A new direction

Following the last transfer (#6) I was so convinced it hadn't worked that I made a call to a Reproductive Immunologist, Dr Gamal Matthias, who specialises in recurrent pregnancy loss and IVF implantation failure. I learned about him through ladies on various forums that I read. He is one of 2 RIs in Australia that treat for Natural Killer cells and immune issues they way they are treated in the USA and UK (agressively). A lot of FSs are against the protocol he uses, but we're running out of options so we manage to get an appointment for early August to see him.

He is a lovely man. Very proactive and reassuring. He booked me for a Hysteroscopy (to check the uterine cavity for polyps, fibroids and lesions) and Endometrial Biopsy (to test for NK cells). I also go for more blood tests. Surgery was done the following week with a follow up phone consultation 3 weeks later. He found:

- 4 polyps in the uterus. Even one polyp can severely impede an embryo's ability to implant. They almost work like an IUD. So having 4 was not good. But Dr M removed them and said that other than the polyps there was nothing else unusual.

- Acceptable levels of CD 57 Natural Killer cells (uterus)

- High Levels of CD 56 Natural Killer cells (blood). If you don't know about NK cells here is an excerpt from a website:

There are several different types of cells used by the immune system which can determine whether the body will attack or accept the embryo. When this attack does occur due to immune system errors, it can continue to cause multiple miscarriages until corrected. One of the most influential cells in this respect is the natural killer cell (NK cell). These cells are, as the name suggests, designed to kill other dangerous cells and will do so when given an activating signal. In cases of immune system error, NK cells may mistakenly attack the embryo and the attack will continue unless the cell receives specific signals to cease. Certain tests can determine whether or not NK cells are attacking cells, as we have learned that there are many subsets of these NK cells and not all are harmful to the embryo.

Dr M advises me that he recommends an aggressive immune protocol to be used in conjunction with my next IVF/ICSI fresh stimulated cycle. He feels confident that my NK cell levels, along with the polyps have prevented my embryos from implanting and that this can be overcome.

The protocol (and I must stress that this is specifically designed for my unique immune issues and should not be used unless under the guidance of a qualified specialist) is as follows:

Prednisolone: Begin 2-3 weeks before anticipated embryo transfer with daily dosage of 25mg. Increase to 30 mg on day of ET. Increase to 35mg if pregnancy test is positive.

Clexane Injections: Begin between day 2-5 of cycle. Stop 2 days before and day of EPU, and none on day of ET.

Antibiotic - Doxycycline: Begin 5 days before transfer. Take until finished.

Progesterone Pessaries: Double the dose recommended by FS. For me, this will be 400mg once a day from EPU, then increase to 400mg twice a day from ET. 800mg/day total. Had to get this strength made up by a compounding pharmacist. If positive pregnancy test this may be increased to 1200mg/day, depending on my P4 levels.

Intralipid Infusion: 1-2 weeks before transfer.

I bring this protocol to my FS who really has no choice to agree to let me do it. If he didn't I would simply have gone elsewhere. He says he has been hearing good things about Intralipids but is against the high doses of Prednisolone. Oh well! 

I book in for my third stimulated cycle. It will be antagonist with Gonal-F (150) to stimulate follicle growth, Orgalutron (to prevent early ovulation) and Ovidrel (trigger injection). All these, along with daily Clexane (blood thinning) injections have made my stomach look like this:

It ain't pretty. The awesome bloating is also from the drug cocktail. I think I'm actually getting worse at giving myself injections, not better! I've never had this many bruises before. 

This cycle so far has seen me jab a grand total of 26 injections in 11 days into my poor stomach :( I think back to my first ever injection that I had to do. I sat on the couch for about 45 minutes before I worked up the courage to jab it in. Now I can jab 3 times in under 30 seconds!

I'll continue after EPU with just one Clexane injection per day. If I get a positive result this may continue until about 30 weeks of pregnancy, so I better improve my technique!

I'm bad at blogging...

Here I am, 15 months after my last post. Still not pregnant, but still with hope. A lot has happened during this time. I will try and give the abridged catch up without any of the emotions that went with it:

July 2011 - IVF/ICSI Antagonist Cycle 1 - BFN (Big Fat Negative). 14 eggs collected. 13 are mature. 11 fertilise successfully using ISCI (Intracytoplasmic sperm injection ). All grow well through day 4. On day 5, one embryo was transferred and 3 were suitable to be frozen at blastocyst (5 day) stage. AF arrives before BT so I knew it was negative.

Sept 2011 - Natural Frozen Embryo Transfer (FET)  #1- BFN. Didn't make it to blood test.

Oct 2011 - Natural FET #2 - One embryo does not survive the thaw process so they thaw and transfer our final frozen embryo. Didn't make it to BT again. I suspect that no progesterone support may be the problem. FS not convinced. Further testing, mainly karyoptyping (chromosome testing) for both of us and a full thrombophilia screen for me. 14 vials of blood later and still nothing out of the ordinary. I also asked about Natural Killer cells but FS said there isn't enough evidence to prove that they affect implantation and is against testing for them.

We decide to take a long break for physical, emotional and financial reasons. During this time I began weekly acupuncture to try a more natural approach.

February 2012 - IVF/ICSIBegin Long Down Regulated Cycle. Take injections and drugs to make my body think it's in menopause before beginning follicle stimulating drugs.  Go in for egg collection in March and get 16 eggs. 14 are mature and 13 are fertilised successfully. All grow well through Day 4. On day 5 we have one hatching blastocyst put back and are told only one is suitable to freeze. Very disappointing. The next day they tell us that 2 more were able to be frozen, taking our stored embryo count to 3. This cycle I begged them to put me on their Luteal Protocol which involves taking steroids and antibiotics for 5 days each, as well as taking estrogen tablets and Clexane injections. Due date of period comes and goes. Have never made it this far before and allow ourselves to believe it might actually work...

Blood test day. I make J phone for the results. I get home to the news that I am pregnant for the first time ever. Of course, there's a catch so don't get excited. Pregnancy hormone (hcg) should ideally be over 100 by this stage. Mine is 37. Anything greater than 10 is considered 'pregnant'. They tell me to come back 2 days later for a repeat BT. If number has doubled I may have a viable pregnancy. If it fails to double or it drops a miscarriage is inevitable. It's called a Chemical Pregnancy. Spend the next 36 hours madly googling success stories of low beta hcg results that went on to be successful pregnancies. Follow up BT shows HCG has fallen to 24. Advised to cease all meds and wait for period to arrive. Pregnancy ends at 5 w 2 d. Do not cope well at all and take entire week off work. It was so devastating to have gotten so close and then have it taken away. We did try to look on the positive side. I can actually get pregnant. Now we just need to make it stay there.

May 2012 - Plan for a Medicated FET with same luteal protocol. J books flights home to visit family and will not be here for transfer or BT results. After he has left I start to think about receiving results without him home. Begin having major anxiety and book a last minute flight 2 days after transfer to be with him. A week after transfer I have signs that indicate the cycle may not have worked. I decide to do a home pregnancy test to put myself out of my misery (at least if I know it's negative I can start drinking!). Damn HPT is positive! Disbelief. Email FS to ask him what he thinks. He says wait until you get home and come for a BT. That's still a week away. Decide to POAS every day and see what happens. The next day there is still a line. The following day the line is lighter. This is not a good sign, and indicates another chemical pregnancy. The following day the line is lighter again, almost invisible and AF arrives. Positive to this cycle was that we got to meet our beautiful nephew who was adopted by J's sister and brother in law last year. This really opens our eyes up to the possibility of adopting if we are unable to have a biological child and we feel more at ease with this idea after seeing them.

July 2012 - Convince FS to allow us to transfer our remaining 2 embyros in another medicated FET. He agrees, however warnings of complications involved with possible twin pregnancies come thick and fast. Begin medicated FET and luteal protocol once again. On transfer day they call to say one embryo hasn't survived the thaw but they will proceed with the transfer of the remaining embryo. I ask the scientist to keep the 'bad' embryo so I can see it and compare how it looks to the 'good' embryo. Guess what? They looked exactly the same to me and despite FS and scientist assuring us it was fine to transfer I knew immediately that this cycle would not work and we had wasted our money. As soon as I saw the embryo on the screen it looked totally different to the other 5 we'd transferred previously - all patchy and dark. I cry pretty much as soon as we get in the car and get the inevitable news about 9 days later - BFN. Am faced with the realisation that I have undergone 6 IVF cycles and am not pregnant. Around us, everyone seems to be getting pregnant, including people who are way more reproductively challenged than I am (on paper anyway).

I'll finish this long post here and start another one with a new chapter in this journey...