At our appointment, we hope to have the following answered...
1) Specifically what about our personal infertility issues lead him to believe we should only purchase the two-cycle package?
2) Are any other tests or things they can do to gauge how I'll respond to meds, besides antral follicle count?
For example, what about the Clomid Challenge Test? We want to know this because if there ARE other test we can do BEFORE making a decision on how many IVF cycles to purchase, we should do pursue them. I wonder though, if a test came back as questionable, would they still allow us to buy the 3-cycle Refund Package? I would assume not, if it goes against what is in the agreement you sign when you purchase that package. So, given that, is there any point to doing the tests? Wait, did I just answer my own question? :) Better ask the professionals at least!
3) What unique approaches will he recommend for our IVF protocol, taking into consideration PCOS, one ovary and sperm quantity and abnormality issues?
More about the Clomid Challenge Test
I just ran across a write up on IVF1 Infertility Clinics's website and wonder if I might be a good candidate for this as a pre-IVF test, given that I've had an ovary removed and therefore may have egg count issues. The article does say that "There is one concept that must be stressed above all else. A normal clomid challenge test tells you nothing. It does NOT prove that your ovaries are working well. It simply fails to prove otherwise. The clomid challenge test is not a sensitive enough test to identify every woman with decreased ovarian reserve. Some women with very poor egg quality (this may apply to me because I have PCOS) are going to be missed."
However, according to their website, "an abnormal clomid challenge test has specific predictive value. These predictions are very accurate and have been confirmed by a number of different studies from a large number of investigators. It is well documented that women with an abnormal clomid challenge test: *Respond poorly to injectable fertility drugs (gonadotropins), *Have higher cancellation rates in IVF, *Have fewer eggs retrieved in IVF, *Have much lower pregnancy rates in IVF and IUI, *Have higher miscarriage rates and *Increased risk for chromosomally abnormal embryos."
If we did this test (which would be fairly inexpensive to do) and found out that it was abnormal, while we may still have to buy a 2 cycle simply because we may then be disqualified from buying the 3-cycle Refund Package, it might tell us if we need to pursue other things like CGH testing on our embryos. I also wonder if it will help inform my RE as to how he should structure my injectable protocol.
In the end, maybe Dr. Ahlering won't tell us anything that we haven't already discussed, but either way, it will be nice to get his undivided attention and hear everything coming directly from him. Following our appointment, our plan is to be equip enough to make a final decision on how many cycles we'll buy at once and exactly when we'll start!