Is it worth me getting my hopes up enough to try again?

[kmpleet]

I'm not sure why I'm writing this (well, I do, but I don't know why I have any optimism about it), but I figured that at this point I *have* to talk to someone, and I need a professional's opinion by someone that I'm not giving money to (and thus doesn't have a reason to blow smoke up my...eh, I've sat in too many stirrup chairs).

My husband and I had to stop with the fertility treatments. Even doing the IUIs, it was too depressing and physically draining. But now I'm surrounded by friends that have gotten pregnant, and my brother and sister-in-law, and it's the two-year anniversary of when our baby would have been born if I hadn't had my first miscarriage. I know. So it's only natural that I would start thinking, well, it wasn't *that* bad, and maybe there's something I can do... you know.

Here's my history:
We tried for 3 years with no result.
We enrolled with Shady Grove Fertility Center (with Dr. Sagoskin).
HSG: no uterine abnormalities, no ovarian abnormalities.
No PCOS, fibrosis, or endometriosis
No history of STDs, alcoholism, or smoking
Regular menstrual cycles (but slightly short; maybe 23-24 days between)
Sperm: 80% morphology, good number (perfectly normal), nothing
Minor thyroid issue (barely off normal), take synthroid
Diagnosis: unexplained infertility

4? 5? IUIs with estradiol, clomid, and ovidrel) before pos test. Carried fetus to 8 wk, then no heartbeat on ultrasound.
DNC
Karyotypes (both of us): no abnormalities
Blood screening: no clotting issues
Tiny polyp removal
2 cycles of IVF (lupon, follistim, ovidrel). 2nd had pos pregnancy test. Resulted in a chemical pregnancy with natural miscarriage
Then we did 2 IUIs with no result and finally said "Fuck this."

Toward the later IUIs, I was developing an allergy-like reaction to the prometrium (inserted vaginally) used as a progesterone supplement. At the first IVF cycle, I had an even stronger reaction to the endometrium (also vaginally), with swelling, tenderness, and irritation.

I don't want to go through another round of IVF again. It was really upsetting. I would be willing to do a less invasive, slightly more "natural" (what a bullshit word) approach. I'd like to try hormone supplements in patch or oral form (please say that they have them for both estrogen and progesterone) combined with clomid. I know that it might take longer; hell, I've waited, and I can handle that. But with our diagnosis of persistently unexplained infertility combined with the fact that I don't think that my hormone reactions were taken seriously means that I don't trust what my RE told me ("there's no problem. We'll just keep doing more of the same. Give us another check"). So, am I kidding myself? Is it worth approaching my GYN and asking for a simple protocol?

Katie

[kmpleet]

Um, as you can tell from the letter, I don't really hold much back
And I can answer questions to the best of my ability, if there are any.

Thanks... I know that there are probably a bunch of letters like these all the time. But I appreciate anyone taking the time to read.

[Dr. Wisot]

Unfortunately your story is not unique. There are many out there with the same frustrating struggle.

To give you a one word answer (yes or no) to your question would require a few facts that were left out: your age and FSH level.

Assuming those are good I would first recommend something to put your head in the right place to continue. The best option would be a Mind-Body program which work really well when one gets to your level of frustration. If there is no program near you, then a good acupuncturist who specializes in fertility might be able to help.

Next I would make sure that the rest of your body is in the best shape possible. Read our Lifestyle & Fertility pages and link to Dr. Meldrum's Lifechoices website and have both you and your partner start his regimen of vitamins and antioxidants.

Then get a second opinion on your previous treatments so see if there is anything else out there that your doctor has not considered. If you are at Shady Grove you are in good hands and maybe one of the other doctors there can offer you something else. But when IVF has not worked, then the simpler treatments are not likely to work.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

[kmpleet]

Thanks for your response! I appreciate it.

I'm currently 35 yr old.
I don't actually know my FSH levels. I've been getting some midcycle spotting lately, and I used to have faints during the first initialization of my cycle. They don't happen that much now. In terms of documented ovulation without treatments, by OTC tests, is pretty much 1 out of 3-4 cycles.

I've lost a lot of weight over the past 1.5 yr. I went from BMI = 42 to now 30. I've been working a lot with my diet and exercise program to get myself into shape, and it's really helped (might have to do with the midcycle spotting; no idea). I'm pleased with the results (best shape since college! *grin*). I have therapy options to deal with the frustration and depression associated with the whole process of TTC.

I think that the worst part is the whole "not knowing" thing. Unexplained infertility means that I don't have anything that I can point to and say "Oh! That was it!" I'm left wondering. It helps that I'm not alone, but only somewhat.

Maybe if we ever feel like starting again, I'll work with a different doctor at Shady Grove. We've moved, and we'd be going to a different branch anyway. But, yeah, I figured that if IVF was off the table that it would take something extraordinary occurring. We're planning on waiting until my potential fertile years are over (40 or so) and then doing adoption or tradition surrogacy. It's nice to live in a day and age where there are more options available, even if they weren't your first choice.

Katie

[Dr. Wisot]

Weight is definitely an issue and you sound like you are really working on it successfully. Keep working on it. Also do get started on the antioxidants and vitamins we recommend. I have seen great things happen just from that. A phone call will get you your latest FSH levels.

Your age is good for a decent chance of success.

Work with whoever you can to get you in the right frame of mind and then go get another opinion or two about how to proceed.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

[kmpleet]

Thanks...I'll keep working on the weight stuff. I think that before we do serious trying again, I'm going to make sure that I'm not on my current calorie-restriction diet (I want to be on "maintenance") and at my goal of 25(ish) BMI/under 150 lb. If I keep losing at my current rate, that should be sometime mid next year. I don't think that it's a good idea to do serious TTC work when doing dramatic calorie limiting.
I have a good vitamin and health plan, though.

I'll keep my fingers crossed, and get a second opinion later .
thanks again, for giving me some chance at optimism about the whole thing. I keep hoping I'll be one of those "never thought it would happen and then I spontaneously got pregnant late in life" stories.

Katie