Monday, April 13, 2015

Endometrial Receptivity Array Test

I have been doing some research about Endometrial Receptivity Array Test and I emailed my Re about it.

 I have a strong feeling that this has been my problem with implantation and ivf. When I get pregnant naturally the timing is perfect but the embryos are abnormal. With IVF & PGS the embryos are normal but the transfer date might not be ideal for implantation. My FET was 4 weeks 3 days after my last period 02/20. Something seems wrong there. With my BFP FET where I got to 8 weeks, my transfer was only 3 weeks 2 days after cycle day 1. We all  have an implantation window and IVF totally disregards this!! My RE is looking into whether his clinic can offer this. He said he can do the "scratch" and the biopsy will show if I have endometritis. He doubts I have it.
I really hate being on the birth control pill.  For some reason it is causing my breasts to be really sore and swollen.  However,  with my bad luck I doubt we'd ever catch a euploid egg and Dh does not want to risk it when we have PGS normal frosties waiting for us.Not to mention my age. (almost 44). Of course he doesn't remind me about that fact.

Dr Hamersley, Wtf appointment..

My wtf appointment with RE wasn't much different from all the others. I asked what his thought were why this didn't work. he had no explanation but says he continues to be optimistic.  I am sure he is programmed to say this to patients every failed cycle. He told us this normal embryo was a female. My gut feeling was right when I decided to crochet that baby dress after my transfer. He said he had put in a request for intralipids to the clinic. I am not holding my breath as he also did this last summer after my miscarriage and it was denied. Also, he said that Braverman was not the RI he was thinking of. Other than Sher there are no others on the East coast so I don't know if he was just making up an excuse?. In any case, we would have to pay $3,000 to Dr Braverman (this fee is for cost for ivf transfer but since we are in a guarantee program with our clinic we cannot do this. However, we would still have to pay this fee and that does not include any of the out of pocket cost of the actual immune testing. Re said he cannot interpret the tests results and that I would have to switch clinics. We still have 2 frozen embryos so that is out of the question.

The good news is that we met with Dr Hamersley. She spoke with us over 2 hours and we really like her. First she went through all my miscarriages one by one in detail. Then all the testing I have done so far. Dr H showed us a study and protocol that she feels will work for me. She also prescribed the higher dose of prednisolone I have been begging from my RE for over a year now! Dr H also agrees that I have an inflammation problem, most likely due to autoimmune disease and endometriosis.

Dr H is the first doctor who had actually addessed my Mthfr mutation. She gave me a prescription for Metanx (3mg methylfolate). I told her that I have been taking Thorne prenatal which has 1 mg, despite other doctors saying heterozygous c677t was not a contributing factor to my miscarriages.  When I told her about the over-methylation rashes I get when taking it for several months, she said that can be remedied with Niacin (vit B3). Unfortunately the "flushing" I get from 500mg  is unbearable. It's like a bad sunburn and lasts for several hours! So I will have to switch to a low dose and see if I can stand it.

In the study Dr H printed out, it outlines women doing ivf with known thyroid issues. She is pretty sure that although all my thyroid tests come back fine that I will need to take meds and have my thyroid monitored once I do another FET because she thinks it acts up once I am pregnant. Dr H encouraged me to continue acupuncture as she is a big believer in it. She feels that the lovenox helps with inflammation problem,but maybe I shouldn't start it as early as 3 weeks before transfer as it possibly interfered with building my endometrial lining. This is my opinion on the lovenox, but she agreed that it could be a factor and I should start it only after I have my lining check and it is optimal.

I really like that she emphasizes an anti-inflammatory diet and exercise. She made me feel good about everything I have been doing so far.  Yoga, pilates, acupuncture, no sugar. Lots of organic fruits and veggies. Oh, and she stressed that I should completely cut out sugar while taking prednisolone as it really affects blood sugar. She agrees that the laparoscopy will be a good thing because I definately have all the symptoms and she said that sometimes in the later stages endo symptoms will actually disappear but that the endo is still there causing inflammation. This makes perfect sense because for most of my life I could barely function due to the cramps and vomitting.  I thought cutting out red meat and taking various supplements like Primrose oil had gotten rid of the endo since my symptoms are very mild now. Dr h said eno never just goes away.  Cleaning it all our could be just what I need.

She couldn't believe that other doctors have ignored my positive ANA that has remained that way for the last 9 yrs.  I am sure I missed some info in this post as it was a 2 hour appoint and so much was said. Dh usually remains quiet but he asked her alot of questions and told her some things I had forgotten to mention. I am happy that he liked her and thought that she had done alot of research on our behalf.

So the next step an appointment with my gyno Dr Morosov. He did my hysteroscopy in 2010 and is an excellent surgeon. We will schedule a laparoscopy this summer.

Friday, April 3, 2015

Beta confirms BFN

I had my beta today which confirmed BFN.  I had a long talk with my RE about Dr. Braverman. I told him that I had a phone consult with him in February and that he said I most likely had autoimmune or alloimmune issues.  He said he does respect what Braverman does, but he is not authorized to prescribe the high levels of prednisone or ivig that he recommends.  I said now we know for sure chromosomal issues are not the cause because this was a PGS tested embryo. I asked him to at least order the HLA testing to see if Dh and I have matches and he said he would read the website.  Even if he orders the tests, he cannot promise that he will be able to do the immune protocol that Braverman recommends.  I told him I am not transferring anymore PGS normal embryos until we get tested. I also want to have a laparoscopy because my gyno has always suspected that I have endo and the RE didn't think it could cause miscarriage but now after all the research I have shown him that Dr. Braverman has done he admits it could be a possibility. I want the gyno/surgeon who did my hysteroscopy in 2010 to do the lap though. Not my clinic. They did a lousy job with my last d & c. At my WTF appointment I am also going to ask him about an endometrial scratch or biopsy to see if I have Endometritis (an infection in the endometrium lining from a d & c). 

Dh wanted  know the sex of our lost embryo. Re was supposed to tell me once I got pregnant. I was so busy advocating for reproductive immunology I completely forgot to ask.  Over the last 2 weeks I crocheted a baby dress. We will see if my feeling was right. I included that question in the email I sent.

Next step is meeting Dr Hamersley (MFM).. I have been told that she does believe in autoimmune treatment.