Head. Spinning.

Well, well, well, I had my consultation with Big Snake Oil Immune Issues Clinic, who shall henceforth be known as Las Vegas Clinic because that other nickname is too damn long.

Well.

It was not what I expected.

I have always been wary of Las Vegas Clinic - in fact it is part of a chain - they have clinics all over the country.  I'm sure you know the one.  It was started by a controversial guy who does things his own way, is very much the show man and who pushes immune issues.  I am not a big believer in immune issues.  I mean, if the success rate for donor eggs is so high I think we can safely assume that none of those women had immune problems in the first place, but rather crappy eggs.  Sure, it has to be an issue for some people, but I tend to think that they are the ones with known problems like lupus or recurrent miscarriage or other such things.   Anyway, frankly I think they are pushing snake oil when they try to get people to do things like IVIg.

I would not have contacted them but for seeing that they are running various studies and as the financial resources are dwindling, the thought of getting an IVF for cheap was quite appealing.  I mean, if I am going to do another IVF with my own eggs, it might be nice to still have enough cash to do a donor egg cycle afterwards if it fails.  The RE, Dr. F., emailed me and said I might be a good candidate for their CGH study.  This is where they biopsy the embryos like with PGD but test all the chromosomes (PGD only tests some).  I have been worrying about this.  I mean, if I end up with only four fragile, crappy-looking embryos, might they all self-destruct if they are biopsied?  Even if one of them might have been normal?  And I had been saying that if an RE could tell me that all my eggs are abnormal, it might allow me to draw a line under this process and move to DE.  But surely the fact that none of my IVFs have worked leads one to the conclusion that all the eggs produced so far have all been abnormal.  Hence why they haven't worked.  So what is a test going to tell me that I don't already know?  In other words, I am my own assay.  We stick all the embryos back in and the good one sticks.  Or not.

So I was really just going through the motions when I went through with the consultation.  I was leaning heavily towards another cycle at Big Clinic.  Or perhaps they should now be called New York Clinic to lessen confusion somewhat.

But the RE was nothing like I expected.  He was very nice.  I liked him.  He had clearly gone through my file carefully and thought things through.  He did not mention immune issues once.  Not a once.  He first went through the final stages of follicular development, stating how the eggs are very responsive to the hormonal environment in the follicles.  He said how in the natural cycle the body picks one egg to ovulate, and that egg becomes responsive to estrogen in the final stages of development.  The rest of the eggs that had been developing along with it now respond to androgens that are also circulating, and die off.  He said how they believe that as we age, we are producing more androgens and also producing more LH too early.  That some of us (namely me) become over-sensitive to androgens and our follicles are reacting to the androgens by dying off or not developing appropriately.  That it is essential to avoid androgens.  And that he believes, by doing this, it may be possible to influence the quality of the eggs at the time of ovulation, because he believes that we can manipulate the hormonal environment enough that more of the eggs will develop properly.  As if they were the dominant follicle, and therefore will react to the estrogen and not go into apoptosis because they are instead reacting to the androgens.  He thinks this is why I have a dominant follicle problem - not because I'm producing FSH too early but because I'm producing LH too early and am too sensitive to the androgens.  That it's not that one follicle starts developing too soon, necessarily, but that the other follicles are going into death-mode too soon.

So he said he thought my issues were caused in part by the stimulation protocols that I've been on.  That I've been on too much LH too early.  That nobody's been controlling my androgen levels He said they had a new protocol that is being published in one of the fancy journals in February that he would like to try me on.  It involves BCP, preferably one like Yaz or Yasmin which has a good androgen-lowering effect (though he said all BCPs do it to some extent), then you start Lupron as if doing a long lupron cycle.  But they stop Lupron when you get your period and switch you over to antagonist on day 1.  Then they add estrogen and only after a few days on that do they add stimulation meds.  And they use FSH only to start with, and start adding small but increasing quantities of LH as you get closer to trigger day.  But much smaller quantities of LH than I've previously been on, and they use Luveris instead of Menopur.

Hmmm.

He didn't know if it was worth trying CGH either.  For all the reasons I had worried about it.  But he said I could try it if I wanted, and I could be in their study if I wanted.  But the study doesn't involve a cheaper cycle, but instead a very reduced cost second cycle if the first one doesn't work.  Which they kind of let you do anyway if you buy a two-cycle plan from them.  And CGH costs extra money so I am not sure that is worth considering at all.

I am going to speak to their financing lady on Wednesday to really crunch the numbers.  He said I could cycle at the end of March if the FET doesn't work.

Hmmm.

It was strange.  Here is an RE telling me about my exact problem.  That he has clearly thought about and has a protocol tailored for.  Previously it's always been me telling the RE's that I thought I had this problem, and steering them towards long lupron cycles because of it.  Here is a protocol designed for women like me.  Not a standard regular-old IVF protocol that they're using because they don't know what to do with me.

And he recommended I check out the fertility diet published recently in Newsweek - http://www.newsweek.com/id/73354 - sorry, haven't figured out how to link when posting from the Mac.  Because it helps with insulin resistance and blood sugar, and therefore androgens and all that jazz.  I liked that.  I liked that he suggested stuff I could do.  I liked that he was focussed on egg quality and not immune issues.  I quite like the thought of trying something different. 

So now I have a choice.  Switch to Las Vegas Clinic and try this other stimulation protocol in the hope of getting better eggs.  Or stay with New York Clinic and stick with the same old same old but hope that coculture and a better lab save the day.

Hmmm.  What would you do, internets?