Catching Up: The Post- Depot Lupron FET

Hi!

Sorry it's been a while. Life has been absolutely nuts.

Here is how things went down for this long-awaited transfer, 7 months in the making.

Like planned, I had my last DL injection on 5/1. Per Dr. KKs protocol, I started 10mg Prednisone daily on 5/3 (21 days before CD1, or the first day of FET meds). So far, so good.

I was instructed to send in blood work two weeks later. This involved some pretty easy blood panels, like metabolic panels and CBC, but also the Kwak-Kim specific panels like NK cells and Cytokines. So, they needed to be mailed to the Rosalind Franklin University lab. To do this, I called local hospitals to see if they would do what's called a "courtesy draw" for me, where I provide the orders and the vials of blood (which KKs office mails me), they draw the blood and then they mail it for me. Dr KKs office also provides me with a FedEx clinical pak to package the vials and all I have to do is print an overnight shipping label. The phlebotomist then puts my pack o' blood with their FedEx pickup and it arrives in Chicago the next day.

My first results showed that my cytokines, which had been slightly elevated at 35 (normal is less than 30.6) were now very elevated at around 49. My NKs, which had been 4.5%, were now around 16% (anything above 15% is elevated). This led me to the great IVIG debate, which I will write about later.

From there, my Prednisone was increased to 15mg daily. Fine. Other than that, I just kept taking my Synthroid.

On 5/23, I had my baseline. They had a hard time "finding my lining" which I guess was to be expected coming off of the DL - after all, it was supposed to strip my lining and bring back a new, shinier version.

From there, I started my FET prep - this involved 2mg Estradiol three times daily, Augmentin to make sure I didn't have an infection, and Letrozole (Femara) once daily. So far, so good.

On 5/28 (CD 6 of meds), I began a daily lovenox injection (40mg) per Dr. KK for my poor uterine blood flow.

On 5/31, my husband surprised me with a puppy!! Chaos ensues :-)

On 6/2, I flew out to Chicago for a Friday 6/3 appointment at Dr. KKs office to check my uterine blood flow, run some blood levels and meet with Michell, the NP, regarding my plan going forward. I had been super anxious that whole week because I decided not to do IVIG despite having it covered by insurance, but was happy to find out that my uterine blood flow was awesome, my lining looked amazing (in fact, Michelle said it was rare that they see a lining looking this good!), and while my NKs had gone up slightly to 17%, my Cytokines were way down at around 36 I think. I was super excited!!! I was officially cleared to start Progesterone per my RE the next day.

My transfer was scheduled for the 6th day of Prednsone on Thursday 6/9. I scheduled pre/post acupuncture on transfer day and we headed to see Dr. Wang. Luckily, both embryos thawed and continued to expand! I didn't ask about grading because honestly, it wasn't going to matter. Good embryos don't always implant and crappy embryos sometimes make babies.

I was also instructed to stop lovenox 24 hours before transfer and begin it 12 hours after, and starte 200mg prometrium twice daily beginning 48 hours after transfer.

I had a really challenging TWW. My chemical in October had produced pinching sensations and cramps and slight nausea. This time, I didn't feel much of that - some twinges here and there, and some slight dizziness towards beta, but that was it. I always go beta or bust.

At 8dp5dt, I had my first beta. I was a nervous wreck all day and had them call my husband. After a delay in getting the beta (thanks, Quest), it came back at 78! I was elated....and also ridiculously anxious! Beta at 12dp5dt came back at 634 and today, at 14dp5dt came back at 1945! Holy crap!

My symptoms come and go...anything from twinges to cramping to back aching to very very slight nausea. I'm praying that on Monday, my next beta (per Dr KK, who wants betas up until you see a HB), keeps heading in the right direction!

The Game Plan

     My last Depot Lupron injection was May 1st - the last in a series of 3. You can read more about my premature foray into menopause here. While I have been on Lupron injections, I have been working with Dr. Kwak-Kim, a Reproductive Immunologist based out of Chicago, to formulate an immune protocol for my FET. My RE has been out of the country visiting family, and he is now back in action, and together we also came up with a plan. The marriage of this entire preparation is overwhelming.

Here's what we got so far:

5/1 last Depot Lupron injection

5/3 begin Prednisone as part of immune protocol to decrease cytokine level

5/17 blood work for Dr. KK - CBC, metabolic panel, TSH, NK cells and Cytokines (NK and cytokines have to be drawn and then mailed to Dr. KKs lab - a local hospital is willing to do this "courtesy draw" so long as I supply the orders, test tubes, etc - which Dr KKs office supplies me with)

5/23 Baseline u/s for FET...if all goes well I start estrace and Augmentin ( a broad-spectrum antibiotic to r/o endometrial infection)

5/28 Begin Lovenox as part of my immune protocol

5/31 Repeat the blood work panel from 5/17

6/3 Fly to Chicago to have my uterine blood flow checked. I am also due for a lining check for my RE so I plan to have them do it there...if all goes well, I'll start progesterone

6/8-6/10 ****crossing my fingers SO DAMN HARD**** that this will be a transfer of 2 blastocysts.


So many thing are different about this cycle, and these differences bring hope. Hope is a scary thing.

Our prior cycles were antagonist with equal parts Menopur and Gonal F. The only difference between them was the fact that we used estrogen priming for IVF #2. Both yielded 7 usable eggs, of which 4 and 3, respectively, fertilized. Both cycles were 3dts - our first IVF we did an eSET, and our second we transferred two.

This cycle has been a total 180...we did MDLF with estrogen priming, we used a lower total dose of stims, we used a small amount of Menopur instead of equal amounts, we added HGH, we found out that I was heterozygous for MTHFR and began treating that with Methylfolate, we visited the RI who put me on levothyroxine for my thyroid, I took prednisone during stims for my cytokines, I began self-treating cytokines with fish oil and chia seeds, we primed my uterine lining with Depot Lupron for 3 monthly injections, we are doing a FET for the first time, and we have blasts!! Something we have never had before...and, finally, I'll be on lovenox for poor uterine bloodflow and prednisone for my cytokines. If that doesn't work, we will use IVIG, which was somehow, some way, approved by my insurance (but will still be $520/infusion until we hit our OOP max).

Whew...did you keep up with all of that?

These changes excite me, but they also scare the shit out of me because nothing will guarantee that it works. I'm at a point where I feel it is impossible to be pregnant, and I am trying so.damn.hard to keep my chin up, pretend the glass is half-full, keep my eyes on the prize, see the silver lining, and all sorts of other cliché things that people say when you want to crawl in a hole and die over how shitty your life is going.

Time will tell, and for once in this whole shitty journey, I'm really hoping that it is finally MY time.



A Punch in the Gut

      Normal, everyday life is comprised of a series of little surprises. Some good, some bad, and most are average. These mini events lead to happiness, joy, anxiety, excitement,  and anger. You name it, and you feel it over the course of a given day. In the Land of Infertility, nothing stings more than an unexpected pregnancy announcement. In fact, I wouldn't even say it stings. It's more like a punch to the gut.

Over the past few weeks I've been trying to heal from a chemical pregnancy and the overwhelming journey that 2015 has brought me on. Between therapy, my mind/body group, acupuncture and mediation, I've really worked hard at keeping my calm during this storm. I've finally stopped feeling like a kicked dog every time I see a pregnant woman, and I've stopped rolling my eyes at them. Now, I mostly study them walking throughout the stores, conducting their pregnant business as if they are curious creatures who, by virtue of getting pregnant, have performed a magic trick for which I will never know the secret.

I have begun to accept infertility, and have learned to expect that everyone I know will end up pregnant, and will likely give birth before I do. I have a tally in my head of friends who are pregnant, those who are trying, and those who will likely try soon. It's a not a sick obsession (although I'm sure my husband would beg to differ), rather, it's a protective mechanism. If I can stay on the defensive and on top of this fertility roster in my mind, then I won't ever fall victim to the unexpected pregnancy announcement, for I know when to expect them all.

Yesterday I found myself on the losing end of that game, with a one-two punch to the gut. In a 30-second time span, I received news that my father was in the hospital and may be having a heart attack, and that a college friend of mine and his wife are expecting. The pregnancy notice came complete with a group text (to ensure that you constantly have to re-live this information with every response from the group) as well as an ultrasound photo. The worst.

The group text messages began pouring in, with everyone exchanging excitement and due dates. I was still disoriented about the news of my father and simply responded to the text with "Congrats. Please remove me from this group text." I then tried to re-focus my energy on my dad, who, while still hospitalized, did NOT have a heart attack, but is awaiting further cardiac function tests over the next day or two.

I knew my friend and his wife were going to begin trying last winter. I knew she would likely get pregnant soon. I'm guessing it took them about 9 months to get pregnant, which is better than hearing it happened immediately, but still. A group text complete with an ultrasound photo is as bad as it gets. I would love to say that I'm someone who "is happy for other people but sad for myself" but that simply isn't true. I'm not happy for them. I'm not excited for them. I don't wish them harm. I don't wish them trouble conceiving. I just am blah about the whole thing.

In an abstract way, I feel that each person who gets pregnant moves me further away from pregnancy myself. I know that is not true, and I know that another person's pregnancy has nothing to do with me, but each announcement is another reminder that everyone else is able to do something that I can't. And that sucks. Badly.

I did go on to apologize to my friend and explain the news of my father and through gritted teeth, I extended another congratulatory message. For now, I walk away from another gut punch, bruised, but okay.

An Intro

I always find intro posts on blogs to be awkward. How does one sum up everything that led them to this? What finally made you crack and realize you must share your life, of a portion of it with the blogosphere?


For me, it's the fact that everyone but me....is pregnant.


Literally everyone. Friends, acquaintances, and almost every member of the world around me.


So, pull up a seat and stay a while...this is the newest infertility blog to hit the stands.