If you’ll recall, during my last phone conversation with my nurse, she mentioned that I shouldn’t be discouraged because my RE has lots of tricks up his sleeve. When she said tricks, I was thinking fancy and unconventional protocols (EPP), co-culture, different med combinations, etc. As it turns out, my RE appears to have no tricks up his sleeve for me for our third and final IVF with this clinic.

Our WTF consult started out as it always has in the past, with him saying how he’s so sorry that things didn’t work out. It’s nice that he cares and expresses that emotion, but it kind of feels a bit hollow at this point. Anyway, he went on to say that I stim great, we just need to get some better results with the embryos. Obviously my concerns are that from 19 and 18 eggs retrieved, we’ve only ever ended up with one blast and one morula on day five. He mentioned that on average 4 out of 5 human eggs are “junk,” so my results aren’t too far from the norm. That stat really shocked me because it just doesn’t really mesh with how I see so many other women’s cycles go (not to mention all of the women who get pregnant the first month they try). But I guess it’s irrelevant, it doesn’t really matter what the stats are, just how things go for us.

So given that I had a good response to the last cycle, he plans to do the exact same antagonist protocol again. I was somewhat disappointed when I heard this because in the back of my mind I was hoping that he’d have some special “high quality” protocol that would be just perfect for me. To hear that we’ll be doing the exact same thing that we’ve already done was kind of a letdown.

OK, so no tricks up his sleeves with the protocol. The tricks must be in the details of the cycle. And here’s where I should give you some info on my doctor. He’s super technical and really seems to know his stuff (as he should for what we’re paying him) and he is very opinionated. If you bring up something that he doesn’t believe is useful in treating infertility, he will let you know, and in no uncertain terms, that he thinks it’s all a bunch of hooey. So without further ado, here’s the list of “tricks” that I came up with that were pretty much all shot down by him.

• Three day transfer – this was shot down since they believe that a five day is really the way to go. Never mind that the uterus is really the best place for those embryos to be while they’re trying to grow up nice and strong. But, in all fairness, I can’t really argue with this one too much since they do have a phenomenal pregnancy rate of 61.8% per transfer for my age group and 90% of their transfer are day five.

• Embryo glue – Many people have mentioned this, and it seems that my clinic already uses this, though I was completely unaware that they did. This is another one of those things that my doctor doesn’t really buy into and he even said that they’re going to discontinue using it in the future because it doesn’t really seem to make a difference in success rates.

• Assisted hatching – I remember from our consult many months ago that he said the clinic only does AH on day three embryos, not on blasts. He said once they get to day five most of them are already starting to hatch on their own, and if they aren’t, the blast can actually be damaged by scoring it at that stage. I knew this, but I thougth I’d question him on it again anyway. He stated that the hole that is made during the ICSI process usually works just like AH does. The blast tends to expand out of that hold just like it would if AH had be performed on the embryo. So I asked him if my two blasts had been hatching when they were transferred and he took a quick look at the photos and said that yes, both of them were starting to hatch. I looked, and for the life of me can’t see anywhere on either of the two blasts where they might have been starting to hatch, but I guess he’s the expert, not me.

• Co-culture – Many women have attributed their eventual success to co-culture, so I thought I’d ask if they even offered it at my clinic. He said that yes they did, but again it’s one of those things that he doesn’t believe actually increases pregnancy rates. He actually told me that it’s a pain in the ass and the lab people hate doing it and it’s more hassle than it’s worth. Wow. Just wow.

• Additional testing – I asked about additional testing like antibodies, thyroid, karyotyping, etc. He said we could if we wanted to, but the results are often hard to interpret and even more difficult to treat. Not sure I really understood this one, but he seems to think that the testing we’ve already done is sufficient. Since this is an area that I really don’t know a whole lot about, and because this testing can be really, really expensive, I was willing to take his half-assed response to this line of questioning as is.

So that’s the list of things that he essentially shot down. Here’s my list of consolation prizes…things he was willing to compromise with me on.

• ICSI – When we originally met with this doctor, he stated that it was possible that Mark could have developed anti-sperm antibodies due to two hernia surgeries. He told us that we could test for it, but if the test came back positive, the way to get around it is to just do ICSI. So to save the time and money involved in testing, he suggested just doing ICSI to avoid the whole issue. OK, fine. That’s what we did the first two times. Now I’ve heard experiences from women who have split their batch of eggs in half and done ICSI on half and let the rest fertilize naturally, and the ones that fertilized naturally have developed better than those that were ICSI’ed. I mentioned this to him and he said that he thinks those situations are ones where the ICSI is just not performed well and that’s what causes the embryos to not do as well. Again my clinic has great success rates, so I’m inclined to think that the embryologists are very skilled at what they do, but I’m still curious. I told him that if we were to get a decent number of eggs, I would like to do ICSI on most, but leave a few out to fertilize naturally just to see what happens. Even with his opinion, he was willing to do this, which makes me feel better. Plus, I’d still really like to know if fertilization is our issue, and this would be a great way to find out.

• P4 follow up – This last cycle I was spotting heavily for a few days before my negative beta. Now I’ve always been a chronic spotter, but I really thought that doing PIO would mean that I wouldn’t spot (and this was true with my first IVF). The fact that I was spotting for 3 days before my beta makes me really wonder if my body has issues absorbing the progesterone. He said he didn’t think that was the case because I’m taking so much progesterone. I asked him if I could have my P4 checked 7 days after retrieval just for my peace of mind. He said sure, that they have their local patients come in for a progesterone check mid-lueteal phase. Ummm…what? Why would you have a different protocol for in town patients versus out of town patients? I know it’s very unlikely that there is anything wrong with my P4 levels, but I still want to know.

• Stim dosages – I mentioned that I was concerned that maybe the stim dose was burning out my eggs and that’s why we were having such quality issues. I told him that I would gladly trade a smaller number of eggs for better eggs if he thought that would help. He said that we could definitely do that and thought it might help. As opposed to the 225 Follistim and 150 Repronex daily, he threw out 150 Follistim and 75 Repronex as options. I’m not sure if that will be my final dose once we actually get around to starting the cycle or not, but it’s on the table at least. On one hand I’m really hoping that this will be the key to better quality, and on the other hand, I’m absolutely terrified that the lower dose won’t work at all and I’ll be cancelled again. I guess I just have to suck it up and hope for the best.

• 3 embryo transfer – For fun, not thinking that he would ever agree since my clinic has what I thought was a strict “only two embryos in women under 35” rule, I asked him if, by some miracle, we ended up with three embryos on day five of this next cycle, if we could transfer them all. The words had barely escaped my mouth and he was already replying “absolutely.” I looked over at Mark and he gave a big smile and a thumbs up to me. Of course having the option to transfer three means nothing if we don’t have three to transfer. Past history would indicate that the chances of getting three are not so hot, but I’m still happy to know that we can do it if we have enough embryos.

When we hung up the phone I turned to Mark and said “well that was horseshit.” It’s not that anything went particularly badly, I guess I was just expecting more than “we’re doing the exact same thing” as his plan. The changes that we’re making are because of my doing, not because he thought it would be best. And part of me isn’t satisfied with his answers to some of the questions, but I honestly don’t have the energy or desire to really push the issues. I really just want this next cycle to be over so that we can move on in some way.

So there. That’s probably a lot more reading than you were expecting on a Thursday. In fact, that’s a lot more typing then I had planned to do. But there it is. Accordingly my fertility signs (which no matter how hard I try, I can’t ignore), I am about half way through my “break” cycle now, so I should be starting BCP’s for our final IVF sometime the week of the 20th. Good times.

Advertisements