a new hope?

over the last week or so, i've been doing a lot of reading - mostly blogs and websites - but i've come across a glimmer of hope. i'm in the midst of changing my rheumatologist to an osteopathic doctor, investigating acupuncture for both RA & IF, and looking into my discovery - the field of reproductive immunology!

most doctors i've talked to don't really acknowledge a correlation between my medical history and my struggles with IF, but i cannot see how they are NOT related. between my RA and HS, reproductive immunology seems to be the next logical step. from what i've read, there are other immunological tests that can be done and different IVF protocols that can be used when there are abnormalities of the immune system.

From a number of websites (including inciid.org):

The indications for testing are:

1) Two miscarriages or two IVF or GIFT failures after age 35 or three miscarriages or IVF or GIFT failure before age 35 - i've only had two failed IVFs to date, but close enough.
2) Poor egg production from a stimulated cycle (less than 6 eggs) - ding, ding, ding - i'm the definition of a poor responder
3) One blighted ovum - n/a
4) Unexplained infertility - ding, ding, ding - again, i have no specific IF diagnosis.
5) Previous immune problems (ANA positive, rheumatoid arthritis, and/or lupus) - ding, ding, ding - RA folks.
5) Previous pregnancies that have shown retarded fetal growth - n/a
6) One living child and repeat miscarriages while attempting to have a second child - n/a

so 4 out of 6 - i think it's time for some immune testing.

now, i don't want to jump to conclusions. since noah was born, we've really only tried to conceive once, which was the failed IVF cycle. we'll try again this summer the old fashioned way, but because of the concern with the possibility of premature ovarian failure or reduced ovarian reserve, i don't want to put all my eggs in that basket - cue the snare and cymbal!

of course, with that said, i really think the IVF cycle failed because my RA flare. the more i read, the more i'm convinced. hopefully i'll get that in check quickly with the help of the OD and acu and maybe Humira, and then everything else will fall into place.

did i mention, i want another baby? --- on a side note, after a year full of bad news and sadness, a dear friend did get some amazing and miraculous news this week. i won't elaborate because i'm not sure who all reads this blog, but let's just say i still believe in miracles, and this time, without medical intervention! :)

my 100th post ... and what a post.

so my follow up consult with fertility doctor (or RE, reproductive endocrinologist) was this morning, and i think i'm even more confused! i asked why it didn't work and he said it was likely due to poor quality embryos. i asked why the embryo quality was bad, and he said likely because of egg quality. i asked about the decision to do a day 5 rather than a day 3 (which we did with noah), and he said there were more embryos (than we'd ever had before) and they wanted to make sure to transfer the best. unfortunately, what looked good on day 3 looked bad on day 5 and at that point, we'd already "used" our cycle, so we had no choice but to transfer what we had. he said next time, he would strongly consider transferring 3 on day 3.

i asked about taking a few months off to regroup and get my RA in check, and he said a few months definitely wouldn't hurt, and getting my RA in check is huge. there is so little research on RA and fertility, but we did talk about a medication that he feels (based on the FDA rating) is safe to be on during IVF treatment and is known to be effective. i promptly made an appt with my rheumatologist after my RE appt - i see the new doctor on july 1st. :)

as for moving forward, he said we can go ahead on try on our own for the months we're off, and there's no need for additional testing or medications. when we're ready, we have one more IVF cycle covered by insurance - if we're lucky, we'll get some extra embryros to freeze. but here's the catch... (and my source of confustion)

we talked about donor eggs. i asked how to improve the quality of my eggs and/or embryos, and he said that i likely have a limited number of good quality eggs left and we might consider using a donor. despite having a reasonable FSH level (i think he said 4 point something), the quality is fleeting - not shocking to me since my mom went through early menopause, and maybe the RA and drugs over the years DID have an impact on my eggs... i asked about how that all works, and the costs, and he explained it is cheaper to use a known donor (which 20% of their patients who use donors do).

i have so many thoughts about donor eggs, and i can't wrap my head around the concept. just like years ago, i never though I would need to do IVF... i also never thought i'd need a donor. i'm only 31, for christ sake!

i've never even really given thought to using donor eggs or going the route of adoption, but now i'm in a weird spot. do we try our one more IVF cycle with my own eggs? do we get insurance to pay the majority and use a donor, only paying the donor costs? do we start saving for the possibility of fresh IVF #5 (or beyond - my eggs or donor) or more of a "sure thing" - consider adoption?

ugh. i was hoping for some guidance, but now i just have more questions.

i almost forgot how much infertility sucks. but at the end of the day, i keep reminding myself, thank god i have my precious little noey.

next steps

well, i'm not pregnant. ivf 3 was a colossal failure. i somewhat feel like we wasted it. i don't know. it is what it is, i guess, and hopefully we'll get some guidance on monday when we have our follow up with the doctor.

i feel like we have to proceed with caution because our insurance only covers one more ivf cycle. one more. that's it, and after that - what? do we decide to remain a family of three, and continue to cherish noah as the most precious boy in our lives? is that so terrible? well no, and for a minute i thought i was okay with only having one child, but on second thought, i want to be selfish for myself and i want noah to have a sibling or siblings to grow old with and to have with him after ben and i are gone.

or maybe, we think about adoption, which i think is a very respectable and generous route, but has never really been in the forefront of my mind. it's never even really been in the back of my mind. again, i'm selfish. i want to be pregnant again. i want to try a vaginal delivery. i want to try to breast feed. i want my own biological child, and noah's biological sibling.

and while the process of adoption is length and stressful, it's almost more of a sure thing than scrounging up the money to pay for ivf #5 (or beyond) which is NOT a sure thing. i'm getting older. my eggs are getting older. i don't have the luxury of time.

but maybe i do. maybe we need to take a minute and see if things "changed" after my being pregnant and delivering noah. the doctor's like to say things can "change" after infertility. i don't really believe them. they also said my infertility is not linked to my medical history, which i also don't really believe...


i'm kind of numb right now, which is maybe good, but probably bad. i actually had a long conversation yesterday with my friend stacy about the fact that ivf #3 failed and that i wasn't sure what to do next. after losing her twins at 2- i just have to stop and say i kind of hate myself at this moment for just forgetting how many weeks stacy was...... she lost the twins at 23 weeks, and she is doing remarkably well. she is able to acknowledge the pain of the loss, and the reality that the end goal has not changed, but the path has. and still i feel selfish and watch my words when we talk, though we are dear friends and i know i don't have to, but i have noah, and she has two angels who she never got to know. BUT the point is, she is already talking about doing ivf #6 (with a frozen embryo) in the fall. she wants to understandably get passed her due date before doing so, which unfortunately happens to be the same day as her 31st birthday. happy fucking birthday.

i feel like i have so many questions for my doctor, but i can't get them all out of my head. it's all just swirling, and i keep thinking now is just not the time. maybe i need to get myself in a better place physically first and then it will happen. but like i said, my clock is ticking at like warp speed, and i don't know how much longer we can wait.


i need to make an appointment with my new rheumatologist. i got really motivated after news came of my negative pregnancy test, and finally decided to call and ask to switch doctors. i also decided i need to look into starting acupuncture and massage ASAP - i 100% plan on doing acu during my next ivf cycle, whenever that may be.


so - okay, that's enough from me for tonight, if any of that even made sense. i'm too tired to focus right now, and hopefully i'll have some clarity this weekend so ben and i can have a long convo about what to do and questions to ask. ultimately, i kind of think i have my mind (or my heart?) made up that we need to find a way to have another baby, if it means paying for ivf beyond what insurance covers. but god, i hope it doesn't have to come to that.