Reflections

Yesterday was the last day of National Infertility Awareness Week.  It was also the one year anniversary of the day we found out that our final pregnancy had ended and our dream of having another child was over.

I reflected that April, and particularly the end of April, tended to be a rough time for us, at least since we started trying to have a child.  We’d been doing fertility treatments pretty constantly for the last few years, and had more than a few unpleasant events, so it’s not surprising that our Aprils included some bad news.  Of course they were not all bad, but did tend to be, well, kinda bad….

·        On this day April 2009 – We had just started TTC, and I was very newly pregnant but did not know it.  A few weeks later I would Google “ectopic pregnancy” for the first, but not last, time.

·        On this day April 2010 – I was cleared to try getting pregnant again, and was in the process of measuring my basil body temperature, doing acupuncture, and taking lots of failed pregnancy tests.  After a miscarriage at the beginning of 2010, I would start seeing a fertility doctor in September.

·        On this day April 2011 – I was in the midst of my first IVF stim cycle, with a transfer in May.

·        On this day April 2012 – I was hanging out with my new baby.

·        On this day April 2013 – I was hanging out with my 1yo baby.

·        On this day April 2014 – I was at the end of the 2WW of my second IVF cycle.  I would end up pregnant, but there would be no heartbeat at the 6 week appointment.

·        On this day April 2015 – We were 14 weeks pregnant, but would find out a couple weeks later our baby had anencephaly.

·        On this day April 2016 – 1 year ago yesterday, after heartbreaking 12w appointment where we found out our little one was very, very sick, we found out she had passed away.  With her died my dream of having a second child.

Fortunately, the cessation of fertility treatments/pregnancy attempts appears to have given us a reprieve and, I am happy to report, we had a lovely month and particularly nice day yesterday.

If I could go back and give myself some advice when I was going through fertility treatments, here’s what I would say

·       Realize it might not work (but it does for more people than it doesn’t!)

·       Use the money you’re saving on alcohol to treat yourself to some nice self-care products (I’m partial to Lush bath bombs)

·       Since you’re probably not going to want to buy new clothes for a while, and you’re going to be hanging around in hospital gowns from time to time, consider investing in a few pairs of really nice underwear (my recommendation? Hanky Panky)

·       Wait the full time to read a pregnancy test.  If it says read 3-10 minutes, read at three minutes, and then read again at 10 minutes.  (I cannot emphasize this enough….)

·       If you manage to get pregnant, have someone with you at the first heartbeat appointment and the first ultrasound appointment

·       Be gentle with yourself and others

·       There are lots of ways to build a family

·       This won’t last forever

·       Someday you’ll be happy again

My stats

	Date pregnancy ended or delivered	Treatment	Embryo Quality	Lining	Outcome
1	April 2009	None			Ectopic
2	January 2010	None			Early miscarriage (appears ectopic)
3	April 2010	None			Undiagnosed early miscarriage
4	Jan 2012	IVF – fresh	day 5 B2	8B	Vaginal delivery – full term
5	May 2014	IVF – fresh	day 5 B2	8B	Blighted ovum
6	August 2014	IVF – frozen	day 6 B3	11B	Not pregnant
7	Oct 2014	IVF – frozen	day 6 B3, hatching	10B	Early miscarriage (HCG 131@16 dpo, 190@18dpo)
8	June 2015	IVF – fresh	day 5 B2, hatching	11B	Termination at 17 weeks (anencephaly)
9	Oct 2015	IVF – frozen	day 6 hatched B2, chromosomally normal	8B	Chemical pregnancy (HCG 2)
10	Nov 2015	IVF – frozen	day 6 hatching B3, chromosomally normal	7.7B	Chemical pregnancy (HCG 1)
11	May 2016	IVF – frozen	day 6 B3, chromosomally normal	8.5B	Miscarriage at 12 weeks after poor spinal ossification and omphalocele diagnosis

Cycle	Eggs	Mature	Fertilized	Day 3 Embryos	Day 5/6 Blastocysts
May 2011	16	11	10	?	·  Day 5 B2 – full-term baby ·  Day 5 B3 (frozen) – accidentally destroyed ·  Day 6 B3 (frozen) – accidentally destroyed
April 2014	17	14	11	7	·  Day 5 B2 – blighted ovum (no heartbeat at 6 wks) ·  Day 6 B3 (frozen) – survived thaw, no pregnancy ·  Day 6 B3, hatching (frozen) – survived thaw, early miscarriage ·  Day 6 early B3 (still frozen)
Feb 2015	14	11	10 (ICSI)	8	·  Day 5 B2, hatching [girl] – anencephaly, terminated at 17 weeks ·  Day 6 B2, hatched [girl] (frozen, chromosomally normal) – survived thaw, chemical preg ·  Day 6 B2 [boy] (still frozen, chromosomally normal) ·  Day 6 B3, hatching [girl] (frozen, chromosomally normal) – survived thaw, chemical preg ·  Day 6 B3 [girl] (frozen, chromosomally normal) – survived thaw, miscarriage 12 weeks after omphalocele, poor spinal ossification, and umbilical cord cyst ·  Day 6 B? [boy] (chromosomally abnormal – chromosome 11)

One more link on subchorionic hematomas

http://community.babycenter.com/post/a22280651/how_quickly_can_a_sch_resolve

Post-miscarriage/pregnancy loss weight loss

I can speak both from experience and from anecdotes of what my friends have experienced that losing weight after pregnancy loss SUCKS.  Seriously, it sucks.  For me, it took over a month of very careful eating and serious exercising to see any kind of movement on the scale, and the weight loss was very gradual.  But I can also say that, once it started to come off, it did come off.

I didn’t really try to lose weight after my pregnancy with my son.  I ate healthy and breastfed, which allowed me to lose most of it, although those last 5 lbs were very stubborn.  I assumed that I would have another kid and was not focusing too much on having the perfect body.  So I was carrying a little bit (not a ton—5+lbs) of weight beyond what my ideal would have been when I got pregnant again.

With my anencephaly pregnancy, it took me 17 weeks to gain around 15 lbs (bedrest/stress eating), and then 9 months of working out VERY HARD (just about every day, doing a lot of Insanity/T25—Shawn T was my friend) to lose those 15 lbs plus the 5 lbs I’d been carrying around.  At the end I looked amazing and was rock hard because I lost 20+lbs of fat and gained a ton of muscle.  Of course, then I just got pregnant again. 

With my omphalocele pregnancy, it took me 12 weeks to gain 10lbs (stress eating and all but bed rest=buh-buh rock hard body).  It then took me 5 months of working out pretty hard (marathon training) to lose the weight, and then two more months to get down to my adult-low (freshman year of college) weight.  It was easier to lose the weight this time than last time because I’d started at a lower weight, was in better shape, and had less to lose.  And, most importantly, I had a good plan in place (thoughtful eating and massive exercising) because I had just done it.

My weight loss journey was not easy, by any stretch, but I did it.  And my husband (who never had the ups and downs I did but nevertheless did a fair bit of sympathy/stress eating of his own!) got into the fitness groove as well.  Both of us are now in the best shape of our adult lives.  It might not be super fun and it definitely won’t be fast, but if you are looking to lose weight after a pregnancy loss, you can do it. 

CCRM protocol

When I talked to Colorado Center for Reproductive Medicine, I understood my protocol would look something like this:

·       No exercise

·       No dieting

·       No alcohol

·       No caffeine (entire pregnancy)

·       Try to limit work to 55 hours or less

·       Vitamin cocktail, depending on your particular needs

·       Acupuncture

·       No travel after implantation for 6 weeks

·       Tested thyroid levels after implantation and potentially take a syntheroid

·       10 mg prednisone starting 2 days after transfer, start weaning slowly at 6 weeks 

·       Low dose aspirin entire pregnancy

·       1ml progesterone in oil every other day for 9 weeks

·       Medrol (a low dose steroid) 16 mg starting with progesterone for 4 days

·       Antihistamine treatment (Claritin and Pepcid) with the steroid for 12 weeks and then stop

Natural Killer Cells / “alloimmune implantation dysfunction” / “autoimmune Implantation Dysfunction"

Here’s post 2 of 2 on some of the more “pseudo-science” infertility issues: natural killer cells / “alloimmune implantation dysfunction” / “autoimmune implantation dysfunction”.

http://haveababy.com/fertility-information/ivf-authority/understanding-immunologic-implantation-dysfunction_16-2

I’ve read about “NK” (natural killer) cells (it sounds like something made-up, doesn’t it?), and I found an article that gives some background on them:

“Natural killer cells acquired their name as a result of the initial test used to identify them in vitro…. Regrettably, this is a misleading name in reproduction, and the powerful image of maternal cells attacking the fetus is emotive and easily exploited.”

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC534451/

The article concludes that, at least as it relate to NK cells, there is no evidence to support use of steroids (such as prednisone):

“Infertile women and those with recurrent miscarriages are being given treatments such as steroids, intravenous immunoglobulin, and tumour necrosis factor-α blocking drugs with the questionable aim of suppressing NK cells. Recent high profile radio and press reports have featured a UK trial of steroids in recurrent miscarriage that has not been published but claims a success rate of about 85% (Woman's Hour, 29 Jan 2004).14 How this study was controlled is uncertain, but it is important to bear in mind the placebo effect and the well documented success achieved with such patients simply using care and reassurance.15 Neither steroids nor the other treatments being offered to women with “raised” levels of NK cells in blood are licensed for use in reproductive medicine, and all these treatments are associated with known risks to mother and fetus. The treatments are offered despite recent guidelines from the Royal College of Obstetricians and Gynaecologists, a Cochrane review, and a meta-analysis all concluding that there is no evidence to show they are beneficial.”

Here’s another study talking about: “peripheral blood NK cells of women with [repeated spontaneous abortion] and infertility of unknown aetiology have higher proportions of activated NK cells in vivo.”

http://www.ncbi.nlm.nih.gov/pubmed/11331628/

See also http://www.ncbi.nlm.nih.gov/pubmed/7752757/

“Multiple studies have shown an association between high density of uterine natural killer cells and recurrent miscarriage. We have shown that prednisolone reduces the number of uNK cells in the endometrium. The question remains as to whether reducing the number of uNK cells improves pregnancy outcome.”

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2785777/

“Embryo implantation and early pregnancy development occur in a relatively hypoxic environment (2-3% O2) [12]. Inappropriate blood flow to the intervillous space has been associated with oxidative stress damage to the developing placenta and thus miscarriage [13]. UNK cell density in women with recurrent miscarriage was found to be positively correlated with endometrial angiogenesis and uterine artery blood flow [14]. A similar positive correlation was also found in women with unexplained recurrent failure of in-vitro fertilisation (IVF) [15]. Thus, we have proposed that increased uNK cell density is associated with increased number of spiral arteries which may lead to inappropriate blood flow to the developing foetal-placental unit causing oxidative stress and consequent miscarriage [14].”

This study wants to do a trial on prednisolone use.

Here’s another article that suggests that 20mg prednisolone reduces UNK cells:

http://www.ncbi.nlm.nih.gov/pubmed/16213853

Here are some other links:

http://www.inciid.org/node/137

http://drgavinsacks.com.au/wp-content/uploads/2013/12/PredCaseReportRevised.pdf

http://haveababy.com/fertility-information/ivf-authority/understanding-immunologic-implantation-dysfunction_16-2

Antinuclear antibodies (ANA) / Anti-thyroid antibodies / antiphospholipid antibodies (APA) / antiovarian antibodies (AOA)

Here’s post 1 of 2 on some of the more “pseudo-science” infertility issues: antinuclear antibodies (ANA), anti-thyroid antibodies / antiphospholipid antibodies (APA), and antiovarian antibodies (AOA).

This article suggests that in a small study of women with antithyroid autoimmunity, “pregnancy rate was 33.3% (8/24) among women treated with prednisone [starting 4 weeks before IUI] compared with 8.4% (2/24) among women who received placebo …. In the antibody-negative group, the pregnancy rate was 8.0% (4/50). Among the pregnancies, the miscarriage rate was 70% (7/10) versus 75% (3/4) for women with or without antithyroid antibodies, respectively (P = NS); the miscarriage rate was 75% (6/8) for women treated with prednisone versus 50% (1/2) for women taking placebo (P = 0.49). No adverse effects were reported.”  In other words, prednisone works for women with antithyroid autoimmunity.  But yikes, that’s a high miscarriage rate!  

http://www.ncbi.nlm.nih.gov/pubmed/21353109

This article suggests “Anti-nuclear antibodies (ANA) are suspected of having relevance to adverse reproductive events. . . . These observations suggest that ANA could exert a detrimental effect on IVF/ICSI outcome that might not be titre-dependent, and [prednisone plus low-dose aspirin] adjuvant treatment could be useful for ANA + patients.”

http://www.rbej.com/content/11/1/98/abstract

This article suggest “Anti-thyroid antibodies (ATA), even if not associated with thyroid dysfunction, are suspected to cause poorer outcome of in vitro fertilization (IVF). . . . euthyroid ATA+ patients undergoing IVF could have better outcome if given [levothyroxine, acetylsalicylic acid, and prednisolone] as adjuvant treatment”:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2788572/

This article suggests that pregnancy rates are very low in non-treated ANA-positive women (0%) and were higher when women were treated with prednisone:

http://www.ncbi.nlm.nih.gov/m/pubmed/16050562/

Here’s another one that says the same thing:

http://www.ncbi.nlm.nih.gov/pubmed/8313738

Here are some other links:

http://www.bloodjournal.org/content/117/25/6948?sso-checked=true

http://www.ncbi.nlm.nih.gov/m/pubmed/9848293/?i=3&from=/16050562/related

http://www.ncbi.nlm.nih.gov/m/pubmed/16050562/

http://apps.who.int/rhl/reviews/langs/CD002859.pdf

http://www.biomedcentral.com/content/pdf/1477-7827-11-98.pdf

http://link.springer.com/article/10.1186%2F1477-7827-11-98

http://www.clinicaltherapeutics.com/article/S0149-2918(11)00011-7/abstract

http://www.ncbi.nlm.nih.gov/pubmed/21527518

https://mylifeasacasestudy.wordpress.com/tag/ana/

http://www.ncbi.nlm.nih.gov/pubmed/8313738

http://www.cochrane.org/CD002859/PREG_prevention-of-recurrent-miscarriage-for-women-with-antiphospholipid-antibody-or-lupus-anticoagulant