We had our visit with the reproductive immunologist this afternoon. We only waited about a half hour after filling out some forms to update their records. We went back to the original reproductive specialist/immunologist we saw in October of 2010. I had all sorts of feelings before going in. Would he remember us? He has returned my emails over the years. Would he be mad? Would he tell us it was too late? What if…
I knew I’d have to get more blood work done anyway, that’s how these things work. But, that will have to be another day, as the phlebotomist had gone home already. That just means I have to go back in and have it done.
We sat in the office and he was great. Made a few jokes about us taking a while to get back to him. I think it helped ease the tension. We fillled him in on my surgeries and the IVF and FET that we did. We told him about our last embryo. We brought all of the records from the RE and Dr. K. And then, we discussed the endometriosis and immune issues. He clarified a few things for me, that aren’t as bad as I thought they were, thankfully.
Apparently, he is having luck treating women with endometriosis with Femara and Aygestin (norethindrone acetate tablets). I’ve heard both and I am petrified of drugs in general! He said if we weren’t ready or if I hadn’t just been “cleaned up”, he would recommend this for me.
Basically, we have 2 real options. Using Our Last Embryo with a Frozen Embryo Transfer cycle or do a fresh IVF cycle instead. Here’s what each would entail:
FET would be going into the office on day 3 for the usual ultrasound and bloodwork, then get put on Birth Control Pills (yuck, one of my least favorite things) for two weeks and add prednisone (a steroid to prevent myself from attacking myself), and Lovenox (Blood thinner with so much more to add) and then take Lupron shots for 5 days, then Estrogen for 10 days, then start the progesterone (shots in the rear) for 5 days and IF the embryo survives the thawing process, transfer the embryo into my uterus!
A fresh IVF cycle called a Flare cycle, but not with Lupron or BCP’s. This one would be using the Femara, for 5 days, then starting the stims (stimulation meds) and then adding Ganirelix (an antagonist to prevent ovulation) then the HCG and Egg Retrieval (oh no more anesthesia), then the progesterone (in the rear). Of course, I would be on the Lovenox and prednisone as well. I can’t avoid those at all.
The reasoning behind suggesting the fresh cycle versus the Frozen embryo, is that our last embryo isn’t a great quality one, it’s not bad, but it’s not ideal. He’s worried that it may not survive and then we’ve done all those drugs for nothing. Drugs I have a fear of taking. I hated the way the BCP made me feel. Let me describe these meds for you (who may not know):
BCP in IVF – used to allow a rest period and a starting point, used for timing of the cycle.
Lupron (a GnRH Gonadotropin Releasing Hormone/agonist) assists in the release of the pituitary hormones FSH and LH. To better control the Ovarian hyperstimulation.
Lovenox is a blood thinner, but it is also known to help with implantation of the embryo into the uterus. I thought I had to take this because of the MTHFR, but that’s not the reason.
Femara is a drug designed for Breast and Ovarian Cancer and it has shown positive effects on endometriosis when combined with the Aygestin. It has also been known to help stimulate the pituitary which helps in the release of FSH, helps the IVF cycle.
Prednisone a synthetic corticosteroid drug that is particularly effective as an immunosuppressant drug. It is used to treat certain inflammatory diseases (such as moderate allergic reactions) and (at higher doses) some types of cancer, but has significant adverse effects. Because it suppresses the immune system, it leaves patients more susceptible to infections. I need this because of all of my autoimmune issues.
Stims (Menopur, follistim) do just that, they stimulate your ovaries to hyperproduce follicles with eggs in them. THe more the merrier, but too much is bad too. There are more that the two I listed, but those were the ones we used for our first IVF, so I figured I would list those.
Antagonist (Ganirelix) to prevent ovulation from occurring before the egg retrieval
HCG shot (Before the Egg retrieval) has to be timed perfectly. It’s usually called the trigger shot.
So, what should we do? We could go through all of the above drugs for a FET and then the embryo doesn’t survive the thaw, or it does and it has “chromosomal abnormalities,” or it could work. OR, we go with the fresh IVF cycle, pray it doesn’t make my endometriosis worse with the stims (like it did in 2011), come up with a new batch of embryos and transfer 2 in to give us a better shot at it working. He did say at my age, we should transfer 2. I could go on and on rationalizing each one. I did quit smoking before the first IVF cycle, maybe those embryo weren’t good? Maybe a new batch would be better to have just in case, what if the endo gets worse? Now would be the best time to try. We are not getting any younger. He did say that we have to throw everything at this because of my endo and immune issues (not to mention my age, which he agreed, is a factor)!
Here’s the thing. I have to have a period, skip that month and go to my next cycle to start, but I haven’t gotten my period yet. It was supposed to come March 27th. I had a few symptoms, but it never came and the symptoms disappeared too. I find that strange because I had been pretty regular. My cycles changed after the D &C’s, but he didn’t do one this time. And I know I’m not pregnant (no tubes remember?). It’s wonderful to be a woman!