IVF#2: To Exercise, or Not to Exercise?

This question plagues me every single time we get close to an FET/IVF/TWW, and to be honest, I am no where closer to a solid answer on this.

As most of you know, I am a very physically active person. I played multiple sports on a competitive level. My regular schedule of activity before TTC was intense hockey games 2-3 days a week, plus weight lifting 3-4 days a week. My body loved it, my mind loved it. Sometimes I wonder if that’s how I managed to keep my depression at bay without meds for so long.

When we started doing the IUIs, I continued playing hockey twice a week, weight lifted 2-3 days a week, and limited my exercise to regular daily activities during the TWW (no hockey, no weights). In between BFN’s, I would go back to playing hockey and lifting. In total, I had 4 BFNs from IUIs.

When we moved to IVF last year, I went down to playing ice hockey once a week, and continued weight lifting. Once my ovaries started becoming palpable from the outside (approx stim day 8), I stopped everything except for walking the dogs. We got lots of eggs that round. 21 mature –> 14 fertilized –> 7 day five blastocysts.

Embryo transfers 1 and 2 were DW’s, and she weight lifted once a week plus dog walks before the fresh transfer, and only dog walks during her TWW. After her 5 week miscarriage she joined me back playing hockey once a week. After her second transfer, she only did dog walks, until her miscarriage again at 5 weeks.

Prior to embryo transfer #3, I was playing ball hockey twice a week, and walking the dogs almost daily until the TWW. During pregnancy, I only did dog walks a couple of days a week, until 6 weeks when I went back to weight lifting, and then miscarried sometime during week 7/8.

I returned to the gym a week after my D&C at week 9, and for three months, lifted heavy weights and did compound lifts (squats, deadlifts) 3-4 days a week. I also did sprints 2 days a week. This is until embryo transfer #4, after which I did nothing but dog walks.

After embryo transfer #4 = BFN, I look two weeks off due to being depressed and Christmas holidays. For the past two weeks, I have been working through this high volume fitness competition program. I am on week three of the muscle building phase. Since I started it, I’ve packed on three pounds, but it’s hard to know if it’s just water weight from re-introducing carbs (from 15% to 35% of my macros), muscle mass, or gosh fat (from eating nearly 500 more calories daily than before). I am loving the program so far, and find that I am so hungry even with the increase in calories (from more muscles?), but realize that I shouldn’t be continuing this program once I start stims. The program has me lifting for 90 minutes 6 days a week, plus the 3 days of cardio that I’m not doing (I don’t want to create a calorie deficit). I realize that this is too much, and too frequent for a body trying to optimize reproduction.

Now, I’m trying to decide whether to limit myself to dog walks soon, or whether it’s safe to keep lifting, but at a much lighter resistance.

During my research, I find things like this, which has me thinking that since I have worked out regularly for over 15 years now, no matter what I do, my outcome will be the same. This study essentially says that women who have a history of exercising regularly for five or more years generally have poorer outcomes than sedentary women, regardless of if they exercised during IVF or not.

Then of course, there’s this, which has me totally thinking that I shouldn’t exercise during the first 18 weeks of pregnancy because of the greater risk of miscarriage, but then confuses me by showing studies that say exercise helps to prevent miscarriage. Though, neither really matters to me right now because my concern is about IVF outcomes.

The alternative medicine doctor part of me thinks that all strenuous activity (things that make you sweat, hold your breath, increase your intraabdominal pressure) should take a back seat during stims and the TWW because these kinds of activities drain the resources (Qi) needed to make and nourish developing eggs/embryos. From a primal/paleo perspective, these activities would mimic the unfavourable conditions of running away from predators, or having to hunt/forage, both of which indicate to the body that right now food is scarce and not a good time for baby making. Also, heavy lifting encourages the cycle of muscle damage and repair, which is the basis of muscle building. This increases the oxidative load on the body, and the resultant increase in metabolism increases the amount of free radicals floating around, which is also bad.

As for light exercise such as walking, and light cleaning, I believe these activities are good during stims and the TWW. They increase the circulation through the body, and get some good endorphins flowing.

What I would love to see is a study comparing consecutive IVF cycles- one with exercise and one without, with identical treatment plans, and what the resultant embryo numbers and qualities are. Too bad I can’t find anything like that, as it would shed some light on what I should do.

What I do Know
– I have already stopped doing cardio because it is counterproductive to try to burn calories
– I will keep my calories the same as right now (well-fed and higher than maintenance).
– I will definitely not put myself at risk of ovarian torsion.
– I will not exercise while my ovaries are healing from egg retrieval (last time took two weeks to have a non-painful poop)

Those of you who have done IVF- what kind of activity did you maintain during your stims? What kind of outcome did you have from your IVF? What would you do if you had to do IVF again? What was recommended to you by your RE?

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F$%K Presents! We’re Buying Ourselves IVF for Christmas!

A little over a year ago, DW and I embarked on our very first IVF. It was a special IVF, as it was a reciprocal IVF, and we were amazed by how science could allow my wife to carry embryos with my biological genes in a pregnancy. If you’ve followed our journey since last year, you know that for unexplained reasons, she miscarried twice. She had all of the immune testing that I had, with the exception of the natural killer Th1/Th2 cytokine ratio. All of her results were normal. Later, in September, I miscarried a blighted ovum. It has been heartbreaking for both of us, but hers seems to be a silent one, as we have moved our primary reproductive efforts to me. I try to honour her role and contribution to our journey, but realize that it is nearly impossible to fully do this because she is in essence “being benched” for the time being. She deserves so much more than that, but due to her age, our financials, and the unexplained nature of her infertility, this is the best that we can do for now. I know however, that my wife will be an amazing mother to our babies, and I am so lucky to have her as my partner. All you non-gestational parents out there, share your awesomeness with us.

For days now, I’ve been waiting to hear from our fertility clinic about our next steps, and finally, we have a plan!

We will be doing another round of IVF.

I bombarded our RE with some questions, relayed by email through his nurses. Of course, his answers were super vague and generally unhelpful, but provided some reassurance.

I have copied and pasted them below:

1. Why do you think that none of the seven day-five blastocysts were
successful?

It can be either embryo— genetics vs
random bad collection—– or it could be recipient issues.

2. What is your opinion on how my body responded to the stimulation cycle?

The response was good

3. Any changes he would make to the stimulation cycle this upcoming round,
and why?

Nothing different.

4. Would he recommend that we do PGD/S testing for chromosomal issues or
aneuploidy?

He wouldn’t recommend either.

5. Does the clinic do PGS on day 3 or day 5?

We do pgs on both day 3 and
day 5 embryos. We can do PGS testing on either day 3 or day 5 embryos.

6. If we do PGS, does that mean that we cannot do a fresh transfer (and all
have to be frozen for FET)?

If bx is done on day 5 embryos then those embryos are frozen. This is what is preferred. We are able to do a day 3 bx and then proceed with a fresh cycle and transfer would happen on day 5.

So what I gather from this is that he does not think that there is an issue with our embryo quality (pathology testing of embryo in September 2014 miscarriage was of a chromosomally normal female), and even though we are willing to shell out the dough for PGD/PGS, he doesn’t think that we need it. In fact, because he doesn’t recommend it, the clinic’s plan for me is not to to PGS. I have mixed feelings about it, as embryo quality is one of the major factors that affect IVF success.

Now, some of you may be surprised that we are sticking with the same clinic, but after a lot of thought and consideration, we decided that it was in our best interest to continue with them for several reasons:

– continuity of care- they know what worked/didn’t work for us last time.
– familiar with their system- I know who to call when I need whatever, and have realized that if I need to talk to the nurse asap, I just need to flood the nurses voicemail line with messages.
– the RE is open-minded enough to treat me aggressively for the immune issues, which if we started at a new clinic, would want to put me through the ringer before being satisfied that I need all of the intralipids/steroids/blood thinners.
– proximity- the clinic has 5 locations, 2 which are within 15-20 minutes of our home and work places.
– we got a good lot of quality blastocysts the last IVF. Carrying was the issue.

There is one uncertainty that I feel we just need to live with, and that is the quality of the clinic’s embryology lab. On one hand- we got 7 good day-five blastocysts in the end, but on the other hand, none of them worked out for us. The fact that we got 7 blasts makes me think that their lab is good enough to support their development to day 5, but with none of them working, it leaves me to wonder if it’s them (lab), or us (uteri). Anyway, it’s something we kind of have to roll with, and I will never get an answer to that question, so I should just move on with my life.

I am currently on day 8 day 9 of my current cycle, on no meds, and on day 21 I start taking Lupron again. As you know from above, the plan is to do the long Lupron protocol again. Last time, they started me on a 200IU dose of Gonal-F, went up to 250IU for a few days, and then back down. In total, I stimmed for 14 days, which is on the long end of normal, but I think the Lupron over suppressed me a bit, and 200IU is quite low of a dose of stims.

Last year, the pain of the egg retrieval had me swearing that I would never do IVF again… And here we are, a year later, seemingly in the same place we were last year. We aren’t- we are more desperate, more jaded, but hopefully also little wiser (immune issues). While we are doing the same protocol again (the results were good), I won’t be on BCP’s at the beginning of this one (unlike last IVF- anyone with experience doing IVF without BCP? Please share your experience in the comments below), and we will be fully armed with the intralipids/prednisone/fragmin/aspirin that we weren’t last year.

So yeah, F$&K presents! We are buying ourselves IVF for Christmas!

Happy holidays to you and yours!

Happiness Cycle Day 13: Intralipids

I’ve got two hours to kill while hooked up to an IV bag of intralipids, so I thought I’d type up a post with my left hand. It’s harder than it seems!

I had a crappy sleep last night, as something’s up with my digestive system. I had the worst bloating and gas, which continued overnight and into the morning (poor DW). My diet is so clean right now, that I have no idea what could be causing it. My colon felt like a balloon that was inflating and reaching its maximum stretching ability. As I lay here hooked up to a bag of mayonnaise, all I wanna do is fart. But because they’re checking my vitals frequently, and I’m in a closed room, I’m trying to hold it in. Unpleasant!

Anyways, I’m happy to be doing the intralipids. It gives me some hope for this FET. While I wish we had two embryos to transfer, that’s nothing I can change. All I can do is give all of my love and hopeful energy into this embryo. The RE finally reviewed all of my immune results and wants to put me on prednisone, fragmen, and baby aspirin, in addition to the estrogen and progesterone that I will be starting someday soon. I’m happy that it seems like we’re finally being taken seriously now. Fingers crossed that our embryo is a good one, and that he/she thrives inside me.

As for the intralipids, today I’m having 100mLs injected into a bag of saline, to create a 20% mixture. Then the mixture is introduced to my bloodstream via IV cannula. I’m glad that I brought a blanket, because I feel so cold not being able to move. I also brought my iPad, a decaf vanilla Earl Grey Tea almond milk latte, and two slices of the paleo banana bread that I made last night. I haven’t been able to do much other than type on my iPhone.

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Once I get a positive beta, there’s another infusion (approx four weeks), and then one more after the six week ultrasound. Each treatment is $750, and out of pocket.

The cannula hurt going into my arm, but is fine now that it’s in. I can’t feel the intralipids at all, though I feel colder than usual overall.

The nurse comes by every 30 minutes to check my temperature, blood pressure, and heart rate,

It’s been about an hour and a half, and I’m almost done:

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Tomorrow I have to go in for monitoring blood work and ultrasound again. Hopefully we will find out when our transfer will be. We also meet with our family doctor, who will hopefully agree that it’s in my best interest to continue being off work until I’m in the right state of mind to deal with those additional stresses. DW has taken the day off tomorrow to support me.

More updates tomorrow!

Liebster Award!

Thank you to TwoMommasInTheWorks for the nomination! Pops and Oli, you have been a pleasure to follow! This is my first nomination, and it sure feels good.

So here is how it works:

1. Link back to the blogger who gave you the award.

2. Answer the questions designated by the blogger who nominated you.

3. List 11 random facts about yourself.

4. Nominate 3-5 other bloggers with less than 200 followers.

5. Make up a set of questions for the nominated bloggers to answer.

The Questions:

1. What state do you live in?

I live in Ontario, Canada.

2. If you weren’t pregnant or in the TTC process, what would be number one on your bucket list?

I don’t really have a bucket list. I kind of treat it as a “To Do List”. If I wasn’t trying to be host to a parasite, I would have enjoyed spending my summer either: chasing turtles in the blue ocean around Maui, walking the public markets in Thailand, or getting diarrhea in China.

3. Is your family supportive of your plan into parenthood?

My mother and sister know, but father doesn’t yet. My wife’s immediate family all know. Everyone has been very supportive so far.

4. What are three things that make you want to follow someone else’s’ blog?

Humour, relevance, and regular posts.

5. How many kids do you ideally want and what genders? Twins?

Oh gosh, I want a whole litter. Other than my parents only having two, everyone else in my extended family all had 4 kids. My grandparents on both sides had 5 and 6. It feels a bit lonely right now because I live so far away from my family, and I’m so used to having tons of cousins around.

Gender is not important to me. Children of both genders have annoyed me. lol.

Twins would be awesome (but my nipples would hurt like hell).

6. Are you planning ahead to have the same donor for other kids or one step at a time?

It was slim pickin’s for us when we were buying sperm. And I approached the situation much like one does when organic chicken broth goes on sale at Costco- I bought it alll…… But really, all meant that we ended up buying 4 viles of Cherokee (our nickname for one donor), and 2 viles of Braun (the nickname for our other donor). So far, we’ve used up 3 Cherokee and 1 Braun for IUI’s and 1 Cherokee for the IVF. 1 vile of Braun remains. If we don’t two babies out of our last two potential FETs, then we will probably use up the last Braun. Sorry for making this into a math problem.

7. Does your partner read your blog?

Yes, she does. But since she doesn’t have WordPress on her iPhone, she just kind of checks it out whenever. Sometimes this means that she misses many posts in a row, and then finally finds out that I wrote a post about her masturbating me. lol. Ooopps!

10. What made you fall in love with your partner?

It was love at first sight… in a nasty musky hockey change room. She was running her mouth about something that I wasn’t listening to because I was staring at her abs…. and biceps…. and deltoids

Not only that, she has a sharp wit, is extremely handy (I’m a bit of a princess at times), and super thoughtful.

11. What do you typically do Sunday mornings?

Sleep in, sip an americano in bed (care of my lovely wife), make a kick-ass brunch, and go on a romantic hike with my wife and our dogs.

 

Random Facts:

1. Our little dog, Clementine (chihuahua-pug mix) aggressively humps a microfleece blanket at least 7 times after every meal. Right in our front bay window. For everyone to see. Especially the preschool group that walks daily along the sidewalk in front of our house.

2. Our big dog, Juno (husky-lab-retriever mix) has killed over 40 animals, ranging from birds, to medium sized mammals, to baby deer. She is extremely protective, and unstoppable.

3. My wife is more Chinese than I am (not literally). She is 4 inches shorter than me, has pin straight black hair (mine is wavy/curly), is proficient using chopsticks with both hands, and has actually been to China. She tops this off by sporting a rice-picker hat every year at Pride.

4. My wife used to be a competitive powerlifter.

5. We both used to play varsity field hockey for our undergraduate universities.

6. We have 6 university degrees between the two of us, and just finished paying off the student loans that they incurred in 2012.

7. I grew up playing in a family band (like the Partridge Family). We performed on a cruise ship once.

8. DW was part of the Young Astronauts Club, and witnessed the Challenger tragedy in grade 3 (1986). She remembers pointing at the TV screen, yelling “They’re all DEAD! They’re all DEAD!!!”, and was subsequently ushered out of the room by the teacher.

9. I have abnormally long limbs. I stand at 5’7”, but my wingspan measures 5’11 (they’re supposed to be the same). In medical school clinicians used me as an example of “Marfan Syndrome”. I don’t actually have Marfan Syndrome. Marfan Syndrome is actually really sad.

10. I’m really bad at foreplay. I kind of like to just get it on. DW has to remind me of these four five syllables: “fore-play-cuddle-after”. It’s so bad that it’s kind of a joke now.

11. I have dreadlocks. They are self-maintaining, clean, and beautiful. They also smell amazing- like scalp and Aveda.

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(The little dog demonstrating the proper “cuddle after” technique)

 

Nominations:

1. The Gayby Project http://lyonsferocious.wordpress.com/

Hilarious, honest, and super awesome. These girls are doing their first FET today!

2. Not Sisters http://notsisters.wordpress.com/2014/07/17/6249/

Also hilarious, very entertaining, and apparently look alike. They recently miscarried, and are navigating these waters with a wee little one already.

3. Religion: Optional https://wordpress.com/read/blog/id/47035424/

Their little girl Punky, should have her own Tumblr. She is friggin’ adorable. Rachael, Kim, and Punky are a sweet family that I really enjoy following. Rachel’s posts are so honest and heartfelt. Sometimes, they are a little ray of sunshine in my day.

Questions for Them:

1. Describe your most embarrassing moment.

2. Team Jacob or Team Edward? Explain.

3. What is a recurring inside joke between you and your partner?

4. What is a baby name that you absolutely cannot stand?

5. What would you do if you won $20,000 dollars (that cannot be put towards baby-making or paying off debts).

6. What are 3 qualities that you love about your partner?

7. Teenage celebrity crush?

8. What is a guaranteed way to get you out of a bad mood?

9. What is your favourite comfort food?

10. Team or individual sports?

11. Describe yourself.

Updated Plans

So I’ve got a bunch to update you on. We had a review appointment on Wednesday with the RE, to discuss DW’s two recent miscarriages.

The RE really didn’t have much to say. I brought all of my questions, typed into notepad on my iPhone, and we went through them all. He has no answers for why DW didn’t stay pregnant. He did say that it was unusual given our excellent conditions.

The embryos or the uterus, who is the culprit?

He looked at the embryologist’s notes on our 5-day-blasts, and they are excellent quality, and all survived the thaw, which is also an indication of quality. He said that genetic or chromosomal issues are weeded out very quickly in these early phases, and that since I’m young, the quality of the eggs is unlikely to be the problem. But of course, not all eggs were meant to become live births.

He suggested two possible next steps:

1. Aggressively investigating into DW’s immune system and uterine health through more blood tests (one of which costs $600, and can only be analysed in the States), and a hysteroscopy to visualize uterine abnormalities. If her immune system is found to be overactive (essentially attacking the embryo like it is a parasite), then a combination of immunosuppressant therapy (intralipids) might happen so that she could still carry. A colleague of mine has gone through this treatment (with the same clinic), 3 times I believe, and it didn’t work. If it’s polyps/fibroids or some scar tissue, we could probably have them surgically removed (my guess).

2. I carry.

Obviously, option 2 makes more logical sense at this point, given the circumstances. However, there is also the factor of DW’s feeling physically connected to these future babies, which is the whole reason for us going down the path of IVF in the first place.

So, we decided on both paths, concurrently. We will do the investigations and see if DW maybe has some polyps/fibroids/scar tissue/uterine abnormalities or too many natural killer cells or other immune issue, and we will get me ready for an FET at the same time.

Some of the ducks are already in a row, and some of them the clinic has taken out of the rotation so that we have to put them back. It is really frustrating because I’m sure that it’s just a money grab on their part.

For example, my endocrinologist called yesterday to tell me that my thyroid levels are right on target (so no adjustment needed). Yay! She basically gave me the green light to giv’r this cycle. Also, my period just started on Thursday, so I could’ve started on the estrace today.

But instead, the clinic wanted to repeat their big ass blood screening panel to test for everything under the sun (that they had done in May 2013 and January 2014), as well as another sonohysterogram.

Yes, I bolded that. Another SONOHYSTEROGRAM. I think it’s completely unnecessary because I had one done last year, and nothing has changed. I also think it’s unnecessary because he was just up in there in January during my egg retrieval, and the main reason for it is to check the patency of the Fallopian tubes, which isn’t even involved in an FET. Plus, it’s another hundred dollar cost out of pocket for us.

If you’ve been following my blog for a while, you’ll remember that the sonohysterogram was extremely painful for me. I bled substantially on the paper sheet that covers the medical table, as well as in my underpants on the drive home. They said that it shouldn’t hurt and that I could return to work that day, but despite taking Tylenol before the procedure, I ended up sitting in the car crying from my angry cervix pain and uterine cramps, wishing that DW could drive me home.

I still get nightmares about that sono.

From now on, I shall refer to it as the sononightmarogram.

Anyway, since they insist on repeating this damn sono (booked for the 20th), we can’t do the FET this cycle.

So I guess I’ll continue to play ball hockey twice a week and party like a rockstar during World Pride, at the end of the month.

Meh. I’d rather be trying to have a baby….

598 and 1069 Mean Nothing to Me

So after the tactless voicemail I received from the RE’s nurse last week which included both: abnormal cortisol levels and cancelled IVF cycle, the nurses did not return my emails nor voicemails for a week! Normally, they reply within a 24 hour period, but this time it took me writing an angry email to coerce a reply.

I had asked to see a scanned copy of my lab results, but instead, she just gave me two values for my cortisol levels which mean nothing to me without reference levels or even UNITS! Sometimes the results are given in mcg/dL and other times it is in nmol/dL, and the conversion factor is somewhere around 27.59 to go from the former to the latter.

The upper range of normal is from 5 to 23 mcg/dL, which converts to an upper limit of 635 nmol/dL. This puts me within the normal range for my first result (pre-Marvelon).

My second result, was taken after I had started Marvelon, which can significantly increase serum cortisol levels anyway, so I’m skeptical of how they feel my second cortisol level is data they can even consider to be reliable.

I asked two other questions in my email, which she didn’t address at all.

For partially privately paid health care in Canada, and for a treatment cycle that costs 11 000 not including the cost of fertility drugs, I was expecting better care.

I’ve been shopping around for different RE clinics, but the reality is that they’re all the same: one doctor, 5 clinics, and a bunch of nurses who have been trained not to think for themselves.

My beef is not with the nursing profession- but rather with how these clinics are run- and how it makes me and other patients feel like we are nothing but a file number with a dollar sign.

Oh- and I’m STILL waiting to hear from the endocrinologist. Argh.

Plan B Derailed

Missed a call today from our RE’s clinic. They left a voicemail that make me want to cry and call them back, both at the same time.

Last week, my blood test revealed some abnormally elevated cortisol levels. The RE was concerned, so he had me come in this week to have my blood tested again. They called to let me know the following things:

1. My cortisol levels were still really high.
2. They’ve sent an urgent referral to an endocrinologist to have it investigated further.
3. Our IVF treatment cycle has been cancelled until further notice.

I am on the brink of crying, not just because this Marvelon is seriously fucking with my emotions (extremely irritable and anxious lately possibly because of it), but also because I’m:

A. So disappointed that we can’t proceed with the egg retrieval.
B. Actually worried about what might be causing the elevated cortisol.

All of my blood work has been normal up until now, and I doubt that the teenage brats at school are driving me nutz enough to cause a sustained elevation of cortisol!

Anyway, all I can do is keep my fingers crossed that I get in to see the endocrinologist soon, and we figure out what this nonsense is about.