The upshot of my conversation with Dr. Gorgeous is that I'm leaning heavily toward putting all my eggs in one basket (er, make that petri dish) for an August IVF. (That assumes my body clock will synch with their clock, and I think I'm a week short of that happening, but I'll let the nurses do the math.) And then if that doesn't work, natural cycles in the fall.
If I do this IVF, it will be similar to the last go around, which involved a ganirelix + half dose microdose lupron lead in but 600 IU Follistim instead of Menopur/Follistim combo. I asked about estrogen priming, and she's pretty insistent (as she was last year) that her patients do better with the short burst of MDL. I told her that I wouldn't consider going to retrieval with 4 or fewer follicles, and she agreed.
I'm not sure about this plan. I told her point blank last Oct that I wouldn't consider doing another IVF again. But it seems right now that I'm doing all the work of IVF (suppression, high dose stims, daily monitoring) without the potential payoff of retrieval/transfer. So if I go into an IVF cycle with the knowledge that it might very well become an IUI, I think I'm okay with that.
But I'm not sure what the benefit of IVF is, unless I do PGD... which we didn't discuss. I'd hoped I could go away with LG during this tww and forget about ttc. But this decision will need to be made pretty much immediately. Is this crazy?
For now, I'll hang on to this. "You know," she said, "I was just telling [Cute Andrologist] that I really think Gwinne is going to get pregnant."
For what it's worth this is my story, maybe it will help you in your decision. I have always been a low responder. (My son was conceived through IVF during my second cycle.) When I went back to conceive number 2, I discovered that I was an even lower responder. (I guess I can thank old age for that. I was 42, a year ago, when I started to try for number 2.)
ReplyDeleteOn my first try (MDL protocol), I had 3 eggs retrieved. (1 was immature, 1 fertilized abnormally and 1 fertilized fine.) And, only one to transfer. I did get pregnant. It truly only takes one. But unfortunately, probably due to my age, it was not genetically stable and I ended up miscarrying.
Here's where I panicked and started doing stupid things. Instead of just sticking with things I knew worked with my body, I tried to increase my odds on the next round by taking DHEA (even through my FSH was fine) and doing an estrogen priming protocol. I ended up with only one follicle and decided to cancel the cycle. I stopped the DHEA after that cycle because my body just started to feel "off" plus my response to stims was the worst it had ever been. The next cycle, I think that the DHEA was still in body; I still felt "off". And I only had one follicle again. I decided to go through with the retrieval, but unfortunately there was no egg to be found.
Then for the next cycle I tried a high dose of L-Arginine because I had read that it helps you stim better. And it does. I just forgot to research if it effects fertilization rates. And... it does! I had 4 mature eggs but they all disintegrated during ICSI. So nothing to transfer.
So, I realized that it's best not to muck around too much with Mother Nature. I did a Dandilion and Milk Thistle cleanse. Took Grape Seed Extract and drank lots of Wheat Grass. Took a month off. Did a HSG just to see it my tubes were blocked. And convinced my RE to do a MDL cycle with no initial suppression. No BCP and no lupron upfront. I ended up having a pretty good cycle (for me). I had four eggs retrieved (2 immature and 2 mature.) I had 2 two day embryos put back and I am now almost 18 weeks pregnant with another little boy.
Though this last cycle, I kept calming myself down when I would start to panic about time slipping away, by just telling myself that I would have the baby that I was meant to have. It might sound foolish, but that mantra (in the end) kept me on course and helped me to listen to the truth that my inner voice was speaking, instead of the craziness that my panicked self was shouting.
Good luck. All of these decisions are so personal. I know that you will make the ones that are right for you, your body and your life.
Gwynn, first, congratulations on your pregnancy! Your story does give me some good perspective. I am taking DHEA and will probably continue to do so, as I don't feel worse on it (and, if anything, I think I'm slightly better moodwise). But I'm wavering on IVF...
ReplyDeleteYou told me a while back that the IVF was so much more difficult emotionally than IUI. At the time I couldn't quite conceive of why it would be all that much different from an IUI. But you were right, it is.
ReplyDeleteBut it sounds like you may be ready for it again. It does mean that you can check off a significant number of the things that can go wrong with fertilization. That's mentally comforting.
But at the same time, it is also mentally tortuous.
And then there are the progesterone shots.
I think your idea of going into it with the intention of IVF and converting to an IUI if necessary is a good one. That mental game is not bad, as an IUI with several follicles is a good IUI.
I have my fingers crossed that you get 18 wonderful follicles and then have the FET option if the IVF doesn't work right off the bat.
Your determination has just got to pay off sometime very soon.
InB, there's no way I'd get 18 follicles! But if I get the 7, I did last time (and there's actually 7 eggs) I'd be pretty darn happy. Dr. Gorgeous is pretty convinced that persistence does pay off, too, which I take a lot of comfort in. I think the reason I want to do this--those moments I want to do this!--is because I need to give my body one more big push before I'd give it up to natural cycles (and eventually donor egg). But I don't know...
ReplyDeletehey, I can always hope for 18 follies for you!!! you be the practical one and I'll do all sorts of superstitious stuff to bring you good luck. One of these days the fertility gods just might listen.
ReplyDeleteYou know the problem with picking a protocol is that you never know what is going to work... regardless of what worked for anyone else, or what works better for a doctor's patients. I did estrogen priming protocol, and variations on a bcp then stim like crazy protocol (with and without femera). In 7 cycles (that went forward) I had pretty much the same results: 6-10 follicles, 6-8 eggs, and around 4 embryos to transfer. I have quite a few friends who did really well on an estrogen priming protocol (one SMC went from 8 to 18 eggs at 44...), but you never know. And just because one cycle is bad for you, you never know if it's the protocol or a bad cycle. Lots of tough choices.
ReplyDelete-Margie
Thanks, Margie. I'm sort of keen to try estrogen priming just because I haven't done it for IVF (I've been doing luteal estrace at various doses for IUI set up). But you're right, there's really no way to know what's going to work. I had an *abysmal* cycle last July/Aug, when I only had two follicles mature (out of 11 or 12 antral), and Dr. G seemed to think I was oversuppressed from the birth control/MDL combo. My second attempt was significantly better, and that one didn't have birth control as a lead in (I had almost 3 weeks off between the pill and the start of the cycle). What she's suggested this time is much more like that cycle, with even less of MDL (just 3-4 days, for the flare, and then off). I think I like it...but there's no way to know until I've tried it. She's pretty willing to let me try anything, but EPP is one thing she really seems to dislike for me for IVF...
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