Tuesday, April 14, 2009

We're a go! Doing IVF with SIRM in August!

It's official, though I'm not sure if it's quite set in yet! Our appointment with Dr. Ahlering on Monday went well, as I anticipated, but I don't believe we learned all that much new. Prior to our appt, I made a list of questions that were slightly different than what I posted previously. I find that when I make the list it is a chance for me to run down the conversation in my head, with the goal that I don't forget any major points. By the time we actually get to the appt, I pretty much have the list memorized, but it's nice to have in front of me so that I don't get caught up in the conversation and leave something out. As you'll see, I do need to learn how to set-up my questions better so that, hopefully, they are answered a bit more on target... oh well, there will be plenty more appts for me to try this out on, I'm sure. :-P

Our final list of questions were:

1) What is positive that we have going for us, and what will be our challenges?
As I look back on how this question was answered, I don't think we had a definite clear answer on this from the doctor. Not because he was trying not to answer it. I should have framed my conversation better. After I asked the question, he was like "well that depends..." and then I backed up and stated IVF and he took time to elaborate on how he thought that really was the best approach for us, given our IF issues, and from a monetary standpoint and controlling multiples standpoint. When it comes right down to it though, I do feel fairly confident that I know what we're up against. My husband's issues can be "fixed" via HRSS (high-res sperm selection) ICSI. My issues will be a matter of getting a good number of eggs from the one ovary and then getting them to fertilize into embryos, all the while trying to avoid OHSS. Right now, age is on our side and the fact that my one ovary has so many follicles is a good thing. We won't really know how I'll respond to stims until we try it.

2) Are there any other tests we can do to gauge how I'll respond to meds, besides my FSH (5.5), Estradiol (55) and antral follicle count (15+), which are all within good, normal ranges.
When I framed this question I, again, was wayyy too wordy. I tend to do this sometimes when I get nervous. As a result, it's too much for the other person to remember and they end up not answering everything in the manner I'd hoped. So, scratch that question. From what I'm finding online, there isn't really a way to tell this, other then the above things already mentioned. I think they just begin a protocol that they feel will best address your issues and then adjust throughout the cycle and, if no BFP, further adjust in the next cycle. Not the best scenario possible, but it is what it is. If anyone is reading this and knows of any additional things they can test for, please comment and let me know!

3) Regarding the issue of hydrosalpinx tubes, is the FUS (fluid ultrasound) enough to rule this out, or should we do an HSG? If we ended up needing to do a laparoscopy, would that only cause more pelvic scarring, thus risking further damaging my ovary?
Ok, so this is the point in the appt that I must have woke up (about time, don't ya think!). I remember this answer quite clearly and even took notes on it. He basically confirmed that, yes, he doesn't feel we should be worried about a hydrosalpinx, because our FUS didn't show signs of an enlarged tube. He said that, yes, we could do a laparoscopy and that he would for sure if he thought there was a real cause for concern, but as of now we'd be don't it just because and since I have had a previous abdominal incision (a long vertical one), it makes it more challenging to do a laparoscopy and increases the risk for bowel injury. He said that at this time, it's not a risk that would be worth taking.

4) What about our personal infertility issues lead you to believe we should only purchase a 2-cycle package?
Honestly, he didn't form an answer that was extremely directed to our situation. Rather, he focused on their success rates and the fact that a majority of their BFP cycles happen within the first or second transfer. Based on that, he said he believes that would then be the most cost-effective path for us would be the 2-cycle. We did want a more direct answer, however, we're realistic and know it would be difficult to give a highly pinpointed answer (I don't believe they ever truely know how a cycle will turn out).

5) Should we consider CGH, given that PCOS are high responders and tend to have a disproportionate percentage of eggs which are chromosomally abnormal (or aneuploid)?
He said he doesn't recommend this for us at this point in time. The PCOS isn't cause enough to do CGH as a first line approach. He said he would do it if we asked for it, but he doesn't think it's the best way to spend our money right now. That it wouldn't tell us all that much more, other than the exact one we should put in, vs. transferring 2 embryos. He did say though that in rare cases were tons of eggs fertilize, it can be challenging to determine which 2 of the bunch to put back in. Typically, there may only be one or two babies in the entire group, so it's difficult and often becomes a trial of elimination. CGH, in that situation, would be helpful. I'm guessing we would cross that path if that ended up applying to us.

6) IVF Protocol - What is the likely path for my circumstances?
Dr. Ahlering said that he would most likely start me out on the the "classic" Lupron protocol, or L3C Protocol, as they refer to it as SIRM. More to come on that. I don't know specifics from SIRM yet, but you better believe I've been googling my heart out :-)

So... good news!! August will be here before we know it I'm sure!

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'Murgdan' April 17, 2009 at 6:08 AM  

August will be here before you know it! Good luck!

Cathy April 21, 2009 at 11:34 AM  

Thanks for you support! We can't wait!!

LifeInMyHead May 20, 2009 at 6:56 PM  

Hi Cathy,

I was searching for info about hyper responders and your blog came up in a search. I read around and really enjoy your writing style and the info you throw out there. In this post, you mention OHSS. I did my first IVF cycle in Mar 09 and was indeed hyperstimulated which resulted in OHSS (I am 40 and they got 63 eggs. Virtually unheard of for a woman my age). I did not get pregnant which I have come to find was a very good thing because I would have been very, very ill. OHSS gets significantly worse if you have implantation. I actually just switched to SIRM in Manhattan to do my next cycle (July) because from my research, I came to learn that my RE didn't handle my cycle very well (mutliple issues...too much too type). Anyway, the reason for my commenting to you is to let you know that OHSS is related to two things 1) how many follies you have and 2) your e2 level. If your e2 is under 3,000 you will most likely not develop OHSS (mine was over 4,500). There are guidelines for how it should be rising while you are stimming so if it goes up too fast, your RE can drop your stims so that it rises less rapidly. I was really impressed with the RE at SIRM that I met and I imagine that all of the Dr.s are well trained. You should be in good hands but if you track your e2 during your cycle and ask "what is the normal range", you will have a good idea of how things look. On day 4 of my stims my e2 was over 900 when it should have been between 100 and 400 but I didn't know to ask at the time. [Also, given that you are sans an ovary, I imagine that your chance of OHSS are low to begin so you really shouldn't worry]. Oh, and should you develop any OHSS, even a touch, let them freeze your embryos for a month to let it clear up first. If you end up preggers with OHSS, you will have it for a long, uncomfortable time and, the RE at SIRM told me that if you have OHSS, your body isn't too receptive to implantation so you have a great chance at success if you let the hormones cool down for a month before transfereing. Good luck to you and your hubby and may that dream of holding your baby come true before you know it.

Anonymous June 12, 2009 at 12:43 PM  

Hi! I'm so happy to have found your blog. I found it while doing a google search for "2 cycle plan SIRM", since that's what we're saving money for. I'm also getting ready to do IVF with ICSI in August with SIRM in Sacramento. I can't wait to read your blog and learn even more about IVF & SIRM.

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