Persistent delay

This morning I was scheduled to go in for the third biopsy to see if the latest dose of antibiotics worked to clear up the inflammation. Before the appointment, I got a call from my doctor who wanted to run an idea by me.

Since it's a teaching hospital, they have symposiums and clinics and world-renowned visitors every so often. Last week my doctor attended a presentation by an RPL specialist and presented my case. In short, the specialist recommended a test similar to the CD138 stain but more specialized in that the results offer the cause (type of bacteria/microorganism?) so the antibiotics can be more targeted. Additionally, he said that the inflammation is unrelated to the ERA and we don't have to wait for one to clear up to do the testing for the other. So my doctor recommended skipping today's biopsy which is just a yes/no test, since it is uncomfortable and won't give us any information we won't get otherwise, and instead doing the new test along with the ERA.

This change of plan doesn't necessarily delay anything. The plan was always to do an ERA test after this biopsy. The results are expected within 15 days for both ERA and new test so we're not losing any time there. It will only be a delay if it comes back positive and then we have to go through antibiotics again.

I'm not a fan of not seeing something through so I'm working through the uncomfortable feeling of this morning's last minute cancellation, but there was really no reason to go through with it given this new information.

I'm already assuming that I'll have to repeat antibiotics because it will just be easier to hear that news if I'm mentally prepared for even more delay. I did the calendar math and if it does come out positive then we're looking at FEB for earliest possible transfer. Can't even process that. One step at a time.

Antibiotics

As expected, the antibiotics are wreaking havoc on my stomach. While I don't normally drink that much caffeine or alcohol, right now I'm having none. Drinking a lot of water. Having the medication with food helps, although I need to time it correctly in the mornings with the synthroid. If I take them at the same time and then can't eat because of the synthroid wait window, I get nauseous. But if I take the synthroid separately then I worry I'll forget the ab and miss a dose. I'm taking probiotics. Also brushing more often to try to get rid of the gross taste in my mouth. One more week to go.

My doctor wants to wait at least two weeks after the last dose to do the biopsy. Of course. It's not like I had in my mind that I finish the last dose one day and then do the biopsy the next. This whole deal delays the timeline by six weeks.

It's fine, I'm fine, we'll be fine.

Persistent Endometritis

Yesterday I drafted a post about how drained I was feeling. Emotionally exhausted and mentally spent. The constant rain, the seemingly endless holidays, the lack of routine, and the perpetual wait for results all having something to do with my mood.

But I didn't post it because it didn't feel fleshed out. I feel numb in many ways, but then I'll get a burst of energy and get so much done. I watched part of the hearings yesterday and felt a slew of emotions not only for those testifying, but for all of America and how broken the country is right now. I felt like my personal fatigue is a luxury our nation can't afford. That sounds more dramatic than I mean, but the post has a complainy vibe to it that I wasn't happy with so I put it aside to maybe look at again with fresh eyes.

Then this morning I got a results update from my second CD138 stain and it came back showing persistent endometritis. Of course. I'm in the 20% of the population that didn't have it cleared up with the first go around of antibiotics so they're putting me on a stronger dose for twice the time.

As numb as I thought I was, there's nothing like being told there's a delay to bring on the sting of tears. I'm obviously on board with wanting to clear this up before moving forward. The more it comes up the more convinced I am that this is probably the cause of our RPL. Still. That doesn't soften the blow of knowing that we've just added another month+ to the wait before a transfer. What happens if it doesn't clear up? I asked my doctor that question even though the answer scares me.

I feel lucky and conflicted at the same time. I feel lucky that we have something tangible and (hopefully) fixable that we can work on. We have a defined plan and timeline to hold on to while we wait. Having to wait in between cycles is really hard but at least there's a finish line. It's difficult that the finish line keeps moving. So long as it's somewhat visible, though, there's still hope. 

I'm waiting to hear back how long after the ab treatment, if any wait, is needed before they can retest. I'm preparing to be told that they want at least a few weeks after the end of treatment before another biopsy, which delays it more by yet another month.

The original schedule was:
Aug retrieval
Sept CD138 retest
Oct ERA
Nov transfer

Now we're looking at:
Oct antibiotics treatment
Nov CD138 retest again
Dec ERA
Jan transfer

This requires an infinite amount of patience, hope, and stamina which I just don't have right now. Maybe I'll find some calm at the bottom of a pint of ice cream.

Results and next steps

We got genetic results back. Of the four embryos sent for testing three are healthy and transferable. To say that was surprising is a complete understatement. I was so upset when they got "so few" eggs! I braced myself for another busted cycle even while hoping for the best. When we got close to end of the embryo growth stage and it was possible we'd have 4, even 5, embryos biopsied it was amazing. Even more amazing to get the genetic results back that they were 75% are healthy. Amazing. We're obviously thrilled with the news but we're very, very guarded. Embryos don't mean babies... we already know that. I'm really happy it was not a busted cycle after all.

My headaches have gotten less intense since I started the bp medication but they're not gone completely. I followed up with my pcp who sent me in for a CT scan. All looked ok in the scan. She said if they persist she'll send me to see a neurologist. I'm hoping that with the weather changing it will continue improving without needing any more intervention.

Today I went back for the CD138 stain retest. There's an 80% chance the inflammation cleared up. If not, then we go another round of antibiotics. My gut flora is already unhappy. I found some probiotic yogurt and hoping it will help.

If it is confirmed that the inflammation is cleared, we start the natural ERA next cycle. My doctor went over the schedule for the next few months. Each step gets us a little bit closer to a transfer. Embryos in the freezer contain so much hope and possibilities. But I know we need to risk one for a transfer. I know. Just scared it will end up like all the other transfers. My doctor is very optimistic and it's helping to keep me positive.

IVF 8: trigger and CD138

Yesterday I went in for this cycle's final monitoring. Those lab techs are the best I've seen - one stick every time for bloodwork. Results came back and we triggered last night. Egg retrieval is scheduled for tomorrow first thing in the morning so I took off Thurs and Fri from work.

During my hysteroscopy in June they took a biopsy for a test that the RPL specialist recommended called the CD138 stain. The hysteroscopy was one way of checking for inflammation (and possible other issues) and this stain was another test for something similar, looking for micro inflammation not as easily visible and oftentimes overlooked. It took a while to get the results back and then send them out again for more testing - a total of 7 weeks for the process. 

My doctor called me yesterday with the results: turns out the test came back positive for micro inflammation, aka chronic endometritis. This is a known factor to hinder normal implantation of an embryo and its subsequent development. When I got the news I kind of just took it, asked the doctor my initial questions, and listened to the next steps. As the afternoon wore on and the more I thought about and researched it, I was overwhelmed by emotions:

• Hope: this is finally it - the reason for all the loss
• Skepticism: some articles say that past history of abortion causes CE, so maybe it's not the original cause of the issues but rather a side effect of all our treatment
• Sadness: why wasn't this thought of sooner. it's such a simple fix, why did we go through all that we did if this is answer
• Fear: what if treatment doesn't fix the issue. what if we fix this issue and still lose the pregnancy. what if we fix the issue and it comes back before the transfer.

According to this article, "pregnancy outcomes after treatment for CE in women with RPL are encouraging." The treatment is a dose of antibiotics. I just want to cry.

So what does this mean now? After the retrieval both my husband and I take a round of antibiotics. Then we wait for my period and retest this CD138 stain next cycle. We'll wait for the results before scheduling the ERA/transfer because obviously we want to ensure that the lining has been cleared up before attempting a transfer.

We were originally going to take September off for the Jewish holidays, but now I'll plan to do this biopsy during my September cycle. It wasn't feasible to do a natural ERA cycle with all the yamim tovim, but a scheduled biopsy is plannable and there's no reason to wait, especially if results take a while to come back.

I've stalled on my diet. Not because I'm eating differently but I think I'm retaining fluid from my expanding ovaries. Is that a thing? I also lost a lot last week so I think may just be a natural plateau. In prep for the retrieval I started drinking smart water yesterday so that it's already in my system. I'm also looking at nearby gyms and will consider joining if I can make it work with my schedule. The weather has been too unpredictable to be outside and as much as I want to make it work, I'm just not working out enough at home. I got my cleaning crew in yesterday and caught up with laundry to make sure I'm not tempted to overdo it after retrieval.

I really hope this is it. I don't know how many eggs will be retrieved. I don't know how many will fertilize and make it to blast and through the other side of genetic testing. Of our previous seven cycles, three cycles results in no embryos to transfer. Going into our eight egg retrieval, I know the next weeks are going to be a roller coaster of emotions. I can only hope we get a few good embryos to finally start our family.