Immunology bloodwork results

I received a phone call from Dr. B this afternoon.  Yes, he said 4-6 weeks for results & we only did the bloodwork 3 weeks ago.  What’s this, a doctor that calls you himself & does it sooner than the time frame given?  Be still my heart!

For the 1^st time in almost 6 years of TTC I can finally utter these words: we have answers.

Starting off, my husband & I have some haplotype issues.  Specifically, the concerning one is we have a matching HLA type (AA haplotype).  Fascinating yet bizarre.  Genetically, we are quite different (he is Tamil, I am a mix of Portuguese, Hawaiian & Irish) so one would like Darwin’s theory of genetic diversity leading to fitness.  Guess not. 

The good news here though is our chromosomes are normal which I was slightly concerned about since Vid’s parents are second cousins.  Gotta love (or not, in reality; ha!) arranged marriage. 

I also have a high level of anti-nuclear antibodies & an 8.1 extended haplotype as well as TH2 dominance which point to my body attacking foreign bodies, a.k.a. embryos.  Also, based on the T2 he is recommending a repeat lap to check for endo as in his experience there is a huge correlation.  Given my testing positive for so many inflammatory immune things, he said he’d be remiss not to order it.  The dude he recommends is on Long Island so I will have to check with my insurance & pray it’ll just be a matter of an out of network co-pay.

My AMH is on the low end of normal @ .79.  According to all the charts I’ve seen on Dr. Google, that is about average for a 40 year old woman.  I will be 35 in 2 months.  It’s not low enough to be considered DOR but basically the sooner we get pregnant the better (no shit!) because when I am actually 40, we’d most certainly have to venture into donor eggs.  I have no interest (or funds) to do that.

The shocker: I have fucking celiac disease.  My husband, you know, the one who shits like a buffalo & has the gas to match whenever he eats anything with gluten?  Nope.  Totally odd.  He grew up in South India where it’s a rice-based diet & never has GI issues when he visits home & eats the traditional diet.  I’ve been begging him for years to get tested & he never has.  But now we know.  And I, the queen of carbs who has a gut of steel (seriously, I’ve eaten in some very shady road side stands in developing countries with no issue) has fucking celiac.  This was me today upon hearing the news:

I am so sad it’s pathetic.  I don’t want to live in a world without bagels or pizza.  Yes I know there are gluten free options out there but they’ve hella pricey & often taste like ass.  Alas, having a kid is more important @ this point than having a bowl of pasta.  And once I give birth, I am eating ALL THE CARBS in celebration!

Still alive

Hey, so, yeah...it's been a while.  When last I blogged a little over a month ago we had just met with Dr. Braverman to hatch our master plan. Then, lots of things happened:

We ran away for Thanksgiving as tradition dictates (we've done it every year except 1 since we've been together) to Niagara & Toronto.  

Then early this month Vid's mom took a bad turn & ended up in a coma for 4 days which she somehow managed to come out of.  Seriously.  So he's trying to figure out a way to get over there sometime next month for another visit.  

My job has reached the point of intolerability.   I seriously cry when I wake up in the morning several times a week.  My therapist actually suggested I quit if it were financially possible. Yeah, no.  But I am sending out resumes into the ether, hoping to land something less stressful with increased pay.  Should be easy in this economy, right?  LOL!  

And my niece came home last week after 3 months & 3 days in the NICU, with a mic-key button, which is wonderful news but also a challenge obviously.  It remains to be seen what kind of delays, if any, she will have as a result of her premature, traumatic birth.

Then Christmas was yesterday.  It was pretty chill actually.  So.  Much.  Food.

So yeah, lots of things.

Today we did immunology bloodwork.  Thankfully, the company Dr. B uses is actually headquartered nearer to us in Boston so we were able to do it at their main office & therefore didn't have to drive 3 hours to NY.  Yay!  We did what they call the "Fertil panel" (no "e"; fancy!) & should get results in 4-6 weeks.  I had 12 big vials & 16 little vials taken, while Vid had 1 big & 4 little taken.  Guess which one of us closed their eyes & sweat like a pig for the duration of the bloodwork while their spouse kept rubbing their back so they wouldn't pass out?

Yeah.

A meeting with the Pope (kind of)

We took a day trip to NY to meet with His Holiness, Dr. Braverman, yesterday.  We left @ 5 am & thankfully the traffic gods smiled upon us, as wel as the weaher gods.  Afterwards we went shopping @ the giant Indian grocery store nearby & had a nice South Indian lunch (Vid's people) before heading back home.     

 

Overall, it went well. DH was impressed with his office set up (4 monitors = comp sci prof's dream) & his liquor bottle collection, LOL.  He was very approachable with a good sense of humor & also wasn't afraid to use big words with us.  I like big words!

We're starting out with testing for karyotyping & basic immune stuff. He's also testing my AMH. The nurse will call to set things up next week, hopefully locally to us, or @ least nearby in Boston where Reprosource has an office, which is way closer than Long Island.  He says results should be in by around New Year's or so.

For IVF #2 we did "low & slow" with a Clomid kickstart, adding Follistim, Cetrotide & Menopur which by far gave us our best results. Based on this he thinks we need a flare type protocol but is not sure about micro flare Lupron given wh...at a disaster IVF #1 was. He also suggested maybe straight Menopur.

He did a pretty in depth exam/ultrasound & found something interesting: the blood flow in & out of my right ovary is very restricted. He asked if I knew how many eggs were retrieved there vs. left as well as mature eggs out of left vs. right & I said I don't know. I told him I feel it when I ovulate out of lefty but never out of righty. While he doesn't suspect endo it's in the back of his mind & depending on other tests I might have another lap.

When it comes to my weight he does not think it's what's preventing me from becoming pregnant. He does suggest going back on Metformin since it can normalize leptin levels which tend to be higher in obese folks who don't have IR. Leptin affects the release of LH among other things.

For the hubs, based on his sperm frag test & low morph he says to try the FertilAid & see what happens. Clomid might also help with the morph. Ensuring my other half takes his pills will likely be the most challending part of all.  He doesn't think Vid being the product of a cousin marriage is an issue. Also suggested a course of antibiotics prior to cycle which we also did with IVF #2.

More about the war on infertile fat people

 

Over the years I've been blogging you know how passionate I am about advocating for better treatment of those of us with elevated BMIs who are also dealing with infertility.  Too often, otherwise healthy fat folks are told to lose weight & magically we'd get pregnang on our own.  I've posted several articles written based on data gathered from studies on overweight & obese women.  This time, it's the men's turn:

 

A study cited in Renal and Urology News (November 2013) found that "While those who underwent surgery had increased sexual function as well as increased luteinizing hormone, follicle-stimulating hormone, and testosterone, their semen parameters went completely unchanged."

 

So just like the study I wrote about a year ago about women who underwent gastric bypass surgery not having their fertility improved by the surgery, the same apparently goes for men.  Furthermore , just like their female counterparts, infertile men had a libido increase that may be explained by the fact they were given false hope that this surgery would allow them to finally become a parent.  Once again, if the researchers followed them more long term, the level of sexual desire probably decreased with each cycle they didn't impregnate their partner.

 

I'm not minimizing the fact that obesity likely does play a part in some people's infertility.  We all know it's associated with many medical problems besides an inability to conceive.  However, if an overweight or obese person doesn't exhibit any of the associates comorbidities, then why suggest people go through ultra-invasive, extremely risky surgery to correct a problem when there appears to be no evidence it will acheive the desired, supposed affect of improved gamete quality?

Infertility conference recap

In all my years as an infertile I've never attended the Resolve of New England.  I've always wanted to but the cost made me pause.  Then, I found out you could attend for free if you volunteered.  So, I did.   I was a room monitor which basically meant I did a head count of the room, collected feedback forms @ the end, kept the speaker on time & trouble shot any issues that came up.  Using "strategery", I volunteered to monitor the sessions I wanted to attend for information purposes, so it was a win for RNE as well as myself. :)

I met the new doc @ my RE's office & she's super chill. Probably my age? From Greece originally. She's also on the board of RNE. I told her about starting up a peer group in Providence soon & she said she would be willing to let me use office space for it.  Did I mention that I am going to be a peer leader?  Yeah.  Because I don't have enough going on.  But seriously, I'm looking forward to it!

I met the dude who invented the sperm frag test Vid recently had done! He gave me a sperm pin, lol. I got a ton of cool swag (pens, sticky notes, lip balm, stress relief egg, a book on love & infertility).  Here's a pic to prove it really happened:

I also met a really nice Indian couple who were also unexplained & had gone through 5 (!) IVFs so far. I've already been e-mailing back & forth with the wife. She is also thinking about going to Braverman for immuno testing too.

Some stuff I learned:

• 2nd hand smoke is as detrimental to gamete quality as smoking yourself is. Yet another reason for me to be looking for another job since most of my patients are smokers (people with a mental health dx smoke @ a rate 3x that of the general population).
• PICSI does not increase fert but does decrease m/c risk.
• B6 levels are naturally higher in fertile women. My B vit levels are low normal as I'm a vegetarian. However, due to my having beta thalessemia my body does not manufacture iron well & I've probably avoided having to have blood transfusions in my life since I don't eat meat. A lot of oral B vits have iron additives which could be dangerous. Given this, might be time for vit injections according to the RE who did the talk.  What's another needle @ this point?
• High omega 3 levels are associated with increase in prostate cancer & increased morph issues (interesting since DH eats a ton of seafood).

BINGO!

A Letter to All the Pregnant Women in My Life

An interwebs infertile friend recently posted this; I nodded along through the entire thing.  I don't normally copy & paste others' work, but this was way too good (as well as appropriate for where I am mentally) not to share.  You may nod along as well if you're still in the trenches of infertility:

It’s not you, it’s me.

I’m not like your high school boyfriend who heard that phrase in a romantic comedy and repeated it to you just days before taking your best friend to prom. I really mean it. Everything is me. You are wonderful. You are careful with me. You are kind.

I sit, every minute of every day, with the knowledge that I may not be able to have a family, and that even if I am able to have a family through adoption, I may not ever be pregnant, carry a pregnancy to term, give birth, glow, hurt, heal. There are moments, brief and beautiful moments, when I am so in love with my life that I forget about infertility and I feel actual joy. Those moments never happen around you. I can’t forget around you. Back when I had hope, I could find excitement in your growing belly and happy plans. Now, I just don’t know how to.

Most of the time, I am walking around in one of two states of emotion–both distant from my pre-infertility emotional self, both distant from joy. One of those states is a disconnect. Disconnection from my emotions is how I live through this; it’s how I get through every day. I want to compare it to wearing a bandaid to protect a scab, but it’s not quite like that. It’s more like a helmet covering a thin layer of flesh over an otherwise raw and exposed bundle of nerves, delicate and tender and requiring care and protection. I can talk about what I’m feeling while I’m not actually feeling the emotions. It’s the closest I get to being able to share what I feel with others.

Then, when the helmet comes off, it is not pretty. That is the other emotional state I sometimes find myself in, filled with intensity uncommon in my adult life, feeling emotions that make me uncomfortable and unrecognizable to myself. Anger, jealousy, hurt, resentment, despair, loss. I prefer to experience those alone. Which is lonely.

I don’t know how to engage with you, my dear friend, the way I used to. With my helmet on so tightly, how can I connect with you during this most important time of your life? With my helmet on so tightly, I feel like everything I say is a lie. But, with my helmet off, there’s nothing about me you’ll want to be around and there’s nothing about me that is comfortable for me to show around you. It cannot come off.

So, I miss you. Each time a friend begins to “try” I withdraw a bit more. When they succeed I become a little more alone. Over three years of this, the losses have accumulated and I have steeled myself for them a little better each time, faking it with a bit more success. I don’t want your happiness to feel like a loss to me, but it is. At least for now.

I read constantly that it is impossible to get through this without losing girlfriends, but I really don’t want to give in to that. In my lowest moments I see how infertility might take away everything. In my better moments, I hold out hope that when I come through this I will still be loved and able to give love.