A Plan

I know it has been a little bit since I had anything worth while to say. I have been doing ok, I guess. I am not in the Christmas spirit, not even a little bit. We did not even decorate the house this year. We had very little shopping to do, which was good. I am going to make homemade candy this weekend and I did do holiday cards, but that is about it. My kids are finished with exams and I am finished tutoring until January and am looking forward to the little break. We head up to Bu.ffalo on Tuesday.

I had my WTF appt on Monday with Sh.ady Grove and while it was somewhat informative, I found myself walking away feeling frustrated. Dr. M was compassionate and asked us to keep trying. He agreed that the Ganirelix protocol did not do what we were hoping (more eggs) and that we would go back to a long Lupron if we ever did another fresh. He seemed kind of stuck on the fact that we are "new patients" to him and we "only" had one failed cycle with him and we were hoping he would look more at the big picture. He totally dismissed immune issues, beta 3 integrin (sticky glue), and basically did not see the need for anymore testing. Overall, he suspects a chromosome problem and said we are more prone to one because of the severe male factor. However, he doesn't think we are candidates for any type of genetic testing at this point. He said we don't make enough embryos to risk sending them out. He is not a big fan of PGD and said that they are still in the learning stage of CGH. They will be offering eventually, but no time soon and in his opinion, we are not making blasts, so no CGH for us. This is where I was getting frustrated because I felt he wasn't offering us anything new to get us over the hump. His overall plan:

1. Join their shared risk program - $22K 6 fresh cycles, unlimited FET, 100% refund.
2. Bring our 6 frozens over and include them in shared risk.
3. Try to thaw all embies and grow to blast.

That's it. He wasn't very optimistic about an FET - puts it around 20-25%. I was frustrated. I felt like he was kind of dismissing our frosties and putting more emphasis on shared risk and more fresh cycles.

Our consult at our old clinic with Dr. P was really, really great. Everyone was so happy to see us - it is so warm and friendly. We got hugs from the nurses and receptionists and billing and everyone was sorry to hear we had another failed cycle. I thought I was over needing the warm and fuzzy, but it felt so good to feel so cared for.

Dr. P was completely understanding about us seeking a 2nd opinion and doing IVF elsewhere. I was nervous about that and he put my mind at ease. We talked about the failed cycle and he also said no more anatagonist protocol for me. For another fresh he said long lupron or possibly microdose. He said he was going to pretend that all three cycles failed with him and treat us accordingly, which made us happy because any way you slice it, we have still had 3 failed IVFs. He thinks we are still very good candidates for IVF and have a good prognosis. He also feels that we have some great frosties and is much more optimistic than Dr. M about it. He is excited about doing an FET because he thinks I might just be one of those people who responds well to an FET.

Dr. P is a little concerned why I am so prone to polyps and is wondering if it indicates a possible lining issue. He agrees there could be chromosome issues, but is hesitant to jump right to genetic testing. He said PGD is a very flawed science. It misses a lot of abnormalities, there are a lot of false positives and false negatives and PGD has not been found to increase pregnancy rates in IVF patients. He thinks it has its place if there is a known genetic issue that they are screening for. He admitted to not knowing much about CGH, but would be open to genetic testing under the right circumstances. He thinks we need to focus on getting some blasts before we worry about that though. He also dismissed immune issues/testing and beta 3 integrin. Dr. P doesn't believe there is good science or data to justify testing or treating either. Supposedly, after more than a decade of research on both, there is no increase in PG rates for those undergoing immune therapies or Depot Lupron for Beta3. He also feels there is a huge conflict of interest that only one lab in the country does the beta 3 screenings and they also publish all the studies. He discussed how results can vary wildly cycle to cycle and he believes if it worked and truly increased success rates, every RE in the country would screen for these 2 things. He doesn't believe in testing for the sake of testing or "going fishing" as he put it. I just don't know what to believe in this department as there are so many varying opinions in the field.

Anyway, without further ado, his plan:

1. Repeat SIS on Tuesday to check lining. B/W to screen for insulin resistance and check my prolactin.
2. Order a DNA karotyping for me. Revisit genetic testing pending results.
3. Do a mock cycle before my FET. This means prepping my lining for an FET using Estrace and Endometrium, but instead of doing a transfer, he will do an endometrial biopsy instead to check my lining. I am not sure exactly what he is looking for, but he said "abnormalities" and to see how my lining responds to meds. It always looks great on u/s, but he wants to see it under the microscope. He said tweaks can then be made and if there are abnormalities, they are treatable. I have never really heard of this before, but if it means learning more, then I am all for it.
4. Do an FET cycle after mock cycle. Thaw all 6, culture to blast, transfer 2 or 3 blasts. He feels confident we will get some blasts. Fingers crossed.

Overall, we walked away feeling much more confident about Dr. P's plan. He seems more thorough and more optimistic about the success of this FET. Plus, I feel good knowing my embryos were created there, frozen there, and were the result of 2 good cycles. I walked out feeling like my questions were answered and like the weight of the world had been lifted from my shoulders.

I have b/w and SIS on Tuesday and I will do my mock cycle in Jan. FET in Feb pending results all the testing.

I feel like my mood has improved slightly since meeting with him and as I have said before, I do best when I have a plan. Now, I hope we get some answers!

Whew, that was loooooooooong. The end.