Category Archives: TTC

Update and my mood

Hello everyone! Just wanted to say hi and that I’ve been enjoying all of your updates and commenting, but have not written one of my own due to sheer laziness. 

Baby A is 9 months and weighs in at 15lb 5oz…9th percentile. She’s so petite but super strong and has been crawling and pulling up since 7 months (she learned to crawl in Hawaii…so much for a relaxing vacation)! Now she has started to cruise and she can stand on her own for 5-10 seconds. She’s babbling a ton, says dadada but no mamama yet. We are eating tons of solids, and even starting to feed her from what we are eating. Still breastfeeding. All in all she’s so much fun!

Sleep in general has been difficult. This past weekend she took 2 1.5 hour naps in one day and that was a first! She sleeps 10-11 hours at night, and generally can put herself to sleep quickly after her bedtime routine with minimal crying. But we frequently get a wake up about 40 minutes after going to bed and she can scream and fuss for up to an hour and is incredibly difficult to console. Once we go to bed, if she wakes up we just bring her into our bed (as we are sharing a room in our 1 bedroom apartment and letting her scream doesn’t work for the neighbors or for our sleep). I just feel like the room sharing makes it really hard for her to sleep long stretches bc we disrupt her. But I’m just dealing with it bc there is no other option for now. I’m open to suggestions!

The sleep issues really get to me. I have such a hard time listening to her cry and I dread bedtime and nighttime. My back is also really sore all the time and I think it’s due to cosleeping bc I have to stay in the same position for too long. This makes me moody and cranky. I’m not exactly a pleasant person to be around and I feel like a bad parent bc my baby won’t sleep like a “good” baby. I’m also pretty lonely as it’s hard to make plans when you work almost full time and you’re obsessed with your baby’s sleep (I don’t like leaving to house bc I fear her not getting good naps and thus making nighttime worse for me than it already is). I have no clue if this classifies as mild PPD/PPA bc when I read about both of them I don’t feel I fit the description but I’m just not sure. 

So I’m looking for a weekly yoga class to get myself out of the house.  I’m hoping to meet some nice people and also help out my back pain. I’m also making a effort to go on a Mom date once a month. I did one in June and there is one in the works for July. Hopefully this will help!

Lastly I’m wondering when your periods came back. Mine is no where to be found at 9 months out. I would be ok with one baby but my husband really wants another so I’m willing to try. Since my numbers were heading toward DOR when they were tested 1.5 years ago I feel that we should try again sooner rather than later but that’s kind of hard to do when you still don’t have your period. Im guessing the night nursing is the problem but see above about sleep to guess how I feel about stoping that…….

Hoping everyone is doing well in their lives. I love reading your updates so keep ’em coming!

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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. 

This time has been different 

Trigger warning-pg post 
I don’t want to hurt anyone by posting this so if you’re not in a good space please don’t read.

Feb 11:

Take a cheap dollar store test. Verify the positive with and FRER. Obviously glad to be pregnant again but very nervous given my history. 

Feb 13-23

Beta HGC doubling every 2-3 days until my last draw. Cue freak-out. 

Feb 29

6w2d. First ultrasound. I’m convinced it’s going to be bad because the HCG didn’t double. So convinced that I tell my husband to not bother coming. So I’m SHOCKED when she shows me a beating heart (which I could make out myself). The nurse practitioner tells me once the HCG levels are greater than about 5k they only expect a rise of about 60%. Wish my doctor would have mentioned that! 

March 8

7w3d. My husband comes to this appointment. We still see a perfectly beating heart at 144, and we can hear it! Graduate to the OB. Bittersweet. 

March 17

8w5d. First OB appointment. I’m again feeling nervous because my boob soreness has gone away for the past couple of days. I’m still feeling some pulling and cramping in my uterus but I’m not very frequently nauseated. Again I am so surprised there is still a heartbeat, at 176, and baby is measuring right on track I guess symptoms really do come and go. Also, this was my first time meeting her and I am so glad I switched. 

April 1

This will be an extra heartbeat check for peace of mind. Thank goodness I asked. 

******

Honestly I’m dying to feel nauseated constantly so I can have some reassurance but it looks like my dominate pregnancy symptom is cramping in my uterus. I’ve never noticed this in my other pregnancies so it’s what gives me comfort. Obviously we are no out of the woods yet, and with my unicornuate uterus I’m at increased risk for complications. However, I’m doing a pretty good job of staying calm and just taking it day by day. 

I’m taking vaginal progesterone twice a day, which I’m suppose to take until 10 weeks but she said if it makes me more comfortable I can stay on it through the first trimester. I’m also taking baby aspirin daily, a prenatal and extra folic acid. She’s going to ask the maternal fetal medicine doctor about if I can stay on the aspirin and also what extra monitoring I may need with the UU. Once I hear what the MFM has to say, then I’ll make my case for extra monitoring of my cervix. I’m also doing acupuncture twice a week throughout the first trimester. It’s been incredibly calming.

Hubby thinks it’s a girl. I do as well. I hope we get to find out. 

Due date is Oct 22, 2016.

IVF is on my mind…

While I have been reading and keeping up with everyone’s blogs, I have been un-interested in writing about myself. There was nothing interesting to report. That has changed in that we have some progress after all of my second opinions. The writings below explore the opinions of the four doctors I have consulted with. Three of them are IVF doctors, and one is my RE. My RE is Dr. N, and the IVF doctors are Dr. H (#1), Dr. Z (#2), and Dr. ML (#3). I’m sure this post will get confusing, sorry!

Unicornuate Uterus

All four reproductive doctors concur that my uterus is not a likely cause of my miscarriages, although one of the four does think it could be a factor. I’m going to consider that good news, although I’m not fully convinced that it’s not part of the problem

IVF

My RE, Dr. N, is very pro-IVF for us due to my UU, as he felt doing a single embryo transfer was very important and I should not risk the chance of having twins naturally.

Our first IVF doctor, Dr. H (through Kai.ser), feels very strongly that doing IVF will be beneficial to us in that we can genetically test the embryos. His thought is that we would probably only get one genetically normal embryo based on my AFC and FSH (although we do run the risk of getting no normal embryos). His suggestion is the microdose Lupron flair protocol. I really liked his bedside manner, but I have huge problems with going on birth control for 2 months prior to cycling. I am very concerned about over-suppressing myself due to my borderline DOR. Kai.ser is an IVF machine that batches their patients and has great SART ratings, but I don’t think this approach is for me.

Dr. Z runs a private fertility clinic that only does IVF. He is a one man show. His big thing is that he also does immunology (something I am interested in because of my recurrent miscarriages). They are the most expensive option out of the three clinics, but I did have him run tests for my natural killer cells and my TH1:TH2 ratio (cytokines). After $800 for 4 vials of blood, my cytokine ratio was elevated but my NK cells were normal as far as I can tell. I do not understand what that means, even after consulting Google and reading some medical literature (I am able to wade pretty well through medical journals because my first undergraduate major was Chemistry…what was I thinking there, but that’s another story). If anyone has any insight into cytokines and recurrent miscarriage, please enlighten me. I am comfortable with his recommendations based on my results to have an intralipid infusion before my FET, and then do two more intralipid infusions upon confirmation of a positive pregnancy test. So what is my reservation with his clinic? I feel like they are just out there to make as much money as possible. The do a ton of unnecessary genetic testing that really adds to the cost (the overkill on the genetic testing is just my opinion). I realize that IVF is a business but I really didn’t like the feeling I got working with his clinic. I did like his protocol recommendation of a natural start IVF cycle (no BCP). I could see myself going back there someday if our plan doesn’t work out.

My final consult was with Dr. ML, who works in a large research hospital in SF (if you’re in the area, I’m sure you can figure out where this was, haha). I immediately loved her bedside manner and how well she knew my case. She does not quite agree with Kaiser’s diagnosis of DOR just yet, especially since I am still getting pregnant. Her suggestion was actually to keep trying naturally and if I miscarry again, have the embryo genetically tested so we can get an idea of why I’m miscarrying. However, she said if my husband and I wish to go forward with IVF, she would do an estrogen priming protocol, where I wear estrogen patches during my TWW prior to the IVF stims starting. And no BCP!

So what the heck are we doing with all this information? We’ve decided to keep trying naturally for the next couple of months and hope that we can just get pregnant on our own and it’ll work out for us. Lucky for me I have a lovely cyst on the left ovary (the side that is NOT connected to my uterus), so we are at least getting in good tries from the right side for the next couple of months. If we do get pregnant and I miscarry, we will try to get the embryo genetically tested.

We plan to start our IVF path with Dr. ML with my March cycle, with plans to actually do stims and retrieval with my April cycle. If we get a normal embryo, we will transfer it and see what happens. If there are no normal embryos, we will consider trying another cycle or possibly consider donor eggs. If I miscarry a normal embryo, then we will probably move onto surrogacy, or we may consider looking into doing some immune treatments with the Alan Beer Center, as we live close by.

I am not sure I want to keep miscarrying with no end in sight. Nor am I sure I want to do experimental treatments with no guarantees they will work (although if I’m saying that, IVF is a total experiment for us with no guarantees to give us a genetically normal embryo, so maybe I will be willing to try them). I’m not done yet, but I just don’t want to live my life from one miscarriage to the next, not knowing if it’ll ever work.

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?

An attempt at a work-up and other thoughts

I finally met with my OB/GYN about the two miscarriages. I went in armed with a list of questions and requests and left with a lot of reassurance from her that this is still within the realm of normal. She basically said she cannot order most of the tests I was requesting because it is not within her scope (it’s for the fertility specilists). And when I pushed for a referral I learned that her hands are tied. I am a member of K()aiser, and due to the joys of HMO insurance, I need to meet the criteria for a referral. That criteria is 3 miscarriages. Then I tried playing the “year of trying” card but it needs to be a year of trying without a pregnancy, and I’ve had two (failed…but that doesn’t matter in this situation).

I did manage to get her to order an ultrasound (regular) to check out if there are any abnormalities. It showed a possibility of a very small uterine polyp, which she says should not affect my chance of getting pregnant. I decided not to pursue any further investigation at this time because I’m scared to have any procedure that could cause scarring. Since I am able to get pregnant, I don’t want to mess with procedures just yet. If it starts to take a long time to conceive, then I’ll revisit the possibility of having the procedure. I’m thinking that if by the end of this year we are not pregnant I will request it.

I also looked into the possibility of an outside second opinion. However, it’s extremely expensive so I am letting it go for now. If we have a third miscarriage, my insurance covers the entire work-up and any procedures (except IVF). It is my gut feeling that something is really wrong, but for now I have to push those feelings aside. We have exhausted all of our options that we can afford right now and I have made peace with it. Honestly, I just hope we get pregnant quickly so if we are going to have a third miscarriage we can get it over with and move on to the next steps. I feel like it’s terrible to think like that but I just hate being in limbo. Obviously I’m really hoping that the third time is the charm, but I’m trying to have realistic expectations that will not crush me if it doesn’t work out.

Personally, I feel like this second miscarriage was easier than the first. I knew what to expect and I also had more realistic thoughts about the possibility of having a miscarriage. However, I’m trying to make some changes that may increase our odds next time I’m pregnant (hopefully I can get pregnant again). I read the book It Starts With The Egg upon seeing that many of the blogs I follow have done the same. I have started taking some extra supplements, have made some dietary changes, and have switched over to the most natural products I could find. Unfortunately I don’t think it’s realistic for me to do all of her suggestions but I’ve made peace with doing the best that I can.

I’m sick and tired of being sad and having my life revolve solely around trying to have a baby. I got a gym membership and have been doing personal training. It’s made me feel so empowered to take control of something (my health). It’s been 5 weeks of consistent work-outs and I feel great. My mood has been great and I’m sleeping better than I have in the past year. I am learning to let go of the things I can’t control while taking control of what I can. I am also doing pediatric ICU training at work. We just started and I am really excited to have something new at work to focus on. My hubby and I have several fun things lined up for this year like weddings, camping for our two year anniversary, and hiking half dome (side note: I am freaking out a little bit about my minor fear of heights while doing this hike. But I’m just trying to keep it in perspective and I will not be mad at myself for stopping before I reach the top if I can’t handle it).

Now we try again. Oddly enough, my CD1 is literally one day off from my June cycle last year, the one that resulted in my first miscarriage. If my cycle length is the same then I’ll be on par with last year. That will be really weird. I’m hoping its a sign! This cycle, I’m temping and using OPK’s to see if things are the same. If so, I plan on not doing any monitoring because it’s just too much pressure. My temps were a little wacky for the first 10 days of my cycle but now they seem to be more stable. No positive (or really anything) on the OPK yet. I’m wondering if I’ll even ovulate this cycle as it’s the first one after miscarriage number two.

It is what it is…

#2

Hello blog world. I’ve been MIA for a while because I found out I was pregnant again on March 24. Spoiler alert: I’m now sitting on the couch waiting for the Misoprostol to work so I can get miscarriage #2 over with and move on with my life.

We were so happy, and then I proceeded to completely ignore the fact that I was pregnant until the ultrasound. That was April 22. Almost a month of bliss (who am I kidding, it was a month of pure torture). I honestly had some nausea this time. It was especially bad at the beginning. But I hardly had sore boobs and really didn’t feel pregnant. Not that I actually know what it’s like to feel pregnant and have a successful pregnancy. But the feeling wasn’t right.

The ultrasound showed a sac but only a blip inside it. I was very sure of my dates and even if I was off, there still should have been a heartbeat. The doctor who scanned me had me draw blood that showed decreasing HCG levels but she still thought we should rescan. So that happened today. I had my regular OB this time and she said the sac measured 8 weeks but there was only a tiny blip in the sac. So no viable pregnancy (I wasn’t holding my breath for a good outcome). I’m a realist at heart.

She said for my next pregnancy (assuming that happens) we can do progesterone supplementation as a precaution. Obviously I’m going to do it but it certainly seems that isn’t the problem. If it was, I think I’d have already started bleeding, but I’m no doctor. I also asked her to do some tests because autoimmune diseases run in my family and it seems like the likelihood of something being wrong is greater after two losses and no live births. She really doesn’t think anything is wrong, and that I don’t yet meet the criteria for recurrent pregnancy loss. Hopefully she’s right.

The tests she ordered were as follows: TSH, lupus anticoagulant, anticardiolipin (apparently the same as antiphospholipid), pT and pTT. I was not on top of my game and should have pushed harder for more but I will do that later. Does anyone have any suggestions for what else I should test for?

I am so heartbroken that this happened again. I feel like my body is unable to perform its main biological function. And not only can I not stay pregnant, it takes my body forever to figure out that it’s time to miscarry. It’s so frustrating. On top of that I’m so sick of being sad. I’ve been sad since August when we experienced our first loss. Yeah, I’ve been just fine, but I certainly don’t feel happy. I think I’m going to get a gym membership once the miscarriage is done so I can get my body back into shape. I’ve been so lazy and unmotivated in the last 9 months. I’m also going to seek out some counseling, as I think it would be helpful.

I still have plenty of hope that I will be able to carry a pregnancy to term and successfully have a healthy baby that lives a long and productive life. For now, it is what it is.