Just call me Jen.nifer Ani.ston

So did anybody see the celebrity rag about Jennifer Aniston doing fertility preservation?

Ok, well she copied ME!!

I mentioned in a previous post about Dr. Danderfluff and his wonderful second opinions, well, we’ve decided to switch clinics to start fertility cycling with Dr. Danderfluff (hence our recent trips up to Sacto). Not because he has the lion’s share of fertility information but rather, because his clinic will do the types of treatments that address our moral concerns.

So I have been terrified of having another miscarriage. It wouldn’t be so bad for me if D&C’s were as benign as they are supposed to be, but for me both of my miscarriages requiring D&C’s were followed by complications – the first miscarriage/D&C was followed by a uterine blood clot and a second emergency D&C (one in which I was AWAKE!) in the emergency room five days following the first one! The second pregnancy brought with it a D&C followed by 10 ½ weeks of being severely ill – so much so that I was out of work for a month, was a terrible bridesmaid to a very dear friend, and nearly lost my job. My symptoms had the Stan.ford Univ.ersity doctors all wondering what the heck was wrong with me, on the list of possible ailments was brain tumor and leukemia … nice. So when I had chemical pregnancies for pregnancies 3 & 4 … to me they were answered prayers – literally. I prayed that if God wasn’t going to see these pregnancies to live birth, then I needed them to end sooner rather than later – and He answered those prayers. So yes, I’m more gun shy than most at having miscarriages … and hey, not to mention that I don’t enjoy the heartbreaking turmoil they cause emotionally.

Because of the adverseness to miscarriages and D&C’s and because of my tendency to have them both, all of the specialists that we’ve talked to have suggested that we use PGD – Pre.implantation Gen.etic Diag.nosis: embryo screening (chromosomal testing of embryos) in order to test and choose the most viable embryos/babies for tranfser.

Last year, I remember watching a Dis.covery H.ealth program about a couple whose child had an incurable genetic disease that was causing the rapidly approaching death of their child. The couple was going through IVF with PGD in hopes to create an embryo (or sibling for the ailing child) so that they could select the baby that was not a carrier of the disease, but that had the right blood type (or something like that) in order to donate stem cells or bone marrow to their diseased child. I remember my mouth dropping to the floor as I considered the gravity of the decision this couple had made to pursue IVF for a baby with the correct genetic makeup to help cure their already living child. My first impulse was to judge this woman for playing God and choosing which baby would live and which baby would die. But then they interviewed this woman and she said “don’t judge us until you’ve had to walk in our shoes” … and although I don’t agree with their actions, I was done judging them for making their decisions, my heart broke for them – I can’t even imagine being in their situation and I thank God that I’m not. So ten months after seeing the program on TV, here I sit, encouraged to use the same technology that this couple was using. Our doctors have told us that it makes sense for us to use PGD: because we have two miscarriages proven to be chromosomal issues in nature, and because the other two miscarriages were chemical (the medical industry indicates chromosomal issues for chemical pregnancies when progesterone levels and uterine competency can be shown to be adequate) – testing embryos and selecting the most chromosomally viable ones would highly reduce our chance of miscarriage.

Morally, this is a hard pill for us to swallow. We can’t choose to learn information about these embryos and use this information to decide which ones thrive and which ones get discarded. Basically this type of testing would tell us which embryos have Down’s Synodrome, Turner’s Syndrome, complex chromosomal issues, normal chromosomes, etc. Armed with that information, the couple (us!) … is supposed to be able to decide to only put back the embryos that are chromosomally normal. Now, this sounds logical enough, doesn’t it? I mean, who would want to put back a baby that could cause another miscarriage (95% of Turner’s Syndrome babies miscarry and never make it to live birth) … However, did I mention that I have a friend who is Turner’s Syndrome, like a real live girl that I mentored for a few years! If the doctors told me that one of my embryos was Turner’s Syndrome, they would not allow me to put it back in my womb. But could I let that baby die? I couldn’t.

So in order to take advantage of chromosomal testing I could really benefit from technology that tested the sperm and the egg separately, not the embryos. Well, as of last year they didn’t offer this to the general public, but in early 2008 they made this technique available. So that is what we are doing this cycle – chromosomal testing on my eggs (Polar Body Biopsy). If we find abnormal eggs – I’m fine tossing those out, but poor babies who might or might not live to child birth – I would not be ok making those decisions.

Polar body testing can be done in two ways:

• PBB1: Polar body biopsy 1: they take the polar body from the mature eggs at ovulation (polar bodies are shed by the egg and represent a mirror image of the chromosomal make up of the egg)
• PBB2: they take the polar body biopsy from the mature egg when the egg is ovulated (as above) and they take a second biopsy from the embryo following fertilization.

We are getting the PBB1 testing done. So last week when I did the retrieval, they tried to get as many eggs as possible. They biopsyed (sp?) those eggs (by taking their naturally shed polar body) and have cyto-preserved the eggs while we wait for the test results to come back. (It takes 4-6 weeks for the test results to come back – this is why they freeze the egg and why the procedure is called "fer.tility pre.servation"). I should know how many eggs are normal by June 2nd … mark your calendars and grab a bag of popcorn – that for sure will be an interesting post.

The IVF package that I signed up for at my new clinic is actually the fer.tility pre.servation package – not what I was looking to do (preserve my eggs for later use) cause I want to be pregnant sooner rather than later! But the testing was only offered in this package (*hence the title of this post – fer.tility pre.servation [putting her eggs on ice] is what Jen.nifer Ani.ston was recently reported to be doing – that’s how she’s copying me. Ok, you get it.) Otherwise they would have made me do the testing on the embryos – which I cannot do. It is kind of cool that I might actually benefit too from the preservation aspect of the package – given that I’m closer to menopause than most 38 year olds! But I really just want to have as many babies as possible, as soon as possible!

So there were three packages Berilac and I were trying to decide between:

• Single cycle: One cycle of retrieval, egg testing, cyto preservation of any/all “normal” eggs.
• Age-based cycle: (cost is based on your age, the younger you are the “cheaper” [if you could call it that] it is) One, two, or three cycles of retrieval, egg testing, cyto preservation of six “normal” eggs. You only do as many retrievals as you need to in order to get six normal eggs. If you get six normal eggs in retrieval one – you don’t have to go through the two other retrievals. Regardless, you have to stop after three retrievals – so if you don’t get six “normal” eggs in three rounds of stims – your loss.
• Triple cycle: Three cycles of retrievals, egg testing, cyto preservation of all/any “normal” eggs that you retrieve during three retrievals – you could end up with two normal eggs, you could end up with sixty normal eggs.

… keep in mind that these are not how many total eggs get retrieved, but how many normal eggs get retrieved. Based on the trials that were conducted using this method, it is estimated that for women in their twenties, 70% of their eggs are not “normal” quality.

We decided to go with the age-based fertility preservation package. We will do one, two, or three egg retrievals in order to get six “normal” eggs. My hope and prayer was that we just had to do one – but given that we only got 5 mature eggs we need to do round 2 (yes we got 6 eggs, but 1 was immature – meaning it didn’t have the polar body to actually biopsy)! We shall soon find out what our next steps are. It’s also worth mentioning that if we get five “normal” eggs in our first retrieval – then by the rules of the package we go through a second round of retrieval to try and get one more normal egg (to make up a total of six normal eggs) however, if we get five more “normal” eggs in that cycle – we get to keep all ten eggs for the price of six!!

It’s most likely that we’ll get 0, 1, or 2 “normal” eggs. But my prayer is for five!! I’m trying to keep the hope alive. Keep it alive with me, will you?

All of this to say ... in case it's not obvious ... there will be no positive pregnancy test in the near future. So there will be no embryo tranfser update and no peeing on sticks to see if I'm pregnant. Not yet anyway ...

IVF #1 - ER results

So night before last Daisy and her family were gracious enough to let Berliac and I stay with them overnight (thank you Daisy!). We decided to stay with Daisy because her house is only 1 hr from our clinic (and we're more like 2hrs) - so she cooked us a lovely dinner and we got to hang out with her two beautiful children (one of which is our Godson!!)

It was all going wonderful until after dinner my tummy didn't feel well (and no, it wasn't the cooking) and I decided that my pants were too tight so I changed into my sweatsuit/pj's thinking that would help. Well, within 5 minutes I realized that that didn't help, before I knew it I was shaking and nauseated, I went in to weigh myself on her scale and I was 5 pounds up from my Friday weight - FIVE POUNDS! At that point I started getting really worried. My heart started to pound out of my chest (at well over 100 beats per minute) and my temperature dropped to 97.0 (this was about the time I started shaking with the chills) Daisy and Berilac were so worried about me - Daisy opened the window for some fresh air and wrapped a cozy blanket around me.

Anyone ever hear of OHSS? Doesn't it kind of sound like it?


So I stopped drinking liquid at about 8:30 (after dinner and right about when this episode started) ... well let me tell you that within 4 hours I peed like 10 times and I wasn't drinking any liquids - my body was trying to process something I just don't know what.


After a few hours I started to feel better. By midnight I was doing much better. I had peed enough that I lost 1.5lbs (and was now only 3.5lbs heavier than I was 3 days prior) and my tummy was feeling less full and bloated. I wrapped a string around my waist to measure just how bloated I was (I had no baseline, but I assumed that hopefully the next morning things would look better and sure enough there was a one inch difference between evening and morning.)

Finally by midnight I was ready to fall asleep and I was going to be NPO. But I was so thirsty I had some water at 12:30 (when I shouldn't have had anything after midnight). I got a few hours of sleep and woke up Monday morning ready to get some answers and to get these eggs outta me!

We got to the clinic on time 10:15, and we filled out all the prerequisite forms ... I got prepped and ready to go. The nurse tried twice to get me IV'd, but she couldn't get the veins - fun. So we waited for the anasthesiologist and he did a fine job hitting the vein. He started the relaxin' meds because my heart rate was 100bpm (I have white coat syndrome).

I asked about my episode the night before - the nurse thought it sounded like overstimulation, the doctor said it was "normal" ... my thought was, if it's normal then why the heck didn't he tell me it would happen (preemptively!)

So they had me walk into the OR I got all situated in the stirrups and then I remember the anasthesiologist say that he was putting in the sedation stuff. Next thing I remember I was waking up back in the recovery room asking them when we were going to get started! She laughted and said that we were all done!

So the results: so of the 18+ follicles the doctor was only able to retreive 6 of them. 5 of them were mature. The doctor said that he tried flushing all the other follicles, but he didn't get any more out. He said they checked the free floating fluid for eggs in the hopes that maybe I had ovulated them, but there were none there.

Berliac and the doctor were disappointed but I'm content my original expectation was 6 going into this cycle - so when we had 18 I was pleasantly surprised. In my book, God is in control and if it's only 6 then it's only 6.

I've read articles online that talk about the hcg trigger shot causing empty follicle syndrome - either we didn't inject it into the right muscle that best absorbs or we didn't get enough (though I did a 10,000 iu shot intramuscularly) or my body metabolized hcg really well.

So overall, I'm happy and now I'm just recovering from the procedure. If you think of me, please pray for a quick and uneventful recovery.

IVF #1 - CD13 Cycle Update

CD13 (Today): 11.2mm endometrial lining, 18 follies between 13-18mm, E2 ~7700.

For those that are in the know, this E2 level is concerning. But my doctor is not concerned about OHSS because he says that you need >15 follies on each side and I have about 9 per side. I'm just trying to stay calm and positive.

I trigger at midnight on Saturday and go in for my egg retrieval at 11AM on Monday.

So pray for zero complications from OHSS, a safe and successful egg retrieval, and lots of good quality eggs!

Thanks for all your love, support, and prayers.

Nal.gene to phase out hard-plastic bottles

Did you read this article?

No? Ok, I'll sum it up for you:

"Polly Gamwich has had a dehydration problem for as long as she can remember. Every time she gets remotely sick she takes a visit down to the ER due to dehydration and gets herself a good liter or three of IV solution to get back on track. When she's really sick, she goes back to Urgent Care or the ER (depending on the hour) to get repeat IV's during a lengthy sickness. Polly reported this to her po-dunk doctor, the one she had prior to moving to the Bay Area, and the doctor instructed Polly (and I kid you not on this one) that she needed to drink 1 liter of Gatorade and eat a bag of chips per day, to remedy the daily excessive thirst and the frequent trips to the ER that Polly deals with. This didn't sit well with Polly - and it sure didn't help her enormous thirst. So Polly started to drink lots of water (and yes, Gatorade too for good measure) and guess how Polly consumed this water? In an environmentally friendly manner - enter Polly's six-bottle-strong collection of Nal.gene water bottles - at peak thirsts, Polly was known to consume FIVE Nal.gene bottles of water a day!!! FIVE!! That's 160 ounces of water PER DAY! So you know when doctor's recommend that you drink 6-8 eight ounces glasses (which, by the way is no longer true and they tell you to drink less!) Good ol' Polly was drinking TWENTY 8 ounce cups of water contaminated with Bisphenol A ... What is Bisphenol A you might ask?

(well, according to the article:)

is found in dental sealants, baby bottles, the liners of food cans, CDs and DVDs, eyeglasses and hundreds of household goods. The chemical has been linked to neurological and behavioral problems in infants and babies, along with certain cancers, diabetes and obesity.

So, that's not so bad, right? I mean isn't everything these days a carcinogen? Well, yes, but the article continues with it's potential bad side effects of ingesting this crap:

critics point to an influx of animal studies linking low doses to a wide variety of ailments — from breast and prostate cancer, obesity and hyperactivity, to miscarriages and other reproductive failures. (read: like premature menopause!)

Here in Polly's case - she had an overdose (if you will) of this crap while she was trying to be healthy and stay hydrated. And what did she get for it? But a bunch of lost babies."

Interesting article huh? Read the article if you want, but I'm telling you that is what it says.

I'm not bitter, I swear.

IVF #1 - CD11 Cycle Update

So Monday and this morning we went in for follow up ultrasounds. Sorry I didn't post about Monday's appointment, the loss of Emily was a little overshadowing :-(

So we have been to two ultrasounds since I last mentioned our status, here are the results:

CD9 (Monday): 9.2mm endometrial lining, 15 follicles over 8mm, E2 ~1100, (Dr thinks last E2 reading was a lab error).
CD11 (Today): 10.1mm endometial lining, 16 follicles over 12mm, E2 >1500.

I forgot to take my Estrogen suppositories on Sunday night and Tuesday night - the doctor said it was fine but I feel like an idiot ... I'm paying how much money and I nearly mess the whole thing up?? ARGH! After earning the track marks all over my thighs and tummy from all those shots - you'd think I could remember an innocent little suppository!

Oh well, the doctor says the cycle is going better than expected and is estimating retreiving between 12-18 eggs on this coming Sunday or Monday.

Thanks for all your prayers - keep them coming!

Good bye Emily

With us for three and a half years, it's time to say goodbye to our little doggy. My little dog Emily died yesterday.

Three and a half years ago I said to my husband "dog or baby, I need one of them! You choose." ... well he chose dog and honestly, we've regretted that decision ever since. (But that's another whole matter.) Now that we've grown accustom to our little doggies, we're sad that we've lost our little girl.

We decided to get a miniature pinscher because Berilac wanted a big dog and I wanted a small dog so we compromised and got a small version of a big dog.

When I was growing up we had one dog that lived 18 years - yowza! And I knew that I wasn't ready to get a puppy that we'd have around till our kids were in high school - that was something I just couldn't fathom. I wanted to get an older dog for three reasons:

• There are so many good dogs in the world that need homes, I figured we could help out and take one in.


• We could get an older dog - you know, the kind that would be put to sleep because nobody else wants to pay for their increasing vet bills.


• From a practical perspective: we wouldn't have to have the dog for 18 years we could have it for a shorter amount of time - see if Berilac and I, as a family, are dog people.

The obvious place to get these older dogs was through the min pin rescue. When we went to look at the available dogs Berilac and I couldn't agree on a dog. He wanted a bouncier, more vibrant dog who would wrestle with you and play fetch. I wanted a calmer dog that would cuddle in your lap when you were feeling down. So together we decided that perhaps two dogs are better than one because one dog could keep the other dog company while we're at work and we could both get what we want - by getting two dogs who met those needs.

Meet Emily & JD:
Emily is the crotchety old girl sitting less than ladylike - as she always did, JD (short for Jim.my Dean, as in Jim.my Dean Sausages) is the quizical looking troublemaker. Emily turned out to the be the sweet, aloof cuddler that I was looking for - though because of her age cuddling in your lap was uncomfortable for her old bones. JD has a ton of energy, but doesn't chase toys or play any games with people - he does desparate velco dog really well. So neither of the dogs really met our desires - but we loved them just the same.

When we got the dogs, they told us Emily was about to be put down because she was deemed "unadoptable." She was about 13 years old, with a gray face to match. She coughed all the time because of her collapsing trachea. She was ricketty, but sweet and adorable. In the three years that we've had her, we've helped her to drop her weight so that the collapsing trachea (along with the constant coughing) isn't so painful for her. While we had her she completely lost her vision and hearing, and we assume her sniffer was out of commission as well. In a recent vet visit we learned that Emily had an enlarged heart - something common for an old dog. For the past six months Emily has been wearing a little doggie diaper because she wanted to do her business in the warmth of the house rather than go outside - where she was supposed to go! For a few months now we have discussed "how do you know it's time to put down a dog?" And what we learned was that you identify some obvious signs - pain & wimpering, not able to get up and walk around, lack of appetite, etc. And if you see those then it's obvious. However, there were some soft markers we were also looking for: does she still get enjoyment out of life? And we decided that we were looking out to watch if she still cuddled into scratching when you reached out to her and whether or not she scavenged the kitchen floor after food prep. Emily was doing just fine yesterday and the days and nights leading up to yesterday.

Berilac and I travelled to Sacramento, CA for the week for our IVF treatments. We are staying in a dog friendly hotel with our two little doggies. Yesterday, we had our CD9 u/s and when we came home from the appointment Emily didn't climb out of bed to greet us. This wasn't a new concern as Emily was so old that she probably slept 22 hours a day. I was worried about her and wanted to check on her, but we decided to let her sleep rather than wake her up just because we wanted peace of mind. After a couple of hours and no Emily appearance, I decided to check on her. Burrowed below her pillow, on top of her bed, I found my sweet little girl passed away. We think she died in her sleep.

Right before we left for our doctor's appointment Emily was mobbing (blind now, remember) around the unfamiliar hotel room, trying to get some water, searching for a nibble - you know the typical dog routine. When she couldn't find her bed (cuz she's blind) she settled down on a blanket and cuddled in. I heard her give a little yelp and I figured it was because she was upset about not being able to find her bed ... I picked the sweet girl up and put her in her bed. That was the last time I got to touch her.

For my own closure, I want to put together a list of the things that I'll miss about my "little girl" (AKA: Meelie-Wa-nee-le-ah):

• Holding and carrying her with one arm she was so tiny.
• The way she scratched her back against things like a cat.
• The way she would assert leadership around dogs 10X her size.
• Her yucky breath.
• The way she danced when she knew food was coming.
• Her sweet, sweet face and unassuming personality.
• The way she'd knock into walls when she became blind (it was funny, not painful).
• Her UN ladylike sitting posture.
• How she would fall over when she tried to lick herself.
• Her cute little diaper butt - in the last few months.

My sweet girl Emily: Adopted into our family October 2004 - April 2008

We tried to make her geriatric years as comfortable as possible, given all of her elderly ailments.

Sweet Emily, we'll miss you.

First Ultrasound Results ...

My computer is having connection issues - so I'm posting quickly from Berilac's computer ... and it doesn't have my protocol blog document on it ... so you'll have to wait for that.

One important piece of information for you regarding this IVF cycle: we are not doing an embryo transfer this cycle - so ironically we are not trying to get pregnant this cycle - more to come on this front.

***

Ultrasound update: Went in yesterday for a CD7 ultrasound and we found 13 follicles developing - from 7 to 15mm in size. I'll be soaking my feet tonight ;-) My E2 came back at almost 6000 - not sure how it can be so high given that I don't have a lot of follicles - perhaps it means that I'll have a lot more come Monday? Anyhow, I asked my doctor about it, he said that he's not concerned - he said that during pregnancy your estrogen levels get in excess of 80,000. And given that I don't have a lot of follicles - he's not too worried about OHSS.

I go in for my next ultrasound tomorrow at 11A - I'll keep you posted.

There’s no way our children can claim that we never wanted them

I remember when I first got married, I was afraid to have children. When I was growing up I was told by one parent that the other parent never really wanted a daughter, never really wanted a third child, never really wanted me. That was very painful to hear and to absorb as a child. As an adult, it still haunts me. I remember having a conversation with a girlfriend of mine shortly after getting married and I confided in her, telling her that I was not sure I wanted to have a child because I was afraid the child would not feel wanted enough by me. I told her I wasn’t ready to have children because I wasn’t feeling this overwhelming need (as I had seen in so many of my friends – who now, by the way, all have at least two children and in some cases three!) to become a mother. She encouraged me that because I was worried about it and thinking about it, it meant that I wouldn’t one day surprisingly find myself there.

Well, last week this box arrived at my door (yes, I did order it, but it sounds so much more fantastical if it ‘just arrived’).

Enter the traditional IVF meds picture:

If you can’t tell from the picture – there is a whole lotta drugs I’m going to be shoving into my body – either by needle or by suppository (multi-purpose orifices, I guess?) in order to have a child. If I’m willing to do this to my body, then oh yes friends, there is no denying that this child is very wanted!

So, yes – I am a closet IVFer. I took a month of birth control pills, a week of Lupron (a drug that can have nasty side effects whose intent is to reduce the amount of estrogen in the body), I’ve been on Ganirelix for awhile, and I’m starting stims tomorrow! … And I’m just now coming out of the closet!!

So first, let me tell you a bit about what frightening drugs are in that picture. I am slated to take said drugs for at least 41 days and perhaps longer (today is day 33 of 41 … so I’ve been hiding this little secret of mine for quite some time) For those of you that don’t know, after I take all these drugs I’ll be primed for an egg retrieval (a process where they enter through my wahoo to aspirate way too many eggs from my swollen bovaries!) that will happen sometime between 4/16-4/19.

So, can you see the picture? Can you see how many needles there are in there? Well, lucky for you I have inventoried the lot. Here’s what it will take for this one cycle of IVF:

(1) Sharps Container
(1) Follistim Pen

(6) 900iu cartridges of Follistim (yes ladies, SIX 900 iu vials!)
(1) 20mg vial of Estradiol Valerate
(1) 10,000 unit vial of HCG
(4) 75iu Vials of Luveris
(1) 1mg Vial of Lupron
(20) 125mcg Ganirelix

(30) 28guage ½ mL .5in. syringes
(35) no guage 1 mL syringes
(26) 27guage ½ in needles
(10) 22guage 1 ½ in. needles
(15) 18guage 1 ½ in. needles
(1) 25guage 1 ½ in. needle

(12) 2mg Estradiol Suppositories
(82) Prenatal DHA (Omega 3's)
(82) 2.2 mg FolCaps
(41) 75mcg caplets of Levothyroxine
(41) 81mg Baby Aspirin
(41) Prenatal Vitamins

(102) Alcohol Wipes
(21) Active BCP's
(5) Guaze Pads (for those scary intra muscular shots)
(5) Bandaids (again, for scary IM shots!)

Any veteran’s out there see anything missing? (hint: I only have (10) 22 guage 1 ½ inch needles)

Over the course of 41 days I will inject myself 42 times subcutaneously (I do not do shots everyday and there are a few days where I have to give myself four shots) and over the course of this time, Berilac will give me 5 intra muscular shots (ouch!). During this time I also have to whip out my pillbox to remember to take my 287 pills and before I go to bed some nights there are 8 suppositories (no comment) waiting for me.

So I’m coming out. I’m almost done with my first IVF cycle.

How could I go this long without sharing this exciting news? Honestly, it’s because I have too much other good stuff going on in my life right now. I spent a few hours with a close friend of mine who’s going through some marital issues lately and I was just so desirous of hearing about how she’s doing and supporting her through this rough time – my infertility issues seem less central, like somehow everything is going to work out … so why bother fretting about it? (a total 180, I know).

So in my next post I’ll tell you all about the protocol and the plans for us to add to the Gamwich family.

Consult following the fourth loss - and more tests!

So before I share about our new plans, I thought I'd catch you up on the tests and test results that Berilac and I have had following our most recent miscarriage.

We lost our fourth pregnancy to early miscarriage on Jan. 24th, 2008. In an effort to get pregnant that cycle we were using injectible fertility medications to try to release more than one egg. The cycle turned into a disaster (in my opinion) and in the process (maybe I saw the writing on the wall?) I booked a consult (a second opinion) with a second RE. The consult was scheduled for early February. In mid January, when we found out we were pregnant, I didn't cancel the consult. I guess when loss happens to you 100% of the time, it's hard to think it'll work out any different (at least that's what I used to think, today I have a very positive outlook on how things will turn out!)

I met with the second opinion RE, let's call him Dr. Danderfluff. It was very refreshing to talk with a doctor that was more interested in getting to the bottom of things, taking more tests, reviewing and comparing old tests to new ones, basically rolling up his sleeves and digging into the causes behind our recurrent miscarriages. My current RE, we'll call her Dr. Chubb, has always feigned "bad luck" and dismissed my ideas for probable causes - mainly due to their controversial nature.

It cost us hundreds of dollars to meet with Dr. Danderfluff. He works at one of the top clinics in the country. Of course they do not have a relationship with our insurance carriers and thus it's all out of pocket. As we discussed our history a few suspicions surfaced:

• PCOS: I responded really well to fertility meds. If you remember, during one of my cycles I was producing 9 follicles when we were shooting for no more than 4. This response is especially surprising given that I have the diagnosis of early menopause, early menopause suggests that I should not respond well to drugs. Just to cross all our T's, Dr. D suggested I get tested for Polycystic Ovary Syndrome (PCOS). I don't show many of the obvious signs (obesity, male traits such as facial or chest hair, etc) but b/c I have recurrent miscarriages (more common for women with PCOS) and b/c I respond with many ("poly") follicles during a medicated cycle - it just might be that I've got PCOS.
• Autoimmune issues: People with autoimmune issues have a higher liklihood of having miscarriages. In April of 2007, I tested positive for ANA - my Hashimoto's Hypothyroid was found. People who have one autoimmune issue are more likely to have others pop up over the course of their lives. If there is another autoimmune issue - it needs to be treated.
• Uterine health: My first two pregnancies last longer than the last two. (10 weeks, 8w, 5w, & 5w respectively). Dr. D suggested that perhaps one of the three D&C's from the first two miscarriages perhaps caused damage to my uterus and thus did not provide a place for the 3rd and 4th pregnancies to nestle into my uterus.
• Alloimmune issues: These are cousins to autoimmune issues. They are very controversial - very difficult to prove that they exist and that the treatment identified for them is effective. But women who test positive for these types of issues generally have recurrent miscarriages and vice versa.
• Verification of early Menopause: So far my confirmed diagnoses are: Rh-, Hashimoto's Hypothyroidism, Compound Hetero MTHFR, & suspected early Menopause. The Rh- does not need to be treated while trying to conceive, the Hashi's and the MTHFR do need to be treated - and we are treating them. So still in question is the quality of my eggs and basically my "sell by" date. How close am I to menopause?
• Sperm quality: So all of this time we've been concerned with my egg quality and we've NEVER tested Berilac - no basic sperm analysis, no nothin'! They never tested his sperm's swimming ability b/c we've gotten pregnant each cycle we've attempted - this implies that the soldiers are good swimmers. But given that we've lost all the babies - that could imply that we have sperm quality issues. Dr D pointed out that our second loss was due to XXYY (tetraploid) which indicates that more than one sperm entered the egg. This could be an egg quality issue, or it could be a sperm quality issue. It is possible that they swim well, that they just don't deliver the package of DNA well, or the DNA package itself has issues.

At the end of our consult he wrote up an entire lab sheet of tests for us to take. My first reaction was of excitement... finally someone was doing ALL the tests, not just the conservative (read: "standard") ones. My second thought was ... how much is this going to cost me outside of my insurance coverage? *Gulp*.

Then I had a bright idea.

I emailed Dr. Chubb, my current RE, and we scheduled a follow up appointment. I met with her just days before my expected period (as many of these tests have to happen on the third day of your period). She was so very compassionate, I think she even gave me a hug. It felt sad and strange to have the entire staff look upon me in sadness. The empathy was nice, the pity was a bit much - but honestly my heart is so broken, I have a hard time telling the two apart. But I put my head down and focused on the consult with my doctor.

I hadn't told her about my consult with Dr. Danderfluff, but proceeded to ask her to take all the tests that Dr. Danderfluff recommended. Surprisingly, I didn't have to work too hard - she was so compassionate and helpful, at this point this extremely academic and conservative specialist was suggesting I do the alloimmune testing on the side (as she doesn't run these types of tests). It was nice to feel heard.

So alas, after the consult with Dr. Chubb, she ordered the litany of tests that Dr. Danderfluff wanted to order for me - and because she works with my insurance carrier - all the tests suggested by Dr. Danderfluff were covered! Whew.

So you could be disappointed that I took this long to update my blog or you could look at the positive side of things - I have spared you the agony of waiting for the results - I took these tests back in early March. Drumroll please:

• PCOS: in order to test this they took all sorts of blood levels: glucose levels, insulin resistance, testosterone levels, & LH:FSH ratio. I tested negative in every test for PCOS.
• Autoimmune: We took an ANA Screen to see if there are any other autoimmune issues that might be lurking … although last year at this time I tested a very low positive for this, this year I was negative.
• Uterine Health: My doctor ordered the gold standard of uterine evaluation tests. We did a Hysteroscopy on March 13th. What is a Hysteroscopy? Well, they send a camera up my wahoo to check out the landscape, see if it was a place where a baby could lean back, kick up their feet, and call it home. They had me go under general anesthetic, they were looking for septums, fibroids, polyps, and/or scar tissue and if any were there they were going to remove them. The results of the surgery were officially "unremarkable". I had no physical issues with my uterus – a very “fertile” uterus.
• Alloimmune tests: we still have not conducted these tests. It’s so hard to consider taking these tests because the treatment for these tests, if you show abnormal test results, is called IVIg, which basically is a blood transfusion near pregnancy implantation. The premise is that you’re putting other people’s blood in your blood, so if you have any antibodies protecting your body from foreigners they are going to attack other people’s blood rather than your growing baby.
• Verify early menopause: so unfortunately, our cycle day 3 FSH blood levels showed an increasing level – in July of 2007 my level was 11.7, today it’s 12.3 a woman my age shouldn’t have such high levels and the more it rises the more concerning it becomes. In terms of my AMH level. The test result range is between 0.0 and 6.5:
  
  if you’re above 5.0 you most likely have PCOS, if you’re below 0.3 you are in premature ovarian failure. A woman my age should have a reading around 3.0 … my level came back at 1.0 – this test result validates that the elevated FSH is pointing toward early menopause, rather than something less concerning – like maternal twinning (women who have fraternal twins run a higher than average FSH level, hence them having twins – their brain increases their FSH levels, the ovaries respond by producing more than one egg at ovulation) which can be passed down from mother to daughter.
• Berilac’s sperm quality: this was the surprising test result. All this time we thought this whole miscarriage issue was all because of me and my rotten eggs. Well Berilac took two tests. One test came back normal, but another test, the sperm DNA fragmentation and decondensation assay came back showing abnormal results. Basically, this means that Berilac's boys are delivering packages well, they are just not unloading them properly.

So what does all of this mean?

It means that I don't have to worry about producing too many follicles during a technology assisted cycle (as I don't have PCOS) that combined with the fact that my ovarian reserve is seriously in question means that I don't have to worry about OHSS - one of the major complications that can occur while doing an assisted reproductive cycle. It also means that my biological clock, thought I don't hear the ticking, is pounding in my ... ovaries?? regardless of how young I am. And lastly, it could mean that perhaps these miscarriages aren't all because of the failures of my body, perhaps Berilac has contributed to the losses. Honestly, the idea of this feels good to us. It's hard for me to go through repeated medical procedures, medications, etc. while Berilac wants to take my place - and do all of the yucky tests and treatments instead of me. Although that's not possible, it does mean that there are supplements that he can take to improve the DNA within the sperm (21 pills a day!) so he'll do that for a few months and we'll have his test retaken - we hope this will resolve his contributions to the miscarriages.

So basically, we would really benefit from testing the quality of my eggs and the quality of his sperm (in the hopes that we find "normal" ones) when you use normal egg and sperm, you have a higher liklihood of creating normal babies - basic concept, I know. Just not one we have mastered yet. We would also benefit from preserving some of my 30 year old eggs for a few years so that if menopause comes knocking in a few short years, I'm not left emptyhanded.

The last thing I wanted to say is ... can you believe all of the informative links included in this post? It's frightening how much we've learned over the last couple of years - for those of you who know more than me, please share and post your references in a comment.