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  • New Person Needs Guidance

    Hi:

    I am new here, and was hoping to converse with others who are going through similar struggles. Hopefully I can receive some advice, words of wisdom, and support...I feel very isolated in this situation, and am driving myself, and everyone around me nuts!

    My background....I am a female, 27 yrs old. I had precocious puberty, started menstruating at age 9, and have had problems from the start. I was first diagnosed with endometriosis at age 16. Was put on Lupron for one year... that was a diaster, and lead to serious and permanent health complications. I didn't learn of the dangers of the drug until after I had been on it for several months, and began to lose portions of my vision, and use of my hands. My endo returned following treatment and continued, despite having my 5th laparoscopy this past March.

    I was diagnosed with Systemic Lupus in 2001. I started becoming very skilled at growing large endometriomas in 2002, for some reason, but never had them before. My largest has been just over 10cm. I was also diagnosed with Hashimotos Thyroiditis and Raynaud's in 2003. Continued to have laps, and the endometriomas recurred sometimes as early as three weeks following surgery. (They took a whopping 6 weeks this time - I guess I should consider myself fortunate!) I've had a few ruptures and one twist, but fortunately, it straightened out on its own. During my lap in 2007, I had an upper endoscopy, and was diagnosed with Autoimmune Atrophic Gastritis, which typically occurs in older people. It explains my constant stomach pain, B-12 and iron absorption problems, but is unfortunately incurable. It can lead to cancer, so I am scoped every 1-2 years to check for cellular changes. In addition to the Lupron "treatment", I have tried a variety of birth control pills, progesterone, physical therapy, biofeedback, and finally, was put on morphine to control the pain, as the repeated surgeries are just adding more scar tissue, and do nothing for me long-term.

    My goal in life has always been to become a parent. I hoped to adopt one day when I'm older, however, I would like to have one biologically as well. After losing my beloved grandmother last year, whom I was full-time caregiver to for four years preceding her death, it has become extremely important to me to be able to have a baby. My partner and I have been trying unofficially since October of 2007, no luck yet.

    Following the surgery this past March, which showed worsened endo, adhesions, and some loss of flow in the left tube (had the dye test too), my OB/GYN felt that it's imperative for me to have a baby as soon as possible. My other doctors aren't thrilled with my decision to have a baby due to my many health problems, however, they feel that if I am going to do it, it also needs to be soon, as the medical risks will increase with age and progression of the Lupus. I also need to be on immunosuppressives, which I cannot do while pregnant or TTC, so they are in support of the need to move things along, so that I can get back on treatment as soon as possible after the birth.

    I started going to a high-risk OB evaluation, and then to a fertility center in late March. They are very nice, but I have to admit that I've been feeling a bit lost in the process. We did one cycle of Clomid and Novarel (HCG) injection. My partner and I did things naturally at home otherwise, no insemination yet, but they said that I ovulated well (watching ultrasounds and bloodwork) and that we could try it that way for a month. I was very disappointed to hear that it didn't work. I felt crummy while on the meds, very emotional, had some blurry vision, and very bloated. I also felt like my cyst was recurring...but I had really hoped that it had worked.

    When I went in for my first cycle day ultrasound and estradiol test on Friday, I was surprised to hear that the cyst, which resembles an endometrioma, is back on the right ovary, at around 7 cm. The left also has several large cysts/follicles still there. The nurse called me later and told me that I couldn't take the medication this month because my estradiol is in the 500s, so we had to give it a cycle to calm down. I was SO upset...I had no idea that could happen, and the idea of losing a whole cycle really disappointed me.

    I realize that some women have struggled with this for MUCH longer than I have, so I hate to complain about it to anyone. I guess the medical risk factor of my other diseases, the fear of the endo and infertility worsening quickly, and how crummy I've been feeling since starting the drugs is contributing to my sense of urgency, and the feeling that losing 28 days is a tragedy. Then my rational side kicks in and I feel silly, because in essence, it's only one cycle, etc etc.

    I am having a meeting with the fertility dr this week so that we can go over everything again. I have so many questions...such as, what if the estradiol doesn't go down, what if this happens every month, and what if we go to stronger injectables, will it lead to ovarian hyperstim., if I reacted like this to just Clomid and HCG...etc.

    Does anyone have any advice or words of wisdom to share? Is there anyone else on here who has other serious medical issues, and is trying to get pregnant anyway? And as a question to everyone and anyone...HOW do you manage the worry that comes along with the process? I am only in the very beginning stages...but now I feel like everything is a concern. I know that it's important to relax, but I think that may be a lost cause in my case! I try to keep things light and maintain a sense of humor, but internally, I feel like a mess. I just cannot seem to control the worry and frustrations...I don't know if it's the hormones or what. I am covered with pimples for the first time in years, so I think they may be playing some part in this.

    I also worry that if I am able to conceive, there are SO many things that can happen even then....multiples, ectopic pregnancies, miscarriage, problems with the pregnancy, preeclamsia, premature births, stillbirth...Sometimes I feel as if it's a wonder that any babies are born in this country, with all that can go wrong! Yet I see on a daily basis how many women get pregnant and have children so easily, sometimes even when they didn't want to...it's very hard to get a grasp on that.

    Would appreciate any comments possible...feel free to email if you prefer.

    Thanks,

    Kimberly

  • #2
    Hi Kimberly

    Hi Kimberly - you sound as though you have had more than your fair share of health problems - way before you got on the infertility train - so I think that people will understand your anxiety despite, being in the earlier stage of the 'official' ttc process.

    I am sure that you are aware that both SLE and hypthyroid can influence fertility and it is especially important for you to also be aware of the risks of ovulation induction (stimulation) if you are in an active phase of your lupus (make sure you discuss all of these things with your RE etc). You don't mention any medications that you are on currently or what your nutrition/lifestyle and exercise routine is. This is important with respect to understanding which drugs can influence pregnancy and miscarriage rates - and there are some things that you can do to mitigate their risks. If you believe that you are doing the best that you can for yourself with respect to lifestyle (which is where I belive you have the most personal influence) you might also want to consider consulting with an acupuncturist. Not because I don't think that you also need to be seeing your medical doctor but because you sound as though you are looking for a way to take back some power over your body. THey will generally make signficant dietary recommendations.

    Were you seeing a physical therapist to address your adhesions/pelvic pain? typically I have found this to be helpful if the predominant intervention is manual therapy - biofeedback is used to assist in muscle relaxation or down training but does not help to mobilize 'stuck tissues'.

    Your fear is understandable - you have been thrown an enormous amount to deal with in your 20 + years - finding a way to live in the circumstances you are in as well as those ahead with a little less trepidation and a little more confidence is not impossible. I would encourage you to see whether there is a chronic pain program in any of the hospitals near you that offer a 6-10 week mindfulness/stress reduction workshop. THese classes provide essential support and a number of strategies that can help you to reduce your day-to-day anxiety. There is good research out now that also demonstrates that this approach has a beneficial influence on our immune system and overall health.

    Your medical history tells a long story or hormonal instability and it is likely that your body is extremely sensitive to both external and internal disruptions to your endocrine system. (Maybe this is why your estradiol remained so high after the first stimulated cycle). You might talk to your doctor about doing a natural ivf cycle should things come to that - I think given your history this is a viable option. In addition, you might also think about surrogacy which would allow you to have a biological child without the compromise to your health that a pregnancy would bring. I appreciate that these are all difficult things to consider this early in the process but you seem well infromed about your other health concerns and it is important to ask as many questions as you can as early as you can so that make the best decision.

    I am sure others will offer feedback to. If you are interested in a 'live'
    support group in your area you could contact resolve - of if you ar ein the USA I could help you find a counselor who specializes in your issues - sometimes one or two visits really helps (although more is good too) - best to you, in kindness Liz

    Comment


    • #3
      New Person Needs Guidance

      Hi Liz:

      Thanks for your comprehensive response!

      >>>>both SLE and hypthyroid can influence fertility<<<

      I did see a high risk OB, my OB/GYN, an RE at Tufts, and my Endocrinologist at MGH. The latter felt that because I respond well to my Levoxyl therapy, it should not affect my fertility. The others feel that the greater risk concerning the Lupus is what will happen after I conceive. They feel that the more significant barrier I am facing is the endometriosis.

      >>>also be aware of the risks of ovulation induction (stimulation) if you are in an active phase of your lupus <<<<

      What are some of the risks, and where I can read more about them? I am having trouble finding specific information online. I do think that the meds caused a flareup in my system in general....increased allergic response (itching, rhinitis worsening, etc), skin rashes, more fevers, worsened arrhythmia, more pain, anemia values down again despite being on treatment, etc. I am meeting with my RE tomorrow and will discuss this with her as well.

      >>>You don't mention any medications that you are on currently or what your nutrition/lifestyle and exercise routine is.<<<

      I could've sworn that I did...perhaps it was in a different section. I am on Levoxyl 0.75 mg, took Clomid 100 and HCG injection last month, and take Hydroxyzine or Zofran as needed for my stomach. I do take morphine sulfate for pain, however, I stopped during ovulation, and did not take it again until I confirmed that I was not pregnant, just in case. I get iron infusions and B-12 injections regularly as well. I am taking folic acid, vitamin D, and vitamin c. I do not drink or smoke.

      I am supposed to be on Cellcept and/or Imuran to try to treat the Lupus and overall autoimmune situation, but obviously can't do so now. The goal is to get me pregnant as soon as possible, so that I can get back on treatment as soon as possible.

      In terms of the acupuncturist, I've heard of people doing this...but I wonder if it is mere concidence? Is there any documentation on the web surrounding studies that have been done on this? I understand that it can't hurt, except for my wallet, as my insurance doesn't cover it....so I'd prefer to see some empiracal evidence before parting with the cash.

      >>>Were you seeing a physical therapist to address your adhesions/pelvic pain?<<<

      What is manual therapy? Are there any practitioners in the Boston area who offer this, and if so, where can I find them?

      >>>I would encourage you to see whether there is a chronic pain program in any of the hospitals near you that offer a 6-10 week mindfulness/stress reduction workshop.<<<

      I actually have gone that route before. I have experience with mindfulness workshops. I have had two people in my family who have BPD, so I joined a family support group and workshop for this several years ago, and continue to go to some meetings as I can. Most importantly, I saw a pain psychologist at Tufts for five years. She was wonderful, but has since left the practice. She helped me with many issues over the years, in addition to the biofeedback/relaxation. However, I'm a work in progress (or perhaps, just a piece of work?? :-) and have asked my OB/GYN to help me get in to see the women's health psych at our hospital. I think that the continued support would be beneficial - This is a very stressful process, and while I certainly do not want any medication, some more specific coping strategies would be very helpful.

      I did try to find someone on my own after my prior psych left, but didn't have much luck. They were nice, but no one seemed to be the right fit for me. I really need someone who is familiar with medical problems, so this practitioner seems ideal for me. Of course she doesn't take my insurance, so we're submitting a form to see if they'll grant special coverage. Perhaps I should threaten to call the insurance co. on a weekly basis, and share my problems with their reps instead...bet that approval would be granted in no time! >:-)

      >>>THese classes provide essential support and a number of strategies that can help you to reduce your day-to-day anxiety.<<<

      Yes, I have been really wound up lately, despite having learned stress reduction techniques. I don't think that the hormonal fluctuations are helping! I will have to look into that.

      >>>You might talk to your doctor about doing a natural ivf cycle should things come to that - I think given your history this is a viable option.<<<

      Yes, that's what everyone has been telling me...except for my own RE - That's the scary part! I'm wondering if I did the right thing by just automatically going to this clinic. I never even checked them out, and probably should seek a second opinion on something this important. I will definitely bring up these issues with her tomorrow, though - perhaps there's a reason, based on my medical history, why they want to do things this way.

      >>>In addition, you might also think about surrogacy which would allow you to have a biological child without the compromise to your health that a pregnancy would bring.<<<

      Well...that's really not an option for me. I don't know anyone personally who could do this, and I would have some serious concerns about hiring a stranger. The money is an issue as well, as the insurance doesn't cover them in full. One of the benefits to my being pregnant (yes, there is one benefit!) is that it may help improve my severe endo, which it did for both my mother and grandmother, for several years. I REALLY don't want to resort to a hysterectomy this young, and from what I've heard, has not always ended up relieving all of the pain.

      I appreciate that these are all difficult things to consider this early in the process but you seem well infromed about your other health concerns and it is important to ask as many questions as you can as early as you can so that make the best decision.

      >>>resolve - of if you ar ein the USA I could help you find a counselor who specializes in your issues<<<

      I am in Boston, and have Blue Cross Advantage health insurance (it's an EPO.) Any help is definitely appreciated! I will also look up the URL for RESOLVE...I have heard of this before, somewhere...

      Thanks again for your note!

      Kimberly

      Comment


      • #4
        Boston is a good place to be...

        Kimberly I would encourage you to contact the Domar Center for Mind Body Medicine (link below) - as far as I know this 6-10 week program is covered by insurance as this is mandated in the state of MA.

        http://www.domarcenter.com/

        The information below might be helpful - found at the following link:
        http://www.medscape.com/viewarticle/578245_2

        From my own experience with clients in your position they are often placed on anticoagulants and have undergone natural and stimulated IVF cycles - the decision to do either is dependant upon a lot of things. It is true that pregnancy is often considered 'therapeutic' for endometriosis and only your RE with all of your records in front of them can help you to decide which direction to take. I understand the concern regarding acupuncture - The Domar Center should be able to provide you with the empirical data referencing acupuncture - it is my understanding that the major benefit to TCM is the improvement in blood supply to the pelvis (improved lining) and improved ovulation/cycle length. You can look up some more articles at the following link: http://www.ncbi.nlm.nih.gov/pubmed/16616748
        Impact on Fertility and Pregnancy

        Antiphospholipid antibodies (aPL) found in 20% to 35% of lupus patients are autoantibodies that are associated with recurrent reproductive failure and thrombotic disease; however, the exact cause of reproductive failure remains unknown. Infertility management is further complicated by the increased thrombosis risk for women with aPL antibodies during ovulation-induction. Ovulation-induction therapy should be restricted to patients with inactive disease, and these patients should be counseled that aggressive anticoagulation (aspirin and/or heparin) would probably be required along with increased corticosteroid suppression.[3] In the absence of aPL antibodies, however, little data suggest that SLE by itself is a major cause of either female or male infertility.[4] With active disease, menstrual alterations ranging from menorrhagia to temporary amenorrhea, and premature ovarian failure, infertility is not uncommon. Infertility in both men and women has been most closely associated with the use of the alkylating agent cyclophosphamide, used for the treatment of severe SLE, and disease activity. Female patients over the age of 35 years given cyclophosphamide almost invariably develop infertility as a result of drug-induced ovarian failure, but this is much less common in women under the age of 30. Severe gonadal failure with transient or permanent azoospermia occurs in 50% to 90% of men treated with cyclophosphamide. Sperm banking remains the only proven method of fertility preservation in males.

        Best of luck to you - please come back and let us know how your appointment went - kindest Liz

        Comment

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