Appointment with Dr Candour today to review the cycle. He confirmed that:
- They were happy-ish with the stim. Eight eggs is what they are aiming for. Six eggs is pretty good.
- Oestrogen levels were good and rose nice and steadily
- Lining was good (10.5mm which I thought was a bit on the low side, but there you go)
- We had beautiful eggs - six/six fertilised is not usual
- The embryos we put back were perfect, they couldn't have been better - particularly the fact that one of them was compacting
Because everything looked so good, he said that, at transfer, they were very "gung ho" about our chances of success. He was therefore very surprised that I started bleeding at 8dp3dt. Given that I started bleeding so early he thinks my beta of five on 10dp3dt was a false positive result rather than a chemical pregnancy. Apparently the false positive level goes up to 8, so it's hard to tell either way unless the number is higher than that.
Responding to all of this, the protocol for next time would be:
- Long day 21 again. Although this is slow, it got us some high quality eggs so they don't want to mess with it. His experience of antagon protocols is that they produce fewer and less good quality eggs. I tested the antagon/letrozole protocol with him that Pru is on and he had never heard of anyone in the UK doing it other than for breast cancer survivors. So now he wants to meet Pru's doctor.
- They will start me on 200iU of Puregon next time, instead of starting at 150
- Much against clinical evidence, which says that there is no difference in pregnancy rates between PIO and suppositories, he wants to respond to my early bleeding and use PIO next time. Oh joy.
- He is not in favour of assisted hatching or 5 day blastocyst transfer as neither show any improvement on 3 day transfer rates. Assisted hatching does show a small positive improvement in pregnancy rate for women over 39, which I will be, but he says it's not enough to risk it yet. Blastocyst transfer improves success rates per transfer, but not per cycle started. They have not found it worthwhile to do the "survival of the fittest embryo" on a regular basis for that reason. If I had six good embryos on day 3 next time, they'd be prepared to have the discussion, but he wouldn't recommend it as a starting protocol.
However (you could tell there was a 'but' coming, couldn't you), he first needs to scan me to see how bad these endometriomas are on a non-stimulated cycle after my ovaries have calmed down. Which means a scan in the first half of January, after two unstimulated cycles. Then he'll decide if we should do a lap or if we can go straight to IVF. Broadly we have four options re the endometriomas:
- Do nothing. They'll stay there, and will gradually get bigger. Hence not a very good option long term.
- Aspirate them. They fill up again pretty quickly
- Drain them and laser clean the walls. They are likely to reform, but more slowly and in 10% of cases they are gone for good. This is what he did last May for the one I had then
- Drain them and ablate the cells surrounding them. This removes them for good 90% of the time. It also destroys a significant chunk of the ovary that surrounds them. Hence not a good option when, in his words, "we are trying to preserve fertility."
He will therefore consider either option 1 or option 3 depending on how they look in a couple of months time.
Again we had a very good discussion. Although he kept us waiting for 30 mins, he did then gave us an hour which was double our appointment time. He did stop at one point and ask me if all the research I had done was helping me or making me more stressed (after I asked him a question about the effect of androgenising hormones on endometrial quality and egg quality in the context of an antagon cycle), which I thought was a good question. H thinks that at the margins the research makes me more stressed, but I do feel I need to know stuff, and I have stopped myself on obsessing on some things which only make me feel worse like the success rates for women with endometriosis. I told Dr Candour that and he said: "well, as long as you've got it under control, you should do what helps you the most."
I asked him about the effect of endometriosis on implantation. He says that the evidence is equivocal. Because they still don't understand the basic biology of implantation it's hard to say what this problem is, but his sense is that it there is a link, given the lower success rates for IVF for women with endometriosis even when they have the same quality eggs and embryos as a couple coming in with, say, male factor. I forgot to ask him about beta-integrins and whether it's worth testing for a problem there, possibly linked to implantation.
Other questions I forgot to ask him were:
- Was I not a bit oversuppressed after 17 days on Buserelin before stims began? In fact I did ask it, but we got distracted half way through his answer
- What does he think about immunological issues as contributors to endometriosis? And what does he think about the work on diet and endometriosis in that context?
So where does this leave us? I have today filled in the form to get my records released to send to the Big Guns Clinic (hereafter BGC). We'll do another cycle at my current clinic, then see where we are. However, I'm desparately sad that all this waiting means we are a year away, at best, from a baby. On the current schedule, assuming I don't need a lap, we'd start at the end of January, retrieval would be mid-March. If I do need a lap, all bets are off.
This just seems so far away. I am less and less likely to have a baby before I turn 40. But I just want a baby. I want to be a mother. I'm sad and mad that it's so hard for us. I want to do this for me, I want to do this for H. I want to bring someone into the world, to love them and help them become a real person. I want to find out what they are like and what they want to do with themselves. I want to watch them grow and learn. I want to bake them cake and have them cover the cake with too much icing and ugly sprinkles. I want to treasure glittery paintings. I want to put sticking-plaster on skinned knees and hold them on my lap when they cry. I want to tell them they're beautiful. I want to watch them sing twinkle twinkle. I want to help them with their homework. I want to watch them play football with H or head off on their bicycles to the park together. I want to worry about them when they're out too late at a party. I want to listen for them sneaking up the stairs, thinking we don't know how late it is. I want to take them to the leaning tower of Pisa and explain to them why it's not straight. I want them to explain how a train works to me, and point out all their favourite dinosaurs at the Natural History Museum. I want to take them on the Earthquake at the National Geological Museum and tell them how their Grandpa used to take me there every Sunday. I want to wach them climb the climbing frame in the park and worry about them falling off. I want to help them buy their first flat and chose something lovely from home for them to decorate it with.
It's not so much to ask, is it? But it all seems so far out of my grasp.