WTF Brain Dump

OK, where to begin. There is so much information, I want to get it all down so I don't have to keep it in my head.

First of all, Dr. A says we're making progress, which is good I guess. Our embryos this time around were WAY better than with IVF #1. She said id she gave grades, she would have considered the 8 cell to be an A-/B+, and the two seven cells to be Bs. But yet, it still didn't work.

She says all signs point to an egg quality issue. It really is a numbers game, and you just have to try to get as many eggs as possible so that your chances of having a good one in the bunch are greater.

We asked a ton of questions...

- Autoimmune issues - She says there are a few autoimmune issues, Lupus being one of them that can cause issues. But didn't seem to think there is a need for any testing. Damn, I really should have taken more notes while she was talking. I always think I'm going to remember more than I do. But she basically has a study to quote for every question that says it doesn't make a difference.

- Thyroid antibodies - I've never actually been treated for them, but since I have hypothyroidism and it's not because I don't have a thyroid, I have antibodies. But, they should not have an impact on pregnancy because I am being treated for it.

- Natural Killer Cells - She's a doctor who falls clearly "in the middle" as hubby puts it. She's extremely evidence based, and doesn't buy into the natural killer cells having an impact because when you look at the data that has been gathered collectively, instead of an isolated study, there is no real proof.

- Endometrial Biopsy - I haven't had one yet. We asked if I should. She said it couldn't hurt (except, well, that it does) and therefore she would leave it up to me. There is a 1% chance of it showing anything. I am planning to do it. I would much rather check that box off the list that have another cycle fail first.

- Vitamin/Mineral deficiencies - I had some electrolytes checked by my primary care right before this last cycle. I showed as anemic, and low calcium. When my calcium was rechecked two weeks later, it was fine. She said I would have to be anemic to the point of needing a blood transfusion before it would matter.

- Karotyping - She brought up doing it before we did.

- Luteal Phase Defect - Hubby has been obsessing over this one for awhile because my luteal phase always seemed to be border line on the short end. Her answer was that I'm getting progesterone, so it's not an issue with IVF cycles.

- Lab chemistry - We had heard that you shouldn't do more than two cycles with one lab because of the way that particular culture medium might react to our unique DNA in the embryos. She said there are only 3-4 culture manufactured, so that all the labs are really using the same thing.

- Clotting - She quoted a study that said clotting issues were shown to have no impact in miscarriage rates.

- BMI - She brought this one up. I hover right between overweight and obese, which is kind of amazing to me, because, while I know I'm a little bit Rubenesque, I just don't see myself as fat. I'm hovering between a size 14 and a 16, and have manage not to put on any weight (or at least get rid of it all) from these two cycles. She doesn't think it's the reason I'm not pregnant, but it's proven that with a normal BMI, pregnancy rates go up, and miscarriage rates go down. I think I need to loose 30 pounds to get to normal. Geesh. Not easy with the holidays coming.

Then we got to what the new protocol will be. I'm going back to Lupron, no BCPs. But it will be "Very Low Dose Lupron." Which is basically the same as the Long Lupron, but it's a diluted version. (I hope that doesn't mean I have to mix it myself!" I will only stim with Gonal F 225 at night only. (Wow, just realized that this means only two injections a day, one morning, and one night, not bad!) So, because we had a higher fertilization rate this time, it seems that my eggs do better with just FSH, as opposed to FSH and LH, which is what you get when Menopur is in the mix. But, I didn't have as many eggs this time, so think that's why they are changing up the suppression method again. They are also lowering my dose of stims, because I stimmed a little fast the last time, but had only one follicle that was 18 at trigger. But, they had to go with it or risk ovulation through the suppression. I am a little confused by this, because with my first cycle, I had a few over 20 at trigger, and they even stretched it out over another day.

OK, so I'm happy with the protocol. But, what about second opinions. We had promised to get one after the second cycle. She said she recommends it after the third with her for sure. She asked where we were going, and when we told her, she made a face, and said please don't let that be your only second opinion. Our nurse had a similar reaction when she recommended two other possibilities, and then said "and that's all I'm going to say."

Admittedly, when I look at the picture of Dr. H who we're scheduled to see next Friday, I do get a bit of an oily used-car salesman feeling. I just don't know what to make of it. Dr. A did rattle off a few other names of people she would recommend. I'm so torn. I like her, and I like that she has stats for everything, but I'm also not opposed to out of the box, not necessarily proven yet, thinking. We chose this doctor not based on reviews, or SART data, but just based on the fact that he gives an IF should not be unexplained talk at the conference. I don't know, though, is egg quality enough of an answer to explain my IF? Ugh, what to do?

Hubby and I chatted briefly before dashing off to work, three hours late. He thinks we should keep the Dr. H appointment, possibly go ahead with Dr. A's new protocol and try to get it in before Christmas and the lab closure, and then seek out additional second opinions after that. I did a quick calendar when I go to work though, and it looks like if I have normal 28 days cycles, we'd be aiming directly for a xmas week retrieval, which is a no go. It looks like we'll have to wait until the new year, or at least the week after xmas to start lupron. So, maybe I will go ahead with another opinion or two in December. We can do the biopsy next cycle, but we can't try that month, and we also can't try with lupron, so we're now looking at two wasted cycles in terms of trying naturally. That's a little bit frustrating. I'd like to push the biopsy off to the start of the IVF cycle maybe, so as not to waste one, but then we'd have to schedule that to a specific cycle day right after christmas, which might be hard to do. It's not looking like I have much choice other than to bide my time and try to stay calm and get skinny.

OK, that's enough of a brain dump. It's 1:30. I really should start some work for the day! Three cheers to anyone who got this far.