There’s something kind of nice about returning to the RE after a hiatus. There’s no paperwork to fill out, the nurses already know your name, and the stress level is much, much lower. After all, I have literally NOTHING to lose with this. Dr. Local and I sat and talked for about 1/2 an hour — 100% pants-on visit. I always do like those. The rundown is pretty simple, and since I’m about to crash, y’all get bullets:
- I’m pretty much too late for the April cycle, but that’s okay since I wanted to wait until after the semester anyway. So that leaves me with July or October for this year, then on January next year. I just need to let them know ~6 weeks ahead of time to get on birth control pills.
- Manly needs to stop smoking 90 days before cycle. His BMI is within Dr. Local’s limits, but he (Dr. L.) wouldn’t mind seeing him lose 10-15 lbs.
- My BMI is higher than what he wants to see — he likes to get as close to 24-25 as possible, but definitely under 30 (I’m currently at 32). When I pointed out that I have never been able to get my BMI that low he simply replied that it must just be too low for my body’s natural setpoint (gotta love that!) So we agreed that a target range of 140-150 would probably be both do-able for me, and close enough for him. He did point out that it wasn’t so much actual weight that was a predictor of issues, but of waist circumference due to intra-abdominal fat storage. He would like to see my waist be a maximum of 35″, which I am actually very close to. If I can lose the cough*2030lbs*cough to get my BMI down, I’ll get the waist circumference for free.
- He strongly suggests running to get in shape before attempting IVF, and not just for weight loss. It improves vascular/circulatory health, is a weight-bearing exercise that builds bone density, and builds lean muscle that acts as an “insulin sink” to help metabolic regulation. I think his words were pretty close to, “We don’t know exactly why running does all the things it does [as opposed to other exercise], but it seems to help.”
- No problem getting me back on metformin — it apparently reaches maximum effect after being in your system for 12 weeks, so he went ahead and gave me a prescription.
- At some point before we start an IVF cycle, he would like to get an updated thyroid panel and fasting glucose. No need for any of the STD tests that were done last time since I passed and have been in a monogomous relationship. Manly doesn’t need to be re-sampled.
- In his recent IVF cycles, he has done split-ICSI with a few women who had similar history to mine (ie, unexplained). He said that the results had been (assume you start with 16 eggs – 1/2 get ICSI, 1/2 get standard fertilization) that 1/8 in the standard fertilization had actually fertilized and progressed, but 7/8 of the ICSI had done so. So with me he would recommend at least split-ICSI, if not completely ICSI.
- The fact that I am ovulatory and have regular cycles, combined with my previous response in oral med cycles, makes him think that egg reserve/quality is not my issue. He’s leaning more towards possible zona issues or zona/sperm incompatibility. But, as always, no one can know until we at least try this.
- He does not do a standard 3-day or 5-day transfer, but takes a day-by-day grading approach. If things look good on day 3, they’ll try to progress them further. If I have embryos left after the transfer, they let them continue to progress as far as possible before freezing.
- I asked about my potential for OHSS due to my response to clomid, and he responded that we would definitely be watching for that and using as low doses of stims as possible. If I do develop OHSS, they will do the best they can to still do a transfer, but if my health deteriorates to the point where that can’t happen, they will do a complete freeze and transfer later after I am better.
- He doesn’t recommend bedrest after transfer — he said that no studies that he had seen had shown any improvement in pregnancy rates due to it. He actually quoted one Australian study that had seen couples who had intercourse after transfer and actually seen a slightly higher pregnancy rate.
- Because of my age and ovarian response, he would normally quote a 50-60% probability of pregnancy during the course of one fresh transfer (including any FET’s that might result). But because of the duration of my proven infertility (hello, 4 years in June!), he would lower that to 40-50%.
- Their FET pregnancy rates are 80-90% of their fresh transfer rates, so — doing the math here — 32-45% probability for me.
- Because I asked and thought the response was interesting, appx. 2/3 of his patients express an interest in embryo donation of any excess embryos after they have finished building their family, but only about 1/3 of that 2/3 actually pursue it. His clinic also does “respectful” disposal, thawing the embryos and letting them divide until they stop and they also keep a long-term freezing facility for clients. And again because I asked, at nitrogen-freeze temperatures, embryos will experience approximately a 1% degradation of DNA over the course of 10000 years — “time stops for them”.
So plenty to think about. But no rush to make any decisions, especially as I now have to go convince someone to stop smoking. By the way, did I ever mention here that I quit at the beginning of the year? I have not had a cigarette in about 30 days. Go me, woot!