Meeting with a New Doctor

This afternoon I met with Dr. Hamersley and

I

Feel

Validated!!!

It isn't often that a doctor cries in front of their patient, but that is just one of the many wonderful things I experienced at this pre-conception appointment.

I'm too excited to write down everything tonight, so I'll stick to the basics.

Sheri Hamersley treats that 2.5% on either end of the normal curve.  That 3rd standard deviation. Women like Me, that don't fit the mold of standard medical care. And she does it because she is one of us; she lost multiple babies, too.

The most validating part of the conversation was our discussion regarding Jackson's autopsy and the treatment we'll be pursuing.  The portion of the report that I'd researched led me to believe that he had passed away due to a clotted placenta.  Dr. Hamersley confirmed that I was correct.  When I asked if it meant that my lovenox dosing was to blame, she stopped short of condemning the doctors I had seen with, "Hindsight is always 20/20 but we will be monitoring you much more closely.  Your anti-Xa levels will be checked regularly and we'll have you on a different dose."

How different a dose?  I had not known that lovenox is prescribed on a weight based scale in addition to anti-Xa levels.  Based on my current weight of 153 lbs, the dose I've been prescribed is 60 mg each morning.  This will begin immediately and will be taken during my luteal phase along with the prometrium I already take. If I get a negative hpt on 14dpo, then I stop both and wait until ovulation again.

Lovenox, in addition to thinning the blood, has anti-inflammatory properties.  I had already figured out that APS is immune based and anyone with an autoimmune problem knows that inflammation is a bad thing. So by taking lovenox during my luteal phase, it will reduce inflammation at the time it is most critical to do so: when a fertilized embryo would try to implant and begin to grow. I will not take it during my follicular phase.

During my pregnancy with Jackson, my dose was 40 mg once daily.  My new dose, if/when I get pregnant, will be 60 mg twice daily with regular monitoring to adjust the dose as needed. Why twice a day when I was only on once a day before?  Because lovenox has a short half-life.  She says the medicine is already half broken down by the body within 4 hours of injection.  A once daily dose during my luteal phase will reduce inflammation, but the twice daily dose will prevent clots.

Does that make sense?

She also wrote out an Rx for a prenatal vitamin that has her preferred amount of 5-methyltetrahydrofolic acid (a naturally occurring form of bioavailable folic acid) as well as a comfortable amount of DHA.  In 11 years of ttc, this is the first time anyone has ever written a prescription for a prenatal for me.

I also have some blood work to get done that I'll research soon. I believe it's another antibody test that Shady Grove did not run.

The last Rx is for Metanx, a medical food generally used to treat problems with diabetic neuropathy (numbness in extremities due to nerve damage).  One of the ways it functions, according to Dr. Hamersley, is to "open" the circulatory system. It increases blood flow throughout the body and increases nerve density.

I am super excited to move forward.  I'll also be removing my biggest stress in a month to help reduce my cortisol levels. The swimming pools have opened and I need to swim, alone, three times a week.  I love to swim and this will give me the three hours of exercise a week that I need as well as a time to just breathe.  Count my strokes and breathe.

If you're a swimmer, you might just understand what I mean.  I can imagine that runners feel the same thing about the sensation of their feet hitting the ground.  I'd probably like running if my knees could handle it.

So I swim.

I will also be going on an anti-inflammatory diet.  No more potatoes or white rice, limited whole grain noodles and bread, lots of vegetables. She recommended kale to increase my vitamin K levels, which should help with the bruising from the lovenox.

Oh!! And SHE USES ESSENTIAL OILS!!!!

Yeah, I think she's going to be a fantastic fit for me, both personally and medically.

Can I get a HOO-RAH?!?!?? (said in your best R. Lee Ermey voice)

What Did Not Work for Us

Over the last week, since we made our happy announcement here, I have had multiple inquiries through facebook regarding what I did this particular cycle to led us to achieving pregnancy after so many months without success.

When I lost our baby girl in September of 2012, I knew our chances would be slim of getting pregnant again based on some discoveries about my health and that if we did, it would likely cost of quite a bit of money--money that we didn't have and could not have saved up for several years.

I began cycles of 50mg clomid in December 2012 and January 2012, prescribed by my OB/GYN but completely unmonitored.  When those didn't work, they increased my dose to 100mg. Those cycles were started in March and April of 2013.

It was then that I scheduled an appointment at Shady Grove. By then I had researched our insurance and knew that all of our diagnostic testing would be covered as well as any medications that were prescribed for a timed intercourse cycle.

It wasn't much, but it was better than I'd expected and I also knew that we'd have the option of changing our insurance to something with significantly more coverage during open enrollment at the new year.

We completed all the testing.  I had 21 vials of blood taken (David had 6 and had his sampling done), an HSG, and an ultrasound. The only thing that came up from our testing was that my anticardiolipin antibodies were elevated. The best part about this test is that we now had an explanation for my 4 confirmed losses and the reason for my other 2 possible losses (positive hpt but negative beta the following day).

There's a pregnancy protocol for women with the antibody problem: Lovenox.  But by golly I had to get pregnant first!

After 1 cycle with my RE on clomid with 50mc clomid, monitored via blood work and ultrasounds, and only one mature follicle, I was bumped up to 100mg.  The first cycle I had 1 mature follicle but 2 that were close behind when they had me inject my HCG trigger shot. I was then able to complete 2 more cycles on 100mg, but each of those cycles had 4 mature follicles.

It was a horrible irony that the doctor had to discuss the option of pregnancy reduction if all 4 eggs matured and implanted.

None of them did.  Either month.

So I set up an appointment with the RE in late October to review everything and get the ball rolling for IVF in March.  At that point, we knew we would be changing our insurance over to a Kaiser plan that would provide 50% coverage for the cost of IVF as well as most of the medications needed.  The out-of-pocket cost for IVF and meds would have been in the vicinity of $13,000, so 50% coverage is huge!!

With plans set to do a mock transfer in December, I left the office resolved to get my body as healthy as possible between then and now. We had a plan and I was going to put that plan in motion.

In all, I had completed 9 rounds of clomid in 16 months, with only the first round resulting in a pregnancy.  I felt hopeless and very let down by my body.  Everything was lining up perfectly each month.  Mature follicles, good uterine lining, and perfectly timed "TI".

Why wasn't any of that working???