Thursday, April 2, 2009

Today's Appointment

Today's appointment went exactly as I expected it to. I wouldn't say that anything new came out of the appointment. We discussed everything on my list and I feel good about having all of my questions answered. I don't feel 100% confident with the plan, but I rarely feel 100% confident about anything related to infertility. Here's what my RE had to say ...

Low E2 during IVF #1 - RE said that this absolutely had NO negative effect on my egg quality. He explained that women who've been diagnosed with cancer and are racing to do a cycle prior to chemo are actually given lupron while stimming to keep their E2 low and it doesn't hurt their eggs and/or resulting embryos. Again I'm just one of those women who have low E2 that doesn't correlate with follicle counts, but still have mature eggs in the follicles. We'll try to do less bcp leading up to IVF #1 to see if that helps.

Egg quality - from the embryologist's perspective my eggs look great, but just like any 32 year old I probably have eggs with extra or too few chromosomes. He said that it's impossible for them to say if I have a higher than normal number of bad eggs, but that he doubts it. He said that we know that I can make good eggs because Myles is proof of that, so he feels confident that I'll be able to make some other good eggs.

Embryo quality - embryos appear to be good ... growth to blast, high morphological grades, and able to survive freeze/thaw process. Dr. S admitted that grading embryos based on morphology is primitive, but it's all they have right now. He admitted that a % of Grade A embryos won't actually be chromosomally normal (euploid). I read a study that found around 20% of high graded embryos from women in their early 30's aren't normal. Again he reiterated that Myles was a Grade A embryo and he was perfect, so he thinks we'll get others in our next cycle.

PGD - Dr. S doesn't think this is useful to us. He explained that it works very well to identify single gene defects (e.g., Tay sachs), but that it's use to identify aneuploidy is limited. The research shows that pregnancy rates are lower in women who used PGD than those who didn't. It only tests a handful of chromosomes and it is known to inaccurately identify normal embryos as abnormal. It can significantly damage and/or kill the embryo. All of this on top of being very expensive. So, he doesn't think it's a good choice for us. I already knew all of this from my own research and from what I had learned I wasn't thinking it was something I'd want to pursue, but I wanted to hear his opinion.

CGH - Again this isn't a treatment option at my clinic. My RE said that the preliminary data is quite promising and will revolutionize IVF, but that right now it's experimental and only offered at a select few clinics for a hefty fee.

My clinic recently started a clinical trial where they use this microarray CGH procedure (similar to CCRM or SIRM) to biopsy the trophoblast of the blastocyst (the outer ring of cells that becomes the placenta) before they transfer them. They are looking to compare the biopsy results (karotype of the embryos) to embryo morphology and grade, pregnancy rates, miscarriages, implantation failures, etc... They aren't using the data to determine which embryos to transfer (at least not yet). I asked why they couldn't biopsy the embryos, freeze them, analyze the data, and only transfer the "good" ones ("staggered" IVF). He said they hope to be able to do that in the future, but that right now their funding for the study doesn't involve that. Dr. S mentioned the benefit of not injuring the embryo, which is a separate cell mass interior to the trophoblast, when you take the cells from the trophoblast, but mentioned that there are instances when the trophoblast cells do not match the embryo cells. I requested that I be included in the study because at the very least we'll get information regarding the embryo's chromosomal make-up after the transfer, which may give us some clues as to what happened and why.

Metformin - i need to go back on this ASAP even though I'm not IR.

DHEA - doesn't think I need this. He worries that overuse of this in PCOSer's can have a negative impact.

Acupuncture - it's totally up to me. He said he thinks it helps reduce stress, but that there are others ways I can do that. He said if he thought it was that important for my cycle, he'd require it and he's not. I'm thinking I may actually skip it during the stimming, but will have my GC do it pre- and post-transfer.

IVF #2 Protocol - antagonist protocol again with Menopur and Bravelle. He's going to up my Menopur dose in an attempt to help with egg quality. He's also going to start me on a slightly higher dose of meds in the beginning and is shooting for 10 days of stimming instead of 14. He said that he can be less conservative now that he knows how I respond. He's confident we'll have a similar result in terms of numbers.

IVF #2 Timeline - I can do IVF #2 in June. He left the time frame up to us and told us to contact him when we're ready. I forgot to ask him how he felt about doing ER and freezing everything, so I plan to call him tomorrow.

Surrogacy Stuff - Dr. S said that he understands K's need to take some time to decide if she will continue. He felt terrible for all that she and her family went through with the D&C. Dr. S mentioned that he hopes K is able to carry for us again because she's "proven"--we know that she can get pregnant with our embryos, so if we put in one or two good ones he's very confident that she will get pregnant again and deliver us a baby (or two)! However, he said he understood if K wasn't able to move forward with us. He asked what we'd do if K can't carry for us and I told him that we have another friend who offered to carry for us if K isn't able to do so.

We didn't schedule anything yet, but I'd love to do an ER in June (which works with Dr. S's schedule). IF Dr. S is fine with me freezing all of my embryos, then we will definitely do an ER in June and do a FET at a later time when our GC is ready.


Anonymous said...

Sounds like you got a lot of good information and the so far a June ER is working out - that is great.

A Mom in Jacksonville, FL said...

Glad things went well and that you have a doctor who took time to answer all of your questions. :)

Caroline said...

It sounds like a good plan Niki. Now you can start to make further plans about your next IVF cycle. I am really hopeful for you.

R said...

Sounds like you have a very good Dr.. Will be praying for you and your upcoming ER. (That gives me two months of prayers)

momsoon said...

Good plan. Sounds like the doc. is thorough and understanding which is so great..I always feel better with a plan (even though I too, may not have that 100% confidence anymore) because then I can focus on getting as healthy as possible.
I am very hopeful for you guys and will be sending prayers your way...

travelaunt7 said...

I'm glad you got some answers. It can ease your mind a little. As always I wish you the best with the ER and finding a surrogate. You're in my thoughts.

Lost in Space said...

That is a lot to process, Niki. It looks like you covered all your bases and are on your way to the next step. I really believe good things will come from your next cycle......