Bring on Dr. Next

I had my appointment with Dr. Next today (actually he's Dr. S but Dr. Next sounds so James Bond for some reason - maybe I'm thinking of Dr. No?). Julianna is seeing him, too, and will have to make a note to grill her on how she is liking these folks. Okay. I have an idea why we all like Dr. S. Let's face it . Dr. S is pretty damned hot, he's brilliant, articulate, makes sense, he's got great stats behind him, he's got great bedside manner. Let's leave it at that.

So...we went over the protocol that Dr. Z had used on me in my failed cycle. Some issues that he raised:

1. Dr. Z didn't do an FSH test before my IVF cycle. They use the Lupron Challenge test at this place...essentially it tests FSH/E2 before lupron is administered and then tests them again the next day (16 hours later I think?). If I fail, we wait for another month and see if my FSH values/lupron response changes. Interesting tidbit: there's a Japanese study that shows, as I've always suspected, that women's FSH values do indeed to fluctuate seasonally. Damn, isn't it amazing that there's a study for just about everything under the sun? Thank god for overzealous graduate students. The study was pooh-poohed by some labs either here or in Canada, but hell there you have it. The crux: Spring and summer months seem to turn out lower FSH values than autumn and winter. Makes sense from a biological perspective: we, like other mammals and animals, have some sort of seasonality to our breeding. And why not? Needless to say, I am STOKED. There is hope for my quasi-shitty FSH. Last May my FSH was 6.5 and by October it had hit 10.5. Late November it dropped to 7.5 but my E2 was nearing 100 and this is probably cuz I was popping DHEA trying to improve my egg quality. So all I can say is, "Bring on Spring! WOOHOO!"
   
2. The Lupron Flare Protocol is highly aggressive and doesn't seem to turn out as many pregnancies as a Long Lupron Protocol. Yep. Someone did a study on this, too. Apparently this means that egg quality suffers because of it as this isn't going to affect implantation. He's not sure why Dr. Z opted for this route but as my friend AP says, "Dr. Z only has a couple of recipes that he uses and that's it."
   
3. He's glad to put in as many embryos as I want. They'll just "guide and suggest" but they'll defer to me. (Thank god. The girl at McGill told me that they really strive for singletons and that they wouldn't want to put in more than 3 or 4 AT MY AGE...omfg...is she kidding? HELLLLLO? Look at my past history for god's sake why don't you? I'm nearing 42...I don't have embies to spare or to freeze. Put them all in, dammit! Twins? Buy 1 get one free! As if we'd complain about getting two?)
   
4. They like to see embryos with 6, 7 or 8 cells. That 9 cell embryo that I got all excited over? Well it was likely growing too fast and had some cell growth factors that were out of whack. So it wouldn't likely result in a pregnancy anyways. He clarified that 9 and higher celled day 3 embryos tend to NOT result in pregnancies. Hmmm.... He also agreed that Dr. Z was on target for not putting in the 3 cell embie. He said he's never seen a 3 cell embie result in a BFP. Okay, so out of our six embies that we put in, four were worthwhile (two 6's, one near perfect 7, and one 8). Hard to imagine that there was something wrong with that 7...it was beautiful.
   
5. No IM progesterone. They use suppositories and say that they get 3x's the levels of progesterone in the uterus than with oral or IM progesterone. Okay. Yet another study. Somehow taking it orally and intra-muscularly just doesn't get it to the uterus as effectively as the waxy suppositories. So no more PIO for me and I think I'll have to invest in disposable underwear...washing that white waxy shit out of my thongs is just too disgusting. I swear I washed a few pairs three times and they still weren't fit to wear.
   
6. Progesterone is only given up to a BFP and then "Yer cut off!" Their reasoning is that a healthy pregnancy will be making it's own by this time and to supplement a bad pregnancy only means that you prolong the time to an inevitable miscarriage. Okay. That's a bit of a reality check. Ick.
   

So, for the second time, "J" didn't come to my appointment as he was en route from Phoenix to SJC...but I think that I'm pretty much SOLD on trying Dr. S's protocol. Hell, I'll try anything so I'm not sure where my judgment is at. Someone could open a business, I kid you not, helping us infertiles wade through the stats and varying protocols to help us come up with the best doctor for each of our particular situations. HoldingPattern mentioned in her blog something about wanting to be a RE at some point in her life, and I think she would be awesome as she's keenly sensitive to what makes a good RE, but maybe something like this she could do immediately? Hmmm...

So right now I am sitting here wishing I had stuck with Dr. S the first time, but honestly, I was too afraid of being cancelled (ie, failing his lupron challenge). God it's terrible getting older and feeling this desperation. Maybe being cancelled in a shitty month would have been a godsend for us? Maybe waiting for Spring or Summer when my FSH is (hopefully) more in tune with making good embies would have been what we should have done. Okay that is enough...I have got to quit this line of crap or I'm going to "shoulda woulda coulda" myself into insanity.

Ah and lastly...today is CD14 - we had one go at it two days prior so maybe there's a small chance in hell. Let's be clear: the chances of my getting pregnant naturally are less than dismal. My right tube is totally blocked and the left barely passes dye. But each month I hope that a miracle would happen and that little egg will get fertilized and find it's way down my tube. I hope, but I realize that it's a one in a gazillion chance but STILL I despair at not having gotten a chance to get pregnant. It's not silly at this point. It's fucking insanity. I despair at losing a smidgen of a chance. I am desperate. That should be clear. And besides there's no logic to the mind of a woman trying to get pregnant.

So my Lupron Challenge will be about March 20th. I guess if we fail it, we can blow some cash at McGill trying our hand at a round of IVM. The nice thing about the IVM is that it won't mess with my cycle like the IVF would and we can try another challenge the following month. And in the meanwhile, I'm applying at every Sillycon Valley job I can find that covers multiple IVF cycles just as a preventive measure against bankrupting ourselves during this madness.

OMG...that's enough for one night. Off to bed for me.