It's been quite a week on the work front, hence no posts. Although I am very proud of myself for having caught up with most of you on the 'still trying' list on various slow connections from cars and trains. I seem to have missed out on a couple of blog storms while I was away, plus several people deciding to go password protected for various reasons, and my dear internet friend Kay has quit blogging completely, which is a huge loss to our community. I have to confess, it's made me a bit frightened that at some point someone will dooce me, or I'll get spotted by the trainwreck guys (they already took one of my comments on Mare's site and trashed it, but that's not quite as invasive), or something similar. I'll have to think more about this.
Today was day 5 of our cycle, and, as is my wont, I attended the clinic for a wanding and blood tests. I find it amusing that on each cycle since the first I've had to insist on being monitored on day 5. They don't usually do it. Despite this my treatment has changed on day 5 on both previous cycles. My E2 has come back low, and they've put up my dosage somewhat - from 150 to 200 on cycle 1, and from 250 to 300 on cycle 2. Surprise surprise, today my E2 is low. Really quite low - 205 to be precise, that's 55.85 in American. I do have nine follicles appearing - for a change five on the left and four on the right (usually my left ovary is a little slacker) - all under 8mm. I produced a little spreadsheet to make sense of this. I tried to post it but it looks stupid in the column format, so you'll just have to trust me on the data.
Since today was also the day of our appointment with Dr Candour to talk about the miscarriage, Dr Casual when he called with the test results asked me to check what Dr Candour wanted to do - i.e., did he want to put up the dose or not. So we discussed it with Dr Candour. He says that above 300mIU of recombinant FSH (i.e. not the stuff purified from urine but the stuff produced in culture), there is very little improvement in response. The clinic docs had suggested putting me up to 400mIU. Dr Candour said that if I wanted to increase the dose, he'd be fine with it, but that he thinks it would have no effect so it would be mostly just to keep me happy (he said this with a smile!). When I challenged him on that, he said that he was trying to think from our side of the desk. That if he was sitting where we were, he would want his wife scanned every day, and he'd want the most responsive treatment, despite the fact that a study from Bristol has shown that it makes no difference in success rates when women are scanned just once during a cycle compared to scanning every other day (for scanning read scan plus bloods).
So he suggested a compromise. That we come in for a scan on Sunday, and see how things are going. If the follicles haven't grown (they don't get blood work at weekends) they will up the dose then. I confessed that I was tempted to self-medicate and up the dose to 350 as a compromise, anyway, and he told me straight that in his clinical experience there would be no impact of me doing so. We'll see what my instincts tell me tomorrow morning.
We had a great conversation for the rest of the consultation.
- We talked about the miscarriage and it didn't really change anything but confirmed that we should not be pessimistic. The chance of another miscarriage is less than 1%. Yes, we all know we can be on the wrong side of the statistics, but this is an ok number to go on.
- He does not think we are under-treating the MTHFR - in fact he thinks we are over-treating it, although he's not suggesting changing it.
- We talked about transferring three embryos. He said that he just could not override the HFEA's rules on this, despite the fact that in his clinical judgement it would be a good idea, and that I will be 39.75 by the time we do transfer (for those not in the know, the HFEA say that you cannot replace more than 2 embryos in a woman under 40, and that you can't put back more than three in a woman over 40).
- We talked about exercise and IVF. He said studies show it's a good idea to do some exercise, but that you must not let your core temperature become elevated, nor should you become dehydrated, so to exercise at a more moderate pace than you might usually.
- We talked about UK statistics and why one clinic always looks much better than the others. The answer is they have another clinic next door, and when cycles go badly they do the transfer at the next door clinic, and so they don't have to report those numbers. Apparently the HFEA say they can do nothing about it - it's completely legal.
- We talked about the fact he's taking the week off next week, and he had the grace to comment that he seemed to often be away when we had critical things happening. I told him that those of you who read my blog think he takes a lot of holidays. That you like him, but think he's quite lucky with his time off. He didn't really know what to make of that! He did say that we could email him at any point next week and he would get back to us.
- We talked about PGD and he said it's not indicated for us. That he can see a future (say 3-8 years out) where they will screen embryonic DNA against the total human genome on a chip to look for abnormalities, and where they will biopsy the uterus during the cycle to see if it is receptive. But that we aren't there yet, and he doesn't know whether any of us now in treatment will get to benefit from those kinds of advances. This is for all of you in your 20s now - perhaps some of this can come true for you if treatment isn't working for you right now - or maybe by the time it is available you will have moved on to other paths.
I do really appreciate having a doctor like him, who is prepared to discuss the issues with us, to take our concerns and our questions seriously. We are lucky.
So onwards to Sunday. Let's hope my body is just taking a while to get going.