Tuesday, April 30, 2013

Blubbering mess....

Yup, that is what I am...Just a mess....

I don't know if it is the stress of everything riding on this cycle, or hormones, or just life...But, today, I cannot stop crying!! I hate it!!..

No word back yet on the prior authorization crap with my insurance for neupogen...I hope to hear back in the next couple days...Praying for some kind of a miracle...

Ok-I need to pull it together and make dinner, but all I can think about is curling up in bed and crying....Lord help me...

Monday, April 29, 2013

UGH-

Well, not sure what I am going to do...

My new insurance won't cover the Neupogen- I am trying to scramble to figure out what to do next, if anything at all...Why must this all be so hard!!

=(

follie check-

Went in today for my follicle check-

Got two leads- one on each side, measuring at 13 mm and 14 mm- so not much change from 5 days ago...which is pretty normal for me, I tend to be a slower responder and later ovulator...I was hoping things would look a bit better today though...=/
Not sure what my E2 and the rest of it all looks like, we will see in a couple more hours probably. I am hoping this cycle is not a bust already...

I will check back in when I hear back from DR. B.

Sunday, April 28, 2013

plans...

Never work out...LOL...I "planned" to go to the RE office tuesday for my clinic appt, as DH usually has tuesday mornings off- This week...The ONE week I make an appt, he has to work..LOL...Had to make a quick changearoo to tomorrow morning at 9 am- which is probably for the best considering my OPK's are starting to get mighty dark.....Cant wait to see what those follicles have been doing in there!!

Friday, April 26, 2013

Recap- Official diagnosis


Well, I finally had out follow up-
here is what he had to say! ( below)

I was surprised to learn my NK cells had gone to normal, which is great news! (not mentioned in recap)
anyway- I really hope these meds work!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Hi Megan , here is a summary of our findings and our plan for treatment

1.       You have a high level of antibodies against your husbands HLA genes and these are complement fixing so we know they cause damage to the pregnancy and may explain your 19 week loss.
2.       You  have a HY restricting allele the DRB3 and this causes you to make antibodies against any male pregnancy and if fact when the immune rejection for the male becomes strong enough most of your pregnancies will be rejected , all of this starts usually after a full term male pregnancy has occurred.
3.       You have a combination of HLA genes that predisposes the embryo  to making low levels of HLA G , a molecule the embryo must make to HELP create immune tolerance for your husbands genetics which obviously is not working
4.       You have significant uterine artery flow issues
5.       You do not have enough differences with your husband on certain HLA genes that are necessary to create immune tolerance toward all of his genetics.

To treat this we recommend

1.       Prednisone to decrease the production of the anti HLA antibodies that you have (you should start at 40mg , 20mg twice per day) we discussed IVIG as well but this is very expensive , however we will try and order it to see if it is covered but I would doubt it.
2.       Neupogen for the HLA matching issues and to help develop tolerance toward your husband genetics. It is important to have relations as often as you can while on the neupogen.
3.       Lovenox to improve the uterine artery blood flow and to prevent the activation of complement caused to your complement fixing HLA antibodies that is the root of the problem with these types of antibodies.

The nurses will call you to go over injection teaching.

You must reorder the HLA antibodies and Treg cells with each pregnancy test as well as an heparin anti XA level that we will be sure you get scripts for , you need a CBC with each pregnancy test as well.

Regards,

Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology

Follow up later-

I have my Follow up skype consult with Braverman today, at noon. I am anxious to hear what he has to say in regards to the labs they ran when I had my office visit....Wondering if it changes the game plan at all...I Guess I will find out soon!

I got a message back from Dr.B's nurse about my monitoring I had done wed- They want me to go back on Tuesday for one more scan/blood work.  We will see how things are when we get to that point I guess...He was concerned with the Low E2- I have had this happen in all my other femara cycles as well, where my E2 is soooo low, but my follicles keep growing etc- and even when they get mature the E2 is less than it normally would be with say, injects or whatever...Anyway...I have always been told having the low E2 with femara was normal, but I plan to pick Dr. B's brain about it later today just to see what he has to say...

I am starting to feel nervous about this...I feel like this is not as well planned as I would have liked...I really wanted 30+ days  gluten free before cycling, lose some weight etc, etc...Because the money came so fast, and DH and I were so  excited to have a REAL chance, We decided to just go ahead  this month, and now I am second guessing myself...Also feeling guilty for spending the money...We could use it on sooooo many other things, and the thought of the money just going down the drain if we don't get a sticky just kills me inside...Not to mention, I was informed YESTERDAY, that I won't get any more neupogen RX's until I get a + beta, and pay the first trimester monitoring fee....I need to KNOW my new insurance will cover the meds , so I am not just left to miscarry, because I cannot get the meds I need due to cost or other factors....I need to have this info all nailed down....

SO many Fee's and I am wondering how much of this is just to put  money in their pockets...I am starting to feel like a cash cow and not so much of a patient...I dunno...Maybe I am just hormonal...I just feel so, "ugh"...
I will update later after my follow up appt....

Wednesday, April 24, 2013

Monitoring-

I paid the cycle fee today! Yay! Things are really rolling now-
I picked up all my other meds, and am all set to go!

For good measure, since we are putting so much into this cycle, I wanted to get a follicle scan, even though it really isn't needed. I still wanted one to make me feel better...lol....So, I went ahead and did my ultrasound and blood work today at my RE office, just to be sure things were going ok. I am on CD 9 today- Finished my femara last night.

Ultrasound showed 6.3 mm lining-
left ovary: 5- under 10mm and-  a 11mm and 13 mm
right ovary: 5- all 10mm and under

TSH- 0.89
FSH- 6.4
LH- 9
E2-20 ( low due to the femara effect)

So far, so good- No word back from Dr. B on the clinic results.
He may ask me to go for one more scan just to see how they are growing- but maybe not- I am the one who requested the scan anyway...

Can't wait to freaking ovulate and get into the TWW! LOL
=)




Monday, April 22, 2013

Yay!

Check is in the bank! Wooohooo!!! I am paying my cycle fee's on Wed- Then, I have my skype follow up appt set with Dr.B on Friday at noon (I am sure it will be a bit later, he is always behind)...Then next week I go (to my local RE office)  for a follie check to check on the eggies! By this time next week, we should be only a couple days away from O (aka show time!).


Friday, April 19, 2013

Hello, Hot flashes


Generally Femara isn't too bad for me in term of side effects, but I can def feel some hormonal action going on today. =) Means everything is working I suppose! whoo hooo!

AF is winding down a bit, thankfully! DHis looking forward resuming BD activity! ;)

Still waiting for the check for our cycle fee funds to get here!! UGH! WHY this week of all weeks does the mail have to run sooo slow!! I really wanted to have my skype consult done with dr. B before this weekend, but we have to wait- Hopefully by mid week I have all the stuff done, and details on neupogen dose etc to start when I O...Really praying the heck is there in the mail this afternoon...Would make me a very happy camper! Getting down to the wire here...Which Dr. B assured would be fine, since I need so little management as far as my cycle goes. But the planner in me is going crazy with this last minute stuff!!



Thursday, April 18, 2013

OK- scratch that-

OK....So, forget the neutral stuff and the last post...lol...

I have been in a "mood" for the last few days, since that string of BFP/preg announcements that rolled in a few days back, and I have not been able to shake it...Totally made me a melancholy mary today...Anyway...

Had a LONG talk with DH today on his lunch, about this cycle, and all that jazz...He said a lot of really good things...One thing that stuck out to me he said, "If you walk into this with the mindset that you are going to fail, or it isn't going to work, it probably won't"...Which is soo true...The mind is half the battle when it comes to fighting anything...Your mind is a powerful thing...I realized, I am letting all the past losses shape how I walk into and feel/view this cycle,and how it is going to go. I cannot do that....This one is going to be different...We are actually going to be on meds that we need, that have been shown to give positive results in many ladies...Not all, but a LOT ...We really DO have a chance at a sticky this month, and I need to stay as positive as possible ....So we decided, together, we are going to be as positive, upbeat and happy as we can, no matter HOW HARD it gets, and how much fear, doubt, and cynicism creeps in, we plan to kick it out and stay focused on the much wanted baby bean that we are about to create....If we come to the end  of the cycle and do not get the desired results, we will decide what steps to take next....For now...I stay positive...Lord help me...


Psalm 27:14
Wait patiently for the Lord.
    Be brave and courageous.
    Yes, wait patiently for the Lord.
Isaiah 40: 10
Don’t be afraid, for I am with you.
    Don’t be discouraged, for I am your God.
I will strengthen you and help you.
    I will hold you up with my victorious right hand.
Isaiah 40:17
 Because I suffer and am in need, let the Lord think of me. You are my help and the One Who sets me free. O my God, do not wait.

Eph-3:30
Now all glory to God, who is able, through his mighty power at work within us, to accomplish infinitely more than we might ask or think.

Neutral

I am trying to stay as emotionally neutral, and realistic while TTC this cycle...I know that will be MUCH easier to accomplish during the first half of this cycle, VS the latter half...It always seems to work out that way. I know this cycle holds MUCH better chances for us to have a take home baby, than any of the other cycles we have ever done in the last 2 years...But, I am just soooooo scared of how I will feel and what I will do, should this NOT be "the cycle" that brings us our rainbow...It literally is the most paralyzing feeling...I almost have to force myself to take my meds and get "into it" this month, because I am just so nervous...

I remember how I felt after the 2nd intralipid cycle didn't work...I was sooooo crushed, and depressed, and felt so empty and totally broken....I went into the start of that cycle feeling like that was going to be "it", and when it didn't work, and we HAD to move on to seeing Braverman, it was such a punch in the gut...Still, I feel like this time, would be even worse, since there is no "next step"...There will be no more specialists to see or treatments to try...It will be checkmate, game over, for us, and that scares me...

I wish I could throw myself totally at this cycle with un abandoned hope and faith...If this is one of our last, I feel like I "should" give it everything I have, and really throw all caution to the wind- even at the risk of a major crash and burn at the end...But I have been there and done that, and the fallout was very hard to pick myself up out of...

Part of me thinks being so "realistic" is really just disguised cynicism and doubt...But then I am reminded, even Braverman said, "be prepared for this to not happen the first or second try- It could, but it might not..." Some might think thats a bit grim to say to someone, but I appreciate the realism and honesty.

Anyway- Here is to me staying as calm, collective, and as neutral as possible, yet, somehow, hopeful for the rest of this month!

Tuesday, April 16, 2013

CD 1- Here we go...

Well, AF showed with a vengeance. Yay me.  The heat pack is my best friend....lol

I got the clear (Email back) from Braverman, that we could cycle this month. I will do my follow up consult with him later this week or next, on skype (depending on when the freaking check clears etc), instead of waiting until May 11th to do my F/U appt in person...Then I will pay the cycle fee, and get all my meds RX's- Since we are doing a semi natural/un monitored femara cycle, I don't have to worry about monitoring fee's, travel etc, we can just jump right in this month...I already have some neupogen on hand anyhow, and lovenox and prednisone, but I will have everything I need for the next 12 weeks soon anyway....

It is all starting to become real. I am not nearly as worried or stressed  about it all now....I think the last few days' mood swings were magnified by the hormones preceding AF...Beeotch!...Only a hint of melancholy today...Just wish I could know before hand, how this cycle was going to work out...Its a bit nerve wracking...Really hoping and praying it takes only ONE cycle, and we can snag a sticky!!! Hopeful EDD is, Jan 21/22/23- if I O in my normal range...=)

So far, here are the meds/supps we will be using this month:

Along with my normal prenatal and Synthroid I will be taking...

1. NAC (AKA N-acetyl cycteine) from CD 1 to Ovulation.
2. D3 10,000 IU a day
3. Metformin 2000 mgs a day
4. Prenisone 20 mgs a day
5. Femara CD 2-8
6. 10,000 IU HCG trigger ( pregnyl given SC) at + opk
7. Lovenox- 40 mgs 2 x a day by injection all cycle long.
8. Neupogen (dose TBD) from O to 12 weeks pregnant-
9. 1 baby aspirin a day
10. PIO 50 mgs inject 1 x a day
11. Prometrium- 1200 mgs a day

I also ordered some more OPK's/HPT's and some Preseed just to have on hand...I think I might need a new BBT therm too...Better get that soon!...

OK- Here we go- TTC with the big guns this time!



Monday, April 15, 2013

Hear my heart...


When there are no words to say
And no prayer that I can pray
Hear my heart
When I don't have strength to try
And I've cried all I can cry
Hear my heart
'Cause You know every fear
And every doubt I cannot speak
You know all the ways I need You
And all the way I'm weak
S I'll be quiet so you can hear my heart

Sometimes I feel
No one's ever been in this place before
This is hard
And I'm not sure that I can do this anymore
I know someday I'll look back
And all this won't seem real
But Lord right now
I need You to know just how I feel

Every now and then
I recall a simple phrase or melody
It comforts and it quiets
Lifts me up and then it carries me
Far above the pain and hurt
I think will never end
The song speaks words I cannot
And calms the fears within

Lord I'll be quiet for You can hear my heart

(song by: sherri easter)

Sunday, April 14, 2013

Not ok

I am not OK...
This is NOT ok...
Nothing about any of the last 2 years of my life has been "ok"...

Some days, I do a realllllyyyyy GOOD job at pretending everything is "ok", but the truth is...It is NOT...Not at all...

Yesterday, as I was starting to really think about how risky all this immune treatment stuff is...I was pondering what I would do if this doesn't "work"...How will I feel, what will I do? How will I move forward??...I didn't get too far into this thought process before I was spinning in circles, half crying, feeling so overwhelmed and hopeless...We really only have ONE shot at this to make it happen before we run our of money for this stuff...It sets the term "putting your eggs all in one basket" in a whole new light...ugh...

In the midst of that whirlwind of thoughts swirling in my head...I was informed my sister in law, who just got married not long ago, is pregnant... Now, I LOVE my SIL with everything I have, and I was generally happy for her...I reallllyyy, realllly am....But, Inside, I just screamed, and cried...I was not mad they got blessed..I want them to have the blessing of babies too, more than anything....BUT......My heart ached for US, for  the pain both my husband and I have walked through...... It ached for all my angel babies...It just ached sooooo bad knowing that even WITH the help of Dr. B, this wont be a easy road...I need to be ready for that, and I just hate it...I want the HARD parts to be over with...I want to reach the other side of this valley of shadow of death...I want to rejoice in the blessing of new life without fear...I just don't think I will ever get that again...I hate that this whole process has robbed me of so much....I hate that I cringe everytime I get a text or a message or hear a phrase similar to - "hey I have good news"--I instantly think "pregnant", and plan how I am going to play off my tears or pretend to be elated for them...Then, In the next moment, feel like such a asshat for even feeling upset, when I have beautiful children already...Ugh, the circles I run in...Sorry for my bipolar TTC blog....One day I am ok, one day I am not...UGH - The "joys" of this journey....Anyway...

I spent a considerable amount of time feeling sorry for myself yesterday afternoon...Then one after another...More announcements rolled later in the day...And MORE today...I keep seeing pics of babies that would be as old as some of our angles right now...I should  have a 1 year old, and a 9 month old etc etc etc...Constant reminders alllllll over the place...Then the stress of all this cycling and money....

Needless to say, I am in a funk, and feeling pretty low...I am just not OK right now...I am not sure I will ever be "ok"....The last two years have really ripped me into bits...


Please God,I need you now....

More info on immunological implantation dysfunction-


( Below is some info on the immune issues we are facing- This is really only a glimpse of how it works-We have a kind of complex case, in the sense that we have several auto immune and allo immune factors working against us)

Immunologic acceptance of the implanting embryo by the uterus of the mother is both highly complex and magnificent. Not only is it essential for pregnancy to occur, but it also sets the scene for our body’s own cells, tissues and organs to be shielded from attack by our own immune systems. For a moment, consider how, when confronted by foreign proteins (bacteria, viruses, foreign tissue grafts/transplantation), the body’s immune system goes on the attack, but yet an embryo that is derived from proteins that come from another individual (the sperm or paternal antigen), usually safely implants in the pre-pregnancy uterine lining and then grows into a healthy baby.This phenomenon has come to be referred to as the “immunologic riddle” of pregnancy.
For such a complex arrangement to be foolproof would be without precedent in human biology. To argue that this system can never fail is in my opinion, an absurdity, bordering on arrogance. It can and does go wrong in about 15-20% of women with reproductive failure.When it does, it presents either as failed implantation (presumed by the patient to be infertility), as miscarriage, or (much less frequently) as placental failure and compromised fetal development or intrauterine death. It all depends on the timing, nature and severity of the immune assault.
It is well known that the reason the implanting normal embryo thrives in the womb is that unique immunologic adjustments convert the pre-pregnancy uterine lining (decidua) into a “privileged site” where the embryo and the fetus come to be regarded as the “body’s own” and as such are protected from immune attack. This initial acceptance of the embryo as “self” or “friend” rather than “non-self” or “foe” (in spite of it being composed partially of the father’s “foreign” cells), is one of the miraculous adaptations of nature, and is in large part responsible for our survival as a species.
As soon as implantation begins, the paternal genetic contribution to the embryo (so called DQ alpha genes) initiates asignal to the pre-pregnancy decidual immune system which thereupon determines whether the embryonic “allograft” should be welcomed as “friend” or be rejected as “foe” through immune attack. The process is referred to as “alloimmune recognition.”Given that with the exception of monozygotic twins, interpersonal differences in genotype are inevitable, it follows that maternal and paternal DQ alpha gene combinations will usually also differ in the vast majority of cases. Thus, preservation of the human species required that in spite of such immunogenetic dissimilarities, the immune system of the pre-pregnancy endometrium (decidua) evolutionarily adapt and recognize the embryo as friend rather than foe.
Upon reaching the uterine environment, the genetically “competent” embryo hatches and within 12-24 hours starts sending its root system (trophoblast) into the decidua. The trophoblast has both a villous (root-like) and an extravilous (diffuse) component. The extravilous trophoblast which diffusely permeates the decidua, expresses several so-called “major histocompatibility complex” (MHC) class-1 genes (e.g. histocompatibility leukocyte antigen [HLA]-C, E & G)].These HLA genes, (mainly HLA-G) regulate primarily two types of lymphocytes present in the decidua.These are: a) uterine natural killer cells (NK) and b) cytotoxic lymphocytes (CTL). NK cells comprise approximately 75% of decidual lymphocytes and CTL comprise about 10%. They both play a vital role in regulating the normal implantation process by controlling the penetration and functioning of the trophoblast.
The recognition of proteins as self (“friend”) or non-self (“foe”) is propagated by highly specialized immune lymphocytes known as Regulatory T-cells. These so called Treg cells can “turn-off” immune reactions even once they have been started by conventional immune cells. They play a pivotal role in the immune system’s ability to prevent rejection of an embryo whether due to an autoimmune or alloimmune response. Other immune cells known as “dendritic cells” introduce antigenic proteins to these Treg cells, whose concentration increases when the antigen is recognized as “friend” and decreases when recognized as “foe.” MHC (primarily HLA-G) signalingthrough the Treg lymphocyte mechanism working in combination with other regulatory proteins, influences the production and release of so-called cytokines by the NK and CTL cells.
There are 3 varieties of cytokines, two of which play defining roles in the maintenance of implantation:The first isTH-2 cytokines, which encourage growth and expansion of the trophoblast and promote proliferation of blood vessels (angiogenesis). TH-1 cytokines promote destruction (cytolysis) of trophoblastic cells and also cause blood to clot (procoagulant effect).A balance between TH-1 and TH-2 cytokines is essential for normal implantation and development of the placenta (placentation). Over-activity (dominance) of TH-1, the hallmark of NK cell and CTL activation, leads to damage of the trophoblast, implantation dysfunction and reproductive failure.
Alloimmune Implantation Dysfunction
Every human being has two DQ-alpha genes. One is contributed by the father and the other by the mother. In a small percentage of patients undergoing IVF, paternal-maternal DQ-alpha gene similarities occur.In such cases, following repeated exposures to such genetically matching embryos, this will provoke activation of the decidual immune system. In most cases, through the mechanisms described above, this will lead to NK/CTL activation and reproductive failure (i.e.; infertility, and pregnancy loss).We refer to this phenomenon as alloimmune implantation dysfunction.
This is how alloimmune implantation dysfunction happens:Immunogenetically triggered HLA-G signaling by the embryo leads to a reduction in Treg cells, and eventually to a destabilization of NK/CTLs with domination of TH-1 over TH-2 activity. The severity with which this occurs determines whether total implantation failure will occur, or whether there remains enough residual trophoblastic activity to allow the pregnancy to limp along until the nutritional supply can no longer meet the demands of the pregnancy, at which point miscarriage or pregnancy loss occurs.
With paternal-maternal DQ alpha matching, it often takes several pregnancies for natural killer cell activation to build to the point that a woman with alloimmune implantation dysfunction will present with clinical evidence of implantation dysfunction. Sometimes it starts off with one or two pregnancies surviving to the birth of a baby, whereupon NK cell activity later starts to build, leading to one or more subsequent early miscarriages. Eventually the NK cell/CTL activity is so high that subsequent pregnancies can be lost before the woman is even aware that she was pregnant at all. At this point she is often diagnosed with secondary “unexplained” infertility.
Autoimmune Implantation Dysfunction:
With autoimmune implantation dysfunction, NK cell activation is already well established by the time the embryo reaches the uterus. Accordingly, in such cases the pregnancy is usually lost before its presence can be established by a blood pregnancy test or an early ultrasound examination (i.e., it presents as a negative pregnancy test or a chemical gestation).
So how is autoimmune implantation dysfunction established?The initialrecognition of the non-DQ alpha matching embryo as “friend” or “self” sets the stage for the cells/tissues of our bodies not coming under immune attack. However under certain circumstances, genetic, infective, toxic and degenerative influences can result in our own body’s proteins coming to be regarded as “non-self” (“foe”). When this happens the immune system starts to produce antibodies that are directed against our body’s own proteins. These so called autoantibodies then start attacking the body’s own cells/tissues/organs, creating pathologic states (diseases) such as can be seen with certain (autoimmune) diseases (e.g.,lupus erythematosus, autoimmune hypothyroidism [Hashimoto’s disease] and rheumatoid arthritis).
There are also certain reproductive diseases such as endometriosis, where cell membrane phospholipids are often altered by the disease process, and then combine with proteins to evoke the production of so calledantiphospholipid antibodies (APAs)Certain types of APAs can both directly damage the trophoblast and can also lead to a reduction of Treg lymphocytes, culminating in activation of NK/CTLs.
This type of reaction, albeit due to a predisposition to autoimmune diseases such as lupus erythematosus, Hashimoto’s disease, etc., or reproductive conditions such as endometriosis, is referred to as autoimmune implantation dysfunction. Autoimmune implantation dysfunction is much more common than alloimmuneimplantation dysfunction. In fact, it is probably responsible for more than 85% of reproductive failure attributable to immunologic implantation dysfunction. The most common autoantibodies involved are:
1) antiphospholipid antibodies (APA)
2) antithyroid antibodies (ATA)
3) antiovarian antibodies (AOA)
Since autoimmune implantation dysfunction is often genetically transmitted, it is not surprising that this condition is more likely to exist in women who have a family (or personal) history of primary autoimmune diseases such as lupus erythematosus, scleroderma, clinical or subclinical hypothyroidism, rheumatoid arthritis, etc. Reactionary (secondary) autoimmunity can occur in conjunction with any medical condition associated with widespread tissue damage. One such gynecologic condition is endometriosis.
As previously stated, autoimmune implantation dysfunction is usually immediately lethal to the implanting embryo and accordingly most often presents as “unexplained “ infertility and/or “unexplained” IVF failure, rather than as miscarriage.This is because NK/CTL activation is present prior to implantation and as such, the embryo’s root system is severely damaged from the get-go. Autoimmune implantation dysfunction isreadily amenable to reversal through timely, appropriately administered, selective immunotherapy (IVIG, Neupogen etc)
Diagnosing Immunologic Implantation Dysfunction:
Whether alloimmune or autoimmune in origin, it is only once specialized immune cells in the uterine lining known as Natural Killer (NK) Cells and Cytotoxic Lymphocytes (CTL), become activated and TH-1 cytokine dominance is established that IID occurs. Thus, a full evaluation of immunologic implantation dysfunction requires that DQ alpha, APA, ATA, as well as NK/CTL activation be evaluated. This involves highly specialized blood testing and possibly also endometrial tests that can only be performed in a handful of reproductive immunology laboratories in the United States.
Alloimmune ID is diagnosed by testing the blood of both the male and female partners for matching DQ alpha genes. A sufficient degree of matching clinches the diagnosis. Since matching DQ alphas will rarely cause reproductive failure unless there is concomitant NK/CTL cell activation, it is important to test the embryo recipient for NK cell activation (the K-562 target cell) test and CTL activation (by a blood immunophenotype and HLA-DR measurement). Some reproductive immunologists might also test blood Treg cell concentration and/or recommend an endometrial biopsy to histolochemically evaluate uterine NK cells or assess the local TH-1/TH-2 balance. The performance of blood TH-1 and TH-2 cytokines to assess for TH-1 dominance is controversial and is of unproven value.
 
 




Saturday, April 13, 2013

Not sure I am ready-

Man, all of this stuff is soooo emotional...I keep flip flopping...

One minute, I am OKAY and ready to go full force into cycling with Braverman, feeling like it is going to be GREAT, and we will walk out on the other side with a much loved and wanted baby...The next, I am scared to death, and feeling soooo nervous about it all...What if it doesn't work, and we spend 5 grand a cycle on NOTHING!??......We just don't have thousands sitting around to blow on something that may or may not even work!! I hate that we are even "here"...I hate that the last two years were all in vain...Nothing I did or could have done would have even helped...All the meds, supps, DR's, tests etc...Just to end up here at the "worst case scenario situation" anyway...The one thing I hoped and prayed was NOT our issue, when I was researching reasons for losses back, 2 years ago after my 2nd loss in a row...Of course, that HAD to be what we are dealing with...UGH!!.....And no one can guarantee that our ONLY shot with these controversial meds will work either...At least with IVF you get a pretty good chance of walking away with a baby, or at least a few more frosties to transfer later...This stuff is just a crap shoot, and could take 3 cycles just to find the "right combo" and even THEN you still have a risk of M/C'ing - especially with our HLA restricting issues...God, I just don't know if I can handle this...I don't know If I am strong enough to walk down this road...I am afraid, if it doesnt work, I wont ever get past all this hurt...Some how, I need to over come the fear...

Friday, April 12, 2013

Getting ready


  I have been busy ordering my other meds, so I have them on hand for when we decide to cycle again. I have my HCG trigger on it's way to me- should be here middle of next week. I have my PIO injects ready to be picked up too (and tons of femara already on hand). I have 30 days of Neupogen on hand as well. I am waiting to have my follow up appt with Braverman, to go over the most recent testing we did at me new patient appt.(praying there is nothing else that pops up that warrants even more treatments etc)...Once I do that, and pay the 1250 cycle fee (which insurance will reimburse some of) I will get a RX for more Prednisone, Lovenox (40 mgs 2 x a day- a bit more than I was previously on) and Neupogen. Fingers crossed my new HRA insurance will cover the neupogen...I NEED it to be covered. I cannot put out 4 grand for 30 days worth- no way, no how....Please oh please be covered!!!


   Anyhow, I am off to go get a mani/pedi ..Oh yeahhh...I am in desperate need of some relaxation time .....Its been over a year since I have treated myself to more than a latte in the drive through- lol
=)