Consultation re IVF - REFRAMING (Part 1)
Written by Arpee on September 23, 2008 – 11:51 pm -We had our consult with DrH and she was very accomodating. She answered all our questions - I didn’t necessarily like all her responses, but it is good that she didn’t sugar coat it. She said that she would have discussed most of the topics anyway but appreciated the questions I sent in because it gave her an idea where we were coming from.
She said that she wished there were more couples who were more concerned on what would be done to their embryo. She just gave me some more additional things to dig more on too…
Anyway, I wrote all that I could remember from our consult … yes I forgot the recorder… and writing it down resulted into a very long post, so I am broke it into 3 parts.
OUR INFERTILITY FACTORS
The factors we are facing are Advanced maternal age, PCOS/Anovulation and Low sperm morphology:
- PCOS/Anovulation can be “tricked” by controlled ovarian hyperstimulation (COH).
- Low sperm morphology effect would be minimized with IVF.
- So, the only factor that we cannot do anything about is the advanced maternal age - that determines the egg quality. (I got the usual talk about “women are born with all the eggs for their whole lifetime. As the woman ages, the quality of the eggs “deteriorate”.” In essence, my eggs are old… my raw materials have deteriorated. 
Re my 3.5 FSH - DrH said that what it means is that for a 40-year old woman, that was good. However, it still does not compare to a 25-year old woman’s eggs who tests as 3.5 FSH. My eggs are still 15 years older!
WHAT OUR IVF WOULD LOOK LIKE
Since I am a good responder to the gonadotropin, DrH expects to be able to harvest a lot of eggs if I undergo COH in preparation for IVF. However, she said that fertilization and viability of embryos from eggs of someone my age may not be very good, so just fertilizing a few eggs will not make sense and that the procedure will not be worth it. She also recommends to transfer back 3-4 embryos since the implantation of embryos for someone of my age may not be very good as well. (So that means the “fate” of embryos that are not transferred is a real key question.)
As for typical reasons for IVF cancellation, DrH mentioned 3:
- low stimulation
- overstimulation (typically for younger women)
- ovulated early (or early LH surge)
What to expect with Lupron?
- Before starting, ultrasound to make sure there are no cysts
- Start Lupron. Attend IVF Orientation
- Expect period
- Baseline ultrasound
DrH said that the Follistim dosage she would use for IVF would be at the same level as our 1st Follistim stimulation (that was cancelled) which showed I was a good responder. So instead of the $3K medicine cost estimate, she thinks I would only be using $1.5K worth of meds.
Progesterone is going to be intramuscular (IM) injection…on the butt? on the thigh???. (I was hoping it was just suppository even if it was a bit messier.) Uuuggghhh…
Tags: advanced maternal age, anovulation, consultation, follistim, infertility, IVF, lupron, morphology, progesterone
Posted in Conversation, IVF, In Between Cycles, Infertility Learnings |
September 24th, 2008 at 9:15 am
At my RE consult yesterday, she told me that I could choose between the normal PIO big shot or a suppository. She said the suppositories are new but some of her patients have tried it and been successful. She would like me to try the shots first and then if it is too difficult switch to supps. She just wants to start with shots because she knows for sure that they always work. So ask your RE about the supps.
September 24th, 2008 at 5:26 pm
Thank you so much for stopping by my blog. Progesterone in oil, ouch! Best Wishes for these next steps and the happiest of outcomes to you and your family.
September 24th, 2008 at 7:38 pm
I wish you all the best of luck on your journey through IVF. I am heading that way soon.
September 24th, 2008 at 8:21 pm
Popping in from ICLW…
Best of luck as you go down this path. As for the PIO shots, I hear that icing the area 1st with an ice cube sometimes helps.
September 24th, 2008 at 8:23 pm
PIO shots versus suppositories seem to be a matter of RE preference. You can give the shot in the thigh or the butt, but most people go with the butt after icing it up first. The butt tends to have more meat in it, and hurts less when walking around.
ICLW
September 26th, 2008 at 6:17 pm
Thank you, ladies, for your responses…
I have just done a lot (!) of reading on IVF in different clinics and blogs and I tend to agree that IM or supp for progesteron is a matter of RE preference.