"The Woman with the Thin Lining" - UPDATED

The second part of my consult with Dr. March was on Friday. On one hand, I came away with it knowing I had the advise/knowledge from an expert in the field of Asherman's Syndrome. On the other hand, he said I'm going to be "a tough nut to crack". Probably not something I necessarily wanted to hear. He believes that there is most likely significant damage to my uterus.

Based on all the records he has, he believes that the best thing to do now is to go forward with a protocol that he's seen success with. He called it the "all guns blazing" protocol. The good news is it isn't far off from what Dr. G and I just decided on. It's just a few tweaks. For anyone else that may be dealing with a chronic thin lining, I'm going to post it here and also on a tab in my blog so that it's easy to find in the future.

Dr. Charles March - Protocol for women with thin lining:

1) Ultrasound of ovaries on cycle day two

2) If no cysts, begin Estrace, 2mg three times per day

3) After 10-14 days of treatment, repeat ultrasound, focusing on ovaries and endometrium

4) If lining is at least 5mm, and follicles are in synchrony with respect to size, measure estradiol and progesterone in blood

5) If progesterone is less than 1ng/mL, begin stimulation with injectable fertility drugs and continue Estrace at the same dose

6) Monitor follicle development as per the doctor's usual routine and measure estradiol and uterine lining at each visit

7) As the estradiol level in blood begins to rise above the noted prior to beginning the fertility medication, begin to tapir the dose of estradiol

8) Administer HCG when follicle maturity (and hopefully a good lining) has been achieved

After step 8, either insemination or IVF with recovery (or transfer in my case)

In addition to the protocol above, he is recommending that after the HCG injection and eggs are released, G-CSF (Granulocyte Colony Stimulating Factor) should be administered as a "uterine flush".

Dr. March sent me the protocol so that I could share with Dr. G. I sent Dr. Gustofson a long email Friday morning. This is where it's always weird, because I obviously trust my doctor, but at the same time, here I am asking him to change his protocol based on the opinion of someone else. Dr. G has always answered my emails within 24 hours. So far, I haven't heard a peep.

I also received the results of my most recent TSH/T4 labs. I've been on Synthroid for the past 5 weeks and my levels have dropped from 4.76 to 1.28. Which is great news! When I emailed my nurse at CCRM on Friday she said she had received the results and was waiting on Dr. G to review. Another reason it's odd I haven't heard anything. So now he hasn't responded to my email OR my labs.

There goes my mind…freaking out, worrying that I've offended my doctor and he's completely written me off. Awesome.

I'd be lying to say I'm not a little disappointed that Dr. March didn't have some elaborate plan to "fix me. Rather…I'm feeling a bit "unfixable" at the moment.

To top it off, someone posted this on Facebook this morning, and my heart died just a little:

So many obstacles have stood in our way. Should I read the signs and acknowledge that I should be letting go?

Update since my original post:

Dr. Gustofson did finally get back to me last night. He is more than happy to do an estrogen priming followed by a stimulation FET as there isn't much difference and it may have some improvement. However, CCRM did a study with 40 women with thin lining using the GCSF uterine wash and only 2 had improvement (5%) so they have since abandoned that protocol. He is willing to do it, just doesn't believe it will help. 

I appreciate his honesty. 

Only Kindness Matters

It's been almost 2 weeks since my last post and even after two consults/regroups with doctors, a natural cycle and vacation, I still don't know where to start or what to say.

CCRM Regroup - Dr. Gustofson

My first regroup was with Dr. G at CCRM (via phone). It went fine. There was nothing surprising and I didn't learn anything I didn't already know.

- My mock cycle was not favorable
- He too, was shocked by my positive Beta 3 Integrin results
- We can move onto an FET with my next period
- We can do a low-dose stim cycle to see if that yields better results
- My chances of success are low, he does not believe my Ashermen's can get better than it is right now
- He isn't concerned about my TSH levels, rechecking those tomorrow
- "Cystic" uterus was just fluid, it can be aspirated prior to transfer.
- If my FET lining is looking too thin, I can convert to an IUI if I have less than 5 follicles (that shouldn't be a problem
- My risks are high for placenta accreta which could lead to a hysterectomy
- He does not recommend transferring more than 1 embryo for this reason, carrying twins could be a "disaster" for me

California Fertility Partners Consult - Dr. March

Later the same day, I had a call with Dr. March. He's one of the top 2 doctors in the country for Asherman's Syndrome.

- Actually believes my scarring came from my laporoscopy/hysteroscopy procedure last February when the doctor perforated my uterus. A common occurrence, but can sometimes cause problems, the D&C probably just exasperated the issue.
- Fluid in the uterus almost always means there is still scarring
- OBGYN's are like motherhood and apple pie with D&C's, "If an OBGYN was standing over my grandmother's grave, he would want to preform a D&C on her"? Strange way to put it, but it was funny.
- He was happy to hear I started the Trental/Vitamin E protocol
- Viagra is worthless, he's seen it work 0 out of 10 times
- It did sound like he was saying my uterus could use some additional "fixing".

He has a direction that he's leaning in my case. Unfortunately, CCRM never sent my medical records. He really wants to see those and will call me back once they've been reviewed.

So we have some decisions to make. Do I move forward with the FET right away? If Dr. March thinks that it's worth me coming to California, do we try that first? Do I do the FET then see Dr. March if it doesn't work? Obviously my next phone call with him will give me more information. But this is why I've been stumped on what to write about…because really, I'm not sure about anything right now.

Last week we were in Florida for vacation. My mother-in-law turned 65, and for her birthday, we spent the week with her. She lives there, so it's a nice way to get some beach time in, and get a visit in at the same time (without having to spend a lot of money, which is a plus when you're teetering on the edge of a gestational carrier).

Here are a few of my favorite pics from the week

It was a great trip. Maybe not the best vacation since it wasn't just T and I, but still, a really nice time away. 

Sadly, I had hoped we'd be able to try on our own over vacation. Even when I wasn't having periods last fall, I was still ovulating. However, we prevented all these months because I didn't want to ruin my chances by getting another ectopic. Now, the one month I decide to go for it, I don't seem to be ovulating. No positive OPK's and my temps actually dropped this cycle from where they normally are. So no BBT confirmation either. Kind of a bummer. 

And to a very special person that gave me such a wonderful gift this past week, you know who you are…I'm truly blessed to have this amazing place where I have met such strong, resilient, kind and loving women. I am thankful that I will never know what it's like to be alone in this journey. 

Ladies, We Have a Win.

My Beta 3 Integrin biopsy came back positive!! Which is great. It means I get to skip the 2-month-of-hell DepoLupron treatment.

I was pretty confident, as was my doctor I think, that the result would be negative. My uterus just hasn't cooperated very much, so this was certainly a shocker that it decided to step up to the plate this once.

It's a small win, but a win nonetheless and I will gladly take it.

Not only that, my nurse made no mention of using any birth control or meds for this cycle. So consider this cycle officially a break! My regroup with Dr. G is next Wednesday morning, followed by my consult with Dr. March later that afternoon.

On a more somber note, please stop by and visit Julia at Finding A Way Out of IF. She's already been through so much and it simply isn't fair that she is dealing with another loss. Give her all the love you can.

xoxo

Hooray for Cycle Day One

One things for sure…my body is certainly cooperating much better in 2014 than it did the second half of 2013.

I used to get my period only a few days after stopping any form of progesterone. Last year after my D&C, no amount of progesterone would bring on a period. This year, since surgery, things are normal. My last dose of Prometrium was last Thursday. I started spotting on Saturday with my period and cycle day one, officially starting yesterday.

T and I basically decided that with us being on vacation next week and my body feeling wrecked from all the meds, that we may just throw caution to the wind and try naturally this month. This is something we've not done since last June when we conceived our doomed ectopic. Since then, I've been so worried of another ectopic or just anything that would throw off moving forward with our DE transfer. But…here we are, talking gestational surrogate. So maybe, it's time to just go all in.

What are the chances anyway? I have DOR and a chronic thin lining. Hopefully the scar tissue that was blocking my tubes has remained clear and will reduce the odds of that happening again. But really, I just want to be normal. I want to go on vacation, let loose a little and see what happens.

When I called CCRM today, my nurse is out until Wednesday. The nurse that left me a message said she was unsure if my nurse is planning on putting me on birth control pills or not.

What??

Well, no matter, I'm just going to request that we skip this cycle. I need a break. A break from the meds, a break from preventing, a break from CCRM…(don't tell them I said that).

My body just needs to be left alone for a few weeks.

Then…I can jump back into the depoLupron (depending on the biopsy results) or whatever protocol we'll be moving forward with…

Doesn't this seem like an okay plan or am I crazy??

One more step…done

Biopsy for Beta-3 Integrin. Check.

It was not pleasant, but really no worse than an office hysteroscopy. I'm glad to have it over, that's for sure. My results will be available next Wednesday or Thursday. My regroup with Dr. G is on April 16th.

I have never been more happy to ditch the estrace, patches and progesterone. Finally after 5 WEEKS!! My poor tummy was raw and to be quite honest, I was pretty tired of constantly having to insert pills into my lady bits. Thanks to all the hormones, my boobs are twice as big and I can barely move without them hurting. Lets finally stick a fork in this mock cycle, mmmmmm...k?

Hopefully my period comes in the next week, and we'll just go from there.

I was also so excited for my amazing friend Jessah from Dreaming of Dimples to be nominated for best blog in her local area. She's such a fantastic writer, great friend and one of the strongest gals I know. So we should all certainly support her, as a fellow blogger to win such an acknowledgement that brings attention to infertility.

VOTE

How much is too much?

This post is long overdue. The past few weeks has been nothing short of chaos. Literally and mentally. With crazy travel schedules, T was in Pennsylvania last week, we spent the weekend in St. Louis, and I've been in Phoenix this week. So most importantly…I miss my husband. I'm ready for us both to be home…at the same time.

I've also dove head first into the gestational carrier world. Not because a decision has been made…but because I'm a planner. Because when our decision has been made…I'm completely informed and ready to say "go". 

I still completely plan on going forward with another cycle to give my uterus a fighting chance. To know without a doubt I have done everything, and I mean everything I possibly could. 

I want more than anything to carry our child. To experience pregnancy. But if that is not meant to be, I am ready to fully embrace the path of of a carrier. 

Like I mentioned before, we have had offers. One was never really an option due to a complication in a previous pregnancy and CCRM's strict guidelines. The other, was an option from all angles…but one. 

The legal aspect. She lives in a state that is not gestational surrogacy friendly. This particular state, because of my lack of genetic connection to our embryos, I would have to go through a step-parent adoption after the birth. The same adoption procedure that couples go through to adopt a child…I would have to go through to be able to adopt a child that comes from an embryo that legally belongs to me. 

I've struggled the past weeks since speaking with an attorney and an agency to sort out my feelings on this. 

I've given up my eggs…I've given up my uterus…this would break my heart to have to go through almost a year of legal hoopla just to be my baby's legal parent. It's too much. 

So our option of a much, much cheaper option, may not work. Our other option is going through an agency. The cost is mind blowing. So I'm plagued with guilt. Guilt that my body won't cooperate and guilt that my heart can't give up more than I already have. 

So for now…I have all of this information in the back of my head. My Beta-3 Integrin biopsy is on Friday. Hopefully the results don't take long, and I can schedule my regroup with Dr. G. 

I also have a tentative appointment scheduled with Dr. March. One of the top Asherman's Syndrome doctors in the country. It would be an expensive route to go, but it won't hurt to have him look at my chart. I'm 50/50 on this and whether not I can go in that direction.

We also are just over a week away from vacation. Not an extravagant vacation…but a trip that involves  my husband, some great friends, a very supportive mother-in-law and a beach! So to us, it will be heaven. I can't wait!!