The ivf doctor asked how many embryos are we putting back. I replied two. Oops, I forget to mention my grandfather has a twin brother. My mother has miscarried a set of twins. (Shhhh... Not pregnancy related complication...) secret!
What are the risk of multiple pregnancy? Many to mention... Preeclampsia is included in the risk. If we transfer two, chances are one may split into twins making the fetus = 3. Preeclampsia is very common for immunologic patient. I heard so many stories of 31~32 weeks pre term delivery. I don't like to decide. To me, having twins means I am dividing the survival chance by half.
Recently, I heard the sad story of the quadruplets. The mother has immune problem and she had a premature labor. Then one by one the babies died in the NICU. The last time I heard was only one left but still in the NICU. Preeclampsia is unavoidable. Complete bed rest cannot prevent it either.
Another sad story was my friend's wife had a preterm delivery because she suddenly developed immune problem during pregnancy. Both babies were sent to NICU, sad to say after a week of discharge, one died. The baby who died had retinopathy of prematurity. Oh my god!
If we put one only but it was not able to implant. This sounds like my coin tossing theory. One coin= 50% of getting a head. Two coins= 75% chance of getting at least a head. The embryo transfer cost is the same- no matter what is the count.
Finally, I asked my ivf doctor to decide for me. Hehe, he is smart! He just said we will decide this issue together. ^.^
http://www.oneatatime.org.uk/37.htm
http://www.oneatatime.org.uk/38.htm
Monday, January 5, 2015
Am I ovulating?- Surprise FET this cycle!
My menstruation came 5 days after my egg retrieval. That menstrual period was abnormally short, 16 days only. I remembered the ivf doctor said my period will come earlier. I need to wait til my period becomes normal and get back to him. I thought I needed two bleeds.
After my follicles were sucked out, I guess nothing left. I thought this was the reason why I don't feel like ovulating. No mucus discharge. My hormones went crazy. Google google... Ai... Better check it out from an obgyne.
Surprise! My endometrium lining is 0.97 cm and my follicle measures 1.96 cm. Wa! I had my urine LH test, It was still negative but there is a faint line already. It will turn positive by tomorrow. I am ovulating in no time. The impression of the ultrasound report says periovulatory. My obgyne was so excited.
To kill her excitement, I told my obgyne that we will use the estrofem cycle. She prefers the natural FET cycle. She said my endometrium lining is perfect and my follicle is ready. When am I flying to Hong Kong? What Am I waiting for? I suddenly felt the rush. When can I have Ivig? When Can I schedule a consultation with my immunologist? Oh my god, saturday night. At least, there is chance. I plan to fly out on Sunday morning.
I emailed my hk ivf doctor to ask the possibility of having the embryo transfer this cycle. Affirmative! I need to have my estradiol and progesterone tested tomorrow morning. Go! Sheila, go! I feel like I am a contestant in the Amazing Race.
After my follicles were sucked out, I guess nothing left. I thought this was the reason why I don't feel like ovulating. No mucus discharge. My hormones went crazy. Google google... Ai... Better check it out from an obgyne.
Surprise! My endometrium lining is 0.97 cm and my follicle measures 1.96 cm. Wa! I had my urine LH test, It was still negative but there is a faint line already. It will turn positive by tomorrow. I am ovulating in no time. The impression of the ultrasound report says periovulatory. My obgyne was so excited.
To kill her excitement, I told my obgyne that we will use the estrofem cycle. She prefers the natural FET cycle. She said my endometrium lining is perfect and my follicle is ready. When am I flying to Hong Kong? What Am I waiting for? I suddenly felt the rush. When can I have Ivig? When Can I schedule a consultation with my immunologist? Oh my god, saturday night. At least, there is chance. I plan to fly out on Sunday morning.
I emailed my hk ivf doctor to ask the possibility of having the embryo transfer this cycle. Affirmative! I need to have my estradiol and progesterone tested tomorrow morning. Go! Sheila, go! I feel like I am a contestant in the Amazing Race.
Saturday, January 3, 2015
Looking forward to consult my immunologist
After resisting him for quite sometime, I feel I trust him more than anyone else. I wish to schedule a consultation with him. I was surprised my HK hematologist has heard of "the midnight doctor". His fame has reached overseas.
My dear immunologist, what will you prescribe this time?
- clexane vs heparin?
- viagra?
- neupogen- yes or no?
- uterine pulsatility any comment?
Whatelse shall we discuss?
My dear immunologist, what will you prescribe this time?
- clexane vs heparin?
- viagra?
- neupogen- yes or no?
- uterine pulsatility any comment?
Whatelse shall we discuss?
Anybody joining my anti neupogen camp?
I am not campaigning against Neupogen or its bio equivalence. I found this web video promoting Neupogen. I saw this doctor's name appear in several blogs as well.
http://www.preventmiscarriage.com/Reproductive-Immunology/Treatments/Neupogen-Filgrastim-.aspx
------
I don't want to use Neupogen. I try to recruit people to join my side so that I can justify my decision on not using Neupogen. It seems nobody is joining me yet.
First potential recruit:
I told my ivf doctor, that I refuse to use Neupogen as prescribed by the hematologist. He said "Neupogen is mainly used in cases where IVIG or LIT have failed in the past. If you feel uncomfortable with it, then maybe you shouldn't use it at least for this cycle of treatment." Hmm... Sounds like he plans to use it in the future ya! One hour later, he emailed "He (hematologist) probably feels that given your immune record, it maybe helpful."
Second potential recruit:
A pharmacologist/toxicologist.
He said all medicines have some risks. if the benefit outweighs the risk go for it. With or without gscf cancer may occur. One or two shots of gcsf may not cause cancer. He has a point!
Third potential recruit:
I want to try my beloved immunologist(Phils) as my third potential recruit. ^.^ Hehehe
Who else?
My concern is Neupogen may cause cancer! Why not talk to my hematologist? After all, he is also a hematological oncologist. Times like this, I need to make my own stand. After all, this is my body.
http://www.preventmiscarriage.com/Reproductive-Immunology/Treatments/Neupogen-Filgrastim-.aspx
------
I don't want to use Neupogen. I try to recruit people to join my side so that I can justify my decision on not using Neupogen. It seems nobody is joining me yet.
First potential recruit:
I told my ivf doctor, that I refuse to use Neupogen as prescribed by the hematologist. He said "Neupogen is mainly used in cases where IVIG or LIT have failed in the past. If you feel uncomfortable with it, then maybe you shouldn't use it at least for this cycle of treatment." Hmm... Sounds like he plans to use it in the future ya! One hour later, he emailed "He (hematologist) probably feels that given your immune record, it maybe helpful."
Second potential recruit:
A pharmacologist/toxicologist.
He said all medicines have some risks. if the benefit outweighs the risk go for it. With or without gscf cancer may occur. One or two shots of gcsf may not cause cancer. He has a point!
Third potential recruit:
I want to try my beloved immunologist(Phils) as my third potential recruit. ^.^ Hehehe
Who else?
My concern is Neupogen may cause cancer! Why not talk to my hematologist? After all, he is also a hematological oncologist. Times like this, I need to make my own stand. After all, this is my body.
Snake and Ladder Game and my journey to fertility
I feel like playing the Snake and Ladder game. I am one month away from the embryo transfer. Now, I am trying to make my calculated move- trying to avoid the snakes. My game has reached its climax as I and my husband are about to reach our goal. I can see the finish line from here. I am nervously praying hard as I must get a 'five' in order to land on a safe space. In one more turn, we will safely reach our goal. My journey to fertility has lots of obstacles. If I roll a 'three', I will be bitten by the snake. And, I need to start over another round of frozen embryo transfer. If I roll a 'six', I will be bitten by the snake. And, I need another round of lymphocyte immunization therapy.
Everyone has finished playing this game already. I am the only player left playing! I am the unluckiest person who keeps on being bitten by the snakes. This game seems like an endless loop to me. Should I blame the dice? Should I blame the rules? Or should I blame my autoimmunity? Why did the other autoimmune patient make it to the finish line? We don't have control over the dice! I surrender to my fate!
What is important right now is to have little more patience. We almost there. Stay positive! Worrying does not increase our chance. If I am bitten by the snake again and start from square one, let us see. I hope I can safely roll a 'five' and everything will be smooth sailing.
I believe everyone can reach the finish line in the Snake and Ladder game. But, Idealism maybe totally different from reality. To me pregnancy is god's grace. What is ought to be shall ought to happen. If I have tried my best but nothing happens, then I should learn to accept my fate.
Lymphocyte immunization therapy, ivig, neupogen, viagra, clexane, prednisolone and whatelse... If this does not result into implantation, I will do pgs on all frozen embryos. If no still no implantation, yay! I surrender to my fate!
What is important right now is to have little more patience. We almost there. Stay positive! Worrying does not increase our chance. If I am bitten by the snake again and start from square one, let us see. I hope I can safely roll a 'five' and everything will be smooth sailing.
I believe everyone can reach the finish line in the Snake and Ladder game. But, Idealism maybe totally different from reality. To me pregnancy is god's grace. What is ought to be shall ought to happen. If I have tried my best but nothing happens, then I should learn to accept my fate.
Lymphocyte immunization therapy, ivig, neupogen, viagra, clexane, prednisolone and whatelse... If this does not result into implantation, I will do pgs on all frozen embryos. If no still no implantation, yay! I surrender to my fate!
Wednesday, December 31, 2014
Macrophage colony stimulating factor- yes/ no?
http://en.m.wikipedia.org/wiki/Macrophage_colony-stimulating_factor
" Additionally, high levels of CSF-1 expression are observed in the endometrial epithelium of the pregnant uterus as well as high levels of its receptor CSF1R in the placental trophoblast. Studies have shown that activation of trophoblasitc CSF1R by local high levels of CSF-1 is essential for normal embryonic implantation and placental development. More recently, it was discovered that CSF-1 and its receptor CSF1R are implicated in the mammary gland during normal development and neoplastic growth.[5]"
http://www.hindawi.com/journals/mi/2012/967629/
"While much research has been dedicated toward circulating cytokines in pregnancy, local cytokine production at the maternal interface may be of greater significance than measurements obtained in the peripheral blood [23]. IL-4, IL-10, and macrophage colony-stimulating factor (m-CSF) production by T cells at the maternal fetal interface is associated with successful pregnancy [23]."
http://www.drugs.com/sfx/neupogen-side-effects.html
"Oncologic effects may occur due to filgrastim (the active ingredient contained in Neupogen) effect as a growth factor with any myeloid tumor.[Ref]"
http://chemocare.com/chemotherapy/drug-info/granulocyte-colony-stimulating-factor.aspx#.VKS6S38ayK1
- csf and tropoblast growth factor
- Is there a growth factor for cancer cell? Does csf promote its growth?
- ehem ehem, why am I so particular with cancer. Hey, there is a risk for spleen rupture as well.
- anyway, if csf does not promote growth factor for cancer or tumor, i may give it a try
- wait... Csf promote white blood cell production or neutrophil only? I am thinking it will magnify my nk cell count.
Ei.... My dear immunologist, I walk to have a long chat with you. Grrr.... I hate "neoplasm". Excuse me. I admit I am an ignoramus. To me, neoplasm is synonymous to tumor or cancer. Grrr... yes or no? Oh no... There gm-csf, gcsf, m-csf sounds like different things? Google google...
" Additionally, high levels of CSF-1 expression are observed in the endometrial epithelium of the pregnant uterus as well as high levels of its receptor CSF1R in the placental trophoblast. Studies have shown that activation of trophoblasitc CSF1R by local high levels of CSF-1 is essential for normal embryonic implantation and placental development. More recently, it was discovered that CSF-1 and its receptor CSF1R are implicated in the mammary gland during normal development and neoplastic growth.[5]"
http://www.hindawi.com/journals/mi/2012/967629/
"While much research has been dedicated toward circulating cytokines in pregnancy, local cytokine production at the maternal interface may be of greater significance than measurements obtained in the peripheral blood [23]. IL-4, IL-10, and macrophage colony-stimulating factor (m-CSF) production by T cells at the maternal fetal interface is associated with successful pregnancy [23]."
http://www.drugs.com/sfx/neupogen-side-effects.html
"Oncologic effects may occur due to filgrastim (the active ingredient contained in Neupogen) effect as a growth factor with any myeloid tumor.[Ref]"
http://www.neutropenia.ca/about/patient-evaluation-and-treatment/treatment-for-severe-chronic-neutropenia
" The SCNIR collects information on SCN patients and pregnancy; however, the number of pregnancies reported to date is relatively small and thus little information is known about the potential effects of G-CSF during pregnancy. Therefore, the use of G-CSF during pregnancy should be evaluated individually with your primary physician, who can weigh the currently known risks and benefits of treatment in the context of your individual situation. Because the safety of G-CSF administration during pregnancy is not yet established, the current recommendation given by the experts of the SCNIR is that if possible, G-CSF should be avoided or minimized during the first trimester. You should discuss this issue with your physician well in advance of any decisions regarding pregnancy. It will then be possible for your physician to review the current pregnancy data with you and develop a plan for G-CSF dosing."
http://www.ptglab.com/Products/G-CSF-R-Antibody-18310-1-AP.htm
" GCSF receptors can be found on neutrophils, myeloid leukemia cells that respond to GCSF, bone marrow cells of neutrophilic granulocyte lineage, and on placental trophoblasts. "
" The SCNIR collects information on SCN patients and pregnancy; however, the number of pregnancies reported to date is relatively small and thus little information is known about the potential effects of G-CSF during pregnancy. Therefore, the use of G-CSF during pregnancy should be evaluated individually with your primary physician, who can weigh the currently known risks and benefits of treatment in the context of your individual situation. Because the safety of G-CSF administration during pregnancy is not yet established, the current recommendation given by the experts of the SCNIR is that if possible, G-CSF should be avoided or minimized during the first trimester. You should discuss this issue with your physician well in advance of any decisions regarding pregnancy. It will then be possible for your physician to review the current pregnancy data with you and develop a plan for G-CSF dosing."
http://www.ptglab.com/Products/G-CSF-R-Antibody-18310-1-AP.htm
" GCSF receptors can be found on neutrophils, myeloid leukemia cells that respond to GCSF, bone marrow cells of neutrophilic granulocyte lineage, and on placental trophoblasts. "
http://chemocare.com/chemotherapy/drug-info/granulocyte-colony-stimulating-factor.aspx#.VKS6S38ayK1
- csf and tropoblast growth factor
- Is there a growth factor for cancer cell? Does csf promote its growth?
- ehem ehem, why am I so particular with cancer. Hey, there is a risk for spleen rupture as well.
- anyway, if csf does not promote growth factor for cancer or tumor, i may give it a try
- wait... Csf promote white blood cell production or neutrophil only? I am thinking it will magnify my nk cell count.
Ei.... My dear immunologist, I walk to have a long chat with you. Grrr.... I hate "neoplasm". Excuse me. I admit I am an ignoramus. To me, neoplasm is synonymous to tumor or cancer. Grrr... yes or no? Oh no... There gm-csf, gcsf, m-csf sounds like different things? Google google...
Gonal-f, menopur, cetrotide drug interaction?
I feel dry eyes. A little blur vision. Oh my god...
http://www.ehealthme.com/Menopur-Gonal-f-Cetrotide-3735486
http://www.ehealthme.com/Menopur-Gonal-f-Cetrotide-3735486
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