Saturday, October 9, 2010

Answers, In a Way

FYI: This is gonna be a long post and possibly interesting only to me.

I got my 7dpo progesterone levels (unmedicated cycle): 14 (YAY!)

So by way of an update on our re-visit with the RE... all in all we left the appointment feeling fairly upbeat, which is quite a feat as you will soon see. We reviewed the last 11 months of treatments and discussed positives, negatives and possibilities. He even apologized profusely (unprompted) for our experience with Dr. Hate. It was pretty clear that we weren't the first patients to have such an encounter with her, and that she is on her way OUT.

To review the questions we took in with us:

What's with the regression to the 9 day luteal phase?

The big surprise for me was that he feels like the last two cycles with the 9 day luteal phase were actually early miscarriages rather than failed LPs. Non-viable embryos that implanted for a day or so and then fell apart. This is based on the statistics for success for my protocol, my response to it, the bloodwork, the ultrasounds and the fact that a similar ovarian response with the Clomid DID result in a full 14 day luteal phase.

Why did Clomid fix the LPD, but injectibles + progesterone supplements NOT (even with multiple follies)?

This is related to the above. He explained that Clomid would result in the desired amount of progesterone and length of luteal phase, but can negatively impact the quality of the uterine lining, whereas the injectibles would improve both, making it more likely that with injectibles we got implantation (with subsequent failure).

Is it possible that my body simply isn't making use of the available progesterone for some reason?

He doesn't think this is realistic in my case, as I did carry that blighted ovum to more than eight weeks even without progesterone supplementation.

Has the diagnosis shifted from LPD to "Unexplained"?


What is the plan to get better response from Rightie this time? Should we just wait for Leftie's month instead?

He doesn't feel like there is good evidence to support waiting for a Leftie month. In reviewing my previous cycles, there were months that Rightie was noticeably more responsive and there is no guarantee that my ovaries are on a strict rotation. The plan is for increased GonalF dosage and progesterone (both oral AND suppositories).

Has my AMH been tested? If so: what was it, and if not: why?

No. All evidence from my other blood levels, tests and ultrasounds show that I respond well and can produce plenty of eggs. He says he does order the AMH test for some of his patients, but doesn't see indicators that it would be valuable in my case.

If this doesn't work, what is the next step?

This brings the total to three suspected early miscarriages and one blighted ovum miscarriage. Which now that I've had some time to consider it,  makes me wonder about my egg quality. Question for the next visit.

We discussed the statistics for success with the injectibles/IUI protocol, and our RE feels like after three failed cycles on this plan, there isn't much point to continuing it. So we're doing one more injectibles/IUI cycle with adjusted dosages and tweaked progesterone delivery. After that, he suggests switching to IVF.

Deep breaths.

He also informed us that our insurance won't cover it (not even meds).

Deeper breaths.

The "good" news is he estimates the total cost, including meds, will be about $10K per cycle (including the cost of meds). From what I've seen on Twitter and in BlogWorld, this is downright cheap for an out-of-pocket IVF. Not that we have $10K laying around. It will probably mean coming out of the IF closet to our families and begging for funds.

More deep breaths.

It will be worth it if we get a baby out of it.


  1. So glad you got to talk to your RE and got all your questions answered. I really hope everything adjusted this cycle will make it work. If this cycle doesn't work for me I am probably headed towards ivf just like you. Good luck!

  2. It's nice to feel like you know your path and where you're going. A plan, if you will. I'm so happy you got your questions answered! You and I sound like we're on the same path--I have 2 more IUIs (we chose to do 4 instead of 3) before moving to IVF. But not sure if your IVF is the same as mine, but one cycle for ours would cost about $9,600. BUT the meds alone are $3,500 so it's more like $14K for me. I don't know if your insurance covers meds, but mine, sadly, does not. I hope that your insurance covers it all and you don't need to worry about it like me!

    Wishing you SO much success, Slackie. I'm hoping so much for you. xo

  3. That sounds like a great visit. Although an "unexplained" diagnosis has its own frustrations. I have always found it helpful to have a plan. I know coming out of the IF closet is scary as is contemplating ivf. Once you are out, I can only imagine getting a lot of support, hopefully. I hope your iui works but if you have to move to ivf, it hasn't been too difficult, yet.
    Thanks for the shout out/award! I'll be doing it soon.

  4. That's a lot to take in, and I know how overwhelming this information can be. Huge hugs to you and the prof. Thinking about multiple miscarriages must be difficult.

    We're in a very similar place with our treatment... this is our last IUI, and we'll move to IVF next, with egg quality as the #1 suspect. I'm so glad the the cost looks more reasonable for you (what a world that 10k looks reasonable?!), but I'm really praying that you won't need it!

    Two things: Are you considering a second opinion before trying IVF? And, I don't really understand why he wouldn't test your AMH. That seems off to me (IMHO). It's a simple blood test, and if you're in an unexplained category, I don't see a reason not to. Wouldn't it just be nice to know it's not a problem?

  5. Wow, that's a lot of information for one visit. Just hearing about the fact that it was early miscarriages alone is crazy. It's a lot to sort. Thinking of you and wishing you the best.

  6. I know that is a lot of information to take in but I am glad that you got your questions answered. Take lots of deep breaths and take time for yourself <3

  7. That's great that you're now armed with so much more information. I'm sorry you have more difficult decisions to make - you may be surprised with the amount of support that you get if you do come out of the closet, and I hope this is the case.

    Incidentally, my current clinic never tests AMH. They reckon its value has not yet been proven as a diagnostic measure - which is particularly interesting considering that they do a lot of things which other clinics consider experimental. I know from my previous clinic that I have low AMH, but this clinic has never factored that into any of its considerations.

    Take time to process the new information, and I'll be cheering you on for the next stage.

  8. It sounds like you're getting some good answers and direction from your RE. It seems to me (I'm not a doctor of course) that only IVF will be able to tell you about the quality of your embryos. The thought of IVF is certainly overwhelming but we're here for support. And yes, you might have to come out of the closet for funds but maybe you'll be surprised by the kindness you'll receive.

  9. I'm sorry about the early miscarriages. That sounds hard. But I'm glad you got some answers. Also, FWIW, my doctor does not believe that the AMH is of much value.