Back Down to Earth

After yesterday's (what went wrong, what the fuck, what's the plan) follow-up meeting with my RE, it's safe to say that I'm retiring my astronaut helmet for a bit. I love my RE because she has a no-bullshit attitude which perfectly counters and levels out my fear and pessimism throughout this journey. Our conversation was very straight forward, and she answered all of my questions, regardless of how ridiculous they may have been.

Here's what I learned from yesterday's meeting: 

Do I need to start thinking about my comfort with donor eggs / sperm, or even adoption at this point? 

No. You're a lunatic.

My doctor explained that I am still currently in the realm of "normalcy" for failed pregnancy, in both the fertile and infertile world. While many doctors/OB's say it takes healthy couples up to a year to conceive, most RE's will contrarily tell you four months is a more realistic window for conception, pending no fertility issues. That said, I've really "just started trying", having experienced one failed 6 week pregnancy through a fresh IVF cycle, and one chemical pregnancy through a Natural FET cycle. These occurrences are just as likely to happen to those not battling infertility, with most "fertiles" completely oblivious to the fact that they may have experienced an early miscarriage or chemical pregnancy. If you really drill it down, and count each cycle as a "month of trying", this would make my current cycle my third (times a charm) try. Some women unfortunately take more than two, three or even four rounds of IVF to achieve pregnancy, and I am now one of them. My RE is confident we will achieve a healthy biological pregnancy, and has told me at this point to save my adoption plans for the future if I have a yearning to help a child in need.

Do we need to do immunology testing (i.e. Natural killer cells, elevated cytokines)?

There is no conclusive medical / scientific data to back up these practices at this time.

My RE shuddered at this question, as I'm sure she knew it was a result of one of my outrageous googling episodes. Clearly I have yet to learn my lesson (and probably never will). Very simply put, my RE explained that there is no conclusive data at this time connecting this type of immunology testing to successful outcomes in IVF. The tests are extremely expensive (pending coverage), and the results are debatable. Without getting too science-y, she explained that natural killer cells and cytokines are innate components of the immune system, which means everyone has them. While you can have a deficiency or over abundance, there is still no proof that treatment of these immune issues positively affect the outcome of IVF. Pursuing this type of testing is a personal decision, and for me, without data, it's just not something I am willing to commit to financially at this time. It is important to note that I did in fact get a BFP on my first IVF cycle, with a low and slow rising beta, that ended at six weeks...so we did get pregnant, even if only for a very short time. That said, we are moving forward with what my RE considers some more justifiable testing which includes the following:

Genetic Testing

Karyotype (for both Mr. UKU and I)

Chromosome analysis (aka Cytogenetics / Karyotype testing) can detect the presence of genetic abnormalities. The test evaluates the size, shape and number of chromosomes in a sample of cells, to determine if the right number is present and if each chromosome appears normal.

*I have previously done genetic testing through recombine, but this differs from the chromosome testing. My genetic testing identified me as a carrier of one genetic disorder (Limb-Girdle Muscular Dystrophy: Type 2I) that would only be passed down if we are both carriers. We chose not to have Mr.UKU do this test, as chances of him also being a carrier of this very rare genetic disorder are extremely low and the cost was not feasible at the time.

Thrombogenic Testing

Anticardiolipin AB IgG/IgM

Cardiolipin is a phospholipid that is one of the main components of cell membranes. It is involved in the essential cell functions necessary for proper embryo development. Elevated levels of antibodies to Cardiolipin may interfere with its ability to function normally and have been associated with vein or artery clotting, few blood platelets and fetal loss.

Thyroid Peroxidase

An enzyme normally found in the thyroid gland, plays an important role in the production of thyroid hormones. The presence of TPO antibodies in your blood suggests that the cause is an autoimmune disorder, such as Hashimoto's disease or Graves' diesease. In autoimmune disorders, your immune system makes antibodies that mistakenly attack normal tissue.

Antithyroglobulin AB

Antithyroglobulin antibodies can be found in women with infertiltiy and recurrent miscarriages. One possible effect is the release of toxins when an embryo tries to attach to the uterus (embryo implantation) resulting in miscarriage.

Lupus Anticoagulant
Lupus anticoagulant testing is used to help determine the cause of an unexplained blood clotting, or recurrent pregnancy loss. It is a specific type of antibody in the bloodstream that can cause abnormal blood clotting.

Antiphosphatidylserine AB
Positive APA relfects an increased blood clotting tendency that can cut off blood flow to the fetus. These antibodies can also cause the placenta to attach too weakly to the uterus.

Anti-Beta 2 Glycoprotein Antibodies IgG and IgM

The presence of this antibody is an independent risk-factor for thrombosis and pregnancy complications. It is a naturally occurring anticoagulant that may interact with other components involved in the blood clotting process causing abnormalities. This protein has also been shown to bind to phospholids (major component of cell membranes) making them more susceptible to attack by antibodies. Damage done by these antibodies to cells involved in fetal implantation may cause pregnancy complications.

We should receive the results back in a few weeks, but in the meantime we are pushing forward with another fresh cycle. Should the results come back proving a need for further treatment, it can include the addition of steroids and blood thinners to the protocol.

CGH Embryo Testing

Array CGH "Comparative Genomic Hybridization" Testing

Allows for the study of all 46 chromosomes via biopsy of day 3 embryo or day 5 blastocyst. Results are available in less than 24 hours after sample reception according to the facility that will be doing the testing. There's a great article to learn more about this testing here. 

Can we transfer our last remaining frozen blast during this fresh IVF cycle?

No medical or technical reason to prohibit this. Approved by lab director. 

If you've been following my story all along, you are aware that we have one, lonely little frozen blast remaining from our first fresh IVF cycle. Since we are moving forward with CGH testing on the embryos we expect to create during our current fresh cycle, we know that if we don't attempt to transfer our final remaining blast this round, it will most likely be (for lack of better words) forgotten...pushed to the back burner? I would forever wonder "what if that was the one?". I haven't heard of many IVFers transferring a frozen blast on a fresh cycle, but I don't see medically why it couldn't be done, and fortunately neither does my RE. We know we are taking another gamble, as we have no idea if this final blast is chromosomally normal, or if it will even survive the thaw, but we are willing to take the risk, as we wait for our new embryos to go through testing.

So, here's the plan:  

- Continue with Fresh IVF/ICSI Cycle "Antagonist Protocol"

- Do blood panels for genetic, thrombogenic testing

- Send samples of embryos for CGH testing on day 3 or day 5 (at embryologist discretion) 

- Prep to transfer remaining frozen blast on Day 5*

- Cryopreserve any remaining CGH tested embryos

*pending that it survives the thaw, or we don't have new CGH tested embryos to transfer in its place

Let's recap the progress:

First Fresh IVF Cycle:

Birth Control Pills

Lupron

Menopur

Follistim

Novarel (HCG Trigger)

Progesterone in Oil (PIO)

Doxycycline (Antibiotic)

Medrol

Elective Single Embryo Transfer of one 4AA Embryo

BFP (Beta 27-1000) -- Ended at 6 Weeks, followed by D&C

Natural Frozen Cycle:

Doxycycline (Antibiotic)

Medrol

Progesterone (Oral)

Elective Single Embryo Transfer of one 4AB Embryo

BFN (Beta 6) -- Chemical (Positive HPTs 5DP5DT - 7DP5DT)

Second Fresh IVF Cycle (In Progress):

Menopur

Follistim

Ganirelix

Novarel (HCG Trigger)

Progesterone in Oil (PIO)

Doxycycline (Antibiotic)

Medrol

CGH Embryo Testing / Transfer details to be determined

Overall, I am happy with my treatment and the progress we are making in further testing as we move forward in this journey. It is not common to test for everything under the sun right out of the gate when you've been diagnosed with infertility, as both testing and treatment can be expensive. I think we are taking the right steps towards receiving answers or better yet, achieving pregnancy. I would very easily give up my lucky number 17, for the number 3 if this round is a success :)