Wednesday, July 29, 2015

Dreaded depot lupron: third time is surprisingly...different

I wanted to write a brief update on my depot lupron experience this time, in preparation for FET #3.

I have done two rounds of it this time. Previously, I have always had really intense side effects: hot flashes, hair loss, insomnia, headaches, and pretty intense blues too. It tends to feel like the bell jar is descending... just wham, despondency.

To be honest, out of years and years of infertility treatment, my experiences with depot lupron have been among the most difficult. To say I dreaded taking it again would be an understatement.

I anticipated that this time would be no different.I was so sure, that I had Dr. Schl. prescribe add-back therapy ahead of time, because previously that has ameliorated the worst of the depressive symptoms.

This time, month one went by, not much problem. Hot flashes by the end, and the searing headaches, but eh, I've been through worse (I guess there's a positive side to having had lymphoma?!)

I did the second shot, waiting for the veil of progressive doom to fall onto me....

And...well...I can't sleep, and I'm hot flashing, and my hair is thinning....but...well, mood-wise, I feel fine! And really, with my mood intact, the rest of this is no big deal. Uncomfortable and unpleasant for sure, especially in the midst of this heat wave, but seriously, it's fine.

I keep wondering - why is this time so different than my prior two experiences with depot lupron? And all I can guess is that having Magpie means I am so very happy, that plunging me into a chemically-induced menopause can't shake it.

I don't know if that's the real explanation, but I'll take it. I start estrogen in about a week...and dare I say it? This has been so doable this time.


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Friday, July 10, 2015

Toddler straight jacket

Little Magpie is a crib climber. I first learned this when she was 18 months old and I heard a crash from her crib, where I thought she was sleeping. Fortunately, she wasn't injured in that long ago fall. But I knew from that moment that she was no longer safe in the crib as things were.

I also knew that she was not the kind of child who would do well at that age in a toddler bed. My Magpie is the kind of child who would have quietly woken up and then gotten into all kinds of trouble if she were able to get out of bed.

So we had to think quickly about what to do, and we ended up deciding to introduce a sleep sack, which I hastily purchased that night. The sleep sack has now become an indispensable part of the nap and bedtime routine, and we have two different weights of sack, one for winter and one for summer. We now use the Grobag, which is a bit pricier than some of the other brands and comes from the U.K., but is really well-made and high quality. And they make a size that goes up to 36 months, that fits Magpie just fine.

It keeps Magpie warm, but it also keeps her contained. She is quite capable of toddling around in it but not able to get enough leg movement to climb, which is fantastic! We will soon hit the point where Magpie needs to be up in the night to use the potty, and I guess that is the point in which we will introduce a toddler bed. She's basically potty trained now during the day, so at some point it will be time to tackle nighttime as well.

Those of you with toddlers: when did you first introduce a toddler bed? any recommendations on how to go about it to make the transition as easy as possible?

I am aiming to get Magpie as close to age 3 as possible before introducing it but will also be mindful of not delaying her development regarding overnight toilet training.

For now, the situation works for us. We've put the sack right into the nightly routine...

Which looks something like this:
1. Dinner
2. Bath time
3. Pajamas and diaper on
4. Tooth brushing (more popular than ever before now that we use special "princess toothpaste")
5. Sack on
6. Reading in the rocking chair
7. Turn on the white noise
8. More rocking and storytelling ("Tell me about my day"!)
9. Magpie goes in the crib and mama sings (usually "Frere Jacques" and "You Are My Sunshine," at her request)

The days are long and demanding, and I am often exhausted by the end of them, but oh I will miss this stage later when she's more self-sufficient and doesn't need us so much.


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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 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, 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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