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Monday, March 06, 2006

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.

Comments on "Bring on Dr. Next"

 

Blogger Coloratura said ... (2:07 AM) : 

I am amazed at all the research you seem to have combed through and digested. It just all makes my head spin. I hope I'm doing the right thing by going with Dr. Z, if that's what we end up doing.

I am keeping my fingers and toes crossed for you, my dear. You deserve to have a little healthy, darling baby too!

Thank you for your kindness and support. It helps.

 

Anonymous Anonymous said ... (5:22 PM) : 

I must have been in the office right after you!

The reason I call him Dr. Next is because I researched so much, went with Stanford initially, and then after two failed IVFs there, I interviewed REs again.....

I felt like I was interviewing people and saying, "Next!" until I decided, happily, on them.

It is actually quite fitting for you as well, now! Next!

We do not want him to be Dr. No! NO! NO! NO!!!!

Not to offend, I hope I write this well, but you could have talked to ten REs and they would all have said different things in one way or another.

I love my Dr and their staff. After the chaos that was the Stanford clinic, they are a breath of fresh air.

Honestly, none of it really matters unless it works.

They are the hero when one succeeds but the dog when one fails.

I have heard wonderful things about Dr. Z....wonderful, wonderful things. If your cycle had worked for you, you would still think he is brilliant.

There are many REs who don't do the FSH (3 day blood work) and there are many REs who always go to blastocysts. Dr. Next NEVER, EVER does blasts - ever. So, someone could question his practice.

I hope that your next cycle is successful. Unless a patient is REALLY annoying, they are incredibly awesome and patient and kind and loving.

None of it really matters in the end, unless there is success.

Much luck to you!

 

Anonymous Anonymous said ... (1:51 AM) : 

Well, I totally disagree with Dr. Next about the efficacy and meaningfulness of the Lupron Challenge. I've read a LOT of the reasesarch. But at the end of the day, he's the RE. Go for it. Hope it works.

As far as companies that cover IVF, try Philips Medical in Milpitas. 3 lifetime cycles, including drugs. (they are not my employer)

 

Blogger linda said ... (1:30 PM) : 

Julianna,

That is so funny that I almost bumped into you at his office. I would have loved to have seen you!

I totally agree that you can talk to 10 RE's and get 10 different opinions. It's so hard to know who to use or which protocol to use and even the studies sometimes contradict themselves, so then what to do?

Thanks for the insightful comments and for stopping by. :-)

 

Anonymous Anonymous said ... (5:31 PM) : 

It's funny how close I was to going to Dr. Next's office (my OB totally digs their office). As much as we smack talk dr. Moustache, I'm still hopefull something good will come out of it. He might have only a few recipes, but his success rates are pretty good for someone in my age range.

It's really weird that he didn't test your FSH though. I mean, all the shit that he does check for, you'd think he'd check your FSH.

You'll have to keep me posted on Dr. Next and how you like them. Maybe I can convince the meester to do one more cycle with them.

 

Blogger Pamplemousse said ... (7:21 AM) : 

Hi. I just found you over at Holding Pattern. Sorry about the last IVF but you seem to be moving forward with things. I would like to hear more about your experience with DHEA. I have read the studies but it is good to hear a personal opinion.

 

Blogger linda said ... (12:08 PM) : 

Hi Pamplemousse :)

Thanks for stopping by!

Well I had found a study that provided "anecdotal evidence" that DHEA assisted in increased follicle production....here is the intro page and there's a couple links in it to the study (in PDF format).

The Introductino to the Study (lots of good reading here)

The Study - pdf

I did take it CD 1 thru CD3 or 4 in one cycle, went in for an antral count and my antral count was 16. That's high for me as I'm 41 and I usually tend to produce only 12 each month. Also odd was that my FSH had dropped from 10 the prev month to about 7.5, but my E2 had risen to over 90 (but under 100). I'd read elsewhere that this raising of E2 levels can happen with DHEA in sensitive individuals. I also know that in women my age have fluctuations as our ovaries tend to get old. I'm going to start taking it again in hopes that I can get another count of 16 out of it.

Side effects: I get terrible pressure in my head from the stuff. It happens maybe 4 hours after taking the stuff. I tried taking it after my failed cycle but it happened again and then I got really sick (fever, flu symptoms) so I'm wondering if I have a tainted batch? Or it's just coincidental that I got sick after this trial?

The study says to take the micronized version of DHEA (available at Whole Foods for like $11). The lady in the study was taking 75mg a day. I was having bad symptoms at 25mg/day. My ob/gyn is supposed to be writing to the lead doc who is doing the study to find out his protocol but I haven't heard back from him yet.

 

Blogger Sparkle said ... (11:39 PM) : 

Interesting stuff.
My clinic only ever tested LH at the beginning of cycles too.

FYI, I followed the DHEA story and self administered. I had been taking for close to 4 months by retrieval of my last cycle.

Unfortunately it was my worst cycle (of 5). I had always had at least 7 eggs, that turned into 7 embryos. This cycle they collected 5 eggs, 2 immature and I ended up with only 1 viable embryo.

I also did acupuncture throughout my cycle (and for months beforehand).

It's possible that I still hadn't reached the point where the full effects were going to happen.

To say I was disappointed is an understatement. Possible that DHEA is not a panacea for all women.

 

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