It's amazing how a change of a day can some how help reset your strength and hope. I have been feeling so much better, I have been feeling more like me the happy me that I lost at about a year mark of this journey.
I'm excited and nervous for tomorrows appointment. I'd love to get the news that we'll be put on fertility meds tomorrow but in retrospect I'm happy we can try again so soon. The other side of me is absolutely terrified, I'm terrified of (oddly enough) getting pregnant again. I'm terrified of what that does to me emotionally, how much worrying I put myself through. I know this time around no amount of comforting words will make me feel like there's light at the end of the tunnel and I'll just have to find ways to cope with the anxiety that pregnancy seems to plague me with now. I'm in high hopes that the anti anxiety meds I'm on (which are pregnancy safe btw) will help curb that anxiety and over obsessive nature I get once we get pregnant. I almost don't like the person I become, very negative and such a worry wart. I am going to try to hold onto the thought that the medication they had me on with Angela helped and WORKED. That I know at some point will be a helpful thought that I wasn't able to have with our last pregnancy as it was our first time on the RPL protocol.
Either way I've been trying to keep my excitement just to excitement. I've been really focusing on my health and learning to live with PCOS. I turned to the South Beach diet and so far I've found between it and weight watchers it really caters to my PCOS minimizing carbs to a huge extent which is what I needed. Weight watchers is an amazing program but it opened my eyes to the fact that literally not every diet program works for everyone. Sometimes per-existing conditions will require a different approach be taken. So I've been working out and really putting a good foot forward with my eating. So far I'm down 4lbs and have hopes of being down 10 lbs by my the time I have my IUI done.
So I've been one busy little bee, between going to Canada to see my family, to having a slew of photos to fix up, and I'm designing my Future Sister in Laws wedding invitations. There's so much to look forward to and so much to do in so little time. I like my activity level now though and I really think it's attributing to my happiness as well. It always feels better to know that you're doing something and not just sitting at a computer. I found it really played into why I wasn't happy. It was my excuse for not getting up and doing things with my fitness and overall things with my family. That's just me and was a huge eye opener over how much time I literally spent on the internet. Others know moderation where I didn't. So 2013 my word of the year is "Moderation" this will speak to many facets of our life. Moderation in food, moderation in internet, moderation in money. Moderation is my key :).
I've been posting a lot about the emotional side to what we've been going through but I feel I've left out a lot of our journey from a technical stand point. I want my blog to not only be something others can relate to but also find informative as I know I've always scoured the internet for certain answers. So I wanted to provide you all the opportunity to learn from what I've been through. If you have any questions please feel free to email me amandanicole1828@gmail.com or leave a comment and I will try my best to answer or point you in the direction to a place that can better answer your questions.
After our 4th loss I took some down time but deep inside I've been yearning to find answers. So after searching for some answers I was strongly urged by more then a few women to seek out another doctors help who would work with my Reproductive Endocrinologist. I have to admit I was hesitant at first and I still don't know where I mustered the guts to call but I did. I called this other doctor. He is a Reproductive Immunologist. Which is a bit different then an RE in that they focus heavily on auto immune problems. The doctor I sought out practices in NY, NY. His name is Dr. Braverman. We have a free 10 minute phone consult with him come December 12th and I'm nervous. We're just going to chat with him and do a brief patient history. Then we'll have to at least go down once to see him. ( I have never been to the "Big Apple" before so why not ;) ) The most amazing thing is that when I spoke with my RE's office they were completely for working with this RE and have done so in the past with other patients. Knowing that your RE's office can do this to me says a lot about their Character and what they stand for. Some offices get their ego's hurt if you seek out another professionals advice or even a second opinion. Mine was completely for it and encouraged it. So here I am filled with a little bit more of hope knowing that these two offices will do whatever is in their power to help us have a viable pregnancy carried to term.
I have been doing a little bit of reading on Immune issues. I'll share with you bits and pieces of what I read. Most of what I'll share will be off of the FAQ section of the Fertility Friend Forum section for women with Immune system infertility. I've also been doing some reading up on my PCOS. Ever opportuanity I have to learn something about it is one step forward. I went back into my blood tests and I found that my AMH levels were very high into PCOS range, which I never really connected the dots to. I'm still on metformin and probably will be for the rest of my life. I recently purchased a book called the PCOS Workbook. I'm just getting into it but will let you know how I found it. So far I find it to be very interactive (if you like this kind of stuff (writing things down) then this may be for you).
Here is a basic overview that some of you may find interesting about immune system infertility. I never knew that there could be something more to this. Nor that there was more medicine that could possibly help us. Knowing there may be more answers to me at least gives me that hope I need right now. Even if something is wrong with me I'd rather hear it so we can be proactive and 'fix' it.
(Please note with anything medical that I post here it does not mean it's written by a medical professional. Please always consult your doctor and never self diagnose/ treat. It could do you more harm then good)
Do I have immune system problems?
(http://www.fertilityfriend.com/Circles/viewtopic.php?t=2569485&start=0)
It is hard to know whether one has immune system problems. Sometimes
there are obvious signs like repeated miscarriages or failed transfers
of good embryos on IVFs. Lot of times it is just the intuition that
there is something wrong in that area. Things to consider are family
history of autoimmune problems, miscarriages that happen earlier and
earlier or few miscarriages followed by no implantation at all as well
as having no positive pregnancy tests at any point. Any of those can be
due to immune system issues. The immune system issues can either
prevent implantation altogether or cause repeated pregnancy loss.
Immune system issues can also cause ectopics as the embryos have an easier time implanting in the tubes where the inflammation and/or high NK cell activity are not present.
There are two types of immune system issues: autoimmune and alloimmune
issues. Autoimmune issues are common when either the woman or her
family has other autoimmune issues. Other autoimmune illnesses are for
example
- endometriosis,
- adenomyosis,
- thyroid problems,
- celiac disease,
- eczemas
- allergies,
- asthma,
- autism etc. (see a list here). Alloimmune problems mean that there is a close match with the partner and body rejects the embryo for this reason.
Here is a break down of reasons for repeated pregnancy losses:
- Infection 1%
- Anatomy abnormal 5-10%
- Progesterone level low 20%
- Chromosome abnormal
- Primary miscarrier (no live births) 7%
- Secondary miscarrier (one or more live births) 50%
- Immune mechanisms 50%
- Unknown 15%
Which tests do I need?
To test immune system issues, a good set to start with is most
importantly the NK cell assay which shows how active the NK cells are in
destroying the trophoblast (early placenta) and preventing
implantation/causing miscarriages as well as underlying inflammation
markers such as Th1/Th2 and Tnf-alpha along with some other inflammation
markers of the list (below under tests). The inflammation markers are
important because inflammation either causes NK cells to become
activated, or NK cell activity causes an increase in inflammation.
Therefore, even if the NK cell assay is normal, if there is underlying
inflammation, implantation can be prevented when in the presence of an
embryo, the immune system flairs up.
For the alloimmune issues, one needs to tests a full HLA-panel as well as DQ-alpha matches.
An additional issue is blood clotting problems. These are tested for
under the RPL (repeated loss panel). RPL issues usually only come into
play with 2nd trimester losses. So if someone does not get pregnant at
all or has early losses, most likely auto- or alloimmune problems are to
blame.
How are immune system issues treated?
Typical treatment consists of intralipid infusions for the elevated NK
cells, prednisone and lovenox for the inflammation and NK cells (as well
as for better egg quality, inflammation can cause poor egg quality) and
Neupogen (with Dr. Braverman and Kwak-Kim at least) for the alloimmune
matches.
The RPL problems are treated with heparin and baby aspirin typically.
Other things one can do at home are to start an anti-inflammatory diet,
i.e. stop eating gluten, dairy and sugar which cause the immune system
to flair up. Start anti-inflammatory supplements such as high doses of
fish oil (6 capsules per day). Dr. Braverman recommends Maxi-Flavone.
Limit exercise during treatment cycles (exercise causes and inflammatory
state in the body). Though exercise outside of treatment cycles as
over long term, exercise reduces inflammation. Use any relaxation
methods. Eat/take antioxidants which reduce radical oxygen species
(ROS). ROS are created by inflammation and cause destruction in the
body.
