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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.

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?