Tuesday, December 23, 2008
Not much to talk about at the moment. I mean there is stuff I could write about but I don't have the energy to do so. Besides I'm at work and should get stuff done.
On a good note my husbands relatives that had been living with us for 6 months got a house! I forgot how quiet it is when it's just him and I. I definitely still want kids but for now I'm enjoying every minute that it's just my husband and I. For right now I'm not in to much of a hurry. Yes I'd still LOVE to get pregnant or get picked for adoption but for now I'm happy with where we are at.
On the adoption front...our profile is not yet approved. The snow storms we had caused the agency to close and they got behind but have assured me we will be approved by the first of January...which was my goal. :)
Honestly I think I was just over whelmed with Jon's relatives living with us combined with all my IVF's. I'm sure once it's been a month or two of my husband and I that I'll start getting baby fever again.
Ok well I should get back to work.
Thursday, December 11, 2008
This weeks session was based around the anxiety attack's I've been having. We have family living with us and it's grown increasingly hard for me . I love them dearly but I need my house back. My therapist "Carla" asked me what emotions I was feeling when I had an anxiety attack. Anger was all I could think...anger is what I felt. Ok so that was easy... but "what do you feel right before you have an attack, worry? concern? over whelmed?" I couldn't answer her question. She said that the reason I feel angry (and get angry) is because it gives me a sense/feeling of power. Anger is a powerful feeling. Her theory was that I had issues when I felt I lost control of something and anger was my way of feeling powerful or "in control" again. Her suggestion was the next time I had an anxiety attack that I sit there and concentrait on how I'm feeling. So I did...the very next day when I had yet another anxiety attack. It was hard to just sit there and feel. Anxiety is not fun. I realized that what often pushes me to have an anxiety attack is when I feel I have lost control over something.
My brother in law had waited till my husband and I got home at 7 pm to make dinner on Tuesday. I had expected to come home and make my own dinner. It was a nice gesture and as much as I appreciated it I usually need time to cool down after work and just have some me time, then I'll resurface and talk to people. I don't like being bombarded the second I get in the door. Give me a minute to take my jacket off and relax a bit...that was probably a learned trait from my mother cause she's the same way. Anyhow I passed on dinner and said I would just eat a bagle or something. I went to my room and surfaced again about 45 minutes later when my brother in law and his wife were done eating. Now there is nothing wrong with someone making you dinner (I mean who wouldn't want to come home to a nice warm dinner??) but for some reason that cituation pushed me to have an anxiety attack. I no longer feel like the head of household. I'm a very independent person so being weighted on hand and foot isn't something I'm used to.
So now I have realized I have a problem with control. I don't like it when I feel as though someone has taken something away from me. At work I've been put in charge of making a weekly newsletter. Today my boss asked about it and wanted to see it. And proceeds to tell me her idea's and what she thinks I should put on it. So now she's going to email me once a week and tell me what she thinks should be in the newsletter. Granted having her opinions is nice. But it's always followed by "because of my many years of coop experience". As if to say I don't know what I'm doing. As if the past 3 1/2 years experience I have is total and complete crap. So not only do I now feel worthless but she has taken over MY newsletter. The newsletter that I still have to put together. Then she tells me that she wants a weekly to do list from me so she knows what is going on "in my world". yet I never know what she's doing. She comes in aroudn 10 every day, takes a 2 hour lunch and either leaves before me or stays late. Now how late she actually stays I don't know. All I know is she is almost never here which is FINE by me cause she's been here all day today and I'm going to go freaking insane. Today I feel like quitting my job. I dont' like to be micromanaged. Again it all comes back to the feeling of control. My newsletter was taken away from me. I have lost control of it. it's no longer mine. Apparently I wasn't doing a good enough job in her eyes. I can't tell you how many times she says "cause of my years of coop experience I'm the one that should go through the papers and look for missing coop" and If I do it she says "are you sure you dont' need me to double check them? so I don't go through the papers any more. instead they stack up and wait for her...and she inevitably waits till the last day of the month to hand in a bunch of missing coop. I mean I worked side by side with 2 excellent well known coop people for nearly 4 years it's not like I dont' know what I'm doing. Yes I'm not perfect and yes I'm still learning but jeesh. This woman just doen't know how to talk to people.
So I can't remember if I mentioned but Carla also thinks that my control issues have gotten worse or even come from the past 3 1/2 years of infertility and over 2 years of constand fertility treatements. All stuff I couldn't control...but you bet I tried hard to control it. Like I'm going to trust doctors with my body...I dont' think so. It all started with obsessing over having to know everything and it's been down hill since there.
So I guess I've moved on from the infertility crap to having to over come my need to control everything. It's not going to be easy and it's not going to be fun but I have no choice but to deal with this and stop trying to control every little thing.
Side note: I'm an independent person and I work better alone. I did my best when I was an inside sales rep and I didn't have anyone to answer to. No one to micromanage. I don't mind being giving a to do list. that's not micromanaging.
speaking of work it's time for me to get back to it. I just need to make it through the day. 4 more hours of work.
Tuesday, November 25, 2008
Well I made an appointment for a hemetologist for mid January. That's the earliest I could get in, which is fine cause I have new insurance as of January anyway. The office I called is in the town I work and they have 2 doctors. The receptionist asked if I had a preference as to which doctor I saw. I said "well I'm going to be honest with you, it took 3 1/2 years of crap to find out I have this disorder so I'd like to see someone that will listen to me and someone that will treat my disorder regardless of how 'minor' my disorder is". She said "sounds like Dr. Paul will be a good match for you. I have to be honest. I did get a hair emotional when I was talking to her but how can I not get emotional? I had been asking for this testing for 2 1/2 years and it took begging and 4 doctors before I finally got it done. I mean I'm glad I got answers and I have to admit my gut was right all along. I just knew deep down inside I had immunological issues. I also had a bit of an incling that there was a tad bit of an egg quality issue there but I didn't think it was THE only issue...I mean woman get pregnant in their late 30's early 40's all the time and clearly their eggs are getting on the older side (no offence ladies).
Anyhow, we'll see what this doctor has to say. I'm waiting for my blood work results to be emailed or mailed to me then I'll fax them over to the hemetologists office so he can review them before my appointment.
Oh and she asked what my disorder was and I said "MTHFR" she paused. I said "I could give you the whole name but it's long and obnoxious"...."and it's not what it sounds like" she got a chuckle out of that.
anyhow, for now the doctor in NY told me to start on baby asprin daily in order to help with any possible clotting issues the MTHFR might cause (as well as the other issues I have) Baby asprin is something I'll be on daily for the rest of my life now. Which is fine cause he says it's good for your heart.
ok back to work I go.
not much on the adoption front. have to finish the birth mother letter so our home study can be approved. Don't even get me started on the agency. We should be approved by early December. So hopefully for Christmas we will be officially waiting for a match. However my goal was to be officialy waiting by the end of December. I've upped that goal to Christmas. :)
This Sunday my husband and I left church early cause we weren't feeling well. I had a borderline migraine and I was in bed. My brother in law and his wife had invited a couple that we go to church with over for dinner. It took me by surprise cause I had no idea they had invited people over. We would have eaten with them but my husband and I weren't feeling well so I politely declined and went to bed. not to mention we were eating dinner at my in laws 2 hours later so I decided to skip lunch all together.
Saturday, November 22, 2008
On top of the MTHFR I found out I have 2 other immunological issues.
Onee is my NK cells (natural killer cells) are elevated...that's bad. That means my body is attacking the embryo's. Now my level was a 9.6 the RE's at SIRM think a level of 10 is bad and thus my level of 9.6 is elevated and not good.
The next issue is DQ-Alpha protein. There are about 20-30 of these genes you can get. You get 1 from each parent. I got 1.1 and 1.3. Jon got 1.1 and 1.1. We have 1.1 in common which is bad. Basically when make a baby we have a very high chance that our baby will be a 1.1 (jon automatically gives our baby a 1.1 in the begining-till the baby later starts to get more DNA of it's own). Since I'm a 1.1 too my body see's this as "my own" and doesn't recognize it as an embryo. Thus when the embryo gets into the uterus my natural killer cells start to attack the embryo. If the embryo does implant it may not grow for very long. My body will attack the baby and kill it off.
Here is what one of the RE's at SIRM said about NK cells and the DQ Alpha protein match
Natural Killer (NK) Cells
After ovulation and during early pregnancy, NK cells comprise more than 70% of the white blood cell population seen in the uterine lining. NK cells produce a variety of local hormones known as TH-1 cytokines. Uncontrolled, excessive release of TH-1 cytokines is highly toxic to the trophoblast and endometrial cells, leading to their programmed death (apoptosis) and, subsequently to failed implantation. In the following situations these NK cells can become abnormally activated, and thereby produce these TH-1 cytokines:
*When both male and female share specific DNA (DQ-alpha) similarities. In such cases, the presenting problem is usually recurrent pregnancy loss, rather than “infertility”.
-Now I've never been pregnant...that I know of...I mean I've never had a positive pregnancy test. Now that's not to say the NK cells aren't attacking the embryo. However we do suspect egg quality on top of this so maybe a combination of these three plus the MTHFR is making it almost impossible for me to get pregnant. now keep in mind that quote is from 2006 so the date is kind of out dated. SIRM keeps up to date on their testing . None-the less I do appear to have an egg quality issue.
Now some doctors don't buy into the whole protien match and think it's utter crap. I for one dont' believe that egg quality is our ONLY issue so i'm a firm believer that these 3 issues combined with my egg quality is keeping us from getting pregnant. Their is a new easier way to fix this. They used to (and still do) use IVIg which is VERY expensive and invasive from what I've heard. (click on the link to learn more on what it is)
Recent studies have shown that INtralipid has been just as if not more effective than IVIg and is less expensive and less invasive. he even said he could probably find a nurse to come to my home and do it there instead of me traveling to NY.
The RE I spoke to said the treatment for this is Intralipid infusions. It's $200 (not covered by insurance). I'd have to get it done before we do IVF and then again once a month if I get pregnant...although I believe it's only for the first trimester but I'm not 100% sure.
Anyhow, we don't want to cycle again any time soon so that's not really up for discussion right now. If we do cycle it will be summer of 2009 but I was honest with the RE and said I was sick of using my vacation and sick time and if I went there I'd try to make it into a vacation. He agreed that mental health was top priority. They are in NYC so he promised he'd find fun things for me to do LOL.
For now we are focusing on our adoption. Honestly I'm sick of focusing on babies. I'm focusing on living life. that's what I'm focusing on. I MIGHT do another IVF with them. I'd like to give them a shot. But probably not till late 2009. We changed ins companies but I've been told the coverage is the same...we shall see. So yeah, for now I focus on living life again and enjoying having 2 incomes and saving lots of money each month so we can pay off student loans and our car. My student loans and our tenants bathroom should all be done by the end of 2008. The car should be paid off by early to mid summer 2009...Maybe sooner. YAY! We knew when we got it that we wouldn't have the loan for long. We had a few things we had to fix around the house thath as set us back but it will be paid off soon none-the less.
Saturday, November 8, 2008
Compound Heterozygous MTHF. It's extremely hard to explain. Basically it means my body doesn't absorb folic acid...but it's not that simple either. Here is a blip from a web site that pretty much explains what it is: (please bare in mind that this breifly talks about men and how MTHFR effects them but none the less I still think it's quite informative.
Fortunately, most symptoms of MTHFR are surprisingly easy to treat. All it usually takes is some extra folic acid, a common B vitamin.
Most of the studies on folic acid and the MTHFR mutation have been done in women. But at least three have been done in men. These studies are too early to be conclusive but they suggest a link between low folic acid, the MTHFR mutation and male fertility.
To understand this link, we first need to learn about MTHFR. And how low levels of folic acid can affect our DNA, fertility, and risk for miscarriage.
MTHFR is a gene that makes a protein called methylenetetrahydrofolate reductase (now you see why we call it MTHFR). The MTHFR mutation is actually just a certain version of the gene.
This version leads to a weaker MTHFR protein. And people with weak MTHFR proteins need extra folic acid.
We know that folic acid is important for all sorts of things. You’ve probably heard doctors tell women to take their B vitamins when they are pregnant. Or even thinking about getting pregnant. Lots of our foods are now fortified with these vitamins too.
These B vitamins are recommended for the reasons we talked about before. Extra folic acid can help prevent miscarriages and protect developing babies from getting birth defects. And as I said, women with the MTHFR mutation need even more.
The MTHFR protein converts something called homocysteine into methionine. When MTHFR is not working properly you can get a buildup of homocysteine in the blood and not have enough methionine.
Folic acid fits into this because MTHFR doesn’t do its job alone. It needs to work with folic acid to turn homocysteine into methionine. This is actually why folic acid can help people with weak MTHFR. Extra folic acid pushes the reaction along so that the build up of homocysteine goes away.
OK, so having a weak MTHFR protein leads to an increase in homocysteine levels and a decrease in methionine. And both of these can lead to DNA damage in different ways (click here to learn more).
** this is what you find when you "click here"***
One of the effects of increased homocysteine build up may be more lost pregnancies. One number I saw was that 21% of women with high homocysteine levels have recurrent pregnancy loss! But if this is true (and I haven't seen the hard data to confirm it), is it because of chromosomal abnormalities? Or something else?
Hard to say. There are a couple of ideas out there for how high homocysteine levels might affect a pregnancy. There is some evidence that clots form more easily in these women’s blood. Too much clotting can lead to problems like cystic hygromas which are known to affect pregnancies.
Another possible consequence of high homocysteine levels is chromosomal problems. DNA is often thought of as unchanging but it is actually pretty dynamic. While the A, G, C, and TÂ’s rarely change, something called DNA methylation can change a lot.
DNA is decorated with little chemical groups called methyls. These methyl groups can affect whether a gene is turned on or off. They can also affect whether a chromosome goes to the right place when a cell divides.
The connection here is that high homocysteine levels decrease your pool of methyl groups. What this means is that there is less methyl around so your DNA might not get enough. What folic acid does is provide extra methyl groups to the pool.
It certainly looks like women with the MTHFR mutation have more babies with Down syndrome when they don’t get extra folic acid. But, is there a connection with other chromosomal problems?
No one knows for sure. In one study, researchers failed to find a connection between the MTHFR mutation you mention and any other trisomies except, possibly trisomy 18. However, the researchers couldn’t tell from that study whether the mothers had had enough extra folic acid in their diet to overcome their mutation.
As you can probably tell, more research needs to be done. For now, no research has shown that extra folic acid can help prevent trisomies in the absence of some health problem like the MTHFR mutation.
Here is some more information. Just for the record I'm Compound Heterozygous MTHFR for 677CT & 1298AC
MTHFR = methylenetetrahydrofolate reductase
The gene MTHFR encodes the protein/enzyme MTHFR.
Its job is to convert one form of folate (5,10-methylenetetrahydrofolate) to another form of folate (5-methyltetrahydrofolate). 5-methyltetrahydrofolate is used to convert homocysteine (a "bad" amino acid) to methionine (a "good" amino acid). Therefore, if MTHFR is not doing its job as well, homocysteine will not be converted to methionine and will be elevated in plasma. Normal plasma homocysteine levels are generally quoted as between 5 and 12 uM (uM = micromoles per litre). Elevated homocysteine has been associated with a variety of multi-factorial diseases.
Folate is a generic term referring to a family of related molecules that are interconverted between each other by a number of enzymes (including MTHFR). Folic acid is the synthetic, easily absorbed form of folate. Food has been fortified with folic acid for the past decade in North America. The recommended daily intake of folic acid is 400 ug/day (ug = micrograms). MTHFR does NOT affect how folic acid is absorbed into your body --> it affects what folate forms are in your body.
In general, if you have a mutation is a gene, there are a number of consequences.
Sometimes, the gene mutation has no effect whatsoever on the protein - therefore the protein can still do its job.
Sometimes, the gene mutation has a little effect on the protein - the protein still does its job, but not as well.
Sometimes, the gene mutation results in very very little or no protein - these are serious mutations.
The 677C-->T mutation
This mutation is an example of one that has a moderate effect on the protein. It is called a "polymorphism" which means that it is a common mutation.
The C is the normal allele (copy of the gene).
The T is the variant allele (copy of the gene).
The T mutation in the MTHFR DNA causes the MTHFR protein to be "thermolabile". This basically means that it is less stable. Folate can increase the stability of thermolabile MTHFR to a level similar to that of normal MTHFR --> that's why it is important to take a BIT extra folic acid if you are 677TT.
677CC is the "normal" or "wildtype" genotype
677TT individuals (homozygous) are said to have mild MTHFR deficiency
677CT individuals (heterozygotes) are almost the same as normal individuals because the normal MTHFR can make up for the thermolabile MTHFR.
The 1298A-->C mutation
This is also a polymorphism and has little to no affect on the protein.
The A is the "normal" or more common allele.
The C is the "variant" or less common allele.
The C mutation does not appear to affect the MTHFR protein. It does not result in thermolabile MTHFR and does not appear to affect homocysteine levels.
Mutations at 677 and 1298 are both in the same gene, MTHFR. They are at different locations in the same gene. Some studies have shown that the MTHFR protein in people with the genotype 677CT 1298AC does its job a bit less well than the normal MTHFR.
MTHFR Polymorphisms & Disease
There are MANY studies associating MTHFR polymorphisms with various diseases. Sometimes one study will say one thing, another study will say another thing. It is important to remember that these problems (NTDs, miscarriages, cancer) are MULTIFACTORIAL - they have a combination of causes. MTHFR polymorphisms alone will not be the sole cause of them.
In terms of "severity" of genotype for various conditions:
677TT > compound heterozygous > every other genotype
NTDs - it is clear that folic acid deficiency increases the risk of having a baby with neural tube defects such as spina bifida.
Miscarriages - some studies have shown an association between MTHFR and miscarriages - some have not.
Cancer - 677TT genotype may help protect against colorectal cancer and some leukemias.
Severe mutations in MTHFR
These are very very rare (about 50 worldwide).
Severe mutations result in little or no MTHFR protein being produced. They are different from the above-mentioned polymorphisms.
The result in motor and gait abnormalities, mental retardation, decreased lifespan, etc.
This effects more then just fertility. A few of the symptoms are depression, anxiety & migrain headaches. All of which I suffer from. It can also cause other problems down the road like alzheimer's, problems with your heart, clotting disorders etc. Of course the symptoms all depend on what variation of MTHFR you have. One part of the info above says mine does it's job a "bit" less well then normal MTHFR then towards the bottom in "sevarity" it is in the middle so who really knows. All I know is I'll be booking an appointment with a hematologist just to make sure we keep this under control. Since this effects my over all health I'll be making an appointment as soon as my husband and I get back from vacation.
Side note: yesterday was our 5 year anniversary and we are going on vacation from Tuesday through Saturday. I can't wait. We are doing the same thing we do every year...but it's our ritual. :) We go back to where we honey mooned. Well it's late so I should head to bed.
Friday, October 24, 2008
The agencies secretary called the other day and said "I didn't realize how far along you were, we could have set up your 1 on 1's with the SW (social worker) a while ago". I'm upset but excited at the same time. We are meeting with him next Thursday!!! Then we get to have our home visit and wait for our homestudy (the paperwork) to be done. I guess it can take 30-60 days for the home study to be approved. We still have to do our birth mother letter and our profile. We are having more pictures taken Monday. Someone we go to church with does photography on the side. She is an excellent photographer. It's $125 but she's amazing and we get to have some pictures done outside. I hope the leaves are still pretty...we are doing this Monday...I've noticed that the leaves are really falling off the trees and I'll be kind of sad if the trees where we are going are bare.
Anyhow, off to watch Ironman with my hubby.
Oh and work this week was AWFUL!!! I'm really starting to know how my friend Jeni felt wihen she was in this position. And the reps are doing AWFUL selling sections. Our seniors section had a goal of almost $20k and they did $7,200. our home and life section had a goal of almost $18k and they did just over $6k...I mean I know the econemy sucks but are they really trying to sell? Corporate is making a big push for internet and my theory is they are selling that and print is failing because of it. I mean my coop goal is $20,000 under for the month. Corporate is really really pushing internet so between that, the econemy and the fact that..well...I have no idea to be honest. *sigh* enough of that crap it's FRIDAY!!!!
Tuesday, October 21, 2008
Doesn't help that I'm so freaking exhausted. Since I stopped all the fertility hormones my thyroid is going down and now I'm over medicated and slightly hyper thyroid. My period was almost non existent this month and I have to drink soda to keep from falling asleep at my desk. usually it starts around lunch time but today it is starting around 11:15. *sigh*
The fatigue doesn't help my mood. All I want to do today is go home and sleep.
So get this. My boss (D) told someone in editorial that "we" could help type up the stories for a veterans tab we are doing. Well guess who is typing them all? Yup you guessed it I am the one typing them up. Kind of makes me mad but what ever. I also get to work a booth at the Warren Miller festival the night before Thanksgiving. It's part of my job so I can't really complain but I hate sports LOL.
Well I feel a tad bit better after writing this out. My husband and I are going to sit down tonight and go over our adoption stuff. We were supposed to go to the gym but the adoption stuff is to important. Looks like we'll go to the gym on Saturday some time instead. either that or start next week. We've had our memberships for 3 weeks now and just yesterday had the time to go buy clothes and shoes.
Thursday, October 16, 2008
I'm ecstatic but at the same time this means the issue probably is with my eggs.
My husband and I talked again about donor embryo and it's just not something he really wants to do so we are not going that route. I guess that's ok with me though because I'm a bit more excited about adopting anyway. Part of the reason I'm ok with not doing donor embryo is the comments I'd get from people "I knew you'd get pregnant once you adopted" bla bla bla. People are so freaking stupid! That's not the only reason but that's one of them.
On the other hand I'm frustrated that I won't get to experience pregnancy. I know some day I'll have a miracle pregnancy of my own and I'm trying to be patient till then. I can't tell you HOW I know (ok I can but revelation is personal and readers probably wouldn't understand anyway) but I just know that some day God will bless my husband and I with a little miracle of my own.
So I guess the plan is to cycle with SIRM. The question at hand is do I pay $4,500 for the CGH/egg testing? All it will do is confirm that my eggs are indeed genetically abnormal....or tell me they are not and leave me confused. I have no idea how much my insurance company will reimburse but they said they will...just not how much. You see in January my husband and I have to start paying on his student loans and I really really want to get our car paid off and $4,500 is almost 1/2 of what we owe on the car so it's really hard to justify spending it on CGH...I'm just not sure what to do. Looks like I'll be calling my insurance company again. *sigh* Fun fun
Monday, October 13, 2008
This is where I blog about my infertility so keep that in mind.
I'd keep the title but I have an opendiary account with the same title. I'm trying to avoid family stumbling across my blog. I love them but I don't want them to get hurt by some of the things I say here. This is the one place I can vent and not worry about hurting someone's feelings.
Thursday, October 2, 2008
I felt better after I cried but I hated the fact that I wasted my precious time being depressed. Who really wants to go home and think about these things after 9 hours of work? No one does....and if you do you are insane. My time after work is precious and the last thing I want to do is think about my infertility. One way or another I've got to come to an acceptance so I can feel better and move on...but how can I accept the fact that we can't have kids? I'm not sure that's something I can EVER accept. How does one accept something they have longed for their whole life? All I want is to have a child to love and raise and to be a stay at home mom.
Speaking of work...my coop bills are calling my name...back to work I go.
Wednesday, October 1, 2008
I wasn't sure where to write this so I thought I'd do it here.
My husband and I have been going to therapy together for a month now. It's to help me deal with the emotions that come with infertility and all the IVF failures I've had. It's been wonderful having him go with me. He's finally starting to understand why I act the way I do and how he deals with things differently then I do.
I'm at a point right now where I don't know what direction we are going in. We have 3 things we are thinking of doing.
#1 we ARE pursuing adoption and should have our home study complete before 2009.
#2 we are planning IVF/ICSI #7 with SIRM so we can do CGH on my eggs and confirm that they are indeed genetically abnormal.
#3 we are contemplating embryo donation.
My heart wants to do embryo donation and continue with the adoption as well. If we got pregnant our file goes on hold for 12 months post when we tell them (so 12 months after I tell them I'm pregnant we can re open our file). My husband will have an answer this week as to whether he wants to do embryo donation or not. I'm thinking that he's probably going to want to but I'm not sure. I really feel this will bring us a baby sooner. The only problem is we would want to do it privately rather then through an embryo donation agency. (which means it may be a long wait).
I'm torn at the moment. I'm sick of thinking of TTC. I don't even know why DH and I are trying on our own. I mean our chances have got to be less then 5% a month. I'm sick of holding on to hope. I really just want my life back.
I wish I could be happy baby free but I can't. I really have always wanted to be a stay at home mom and I don't think I'll ever be 100% happy till I can do that. So for now I just keep trudging along working my job 40 hours a week and putting on my fake happy face to please management.
I guess I could find a new job and cut down to part time...that way I could at least work less hours and volunteer or spend time with family (my SIL is a SAHM). however that means less pay...which means saving less money. the one thing I like about not having kids is I can work this job and save a lot of money each month...so DH and I can have a nest egg and still afford to buy our selves things when we want...and hopefully go on a nice vacation next year.
sorry about the me post...I really needed to get that off my chest. My therapist says I need to write it down and talk about it more.
Thanks for listening. :kissfriend:
Tuesday, September 30, 2008
I've been putting off writing....as a matter of fact this blog window has been open since 9 am this morning and it's now almost 2:00 in the afternoon.
I don't even know where to begin or how to explain how I'm feeling but it's not a happy place. Not at all.
Even my infertile friends are getting pregnant. (whether by IVF with their eggs or donor eggs) I'm definitely being left behind. Some of my friends are even on their second baby.
I honestly just want this to be over. I want to forget about babies. I just want to stop thinking about this but I can't. I can't stop thinking about something my heart desires this much. It's just not possible.
I don't have the energy to write about this now. I can't do this to myself when I'm at work but when I get home I don't want to either.
Tuesday, September 9, 2008
Today is one of those days where I'm depressed. It's been happening since Friday. I've been slowly declining since then. I wish I could stop thinking about TTC but I can't. My friends are all having babies...heck even my infertile friends are prego...some of which are via egg donors but none the less I feel left behind. Some of my long time FF buddies are on baby #2 or more. Quite depressing.
A co worker of mine that has been TTC for 2 years went on clomid and got pregnant right away. Unfortunately she had a chemical but she got pregnant the second time and so far the baby has stuck. I'm incredibly happy for her but I am jealous. Pretty pathetic huh? Jealous of a woman who had to struggle for 2 years to get pregnant. I just wish to myself "I wish it was that easy for me". I know for her it wasn't easy. For her it was torture. However to me she is very fertile. It's pretty sad how my infertility and IVF history has warped my way of thinking.
I know some day I'll be a mother but I'm honestly sick of thinking about it. I wish I could live a happy baby free life but I can't. I'll never be fully happy if I can't have kids.
I think my problem is that I'm taking on to much. I'm taking a break so I can grieve and deal with the fact that I can't have kids. The book "adoption after infertility" often refers to infertility as a loss. I have to deal with my emotions so I can get back to a better state of mind. On the other hand my insurance is only good through 6/30/09. The company I work for was sold and so the insurance could change next year. So I'm in the middle of trying to plan an IVF in January. My husband and I decided we wanted answers so we are going to get CGH (genetic testing) done on my eggs to see if they indeed are the reason our embryo's are chromosomally abnormal. We both think it will give us the closure we need. However this procedure costs $5,200. I have to pay out of pocket then attempt to get reimbursed by my insurance company. I've tried to get my ins company to tell me how much they will reimburse but they can't. That's a LONG story and confusing so I'm not even going to try to explain. Just take my word for it.
On top of that we have been doing our paperwork for adoption. Then, thanks to the book I'm reading, I have started to think about donor embryo. It will take a few months of research and thought in order to come to a decision. I did talk to my husband about it but he's not to fond of the idea. He did admit though that he has no good reason to feel that way and that we need to research it.
Well I suppose I should get back to work.
Monday, September 8, 2008
I ended up consulting with Dr. T at SIRM. If we cycle with them it won't be till January 2009. DH and I aren't quite financially ready to put down $5,200 down for the egg testing (CGH on my eggs).
In the mean time we have started the process to adopt. Sometimes I'm excited about it and other times I feel like I'm having an emotional break down....Today's is one of those days.
I'm reading the book "adoption after infertility" and it has got me thinking. In one of the chapters it asks you to basically think about all your options (husband and wife do this separately) Honestly it's really hard to explain what she asks you to do so I'm not even going to try. Not to mention I don't have the time. It's really got me thinking about adoption vs embryo adoption. Being in such a state of limbo isn't easy though.
I've been trying to take time for myself but this weekend I did NOT get to do that. From Friday on I was with people 24/7. I feel like an emotional wreck today and can't wait to go home and shut myself in my room.
Oh yeah I can't remember if I ever mentioned that my husbands step brother, wife and 16 month old are staying with us. It's been quite hard having them around while I'm going through all this emotional crap. The problem isn't that they are here (they are quite helpful actually, my sister in law cooks and cleans so that takes that off my shoulders). What is hard is when I'm really upset I sometimes tend to offend my brother in law. He's kind of like an emotional sponge. He wants to help when someone is upset and I tend to "crawl in my hole" and not accept help. I need to get better at that. I'm not good at accepting help at all. And I will sometimes (not on purpose) offend him and I hate that I do that to people. This is just a really hard time emotionally for me.
My brother in law finds out this week if he is getting a job with liberty mutual (they have been with us since mid June).
Oh and because they live with us they also have a lot of paperwork to do so we can adopt.
I love my family but it's hard sometimes to have people around when I'm an emotional basket case. I hate people seeing this side of me.
As of yesterday I started thinking about embryo donation instead of adoption. We already put a $1,000 deposit with our adoption agency so we can't get that back. But embryo donation sounds rather interesting so I'm looking into how that works and costs.
my brother in law just called to say he got the job! Yay...now hopefully they can find a house and close with in the next month or two (that is their goal)
Friday, July 25, 2008
I'm doing a bit better then I was the day I found out my RE couldn't help me any more. At this point I've accepted the fact that IVF may never work for us and if it does it will take multiple attemps. I actually took the initiative to consult with Dr. Totoriello with SIRM NY. My consultation was on 7/22. Like CCRM SIRM is VERY advanced when it comes to genetic testing. Their success rates aren't nearly as high as CCRM's but they are more local and they will do most of the same tests that CCRM would do. I talked to the doctor for a while. Their clinic has a unique protocol called estrogen priming that they would try. Like the microflare protocol that my last RE used (and most RE's use) it's used for woman who are older or who have diminished ovarian reserve. He said he would use the "leave no stone unturned technique" he basically wants to do a lot of testing including the immunolotical testing I've been wanting to get done for 2 years now. It will check for numerous things. It basically checks to make sure my body is a safe place for an embryo and that it isn't trying to kill off the embryo. He also would do a SDT (sperm DNA test) to see if my husband has abnormal sperm (thus making our embryo's genetically abnormal). I will also be doing genetic testing on my eggs to see if they are normal. To my surprise Dr Totoriello told me that the normal response for health fertile woman in their 20's is getting 3-4 normal eggs out of 10. Meaning out of 10 eggs only 3-4 will be normal....for a perfectly healthy, young woman. I was shocked. No wonder the average woman only has a 15-20% chance of pregnancy each month.
Anyhow, the results take 4-6 weeks so I wouldn't be doing
a transfer. We'd have to see if any made it to freeze and if those came back as one of the normal one's (most abnormal embryo's wont' make it to blast-the day 5 stage) then we go back and get the embryo transfered. I'm not really going into this expecting to have a transfer or to get pregnant. I'm just wanting answers.
The down side to all of this is between the genetic testing and all the tests we need to get done we will fork out about $6,500. It's a LOT less then most people pay (people with no IVF coverage) but it's more then we've ever paid. So long as my husband gets a good job offer soon we will do it.
Speaking of job offer we should hear back in a few days if Jon gets the job he recently interviewed for. Honestly I can't remember if I wrote about it. I suppose if he gets it then I'll be writing a diary entry about the job and how it came to be.
Anyhow, back to my cycle. SIRM batches their patients so I'd start injections on 10/27. Wether that's lupron injections or the gonal F I have no idea but I'd be starting them around 10/27. I have to tell them by mid September if we want to do it and if we do we have to pay a deposite. Money isn't really to much of an issue so long as Jon gets this job. Right now we save a very large sum of money every month (unless we put it into the house for some kind of repair) so if Jon gets this job we will be able to save money and still be able to afford to pay for this procedure. Oh we also have to save for adoption too and that's going to be $5 or 6k.
Speaking of adoption the agency FINALLY got the last document they needed from my references so we are all set to meet them on 8/18. They will talk to us about the adoption process, take our $1,000 deposite and give us a lot more paperwork to fill out.
Here is some info from the SIRM web site on sperm DNA testing (they are one of the few clinics that believe in this procedure)
Although it is possible for abnormal SDIa to sometimes spontaneously revert to normal, this occurs rather infrequently.
- Although abnormal SDIa are detected in men with apparently normal semen analysis, an abnormal result is more commonly seen in cases of oligozooasthenospermia (abnormal sperm count, motility and/or morphology)
- There is some suggestion that the use of antioxidant therapy (L-Carnitine 3-5 grams per day, acyl carnitine 500mg-1gm per day, Vitamin C 500mg X 2 per day and Vitamin E 400 U X 2 per day) taken for 3-6 months, can in some cases cause the SDIa to revert to normal.
- There is some suggestion that men who have varicoceles ( a collection of distended veins in the scrotum) associated with an abnormal SDIa may experience a reversion of the SDIa back to normal, 3-6 months following surgical or radiological ablation of the varicocele.
In summary, an abnormal SDIa augers poorly for, but does not totally preclude a successful IVF/ICSI pregnancy. However, the prognosis worsens progressively as the age of the egg provider advances beyond 33yrs. Although abnormal SDIa results rarely revert to normal spontaneously
Wednesday, July 16, 2008
I'm not sure I can handle this right now. The therapist in my support group says I need to deal with my grieving and let myself cry but how on earth am I supposed to do that when I have a job to do? I suppose I could go in the bathroom and just cry but who wants to do that? I could see someone walking in and saying "are you ok?" I already had someone say "you face is red are you ok?" in which I replied "I'm having a bad day."
I think it would be good for my husband and I to get away for a weekend together. Somewhere away from home.
Ok I'm done with this crap. CCRM just called and said they typically only do one consult (a free one) which I had back in December and they typically don't do another one till they know 100% that I'm going there. So they basically told me I couldn't talk to Dr. Schoolcraft. then I told her that they don't accept my insurance anyway so I guess it doesn't matter. In which she replied that if I wasn't going there they don't do consults.
What ever. I'm so done with this crap. I think I'm done with IVF completely.
I'm not sure I can handle being at work today but I'm also not sure I could handle going home and being around family either. I just want to go away for a bit. I really think DH and I need to go away for a weekend so I'm looking into local places we could go to. I want to be away from home. My BIL and his wife offered to go out for a night and give DH and I space but I want to be away from home. Not because of them but because it's so much nicer to go some where away from home.
I feel like I'm going to puke
Tuesday, July 15, 2008
I think the hardest part is how screwed up I have gotten over the past year or two. I obviously didn't deal with all the failures well (even though I've been to therapy off and on for a year now). I'm messed up emotionally. I'm completely closed off, even to my husband. I feel terrible. I don't want to be touched, I don't want to be hugged. heck sometimes I don't want to be loved I just want to run away and forget that this ever happened. I love my husband, he's my best friend and we have gotten closer because of this trial but at the same time I have distanced myself emotionally from him. I feel numb. I'm in a fertility support group (led my my therapist) and last week we talked in length about how you have to go through a grieving process when you have a failed IVF. She said I have to cry. I don't want to cry. I don't want to feel the pain. I want to forget about it and go on with life...which is why I did so many IVF's this year (I did 6 over the course of 14 months-bear in mind that the IVF process takes a total of 2 months from beginning to end). Now I'm not sure how to deal with all this. I feel like my husband and I need to go to therapy so I can learn to reverse the damage I've caused upon myself. but I'm sick of missing work. I'm sick of having to be late for leave early for doctors appointments. I have 12 sick hours left, 2 vacation days and 2 "floater" holiday's left. I have used 5 days of vacation. All 28 hours of my sick time has been used for IVF stuff. I really want to save the rest of the time I have so my husband and I can go away for our 5th anniversary in November.
Looking back I wish I had taken more time in between IVF cycles. No wonder all my FF (fertility friend) buddies thought I was crazy. Some days are good and some are bad. Last week was a pretty good week. Today is one of those days where I want to go home and be alone. The problem is when I think about all my IVF failures and how my body has failed me as a woman I get depressed. I don't know how to deal with all the failures with out getting depressed, which is why I don't think about it. Being depressed is the worst feeling.
Well I'm at work today and have a job to do so I suppose I should get back to that. Get back to forgetting about all this crap. Yet again pushing it to the back of my mind and letting it collect dust.
I suppose if anyone has any spectacular advise on how to fix the emotional train wreck I've seemed to get myself into that would be great.
Monday, July 14, 2008
Well CCRM is out of the question. Apparently the doctor I’d be seeing is in net work (thus covered) but their laboratory and surgery center is not in net work. They are not partnered with my insurance so we’d have to pay for over 12 grand worth of medical stuff. Not to mention all the money we’d spend in traveling expenses.
Friday, July 4, 2008
As far as what I'm going to do next I have no idea. We are still proceeding with adoption but one of my references STILL hasn't passed in the paperwork so we are at a stand still. I have been emailing or reminding her at least once a week. Last time I was bold enough to say (via email) that I can't move on to the next step till she mails in her paperwork. I'm very annoyed. She's had this paperwork at least a month if not two months now. I will see her at work on Monday. If she still hasn't passed in the paperwork I'm calling the agency, asking them to fax me a blank copy of the paperwork and giving it to someone else that I KNOW will fill it out and mail it back right away. I don't want to be mean but I'm very upset that she is dragging her feet.
As far as doing another IVF I really feel lost. I have a feeling that either we have more issues that have not been found OR my embryo's, regardless of how they look, are genetically abnormal and not likely to make a baby. I also found out that we are dealing with slight MFI. DH's count was only 33million for this IVF. Thank goodness we do ICSI. I mean it is plenty for even regular IVF (I think) but his SA's seem to fluxate a LOT. The more he's stressed the worse his SA's come back.
I'm debating going to CCRM later this year. The only problem is in November it's my 5 year anniversary and DH and I wanted to go away. We always go to North Conway and stay at the Spruce Moose Lodge. We stay in the cabin where we honeymooned. I love it there. We always hit the shops and do our annual clothes shopping. Not only are they outlet stores but they have huge winter sales on top of it. Ok so back to IVF. If I go to CCRM I'll need to take at least a week off minimum from work. That means I'd have to use the rest of my vacation time that I have. (I've already used all my sick time for my other 3 IVF's this year). I just took a weeks vacation built around the 4th of July (go back to work Monday) plus a day here and there that I've taken for one reason or another. I think I could scrape up 4 or 5 days if I work the rest of the holdays this year instead of taking them off (we get floater days). Anyhow, one of my friends on FF suggested I anniversary in Colorado w/ DH while I do my IVF. I suppose that's not such a bad idea. Only problem is my company blacks out the 4th quarter so the most I can get is a couple of days off unless I get special permission from my manager and my managers manager. SO I'm not sure what I'll do. Doing an IVF at the same time as my anniversary vacation isn't ideal but I suppose it would work. I mean when I'm on bed rest or recovering from ER DH and I can veg, cuddle and watch movies and order food. It's something that I'll have to budget to see how much it would cost. Honestly I don't expect IVF to actually work. I've given up on any hopes of having bio children any time soon. I just want solid answers as to WHAT is wrong with us and I know CCRM is the only place that will give us those answers.
So in the mean time I'm on a break, not sure for how long. I meet with my RE on the 16th. I have no idea what he'll say.
Sunday, June 29, 2008
ER (egg retrieval) was on the 20th and ET (embryo transfer) was on the 22cnd As stated in my last entry I had 16 follies at trigger. E2 ended up being 2,655 the day before I triggered. They retrieved 10 eggs. At first I was a tiny bit upset with that (since I had 16 follies) but first of all they almost never retrieve eggs from all the follicles. The other reason might be because they used a different kind of HCG for trigger. it was 1/2 the dosage I normally get (I think). So that could be another reason. Out of the 10 eggs 9 were mature and 6 fertilized on ICSI. By day 2 (transfer day) we had 5 remaining. To my surprise 2 were great quality. Both had 4 cells, all cells were the same size and each cell had 1 nuclei! The 3 remaining embryo's weren't to good but they were MUCH better then my last IVF. Here are the stats on those: embryo's kept to grow in lab: embryo 3 7 cells uneven cells no nuclei present Day 5: embryo 3 morula by day 5 but poor quality and not good enough to freeze Most of the time my embryo's arrest (stop growing/die) around the 5-7 cell stage. The fact that I had a 10 cell AND a morula (that is what it should actually be by day 4. By day 5 they should all be a blastocyst) was GREAT. even though the morula was poor quality and a day behind schedule I am still excited that I had an embryo make it that far! None survived to freeze though but I'm ok with that. What I'm excited about is I had NO embryo's that were multinucleated! Multinucleated embryo's are a LOT worse quality wise then embryo's with no visible nuclei. the nuclei holds the DNA so it's important that each cell have ONLY one nuclei. Embryo's with more then 1 nuclei in each cell is chromosomally abnromal and usualy don't survive very long before they arrest :( Looks like the new protocol worked great for me. I'm so happy that we had 2 good quality embryo's to transfer. My RE and my embryologist are both very excited and hopeful for me. I'm not as hopeful as they are but how am I supposed to feel after all the failures? At this point I don't get excited. I'm just taking it day by day. Even if this IVF doesn't work at least now I have renewed hope. And here I was thinking this would be my last IVF. Knowing that I DO have a chance and I CAN make goood quality embryo's gives me the hope I needed to keep enduring. on a not so good note my husbands count was VERY low. It was 33million when I normal count has around 80 (I think don't quote me on that) However his results have always proven to be linked with stress. When he was not in school and just took a summer off to work his results were MUCH MUCH better. I just need to get him on a suppliment. I want him to go on fertility blend for men but it's kind of expensive. Worth it though because I've seen lots of woman on FF (fertilityfriendonline) tell success stories. I should probably get back to work. A lot has happened in the past few weeks. My BIL and his wife and 13 month old are staying with us. I'm on vacation from 6/27 (my b-day) and don't return to work till the 7th of July! Unfortunately however my husaband stil works at his campus job (still looking for work now that he's graduated) so he doesn't get paid time offf. I will probably still have him take a Friday or Monday off though so we can do something together. At least I have Jon, Beth and Owen around to hang out with and go on day trips....now if I could only convince my mother in law that she had to take a day off to go flower shopping and yard saleing (not even sure that's an actual word)
embryo 4 5 cell even cells no nuclei present
embryo 5 5 cell fragmented no nuclei present
embryo 4 made it to 10 cells & arrested
embryo 5 arrested at the 5 cell stage
ER (egg retrieval) was on the 20th and ET (embryo transfer) was on the 22cnd
As stated in my last entry I had 16 follies at trigger. E2 ended up being 2,655 the day before I triggered.
They retrieved 10 eggs. At first I was a tiny bit upset with that (since I had 16 follies) but first of all they almost never retrieve eggs from all the follicles. The other reason might be because they used a different kind of HCG for trigger. it was 1/2 the dosage I normally get (I think). So that could be another reason.
Out of the 10 eggs 9 were mature and 6 fertilized on ICSI.
By day 2 (transfer day) we had 5 remaining. To my surprise 2 were great quality. Both had 4 cells, all cells were the same size and each cell had 1 nuclei! The 3 remaining embryo's weren't to good but they were MUCH better then my last IVF. Here are the stats on those:
embryo's kept to grow in lab:
embryo 3 7 cells uneven cells no nuclei present
embryo 3 morula by day 5 but poor quality and not good enough to freeze
Most of the time my embryo's arrest (stop growing/die) around the 5-7 cell stage. The fact that I had a 10 cell AND a morula (that is what it should actually be by day 4. By day 5 they should all be a blastocyst) was GREAT. even though the morula was poor quality and a day behind schedule I am still excited that I had an embryo make it that far! None survived to freeze though but I'm ok with that. What I'm excited about is I had NO embryo's that were multinucleated! Multinucleated embryo's are a LOT worse quality wise then embryo's with no visible nuclei.
the nuclei holds the DNA so it's important that each cell have ONLY one nuclei. Embryo's with more then 1 nuclei in each cell is chromosomally abnromal and usualy don't survive very long before they arrest :(
Looks like the new protocol worked great for me. I'm so happy that we had 2 good quality embryo's to transfer. My RE and my embryologist are both very excited and hopeful for me. I'm not as hopeful as they are but how am I supposed to feel after all the failures? At this point I don't get excited. I'm just taking it day by day.
Even if this IVF doesn't work at least now I have renewed hope. And here I was thinking this would be my last IVF. Knowing that I DO have a chance and I CAN make goood quality embryo's gives me the hope I needed to keep enduring.
on a not so good note my husbands count was VERY low. It was 33million when I normal count has around 80 (I think don't quote me on that) However his results have always proven to be linked with stress. When he was not in school and just took a summer off to work his results were MUCH MUCH better. I just need to get him on a suppliment. I want him to go on fertility blend for men but it's kind of expensive. Worth it though because I've seen lots of woman on FF (fertilityfriendonline) tell success stories.
I should probably get back to work. A lot has happened in the past few weeks. My BIL and his wife and 13 month old are staying with us. I'm on vacation from 6/27 (my b-day) and don't return to work till the 7th of July! Unfortunately however my husaband stil works at his campus job (still looking for work now that he's graduated) so he doesn't get paid time offf. I will probably still have him take a Friday or Monday off though so we can do something together. At least I have Jon, Beth and Owen around to hang out with and go on day trips....now if I could only convince my mother in law that she had to take a day off to go flower shopping and yard saleing (not even sure that's an actual word)
Wednesday, June 18, 2008
ER is Friday at 9:30 AM. I'm just ready to get this over with.
Monday, June 16, 2008
Here is the break down thus far from my IVF
6/7 Baseline Lining = 3.5
start 0.10ml of Micrdose Lupron
6/8-6/11 0.10 Microdose Lupron 2x a day. 225 Gonal F 2x a day (max dosage my RE will do) - Total = 450 FSH
6/12 (4 days of stims)
Lining=7.5mm - weekday tech
6/12 & 6/13 450 FSH & 0.10 microdose Lupron
6/14 (6 days of stims)
E2 = 936
Lining = 13.4 - weekend tech measures larger then weekday tech
Follies = R 3@11mm 1@ 12mm
L 13mm, 10mm, 11mm
6/14 & 6/15 450 FSH & 0.10 microdose Lupron
6/16 (8 days of stims)
E2 = 2,445!!!
Lining = 11.5 week day tech
Follies = 12 between 12mm-16mm
6/16 -225 FSH & .10 microdose Lupron in AM
150 FSH & .10 microdose Lupron in PM
The E2 for my last IVF cycles were around 1,500 and each time. IVF #4 I had 12 eggs retrieved (12 follies) but 8 were mature. last IVF I had 13 follies and 9 eggs retrieved (all 9 mature).e2 for me seems to be about 200 per mature egg so I'm willing to bet I have about a dozen mature eggs right now. I decrease my evening dosage to 150 (total for the day will be 375 down from 450). Then I do my microdose lupron in the AM and go in for more b/w and another ultrasound.
I'm on the microflare protocol. I've been on .10 units of microdose lupron 2x a day as well as 225 gonal f 2x a day. (max dosage my RE does).
I'm not getting my hopes up though because even if by some miracle we end up with 12 eggs (and if my fertilization/ICSI stays as great as it has been we will have 12 embryo's) they could all still be abnormal/multinuclated so we shall see.
Friday, June 13, 2008
There may not be ways to fix sperm DNA problems but it certainly will tell you why you are not pregnant. It's like egg quality...there is no real way to fix egg quality but it would be nice to narrow down what the problem is. Unlike eggs sperm regenerates every 90ish days. Thus sperm quality CAN be helped to some extent. Woman are born with their eggs. Some say you can fix egg quality and some don't.
Here is what I found on that web site. I personally don't think this test is a waste of time. CCRM does this test on all couples and their statistics are through the roof. (then again they do all kinds of tests that other RE's don't want to "waste" their time doing. Personally I think the more tests you get done the better. I'd rather find out exactly what my problems are before I do IVF. Here I am doing a 6th IVF and we still don't know for sure what is causing my embryo's to be abnormal. Here is the link to that web site if you find the below quote hard to read:
Also oddly enough the way they describe what happens to the embryo's due to Sperm DNA problems is exactly what happen to mine. They all arrest around the day 3 stage. It could be sperm issues, egg issues or a combination of both but I for one would like to know what is causing the issues so we can try to fix it or at least accept it and move on.
The Sperm Chromatin Structure Assay (SCSA) and DNA Fragmentation: What Is It and What Does It Mean?
This article from a Resolve 2006 newsletter
Until several years ago the belief among most reproductive specialists (including myself) was that if a man had live sperm then they were suitable for use with IVF / ICSI and if the female partner didn’t get pregnant or a miscarriage ensued then it was probably an egg quality issue. Several studies had implied that the conventional sperm parameters (count, motility and morphology) as measured on a routine semen analysis had no bearing on success when ICSI was used. Many couples pursued egg donation after failed IVF attempts because the husband’s semen parameters were relatively normal and yet conception hadn’t occurred. Some of these same couples were still unable to conceive even with the “better quality” donor eggs leaving both the doctors and the couples frustrated and perplexed. Some couples then went on to use both egg donors and surrogates thinking it was both an egg quality and implantation issue, again without success. The only commonality was the husband’s sperm.
About a year and a half ago a relatively new concept was introduced to clinical practice; sperm quality was dependent on the amount of damage to the sperm DNA or DNA fragmentation. Simply put, DNA is arranged in a double helix or ladder configuration with side rails and rungs. If the rungs are broken, then the ladder is unsteady and won’t function properly. What has recently been shown in several studies is very interesting and in some ways unexpected. Sperm DNA fragmentation has little or nothing to do with the parameters that we measure on the routine semen analysis. It has little to do with the shape of the sperm or whether the sperm are moving. It is a completely independent variable. Men with otherwise normal semen analyses can have a high degree of DNA damage and men with what was called very poor sperm quality can have very little DNA damage. More importantly what has also been demonstrated is that the degree of DNA fragmentation correlates very highly with the inability of the sperm to initiate a birth regardless of the technology used to fertilize the egg such as insemination, IVF or ICSI. Sperm with high DNA fragmentation may fertilize an egg and embryo development stops before implantation or may even initiate a pregnancy but there is a significantly higher likelihood that it will result in miscarriage. By testing for sperm DNA fragmentation, many cases of formally “unexplained” infertility can now be explained. Many of those couples who have been previously unable to conceive with what would be considered extreme measures have been diagnosed with high sperm DNA fragmentation and treated. It is now very clear to see that having this information about the quality of the sperm can be tremendously helpful to couples and their physicians.
There are several ways to test for sperm DNA fragmentation; the most widely used and statistically robust test is called the Sperm Chromatin Structure Assay or SCSA. The patient semen samples are frozen and shipped in a liquid nitrogen container to the SCSA reference laboratory in South Dakota. The sperm are thawed out and a stress is applied (low pH). The sperm are then labeled with a special orange colored dye that only attaches to the ends of broken DNA within the sperm cell. If the DNA is intact then no dye will attach to the sperm. A machine called a flow cytometer is used to analyze ten thousand sperm from the sample. The sperm are passed single file by a beam of light that hits the dye inside the sperm cell and reflects light at a specific wavelength causing the sperm to appear either orange (damaged) or green (normal). A computer counts the percentage of green versus orange-labeled sperm and software allows for creation of a graphic plot of the percent of damaged sperm giving an index known as the DNA fragmentation Index (DFI).
The data from thousands of patients has been analyzed and correlated with the patient’s clinical outcomes and references ranges were compiled. A normal sample has less then 15% of the sperm with DNA damage. Men with poor fertility potential have greater then 30% of their sperm damaged. A DFI Between 16% and 29% is considered good to fair fertility potential but becomes poorer as it approaches 27%. These numbers are thresholds meaning that above 30% the outcome for most couples was failure to have a birth even though only 30+ percent of the sperm were damaged. Under 15% most couples achieved success. The logical questions that arose were: what about the rest of the undamaged sperm in the sample? Why don’t those sperm work? What causes sperm DNA fragmentation? Can the DNA fragmentation be reduced and the sperm improved? If so, How?
DNA fragmentation can be thought of as a marker for other types of damage to the sperm. It is a kin to seeing the tip of the iceberg. Apparently, in semen samples with greater then 30% DNA fragmentation, other abnormalities are occurring with the non-fragmented sperm that the SCSA doesn’t measure and that is why samples used with DFIs above this level do not usually result in births.
The causes of high DNA fragmentation are those same causes of male factor infertility that we have known about for years such as chemical/toxin exposure, heat exposure, varicocele, infection, age, smoking, testicular cancer, radiation, and anything that increases the free radical levels in the semen among a list of many other things. It is very important to understand that sperm DNA fragmentation can change with time and it can be improved in many cases. The goal of a male factor evaluation is to seek out the causes of poor sperm quality and try to correct them so conception can occur naturally or to improve the sperm quality for IVF and maximize the chances of success. In situations where DFI can’t be improved there is evidence to suggest that removing the sperm directly from the testicle via biopsy and using it with ICSI may lead to better outcomes then using poor quality ejaculated sperm. Other options include counseling patients regarding the use of donor sperm either by insemination or fertilizing a portion of the eggs harvested for ICSI with donor sperm and a portion with the patient’s sperm, once again to maximize odds.
The clinical utility of the SCSA is readily apparent. All men with an abnormal semen analysis are candidates for this test as well as men with normal semen analyses who have failed IVF for unexplained reasons. Those couples using egg donors or surrogates may also benefit from screening prior to going thru the procedures because the effort and costs are so great. Men with poor DFI should have a male factor evaluation including a physical examination by a male reproductive specialist. These new concepts have a significant implication on how we practice and what we recommend to couples but we must bear in mind that this test does not have a predictive values of 100% as healthy babies have been born from men with high DFI but this is fairly uncommon.
Friday, May 16, 2008
I just don't know what to do. I might cancel this cycle all together.
I feel so lost and alone.
I have a major headache but wanted to write in my diary real quick.
I have had a headache everyday since I stopped the progesterone. Happens to me all the time. I get headaches WAY to much. I'm presuming it's due to all the hormones I put in my body.
My doctor gave me a 15% chance of IVF ever working. A normal fertile couple who times intercourse perfectly has a 20% chance every month (no medial assistance, just timed intercourse). My chances of conceiving on my own are very very slim.
My doctor is trying a new protocol, microflare. it's used for woman over the age of 42 and woman with Diminished Ovarian Reserve. My doctor things it's an egg quality issue but there is no way to tell if it's DH and I with out further testing. Testing that my doctor just doesn't do.
Anyhow, I have to get off the computer before this headache turns into a migraine.
Oh on a side note. I have asked for adoption paperwork to be mailed to us. Our church adoption agency is extremely inexpensive. It will be around $5k when all is said and done but it's a very long process. I'm pretty sure the people work as volunteers to help cut down on costs so it's not the quickest service. I requested paperwork on the 8th or 9th and STILL haven't gotten it in the mail. They said they mailed it on Monday. I was hoping to have the paperwork by Sunday so I could have my bishop fill out his recommendation but I don't think I'll have it in time.
Friday, May 9, 2008
Thursday, May 8, 2008
I'm completely devistated. It really doesn't seem fair but there isn't much I can do about it. As for future plans...I'm not 100% sure. I'll probably stay with my current RE for another cycle...yup IVF #6 CRAZY!
My current RE is meeting with the other 2 RE's as well as their lead embryologist. On the 14th I will find out what conclusion they all came to as to what they think I should do next. I really like how they meet as a group. Makes me feel even more important. I think it's important to get all their thoughts on my situation. More heads are better then 1.
I really feel like I need to take tomorrow off from work but I doubt I will. Saturday I'm going to see my mom and Sunday is church. I really need time to digest this. I need time to grieve. It truly is a grieving process. I don't think people understand the emotional and physical toll that infertility does to people. I think lots of people kind of shrug it off and just expect you to suck it up. Yet they wouldn't be caught dead saying that to a cancer patient. How can I compare the two you might ask? Well I've never had cancer so I really can't compare the two. I can't say they are similar. Mainly because I'm not dying so thus it can't be to similar. It is however like having a disease. (in a way) I really don't know how to explain it. I probably shouldn't even try.
Sunday is Mothers day. Church talks will be based around moms and baby's. I'm not sure if I could handle that emotionally. I already told DH I'm probably not going to be attending. The pain of my 5th failed IVF is to fresh. Having to decide the next step is not easy. Turning 29 will not be easy. None of this is easy. I'm ready for this to be over but I just have to accept the fact that I might be dealing with this for a few more years. Even if I do adoption there will be a wait. It's not a simple fix. With adoption comes more hurdles, more stress, different things to worry about.
I should probably get back to work now. *sigh*
Sunday, April 27, 2008
I guess judging by the research I've done that my embryo's are considered chromosomally abnormal. There are tests we can do to check if that is the case however in order to do those tests my embryo's have got to make it to day 3 (which they normally do) on day 3 they take some cells and do a biopsy on them to see if they are abnormal or not. However it takes a few weeks for the results to come back so they would grow the embryo's to day 5 and freeze them. My embryo's never make it to day 5. So essentially I could get the test done but odds are I'd have no embryo's to freeze. I suppose then at least we'd have an answer.
I believe this study was done back in 1996 so I'm sure there have been new developments. Which is one reason I want to talk to my embryologist. She said she could email me some of her studies so I might take her up on that offer.
Titre du document / Document titleThe presence of multinucleated blastomeres in human embryos is correlated with chromosomal abnormalities
Auteur(s) / Author(s)KLIGMAN I. (1) ; BENADIVA C. (1) ; ALIKANI M. (1) ; MUNNE S. (1) ;
Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)(1) The Center for Reproductive Medicine and Infertility, The New York Hospital-Cornell Medical Center, New York, NY, ETATS-UNIS
Résumé / AbstractThe purpose of the present study was to determine whether the presence of one or more multinucleated blastomeres during early embryonic development is associated with chromosomal abnormalities in sibling blastomeres of that embryo. Embryos with multinucleated cells (n = 47) detected on day 2 or 3 of development were compared to dividing embryos without multinucleation. Arrested embryos were excluded from this study. Chromosome abnormalities were detected using fluorescent in-situ hybridization (FISH) with X, Y, 18 and 13/21 chromosome-specific probes. Of 47 embryos included in this study, 76.6% were chromosomally abnormal, compared to 50.9% in the control group (P <>
Saturday, April 26, 2008
at ER we had 9 eggs retrieved which is exactly how many my RE thought we'd get based on my E2 levels.
Out of the 9 7 fertilized with ICSI.
We did a 2 day transfer of our 3 best embryo's however only 1 looked promising.
Embryo #1 was 4 cells and had even cells (meaning all the same size) and 1 nucleus in each cell. This embryo is a high quality.
Embryo #2 had slightly uneven cells but was a 4 cell embryo. 2 of the cells had 1 nucleus but the other 2 cells had multiple nucleus.
Embryo #3 was a 4-5 cell embryo. they said it was cleaving and starting to divide. I can't remember what the cells had for nuclei but I am pretty sure this was the lowest grade of the 3.
I'm not sure of the quality of the rest of my embryo's. I had a 2 cell and I think the rest were 4 cells but I'm pretty positive that the rest were abnormal in one way or another. I tend to get embryo's that are multinucleated (which is poor quality and leads to decreased pregnancy rates. These embryo's often don't survive)
here is what I found on the internet that might help explain how my clinic grades embryo's:
Eggs retrieved from the ovaries are inseminated with sperm during therapeutic in vitro fertilization (IVF). Fertilization must be confirmed by the embryologist and embryo development carefully monitored thereafter. On the first, second and third days of development, embryo quality is evaluated based on key morphological markers, including the number of cells, cell size and symmetry, multinucleation (more than one nucleus in each cell) and the presence of cytoplasmic fragmentation. The thickness of the zona pellucida, the protective shell surrounding the developing embryo, is also a consideration for embryologists as they select the "best" embryos for replacement in the uterus.
The rate of cleavage (cell division) is an important predictor of an embryo’s developmental potential. Evidence indicates that early cleavage, embryos with four cells on day 2, and embryos with seven to nine cells on day 3 result in higher implantation rates and establish more pregnancies than those with fewer or more cells at those time-points. Based on this, we preferentially replace seven to nine cell embryos on day 3 and consider others for cryopreservation if they meet additional quality standards.
Uneven cleavage is common among human embryos developing in-vitro and there is general agreement that replacement of embryos with this characteristic results in lowered pregnancy and implantation rates. This may be due to an unequal distribution of cellular components among uneven cells or the occurrence of more nuclear abnormalities among them. As a result, these embryos generally are not selected if others are available.
A. A normally fertilized egg showing two pronuclei
B. An uneven 6-cell embryo with one multinucleated cell
C. An 8-cell embryo with minor cytoplasmic fragmentation
Following the first division, some blastomeres in human embryos show multiple nuclei rather than the normal single nucleus. Possible causes are the lack of appropriate oxygen levels during follicular development or a rapid response to hormones during ovarian stimulation. Regardless of the cause, implantation and pregnancy rates decrease with increasing proportion of embryos with multinucleated cells replaced in the uterus. These embryos also have a considerably reduced ability to reach the blastocyst stage in extended culture. The selection of such embryos for replacement is avoided if at all possible.end quote:
I wish I had pictures of my embryo's to share but I forgot to ask for them. I'll call on Monday and when I talk to the embryologist I'll see if they took some but I doubt it. At my old clinic I was used to them automatically taking the picture and giving it to me.
As you can tell from reading the above criteria only one of my embryo's is promising. However that's more then I've had in a year so I'm over the moon that I have a perfect embryo. Granted I am still holding out hope for my other two. I guess you never know...but an embryo with multiple nucleus is chromosomally abnormal.
I bolded a part I thought was important. I just assumed that meant that I had crappy eggs, when in reality maybe it means that all this time my eggs/body didn't respond well to the medications. I do tend to respond a tad quicker. and lots of my embryo's grew with in the last few days of my stim's. most of my cycle I had 7 embryo's, it wasn't till the last few days where the other 6 showed up so they grew rather rapidly.
This does give me a slight hope that I can conceive naturally. however the abnormal embryo's could just be becuase I have poor quality eggs. it's possible that we just have a high number of chromosomally abnormal eggs. Some of the eggs we have are abnormal and will NOT make a baby. Which is why almost no one gets pregnant right away. It's why it can take up to a year for perfectly healthy people to get pregnant. Unfortunately I guess I just have a high number of abnormal eggs.
All in all this batch did look better then the last batch I think. Most were "even" as in they were 2 or 4 cells. Unlike last time where I had mostly 3 cell embryo's and some 4-5 cell's that were extremely abnormal.
I'm going to talk to the embryologist on Monday for 2 reasons. 1 is to get an update on if my embryo's survived the weekdend (by Monday they should be at the day 4 stage, morula. My embryo's have NEVER made it this far. But i also want to pick her brain about my embryo's. What the chances are of a multinucleated embryo making a baby. I'd kind of like to know what my chances are. I'm not sure switching clinics will help me at this point. This RE has proven that he can get double or triple the eggs my last RE did.
Side note. The RE today asked me what I did for a job. He thought I was in the medical field because I knew what I was talking about. I chuckled and said "nope I'm just obsessed with having to know every single detail, I've spent hours on the internet researching." My husband then replied "those hours have probably added up to days and weeks by now." LOL
Monday, April 21, 2008
-Taking Whey protein to try to help egg quality
-Doing my shots at 9 pm instead of 5:30
-Starting my cetrotide (antagonist) at 2:30 rather then in the evening like they told me too.
I'm very excited!
Here's my stats:
CD 9 (7 days of stims)
E2= 632 Lining= 10.1
Right: 1@16mm 2@12mm, 3@13mm
4/19-4/20 Same dosage
300 Gonal F, 150 Repronex
Total FSH = 450, total LH = 150
4/21 (9 days of stims) b/w and u/s
E2=waiting on results
Right side: 1@16mm, 1@17mm 5 between 13 & 15mm
Left: 6 around 13/15mm!
I'm very excited that I'll probably be stimming for 10 full days! That makes my ER on Thursday and my ET on Saturday! That works out best for Jon and I too! I'm over the moon.
E2 was 1,432 Just a hair under what it was last time. I'm sure not all 13 follies will be mature but I'm fine with that. I do one more round of shots tonight and trigger tomorrow. I'm excited that I made it to 10 days of stims!
Thursday, April 17, 2008
Today is day 5 of stims. my E2 was 306 and I had 4 follies, 1 at 12mm and 3 at 11mm. It's still early so I'm sure I'll get more. My E2 is very low though compared to what it usually is. It could mean that I'm just stimming slower (that is what I'm hoping) or it could mean I'm just going to get less eggs this time. I'm on more meds then I've ever been on and the side effects are really starting to get to me. Headache, achy all over, nausea, and the runs. I didn't have the energy to cook so I went to KFC and got a bucket of chicken and some potatoes.
anyhow, I am on a total of 450 FSH and 150 LH now. I go back on Saturday morning at 7 am for blood work and another ultrasound.
I'm hoping ER will be Thursday.
Ok I went to ok a comment and I can't find it. I have no idea who it was from or what the whole message said but it was something about "my re okayed 5-6" or something like that...
Tuesday, April 15, 2008
I did -4/12-4/14 225 Gonal F
today: CD 6-4/15 E2 was only 75 that is after 3 days of 225
keep gonal F at 225 but ad 150 repronex (total FSH = 375 total LH = 150)
do that for tonight and tomorrow. return on 4/17-Thursday for more b/w and u/s
I didn't have an u/s today and I'm fine with that.
I'm kind of scared right now...quality over quantity...all I want is 2-3 perfect 4 cell day 2 embryo's for transfer...that and a nice thick lining.
I'm trying to be optimistic.
My fear however is the BCP's over supressed me. Honestly I shouldn't have been on them at all but that is JMO
Maybe this is a GOOD thing. I mean maybe I'll stim for 10 days *holds breath* I have NEVER stimmed for more then 9. Heck stimming for 9 is a miracle for me. LOL
Maybe I"m just up to a slow start. I"m 100% ok with stimming for 10 + days, all it will do is improve my egg quality. Stimming to fast is bad for egg quality. So this is good right? I refuse to give in to the fear that I might be over supressed.
My E2 has NEVER been that low. Heck it's usually over 400 by now. HAHA. My last IVF it was around 200 I think and even that was low (I attribute that to the fact that I'm at a different RE so different lab)
anyhow, I'm hoping this means I'm stimming slower...what do you think? He increased my FSH to 375 and adding 150 of LH (225 Gonal F and 150 repronex)
I wonder if I'll *gasp* actually stim for 10+ days? I'd LOVE to stim for even 10 days!!! Maybe it will help with my egg quality. I'm grasping at straws here and trying to be positive rather then give in to the fear that I may be over supressed.
All I need is 2-3 perfect 4 cell embryo's for a 2 day transfer. LOL
My embryo's however are very poor quality and barely even make it to the day 3 stage. I've added whey protein to my diet and gotten my hypothyroid fixed.
The only change I made this time was taking my shots t 8:30 pm instead of 5:30pm. I wouldn't think that would make that HUGE of a difference.
my last IVF I was E2 of 257 after 3 days of stims (and even that is low for me)
Saturday, April 12, 2008
Lining was 4.2 (CD 2)
Left ovary less then 10
Right ovary less then 10
My RE already told me that based on my past IVF's I probably have a reduced count. Ok he didn't flat out tell me that but he eluded to the fact. normal antral count is 15-26. So I could have a normal count but my guess is my count is just below normal since I have had a so so response to stims. Who knows. Numbers don't really matter to me any more. All I care about is getting some good quality embryo's one way or another. Unfortunately my odds are better if I have more eggs retrieved. If we can get 12 eggs again this time I'll be happy. Last time 8 were mature so my guess is he will push me an extra day with stims but who knows.
Today through Monday I do 225 Gonal F. Tuesday I go in for blood work but no ultrasound. I already have been told he will most likely (per him) increase FSH to total of 300 per day and ad LH of 150 per day So 150 Gonal F and 150 Repronex.
Thursday, March 27, 2008
Well I had my consult. It went ok. To be honest I'm NOT thrilled. He wants to do the same protocol with minor tweaks. He wants to start me on a higher dosage of Gonal F (225) and gradually raise it. He is also going to start me on 150IU Repronex on day 4 of stims rather then 75 units of Repronex. He thinks I need more LH (I think it's the LH that made my embryo's suck). Other then that no changes. He wanted to do AH (assisted hatching-where they poke a hole in the shell of the embryo to help the embryo to "hatch" out of the shell and implant) but he changed his mind because apparently you can't do it on day 2 it has to be day 3+. I'm really bummed. He won't push me to a day 3 transfer because of my crappy embryo's. Odds are I don't need AH anyway. My embryo's don't even make it to the blast stage (the stage right before they hatch which is day 5)
He see's no point in any of the additional testing I want done. He says since I have not had any losses that I shouldn't need it. -the tests I want done are simple blood tests. It's not like I'm asking for surgery or anything.
I talked to the nurse at length after I met with him. She went over my protocol and time line. She then asked how I felt about this next cycle. I told her I wasn't feeling to positive about it. She asked if I told the doctor that and I said no. I'm assuming she will end up telling him. I explained to her that since I've had so many failures it's almost impossible for me to get excited about cycling again. I also explained to her how I think I should get the testing done if my insurance covers it.
They gave me a customer service survey to fill out and there was a comment section. The things I told them was Dr. H talked to fast and I feel rushed when I meet with him. I also explained (this is on the survey) that he shouldn't have told me about donor egg during my transfer. He should have waited till my follow up consult to discuss that with me. I also explained that I feel as though I should get the testing if my ins covered it. Who's to say that when if finally do get pregnant (yes I said finally) that I won't m/c? Who is to say I don't have any immunity/clotting disorders? The reason I'm not pregnant is embryo quality. We have no idea what will happen when I finally get an embryo to implant and to be honest if I'm that lucky I don't want to chance having a m/c because he didn't do the testing.
I fully plan on faxing that survey tomorrow and on the cover sheet asking her to check with my ins about the tests and that I want them done before I start stims. From my understanding these tests can take weeks to come back so I want them done now.
Anyhow, that is my 2 cents.
honestly I'm to tired of this process to argue with my doctor and at first I wasn't going to argue about the testing. I've had time to think and decided that I need to suck it up and push for the testing whether I like it or not.
Geesh This is my 5th IVF you'd think he'd want to do the testing. I shouldn't have to have a m/c to get it done. That is stupid!