Warning: Lengthy Post!
Yesterday we had our IVF
consultation and met Dr. Loret de Mola (I’ll refer to him as Dr. LdM for short)
for the first time. My overall first
impression of him is good. He is very
serious and knowledgeable and explained things exceedingly well which
Joe and I both noticed right away and is a quality that is important to
me. He has some things that he wants us
to do initially before we start a cycle and I was happy to hear his concerns
and how he wants to address them.
First off, a hysteroscopy, using
a camera to examine the cervix and the uterus, will be done as soon as my
period comes, probably in the next 8-10 days.
I will also start a LH surge indicator around the same time in
preparation for an endometrial biopsy.
Dr. LdM has concerns about why the embryos have not implanted after 3
cycles. The endometrial biopsy will test
for Beta-3 Integrin, it’s a protein that is necessary for implantation and is
only present in a small window of a cycle, hence why I am doing the LH surge
indicator. The biopsy needs to be done
within a certain timeframe. It will be
sent off to a lab and they will test for the protein. If it’s present, then we’ve ruled out that as
an issue, if it’s not then another protocol will be added to my cycle. He is also going to take some specific
bloodwork at one of these two appointments.
The endo biopsy is something that I asked my previous doctor for and he
said he didn’t feel it was necessary.
Once these two procedures are
done we can move forward with an IVF cycle.
He wants me to do a one-time dose of Lupron Depot which differs from the
Lupron that suppresses ovulation. A
Lupron Depot is what is used to prevent and diminish endometriosis. I had never been given a real diagnosis from
my previous doctor and when I had my lap, he said that he removed some endo,
but never indicated what stage I had.
Dr. LdM believes that I have Stage II-Mild which is more than what I
thought I actually had. I’ve been lucky
that it’s never been debilitating for me, but it something that we need to
address. The Lupron Depot is good for 30
days and will be taken at the beginning of my cycle while I’m taking BCP.
For the actual IVF cycle he
wants to see me on less FSH (the drug that makes the eggs) than my previous
fresh which was 200units x day. He said
that I respond too well which is a problem; he wants to see me on 150 or
100units and then monitor me every couple days to see how I am responding. He said that once you get to 20+ follicles,
their quality reduces significantly. If
you recall, last time I had 34 follicles which is too many. He wants to see between 10-15. I have two options for trigger, either a Lupron
or an Ovidrel trigger which we will determine when we get closer to starting
meds. They will also have me on a steroid,
Medrol along with Doxycycline for an antibiotic. I’ve never had a steroid in my protocol
before, but it is something that I’ve wanted so I’m happy to add that.
For fertilization he said we
do not need ICSI (where they take an individual sperm in a needle and inject it
into an egg) this time. Some believe
that ICSI is “better”, but in reality, it isn’t necessarily better for everyone. If you don’t have MFI (male factor
infertility), then ICSI is not needed.
He said that most often they will ICSI your best follicles leaving the
lower quality follicles to fertilize on their own. For me this could be part of the
problem. I had more embryos fertilize on
their own than I did with ICSI. I’m
happy that we aren’t doing things that we don’t need. He was happy with Joe’s semen analyses that
he’s had. I am definitely the problem,
which is tough, but we have known that for a while. I am thrilled that we are doing some different
things to try to solve this problem and beat this.
We will not be doing PGS/PGD
at this time. He said that it’s very
expensive and wouldn’t be a huge benefit to us.
He did say that they have new technology recently approved by the FDA
about 3 weeks ago called Eeva. Its
non-invasive testing that is done to the embryos to aid in picking the best ones. What it basically does is flashes a beam of
light into special incubators that the embryos are in every 90 seconds and they
can watch the embryos develop much closer and pick the best ones. The only downside is they only have 3
incubators so they can only do this for 3 people at a time. He said we are great candidates for it, but
it will depend on availability at the time of our cycle. Please cross your fingers that we will be
able to use this technology. You even
get a video of your embryos and get to see how they grew over the 3-5 days in
the incubators. I think it’s awesome
that they are so open to using such a new technology and I’m really hoping that
we get to be part of it!
The last thing he asked me is
why, if I already have 4 frozen embryos do I not want to use those first. I told him that I refuse to keep doing the
same thing over and over. My previous
doctor was not open to changing the protocol and did not seem to monitor some
of the vital things that Dr. LdM thinks we should be watching. I told him that I was afraid that they would
just push transferring 2 embryos on me and that is not something I’m open to at
this time. I told him that after 3
failed IVF cycles and no changes to how things were being done that a second
opinion and a fresh outlook were necessary, at least in my mind. He said that was fair and that he understood
my concerns.
Joe and I are both really
happy with Dr. LdM and are excited for what’s to come. I feel a lot better about things and I don’t
feel nearly as anxious to get things started as I have been in the past. I’m not wishing my days away, I’m just taking
things as they come. I think this 4
month break that we’ve been on has been such a blessing and what we really needed. This is what will hopefully work for me and my situation, everyone is
different so I hope that no one takes any offense to anything that I’ve said in
this post. Thank you all so much for
following along and supporting us on this journey!
