My RE’s visit went well today. Traffic wasn’t bad. There were a few slow downs but no biggie. When I passed by the fertility clinic where we did our retrieval, it was so surreal to know that we were here three weeks ago.. and my potential future baby was so close by.
Dr. E must have been busy. I got there early and was seen 25 minutes after the appointment time. This was the longest I ever had to wait for her. But it’s okay. I have waited for much much longer at my OB/GYN’s office.
I have my embryology report in my hand. It is very interesting to decipher what everything means. It recorded when Bob did his deeds, collection method (“Mast” was circled, I wonder what “Other” could mean), time of analysis, and the results. So the count per ml was 60 million, and the “total mot” (I guess motility) was 79.2 million. The post wash count was 42 million and the recovery rate was 47.7%. According to Dr. E, everything looked great on the male side. The report also tells the number of eggs collected, fertilized, and what happened to the fertilized eggs. It is such a weird feeling to see the progression of things that unfolded on a piece of paper. It’s so….. clinical, as compared to how emotional it was for us. I am imagining at 6:11am on July 12, 2013, an embryologist was doing his/her job, looking at the embryos, and recording that two embryos didn’t quite do what they needed to do. I am trying to imagine what went through his or her mind. Probably not much since this is just a part of a job and there should be no emotional or sentimental value attached to any of these embryos. However to Bob and me, these embryos were everything that we were putting our hope on. It is also priceless for me to see the Roman numeral 2 and the two letters BB on paper. This sequence of number and letters signify a dream that is still alive for the both of us.
Here are the answers from Dr. E. (I have put all the related questions together.)
How was my response to the protocol? Would you rate it as bad, okay, good, or excellent for someone who has diminished ovarian reserve? Compared to other people who has done a similar protocol with similar FSH, AFC, and AMH, how was my response?
Dr. E thinks that my response was fantastic for someone like me who has DOR. She has had patients who had a couple of follicles, a couple of eggs, no eggs, no fertilization, or eggs fertilized but didn’t make it to anything transferrable. She has even had patients who had 20 or 30 eggs but none fertilized.
How was the quality of the embryos from last cycle? We had three fertilized eggs from the four that we retrieved. We only got one embryo out of the three. Is that an expected fertilization rate? Regarding the one blastocyst that we have, does the slow progression of its growth indicate quality issue, implantation potential, neither, or both?
Dr. E thinks that it was a great fertilization rate for me, someone who has DOR. Like the questions above, she has seen a variety of cases of no fertilization. The fact that three fertilizing and one becoming a blastocyst is again “fantastic”, using her term. In terms of the quality of the blastocyst, she said that 2BB is good, but not the best. The slow progression of its growth could indicate a higher chance of chromosomal abnormality and a lower chance of implantation. However, it does not mean that it won’t implant and it will be chromosomally abnormal. She said that she has had a few patients with day six 2BB blastocysts that turned into real babies. Some of them are walking and running around. So anything is possible. For me specifically, this blastocyst has a 30% rate of implantation. I’ll take 30%. It is much much better than the 1% and the 5% that I previously got.
How soon do you recommend starting a new cycle? What will be a good indicator (in terms of FSH and AFC) for starting a new cycle?
We’ll start our new cycle when AF comes next time. I’ll call the office about 7 days past ovulation to schedule an ultrasound. At that time, we’ll look at my resting follicles and check the status of the ovaries (hopefully Rekka is not going to be reborn). If the AFC is about similar as last time, we’ll proceed with the cycle.
What protocol would you recommend? The same one? A modified one? A totally different one? What is the reason for keeping the same/modifying/doing a different one? How can we do better next time so that we get more eggs and embryos?
Based on my response from the last cycle, Dr. E is most likely going to do a “hybrid” protocol. She wants me to be put on oral meds as well as injectables. Her choice of oral meds would be Femara. I’ll still be on Menopur but it will be cut down to 150 IU rather than 300 IU. She thinks that she could cut down on the meds and could still grow similar number of follicles and eggs. She thinks that this hybrid combo might give me even more follicles. Of course, we don’t know what will actually happen. I might have only one to two follicles with the new protocol. It will definitely save us some money on the medications since we’ll have to pay out of pocket from this point on. It seems like what she intends to do is somewhere between mini-IVF and conventional IVF.
When do you recommend transferring the blastocyst? Do you recommend transferring it during a fresh cycle with other embryos or just transferring it by itself?
This part is interesting. She recommends thawing the blastocyst when we do our fresh cycle transfer next time. This will ensure that we’ll have something to transfer even if we don’t end up having more embryos. If we do get some embryos, she would still recommend transferring the frozen embryo with the other embryos that we may have. If we have more than a couple, then we’ll freeze new ones for subsequent cycles. She also said that since now that we know that we can grow blastocyst with my eggs, she may even recommend transferring a morula on day five since it may really grow in my uterus.
In your honest opinion, should we go with Dr. Y for mini or natural IVF if we only get one embryo every time we do a cycle? Financially and in terms of the amount of medication used, would that be a more reasonable option for us?
Dr. E thinks that we still have a shot at getting more embryos using her protocol. We’ll do it cycle by cycle and see what we get. She does think that going to Dr. Y is more cost effective. Her new protocol for me is between Dr. Y’s minimal approach and conventional IVF’s high stimulation approach. If we go with Dr. Y, it is most likely that we’ll get one embryo at each round that we’ll try to grow to a blastocyst. I am now gambling that we may get more embryos this coming round.
How does the Attain Program work? With DOR, do we qualify for the plan? Or because of my FSH, do we have to pay for each cycle?
Dr. E does not participate in Attain but does participate in ARC Fertility. She does not know the answer to my questions regarding finances. ARC offers one, two, three cycle plans but it tells no details about pricing online. I will have to call the ARC number to find out more. I will also have to talk to Dr. E’s financial person regarding finishing up using the insurance money. Since we have insurance coverage for monitoring ultrasounds and labs, we should not have to pay the package price. Dr. E’s financial person was off today so I’ll have to call her at another time.
There you have it. At this point, we have decided to go with Dr. E for another cycle. We’ll take it one step at a time. I’m thankful that we have a doctor who is no nonsense and does not sugarcoat things. Who knows? We may end up with a baby or two???