Fatty acids on board

This morning I returned to the RE for my first Intralipid infusion.  It was my first time at the RE since I triggered ovulation, and my first experience with Intralipids (ILs).  Despite a morning of firsts, it was a pretty boring event.

My vein milkshake

I’ve been aware of ILs for a while now, but up to now have always had doctors who strongly poo-pooed both ILs and the entire world of immunological infertility and miscarriage.  Back in my young, naive, spry days I remember asking RE#1 about immune implantation failure and ILs or IVIG and his immediate response was, “Get off the Internet!”  My inner self replied, “As soon as you get your head out of your ass,” but I smiled, thanked him for his time (why do I do this when all I can think is what a waste of my time such visits are), and went home to bitch to my friends in the computer.  So, though RE#2 is by no means my favorite person in the world and he often makes me miss RE#1, I was happy to discover when pursuing his website before making our move that he did at least do some therapies aimed at the immune system.  Granted, he does no immune testing, his NPs and nurses no less about the therapies than I do, and he blindly moves all repeat loss patients (RPL) to his cookie cutter RPL protocol (Lovenox, Baby Aspirin, ILs) without a thought toward their history or medical background, but even when motives aren’t quite pure, the results can still be positive.  And, I’m feeling positive now that my own Intralipids are on board.

Intralipid is a brand name for a type of fat emulsion.  Basically, the “medicine” is comprised of soybean oil, egg yolk phospholipids, glycerin, and water, and is administered via an IV drip.  The substance was initially created to help nourish adults and infants who are unable to get sufficient nutrients.  At about 2,000 calories per infusion (ack!) that makes perfect sense.

Somewhere along the way, however, it was postulated that ILs could also correct immunologic dysfunction in the uteri (yes, hah, that’s the plural) of women experiencing infertility, repeat miscarriage, or repeat IVF failure with normal-appearing embryos.  As Dr. Braverman explains, “Intralipids have a suppressive action on certain components of the mother’s immune system, essentially safeguarding the embryo from the immune reactions which might otherwise result in a miscarriage.”  As the lucky recipient of two autoimmune diagnoses (Hashi’s and Raynaud’s), the sufferer of three miscarriages (including one 9 week loss of a normal-looking, strong heart beating almost fetus), and the owner of a set of crazy and yet undiagnosed autoimmune lab results, I’ve decided it’s time to throw everything there is at this trying to conceive shit and see what works.  I believe in my heart something immunological is happening to cause my abnormally low progesterone and HCG and to interrupt my pregnancies.  We know my immune system is already fucked by i’s propensity to attack itself, so why is it so strange to think it’s also attacking babies?  I’m loudly shaking my head along to Dr. Sher who writes, “In my opinion, it is very regrettable and unfortunate that so many patients are denied the ability to go from ‘infertility to family’ simply because (for whatever reason) so many reproductive specialists refuse to address the role of immunologic factors in the genesis of intractable reproductive dysfunction.”  Preach it Dr. S!  So even though medical researchers are still spouting the same, “appropriately controlled, large-scale, confirmatory studies are necessary,” hurry up and wait, I had 2,000 calories of egg yolk and soybean oil injected straight into my vein this morning.  Breakfast of champions indeed!

Now, normally ILs would be given a few days prior to ovulation, a few days after, and then again sometime in early pregnancy.  This is what I wanted, this is what we planned, this is the proper way of things.  But, when we mapped out this entire cycle back in March Intralipids were on a nation-wide back-order at every specialty pharmacy currently covered by my insurance.  I frantically messaged my NP through our patient portal, told her I couldn’t get the Intralipids, and asked what to do.  She replied with a simple, “Oh, yea, they’ve been backordered for a while now.  We’ll make do without them.”  I’m glad she was so fucking calm, because I most certainly wasn’t.  Then my high ANA was discovered and I was left hanging in the breeze, unable to try and conceive, stuffed full of birth control pills again, and waiting for the world’s most unhelpful doctor visit to pass me by in mid-May.  When this cycle started we reviewed the meds I had in my possession (those gathered for the March cycle that never happened), I got poked, I got probed, and the rest was history.

At my final follicle check before I triggered I had the “good” NP (and not the “chipper” NP, the “grumpy” NP, or the “clueless” NP I’d had for prior scans that cycle) and she dutifully asked me to review my history and the plan for the cycle.  I explained it all and she asked why we weren’t doing ILs.  I told her I’d tried in March but was told it was hopeless and there were none to be had.  She informed me that they had a new supplier and that I really should be doing them.  I agreed immediately.  She wanted to book me the next day (the day of my trigger) for my first infusion.  And here’s the hiccup.  First, the meds had to somehow be ordered, approved by insurance, paid for, and shipped across two states in under 24 hours.  Doable (I’ve done it with PIO before), but not exactly stress-free.  Second, and the bigger deal, I would need to take an entire morning off work with only a few hours notice.  With an hour drive each way to the doctor, and two hours spent in the chair receiving the drip, that’s at least a 4.5 hour absence.  I have freedom to take time as I need and my boss has been quite supportive, but I just couldn’t do it.  So, I didn’t get my pre-O dose in.  I’m not incredibly concerned about it, but I am annoyed by how it happened.  Between my baseline and my final scan I had 5 appointments with the RE to discuss my protocol, yet only at the last was this question (a question I would have never thought to ask myself) raised.  Once again, my treatment is being dictated by bad timing.  Next thing you know I’ll have the gall to miscarry again on a weekend!

The infusion itself was, I don’t know, what’s the word?  OK?  Fun?  Not terrible?  Oddly relaxing?  Honestly, it was probably my best trip to the RE because 1. no talked to me much, and 2. I didn’t have to take my pants off.  (Yes, the things that make for a very bad night on the town, make for a very good visit to the RE.)  It’s strange the things I worry about in advance of my appointments.  Last night I wasn’t remotely concerned about the infusion itself – the needles, the drip, the visual, the waiting.  What I was concerned about was what they were going to do with me, where they were going to set me, what my surroundings would be like.  I’ve complained before about my ski chalet fertility spa clinic, and this is perhaps a topic I should expand upon a little more in future weeks, but long story short, I hate feeling like I’m being pandered to, like my medical condition is being minimized, like only aggressive femininity is catered to by my fertility boutique.  The Bose speakers blasting tranquil bird and water sounds, the Keurig in the lobby, the overstuffed furnishings and fireplaces, and the spa out back do the exact opposite of relax me; they enrage me.  So, my biggest fear with the Intralipids was that they would set me in some dimly lit cave of tranquility while administering them and that the entire time I’d be getting increasingly annoyed that my fate had come to this.  Me, the gal who hates getting her hair done at a salon, the woman who’d prefer a beer and football to wine and a chick flick, left to fester in a doctor’s office most convincingly camouflaged as a day spa.  Talk about the awful things IF has done to me!

I should definitely get overtime for this!

To my great pleasure, however, I was whisked away to a bright and sterile procedure room, instructed to sit in an exam chair that reclined to a lounge position, given a warm surgical blanket, and asked to review my history and sign several consents.  Once the IV was in I was handed the water bottle and laptop I’d smartly brought from home and more or less left to my own devices for the next 2 hours.  I got a little work done, worked on the questions I’ll be asking when Mr. But IF and I host our village’s weekly trivia night on Wednesday, and before I knew it time was up.  It would have been perfect save dealing with the pulseox monitor they required me to keep on my finger, which greatly inhibited my typing.  (I was hoping to post this from my chair this morning!)

Now we wait.  My first pregnancy blood test is a week from Monday.  Hopefully the milkshake my veins just drank in does some good, and even if it doesn’t my morning alone with my laptop and thoughts certainly did.