Meeting my surrogate

Sadly, I've missed International Delurking Week by a mile. Its nice to have a legitimate excuse to ask people to delurk and its even nicer when some of you do so. I've got one of those blogs where the proportion of commentors to readers is microscopic- I'm clearly not one of the writers whose writings make people inclined to emerge from the shadows and say something, and I have to say, I'm madly jealous of those who are! But still, I'm so glad there are people who come here to read, you make me feel good. And even if it is a week or two late, I hope some of you delurk in the spirit of International Delurking Week.

Things have been happening to relieve the limbo. My green card petition was approved! This one is through the horribly long process, which means I may end up getting it in 2016, still that fits in nicely with my plans, assuming I get to make a baby. The petition that gives it to you immediately is still under scrutiny, I kind of want it to pass too, because it gives me the freedom of choice.

In my last post, I had mentioned I was afraid to find out about the surrogate, mainly because I thought I would find major fault with whoever got picked- mostly because how the heck can you trust somebody to do something so freaking important? Because of that, I delayed finding anything about her and meeting her for as long as possible, but finally, it was time to sign the contracts, because the process is almost ready to begin.

My parents and I met her, and her 'handler' yesterday. Just FYI, here is how things work in India- the surrogate is from a lower economic strata, and the handler is a woman who has previously been a surrogate, who lives in her neighborhood, checks up on her, takes her to her doctors visists, and who guides her through the whole process, based on the familiarity with the system and the process.

The handler also is instrumental in recruiting the surrogate. Apparently, my handler is an old hat at this process, after her surrogacy, she has handled over a 100 pregnancies. 

Anyway, my fears turned out to be baseless. These are women who can't speak English, they had no idea that fish during pregnancy can be bad but they are simple, nice women I instinctively had a good vibe for, as did my parents. I gave her my fancy prenatals and vitamin D, thanked her repeatedly, cried a little when I told her about the fact that she might go through a loss because I had already lost 3 babies.  She, on the other hand reassured me and told me that she would take the best possible care of the gift she would carry for me, and that god willing, things would go well this time. It was really sweet, and reassuring. I'm so very thankful I feel so positive about this going forward.

She gets her period in a few days. Then-- we start.

More in a little while on other topics, including H pylori, PCOS and GERD. 
  

Craziness all around

I get a call back about my AMH, with the lab informing me that they have to retest it. I used my 'Dr.' title to make them give me the preliminary result- its apparently OVER 6.9, and out of range probably.

An explanation of the reference ranges used by a testing lab in India

WTF?

2 years ago, I was looking definately PCOS-ish, with an AMH of 5.6 and an AFC of 30.

3 months ago, it was 1.9 one month, rose to 2.6 the next month, at which point my AFC was 13.

Fastforward 2 more months, now my AMH may be over 6.9, with an AFC of 25- back to looking PCOS-ish.

Like I've said, all I can monitor that has truly changed in my body are my vitamin D levels. My doctor, playing devil's advocate pointed out there could be a lot more changing that you could be aware of. Theoretically, that is a perfectly valid point. What confounds me is the timing- when my vitamin D levels stay within a range, say, deficiency, nothing changed over many months monitored. When my levels were really high, things changed and then stayed constant for a while. Now that they are lower again (but, above my original levels), things have changed again- we will need to monitor for many more months before drawing conclusions of any sort. 

What is my diagnosis? I have fertility issues sure, but the underlying causes are damned near indecipherable. Most people can get a clear label- of 'PCOS' or 'Diminished ovarian reserve'. With all my knowledge and recall of all the minutiae of my case, I have no idea how to label myself. I lean towards PCOS, but I'm not quite there.

So what I'm wishing for in 2013, aside from a baby-- enlightenment. Also, for concrete and viable solutions to counter gun violence and  violence against women, but sadly, there is a much higher chance of me actually having a baby than meaningful progress being made in those directions. 

Happy new year everybody. I hope this one is a kind one, on the whole.

Also, please go offer a shoulder to MN, as she faces the unthinkable, yet again.

Erm, what is going on?!?!?

That, gentle readers, is not a question that is likely to be answered anytime soon, if ever. After my IVF, when things had looked super weird, my RE and I concurred that maybe following my AFC  for the next few months would be a good idea. I finally rolled off the procrastination wagon and took myself off to get an antral follicle count (AFC) done. The results floored me.

To recap the madness, mostly for my own records: 

• August 2010: AFC = 34 (evenly distributed in both ovaries)
• November 2010 (post 1 pregnancy and 1 loss): discover AMH is paradoxically low and am Vitamin D deficient, correct vitamin D deficiency
• December 2010 ; AFC = 30 (evenly distributed in both ovaries) ; AMH = over 5 ng/ml
• December 2010-April 2011- Take around 4000 IU vitamin D daily
• April 2011: AFC = 16  (11 in one ovary and 5 in the other)
• April 2011-Feb 2011: Add prenatal with extra vitamin D, so total is 5000/day, start taking calcium (50 % of RDA) daily as well.
• Feb 2012: AFC = 16 (but now evenly distributed in both ovaries) AMH=4.3.
• March 2012: IUI# 3 results in failure
• March-July 2012 - Drop vitamin D dosage to around 3000 IU/day
• June-July 2012- 3rd pregnancy and loss, due to Trisomy 4.
• August 2012-October 2012- drop Vitamin D dose 2500-3000 IU/day, continue calcium, however less regularly. Start Metformin
• October 2012: AFC = 13 (more or less evenly distributed in both ovaries); AMH= 1.6, then 2.6 on retest
• November2012-December 2011: Stop Metformin. Continue vitamin D at  2000 IU. Stop calcium almost completely.
• December 29th 2012: AFC = 25 (evenly distributed in both ovaries)! AMH still pending.

With the drastic drop in my AFC (from 30-13 in 2 years), my RE was afraid that it  was because of drastic ovarian aging. I was less afraid of this, and felt that it was an unexplainable response to physiological changes induced by varying levels of vitamin D and *maybe* calcium in my system. I had hoped that after I dropped it to 2000 IU/day, with no added calcium, things would change as far as AFC went eventually, but this big jump back up surprised the crap out of me.  I don't know what to make of any of this- the changes in my Vitamin D intake alone are not that drastic, and there are no good explanations. 

I've played around a lot with vitamin D. Not supplementing at all, and just relying on sunlight and diet is a joke, its been proven time and again that this will leave me in the deficiency range.  What does deficiency do for me? I also lost a chromosmally normal child in this period, and my luteal phase used to be far too short on occasion. Its not so great from a physiological viewpoint- my health overall has subtly but definitely been improved by bringing me into the sufficiency range. However, how sufficient should I be? 

Deficiency of vitamin D is something that has been proven to be a contributor to infertility.  But a too high blood level may be equally bad, or worse, in my case.

4000-5000 IU with added calcium was something I felt great on, but *may* have had unanticipated, adverse effects on my reproductive system, which is not surprising in theory, because hey,  Vitamin D has been shown without doubt, to be a powerful modulator of this system.

2000 IU, the dose I am on now, is a fairly conservative, play-it-safe dose, given all the hot debate on the Vitamin D RDA. The IOM's  2010 recommendation of 600 RDA/day is pretty controversial and has not been well received at all. Other, seemingly saner voices advocate in the 1000-2000 range. The vitamin D council recommends over 4000/day, I believe. Experts at endocrinology are all of differing opinions.  In my revised opinion, everybody needs to keep their blood levels around 30 ng/ml, and its best not to go much higher. The amount you may need to get your blood level to 30 may vary from person to person, some trial and error might need to go into how much you need.

So I'll stick with 2000 IU/month for a while and see how I do, longterm. I'm now also going to start the CCRM regimen (melatonin, argenine, myo-insoitol, coQ10 etc) and see how my AFC fares with that. I'm only wondering whether I should wait one more month to start it, to confirm this rise in my AFC. However, I want to be on this atleast for 3 months before we attempt another IVF, which may be necessary very quickly if the transfer to the surrogate next month fails.

But, hey, on the bright side, my issue does not look like ovarian aging.  If only I can figure out what exactly it IS, though.  Bloody, bloody biology.

In limbo..

I was so very low when I wrote my last post. About a day after that, I made up with the person I'd fought with, and no other awful thing happened, and within a few days, I was back to my usual even keel. If I'm truly, deeply thankful for anything, I think it is my natural tendency to be ok, no matter what.

Its been a very busy few weeks- my house got remodeled (we are talking painting, polishing, putting new windows and false ceilings in) followed by my brothers wedding- a fun, joyous, if completely exhausting event. We were all so tired that nearly everybody in my house was sick, mostly from our immune systems being hammered from overexertion.

After things came back to normal and most of the guests departed,I'm in limbo now on so many fronts. Waiting to see what happens with my green card application. Waiting for a surrogate to be recruited. Waiting to see what happens, on the career front (I'm working, but its mostly for shits and giggles, not a serious job, its a situation  where I'm just trying to learn new things that will make my resume more attractive to future employers).

Nothing in my life is decided. I've been battered by circumstances going south on me so many times- 3 pregnancy loses- it still is mind boggling. Especially when combined with that un-imaginable IVF result, I *should* be terrified for the future. The weird thing is, I'm not. I'm remarkably ok with the current state of uncertainty, which is a wonder in itself.

But the one thing I don't have in large supply is faith. Nothing really seems to work, and why should I hold out hope that this trend will reverse in the future? But  it can. The other day, I read such a lovely post by Mo, about  an email from her RE about her long term prognosis being excellent, shortly after her first loss. It took so many more losses and so many years for that RE's prediction to come true, but it did. I think that post is a must read for all of us still in the trenches, not to give up hope, and to keep going.

Update just in: a surrogate is close to being recruited. There is a part of me that does not want to know anything about her. I'm a painfully picky person in so many areas. i rejected almost every sperm donor I looked at, and I looked at over a 100 donors easily. And you can't control a surrogate and you have to be ok with whoever you get, whatever their background and habits are, and pray that they will take good care of the precious cargo entrusted to them, that their womb is fertile and they will faithfully swallow the vitamins you plan to give them and avoid chemicals during their pregnancy. I'm almost tempted to try with my own uterus,  then the remembrance of each loss hits me and I'm paralyzed and ready to do anything to avoid going through that again. So right now, I'm burying my head in the sand, and not calling my RE to get every last detail about whoever he has picked. Its so very unlike me.

But for now, I'm very ok. Out of my funk, still missing my cat. We rescued a tiny kitten off the streets. Had we had my old cat, we would not have considered doing this. Ah, the circle of life- one life splutters out, another living thing gets a shot at survival because of that.

A lone contender

Its been an incredibly tough few days. I'm still not over how my cat died- the violence and the wrongness of it. And I miss her so much-- I've had multiple pets in the past few years- I had a cat when I was a student, and when I moved, I found her a good home and kept tabs on her for a couple of years, but letting go of her, while not easy, was possible.I've lost an another dog and cat which were family pets and while those losses tore me up, it was nothing like this. I never bonded with any other creature the way I bonded with H. I could not imagine parting from her, so I never even considered trying to find her a good home when I left New York, even though bringing her across oceans was not easy, neither for her nor me. In the world of a gzillion cats and dogs, she was special. This is really, really hard.

 Now, to the part I'm sure some of you were wondering about--my IVF cycle. In the end, I only had 4 mature eggs. 3 of these fertilized to form 2PN embryos. One embryo arrested immediately, started up again, arrested at the 4 cell stage and stayed there. The second looked perfect (Grade 'A') on day 3, but started stalling on day 4. The 3rd, met all of its developmental benchmarks perfectly, compacted on day 3, morulated(??) on day 4 and was a 'gorgeous' 3AA blastocyst on Day 5, at which point it was frozen.

So---all that, and I end up with what I would have ended up with in an IUI anyway- one great looking embryo, my sole contender.  Since we had only one, we could not even think about comprehensive genetic screening- we have to transfer this one, and pray. We are currently on the surrogate recruiting portion of this program.

A detailed postmortem of my IVF cycle is badly needed, with all the following questions:
1) Am I a poor responder to superovulation or was it the combination and timing of drugs which was not optimal for my system? On CD9, I had 6 synched up follicles, which, I suspect, gave rise to my 4 M2 and 2 MI eggs.  At that point, we switched to from Foliraf (recombinant FSH) to menagon(Urine extracted FSH + LH), upped the dose of stims, and on paper, based on E2 and follicle size, I responded, but most of what came then were immature eggs. So all of that later stimulation, and waiting for the last follicles to respond, *may* have been futile. .As my doctor said, this is gambling to a extent- we did, and we lost. If we had aimed for just 6, and triggered me sooner, would these 6 eggs have been better?
2)My follicles were probably not synched up, whatever that means. Here is a question for you all- does a long lupron or BCP protocol help? I have to go back and look at my baseline ultrasound, but I remember thinking that the follicles in one of my ovaries (the right one) looked larger, and those just turned out to be cysts. 

Anyhow, all of these are things for the future. I pray I will not have to do another IVF and  my one blastocyst turns into a take home baby, But I have to say, my odds are much, much poorer than I thought they would be at this point. I'm so down, for so many reasons. The unimaginable result of this cycle. The massive fight I've had with somebody close to me that near shattered me yet again, just when I thought I'd started to recover from my poor cat's loss. Issues with living in India-that is what triggered that fight. And still, by far the most painful, the loss of my cat.  This is the roughest time I've had in a while, almost on par with the darkest period in my life, the weeks after my first loss. I have not been able to stop crying for the past 2 days and this morning, just in passing, I thought about anti-depressants. I NEVER think about anti-depressants, not even during the worst times of my life so far, so that was a shocker. But- if nothing more comes along, I will mend and get over this. I'm really praying for some kindness from the universe right now.

A time of horror

I had my retrieval last night. They got 11 eggs, so that did not seem too shabby.

I came home, was given Lyrica by my mom and went straight to sleep. Around 3 am, my parents woke me up. My cat, who likes to hang out in our garden (only at night, she is so contrary), which is gated and fenced, was attacked by feral stray dogs that came in through the gate somebody left slightly ajar. My dogs, who were inside the house started barking and my dad and housekeeper rushed out,chased the dogs away,  to find her mauled and barely alive. They bought her in and 10 minutes later she died.

This was a cat I'd rescued from a shelter. I  formed such a deep bond with her that when I left the country, I bought her with me, to keep her safe and give her a good life. It took her a while to get adjusted- which she finally did and now, this happened. I could not keep her safe, I feel so guilty and I'm such a mess emotionally, I can't believe she is gone, I have not been able to stop crying since I woke up this morning.

To add to the misery (that is all that seems to be on the menu for now), I got the fertilization report- out of the 11 eggs, only 4 were mature(in the M2 stage), and 3 out of the 4 fertilized.  None of the 2 M1s fertilized, and from the 4 immature eggs, which were put through in vitro maturation, one made it to M1 and was injected with sperm today.

So at the very best, I may end up with 4 blasts to freeze on day 5, but I doubt I will be that lucky.

My RE is baffled-my case is so, so weird. He says he will do another IVF only if something changes with my AFC or AMH, but right now, I am a shitty responder to superovulation, apparently.

The best thing for me would be to try again naturally- I've gotten pregnant 3 out of 4 times. But I'm done with that- I can't handle another loss.

I'll figure out what to do later, but right now, I'm shaken and saddened to my very core. Out of the two horrible things that have happened today- If I could make  the universe fix one of these 2 things, it would be what happened to my poor, poor cat.

When the universe hurls crap at you, boy is it generous.

Triggered!

I got the first piece of good news this cycle so far yesterday- my estradiol (E2)went up from 2200 (pg/ml) on CD12 to 3521 48 hours later. My ovaries are filled with largish follicles. We did not bother measuring anyway- we could tell that many had increased in size from 2 days ago, but there are no foolproof indicators based on size of whether a follicle has an egg, and a mature one at that.

An E2 of over 3000 is considered decent territory for an IVF response, but when I asked my doctor of how often E2 levels can predict mature follicle number (assuming each follicle produces between 200-300 pg/ml of E2)--he said--75 % of the time. So yeah, its always a crapshoot.

He did say that, barring my lowish AFC(13) for my age, my response has been 'textbook'.

So I triggered (with 5000 units HCG) this morning. And unfortunately, something happened. The injection is given IM, I asked my mom to give it in the hip area, bad call. As I was getting it I felt the muscles in my leg seize up. 4 hours later, I'm limping horribly and can't sit, and nor can I take any muscle relaxants/anti-inflammatories. Spending the day in bed---not as enticing as it sounds, unfortunately!

Minor issue though-egg collection is tomorrow evening, and I hope that brings good tidings. Wish me luck!