Sep 25, 2011

bike to nowhere

Rosh Hashana approaching and almost one year since the beginning of my one (shortly lived) pregnancy has me a little blue. Milestones and markers remind me of the passage of time and give me the creeping sensation of having gone nowhere. It seems like everyone else is off to somewhere in life but we've just been peddling away furiously on a stationary bike. And yet in some strange sense I am somewhere completely different from where I was last Rosh Hashana, it is just not the somewhere I imagined I would be.

Sep 19, 2011

and the seasons they go 'round and 'round...

and the painted ponies go up and down.

We returned today from our 2.5 week trip to North America to another bright, sweltering hot day here in Israel, while on the other side of the pond, slightly cooler temperatures and the first signs of fall seemed to already be upon us. It's hard to believe that it's almost Rosh Hashana, the Jewish New Year, again. Last Rosh Hashana was the cycle that I got pregnant via our 2nd IUI.

Since we received the negative beta for our 2nd FET, I've been back on birth control. The current plan is for me to discontinue BCPs on October 14 and start the stimulation for a new IVF on October 17. I will be doing the antagonist protocol again with the same dose of Gonal-F and some Luveris (LH) added in as well to help with the final maturation of the follicles. We would really like to make it to a day 5 (blastocyst) transfer this time around, so here's hoping for healthy embryos and some good looking blasts!

Y has army reserve duty during October and November (he is the physician for a combat unit- basically, he oversees a group of combat medics) and that is definitely adding some extra anxiety to our next IVF, especially as the political climate continues to heat up here in the Middle East. He should be able to take a day off for the egg retrieval without a problem, but still, his emotional support and just having him around while I cycle means a lot to me and of course I worry about him while he is away.

I don't know what it will take to get us pregnant with a healthy, sustainable pregnancy, and as usual, I which I knew how much of this marathon we've already run to get there, but I am always hoping hoping hoping we are further to the end of this journey and closer to the beginning of the next era than we think. I am very happy with our choice to switch REs and clinics, and I am hoping the new place and new year will bring us a change in luck.

Sep 6, 2011

where we are

Today I am 13dp3dt. I have only received BFNs so I am 99% confident that we are out this cycle, but since we traveled to North America at the end of last week and since it was Labor Day weekend on this side of the pond, I was only able to get a beta drawn this morning. The phlebotomist here was AMAZING...I never thought the phlebotomist in Israel was bad or anything, but this woman was "off the hook" as Y might say :)

This cycle was pretty depressing. I knew since we only had one embryo that survived thawing to transfer and since it was more fragmented than the other embryos we have transferred in the past, that our chance of success this round was probably quite low. However, for the first time since starting IVF, I actually had some pretty strong 2ww symptoms, which made me a little hopeful. The symptoms were strongest 4-5dp3dt and disappeared suddenly by 7dp3dt. In fact, when I went in for my progesterone check on 7dp3dt, my P4 was the lowest its ever been at this point of my cycle, 22, and I was told to start taking 2 supps mid-day in addition to my usual 2 in the morning and 2 before bed.

Last week we met with the new RE and we have decided that for our next fresh IVF, we will be switching clinics. He said that he would support us attempting a blastocyst transfer (my current clinic is very anti-day 5 transfer) and concentrating more on the fresh cycles. He said that he would recommend monitoring every day as we approach trigger, since based on my last fresh cycle, it seems like they missed my E2 peak and then I just sort of plateaued. He also said that he would add in LH as well so we aren't doing straight FSH, which might help with the final maturation of the eggs, and that he would stick with the antagonist protocol and probably the same dose of Gonal-F.

I raised my concerns about possible immune/implantation issues but he seems to be just as much a disbeliever in autoimmune infertility/implantation failure as my previous docs. I can't help it - being 27, essentially unexplained, with no obvious egg or embryo quality issues, 6 IUIs, and now 3 IVF transfers under my belt, 1 loss and no other positive cycles, I can't help but become increasingly paranoid that everything is great except that my body is attacking embryos.

Like the REs at my current clinic, Dr. T. said that IF and IVF failure caused by implantation problems is much more rare than IVF failure caused by embryo problems and in the absence of good measures of embryo quality and competence beyond morphology, we just have to assume that our problem lies in the embryos themselves because that is much more common. He also said that in terms of immune testing, he doesn't take much stock in it because there is such an endless array of genes that could be involved and that the actual clinical significance of the results for the tests that are currently available is very unclear. I know Y agrees with this view completely, but I still feel increasingly helpless and desperate in light of not having any satisfying answers for either our infertility or our treatment failures.

As far as Dr. T's general view on pursuing further testing, he says that medicine is currently much better at treating infertility than understanding it. I know that this is how many REs (and physicians in general) think about things but as a scientist, I just have a lot of difficulty with this mentality. He did say he would put in a request for a thrombophilia/clotting panel, but that it may not get approved because he doesn't think my history really warrants the testing.

I know some doctors in Israel who will throw Clexane (Lovenox) and prednisone at almost everyone who walks in the door, especially with previous IVF failures, (I think these types are even more common America), and I sort of want a doctor like this, but I know Y would disagree and says that it is irresponsible medicine to prescribe medications with serious side effects with no strong clinical indication other than "Why not? It might work!".

I would counter this argument by asking which is the worst of 2 evils - potentially unnecessarily subjecting a woman to mega-doses of hormones again and again because she keeps failing and you are unwilling to be more bold in her treatment or throwing in the kitchen sink and prescribing her a bunch of stuff that is potentially harmful (though arguably less so than the repeat mega-doses of hormones) with no clear indication for it other than it might just work and therefore eliminate the need for future IVF cycles? I have no idea - I guess only a prophet could answer this question and I suppose we see both approaches in infertility treatment all of the time. It will be the end of October/beginning of November when we begin another fresh IVF cycle. Anyhow, that is all that is new with us on the IF front. I hope that the end of summer is treating everyone well.