Monday, March 26, 2018

Microblog Mondays: I Declined

Welcome to Microblog Mondays! Want to learn more and read more? Head over to Stirrup Queens for the details!

The last few weeks have been LONG. I now manage a team that includes employees in Bangalore, Tokyo, Queensland, and Shanghai. Our team is also matrixed with leaders in Madrid, France, Santiago, Istanbul, and cities you've never heard of in Poland and the Philippines. I LOVE figuring out how to achieve needed outcomes across the diverse perspectives and cultural approaches. I don't love having many days with phone calls running from 6 am to 7:30 pm. The last two weeks have been bad, and there's no end in sight.

On the TTC front, ovulation is missing as of CD20. I'm not sure if this cycle will be anovulatory, or if it's just really late. If I don't ovulate by tomorrow (impossibly unlikely), I probably won't be able to cycle until May due to a business trip. I'm trying to maintain the mindset of 'it will be what it will be,' but I'm both sad at the possible delay and terrified that this lack of ovulation is the start of menopause.

We had a regroup with our RE last Monday. We're adding in vaginal sildenafil. I very strongly wanted to add prednisone, given my history of autoimmune diseases (juvenile rheumatoid arthritis and celiac). She refused, saying she thinks my lining and my age (e.g., aneuploidy) are the causes of all 5 early losses. One one hand, she's right that those are the most likely causes. On the other, for fuck's sake, the last two years of my life have been littered with unlikely causes. She agreed to dexamethasone at a low dose. I wish I had researched that before hand, as it crosses the placenta, unlike prednisone, and it's been linked with negative outcomes in infants when given in much higher doses.

I also divorced my acupuncturist on Friday. You heard about appointment #1. Appointment #2, she told me I was done, I sat up, and discovered I still had needles in one ear and both knees. At both appointments 1 and 2, we discussed that I am allergic to adhesive, so the ear bead patches she wanted to use would not work for me. Appointment #3 seemed to go well enough, until my ear started hurting after I left, and I discovered she'd put patches on. I called to cancel my next appointment and explain exactly why I was doing so. To her credit, she took responsibility and offered me a free appointment next time. To my credit, I declined. I see a new practice this Friday.

Monday, March 12, 2018

Microblog Mondays: When Stress Relief Isn't Relieving

Welcome to Microblog Mondays! Want to learn more and read more? Head over to Stirrup Queens for the details!

My workout time is my primary stress-relief time. Forty-five minutes (more on weekends) of hard sweating, heart-pumping, endorphin-generating cardio seems to make everything better. I feel better about my body, I sleep better, and I feel relatively confident that my cardiovascular system approves, even if my acupuncturist doesn't. 

My workout time is also when I watch crap on Netflix. In the summer, I'll be outside on my bike, but in the winter, stuck in the gym, it's all about the Netflix. I've been watching this show called Travelers. I like sci-fi, I like action, this is a decent combo of both. But, (**spoilers ahead**), one of the main characters has a wife who lost a baby in the past due to placental abruption. This was all "in the past", and not re-enacted on the show, so while it's hit a bit too close to home, I've kept watching. Then the couple get pregnant again and thanks to the miracles of un-realistic TV writing and sci-fi, although there's some worry early on, everything seems to be going swimmingly. Until the episode I watched today. Where the bleeding starts in the bathroom one afternoon. And the wife ends up in the hospital. And the doctors are telling her it's a partial abruption, so they'll monitor her, but she and the baby should be ok. Until suddenly she isn't ok and the baby is gone and she's almost gone, too. And now I'm chugging along on my elliptical sobbing my eyes out, especially during the scene with her in the hospital bed and the doctor telling them they'll just have to wait and see, and they're terrified and holding hands. . . and, holy shit, that's familiar. 

Good enough show, but I think tomorrow I'll be watching an episode of the Great British Bake Off, because today was not a stress-relieving workout, it was a stress-reliving workout. 

Friday, March 9, 2018

Po-tay-to, Po-tah-to

Today was my first  fertility acupuncture session. We started out with a consult. She went through my fertility history. Then she told me all the things I've done wrong. IUD? Bad for the lining! D&Cs? Terrible idea, guaranteed to have lining issues after 3 D&Cs. Should have managed a natural miscarriage after my first loss, even though my body hadn't miscarried 5 weeks out. Egg quality? Likely poor. Exercise habits? Bad - wasting my life energy on exercise. Should avoid sweating. Feeling stressed when pregnant? Terrible for me and baby. She also noted that some people have actual problems to fix, some just have symptoms. I fall into the actual problems category.

She summarized: "you have bad soil."

Fair, I guess. I say 'my lining sucks', you say 'bad soil.' Po-tay-to, po-tah-to.

She wanted me to take 3 months off from trying (100 days) and focus on weekly acupuncture sessions and 24 herbal pills a day, with the intent of helping egg quality. I indicated that if CD1 falls early enough in April, I will start fertility treatments. She said most patients don't want to wait, so we'd do one month of pills and treatments once a week. Once I start injections, I stop the pills, but try for twice a week and try to schedule on ovulation day. 

We'll give it a shot. I mean, hey, it's only hundreds of dollars more and additional unpleasant poking and prodding, right? And hey, the placebo effect produces results, and all I really care about is the results, not the methodology!

First acupuncture session was . . . not terribly pleasant. She placed needles in my hands, feet/lower legs, abdomen, and one in my head. She focused a heat lamp on my abdomen, and did electrical stimulation of two of the abdominal needles. The heat was nice, the electrical stimulation went from being unnoticeable to unpleasant and back over the 20 minutes I was there. I didn't feel most of the needles during the session, but my hands and feet are sore now. I've taken my first 12 pills (6 Shao Fu Zhu Yu Pian and 6 Wen Jin Pian, twice a day). She said I might have more bleeding as a result of the treatment, but so far, nothing.

Back again next Thursday. We'll see what that this month brings.

Wednesday, March 7, 2018

Sadness, in Real Time

I lost the pool. Spotting started late Monday. Bleeding heavily yesterday.

I had a truly awful moment in the bathroom this morning when I went to pee and was bleeding a heavily (for me). Instantly I was back in the hospital bathroom, pregnant with Quinn and passing the same gobs of mucousy blood. Hope, punctuated by terror, in memory. Once I shook it off, it was just sadness, in real time. Memory is a funny thing, and surprisingly unkind at times. I guess life is, too.

Acupuncture on Friday. I keep moving in the hopes of getting somewhere better.

Monday, March 5, 2018

Microblog Mondays: Waiting Again

Back to waiting. There's something obnoxious about the fact that I was bleeding at 12dpo when I certainly did not want to be, and now there's no sign of bleeding at 20 dpo. I'm actually considering starting a pool: when will the bleeding/miscarriage start?

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.

Saturday, March 3, 2018

No More Vag Pills

Just got the call: hcg is 20. Stop the progesterone and estrogen, send the clinic a note when I start to bleed, repeat beta to make sure it hits zero after bleeding stops. I'm grateful it's resolving on its own.

Topics to cover before trying again:
Autoimmune protocol, especially prednisone
Need to do doxy again?

It took us three losses to get Alexis and Zoe. I try to hold on to the hope that as awful as more losses are, maybe they'll bring us back to a better place again some day.

Friday, March 2, 2018

What's in a Number?

Part of me tried to tell myself I was being too pessimistic. My hcg wasn't 0, and it did double, even if it should have grown more at such a low level. That bodes well, right? So I went looking for research on the prognostic value of hcg. My conclusion: I wasn't being pessimistic enough.

Here's a table, in the IVF setting, looking at 14 and 16 days post retrieval. At 14 days, median value for viable intra-uterine pregnancy was 89, with a range of 68-121. Non-viable? Median of 95 with a range of 30-118. Mine? 64. Mine was below the lowest observed value in the viable pregnancy cohort.  Study.

They did find that ratio (e.g., doubling time) was more predictive than day 14 hCG, wich makes sense as it appears that for non-viable pregnancies, hcg didn't rise much beyond day 14 levels. With my past chemicals, hcg has usually peaked by 12 dpo, so it's interesting to see this showing a later peak.

Another study looked at 12dpo hcg (7 days post 5 day transfer). You can see from the table below that for my age group (B, 35-39 years), an hCG of 29 had a 39% chance of live birth, 64% chance of clinical pregnancy. Which means Nearly a 64% chance I'll get to see a heartbeat, but it'll die before birth. As an Asherman's patient with a TAC, that terrifies me. If I have to lose another one, please don't let it be in a way that causes more scarring.  Study.

So, what's in a number? Stress, that's what's in a number. :(