Insanity or perserverance

Insanity according to Einstein is doing the same thing over and over again and expecting different result. Proverb says try and try until you succeed. Am I a loyal follower of Sun Yat-sen? Is perseverance a key to success or is it an act of insanity? After first batch and second batch (with heparin and aspirin) failed, what is next? IUI again? I want to give immunology a try or immediately proceed to IVF?

What if I had LIT and yet I fail my IVF? I heard somebody had 100% PRA but her IVF failed. What if I have my IVF first? I also heard many people had IVF but they knew they have immunologic problem only in the second trimester. 

Since, I doubted my immunology as the culprit of my infertility and I had suspected that I had a miscarriage on my 5th IUI, it is about time to follow my instinct. Refusing LIT will not increase the pregnancy chance. Another counter question is: will LIT increase my pregnancy chance?

After my long merry go round ride, I choose Immunologist2. I have lowered my resistance against LIT. I am volunteering myself as a guinea pig. If I join a combat, I will bring an amulet. Sad to say, there is no scientific evidence on the efficacy of amulet in winning a war. LIT is my amulet. LIT is banned in America because its efficacy is unproven. I will do hysterocopy (polypectomy) if it will increase my pregnancy chance. I will do endometrial scratching, if there is a need. I will wear lucky panty. (Just a hyperbole.)

I hope my crazy ideas is not a manifestation of insanity. According to Einstein, doing the same IUI procedure and strategy over and over again is a true manifestation of insanity. What is my next step?

Keep on trying! Maybe one day my perseverance can move the heavens. I may have success on my eleventh IUI attempt. If that happens, this will be my best Christmas gift ever! Go Sun Yat-Sen! Fight! Ooopss... I knew nothing about history!

I will keep my fighting spirit alive. I will have my LIT then polypectomy and then IVF. Come what may! I need to get a clearance and pregnancy go signal from my immunologist first. My husband karyotype result is annoying. I wished to check it out again as well.

6th IUI and second consultation to Immunologist2

I don't like to do IUI again. But since My Fairy Godmother extended one more IUI, I just complied. I have pending anti-sperm antibody result. It was withheld for quite sometime, because they need to check my husband's blood first before releasing it. The result was just release one day before our scheduled IUI.

On day12 past ovulation, I was able to schedule a consultation with Immunologist2. I told him, I want to have IVF first, before going back to see him again. He said my eggs will be swimming with TNF-a (tumor necrosis factor- alpha). It is a pro-imflammatory cytokine. At the time of harvest, my eggs will look great. However, after ICSI, the embryo development will be sluggish or poor development. I admire Immunologist2 for his exercising his maximum patience on pesky stubborn patients like me.

I don't believe in LAT (cross match test). Some people can get pregnant despite of 0% PRA. I believe fetal rejection occurs only during second trimester, I am safe for now. His reply: any damage to the placenta is irrepairable. Second trimester is the payback time.

At the end of the lengthy consultation,  I confessed that I had my 6th IUI. I will know the result within 2 days. I told him My Fairy Godmother said anti-sperm antibody can be circumvented with sperm washing. Crinone is a progesterone. It can take care of my uterine NK cells. He said my CD19 is high. CD19 is an antibody producing cell. No wonder I had developed an anti-sperm antibody. No doubt I may also develop anti-progesterone antibody.

After 3 days, I went back to My Fairy Godmother. My menstruation was delayed. Unfortunately, that evening, my period came. I had collected the large blood clot discharge and brought it to My Fairy Godmother. The discharge was crinone and some blood tissue. I also told her our discussion with Immunologist2. My Fairy Godmother asked me to have LIT. Did I hear this correctly? I thought she said LIT is banned in America.

I want to have LIT. I want to give immunologist a chance. After all, I was the one who suspected my autoimmune disorder as the main reason for my infertility. I refuse LIT mainly because of my cowardice!

I like take immunologist2's track record as his promise. He said he has 85% success rate.


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Immunology category5 problem

Eeny meeny miny moe

My Fairy Godmother's patient, who had born a 100% chromosome normal baby, had a Robertsonian translocation. It has 50% success rate. Most of the translocation, I saw in the web, is Robertsonian 45xy tranlocation. My husband has 46xy translocation.

PGS (pre-implantation genetic screening) is not allowed in the Philippines. Does good morphology mean normal chromosome? I guess not. I saw from the web ICSI results in 40% abnormal chromosome. I better consult a geneticist. I saw in the internet the pregnancy chance from 46xy balanced translocation carrier is less than 25%.

Imagine, I successfully retrieved 10 eggs, and 10 eggs were fertilized. What if only 7 are chromosomally normal. How does an embryologist decide which to implant?  Eeny meeny miny moe... Which is the fairest embryo of them all? Two embryo transfer? Quantitative analysis comes into play.What is the chance of picking implanting 2 good embryo? Combin(7,2)/combin(10,2). I almost failed in quantitative analysis back in college. I don't want to scratch my brains and I hate the eeny meeny miny moe!

In reality, the embryologist will be playing an eeny meeny miny moe on my embryo if we don't do PGS. I hope that embryologist is not the one, who did the crappy semen analysis. What if on the first few embryo transfer, all the transfered embryos are with chromosomal abnormalities? It will be a devastating experience for me.

If I do the IVF in the Philippines, can I freeze all the embryo and send samples abroad for testing?  

Not so fast, My Fairy Godmother said she wanted another IUI first before moving on to IVF. IUI again! Why? Grrr... She believed my husband sperm motility and morphology improved a lot. Was that a reverse psychology? I was afraid to have IVF before because I am afraid of OHSS ovarian hyperstimulation syndrome. Now, I am so eager to have ivf, then she wanted to try another round of IUI.

5th IUI part2

After consulting Immunologist2, I feel immunology is an intangible branch of medicine. I don't believe in those extra terrestial and unidentified flying objects. To me aliens and immunology are just fiction. I went to back to My Fairy Godmother after consulting with Immunologist2. It was day20 already. I regret I missed the IUI. She did a transvaginal ultrasound to check my Luteal phase endometrium. I told her I will believe in immunology only after I experience a miscarriage. I ignored my inner voice at that moment.

I told her my scary experience with Immunologist2. Nobody leaves his clinic without immunologic problem. Everyone needs LIT. I told her I retracted my request of having an immunologist. She asked me to consult Immunogist3. Either ways, I feel I cannot escape immunology. After more 10 days of resisting Immunologist2, I did all blood works requested by Immunologist2.

I was not able to visit My Fairy Godmother on day2. On day5, she said my follicle was too big for day5. Maybe it was a carried over effect of previous cycle's GonlF. This was not an ideal cycle for IUI to start with. She asked me to go back to her clinic 4 days after. I have no idea on what she was planning, I just followed her instruction. I was hoping she would do the IUI this cycle. Surprise! Good news: I was ovulating on the right side. She asked me to have Pregnyl shot on Saturday 5am. She scheduled our IUI on Sunday. Hospitals and fertility lab are closed on Sundays. Luckily, one lab is open on Sundays (by special arrangement). Bad news: karyotype result was released already. I did not have the courage to ask her about the karyotype result yet. I was thinking of the survival of the fittest sperm. I also inquired two Taiwan hospitals if they do abortion on grounds of chromosomal abnormalities. I cried again. But, I accepted my fate- come what may!

I thought this was an answered prayer. My husband's sperms were very motile and the morphology had jumped to 7%. This was a miracle.

The next day after the IUI, I went to My Fairy Godmother's clinic to check whether my follicle ruptured or not. Then, she shared her bad news about the karyotype. It is about my perspective, how I would see a glass as half empty or half full. She sees it as half full. She had a patient with chromosomal translocation who delivered a 100% normal baby. She extended one more IUI before we do IVF. She said my husband's sperms have improved a lot. I did not want to contest her. I was afraid she will blame me again for being pessimistic. I don't like another sermon. But, I gained enough courage to tell her that I really cannot accept the semen analysis result. How come the sum of motile and non-motile sperm exceeded 100%? For this reason, I don't believe in any of that lab's report. I don't believe in the 7% morphology.

After 14 days of waiting, I had spotting. I went back to My fairy Godmother the next day. She said my endometrium was thick and this was not a menstruation. She suspected pregnancy. I told her I have just passed large chunks of blood that morning. She asked me to come back 2 days after I experience larger blood flow.

Did I just experience a miscarriage?  Was it because of chromosomal abnormality? I guess not...  Why did she get mad when I asked if I had miscarriage? My stupidity, I did not use pregnancy kit. That product drives me crazy!  I felt guilty because I was just shopping for immunologist. I was not having any immunologic treatment. I doubted my immunology has cause the miscarriage. Did I have a miscarriage?

My first consultation with Immunologist2

I was scared by Immunology2 jumps to conclusion style of deduction and his leading questions. I wish I have brought a lawyer to defend me. I feel everybody who walks into his clinic has Immunologic problem!  After the consultation, I refuse to believe in immunology as the reason for my infertility. I regret of making a wild non-sense guess to my OBGYNE1 in trying to link an autoimmune disease (HLA-B27 spondyloarthropathy and uveitis) to infertility. 

I told him that if I failed in LAT (crossmatch test) PRA=0%, it doesn't automatically mean that I have immunologic problem. Somebody who never had blood transfusion, organ transplant and sex will have zero PRA (panel reactive antibody). Consider surrogacy case... a virgin... If we do an IUI on her, it doesn't mean she will not produce anti-blocking antibody.  I argued that my husband has erectile dysfunction. Limited semen exposure produced limited HLA antibody. No wonder my PRA is zero and my reaction code is 2 and 2.

I argued my CD56 NK cell count is just above the border. My result was 22.43 while St. Luke’s cut-off is 21. Immunologist2 argued that my NK cell is high. This is the reason why I seldom get sick. Grrr.. I am not as healthy as what he imagines. I complain he is using a cannon to kill a mosquito. What he is doing is really an overkill. He should make sure his cannon ball will hit the mosquito. Otherwise, it will be a laughing stock.

I asked if there are other factors aside from NK cells which contribute to my infertility? I have autoimmune disease, am I at higher risk compared to his other patients? He said I need to test Th1/Th2 ratio. (T helper cell 1 and 2 ratio).  Pro-inflammatory vs anti-inflammatory cytokine ratio. What the heck is this?

Since my NK cells are VERY HIGH and VERY ACTIVE, I need to test my NK cell Cytotoxicity. After 10 days of resistance, I had my blood sent abroad for testing. 

I can kill a mosquito with a swatter. I don't need to use a cannon. Btw, Why should I be resisting, after all it was just a blood test? (APR 2014)


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Reading material
Leukocyte antibody
Immunology category1 problem

5th IUI part1

My fifth IUI was a make or break. I had consulted an immunologist for the first time. I was prescribed with prednisone 10mg from day6 til next menstral period. I was also advised to have LIT (lymphocyte immunization therapy) 3 weeks after the IUI. What should go first IUI or LIT? I can read between the lines. I became undecisive because friends said they did LIT first. Is there any difference between third week after IUI and first week of next cycle? I felt Immunologist1 actions were biased. I did not get straight forward answer because she did not want to offend the referring doctor.

What would you prefer: IUI with NK cell highly active or IUI after NK cells are subdued? I prefer the latter. I cling on to hope that LIT is my silver bullet. LIT should be done first.

I called My Fairy Godmother to tell her I wished to cancel my IUI this cycle. But I was requested to see her at her clinic on day10. I went to her clinic as instructed. I also felt she and my immunologist had opposing opinion. I cried in her clinic as I told her my frustrations. Ooops... I made a white lie to cover up something. My Fairy Godmother was mad at my immunologist. I told My Fairy Godmother that I never confirmed the LIT, I was waiting for her go signal. My Fairy Godmother said LIT and IUI can be done simultaneously in one cycle.

I did not know who to trust. After a lengthy conversation, I agreed to proceed with IUI. She gave me a GonalF shot. Two schools of thoughts, either ways I can reach my goal. I chose to trust My Fairy Godmother. Then, I remembered OBGYNE1 last statement: no iui or ivf shall succeed if I have immunologic problem- this became the voice of my conscience. Grr... the voice my conscience is very noisy.

What should I do? There might be several other factors for my infertility. I was not absolute that my ultimate cause for infertility is immunology. Ah! Call my godsister- she is also a physician. If she did the LIT, ergo LIT must be safe. I will just follow her footsteps.

I cancelled the fifth IUI. No pressure, I can have my IUI again next cycle. The sad thing is : I just have offended My Fairy Godmother.

4th IUI

My Fairy Godmother's plan: 2 IUI first before IVF.

She believes immunologic factor is a secondary cause of infertility. She had requested my husband to have chromosome karyotyping because he has OATS oligoasthenoteratozoospermia. Hormones for husband and me...LH, FSH, Prolactin, Estradiol, etc...

Anti-mullerian, etc... For me. The only proven treatment for APAS (anti-phospholipid antibody) and ACA (anti-cardiolipin antibody) is heparin and aspirin. 

It was one day prior to ovulation when I had my first consultation with My Fairy godmother. We did the IUI the next day. I love about her aggressiveness. She suggested a double collection. Double insemination. But unfortunately, we never tried it.

I had a delayed period. I thought this was my fairy tale pregnancy! After I had endured the pain and bruises brought by heparin, but there was no reward. It was devastating to learn  that my endometrium did not get thicker after 2 weeks. 

Don't question why heparin... Heparin injection can be done after confirmed pregnancy but she prefers it to be injected immediately after IUI. She wants to improve pregnancy chance.  

I ovulated on the left. I suspect my left fallopian tube is blocked. I hope my problem was fallopian tube not immunology. I did my HSG with OBGYNE1. She believes my fallopian tubes are not blocked. Because she did the procedure but the radiology report shows otherwise. OBGYNE1's statement still reverberates at the back of my mind. No iui or ivf shall be successful if I have immunologic problem. For this, I requested My Fairy Godmother to hand me over to a reproductive immunologist. I just have the feeling she played blind on my LAT.