Busy, busy

I just finished my cycle with three rounds of acupuncture under my belt. And shall I say, I am concerned. I just had the shortest cycle of my life. I am not kidding. I still had cramps, but then the bleeding only lasted for 2 days. Yes, that is right two days. Mr. Hoo commented that if this were any time than us trying to get a thick uterine lining it would be wonderful. Two days of blood, awesome. Now, I am left confused. Is my uterus just drying up? Is the acupuncture working in the reverse direction? Are the herbs messing with me? I just quit taking them. I am getting more and more frustrated. If anyone knows of bloggers that have had lining issues resolved, I would love to hear about them. I need some hope from somewhere. Heck, I am only assuming that a short period means thin lining. Maybe it means early menopause. I just don't know.

Walking a thin line (ing)

Well went in last Tuesday and the lining was a bare 6.5mm. Yuck. Then asked if we could thaw only one embryo in case this cycle is a bust, but no they were frozen in twos.


You have got to be kidding me. This just keeps getting worse and worse.

We are on for a transfer on Friday, though. I do not have my hopes up. The lining is thinner than it was last time. The doc said we could put it on hold, but then the uterine biopsy was for nothing. Though I don't know how any inflammation could still be going on seeing as I had the biopsy over 3 weeks ago.

One good thing is that the estrogen has made intimacy with Mr. Who very fun. My breasts have also gotten quite large (although they are very tender).

I am really just in the dumps today. Feeling as if we have to waste two more good embryos. Then we will only have two left. That just sucks. The whole donor egg 66% success rate seems highly unlikely at this point. Lets hope at least the transfer goes well. I had a stitch placed in my cervix to make the transfer easier. Basically the Dr. yanks on the thread to straighten my curvy cervix out and it makes the catheter enter more smoothly. I don't know, with all of my problems maybe it wasn't only my eggs that make it difficult to get pregnant. Maybe my cervix and uterus are just not hospitable environments for procreation.

Advice

As a female scientist, I have some opportunity to mentor younger female scientists as well as listen to advice from women more senior than I. Interestingly, the more senior women seem to fall into two categories. Those that had children early in their career and those that waited too long. I am amazed how the first category of women fail to recognize that the odds of having children decreases with increasing age. I have to admit I fell into this category. I was mostly concerned about birth defects. I, to be honest, never heard about how difficult it is to procreate in the late 30's and early 40's. Now that I know, I am making it one of my objectives to spread the word to as many women as possible. This is not an easy task. Many younger females laugh and joke about the horror stories about shriveling ovaries. They think that I am being overdramatic. I don't want to frighten them. I just want the facts to be known and evaluated. I am not trying to convince everyone to go out an have babies immediately, I just want them to look at the scary charts that all the REs have shown me. They truly are frightening.

Then there are the naysayers who already have kids. They always come up with anecdotal data about the 45 year old who had a kid. And yes damnit, at my work place I am surrounded by these miracle women. 3 women over 40 who have unexpectedly become pregnant. Actually two out of the 5 professors in my department fall into this category. One of these did injectables, had one follicle, and did IUI. Two others over 45 who have also had a child within the past 4 years. I assure you that these women did not go through any IF treatments. None.

Why can't I be in that category? Why am I the poster child for delayed gratification? Well, any way. I get on my soapbox as often as possible, but I am not sure I am getting through. At least they are a bunch of scientists, so I think they appreciate the crummy curve that shows the precipitous drop in fertility after 35.

Tomorrow is my lining check. 3 weeks on injectable estrogen. My breasts are so tender and engorged. Lets hope that my lining has increased to match. Last week my E2 levels were 3500. Yikes, that seems pretty high. My lining was only 6.5mm but trilaminar. Wish me luck.

Not yet

There is a little Mexican restaurant around the corner. My husband is always asking if I want to go there on nights when we can't decide where to eat. My pat answer is "Not yet." He says I say that a lot. I guess it is true. My whole life has been a not yet. Is it time to get a pet? Not yet, I don't spend enough time at home. Is it time to go on vacation? Not yet, I have too much to do for work. Is it time to remodel the kitchen? Not yet, I don't want contractors all over the house. Is it time to move so that we can live in the same city? Not yet, I want to get tenure. Is it time to have kids? Not yet, I want to have some time together before we are tied down.

Then finally we decide to have kids. Ok, pregnant the natural way. Not yet. Clomid? Not yet. IUI/IVF. Not and not yet. Bite the bullet. Move on to donor eggs. Fresh cycle. Not quite. Finally, well prepared FET. Estrogen levels. Check. Endometrial biopsy. Check. I go in today to get a final lining check before the progesterone. Not yet.

Thats right. The only thing that my body needs to do right now is what it has been doing every month for the past 30 years. I don't know how well it did it, but it certainly doesn't seem to do it well now. This means no transfer next week. Another week on estrogen. Nothing else that I can do.

Not yet.

Quick update

Well, tomorrow I go in for the lining check. I am pretty sure we are going through with this cycle no matter what because of the biopsy. Have to take advantage of the inflammation, I guess. If everything goes as planned, I should start progesterone on Wednesday. I think the norm is 6 days then the FET. I asked the nurse if it is possible to do one embryo at a time with the FET, but I received no reply. After all, if it was my sucky lining then I don't want to blow two more embryos for nothing. I am really worried because we only have 4 frosties left. I think they range in grade from AB-CB.

In the fresh cycle we transferred one 5AA blast and one 4AA 5 day blast. From the initial HCG they think both implanted then something went terribly wrong. I probably will save those details for another time, but lets just say those were the worst cramps I have ever experienced in my entire life.

Endometrial biopsy

My new RE is really into this idea that an endometrial biopsy somehow helps the uterus prepare better for receiving the blastocyst. There really doesn't seem to be much analytical data about why this works. Really it seems mostly anecdotal. I did find a recent article attempting to explain this phenemenon.

Am J Reprod Immunol. 2010 Jan;63(1):17-21.

Inflammation and implantation.

Dekel N, Gnainsky Y, Granot I, Mor G.

Department of Biological Regulation, the Weizmann Institute, Rehovot, Israel.

Approximately half of all human embryo implantations result in failed pregnancy. Multiple factors may contribute to this failure, including genetic or metabolic abnormalities of the embryo. However, many of these spontaneous early abortion cases are attributed to poor uterine receptivity. Furthermore, although many fertility disorders have been overcome by a variety of assisted reproductive techniques, implantation remains the rate-limiting step for the success of the in vitro fertilization (IVF) treatments. It has been demonstrated that endometrial biopsies performed either during the spontaneous, preceding cycle, or during the IVF cycle itself, significantly improve the rate of implantation, clinical pregnancies and live births. These observations suggest that mechanical injury of the endometrium may enhance uterine receptivity by provoking the immune system to generate an inflammatory reaction. In strong support of this idea, we recently found that dendritic cells (DCs), an important cellular component of the innate immune system, play a critical role in successful implantation in a mouse model. In this review, we discuss the hypothesis that the injury-derived inflammation in the biopsy-treated patients generates a focus for uterine DCs accumulation that, in turn, enhances the endometrial expression of essential molecules, which facilitate the interaction between the embryo and the uterine epithelium.

I find it hard to believe that dendritic cells are responsible for the success of this procedure but nonetheless my doctor has decided that this is the best mode of action. Why has the doctor decided this. Well, it turns out that I am incapable of making a thick lining. Only 7.5 mm. In the failed fresh DE cycle, I had implantation but likely lost two embryos 4 days after by 370HCG. Any way, we didn't do a mock cycle because we assumed that the other clinic would have commented or done something special if my lining was thin.

In January we started an FET cycle. Dr. L was not happy with the thickness of my lining using oral, vaginal and transdermal estradiol. Then I went a week doing twice a week injectable estradiol. Still the lining was wimpy so it was converted to a mock cycle with vaginal progesterone and endometrial biopsy.

The biopsy was a little bit of a fiasco. It turns out that I have a tricky cervix. For the fresh embyro transfer Dr. L put a stitch into my cervix so he could tug on it to straighten it out. Dr L was not available for my biopsy so his partner did it. There seemed to be some issues because he kept leaving the room to get additional equipment. Seriously, he left the room three times after his first attempt. There I was, my legs up in the stirrups and speculum in place. The biopsy itself was also somewhat crampy and bloody. Not too bad, and it went away after a few minutes.

So here I am going through the FET cycle for real this time. I have to do injectable estradiol, but it is only twice a week. I go in on Tuesday to find out the lining thickness. Today I found out that my biopsy was completely normal and in phase. Which in my mind kind of sucks because there is nothing that can be done to improve it, but the nurse seemed to think that it was a good thing. We shall see.