Small Prolactinoma

by Jessica Jaruczyk
(Clark, NJ USA)

Hi Amelia,
My name is Jessica Jaruczyk and I live in Clark, NJ. I am going to be 41 next month and just recently had a failed IVF. I had two children naturally from a prior relationship. My husband and I concieved naturally when I was 29 and had a healthy baby boy at 30. Two years later while still nursing I concieved naturally and we had a baby with Trisomy 18. He passed away 26 days after birth Then for 7 years we tried to concieve but could not. We pretty much gave up.

After a physical, my doctor told me that I was very anemic and low in vitamin D. I decided to take a natural form of iron and D3 as well as to eat organic meats and foods. To my surprise about 8 months later I became pregnant and was told my progesterone was low but my HCG looked really good, however I miscarried at 8 weeks (September 2, 2012).

At that point I started researching and my husband and I did a cleanse and eliminated all sweets from our diet as well as dairy and enriched flours. We only ate organic friuts, vegetables, chicken, turkey and certain fish. I began drinking coconut milk and continued taking my new chapter prenatals. I made sure my creams and makeup were organic or at least natural.

I added a filter in my shower and only drink filtered water in a BPA free bottle. I tried to become the most healthy I could. We even tried acupuncture for a month with a Chineses herbalist in NY but it was getting expensive and the distance was inconvenient, so we could not continue.

We decided to go to a fertility clinic as my insurance covered IVF. They ran tests and found that I had a high prolactin levels (32) and sent me for an MRI. It confirmed that I had a small prolactinoma (about 3cm) and they put me on Bromocriptine to lower my levels. They did say however that I had a good number of egg reserve.

They said that my husband had poor sperm motility and morphology and because of my age and the Prolactinoma that our best bet was IVF with ICSI. I was uncomfortable with all the drugs being that I had worked so hard to get healthy but we went ahead with the IVF, but without the ICSI as we were not comfortable with that. We got 12 eggs and 9 fertilized naturally. We transferred on January 3, 2012, 2 embryos and were told that my uterus looks great but they did not implant, we did not freeze any. It did not work and now I am trying to cleanse myself of all the drugs. I purchased the natural fertility cleanse kit, ovuwise and am doing fertility massage with castor oil from the natural fertility shop. I am not sure what else to do. After paying for medications and cleanses and organic foods and vitamins the money belt is getting tighter.

Please if you can please help me and give me some direction. My husband wants to go back to his pre trying diet and enjoy a glass of wine because he doesn't think it will make a difference if we got pregnant in July without making changes, but I keep telling him lets try one more month. People tell me I should be happy I have children and I am blessed, but I would really love to have another healthy child. It has been extremely difficult to get past the death of our son who passed away in my arms and I just about gave up when I got pregant again 7 years later.

When I heard the heartbeat I cried just to go back the next week and be told we are miscarrying. Miscarrying was like an old wound being reopened and kicked. I still have a strong desire to have another baby.

I wish I was closer to RI but I am not and really can not afford the travel or continuous acupuncture which I would love to do again. Any direction or suggestions would be greatly appreciated. Also I work as a teacher for children with autism and my job is challenging and at times stressful. I just thought I should add that in, not sure if it has any relevance.

Thanks,
Jessica

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Some Heartfelt Advice
by: Amelia Hirota

Hi Jessica,
Your story is heartbreaking. I'm so sorry for the loss of your beautiful baby and for the recent miscarriage. Clearly, you've done a ton of work to prepare your body for pregnancy. I just wish that there was some sort of justice when it came to pregnancy, but there's not.

You've done all of the right things and even had a good IVF cycle. Even if you lived nearer to my clinic, I don't know if it would make enough of a difference. You're at an age where it's difficult to really let go, as getting pregnant at 41 isn't unheard of, which is why my heart goes out to you.

There are a few issues that make me think it might be best to not push yourself so hard to conceive. Although you're on Bromocriptine for the small prolactinoma, I still wonder how well the pituitary gland is functioning overall to support a pregnancy. I've had many patients on Bromocriptine or Cabergoline because of elevated prolactin and I haven't seen many pregnancies take place in these patients. I realize that the meds lower the prolactin, but because of the infrequency of pregnancies that I see in these patients, I always wonder about other pituitary problems.

Also, I'm concerned about your husband's sperm with the low motility and morphology. Although you did conceive naturally in July, so there was a sperm that swam the distance. However, I wonder about the quality of the sperm and if that contributed to the miscarriage. It's hard to know, but low motility and morphology are concerning.

I'm a little hesitant to give you advice as to what you should do, but since you ask, I'm going to tell you what I feel. I feel it's not a good idea to do another IVF cycle. I don't feel good about pushing your body. While you had 9 follicles fertilize and that's a good number, none made it to Day 5, so that may explain why you didn't get pregnant with IVF. These follicles may not have been viable.

You clearly have a strong desire to having another baby and you're motivated, so many you want to give yourself 6 months to 1 year of trying naturally. This would entail you and your husband maintaining nourishing diets, but that's really not that much hardship in the scheme of things.

During this period, you may want to do some work on letting go of the process, being in the moment and feeling grateful for all that you have. Don't try with steely determination, but keep an eye on your cycle with charting and do your best to enjoy baby dancing with your husband. Try to get in the mindset of acceptance and receptiveness for what may be. We can not control this journey, nor force a pregnancy, so opening ourselves up and being present can sometimes result in miracles. I wish one for you.

Sending Babydust Your Way,
Amelia Hirota, D.Ac.

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