When Nothing Goes According to Plan: Latest Immune Test Results

Yesterday was a stress-filled day. I discovered I had screwed up at work not once but twice (one much more significant than the other, thankfully, but both affecting other lawyers with whom I have not worked much before so not great for my reputation in either event). That got me down. I was also pulled in a half-dozen different directions, which is always challenging. Then I got an unannounced call from Dr. Braverman, which of course I missed by a millisecond. I knew what that meant before I even returned the call: bad news, particularly since he did not preface the call with an email sending me my report and asking me what time worked to discuss it.

I called back. Finally my December 22, 2014 test results had arrived and his team had completed their analysis and graphing of what they all meant on their own and in the context of where I’ve been and where we hope to go with this pregnancy. In a word, the results were awful. Many of my inflammatory intracellular cytokine levels were the worst they have ever been. Almost all of them are elevated, as are a number of my inflammatory chemokines. All of my Natural Killer cell levels and activity (NK, NKT, NKa) are elevated and I continue to have a notable (and worsening) T1 bias.

In short, my immune system is reacting to this pregnancy with a boatload of inflammation. The diagnosis is significant systemic inflammation and an immune spike at 12.5 weeks (which for those of you who don’t remember is layered upon my last immune spike at 8.5 weeks). The treatment should be IVIg but for reasons discussed below will be more steroids, more frequent Intralipid IV treatments and low-dose aspirin. Oh, and prayers. Heaps of prayers.

This was not the news I was hoping for. Bad didn’t even cut it. Awful made it sound like a root canal. But although I have never had one (yet) my understanding is that a root canal has an end date, a date by which you can expect to have endured sufficient physical and financial discomfort as to be released from purgatory for years to come (at least in relation to the specific tooth in issue). Not so when your immune system fights a pregnancy tooth and nail. Every day until baby is either long gone and a long (read: endless) recovery and grieving process well entrenched or until baby is safely in one’s arms – alive and wriggling – does the terror and torture end.

It would be a gross understatement and trite to say that we have had enough bad news already on our journey to conceive. I guess no one among “the powers that be” is keeping score. Or cares. I do not appreciate being reminded that life’s adventures are often fundamentally “unfair”.

Not that I am suggesting that my and others’ suffering should be spread around among other women struggling to have or grow families. I do not wish on others my experiences or the agonies of those around me with whose suffering I suffer alongside. But I do wish some days that I could catch a break. The litany of bad news becomes exhausting. As do the side effects of the drugs I have to take to address the bad news. Despite what seems like a lousy hand to have been dealt, I would not and do not wish it upon others. At the same time, I would not consider myself human if I did not acknowledge that it sucks and I am unhappy about it.

The call with Dr. Braverman went as well as it could have. I did not break down. I did not even think of crying. I was all business despite the lump in my throat and the fire exploding in my head (why do these calls so often incite a fierce pain in my head?). He repeatedly told and I believe was trying to reassure me that he does not believe that we are at risk of losing this baby right now. I believe him. In his experience, which is considerable, this is very unlikely to happen *right now*.

A silver lining. Thank God. There is one, even now.

For today, Azulito/a should be okay. In future? Well, that’s where things get dodgy again.

The reason for Dr. Braverman’s (and the LP’s and my own) grave concern is that I am at serious risk of developing either or both of intra-uterine growth restriction (IUGR) and preeclampsia (toxemia), each of which is generally considered a serious third-trimester complication though symptoms of preeclampsia can show up in the second trimester. The former poses significant and serious risks to baby; the latter to both baby and mom.

IUGR scares the pants off of me. Preeclampsia scares the pants off of the LP (and it doesn’t give me warm fuzzies either, believe me). Both have been found in scientific studies to have higher rates of occurrence among women who lack Killer Immunoglobulin-like Receptor (KIR) cells, as I do. They are also both more frequent among women with significant systemic inflammation. It sucks to be me, huh?

Back to the treatment protocol. Dr. Braverman wants me to increase my Prednisone from 20 mg (I had finally tapered to that only a few days ago) to 60 mg again for two weeks then stay on 40 mg until a further set of testing is completed, results returned from Reprosource to Dr. B’s team and analysis of them completed. I am also to switch from biweekly to weekly Intralipid IV treatments effective immediately. I was due for the next biweekly treatment this Friday in any event so I am keeping that appointment and adding one every other Friday until further notice.

Returning for a moment to the issue of stress, I recently applied to refinance our home to pay down some of the bills I have incurred in the past two years of trying to bring Azulito/a home. I was feeling pretty good about biting this bullet. I was not expecting a bunch of new immune-treatment-related expenses to crop up. Live and learn.

All of the Intralipid treatments, both medication and payment to the nurse who administers them with her Resident husband at our home, are 100% out-of-pocket as my insurance will cover neither. In total I pay abut $300 CAD per IV which will now amount to a minimum of $1200 per month. Thank goodness all of my other medications have been covered 100% by my insurance. None of the travel to/from New York and none of the testing is insured. Each trip including only airfare and lab expenses to Reprosource have cost me between $1800 and $2400 CAD. I have to go back to NYC at the end of January or very beginning of February (I need to work around my office commitments and a trip I booked to visit my best girl friend so I have not booked a flight yet) to do the next round of immune testing and see where things are at then after weekly Intralipid IVs and two weeks on 60 mg of Prednisone.

This seems like the perfect segue to the ideal treatment protocol for what has been happening with my immune system. Out of the gate in yesterday’s call, Dr. Braverman said he would ordinarily recommend IVIg in this situation notwithstanding the fact that there is no conclusive evidence to establish the likelihood of me responding better to it than Prednisone and Intralipid. My original test results in July indicated that my NK activity was lowered significantly more in the lab test environment with IVIg than with Intralipid (the difference was dramatic as I recall, with a delta of about 20%). Dr. Braverman noted when I asked about that what seems like ages ago that those tests do not necessarily translate into comparable results outside the lab when all of a patient’s immune factors are in play at once.

Dr. Braverman asked me about the logistics of my getting IVIg administered where I live. The chances of that are nil and I told him about my own and My Perfect Breakdown‘s investigations into that reaching the same conclusion. It is simply not going to happen for pregnant patients where we live. Dr. Braverman said he did not understand this but suspected I would say that.

We talked about the logistics and cost of my flying to NYC for IVIg. He noted that I would first need to be tested to ensure I was not allergic. If not, he could arrange for me to receive those treatments through his office at a cost he estimated to be between $4,000 and $5,000 per IV treatment. This would involve me flying to NY throughout the second trimester and for who knows how much longer after that, all with no guarantee of a better result.

Given the logistics, financial considerations, travel stress and risks and where I am in this pregnancy (I am 16 weeks today), Dr. Braverman and I agreed that this was not an ideal option right now. From my perpsective, it is not an option at all. I cannot afford another $20,000 gamble – it’s as simple as that. Dr. Braverman did note that if I were earlier in this pregnancy he would be pushing hard for me to do the IVIg but at almost 16 weeks, when we spoke, he felt that Prednisone, Intralipid and Lovenox was a good second choice. Let’s hope that proves true.

I am trying not to engage any guilt over this decision being largely though not entirely about money. Dr. Braverman said “look, I know you would do anything to keep this baby but some things are simply not practical.” I appreciated that human element and am trying to remind myself, I am doing and have done everything I reasonably can to bring Azulito/a home. I cannot bankrupt myself or my family in the process.

Finally, I also (starting yesterday) resumed taking low-dose (81 mg) aspirin with Dr. B’s agreement. There is medical literature suggesting it can lower the risk of preeclampsia for some women and it is relatively benign otherwise now that we are no longer or not currently worried about bleeding.

In other news, I am getting increasingly concerned about how big I’m growing this early and that I have added more weight by this point in this pregnancy than I did by 27 weeks (the end of the second trimester) in the Miracle Toddler’s pregnancy. Despite the high steroid dose, I had only gained about 5 pounds by my last prenatal appointment in late December and if our bathroom scale is correct I have gained about 8-9 pounds since then. What the heck? I can tell some of that is retained fluid from the steroids but what is up with the rest? Rapid weight gain can mean trouble in the form of increased gestational diabetes and preeclampsia risks. Really? I need more to worry about and more weight to lug around this early? I want to cry!

Enough about me and this very challenging pregnancy. I will end on a positive note by saying I am so incredibly grateful that this baby is inside me and I get to lug it and this extra weight around in the hope of holding wee (but not too wee, please) Azulito/a in my arms in a few more months. Please may that dream come true.

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Uncomfortable Entrance into the Second Trimester

* pregnancy mentioned *

I feel remiss. I have been offline for what feels like ages and long overdue in reading or commenting on many of your posts or in posting any kind of substantive update myself. The holiday season took our home and my life by storm. We have had guests in our home for the past nine days. I had a great visit with my best friend and her munchkins but I am officially dead beat (and the Miracle Toddler is coming down with something, that’s what he gets for refusing to nap all but two of those nine days). Please accept my heartfelt apology for not keeping track or in touch more reliably. You know I’ve been thinking of you (or I hope you do).

I officially entered the second trimester earlier this week. The second trimester is supposed to be the “honeymoon” phase of pregnancy. Bah humbug on that. So far it has been an exercise in serious discomfort for me. I have suffered from terrible pregnancy-driven bloating, constipation and general malaise so badly that I’ve actually wept on occasion over the past week and a half. My digestion has apparently slowed to an all-time low and on some days I looked as though I were 6 months, not 14 weeks pregnant. My poor belly hurt! Heaps! Any woman who has said that pregnancy was a blissful state for them was lying. That said, I am very happy to have a little more energy and not to be falling asleep at my desk these days. Yay for small mercies! Now if only I could sleep through the night…

In addition to the GI troubles, I finally developed the dreaded moon-face while on 60 mg of Prednisone and it’s still not gone as I wean down from 40 to 20 mg while I await the results from my last immune testing. My blood was drawn December 22, 2014 and it takes about two weeks to get the report from Dr. Braverman’s office so I’m hoping that by early next week I will have some idea how things were looking at just shy of 13 weeks. I would love to drop down to 20 mg Prednisone and then wean off slowly to nothing by 20 weeks or earlier if things look good and my crazy symptoms don’t return with this or the next drop in dosage. Fingers crossed!

In other news, I tried an amazing Paleo bread recipe for the first time yesterday. So yummy! The house guests, the LP and I devoured most of a loaf in a single sitting. The MT would not try the bread as he was obsessed with the grapes and apple we’d served to accompany the bread. I’m sure he will try some another time; like his Dad, the MT loves bread!

The LP and I told some more family about this pregnancy over the holidays. I also told the important people to whom I report at work that I’m expecting last week. Telling work was kind of a big deal for me. Law firms are not known for their friendly responses to family planning matters and my last experience was a nightmare from start to finish (the finish being my resignation while on maternity leave, a decision I have never regretted).

In the MT’s pregnancy, I was suffering post-loss trauma and massive anxiety, trying to survive a toxic, family-unfriendly (despite protestations to the contrary) workplace and the LP was afraid to tell his older kids about having a new kid. I never admitted I was pregnant at work to anyone but my immediate superiors until after 20 weeks. I lied more than once. The good thing was I was smaller and didn’t show a lot until around the 20-week mark. Some women tried to hand me drinks to see if I would take them so they could “out” me as pregnant before I wanted to disclose that. Yes, I worked in a law firm then. An international law firm. Did I mention it was toxic?

Telling the managing partner and my practice group leader at my current law firm was a very different experience. They are both men (of course) and they both know the LP and I are… well… old. They each appeared to be sincere in their immediate congratulations and neither one asked me inappropriate questions or leapt to how long my leave would be. To be honest I think the managing partner was relieved that when I’d asked for a meeting with him I was not coming in to resign. (When I joked about that he admitted those “can I see you for a moment before you leave town” emails usually result in bad news so this “good news” was a relief.)

I haven’t told my “mentor” at work (my firm has a formal mentorship program despite the fact that I’ve been practicing for a decade, which I actually think is a good thing on the whole). I think he (yes, also a man – the legal profession or at least private practice still has huge issues with retention of female practitioners beyond the 5-year mark in Canada and I’m guessing elsewhere in the Western world) guessed on the one day I saw him last week. I felt a moment of guilt for not being forthright and then thought about how he had treated me rather poorly the week before when really stressed out and decided the guilt was both misplaced and unnecessary. Not telling him early on suddenly felt like retribution for his unkindness. Apparently I have a passive aggressive side. Who knew?

I am 14 weeks 2 days today, meaning I have 25 weeks and some days left to go if I carried Azulito/a to 40 weeks (which will not happen!). Given that this is my 10th pregnancy, it seems that my body has decided I should look as pregnant as possible as soon as possible. I’m a little disappointed as I feel huge already and worry what that means for 15 weeks from now and onward but I am trying to practice acceptance and embrace my new shape(lessness). At the request of the inimitable My Life as a Case Study (MLACS for short), here is a “bump” photo at 14w2d.

bump

I sincerely hope that each of you has had a peaceful holiday (and that those of you who have suffered this holiday season will find peace in the coming days and weeks while you remain in my thoughts and prayers) and have something to which you might look forward in this new year. The year that has ended was a very difficult one for a great many of us – and also a new beginning for some, present company included – and will not be missed by many, I’m sure (present company included). For me and for the LP, 2013 and 2014 brought deep heartache and yet a sense of hope after all hope seemed lost. I wish so much that each of you reading this also find hope where it has been or seemed lost and for those of you whose hope has been restored, I wish that it remains so and that the Universe is kinder and gentler now than it has been in times past.

With a full heart and a bloated belly, I blow you all a new year’s kiss. Don’t worry, I used a dental dam so I won’t contaminate you with the Miracle Toddler’s latest bug. All the best to each of you.

I am Still Alive and so is Baby

* pregnancy mentioned *

In case you’re wondering… I am still kicking about and so is Azulito.

It was a very busy week at work and I got some really devastating news on Thursday morning that a close friend had died suddenly and unexpectedly on Wednesday afternoon. I was a mess all day Thursday and eventually went home early and to bed.

As fates would align, I was also blessed with bad morning (meaning all day and evening) sickness and the most intense exhaustion I can remember short of the day after an all-nighter this past week. I actually fell asleep sitting at my desk four times with past week. I need to start closing my door so passers-by don’t wonder if I have developed a case of narcolepsy.

The LP and I got to see baby together on Friday. The little munchkin had very obvious leg and arm buds and a great big noggin. The technician tried to arrest my heart. She said baby was measuring one day behind my dates based on transfer – meaning it was measuring 9w1d, the same as s/he had measured four days earlier at Dr. Braverman’s office. My stomach flipped and my heart raced and leapt into my throat. I asked her how that could be since baby looked bigger and had measured that size four days ago.

She insisted I was just paranoid from all of my losses and tried to explain how a “proper” crown-rump length (CRL) measurement is taken. I wanted to smack her and let her know I could probably do her job by now and that I was pretty sure she and her equipment were not more accurate than my Reproductive Immunologist and his wares. I gave her my best “lady, you are about to kill me or me you” look. She tried again. 9w5d. As egos would have it she maintained her first measurement had been accurate but said she would take 3 and average them. The average was 9w4d but I know the last two were 9w5d so I am going with that and hoping I don’t get the same technician next time.

I am still really tired all the time and that – coupled with passing out at my desk – means I’m behind at work. And that means this post ends here do I can finish up some work and go home to my boys and my four legged girl.

I hope everyone in the good old US of A enjoyed a safe and love-filled holiday (or survived insufferable relatives if not). I am officially excited about the coming Christmas holidays even if I sometimes wonder whether I married Ebenezer Scrooge reincarnate.

7w1d: U minus 8.5 hours and counting

I have my second ultrasound in about 8.5 hours. My heart races when I think about it. I wish I could will myself not to think. About it or anything else related to fertility, babies, autoimmune or recurrent pregnancy loss.

Some part of me cannot imagine this scan being another catastrophe. How could we really be so cursed? But the reality is, even if Dr. Braverman’s immune protocol is still working, there is always the chromosomal component that could cause this baby to stop developing or developing normally. We could still have a missed miscarriage for reasons completely unrelated to my hopefully-suppressed and still-behaving immune system.

My best friend wrote me yesterday that she cannot imagine the energy it takes to face the worry every day after all that we have been through to get here. That strikes me as a poignant observation on a few fronts:

1. No wonder I’m exhausted. I’m making another human (I hope) and shouldering or at least trying to process and let go of *so much worry*.

2. My normal is not most expectant mothers’ normal. I am so immersed in my situation and the RPL experiences of several of you that I sometimes forget how rare my circumstances are. How many women have an immune system hell-bent on destroying new life? Thankfully not many in the grand scheme though I think it happens more than most doctors ever acknowledge or are prepared to consider.

3. Knowledge is a double-edged sword. I am so grateful to know why we have lost so many babies. I am also terrified knowing that aside from the chromosomal issue we cannot control there is always the possibility of my immune system developing an adaptive response and doing a 180 on us, especially during the first and early second trimester. This is of course why Dr. Braverman pushes monitoring and why I was so quick to drink that kool-aid. I have been working to accept that so far things look good and I am doing everything I can to make this work. This is as good as it gets. I pray and hope that it is enough.

4. Finally, maybe this will work. And maybe one day in this pregnancy I will wake up and be genuinely less afraid. Not entirely free from worry because motherhood is laced with worry from start to finish. But able to worry less and feel some shade of confident that we really will welcome another child into our lives and home.

For today, my wish is for peace. Peace of mind. A peaceful ultrasound this afternoon. A peaceful sleep tonight. A peaceful journey to December 25th (13 weeks) and beyond. A peaceful birth.

A girl can dream. This is mine.

Hiccup?

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.  

*Hiccup!*

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.

Giving Serious Thought to Giving Up

I have been dumbstruck by how many symptoms of my immune system collapse to which I had become so accustomed that I no longer considered them indicators of abnormal or unhealthy. Since the first couple of days after I began taking 60 mg of Prednisone to treat my sky-high Immunoglobulin-E levels and relentless allergic reactions to my environment and myself (my own hair was irritating my skin), I have noticed many changes, including:

* my eyes are not sore or burning and they do not weep while I sleep

* the skin around my eyes is not scaling, flaking, red, sore or peeling even when I forget to apply the steroid cream or antibiotic drops I’ve been on since March

* my inner ear channel is not burning and itching

* my throat is not swollen, sore or itching 

* I do not have instant inflammation in my mouth and throat when I eat – even when I eat foods that have some dairy and or gluten in them 

* I can breathe through my nose (even after being around environmental allergens)

* I do not feel foggy from a constant barrage of histamines coursing through my system 

I did not appreciate how sick I was until now.  I rarely get sick usually but I’ve been under this cloud of constant ill-health for months and months. It grew incrementally worse so I didn’t really notice the changes until they combined to create an unliveable situation. However, it took losing our perfect donor-egg embryo in May for me to really question the lie I’d internalized that all of our prior 5 losses since March 2013 were due to my “old eggs” and not an immunological issue or issues.  My heart is very heavy with the knowledge that I ignored my gut for months and basically threw away that perfect embryo before listening to my inner voice reminding me that something deeper is amiss and has been that way for a while. 

There are downsides to the Prednisone. Menstruation, which made every indication it was on its way, has gone AWOL. I feel a new kind of foggy, one riddled with the jitters and a strange fatigue (I imagine this being how I might feel on uppers and downers at the same time). I am retaining fluid and I feel gross about it.  My lower back hurts (I pride myself on not having back pain despite toting a toddler around several hours a day on any given day).  And I am depressed. More than I was before I started this drug.

This is the most worrisome symptom. I need to keep an eye on the depression. I’m not on medication for depression or anxiety anymore (I was – coincidentally the last time I was on them was the first time my immune system went off the rails – a long time ago).  Today I have considered speaking with my doctor about resuming drugs for depression.  I have not made a decision.  

I did talk with the LP about anti-depressants last night and why I’ve tried to avoid them while TTC.  We talked about how down and flat and unable to enjoy life we are and have been over the past 12-18 months. The LP asked what there is to feel good about, noting I am really sick, I’m on harsh drugs to recover from trying to have a child, we have suffered blow after blow, we are in debt and are stressed about that, our work has suffered which causes more financial stress and general worry, we have no explanation as to why I can’t stay pregnant and have gotten so sick.  

The LP is right. Apart from our Miracle Toddler there is nothing about which we feel joyful or glad to be alive.  We are surviving – existing at best – but there is no light at the end of the dark tunnel down which we have been staring and walking for what feels like a long time, though I know for others 18 months would seem like nothing. Six dead babies and the loss of my health are not nothing to me, to us, however.  This feels like a crossroads. 

Last night’s conversation with the LP and a tearful email earlier today to a friend who knows the heartache of losing babies and giving up on TTC led me to wonder if this is the path I should be on anymore.  Maybe be it is time to give up?  At what point does it all become too much?  

As as I wrote to my friend, the more humane and fiscally responsible choice at this point seems obvious. Quitting – giving up on our remaining two DE blastocysts and on any future efforts to try to conceive naturally – seems so much more rational than continuing to smash my face into a wall covered in broken glass. 

One thing I know about grief, depression and mood-altering circumstances generally is that they are not optimal environments in which to make lasting or permanent decisions. So I will not make a final decision today.  But I am giving serious thought to giving up.  At this point it would be irresponsible for me not to do so.   Something has got to give.