Wednesday, December 17, 2008

IVF Consult

Okay so the IVF Consult with Dr. Slayden (Dr. S from here on out) at RBA was today. His office is in Lawrenceville and not at the main office. That is one heck of a ride! 40 minutes north from my job and I live 45 minutes south from my job so the math...that one crazy ride from my house straight to the doctors!

So I left feeling kind of iffy and kind of okay. There were some things he said that I particularly didn't like and some things he said that I liked. So let's start from the beginning.
He started out with small talk about Adr!@n and I and where we were from, what we did for a living, etc.

Then he spends like the next 20 minutes talking about me being a beta-thalessemia carrier and Adr!@n being a sickle-cell carrier, if the two link up it causes Sickle Cell Disease. We knew this already as we went through this with Dr. Perloe my first doctor. He (Dr. Perloe) really wanted us to do PGD so that we wouldn't take the 25% chance that the baby might get Sickle Cell Disease and 75% that the baby wouldn't. After being sent to a genetic counselor to discuss all the horrible things that could happen if we didn't get PGD to test for this, many sleepless nights, prayers and weeks contemplating we decided against doing PGD. Dr. Perloe (who by the way has the worse bed-side manner ever) was clearly pissed with our decision and didn't try to hide that he was pissed. I left this man's office in tears on many occasions! So I let Dr. S continue on with how he felt it was so important and told him that we were thinking about doing PGD anyway to transfer normal embryos back but that Dr. ML had said we could only test for one or the other. We couldn't test for Sickle Cell and test to see if they were normal. Dr. S said that he would speak to the embryologist to see if we could test for that as well as maybe 5 out of the 9 they normally test. Then he goes on to say that they would want at least 10-12 great looking embies before they would want to do PGD which we all know I haven't been getting. He then said I could get pregnant and do some test at 12 weeks to see and if the baby has the disease we could terminate pregnancy, which I immediately shot down as that is NOT an option for me. He then said we could do like 3 IVF's with no transfer to bank embies then do PGD then transfer. That's crazy and by the time that's done I will have done 8 IVF's and that's out the question! So we came to the conclusion if we have enough we will discuss it then and if not, Adr!@n and I are content in our decision we made in the past as it wasn't a decision we made lightly but we took weeks to discuss it, think about it and pray about it. I told him how Dr. P acted when we made our decision and asked him if he would act like that as I can see its something he feels strongly about and he said no. We are two grown people and are both able to make our own decisions he just wanted us to be educated on the decision we were making.

Next topic:

He said that he would want me to go on Depot Lupron for 3 months instead of 2. He said the first month doesn't really count as a month because you're not suppressed your body is just working up to the suppression so it would be more like 2 1/2 months of full Lupron effect.

He said that he sees Dr. ML was looking to do the Flare protocol following the Depot Lupron treatment and that is the wrong choice. He said the Flare protocol wants to capture the LH surge in your body to get the follicles to start growing. But if I've been on Depot Lupron I wont' have ANY LH in my system because the Lupron has shut my body down, which would lead to no response or a horrible response.

He said he would do a protocol similar to what Dr. Perloe did which is the cycle I had my best response on. (HELLOOOOO....Have I not been screaming this to Dr. ML for the past 3 cycles!! Pisses me off!!!!)))) With Dr. P I was on 300 Bravelle which is pure FSH and I was on 75 Menopur which is LH. He said as you can see that's not 50/50 and I would do more 50/50 to hopefully get a better response, because we have to wake your ovaries after being sleep on Depot Lupron. His (Dr. S) protocol for me would be 150 Gonal-F and 150 Menopur twice a day. The last month on Depot Lupron he would put me on a low dose of estrogen (patches) and a low dose of progesterone (I think causing a mock transfer cycle type deal) and then do another endo biopsy so that he has a better feel of how I would respond. He also said that he want to do another SGH a couple of weeks before the biopsy to make sure I don't have any polyops. He will then put me on a low dose of lupron and I would begin stims 28-30 days after my last shot. He said he also noticed that Dr.P had me on a lot of stuff after the transfer like PIO shots, estrogen patches, endometriams (I think that's the name -- the white tablets you stick up in your ya-ya). But anywho he said he would also have me on PIO shots as well as the endometriams to make sure I'm getting enough progesterone.

He said that with no PGD testing he would consider transferring 4 or 5. Which scares the beejezus out of me! I was cool with 3 fresh because I want twins and figured transferring 3 wouldn't be that bad. I was cool when we transferred 4 last time because 2 were frozen and I know that effects the quality of them. But honestly transferring 4 or 5 FRESH....scares me! He said Normal PGD's embryos he would probably transfer 3. He said seeing that I am not okay with terminating a pregnancy he knows I will not be okay with selective reduction so this is something to think about when deciding how many to transfer but given my history he wants to be aggressive.

I asked about the extra folic acid - Folgard, and he said it wouldn't hurt but wouldn't help either. He said I would be on Rhogam or something like that because I have O- blood if I needed it while pregnant and not Folgard.

He said that my bloodtest showed that my Protein S was low and this keeps the blood from clotting. He said that sometimes the tests are not reliable so he will recheck it and if its still low he will put me on Lovanox. I was like funny you mention that because that was one of my questions to ask you. I told him Dr. ML had said she was going to put me on Heparin and he said that stuff is horrible and from the 1950's. (Susan you were correct! xoxo) He said he would test it again if it comes back low he would put me on Lovanox for the first 12 weeks. But also gave me a referral to see Dr. Duncan at Emory Hospital here who is a Hematologist to determine if I need to be on the entire pregnancy and maybe 6 weeks after the pregnancy (Thanks again Susan! xoxo) I have her number and I will call to set up an appointment with her soon.

He said in Nov 07 my FSH was 11.7 which is high and high normally means decreased egg quality. No one ever told me my FSH was high...hum. He said in women under 30 high normally doesn't carry any weight, it normally matters in older women, but since I don't respond like younger women, he would keep an eye on it. Can't get it tested again before cycling because I will be on Lupron.

Oh yeah he wants me to start Lupron TONIGHT! He said if we waited till day 3 of my cycle like Dr. ML was going to do that it surges the ovaries and make follicles and that's the opposite effect that we want. So he said right now in the lutheal phase of my cycle is the best time to start. He told me to take a pregnancy test but even if I did, it would be too early to tell anything, but what are the chances of that happening I'm not worried about that.

He sent me to get bloodwork. Ended up getting 8 tubes done! He is checking:
-Progesterone (guess to make sure its functioning correctly since I already ovulated) -CA-125 which is a level check and they can use it as a marker. With Endometriosis it's normally higher and he will want to check it again after my Depot Lupron treatment to see if it has decreased. He said with some women it does decrease and some women it doesn't....but he still wanted to check.
-Thyroid because of my mother having issues with it -Something about Claumidia. He said even though I have never tested positive for it, he said sometimes he notice women with Endo sometimes have had it and the anti-body for Claumidia could still be in the bloodstream and if so he would want to treat that with a strong Anti-body for 2 weeks.
-Protein S - blood clotting
And some other things that I can't remember.

Okay so the things that I didn't like......

He talked about donor eggs the first time meeting me. I know I got a few cycles under my belt but clearly the protocol I've been on the past few cycles hasn't been the best for me. I say no, I'm not ready for that and he says good, because I didn't want you to go that route. Then why did you bring it up in the first place!

2nd he brings up gestational surrogacy on our first meeting. I cut him off before he can even get it out his mouth good as he is saying I'm not sure if you're aware of this. I tell him I'm fully aware of it as my husband always brings it up and it's an argument every time. He said, oh okay I see. I just wanted to mention it because a lot of women have never thought about it and when I mention it to them they say wow I can do that I've had people offer to carry for me. I was like well yeah I've had people offer to carry for me too, but its not what I want to do. He says again.....good because I didn't want you to. Then why did you mention it then!

These two points didn't come up at the end and they didn't come up at the same time, but I just saved them for the end.

I think that's about it. He (Dr. S) gave us the okay to have Adr!@n give me my Lupron shot, so we will attempt that tonight.

Oh yeah my Endo Biopsy came back normal - can't remember if I shared that already and my Karyotype results came back normal. Still waiting on Adr!@n's Karyotype results.

So that's that. Even with the 3 months of Lupron we're still aiming for a March IVF!


Michele said...

I dont think it's strange that he brought up donor eggs/surrogacy. In our first meeting with Dr. Lee, she asked our feelings on everything, I think to gauge where we were on. We said what we were okay with and what we weren't okay with, and those things have never come up again. Perhaps he thought that another doctor may have suggested donor eggs, and he thinks that your eggs are fine, and wanted to tell you? I dont know. It does sound like an "odd" way to bring it up and then say "good, I didnt want you to do it anyway". But maybe it's just a lack of great bedside?

We've been lucky with docs, but I've heard about some NASTY bedside on some of these guys! You'd think that they realize how damn hard it is to be there in the first place!

anna said...

He mentions these things to have an understanding of what he can or cannot pursue with you. So having this in writing now, will cover both him and you... so that God forbid, much later if he were to discover these were okay with you but never pursued.
It's just information gathering.

Best wishes and tons of blessings to you.

Ms. J said...

Tash . . . WOW! I read this on my Treo as I ate my lunch yesterday in the car. WOW! So much info to sort through for you and Adrian.

May I salute you on your commitment to not selectively reduce?! I think it's so wonderful that you and Adrian prayed on this, and have made the decision to respect life in this manner.

It sounds like the new doctor offered these other routes (donor eggs, surrogacy) as informed alternatives. But like most specialists, HE wants to be the one to cure/fix/solve your medical dilemma, hence his wanting you to be the one to try again.

It sounds like this is a much better fit for you than the _____ (insert expletive of your choice) that you had been seeing. I'd jump ship ASAP if it were me. (But it's NOT me, and I support you regardless!)

As for the long ride . . . sounds like it's time to invest in some books on CD to pop into the car'd CD player for the commute ;o)