"So, how do you feel about entering menopause for three months, Thalia my dear?"

Just back from the consult with Dr Candour. Boy was London traffic shitty today. We were nearly late for the appointment, partly due to the traffic, and partly because I had an eyebrow emergency on the way out. That's what happens when you don't pay attention for a week or so. Instant monobrow, lots of random sprouting under the usually quite elegant line that an expert created for me a couple of years ago. It was heading back towards the virgin territory that came to a screeching halt a week before my 30th birthday when a makeup artist at a MAC counter at King of Prussia said: "You know, your eyebrows could be a great shape if you just plucked them a little." I'd honestly never thought of it before. Off to the beauty salon it was the following day, and I've never looked back. So to speak.

Anyway, I was forced to stop for some emergency plucking, which put us behind by a few minutes. But we shouldn't have worried, Dr Candour was doing his usual thing of spending as much time with each couple as they need him to spend, regardless of the fact that everyone has a 30 minute appointment. So we had plenty of time to wait. And wait. H isn't very good at waiting.

When we eventually got in there, we had a good debate about the pros and cons of the long term agonist shut down of my ovaries (the three month depot-lupron protocol that Lynnette has spoken about) versus going on birth control for three months. He is not a fan of the shorter shut downs, as he feels it won't give my ovaries a chance to recover, and won't sufficiently shut down the endometriosis. It turns out that this week he has conducted the third laparoscopy on a patient that he feels he should have been much more aggressive with, and he's been quite affected by that. This led him to be leaning towards the agonist shut-down as he feels it is the most likely to deliver a blow to the endo. He has tried birth control protocols before with mixed subsequent IVF success rates.

The pros of the agonist long term suppression is that it will definitively shut the endometriosis down, and that is associated with better implantation rates in the IVF cycle immediately following. Dr Candour doesn't believe that it will kick start the beta-integrin presence (as suggested by Dr Lessey) as he doesn't believe in that research, so that doesn't swing him one way or another. The con of the agonist suppression is that it might over suppress me such that we get no eggs when we eventually do a cycle. But he feels that since we got such great eggs and embryos, although too few, last time,  on a pretty low dose of drug, that we could do ok on that by using higher doses and an antagonist protocol. He is sure that the problem last time was implantation since the embryos were so good, so that's the part of the protocol he wants to address. He feels the bcps will shut down the endo, although not as completely, and he wants to do a full-on job.

He is clearly uncomfortable telling us one way or another, since he is someone who believes very strongly in evidence-based medicine, and there really isn't compelling evidence on the right decision here. I am tempted by the agonist suppression, but am very afraid of getting no eggs on a subsequent cycle. We agreed that he would have a conversation with the UK's expert on the drug that they would use for the suppression - someone who believes that all endo should be treated medically rather than surgically since he's had such good results with this drug. This guy has just taken a role at the med school to which my clinic is attached, and Dr Candour says BigAgonist guy owes Dr Candour a favour as Dr Candour has just arranged for him to join the skiing holiday he's organising for next week. 14 gyneacologists in the Alps, what a prospect.

Since my period will probably arrive in the next 10 days, I left with a prescription for the pill just in case Dr Candour can't get an opinion for me from BigAgonist guy before then. I may end up taking a few days of the pill, then going on this agonist drug (Zoladex) only later that week. Dr Candour is clearly very concerned to ensure that my hormones, and hence my endo, get no chance to kick in.

There you have it. Almost certainly I will be entering menopause for three months. Whopee. I think I want to do it because I think it gives us the best chance of successful implantation during an IVF cycle. But whether we'll have any embryos to implant? Hah, we'll just have to wait and see.

Comments

[statia]

Sounds like you have some tough decisions coming up this week. Good luck with whatever you choose.

And man, King of Prussia. You're killing me. I miss that mall so much. I still know my way around after almost two years.

[Ornery]

I can't help laughing at the thought that the direction of your treatment protocol is somewhat dependent on a gynecological ski trip to the Alps!

Best of luck with whatever procedure you end up taking!

[Lori]

None of this easy but I hope BigAgonist guy is able to shed some light on the supression issues. Thank g'd for ski trips. How else could we expect to get quality care??

[amanda]

I hope this does the trick for you, Thalia. I really, really do.

[stephanie]

what a decision to have to make. I do not envy. and I think that it should be IF patients who get the skiing trip to the alps!

[Mellie]

I like Stephanie's idea - maybe we should all converge on the Alps at the same time as the REs.

It sounds to me like Dr. Candour is totally looking out for YOU and making his recommendations on what'll work best for YOU - and that's so encouraging. Even if it takes an extra 3 months, it sounds like the right plan.

[Spanglish]

An eyebrow emergency always requires attention... I'm glad you tended the brow (I always feel so much better when mine are groomed).

I hope your ovaries get the rest that they need, no matter which way you go.

[Demeter]

De-lurking here, I hope this one works for you. You won't enjoy the hot flashes. But don't worry they are short. You are 3 months closer to your dream!

[lindy]

Sounds like you're gettting great advice, but I can only imagine what a tough decision it is. We'll all be here pulling for you, whatever you decide.

[Julianna]

I wish we lived closer, we could have a menopause party. It is sooooo very long of a protocol.

I was crying every time I gave myself my lupron shot, just aim, shoot and cry. Now, I am just saying "ohhhh, to hell with it" and have even resorted to loading the needle and injecting without even the alcohol ritual....I mean really, the needle is sterile, right?

Good luck with everything, my dear.

[Larisa]

I hope you hear soon - I've been reading the info about medically treating the endo before the IVF cycle. I hope it works for you, and that he works out any implantation issues he thinks may be at work.

And picturing 14 gyns skiing...well, really thinking of the conversations they could be having.

[Jennie]

hope you hear sooon, sooner started sooner finished, I'm just v v impressed your doc actually thinks implantation could be an issue instead of fobbing it off on eggs/sperm/day of the week/moon waxing etc reasons.

[Jenn]

It sounds like solid reasoning to me. I really hope this works for you.

I am in no position to give eyebrow advice though :)

[Mary Scarlet]

A plan is always good, particularly if it's a plan that's been confirmed as a good choice by the leading dude in the field. I know three months seems like forever. Sounds like it's worth it. (Interesting that the docs choose to hang out with each other on vacation time)

[Lynnette]

Oh, I'm glad that he is at least exploring other options. I should be taking my first depot shot on Sunday or Monday, so we're not too far apart. I really hope this is the cycle for both of us. I know three months of "menopause" feels like an eternity when the clock is ticking. I waited 18 months for my cousin to be able to cycle with me, last summer. Pregnancy, breastfeeding, three periods, work-ups, waiting for her school to let out, and then I make one embryo! I'm so tired of waiting! Oh, wait, this is your blog...sorry for the rant. GL! And let me know about a grabbing a cuppa during my layover.

[elle]

Yikes, that is quite a lot to consider. I hope you get some answers and I hope whatever protocol you use works for you. And, please, you didn't tweeze til you were 30? Honey, I been tweezing since grammar school. I got electrolysis done abt 10 yrs ago, permanent removal, it's awesome

[millie]

I've got to work to keep my own monobrow at bay so I know the plucking routine all too well.

I'm glad Doc C is all over this. It sounds like he really wants to come up with the very best plan for you and that's great.

Hoping this three month menopause does just the trick.

[Portlairge]

I think I love your doctor. It's taken me a while to catch up and I'm sorry I haven't commented for so long. I know that 3 months is so long to wait but you have been through so much and know so much and if your gut instinct is to go with the three month menopause then listen to your gut. I hope you get an answer soon, before the ski trip.

[md]

While it may have been disappointing to hear, the 3 month wait does sound like the best plan. And, it's great that Doc C is taking an aggressive approach.

Wishing you a speedy recovery.

[Sunny]

Menopause isn't all that bad. There are pros and cons. I really hope it does the trick!

I applaude the eyebrow change. :)

[Jenny]

Hot flashes and headache's - what we won't do to get pregnant.
Even if it is 3 months, the cycle is starting and that's a plus.

[Vanessa]

I know the two choices are much right now, and I'm sorry you are in the midst of a ski-trip dependant debate (although that has to be the only time I've ever heard of a protocol being decided amongst a plate of raclette, I'm sure).

Good luck, and know you're not alone.

[Pamplemousse]

You are like me, in that every wait seems to be accompanied by the huge weight of time passing and the deafening noise of the clock ticking.

Dr Candour seems like a tell-it-like-it-is kind of doctor which is so rare here in the UK. I would trust him but only you can decide.

Is it very bad that I have never plucked my eyebrows in my life? Too much hair elsewhere to contend with, to bother with my not-unruly eyebrows hahaha!

[Prop Your Hips Up]

I hope the BigAgonist is able to provide some insight on the suppression piece. Now I need to go check my 'brows - looking like Bert from Sesame Street right now I think.

[Vivien]

Had my eyebrows done at the weekend, and it is a GOOD thing. I think Dr Candour sounds great, and has the best advice you could hope for. I apologise if I appear to have been objecting to his views on the NK cell thing - it is just my way of keeping my head above water too. I wonder where it will all end? I hope he is right about you, and wrong about NK cells, anyway.
Very best of luck. xx

[Sparkle]

Just had my 'brows waxed, plucked and dyed yesterday. Feeling less shabby now.
Your dr. sounds fantastic - especially to contact the expert. At least he's not sticking the the same old protocol time and time again.
Sounds like a long road ahead, but the best one.

[zhl]

I've always found that the car rearview mirror shows every hair.

I hope the menopause inducement does the trick. And I thought it was bad enough that we take BCPs to get pregnant.

Good luck. Wouldn't it be fun to crash the skiing trip?

[Lisa]

It's been over 3 months for me and that lupron is STILL in my system!

[Beagle]

The more I read about infertility the less informed I feel.

I wish you luck with whatever protocol you ultimatley decide to do.

Sometimes we have to take a leap of faith and hope these docs know what they're doing. (Skiing in the Alps on our dollar perhaps??) Seriously, it sounds like your Dr. C. is up on things and the fact that he consults with others in the field is a good sign in my book.

[mm]

So glad that Dr C is really thinking this through, which, unfortunately, seems to be a rare thing with REs. Good luck!!

[Nina]

Your doctor sounds great. Wishing you lots of luck!

[April]

Thinking of you and wishing you luck.

You've got a lot of decisions to work through, and I hope you find the answers you need.

[k #2]

Sounds like a great plan and how nice that your doctor sounds pro-active and not reactive! Good luck!

[Kath]

Dear Thalia, I just went through your last posts again and realized to my horror that I have not commented. I'm so sorry! Don't know whether it was a computer or a human malfunction (my guess is the latter -- I've been out to lunch) but I just wanted to say I'm glad your lap was so successful. I hope the suppression protocol works like a charm for as long as it's needed and not a second longer. The plan sounds very good indeed, and I like Dr Candour's approach and the fact that he seems to take your questions seriously. Can I have him?

And 14 gynos skiing in the Alps gives a whole new meaning to the term "downhill", don't you think?

[Kinneret]

Many wishes for good luck with this approach - here's hoping it's the path you've been waiting for. *hugs*

[HoldingPattern]

enjoy the hot flashes my dear. I hope that this does the trick for you. good luck.