Sunday, September 14, 2008

WTF Appt and New Protocol

So - I've been MIA for a while - between needing a break after the BFN, to being at training and not feeling well, I just haven't been on to post. And, if I know myself well enough, I'm probably about to type enough in this one post to make up for anything I haven't been typing - so, I apologize in advance!

So - our WTF appointment was last Thursday. Turns out, the doctor from the Syracuse location who actually did my Retrieval and Transfer (and who founded both locations) was at my local office, so I ended up meeting with him for the appointment. My biggest questions were "Why haven't either worked?!" and "Why wasn't the protocol changed after IVF#1 and only getting 4 mature eggs?". And his answer to both? I honestly don't know, but they should have. Great. Awesome. That makes me feel good, doesn't it? Especially that the protocol should have been changed.

I mentioned that during my 2nd cycle a few times, but it was never changed. And now I feel like it was just a waste of a cycle - that if they had in fact changed it, maybe we would have had a better chance.

But, enough of that. The past is the past. So we talked about what we are going to do for the 3rd round (once we can afford it). So it looks like we're going to do a combined Estrogen Priming/Antagonist protocol. I still have a few questions, but here is how I understand it to go:


- CD21: Lupron
- Get Period
- CD3: Baseline bloodwork, Stop Lupron, Start Estradiol Valerate (estrogen) injections 2x/week for 10 days
- CD3 (again??): bloodwork, start Stims - 150 iu of Follistim + 75 iu of Menopur, no Lupron, Ganirelex when it gets closer to ER to prevent ovulation
- Egg Retrieval
- Embryo Transfer: start Lovenox injections (I have questions on this), HCG injections, Baby Aspirin, Estrace, Prometrium supps and Progesterone in Oil (PIO - yikes - this one's an IM injection!).
- And with all of this, the Dr. is a huge fan of Eastern medicine - acupuncture, yoga, positive attitude, etc... HUGE fan! lol

He also suggested I have an Endometrial Biopsy and Hysteroscopy. And possibly a Lap. Not sure why on the Lap, but that's just one of my questions I still want to follow-up on.

He also mentioned doing IVIG - basically where they go in and irritate your uterus a little prior to the ET. I guess while it's healing from the irritation, it helps with implantation. I had heard of this - have any of you tried this?

So let's just say it's a big change from my previous, regular, long Lupron Cycles - Lupron + Follistim + Trigger. Hope it works!

Here are some of the questions I still have:

1) Why the Lovenox if I'm also on Baby Aspirin and haven't had any clotting issues that I'm aware of. Isn't it a blood thinner?
2) Why the lap? I don't have any signs of Endo and I don't need my tubes - wonder what they'll be looking for.
3) Clarify up my timing better
4) The PIO shots - I hear that having them mixed with Ethyl Oleate is much easier than Sesame or another oil. I hope that's what they had in mind!
5) IVIG - want more info - should I do it? It's expensive! But, not as expensive, perhaps, as asking - should I have done it? If this next cycle doesn't work? I mean - the $700 to try IVIG is cheaper than another few grand on a potential 4th cycle, right? I don't know!
6) How in the work can I afford this!

That last question is our biggest concern. Between issues with DH's car, Riley's accident, and the past 2 IVF cycles, we have pretty much depleted any amout of savings we have. It's so scary! We'll have to save up again just to have enough to do another cycle, let alone having any sort of buffer in our savings should there be an accident. My mom has offered the money from their tax return a few times - which is so incredibly nice of her - but I just can't get myself to do it. They need the money themselves, I just couldn't do it.

I mentioned the cost issue a few times. And, to my surprise, we were in for a surprise! The doctor excused himself and then came back - and guess what he said?! He is willing to only charge $1000 for our next IVF cycle. How awesome is that! Technically it's only $600 since $400 has to go to the anesthesiologist - but that's definitely a help! Granted - it doesn't cover the ultrasounds or the meds, but they said the insurance should cover the ultrasounds (they are confirming) and meds - well, we're working on those.

They are checking with our insurance companies to see if any of the new ones are covered. And if not, they said to keep checking with them on any they may possibly have to donate. And, to my huge surprise, we were lucky enough to have a fellow Nestie offer up her extra Ganirelex - can you believe it? 4 vials and I just have to pay for shipping. She had to pay out of pocket for her cycles as well and wanted to donate what she could - we couldn't be happier - thank you Vandelay!

So - now we are just waiting to hear back from the RE on what they found out re: what will and won't be covered on the new protocol. And based on that, will determine what our new timing will be and how much time we'll need to save.

But - we are on our way - so, for now, we're just praying for one of those rare miracle break cycle BFP's - can't hurt to dream, right?! ;-)

2 comments:

Melissa said...

Wow! Thats pretty overwhelming.. The only thing i can possibly shed a little light on is the lovenox/baby aspirin thing. Its pretty routine to do them together. I am on heparin and baby aspirin..I have also heard that a lot of REs will prescribe BA and Lovenox/heparin even if there is not a clotting disorder found because there may be some that haven't been "discovered" yet..

I have a really good miscarriage book that talks a lot about repeated IVF failure and they say that a lot of the reasons are the same for RPL and Repeat IVF failure. It talks a little bit about IVIG too.. but I am not very familiar with that. I can send you the book if you'd like.. just email me.. Melissa at Melissaandjeffrey dot com

latebloomer65 said...

this is great news! glad you are getting a new protocol and glad the clinic stepped up to help you out.
one thing on the ganirelix: don't refrigerate it. i refrigerated mine thinking it wouldn't hurt...i was VERY wrong. i had to reorder it. it says on the package to keep between a range of temps, and they mean it! (yes, it should say DO NO REFRIGERATE) but it doesn't. good luck!