Thyroid follow up

My first appointment with the endocrinologist was early December. Last week I went back for a follow up to see how my body is reacting to the dosage. I got bloodwork done and the results just came back that my TSH is higher.  My initial test back in Dec had my TSH at 2.96; last week it tested just above 3.

I don't get it. I've been taking the dose as recommended for 8 weeks. Why would my numbers go up? My doc is recommending doubling the dose from 25 to 50 and retesting in six weeks. I told the tech relaying this message that I want to speak to the doc because I have questions. Am I supposed to delay a transfer for this? It's too precious and expensive to transfer before fixing this, but in the meantime I'm not waiting six weeks to find out if it worked. If she doubles my dose I want to be on it for a week and then retest. If it's still not good then the dose needs to go up again. I'm not being impatient, I just don't think the endo doc realizes my timeline.

My doc answered some of my questions. First she said the number is within normal variation range so she would interpret the results that the TSH didn't change, not necessarily that it "went up," and the dose needs to be increased. Second, she said it takes a minimum of 4 weeks to see the full effect of a dose so she doesn't recommend repeating labwork within a week but would cut it down from six.

She did say that since my "TSH is in the normal range now, it will not cause a miscarriage or fetal demise so it would be safe to continue with the FET." Do I trust that? I don't know if I believe her. Every single article I read says that TSH numbers above 2.5 have a greater chance of a miscarriage.
I don't want to take Google's word over that of the trained professional doctor who is paid to treat my specific case but it's hard to argue with a study like this: First Trimester TSH levels between 2.5 and 5.0 are associated with increased pregnancy loss

Do I loop in my RE? I can already imagine that his answer would be "it's up to you." On one hand I definitely don't want to delay. Four weeks to wait to test seems like a lifetime right now. And then what if it's still high? That's another increase with an additional four weeks of waiting. What if this is just my normal and no dosage will help? On the other hand I don't want to risk it. I don't want to have found an actual issue and then just plow forward and ignore it. I know I would be devastated if the FET doesn't take and I will feel like we could've done something... like wait for TSH levels to get to the ideal range. But at the same time if we're increasing the dose and then checking it again soon (and possibly increasing it again due to a pregnancy?) then isn't that enough? Some women get pregnant not knowing their TSH levels are up and only add on thyroid meds once they're already in their first trimester. Is that a risk I'm willing to take?

What to do??

Contented

The past few days I've been so tired. As in, unable to keep my eyes open past 8:30 PM tired. Maybe it's the weather? Maybe it's residual jetlag? Maybe effects of the flu shot from Friday? I don't know. The flip side of it is that I've been up before 5 AM in the morning. It's been getting better every day, now to the point that I can asleep until my alarm so I think we're slowly transitioning back to normal.

I've also been feeling really content. I don't know if I'd go so far as saying "happy" but I might be that too. I've been feeling optimistic about this upcoming cycle even though I know how dangerous that is. I can't help it, I'm naturally a positive, hopeful person. I feel like we've put some really good things in motion for this one, including adding the thyroid meds; doing the hysteroscopy which counts as an endo scratch; and since we've done the ERA, they've perfected the procedure - more on that in a minute. In addition, I've read old posts and found that when I take a vitamin D3 supplement the transfers have done better. I don't know if that actually does something but I've added it just in case.

I don't feel that we deserve for this to work, per se. It's not like it will suddenly be different because we've "put in the time and effort" so now it has to. But statistically speaking why shouldn't it? It has the same chance of working as it does failing so why can't I assume the best. I don't expect it to work; I'm hoping that it will.

Yesterday my nurse calls and asks if by any chance I remember approximately the time frame I took my PIO shots back in 2016 when doing the ERA protocols. I asked what she's looking for and she said that since I've had the biopsy done, they've fine-tuned the test so that they can give an even more specific time window for transferring. I told her I can do one better: I logged all my shots. In the beginning it was to help me remember which side the shots were done on so that I can remember to alternate, but it also helped me keep track of what meds needed to be taken when and eventually it became part of every cycle, even a simple mock-transfer ERA. I was able to send her the exact time and date of the shot they were looking for. It's nice to know I can benefit from the new technology without repeating the test.

I think I'm also excited to try again. Our last transfer was in April 2017 which was nearly a year ago. A lot has happened since, it's not like we stopped treatment, but we haven't attempted a transfer. I feel like there's only so much we can do on our end and eventually nature and Hashem have to take over but we do need to do our part and initiate a transfer.

There are a few dark clouds hampering my mood. First is the news of a friend's sister-in-law who was diagnosed with stage four breast cancer. In her post on a private fb group she said, "She waited so long to have a baby who's 15 months old; let her at least see him grow up a little." It broke my heart. It's literally my nightmare. It's not about me and today she needs prayers not my response of shock and terror. The other thing making me nervous is the flu. I'm not sure it's a rational fear. I feel like if I get the flu I'll be sick for a week and then get over it. I'm more concerned about the people I love and young people in my life, especially my niece who was born a premie over a year ago. It's hitting people hard and I'm worried. Yesterday a coworker was going around coughing into her hand and then using that hand to open doors and use the copy machine. I passive-aggressively went after her with a colorox wipe because I was too chicken to say something to her directly. Finally, the news. Russia investigation. FBI memo. Government shutdown. Disgraced gymnastics coach. Opioid epidemic. I'm done hearing about the leader of our country. I try to balance wanting to be informed and not wanting to be constantly bombarded by what's going on. There has also been some drama at work that isn't simmering down but it's become somewhat part of the background noise, even though it's enough to cause significant tension at my job.

So a lot of things to compartmentalize and balance. Happy but restrained. Worried within reason. Informed without getting consumed. And with that... we welcome in February.

First of the season

It's been a long week. I wake up in the mornings feeling hung over and groggy and puffy. Morning nausea lasts until lunch time and if I eat a solid lunch then it simmers down to manageable levels. I've been uncomfortably gassy and running to the bathroom constantly with a lot of TMI. There's a special gross-factor about taking pills with water on an empty stomach, while nauseous, and knowing the pills will make them worse. But sometimes happens when I'm running late in the mornings.

All that pales to the anxiety. Today that boiled over. I was running errands, getting stuff ready for Shabbat and for my mom for Mother's day. I thought I should drink more water but figured I'd get to it as soon as I got home. I later had some cramps that were.... different. Then I went to the bathroom and found discharge that was... different. I freaked out. I started contemplating whether this is the beginning of the end. At some point the tears started and I just couldn't stop. I decided to take a shower to try to calm down.  Things took a turn when I decided to brush my teeth to get rid of the gross taste in my mouth. Between the tears, runny nose, and sobs I gagged on the toothpaste and then threw up. Luckily it was mainly water but the whole thing just upset me more. First barf of the season.

My husband heard and came over. He helped me clean up and did what he could to try to settle me down. It wasn't until I thoughtfully and purposefully made up my mind that everything is from Him and that there's nothing I can do either way, that I started to calm down. 

I had more thoughts but it's almost Shabbat. It's just insane to realize that infertility trauma is for life. It never goes away and there's no time you feel you can breathe easy. Every day is a miracle; every day we get closer is just one rung higher to fall if it all goes sideways.  Praying and hoping that doesn't happen. 

Shabbat shalom.

FET 5: 10dp6dt

Well, we've hit double digits for days post transfer. It seems like the days have taken forever while whizzing past at the same time. It's the last night before beta. Suddenly I'm scared for the 2ww to end. If we don't get good news tomorrow then this closes the chapter on FET 5, something we've been gearing up for, talking about, and preparing for for so long.

I've been trying not to cry all day. As distracted as I was at work, I still managed to get a few things done but not much and I don't have high hopes for tomorrow's productivity. I kept going over the possible outcomes in my mind over and over, good and bad. I kept going over things we did and wondering if there's anything we missed or anything we should have done.

Symptoms have changed which concerns me. No nausea anymore, not for a few days now. No sore boobs. Ever-present cramping, similar to period cramping. Bloating. Last night I googled "fet 2ww no symptoms bfp" to try and get some reassurance that symptoms or lack thereof don't mean that it didn't work. It was somewhat reassuring. I'm still worried.

I cried as I prepared the dosage for this evening's shots. I don't want this cycle to end until a healthy baby comes out. That's not up to me, though. Whatever happens is in His plan and I hope to have the strength to get through whatever comes next.

It's our hope that the next step is a good beta tomorrow. Wish us luck.

Choices

I've been stressing about the possible options moving forward.

The fact that we don't know what can help means that we're just going with trial and error until something sticks. Nothing we tried worked until now, which means everything else is an option.

I found it helpful to write out all the pros and cons of each option, however minuscule.

The first thing I did was go to pdfcalendar.com and print out a 12 week calendar starting at 1/15. I laid out the potential timelines. Being generous for a cushion in case insurance verification takes a while, I estimated a potential baseline at 1/23. From there, it branches out to several options:

• For a new IVF, we're looking at a potential egg retrieval date at about 2/9 
• If we transfer right after, potential FET 2/15 
• If we wait a cycle, potential FET 4/5 
• For only FET, possible transfer on 2/10 

I kind of hate the idea of a possible timeline that doesn't have a transfer until April. Why April? History has shown that it takes my body about 2.5 weeks after an egg retrieval to get my period. They can't start the FET protocol until after a bleed. Once the period comes, it's back on birth control for three weeks before they start the FET meds. That's approx 7-8 weeks total. So, April. I don't want to wait until April to try again. That's four months away! Pesach starts on 4/10 so I'd have a transfer like a week before? I really don't like that.

We talked about all the options and discussed each one. My husband is more gung ho about doing another IVF now than I am. I'm ok either way but I might also be ok just doing the FET. The arguments for it are that it's better to bank embryos while I'm younger; getting it out of the way, since we'll probably have to do it again if we want more children; sooner we get it done, sooner we can keep trying if FET 5 fails. The argument against it? We've been so focused on thinking several steps ahead, but it hasn't really gotten us anywhere. Maybe I should stop being so greedy about trying to get "more children" and just focus on having one first, one at a time. In thinking back about our past trials to try to bank embryos, after the first IVF cycle where we got two healthy embryos, it took three more cycles until IVF 4 to get any additional healthy embryos. Yes, two back-to-back cycles (#2 and #3) resulted in zero transferable embryos. So even if we do IVF now, there's no guarantee it will results in any additional embryos. There are no guarantees at all in this, part of which is what makes it so frustrating.

In the grand scheme of things, waiting an additional 7 weeks for a transfer is not a big deal. I know that. I can be patient if need be. But if we're waiting that much time before we can transfer and then that transfer fails, it's devastating that we've lost all that time.

And that apprehension about waiting is the truth hitting where it hurts. It's not the time I'm really worried about; it's the fear of another failure. I'm continuing to go through the motions and doing what needs to get done, but I have no faith in the protocols anymore. I don't know if it will work. Maybe ever? I don't know. I'm worried and scared. All we can do is continue to do our part, brace for the worst, and hope for the best.

Meltdown

I kind of had a meltdown this morning before work. I had the tiniest bit of tan color on the TP this morning and it made me so sad and so sure that it's all over. I couldn't stop crying and was worried I'd have to take the day off work since I can't go as a blubbering mess.

As of noon today the cramps are back but they feel like period cramps and I'm scared to look every time I go to the bathroom. I'm having weird discomfort around my cervix. Can I even feel that? I don't know - that's what I'm assuming it is.

My nurse said that if things progress I'll have to be on the shots until about 10 weeks. Even though I'm running low I decided I'll only place the order if the numbers from tomorrow's bloodwork indicate that's necessary.

I told my mother the news. I went over to the house this morning on my way to work. It was scary! We chatted about random stuff for about 10 minutes while my heart was pounding trying to figure out how to best tell. Now I get why people get funky with the reveal. It was hard to actually say the words, especially when the situation is still so precarious and I'm so superstitious. I basically just said it and the reaction was immediate. She was so excited and so happy. I got a big hug and we cried together. Once I caught my breath I explained that the numbers are low and that there's still a long road ahead. I explained that the numbers need to double now every time I go back for bloodwork until such time that they can do an ultrasound and so on. Here I thought the 2WW was the worst.

I kind of felt bad landing that on her at the beginning of the day but at the same time it felt like the burden was suddenly not as heavy to carry. She has plenty of experience with kid-related anxiety raising us so I'm not so worried about that. I'm not sorry we shared the news. I was happy to have the news to share and until I hear otherwise, I'm calling it what it is!

4w2d

I'm so bummed. I know it's not over til it's over, but things feel different.

For one, the cramping stopped. It's been a constant buddy since transfer day and this morning I just didn't feel it anymore.  For another, I took a HPT with fmu and the line barely showed up. I cried most of yesterday evening after reading what it takes for such a low beta to result in a healthy progressing pregnancy. It wasn't hysterical sobbing, just a quiet mourning and sadness of what's possibly to come.

I told my husband that we should have shared the news with parents while it was still relevant and we were excited, instead of just sharing a chem preg / miscarriage. He said that we can tell them tonight, before Thursday's bloodwork, and that it may still be ok. I feel like at this point we shouldn't get their hopes up only to possibly crush them tomorrow. Then again, the support and prayers would be appreciated so I might take him up on the offer.

Whenever I starting thinking about cutsie ways to announce the pregnancy I stopped short, not letting my train of thought run wild. I didn't calculate a due date. I didn't figure out with a calendar when each trimester would be done. I didn't come up with a list of friends I want to personally notify. I didn't think about a way to let my supervisor and her boss know. I didn't devise a cute plan of how to tell my coworkers. I put everything on the back burner - first I wanted to see a heartbeat.

I know there's technically still hope but none of the signs point to a good outcome from this and I'm so guarded about holding on to false hope. Even if tomorrow's bloodwork comes out shitty they still want to see me again on Monday to follow the progression, if any.  So we might not get a definitive answer tomorrow, but hopefully we'll know more. 

:'(

T minus 4 days

I've been dreading the start of the FET cycle. My baseline appointment is Friday and it seems like it's looming over me. I want to start the cycle but I'm nervous it won't work. I'm worried about the hormone-induced emotional roller coaster. I'm scared it will all be for nothing and that we'll lose another embryo. I'm anxious about putting so much into something and having it fail. I remember what it was like from last time and I really don't want to go through that again.

Work has been keeping me busy which helps me push these concerns to the back of my mind. It's only when I get home I remember that I'm one more day closer to the end of "normal." Regardless of how this turns out, whatever I have now will be over. Either it works and our lives are forever changed by pregnancy, or it fails and we're once again surrounded by grief and shattered hopes.

I need to get new hair products. I realized today that I have an association with the current hair mousse I use. It happened to be that during IVF 3 I got a brand new pricey bottle of Paul Mitchell Sculpting Foam. It's actually really great - it dries soft instead of that crunchy texture other products leave behind. It has a pleasant yet distinctive smell and during my IVF cycles, it happened to be that the mornings I was rushing out the door for monitoring appointments I would just put some product in my hair and wear it curly for the day instead of taking the time to do anything with it. Well, alone in those waiting rooms all those appointments and all I could smell was my freshly pickled hair... I started associating that smell with the clinic. So now I get a reminder of that feeling of blood draws and waiting and anxiety every time I smell it, so I have an unused half-bottle I'll probably be giving away soon.

I've been doing great on my diet. I knew 3.5 lbs was too good to be true and sure enough I was back up by 1.5 lbs at the end of the week, still netting a minus 2 so I consider it a win. Still counting calories, still using myfitnesspal.com, still feeling like I'm doing what I can to help this transfer.

Meds order is scheduled to arrive tomorrow and we need to finalize some paperwork. Other than that, just waiting. In other news, we have exciting plans to see one of my favorite comics later this week and this morning I had an almost pleasant encounter with Verizon about my busted charger! All in all, a good Monday.

No news

Still no news, though I see that the lab charged my credit card. I know we shouldn't expect news yet - it hasn't been 10 business days (wth kind of timeline is that for something that happens immediately) - but I couldn't help emailing my nurse to find out if she knows anything yet. No news.

I've been trying to be better with eating and exercising. I tried starting South Beach diet but thinking about food is so time consuming. My chin broke out so there's still time until my better eating habits kick in. It used to be that it was the exercise part that would trip me up but for now I'm pretty good with that. I'm using myfitness"pal.com and the app for accountability.

On my path to new hobbies, I signed us up for a pottery class! I'm making my husband join in, at least for the first one.

Work has been crazy trying to catch up from when we were out for the week. It's only going to get crazier as we get toward the summer. I love summer and everything it includes like BBQs and bonfires and watermelon and beach time.

I saw Colin Farrell on TODAY talking about his new movie, "Lobster," coming out this summer. It's the weirdest plot: In a dystopian near future, single people, according to the laws of The City, are taken to The Hotel, where they are obliged to find a romantic partner in forty-five days or are transformed into beasts and sent off into The Woods" (IMBD). How weird! I love it. I want to write a novel with a quirky new concept and this just motivates me to get started.

I started watching Veep and Leverage - both awesome! Yay for having new shows to watch.

Roller coaster

Back to the mood swings and I'm on a low thanks to AF. I was really sad this morning and sent my husband about 12 texts with reasons about why I'm sad and anxious ranging from worrying about our embryos and the results from the mole biopsy to being sad that I can't find my heating pad. I'm also anxious about having guests staying with us for the weekend (arriving today) when I'm so not in the mood.

I found some pudding and put on some Iliza Schlesinger to make me feel better.

Embryo Watch: Day 5 update

The nurse tried to keep me posted all day but she wasn't getting much info from the lab. Toward the end of the day we got the news that one embryo was biopsied, two-ish stopped growing, and the rest are at various stages of growth so they will give them a chance to grow one more night. She said her best estimate is that 4 +/- total may be biopsied but she didn't want to lock in a number because there's no way to know which ones will survive til tomorrow.

It's not bad news; it's just not final news so the wait continues. Always waiting.

In other news, I was very productive today while waiting for this update. I made chicken soup, matzah balls, fish, stuffed chicken, roasted chicken, meatballs, two each of zucchini, carrot, and potato kugel, chocolate cake, blondies, mandel bread, potato salad, and cheese souffle. Tomorrow I'll make cheesecake and salads. I'm feeling productive and full from the tastings menu ;)

Embryo update

Out of the 27 eggs from yesterday's retrieval, 15 were mature and of those 13 fertilized. So there are now 13 on Embryo Watch 2016. I couldn't help feeling disappointed with that number. I know it's a great number. I know that we are so, so lucky to have gotten this number this far. I'm just worried about having enough make it to blast stage so they can be sent for PGD testing.

In the end I know it doesn't matter because in cycle 2 we had 6 make it to blast and none were healthy to transfer, so logically numbers don't actually mean anything. Still, I was unrealistically expecting something like 18 embryos to make it to this point. That's insane and I recognize that. I also realize that my hormones are completely swinging again and that's contributing to the exaggerated expectations.

Recovery is going really well, considering. Either my body is just used to it by now or I had a super gentle doctor, but I'm feeling so good compared to previous egg retrievals. At one point I told my husband that I'm concerned they lied to me or that I misheard about the number of eggs because it doesn't feel like I was poked that many times. I'm bloated, as expected, but I don't feel the same pain as before. It's possible I'm also a pro at recovery by now: keep hydrated to flush everything out, stay upright for the hours after, keep the heat pack on.

I've been conservative with the pain meds. I just don't feel like I need them, even the Tylenol. It's been such smooth sailing so far that I've literally had to hold myself back from doing things like carrying heavy laundry. I was ready to drive last night and my husband outright refused to "allow" it (tee hee, like he can stop me. I didn't drive because I would have felt guilty if I'd killed someone else, but I felt confident that I could). I'm forcing myself to take it easy today so that I can be more efficient in Pesach preps this week.

Next embryo update tomorrow. I know it's unrealistic to expect all of them to make it, but I still hope they do.

IVF 4: Baseline

My baseline appointment was on Tuesday and everything looked good to start, so I begin stims on Friday. My medication order came in and I'm all set to start again. The bloating I had last week is almost entirely gone - I didn't need antibiotics or anything else. I think stopping to eat crap and adding water and exercise may have helped with that. So now I'm feeling nice and unbloated... just in time to start a cycle again.

I'm worried about this cycle. I worry before every cycle, but this one seems different. It's possible that it's worrying me to have a cycle so close to Pesach. I've started menus and lists, and we've figured out our Seder plans. It doesn't mean that prep is done, but rather that I realize how much still needs to be done and recovering from an egg retrieval just days prior is overwhelming to think about.

I'm also worried about last cycle's count. We ended up with one embryo from a whole cycle but we never got it tested so we don't know if it's transferable. I'm worried about the results from this one might not be better. I really want this to work already. I'm ready to move on. I want to make it to the next steps.

When we started 2016, I was sure we'd be welcoming home our baby by December. It was just a given - of course it will work, it's a third cycle! Why haven't I learned yet? It's not a given. Nothing is a given and there's no guarantee any part of it will work. It's not even that the transfers aren't sticking anymore, it's that we haven't gotten anything to transfer yet, regardless of how much money we've sunk into this so far.

It's hard to get sucked into the what if's and the should-haves... it should have worked and I should be expecting by now. In fact, had the first transfer stuck, I'd be coming up on my due date in May. How crazy is that? I realized what a different year I've had than the one I expected when we transferred in the fall.

One thing I did learn, aside from managing my expectations, is that each cycle is unpredictable. I don't know what this cycle will bring. I'm hoping the recovery will be simple and that I'll be able to enjoy Pesach. I'm hoping it will be successful and we'll get several transferable embryos out of it. I'm hoping it will lead to a successful transfer this summer. I hope it's the last cycle for all the right reasons.