Which Way

I’d like to say things are getting better and staying better but it seems that returning to infertility treatments has halted and also reversed any healing I did after my miscarriage.

I hate hate hate where I am right now and I’m angry that I cannot seem to snap out of it. Women have miscarriages all the time, it’s not like I’m special or anything. I wish I knew how to just suck it up and move on. On one hand I remind myself that I only lost the pregnancy a few months ago but on the other hand I feel like I should of made more progress? I should be feeling better? I don’t know. It’s just, we put so much emotional, physical and financial effort into that baby we lost: 3 IVFs, a polyp removal, CCS testing, 1000’s of injections (FU Lovenox), the bulk of our savings, etc and now I just feel empty. I have always been a strong person and I feel so very defeated.

Yesterday I cancelled on my RE literally 1 hour before I was scheduled to have a procedure. Instead, I stayed in bed and cried for a few hours. My husband then called to see how the procedure went and was shocked when he heard I didn’t go. I always go. I finally dragged myself out of bed, worked a few hours and then cut out early for a manicure and pedicure. I am trying, but some days the sadness is just overwhelming.

Perhaps it isn’t just the miscarriage, but that I am so worn down after almost 2 years of failed infertility treatments? Why continue when we always get bad news? There are just so many obstacles against us. I don’t know how we will overcome my husbands sperm DNA fragmentation and I don’t know how to overcome the HLA match issues. Especially as there is now some concern about using Neupogen due to my blood clotting issues. While we are fine using a gestational carrier it is a huge expense for us on top of 2 years of expensive infertility treatments.

I’ll admit it, I bought Powerball tickets yesterday. Unlimited funds would really help us reach the goal of 1 baby. We won $7.

Just a note to those of you who sent me an email, txt, or left a message after my last post. Thank you for checking in. Thank you for taking 1 minute out of your day to say hello, commiserate or just support. It made me feel less alone.

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Prep

We are oh so slowly prepping for our next IVF. We are throwing so many new things at this next cycle I honestly have no idea what to expect. In reality, my confidence is so shattered that I am not anticipating much success.

I think the most significant adjustment is that I have severely limited gluten and dairy. As I had no concrete knowledge on how to go about such a change, this was quite a learning process. It involved vast interwebs research, interviews with crunchy time friends, discussions with a doctor and a nutritionist, and recon at Whole Foods and Trader Joe’s. The conclusion was I needed to identify the diary and gluten items I could not live without and find alternatives. If you are curious how it’s going, all I can say is this insanity is still in its infancy, so I have no major conclusions as of yet.

Next, I am now taking micro green pills, mitochondrial supplements, and vitamin E. These have been added to my current regimen of baby aspirin, vitamin D, and acupuncture. CO-Q10 has been wiped from my list, and DHEA is still up in the air.

My husband is taking an antioxidant supplement and Clomid. He has severely limited his alcohol consumption and is eating very cleanly. After a few months on this plan he will repeat the sperm DNA fragmentation test.

Dr. Braverman and I discussed the decisions made throughout my prior IVF protocols. It was scary to hear his thoughts, as many of them mimic my own conclusions. My ovaries should of been gently surpressed (I have a repeated history of lead follicles) and estrogen priming should of been implemented. Every single IVF cycle was too short, in fact, I should of stimmed for longer than 8 days. For my last cycle, 3 days of human growth hormone was concluded to be not enough. Also, my Gonal-F dosage should have been stepped down throughout the stim process. Dr. Braverman does suggest very high initial stim dosages (like 750IU) and eventually stepping down. This level of stim medication sets off a warning bell for me. Has anyone stimmed with these types of dosages (after suppression) and been successful? I am very curious for any feedback. Particularly from those working with Dr. Braverman, however all experience with high stim dosages and success are welcome.

We are not focusing on the embryo transfer process at this time, so I suspect I won’t post about it for a few months. I believe we will start IVF #4 in January. It will (hopefully) be a freeze all and embryo banking cycle.

This may all seem like progress, but emotionally, I am not doing well. I am avoiding most people. I cry a few times a week. I tear up everyday. I am in a funk. I am tired all the time. It is a challenge to take care of myself like I used to, so I started making lists. I saw the dermatologist. I scheduled the orthopedist. I visited the acupuncturist. I got a pedicure. It is only 7 weeks out from my miscarriage, and I am still waiting for it to get easier, to feel more like myself. However, I just feel like I’m just going through the motions.

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.

IVF #4

We are (slowly) gearing up for IVF#4, which is tentatively scheduled for December or January.   Why so far away?   The treatment for my husband’s low morphology/sperm DNA fragmentation will take approximately 3 months to (hopefully) be effective and my body needs to get back to regular rhythms. I’m also behind on my supplements and acupuncture,  2 things that proved to very effective for IVF #3.  Oh and there has been a return to healthy eating and virtually eliminating alcohol.

After IVF #4, we are done.  We will transfer whatever we have (perhaps into a gestational carrier), and if nothing sticks, we will not have children.  I am no quitter, but it will be financially impossible to continue on after this point.

In fact, last week we cashed in an investment we made 13 years ago, something I have often affectionately referred to as “my engagement ring.”   Prior to our marriage, I decided I wanted to put the money my husband had set aside for an engagement ring into a real estate deal instead.   When my friends said “show me your ring!” I replied with “we are the proud owners of few doorknobs in Bucks County, PA.”  I rarely doubted this decision, as the investment paid us quarterly and has increased in value significantly.  However now because of infertility costs, we had to liquidate “my engagement ring.”  I feel a real sense of loss that we had to do this.   How many other women have sold their engagement ring for the oh so slim chance of having a baby?  I am in the minority.  On so many levels.

It stuns me me that people actually have sex and the result is a baby, while in comparison we have countless years of sadness and an empty bank account.    All that really runs through my head is “what losers we are.”

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.