Posted on

Consult – Some Answers

I’m fairly overwhelmed, and upset with some of the information I was given today at our consult.  Maybe later I’ll post on my feelings and reactions, but for the time being, below is simply a recap of the answers.  These questions probably weren’t in a very good order, so I apologize for the awkward flow.  Those in quotes are very close to my doctor’s words, but I was writing fairly quickly!

 

Eric and I passed on all genetic testing for him and me, as well as our embryos…  Is there anything you’d suggest at this point?

Genetic testing on Eric and I won’t have an impact on the success or failure of our IVF cycles, only on the health of children, God willing we ever get to take some home.  I assume this is why Eric and I passed on this testing initially, as if we’d had children the ‘traditional’ way, for lack of a better term, we wouldn’t have been pre-tested.  This testing isn’t all that expensive, well, relative to IVF treatment as a whole, so I decided to go ahead with this today.  It’s an easy blood test, which is drawn at the University and sent away, so heck, why not.  The testing service used is Counsyl and the diseases they test for can be found here.  I should have these results in 2-3 weeks.

Testing of our embryos may be something we want to look into, but our physician wasn’t overly concerned yet.  Perhaps this is dependent on the results of another blood test I had drawn today, the Anti-Mullerian Hormone Testing of Ovarian Reserve, more on this topic below.

 

After our positive pregnancy test, I was prescribed both progesterone and estrogen supplements, why?

“Both your levels were too low on the day of your first positive beta.  This is not uncommon with an IVF cycle, as even though we are trying to mimic the natural process, it’s almost impossible and thus we often need to supplement hormones the body would normally make on its own during the cycle.”

 

Does this reveal any link to why we weren’t getting pregnant on our own or with the IUIs?

“Hard to say since we didn’t test your levels during your IUI cycles.”

 

Throughout our monitoring I was repeatedly told, and shown on ultrasound, I had 15+ follicles, why did we only retrieve 6 eggs?  Were all 6 mature?  Does this relate to egg quality, some defect with me?

“All 6 were mature, although only 4 fertilized, although we never expect a 100% fertilization rate.”  Male factor infertility is not an issue for us.  “As to why we only retrieved 6 eggs, hard to say, but this and other signs point to a low ovarian reserve, basically you’re running out of eggs and/or you have too few good quality eggs.  Other signs include your cyst and high estradiol level which caused your first IVF cycle to be cancelled, and your miscarriage which can also be an indicator of poor quality eggs.”  My FSH was 7.7 when tested last, which my doctor says is good, but not always the best test, hence the Anti-Mullerian Hormone Testing of Ovarian Reserve (AMH) blood draw was done today.  I should have the results by the end of the week.

 

Was the timing of our retrieval too soon or too late after our trigger?

“Very hard to say.  IVF is not an exact science.”

 

Do you believe our miscarriage is in any way related to our unknown infertility issues?  Or do you view our past IVF cycle as a success which just unfortunately resulted in a miscarriage?

“At this point we only possibly suspect poor egg quality related to low ovarian reserve.  If you experience two miscarriages in a row we’d need to look into the cause further.”

 

Do you suggest we change the medications we use in future IVF cycles?

“Yes, we need to use a stronger protocol in an effort to ‘wake up’ more follicles in the hopes of retrieving more eggs.  Next time we will use the micro-flare IVF stimulation protocol.”

 

Will we be allowed to transfer two embryos in a future cycle, even if transferring at 5 days?

“Yes, since we transferred two embryos in your past cycle without success we would allow you to transfer two embryos in the future, either at 3 days or 5 days depending on embryo quality and grading.”  My doctor stressed the risk of multiples, a 39% chance of twins when transferring two, and a 3% chance of triplets, as IVF embryos are somehow more likely to split.  How and why, I have no idea!

 

Do we have any reason to suspect immune issues?  Is it possible to test just to rule them out?  Anything else we can test to rule out?

“You don’t have any risk factors, I see no reason at this point to test.”

 

Is there any possibly link between my infertility issues and those of my sister (no biological children), my aunt on my father’s side (no biological children), and my grandmother on my father’s side (difficulty conceiving)?

“Very difficult to say without digging into their medical histories, which we don’t have access to.  Some fertility issues are hereditary, such as Polycystic ovary syndrome (PCOS), but you do not have this condition, nor any other which is considered hereditary.”

 

What are our next steps, how soon can we start our next IVF cycle?  Anything I should be doing in the meantime?

“As soon as you get your next period, call and we can get you started on birth control pills and then right into the stimulation drugs 4 weeks later.  No need to sit out several cycles, as at 7 weeks pregnant when you miscarried, you’re body wasn’t under stress and therefore doesn’t need to heal.  You’re more than welcome to spend your money on supplements claiming to improve egg quality, or try acupuncture, but there are no medical studies which prove any link to improving IVF success.”

18 thoughts on “Consult – Some Answers

  1. Good job for asking questions, although in my experience there usually aren’t too many answers. Which day did you test your FSH that you got 21? My FSH is high and AMH is low. Hence the diagnosis of diminished ovarian reserve. It seemed like you had a good number of follicles. So I do wonder about whether the protocol was a good fit for you. I’m glad that the doctor is changing the protocol. A lot of times, the first IVF is a trial and error. The doctor can usually tweak the protocol to yield a better result the next time. Hopefully it’ll be THE protocol for you.

    1. Yes, I so hope next time is better. My FSH of 21 was on cycle day 3. If you don’t mind me asking, what are your levels? I’m so confused… The more information the better I guess!

      1. So… They usually use the day 3 level as a guideline. 21 is considered high. How old are you? Usually people in the 30s still have levels that are below 10, which is the cut off for normal. My levels have climbed steadily. Went from 10.3 to the highest at my last IVF cycle, which was 19. For a level of 21, your antral follicle count was quite good. Usually people with this level would have AFC that is about 6 to 8. Mine has dropped steadily… from 8, to 6, to 4… most recent was 3. FSH number is one test that they use to determine ovarian reserve. The higher it is, the harder the brain has to tell the ovaries to ovulate. AMH is the other test. Mine was below 0.16, which is like undetectable. Both of these tests tell you about your ovarian reserve. How many embryos did you make at your last cycle and what was their quality?

        1. 4 of the 6 embryos we retrieved fertilized. And they told me they were excellent quality. We transferred 2 but the other two didn’t live to day 5 to freeze, so how could they have been excellent?? I’m 34, my fsh was drawn several months ago when I was 33.

          1. Some embryos look good on day 3 but arrest before they get to day 5 (stop splitting and growing). So they could have been good quality on day 3 but just stalled after that. Did you only have one blood draw for FSH or did you have repeated blood draws? It’ll be good to check again when you get your AMH done. This is a website that I go for when I have questions. This is the information I found on FSH: http://www.advancedfertility.com/day3fsh.htm
            It is a lot of information to digest. I am always here to help if I can. Having a lot of information is dizzying. Take your time in understanding it. *Hugs*

            1. I might be losing my mind. I looked back in mychart and my fsh is 7.7. No clue, but I swear he said 21 today. I’m losing my mind!

              1. Yay I’m happy that it wasn’t 21! FSH of 21 usually wouldn’t have so many antral follicles. So I think changing the protocol may really do the trick. Carry on!

                1. Yes, I’m feeling much better now. Maybe he was referring to a different test…

  2. I’m kind of peeved on your behalf that they didn’t test AMH prior to your cycle! It seems like that would be an automatic test if you have otherwise “unexplained” fertility. Or clinic had lots of hoops to jump through which took a lot of time but I’m growing more and more grateful that they really check out all the most reasonable possibilities before a cycle. It breaks my heart that you are left in this position after a miscarriage when a simple blood test might have provided some insight.

    1. I’m peeved for me too. I mean, of all the blood they have taken, why not just test for everything up front??

  3. i’m happy to hear you don’t have to wait the several months you thought you would for your next IVF cycle !! 🙂

    1. I know! I’m thrilled! Can’t wait to start sticking myself daily again. And never thought I’d be saying that!

  4. I think you asked really solid questions and got some great answers. I don’t know if it was your doctor sounding like he was brushing off the supplements and acupuncture or if it was just how I read it, and I’m not saying to do acupuncture or take anything you don’t want to take, but I have read tons and tons of information about acupuncture helping with IVF. .I don’t want to rule out placebo effect, and maybe it’s just the idea of allowing your body to relax for awhile, but I’ve heard (both in the IF community and through Google) many stories about improved IVF and overall conception rates with a combo of Western and Eastern medicine. Just a thought. I did acupuncture for awhile last fall but then I stopped once I went back to the RE because I couldn’t pay for both. If this IUI doesn’t work, I have every intention of going back to acupuncture for a few months just to detox. While I don’t particularly feel like I have a few months (I am 36), I also can’t afford treatment cycles for a few months.
    As far as FSH rates go, I’m at 8.8, which I am told is borderline. My RE told me anything higher than 10 is considered, well, high.
    My AMH at last check was 2.0, which I am also told is borderline.

    1. To a certain extend I did feel like my doctor was blowing off supplements and acupuncture. I’ve actually been meaning to post separately on my thoughts related, so more to come on that 🙂

  5. I can definitely understand your mixed emotions. I don’t get why doctors are so comfortable throwing terms like DOR around on the SOLE basis of ONE ultimately unsuccessful IVF cycle. That seems fairly irresponsible to me, given your good FSH and antral follicle counts. I feel like your response could very easily be chalked up to the wrong protocol. (But that would be the doctor’s fault, so let’s blame your eggs instead.) I hope your AMH levels come back in range. I’m glad the positive is really positive: you can get back to baby-making in no time. Yay!

    1. Thank you, I am really excited to get started again… and to get my AMH results!

  6. There are studies showing acupuncture does improve outcomes. I don’t know what he meant by medical studies? Anyway it does help.

    My Life As A Case Study and My Hope Jar (both wordpress sites – sorry I’m on phone and can’t link) have lists of supplements they used to improve egg quality and both are now pregnant. Just sayin….

    I have to say how much I hate when REs say they have no flipping clue because IVF is not am exact science. I wanted to throat punch my first RE the first and every subsequent time he said that.

    Are you going to wait to use supplements for a bit or jump right in next period? Wishing you success whatever you do.

    1. I’ve actually been meaning to post about supplements, acupuncture, and other related topics that are often mentioned on other’s blogs. I think I can better explain what my RE meant, and also wanted to include my own thoughts and reactions, so more to come on that, stay tuned.

      At this point I really want to jump into the next cycle. One of the (only) perks of my husband in residency is free healthcare. Well, not free, our insurance pays, but at 100% for all treatment and medications. That said, my husband will finish residency next July and thus our insurance coverage will end. I hope this doesn’t sound ungrateful, but I guess knowing our cycles for the next 11 months are covered, well, I’d rather jump right in sooner rather and later and hope we are successful. And I’m the world’s most impatient person, so there is that too!

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.