PGS Results

ONE.

Out of the three, only one embryo tested genetically normal.

It's a BOY!

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We did not get to choose the gender.  It has been chosen for us.  We may have been dreaming of a girl to complete our family but we know what a blessing any child is.  Now it's time to start dreaming of having two boys, brothers, lifelong friends. I am very excited to hopefully have another beautiful healthy baby boy to add to our family and I am feeling optimistic Dr. Braverman will be able to help us carry to term again.

Embryo Watch 2017: Day 6 Update

My power was out last night (no this house didn't come w a generator - but now we know we really do need one #cityfolkgonecountry) so I haven't been quick to update the blog - and I am waiting for some more information - but I just saw someone had asked for an update.  

So, drumroll, please...

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I heard from the nurse last night that I had 2 blasts on day 5 that were biopsied and the other 2 would be biopsied today. 

I asked for some more details today, like, were the other two actually biopsied today?  But, I am still waiting to hear.

I will let you know more when I know!

Xo, 

Natalie

Embryo Watch 2017: Day 3 Progress

Quick update: 

I received and email from my nurse tracking the growth of my embryos.   

3 Grade As

1 Grade B

I am happy with the progress.

If there are 3 or more blasts, we will do genetic testing on the embryos.  I will feel most comfortable moving forward with a genetically normal embryo.  So, I am praying I have one.

I will post soon weighing the pros and cons of genetic testing.   

 

XO,

Natalie

 

How We Did It for #1: Fertility Timeline and Braverman Protocol

Here, I am sharing my fertility timeline and successful Braverman Protocol used to have my son.  My very own Braverman Baby.

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I am often sharing this information with people online and now I can just send everyone here.  Hopefully, now that it's here it will help many more..

Crazy story.  There was one person online with whom I shared my protocol and working with her doctor, who prescribed it for her, she was finally able to have a successful pregnancy.  Then, her friend did the same thing and also had a successful pregnancy - twins.  She credited me with the 3 births and it really made my day.  Her daughter was born October 16th and my birthday is October 17.  The world really can be magical sometimes.

I do, however, believe it is in people's best interest to go to Dr. Braverman over using their own doctor in this way.  Dr. Braverman and his team are the experts and they are going to be able to give people the right protocol for them. But, I am still full of pride that I was able to help this woman and her friend.

I think this timeline shows that Braverman immune treatment was what I needed to have a successful pregnancy.

Also, I left out a lot of the negative things that happened at NYU.  I wrote them an 11 page complaint and am not sure if I will get into some of it on the blog ever.  But, I strongly do not recommend that fertility clinic because of my experience.

 

Fertility Time Line

  • December, 2010         Start trying to have a baby
  • August, 2011                Ovulation kits
  • December, 2011           Acupuncture
  • February, 2012            Met with Mukherjee at RMA
  • February, 2012            Hormone Tests FSH was 28.5
    • Dr. Mukherjee says that the immune system has absolutely nothing to to with having a healthy pregnancy
  • April, 2012                  IUI - #1 - 2 eggs on 150 units of gonal-f
  • May, 2012                   IUI - #2 2 eggs on 250 units of gonal-f
  • June, 2012                 We leave RMA for NYU
  • June, 2012                  Met with Dr. Licciardi at NYU - I requested to be sent for a laparoscopy
  • July, 2012                   Surgery 
    • Stage II endometriosis removed – with Dr. Martin Robbins in Maine. 
    • Great experience generally but I am now upset that he also took out my appendix during my laparoscopy. 
      • He did explain that he may do this and I did have some pain on my right side. 
        • But the right side pain never went away and I wish I did not lose part of my body.
  • July, 2012                   Met with Dr. Batzofin
    • Had some minor immune testing done. 
    • Realized I was A1298c Homozygous. 
    • He recommended IVF directly so we left to go to Scher and return to NYU because we weren't ready to do IVF.
  • February, 2013            Met with Dr. Scher
  • February, 2013            IUI #3 clomid w/ Scher immune treatment at NYU
  • March, 2013                 IUI #4 clomid w/Scher immune treatent at NYU
  • May, 2013                    IVF #1
    • Estrogen (Vivelle Dot) Prime with Ganerelix Cycle; 150 units menopur, 450 units Gonal F.  10 mgs prednisone starting from Cycle Day 5.
    • 5 eggs retrieved  
    • complete fertilization failure
    • Rescue ICSI performed 24 hours after procedure
    • 2 blasts transferred
    • BFN
  • June, 2013                  Start Acupuncture w/ Angela Le
  • July, 2013                    IVF #2  
    • Same Drugs as Number IVF#1
    • 12 eggs retrieved
    • 9 embryos became blasts 
    • We transferred the 2 best looking blasts
    • We froze the remaining 7 frozen. 
    • Ended in a miscarriage. 
    • Testing showed a genetically normal female. 
      • they did not do a maternal contamination study but the doctor was certain it was a genetically normal girl.
    • Scher autoimmune treatment. 
    • D&C performed at 7 weeks.
  • Fall 2013                      7 remaining embryos thawed and PGS tested
    • 2/7 normal 1 boy, 1 girl
  • November, 2013          Frozen embryo transfer of PGS normal female embryo at NYU. 
    • No autoimmune treatment.
    • I called it the "NYU special" because they insisted immune treatment was rubbish.
    • Positive beta but pregnancy never progressed.  
    • They hardly saw anything on the ultrasound.
    • Technically a chemical pregnancy/early miscarraige. So "less" pregnant than with Scher's immune treatment.  
      • I say "less pregnant" to make a point that my with first pregnancy I used some immune treatment and it lasted longer. 
  • Winter 2013                My NYU doctor changes his stance on immune issues.
    • My NYU doctor now says I might be one of the 2% who need immune treatment.  When I started with him, he said he didn’t believe in that treatment and that it didn’t work. 
      • When I asked about it having worked for people I know – he said - sometimes people just get pregnant.  
    • After 2 miscarriages with him our doctor said he would be happy to work with Dr. Braverman; but when the time came for him to speak with Dr. Braverman.  
    • He never called us back.
    • So, after many unreturned phone calls and wasting weeks waiting, we moved our last embryo in a nitrogen tank Dr. Braverman’s lab.
  • February 2014             Moved Embryo in nitrogen tank to Dr. Braverman’s lab
  • April 12, 2014               Frozen embryo transfer.  Autoimmune treatment by Dr. Braverman
    • Braverman is THE EXPERT IN REPRODCUTIVE IMMUNOLOGY. 
      • Pregnant!  Everything is going perfectly.
  • August 2014                 Bleeding
    • 3 nights of gushing fresh blood at 18 weeks.
    • Cervix still long and closed and baby is fine.
    • Doctors are taking bleeding seriously but concern is low.
    • Bed rest for a week and lovenox dose lowered and no more baby aspirin.
    • Bleeding stopped - thank goodness
  • January 7, 2015           Our beautiful son is born! 

My Successful Braverman Immune Protocol

  • 2.5 mg Letrozole at bedtime for 5 days starting 12 days before 5 day transfer
    • this is for endometriosis and implantation
  • Lovenox 40mg 2X a day starting about 15 days before 5 day transfer 
  • Baby Aspirin - one a day
  • 40mg of prednisone
    • I started prednisone at end of Jan 2014 and my transfer wasn't until 4/12/14.
      • I had to take it for 2 weeks an then wait 2 weeks for the blood test to come back to make sure it was working and then wait for my period to come.
      • At some point before transfer I had to drop to 20 mg because of terrible knee pain from the prednisone.
      • But, at some point he put me back on 40 mg for my pregnancy.
      • I also had the knee pain at 9 weeks pregnant so Dr. Braverman dropped me to 20 mg then.
      • He would have preferred me to stay on 40mg but he had to balance my health with the baby's
      • I was weaned off the prednisone completely by 17 weeks pregnant. 
  • BCP then Lupron after period to suppress cycle.
  • Intralipids every other week starting about 2 weeks before transfer.
  • 4 cc Delestrogen 2 times (Tues evening and Friday evening) a week injected in bum from 15 days before transfer until 12 weeks pregnant (although he let me stop at 10 weeks)
  • 2 ml progesterone injected nightly in the bum nightly starting 5 days before 5 day transfer through 10 weeks pregnant.
  • Estrogen and progesterone (E2 V2 with P4 2/100) suppositories - not sure when I started or stopped these but I think I started the day of transfer and stopped at 10 weeks pregnant.
  • He also had me take some doxycycline before the transfer but cannot remember exact days and some sort of antibiotic vaginal suppository as well before transfer.

 

Embryo Watch 2017: Day 1

Four eggs fertilized.  I didn't get the email until just recently letting me know that 4 of the 5 eggs fertilized.

As I was waiting to hear today's results, I started really feeling bummed I did not take prednisone during this retrieval cycle.  During my other IVFs I did take 10 mg of prednisone starting at cycle day 5. I think I was taking it last time to prepare for my transfer but wonder if it also helped the results of the retrieval.  Since inflammation is what is affecting my infertility it makes sense to me that some prednisone may help during the retrieval stage as well. 

I didn't remember and confirm that I had been on prednisone for my last IVfs until the day before the retrieval so it was too late to start.  Just another thing that went wrong because my brain really does not work well on these meds. 

Since this is my worst retrieval yet, I am worried that the lack of prednisone will affect my egg quality.  And/or it may have been what caused this cycle to not result in as many eggs as others.  Although, I am about 4 years older.

Interestingly, my right ovary did perform quite well this cycle.  I think that is support that the lack of prednisone did not affect the cycle and that there was just some fluke with the left side. 

I am trying to stay positive and focus on the fact that I was super healthy this cycle.  My diet was on point.  My stomach wasn't bloated at all and I showed no signs of inflammation.  I was feeling physically quite good considering all the drugs I was taking.  So, hopefully, that will help with the quality of these four eggs that are left.

All I can do now is wait and pray.

Grow embies! Grow!

Just another note:  it is super surreal and exciting to think that the any future children I may have could be sitting in a lab on W 54th St in Manhattan right now.  Very cool stuff.  #IVFISAWESOME

  

Retrieval Day!

Today was my retrieval!  And I am in great spirits. 

I hardly feel bad at all from the procedure.  Although, I tend to do very well with surgeries and procedures.  I was up like a champ the day after my c-section to the point my doula said that she thought that my body does not send intense pain signals to my brain.  So ya, I may have some super powers, getting pregnant easily is just not one of them.

The retrieval otherwise also went very smoothly.  We arrived at the lab at 6 am this morning and we left around 8 am.  We filled out the paper work.  Then, my husband went to give his sperm sample.  I'll spare you the details.

And, I changed into a hospital gown, hat and blue booties.  Next, the nice anesthesiologist entered and put something in my arm so that she could give me medication to keep me sedated during the procedure.  Then, we went into the procedure room. 

I had a little anxiety about this.  I had a super bad experience at my last fertility clinic.  They had this metal contraption they put your legs into; so that your legs were in the air and spread.  And, they didn't cover you, in a room full of people.  It was insane.  It was part of my 11 page complaint to them.  It is my understanding that they are better about covering people now, which is nice for the patients after me.  But, it didn't help my anxiety going into this procedure.

Thankfully, the room was way less scary than the room at my last fertility clinic and they gave me a paper blanket to cover up.  The anesthesiologist started me on some gas.  I breathed in ...and breathed out few times and I was out in no time.

Soon, I was awake.  I had a conversation with whomever was in my room when I woke up but cannot remember the details.  I think it was the anesthesiologist and I think was talking about how they didn't properly cover me at my last fertility clinic....

The nurse brought me some apple juice and a cookie.  It was total GMO filled terrible cookie and I was glad I brought myself a GMO free, gluten free fig bar that I ate instead.  The apple juice wasn't organic.  But, I decided to live dangerously and drink it anyway.  Seriously, though, I don't really understand why they would give women with immune issues such inflammatory junk food to eat.  But, the medical community rarely is focused on diet and seem to not understand that food can be healing if you make the right choices.  Anyway, in this day and age, you pretty much have to bring your own food everywhere or you are going to be eating something toxic.  Some people can handle it, but people, like me, with immune issues have to be careful about what we eat.

Next, someone came to tell me how many eggs they retrieved.  5 eggs!  That's one more than we thought I would get last Friday from looking at the follicles.  I am now feeling optimistic we will have at least one good one.

I also am just so happy to be done with almost all of the drugs for the retrieval.  I am done taking hormones for this part of the process.  Although, I did have to take a prophylactic 3 day dose of doxycycline, an antibiotic, to prevent infection from the procedure, which I was not happy about. After tomorrow, thankfully, I will even be done with that.   There will be many more drugs during this process and I am really not looking forward to the side effects but let's not worry too much about that for now.

I am excited to feel myself again and get back to focusing on having amazing health.  I am going to start a 2 week detox and another 2 weeks of Sakara Life Monday.  I will also be super diligent about taking my probiotics for gut health after being on the antibiotics. I will be feeling super healthy and happy again soon!  And, it will be great to be in good health for the upcoming transfer.

After the retrieval, the embryologist performed ICSI on our sperm and eggs.  ICSI stands for intracytoplasmic sperm injection, where one sperm is injected into each egg.

Tomorrow, we should hear about how many of the eggs fertilized.

Then, in 5 days we will hear about the quality of the embryos.  And, we will decide at that time whether to do genetic testing on the embryos or not.

On the fifth day we will freeze all the embryos. 

I will continue on a super healthy anti-inflammatory diet and start immune medication to prepare for the embryo transfer!

It's going to be a long process.  My guess is that the transfer will not be until January or February.  But, also that's very exciting because that means I could be pregnant in January or February - woah and woo hoo!!

 

 

Cycle Day 12: Trigger Shot

Today is cycle day 12.  Mood is bummer with a side of this sucks.  The ultrasound showed 5 eggs.  So one more than last week but still not what I was hoping for and probably not enough to bother with PGD.  I guess we'll see how it goes.

Also, I am done with all but two of the injections that I have to give myself for this retreival cycle.  WOOT!  The retreival is scheduled for Wednesday.  So I will take my HCG trigger shots tonight and should be just about ready to ovulate Wednesday morning.  Still waiting to hear the exact details but this is what I have done in the past.

This morning was rough, I realized that on my last two cycles I had been taking prednisone (10 mgs a day starting on cycle day 5) and this cycle I have not been taking prednisone.  I am concerned this may be why I am not responding as well as my last cycle.

I do have prednisone and I haven't spoken to the nurse yet so I am not sure why I have it.  But, I was told at my appointment today that Braverman does not prescribe prednisone during retreival cycles. 

This morning, however, before I heard back anything, I freaked out and took a 10 mg dose of prednisone so that could be contributing to my not great mood.  I am sure it's fine that I took it because I was on it for my last two IVFs with different doctors and they turned out fine.  But, probably not advisable to just start popping pills.  So nobody try this as home.

I also almost forgot to take my Ganirelix shot this morning and had to turn back to take it - that cost me abut 15 minutes on my drive in.  Then, because I am just an overall hot mess, I am serious your brain doesn't work when you are taking all these hormones, I missed the exit to the Merrit Parkway and ended up taking the 95 into the city.  95 is way more annoying and full of traffic compared to the Merrit so that wasn't a great move on my part.  I was about a half an hour late and lucky that Dr. Vidali (the Doctor who does my scans in the city) was still there and very nice about it. 

Anyway, 5 isn't AMAZING.  But, it can definitely get the job done.  It could be better but it could also be worse. I certainly am happy we are almost to retrieval day.  IVF is a miserable experience.

Now it's time to wait and see and hope for the best.  I am still a stressed hot mess but doing my best to seem like a normal human being.  My acupuncture absolutely helped with my hot mess-ness so grateful for that.

Chow for now,

Natalie

Infertility is Miserable: How to Dis Disenfranchise Your Grief

If you clicked on this article because you are struggling with infertility, I am here to assure you that it's ok to be sad and pissed.  It's ok to have any miserable feeling you want because what you are going through is truly miserable.  Let yourself be sad, mad and even bitter if that's what is coming up for you.  It's ok.

There is something in psychology called disenfranchised grief.  Disenfranchised grief arises in any circumstance in which society denies our “need, right, role, or capacity to grieve” (Doka, 1989).  This happens with infertility.

With regard to infertility and grief, the loss isn't recognized because it isn't a death and it's something many people do not speak about.  Those trudging through infertility understand this all to well.  When we mention our struggles we are all too often dismissed by (hopefully) well-intentioned people who, dismissive of our grief, say things like.  "Oh it will happen, just relax." Or, "oh I have a friend who struggled to get pregnant and - finally when they stopped trying they had a baby naturally!"  Suggesting if you too stopped trying, you would finally have your miracle.  

Unfortunately, those of us who have real physical issues cannot get pregnant unless we try, try hard, and don't give up.  And, there are some women who are never able to have children. 

For people who are truly infertile, this new reality, the embarrassing one where your body has failed you and your dreams are shattered month after month with the sight of literal blood seeping from your body is devastating.  It's a nightmare.  Our hopes fade as time passes.  Our hopes of having the family we not only have a biological imperative to desire but also we want because we just know it will be so wonderful, turn into fears of never having a child.  The pain from this experience is real.  Research has shown that infertile women's anxiety and depression equaled those of women with conditions such as cancer, HIV and chronic pain. The Journal of Psychosomatic Obstetrics and Gynecology (Vol. 14, Suppl., 45-52). And when our pain is dismissed it makes this hard time even harder.

This dismissiveness from society can deny our right to grieve.  And can make the grieving process much harder.  

And when we miscarry or in some cases women have stillbirths, this all is just amplified exponentially.  Our hearts are so broken.  For me, I was hardly able to move.  But our angels have no funerals.  Our family and friends don't surround us. There are no rituals, no gatherings and no ceremonies to say goodbye and share our greif.  But we must somehow process that our child who we want so dearly has died inside of us and we have to endure that child physically leaving our body and us forever.  We also have to experience the disappointment of our partners.  The sadness in their eyes can crush your already broken heart.  There is no doubt grief and I experienced how confusing it is when our community does not recognize our loss and our struggle.  Something along my journey helped me with this.

For me, there was a real turning point in my grieving journey that gave me an understanding of disenfranchised grief before I had ever heard the term.  A friend of mine was a true silver lining.  She had two failed IVFs and tried for a couple of years before having her children and completing her family. She was a support to me in my struggle to have children and I am so grateful.

She explained to me how difficult her infertility journey was.  She explained that her infertility journey was even more difficult for her emotionally for her than when her dad, whom she loved dearly and was close to, died in her 20's.  This doesn't diminish how difficult her loss of her father was.  But, it is a testament to how difficult infertility can be.  She said that when her father died there was a funeral and support from so many people.  It was a finite event that she was able to grieve and move on from.  Her infertility journey, however, was a dark time that was riddled with uncertainty.  The emotional support is scarce and it dragged on for years.  Additionally, the financial drain is painful. So, it was much more difficult for her.

When she told me this, she gave me permission to release what I was feeling.  And until she told me this I didn't even know what I was feeling.  It was intense sadness.  And sometimes bitterness towards others who were having babies so easily.  What she told me though was so powerful because it allowed me to express what I was feeling so I wouldn't get stuck in those emotions.

I stopped feeling weird or guilty for my feelings and just owned them.  Because I was a queen warrior goddess battling through the depths of hell and I had to take care of myself.  Once I could recognize my feelings, I could start to heal myself or at least ease the pain.

So, I surrounded myself with people who were capable of being empathetic towards what I was feeling and could show me support. And, some people are beautifully empathetic and supportive, I am so blessed to have experienced that and learned from them.  In some cases, I even paid people like my therapist and acupuncturist for that support. I also learned what I liked so I could cheer myself up. And, I took the time and made the financial investment to do these things. 

Among many other things, during that time, I learned that I like to take photographs, eat fancy lunches (and photograph those fancy lunches), have a spa days, watch funny movies, spend time with supportive, kind empathetic people, watch sunsets, laugh and cuddle with my husband, and cook and eat healthy AND delicious food and so on... so I did those things because I needed to to survive.  And I didn't feel guilty because they were not "productive" enough.  And, what I learned is that I always want to be taking the time and making the investment to do these little things that I love that bring me joy.  I want to always be learning about myself and what makes me happy so I can have a more joyous life. 

One of the things I learned about myself while I was struggling to have my first child was that I enjoyed was taking photos.  This is what happens when you take photography classes while struggling with recurrent pregnancy loss.

One of the things I learned about myself while I was struggling to have my first child was that I enjoyed was taking photos.  This is what happens when you take photography classes while struggling with recurrent pregnancy loss.

So, once again, this journey, helped me to be a better mother.  To be the best mother I can be, it is important that I "put my oxygen mask on first" so that I not only can be present, happy, patient and available for my son.  But also, so that I can show him an example of a joyous adult so he can grow up to be one too.

And even though I did all this at the time.  It was still unbearably hard struggling to have a child.  And the only thing that made it not hard anymore was the birth of my son.  That was a heart-expanding, body-floating cheeks-sore-from-smiling kind of day. 

So to the soon to be mothers struggling. If I could give you one tip, it is to let yourself be low and experience your negative emotions.  This IS a painful journey and the pain you are experiencing is totally understandable.  The battle to have a child is a miserable and dark time.  Take amazing care of yourself to recharge and put on that warrior gear.  Lots of love to all women and mothers no matter how your journey ends, I hope you'll find joy and peace.

 

Cycle Day 9

At Sant Ambroeus, watching some fabulous people accross the restaurant be photographed while eating their breakfast.  The photographer's shirt is unbuttoned and he has a black scarf wrapped around his neck and curly black hair - he really looks the part.  I am really burying the lead here.

And also, I am eating eggs for breakfast and thinking about my eggs, or, I should say, lack thereof.  

I only have 4 damn eggs!!  $6000 worth of gonal f and my left ovary is taking a nap. All the follicles are on the right side.  This doesn't mean they will retrieve 4 eggs - only that it looks like they might retrieve 4 eggs.  WTF!!!

This is not a total disaster bc I really only need one great egg but in my last IVF I made 12 eggs and that resulted in one baby.  Stuff happens when you dancing with IVF and infertility so you want to get a decent amount of eggs to work with especially when you are spending this much money. 

I am 5 years older than when I did my last IVF, and 39, so I guess this was to be expected.  But, my plan was to get super healthy, get a good amount of eggs, PGD the embryros to make sure we were transferring a good one.  The PGD also would also possibly enable us to choose the gender and we would love to have a girl. Both of my miscarriages were girls.

I will stop and say that I am grateful that there are some eggs.  I know this is a result people get.  And this can result in a healthy pregnancy.  It's just not whay I was hoping for. 

The plan has changed now.  I discussed it with my husband and the plan now is to skip PGD and implant one or two of the best looking embryos and go with god, just like our ancestors.  Well, like our ancestors minus the tens of thousands of dollars and medical intervention.  But with regard to the gender go with god. ...

And then I am done.  I am not doing this again and I am perfectly happy with one child and perfectly happy with my life.  I am not going to keep doing this to my body and draining our bank account.  Yes, I would love to have another child and hopefully this will work.  If not, maybe we will adopt or something.  Or, I can be one of those miraculous stories.  Ya know like Stan and Sue they tried and tried and then when they stopped trying - poof a baby was in Sue's belly and they all lived happily ever after -- thanks to the people who always throw stories like that in my face when I tell them I am ttc.  It's not likely for us with our issues - but I'd take it.  Anyways, I am not doing IVF with immune treatment again if this doesn't work.  It's a miserable hell and no one should have to go through it.  You defintley have not seen the worst of it.  The high dose prednisone and terrible side effects are yet to come.

I'd like to take this time to send a big F U to my last fertility clinic for letting me waste my 34 year old PGD normal eggs.  By implanting them in me and letting me miscarry.  They said immune issues had nothing to do with having a healthy pregnancy.  They said it -- but they were wrong.

Bitterly, 

Natalie

Miscarriages Remembered

I originally wrote this article for Well Rounded in 2014.  I would like to share it with you again, with some edits, because October is pregnancy and infant loss awareness month.

I've learned so much from the women I have met through this infertility journey.  I call them my fellow warrior goddesses. I've met many in internet communities.  “Look for the gifts your baby left you,” is one phrase I read on a fertility board somewhere that has both haunted and helped me so much. When I read those words, they broke my heart. Even now, I can hardly think of them without my eyes welling up in tears. I didn’t like to think of the babies I lost as babies. I preferred to think of them as cells dividing that just didn’t make it. They didn’t have a soul, did they? But, they were so much more than “just cells dividing,” regardless of whether they had souls or not.

We had been trying for years just to get a positive pregnancy test. My two pregnancies came only after much time, heartache, frustration and financial drain. Each time I miscarried, I lost not only my hopes and dreams surrounding the arrival of the babies inside me, but also the possibility of relief from the infertility nightmare we were schlepping through. And, of course, so much more than that.

The day of my D&C procedure, and the weeks after my first miscarriage, were some of the saddest–if not the saddest–that I have known and ever hope to know. At the hospital, I had to leave my husband in the waiting room. Except for unfamiliar faces, I was alone. It was cold floors, white stale, cold lights, and a cold, naked body covered with a green gown and paper hat.

The crying came from another world. I was watching myself yelp, and I couldn’t stop. My mind went blank. Sadness simply poured out of me, and that’s all that was there. I’d never experienced this kind of sadness. I went to the bathroom and stared out the window and cried; I walked into the second waiting room and cried; I laid down on the procedure table with tissues in my hands and I cried some more.

When I woke from the anesthesia-induced sleep, there was some relief. My pregnancy was over, but so was the painful waiting to find out whether I was going to lose my baby. I had my answer. It wasn’t the answer I hoped for, but it was my answer, and I had to accept it.

Through this process I learned that when I mourn, sadness comes in intervals. When the sadness came, I allowed myself to mourn. I didn’t try to cheer myself up. I protected myself, and took care of myself in every way I could think of, and I allowed myself to go into the darkness. It was so terribly sad and dark. It was awful.

The lows were followed by highs and then the lows would set in again. During the highs, I received one of the greatest gifts from my first baby. When the tears ran dry for a while, and I had some time before the next low, I felt amazing peace. My heart was open. The pain had cracked it open. When the river of tears ran dry, there was an opening that let the light in.

Maybe too exhausted to think, I would experience the world just as myself, with no commentary from my mind. Colors were vibrant, everything was beautiful, love and intimacy came more easily. It is something that I still practice now–trying my best to stop the mind so that I can enjoy the moment as myself. With the help of this sweet little soul, I had some pure moments filled with love. These moments still help me in my practice of keeping my heart open, and I am forever grateful.

I was still experiencing the ups and downs of my first miscarriage when we transferred our next embryo. When I was pregnant with this baby, I remember feeling so happy and thinking to myself what a sweet girl this baby is (we knew the gender because we had genetic testing done on our remaining embryos). I believe I could feel her sweetness.

She did not make it far along at all.  I did have a positive HCG level but it was low and not rising properly.  I think this was considered a chemical pregnancy because we never saw much, if anything on the ultrasound. “I think I see something but I am not calling it your pregnancy,” is all the doctor ever said. Shortly after this, I stopped my fertility medicine and the pregnancy ended on its own. I didn’t allow myself to go deep into the darkness this time. I was pissed.

I decided that I didn’t have to be nice anymore. I always try my best to be nice; I am sometimes a real people pleaser, and I am trying still to navigate my way through being nice and being genuine in times of conflict.

But for a while I wasn’t so nice at all. It didn’t make me feel better. In fact, when I wasn’t being nice, I realized the world wasn’t so nice back. I realized that being able to be nice was a gift that I had for many years and took for granted. This sweet baby girl showed me that being sweet is a gift, and I didn’t deserve anything for it. But the world returns the favor anyway.

After my tears dried for that pregnancy, and life moved on and the pain faded some, I realized that the gifts my babies left me came in the form of lessons. And these souls who never made it to the world except inside my womb, chose to come here to teach me about love. One broke my heart open and created a gateway allowing light inside that prior to her visit did not have an entrance. The other taught me that being kind is not something that I am giving away or something for which I am owed, but it is a gift that I have been given. When I am kind, my world is more beautiful. I get to experience my own kindness as well as reap the gifts of kindness that return to me.

Even as I write my feelings on this page, tears stream down my face. The pain doesn’t necessarily go away.  But, I have no doubt that these gifts will help me be a better mom, wife and person. And, for that I am grateful.  Still, I do not think this is fair.  Infertility is not fair.  Make it known - I do not condone this type of learning - universe.  I also believe people can learn from joy and abundance and I pray that is how my and everyone's lessons come from now on.

Cycle Day 6: Egg Watch 2017

Today is my birthday!  And this morning I drove to NYC for my blood work and ultrasound appointment.

My right ovary was definitely more generous this birthday.  She had 4 follicles that were substantial enough to mention.  The left side, the doctor said was "quiet."  So the left ovary needs to get in the game.  The nurse assured me that this was normal at this stage in the cycle.

I honestly cannot remember my last IVFs, they were quite a long time ago.  So I cannot remember the results from those first monitoring appointments for those IVF cycles.  But, the notes show that no follicles were mentioned until the appointment on cycle day 8.  I am going back in for Friday which will be cycle day 9.  So, I am sure I will know more then.

I'll tell you what I am wishing for - 10 eggs.  That would be a fantastic cycle.  My first IVF, 6 eggs were retrieved and my second IVF, 12 eggs were retrieved.  But, those cycles were about 4 years ago when I was 34.  I just turned 39.  So, if we ended up with 10 eggs, it would be a huge win for me.  Even 8 would be great.  And, I wouldn't balk at 6.  What's even more important is how many of the embryos turn into blasts and how many test genetically normal.  Even with just one genetically normal girl, I would be thrilled.  That means, I am, however, banking on it working the first try.  And, I am.  That's what I am manifesting and that's what I believe will happen. I really believe that Dr. Braverman was the key to my success last time, so we will be successful first try with him again.

Drugs & Symptoms

 

10/9   -   CD 20 - Vivelle Dot .1 MG (Patch) & Ganirelix Acetate Injection 250 mcg/.0mL (Ganirelix):

10-/10 - CD 21 - Patch Day 2 & Ganirelix: [achy and crampy in stomach area from shot]

10/11   -  CD 22 - Apply Patch & Ganirelix: [achy and crampy and a little weepy from estrogen]

10/12-  CD 1 - Patch Day 2 & Ganirelix: [Menstruation begins period cramps depressed]

10/13-  CD 2   - Evening 450 Gonal F & 150 Menopur; [morning nausea]

10/14   -  CD 3 - Evening 450 Gonal F & 150 Menopur [morning nausea]

10/15   -  CD 4 - Evening 450 Gonal F & 150 Menopur [starting to be aware of ovaries]

10/16   -  CD 5 - Evening 450 Gonal F & 150 Menopur [Bloating pain in abdomen area and back]

10/17   -   CD 6 - Evening 450 Gonal F & 150 Menopur [Still crampy and not feeling great in general]

10/18   -   CD 7 - Evening 450 Gonal F & 150 Menopur [Not as crampy, I actually found some Panaway essential oil a friend gave me a while back (just sitting out on the counter like an angel left it there for me), and I have been sniffing it whenever I am uncomfortable and I put a couple drops on my wrist; it has been working well for me.  I have a super short fuse and am just in an over all in a bad mood.  Taking care of a toddler feeling this way has been rough and I am scheduling some extra help from babysitters and my husband for Friday and the weekend to give myself a break.  I don't think last time I felt this badly because I was in such a bad place from the fertility struggle, it didn't seem so bad - it was also my only way out of the pain I was in.  Now, life is pretty sweet so relatively this is miserable.  Oh Einstein it really is all relative.]

10/19 - CD 8 - Morning Ganirelix/Evening 450 Gonal F & 150 Menopur

10/20 - CD 9 - Morning Ganirelix/Evening 450 Gonal F & 150 Menopur

10/21 - CD 10 - Morning Ganeirelix/Evening 450 Gonal F & 150 Menopur

10/22 - CD 11 - Morning Ganirelix/Evening 450 Gonal F & 150 Menopur

10/23 - CD 12 - Morning Ganirelix/Evening Ovidrel 2X (trigger shot)[I just realized I haven't updated this for a while.  The symptoms for the past few days have included feeling like a different person who is totally miserable, overthinking, stress, fatigue, I wish I could just curl up in a ball and stay there all day.]

10/24 - CD 13 - Doxycyline 1 in the am, 1 in the PM

10/25 - CD 14   Doxycyline 1 in the am, 1 in the PM

10/26 - Doxycyline 1 in the am, 1 in the PM

Retrieval DONE!!  YAY!!

 

 

 

Cycle Day 2: Start of Follicle Stimulating Hormones

Today was certainly a big day for this IVF journey.  It also was one of those days!  Every step of the way I was met with an obstacle.  But, every obstacle was turned into an opportunity for a solution.

If you read my last post you'll see that I am on vacation and I was not prepared to start my cylcle this weekend. I didn't have my Menopur and I had to find a place to give me the ultrasound I need to start my cycle. When I called this morning, the hospital was like there is no way you can have a transvaginal ultrasound today.  They had said I could have it done today just yesterday, so this was a shock.  But, after a bunch of calls and some tears I was able to get in.

Then it appeared it was going to cost about $1000 out of pocket for the procedure but after a few calls to my insurance and about an hour and a half of time spent and some more tears we were able to get everything covered.

Then my package that was sent to me with my medication hadn't arrived by noon like it was supposed to.  And when I called UPS they said it was stuck at the hub in Vineyard Haven.  So I drove there, and they said it was out for delivery. 

The package came at 4:45 PM essentially the same time as I got the green light to start my meds.  So, I went to inject them.  I started with the Gonal-f.  I've done this before so with a quick you tube refresher, I was good to go.  Then on to the Menopur; I went to look at what I needed and I didn't have the right needles for the sub-q injection.  I had to run out to the pharmacy to get some needles.  So around 5:45, I was able to inject the Menopur.  BOOM! I did it!!

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In the end everything worked out but there were certainly a lot of obstacles today.  I had been in pretty terrible spirits and stressed from the hormones of course; but also, feeling like I was swimming up stream for a good part of the day.  And also it felt very evident that I was having to go through this struggle just to have a child again.  I ended up talking to some people today at the hospital about what I went through to have my son throughout the day and it just brought back some of those really dark feelings.  Not to mention, I am supposed to be enjoying myself on vacation this weekend! But, when I was able to focus on overcoming the obstacles and to focus on all the people who were so kindly helping me, I started to feel less like I was fighting against the current or reliving the past and more like I was just going with the flow. 

I also happened to have one of my favorite spiritual books in my bag while I was waiting for my ultrasound.  It's titled "Emmanuel's Book" A manual for living comfortably in the cosmos, by Pat Rodegast and Judith Stanton.  This book is way out there and certainly not for everyone.  But if you feel this fertility journey is a spiritual one for you and phrases like "In spirit the essence of your being is love" and "There is an overall plan of which you are not aware and to which you can only contribute by being who you are, doing your best, seeking your higher truth, and following your heart," ring true to you as well, I recommend the book highly. Today it really helped my depressed thinking lose it's mojo and allow me some emotional peace even in the face of a difficult day.  Although, it also felt like I may have just short circuited on negative and had to detach a little from the stress of it all.  Maybe it was a bit of both. 

EmmanuelsBook.JPG

 

Regardless, I am feeling more optimistic and am excited to start this cycle.  I really hope I make some nice eggs.

Aunt Flo: I Wasn't Expecting You!

So, I got my period today and I am on vacation.  I literally realized that I got it a few minutes after we arrived. I was not prepared.  I didn't bring all of the drugs I needed and I didn't know where to get an ultrasound that I need to get tomorrow.

I thought I wasn't going to be getting my period until Tuesday after we got back from our trip.  But, in hindsight I really should have known that I may get it over the weekend.  I won't go into all the details but I made some bad assumptions.  I luckily did grab one Gonal-f pen on the off chance that I *might* get my period.  Gonal-f has to be refrigerated and one pen is about $1000 so it is good that I brought it because it's harder to ship.  What isn't great, is that it somehow slipped my mind that I needed Menopur too.

What's not helping the situation is that physically, I am crampy, for obvious reasons, and there is an achy pain in my abdomen, like in the skin.  I am sure it is from the shots.  Emotionally, I feel depressed with a side of rage.  I will blame the messy situation I got myself into on my brain and body being fried already from the drugs. I haven't even started stimming yet.  I do think it will all be ok logistically though.

Luckily, we are right near Martha's Vineyard Hospital. Everyone at Braverman's office was awesome and helped me get everything sorted out.  Martha's Vineyard Hospital is able to do my bloodwork and ultrasound tomorrow.  And, my cleaning lady was so wonderful and ran the Menopur I needed to the post office.  It will be here tomorrow.  We are going to still make the best out of the trip.  But, I am not going to sugar coat this one.  #ivfisnotawesome

I spent our first lunch here making calls and getting this all set up and tomorrow morning is going to be spent at the hospital.

I am also, for the first time, feeling pessimistic about the cycle.  What if I am not relaxing enough and I am getting too stressed by everything not being in order and it affects my eggs?  And, that's just the tip of the negative Natalie swirling around in my brain.  My head is a super dangerous place to be right now.  I won't scare you with more.

Now, I am going to sleep to try to find some Zen.  I know it's ok.  I know I am blessed.  - I am somewhere so beautiful.  I have the opportunity to do IVF.  I have Silvanna working at my house and she ran out to send me my drugs.  Also, my nurse Sandra was on call and helped me on her day off and many others in the office helped as well.  And of course, my husband was helping out.  - But, it just doesn't feel that way right now.  It feels like a crap sandwich - I guess I should say crapster roll since I'm on the Vineyard.  Hoping things feel brighter in the morning.

 

What is an Estrogen Primed with Antagonist Cycle?

I just gave my self my first shot for this IVF.  And, boy has the meaning of shots to me changed a lot since I was in college!

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I just want to reiterate that I am not a doctor so this is in NO WAY medical advice.  But, if you have similar issues to me, this may be information that would be helpful to consider when speaking with your doctor.

I am doing an Estrogen Primed with Antagonist Cycle.  So I put on my estrogen patch yesterday evening and I took my first shot of Ganirelix this morning.  A more detailed post with the drugs used in my Estrogen Priming Protocol is here.

This is a protocol doctors use for people who have a poor response to fertility medications because typical BCP or Lupron cycles may suppress the ovaries. An antagonist like Ganerelix and estrogen are used during the pre-treatment cycle.  Using an antagonist like Ganerelix during the pre-treatment cycle prevents premature recruitment of follicles that can reduce the number of follicles available for stimulation.  And estrogen is used to provide optimal conditions to help the young follicles to grow.

I have read that studies show that this protocol allows more slow and even growth of follicles resulting in improvement of embryo quantity and quality. Although, your doctor may not want to use this protocol because there is less control over the cycle planning as stimming can start on any day.  Luckily, my doctor is cool with this type of cycle.

I am a good candidate for estrogen priming because my FSH fluctuates but is always quite high. I've never had an FSH reading below 9 and my high FSH level was 28.5. 

My AMH is also super low.  I've only had my AMH tested two times.  The first time it was .2 and the next time it was .37.  These numbers are very bad and generally are indicative of low ovarian reserve. 

My antral follicle count, however, does not match these low numbers.  Whenever doctors look at my ovaries early in my cycle they say that they look good and that there are a substantial number of follicles in each ovary. This is a clue that something else is going on besides low ovarian reserve and early menopause and points to what we know now to be a fact.  That I have immune issues that need to be treated to have a healthy pregnancy.

Still, I am a good candidate for an E2 Prime protocol because generally I do not respond well to follicle stimulating hormones.  Way back in 2012, I started my journey by doing medicated IUIs.  On 150 units of Gonal F, I only made 2 eggs.  On 250 units of Gonal F, I still only made 2 eggs.  This is a poor response indeed.

Finally, I am already an estrogen prime success.  For my 2 and only IVFs, I did an estrogen prime with antagonist protocol with 450 gonal f and 150 menopur, and I made 6 eggs the first time and 12 eggs the second time.  The first cycle was a bust because we didn't, but we should have, used ICSI.  And the second cycle with ICSI, I made 3-4 genetically normal good looking 5 day blasts.  I believe this is a real success if you consider my dismal hormone readings.  I am not going to be talking much about the fertility clinic where I did my first IVF because I had such a horrific experience there.  But, I do have to give them credit for choosing this protocol for me. 

All right, let's do this!

XO,

Natalie

 

 

 

 

 

Starting Medication Today!

Today is the day!  I start my medication for my E2 prime cycle for my retrieval.  It looks like the retrieval may be October 31, Halloween...spooky :) 

Today was a brutal day.  Last week, I did a detox from Sakara Life and so many things were great about it. I do think it was beneficial for my health.  But, it was a little too extreme for me.  The second to last day was a liquid day and I feel like I did not get the nourishment that I needed and have just had a really short fuse since.  So now I am focusing not on detoxing but just getting the healthy nourishment I need to grow some beautiful eggs. 

Tonight I slapped on one of these lovely estrogen patches.  I actually think it helped with my mood.  Or, maybe it was the grass fed New Zealand raised lamb chops I ate with Sebastian for dinner, after being practically vegan for the last couple of weeks, that boosted my mood.  Regardless, this is getting real now!

estrogenpatch.JPG

I will be putting on a new patch every other day until the end of my cycle (aka Auntie Flow comes to town).  For the next three days, I will be doing Ganirelix shots as well.  So the poking will begin.  I am not worried about the Ganirelix shots at all; these are no big deal compared to some of the shots I have to take, like the Lovenox - those sting!

So the patch (or the chops or both) lifted my mood and I am not worried about the shot.  I am also feeling super optimistic about the cycle.  Once you see all I have to go though to have this baby, you'll see it's there is not much to be excited about.  Well, except a baby!!!!!!  And for a baby it's all worth it!  I am also doing this, this time around, already a happy mom so that really takes the edge off.  A sibling would be nice though so I am thinking positive thoughts for a positive outcome.

XO,

Natalie

Cycle Day 3 - Elevated FSH

Fertility doctors have you come in on cycle day 2-5 to test some hormone levels that can give an indication of the state of your fertility.

A couple weeks ago, I went in on cycle day 3 for my blood work.  My estrogen was in range (I mention this because if estrogen in not in range then the FSH reading may not be accurate) and my FSH was 15.  15 isn't good - in general.   If you do a quick internet search, you can learn a lot about FSH.  Here is what one fertility clinic with an office in Manhattan says about age and normal FSH levels:

What is a normal FSH level?

33 year or less = less than 7.0mlU/mL

33-37 years = less than 7.9 mlU/mL

38-40 years = less than 8.4 mlU/mL

41 years = less than 8.5 mlU/mL

I am 38, so an FSH 15 is getting close to double the top FSH this clinic would expect one to have at my age.  But, when I went to my first fertility appointment at 33 years old.  Guess what my cycle day 3 (aka follicular phase) FSH level?...28.5!  Yes, you read that right.  28.5.  I received that number by a phone message from my clinic at the time and then went to Dr. Google.  What I found was information similar to this:

FSH Test Levels

Normal Menstruating

Follicular Phase 2.5 to 10.2

Postmenopausal 23.0 to >116.3

The above is fairly typically what you will find about FSH levels online.  Do you see where 28.5 falls according to earlymenopause.com?  That's right, postmenopausal.  At 33 years old.  That was a real Uh-oh moment for me in my fertility journey.  I was concerned that I would be unable to have a biological child.

When I went back to my doctor at the time (who worked at a large Manhattan fertility clinic and New York Magazine claimed was one of the best) to discuss this, he asked if I had childhood cancer and tested me for Fragile X.  I didn't have childhood cancer and I do not have Fragile X syndrome.  According to that practice, other than childhood cancer or Fragile X there was no reason that I would have such a high FSH levels unless I was going into early menopause and the doctor was already preparing me to think about using donor eggs.  At the time this practice acted like believing immune issues would affect a pregnancy was akin to believing in Santa Claus or the Easter Bunny.  I was freaking out.

Now, I know, that doctor was wrong to start talking to me about donor eggs so early on.  And, I know that doctor was wrong to dismiss immune issues.  This is unfortunate because he (and other doctors after him) caused me a lot of stress and heartache.  But, luckily, he was wrong because I did not need donor eggs.  I just needed to go to a doctor who better understood endometriosis and reproductive immunology.

This is what Dr. Braverman's blog says about women with unexplained elevated FSH:

Many patients come to our practice with a history of recurring pregnancy loss or multiple failed IVF cycles and these patients are found to have either remarkably or even mildly elevated FSH levels. Sometimes there is no clearly identifiable cause as many of them are under age forty and that is an unusual age to have them start to have a rise in their FSH levels. My job is to find out why their FSH is going up if it is not clearly related to the patient’s age. There are several reasons for elevated FSH that can be treated and improve the chances of conception in this group of patients.

One of these diagnoses is autoimmune oophoritis which is simply an immune condition where the mother actually attacks her own ovaries and actually the follicles inside the ovaries. This can be tested for and we look for the presence of high levels of ovarian antibodies and the good news is by treating these high levels, if the diagnosis is made in close proximity to the actual onset of the disease, we can actually create a window where we may actually get a better response to the stimulatory medications that are used in either the in vetro fertilization cycle or the insemination cycle.

The second situation with unexplained elevation FSH is those patients that are found to have endometriosis. As we mentioned elsewhere on the website, when the ovaries are bathed in abdominal fluid with high levels of inflammatory cytokines such as tumor necrosis factor, this also begins a very slow degradation process in the patient’s follicles and slowly decreases her ovarian reserve. What we found in these situations if we put the patients on high doses of antioxidants and we begin to lower the attack on these ovaries by these inflammatory cytokines we can actually improve not only the quantity of eggs that we see with in vetro fertilization cycles but actually the quality of these eggs.

Sometimes our patients have to go to surgery to debulk the amount of endometriosis if the medical therapy is not working. So it’s important if you have an elevated FSH level and even if it is due to advance maternal age that you are aggressive and you treat each of the problems that are found. In our patients with no other identifiable cause except advance maternal age or a family history of premature ovarian failure, we have therapies that can increase the number of receptors on these older follicles so we get a better response from the stimulatory medications.

So if you have an elevated FSH you may be in this group of patients that still have an opportunity to have a child and you may not necessarily need donor eggs; although a large portion of patients still must be realistic that it’s a difficult battle, but one that we are willing to fight and many times we’re successful.

Luckily, I ultimately found Dr. Braverman who understands that elevated FSH can have other (apparently not as well known by many Reproductive Endocrinologists) causes.  And, luckily, I was in the group of patients that still was able to have a biological child.  Unfortunately, it took me a while before I finally became a patient of Dr. Braverman and had my miracle.  It was a mistake that I did not go to Dr. Braverman earlier.  But, hindsight is 20/20.

When I first learned that I had unexplained high FSH, I did find Dr. Braverman online and similar information to what is posted above.  It made me consider whether I may have endometriosis.  At that time, I asked my next doctor (who also worked at another big Manhattan fertility clinic)  to send me for a laparoscopy to look for endometriosis.  He said, "We only send people who have symptoms of endometriosis for laparoscopy."   I had to remind him that I did have those symptoms and ultimately I went for the procedure.  I did have stage 2 endometriosis and my surgeon removed it.  So, at least, I finally had a clue about what was causing my high FSH.

As you know, eventually, I went to Dr. Braverman and with an immune protocol I was able to carry a baby to full term.  Sadly, this was after 2 miscarriages with other clinics.

Now, for my second IVF even though my FSH is a whopping 15, I still feel hopeful I will have another biological baby because we know we are with the right doctor, for me, Dr. Braverman, and that can make all the difference.