry and catch up on things. It was also an intentional day off just in case things didn’t go ‘as planned’, which they didn’t, and I thought I would need an extra day to just absorb everything that had happened. At work I put on a ‘happy face’ and gushed about the perfect weather, kayaking in the ocean, watching dolphins, everything except the most important thing because I keep my work life separate from my personal. On my first two days back I had to conduct a training for about 20 staff. It’s one I do twice a year so I know it like the back of my hand and it was so good for me to not have time to think and to just be busy.

And so we’ve kept busy by having dinner with friends, seeing local music, attending fall parties; anything and everything so we don’t have to think about what could have been. I’ve gone four days without crying. I’ve held newborn babies. I’ve laughed. I’ve eaten sushi and drank wine. But I don’t feel free. I thought that after it was over that I’d feel ready to move on to something new that held more promise of expanding our family. Maybe I just need more time. But I still have this nagging feeling that I can’t shake. I can’t explain it.

Hammer and I have talked some more now that we’ve assimilated back into our regular schedules. There is just one last piece that both of us want to pursue. Hammer has never been evaluated for MFI. After all this time (4 years!) we’ve had mixed opinions by our doctors on is or is he not affected by MFI. His first SA showed him just above the cut off for normal. His first three IUI post washes were a dismal 11, 13 & 17 million. And of course, let’s not forget his DNA frag at 48%. We did find out that after vitaminizing the heck out of him he posted a prewash of 100 mil and a post wash of 56 mil. But clearly whatever is affecting the DNA is making a viable pregnancy impossible. So we’d like to at least have someone check to see if there is something that can be corrected. Even if we are going to be pursing adoption that does not mean that we’re not going to be praying for a miracle so why not at least check things out. This means that we’ll also be looking into a urologist in our area that specializes in MFI just to make sure that we haven’t missed anything. We will also have our last WTF(lip) appointment on the 11th where we hope to find out more about our clinic’s embryo donation program, get a copy of our records and find out if they have recommendations for a referral for Hammer.

But for right now my goal is five days without crying.

IVF #4 Summary

8/22 - Hello friend = AF shows

8/23 -> 9/29 - Acupunture

8/24 - FSH = 5.5 (yeah!)

8/24 -> 9/13 - BCP

9/6 -> 9/24 - Lupron 10 U/d

9/21 baseline u/s - E2 = 16 supressed; total of 13 antral follicles puts me in the low normal category which is excellent for me!

9/25 -> 10/6 Lupron 5 u/d

9/25 -> 10/6 - Gonal 225 u am & pm

9/29 - follie check #1 L = 6 follies R = 2 follies Lining = ~5mm E2 = 127

10/1 -> 10/6 Luveris 75 u/d

10/2 - follie check #2 L= 14, 13, 11, 9, 9 R = 13, 12, 8 Lining = 8mm E2 = 737

10/5 - follie check #3 L= 20, 20, 17, 16, 16, 13 R= 19, 15, 10 Lining = 10mm E2 = 1,915 *Best ever!

10/5 - trigger 10pm

10/6 - TSH = 2.54, Free T4 = 1.1

10/7 - retrieval day = 9 eggs retrieved

10/7-> 10/12 - medrol 16mg

10/8 - Fert Report #1 Of 9 eggs retrieved, 7 were mature

4 fertilized normally
1 fertilized abnormally
2 did not fertilize

10/9 - Fert Report #2 "Ham"bryo's

4 cell - grade 1, 0% fragmentation
2 cell - grade 1, 0% fragmentation
4 cell - grade 3, 0% fragmentation
6 cell - grade 3, 0% fragmentation

10/10 - 3 day transfer

"Ham"bryos in the oven

10 cell - grade 1, 0% fragmentation
8 cell - grade 1, 0% fragmentation
8 cell - grade 1, 0% fragmentation
*Assisted Hatching performed

10/10 - acupuncture pre & post transfer

10/14 - progesterone check = 85.3

10/21 - beta #1 = Negative :(

Many Thanks

I just wanted to thank all of you for your kind words, thoughts and prayers of comfort.  We are, obviously, heart broken.  It's so frustrating to have done all of these treatments only to end with such certain finality.  I know that our issues with high DNA fragmentation make this situation a more likely outcome but it does not decrease the pain of another failure. 

While we will be taking some time to recover we will be moving on to adoption, possibly embryo adoption/donation and/or traditional domestic adoption.  Of course, just because you stop fertility treatments does not mean to stop trying and praying for a natural miracle.  We'll be exploring some other natural options as the adoption process can be long.  We have sp.erm and I do ovulate on my own so maybe with time we'll eventually have the right sperm meet the right egg...that is what happened with Hammer.  It took his parents 14 years before they conceived him and I can tell you that they were definitely not putting forth nearly as much effort as we have been. 

This blog will not end it will just change a bit.  I welcome you all to follow along with us as we continue to walk down this long and winding road to becoming parents.  You have been such a support system for me that I could not imagine continuing on this journey with out all of you.  Thank you from the bottom of our hearts.

Mr & Mrs Hammer

Not meant to be

We just learned that our blood test was negative.  Three beautiful embroys...gone.

24 hours

That's how long until we'll know the outcome.  On 10dp3dt I hadn't actually fallen asleep until 2 am and then woke up at 7:30 am.  I was so exhausted and I think I ended up with a migraine because my head was pounding all day and I was nauseated.  I ended up going to bed at 9:30 pm to try to get myself back on a schedule.  I did fall asleep but then woke up at 2 am, grrr....  I ended up tossing and turning and falling back in and out of sleep until about 8 am.  During that time I had wild, vivid dreams that were all over the place and made absolutely no sense.  On top of that, when I was up at 2 am I was extremely hot and cramping.  Not intense painful cramps but more like pre-AF cramps.  The cramps have continued today (11dp3dt) and I am STILL tired.  But the bbs are totally 100% not sore anymore :(  With our first pregnancy and chemical I had sore bbs so I'm concerned about that symptom being missing even though I know many women (several of them are you my dear readers) do not even have sore bbs.  At this point I'm totally confused and leaning towards it not having worked.  I did get my blood drawn today but we won't hear until tomorrow morning.  I still can't bring myself to test partially because I'm scared and the other part because I just don't want to waste the money if we're going to find out soon.  But I have to say the suspense is killing me.  I just want to know so I can be put out of my misery.  At this point I think we need a miracle.

The State of Affairs (9dp3dt)

It's 12:40 am and I can't sleep. Not that it's from worrying but I seriously have not been able to fall asleep. Things have changed since my last post. Even when I look back at my symptoms across the last few days I think, wow this could have worked. Except that beginning 8dp3dt (11po), which was the morning of my last post, my symptoms started disappearing over the course of the day. The sore bbs began to decrease and there was no cramping. Today at 9dp3dt they are practically non-existent although I have started with mild cramping this evening.

Last two cycles on 9dp3dt I had sharp painful cramps but these are very mild in comparison and more like typical PIO induced cramps. Maybe in the last two cycles that was late implantation? I have begun to wonder if maybe our embys tried to make it causing all those glorious symptoms early on but didn't which is why they are fading? I still can't bring myself to test so I'm left with going through all these mental hoops. When our cycle worked last time I was so fatigued compared to this time where sleep is evading me. Yesterday I was up at 6:30 am and again today. I was happy to see that I was fatigued all day today and was hoping that it was a good sign like last time but here I sit still typing away at 12:48 am. I just have a feeling that we'll be getting bad news on Friday. Hope is ever elusive and my faith is struggling to keep afloat. This is it for us, our last chance to have a child of our own. And while I do look back and remind myself that God gave us three beautiful embryos it is not a guarantee that it worked and that frightens me to death. Maybe I'm just doing too much thinking at too late of an hour. I think I do better in the day time when I can spend my time sitting on a lounge chair watching the ocean waves and pods of dolphins swim by every few minutes. Five and a half more hours till the sun comes up. One more day until beta.

8dp3dt

The beach has been an amazing distraction.  I really don't have any desire to test prior to beta because I just don't want to ruin my vacation.  I'd rather not risk seeing a negative screen and possibly spoil a beautiful cloudless day on the beach.  Especially knowing what happened with IVF#2 where I had negative tests up until my beta of 24.

On the symptom spectrum, I've been all over the place:

• 7dp3dt (10dpo) Sunday - cramping mainly on the right side, nausea, (TMI) loose stools, but no bloating & has gone away almost completely, super sore bbs
• 6dp3dt (9dpo) Saturday - mild cramping, sore bbs, constipation, bloating ultra nauseas and nearly lost my dinner over night, room was almost spinning.
• 5dp3dt (8dpo) Friday - nausea in AM resolved with eating, same at lunch, sore bbs, constipation, bloating
• 4dp3dt (7dpo) Thursday - abdominal bloating, constipation, twinges & pulling (possibly from constipation?)

The lack of bloating and loose stools has me really thrown while the other symptoms are encouraging.  So I really just can't tell one way or another.  One minute I will feel like it didn't work so I'll talk to my emby's to let me know if they are there and then end up with a ton of symptoms.  It could go either way people.  I just think the bloating being gone is the most concerning but then Hammer reminds me that PIO can either give you constipation OR diarrhea and that if I have the latter I wouldn't really be bloated like I was last time when I was contstipated the whole cycle.  *sigh*

I think all this thinking calls for some sunbathing...

3dp3dt

This is a big day for the "Ham"bryos. If all is continuing to go well they should be hatching out of their shells and beginning implantation. We hope to have made this a bit easier for them by having done assisted hatching prior to the transfer. I've been having mild cramping on and off today and yesterday but this is pretty much par for the course as far as IVF cycles go. I think it must be the progesterone since this is the third time that the cramping has occurred and we have had BFN & BFP. So now I'm on 'twinge watch' to see if I can feel any twinges of implantation. I think I do but maybe I just want to feel it.

Right now I have indulged myself and have taken off the entire week since Thursday we are heading down to FL for vacation. Normally I'd be at work but I have to say this is much better. Yesterday, since I was feeling crampy in the morning, I continued to take it easy. Later that night, Hammer and I went to a concert. I was a bit concerned when I was there because the bass was so loud that there was massive vibration coming through the seat and into my pelvic region. I began to worry that I was literally shaking our babies to death but I have no idea if that's possible or not. Regardless I ended up kneeling on the cement during the opening band. I think the people around me thought I was crazy - they would be right. Once the headliner came out everyone was on their feet so no kneeling was needed and the bass was not nearly as bad.

Today I'm occupying my time with packing and wrapping up a few things before we take off tomorrow. I sure hope that this trip is an excellent distraction from all things 2ww related. I found that sitting at my desk at work only ended up in me pretending to work while I put myself through all the mental contortions of "Am I/Am I not" and sought Dr. Google hourly for confirmation. Maybe forced internet absence will be a good thing. Don't worry, it's not total absence. I promise to keep you all posted.

"Ham"bryos are in the oven

Well the transfer went really well. We started off our day very early at the acupuncturist. I laid there envisioning my uterus getting ready for the 'planting' of our embryos and praying that we had healthy ones to transfer. We had been told to arrive at twenty after eight with a full bladder. But when we got there the clinic wasn't even open yet! Then I started to worry that the reason was because all of our embryos had died over night and they had cancelled but forgot to tell us. (irrational I know) But shortly after we saw the front desk girl pull widely into the parking lot, clearly late. My bladder has yet to forgive her.

We had the on-call RE who was wonderful and who was the same RE who did our retrieval. I think he performs the best retrievals at the practice because I felt so good afterwards unlike last time. Anyway, the RE came in with the report on our embryos to discuss what we would be transferring. We were shocked to hear the best report we have ever had!

10 cell - grade 1, 0% fragmentation
8 cell - grade 1, 0% fragmentation
8 cell - grade 1, 0% fragmentation

We've had maybe one 8 cell grade 1 but the rest have been of lower quality. So even though we've had more embryos the quality just was not as good. We ended up deciding to transfer all three and our RE highly recommended it since we've had previous failed cycles. Afterwards we headed back to the acupuncturist to 'cover' up our embryos. So now I'm back home on bed rest. We're praying that at least one makes it's home for the next few months.

Fert Report #2 - The Power of Prayer (aka keep it coming ladies!)

Thank you so much for all of your prayers and positive thoughts.  We got our call this morning at about 8:40 am regarding the transfer time.  We are all set for an 8:45 am ultrasound guided transfer for tomorrow.  While on the phone with the RN I asked if I would still get a call from the lab.  She said she wasn't sure but that if she got the message to schedule then everything should be going well.  So I hung up with her and immediately called my acupuncturist with the transfer time so that we can schedule our pre & post sessions.

Shortly after that my phone rang again.  It was the lab.  I was greated with a chipper female voice but the whole time I was holding my breath that maybe she was just one of those overly happy morning people bearing bad news.  On the contrary, she reported that all four of our embryos are growing strong.  Our lab grades early embryos on a scale of 1-5 (1 being the best) and then gives percent fragmenation.  Day 2 embryos should be between 2-4 cells.  Our little "Ham"bryos are:

4 cell - grade 1, 0% fragmentation
2 cell - grade 1, 0% fragmentation
4 cell - grade 3, 0% fragmentation
6 cell - grade 3, 0% fragmentation

Did you read that?  NO fragmenation!!!  The Embryologist encouraged us that the grade 3's having no fragmentation typically mean that they were in the process of dividing when she looked at them and not to be concerned at all.  She said that everything looks perfect.  We discussed how many we'd transfer because we have elected to do assisted hatching.  Typically this is used for a number of things but one of them is when a couple has had failed IVF cycles with healthy embryos, and that's us.  Hence the Medrol that I'm taking to prevent any inflamation that could harm our embryos and their intentionally cracked zona.  Hammer and I are very encouraged and thankful for all of your prayers and ask that they continue as we wait till tomorrow to put our little "Ham"bryos back where they belong - at least for 9 months.

Fert Report - Prayer needed

Well of the 9 eggs we retrieved, 7 were mature but only 4 went on to fertilize normally (1 abnormally & 2 did not fertilize).  We will have our transfer on Sunday.  Please pray for our four little embryos that they continue to grow and divide normally!