Tuesday, 28 February 2012

My case review

Well I went to the doctor today and I'm feeling more optimistic (for now).  We went through EVERYTHING and reorganized my file, which is like a huge brick.  It was good to not be rushed like when I usually talk to her during cycle monitoring, and she was very nice and I feel my faith in her is somewhat restored.  Everything she said made sense and we were able to come to some conclusions.  So basically she said that my age is the main problem at this point, however she assured me she still has a lot of success with 39 year olds so it isn't over yet.  She said she has had successful pregnancies at the clinic up to age 44 and then only 1 patient age 45 who did get pregnant with her own eggs.  Donor eggs can be done up to age 51.  So I felt a bit better about being 39 (although I'll be 40 in a few months!)  My cycles are regular and I ovulate on my own.  I had a bit of endometriosis that we removed during my laporoscopy last year.  DH has good volume and count of sperm, but low motility, so we are getting another sperm analysis and DNA fragmentation to see what's going on with that.  All my bloodwork and immunology came back fine except the thyroid and prolactin.  I'm now on thyroid med (low dose) and that level is fine now, but we are going to recheck the prolactin.  Mine was too high for some reason.  My AMH is very good, however she said she takes it with a grain of salt since it is actually extremely high (32.6), it doesn't really fit with the rest of the picture.  She said the FSH levels have been fluctuating (going up) but she said that was unreliable since my other hormones were out of synch last cycle, and the FSH shouldn't change that much from one cycle to the next normally.  Basically it seems that I have a lot of eggs but the quality is very questionable.  Her plan is to try the "different recipe" of IVF to see if we can get better quality eggs.  We will try the antagonist cycle, as we were about to do when my cycle got cancelled.  She also suggested that I start taking DHEA, which is a drug that is normally recommended to patients with low AMH.  It is to improve the egg quantity and quality so in my case she said she didn't recommend it before because we didn't want any MORE eggs because I would hyperstimulate.  But she said little is known about it so if I wanted to try it there may be a benefit, as she has had patients with very low AMH (like 2 or 3- which is not my problem, but still)  who got pregnant after taking it.  So I decided to go ahead with that after she assured me that it would not do any harm and may do some good.  Also, I'm continuing to take the CoQ10.  She then said her next suggestion if the antagonist cycle does not work is to try a minimal stimulation cycle.  The goal is to develop a few good quality eggs instead of a lot of eggs that end up crapping out anyway.  However, the risk is that there may be nothing at the end since you are starting with so few.  And in that case the PGS may not be worth it since you pay the same fee whether you have 8 embryos or 1 embryo, it's still $5000.  She did seem to think I should carry on with the PGS and answered my questions about it.  Aside from the price being a deterrent, she assured me that it did not damage the embryo since they take it from the day 5 or 6 blast (taking it from a day 3 embryo WOULD damage it, so they stopped doing it that way) and it does save time since they don't transfer the abnormal ones that appear normal.  Anyway, we will do the PGS for the antagonist cycle, not so sure about the 'minimal stimulation' cycle though.  And then we can go to donor embryos after that.  As I already found out, it costs $15,000 - $20,0000 for a shared cycle (ie. shared with another couple using the same donor, and you get half the eggs from the cycle, usually about 10 eggs each).  That's about the same price as our IVF with PGS so it won't be such a shock to move on to that (other than losing the genetic connection).  She said not to bother with the PGS with the donor cycle, since the eggs are younger there is a lower chance of abnormality, so not worth the money. 

So that's it.  I feel like I know what's coming, at least.  So this cycle I am just doing the DHEA, CoQ10, and in a few days I'll start the estrogen patches to prime for the next cycle.  Hopefully the antagonist cycle will go ok.  And I know if it doesn't, and the minimal stimulation cycle also doesn't go well, I will feel like I gave it a good shot before moving to donor eggs.  I don't want to waste time, but I don't want to give up too early either.  And we're not millionaires, so we have to strategize this a bit.  I'm praying that one or two more cycles is all I need to end this nightmare, but if not, then with the donor eggs at least I will have increased chances of it working and becoming a mom, although it won't be my genetic child.  I think I will be ok with that if it comes to that point. 

The meeting with the counsellor went well also.  I was feeling pretty good from getting so much information from my doctor, so I'm not sure I really needed a session.  But it was good to air a few things and I have some concerns about next week being my EDD (March 4th).  It has crept up on me, and I'm not sure how I'm going to feel on that day, and if I should be planning something to acknowledge what would have been.  I'm still not really sure what I'm going to do that day, but I don't want to be unprepared and have it hit me like a ton of bricks all of a sudden.  Also, I talked to her about my dentist appointment next week, and the last time I was at the dentist I told them I was pregnant, and then the NEXT DAY I went in and had my abnormal Nuchal Translucency screening, which was the beginning of the end.  So I'm imagining what they will say or what I will say when I go in next week.  I know that the hygenist wrote "12 weeks pregnant" on my file, so I think they will say something.  If she hadn't written that down, I would maybe hope that they just forgot.  Anyway, I don't really have a plan yet about that either.  I will bring kleenex, that's my plan so far.  I think a breakdown is inevitable.  Even if they don't say anything, I think that will upset me too.  Crap!

The counsellor didn't go on about the donor eggs this time, mainly because I went through my plan with her that had donor eggs as "Plan C"  (plan A - antagonist cycle,  plan B - minimal stimulation...)  I know when I get to that point she will be happy to talk about it!  (It's her favourite thing!)  Apparently a major part of her job is interviewing the donors.  I told her I went to the support group that she suggested and she was interested in that.  She said she would like to go also to get a different perspective since she mainly works with the donors, and she would like to hear more from the recipients. 

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