Thursday, April 25, 2013

Letter to the new doc

So I want to write a letter to the new doc to explain my history and wishes as succinctly as possible.  Here goes:

Dear Dr. Hirshfeld,

I don't know if you remember me or not.  I started seeing Dr. Stephenson after my second miscarriage.  She did lots of testing on me and never found anything wrong.  I followed her when she moved from U of C to U of I and I met you during my next pregnancy.  This one turned out to be monoamniotic identical twins.  This would be my third miscarriage.  I got pregnant again quickly after that and immediately had my fourth miscarriage under your care.  We talked and I decided I wanted to try to do IVF with PGD, to hopefully find a the euploid embryos.

I went to see Dr. Hickey at Hinsdale IVF and as I started my IVF cycles it became clear that I have Diminshed Ovarian Reserve.  My first cycle was cancelled when I only had 3 follicles developing and my next cycle I only had 4 follicles develop.  My FSH was always around 5-7, but my AMH was at 0.24.  Additionally, it became apparent that my hormones were also out of sync as my Progesterone began to rise before ovulation.

Here's what I would like to do.  I have infertility coverage on my insurance and I would like to do 4 IVF cycles in which we would freeze all embryos we get and then start putting them back in a hormonally balanced cycle.  I hope this would circumvent the previously listed problems and hopefully preserve whatever fertility I have left so we can continue to grow our family.

Thank you for reading this.  I'm really hoping you can help me.

Signed, Me

So how does that sound?  If you were just reading this letter from the outside would it make sense?  

Friday, April 19, 2013

The end of a doc...

So, the follicles were about 23.5, 22.5, 20 , 19 and a 10. 

So 4 good follicles today, estrogen at 717 (it should be about 200 per mature follicle) and lining at 11.

BUT, the doc called and they never call if its good news. He said my progesterone was already starting to rise and was at 4.8. This is too high for pre ovulation. He feels that this is the reason I've been miscarrying. He feels that my hormones are out of sync with my cycle.

The phone conversation was almost comical. He clearly wants to get rid of me and started giving me the speech that I'm not going to have any more kids, love the ones you have, the only answer is donor embryos an I cut him off and said. "So if the problem is my hormones are out of sync with my body then won't a freeze all cycle and FET solve that?" He stopped and admitted that that would actually work. Ha!

But I'm done with him. I'm moving on. So I'll still trigger tonight and get together with DH. And what will be will be.

One thing I don't understand. I understand the implantation window for the endometrium. But embryos have a few days to implant as we all know. They can implant anywhere from 6-12 dpo and still be fine. We know that 8-10 dpo is a very good implantation window. So if my hormones are just a couple of days out of sync, I still could have a successful pregnancy, right? 
After looking it up, I DO see the studies that say that high progesterone on the day of HCG administration has a much lower pregnancy rate.  But, it seems to me that because my body wanted to ovulate a few days ago, my endometrium was just advancing like it wanted to as if I had ovulated when my estrogen peaked.  Did that make sense? 
And, I found a study to back this idea up.  It seems the endometrium keeps advancing as it should even if you chemically stop the LH from surging. 
Once again, the answer for this is to freeze all and put the embryos back in during an in sync cycle. 
So, this all comes down to that I'm one with this doc and I have an appointment with a new doc for May 6th.  So, a crappy 2 week wait (which will probably be less than 2 weeks since the endometrium will have advanced faster....) and then I'll see the new doc. 
The full plan going forward is to do 4 IVF cycles and then do FETs.  So, here we go again.  I just hope this doc is on board with my plan. 

Wednesday, April 17, 2013

IVF 1.2 (?) Update

So, on Sunday the Doc had me come in and check things out.  I had the following follicles:  16, 13, 13, 12, 10,7 and they later told me my estrogen was 180.  So, I'm feeling slightly vindicated for keeping going.  I asked the doc about the Ganirelix to stop me from ovulating the 16 before the others were ready.  He seemed unconcerned but said I could start it Tuesday night if I really wanted to.  I started it Monday night.  I know follicles grow 1-2 mm a day and I didn't want the 16 to become an 18 and ovulate before the others were ready.

Well it worked!  Today, Tuesday, the follicles were at 18, 17.5, 17, 16, 12, 10, 8, 7, 7.  So the 4 good ones are still going strong and are really close in size.  The Ganirelix let the 16 slow down and the 12 and 13s catch up. 

The nurse today said the doc wants to see a minimum of 3 to do IVF.  Now, I'm not sure I want to do IVF with him.  I've already made another appointment with a different doc who might see more willing to work with someone with DOR.  But, if I go to a new doc, I'm afraid that I'll have to start this whole process over again which just sounds exhausting.  At the same time, I don't know if this doc is able and willing to treat me.

My plan is still to do my 4 IVFs covered by insurance and freeze all embryos we get.  Then once we have a pile start putting them back.  Whatever doc I start that process with I'm stuck with.  I wouldn't want frozen embryos all over the place.

So, what should I do?  IUI this month with 4 very good follicles and 2 behind?  Or stick with this doc and start building my pile of embryos?  Or just do one cycle of IVF with this doc and if that doesn't work do my next 3 IVFs with a different doc?  (I really don't think I'd the third option.  If I'm going to do IVF I'd like to try to build the pile.)  

Thursday, April 11, 2013

IVF #1 Take 2

So, this cycle didn't start out much better.  Only 3 follicles seen on the initial u/s, but we charged ahead anyways. 

Not much has happened and the doc's wanted to cancel us yesterday.  Estrogen has not been rising as much as it should.  But, I feel why bother cancelling?  What's cancelling going to get me.  It's certainly not going to get me pregnant! 

So, there were 2 good follicles today and 3-4 little ones. I have good insurance and meds are only a $40 co pay. So, I talked the doc into continuing on at a lower dose to try to get those 2 to grow and either doing timed intercourse or an IUI. None of this makes any sense. We never had a problem getting pregnant. The longest amount of time to conceive was 4 months!

I'm trying to figure out what went so wrong and there were only 2 things that changed from testing to cycling. That was the addition of dexamethasone and the birth control pill. I'm starting to suspect the dex even though the doc says it can't be the problem. If DHEA is so important to older women (and lots of studies say it is), dex is the anti-DHEA. Dexamethasone causes DHEA to fall. I asked the doc today about DHEA and he felt it doesn't really do anything, but if I want to try it go ahead. Well, I know the studies show it does do alot for women with DOR. Here's a list of the studies in case anybody's wondering: So maybe after a few months and the dex gets out of my system... After looking that up, the half life of dex is only 36-54 hours, so it should be all out of my system. The more depressing theory is that since DHEA seems to work at improving the follicular environment, the dex may have damaged the follicular environment. Since folliculogenesis takes months it may be a long time before the follicular environment has recovered from the assault. I'll know I'm right if my AFC recovers over the next few months.

So, doc also ordered an AMH test. That's fine I've never had one. If the AMH comes back low, we'll know it's DOR. If it comes back ok, the doc's other theory is that some women's bodies just don't respond to exogenous FSH. So, all the Follistim in the world wouldn't have that much effect on me. In that case, the only other answer is to use my body's own hormones through a Lupron flare protocol or clomid.

So much to think about...