IVF or FET November/December 2015 - chat thread

[Asterimou]

Amanda: positive vibes for Friday. You have done so well to stay optimistic, there is every possibility this time it will work. Better to get on board with the outcome you want

Thanks for all the advice everyone. I am on the NHS wait list for it but could be 8 weeks. My private health cover doesn't cover it and it would still be 2-6 weeks wait so isn't worth spending the extra. I could do a cycle in between and if they are good enough to freeze the take Klik's advice and do a FET after the op. If they are not freeze grade then I guess it's pop them in and hope for the best. Or I just wait the 8 weeks and then another month after that until start :/ seems a long way away but maybe the waiting and prep will pay off.

 

[Asterimou]

Oh dear. Just got my AMH back and it's 4.6. It was 12 before do has dropped and doesn't align with my age His just fees like a constant battle!

 

[Wish2BMom]

woah, that's quite a drop, Aster - when was your first one done? I thought I read that you can have an 'off' day. Maybe have them do it again?
Re: your decisions, i think that klik's idea was a great one. Worth a shot to get some earlier eggs! I hate that we even have to make decisions like this!

amanda - good luck on Friday! no pressure, but YES, we def need some good news on this thread!!

disney - that's a wonderful cut to your commute!! I'd be counting down the days until a trip to HI too, that just sounds so...ahhhhhh!

nothing really going on here, just wanted to say hi and thank you all AGAIN for your constant support and encouragement. You're all truly wonderful women.

 

[Asterimou]

Hi Wish, my AMH was a year ago but my RE said it only reduces my odds by 5% due to other factors so it isn't quite as bad as I first thought but still not good. He said a few months won't make much difference so I'm going for the laparoscopy as I only have one round left in me I think, so need to do absolutely everything I can to make it work.

 

[Disneyfan88]

Aster - I agree with your rationale. If you only have one try left, I'd do everything I could before, too. It's possible that I'll be doing my IUI around the time that you are cycling.

My doctor also says that AMH isn't everything, and there are other factors that come into play along with AMH. There are supplements that can help with things like egg quality that your doctor may be able to recommend while you are waiting.

 

[boopin4baby]

Hi Ladies,

The results are back from my blood work and diagnostic tests. Every single test performed came back NORMAL/NEGATIVE. And the pathology report on my recent miscarriage resulted in a "normal male embryo". I'm elated that I don't have any known immune/clotting issues, however, I'm still perplexed as to why I miscarried a perfectly normal embryo with a strong hb. I'm officially in the unexplained loss category. I think that's more frustrating than having an actual diagnosis. At least with a known problem it can be treated.


The plan moving forward is to use empirical treatment with my next FET cycle. My RE wants to treat me with lovenox, aspirin 81 mg, antibiotics and steroids in conjunction with my routine protocol. He says that it can only help, not hurt in my situation. So, why not? What do you ladies think? Any suggestions for additional testing or treatment? Any and all input is greatly appreciated. TIA


Tests performed:

AntiB2 Glycoprotein (IgG/IgM)
AntiPhosphoSerine Ab (IgG/IgM)
Factor V Leiden Mutation
Homocysteine level fasting
Factor II activity (prothrombin 20210A mutation)
Antibody Screen
Cardiolipin Antibody
Lupus Anticoagulant
Protein C activity
Protein S activity
Prolactin fasting
Comprehensive Metabolic Panel fasting
Complete Blood Count
Vitamin D = 40
TSH = 0.81

3D Sonohysterogram

 

[Asterimou]

Hi Boopin, congrats on the all clear, so many tests! Have you tested Natural Killer Cells? I may have missed that. Something my RE said was he would test progesterone at trigger and freeze all if it wasn't at the right level (I think he said trigger), reason being is he had found a correlation with progesterone levels and success even if lining looks good. My RE thinks my hydrosalpinx could be the reason for not implanting, they can also cause miscarriage but I don't think you have tube issues? It is frustrating that the embryo was normal and just let go, there must be a reason but I know what you mean about the unexplained. Wishing you all the best.

Disney: thanks for insight on AMH, I'm just trying not to get hung up on it. There is a chance I could get a private lap next week! I'm going to do it if I can as I reviewed how long I waited last time and it was 4 months! I don't have that time to spare.

 

[klik]

Sorry I've been MIA, ladies! It's been intense... -- my update below, but first:

Asterimou: Yeah, maybe what everyone who voted Brexit wanted was stamps in their passports! Yeah, it is definitely surreal, and so uncertain... And you have a lot of uncertainty in your life, too! The AMH... I must say, I'm of the opinion that it tells you little that your antral follicle count couldn't tell you... I know people with undetectable AMH who have gotten a take-home baby. So yeah, take it with a bucket of salt! And hey, I think if you can indeed do your laparoscopy next week, that would be the best of all worlds for your next attempt... I'm sorry you'll have to pay for it, though... I hope that's the ticket for you, and that Lister is the place you need... Sounds like your RE has some brilliant ideas--I hope it works out for you!

Amanda: Hurray for optimism! That is a gorgeous, thick lining, and it seems you will be ready! Hopefully all the weird results are behind you, and this time you can get your lasting pregnancy, and then your baby!

Disneyfan: I asked my pharmacy about those adhesive removers and they said to use oil, like e.g. baby oil. Anyway, as it turned out I only had to use three (one at a time), and had to remove the last one yesterday (it had REALLY brought my FSH down...) I totally get wanting to have the trips behind you before getting back on the TTC carousel. They sound so lovely, and it will be great to enjoy them without having to worry about how much you're allowed to walk, or every little thing you eat, or whatever else we worry about after a TTC attempt... Have a brilliant time!

Wish: Thanks for supporting us, too! Did you have a DE meeting yesterday? How did it go? I'm so rooting for a smooth road ahead for you...

Boopin: I'm so sorry... not knowing is so heartbreaking... re. steroids, is it just medrol or is it more than that? Because I resisted steroids like crazy when my RE wanted to prescribe them, but apparently loads of women in North America are prescribed medrol to prevent MC's... If you're not testing NK cells, given your history, something like medrol probably does make a lot of sense... As for lovenox, my clinic here prescribes something similar as a matter of course. And re. aspirin, my RE here said there's no conclusive evidence either way--if anything, there's a slight detrimental effect to taking aspirin, so he didn't recommend it. But basically he was neutral on it. I'm sorry I can't be more helpful, but whatever you decide, I really hope it works!

AFM: Off to NY on Friday morning! I'm really overwhelmed--if I manage to pack, I'll have done great... My baseline scan showed an AFC of 5, which is terrifying me because last time I had that many, they all blew up like fireworks and a number of them became cysts. Hopefully the medication regimen will do the trick... The patches brought FSH and LH WAY down, so I was asked to remove the last one immediately and start taking clomid. On Friday, I add 75iu Menopur and 150iu Gonal-F (which some of you have as Follistim). I'm super-anxious--I have to keep my meds cold, somehow, on the plane--gaaaah! And to make matters worse, my partner doesn't even know if he can join me in NY. His passport is held up at a government agency at the moment, because his estranged wife needs to have her residency permit extended--imagine that! He can't travel to help make our baby because of his estranged wife!? It's a miracle I have not yet strangled him... Hopefully if he doesn't make it they'll let me freeze my eggs...

 

[Asterimou]

Oh Klik, big day Friday! What a crazy turn that your partner may not make it. Take deep breathes and hope for the best, I really hope he gets his passport on time, like you needed a bit more stress! You'll be fine keeping them cold but I would call the airline and see if you can store them somewhere in flight. Isn't it 7 hours? A good grade cool bag will do the trick I think. Remember each cycle is different and your follicles may not blow up this time. It is hard not to think of past cycles though. You are doing amazing and completely owning this cycle. I'm wishing with everything I have that it works for you xx happy travels xx

 

[boopin4baby]

Aster - I asked my RE for the NK cells test, but he didn't recommend it. He's definitely a doctor whose opposed to this controversial test. He gave me a really long argument supported with case studies of why he isn't convinced that NKc is linked to infertility or miscarriage. I'll copy and paste his original email below.

Hi Angela:

Don’t waste your money on NKc assays.

The role that Natural Killer cells (NKc) play regarding infertility and miscarriage remains controversial. NKc are found in normal individuals with a healthy immune system and have specialized functions in the blood and endometrium (the inside lining of the uterus). Around the time an embryo implants in the endometrium, more NKc arrive to focus the establishment of a blood supply between the embryo and the uterus. Ultimately, only part of the uterus is attached to the placenta and NKc are believed to control this process. Without NKc the implantation process may proceed out of control, creating problems with the placenta and then problems with the pregnancy.

A theory has been recently proposed that too many NKc, or over-active NKc, can also cause problems with implantation by not allowing enough establishment of a blood supply between the embryo and the endometrium. A few small studies have found that women with too many, or over-active, NKc are more likely to have a miscarriage. However, larger studies found no link between NKc levels and miscarriage. The link between infertility and NKc is even more theoretical than the link between NKc and miscarriage. Neither has been proven with any reliable studies. Further, there is no consensus how to measure NKc, either.

Assuming there truly is a link between NKc and either infertility or miscarriage, the available treatments attempt suppress the overall immune system or involve blood thinners. The use of blood thinners, such as heparin, carries only a small risk to patients and heparin is relatively inexpensive. There are no studies proving its effectiveness for the treatment of high levels of NKc. Oral steroid pills, such as prednisone, Medrol (prednisolone) or dexamethasone, suppress the overall immune system and given for a short duration have few side effects and are inexpensive. Intravenous Intralipid therapy carries little risk but costs up to $700 per dose and typically 3 or 4 doses are recommended. One treatment, called Intravenous Immunoglobulin (IVIg) therapy is very expensive, unproven and may cause harm by injecting someone else's blood products into your own blood. As of July 2016, there are no studies showing that Intralipid or IVIg therapy enhances fertility or decreases miscarriage.1-3 Until there is better data, IVIg therapy or Intralipid therapy for NKc should be considered experimental, performed under surveillance with established research protocols and patients should not have to pay to participate in that type of experiment.

In summary, the link between NKc and fertility or miscarriage remains controversial. Until a true link exists, spending the money on the test does not make sense, particularly because it is not covered by insurance and there is no agreement how to test for NKc. On the other hand, I routinely recommend the oral steroid pills for many IVF patients, because the pills may help suppress factors in the immune system (not just NKc) when an embryo is implanting, are unlikely to cause any harm and are inexpensive.


1. Stephenson MD, Kutteh WH, Purkiss S, et. al. Intravenous immunoglobulin and idiopathic secondary recurrent miscarriage: a multicentered randomized placebo-controlled trial. Human Reproduction (2010) 25(9): 2203-2209.
2. Egerup P, Lindschou J, Gluud C, et. al. The effects of intravenous immunoglbulins in women with recurrent miscarriages: A systematic review of randomised trials with meta-analysis and trial sequential analysis including individual patient data. PLoS One (2015) 10(10):e0141588.
3. Christiansen OB, Larsen EC, Egerup P, et. al. Immunoglubulin treatment for secondary recurrent miscarriage: a randomised, bouble-blind, placebo-controlled trial. BJOG (2015) 122(4): 500-8.

Dr. ******

 

[boopin4baby]

klik and amanda - GL at your appointments on Friday!! I'm sending you both all the positive vibes and baby dust that I can!! Fx'd!!

 

[Wish2BMom]

omg what a big Friday we have coming up!!

boopin - I'm so sorry for the inconclusive results. No real closure on that. So then I start to just wonder - the spirit that is trying to get to you wasn't happy with that little body or maybe something could have happened later on and it was best to bail now. He'll make his way to you!!!
I wish I knew more about more tests you could have too but you sound normal to me! I have a really good feeling about your next round. You're gonna nail it.

klik - WOW what a whirlwind of a week you're having!! That's crap about your partner's estranged wife situation. Time for focus to be on YOU! I'm sure they'll let you freeze your eggs. And I had to travel with Gonal-F as well - it can be at room temperature for about a month, so you're good. I did pack mine with an ice pack that you'd put on a wound and then I wasn't concerned when that got warm. You should be ok. And I know menopur doesn't have to be refrigerated. No worries, no stress!!

aster - I'm so happy you can get your lap over with earlier!! Stinks for it to be OOP, but the timing is great.

So we did have our consult yesterday and it was great. Daunting b/c we talked for almost 2.5 hrs with everyone, but great to get it going and also good to see that DH are almost 100% on the same page about everything. And the things we're not are easy to overcome (just things like telling the child and such - had a good long talk about that one). So it was exhausting, I kinda wanted to vomit or pass out afterwards, but all is good.
Next up is signing the consent forms and getting access to the donor database. I guess we can go on there now and see limited info. I'm dying to but too busy at work to sneak off for an hour or 3!!

 

[klik]

Asterimou, thank you so much for the wishes! So, do you really get your lap next week?!

Boopin: thanks for the wishes, and for sharing your RE's opinion on the NK-cell test. What your RE is recommending for you is exactly the two things he deems safe and potentially useful: the lovenox (heparin) and the medrol (steroids). In your place, I would definitely take them... But good luck with whatever you decide!

Wish: hurray on the consult! Glad you and your DH are on the same page!!! That makes this difficult process so much easier... Good luck with the donor choosing... I'm sure you will pick a wonderful one!

Ok, I've bought a cold bag and some ice packs, and I'm good to go! My airline (BA) won't let their onboard fridge be used--they probably don't want to be sued if something goes wrong... But I'm cautiously optimistic. Wish, funny enough the Pregnyl (hcg trigger) we have in the UK is also to be refrigerated--I've heard in the US it doesn't have to be. Weird!

Next check-in probably from New York. Sunday morning is my first scan/bloods. Boy, am I anxious!

 

[boopin4baby]

klik - You'll be fine transporting the medication on your flight with a cold bag & ice packs. When refrigerated meds are sent from the pharmacy via postal mail/delivery they're in an insulated package with a cold pack(s). You're GOOD to go!!

I can't wait to get your next update. I'm so excited for you!!

 

[Asterimou]

Oh Klik, I almost feel I'm on the plane with you! Go girl, did DH get his passport?

Thanks for sharing the NK research Boopin. I must admit I did have my reservations but felt I wanted to know. Mine came out okay so I guess it's one Unknown off the list

Wish, it is great you are forging ahead, I sense the excitement and really hope you get your donor soon.

I'm booked in for the lap on Tuesday as long as AF comes by Saturday! Why are we always waiting for AF or hoping it never comes! To think all those years where I took no notice. Ignorant bliss! I'm actually a little sad that the tubes will be clipped, it kinda takes away my last glimmer of hope for a natural pregnancy. I know they don't work but they are my tubes and I'm effectively sterilising myself :/ it feels right though and gives me a better chance of success.

Happy Friday all xx

 

[boopin4baby]

Aster - I'm fine not having the NKc test done. All of my immune tests have come back Negative/Normal, so the chances of me having high NKc's are slim to none. And even if I do, I switched my folic acid to folate and my RE is using the empirical treatment with my regular protocol. I feel I've done all that I can do to set myself up for success next transfer, FX'D!!

The better show her ugly little face by Saturday.. lol!! I'm wishing you all the best for Tuesday's lap procedure. I think that you made the right decision to clip your tubes. Like you said they're rubbish anyways.. GOOD RIDDENS!! xx

 

[Wish2BMom]

boopin - I'm sorry, I've lost track - when is your next transfer? you already have the eggs right? or are they full embryos now and you just need to set up for that?

aster - I hear ya, always hoping she's here quickly or not at all. I bet she yells right back at us and says 'I'm doing what I'm supposed to!! leave me alone!!'
And yeah, I'd be sad about the tubes too. Oddly enough, your sterilization is what will help get you pregnant! That's kinda cool to think about!!

klik - are you flying today? we had a couple of things going on today. Amanda - good luck today too!!! I can't wait to hear all the good news!

afm - just winding down the week. I have to take stock of what I have for meds/patches/etc and call my doc to order everything else for me. Like count my leftover Estrace tabs, etc. Stillll not using the Cetrotide in the fridge, so if anyone needs any of that and don't want to pay for it, I'll ship it to you!
Then we have consent form signing on Monday - THEN we can start to look at donors. I haven't had a chance to this week and we'd only have access to a general overview of them anyway. But I have to get the ball rolling on financing and all that. Sigh, so much to do.

Also, I'm hosting my all-women's fantasy football draft this weekend! I can't wait, should be a good time. 12 women discussing the pros and cons of football players for 2 hrs, then out to dinner and drinks to hang out. YAY! hahahaha I realize this isn't everyone's cup of tea, but I LOVE football and I LOVE the fall. This is my favorite time of year!

 

[boopin4baby]

Wish - I have 1 6BB embryo remaining from my previous de ivf cycle. I plan to transfer my precious cargo end of October. No set date. Everything's tentative, depending on how I respond to the medications.

I'm a diehard Dallas COWBOYS fan!! I LOVE, LOVE FOOTBALL!! I'll be going to a Cowboys game this year with OH. I'm so happy we picked Dak Prescott as our back-up quarterback. He was the best QB pick in the 2016 NFL Draft!!

 

[Disneyfan88]

Hi ladies. I missed a lot here!

Klik - I hope that you arrived in NY safely and that everything worked out for your partner to join you. I was on Menopur and Gonal-F when I was undergoing my IVF cycles. Good luck!!

Boopin - I was in your shoes with all of my testing. Everything basically came back normal with no explanation of why my "normal" embryos weren't leading to (normal) pregnancies. It's interesting to see your doctor's thoughts on the NK tests. My results came back normal but cost me $400 to get them -- and that was after talking them down from over $1k. I hope that the tweaks to your protocol are just what you need to find success this next time.

Aster - I hope AF comes on time! I totally agree - it seems like AF always comes when you don't want it but takes forever to show up when you need it. Good luck!

Wish - I'm glad that your appointment went well and that you guys are pretty much on the same page for the big stuff. It's so exciting that you are getting things lined up and moving along. I'm pulling for you!!

Hope - I hope you're doing well! You're getting close!!

 

[klik]

Boopin: when is the game? Sounds exciting!

Asterimou: did AF arrive?! I hope she did, or does today! As for your tubes, one expression that I really love is, "there is no change without loss." So true... I think it is devastating to have to get your tubes snipped... But as Wish said, it may be what ends up helping you to have your successful pregnancy... I also hope Lister can give you a protocol that helps with the egg quality (if that has really been an issue and it wasn't the sperm instead...) Still, there is grieving to do, for your tubes and the potential for an unexpected natural pregnancy...

Wish: I love the idea of an all-female fantasy football league! I have to say, American football never penetrated my psyche (when I lived in the US I used to enjoy the Superbowl ads, but that's it!) Still, it sounds like great fun--enjoy! Also, my cetrotide is not in the fridge, but NYC is so hot maybe it should be... Next week sounds intense in your TTC journey... good luck!

Disneyfan: tell us about you!

Amanda, I hope things went really well for you yesterday--how are you feeling?

AFM, I am in NYC, in a sweet AirBnB flat that I've only got til Wednesday (I mean, maybe I'll show up at Cornell tomorrow and they'll tell me that it's hopeless and I have to go home). My main task today is to book a hotel or somesuch over labor day weekend that has a flexible cancellation policy--that's going to be fun to try!

Also, I've lived in NY before but never in this neighborhood, so I was not particularly successful hunting down decent food last night. My dinner was tortilla chips and salsa. Not what I want to be feeding my body right now! I'm going back to my old haunts today to pick up some delicious fresh food, while I've got a proper fridge to put it in!

Speaking of which, I filled my cool bag with ice packs and they'd all melted by the time I got here... Still, it was all still fairly cold. I think I'll be ok!

DP is not here (else we would have gone to a restaurant for dinner--I don't feel like doing that alone, and was too tired to seek out a friend.) His passport is still stuck in bureaucratic no-person's-land. He thinks realistically if we're lucky he'll get it late next week, which by my guess would mean that he might arrive just before ER--best-case scenario! Otherwise I'll have to freeze some eggs... Assuming there is anything to collect, that is . And we'll have to buy his flight really last-minute, which will be eye-wateringly expensive!

Right, time to start the day!