PCOS

Photo of Pearls from Wikimedia Commons

September was PCOS awareness month, and suddenly it's over and I realize I didn't do an official post for it on this blog!  I did address my PCOS in my last post, so if you want to know more about it, you can read it here. I also addressed it further in a guest post for the Resolve New England blog. I'm rather proud of that post, and would love for you to go read it at http://www.resolvenewengland.org/2012/09/pcos-from-not-me-to-thats-me/.

Something that a lot of people don't think about is that PCOS, or Polycystic Ovarian Syndrome, covers a huge range of experiences and symptoms. It's even in the name. The term "syndrome" references the fact that it is a spectrum disorder. In some women, PCOS causes ultra-long or non-existent menstrual cycles, but not all. For some it's a cause of infertility, but not for all.  For some, it causes miscarriages, but again, not all. Some women, but not all, have related weight difficulties, and some struggle with facial hair and/or acne. But it's a little different for almost everyone.

The most important piece of information to take from this though, is that PCOS is very common. It's considered the most common cause of infertility, and it is estimated that between 5 and 10 percent of women of reproductive age are affected by it. You can learn more about it here.

The Decision to do DEIVF



Fractal Ovary by Gilberto Santa Rosa

So where are we now as far as trying to add to our family? What’s the next step?

Basically, we have decided our next step will be to use donor eggs, also known as DEIVF (Donor Egg In Vitro Fertilization). It’s been tough getting here. Not just because of all we’ve been through. Making the actual decision has been hard. And since we can change our mind at any time realistically until our donor has started meds, maintaining this decision is also challenging.

First, it took some time for the Wacky Wicketeer to come around to the idea. When I brought it up at first he was just negative about it. Then he told me why – because he couldn’t imagine his DNA combining with anyone’s other than mine. It was this really weird, romantic, unexpected reaction, so I was like, “awww!” and “WTF?” at the same time! Later, we talked about it some more and I told him I didn’t think he realized what he was taking away from me by deciding we wouldn’t use donor eggs. As opposed to donor embryo, he was taking away my opportunity to bring more of HIM into the world. This man I love so much…I just can’t imagine the world without him in it, and part of my safeguarding that, since I know it will happen someday, is in trying to duplicate him. LOL. I know, that sounds strange, but there it is.

As compared to adoption, which he was ready to go ahead with, DEIVF would allow me to be pregnant, give birth, and possibly breastfeed. I would still have the opportunity to be the child’s birth mother, if not its genetic mother. I might be ready for adoption someday, but I’m not right now. To be ready for it, I would need to grieve these things.

He was still reluctant. Then one day he came home from work and said he was ready to proceed using donor eggs. I asked him what changed his mind. He told me a guy at work told him he needed to “just get over it!” Hah! After all that I had said, it took some guy from work who had been through an IVF or two to have his child, telling my Wacky Wicketeer to get over it.

I have heard it recommended that once you have a failed cycle at a clinic, you should change clinics. I think if it was a complete failure, i.e., no frozen embryos remaining, this is likely excellent advice. Each clinic I’ve been to has made little mistakes here or there that impact my confidence in them as a major part of my Fertility Team. So, we decided to change clinics. That same work friend of his, and an online friend of mine, each recommended a particular clinic in the Bay Area. So, we are switching to that one.

Because of the change, and because our initial infectious disease testing has expired, we have a lot to do before we’d actually cycle. I found myself procrastinating in getting the records and such. I finally realized that I hadn’t fully come to terms with the loss of my genetic connection to this theoretical child. I was, and still am, in the midst of grieving this aspect. My therapist says it will continue through to the child’s birth, but that the important part is that I get through some initial stages of it first. What I realized was that I was still in some denial about this being what we need to do.

I have recently lost about 20-25 pounds. For the first time during this infertility roller coaster, I have a healthy BMI. As I’ve mentioned before, the primary cause of my infertility and miscarriages is poor egg quality caused by PCOS. Hence the egg donor route. However, the weight loss, and the fact that I’m now running regularly, can help regulate my insulin, and possibly result in my ovaries being less PCOS-ey. (How’s that for a made-up word?) In summary, my improved weight could mean better fertility. Of course, we still have that pesky little slow sperm problem, so it’s still unlikely we’d get pregnant on our own.

Over the course of this journey, I’ve become a fairly religious person. So here’s what goes through my head: What if God meant for me to get healthy again before having kids? What if he delayed my dreams coming true because I was headed down the same path to diabetes and kidney failure that killed my Grandma at age 63? So just in case, how about giving my body a few cycles of trying out the old-fashioned way? Now that my eggs might be better? Maybe after all, God does intend us to use an egg donor, a donated embryo, or to adopt a born child. Maybe the child or children that we are destined to parent are a different genetic combination. But we can’t know that. I just need to give my body this opportunity, to accept the reality that we need an egg donor.

So, we’re taking our time getting the paperwork and initial testing done for the new clinic. Then we have to pick out a donor. By then, we’ll have gone through a few cycles of trying to get pregnant on our own again. What’s meant to be, will be!

If you have any questions, please ask! Nothing is off limits here. Just please be kind. J

The IVF Experience: Through Trigger

Here's where I start to give you the details about what this IVF cycle entails. At the moment, I'm frankly a little buzzed on a prescription painkiller my RE gave me after egg retrieval, so please, bear with me!

The first part of preparing for IVF is down-regulating. Particularly with PCOS, the woman's hormones need to be under control prior to starting stimulation. To accomplish this, Dr. Analytical had me go on birth control pills (BCPs) in December. On a Wednesday in mid-February, I started daily injections of Lupron, which does a lot of things, but mostly suppresses estrogen production. Thus, side effects are like a mini-menopause: hot flashes, fatigue, headaches, etcetera. At the same time as the Lupron, I started taking Dexamethasone, to help suppress my immune system. The next Monday, I stopped BCPs, and Aunt Flo officially began my cycle that Wednesday.

I had to get my estrogen level tested the next day to make sure that I was properly suppressed, which I was, with estradiol at 25. So I was on course to start stim injections the following week, which included Follistim and Luveris.

You might be noticing that there are a lot of injections involved. Most women either do these themselves, or have their husband or partner do them. However, the Wacky Wicketeer has a tendency to faint at the sight of needles, and while he nonetheless offered to try, I decided that I did not want a passed-out husband on my hands while going through this. The idea of doing them myself totally stressed me out, but I'm fortunate enough to have a Stepmom that is a nurse! So, she was kind enough to arrange twice-daily injections with me.

After a week of stims, I had my monitoring appointment, which included an ultrasound and another estradiol test. My estradiol was 3500, my uterine lining was 9.5, and I had 21 follicles ranging from 12 to 21 mm, with most of them in the 15 to 18 mm range. Dr. Analytical said I responded perfectly to the stims, that it looked great, and we should stop stims, trigger, and schedule egg retrieval for Wednesday - 2 days ahead of schedule!
So we did.

We had to administer the trigger injection - Human Chorionic Gonadotropin (HCG), a.k.a. the pregnancy hormone - at 1:45 in the morning! So, Stepmom stayed overnight, and we got up in the middle of the night to get it done.

Next up, the scary part: Egg Retrieval!