Tuesday, June 30, 2015

Getting our FET ducks in a row

We are in preparations for an FET at the end of August to transfer our three remaining embryos. Full steam ahead, trying to get everything lined up.

My plan is to do everything we did that brought us Magpie. We don't know which pieces of our previous plan were causal, and these are our last three embryos, so we want to do all we can. Likely a lot of it is unnecessary but this way we can know we did all there was to do if the FET fails.

So what are the pieces so far?

Consults and more consults. We went in to see our old local RE, who will be monitoring me here before I travel to Denver. We have an appointment to see the miscarriage wizard again mid-July for all of his reproductive immunology advice and plans.

What are our ingredients for hopeful success?

Depot lupron to decrease endometriosis/improve implantation potential: I took the first of two depot lupron shots on 6/12 and feel nothing yet, although I have begun bleeding the past several days. But no hot flashes, night sweats, no depressive mood. Hopefully that will remain the case. I truly HATE depot lupron, but stage 3 endo is a real thing. And so....I can do this shot x 2 one last time.

Endometrial biopsy: Our old RE has agreed to do an endometrial scratching/biopsy about one month prior to the transfer. There is some data that the growth factors released in the healing process increase implantation rates, with some studies saying success improves by up to 50%. We did it last time, before Magpie's transfer...

Prednisone: I was on prednisone starting about two weeks prior to Magpie's transfer and through most of first trimester (I think it was that long). I'll do whatever the reproductive immunologist says on that count.

Lovenox: I was on this after transfer and throughout my pregnancy. Will see again what is recommended, but I'm sure I'll be on it. The reason was just in case of coagulation issues, since i've had so many losses. Probably unnecessary. but not harmful. and we did it last time...

Diet changes: Last time with Magpie's transfer, I cut out gluten and dairy and eggs and tomatoes. OMG. In a bid to reduce inflammation, and because some testing I had a while ago showed that I supposedly have some sensitivity to these things. So, sigh, I guess I'll do that again, at least for a while... with her I stayed on track with the restrictions through most of the first trimester. Can't imagine doing it again that long, but we'll see.

IVIG: This is the one that causes the most marital conflict (Will doesn't want to do it again). So expensive! And makes me so sick! But then again Magpie is here...so I will be doing this again, at least until (if we are lucky) we can get a solid implantation and heart beat going.

Folic Acid: I took a lot of this last time. Something like 3000 micrograms a day. I'll do whatever the reproductive immunologist says. For now am just on my regular multi, which has 800 mcg.

Multi + Vitamin D + Fish Oil: Yes, I'm taking taking them all, just like last time.

Caffeine: Will be cutting this out. Decaf products too. Sigh. Until later in first trimester. This one's a bit tough, but will do it.

Acupuncture: I did this last time because of uterine blood flow issues, but was going to skip it this time because I passed the uterine doppler test the Denver clinic does. Also because I don't know how I could possibly fit it in to my schedule. Will likely do it immediately before and after transfer though, just not the 6 weeks 2x/week insanity I did last time.

Baby Aspirin: I'll be adding this in but can't remember when.

Alcohol: Will be cutting this out too. Sigh. Last time I did so about 6 weeks in advance. Will find out if that is truly necessary or if I can wait until closer to the transfer.

I think that's about it (Thank God).

Anything else anyone's aware of that can help with implantation? Let me know!


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Sunday, June 14, 2015

Back on the depot lupron....headed toward FET

We opted to go with our remaining three frozen embryos and not do another fresh IVF cycle. Procedurally, for me this means two months of depot lupron (to reduce my endometriosis) prior to then starting estrogen, etc., to build up the lining again and going for the transfer itself. Hopefully the transfer can occur in August, but they haven't given me a calendar yet (finding the bureaucracy much more difficult to navigate than in transfers past), so I'm not certain I can arrange the time off, given my colleagues also likely taking time that month.

I talked to Schoolie on Friday about our Day 3 results. I'd already come to the conclusion that it didn't take a world class reproductive endocrinologist to tell me I'm pretty darn infertile, and that more IVF at 43 and change is not the surest pathway to more kids if we felt we needed to have them. We only did the day 3 testing in the first place at Will's request. In my mind, if we'd strongly wanted to cycle fresh again, we should have done it as soon as I weaned Magpie or, possible weaned her early to try to maximize our chances.

I also remind myself that we'd gotten to a place where we were comfortable with third party reproduction, and actually, now that Magpie is here, I'm more open to adoption than I was previously as well, although that's not an easy path either. Any of those alternative paths, however, seem a surer bet than my own eggs at 43.5, especially with a history like mine.

Schoolie confirmed. He said the numbers suggest I may still have good eggs left, but I certainly don't have many of them (only 4-5 follicles). So...well...yeah... no more fresh cycles.

Instead, I injected myself with depot lupron Friday night. How far we've come that Will can now be in another room, and I can self-inject intramuscularly in the bathroom. Sub-Q injections have never fazed me, but the IMs? Yikes. But well... doesn't faze me now. I worry about the emotional effects of the depot lupron. I've found it historically to be the hardest part of the medical infertility stuff, with me tending to crash headlong into hot flashes and dark, black mood states. Really hoping this time is somehow different, but we shall see.

So... heading forward. We shall see what happens...


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Friday, May 29, 2015

Day 3 blood work

On a lark (and at Will's request), we did Day 3 blood work after our most recent one day work up in Denver.

I got the results today, and was surprised at the levels.

E2 = 58 (slightly elevated but not monstrously so, I think)

FSH = 6.8 (seriously? I know the E2 suppresses FSH, but this number still seems shockingly good)

LH = 6.4 (after years of fertility treatments, I still don't know what this number means)

AMH = 0.4 (OK, decidedly low, but my sister's AMH was 0.19 and she's six months pregnant, so it could be much worse). Nurse said this predicts how many eggs would be retrived (versus FSH is a proxy for quality)

My antral follicle count was five total (guess that explains the low AMH).

Will had had the idea that maybe we'd do one last fresh IVF cycle (ha ha!). So in my mind, these tests were basically to confirm that at age 43.5, the fresh cycle days are over. And well, hmm...now I don't know what to think.

I wonder what Will will make of these results and whether he'd want to endure the time and expense of cycling again with a fresh IVF.

Fellow amateur fertility specialists, what do you make of these numbers?


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Monday, May 18, 2015

When the sky is falling

Yesterday there was a tragedy in my neighborhood. A two-year-old little girl was sitting with her grandmother in front of a building when some bricks came loose from the building's window ledge and fell onto them. The grandmother was injured. The little girl suffered massive head injuries and died today.

The sidewalks around this corner building were closed off on both sides yesterday and my neighborhood was filled with news vans and police cars all day. New York is such a strange place because we are all packed in so tightly, traveling, walking, living together. Many of the buildings are old. Most of them are tall. When a brick falls here, it will likely hit someone.

This tragedy hits very close to home, because, it is close to home. This girl is two, and so is my girl. We walk by that spot as a family frequently. We walked by that spot one hour prior to this event happening yesterday.

I hugged Magpie extra tight last night and sang to her in the rocking chair longer than I usually do, "You are my sunshine, my only sunshine," at her request. She seemed to sense my slightly raw mood and turned my face with her little hands to look directly into hers, "I love you, Mama."

And I think she knows that she is deeply, deeply loved in return. I just wish I could be sure she was always protected. That nothing terrible could happen. And yet, of course it can. Random, terrible things sometimes happen, a part of life that has to be accepted. You do what you can and you let the rest go. I know this, and yet, ugh.

I've spent the past day sending all of my thoughts to that mom and dad, and that grandmother, who was injured and will survive but was unable to save her granddaughter. I just can't even imagine.


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Wednesday, May 13, 2015

Two and a half

Magpie is now two and a half. Wow. How did that happen?

She is more and more a little girl, with fewer glimpses of the baby she once was. She is so definitively herself. Ardent, enthusiastic. joyful. Dare I say it? intense.

She loves to be read to. She loves to go through a review of her day with me at bedtime. "Mommy, tell me my day please?" And I walk her through her day, starting with awakening and ending in the present moment. To which she then says, "Tell me my day again?"

Her lovey is a lamb who has become a close friend now and often plays the role of baby, or the student in a ballet class (guess who else is in ballet class?), or the child who goes to school "all by herself!"(an upcoming event that Magpie is very excited about)

Slightly more controversially, Magpie wraps the lamb in a swaddle and says it is the Baby Jesus and she is Maria (her caregiver is Spanish-speaking and very observant Catholic). She also sometimes puts a towel on her head and says, "I'm the Baby Jesus!" (Will and I usually give each other a behind the scenes wide-eyed look when this happens. I think it strikes us both as almost sacrilegious, although she means it in the most innocent way). I'm not sure how this Baby Jesus role play will be received once she officially starts school next fall (I'm thinking it will need to stop), but Magpie seems drawn to it for now, and it doesn't bother me personally. As long as any God the caregiver introduces is benevolent and loving, it's fine by me.

Magpie is very chatty and speaks full sentences almost all of the time now. Many of these are directives, like "Mommy, I would like warm milk in the sapo (frog) sippy." Or "Daddy, no cut my meat. I do it myself!" My girl is often emphatic and has a very specific vision of how she wants things. We are working on developing patience and flexibility.

More and more Magpie seems like she is learning to handle her "harder" emotions, which makes me happy because she's a pretty intense kid. Last night, I was responding to a work email and Magpie wanted my attention and wasn't getting it fast enough. She started singing a tune from Daniel Tiger, "When you feel so mad that you want to roar....take a deep breath...and count to four. 1.....2.....3....4!" I very much liked her using a cognitive and behavioral skill in the moment to cope with her frustration. Go Magpie!

Magpie is usually correct in her use of English but has a few adorable mashups that I love. A few recent ones:
"Daddy, are you going on the climber?" (stepladder)
"Let's play hide and peek!" (hide and seek, although her version does involve a lot of peeking)
"I'm going to sneak Daddy!" (sneak up on)
"Tell me my born" (the story of when we first saw her and she first saw us after she was born, a significantly sanitized version)

Not a mashup but a new word last night that got a lot of air time (and made me think I must be using it a lot): "And then the Daddy came back, eventually." We will brush our teeth, eventually." 

I enjoy watching her creative language constructions to get her ideas across.

With Will and me, Magpie speaks all English, with some Spanish vocabulary thrown in: servieta (napkin), sapo (frog), basura (trash). With her caregiver E, she understands everything in Spanish and she will reply in Spanish sometimes and English sometimes. I'd like to push her to only speak Spanish with E, but it's difficult because she knows that E speaks English too. When she stayed with E and her husband while we were in Denver recently, she spoke mostly Spanish with them for the day and a half we were gone, so I know she can. I'd like to emphasize that more for her, because I know it's a use it or lose it. She's able to translate back and forth between English and Spanish and seems to really understand what words belong in which language, which surprises me a bit.

We talk a lot about feelings. Trying to identify what a character in a book is feeling and then identifying why we are making that guess, pretending to express different feelings (happy, sad, surprised, scared). I see this as hopefully building the beginnings of emotional literacy for Magpie. I work with adults who sometimes can't identify their feelings in words, can't observe the physical manifestations, thoughts, and behavioral urges associated with various emotions to figure out how they are feeling or why they act the way they do, which I think makes life much harder. I figure the more Magpie can know her own emotions and become a skilled observer in noticing those of others, the better off she will be. And it seems like she's getting it. She often points out characters now and talks about their feelings. And the other day, she looked at me and said, "Mommy, are you sad or mad?" Taking me completely by surprise. I was rushing to accomplish something in the evening and realized I had a furrowed brow. Funny to have my little girl now be able to let me know she's noticing my emotional state (and help me then to correct it in the moment!).

She is able to count to 11 in English (then skips to 40 for some reason) and to 20 in Spanish, but if she's counting objects or pictures she's only able to get to four or five before getting confused. She still seems to not know ANY colors, but she knows enough to name a color (confidently). So if you ask her to what color something is, she will (confidently) tell you a color name that isn't even close. Not sure when that will sort itself out, but I'm sure we'll get there before she reaches adulthood.

She is very independent and wants to try to dress herself, undress herself, and generally navigate her way in the world  herself. Magpie remains super active, always always always on the go. She doesn't like to sit in the stroller. Or really to walk for that matter. "I run!" she tends to say, exuberantly.And even when sitting she is often tapping her foot or playing with her fingers. I can catch her for a quick hug and then she's off again to the next thing. If only I had her energy.

She's eating most everything but the volume is not as much as I would like. Partially because she gets full fast, and partially I think because it is hard for her to sit still. So she is still a small little one, weighing I think between 24 and 25 pounds. She loves all kinds of fruits, especially berries and loves all kinds of nuts. She loves many vegetables: peas, green beans, broccoli, carrots, corn, tomatoes, avocado (I know some are technically fruits, but I'll take it). She loves beans of all kinds: pinto, edamame, black beans, lentils. She likes cheese and fish and chicken and beef. She loves tortillas. We try to offer a number of different flavors and ethnic foods (sushi, Mexican, Indian, Chinese, Thai) and she's usually game to try everything. Sometimes she spits it out, but I love that she will try. Especially when we are eating something spicy for dinner, I'll be sure to have a toned down version available if the spices are too much for her after she tries it.

Magpie starts school in the Fall and she is already very excited about it, "I will go to school by myself!" The several month long application process for New York preschools....I will just say, Oh My God. Another one that should be its own post. I feel fortunate that we can send her to be honest, but the process was outrageous (lotteries to get applications, multiple essays - and how much can you say about a kid who was 1 at the time of the applications?, interviews for Will and me, interviews for Magpie, open houses, tours, just WOW).

Magpie has become an expert at her routine. Last night we were walking Moxie and on the way back home, I reviewed with Magpie what we would do once we returned to the apartment (reviewing in advance seems to help reduce resistance when the time comes.)
Me: "What will we do when we get home?"
Magpie: "What will we do?" (Magpie has the habit of repeating your question when she's not sure of the answer).
Me: "We will put on our bathing suits!" (said in a silly way)
Magpie: "Naaah! We will put on pijamas!"
Me: "Oh, yes! pajamas. You're right! And then what will we do?"
Magpie: "We will read!"
Me: "What do we always do before we read?"
Magpie: "Brush our teeth!!"
Me: "Let's do it!"
Magpie: "Yay!"

Having tooth brushing (which used to be a big battle) now occur as a precursor to reading (a favorite activity) has basically eliminated all tooth brushing resistance. That was Will's idea, and it was a brilliant one.

I will try to do a whole post on potty training but for now I will just say we are in the midst of it. She's doing really well and proudly wears Dora and Hello Kitty underwear when we are at home. She's usually good at noticing when she has the urge to use the potty. I've learned to drop everything and help her get there because there have been a few occasions of not making it in time, which is very upsetting to her. She is mostly self-motivated about wanting to use the potty and yesterday apparently wore panties all day with E, even out of the house (I've been putting diapers on her for outside the house outings beyond just a walk for the dog around the block, but maybe I need to advance to the next step).

Overall, Magpie is doing really well. It's a joy to watch her grow and develop.


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