Sunday, June 10, 2012

Follow-Up Chat/WTF Appointment

My appointment didn't go exactly as I had hoped, but it was pretty good overall. My plan was to let my RE (Dr. Greene) tell me what he thought before asking any questions. Well, he came into the room, introduced himself (even though I've met him 3 times already), and immediately asked me what questions I had. 

So first I asked why he thought I was having chemical pregnancies. He said that he thought it was likely genetic. He explained that at the point that we transfer the embryos they have only made simple determinations as to what type of cells they are going to be (placenta, fetus, etc.) but it's not very complicated. The cells are multiplying and dividing, but not getting too detailed. He made an analogy to a book. It is as if the embryo copied all of the chapter titles of the book, but didn't yet get any words. He said that as things progress the embryo needs to make more complicated divisions and the cells determine exactly what everything will be (liver, brain, blood vessels, etc.) This is where there appears to be a problem. 

He didn't recommend donor eggs, donor sperm, or PGD at this time. He recommended we just keep trying. This I found somewhat frustrating. It's not that I want to do any of these things, but I wish we had more concrete answers. 

His recommendation was to do the FET before moving on to another fresh cycle. He said the quality isn't great for the ones we have, but it is best to focus on this as our next step. When the embryos were frozen both were graded 4CC. 

He then said grading is just a beauty contest. It's not that he doesn't give the embryologists credit for the amazing job they do, but he and the other doctors at the practice don't care as much about the grade. He said it probably means more to me than it does to him. Dr. G told me a story about a woman who had only 1 embryo to transfer that the embryologists graded as so poor they didn't even recommend transferring. This woman got pregnant and her son now speaks 3 languages and plays 2 instruments. He said even though our embryos didn't get a great grade on their report card there's no reason to believe they can't turn out to be perfect babies. The grading plays no part on what the child ends up as, it's just a simple way of judging them when they are at such an early stage. Once they implant there is no reason to believe they will be inferior or imperfect. 

He also said he did a study which compared embryos with PGD. He said often the best looking ones were the ones that were the most abnormal. His theory was that the ones that don't look as great could have had a simple problem during division and they already corrected themselves, giving them a less than perfect appearance. 

Dr .G didn't seem to think the coasting had much of an effect on my eggs. He said the HCG trigger is what is responsible for the final maturation and not the other meds. He did say that one option is to do a staggered cycle. This is when you don't coast at all but you freeze all embryos and transfer them in a subsequent cycle. 

He didn't see any problems with egg quality, sperm quality, or embryo quality. This is pretty good because I was worried about my eggs and embryos. My last clinic told me that all of our embryos were slow to develop. He said this wasn't the case with my past 2 cycles. He compared it to puberty. Just because people go through it at slightly different times doesn't mean either are better or worse off. 

I asked about my thyroid since my levels vary a bit. Since they are always (more or less) within the normal range he didn't think any further testing was necessary. He said TSH levels can affect a person's ability to get pregnant, but don't typically unless they are grossly abnormal. 

I asked about doing a panel for RPL but he said it wasn't going to change anything we are doing. It is just more testing and more money, but it won't change our current protocol. He was skeptical about Lovenox, but said the other doctor in the clinic highly believed in it. He said there weren't any specific studies to prove it is effective. He seemed to be on board with intralipids and Metformin to help reduce miscarriage rates. 

I really wanted a plan for our next IVF, but he was more focused on the upcoming FET. He said he could sit down and look specifically at my past cycles and make a new plan, but he didn't feel like we should focus on that yet. He said I could email him any time and I plan to (if necessary) about this rather than booking another appointment if our FET doesn't work.

The dialogue part of the appointment was pretty short and a nurse popped her head into a room at one point and I heard something about someone being ready for an HSG. He pretty much wrapped things up and said to stay positive and focus on our next FET rather than trying to plan for our next IVF. 

I then asked if I was going to get an ultrasound. He said I could if I wanted one. I explained that I was wondering if this cycle was ovulatory or not and wanted to get a prescription for progesterone if it wasn't. 

They brought me into another room and I waited a bit. I'm guessing he did the HSG in that time. Then he came in and did the ultrasound. First was my lining. It was a bit thin for me at 7.5. He then went to my right ovary (the one with a tube) and there was a great looking follicle which measured about 17 mm. On my left ovary (the one without a tube) there was another one which was larger and a little bigger than 20. I asked about a natural FET and he asked when my HCG came back negative. I think how recent that was paired with my thin lining made him say it wouldn't be a good cycle to do it. He said I should pick up ovulation tests and start using them. He then said we should definitely try on our own this month.

To find out I was actually ovulating was pretty great. There are some perks to going to a fertility clinic, such as getting a peak inside even when you are not actively cycling. In total, W and I only tried on our own 3 months. One was the first month before we saw a RE, and 2 cycles were post D&C so I don't even know if they were ovulatory. Sometimes I wonder if we could do this on our own, but it's hard to have faith in my body at this point. Dr. Greene did say that often women get pregnant in the cycles immediately following an IVF cycle. This is because the eggs are exposed to a more favorable environment preceding final maturation and ovulation. I would certainly take a natural pregnancy at this point!

I know this post is thorough and I may have bored the crap out of you, but I wanted to document and remember as much from the appointment as possible. I'm a seeker of information and always try to understand as much of this process as I can. 

I've been peeing on OPK's for a few days now. Since I have so many and they are cheap, there is no concern with using more than 1 per day. This afternoon the line was darker than it has been and there has been an abundance of EWCM. I'm hoping I get a positive soon and I will keep you posted. 
Wedding #1 for June is over. The groom was my husband's cousin. The bride had a really beautiful dress and the reception was at a country club overlooking an amazing lake. The wine and food were a bit tastier at the rehearsal dinner, but not bad at the reception either. The bride and groom were a bit awkward on their first dance and only cut the cake rather than feeding it to each other. They are both pretty reserved. All in all though, it was fun.

I am SO READY for our bathroom to be finished now. We are so close but things seem to be moving much more slowly now. 


  1. That was all really good info he gave you. I like all the analogies. I learn so much through reading about other bloggers appts. I wonder if thats why i got a natural pregnancy. Becuase it was the third or fourth cycle after ivf. Hmmm. Good luck this time trying naturally! :)

  2. It sounds like your RE is very knowledgeable and has a good plan. I hope this cycle works and you don't need it!

  3. Hey Liz....I checked my FB messages and didn't see any from you? Don't know what happened...maybe try again? Would love to meet up!

  4. Glad that you got answers at your appt and love his explanations about embryo quality... I always worry about that but love that he (and I've heard others say the same thing) aren't so fussed :) Thinking of you for your FET and hope that there's no need to make plans after that one :) xoxo

  5. Thanks for posting this, I love his explanations about the embryos! Good luck on your FET!