September 02, 2007

Next Steps

Some of you already know from previous posts that I am a planner. I have to have my next steps in place, a Plan B, and even a Plan C and Plan D sometimes, so that I can keep moving forward.

Never mind the fact that so far none of the plans have actually gone according to plan; I still have to have them, for the comfort factor alone. So it should be of no surprise that R and I were already talking about what to do next on our way home from the ultrasound that showed the lack of heartbeat.

Some aspects of the plan are easier to write about than others, so I’ll start with the easy stuff.

The Plan, Part 1

This part of the plan is simple to explain: LOSE WEIGHT. Lots and lots of weight.

Now if only it was as simple to execute. Like most of us, weight loss has never been one of my fortes. But I am determined to make it happen.

I’ve gained 40 pounds since beginning the fresh IVF cycle last summer. I didn’t need to gain any weight to begin with, but I now top the scales above 200, and even at 5’7”, that’s not good. Since I’m prone to pregnancy complications anyway because of the PCOS and blood clotting issues, I was pretty stressed about what additional complications the extra weight would cause. One was pretty apparent up front – my blood pressure at all of my ob appointments was high, up to 150/100 during one appointment.

So I’ve created a progress chart that is posted on a wall in our bedroom, and R and I are dieting. I’m not doing any particular diet, just trying to 1) eat less, 2) eat healthier and 3) actually attempt to cook at home from time to time. I also started exercising again two days after the D&C.

In two weeks, I’ve gone from 206 pounds to 202.4. My goal is to lose 2.5 pounds per week, which I know is pretty aggressive, but even if I can be in the 1.5-2 pounds per week range I’ll be pleased. R started out strong, and I was afraid that soon he was going to weigh less than me, which would be wrong on sooo many levels. But the scale was less kind to him during our last weigh in, so I still weigh less than him, at least for now.

My first goal is to get below 200. Then I’m going to concentrate on 170, then 160, and then we’ll see after that. It’s hard to imagine that I used to look at myself in the mirror when I weighed 105 pounds and thought that I was fat, but I did! (Many years ago in college, while I was struggling with eating disorders.)

Ok, so that’s it for The Plan, Part 1. I may post my progress (or lack thereof) from time to time as extra motivation for me to be good.

The Plan, Part 2

I’ve found this to be more difficult to blog about, which is probably part of why I’ve put off blogging about next steps.

On IF blogs, we seem to strike an unusual combination of the public, the private, and the vague. Meaning that our blogs are open for the world to read, we put out there details about cycles, thoughts, feelings etc. that many of us may never share with people IRL, and yet most of us choose to maintain a degree of anonymity by not putting forth identifying information about what clinic we go to, which doctor we see or even (in some cases, like me) specifics about where we live.

But on the treatment front, our next steps are pretty specific. Those of you who are familiar with the theory and approach I’m about to explain are going to know exactly who I’m talking about and exactly where I’m going.

I’m okay with that, because if I wasn’t I wouldn’t blog about it, but on the other hand it feels kind of weird. I think part of it is that I don’t want to come across as an advertisement. Although really, how can I be an advertisement when we haven’t gone through treatment yet, much less had success with it? The other part is some of you may think I’m crazy. But then again, at this point that’s probably not too far off from the truth!

So here goes. There’s a doctor I read about from an online IF forum who believes bacterial infections can cause infertility and miscarriages. I had heard about him a year ago and filed the idea away in the back of my brain. After we lost the twins in January, I thought of it again but was too emotionally tired to pursue it. I finally got around to calling and setting up a consult in the end of April, and then that following week we found out our clinic was requiring us to do our last FET.

We went ahead and did the testing with this new doctor before beginning the FET cycle, just because I wanted to be ready to move forward if we got a BFN. This doctor handles testing in a different way, growing specimens in the lab for about three weeks rather than just a few days, so many patients who test negative through the labs they usually use wind up testing positive through his lab.

The day before our transfer, we found out I tested positive for three infections, and R was positive for four. (None were STDs.) We were a bit surprised that we had that many infections, because we are asymptomatic, but apparently they can be low-grade and still cause problems.

The infections were in my cervix and uterine lining, and it’s likely that they’re also in my ovaries. The doctor believes that introducing an embryo to the uterus can cause the infections to flare, thus raising NK cell levels and resulting in the embryo being attacked by those cells. He says our embryos were likely infected within themselves as well, because R’s infections were found in his seminal fluid, which means that his sperm is marinating in infections as they’re growing and developing. Just like it’s impossible to detect sperm with high DNA fragmentation by looking at them through a microscope, it’s also impossible to detect infected sperm that way.

His belief is that infections damage the DNA, which causes chromosomal issues. And my ob thinks it was likely a chromosomal problem that caused this loss. That could also explain the other losses we’ve had.

So, our next step is to go through high-dose antibiotic therapy to get rid of the infections. Some STD infections tend to be stubborn and can’t be completely eliminated but only tamed down. But since we didn’t have any STDs, the doctor thinks ours can be completely eliminated.

We have to go through a few months of therapy and then wait one more month after that, so we can start trying again around the end of the year. The timing actually works out well, because that will give me a few months to lose some of the weight and develop healthier habits. Also, I need some time to focus on other things in my life, so I’ll have the opportunity to do that.

Once we reach the end of the year, assuming R still has normal sperm counts and I’m ovulating, we’re going to try naturally. I realize that sounds like we’re going backwards, which is a bit insane. (Okay, maybe more than a bit…) But the whole point of IVF was to create better quality embryos that would then last. Clearly, that approach hasn’t worked. And I’m tired of putting my body through all the stress it has to go through when we cycle.

We’ve gotten pregnant naturally twice before, so we know it’s possible. My ob is on board with prescribing the Lovenox, and I’m sure I can get progesterone suppositories from him, too. He doesn’t think they’re necessary, but he knows that given our history, there’s no point in saying no to me because they won’t hurt.

So we’re going to see what happens in 2008. I won’t completely rule out going back to IVF at some point, but definitely not in the immediate future. And if I don’t get (and stay) pregnant naturally in 2008, as much as we dread hate absolutely abhor the idea of adoption hell, we will reluctantly reconsider that option again.

This time it would have to be on our terms, though, meaning the adoption attorney we want to work with would have to agree to take our profile and not call us until there is a baby to be picked up at the hospital. She knows what we’re open to (either gender, any race, no major drug or alcohol use), so she shouldn’t need to call us to see if we want our profile to be shown for a particular situation. And we definitely refuse to go through months of being matched again – twice was waaayyyy more than enough, thankyouverymuch.

So, there it is – The Plan. Now we’ll see how long it takes before it goes drastically and unexpectedly off course…


mchope said...

Congrats on your plan. I know I always feel better when I have mapped out some next steps. It sounds like you are moving in a good direction. As we just learned from an SA that my husband has an e. coli infection, I am very interested to find out more about the physician you mention who does the infection testing. Hopefully some googling will do the trick! Best of luck to you in the coming months!

Anna said...

Okay, it's very good to have a plan. I'm keeping evrything crossed that all goes well. You and R are in my thoughts. I really hope something works. Hang in there.

Grad3 said...

It sounds like you are feeling better and that is always good. GL on both your plans, I know that it can be hard to lose weight, I have extra fluff myself!

I have read about the bacteria idea before, I hope it brings some answers. I think it's amazing how different things can look and feel when we are doing them when 'WE' want to. GL I hope this what you have been looking for.

Nico said...

Both sound like excellent plans to me. Have you explored the weight loss blogs at all? There are some really motivational ones there, one I particularly enjoyed was dietgirl.

I can completely see how low grade infections might be the cause of your miscarriages. I think you have a really great shot of keeping your next pregnancy!

Alice said...

So now I completely want to know who this guy is! I'm serious! alice rabbit at gmail dot com if you want to spill (I understand if you don't!).