Sep 6, 2011

where we are

Today I am 13dp3dt. I have only received BFNs so I am 99% confident that we are out this cycle, but since we traveled to North America at the end of last week and since it was Labor Day weekend on this side of the pond, I was only able to get a beta drawn this morning. The phlebotomist here was AMAZING...I never thought the phlebotomist in Israel was bad or anything, but this woman was "off the hook" as Y might say :)

This cycle was pretty depressing. I knew since we only had one embryo that survived thawing to transfer and since it was more fragmented than the other embryos we have transferred in the past, that our chance of success this round was probably quite low. However, for the first time since starting IVF, I actually had some pretty strong 2ww symptoms, which made me a little hopeful. The symptoms were strongest 4-5dp3dt and disappeared suddenly by 7dp3dt. In fact, when I went in for my progesterone check on 7dp3dt, my P4 was the lowest its ever been at this point of my cycle, 22, and I was told to start taking 2 supps mid-day in addition to my usual 2 in the morning and 2 before bed.

Last week we met with the new RE and we have decided that for our next fresh IVF, we will be switching clinics. He said that he would support us attempting a blastocyst transfer (my current clinic is very anti-day 5 transfer) and concentrating more on the fresh cycles. He said that he would recommend monitoring every day as we approach trigger, since based on my last fresh cycle, it seems like they missed my E2 peak and then I just sort of plateaued. He also said that he would add in LH as well so we aren't doing straight FSH, which might help with the final maturation of the eggs, and that he would stick with the antagonist protocol and probably the same dose of Gonal-F.

I raised my concerns about possible immune/implantation issues but he seems to be just as much a disbeliever in autoimmune infertility/implantation failure as my previous docs. I can't help it - being 27, essentially unexplained, with no obvious egg or embryo quality issues, 6 IUIs, and now 3 IVF transfers under my belt, 1 loss and no other positive cycles, I can't help but become increasingly paranoid that everything is great except that my body is attacking embryos.

Like the REs at my current clinic, Dr. T. said that IF and IVF failure caused by implantation problems is much more rare than IVF failure caused by embryo problems and in the absence of good measures of embryo quality and competence beyond morphology, we just have to assume that our problem lies in the embryos themselves because that is much more common. He also said that in terms of immune testing, he doesn't take much stock in it because there is such an endless array of genes that could be involved and that the actual clinical significance of the results for the tests that are currently available is very unclear. I know Y agrees with this view completely, but I still feel increasingly helpless and desperate in light of not having any satisfying answers for either our infertility or our treatment failures.

As far as Dr. T's general view on pursuing further testing, he says that medicine is currently much better at treating infertility than understanding it. I know that this is how many REs (and physicians in general) think about things but as a scientist, I just have a lot of difficulty with this mentality. He did say he would put in a request for a thrombophilia/clotting panel, but that it may not get approved because he doesn't think my history really warrants the testing.

I know some doctors in Israel who will throw Clexane (Lovenox) and prednisone at almost everyone who walks in the door, especially with previous IVF failures, (I think these types are even more common America), and I sort of want a doctor like this, but I know Y would disagree and says that it is irresponsible medicine to prescribe medications with serious side effects with no strong clinical indication other than "Why not? It might work!".

I would counter this argument by asking which is the worst of 2 evils - potentially unnecessarily subjecting a woman to mega-doses of hormones again and again because she keeps failing and you are unwilling to be more bold in her treatment or throwing in the kitchen sink and prescribing her a bunch of stuff that is potentially harmful (though arguably less so than the repeat mega-doses of hormones) with no clear indication for it other than it might just work and therefore eliminate the need for future IVF cycles? I have no idea - I guess only a prophet could answer this question and I suppose we see both approaches in infertility treatment all of the time. It will be the end of October/beginning of November when we begin another fresh IVF cycle. Anyhow, that is all that is new with us on the IF front. I hope that the end of summer is treating everyone well.


  1. I'm so sorry it looks like this cycle isn't going to work out for you. (((Hugs))) But Yay for the good phelbotomist! That can make a *huge* difference. It also sounds like your new RE is giving you a more customized protocol, which will hopefully have a better outcome. I hope that you are able to get the thrombophilia panel, and that if you do, it sheds some light on what's been going on for you.

    I know I don't comment much, but I just wanted to offer some of my thoughts on reproductive immunology. I'm still learning about it myself, but I agree with you that the risks of high doses of hormones are just as real as the risks of unnecessary immune medications, and that it's hard to predict in advance which risk is worth taking. It must be difficult to have Y on a different page from you about whether or not to even consider the immune treatments. I think your argument is a good one though.

    Like I said before, I'm just in the beginning stages of learning about reproductive immunology, but I'm pretty certain that my most serious issues are immune, and that they are interfering with implantation. If/when you ever decide you want to learn more about that, feel free to contact me tls_with_woman (at) yahoo (dot) com.

    One last thing, since you were interested in the possibility of preventative clexane/lovenox, I just thought I'd mention that some clotting disorders respond to low does aspirin alone (81mg/day), which you should be able to get without a prescription if you wanted to try something else. Anyway, I really hope that one way or another you find the solution you need to get and stay pregnant *soon*!

  2. I'm facing the why-not-try-it-it-even-if-it-looks-like-you-dont-need-it quandary myself, with metformin. I say, if you can, go for it. Especially prednidosone. And I'm somebody in science, saying this. Screw responsible medicine, that can take you most of the way, but when it fails you utterly and there are no answers at hand, then what?

    I think sometimes, patients should take the decisions out of their doctors hands and force them to go in a direction the physician do not want to go in, because THEY have so much invested, while to the doctor it is just a statistic. Nobody knows the answer (and any RE who claims to know the answer beyond a reasonable doubt is a liar). Atleast, when we are the ones suffering, give us the right to make the decision.

    I should add- such empirical treatments should only be tried when it is known that they *probably* will do no harm. But even there, there is a risk- I'm going to have a blogpost on this soon.

  3. It's so tough dealing with different doctors, especially knowing that there are other theories out there. I personally believe in the immunology aspect of infertility, and I believe that treating it this last IVF helped me get and stay pregnant... But I don't KNOW this, and no doctor really does. If you don't feel comfortable, don't continue the current treatment, but it's a tough decision. Thinking of you!

  4. sorry about your BFN again. I wish you lots of luck with your next cycle and new clinic

  5. ((hugs)) I hope your next cycle is the one!

  6. Yay, Dr. T! I'm so glad you are switching. Having one doctor responsible for your treatment can do wonders for your sanity. As for Immunology stuff, the question is do they have anything they can add to your treatment if it does look like you have something going on there. How much of that technology is used in the Hospitals here? As for the clotting stuff and steroids, I'm with you that if it can't hurt you might as well try it. I think in general Dr. T can be persuaded that way too, and I think the reason he isn't going that way yet really is because he thought your last round of IVF produced some not so hot embryos and that you really have a shot at getting pregnant but improving some other aspects of your treatment first.

  7. I am so sorry this cycle did not work out, but it is great to have a plan to move forward & so soon. I am so happy I switched clinics, it made a huge difference. Immunology stuff is so controversial, neither of my REs thought the research was conclusive, go figure.
    (((big hugs)))

  8. Urgh. Sorry this cycle is a bust, but I'm really glad you're trusting your gut and switching clinics!
    A couple of things:
    Clotting issues: You may just want to ask for a referral to a hematologist. Once you get to him/her, if you make enough of a pouty face they'll issue the tests (at least that's what happened in my experience, and it's worth a shot).
    Also - I don't think docs here are more prone to prescribing lovenox. I'm an MTFHR heterozygote, and no one has thrown that drug at me. Just extra B12 and extra folic acid. You may want to ask for an extra-strength folic acid script just in case, I don't think any doc with begrudge you that.
    Re: Immunology - I actually think your doc is right. It's a relatively new field, and usually only undertaken for RPLers. I don't think you're there yet.
    I'm not sure about the protocols for pre-IVF workups, but have you guys done karyotyping? That's something I'm pretty sure a doc would happily refer you to. My hubby and I went in to test for that last month, without a problem (still waiting on the results).
    As always, here if you need me!

  9. Just wanted to let you know that you are in my thoughts. I hate that we have to endure such shit.

  10. I'm so sorry that this cycle may not have worked out for you... and sorry that it's been so long in commenting. I've been on a break after a 'miscarriage' and share your feelings about trying whatever it takes that might work. There seems to be so many mysteries in IVF... and I feels as though anything is worth a try. Thinking of you xoxo