Thursday, April 22, 2010

Baselines and Questions-

So- new cycle started yesterday. Baseline today- Clomid tomorrow.

Well really it's- Clomid 150mg, Dexamethasone 2mg, Metformin 1500mg, Vitamin D 1000iu, Prenatal, Low-dose Aspirin, and DHA Omega-3 Supplements. I just love taking pills, don't you?

My doctor said my ovaries are ripe for the picking- okay she didn't really say that- what she said was that they look "good". Okay, if she says so. I think they look as crappy as they did before. But no large enormous cysts like I got after injectables, so we'll count our blessings. Oh, and I had a 14 day luteal phase. That is totally new for me. I even stopped my progesterone supplements early, and it still held off. Crazy.

She liked the protocol last time, hence no changes. She was happy I had two mature follicles on it, which is still a shock to me because I thoroughly expected having none at all. We'll see what happens this time.

Sooo, I am questioning things and obsessing. I am thinking of declining the Lovenox if I get pregnant. I don't have a major clotting disorder, *just a very minor one*, and for all I know the losses could have been because of the septum and only that- more about that below, join me in obsessively looking at old ultrasound photos- and the risks of it scare me. I know with just aspirin I have more bruising, and when I got sick I popped a shit load of blood vessels in my eyes from throwing up. How much worse could that have been if I'd been on injections? I am just concerned and have to think about it- I mean, this is hypothetical because who knows if I will even ever get pregnant again anyway?

Okay, so the septum thing... my doctor won't say yes or not, but that she wasn't leaving it to chance or taking risks. Okay. But many people I talk to are convinced it was the cause of the losses. I am starting to wonder, thinking it had more to play with it than I originally thought.

First of all, there is the continuous spotting from the moment of implantation. I didn't have that with the first miscarriage, but that one could have been chromosomal or low progesterone related (I ovulated on cycle day 44 and we hadn't done the deed for 4 days before I ovulated... odds were against that one) But pregnancy number 3 had tons of spotting before it went down to zero. Pregnancy two had lots of spotting, but high progesterone. It implanted high up in the uterus (ultrasound picture below) Then the bleed happened. Now the embryo stayed attached for weeks after it stopped developing, but that doesn't necessarily mean anything does it?

Here's an unaltered photo of the pregnancy-


And here's one I edited for you. 1 is the bleed, 2 is the embryo, and I'm wondering if the thing in between is the septum. We've never seen it on an ultrasound, didn't see it on the HSG, doc said it was tiny so that's probably why... so I don't know if it could be or not. But the uterine lining was super thick here because of pregnancy, and the womb had expanded slightly... so maybe that could have made it noticeable? But we didn't notice it because we were focusing on the bleed and the embryo? I am just spouting crap that I know nothing about right now, trying to get opinions... what do you think? Any septum smarties out there with insight?


And if you think I need to stop obsessing and being a complete nut, feel free to tell me that too- I can take it ;)

Bah. See, that's the thing- What if it was the cause? There's no way to know for sure, only guesses. But what if? If it was, and I knew I had an even chance at a successful pregnancy- as even as the next person- I might be more optimistic about this shit. But I can't. So we have to either quit or keep gambling.

Too bad we can't up the ante.

**ETA: My clotting disorder is very minor- it's one normal/one abnormal gene on the PAI-1. So it might, or might not cause issues- originally we were just going to do the aspirin, until I had the 3rd loss (all before the resection) and the doctor offered the Lovenox for next time, but left it up to me.


MrsSpock said...

A 14-day luteal phase is very good! That sounds like a decent ovulation. I know some docs go for just aspirin instead of lovenox, but I'm not sure what I'd do myself. How would you feel if you miscarried after not taking it?

If I can get knocked up, I will be taking aspirin only myself.

G$ said...

Re: Lovenox - I used it in this final IVF cycle that so far = pregnancy. I have no clotting disoders in the clotting panel. My doctor and I decided to go for it with the mindset that "it can't hurt" (and yes, I know it can to a certain extent) - but we wanted to throw everything at our last fresh IVF that we could.

Do I think it made a difference? I will never know for sure, but my placenta is now bilobed, it spread itself around the scar tissue from where the septum was. Would it have tried that hard without Lovenox (and baby aspirin)? Not sure, but this kid is measuring big now so somewhere something kicked in. I will never know, but if I had to do it all over again, you bet your ass I would do the lovenox.

The diagrams - yes, that could be it and no, that could not be it :) See how helpful I am? I should be an RE! The reality is the crap shoot on implantation area. I still believe my weird betas = poor implantation around the septum scar (or residual) but then the placenta spread out the other way and found its footing.

It totally could have been the cause, you will never know. The thing that kept driving me forward was that my uterus (remodeled) could, theoretically carry a pregnancy according to my RE. It feels like beating your head against the brick wall repeatedly, but that glimmer of hope and the What Ifs keep you going.

Hang in there, I am here hoping for you.

Kristin said...

I would probably opt for baby aspirin in your case...just my opinion though. I did lovenox but I had an issue (not a classic clotting disorder but it did qualify). As for the u/s picture, I think that might be the septum.

Another Dreamer said...

My clotting disorder is very minor- it's one normal/one abnormal gene on the PAI-1. So it might, might not- originally we were just going to do the aspirin, until I had the 3rd loss (all before the resection) and the doctor offered it for next time, but left it up to me.

Michelle said...

AHH the "What if" game. Doesn't it just drive you crazy? My RE told me we are going to try an anti clotting med. There is no evidence that I have those problems. Testing is all normal but he said it can't hurt. I say if there is no downside give it a try but I do not know much about it just yet.

((HUGS)) to you!

worldofwinks said...

I am by no means a septum smarty! I wish I was! From having my own septum and the issues that surrounded that...I lost two twin pregnancies prior to septum removal. The doc told me that the septum alters the blood flow in your uterus. If implantation occurs on or near it, things are doomed. (Que dramatic music!) As far as what happens after septum removal, haven't got a clue. All I know is that I did go into pre-term labor, having Genevieve 6 weeks early. Could the septum (or remnant of it, although they claim there are none) be to blame? Sadly, when one has a wacky womb, you just may never know.