March 1, 2011

Potentially, Possibly More Confused

I think I am becoming “that” patient. You know, the one that second guesses the doctor and asks all sorts of “annoying” questions.

I had my consult today. It wasn’t with my preferred RE but instead with her partner. He spent about 30 minutes explaining IVF to me. Luckily, because of the many blogs I’ve read, I already had an idea what the process would entail. It sounds like we will be doing the  long protocol and shooting for about 20 eggs. Apparently, this is a plausible number based on my previous response to injectibles and the number of resting follicles I have. We will then probably use ICSI to fertilize the embryos and send them away for pgd. I was told that he estimates a 50% likelihood that this will work for us (not sure how this number was estimated).

I am being scheduled for a hysteroscopy next month. If anyone has any words of advice, again they would be appreciated. I expressed concerns about my lining (it was 14.7 at last IUI). I was told it’s okay because my lining goes way back down at the beginning of my cycle. However, I also indicated that I haven’t got a bfp since last May. Before shelling out money, time, and energy for IVF I want to make sure nothing else is going on. So, the doctor said a hysteroscopy would be a good way to do this.

In the meantime, supposedly they are speaking to two different pgd labs to determine what is the best route for our situation is. Apparently, we will then begin the process of building the pgd probe. Once the probe is complete, I will be called in to start bcp and will stay on this for 10-14 days. I’m still a bit fuzzy on when I will be hearing about the probe and have my consultation with the genetics lab. If I haven’t heard anything by next week I am going to call and bother them again. It will likely take 2-3 months for the probe to be complete. In the meantime, I will be on no drugs. I’ll be completing my annual exam (yippee) and completing the hysteroscopy. As long as both of those are clear as soon as the probe is ready, we will be in business.

So, we’re looking at around May-June. I’m guessing it’s probably going to end up being July. Mr. F and I are planning a trip to Asia in June and I don’t imagine that ivf will fit well into this. I guess we’ll play it by ear and see how long the pgd lab takes. I’m really, really looking forward to the months of from monitoring and drugs. Of course, in the back of mind, I’m hoping that I’ll get that miracle natural bfp so many ladies have been getting. However, even if I don’t, I think it will be good for myself and Mr. F to get a little break.

There also seems to be a bit of confusion between the insurance company and my REs office. No one seems to be able to really tell me how much this is going to cost. I have a $1200 out of pocket maximum. So, this would seem to mean that I would pay no more than $1200. However, my REs office asks for $2k up front and then provided a host of other charges. I asked if I would then get reimbursed and I think they were really confused. Insurance company says yes, I will pay no more than $1200. So, I’m going to pretend this will work out in our favor and hold onto that $1200 like a life preserver. Either way, I know that we are getting a huge bargain. We would never move forward with this if we had to pay $20k. So, that’s it for now. We’ll see where this leads us. 

February 28, 2011

Consult Tomorrow

So, my consultation is tomorrow. Thanks so much for your questions and suggestions. I made a list and I will be speaking to my RE about each of them.  I also wanted to provide some information for those of you asking questions about PGD and my clinic.

PGD has been found to be useful for translocation carriers. It is one of the recommended course of treatments. It has been very successful for some and extremely unsuccessful for others. As a course of treatment for my BT, I’ve been told donor eggs, continue trying naturally (and withstand the miscarriages) or ivf/pgd. I’ve been trying superovulation in the hopes that a good egg would fertilize and implant. However, I’ve had no success.

My insurance will only cover ivf/pgd if I use specific doctors and stay in network. My geographic location and insurance coverage really preclude us from going anywhere else right now. I’ve looked up the SART rates for clinics in network and IVF success rates hover around 40%. At my particular clinic I am the only patient with a BT (honestly wouldn’t doubt if I’m the only one in the area). The clinic I am at has used pgd only 1-2x before. The SART rates seem to reflect even less usage at other clinics in network.
So, that being said, I feel like I’m forging this path all by myself. I’ve went back and forth between using PGD or instead pursuing an aggressive transfer (meaning 5+ embryos). I’ve seen both methods work for BT carriers. One woman implanted 9 untested embryos and ended up with twins. Most other aggressive transfers either failed or ended up with singleton pregnancies.

I have a lot of questions that I don’t think will be answered at my consultation. I know from reading others experiences that a probe will need to be built. My understanding is this can take up to 12 weeks. In the meantime, I’m not sure what my RE will want to do. However, I’m leaning toward drug free (including bcps) for the 2-3 months it takes to build the probe. I’d like to give my body time to be hormone free, continuing losing the weight that’s crept on, and just generally take care of myself. We will continue ttc those 2 months with the assumption it’s probably not going to work but worth a shot.
I’m also interested to see how this will affect cycling. I imagine most people who go in for a consult and ready to start the process. I feel like I’m a long way off still. So, not sure how helpful this consultation is really going to be. I often feel like all I do is sit and wait; for tests, a new cycle, impending miscarriage, etc. Unfortunately I am not a patient person.

Of course, I’ll let you all know how it goes tomorrow. Hopefully I come away with fewer questions instead of more.