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Sunday, July 5, 2009

What happened?, part dos

OK, so I'm finally typing up the second part of the wtf appointment.

Here's the continuation..

Me: Any chance my body has trouble absorbing or producing progesterone? (Side note to blogosphere: This is something that I have been very conflicted about. I chose not to do the PIO because I was scared of 6 inch needles. I chose this before I did any shots, and at that time I was extremely nervous, so nervous that we considered hiring a nurse when Carlos was out of town. Now I know they are no big deal. But at the time I asked for alternatives and was prescribed endometrin. Since then I have had questions about what "would have been" if I had done the PIO.

Dr H: Very unlikely that your body didn't absorb it.
There are 4 options for progesterone:
- PIO
- Vaginal suppositories (compounded locally into glyceryn and estrogen is added)
- tablet - endometrin
- creme

For natural cycle, I recommend suppository - 1 per night. And your body will produce its own progesterone since we are doing a natural cycle and not putting you on BCPs or anything.

Me: When do I start the progesterone?
Dr H. You will start the suppositories 3 days after HCG shot. Then transfer 4 days after that
PIO rarely done with natural cycle.

Me: Oh yeah, HCG. Will I take Ovidrel or HCG? What is the difference?
Dr. H: Ovidril : recombinant DNA drug, easier to give, more expensive.
HCG : human drug, has to be mixed, less expensive. HCG longer acting and tighter binding.

Me: (reaching for anything that would make any sort of difference.) I read about labs that do embryo culturing in my own endometrial lining. Is that a good idea? You know just do an endometrial biopsy a few weeks before.

Dr. H: Well, we are beyond that now. And your embryos didn't have any trouble growing. We have no reason to believe this would help. The data on this is not very convincing. Success rates not better. Plus there is greater risk for contamination. The studies indicate a very modest increase in success rate EVEN if it's true.

Me: Again I'm searching for a reason why this didn't work. Remember how high my estradiol was. You probably don't. Look it up in your computer. Dude, it was seriously high. Like 79hundred something. What does this mean?

Dr. H: There are lots of pregnancies when this is high. Your ovaries were hyperstimulated, but you did not have symptoms of hyperstimulation syndrome. Yes, your estradiol was very high. You will not have it that high during your frozen cycle because you won't be stimulated.

Me: I read a lot about studies. Do you do any experimental studies here?
Dr H: No, generally no, we are not a research center.

Me: I've been reading about other top centers. Some are highly rated and have high success rates and do PGD. If I have to do another fresh cycle, is there any benefit to doing transfer and PGD onsite?

Dr. H: Onsite doesn't matter. You're not transferring the embryos. Only the genetic material that you had biopsied. It doesn't really matter. That's not a reason to chose a clinic.

Me: Oh yes, Biopsy. That reminds me of another question. I read about Polar Body Biopsy. Coudl we do that instead of PGD?

Dr. H.: Some clinics do that, not a large number of clinics. You have to remember that the more manipulation of the egg and embryo, the greater the chance of problems. There are low pregnancy rates with these cases. Oh and, it's not either, or. You are still doing PGD in these cases also.

Me: Why do these top clinics do better than other clinics?
Dr. H. I really think the embryology lab has a lot to do with it.

Me: What do the clinic do that is so different? Should I go fly to Colorado for a month?
Dr. H.: There is not really an answer for that. But if you choose to do that, you don't have to go for a month. We could do all your monitoring here and work with the other clinic.

Me: Thank you, that's really nice. By the way, next topic. Should I use ovulation predictors this month?

Dr. H.: It won't hurt, but it won't tell you anything about next month's ovulation. You could do your BBTs. That would be free.

Me: Free, yeah, By the way, you know what's not free? Condoms. You don't think birth control pills are a good idea? Did I mention that I really want to have sex with my husband, and sometimes we don't have condoms handy, and I think its really really really weird that we want a baby really really really bad, and I have to freak out and remember to get the condoms.

Dr H. Nah, not good. It could affect pituitary cycle.

Me: Ok, the biggest, most important question.. What *biologically* happened? What could have happened? I need to understand logically.

Dr. H.: You did implant, prob just one embryo. It grew for a short time. Most likely the embryo itself just stopped growing.

Me: WHY?

Dr H. It could have been the environment / could not.

Me: Environment, like what? My uterus? My high e2 level??

Dr. H: Well, we dont' know. Very low probability that there is a problem with the environment. But yes, E2 level will be taken out of the equation for frozen cycle.

Oh yeah, one more. Why are all the doctors against HPTs? I might be out of twon for my Beta dates this time. Why don't I just take a test on my own?

Dr H: I'm not against HPTs. I just know we can have false positives, and we need to know the levels.

Me: Yeah, I get it. But if I get negative, I'm not going to go crazy and drink a bunch or anything. I won't get some majoe wild hair and go get my nails done. And I won't go even crazier and go swim in the ocean or have some deli meat. If i promise not to have deli meat if it's negative, can I take an HPT?

Dr. H: Sure, of course, or you could just enjoy your vacation and come afterwards to test.

Me: I so knew you were against them! Knew it!

Me: Thank you Dr. H. I really appreciate your time and ansering all my questions. I'll see you in August!

--

Well, that's it. Thanks for bearing with me.

8 comments:

Michele said...

I love doctors who take the time to be engaging in the WTF appt. Our RE is like that. I have never felt rushed or like I asked a dumb question.

Fingers crossed for you guys!!!

BB said...

Since you are trying to find answers... I had read about high E2 levels and BFNs. Here are some links if you want to research more (just thought of sharing): http://www.webmd.com/infertility-and-reproduction/news/20030210/estrogen-affects-fertility-window and http://www.sharedjourney.com/forums/Infertility_101/Estrogen_Progesterone_levels_for_IVF/. I spoke to my RE's office about this and they didn't seem to bother much about the high E2 levels, the only reason they said they would cancel the cycle is when you are hyperstimulated (which again is related to high E2). As you have mentioned, you probably wont have to worry about it this time since it will be a "relatively" non-medicated cycle.

sassy said...

I did the progesterone vaginal supposotories - they're not that bad, and I think I would much rather do them again next time than the shots. They do make my boobies hurt, and my belly bloated, and there was always yellow goo in my panties, uh, but honestly, compared to some of the other stuff we have to take... not that bad.

Our Journey... said...

Thanks for the update... I was wondering about the rest of the appointment. Have a good trip!

Ms. Perky said...

Sounds like you had a really good, positive appointment. I know you're disappointed that you didn't get any solid answers, but unfortunately... there usually AREN'T solid answers. (And really? When there ARE solid answers? That's usually a BAD sign and it means there's something REALLY wrong)

Regarding the HPTs - my nurse said their problem with the HPTs is particularly that they'll have patients who get negative HPTs and then won't show up for their betas, but it's turned out they have a low beta at first and they didn't take a second HPT, etc. Things like that. So as long as I still swear I'll show up for my beta (which I almost didn't bother last time...ironic, no?), she couldn't care less WHAT I pee on, so long as I show up. :)

Ms. Perky said...

oh, also, regarding endometrin - my clinic is almost universally switching from PIO to endometrin except in really rare cases (like me - and that's MY choice because I refuse to take endometrin). Studies are showing that it is just as effective for progesterone support.

More interestingly, my Perinatologist from my last pregnancy told me when I went in for my "hey, would it even be SAFE for me to attempt another pregnancy?" appointment (in which he told me, "well, um, not the best idea, but as long as it's just a singleton, you'll be relatively okey dokey") - anyway, he told me that the studies are showing that PIO just isn't necessary in the vast majority of IVF cases, period, but that REs use it because of the very small percent of cases where it could be helpful.

Beautiful Mess said...

Just thinking of you and checking in on ya ;o) Hope you had a nice vacation! Hope you're doing well!
*HUGS*

Julia said...

Hi there! I stumbled upon your blog while looking for other people going through infertility treatments. I added you, and I would welcome you to add me too! I'm over here at www.babyschetky.blogspot.com!

Good luck, and baby dust!