Just a quick update over the lunch hour!
My Dad had surgery today to have one of his kidneys removed due to suspected cancer. He did well in the surgery, and is now resting in his hospital room. He is in quite a bit of pain, but he has one of those button things for meds every 15 minutes that my mom is pushing for him=). So sweet.
We should know the results from the testing on the kidney some time next week. They have already done additional testing on him, and even if the kidney is malignant, the cancer hasn't spread (from what they can tell anyway), which of course is good news! Thank God!
In other news, two pregnant friends had scares this week, and one lost her baby (via ectopic pregnancy) and the other did not (baby looks great on ultrasound and is measuring perfectly). Scary! We are glad that both ladies and their families are doing well now, or as well as they can be. Our prayers are with both of them.
My only update now is that we stop birth control on Sunday! I can hardly wait. Clearing ultrasound and blood work are scheduled for Tuesday, and if all is well, we can start meds Tuesday night. Time is really flying now!
Hope you all are having a great day!
Valentines 2015
Friday, January 29, 2010
Tuesday, January 26, 2010
The Second Opinion. . .
Our insurance doesn't cover infertility, so we pay cash out of pocket for all of our procedures. We have been with our current RE for about 8 months now. She has worked some miracles in that time. She immediately identified my Stage IV Endometriosis on ultrasound, and had me scheduled for laparoscopic surgery to have it removed (or at least "cleaned up") a week later. AND, who can forget that she has gotten me pregnant twice in the last six months. BUT. . .
She has a tendency to be a bit "sloppy" for lack of a better word. My first pregnancy occured after a Follistim IUI cycle where I produced 12 mature follies by the time of the trigger. I got pregnant, but I also developed OHSS and had to be hospitalized because my kidneys decided to essentially shut down and stop producing urine. So that was fun. That was followed by slow increasing HCG levels and no sac or baby on ultrasound at 5 & 6 weeks, and a mass in my left tube instead. Ectopic pregnancy. Awesome. I told my RE I would prefer to have surgery to have the baby removed instead of taking methotrexate to kill the baby (and not be able to try to get pregnant for at least 3 months). Well, my RE didn't do either one. Instead she decided to wait and see if my body would absorb the baby on it's own. Well, it didn't. I had to have emergency surgery at 7 weeks. Awesome. Lost my right tube. Notice the mass was in the left side, but my right tube was the one that tore? Interesting!
Anywho. . .so I lost my right tube. At that point my RE suggested that we move on to IVF. So we did, the very next cycle. Stimming went well, ER was quite painful, but was successful, with 21 eggs retrieved. 14 Fertilized. We transferred 2 beautiful 3 day embryos. Beta 10 days later. BFN (Big Fat Negative = not pregnant). Never fear, we had 10 frozen embryos left over after our fresh transfer! So, the following cycle we did a FET cycle. My RE thawed ALL 10 of the embryos. Apparently she thawed 6 first and two didn't survive the thaw, so she decided she should thaw the other 4 as well (without asking me mind you). So, we had 8 living dividing little embryos. She was growing them out to day 5 or blastocyst stage. Only 2 of the 8 made it to blast. . .but all 8 were doing just peachy at day 4. Anyway, we transferred two blastocysts, and BFP (Big Fat Positive = we got pregnant!). We were ecstatic! My HCG numbers were increasing appropriately, and the ultrasound showed that the baby was in the right place - YAY! BUT. . .there is always a but with us. . . no yolk sac, fetal pole, or heart beat ever developed. We were diagnosed with Blighted Ovum. I had a D&C at 7.5 weeks.
If you read my MTHFR post (or my history post) you know that at this point I had to argue with my RE to try and get her to complete extra bloodwork. She simply straight out refused. So, I had to go to my OB. My OB ran the bloodwork, and it came back that I was compound heterozygous for the MTHFR gene mutation. My OB provided recommendations that I sent to my RE. . .no response. I called her nurse to set up my upcoming IVF cycle and asked her nurse about the results/recommendations. Still nothing. So I decided to seek out another RE for a second opinion to make sure my RE was on the right path with Si and I. My aunt used a RE in Colorado and she loved him, so I contacted him. He did a phone consult with me on Friday. He had a couple of suggestions. . .
He noted 2 concerns he has for Si and I and would test if we came to his clinic.
1- He noticed that we had a large number of embryos at day 3, but very few at day 5 blast stage. It could be due to the fact that the embryos had been frozen prior to growing to blast stage, OR, he thinks there may be an issue with Si's sperm DNA - and recommends a Sperm Chromatin Assay be completed. If that is the problem, it's an easy fix (antioxidants and something else) - although it takes 4-5 months of total treatment to see results since it takes 90 days for the body to make new sperm.
2 - He said I am a VERY high ectopic risk with my endometriosis and previous ectopic history. He must have asked me 10 questions about my ectopic - what happened, how it was diagnosed, how my other tube looked, how much blood there was, etc.. He told me that in patients with severe endo it is very rare for the tubes not to be severely diseased as well. He would like to do a HSG (or have my OB here do a HSG) and see if I have hydrosalpinx (sp) in my remaining tube. His thought process was that since I have had a pregnancy since my ectopic, there could be fluid gathered in my remaining tube (from the endo I think) that could leak down my tube into my uterus and would be toxic to embryos placed in my uterus via IVF. He also suggested that it may just be in my best interest to have my one remaining tube removed at this point, because it is likely causing more harm then help.
However, my research shows 2 things - 1 - hydrosalpinx can be identified and diagnosed via ultrasound. There is no reason I should need to have to such an expensive test (HSG) to determine if I had hydrosalpinx. 2 - hydrosalpinx usually takes a little while to develop. My RE has been rooting around inside around my tube twice in the past 6 months. . .and I have had two HSG's in the last 18 months. I think the probability hydrosalpinx is the problem is very low. BUT, I could ask my RE to check my tube when she does my clearing ultrasound on Tuesday prior to the IVF stimming.
So the question is, do we do the sperm testing the 2nd RE recommended prior to our next IVF cycle? He said that it wasn't necessary to do the testing before going through with my already scheduled February IVF, he just said that if we were his patients, he would do the testing. SO. . . what would you do? Think we should do the testing? Keep this in mind. . .
I am a hurry up person and always have to be on to the next plan ASAP. I hate waiting. . .and really with pregnancy, I don't think I can wait. That's the double edged sword part of this. . . the endo has to be treated/managed quickly or it will return quickly (yes, like within a couple of months). . . pregnancy pushes endo into remission. . . subsequent surgeries to repair endo are not nearly as effective as the first endo removal. SO, I have to be speedy and try to get pregnant, or endure more surgeries that won't be nearly as useful in returing fertility as the first one was (in June). The other option is to take birth control - which is is the other side of the sword. With the MTHFR I can't take birth control for any extended period of time as it will increase my risk of heart attack, stroke, DVT (blood clots), etc. SO, time is of the essence and I don't really have much time to wait. The fact that I have been pregnant twice since June actually helps my case, but I still need to be speedy with this stuff. So although this may seem rushed, it's really out of necessity rather than me just wanting to rush into things. . . conversely, I suppose I could take lupron (which would put me into drug induced menopause - YUCK) if they found that Si's little swimmers had the DNA issue. . . hmmm. . . .
I guess I'm not really as concerned about the money at this point (which I think may have been what I was originally concerned about - paying MORE money out of pocket for testing). Actually right now I am actually thinking - at what point do you stop and just say - if this is supposed to work, God will find a way to make it work? I mean, I can do testing from now until next year, and they can find a ton of stuff wrong with both of us (we were considering visiting a Reproductive Immunologist in Chicago as well for additional immunology testing). I think we need to back off. . .that's my gut instinct. Why God thought I needed to hear the second opinion on Friday I'm not really sure. But I don't think we are supposed to do the additional testing right now. I know we will be blessed with a baby - I KNOW we will . . I don't know when or how we will be blessed, but I just have this feeling we will. So I will keep doing what I am doing, and if it isn't supposed to happen it won't! There I go throwing my gut back into things - LOL!!!
I welcome your thoughts though. . . what would YOU do?
She has a tendency to be a bit "sloppy" for lack of a better word. My first pregnancy occured after a Follistim IUI cycle where I produced 12 mature follies by the time of the trigger. I got pregnant, but I also developed OHSS and had to be hospitalized because my kidneys decided to essentially shut down and stop producing urine. So that was fun. That was followed by slow increasing HCG levels and no sac or baby on ultrasound at 5 & 6 weeks, and a mass in my left tube instead. Ectopic pregnancy. Awesome. I told my RE I would prefer to have surgery to have the baby removed instead of taking methotrexate to kill the baby (and not be able to try to get pregnant for at least 3 months). Well, my RE didn't do either one. Instead she decided to wait and see if my body would absorb the baby on it's own. Well, it didn't. I had to have emergency surgery at 7 weeks. Awesome. Lost my right tube. Notice the mass was in the left side, but my right tube was the one that tore? Interesting!
Anywho. . .so I lost my right tube. At that point my RE suggested that we move on to IVF. So we did, the very next cycle. Stimming went well, ER was quite painful, but was successful, with 21 eggs retrieved. 14 Fertilized. We transferred 2 beautiful 3 day embryos. Beta 10 days later. BFN (Big Fat Negative = not pregnant). Never fear, we had 10 frozen embryos left over after our fresh transfer! So, the following cycle we did a FET cycle. My RE thawed ALL 10 of the embryos. Apparently she thawed 6 first and two didn't survive the thaw, so she decided she should thaw the other 4 as well (without asking me mind you). So, we had 8 living dividing little embryos. She was growing them out to day 5 or blastocyst stage. Only 2 of the 8 made it to blast. . .but all 8 were doing just peachy at day 4. Anyway, we transferred two blastocysts, and BFP (Big Fat Positive = we got pregnant!). We were ecstatic! My HCG numbers were increasing appropriately, and the ultrasound showed that the baby was in the right place - YAY! BUT. . .there is always a but with us. . . no yolk sac, fetal pole, or heart beat ever developed. We were diagnosed with Blighted Ovum. I had a D&C at 7.5 weeks.
If you read my MTHFR post (or my history post) you know that at this point I had to argue with my RE to try and get her to complete extra bloodwork. She simply straight out refused. So, I had to go to my OB. My OB ran the bloodwork, and it came back that I was compound heterozygous for the MTHFR gene mutation. My OB provided recommendations that I sent to my RE. . .no response. I called her nurse to set up my upcoming IVF cycle and asked her nurse about the results/recommendations. Still nothing. So I decided to seek out another RE for a second opinion to make sure my RE was on the right path with Si and I. My aunt used a RE in Colorado and she loved him, so I contacted him. He did a phone consult with me on Friday. He had a couple of suggestions. . .
He noted 2 concerns he has for Si and I and would test if we came to his clinic.
1- He noticed that we had a large number of embryos at day 3, but very few at day 5 blast stage. It could be due to the fact that the embryos had been frozen prior to growing to blast stage, OR, he thinks there may be an issue with Si's sperm DNA - and recommends a Sperm Chromatin Assay be completed. If that is the problem, it's an easy fix (antioxidants and something else) - although it takes 4-5 months of total treatment to see results since it takes 90 days for the body to make new sperm.
2 - He said I am a VERY high ectopic risk with my endometriosis and previous ectopic history. He must have asked me 10 questions about my ectopic - what happened, how it was diagnosed, how my other tube looked, how much blood there was, etc.. He told me that in patients with severe endo it is very rare for the tubes not to be severely diseased as well. He would like to do a HSG (or have my OB here do a HSG) and see if I have hydrosalpinx (sp) in my remaining tube. His thought process was that since I have had a pregnancy since my ectopic, there could be fluid gathered in my remaining tube (from the endo I think) that could leak down my tube into my uterus and would be toxic to embryos placed in my uterus via IVF. He also suggested that it may just be in my best interest to have my one remaining tube removed at this point, because it is likely causing more harm then help.
However, my research shows 2 things - 1 - hydrosalpinx can be identified and diagnosed via ultrasound. There is no reason I should need to have to such an expensive test (HSG) to determine if I had hydrosalpinx. 2 - hydrosalpinx usually takes a little while to develop. My RE has been rooting around inside around my tube twice in the past 6 months. . .and I have had two HSG's in the last 18 months. I think the probability hydrosalpinx is the problem is very low. BUT, I could ask my RE to check my tube when she does my clearing ultrasound on Tuesday prior to the IVF stimming.
So the question is, do we do the sperm testing the 2nd RE recommended prior to our next IVF cycle? He said that it wasn't necessary to do the testing before going through with my already scheduled February IVF, he just said that if we were his patients, he would do the testing. SO. . . what would you do? Think we should do the testing? Keep this in mind. . .
I am a hurry up person and always have to be on to the next plan ASAP. I hate waiting. . .and really with pregnancy, I don't think I can wait. That's the double edged sword part of this. . . the endo has to be treated/managed quickly or it will return quickly (yes, like within a couple of months). . . pregnancy pushes endo into remission. . . subsequent surgeries to repair endo are not nearly as effective as the first endo removal. SO, I have to be speedy and try to get pregnant, or endure more surgeries that won't be nearly as useful in returing fertility as the first one was (in June). The other option is to take birth control - which is is the other side of the sword. With the MTHFR I can't take birth control for any extended period of time as it will increase my risk of heart attack, stroke, DVT (blood clots), etc. SO, time is of the essence and I don't really have much time to wait. The fact that I have been pregnant twice since June actually helps my case, but I still need to be speedy with this stuff. So although this may seem rushed, it's really out of necessity rather than me just wanting to rush into things. . . conversely, I suppose I could take lupron (which would put me into drug induced menopause - YUCK) if they found that Si's little swimmers had the DNA issue. . . hmmm. . . .
I guess I'm not really as concerned about the money at this point (which I think may have been what I was originally concerned about - paying MORE money out of pocket for testing). Actually right now I am actually thinking - at what point do you stop and just say - if this is supposed to work, God will find a way to make it work? I mean, I can do testing from now until next year, and they can find a ton of stuff wrong with both of us (we were considering visiting a Reproductive Immunologist in Chicago as well for additional immunology testing). I think we need to back off. . .that's my gut instinct. Why God thought I needed to hear the second opinion on Friday I'm not really sure. But I don't think we are supposed to do the additional testing right now. I know we will be blessed with a baby - I KNOW we will . . I don't know when or how we will be blessed, but I just have this feeling we will. So I will keep doing what I am doing, and if it isn't supposed to happen it won't! There I go throwing my gut back into things - LOL!!!
I welcome your thoughts though. . . what would YOU do?
Monday, January 25, 2010
Compound Heterozygous MTHFR - now what?
I intended this information to be viewed by my friends and family about my personal history and background with MTHFR, but then it occurred to me that others with the condition may also stumble upon my blog when googling MTHFR so I should probably provide some helpful information to them as well! Feel free to ask questions, and I will definitely try to help answer if I can=).
(Here's my disclaimer though - I am NOT a doctor or healthcare professional qualified to diagnose or make any treatment recommendations. If you have questions or concerns regarding your diagnosis or treatment, please ask your heathcare provider. Thanks!)
Compound Heterozygous MTHFR – My Personal Background
After my last miscarriage in December 2009, I requested that some additional blood work be completed to make sure we weren’t missing any potential causes of miscarriage that could be treated ahead of time, prior to additional expensive fertility treatments. Under normal circumstances this recurrent miscarriage testing (or “habitual aborter” testing as it is commonly called) won’t be covered by insurance until after the female has had at least 3 documented miscarriages. As I have only had two miscarriages, and one was ectopic and may not be considered a “true” miscarriage to some practitioners, my RE (Reproductive Endocrinologist) refused to run any additional testing on me. As I was already paying out of pocket for the IVF cycles, paying the out of pocket cost on some blood work wasn’t a big deal to me. I talked to my OB about the testing and he agreed to have the blood work run. He said that he requests the blood work be completed after one miscarriage. He said especially in a situation where a patient is spending loads of money and is using IVF to get pregnant, it makes sense to do the testing just to make sure you have a clear picture of any potential problems. I love my OB!
So, the blood work came back at the end of December and it showed that I am “Compound Heterozygous” for the MTHFR gene mutation. My homocysteine level was within normal range (although on the high end of normal – this will be important later). Essentially what this means is I have one copy of the C677T gene mutation and one copy of the A1298C gene mutation, and it inhibits my body’s ability to properly metabolize folic acid, and may also be an inherited clotting disorder (depending on homocysteine levels in my blood). I got one copy of the mutations from each parent (so both parents were heterozygous for at least one MTHFR mutation in order for me to end up compound heterozygous).
All other blood work came back normal (Anti-Thrombin, Cardiolipin, Lupus, Plasminogen Activator Inhibitor, Factor V Leiden, and Protein C&S).
Now you may be wondering what this all means! Brilliant! Let me try to fill you in.
Different MTHFR Mutations
With MTHFR, there are two different genes identified for this mutation, and it's possible to be "heterozygous," "compound heterozygous," or "homozygous." According to the information I have found, the order of potential severity from most to least is:
1. C677T & C677T (Two C Copies - C677T Homozygous)
2. C677T & A1298C (One Copy of Each The C & A - Compound Heterozygous)
3. C677T (One C Copy - C677T Heterozygous)
4. A1298C & A1298C (Two A Copies - A1298C Homozygous)
5. A1298C (One A Copy - A1298C Heterozygous)
The heterozygous MTHFR mutation is relatively common in the general population. Approximately 44% of the population is heterozygous (having one copy of one of genes) and another approximate 12% are homozygous for the MTHFR mutation (two copies of either C677T or two copies of A1298A). Compound heterozygous and homozygous MTHFR have the highest incidences of being linked to implantation failure, late term miscarriages, specific birth defects and overall vascular health. (See also supporting study)
What does the MTHFR gene do?
Essentially the MTHFR gene takes the folate that you consume from food or vitamins, and breaks it down into a metabolized form that can be used by your cells to complete protein synthesis (the building blocks of DNA). More specifically, the gene MTHFR (Methylenetetrahydofolate Reductase) encodes the protein MTHFR. Its job is to convert one form of folate (5,10- Methylenetetrahydofolate) to another form of folate (5-Methyltetrahydrofolate). 5-Methyltetrahydrofolate is used to convert Homocysteine (a "bad" amino acid) to Methionine (a "good" amino acid). So, if MTHFR is not doing its job as well, homocysteine will not be converted to Methionine as efficiently and the homocysteine will be elevated in patient’s plasma. Elevated homocysteine has been associated with a variety of diseases (including but not limited to cardiovascular disease, stroke, Alzheimer's, recurrent miscarriage, etc.) and can also indicate a higher risk of DVT (deep vein thrombosis) or blood clots (hence MTHFR is considered an inherited clotting disorder in patients with elevated homocysteine levels).
My homocysteine level was checked when the recurrent miscarriage blood work was completed (I was not pregnant at the time). My homocysteine level was within normal ranges at the time it was drawn (although it was on the high end of normal). I will likely request that my homocysteine level be drawn again once I become pregnant to ensure that everything is still normal=). In the meantime I have been switched from a “normal” prescription prenatal vitamin to a special prescription prenatal vitamin (Neevo) containing the metabolized form of folate that my body can actually use (5-MHTR). Additionally my OB has recommended that I start taking an 81 mg baby aspirin every day, and I will continue taking said baby aspirin all the way through pregnancy.
Is there any research? What are the treatments?
Some research has been completed on MTHFR, particularly by Dr. Alan Beer, a Reproductive Immunologist (RI) who passed away in 2006 (and his colleagues). Dr. Beer had a specific protocol that he used when treating ladies with homozygous or compound heterozygous MTHFR, particularly with elevated/abnormal homocysteine levels (although it doesn’t appear that elevated or abnormal homocysteine levels were required to use his treatment protocol during fertility treatments – I am currently trying to find the article of Dr. Beer’s that I read that shows this). I have joined a yahoo group with other ladies with MTHFR, endometriosis and other immune conditions, and being a member of the group has given me access to piles of research, information, and even some protocols used by patients of the Beer Center. From what I can gather, Dr. Beer would begin Lovenox (40mg/once a day) on cycle day 6 of a fertility cycle (particularly IVF) and would continue the Lovenox throughout the cycle. If pregnancy is confirmed, this dosage would probably be increased (Typically up to 40mg/twice a day, but potentially higher doses can be prescribed – up 60 mg/twice a day- dependent upon blood work results and homocysteine levels) and usage continues throughout pregnancy. Approximately two to four weeks prior to birth, the patient is usually converted to Heparin and continues to take an anti- coagulant for another 6 weeks postpartum.
Dr. Beer’s Center for Reproductive Immunology and Genetics website is a wonderful source of information and can be accessed here. This is a specific link to information regarding inherited and acquired thrombophilias. You can go backwards through the site for more general information. This page speaks to MTHFR and other inherited an acquired clotting disorders.
Many doctors prescribe “Folgard” or “Metanx” to ladies with MTHFR gene mutations, which is a prescription vitamin supplement containing very high levels of folic acid, B12 and B6. To put these amounts into perspective, the average multivitamin contains 400 mcgs of Folic Acid , and most decent prenatals have 800mcg of Folic Acid (about 200% of the normal daily value). It is recommended to take 1 -2.2 mg Folgard or Metanx per mutation. Those that are compound heterozygous and those that are homozygous for the mutation are recommended to take nearly 4.5-5mg of Folic Acid/B vitamins (or 2 Folgard or Metanx) (12 times the average multi-vitamin and 6 times more than prenatals)!
However, recent research has indicated the importance of supplementing with 5-MTHF instead of the actual folic acid that is provided in both the Folgard and Metanx. 5-MTHF, is a bioactive form of folate. Although synthetic folic acid is the common form of "folate" used for supplementation and food fortification, it must be converted to 5-methyltetrahydrofolate (5-MTHF) by the intestines and liver to become biologically useful to cells.
The prenatal vitamin I am taking now, Neevo, contains 5-MTHF. I don’t know if it really is better or not, but that’s what my OB wanted me to do, so I’m running with it! It is also recommended that patients with MTHFR begin taking a low dose or “baby” aspirin (81 mgs) once a day, every day, for the rest of their lives.
What does this mean for me?
I have spoken with several RE’s, and so far, no one has suggested that I take lovonox during my upcoming IVF cycle or after a pregnancy is confirmed. I will check with my OB after we successfully achieve pregnancy again. Several other ladies with compound heterozygous MTHFR and seemingly normal homocysteine levels informed me that after they achieved pregnancy that their RE’s gave them the option to continue taking baby aspirin or switch to lovonox, but due to the risks of lovonox, they chose to stay on the baby aspirin. So far their pregnancies are progressing wonderfully! This is wonderful news! I would definitely give myself a daily shot or two of lovonox or heparin if it meant I would have a happy healthy baby (I will do nearly ANYTHING for a happy healthy baby!), but if it’s not necessary I have no desire to jab myself in the abdomen twice a day either!!
There is a lot more information out there online regarding MTHFR. A diagnosis of a MTHFR gene mutation and subsequent treatment still seems to be pretty controversial, and testing has only become common in the last 5-7 years or so. Some physicians recommend no “treatment” for the mutation, and others will treat with increased doses of folic acid (because extra folic acid “can’t hurt”). Some providers may recommend baby aspirin, and others may not. Still others may recommend lovonox or heparin during a fertility cycle and during pregnancy, while others will recommend against such treatments stating that they are unnecessary and offer more of a risk than a benefit. I’m quite sure that as more research on MTHFR is completed, we will get better treatment recommendations. If only we had the 10 years to wait for that research to be completed!
If you think your physician isn’t being aggressive enough with treatment, please don’t hesitate to seek out a second opinion or even see a reproductive immunologist or a genetic counselor. You are your #1 advocate!
*Update*
Just in case you may be curious what the recurrent miscarriage/habitual aborter workup will run you - my insurance was charged $1026 for all 9 tests. I have good insurance - I only had to pay about $40 out of pocket - but it still would have been worth it to me to have the testing done even if I would have had to pay the entire amount out of pocket. It really is worth asking your doctor about.
I wrote this post in January of 2010. Since that time I have had a successful twin pregnancy and gave birth to two beautiful little baby girls on October 13, 2010 as well as a successful singleton pregnancy and gave birth to a beautiful baby boy on June 12, 2012. I took Neevo prenatal (with the metabolized form of folic acid) and baby aspirin throughout my entire pregnancy for both pregnancies. It CAN work. One of my fellow bloggers and commenters on this post also had a successful twin pregnancy and gave birth to her boy/girl twins a few weeks after I did. She is homozygous for the C677T mutation and was on lovonox injections and metanx (among other things for her other clotting conditions). My point being - with the right treatment - you very well may be able to have the baby you have always dreamed of. Please make sure to explore your options, push for the testing you believe that you need, and above all, don't give up!!
**Update 10/30/13**
Since my original posting, there have been several occurrences where people have been unable to ascertain Neevo due to manufacturing changes, or the copays have simply been too high for people to be able to afford it. I have been taking Neevo DHA again for the last 18 months, and I want to take a moment to share with you a more cost effective option with you to get the Neevo you need if your insurance doesn't cover it:
The maker of Neevo is Pam Laboratories
If you click on the Neevo link on the Pam Laboratories site, then click on the "ordering information" tab you will see information about ordering Neevo through "Brand Direct Health". I would highly encourage you check out this ordering option. I just refilled my Neevo DHA prescription for 90 days (with GOOD federal insurance) through Hy-Vee, a local grocery store and one of the few places in town that carries Neevo, and my copay was still $150! When I had called Brand Direct Health previously (a year+ ago) they had quoted me $114 for a 90 day supply, and they will ship it direct to your door! Your OB just needs to fax in the 90 day prescription. I would highly encourage you to check this option out. Neevo IS still available!
Also, for those of you who are reading this blog who are NOT trying to get pregnant, if you go to the Pam Laboratories website you will see that they are also the makers of Metanx AND Deplin... you can also order these products instead of the prenatal through Brand Direct Health for substantial savings. Remember, MTHFR is a lifelong issue, that you will need to treat forever, not only when you are pregnant or lactating.
God bless ladies, and Good Luck!
.
(Here's my disclaimer though - I am NOT a doctor or healthcare professional qualified to diagnose or make any treatment recommendations. If you have questions or concerns regarding your diagnosis or treatment, please ask your heathcare provider. Thanks!)
Compound Heterozygous MTHFR – My Personal Background
After my last miscarriage in December 2009, I requested that some additional blood work be completed to make sure we weren’t missing any potential causes of miscarriage that could be treated ahead of time, prior to additional expensive fertility treatments. Under normal circumstances this recurrent miscarriage testing (or “habitual aborter” testing as it is commonly called) won’t be covered by insurance until after the female has had at least 3 documented miscarriages. As I have only had two miscarriages, and one was ectopic and may not be considered a “true” miscarriage to some practitioners, my RE (Reproductive Endocrinologist) refused to run any additional testing on me. As I was already paying out of pocket for the IVF cycles, paying the out of pocket cost on some blood work wasn’t a big deal to me. I talked to my OB about the testing and he agreed to have the blood work run. He said that he requests the blood work be completed after one miscarriage. He said especially in a situation where a patient is spending loads of money and is using IVF to get pregnant, it makes sense to do the testing just to make sure you have a clear picture of any potential problems. I love my OB!
So, the blood work came back at the end of December and it showed that I am “Compound Heterozygous” for the MTHFR gene mutation. My homocysteine level was within normal range (although on the high end of normal – this will be important later). Essentially what this means is I have one copy of the C677T gene mutation and one copy of the A1298C gene mutation, and it inhibits my body’s ability to properly metabolize folic acid, and may also be an inherited clotting disorder (depending on homocysteine levels in my blood). I got one copy of the mutations from each parent (so both parents were heterozygous for at least one MTHFR mutation in order for me to end up compound heterozygous).
All other blood work came back normal (Anti-Thrombin, Cardiolipin, Lupus, Plasminogen Activator Inhibitor, Factor V Leiden, and Protein C&S).
Now you may be wondering what this all means! Brilliant! Let me try to fill you in.
Different MTHFR Mutations
With MTHFR, there are two different genes identified for this mutation, and it's possible to be "heterozygous," "compound heterozygous," or "homozygous." According to the information I have found, the order of potential severity from most to least is:
1. C677T & C677T (Two C Copies - C677T Homozygous)
2. C677T & A1298C (One Copy of Each The C & A - Compound Heterozygous)
3. C677T (One C Copy - C677T Heterozygous)
4. A1298C & A1298C (Two A Copies - A1298C Homozygous)
5. A1298C (One A Copy - A1298C Heterozygous)
The heterozygous MTHFR mutation is relatively common in the general population. Approximately 44% of the population is heterozygous (having one copy of one of genes) and another approximate 12% are homozygous for the MTHFR mutation (two copies of either C677T or two copies of A1298A). Compound heterozygous and homozygous MTHFR have the highest incidences of being linked to implantation failure, late term miscarriages, specific birth defects and overall vascular health. (See also supporting study)
What does the MTHFR gene do?
Essentially the MTHFR gene takes the folate that you consume from food or vitamins, and breaks it down into a metabolized form that can be used by your cells to complete protein synthesis (the building blocks of DNA). More specifically, the gene MTHFR (Methylenetetrahydofolate Reductase) encodes the protein MTHFR. Its job is to convert one form of folate (5,10- Methylenetetrahydofolate) to another form of folate (5-Methyltetrahydrofolate). 5-Methyltetrahydrofolate is used to convert Homocysteine (a "bad" amino acid) to Methionine (a "good" amino acid). So, if MTHFR is not doing its job as well, homocysteine will not be converted to Methionine as efficiently and the homocysteine will be elevated in patient’s plasma. Elevated homocysteine has been associated with a variety of diseases (including but not limited to cardiovascular disease, stroke, Alzheimer's, recurrent miscarriage, etc.) and can also indicate a higher risk of DVT (deep vein thrombosis) or blood clots (hence MTHFR is considered an inherited clotting disorder in patients with elevated homocysteine levels).
My homocysteine level was checked when the recurrent miscarriage blood work was completed (I was not pregnant at the time). My homocysteine level was within normal ranges at the time it was drawn (although it was on the high end of normal). I will likely request that my homocysteine level be drawn again once I become pregnant to ensure that everything is still normal=). In the meantime I have been switched from a “normal” prescription prenatal vitamin to a special prescription prenatal vitamin (Neevo) containing the metabolized form of folate that my body can actually use (5-MHTR). Additionally my OB has recommended that I start taking an 81 mg baby aspirin every day, and I will continue taking said baby aspirin all the way through pregnancy.
Is there any research? What are the treatments?
Some research has been completed on MTHFR, particularly by Dr. Alan Beer, a Reproductive Immunologist (RI) who passed away in 2006 (and his colleagues). Dr. Beer had a specific protocol that he used when treating ladies with homozygous or compound heterozygous MTHFR, particularly with elevated/abnormal homocysteine levels (although it doesn’t appear that elevated or abnormal homocysteine levels were required to use his treatment protocol during fertility treatments – I am currently trying to find the article of Dr. Beer’s that I read that shows this). I have joined a yahoo group with other ladies with MTHFR, endometriosis and other immune conditions, and being a member of the group has given me access to piles of research, information, and even some protocols used by patients of the Beer Center. From what I can gather, Dr. Beer would begin Lovenox (40mg/once a day) on cycle day 6 of a fertility cycle (particularly IVF) and would continue the Lovenox throughout the cycle. If pregnancy is confirmed, this dosage would probably be increased (Typically up to 40mg/twice a day, but potentially higher doses can be prescribed – up 60 mg/twice a day- dependent upon blood work results and homocysteine levels) and usage continues throughout pregnancy. Approximately two to four weeks prior to birth, the patient is usually converted to Heparin and continues to take an anti- coagulant for another 6 weeks postpartum.
Dr. Beer’s Center for Reproductive Immunology and Genetics website is a wonderful source of information and can be accessed here. This is a specific link to information regarding inherited and acquired thrombophilias. You can go backwards through the site for more general information. This page speaks to MTHFR and other inherited an acquired clotting disorders.
Many doctors prescribe “Folgard” or “Metanx” to ladies with MTHFR gene mutations, which is a prescription vitamin supplement containing very high levels of folic acid, B12 and B6. To put these amounts into perspective, the average multivitamin contains 400 mcgs of Folic Acid , and most decent prenatals have 800mcg of Folic Acid (about 200% of the normal daily value). It is recommended to take 1 -2.2 mg Folgard or Metanx per mutation. Those that are compound heterozygous and those that are homozygous for the mutation are recommended to take nearly 4.5-5mg of Folic Acid/B vitamins (or 2 Folgard or Metanx) (12 times the average multi-vitamin and 6 times more than prenatals)!
However, recent research has indicated the importance of supplementing with 5-MTHF instead of the actual folic acid that is provided in both the Folgard and Metanx. 5-MTHF, is a bioactive form of folate. Although synthetic folic acid is the common form of "folate" used for supplementation and food fortification, it must be converted to 5-methyltetrahydrofolate (5-MTHF) by the intestines and liver to become biologically useful to cells.
The prenatal vitamin I am taking now, Neevo, contains 5-MTHF. I don’t know if it really is better or not, but that’s what my OB wanted me to do, so I’m running with it! It is also recommended that patients with MTHFR begin taking a low dose or “baby” aspirin (81 mgs) once a day, every day, for the rest of their lives.
What does this mean for me?
I have spoken with several RE’s, and so far, no one has suggested that I take lovonox during my upcoming IVF cycle or after a pregnancy is confirmed. I will check with my OB after we successfully achieve pregnancy again. Several other ladies with compound heterozygous MTHFR and seemingly normal homocysteine levels informed me that after they achieved pregnancy that their RE’s gave them the option to continue taking baby aspirin or switch to lovonox, but due to the risks of lovonox, they chose to stay on the baby aspirin. So far their pregnancies are progressing wonderfully! This is wonderful news! I would definitely give myself a daily shot or two of lovonox or heparin if it meant I would have a happy healthy baby (I will do nearly ANYTHING for a happy healthy baby!), but if it’s not necessary I have no desire to jab myself in the abdomen twice a day either!!
There is a lot more information out there online regarding MTHFR. A diagnosis of a MTHFR gene mutation and subsequent treatment still seems to be pretty controversial, and testing has only become common in the last 5-7 years or so. Some physicians recommend no “treatment” for the mutation, and others will treat with increased doses of folic acid (because extra folic acid “can’t hurt”). Some providers may recommend baby aspirin, and others may not. Still others may recommend lovonox or heparin during a fertility cycle and during pregnancy, while others will recommend against such treatments stating that they are unnecessary and offer more of a risk than a benefit. I’m quite sure that as more research on MTHFR is completed, we will get better treatment recommendations. If only we had the 10 years to wait for that research to be completed!
If you think your physician isn’t being aggressive enough with treatment, please don’t hesitate to seek out a second opinion or even see a reproductive immunologist or a genetic counselor. You are your #1 advocate!
*Update*
Just in case you may be curious what the recurrent miscarriage/habitual aborter workup will run you - my insurance was charged $1026 for all 9 tests. I have good insurance - I only had to pay about $40 out of pocket - but it still would have been worth it to me to have the testing done even if I would have had to pay the entire amount out of pocket. It really is worth asking your doctor about.
I wrote this post in January of 2010. Since that time I have had a successful twin pregnancy and gave birth to two beautiful little baby girls on October 13, 2010 as well as a successful singleton pregnancy and gave birth to a beautiful baby boy on June 12, 2012. I took Neevo prenatal (with the metabolized form of folic acid) and baby aspirin throughout my entire pregnancy for both pregnancies. It CAN work. One of my fellow bloggers and commenters on this post also had a successful twin pregnancy and gave birth to her boy/girl twins a few weeks after I did. She is homozygous for the C677T mutation and was on lovonox injections and metanx (among other things for her other clotting conditions). My point being - with the right treatment - you very well may be able to have the baby you have always dreamed of. Please make sure to explore your options, push for the testing you believe that you need, and above all, don't give up!!
**Update 10/30/13**
Since my original posting, there have been several occurrences where people have been unable to ascertain Neevo due to manufacturing changes, or the copays have simply been too high for people to be able to afford it. I have been taking Neevo DHA again for the last 18 months, and I want to take a moment to share with you a more cost effective option with you to get the Neevo you need if your insurance doesn't cover it:
The maker of Neevo is Pam Laboratories
If you click on the Neevo link on the Pam Laboratories site, then click on the "ordering information" tab you will see information about ordering Neevo through "Brand Direct Health". I would highly encourage you check out this ordering option. I just refilled my Neevo DHA prescription for 90 days (with GOOD federal insurance) through Hy-Vee, a local grocery store and one of the few places in town that carries Neevo, and my copay was still $150! When I had called Brand Direct Health previously (a year+ ago) they had quoted me $114 for a 90 day supply, and they will ship it direct to your door! Your OB just needs to fax in the 90 day prescription. I would highly encourage you to check this option out. Neevo IS still available!
Also, for those of you who are reading this blog who are NOT trying to get pregnant, if you go to the Pam Laboratories website you will see that they are also the makers of Metanx AND Deplin... you can also order these products instead of the prenatal through Brand Direct Health for substantial savings. Remember, MTHFR is a lifelong issue, that you will need to treat forever, not only when you are pregnant or lactating.
God bless ladies, and Good Luck!
.
Sunday, January 24, 2010
IVF 101
This is borrowed from another bloggers page "God's Faithfullness Through Infertility", but I thought it was a very good overview, so I borrowed some of it! This is my second fresh IVF cycle, so I am already familiar with the process and I know what to expect (for the most part anyway)!
This post is meant to serve one main purpose: to help family and friends who never been through in-vitro fertilization (IVF) to better understand the process. It is complicated, and if you have questions, please don’t hesitate to ask!
There are five main phases of the IVF process. The process is completed during the same amount of time it takes to complete a normal one-month menstrual cycle.
1. Ovarian Stimulation
1. Egg Retrieval
2. Fertilization
3. Embryo Culture
4. Embryo Transfer
Ovarian Stimulation
During ovarian stimulation the ovaries are stimulated using powerful fertility drugs with the goal of having as many eggs as possible mature. Having as many eggs as possible mature is necessary because some may not fertilize at all while others will fail to develop normally after they are fertilized.
The ovarian stimulation drug I will be taking is called Follistim. Many ladies undergoing IVF procedures have to take multiple stimulation drugs, but I stimulate very well on just the one, so there is no reason to add another!
During ovarian stimulation my ovaries will be closely monitored by frequent ultrasounds, and my estrogen and progesterone levels will closely monitored by frequent blood work. When any of the follicles get close to measuring on the “mature” range (usually above 14 mm) I will start taking another medication called Ganerillex. Ganerillex with keep my body from ovulating on it’s own, prior to the egg retrieval (which would be VERY bad and would cancel the IVF cycle!). On average I take the Ganerillex for about 3-4 days prior to the egg retrieval.
There is a condition called Ovarian Hyperstimulation Syndrome (OHSS) which can occur during ovarian stimulation. I am at a higher risk for developing this condition because I am young, lean and have developed the condition before (in July with my Follistim IUI cycle – I had to be hospitalized – YIKES!). The ultrasounds will also allow my doctor to watch for OHSS developing during ovarian stimulation.
The stimulation drugs have all kinds of lovely side effects (pages in fact). However, I’ll just have to take what comes, knowing the side effects will only be temporary. Again, we will be praying against negative side effects!
Egg Retrieval
As the eggs mature I will have one last injection: an hCG injection. I had this injection during all three IUI cycles to induce ovulation. The purpose of an hCG injection during IVF is to mature the eggs even further before they are retrieved (instead of ovulated).
The egg retrieval procedure is performed in the surgical unit on the 9th floor of Methodist Hospital here in Omaha. The procedure takes approximately 15 - 20 minutes.
Eggs are retrieved by a transvaginal ultrasound-guided aspiration procedure. Basically, during the procedure an ultrasound probe is inserted into the vagina to identify mature follicles. Then, a fine needle is guided through the vaginal wall and into the follicle where the egg is aspirated (retrieved) through the needle.
Ouch?!?! Don’t worry. I will be fully sedated throughout the whole procedure although I have to admit, I would love to witness the whole thing. It does tend to be pretty painful for a couple of days afterwards too, but I should be medicated appropriately and it shouldn’t be too big of a deal=).
There are many variables that influence the number of eggs that will be retrieved from any one woman.
Fertilization
Shortly after egg retrieval, eggs are placed with motile sperm in a petri-dish (hence the name, in-vitro fertilization). And then, well, it’s quite simple. The number of eggs that successfully fertilize is completely up to God, since He is the creator of life.
Depending on the quality and quantity of the sperm sample a procedure called intracytoplasmic sperm injection (ICSI) may be performed. During ICSI, a single sperm is injected directly into the egg, however, fertilization is still not a guarantee because, once again, fertilization is God’s business. God is the creator of life! Our RE automatically does ICSI on IVF cycles, so we know ICSI will be used this cycle as well.
The day after the egg retrieval I will receive a report on how many eggs fertilized successfully. Fertilization is documented by the presence of two nuclei. One nucleus is from the sperm and one is from the egg.
Embryo Culture: A Three to Five Day Process
Day 1: After fertilization, the nuclei from the egg and sperm fuse and the cellular division process of the newly created embryo begins.
Day 2: The embryos are carefully monitored for growth and proper cell division. The embryos are growing from a two-cell embryo to a four-cell embryo.
Day 3: The embryos are in the six to eight-cell stage now. Depending on the number of embryos, day three may be the transfer day (will explain what “transfer” is below.) If three or more eight-cell embryos are present, a 5-day transfer is very possible. Five-day transfers allows for better embryo selection since some of the embryos will not progress beyond the eight-cell stage. The decision on whether to do a 3-day or 5-day transfer is largely dependent on the number of embryos present and their quality. The first IVF cycle we did we transferred 2 – 3 day embryos and did not achieve pregnancy. On our following frozen IVF cycle we transferred 2 – 5 day embryos and did achieve pregnancy, so I suspect for this fresh cycle we will be doing a 5 day transfer.
Day 4: Eight-cell embryos that continue to grow and develop will now be at the morula stage (15-32 cell embryo).
Day 5: The embryos who make it to day five, form a cavity called the blastocoel (which is why the embryo can now be called a blastocyst).
Everyone going through IVF prays for embryos that are strong enough to make it to a 5-day transfer.
In summary, there are three critical development points that must occur if a 5-day transfer is to take place:
Fertilization
Four to eight-cell embryo stage
Morula to Blastocyst Stage
Embryos are “graded” using a numeric grading system with a Grade 1 embryo being the best and a Grade 4 embryo being the worst. It is important to know that the grade an embryo receives is no indication whatsoever about whether it will become a healthy or unhealthy baby. The grade is meant to only give doctors and their patients a means by which to measure the viability of any one embryo. In other words, a Grade 1 embryo has a much higher chance of actually implanting into the uterus and becoming a viable pregnancy whereas a Grade 4 embryo’s chance of becoming a viable pregnancy is not impossible, but very unlikely.
Obviously, we will be praying for many Grade 1 embryos that can make it to a 5-day transfer!
Embryo Transfer
During the embryo transfer, the doctor inserts a catheter through the cervix into the uterus and transfers one or more embryos. The embryo(s) is/are strategically transferred to the particular place an embryo would naturally implant in the uterus. If the embryo continues to develop in the uterus, it will hatch from the egg’s outer layer and implant into the uterine lining approximately six to ten days after the egg retrieval.
Depending on a woman’s age and the viability (grade) of her embryos, the American Society for Reproductive Medicine recommends transferring one to three embryos.
Cryopreservation – What to do with any “left over” embryos
Any remaining embryos following the embryo transfer can be frozen for future use.
This is perhaps the most controversial aspect of the in-vitro fertilization process. I believe the only unethical aspect of the cryopreservation process is discarding left-over embryos because “we are done having children”. I also believe that the moment sperm and egg unite, new life is formed.
If there are any “extras” and the first cycle of IVF fails, we will not have to go through any of the first four steps described in this post. A certain number of frozen embryos will be “unfrozen” and then transferred into my uterus at a third of the cost that this first, fresh IVF cycle.
This post is meant to serve one main purpose: to help family and friends who never been through in-vitro fertilization (IVF) to better understand the process. It is complicated, and if you have questions, please don’t hesitate to ask!
There are five main phases of the IVF process. The process is completed during the same amount of time it takes to complete a normal one-month menstrual cycle.
1. Ovarian Stimulation
1. Egg Retrieval
2. Fertilization
3. Embryo Culture
4. Embryo Transfer
Ovarian Stimulation
During ovarian stimulation the ovaries are stimulated using powerful fertility drugs with the goal of having as many eggs as possible mature. Having as many eggs as possible mature is necessary because some may not fertilize at all while others will fail to develop normally after they are fertilized.
The ovarian stimulation drug I will be taking is called Follistim. Many ladies undergoing IVF procedures have to take multiple stimulation drugs, but I stimulate very well on just the one, so there is no reason to add another!
During ovarian stimulation my ovaries will be closely monitored by frequent ultrasounds, and my estrogen and progesterone levels will closely monitored by frequent blood work. When any of the follicles get close to measuring on the “mature” range (usually above 14 mm) I will start taking another medication called Ganerillex. Ganerillex with keep my body from ovulating on it’s own, prior to the egg retrieval (which would be VERY bad and would cancel the IVF cycle!). On average I take the Ganerillex for about 3-4 days prior to the egg retrieval.
There is a condition called Ovarian Hyperstimulation Syndrome (OHSS) which can occur during ovarian stimulation. I am at a higher risk for developing this condition because I am young, lean and have developed the condition before (in July with my Follistim IUI cycle – I had to be hospitalized – YIKES!). The ultrasounds will also allow my doctor to watch for OHSS developing during ovarian stimulation.
The stimulation drugs have all kinds of lovely side effects (pages in fact). However, I’ll just have to take what comes, knowing the side effects will only be temporary. Again, we will be praying against negative side effects!
Egg Retrieval
As the eggs mature I will have one last injection: an hCG injection. I had this injection during all three IUI cycles to induce ovulation. The purpose of an hCG injection during IVF is to mature the eggs even further before they are retrieved (instead of ovulated).
The egg retrieval procedure is performed in the surgical unit on the 9th floor of Methodist Hospital here in Omaha. The procedure takes approximately 15 - 20 minutes.
Eggs are retrieved by a transvaginal ultrasound-guided aspiration procedure. Basically, during the procedure an ultrasound probe is inserted into the vagina to identify mature follicles. Then, a fine needle is guided through the vaginal wall and into the follicle where the egg is aspirated (retrieved) through the needle.
Ouch?!?! Don’t worry. I will be fully sedated throughout the whole procedure although I have to admit, I would love to witness the whole thing. It does tend to be pretty painful for a couple of days afterwards too, but I should be medicated appropriately and it shouldn’t be too big of a deal=).
There are many variables that influence the number of eggs that will be retrieved from any one woman.
Fertilization
Shortly after egg retrieval, eggs are placed with motile sperm in a petri-dish (hence the name, in-vitro fertilization). And then, well, it’s quite simple. The number of eggs that successfully fertilize is completely up to God, since He is the creator of life.
Depending on the quality and quantity of the sperm sample a procedure called intracytoplasmic sperm injection (ICSI) may be performed. During ICSI, a single sperm is injected directly into the egg, however, fertilization is still not a guarantee because, once again, fertilization is God’s business. God is the creator of life! Our RE automatically does ICSI on IVF cycles, so we know ICSI will be used this cycle as well.
The day after the egg retrieval I will receive a report on how many eggs fertilized successfully. Fertilization is documented by the presence of two nuclei. One nucleus is from the sperm and one is from the egg.
Embryo Culture: A Three to Five Day Process
Day 1: After fertilization, the nuclei from the egg and sperm fuse and the cellular division process of the newly created embryo begins.
Day 2: The embryos are carefully monitored for growth and proper cell division. The embryos are growing from a two-cell embryo to a four-cell embryo.
Day 3: The embryos are in the six to eight-cell stage now. Depending on the number of embryos, day three may be the transfer day (will explain what “transfer” is below.) If three or more eight-cell embryos are present, a 5-day transfer is very possible. Five-day transfers allows for better embryo selection since some of the embryos will not progress beyond the eight-cell stage. The decision on whether to do a 3-day or 5-day transfer is largely dependent on the number of embryos present and their quality. The first IVF cycle we did we transferred 2 – 3 day embryos and did not achieve pregnancy. On our following frozen IVF cycle we transferred 2 – 5 day embryos and did achieve pregnancy, so I suspect for this fresh cycle we will be doing a 5 day transfer.
Day 4: Eight-cell embryos that continue to grow and develop will now be at the morula stage (15-32 cell embryo).
Day 5: The embryos who make it to day five, form a cavity called the blastocoel (which is why the embryo can now be called a blastocyst).
Everyone going through IVF prays for embryos that are strong enough to make it to a 5-day transfer.
In summary, there are three critical development points that must occur if a 5-day transfer is to take place:
Fertilization
Four to eight-cell embryo stage
Morula to Blastocyst Stage
Embryos are “graded” using a numeric grading system with a Grade 1 embryo being the best and a Grade 4 embryo being the worst. It is important to know that the grade an embryo receives is no indication whatsoever about whether it will become a healthy or unhealthy baby. The grade is meant to only give doctors and their patients a means by which to measure the viability of any one embryo. In other words, a Grade 1 embryo has a much higher chance of actually implanting into the uterus and becoming a viable pregnancy whereas a Grade 4 embryo’s chance of becoming a viable pregnancy is not impossible, but very unlikely.
Obviously, we will be praying for many Grade 1 embryos that can make it to a 5-day transfer!
Embryo Transfer
During the embryo transfer, the doctor inserts a catheter through the cervix into the uterus and transfers one or more embryos. The embryo(s) is/are strategically transferred to the particular place an embryo would naturally implant in the uterus. If the embryo continues to develop in the uterus, it will hatch from the egg’s outer layer and implant into the uterine lining approximately six to ten days after the egg retrieval.
Depending on a woman’s age and the viability (grade) of her embryos, the American Society for Reproductive Medicine recommends transferring one to three embryos.
Cryopreservation – What to do with any “left over” embryos
Any remaining embryos following the embryo transfer can be frozen for future use.
This is perhaps the most controversial aspect of the in-vitro fertilization process. I believe the only unethical aspect of the cryopreservation process is discarding left-over embryos because “we are done having children”. I also believe that the moment sperm and egg unite, new life is formed.
If there are any “extras” and the first cycle of IVF fails, we will not have to go through any of the first four steps described in this post. A certain number of frozen embryos will be “unfrozen” and then transferred into my uterus at a third of the cost that this first, fresh IVF cycle.
Momma Foster Pug
I think that God is trying to show me that everyone and everything is more fertile than I am! HA! I'm just kidding. . .I think! SO. . . .last week we found out that our current foster pug is pregnant! I saw the little heartbeats on ultrasound with my own two eyes and it was AMAZING! I have no other way to describe it. I almost cried. I can't wait to have that opportunity with a human baby growing inside of me! Anyway, I digress. . .
So, we knew she was pregnant. . .the next thing we wanted to know was how soon we should expect the babies, and how many we should expect. The vet that did the ultrasound told us that she was sure that there were two babies, but she thought that there were probably 3 or 4.
Now we have been doing rescue for over a year now, and we are the "puppy foster home". . .we deal with puppies all the time. . .I think we have fostered 9 total. But never more than 2 at a time. . .it's just TOO stressful. So, I was really hoping big momma Trinity was only pregnant with 2, or 3 at the most. We had an X-ray done this past Friday, and imagine the fact that she is pregnant with SIX!!! She is going to have sextuplets!! LOL!
I have NO idea how we are going to deal with 6 puppies in our household. That will bring our total pug count at one time up to 9! 9?! How is that not absolutely crazy?! And of course, we have our IVF planned for February because we OBVIOUSLY won't have enough going on with big momma pug! I'm kidding of course - we set up the IVF cycle prior to getting Trinity into the rescue. And, she should have her babies before the IVF cycle even starts. The vet told us on Friday 7-10 days. . .so we have started temping her. When her body temp drops by 2 or so degrees, she should deliver within 12 hours. This is so exhilarating, yet so scary at the same time! It will definitely take my mind off of IVF and trying to get pregnant! LOL!
So, we knew she was pregnant. . .the next thing we wanted to know was how soon we should expect the babies, and how many we should expect. The vet that did the ultrasound told us that she was sure that there were two babies, but she thought that there were probably 3 or 4.
Now we have been doing rescue for over a year now, and we are the "puppy foster home". . .we deal with puppies all the time. . .I think we have fostered 9 total. But never more than 2 at a time. . .it's just TOO stressful. So, I was really hoping big momma Trinity was only pregnant with 2, or 3 at the most. We had an X-ray done this past Friday, and imagine the fact that she is pregnant with SIX!!! She is going to have sextuplets!! LOL!
I have NO idea how we are going to deal with 6 puppies in our household. That will bring our total pug count at one time up to 9! 9?! How is that not absolutely crazy?! And of course, we have our IVF planned for February because we OBVIOUSLY won't have enough going on with big momma pug! I'm kidding of course - we set up the IVF cycle prior to getting Trinity into the rescue. And, she should have her babies before the IVF cycle even starts. The vet told us on Friday 7-10 days. . .so we have started temping her. When her body temp drops by 2 or so degrees, she should deliver within 12 hours. This is so exhilarating, yet so scary at the same time! It will definitely take my mind off of IVF and trying to get pregnant! LOL!
Some background on our infertility journey
For those of you that are unfamiliar with Si and I's infertility journey up to this point, this post should bring you up to date! We started trying to have a baby right after we got married in July 2004. We were both young (and some would definitely argue we still are!), so we really weren't taken seriously when we told people we were having difficulty getting pregnant. Well here we are, over 5 years later, and still no baby! About a year and a half ago people started taking notice! Here's a quick rundown of what we've done and the subsequent outcome:
March 2008 - Visit with my OB regarding infertility
July 2008 - Hysterosalpingogram (HSG) - result: normal
September 2008 - Clomid - 100 mg - result : BFN
October 2008 - Clomid 50 mg - result: BFN
November 2008 - Clomid 50 mg - result: BFN
December 2008 - Clomid 50 mg - result: BFN
January 2009 - Clomid 50mg + IUI - result: BFN
February 2009 - Clomid 50 mg + IUI - result: BFN
March 2009 - Clomid 50 mg + IUI - result: BFN
Referred to RE: Maud Doherty in Omaha , NE
May 2009 - Consult with Maud - ordered more testing
June 2009 - Laparoscopic surgery - result: Stage IV Endometriosis! A reason for our infertility! FINALLY!!!
July 2009 - Follistim + IUI - Result - BFP!!! But. . . HCG levels increasing slowly, no sac seen on ultrasound at 5 weeks, but mass seen in left tube=(. Ectopic. Maud decided that since my HCG levels were low we could wait to see if my body reabsorbed the baby. Unfortunately my RIGHT tube tore at 7 weeks and I had to have emergency surgery. I lost my right tube. Hmmm. . .anyone thinking twins, both ectopic??? I am!
August 2009 - We were told that IVF was our best option for a healthy pregnancy
September/October 2009 - our first fresh IVF cycle - we transferred two beautiful 3 day embryos. Result: BFN. We were devastated! We knew it was possible that we wouldn't succeed, but we were young, had a ton of beautiful looking embryos - how could we NOT succeed??? Anyway, we had 10 frozen embryos left from the fresh cycle, so we didn't waste any time and in November we decided to try our luck again!
November 2009 - FET (Frozen Embryo Transfer) cycle - all 10 of the frozen embryos were thawed and were grown out to blastocyst stage. Only two survived to blast stage, and one 5 day and one 6 day blast were transferred on November 5, 2009. BFP 5 days later on HPT (Home Pregnancy Test)!!! It was AMAZING!! HCG numbers were much higher this time, so we were very excited! My OB checked me super early (4w4d) due to my previous ectopic, and he saw the sac! It was in the right spot! To our dismay however, the sac is all that ever developed. . .no yolk sac, no fetal pole, and consequently no heartbeat. Si and I were SO upset! It was diagnosed as a blighted ovum, and I had a D&C December 7th at 7.5 weeks.
After our D&C I asked the RE to run the recurrent miscarriage blood work panel (Leiden factor V, Protein C&S, APA, ANA, etc.) and she refused. So wouldn't you know, I asked my OB to run it. He was happy to! I got the results a couple of weeks ago. I am Compound Heterozygous for the MTHFR gene mutation - meaning I have one copy of each mutation - the 677C and the 1298A. This is an inherited clotting disorder, as well something that keeps my body from being able to appropriately metabolize folic acid! Problematic when trying to make babies I would say!!! People with the MTHFR mutation commonly can only metabolize about 1/3 of the folic acid they take, so they definitely need supplementation. Some reproductive immunologists will prescribe specific additional vitamins, recommend baby aspirin while ttc (trying to conceive), and progesterone suppositories after ovulation while ttc. My OB changed my prenatal vitamin to Neevo, and added a daily Baby Aspirin (81 mg) into my routine.
I faxed my blood work results from my OB to my RE and called my RE a couple days later to follow up and get her thoughts on the MTHFR mutation and provide any recommendations she may have for additional testing, and I got no response. ZERO. I called and talked to the nurse to set up my next IVF schedule, and I discussed my concerns with her about the RE not being responsive to me. She told me that she would make sure that she talked to the RE about the blood work and testing. . .well. . .I never heard back. Not a word. SO, I decided to get a second opinion from a wonderful RE in Colorado. He identified several potential issues with Si and I's case and suggested some additional testing. As we are already in the birth control portion of an IVF cycle and are set to start stimming in about a week and a half, we decided not to cancel this cycle. BUT, I may check with my OB and see if he can do the testing that the RE in Colorado suggested. I haven't decided if I am going to tell my current RE what the other RE suggested. . .she wouldn't do the extra testing anyway, so WHY bother?! I am so frustrated with her right now!
Anyway, that brings you up to our current status! We are set for a February IVF session! Wii hoo! We have 7 days of birth control left, then we go in for clearing blood work and ultrasound on February 2nd. If all is well, we can start Follistim the same day! For those of you unfamiliar with this whole IVF process, I will post some general information so you can follow along. It is very intensive, but it's also a very amazing process. I can't believe how far science has come!
Thanks for reading=).
March 2008 - Visit with my OB regarding infertility
July 2008 - Hysterosalpingogram (HSG) - result: normal
September 2008 - Clomid - 100 mg - result : BFN
October 2008 - Clomid 50 mg - result: BFN
November 2008 - Clomid 50 mg - result: BFN
December 2008 - Clomid 50 mg - result: BFN
January 2009 - Clomid 50mg + IUI - result: BFN
February 2009 - Clomid 50 mg + IUI - result: BFN
March 2009 - Clomid 50 mg + IUI - result: BFN
Referred to RE: Maud Doherty in Omaha , NE
May 2009 - Consult with Maud - ordered more testing
June 2009 - Laparoscopic surgery - result: Stage IV Endometriosis! A reason for our infertility! FINALLY!!!
July 2009 - Follistim + IUI - Result - BFP!!! But. . . HCG levels increasing slowly, no sac seen on ultrasound at 5 weeks, but mass seen in left tube=(. Ectopic. Maud decided that since my HCG levels were low we could wait to see if my body reabsorbed the baby. Unfortunately my RIGHT tube tore at 7 weeks and I had to have emergency surgery. I lost my right tube. Hmmm. . .anyone thinking twins, both ectopic??? I am!
August 2009 - We were told that IVF was our best option for a healthy pregnancy
September/October 2009 - our first fresh IVF cycle - we transferred two beautiful 3 day embryos. Result: BFN. We were devastated! We knew it was possible that we wouldn't succeed, but we were young, had a ton of beautiful looking embryos - how could we NOT succeed??? Anyway, we had 10 frozen embryos left from the fresh cycle, so we didn't waste any time and in November we decided to try our luck again!
November 2009 - FET (Frozen Embryo Transfer) cycle - all 10 of the frozen embryos were thawed and were grown out to blastocyst stage. Only two survived to blast stage, and one 5 day and one 6 day blast were transferred on November 5, 2009. BFP 5 days later on HPT (Home Pregnancy Test)!!! It was AMAZING!! HCG numbers were much higher this time, so we were very excited! My OB checked me super early (4w4d) due to my previous ectopic, and he saw the sac! It was in the right spot! To our dismay however, the sac is all that ever developed. . .no yolk sac, no fetal pole, and consequently no heartbeat. Si and I were SO upset! It was diagnosed as a blighted ovum, and I had a D&C December 7th at 7.5 weeks.
After our D&C I asked the RE to run the recurrent miscarriage blood work panel (Leiden factor V, Protein C&S, APA, ANA, etc.) and she refused. So wouldn't you know, I asked my OB to run it. He was happy to! I got the results a couple of weeks ago. I am Compound Heterozygous for the MTHFR gene mutation - meaning I have one copy of each mutation - the 677C and the 1298A. This is an inherited clotting disorder, as well something that keeps my body from being able to appropriately metabolize folic acid! Problematic when trying to make babies I would say!!! People with the MTHFR mutation commonly can only metabolize about 1/3 of the folic acid they take, so they definitely need supplementation. Some reproductive immunologists will prescribe specific additional vitamins, recommend baby aspirin while ttc (trying to conceive), and progesterone suppositories after ovulation while ttc. My OB changed my prenatal vitamin to Neevo, and added a daily Baby Aspirin (81 mg) into my routine.
I faxed my blood work results from my OB to my RE and called my RE a couple days later to follow up and get her thoughts on the MTHFR mutation and provide any recommendations she may have for additional testing, and I got no response. ZERO. I called and talked to the nurse to set up my next IVF schedule, and I discussed my concerns with her about the RE not being responsive to me. She told me that she would make sure that she talked to the RE about the blood work and testing. . .well. . .I never heard back. Not a word. SO, I decided to get a second opinion from a wonderful RE in Colorado. He identified several potential issues with Si and I's case and suggested some additional testing. As we are already in the birth control portion of an IVF cycle and are set to start stimming in about a week and a half, we decided not to cancel this cycle. BUT, I may check with my OB and see if he can do the testing that the RE in Colorado suggested. I haven't decided if I am going to tell my current RE what the other RE suggested. . .she wouldn't do the extra testing anyway, so WHY bother?! I am so frustrated with her right now!
Anyway, that brings you up to our current status! We are set for a February IVF session! Wii hoo! We have 7 days of birth control left, then we go in for clearing blood work and ultrasound on February 2nd. If all is well, we can start Follistim the same day! For those of you unfamiliar with this whole IVF process, I will post some general information so you can follow along. It is very intensive, but it's also a very amazing process. I can't believe how far science has come!
Thanks for reading=).
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