Adrift: A Novel

Monday, June 10th, 2013.  CD3.

Warning:  Word Dump to Follow…

Business first, I guess…

If you follow the blog’s Facebook page then you probably already know this, but my last-ditch effort IUI hybrid injects/Femara cycle was a bust.

If you’re keeping tabs, that’s five IUIs, four inject cycles, 15 medicated cycles, and Godknowshowmany natural cycles that have failed.

That all comes to fifty months of failure under my belt.  That means that if my baby-making efforts had been successful at the start, I’d have a preschooler at this time.

My infertile journey is a walking, talking, potty-trained small person with a personality at this point.  Beat that, suckers!

Aside from the high levels of crazy I’m currently emitting, I’m also reasonably devastated.  I had a lot of hope for the countless changes in diet, lifestyle, and medication to make enough of a difference for this to have worked.

Maybe it’s too soon for all that change to have kicked in…

Or maybe it just won’t ever make a difference.

As the husband and I laid in bed on Saturday night talking about how shitty it is that we’re in our fifth year of progeny non-production, I could hear the frustration in his voice as he asked “When do you think these doctors will figure out why this isn’t happening?”

Oh sweetie.  I wish I knew.  And it breaks my heart that you’re now feeling what I’ve felt for so long…

I don’t know where to go from here.  I still haven’t heard back from the nurses on what Dr. F would like me to do now, whether that be further testing (which I’ve requested) or more medicated cycles (which I doubt, considering my track record).

I’m adrift.  No direction, no solutions, no options.

Well, not exactly NO options…

I’ll tell you what I told the husband:

At this point, every test I’ve had in the past four years has pointed to me being the problem.  For most of that four years, we didn’t know why.  At least now we have a vague idea, but thus far we haven’t been able to resolve anything.

In my mind, this all comes down to an egg quality issue.

No matter what the cause, something is happening with my eggs that’s causing them to either develop poorly, release weakly – or not at all, be of a quality so poor that fertilization doesn’t occur, or be of a quality so poor that when they do fertilize, they don’t develop properly into healthy embryos.

The basis for this hypothesis comes from a few things I’ve picked up through the years.

First, during natural cycles, I tend to ovulate weakly, if at all.  That has been proven with a combination of temping, varied OPK results, and ultrasound monitoring.  For this, we use a trigger to help force the mature follicles release the eggs, resulting in a stronger ovulation.  As to why I am not ovulating in a normal, healthy fashion… Well, that points to some sort of hormonal imbalance, and likely a poor quality egg that’s not triggering the body to ovulate on its own.

Second, even during medicated cycles wherein I am monitored closely and respond perfectly, pregnancy does not occur.  It stands to reason that the odds of anyone getting pregnant in any given month are between 20 and 25%, but considering the number of good-response medicated cycles I’ve completed, I should have seen some results by now given those odds.  That leads me to believe that the healthy sperm are just not finding anything worth fertilizing, or that there’s something wrong with the egg itself that causes it to not be able to be fertilized at all.

Third, I have had one cycle that resulted in pregnancy, but also ended in miscarriage.  During this hybrid Femara/Menopur cycle, I didn’t respond as well as expected, taking twice as long with the injects as I was led to believe would be necessary.  It’s true that not everyone responds the same way in every cycle, but that month felt a great deal like forcing my body to do something it was patently against.

Now, in that cycle, I spent five days taking Femara, ten days taking 75IU shots of Menopur, triggered with one decent-looking follicle and one just-okay follicle, and managed to get pregnant with the good ol’ mattress-dancin’ method.  Aha!  The swimmers can swim, and they can do what they’re meant to!  Check one unresolved question off the list.

My first beta was very low, which was a warning sign in retrospect, but I was told not to be terribly concerned.  Second beta was also low, but had doubled in the appropriate timeframe.  Then, at just before six weeks, I had some minor spotting that lasted only a few hours.  Again, I was told this was no big deal, and all was well.

A few days after that, I had what I can only realistically describe as a panic attack.  I don’t know what brought it on, I just knew that something was wrong and that I felt… off.  The doctor saw me right away, and found that my heart rate was high.  I was sent into the ultrasound room for a quick peak with directions to stay hydrated.  The ultrasound didn’t show much… that was the third warning sign.  By six weeks, a heartbeat is usually visible, but at 5wks6days, there wasn’t really even a definable embryo there, only a black spot where it should be.  I was sent home with instructions to come back in a week for my regular ultrasound, and not to worry, as my uterus is tilted in such a way that I might have some trouble with early ultrasounds.

Everyone knows how this story ends – the next two ultrasounds show little, if any, growth.  Development was not on track, and eventually started to revert.  No heartbeat was ever seen, let alone a fetal pole.  I miscarried, given the diagnosis of a missed miscarriage.  I think, to this day, that it may have been more accurately diagnosed as a blighted ovum, though I suppose a missed miscarriage can BE a blighted ovum.

Basically, a blighted ovum occurs when a fertilized egg implants, but development is slow, stops, or never starts due to a chromosomal abnormality.  This typically occurs in either the sperm or the egg, and since we know that the husband has super-swimmers, we can reasonably assume that this is the fault of my shitty eggs.

In order to prove this hypothesis, we need to complete an IVF cycle.  In order to examine my eggs closely, we would have to go through the whole process of stimming, retreiving, fertilizing, and observing the growth of the embryos.  If I have truly shitty eggs, they may not even progress into viable embryos, but there’s no way to tell until we’re fully invested.  It’s a big risk, both emotionally and financially.  To dump nearly $15K into something that has only a 50 to 60% chance of working is like savings account Russian roulette.  And that 50 to 60% is only if my eggs manage to fertilize properly, develop appropriately, survive a few days in a petri dish, and then implant in my uterine lining they way they’re meant to.

That’s a whole lotta really pricey ifs.

And so, that’s where we are today.  I have great sperm at my disposal, we know that my body is hospitable enough to carry a pregnancy, at least in the very early stages, and I respond well to medications.

I also have a mystery hormonal issue that is causing my eggs to stew in an imbalanced mixture of stuff that’s causing them to mutate into worthless cells that kill my chances at pregnancy month after month.

I’m doing everything I can to help my body make better eggs.  I’ve improved my diet, I take like thirty vitamins a day, and I regulate my insulin levels with dietary changes and medication to help balance my hormones as best I can.  I get plenty of rest, I stay hydrated, I relax as much as possible.  I am proactive with my health, and make sacrifices left and right to get my body into fighting shape.

I realize that most of what I’m doing takes time to make a real difference in egg quality.  Studies show that Metformin itself takes four months or more to see a noticeable improvement in quality, and I’ve only been taking that for 2.5 months – and at that, I have only been taking the full dosage of the original formula Met for one month.  I may not see improvement in my eggs until early July at the earliest, realistically sometime in August or September… Or possibly even later.

Another concern I’ve had is with my recent estradiol numbers around ovulation.  They were rather low, and I have heard that can be an indicator of low egg quality.  Would I be a good candidate for estrogen priming?  Maybe.  Do I want to bring this up to my doctor and sound like a crazy person so early in our relationship?  …Maybe not.

Anyway, I’m obviously spinning out of control here, which we have all learned happens when I have no set plan in place.

This is why I am attempting to get my freaking doctor on the phone – I need a plan.  I need details, and a schedule, and a PLAN.

Here’s what I have so far:

*  Laparoscopy – I need to have one.  More and more, I think that this pain gets worse each month, and even if they find nothing amiss in there, I will likely need to have had a lap to start the IVF process anyway.  Might as well get it out of the way during the summer months.

*  DNA Karyotyping – The husband and I both need to do this.  I don’t know whether insurance will pay for the testing, but it’s getting done one way or another.

*  Genetic Screening – I especially want to have this done to find out whether I have some form of MTHFR.  That, and I probably need to do the CF screening to move forward with IVF, despite the fact that there’s no family history.

*  Autoimmune Testing – I’d like to have this done locally, but I know that most doctors don’t want to touch immune issue infertility with a ten foot pole.  I’m going to ask my current RE, however, if she can run the basics at least.  From there, I can at least get an idea whether I need to pursue further testing or treatment with one of the immunology bigwigs.

So that’s where I am.  I have very little information at hand, but I do have a lead.  I’m going to continue to take care of myself, and to press my doctors for more information and more testing.  I’m going to keep trying, month after month, whether it’s with IVF, plain old Femara, or just the good old fashioned bump n’ grind method.

Apologies for the giant word dump.  Sometimes you just need to take one.