CD27: Fired by Dr. Moustache

I guess it was inevitable.

I asked questions. I didn't trust him 100%, but then I don't trust ANYONE 100%.

This last time I actually went so far as to attach a few studies to my last email when I asked whether or not a long lupron protocol might be suitable for me since I have severe endometriosis. Two IVFs and a FET later, one would think that it would be NORMAL to ask questions. I honestly thought that I had been neutral in my my most recent email. I was careful to not demand answers or to lay blame, but merely to pose the question: "Can you please tell us how this sort of protocol works?" (ie, the long lupron protocol).

But I guess it was too much for Dr. Moustache, because today he off and fired me. I'm torn between wondering if he officially cut me loose because I was ruining his stats? Or was it that he just didn't have time to answer a few meager questions? (Honestly, I don't really don't write to him THAT much. I know patients of his that barrage him with emails. Oh, but they got pregnant. Hmm...maybe that's the difference?) But part of me wonders if his ego is just so big that he can't stand the fact that I asked questions.

Another friend of mine, AP, was a former patient of Dr. Moustache's. She, too, dared to ask questions. Questions that had merit, questions that anyone would ask after doing PGD and putting in 3 perfect embryos...and *poof*, nothing happened. AP is a VP at a rather well know financial institution and is very poised, articulate, polite...gosh, I can't say enough good things about her. But I cannot for the life of me imagine that any questions she could pose could ever result in her being fired from Moustache Man. But you know. He fired her, too.

So, here's the fated email. You tell me. Can you read in between the lines here? Is there any real reason here for this? I'm baffled. Oh, and of course I'm pissed. As one of my crone friends said to me earlier today, "You should have broken up with him before he broke up with you!!!"

Yep, I'm the dumpee, not the dumper.

Dear ....,

Thank you for your note and the accompanying articles. I have not found this approach particularly advantageous and the side effects are not insignificant.

When we last spoke after your recent frozen cycle, I shared with you that outside of the PGD which I recommended both times, that I had given your fertility problem my best shot.

You had already requested transfer of records for other opinions on your case and I encouraged this after your e-mail implied that you were unhappy about certain additional tests not being offered or discussed.

I would recommend that you seek further opinions in the ... area and also possibly a consultation with Dr. ... in ..... Maybe a new and fresh evaluation of your situation will bring you the success that you so richly deserve.

I have decided not to participate in future IVF cycles with you and we would be happy to send an additional copy of your records directly to you upon receipt of a request signed by both of you.

Sincerely,
Dr. Moustache

Yep, he did suggest PGD, but not in a way that made us understand its importance. We explained to him that although we fully understood the reasons to do PGD NOW that it just wasn't presented in a way that the full impact was impressed upon us.

And his comment about me transferring records? I had them sent to Nova before our "your cycle has failed" conversation. Dr. Moustache took two weeks to talk to us once our cycle had failed. Much too long in my opinion considering the loss we felt. But he was clearly busy doing other things. So in that time I stewed. I cried. I wondered what went wrong.

And I went looking for answers.

So maybe he's pissed that I went looking for answers before he could give me any?

Who knows.

.........................................

Along another note...J and I are heading to NYC tomorrow to visit with Dr. Hungarian. We have an appointment on Monday morning at 8:00 on the Upper East Side. We'll have two days in the city before our appointment and then back again on Monday night. One of our typical whirlwind infertility vacations. This is our first trip together to NYC...we've each been there separately, before, but this will be such a fun trip. I've got our dining excurions mapped out for Saturday night, Sunday breakfast & lunch. In between breakfast and lunch on Sunday we're going to make a trip to the Met to check out the Cezanne and Picasso exhibit.

I think after lunch we'll head to Greenwich Village, SoHo, and a couple other areas I've been dying to visit. My mom moved to Greenwich Village in 1965 or 1966...I am so jealous. That would have been quite a wild time to live there. She was there for a couple of years and then I think she went to Florida. Like me, she's always on the move.

There's just not much time to see everything I want to see...but I'd like to just sit on a bus and check out the different neighborhoods in the city and get an idea of what's what.

So on Monday we see Dr. Hungarian...and he is an ob/gyn that specializes in infectious diseases of the uterus and prostate. He's got some rather interesting theories as to why some of us just have such problems with getting knocked up. Hope he's got some answers for us.

Our plane departs Monday at 6PM, so we have time for breakfast and lunch before heading out. I hope that we do a lot of walking. There are so many good restaurants there that I'm worried I am going to gain weight during our three day trip!

CD19: NoLa & Other Good Things

Met with some of my gal friends over at NoLa last night for drinks and grub. While the drinks could have used a kick in the pants (lightweight me didn't even have so much as a buzz after two pint sized mojitos) the food was tasty and the dessert tray quite yummy. Although I'm allergic to milk, that didn't stop me from chowing down a helping of the bread pudding. But more than anything, it was great to connect with these ladies.

On the IF highway...we had our "Your Cycle Failed" discussion with Dr. Moustache on Tuesday. He basically said that we've put in 17 embryos and not a one implanted...and this defies odds even at my age. We would have at least expected to see implantation then a chemical or even a sac, but since we've seen nothing he says we have "implantation failure". D'oh. I kind of knew that. He said we should get second opinions on this which, to me, felt kind of like him cutting us loose but I do know that he wants us to be sure that we want to continue with him. (On this matter, I don't, but J does. I say J does cuz he's being cheap about Dr. Pompy charging $1600 more for the same procedure: IVF). I am also sure that he knows that we sent our records to Dr. Pompy's, and is thinking we're not coming back anyways. Or maybe he doesn't want my screwed up uterus to mess up his stats any more than they already have?

What else?

Dr. Pompy's office (aka, Dr. Next) confirmed that they have received all of my records from Dr. Moustache. I forwarded off all of my other bloodwork from Dr. G, and the immune work from Dr. S's office. Dr. Pompy, like all of the other REs are in Lousianna this weekend at a conference. If you are wondering where your RE is this week, now you know.

Yesterday morning I had a chat with the very sweet Dr. C in Chicago. She is doing a study on intralipids and whether they help to suppress NKs in women with elevated NKs. It was a short 30 minute conversation, but she was well organized and seemed to have gotten just about everything out of me in that short time. She'll be sending me a styrofoam container with vacutainers...I'll do a draw at Dr. S's and forward the blood to Millenova laboratory for testing. Essentially they'll be looking to see if intralipids can suppress my NKs in the test tube. If they DO, then I'm off to Chicago for an infusion, or two. If they do NOT, then I won't be infusing intralipids.

We already know that IVIg doesn't suppress my NKs in the test tube (in vitro), so if intralipids follow in the footsteps of IVIg, I'll only be left with LIT to get my NKs under control....and this brings me to update you on the status of my mad science experiment:

Centrifuge #1 arrived a few days ago. It's a Hermle Z-230 with variable speed settings, 60 minute timer, brake, and holds 8-15ml centrifuge tubes. It has a fixed angle rotor so it's not ideal. But it'll work in a jiffy for separating the RBCs from the plasma/PBMCs (peripheral blood mononuclear cells).

What IS ideal, however, is the Sorvall GLC-2, that I just picked up on Ebay for $80 plus shipping. It has a nifty HL-4 horizontal rotor (worth $475) which takes Sorvall 598 buckets (buying these in Canada for $62/4 buckets update: they wanted $62 PER BUCKET, not for four buckets! Forget THAT! I can buy a complete centrifuge on Ebay with buckets for $299!), each bucket can hold six 15ml centrifuge tubes. So it can spin more all at a time PLUS it has swinging buckets for getting my serum to separate into rbc, gradient, PBMC, and plasma layers. Horizontal layers that is, without disturbing these precious layers when I remove the tubes. The other centrifuge, as I said, has a "fixed angle rotor". So the tubes goes in on an angle and the stuff inside layers out into angles. That's okay for the first centrifugation, but not for the second as it's more "liquidy", and that lymphocyte layer needs to come out undisturbed.

I'm not sure why I didn't think of that before, but it means that I now have two centrifuges.

What am I going to do with two centrifuges you might wonder? Well, the ex, Dr. S, is a chemistry professor at a SoCal college, so I've warned him that I'll be making a donation to his laboratory. I paid $75 for the first centrifuge (including shipping) but a centrifuge of this quality is worth about $1000 to $1200. I am stunned that the folks selling these things on Ebay just don't know how to market a centrifuge. They'll take a picture of the outside of the centrifuge, tell you it has the rotor, but do they show you the rotor or describe it? NO!!! So frustrating! It's also partly Ebay's fault for not having subcategories for microcentrifuges, bench centrifuges, or floor centrifuges, and further separations beyond there. But it does mean that I was able to get some very good buys there.

So that first centrifuge is going to be a very good tax write off. :) In fact, I think all of this equipment will be going south once this lab experiment is over.

You know what I find amusing through all of this is that the ex hasn't even bothered to ask me what the hell I am doing with centrifuges at HOME. I don't know if it was the plasmodial slime mold I had growing on the top of the refrigerator or the cadaver cat I brought home from the Anatomy lab...but I guess he kind of knows better than to ask.

CD14: Wine Cures Infertility

Okay. LH strips suck ass. One batch said I surged on CD9. Another batch says I've surged last night (CD13). That's quite a spread, don't you think? By the way my side is hurting and the fact that I've got a bit of that FCM stuff going on, I'd say that the first batch was smoking crack.

So I'm in the midst of doing my taxes. That would be 2005 taxes. Not my quarterly. I'm not organized enough to do quarterlies.

I have receipts all over my desk and a couple of them gave me pause. A bit of history: J and I buy a lot of wine. We used to drink a bottle with dinner now and then, but many of them wind up as gifts for folks when we go to their homes for dinner. Some wind up as client gifts as well. Just how many were client gifts in 2005 is long beyond me by this point. But something just dawned on me.

So I came across three wine receipts just now for purchases made last year. I hope we don't sound like raging alcoholics, but bear me out. On 4/13/5 I purchased 7 bottles of wine from the Wine Club in Santa Clara. On 4/29 I bought a friend/client a bottle of Veuve Cliquot for his birthday. Then there's a lack of receipts til 7/20/5 when I revisited my fav wine proprietor and purchased eleven bottles of wine.

Now this might not mean much to you, but at this point in our lives we didn't have wine storage as we do now. We lived in a house built in 1902 that has neither air nor insulation. Hence, I wasn't buying wine and laying it down. I was buying wine to CONSUME. We were drinking it.

And get this. On May 7, in the midst of this wine drinking binge, I went and had my CD3 FSH tested. Mind you this was before I realized I was infertile and I hadn't a care in the world about what imbibing might do to my fertility.

And wouldn't you know it?

My CD3 FSH came in at a proud 6.5.

The lowest it's ever been.

Unfortunately the good doctor didn't run my E2 so we will never know for sure just how good that number really was.

I've been looking for things correlated to low FSH, and I don't know about you, but I think this means it's time to break out the magnum pinots I've been stashing away.

CD11: FSH & Lexapro

I got my CD3 FSH/E2 results today. And after all my bitching and moaning about how to get my E2 down, guess what happened?

It hit rock bottom.

36.

Last month it was 72. So it dropped by exactly 50%.

What gives? I don't know what part of my immune drug cocktail is responsible for this, but it has NEVER, EVER, been lower.

FSH?

7.2

It has been lower only once.

I don't get it. But god do I wish I knew what did it. So right now I am kicking myself to high hell for not having cycled this month. My numbers are perfect (for one edging up on 42). If you're 35 you're probably thinking my numbers suck ass, but these numbers are great for me.

Along another line...the post lexapro headaches haven't left me yet. I still don't feel quite right in the head. I'm bitchy, argumentative, and I have 2005 tax shit strewn about my office. It's a mess. J won't talk to me about using a surrogate, seeing Dr. Hungarian, or anything. He just came home from a gig in SF and went right to bed.

I'm seething. Which means I'm feeling more like me. But I really do feel ill. Something's not quite right.

What does any girl do with a medicine closet that looks like mine?

Well I cut a lexapro into 1/4s and washed one tiny piece down with some nettle tea and a 5-HTP chaser. That's what. I'm going to try microdoses of 2.5mg and hope that I can get my brain to give up the junk, but more slowly this time.

CD10: What's up with shitty LH sticks?

I've been POAS again...but this time it's to find my LH surge so I can start counting the days til my next endo biopsy. I think that I've got to get the sample taken 11 days after my LH surge...something I'd better figure out in a hurry here!

I had 3 fancy pee sticks leftover from last month. You know, the hard plastic ones with the windows just like the HPTs (they're made by Inverness if that's any clue). I've done three of these, and according to the one I peed on at CD8, I had my surge on CD8.

That is nonsense.

Sheer nonsense.

I'm on a 27 day cycle. Sometimes 28. I don't have a luteal phase defect...and my charts show a BBT surge at the appropriate day.

Last cycle I used these fancy ones by Inverness alongside another brand. A cheap box of "Answer" brand LH strips. Because you get 20 strips to a box, I didn't squirm about doing 2 of them a day to catch that ever elusive surge.

Well last time the cheapo strips from Answer were the ones that caught my LH surge.

When I saw today that CD8 had the darked LH line in the last 3 days, I said, "WTF?" and I ran out and got me-self another box of the Answer strips. I should be surging tomorrow or the next day...maybe even CD13, but my gosh, CD8? What is wrong with these things?

It is so frustrating when we're told to use a $22 box of strips in order to take a $459 test, not counting shipping or the doctor's fee for the biopsy. You'd think they'd get this LH stuff down. It's all rather unsophisticated, this LH testing, in light of how much we are spending on the subsequent tests.

CD7: FSH and BMI Inversely Related?

Gonadotropin and body mass index : High FSH levels in lean, normally cycling women


Key points:

-Follicule-stimulating hormone levels and BMI were inversely associated during the whole cycle, independent of age.

-Day-3 FSH levels were also significantly higher in the low-BMI group than in the high-BMI group

What is odd about this, is that women with anorexia nervosa often have very low FSH and E2.

So thin + lean = high FSH

Anorexic thin = low FSH and E2

What gives?

I'm looking for what is correlated with low FSH and normal E2 values. There's got to be something out there.

CD5: TSH Test

TSH test results came in today. My level is down to 0.9, low enough to make my RI happy. I forgot to ask if I tested (+) for ATAs (anti-thyroid antibodies). I DID see autoimmune thyroiditis on my list of diagnoses, so I think I do test positive for them...which means synthroid for the rest of my life I would imagine.

Stumbled on to a good list of vitamins and herbs for the IF woman at Life Begins. Check it out.

Note, it's thought that substances that are anti-oxidants will usually raise NKs (ie, wheat grass, vitamin C). But in saying this, I look back on IVF#1, when I was doing buttloads of wheatgrass, and my NKs were at their lowest then.

Maybe it's time to get out my wheatgrass juicer once again. :)

CD3: The Lexapro Rollercoaster

I think I've been off of the lexapro for 5 days now. It hasn't been easy quitting this fast. I've had terrible nausea for days, light bothers my eyes intensely, driving in a car makes all of the nasty symptoms come together at once.

So far this morning I haven't felt nausea. Yet. It might happen once I get out into bright light, but I am so hoping that it's gone for good. I was reading an email from a girlfriend of mine, AP, who is an IF that's thrown in the towel after 3 IVFs.

She and her DH are adopting a Russian baby and hope to be placed next summer. She wrote a line at the end of her email that had me in tears:

I just know that there is a child out there who needs me and "B" as much as we need her.

That did me in. But for the first time in a long time, I felt. I cried. I truly felt pain.

I think I'm nearly back.

CD2: I Love Dr. Pompy

I sent the receptionist at Dr. Pompy's an email last Friday about doing SCSA tests on J's sperm. Monday she called. Tuesday she sent me an email that they don't do SCSA. So I phoned her back to ask why they didn't...and she said, "Let me go and get your file." She put me on hold.

And Dr. Pompy picks up.

He chats my ear off for 20 minutes or so. He answered all my burning questions without fail and then some.

I'm still in disbelief that I actually got phone time with an RE without an appointment. He said that since my ovaries weren't stimulated in this last cycle that I can come in for a lupron challenge right away and get started on a cycle right now if I want to. I'm not sure if I am ready or not - I feel I'm still kind of grieving, but maybe I just need to get back on that horse without delay?

Any opinions on this?

In a way, I mght want to do a lupron challenge just to see where I'm at...even if I'm not yet ready to cycle. He said my CD3 FSH of 9.2 is just fine and that they see plenty of women get pregnant at this range. He said if I'm not ready that in the meanwhile it would be helpful for me to get a copy of all of my records so he can start studying them with a fine tooth comb. (Statia: I'll need to talk to you about how hard it was to get them from Dr. Moustache's office).

Although he disagrees with most of the treatments that I did at Dr. Moustache's and DB's offices, I know he'll let me do whatever it is that I want. But he just doesn't think that there is data for any of it. I don't know if I am 100% on board with cutting everything out for 1 cycle, but I might be.

What a breath of fresh air.

I heart this man.

CD32: Doing Crazy Shit While I Wait For AF

I was riding the couch with J tonight, watching something mindless on Channel 11 and they break to what's on tomorrow night...and it's none other than Dr. Moustache on a show about people having babies via IVF. Bleh. We can't escape him even in the privacy of our own living room. It was deja vu of a whole new variety. HIS voice in OUR living room. What could be more creepy? Thank god Statia wasn't here. She hates him more than I do and might have thrown something at our new TV.

What else?

I stopped taking my lexapro. Cold turkey. I may regret this any moment now, and I almost did this morning as my heart was beating so hard I thought that it was "it", but after that I have mostly felt headachey and a bit bitchy. My old self returning or what? :-) Now if my libido would just return! But I can tell that I'm having side effects from this choice of mine to quite cold turkey. It's 2:30AM and I'm up buying shit on ebay and feeling not quite right. Bit of pressure in m head and my jaws feel tense. When I was taking lexapro I could barely stay awake past 11PM. My old self is definitely on the horizon, and she's not too far away. I can almost see her.

So maybe you recall my crazy posts where I was going to do my own LIT treatments and skip ever having to go to Mexico and pay Dr. Q $600 for a LIT treament ever again? Well given that LIT is the ONLY thing that reduces my NK cells, and I have a while until my next IVF, I did it: I started to buy the lab equipment that I'll need to get this done.

Tonight, on ebay, I bought:

50 Sterile 21g BD Butterfly Syringes with 3/4" needles and leur locks
100 Sterile Pasteur Pipettes

I've already got insulin syringes for delivery and a latex tourniquet.

And I've got my eye on a really sweet centrifuge with swing out rotors...all digital controls, temperature control, variable speeds, and a timer. I will be stylin' with this thing.

What else do I need?

• Gloves (costco)
  
• One Use Holders. You attach butterfly syringe to this so that you can slip the vacutainer tube onto the needle end. (ebay)
  
• Sterile 15ml Centrifuge Tubes with Caps (ebay or old lab where I worked)
  
• Sterile PBS Buffer for washing step (where to get? making sterile solutions is a PAIN without a lab!!)
  
• Sterile Hartmans's or Ringer's solution for resuspending & injection (A pain. Where to get?)
  
• BD Cell Separation Tubes. These are so cool. One step separations! BD says you can't use these for in vivo applications, but I'd be washing the separations 2 or 3 times, pelleting, and resuspending before injecting. They'd be darned clean by the time I'm done with them.
  

I think that is actually about it and I hope to have everything at least ordered by the end of this week so that I can get started.

I'm THIS CLOSE to being able to do my own LITs. Amazing! I know it's crazy shit to be doing this. You don't have to tell me this. But I've done a lot of research on this procedure and I really think it can be safely done without a physician's supervision. The big deal here is using sterile technique, which I have done in my job in the lab time and time again. Keeping sterile and being meticulous about isolating that buffy coat and not letting it get contaminated with RBCs are the important issues here. Last thing we want is any of J's type B+ blood mixing with my A+. Imagine the hoopla that would ensue in the ER room as I tried to explain myself. It would be even more entertaining than last month's trip to the ER when I thought I'd aspirated a garbanzo bean into my lungs.

So I'm going to do it. It's scary to experiment on oneself, but I'll hit up RI's office tomorrow and see if they won't share any of the procedure with me. I know it's illegal to actually DO the procedure to someone since the FDA ban, but to share information about an "outdated procedure" doesn't really fall under any regulation.

I'll definitely photodocument the entire procedure when I finally get around to doing this. Hopefully soon!

Stay tuned for more crazy shit as my lexapro wears off. :o)