Hanging on a “However”

Last week I had an endometrial biopsy and, y’all, that hurt. I didn’t read up on them beforehand.  I knew I wasn’t being put under or given any pain medicine for the procedure so I didn’t expect it to be much of anything.  Then, surprise!

Based on my recent experience, an endometrial biopsy involves inserting a skinny stick-like instrument through the cervix into the uterus and jabbing around a few times to collect pieces of the endometrium (aka lining). Man, when the uterus realizes some foreign object is just hacking away in there, she retaliates. I had sharp pains that made me almost jump off the table.  I kept looking at Brennen and asking with my eyes, “Is it over yet?”  He shook his head no, and the doctor asked me if I was up for it one more time.  Then again.  Finally, it was over…or so I thought.

IMG-3428I sat up, and we began talking about what this test would tell us and then how we would proceed from there.  I didn’t catch much of Doc’s plan because, after a couple minutes, the only thing I could hear was a voice in my head saying, “Don’t throw up. Don’t throw up.” I got light headed, hot, sweaty, and finally interrupted the conversation with, “I need a trash can.”  The next thirty minutes were a bit blurry, but I know they consisted of vomiting, extreme cramping that radiated through my legs and back, and trips back and forth from my room to the bathroom, barefoot with my pants unzipped.  I hurt so bad that I didn’t even care.

Brennen went to the car to get some leggings for me to change into.  The skinny jeans I wore to the clinic that morning were not going to work for the trip home!  After he helped me change, I laid there on the bed squeezing his hand. Every 5 seconds he would ask, “Are you ok?” and then follow up with, “I’m going to ask you every 5 seconds.” He wasn’t kidding.  (Note from Brennen: I thought she was going to pass out.)

Finally, my uterus calmed down, and we could leave.  Doc gave me something for nausea since we had a 3-hour drive home, and I spent the rest of the evening lounging in bed and binge watching Gossip Girl (again).

One week and one season of Gossip Girl later, the results were in! My doctor called me at 8:30 am Wednesday morning, and of course, I missed it. In fact, I didn’t even notice the missed call until an hour or so later. I was so mad! Then, I saw where he had left a 3-minute voicemail.  My hands were shaking as I hit play. I listened and jotted down notes.  I was excited and relieved to hear that the Beta 3 integrin was present in my endometrium which means my lining is receptive to an embryo. This is a big win for us! He then went on to say my lining was “out of phase” and tested positive for BCL6.  I figured that wasn’t good. The 3-minute mark quickly approached, and the last thing I heard was, “You’re lining is receptive to an embryo, however…” And it cut off.  That was it. I was left hanging on a “however.”

I immediately called the clinic back and left a voicemail.  That “however” stayed with me all day long.  What does this mean for us? Is there a treatment? What’s next? Is this the end? Should I make sure my sister is still on board to be a surrogate? Has it come to that?  My production at work was spotty to say the least.  I couldn’t get “out of phase” and “BCL6” off my mind.  I did a little Googling but stopped myself.  With what little information I had, Googling was only going to make things worse.  Finally, Nurse Memphis called me back that afternoon with a protocol.  Sweet relief! And today, I talked to my doctor.  It’s difficult for me to put into words what the results mean, what we know now, and what we’ll do next because my brain is still processing all the information…and it’s a lot.

So in a very large nutshell…

The good news – My lining seems to be receptive to an embryo.

The not so good news – My lining was “out of phase” meaning it wasn’t where it should be in my cycle.  My biopsy was on day 21, but my lining was already beginning to break down for a period. Day 21 is right around the time an embryo is implanting, while my lining is breaking down, that’s not a good at all.

More not so good news that we sort of already knew – I tested positive for BCL6, which is a marker for endometriosis. Duh, I have endometriosis. But this test showed us that my endometrium is inflamed, and the likely culprit is, of course, the endo.

The plan to tame my uncooperative endometrium is to suppress my system with Lupron instead of birth control.  Birth control is estrogen, and estrogen feeds the endometriosis. Lupron, on the other hand, cuts off the body’s estrogen supply and puts me in an induced menopausal state. Now I’ve been on Lupron before, but it was a small dose in a subcutaneous injection. This Lupron shot will be a 30-day dose administered intramuscularly.  The first shot will be in November. The second in December. And as planned, we’ll start preparing for a frozen embryo transfer in January. This works out because it gives us the rest of the year to chill. Well, I hope I can chill considering the hot flashes that are coming my way!

So…there’s that. We have some answers thanks to this biopsy and can find some ironic comfort in knowing what we know now, even if it’s not all good news.  At least we have a plan though. Silver linings, right?  Still, I can’t help but think that we have an answer to a question that wasn’t really a question until recently.  That question – why won’t my lining thicken? Then again, maybe endometriosis has been our problem all along, and it’s starting to show its teeth even more so now with these lining problems.  Who knows! I try to stay positive and feel like we’re moving forward (more on that later), but overall, my mind just feels like…I don’t know…a bunch of scribbly lines.  I’m still processing and trying to straighten things out.  I just hope that this new protocol works because, even though I now know what the rest of that voicemail was going to say, I still feel like I’m hanging on that “however.”  That’s what this process has been for us all along.

Your cycles are normal.
You are young.
You are healthy.
Your husband doesn’t have male infertility factors.
Your hormone levels look good.
Your tubes aren’t blocked.
Your prolactin is under control now.
You respond well to ovarian stimulation.
You had an excellent retrieval.
You have multiple embryos frozen.
You did have implantation of an embryo.
You are capable of a thick lining.

However….you still aren’t a mom.

Hopefully, we can let go of that “however” in 2018.

endometriosis

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Well $h!+

Let me start out by saying that the 2-week wait to see if my lining was thick enough for transfer was worse than the 10-day wait for a pregnancy test.  In fact, it’s second only to the wait for the call that tells us how many embryos made it to blastocyst stage for freezing.  I wouldn’t have said that a year ago when my uterine lining wasn’t an issue.  Through 3 IUI’s and 2 transfers, I had always measured around 9mm.  But recently, my reproductive system has had a new hurdle to get through – my lining.

After my baseline appointment on September 20th, I made a list of everything I could possibly do to thicken my lining and planned it out over the next 14 days.  Aside from the Estrace pills my doctor had prescribed, I was going to take a natural approach as well.  Every day I drank 8 ounces of pomegranate juice and red raspberry leaf tea.  On top of my pre-natal vitamin, I added DHA, which gave me an extra boost of Vitamin E for blood flow.  I threw in some L-Argenine in the last week before the scan.  I made a point to get up and move and stretch at work since my job is pretty sedentary.  I gave myself fertility massages almost every night and used an essential oil mixture as my massage oil.  I also meditated before bed using a program specifically designed for frozen embryo transfer preparations.  It would say things like, “Picture your uterus as having open arms, stretched out to welcome new life” or something like that.  I rolled my eyes about it at first, but it absolutely helped me relax.  Brennen even meditated with me but was sure to watch enough football to prevent growing a uterus.  The night before the checkup, he said, “Well if it’s not thick enough, it sure isn’t from a lack of trying.” After two weeks of all things uterine, I gave him an “Amen.”

Fast forward to Thursday morning as I nervously braced myself for the ultrasound.  My uterus popped up on the TV screen, and the nurse practitioner said those dreaded words, “It’s not quite thick enough.”  She then proceeded to click around for a measurement….5.33.  WTF?! That’s the thinnest it has ever been.  In frustration I said, “What the heck? It was thicker than that when I was on birth control.” And it was! At my baseline ultrasound 2 weeks ago (before Aunt Flo) it was measuring over 6.

We use a local fertility clinic for outside monitoring, so we usually don’t ask questions during our visits.  They just measure and send info to our clinic.  But in desperation, Brennen let out a huge sigh and asked, “I mean, what in the world is going on?”  The nurse practioner, unfamiliar with our case, didn’t really have any specific answers for us but said they see this sometimes – an uncooperative uterus – and that my body may need another way to take in estrogen.  Obviously this little blue Estrace pill is not doing the trick. She printed a picture of my uterus for me. (Note to self: buy darts).

thinlining

So what does this mean?  Transfer cancelled.  We knew going into that appointment that it would be cancelled with any measurement less than 8. We had accepted that.  And I think that if it would have been 7 or 7.5, we would have told ourselves, “Good try. We’re getting there.”  But man, at 5.33, you can’t find anything to be positive about.  Brennen held it together as we left the clinic; he was on the verge of tears.  Me, you couldn’t see disappointment on my face, but my body felt weak and sluggish, as if I could feel the sadness all the way to my bones.  I took the rest of the day off work.

Nurse Memphis called that afternoon to talk to me about the next steps.  Next week, Brennen and I will head to Memphis so I can have a biopsy done on my endometrium.  All I get is a Valium, so that should be fun, right? While we’re there, we’ll make a game plan for 2018, but as for 2017, we’re done.  Last year, I found out I was pregnant on Thanksgiving Day and miscarried on Christmas.  We’ve done the infertility-over-the-holidays thing and don’t want to do it again.  This holiday season, we’ll regroup and give IVF a backseat.  For three years, we’ve tried to get pregnant, and for three months, I just don’t want to try.  We’re not giving up, we’re just coming up for air.

Prayers for our trip to Memphis!