Here we go…again…

July marks the month where we start trying again. I literally cannot believe that I’m writing those words. After 5 years of TTC, we are still at it. It’s such a surreal feeling.

July 9th was the 5 year anniversary of my first positive pregnancy test. We got pregnant on the first try. Living the dream, right? WRONG! It is unbelievable that after getting pregnant so easily I have experienced 5 miscarriages, a stillbirth, a uterine anomaly diagnosis, DOR and the miracle birth of my daughter. The whole story sounds like it’s someone’s nightmare, but nope, it’s my real freaking life. And I am actively choosing to continue what I assume will add more depth to the nightmare. Sometimes I seriously wonder what is wrong with me and why do I have such a desire to experience pregnancy and a successful live birth again after all we’ve been though. But I’m just not ready to give up on my body. I want this journey to end on my terms instead of on the shitty terms I’ve been dealt.

I have thought a lot about how I wish I had a different (in)fertility diagnosis. For example, I wish I needed IVF to conceive but was able to carry pregnancies with no issues. Or I wish I had a uterine septum instead of a unicornuate uterus. Obviously I have no idea what another road would have been like so I cannot really speculate that I would have preferred another path, but it certainly seems like it would have been less painful. Although, as I’m learning, pain is relative, so it’s likely I would have experienced the same heartbreaking feelings on another journey.

I had my cycle day 3 labs and AMH redrawn and boy are they shitty. My AMH had cut in half in 11 months from 1.2 to 0.6. My FSH is 14 but my E2 is 84, which means my FSH is being artificially suppressed and is likely higher. So now I’m in the full blown DOR zone and not just the likely DOR gray area. It makes me so upset that Colton died and that he may have been my last shot at a normal embryo. I hate the uncertainty of this road and that I have no idea if I will even be able to get pregnant again. But then I think about how I made 2 normal embryos last year and it can’t be that bad yet, right? I’m only 35 and while that’s considered to be of geriatric age for getting pregnant, so many people get pregnant and have no problems at this age and above. There was also a study that came out in 2017 basically saying that having low AMH and/or high FSH showed no difference in the ability of a non-infertile woman to get pregnant naturally. So I’m hoping that since I have never had a problem getting pregnant I am considered “non-infertile” and  I will still be able to get pregnant. Hopefully I still have some good quality eggs left. Too bad my uterus sucks and I have to gamble that the normal embryo implants in the right spot. Lastly I really hope that D&C did not screw up my lining but only time will tell.

Since March I have been taking ubiquinol, prenatal vitamins, vitamin E, vitamin C, vitamin D, extra folic acid, and a B complex vitamin in hopes to improve my egg quality. I also re-read “It Starts with the Egg” by Rebecca Fett and have re-committed myself to eliminating toxins from my household items and food as much as I possibly can. I also plan to re-introduce baby aspirin next month (which I am a bit scared to do since I’ve been dealing with some pretty bad heartburn since Colton’s delivery, but it’s been a lot better recently). Since June I am also eating  no processed carbs, no dairy, no alcohol and no coffee. The no processed carbs and dairy are really easy for me. I had wine/beer on my vacation but that is actually easy for me to eliminate as well. I just wanted to enjoy my vacation and my 6 year wedding anniversary. But man do I love coffee. I did quit for a month, but started again this past week on vacation so now I have to eliminate it again.  There is something so magical about a cup of coffee in the morning. I sound like an addict…

And that’s where I’m at. Overall I am doing just fine considering my baby died 4.5 months ago. We’ve done a lot of fun things, and I am really enjoying my toddler a lot. She’s at such a fun age. I know I sound really negative in this post but I think a lot of it is apathy. It just seems like it’s a futile attempt so I just am finding it hard to really commit to putting my all into trying again. But then I really want to have another baby and there is always the underlying hope that maybe, just maybe, it will actually happen.

The “What Ifs” are Hard to Carry

First of all I want to thank you all for your comments on my last few blog posts. I have not made time, nor have I had the energy to respond. I feel like I’m just going through the motions with a lot of things in life right now, and I’m ok with that.

Now onto the point of this post. Last Tuesday I met with my MFM to go over his thoughts on what the heck happened. He is a fabulous doctor, and he answered about 98% of my questions without me having to ask them. I wonder if that’s because he’s extra awesome or if that’s pretty standard for most people. Of course we don’t really know what happened. However, his best guess is that something was wrong with the placenta given that the placenta was on the smaller side and I had growth restriction in my pregnancy with A. But even with him saying that, he reiterated that we don’t know if Colton was growth restricted based on his weight (2lb 1oz, which was on the lower side of normal for gestational age) since we did not have a growth scan scheduled until 30 weeks.

There were no signs of infection, no blood clotting issues, no maternal fetal hemorrhage, or signs of a cord accident (there was a loose nuchal cord noted when I delivered him but this is very unlikely to be the cause of his death according to my MFM). I honestly wish there was a concrete answer, even if it was that my uterus sucks, because that would make it a whole lot easier.

Then we moved into the (scary) realm of trying again. If this is our decision, we should wait at least six months from the delivery, which puts us at late August. Getting pregnant too quickly increases the risk for growth restriction and pre-term labor, both of which I’m at risk for in general with my unicornuate uterus. Then we talked about what kind of monitoring I would need, and he basically said he wanted to meet with me early in my next pregnancy to come up with a plan I’m comfortable with. He offered to manage my entire pregnancy if I want, or we can co-manage with my OB, or I can just be managed by my OB (HA, yeah right!!). His recommendation is a growth scan around 23-26 weeks at least, and if I feel I need more frequent monitoring then he is happy to do it. He also said he would be happy to meet up and talk again before I am actually pregnant to go over any other questions I may have.

I asked the ever so important question of what is our risk of having another stillbirth, and both my husband and I were pretty shocked by the answer. He did the statistics in his head based on his knowledge of studies and experience and came up with 5-10%, but likely closer to 5%. His reasoning is that I will be monitored much more closely in any future pregnancy. That does not necessarily mean that I will have a term baby, but a 95% chance to deliver a live baby (meaning it’s possible that I may be induced early and have a premature baby). We both were surprised that the recurrent stillbirth prediction is so low (not 1% low like most people who have an “unexplained” stillbirth, but still low). He also calculated that my risk is about 50% to have another growth restricted pregnancy. This is way lower than my husband and I would have thought. Another related thing I wanted to know is how many times he’s seen someone have two stillbirths in a row and he said once, and both of this person’s babies had genetic defects as the reason for stillbirth.

Overall, this makes me reassured that if we do decide to try again, I will be monitored much more closely than with both Colton and A.

Something I asked him is if he thinks I’m crazy for wanting to try again. He said based on my risk factors and his analysis, he does not think it’s crazy at all for me to try for another pregnancy. I just have to make sure I can cope with the worst happening again.

My last questions was about using lovenox in a subsequent pregnancy. He does not think it’ll do anything (and he also does not think the aspirin does anything) but if I want to try it and can’t find someone to prescribe it, he would be happy to prescribe it for me. My husband does not want me to use this medicine and says it’s a deal breaker for trying again. I would like to try it if we do try again so I’ll have to figure out if I can convince him to let me do it.

I just wanted to add that my D&C showed that I had an infection in my uterus (endometritis) and no retained placenta was noted. The mass my OB saw could be a small fibroid (which has never been noted on any ultrasound or other test I’ve had so I’m guessing it’s a recent growth). We will follow up on this later, especially if I have long periods or bleeding and cramping in between periods. I finished a 5 day course of doxycycline and I am taking a 2 week course of Augmentin to hopefully get rid of it. My MFM says that endometritis is something the pathologist writes when they don’t have anything else to put down so it’s possible I’m taking the antibiotics for nothing. Awesome…

I don’t think I’ve actually written much about the events surrounding us finding out that Colton died, but I only noticed reduced fetal movement about 2 days before he died, and I have major regrets that I did not go in on Friday night after noticing the reduced movement. I was super concerned that night and I will always wonder if I would have gotten checked out if he would be here today. I am well aware that a 28 week delivery would likely have had some bad outcomes (including him dying anyway) but it’s hard to not wonder if he would be coming home soon (since this past Saturday I would have been 37 weeks). Both my OB, MFM and husband all say to not beat myself up over this, and I’m not, but the what ifs are hard to carry. I’ll leave it at that.

Ask Me How I’m Doing

I went back to work last Monday. It was initially really hard walking in and getting the hugs and condolences, and then it was just normal. Normal is so nice, and I have been wanting to feel some sense of normalcy since Colton died. One of the doctors shared with me that she also suffered a stillbirth. She said no one at our workplace knows and she only shares when it happens to someone she knows. In some ways I think it would be easier to have no one know. But since they do know, I think it’s appropriate to ask me how I’m doing. It allows me to open up if I’m feeling up for it, and it shows that people care. Another doctor did this, saying welcome back and asking how I was both physically and emotionally (physically almost normal and emotionally is day by day in case you were curious). I was really grateful that he did this, as I wouldn’t have expected it from him.

In my personal life, only a few people have been asking me how I’m doing. To be fair, I sent an email when Colton died saying I needed time before discussing it, so maybe I need to open up. But it makes it so much easier if my friends and family would just ask me how I’m doing. It’s hard to bring it up but I want to talk about it. My sister in law sent an email saying she didn’t know how to act and asking how she should act. I told her I wanted her to ask me about him and still be in touch with pictures of her kids. She has been texting pictures of her kids like we normally do, but then this past weekend when she visited, she said nothing about Colton. I even tried to bring up the delivery in a conversation and she just changed the subject. It’s so frustrating.

I have a couple of friends who have been texting and calling frequently and I am so eternally grateful for their support. It’s eye opening when you suffer loss to see who really cares. I’m not surprised by who has been in touch, but there are a couple of people I would have expected to be more present that have been missing. That’s life I guess.

In other news, at my follow up doctor’s appointment I still had the retained placenta. My OB was able to get me in really quickly for a D&C, which I had yesterday. It’s really hard to feel done with the physical part of birth when you’re still bleeding and cramping everyday. I was so incredibly scared to have this procedure done that I insisted it be done in the OR where I could sleep through it. Luckily this was accommodated. The OB who did it was fabulous and I even continued to advocate for myself by asking that the resident did not perform the procedure. After everything I’ve been through, if this procedure screwed up my uterus I certainly want to know that it was messed up by someone very experienced and not someone still learning. What a weird thought to have, right?!

I was so relieved to have the procedure over and done with yesterday that I was in a fabulous mood (after I napped for 3 hours). I had to have general anesthesia and a breathing tube due to heartburn, which was not something I wanted but it went fine so I’m just going to be thankful there were no problems. I am also so thankful that I didn’t lose my uterus. Being in the medical field, I just know way too much and I was so freaked out this would happen even though the risk is incredibly low. I certainly hope there is no scar tissue either.

Today I have no cramping and just light pink spotting. It’s glorious! I feel normal and it’s just so incredible to have my body be getting back to normal. Now I have to lose the last 10lbs of baby weight, but I can at least squeeze into a good chunk of my pre-pregnancy clothes. I’ve been running, walking and doing exercise videos with my husband to slowly get back into shape. It makes me feel so good. My husband and I both have noticed how we are in such better moods when we exercise. The mind-body connection is incredible.

Not a day goes by where I don’t think of Colton but I am no longer crying everyday. I do randomly have tears well up in my eyes and I also cry sometimes, but it’s much less frequent. I know that grief ebbs and flows and I’m pretty sure hitting all the milestones like the due date and birthday will be hard for me, along with lots of other random things. This is a part of me finding my new normal. It sucks that I have to do this, and I hate that I have to do this. Life is just so unfair.

Next week I meet with maternal-fetal medicine to go over the results of the stillbirth and figure out where to go from here. I already know there is no obvious reason for his death based on all the tests that were performed. However, I’ve crafted a list of questions to ask and I’m hoping to get something new out of our conversation.

Saline sonogram 2.0

I had my saline sonogram yesterday on CD10. I found my last one in 2015 to be quite crampy and uncomfortable. It was (and still is) my most uncomfortable experience with fertility procedures. This time I took 300mg Motrin 1 hour before and what a difference! Although maybe it was the doctor’s technique that was better but I literally had no pain (although I was bracing myself for pain the entire time). (Edited to add that I apparently took 800mg of Motrin before my last procedure so it must have been my new doctor’s technique). It took less than 10 minutes.

Fortunately there is nothing in my uterus that shouldn’t be there. He also reiterated that if we didn’t know about my UU, he would never be able to tell based on ultrasound that I had one. Oddly enough I almost wished for a polyp so I could undergo another hysteroscopy. One of my theories is that baby A stuck around because of the hysteroscopy creating an area for her to burrow in deep, sort of like an endometrial scratch. Alas I will never know if that was the magic needed but it’s certainly possible.

I still have the same cyst on my left ovary so I hope it stays for several months so I can ovulate from my connected right ovary for awhile, hopefully increasing my chances to be pregnant for the 3rd time in a year…sigh. When we were on our journey toward baby A I had a cyst on my left ovary for a long time, around 6 months. Maybe that is a more cyst-y ovary, if that is even a thing.

I am so unsure that I will ever carry another pregnancy to term. While I now know my body is capable of doing it, I certainly have pretty terrible odds with pregnancy outcomes. What a weird and lonely journey to be on. Never in a million years would I have expected to have recurrent pregnancy loss. I didn’t even know this was a thing until after I had my first miscarriage. Oh to be blissfully ignorant again.

Kidney ultrasound

This is just a quick update mainly geared toward anyone who may have a unicornuate uterus who reads or finds my blog.

People with mulliarian anomalies are more likely to have kidney problems or be missing a kidney. Back in December 2015 I had an MRI to evaluate my uterus and make sure I didn’t have a communicating or functioning rudimentary horn (which I don’t, I literally only have the right side of my uterus). That test also showed that I have 2 kidneys but it couldn’t evaluate whether or not they are fully functional. My MFM told me I should have the kidney ultrasound done once I was no longer pregnant, which I promptly forgot about until I was reviewing all of my medical records prior to my appointment with the new RE. I asked him if he could order the test for me and he obliged.

Yesterday I had the ultrasound. I had to drink 24 oz of water 1 hour prior to the test and then hold it. The ultrasound tech was really nice and chatty. She scanned my right kidney first with no problems. She then did the left kidney and she had a harder time, even saying that the left kidney likes to hide. Of course I thought that meant something was wrong with it (since that is my “bad” side/on the side that is missing the uterus). Then she scanned my full bladder, had me pee, and then scanned my empty bladder. It went from looking like a huge rectangle to a tiny slit, starting with 500ml of water and ending up with 5ml. At least I know I can urinate well!

I was told I would get the results in 2 days. Well I was pleasantly surprised when 2 hours later my RE emailed to tell me everything looks normal. That is a huge relief!

So I wonder if my anatomy is not normally positioned on the left which is why she had trouble with the left side. Who knows!

Meeting with the new RE

We had our meeting with our new RE this week, Dr. H2. Overall it went well, I liked him a lot. Kind, easy to talk with, organized and no bullshit. He had all my results and his recommendations typed up when we got into his office, and he reviewed everything with us from that sheet (and I got a copy of it)!

My FSH is up to 15.3 (from 13ish in Sept. 2015). So worse, but not by much. My AMH, however, is still 1.2 (I was 1.24 in Sept. 2015) so that is encouraging. Honestly I’m surprised (and thankful) it hasn’t changed more. All of my other labs are normal, and the clotting lab I was concerned about is not even elevated according to Dr. H2 so that’s good news. He did an ultrasound and my AFC is 8ish on CD 6 with 4 follicles one each side (and a huge cyst leftover from last month). So that hasn’t really changed either. He also said I can do a saline sonogram in my next cycle so I will be scheduling that in the near future.

As for his opinion on my most recent miscarriage, he thinks it was likely due to the fact that a unicornuate uterus has areas of poor blood flow. While one treatment for RPL is IVF with PGS, he does not recommend this in my case since they cannot control where that embryo will implant and I do make normal embryos so it likely won’t help. (It makes me think back to how we were gong to do IVF and then I got pregnant and it worked out. I wonder how that would have ended up.) He suggests baby aspirin and progesterone, both of which I’m already doing. I also asked if he thinks more of my miscarriages were normal embryos and he said most likely yes.

I don’t know why but I feel strangely validated by that bit of information. If I had to wager a guess, I would think that 4/6 of my pregnancies were actually normal, although I can only prove 2 (my live birth and my most recent miscarriage). I mean who really knows but finding out that the last one was normal really makes me question the poor eggs theory (although I still believe my egg quality is lower for my age given my AFC and FSH). He is also the first RE who said this to me. Everyone else said it was more likely my eggs (although I don’t blame them bc no one else had the chromosomally normal miscarriage as evidence). I guess I would have liked to hear this sooner but there was no way for that to happen.

Armed with this new information, I am really beginning to believe that it is a miracle that I have my beautiful, spunky, fabulous toddler and I feel even more lucky to have her.

As for now, the plan is to keep trying and hope the next embryo is normal AND implants in the right spot. But who knows if lightening will strike twice!

The next steps

Just a quick update to say I finally got my referral to the new RE and they had a cancelation so I’ll be meeting him next week. Most of the RPL labs I did last time were ordered and to my knowledge they look normal. Except for my beta 2 glycoprotein 1 came back positive. I did not have this drawn last time and from my research this can cause blood clotting during pregnancy contributing to miscarriages. Apparently to be considered an issue the test needs to be positive twice with 3 months in between tests. So it’ll be interesting to see what he has to say about that. I also asked for my FSH, E2, LH and AMH to be run for comparison.

Honestly I am mostly interested in a thorough uterine cavity evaluation looking for polyps or anything else that could cause issues. But if anything else can help us that would be great too!

I ovulated on CD 13 this month, which is unheard of for me. My earliest ovulation date is CD 17. Now I’m wondering if this in a one-off or if it’s an indication of my declining fertility. I guess only time will tell.

I have basically cut out all refined carbohydrates, sugar and alcohol. And I’m about to wean off the caffeine too! It’s been easier than I thought it would be so I’ll be keeping it up for as long as I can. I figure it can’t hurt, right?!

Emotionally I’m doing well. It took a little time but I have been going about my life and have been feeling pretty happy, all things considered. I hope we will be able to have another baby but if that is not in the cards, I think I’ll be ok. My husband said to me recently if I wanted to stop trying he is ok with that, even though he does want another child. It really helped to hear that. So we shall see.

Hope everyone else is doing well.

A Cause for the IUGR

I had my 6 week postpartum appointment yesterday. Baby A came with me and screamed a lot. I ended up breastfeeding her while walking into the appointment room and during my pelvic exam…surreal. Everything looks good on my end!

We discussed several things throughout the appointment. 

•I expressed to her that I do not wish to be on birth control. Firstly, I am not convinced that it didn’t contribute to our difficulties TTC. Secondly, we plan to try again (although I cannot imagine that right now…more on that in another post). Lastly, I have switched to all natural products and I am not interested in introducing hormones into my body at this point. 

•She said that since I had an uncomplicated vaginal delivery we could try again as early as 6 months (I think that’s crazy).

•When my cycle returns and is regular, she can order a follow up FSH, AMH, and E2 so I don’t have to go back to my HMO fertility clinic right away. I am relieved about that (even though I had a pretty great experience with our RE). I’m wondering how those numbers will have changed a year or so after having them drawn. I also hope it will give us an idea of what to expect. 

•And now the main point of this post. The results of my placental pathology. It was small (as we already knew from looking at it after delivery). This could have been due to the UU (meaning the smaller size of my uterus) or uteroplacental insufficiency. The placenta showed signs of chronic uteroplacental insufficiency. Basically this means that the blood flow from my uterus to the placenta was insufficient for a good chunk of the pregnancy. Thus the IUGR diagnosis. I have lots of thoughts about this. 

Firstly, the baby was in the 38th percentile at the 20 week anatomy scan. That is normal. Then, right before 30 weeks at our growth scan, she was less than 3rd percentile. So things went wrong somewhere between 20-30 weeks. I stopped taking the baby aspirin at 28 weeks (which I was taking to hypothetically increase blood flow to my uterus…who knows if it helped. I feel it did help). I don’t think that would have affected growth that drastically in 2 weeks but I can’t help but wonder if I had stayed on it (or restarted it) if her growth would have been less restricted. 

Secondly, I wonder if the less than ideal blood flow had anything to do with my 3 miscarriages. I did not take aspirin until before the 4th pregnancy (which actually worked). I do have signs of poor egg quality with high FSH and boarderline AMH. All the miscarriages were missed, with no growth each time past 6-6.5 weeks. Could that have been due to poor blood flow and not egg quality? My gut says its egg quality. I guess we will never know but I wish we could. Too bad we were unable to test the embryos that miscarried.  

Thirdly, I wonder if the pregnancy being successful is because the embryo implanted in an area of the uterus that had better blood flow and the majority of my uterus has poorer blood flow. Those with a unicornuate uterus can have poor blood flow due to the abnormal formation of the uterus. Am I doomed to have tons of miscarriages? That remains to be seen.

Lastly, I wonder if I am lucky enough to get pregnant for a second time (and not miscarry) if this will happen again. And if not, how much more will my uterus grow? Can I make a bigger baby in my half uterus? It obviously stretched a ton this time but not like a normal sized uterus did. 

I made my OB cookies and wrote her a thank you note because she was so incredibly kind and supportive throughout the entire pregnancy. I know I was a high needs patient (for good reasons I think) and I wanted to let her know how thankful I am for her care. I ended the card saying “I am so thankful for my beautiful baby”, and I teared up as I wrote that. The gratitude I feel toward having her is immense and I don’t think I could put it into words. 

I am a Unicorn

I had an HSG right after my SIS at the beginning of November. It was “optional” per my RE, as he felt the SIS had showed us the probable polyp and we were already going to remove it at the hysteroscopy. Of course, I am a glutton for all the information I can get regarding my fertility, so I went ahead with the procedure.

It was done by a nurse practitioner. She prepped me for the procedure, the radiologist joined us, and we got started. The x-ray machine was turned on and they injected the contrast.

Side note: the procedure didn’t hurt at all, and I like to think that as a nurse, she was more gentle than my doctor (I am a nurse also). She inflated the catheter balloon very slowly, as that was the worst part of my SIS, and it did the trick. So I’d recommend that you ask whoever does these two procedures inflate the catheter balloon slowly and it may help with some of the cramping and pain associated with these procedures.

They had a hard time visualizing my full uterus so I turned from side to side and did everything I could to help them get a full picture. Then the NP said it…

“I think it’s unicornuate“. 

The first words out of my mouth were “Oh shit, that’s not fixable”. She said she’d talk with my RE as soon as she got back to the clinic, and I received an email later that night from Dr. N saying he agrees with the NP and he’d be able to tell more at the hysteroscopy.

For those of you that don’t know, a unicornuate uterus (UU for short) is a type of Mullerian anomaly (mis-formed uterus). Basically, I only have half a uterus that is connected to 1 Fallopian tube and 1 ovary. Something went wrong and the other half of my uterus did not form as I was developing. It happens very early on in embryo development. Apparently, it’s the most rare of all the uterine anomalies, occurring in 1/4000 women. Women with this anomaly have poorer pregnancy outcomes according to my research.

My RE confirmed that it’s a right UU at the hysteroscopy, and the tissue they removed did not show a polyp (although it showed some “necrotic” tissue, which he is unsure about and wonders if it’s left over from the last miscarriage). At our follow up he said this is no reason I can’t get pregnant and carry a baby to term. He still believes that the miscarriages are due to my egg quality and not my uterus. So apparently if we catch a good egg, then things should be good. However, now I only have a chance to get pregnant naturally if I ovulate from my right ovary, as the right side is actually connected to my uterus.

There are a whole host of other issues that come with a UU. The most notable for TTC are pre-term labor and IUGR because the baby runs out of room to grow since the uterus is not a normal size. So in the exciting event I can catch a healthy egg, I will have lots of other high risk pregnancy fun to deal with. And of course there are no guarantees that my uterus isn’t to blame for the miscarriages due to poor blood flow or something along those lines. Also, those with a UU also have a 50% chance of only having 1 kidney. I had an MRI that confirmed the UU and that I have 2 ovaries, 2 kidneys, and no rudimentary horn (meaning the remnants of the left side forming were not visible).

So what’s the plan? For now, my husband and I are continuing to try naturally since I have been getting pregnant. My RE suggested IVF with a single embryo transfer (as with my half uterus, the risks with multiples are very real and much more pronounced). I have a second opinion and two other IVF seminars in my area next month so I can pick a place for IVF that I am comfortable cycling with. IVF is completely out of pocket wherever we go, so I want to make sure the clinic is reasonably priced and puts its patients individual situations first.

Our first IVF consult was with Kai.ser and while I loved Dr. H, I am not wild about doing it there because they cycle their patients at the same time and only use 3 protocols. I’m worried with my DOR that I may need a more individualized approach and I am scared to go on birth control for the 2.5-3 months before the stims start. I took it just now for 6 weeks prior to my polyp removal and my ovulation this month is super delayed. I’m scared it’ll cause me to be a poor responder. Dr. H also confirmed that he believes my miscarriages are due to my egg quality, and he thinks I can have a successful pregnancy with the UU.

I am glad to have more answers as to why things are not going my way, as I believe more information will help us achieve our goal to have children. I was saying to a friend that I can make peace with donor eggs, surrogacy, or adoption, but I cannot imagine a life without children, so I’m on this roller coaster for the long hall. We are not done trying with my eggs or uterus yet.

Happy 2016 everyone. I hope we can all realize our dreams this year. Let me leave you with a sign I found. I am learning to embrace everything about my body, and since I now know about my UU, I have to learn to love it. 

A Diagnosis? Sort-of…

As I write this, I am two tests away from a complete RPL work-up (according to my RE Dr. N). This is what I’ve had done (please note that my lab values normals are according to the Kaiser Lab and my RE). I have loosely grouped the tests below based in my understanding of them.

Genetic:
Chromosomal analysis on myself (normal)
Cystic fibrosis carrier (negative)
Chromosomal analysis on my husband (normal)

Clotting issues:
Lupus Anticoagulant (negative)
Cardiolipin Antibody (negative)
PT/APTT (13.3/30.1seconds, normal)
Factor V Leiden and prothrombin mutation (negative)
Homocysteine (5.7, normal)
Beta 2 glycoprotein IGG, IGM, IGA (all <9, normal)

Hormonal:
Testosterone (19, normal)
Hemoglobin A1C (5.1%, normal)
Fasting Glucose (83, normal)
Thyroperoxidase antibody (27, WNL)
TSH (2.11, my RE wants <2.5)
Prolactin (12, normal)
Vitamin D (25, normal)
AMH (1.24, low, want >2)
FSH (13, high, want <10)
Estradiol (<50, normal)
LH (3.6, normal)

My husband and I are taking a 10 day course of Doxycycline just in case there is an infectious component to our losses.

These are the two tests I have left to do:

Progesterone level at 7 DPO
Saline Infusion Sonohystogram (SIS) to evaluate for fibrosis and polyps

After I ovulate this month I’ll do the progesterone and I’ll be doing the SIS hopefully next month (there were no openings this month and the test apparently has to be done after your period stops but before CD 12…obnoxiously short window). Hopefully these will be normal. I will update once I have those test results.

So, what does my RE have to say about all this? Basically, he thinks the reason for my miscarriages is due to poor egg quality. Since my AMH and FSH are abnormal, my ovarian reserve is low and my egg quality is on the poor side. His exact words are: “When the [AMH] level is between 1 and 2, this shows egg quality is starting to change. It’s what we call the “gray zone”. It’s not bad, but makes it harder to conceive. Once the level drops under 1, we know that the number of quality eggs remaining are much lower. It is harder to conceive and we tend to see more miscarriages.” And “Your FSH of 13 is high (over 10), showing hormonal evidence of ovarian aging.” His recommendation is to start taking 75 mg/day of DHEA since research shows this helps improve egg quality and reduce the risk of miscarriage.

Of course I was freaking out and immediately asked him if we should proceed directly to IVF because I would really like to have a child that is genetically mine. He, however, says “Since you are still young, I think your egg quality is better than the AMH level.” I guess he thinks we should be ok with these numbers, but only time will tell.

I visited an acupuncturist recommended to me by co-workers who gave me some dietary tips, supplements, and will start my treatments next week. He does not think the DHEA is necessary at this time but did not tell me to stop it since my doctor told me to take it. He does not think my AMH is too terrible but is hoping to work to lower my FSH and my TSH. His plan is to relax me and increase blood flow to my uterus and ovaries in hopes to improve my egg quality and help with implantation.

My plan is as follows for the next 3 months (we will still continue to try naturally as I make these changes): DHEA per my RE, Co-q 10, vitamin e, vitamin c, prenatal vitamins, b-complex vitamins per the book “It Starts With The Egg”, and 81mg aspirin, diet changes, and acupuncture per my acupuncturist. I am also continuing to exercise. At the end of three months I will ask for a repeat of my AMH and CD 3 FSH/LH/estradiol to see if there are any changes. As long as they are not worse, I will probably continue on this supplement regime as we keep trying naturally. If the numbers are worse, I am going to start exploring the idea of IVF with PGS. I may also start exploring the use of medicated cycles to maybe try and ovulate more than one egg to increase our monthly chances but from what I am reading, using these types of medications is not great for people with increased FSH (since my ovaries are already working harder to ovulate each month). That’s something I will need to discuss more in depth with Dr. N after three months. If we do happen to conceive, we will see what happens and if we have another miscarriage I will strongly consider proceeding to IVF (my hubby isn’t wild about this option).

My long term plan if I cannot successfully have a baby is to do donor eggs, so at least my husband can have a biological child. I would still like to be pregnant/breastfeed if possible.

Obviously this could all change but it’s the plan for the moment.

I’m not sure how I feel about all this. I was convinced that something was wrong, but I was not expecting it to be ovarian reserve or egg quality because I am still relatively young (32 next month). Also, it really does feel like a “sort of” diagnosis since I’m getting pregnant. And I’m not wild about my TSH. I wish I could convince my doctor to treat it as I think it could only help. But it’s not my realm of expertise. I’ve done a ton of reading and it seems like there is a chance we will be able to have a baby, it will just take longer. Honestly, being well versed in medical crap is more like a curse because I can’t just listen to the doctor. I’m constantly researching and asking questions but if there is anything I’ve learned in my nursing career it’s that you have to be your own advocate in the health care world or you will never get what you want or need.

Any thoughts? Or any suggestions? Or can anyone point me in the direction of bloggers with a similar problem?