Diagnosis: Numerous Implantation Hurdles

So more tests have rolled in and unfortunately they’ve presented some issues. Luckily we were able to get in with Dr. Hail Mary this morning to get an explanation of what those test results mean and what we should do about them.

While we’re still waiting on the results of the receptivity biopsy, the Beta-3 Integrin biopsy has come back negative…and this is one that you’d rather hear “positive” as a result. Beta-3 integrin helps with implantation….without it, things are…..”tougher” – not impossible, but “tougher.”  Also, they also found out that my endometrial lining is out of phase – meaning, it doesn’t mature at the proper time (this could be causing the negative Beta integrin) which also makes implantation difficult. The negative beta integrin can also be secondary to inflammation – meaning, there could be some endometriosis in there.  (These issues are on top of the elevated Protein C we found out about that can also get in the way of implantation – I’ll take blood thinners for that).

By the way – I am completely asymptomatic for endometriosis, but the doctor roughly 1/3 of all women with endometriosis do not have any symptoms.

He gave us 5 options for how to proceed:

1. Repeat test/trial cycle with a different hormone protocol i.e. injectable estrogen to build up lining and injectable progesterone to mature the lining – see if they can build as hospitable apartment in there.

2. Ignore the results.

3. 3 months of Lupron to shut down system, shrink any endometriosis (if there’s any) that might be causing negative Beta-3 and then try to get pregnant after that.

4. Laparoscopy/hysteroscopy – go in, look for endometriosis, get rid of it if it’s there.

5. Use a gestational carrier.

We found 2 not so logical, 3 not really an option due to our insurance ending in May/June (at least insurance that has fertility coverage, so we need to get this show on the road) and 5 just made us giggle.

So, we’re going to combo-platter 1 and 4: test/trail cycle at the same time as laparoscopy.

If they get in there with the laparoscopy and there’s no endometriosis then we’ll continue the testing/trial cycle by repeating the endometrial biopsy to see if the injectable estrogen/progesterone did the trick re: maturing the endometrium during the necessary window of time for implantation. If they find endometriosis then we’ll end the trial cycle – the doctor figures that would be the cause of the negative Beta3, therefore no need to repeat that biopsy (which was a real joy to do the first time…..cough cough…hey look over there!).

I mean, it’s enough that I gotta stress about making at least one friggin good embryo – now I gotta worry about even being able to build a house that’ll accept a resident!

The laparoscopy is scheduled for next Friday, March 14, so we’ll see what we see then. In the meantime, I start injectable estrogen tonight.

Ah the joys of what we do.

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The Endometrial Receptivity Test Can Suck It

Playing catch-up here – busy with a mess of work lately, which is awfully nice. I’m writing you from Phoenix where I’ve got some work tomorrow….it’s warm, and that’s like a reboot to the system after the Chicago winter we’ve had.

Last Thursday I had 2 biopsies taken for an Endometrial Receptivity Array (ERA).

As the name indicates the Endometrial Receptivity Array tests to see if the endometrial lining is receptive to implantation. (I encourage you to Google a more technical description to fully define the tests). Dr. Hail Mary wanted to run these two biopsies to see if anything was afoot in there since I’ve had three embryo transfers and no permanent residents. The test is done in the implantation window of your cycle (mine was done Day 23) following at least 5 days of progesterone (which I started taking back on February 14…..how romantic).

What’s the procedure like, you ask? Well, a speculum is put into place just like for a Pap, the cervix is cleaned off with a bit of iodine on what looks like a Q-tip on steroids, and then a pipette is snaked in. Once the pipette’s in place it’s moved around the lining and with a bit of a suction it gathers tissue for the biopsy.

It. Was. Not. A. Walk. In. The. Park.

Since I was having tissue drawn for two different test I had to go through this twice. (I’m not asking for your sympothy, just stating the facts….but it was a fucking crappy test). During the first one the nurse kept saying, “you are doing really great.” Now….I know that something likely needs to be said during these things, but perhaps me “doing really great” simply sprung from not swearing out loud like a men’s rugby coach or using my fists to punch at the table….likely “doing really great” mostly had to do with my ability to just lie still. I did get my deep breathing on – that was super helpful. If you ever have to do one of these just breath as deeply and as much as you can, it does make a difference – if not, you’re just…clenching, and that’s not going to do anyone any good.

It’s hard to explain exactly how it feels…..it’s loads of heavy cramping, for about 45 or so seconds, maybe a minute. Now I know that’s not a long time but if somebody had a pipette up your business and it was suctioning out bits of your endometrial tissue, 45 seconds is 45 seconds LONGER than you want that to be done.

The only ray of sunshine I can add is that 45 seconds really isn’t THAT long and when it’s over it’s over – instant relief. I think some Tylenol or ibruprofen would have helped if I’d thought of taking it beforehand….and afterwards I just had some lingering mild cramps (like a mild period) so I was fine. The tissue’s being sent off to a lab so it’ll be a few weeks before we know anything. We are of course aiming at a diagnosis of: Receptive. Though Not Receptive isn’t a deal breaker, it gives them info to work with and likely treat….so we’ll see when we see.

I’ll keep taking progesterone shots through the 25th – 1ml in the morning (right cheek) and 1ml at night (left cheek) – and then I’m to call them when my period ensues. Then it’s on the birth control pills, and if all these tests are fine then we’ll get started with IVF4 for reals.