Compounded Grief

a44ae5d84dcad7fc80807bc2413b512dOne of the hardest things about infertility for me so far has been the compounded grief. It’s something I don’t frequently talk about, but something I feel on a daily basis. For those that don’t know, both of my parents are deceased. My Mom died suddenly from a massive heart attack when I was 13, and my Dad died after multiple strokes and struggling for several months when I was 26.

As far as it goes, my Mom’s death has been the hardest to deal with. Not surprising when you combine my age (13) with the fact that it was unexpected. There was no illness or anything precipitating her death. She went to work, I went to bed. I woke up and my Mom was dead. My Dads death was painful, but I had plenty of time to mourn his coming death, and in the end he was better off dead than he was suffering alive.

Infertility has been without a doubt the most traumatic and painful thing I have dealt with though. As a child, as horrible as it is, you expect to mourn the passing of a parent. That might not make it easier to do so, but it is a shared experience the majority of us will go through. Infertility is a minority experience. On top of it being something only afflicting a small number of people, it is also looked at as unimportant, given that having children seems to be viewed as a luxury when you can’t just make it happen on your own for free.

The most surprising thing for me out of all 3 of these experiences has been how they affect each other. While I would never claim to be “over” my parents passing, I have dealt with them in a healthy manner. I can talk about them and think about the past without becoming overly emotional and just remember the past. This is not a place I am at with infertility, every single month the wound is reopened on that grief.

The grief I feel over my infertility though brings back the profound loss I feel having lost my parents so early. It shines a bright light on the fact that I have no readily available family. Every month I fail I can’t help but think how much I wish my Mom or Dad were here, as I know they would support me in any way they could. It’s only made the isolation one feels being infertile that much worse. Not only are you isolated from peers, but you are also isolated in the fact that you don’t have any parents to turn to.

Now, that is not to say that I don’t have extended family, or my dear, amazing husband. I do. But in dealing with my infertility it has definitely brought back grief I hadn’t felt for a number of years. And it’s hard. It feeds the feeling of unfairness you have in the rabbit hole that is depression. While I’m well aware of the fact that life is not in fact fair, it still doesn’t stop the thought from occurring.

The more frequent thought I have though is just when is it enough? When has one felt enough pain and it is deemed they have suffered enough. I know there is no logical answer to this, but again, depression is never sensical in the thoughts that run through your mind.

94bf59ff24f8dc667d9078873d8afd15At the end of the day, all I can really do is just keep breathing. Celebrate the small victories and try to process the grief as it flows over me. Some days that means just being happy I got out of bed and showered.

 

WTF Appointment Followup

c3db6596bdbdf58f0024f5de396179f7Also known as, not fucking pregnant yet. Or, let’s try this next time.

As most of you know, last Friday I had the followup appointment to my failed fresh and frozen transfer. After some drama getting the Dr on the phone (middle of the day phone appointments are a bad idea mmkay?) I have a game plan.

As expected, right now, there is no for sure reason why it didn’t work, it was either bum embryo’s or implantation failure. Egg quality is good. Sperm is good. Lining was textbook. Bloodwork is good. All in all Bill shouldn’t be able to look at me without me getting knocked up. But as we all know, that isn’t happening. So the Dr will be treating it as implantation failure and we will operate on the assumption that my body is an asshole and views our embryo’s as a foreign body.

As per my questions list, here are the answers to those questions:

  • Why did I have so many immature eggs? (7 out of 17)
    • Dose was started low due to high antral follicle count. Small follicles did not catch up in time.
  • Of the immature, how immature were they?
    • Not overly immature. Starting at a higher dose will resolve this issue.
  • Were any over mature or were those not retrieved?
    • The overmature eggs were not retrieved.
  • Is my overall egg quality okay for my age?
    • Egg quality is great.
  • Did we have any sperm issues of any sort?
    • Sperm quality is great.
  • Out of 10 fertilized eggs, only having 2 to transfer and 2 to freeze, is that an okay amount?
    • Fertilization and the amount that made it to transfer and freeze was as expected.
  • My ovaries have repeatedly been referred to as PCO, is PCOS still ruled out for me despite other symptoms?
    • PCOS still ruled out based on bloodwork comparison.
  • Should I try adding Metformin? Specifically 1500mg extended release to try and help egg quality before next retrieval.
    • No metformin needed.
  • I currently take folgard and baby aspirin, which I have been told is fine for my type of MTHFR. But should I switch to l methyl folate and/or a different prenatal?
    • Folgard is okay for the type of MTHFR I have. Prenatal is also fine.
  • I have read that starting lovenox with stims can help bloodflow to the ovaries. Should I try starting with stims rather then right before transfer?
    • Will start lovenox with stims to help bloodflow to ovaries.
  • Should I also possibly be taking lovenox twice daily, given A1298C is linked to shallow implantation?
    • Will start with higher dose once daily, going to twice daily with positive beta.
  • Should I have excision surgery before I do another cycle? I have a consult appointment with an endo/excision specialist for February.
    • Absolutely yes.
  • Should I have any immune testing done? Endo is possibly creating an immune response, but maybe something else as well?
    • Testing could be done, will be treated as immune failure anyway.
  • Is dexamethasone enough, or should I consider prednisone?
    • Will be on prednisone.
  • What about intralipids?
    • Will take intralipids every other week.
  • Any other supplements or diet changes you recommend before cycling again?
    • Previous supplements are fine.
  • What protocol changes will you make for another cycle?
    • Will switch to antagonist protocol with a lupron trigger. Possibility of having to do freeze all. Start at 225 Gonal-F and 150 Menopur, lowering the gonal based on response. No lupron to suppress.
  • NK cell and/or dq alpha testing?
    • Forgot to ask about dq alpha, but will be treated as though I have high NK cell activity.

So to sum it up, this is what will happen over the next couple months:

  • Consult with Dr Falcone
  • Excision surgery for endometriosis, possible ovarian drilling, and recovery time (4 weeks recovery).
  • Low carb, no sugar diet (helps with endo related immune response).
  • Start BACK on cycling supplements since it takes 90+ days to affect egg quality.
  • Endometrial biopsy.

Hopefully mid to late summer I can cycle again:

  • Start with birth control for 2 weeks
  • Get period
  • Start stims
    • 40mg Lovenox once daily
    • 225 IU Gonal-F, tapered down to 125IU after 2-3 days
    • 150IU Menopur the duration
  • Immune treatment:
    • Intralipids every other week
    • Neupogen wash pre-transfer
    • Intrauterine HCG at transfer
    • Prednisone

From there it is hope for the best and pray for no implantation failure again.

WTF Appointment Questions

This coming Friday I have what is lovingly referred to in the infertility community as a WTF appointment. At this appointment I basically ask any questions about why the Dr thinks my transfers failed, and what changes we will make for another try. So far I have a fairly extensive list and thought I might share it with everyone, and see if anyone has any other additions for me. Anyhow, on to the questions:

  • Why did I have so many immature eggs? (7 out of 17)
  • Of the immature, how immature were they?
  • Were any over mature or were those not retrieved?
  • Is my overall egg quality okay for my age?
  • Did we have any sperm issues of any sort?
  • Out of 10 fertilized eggs, only having 2 to transfer and 2 to freeze, is that an okay amount?
  • My ovaries have repeatedly been referred to as PCO, is PCOS still ruled out for me despite other symptoms?
    • High antral follicle count
    • Abdominal weight
    • Male pattern hair growth.
    • Issues losing weight.
  • Should I try adding Metformin? Specifically 1500mg extended release to try and help egg quality before next retrieval.
  • I currently take folgard and baby aspirin, which I have been told is fine for my type of MTHFR. But should I switch to l methyl folate and/or a different prenatal?
  • I have read that starting lovenox with stims can help bloodflow to the ovaries. Should I try starting with stims rather then right before transfer?
  • Should I also possibly be taking lovenox twice daily, given A1298C is linked to shallow implantation?
  • Should I have excision surgery before I do another cycle? I have a consult appointment with an endo/excision specialist for February.
  • Should I have any immune testing done? Endo is possibly creating an immune response, but maybe something else as well?
  • Is dexamethasone enough, or should I consider prednisone?
  • What about intralipids?
  • Any other supplements or diet changes you recommend before cycling again?
  • What protocol changes will you make for another cycle?
  • NK cell and/or dq alpha testing?

Anything I seem to be missing?

2014 Was Shit

I would do a year in review. But who needs more depressing shit to read? I certainly don’t need a checklist to stare at to remind me how shit this year has been. Instead, I’ll just say it’s been shit. I’d love to say 2015 will be better. But in all honesty, unless I hit the lotto I don’t play, nothing will change. I’m just sitting here, waiting for my life to continue on. Because that’s what infertility does to you, and I have no hopes of spending next Christmas with a baby in my arms. Until then, I get to just sit here, and watch everyone else move on. Put up with being asked why I’m not moving with them, when will I, and why don’t I just go do ________________.

I really hate resolutions, as you never follow through on them, but I have some for this year. They are:

  1. thDo the handwritten planner thing
  2. Weekly meal plans
  3. Change diet
  4. Track what I eat
  5. Go back to the gym
  6. Get a cheaper house on land contract
  7. File bankruptcy
  8. Go back to counseling
  9. See endo specialist
  10. Do IVF again

So yeah. There’s my list. Let’s see how quickly I can fail on those!

Egg Maturity at Retrieval

I also posted this at the RESOLVE forums, but figured I would ask the community at large here for help (feel free to respond over there if that is more comfortable for you!):

I am starting a list of questions for my WTF meeting, and one of my biggest questions is about the maturity of eggs retrieved for my first IVF. In total I had 17 eggs retrieved, 7 of which were immature. That just seems like alot to me. There has been no mention of poor egg quality, so I am wondering if anyone else has had so many immature eggs at retrieval and if so, what was the reason you were given? If you cycled again, what did you change and did it bring about more mature eggs?

Right now, my guess is that my dose of meds was bumped up too late. I was at risk of OHSS due to an extremely high antral follicle count, so started out at 75IU Gonal-F and 75IU Menopur for 6 days. I was then bumped up to 150IU Gonal-F and 75IU Menopur for the following 5 days. In all I stimmed for 11 days. Although the day of trigger I was ordered to give myself one final bump of Gonal-F that morning, which was another 150IU. But of course, this is just a guess, so any comments or suggestions would be greatly appreciated. Thanks ladies!