Monday, April 25, 2011

RE Appointment Today

I had a post op appointment and consultation with my RE today. I seem to be recovering well from the miscarriage and D&C. They did test the tissue they got from the D&C and it was placental tissue, so it was a good thing I had it done to clear everything out. She said it looks like I am about to ovulate. To confirm that, I took both a pregnancy test and an ovulation test tonight. The pregnancy test is very faint and it is a sensitive test, so I would guess my HCG level is below 20. The OPK is pretty close to positive. It looks like my RE knows what she's talking about ;) No surprise there!

We talked for a long time during our consultation about our different options in moving forward to try for another baby. The problem is there is no perfect solution or medication for what we are experiencing. The chromosomal abnormalities I have had with two of our babies are abnormalities that can be compatible with life and live births, so we can't be certain that is what caused my miscarriages, although it is the most likely cause. There could be other factors even though most of our testing has come back fine, aside from being PAI-4G/4G, but my PAI levels are in the normal range.

One option is she could send us to Chicago to see Dr. Kwak-Kim who specializes in immunological diseases. I *could* have natural killer cells that attack the babies and cause me to miscarry. Dr. Kwak-Kim can test for that and if I test positive, she does a therapy that I don't fully understand. What I understand her treatment to be is she infuses your blood several times throughout your pregnancy with something that helps block the natural killer cells. It is quite expensive, around $1500 per infusion and can cost up to $20,000 for an entire pregnancy. Chances are I don't have that because we have our daughter but natural killer cells can develop at any time, so it is a possibility.

Another option could be a new medication that is an insulin sensitizer since the Glumetza didn't work for me. My RE is not familiar enough with it and wants to check more with a doctor who is.

IVF is not recommended for someone in our position. Since we are not having problems getting pregnant and since our chromosome problems are too broad, they don't recommend that for us. IUI will not increase our chances at a healthy baby either. So both of those are out. My Clomid challenge to test my FSH, egg quality, and ovarian reserve looked good, which is better than looking bad, although no guarantee we can have another healthy baby. She said from the ultrasounds my ovaries look good, not polycystic, and it looks like there are eggs in there.

The plan we think we are going with for now is as follows: 100 mg of Clomid CD 3-7, ultrasound to check follicles on CD 12, HCG trigger shot when follicles are the correct size, and heparin shots once I get a positive pregnancy test. We are hoping taking Clomid CD 3-7 will produce more eggs so that my body naturally selects the highest quality egg for pregnancy. The HCG trigger shot will ensure the egg releasing before it gets too mature and starts to deteriorate. I need to make an appointment with my general practitioner and set up either a CT Scan or an MRI for my brain because brain aneurysms run in my family and we want to make sure everything looks okay before starting heparin injections. The heparin will help if any of my miscarriages were caused by blood clotting disorder factors. It will be something that I will inject twice per day (in my stomach *cringe*)  for the entire pregnancy (or at least until it's close to delivery time). They will monitor my platelet count and my red blood cell count and I will increase my calcium and vitamin D because it can cause osteoporosis. I am also starting back up on baby aspirin and will probably continue with the Neevo DHA prenatal vitamins. I'm already on an increased vitamin D3 dose.

It always feels good to have a plan. I am afraid of having the CT Scan or MRI because I'm terrified of getting bad news. Once that is over, assuming all looks good, I think I'll feel a bit more confident in our plan. It is disheartening to me that she basically laid out all of our options and let us choose which course we thought was best for us because there is no course of action proven to work for our situation. It looks like our problem may be more advanced than medical science is at this time. We are holding on to hope though and trying our best to bring another healthy baby home.

1 comment:

LisaB said...

It looks like you are getting so many good things in place! I am staying hopeful and positive for you. I am the same way - I'm hoping that one of these times, we will find that "golden" egg. I hope you do, too.
I'm curious about the Natural Killer Cells, too. My doctor doesn't test for it. I need to look into getting that test. I can't believe how expensive the infusions are!! UGH!! Hopefully neither of us would need those.
I'm taking blood thinners, too. They DO kinda suck :-( Hopefully everything we're both doing pays off!
Thinking of you and praying for nothing but the best possible outcome!! HUGS!