Drum Roll Please…More Results!

As you know, we saw another RE last week for a second opinion.  He suggested that I have a few additional tests run that I have not had run before.  He also recommended that my husband get some tests re-ran.

Here are the results for my panel: 

Vitamin D – in normal range. Normal range is 30-100, mine came back at 46.  

Celiac disease– in normal range.  Anything less than 4 is considered normal, mine came back at 1.

Biliruben- abnormal; normal is 0.2-1.2; mine is 2.3.  The RE would like me to see a Gastro Dr. in between now and our next visit back to him.  I called and set up an appointment with one today.  I did not do what I would usually do, and ask a million questions about what this abnormal result means and the correlation (if any) between RPL and it.  I figure I will find out soon enough.  I do know that high total bilirubin levels may occur with liver and/or gallbladder disease.  The only reason I know this is because it is why our fur baby, Nacho, ended up passing away.  He could not process the bile or waste out of his system any longer and his kidneys failed. I believe his level was somewhere around a 10 at the end.  Poor baby. 


Husband’s results:

Prolactin- normal range

Testosterone- normal range.  Normal is anywhere from 250-827, his was 417.

LH- normal range

TSH- normal range

FSH- abnormal.  Normal is 1.6-8.0; his is 9.4, so it is slightly elevated.  The RE said that this just means his brain is working extra hard communicating with his testicles to produce sperm. An A+ for effort at least! LOL. 

Since all of his levels except his FSH were normal, Clomid will be of no use in improving his count. These other hormones (especially testosterone & TSH) would have to be out of whack as well. So really nothing has changed hormonally the past few years since the last panel was originally run on him. In the meantime, I did start him on CoQ10 because I have heard so many wonderful things about it. I figure it can’t hurt to at least try right? 

Next on the agenda was setting up the mock transfer with the new RE, so I did.  I also set up the follow-up consultation after the mock transfer to review it, the gastric results, and a calendar for a FET.

I know it may sound like we have made our final decision as to where we will be moving forward at with our FET and precious embies, but we haven’t completely yet. However, we feel all of these steps in the meantime are very necessary in aiding the decison making progress.  Only a few more weeks and the decision should be made! 

Second Opinion #1

This week has been full of surprises! Right now, I am going to focus on the RE piece, and save the other stuff for later.

We had an appointment with another well-known RE for a 2nd opinion about our IVF and RPL situation this week.  Overall, it went extremely well!  He spent 3 hours (no joke) going through our records and discussing them. 

Before I get into detail, I should first start off by saying that according to ASRM, this clinics success rate for live IVF births is equivalent to the clinic we are at now (about 60% which is quite good if you research clinics across the US).

Here are some of the main points we covered at our consultation:

  • I need to be tested for Vitamin D deficiency as I have never been.  Went and got this done today.
  • I need to be tested for Celiac Disease.  Celiac disease can be linked to recurrent pregnancy loss, but is not on the usual RPL panel work-up & of course, I have not been tested for it yet either.  You would think since it is a simple blood test, why wouldn’t my current RE just order it? If I did end up having have Celiac disease, it would require a gluten-free diet. I also got this test done today.
  • Husband needs to get his testosterone, LH, FSH, Prolactin, etc. run again so we can see if Clomid would be of any use in upping his count.  It has been about 5 years since we tested these in him. They were all in normal range before, so using Clomid was not an option (it doesn’t assist with just a low count, there has to be a hormonal imbalance happening too).  Got this test done this a.m. as well.
  • This RE was very impressed with my husbands improvement from pre-varicocele surgery to now, 2 years post surgery.  He said our chances of conceiving on our own have gone from a measly 1% to about 15%.  And if we got him on Clomid, there would be an even higher chance on our own or via IUI, about 25%.  Hey, we will take what we can get here!
  • At this clinic, we can pick any day for our transfer, as we go along in our cycle.  It does not need to be done in advance.  This is HUGE to us.  Our current clinic only does transfers 1 week out of the month, and hence, they try to control everyone’s cycles with BC and Lupron, picking out the exact transfer date months in advance.  I despise this! This clinic does transfers 365 days a year if needed, depending on the woman’s individual body/cycle. Just call on day 1 of your period and off to the races you go!
  • He would only want to transfer 1 embryo in a future FET.  Great news!!!  Why do we need to transfer two if I get pregnant with twins every time we transfer two?  If we transferred just 1, we would most likely still get pregnant like we did the first time when we transferred 1! Obviously, I do not do very well with twins, and he felt that there is a chance that one twin vanishing could have affected the other making it.  Of course, there are lots of times where one vanishes and the other does perfectly fine, but not always.  There is no solid way to prove or disprove if losing one twin could have played a role in losing the other.  
  • He would do a non medicated FET like we have been pushing for.  Since my cycles are regular, & my lining looks well post surgeries, there is no reason not to.  This could involve the use of trigger or not, which we can decide down the road.
  • He wants to investigate my super high progesterone levels during each pregnancy. Our current RE said my levels are the highest she has ever seen, but also said it wasn’t an issue as far as loss goes; only low progesterone is a cause of RPL.  I know that low progesterone can cause loss, but there is something strange about how high these levels are when pregnant.  When this RE saw them, he also said they are also the highest he has ever seen.  He has been practicing for 30 years.  Hmmm…sounds fishy to me.  Our last pregnancy my progesterone level was around 300, and we are talking about with my first beta it was this high. First trimester progesterone levels are usually under 80!  They stayed consistently high like this too until every loss.  I was using Crinone for my progesterone supplementation during each cycle.  Obviously, I did not need to be doing the Crinone 2 times per day at $15 per insert for 10 weeks with a progesterone like that.  When I mentioned this concern to my current RE when pregnant, she said to keep doing them as I was regardless of how high the levels were.  Uh, OK.  The new RE said he would like to discuss the levels with his partners at the practice, which we really liked to hear.  Never once has my current doctor said she would like to consult with another person about us.  2 minds are better than 1, right??
  • He wants to perform a mock transfer if we choose to move forward at his clinic, and another Hysteroscopy to be sure my uterus is all clear.
  • Relocating our embryos will cost us $100 (dirt cheap in the IVF world), it’s a simple form to fill out, and takes about 2 weeks to get done start to finish (both clinics use the same transportation/storage facility which is good).  Also, the embryo medium is the same between clinics, they have had several patients transfer back and forth between the 2 before without issues.
  • He feels our chances of carrying to term are still quite good; I didn’t bother asking for a percentage.  He said he has had patients that have carried to term after 3 unexplained IVF losses with no prior children.  Hope!!!
  • He cannot definitively say that the submucosal fibroid caused our last loss.  Mainly because we do not even know with certainty that it was there during the pregnancy since the Hysteroscopy that identified it was not performed until 2 months after.  We figured this already.
  • We discussed anti-depressants, and post-partum depression, which due to my situation, I am at high risk for. You would think it would be the opposite, but its not. More to follow on this soon. 
  • Saving the best for last, his practice has a blood and ultrasound monitoring center literally 10 minutes from our house! Almost unreal, right? We are used to traveling about 70 miles per visit.

So, now what?  Well, we still have an appointment with another new RE set up for July 22nd.  However, we have started to ask ourselves if we should even go for another opinion??  Will it just confuse us even more?

In addition, we have an appointment back at our current RE August 6.  I feel like this appointment is almost a last-ditch effort; one last chance to tell us what we can do differently moving forward.  Each day though, I wonder if I even want to bother with it.  I guess the question is, if we like this new RE’s opinion & experience, should we just make the decision to go there and be done with it? Perhaps more information will just cloud our vision even further. 

  

Guest Post–A Happy Ending for a Couple Diagnosed with Unexplained Infertility

Today I am featuring a guest post from a couple diagnosed with unexplained infertility who are so very dear to my heart- my 1st cousin, Nina and her husband, Bryan.

Although I am sad that we both have had to battle infertility, I am forever grateful for the support and love we have been able to give to one another through this time in our lives.  Those of you who follow my blog know that I always say infertility has brought my husband and I closer.  Well, I can easily say the same thing about my cousin & I’s relationship, too.

Here is their story.


Nina & Bryan’s Story

So, when Ang asked if we would want to share our journey, I right away thought yes of course….then I thought oh goodness I am no writer and have never really written out our story….but quickly let her know that we would be honored to be a part of this amazing avenue for those on the infertility rollercoaster!  I am so proud of you Ang!

If you would have told me 7 years ago that I would be sharing our story on an infertility blog, I probably would have said, “No certainly not me…you must have the wrong couple!”  I say 7 years ago because my husband and I just celebrated our 7th wedding anniversary on June 21!  As newlyweds, we knew we wanted to have a year to enjoy being married, but wanted to start our family soon after.  We envisioned choosing a month to start trying, become pregnant and soon after have our sweet little bundle of joy!   Perfect picture right?!  Well, the reality was much different….

After about a year of trying with no success one of my very best friends (who was going though infertility) told me she would, without a doubt get to the doctor to get things checked out.  Without hesitation I did just that, all the while still thinking we weren’t going to find anything wrong and would be pregnant soon enough!  My friend advised that it was a good idea to start with the male factor to rule out anything.  For this, I would have to get a referral from my OBGYN first.

Here begins our journey!  To be quite honest I am horrible with dates and I cannot remember the exact timeline.  But, here are the steps we took.   First, I made an appointment to see my OBGYN.  We explained our concerns and asked for a referral for my husband to have things looked at.  She reassured me that I was young and healthy (I had no previous issues, regular cycles, etc.) and that these things take TIME….oh boy was she right about the TIME thing!  The next step was heading to the Urologist for Bryan.  We found that Bry had sperm for days, but they seemed to be taking a vacation.  Our urologist also informed us that Bry had some sort of infection.  One that could easily be taken care of with an antibiotic and that after we would do another analysis.  Fast forward to a few more visits to the urologist and a few more tests….she basically tells us that she is stumped and isn’t sure what to do!  Hence, our unexplained infertility diagnosis.  It felt like months of “wasted” time!

So, I then make an appointment to see the fertility specialist for a consultation.   It was over Christmas break, being a teacher I took any appointment I could get…that being said Bry couldn’t get off work.  So I take my sisters along with me for support and extra ears!

December of 2010 began our journey with the amazing Dr. Karnitis!  He thought that we were great candidates for IUI.  We started up right away.  We were so excited….first IUI cycle was simple.  Clomid, trigger and Bry to the office for his “intimate” alone time, then the procedure…wahoo we were sure to be pregnant after all of this!  We had everyone praying and hoping for the great news.  We choose to be pretty open about everything.  We figured we needed the prayer and support regardless of what was going to happen!  The IUI’s continued….another round of Clomid with injections, then we tried Femara with injections.  Nothing seemed to be wrong, but things just weren’t working!  Even with the injections my eggs didn’t seem to mature like they should be.  We tried a few more rounds of IUI, thinking it just had to work.  But after 5 failed IUI’s, we were finally ready to move on to IVF.  You are probably wondering why we continued trying IUI’s.  I think it was a combo of our doctor being very conservative and careful, and honestly I’m not sure that we were ready to make the IVF move quite yet!

We started up on our 1st round of IVF.  We were both very excited, knowing that with this more invasive procedure our chances of having the sweet babe we have been longing for was pretty great!  Dr. K was always so very optimistic as well.  During this process we were very fortunate to have a wonderful support system and prayer chains galore!  After our many rounds of IUI, we were able to find out that my body did react a little funny to the meds.  It was almost like I would need them upped, but when he would my body would go a little too crazy when they were.  We had to tread lightly.  Again, my eggs weren’t quite what Dr. K wanted, number or size, so he would up the meds just barely.  The eggs ended up getting there, but my levels shot through the roof.  He said it was too dangerous to trigger and continue with the retrieval.  We were so extremely devastated that our cycle was cancelled!  We then took a little break to give my ovaries and body some recover time.

Then it was on to IVF Round 2.  This time around we used a little different med concoction.  Things were going very smoothly, many eggs were developing and my lining was just where he wanted it.  My levels were getting nice and high, which was scary, but he felt comfortable moving forward to the egg retrieval.  YAY!!!  I apologize for not having many details, but to be honest I have difficulty remembering it all.  What we were living day to day, that I never thought I could forget, seems like a blur!

I will tell you that I did not forget any part of the egg retrieval.  We were so excited to finally get to this part.  We were one step closer to our goal!  During the retrieval I was in twilight and was feeling very good.  I remember trying so hard to focus because I wanted to see every single egg Dr. K got and wanted to be sure everything was good to go…as if I could change anything that was taking place!  Dr. K was able to retrieve 17 eggs!!  The next few days were just crazy…we got calls daily explaining how our embryos were doing.  By the end, we had 4 awesome day 4 embryos.  4 days later we did our fresh transfer of 2 embryos.  The other 2 were then frozen.  The day of the transfer was super calm and easy.  We just took it easy and prayed!

I thought for sure that it didn’t work.  I am a worrier to say the least…I didn’t feel any different and I was totally bummed.  Then watch out….here came day 11.  Bry was actually sick with the Norovirus.  So to get me away from it all my mom took me to Outback to eat.  I felt a little queasy, thinking I had caught the awful bug that Bry had.  Oh my goodness was I wrong!  I was a hot mess.  I was getting sick, had migraines, and was passing out on the bathroom floor.  We were on the phone with Dr. K who advised us to get to the clinic, which was located in the hospital and that this was actually great news.  Ummm…I felt absolutely terrible, how in the world could this be good?!

I got there and was hooked up to IV’s right away.  I was extremely dehydrated and had OHSS (Ovarian Hyperstimulation Syndrome).  They kept me all day.  Dr. K then decided to do a beta….he said it was early and that if it was negative, there was still the possibility that it could be positive, but if it were positive I was in fact pregnant!  He came back shortly, and the news we had been waiting to hear for years was given to us!  CONGRATS…we were pregnant!!  I am going to be honest we literally looked at each other, smiled and kissed.  I then tried to fall back asleep!  We had def pictured something a bit different, but hey who the heck cares!!!  We were going to be parents finally!  As Dr. K walked out of the room he had a smirk on his face and said under his breath, those are twin numbers!!!  Oh my…could it really be!? I felt pretty terrible for weeks after.  I remember Bry literally carrying me to put me into the bathtub!  He is my ROCK!   I looked like I was 4 months pregnant in the matter of a few days, due to the fluid because of OHSS.

Our next appointment was scheduled at 7 weeks to have an ultrasound.  I was still under the weather, but doing a bit better!  We were nervous…so so nervous.  We just wanted to be sure we really were pregnant.  We wanted to see that heart beat!  In comes Dr. K and here we go…“Yep….2 sacs, and 2 heartbeats”!!!!!! WHAT…….we literally looked at eachother and started laughing!  It was a nervous, super excited laugh!  Dr. K joined in the fun!!  Then I had to triple check that they were both healthy so far and look just as they should!  He reassured me they were.

We gave birth to two beautiful babies on September 8, 2013.  They just couldn’t wait to meet us and came 2 months early, but we made it through the 5 week NICU stay!  We thank God everyday for our sweet miracles.

Thank you for allowing us to share our story!  I hope that it can give everyone reading this hope.  No matter where are you in your journey!  Infertility is so very frustrating and it can be easy to lose all hope.  We were there on numerous occasions…keep the faith!

You are all in our prayers ,

Nina and Bryan

Our miracles!!!
                         Our miracles!!!

Coping with Male Factor

Male Factor.  That was our official diagnosis as to why we were infertile back in 2011.  When they do a sperm analysis, they don’t just look at the count as many people think.  They look at about 7 other major factors too.  NOTE: I do not claim to be a doctor in anyway, all of this information is based purely on experience. Some of these factors are sperm volume, concentration, motility (IMPORTANT!), viscosity, PH, and morphology (ANOTHER BIGGIE!). When it comes down to it, the 3 most important factors are: count, motility, and morphology.  In other words, the amount of sperm, the rate at which they swim, and if they are shaped normal or not.  Don’t worry, I won’t get into all of the details and percentages like a doctor will and bore you to death, however feel free to ask if you are curious.

When we had our 2nd sit down with the fertility specialist after the 2nd count, he told us our only option was to do In Vitro Fertilization (IVF) with Intra-cytoplasmic Sperm Injection (ICSI).  WHOA! What? These are very common terms to the infertile couple even though they may sound foreign to a fertile myrtle (notice I emphasize may).  Basically, we figured out on our own that IVF meant retrieving my eggs and putting them with my husbands sperm in a dish in hopes they would form an embryo(s) that could be transferred into my uterus.  The ICSI part meant that instead of allowing the sperm and egg to join together on their own in the dish, the embryologist would pick the best sperm and inject them into the best eggs.

Initially, we wanted NOTHING to do with IVF.  It was so scary to even think about it.  We had friends that went through it and we knew what hell it was for them, whether they finally achieved the pregnancy or not.  Emotionally, physically, financially…we didn’t want anything to do with it.  So, we insisted that the doctor allow us to do an Intra Uterine Insemination (IUI) first. The doctor clearly told us there was no chance it would work as we only had a tenth of the sperm they recommend for this procedure.  We didn’t care.

Here’s why:  In my opinion, IUI is wayyyy easier than IVF.  The amount of hormones and monitoring by the doctor is significantly less.  Plus, it is much less evasive and significantly cheaper (IUI is only about $1,000 each round).  For us, IUI involved taking Clomid (sometimes referred to as the “gateway drug” for infertile couples) for a few weeks before ovulation, with ultrasounds in between to measure the size of my follicles, and when they were the right size, I would inject myself with a “trigger” shot (OUCH! This one was in the stomach though, not like the big daddy IVF one in the a** which is so much worse).  The trigger shot meant I would release my eggs (ovulate) within 36 hours. During that window of time, we would go into the doctor, Shane would do his part, and they would inject it into me.  It was definitely worth a shot to us.

Here’s the catch-the only way you can proceed with an IUI or an IVF is to have MORE tests done first.  Anyone embarking in the field of assisted reproduction should understand and accept that there will always be tests to be done on them. The two most common diagnostic uterine tests are the Hysterosalphigogram (HSG) and the Saline Infusion Sonohysterography (SIS).  Ask any woman who has had an IUI or IVF done and I bet she will know exactly what these are.  The HSG is an x-ray that checks your uterus to make sure your tubes aren’t blocked.  You go into the same type of room as you would for an x-ray, except you lay down and they inject a “dye” into your uterus through a catheter so they can see the uterus better.  I HATED this test the most of all tests (all 3 times I had it done).  It was uncomfortable and took about 20 minutes.  And there was an issue.  The doctor said my right tube appeared to be blocked and we would need to repeat the test to be absolutely sure (there was a chance I was just having a spasm that was causing it to appear blocked).

#HSG

So, I repeated the evil test and it came back normal, no tube blockage, just a spasm.  Next on the list was the SIS.  This one isn’t as bad.  I’ve had it done about 5 times.  Here a catheter is inserted and saline is injected into the uterus.  This test looks for things like polyps, fibroids, and scar tissue.  My first one came back normal and we were finally ready to give the IUI a go!  As you can see, it takes a while for anything in the fertility world to actually happen.  From the time we decided to do the first IUI until we actually did it, it was around 3 months later.

The day following my trigger, we went to the doctor for the insemination.  My husband did his job in the “secret room” while I was prepped in the room adjacent.  It took about 20 minutes because they have to wash, or spin out his sperm, finding only the moving ones with nice shapes.  There weren’t many they told us.  But, we were still hopeful.  Hey, it only takes 1 right?! I laid back and the doctor injected the sperm into my uterus through a tiny catheter.  Piece of cake! After I rested there for about 30 minutes while we talked. I took the day off work even though they said I could return to my normal activities. We went back in the following day & went through the same steps trying to make sure we timed the IUI perfectly right.  I took off another day to relax.  And then 2 week wait began (2WW).

In the world of infertility, this is one of the most dreaded times.  Seriously, Google it and you will see. During the 2WW, I tried to stay busy at work and at home, and so did my hubs.  We didn’t tell anyone we did the IUI, other than our fertility buddies at the time. The doctors tell you that you should never take a pregnancy test early, but we did anyways.  Negative.  We still thought it might have worked.

That’s the viscous cycle with infertility; you are always hopeful and sure THIS is the time.  But, the day my blood was to be drawn at the doctor, I got my period and it confirmed the BFN.  It was now 2012.

#negativepregnancytest