Follow Up With Dr. B

Thursday was our follow-up appointment with Dr. Br.averman. Our appointment was at 2:30 in the afternoon and we had planned to both work on Wednesday and head down after to stay with my cousin in NYC. Well, they had predicted about 9 inches of snow so we ended up leaving early to avoid it. We got into Manhattan around four and my cousin wasn't going to be free until quite a bit later. We parked our car and walked around Ti.mes Sq.uare, Br.oadway, and Ro.ckefeller Cen.ter. The weather was pretty awful and within a short amount of time we were ready to head back to the car. We were both soaked and cold. 

From there we decided to do the driving tour of Manhattan. We saw the Empire State Building, the Freedom Tower, 5th Avenue, and Greenwich Village. It was so much better from the warmth of the car. W only triggered one episode of road rage from another driver, so, all in all it was successful and much more enjoyable. 

We met up with my cousin and her husband and had dinner delivered to his Muay Thai boxing gym in Manhattan. They were doing some maintenance since they were closed for the holidays. After a bit we headed back to Queens to their apartment. 

W and I slept on their fold out couch which wasn't the most comfortable, but was most definitely free. We woke on Thursday morning, showered, got some breakfast, and hung out for a bit before we headed to Long Island for our appointment. I had my list of questions and was ready to meet with Dr. B. 

We didn't wait long to see him and there weren't many people in the office. It was such a different feel from my current RE's office where you wonder if there is going to be enough seats for everyone. One woman came out and was talking with the receptionist. Then Dr. B came out and gave her a big hug and chatted with her for a bit. I'm pretty sure she was pregnant, although I tried not to eavesdrop. 

When we headed back to Dr. B's office he greeted us warmly and mentioned something about how much easier this appointment was than the last one. He first asked how many frozen embyros we had left. When I told him five he started to make a plan for that. Then I told him we were more interested in doing a fresh cycle at his clinic than using those frozen embryos right now. 

He thinks our past failures are more linked to the lab than either eggs or sperm. I can't deny the success rates are really low at my current clinic for fresh cycles. Their frozen success rates are abysmal. That's not to say it doesn't work for some people. I know lots of people who got pregnant there. I just don't appear to be an easy case. 

Dr. B thinks we should do a similar protocol to last time with a Lupron trigger, so that means no Lupron to suppress. I've been on birth control pills for around two weeks now so will stop that soon. At that time we will start stims. I haven't received a calendar yet, but I have an idea of what it will look like. We will use Gonal-F and Menopur and I'm also guessing Ganirelix. In addition, we will increase the Neupogen dose a bit. We will wait until the day before the transfer to add in the Neupogen since I guess it has been linked to higher estradiol levels when added sooner. We don't need any help in that department. 

I asked about doing an endometrial biopsy again and he said studies aren't conclusive enough to do it at this point so it's probably not worth it. I asked about repeating the HSG since I've only ever had that done once and he said he sees too many false positives with it and that it's not a great test. The best way to look at everything is with a lap surgery which I have had, twice. I asked about PIO vs. Crinone and he said that at least initially he prefers to use PIO. I asked whether our chemical pregnancies were likely the result of chromosomal abnormalities or the HLA matching. He said it could be a combination of both and that it's hard to know. 

I asked at what point implantation is reduced with high estradiol levels and he said around 4000. He agreed to aim for a fresh transfer and said that, "maybe there's something there" since I've only ever had implantation with fresh cycles. 

He was super positive and said we will have a baby. Even if it's not a guarantee, it was really nice to hear. He even said that if we aren't successful this cycle (frozen embryos included) that he will give us another cycle for free. He's not going to leave us hanging. 

He said his lab is able to mature eggs and that if it means triggering me a day sooner to keep my estradiol a little lower, it's not a big deal. At that point we would likely have some mature eggs so it would just mean some would have to undergo in-vitro maturation.

 Once our conversation appeared to be at a near end I asked if I was going to get an ultrasound. He said yes and called his tech down. 

We went into the ultrasound room and started. The tech didn't say much but I knew a doppler blood flow portion would be performed. The ultrasound took a really long time as she was super thorough. I had no idea what she was looking for with the doppler so I lost interest quickly. When she finished she told me not to get dressed and to wait for Dr. B to come in the room.

When he came back he told me a number of things, all new to me. He told me I had a fibroid that was about an inch. It was making my uterine cavity appear curved. I asked whether this was something that grew slowly and he said it had likely been there for a while. This pissed me off a bit that I had never been told about it at all. I'm wondering if my current clinic ever even saw it. He said he wanted to perform a hysteroscopy to take a look at it to be sure it wasn't in my uterus. If it was we were looking at surgery to remove it. He joked that he could do it that day but that the machine wasn't sterilized so he could give me a half off deal on it. I asked whether it could be done the following day and he said fine. 

He then told me I had reduced blood flow to both sides of my uterus. He recommended I use Viagra vaginally to help with blood flow as well as Vitamin E daily. In addition, he said they would double my dosage of Lovenox next cycle to twice a day. Hopefully this will all help with the blood flow issue. I'm really glad I went and had this done because it obviously gave us new information and changed our treatment a bit. When the tech was performing the doppler portion I asked her why more clinics don't do it. She said it's because they likely don't understand the importance. 

We returned the next morning for the hysteroscopy. We waited a bit in the procedure room this time but when Dr. B came in he joked about reading the cliff notes for how to perform the procedure. When I asked the previous day whether I would be conscious for the procedure he said I would but he would not. The hysteropscopy itself was short and showed the fibroid wasn't going to interfere in any way so that was really great news. From there he turned to W and said he was sorry he didn't find his watch in there. 

I talked with his nurse for a bit and we talked about meds for this upcoming cycle, my calendar, and supplements Dr. B recommended. These were: Omega 3 Fish oil 2x's/day, Vitamin C 1000-2000 mg/day, Vitamin D 4000 units/day, Pycnogenol 100 mg/day, Vitamin E 500 mg/day, and Vitamin B complex. In addition, she gave me a sample of something called Preg.nitude which contains Folic acid and Myo-inositol and instructed me to take in twice a day. They also wrote me a script for Mentanx which is to help with the MTHFR. The nurse also said Dr. B is going to want to see me around day eight of my stims to perform the ultrasound and take a look for himself. This is going to make things a lot more complicated and I don't think W will join me for that appointment. We will see at what time it falls and see who I can rope into coming with me. 

All in all, I'm really glad we went. Talking with someone face-to-face is so much better than over the phone. We regained some confidence and feel positive moving forward with Dr. B. We also received some new information that changes things a bit. I'm not holding my breath that IVF #5 (holy crap) is going to be the one, but it's nice to have some hope again that it may work out in the end.