Dr. Anatomy Download

Whew, first of all, thanks for all the support yesterday. I needed it. I feel like all I do lately is write really long posts filled with technical information. And yes, here I go, yet again.

First, let me tell you a little story about having the name Jen.

After being accosted by the wall o'babies, I had a seat in the waiting room. I was early, so I knew I'd be waiting awhile. I had seen Dr. Anatomy come out of a door across the room to take a couple back to meet. A few minutes before my appointment, another doctor came out of a door closer to me, and said "Jennifer?" I was sort of out of it, feeling weepy and distracted, as I mentioned yesterday, so I didn't look around to see if anyone else reacted to the name. I just went with the man who was clearly not the man I was there to see. I mean, who knows how these things work. Maybe Dr. Anatomy had gotten tied up or something.

We get back to his office, and he says "So, Dr. K sent you to me?" Uh, who the hell is Dr. K? So I say "Um, I'm Jennifer I-----?" We realize I'm not the right Jennifer, so we head back to the waiting room and discover that one of the other two women in the room is also Jennifer. Big surprise.

A few minutes later, I hear yet another Jennifer check in at reception. Seriously? By then, I am now distracted because my friend from Resolve so my blog post, and we are texting back and forth. Have I mentioned that her name happens to be Jen?

Then, a nurse comes out of the door where I had previously seen Dr. Anatomy, and says "Jennifer?" The new woman gets up and goes with her. They seem to recognize each other, so I don think anything of it, until about a minute later when Dr. Anatomy finally reappears and says "Um, Jennifer I-----?"

Honestly people, have you not picked up yet on the fact that there are more women between the ages of 30 - 40 with that name than any other, and that we are the prime age group for your clientele? Initials, people, please! I don't need to end up with some other Jennifer's baby. Wow, that kind of sounds like a name for a bad lifetime movie. "Some Other Jennifer's Baby." Starring Jennifer Lopez, Jennifer Aniston and Jennifer Hudson.

Anyway!

OK, on to the details. I'm feeling a bit confused about it all. I tried to take notes since I was there by myself, so we'll see if this helps me sort things out.

He reviewed my history, and immediately realized that I am more than halfway up the ladder of treatment that he was lobbying against in his presentation at the conference. It's frustrating to think that I wasted nearly a year on IUIs without a good reason for why I wasn't getting pregnant. The one real lesson to me in all of this is for anyone with an unexplained diagnosis, keep pushing for answers. Don't keep repeating the same kinds of treatment endlessly. If I had to do it all again knowing what I know know, I would have gone for second opinions when I first heard the words "unexplained" instead of over  a year later.

One of his first assessments is that he thinks it's a sperm issue. Although he didn't really make it clear why he thought that. He said the labs looked good when we first looked at them, but then referenced his presentation about how what they consider to be normal not being the right parameters, and that far fewer men actually fall into that category, or something. I apologize, this is the part I am having trouble understanding.

I think, though, the fact that the first IVF with 13 mature eggs, only 4 fertilizing, and the fact that there were virtually no unsuccessful sperm actually hanging out in the dish around the embryos, is leading him to this assessment. He did say, however, that since our second IVF was with ICSI, we are already treating a sperm issue, and there there is not much point in further testing if it is not going to change the treatment plan.

Protocol wise, he was not happy with my second IVF with the antagonist protocol. He basically thinks the protocol was right the first time, but since we didn't have ICSI, we didn't have a chance. And when we got to ICSI, we had the wrong protocol. He is not a fan on bcps before a cycle. He said that the eggs start developing long before the bcps are given, and when you interrupt that process, they get confused, and end up staggered. That is something I have read about the antagonist protocol, but some seem to think it is the right way to go for some people. I think Dr. Stats agrees that it's not right for me, since she is going back to a lupron based suppression. Dr. Anatmoy would go back to full Lupron, though, not the diluted version that Dr. Stats is suggesting. He is afraid that I will ovulate through it. However, I think I see her reasoning for it. I think I was over suppressed on the first cycle, based on the fact that I didn't start to bleed by the time they thought I would, and that they had to increase my stims halfway through the process. From what I understand, it's better for the eggs to grow evenly, rather than slow at the start, and faster at the end. So to me, the very-low-dose lurpon makes sense. I'm not sure Dr. Anatomy had enough time to absorb those details. He was looking for very specific facts and figures, and not necessarily diving in deep to the data. OK, so the conclusion of that, is that I think I am comfortable with Dr. Stats's recommended stimulation protocol for IVF 3.

Dr. Anatomy would also prefer that I be on PIO until a pregnancy is confirmed. I can't remember if he said a chemical (positive beta) or a clinical (positive u/s), and then switch to crinone. He mentioned this in relation to two chemical pregnancies. So, my veteran friends out there, thoughts on PIO vs. crinone? I may push for PIO for peace of mind (and pain of ass) if I stick with Dr. Stats. They do seem to prescribe it in some cases.

In terms of further testing, I asked if he thought any laporoscopic investigation was recommended. He said, "What do you think? I told you I think it's a sperm issue. Do you think poking around in your stomach is going to tell me anything helpful?" So, I guess that's a relief! If we were to go with him, he would like to repeat Day 3 and Day 10 bloodwork, do his own hysterocopy with a biopsy, and also have a look for himself at Hubby's sperm. Which sort of contradicted his earlier statement of if we're already doing ICSI, what's the point. But, I guess he wants to be thorough and get his own eyes on everything. The other interesting thing that we are going ahead with is some genetic testing through a service called Counsyl. Basically, he gave me a code to go to their website and order a kit for me and Hubby. They send you a tube, you spit in it, send it back, and they test for literally hundreds of genetic diseases based on your ethnic background. This would determine if PGD was necessary in the future to ensure healthy embryos. He says its covered by insurance. I'm waiting for my confirmation email on that right now, so I will keep you all posted. But it seems like an easy and harmless way to be prepared and/or gain some peace of mind about the health of our future children.

I almost forgot to mention that when I mentioned that Dr. Stats said there was a 1% chance the biopsy would show anything, he said it's more like 15%. He feels that the pathologists are too focused on finding cancer, and that the endometrial inflammation is actually really hard for the them to find, so he stressed the importance of a thorough screening. He also wants Hubby to stop drinking, or at least keep it to just weekends. And he needs to start now because sperm takes 74 days to develop. Hubby seems willing to do this. I hate to ask him, because he's been super stressed and busy at work, and his nightly bourbon has been part of his winding down routine after work. But we'll do anything to make this next cycle work. I think though, that a free pass for Christmas and Thanksgiving days might be ok.

In regards to the small world or reproductive endocrinology that lives inside the expansive Boston medical community, he said the he knows Dr. Stats. He, and some of his partners came from her hospital. One of his partners used to run the department. They left for private practice so they could do things without the red tape (ie. not get stuck on the ladder of treatments that is clomid, injectables, IVF, etc.) but also, lets me real, to make a lot more money I am sure. He remembers interviewing Dr. Stats. He had all positive things to say except for that "She's young," which could be left up to interpretation. But he was extremely positive about the medical care in general there, except for the red tape issue. But, this does bring some clarity to the reactions of Dr. Stats and her nurse. Everyone has feelings about coworkers that may or may not apply to their actual professional expertise, so I am just going to try to sweep all of that under the rug.

The last interesting thing that happened, which I'm not quite sure how to judge, was that Dr. Anatomy showed me some charts, which he is not allowed to post on his web site. One was comparing live births across all the hospitals and clinics in the area. His clinic ranked first, of course (or why would he be showing me that). Dr. Stats's was second I think. The second chart was in regards to how many cycles it takes to achieve that live birth. Again, he was the lowest, 2.1 something. But again, the Dr. Stats's came in second place, on the higher end of 2 cycles.

So, in conclusion, he gave me some things to think about. I'm excited about the genetic testing. He does think my prognosis is good (cause I'm still young after all, wish I could believe that!) He seemed to confirm that Dr. Stats's is essentially doing what he would do, with a few minor variations. Now, I need to decide if we think it's worth uprooting ourselves before IVF 3, or give it one more go and hope that the third time is the charm and we don't need to switch. The process where I am already in terms of monitoring fits into my life much better than with Dr. Anatomy's office which is not nearly as conveniently located. And let's face it, that's a huge part of remaining calm through the process. One of the RE's at the conference said that when people switch, it's really more for their own peace of mind, to feel like they are doing something to help the process, but sticking with a clinic who knows you and your history simplifies the process. I would add, as long as they keep trying new things, and are not stuck endlessly in the same process. If we were to switch, we would be able to get in one more cycle this year, because they don't close for the holidays. However, I would need to go for days 3s tomorrow to get the process started, and I am heading out of town for the night. I also have two more trips to Buffalo coming up in late Nov and mid Dec, so it seems to me that it's just not the right time. Hubby and I can relax and enjoy the holidays, and kick of the new year with another go.

As of last night, I think we were leaning toward one more cycle with Dr. Stats. But, since we have some downtime, we may seek out another opinion or two so we're more prepared if we end up needing to switch. But we won't, right? Cause the third time is the charm...right?