Thursday, 11 April 2013

Surprises and second guesses

We had our WTF appointment on Tuesday.  As expected, there weren't really any answers.  Since this was our first full IVF, my RE said that there was a certain element of trial and error involved.  She believes we got a decent number of eggs, but that obviously the main problem was the fact that we only had a 50% fertilization rate.  

What surprised me was that she didn't seem to be attributing this completely to my eggs.  This is despite the fact that when using Oosight (a fancy technology that allows the embryologist to view the inside of my eggs when setting up for ICSI) only 35% of them had a normal appearance.  Instead, my RE seemed to kind of focus on M's sperm quality.  He has approximately 26% DNA fragmentation, which is slightly higher than normal, along with his abnormal acrosomes (which are what allows the sperm to drill into the egg and fertilize it).  

This is where the second guessing comes in.  When his sperm issues were first discovered, M was told to start taking a fancy male fertility supplement to see if the situation improved.  Our RE is now suggesting doing a new sperm analysis to see if it's helped any.  The problem is, it hasn't.  Because M hasn't been taking it.  He discovered pretty early on that it gives him terrible heartburn, and he quietly stopped taking it.  When I realized this, I was initially kind of pissed.  Here I was taking supplements and vitamins, injecting myself with drugs, and subjecting myself to endless blood tests and trans-vaginal ultrasounds, and he couldn't be bothered to take a damn supplement?  But on the other hand, I was convinced that our problem was my eggs, and that ICSI could fix any sperm issue.  So I didn't push it.  And now I'm wondering if I should have.

The good news is that our RE really thinks we should give IVF another try.  She suggested that we might tweak my drug protocol, and possibly try estrogen priming.  But she was heartened by both my age and the fact that despite my undetectable AMH, we managed to get 8 eggs and one good-looking blastocyst.  As for why it didn't implant, she said that even with a great blast our chances were only 50/50.  It may have just been bad luck.  But to rule out any lining issues, she's recommending doing a fancy (and expensive!) Endometrial Function Test (EFT) run by Yale University.  It's basically a mock transfer cycle, with an endo biopsy to determine whether the lining has certain specific markers that are required for implantation.  That'll be my fourth endo biopsy, for anyone who's counting.  But having had a quick glance online, I'm a bit skeptical of how helpful this particular test might be, especially since it's not like I've had repeat losses or anything.  If you've had this done, please let me know in the comments or email me and let me know if you think it helped at all.

Finally, while my RE didn't bring it up herself, she agreed to give me a prescription for DHEA.  You know, I love living in Canada most of the time, but every once in a while it feels like I'm in a Soviet gulag.  Two hours' drive away from me across the border, people are buying DHEA in the supermarket.  Here, I'm trekking halfway across downtown in the pouring rain to go to a special compounding pharmacy where they make DHEA.  It cost me $133 for a three month supply, and it's not covered by either OHIP or my drug plan.  It makes about as much sense as charging me a special "Canadian" price for books and magazines.  Or blocking me from Hulu.  Sigh.

Anyway, our tentative plan is to use next cycle for the EFT (if I decide to drop the $500 for it) and wait out the rest of the summer letting my DHEA and M's supplement (affectionately known as his "boner pills") take effect.  With any luck, we'll have super eggs and super sperm for the next go around, combining to make super embryos that will grow into super babies that will blast forth from my super vagina.  Here's hopin'.

20 comments:

  1. So....I had one endo biopsy, and it didn't help anything at all (but man, do those hurt). I wonder the same thing as you through, if it really has helped people.

    As for DHEA, I took 50 mg for one month in conjunction to Co Q 10 and that cycle ended up being my best cycle ever with 7 eggs and 100% fertilization. Who knows!!

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  2. Ugh, that's frustrating. I'm so glad you have a plan, but it sucks to be second-guessing decisions. Here's hoping the DHEA and the sperm supplements do the trick.

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  3. i had an eb and it was fine. i have heard mixed resuts with the yale tests if you are missing beta 3 they recommend lupron for 3 months.,.and honestly that is like sudden menopause. my clinic doesnt support that test for that reason and i cant say that i blame them since with any chance of DOR you risk your supply. it is kind of a gamble

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    1. Yeah, my RE said that if they found abnormalities (she didn't say what) then they'd put me on Lupron for two months before I cycled again. I asked if that wouldn't be VERY counterproductive seeing as how I was over-suppressed and my Lupron cycle got cancelled. It kind of feels to me like they're "selling" this particular test, and we have no reason to think my lining is bad other than the fact that ONE embryo didn't implant. I'm not sold.

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  4. I met Dr Kliman and listen to his lecture on the endometrial test when I was working in Connecticut, most of his findings were based on patients (not necessarily infertility) who had experienced recurrent losses. He promoted how it could benefit patients undergoing IVF, but testing the soil as he describes it. I kinda of forgot all about this testing until recently when I saw some other IF women on a fertility forum inquire about it. It was 2004-2005 when I heard his speak, and I can't help to think that it was really essential, why wouldn't it be the standard of care to do before every IVF cycle. I cooresponded with a woman on a foum who has unexplained infertility and had three failed IVF cycles (chemical pregnancies) and I thought she should consider doing it. I supposed it's a matter of looking at what you have to lose (beside the $500) I've actually thought about considering it if (when) we're getting ready for IVF

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    1. This is really helpful, thanks! You're right, for the relatively low cost (at least in the scheme of fertility treatments) it's probably better to do it and have the peace of mind.

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  5. I can relate to the experience with getting DHEA...what a pain! I'm 37 with DOR and I seem to be one of the unlucky ones that DHEA didn't really work for. I was on it for 6 months but both my FSH and AFC were worse. Based on that and the side effects, I stopped taking it and we are now trying naturally. Good luck!

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  6. I was so pissed when my husband complained about the small amount of multivitamins he had to take to improve his sperm and how they gave him heartburn. Men are such babies. I was like HELLO I AM INJECTING MYSELF EVERY DAY AND IT DOESN'T FEEL GREAT. Ugh.

    I hope that you can get him on board- or shove them down his throat every day. :-)

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  7. I'm sorry you didn't get any solid answers. I thought I would share my story since it seems to be very similar to yours. When I went through IVF, my doc also put me on testosterone -- first a gel and then a patch before I started stimming. He said it is a fairly new protocol, but has been proven to increase egg quality. My clinic says they've had great success with it and have seen several ladies with low reserve diagnosis' get pregnant. Just a thought.

    I too was on a ton of supplements. I think it's so confusing to know what to take and what not to take. I'm glad your doc is willing to explore the use of DHEA. My RE had no interest/insight/input on supplements to take. They definitely do not take a holistic view of the situation at my clinic.

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  8. I always wondered what the whole point of WTF appointment was really worth. My doctor always told me things I already knew or said they didn't know what is wrong. Of course with unexplained infertility it is hard to pin point the fault.

    Glad you got rx for DHEA. I take DHEA, b-12, CoQ10 to help with mine.

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  9. I'm sorry your WTF appointment didn't give you a lot of answers, but it sounds like your clinic does some pretty fancy stuff! It's true, the first IVF really can be a bit of trial and error (an expensive one!) but I do think you have a really good chance at success. I will be cheering you on until you get that BFP!!

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  10. My husband started taking a whole bunch of vitamins and supplements after our 2nd IVF failed in case sperm quality was part of the problem. It was a ridiculous amount of pills. So between his supplements and mine I guess we finally did produce super sperm and super eggs.
    It is kind of crazy how hard it is for you to get DHEA in Canada. Though maybe it's something that should be taken under supervision of a doctor and the US has it all wrong. I am so glad to hear your doctor has confidence in another cycle working.

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  11. Hmm...we were told that anything below 30% DNA fragmentation was normal. Hubby's was way higher than that, and we still had a fertilization rate of over 80%. However, our doc did say that the sperm issue could have been why neither of our embryos implanted. My husband took supplements for a while, but they literally made him gag--they smelled horrible! But if they work, supplements can be a relatively simple fix, and I hope you both see an improvement.

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    1. Yeah, the boner pills stink big time. Makes you wonder what the hell is in them!

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  12. I just had my first Ivf lastmonth and it failed. I feel ur pain.

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    1. Sorry to hear that Marie. Yep, it sucks!

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  13. When we first started this whole IUI/IVF process, my husband literally said "I think I have the hardest part in this whole thing." He was talking about having to give his sample. He has since taken back those words! Lol. But at the time, he was dead serious. It's amazing what us women can withstand, but men are big babies when it comes to themselves. Haha!

    Whatever you guys decide to do next, I wish you the best if luck and success. I'll be cheering you on.

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    1. He DID NOT say that! I hope you gave him a lot of stink eye for that.

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    2. Haha! He did actually, but he has drastically changed his mind. Although, he did feel sorry for himself having to give me the PIO injections. He hates the idea of causing me pain. I told him he needed to try being on the receiving end! Lol

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  14. I'm sorry that you're on hold for three months! Boooo!!! I hope the DHEA (and the boner pills - HA!!!) makes a big difference!

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I'm needy and your comments validate me. Help a sister out!