WTF at my WTF!!

Ok, first things first, a WTF appointment is a what the F appointment with your doctor after a failed cycle. We had ours with Dr. Check last night. Oh, and before I get into it, I have to let you know that our appointment was at 3pm and I didn’t leave the office until after 7.

At the start of our appointment, we discussed the fact that no one really knows what to do with us. I find that ultimately frustrating. We discussed the enigma that is my ovarian reserve. My fsh level hovers around 7 now, which from what I understand, is still normal. My antral follicle count is usually around 12-16, which again, is normal. However, my day 2 estradiol levels have been around 70 the last few months. So, the doctor really isn’t sure if I have diminished ovarian reserve (DOR), as my antral follicle count should be lower if that was the case. So, first UNKNOWN. Because I’ve done a low dose stim cycle, and a frozen cycle, he’s not sure that the high meds in my system were a cause of not getting pregnant with the first 3 IVFs (which were with a different RE). So, where do we go from here?

I requested some additional testing. I suggested doing a sonohysterogram (where they infuse your uterus with saline solution, and take 3d pictures), karotyping, and having an immunological workup. Dr. Check said that he didn’t think I needed a SHG, but that they could do it that night. I had it done, and of course, my uterus looks fine. Should be good news, but it left me frustrated. As for karotyping, he didn’t think I was a candidate for that. He said that karotyping is usually done when you have repeated miscarriages. Since I haven’t even been pregnant, he didn’t think I should do the test. He said that if I really wanted to, he would do it, but felt it was a waste of money. He also doesn’t put too much stock into the NKa (natural killer cell) issue, so didn’t think I needed an immunological workup. He did say that with the LIT I underwent in August, it would “solve” any issue I had with NKa anyway. He did suggest that maybe I had mild endometriosis (although, he really doesn’t think I have that). He recommended that I get a CA 125 blood work up, and if my levels are positive, then I could consider doing a laparoscopy. So, I had mid cycle blood work and did a CA 125 work up. I’ll have to have the CA 125 bloods done again at the start of AF next cycle, and they will compare the 2 numbers. If I’m positive, I would schedule a laparoscopy. As I said before, we don’t expect the number to reflect endometriosis.

Along the lines of immunotherapy and LIT, Dr. Check mentioned a study that he did using intralipids. Intralipid is basically an iv that is given to me around 7-14 days before my ET and if I get a positive pregnancy test, I do another infusion. It’s supposed to help the embryo bind to the uterine lining, enabling it to implant. It’s cheap, and doesn’t do any harm. Anyway, in his study, he found that women 35 and under had higher pregnancy rates after receiving intralipids. However, for women over 40, it did NOTHING for them. So, since intralipids are relatively inexpensive, and I am still 35, we will be doing that with our next ivf cycle. In addition to the lack of implantation, Dr. Check also recommended some kind of endometrial irritation. Basically, they go in and remove some tissue from my uterine lining. This will cause the lining to become irritated, and apparently, that could also aid in implantation, so we will try that one too. It does kind of seem like this is another “throw everything at the wall, and see what sticks” kind of cycle, but I guess since we are a special case, no one really knows what to do or where to go from here.

Dr. Check also mentioned the idea of using donor eggs, or donor sperm or donor embryos or a surrogate. His thought process was that if we just want a baby in our arms already, we can use one of the above and then worry about having our “own” child after we already have one under our belt. I thought that was just ridiculous. I want a baby more than anything, but until someone tells me “you WILL NOT get pregnant with your own eggs and Mark’s sperm,” I’m going to keep going using our own stuff! One interesting aspect was that when the doctor suggested using Mark’s brother’s sperm for ivf…using Mark’s sperm and his brother’s sperm…and not knowing who’s sperm fertilized the egg, Mark seemed Ok with that idea. I told him that I’m just not there yet, but if we ever did decide to use donor sperm, I think his brother would be our BEST option, as we still get his family’s genetics. If Mark’s brother is reading this, we have some fun things to ask you and discuss over Thanksgiving ; - )

Ok, so getting back to doing another ivf cycle with Cooper…one extremely frustrating aspect of our WTF was when we mentioned that EVERY doctor has had trouble doing my egg transfer. Apparently, my cervix is anterior, or something like that, and it’s hard to get to with the usual flexible catheter. Well, this was all news to Dr. Check. Um, don’t the doctors in the practice talk to one another?? That really pissed Mark and I off and that is when we decided that this is our last IVF cycle with Cooper. If I don’t get pregnant, we are moving on. At our last transfer, the dr. said that we should use a rigid catheter for our next transfer. Dr. Check told us that when you use a rigid catheter, your pregnancy rates can be lower. Ok, why the F didn’t someone realize that after our first Cooper transfer. He said that when you do assisted hatching of the embryo, coupled with a rigid catheter, you are just asking for a negative pg test. So, with the next cycle, we won’t do assisted hatching, and we will have one of the more experienced doctors do my transfer. We also discussed the option of doing a 5 day transfer instead of a 3 day transfer. I have never done a 5 day transfer, and therefore, have never transferred blastocysts…we have only ever transferred 8 cell embryos. Of course, doing a 5 day transfer is kind of dependent on how many eggs we are able to get at retrieval.

I also insisted that in addition to all the above mentioned tweaks to our cycle, that I definitely wanted to use a different protocol. We didn’t want to do the long lupron protocol (which is what we used for our first 3 failed ivf cycles). So, basically, Dr. Check said that my last cycle I used too much LH (Menopur), and that could result in poor eggs. Another case of the nurse telling me something that wasn’t accurate (she said that it didn’t matter if I took more Menopur than Bravelle, as that’s what I already had on hand). So, that being said, we agreed to do a protocol of using 225 units of Follistim, and 75 units of Menopur…and then adding cetrotide in around the 4-6 day of stimming. The truth is that this isn’t that much different than my last cycle with Cooper, but I did respond well using Follistim for ivf 1-3. If this is confusing for you, imagine how I feel!!!

So, what does that mean for right now? Well, as of yesterday, I was on CD 13 and I had a 15.3mm follicle. That means, that I haven’t ovulated yet. So, Dr. Check wants me to do another monitored “natural” cycle this month, with progesterone support after ovulation. He also wants me to do another post coital exam. So basically, first thing tomorrow morning, Mark and I need to have sex. Then, I get to run to the doctor’s office where they will first do an ultrasound (checking to see the size of my follicle). After the u/s, a nurse will take a syringe and pull out some liquid from my cervix, and look at it under a microscope. She will be looking for 2 things…how much cervical mucus I have, and if Mark’s sperm can move through it. If my post coital results are good, then Mark and I just need to have timed intercourse and hope that I get pregnant naturally (as if!!). If the PC looks bad, then we can consider doing an IUI this cycle. However, I doubt that Mark and I will do an IUI as that’s just throwing $1k down the toilet. Dr. Check wants to do whatever we can while the LIT is still hot, so that gives me another 2-3 months.

If you have read this far, good for you!! You are a better person than I am.

So, if I don’t get pregnant with either our natural cycle, or with ivf #6, we are moving on. I have a consultation with CCRM on Monday, October 12. I think that Mark and I will likely pursue IVF with either SIRM (in Bedminster, NJ) or Cornell in NY. That will make monitoring appointments very stressful, as my commute for a 5 minute appointment will be somewhere between 3-4 hours! UGH!

Stay tuned…