Friday, 18 January 2008

Thank you

After spending much of yesterday crying, and cursing my lousy fucking ovaries & the lousy fucking doctors, I went to bed at 10pm with a splitting headache. I logged on this morning to find all your fantastic messages of support. I want to thank each and every one of you for your kind words - it means a great deal to know that there are so many of you out there rooting for me.

Luna asked about Mr H's SA. Based on the tests we've had done so far, his count ranges from between 17 & 19 million, and motility between 54% & 76%. The main problem seems to be with morphology (the results have consistently showed around 75% abnormal forms). They also do not appear to hang around for that long - when we switched to this particular clinic, they performed a swim up test which showed that, two hours later, most of them are dead in the water.

And yet, in spite of Mr H's wonky sperm and my now seemingly recalcitrant ovaries, we did manage to conceive without medical assistance (I then lost the baby at seven weeks) - which is what led me to think that IUI might be a way of salvaging something from this cycle.

I've spent the morning obsessively googling such cheering phrases as 'IVF poor response' and 'diminished ovarian reserve', and have come up with a list of questions ready to ask Dr Abrupt tomorrow:

Is it possible for us to convert this cycle into an IUI? And secondly, what are the costs involved in doing this? As Claire so rightly acknowledges, money is an issue in all of this. If we cancel this cycle prior to retrieval, we still have to pay £1,000 plus £500 for the drugs (the bulk of which I have now taken). If we go ahead, we are looking at £3,000 for a complete cycle plus the £500 for the drugs. Working on the assumption that we are unlikely to get a positive result with this first cycle, then it makes financial sense to cancel & focus our efforts on the next cycle, rather than paying out for something that probably will not work.

Other questions for Dr Abrupt:

Why did I have such a poor response to the Menopur? Is this an indication that my eggs are in fact past their sell by date, or do they simply need to adjust the meds?

And finally, leading on from this last one, do they have a protocol in mind for next time? As both Mel and Luna asked, is there a particular reason why they seem so intent on Menopur? Would a shorter, 'flare' protocol perhaps produce better results?

From what I read, it seemed that acupuncture may help - does anyone have any thoughts, positive or negative, on this one?

Dr Approachable said that I should in the meantime carry on with the Menopur injections, which I have been doing. But all we can do now is to wait - tomorrow's appointment will presumably resolve things one way or another.


Lisa Rullsenberg said...

Good thoughts and questions: and hey, what can I say except providing encouragement and support is what (blog) friends are for...

luna said...

glad you have some good Qs for the doc. like you I managed to get pg once w/o med. asst. (though liost it later). my hub's morph was much worse (over 90%, wtf?), but his count was a bit higher which meant he still had some good swimmers. I don't know if we ever had the swim up test though...

you don't mention what the cost would be to convert to IUI to salvage the cycle (and not waste all those meds too). it's probably not too much but I imagine the doc is concerned about success if he thinks ICSI is necessary. also, fyi, for our IVF we did split ICSI and some of my eggs still fertilized w/o ICSI even with our bad morph. so there's always a chance, right?

good luck! ~luna

Kim said...

I don't have much to add except that I also had a crappy response to Menopur (on an IUI cycle). I'm sure that my dosage was much lower then yours (initially 75IU and then 150IU), but after 11 days of stims I only had one good follie and one that was 'eh'. Maybe it's a Menopur thing. We were blessed with a successful cycle, however. If we decide to go through all of this again, I'll be asking for a different protocol. It's just too much money to play around with if you're not getting good results.

Kim said...

P.S. My husband has a great count and good motility, but over 98% abnormal forms, but our second IUI was successful. I wish nothing but the same for you!

Meghan said...

I don't have anything too helpful to add, just good luck at your appointment tomorrow. Hope you get all your questions answered

Thalia said...

IUI is always an option in this kind of situation, and should be much cheaper as the expensive part of ivf - retrieval - is skipped. Honestly, I'm not sure why they are being quite so negative. Yes, 5 follicles at this stage is not great, but I've stimmed for 16 days before retrieval due to over suppression, and got 6 good quality eggs, all of which fertilised. I hope you're going to get another scan before they cancel you, those follicles might yet surprise you.

Menopur is a very 'old fashioned' drug, the hypothesis used to be that it's better as it contains a small amount of LH as well as the purified FSH, given that it's purified from human urine. The recombinant drugs, puregon/gonal f/follistim - dont' have any LH. Docs used to think that having a bit of LH helped the eggs mature, but that's been shown to be untrue, so it may well be worth trying one of the recombinant drugs instead, not to mention a shorter protocol with less suppression. The bcps that many US clinics use are really just for scheduling purposes to get all the women lined up for the right dates, they don't do anything good for you and can lead to over suppression, so definitely ask about a different protocol.

Sorry you're having to deal with all of this.

Waiting Amy said...

I have had a similar experience. My first IVF went so-so and it looked like they retrieved a little too early since there were some egg maturity issues. We did basically the same protocol a few months later and it TANKED. My E2 was constantly low, I was maxed out on Gonal-F and Menopur. I stimmed for over 12 or 14 days. We did convert to IUI, but mostly because insurance would cover it. RE told me that with the prolonged stim, my progesterone was rising, indicating my body was trying to enter the luteal phase despite no ovulation. This negatively impacts the egg quality and he gave us very low chance of success with IUI (my husband's swimmers are ok).

Anyway, I thought we were finished (that was going to be our last try). But he helped us do another cycle. We did a low-dose lupron flare protocol, I took DHEA for 3-4 months before hand, and most of my stim I used Gonal-F (only a little Menopur the last 2 days). I did remarkably better, had 10-12 follicles, they had to decrease my meds. You can read the whole story on my blog.

The punchline is -- I'm turning 36 in 2 weeks, and I'm 8.5 weeks pregnant with twins. Don't give up if you're not ready.

luna said...

thalia raises a good point about the menopur protocol. my RE prescribed a low dose of Repronex to go with the FSH/Follistim because it contains LH. it's one more needle, but it had the desired response. she had me on a higher dosage at first then gradually decreased both. good luck. ~luna