Monday, 18 April 2016

Follow Up Questions

These are the questions I asked our doc...

1) We'd love to know your personal gut reaction, thoughts, musings or otherwise. As the professional, we defer mostly to you to tell us in your opinion, why you think we've had 3 failed IVFs as a healthy young couple. What would your plan be moving forward. 

2) Endometriosis... given the fact that we have never gotten pregnant successfully, I am beginning to feel that perhaps it is time to pursue laparoscopy/surgery to discover how extensive the disease is. 
- Do you support this/think this is a good idea?
- Do you think it may aid with implantation?
- Do you think that the endo is a significant factor in our implantation failure?
- What are your opinions on other treatments in terms of FET protocol (lupron, prednisone, bcp prep, or otherwise)?

3) Immune Response
I've sort of felt from the get-go that my body rejects the embryos. I know we did Intralipid, but I'm just curious on your thoughts since they recommend blood thinners in a lot of these cases. I had asked about baby aspirin, but that was not recommended. Most of the immune related treatments would also likely be linked to the above endometriosis topic, but I am curious about the chance of a clotting disorder or what could be done to stop this immune response. 
- I believe I might have celiac (given my severe response to wheat along with confirmed lactose intolerance which often go hand in hand). Do you recommend I have a scope? What would this tell us in terms of treatment (I'm already GF/Dairy Free)?
- Is more testing needed?
- What tests/information is out there for immune related infertility?

4) Assisted Hatching - this is something I sort of had asked about prior to our transfer but was not recommended. 
- How did the zona pellucida on each embryo look before transfer? 
Is this something that may be a factor in our implantation failure? 
- Did any of our embryos begin to hatch before the freezing stage?
If not, could this be indicative of blastocyst arrest (I think that's the term at least)?

5) Male Factor
- How did the sperm sample look on retrieval day?
- Given my clear results (minus MTHFR), could there still be a reason to have Homme InFertile genetically screened (ie. if my eggs are not "strong enough" to compensate for poor dna (or repair it?)?
- Could this be a factor in why we are not getting pregnant?
- How were our PICSI results? Did a large number appear to be normal whilst using PICSI for sperm selection?
- Would you recommend we pursue the DNA fragmentation test at this point to get further insight to any or the extent of the fragmentation? 
- If so, and if Homme Infertile's results are highly fragmented, what would this mean in terms of our likelihood to conceive with his sperm? Would any course of treatment differ?

5) PGS - we had contemplated doing this, however financially were not fully in a position to do so, and in addition, were not certain at our age how necessary it would be. 
- Do you think there is a high likelihood genetic abnormality is the primary reason for our lack of success?
- How were our embryos frozen? 
- If they were vitrified, have you ever done a thaw, test, and re-freeze? What are the outcomes like? 
...I have also heard of thaw, 24 hr test turnaround and day 7 transfer, but not common - thoughts?
- Do you have any recommendations on this factor for us, given the position we are in?

6) Progesterone 
Because I spot during my luteal phase for many days every cycle, progesterone has always been a concern for me... I did NOT spot at all during use of suppositories this cycle which is encouraging.
- Have my progesterone levels been checked and HOW normal were they? (I know there is a normal range, but was I on the low end of normal? etc)
- Many women speak of PIO shots, would this be a stronger course of action for me in the future for FET?
- My progesterone was not monitored throughout my cycle, is this something you would consider moving forward?

7) Lining
I know we briefly touched on this this a.m...
- How was my lining on transfer day? (ie. thickness, evenness etc)
- Receptivity, I know we're both concerned about this, but what would be different in terms of protocol or prepping for transfer? 
- Uterine Scrape (I know this is mostly new, and more common in UK), what are your thoughts?
- Would this mostly be addressed through laparoscopy/hysteroscopy?

8) Further testing
- Thrombophilia ... especially with endo I was surpised you didn't recommend at least aspirin, but is there a chance I have a clotting disorder? Am I crazy to think there is a link?
- male or female karotyping defects (not even really sure what this is)?
- confirm my NK cells or elevated inflammatory cytokines levels? (relates to immune above)
- anti-sperm antibodies in Homme InFertile? I'm probably making tests up ;)
- anything else I'm missing/not thinking of?

9) Surrogacy 
- Given my endometriosis and repeated failure, is surrogacy a strong option for us if lap/surgery come up with no explanation?
- Do eggs/blastocysts conceived by a person with endometriosis have good results with surrogacy pregnancy and live birth rates?
- What are your general opinions/thoughts on this for our case? 
- Obviously this is really expensive, if I had a friend (doubtful but just covering bases) willing to do it for me, what is the testing process like?

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