Also known as, not fucking pregnant yet. Or, let’s try this next time.
As most of you know, last Friday I had the followup appointment to my failed fresh and frozen transfer. After some drama getting the Dr on the phone (middle of the day phone appointments are a bad idea mmkay?) I have a game plan.
As expected, right now, there is no for sure reason why it didn’t work, it was either bum embryo’s or implantation failure. Egg quality is good. Sperm is good. Lining was textbook. Bloodwork is good. All in all Bill shouldn’t be able to look at me without me getting knocked up. But as we all know, that isn’t happening. So the Dr will be treating it as implantation failure and we will operate on the assumption that my body is an asshole and views our embryo’s as a foreign body.
As per my questions list, here are the answers to those questions:
- Why did I have so many immature eggs? (7 out of 17)
- Dose was started low due to high antral follicle count. Small follicles did not catch up in time.
- Of the immature, how immature were they?
- Not overly immature. Starting at a higher dose will resolve this issue.
- Were any over mature or were those not retrieved?
- The overmature eggs were not retrieved.
- Is my overall egg quality okay for my age?
- Egg quality is great.
- Did we have any sperm issues of any sort?
- Sperm quality is great.
- Out of 10 fertilized eggs, only having 2 to transfer and 2 to freeze, is that an okay amount?
- Fertilization and the amount that made it to transfer and freeze was as expected.
- My ovaries have repeatedly been referred to as PCO, is PCOS still ruled out for me despite other symptoms?
- PCOS still ruled out based on bloodwork comparison.
- Should I try adding Metformin? Specifically 1500mg extended release to try and help egg quality before next retrieval.
- No metformin needed.
- I currently take folgard and baby aspirin, which I have been told is fine for my type of MTHFR. But should I switch to l methyl folate and/or a different prenatal?
- Folgard is okay for the type of MTHFR I have. Prenatal is also fine.
- I have read that starting lovenox with stims can help bloodflow to the ovaries. Should I try starting with stims rather then right before transfer?
- Will start lovenox with stims to help bloodflow to ovaries.
- Should I also possibly be taking lovenox twice daily, given A1298C is linked to shallow implantation?
- Will start with higher dose once daily, going to twice daily with positive beta.
- Should I have excision surgery before I do another cycle? I have a consult appointment with an endo/excision specialist for February.
- Absolutely yes.
- Should I have any immune testing done? Endo is possibly creating an immune response, but maybe something else as well?
- Testing could be done, will be treated as immune failure anyway.
- Is dexamethasone enough, or should I consider prednisone?
- Will be on prednisone.
- What about intralipids?
- Will take intralipids every other week.
- Any other supplements or diet changes you recommend before cycling again?
- Previous supplements are fine.
- What protocol changes will you make for another cycle?
- Will switch to antagonist protocol with a lupron trigger. Possibility of having to do freeze all. Start at 225 Gonal-F and 150 Menopur, lowering the gonal based on response. No lupron to suppress.
- NK cell and/or dq alpha testing?
- Forgot to ask about dq alpha, but will be treated as though I have high NK cell activity.
So to sum it up, this is what will happen over the next couple months:
- Consult with Dr Falcone
- Excision surgery for endometriosis, possible ovarian drilling, and recovery time (4 weeks recovery).
- Low carb, no sugar diet (helps with endo related immune response).
- Start BACK on cycling supplements since it takes 90+ days to affect egg quality.
- Endometrial biopsy.
Hopefully mid to late summer I can cycle again:
- Start with birth control for 2 weeks
- Get period
- Start stims
- 40mg Lovenox once daily
- 225 IU Gonal-F, tapered down to 125IU after 2-3 days
- 150IU Menopur the duration
- Immune treatment:
- Intralipids every other week
- Neupogen wash pre-transfer
- Intrauterine HCG at transfer
From there it is hope for the best and pray for no implantation failure again.