As of yesterday, I had sorted out my dilemma of what to do with my spiralling mental health, no doubt a by-product of my spiralled physical health and the 6 miscarriages we’ve undergone since March 2013 in our pursuit of living child number two. The decision I’d reached was to make no major decisions except to embrace life, try to live in the moment, restore my health (physical, mental and financial) and the proverbial “wait and see.”
Today, I have had some adventures:
1. I woke up with cause for celebration – I am bleeding heavily. The old menses has finally arrived, only delayed a few days by the 60 mg of Prednisone I’ve been on for 5 days to combat my immune system flare-up. I’m relieved, it did not feel good to have a womb full of blood that wanted to escape and was being held captive past its prime.
2. Despite the heavy outpour of blood, I actually feel lighter of spirit (and body, thanks to the blood-letting, no doubt). I’d swear I were miscarrying, this is super heavy bleeding. Sorry for the too-much-information confessional. Most of the day later, I still feel lighter of heart, but for the few forays into unadulterated rage and forehead-smacking (keep reading). I guess hormones were not helping with the depression that was sinking in a couple of days ago when I penned my last post.
3. I lost my head and launched into a tirade at the LP for neglecting to deal with laundry in any form of civilized fashion. In my defence, his only responsiblity was to put away what was already washed and folded and to carry to the laundry room the mountain of unmentionables he’s been hoarding (apparently for the past 14 months or so it might appear to the untrained eye)
4. I discovered that letting our two-year old practice “driving” meant my vehicle’s battery was stone-cold dead and required me calling the automobile assocation, which required me to pay over 200 clams for both the LP’s and my annual memberships because someone had neglected to pay that since it was due on March 31, 2014. No names mentioned (hint: he isn’t two).
5. I signed up for a new gym membership and I start kicking my own butt tomorrow. Yay!
6. I spent some time quietly sipping tea and looking forward to camping with the LP and our Miracle Toddler (also known as Car-Battery-Killer). I gave or threw away all of my camping supplies when we moved a couple of years ago because the LP “is not the camping type” (read: “wasn’t the camping type” – he has agreed to give this a bona fide effort). The Car-Battery-Killer and I ahd fun yesterday picking out some new camping equipment as part of the newly hatched plan to live in the moment, restore mental, physical and other health and forget attempts-at-baby-making-as-lifestyle for the immediately foreseeable future.
7. I got a couple of e-mails with advice from our RE.
So, the RE was thoughtful and careful in his responses. The key points are below:
A. The immune flare may be the cause of my TSH more than doubling since a year ago. It’s always been well under 2, it was 1.55 last June and it was 3.17 this June 24th, 3 weeks after our most recent miscarriage and in the midst of my autoimmune symptom hell that led to the current Prednisone protocol.
B. Meds to lower TSH take 3-4 weeks to take effect so the RE recommends I start now. Okay…
C. The RE accepts that immune factors appear to be at play for some women (present company included) in assisted reproductive technology (ART), recurrent pregnancy loss and/or infertility (primary or secondary), even though the subject is hotly contested within the ART community and has not been accepted by the American Society of Reproductive Medicine (ASRM).
D. With the exception of some established autoimmune conditions (none of which I have been diagnosed as having) and their respective protocols, the testing and treatment for suspected immunological factors such as natural killer cells (NKa) and HLA-matching are not recommended by the ASRM and lack convincing, reproducible data.
E. Typical “immune-modulating” interventions include intra-lipid infusion, IViG and steroids. Again, the RE maintains, these lack convincing, reproducible results and are not recommended by the ASRM.
F. Although in his personal opinion, immune factors “probably play a role in some cases”, he acknowledges that “our ability to identify and treat is lacking.” This will likely change in the coming years, but that does not help me and others like me now or in the immediately foreseeable future.
G. The RE sees a potential “window of opportunity for embryo transfer” of one or both of our remaining two frozen blastocysts “shortly” after I conclude my current course of Prednisone (I should be done treatment in the third week of July), when hopefully the antibody levels (IgE) have returend to normal. I asked for clarity on the RE’s definition of “shortly thereafter” but the best I got was a sense of it being in the month or two after I end the steroid treatment (and that’s more my inference than him spelling it out).
H. The RE is open to using intra-lipids pre- and post-transfer (if successful) and a sub-cutaneous injection of hCG before transfer but NOT further use of steroids during the transfer cycle.
I. The RE is also not in favour of using an intra-uterine injection of hCG at the time of transfer on the basis that it is primarily aimed at assisting women who fail to develop an adequate uterine lining (which is not my issue, he said) and because he is concerned about placing excess liquid in the endometrium because “it may be a conduit for embryo movement.” There are some docs who suggest that the intra-uterine injection is also targeted for women with known or suspected immune issues, but I have not raised this and frankly the research on that appears limited and as our RE would say, “lack convincing, reproducible data”.
What does all of this mean for my plan of taking a break from all of this baby-making madness for the rest of summer and maybe longer? I have no idea. Do I agree with everything he’s said? I don’t necessarily disagree, I have some anxieties but I’m letting them go gently right now. And I plan not to think about the what-ifs beyond having blocked off dates in the LP’s and my respective work calendars in case we decide to take advantage of the “window of opportunity”, should my gut tell me it’s the right thing to do in one of the coming few months. For me, right now, that is plenty. I am not committing to any dates right now.
Rather, I plan to press on with the plan to live and rebuild our lives, be in the moment, and go camping (first in the backyard – we need to break in the Miracle Toddler and possibly the LP, after all). I also plan to call my doctor tomorrow and accept her offer to prescribe me a low dose of thyroid medication to bring my number back under 2. I can live with that.
It is time to live and to be. Alive. Alone. Together. Here. Now. And whatever else happens? Well, it will happen as and when it is meant to happen. This hiccup is not derailing my plan to embrace the life we once had and enjoyed. I want that back, no matter what else happens.