Sunday, December 30, 2012

Erm, what is going on?!?!?

That, gentle readers, is not a question that is likely to be answered anytime soon, if ever. After my IVF, when things had looked super weird, my RE and I concurred that maybe following my AFC  for the next few months would be a good idea. I finally rolled off the procrastination wagon and took myself off to get an antral follicle count (AFC) done. The results floored me.

To recap the madness, mostly for my own records: 
  • August 2010: AFC = 34 (evenly distributed in both ovaries)
  • November 2010 (post 1 pregnancy and 1 loss): discover AMH is paradoxically low and am Vitamin D deficient, correct vitamin D deficiency
  • December 2010 ; AFC = 30 (evenly distributed in both ovaries) ; AMH = over 5 ng/ml
  • December 2010-April 2011- Take around 4000 IU vitamin D daily
  • April 2011: AFC = 16  (11 in one ovary and 5 in the other)
  • April 2011-Feb 2011: Add prenatal with extra vitamin D, so total is 5000/day, start taking calcium (50 % of RDA) daily as well.
  • Feb 2012: AFC = 16 (but now evenly distributed in both ovaries) AMH = 4.3.
  • March 2012: IUI# 3 results in failure
  • March-July 2012 - Drop vitamin D dosage to around 3000 IU/day
  • June-July 2012- 3rd pregnancy and loss, due to Trisomy 4.
  • August 2012-October 2012- drop Vitamin D dose 2500-3000 IU/day, continue calcium, however less regularly. Start Metformin
  • October 2012: AFC = 13 (more or less evenly distributed in both ovaries); AMH= 1.6, then 2.6 on retest
  • November2012-December 2011: Stop Metformin. Continue vitamin D at  2000 IU. Stop calcium almost completely.
  • December 29th 2012: AFC = 25 (evenly distributed in both ovaries)! AMH still pending.
With the drastic drop in my AFC (from 30-13 in 2 years), my RE was afraid that it  was because of drastic ovarian aging. I was less afraid of this, and felt that it was an unexplainable response to physiological changes induced by varying levels of vitamin D and *maybe* calcium in my system. I had hoped that after I dropped it to 2000 IU/day, with no added calcium, things would change as far as AFC went eventually, but this big jump back up surprised the crap out of me.  I don't know what to make of any of this- the changes in my Vitamin D intake alone are not that drastic, and there are no good explanations. 

I've played around a lot with vitamin D. Not supplementing at all, and just relying on sunlight and diet is a joke, its been proven time and again that this will leave me in the deficiency range.  What does deficiency do for me? I also lost a chromosmally normal child in this period, and my luteal phase used to be far too short on occasion. Its not so great from a physiological viewpoint- my health overall has subtly but definitely been improved by bringing me into the sufficiency range. However, how sufficient should I be

Deficiency of vitamin D is something that has been proven to be a contributor to infertility.  But a too high blood level may be equally bad, or worse, in my case.

4000-5000 IU with added calcium was something I felt great on, but *may* have had unanticipated, adverse effects on my reproductive system, which is not surprising in theory, because hey,  Vitamin D has been shown without doubt, to be a powerful modulator of this system.

Two thousand IU, the dose I am on now, is a fairly conservative, play-it-safe dose, given all the hot debate on the Vitamin D RDA. The IOM's  2010 recommendation of 600 RDA/day is pretty controversial and has not been well received at all. Other, seemingly saner voices advocate in the 1000-2000 range. The vitamin D council recommends over 4000/day, I believe. Experts at endocrinology are all of differing opinions.  In my revised opinion, everybody needs to keep their blood levels around 30 ng/ml, and its best not to go much higher. The amount you may need to get your blood level to 30 may vary from person to person, some trial and error might need to go into how much you need.

So I'll stick with 2000 IU/month for a while and see how I do, longterm. I'm now also going to start the CCRM regimen (melatonin, argenine, myo-insoitol, coQ10 etc) and see how my AFC fares with that. I'm only wondering whether I should wait one more month to start it, to confirm this rise in my AFC. However, I want to be on this atleast for 3 months before we attempt another IVF, which may be necessary very quickly if the transfer to the surrogate next month fails.

But, hey, on the bright side, my issue does not look like ovarian aging.  If only I can figure out what exactly it IS, though.  Bloody, bloody biology.

Updated: Much, much later, I figured out that the issue is that my RE (Dr. Malpani's) machine is older and has poorer resolution. At the point of my second IVF, we checked in two different machines: my AFC was 16 when using the much older 2D machine, and 24 when using a fancy 4D ultrasound machine. All the scans that showed a high AFC (25-30) were done using the 4D machine. Facepalm moment, for sure.

Thursday, December 13, 2012

In limbo..

I was so very low when I wrote my last post. About a day after that, I made up with the person I'd fought with, and no other awful thing happened, and within a few days, I was back to my usual even keel. If I'm truly, deeply thankful for anything, I think it is my natural tendency to be ok, no matter what.

Its been a very busy few weeks- my house got remodeled (we are talking painting, polishing, putting new windows and false ceilings in) followed by my brothers wedding- a fun, joyous, if completely exhausting event. We were all so tired that nearly everybody in my house was sick, mostly from our immune systems being hammered from overexertion.

After things came back to normal and most of the guests departed,I'm in limbo now on so many fronts. Waiting to see what happens with my green card application. Waiting for a surrogate to be recruited. Waiting to see what happens, on the career front (I'm working, but its mostly for shits and giggles, not a serious job, its a situation  where I'm just trying to learn new things that will make my resume more attractive to future employers).

Nothing in my life is decided. I've been battered by circumstances going south on me so many times- 3 pregnancy loses- it still is mind boggling. Especially when combined with that un-imaginable IVF result, I *should* be terrified for the future. The weird thing is, I'm not. I'm remarkably ok with the current state of uncertainty, which is a wonder in itself.

But the one thing I don't have in large supply is faith. Nothing really seems to work, and why should I hold out hope that this trend will reverse in the future? But  it can. The other day, I read such a lovely post by Mo, about  an email from her RE about her long term prognosis being excellent, shortly after her first loss. It took so many more losses and so many years for that RE's prediction to come true, but it did. I think that post is a must read for all of us still in the trenches, not to give up hope, and to keep going.

Update just in: a surrogate is close to being recruited. There is a part of me that does not want to know anything about her. I'm a painfully picky person in so many areas. i rejected almost every sperm donor I looked at, and I looked at over a 100 donors easily. And you can't control a surrogate and you have to be ok with whoever you get, whatever their background and habits are, and pray that they will take good care of the precious cargo entrusted to them, that their womb is fertile and they will faithfully swallow the vitamins you plan to give them and avoid chemicals during their pregnancy. I'm almost tempted to try with my own uterus,  then the remembrance of each loss hits me and I'm paralyzed and ready to do anything to avoid going through that again. So right now, I'm burying my head in the sand, and not calling my RE to get every last detail about whoever he has picked. Its so very unlike me.

But for now, I'm very ok. Out of my funk, still missing my cat. We rescued a tiny kitten off the streets. Had we had my old cat, we would not have considered doing this. Ah, the circle of life- one life splutters out, another living thing gets a shot at survival because of that.