Slowly slowly slowly

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.

Comments

[Summer]

Each time you relate an appointment with Dr. Candour, I am amazed at what a great doctor you have. How wonderful that he treats your concerns with such attention. Though, I wish he would bend the rules and let you transfer 3.

Got my fingers crossed for your ultrasound on Sunday.

[waiting line]

he sounds like a very good doc indead.

looking forward to hearing about your upcoming ultrasound, and confirmation that you were right!

[Cricket]

What a find - a doctor who listens, cares, and even remembers your past together. Good luck Sunday.

[PBfish]

Best of luck on Sunday, I hope all goes well.

[Lut C.]

I remember the trainwreck incident, but I'm not sure I understand what happened to Kay. Something similar, I guess. Very sad.

I'm glad you're consult with the dr. went well.
Good luck on Sunday.

[hopefulmother]

Thalia, I hope things look good for you on Sunday. I'm so glad they're agreeing to let you do more scans than "normal."

I wish, too, that I would be able to use the "future advances" like comparing embryos' DNA to that on a chip - that would be so cool. At least then we could say after a BFN - "it wasn't the embryo." Oh well, I guess we have to go with what we got...

Wishing you all the best!

[statia]

Good luck on Sunday.

[Kay/Hanazono]

Oh sweetie, thank you so much for the kind words. I will miss my little corner of the blogosphere. And I had no idea about you (or Mare) and the T-wrex. I'm so so sorry about that.

Re: your meds -- on my last two cycles I was taking 375IU Follist*m which is recombinant FSH and (poor responder that I am) the RE suggested we also add in Men0pur/hMG -- basically he wanted to do an IVF stim for an IUI cycle. He also wanted to add in Cl0mid for the first 3-5 days of stimming. I can't remember if you've already talked with Dr. Candour about either of those things. I didn't go through with either protocol, so this is assvice of the highest order.

Keeping everything crossed for this cycle, and hoping for some good progress by Sunday :) Love to you & H,
xx

[Hoping]

sounds like a great doc and that you are in good hands.

[Tania]

Sorry I've been away for so long. I can't seem to keep on top of anything in my life these days....

Hoping that everything is looking good on Sunday!

[spanglish]

I hope tomorrow is perfect... Good luck.

[Meri-ann]

I really hope that your body is just taking things slowly, and best of luck for Sunday.
As an aside, if you're not happy with Sundays results, I would really urge you to push for having your fsh dosage upped. At my initial clinic I did 3 cycles at 300iu maximum, and only ever got a maximum of 2 or 3 follicles. At my new clinic I was allowed up to 600iu and responded beautifully. When I pressed my RE about the why's and how's of this, he explained that every now and again one person may respond magnificently to a higher dose, whereas in general most people have a similar response at 300iu as they would at 600iu. I ended up at 450iu and responded much better each time, but was told by many doctors that it just wouldn't make a difference.
Will get back in my box now! ;-)

[Carrie P]

It's good to know you're back.

That is *very* interesting about TopRatedClinic. I have long been suspicious about their stats, but I hadn't guessed at that particular reason. Are the next door clinic's stats even published? Are they dire?

Wishing you all the best for the rest of this cycle.

[Kath]

Dear Thalia, I'm so glad you're getting the clinic to monitor you more closely. It really does seem to make a difference. Your doctor is truly exceptional -- and I'm not talking about his vacation allowance. He's treating you as an equal (and well he should), and he's both knowledgeable and flexible. Plus, and this is the clincher, he's a Mensch. I've got severe doctor envy over here.

Rise, E2. Grow, follicles. Respond, ovaries. Waving my magic wand as I say those words.

By the way, thanks for your info on my blog about the E2 levels and the differences in the units used. I really should have posted the units and not just the numbers. (My high school math teacher would have strung me up for that.) They use the American system in Germany (pg/ml), so my E2 is actually high. Just outside the reference range for day 3. But I'm choosing not to worry about that. (You know me -- I'm so fantastic at keeping worries at bay!)

[Womb in waiting]

He does sound great...your dr....it makes such a difference when we have a dr we can openly discuss things with & trust. Well good luck & i wish we could benefit from the advances of the future....its a bummer us late ones will miss out.

[lindy]

I love Dr. Candor. And I'm hoping things get moving along for you by Sunday.

[Louise]

I'm glad you had a relaxing holiday and I wish you all the best this time round.
That is fascinating about the clinic next door. I have often wondered how they did it. Thanks for letting us know.

[Lynnette]

Good doctor. Nice to have one in your corner. Sorry about the 3rd embryo, though. Good luck with the scan tomorrow...

[Vanessa]

Your doctor sounds wonderful, and I think you've got a healthy working relationship with him.

[ellie]

Hmm, maybe i ought to consider trading up- I haven't even spoken to mine this cycle yet. I don't mind right now- I mean if he shows up for the important stuff at the end- I am cool with it. But it is nice that yours is so open about talking.

[Ann]

Good luck Thalia!!!

[Angie]

Best of luck on Sunday!

[Meredith]

It's so great to have you back! Your trip sounded lovely and now you're all rested up and ready to go. I'll be here-- following, hoping, and keeping it all crossed!

[Linda]

I hope this doesn't come out as assvice, but being that I am nearly 42, and you are nearing 40, I would personally opt for the PGD primarly because you are limited to 3 embryos in your country. With PGD you'll be able to isolate those embryos that are more likely to implant/survive. I don't recall how many eggs/embryos you retrieved last time, but since you have nine follicles this time, you theorhetically could have as many as 6 or so embryos.

Here in the states the cost of PGD is about $3500, and the cost of a FET is $2600, and Assited Hatching is $600. So a total FET is about $3200, which is darned close to the cost of PGD at $3500. If you had 6 embryos and didn't do PGD, you'd have two transfers of three, right? But you wouldn't know which were normal or not. Normally 1 in 5 will be normal so it's possible that one of those transfers could potentially not have a single good embryo. If you do PGD, you would do a single transfer obviously but you'd be putting your best foot forward.

Okay. I pray that didn't sound too much like assvice...I'm only conveying the arguement that my own RE provided to me on PGD. We ignored him and now I'm agonizing over my FET of six embryos, and whether there is a good one among them. There probably is, but I just don't know for sure.

Can you override your physician on this if you so wish?

I wish you the best of luck with this cycle!!!

[Lisa P.]

Thalia, I am an idiot, because I didn't recall somehow that you were dealing with MTHFR too. What protocol are you on that the doc feels you're over-treating??

I'm very glad you're back. :)