WTF & Next Steps

Today's appointment went well... I think.  Determined not to forget any questions or things I wanted to cover I prepared a 4 page handout for discussion.  Don't laugh.  Okay laugh. It's ridiculous.  (It even had a page titled "Notes" at the back. I smiled from ear to ear when Dr. S turned to it and started scribbling furiously.  Take that Mr. R! Ohhhh how he laughed at me for that page).

Anyway, I didn't want to waste this time dwelling on the "what went wrong" portion of the program, so I jumped right over that and talked about my insurance cover, what we have left, how we've met all our deductibles for this year and what our next plans are.  I explained my reasons for each step and Dr. S seemed very supportive.

So in order here's what we covered:

1)  Vasectomy reversal.

Dr. S says that based on the low motility we're seeing in the TESE samples he's not expecting miracles to occur here, but he agrees with me that there is no reason for that door to remain shut.  You never know what might happen and also... for future attempts - depending on SA results post-reversal - we'll probably be able to avoid TESE either way since we'll only really need fewer than 8 for ICSI, but it does open the door for wildcard IUI tries in the future since we still have cover for this.  He says to go for it, but do it ASAP.

He has ordered an endocrine panel for Mr. R on Saturday.  We have our consult with urologist on Wed next week and we're HOPING to have surgery the week after.

2)  Laparoscopy.

My reasons for wanting this are threefold.  Firstly, I have mild endo and my last lap was 3 years ago.  I want to know that it's gone and won't be a problem for next transfer, for SURE.  Also, I have dysmenorrhea (ridiculously painful periods with hideously heavy flow) and the last 6 months we've gotten to the point where I literally cannot get out of bed for CD 1 and 2, and I only make it through the day hopped up on 4-600mg of Ibuprofen every 2 hours and by assuming labor positions on my knees and arching my back up and down while sobbing hysterically and rushing to the bathroom every hour.  Yes, I know that's a LOT of ibuprofen, but its better than what my OB prescribed -- hydrocodone, which incidentally doesn't work at all!  I cannot go on like this much longer and it definitely got better for a short while after last lap.  And lastly, I figure a lap may double as an endometrial scratch of sorts.  Dr. S doesn't give much weight to endometrial scratching as being beneficial, but it can't hurt so he has agreed to do a lap for me.

They're scheduling me for lap surgery next week.  Will hear tomorrow what day. This is too far out from transfer cycle to be beneficial as a "scratch" replacement I think. Oh well.

3)  PGS Cycles

So here's where it gets pretty up in the air.  We discussed briefly how we feel about outcomes of the Micro Flare protocol.  We both agree that 6 retrieved, 5 mature is pretty close to the top end of what I can expect in any cycle, it's a pity about the fertilization - though to be fair (standing up for my eggs) 3 fertilized out of 5 mature is not abysmal by any stretch of the imagination. If only they'd all keep growing from there!

I've been reading up on the Agonist/Antagonist Conversion protocol (thanks to an amazing friend on TWW forum) designed by the famous Dr. Scher of Las Vegas.  I added a note about it in my handout - didn't mention the good Dr. Scher at all, just the possibility of considering a protocol that focused on keeping the LH low throughout and giving a max dose of FSH on day 1 & 2 of stims, before exposure to LH.  Dr. S read about this and said, "Ah yes, the Scher Protocol.  We've used this in the past and had moderate success with it, but we haven't used it in a while.  It might work here."  I felt REALLY good about him in that moment.  I am SO glad I switched REs in this clinic.  My last RE had a tendency to pooh-pooh any suggestion I made without even considering it.  Dr. S is going to discuss it with his partners (including my other RE) but he feels that given our time constraints, remember everything has to be done by Dec 31 to avoid extra costs, this might be too long for our time line.

He does believe there is still some wiggle room in my max dose of Follistim.  I cycled on 450 last time, and he says he has gone as high as 600 before.  We're probably going to up me this time.

He mentioned a protocol that they've already been discussing for me called Lupron Overlap -- I've never heard of this before, so anyone with experience on this protocol please let me know.  He wants to give this some more thought.

In order to run with our desired timeline two months spent languishing on BCPs is not going to work, so for the second retrieval cycle he is thinking about letting me start right after AF shows up post retrieval #1 without a break BCP cycle.

I start BCPs for first cycle tonight.  He drew an updated AMH today to see if I have continued to improve (see sidebar). Fingers crossed!

4)  Donor Cycle

Now here's where it gets tricky/confusing/tough to plan and honestly we didn't go into this part in too much detail as we'd already gone 45 minutes over my 30 minute appointment.

Two retrievals will already land us somewhere in mid November before we have PGS results -- and this is of course barring any delays, cysts, needing to delay trigger to allow stragglers to catch up, etc.  I haven't had a troublesome cyst yet, I know I am due one.  And last cycle we delayed trigger by 3 days waiting for my slow-pokes to catch up. 

If we get to November and find that we have no viable embryos for transfer we're going to have to rush into selecting a donor, paperwork, etc.  Nevermind stimming the donor, retrieval, etc.  It doesn't seem likely that we'll be able to transfer before the end of the year.

We're hoping that my insurance will be agreeable to starting the donor process before we get results of PGS.  I am a realist, and I know that of the 2-3 embryos we're sending for testing the odds of even one of them coming back normal is very, very low.  If by some miracle we do get one of the expected three back, I am still hesitant to transfer a singleton.  I know everyone has their preferences, mine is a twin transfer every time.  We are fully prepared for twins, we would welcome a twin pregnancy with incredible joy - we would be equally ecstatic if twin transfer became singleton pregnancy. 

So the hope is that we'll be able to select, sign ,and start a donor in November, for ER in December.  This way, IF we have one normal genetic embryo we can still put two back.  One genetic and one donor and freeze the rest of donor embryos for future FETs at a much more affordable price.

What may end up happening is that we end up doing a transfer in the new year.  We're hoping not to have to do this, but transfer only is a much more affordable price tag.  I am pretty sure though, that a cycle started in 2014 will count towards 2014 benefits, even if it is completed in 2015? I have no idea how that will work...

I need to redouble my efforts to seek out a  donor who matches a reasonable set of requirements and is based in or around the Houston, TX area.

I also need to spend an hour with an insurance rep to go into these details.

So there you have it... This post is pretty much verbal diarrhea I am afraid.  I just have to get it all down on paper before I forget it - especially the donor part of the plan.  Dr. S and I didn't discuss it in much detail because we spent much too long talking about protocol options.  This is what I understood from our conversation, but I am hoping to hear from his nurse tomorrow with a schedule and more clarity on the specifics - as far as we can see them from here.