More Tests?!?

After our 2 losses, we had 5 embryos left in the freezer, none of which were the highest grade. I refused to do another cycle without some answers.  I wanted to know why this happened to us. I am totally a type “A” personality, whereas my hubs is not (probably why we mesh so well).  I always had been in control of what was going on in my life, and usually it followed the plan that I had created. Through this process, I was slowly learning I couldn’t be in control anymore and just because I had a plan, didn’t mean it would happen. I started to sift through all of the paperwork from the start of our journey (which now easily filled a thick binder).  I looked through numerous semen analysis’, blood tests, ultrasounds, HSG’s, SIS’s; basically anything I could to see if something was being overlooked.  Something that was causing me to not be able to stay pregnant.

paperwork

I came across the results of my genetic testing.  I started to remember vaguely that I was a carrier for Prothrombin, MTHR deficiency, Hemochromatosis, and Gaucher’s.  I started reading more about them.  I started learning that in isolation, Prothrombin and MTHR can slightly increase the chance of pregnancy loss.  I set up an appointment with a hematologist who was well known in South Florida.

My mom and I went to the hematology appointment in October.  Of course, more blood work. This time we were looking at homo-cysteine levels (new test), and a full thyroid panel with TSH (which I had previously).  Everything came back normal.  However, this doctor felt due to me being a carrier for a blood clotting disorder, such as Prothrombin, I  needed to be on a blood thinner during my pregnancies.  He recommended Lovenox injections daily into my stomach for the duration of any future pregnancies to prevent a potential blood clot.  With our most recent loss, his theory was that I most likely had a blood clot that cut off the oxygen supply to the yolk sacs.

We started to feel angry that I hadn’t been on it previously.  We knew several women who had miscarried, and once on a blood thinner had successful pregnancies.  So, the question was why wasn’t I? I scheduled an appointment with my regular OB-GYN who I have been going to now for over 10 years.  It had been over a year since my last annual, and I wanted her opinion on why this was happening.  I also wanted to know what she thought of the blood thinner recommendation.  We did my pap and it came back normal.  I shared the genetic results with her, and the recent losses.  She believed that both losses were most likely genetic; about 75% of early losses, according to the “statistics” are.  She thought there was no harm in going on the blood thinner, but she told me not to get my mind set that being on it would have prevented the losses.  Not exactly what we wanted to hear. We wanted definite answers.

So, we scheduled the dreaded post-IVF consult for late October (the one for failures in the world of IVF).  Our fertility doctor told us that she would like to do a full recurrent pregnancy loss (RPL) work-up on me, along with another SIS.  This involved more blood tests, but this time it would take about a month to get the results.

We shared with her that I had recently seen a hematologist, and he recommended I go on a blood thinner for my Prothrombin status.  She pointed out that I am a heterogeneous carrier, not a homogeneous carrier, and that studies generally do not show Lovenox, or any blood thinner for that matter, will prevent pregnancy loss with this status. She said in fact, sometimes if not needed, they can cause pregnancy loss.  Wait? What?! We were now even more confused.  The fertility specialist, like my OB, felt it was most likely a genetic abnormality with the embryos that caused the losses.  Something inside of me didn’t believe it was genetic though. I did as told and got the full RPL work-up done, hoping for an answer. This tested me for auto-immune disorders such as Lupus and Antiphospholipid antibodies.  She also tested my prolactin levels.  Everything came back normal, again.  One might think you would be pleased finding out nothing is wrong-not true! Finding out what was wrong would help us have some closure and in turn, determine a future treatment plan.

The SIS to examine my uterus for polyps, fibroids, and scar tissue was next on the list.  This time my cervix was being stubborn so the doctor had to numb it with a shot to do the procedure (yes, that’s right -a shot in your cervix).  Again, everything looked fine.  Can I tell you how sick of hearing that I was?

The fertility specialist brought back up the lining issue we had (my lining only measured a measly 6 when we transferred the 2 embryos in August).  If we were to undergo a future cycle, she wanted more ultrasound monitoring, along with an extra week of medications (estrogen) for my lining to adequately grow.  She also recommended I take vaginal Viagra. I know you are probably chuckling at this one! We couldn’t help laugh ourselves.  Vaginal Viagra is apparently not just used to make men happy, it is also used to thicken the uterine lining in women, especially those in the world of IVF. You must decide up front before a cycle if you plan to use it, because the cycle must be timed appropriately around it.  We didn’t have a problem with this; I researched it and the side effects were minimal.

We decided that December could be an option for a future transfer.  During Christmas break, I would be off school for 2 1/2 weeks and have plenty of time to rest.  We had always planned that I would take time off work to stay home after the baby was born, and with an August due date, I just wouldn’t start off that year teaching.  We had also spoken with an accountant, and if we did the transfer before the calendar year ended, we would get more of a tax break than if we waited and started from $0 in January.  All of this seemed perfect.

We asked for a calendar showing the available December transfer dates, along with medication and monitoring dates.  This calendar dated from early November to January.  At this point, we felt we had done everything we could do before moving forward, even though we still had no definite answers.

This being said, we chose December 19th, 2014 as our BIG day, and we were ready to rock and roll again!

To IVF or Not to IVF?

After the sperm count showed little improvement well after a year of his Varicocele surgery, we decided we would go back to meet with a fertility specialist.  Don’t get me wrong, we kept busy from 2012 up until 2014…I got my master’s degree, we got a new dog, we remodeled our master bathroom, we put in new floors throughout our house, we traveled. We pretty much did everything we could to take our minds off trying to get pregnant. But deep down inside our minds were still there.

We ended up choosing a different fertility practice this time than where we had done our IUI’s.  Let me tell you why.  As I mentioned in a prior post, the previous office had numerous doctors with various locations.  During our short time at the practice, we drove up to 2 hours away for an appointment.  And we knew if we did IVF there, it would be even more driving (not done at all locations).  We also disliked the idea of a different doctor possibly performing the procedures each time. The more times the same doctor is examining your uterus, the better we thought. Getting a second opinion from another fertility practice was very important to us as well.

We found another practice about 30 minutes from home, with a woman doctor this time.  Both of us just felt more at ease when we went to our initial consultation with her.  She spent at least an hour with us. We would not have to drive to different locations or see different doctors either.  Of course, I had taken all of our records with all of the “test” results to this appointment.  By now, these tests were over a year old, so guess what? Yep, you guessed it…REPEAT all tests! This entailed: a pap, blood work & a sperm count, genetic testing for both of us (a must before IVF), another HSG and SIS, etc.

All was normal with 2 exceptions: the sperm count and the genetic testing done on me.  It came back that I was a carrier for Prothrombin Thrombophilia, Hemochromatosis, & Gaucher’s, and I had the MTHR deficiency condition.

After you do genetic testing, the genetic counselor calls you and reviews the results with you.   I was told that none of what I was a carrier for, nor had a condition for, would affect reproduction.  The new fertility specialist we were seeing confirmed this at our next meeting.  In the case I became pregnant, all I would need to do is take baby aspirin for the Prothrombin & folic acid for the MTHR.  Easy enough!

She went on to tell us what we prayed she wouldn’t; without IVF with ICSI there was no real chance of us conceiving on our own.  And she said she wouldn’t bother to do IUI again and waste our money.  OUCH.

So, we met with the financial coordinator to see what we would be in for if we decided to do IVF.  We had already heard how costly it was. There are about 1 million different packages to choose from.  Seriously!  Packages can range from (here comes the jargon) 1 fresh cycle with 3 frozen cycles, to 3 fresh cycles with 2 frozen cycles, or you can just pay for one cycle at a time. To give you an idea, the price for a single fresh cycle with meds was around $14,000, and a multi-cycle (both fresh and frozen) was about $28,000. YIKES! Talk about breaking the bank.  After talking with the financial coordinator, we both needed a stiff drink to say the least.  How could we ever afford to have our family? 😞

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