So the WTF appointment happened yesterday (appointment to go over every aspect of the cycle to see if there was something that could be done better or differently). Overall, it was pretty much like I expected: nothing really went wrong—other than the fact that I didn’t get pregnant. However, it was the other information surrounding the appointment that was very interesting and helpful… and hopeful.
This is going to be long, so bear with me. Here’s what came from the appointment:
- My antral follicle count was 11 at my baseline appointment. This wasn’t great, nor was it worrisome. It was middle of the road.
- My E2 level was less than 5, but she didn’t feel I was oversuppressed because it didn’t take an extra long time for my stims to work.
- I stimmed well. I was on stims for 10 days, which isn’t too long, and it isn’t too short. Middle of the road again.
- I questioned my high E2 on Stim Day 9 (3,203) and she wasn’t worried it was too high and they chose to do one more day of stims, even though the E2 was already high because they wanted time for my smaller follies to catch up.
- If she were to do the cycle over again and the same thing happened, she’d choose to not stim an extra day just in case that was why my eggs weren’t exactly the best. But she’d only choose that because we know the outcome of this cycle.
- They got 11 eggs. This was middle of the road. Not anything to jump for joy about, and not anything to be worried about.
- Of the 11, two were immature (normal to have this) and two were abnormal (might just have been the batch). Again, nothing to worry too much about.
- Of the seven mature, four fertilized for a fertilization rate of 57%. Lower end of normal, but normal.
- The embryologist put in the notes that the eggs were hard to penetrate. This might be an issue, or it might not be.
- On the first day, one embryo died. Two were considered “eh” and one was good.
- On day three, two were considered good (the best quality they give) and one was a day behind. The one that was a day behind died on day 5 before it could make it to blast stage and be frozen.
- RE told me that the first three days of an embryo’s existence is solely because of the maternal DNA in it. Starting day 4, the paternal DNA kicks in and that’s why a lot of embryos die between day 3 and day 5… and why day 5 blasts are the goal to transfer. Most of the “issues” with maternal DNA happen during fertilization and that first day.
- I asked if you could have endometriosis without having many symptoms (I have super long and heavy periods and cramps a few days that require Ibuprofin 800… both are resolved when on birth control). Apparently, you can. She said she’d not suggest a laparoscopy if we are just going with IVF, but she’d be willing to do one if we wanted to try more natural options with TI (timed intercourse), especially with my family history. My mom had really bad endo in one of her ovaries (it was the size of a grapefruit) and out of her six aunts (my grandfather’s six sisters), four of them were childless—which was not the norm in the 40s and 50s. In fact, one of the two who had children, only had one child.
- I asked about DNA fragmentation. There’s a test that can be done, but she doesn’t advocate for it unless it’s going to make your choice between continuing or not continuing treatment and/or using donor sperm instead… because if you are going to continue with the sperm anyway, there’s no reason to be worried about fragmentation when even if it’s present, it might not hurt your chances.
- I asked about autoimmune diseases. My family history includes Grave’s Disease and Pernicious Anemia. About nine years ago, I was tested for a bunch of things since I was tired all the time. I came back ANA positive and SSA negative and SSB positive. A positive SSA would indicate Sjogren’s Syndrome. My doctor at the time said the SSB could mean I might get it at some point or that I might not. He wasn’t worried enough to send me to an RA to do more because I didn’t really have all the symptoms, especially the classic ones like dry mouth and dry eyes. She wasn’t worried about this, but said if I was to go back to my PCM and ask for a referral (I’m not worried). However, due to the thyroid issues in my family and the fact that I’m on 30mg of Armour Thyroid myself, she went and ordered the full thyroid panel, which included things that weren’t ordered before like T3, Free T4 and TPO.
- About five years ago, I was tested for a range of things, including Vitamin D and Vitamin B12. I was severely lacking in both… in fact, the B12 required two shots just to get me up to a normal level. I continue to take daily supplements and at the three, six and 12 month marks, I was still within normal range with my supplements. She ordered testing of this as well to make sure the supplements are still doing their job.
- I asked about an antagonist protocol vs the Long Lupron protocol for medications. RE told me she spoke with the director of the clinic about me and changing to antagonist and the answer is… they have no feelings one way or another with my case. I’m so middle-of-the-road that there’s nothing that is telling them one protocol would be better than the other for me. We know Long Lupron works and gives me some eggs, but they weren’t the best. If we go for the untried (in me) antagonist protocol, there’s a chance my response could be worse. Of course, the beauty of the military program is I could cancel before retrieval and wouldn’t be out any money. So we’ll have to decide on which one later.
- RE told me we are still prime candidates for IVF and even though it didn’t work this time, that there’s no reason to think it might not work in the future (but she wasn’t pushing it, because she doesn’t believe in that).
- She also said if we wanted to, we could do injectables with TI (for free since the military will pay for them if it’s not “unnatural” like IUI/IVF).
- She said we could do a hybrid cycle with Femara and injectables with TI.
- She said we could do just Femara (I refuse Clomid anymore).
- She said we could do a full injectable cycle with IUI, and they have a company that gives deep discounts to military (normally it’s $1,000-$3,000 for the medication alone).
- Of course, we can stop everything and not try any more.
Our Plan Ahead
- Huzzy is going to have his varicocele surgery at the end of January. We aren’t sure of the recovery time of the “goods” but it’ll be at least three months since it takes them that long to be made.
- I’m still researching on if doing a lap to check me for endo is the right choice.
- We are going to go ahead a few cycles of injectibles with TI and/or hybrid Femara-injectibles with TI once Huzzy’s boys are recovered. This will probably happen in April through July, but each month may be affected by my ability to be at monitoring appointments because I have some travel in there for both Navy Reserve stuff and Navy civilian stuff. Of course, there’s also no point in doing the meds if I’m not going to be home during ovulation time. We’ll see! In the event of more sequestration stuff shutting it all down (again!) this year as well, we’ll still hold off on IVF until August in order to give ourselves some time with injects.
- I booked a spot in the list for August IVF. Hopefully we won’t need it, but if we do, there it is.
So that’s where we are–unless something unexpected comes up. Which it may because, well, that’s my luck.