Problem/Solution

Where do I begin to explain how I've been feeling about this Egg Donor Cycle? Naturally, I've been scared out of my mind. I continuously worry something is going to go wrong. I continuously worry that we won't get enough good quality embryos to have an embryo transfer. I continuously worry that I won't become pregnant from our embryo transfer. I continuously worry that I will miscarry within the first trimester. I continuously worry that we will have to have another funeral for another child. I worry so much that what we are doing isn't going to be enough to answer our prayers. I have to stop and remind myself constantly that we are doing EVERYTHING we know to do about the problems that we are aware of in this moment in time. And there is nothing more than I can do than that.

SO to calm down my fears, I decided to make a list of the problems we are aware of and how we are attempting to solve the problems to have a healthy pregnancy and healthy baby.

1.) My Translocated Chromosome: One of my #13 and one of my #21 chromosomes are attached. This is what doctors believe has caused my recurrent pregnancy loss (stillborn daughter at 24 weeks and 3 first trimester miscarriages). Only the last two babies had genetic testing which confirmed their diagnosis of Down Syndrome caused by my translocated chromosome. We attempted IVF with PGS (preimplantation genetic screening) which failed to work for us due to poor egg quality and genetically abnormal embryos. SOLUTION: Donated Eggs from my Sister who Does NOT have the translocated chromosome.

2.) Homocystinuria: This genetic disease which prevents me from metabolizing protein and can cause blood clots which in turn can cause miscarriage and stillbirth. When I was first diagnosed in 2012, we were told this could have been the reason our daughter was stillborn in 2008 instead of the cord strangling her to death like we had thought for the past four years. Medication and diet are the only ways to control the Homocystinuria itself, but the potential clotting issue is a second layer to the disease. With my first pregnancy after getting diagnosed I started Lovenox injections at week 7 once we heard the heart beat. With my last pregnancy I started taking Aspirin daily months prior to getting pregnant and started Lovenox injections a few days after the positive pregnancy test. SOLUTION:Medication and vitamins to control my homocystine levels-Cystadane, vitamin B12, vitamin C, Calcium, Folate (been taking for months); Daily baby Aspirin (been taking for months) and daily Lovenox injections beginning 2.5 weeks before embryo transfer to prevent blood clots in my uterus

3.) MTHFR Mutation: We discovered after I miscarried our third baby that I have this genetic mutation that is associated with causing Neural Tube Defects in babies and causing difficulty metabolizing folic acid, the synthetic form of Folate. Folic acid has been an essential vitamin for pregnant woman for ages but I didn't know until after our fourth loss that there are specific prenatals that have the real form of Folate in them and that Folic Acid, because it's synthetic can actually be harmful to me and a baby. SOLUTION: Daily Neevo DHA prenatal, a prenatal designed specifically for women with the MTHFR mutation, And daily Thorne Research 5-MTHF 1mg capsules (2 per day) which is the natural form of Folate.

4.) PAI-1 4G/5G Genotype with Insulin Resistance: This is something we just recently discovered thanks to several friends who told me they were put on Metformin due to their insulin level which can affect egg quality and can cause miscarriage. When they told me what their insulin level was when they got put on Metformin, I looked mine up from my fertility testing in January before we started our first IVF cycle. My level was higher than theirs was...so I was really upset this was not addressed! When we went to New York to see Dr. Braverman he right away said I needed to be on Metformin because my Insulin level was too high and could cause me to miscarry and likely caused my eggs to be really poor quality. My fertility doctor here in Ohio agreed to prescribe it to me, but when we switched to the other doctor in his practice she ran a genetic test on me that we had never heard of or done before-the PAI-1, which she said can cause miscarriages when associated with Insulin Resistance which is what I had. Sure enough, the test came back that I had the moderately severe genotype which is associated with causing coronary problems and blood clots. SOLUTION: The only solution for this is Metformin. I take 1500mg daily and will throughout the pregnancy.

5.) Elevated Thyroid Stimulating Hormone: We discovered after our third loss that my Thyroid Stimulating Hormone was too high when we did our initial fertility testing. Elevated TSH has been known to cause miscarriage SOLUTION: I've been taking Synthroid-75mcg daily since April 2013 and my levels have been controlled. My new doctor just added Selenium-200mcg daily.

6.) Poor uterine blood flow: When Dr. Braverman did a color flow doppler on me he said my blood flow to my uterus was "resistant." This test was done in July of this year. SOLUTION: I've been doing Acupuncture every 2-3 weeks since the middle of August. I'm going to start going weekly for the next three weeks and then twice the week of my sister's egg retrieval and twice the week of the transfer. Acupuncture is known to help increase uterine blood flow. I've been taking L-Arginine and Coq10 also, and the Lovenox injections that I start next week will help too.

7.)Possible Autoimmune Issues: I have some elevated cytokines which are the chemicals inside of cells that can be indicative of auto-immune problems. I have had Psoriasis, an autoimmune disorder, since shortly after my daughter was stillborn. I've had elevated Anti-nuclear antibodies after my third miscarriage which is evidence of my body attacking itself. I have low T-reg cells which are needed to recognize what is a normal invader and what is an abnormal invader in our bodies...a low level means almost everything appears to be an invader. There is a definite possibility that my body views a baby as an invader and attacks it to get rid of it. SOLUTION: I will get Intralipid Infusions every 2 weeks-I had my first one on Monday. And I will take 10mg of Prednisone twice a day which will both work together to suppress my immune system so it stops working in overtime all the time. My dermatologist thinks this will help my Psoriasis too! I've seen a little bit of improvement which just one Intralipid Infusion and my legs and joints don't seem to hurt as much either...so I think this will help in more ways than one!

8.) Low Progesterone: I was on oral progesterone for my last pregnancy and that shot my level up really high but apparently oral progesterone doesn't get to the uterus. With my first IVF cycle I was on Progesterone in oil injections everyday and that did not seem to help my levels at all. SOLUTION: My doctor insists that the injection form of Progesterone is the best and wants me to try it again. I'm agreeing to try it again only because she agreed to check my level 2 days after transfer and will add Progesterone suppositorys if my level it too low.

9.) My husband's poor sperm morphology and borderline high DNA fragmentation in his sperm: With our first IVF we just did ICSI (Intra-cystoplasmic sperm injection) which increased changes of a normal sperm fertilizing my eggs but our embryos' development was so poor due to fragmentation issues which could have been the result of problems with the sperm. SOLUTION: For the past couple of months my husband has been taking tons of vitamins to improve his sperm...and they did improve his count and motility but not morphology. He takes Antioxidant, Coq10, B Complex, Multivitamin, Vitamin A, Folic Acid, and Vitamin D. This past month he also started taking ProXeed which is a male fertility supplement recommended by Dr. Braverman to improve morphology and fragmentation issues. We will still do ICSI to be on the safe side. He will also take an Antibiotic for 14 days starting Monday which will kill any potential bacteria in his body that could affect sperm quality.

Other things that I am taking are Estrace which is used to thicken my uterine lining since my uterus has to be ready to accept an embryo that has already started developing outside of my body. I responded really well to my trial on Estrace so I have no doubt my lining is going to be just fine this time too. I'm taking Vitamin D because I've had a Vitamin D deficiency after my third loss and that can cause miscarriage too...but my level has been fine since then and I want to keep it fine. And Finally I'm taking Fish Oil which benefits me in multiple ways and was recommended by Dr. Braverman.

Looking at this, it is a lot of information to take it. It is a long list of problems which all have the potential to cause harm to me and a growing baby. It's easy to get overwhelmed and to feel like I am doomed to always miscarry or to never be able to have a baby. I have to stay focused on the solutions and have to remain thankful that we have solutions to these problems, and I have to trust that these solutions are going to work for us. My number one solution to my biggest problem-fear, is praying for peace to overcome me and trusting that ultimately, God is the one in control.