Last week, hubby and I went for our IVF cycle review/consultation.
I used the Voice Memo app on my iPhone to audio record the meeting. This has become a really helpful habit, not only for blogging purposes, but just to remember what was discussed. So often during a doctor’s appointment, you’re in the moment and caught up in conversation – then you get home, and are fuzzy on the details.
Dr. S led off the conversation… “We were close! So close, then it got really frustrating… well the whole thing is frustrating I’m sure. Good news – the good thing is that you got pregnant, which means a lot of hurdles were overcome already. It definitely was a pregnancy because we had positive pregnancy hormone in your blood – it just didn’t stay attached. We don’t know why, because it wasn’t big enough to see by ultrasound, so that’s what we call a chemical pregnancy. It means we know you were pregnant because of these biochemical tests but weren’t able to see it.”
He said the average first HCG levels are around 100. The lower the starting point, the more concerned they are. He said they’ve had patients start out with levels of 20′s and 30′s and have normal pregnancies (I was 27), but usually it’s around 100.
He also isn’t entirely sure it was a tubal ectopic because my levels were just so low after the miscarriage. They aren’t able to see anything on ultrasound until the levels are between 1,000 – 1,500, so there’s no way to tell if I had an official ectopic pregnancy after all… but they had to do the methotrexate shots as a precaution because my levels kept rising (from 10 up to 15 in the span of a few days).
He pointed out a lot of other good things about the cycle:
- I had a good egg supply
- I responded well to stim medicines
- I got pregnant on the first IVF attempt
- We have one embryo frozen
He also said another good thing is that we don’t need to do ICSI next time because 5 of the 7 eggs fertilized by themselves. I’m not sure why this is considered “good”, but that’s what he said. We had done a 50/50 approach… fertilize half of my collected eggs via ICSI, and let the other half try to fertilize on their own (8 of the 9 fertilized via ICSI).
However, out of the 13 fertilized eggs, only 3 made it to the final blast stage and that’s where Dr. S said he wasn’t sure what was going on. The egg quality in general was good. Some eggs looked “funky” but he said that’s expected with a large egg retrieval like mine (21 eggs), and that they won’t all be perfect. Did he just say I have funky eggs?
As the eggs were dividing they were looking good, but as they got further along, some of them were slowing down and a lot of them didn’t make it to the blastocyst stage.
Dr. S said that sometimes he sees this with PCOS patients, where they get lots of eggs, but they’re not always necessarily good eggs. Nobody really knows why, but the Metformin is supposed to help with that, keeping the insulin levels down.
Also, using birth control prior to the IVF start can help with egg quality (which I realize sounds completely counter-intuitive). He said there’s some evidence that being on birth control at least 2-3 months prior to IVF helps because it suppresses the higher levels of testosterone that PCOS patients have. Testosterone, insulin and other such hormones can have adverse effects on eggs.
So, where do we go from here?
We have one frozen embryo, but they generally don’t recommend a frozen embryo transfer (FET) with just one. There is a lot of prep work that goes into an FET, and there are chances that some embryos don’t survive the thaw… so they wouldn’t want me to go through all that prep, with the possibility of the one embryo not making it.
We will be moving forward with another fresh cycle, with a switch to an “antagonist” protocol…
- Birth control for 2 months prior to start of IVF.
- After 2nd period, start Menopur & Follistim to get eggs growing (in previous cycle, I did Lupron shots for a few weeks prior to stim meds, so this approach lessens the amt of shots I’ll need, woot!)
- After eggs start growing, begin Ganirelix which blocks ability to ovulate prematurely.
- Once eggs are ready, use a bola of Lupron – because Lupron will mature the eggs if you’re not on it already.
- The beauty of a “Lupron trigger” is that the ovaries shrink back down quicker after the egg retrieval which helps prevent hyperstimulation.
After the methotrexate shots, I was off all medicines. So now I have to restart taking Metformin again, as well as prenatal vitamins. I was supposed to restart the Metformin last week but have been putting it off… its just such a yucky pill.
I will also be switching from Doxycycline to Zithromax during IVF prep because Z has less side effects. The Doxycycline absolutely wrecked me, I was so nauseous both times I was on it and could barely eat anything… the only thing I could stomach was mashed potatoes.
So for now, I’m waiting to get my period. In the event I don’t get it by Friday (which I will likely be the case), I’ll take Prometrium again to induce a period, then begin the birth control.
I’m off to meet with my therapist Dr. G tonight… I am really enjoying our sessions.