Thursday, 6 March 2008

Plan of action

Yesterday, we returned to the Great Big Fertility Clinic for our review appointment with Dr Abrupt.

Dr Abrupt, I am now beginning to appreciate, responds better when confronted with specific questions, as long as they are not overly emotive, and are couched in relatively scientific language. 'Are my ovaries on their last legs?', for example, will not meet with a good response. If, on the other hand, this same question is rephrased as, 'How worried should I be at this stage about diminished ovarian reserve, or could my poor response to the last cycle simply be down to either over-suppression or under-stimulation?', he is more willing to engage in dialogue.

His answer to the above was that, at this stage, we simply don't know. Once again, he reiterated that my FSH levels (7.6 in March 2007, 5.6 in September 2007) did not appear to indicate any underlying problem which could have been anticipated before we started treatment in December; we simply have to try a different protocol and see what happens this time round.

He recommended that we wait another month before trying another cycle. This time round, we will do a shorter, 'flare' protocol, and will triple the dose of Menopur from 150iu to 450iu. I did ask why he thought Menopur was the best option - would I perhaps respond better to a recombinant? He referred to an unspecified meta-analysis (as anyone who has read of my prior dealings with Dr A will know, he is very keen on statistics and meta-analyses) which suggested that the choice of either a recombinant or a urinary based stimulant did not appear to have any major impact on success rates. Having had such a poor response to the Menopur last time round, I do feel a little bit iffy about taking it again, and will perhaps raise this particular concern with him at our next appointment.

He also suggested that, this time round, we would definitely proceed to retrieval, whatever my response. We are now at the stage where he feels it necessary to have a sense of the quality of any eggs I do produce - that way, he will be able to advise us on whether he feels that there is any point in us continuing treatment.

Such a lot is riding on this next cycle. Although there is a tiny voice inside me telling me not to panic, that I could well be OK on this new, more aggressive protocol, there is a far larger part of me that is trying to begin to find a way of processing the fact that this cycle could possibly mark the end of the road for us.


Jendeis said...

Good job on getting the answers to your questions. Even though Dr. Abrupt is not able to converse on your level, at least you are able to converse on his level. This seems like the best way to proceed with him, provided that you have confidence in his abilities as a doctor.

soul-quest said...

May this next cycle be THE one!!!

Lisa said...

Glad you have a plan. Hoping the change in protocol will make all the difference!

Lisa from Infertile Ground

luna said...

as jendeis said, at least you are able to communicate at his level.

it sounds like you have a plan in place. I'm not sure I understand his response on the menopur, but I don't speak his language. maybe he's not convinced something else would work better and he's more comfortable with menopur? if you're not convinced, you could ask if he uses any of the other specific drugs. I imagine he'll say the higher dosage should have a better outcome, but since you responded so poorly before you could say you'd like to try something else this time.

as far as anticipating it will be your last cycle, I know that feeling well and it's really hard to face. in fact I'm facing it now with my upcoming FET. the best I can do is try not to think about that part right now. easier said than done, I know. ~luna