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?

Day 14

Retrieval day!!!

SOooo I woke up with my head cold which had gotten worse overnight. I give thanks to little to no rest due to lightning/thunder followed by sirens, followed by wind, followed by cramps and nerves keeping me awake. I literally had nightmares of ovulating all my eggs out and going in for retrieval and there being nothing to retrieve. (spoiler alert... this was not the case). So its no surprise I was a little overtired and feeling pretty crummy when I woke up.

Anyways, we headed in to the clinic bright and early. We had to be there for 830, and our retrieval was scheduled for 930. We sat in the waiting room for a while as woman after woman was taken back. Seeing them come back out assured me they were just here for check-ups. Anyways, we were finally brought back shortly after 9am, and I changed in to my sexy gown and rubber soled socks.

First the embryologist came in to discuss my "fertilization plan" which she said, although good in theory, simply wasn't practical. She explained to me that when they natural fertilization they do not clean the eggs and minerals or whatever around them, so they can't know how many are "mature" at that point. With ICSI the eggs are washed before they are fertilized so they do. So unfortunately we had to throw my entire plan out the window. I was kind of annoyed since I emailed the doc (on holiday) in advance to see if this plan was feasible, and he assured me it was, and even the nurses confirmed it, so I thought it was all good to go. I was just too overwhelmed to make a decision so made her and Homme InFertile make the new plan for me. So we settled on doing a direct split of whatever we got and going 1/2 and 1/2. Simple enough.

Today I had yet another new doc. Again, this has been annoying for me since I was so excited to be at a clinic where each and every time (almost... ) I'd get my actual doctor. Well this ended up being far from the case, but the good news is the doctor doing my retrieval was a huge teddy bear and absolute sweetheart. So in the end, whatever. I just keep reminding myself to have FAITH that it will all work out, and this is exactly how its supposed to be going. It's kept me a bit calmer I think.

The anesthesiologist was different from last time as well. Very sweet. I was out very quickly in the room again. So strange to know its coming. So here's the funny part, and still a grand mystery. I BELIEVE I woke up in the operating room just as we were finishing up, and INSISTED that I lift myself off the table onto the trolly bed. If you watch the video you'll hear me talking about it, but I'm pretty sure I probably went to throw myself off the table and they all rushed to lift me. Ahhhh good times.
And next thing I was waking up in my room with Homme InFertile by my side. He video taped me and I can honestly say I don't remember anything up until "Rock Star" ... I was calling my anesthesiologist a rock star for her timing of when I woke up on the table. I get very weird on sleepy meds. For your viewing pleasure...

In terms of the procedure, found out I had 20 eggs retrieved. I was thrilled of course, as I really wasn't sure what to expect since one day they found 17 follicles, and the next 22... so 20 sounded perfect.

In terms of recovery I was in a lot of pain and requested some extra pain meds. That helped and was able to get some fluids and snap out of my fog brain. When we got home I had lots of cramps and bloating. My appetite fluctuated from non-existent to famished. I made sure to get lots of rest and fluid and was basically a couch potato the entire day. My cold continued on as well which sucked, but I napped and am hoping to feel better soon.

Before bed I stared my progesterone suppositories (read someone who used their unused pre-seed applicators so gave that a try.... I recommend just using your finger personally), as well as my estrace. Really feels like I'm in the 2ww even though I haven't had the transfer. I guess technically ER day is like O day so technically, TECHNICALLY, I am.