Saturday, June 18, 2011

Did my lining kill our fetus?

I was ready to write a cheerful post on the tail of convocation last Tuesday, but our appointment with Dr. RE on Thursday has overshadowed that brief glimmer of light. I can't say it was bad news, but it wasn't good news either.

The day didn't start off too well. I woke up with a start when the alarm sounded. I was having a dream that Chicken had been run over by a car. Then as I was trying to get in the car, carrying a bunch of things in my hands, I dropped my beautiful pottery commuter mug and it smashed to bits (notice a pattern here?). I was in a great mood after that. I couldn't help thinking about the water bottle smashing on the day of extreme bad news. My mind was drawing lines and making predictions about the appointment.

Dr. RE was great as always. He came in and right away expressed his sympathy for our loss. He said that they wanted to call, but knew I was likely in shock and that it was better for me to receive care in Pleasantville rather than in FTT, so he let my family doc. handle it (but he did all my family doc to make sure I was looked after). He reviewed the prom.etrium schedule I was on during the pregnancy, to rule out that we had stopped too early. I was taking the prome.trium up until the morning of the ultrasound (12w1d), so we ruled it out as a contributing factor in the miscarriage.

After some discussion of this and that, he said that he couldn't come to a conclusion in his mind as to whether the m/c happened because of the embryo or because my lining couldn't support the pregnancy. My lining is not, as previously believed, as good as we would like. In fact, he said that my lining had never reached an optimal thickness in the last three years that I've been under his care. The embryo might have been perfectly healthy and viable, but it was my deficient lining that cased it to stop growing.

Gulp.

I think that in my mind, I had created what I was hoping to hear him say at the appointment, and was obscuring what I was afraid to hear. His actual assessment was somewhere in the middle. He didn't say: "Hey, that was a fluke of bad luck. Let's get back on that horse and try again next month". What he said is getting us steps closer to: "there isn't much to do with your body in terms of growing a fetus, so you should just cross that out as an option."

Dr. RE suggested that we try a more aggressive lining building strategy over the summer by having me take estr.ace orally, vaginally and through a patch (are there any other possible routes of entry for the estrogen to come in? I can bathe in it or sniff the darn thing just to be sure). He will then do two endometrial biopsies: one during the follicular phase and one during the luteal phase of the cycle. This needs to be done over two different cycles because once he's biopsied the endometrium during the follicular phase, he won't be able to get valid results for the luteal phase in the same cycle. So, hopefully, by the end of the summer, we should know more about next steps.

Dr. RE also said that Sattva's response was not as good as he had hoped, especially since non of the embryos made it to freezing.  He did say there could be modifications made to her protocol (i.e. more drugs) to see if it would produce more eggs, but he didn't say too much more about that. I tried to discuss whether he thought we should accept Sattva's offer or start the process for embryo donation, but he wanted to defer that conversation until we knew more about my lining. He acknowledged that even if my lining continues to be sub-optimally responsive, we may still chose to try egg donation (because women get and stay pregnant with less-than-ideal linings). Would I really do that though? I don't think so. That would be my cue to stop persisting down this path.

It's always been hard to believe that my body would or could do this pregnancy thing. I am losing faith that it ever will. These are dark days for me. Mr. A is keeping an open mind, and waiting to hear the results. Thankfully, he has enough optimism for two.

I leave you with a picture of my graduation.

19 comments:

  1. Really beautiful graduation pic Augusta. Congratulations again!

    Trying to figure out the best options moving forward must be quite overwhelming. To start back into testing and waiting and decisions and more waiting. It is not surprising that these are dark days for you. I was talking to a friend yesterday about the way that couples trade optimism during challenging times. It is a pretty incredible social coping mechanism when you stop to think about it.

    I had to share a funny little observation that your post went up at 3:10pm and I'm leaving my comment at 2:25pm on the same day. This internet really does make the world feel so much smaller.

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  2. To have someone with a big, fancy medical degree say what I think we all fear and feel anyway--that we are somehow deficient--is a dagger right to the heart. I so wish that this were simpler for you. I'm glad there are plans for routes to next steps--did you consider melting estrogen candles into your ear canal?--but this shit ain't easy. Holding you tightly in my heart until I can hold you in my arms. Love you, woman.

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  3. Oh that must be so hard to hear an unsure response to what went wrong. I only hope that these tests and biopsies paint a clearer picture for you to make moving forward less complicated. I will be thinking of you two as you move forward.

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  4. Congrats on your graduation. I am so sorry that these are dark days for you, it's just not fair. Thinking of you and sending you warm thoughts.

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  5. Congratulations on your graduation. That is a great accomplishment.
    Here are a few thoughts I had as I read your post.

    As far as embryo freezing is concerned, I was really let down that I didn't have any embryos to freeze until I heard that really only 10% of people are able to freeze any. Maybe the info I got was wrong, I am just saying, maybe it is perfectly normal, yet unfortunate, that you weren't able to freeze any embryos.

    Also, have you considered acupuncture for improving your lining? I have heard that it can help with that. I did acupuncture and I think it helped a little--my egg quality was much improved and I think my lining was a little better (I can't remember for sure), and I did have a different doctor and a slightly different treatment approach, so who knows how much any one thing helped. because in the end, none of it worked. so what i am saying is, what do i know? nada nada enchilada.

    I just don't want you to lose hope based on this appt. I want to see a picture of the front of you with a baby in your belly.

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  6. Congratulations, Dr. Augusta!

    I'm a little confused as to why the RE would revise the assessment of your lining at this stage. I would think that if you had never had an optimal lining over 3 years, that he might have mentioned that before now. It sounds like he has a solid plan moving forward, though.

    Once again I'm so sorry for all that you're going through. You don't deserve this...it is time for your take-home baby.

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  7. Hey Augusta. I think its easy (oh so easy, I of all people know) to immediately grasp the negative (ie: your lining is to blame) but there is so many reasons why this may not be the case so I really really hope what I'm about to say gives you some hope rather than annoys the hell out of you... sometimes I'm not sure if people want to be given suggestions or hear other success stories because I know that there is a time and place for these things and sometimes when you're feeling low it sucks to hear these things. So if this is one of those days for you then feel free to discount my comments and dont give what i'm abotu to say a second thought:
    For ages i was of the belief that my lining was rubbish too, and its hard not to immediately assume that means your responsible for the death of your embryo. But my RE admitted that there really is so much in the air with lining thickness and quality and so many woman get pregant with what appears to be less than optimum linings that its hard to believe that it is the major contributing factor in the downfall of a pregnancy. So please just know that a lot of this IF business is experimenting and educated guessing, nothing is really for certain.
    I wonder if your RE has considered trying you on Viagra to help increase bloodflow to the uterus. I dont know if you recall, but it is a new thing that I tried recently and it seemed to make a big difference to my lining. My RE was very skeptical about it at first and said that the jury is still out on whether it would help, but it was either the Viagra or pure luck (either is possible)as my lining was much better when I took it and I figured anything was worth trying.
    Its scary to have to go through more tests and its hard not to blame yourself but I really believe if you decide to try again you have a very good chance. Unfortunately so much of it comes down to persistance, but that has to be balanced with what feels right for you personally.

    Much love as always. xx

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  8. First congratulations on your graduation!

    Second, I'm sorry about the news about your lining. I know that feeling as if your body is betraying you. Fingers crossed the estrogen is just what you need.

    Hugs

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  9. Uggh. I love what Egghunt says so much--what can I add? Well, first, smash all your drinking vessels immediately. We don't need any more portents of doom. Second, I hope the glimmer of light contained a lot of feeling extremely proud of yourself. It's an incredible achievement, and a beautiful hood! It looks like your coloring can handle the purple robe, too...

    I wish he'd gone about this whole thing a bit differently. More "let's see if we can make your lining any better for next time" not YOU ARE TO BLAME. I think I'd feel a knife in my heart for the rest of my life if someone told me I was "deficient". Doubtless you are more psychologically robust...On the other hand, you need to know the truth, particularly given that there's another party involved. Maybe some research will be soothing in the coming days. I'm hoping the biopsies will be encouraging rather than discouraging.

    Lots of love.

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  10. I have lining issues too as you know, and I was told by a few Drs that uterine problems are rarely to lame for miscarriages - at least first ones. I was also told that chromosomal problems are more likely. I found this SO hard to believe that my DE embryo from a 3 time successful donor was the reason opposed to my "optimistic" 6.5 lining.

    That being said, I definitely think doing the m/c panel and a more aggressive lining protocol will be great moving forward. I have a lot of suggestions for medications to help improve linings and my best suggestion is electro-acupuncture 2x week for 4 weeks leading up to transfer.

    Whatever you decide, we are all here supporting you and rooting for you. Congrats on your graduation!

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  11. I feel that I am to blame for all my losses. It's what my brain does in dark moments. Me. Bad eggs. My fault. I know that even when I hear otherwise during appointments, I focus on the part related to me bein too old, too jacked up to ever be a mother. There is a ton to sink in after that whirlwind of information, but I do see bits of hope that in will cling to for ywithIn also with Bunny on this bit, arm yourself with new stainless steel commuter mugs and water bottles (go get a few now, I'll wait).

    I am sorry to know that such a tremendous achievement as your GRADUATION is a wee footnote to everything else. It's huge and worthy of a thousand hours of song about Augusta. I am singing a few verses now. Congratulations, my dear.

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  12. I wanted to tell you that I was shocked and devastated to read the news about your loss. I really thought you were on The Path, and I was just brought to my figurative knees when I plugged back in to blog land to catch up. My deepest deepest condolences; what an inadequate thing to offer. But it's all I've got and it's sincere as hell. Thinking of you here in the South.

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  13. Hey Augusta...during my mock cycle prior to transfer before my actual transfer my lining wasn't very optimal either and the pattern was sketchy. so they added estrogen patches and vaginal suppositories. Next would have been delestrogen intramuscular injections if that didnt work. So there are lots of options with regard to getting that lining going. Like the idea of biopsies your RE suggested. Also, like R, I did electroacupuncture twice weekly for like two months. I believe it made all the difference. then at the time of the real transfer my pattern was perfect and great thickness. Just frustrated that your RE had to tell you this now about your lining issues he's noticed for the last three years (WTF??). Anyway, I think you've got a good plan. Hugs Augusta. Congrats on your convocation!

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  14. Beloved friend, I am sorry to hear that Thursday held such ambivalent news, especially coming on the heels of Tuesday's official commemoration of your great accomplishment, your PhD. I will be calling you soon, so will simply say here that I love you and Mr. A so much, and I am asking the universe to grant you relief from these dark days, and soon. XOXOXO, H.

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  15. I'm always a glass half empty type of person - I expect that it's all my fault and am I'll screwed up and there's nothing I can do, so my hubs should just leave me and find more-fertile fields while he is still young...and so that's what I hear everytime the doc opens his mouth. To have that confirmed, even a little, would be soul-wrenching.

    Congrats on the whole PhD thing - that should never have to be an afterthought. :( :)

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  16. Congrats Doc!!! That is awesome- the PhD bit anyway.

    But, coming to what your doctor said, I'd take it with a pinch of salt. While I'm no RE, I'm a scientist in a closely related field and I've read extensively on this topic and hang with out with doctors who who study immune causes of miscarriage, so I'm not exactly a layperson either.

    Sure, your lining could have been at fault, but so could have about a 100 other things. And when you think about the fact that the baby implanted normally and grew till about 8 weeks normally, to me, it does not seem like the strongest case to argue that a lack of nutrients because of a less-than-optimal lining killed your baby.

    The one thing that absolutely should be done is a karyotyping of the products of conception, because most first trimester losses happen because of genetic abnormalities, and often the fault is a numerical abnormality in chromosome number. Another common link to first trimester loss is you have anti-thyroid antibodies, because they are really common (10% of the population I think) and also seem to play a role in first trimester losses. Given the investment from all parties, even though it is just one loss, a full RPL panel might be prudent. If not a full RPL panel, atleast Anti-phopsholipid and anti-thyroid antibody levels should be investigated.

    Another incriminating factor that pops up commonly- PCOS. Its easy to miss because some people have only few of the presentations- you should check if Sattva would qualify, because less than optimum egg quality could possibly contribute.

    Miscarriage is the deepest of mysteries. I've spent months obsessively reading about it and getting myself tested. I''ve found some clues and have been treated for some things, but at the end of the day, we are still in the dark:(

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  17. If you think real hard, can you feel your uterus? Now that you have it, concentrate a little harder and thicken your lining. Go on, I will wait.

    What? It didnt work? Oh, you mean you have zero control over that random yet mighty organ? Yeah, sadly we do not. No amount of fitness training or mediation can get that thing to behave.

    I hope you laugh and dont mutter for me to fuck off. I just want to bring you a smile and remind you what you already know (if only in your head, not your heart): you are not responsibile.

    I was on loads of estrogen - both patches and vaginal. It made a lot of difference for me and I am eager to see it do the same for you.

    Congratulations Dr. Augusta. Walking to the future in a beautiful picture...

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  18. I love love love your graduation photo it's lovely.

    I also want to tell you how sorry I am that you lost your baby. Loss is so utterly difficult, hard and sad. I just with I could reach out and hug you.

    I wanted to share with you information about linings. You know, I have seen many women carry babies with a linings of 5-6. You don't have to have a 10+ lining to carry a child. What we look for in endometrium lining is what we call a triple pattern, or a triple stripe. That's what really look for.

    I'd be happy to talk to you off line about what happened, and help you problem solve from my end. I have helped many women become mothers, and we never charge for the help. It's just what we do.

    Hugs again.

    Marna Gatlin
    Parents Via Egg Donation
    http://www.pved.org

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  19. Augusta, it sounds like a very difficult day and a difficult appointment. Reading between the lines, your doctor isn't sure what caused the loss. This makes him a pretty good doctor (better than, say, someone who would say "It was THIS, full stop"). And because he can't find an exact reason, he's looking at all possible causes, one of which may be the lining. I agree with the poster above. It depends how sub-optimal the lining was. Many, many women conceive (and carry) with less than 10+. Also, I'm curious what he said about the fact that you were so far along when the loss occurred, in terms of that lining? Wouldn't the pregnancy be fairly well established into the wall at that point?

    I know it's so much more difficult than saying, "Okay, I won't give up all hope." Because that's so hard to do. But his plan to move forward by checking things out lining-wise sounds smart. Did he mention Viagra, by any chance? I have heard stories of some women with lining issues using it, with very great effect.

    (Beautiful photo. It is very hard to go through those milestones of life when there is tragedy hanging over you, and grief welling up from inside. But well done. It's not a little thing to do under normal circumstances. And it's quite a huge thing to do under difficult circumstances.)

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