Thursday, February 12, 2015

Science, Setbacks, and Hurry Up and Wait...



UGH...

I am so amazed and encouraged by what is in store for us that I seriously can't wait for the next few weeks to go by, but wait we must...because, you know...4 years and 8 mos isn't quite long enough or something...

So in my spare time/relatively sleepless nights/time spent peeing (interstitial cystitis flare--I had to pee 38 times Tuesday...apparently I really do have it, dammit), I have read up on the endometrial receptivity array (ERA). This is the test that I will have performed on my lining hopefully here in the next 5/6/7 weeks depending on how quickly my elderly ovaries want to get up and play.

If you are an uber dork/geek like me, then here is a good start, or more reader friendly here.  Anyway, this seems pretty amazing/promising.  They will basically test for different kinds of  RNA being expressed in my endometrial cells to see if they are "in phase" or receptive to an embryo implanting. When your endometrium is in phase, it produces more of one type of RNA.  Some women, who have not had any success with healthy embryos implanting, have found out from this test that they need to tweak/personalize (I'm digging the slashes today) their protocol.  Credit this info to B.W. Donesky, MD.

Flashback to middle school health class- we base everything off a 28 day system for women.  If there is variation in the length of your cycle, the follicular side (from your period to when you ovulate) is what we blame the variation on. If a sperm does not meet an egg 2 weeks after you ovulate, you will have your period.  That part (luteal phase) is supposed to be relatively fixed.  This is what the calendar method of birth control is based on.  So basically count the days of your cycle - 14 = the day you ovulated.  Credit this info to M.E. Bullen, MD...and maybe whoever my middle school health teacher was that made this information way too humiliating to actually be useful and tainted it with getting pregnant from kissing stories and other lies...hmm...arguably it was all lies for me...

Anywho, some women's ovaries weren't necessarily paying attention to Ms. What's-her-name in middle school.  There are luteal phase defects which is controversial in fertility land because dammit, 14 days.  But according to relatively new research based off old research that inspired more research...it may actually be a thing.  Some women's uterine lining just doesn't sync up with the timing of their ovulation.  The ERA helps figure out if the endometrium is is too mature or immature to allow an embryo to implant.  It reminds me a lot of trying to find off campus housing...either the housing was ready for you to pay rent in July, or September, but never August when you actually started class... I digress...even better if not being in phase is your problem, it is modifiable.  You either start your progesterone earlier, or later.  FIXED! Pretty simple.  Usually the off track lining requires a follow up ERA  to ensure you have everything lined up correctly, so that takes more time...but totally worth it.  Repeat previous statement until belief occurs. Oh, and also credit Dr. Donesky with this information while realizing it is heavily paraphrased...actually all of this is...

So back to me...Yeah... recovery has been pretty smooth until my heavily into remission interstitial cystitis seemed to decide that now was an appropriate time to make my life a living hell.  Did I mention I had to pee 38 times Tuesday?  It honestly gets to a point that you don't even want to flush...or get off the toilet for that matter. Fortunately I was able to have a treatment yesterday, which has greatly, so far, decreased my field trips to the loo...When it rains, I pee...

Other than that, I am sailing right along, and BJ is my ever-ready, willing, and wonderful accomplice. Not to say all this waiting isn't frustrating. It totally is, but we don't have any options that don't require a wait.

I'm also fully aware that nothing is guaranteed. I could have this test and be totally in phase.  I don't think that really will be any more damning to our situation.  Yes we've possibly attempted to conceive 56 times, but honestly, that last FET, was probably the first time we had a real chance with what appeared to be a viable, healthy blastocyst.  So you could very easily argue, we've only had one real shot so far.  And just because you have a blastocyst, does not always mean they are perfect/healthy embryos.  In conclusion...


Peace, Love, and Never Forget What God and Science Can Do,

MK


Friday, February 6, 2015

Surgery #2.

I feel like a legit, infertility veteran now.  I mean half a decade, 2 surgeries, multiple treatment cycles. I think I should get another merit badge.

Anyway, I had surgery #2 yesterday and it was pretty easy.  Dr. Donesky removed some tissue from my cervical canal and uterus to help catheters pass through more easily.  Hopefully this will mean less uterine irritability after my next embryo transfer.  It also should make just having a period a little easier.  Apparently, I had a lot of tissue that was getting in the way of my internal cervical os.  I did not have any fibroids, which I was pleased with since my mother has a history of fibroids.  Dr. D told my husband that my uterus appeared healthy. Also my failing ovaries seem to have calmed my endometriosis, some.  There is some good with the bad.

In our next step we will be doing a mock cycle with an endometrial function test performed on the day that would have been my transfer day.  I have spent way too much time researching the wrong test and had myself all worked up into a frenzy about how I will never be able to carry a child.  There is an older, but still widely used E-tegrity test that tests for beta-3 integrins.  Beta-3 integrin is a protein that helps with tissue adhesion...so basically glue to hold the embryo to the wall of the uterus. Many women with mild endometriosis have little to none of this protein and so their results come back saying they need to use a surrogate.

So reading this, I was devastated.  I have mild endo, and I have been unable to conceive.  I was sure we would be told we would need a surrogate.  I have nothing to give a surrogate, so basically that means we would have to adopt.  And it would be all slapped on my face at one time.  I'm not ready. If we were ready, we would have turned in our adoption application instead of staring at it with hesitation, fear and ultimately devastation.

When Dr. Donesky came to pre-op he asked if I had any questions, and I ended up asking him about the biopsy. He told me he did not like the E-tegrity test, and that he's been able to help many women "without beta-3 integrins" conceive using donor eggs.  I don't think I'd ever been so happy about our fertility options in a long-while until I heard that.  He'll be doing a test with another acronym that's only a year old.  Miami and LA are the only places in the US that run the test. I've had too many drugs in the last 24 hours to remember what the acronym was.  Anywho, the answer will not be if I can or can't carry a pregnancy, but how many more or less days of progesterone I need to get my endometrium in the right phase.

Anyway...I'm supposed to heal for a few weeks, and hopefully we can begin the mock cycle.  I'm excited.  We've still got some time and options.  And I'm ready to use that time to take them!




Peace, love and hopefulness,
MK