Information Overload

Hubby and I spent the day yesterday at the Resolve conference. It was quite a day jam packed with information. I was exhausted by the time we got home. I think it's a good thing that I am shuffling off to Buffalo later tonight for work, and won't be back until the wee hours of Thursday morning. We both need a break from IF!

But, of course, I wanted to summarize some of the things that we learned so that I don't have to carry them around in my head while I am away.

The morning started with a keynote speech by Dr. Ali Domar. She rattled off a lot of stats about her studies, and seemed to directly quote phrases out of her book Conquering Infertility, which I am currently reading. She mostly talked about does stress cause IF, and does IF cause stress. Her answer was yes. One of the interesting things she mentioned, was that in some newer studies, she has some evidence to show that stress at the beginning of a cycle might actually be beneficial, as long as during the stimulation process, the level of stress drops significantly along the way. So, I guess the lesson is to not freak out if we're anxious at the beginning, but to make sure we have the proper coping mechanisms and relaxation strategies in place.

Someone asked her about exercise, and she was reluctant to answer because her belief is that too much exercise is indeed harmful. She often recommends to heavy exercisers who can't conceive that they cut back from three months to see what happens. I am no where near a heavy exerciser. I stick to walks and the elliptical, but you can bet that I use this evidence to when Hubby suggests I join him running. There is not much I hate more on this earth that running!

We also ran into her at her center's booth in between sessions. Hubby asked her about exercise in relation to Dr. A's suggestion that I lower my BMI. (By the way, I think I need better names for my doctors. Some of you have fun nicknames, and I've decided it's time, so from now on, Dr. A will be known as Dr. Stats.) Dr. Domar said that her understanding of the effects of BMI on pregnancy and miscarriage come into play at a BMI of 35 to 40. She looked at me and said, you're probably a 30. I don't think you need to worry. (She's right by the way!) She suggested that eating as heathfully as possible would be a good route for me, and that I could make an appointment with their nutritionist. I might consider it, but I do think a lot of a healthy diet is just common sense, and the will power to stick with it. And of course, I will keep up my 30 minutes on the elliptical in front of my Tivoed General Hospital as often as I can.

OK, so the first actual session we went to was an overview of Donor Egg and Adoption, with a panel of parents. We decided to take advantage of this conference to do some exploring into what our plan B might be. It was very emotional to hear the parents talk about their joy at finally achieving parenthood. Right now, we don't think donor egg is for us. If we have to loose one set of DNA, we'd rather loose both. I would love to be pregnant, but it's nine months out of the lifetime of a child, so it's something I think I could give up if it comes to that. In addition, we're so lucky to not have to spend exorbitant amounts of money on IVF, but I feel like if it comes to having to spend $40k to build our family, I'd want to spend on something that's a 100% chance instead of only 60%.

Our second session was on why infertility should not be unexplained, with Dr. H who we are scheduled to see on Friday. I'm feeling much better about that appointment, after one of my lovely readers reached out to me with a good experience with him. And, he looks much less like a car salesman in person that he does in his picture. I'm struggling to come up with a good name for him, but I think we will call him Dr. Anatomy. One of the main topics he focused on was on anatomical issues, like problems with tubes being adhered and not being able to swing to the ovary and receive the egg, or similar issues with the uterus. He seems to do a lot of laporoscopies to check for these things. He also stressed the importance of a trained eye looking that the films of the HSG, not just the report, to identify subtle issues with the tubes, or potentially these adhesions he talked about. I'm a little bit bummed that when I requested my medical records to be sent to him, I didn't think about the fact that I needed to request the HSG film separately, so I'm not sure I can get that for Friday.

One of the other things he brought up were the success rates of Clomid IUIs. 7%. Hubby asked him why we still bother if the rates are so low. His answer was that his practice does not use clomid. It was hard not to feel like we wasted 6 months of this journey on our 3 clomid IUIs. For scheduling reasons, we were never able to do them back to back, so it took awhile. But, it's in the past now. I really just need to let it go, and consider it part of the process to prepare one's mind for IVF.

Another point he made was about the various progressions of treatment that we often end up on because insurance requires it. Clomid IUIs, Injectable IUIs, then IVF. He said that insurance doesn't really require clomid IUIs, and it's up to us and our doctor to advocate. If our doctor has a medical reason to do something, insurance should approve it. I think the problem is with the diagnosis of unexplained infertility, insurance doesn't want to approve procedures without knowing that simpler and less expensive ones didn't work first. It's ridiculous that insurance gets to dictate medical care at all.

I was a little disappointed that his investigations were so anatomically focused. You guys know I'm interested in immune and clotting issues. He didn't bring those things up at all.

Our third session was on what to do after a failed IVF. It was way overfilled with charts and graphs and data that were hard to understand. But, one of the more interesting graphs showed pregnancy rates compared to age from 22 to 44. It's frightening to see that line take a nose dive. I'm on the downward slope already, and it only gets steeper with every minute that passes. The interesting part was that they also showed pregnancy rates with donor eggs across all of these age groups. the line stayed level, meaning that age has virtually no affect on a woman's ability to get pregnant with god, young eggs. This information does reinforce Dr. Stats's opinion that we are dealing with an egg issue. This presentation did also say that egg issues are the number one reason why IVFs don't work. And it's not that it means my eggs are bad, just that unfortunately, I'm getting older, and there are just fewer normal ones left. Dr. Stats told us that 1 in 15 are normal in a 40 year old woman. Terrifying!

After the session, I did go up to one of the presenters to ask about natural killer cells. She said that basically, the topic is being researched, and there is not enough data to suggest what to do with the diagnosis yet, so most doctors are not testing for this right now. She said that there are a few (Dr. Sher being one, from what I understand) and if her patients push for it, she sends them to those doctors. For me, that means going out of state, and not being able to use my benefits. I'm not sure if I'm ready to do that quite yet. Later in the day, I asked another doctor about natural killer cells. He said that testing/treatment is not endorsed by the American Board of Obstetrics and Gynecology. This third opinion of the topic definitely left me feeling like this topic is not one that will be looked at in the great state of Massachusetts.

Our fourth session was basically an overview of domestic adoption. If we were to adopt, we would prefer an infant, so we would not be going international. There was a lot of talk about the decrease in international adoption as well. I'm not sure why, but there seems to have been a significant decline. Anyway, it's a plan B that's off in the distance, so I won't spend too much time on it now, but it was good to get a better understanding of steps, timing, and those god damned costs! Hubby went to the hotel bar for a Bourbon after the session ended, while I went to a Q&A session.

Lastly, at a question and answer session with an RE at the end of the day, the one who told me about the nk cells not being endorsed, I also asked him about clotting and immune issues. He said those things are tested in relation to repeated loss late in the first trimester or later, so they don't apply to my two chemical pregnancies. People also asked him about supplements. He said CoQ10 doesn't do anything, but it can't hurt you, so if there is a placebo effect, he's fine with is. He also suggested omega 3, but he said he was not a fan of DHEA. He said that baby aspirin was a placebo effect too, and that it should not be taken until a few days after retrieval because it could cause bleeding issues in the retrieval process.

Whew, I think that about sums up most of what I absorbed yesterday. The day made me feel more confident in Dr. Stat's assessment, although I still plan to keep the appointment with Dr. Anatomy. I looked at my calendar, and I think it's unlikely that we will be able to get in our next cycle before the lab closes for the holiday, so I'm debating whether to pursue a third opinion now, or to wait until after IVF #3. I think I have until about the second week in December until I would have to give Dr. Stat the go ahead to get insurance approval to start lupron at the end of December. And since we won't be able to try for two cycles to to the endometrial biopsy and the lurpon cycle, getting more opinions might make me feel like I am actually doing something instead of sitting around waiting. But, since I'm off to Buffalo later today, I think I will have to sort that all out when I get back.

I'll be reading while I'm away, but commenting will probably be hard, since I'll only have my phone with me. See you later!