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So I never officially updated my blog as to what my current status is. AF did in fact arrive, unwelcome and unannounced, on Thursday afternoon. This made my cycle a whopping 23 days! I got in to see my doc the next day, and took with me a big list of questions.
Here is the summary:
My blood was drawn for two tests: a vitamin D deficiency test, as well as something called TPO, which from what I understand is some kind of antibodies in your thyroid. I will find out the results of those tomorrow.
We are also going to stick with the Bravelle and practically the same protocol. Instead of starting off at 150iu, however, we will just start at the minimal 75iu. I had so many measurable follies early on last cycle, and he wants to get that number down a bit.
I am also going to start with progesterone suppositories after ovulation for luteal phase support. I've never had an issue with my LP before, but this last cycle it was only 11 days (typically it has been around 15 or 16).
So, I am on my 4th day of Bravelle injections, and go in tomorrow morning for an u/s.
My RE, who as we all know has been less than satisfying, actually spent an hour with me going over all of my questions. I was impressed and very appreciative. Here is what we discussed:
1) My LP from this cycle. He inisists it was in normal range, even if it was shorter than my previous ones. For this upcoming cycle, I am going to use progesterone suppositories for LP support.
2) Regarding more extensive testing: I mentioned several tests, and asked if any were applicable. I mentioned: AMH, Prolactin & TSH, Karyotyping (genetics), clotting disorder, vitamin deficiencies, antisperm antibodies, post-coital (for checking for hostile CM). Out of these, the ones he thought would be worthwhile were the Vitamin D deficiency and TPO, which is testing for antibodies in my thyroid, or something like that.
- Clotting disorder and karyotyping he ruled out b/c they are mostly used for checking on multiple m/c's
- AMH he ruled out b/c my FSH was good, and AMH is generally checked along with Antral Follicle count to see how many eggs could be retrieved for IVF. It's not really a test that would show us anything about my situation.
- Regarding antisperm antibodies & hostile CM... he said that the post-coital isn't necessary b/c we are bypassing the CM anyway with the IUI. Also, the general consensus on post-coitals is split. More recently it is not believed to be an accurate test. As far as the antisperm antibodies, if my DH had them there would be some evidence of such in either his S/A or when he gives his sample for IUI. There is no evidence of such as of now.
- Vitamin deficiencies and TSH (thyroid) - These were the only ones he thought worthwhile, although not TSH exactly. My TSH levels were great on my last CD3 b/w appt (1.1 to be exact), but he wants to check for these antibodies. I can't remember what he said about the study that looked into them.
3) Regarding a laparoscopy and Endo/PCOS.... There have been several studies in a few countries basically saying that the success rate of being pregnant after a lap for mild to moderate Endo is the same as if you didn't have the lap and just kept trying. He is hesitant to do such an invasive surgery for no real justification, other than completing the check list of potential problems. No Endo has been seen on any u/s, and my tubes are clear and there is not endo blocking them. I agree with him here. As far as PCOS, I do not exhibit any of the symptoms, although with as many follicles as I produced on the Bravelle last time in the early cycle days, he said that could be considered like pre-PCOS. But with not having any other symptoms, there is nothing else to back that theory up.
4) Double IUI and extra hcg booster post-ovulation - The double IUI, based on research and cost efficiency, isn't really worthwhile, in his opinion. As long as the first IUI is done prior to the rupture of the follicle, there is no reason that 2 should be needed. I asked about the hcg booster, and he said that in the past, it led to people over-stimulating. So now, they do progesterone suppositories instead to avoid that.
5) Strict/critical morphology - This was tested back in Aug 2009, and was normal. He mentioned my DH having variable motility, and he cited 63% motility on the last sample for the IUI (prior to being washed). Because it is being washed, though, it's not an issue.
6) He found this study from the Netherlands in which he entered mine and DH's basic info, and it gave me a 26.7% of conceiving on my own in the next year with no treatment. I guess they tested the people in the Netherlands who had to wait a year before their government-funded IVF. They found some of them became pregnant on their own. Here is the website, with a predictor: http://www.freya.nl/probability.php. Please keep in mind that this is used for women with unexplained infertility.
The last song I heard before getting out of my car is stuck in my head! Vampire Weekend's "California English". Enjoy!