Phone Consultation with CCRM...ALL the Details!

Mark and I had our phone consultation with CCRM on Monday, October 12. We spoke with Dr. Minjarez about our case. The conversation was about 1 hour long, and although we didn't get an idea for what other protocols we should be trying, we at least got some good tips.

Dr. Minjarez recommended that I get tested for karyotyping (chromosomal analysis), and that I undergo an integrin biopsy. The integrin biopsy will look to see if you are missing the beta protein that's necessary for an embryo to implant in the uterus. We will be doing a regular endometrial biopsy during my last ivf cycle with Dr. Check. However, you cannot do the integrin biopsy during an ivf cycle. So, it looks like I will be very lucky and get to undergo the procedure twice. Did I mention that it's painful?? She also suggested that I do the clomid challenge test, which apparently would give her a clue as to how I would respond with stims, or if I would even respond. If we don't go with CCRM, I doubt that I would do the clomid challenge, considering I've been doing ivf and they are always able to get at least 6 eggs on a full stim protocol.

Dr. M. recommended that Mark also have karotyping done and a sperm chromatin test. The sperm chromatin test measures the level of dna fragmentation in the sperm, to enhance the diagnosis of and treatment of male infertility.

Based on these recommendations, it's clear that as of right now, we haven't done enough testing to determine if this is female factor or male factor infertility. So, we are still in the category of basically "unexplained."

She also recommended that Mark and I both start on supplements. They take 3 months before you actually see any results, but we will start taking them now, and still do ivf in about 1 month. Here is what she suggested for me:

DHEA: this is supposed to help with stimulation
L-argenine: this is supposed to help improve egg quality.
For Mark:
Vitamins E and C
Co Enzyme Q
L-carnatine.

I would assume that the above are to help improve sperm count and quality.
Dr. M. did discuss hypotheticals for doing an ivf cycle with her office. When she looked over my past protocols, she seemed to think that going with a gonatropid stimulation (which I have done for all 5) was a potential problem. However, she didn't tell me what protocols she would recommend if we cycled with CCRM. She also told us that we should try our hardest to push for a 5dt as she has seen a 50-60% chance of implantation. This was news to Mark and I. All our other Drs had said that there is no difference between a 3dt and a 5dt. Also, if we are lucky enough to get enough embryos to a 5dt, she would recommend doing CGH (full genetic testing of the blastocysts). If we are able to transfer any blasts that appear normal through CGH, there is a 70-80% success rate.

So, here's what scares me…my fsh level was 3-4 when we first started all this…with normal E2 levels on cycle day 3. Now, my fsh level is around 8 and my E2 levels are over 70. We were able to get 18 eggs with our second ivf cycle, and we took the advice of our then RE and only icsi'd half. None of the conventionally fertilized eggs, fertilized. We have one frozen blast from that cycle. I WILL ALWAYS WONDER…if we did icsi on all of them, if we would have been able to do a 5dt and if I would have a child at this point. It makes me sad thinking about it. After that great egg cycle, we got 8 eggs, 3 eggs (minimal stim), and 7 eggs with our subsequent ivfs. I'm just nervous that I missed my window, and that I will never make more than 7 eggs. Hindsight is 20/20, and although it's out of my control now, I can't help but get upset about what we did or didn't do in the past : (

So, looking forward, if we were to cycle with CCRM (and that's a big IF), we probably wouldn’t start until February, meaning we wouldn't do an IVF cycle until about April. Plus, it's about $20K and Mark and I are completely out of pocket. Again, I get sick just thinking about all of this.