In July of 2016, I had an 11 day luteal phase. When I went in for my first ever baseline ultrasound, I had an antral follicle count of 9. I was thrilled by that, it was low, but not horrible, given my AMH.
That cycle gave us our twins.
This July, I just had the first 11 day luteal phase I've had since July of 2016! They've all been 8-10 days since. And, best of all, my antral follicle count today was 9 again! I've been as low as 4 and only as high as 7 since 2016, so I'm overwhelmingly thrilled by 9.
I got the call confirming I can start, and I've done my Menopur, Gonal-F, Saizen, and doxy, and I'll do the estrace and sildenafil at bedtime with the first prednisone alongside breakfast tomorrow.
All the nurses I talked to today told me they, and Dr. B, really want to see things work for us. Perhaps that's because during today's ultrasound, when the nurse innocently asked me what I was doing this weekend, I told her it was the anniversay of Quinn's birth and passing. Perhaps it's just because they're all sick of me asking questions and following up when things don't seem right! I hope it works for us, too, so I'm writing a letter to the universe today:
Universe, I'm asking you very nicely, could you keep this cycle looking the same as our July 2016 cycle? I'd like it to be exactly the same, right up to 16 weeks, 6 days, and then a change would be good.
I know that's a lot to ask, but Universe, you've thrown a lot at me in these two years. I've withstood it all, but now is the time for something good. And now is the time for that good to be lasting. If you want to throw something else at me, could it please be 'the terrible twos', in another two years, nine months?
I know the top of this page says 'not my lines yet', but Universe, I'd really like you to know that 'yet' has come and gone, and it is definitely time for my lines. It's time for my babies to come home with me, alive and healthy. Please and thank you.
Love, Me.
Showing posts with label prednisone. Show all posts
Showing posts with label prednisone. Show all posts
Thursday, July 19, 2018
Saturday, June 16, 2018
A Positive Regroup
We had a very interesting regroup with Dr. B Thursday. I had a list of questions, and we wound up somewhere I'm really happy with, but didn't necessarily expect.
Question 1. What's your take on why this keeps happening? Lining? Aneuploidy? Something else?
A: Most likely aneuploidy. She'd like to see my lining get to at least 7, and there's no way to rule it out for sure, but everything suggests it's an egg issue for these last two CPs, not a lining issue, while the Dec and 2016 CPs were probably lining.
2. Let's talk prednisone again.
A: If I want an immune protocol, CCRM isn't the right clinic. She will put me on low dose prednisone for my next cycle. (I brought a list of six peer reviewed journal articles supporting this. I also acknowledge that I could find just as many that show no result.)
3. Lining was thicker in May. Does that suggest it could improve or give us ideas on what to do to improve it?
A: It could improve. It's most likely that having more days of estrogen exposure due to the long stim was what helped it. As a result, we'll take the following approach: 1 estrace/day vaginally until the dominant follicle hits 14, then increase to 2. We'll keep using the viagra. Estrogen is what makes the lining trilaminar, nothing else can change the pattern, so there's no way to help that.
4. Do my lining issues indicate I need a repeat hysteropscopy?
A: Not yet. We've seen it trilaminar since my last surgery, and we've seen it up to 6.7. I've also been through a lot of "instrumentation", no reason at this time to repeat. We looked at my u/s from trigger day, and there is no clear pattern. When I asked why, she noted that it's probably because things were thicker in some spots than in others. At this point we really just have to hope for the best in future cycles.
5. Ovaries didn't respond until we backed off the estrogen. Thoughts?
A: Largely addressed this with #3. We'll reduce the estrogen and aim to stim for ~12 days - longer than many of my cycles, but shorter than this most recent one.
6. We ordered cetrotide after our August '17 regroup. When would I use it?
A: Only if your LH was rising indicating ovulation. The estrogen seems to be supressing that really well for you, so there's been no need. That might change if we try to stim you for 12 days, so hang on to it.
7. Best guess on our chance of pregnancy if we continue this approach? Where's the tipping point when we should move to IVF, either OE or DE?
A: Impossible to say. She noted that we clearly have fertilization and embryos that reach 12-14 days every time, so she would expect that even if we only retrieved 2-3 eggs, we'd get a blast or two. It's a numbers game as to whether those would be euploid or not. Obviously, changing to donor eggs makes the numbers more likely to fall in our favor. The advantage of IVF is it would allow us to rule out aneuploidy as a problem, and eliminate many of the worries about a late first-tri loss. The disadvantage is that we'd probably only get 2-3 eggs. Also, even euploid blasts don't implant and do miscarry, so IVF would really be diagnostic.
8. If we moved to IVF, is it possible to get a better lining if we don't care about ovulation?
A: Maybe. My OI protocol is their 'poor lining kitchen sink' protocol, so it might give us our best chance. We could try delestrogen injections plus vaginal estrace and vaginal viargra in a mock FET to see what my lining did, and that might get better. Hard to predict. She'd really like to see me at 7 before a FET, and I have gotten to 7 before.
9. If we did IVF, is there any way to improve ovarianresponse?
A: We could do a clomid/FSH cycle if it's IVF and we don't care about lining. That might get us another follicle or two. Still, don't expect more than 2-3 embryos.
10. If we did OE IVF, is there anything we could do to improve egg quality?
A: We could add in HGH. In fact, we could add that now. So, Saizen goes into my current protocol.
11. Do I retake doxy for a future cycle?
A: Yes, unless it's making me really sick.
12. Is a plan of ~3 more OI/TI cycles, followed by a mock FET to test lining, then OE/DE IVF if lining is good enough, reasonable?
A: Yes. Probably wise to test lining before investing in IVF of any sort.
I'm really happy with this. If we throw my current meds, plus prednisone, plus HGH into the mix for 3 attempts and I'm still not pregnant with a baby that can reach the second tri, I'll feel pretty good that we're not going to find the 'gold egg' from my ovaries via IVF, and we can move to DE or DINK. That's a different decision point.
Question 1. What's your take on why this keeps happening? Lining? Aneuploidy? Something else?
A: Most likely aneuploidy. She'd like to see my lining get to at least 7, and there's no way to rule it out for sure, but everything suggests it's an egg issue for these last two CPs, not a lining issue, while the Dec and 2016 CPs were probably lining.
2. Let's talk prednisone again.
A: If I want an immune protocol, CCRM isn't the right clinic. She will put me on low dose prednisone for my next cycle. (I brought a list of six peer reviewed journal articles supporting this. I also acknowledge that I could find just as many that show no result.)
3. Lining was thicker in May. Does that suggest it could improve or give us ideas on what to do to improve it?
A: It could improve. It's most likely that having more days of estrogen exposure due to the long stim was what helped it. As a result, we'll take the following approach: 1 estrace/day vaginally until the dominant follicle hits 14, then increase to 2. We'll keep using the viagra. Estrogen is what makes the lining trilaminar, nothing else can change the pattern, so there's no way to help that.
4. Do my lining issues indicate I need a repeat hysteropscopy?
A: Not yet. We've seen it trilaminar since my last surgery, and we've seen it up to 6.7. I've also been through a lot of "instrumentation", no reason at this time to repeat. We looked at my u/s from trigger day, and there is no clear pattern. When I asked why, she noted that it's probably because things were thicker in some spots than in others. At this point we really just have to hope for the best in future cycles.
5. Ovaries didn't respond until we backed off the estrogen. Thoughts?
A: Largely addressed this with #3. We'll reduce the estrogen and aim to stim for ~12 days - longer than many of my cycles, but shorter than this most recent one.
6. We ordered cetrotide after our August '17 regroup. When would I use it?
A: Only if your LH was rising indicating ovulation. The estrogen seems to be supressing that really well for you, so there's been no need. That might change if we try to stim you for 12 days, so hang on to it.
7. Best guess on our chance of pregnancy if we continue this approach? Where's the tipping point when we should move to IVF, either OE or DE?
A: Impossible to say. She noted that we clearly have fertilization and embryos that reach 12-14 days every time, so she would expect that even if we only retrieved 2-3 eggs, we'd get a blast or two. It's a numbers game as to whether those would be euploid or not. Obviously, changing to donor eggs makes the numbers more likely to fall in our favor. The advantage of IVF is it would allow us to rule out aneuploidy as a problem, and eliminate many of the worries about a late first-tri loss. The disadvantage is that we'd probably only get 2-3 eggs. Also, even euploid blasts don't implant and do miscarry, so IVF would really be diagnostic.
8. If we moved to IVF, is it possible to get a better lining if we don't care about ovulation?
A: Maybe. My OI protocol is their 'poor lining kitchen sink' protocol, so it might give us our best chance. We could try delestrogen injections plus vaginal estrace and vaginal viargra in a mock FET to see what my lining did, and that might get better. Hard to predict. She'd really like to see me at 7 before a FET, and I have gotten to 7 before.
9. If we did IVF, is there any way to improve ovarianresponse?
A: We could do a clomid/FSH cycle if it's IVF and we don't care about lining. That might get us another follicle or two. Still, don't expect more than 2-3 embryos.
10. If we did OE IVF, is there anything we could do to improve egg quality?
A: We could add in HGH. In fact, we could add that now. So, Saizen goes into my current protocol.
11. Do I retake doxy for a future cycle?
A: Yes, unless it's making me really sick.
12. Is a plan of ~3 more OI/TI cycles, followed by a mock FET to test lining, then OE/DE IVF if lining is good enough, reasonable?
A: Yes. Probably wise to test lining before investing in IVF of any sort.
I'm really happy with this. If we throw my current meds, plus prednisone, plus HGH into the mix for 3 attempts and I'm still not pregnant with a baby that can reach the second tri, I'll feel pretty good that we're not going to find the 'gold egg' from my ovaries via IVF, and we can move to DE or DINK. That's a different decision point.
Monday, March 5, 2018
Microblog Mondays: Waiting Again
My first two chemicals, I've always started CD1 by the time my hcg was ~8, which was usually at 14 or 15 dpo. Last chemical, I stopped Endometrin on a Monday after home tests were negative, started bleeding Thursday, and still had detectable hcg on Friday. I'm picking Thursday in the pool. I stopped Endometrin on Saturday, but I was definitely still turning home tests then. BBT's still slightly elevated now. We'll see.
Regroup is scheduled for 3/19. I need to ask about:
- Menopur vs. Gonal. My successful cycles were Gonal only.
- Doxycycline. Do I need to take it again next time?
- Immune protocol, especially prednisolone/prednisone
- Baby aspirin, considering my issues with NSAIDs?
- Other options for lining (viagra?)
- Any concerns with acupuncture?
- WTF is up with mistakes from the office?
I might word the last one a bit differently when I actually talk to her. I might not.
Is there anything else I should be asking about now? I've gotten all my paperwork together to send to Dr. Kwak-Kim, one of the leading reproductive immunologists, but I'm really on the fence about that. I don't think we'd actually do any of the more controversial treatments (itralipids, ivig). I would sign up for uterine gcsf (Neupogen) wash in a heartbeat if anyone here did it, but I don't think Kwak-Kim does, nor does CCRM to my knowledge. So, on the fence about the utility of Kwak Kim.
Diet is officially on anti-inflammatory mode. Breakfast: chia seed pudding made with coconut milk, almond butter, and dried fruit. Lunch: Tofu, bell pepper, snap pea, and pineapple curry or lentil and soy chorizo omelette. Dinner: Beet and black bean burgers and asparagus. Snacks: carrots and hummus and whole-milk greek yogurt. I know the perspective on dairy and inflammation is mixed, but I think getting the live bacterial culture is the better part of valor. Given my estrogen issues, I'll probably eliminate the soy and tofu from future weeks and switch over to shrimp or some other fish.
Trying to take things one day at a time and remain hopeful. It's really hard right now.
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