Monday, February 28, 2011

Onwards and Upwards

Wow, I've been a horrible ICLWer this round. The Fates conspired against me with two blows last week and I was just DONE with the internet for the most part. Friday night I indulged in excess alcohol in a way I haven't for years, and I paid the price on Saturday.

My dear, dear husband tried his best the entire weekend to keep my mind off things which resulted in a 5 hour car ride to nowhere, really, yesterday (but hey I admit I was entertained).

So I will try again next month, and hope that I can be a much better commenter.

I met with the RE today for my "what the f" meeting. It seems like this cycle wasn't all that great anyway. It is surprising to me because my FSH was pretty low - 2.6. But I just didn't respond the way they expected me to.

On day 3 of stims, my E2 was 260 - in the right range of 200-400 but on the lower side. They upped my Bravelle from 2 to 3 vials and 3 days later my E2 had gone to 801 - perfect. But after that, things started to fall off the track, and I'm not sure why. Neither is he (comforting, you know? Not).

On day 10 of stims, my E2 had only gone to 1364, and SOME (not all) of my follicles had actually gotten a little smaller (L pointed out to me they got smaller by 1mm, which he believes could just be human error as he thinks they're not all that precise about measuring follicles). According to my RE today, given my numbers, he would have expected to see an E2 of 2000 at this point.

Then, on the final day of stims (day 12), my E2 actually fell slightly, to 1308. I had 4 really good sized follicles, so they couldn't stim me any longer, but according to my RE, I had so many slightly smaller follicles he thinks my E2 should have been close to 4000 at that point.

So what the hell?

I asked if the BCP I was on for 5 weeks might have oversuppressed me but he said my E2 was 38 at baseline. If it were, say, 7, he might agree with me, but E2 is within the acceptable range of 20-50. He says it's possible the Lupron might have surpressed me a little too much, but he's not positive. However, I think he's keeping the same exact Lupron protocol the next time around, which confuses me.

He did say that for IVF #2, he will be upping my stim dosage. Instead of starting me on 3 and going down to 2, he will be starting me on 3.5 vials and going down to only 3 vials. I really hope that does the trick...

He said if possible, *I* should be more proactive about my cycle. I think this is slightly bullshit, because A) I'm no doctor, and B) This was my first IVF. But I also see his point as well, he knows I'm a control freak, and if I'm seeing that my estrogen isn't as high as would be expected, I might ask about additional estrogen to help things along in the middle of stims next cycle, or, if there needs to be a 3rd cycle (please God, no) to do away with Lupron altogether.

Even after the stims though, things still weren't entirely clear. They retrieved 12 eggs from me, which he said in terms of numbers were spot on average and what they like to see. But only 7 of them were mature, which he said was less than they expected. Out of those 7, 5 fertilized. Out of those 5, 1 arrested after only 2 days, the other four turned into 2 "ok" 8-cell embryos and 2 "good" 6-cell embryos. He didn't mention any fragmentation.

So they implanted the 2 good ones, which teaches me they prefer the quality of the embryos to the number of cells they have.

The 2 "ok" ones they left to see if they could make it to freeze, and only one made it to a day 5-blastocyst, but it was of such poor quality (3CC) they didn't freeze it.

So the overall notes I have from their summary is:

Oocyte quantity was good, maturational status was fair, and oocyte quality was poor....Overally this was a lesser quality cycle than expected for a young woman. However the embryo development was acceptable.

But the question is, does changing the stimulation protocol help with that?

Keeping in mind he was suggesting me to be more proactive where I felt necessary, it gave me the courage to ask about the things I wanted going forward. So I asked if they would please test my progesterone and E2 levels during my 2ww next time, because I am concerned with the fact that I started bleeding much earlier than I do in a non-IVF cycle. He agreed.

And finally I brought up my concern about my loss panel that I've had done. He does not think I need heparin, but said I could take lovenox starting right after ET if I wish. I do wish it, thanks.

So, on that note, I FINALLY got a hold of someone at Brigham and Women's and made an appointment with Dr. E, the MFM recommended to us by Dr. Mike 2 years ago now...sigh...

I could either meet with her this Thursday or on 3/31. And she wants to see my lab results from the loss panel, since I haven't seen her in over a year because, you know, we have yet to get to 8 weeks.

I was debating whether I could wait till 3/31 because Thurs. is really short notice to take off of work, and I have a deposition that day anyway. I waited till IVF Jen called me to let me know about my calendar for IVF#2, and then called Dr. E's office back to say I'd take 3/31.

This way I'll hopefully have a plan for post ET going forward.

So...onwards to IVF #2. I hope this works out better for me than IVF #1.

1 comment:

  1. (((hugs))) I am so sorry you have to go through all of this. None of this is fair or easy. I wish your Dr. had more positive things to say, or at least a better idea as to what may have gone wrong. I hope the MFM has some good news for you as well, I know we have looked into seeing one by us if needed. None of this is what we were led to believe would be needed to have a baby, and it sucks. I'm glad you have a wonderful DH to help you out and can only send you my positive thoughts as you move on to your next IVF cycle.