Thursday, July 25, 2013

Another doc, another opinion

So to keep everyone up to speed, I got my period last Thursday after an 11 day luteal phase. Not surprising since I quit the progesterone at 4 dpo when it became apparent that all my embryos would make it to blast (woo-hoo!). So now another 3-4 weeks before I start my next IVF cycle. Today I have 3 docs appointments:

1. I set up an appointment with Dr. Kwak-Kim in Vernon Hills. She's the other RI in the area. I actually set up the appointment months ago, but she is extremely hard to get into. So, they ran an in depth u/s, a ton of bloodwork and a full history and then I talked to the doc. It'll be a few weeks until the bloodwork comes back, so I'll go back 8/13 to find out those results. The u/s was the interesting part. She determined that my Resistance Index (RI) was at 0.61 for my uterus, 0.57 for my left ovary and 0.46 for my right ovary. It's a scale of 0-1 with lower being better. 0.6 is their cut off. Higher than that is bad, lower is good. So the ovaries look good and the uterus looks bad. I have a few concerns about this determination. Since I'm at cd5 wouldn't it make sense that my ovaries are getting a lot of blood flow as the start to grow a follicle?  And wouldn't it make sense that my uterus is limiting blood flow since its at the very tail end of my period and its trying to stop the bleeding?  They acknowledged this, but still felt it should be better...  Eh, I'm not sure. I know she's going to want to put me on Lovenox and I need to do more research on that to determine if its something I want to do.  

One interesting study I found is this:

It states that the RI is greater in women with elevated NKCs.  Hhhhmmmmm.  So it would appear that treating the NKCs would solve the decreased blood flow problem.  

Another interesting side note is I often wonder why the twins did so "well".  They were unlike my other low and slow losses.  They looked great at 13 weeks.  All of the docs have just dismissed the twins as a red herring saying well they probably died from the twinning process itself.  I don't disagree, but my question is why did they do so well???  One thing that was different was before they were conecived I started on low dose aspirin (LDA).  After they died, I quit the LDA, afraid that it might have contributed to their death.  Since I had 2 losses after that I've gone back on the LDA and have since had some high quality cycles.  Correlation does not equal causation, but I'll be staying on the LDA.  

2.  The dentist. After a lot of self reflection, I wonder about my teeth. After my dd was born I had a bunch of dental work including a root canal. Since the elevated NKCs indicate a low level infection somewhere in my body, I wonder if its not the root canal. I saw a homeopathic dentist, but she takes no insurance nod wanted about 4K to pull the root canal tooth. I also have a couple other cavities. I decided to go to my regular dentist who takes my insurance and get the work done here. First I'm going to get one of the teeth fixed that has a particularly bad cavity. Honestly, and this is a little embarrassing, it's the tooth right next to the root canal. And for quite a while there been a bad smell on the floss from that tooth. I thought it was the root canal, but in hind sight, and the homeopath said this, it's probably from the cavity. Also, each IVF cycle has put me on antibiotics and each time the smell has gone away for awhile only to come back later. So I'm hoping to get that tooth fixed. Maybe that's the source of the infection. It certainly feels like a good candidate. And I REALLY don't want to lose a tooth.....  

3. Follow up with the RE.  So, she was pleased with the cycle.  She said she wasn't surprised, though, since I get pregnant easily enough!  Well, I was surprised.  She offered an alternative stim cycle of the Micro Dose Lupron Flare.  My only concern with it is that I'd have to start with BCP.  Last time I took the BCP, it completely messed up my cycle.  Or, maybe it was the Dexamethasome.....  Either way, I have no desire to take either one again.  She was fine with that.  We did decide to add the Saizen (Human Growth Hormone) to the first 5 days of this next cycle and then the antagonist cycle again.  We'll up the starting dose of Follistim to 450 iu.  Sounds good.  And, that's it.  It'll be another freeze all cycle and then if it's as successful as last cycle, we'll do a fresh cycle. 
So, that's it.  I'll update again when I start my next cycle. 

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