4DP 3DT: IVF 9 Spiral Arteries & Progesterone Levels

Made the journey to an out-of-the-way ultrasound clinic to get a quick doppler of my uterine spiral arteries. According to Dr. KK, for IF/immune patients, the resistance index (RI) of the spiral arteries should be below 0.6. If not, then additional lovenox should be added to get the number down. Too much resistance to the blood flow means that it is moving slowly and can clot. Something detrimental to an embryo if it attaches and finds a clot rather than a nice blood source. More about this procedure here.

I'm typically on 40mg/day during a cycle, but if you look at standard dosaging on the lovenox website, one should take 1mg per Kg of body weight. For me that winds up being 79mg/day, or, two 40mg syringes a day.

Dosaging for general purposes *might* be the same as for IF, but I'm not really sure on that, so I increased to 70mg a day since transfer.

So, after 3 days of 70mg/day of lovenox, the U/S technician found that my RI wavered between 0.65 and 0.74. He took multiple data points to be sure, but the number likely means that even at 70mg/day, I'm still not taking quite enough. One thing I am unsure of, is that Dr. KK often does this sort of U/S on certain days of the cycle and I'm not sure if these values apply in the luteal phase when under P4 support. It's a calculated risk to up to 80mg/day, but one that I think isn't too unsafe.

So today I upped to a full 80mg/day, but I am unsure as to whether I should do even more while unsupervised. I've actually seen some of her patients reporting that they're doing 60mg, twice a day. Holy crap. Maybe 80mg isn't enough? I did a PTT test about 10 days ago and I was in range then, but how about now?

I put in a call to Dr. KK two days ago and am going to get on her list of patients. She can treat me remotely, so that's reassuring. (BTW: The U/S technician that did my doppler today was trained by Dr. KK's ultrasonagrapher - so he definitely knows what he's doing.

My other concern, besides getting the right lovenox dosage, is that doing a doppler around this time feels a bit risky. I'm not sure if it is though. Dr. Czech's nurse did a U/S on me yesterday to ensure that my lining had converted post transfer - it had - so is this sort of ultrasound anymore risky than a doppler one? I asked if the "intensity" of the waves used was any different and he said "no". So I think I should be ok. So then the concern of just having yet another wand up my hoo-haa, trolling up in my nether regions. He was actually quite gentle though - no complaints on that department, so I don't think I need to worry about physical jarring of the embryo.

Maybe I worry too much? I just feel that this is one major thing (RI) that's been overlooked in my cycle for the last 5 years and it seems, well....sorta big!?

They also did my blood work yesterday to see how my progesterone levels were - I'm doing 400mg twice a day (supps):

Blood values:
E2: 360
P4: 47.6

I've read that doctors really like to see this number above 30, but I've seen many ladies report values around 10.

They said to change nothing in my protocol. I have to be honest: I don't know if this is a good P4 number considering how much I am taking. I do realize that oral and vaginal suppository P4 yields lower blood P4 levels than, say, PIO. But I'm not sure what the "curves" look like for: method of delivery against amount of P4

Anyone have an idea what a normal range for P4 is after transfer if using the suppositories?

IVF9: 1DP3DT

I know that this is supposed to be a relaxing few nights in a hotel, but it's actually quite *boring*. I have two more nights here then I head to a conference at work all day Thursday.

I've been wondering about my lovenox prescription. I've been doing 40mg once a day for all of my cycles without a change in protocol. If you follow Dr. Kwak-Kim at all, she's been doing some great studies of uterine blood flow through the spiral arteries by measuring the resistance index. She likes it to be below 0.6 or she may increase your lovenox dosage until it is. Granted you need to check PTT to ensure that you can still clot if need be!

I'm not supposed to go to 40mg twice a day until I get a BFP. So it's not an unsafe amount for me. But I'd like to know where my RI on the spectrum of things.

So one of the gals over on the Immune Board pointed me at an U/S facility in Flemington NJ that can test this for me. They're in network and I don't need a referral. Woohoo!

So I'm heading over on Friday afternoon to get my spiral arteries looked at - a 15 minute procedure with the dildo-cam that I am assured will be gentle and cause no harm to my one embryo. They'll forward the results to Dr. Czech so that he'll be fully informed as well.

Hopefully I'll leave with a bit of information on whether my uterus is actually working properly!