New Doctor, New Protocol

The appointment with my new doctor finally came today.  The office assistant was kind of crabby - I overheard her say she hadn't had a break or chance to eat so this is understandable - and the nurse was quite rushed, pulling me about like a piece of meat.

But once I got into the good doctor's office, ahhh.  Very calm, intelligent, and trust-inspiring.  She took lots of time - sometimes a bit more detail than even I cared for, which is saying something - but it was welcome.  We discussed questions and topics I want to thoroughly understand, like immune testing, potential uterine and egg issues, and recommended protocol.

I will not be able to do the conversation about immune testing (MTHRFR and NK Cells, etc.) justice here.  Suffice to say, Kai.ser lab is inexperienced with these tests, so she would have to send me to an outside lab at full cost.  Also, she prefers not to order tests unless there is real data indicating there may be a problem.  This data comes through sp.erm testing and IVF, neither of which relate to me.  Lastly, this falls under the uterine issue percentage listed below, and she believes my issue is in the egg category.

But, she admitted there is so much they don't know, and research is underfunded because the affected population is relatively small. :(  All facts considered, I'm not pursuing these tests right now.  I did have prior clotting-related Lupus anticoagulant and Cardiolipin ab tests, which came back negative.

Regarding potential uterine issues:

• She said 2-5% of problems are based on uterine issues.  It was kind of cute, as much as a uterine metaphor can be cute:  she talked about the uterus as a good child, sitting there waiting, but usually the problems happen prior to the uterus even getting involved.

• I asked about ureaplasma infection, which I understand can cause problems, and she said they treat every patient with Doxycycline, because the testing for ureaplasma is difficult and expensive.  I'm okay with that and will begin taking Doxycycline when my period starts.

• She reassured me that they could see polyps on the ultrasound but occasionally there are spots on the uterus wall, like the start of a polyp or something, and they can more readily see these if they do a saline-infused sonogram.  So, I guess that's an option if I choose, but the longer we talked, the more I agree that it's probably egg-related issues...

Regarding potential egg-related issues (this info. may be old news for some of you):

• She said some of the follicles don't even have eggs in them.  What?  It's true.  So, they can look fine on the monitor, growing well etc., but the egg is crap and disintegrated (she definitely did not use the word crap!).  They know this from IVF harvesting.  She did say that, considering my tests/FSH, it's highly unlikely all three or four follicles would be empty.

• Some eggs fertilize but have three sets of chromosomes.  These don't make it past Day 2 or 3.

• Usually, the problem is an extra chromosome, like with Down's Syndrome or Trisomy 16, etc.  These will usually form a blastocyst, but then I guess they stop developing at some point.  If they reach blastocyst, though, they have the potential to implant.

• She gave an example of one 42-year-old patient undergoing IVF:  On day 3, 50% of embryos made it to blastocyst and of these, 50% were normal.  Soooo, I'm taking from that, relating to me and an injectable cycle, starting with 4-6 eggs would be a good thing if you're cutting in half and then half again!  I had 3 eggs last time... which brings us to protocol...

Protocol for Upcoming Cycle (in possibly as soon as 9 days!)

• I'm getting my thyroid and 21-day fertility tests in a few days, even though I'll be on progesterone again so that result doesn't matter much.

• We're going for a more "gentle" protocol, since I responded so quickly.  Did I mention I love this new doctor?  She looked at my results, and she saw ways they could be improved.  Dr. Negative looked at them and said, "Meh, might as well do the same thing."

• So as mentioned, I'm going to take the Doxycycline to get rid of any infection that may mess with things.  Sounds good.  And, stage two, I'll take Letro.zole for five days.  Then, finally, I'll inject Meno.pur again, but less aggressively at two vials a day versus three, and no Lu.pron.  Hopefully, this will help line things up, and I can collect all my eggs, instead of half.

Now, to decide if I want to go with the same donor...

*On a side note, the doctor was very encouraging and positive about doing international IVF.  She said they collaborate with other clinics (doing everything but egg retrieval and putting embryos back), and she's worked with folks in India and Europe.  She thought Canada would be even easier.  I located a good clinic in Vancouver, but I would definitely need to also find a lending source, even with the dramatic cost reduction.