Protocol for FET #3

My next FET will vary from my last one in a number of ways. To prep, I am going to do an endometrial scratch and a long course of antibiotics (to treat any possible infection). My last cycle, I had a combo saline sonogram/mini scratch. While my doctor doesn’t put much stock in the scratch, he is willing to do it as it cannot hurt our outcome.     We are also going to follow my natural cycle, with supplementation of estrace and progesterone, only as needed.  There will be 0 medicated suppression.  The immune protocol will remain the same.

Let’s be honest, things aren’t very positive here right now.   We’ve been actively pursing infertility treatments since March 2011 and we have 0 living children.   Short of using a gestational carrier, there isn’t much more we can do to make this work.

Supplements (daily):
Vitamin E (400-600iu), Vitamin D (2000iu), Calcium (500mg twice a day), and Fish Oil (1000mg)

FET Medications
Prenatals
Estrace Pills (Oral)
Progesterone in Ethyl Oleate (100ml / 2m l)
Doxycycline (for 2 weeks)

Immune Medications
Metanx
Baby aspirin
Prednisone 20mg
Lovenox (30mg 2x a day until first ANTI-Xa)
Intralipids

Newsflash: Life is Unfair.

I have debated posting this, but after some thought, I think there are some important lessons to learn here, so while this is now live to my readers, I am not posting for pity and the comments on this post have been turned off. Life is unfair, and one thing I am not, is a whiner.  There are worse things to suffer from than this, and I remind myself of that often.

Recently, we transferred a hatching, CCS normal embryo and the cycle resulted in no pregnancy.   There was a significant immune protocol in place and my lining was at 11 and it was triple-striped.   I did acupuncture and followed an anti-inflammatory diet too. The lesson:  even the most perfect of circumstances can result in a BFN.  Another lesson: Just because you have a chromosomally normal embryo doesn’t mean you are guaranteed a BFP.

I had a lot of symptoms leading up to my BFN, all of which can be contributed to the medications, especially the progesterone. That’s another good lesson:  those symptoms? They are from the medications.

My next FET is already scheduled and we will be following a more natural FET protocol vs. what we did recently, a more medicated FET. If this cycle results in another BFN, I will immediately start IVF#9 and do another retrieval.

Results

The results are in from our testing with Dr. Braverman.

My husband has significant sperm DNA fragmentation.   Significant.   I feel very cheated by my RE, who told us ICSI would bypass his sperm issues.   Based on our 3 crappy IVF cycles and oh so much heartbreak, it hasn’t.   This is main reason that we’ve made so few blasts, despite a decent number of eggs.

We also have 6HLA matches. S-I-X.  To over simplify (and quite poorly at that), we are too genetically similar. This is the top reason my body rejected a perfectly normal embryo. That and the clotting factors.

There is a lot of information about HLA genetics, but the brief version is this: if a man and woman have similar genetics (something that occurs by chance in nature), the mother’s body may not receive the proper message about protecting her baby. Instead, her immune system will mistake the embryo for a foreign invader and attack it as though it is a cancer or virus. An amazing thing normally happens when a woman’s body carries a baby — her immune system recognizes that baby as something to protect, and produces blocking antibodies to keep it safe from her own natural killer cells. But if, on the cellular level, she and her mate have similar tissue proteins, her body cannot make the distinction between her child and a germ.

More tomorrow.  Today was a very difficult day that I just chased down with a full bottle of wine.

The Issues

We met with Dr. Braverman last week.  We initially had an appointment 6 weeks from the day we called, however a cancelled appointment opened up.  It was a long day, 7 hours door to door, and there was a lot of information to process.

To  sum it up, we have a lot of issues, and we are testing for a few more:

1.  My husbands 0-1% morphology could be a significant contributor to why we lose so many embryos on day 5 and 6.   He is going to do a sperm DNA fragmentation test, and if the numbers are bad, he will start various medicines.  He will do supplements either way.

2.  My clinic suggested a possible reason for the miscarriage was a “an energy issue at the  cellular/mitochondrial level.”  I honestly feel this is their generic answer when there is a failure with a CCS tested embryo. However,  Dr. Braverman did not rule this out, but did say it’s hard to diagnose.  I am going to be taking new supplements to improve this along with CO-Q10.  This could also be a significant contributor to why we have gotten so few quality embryos during our IVF cycles.

3. A doppler test indicated restricted blood flow to my uterus.  A very important piece of (treatable) information to know prior to transfer, no?  I questioned my current RE about it and she said they are “planning to start this testing in the next few months.”    Mind you, this is testing that is part of the normal CCRM workup.

4. During my pregnancy, my lovenox dosage was too low, as indicated by my anti-Xa test.  This may have been caught too late.    Clotting factors at play.

5.  I could have immune issues, natural killer cells, etc.   I am having the bloodwork for this next week.

6.  My husband and I could have HLA matches, i.e. our genetic makeup could be too similar, and  therefore my body is rejecting our babies.  We are also having bloodwork to test this next week.  I honestly don’t think this is our problem.  I think our problems are 1-4, with a dash of #5.

So there it is.   We both liked Dr. Braverman.  He was very knowledgeable, yet personable.  He offered us cost saving options, and ruled out a lot of different repeat testing.  Having said that, his hourly rate is insanely expensive.  Vomit in your mouth, expensive.  Our test results should be back in mid-September, and we will be meeting with him again shortly there after.  We are not even thinking about another transfer.  Our first goal is to improve upon the above issues, so that in December, we can cycle again (probably at our current clinic with some rogue input from Dr. B) with better results.

Also, my beta HCG level is back to zero.   It took me 17 months at my infertility clinic to get pregnant, and only 2 weeks to get unpregnant.

Sweet Relief

Oh sweet relief.  We saw and heard our little guys heartbeat yesterday.  He is right on track for his gestational age and the MFM said the sac looked “textbook perfect.”

It’s about fucking time that something was textbook perfect.

Since this is my first rodeo, I found this chart helpful in understanding the proper heartbeat ranges based on gestational age:

Age Normal Fetal Heart Rate
5 Weeks (Beginning) 80-85 bpm
5 Weeks starts at 80 and ends at 103 bpm
6 Weeks starts at 103 and ends at 126 bpm
7 Weeks starts at 126 and ends at 149 bpm
8 Weeks starts at 149 and ends at 172 bpm
9 Weeks 155-195 bpm (average 175 bpm)
12 Weeks 120-180 bpm (average 150 bpm)

Prior to my MFM appointment, I had Anti-Xa bloodwork done at the hospital.  This is a timed test that is used to determine if the blood is thin enough while on Lovenox.  The results were back within the hour and we learned my blood is a tad too thick.  My hematologist is increasing my dosage of Lovenox from 40mg to 60mg.  I must admit,  this conversation brought me to tears, tears of relief that I (finally) have the right doctors who will monitor my issues.   It gives me some hope for this pregnancy.

Also, as much as I bemoan the issues that make my pregnancy high-risk, we were really impressed by the ultrasound machine at the MFM’s office.  Dare I say they were sex-ay? They really blew my RE’s ultrasound machines away (and those are nothing to sneeze at either.)   We also straightened out my monitoring and ultrasound schedule for the next 15 weeks or so and now we can can schedule some things we’ve been holding off on.  So while being a clotting nightmare is no prize winner, there will be many appointments, and the constant reassurance during this pregnancy is welcome.