Two Years and Counting


Laparoscopy here I come
August 26, 2008, 3:49 pm
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Yesterday was supposed to be our “risks and benefits of IVF” talk with Dr. H. M and I planned to suggest a laparoscopy to her, in hopes that she’d agree that it’s a good idea. Imagine our surprise when she was the first one to bring up the lap, and right when we sat down! Turns out, I had yet another blood test come back that showed a “borderline” high level of antibodies, this time in the aCL level—anti cardiolipin. This can point to hereditary blood clots (which isn’t a surprise given that both of my grandmothers have had strokes due to blood clots) and it can also point to possible endometriosis. (I’ve done a little more research today and it appears that women with high levels of aCL tend to have a harder time getting and/or staying pregnant, but it can be alleviated by taking daily baby aspirin.)

Anyway, I also mentioned to her that I get pretty bad cramps for 1-2 days at the beginning of my period that are alleviated with Aleve (ha, maybe that’s where they came up with the name “aleve”!) and some time on a heating pad. I hadn’t mentioned that before because I just figured cramps like that are normal–it’s not like I’m home from work for days. She said having to use a heating pad isn’t normal, and that coupled with the aCL level gives two reasons to have a lap. I didn’t even have to mention that I talked to the other doctor who suggested I have one.

I’m relieved that she thinks the lap is appropriate. I didn’t want to be asking for one when she thinks it’s not necessary. In my mind, given the aCL level and the cramps, it’s possible there’s endo there that maybe is causing some trouble. She said having a lap and removing endo only increases your chances of getting pregnant naturally by around 5-10%. This is a tad discouraging, but I have heard of and know several women who have had endo removed during a lap and have gotten pregnant fairly quickly afterwards. I’m trying not to hold too tightly to that though, just to keep my expectations in check. Dr. H. said that if they find moderate endo, they’ll remove it, then we’ll wait about 4 cycles before moving onto IVF. In those 4 cycles we can either try to conceive naturally, or go back to IUIs. If they go in and only find minimal endo, then it’s safe to say that’s not where our problem lies, and we may be back to going ahead with IVF.

The surgery is scheduled for Sept 19. Two weeks after the surgery, I’ll go back for a post-op check, and at that time, they’ll retest my aCL level and thyroid. If the aCL is still high, they’ll probably prescribe aspirin, and it may or may not have some effect on a pregnancy, should I get pregnant. She doesn’t seem to think the thyroid thing is an issue. My TSH level from Jan was very normal (1.57) so she thinks what’ll probably happen is that, due to the thyroid antibodies that I do have, at some point in my life (could be years away), my thyroid will probably stop functioning properly and they’ll put me on synthroid. Not that big of a deal.

So, that’s where we are. I’ll get a big packet of info in the mail about the lap, and I’ll have to go back in a week and a half or so to have some pre-surgery bloodwork, then I just wait til the 19th.

Hope you’re all doing well. 

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What else?
August 19, 2008, 3:33 pm
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Well, we’re adding another twist to my tale. The nurse called me late last week to tell me that one of the blood tests they did the last time I was in (when we talked to Dr H about ivf) came back showing I had elevated thyroid antibodies. They did a TSH test on me back in January that came back normal, but since these antibodies are high (54.2 and should be <33.9), they’re going to retest it next week when we go back on Monday for our “risks and benefits” discussion. She said if my TSH is high, Dr H will probably want to put me on sy.nthroid. She also said that if you’re hypothyroid, it can impair fertility and if left untreated, can increase the risk of miscarriage, but that the sy.nthroid can help that.

I did a little research on Dr. Google and found that most women with a thyroid problem should be maintained at a TSH level of between 1 and 2 to help them get pregnant and stay pregnant. I don’t know what my level was in January, but I’ll ask, and I’ll get the number of the next test. I also read that just the presence of thyroid antibodies increases the risk of miscarriage (although my dad, who’s a doctor, said having antibodies isn’t a problem, but an elevated TSH is), and that antibodies can impair conception after IVF.  

So now I’m wondering if thyroid issues have played a part in my not getting pregnant. Then there’s the question of whether or not I need a laparoscopy. Honestly, M and I are leaning towards having one. I figure, why not have a fairly routine outpatient surgery that could uncover an obstacle to getting pregnant? (I know it’s not a simple surgery, but I’m reading that many times it’s part of an infertility patient’s general work up, so it’s not out of the ordinary.) If they find nothing, then at least we didn’t leave that stone unturned in our quest to do everything possible before we resort to IVF. I know that even if we have a lap and I have a thyroid problem and get on syn.throid, that still may not resolve our issues and we may still need ivf. BUT…I do have one friend who had some issues with her thyroid, and soon after she got on medication to regulate it, she got pregnant. And also, Dr I (the doctor in my hometown who I’ll hopefully be talking to soon when he receives my medical records in the mail) said he had a patient who had no symptoms of endometriosis, had a lap, discovered she did have endo, they took it out, and she was able to conceive on her own. While I’d LOVE for one of these situations to happen to me, I figure even just the possibility of them is enough to make me pursue these two leads until I am satisfied that we’ve done all we can do.

The thyroid thing is not a huge surprise to me. My mom, aunt, and grandmother all have thyroid issues, so I’ve known for a while that I’d need to keep an eye on my thyroid. I was actually surprised when the test came back normal in January. M and I have been laughing all week, saying (half way joking, but maybe a touch serious too), “When else in your life would you actually want to have endometriosis and a thyroid issue?!” I’ve said this whole time that it’d be easier if there was a specific problem that we could fix, rather than have no discernable problem and just say we’re “unexplained.” I don’t know if these are our problems, and if they are, if they’re our only problems, but I’m anxious to find out.

(If you haven’t already, please go give Stephanie some support. She received some hard news today regarding her eggs and current IVF cycle.) 



Uplifting
August 14, 2008, 9:02 am
Filed under: Uncategorized

I wanted to share this with you all this morning. It’s a devotion I got by email today. 

Wastelands
There are dry, fruitless, lonely places in each of our lives, where we seem to travel alone, sometimes feeling as though we must surely have lost the way. What am I doing here? How did this happen? Lord, get me out of this! 

He does not get us out. Not when we ask for it, at any rate, because it was He all along who brought us to this place. He has been here before–it is no wilderness to Him, and He walks with us. There are things to be seen and learned in these apparent wastelands which cannot be seen and learned in the “city”–in places of comfort, convenience, and company. 

God does not intend to make it no wasteland. He intends rather to keep us–to hold us with his strength, to sustain us with his sure words–in a place where there is nothing else we can count on. 

“God did not guide them by the road towards the Philistines, although that was the shortest…God made them go round by way of the wilderness towards the Red Sea” (Ex 13:17,18 NEB). 

Imagine what Israel and all of us who worship Israel’s God would have missed if they had gone by the short route–the thrilling story of the deliverance from Egypt’s chariots when the sea was rolled back. Let’s not ask for shortcuts. Let’s keep alert for the wonders our Guide will show us in the wilderness.

Amen!

(I’m not sure what the rules are about re-publishing things like this so in the interest of full disclosure, I got this from the Back to the Bible, Elisabeth Elliot daily devotional.)

By the way, thanks for all the info and input about the laparoscopy. I’m still waiting on Dr. I. (the doctor in my hometown) to receive and review my records. Then I’ll go from there.



Question about laparoscopy
August 12, 2008, 8:58 am
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My former college roommate’s father is a well known fertility doctor in my hometown. My family has known him and their family for a long time. Once I got into really thinking about IVF, I decided to shoot the father, Dr. I., an email. My main reason was that I wanted his personal opinion of embryo cryopreservation. I know he’s a Christian and a very gentle man, and I wanted to get his opinion outside of being a doctor, if that makes sense. I wrote him a letter and briefly summarized where M and I were in our journey and told him what tests we’d had. I was expecting him to write a brief summary of his opinion on freezing, if I heard back from him at all (he’s a busy man, and I’m not one of his patients, so I wasn’t even sure he’d get back in touch with me.)

Well, to my surprise, he emailed me back right away and asked if I would get my doctor, Dr H,  to send him M’s and my full records so he could see for himself what’s been going on. I got the feeling he wanted to make sure we weren’t jumping into IVF without having done all the preliminary CD3 bloodwork, a SA for Matt, laparascopy, HSG, etc. I totally understand him wanting to make sure we weren’t heading for the big guns right away, especially since I think my doctor is a big fan of IVF (although I don’t feel like she pushed us to IVF at all.) I was very happy to send him our records, and faxed a medical release to my doctor yesterday to get them sent to him. I feel so blessed to have another doctor who I know and trust (because he knows my parents very well and I know he’d take care and caution in dealing with me) looking at our records. It’s not at all that I don’t trust Dr. H at my clinic or that I’m looking for another doctor (he’s in another city, at any rate) but it would make me feel much better to either have a second doctor agree with what Dr. H has said, or even suggest something else we could try. (I’d still take something else over IVF any day, if possible!) 

I wrote Dr I back and told him we’d had all our blood work and tests done, that everything had come back normal, including an HSG, but that I didn’t have a laparoscopy because nothing yet had pointed to endometriosis and that I was hesitant to have a surgery that may be unnecessary. He wrote back and his reponse to my comment about the laparoscopy was that most patients would have a lap or a hysteroscopy before being given the label of unexplained IF. He said often the only sign of endometriosis or pelvic adhesions is the inability to conceive.

So, this brings me to my question. Those of you with unexplained infertility who have done IVF or are thinking about it, did you have a laparoscopy to rule out endo other other bad things before IVF? I still don’t want to have an unnecessary surgery…but then again, if, just IF, the surgery showed endo or another issue that could be resolved without IVF, I would be a happy girl. Surgery is less expensive than IVF…but then again, it may not show anything. Is it worth it? Do any of you have any thoughts about it?

Thanks!



Onward
August 8, 2008, 11:55 am
Filed under: Uncategorized

Sorry I haven’t updated in a while. I’ve been writing furiously in my journals and just haven’t gotten around to writing here. Plus, for some reason WordPress won’t let me post new entries on my computer at work (probably a good thing!) and since I’m on the computer all day at work, usually the last thing I want to do when I get home at night is pull out the computer again! So anyway, here I am.

M and I had an appointment with Dr. H on Monday to discuss the zillion more questions I had about ivf. If you remember, after our last discussion with her in May in which she suggested ivf as a next course of action for me, I left the meeting feeling pretty teary. We resolved to spend the summer thinking about the procedure and praying about it, and basically figuring out where we stand. I agonized for a long time, feeling the pressure to just “Decide!” I finally realized that I couldn’t just make the decision, that God was going to have to move me to a place where I was able to say, “Yes, let’s go forward with ivf,” or “No, this isn’t something I can do.” I knew M was for it. He didn’t want to even think about adoption until we’d tried ivf at least once, just to know we tried all we could to have our own child. I agreed with him, but I continued to be hung up on the drugs, the ethical issues, the overall scariness of it all.

As the weeks went on, I just decided to put it all out of my mind. I continued to pray and dwell on verses that told me God would not forsake me, that God gives wisdom when we ask for it, and that all his workings are for my good. I had great conversations with a select few friends who know what we’re going through and I knew they were praying for us and our decision.

So, Monday rolls around and I wake up with my stomach already in knots. I just didn’t know how I would react to the meeting. I hoped it wouldn’t be a repeat of the meeting in May. But the thing is, I left feeling much more at peace and ok than I really ever expected. It’s sort of hard to explain without it sounding like I had a complete 180 turn in the span of 2 hours. And really, that’s not it. I had prayed so much leading up to this appt that God would use the appt to show us what he wanted us to see and hear, that our hearts would be soft, that I’d feel guided in a direction–any direction! I even prayed that he’d use Dr H and have her speak the words he wanted us to hear. Now, I can’t say that happened for sure. When I talked to a friend a few months ago who went through ivf to have her son, I prayed then that God speak to me through her…and after that discussion, I didn’t feel any better because it turns out she sort of went into it full steam ahead and didn’t have any of the concerns I did. So who’s to say that God did or didn’t use her to speak to me.

Anyway, Dr. H was just really warm and encouraging, and for every issue I brought up, she had a reason why I could be calm about it and feel a little better about it. (Turns out that while I had a lot of legitimate concerns, some of my concerns were based more on what I got from random google searches than based on fact!) She didn’t poo-poo my concerns or made me feel like I was crazy for having those concerns, she just explained the facts of the process more clearly to me. I told her right off the bat that M and I are Christians (I couldn’t remember if I told her that before) and that we had concerns that maybe other couple wouldn’t have when going through ivf. She said she’s a Christian too (which I figured from the first time we met with her, and Steph verified) and she explained why she’s ok with ivf and where her beliefs stand in regards to it. I went through my list of questions and was pretty satisfied with all her answers. We even talked about the number of embryos we’d want to fertilize, acknowledging that we’d only want to transfer one at a time. (M and I will talk more about that in the coming weeks and months.)

When our talk was over, she said we’d schedule another visit so we can have the “risk and benefit” talk, and I needed to have a couple of blood tests–some sort of lupus test and an antibody test. Not sure of the details. It’s just another stick in the arm for me! We also started the ball rolling on insurance pre-approval. It stinks because I have the coverage for ivf (or at least a good portion of it) but they really don’t want to pay for ivf unless they have to. They (the ins. company) wants us to be able to show them documentation that we’ve been trying to conceive for 24 months before they’ll pay for ivf. I guess that makes sense from an insurance point of view. It’ll officially be 2 years in January. But the hang up is that I didn’t tell my obgyn that we were having trouble until last July. So they could feasibly come back and say they won’t cover ivf until next July…which would be a big pain since we’re now fairly ready to do it. I’ll just pray that God will continue to have his hand in this and that if we are to go forward with it, that he’ll pave the way.

I was going through all this with my mom a couple of nights ago, and I explained it to her in this way–and I didn’t even realize this was how I felt until I put it into words–I feel a sense of relief. I have felt lighter this week since our meeting. I spent the last two and a half months having no idea where we were going, feeling really unsteady not knowing what our next step would be, and sort of feeling like all the pressure to decide was on my shoulders. I now feel like I can see the next step. It’s like the idea that God only illuminates one step ahead on the path, but not the next 10 steps. I now can see a little bit of light showing me our next step. And I’m relieved. A friend’s mom did ivf several times and it never worked, so she moved on to adoption. She’s been waiting for a baby from China for three years, but I’d imagine she felt some relief when, after all the failed ivfs, they decided they were going to adopt. They saw light illuminating their next step.

I’m still worried about some things with the process, and by no means is ivf what we want. We don’t WANT to have to do this. But we’re eager to expand our family, I have a job that affords me a lot of sick and vacation time that I can take, I have a boss that will work with me on taking time off, I have good insurance coverage, I have a solid support system around me and I know I won’t be going through this alone…all these things add up to this being the road for us. That, and I feel fairly at peace with it. (And I say “fairly” because, again, this is not the road we’d have chosen for ourselves, but my hesitations and big concerns have been lessened.) I am now seeing ivf as an option for people who have trouble getting pregnant. Much like the sick person may need to take drugs, have major surgeries, or other interventions to get well, this is an option for us to help what may be a medical issue. It’s not 100% necesary–I could opt to not do it, but there is a chance it could work. I believe God will be completely in charge, and if he desires us to have our own child(ren), it will happen in some way. It just may be through ivf, but it may not be. (I’m also praying that God will make ivf unnecessary!)

We still do have the risk and benefit meeting with Dr H and I suppose I could freak out when she tells me the risks, but I’m going to trust God to either continue to give me peace, or give me a huge hesitation or check in my spirit that makes me say No Way. I just want him to be clear with me!

So that’s where I stand. Thanks to all of you who’ve been thinking about me. The personal experiences you’ve shared on your blogs have really helped me a lot in figuring out what I want to do. And it’s always so reassuring to hear of other people who are in a similar situation.

Have a great weekend!



Office Woes
August 3, 2008, 7:06 pm
Filed under: Uncategorized

(I wrote this during the day Friday…)

Oh my gosh, these 2 ladies in my office! I don’t think I’ve written about them here, maybe on my other blog. Anyway, aside from the comments they always make about my size, one of them is always making comments to this pregnant girl who sits on the other side of the cubicle wall from me. The lady is being nice, as in, not trying to be mean, but from what pregnant friends have told me, sometimes you just want people to keep ALL comments to themselves when you’re big, hot, and irritable. She (the lady) just came into the girl’s office and said, “Oh you’re looking cute, your face has filled out now. It’s cute.” I mean, seriously. What girl wants to know her face has filled out! I admit, I’m sort of looking forward to gaining pregnancy weight (if for no other reason that it’ll mean I’m actually pregnant!), but not in my face! I can’t imagine it’s nice to hear that you have a FAT FACE when you’re 8 months pregnant!