What it Takes

My mind is blown.  After years of trying and saving and desperate pleas to God I am at last standing here with a GIANT box that is filled with the makings of my future baby/ies.

THIS is what it takes for me to have a child...  I don't know whether to laugh or cry. I know this isn't my first cycle, but really, this is the first "REAL" cycle. This is the first time I got to meet the Fedex guy carrying my giant box of meds instead of hanging around the RE's office waiting for labs to determine if I get to return home with the next batch of drugs.  My last cycle was really only Lupron, Gonal F, Ovidrel and Crinone (aside from antibiotics, valium and that blasted enema). We won't order our Lupron until closer to start, so that isn't pictured here.

 

Here's what is in each pic:

Crinone x 2 boxes
Follistim Cartridges x 4

Menopur Mixing vials

Doxycycline
Prednisone
Diazepam
Estradiol
(And peeking in at top left, my needles)

 

Here we have:

Meopur vials again

Follistim pen and handy carrying case (boxed)

Syringes
Q caps

And lastly:
- Novarel
- Syringes
- Q caps again
-Alcohol wipes
- Biohazard container

Awesome... making a baby (for me) requires the use of a biohazard container.

Honestly though... This box mostly makes me so ridiculously, incredibly happy!  I didn't think I would EVER make it this far.  We were so sure that we'd never be able to do another cycle if the trial didn't work and yet by the grace of God here I stand with a box full of medication standing on the doorstep of another cycle. We are blessed!  I am grateful.

T minus 11 days till CD1 (hopefully)

(Some) Results Are In

I just got the call.  SOME of the blood work is back.  Well, the ones I was most concerned about are back anyway....

First a trip down CD3 test memory lane:

DEC, 2012:
AMH: <0.16
FSH: 19.8
E2: 17

MAY, 2013:
AMH: 0.28
FSH: 10
E2: 23

"NORMAL":
AMH: 1-3
FSH: 3-10
E2: 25-75



*drumroll*




JAN, 2014
AMH: <not tested>
FSH: 8.9
E2:  50.1

HO-LEE-CRAP! My FSH and my E2 are now what they would consider to be "normal"!?!  My December 2012 readings were such that my RE opened the conversation with a recommendation of donor eggs.  "No point wasting money trying with your own.  These numbers do not bode well for you."

AHHHHH!!!!  I want to run around this office nekkid yelling at the top of my lungs!

Still Prolactin and Thyroid results to come, but I've never had any concerns around these two, so not super concerned... Of course now I've said that THIS is where the problem will be.  Erg. Infertility man. 

New Year. New Us. New Home. Oh... and the trial has started...

Yep!!!  We called last week to check in and make sure that the trial was still going to happen as we hadn't heard anything in a LONG time.

Nurse: "Oh yeah, the trial has started."

Mr. R (with me listening in): "Ummm... so... ummmm..."  *Looks at me expecting a full-scale meltdown of tears and drama.*

Nurse:  When can y'all come in to sign consents?

Mr. R: "So we're still IN???" Then to me, "WE'RE STILL IN!!!!"

I started my period late Sunday night and called on Monday to schedule CD3 testing for the next day.

So here's what I know so far:

1)  The trial is comparing a new antagonist with Gonal-F.  I will either be part of the control group using Gonal-F, or part of the test group using the new product -- name escapes me, and I don't have paperwork with me at the office.   

Some of you may balk at my lack of knowledge around this drug that I am allowing them to pump me full of... but those of you in a similar can't-pay-for-even-one-IVF-cycle-on-our-own boat will understand... "You want to inject me directly with urine from some post menopausal nuns but I get a cycle of IVF for free?  Sure. Where do I sign?"

2)  The trial required that I have more than 10, but fewer than 20 on my AFC.  I passed this phase with flying colors.  (Huzzah!  My repro system did SOMETHING right for once!!) Mr. R was the only one conscious enough to pay attention to numbers... I was just so deliriously excited to be in there with the dildo-cam that I didn't hear a word out of the nurse's mouth.  (Yes, I said deliriously excited and dildo-cam in same sentence.) Per Mr. R's memory my AFC was 8 on Rt and 9 on left so 17 total.  Phew!

3)  I also had a blood draw and we're waiting on the results of that to see if I squeak in and can participate.  They need my FSH to be no higher than 10 [Edit: correction 15].  As you can see from my two previous tests my FSH numbers can vary greatly.  19.8 back in Dec of 2012 and 10 in May 2013.  So we have all kinds of prayers, fertility dances, candles, etc lit that my body plays along again and shows them a number they will accept.

4)  I also have to have an updated HSG and I am ashamed to admit that while my lady parts have been incessantly poked and prodded over the last year, I am overdue for a pap, so that needs to happen as well.

Now for the good news... I am actually as we speak taking the first of the drugs I will be required to take to start this cycle.  Okay, so it's only birth control... but it's seriously the furthest I have been so far in this journey and I was so excited to take that little pill this morning I could have cried.  I feel like I am actively doing SOMETHING!!!

Of course on Friday my results could come back with an FSH reading of 20 and I could be out of the trial in one swift second... but for today I am enjoying this TEENY TINY thing.  It's a step forward and I have GOT to celebrate this.

Taking a DHEA Break

Urg... I was going to save the next supplement update for 2 weeks time and give you a full month feedback but this change came with such a dramatic hormonal performance I feel like I should add this in right now so everyone is aware of this potential side effect.

I mentioned in another post how I started feeling a little more emotional than normal, but I figured it might just be DHEA, a little PMS mixed in with an emotional day (Father's Day) and lack of sleep.

Last week I was bouncing off the walls with emotions.  Literally up one second and down the next and then crying, then angry and then outrageously happy or excited.  By Saturday I was a mess.  I was having panic attacks, crying -- I mean SOBBING -- at the drop of a hat and one minute I felt like I wanted to slap Mr. R and the next I wanted to hug him and just cry.  Bless him he was so patient in dealing with me and it gives me hope for how he will be when it comes time to hit the hormones for treatment, but really  this was NOT fun.

I am convinced that it is related to the DHEA and so I stopped taking it on Saturday.  Yesterday (Sunday) I felt a bit better, not as emotional and today (Monday) I feel better still.  More in control of myself.  I plan to give myself a week long DHEA break and then maybe bring it back at a lower dose, and go for a week on, and then a week off, and repeat like that until we stim.  Dr. C has already told me no DHEA after we get started.  He's not a big fan of the stuff.

Anyway, if anyone out there is following along with the supps I am taking, I would advise you to keep a close eye on the DHEA because WOWZA did it ever cause a reaction in me!

Supplement Cocktail - 2 Week Update

Today I finally got my order in and have added wheatgrass, Maca and Chaste Tree (Vitex) to my daily supplements.  I've already learned that PB protein shake and wheatgrass should never, NEVER be mixed together... under any circumstances!  Awful stuff.  But given the price of wheatgrass I gulped it down like a good girl anyway. :) 

As a reminder, here's what I am currently taking daily:

CoQ10 - 800mg/day
DHEA - 75mg/day
Royal Jelly - 456mg (concentrate) / day. If you have the jelly itself you need 1500mg/day
Fish, Flax, Borage, Omega 3,6,9 - 2 caps/ day
Melatonin - 3mg/day
Prenatal Vitamin - 1/day
L-Arginine - 1 cap 3x/day
Black Cohosh 3 caps/day
Ginseng - 1 cap/day
Thai Ginger- 1 cap/day
Vit D3 - 1000mg / day
Baby Aspirin 1/day
Red Raspberry Tea - 1cup/day

I have now added:

Maca - 2 caps/day
Vitex - 2 caps/day
Wheatgrass - one shot/sachet

Still waiting on :

Myomin
Pregnitude

Actually, I've been taking my other mother-load of supplements for close to two weeks now and I haven't yet mentioned anything about what I am feeling as a result, aside from this post where I thought maybe the DHEA was partly to blame for my agitation.

Really there hasn't been much to note.  I suppose I have been noticing more "twingy" feeling in that general area, but then I am more focused on it than normal. 

I can definitely say that this has been the most painful period I've had in a while, and for someone with endometriosis that's saying something!  This month has been the kind where you get up at night and pace and cry and rock yourself back and forth and give in and take a hydrocodone to numb the pain.  This may be TMI... but it's important for me to track this... I am usually a clotter.  Every period is just horrendous with the large clots but this cycle (maybe from baby aspirin) the clots have been MUCH smaller, but the flow has been heavier. 

My skin has been a little oilier than normal, and I have super oily skin to start with so I am not enjoying that.  Also I have had a small break out, not unusual for me at this time of the month.  I will keep an eye on it and let you know if it continues past this week.

Other than the above my nails are growing long and strong as you'd expect and thanks to the melatonin I am sleeping deep and full of crazy dreams.  Oh!  And I have definitely been more energetic and am getting more done in the day -- but then this has been ramping up slowly with my weight loss as well.  I kind of feel half as though I am "nesting".  Clearing out closets, and cleaning behind large pieces of furniture.

I'll check back after a full month with a recap, but so far I am not experiencing anything that would deter me from continuing to take this cocktail of supplements at all. Everything has been mild, apart from my cramps - but they suck anyway. On the flip side, I am also not experiencing anything that leads me to believe that this wonder-mix is working it's magic.  We're going on blind faith here people... isn't that pretty much ALL we do in dealing with infertility? 

Goals: #3 Improving Egg Quality

Let's take a quick peek at where we've been before we look at Goal #3.

GOALS:

1)  Financing.
2)  Improve AMH
3)  Egg Quality
4)  Research protocols for DOR

IMPROVING EGG QUALITY

In my situation, and according to Dr. C, my egg quality is not a concern however I have read enough sad stories of ladies with DOR who only got 4 eggs and they were all of poor quality - despite their young age.  At 34 I know I am no longer in my baby-making prime, but according to the good doctor I am not quite yet a shriveled old hag, in spite of what my empty ovaries would have you believe.  This middle ground is one of the things that concerns me in all of this.  If I was 25 they'd say "You're young!  They'll be perfect!" If I was 45 they'd say, "You're older and so we're not expecting beautiful eggs." At 34 opinions vary from doctor to doctor. Being the OCD perfectionist that I am, I'm going to take precautionary measures just in case.

Look, as I've previously mentioned we're killing ourselves to come up with money for this one cycle.  Dr. C provides unlimited FET, but I do not anticipate having any spares for freezing. Those of us for whom IVF is a luxury well beyond our budget ALL say, "I have this one shot." But those of us on a shoestring budget AND who have DOR really may only have ONE shot.  There will be no extra eggs for FET, one single try.  You're in, or you're out.  (And really... the interwebs, have shown me that I might not even get the one try I am hoping for.  If I only get three eggs, and none of them are good, or don't develop properly, that's it.  I am out before I even get started.)

But, I digress... egg quality.  We want them plump and healthy and ready to get to work.  We want them perfect.  P-E-R-F-E-C-T! But how?  I'll collate all the tips I have learned in one place, but first I want to give the sources a moment in the sun... (Speaking of sun... how are you doing on that Vit D for increasing AMH?)

Ready for some linkage?  Here it comes.

One in Ten Million - Blog
So here's (in my opinion) the creme de la creme of resources for those of us with DOR, or POF. Cole Jeanette is one tenacious lady and she has, in 4 short months, taken her body from a 1 in 10 million chance of falling pregnant to pregnant with twins.  *Gasp!* I know!!!  She lists EVERYTHING she took and alternative therapies she tried on her blog and gives clear, easy-to-follow instructions on anything that you will need to "MacGuyver" at home for yourself. This is my number one recommendation.  If you read nothing else I post, definitely go and read just this ONE blog.  You'll learn a lot! (and you'll notice how many of her suggestions are in my list below)

Natural Fertility Info
I know, here I go with the "touchy feely" sites again, but despite the name this site is very explanatory.  I thought I knew all there was to know about my ovaries and the eggs therein from Bio class in school.  Boy was I wrong.  Lot's of interesting information here and great clear diagrams.  Also some hints and tips on how to naturally  improve your egg quality in 90 days.

News Medical
This isn't a pretty, easy to use site and they don't focus on fertility specifically, it's more general medical.  But I found this article on the use of Melatonin to improve egg quality to be very interesting and I wanted to include it.

The Magic List

At this point you may wish to grab yourself a cup of coffee and a note pad, oh and a full pen... I am talking brand new, fully stocked with ink.  The list is long.

SUPPLEMENTS

I'll start off with the ones I am taking.  Note that some of these are dual-purpose and were mentioned in my previous post about increasing AMH.

CoQ10 - 800mg/day
DHEA - 75mg/day
Royal Jelly - 456mg (concentrate) / day. If you have the jelly itself you need 1500mg/day
Fish, Flax, Borage, Omega 3,6,9 - 2 caps/ day
Melatonin - 3mg/day
Prenatal Vitamin - 1/day
L-Arginine - 1 cap 3x/day
Black Cohosh 3 caps/day
Ginseng - 1 cap/day
Thai Ginger- 1 cap/day
Vit D3 - 1000mg / day
Baby Aspirin 1/day
Red Raspberry Tea - 1cup/day


Here's how 1 full day's intake looks (Actually, I have added some stuff since these were taken):

Some others (slightly more difficult to find if you live out in the country like me, but I have ordered them and am waiting on delivery.)

Wheatgrass
Chaste Tree (AKA Vitex)
Maca
Myomin
Pregnitude (easy to find this one, online only, but too pricy for me right now, and I am concerned about taking this WITH my existing prenatal before I speak with Dr. C again)

THERAPIES

Fertility acupuncture
Fertility Yoga
Fertility Massage
Mayan Fertility Massage (Difficult to find a qualified practitioner on this one)
Castor Oil packs

Goals: #2 Improve AMH?

Today I'm going to get into Step 2 of my Goals list.  As a reminder, here's the list again:

GOALS:

1)  Financing.
2)  Improve AMH. NEED MORE EGGS
3)  Egg Quality.
4)  Research protocols for DOR

So, yeah, improving AMH levels... Impossible right?  I was told as much by Dr. C however I proved him wrong in 4 short months by losing weight, eating clean, drinking 1gal of water per day and adding Fish, Flax, Borage, Omega 3,6,9 oil supplements.  I increased my AMH from <0.16 to 0.28 -- now I realize that those of you who don't have DOR will look at that and laugh at the "improvement" but my DOR girls will know what a big deal ANY improvement on that number is.  It IS possible.  I've already done it once.  I WILL do it again. Mark. My. Words.

There are few good sources of info on improving this online.  I will link to what I consider to be the best below.  (Actually, I think for convenience I will add a link list to my sidebar which will include ALL helpful links that I post about.)

The one I've seen posted about most frequently is Dr. Malpani and I think it's because he gives the clearest list of supplements/steps to take.

Here's what Dr. Malpani recommends:

1. Yoga
2. Acupuncture
3. ** DHEA, 25mg thrice a day. (tee-hee I love a man who uses "thrice")
4. Wheat germ daily
5. CoQ 10, 100 mg daily
6. Vit D3 ( Calcirol), 60000 IU, once a week for 10 weeks

In this article on FertileHeart.com the writer doesn't give much weight at all to AMH levels calling them unreliable.  She goes on to state that weight loss can improve these numbers.  I am inclined to agree with her on this part.  I've proven it myself, 40lbs down = an improvement of at least 0.12 points. Okay, so I've not solved the puzzle completely but given that "ideal" is 1-2, I'd say that's a pretty good leap, no?   In a more recent article she recommends a Vitamin D supplement and calls Vit D deficiency a "virtual epidemic".  Living in one of the sunniest states in the nation I have never been concerned with a lack of Vit D, but if it's being recommended by at least two sources I am going to give it a go.  Can't hurt, right?  I can also say that at first CD3 test in December, 2012 I was pretty much indoors all the time and seeing as how I have worked nights for two years I don't really spend a lot of time in the sun.  At time of second test in May, 2013 I was walking outdoors on a track in the sun almost daily in the afternoon for a minimum of 1 hour.  More sun = more Vit D = improved numbers.  It might be a bit of a stretch, but I can see that.  Be advised the FertileHeart site is very "new agey" and "touchy feely" in nature, but they do have some very interesting articles and I value and agree with their opinion on this.

Natural Fertility Info is another great resource site with natural supplements you can add to your regimen to support your body's natural functions and nourishing the edocrine system.  They make no claims that their suggestions will miraculously cure your low AMH. That being said, a number of the suggestions on their list are recommended above, and in tomorrows post on improving egg quality, so I am happy to throw them in with the pile of supps I am already taking.

And I am afraid that's it. I've scoured countless blogs and forums for the miracle AMH increase trick but aside from the above nothing of any real value comes back and I haven't been able to find any published studies that support either of the above two options either.  So when it comes to improving AMH we're kind of on our own.  None of the above would hurt though, right? (** There are warnings associated with DHEA so definitely research that one some more before you take it).  But what can it hurt to increase Vit D intake?  To add a little wheatgrass to your regimen?  Top that up with some CoQ10?  (One of these days I'll post a pic of my daily supplement intake that will have you in stitches I am sure!)

There you have it. Improving AMH is, in my opinion, not impossible, but not going to be quick, easy, or certain.  I feel that the changes required are not drastic and so I will continue working on the above in the hopes that by the time we get to trigger I have a bountiful crop of lovely, strong follies and many, many eggs! Now, please excuse me while I meditate on that... "Ohm... bountiful eggs, Ohmmm"

UPDATE:  In January 2014, after 6 months on this regime I have improved my numbers further.  Unfortunately AMH was not tested this round. But the other numbers look GREAT!  

UPDATE: In April 2014, my AMH has risen again, almost double what it was in May 2013 at 0.53.  Look, it's still not a normal 1, but I am halfway there! 

Improving Odds

With the second round of CD3 testing concluded, we found ourselves back in Dr. C's lobby waiting for our appointment.  Other patients who arrived later were seen first... we waited some more... Having read other blogs, I know this doesn't make for good news... I had worked a 12 hour night shift, as had Mr. R.  We got home, showered and headed straight to Dr. C... a 1.5 hour drive. I was tired, and starting to freak out... I cried.  My best friend B, in town from South Africa on a visit, tried to console me to no avail.  Dr. C had something bad to tell me, I could feel it.

Finally the nurse ushered us into the waiting room.  Took my weight and BP and complimented me on my weight loss.  She seated us in a consulting room and we waited... and waited... in fact I dozed off and on in my chair.  Finally, growing restless Mr. R checked with the nurse who sent in Dr. C's assistant who explained that the doctor was held over in surgery that had gone longer than expected.  *sigh of relief followed by sadness for that poor woman who, it seemed, may be in a worse place than me right now* I agreed to wait a little longer and fell back asleep.  It was now 1.5 hours beyond our appointment time and 2 hours since our arrival.  Assistant came back in to say that we were welcome to go on home and she would have the doctor Skype us, since we live so far away.  She asked for our phone number and we headed out.

We live in the COUNTRY and have no access to Starbucks so I wanted to stop and get a drink.  (yes, yes, I know caffeine is like the devil when it comes to fertility.  Don't judge me!)  We just pulled into the parking lot when the phone rang, it was Dr. C and he said he had some good news... well, better than last time, but let's be real here, it's not hard to beat that news!

MAY, 2013 RESULTS:

AMH:  0.28
FSH:  10
E2:  23

(I think I am going to pop my test results, as well as what are considered "normal" readings in the side bar for quick reference.  Check there if you want to know how far below "normal" I am).

He was happy about the improvements, surprised to see even that little improvement on the AMH and said it was looking more promising than last time.  He is now willing to give us odds of about 25% but also said that this is based around our possibly not getting any useable eggs.  He has no concerns about my egg quality given my age -- if you've read any blogs or forums you will know, like I do, that your physical age means nothing when it comes to egg quality! -- but he is more concerned about how many we might get, and how many will fertilize so he is being conservative with that figure.  However, if we get 2-3 decent eggs fertilized for transfer, he is comfortable giving us back the 60% odds of conception.  WOOHOO!!

"There is some bad news though..." *deep breath in* "... I am concerned about how much time has passed and given your numbers I want to stress to you that you do not have time to waste here.  The estimates I have given you are based on taking action by Aug/Sep at the latest.  How far are you with finances?  Have you spoken with our finance department?  There are excellent IVF lending programs out there."

Oh, the finances... They've bothered me from day 1. Honestly, for a person who is not at all concerned with the trappings of wealth, finances sure do trip me up a lot!  We've both gone through divorces recently enough that our credit is still ruined.  We both endured foreclosures on our homes and were left with sky-high credit card debt.  Being the "leaver" comes at a high cost it seems! No bank in their right mind would loan us a penny right now.  No,  if this was going to happen it was going to be from the sweat of our brows and the kindness of family donations.

We sat for a moment and let the conversation sink in.  Mr. R knows me well enough to know that I can be a tenacious b*tch when I have to be.  He has witnessed it all through my weight loss.  If I have a goal I immerse myself in it.  I research it.  I live it. I breathe it like air.  He knew in that moment that I now had a goal, a cut-off date.  And I think he knew right there that the next 60-90 days were going to be hell for him.