Wednesday, August 22, 2012

Oh you get up, you get down and you try it again

And we're off...

I had a whirlwind day of appointments today.  Since I really wasn't planning to get a lick of work done, I officially took PTO and slept in until 8 today.  That on its own made today a winner!

We then had our latest touchbase with our RE doc.  We're officially on board to do IVF#2 next cycle.  Changes this cycle:

  • Endometrial biopsy:  he discussed this at our WTF appointment last spring.  Basically, he'll go in and rough up my uterus a bit.  Create a happy landing for our embies.
  • T will freeze some swimmers.  That way he won't have to worry about "performing" on the big day.  This is MAJOR news for T, because it means he can ride his bike again!
  • I will do the microdose lupron protocol.  I'll only take birth control pills for a couple weeks (versus the whole pack), then a diluted form of the suppression drug Lupron.  Then I'll stim my heart out for a week and ideally provide the doc a few more good eggs to work with.  We're hoping for two awesome embryos and ideally a few to spare as snobabies.  
The microdose lupron (MDL) protocol ends up being a little shorter than the other I did in the spring.  I should start my birth control pills mid-September, and then, if all goes well, my transfer will be done by October 15th.  We'll know by Halloween if we punched the lucky ticket this time.

I'm a little sad, because we're going to have to cancel a trip to Omaha to see Beach House in concert in mid-October.  But we decided to go to Minneapolis for a baseball game in September instead as a last little getaway before the whole process starts.

I then spent a nice hour with my therapist who has promised to keep me sane through this whole process.

Then...on to acupuncture!  I'm not sure what I was expecting, but ultimately it was pretty anti-climatic.  She stuck some needles in me and I laid back to listen to my newly created "acu" playlist.  Twenty-ish minutes later, we were done.  I did feel awfully relaxed on my drive home, but it could be because I got to take a nap in the late afternoon.  And no one would argue with that being a treat.  I do this through the retrieval.  On retrieval day, I go the night before, then I go the  morning of the transfer.  Another round right after transfer, then I'm on my merry way to get some embies sticking to me and don't come back for a couple weeks.

Ultimately, my goal is to feel no regrets if this round doesn't work.  No thinking I should have done acupuncture.  I should have limited my extracurricular activities/stressors (I quit my part-time job and backed off some volunteer work).  Nope - I'm just DOING it and will know that I gave this all I have.

My one major upset thus far is learning that I can't work out.  This wasn't an issue last time, because, well, I simply wasn't working out.  But I was motivated and raring to work up to a 3-4 mile standard by the time retrieval occurred.  I figured then I could keep up that pace if I did indeed get pregnant.

However, turns out that cardio and IVF do not get along.  Several studies have shown that someone who works out 3-4 times per week has a 50% less chance of success.  Somehow the activity changes your hormones or something like that.  This is even true if you've been working out regularly for up to 10 years!!  So my lazy ass gets to do light walking and eat full-fat ice cream (also recommended!) to prepare for this last cycle.  If you see me a couple months from now, and I look like I packed on a few, please don't assume that it is because I'm pregnant.  It very well could be Ben & Jerry's Phish Food finding a permanent home in my belly.

Thursday, August 16, 2012

We can only look forward

(Warning, this is another long one.  For the tl;dr folks:  we suck at making babies and are back to IVF.  Itchy feet should stay at bay.)

Great News
My visit to the allergist this morning was fabulous.  At first, I was a little unnerved by the nurse and her lack of ability to understand my concerns.  It took her about 6 tries to spell progesterone.  Then, she kept asking me when my last shot was.  "February -- I'm not allergic to the shots.  I think the shots triggered the allergy".  "So, where does the progesterone come from"  "My body"  "Because you are taking shots?"  "No, bodies produce progesterone normally.  Forget the shots." "So the shots, then?"  AARGH!!!  Enter the phenomenal doctor to save the day.  Not only has she heard of APD before, she has treated it and had successful pregnancies.  Yippee!!!  I am on daily Zyrtec and a prescription steroidal cream now (only for breakouts for the cream).  We'll see if that gets me through a natural cycle without concern.  If so, then we'll adjust the dosage as necessary for the IVF cycle.  If not, we'll experiment some more.  Her goal is to let me survive the square-in-the-ass progesterone shots for IVF.  If I can survive those, I can definitely survive pregnancy.  (So let's work on that pregnancy part!!!)  Which leads to...

Good News
We are on course for IVF #2 (aka IUI #4 = big fat bust).  I have to take off this next cycle (through mid-September) to get all the Clomid out of my system.  We meet next Wednesday with the doc to discuss the protocol for the upcoming cycle.  Ideally, it is not exactly like the last one, because it would make me fall into the four days annually that the doctors are not available due to a conference in San Diego.  Of course.  But since it seems I was oversupressed last cycle, I imagine there will be a shortening of my suppression period which will help me avoid the no doctor time.   More to come there.  Bring on the shots!!

I am also taking on acupuncture for this round.  I had my consultation a few weeks ago, and have my first "official" session this week.  This was recommended by my RE and my allergist, so I'm raring to go.  The goal is to get me nice healthy eggs and good implantation.  Ideally, we have some frozen embryos (official terminology:  snobabies) this time around.  I've heard that people have better luck with frozen transfers, as you have less drugs in your system.  Fingers crossed!!

Although, now I have on a regular schedule:  a reproductive endocrinologist, an allergist, an acupuncturist, and a therapist.  All for my body/our infertility issues.  I literally have to take PTO for almost a full day this upcoming week to see 3 out of the 4.  If this thing doesn't work, I've at least made a new set of friends.  I'll have to host a happy hour when this is all said and done.  Which leads to...

Meh News
This IVF will probably be the end of the line for us. If we are lucky enough to have snobabies, we will certainly leave no man (or baby) behind.  But if we have essentially the same result of last time, meaning a BFN and no more chances without a new cycle, then we will likely be hanging up our hats.

I have my books on adoption to prepare for that step.  I am generally okay with adoption.  I have no concerns with loving an adopted child like my own.   I will love that boy or girl more fiercely than some love their biological children.  That child will never lack for complete devotion.

I just can't shake the guilt aspect.  Again, I'm putting off a full post for another day, but I only feel guilt when I think about adoption.  In my head, I very feasibly could have placed a child for adoption if I had been pregnant in high school/early college.  I can't say that for certainty, since it didn't occur, but is very possible.  While I'm pro-choice, I don't think abortion would have ever been an option for me.  So adoption would have easily been at the top of the list, given I wasn't sure if I wanted children EVER until about mid-college.

But heart breaks every day that I don't have a son or daughter with T.  The pain that it brings to me, to T, is simply unbearable at times.  If I knew I had a child out there, I'm not sure I could survive that pain.  I DON'T KNOW THAT I CAN DO THAT TO SOMEONE ELSE.  Silly, I know.  If I don't adopt the child, someone else will.  It's not like my non-participation in the adoption world changes that.  But I am not able to currently separate that in my head, and it makes adoption a very uncomfortable place to be right now.

So that's that for now...treatment for my APD (the allergy), IVF#2 in Sep/Oct, and then a big & black unknown for us.  Thank goodness my teetotaler time hasn't kicked in yet.  This girl needs a big glass of wine.


Monday, August 13, 2012

Autoimmune Progesterone Dermatitis

I'm starting to get more answers than questions, which is something that makes me VERY happy.  I actually am able to see the allergist on Thursday after they discussed me today (versus late October, which was initially the "first appointment" they had open).  Apparently, I piqued their interest enough to get me in the door quickly.  Diagnose and treat me, please!

With my well-earned MD using Dr. Google as my tenured professor, I am about 99% certain of what I have:

Autoimmune Progesterone Dermatitis

Sounds kind of scary and awful, right?  In reality, it might not be that bad.  And something identifiable can be treated, so that's pretty great.   The allergist will need to either do a skin flap test or an antibody test to ultimately confirm my ailment, but I'm pretty positive that we'll be able to move on pretty quickly to treatment once that occurs.

Some key points from Dr. Google:

-Autoimmune progesterone dermatitis (APD) occurs as a result of an allergic reaction to a woman's own progesterone.

-APD may be caused initially by a woman taking birth control pills or another hormone supplement containing progesterone that results in sensitization to the hormone.  Like progesterone in oil shots!!!!

-APD can have a variety of different symptoms, although most, if not all, include skin rashes.  I am feeling my itchy feet and the breakouts on the rest of my body right now!

-Symptoms typically occur anywhere from 3 to 10 days prior to the onset of menses, and begin to resolve within 1 to 2 days after the onset of menstruation.  Mine have almost always started at 3 days past ovulation (about 10 days prior to my period) and clear up by my period.

And the good news:

-Treatment of APD may be successful with the use of antihistamines and oral or injected corticosteroids

And the BEST news:

-The cells responsible for this are the CD 19+5+ cells. By 10 weeks of pregnancy these cells are usually suppressed to normal numbers and the progesterone allergy is less of a problem.

One thing to note is, as with any condition, there is a wide spectrum of how the symptoms show themselves.  My itchiness seems to be at the more minor end.  Some people can go into anaphylatic shock due to their allergy and ultimately must have their ovaries removed as the only treatment.  I am VERY thankful I do not appear to be in that category and my heart goes out to the people that are.

So I'll update on here what the ultimate result and treatment was, especially for those poor folks that have been googling "progesterone allergy and pregnancy" in panic for days on end, and stumbled across this post.  It sounds like there is a light at the end of the tunnel, and hopefully this is just one more hurdle that we can conquer!

Friday, August 10, 2012

My own worst enemy

While not 100% confirmed, evidence continues to support a theory I have had for some time.

I am allergic to myself.

Awesome, right?

The story starts back to when I was blogging specifically about our IVF cycle.  As part of normal IVF protocol, you are put on progesterone support since your body is not making any on its own.  In a natural cycle, when you ovulate, the follicle evolves into something called a corpus luteum.  This corpus luteum starts producing progesterone.  The progesterone production peaks around seven days after your ovulation, then tapers off from there.  The complete reduction of the progesterone is what triggers the onset of your next period.  (Progesterone is also responsible for your increased body temperature during the second half of your cycle -- which is how I knew my period was coming when my temperature dropped).  If you become pregnant, your embryo starts producing the pregnancy hormone, and that signals the corpus luteum to keep on producing for the next several weeks to help the pregnancy.

I never had any problems, at least not that I was aware of, prior to IVF.  However, in IVF, you are not necessarily replicating the natural production of progesterone by utilizing the shots.  Rather, you are injecting very concentrated progesterone into your body, essentially hitting it all at once vs being a steady source. 

At the time of the IVF, I did have a reaction to the shots -- horribly itchy painful feet.  We assumed it wasn't the progesterone itself, but rather the medium it was delivered (sesame oil).  Switched to a vaginal solution, and the symptom did clear up quite a bit.  It didn't disappear completely until I was completely off progesterone, but I just figured it would take awhile for the sesame oil to clear out of my body.

Fast forward to the next several natural cycles....every cycle around 3-4 days past ovulation, the feet would start to itch again.  I say itch because I don't know how better to simply describe it, but it is essentially pins poking at my feet on the bottom and alongside the inside arches.  I noticed it, but it was very minor during these cycles, so pretty much ignored it.

Last cycle on Clomid, it was much worse.  I was putting gel Benadryl on my feet at night, which helped, but it further supported my theory that the progesterone was indeed causing this issue.  I studied the progesterone hormone quite a bit, and found graphs that illustrated the level in the body and different times of the cycle.  My symptoms aligned with that graph perfectly.  This first Clomid cycle, my progesterone was measured at 44 (15 is fairly normal for a medicated cycle). 

This current cycle has been horrible.  I can't sleep.  I'm crying.  I put ice packs on my feet at night to numb them, because the Benadryl doesn't do shit. .   I have to get up in the middle of night to trek to the freezer for a fresh one.    My sleep is then uncomfortable because of the numb feet and because of the weird contortionist way to sleep to ensure both feet are touching the ice pack.  My ridiculously awesome coworker suggested getting ice pack sleeves that I can actually slip onto my feet.  I'm definitely following that advice.   I figured my progesterone HAD to be higher than last time for these worse symptoms.  I asked the RE to get it measured -- if it was higher, it is only further support that this is a progesterone allergy.  If it wasn't, I'd have to reconsider the source.  It was 65. 

Anyway, my RE has referred me to an allergist.  The allergist herself was out this week, so the nurse talked to me and was pretty dumbfounded by my issue.  We're supposed to have a call on Monday to discuss further and I'm hoping that they can (1) officially diagnose me and (2) treat me.  The realization that this can occur is fairly new, but there are studies on the internet that show going a birth control is a great method to control.  Obviously that isn't the objective here. 

My biggest concern is that if you do get pregnant, your progesterone only continues to rise.  I"m worried that I will have 9 months of crying myself to sleep with ice packs.  Ultimately, if that is the case, I am up to the challenge.  I'm just really hoping that isn't the case, because if we are able to get pregnant, I do want the chance to actually enjoy the pregnancy without this staring me down from the start.  Another concern is that this is actually preventing me from getting pregnant, although research shows that miscarriage is more of a symptom then simply not implanting an embryo. 

So that's the update.   It is very feasible that the allergist and RE will agree that I simply shouldn't get pregnant.  And that will be that.  Please keep your fingers crossed that we can find another option than that.

Sorry this was so long, but I vented this story to a friend of mine last night, and needed some further venting today.  Thank you guys and gals for being my wonderful audience for my issues (or realistically, thank you Dad, T, and gals)!

Friday, August 3, 2012

I'm ready for IVF

We did our fourth (and last!!!!) IUI this morning.  I will officially let the world know that I unequivocally hate Clomid.  I hate IUI.  I hate monitoring sperm counts.  I'm not sure someone could pay me to do this again.  My body will thank me profusely when this damn Clomid is out of my system.

I'm still hoping for a miracle, as I do every other two-week increment, but I'm looking forward to our likely upcoming IVF cycle.  We'll take a month off after this cycle, and then start up again after that.  Ignoring the financial aspect, I really love IVF (relative to IUI).  There is more rigor behind it, and it appeals to my analytical side much more so than IUI.  The stages are better defined, and you can actually pinpoint where the issue may be (such as implantation).  That doesn't mean you can necessarily solve that issue, but the knowing aspect is a huge relief.   With IUI, I just feel that we throw a bunch of crap at the wall to see what sticks.

While this TTC madness is ridiculously life and relationship consuming, T and I do have an existence outside of it (although sometimes that is hard for us to believe).   We attended my stepdaughter's band concert last night, which was SO much better than the last one where we heard more squeaks than audible on-key notes.  She is an amazingly awesome and accomplished girl and I couldn't be prouder of her.  Her tween angst is starting to shine through though, so we'll have to keep a look out for that.   I only have to think back my own tween/teen years, and I then consider myself adequately forewarned.

Our August is chock full of family, friends, and fun.  We'll have multiple visitors over the next several weeks, are attending some concerts, and just are generally looking forward to some respite from the insane temperatures of the last month.  I'll be honest.  Sometimes, T and I have to consciously remind ourselves how truly good we have it.  Almost all of our friends are in the midst of baby mania of their own in some way or another, and it can be easy to dwell on the fact that we have been so unlucky in that area thus far.  In reality, our lives are so permeated with love from each other, our extended families and our awesome friends, that it sometimes seems petty to ask for even more.  But that one small thing that we desire is truly the biggest thing that would ever happen in our lives, so we'll keep on truckin'.

The most fabulous news on this Friday is that we have NO plans tonight.  We were meant to hang out with some friends, but switched it to a different weekend since we were unsure if our IUI would be today or tomorrow.  So, friends, while we love you, we are greatly looking forward to some T and C time.  Wine will be flowing, grill will be grilling, and big screen basement TV will likely be playing an awesome movie.

(On the movie note, we watched a REALLY good movie this week.  If you like creepy, but not scary, movies, and can handle foreign films, rent "The Orphanage (El Orfanato)".  It's in Spanish, and is a technically a ghost story, but is ultimately about how much a mother loves her adopted son.  I totally cried and thought it was great).

Have a phenomenal weekend!  I keep promising an adoption post, and I have one percolating in my head, but I'm not quite ready to get thoughts to paper (screen) on that one yet.  So sometime soon...

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