October 30, 2009
And we’re off…like a herd of turtles.
We had our second consultation with the RE last night, and everything was largely as I expected.
- Hormone levels – normal, with the exception of elevated testosterone (typical for PCOS)
- S’s counts – normal
- Clotting tests – normal (no reason why I experienced bleeding after last ER)
- MRI – normal (no brain tumor, phew)
- Genetic tests – normal
So what’s next? Here’s what we discussed:
- He’d like me to start back with Metformin (extended release, 2 tabs/1000 mgs, at night), although my insulin levels look normal, to make sure that nothing having to do with my sugars is affecting my ability to ovulate
- I need to do 4-8 weeks of BCPs (probably around 6 weeks), to regain a more normal hormone balance and suppress my inflated LH levels. I’ll be starting these as soon as they receive insurance approval for this cycle.
- We will be using Lupron again (luteal Lupron) as part of my protocol. I pushed him on this, and he said that this is absolutely needed in my case, to suppress my ovaries and prevent OHSS.
- We will not be using Follistim as the second part of the protocol, but instead will be using a combination of two drugs, likely Gonal-F and Repronex. He’s going to make the decision on that once he’s had a chance to more closely study how I responded to the Follistim (why he didn’t do that before this appt, I don’t know).
- We will definitely be doing ISCI this time (because of the low fertilization rates previously), and potentially assisted hatching as well.
- We will make a game time decision as to whether we’ll be transferring on day two, three, or five. If the embryo quality and fertilization is better this time (which hopefully it will be!), we should have more embryos to choose from, in which case we’ll probably push out to day five. The way he explained it to me is that if there are five or six very good embryos, they have no way of knowing on day three which one(s) will be the best, so they let them continue to grow and self-select. If there are only one or two, then they’d transfer them earlier because the womb is a better incubator than the petri dish. The one concern I had (that if we waited to day 5 that we couldn’t freeze the extra) is unfounded – they freeze all embies on day 5.
- He is open to the idea of transferring two embryos, depending on the quality of the embies. Again, if we have several perfect embies to choose from, we may put in one and freeze the rest. But if there are two or more B-quality embies, I’m going to push for transferring two.
- The antagonist protocol is not appropriate for me, and he seemed kind of annoyed when I asked him about it. In fact, whenever I brought up something that I had researched or heard about, he seemed annoyed. Like he didn’t want me doing my own armchair diagnosis – which I respect – but at least give me credit for doing my research and EXPLAIN to me why those things will or will not work!! His personality still kind of rubs me the wrong way – despite being very nice, there’s just something about him that bugs me – but S likes him, and he’s a very good judge of character. Plus, he’s just here to get me pregnant, not to take me out to dinner, right?? 😉
So, right now we’re looking at a transfer probably mid- to end of January. Pro – gives me a chance to get back on track with my diet and exercise and really enjoy the holidays. Con – more WAITING, ugh!! The only thing that’s left to do is a DNA/fragmentation test of S’s boys, since we’ll be bypassing nature’s self-selection with the ISCI. This test isn’t covered by insurance, but our RE thinks it’s important to double check. Apparently a capsule of liquid nitrogen arrives on our doorstep, with instructions for collection and shipping back. The whole process sounds hysterical and I’ve already warned S that I’d be taking pictures…of the apparatus, not the “event,” don’t worry! 😉