Past and Present; or, How to Handle a MTHFR

Thanks to everyone who commented or e-mailed me with your advice on last Friday's post. Your suggestions were invaluable and have helped clarify some things for me. I'm so grateful to have a community of women who have been in this position to turn to when things become challenging.

Lawyer Guy is going to find out the max allowance for the FSA today, which should help clarify matters. He's also going to confirm that fertility treatments are permissible expenses (I'm sure they are, but we want to be extra-sure). Additionally, a friend of mine from my message-board support group (who is currently pregnant) offered to mail me several unused gonal-f pens of hers, enough it seems to get me through one round of injectibles+IUI. Given all this, we're leaning really heavily to putting $5000 or so in the FSA (or whatever the max is) and trying to do at least one, maybe two IUI cycle with injects. If the meds are free for the first it will be quite reasonable to pay for both, and I agree with all my bloggies who said it's a good way to test out my response to the stims before the high pressure of an IVF cyle commences.

Obviously, this is all contingent on the outcomes of the next few cycles and our conversations with Dr. W. But I feel like I have some perspective on the situation and a plan, and that always helps.

Also giving us some clarity (though not as much as we'd hoped): Dr. W's office called with the results of my RPL testing today. I tested positive for hetero MTHFR mutation, but everything else was normal. The nurse said that Dr. W is not concerned about the hetero mutation and doesn't fall in the camp that associates it with higher risk of pregnancy loss. The only snag is that the lab didn't test my homocysteine levels, so I need to have another draw to test that when I go in for monitoring for my January Clomid+IUI cycle.

While I'm a little nervous about the hetero MTHFR, I'm beyond relieved that I have no translocations or abnormalities on my karyotyping (and that LG is also free of them). Hetero MTHFR seems to be very common, and I've seen many women identified with it who have healthy pregnancies, so I'm going to hope that it won't cause any harm and that my homocysteine levels come back normal-- or, if they don't, that there's an easy fix for that.

Other than some reflection on hypotheticals and a smattering of test results, not much is happening reproductively right now. I should be getting back together with Pissy in a few days. I think she'll be happy to see me again, but you never know with her. I'm still buried under a mountain of student essays to grade, and after I finish that comes the preparations for Christmas, and then our New Year's trip to the Bahamas, and then AF right when we get back. And then it's 2011 and a new year and a new cycle, and this time a new year is going to actually signify something new for us, dammit.

Doctor's Orders; or, The Follow-Up

Dr. Wonderful called this morning to discuss yesterday's results. It was a good conversation--a little scary, but also reassuring and she took lots of time to answer all my questions.

First of all, she said she thinks it's a positive sign that we achieved a pregnancy, even if only a chemical one, in our very first attempt at an IUI. She said this shows her that the treatment can work for us. I'm going to take that and try to find comfort from it.

She then told me to prepare myself for this pregnancy not to last, and I said that I'd basically been anticipating that ever since I saw those ghostly shadows of lines on the pregnancy tests. Those were not lines that suggested a promising ending.

She said she considers this a different category of loss than our miscarriage and that chemical pregnancies are extremely common and an "underdiagnosed" condition. It may be just a fluke--a less healthy egg that happened to be produced and fertilize, which she said all women have.

But we're still going to do an RPL (recurrent pregnancy loss) panel once my betas get back down to zero--karyotyping on Lawyer Guy and me and clotting disorder testing on me. Dr. Wonderful warned me that this will involve a lot of blood work for me. Lawyer Guy is going to see a urologist and Dr. W said that his new doctor may recommend additional testing of LG's sperm based on the morphology stats.

At the same time, we're not going to hold off on treatment until the results come back. Dr. W said she's ordering the panel because she wants to be thorough and leave no stone unturned, but she doesn't think that anything will come back positive. Once my levels drop and I get my period we'll start the RPL testing and also begin treatment for next cycle: another dose of Clomid and another IUI.

Right now I feel a lot of conflicting emotions. I'm glad that Dr. W wants us to go forward with treatment; I'm glad that she thinks we've got a real shot at a healthy pregnancy with IUI; I'm glad that she thinks (or at least says) that the RPL testing is more of a formality than anything else.

And I'm also scared that I've now had a second loss. Even though chemicals are so easy to miss that many, many women may have had them without knowing it, I'm still bummed to be in that tiny category of women that have more than one lost pregnancy. Ever since we lost the m&m, this was my greatest fear: that we would have trouble both conceiving and maintaining pregnancies. That each year we'll get pregnant once only to lose it (I'm eerily prescient, aren't I?).

I'm trying to hold onto the hopeful stories I know--the many women who've had chemical pregnancies and losses and yet are currently cooking babies that seem to be doing well: People like Leslie and Al and Mo. And it's also encouraging that I've now got a doctor whose expertise is exactly this-- someone who responds to unexpected flukes with "Let's be thorough and check everything out" rather than "Eh, chances are everything's okay. Stop worrying."

And like I wrote yesterday, I don't feel like I lost a child, though I also feel considerably more miserable than my usual BFN funk. I never had one moment of "Yay, I'm having a baby!" and I never felt certain that there was anything growing and living inside me. But I also let myself imagine a little--I imagined telling family and friends at Thanksgiving; I imagined bringing 6-week-old twins to my sister's wedding. And those daydreams, fun while they last, create an awful sting when they fall apart.

I guess I'll just sit here for now in this very comfy chair and maybe read a little and try to sleep. And hope that things will seem brighter and more hopeful tomorrow.