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