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

Estrogen measurements during an FET

We all know that estrogen can be an issue in fresh cycles because your body is making so many follicles and saturating your body with estrogen.  (Estrogen measurements can be related to the number of mature follicles—lots of follicles equals lots of estrogen.  http://3yearwait.blogspot.com/2015/02/what-do-all-of-those-measurements.html)  Ovarian hyper simulation syndrome can be a risk (http://3yearwait.blogspot.com/2011/05/ivf-side-effects.html), and high estrogen can have a detrimental effect on chances of pregnancy success.  (http://www.ncbi.nlm.nih.gov/pubmed/24757341)

But what about estrogen in a frozen embryo transfer?  Does it even matter?  I mean, they measure it for some reason….

Six days before one of my scheduled FETs, I had an estrogen measurement of 231.  Another time it was 265.  Are those good?  Bad?

Not much appears to be written about this.

In the past, I’ve read e2 should be around 200 per mature follicle.  (That’s why estrogen can be so high on an egg retrieval cycle—lots of follicles.)  Reading non-medical sources, it appears some clinics want at least an e2 measurement of 300 to do a transfer, and prefer 500-1000, with 800 being the ideal.  My clinic looked for anything above 200, although it was not clear to me that they would not do a cycle on less than that.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2467429/

Here’s more regarding e2 measurements for a retrieval cycle:

http://paperity.org/p/73970726/the-association-of-serum-estradiol-level-with-outcomes-of-clomiphene-citrate-human

Also, here’s something that discusses estrogen:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4230061/?_sm_au_=iVVRLsPQQNDHb7WD

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2467429/

And estrogen monitoring:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2467429/

Decrease in e2 after HCG shot is bad:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415290/

Info on estrogen:

http://www.yourivfjourney.com/estrogen-why-do-fertility-patients-need-it/

More links on neural tube defects

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4825100/ (“Inositol for the prevention of neural tube defects: a pilot randomised controlled trial”)

http://hmg.oxfordjournals.org/content/18/R2/R113.full

https://academic.oup.com/hmg/article-abstract/18/R2/R113/604196/Genetics-of-human-neural-tube-defects?redirectedFrom=fulltext (“Genetics of human neural tube defects”)

More links on IVF

http://download.springer.com/static/pdf/674/art%253A10.1186%252F1477-7827-10-107.pdf?originUrl=http%3A%2F%2Flink.springer.com%2Farticle%2F10.1186%2F1477-7827-10-107&token2=exp=1461867487~acl=%2Fstatic%2Fpdf%2F674%2Fart%25253A10.1186%25252F1477-7827-10-107.pdf%3ForiginUrl%3Dhttp%253A%252F%252Flink.springer.com%252Farticle%252F10.1186%252F1477-7827-10-107*~hmac=26ec86ddb2d451ab460ea8c636c67a42e59302dfb23574ddbf65440ed82923fc (“The optimal duration of progesterone supplementation in pregnant women after IVF/ICSI: a meta-analysis”)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3341449/ (“Serum biomarkers for predicting pregnancy outcome in women undergoing IVF: human chorionic gonadotropin, progesterone, and inhibin A level at 11 days post-ET”)

http://fertilityfile.com/2008/03/25/everything-you-need-to-know-about-embryo-transfers/ (“Everything you need to know about Embryo Transfers”)

http://www.huffingtonpost.com/tina-donvito/why-i-did-7-rounds-of-ivf_b_7101700.html (“Why I Did 7 Rounds of IVF”)

http://www.ncbi.nlm.nih.gov/pubmed/25007008 (“Alcohol consumption and in vitro fertilization: a review of the literature.”)