Friday, May 30, 2014

"Oh no, not again"

You know when you're lying bare-assed on a metal table and someone is trying to shove a catheter up your cervix, and it's not going in and you're all

Ok, maybe not.  (BTW, yes, this is an image from Spaceballs - riffing on Alien of course -  because when you have a reproductive history like mine, Mel Brooks can help).

Let me back up.  This morning I went in for an HSG, with Dr. K.  Dr. K did read my chart thank god, saying, "you have had quite a few surgeries I see."  Yup, two D&Cs two hsyteroscopies without anesthesia and one in the OR.  He wasn't as irritating as Dr Dickhead, so I played along with his slightly lame morning quips.  He first gave me a pap test and noted that he hadn't done one in a year, but assured me he was a MD and qualified.  I noted that I wasn't an MD but was a JD.  He asked me not to sue him.  I replied that if I was going to sue a doctor I would have started a long time ago.  Nothing but pre-icky procedure mirth around here my friends.

So, this test basically involves inserting a catheter into your uterus and filling it up with dye, so that it can be seen on an X-Ray machine.  Hopefully the dye will travel easily through your fallopian tubes.  It gives the RE a clearer picture of the structure of your uterus and will also indicate any potential problems with your tubes.

I am happy to report that I survived this experience with some deep breathing (and the experience of in-office hysteroscopy without any anesthesia under my belt).  I am also insanely happy to report that Dr. K DID eventually get the catheter in, it just took a few tries.  And that my uterus and one tube looks great.  I am less happy to report that the other tube looks a little hinky and that Dr. K expressed "concern" about it.  He showed me the image captured on the monitor, it's not scarred, but it's a little misshapen.  It could have been damaged from an infection or perhaps always looked this way.  "You're going to do IVF so it isn't a problem," he said.  That worried me for a moment.  "Well, I am hopefully going to do IVF if I can afford it," I responded.  And I also noted that I had already been pregnant four times despite the hinky tube.  He said that while he was curious about it, it wasn't worth putting me under for another exploratory surgery and I happily agreed.  I have had enough of those.

I was practically skipping out of the office, so relieved that the procedure really wasn't so bad on the pain scale and that my reproductive system looks relatively normal for my all of my troubles.

On other fronts, I have been peeing on ovulation sticks and expect to see a surge any day/hour now.  I have been instructed not to have sex for 24 hours, but depending on what this afternoon's stick says, I may live on the edge and bump that a little to 12 or 18 hours (assuming of course that dear husband and I can keep our tired-assed middle-aged selves awake).  In any event, tomorrow morning at the latest, we will test the following two theories:
1. Women are more fertile after HSGs
2. Women are more fertile after miscarriages.

Thursday, May 29, 2014

Off to a flying start

So, it looks like I am back at my old fertility clinic.  Uhhh, two steps forward....

I had something of a reassuring conversation with a new doctor, Dr. B, an incredibly kind, compassionate soft-spoken doctor.  I must confess, I wonder,  how the hell does she navigate working with the testosterone driven male assholes she is surrounded by (this is not conjecture, I know a number of women who have been through this factory - I mean clinic - and had similar opinions of the male REs there).  I gave her my history, which she admitted was unusual, and then asked her the questions.  Is my current RE correct that I would ideally proceed directly to IVF with PGS?  Yes.  What if I can't afford the PGS, is IVF worth it?  THAT one, she mused, was an interesting question.  "You're fertile," she said, "so your not automatically an IVF candidate because you clearly can get pregnant."  The bottom line is that my eggs could use the help of screening, but IVF isn't necessarily my ticket on its own.  It's one to ponder, because the fact that it is covered by my insurance is the only reason I am even considering it.  Nevertheless, we developed a plan:

This cycle: testing.  An HSG (ugh, tomorrow morning, more on that I am sure).  A full Repeat Pregnancy Loss (RPL) Panel.  Karyotyping.  A mammogram next week because I am fucking 40 and they won't even let me proceed with an IUI without one.

By the way, want to know what bloodwork looks like for someone who has lost three pregnancies?  Here's PAGE 1 of my lab order - Xes mark the vials of blood taken from me:

In case you were wondering, the feeling is finally returning to my arm.  I am being tested for everything under the sun, thyroid, clotting disorders, you name it.  All with the expectation that nothing will turn up but covering our bases.

Next month, schedule of demanding job permitting, I go in for a third and likely final IUI.  I'll go back on clomid, because it worked for me and I had no ill-effects, only this time with a trigger shot of ovidrel to induce ovulation so we don't miss my surge.  It will be a relief not to totally depend upon reading lines on sticks.

If that fails, we then explore IVF.  I think I can buy some time - I need a good 4 weeks cleared on my calendar for the monitoring and frankly, that's difficult with my day job. I realize that women of - ahem - advanced maternal age - don't have the leeway to say this, but I honestly don't want to rush into this.

Speaking of jobs, I asked another million-dollar question, can I zumba during an IVF cycle?  Sadly no, because the jostling could actually turn my ovaries around while they're being stimulated.  Is this a rare situation?  Yes.  But crazily enough, Dr. B and I agreed that the word "rare" tends to mean "THIS WILL HAPPEN TO YOU" when applied to me.  So, all of this means that I could end up agreeing to an incredibly high-stress medical intervention without the benefit of releasing much-needed endorfins to burn off steam and stave off depression.  Oh yeah, that should work out great.

Raise your hand if you think life would be easiest if I just found myself knocked up the old fashioned way this month?

Tuesday, May 27, 2014

it's been a while

So, my period finally came last week - again on a plane, what gives?  But I am happy to report that it was heavy, occasionally painful, and all around normal.  With that, the sad chapter of my third miscarriage can now be officially closed.

Today I update this blog at CD 8 of my cycle, so I'm entering my "fertile phase."  The grass is lush and green outside my house, situated in a beautiful section of the Mid-Atlantic U.S.  The flowers outside my front porch are blooming.  Bunnies have invaded my yard and my husband is on strict orders not to chase them out, plants be damned (he is also on strict orders not to imbibe, I run a tight ship). As you can see I am hoping for the best here.  I would love to be another "I was all set to start an IVF cycle and BAM we got pregnant the old-fashioned way" success story.  Lurk the support boards enough and you too will convince yourself it can happen to you.  On a beautiful sunny day in May you can convince yourself of anything.

Tomorrow I will consult with a new RE at Babies R Us Fertility Center.  I have written out my history, hell, I've been reciting it in the car, the dates and events and surgeries and details surprisingly exact.  Creepy perhaps, but if I don't take charge of my medical history and advocate for myself no one else will.  To be honest,  I am not sure what this new RE will bring to the table:  Gloom and doom?  The unaffordable solution of Donor Eggs because of my miscarriages?  IVF with PGD that I cannot afford?  A prescription for more medicated IUIs?

I'm nervous.

Monday, May 19, 2014

Still waiting part deux.

It's Day 37 since my miscarriage, and I write to you from the land of the insane.  Can I whine a little?  Because seriously, the clock is tick-tocking away as my body tries to figure out what the fuck to do next.  I know, I know, a period after a natural miscarriage can generally come anywhere between 4-6 weeks later (according to Dr. Google at least).  I am somewhere in week 5 with nothing but a slightly blood-tinged piece of toilet paper to show for it (Yes.  I did need to share that because it only exemplifies the crazy).  And I can't imagine that a wall of scar tissue has suddenly formed over my cervix without any of the trauma of a D&C, so I am going to assume that my hormones are just completely out of whack.  And I am currently only a week off of my plan to resume the baby-making.  But any more of this waiting and I swear..... I will just start to cry like a baby. 

Wednesday, May 14, 2014

Still waiting.

Aaaand it has now been 32 days since my miscarriage began.  AS USUAL I am waiting for my period.  I should probably title the entire freaking blog "waiting for my period" since this could capture like, half of my reproductive life.  I have work-related meetings all day today but a visit to my rock-star acupuncturist is scheduled for this evening.  If anyone can jump start this bitch, it's her.  In other words, "Hey Work:  Let me the hell out on time."

Waiting.  This is the key word, if you will, for the ranks of the infertile, isn't it?  Each month is a mini-cycle of waiting, compounded on months - or in some unfortunate cases - years.  For those who move on from the physical act of reproduction to adoption, the years continue on as well.

Personally, I have been "waiting" to bring a second baby into our home since 2012.  A little over two years?  An eternity.

Monday, May 12, 2014

The circle of life. Or something.

So this is the season where justonemore is hopped up on zyrtec and flonase, and basically trying to breathe.  All of these meds are doing some EFFED up things in my subconscious because my dream state is getting ridiculous.  The night before last I was trapped on a bus. On a "hell-bus" - yes you read that right, it's like something out of a Buffy episode, we were trapped on a bus where all of the passengers were actually dead, demons who looked like people riding a bus and carrying me (and some coworkers) away to my fate of death.  Or something like that.

On the other end of the spectrum, last night I dreamt I was knocked up.  Like, hugely pregnant, like I couldn't fit into my clothing and appeared to be 7 months along (though I think I mentioned to someone I was only 5 months in the dream?)  A vast improvement over the hell-bus.

Thursday, May 8, 2014

Goin' back(wards?)

So I have been busy trying to squeeze in some research the past two days (given that I am a researcher this has been surprisingly difficult on a time-management level).  Long story short, we have to consider IVF again, albeit without the PGD.  Because Husband's insurance is NOW saying they WILL pay for three rounds, up to 90%.  With that we have to consider it.  I know I just can't face the potential regrets of not exploring it before it's too late.

There's also this:  A new clinical trial showing that IVF is actually twice as effective for 38-42 YOs who are looking to conceive.

So then I needed to go back and look up IVF statistics for my age group (data which is helpfully collected here).  And discovered that the clinic where I had such negative experiences for Asherman's diagnosis and Treatment has the best stats for live births for women in my age group in my region.  Sigh.  You will recall some of my complaints about "Babies Guaranteed" (though that's a misnomer for 40 YOs).  These complaints basically stem from the general douchiness of one doctor, a patronizing dude who tried to make me feel like an idiot and unnecessarily dilated my cervix.  Yeah, fun times.

But the facts are the facts.  Dr. Cuddles is an incredible RE but I don't feel comfortable attempting IVF (if I'm even a candidate) with her very scatter-shot office.  BABIES GUARANTEED has not only stats but the added bonuses of in-house labs for bloodwork and monitoring, and a financial counselor who will deal with all of the arguing and haggling and general life-sucking bullshit with your insurance company for you.

Last night I called a close friend of mine who has experience with this clinic (including a TERRIBLE experience with doctor dickhead), and eased my fears about things like the bajillion injections I would be agreeing to if I go down this road.  And she suggested something pretty simple.  Pick a new doctor, they certainly have enough of them.  Try Doctor B, who is actually pretty compassionate.

So I pulled the trigger.  I called and made an appointment with Dr. B during the last week of May for a consultation.  I can pose the pressing questions niggling my brain at 3am.  Is my low-ish AMH a deal-killer for IVF's efficacy?  Does IVF without the PGD even make sense for a 40 year old who has had three back-to-back losses as a result of hinky chromosomes?  Are more IUIs madness?

Wednesday, May 7, 2014

A control freak with not a whole lot to work with

This all kinda sucks. I'm waiting for my period so I can plan next steps, yet I have no real plan in place to move forward when it does arrive.  The next cycle will likely be a bust since I am traveling for work.  Right now I feel pretty dejected and helpless.  Even when medicated cycles didn't work, at least I felt like I was doing something to improve my very low odds.  Now all I have in my toolbox are OPKs, some pre-seed and yeah, the fact that I do think my husband is sort of hot, if I may say so publicly.

(And the thought just hit me once again that baby-making can be the dreariest, most unsexy thing in the world).

So, the only other thing I really have to work with right now is my diet. Lots of women on the boards have sworn by the power of nutrients to improve our eggs.  They're not all wrong, in fact there's an NIH study on the topic:  The contribution of mitochondrial function to reproductive aging.

Without forcing you to read the study, the gist of it is this:  Our eggs age as we age, which leads to all sorts of reproductive failures (See:  my past two years).  But it's not as simple a problem as "the eggs get old," it's more like, "the cellular energy of our eggs gets a little weak, the eggs get a little tired, and they don't function at peak capacity."  Specifically, mitochondrial function declines.  The question then, is can you improve mitochondrial energy to get those eggs to perform better when they're called up to the challenge? 

So with that theory, umm, yeah,  I have finally made some interesting movement on the diet front.  I have bumped my CoQ10 to the "Ubiquinol" kind that is supposedly better absorbed by the body (this supplement was touted in the above-cited study.  Full disclosure, I took a lot of CoQ10 before this last miscarriage and still lost a baby, but more of the jacked up version couldn't hurt). I've also eliminated dairy.  And most processed foods. And pasta, rice and potatoes. I am drinking a smoothie made from almond milk, fruit, flax-seed, kale and fucking wheat grass.  Yes, you read that right, I am now one of those people that you see at the Wholefoods that you would rather not eat out with at a restaurant because they sound like such a drag.   I am considerably poorer from this entire endeavor, but what the hell, right?  I have little else to control these days.

Note: My acupuncturist was quite supportive of this dietary exploration (she's the one who helpfully suggested I add the fucking what? grass to the already delectable smoothie).