Friday, November 8, 2013

Next steps: Letrozole and Neupogen (G-CSF)

Let's be real.  This will probably be a miscarriage.  So, it always helps me to have a plan.

First off, 'm going to have a consult with the doc on Monday when I do my repeat beta.

My thoughts are this:   With this pregnancy, no matter what the number is I'd like to keep the progesterone going strong until the late 6 week or early 7 week time frame.  The day before Thanksgiving is 6w6d, so I'll try to get an u/s then.  If there's going to be a heartbeat it'll be there.  (I'll take a miracle.  And, I figure someone must live in the tail ends of the HCG bell curve, I'd be thrilled if it was me.)  But, there won't be.  So, then we can have a D&C.  This will give us the opportunity to karotype the bean.  I think this will give us a firmer answer as to whether this is a soil or seed problem.  At this point, the odds are there's a problem with the endometrium (the soil), but we haven't ruled out that maybe we just make a lot of genetically incompetent embryos (bad seeds).  I think this'll give us some answers.

Moving ahead, we have only 4 IVFs covered by insurance.  I'm not sure, but I think after the fourth IVF all infertility benefits cease.  And, overall, I don't think the lab is really doing anything for us.  We seem to make great embryos that make it to blast all the time.  So, an IUI would give us just as good of results as an IVF.  I'd like to talk the doc into keeping the same high dose of stims.  I think we need every target we can get to get a baby out of this.  So, I'll ask about that.

The meds I want to add are this:
Letrozole (Femara)  Letrozole is a first line med to get women to ovulate.  But, it has the nice side effect of regulating Beta 3 Integrin levels.  There's no reason to think I have this problem, but it's such an easy fix and fits in well with an IUI plan I don't see any reason not to.

The other thing I want to add is more controversial.  It's Neupogen (G-CSF).

I've read the article numerous times to try to figure out what Neupogen actually does, but I still have a hard time understanding it.  According to the article, "Granulocyte colony-stimulating factor (G-CSF) is a cytokine which stimulates neutrophilic granulocyte proliferation and differentiation. It is expressed and produced by the decidual cells, and its receptor, c-fms, is expressed by the trophoblastic cells"   

The great part is this, "Results In the group treated with G-CSF, 29 out of 35 (82.8%) women delivered a healthy baby, whereas in the placebo group, this figure was only 16 out of 33 (48.5%) (P = 0.0061, odds ratio = 5.1; 95% confidence interval 1.5–18.4). Significantly higher β-hCG levels were found in gestation weeks 5–9 in women treated with G-CSF versus placebo"

I REALLY like the idea of higher HCG levels.  I have always suffered from this problem.  I wonder if the HCG is a chicken or the egg sort of problem.  Which comes first.  Does a bad embryo produce poor HCG numbers?  (The common theory).  Or, can the low HCG numbers cause the body to not make the necessary changes to fully accept the implanting embryo?  It would seem as if the problems fed off each other.  But, no one seems to really know the full effects of HCG on the endometrium.

Sigh.  So much to think about.

But, that's the plan for next time.  IUI with Letrozole, Follistim, Menopur. Lovenox, Prednisone, HCG trigger and progesterone support.  And, I'll also ask about HCG boosters in the 2ww.

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