The consultation

I am back from my post-IVF meeting with my RE. Had to have a little cry on the way back, but that's just because I'm a sap, as we all know. It just seems so hard sometimes to hold on to hope when you're staring down IVF cycle #4 (or #3, depending on if we are counting the cancelled cycle).

The upshot of it all is that he thinks all my problems are due to aging crappy eggs. He mentioned donor eggs, though said he wasn't ready to give up on me yet but it was an option to think about. I said I'm not doing DE, as at that point, I'm done. I told him I'd do one more fresh cycle with them, maybe the frozen embryo transfer (although he said with only one frozen embryo there's only a 1 in 3 chance of making it to transfer), and then I'd go somewhere out of state with really good success rates. He looked a bit shocked at that, and said their success rates are really good. I said they were OK, as they're pretty average if you ask me. To which he countered that I was looking at the 2004 statistics, and the 2006 statistics are much much better. I asked why the change, and he said it is because of their new lab, which has all new equipment, better and more stable culture medium, the staff are more used to the procedures, etc. So that made me feel a bit better about them, but I'd still like to see these fab statistics written down! We joked that I wasn't exactly helping his stats any, but hey. Anyway, he said he didn't mind me seeking a second opinion or trying somewhere else at all, if that's what I wanted.

Sooo, onto the plan. We discussed my dominant follicle problems, and how I often have a 16mm follie on CD6, which is not good, and how my fast stimming and early egg retrievals could be contributing to the poor quality embryos. Because of all that we're going to try the long lupron protocol to try to get slower and more even follicle development. I asked about the studies that say microdose lupron worked better with poor responders. He said yes, but long lupron is their preferred "recipe" for everyone else, and it depended on what he was most worried about - the cycle I got 14 eggs I could hardly be classed as a poor responder, so maybe we should switch focus to the dominant follicles rather than thinking about the poor response. Besides, we've done 3 cycles of microdose lupron and I'm not pregnant. And on my two bad cycles I had early dominant follicles, so he said why not see if the long lupron would help with that. He even said we could ditch the lupron mid-cycle if I was oversuppressed and move to an antagon (Ganirelix) if we felt like it.

I will be doing a 3+3 protocol, so the same overall amount of stims as the last two cycles, but equal repronex to follistim, meaning slightly more LH. Or in other words, I will be shooting up with 3 vials of follistim and 3 vials of repronex a day. Plus lupron.

He wants me to do a saline infusion sonogram, to see if the recent midcycle bleeding is due to the polyps coming back. So, I'll do that next cycle. What fun. Another fun procedure of someone sticking something unpleasant up my cooter.

Then I said I should bring up the usual question of immune issues, though I felt a bit stupid talking about implantation when he'd just more or less said my eggs were crap (but in a nice way). He said he didn't mind running tests if I was worried, and the fact that I keep bringing it up obviously showed it was on my mind, but the thing he disagreed with was some of the treatments, which have not been shown to do any good. Like IVIg, which he said doesn't help. But, we decided we'd see if my insurance would cover it and/or if I could bear the costs on my own, and if I still wanted to do the tests, we'd do them and discuss further once the results are back. In fact, he had details of a lab that is new to them where you can pay a "safeguard price" that is a 75% discount on the full price if you pay up front, and if they get reimbursement you get the lot back. And they will go to your house for no extra charge to draw the blood. So I'm going to do the following tests for $706 and hope to get reimbursed:

Anti-coagulation antibodies
Anti-phospholipid antibodies
Lupus anti-coagulant
Anti-beta2Glycoprotein antibodies
Activated Partial Thromboplastin time
Embryo Toxic Factor assay
Natural Killer cell assay

So that's the big plan. I'll go on BCP in October after the period after next, or in other words, 2 full cycles break.

I'm a bit conflicted about the immune stuff. I mean, what's the point of testing if he doesn't want to do any treatment? I suppose if something did come back bad, he'd have to treat it, otherwise I'd complain a lot, and if miraculously everything is normal I can quit worrying about that. So I should be happy that he agreed to it. But still. I have this nagging doubt because he seems so adamant that it's not the answer.