Positively Positive +

Well, here it is…

 
My BFP ovulation prediction test.  No, this is not a BFP pregnancy test! However, we are still stoked about this positive.

Would you believe it if I told you I have never gotten a positive on one of these before? Never, ever? Well, it’s the truth, because I haven’t. I tried the Clear Blue tests years ago, before our IVF days & never saw success with them. They were pricey, and eventually I gave up.

Looking back, I didn’t know nearly as much about my fertility then as I do now. That being said, I think I was always testing too early during my cycle. We didn’t really think much of it either because I was always getting my period every 28 days, so we knew I had to be ovulating at some point. We just couldn’t pinpoint it. Instead we followed my OB-GYN’s orders, did the deed starting on day 12 up until day 16, and hoped it would just happen like it does for others. Well, as you know, it never did.

Now to the present day, 3 IVF miscarriages later. I recently bought the Wondfo tests in bulk, and I started testing (morning-afternoon-evening) beginning on day 9.  By day 13, I had a faint line, but it wasn’t until night time on day 15 that I finally got a positive LH surge. This means I should ovulate anytime in the next 12 to 48 hours, which would be day 16 or 17 of my cycle.

As many of you know, my lining check on day 12 was 5mm. I’m actually happy that I’m not ovulating until 4 or so days after the check because this means my lining had even more time to thicken itself. Maybe it even made it to the desired 8mm mark! Who knows. But I would like to think positively and say it did.

We originally bought these tests with the intentions of making sure my cycles were still regular.  I didn’t think we would even be allowing the thought of getting pregnant on our own the slightest consideration, but for some reason we are. I’m not really sure how it happened, but it did. I guess we figure that since we aren’t moving forward with another FET anytime soon, what the heck. It’s officially been over 2 years since my husband had his Varicocele surgery, & even though his count is still lower than normal, it is the highest it has ever been; almost 10 million more than when we began this journey. We know when I am ovulating now, my uterus is clear, & overall, I am pretty relaxed.

Regardless of the outcome of us TTC on our own over the next few months, it’s reassuring to know that it’s all in Gods hands. We believe miracles can happen, but this doesn’t mean one will right now. God’s timing might not be ours. We also find comfort knowing that no matter what happens, we still have our 3 frosties waiting patiently for us!  

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“I’ll Take an All-Natural FET, Please”

What causes Adenomyosis? After we discussed how we plan to get rid of it, that was the next “big” question on my mind.

Here’s what we got:

  • Damage to the uterine lining
  • Excessive estrogen
  • Pre-menopause
  • Unknown reasons

Damage to the uterine lining is a possibility for us.  We have had d & c’s done, and every time you do, the lining of the uterus is scraped.  I have also had a history of thin lining which goes hand in hand with this.

Estrogen.  Too much freaking estrogen.  I have been taking synthetic estrogen for 8 out of the past 12 months (1 fresh and 2 frozen cycles).  And of course, since I have thin lining, I am prescribed even more estrogen than the average woman in an IVF cycle. This is because estrogen is what causes the uterine lining to thicken.  As you can see, it’s totally a catch 22 here. I need estrogen for a thick uterine lining, but excessive estrogen can not only cause Adenomyosis, but feed it.

adenomyosis

The last FET we did my estrogen levels were through the roof.  I felt like I was on speed the week before the transfer.  It was horrible (don’t worry you can’t hyperstimulate like you would with levels like that on a fresh cycle).  During a FET, a woman’s estrogen levels are supposed to be close to that of a woman who conceives naturally…mine were quadrupled, but hey, I had my lining of an 11 or 12!  And, remember, at the time we didn’t know we were feeding a monster either. So, the question becomes how can we even consider pumping more estrogen into my body during a future cycle, now that we are aware of this new diagnosis? We have two options.  Do a “super quick” FET, with estrogen, supposedly not allowing much time for Adenomyoma growth, or do a natural FET with no hormones (aka non-medicated FET). We are all about the latter, therefore I brought it up to our RE.   She said she would be willing to try an all natural FET with us. No estrogen patches and pills, no shoving progesterone up my who-ha 3x a day.  Just taking our sweet little embryo and transferring into my uterus at the right time.  Amen! She warned us that pregnancy rates are not as good for a natural FET, and that a lot more monitoring (blood and ultras) is involved.  Pregnancy rates are not as good because your body is not as controlled (more specific details about how a natural FET works coming soon in another post).  She said she has had a “few” pregnancies result from a natural FET.  I didnt ask for a percentage, because I really dont care what it is anyway. Any success stories from my TTC sisters is welcomed here!!

Let me tell you, I will go in there everyday for an ultrasound and blood if I can stay away from all the damn hormones.  And again, we have gotten pregnant every single time we transfer, so the “pregnancy rates aren’t as good” part doesn’t necessarily apply to our situation.  We want to stay pregnant.

Another reason this sounds appealing is because I have never had an issue with my progesterone either, in fact, it is always high (ruled out as a cause for our RPL). As far as growing my lining, I feel it can happen without the synthetic estrogen, with God’s help of course (and some yoga, acupuncture, and super foods).

At this point, we just feel like it’s at least worth a shot. 

  

The Weeks Leading Up to FET #2

My favorite time of the year was here. Winter in Florida had finally arrived. 60’s at night, 70’s during the day, ideal weather for a hoodie and some comfy leggings (maybe even a pair of boots).  Who wouldn’t love this weather?  Just like northerners look forward to the summer every year, likewise, we Floridians, look forward to the winter.

During what felt like the longest November ever, I taught during the days, and at night, I practiced yoga or received acupuncture. In fact, I was going to acupuncture 2 times a week (not cheap!!!), and yoga 3x a week for a solid month.  My goal was not only to reduce my stress levels, but to get the blood flowing to my uterus, which in turn would help thicken my lining.  At home I was also practicing yoga. Every night I had my “legs up the wall.”  All you yogis out there know exactly what I am talking about!  I would sit, butt up against the wall with my legs up for at least 30 minutes, all the while praying my lining was growing.

yoga-leg-up-the-wall-pose

After that, I would pour a glass of red wine (something I never did with other cycles–you get risky after you are a pro!), and take a candle light, lavender bubble bath.  I remember feeling incredibly tired day after day, especially come mid-November, when I starting taking all of the hormones again. There were many days when all I wanted to do was just take a hot shower, eat dinner, and curl into bed after work.  But I pushed, and kept going. I kept thinking about December 19th, our “big” day; for this was the day we would start our family.

All of the therapeutic practice paid off. By the first week of my ultrasound monitoring, after only 1 week of estrogen pills and patches, my lining was already at an 8.  Yep, that’s right, an 8! The thickest it had ever been.  And the best part was I still had 2 more weeks for it to continue thickening.  FYI: Lining doesn’t get thinner, or shed, until a menstrual cycle.  This being said, we knew my lining, at minimal, would be an 8 for the transfer.  As it ended up, I never even needed to take the vaginal Viagra, which I couldn’t complain about (even though we already paid for it).

The week following my first ultrasound, on what just so happened to be Black Friday, my lining was up to a 10.  We walked out of that appointment just staring at each other in awe.  We couldn’t believe it!  The doctor and nurses couldn’t either.  They were actually clapping and cheering.  We thanked God over and over again.  When they asked me what I was doing differently this time, I said, “praying harder.”  We tried our best to give God the glory any chance we could.

December was here. At our 3rd ultrasound, my lining measured a whopping 12.  Anyone in the world of assisted reproduction knows how awesome this is! I had finally made a thick, cozy bed for those embryos to burrow into. I was actually proud of my body, which I hadn’t felt in quite some time.  At this point, I stopped taking the Estrace vaginally and switched to a lower dose orally since my lining didn’t need to grow anymore.  I scheduled 1 more ultrasound for the next week, just to make sure everything was perfect before I started taking the progesterone.

The morning of the final ultrasound did not start out well.  First, let me tell you that every one of our ultrasounds were scheduled for Friday mornings at 7:30 a.m. so I could be on time for work. Even though it meant getting up at 5:30 a.m., and leaving the house by 6:30 a.m. to get to the appointment on time, it was better than missing work.  Bright and early that Friday morning, I stopped to get gas before I got on the turnpike and headed to my appointment.  After I pumped the gas, my car wouldn’t start.  I called my hubs since he was still at home.  Of course, I was crying hysterically!  A woman, on tons of hormones, the week before her 3rd IVF transfer, stranded at a gas station, in a skirt, and it’s barely 50 degrees.  Not good.

out_of_chocolate

He was there within 15 minutes.  He tried to jump the car, no luck.  It was obvious that not only was I going to be late to work, I was going to be late to the ultrasound too.  And the kicker was I couldn’t even call the doctor’s office to tell them I’d be late because they don’t answer the phone until 9 a.m. (don’t ask me why!!).  We had two options: A.) He takes me to the appointment, then takes me to work, and finally, one day, gets to his job (God only knows by that time it would be noon-everything literally takes hours in Florida), or B.) He drops me off on his way to work to get a rental car, I go to the appointment, and then, eventually, to work.  We chose B.

I got the rental car and arrived at my appointment, needless to say, an hour late.  I stormed in completely flustered, waiting for someone to even try to tell me they couldn’t see me because I was late! Thankfully, everyone was understanding and the nurse saw me right away. I figured once she took me back, I would be in & out within 20 minutes. Quickness is the norm with these blood and ultra appointments during a cycle. But today, that was not the case. Today, I had what appeared to be fluid in my uterus. Fluid in my uterus meant our cycle could possibly be cancelled.

I burst into tears in the office. The nurse told me she wanted me to stay until the doctor arrived to get a second opinion. Well, the doctor did a scan & thought it was fluid as well.  She said we would have to cancel the cycle if it was.  She suggested inserting a catheter into my uterus where the fluid appeared to be, in hopes that it suction the fluid right out.  We tried 3 times that day.  We tried with an abdominal ultrasound view once, and then a vaginal view twice.  Yes, I had an ultrasound probe and a catheter in my you know what at the same time.  I could see the catheter right at that fluid sac, but nothing would come out.  We tried again the following day (thank God I rented that car, mine was still out-of-order).  Still couldn’t get it out. More tears.

The doctor came to the conclusion that the fluid had to be right outside my uterine cavity.  She said she would not cancel the cycle at this point.  Can I tell you how mixed my emotions were?  I completely despised the thought of cancelling the cycle because that meant the past 2 months were pointless.  However, what I hated even more was the idea of something being wrong and going through with the transfer.  If there was fluid, and we did the transfer, it could be deadly to the embryos.

Right then, I begged her not to do it if she thought there was any fluid in my uterus. I told her I could handle it being cancelled, when in all reality I didn’t know if I could.  She must have thought I was crazy; I didn’t care.  I didn’t want anyone to feel bad for me, and thus sway their decision.  She assured me that she would not perform the transfer if she thought there was fluid in the uterus, or if the fluid increased in size or changed location at all in the next week. This being said, we set up another ultrasound to check the day before the transfer.  This was now the new “big” day.

For the next 6 days we didn’t know if we were going to be doing the transfer or not.  I started my progesterone as if we were, as I was told, and waited.  I was a nervous wreck.  Unfortunately, there is nothing else you can do to get the fluid out of your uterus, it simply dissipates on its own. Sometimes quickly, sometimes not.

We were so frustrated! In a matter of minutes, we went from being over the top about the lining to not even knowing if we were moving forward.  I know I’ve said it before, but I will say it again, with IVF there are no guarantees, and something major can go wrong at any given time.  In all actuality, just when you think you are free & clear, you realize you may not be. And so, our prayers began to change. We prayed for God to close the door if he didn’t want us to move forward.  If this was his way of telling us no, then so be it.  Over and over again, I whispered, “anything God, but PLEASE, PLEASE just don’t let us lose another pregnancy.”

The day before the transfer finally rolled around.  Another week that felt like a year.  My blood pressure was through the roof when I got there, and I was shaking like a leaf.  As soon as the doctor came in, I was crying.  The things hormones will do to you. The things you will do to have a child.  The things you will do for your dream of a family.  She inserted the probe and we stared at the screen. Then we got the news: ALL THE FLUID HAD DISAPPEARED.

IMG_2789

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!

FET #1

This post will detail our 1st FET (frozen embryo transfer) cycle from the start of medications to the long-awaited transfer day, and subsequent 2WW.

We hope that it will give insight to those who are embarking on the IVF journey, especially a frozen cycle.

We do not claim to be doctors, everything is based solely on our experience.

Medications prescribed:

  • Lupron-5 units daily, injection into stomach (this is the easiest injection I’ve ever done…honestly, the needle is so tiny you barely feel it).  The purpose of Lupron is to stop the ovaries from producing eggs (the complete opposite of what was happening in a fresh cycle!). We did Lupron injections for a total of about a month up until the week prior to transfer.  Yes, that’s correct you will be injecting yourself everyday for a month.
  • Estrace (estrogen)-1 tab 2x per day orally.  We continued taking Estrace until the pregnancy test, and if positive, up to 12 weeks.
  • Vivelle (estrogen) patches-2 patches applied to stomach, apply new patches every other day. We continued the patches until the pregnancy test & if positive, up to 12 weeks.  The purpose of all the estrogen is to thicken the uterine lining.  I hated the patches-they left what looked like little dirt rings on my stomach which were so hard to get off.  And the estrogen is what makes you cray-cray!!!

meds

  • Prental vitamin/Folic Acid/Baby Aspirin-1 pill each per day.
  • Crinone (progesterone)-vaginal 2x per day starting 6 days before the transfer, and if positive, up to 12 weeks. A lot of women choose to do progesterone in oil shots during a FET instead of Crinone.
  • Prometrium (more progesterone)-3x per day orally starting 6 days before the transfer, and is positive up to 12 weeks.
  • Medrol-1 pill orally every 6 hours starting 4 days before the transfer, and none thereafter.
  • Doxycycline-orally 2x per day for the 2 days prior to transfer.

fet-timeline

Monitoring (blood and ultras): 

For this FET, I only went into the office 3 times for blood work and ultrasounds before the actual transfer.  This is typical protocol at most practices, which is why people say a FET is way easier than a fresh.

The ultrasound monitoring during a FET is focused solely on the thickness of the uterine lining, which grows from the estrogen being taken.  It makes sense then that the blood work is monitoring the estrogen levels.  Doctors like to see the lining measuring at least an 8. During our fresh cycle, my lining was only a 7 on transfer day. Not a huge deal at the time, but in hindsight, it could have been a red flag that my lining would be an issue down the road.

The first ultrasound, about 2 weeks before the transfer, showed my lining measuring only a 5. This was OK since I had just started the estrogen and had my period.  We assumed by the following week it would be up to about an 8 or so like it should be.

The second ultrasound, a week later, showed that my lining was only measuring a 6.  The worst part was that the transfer was just a week away now.  I know you might be thinking, “so it still has a week to thicken then!” False. Once the progesterone is added in, the lining no longer thickens; it actually compacts. And remember, the progesterone needs to be added in a week prior to the transfer.

This was a BIG problem. The nurse informed me that she thought we would have to push the transfer date back with my lining being so thin, but the final call would be the doctors.  We were not happy with this. Not only was I mad that it was thin and not growing as it was supposed to be in response to the estrogen, I was mad I even had to know what my lining measured at all.  I was jealous of the women who never even thought about their uterine lining, let alone what it flipping measured.

The doctor called us later that night.  I still recall the conversation as clear as day.  She put the ball in our court.  We had two options: move forward, or cancel the cycle.  I was not interested in postponing it at the time; our date was set for the Friday before school started. I could not miss the first few days of school! Looking back, I see how foolish that was of me to even worry about.

The doctor told us there was a 50% chance (here we go with the percentages again!) of the transfer working with my lining measuring what it was.  She also said the fact that I got pregnant on the first transfer was on our side, even though it resulted in a loss.

Then I asked her if she had any other patients who were successful at achieving a pregnancy with a thinner lining like mine.  She told me a story about an IVF patient who had a lining of only a 5 and how she went on to deliver a healthy baby.  In the moment, this gave us hope.  I feel like at times you are really just grasping at straws and will take what you can get.

The last question I asked was probably the most important one of all-would my lining, in any way, cause me to miscarry again. Negative.

Shane & I slept on it, prayed about it, and in the morning decided to move forward with the transfer later that week.  Instead of doing acupuncture only once that week, I went 3 times.

chance

Transfer Day 

I really can’t put into words the way you feel the morning of a transfer; if you have been through it, you know what I’m talking about. It’s surreal to say the least.  You are nervous & excited, and part of you feels relief, even if it’s just for that 1 day.

Shane & I had just celebrated our 7 year wedding anniversary 2 weeks earlier, and now we were starting our family together… FINALLY!  Before we left the house, we read our daily devotionals together, took Rocket for a walk, & ate a breakfast high in protein just like the doctor ordered.

I learned from IVF #1 how miserable it is to have a full bladder before and during the transfer.  This could be because I have been diagnosed with a tiny bladder to begin with, as I have heard other infertiles say it wasn’t that bad at all for them.  Either way, I knew there had to be a better way.  I spoke with the nurse, and she said they could fill my bladder immediately before they did the transfer.  Sounds much better right?! So that is exactly what we did.

The embryologist brought in the picture of the 2 embies (they survived the thaw!!!) and discussed their grade again with us (both 6AA’s, the best they could be). These were the only 6AA’s we had left; we transferred the other 1 on our fresh cycle.

embryos
Our day 6 embies

Shane held my hand, the lights were dimmed, with the music was playing (as I said before, my doctor enjoys tunes during transfers). We watched on the screen as my bladder was filled & the doctor gently inserted the catheter.

As soon as it was placed in the right spot, she called for the embryologist to bring our 2 embies in. Remember, this is the longest part, even though in all reality it is maybe 20 seconds.  Again, we saw the little white dots, which we prayed were our future babies, being released into my uterus.  They looked like shooting stars.  And just like a heartbeat, you won’t ever forget it.

The 2WW

2ww (1)

The bell rang that Monday morning, and the 2014-2015 school year had begun!  If you teach, or have taught, or know someone closely who has, you know that the beginning of the year is just plain BUSY. I couldn’t complain this time, it kept my mind off whether or not our embryos were burrowing into my (thin) lining like so desperately prayed they were. Shane was still super busy at his job too, August in Florida means 60 hour work weeks in the HVAC field.

I think when you are pregnant, you just know you are (especially if you have been trying).  At least that’s been my experience.  It’s hard to put your finger on it and explain it, it’s just a complete head to toe change that occurs within the body quickly.

That being said, exactly a week after the transfer, I knew I was pregnant again before I even took a test.