While I have been reading and keeping up with everyone’s blogs, I have been un-interested in writing about myself. There was nothing interesting to report. That has changed in that we have some progress after all of my second opinions. The writings below explore the opinions of the four doctors I have consulted with. Three of them are IVF doctors, and one is my RE. My RE is Dr. N, and the IVF doctors are Dr. H (#1), Dr. Z (#2), and Dr. ML (#3). I’m sure this post will get confusing, sorry!
All four reproductive doctors concur that my uterus is not a likely cause of my miscarriages, although one of the four does think it could be a factor. I’m going to consider that good news, although I’m not fully convinced that it’s not part of the problem
My RE, Dr. N, is very pro-IVF for us due to my UU, as he felt doing a single embryo transfer was very important and I should not risk the chance of having twins naturally.
Our first IVF doctor, Dr. H (through Kai.ser), feels very strongly that doing IVF will be beneficial to us in that we can genetically test the embryos. His thought is that we would probably only get one genetically normal embryo based on my AFC and FSH (although we do run the risk of getting no normal embryos). His suggestion is the microdose Lupron flair protocol. I really liked his bedside manner, but I have huge problems with going on birth control for 2 months prior to cycling. I am very concerned about over-suppressing myself due to my borderline DOR. Kai.ser is an IVF machine that batches their patients and has great SART ratings, but I don’t think this approach is for me.
Dr. Z runs a private fertility clinic that only does IVF. He is a one man show. His big thing is that he also does immunology (something I am interested in because of my recurrent miscarriages). They are the most expensive option out of the three clinics, but I did have him run tests for my natural killer cells and my TH1:TH2 ratio (cytokines). After $800 for 4 vials of blood, my cytokine ratio was elevated but my NK cells were normal as far as I can tell. I do not understand what that means, even after consulting Google and reading some medical literature (I am able to wade pretty well through medical journals because my first undergraduate major was Chemistry…what was I thinking there, but that’s another story). If anyone has any insight into cytokines and recurrent miscarriage, please enlighten me. I am comfortable with his recommendations based on my results to have an intralipid infusion before my FET, and then do two more intralipid infusions upon confirmation of a positive pregnancy test. So what is my reservation with his clinic? I feel like they are just out there to make as much money as possible. The do a ton of unnecessary genetic testing that really adds to the cost (the overkill on the genetic testing is just my opinion). I realize that IVF is a business but I really didn’t like the feeling I got working with his clinic. I did like his protocol recommendation of a natural start IVF cycle (no BCP). I could see myself going back there someday if our plan doesn’t work out.
My final consult was with Dr. ML, who works in a large research hospital in SF (if you’re in the area, I’m sure you can figure out where this was, haha). I immediately loved her bedside manner and how well she knew my case. She does not quite agree with Kaiser’s diagnosis of DOR just yet, especially since I am still getting pregnant. Her suggestion was actually to keep trying naturally and if I miscarry again, have the embryo genetically tested so we can get an idea of why I’m miscarrying. However, she said if my husband and I wish to go forward with IVF, she would do an estrogen priming protocol, where I wear estrogen patches during my TWW prior to the IVF stims starting. And no BCP!
So what the heck are we doing with all this information? We’ve decided to keep trying naturally for the next couple of months and hope that we can just get pregnant on our own and it’ll work out for us. Lucky for me I have a lovely cyst on the left ovary (the side that is NOT connected to my uterus), so we are at least getting in good tries from the right side for the next couple of months. If we do get pregnant and I miscarry, we will try to get the embryo genetically tested.
We plan to start our IVF path with Dr. ML with my March cycle, with plans to actually do stims and retrieval with my April cycle. If we get a normal embryo, we will transfer it and see what happens. If there are no normal embryos, we will consider trying another cycle or possibly consider donor eggs. If I miscarry a normal embryo, then we will probably move onto surrogacy, or we may consider looking into doing some immune treatments with the Alan Beer Center, as we live close by.
I am not sure I want to keep miscarrying with no end in sight. Nor am I sure I want to do experimental treatments with no guarantees they will work (although if I’m saying that, IVF is a total experiment for us with no guarantees to give us a genetically normal embryo, so maybe I will be willing to try them). I’m not done yet, but I just don’t want to live my life from one miscarriage to the next, not knowing if it’ll ever work.