Traffic Ticket and Blood Tests Results

My speeding ticket:
I got a speeding ticket at the end of December. I had to go to court this week to speak to the ADA to see if I could get it reduced.  When I got there and saw that the room was already full of people I knew it would be a long night. You sign in and then they call you up to speak to the ADA for like a min in the corner but it was still in front of everyone. I sat there and watched everyone go up and listened to see what kind of deal they got. It seemed that everyone got a large reduction on their pts but had to pay $150 fine. Then it was my turn. I got up there and I was all set to plead my case but he already had a deal without hearing any info from me. He reduced it from 6 pts to 2 pts. Then I had to also pay a fine of $150 plus the state surcharge of 85. So for my first offense I had to pay a large fine and also get two pts. I am not complaining bc it could have been 6 pts plus at least $300. So this is ok with me. I am just glad that this two month drama is finally over. I can go to a defensive driving course and remove my pts.

 TTC:
My blood tests came back. I have to speak to the dr but I have some ideas on the results thanks to the Internet and my past experiences.

I tested positive for another blood clotting disorder.  That puts my total up to five  which includes  PAI-1 4G/5G that is mentioned below. I think I have been tested for 9 or ten, so I have about half of them. Sometimes it amazes me that I even walk around. It seems that I really need the blood thinners. My hematologist upped my dose to 40mg once a day. It is hard to know if this is enough, bc she said I am her only IF patient. Her others are all pg women with RPL and she wants to give me the same dose as them.

 My natural Killer cells were high, but about the same as usual. This was what I expected to see. When I start TTC again, I will go back on the med to lower this. My  TNF was a little higher than my usual but still in the normal range.

My Vitamin D level is getting better each time. I am very pleased to report that it is now up to 46. It is so great when something works correctly. 1,000 equals 10 pts and that is what has been happening with me. I have been taking 3,000 so now I am going to add another  1,000.

My ferritin level was low. It was 37 which seems normal  in the lab's range, but everything I read online stated that under 40 caused fertility issues. Some sites mentioned wanting a level near 60. So I am going to slowly ease in some supplements in order to prevent GI distress.

My folate level is still really high but it came down a lot since the last time I was tested. A few months back, I was taking  a high dose folate supplement for my MTHFR. I reduced the dose after the test came back much higher than the range. Since it is still outside of the normal range, I am going to reduce it some more. I eat a lot of salad so I guess I do not need to supplement that much.

Here is something I found online. 
http://www.rbmojournal.com/article/S1472-6483%2810%2961004-8/abstract

While the role of inherited thrombophilia has been accepted as a cause of recurrent late pregnancy complications, the contribution of mutated thrombophilic genes to implantation failure has not been studied. Proteins involved in fibrinolysis are necessary for trophoblast invasion into the endometrium. This study compared the prevalence of 10 thrombophilic gene mutations among 42 women with a history of recurrent implantation failure after IVF–embryo transfer with 20 fertile control women. Buccal swabs were taken from all of the women for DNA analyses. Women with a history of implantation failure after IVF–embryo transfer displayed a higher prevalence of PAI-1 4G/5G mutations than controls (P = 0.007). No differences in the frequency of the other specific gene mutations were detected. However, the prevalence of total gene mutations among patients with implantation failure was significantly higher than among controls. More than three gene mutations among the 10 genes studied were observed in 74% of women with implantation failure and 20% of controls (P = 0.0004). 

It is concluded that inherited thrombophilias are associated with implantation failure. This association is manifest by total number of mutations as well as with PAI-1 mutations.

What a Great Day!

Yesterday I had a great day!

I woke up and had a pos OPK. I love seeing those two blue lines bc they might just be the only ones I ever see. It is also a reassurance that part of my system is working. This happened on CD15 which is great. That is back to my usual. Last month it was much later due to stress. I took my trigger.

Later on that day my dr's office called and made an apt for next week. I was happy to hear back and have something written down. It was Friday, dress down day, and a pay day, so that just made it even better.

My work situation continues to improve. My boss gave me a compliment on something I did. I had to work on something with the teachers that I had an issue with in Sept. I did a great job collaborating and then I came up with a great idea and everyone loved it. I was so happy to hear that. I enjoy working there and I want to be able to move forward.

After school I was just cleaning my room when my cell phone rings and it was my napro Dr. =)   I told him that I just made an apt to talk with him next week. =)  He is so great. I love the compassion and positive energy in his voice. We spoke about doing the lap surgery. He said that there is a possibility that if he takes away too much tissue I could go into early menopause. Yikes. At this point I am not willing to risk that. Then we talked about how all my napro stats are great. I mentioned the polyps and how I was worried that they may have come back in the past 3 years. He agreed to do the hysteroscopy and also check my tubes. I am so thrilled. I told him that I need to know that my uterus is in top shape before I get into any more medications. The dr that did the last one 3 years ago was not napro so I am excited to have my napro surgeon get a good look and give me his expert opinion.

We also spoke about using nsaids to calm down inflammation. I have heard many people talk about using them. I have always avoided them due to my lufs, since nsaids can make it worse. My Dr said that there is some research that a specific nsaid can help with implantation. He suggested that I only use it post peak after the threat of lufs is over. I also have thick blood, so this will thin it also. I did a google search and found an article on  piroxicam and implantation rates    The implantation rate was 12.3 vs. 7.7% (p-value = 0.04) and the clinical pregnancy rate was 25.5 vs. 10% (p-value = 0.015) in the piroxicam vs. control groups, respectively.  

Even though the article is talking about IVF, we can use this information for non ivf too. It mentioned  prostaglandins which is something people like me with endo have issues with. It said that they can increase uterine contractions and decrease receptivity of embryo and nsaids block prostaglandins. I am going to try this after my procedure.

New ideas?

Today is CD10, so AF already came and went. No surprise there. My DH was sweet this month. I usually do not tell him when I get a bfn, I will just wait for af, I guess I still cling on to that last chance miracle. This time I told him the day I took the test. He came home that night and brought me a rose. It was a sweet gesture. We usually do not even talk about it. This time it was nice to bring it out into the open. We talked about the future. I am getting to the point of hitting another dead end. I have been here before. Last year I was at a dead end with my LUFS and then I found something to treat it and also my immune issues.

My latest plan was to address the blood clotting disorders with lovenox. I did that for three months in a row. I am not sure if it is doing anything. I see the hematologist in March. I am taking this month off from the us monitoring apts, and lovenox This way I can let my body relax from the welts and bruises from the shots and the blood thinners since they have a risk of osteoporosis. I am still going to take the trigger so I do not get a cyst. I will most likely take the progesterone. I need to take a break while I go over my options.

I would like to have another napro surgery. I wrote my Dr. a letter and I am waiting for his call to discuss it with him. I had my endo removed 2 years ago. I had uterine polyps removed 3 years ago. My right ovary is now covered in endo and does not work. I am worried that since it took me two years to discover my immune issue that my polyps came back. I do not even know if my tube is still open. We all know that surgery  can be a game changer for many. My friend had been TTC for 5 years. Then she had surgery and bam 3 months later got pg.

I have also been searching the web for anything else I have missed. I found some information on Ferritin levels. It seems that if your level is too low that can cause infertility and if your level is too high that can also cause infertility. So you cannot just take supplements if you do not know what your level is. I am going to ask to get that tested. My CBC came back normal last week. Your hemoglobin measures your short term iron levels and the ferritin measures your long term storage. Has anyone ever had this checked out? I am the point of checking anything that has even the slightest chance.

I found these articles
http://www.endfatigue.com/health_articles_f-n/Infertility-effective_natural_treatment.html
http://www.irondisorders.org/Websites/idi/files/Content/854256/HHC%20FACT2010.pdf

Then I saw something about thyroid  that sounded just like me. My tests came back normal but yet I have the symptoms below. I know that many women get their thyroid treated and it works. I am not sure if I want to mess around with my thyroid.

• "If you have a tendency to constipation, cold intolerance, dry skin and thin hair, and/or temperatures which run under 98.2 during the day, there is a good chance your thyroid may be slightly underactive despite normal blood tests. In the absence of underlying heart disease, a trial of a low dose of thyroid hormone (e.g. Armour Thyroid 1/2 grain a day) may help you get pregnant and has a low risk of causing problems." 

 My plan for now is to research new ideas and wait to talk with my Dr. I am hoping to have surgery next month, see the hematologist in March and then have a new plan in April.

Co-Q10 and CRVs

TTC News:
Yesterday I went online to buy more Co-Q10. A little birdie told me to make sure it does not interact with my blood thinners. (I have been taking co-Q10 since last January based on the RI's recommendation.) I have only been taking blood thinners since Sept. I did  a search and came up with the following.
http://www.umm.edu/altmed/articles/coenzyme-q10-000295.htm
 http://www.drlam.com/opinion/blood_thinners_and_nutritional_supplement.asp
 http://coq10wellness.com/coq10-side-effects/

It seems that they are saying that Co-Q10 will make your blood coagulate or thicken so it will go against the reason I am taking blood thinners. I am really glad that I checked. I did not order any more. I have mixed feelings about this discovery. I am mad that I possibly wasted a year of TTC since I have been taking it that long. I am glad that I found out bc maybe when I stop it will make the blood thinners work better and I will finally have success. Who knows? UGG it is so annoying that I have to check everything that I take for more than one issue, my ovulation, my immune system, and now my blood clotting issues.


Other News: I have been enjoying the rental too much. I have to give it back tomorrow. I still do not have a car so that means I have to get rides to work or continue to pay the rental fee. I am not really sure what I want, but I am going used so it makes it harder to be picky. I thought by the time I had to get another car I would have kids and need a car suited for that. My DH does not really think that I need the kind of car I want. It is rough to face the fact that I don't really need it now. I want a small suv like a honda CRV or something in that neighborhood. I could get one now and  be able to afford it or get something smaller and save some money.  I wanted this kind of car 10 years ago and could not afford it so I got a civic. Now 10 years later I can afford it.  I feel that I should just get what I want bc I am tired of waiting around. If I can't have kids, at least let me have a nice car.

I went online and saw some good deals. I am going to check some out and then see what the real deal will be. Hopefully I can get something this week.

Results of Lovenox PC Survey

Thank you to all the ladies who responded to my question about lovenox preconception. I decided to collect all the answers in one place for my future reference and anyone else thinking about the same thing. I only used the first letter of someone's name to protect their privacy. I got some responses from my blog, the immunology yahoo forum and the MTHFR yahoo forum. There seems to be a lot of variation.

I am also wondering how much your weight makes a difference since some people mentioned weight. If I go by the 1mg per kg, then I should be taking 60 a day. My napro Dr does not want to increase my dose, he wants me to talk to my hematologist which is the responsible thing to do. It is just more of a pain bc I get monthly cbc but I do not see her, I go to the lab and then she just checks the results. Now I have to make an apt to speak with her,but the practice is huge with more than one Dr and it is a nightmare to call and try to get through to her office.

Then there is talk about a perinatologist which might be another avenue. I don't know what I want to do, I may just give my dose a few more tries and then decide.

Immunology Forum:
AEB has you start on CD6...30mg if you are under 140lbs and 40mg if you are over
140lbs...once a day until a positive pregrancy test and then twice a day with a
pregnancy thru 36 weeks. I hope this helps.
-H

 Dr.B now had take 30 mg and start it on CD3. After taking it for 7 days he had a Heparin Anti-XA level drawn to make sure my dose was high enough.
-K


I take 40 mg  once a day. It was the dose recommended by two RI's, my hematologist and OB. I have MTHFR, evidence of APA and history of miscarriage. Hope that helps. Oh and I started it around CD 5 but
Dr A was not strict on when I start. I requested I start it early, otherwise he would have me start on BFP.
-D

 I am dx with APS, lupus anticoagulant. I have a history of m/c as well as a history of a blood clot. My hematologist believes in dosing lovenox at 1mg per kg. I am a bigger woman, 5' 11" and I weigh 236lbs, so my hematologist has me on 100mg of lovenox twice a day. When I was ttc, I only did one a day starting on cd6, but as soon as I got a BFP, I went to twice a day. My hematologist doesn't believe in doing Anti XA levels until the anatomy of my body begins to change due to the growing pregnancy. So I believe he won't adjust my dose until 20 weeks + and then he'll adjust based on my AntiXA essay. But for now, it's simply 1mg/kg. He does monthly CBC's on me to make sure my blood count is okay and that's it for now. I'm currently 14w6d. This is the farthest I've ever made it...so fingers crossed
-A

MTHFR:
 I am homo MTHFR CT and take 40mg twice a day starting at my BFP.  My peri calls this a therapeutic dose (higher than a prophylactic dose).  I had my anti-factor Xa tested, and it was .64 - for a therapeutic dose, it should fall between .6 and 1.1.  Both my doctor and I are happy with it being on the low end, because I have no history of clots.  The MTHFR alone is not enough for most doctors to recommend 40mg twice a day, but my history of a (first pregnancy) stillbirth at 31 weeks, (second pregnancy) ectopic, (third pregnancy) placental abruption at 28 weeks, and (fourth pregnancy) miscarriage at 9 weeks indicates that I need a therapeutic rather than prophylactic (which would be 40 mg once a day) dose.

 I'd definitely get a second opinion through a pre-conception consult with a perinatologist or RE and have that doctor's recommendations sent to your doctor.  I did a pre-conception consult before my current pregnancy to outline everything that would be done and be sure I underwent all the tests recommended before ttc.  

-W

40mg 1/day I know Dr. B would def. put you on lovenox 40mg 1/day.  that's what he did for me.

 -J

He can order an Anti Xa Test or Heparin Anti-Xa test that will show if you are taking enough.

I did not take Lovenox preconception, only starting at positive pg test. I have FVL and MTHFR both hetero. With one pregnancy I took 40mg/day Lovenox and did fine. With my next, I clotted at 9w in my leg on that dose. We did an Anti Xa test and it barely showed I was taking anything. Changed dose to 30mg/twice a day, Anti Xa test again, and result was not much different. My OB was also reluctant to increase my dose so I asked to see a perinatologist. Eventually, using the Anti Xa test, he got me up to 60mg/twice a day which put me at a low therapeutic level on the Lovenox. 

-C

My Blog:

I started out at 40mgs 2 x day, and I was already taking it when I went to Dr K-K for that Doppler Uterine Biophysical Profile, which still revealed an elevated resistance index in the spiral and radial arteries. I then went to 60mgs 2 x day, which was subsequently decreased when my aPTT (pro-thrombin time, a blood test to see if your blood is clotting too slowly) was really long. I was decreased to 60mgs 1 x day.
-T

My New Favorite Nurse

Today I went in for my CD3 baseline follicle scan. You never know what crazy stuff you will find in there. I got a new nurse. I have been going to my clinic for many years now and all the nurses know me by name. The Dr who owns this clinic closed another one that he owns so he brought those nurses here. We introduced ourselved and made small talk. You have to get to know someone before they probe you right? She was very nice her name was C. She said she has been doing this for 30 years. Good, I thought, she has experience.

Then I had to give her my right ovary's history. It has some crazy things that are always there, some of the nurses have had trouble with it. She takes a look and knows what I am talking about. Yeah. I had a large 45 mm cyst from August and it was still there, but it now has an irregular shape and seems to be shrinking. She said that sometimes when they are large they take a while to go away. It was ok bc it was on my right and that one does not really work anyway.

Then she goes to the left. It was a clean slate. YEAH. That means no new cyst!!! Hoorah this is a big deal for me. Then she wins me over and becomes my favorite. She took her time to really check me out. A lot of the nurses do not bother and they just rush. She started to look at my antral follicle count. None of the nurses had ever bothered to count them before. She counts then and tells me the number. I asked her what is normal. She says that it varies so I got worried. I asked her what she thought about mine and she said it was "nice" NICE NICE NICE OH YEAH. I was so excited to hear someone say that my ovary looked nice. I got so excited that I feel hopeful again.

We talked about LUFS and she knew what it was. WOW Nobody knows what that is outside of Napro.  I used to request S but now I am going to request C. She seemed to understand me and did not judge me.

I am so excited to have a new favorite nurse......=)

Since I got the BFN I have been thinking about what went wrong. I know that sometimes it takes a normal person a few months, but I am not normal so I worry. I have the lufs under control, the NK under control. I started the blood thinners so now I am wondering if I am taking enough. I go to the Dr for a CBC next week. I am going to try to get a test done to check if I am getting enough. If that is fine, then the last piece must be my uterus. I tested low for uterine embryo protection cells so I may have to find another treatment to address that. I thought the neupogen would cover it but I am not sure. My only other thought is that 3 years ago I had uterine polyps removed and maybe they came back.

Hematologist and Napro Dr visit.

Okay so I am taking a break from my vacation story. Last night I wrote a post about the next day and then blogger malfunctioned and I lost it. I thought I could get the whole vacation story done first, but I have had some TTC updates that I want to share. I will continue with the vacation story another day. Writing about that trip makes me so happy. It reminds me that life does not have to revolve around us apt and taking meds.

Last week I saw a hematologist for the first time. I made the appointment last month. I was nervous that she would think the blood clotting issues and if link was bogus. She was great. She knew all about lovenox and said it was safe to use. She has many pregnant patients on it. She wants to monitor my CBC monthly to make sure my platelets do not go too low. She also said to take extra calcium bc lovenox can cause osteoporosis. She has a lab in her office. She took my blood. Then I walked down the hall and she already had the results. I was amazed. My levels were great so she cleared me to start. I was so excited that she was nice and on board. She said she would be happy to be part of my team.

Yesterday I traveled to see my napro dr. His office is 3 hours away. I speak to him often on the phone, but I had not seen him in person for a year.  I also needed to get the some tests done with a uterine biopsy. He said I could do it locally.  I do not trust a non napro dr as much as I trust him so  I thought it might be a good idea to visit. He recently moved into a new office space. It was very nice. Everyone who works in his office was very nice.The first thing I got done, was an us. At my local clinic, they said they saw something on my ovary. I wanted a second opinion from someone who I can trust. So I had TCIE scan me. It was great to finally meet her. I was a little shy bc I read her blog and meeting her was like meeting a celebrity. She was very thorough and kind. It turns out that they were correct. I do have some endo regrowth on my ovary. It has been 1.5 years since my surgery and I knew that it would come back someday. I am just very thankful that God gave me two ovaries bc my left one is still clean. I am also thankful that my fibroids did not grow back. She said my uterus was moving and then the dr said that was great bc it meant it was not stuck to anything with adhesions. Yeah!

Then came the biopsy. I was worried about how much this was going to hurt. My dr is so gentle that he takes his time and tries to make sure he is not hurting you if possible. I have been to many drs and some of them will just get rough bc they rush. It was not too bad. Crampy but not sharp pain. This got sent out to check for all sorts of things.

At this point I got the green light to start the lovenox next month. I feel like I am getting ready to go into battle. I had the summer off from US apts and any real expectation of TTC. Now next month I am getting back into the game. It was nice not having any expectations. Now I am scared to try again.

Starting next cycle on CD6, I will take a shot of lovenox daily and then add a shot of neupogen around peak. UGH but I can do this. I am going to try this for 3-6 months if I can stand it. If this does not work, I have nothing left. But that is what I said last Nov. Last Nov, I had nothing left to try and my LUFS was really bad. Now almost a year later, I found out about my high NK cells and my blood clotting.

Feeling Hopeful

Yes, I am feeling hopeful today!!!!!!!!!!!!!!!!!!!!!
I do not know how long it will last, but I will enjoy the moment. Over the past 4 years there have been lots of ups and downs so I am used to this roller coaster I am stuck on. I am always hopeful when I have something new to try.

 I spoke to my napro Dr today. He is so wonderful and supportive. He spent time going over my treatment plan. He makes sure to tell you the pros and cons of the medicine so you are well informed. We discussed my blood clotting issues and my immune issues. He has been really great with this. I understand that this is not his area, but he has been willing to work with the immunologist. One of his great traits is the fact that he is open to new ideas. He says he always learns from his patient. He agreed to write me two new scripts. One is for a high dose of folic acid and the other is for the clotting issue.

Now I have to wait and see if the insurance will accept it. You never know with infertility. Some things are covered and others are not. I have to go through a special mail order pharmacy due to my insurance benefits. When I called, the rep was great. She took down my info and said she would contact the Dr and get it taken care of. It sounded prominsing, but fx until I get the call about delivery.

I am going to start the vitamins when I get them. I am still planning on going full force with treating the NK and the blood clotting in Oct. I like to get things taken care of early.. I have learned that insurance/pharmacy benefits are unpredictable so it is better to be safe than sorry.

I know I still have a long road ahead of me. I know this may not work. I am just thrilled to have another chance.